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Press releases Saturday 10 September 2005
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(1) FUNDING THE “WAR ON TERROR” COULD COST MILLIONS OF LIVES
(2) LATEST GOVERNMENT REPORT ON HEALTH INEQUALITIES “HUSHED UP”
(3) HIGH LEVELS OF DAILY STRESS MAY RESULT IN LOWER RISK OF BREAST CANCER
(4) GOVERNMENT’S ALCOHOL STRATEGY WILL FAIL BECAUSE OF PARTNERSHIP APPROACH WITH DRINKS INDUSTRY
(5) TREATMENTS FOR ALCOHOL ABUSE SAVE SOCIETY FIVE TIMES AS MUCH AS THEY COST
(6) A QUARTER OF HOSPITAL MRSA BACTERAEMIA OCCURS IN NEW ARRIVALS
(7) MEDICINE STILL A WHITE MALE PRESERVE, BUT THOSE DAYS ARE NUMBERED
(1) FUNDING THE “WAR ON TERROR” COULD COST MILLIONS OF LIVES
(Editorial: Funding the public
health response to terrorism)
http://bmj.com/cgi/content/full/331/7516/526
Funding the “war on terror” could cost the lives of millions of Americans, says a senior doctor in this week’s BMJ.
Professor Erica Frank argues that the US government’s decision to shift funds away from basic public health services towards preventing terrorism has cut funding for common diseases and for disaster relief, resulting in enormous numbers of unnecessary deaths.
“The most recent effects of these diversions of funding have been seen in the unfolding tragedy of Hurricane Katrina in New Orleans and the surrounding area,” she writes.
On September 11 2001, 3400 people died because of four horrific, intentional plane crashes. On the same day, 5200 Americans died from common diseases. A similar number of American deaths from these same causes has happened every day since then, she adds.
Concerns about disproportionate funding in the US have been building for some time. As early as 2002, many public health workers thought that the Bush administration’s plan for smallpox vaccination was a misguided redirection of public health funds.
Although pressure to provide mass immunisation against smallpox has subsided, preparedness for bioterrorism still seems magnified well beyond its proportional risk. For example, in September 2002 New York was awarded $1.3m to reduce heart disease, the leading killer of New Yorkers, while $34m was awarded for bioterrorism preparedness in the state.
FBI funds designated for investigating fraud in health care also seem to have shifted to other purposes, including fighting terrorism, and military funds for cleaning up polluted sites and meeting clean air standards have been proposed for capping and exemption by the Pentagon.
These observations are not intended to diminish the tragedies of 11 September 2001 or 7 July 2005 or other terrorist actions, nor to negate the importance of developing effective ways of making sure such tragedies are not repeated, says the author.
It is certainly justifiable for governments to appropriate substantial funds to prevent potential future threats to our security. But public funding for current threats should not be compromised.
“Predictable tragedies happen every day. We know strategies to reduce deaths from tobacco, alcohol, poor diet, unintentional injuries, and other predictable causes. And we know that millions of people will die unless we protect the population against these routine causes of death,” she concludes.
Contact:
Professor Erica Frank, Department
of Family and Preventive Medicine, Emory University School of Medicine, Atlanta,
GA, USA
Email: efrank@emory.edu
(2) LATEST GOVERNMENT REPORT ON HEALTH INEQUALITIES “HUSHED UP”
(Letter: Labour’s “Black report”
moment?)
http://bmj.com/cgi/content/full/331/7516/575
Researchers in this week’s BMJ accuse the government of suppressing their latest report on health inequalities, showing that the gap between the rich and poor in England has continued to widen under New Labour.
They argue that the report appeared at a time when the responsible minister was on holiday and her deputy unavailable - curiously reminiscent of the deliberately covert release of the Black Report on an August Bank holiday Monday in 1980. Labour, then in opposition, was “incensed” by this cover up attempt.
Even stranger, say the authors, the press release referring to the report deflected attention from its main message by focusing on the introduction of “health trainers.” The scientific endorsement of the report was also at odds with its key findings.
To dismiss health inequalities as minimal is surely misleading when even the most conservative measures show that infants in poorer areas of England are at least twice as likely to die in their first year of life than those in more affluent areas, they write.
The hushed up release of this report raises fears that the bold statements and unprecedented promises of Labour’s first years in power (for example, the pledge to eradicate child poverty within a generation) have now been wholly overtaken by the individualistic rhetoric of behavioural prevention and “choosing health” and its three principles of “informed choice, personalisation, and working together,” say the authors.
They suggest that rather than focusing on changing the health choices of millions of individuals, the government should think more about a healthier way to govern and at last choose to use the tax and benefit systems to kerb growing social inequalities in income and wealth.
Contacts:
Mary Shaw, Reader in Medical Sociology,
Department of Social Medicine, University of Bristol, UK
Email: mary.shaw@bristol.ac.uk
George Davey Smith, Professor of
Clinical Epidemiology, Department of Social Medicine, University of Bristol,
UK
Email: George.Davey-Smith@bristol.ac.uk
Danny Dorling, Professor of Human
Geography, Department of Geography, University of Sheffield, UK
Email: danny.dorling@sheffield.ac.uk
Richard Mitchell, Associate Director,
Research Unit in Health, Behaviour and Change, University of Edinburgh Medical
School, Edinburgh, UK
Email: Richard.Mitchell@ed.ac.uk
(3) HIGH LEVELS OF DAILY STRESS MAY RESULT IN LOWER RISK OF BREAST CANCER
(Self reported stress and
risk of breast cancer: prospective cohort study)
http://bmj.com/cgi/content/full/331/7516/548
High levels of daily stress appear to result in a lower risk of developing breast cancer for the first time, says a study in this week's BMJ.
But high stress may put women at risk of other serious illnesses warn the researchers, a team from Denmark.
The findings follow an eighteen year study of over 6,500 women in Copenhagen. At the start of the study researchers asked the women what levels of stress they experienced routinely in their lives, and classified the results into low, medium and high levels. Stress was defined as tension, nervousness, impatience, anxiety, or sleeplessness. (Stress levels were not measured throughout the study.)
In calculating the effects of stress, researchers also adjusted the results for other factors, such as whether they had children or whether they were menopausal, which would have an influence on developing breast cancer. They did not account for risk factors such as family history of the disease however.
Of the 251 women diagnosed with first-time breast cancer over the study period, researchers found that women reporting high levels of stress were 40% less likely to develop breast cancer than women reporting low levels of stress.
The study further found that, for every increased level of stress on a six-level scale, women were 8% less likely to develop breast cancer.
One explanation for the findings may be that sustained levels of high stress may affect oestrogen levels - which, over time, may have an influence on developing breast cancer. But this theory has not been tested, and research in this area so far has mainly been restricted to animals, caution the authors.
Despite the findings, the authors warn that stress-induced changes in hormonal balances are not a healthy response, and continued stress may play a damaging part in other illnesses - particularly heart disease.
Contact:
Naja Rod Nielsen, Research assistant,
National Institute of Public Health, Copenhagen, Denmark
Email: nrn@niph.dk
(4) GOVERNMENT’S ALCOHOL STRATEGY WILL FAIL BECAUSE OF PARTNERSHIP APPROACH WITH DRINKS INDUSTRY
(Editorial: British drinking:
a suitable case for treatment?)
http://bmj.com/cgi/content/full/331/7516/527
The Government’s strategy on alcohol will do nothing to tackle problem drinking in Britain, because it “embraces the industry’s diagnosis and preferred remedies”, says an editorial in this week’s BMJ.
Current policy accepts the industry view that those who endanger their health through drinking and take part in anti-social behaviour are a minority, and should be targeted through education campaigns, treatment, better policing and self-regulation from the industry.
But these are exactly the policies least likely to reduce problem drinking according to the evidence, says the author.
The rise in drinking in Britain is probably the result of lowering the cost of alcohol while increasing its availability, mixed with heavy promotion of alcohol in British cities, he argues.
Alcohol abuse is now thought to cost the British economy £30bn a year, and alcohol dependency rates in the UK are amongst the highest in Europe, at 7.5% of British men and 2.1% of British women.
The most effective policy to reduce problem drinking is to increase taxes on drinks with the highest alcohol concentration – a policy which the Government has snubbed, rejecting the views of the world’s leading researchers on alcohol.
In Australia, a country with liberal licensing laws, alcohol consumption has fallen per head by 24% in twenty years, while at the same time rising by 31% in the UK. A policy of lowering taxes on low alcohol drinks, reducing the drink-driving limit to 0.05% (rather than the UK’s 0.08%) with vigorous enforcement, has been effective. Low alcohol beer now accounts for 40% of all beer consumed in Australia.
The two alcohol reduction treatments evaluated in this week’s BMJ – motivational enhancement treatment and social network therapy – are cost-effective, and ministers should also look at investing in these to increase access for those affected.
If the Government wants to prevent a “worsening epidemic” of alcohol misuse, it should replace its current policies with some that “have a chance of reducing (rather than merely preventing further rises in) alcohol related harm,” concludes the author.
Contact:
Professor Wayne Hall, Office of Public
Policy and Ethics, University of Queensland, Australia
Email: w.hall@imb.uq.edu.au
(5) TREATMENTS FOR ALCOHOL ABUSE SAVE SOCIETY FIVE TIMES AS MUCH AS THEY COST
(Effectiveness of treatment
for alcohol problems: findings of the randomised UK alcohol treatment trial
(UKATT))
http://bmj.com/cgi/content/full/331/7516/541
(Cost effectiveness of treatment
for alcohol problems: findings of the randomised UK alcohol treatment trial
(UKATT))
http://bmj.com/cgi/content/full/331/7516/544
Two types of non-residential treatments for alcohol abuse are highly effective and save society five times as much as they cost to run, say two papers in this week’s BMJ.
In the first ever UK Alcohol Treatment Trial researchers compared the success of a new treatment – social behaviour and network therapy – with the tried and tested motivational enhancement therapy. Both of these allow clients to continue their daily lives rather than involving residential stays.
As part of the study a separate paper looked at the cost effectiveness of both treatments.
The study involved over 600 people with alcohol problems across three regions - West Midlands, South Wales and Leeds. Clients were from a range of social backgrounds, and were interviewed at the start of the study, after three months, and again after 12 months.
The researchers found that both sets of treatments resulted in much-reduced levels of alcohol consumption and dependency on alcohol. After three months of therapy, the number of alcohol-abstaining days had risen by almost 50% on average for both treatments, while the number of drinks per day had dropped by a third.
Importantly clients sustained these levels of success, with similar results maintained twelve months into the programme.
The therapies were also effective in reducing alcohol related problems - decreasing by 50% on average for both therapies after 12 months. Clients also reported improvements in mental health and general well-being.
In determining the cost effectiveness of both therapies, researchers looked at the cost of the treatments (training and salaries of therapists, hire of therapy rooms, etc), and the clients’ cost impact on public sector resources before treatment, such as use of social services and appearances in court. They also included the impact on health services before treatment - such as use of GP time and number of hospital visits.
They found that the therapies resulted in substantial savings across health and social services - saving the public purse five times as much per client as the sum spent on their treatment.
As the name suggests social behaviour and network therapy helps people with alcohol problems to build social networks to support them in changing their drinking behaviour, and involves up to eight 50 minute sessions with a therapist.
Motivational enhancement therapy, made up of three 50 minute sessions, combines motivational counselling with feedback on progress.
Training therapists for both sets of treatment costs little and results in significant financial gains for the economy, the authors conclude.
Contacts:
For paper: Effectiveness of treatment
for alcohol problems - Dr Gillian Tober, Leeds Addiction Unit, Leeds Mental
Health Teaching NHS Trust, Leeds, UK
Email: gillian.tober@nhs.net
Godfrey, Department of Health Sciences,
University of York, UK
Email: cg2@york.ac.uk
(6) A QUARTER OF HOSPITAL MRSA BACTERAEMIA OCCURS IN NEW ARRIVALS
Online First
(MRSA bacteraemia in patients on arrival in hospital: a cohort study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38558.453310.8F
One in four cases of MRSA blood stream infection in hospital occur in patients who have just arrived from the community. These patients tend to be older and have been in hospital before.
These results, published on bmj.com today, should help to refine infection control policies in UK hospitals.
In the past 10 years, MRSA infection has increased in the United Kingdom. The bacterium can infect many sites; one serious form of infection is that in which blood-stream infection occurs (bacteraemia). A national surveillance scheme counts MRSA bacteraemia by hospital trust, but it has not yet addressed whether cases of MRSA bacteraemia are arriving in hospitals from the community.
Researchers at the University of Oxford analysed methicillin resistant Staphylococcus aureus (MRSA) and methicillin sensitive Staphylococcus aureus (MSSA) bacteraemia in patients on arrival in two Oxfordshire hospitals over a seven year period (1997 to 2003).
At one hospital, patients admitted from the community accounted for 49% of total MSSA cases and 25% of total MRSA cases. The proportion of methicillin resistance among patients admitted with Staphylococcus aureus bacteraemia, rose from 14% in 1997 and 1998 to 26% in 2003.
Most patients (at least 91%) admitted with MRSA bacteraemia had previously been in hospital, half had never had MRSA detected before, and 70% were admitted to emergency medical and surgical services. A similar pattern was observed in the other hospital.
Despite some study limitations, the authors conclude that, of the cases of MRSA bacteraemia detected in hospital, a quarter occurs in patients who have just arrived from the community, and that this proportion is increasing. They call for additional research to be undertaken into the best way to recognise these patients.
Contact:
Oliver Francis, Communications Manager,
Oxford Radcliffe Hospitals NHS Trust, UK
Email: oliver.francis@orh.nhs.uk
(7) MEDICINE STILL A WHITE MALE PRESERVE, BUT THOSE
DAYS ARE NUMBERED
(Women doctors and their careers:
what now?)
http://bmj.com/cgi/content/full/331/7516/569
Despite a record number of female medical students, medicine remains a white male dominated profession – but its days as such are numbered, says a paper in this week’s BMJ.
Twenty years ago “the old boy network and behind the scenes telephone calls were dominant factors in the selection process, and many women who wanted to reduce their hours to spend time with their children were not regarded as proper doctors” says Isobel Allen, Professor of Health and Social Policy.
Since then however the proportion of women consultants has doubled from 12% in 1983 to 25% in 2004. General practice has also seen figures multiply - from 19% in 1983 to 38% now.
Changes to the medical career structure in the last few years, such as more flexible training programmes, and shorter hours due to the European Working Time Directive, have all made the career more viable for women.
Ongoing concerns remain, however. Only 7% of consultant surgeons are female for instance, and women doctors do not even make up 40% of the workforce in either general practice or hospital medicine, says Professor Allen. Also, less women than men are in registered doctor training posts.
Academic medicine - training the doctors of tomorrow - is a career path facing serious shortages of women, as the demands of juggling research, being a doctor, and having a family life when little career flexibility is on offer has made the job unattractive to women.
Women often have an ‘M-shaped’ career structure, showing that contrary to popular belief, many women do not abandon medicine after childbirth but return to their careers.
Despite this, there is still suspicion about those who have not reached a certain grade by a certain age. It is time to reject old fashioned practices and attitudes like these, which deny women the opportunity to make their full contribution, says the author.
The days when pursuing a career in medicine meant losing the right to a ‘normal’ life for either men or women are rightly gone, says Professor Allen. “It was not a golden age and will never return,” she concludes.
Contact:
Professor Isobel Allen, Policy Studies
Institute, University of Westminster, London, UK
Email: i.allen@psi.org.uk
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