Press Releases Saturday 10 July 1999
No 7202 Volume 319
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
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If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(1) SENSIBLE
HEALTH WARNINGS TO STAY OUT OF SUN MAY
ALSO BE
DENYING SOME PEOPLE THE BENEFITS IT
PROVIDES
(2) PFI IS
SUPPORTED BY "SPURIOUS ECONOMIC
ARGUMENTS"
(3) READILY
AVAILABLE EMERGENCY CONTRACEPTION HAS
NOT REPLACED
CONVENTIONAL METHODS IN
ADOLESCENTS
IN FINLAND
(4) FOOD
SHOULD BE FORTIFIED WITH FOLIC ACID TO
ENSURE ALL
MOTHERS RECEIVE RECOMMENDED DAILY
REQUIREMENTS
(5) MANY
PATIENTS WITH DIABETES DO NOT FOLLOW
ADVICE TO
MONITOR BLOOD GLUCOSE
(1) SENSIBLE HEALTH
WARNINGS TO STAY OUT OF SUN MAY
ALSO BE DENYING SOME PEOPLE THE BENEFITS
IT
PROVIDES
(Are we really dying for a tan?)
http://www.bmj.com/cgi/content/full/319/7202/114
Despite all the warnings of skin cancers,
people worldwide continue to
worship the sun - but are the effects
of the sun all bad for people? In
this week's BMJ , researchers from the
University of Bristol raise the
issue that the public should be educated
on both the pros and cons of
sunlight exposure, so that they can weigh
up the associated risks for
themselves. Some people, who are not at
high risk of suffering skin
cancer, may be missing out on the health
benefits of the sun, say the
team, but they warn this observation shouldn't
signal a rush for the sun
loungers.
Dr Andrew Ness and colleagues explain that
as well as being a major
factor in malignant melanomas, sunlight
also provides some health
benefits. For example, essential vitamin
D (produced after exposure to
sunlight) has been reported in some studies,
say the authors, to have a
protective effect against coronary heart
disease (there are more
deaths from heart attacks during the winter
months). They also
suggest that being in the sun has a positive
effect on mental health, as
sitting in the sun is enjoyable and relaxing.
Other health benefits, say the team, include
reducing the risk of rickets
(caused by vitamin D deficiency); treating
certain skin conditions, such
as psoriasis; and the incidence of multiple
sclerosis.
Ness et al surmise that evidence exists
to suggest that in some cases
the potential benefits of exposure to
sunlight may outweigh the widely
publicised adverse effects on the incidence
of skin cancer. They stress
that this does NOT mean that the advice
should now be for the public
to increase their exposure to the sun,
particularly in light of the thinning
of the ozone layer, and that sunworshippers
should wait until the
conclusions of formal research in this
area are made before rushing for
their sun loungers.
Contact:
Dr Andrew Ness, Senior Lecturer in Epidemiology,
University of
Bristol, Department of Social Medicine,
Bristol
Email: Andy.Ness{at}bris.ac.uk
(2) PFI IS SUPPORTED
BY "SPURIOUS ECONOMIC
ARGUMENTS"
(PFI in the NHS - is there an economic
case?)
http://www.bmj.com/cgi/content/full/319/7202/116
Clinicians should not allow themselves
to be deterred from criticising
the PFI by spurious economic arguments
say the authors of an article
in this week's BMJ. In the second of a
series of articles on the
government's controversial private finance
initiative in the NHS, the
team of researchers from UCL, Manchester
and Newcastle argue that
the government's claim that PFI hospital
schemes represent better
value than public funding is not supported
by the evidence.
The annual cost of paying private sector
financing charges, they point
out, is between 11 and 18 per cent of
the cost of building the hospitals.
They argue that the government could finance
these schemes itself by
borrowing at 3 per cent interest rates,
thus saving the taxpayer millions
of pounds. The authors believe that these
extra costs are largely being
met through cuts in services and subsidies
from the NHS capital
budget.
In comparing the costs of PFI with public
procurement, Gaffney et al
argue that the government does not use
the full costs of the
investment, but discounts the costs at
a rate of 6 per cent. This favours
privately financed options say the team
and effectively disregards the
lower cost of public sector borrowing.
The authors say that they show
how very slight changes to the discount
rate eliminate the apparent
economic benefits of PFI.
PFI business cases have tended to justify
high private sector costs by
arguing that the private sector is taking
on risks under the contract
which they are entitled to be paid for:
sums of between £18 and £62
million have been allowed for risk transfer,
say the authors. They show
that in many cases risks have been ascribed
to the private sector
which they have not in fact taken on.
The authors also point out that PFI business
cases have consistently
overestimated the inefficiency of public
sector procurement: one trust
assumed that any publicly funded scheme
would overrun on costs by
34 per cent, when cost overruns in the
NHS have been between 6 and
8 per cent during the 1990s.
They conclude that government's formal
appraisal of the PFI is not
objective and that it disguises the higher
cost of private sector
provision.
Contact:
Dr Allyson Pollock, Head, Health Policy
and Health Services
Research Unit, School of Public Policy,
University College, London
Email: Allyson.Pollock{at}ucl.ac.uk
(3) READILY AVAILABLE
EMERGENCY CONTRACEPTION HAS
NOT REPLACED CONVENTIONAL METHODS IN
ADOLESCENTS IN FINLAND
(Questionnaire study of use of emergency
contraception among
teenagers)
http://www.bmj.com/cgi/content/full/319/7202/91
Readily available emergency contraception
has not become a
contraceptive choice replacing conventional
methods among
adolescents in Finland, report researchers
in this week's BMJ. Dr Elise
Kosunen and colleagues from the University
of Tampere also found
that easy access to contraceptive services
(including emergency
contraception) and intensive sex education
had not increased
adolescent sexual activity.
Kosunen et al surveyed 21,940 adolescent
girls aged between the ages
of 14 and 17 years. They found that among
these girls there was a
high level of understanding of what emergency
contraception was (97
per cent of 14-15 year olds and 98.5 per
cent of 17 year olds). Their
study also found that the proportion of
girls who had used emergency
contraception increased with age (2.1
per cent of 14-15 year olds as
compared with 15.1 per cent of 17 year
olds). In terms of the
frequency of use of emergency contraception
the researchers found
that about two thirds of all girls who
had used this method had used it
only once.
The team also investigated levels of sexual
activity among the
adolescent girls and found that 13.3 per
cent of 14 year olds, 28.8 per
cent of 15 year olds and 51.5 per cent
of 17 year olds had had sexual
intercourse at least once. They conclude
that these levels are no higher
than in the late 1980s or early 1990s
when emergency contraception
was not widely used.
Contact:
Dr Elise Kosunen, Senior Lecturer in General
Practice, University of
Tampere, Medical School, Department of
General Practice, Tampere,
Finland
Email: meelko{at}uta.fi
(4) FOOD SHOULD BE FORTIFIED
WITH FOLIC ACID TO
ENSURE ALL MOTHERS RECEIVE RECOMMENDED
DAILY
REQUIREMENTS
(Neural tube defects and periconceptional
folic acid in England and
Wales: retrospective study)
http://www.bmj.com/cgi/content/full/319/7202/92
(Commentary: Food should be fortified
with folic acid)
http://www.bmj.com/cgi/content/full/319/7202/92#resp1
Foods should be fortified with folic acid
to ensure that women
considering trying for a baby receive
the recommended levels of this
important nutrient, say commentators in
this week's BMJ. The authors,
commenting on an analysis of the numbers
of pregnant mothers taking
folic acid, base their suggestion on the
fact that forty per cent of
pregnancies in the UK are unplanned and
therefore these women are
unlikely to have taken the advised periconceptional
folic acid
supplementation.
Professor Eva Alberman and Joan Noble from
the Wolfson Institute of
Preventive Medicine say that despite expensive
and large scale health
education campaigns to encourage mothers
to take folic acid before
conception, the proportion of women doing
so is not much more than
30 per cent. They say that because so
many pregnancies are
unplanned this is hardly surprising and
therefore a better means of
ensuring women receive their recommended
daily dose of folic acid is
to implement a policy of fortifying foods
with the nutrient.
Neural tube defects (such as spina bifida)
have been shown to be
reduced by mothers taking periconceptional
supplementation. In a
separate paper, also in this week's BMJ,
Dr Rezan Kadir and
colleagues from the Royal Free and University
College Medical School
report that neural tube defects have been
decreasing since the early
1970s. In 1992 the Expert Advisory Group
in the United Kingdom
recommended that women who were trying
to conceive should take
0.4mg of folic acid each day.
Kadir et al assessed whether there had
been any change in the
incidence of neural tube defects since
this recommendation was made
and they found that the rate of decline
in the numbers of babies (births,
stillbirths and terminations) with such
defects had slowed. They say
that this may be because mothers are not
taking the supplement over
the correct period; it may not be taken
by those at highest risk, or the
recommended daily dose may be too low.
They also speculate that the
incidence of such defects has reached
such a low level (the incidence
of spina bifida fell from 215/100,000
in 1972 to 38/100,000 in 1991) that
it is not possible to achieve further
reduction through supplementation.
They conclude that there is a need for
continued health education on
the benefits of folic acid both before
pregnancy and immediately after
conception in unplanned pregnancies.
Contact for Paper:
Mr Demetrios Economides, Senior Lecturer,
Department of Obstetrics
and Gynaecology, Royal Free and University
College Medical School,
London
Contact for Commentary:
Joan Noble, Administrator, Department of
Enviromental and Preventive Medicine,
Wolfson Institute of
Preventive Medicine, St Bartholemew's
and Royal London School of
Medicine and Dentistry, London
(5) MANY PATIENTS WITH
DIABETES DO NOT FOLLOW
ADVICE TO MONITOR BLOOD GLUCOSE
(Frequency of blood glucose monitoring
in relation to glycaemic
control: observational study with
diabetes database)
http://www.bmj.com/cgi/content/full/319/7202/83
People with diabetes do not self-monitor
their glucose levels as often
as they should, find researchers in this
week's BMJ. Based on their
study of diabetes sufferers in Tayside,
Scotland, the authors of the
paper find that self-monitoring of blood
glucose levels is associated
with the ability to achieve better control
of blood sugar levels, in
patients with type 1 diabetes (when a
patient has an absolute
deficiency of insulin) at least.
Dr Josie Evans and colleagues from Ninewells
Hospital and Medical
School in Dundee found that in their study
of over 800 diabetic patients
in the Tayside area of Scotland, many
patients did not conduct any
blood sugar testing and that less than
one fifth tested their glucose
levels daily. They report that frequency
of testing depended on
characteristics such as age and level
of social deprivation and that
patient groups who do not test their blood
regularly should be identified
and targeted to encourage better self-monitoring.
Evans et al report that their study has
shown that there is a direct
association between frequency of testing
and improved control of
blood sugar levels, thus making the self-monitoring
even more
important. They conclude that the average
cost of glucose
management per patient (£409 per
year for a patient who monitors
their blood glucose four times a day)
is still low when compared to the
costs of treating patients with diabetic
complications.
Contact:
Dr Josie Evans, Wellcome Postdoctoral Research
Fellow in Health
Services Research, Medicines Monitoring
Unit, Department of Clinical
Pharmacology, Ninewells Hospital and Medical
School, Dundee
Email: josie{at}memo.dundee.ac.uk
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