Releases Saturday 24 November 2001
No 7323 Volume 323
Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(1) NIGHT SHIFTS IMPAIR SURGICAL DEXTERITY
(2) CONCERNS
RAISED OVER POLICY TO ADD
FOLIC ACID
TO FLOUR
(3) MEASURES
NEEDED TO REDUCE
BLOODBORNE
INFECTIONS IN IRISH
PRISONS
(4) PRE--ECLAMPSIA
LINKED TO HEART DISEASE
LATER IN LIFE
(5) GENETIC
DIAGNOSIS "WILL HAVE FEW
SOCIAL CONSEQUENCES"
(1) NIGHT SHIFTS IMPAIR SURGICAL DEXTERITY
(Laparoscopic performance after one
night on call in a
surgical department: prospective
study)
http://bmj.com/cgi/content/full/323/7323/1222
One night on call in a surgical department
affects a
surgeon's ability to perform laparoscopy
(examination
of the interior of the abdomen using a
specialised
viewing instrument), finds a study in
this week's BMJ.
All 14 surgeons (11 men and three women)
in training
at teaching hospital in Denmark participated
in the
study. A night shift started at 3.30pm
and finished at
9am the following day. All trainees had
similar, limited
experience in laparoscopic surgery.
Using a virtual reality surgical trainer,
all participants
performed nine repetitions of six tasks.
The
laparoscopic surgical skills of the 14
trainees were
assessed on the 10th repetition of the
task, which was
performed during normal daytime working
hours and
again at 9.30am after a night on call
with impaired
sleep. The average total sleep time during
the night on
call was 1.5 hours.
Surgeons showed impaired speed and accuracy
in
simulated laparoscopic performance after
a night on
call, suggesting that significant deficits
in psychomotor
performance occur after 17 hours on call
with disturbed
night sleep, say the authors. Factors
connected with
surgical work, such as emergency workload,
stress, and
emotional demands, may potentiate the
effects of sleep
deprivation alone, they add.
"Further studies should determine how long
it takes for
surgeons' laparoscopic performance to
recover after an
extended period on duty and should be
aimed at
developing and evaluating countermeasures
that can
maximise alertness and reduce fatigue,"
they conclude.
Contact:
Teodor Grantcharov, Research Fellow, Aarhus
University, Kommunehospitalet, Aarhus,
Denmark
Email: ttgrant{at}dadlnet.dk
(2) CONCERNS RAISED
OVER POLICY TO ADD
FOLIC ACID TO FLOUR
(Editorial: Fortification of flour
with folic acid)
http://bmj.com/cgi/content/full/323/7323/1198
A UK Department of Health committee has
now
recommended universal fortification of
flour with folic
acid to reduce the level of neural tube
defects. Yet
researchers in this week's BMJ warn that
we need to
be cautious before introducing such a
policy.
Although the benefits of supplementation
are clear, the
possible harms of such a policy are not,
as there is no
trial evidence of the efficacy and safety
of the
intervention, write child health experts,
Brian Wharton
and Ian Booth.
In the United States, a 19% reduction in
the prevalence
of neural tube defects has been reported
following folic
acid fortification of grain products.
However, this
reduction is less than half that seen
in England and
Wales in the 1980s without a fortification
programme.
These data are hardly a substitute for
a controlled field
trial, they argue.
Furthermore, mandatory and universal fortification
does
not, at present, need the same trial evidence
as for a
drug. Yet a drug is not given in imprecise
doses to all
members of the population without choice
or indication,
they add.
In 1998, 399 pregnancies in England and
Wales were
affected by central nervous system malformation.
Although a field trial would not be easy,
say the authors,
is it acceptable to increase the folic
acid intake of 50
million people to prevent a third to two
thirds of these
affected pregnancies before there is firm
evidence of
efficacy and safety in people who are
not pregnant?
Contacts:
Brian Wharton, Honorary Professor, Institute
of Child
Health, University College London, UK
Email: bwharton{at}ich.ucl.ac.uk
Ian Booth, Professor of Paediatrics and
Child Health,
Institute of Child Health, Birmingham,
UK
Email: i.w.booth{at}bham.ac.uk
(3) MEASURES NEEDED
TO REDUCE
BLOODBORNE INFECTIONS IN IRISH
PRISONS
(Prevalence of antibodies to hepatitis
B, hepatitis C,
and HIV and risk factors in entrants
to Irish prisons)
http://bmj.com/cgi/content/full/323/7323/1209
There is an urgent need for increased infection
control
and harm reduction measures to reduce
the transmission
of hepatitis B and C viruses, and HIV
in Irish prisons,
concludes a study in this week's BMJ.
Between 6 April and 1 May 1999, researchers
visited
five prisons in the Republic of Ireland
daily and
interviewed all those committed within
the previous 48
hours. An oral fluid sample was collected
to determine
the level of antibodies to hepatitis B
and C viruses, and
HIV.
The level of antibodies to hepatitis B,
hepatitis C, and
HIV in prison entrants who had previously
been
imprisoned was similar to that found in
the recent
national survey of Irish prisoners. However,
the level of
these antibodies was much lower in the
third of prison
entrants who had never previously been
in prison.
Only 7% of those entering prison for the
first time had
ever injected drugs, compared with 40%
of those
previously imprisoned. The most important
predictor of
hepatitis antibodies was a history of
injecting drugs, say
the authors. Tattooing in prison was also
an
independent risk factor for hepatitis
C infection in
prisoners who had never used injected
drugs.
Unlike England and Wales, Ireland already
has a
programme of proactive hepatitis B vaccination
in
prisons. However, increased control measures,
such as
offering hepatitis B immunisation to all
prisoners during
committal procedures, could further reduce
rates of
infection in Irish prisons, conclude the
authors.
Contacts:
Jean Long, Lecturer in International Health,
Trinity
College Centre for Health Sciences, Dublin,
Republic of
Ireland
Email: jelong{at}tcd.ie
Shane Allwright, Senior Lecturer in Epidemiology,
Trinity College Centre for Health Sciences,
Dublin,
Republic of Ireland
Email: sllwrght{at}tcd.ie
(4) PRE--ECLAMPSIA
LINKED TO HEART DISEASE
LATER IN LIFE
(Long term mortality of mothers and
fathers after
pre-eclampsia: population based
cohort study)
http://bmj.com/cgi/content/full/323/7323/1213
Genetic factors that increase the risk
of cardiovascular
disease may also be linked to pre-eclampsia
(a serious
condition that can develop during the
second half of a
pregnancy), finds a study in this week's
BMJ.
Researchers in Norway identified 626,272
mothers
whose first delivery was registered between
1967 and
1992. Mothers and fathers were divided
into groups
based on whether the mother had pre-eclampsia
during
the pregnancy and whether the birth was
term or
preterm. Deaths from cardiovascular causes,
cancer,
and stroke in both parents were followed
through to
1992.
Women who had pre-eclampsia and a preterm
delivery
had an eightfold higher risk of death
from
cardiovascular disease compared with women
who did
not have pre-eclampsia and whose pregnancies
went to
term. The long term risk of death was
no higher among
the fathers of the pre-eclamptic pregnancies
than the
fathers of pregnancies in which pre-eclampsia
did not
occur.
These findings are consistent with but
do not prove the
hypothesis that the long term risk of
death from
cardiovascular causes is associated with
a maternal
genetic predisposition to pre-eclampsia,
say the
authors.
"Although our results apply only to relatively
young
women, the implications for the determination
of the
causes of pre-eclampsia and eventually
its prevention
may still be important," say the authors.
With longer
follow up the pattern of risks may become
clearer but
may also change. For instance, it is possible
that the risk
of death in the long term changes with
outcome in
subsequent pregnancies, they conclude.
Contact:
Lorentz Irgens, Professor, Medical Birth
Registry of
Norway, University of Bergen, Haukeland
Hospital,
Bergen, Norway
Email: lorentz.irgens{at}mfr.uib.no
(5) GENETIC DIAGNOSIS
"WILL HAVE FEW
SOCIAL CONSEQUENCES"
(Ethics of using preimplantation
genetic diagnosis to
select a stem cell donor for an
existing person)
http://bmj.com/cgi/content/full/323/7323/1240
Using preimplantation genetic diagnosis
(PGD) to
choose a stem cell donor is unlikely to
cause harm to
anyone and is likely to be beneficial
to some, suggest
researchers in this week's BMJ.
Clinical Genetics Fellow, Robert Boyle,
and Professor
of Medical Ethics, Julian Savulescu, argue
that the
uptake of this procedure will have few
social
consequences and is likely to be a reasonable
use of
limited health resources.
Since the 1980s, over 2,500 cycles of PGD
have been
performed worldwide. A common objection
to using
the procedure for the benefit of a sibling
is that children
conceived in this way are not valued in
their own right.
The authors argue that psychological harm
to the
offspring is unpredictable, unlikely to
occur, and, even if
it did occur, unlikely to be so severe
that it would be
better for that particular child never
to have existed.
Moreover, selection of children on a much
grander
scale is already commonplace. An estimated
18,000
amniocenteses take place annually in Britain,
mainly to
detect chromosomal abnormalities such
as Down
syndrome, they say.
Who is harmed by allowing PGD to be performed
solely for the benefit of a relative,
they ask? Not the
couple who wish to produce an embryo.
Nor the child
who would not otherwise have existed.
Nor the person
who receives the stem cell transplant
that might save his
or her life. We must avoid the trap of
interfering with
individual liberty by preventing such
procedures for no
good reason, simply out of the "genophobia"
that grips
much of society today.
"Some people object to using PGD along
with in vitro
fertilisation for any indication. But
if these procedures
are acceptable, as they are in many countries,
it is
reasonable to use them to both bring a
new person into
the world and to help save an existing
life," they
conclude.
Contact:
Robert Boyle, Paediatric Registrar, Department
of
Paediatrics, Hillingdon Hospital, UK
Email: BobBoyle{at}doctors.org.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)
What's new
Keep updated
Services
Tools
Online poll
Resources
Print issues
