Releases Saturday 16 March 2002
No 7338 Volume 324
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(1) ACTION TO PREVENT DIABETES SHOULD BEGIN IN
CHILDHOOD
(2) PATIENT
LEAFLETS MAY NOT BE EFFECTIVE IN
THE REAL WORLD
(3) DEMAND
FOR EMERGENCY AMBULANCES HAS
RISEN
(4) GUIDELINES
NEEDED TO PREVENT SPREAD OF
INFECTION IN
EUROPEAN HOSPITALS
(5) STRINGENT
REGULATION OF TRADITIONAL
MEDICINES IS
URGENTLY NEEDED
(1) ACTION TO
PREVENT DIABETES SHOULD BEGIN IN
CHILDHOOD
(Early evidence of ethnic differences
in cardiovascular risk:
cross sectional comparison of British
South Asian and white
children)
http://bmj.com/cgi/content/full/324/7338/635
(Editorial: Epidemic of cardiovascular
disease in South
Asians)
http://bmj.com/cgi/content/full/324/7338/625
Action to prevent non-insulin dependent
diabetes and heart
disease in South Asian people may need
to begin during
childhood, finds a study in this week's
BMJ.
Researchers in London identified 3,415
white and 227 South
Asian children aged 8 to 11 years from
primary schools in 10
British towns. Blood samples were taken
from 1,287 white
and 73 South Asian children.
An early stage in the development of diabetes
and heart
disease risk is insulin resistance, when
insulin levels are
increased. The researchers found that
South Asian children
showed higher average levels of insulin
and insulin resistance
than white children. These ethnic differences
were not
associated with corresponding differences
in adiposity
(fatness), say the authors.
Insulin metabolism seems to be more sensitive
to a given
degree of adiposity among the South Asian
children compared
with white children, add the authors.
They suggest that the
prevention of insulin resistance and its
consequences may
need to begin during childhood.
Contact:
Peter Whincup, Professor of Cardiovascular
Epidemiology, St
George's Hospital Medical School, London,
UK
Email: p.whincup{at}sghms.ac.uk
(2) PATIENT LEAFLETS
MAY NOT BE EFFECTIVE IN
THE REAL WORLD
(Use of evidence based leaflets to
promote informed choice
in maternity care: randomised controlled
trial in everyday
practice)
http://bmj.com/cgi/content/full/324/7338/643
(Qualitative study of evidence based
leaflets in maternity
care)
http://bmj.com/cgi/content/full/324/7338/639
Leaflets used to promote informed choice
in women using
maternity services in the UK are not effective
in everyday
practice, say researchers from Sheffield
University in this
week's BMJ.
Thirteen maternity units in Wales participated
in the study.
Units either used leaflets to promote
informed choice
(intervention units) or continued with
usual care (control
units).
Questionnaires were then sent to four different
samples of
women using these maternity services.
Women in the
antenatal samples received the questionnaire
28 weeks into
their pregnancy, and women in the postnatal
samples received
the questionnaire eight weeks after delivering
their babies.
There was no change in the proportion of
women who
reported exercising informed choice in
the intervention units
compared with the control units for either
antenatal or
postnatal women. Only 70% of women in
the intervention
units reported being given at least one
of the leaflets,
indicating problems with implementation.
The leaflets did not help to promote informed
choice in
maternity care, say the authors. They
suggest that decision
aids may not be effective in the real
world.
Within the same study, Helen Stapleton
and colleagues found
that time constraints and other pressures
on health
professionals resulted in a lack of discussion
of the content of
the leaflets. Health professionals also
promoted normative
practices rather than choice and, as women
valued their
opinions, this ensured informed compliance
rather than
informed choice.
They conclude that these leaflets are unlikely
to promote
informed choice in maternity care unless
they are introduced
as part of a coherent strategy addressing
power imbalances
and the ambiguities currently underpinning
choice.
Contacts:
Alicia O'Cathain, Research Fellow, School
of Health and
Related Research, University of Sheffield,
Sheffield, UK
Email: a.ocathain{at}sheffield.ac.uk
Helen Stapleton, Research Midwife, School
of Nursing and
Midwifery, University of Sheffield, Sheffield,
UK
Email: h.stapleton{at}sheffield.ac.uk
(3) DEMAND FOR
EMERGENCY AMBULANCES HAS
RISEN
(Trends in demand for emergency ambulance
services in
Wiltshire over nine years: observational
study)
http://bmj.com/cgi/content/full/324/7338/646
Demand for emergency ambulances in the
United Kingdom is
rising. A study in this week's BMJ examines
the reasons for
this rise.
Researchers analysed emergency ambulance
dispatches
using a randon sample of records held
by Wiltshire
Ambulance Service NHS Trust. They identified
details of
6,100 calls relating to 5,821 incidents
over a nine year period.
The proportion of incidents in response
to a call from a
general practitioner, or incidents where
one was present,
remained fairly constant over the study
period, whereas the
proportion of calls made by patients and
relatives rose from
12% to 20%.
The category "sudden illness at home" showed
an increase
out of line with that seen overall. Incidents
described as
"collapse" fell from 35% to 20%, whereas
those attributed
more specifically to cardiac problems
rose from 22% to 31%
and those attributed to respiratory problems
from 12% to
21%. This suggests that people are using
more specific
terminology to describe emergency incidents,
say the authors.
Demand for emergency ambulances has risen,
say the
authors. Although this increase is often
attributed to general
practitioners redirecting patients with
urgent problems to the
ambulance service, particularly out of
surgery hours, they
found no evidence of this.
"Research identifying influences on callers'
perceptions of
urgency is necessary if we are to improve
our understanding
of the demand for emergency care and our
ability to plan for
the future," they conclude.
Contact:
Steve George, Reader in Public Health,
School of Medicine,
University of Southampton, Southampton,
UK
Email: pluto{at}soton.ac.uk
(4) GUIDELINES
NEEDED TO PREVENT SPREAD OF
INFECTION IN EUROPEAN HOSPITALS
(What action should be taken to prevent
the spread of
vancomycin resistant enterococci
in European hospitals?)
http://bmj.com/cgi/content/full/324/7338/666
National and European guidelines to control
the spread of
vancomycin resistant enterococci should
be drawn up before
these bacteria become endemic in European
hospitals, argue
researchers in this week's BMJ.
Vancomycin resistant bacteria have a low
virulence but can
cause serious infections in transplant
patients or those in
intensive care units. Infections are becoming
increasingly
common in American hospitals, but are
rare in European
hospitals.
A recent outbreak in a Dutch hospital was
halted by strict
infection control measures, but these
measures were
expensive and at times stopped new admissions
and routine
surgery.
With the American experience in mind, many
doctors agree
that spread of these multiple resistant
bacteria should be
prevented. On the other hand, a rigorous
infection and control
policy will result in extensive patient
discomfort, increased
workload for healthcare workers, and substantial
extra costs
for healthcare organisations.
The authors propose that a European consensus
on control
measures should be reached and guidelines
drawn up on how
to approach hospital outbreaks before
these bacteria become
endemic in Europe's hospitals.
Contact:
Marc Bonten, Internist, Department of Internal
Medicine,
Eijkman-Winkler Institute for Microbiology,
Infectious
Diseases, and Inflammation, Netherlands
Email: m.j.m.bonten{at}azu.nl
(5) STRINGENT
REGULATION OF TRADITIONAL
MEDICINES IS URGENTLY NEEDED
(Letter: Chinese medicines for slimming
still cause health
problems)
http://bmj.com/cgi/content/full/324/7338/679
Traditional Chinese medicines for slimming
still cause health
problems and stringent regulation is urgently
needed,
according to a letter in this week's BMJ.
Researchers at Southend Hospital in Essex
analysed several
slimming preparations and the urine of
several patients who
had been attending a particular Chinese
herbalist for weight
loss remedies.
They found a high concentration of fenfluramine
in tablets
supplied to patients and also in the patients'
urine.
After reports of an association with pulmonary
hypertension,
fenfluramine was withdrawn even as a prescription
only
medicine in 1997. Its use as described
is obviously illegal, say
the authors. This case is now under investigation
by the
Medicines Control Agency, which has yet
to establish exactly
where in the chain of supply adulteration
with fenfluramine
occurred.
"The vast majority of Chinese herbalists
and practitioners of
other traditional medicines are responsible,
professional, and
caring," say the authors. "Our recent
experience, however,
highlights how the public's trend to believe,
often with great
naivety, in natural remedies can be abused.
Stringent
regulation of traditional medicines, at
least to the standards of
conventional practice, is urgently needed."
Contact:
Cathryn Corns, Consultant Biochemist, Southend
Hospital,
Westcliff-on-Sea, Essex, UK
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