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(2) EATING
MORE OFTEN CAN REDUCE
CHOLESTEROL
LEVELS
(3) FAT
CHILDREN DO NOT NECESSARILY
BECOME FAT
ADULTS
(4) IS
NICE PROVIDING FASTER ACCESS TO
MODERN TREATMENTS?
(5) INFERTILITY
CLINICS ARE BIASED AGAINST
PATIENTS WITH
HIV
(6) ANOTHER
NHS REORGANISATION "CAN
ONLY WORSEN
THE SERVICE"
(1) THIN BABIES
ARE VULNERABLE TO HEART
DISEASE IF THEY ARE POOR AS ADULTS
(Size at birth and resilience to
effects of poor living
conditions in adult life: longitudinal
study)
http://bmj.com/cgi/content/full/323/7324/1273
(Editorial: Aetiology of coronary
heart disease)
http://bmj.com/cgi/content/full/323/7324/1261
Men who are thin at birth and have poor
living
standards in adult life are at highest
risk of coronary
heart disease, finds a study in this week's
BMJ.
Professor David Barker, and colleagues
in Finland,
followed a large group of men born in
a Helsinki
hospital during 1934-44. As expected,
they found that
men who had low social class or low household
income
had higher rates of coronary heart disease.
These
effects, however, were confined to men
who were thin
at birth, but then rapidly gained weight
during
childhood. Men who were not thin at birth
could
withstand the later effects of poor living
standards.
Improvements in fetal, infant, and child
growth may
prevent coronary heart disease in the
next generation by
improving the body's fitness and making
it resilient to
later social adversity, conclude the authors.
The most interesting finding of this paper
is the
interaction between childhood and adult
conditions,
writes Professor Michael Marmot in an
accompanying
editorial. In showing the importance of
early life
conditions, adult conditions, and their
interaction, this
paper reinforces the call to look at the
influence of
conditions throughout life in determining
social
inequalities in disease in adulthood,
he concludes.
Contacts:
Paper: David Barker, Director, Medical
Research
Council Environmental Epidemiology Unit,
University of
Southampton, UK
Email: djpb@mrc.soton.ac.uk
or
Johan Eriksson, National Public Health
Institute,
Helsinki, Finland
Email: johan.eriksson@ktl.fi
Editorial: Michael Marmot, Professor, International
Centre for Health and Society, Department
of
Epidemiology and Public Health, University
College
London, UK
Email: m.marmot@ucl.ac.uk
(2) EATING MORE
OFTEN CAN REDUCE
CHOLESTEROL LEVELS
(Frequency of eating and concentrations
of serum
cholesterol in the Norfolk population
of the European
prospective investigation into cancer
(EPIC-Norfolk):
cross sectional study)
http://bmj.com/cgi/content/full/323/7324/1286
Eating frequently is associated with lower
blood
cholesterol concentrations, finds a study
in this week's
BMJ, suggesting that we need to consider
not just what
we eat but how often we eat.
Over 14,000 men and women aged 45-75 years
were
asked "How many times a day do you eat
including
meals, snacks, biscuits with coffee breaks
etc?"
Participants were then classified into
five categories of
eating frequency and concentrations of
blood fats
(lipids) were measured.
Cholesterol concentrations were approximately
5%
lower in men and women who ate six or
more times a
day compared with those who ate once or
twice a day,
despite higher intakes of energy, including
fat, in people
who reported eating more frequently. This
association
was still present after accounting for
body mass index,
physical activity, cigarette smoking,
and dietary intake.
Although not large, this difference in
cholesterol
concentration is comparable to that achieved
in studies
involving alteration of intake of dietary
fat or
cholesterol. It is also associated with
reductions in
coronary heart disease ranging from 10%
to 21%, say
the authors.
If applied population-wide, such reductions
might have
a substantial impact, particularly in
older people, who
have higher rates of heart disease, they
conclude.
Contact:
Kay-Tee Khaw, Professor of Clinical Gerontology,
Institute of Public Health, University
of Cambridge, UK
Email: kk101@medschl.cam.ac.uk
(3) FAT CHILDREN
DO NOT NECESSARILY
BECOME FAT ADULTS
(Implications of childhood obesity
for adult health:
findings from thousand families
cohort study)
http://bmj.com/cgi/content/full/323/7324/1280
Most fat adults are not overweight as children,
concludes a study in this week's BMJ,
casting doubt on
the widespread popular belief that fat
children become
fat adults.
Researchers at the University of Newcastle
upon Tyne
used detailed information collected on
412 people from
birth until the age of 50 to establish
whether being
overweight in childhood increases adult
obesity and risk
of disease.
They found that, although overweight teenagers
were
more likely to become fat adults, most
fat adults were
not overweight as children and those thin
in childhood
were not protected from obesity as adults.
In fact, those
thinnest in childhood who went on to be
fat adults
experienced the most adverse consequences.
Current concerns about rising rates of
overweight in
children hinge on the assumption that
fat children are
more likely to become fat adults. "Our
data suggest a
much less deterministic situation," say
the authors. As
such, large-scale measures to reduce body
mass index
in childhood may not benefit adult health,
they conclude.
Contact:
Charlotte Wright, Senior Lecturer in Community
Child
Health, Yorkhill Hospitals Glasgow, Scotland
Email: charlotte.wright@clinmed.gla.ac.uk
(from Fri 30 Nov):
Email: C.M.Wright@Newcastle.ac.uk
(4) IS NICE PROVIDING
FASTER ACCESS TO
MODERN TREATMENTS?
(NICE: faster access to modern treatments?
Analysis of
guidance on health technologies)
http://bmj.com/cgi/content/full/323/7324/1300
Despite the hostile publicity it receives
when it tries to
deny new drugs, the National Institute
for Clinical
Excellence (NICE) approves many more treatments
than it bans, at a net cost to the NHS
of around £200m,
according to James Raftery, Professor
of Health
Economics, in this week's BMJ.
He reviewed NICE's published guidance on
health
technologies up to March 2001 against
three set
criteria: clinical benefits, cost per
quality adjusted life
year (QALY), and impact of cost on NHS.
Of the 22 technologies on which NICE had
issued
guidance by March 2001, three were not
recommended (with a change of judgement
on the new
flu drug, zanamivir). The guidance recommending
use of
the other 19 technologies all cited evidence
of clinical
benefits, while only around half cited
cost per QALY.
This suggests that economics had a lesser
role than
evidence of clinical benefits, says the
author.
Many of its recommendations specified conditions
for
use, such as subgroups of patients most
likely to benefit,
which have generally helped keep the cost
per QALY
below £30,000, adds the author.
For example, the
provisional recommendation against the
use of beta
interferons and glatiramer for multiple
sclerosis cited
their high cost per QALY (£40,000
to £90,000).
The combined net cost of these 22 judgements
was
£200m-£214m or around 0.5%
of annual NHS
spending in England and Wales.
Overall, however, NICE's guidance recommending
use
of most technologies appraised will arguably
lead to
"faster and more uniform access" to these
technologies
rather than to denial access, he concludes.
Contact:
James Raftery, Professor of Health Economics,
School
of Public Policy, University of Birmingham,
UK
Email: J.P.Raftery@bham.ac.uk
(5) INFERTILITY
CLINICS ARE BIASED AGAINST
PATIENTS WITH HIV
(Access to infertility investigations
and treatment in
couples infected with HIV: questionnaire
study)
http://bmj.com/cgi/content/full/323/7324/1285
Infertility clinics are biased against
patients infected with
HIV, finds a study in this week's BMJ.
All 75 clinics providing assisted conception
in Britain
were surveyed regarding their policy on
treating patients
infected with HIV. Of 57 responses, 41
units (72%)
had a policy on treating patients infected
with HIV,
although most (61%) of these had not seen
a patient
infected with HIV in the previous year.
Units that had seen patients infected with
HIV in the
past year were more likely than units
that had not to
investigate or to offer treatment when
the man was
infected with HIV. The same trend was
not seen when
the woman or both partners were infected
with HIV.
The Human Fertilisation and Embryology
Act 1990
requires the welfare of the child to be
taken into
account before treatment starts, but it
does not exclude
any category of woman from being considered
for
infertility treatment. A blanket refusal
to provide
infertility investigations and treatment
to couples infected
with HIV may lead to an increase of uninfected
partners
becoming HIV positive while trying to
conceive
naturally.
Not all patients infected with HIV will
be suitable for
infertility treatment, but whether couples
are offered
assisted conception in Britain is a lottery,
as there are
no established guidelines, say the authors.
Centres
offering assisted conception should have
a less
restrictive attitude towards patients
infected with HIV,
they conclude.
Contact:
Ade Apoola, Specialist Registrar, Whittall
Street Clinic,
Birmingham, UK
Email: apoola@yahoo.com
(6) ANOTHER NHS
REORGANISATION "CAN
ONLY WORSEN THE SERVICE"
(Editorial: The "redisorganisation"
of the NHS)
http://bmj.com/cgi/content/full/323/7324/1262
The government's latest NHS reorganisation
- the
largest, and least debated, reorganisation
of the NHS
for two decades - can only worsen the
service, argue
researchers in this week's BMJ.
Ministers talk of the language of empowerment,
devolution, collaboration, and support,
but they display
an unforgiving, top down command and control
style of
management in which unrealistic targets
and objectives
are showered down on managers, who are
left feeling
undermined and undervalued, they write.
If managers are to lead the radical changes
to services
demanded by the NHS plan, they need time
and space
in which to acquire new skills such as
developing and
implementing care pathways and changing
the nature of
professional work. Instead they struggle
in a macho
climate that demands instant delivery.
What is required is a fundamental rethinking
of the
relationship between central government
and the NHS,
say the authors. The answer could lie
in a move to
regional government, with the NHS being
transferred to
the control of bodies like the Spanish
regions or the
Swedish county councils.
The price to be paid may be greater local
variation and
diversity, but given that this already
exists between the
four countries within the United Kingdom,
surely this is
a price worth paying, they conclude.
Contacts:
Judith Smith, Senior Lecturer, Health Services
Management Centre, University of Birmingham,
UK
Email: j.a.smith.20@bham.ac.uk
Dr Kieran Walshe, Senior Research Fellow,
Health
Services Management Centre, University
of
Birmingham, UK
Email: k.m.j.walshe@bham.ac.uk
Professor David Hunter, Professor of Health
Policy and
Management, University of Durham, UK
Email: d.j.hunter@durham.ac.uk
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