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(2) HEARING
LOSS IN CHILDREN IS HIGHER
THAN PREVIOUSLY
THOUGHT
(3) WHY
DO MORE MEN DIE FROM HEART
DISEASE THAN
WOMEN?
(4) FLAWS
IN NEW ELDERLY CARE
REGULATIONS
MAY PUT PATIENTS AT RISK
(1) MENINGITIS
IN INFANCY LINKED TO
DEVELOPMENTAL PROBLEMS
(Meningitis in infancy in England
and Wales: follow up
at age 5 years)
http://bmj.com/cgi/content/full/323/7312/533
(Editorial: Legacy of bacterial meningitis
in infancy)
http://bmj.com/cgi/content/full/323/7312/523
Children who get meningitis in their first
year of life have
a 10-fold increased risk of severe or
moderate disability
at 5 years of age compared with other
children,
concludes a study in this week's BMJ.
These findings
provide a complete picture of the range
of problems
experienced by children from England and
Wales who
have had meningitis in infancy.
Over 1,700 children who survived an acute
attack of
meningitis between 1985 and 1987 were
identified.
Children of the same age and sex, but
who hadn't had
meningitis, served as a control group.
General
practitioners and parents of children
in both groups
completed a questionnaire about the children's
health
and development. Children were allocated
to one of
four categories of disability, based on
evidence of
developmental problems.
Two per cent of children who survived the
acute attack
died before the age of 5 years. Among
the survivors
there was a 10-fold increase in the risk
of severe or
moderate disability compared with the
control group.
They also had an increased risk of mild
disorders such
as middle ear disease, squint, and behavioural
problems. The researchers also found that
children who
had meningitis as newborns had more health
and
development problems than those infected
after one
month of age. The rates of disability
also varied widely
in children infected with different strains
of bacteria.
In an accompanying editorial, Professor
Keith
Grimwood believes that doctors need not
only to check
vision and hearing after bacterial meningitis
but also to
ensure that caregivers and schoolteachers
are aware of
possible language deficits and problems
understanding
language based material. "Simple educational
interventions may help compensate for
these deficits,
improving academic performance, behaviour
and self
esteem," he concludes.
Contacts:
Helen Bedford, Senior Research Fellow,
Institute of
Child Health, London, UK
Email: h.bedford@ich.ucl.ac.uk
John de Louvois, Director, Public Health
Laboratory
Service, Environmental Surveillance Unit,
London, UK
David Harvey, Professor of Paediatrics
and Neonatal
Medicine, Queen Charlotte's and Chelsea
Hospital,
London, UK
(2) HEARING LOSS
IN CHILDREN IS HIGHER
THAN PREVIOUSLY THOUGHT
(Prevalence of permanent childhood
hearing impairment
in the United Kingdom and implications
for universal
neonatal hearing screening: questionnaire
based
ascertainment study)
http://bmj.com/cgi/content/full/323/7312/536
(Commentary: Universal newborn hearing
screening:
implications for coordinating and
developing services
for deaf and hearing impaired children)
http://bmj.com/cgi/content/full/323/7312/536
(Editorial: Measuring the prevalence
of permanent
childhood hearing impairment)
http://bmj.com/cgi/content/full/323/7312/525
Far more children in the United Kingdom
suffer with
permanent hearing impairment by the age
of 9 years
than previously estimated, find researchers
in this
week's BMJ. This has important implications
for
co-ordinating services for deaf and hearing
impaired
children.
Postal questionnaires were used to identify
over 17,000
children throughout the UK with permanent
hearing
impairment. The level of hearing impairment
increased
until the age of 9 years to a significantly
higher plateau
than previous studies have estimated.
The team
calculated that for every 10 children
with a permanent
hearing impairment detected, another five
to nine
children (50-90%) would develop a hearing
impairment
by the age of 9 years.
These additional children would include
some with
inherited impairments who either miss
hearing screening
as newborns or pass the screening despite
having a
hearing impairment, some who acquire an
impairment
(for example, after meningitis) and others
who develop
late onset or progressive impairments,
explain the
authors.
Unless newborn screening programmes in
the UK
improve, significant numbers of children
will still need to
be diagnosed with each passing year, warn
the authors.
Child audiology services must have the
capacity to
achieve early identification and confirmation
of these
additional cases, they conclude.
Contacts:
Adrian Davis, Epidemiologist, MRC Institute
of Hearing
Research, Nottingham, UK
Email: Adrian@ihr.mrc.ac.uk
Shirley Russ, Assistant Professor of Pediatrics,
Department of Primary Care Pediatrics,
Cedars-Sinai
Medical Center, Los Angeles, USA
Email: shirlyruss@aol.com
(3) WHY DO MORE
MEN DIE FROM HEART
DISEASE THAN WOMEN?
(Sex matters: secular and geographical
trends in sex
differences in coronary heart disease
mortality)
http://bmj.com/cgi/content/full/323/7312/541
In most industrialised countries more men
die from
coronary heart disease than women but
what causes
these sex differences?
The most widely accepted explanation is
that the
hormone oestrogen protects women, yet
a study in this
week's BMJ suggests that sex differences
are largely
the result of environmental factors. If
so, it may be
possible to reduce deaths in men to levels
similar to
those found in women.
Using several national and international
data sources,
researchers at Bristol University examined
trends in
deaths from coronary heart disease in
men and women
from different countries. From 1949, in
England and
Wales, these trends show a marked increase
of deaths
among men, peaking in the early 1970s.
Rates in
women over the same period were stable
or declined.
Similar trends were seen in Australia,
France, Sweden,
and the United States.
A protective effect of oestrogen alone
cannot explain
these trends because it is inconceivable
that levels of
oestrogen in women have changed dramatically
over the
past century or vary greatly among women
of different
countries, say the authors. Instead, they
are largely the
result of environmental factors that affect
only men.
Understanding more about the factors that
cause the
sex differences in deaths from coronary
heart disease
has important public health implications,
particularly in
countries or parts of countries where
death rates for
coronary heart disease are currently increasing,
they
conclude.
Contact:
Debbie Lawlor, Lecturer in Epidemiology
and Public
Health Medicine, Department of Social
Medicine,
University of Bristol, UK
Email: D.A.Lawlor@bristol.ac.uk
(4) FLAWS IN NEW
ELDERLY CARE
REGULATIONS MAY PUT PATIENTS AT RISK
(Caring for older people in the private
sector in
England)
http://bmj.com/cgi/content/full/323/7312/566
The regulatory system that is supposed
to protect
private nursing home residents in England
and Wales is
flawed because of compromises made by
the
government, suggest researchers at University
College
London in this week's BMJ.
As over half of the healthcare beds in
the United
Kingdom are in independent nursing homes
for older
people, adequate staffing, monitoring,
enforcement, and
accountability are key to delivering good
quality care,
they write.
Under new legislation, which comes into
force in
England and Scotland in 2002, responsibility
for
registering and inspecting homes and enforcing
regulations will be transferred to the
National Care
Standards Commission in England, the National
Assembly for Wales, and the Scottish Commission
for
the Regulation of Care. Yet, since the
mid-1980s the
number of places in nursing homes in England
has
increased sevenfold but the number of
inspectors has
only tripled. Furthermore, little attention
has been paid
to what structures and mechanisms will
be required to
ensure high quality care and accountability
to users.
In particular the government has failed
to stipulate
national minimum standards in the key
area of staffing
against all the international evidence.
A Treasury commissioned report recently
highlighted
the difficulty for accounting for public
funds when care
is provided by the private sector and
the need for
government to put in place robust mechanisms
to
safeguard all clients and those on behalf
of whom it is
commissioning services. The paper highlights
the
absence of information on and monitoring
of the
healthcare needs of some 500,000 vulnerable
residents
in care homes.
International evidence shows that public
information on
quality of care, staffing and good systems
for public
accountability are essential to help prevent
the risk of
regulators and government being pressurised,
captured
and paralysed by the private sector industry.
If new regulations are to protect patients,
they must be
strengthened to ensure that frail and
vulnerable elderly
people are not at increased risk of neglect
and poor
quality care, they conclude.
Contact:
Allyson Pollock, Professor, School of Public
Policy,
University College London, UK
Email: allyson.pollock@ucl.ac.uk
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