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(2) BLOOD
SCREENING TEST FOR DOWN'S
SYNDROME NO
MORE EFFECTIVE THAN SIMPLY
USING AGE AND
SCANS
(3) SHORT CHILDREN MORE
LIKELY TO BE BULLIED
AT SCHOOL
(1) UK HEALTH
SPENDING WON'T REACH
EUROPEAN UNION AVERAGE WITH CURRENT
GROWTH RATES
(Getting UK health care expenditure
up to the European
Union mean. What does that mean?)
http://www.bmj.com/cgi/content/full/320/7235/640
The government's stated intention to equal
the European
Union (EU) average spend on health care
by 2006 cannot
possibly be realised on the basis of current
growth rates,
concludes a study in this week's BMJ.
A study from the Office of Health Economics
shows that the
government's plan to reach an NHS spend
equal to 8 per
cent of gross domestic product (GDP) by
2006 is based on
faulty calculations. The UK's GDP spend
on health care is
currently 6.7 per cent, one of the lowest
in the EU.
The government intends to increase the
NHS budget by 5 per
cent a year, after adjusting for inflation,
to reach its target.
But, argue director Adrian Towse and associate
director, Jon
Sussex, the real annual growth required
to reach this is 5.8
per cent from next year.
Furthermore, the UK's low GDP spend drags
down the EU
average. The rest of the EU actually spends
9.1 per cent of
its GDP on health care: to bring the UK
in line with the rest of
the EU, therefore, say the authors, means
the same GDP
spend. And to achieve that, the UK is
looking at an annual
increase in the health budget of between
7.7 to 8.7 per cent.
The UK does not include nursing home care
in its health
spend calculations, unlike some of the
other EU countries; if it
were to do so, the lower figure would
apply.
As a political goal, aiming for the average
EU rate of
expenditure is sensible, say the authors,
because GDP is
strongly linked to spending on health
care, and the average
income in the UK now matches that of the
EU. But, they
conclude: "Without additional funds, the
NHS will struggle to
meet the government's ambitious agenda
for a more effective
and consumer responsive, 'modernised'
health service."
And the bad news is, that even if the government
sticks to its
8 per cent target, other areas of public
expenditure will suffer
unless taxes rise, to compensate, conclude
the authors.
Contact:
Adrian Towse, Office of Health Economics,
London.
Email: atowse@abpi.org.uk
(2) BLOOD SCREENING
TEST FOR DOWN'S
SYNDROME NO MORE EFFECTIVE THAN SIMPLY
USING AGE AND SCANS
(Six year survey of screening for
Down's syndrome by
maternal age and mid-trimester ultrasound
scans)
http://www.bmj.com/cgi/content/full/320/7235/606
Antenatal screening for Down's syndrome
using a blood
test-serum screening, sometimes known
as the "triple test" - is
no more likely to detect the condition
than using the mother's
age and ultrasound scans, finds research
in this week's BMJ.
Furthermore, the method was introduced
without any
scientific evidence for its clinical effectiveness,
say the
authors.
Since 1992, serum screening has been widely
accepted as
the preferred method for antenatal detection
of Down's
syndrome, the risk of which rises with
age, especially after
35. Despite its additional costs, the
test was introduced on
the assumption that it can detect around
two thirds of all
affected pregnancies compared with less
than a third on the
basis of age alone.
David Howe and colleagues from the Wessex
Maternal and
Fetal Medicine Unit at the Princess Anne
Hospital,
Southampton, assessed the antenatal detection
rate of
Down's syndrome among all women booked
for delivery at
the hospital over six years up to the
end of 1998. Screening
for Down's at the hospital is based primarily
on older age,
with amniocentesis offered to women 35
years and older. All
women are also routinely offered an ultrasound
scan at 19
weeks, followed by invasive testing, such
as amniocentesis, if
indicated by the scan.
Fifty seven cases of Down's syndrome were
detected from
among over 31,000 pregnancies' a rate
of 1.7 in 1000 live
births, and equivalent to national figures.
Just over two thirds
of all cases were detected antenatally.
In women below the
age of 35 this rate was 53 per cent, with
most of the cases
detected by scanning.
Although the antenatal detection rate was
lower in younger
women, say the authors, serum screening
is also less effective
in this age group. Among the 17 cases
that were not detected
antenatally, seven of the mothers had
refused invasive testing
and three cases occurred in twin pregnancies,
where serum
screening would not be effective.
None of the arguments advanced for the
introduction of
serum screening, including that it is
cost effective, holds
water, conclude the authors. Worryingly,
they say, serum
screening has not been submitted to the
rigours of a
comparative trial to produce clinical
evidence of its
effectiveness.
Contact:
Dr David Howe, Wessex Maternal and Fetal
Medicine Unit,
Princess Anne Hospital, Southampton.
Email: dth@soton.ac.uk
D.T.Howe@soton.ac.uk
(3) SHORT CHILDREN
MORE LIKELY TO BE BULLIED
AT SCHOOL
(Bullying in school: are short pupils
at risk? Questionnaire
study in a cohort)
http://www.bmj.com/cgi/content/full/320/7235/612
Short children are more likely than those
of average size to
complain of being bullied at school, suggests
research in this
week's BMJ. But, say Linda Voss and Jean
Mulligan from
University Child Health at Southampton
General Hospital,
teachers report that being short does
not stop short children,
including girls from being bullies themselves.
The team compared two groups of teenagers,
the average
age of whom was 14. Ninety two of them
were short for their
age; 117 were of average height. The children
filled in
questionnaires designed to find out how
often they had been
bullied, and additional information was
gathered from
teachers, parents, and school records.
More short pupils claimed to have been
bullied at some point
in secondary school. Short boys were twice
as likely as their
taller peers to say that they had been
the victims of bullying,
and much more likely to say that bullying
upset them.
Significantly more of the short children
said that bullying had
started in junior school and that they
were still being bullied.
Although short children had as many friends
as their taller
peers, they tended to spend significantly
more break time
alone, which could be either the result
or the cause of their
bullying, say the authors.
Teachers also reported that significantly
more short pupils
were the victims of bullying. But according
to parents, who
reported more bullying than either the
teachers or the children
themselves, a lot of taller children are
also bullied. Among
those of average height, significantly
fewer girls than boys
were bullies. But short girls were as
likely to be bullies as any
of the boys - short or tall.
Contact:
Ms Linda Voss, Child Health, Derriford
Hospital, Plymouth.
Email: linda.voss@phnt.swest.nhs.uk
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