bmj.com -- Press Releases

Press Releases Saturday 7 November 1998
No 7168 Volume 317

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(1) JOBLESSNESS LINK TO SUICIDE

(2) PERCEIVED RISKS OF BREAST CANCER ARE VASTLY OVERESTIMATED

(3) INPATIENT MENTAL HEALTH SERVICES ARE BEING NEGLECTED

(4) INEQUALITY IN COMPUTING RESOURCES WILL LEAD TO
TWO-TIER PRIMARY CARE

(5) NICOTINE REPLACEMENT THERAPY SHOULD BE PRESCRIBABLE
ON THE NHS

(1) JOBLESSNESS LINK TO SUICIDE

(Suicide, deprivation and unemployment: record linkage study)
http://www.bmj.com/cgi/content/full/317/7168/1283

Suicides make a substantial contribution to the numbers of premature
deaths and, in order to try to prevent people taking such action, there
is a need to understand who is at risk. In this week�s BMJ Glyn
Lewis from the University of Wales College of Medicine and Andy
Sloggett from the London School of Hygiene and Tropical Medicine
find that the link between suicide and unemployment is more powerful
than other socio-economic measures.

The authors studied data on suicides occurring between 1983 and
1992 in the Office for National Statistics longitudinal study, and
found that unemployment was associated with a doubling of the
suicide rate. The authors found that other measures of socioeconomic
status, such as social class and housing tenure, were not associated.
The authors warn that their study was not adjusted for some
potential confounding factors; however, they conclude that their
study provides strong support for the possibility that a reduction
in unemployment levels would also reduce rates of suicide.

Contact:

Professor Glyn Lewis,
Professor of Community and Epidemiological Psychiatry,
Division of Psychological Medicine,
University of Wales College of Medicine, Cardiff
email: wpcghl{at}cardiff.ac.uk

(2) PERCEIVED RISKS OF BREAST CANCER ARE VASTLY
OVERESTIMATED

(Putting the risk of breast cancer in perspective)
http://www.bmj.com/cgi/content/full/317/7168/1307

Recently notices on London�s underground warned that women have a
one in 12 risk of developing breast cancer. That�s only part of the story,
say the authors of a paper in this week�s BMJ. Dr John Bunker for the
Cancer Research Campaign and UCL Trials Centre estimates that in
fact the risk of developing breast cancer in a woman under the age of
35 years is one in 625. By the age of 50 this risk rises to one in 56; to
one in 18 by the age of 65; and one in 13 by the age of 75 years. The
authors conclude that overall, for most women, the lifetime risk of
dying of breast cancer is one in 26. This risk should be understood
in the context of other serious threats to life. For women who smoke
and live to age 75, for instance, the risk of dying of lung cancer is three
times as great as dying of breast cancer.

Contact:

Dr John Bunker,
Visiting Professor,
Cancer Research Campaign and UCL Cancer Trials Centre,
University College London Medical School, London

(3) INPATIENT MENTAL HEALTH SERVICES ARE BEING NEGLECTED

(One day survey by the Mental Health Act Commission of acute
adult psychiatric inpatient wards in England and Wales)
http://www.bmj.com/cgi/content/full/317/7168/1279

Over the past 50 years the number of psychiatric patient beds in England
has decreased greatly. The number has fallen from 150,000 in 1955
to 42,000 in 1994-95. Despite the increase in community services,
these beds still account for two-thirds of expenditure on mental health
services.

In this week�s BMJ, Dr Richard Ford and colleagues from the Sainsbury
Centre for Mental Health in London report on the state on adult psychiatric
inpatient units in England and Wales. Their study is based on an
unannounced one day visit by the Mental Health Act Commission to acute
psychiatric wards on 21 November 1996. They found that there is a
relative neglect of inpatient services, as opposed to the focus that has
been placed on activities in the community.

Their visit revealed that leave arrangements for detained patients on
psychiatric wards (who were given �trial� periods in the community)
caused considerable difficulties in bed management, not helped by their
finding that around one-third of nursing staff seem to be employed on a
casual basis. Ford et al found that nurses spent much of their time engaged
in intensive observation of a few patients, but a quarter of wards had no
nurse interacting with patients at the time of the national visit. Only
one-third of the female patients had the use of self contained,
women-only areas.

They conclude that London wards have the most severe problems and
that policy making, management and training must be refocused to
improve the quality of acute inpatient psychiatric care.

Contact:

Dr Richard Ford,
Head of Service Evaluation,
Sainsbury Centre for Mental Health, London
email: r.ford{at}scmh.org.uk

Please note: This study should not be confused with the results of
the three-year study of care in acute psychiatric wards to be
released on Monday 9 November by the Sainsbury Centre for
Mental Health.

(4) INEQUALITY IN COMPUTING RESOURCES WILL LEAD TO
TWO-TIER PRIMARY CARE

The costs of computing for primary care groups
http://www.bmj.com/cgi/content/full/317/7168/1265

In an editorial Andrew Willis, a GP and former chair of the National
Association of Commissioning GPs, warns that the Government�s aim
of greater equity for patients and practices in primary care will be
frustrated if resources are not urgently pumped into better information
systems for primary care groups. Dr Willis says that when fundholding
was introduced, extra money was released to reimburse fundholders
for computing and personnel costs and a national specification for
software was developed. Non-fundholders are still lagging behind,
commonly using much simpler systems which do not have the
capacity to share information on the scale needed to make
primary care groups work effectively.

Contact:

Dr Andrew Willis GP,
Northampton NN3 3DA

(5) NICOTINE REPLACEMENT THERAPY SHOULD BE
PRESCRIBABLE ON THE NHS

http://www.bmj.com/cgi/content/full/317/7168/1266

Nicotine replacement therapy is a cost-effective aid to smoking
cessation and should be prescribable on the NHS, say Dr Liam
Smeeth and Professor Godfrey Fowler. The authors argue that a
lthough NRT may appear expensive initially, it is not a life- ong treatment
and, if seen in terms of costs per life year saved, is a cost-effective
as well as clinically effective intervention. The authors argue that its
high retail cost makes it prohibitive to many people on low incomes.
If NRT were prescribable, the current prescription exemptions
would effectively target nicotine replacement therapy at the most
socially disadvantaged groups.

Dr Godfrey Fowler,
Emeritus Professor of General Practice,
Divison of Public Health and Primary Care,
Institute of Health Sciences, University of Oxford,
Oxford OX3 7LF
email: godfrey.fowler{at}balliol.ox.ac.uk