Press Releases Saturday 19 June 1999
No 7199 Volume 318
Please remember to credit the BMJ as source when publicising
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the source BMJ article (URL's are given under titles).
(1) CLIMATE
CHANGE WILL HAVE DETRIMENTAL
EFFECTS
ON HEALTH IN EUROPE
(2) MAJOR
ECONOMIC CHANGE CAN LEAD TO AN
INCREASE
IN DEATHS IN CAR ACCIDENTS
(3) UNIVERSAL
ANTENATAL HIV SCREENING NEEDED IN
AREAS OF
HIGH PREVALENCE
(1) CLIMATE CHANGE WILL
HAVE DETRIMENTAL
EFFECTS ON HEALTH IN EUROPE
(Climate change and human health
in Europe)
http://www.bmj.com/cgi/content/full/318/7199/1682
Climate warming and changes in rainfall
patterns may have
significant and wide ranging impacts on
health in Europe, say a
team of researchers in this week's BMJ.
The team are part of the
International Working Group on the early
human health effects of
climate change, convened by the Rome division
of the World
Health Organisation European Centre for
Environment and Health.
They say that societies will need to adapt
to climate change to
minimise any adverse effects on health
and to this end surveillance
of diseases sensitive to climate should
be enhanced.
It has been estimated that average global
temperature is likely to
increase by one to 3.5 degrees centigrade
by 2100, say the authors
and they argue that this will affect human
health hand-in-hand with
other ecological and demographic changes.
Increases in average
seasonal temperatures will entail an increase
in the number of
heatwaves and decrease the number of cold
spells, predict the
authors. Health professionals, they say,
should be prepared to
tackle increased mortality during heatwaves.
However one benefit
of climate change may be a reduction in
excess winter mortality.
Kovats et al also report that an increased
risk of river flooding in
Europe is likely in the future. They say
that flooding has long term
effects on mental health; may disrupt
water purification and
sewage disposal systems; cause toxic waste
sites to overflow and
dislodge chemicals stored in the ground.
There may also be an
increased risk of communicable diseases
after flooding, they warn.
Malaria, visceral leishmaniasis, tick
borne encephalitis and Lyme
disease are all vector borne diseases
that are likely to be affected
by climate change and may find their way
into new populations.
The authors conclude that potential options
for adaptations to
reduce health impacts include strengthening
public health
programmes, including disease surveillance
systems and vaccination
programmes for diseases that are likely
to become more
widespread. There is an urgent need for
Europe-wide coordination
to improve adverse health impacts, say
the authors.
Contact:
Ms Savi Kovats, Research Fellow, Department
of Epidemiology
and Population Health, London School of
Hygiene and Tropical
Medicine
Email: s.kovats{at}lshtm.ac.uk
(2) MAJOR ECONOMIC CHANGE
CAN LEAD TO AN
INCREASE IN DEATHS IN CAR ACCIDENTS
(The carnage wrought by major economic
change: ecological study
of traffic related mortality and
the reunification of Germany)
http://www.bmj.com/cgi/content/full/318/7199/1647
(Commentary: Road deaths in European
countries)
http://www.bmj.com/cgi/content/full/318/7199/1647#resp1
(World Bank must do more to develop
safe and sutainable
transportation systems)
http://www.bmj.com/cgi/content/full/318/7199/1694
Based on the experiences of the reunification
of Germany,
researchers in this week's BMJ warn that
during times of economic
change and modernisation, deaths and injuries
from road traffic
accidents are a predictable side-effect
of the sudden affluence
which increases car ownership.
Dr Flaura Winston from The Children's Hospital
of Philadelphia and
University of Pennsylvania along with
colleagues analysed deaths
from car accidents in East and West Germany
from 1985 to 1996 -
ie both before and after reunification.
After reunification, which
caused a sudden, temporary affluence there
was an associated
four-fold increase in car accident fatalities
between 1989-91.
The age group most affected, find Winston
et al, was 18-24 year
olds - death rates in 18-20 year olds
increased eleven-fold during
this period and eightfold in the 21-24
age group.
The authors conclude that a tragic consequence
of the reunification
of Germany was the dramatic increase in
death rates of car
occupants. They say that sudden economic
change and availability
of cars resulted in both a rise in vehicle
ownership and an increase
in the number of inexperienced drivers
on roads that were ill
prepared for the increased traffic.
Dr Winston and colleagues report that although
modernisation of
underdeveloped nations and their economies
is ultimately beneficial,
it can prove fatal without appropriate
injury prevention measures.
They say that public health and medical
communities must take the
lead in ensuring that economic change
does not adversely affect the
health and safety of the public.
Also see accompanying commentary to this
paper by Professor
Mark McCarthy and letter by Dr Ian Roberts.
Contact:
Dr Flaura K. Winston MD, PhD, Director,
TraumaLink, The
Children's Hospital of Philadelphia Assistant
Professor of
Pediatrics, The University of Pennsylvania,
34th Street and Civic
Center Boulevard, Abramson Pediatric Research
Center, Suite 706,
Philadelphia, PA 19104, USA
Email: flaura{at}mail.med.upenn.edu
Professor Mark McCarthy, Department of
Epidemiology and Public
Health, University College London Medical
School, London Tel:
Email: m.mccarthy{at}ucl.ac.uk
Dr Ian Roberts, Director, Child Health
Monitoring Unit,
Department of Epidemiology and Public
health, Institute of Child
Health, London
Email: ian.roberts{at}ich.ucl.ac.uk
(3) UNIVERSAL ANTENATAL
HIV SCREENING NEEDED IN
AREAS OF HIGH PREVALENCE
(Universal HIV screening of pregnant
women in England: cost
effectiveness analysis)
http://www.bmj.com/cgi/content/full/318/7199/1656
(Antenatal HIV testing: assessment
of a routine voluntary
approach)
http://www.bmj.com/cgi/content/full/318/7199/1660
Universal voluntary antenatal HIV screening
should be
implemented in the London area, argue
researchers in this week's
BMJ. Dr Eddy Beck from Imperial College,
London, UK and Dr
Maarten Postma from the National Institute
of Public Health and
the Environment in the Netherlands, along
with their colleagues also
believe that serious consideration of
such a policy should be given
for other areas in England, depending
on prevalence and screening
costs
The lifetime costs of care for a child
infected with HIV have been
estimated at £178,300. However,
screening pregnant women for
HIV can avert this cost and lead to gains
in life years for both
mothers and children, say Postma et al.
In high prevalence areas,
screening pregnant women for HIV is estimated
to be a cost
effective intervention with a net cost
of less than £4,000 for each
life year gained.
In a separate paper, also in this week's
BMJ, Dr Wendy Simpson
from the University of Edinburgh along
with colleagues from
Glasgow investigated the effect on uptake
of antenatal HIV testing
(which is currently low in Britain) if
testing was routine unless a
woman declined - ie opt-out testing.
Of the 924 pregnant women studied, 816
(88.3 per cent) had an
HIV test and when asked "Do you think
the HIV test should be a
routine test like all the other blood
tests during pregnancy?", most
women (87.7 per cent) said yes.
Simpson et al report that the uptake of
the HIV test in this study
was more than double the rate of uptake
in one of their previous
studies, where women were required to
opt-in to the test (88 per
cent as opposed to 35 per cent) and that
the opt-out approach was
not time consuming, required no extra
staff and was positively
endorsed by most women.
However, the authors say that such an approach
will not
necessarily achieve a similar outcome
in London, where there are
more complex issues of language and different
cultures. But, they
conclude, so long as safeguards are in
place to ensure that women
can make a fully informed choice, their
routine voluntary approach
is in keeping with recent guidelines.
Contact for Universal HIV Screening:
Dr Eddy Beck, Senior Lecturer, Department
of Epidemiology
and Public Health, Imperial College School
of Medicine,
London
Email: e.beck{at}ic.ac.uk
Contact for Antenatal HIV Screening:
Dr Wendy Simpson, 22 Lumsden Park,
Cupar, Fife KY15 5YL
Email: wendy{at}lumsdenpark.freeserve.co.uk
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