Press Releases Saturday 17 July 1999
No 7203 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 the
journal's web site (http://www.bmj.com).

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the source BMJ article (URL's are given under titles).

(1) BREAST FED BABIES ARE LESS LIKELY TO BECOME
OBESE CHILDREN

(2) SPARE BEDS ARE CRUCIAL TO COPE WITH
GROWING NUMBER OF EMERGENCIES, BUT ARE
EMERGENCIES REALLY INCREASING?

(3) CHOLESTEROL LOWERING MARGARINE MAY NOT
BENEFIT THOSE ALREADY EATING A HEALTHY
DIET


 

(1) BREAST FED BABIES ARE LESS LIKELY TO BECOME
OBESE CHILDREN

(Breast feeding and obesity: cross sectional study)
http://www.bmj.com/cgi/content/full/319/7203/147

Prolonged, exclusive breast feeding reduces the risk of
children becoming obese, say researchers in this week's BMJ.
Dr Rüdiger von Kries and colleagues from Ludwig
Maximilians University in Munich suggest that this finding may
be an important argument in the drive to encourage breast
feeding in industrialised countries.

From their study of 9,357 children in Bavaria the team found
that infants who were breast fed exclusively for three to five
months were more than a third (35 per cent) less likely to
suffer from obesity by the time they reached school age. They
conclude that the protective effect of breast feeding from
obesity is more likely to be related to the composition of breast
milk than lifestyle factors associated with breast feeding.

Contact:

Dr Rüdiger von Kries, Professor of Paediatrics, Institute for
Social Paediatrics and Adolescent Medicine, Ludwig
Maximilians University, Munich, Germany
Email: ag.epi{at}lrz.uni-muenchen.de
 

(2) SPARE BEDS ARE CRUCIAL TO COPE WITH
GROWING NUMBER OF EMERGENCIES, BUT ARE
EMERGENCIES REALLY INCREASING?

(Dynamics of bed use in accommodating emergency
admissions: stochastic simulation model)
http://www.bmj.com/cgi/content/full/319/7203/155

(The rise in emergency admissions - crisis or artefact?
Temporal analysis of health services data)
http://www.bmj.com/cgi/content/full/319/7203/158

The National Health Service (NHS) must recognise that
maintaining some empty beds, with staff on hand, is not
wasteful, but a cost which must be incurred if a quality service
to patients is to be sustained, say a team from the University
of York in this week's BMJ. Adrian Bagust and colleagues
argue that spare bed capacity is essential for the effective
management of emergency admissions and the cost of doing
so is an essential element of running an acute hospital service.
Bagust et al simulated emergency admissions in a hypothetical
hospital in England using computer modelling. They found, not
unexpectedly, that there was a rapid increase in the risk of
there being no beds available for emergency patients when the
hospital had a high occupancy level.

They conclude that emergency admissions are, by their nature,
sporadic and difficult to predict and that their study suggests
that spare capacity is essential if an emergency admissions
service is to operate efficiently and at a level of risk
acceptable to patients.

However, in a separate study also published in this week's
BMJ a team from Bristol argues that "....whatever else is
causing a real or perceived crisis in the NHS, an increase in
the number of people requiring or demanding emergency
treatment is not the explanation".

In an analysis of emergency admissions in an area served by
Avon Health Authority, Dr Kieran Morgan and colleagues
ascertained that the "....supposed rise in emergency
admissions is almost entirely attributable to the increased
reporting of internal transfers of patients after admission."
They explain this by using the example that if someone who
has suffered a stroke is transferred from an assessment ward
to the care of a neurologist, then referred on to see other
specialists, this single admission may be recorded as three or
even four "episodes". Because costs are attributed to episodes
and not admissions, the cost of emergency care has risen
dramatically during a period when capacity and demand have
changed little, say the authors.

Despite their findings, the authors conclude that many patients
and their carers have deeply unsatisfactory experiences when
seeking access to emergency care. They say that it is
important that their study is replicated elsewhere to establish
whether the problem of emergency care is really one of
changing demand or more a matter of the quality and
accessibility of the capacity that is currently available.

Contact: Mr Adrian Bagust, Deputy Director, York Health
Economics Consortium, University of York
Email: ab13{at}york.ac.uk

Professor Stephen Frankel, Professor of Epidemiology and
Public Health Medicine, Department of Social Medicine,
University of Bristol, Bristol
Email: stephen.frankel{at}bris.ac.uk
 

(3) CHOLESTEROL LOWERING MARGARINE MAY NOT
BENEFIT THOSE ALREADY EATING A HEALTHY
DIET

(Cholesterol lowering margarine may not be useful in healthy
fat modified diet)
http://www.bmj.com/cgi/content/full/319/7203/186

Benecol, the "cholesterol lowering margarine" launched in the
UK in April, is a costly product that may not reduce lipid
concentrations in those already following a healthy diet, writes
Dr Charles van Heyningen in a letter in this week's BMJ. Dr
van Heyningen from University Hospital Aintree in Liverpool
argues that the evidence of Benecol's cholesterol lowering
properties is based on trials with people who consume an
average fat containing diet.

Those studied had an intake of dietary fat of about 35 per cent
of total energy intake and a cholesterol intake above 300mg
per day, says Dr van Heyningen. These people achieved a
mean reduction in total cholesterol of 7.4 per cent over a six
month period and after 12 months saw a 10.2 per cent fall.
This reduction translates into a 13 per cent decrease in the risk
of coronary disease over 10 years, says the author. However,
a separate trial has shown that people with a low intake of fat
and cholesterol may not benefit from eating Benecol, he
concludes, as it did not lower cholesterol concentrations
significantly.

Contact: Dr Charles van Heyningen, Consultant Chemical
Pathologist, Clinical Laboratories, University Hospital Aintree,
Liverpool 
Email: cvh{at}AHTPATH.demon.co.uk

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