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(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?
(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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