Online First articles may not be available until 09:00 (UK time) Friday.

Press releases Saturday 19 November 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) WOMEN STILL AT RISK OF CERVICAL CANCER DESPITE TREATMENT REMOVING PRE-CANCEROUS CELLS

(2) HIV DRUG RESISTANCE INCREASING IN UK AND AMONG HIGHEST IN THE WORLD

(3) NEW LABELLING ON FOODS STILL NOT CLEAR ENOUGH FOR ALLERGY SUFFERERS

(4) INDIANS SUFFER POOR HEALTH SERVICES WHILE PRIVATE SECTOR EXPANDS FOR FOREIGNERS

(5) TWINS’ LOWER IQ LEVELS THAN SINGLE-BORN CHILDREN NOT DOWN TO SOCIAL FACTORS

(1) WOMEN STILL AT RISK OF CERVICAL CANCER DESPITE TREATMENT REMOVING PRE-CANCEROUS CELLS

(Risk of cervical and other cancers after treatment of cervical intraepithelial neoplasia: retrospective cohort study)
http://bmj.com/cgi/content/full/331/7526/1183

Women who have had pre-cancerous cells removed remain at higher than average risk of developing cervical cancer in the 20 years following treatment, says research in this week’s BMJ.

Cervical cancer is one of the major causes of death from cancer for women worldwide. But in countries with organised screening programmes for cervical cancer, incidence rates and deaths drop significantly.

The study looked at the long-term risks of cervical and other cancers for women after treatment to remove pre-cancerous lesions, a procedure called cervical intraepithelial neoplasia (CIN). The treatment removes abnormal cells that, if left untreated over a period of time, might turn into cancer.

Researchers studied 7,564 women treated for CIN during 1974 and 2001, and followed this up through the Finnish cancer registry until 2003.

Over the period, the researchers identified 448 new cases of cancer among the women, which was 96 more than they anticipated when considering average rates among the female population.

Of those new cases, 22 had developed invasive cervical cancer and showed that women were at more than average risk in the first and second decades after their CIN treatment.

The authors say their findings are in contrast to previous studies that said the risk of cancer did not increase after eight years follow-up after CIN treatment.

There are three types of CIN – mild, moderate and severe. The authors found that the risk of cervical cancer was higher for women previously treated for the mild or moderate type of CIN, possibly because people with less serious lesions tended to have less systematic follow-up checks than those who had experienced the more severe form of CIN.

Despite this, the authors say the treatment of CIN is still effective and that an estimated 28-39% of cases without treatment would progress to invasive cancer.

Contact:

Ilkka Kalliala, researcher at the Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland
Email: ilkka.kalliala@helsinki.fi

(2) HIV DRUG RESISTANCE INCREASING IN UK AND AMONG HIGHEST IN THE WORLD

Online First
(Time trends in primary resistance to HIV drugs in the United Kingdom: multicentre observational study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38665.534595.55

Those infected with HIV in the UK have one of the highest rates of resistance to anti-HIV drugs of anywhere in the world, prompting fears of a second wave epidemic of resistant virus, a new study claims in this week’s BMJ.

The study authors are concerned that the large reductions in deaths and improvements to health since people with HIV were given combinations of drugs (combination antiretroviral therapy) may be compromised because of this.

Using national data on HIV positive cases, the researchers tested patients for resistance to the antiretroviral drugs before embarking on the treatment. Tests were conducted on 2,357 patients between 1996 and 2003 – thus researchers could track if there were changes to resistance patterns as time went on.

They found that 335 people showed some degree of resistance to one or more antiretroviral drugs in total. Most of these people – 257 – were resistant to drugs within one class only, 44 cases showed resistance to drugs within two classes and 34 showed resistance to drugs within all three commonly used drug classes.

Overall, this equates to a 14% rate of resistance to one or more of these drugs among the group studied over the whole time period. The resistance had reached an estimated 19% for the most recent time period of 2002-2003.

The UK’s 14% rate of resistance was considerably higher than the 7% estimate for chronically infected patients in the USA, 6% in France and 10% elsewhere in Europe. Direct comparisons should be treated cautiously, however, as different studies have used different definitions of resistance. Using a more conservative definition of resistance (high level resistance to at least one drug) gives an overall estimate of 9% for the UK for the years 1996-2003, with the rate being 12% in 2002-3.

The authors say: ‘The United Kingdom has among the highest reported rates of primary resistance to HIV drugs worldwide. By limiting the therapeutic options for a significant number of patients, the secondary epidemic of drug resistant HIV represents a major clinical and public health problem.’

Contact:

Deenan Pillay, Head of Centre, Centre for Virology, University College London and Head of Research, HIV/STI and Blood Borne Viruses, Centre for Infections, Health Protection Agency
Email: d.pillay@ucl.ac.uk

(3) NEW LABELLING ON FOODS STILL NOT CLEAR ENOUGH FOR ALLERGY SUFFERERS

(European developments on labelling of allergenic foods)
http://bmj.com/cgi/content/full/331/7526/1155

Safety for people with food allergies will be boosted later this month when new European laws will force manufacturers to label their food more accurately, but the laws do not offer full protection, says an editorial in this week’s BMJ.

The European Union directive on food labelling, which comes into effect on November 25, means manufacturers of packaged food will have to detail clearly if certain allergens are present in food, such as nuts, milk, eggs and fish.

The authors say this is welcome and shows that the threat of allergic reactions is now being taken seriously, but the general public needs to be aware that food manufactured and packaged before November 25 may still be in old style packaging.

Also, freshly prepared foods are exempt from the rules, something the authors are particularly concerned about, as they say most severe anaphylactic reactions to food happen when people are eating out in restaurants and cafes.

The EU should follow the approach adopted in Australasia, they argue, where all food suppliers have to give consumers detailed information on food either on packaging, on a display alongside food being served, or to the purchaser on request.

Another shortcoming of the EU rule is that it does nothing about the vagueness of the “may contain traces of nuts” warning, so the authors call for factories to establish separate production lines, processing and packaging for foods that contain the main allergens.

One of the authors Professor Aziz Sheikh, professor of primary care research and development at the University of Edinburgh, said: ‘Policy makers, legislators and food suppliers need to appreciate that neither underplaying or overplaying the risks of exposure to allergenic foods is helpful for those living with what is often a highly debilitating life-long condition.’

Contact:

Dr Chantelle Anandan, Department of Primary Care Research and Development, Division of Community Health Sciences, University of Edinburgh, Scotland
Email: chantelle.anandan@ed.ac.uk

(4) INDIANS SUFFER POOR HEALTH SERVICES WHILE PRIVATE SECTOR EXPANDS FOR FOREIGNERS

(The private health sector in India is burgeoning, but at the cost of public health care)
http://bmj.com/cgi/content/full/331/7526/1157

Public health services in India are suffering while the private sector is rapidly expanding to cater for foreigners and richer citizens, says an editorial in this week’s BMJ.

At less than 1% of gross domestic product (GDP), India has one of the lowest levels of public spending on health care in the world. Meanwhile successive Indian governments have subsidised the private sector with tax breaks and releasing prime building land at low rates, argue the authors.

Patients from western nations like the UK and USA are capitalising on the quick and cheap operations - from routine procedures to heart bypass - provided by India’s growing private health industry.

But in public health services many drugs and diagnostic tests remain unavailable. Indians waiting to see harassed doctors face grubby surroundings and “hordes of other patients”. There are even reports of hospital patients having to pay bribes to get clean bed linen.

Indians are consequently going to great lengths to pay for private care. Two fifths of hospital inpatients have had to borrow money or sell assets to finance treatment. And a quarter of farmers are driven below the poverty line to fund their medical care.

Drug companies and other big businesses have now begun to dominate the private health sector, with five-star hospitals providing services which “only foreigners and the richest Indians can afford”. But these are “largely unregulated, with no standardisation of quality or costs”, warn the authors.

The current Indian government aims to create an insurance scheme for poor families and increase health spending. Yet the share of GDP spent on health has decreased in the past two years. The government must focus on improving the health of its citizens rather than “enticing foreigners… with offers of low cost operations,” conclude the authors.

Contact:

Samiran Nundy Department of Surgical Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India Mob: +91 981 111 7507
Email: snundy@hotmail.com

(5) TWINS’ LOWER IQ LEVELS THAN SINGLE-BORN CHILDREN NOT DOWN TO SOCIAL FACTORS

Online First
(The cognitive cost of being a twin: evidence from comparisons within families in the Aberdeen children of the 1950s cohort study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38633.594387.3A

Social and economic circumstances do not explain why twins have significantly lower IQ in childhood than single-born children, according to a study in this week’s BMJ.

Researchers studied 9,832 single-born children and 236 twins born in Aberdeen, Scotland between 1950 and 1956, using a previous child development survey as a base. They also gathered further information on mother’s age at delivery, birth weight, at what stage of the child’s gestation they were born, their father’s occupational social class, and information on other siblings.

They found that at age seven, the average IQ score for twins was 5.3 points lower than that for single-born children of the same family, and 6.0 points lower at age nine.

The study also showed that taking into account factors such as the child’s sex, mother’s age, and number of older siblings made little difference to the IQ gap.

Despite advances in recent years in obstetric practice and neonatal care, the authors argue that the likely explanation is because some twins have a shorter length of time in the womb than other children and are prone to impaired fetal growth.

Contact:

Professor David Leon, professor of epidemiology, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London
Email: david.leon@lshtm.ac.uk

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)