The association between paracetamol use and asthma: causation or coincidence?

A better understanding of the causation of asthma and allergic disorders could potentially lead to intervention strategies that reduce their prevalence and severity. One potential causative factor is the use of paracetamol. Most of the evidence for the link with asthma is from non‐experimental studies of paracetamol exposure in utero, infancy, childhood and adult life; however, it has been difficult to rule out confounding and bias in the associations observed. The two randomized clinical trials of the effect of paracetamol in patients with asthma have been difficult to interpret, due to methodological issues. There have been no randomized controlled trials of paracetamol use and the development of asthma. Both asthma and paracetamol use are common, and so even if there is a relatively small effect of paracetamol exposure on the development of asthma or its severity, then such an effect would be of major public health significance. It is proposed that randomized controlled trials of the effect of paracetamol on the development of asthma and its severity are a high research priority.     

Clinical negligence

Clinical negligence cases are based on the assumption that a doctor owes patients a duty to take reasonable care when treating or advising them. Doctors breach this duty if their treatment falls below the standard expected by a responsible body of medical opinion. The doctor will be held to have acted negligently. A patient may then have a claim for compensation if, and only if, the patient can prove, on the balance of probabilities, that the negligence has caused physical or emotional injury. A claim must be commenced within 3 years of when the injury occurred or it will be time barred.     

Reciprocal Relationship Between Pain and Depression: A 12-Month Longitudinal Analysis in Primary Care

Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P < .0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P < .0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months.

Perspective

This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.     

Medicolegal issues in obstetrics

Obstetric claims cost over £1.8 billion pounds per year. Recent judgements have changed the emphasis on consent issues and these are becoming very important in obstetric cases. Clinicians need a basic understanding of legal principles around the Bolam case, The Montgomery consent case and the concept of material contribution. Understanding the way a claim will be analysed will assist clinicians when they get involved in legal cases, which is almost inevitable in obstetric practice. It will also inform them about the importance of having discussions with women about treatment plans and documenting the nature of the discussion and its outcome.     

182例特重型颅脑损伤的死亡原因分析

目的分析特重型颅脑损伤的死亡原因,总结特重型颅脑损伤的救治经验。方法回顾性分析182例特重型颅脑损伤患者的临床资料,选择12个相关死亡原因进行统计分析及总结。结果182例特重型颅脑损伤的死亡率为67．58％,相关死亡原因中受伤原因、入院时GCS评分之间差异无统计学意义（P〉0．05）;院前急救情况、损伤类型之间差异有统计学意义（P〈0．05）,瞳孔的变化、基底池评分、手术情况、血氧水平、血糖水平、合并伤、并发症之间差异有统计学意义（P〈0．01）。结论特重型颅脑损伤死亡原因复杂,死亡率高,死亡因素与院前急救不及时、脑疝晚期、脑损伤程度、低血氧、高血糖、合并伤、并发症等有关;主要死亡原因是脑疝和肺部并发症。     

The Environment in the International Classification of Functioning,Disability and Health

Background The World Health Organization has adopted two classifications relating to disability, one was published in 1980 and the more recent one in 2001. Although the international classification of functioning, disability and health (ICF) was drafted as a revision of the international classification of impairments, disabilities and handicaps (ICIDH), the ICF is based on major changes when compared with the ICIDH. One of them has to do with the environment. Method Quotations from the classification manuals and related articles are presented in order to make clear the scope of the environment in the ICF. Results The ICF has a universal application. The gap between capacity and performance reflects the barriers created by the environment. Conclusions In the ICF, universalism and barriers have specific meanings, reflecting specific policy choices.