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(2) TRAINING
OF TOMORROW'S DOCTORS
UNDER THREAT
(3) DENIED PREGNANCIES ARE NOT RARE
(4) NHS
PLAN UNDERESTIMATES NEW DOCTORS
NEEDED
(1) EATING FISH
IN PREGNANCY PREVENTS
PRETERM BIRTH
(Low consumption of seafood in early
pregnancy as a
risk factor for preterm delivery:
prospective cohort
study)
http://bmj.com/cgi/content/full/324/7335/447
Low consumption of seafood during early
pregnancy is
a risk factor for preterm delivery and
low birth weight,
finds a study in this week's BMJ.
Over 8,000 pregnant women in Denmark were
surveyed about how often they had eaten
fish during
their pregnancy. The occurrence of preterm
delivery fell
from 7.1% in women never eating fish to
1.9% in those
eating fish at least once a week.
Overall, low birth weight and preterm birth
tended to
decrease with increasing fish consumption,
and average
birth weight and length of gestation tended
to increase
with increasing fish consumption. This
relation was up to
a daily intake of 15g fish, say the authors.
These findings agree with some previous
trials showing
that consumption of fish oil in pregnancy
can increase
birth weight by prolonging gestation and
prevent
recurrence of preterm delivery. The authors
suggest
that, in women, with zero or low fish
intake, small
amounts of omega-3 fatty acids ± provided
as fish or
fish oil ± may protect against preterm
delivery.
Contact:
Sjurour Frooi Olsen, Senior Scientist,
Maternal
Nutrition Group, Danish Epidemiology Science
Centre,
Statens Serum Institut, Copenhagen, Denmark
Email: sfo@ssi.dk
(2) TRAINING OF
TOMORROW'S DOCTORS
UNDER THREAT
(Academic medicine: a faltering engine)
http://bmj.com/cgi/content/full/324/7335/437
Academic medicine is in crisis. Over 10%
of clinical
academic posts in the UK are currently
unfilled, yet
1,000 posts will be needed by 2006 to
train 2,500
more medical students. Clinical research
is also under
threat: the number of clinical academics
active in
research in British Universities fell
by 12% between
1996 and 2001.
In this week's BMJ, Professor Paul Stewart
asks why
has this crisis occurred and what can
be done about it?
The uncertain career structure for clinical
academics
remains a major disincentive. Although
a specialist
training programme provides a structured
and
accelerated approach to training junior
doctors, it lacks
flexibility in accommodating the more
prolonged training
of academics.
Thereafter, academic trainees still switch
to a career in
the NHS, and two factors contribute to
this retention
problem. Firstly, career development -
some universities
have eroded clinical lecturer posts, an
important
stepping stone in the development of an
academic.
Secondly, lack of parity of income also
deters
progression in an academic career.
The career structure for clinical academics
is being
improved. In addition to more training
fellowships,
charity and council funded fellowships
are being
recognised as an important step to enable
an established
academic trainee to gain further experience.
Here the
introduction of new clinician-scientist
posts following the
recent Savill report is an important advance.
We need to reward excellence in teaching
if the
Government wishes to train more competent
doctors,
says the author. Equally important are
issues
surrounding career structures and parity
of pay. Despite
a current crisis the future remains bright
for academic
medicine, he concludes.
Contact:
Paul Stewart, Professor of Medicine, University
of
Birmingham, Queen Elizabeth Hospital,
Birmingham,
UK
Email: p.m.stewart@bham.ac.uk
(3) DENIED PREGNANCIES ARE NOT RARE
(Denial of pregnancy: population
based study)
http://bmj.com/cgi/content/full/324/7335/458
Denied pregnancies are not rare events,
according to a
study in this week's BMJ.
Between July 1995 and June 1996, all obstetric
departments in Berlin were asked to report
cases of
women who were not aware of being pregnant
and did
not have a doctor's diagnosis of pregnancy
during the
first 20 weeks, or more, of gestation.
Altogether 62 women did not realise they
were pregnant
until after 20 weeks' gestation. The authors
calculated
that 1 in 475 pregnancies were denied
by the woman.
In 37 women, pregnancy was diagnosed before
the
birth. In the remainder, the diagnosis
was made during
labour. In 12 deliveries a baby was born
without the
woman having realised that she was pregnant
until she
went into labour.
The common view that denied pregnancies
are rare
events is not valid, say the authors.
Deliveries in which
the woman has not been aware of her pregnancy
until
going into labour occur about three times
more often
than triplets. Denial of pregnancy may
put both mother
and baby at risk, they add.
The authors cannot be certain whether these
results are
generally applicable outside of Berlin.
However, a
previous study in the large Austrian city
of Innsbruck
indicates a comparable frequency of denied
pregnancies
across different sociodemographic regions,
they
conclude.
Contact:
Jens Wessel, Senior Lecturer, Department
of
Obstetrics, Charite Campus, Humboldt University,
Berlin, Germany
Email: jens.wessel@charite.de
(4) NHS PLAN UNDERESTIMATES
NEW DOCTORS
NEEDED
(Experiences and career intentions
of general practice
registrars in Thames deaneries:
postal survey)
http://bmj.com/cgi/content/full/324/7335/464
The government's national plan for the
NHS in Britain
may underestimate the numbers of new doctors
needed,
according to a study in this week's BMJ.
A total of 373 general practice registrars
in south east
England completed a questionnaire about
their
experiences and career intentions.
Most registrars were satisfied with their
training and
94% intended to work in general practice
in the United
Kingdom at some stage in their career.
More than 10%
of doctors training for general practice
had attended
medical school in other EU countries,
and this group
showed less commitment to working in general
practice
in the United Kingdom.
Only half the registrars intended to stay
in the health
authority where they trained. Many expressed
an
interest in working part time, especially
women
registrars, who now make up more than
half of doctors
training for general practice.
If the government's ambitions of 2000 more
general
practitioners is to be met, then the 550
promised new
training posts will not be enough, say
the authors. They
suggest that qualified doctors currently
in practice
should be retained and encouraged to participate
more
in the workforce.
Contact:
Isobel Bowler, Independent Health Service
Researcher,
London, UK
Email: isobel@gower.u-net.com
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