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Press releases Saturday 8 October 2005
Please remember to credit the BMJ
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(1) SPORTS UTILITY VEHICLES SHOULD CARRY HEALTH WARNINGS, SAY EXPERTS
(2) UK FOOT AND MOUTH EPIDEMIC WAS A HUMAN TRAGEDY, NOT JUST AN ANIMAL ONE
(3) PRIVATE FINANCE INITIATIVE MAY HAVE HAD ITS DAY IN THE NHS
(4) REFORMING THE NHS: HAVE WE GONE TOO FAR OR NOT FAR ENOUGH?
(5) DAY SURGERY RATES RISING, BUT THERE IS STILL ROOM FOR IMPROVEMENT
(1) SPORTS UTILITY VEHICLES SHOULD CARRY HEALTH WARNINGS, SAY EXPERTS
(Editorial: Sports utility
vehicles and older pedestrians)
http://bmj.com/cgi/content/full/331/7520/787
Sports utility vehicles (SUVs) should carry health warnings to raise awareness of the increased risk to pedestrians compared with ordinary cars, argue researchers in this week’s BMJ.
They believe that this should form part of an integrated approach from public health, transportation and road safety agencies to address this growing threat.
Among road users, pedestrians are already a group at high risk, and older people are particularly vulnerable, write experts from Trinity College Dublin. People over 60 are more than four times as likely to die if injured by a car than younger people.
In Europe sales of SUVs have increased by 15% in the past year, while sales of standard cars have dropped by 4%. A recent US study found that, for the same collision speed, the likelihood of a pedestrian fatality is nearly doubled in the event of a collision with a large SUV compared with a passenger car. Other studies report higher rates (up to four times) of severe injury and death.
The increased risk from SUVs arises primarily from the geometry of the front end structure, explain the authors. Pedestrian injuries from cars are mainly leg fractures and knee injuries from the primary impact with the bumper and head injuries from the secondary impact with the bonnet or windscreen.
But because SUV bonnets are higher than those of cars, this results in more severe primary impact on the critical central body regions of the upper leg and pelvis, and a doubling of injuries to vulnerable regions such as the head, thorax, and abdomen.
The evidence clearly shows that SUVs represent a significantly greater hazard to pedestrians than ordinary cars – and those pedestrians are getting older and more vulnerable, say the authors.
Measures to address this threat should include changing crash investigation processes to identify SUVs in vehicle-pedestrian impact statistics, and displaying warning notices on SUVs to help inform consumers of the increased risks.
Addressing the hazards posed by SUVs to pedestrians is an emerging and real traffic safety challenge in the developed world, they conclude.
Contacts:
Desmond O’Neill, Associate Professor
of Medical Gerontology, Trinity Centre for Bioengineering and Medical Gerontology,
Trinity College Dublin, Ireland
Email: arhc@amnch.ie
or
Dr Ciaran Simms, Lecturer in Mechanical
Engineering, Trinity Centre for Bioengineering and Medical Gerontology, Trinity
College Dublin, Ireland
Email: csimms@tcd.ie
(2) UK FOOT AND MOUTH EPIDEMIC WAS A HUMAN TRAGEDY, NOT JUST AN ANIMAL ONE
Online First
(Psychological effects of the 2001 UK foot and mouth disease epidemic
in a rural population: qualitative diary based study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38603.375856.68
The 2001 UK foot and mouth disease epidemic was a human tragedy, not just an animal one, concludes a study published online by the BMJ today.
The UK’s foot and mouth disease epidemic in 2001 has been described as the most serious event ever to occur in a country previously free of the disease. Between 6.5 million and 10 million animals were slaughtered across the UK and the disaster caused widespread disruption and closure of much of the British countryside for more than a year.
But because the epidemic was treated as an animal problem, little is known about the human cost of the disaster.
Researchers from Lancaster University Institute for Health Research recruited a panel of 54 individuals, representing a wide range of rural workers and residents. Over a period of 18 months, panel members wrote more than 3,000 weekly diaries which were analysed along with in-depth interviews and participated in group discussions to capture evidence about the impact of the disaster and processes of recovery.
Their reports showed that life after the foot and mouth epidemic was accompanied by distress, feelings of bereavement, fear of a new disaster, loss of trust in authority and a sense that the value of local knowledge had been undermined.
Distress was experienced well beyond the farming community. In the aftermath of the disaster, health and social problems included flashbacks, nightmares, uncontrollable emotion, conflict within communities and increased social isolation. In the longer term, there was evidence of stress, anxieties about emissions from disposal sites, loss of confidence in authority, confusion, bitterness and increased fear of unemployment. Many of these effects continued to feature in the diaries throughout the 18 month period.
But the team also found that suffering was alleviated by trusted informal and formal support networks. This implies that statutory and voluntary organisations have a more complex and enduring role after a disaster than has been understood.
They argue for more flexibility in disaster planning, rather than the creation of new bodies or more targets and protocols. “People who have experienced a disaster may not be sick as a result, but they need careful and appropriate support to rebuild their lives and regain confidence,” they say.
They recommend joint service reviews of what counts as a disaster, regular sharing of intelligence, debriefing and peer support for front line workers, increased community involvement in disaster management, and wider more flexible access to regeneration funding and rural health outreach work.
Contacts:
Maggie Mort, Senior Lecturer, Institute
for Health Research, Lancaster University, UK
Email: m.mort@lancaster.ac.uk
or
Ian Convery, Lecturer in Human Geography,
Lancaster University, UK
Email: B.Broomby@lancaster.ac.uk
(3) PRIVATE FINANCE INITIATIVE MAY HAVE HAD ITS DAY IN THE NHS
(Editorial: Is the private
finance initiative dead?)
http://bmj.com/cgi/content/full/331/7520/792
Government enthusiasm for the Private Finance Initiative (PFI) in the health service - private sector investment in hospital building projects - may be dropping because of its high cost, says an editorial in this week’s BMJ.
Hospital trust boards initially welcomed the financing system, which they were told was the major way they could fund new facilities, paying investors back in annual instalments.
But concerns were soon raised that new PFI funded projects were providing less patient capacity than those they were designed to replace. PFI contracts also seemed very expensive, though details on costs were “shrouded in commercial secrecy”, says the author.
The House of Commons Public Accounts Committee recently questioned the “large profits made by the private contractor which built the Norfolk and Norwich hospital”, says the author. And the recent shelving of a flagship PFI venture in West London may herald the end for the PFI healthcare experiment in the UK, he suggests.
The fundamental problem is that PFI does not suit the rapidly changing climate of delivering healthcare in the UK, says the author, as private investors need long-term commitment from hospital managers – commitments increasingly unwise for trust boards to make.
The final blow could be the Government’s own economic operating constraint that debt should not exceed 40% of gross domestic product. Hospital repayments to PFI investors have always been treated as “off balance sheet” finance - not registered in public accounts. But this may soon change if the Government’s Office for National Statistics reclassifies PFI investment, since much of it may be categorized as debt – and at levels possibly breaching the Government’s own economic condition, says the author.
This would remove a key justification for PFI in healthcare, since a financing system which incurred heavy debts on the Government balance sheet overturns the argument for having PFI in the NHS at all, he concludes.
Contact:
Dr Rifat Atun, Centre for Health
Management, Tanaka Business School, Imperial College, London, UK
Email: r.atun@imperial.ac.uk
(4) REFORMING THE NHS: HAVE WE GONE TOO FAR OR NOT FAR ENOUGH?
(Personal View: Reforming
the NHS in England)
http://bmj.com/cgi/content/full/331/7520/852
(Personal View: Bevan betrayed:
the demise of the NHS)
http://bmj.com/cgi/content/full/331/7520/853
The NHS is being taken over by big business so that money that could go towards clinical care is diverted to corporations and their shareholders, warn two senior doctors in this week’s BMJ.
Robert Lane and Alex Paton argue that huge amounts are paid to large private firms for advice about the Private Finance Initiative (PFI) and independent sector treatment centres (ISTCs). Profits are then swollen by the scandalous practice of refinancing buildings, while cash-strapped hospitals must pay the mortgage for 30 years.
But problems go deeper than money, they say. While clinicians are expected to provide evidence to support the actions they take, ideas generated by government advisers are often applied without consultation.
“The result is a stream of untried schemes, based on ideology rather than evidence, that often have unforeseen consequences on different parts of the NHS.”
But for those in favour of reform, the problem is not that we have gone too far but that we have not yet gone far enough. In a second article, Jennifer Dixon calls for full implementation of the reforms already designed (payment by results, patient choice, and provision of care by non-NHS providers).
“The supply of private providers must continue to grow,” she says.
But she also wants more. Key elements, such as stronger financial incentives, boosted commissioning, and effective economic regulation, are urgently needed. The government must also provide more evidence that the risks of reform on this scale can be managed effectively, she concludes.
Contacts:
Robert Lane, President, Association
of Surgeons of Great Britain and Ireland
Email: rhslane@aol.com
Jennifer Dixon, Director of Policy,
King’s Fund, London, UK
Email: d.reynolds@kingsfund.org.uk
(5) DAY SURGERY RATES RISING, BUT THERE IS STILL ROOM FOR IMPROVEMENT
(Dr Foster’s case notes: Trends
in day surgery rates)
http://bmj.com/cgi/content/full/331/7520/803
New figures published by Dr Foster in this week’s BMJ show that day surgery rates continue to rise, yet there is still considerable scope for improvement. These findings support a recent Healthcare Commission report showing that day surgery units are not being used to their maximum capacity.
The NHS Plan predicts that 75% of all elective operations will be carried out as day cases. According to the British Association of Day Surgery, patients prefer day surgery as it provides timely treatment with less risk of cancellation, lower incidence of hospital acquired infections, and an earlier return to normal activities.
Researchers looked at day surgery rates by using hospital episode statistics between 1996-7 and 2003-4, and comparing them against the 25 operations identified by the Audit Commission as day cases.
Overall, the proportion of procedures carried out as day surgery rose from 55.7% in 1996 to 67.2% in 2003. Cataract operations showed the greatest increase in total admissions (including day cases), rising 94.8% over the study period.
Day surgery rates varied considerably between NHS trusts ranging from 40.2% to 82.7%, with only 12% of trusts carrying out 75% or more of the 25 operations identified by the Audit Commission as day cases. The authors suggest this variation might be explained by inconsistent coding or differences in case mix between hospitals.
The conclusions are much the same as those of the Healthcare Commission: day surgery rates are continuing to improve, yet the range of performance between NHS trusts remains wide leaving considerable scope for the poorer performers to improve.
Contact:
Julian Tyndale-Biscoe, Dr Foster,
17 St Helen’s Place, London, UK
Email: julian.tyndale-biscoe@drfoster.co.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)
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