Proliferation of firearms is growing global health problem

BMJ  2007;335:470-471 (8 September):

News

Proliferation of firearms is growing global health problem

John Zarocostas

The growing number of civilians holding firearms is fuelling gun crime worldwide and is putting healthcare systems, especially in poor countries, under stress, an expert report says. Gun crime kills about 250 000 people a year and injures many more.

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Management of chronic knee pain and acupuncture

BMJ  2007;335:786 (20 October).

Two papers have recently been published on bmj.com on the treatment of osteoarthritis of the knee.

Acupuncture has no additional benefit in people taking a course of exercise.

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Cancer incidence and mortality in relation to body mass index

Research, BMJ, doi:10.1136/bmj.39367.495995.AE (published 6 November 2007)
 

What is already known on this topic

• Increased body mass index is known to increase the risk of adenocarcinoma of the oesophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer in women
• Body mass index has also been associated with the risk of other, rarer, cancers, but the findings are not yet conclusive

What this study adds

• High body mass index in women may increase the risk of multiple myeloma, leukaemia, pancreatic cancer, non-Hodgkin’s lymphoma, and ovarian cancer
• Menopausal status seems to affect the relation between body mass index and risk of breast cancer, endometrial cancer, and colorectal cancer
• Among postmenopausal women in the UK, 5% of all cancers (about 6000 annually) are attributable to women being overweight or obese
• Around half of all cases of endometrial cancer and adenocarcinoma of the oesophagus in postmenopausal UK women are attributable to women being overweight or obese

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Management of sepsis

Clinical Review, BMJ  2007;335:929-932 (3 November).

Summary points

• A favourable outcome depends on early, aggressive, treatment
• Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
• Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
• Subtle signs of organ hypoperfusion should be sought in physically robust patients
• The role of activated protein C and low dose steroids remains to be clarified
  

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DRINKING SENSIBLY

BMJ 21 December 2007

With the festive season in full swing, Ian Gilmore and Nick Sheron urge the implementation of policies to curb excess drinking to reduce the harms of alcohol in the UK (read more), whereas Christopher Cook and colleagues consider a classical Greek text that makes it obvious that drunkenness has a long tradition in Western civilisation (Classically intoxicated), and A&E doctor Robert J Douglas from Australia recommends CHAMPAGNE as the safer choice for celebrations.

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ORGANISED MARATHONS NOT ASSOCIATED WITH INCREASED RISK OF SUDDEN DEATH

BMJ 21 December 2007;

Organised marathons are not associated with an increased risk of sudden death, despite the media attention they attract. In fact, marathons lower the risk of fatal motor vehicle crashes that might otherwise have taken place if the roads had not been closed

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Diet and the risk of cancer

Editorials, BMJ  2007;335:897 (3 November).

The possible influence of diet on the risk of cancer is constantly topical. The subject is important because people can change their diets, and even a moderate effect on risk could prevent several thousand cancers each year in a country the size of the United Kingdom. However, apart from the confirmed adverse effects of alcohol and obesity on the risk for some types of cancer, progress in understanding has been slow and the evidence remains confusing.

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Preventing falls and injuries in older people

Simon Gates and colleagues – BMJ, 18 December 2007

There is little evidence that fall prevention programmes used throughout the NHS are effective in cutting the number of fallers or fall related injuries.

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Diagnosis and management of cervical cancer

BMJ  2007;335:765-768 (13 October), by:

Patrick Petignat, consultant gynaecological oncologist, Michel Roy, professor and gynaecological oncologist.

• Cervical cancer is the second most common cancer in women worldwide.
• Cervical cancer is an important cause of early loss of life as it affects relatively young women. 
• Cervical biopsy is the most important investigation in diagnosing cervical cancer

Surgery or chemoradiotherapy can cure 80-95% of women with early stage disease (stages I and II) and 60% with stage III disease.

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Orlistat over the counter in the US

Rapid response to Professor Gareth William’s editorial on the use of weight loss aid, orlistat, correctly concludes that it is no substitute for a healthy lifestyle;

by: Howard Marsh MRCP MRCGP
Medical Director
GlaxoSmithKline Consumer Healthcare, 1500 Littleton Rd, Parsipanny, New Jersey 07054, USA

GSK launched a non-prescription version of orlistat (brand name alli) in the US in June this year, the first FDA-approved weight loss medicine to be available over-the-counter (OTC).

The weight loss that can be achieved with OTC orlistat requires commitment to adopt a low-fat, reduced calorie diet.

Indeed all our communication, including television advertising, websites, in-store communications as well as materials provided to pharmacists stresses this requirement. These materials specifically state that “alli is not a magic pill” and provide candid information about the consequences of eating too much fat.

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