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Press releases Saturday 13 November 2004
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(1) HIV "HIGHER THAN EXPECTED" AMONG LONDON'S DRUG USERS
(2) AFFLUENT COUNTRIES SHOULD EMBRACE 'KANGAROO'
CARE
(3) CAN POOR COUNTRIES
HELP RICH COUNTRIES CONTAIN DRUG COSTS?
(4) POOR COMMUNITIES SHOULD DECIDE THEIR
OWN PRIORITIES FOR AID
(1) HIV "HIGHER THAN EXPECTED" AMONG LONDON'S DRUG USERS
Online First
(Incidence of hepatitis C virus and HIV among new injecting drug
users in London: prospective cohort study)
http://bmj.bmjjournals.com/cgi/rapidpf/bmj.38286.841227.7C
Levels of hepatitis C virus and HIV among injecting drug users in London are higher than expected, according to a study published online by the BMJ today.
During the 1990s, the prevalence of hepatitis C virus and HIV among this high risk group was relatively low compared with other countries. However, targets to prevent bloodborne viruses have been absent from the UK government's drug strategy in recent years.
In 2001, 428 new injecting drug users, mainly from London, completed questionnaires and provided samples to test for antibodies to hepatitis C virus and HIV.
Incidence of hepatitis C virus was high (41.8 cases per 100 person years) and of HIV was higher than expected (3.4 cases per 100 person years). These figures are supported by ongoing surveillance data, and suggest that transmission may have recently increased, say the authors.
Possible explanations for the rise include changes in patterns of injecting drug use and injecting risk behaviour in newer drug users than those injecting in the early to mid-1990s. In addition, there may have been increases in the number of injecting drug users over and above any increase in protective measures.
The authors argue that current drug policy is failing to protect this high risk group from bloodborne viruses. Innovative strategies are required to change behaviour and to deliver health education messages and harm reduction strategies early enough to make a difference, they conclude.
Contact:
Tony Stephenson, Press Officer, Imperial College London, UK
WHAT CAN RICH COUNTRIES LEARN FROM POORER ONES?
Most people in low-income countries
live in abject poverty, yet desperate circumstances and scant resources often
fuel innovation. What can they teach us? This week's special BMJ theme issue
focuses on what rich countries can learn from poorer ones. The rich world
doesn't have a monopoly on solutions, says acting editor, Kamran Abassi. Perhaps
there are local solutions that might teach us, the privileged in richer countries,
better ways of improving health care. Why look to the United States for ideas
when you might easily adopt pioneering initiatives from Bangladesh, Colombia,
India, Haiti, Zimbabwe ??
(2) AFFLUENT COUNTRIES SHOULD EMBRACE 'KANGAROO' CARE
(Kangaroo Mother Care, an example
to follow from developing countries)
http://bmj.com/cgi/content/full/329/7475/1179
(Commentary: Family friendly
care)
http://bmj.com/cgi/content/full/329/7475/1182
A simple technique used to care for premature babies in poor countries is a safe and effective alternative to incubator care and should be encouraged in wealthy countries too, say researchers in this week's BMJ.
Kangaroo Mother Care (KMC) was first developed in 1978 to deal with overcrowding of neonatal units in Colombia. It effectively uses mothers or fathers as incubators. Babies weighing 2000g or less at birth are attached to their mothers, fathers or other carers' chests in skin to skin contact and are kept upright 24 hours a day. This provides ideal conditions for them to thrive.
Current evidence indicates that KMC is at least as good as traditional care with incubators, write the authors. Studies have shown that KMC is safe, works at a fraction of the cost of an incubator, improves breastfeeding rates, and improves bonding between mother and infant. Parental sense of fulfilment and confidence are also improved.
KMC is now practised in 25 developing countries in Asia, Africa, and Latin America. Its use is also supported in industrialised countries such as France, Sweden, the United Kingdom, and the United States.
Almost two decades of implementation and research have made it clear that KMC is more than an alternative to incubator care and should be encouraged in affluent settings, say the authors. KMC, has not been outperformed by standard care, and is deemed a sound, evidence based alternative to treat premature babies in most settings, they conclude.
There is little doubt that KMC appears a safe and effective approach to caring for premature infants, writes Neil Marlow, Professor of Neonatal Medicine in an accompanying commentary.
He explains that scientific study has provided us with evidence for a range of effective interventions that should be widely practised in all neonatal units. In his view, "KMC forms a valuable and evidence based part of this important repertory of increasingly baby sensitive care."
Contact:
Professor Juan Gabriel Ruiz-Pelaez,
Clinical Epidemiology and Biostatistics Unit, School of Medicine, Javeriana
University, Bogota, Colombia
Email: jruiz@cable.net.co
(3) CAN POOR
COUNTRIES HELP RICH COUNTRIES CONTAIN DRUG COSTS?
(The concept of essential medicines:
lessons for rich countries)
http://bmj.com/cgi/content/full/329/7475/1169
(Commentary: The pros and
cons of essential medicines for rich countries)
http://bmj.com/cgi/content/full/329/7475/1172
Rich countries could follow the lead of poor countries and adopt a more systematic way of selecting medicines for reimbursement, according to a paper in this week's BMJ.
Rising costs of drugs is universal. From 1998 to 2001, prescription costs in the United States and England increased by 62% and 30% respectively. Yet, since the 1970s, many developing countries have set up national lists of essential medicines, which aim to increase access to medicines, promote better health and contain costs.
Could the essential drugs concept help rich countries to control the rise in drug costs?
Faced with these spiralling costs and increasing demands for quality health care by ageing populations, industrialised countries would do well to consider and adopt these approaches, writes Hans Hogerzeil of the World Health Organization. Essential medicines are not second rate medicines for poor people; they are the most cost-effective treatment for a given condition, he stresses.
Essential drug lists or formularies are already widespread in rich countries, say experts in an accompanying commentary. But there are trade-offs: limitations on choice of drug may save money, but if rigorously applied, some patients will be affected.
Drug lists also need integration into clinical guidelines, which can improve care but not necessarily cut cost, they add. For instance, in the United Kingdom, National Institute for Clinical Excellence guidelines and setting national standards have increased prescribing costs, they add
"We should learn from the experience of those implementing the concept, but adaptation must be sensitive to different environments," they conclude.
Contacts:
Paper: Hans Hogerzeil, Director ad
interim, Department of Essential Drugs and Medicines Policy, World Health
Organization, Geneva, Switzerland
Email: hogerzeilh@who.int
Commentary: Marcus Reidenberg, Professor,
Weill Medical College of Cornell University, New York, USA
Email: mmreid@med.cornell.edu
(4) POOR COMMUNITIES SHOULD DECIDE THEIR OWN PRIORITIES
FOR AID
(Letters: Learning from low
income countries: what are the lessons?)
http://bmj.com/cgi/content/full/329/7475/1183
Allowing poor communities to decide their own health priorities avoids inappropriate aid, says a senior doctor in a letter to this week's BMJ.
He describes the case of a village that was asked by an aid agency what its priorities for development aid would be, the answer presumed to be a health centre, school or irrigation system. When the villages replied that they wanted a football pitch, the agency withdrew its offer. So the villages built their own football pitch, and this engendered such a feeling of community spirit that they built their own health centre the next year without outside help.
"During famine, we concentrate on nutritional supplementation for children under 5 years old, yet I have been challenged by villagers who argue that the older children should have priority as they have already survived the difficult years of early childhood and are now contributing to their family's potential," he writes. "Listening to communities and allowing them to decide on their priorities avoids inappropriate aid."
Health for All by the Year 2000 failed to meet its goals in many countries, he adds. Aid therefore needs to be widely targeted and supplied in response to priorities that are determined locally.
Contact:
Paul Eunson, Consultant Neurologist,
Royal Hospital for Sick Children, Edinburgh, Scotland
Email: Paul.Eunson@luht.scot.nhs.uk
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