Releases Saturday 3 January 2004
No 7430 Volume 328

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(1) Low dose radiation in infancy may affect intellect

(2) Having a stable partner delays AIDS in HIV patients

(3) New act will restrict patient choice



(1) Low dose radiation in infancy may affect intellect

(Effect of low dose of ionising radiation in infancy on cognitive
function in adulthood: Swedish population based cohort study)
http://bmj.com/cgi/content/full/328/7430/19

Exposure to low doses of ionising radiation in infancy affects
intellectual capacity in later life, conclude researchers from
Sweden in this week's BMJ.

CT scanning, which delivers high doses of ionising radiation, is
increasingly being used in young children after minor head
trauma.

The study involved 3,094 men who had received radiation
therapy before age 18 months during 1930-59. At age 18 or 19
years, their intellectual capacity was tested and high school
attendance was recorded.

The proportion of boys who attended high school decreased with
increasing doses of ionising radiation to both the front and back
parts of the brain.

A significant dose-related response was also seen for learning
ability and logical reasoning, but not for spatial recognition.

Intellectual development could be adversely affected when the
infant brain is exposed to ionising radiation at doses equivalent to
CT scans of the skull, say the authors.

The risk and benefits of CT scans in minor head trauma need
re-evaluating, they conclude.

Contact:
Per Hall, Associate Professor, Department of Medical
Epidemiology and Biostatistics, Karolinska Institute, Stockholm,
Sweden
Email: per.hall@meb.ki.se

(2) Having a stable partner delays AIDS in HIV patients

(Stable partnership and progression to AIDS or death in HIV
infected patients receiving highly active antiretroviral therapy:
Swiss cohort study)
http://bmj.com/cgi/content/full/328/7430/15

For people with HIV, having a stable partner is associated with
slower rate of progression to AIDS or death, finds a study in this
week's BMJ.

Researchers in Switzerland followed 3,736 adults with HIV who
had started highly active antiretroviral therapy (HAART) before
2002. Every six months, patients were asked whether they had
had sexual intercourse with a stable partner.

When starting HAART, 52% of participants reported a stable
partnership. This decreased to around 46% after five years of
follow up. A stable partnership was associated with a slower rate
of disease progression and an increase in CD4 blood cell count
and viral suppression.

The reasons for this are unknown, but the authors speculate that
people with a stable partner may have less depression.

For a healthcare professional caring for someone with HIV, the
absence of a stable partnership indicates that the patient may
progress more rapidly to the later stages of the disease, they
conclude.

Contact:
Heiner Bucher, Professor of Clinical Epidemiology, Basel
Institute for Clinical Epidemiology, University Hospital Basel,
Switzerland
Email: hbucher@uhbs.ch

(3) New act will restrict patient choice

(Choice and responsiveness for older people in the "patient
centred" NHS)
http://bmj.com/cgi/content/full/328/7430/4

Chronically sick and older people may not be able to choose
where they are treated when new community care regulations
come into force in January 2004, warn researchers in this week's
BMJ.

Under the Community Care (Delayed Discharge) Act, local
authorities will be fined by the NHS for failing to arrange social
care services for patients who remain in hospital longer than
necessary.

From 2006, new financial arrangements will also mean that
hospitals make a loss by continuing to care for any patient who
stays longer than the "average length of stay."

These measures could see the chronically sick and older patients
being forced into accommodation which is inappropriate and does
not serve their needs, write Allyson Pollock and David Rowland of
University College London.

The effect of these measures is also likely to undermine the
rights of patients to choose their care home, they add. Patients
exercising their right to choose currently accounts for 8% of all
delayed discharges. Choice for older patients is thus now
presented as an obstacle to the efficient functioning of the
system.

The health secretary, Dr John Reid, has stated that his
government "will empower patients by giving them genuine
individual choices about where, when, how, and by whom they
are treated." It seems that he does not have in mind the frail,
elderly and people with long term illness, they conclude.

Contact:
Professor Allyson Pollock, Public Health Policy Unit,
School of Public Policy, University College London, UK
Email: allyson.pollock@ucl.ac.uk


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