bmj.com -- Press Releases

Press Releases Saturday 20 February 1999
No 7182 Volume 318

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(1) AIR BAGS MAY CAUSE HEARING LOSS

(2) INSECURITY ABOUT CAREER PATH IS BIGGEST STRESS
FOR YOUNG DOCTORS

(3) DEVOLUTION HAS ALREADY OCCURRED IN THE UK
HEALTH SERVICE

(1) AIR BAGS MAY CAUSE HEARING LOSS

(Two case reports of possible noise trauma after inflation of
air bags in low speed crashes)
http://www.bmj.com/cgi/content/full/318/7182/499

Despite contributing substantially to the safety of car occupants
in road accidents, air bags may also be causing hearing loss
due to the high level of noise generated by their inflation, say
Graham Buckley and colleagues from St James's University
Hospital, Leeds and the vehicle Safety Research Centre,
Loughborough in this week's BMJ.

The inflation of an air bag is triggered by vehicle deceleration
and can generate a sound pressure level of 150-170 decibels
which lasts for 0.1 seconds. The researchers state that even
though such levels have not caused permanent damage to the
ears during tests on monkeys, they believe air bag inflation
could cause acoustic trauma in some humans. The authors base
their findings on two specific cases whereby drivers suffered
hearing loss and persistent tinnitus which they believe may
have resulted from air bag inflation in low speed collisions.

Buckley et al fear that injuries from air bags may be more common
in the future, as current safety design is moving towards vehicles
with air bags that inflate in frontal and side crashes for both front
seat passengers. They suggest that lack of space means that side air
bags inflate very quickly and are closer to the ear. The authors
believe that such incidents of hearing loss could be under reported
as they are being attributed to other factors associated with an
accident - a victim is unlikely to register or remember the noise of
the air bag. It is therefore unclear whether the two cases that they
cite are isolated incidents or whether they represent a more
widespread problem.

Contact:

Mr Graham Buckley, Consultant Otolaryngologist,
Department of Otolaryngology (Head and Neck Surgery),
Leeds General Infirmary, Leeds
email: jgrahambuckley{at}compuserve.com

(2) INSECURITY ABOUT CAREER PATH IS BIGGEST STRESS
FOR YOUNG DOCTORS

(Insecurity about progression is an added stress for senior
house officers)
http://www.bmj.com/cgi/content/full/318/7182/534/a

Probably the most important cause of stress among many senior
house officers is insecurity about their career progression, write
Charles Galasko and Barry Jackson from the Royal College of
Surgeons of England in this week's BMJ.

In their letter Galasko and Jackson comment that by means of
coping with the "new deal" on reducing junior doctors' working
hours, the Government recruited hundreds of additional senior
house officers. However, claim the authors, they did not increase
the number of consultant and specialist registrar posts into which
these extra recruits can move once their training is completed,
which has now left too many people chasing too few posts.

The authors undertook a strawpoll of surgical senior house officers
and found that anxieties about career progression is the main cause
of stress. Galasko and Jackson conclude that unless this mismatch
is reduced by an increase in the numbers of consultants and specialist
registrar posts, stress, and the adverse effect is has on individuals
and patients, is likely to increase further.

Contact:

Charles Galasko, Chairman, Training Board or Barry Jackson,
President, Royal College of Surgeons of England, London

(3) DEVOLUTION HAS ALREADY OCCURRED IN THE UK
HEALTH SERVICE

(Is the English NHS underfunded?)
http://www.bmj.com/cgi/content/full/318/7182/522

The NHS in Scotland, Wales and Northern Ireland receives more
funding per head of population than the NHS in England. In
1995-6, Scotland received 25 per cent more, Wales nearly 18 per
cent extra and Northern Ireland five per cent more per capita than
England. In this week's BMJ Jennifer Dixon and colleagues from
the King's Fund and the University of Aberdeen attempt to undertake
an analysis of the implications for patients of these various levels of
funding.

The authors found that devolution is already evident in the health
service in the UK - "If national means the United Kingdom, there does
not seem to be a national NHS". Dixon et al found that comparing data
on NHS activity and interpreting the differences observed across the four
countries, was extremely difficult. That said, they ascertained that the
Scottish NHS buys more hospital beds and staff per capita and has higher
rates of outpatient and inpatient activity than in the English service.
Their research also showed that Scottish NHS trusts experience less
financial pressure and that staff have a lower workload than in England.
Higher funding in Scotland, Wales and Northern Ireland , however, did
not seem to be linked to better patient health.

The authors conclude that a comparison of the four countries of the United
Kingdom does not establish whether the NHS in England is underfunded in
relation to the other countries. They say that it could be argued that the
Scottish "providers" are less productive than their counterparts in England.
Dixon et al conclude that "....the evidence could be used equally well by a
Scottish assembly to argue for cutting health care expenditure....as by
advocates of a larger budget for the NHS in England."

Contact:
Prof. Rudolf Klein, Senior Associate Fellow, King's Fund, London
email: rklein{at}kehf.org.uk

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