Transitions

doi:10.1136/bmjusa.02020001

BMJ 2003;327:E87 (4 October), doi:10.1136/bmjusa.02020001 (published 28 August 2002)

BMJ USA: Editor's choice

Transitions

This article originally appeared in BMJ USA

Life is a series of transitions: from child to adult to senior citizen; from school to work to retirement; from being singleto marriage to widowhood or divorce. There is much about transitionin this issue of BMJ USA.

Are obese children more likely to remain obese as they movethrough adulthood? In a prospective study of 1142 childrenfollowed from birth in 1947, Wright et al found that overweightteenagers were more likely to be obese as adults (BMJ USA p85). However, being thin in childhood and adolescence did notprotect against obesity in adulthood, and most fat adults werenot overweight as children. These findings, the authors conclude,suggest that whole-population interventions aimed at reducing body mass index in childhood may not improve adult health.

As our patients advance into older ages, polypharmacy oftenoccurs, increasing the risk of adverse drug reactions and interactions,and imposing a financial burden on many seniors. In a studyof the impact of a pharmacist's review of elderly patients'medications, Zermansky et al found that the review resultedin significant changes in patients' drugs and reductions indrug costs (BMJ USA p 79).

Women go through a hormonal transition during menopause. Inan editorial, Dixon reviews the evidence showing that hormonereplacement therapy (HRT) reduces the effectiveness of breastscreening and increases the risk of breast cancer in womenaged 50 and older (BMJ USA p 70). Dixon suggests that it maybe time to reassess the value of HRT and to consider otheroptions, such as delivering progestogen directly to the uteruscombined with systemic estrogen administration.

In the transition from medical student to practicing physician,we move through that memorable rite of passage known as theresidency. The European Working Time Directive will limit theworking hours of physicians in training to 58 hours a weekbeginning in 2004, and to 48 hours by 2009 (BMJ USA p 75).In the US, the Accreditation Council for Graduation MedicalEducation's limits on resident work hours are poorly enforced,and remedies are now being pursued through legislation andregulation (BMJ USA p 76). As if excessive hours weren't bad enough, residents are often subjected to bullying, as describedin a poignant story on page 111.

I am moving through my own transition, after having been electedto the American Medical Association's Board of Trustees inJune 2001. Because of a potential conflict between my workfor the BMJ and my new role at the AMA (which publishes JAMA),I am resigning as editor of BMJ USA. I'm sad to leave the journal,but I'm delighted that Steven Woolf, MD, MPH, who has beenan outstanding associate editor of BMJ USA, has been namedas the new editor.—Ron Davis, MD editor, BMJ USA