GP consultations for psychological problems; BJGP 2006; 56: 496-503
This was an interesting qualitative study carried out in nine London practices in which a semi-structured interview was administered to 20 patients following consultation for psychological problems. The aim was to ascertain which aspects of such consultations patients found helpful or unhelpful.
Perhaps unsurprisingly, it was the actual relationship with their doctor that helped or hindered most, with interest and empathy within an ongoing relationship rated very highly.
BMI versus waist-to-hip measurement; Heart 2006; 92: 865-6
This editorial discusses the results of the INTERHEART study of 15,000 cases which found that increased waist-to-hip ratio predicted the risk of MI more accurately than BMI alone. Apparently waist-to hip-ratio is a much better predictor of cardiovascular disease (CVD) because BMI does not discriminate between muscle and fat or provide a determinant of fat distribution.
Even at a low BMI, waist-to-hip ratio is important owing to adverse effects of visceral fat. The converse is that large hips may be protective - many of us will hope this to be true.
Another surprising result was the link between smoking and abdominal obesity. Most people assume that smoking keeps you thin but apparently central adiposity increases in smokers. So stopping smoking will help you in the long run.
The authors conclude that managing obesity is still a challenge.
Atopic dermatitis development: Arch Dermatol 2006; 142: 561-6
The objective of this Danish study was to describe the development of atopic dermatitis in children during their first three years and identify the localisation of early skin lesions that predicted the development of atopic dermatitis.
A group of 411 infants were studied with visits scheduled every six months.
The cumulative incidence by three years was 44 per cent. Lesions on the arms and joints gave greatest predictive value and lesions on the scalp, forehead, ear and neck were also important. Interestingly, nappy rash was not.
This sort of evidence should help us to reassure parents.
Impact of adverse publicity on MMR uptake: Arch Dis Child 2006; 91:465-8
This study was particularly interesting following the increase in measles notification so far this year. It looked at the immunisation record of all children born in Scotland from 1987 to 2004.
Vaccine uptake has fallen since the adverse publicity about MMR in 1997.
It was above 95 per cent (the herd immunity level) but fell to only 90.4 per cent in 2001. Interestingly, parents declining MMR were more likely to belong to a higher socio-economic group. Everyone seems to be suspecting a conspiracy theory these days and few remember how devastating measles can be. Our task now is to get parents to understand the real evidence.
Now, how can we give that a points value?
Effect of feedback on investigations: Lancet 2006; 375: 1,990-6
This study looked at attempts to curb the number of investigations ordered by GPs, which have risen by 80 per cent between 2000 and 2004.
Eighty-five practices comprising 370 GPs received either quarterly educational and comparative feedback on their investigation requests, or one of these, or no feedback at all.
Education and comparative feedback were most successful, and worked better on some tests than others. All very laudable, but one cannot help wondering about the relative contribution of primary and secondary care to the lab workload.
- Dr Glenesk is a GP in Aberdeen and a member of our team who reviews the journals
GP consultations on psychological problems are popular with patients.
Waist-to-hip ratio is a better CVD predictor than BMI.
Atopic dermatitis in children is best predicted by lesions on the arms and joints.
MMR uptake has been affected by adverse publicity.
Educational feedback to GPs reduces the number of investigations requested.
RESEARCH OF THE WEEK
4x4 drivers' behaviour
This observational study looked at the level of compliance with the UK ban on the use of handheld mobile phones while driving and the use of seat belts in drivers of 4x4s and normal cars, before and after the introduction of the ban on mobile phone use.
The researchers collected data from three busy sites in London - it is not clear if it was at rush hour or not or within the congestion zone; 2,944 4x4 drivers and 38,182 normal car drivers participated in the study.
The results might not come as a surprise to Londoners, but they were still disturbing to read. The drivers of 4x4 vehicles were four times more likely to use their handheld mobile phone while driving, even after the introduction of the ban, and were also less likely to wear a seat belt.