News potpourri. (*) (Special Feature).

MATERNAL AND PATERNAL AGE AT DELIVERY, BIRTH ORDER, AND RISK OF CHILDHOOD ONSET TYPE 1 DIABETES: POPULATION BASED COHORT STUDY

Source: BMJ 2001; 323:369-371

The risk of type 1 diabetes may be associated with intrauterine factors and early life environment. This cohort study linked the medical birth registry and the national childhood diabetes registry in Norway. All live births between 1974 and 1998 (1.4 million people) were followed for a maximum of 15 years. The incidence of type 1 diabetes was the main outcome measure. There was no association found between maternal age at delivery and type 1 diabetes among firstborn children. However, among fourth-born children, there was a 43.2% increase in the incidence of diabetes for each five-year increase in maternal age (95% confidence interval, 6.4%-92.6%). Each increase in birth order was associated with a 17.9% reduction in the incidence (3.2%-30.4%) when maternal age was 20-24 years. However, the association was less when the maternal age was 30 years or older.

MORTALITY AMONG PATIENTS ADMITTED TO HOSPITALS ON WEEKENDS AS COMPARED WITH WEEKDAYS

Source: N Engl J Med 2001;345:663-668

People with various serious medical conditions are more likely to die in a hospital if they are admitted on a weekend rather than a weekday. Acute care admissions from emergency departments in Ontario, Canada between 1988 and 1997 were analyzed. The study compared in-hospital mortality among patients who were admitted on a weekend with that among patients admitted on a weekday for the following three diseases: rupturec abdominal aortic aneurysm (5,454), acute epiglottitis (1,139), and pulmonary embolism (11,686). The study also included three control diseases: myocardial infarction (160,220) intracerebral hemorrhage (10,987), and acute hip fracture (59,670). One hundred conditions that were considered the most common causes of death were also included (1,820,885). The results showed that weekend admissions were associated with significantly higher inhospital mortality rates than were weekday admissions in patients with ruptured abdominal aortic aneurysms (42% vs 36%, P < .001), acute epiglottitis (1.7% vs 0. 3%, P = .04), and pulmonary embolism (13% vs 11%, P = .009). There were no significant differences found in mortality between weekday and weekend admissions for the three control diseases. The weekend admissions were also associated with significantly higher death rates for 23 of the 100 leading causes of death, but were not associated with significantly lower death rates for any of the conditions.

RATE OF DECLINE IN US AIDS CASES IS SLOWING

Source: BMJ 2001; 323:417

The rate of decline in new cases of AIDS has slowed in the United States. The Centers for Disease Control say the number of new cases and deaths per quarter (approximately 10,000 and 4,000, respectively) has remained about the same since July 1998. Deaths related to AIDS fell only by 8% from 1998 to 1999, compared to a decline of 42% from 1996 to 1997. Of the 774,467 Americans who were diagnosed with AIDS by December 30, 2000, 448,060 (58%) of them have died. The largest number of new AIDS cases are among African Americans and Hispanics. Also, of the 196 children diagnosed with AIDS in the year 2000, 65% of them were African Americans and 17% of them were Hispanic. On the other hand, perinatal AIDS cases have reached a new low and the number of pediatric cases continues to decline.

IRON SUPPLEMENT MAY REDUCE COUGH LINKED WITH ACE INHIBITORS

Source: BMJ 2001; 323:418

Iron supplements may eliminate the common dry cough associated with angiotensin converting enzyme (ACE) inhibitors. Researchers at Samsung Medical Center, Seoul, Korea studied six men and 13 women (median age, 60 years) who developed a persistent cough while taking ACE inhibitors. These participants took a daily morning dose of ferrous sulphate 256 mg or a placebo for four weeks. Coughs were documented during the period, and a blood sample was taken at the end of the four weeks. Coughs were rated on a scale of 0 to 4 for severity. The individuals took the ACE inhibitor for two weeks. They then took 256 mg of ferrous sulphate or a placebo for four weeks. The average daily score in the group taking iron was 3.07 after the two-week period and 1.69 after four weeks of iron supplementation. There was no significant change observed in scores in the placebo group (2.57 before vs 2.35 after treatment). Eight of the 10 individuals in the iron group showed improvement in their scores, and only one out of nine in the p lacebo group had any improvement.

"VIDEO PILL" MAY SUPPLEMENT STANDARD ENDOSCOPY 

Source: BMJ 2001; 323:358

The US Food and Drug Administration granted approval to an Israeli firm for a "camera-in-a-pill". The tiny encapsulated video camera, developed by Given Imaging, is designed to give doctors a close up view of a patient's small intestines. The M2A Swallowable Imaging Capsule uses wireless technology to beam back images of the lower intestine to a receiver the patient wears on a waistband. The pill goes through the digestive tract and is excreted eight to 72 hours after consumption. The pill is not designed to replace standard endoscopic examinations, but it may keep many patients from having to have exploratory surgery since endoscopes often cannot snake all the way through the small intestine.

EXERCISE AND DIET REDUCE RISK OF DIABETES, US STUDY SHOWS

Source: BMJ 2001; 323:359

A low fat diet and a half an hour of daily exercise can more than half the risk of developing type 2 diabetes. Researchers from the National Institutes of Health found that diet and exercise were more effective than metformin in preventing type 2 diabetes in patients vulnerable to the disease. The study was conducted at 27 medical centers and included 3,234 people with impaired glucose tolerance. The individuals were randomly assigned to one of three groups. One of the groups made significant life-style changes, with the goal of reducing weight by 7% through a low fat diet and exercising for 150 minutes a week. Another group was given metformin 850 mg twice daily, and the third group was given a placebo. The individuals who participated in the life-style changes had a 58% reduced risk of developing type 2 diabetes compared to 31% of the individuals who took metformin.

RESEARCHERS SUGGEST RELAXATION OF FOOD GUIDELINES BEFORE COLON CANCER TEST

Source: Lancet 2001; 358:645

Recommendations to avoid foods, such as red meat, fish, and some fruits and vegetables before a fecal occult blood test may be unnecessary. Researchers from the University of North Carolina, Chapel Hill, completed a meta-analysis of five randomized trials. Patients were either advised to avoid red meat, fish, and certain fruits and vegetables, drugs such as aspirin and other non-steroidal anti-inflammatory drugs, and vitamin C, or were given no dietary advice. The results showed that dietary restriction had no effect on the proportion of positive tests or on false-positive rates.

(*.) Originally prepared for presentation on Southern Medical Association's Web site (http://www.sma.org) by Elaine McClellan-Holm.