Press Releases Saturday 08 August 1998
No 7155 Volume 317
Please remember to credit the BMJ as source when publicising an
article and to tell your readers that they can read its full text on
the
journal's web site (http://www.bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URLs are given under titles).
(1) HIGH RISK HOME BIRTHS ARE INADVISABLE
(2) HOW CAN THE BENEFITS OF BREAST CANCER SCREENING BE EXTENDED?
(3) GENERAL PRACTICE MANAGEMENT OF DIABETES
CAN BE AS
GOOD AS
HOSPITAL CARE
(4) THE HEALTH CONSEQUENCES OF THE NUCLEAR
ARMS TRADE
IN THE
SUBCONTINENT SHOULD NOT BE OVERLOOKED
(1) HIGH RISK HOME BIRTHS ARE INADVISABLE
(Perinatal death associated with planned
home birth in Australia:
population based study)
http://www.bmj.com/cgi/content/full/317/7155/384
In most industrialised countries, only women at low risk of complications
give
birth at home and the outcomes often compare favourably with hospital
births.
However, in this week�s BMJ Hilda Bastian, a consumer advocate,
along with
researchers from Australia�s National Perinatal Statistics Unit, expresses
concern about the current trend in some places for women at high risk
to give
birth at home. Based on death rates of babies born after planned
home births
in Australia, the authors found that the death rate was higher than
for
comparable hospital births and much higher than home births in other
countries.
The authors suggest that the largest contributors to the excess deaths
were
underestimating the risks associated with late babies, twins and breech
births,
as well as a lack of response to fetal distress. Thus they conclude
that high
risk home birth is experimental and inadvisable.
Contact:
Hilda Bastian, Consumer Advocate, Blackwood, Australia
email: hilda.bastian{at}flinders.edu.au
(2) HOW CAN
THE BENEFITS OF BREAST CANCER SCREENING BE
EXTENDED?
(Cost effectiveness of shortening screening
interval or extending age
range of NHS breast screening programme:
computer simulation study)
http://www.bmj.com/cgi/content/full/317/7155/376
(Routine invitation of women aged 65-69
for breast cancer screening:
results of first year of pilot study)
http://www.bmj.com/cgi/content/full/317/7155/388
(Extending the benefits of breast cancer
screening: still hard to know
how large the benefits will really
be)
http://www.bmj.com/cgi/content/full/317/7155/360
The NHS breast screening programme, introduced in 1988, currently provides
mammography every three years for women aged 50-64. But what
if they were
screened more often and what if the programme were extended to women
of 69
years of age? These questions are tackled in a study reported
in this week�s
BMJ by Rob Boer from Erasmus University in Rotterdam and colleagues
from
the UK.
The current breast screening programme reduces deaths from breast cancer
by
12.8 per cent. The authors estimate that by extending the programme
to women
aged 69 it would reduce deaths by 16.4 per cent (at a marginal cost
per life
saved of £2990), while reducing the interval to two years would
reduce mortality
by 15.3 per cent (at a marginal cost per life saved of £3545).
Boer et al conclude that either of these two options for extending the
programme
would reduce deaths substantially if only the budget for the NHS screening
programme could accommodate it.
But if the programme were extended to older women (who are more likely
than
younger women to develop breast cancer), would they turn up for further
screens? Yes, is the overwhelming answer, according to Dr Linda
Garvican
from the South East Institute of Public Health in Kent along with colleagues
from
Sussex and Surrey. In a short report published in this week�s
BMJ, the authors
found that over 70 per cent those women who had previously attended
for breast
screening would continue to do so after the age of 64 years (even if
they hadn�t
been invited for six years).
In a linked editorial, Dr Ursula Werneke and Professor Klim McPherson
from the
London School of Hygiene and Tropical Medicine conclude that the two
studies
reported are important, but that their findings may have only a limited
validity.
They suggest further discussion of the potential opportunity costs
before
implementing any of the proposed changes to the current system.
Contact:
Rob Boer, Informatician, Department of Public Health, Institut Maatschappelijke
Gezondheidszorg, Erasmus University, Rotterdam, Netherlands
email: boer{at}mgz.fgg.eur.nl
or
boer{at}mgz.fgg.eur.nl
Dr Linda Garvican, Principal Public Health Specialist, South East Institute
of
Public Health, Tunbridge Wells, Kent
Professor Klim McPherson, Professor of Public Health Epidemiology,
Cancer and Public Health Unit, London School of Hygiene and Tropical
Medicine, London
(3) GENERAL
PRACTICE MANAGEMENT OF DIABETES CAN BE AS
GOOD AS HOSPITAL CARE
(Diabetes care in general practice:
meta-analysis of randomised
control trials)
http://www.bmj.com/cgi/content/full/317/7155/390
Since 1970 increasing numbers of family doctors in the UK have assumed
responsibility for the routine review of their patients with diabetes.
Evaluation of the care received in the community (as opposed to hospital)
has, however, produced conflicting results. In this week�s BMJ,
Dr Simon
Griffin from the University of Southampton reports that selected primary
care teams, when supported by a central computerised prompting system
(for both doctor and patient), were able to achieve standards of care
as
good as or better than hospital outpatient follow up, at least in the
short
term. He concludes by suggesting that the cost-effectiveness
of general
practice diabetes care needs longer term evaluation.
Contact:
Dr Simon Griffin, University Lecturer, General Practice and Primary
Care
Research Unit, Department of Community Medicine, Institute of Public
Health, University Forvie Site, Robinson Way, Cambridge
email: SJG49{at}medschl.cam.ac.uk
(4) THE HEALTH
CONSEQUENCES OF THE NUCLEAR ARMS
TRADE IN THE SUBCONTINENT SHOULD NOT BE
OVERLOOKED
(Staring into the abyss: walking
the nuclear tightrope in south Asia)
http://www.bmj.com/cgi/content/full/317/7155/363
In an editorial in this week�s BMJ, Professor Zulfiqar Ahmed Bhutta
from
the Aga Khan University in Pakistan laments the growth of the nuclear
arms
race in the subcontinent and writes that �...the enormous costs of
nuclear
weapons must be weighed against the abysmal state of human development
and health in south Asia.� He notes that the region is home to
over half of
all the malnourished children in the world and, what with high infant
mortality and a lack of basic facilities for health and education,
he finds the
diversion of scarce economic resources to weapons of mass destruction
even more incongruous.
Professor Bhutta suggests that the only way to ensure that a nuclear
conflict between India and Pakistan never occurs is to educate the
population in its true horrors and the human costs that such a programme
could entail.
The author concludes that it is imperative that international sanctions
should
not add to the misery of the millions who would bear the brunt of such
measures.
Contact:
Professor Zulfiqar Ahmed Bhutta, Professor of Paediatrics and Child
Health,
The Aga Khan University, Karachi, Pakistan
email: zulfiqar.bhutta{at}aku.edu
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact Jill Shepherd;jshepher{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
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