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Press releases Saturday 18 June 2005

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

(1) SHOULD EVERYONE OVER 50 BE TAKING ASPIRIN?

(2) STUDY FINDS STRONG LINK BETWEEN EPILEPSY AND RISK OF SCHIZOPHRENIA

(3) EUROPEAN WORKING TIME DIRECTIVE MAY PUT DOCTORS’ AND PATIENTS’ LIVES AT RISK

(4) PLANNED HOME BIRTHS IN THE UNITED STATES ARE SAFE, SAY RESEARCHERS

(1) SHOULD EVERYONE OVER 50 BE TAKING ASPIRIN?

(For and against: Aspirin for everyone over 50?)
http://bmj.com/cgi/content/full/330/7505/1440

Experts go head to head in this week’s BMJ over whether everyone over 50 should take a daily aspirin to reduce their risk of heart attacks and strokes.

Peter Elwood and colleagues at Cardiff University believe that the evidence now supports more widespread use of aspirin, and there needs to be a strategy to inform the public and enable older people to make their own decision.

As a general rule, daily aspirin is given only to people whose five year risk of a vascular event, such as a heart attack or stroke, is 3% or more. The authors show that, by age 50, 80% of men and 50% of women reach this level of risk and they suggest that 90-95% of the population could take low dose aspirin without problems. Evidence is also growing that regular aspirin may reduce cancer and dementia.

“The possibility that a simple, daily, inexpensive low dose pill would achieve a reduction in vascular events, and might achieve reductions in cancer and dementia without the need for screening, deserves serious consideration,” they write.

“Although we judge that aspirin should be taken from around 50 years, we insist that the general public should be well informed and the final decision should lie with each person.”

But Colin Baigent of the Oxford Radcliffe Infirmary warns that it would be unwise to adopt such a policy, whatever age threshold is chosen, until we are sure that older patients will derive net benefit from it.

Based on data for 55-59 year olds, aspirin prevents around two first heart attacks per 1000 population each year. However, this benefit does not outweigh the expected risk of a major gastrointestinal bleed at age 60 (1-2 per 1000 per year).

“In my view, we should not contemplate an age threshold approach to primary prevention with aspirin until we have much better evidence of its benefits in older people,” he says. We therefore need further randomised trials comparing low dose aspirin with placebo.

“A recommendation that aspirin be used for primary prevention of vascular disease in unselected people over a certain age could result in net harm, and we must have very good evidence to the contrary before instituting such a policy,” he concludes.

Contacts:

Peter Elwood, Chairman, Welsh Aspirin Group, Department of Epidemiology, Statistics and Public Health, Cardiff University, Llandough Hospital, Penarth, Wales, UK
Email: pelwood@doctors.org.uk

Please note, Colin Baigent is currently on holiday and unable to take media calls. Please contact BMA press office for alternative spokespeople
Email: pressoffice@bma.org.uk

(2) STUDY FINDS STRONG LINK BETWEEN EPILEPSY AND RISK OF SCHIZOPHRENIA

Online First
(Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38488.462037.8F

People with a history of epilepsy are at increased risk of developing schizophrenia and schizophrenia-like psychosis, concludes a study published online by the BMJ today.

The authors suggest that the two conditions may share common genetic or environmental causes.

The study involved 2.27 million people who were born in Denmark between 1950 and 1987, and were identified from national registers. Personal and family histories of epilepsy and psychosis were obtained, and individuals were monitored for up to 25 years.

The team found that people with a history of epilepsy had nearly two and a half times the risk of developing schizophrenia and nearly three times the risk of developing a schizophrenia-like psychosis compared with the general population. The risk was the same for men and women but increased with age.

Both a family history of epilepsy and a family history of psychosis were also significant risk factors for schizophrenia and schizophrenia-like psychosis. For epilepsy, however, the increased risk was more pronounced for people with no family history of psychosis.

The increased risk did not differ by type of epilepsy, but was significantly greater the older people were when they were first admitted to hospital for epilepsy.

“We think that this study is the first, on a population level, to show that a family history of epilepsy increases the risk of schizophrenia or schizophrenia-like psychosis even after adjusting for the effects of personal history of epilepsy and other factors,” say the authors.

“This finding suggests that genetic or environmental factors shared by family members may have an important role.”

Contact:

Ping Qin, Associate Professor, National Centre for Register-based Research, University of Aarhus, Denmark
Email: pq@ncrr.dk

(3) EUROPEAN WORKING TIME DIRECTIVE MAY PUT DOCTORS’ AND PATIENTS’ LIVES AT RISK

(Junior doctors’ shifts and sleep deprivation)
http://bmj.com/cgi/content/full/330/7505/1404

The European working time directive may put doctors’ and patients’ lives at risk, warn experts in this week’s BMJ.

Introduced in August 2004, it aims to reduce working hours in order to improve workers’ health and safety, but the current NHS shift system could threaten doctors’ and, moreover, patients’ safety, argue Professor Roy Pounder and colleagues.

Junior doctors’ working hours are now limited to a shift of no more than 13 hours followed by a break of at least 11 hours. But a survey in December 2004 by the Royal College of Physicians found that most trainee doctors in NHS trusts were forced to work a 91 hour week as a series of night shifts.

Recent studies from the United States have proved the risks to patients and doctors of long working hours. Any shift system should have as few successive night shifts as possible, with a maximum of three consecutive nights. A single night shift, with a day off before and after, is reported to show the least distortion of circadian rhythms.

The aviation industry has taken note of research on short periods of sleep. The NHS must now reassess the practice of shift work to maximise doctors’ safety and efficiency, and to safeguard the interests of patients, urge the authors.

They propose that doctors should be rostered for single nights, with one or two night shifts over a weekend. Health and safety measures should also be built into every shift and doctors should be taught how to cope with night work.

“Those who arrange junior doctors’ working schedules should put patients’ and doctors’ safety first and foremost. It is ironic that the working time directive, introduced to protect workers’ health and safety, should have led to the imposition of 91 hour nocturnal working weeks for most trainee doctors,” they conclude.

Contact:

Roy Pounder, Emeritus Professor of Medicine, Centre for Gastroenterology, Royal Free Hospital, London, UK
Email: roypounder@hotmail.co.uk

(4) PLANNED HOME BIRTHS IN THE UNITED STATES ARE SAFE, SAY RESEARCHERS

(Outcomes of planned home births with certified professional midwives: large prospective study in North America)
http://bmj.com/cgi/content/full/330/7505/1416

Planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births, finds a study in this week’s BMJ.

Midwives involved with home births are often not well integrated into the healthcare system in the United States and evidence on the safety of such home births is limited.

In the largest study of its kind internationally to date, researchers analysed over 5000 home births involving certified professional midwives across the United States and Canada in 2000. Outcomes and medical interventions were compared with those of low risk hospital births.

Rates of medical intervention, such as epidural, forceps and caesarean section, were lower for planned home births than for low risk hospital births. Planned home births also had a low mortality rate during labour and delivery, similar to that in most studies of low risk hospital births in North America.

A high degree of safety and maternal satisfaction were reported, and over 87% of mothers and babies did not require transfer to hospital.

“Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions,” say the authors.

“This evidence supports the American Public Health Association’s recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States.”

Contacts:

Kenneth Johnson, Senior Epidemiologist, Surveillance and Risk Assessment Division, Center for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Canada
Email: ken_lcdc_johnson@phac-aspc.gc.ca

Betty-Anne Daviss, Project Manager, FIGO Safe Motherhood/Newborn Initiative, Society of Gynaecologists and Obstetricians of Canada, Ottawa, Canada
Email: badaviss@sogc.com

FOR ACCREDITED JOURNALISTS

Embargoed press releases and articles are available from:

Public Affairs DivisionBMA HouseTavistock SquareLondon WC1H 9JR
(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for theAdvancement of Science(http://www.eurekalert.org)