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COPD DEMANDS ATTENTION AND ACTION
An international survey of 16 high income countries has identified chronic obstructive pulmonary disease (COPD) as an important health problem, due mainly to its high prevalence and the heavy demand placed by patients on healthcare services. Data from the European Community Respiratory Health Survey on over 18 000 people were analysed and showed that a considerable percentage already suffered from the disease. Respiratory infections in childhood and low socioeconomic class were significantly associated with increased risk, as were environmental tobacco smoke and occupational exposure to vapours, gas, dust, or fumes. (
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REVERSE CAUSATION IN EARLY ANTIBIOTIC PRESCRIPTION
The reported association between childhood antibiotic use and asthma could be attributable to the tendency for prescriptions to be written for the early manifestations of the disease. Researchers performed a retrospective cohort study, examining medical records and rates of self reported asthma and hay fever in almost 750 people. A significant association was found between antibiotic use and asthma, but was largely confined to drugs prescribed for lower respiratory infection, the symptoms of which are very similar to those of asthma and thus, the authors suggest, show protopathic bias, also known as reverse causation. (
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COELIAC DISEASE AND PREGNANCY
Undiagnosed coeliac disease is frequent in pregnant women but is not associated with an unfavourable outcome. Over 5000 women were tested for the presence of coeliac disease and a prevalence rate of 1:80 emerged. The pregnancy outcomes of the affected women were compared with those without the disease and, happily, no excess risk was observed for abortion, premature delivery, small birth weight, or intrauterine growth retardation. These results refute an earlier study by the same authors that found undiagnosed coeliac disease to be a cause of unfavourable outcome in pregnancy. (
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ANTIBIOTICS ASSOCIATED WITH CROHN’S DISEASE
A significant association exists between Crohn’s disease and prior antibiotic use, but it is unknown if that association is causal. The incidence of Crohn’s disease has risen sharply over the past 100 years and its aetiology remains largely unknown. Data on over 500 Crohn’s disease patients and 1460 controls showed that 71% of patients had used antibiotics two to five years before diagnosis, compared with 58% of the controls. Specificity to any subgroup of antibiotics was not found, and similar associations were also found with contraceptive, cardiovascular, and neurological drugs. (
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INTERPRET FAMILY INFORMATION WITH CAUTION
Colorectal cancer is substantially underreported in family histories. Researchers used face to face interviews to record family history from almost 200 colorectal cancer patients and 133 controls, who were then cross checked against cancer registry data to determine the accuracy therein. They found that both the patients and controls were equally likely to underreport colorectal cancer in first and second degree relatives, and that only two of five families who were reported at interview to meet surveillance criteria did so after validation. Furthermore, of the six families that actually merited surveillance, only two were identified by the interview. (
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MANY DEFINITIONS MAKE DIFFICULTIES
There are seven definitions of hip osteoarthritis (OA), and depending on which is used the prevalence of hip OA in older people ranges from 7% to 25%. This lack of consensus can be prohibitive in epidemiological studies, so authors from the Netherlands decided to investigate the quality (validity, reliability, and applicability) of each definition. The definition known as minimal joint space (MJS), and the index according to Lane were found to be the most reliable of the seven, and the authors note that validity has been particularly poorly investigated and suggest that it should be studied further and in more detail. (
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MYASTHENIA GRAVIS IN ESTONIA
Myasthenia gravis in Estonia seems to predominantly strike elderly people, but younger women are more susceptible than younger men. Researchers used a large population based study to examine the prevalence and incidence of the disorder in Estonia, as little such data previously existed for eastern Europe. The average annual incidence between 1970 and 1996 was found to be 3.4 per million (women 4.8, men 1.9) in the younger age group. This sex inequality did not exist in the older age group, which had an incidence of 5.5 per million people. The general incidence of 4.0 per million is similar to that reported in studies from Europe and North America. (
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UNILATERAL VISUAL IMPAIRMENT
Bilateral visual impairment is known to negatively affect health related quality of life (HRQOL), but what about unilateral impairment, particularly when caused by eye diseases such as cataract? After collecting data on over 3000 people, researchers from Australia have shown that it also negatively influences HRQOL, and specifically in three areas: limitations as a result of physical problems, limitations as a result of emotional problems, and social function. Overall, mental domains were more affected than physical domains and, importantly, negative influences were only detected in people with moderate to severe levels of visual impairment. (
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