Releases Saturday 10 November 2001
No 7321 Volume 323
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(1) ACTIVE EUTHANASIA AND PHYSICIAN
ASSISTED SUICIDE SHOULD BE LEGALISED
(2) CHICKENPOX
DEATHS IN ADULTS ARE
INCREASING
(3) FOODBORNE
INFECTIONS IN THE HOME
LINKED TO SOCIAL
FUNCTIONS
(4) CURRENT
NHS APPOINTMENT SYSTEMS "ARE
STALE, AT BEST"
(5) INTENSIVE
TREATMENT DOES NOT REDUCE
VIOLENCE IN
PSYCHOTIC PATIENTS
(1) ACTIVE EUTHANASIA
AND PHYSICIAN
ASSISTED SUICIDE SHOULD BE LEGALISED
(Editorial: Why active euthanasia
and physician assisted
suicide should be legalised)
http://bmj.com/cgi/content/full/323/7321/1079
Last month Diane Pretty was refused the
legal right to
choose the circumstances of her own death.
In this
week's BMJ, Professors Len and Lesley
Doyal argue
that this decision is morally wrong and
that the law
should be changed.
If Mrs Pretty was permanently and severely
incompetent, and if her doctors believed
that medical
treatment could provide no benefit because
of her
inability ever to engage in self directed
activity, then
legally they could withdraw life sustaining
treatments.
Yet, she cannot invite them actively to
end her life and
to advise them about how this should be
done.
This decision becomes all the more morally
questionable when we realise that Mrs
Pretty can refuse
life sustaining treatment at any time,
and her doctors are
legally obliged to respect her choice,
say the authors. If
it can be morally right to allow some
competent patients
to die at their own request, then it must
be morally
justified to give them the medical wherewithal
to kill
themselves, they reason.
It is open to debate whether what Mrs Pretty
requires
can best be described as voluntary euthanasia
or
physician assisted suicide, say the authors.
To provide
either of these to appropriate patients
who make a
competent request represents respect for
their
autonomy and their desire to die with
what they
perceive to be dignity, they conclude.
Contact:
Lesley Doyal, Professor in Health and Social
Care,
University of Bristol, Bristol, UK
Email: l.doyal@bristol.ac.uk
(2) CHICKENPOX
DEATHS IN ADULTS ARE
INCREASING
(Deaths from chickenpox in England
and Wales
1995-7: analysis of routine mortality
data)
http://bmj.com/cgi/content/full/323/7321/1091
Chickenpox causes considerable death in
adults and
may be increasing in importance, finds
a study in this
week's BMJ.
Researchers in London reviewed death certificates
from
1995-7 that mentioned "chickenpox" or
"varicella."
Further information was obtained from
the physicians
responsible for the patients to clarify
the diagnosis.
They found that chickenpox accounts for
about 25
deaths annually in England and Wales,
more than from
measles, mumps, whooping cough, and Hib
meningitis
combined. Furthermore, deaths in adults
have been
increasing for at least 30 years and now
81% of deaths
from chickenpox are in adults.
Deaths were twice as common in men as in
women,
add the authors. Men aged 15-44 years
accounted for
almost half the confirmed male deaths
and over a
quarter of all confirmed deaths from chickenpox.
A chickenpox vaccine is available, though
not yet
licensed in the United Kingdom. However,
these results
do not on their own provide sufficient
evidence for mass
vaccination, say the authors. "We need
information not
only on the burden of disease at primary
and secondary
care levels, but also of the effect of
the vaccine on
herpes zoster. We also need to ensure
a high enough
uptake so that the disease does not shift
towards the
older population and a higher mortality,"
they conclude.
Contact:
Professor Norman Noah, London School of
Hygiene
and Tropical Medicine, London, UK
Email: giovanni.orsi@uniroma1.it
(3) FOODBORNE
INFECTIONS IN THE HOME
LINKED TO SOCIAL FUNCTIONS
(General outbreaks of infectious
intestinal diseases
linked with private residences in
England and Wales,
1992-9: questionnaire study)
http://bmj.com/cgi/content/full/323/7321/1097
Although there has been a downward trend
in
outbreaks of infectious intestinal diseases
in the home,
food is the predominant transmitter of
infection, and
seems to be linked to social functions
such as
barbecues and dinner parties, finds a
study in this
week's BMJ.
O'Brien and colleagues analysed recorded
outbreaks of
infectious intestinal diseases in private
households in
England and Wales from 1992 to 1999.
General outbreaks (outbreaks affecting
more than one
household) accounted for 226 (5%) of the
4604
outbreaks reported during the surveillance
period. Of
4602 people affected, 205 (4.5%) were
admitted to
hospital. The risk of hospitalisation
from outbreaks
linked to the home was higher than that
linked with
outbreaks related to other premises.
Food was the predominant transmitter of
infectious
intestinal disease and seemed to occur
when individuals
catered for larger groups than usual ?
for example,
barbecues and dinner parties ? more frequently
than
other modes of transmission were. The
most frequently
reported pathogen was salmonella.
Poultry, desserts containing raw egg, and
egg dishes
were commonly implicated. The most common
faults in
food hygiene were inappropriate storage,
inadequate
cooking, and cross contamination.
The downward trend in general outbreaks
linked with
the home is encouraging and mirrors the
national
decrease in salmonella infection, conclude
the authors.
Contact:
Sarah O'Brien, Consultant Epidemiologist,
Gastrointestinal Diseases Division, Public
Health
Laboratory Service Communicable Disease
Surveillance Centre, London, UK
Email: sobrien@phls.org.uk
(4) CURRENT NHS
APPOINTMENT SYSTEMS "ARE
STALE, AT BEST"
(Editorial: Non-attendance at general
practices and
outpatient clinics)
http://bmj.com/cgi/content/full/323/7321/1081
More flexible appointment systems at NHS
outpatient
clinics and general practices are needed
to reduce rates
of non-attendance, particularly among
deprived
populations, suggest researchers in this
week's BMJ.
Non-attendance at outpatient clinics in
the United
Kingdom are thought to range from 5% to
34% and in
general practices, figures of 3% and 6.5%
have been
reported.
Non-attenders are less likely to own a
car or a
telephone and are more likely to be unemployed.
Patients with lower paid jobs may have
difficulty in
getting time off work or arranging childcare.
These
reasons also partly explain the peak age
range of 20-30
in non-attenders, as this is the usual
age for raising a
family, explain the authors.
The strategy of overbooking appointments
to allow for
anticipated non-attendance may be counterproductive,
say the authors. Not only does 100% attendance
put
pressure on both patients and staff, but
overbooking
means that the appointment time is rarely
met, so
patients have to clear their commitments
for the whole
morning or afternoon. For some people
this is
impossible, and for others the difficulty
may be enough
to tip the balance towards not attending.
Several hospitals have instituted systems
offering
patients a choice of time and date, which
have resulted
in reductions in non-attendance of up
to 60%, say the
authors. However, increasing flexibility
and therefore
the complexity of appointment systems
carries a risk.
For instance, patients who cannot read
English, because
of learning difficulties or cultural background,
may be
disadvantaged with newer systems.
No single solution will work across the
NHS, say the
authors. Local trusts in primary and secondary
care
should be able to devise local systems
to allow
convenient access for their patients.
"If some of these
measures are adopted non-attendance should
fall,
though it will never disappear � we are
all human," they
conclude.
Contact:
Deborah Sharp, Professor of Primary Health
Care,
University of Bristol, UK
Email: debbie.sharp@bris.ac.uk
(5) INTENSIVE
TREATMENT DOES NOT REDUCE
VIOLENCE IN PSYCHOTIC PATIENTS
(Reducing violence in severe mental
illness: randomised
controlled trial of intensive case
management compared
with standard care)
http://bmj.com/cgi/content/full/323/7321/1093
(Editorial: reducing violence in
severe mental illness)
http://bmj.com/cgi/content/full/323/7321/1080
Increasing the intensity of treatment does
not reduce the
level of violence in patients with severe
mental illness,
concludes a study in this week's BMJ.
Walsh and colleagues identified 708 patients
aged
between 18 and 65 with established psychotic
illness in
four inner city mental health services.
Over a two-year
period, 353 patients received intensive
case
management and 355 patients received standard
care.
Physical assault during the study was
measured by
interviews with patients and case managers
and
examination of case notes.
During the two years of the trial, 80 (23%)
of the
intensive case management group and 78
(22%) of the
standard care group committed assault,
representing no
significant difference. Risk factors for
violence included
a history of violence, drug misuse, younger
age,
victimisation, and learning difficulties.
Even after taking
these factors into account, no evidence
that intensive
case management reduced the level of violent
behaviour
was found.
Legislation for compulsory community treatment
in
England and Wales has recently been proposed
in a
government white paper, say the authors.
Future
research should address the question of
whether such
treatment combined with psychosocial support
can be
developed. These need to be effective
in reducing
violence in a core group of mentally disordered
people,
they conclude.
Contact:
Elizabeth Walsh, Clinical Lecturer, Guy's,
King's and St
Thomas's School of Medicine, Institute
of Psychiatry,
London, UK
Email: sppmemw@iop.kcl.ac.uk
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