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Press releases Saturday 12 March 2005
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(1) FAILURE TO COUNT IRAQI CASUALTIES IS IRRESPONSIBLE, SAY EXPERTS
(2) STEADY RISE IN HIV AMONG HETEROSEXUALS IN THE UK
(3) NEW GUIDELINE TACKLES LEADING CAUSE OF MOTHER AND CHILD DEATH
(4) EUROPEAN FOLIC ACID POLICIES ARE NOT EFFECTIVE ENOUGH
(5) NEW NHS PAYMENT SYSTEM "IS NO PANACEA"
(6) OPENNESS IS KEY TO WINNING THE WAR OVER MMR
(1) FAILURE TO COUNT IRAQI CASUALTIES IS IRRESPONSIBLE, SAY EXPERTS
(News: UK and US governments
must monitor Iraq casualties)
http://bmj.com/cgi/content/full/330/7491/557
(Editorial: Counting the
dead in Iraq)
http://bmj.com/cgi/content/full/330/7491/550
An international group of public health experts has accused the British and American governments of being "wholly irresponsible" over their failure to count Iraqi casualties.
In a statement published online by the BMJ today, 24 experts from the United Kingdom, United States, Canada, Spain, Italy and Australia call for an independent inquiry into Iraqi war-related casualties. "We believe that the joint US/UK failure to make any effort to monitor Iraqi casualties is, from a public health perspective, wholly irresponsible," they write.
They argue that the British government's reliance on Iraqi Ministry of Health figures is "unacceptable." These figures "are likely seriously to underestimate casualties," since they do not take into account deaths during the first 12 months since the invasion, only include violent deaths reported through the health system, and they do not allow for reliable attribution between different causes of death and injury.
The inadequacy of the current US/UK policy was highlighted when the Lancet published research suggesting that Iraq had suffered around 100,000 excess deaths since the 2003 invasion, but the UK government rejected this survey as unreliable.
The experts call for a large, scientifically independent study to "remove uncertainties that remain," but both the British and American governments contend that they have no legal responsibility to count civilian casualties.
A Foreign Office spokesman told the BMJ: "We continue to feel that the Iraqi Ministry of Health figures are the best available in an uncertain situation, being based on an actual head count instead of extrapolation. In the current security climate, more accurate research is not feasible."
Professor Klim McPherson, public health epidemiologist at Oxford University, and instigator of the statement, said: "Basically this is a response to the government's continuing procrastination. Counting casualties can help to save lives both now and in the future—we have waited too long for this information."
Contact:
Katy Cronin, Count the Casualties
Campaign, London, UK
(2) STEADY RISE IN HIV AMONG HETEROSEXUALS IN THE UK
Online First
(HIV infections acquired through heterosexual intercourse in the United
Kingdom: findings from national surveillance)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38393.572188.EB
Numbers of HIV infections acquired through heterosexual intercourse in the United Kingdom are rising steadily, according to surveillance figures published online by the BMJ today.
However, they continue to represent less than 10% of all HIV infections diagnosed in heterosexuals in England, Wales, and Northern Ireland. And, contrary to popular belief, most of the increase is among people who are infected abroad, mainly in Africa. Homosexual men remain at greatest risk of acquiring HIV in the United Kingdom.
Using national HIV surveillance reports, scientists at the Health Protection Agency show that 21,115 adults diagnosed with HIV in England Wales, and Northern Ireland between 1985 and 2003 were infected through heterosexual intercourse. Of these, 1,901 (9%) were probably infected in the United Kingdom.
Sixty two per cent (1,179) had a sexual partner who was infected outside Europe, while nearly a third had a partner infected in Europe (including the United Kingdom). For 8% (153), the partner's country of infection was not established.
Figures may underestimate true numbers as voluntary surveillance systems are subject to under-reporting.
The authors conclude that, as the number of heterosexuals living with HIV (diagnosed and undiagnosed) in the United Kingdom grows, the likelihood of heterosexual transmission within the country will increase, particularly among ethnic minorities.
Contact:
Health Protection Agency Press Office,
London, UK
Email: hqpress@hpa.org.uk
(3) NEW GUIDELINE TACKLES LEADING CAUSE OF MOTHER AND CHILD DEATH
(Risk factors for pre-eclampsia
at antenatal booking: systematic review of controlled studies)
http://bmj.com/cgi/content/full/330/7491/565
(The pre-eclampsia community
guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in
the community)
http://bmj.com/cgi/content/full/330/7491/576
(Editorial: Pre-eclampsia
matters)
http://bmj.com/cgi/content/full/330/7491/549
A new guideline published in this week's BMJ will help to tackle one of the leading causes of illness and death during pregnancy.
Pre-eclampsia is a serious condition in which abnormally high blood pressure and many other disturbances develop in the second half of pregnancy. It affects about seven per cent of pregnancies and is dangerous for both mother and child.
The most important risk factor for developing pre-eclampsia is a previous history, show researchers at the John Radcliffe Hospital in Oxford. Diabetes and a high body mass index almost quadruple the risk, while mother's age and raised blood pressure are also significant.
Many fetal and maternal deaths from pre-eclampsia are associated with substandard care, claim the guideline authors. Poor management includes failure to identify or act on risk at the beginning of pregnancy or to recognise and respond to signs and symptoms after 20 weeks.
Their guideline recommends a straightforward system of early risk assessment and referral to ensure that pregnant women with pre-eclampsia are offered specialist care at the appropriate time for the best outcome for them and their baby.
It is aimed at those caring for pregnant women in the community and is a practical extension of NICE's antenatal guideline.
An accompanying editorial applauds the simplicity and practicality of the new guideline. "We cannot be complacent in the face of the recurrent deficiencies ?" writes Ian Greer, Professor of Obstetrics and Gynaecology at the University of Glasgow. "The pragmatic approach of PRECOG is essential because pre-eclampsia matters."
Contacts:
Paper: Kirsten Duckitt, Consultant
Obstetrician, Department of Obstetrics and Gynaecology, John Radcliffe Hospital,
Oxford, UK
Email: kduckitt@doctors.org.uk
Guideline: Fiona Milne, Guideline
Coordinator, Action on Pre-eclampsia, UK
Email: fionamilne@talk21.com
Editorial: Ian Greer, Regius Professor
of Obstetrics and Gynaecology, University of Glasgow, Glasgow Royal Infirmary,
Scotland
Email: i.a.greer@clinmed.gla.ac.uk
(4) EUROPEAN FOLIC ACID POLICIES ARE NOT EFFECTIVE ENOUGH
(Preventing neural tube defects
in Europe: population based study)
http://bmj.com/cgi/content/full/330/7491/574
The prevalence of neural tube defects in Europe has not declined substantially in the past decade, despite national policies of folic acid supplementation in half the countries, finds a study in this week's BMJ.
Each year, more than 4500 pregnancies in the European Union are affected by neural tube defects.
Researchers examined trends in the prevalence of neural tube defects in 16 European countries between 1980 and 2001, according to their folic acid policies during that time.
They found no substantial decline in neural tube defect rates in Continental Europe in the past decade, and although levels in the United Kingdom and Ireland fell by 32% (a continuation of a long-standing decline) they remain higher than levels in Continental Europe.
These data suggest that policies recommending supplementation of folic acid before conception and during early pregnancy in planned pregnancies are not effective enough, say the authors.
They explain that many women may not receive or respond to health promotion messages stressing the need to commence supplementation before conception, or may remain unaware that changes in diet are unlikely to achieve sufficient folate intake, and a large proportion of pregnancies in most countries are unplanned.
Folate status of most women of childbearing age could be raised by fortifying a staple food with folic acid, which would also help to reduce socioeconomic inequalities in the prevalence of neural tube defects, they write.
The potential for preventing neural tube defects in Europe by raising folate status is still far from being fulfilled, and it is unacceptable to continue to rely mainly on prenatal screening and termination to reduce the number of babies born with neural tube defects, they conclude.
Contact:
Araceli Busby, Lecturer in Environmental
Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Email: araceli.busby@lshtm.ac.uk
(5) NEW NHS PAYMENT SYSTEM "IS NO PANACEA"
(Dr Foster's case notes:
HRG drift and payment by results)
http://bmj.com/cgi/content/full/330/7491/563
The new NHS payment system has already run into problems and requires careful monitoring, say researchers at Dr Foster in this week's BMJ.
In April 2004 the NHS introduced its new "payment by results" system starting with foundation hospitals, whereby providers are paid for each individual case rather than through block contracts.
This new system uses healthcare resource groups (HRGs) as a measure of care based on diagnosis and complexity of treatment, but it has already run into problems. The planned roll-out across all NHS trusts for April 2005 has been restricted, while there is also concern that "gaming" may result, whereby providers reclassify patients into more complex and therefore more expensive HRGs to gain extra revenue.
The research team examined hospital episode statistics to determine whether foundation hospitals showed a change in numbers of emergency admissions and coding patterns compared with those providers still under the old block contracts.
Foundation trusts showed a greater increase in short stay inpatient admissions through accident and emergency departments (24%) than non-foundation trusts (17%). However, average episode costs and HRG codes did not change significantly.
Several countries have introduced case mix prospective payment systems, with varying results, say the authors. However, the payment by results system is no panacea.
This analysis suggests a disproportionate increase of short stay admissions through accident and emergency within foundation trusts. Thus far the English data show no consistent evidence of "HRG drift" but further analysis is needed as more data become available, they conclude.
Contact:
Paul Aylin, Clinical Senior Lecturer,
Department of Epidemiology and Public Health, Imperial College London, UK
Email: p.aylin@imperial.ac.uk
*Dr Foster is an independent organisation that analyses the availability and quality of health care in the United Kingdom and worldwide ( www.drfoster.com)
(6) OPENNESS IS KEY TO WINNING THE WAR OVER MMR
(Editorial: Has the UK government
lost the battle over MMR?)
http://bmj.com/cgi/content/full/330/7491/552
Openness and communication between experts and the public is key to winning the war over MMR, says an expert in this week's BMJ.
In 1998, MMR vaccinations in the United Kingdom reached 92% of its targets. Yet by 2002, after claims of a possible relation between MMR and autism, the United Kingdom lost considerable ground. One of the lowest levels of coverage of MMR is now found in London, at around 75%.
Parents who refused MMR vaccination for their children were not necessarily irrational, writes Professor Paul Bellaby. The high level of coverage achieved before that point had so far reduced the risk of contracting the diseases that parents began to see the vaccine itself as more of a threat to their children.
He believes that the explanation for the reversal lies not with Wakefield or even with parents who took his claims seriously, but with a failure of leadership by health professionals, lack of support for them from policy makers (including the prime minister), and mischief made by journalists.
The solution is not to affect distain for the bearers of false news but develop two-way communication about risk between experts and the public as equals, he says. If the United Kingdom has all but lost the battle for MMR, the war itself can still be won by openness.
Contact:
Paul Bellaby, Professor of Sociology
of Health, Institute for Public Health Research and Policy, University of
Salford, Salford, Greater Manchester, UK
Email: p.bellaby@salford.ac.uk
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