Journals watch: Green tea, needles and prescribing

No time to read the journals? Let Dr Suzanne Hunter guide you through the latest findings

Green tea is good for you 

JAMA 2006; 296: 1,255–65  

Green tea is a tea where the leaves are steamed or baked immediately on plucking, which lets them retain their green colour and leads to a pale green tea of the sort favoured in the Far East.  

This study, set in Japan, compared green tea consumption with mortality and found a positive correlation with consumption and reduced all-cause mortality and in particular cardiovascular mortality. The effect was greater in women where there was a 0.77 reduction in those drinking more than five cups a day.  

Blue needle is best  

BMJ 2006; 333: 571 

Infant immunisation against infectious diseases is a vital public health measure which relies on herd immunity for effectiveness. With some of the press keen on spreading scare stories, GPs need to do all they can to maximise vaccine uptake.  

Although a blue needle is recommended for childhood immunisations, an orange needle is sometimes used because it is smaller and therefore considered to be less traumatic.  

This study showed that the rate of local reaction to the jab was significantly less with a blue needle compared to an orange one. There was one less reaction for every six to eight injections, with no loss of effectiveness. It seems you have to be cruel to be kind.  

Work stress does raise BP  

Am J Public Health 2006; 96: 1,436–43  

It’s official. The urban myth that work stress raises BP has been demonstrated by this Canadian study.  

The researchers monitored the BP of 8,395 office workers in relation to cumulative exposure to job strain from 1991 to 1993, with a follow-up 7.5 years later. Those who were exposed to long-term work stress had a higher BP than those who were not, the effect being greater in men.  

Although the systolic was only raised by 1.8mmHg and the diastolic by 1.5mmHg, this was similar to the rise they found with people who had a sedentary lifestyle.  

The participants with low levels of social support had the highest increase in BP.  

Obstetric clinical examination versus ultrasound  

BMJ 2006; 333: 578–80  

As students we will have seen a consultant laying hands on a pregnant woman’s abdomen and confidently declaring how the foetus lay. We probably all suspected that he was guessing.  

This suspicion has been confirmed by an Australian study comparing clinical examination against ultrasound across all grades of doctors and also midwives. Across the board there was only a 70 per cent sensitivity in detecting cephalic presentation, with all grades having room for improvement.  

There is an argument for all hospital assessments to include ultrasound to avoid missing a breech, although this may lead to even more degradation of clinical skills.  

Wait-and-see prescriptions  

JAMA 2006; 296: 1,235–41  

The idea behind wait-and-see prescriptions (WASPs) is that you issue a prescription for a condition but tell the patient not to collect it immediately but to wait and see if things improve.  

In this case the condition was childhood otitis media. With the WASP approach, 62 per cent did not collect their antibiotics compared with only 13 per cent of the patients who were told to pick up their antibiotics straight away. The WASP approach could lead to a 56 per cent reduction in antibiotic use in otitis media.  

It was also interesting that nearly one in seven of the group who were told to collect their scrip straight away did not pick it up.  

Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals  

The quick study  

Blue needles give lesser local reaction after jabs.  

Green tea reduces cardiovascular mortality.  

Stress at work raises BP.  

Breech presentations might be missed on clinical examination.  

Wait-and-see approach reduces antibiotic use.  

Research of the week  

Maternal vitamin levels linked to infant asthma 

Am J Respir Crit Care Med 2006;174: 499–507  

In this study, set in Aberdeen, the team compared levels of maternal vitamin E and zinc during pregnancy as determined by food frequency questionnaires and blood tests with the incidence of asthma and wheezing in their offspring at the age of five.  

They found that lower levels of maternal vitamin E and zinc were associated with a higher incidence of wheezing and asthma. This emphasises the need for a balanced diet in pregnancy.  

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