Press releases Saturday 05 June 2004
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(1) Advanced breast cancer diagnosis more likely for deprived women
(2) Anti-trafficking measures can increase exploitation
(3) Apathy threatens new NHS foundation trusts
(4) Antibiotics can prevent meningitis outbreaks
(1) Advanced breast cancer diagnosis more likely for deprived women
(Are there socioeconomic gradients in stage and grade of breast cancer at
diagnosis? Cross sectional analysis of UK cancer registry data)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38114.679387.AE
Women living in deprived areas of the United Kingdom tend to have more advanced breast cancer at diagnosis than those living in affluent areas, finds new research on bmj.com.
Researchers analysed data on stage and grade of cancer at diagnosis for nearly 23,000 women with breast cancer in the Northern and Yorkshire region of England. Socioeconomic position was calculated using a recognised scoring method.
They found strong socioeconomic trends in the likelihood of breast cancer being diagnosed at high grade or advanced stage. Women living in more materially deprived areas tended to have more advanced disease at diagnosis than those living in less deprived areas.
These trends were stronger in women potentially exposed to the national breast cancer screening programme. This suggests that the programme may have led to social and economic inequalities in disease progression at diagnosis, say the authors.
Further consideration of the possible impact of interventions on socioeconomic inequalities in health is needed, they conclude.
Contact:
Jean Adams, Research Fellow, School of Population and Health Science,
University of Newcastle upon Tyne, UK
Email: j.m.adams@ncl.ac.uk
(2) Anti-trafficking measures can increase exploitation
(Trafficking and health)
http://bmj.com/cgi/content/full/328/7452/1369
Attempts to prevent human trafficking are making conditions worse for voluntary migrants, argue researchers in this week's BMJ.
Their concerns are based on studies conducted between 2000 and 2002 among child migrants in Mali and Vietnamese sex workers in Cambodia.
A survey of close to 1000 migrants in Mali found that only four had been deceived, exploited, or not paid for their labour. Rather, young people voluntarily sought employment abroad to experience urban lifestyles, learn new languages, and accumulate possessions.
In interviews and discussions with 100 Vietnamese women, only six reported having been "tricked" into sex work. Most knew before they left Vietnam that they would be engaged in sex work and some showed clear ambition to travel for economic incentives and an independent lifestyle.
In both Mali and Cambodia, intermediaries often assist safe migration, yet anti-trafficking policies do not distinguish between a trafficker with intent to exploit and an intermediary who facilitates a young migrant's journey and search for work.
These measures force migrants to rely on corrupt officials and use of clandestine routes, increasing their risk of harm and exploitation, say the authors.
"We do not dispute that in both settings migrants have suffered hardship and abuse, but current anti-trafficking approaches do not help their problems," they write. These studies show that a more flexible and realistic approach to labour migration among young people is required, they conclude.
Contact:
Joanna Busza, Centre for Population Studies, London School of Hygiene and
Tropical Medicine, London, UK
Email: joanna.busza@lshtm.ac.uk
(3) Apathy threatens new NHS foundation trusts
(Editorial: The first wave of NHS foundation trusts)
http://bmj.com/cgi/content/full/328/7452/1332
Local people, it seems, do not want to be involved in running the NHS, according to an editorial in this week's BMJ.
On 1 April 2004, the first 10 NHS foundation trusts came into being, giving local people ownership and accountability for health services. Yet most trusts have found it difficult to persuade enough people to help decide how they operate, writes Professor Rudolf Klein of the London School of Economics.
For example, in the first round of elections for Bradford Teaching Hospitals NHS Trust, well under 1% of the local population voted to elect the 17 governors responsible for the operations of the new trust. The trust's aim was to achieve a modest 10% of the local population.
More surprising was the apathy among the staff of aspiring foundation trusts. In Bradford, only 263 of a total staff of 3,600 voted to elect four governors.
These figures are appalling and might reflect cynicism about the role of the governing boards, says the author. But if the boards do turn out to be unrepresentative, it will be more difficult for foundation trusts to achieve the "freedom from Whitehall control" that they have been promised.
So far there has been no clear statement as to what the minimum level of electoral participation either is or should be, says the author. "If we are to avoid putting a very important experiment in the history of the NHS at risk then the time has come to be explicit about what the standards should be and how they are to be achieved," he concludes.
Contact:
Rudolf Klein, Visiting Professor, London School of Economics, London, UK
Email: rudolfklein30@aol.com
(4) Antibiotics can prevent meningitis outbreaks
(Effectiveness of antibiotics in preventing meningococcal disease after a
case: systematic review)
http://bmj.com/cgi/content/full/328/7452/1339
Giving antibiotics to everyone living in the same household as a patient who has had meningitis can substantially reduce the risk of further cases, according to a study in this week's BMJ.
Researchers analysed five studies to evaluate the effectiveness of giving chemoprophylaxis (preventive medicine) to the patient and to contacts in households and childcare settings.
They found that the risk of meningococcal disease in household contacts of a patient is reduced by 89% if they take antibiotics that eradicate meningococcal carriage. Another way of expressing this risk reduction across a population is that about 200 household contacts need to be treated to prevent one case during the first month.
The evidence also suggests giving preventive treatment to the patient before discharge from hospital, as at least 3% of patients will still carry the virulent meningococcal strain after treatment with penicillin.
However, there was no evidence to support indiscriminate prescribing of antibiotic prophylaxis to people outside this group, and there were insufficient studies to estimate the effect of chemoprophylaxis in childcare settings.
So far, a lack of evidence has led to different control policies across Europe. This paper reinforces current UK policy and provides sufficient evidence to encourage further consistency, conclude the authors.
Contact:
James Stuart, Consultant Epidemiologist, Health Protection Agency South
West, Gloucester, UK
Email: james.stuart@hpa.org.uk
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