Releases Saturday 11 August 2001
No 7308 Volume 323
Please remember to credit the BMJ as source when publicising
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(1) IQ LINKED TO BIRTH WEIGHT EVEN AMONG
CHILDREN OF NORMAL BIRTH WEIGHT
(2) UNITED
KINGDOM RANKED 24th IN HEALTH
SYSTEMS OF
THE WORLD
(3) STUDY
RAISES CONCERNS OVER PUBLICATION
OF UNETHICAL
RESEARCH
(4) SINGLEHANDED
DOCTORS ARE NOT
UNDERPERFORMING
(1) IQ LINKED
TO BIRTH WEIGHT EVEN AMONG
CHILDREN OF NORMAL BIRTH WEIGHT
(Influence of variation in birth
weight within normal range and
within sibships on IQ at age 7 years:
cohort study)
http://bmj.com/cgi/content/full/323/7308/310
Many studies have shown that low birthweight
babies have
lower IQ test scores at school age, but
a study in this week's
BMJ finds that the association between
birthweight and
childhood IQ also applies to children
in the normal range of
birth weight.
Researchers at Columbia University, and
the New York
Academy of Medicine examined the relation
between birth
weight and measured intelligence at age
7 years in over 3000
children, most of whom had birthweight
in the normal range
(2500 grams and above).
They found that, on average, IQ at age
7 years was directly
related to birth weight among these children,
even after factors
such as mother's age, race, education
and socioeconomic
status were taken into account.
The association was stronger in boys than
girls. For example,
a 1000g increase in birth weight related
to a 4.6 increase in IQ
among boys but only 2.8 points in girls.
Unlike most previous
studies of this relationship, the authors
also assessed this
association within sibling pairs, eliminating
the possible effect
of social and economic differences between
families. IQ was
associated with differences in birth weight
between boy sibling
pairs but not girls.
These findings may have important implications
for future
research on the connections between fetal
growth and brain
development, conclude the authors.
Contact:
Thomas Matte, Senior Epidemiologist, Center
for Urban
Epidemiologic Studies, New York Academy
of Medicine,
New York, USA
Email: tmatte{at}nyam.org
(2) UNITED KINGDOM
RANKED 24th IN HEALTH
SYSTEMS OF THE WORLD
(Comparative efficiency of national
health systems: cross
national econometric analysis)
http://bmj.com/cgi/content/full/323/7308/307
(Editorial: Measuring the efficiency
of health systems)
http://bmj.com/cgi/content/full/323/7308/295
Countries with the best levels of health
do not always have
efficient health systems, according to
a study in this week's
BMJ, which ranks the health systems of
the world according
to their efficiency in turning expenditure
into health. The United
Kingdom is ranked 24th out of 191 countries.
Researchers at the World Health Organisation
estimated the
efficiency of health systems in 191 countries,
using data from
1993-1997. After taking account of the
level of education in
the population, they then ranked the health
systems of each
country according to their efficiency
in turning expenditure into
health.
Estimated efficiency varied from nearly
fully efficient to nearly
fully inefficient, implying that although
some countries may be
close to their potential, others are not
reaching anywhere near
maximum levels of health, explain the
authors.
Oman is ranked first, perhaps because it
has drastically
reduced child mortality over the past
40 years, say the
authors. Many other countries performing
best are
characterised by "Mediterranean" diets,
reinforcing the idea
that many different factors affect health.
The United Kingdom
is ranked 24th.
Countries with a history of civil conflict
or high prevalence of
HIV and AIDS were less efficient. Performance
sharply
increased with health expenditure per
capita.
Increasing the resources for health systems
is critical to
improving health in poor countries, but
important gains can be
made in most countries by using existing
resources more
efficiently, they conclude.
Despite its many limitations, the report
has achieved
something, argues Professor Martin McKee
in an
accompanying editorial. It has exhorted
governments to take a
much more active role in promoting health.
It has provided a
useful conceptual framework that begins
to tease out the goals
of health systems, and it has emphasised
the need for a much
better understanding of the undoubted
impact that health
systems have on health.
It has not, however, provided a valid answer
to the question
of whether one system is better than another,
he concludes.
Contacts:
[Paper]: David Evans, Global Programme
on Evidence for
Health Policy, World Health Organisation,
Geneva,
Switzerland
Email: evansd{at}who.int
[Editorial]: Martin McKee, Professor of
European Public
Health, London School of Hygiene and Tropical
Medicine,
London, UK
Email: martin.mckee{at}lshtm.ac.uk
(3) STUDY RAISES
CONCERNS OVER PUBLICATION
OF UNETHICAL RESEARCH
(Failure to report ethical approval
in child health research:
review of published papers)
http://bmj.com/cgi/content/full/323/7308/318
Forty per cent of research papers published
in five American
medical journals failed to report ethical
approval or informed
consent, despite the fact that all journals
explicitly ask authors
to document approval, finds a study in
this week's BMJ. This
raises concerns about the protection of
human participants in
clinical trials.
All research reports relating to child
health published in 1999
in five American medical journals were
reviewed for any
statement about informed consent or ethics
committee
approval. All five journals require studies
with human
participants to report ethical approval.
Of 561 studies, 40%
did not report ethical approval.
Investigators may have failed to obtain
and report ethical
approval because of confusion about the
requirements,
suggest the authors. Alternatively, some
researchers may have
deliberately disregarded ethical approval
standards and laws.
Such occurrences are likely to be rare,
but they are not
inconceivable, they add.
Protecting participants in clinical research
is, and must remain,
one of the highest priorities of medicine,
say the authors. They
recommend that medical journals can play
a greater role in
protecting human participants by ensuring
that every research
study includes a statement regarding human
subjects and any
reasons for exemption are provided.
Contact:
Howard Bauchner, Child and Adolescent Health
Scholar,
Agency for Healthcare Research and Quality,
Rockville, MD,
USA
Email: howard.bauchner{at}bmc.org
(4) SINGLEHANDED
DOCTORS ARE NOT
UNDERPERFORMING
(Do single handed practices offer
poorer care?: cross
sectional survey of processes and
outcomes)
http://bmj.com/cgi/content/full/323/7308/320
Singlehanded general practitioners in the
United Kingdom are
not underperforming clinically, despite
government concerns
about professional isolation and quality
standards, finds a
study in this week's BMJ.
Researchers compared the performance of
206 singlehanded
practices and 606 group practices in the
Trent region of the
United Kingdom using information on hospital
admissions and
achievement of clinical targets within
the practice. The team
found important differences for three
types of hospital
admission. However, after taking other
practice characteristics
into account - such as level of deprivation,
the percentage of
black and Asian residents and the proportion
of patients over
75 years - there were no remaining substantial
differences.
We have found no evidence in this study
that singlehanded
general practitioners are underperforming
clinically, say the
authors. Despite some important limitations,
the results offer
insight into the structural differences
between the two types of
practice and underline the importance
of other practice
characteristics such as deprivation, they
conclude.
Contact:
Julia Hippisley-Cox, Senior Lecturer in
General Practice,
Nottingham University, Nottingham, UK
Email: julia.hippisley-cox{at}nottingham.ac.uk
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