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Press releases Saturday 19 March 2005
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(1) NHS STOP-SMOKING SERVICES ARE INSUFFICIENT TO DELIVER NATIONAL SMOKING TARGETS
(2) ACUPUNCTURE RELIEVES PELVIC PAIN DURING PREGNANCY
(3) COSTS OF ANTIDEPRESSANTS COULD HAVE FUNDED EFFECTIVE ALTERNATIVES
(4) OBTAINING PATIENT CONSENT FOR CLINICAL
AUDIT IS UNWORKABLE WITHOUT EXTRA RESOURCES
(1) NHS STOP-SMOKING SERVICES ARE INSUFFICIENT TO DELIVER
NATIONAL SMOKING TARGETS
Online First
(NHS smoking cessation services and smoking prevalence: observational
study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38407.755521.F7
NHS Stop-Smoking Services are insufficient to deliver national smoking targets, and Government smoking targets are themselves insufficient for the poorest communities, says a study published online by the BMJ today.
The study examined the effectiveness of NHS smoking cessation services in Northumberland and Tyne and Wear. These areas have populations dominated by manual workers and contain some of the worst health and deprivation in the country.
Research showed that smoking cessation services in the region for 2003-4 reduced smoking rates by 0.1%-0.3%. If the trend continues, the study predicts that Stop-Smoking Services may deliver less than 1% of the 2010 target of a 5% fall in smoking prevalence.
Government targets on reducing smoking ignore the health inequalities gap says the author, which is made more disturbing given the poorer health of these communities.
Despite being the focus of targets to reduce cancer and circulatory disease in these populations, the failure to include health inequalities reduction in stop-smoking targets may result conversely in a widening of the gap between the healthiest and the worst off in England.
In California, says the author, heavy early investment in smoking cessation services produced disappointing population results.
Nicotine replacement therapy and buproprion are among the most cost-effective treatments for individuals, but "comprehensive restriction of smoking in all workplaces works better", he argues. England's most deprived communities need more of both sets of measures, he concludes.
Contact:
Dr Eugene Milne, Deputy Medical
Director, Northumberland Tyne and Wear Strategic Health Authority, Northumberland
UK
Email: eugene.milne@nhs.net
(2) ACUPUNCTURE RELIEVES PELVIC PAIN DURING PREGNANCY
Online First
(Effects of acupuncture and stabilising exercises as adjunct to standard
treatment in pregnant women with pelvic girdle pain: randomised single blind
controlled trial)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38397.507014.E0
Acupuncture and strengthening exercises help relieve pelvic girdle pain during pregnancy and are effective complements to standard treatment, finds a study published online by the BMJ today.
Pelvic girdle pain is a common complaint among pregnant women worldwide, but no cure exists.
Researchers in Sweden identified 386 pregnant women with pelvic girdle pain. Women were randomly divided into three groups; one received standard treatment (a pelvic belt and a home exercise programme), another received standard treatment plus acupuncture, and the third received standard treatment plus stabilising exercises to improve mobility and strength.
Pain levels were recorded every morning and evening using a recognised scale and all women were assessed by an independent examiner at the end of the treatment period.
After treatment, both the acupuncture group and the stabilising exercise group had less pain than the standard group in the morning and in the evening. Reduction of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group.
Acupuncture or stabilising exercises as an adjunct to standard treatment offers clear clinical advantages over standard treatment alone for reduction of pain in pregnant women with pelvic girdle pain, say the authors.
Acupuncture was superior to stabilising exercises in this study, they conclude.
Contact:
Helen Elden, Midwife, Perinatal
Center, Department of Obstetrics and Gynaecology, Institute for the Health
of Women and Children, Sahlgrenska Academy, Gothenburg, Sweden
Email: helen.elden@vgregion.se
(3) COSTS OF ANTIDEPRESSANTS COULD HAVE FUNDED EFFECTIVE ALTERNATIVES
Online First
(Opportunity cost of antidepressant prescribing in England: analysis
of routine data)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38377.715799.F7
Some of the costs of prescribing antidepressant drugs over the last decade could have been used to deliver psychological treatments of proven effectiveness, finds a study published online by the BMJ today.
Prescribing of antidepressant drugs has risen dramatically in the United Kingdom since the early 1990s. Cognitive behaviour therapy is an effective alternative to drugs, but has not been developed for widespread use.
Using Department of Health prescribing data, researchers at the University of Bristol estimated the number of patients that could have been treated with cognitive behavioural therapy in 2002, had the rise in prescribing not occurred and the associated costs been diverted to psychological treatment and therapists.
Between 1991 and 2002, prescriptions per head for all antidepressants increased almost three-fold and the total cost (adjusted for inflation) increased by £310m. These costs could have been used to deliver cognitive behaviour therapy to 1.54 million patients, more than a third of the adults in the UK with depression or mixed anxiety depression.
Despite some limitations, this analysis highlights the scale of resources expended in this area. The results indicate that development of psychological therapies is a feasible alternative to antidepressants, say the authors.
There is a clear need for further research to establish the most appropriate balance between drugs and non-pharmacological treatments for depression, they conclude.
Contact:
Cherry Lewis, Public Relations Office,
University of Bristol, UK
Email: cherry.lewis@bristol.ac.uk
(4) OBTAINING PATIENT CONSENT FOR CLINICAL AUDIT IS UNWORKABLE WITHOUT EXTRA RESOURCES
Online First
(A feasibility study of signed consent for the collection of patient
identifiable information for a national paediatric clinical audit database)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38404.650208.AE
Obtaining signed patient consent for audit purposes is difficult and is unlikely to be successful unless extra resources are made available, finds a study published online by the BMJ today.
The 1998 Data Protection Act strengthened controls on the use of personal data, but the Health and Social Care Act 2001 allows patient identifiable information to be made available in certain circumstances, including medical audit and research.
Researchers studied the feasibility of obtaining signed consent for submission of patient identifiable information to a national clinical audit database (PICANet).
Their analysis involved patients admitted to five paediatric intensive care units in England during May and July 2003. Parents and guardians were given a short explanation and an information sheet. Then 24 hours later (or before discharge) they were asked for signed consent. Factors that might influence the chance of consent being given, such as age, illness severity, and length of hospital stay, were also assessed.
Consent was obtained for 43% of admissions, only one refusal was received. Gaining consent for all admissions was difficult and varied widely across units.
The gaining of consent was unrelated to ethnicity or level of deprivation but was better for those who had a longer hospital stays and was worse for older children. The extremely low refusal rate suggested that parents were willing to share personal data.
These results reinforce the view that the logistics of obtaining consent for sharing information presents substantial challenges requiring new approaches to the issue, say the authors. Obtaining such consent is unlikely to be successful unless extra resources are allocated to training, staff time, and administrative support.
Contact:
Patricia McKinney, Reader in Paediatric
Epidemiology, Paediatric Epidemiology Group, University of Leeds,UK
Email: p.a.mckinney@leeds.ac.uk
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