Press Releases Saturday 21 November 1998
No 7170 Volume 317

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(1) REFUGEES NEED BETTER ACCESS TO HEALTH CARE

(2) NURSES NEED GREATER SUPPORT TO PREVENT POOR PATIENT CARE

(3) TOBACCO WILL KILL ONE THIRD OF CHINESE MEN
 

(1) REFUGEES NEED BETTER ACCESS TO HEALTH CARE

(Refugees and primary care: tackling the inequalities)
http://www.bmj.com/cgi/content/full/317/7170/1444

The refugee population in Britain is highly diverse and is likely to remain
large, as conflicts around the world continue. Currently there are 230,000
refugees living in the UK and almost half of these are in London.
Refugees have had to leave their countries of origin to escape persecution,
imprisonment, torture and even death, and when they arrive in Britain
they are often in poor health. Grief and worry about relatives they have
left behind can cause mental health problems, which can be worsened
by various factors including language difficulties, family separation,
hostility from the host population and traumatic experiences before
displacement.

In this week�s BMJ Dr David Jones from the Royal Free and University
College Medical School in London and Dr Paramjit Gill from the University
of Birmingham propose a series of steps that could be taken to improve
access to health care for refugees in the UK. These suggestions include
initiatives such as intensive courses in spoken English; a Department of
Health information pack containing a certificate of entitlement to NHS
treatment; the development of a telephone interpreting service and
guidelines for general practices on the process of registration for a
refugee patient.

The authors also suggest that the £60 million extra funds negotiated for
GPs by the General Medical Services Committee (now the General
Practice Committee) should be used to reward doctors for caring for
refugee patients. They say that this additional workload is not covered
by the current system of deprivation payments. They conclude that a
truly effective solution requires the political will to develop a comprehensive
strategy at a national level, which they recognise will be difficult when other
groups (such as the mentally ill and the elderly) are also in need of greater
resources.

Contact:

Dr David Jones, Lecturer,
Department of Primary Care and Population Sciences,
Royal Free and University College Medical School,
London.
email: d.l.jones{at}ucl.ac.uk
 

(2) NURSES NEED GREATER SUPPORT TO PREVENT POOR
     PATIENT CARE

(The "professional cleansing" of nurses. The systematic
 downgrading of nurses damages patient care)
http://www.bmj.com/cgi/content/full/317/7170/1403

(Some NHS care is unacceptable)
http://www.bmj.com/cgi/content/full/317/7170/1460/e

An editorial linked to a personal view in this week�s BMJ examines
claims of poor quality of care by nurses within the UK. The author,
Professor Hugh McKenna from the University of Ulster, writes that
the "finger of blame for poor care should not be pointed at hard pressed
staff, but at the system that frustrates their desire to do what they are
educated to do - care".

Professor McKenna notes that the number of qualified nurses in England
and Wales fell by 21 per cent from 1991 to 1992 and that this decrease
corresponded with an equivalent rise in the number of untrained care
assistants over the same period. He says that subsequent recruitment
initiatives (that have cost millions of pounds) have not taken away from
the fact that nurses face high levels of stress in the modern NHS and
that they undertake what are perceived by many as unsavoury tasks.
He also believes that recruitment has not been helped by the Government�s
decision to stage nurses� recent, inadequate, pay award.

McKenna suggests that poor quality of care is being perpetuated by a vicious
circle: low numbers of registered nurses lead to poor quality of care,
which leads to high stress and low morale; this in turn leads to high
sickness rates, a shortage of nurses and poor quality of care...

The author concludes that the solution is for nurses to ensure that the reasons
why care is not always as good as it should be are tackled politically,
strategically and operationally.

Contact:

Professor Hugh McKenna,
Professor of Nursing, School of Health Sciences,
University of Ulster, Jordanstown,
Co Antrim, Northern Ireland
 

(3) TOBACCO WILL KILL ONE THIRD OF CHINESE MEN

(Emerging tobacco hazards in China: 1. Retrospective proportional
mortality study of one million deaths)
http://www.bmj.com/cgi/content/full/317/7170/1411

(Emerging tobacco hazards in China: 2. Early mortality results from a
prospective study)
http://www.bmj.com/cgi/content/full/317/7170/1423

China now consumes one third of the world �s cigarettes.  In this week�s BMJ
researchers report on the largest-ever investigation on the hazards of
tobacco.  Involving one and a quarter million Chinese, the study finds that
on current smoking patterns, at least one third (100 million) of Chinese
males now aged 0-29 years will be killed by tobacco related diseases in
middle or old age.

The study also reveals that the pattern of disease caused by smoking varies
widely both within China and between China and the developed world.  Of
deaths caused by tobacco in China, 45 per cent are from chronic lung
disease, 15 per cent from lung cancer and five to eight per cent from each
of oesophageal cancer, stomach cancer, liver cancer, stroke, ischaemic
heart disease and tuberculosis.

Two thirds of men now become smokers before age 25;  few give up and about
half of those who persist will be killed (about half of all persistent
cigarette smokers in Britain and America are eventually killed by tobacco).
Tobacco currently causes 13 per cent of deaths in men but only three per
cent of deaths in women. This, explain the authors, is because the
proportion of young women who smoke is currently small.

The study concludes that if current smoking patterns persist in China, then
such projections cannot be substantially wrong.

The research is a long-term collaboration between the Clinical Trial
Service Unit, Oxford University, the Chinese Academies of Preventive
Medicine and of Medical Sciences in Beijing and Cornell University in the
USA, supported by the Imperial Cancer Research Fund, the UK Medical
Research Council, the US National Institutes of Health, the Canadian
Government and the World Bank.

Contact:

Margaret Willson,
press officer for Oxford University CTSU
email: m.willson{at}dial.pipexm.willson{at}dial.pipex

A video news release, mainly shot in China,
is available from Reuters World Alert.
 
 

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