Releases Saturday 15 July 2000
No 7254 Volume 321
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(1) UNDERCOOKED MEAT IS CHIEF CAUSE OF
PARASITE INFECTION IN PREGNANCY
(2) FAMILY
HISTORY OF HIGH CHOLESTEROL OFTEN
NOT DETECTED
UNTIL MIDDLE AGE
(3) NHS
DIRECT HAS HAD LITTLE IMPACT ON THE
DEMAND FOR
URGENT HEALTH CARE
(4) VIOLENT
DEATHS AMONG RELIEF WORKERS
INCREASING
(1) UNDERCOOKED
MEAT IS CHIEF CAUSE OF
PARASITE INFECTION IN PREGNANCY
(Sources of toxoplasma infection
in pregnant women:
European multicentre case-control
study)
http://bmj.com/cgi/content/full/321/7254/142
(Commentary: congenital toxoplasmosis
� further thought for
food)
http://bmj.com/cgi/content/full/321/7254/142#resp1
Eating undercooked, raw or cured meat during
pregnancy is
the main risk factor for the common parasite
infection -
toxoplasmosis - which can lead to brain
damage in the
unborn child, according to a study in
this week's BMJ.
Researchers interviewed over 1,000 pregnant
women, both
with and without toxoplasma infection,
across six European
cities about their occupations, lifestyle
and eating habits. Their
knowledge about sources of infection was
also assessed. The
authors found that eating raw, undercooked
or cured meat
contributed to between 30% and 63% of
infections. Contact
with soil contributed to up to 17% of
infections and travel
outside Europe or the United States and
Canada was also a
significant risk factor. Weaker associations
were also seen in
women who reported tasting raw meat during
preparation of
meals, drinking unpasteurised milk and
working with animals.
Contact with cats was not a risk factor
for infection.
Interestingly, say the authors, women listed
contact with cats,
eating raw meat and eating raw or unwashed
fruit or
vegetables as the main sources of infection.
Few women
mentioned contact with soil. Despite some
limitations of the
study, the need for preventative strategies
is clear, conclude
the authors. They call for improved quality
and consistency of
information available to pregnant women,
better labelling of
meat according to farming and processing
methods and
improved farm hygiene to reduce infection
in animals.
In an accompanying commentary, Richard
Holliman of St
George's Hospital and Medical School in
London reinforces
the need for preventative strategies "to
reduce the infectivity
of meat products." He believes that
"current health education
may benefit from focus and refinement,
concentrating on the
principal risk factors at the expense
of less important issues"
and concludes "the health implications
of consuming raw,
undercooked or cured meats in pregnancy
require careful
consideration."
Contacts:
[Paper] R E Gilbert, Senior Lecturer in
Clinical
Epidemiology, Department of Paediatric
Epidemiology and
Biostatistics, Institute of Child Health,
London WC1N 1EH
Email: r.gilbert{at}ich.ucl.ac.uk
[Commentary] Richard Holliman, Consultant
and Reader in
Clinical Microbiology, St George's Hospital
and Medical
School, London SW17 0QT
Email: rhollima{at}sghms.ac.uk
(2) FAMILY HISTORY
OF HIGH CHOLESTEROL OFTEN
NOT DETECTED UNTIL MIDDLE AGE
(Extent of underdiagnosis of familial
hypercholesterolaemia in
routine practice: prospective registry
study)
http://bmj.com/cgi/content/full/321/7254/148
Families with a history of high cholesterol
are being denied
early treatment to reduce the risk of
coronary events because
they often remain undetected until middle
age, according to a
study in this week's BMJ.
Using specialist registers and general
practice records,
researchers in Oxfordshire compared the
number of families
identified as having a history of high
cholesterol with the
estimated frequency of the condition.
They found that only
about a quarter of the cases predicted
were diagnosed
routinely, and most remained undiagnosed
until middle age.
Lack of diagnosis was greatest among children
and young
adults: only two children under 10 years
and 12 aged 10-19
years had been identified.
These findings have important implications
for clinical practice
as, in families with a history of high
cholesterol, the risk of a
coronary event by the age of 60 without
effective treatment is
at least 50% in men and about 30% in women.
Underdiagnosis means patients are denied
early treatment to
reduce their risk of coronary events,
say the authors. They
suggest a number of strategies to tackle
this problem, such as
routine testing of patients with early
onset coronary artery
disease and family tracking and testing
by specialist nurses.
Systematic screening of all 16 year olds
may be equally cost
effective, they add.
Contacts:
H A W Neil, Honorary Consultant Physician,
Oxford Centre
for Diabetes, Endocrinology and Metabolism,
Radcliffe
Infirmary, Oxford OX2 6HE
Email: andrew.neil{at}dphpc.ox.ac.uk
D R Matthews, Consultant Physician, Oxford
Centre for
Diabetes, Endocrinology and Metabolism,
Radcliffe
Infirmary, Oxford OX2 6HE
(3) NHS DIRECT
HAS HAD LITTLE IMPACT ON THE
DEMAND FOR URGENT HEALTH CARE
(Impact of NHS Direct on demand for
immediate care:
observational study)
http://bmj.com/cgi/content/full/321/7254/150
During its first year of operation, NHS
Direct had no effect
on the use of emergency care services,
although it may have
restrained the increasing demand for general
practitioner out
of hours services, according to a study
in this week's BMJ.
Researchers in Sheffield University's Medical
Care Research
Unit examined the activity of ambulance
services, accident
and emergency departments and out of hours
general practice
services in the year before and the year
after the introduction
of NHS Direct, across three areas in England.
Overall, NHS
Direct has not "reduced the pressure"
on the NHS as was
hoped when the service was announced in
December 1997.
The authors found no effect on use of
emergency ambulances
or accident and emergency departments,
although NHS
Direct may have restrained the increasing
pressure on general
practitioner out of hours services � from
rising by 2% per
month before the introduction of NHS Direct
to falling by
0.8% afterwards.
The authors warn that observational studies
are open to
different interpretations. For instance,
we can also say that
there is no evidence that NHS Direct has
been associated
with any increase in demand for immediate
care. However, if
NHS Direct "has improved access to health
care for those
who need it," conclude the authors, "then
the fact that this
has been achieved without increasing demand
on other
services seems encouraging."
Contacts:
James Munro, Clinical Senior Lecturer or
Jon Nicholl,
Professor of Health Services Research
Medical Care
Research Unit, University of Sheffield,
Regent Court,
Sheffield S1 4DA
Email: j.f.munro{at}sheffield.ac.uk
(4) VIOLENT DEATHS
AMONG RELIEF WORKERS
INCREASING
(Education and debate: Deaths among
humanitarian workers)
http://bmj.com/cgi/content/full/321/7254/166
Humanitarian workers in areas of conflict
are at ever
increasing risk of death by intentional
violence, according to
new research in this week's BMJ.
Researchers in the United States analysed
cause of death in
humanitarian workers between 1985 and
1998, using records
from aid organisations. During this time
period, deaths due to
intentional violence (involving guns,
bombs, landmines or
other weapons) increased. Of 375 deaths,
68% were as a
result of intentional violence. Overall,
deaths from intentional
violence were most common in 1992-5, when
they
accounted for 75% of all deaths - most
victims died in cross
fire or in cold blood.
Africa accounted for over half of all deaths,
add the authors.
The largest number occurring in Rwanda
and peaking in 1994
during the Rwandan conflict. Since 1994,
reported deaths
among UN staff have decreased whereas
deaths among
workers in non-governmental organisations
have continued to
increase. This may be explained by the
fact that these
organisations often work in small but
intense conflicts, which
may have few UN staff, say the authors.
Continuing to provide assistance in the
midst of violence will
inevitably mean more deaths, conclude
the authors, but
actions can be taken to reduce the toll.
For instance, a clearer
understanding of risks, improved communication
and clear
evacuation plans should all be considered.
Even limiting aid in
high-risk situations is a sensitive, but
potential option, add the
authors.
Contact:
Gilbert Burnham, Director, Center for Refugee
and Disaster
Studies, Johns Hopkins School of Hygiene
and Public Health,
Baltimore, MD 21205, USA
Email: gburnham{at}jhsph.edu
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