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(2)
USE PUBLIC FUNDS TO TEST JET LAG DRUG,
SAY RESEARCHERS
(3) POLICE,
NOT SOCIAL WORKERS, SHOULD
PROTECT CHILDREN
FROM CRIMINAL ABUSE
(4) LEGAL
AND ETHICAL CONCERNS OVER
PRENATAL DIAGNOSIS
(1) COMMUNICATING
WITH YOUNG PEOPLE
WHO ARE SERIOUSLY ILL IS DIFFICULT
(Managing communication with young
people who have
a potentially life threatening chronic
illness: qualitative
study of patients and parents )
http://bmj.com/cgi/content/full/326/7384/305
Young people who are seriously ill can
feel unable to
participate in consultations and parents
may be reluctant
to communicate openly with their children.
Health
professionals must try to balance the
different priorities
of young people and parents, suggest researchers
in this
week's BMJ.
Thirteen cancer patients aged 8-17 years,
and their
parents, gave accounts of communication
about their
illness.
Most parents described acting in an executive-like
role,
managing what and how their children were
told about
their illness, particularly at the time
of diagnosis when
parents faced the difficult job of dealing
with their own
emotional responses. Their accounts were
shaped by
concerns to manage their identity as strong
and optimistic
parents and to protect their child's wellbeing.
While the young people welcomed their parents'
involvement, some felt that communication
was
constrained by their parents' role. One
patient aged 15
said: " I still didn't feel that they
were telling me
everything." Some young people described
feeling
marginalised in consultations and pointed
to difficulties
they experienced in encounters with some
doctors.
The young people in our study clearly wanted
their
parents to be involved in communication
but were not
always satisfied with how communication
was managed,
say the authors.
Professionals need to remain aware of how
the power
relations of professional-parent-child
encounters can be
an obstacle in forging successful relationships
between
health professionals and young people.
These issues will
be of crucial importance in implementing
the new
children's national service framework,
they conclude.
Contact:
Bridget Young, Lecturer, Department of
Psychology,
University of Hull, UK
Email: B.Young@hull.ac.uk
(2) USE
PUBLIC FUNDS TO TEST JET LAG DRUG,
SAY RESEARCHERS
(Editorial: The prevention and treatment
of jet lag)
http://bmj.com/cgi/content/full/326/7384/296
The hormone melatonin has long been used
to prevent
and treat jet lag, but in many countries
it cannot be sold
because it is not licensed. Researchers
in this week's
BMJ argue that if use of the drug is in
the public interest,
then public funds should be used to get
it adequately
tested to be licensed.
Jet lag is caused by the disturbance of
normal body
rhythms as a result of flying across different
time zones.
Melatonin plays a part in controlling
daily body rhythms.
A recent review found 10 randomised controlled
trials
comparing melatonin with placebo in long
distance
travellers. Eight of the 10 trials found
a clear reduction in
jet lag when melatonin had been taken.
The review concludes that 2-5mg melatonin
taken at
bedtime after arrival is effective and
may be worth
repeating for the next two to four days,
together with
several behavioural measures to adjust
the body clock.
In the United States, Thailand, and Singapore,
melatonin
is freely sold as a "dietary supplement"
in health food
stores and pharmacies, although no official
standards of
purity exist. In Europe, Australia, and
many other
countries, melatonin is defined as a medicine
and
requires a licence, but no licensed preparation
is
marketed; only the internet offers a grey
or black
market.
It seems that many people and organisations,
including
governments and armed forces, would benefit
from the
use of melatonin to reduce jet lag, say
the authors. If use
of the drug is in the public interest,
then public funds
should be used to get it properly tested
and licensed. A
finance initiative is urgently needed
to solve the problem
and might best begin with a cost benefit
assessment, they
conclude.
Contact:
Andrew Herxheimer, Emeritus Fellow, UK
Cochrane
Centre, London, UK
Email: andrew_herxheimer@compuserve.com
(3) POLICE, NOT
SOCIAL WORKERS, SHOULD
PROTECT CHILDREN FROM CRIMINAL ABUSE
(Personal view: The police should
take the lead on
protecting children from criminal
abuse)
http://bmj.com/cgi/content/full/326/7384/343
Following Lord Laming's report on the life
and death of
Victoria Climbie, paediatricians experienced
in managing
life threatening abuse suggest in this
week's BMJ that
police, rather than social workers, should
take
responsibility for protecting children
from criminal abuse.
Professor David Southall and colleagues
believe that
most perpetrators, knowing they are committing
crimes,
deceive and intimidate social and health
workers. If
criminal abuse is likely, then the police
must lead and be
responsible for the child protection process,
they say.
They draw on recent papers they have written
concerning a new way of looking at child
ill-treatment,
including a suggestion that special inter-agency
task
forces on criminal abuse are established
and run by
experienced and adequately resourced police
units. They
will best ensure that, as Lord Laming
expects "the
standard of investigation into criminal
offences against
children" will be "as rigorous as the
investigation of
similar crimes against adults."
There is already a major shortage of social
workers in
poor areas, and paediatricians, who are
often the first to
identify a potentially abuse child, are
becoming less
willing to initiate proceedings. Failure
to protect
professionals in order to appease parents
and the public
will continue to deter frontline workers
from speaking
out, they warn.
In addition, Lord Laming's report does
not address the
way in which abusers are increasingly
adept at using
complaints procedures and the media to
attack
professionals.
Addressing the criminal abuse of children
must be a
priority, not only in England, but in
the majority of
countries that do not have any child protection
systems
and where many thousands of children like
Victoria are
cruelly enslaved and exploited every day.
We need an
international response to criminal abuse
? namely, an
effective police led protection force,
they conclude.
Contact:
David Southall, Professor of Paediatrics,
North
Staffordshire Hospital, Staffordshire,
UK
Email: davids@doctors.org.uk
(4) LEGAL AND
ETHICAL CONCERNS OVER
PRENATAL DIAGNOSIS
(Prenatal diagnosis requests for
Huntington's disease
when the father is at risk and does
not want to know his
genetic status: clinical, legal,
and ethical viewpoints)
http://bmj.com/cgi/content/full/326/7384/331
Hospital genetics units occasionally receive
requests
from women for prenatal tests for Huntington's
disease
when their male partners are at risk but
do not want to
know their genetic status for the disease.
In this week's
BMJ, researchers discuss the legal and
ethical concerns
that these cases raise.
Cases like these pose considerable ethical
and legal
dilemmas for clinicians, write the authors.
Does the right
of the pregnant mother to know the status
of her fetus
outweigh the right of the father at risk
to not know his
genetic status?
In a clinical ethics consultation, the
lawyer and ethicist
presented the clinical team with their
ideas on the subject
and had the team reconsider its procedures
in light of the
different viewpoints.
The clinical team's preferred course of
action was to test
the male partner first, and, if he was
found to have the
mutation, to offer prenatal diagnosis.
Alternatively,
exclusion testing (testing to exclude
the risk of the
condition in the fetus) preserves the
man's preference to
not know his status for being at risk.
Both these options
involve the man in the decision making
processes,
thereby meeting his needs for information
and emotional
support.
Should clinicians breach confidentiality
to directly
determine the views of the man who is
at risk? Under
Australian law, decisions about prenatal
testing can be
made solely by the mother. The father's
consent (or even
knowledge) is not required because the
law states that
these are tests on her body, explain the
authors.
The final decision of whether or not the
test should be
done is up to the judgement of clinicians;
a court will not
override their decision, regardless of
the woman's
wishes.
There is no easy answer to such requests,
say the
authors. The law in Australia and the
United Kingdom
may need to be reconsidered and perhaps
clarified by
legislation, while clinical teams need
to deal with them on
the basis of the individual circumstances.
Contact:
Martin Delatycki, Clinical Geneticist,
Genetic Health
Services, Victoria Royal Children's Hospital,
Victoria,
Australia
Email: delatycm@cryptic.rch.unimelb.edu.au
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