Releases Saturday 10 June 2000
No 7249 Volume 320
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://bmj.com).
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) MALE CIRCUMCISION PROTECTS AGAINST HIV
INFECTION
(2) EATING
DISORDERS MORE COMMON AMONG
GIRLS WITH
DIABETES
(3) REPORTED
COSTS OF MEDICAL NEGLIGENCE IN
NHS HOSPITALS
ARE MISLEADING
(1) MALE CIRCUMCISION PROTECTS AGAINST HIV
INFECTION
(How does male circumcision protect
against HIV infection?)
http://bmj.com/cgi/content/full/320/7249/1592
Uncircumcised men are at a much greater
risk of becoming
infected with HIV than circumcised men,
according to new
evidence in this week's BMJ.
Using information from over 40 previous
studies, researchers
in Australia suggest that the virus targets
specific cells found
on the inner surface of the foreskin.
These cells possess HIV
receptors, making this area particularly
susceptible to
infection. The researchers propose that
male circumcision
provides significant protection against
HIV infection by
removing most of the receptors.
The most dramatic evidence of this protective
effect comes
from a new study of couples in Uganda,
where each woman
was HIV positive and her male partner
was not. Over a
period of 30 months, no new infections
occurred among 50
circumcised men, whereas 40 of 137 uncircumcised
men
became infected - even though all couples
were given advice
about preventing infection and free condoms
were available
to them.
Although cultural and religious attitudes
towards male
circumcision are deeply divided, the authors
conclude that, in
the light of the evidence, male circumcision
should be
seriously considered as an additional
means of preventing
HIV in countries with a high level of
infection. Alternatively,
say the authors, the development of "chemical
condoms"
(products which can block HIV receptors
in the penis and the
vagina) might provide a more acceptable
form of HIV
prevention in the future.
Contact:
Professor Roger Short, Department of Obstetrics
and
Gynaecology, University of Melbourne,
Royal Women's
Hospital, 132 Grattan Street, Melbourne
3053, Australia.
(2) EATING DISORDERS
MORE COMMON AMONG
GIRLS WITH DIABETES
(Cross sectional study of prevalence
of eating disorders in
adolescent females with and without
type 1 diabetes)
http://bmj.com/cgi/content/full/320/7249/1563
Eating disorders are almost twice as common
in girls with
type 1 diabetes as in non-diabetic girls
of the same age,
putting them at increased risk of complications,
according to
a study in this week's BMJ.
Canadian researchers surveyed over 1,400
young women
aged between 12 and 19 years about their
attitudes towards
eating. Those with diabetes were 2.4 times
more likely to
have an eating disorder. In total, 10
per cent of girls with
diabetes met the medical criteria for
eating disorders
compared with 4 per cent of non-diabetic
girls. Furthermore,
30 per cent of girls with diabetes reported
binge eating and
11 per cent reported taking less than
their prescribed dose of
insulin in order to lose weight.
Underdosing of insulin is a particular
concern, say the
authors, as it may lead to an earlier
than expected onset of
diabetes-related complications. Indeed,
they suggest that
eating disorders in girls with type 1
diabetes are associated
with about a threefold increase in the
risk of permanent
eyesight damage. The authors conclude
that further study is
needed to determine whether intensive
diabetes treatment
itself could be a risk factor for the
development of eating
disorders in this group.
Contact:
Gary Rodin, Chief Psychiatrist, Department
of Psychiatry,
University Health Network, Ontario, Canada.
Email: Gary.Rodin{at}uhn.on.ca
(3) REPORTED COSTS
OF MEDICAL NEGLIGENCE IN
NHS HOSPITALS ARE MISLEADING
(Current cost of medical negligence
in NHS hospitals:
analysis of claims database)
http://bmj.com/cgi/content/full/320/7249/1567
Although the cost of legal action against
the NHS more than
doubled during the 1990s, it remains far
lower than amounts
reported in the media, according to a
study in this week's
BMJ.
A team led by Paul Fenn at the University
of Nottingham,
analysed all negligence claims within
one health authority over
a number of years, and used this to determine
national trends.
Adjusting for hospital activity, the rate
of closed claims
increased by about 7% per year during
the 1990s - a
substantial rate of growth, say the authors,
but not the
"uncontrolled explosion" often referred
to by the media. They
estimate the total annual cost of clinical
negligence for the
NHS in 1998 was £84 million, with
80 per cent of this
incurred by NHS trusts. Although this
figure does not include
administrative costs, it is still well
below figures quoted in the
press, and represents about one quarter
of 1% of annual
NHS expenditure, add the authors.
Furthermore, the authors regard figures
relating to outstanding
claims - recently reported as £2.8
billion - as a "grossly
misleading indicator" of the costs to
be faced by the NHS.
Many of these claims are unlikely to be
paid or will not be
paid for many years, they argue.
In conclusion, the authors recognise the
importance of clinical
negligence as a clear signal for improving
treatment practices.
However, they argue that such huge discrepancies
circulating
in the wider media illustrates the need
to co-ordinate data
sources to ensure that trends are accurately
monitored.
Contact:
Paul Fenn, Economist, University of Nottingham
Business
School, Nottingham NG7 2RD.
(Patient care: access)
http://bmj.com/cgi/content/full/320/7249/1594
In the fifth of seven BMJ articles on the
modernising of the
NHS, Healthcare Consultant Mark Murray,
looks at delays
in access to care and argues that improving
access involves
determining the demand and applying resources
to match it or
reduce it.
He suggests a number of principles towards
managing
demand and gaining capacity " such as
clearing system
backlogs, reducing the number of queues
and predicting
future demand" and highlights organisations
that have
successfully improved access by adopting
these approaches.
For instance, a primary care group in
Alaska significantly
reduced patient waiting times by adding
extra work with
current staff for six weeks to clear their
backlogs, ensuring
that patients saw their own doctors and
enabling doctors to
do more with each visit, thereby reducing
the demand for
care.
By modifying these principles, specialist
services can also
reduce demand, adds Murray. For example,
partnering with
their referring primary care groups to
clearly define areas of
responsibility for care or ensuring that
specialists perform only
the work that makes them unique in any
system, can help
reduce waiting times and improve overall
clinical care.
Murray argues that these concepts are commonplace
in other
industries, yet "such thinking is long
overdue in health care."
He advocates a fundamental system redesign,
concluding that
"if we don't like the results we have
to change the system -
basically and radically."
Contact:
Mark Murray, healthcare consultant, 2209
Capitol Avenue,
Sacramento, CA 95816, USA.
Email: murraytant{at}email.msn.com
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
