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Press releases Saturday 25 February 2006
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(1) CHILDHOOD DEPRESSION MAY ENCOURAGE ECSTASY USE
(2) RESUSCITATION POLICIES IN LONG-TERM CARE SETTINGS SHOULD BE REVIEWED
(3) WARNING OVER UNFAIR TERMS FOR PATIENTS IN CLINICAL TRIALS
(4) NEW TREATMENTS BASED ON HUMAN BEHAVIOUR COULD REDUCE DRUG PRESCRIBING
(5) CONCERN OVER INSTITUTIONAL CARE FOR CHILDREN IN EUROPE
(6) BLOOD PRESSURE
GUIDELINES FOR STROKE MAY NOT BE RELEVANT TO MANY PATIENTS
(1) CHILDHOOD DEPRESSION MAY ENCOURAGE ECSTASY USE
Online First
(Symptoms of anxiety and depression in childhood and use of MDMA:
prospective population based study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38743.539398.3A
Children with symptoms of anxiety and depression may have an increased tendency to use ecstasy in adolescence or young adulthood, finds a study published online by the BMJ today.
The use of ecstasy is associated with emotional health problems, such as depression, psychotic symptoms, and anxiety disorders. But it’s not clear whether emotional problems are a consequence of using ecstasy or emotional problems lead to ecstasy use.
Researchers in the Netherlands investigated whether use of ecstasy is preceded by symptoms of behavioural and emotional problems in childhood and early adolescence.
They assessed ecstasy use in 1580 individuals from childhood into adulthood. The first assessment took place in 1983, before ecstasy appeared as a recreational drug in the Netherlands. Use of the drug was then assessed 14 years later, providing a unique opportunity to investigate if a pathway from behavioural and emotional problems leading to ecstasy use exists.
Individuals with signs of anxiety and depression in 1983 showed an increased risk of starting to use ecstasy.
Ecstasy’s effects are supposed to include enhanced feelings of bonding with other people, euphoria, or relaxation, say the authors. Individuals with signs of anxiety or depression may be particularly susceptible to these positive effects and may therefore use ecstasy to relieve their symptoms.
However, long term exposure to ecstasy may result in increased depressive symptoms. Individuals with signs of anxiety or depression in childhood are at risk of using ecstasy and may develop depressive symptoms. This may explain part of the link that has been found between ecstasy use and later depression in other studies, add the authors.
Other factors not tested in this study may account for the increased tendency to use ecstasy in some individuals. They include the social environment, novelty seeking, or substance use of parents.
“Focusing on these vulnerable individuals in future studies will increase our insight into the potential harmful effects of ecstasy on brain neurotransmitter systems and associated psychopathology,” they conclude.
Contact:
Anja Huizink, Assistant Professor,
Deaprtment of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam,
Netherlands
Email: a.c.huizink@erasmusmc.nl
(2) RESUSCITATION POLICIES IN LONG-TERM CARE SETTINGS SHOULD BE REVIEWED
(Cardiopulmonary resuscitation
in continuing care settings: time for a rethink?)
http://bmj.com/cgi/content/full/332/7539/479
Resuscitation policies in care homes and community hospitals should be reviewed, argue experts in this week’s BMJ.
Current guidelines require all NHS facilities to provide cardiopulmonary resuscitation unless an overt decision has been made to the contrary. Yet resuscitation is unsuccessful in most people in care homes and community hospitals.
Is it therefore ethical to require all institutions to carry out resuscitation, ask the authors?
In acute hospitals, the overall rate of survival to discharge is about 14% and up to half of survivors will suffer functional or neurological impairment. In public places, typical survival rates are 5-10% with over two-thirds of survivors suffering neurological problems. In care homes and community hospitals, data suggest survival rates of between 0-6%.
When treatment is unlikely to succeed, a presumption of intervention is inappropriate and requires scrutiny, write the authors. Given the low chance of success, it may be that institutions should not offer resuscitation at all, they suggest. Resources saved could be better used in improving the quality of care.
Alternatively, institutions might allow healthcare professionals to make an informed decision on the likelihood of success of resuscitation. If the chances of success were low, a do not resuscitate order could be issued without further discussion unless the patient or resident requested it.
If the chances of success were thought to be higher, resuscitation would be attempted unless the patient had indicated otherwise.
“We believe that the current guidelines should be reviewed,” say the authors. “Future advice should have more regard to the needs of non-acute settings.”
Contact:
Simon Conroy, Clinical Lecturer
in Geriatrics, Division of Rehabilitation and Ageing, Queen’s Medical Centre,
Nottingham, UK
Email: simon.conroy@nottingham.ac.uk
(3) WARNING OVER UNFAIR TERMS FOR PATIENTS IN CLINICAL TRIALS
(Letter: Compensation for
non-negligent harm in trials remains shaky)
http://bmj.com/cgi/content/full/332/7539/489
Patients who volunteer to take part in clinical trials are currently being left without adequate legal protection in the event of injury, warns a senior doctor in this week’s BMJ.
Professor Desmond Laurence argues that when patients are invited to enter clinical trials, they are at present being induced to believe that the trial sponsor will have a legal obligation to compensate them in case of injury, when in fact that is not true.
Patients who volunteer for clinical trials enter a consumer contract with the trial sponsor. Consumer law requires such contracts to be expressed in plain language.
But Professor Laurence argues that the words used in clinical trial contract documents concerning injuries to patients are not plain language and do not therefore meet the legal requirement of fairness and openness under consumer law.
“If the law were to be observed, patients would be told frankly, in words lay people could readily understand, that they might be seriously injured but with merely discretionary compensation,” he says. “The trial sponsor of course may always pay ex gratia compensation, if it cares to,” he adds. “But if it does not, then the cost of compensation for non-negligent harm falls upon the injured patients themselves.”
He calls on the Department of Health to obey the law. “If patients were told the truth, any resultant shortage of volunteers could well lead to the introduction of more humane compensation arrangements for injured patients,” he says. “If it simply will not, then the Office of Fair Trading should now enforce the law.”
Contact:
Desmond Laurence, Professor Emeritus,
University of London, UK
Email: d.laurence@virgin.net
(4) NEW TREATMENTS BASED ON HUMAN BEHAVIOUR COULD REDUCE DRUG PRESCRIBING
(Behavioural medicine: changing
our behaviour)
http://bmj.com/cgi/content/full/332/7539/437
New psychological treatments - behavioural medicine - could significantly reduce the need for drug treatments for some conditions, cutting health system costs says an editorial in this week’s BMJ.
Behavioural medicine - using treatments borrowed from psychology such as cognitive behavioural therapy - has the potential to reduce pain, argue the authors. Treating a patient with a system of behavioural instructions before surgery, for instance, can lower the amount of anaesthetic required during the operation, and cut the time they need to stay in hospital.
This style of medicine could also replace prescribed drugs for some conditions, say the authors. In one study diabetes rates were cut by 58% in a high risk group of patients, by intensively promoting exercise and weight loss - a higher success rate than achieved using conventional medicine.
Using behavioural techniques to reorganise clinical teams has also been shown to result in lower blood pressure in hypertensive patients - sometimes more effectively than prescribed drug treatments.
Introducing the approach more widely has been slow, however. Doctors are used to using drugs and surgery to control disease rather than behavioural techniques, say the authors.
The pharmaceutical industry also exerts a strong influence, being the chief source of funding by far for research on new treatments. “The major imbalance between investments in pharmaceutical development and in understanding and supporting health related behaviours must be of concern,” say the authors.
Things are changing however. The UK has now established a Society of Behavioural Medicine, and research on these therapies is to be included on the Cochrane Database - the ‘central bank’ doctors use for the latest evidence-based treatments.
Behavioural medicine could make significant cost savings for health services, as well as empower patients in managing their conditions, the authors conclude.
Contact:
Professor Theresa Marteau, Health
Psychology Section, King’s College London, London, UK
Email: Theresa.marteau@kcl.ac.uk
(5) CONCERN OVER INSTITUTIONAL CARE FOR CHILDREN IN EUROPE
(Overuse of institutional
care for children in Europe)
http://bmj.com/cgi/content/full/332/7539/485
Researchers in this week’s BMJ express concern over the largely hidden extent of institutional care for children in Europe.
Institutional care for young children is common throughout the WHO European region of 52 countries. Although institutional care for children in need is generally seen as most prevalent in eastern Europe, an estimated 43,842 (14.4 per 10,000) children under 3 are in institutional care within 46 countries of the WHO European countries.
There is convincing evidence that institutional care is detrimental to the mental, behavioural, emotional, and social development of young children.
For example, children in institutional care rarely have the opportunity to form an attachment to a parent figure or carer, and they spend less time on play, social interaction, and individual care than children in a family.
Is this evidence of harm being ignored, ask the authors?
Children who move from institutional into family care before the age of 6 months will probably recover their physical and mental development, but difficulties with social behaviour and attachments may persist, leading to a greater chance of antisocial behaviour and mental health problems, they write.
Although adoption is often used as an alternative to institutional care, adoption agencies and the parents they represent often assume that many children in residential care are orphans. Yet only 4% of young children in residential care have no biological parent living, stress the authors.
They recommend that children less than 3 years old should not be placed in residential care without a parent. In life threatening circumstances emergency institutional care may be essential, but the child should be moved into foster care as soon as possible.
They call for education and training for policy makers and practitioners on the appropriate care and placement of young children facing adversity.
Child protection legislation and interventions to deal with abusive and neglectful parents should also be developed in parallel with community services and alternative family based care for children, they conclude.
Contacts:
Kevin Browne, Director, Centre for
Forensic and Family Psychology, University of Birmingham, UK
Email: k.d.browne@bham.ac.uk
or
Kate Chapple, University of Birmingham
Press Office
Email: k.h.chapple@bham.ac.uk
(6) BLOOD PRESSURE GUIDELINES FOR STROKE MAY NOT BE RELEVANT TO MANY PATIENTS
Online First
(Applicability to primary care of national clinical guidelines on
blood pressure lowering for people with stroke: cross sectional study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38758.600116.AE
Guidelines on blood pressure lowering after stroke may not be applicable to many patients under the care of their family doctor, warn researchers in this week’s BMJ.
International guidelines stress the importance of lowering blood pressure in people who have had a stroke. These guidelines are largely based on the results of the PROGRESS trial, which recruited people with stroke from hospital.
But are these guidelines relevant to patients in primary care, ask researchers at the University of Birmingham?
They compared the characteristics of stroke patients from seven general practices in Birmingham with those of the participants in the PROGRESS trial.
Patients were 12 years older than the PROGRESS participants and twice as likely to be women. The average time that had elapsed since their cerebrovascular event was two to three years, compared with eight months in PROGRESS.
For 61% of patients systolic blood pressure was above the target recommended in the UK guidelines, and for 77% it was over the target set out by the British Hypertension Society.
The “typical” stroke patient in general practice is very different from the PROGRESS study population, say the authors. In this case, the differences are so great that they undermine the applicability of the research to primary care.
Research in appropriate populations is urgently needed before international guidelines are implemented in primary care, they conclude.
Contact:
Jonathan Mant, Clinical Senior Lecturer,
Department of Primary Care and General Practice, University of Birmingham,
Birmingham, UK
Email: j.w.mant@bham.ac.uk
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and from:
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