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TWIN SURVIVAL REDUCES CP RISK

Cerebral palsy (CP) is less common among normal birthweight twins if both survive. It is known to be rarer among singleton infants, partly because they are less likely to be premature or low birth weight. The authors decided to study the condition in twins using national data to identify all UK registered twin births (n = 17 188) in 1994 and 1995. Questionnaires were used to obtain information from parents and general practitioners on the same twins where they are part of two previously described national surveys. An observed excess of CP among normal weight like sex twins compared with unlike sex twins was not found to be statistically significant but the authors hypothesise that monochorionicity is the crucial factor in the higher rates of CP among same sex twins. (

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SMOKERS UNDER-REPORT IN TANZANIA

Smoking is on the increase in East Africa, and women there tend to under-report how much they smoke. Researchers from the University of Newcastle upon Tyne studied the smoking prevalence of a population from Tanzania using a self reporting questionnaire, which was validated by measuring exhaled alveolar carbon monoxide (EACO) concentrations. They found that 5% of women and 27% of men were smokers, based on the questionnaire and EACO concentrations. However, 7.3% of men and 27.3% of women in the study showed EACO concentrations higher than expected for the number of cigarettes they admitted to smoking and were reclassified. Such high levels of smoking are predicted to have enormous consequences for the health of the population in future. (

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NEW GUIDELINES IDENTIFY MORE PATIENTS

Myocardial infarction (MI) has traditionally been defined by a combination of symptoms, increased cardiac enzymes, and ECG changes. Recently, however, the advent of the more sensitive and specific cardiac troponins has led to redefining MI. Researchers tried to compare the two definitions of MI in a sample group of 80 patients admitted for suspected ischaemic chest pain and found that more patients were diagnosed with MI using the new criteria compared with the conventional. The authors concluded that adopting the new guidelines will identify twice as many patients with MI than with current clinical practice. (

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NEW DATA RAISE CARE CONCERNS

Brain arteriovenous malformation (AVM) minimum prevalence in the Lothian health board of Scotland was 15 per 100 000 adults in 1998. As AVMs account for about one third of primary intracerebral haemorrhage in young adults this may contribute to long term disability. Patients were sought retrospectively from multiple overlapping sources including family practitioners, physicians, and surgeons. Diagnoses were confirmed using case notes, brain imaging, and pathology reports. Capture-recapture analysis gave a prevalence of 18 per 100 000 adults, men were significantly younger than women on the prevalence date. Of those meeting inclusion criteria 27% had radiological evidence of AVM therapeutic obliteration and 10% had coexisting aneurysms. AVM prevalence has implications on the provision of healthcare services. (

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COMMUNITY NEONATAL SERVICES PROVE BENEFICIAL

Community neonatal services reduce hospital stay in very low birthweight babies (<1500 g). Small, single centred studies have previously suggested that home support services can allow earlier discharge without an increase in readmission rates. Langley et al decided to investigate the impact of recently introduced Community Neonatal Services (CNS) on length of initial stay, readmission rates, family support, and overall cost of treatment in the first year of life in the UK. Hospital notes and parental questionnaires were obtained on singleton infants from 24 paired units with or without CNS. Analysis of the data showed a significant reduction of 12.6% in length of initial stay but no difference in readmission rates, offering cautious support for CNS. (

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SUSTAINED CESSATION STRATEGIES SUGGESTED

Smoking rates and attributable illnesses are higher among low income and minority populations. There is strong support for training primary care providers in smoking cessation interventions and implementing the four “As” (ask, advise, assist, and arrange follow up). Performance rates for “ask” and “advise” rose from 30% to 44% after training sessions delivered cessation guidelines and tobacco counselling skill building. There were no significant increases for “advise”, “assist”, and “arrange”. The study also found that implementation of “ask” and “advise” tobacco interventions is less likely in obstetrics and gynaecology visits. This is worrying because of the importance of identifying pregnant women who smoke to help them to quit. The authors feel that smoking cessation requires sustained efforts, with multiple strategies. (

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DEMAND EXCEEDS SUPPLY FOR REVASCULARISATION

Coronary revascularisation in England is severely underprovided relative to need and the greatest disparity is among the over 75s. Researchers compared current patterns of referral, investigation, and treatment to a model of population need for coronary revascularisation. The model was based on the population prevalence of the clinical presentations of coronary disease, randomised controlled trial evidence of benefit, and the consensus of an expert panel on the appropriateness of revascularisation in the various clinical situations. Estimated need exceeded current provision by 3.3:1 overall and 7.7:1 among the over 75s, showing that current government targets for increasing revascularisation procedures are certainly justified, and may even underestimate the need for change. (

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CAMPYLOBACTER NEEDS BETTER CONTROL

Foodborne disease halved in incidence between 1992 and 2000, but hospital admissions fell by only 3%. The main culprit pathogens for serious disease are campylobacter and the salmonellas. The UK Food Standards Agency (FSA) aims to reduce foodborne illness by 20% by 2006; this descriptive study provides a useful baseline. Most GP consultations, hospital admissions, and hospital bed days are attributable to campylobacter infection, and salmonellas are the leading cause of death, followed by Clostridium perfringens. Achieving the FSA target requires better control and prevention of campylobacter infection. (

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