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Press releases Saturday 10 December 2005
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(1) DUMMIES (PACIFIERS) REDUCE SUDDEN INFANT DEATHS
(2) AGEING POPULATION WILL IMPOSE HUGE NHS BURDEN
(3) NURSES KEY TO SUCCESS OF MODERN HOSPITALS
(4) FACIAL TRANSPLANTS ARE JUSTIFIED, SAY EXPERTS
(5) ARE US FLU
DEATH FIGURES MORE PR THAN SCIENCE?
(1) DUMMIES (PACIFIERS) REDUCE SUDDEN INFANT DEATHS
Online First
(Use of a dummy during sleep and risk of sudden infant death syndrome
(SIDS): population based case-control study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38671.640475.55
Use of a dummy seems to reduce the risk of sudden infant death syndrome (SIDS), finds a study published online by the BMJ today.
Researchers in California interviewed mothers or carers of 185 infants who died and 312 randomly selected controls matched for race/ethnicity and age.
They obtained information on dummy use during the index sleep (defined as the last sleep or the sleep during the night before the interview), on other environmental factors related to sleep, and on risk factors for SIDS.
After adjusting for known risk factors, use of a dummy during sleep was associated with a 90% reduced risk of SIDS compared with infants who did not use a dummy.
The reduced risk was consistent across a wide range of social and economic characteristics and risk factors examined.
The reduced risk also seemed to be stronger when an infant was in an adverse sleep environment (such as sleeping prone or on the side, sleeping with a mother who smoked, or sleeping on soft bedding), although these differences did not reach significance.
“Use of a dummy is associated with a substantial reduction in the risk of SIDS,” say the authors. “Our results also provide some evidence that use of a dummy may reduce the impact of other risk factors for SIDS, especially those related to adverse sleep conditions.”
They suggest that the use of dummies may be an effective strategy for public health intervention.
Contact:
Dr De-Kun Li, Senior Research Scientist,
Division of Research, Kaiser Permanente Northern California, Oakland CA,
USA
Email: dkl@dor.kaiser.org
(2) AGEING POPULATION WILL IMPOSE HUGE NHS BURDEN
(Dr Foster’s case notes:
The ageing population of the United Kingdom and cardiovascular disease)
http://bmj.com/cgi/content/full/331/7529/1362
New figures published by Dr Foster in this week’s BMJ predict that the UK’s ageing population will impose considerable workload and financial pressures on the NHS.
The number of people aged 65 and over is predicted to increase by about 53% between 2001 and 2031. This is likely to lead to an increase in the number of people who have chronic diseases, including cardiovascular diseases.
Researchers examined the possible impact of the ageing population on the expected number of people with three cardiovascular disorders: coronary heart disease, heart failure, and atrial fibrillation (irregular heart rhythm).
By 2031, they predict that the number of cases of coronary heart disease will increase by 44%, the number of cases of heart failure will increase by 54%, and the number of cases of atrial fibrillation will increase by 46%.
If realised, these increases will have important implications for the NHS, say the authors.
For example, statins have become the single biggest component of the NHS prescribing budget, and their cost to the NHS is likely to increase further. So too will the costs of other drugs, as well as the costs of diagnostic tests, surgical procedures, and regular monitoring of patients. New medical technologies may also have a considerable impact on future caseloads.
Obesity, diabetes, and high blood pressure all increase the risk of developing heart disease, they write. “A key aim of government policy should therefore be to encourage people to remain active, engage in regular physical exercise, and refrain from behaviours that could have a detrimental effect on their health, such as smoking and overeating.”
Contact:
Jennifer Taylor, Dr Foster, London,
UK
Email: jennifer.taylor@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)
(3) NURSES KEY TO SUCCESS OF MODERN HOSPITALS
(Rise and demise of the hospital:
a reappraisal of nursing)
http://bmj.com/cgi/content/full/331/7529/1394
Nurses are the key to restoring public confidence in UK hospital care, argues an expert in this week’s BMJ.
Nurses led the transformation of hospitals in the 19th century. So, why after a century of outstanding success, is the future of the large general hospital in question? asks Professor Nick Black of the London School of Hygiene and Tropical Medicine.
Hospitals are partly a victim of their success, he says. Developments in pharmaceuticals, information and communication technology now offer alternative ways of delivering care. And when patients do need to attend hospital, they are less likely to stay overnight.
These changes are generally welcomed by the public, healthcare professionals, managers, and politicians. But negative reasons also threaten the future of large hospitals, arising from changes over the past 20 years in management, nursing, and building strategy.
So, what can save the hospitals? If public confidence is to be maintained, nurses must have a central role. Indeed, nurses rather than doctors have always really run the hospitals at the clinical level with doctors providing specialist help, writes the author.
Nursing also has the potential to moderate the public’s need for hospital care through innovations such as nurse led telephone help lines and delivering more care in the community.
In many ways, nursing is the key profession and doctors, managers and politicians must recognise and respect the contribution nurses can and must make, he argues. The response to the current crisis posed by MRSA suggests that this may be happening.
The 19th century teaches us that nurses must be central to the running of all aspects of hospitals, not just those areas deemed appropriate by the medical profession.
This will require improved leadership and enhanced opportunities for nurses. In this way everyone can benefit: hospitals will remain viable, doctors will be able to pursue the activities in which they excel, and the public’s concerns will be allayed, he concludes.
Contact:
Nick Black, Professor of Health
Services Research, London School of Hygiene and Tropical Medicine, London,
UK
Email: nick.black@lshtm.ac.uk
(4) FACIAL TRANSPLANTS ARE JUSTIFIED, SAY EXPERTS
(Editorial: Facial transplantation)
http://bmj.com/cgi/content/full/331/7529/1349
With news of the world’s first facial transplant hitting the headlines, experts in this week’s BMJ debate whether the benefit of this procedure to someone with severe facial deformity outweighs the risk of long term suppression of the immune system.
One of the main areas of concern has been the risk to patients from the side effects of long term immunosuppression, say the authors. However, a patient having a facial transplant would probably require a similar level of immunosuppression to patient having a kidney transplant.
Given that one of the main justifications for kidney transplantation is improvement in quality of life, the same argument should apply to facial transplant, they write.
Concern over psychological effects is also misplaced, they say. They argue that a psychological change is not necessarily a psychological problem, and believe that the psychological impact of facial transplant can be anticipated, planned for and managed.
In terms of public fears over altered identity, the authors explain that modelling of the change in appearance, using laser scanning and photography, shows that this does not occur after facial transplantation. “Indeed, preoccupation with altered identity risks becoming too much of a distraction from the important issue of managing immunosuppression,” they warn.
Although research has made the concept of facial transplant a reality, concerns about long term immunosuppression do remain. “But, instead of considering why facial transplantation cannot be justified, we may find it hard to justify why it should not be done,” they conclude.
Contact:
Peter Butler, Consultant plastic
surgeon, Department of Plastic Surgery, Royal Free Hospital, London, UK
Email: pembutler@gmail.com
(5) ARE US FLU DEATH FIGURES MORE PR THAN SCIENCE?
(Review: Are US flu death
figures more PR than science?)
http://bmj.com/cgi/content/full/331/7529/1412
US data on influenza death may be more PR than science, argues a Harvard University graduate student in this week’s BMJ.
The Centers for Disease Control and Prevention (CDC) acknowledges a difference between flu death and flu-associated death yet uses the terms interchangeably, writes Peter Doshi. Statistical incompatibilities also exist between official estimates and national vital statistics data.
For example, CDC states that the historic 1968-9 “Hong Kong flu” pandemic killed 34,000 Americans. At the same time, CDC claims 36,000 Americans annually die from flu. What is going on, asks Doshi?
The CDC uses indirect modelling methods to estimate the number of deaths associated with influenza. Thus the much publicised figure of 36,000 is not an estimate of yearly flu deaths, as widely reported in both the lay and scientific press, but an estimate - generated by a model - of flu-associated death, he says.
Compounding these problems is a marketing of fear - a CDC communications strategy in which medical experts “predict dire outcomes” during flu seasons, he adds.
If passed, the Flu Protection Act of 2005 will revamp US flu vaccine policy. The legislation will require CDC to pay makers for vaccines unsold “through routine market mechanisms.” The bill will also require CDC to conduct a “public awareness campaign” emphasising “the safety and benefit of recommended vaccines for the public good.”
Yet Doshi believes that this bill obscures the fact that CDC is already working in manufacturers’ interest by conducting campaigns to increase flu vaccination.
If flu is in fact not a major cause of death, this public relations approach is surely exaggerated, he says. Moreover, by arbitrarily linking flu with pneumonia, current data are statistically biased. Until corrected and until unbiased statistics are developed, the chances for sound discussion and public health policy are limited, he concludes.
Contact:
Peter Doshi, Graduate Student, Harvard
University, Cambridge, Massachusetts, USA
Email: pdoshi@fas.harvard.edu
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