Releases Saturday 3 June 2000
No 7248 Volume 320

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(1) WORRYING RISE IN HIGH RISK SEXUAL
BEHAVIOUR AMONG HOMOSEXUAL MEN

(2) DECLINE IN TEENAGE DRUG USE IN THE UK

(3) STUDY REVEALS POORER SURVIVAL FOR
PATIENTS SUFFERING STROKES WHILE IN
HOSPITAL

(4) MODERNISING THE NHS: WHAT WOULD MAKE A
DIFFERENCE FOR THE PROFESSIONS?




(1) WORRYING RISE IN HIGH RISK SEXUAL
BEHAVIOUR AMONG HOMOSEXUAL MEN

(Increase in high risk sexual behaviour among homosexual
men, London 1996-8: cross sectional, questionnaire study)
http://bmj.com/cgi/content/full/320/7248/1510

(HIV risk behaviour in gay men: on the rise' [Editorial])
http://bmj.com/cgi/content/full/320/7248/1487

The first ever report of an increase in unsafe sex among gay
men in England appears in this week's BMJ, representing a
worrying shift in behaviour twenty years after the start of the
HIV epidemic.

Julie Dodds and colleagues, from the Department of Sexually
Transmitted Diseases at the Royal Free and University
College Medical School, London, suggest that the likelihood
of engaging in high risk sexual behaviour may be increasing as
new treatments reduce concern about infection.

Over a period of three years, more than 6,500 homosexual
men - aged from 15 to 78 years - responded to a
questionnaire about their sexual behaviour. The survey shows
a significant increase in the reporting of unprotected anal
intercourse, particularly among men under the age of 25.
Furthermore, the chance of having unprotected intercourse
with partners whose HIV status was unknown also increased
over the three-year period. These results, say the authors,
highlight the potential for the continuing spread of HIV
infection and conclude that more effective health promotion
initiatives should be implemented.

In an accompanying editorial, Andrew Grulich from the
National Centre in HIV Epidemiology, Sydney, reports
similar trends from the United States and Australia and
suggests that this rise is associated with optimism over new
treatments within gay communities. He argues that, while "the
immediate and overwhelming threat of death from AIDS is no
longer present - current levels of unsafe sexual behaviour may
lead to an increased incidence of HIV infection."

Contacts:

(Paper) Julie P Dodds, Department of Sexually Transmitted
Diseases, Royal Free and University College Medical
School, London WC1E 6AU.
Email: JDodds@gum.ucl.ac.uk

(Editorial) Andrew Grulich, National
Centre in HIV Epidemiology, 376 Victoria St, Darlinghurst,
Sydney, NSW 2010 Australia.
Email: agrulich@nchecr.unsw.edu.au

(2) DECLINE IN TEENAGE DRUG USE IN THE UK

(Drug use has declined among teenagers in the United
Kingdom [Letter])
http://bmj.com/cgi/content/full/320/7248/1536/a

Since 1995, drug use among UK teenagers has undergone
significant decline, according to a letter in this week's BMJ.

Researchers at the Alcohol and Health Research Centre, City
Hospital, Edinburgh questioned 15 and 16 year old students
attending state and private schools across the UK. The
results were compared to a similar survey conducted in 1995.

Girls showed a significant reduction in their use of illicit drugs.
(33 per cent compared to almost 40 per cent in 1995). These
included cannabis, solvents, amphetamines and ecstasy. Boys
also showed similar declines (39.5 per cent compared to 45
per cent in 1995) including a significant fall in the use of crack
cocaine. The only exception to this trend was heroin -
although its use remains rare, say the authors, it had risen in
both sexes.

There were some regional differences. For instance, students
in Scotland were more likely to have used cannabis and
amphetamines and, in Northern Ireland, students reported the
greatest use of glues and solvents. Although these results may
be temporary, they are striking, conclude the authors.

Contact:

Martin Plant, director and Patrick Miller, Senior Research
Fellow, Alcohol and Health Research Centre, City Hospital,
Edinburgh EH10 5SB.
Email: mplant.ahrc@onet.co.uk

(3) STUDY REVEALS POORER SURVIVAL FOR
PATIENTS SUFFERING STROKES WHILE IN
HOSPITAL

(Retrospective case note review of acute and inpatient stroke
outcomes)
http://bmj.com/cgi/content/full/320/7248/1511

Patients who have a stroke while in hospital remain in hospital
longer and are more likely to die in hospital than patients who
are admitted following a stroke, suggests research in this
week's BMJ.

Aly and colleagues from University Hospital Aintree,
Liverpool, compared the outcomes of two groups of patients
- those admitted to hospital with a stroke, and those having a
stroke while in hospital for another reason. Although both
groups were of a similar age and sex, 60 per cent of
inpatients died in hospital compared with 28 per cent of
admitted patients. Inpatients remained in hospital for an
average of 31 days compared to 16 days for admitted
patients, and known stroke risk factors were also less well
documented for inpatients than for admitted patients.

The authors conclude that early identification and more
thorough recording of stroke risk factors by hospital staff may
improve patient survival.

Contact:

Anil Sharma, Aintree Stroke Unit, Department of Medicine
for the Elderly, University Hospital Aintree, Liverpool L9
7AL.
Email: aksharma@aintreestar.u-net.com

(4) MODERNISING THE NHS: WHAT WOULD MAKE A
DIFFERENCE FOR THE PROFESSIONS?

(Modernising the NHS, Challenges to the health services: the
professions)
http://bmj.com/cgi/content/full/320/7248/1533

In the fourth of seven BMJ articles on the modernising of the
NHS, Isobel Allen, Professor of health and social policy at
the Policy Studies Institute, London, looks at the third of five
challenges set out by the prime minister surrounding more
flexible working practices and less demarcation.

Professor Allen points to a number of key areas for the
modernisation action team to address. These include listening
and acting on what the workforce says, introducing more
flexible working and training, and encouraging those who are
committed to leading the modernisation drive. Professor Allen
argues that health professionals are "ready to change" but
that they must be offered the means to implement it. In a
traditionally rigid working environment that has been slow to
embrace change, the first and crucial challenge for the
government will be to acknowledge doctors' commitment
and the vital role they play within the service.

However, there is a risk of pushing the challenges too far,
warns Professor Allen, causing practitioners to lose sight of
their caring role. The challenge to the health service and the
government, concludes the author, "is to balance the
commitment and motivation of people who want to care with
the demands of people who want to live forever."

Contact:

Isobel Allen, Professor of health and social policy, Policy
Studies Institute, London NW1 3SR
Email: i.allen@psi.org.uk


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