Releases Saturday 23 February 2002
No 7335 Volume 324

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(1) EATING FISH IN PREGNANCY PREVENTS
PRETERM BIRTH

(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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