Journals Watch - Mobiles, meningitis and cold feet

Too busy to keep up with the journals? Allow Dr Alison Glenesk be your guide to the latest research.

MOBILE PHONES AND BRAIN TUMOURS

BMJ online doi:10.1136/bmj. 38720.687975.55

There has been ongoing debate about mobile phones and brain tumours, and this article is an attempt to lay it to rest. In this British study, 966 adults diagnosed with glioma between 2000 and 2004 were matched with controls selected at random. No correlation was found between any measured variables, such as time since first use, lifetime years of use, numbers of calls and hours of use.

Interestingly, we still have to find an answer to the biggest health risk - driving while using the phone without a hands-free kit.

DETECTING UPPER GI CANCER

Postgrad Med J 2006;82:52-4

Recent NICE guidelines suggest that in patients with uncomplicated dyspepsia open access gastroscopy should be limited to those with 'alarm' symptoms. The authors wanted to see how many cancers would be missed if this policy were to be followed.

A total of 228 patients with upper GI cancers were identified from 11,145 endoscopies done between 1998 and 2002. Of these, 14 had had no alarm symptoms, mainly presenting with dyspepsia or reflux, and of these only five had had curative surgery and were still alive. The point is that these five patients would not have been picked up if we were following NICE guidelines. As a GP, however, I am somewhat comforted by the fact that by far the majority of patients with malignancy will present with 'red flag' symptoms.

ASPIRIN FOR PRIMARY CVD PREVENTION

JAMA 2006; 295: 306-13

This is a meta-analysis of six large trials. The authors wanted to find out whether any benefit of aspirin for primary prevention of cardiovascular disease (CVD) was equal in men and women.

In over 50,000 women with no previous CVD, low-dose aspirin significantly reduced the risks of cardiovascular events (12 per cent) and stroke (17 per cent). In over 40,000 similar men, in whom the event rate was higher there was reduction in cardiovascular events (14 per cent) and a more impressive one (32 per cent) for MI over 6.4 years. There were about 300 bleeds in each group. Perhaps it is safest to stick to secondary prevention?

IQ AND HEALTH IN THE WEST OF SCOTLAND

BMJ online doi:10.1136/bmj.38723.660637.AE

The authors of this study tested the hypothesis that 'IQ is a fundamental cause of socio-economic inequalities'.

This prospective cohort study started in 1987 with assessment of the IQ and socio-economic status of the study population of 1,347. Health outcomes such as overall mortality and respiratory disease were highly correlated with socio-economic status.

After adjustment for IQ, the effect of the socio-economic gradient was lessened, but not abolished, with the risk of adverse health outcomes still being double in the less advantaged group compared with the most advantaged.

EARLY SYMPTOMS OF MENINGITIS

Lancet online doi:10.1016/S0140-6736(06) 67932-4

A retrospective questionnaire was given to parents of 448 children aged 16 or younger with meningococcal disease, of which 103 had died. Only half were admitted on first presentation. Classical symptoms developed late, at 13-24 hours, whereas 72 per cent had early symptoms (leg pains, cold hands and feet, colour change) at eight hours on average.

The suggestion is that recognising these early changes could lead to earlier diagnosis. However, the changes themselves are non-specific, can be interpreted quite widely, and, I notice, are already being seen in the surgery (but not accompanied by meningitis).

A breakthrough, or another panic-inducer for parents? Time will tell.

- Dr Glenesk is a GP in Aberdeen and a member of our team who regularly review the journals.

INFORMING PATIENTS

- Mobile phones do not cause glioma in users.

- Upper GI cancers can be detected by open access endoscopy.

- Aspirin should not be used for primary prevention of CVD.

- Health outcomes correlate with socio-economic status.

- Symptoms of meningitis need to be spotted early for best outcome.

RESEARCH OF THE WEEK

Cannabis and psychosis

BMJ 2006;332:172-5 doi:10.1136/bmj.332.7534.172

This article attempts to bring together current research on cannabis and psychosis.

Apparently all studies show an association, but causality can be difficult to prove.

For instance, do people start to use drugs because they are developing a mental-health problem?

The article presents neuroscientific studies which suggest a causal relationship.

The final conclusion is that, although the vast majority of cannabis-users do not develop problems, cannabis use accounts for some 10 per cent of cases of psychotic illness - surely an alarming figure, especially in the recent climate of tolerance towards cannabis use.

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