'Milestone' in childhood pneumonia care
Friday January 4th, 2008
Children with severe pneumonia can usually be cared for appropriately at home rather than being admitted to hospital, experts reported today.
Pneumonia kills more than two million children under the age of five every year. Current guidelines from the World Health Organisation (WHO) recommend hospital treatment with intravenous antibiotics.
But if it is equally effective, treatment at home with oral antibiotic treatment "could reduce referral, admission, and treatment costs", say Dr Donald Thea of Boston University, USA, and colleagues.
The researchers compared home treatment with high-dose oral amoxicillin against inpatient treatment with intravenous ampicillin in a study of 2,037 children in Pakistan.
Treatment failed (i.e. the patient showed clinical deterioration by day six) in 8.6 per cent of those in hospital, compared with 7.5 per cent at home. This difference was not statistically significant. No serious adverse events were reported in either group. Five deaths occurred but these were not thought to be due to the study.
In the Lancet, the researchers state that the two forms of treatment are equivalent for treatment of severe pneumonia in the absence of complications, "suggesting that WHO recommendations for treatment of severe pneumonia need to be revised".
Home treatment of severe pneumonia in children has the potential to improve access to care and inequity, while reducing costs and mortality from pneumonia, they conclude.
Writing in an accompanying commentary, Dr Shams El Arifeen of the International Centre for Diarrhoeal Disease Research in Bangladesh describes this finding as a "milestone". It should change the management of severe pneumonia in children in developing countries, he believes.
Hazir, T. et al. Ambulatory short-course high-dose oral amoxicillin for treatment of severe pneumonia in children: a randomised equivalency trial. The Lancet, Vol. 371, January 5, 2008, pp. 49-56.
Arifeen, S. E. and Baqui, A. H. Treating severe pneumonia in children: we can do better. The Lancet, Vol. 371, January 5, 2008, pp. 7-8.
How to stroll through menopause
Thursday January 3rd, 2008
A regular brisk walk can help women deal with some of the stresses and strains of menopause, researchers said today.
Regular exercise can help reduce stress, anxiety and depression but not the physical symptoms of the problem, according to a study in the journal Medicine and Science in Sports and Exercise.
Researchers persuaded women to undertake systematic moderate exercise - walking for 90 minutes a day five times a week.
They found the most benefit was enjoyed after the end of menopause - when mental distress may continue.
Some 380 women in Philadelphia, Pennsylvania, USA, took part in the research, which continued for eight years.
Researcher Dr Deborah Nelson said: "In the urban setting, these women walked outside on city blocks or in shopping malls. Groups could organise to take walks after dinner. It didn't require going to the gym.
"You don't have to run 20 miles a week to reap the benefits of exercise. If you stick to a moderate-paced walking schedule, it can keep your body mass index down and lower the risk of stress, anxiety and depression."
Finger clue to knee problems
Thursday January 3rd, 2008
Women who have long ring fingers face an increased risk of developing knee problems, according to a British study.
Men tend to have ring fingers longer than the index finger - but in women they are usually of equal length.
The new research, from Nottingham University, suggests women who have a long ring finger face a doubled risk of developing arthritis of the knee compared with other women.
They also had a greater risk of developing the knee problem than men.
The study of more than 3,000 people is reported in the journal Arthritis and Rheumatism. Some 2,000 knee patients were compared with 1,000 others without knee disease.
One possibility is that women with long ring fingers tend to be more athletic than others - and may place their knees under greater strain.
The researchers, led by Dr M Doherty, state: "The underlying mechanism of the risk is unclear - and merits further exploration."
Arthritis & Rheumatism, January 2008; 58:1.
Cyanide antidote found
Wednesday January 2nd, 2008
Scientists have developed a three minute antidote to cyanide - neutralising one potential terrorist weapon, it has been announced.
Current treatments are slow-acting and become ineffective after a while.
The new antidote has been developed at the University of Minnesota, USA, and has so far been tested in laboratory conditions.
It uses the body's natural resistance against cyanide, which is found in small quantities in some fruits and grasses.
Researchers said the treatment could be taken as a pill, rather than an injection. The research has been reported in the Journal of Medicinal Chemistry.
Cyanide works by preventing the body using oxygen - causing rapid suffocation.
Researcher Dr Steven Patterson said: "It's much, much faster than current antidotes.
"The antidote is also effective over a wider time window. Giving emergency responders more time is important because it's not likely that someone will be exposed to cyanide near a paramedic."
Journal of Medicinal Chemistry December 27 2007
Professional chat may reduce risky drinking
Monday December 31st, 2007
A quick chat with drunken patients in A&E may help challenge them to cut alcohol consumption, according to a new study.
A procedure called "brief negotiated interview", or BNI, was used in the US study of more than 7,000 patients.
Some 400 staff were trained in the procedure at 14 university-based emergency departments.
About 25 per cent of patients were found to be heavy drinkers and the use of interviews was compared with simply giving these patients hand-outs and details of alcohol referral centres.
The study found that the BNIs increased the proportion of patients reducing their drinking to low-risk levels from one fifth to one third, researchers report in the Annals of Emergency Medicines.
Researcher Professor Gail D'Onofrio, of Yale University, USA, said: "This study demonstrates that a broad group of emergency practitioners can learn how to perform the intervention and that it is effective across multiple practice sites."
Fellow reseracher Dr Edward Bernstein said: "The BNI, a conversation between emergency care providers and patients that involves listening rather than telling, and guiding rather than directing, is designed to review the patient's current drinking patterns, assess their readiness to change, offer advice about the low-risk guidelines and the next steps to pursue, and negotiate a written prescription for change or a drinking agreement with the patient."
Annals of Emergency Medicine December 2007
Allergic asthma risk from pesticides
Monday December 31st, 2007
Farm workers who did not grow up on a farm face an increased risk of asthma because of chemicals used in modern agriculture, warn experts.
Some commonly used pesticides can trigger allergic asthma in adults if they were not exposed to these chemicals during childhood, say Dr Jane Hoppin and colleagues at the US National Institute of Environmental Health Sciences.
The team studied women who work on farms, as they are "an understudied occupational group". They gathered data on more than 25,000 women.
"More than half the women in our study applied pesticides," they report, "but there is very little known about the risks."
Among these women there was an average increase of 50 per cent in the rate of allergic asthma. But the risk was linked to past exposure.
"Growing up on a farm is such a huge protective effect it's pretty hard to overwhelm it," said Dr Hoppin. "[But] about 40 per cent of women who work on farms don't report spending their childhoods there."
Some commonly used pesticides were strongly linked to allergic asthma prevalence. One of these, malathion, increased risk by 60 per cent. Earlier this year it was banned in the EU. But another, permethrin, is still available. It is used in insect-resistant clothing, anti-malaria bed nets, and as a treatment for head lice.
Dr Hoppin points out: "There is a difference in asthma prevalence between women who did and did not use pesticides but whether it is causal or not remains to be seen."
The team will continue to explore these risks. Their study is published in the American Journal of Respiratory and Critical Care Medicine.
Hoppin, J. A. et al. Pesticides and Atopic and Nonatopic Asthma among Farm Women in the Agricultural Health Study. The American Journal of Respiratory and Critical Care Medicine, Vol. 177, January 1, 2008, pp. 11-18.
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