Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(2) Use of health services does not increase with age
(3)
Doctors who train abroad still face discrimination in NHS award scheme
(4)
Blood pressure tests for under 35s may be misleading
(1) 'Neutered' Government alcohol report pulls its punches
(The alcohol harm reduction strategy for
England: Overdue final report omits much that was useful in interim report)
http://bmj.com/cgi/content/full/328/7445/905
A recent report on reducing harm from alcohol by the Government's strategy
unit has been 'neutered' in comparison with the same study's interim
findings, according to an editorial in this week's BMJ.
The report, Alcohol Harm Reduction Strategy for England published last month, leads on education and communication strategies - though such measures were shown to be largely ineffective in last year's interim report says Martin Plant, Professor of Addiction Studies at the University of the West of England. Rather than popular 'symbolic gestures' such as warning labels, politicians should focus on more far-reaching initiatives to change drinking culture, says Professor Plant.
Despite crime and disorder forming the largest section of the report, it stops short of recommending obligatory local action programmes, says Professor Plant, preferring instead to rely on voluntary schemes. The approach to the alcohol industry also lacks bite, focussing on encouraging better practices - without recommending action for breaks to agreed codes of conduct. Alcohol is too important an issue for health and social policy, he says, for it to be left to voluntary compliance schemes.
Almost no mention is made of important issues such as gender, children of problem drinkers, and pregnancy - all covered in the more comprehensive interim report. And while substantial increases in price are unrealistic politically, the report's abrupt dismissal of a possible role for taxation is unjustifiable, argues Professor Plant.
In the face of alarming rises in alcohol consumption, the complex relationship between people and alcohol, and its deeply embedded place in our culture, must be better understood and addressed, he concludes.
Contact:
Prof. Martin Plant, Professor of Addiction Studies
Alcohol and Health Research Trust, Centre for Research in Public Health and
Primary Care Development, University of the West of England, Bristol BS16
1DD
Email: Martin.Plant@uwe.ac.uk
(2) Use of health services does not increase with age
(Hospital admissions, age and death ? 'The cost of ageing' or 'the cost of dying'? A retrospective cohort study)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38072.481933.EE
Despite public perceptions that older people are a huge burden on health services, new research from Bristol University shows that the use of acute hospital services does not increase with age.
This study will be available on bmj.com on Friday 16 April 2004.
Researchers analysed hospital death statistics for 1999-2000 to examine whether use of NHS hospital services in the three years before death varied with age.
Of the 254,000 people who died in hospital during this period, they found no evidence of increased use of acute NHS hospital services with age in the three years before death.
The number of hospital admissions over this period decreased with age and average length of stay was stable above age 45 years.
While the older sector of the population in total accounts for a high proportion of acute health care resources, this is due to the fact that they are nearing the end of their lives and not because they are individually more expensive, say the authors.
These findings agree with previous studies that have shown that the greatest acute care costs are incurred in the final years of life, no matter at what age this happens to be, they add. Such findings have important implications for understanding the use of acute hospital resources and for distinguishing the costs of dying from the costs of ageing.
Contacts:
Prof. Stephen Frankel, Professor of Epidemiology and Public Health Medicine,
Department of Social Medicine, University of Bristol, UK or via BMJ Press Office:
Email: Stephen.Frankel@bristol.ac.uk
Prof. Shah Ebrahim, Professor in Epidemiology of Ageing, Department of Social Medicine, University of Bristol, UK Email: Shah.Ebrahim@bristol.ac.uk
(3) Doctors who train abroad still face discrimination in NHS award scheme
(Characteristics of consultants who hold distinction awards in England and
Wales: database analysis with particular reference to sex and ethnicity)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38062.639190.44
- BMJ Online First
Discrimination against women and ethnic minority doctors in the NHS award scheme has decreased in recent years, but doctors who train abroad are still under-represented, according to new research.
This study will be available on bmj.com on Friday 16 April 2004.
The distinction award scheme was established at the inception of the NHS to recognise high achieving consultants. However, there have been concerns that the award system may discriminate against women, ethnic minorities, and particular fields of medicine.
Researchers identified all consultants in England and Wales who had been appointed up to 31 December 2001. Details of award status at the end of 2002 and country of training were recorded.
In the past, awards were less likely to be held by women, non-white consultants, and by doctors trained abroad. These differences diminished substantially after taking into account time spent as a consultant, but some under-representation remained.
Recent awards showed no under-representation of women and no appreciable under-representation of British trained ethnic minority doctors. However, both white and non-white doctors who had trained abroad remained under-represented at all levels of award.
Under-representation seems therefore to be a function of place of basic medical training rather than ethnicity, say the authors.
Recently, the award system has undergone major reorganisation and new clinical excellence awards will begin in 2004, they add. The aim is to provide all consultants with equal access and equal opportunities in a fair and transparent system.
Contact:
Prof. Michael Goldacre, Professor of Public Health,
UK Medical Careers Research Group, Department of Public Health, University
of Oxford, UK
Email: michael.goldacre@public-health.ox.ac.uk
(4) Blood pressure tests for under 35s may be misleading
(When measurements are misleading: modelling
the effects of blood pressure misclassification in the English population)
http://bmj.com/cgi/content/full/328/7445/933
Doctors who routinely measure blood pressure in people under 35 are more likely to misdiagnose than to detect hypertension correctly, according to a study in this week's BMJ. This could lead to unnecessary lifelong treatment for many.
Blood pressure naturally varies a great deal from day to day. British guidelines currently recommend that doctors check all their patients' blood pressures but because of the natural variation, it is frequently overestimated or underestimated. This means that hypertension may be overdiagnosed.
Dr Tom Marshall, a public health expert at Birmingham University, calculated how often hypertension would be diagnosed in over 13,000 people. He then calculated how many were truly hypertensive. He found that routine measurement of blood pressure in people under 35 is more likely to misdiagnose than to diagnose it correctly.
Young adults are at low risk of heart disease and therefore benefit little from treatment. But misdiagnosis could mean a lifetime on medication.
Doctors should diagnose hypertension with caution in young adults, taking the average of many measurements or even using a higher threshold, he concludes.
Contact:
Dr Tom Marshall, Lecturer in Public Health,
Department of Public Health and Epidemiology, University of Birmingham, UK
Tel (currently based in Boston, USA): Email:
t.p.Marshall@bham.ac.uk
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American
Association for the
Advancement of Science
(http://www.eurekalert.org)