Releases Saturday 16 November 2002
No 7373 Volume 325
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(1) SUICIDE RISK PERSISTS MANY YEARS AFTER
ATTEMPTED SUICIDE
(2) SCREENING
CHILDREN FOR SPEECH PROBLEMS
IS INEFFECTIVE
(3) DOCTORS
HAVE TROUBLE TALKING TO
PATIENTS ABOUT
PSYCHOTIC SYMPTOMS
(4) SCREENING
FOR AORTIC ANEURYSMS IS COST
EFFECTIVE
(5) HAS
DRUG REGULATION ABANDONED ITS
PUBLIC HEALTH
MISSION?
(1) SUICIDE RISK
PERSISTS MANY YEARS AFTER
ATTEMPTED SUICIDE
(Suicide rate 22 years after parasuicide:
cohort study)
http://bmj.com/cgi/content/full/325/7373/1155
(Editorial: Suicide after parasuicide)
http://bmj.com/cgi/content/full/325/7373/1125/a
The risk of suicide for people with a history
of attempted
suicide or deliberate self harm (parasuicide)
persists
without decline for two decades, finds
a study in this
week's BMJ. Providing a high standard
of care to these
patients could help to reduce this rate.
Researchers traced 140 patients 22 years
after they
presented to a central London teaching
hospital after an
episode of parasuicide in the late 1970s.
The rate of suicide plus probable suicide
during the period
of follow up was 5.9 per 1000 per year
in the first five
years, rising to 6.8 per 1000 per year
in the final three
years. The rate did not decline with time.
Clinicians are encouraged to pay particular
attention to the
management of patients immediately after
an episode of
parasuicide, say the authors. Previous
deliberate self harm
remains a potent risk factor for subsequent
suicide, even if
it occurred many years ago, they conclude.
An accompanying editorial concludes: "To
pay attention to
previous parasuicide in the assessment
of the patient in the
emergency department is crucial, because
it may indicate a
serious risk even if the act was committed
several years
ago."
Contacts:
Paper: Gary Jenkins, Consultant Psychiatrist,
Department
of Psychiatry, East Ham Memorial Hospital,
London, UK
Email: gary.jenkins{at}elcmht.nhs.uk
Editorial: Bo Runeson, Associate Professor,
Karolinska
Institute, Department of Clinical Neuroscience,
St Goran's
Hospital, Stockholm, Sweden
Email: Bo.Runeson{at}spo.sll.se
(2) SCREENING
CHILDREN FOR SPEECH PROBLEMS
IS INEFFECTIVE
(Evaluation of a structured test
and a parent led method
for screening for speech and language
problems:
prospective population based study)
http://bmj.com/cgi/content/full/325/7373/1152
Both parental concerns and screening for
speech and
language problems fail to identify many
preschool children
needing therapy, finds a study in this
week's BMJ.
Researchers set out to compare the performance
of two
methods for identifying speech and language
problems in
preschool children in a deprived inner
city area of London.
They randomly assigned 18 health visitors
to use a
structured screening test and 19 to a
method based on
parental concerns.
Both approaches failed to detect a substantial
proportion
of children with severe language problems
and led to
over-referral of children without difficulties.
The structured
screening test performed as poorly as
the parent led
method.
Although these results apply most directly
to children in
other deprived areas, they suggest that
using formal
screening or a parent led approach to
identify children with
speech and language difficulties is unlikely
to be effective.
Little consensus about alternative approaches,
however,
has been reached, conclude the authors.
Contact:
Stuart Logan, Professor of Paediatric Epidemiology,
Institute of Health and Social Care Research,
Peninsula
Medical School, Exeter, UK
Email: stuart.logan{at}pms.ac.uk
(3) DOCTORS HAVE
TROUBLE TALKING TO
PATIENTS ABOUT PSYCHOTIC SYMPTOMS
(Engagement of patients with psychosis
in the consultation:
conversation analytic study)
http://bmj.com/cgi/content/full/325/7373/1148
Doctors have trouble talking to patients
about psychotic
symptoms, finds a study in this week's
BMJ.
Researchers analysed 32 consultations between
psychiatrists and patients with schizophrenia
or
schizoaffective disorder at two psychiatric
outpatient
clinics in London.
They found that patients actively attempted
to talk about
the content of their psychotic symptoms,
such as
hallucinations and delusions, and the
distress associated
with these symptoms. However, doctors
tended to hesitate
and avoid answering the patients' questions,
indicating a
reluctance to engage with these concerns.
When there was an informal carer present,
the doctor also
smiled or laughed in response to patients'
assessments of
and questions about their symptoms. This
response to
patients' distress may be an obstacle
to successful
engagement, say the authors.
Proactively addressing patients' distress
about their
psychotic symptoms may lead to a more
satisfactory
outcome of the consultation itself and
improve engagement
of such patients with health services,
they conclude.
Contact:
Rosemarie McCabe, Senior Research Fellow,
Unit for
Social and Community Psychiatry, Barts
and the London
School of Medicine, Newham Centre for
Mental Health,
London, UK
Email: r.mccabe{at}qmul.ac.uk
(4) SCREENING
FOR AORTIC ANEURYSMS IS COST
EFFECTIVE
(Multicentre aneurysm screening study
(MASS): cost
effectiveness analysis of screening
for abdominal aortic
aneurysms based on four year results
from randomised
controlled trial)
http://bmj.com/cgi/content/full/325/7373/1135
(Editorial: Screening men for aortic
aneurysm)
http://bmj.com/cgi/content/full/325/7373/1123
Routine screening for aortic aneurysms
in older men is cost
effective, according to a study in this
week's BMJ.
Using data from a large randomised trial,
researchers
assessed the cost effectiveness of ultrasound
screening for
abdominal aortic aneurysms in 67,800 men
aged 65-74
years for up to four years.
Over four years, there were 47 fewer deaths
related to
abdominal aortic aneurysms in the screening
group than in
the control group, but the additional
costs incurred were
£2.2m.
After adjustment, the additional cost of
the screening
programme was £63.39 per patient.
The cost effectiveness
ratio was £28,400 per life year
gained.
Although this figure is at the margin of
acceptability
according to current NHS thresholds, it
is estimated to fall
to around £8,000 per life year gained
after 10 years, say
the authors.
"The clinical analysis and this economic
analysis of the
MASS trial together provide clear evidence
to support the
cost effectiveness of this particular
form of screening in
elderly men," they conclude.
The clinical results will be appearing
simultaneously in this
week's issue of the Lancet.
Contacts:
Martin Buxton, Health Economics Research
Group,
Brunel University, Middlesex, UK
Email: martin.buxton{at}brunel.ac.uk
or
Sue Kimbell, St Richard's Hospital Press
Office,
Chichester, UK
Email: sue.kimbell{at}rws-tr.nhs.uk
or
Louise Brown Medical Research Council Press
Office,
London, UK
(5) HAS DRUG REGULATION
ABANDONED ITS
PUBLIC HEALTH MISSION?
(Making regulation responsive to
commercial interests:
streamlining drug industry watchdogs)
http://bmj.com/cgi/content/full/325/7373/1164
Over the past 20 years, the pharmaceutical
industry has
skilfully managed to achieve an unhealthy
influence over
drug regulatory agencies, which may be
threatening the
public health needs of the European Union,
according to
an article in this week's BMJ.
Professor John Abraham argues that European
regulatory
authorities, which were initially established
to provide
independent scrutiny of pharmaceutical
firms in the
interests of public health, have been
overly influenced by
the industry's desire for rapid drug approvals.
He explains how the industry has undermined
the
credibility of regulatory agencies. As
a result, agencies
have become increasingly dependent on
industry fees for
their survival and now compete with each
other for
regulatory work.
This is of major concern because doctors
and patients
need to be able to rely on the commitment
of the
regulatory system in their country to
put the interests of
public health above the commercial interests
of industry, he
concludes.
These views are reiterated in the first
of three
accompanying commentaries. Danielle Bardelay
and
Christophe Kopp write: "One thing is clear:
the public
needs of the European Union can no longer
be neglected
and the regulatory agencies left to operate
largely for the
benefits of the drug industry."
In the second commentary, J D Kleinke argues
that
making drug regulation responsive to commercial
interests
has not put patients and the public health
at risk. In the
final commentary, Emma Bennion, who has
Parkinson's
Disease, describes how the drug she needs
has suffered at
the hands of the regulators.
Contacts:
Professor John Abraham, School of Social
Sciences,
University of Sussex, Brighton, UK
Email: J.W.Abraham{at}sussex.ac.uk
Christophe Kopp, Staff Editor, La revue
Prescrire, Paris,
France
Email: Christophe.Kopp{at}wanadoo.fr
J D Kleinke, Medcal Economist, Denver,
Colorado, USA
Email: jdklx@sprintmail.com
Emma Bennion, King's Lynn, Norfolk, UK
Email: bennion{at}paston.co.uk
(BMJ launches soap opera)
http://bmj.com/cgi/content/full/325/7373/1131/a
Move over ER, Casualty, and Holby City
� the BMJ's
new weekly soap opera starts on 29 November.
"Misplaced Trust" will follow the everyday
dramas of
Martha Millstone, clinical director at
Murkton Moor
General Hospital, which has just been
the subject of a visit
from the Commission of Health Improvement.
Unfortunately for the trust, the man from
the commission
found a dead body - by the cupboard where
the audit
reports should have been filed.
Nicola Sharp, a specialist registrar in
psychiatry from
Warrington, Cheshire, won the BMJ's competition
to write
the soap opera, beating off 139 other
entries. The judging
panel included Doctors John Hodge (script
writer of
Shallow Grave and Trainspotting) and Jed
Mercurio
(writer of Cardiac Arrest).
BMJ Editor, Richard Smith, said: "We want
it to entertain
readers and to reflect some of the career
dilemmas and
choices that doctors commonly face."
"Misplaced Trust" will appear in the Career
focus section
of BMJ Careers and also on bmjcareers.com,
which will
have added material such as profiles of
the characters,
cartoons, and a synopsis of the story
so far.
The first installment will be performed
by Radio 4's Round
Midnight theatre group at the BMJ's Careers
Fair in
London on Saturday 30 November.
See www.bmjcareers.com/careersfair/ for more details.
Contact:
Dr Rhona MacDonald, Editor, Career focus,
BMA
House, London, UK
Email: rmacdonald{at}bmj.com
Full text of story is available from the
BMA Press Office
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice{at}bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)
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