Vidyya Medical News Servicesm
Vidyya, from the Sanskrit "vaidya," a practitioner who has come to understand the science of life.

Volume 1 Published - 14:00 UTC    08:00 EST    16-May-2000      
Issue 33 Next Update - 14:00 UTC 08:00 EST    17-May-2000      

Vidyya Home  Vidyya

Home Of Our Sponsor, Vidyya.  Vidyya. Home

Vidyya Archives  Vidyya Archives

Search Vidyya  Search Vidyya

Visit Our Library  Ex Libris

Subscribe To Our News Service  Subscriptions

All About Us  About Vidyya




















Back To Vidyya News From BMJ


Comparing Health Inequality In Men And Women: Prospective Study Of Mortality 1986-96

Objectives:

  • To study prospectively the differences in health inequality in men and women from 1986-96 using the Office for National Statistics' longitudinal study and new socioeconomic classification.
  • To assess the relative importance of social class (based on employment characteristics) and social position according to the general social advantage of the household to mortality risk in men and women.

Design: Prospective study.

Setting: England and Wales.

Subjects: Men and women of working age at the time of the 1981 census, with a recorded occupation.

Main outcome measures: Mortality. Results: In men, social class based on employment relations, measured according to the Office for National Statistics' socioeconomic classification, was the most important influence on mortality. In women, social class based on individual employment relations and conditions showed only a weak gradient. Large differences in risk of mortality in women were found, however, when social position was measured according to the general social advantage in the household.

Conclusions: Comparisons of the extent of health inequality in men and women are affected by the measures of social inequality used. For women, even those in paid work, classifications based on characteristics of the employment situation may give a considerable underestimate. The Office for National Statistics' new measure of socioeconomic position is useful for assessing health inequality in men, but in women a more important predictor of mortality is inequality in general social advantage of the household.

bulletNews From BMJ


Size And Quality Of Randomised Controlled Trials In Head Injury: Review Of Published Studies

Cochrane Injuries Group, Child Health Monitoring Unit, Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH.

Objective: To assess whether trials in head injury are large enough to avoid moderate random errors and designed to avoid moderate biases.

Design: All randomised controlled trials on the treatment and rehabilitation of patients with head injury published before December 1998 were surveyed. Trials were identified from electronic databases, by hand searching journals and conference proceedings, and by contacting researchers. Data were extracted on the number of participants, quality of concealment of allocation, use of blinding, loss to follow up, and types of participants, interventions, and outcome measures.

Results: 279 reports were identified, containing information on 208 separate trials. The average number of participants per trial was 82, with no evidence of increasing size over time. The total number of randomised participants in the 203 trials in which size was reported was 16 613. No trials were large enough to detect reliably a 5% absolute reduction in the risk of death or disability, and only 4% were large enough to detect an absolute reduction of 10%. Concealment of allocation was adequate in 22 and inadequate or unclear in 25 of the 47 (23%) in which it was reported. Of 126 trials assessing disability, 111 reported the number of patients followed up, and average loss to follow up was 19%. Of trials measuring disability, 26 (21%) reported that outcome assessors were blinded.

Conclusions: Randomised trials in head injury are too small and poorly designed to detect or refute reliably moderate but clinically important benefits or hazards of treatment. Limited funding for injury research and unfamiliarity with issues of consent may have been important obstacles.

bulletNews From BMJ


Randomised, Double Blind, Placebo Controlled Study Of Fluticasone Propionate In Patients With Moderate To Severe Chronic Obstructive Pulmonary Disease: The Isolde Trial

Objectives: To determine the effect of long term inhaled corticosteroids on lung function, exacerbations, and health status in patients with moderate to severe chronic obstructive pulmonary disease.

Design: Double blind, placebo controlled study.

Setting: Eighteen UK hospitals.

Participants: 751 men and women aged between 40 and 75 years with mean forced expiratory volume in one second (FEV1) 50% of predicted normal.

Interventions: Inhaled fluticasone propionate 500 mug twice daily from a metered dose inhaler or identical placebo. Main outcome measures: Efficacy measures: rate of decline in FEV1 after the bronchodilator and in health status, frequency of exacerbations, respiratory withdrawals.

Safety measures: morning serum cortisol concentration, incidence of adverse events.

Results: There was no significant difference in the annual rate of decline in FEV1(P=0.16). Mean FEV1 after bronchodilator remained significantly higher throughout the study with fluticasone propionate compared with placebo (P<0.001). Median exacerbation rate was reduced by 25% from 1.32 a year on placebo to 0.99 a year on with fluticasone propionate (P=0.026). Health status deteriorated by 3.2 units a year on placebo and 2.0 units a year on fluticasone propionate (P=0.0043). Withdrawals because of respiratory disease not related to malignancy were higher in the placebo group (25% v 19%, P=0.034).

Conclusions: Fluticasone propionate 500 mug twice daily did not affect the rate of decline in FEV1 but did produce a small increase in FEV1. Patients on fluticasone propionate had fewer exacerbations and a slower decline in health status. These improvements in clinical outcomes support the use of this treatment in patients with moderate to severe chronic obstructive pulmonary disease.

bulletNews From BMJ



Vidyya. Home |  Ex Libris |  Vidyya  | 
Subscription Information |  About Vidyya |  Vidyya Archives | 

Editor: Susan K. Boyer, RN
© Vidyya. All rights reserved.