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Press releases Saturday 8 April 2006

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(1) NEW RESEARCH SHOWS SECOND-HAND SMOKE RAISES DIABETES RISK

(2) UK TRAUMA CARE UNDER THREAT

(3) NO EVIDENCE THAT REFERRAL MANAGEMENT CENTRES CAN DELIVER

(4) WOMEN NOW LIVE LONGER THAN MEN, EVEN IN THE POOREST COUNTRIES

(5) BETTER REGULATION NEEDED FOR ETHICAL RESEARCH IN AFRICA

(1) NEW RESEARCH SHOWS SECOND-HAND SMOKE RAISES DIABETES RISK

Online First
(Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study)
http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38779.584028.55

A study published on bmj.com this week shows for the first time that breathing other people’s smoke raises the risk of developing glucose intolerance, the precursor to diabetes.

The US research also shows that overall, white Americans are more susceptible to this effect than African-Americans.

Researchers examined 4572 men and women in four US cities, dividing them into four categories of smoking status: ranging from those who smoked, to those who had neither smoked nor breathed in other people’s smoke. The study focussed only on those who were white or African-American.

The authors then tracked how many participants developed glucose intolerance - where the body can no longer produce enough insulin to regulate blood sugar - over 15 years of follow-up.

The study found that smokers had the highest risk, with 22% of them getting the disease over the study period. Non-smokers who had no exposure to second-hand smoke had the lowest risk, with less than 12% developing the condition.

But 17% of those who had never smoked themselves but were subject to second-hand smoke also developed glucose intolerance - higher than the 14% risk rate in the group who had previously smoked and given up.

Those breathing second-hand smoke are exposed to many toxins, say the authors. And the chemical reactions which produce second-hand smoke mean that some of those toxins may be at even higher concentrations than the levels breathed in directly by smokers. If one of these toxins particularly affects the pancreas - the organ which produces insulin - this may explain the findings, they suggest.

Until now, it had not been known that those breathing second-hand smoke faced an increased risk of diabetes, say the researchers. More studies are now needed, they conclude.

Contact:

Thomas Houston, Associate Professor of Medicine, Birmingham Veterans Affairs Medical Center, Alabama, USA
Email: thouston@uab.edu

(2) UK TRAUMA CARE UNDER THREAT

(Editorial: The neglect of trauma surgery)
http://bmj.com/cgi/content/full/332/7545/805

Delivery of trauma care in Britain is threatened by a lack of training opportunities and a dedicated service infrastructure within the NHS, say doctors in this week’s BMJ.

The management of severely injured patients is demanding because trauma does not respect the boundaries of anatomy or surgical specialty. Yet the UK lacks training opportunities for trauma surgery and a service infrastructure, problems that other countries have recognised and started to remedy, write Professor James Ryan and colleagues.

Efforts to improve training have been retarded by the absence of a dedicated trauma service infrastructure within the NHS, while demands from surgical institutions for a national framework for trauma management and centralisation of expertise have not been heeded.

In North America, trauma doctors continue to enjoy dedicated training programmes and recognition of their discipline, while, in Britain, trauma has never been recognised as a separate surgical specialty, they argue.

As younger specialties such as emergency medicine, and critical care establish ever-expanding fields of responsibility, they warn that the general surgeon’s role as provider of holistic trauma care risks being fatally eroded.

They believe that the UK’s surgical institutions should fundamentally re-examine the issue of trauma training for surgeons. “In particular, Britain needs a robust way of identifying, training, and accrediting a cadre of surgeons with the potential to become clinical champions of trauma services.”

“Sanctioning the birth of acute care surgery as a discrete discipline could provide a training path and career structure for trauma surgeons,” they write. “More importantly, such a development may encourage a retooling of provision in a health service that has so far escaped all efforts to systemise the care of the seriously injured.”

Contact:

James Ryan, Leonard Cheshire Professor of Conflict Recovery and Honorary Consultant in Emergency Medicine, University College Hospital, London, UK
Email: james.ryan@ucl.ac.uk

(3) NO EVIDENCE THAT REFERRAL MANAGEMENT CENTRES CAN DELIVER

(Referral management centres: promising innovations or Trojan horses?)
http://bmj.com/cgi/content/full/332/7545/844

(Commentary: Patients are not commodities)
http://bmj.com/cgi/content/full/332/7545/846

Commentary: Not another innovation
http://bmj.com/cgi/content/full/332/7545/847

No evidence exists that referral management centres can improve the NHS referral process, warn experts in this week’s BMJ.

Referral management centres have been developed to monitor, assess, and redirect referrals between primary and secondary care. They are being heralded as a means to achieve a more efficient referral process that can match demand to supply and improves quality.

Researchers at Cardiff University searched the scientific literature but found no evidence that these centres are effective. The British Medical Association has also raised concerns about safety and confidentiality. Nevertheless, centres are currently being developed across England and Wales.

This has important implications, say the authors. Many potential benefits can be foreseen, especially to generate accurate data about referral volume and quality.

However, if referral centres decide to take on the responsibility of making decisions about where and if patients are referred, doctors may worry that their clinical freedom is being eroded and patients may worry about the lack of choice. Other possible effects will be loss of communication between generalists and specialists and a decrease in the continuity of patient care.

Although they believe that “something needs to be done” they do not know whether referral management centres will increase or decrease risk, efficiency, or choice, and little research evidence exists to support predictions of improved performance, they conclude.

Patients are not commodities, says general practitioner, Iona Heath, in an accompanying commentary. Those proposing and creating such centres seem to view a referral as a simple administrative transaction, whereas those working in primary care know that a successful referral is a much more complex and challenging phenomenon. She warns that these centres “run the risk of undermining not only the safety of patient care but also the complementary nature of the generalist and specialist roles and their consequent cost effectiveness.”

Over-managing the referral process introduces errors and inefficiencies, adds Professor James Owen Drife. “Those who should object are the patients, who will not receive high quality care if they are assessed as units of disease rather than treated as people, he concludes.”

Contacts:

Glyn Elwyn, Research Professor, , Department of General Practice, Centre for Health Sciences Research, Cardiff University, Cardiff, Wales, UK
Email: elwyng@cardiff.ac.uk

Iona Heath, General Practitioner, Caversham Group Practice, London, UK
Email: iona.heath@dsl.pipex.com

James Owen Drife, Professor of Obstetrics and Gynaecology, Academic Unit of Paediatrics, Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Email: j.o.drife@leeds.ac.uk

(4) WOMEN NOW LIVE LONGER THAN MEN, EVEN IN THE POOREST COUNTRIES

(Editorial: Life expectancy: women now on top everywhere)
http://bmj.com/cgi/content/full/332/7545/808

2006 is likely to be the first year in human history when – across almost all the world – women can expect to outlive men, say researchers in this week’s BMJ.

The trend towards this remarkable achievement will probably be confirmed this week in the 2006 world health report.

“We tend to forget that in many countries of the world women could expect, until recently, to live fewer years than men and that maternal death in particular remains a big killer,” write Danny Dorling and colleagues. In Europe, men last outlived women in the Netherlands in 1860 and in Italy in 1889. Elsewhere females’ life expectancy has long exceeded males’: in Sweden since 1751, Denmark since 1835, England and Wales since 1841.

But in all western European countries the life expectancy gap between women and men is now narrowing.

Greater emancipation has freed women to demand better health care and to behave more like men, and most importantly to smoke, say the authors. As this transition is so recent, the processes driving it cannot be purely biological: they relate primarily to social change.

“We must remember, though, that life expectancy data apply from birth onwards, so the picture would be different in some countries if life expectancy from conception was considered,” they add. “But even the life expectancy from birth may not be a permanent achievement, given that the largest remaining untapped market for cigarettes in the world is made up of women living in poorer countries,” they conclude.

Contacts:

Danny Dorling, Professor of Human Geography, Department of Geography, University of Sheffield, UK
Email: daniel.dorling@sheffield.ac.uk

or

George Davey Smith, Professor of Clinical Epidemiology, Department of Social Medicine, University of Bristol, UK

(5) BETTER REGULATION NEEDED FOR ETHICAL RESEARCH IN AFRICA

(Regulation of biomedical research in Africa)
http://bmj.com/cgi/content/full/332/7545/848

Better regulation is needed to ensure that research carried out in Africa and other developing countries is ethical, says an expert in this week’s BMJ.

Although most developing countries adhere to international ethical codes, some foreign researchers have taken advantage of the lack of local legislation and have ignored rudimentary local statutes, writes Sylvester Chima of Northumbria University.

He describes recent cases of unethical conduct and argues that local and regional regulatory frameworks and legislation are needed to protect research participants in Africa.

He suggests that regulations could provide guidance on forming local research ethics committees, informed consent procedures, standards of care, and distributive justice (such as post-trial benefits or compensation for injuries arising from research). Such regulations have already been introduced in Western countries.

But he dismisses the argument that such regulations would discourage drug trials in Africa.

The principles of respect for autonomy require that all people have the opportunity to determine what is done to their own body, in accordance with internationally recognised legal standards, he says. Research conducted contrary to these principles takes advantage of patients whose only fault is that they live in countries where research laws are lax and the quality of medical care is poor.

The suggested approach should not lead to an exodus of research sponsors from Africa. Instead it should encourage ethical conduct and provide a solid legal framework for future research in Africa, designed to safeguard researchers and participants, he writes.

“Experimental medicine and biomedical research will always be hazardous but should be encouraged within a framework of respect for autonomy, justice, and human rights. Ethical practice and new advances in biomedicine are not mutually exclusive, he concludes.”

Contact:

Sylvester Chima, Postgraduate Research Scholar, Northumbria University, School of Law, Newcastle upon Tyne, UK
Email: chimas01@cs.com

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and from:

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