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Press releases Saturday 22 January 2005

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(1) INTELLECT LINKED TO RISK OF SUICIDE IN YOUNG MEN

(2) INVASIVE PROCEDURES DO NOT NECESSARILY IMPROVE SURVIVAL FOR HEART

(3) PHARMACIST REVIEW DOES NOT KEEP OLDER PEOPLE OUT OF HOSPITAL

(4) MANY OF GEORGE BUSH'S HEALTH POLICIES LIKELY TO BE CONTROVERSIAL

(1) INTELLECT LINKED TO RISK OF SUICIDE IN YOUNG MEN

(Low intelligence test scores in 18 year old men and risk of suicide: cohort study)
http://bmj.com/cgi/content/full/330/7484/167

Intellectual capacity in early adulthood is strongly related to subsequent risk of suicide in men, finds a study in this week's BMJ.

Few previous studies have assessed the association of measures of intelligence with suicide, and results have often conflicted.

Researchers analysed the results of four intelligence tests, performed at conscription into military service, for 987,308 Swedish men. The men were monitored for up to 26 years and suicides were recorded.

Better performance on the tests was associated with a reduced risk of suicide. The strongest associations were with the logic test score, where the risk of suicide was three times higher in the lowest compared with the highest scorers.

The strength of the link and the large sample size suggest that this finding is unlikely to be due to chance, they add. One possible explanation could be that influences on brain development during childhood also increase an individual's susceptibility to mental illness and hence suicide. Alternatively, it may be due to an individual's ability to solve problems in times of crisis or maladjustment in childhood, they conclude.

Contacts:

Finn Rasmussen, Senior Clinical Lecturer and Associate Professor of Epidemiology, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
Email: finn.rasmussen@phs.ki.se

David Gunnell, Professor of Epidemiology, Department of Social Medicine, University of Bristol, UK
Email: D.J.Gunnell@bristol.ac.uk

(2) INVASIVE PROCEDURES DO NOT NECESSARILY IMPROVE SURVIVAL FOR HEART PATIENTS

Online First
(Access to catheterisation facilities in patients admitted with acute coronary syndrome: multinational registry study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38335.390718.82

Invasive procedures, often given to patients as soon as they are admitted to hospital with a life-threatening heart condition, do not necessarily improve survival, finds a study published on bmj.com today.

The researchers recommend more selective use of procedures, and argue against early routine transfer of patients to hospitals with specialist facilities.

The study involved over 28,000 patients in 14 countries who were admitted to hospital with suspected acute coronary syndrome between April 1999 and March 2003.

Most patients (77%) were admitted to hospitals with cardiac catheterisation facilities (a procedure in which a fine catheter (tube) is introduced into the heart via a blood vessel, to investigate its condition).

As expected, patients admitted to hospitals with specialist facilities underwent more invasive procedures than patients first admitted to hospitals without facilities.

However, after adjusting for other factors, the risk of death at six months was 14% higher among patients first admitted to hospitals with specialist facilities. The risk of major bleeding and stroke in hospital was also higher.

These results do not suggest that an invasive approach to patients with acute coronary syndrome is harmful but that a more restrictive selective use of invasive procedures is at least as effective as a more liberal routine use, say the authors.

This analysis therefore supports the current strategy of admitting patients with acute coronary syndrome as rapidly as possible to the nearest hospital, irrespective of the availability of a catheterisation laboratory, and argues against the early routine transfer of these patients to a specialised hospital with interventional facilities.

Contact:

Frans Van de Werf, Chairman, Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
Email: frans.vandewerf@uz.kuleuven.ac.be

(3) PHARMACIST REVIEW DOES NOT KEEP OLDER PEOPLE OUT OF HOSPITAL

Online First
(Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38338.674583.AE

The NHS recommends regular medication reviews for older patients, yet a study published on bmj.com today finds that home based monitoring does not keep older people out of hospital.

The research team identified 872 elderly patients discharged from hospital after an emergency admission. Patients were randomly selected to receive two home visits by a pharmacist (intervention group) or usual care (control group).

The pharmacists educated patients and carers about their drugs, removed out of date drugs, reported possible drug reactions or interactions to the general practitioner, and informed the local pharmacist if a compliance aid was needed.

After six months, 178 emergency hospital admissions had occurred in the control group and 234 in the intervention group, a statistically significant increase of 30% in the intervention group.

This trial shows that home based medication review by a pharmacist increased, rather than decreased, emergency hospital admissions, say the authors. Indeed, the intervention seemed to increase admissions by 30% and home visits by general practitioners by 43%. It also seemed to worsen patients' quality of life compared with controls.

The exact mechanism for this result is not clear, they add. It may be that a better understanding by patients of their conditions led to more hospital admissions. Alternatively, patients may have adhered better to their drugs, with a resultant increase in side effects or drug interactions.

Either way, more effective forms of medication review need to be established, say the authors. The recommendation of the national service framework for older people and the NHS plan that this should be widely introduced in primary care seems to lack a clear evidence base, they conclude.

Contact:

Annie Ogden, University of East Anglia Press Office, Norwich, UK
Email: press@uea.ac.uk

(4) MANY OF GEORGE BUSH'S HEALTH POLICIES LIKELY TO BE CONTROVERSIAL

(Editorial: George W Bush's second term)
http://bmj.com/cgi/content/full/330/7484/155

Many health policies under George Bush's second term in office are likely to be controversial, warns a leading British doctor and an American colleague in this week's BMJ.

That the American healthcare system is in a mess has long been apparent, write Professors Martin McKee and Susan Foster. Although the country spends almost 15% of its national income on health care, its outcomes are appalling, with death rates among young people from some common chronic diseases three or four times higher than in European countries.

The reforms that are being proposed contain some potentially good ideas, such as reform of the law on malpractice claims and expansion of community health centres, but others are seriously misguided, most notably the concept of health savings accounts.

Several other domestic policies are likely to prove controversial, write the authors. The expected change in the composition of the Supreme Court will facilitate a review of the legality of abortion, while social policies will emphasise fundamentalist views on sexuality and family relationships. As a result, the already high rate of teenage pregnancies is likely to increase further.

Policies adopted in Washington also have implications for the world, they add. The Bush administration has pursued a sustained campaign against multilateralism, seeking to block action on issues as diverse as global warming and landmines.

An example is the President's Emergency Plan for AIDS Relief, which exists in parallel with, and arguably undermines, the Global Fund to fight AIDS, Tuberculosis, and Malaria by diverting needed resources.

"Like other second term presidents George W Bush will have one eye on his place in history," say the authors. "The greatest epitaph for a politician is that they leave the world in a better state than they found it. History will be the judge."

Contacts:

Martin McKee, Professor of European Public Health, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK Mobile: +44 (0)7973 832 576 Email: martin.mckee@lshtm.ac.uk

Professor Susan Foster, Department of International Health, Boston University School of Public Health, Boston, USA
Email: sfoster@bu.edu

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