Journals Watch - Dermatitis and NHS careers

Too busy to read all the journals? Let Dr Lizzie Croton keep you up to date with the latest research.

Cutaneous and respiratory symptoms in cleaners Occup Med (Lond) 2009; 59: 249-54

Occupational dermatitis is common and has a big economic impact. This study compared the prevalence of occupational cutaneous and respiratory symptoms in professional indoor cleaners with other building workers.

Both groups completed questionnaires to enable comparison between rash and respiratory symptoms. Workplace factors such as training, protective equipment and work tasks were also examined.

The prevalence of rash was significantly higher in the cleaners. Rashes in this group were more likely to be on the hands and to be worse at work. Cleaners also washed their hands more often that other workers.

Cleaners with a rash were less likely to have received work-based training regarding their skin and those reporting a rash within the previous 12 months were more likely to suffer work-related asthma symptoms.

Safety of metoclopramide in the first trimester N Engl J Med 2009; 360: 2,528-35
Metoclopramide for hyperemesis gravidarum remains the drug of choice despite insufficient information regarding its safety in pregnancy.

Metoclopramide use during the first trimester was assessed by linking a computerised database of all drugs prescribed to pregnant women between January 1998 and March 2007 with maternal and infant hospital records from the same period.

Fetal adverse outcomes were compared with metoclopramide use while adjusting for maternal age, parity, ethnicity, gestational diabetes, smoking status and presence of peripartum fever.

Among a cohort of 113,612 singleton pregnancies, metoclopramide was used in 3,458 (4.2 per cent) during the first trimester. Exposure to metoclopramide was not associated with an increased risk of major congenital malformations, low birth weight, preterm delivery or perinatal death.

These findings provide some reassurance regarding the safety of metoclopramide in early pregnancy.

Retention of British-trained graduates in the NHS BMJ 2009; 338: b1,977
This cohort study used postal questionnaires, employment data and capture-recapture analysis to ascertain the number of British-trained graduates who eventually practised medicine in the NHS.

Nine cohorts from graduation years 1974-2002 spread across all UK medical schools were used. In addition, graduates were divided into those whose homes were within the UK when they entered medical school and those whose homes were outside the UK.

Of home-based graduates, about 88 per cent were in the NHS two years after qualification falling to 81 per cent at 20 years, with little difference between men and women.

Of overseas doctors graduating in Britain, 76 per cent were in the NHS at two years post qualification falling to 52 per cent at 20 years, indicating that these doctors tended to remain in the UK as junior doctors but then go on to leave the NHS.

Career progression - men and women within the NHS BMJ 2009; 338: b1,735
This study looked at the career progression of men and women within the NHS. Postal questionnaires were sent to graduates of 1977, 1988 and 1993 from all UK medical schools.

Within general practice, 97 per cent of men and 99 per cent of women had always worked full-time and 87 per cent of women were principals.

Median time from qualification to principal status was 5.8 years for men, 5.6 years for women working full-time and 6.8 years for all women.

In hospital practice, of the 1977 and 1988 cohorts 96 per cent of men were consultants compared with 92 per cent of women who had always worked full-time and 67 per cent of women who had not.

Women who had not always worked full-time were over-represented in general practice and under-represented in most hospital specialties, especially surgical specialties.

Women working full-time were under-represented in both specialties.

The results suggest that women not progressing as far or fast as men was more of a reflection of not having always worked full-time rather than their sex.

The impact of pharmaceutical rep visits Fam Pract 2009; 26: 204-9

This observational cohort study looked at 165 general practices visited 832 times by representatives and 54,080 patients treated with asthma medications.

Outcome measures were the dispensing of company-specific medication when compared with the dispensing of all fixed- dose inhaled corticosteroids and long-acting beta-2 agonists.

The first visit had a significant effect on the GPs' drug preference in favour of the marketed drug. This effect increased further with the second visit but no further increase was seen with subsequent visits.

Parental misinterpretation of OTC cough medication Pediatrics 2009; 123: 1,464-71

Recent concerns regarding the safety and efficacy of OTC cold medications have led to a recent public health advisory against their use in children under two years of age.

This US study aimed to examine the caregiver's understanding of the age indication of these preparations and to identify those factors associated with such understanding.

A total of 182 caregivers were recruited, of which 87 per cent were the infants' mothers. Only 17 per cent had greater than ninth grade numeracy skills but 99 per cent of caregivers had adequate literacy skills.

With regard to the product front label, 86 per cent thought that these products were appropriate for use in children under two years. More than 50 per cent of the time parents said they would give these medications to a 13-month-old with a cold.

Common factors influencing parental decisions were the use of 'infant' graphics on the label (teddy bears etc) and dosing directions.

Carers were influenced by the dosing directions only 47 per cent of the time. Caregivers with lower numeracy scores were more likely to provide inappropriate reasons for the use of these preparations.

These results suggest that label graphics and dosage information should be revised to reduce inappropriate use in children under two years old.

  • Dr Croton is a salaried GP in Birmingham and a member of our panel who regularly review the journals

The Quick Study

  • Occupational dermatitis is more common in cleaners than other building workers.
  • Metoclopramide appears to be safe for use in the first trimester of pregnancy.
  • Medical graduates trained in Britain mostly remain within the NHS.
  • Female doctors experience a delay in career progression due to part-time work rather than gender.
  • Drug preference is only influenced by a drug rep within the first two visits.
  • OTC cough medications are frequently misunderstood and administered to children under two years old.

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