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(2) STUDY
SHEDS NEW LIGHT ON LINK
BETWEEN BIRTH
WEIGHT, OBESITY, AND
CHILDHOOD GROWTH
(3) SCHIZOPHRENIA
RISK HIGHEST IN SMALL
ETHNIC GROUPS
(4) PHARMACISTS
CAN CONDUCT EFFECTIVE
CONSULTATIONS
WITH PATIENTS
(5) BRITAIN
NEEDS MORE PREPARATION FOR
RESPONDING
TO PUBLIC HEALTH
EMERGENCIES
(1) BABIES BORN
DURING SHIFT CHANGES ARE
AT HIGHER RISK OF EARLY DEATH
(Timing of birth and infant and early
neonatal mortality
in Sweden 1973-95: longitudinal
birth register study)
http://bmj.com/cgi/content/full/323/7325/1327
Babies born between the hours of 5pm to
1am and
around 9am are at higher risk of early
death, suggesting
that shift changes and the hours immediately
after are
high risk periods for neonatal care, finds
a study in this
week's BMJ.
Using data from the Swedish birth register,
researchers
in Hong Kong analysed over 2 million births
between
1973-95.
Their observations confirm previous reports
that infants
born at night have a greater risk of early
death (in the
first six days) than those born during
the day. They also
found that there has been no improvement
over the past
two decades, and that this problem is
much more
serious for preterm infants. The causes
are not clear,
but may be due to excess workloads, inadequate
or
less experienced staff on night shifts,
or out of date
systems for managing shift changes within
hospitals, they
suggest.
A more in depth analysis over 24 hours
showed that
there were actually two high risk periods
for neonatal
care: 5pm to 1am and around 9am. The first
risk period
started from the end of the normal day
shift and
extended to the midnight shift. The second
one, around
9am, was immediately after day shift staff
were taking
over responsibilities. This pattern indicates
that shift
changes and the hours immediately after
are high risk
periods for neonatal care, say the authors.
The exact reasons are unclear, but better
vigilance and
an improvement in shift changes may be
required to
improve neonatal health care further,
they conclude.
Contact:
J Karlberg, Clinical Trials Centre, University
of Hong
Kong, People's Republic of China
Email: jpekarl@hkucc.hku.hk
(2) STUDY SHEDS
NEW LIGHT ON LINK
BETWEEN BIRTH WEIGHT, OBESITY, AND
CHILDHOOD GROWTH
(Fetal and early life growth and
body mass index from
birth to early adulthood in 1958
British cohort:
longitudinal study)
http://bmj.com/cgi/content/full/323/7325/1331
(Editorial: Adult obesity and growth
in childhood)
http://bmj.com/cgi/content/full/323/7325/1320
BMJ Volume 323, pp 1320-1
Boys who are light at birth, but then grow
rapidly during
childhood, are more likely to be obese
as adults, is just
one of the findings from a large study
in this week's
BMJ. These potentially complex interrelationships
may
hold the key to effective preventive strategies.
Tessa Parsons and colleagues used data
collected from
all children born in England, Scotland,
and Wales in the
week of 3-9 March 1958 to establish whether
birth
weight is related to obesity at different
life stages.
Not surprisingly, they found that heavier
mothers have
heavier babies and these children tend
to become
heavier adults. They also found that rapid
growth in
childhood (up to age 7) increased the
risk of obesity in
adulthood, especially in men who had been
light at birth
or who had thin mothers.
This is an important finding as this pattern
of growth is
becoming common in developing countries
that are
experiencing a nutritional transition
to Western lifestyles,
writes Catherine Law in an accompanying
editorial.
Instead of concentrating research efforts
on developing
drug treatments for established adult
obesity, perhaps
we should use what we know already to
design and
evaluate social, behavioural, or policy
interventions,
which prevent children from becoming overweight,
she
concludes.
Contacts:
Paper: Tessa Parsons, Research Fellow,
Institute of
Child Health, London, UK
Email: t.parsons@ich.ucl.ac.uk
Editorial: Catherine Law, Senior Lecturer,
MRC
Environmental Epidemiology Unit, University
of
Southampton, Southampton, UK
Email: claw@mrc.soton.ac.uk
(3) SCHIZOPHRENIA
RISK HIGHEST IN SMALL
ETHNIC GROUPS
(Incidence of schizophrenia in ethnic
minorities in
London: ecological study into interactions
with
environment)
http://bmj.com/cgi/content/full/323/7325/1336
The rate of schizophrenia among people
from non-white
ethnic groups rises as the proportion
of these groups fall
in the local population, finds a study
in this week's BMJ.
Jane Boydell and colleagues analysed information
on all
people from a defined area of south London
who had
contact with psychiatric services during
1988-97. They
found that the rate of schizophrenia in
non-white ethnic
minorities was highest in those areas
where these
minorities comprised a small proportion
of the
population and lowest where they comprised
a large
proportion.
These findings point towards there being
a social cause
for the increased rate of schizophrenia
reported in
non-white ethnic groups in the United
Kingdom, say the
authors.
Specific stresses for people in ethnic
minority groups
could include overt discrimination, institutionalised
racism, alienation, and isolation. The
more isolated a
member of an ethnic minority, the more
likely he or she
may be to encounter such stresses. People
from ethnic
minorities may also be more likely to
be singled out or
be more vulnerable when they are in a
small minority,
say the authors.
Reduced protection from the effects of
such stresses
could be due to decreased social networks
or social
buffers in small or dispersed ethnic minority
populations,
they conclude.
Contacts:
Jane Boydell, Clinical Researcher, Institute
of
Psychiatry, London, UK
Email j.kelly@iop.kcl.ac.uk
or
Robin Murray, Professor of Psychiatry,
Institute of
Psychiatry, London, UK
Email: robin.murray@iop.kcl.ac.uk
(4) PHARMACISTS
CAN CONDUCT EFFECTIVE
CONSULTATIONS WITH PATIENTS
(Randomised controlled trial of clinical
medication
review by a pharmacist of elderly
patients on repeat
prescriptions in general practice)
http://bmj.com/cgi/content/full/323/7325/1340
Consultations with a trained pharmacist
are an effective
way of reviewing the drug treatment of
older patients,
without affecting the workload of general
practitioners,
concludes a study in this week's BMJ.
Over 1,000 patients aged 65 or over, who
were
receiving at least one repeat medication,
were divided
into two groups. The first group was invited
to a
consultation at which the pharmacist reviewed
their
medical conditions and current treatment.
The second
group continued to receive normal care
from their
general practitioner and primary healthcare
staff.
The pharmacist review resulted in more
changes to
treatment and lower prescribing costs
than normal care,
without affecting the workload of general
practitioners.
Patients seen by the pharmacist were more
likely to
have changes made to their repeat prescriptions
because the pharmacist did a more detailed
review than
the general practitioner, suggest the
authors. This effect
could be important because patient compliance
has
been shown to fall with an increasing
number of drugs.
Stopping unnecessary drugs may also reduce
the risk of
adverse effects and interactions, they
add.
The small scale of this trial, involving
only four practices,
in one city and just one pharmacist, limits
the
generalisability of the results, say the
authors.
Nevertheless, it shows that significant
and clinically
important results can be achieved by pharmacists
reviewing patients and their treatment.
Contact:
Arnold Zermansky, Honorary Senior Research
Fellow,
University of Leeds, UK
Email: arnoldz@easynet.co.uk
(5) BRITAIN NEEDS
MORE PREPARATION FOR
RESPONDING TO PUBLIC HEALTH
EMERGENCIES
(Editorial: Managing Major Public
Health Crises)
http://bmj.com/cgi/content/full/323/7325/1321
The United Kingdom needs to be better equipped
and
organised to deliver health protection
in the event of
public health emergencies and major disasters.
Though
better prepared than some other countries,
many years
of under-investment leaves us vulnerable,
warn public
health specialists in this week's BMJ.
The recent terrorist and anthrax attacks
in the United
States have shown how all societies need
rescue,
health, and public services to respond
immediately to
emergencies. The numbers of public health
doctors
need to increase, but so do the numbers
of non-medical
and nursing staff. The new commitment
to public health
from the government and the increased
responsibility
given to regions could make this possible
if it is
resourced.
Clear guidance is urgently needed if health
protection is
to be developed by primary care as it
is unclear how
public health staff will be organised
when we move into
the new NHS in April 2001. We need in
place
mechanisms for immediate release of staff
required for
health protection and it must be clear
which bodies bear
local responsibility for the control of
communicable
disease, say the authors.
For a major emergency in the United Kingdom,
some
help could come from continental Europe,
in particular
through the European EPIET programme for
public
health trainees, add the authors. However
the United
Kingdom can and must fundamentally provide
health
protection through its own staff who know
their locality
and have the confidence of the people.
NHS funding has been increased, but mostly
against
specific targets. Recent events make a
powerful case
for increasing investment in health protection,
they
conclude.
Contact:
Emily Collins, Press Officer, Public Health
Laboratory
Service, London, UK
Email: ECollins@PHLS.org.uk
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