Releases Saturday 14 October 2000
No 7266 Volume 321
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(1) PARACETAMOL RESTRICTIONS REDUCE
OVERDOSE SEVERITY
(2) INFANT IMMUNISATION: NEEDLE SIZE MATTERS
(3) SPEECH
AND LANGUAGE THERAPY HAS LITTLE
IMPACT FOR
PRESCHOOL CHILDREN
(4) ONLY
AN "ARMS CONTROL CONVENTION" WILL
STOP CIGARETTE
SMUGGLING
(5) NHS
CAN LEARN FROM CANADIAN WALK-IN
CENTRES
(1) PARACETAMOL RESTRICTIONS REDUCE
OVERDOSE SEVERITY
(Severity of overdose after restriction
of paracetamol
availability: retrospective study)
http://bmj.com/cgi/content/full/321/7266/926
Limiting the number of paracetamol tablets
in a single packet
has reduced the amount taken in single
overdoses, but not the
level of severe liver failure, according
to a study in this week's
BMJ.
Researchers in Belfast identified patients
admitted to hospital
with paracetamol poisoning during the
months January to
June in 1998 and 1999 - before and after
the change to
smaller packets in September 1998. For
each case, they
estimated the amount of paracetamol ingested,
recorded the
numbers of patients transferred to a specialist
liver unit and
deaths related to paracetamol overdose.
Although the amount of paracetamol ingested
was
significantly lower during the second
study period (8 grams in
1999, compared to 10 grams in 1998), the
authors found no
reduction in the number of severe paracetamol
overdoses.
Two patients were transferred to a specialist
liver unit in 1998
and three in 1999. In 1998 neither patient
required liver
transplantation and both made a full recovery.
However, in
1999 only one patient recovered completely;
one died and
one received a liver transplant.
Restricting the availability of paracetamol
has changed
overdose behaviour, say the authors, but
paracetamol
overdose remains the most common cause
of severe liver
failure, they conclude.
Contact:
Professor G Dennis Johnston, Department
of Therapeutics
and Pharmacology, Queen's University of
Belfast, Northern
Ireland
Email: g.d.johnston{at}qub.ac.uk
(2) INFANT IMMUNISATION: NEEDLE SIZE MATTERS
(Effect of needle length on incidence
of local reactions to
routine immunisation in infants
aged 4 months: randomised
controlled trial)
http://bmj.com/cgi/content/full/321/7266/931
Using longer needles to immunise infants
causes less redness,
swelling and tenderness, according to
research in this week's
BMJ. The study calls for vaccine manufacturers
to review
their policy of supplying a shorter needle
in vaccine packs.
Researchers in Oxford recruited 119 healthy
infants, aged
four months old, attending routine immunisation
clinics. Infants
were randomly immunised either with a
25 gauge, 16mm
needle or a 23 gauge, 25mm needle - both
commonly used in
general practice. Local reactions, such
as redness, swelling
and tenderness were recorded for three
days after
immunisation.
The authors found that both redness and
swelling were
significantly reduced when the longer
needle was used. Rate
of redness with the longer needle was
initially two thirds the
rate with the smaller needle, and by the
third day this had
decreased further to a seventh. Rate of
swelling with the
longer needle was initially about a third
that with the smaller
needle, and this difference remained for
all three days. The
overall local reaction rate was 62% for
the longer needle,
compared to 84% for the shorter needle.
Any factor that can reduce the rates of
adverse reactions in
childhood vaccinations has the potential
to improve parental
acceptance of vaccines and would be welcomed
by
practitioners, say the authors. They call
on vaccine
manufacturers to supply longer needles
for routine
vaccinations in the UK.
Contact:
Linda Diggle, Senior Research Nurse, Oxford
Vaccine
Group, John Radcliffe Hospital, Oxford,
UK
Email: linda.diggle{at}paediatrics.oxford.ac.uk
(3) SPEECH AND
LANGUAGE THERAPY HAS LITTLE
IMPACT FOR PRESCHOOL CHILDREN
(Randomised controlled trial of community
based
speech and
language therapy in preschool children)
http://bmj.com/cgi/content/full/321/7266/923
(Editorial: Treating children with
speech and language
impairments)
http://bmj.com/cgi/content/full/321/7266/908
The effectiveness of speech and language
therapy compared
with "watchful waiting" for preschool
children is called into
question in this week's BMJ. The study
suggests that
providers of speech and language therapy
services should
reconsider the therapy offered to preschool
children.
Glogowska and colleagues identified 159
preschool children
with speech or language difficulties.
The children were
randomised to receive one-to-one therapy
or to "watchful
waiting" over a period of 12 months. The
authors found that
therapy was not effective compared with
watchful waiting
and, after one year, 70% of all the children
in the study still
had substantial speech and language deficits.
Despite some limitations, this trial is
by far the largest to date
investigating the effectiveness of speech
and language therapy
in preschool children. Such a low rate
of resolution of
difficulties for most of the children
suggests that further
research is needed to identify effective
ways of helping these
children, conclude the authors.
In an accompanying editorial, Gina Conti-Ramsden
and
James Law argue that there are some features
of this study
that should be interpreted with caution.
For instance, the
authors point out that the children spent
on average just six
hours with their therapist in 12 months.
Offering limited
amounts of speech and language therapy
is not a tenable
solution to the problem, they say. A reorganisation
of speech
and language therapy services is required
to enable therapists
to offer a more flexible package of interventions
to children in
the UK, they conclude.
Contacts:
[Paper] Sue Roulstone, Clinical Research
Director, Speech
and Language Therapy Research Unit, Frenchay
Hospital,
Bristol, UK
Email: sue{at}speech-therapy.org.uk
[Editorial] Gina Conti-Ramsden, Professor
of Child
Language and Learning, University of Manchester,
UK
Email: gina.conti-ramsden{at}man.ac.uk
James Law, Reader in Language and Communication
Science, City University, London, UK
Email: j.c.law{at}city.ac.uk
(4) ONLY AN "ARMS
CONTROL CONVENTION" WILL
STOP CIGARETTE SMUGGLING
(How can cigarette smuggling be reduced?)
http://bmj.com/cgi/content/full/321/7266/947
Cigarette smuggling is getting out of control.
Around one third
of global exports are estimated to disappear
into the
contraband market. But the only real way
to stop cigarette
smuggling is for a convention, similar
to that used to try to
control international arms trade, suggest
Luk Joossens and
Martin Raw in this week's BMJ.
They report that cigarette smuggling occurs
in all parts of the
world - even in regions were taxes are
low - and believe that
the true beneficiaries of smuggling are
the tobacco
manufacturers themselves.
The tobacco industry argues that smuggling
is the result of
large price differences between countries
where cigarettes are
expensive, and those where they are cheap,
creating a market
for smuggled cigarettes in the 'expensive'
countries. However,
say the authors, Western Europe has the
highest prices in the
world, but less smuggling than in other
regions.
The tobacco industry's solution " to reduce
taxes � would
thus be disastrous, since it doesn't address
the real cause of
smuggling � large scale fraud rather than
"market forces". In
Canada, where taxes were reduced because
of concern
about smuggling, the result was increased
consumption and a
fall in tax revenue.
Lessons from other countries show that
the solution to
combat smuggling is not to decrease taxes,
but to reduce the
supply of illegal cigarettes at the international
level, say the
authors. For instance, in 1997, close
collaboration between
the authorities in Spain, France, Britain,
Ireland and Andorra
successfully reduced the supply of smuggled
cigarettes from
Andorra.
The authors argue that only a protocol
on tobacco smuggling,
as part of an international convention
on tobacco control, will
address the true cause of smuggling. Given
the clear incentive
of the tobacco industry to make cigarettes
available for
smuggling, a real crackdown on smuggling
will require control
of cigarette transit at international
level, they conclude, much
like arms control.
Contacts:
Luk Joossens, Consultant, International
Union Against
Cancer, Brussels, Belgium Tel (until 14.30
hrs Wednesday
11 October): +32 2 547 0671 or +32 2 230
2027 (at all
other times) Email: joossens@globalink.org
Martin Raw, Honorary Senior Lecturer, Guy's
King's and St
Thomas's School of Medicine, University
of London, UK
Email: martin{at}rawdata.demon.co.uk
(5) NHS CAN LEARN
FROM CANADIAN WALK-IN
CENTRES
(Walk-in primary medical care centres:
lessons
from Canada)
http://bmj.com/cgi/content/full/321/7266/928
(Editorial: The place of walk-in
clinics in healthcare systems)
http://bmj.com/cgi/content/full/321/7266/909
Canada's walk-in centres and after hours
clinics � doctor led
services introduced over two decades ago
- provide useful
lessons for those embarking on a similar
exercise for the
National Health Service in the UK, and
are reviewed in this
week's BMJ.
Melvyn Jones of University College London
analysed over
20 studies and found that use of walk-in
centres was high,
with over a quarter (27%) of patients
having visited in the
past six months. However, continuity of
health care was one
of the main concerns. Only 47% of Toronto
clinics routinely
informed the patient's general practitioner
of the attendance.
In one study, 79% of patients attending
these centres had a
regular doctor, yet 75% had not tried
to contact them.
The most common reasons for attending walk-in
centres
included convenient location and opening
hours. Patients
were mainly under 35 and children with
minor medical
conditions, such as chest infections,
reports the author.
Centres accounted for 3% of total primary
care health
expenditure, which is surprisingly low,
says the author.
Despite concerns about quality of care
by some general
practitioners, the future of walk-in centres
seems assured,
says the author. It seems certain that
the growing strength of
these clinics "will challenge all doctors
to meet the demand for
a more convenient service." However, it
is unclear how
applicable these findings will be to the
nurse led services in
the United Kingdom, he concludes.
Contact:
Melvyn Jones, Lecturer in General Practice,
Royal Free and
University College Medical Schools, University
College
London, UK
Email: melvyn.jones{at}ucl.ac.uk
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(http://www.eurekalert.org)
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