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(2) SELF-HELP
PROGRAMME FOR PREGNANT
SMOKERS IS
INEFFECTIVE
(3) TOBACCO
INDUSTRY CONCEALED ITS ROLE
IN REFUTING
IMPORTANT STUDY
(4) ß
BLOCKERS MAY AFFECT AIRWAYS FUNCTION IN
ELDERLY PATIENTS
(5) STUDY
QUESTIONS IMPACT OF NHS DIRECT
ON GP VISITS
(Mortality from methicillin resistant
Staphylococcus
aureus in England and Wales: analysis
of death
certificates)
http://bmj.com/cgi/content/full/325/7377/1390
Infections due to MRSA seem to be an increasing
cause of death in England and Wales, concludes
a
study in this week's BMJ.
Whether deaths from MRSA infection have
increased
in the UK has been unknown until now because
the
World Health Organisation's International
Classification
of Diseases used for routine mortality
statistics does not
include a specific code for MRSA.
Researchers manually examined all death
registrations
between 1993 and 1998, indicating staphylococcal
infection on any part of the death certificate,
to identify
MRSA from text entered on each line of
the death
certificate.
The percentage of such certificates, which
included
MRSA as a factor contributing in some
way to the
death of the person, increased from 7.5%
in 1993 to
25% in 1998.
In certificates which gave staphylococcal
infection as
the underlying cause of death, the proportion
mentioning MRSA increased from 8% in 1993
to 44%
in 1998.
MRSA in staphylococcal septicaemia increased
from
3% to 28%, staphylococcal pneumonia from
13% to
44%, and unspecified bacterial infection,
staphylococcus from 19% to 83%. MRSA accounted
for all of an increase in deaths due to
staphylococcal
infection in this period.
Infections due to MRSA seem to be an increasing
cause of death in England and Wales, and
improved
reporting is unlikely to explain the increase,
say the
authors. The greatest rise in MRSA occurred
for
deaths where invasive staphylococcal infection
was
given as the final underlying cause, so
antimicrobial
resistance probably influenced the success
of medical
management.
Further improvements in surveillance and
control of
healthcare associated infection and mortality
should be
a priority if MRSA related deaths are
to be prevented,
they conclude.
Contact:
Public Health Laboratory Service Press
Office,
London, UK
(2) SELF-HELP
PROGRAMME FOR PREGNANT
SMOKERS IS INEFFECTIVE
(Self help smoking cessation in pregnancy:
cluster
randomised controlled trial)
http://bmj.com/cgi/content/full/325/7377/1383
The UK government wants to cut the percentage
of
women who smoke during pregnancy from
23% to
15% by the year 2010. But a study in this
week's BMJ
finds that a self-help approach implemented
during
routine antenatal care is ineffective.
The study involved 128 midwives working
in three
NHS trusts in England and 1,527 women
who smoked
at the start of pregnancy. Half the women
received
normal antenatal care (normal care group)
and half
received the Stop for Good self-help programme
in
addition to normal care (intervention
group). All
women were surveyed 26 weeks into their
pregnancy.
Those who said they had not smoked for
at least seven
days supplied a urine sample for validation.
Validated smoking cessation rates were
low: 19% in
the intervention group and 21% in the
normal care
group. Self reported quit rates were higher.
In the
intervention group, 26% of women reported
not
smoking for at least seven days, compared
with 29% in
the normal care group.
Although the self-help programme was acceptable
to
midwives and pregnant women, it failed
to affect
smoking behaviour at the end of the second
trimester of
pregnancy, say the authors. More intensive
and
complex interventions, appropriately targeted
and
tailored, need to be developed and evaluated.
The discrepancy between validated and self
reported
quit rates calls into question the adequacy
of monitoring
of the government's target for smoking
in pregnancy,
which currently relies on retrospective
self-reported
smoking behaviour, say the authors. Validated
rates
among pregnant women are substantially
lower than the
self-reported rates on which current smoking
policy is
based, they conclude.
Contacts:
Laurence Moore, Senior Research Fellow,
Cardiff
University School of Social Sciences,
Cardiff, UK
Email: MooreL1@cf.ac.uk
or
Dr Rona Campbell, Lecturer in Health Services
Research, Department of Social Medicine,
University
of Bristol, UK
Email: rona.campbell@bris.ac.uk
(3) TOBACCO INDUSTRY
CONCEALED ITS ROLE
IN REFUTING IMPORTANT STUDY
(How the tobacco industry responded
to an influential
study of the health effects of secondhand
smoke)
http://bmj.com/cgi/content/full/325/7377/1413
In 1981 an influential Japanese study showed
an
association between passive smoking and
lung cancer.
Using internal tobacco industry documents,
researchers
in this week's BMJ describe how the industry
tried to
hide its involvement in refuting this
study.
Some 327 documents were identified, of
which 48
discussed the industry's plans to develop
a study to
counter the Japanese study. The goal of
this study was
to produce a credible, peer reviewed article
that could
be used as a public relations tool.
The tobacco industry considered funding
the study
through the Center for Indoor Air Research,
a research
organisation supported by the tobacco
industry, in
order to conceal its involvement.
The parties involved in conducting the
study included a
tobacco industry scientist, a tobacco
industry
consultant, an industry law firm, and
two Japanese
investigators. The consultant was named
as the sole
author of the final published paper. A
general
disclosure of financial support from "several
companies
of the tobacco industry" was also included.
The study found that there was no direct
evidence that
secondhand exposure to tobacco smoke increased
risk
of lung cancer, and concluded that studies
like the
Japanese study have "little scientific
basis."
Hidden or "ghost" authorship occurs in
studies funded
by other corporate interests, as well
as among
academic researchers. When the participants
in the
design, conduct, and reporting of the
study are hidden,
credit and accountability for the work
cannot be
assessed, write the authors.
The acknowledgement of financial support
from
tobacco companies in the final publication
of the study
shows how financial disclosure is an imperfect
indicator
of a sponsor's involvement in the research,
add the
authors. The published disclosure that
the author
received "financial support from several
companies of
the tobacco industry" does not fully describe
the
industry's involvement in the study, they
conclude.
Contact:
Professor Lisa Bero, Department of Clinical
Pharmacy
and Institute for Health Policy Studies,
University of
California, San Francisco, USA
Email: Bero@medicine.ucsf.edu
(4) ß BLOCKERS
MAY AFFECT AIRWAYS FUNCTION
IN ELDERLY PATIENTS
(ß blockers for glaucoma and
excess risk of airways
obstruction: population based cohort
study)
http://bmj.com/cgi/content/full/325/7377/1396
Topical ß blockers are the most commonly
prescribed
drugs for glaucoma in the United Kingdom,
yet a study
in this week's BMJ finds that they are
associated with
excess risk of airways obstruction in
elderly patients.
This finding raises an issue of public
health importance
because of the large number of elderly
patients in the
United Kingdom who are treated for glaucoma.
Researchers in London identified patients
with no
previous diagnosis of airways obstruction.
They defined
exposed patients as those who had used
topical ß
blockers for the first time in the period
1993-7.
Unexposed patients were randomly selected
and
matched for age and sex to exposed patients.
One year after treatment with topical ß
blockers, the
authors calculated that 55 patients would
need to be
treated to cause one case of airways obstruction
during
that time period.
Opthalmologists, general practitioners,
physicians, and
pharmacists need to be aware of the possibility
of
airways obstruction in patients taking
topical ß blockers
for glaucoma, say the authors. When eyesight
cannot
be threatened within their expected lifetime,
many frail
elderly patients may be better off left
untreated than
risk airways obstruction.
ß blockers should be discontinued
immediately when a
patient develops airways obstruction and
their
opthalmologist subsequently informed.
A repeat
prescription that includes topical ß
blockers and drugs
for asthma should automatically sound
an alarm, they
conclude.
Contact:
James Kirwan, Research Fellow, Department
of
Epidemiology and International Eye Health,
Institute of
Opthalmology, London, UK
Email: jfkirwan@ucl.ac.uk
(5) STUDY QUESTIONS
IMPACT OF NHS DIRECT
ON GP VISITS
(Impact of NHS Direct on general
practice
consultations during the winter
of 1999-2000: analysis
of routinely collected data)
http://bmj.com/cgi/content/full/325/7377/1397
The introduction of NHS Direct had no impact
on the
number of general practice consultations
during the
winter of 1999-2000, finds a study in
this week's BMJ,
despite speculation that there was an
influenza epidemic
but that people were telephoning NHS Direct
instead
of visiting their general practitioner.
Researchers grouped practices according
to the degree
of cover provided by NHS Direct during
the winter of
1999-2000. They compared weekly data on
new
episodes of influenza-like illness and
other respiratory
infections during this period with the
three preceding
winters.
Their results do not support the suggestion
that an
influenza epidemic occurred in the winter
of
1999-2000 but was under-reported as a
result of
people contacting NHS Direct instead of
visiting their
general practitioner.
There was a small decrease in the level
of influenza-like
illness in practices covered by NHS Direct
since
November 1999 compared with other groups,
but this
is unlikely to be due to the introduction
of the service,
say the authors.
NHS Direct was not introduced to decrease
or
increase the number of general practice
consultations
but to make consultations more appropriate,
they add.
Contacts:
Gillian Smith, Regional Epidemiologist,
Public Health
Laboratory Service Communicable Disease
Surveillance Centre (West Midlands), Birmingham
Heartlands Hospital, Birmingham, UK
Email: GESmith@phls.org.uk
or
Douglas Fleming, Director and Rachel Chapman,
Primary Care Scientist, Royal College
of General
Practitioners, Birmingham, UK
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