bmj.com -- Press Releases

Releases Saturday 22 July 2000
No 7255 Volume 321

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(1) HOSPITAL RECORDS MAY BE DISTORTING
CANCER STATISTICS

(2) CHILDREN'S HEALTH CARE NEEDS ARE BEING
IGNORED

(3) ARE WE MISINTERPRETING THE scale OF
pOST-TRAUMATIC STRESS?

(1) HOSPITAL RECORDS MAY BE DISTORTING
CANCER STATISTICS

(Effect of improved data collection on breast cancer
incidence and survival: reconciliation of a registry with a
clinical database)
http://bmj.com/cgi/content/full/321/7255/214

Variations in the way breast cancer is registered in hospitals is
leading to missed cases and, as a result, may be distorting
national cancer statistics � currently a principal means of
identifying cancer "black spots" around the county, according
to a study in this week's BMJ.

Researchers in Leicestershire compared breast cancer
records for 1997 at Trent Cancer Registry with a local
hospital database. They found that the recorded date of
diagnosis was, on average, 26 days earlier on the hospital
database than the date of registration, and 70 patients were
assigned to a previous year. By the end of 1998, 134 patients
listed on the hospital database were still not registered.
Therefore, although only 535 breast cancers were recorded
for 1997 at the cancer registry, 599 patients were finally
identified - a 12% increase.

Adding the missing cases to the register increased the level of
cancer and reduced the overall survival in the Trent region
because the missing cases tended to be older with a lower life
expectancy, explain the authors. These findings, they say,
highlight the important influence of data collection on national
cancer statistics, and stress that those who use them must
bear this in mind, particularly when attempting to compare
cancer incidence and survival in different centres and even
countries.

Contact:

Anne Stotter, Consultant Surgeon, Glenfield Hospital NHS
Trust, Leicester LE3 9QP
Email: anne.stotter{at}glenfield-tr.trent.nhs.uk

(2) CHILDREN'S HEALTH CARE NEEDS ARE BEING
IGNORED

(Who is speaking for children and adolescents and for their
health at the policy level?)
http://bmj.com/cgi/content/full/321/7255/229

The government's NHS modernisation plans are ignoring the
fundamental health care needs of children and young people
in England, according to research in this week's BMJ.

A team, led by Professor Aynsley-Green of Great Ormond
Street Hospital for Children and Professor David Hall of the
Royal College of Paediatrics and Child Health, argue that the
health of children and young people is vital for the future
success of our society. Yet, despite this, improving the health
of children is not a key government target.

The authors identify several key areas of neglect �
fragmentation of young people's health services, failure to
charge anyone with the responsibility for children's rights and
interests and a fundamental lack of understanding towards
children's needs. This unsatisfactory position contrasts
starkly with child focused initiatives elsewhere in the UK, they
say. In Scotland, a minister for children has been appointed
and the health of children is one of four new health priorities.
Similarly, children's health issues are at the top of the agenda
in Wales.

If children in England are to benefit from the current NHS
reforms, then several fundamental changes are needed. These
include appointing an independent children's commissioner
for England and developing a national strategy for children's
and young people's health.

With an increasingly older population, the needs of children "
unless made specific" are increasingly likely to be
overlooked, say the authors. They call on the government to
improve the status of children and adolescents in the new
NHS and stress the need for advocacy as the key to
changing attitudes towards this most precious resource in the
long term.

Contacts:

Albert Aynsley-Green, President, Association of Clinical
Professors of Paediatrics, Great Ormond Street Hospital for
Children and the Institute of Child Health, University College
London, London WC1N 1EH
Email: a.aynsley-green{at}ich.ucl.ac.uk

Professor David Hall, President, Royal College of Paediatrics
and Child Health 50 Hallam St London W1N 6DE

(3) ARE WE MISINTERPRETING THE scale OF
pOST-TRAUMATIC STRESS?

(War and mental health: a brief overview)
http://bmj.com/cgi/content/full/321/7255/232

The belief that distress, caused by traumatic experiences
during violent conflicts, is a precursor for psychological
disturbance is called into question in this week's BMJ.

In the third of four BMJ articles looking at conflict and health,
Derek Summerfield, from the Department of Psychiatry at St
George's Hospital, London argues that there is no such thing
as a universal response to highly stressful events. He warns
that labelling the human response to such events as
"post-traumatic stress disorder" - regardless of personal,
social and cultural variables - is a serious distortion, which
may generate large overestimates of the numbers needing
treatment.

Research shows that although some victims do develop
significant psychiatric and social dysfunction, the relation
between traumatic experiences and outcomes is not clearcut.
For instance, in Iraqi asylum seekers in London, poor social
support was more closely related to depression than was a
history of torture. War is not a private experience, says the
author and the social recovery of survivor populations �
rather than medical intervention � should form the major
thrust of humanitarian programmes, he argues.

The scale of mental disorders in developing countries remains
sketchy, says the author. More research is needed on
possible links between chronic illness and unresolved grief or
cultural alienation, the impact of Western psychiatry on
different cultures, and how or why individuals become
psychological casualties. Many questions remain unanswered,
but the complex relation between mental health and culture
means researchers must beware of projecting findings from
one population to another, concludes the author.