Releases Saturday 19 October 2002
No 7369 Volume 325
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(1) WORK STRESS DOUBLES RISK OF DEATH
FROM HEART DISEASE
(2) £100M
A YEAR COULD IMPROVE DIABETES
CARE
(3) FEW
LESSONS ARE LEARNT FROM NHS
INQUIRIES
(4) SHOULD
PEOPLE WITH DEMENTIA BE
ELECTRONICALLY
TAGGED?
(1) WORK STRESS
DOUBLES RISK OF DEATH
FROM HEART DISEASE
(Work stress and risk of cardiovascular
mortality:
prospective cohort study of industrial
employees)
http://bmj.com/cgi/content/full/325/7369/857
Work stress is associated with a doubling
of the risk of
death from heart disease, finds a study
in this week's
BMJ.
Researchers followed 812 healthy employees
(545 men,
267 women) of a company in Finland for
an average of 25
years. They gathered data on stress, blood
pressure,
cholesterol levels, and body mass index
by questionnaire,
interviews, and clinical examinations.
Cardiovascular
deaths were calculated using the national
mortality register.
They found that job strain (high work demands
and low
job control) and effort-reward imbalance
(high demands,
low security, few career opportunities)
were each
associated with a doubling of the risk
of cardiovascular
death among initially healthy employees.
High job stress
was also associated with increased cholesterol
concentrations and body mass index.
In promoting cardiovascular health, the
traditional advice
has been for people to stop smoking, cut
down drinking,
eat less fat, and engage in physical activity.
These findings
suggest that attention should also be
paid to the prevention
of work stress, conclude the authors.
Contact:
Mika Kivimaki, Senior Researcher, Department
of
Psychology, Finnish Institute of Occupational
Health,
Finland
Email: mika.kivimaki{at}occuphealth.fi
(2) £100M
A YEAR COULD IMPROVE DIABETES
CARE
(Implementing intensive control of
blood glucose
concentration and blood pressure
in type 2 diabetes in
England: cost analysis (UKPDS 63))
http://bmj.com/cgi/content/full/325/7369/860
£100m a year could greatly improve
diabetes care in
England, and is less than 1% of planned
increases in NHS
spending, conclude researchers in this
week's BMJ.
The United Kingdom Prospective Diabetes
Study
(UKPDS) found that more intensive control
of blood
glucose and blood pressure for patients
with type 2
diabetes is effective and cost effective.
In their study this
week, Alastair Gray and colleagues estimate
the total
costs and potential savings of fully implementing
these
findings for all people with type 2 diabetes
in England.
The net annual cost of implementing the
main findings of
the UKPDS for all people with diagnosed
type 2 diabetes
in England is about £100m. This
is equivalent to less than
1% of the proposed increase in annual
expenditure on the
NHS in 2001-5 set out in the government's
spending
plans, say the authors.
About 720 additional staff would be required
to
implement these control policies, especially
specialist
nurses and practice nurses, but the advent
of primary care
trusts and the national service framework
for diabetes
should create new incentives and mechanisms
to adopt
these improved standards, add the authors.
Although many claims are made on these
additional
resources, it seems reasonable that one
guiding principle
should be to allocate funds to interventions
of proved
effectiveness and cost effectiveness that
will benefit many
people, they conclude.
Contacts:
Rury Holman, Professor of Diabetic Medicine,
Diabetes
Trials Unit, University of Oxford Radcliffe
Infirmary,
Oxford, UK
Email: rury.holman{at}dtu.ox.ac.uk
Philip Clarke, Research Fellow, Health
Economics
Research Centre, Department of Public
Health, University
of Oxford, Institute of Health Sciences,
Oxford, UK
Email: philip.clarke{at}public-health.oxford.ac.uk
(3) FEW LESSONS
ARE LEARNT FROM NHS
INQUIRIES
(The use and impact of inquiries
in the NHS)
http://bmj.com/cgi/content/full/325/7369/895
When things go wrong in the NHS the official
reaction is
to set up an inquiry. Yet a study in this
week's BMJ finds
that many inquiry reports highlight similar
sorts of failures,
suggesting that lessons are not always
learnt.
Researchers at the University of Manchester
analysed 59
inquiry reports from 1974 to 2002 to explore
their use
and impact in the NHS.
They found that the number and scope of
inquiries is
growing and are increasingly concerned
with the clinical
performance of doctors. Although inquiries
have become
more open and formalised - often in response
to public
pressure - there are no rules or guidelines
on how to run
an inquiry, and few arrangements exist
to carry learning
about the inquiry process over from one
inquiry to
another.
Inquiry reports are often long, and many
produce similar
findings despite addressing failures in
the quality of care
which on the face of it have little in
common, add the
authors. Often these failures are organisational
and
cultural, and the necessary changes are
not likely to
happen simply because they are prescribed
in a report.
The increasing demand for public inquiries
in the NHS
probably reflects a lack of public confidence
in the
alternative methods of inquiry and in
the quality of care
that the NHS provides, write the authors.
They suggest that the credibility and potential
biases of
inquiry findings should be carefully assessed
and that they
should be a measure of last resort, used
only when other
methods of investigation have failed.
Contact:
Kieran Walshe, Reader in Public Management
and
Director of Research, Manchester Centre
for Healthcare
Management, University of Manchester,
UK
Email: kieran.walshe{at}man.ac.uk
(4) SHOULD PEOPLE
WITH DEMENTIA BE
ELECTRONICALLY TAGGED?
(Electronic tagging of people with
dementia who wander)
http://bmj.com/cgi/content/full/325/7369/847
Using electronic tagging to safeguard older
people who
wander into danger is a complex dilemma
of practical
benefits versus ethical considerations.
Some argue that for
the sake of safety, a slight loss of liberty
is a price worth
paying, but two experts in this week's
BMJ suggest that
the need to protect the right to privacy,
especially in mild
dementia, should be recognised.
The problem of wandering in dementia is
not trivial. It
causes stress to carers, referrals to
psychiatric services
and hospital admissions, problems in the
hospital
environment, and an unknown number of
deaths.
However, electronic tracking devices might
settle the
anxieties of others without attending
to the needs of the
person with dementia, say the authors.
The risks and restrictions of alternatives
to tagging should
be kept in mind. But the use of such devices,
even by
families, must be considered carefully.
Rather, the
determination of what is best will require
careful enquiry,
negotiation, and judgement.
It is especially at this point that understanding
the
wandering behaviour and looking for the
least restrictive
ways of dealing with it will become imperative,
they add.
Where no consensus can be reached, the
courts might
have to decide.
This is not however, a sign of failure
but of recognition of
the seriousness with which we should regard
the erosion
of a person's liberty and privacy, especially
when he or
she has dementia, they conclude.
Contacts:
Julian Hughes, Consultant in Old Age Psychiatry,
Centre
for the Health of the Elderly, Newcastle
General Hospital,
Newcastle upon Tyne, UK
Email: jchughes{at}doctors.org.uk
Stephen Louw, Consultant Physician, Care
of the Elderly
Directorate, Freeman Hospital, Newcastle
upon Tyne,
UK
Email: Stephen.Louw{at}tfh.nuth.northy.nhs.uk
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