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Press releases Saturday 15 April 2006
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(1) Harsh famine ahead for NHS, warn experts
(2) Fetuses cannot feel pain, says expert
(3) Self harm high among Goth youths
(4) Lack of basic research putting patients at risk
(5) Parents need help to talk to
their children about cancer
(1) Harsh famine ahead for NHS, warn experts
(Seven years of feast, seven years of famine: boom to bust in the NHS?)
http://bmj.com/cgi/content/full/332/7546/906
As the ±feast± of increased NHS funding comes
to an end, we need to prepare for a harsh famine ahead, warn health economists
in this week±s BMJ.
In 2000, the Labour government initiated a programme of NHS investment
unequalled in any other healthcare system. Almost seven years on, the spending
has improved services, but these improvements have not kept pace with the
spending increases, say the authors.
So what went wrong?
The fundamental problem was that, as funding flowed into the NHS, many spending
controls were relaxed as politicians and managers concentrated on targets for
activity and service delivery, say the authors. The lack of control is most
evident with respect to the role of the National Institute for Clinical
Excellence (NICE), in pay negotiations, and in contracting arrangements.
After 2008, the growth in NHS expenditure will be reined in. So what needs to be
done to prepare for the famine years ahead? Rather than yet another
reorganisation, they suggest that NICE needs a wider remit, staff incentives
need to be overhauled, and health outcomes data should be collected.
±What are needed are ±hard± budgets and improved incentives that create
behaviours that are consistent with efficiently improving the health of the
nation,± they say. ±The feast is over. The famine will be harsh for patients,
practitioners, and politicians.±
Contact:
Alan Maynard, Professor of Health Economics, Department of Health Sciences,
University of York, UK
Email: akm3@york.ac.uk
(2) Fetuses cannot feel pain, says expert
(Can fetuses feel pain?)
http://bmj.com/cgi/content/full/332/7546/909
There is good evidence that fetuses cannot feel pain, says an expert in this
week±s BMJ.
Proposals to tell women seeking abortions that their unborn child will feel
pain, or to provide pain relief during abortions, are therefore scientifically
unsound and may put women at unnecessary risk, argues Stuart Derbyshire, a
senior psychologist at the University of Birmingham.
He examined the neurological and psychological evidence to support a concept of
fetal pain.
Although still immature, the neural circuitry necessary for processing pain can
be considered complete by 26 weeks± gestation, he explains. However, pain
experience requires not only development of the brain but also development of
the mind to accommodate the subjectivity of pain.
Development of the mind only occurs outside the womb, through the actions of the
infant and interactions with primary caregivers.
So, not only is the biological development to support pain experience ongoing,
but the environment after birth, so necessary to the development of pain
experience, is also yet to occur, he says. As such, fetuses cannot experience
pain.
The absence of pain in the fetus does not resolve the morality of abortion, but
does argue against legal and clinical efforts to prevent such pain during an
abortion, he adds.
Proposals currently being considered in the US to inform women seeking abortions
of the potential for pain in fetuses, are not supported by the evidence. While a
mandate to provide pain relief before an abortion may expose women to
inappropriate interventions, risks, and distress.
±Avoiding a discussion of fetal pain with women requesting abortions is not
misguided paternalism but a sound policy based on good evidence that fetuses
cannot experience pain,± he concludes.
Contact:
Stuart Derbyshire, Senior Lecturer, University of Birmingham, School of
Psychology, Birmingham, UK
Email: s.w.derbyshire@bham.ac.uk
(3) Self harm high among Goth youths
Online First
(Prevalence of deliberate self harm and attempted suicide within
contemporary Goth youth subculture: longitudinal cohort study)
http://bmj.com/cgi/content/abstract/bmj.38790.495544.7Cv1
Rates of self harm and attempted suicide are high within Goth youth subculture,
finds a study published on bmj.com today.
Deliberate self harm is common among young people, with rates of 7-14% in the
UK. It is particularly widespread in certain populations and may be linked to
depression, attempted suicide, and various psychiatric disorders in later life.
Contemporary Goth youth subculture has been linked with self harm, but there is
little evidence to support this.
Researchers at the University of Glasgow surveyed 1,258 young people during
their final year of primary school (age 11) and again at ages 13, 15, and 19.
They were asked about self harm and identification with a variety of youth
subcultures, including Goth.
They found that belonging to the Goth subculture was strongly associated with a
lifetime prevalence of self harm (53%) and attempted suicide (47%).
Even after adjusting for factors such as social class, parental separation,
smoking, alcohol use, or previous depression, Goth identification remained the
single strongest predictor of either self harm or suicide attempt.
To test how specific this identification effect was to Goth, they analysed rates
of self harm among 14 other common youth subcultures. Although some other
subcultures were also associated with self harm (Punk and Mosher), the
association was strongest for Goth.
Mr Robert Young, lead researcher on the study, said: "Although only fairly small
numbers of young people identify as belonging to the Goth subculture, rates of
self-harm and attempted suicide are very high among this group.
One common suggestion is they may be copying subcultural icons or peers. But
since our study found that more reported self-harm before, rather than after,
becoming a Goth, this suggests that young people with a tendency to self-harm
are attracted to the Goth subculture.
Rather than posing a risk, it's also possible that by belonging to this
subculture young people are gaining valuable social and emotional support from
their peers. However, the study was based on small numbers and replication is
needed to confirm our results."
Dr Michael van Beinum, Consultant Child and Adolescent Psychiatrist, and advisor
to the study said: "Mental health problems are common in young people and there
is evidence that they are on the increase. For some young people with mental
health problems, a Goth subculture may be attractive, as it may allow them to
find a community within which it may be easier for their distress to be
understood.
Social support is important for all young people to help them cope with the
difficulties they face, and therefore finding a peer group of like-minded Goths
may, for some, be adaptive. Adults helping young people in difficulty need to be
aware that those who clearly identify with Goth subculture may also be
self-harming, and may benefit from learning further coping mechanisms to help
them overcome inner distress. Further provision of mental health services for
all young people is urgently required."
Contact:
Robert Young, Research Associate, MRC Social and Public Health Sciences Unit,
University of Glasgow, Scotland, UK
Email: robert@msoc.mrc.gla.ac.uk
(4) Lack of basic research putting patients at risk
(Editorial: Medical academia is failing patients and clinicians)
http://bmj.com/cgi/content/full/332/7546/863
Patients are suffering because not enough basic clinical research is being done,
warns a senior doctor in this week±s BMJ. He believes that medical academia is
failing patients and clinicians by neglecting this vital area of research.
Basic observational research provides the information that doctors need to
diagnose and treat patients appropriately, writes neurologist Professor Peter
Rothwell. But in the field of neurology alone, many examples exist where a lack
of basic data is the main barrier for effective treatment in routine practice.
For instance, little is known about the reliability of diagnosing stroke and,
until very recently, no reliable data existed on the early risk of stroke in
certain patients. Countless patients have suffered as a result, yet much of this
research is easy and relatively cheap to do, so why has it not been done, he
asks?
He calls into question whether medical academia, in its current form, is
properly fit for purpose.
He believes that medical academia must improve its performance or, less
preferably, be forced by politicians to prioritise appropriately. The recent
emphasis on the development of clinical research is welcome, he says, but there
are potential pitfalls.
Greatest of these is the tendency for clinical research to be defined too
narrowly, with observational research necessary for effective clinical practice
continuing to be neglected, he concludes.
Contact:
Peter Rothwell, Professor of Clinical Neurology, Stroke Prevention Research
Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford,
UK
Email:
peter.rothwell@clneuro.ox.ac.uk
(5) Parents need help to talk to their children about cancer
Online First
(Breast cancer in the family ± children±s perceptions of their mother±s
cancer and its initial treatment: qualitative study)
http://bmj.com/cgi/content/abstract/bmj.38793.567801.AEv1
Parents need help to talk to their children about cancer, say researchers in a
study published online by the BMJ today.
Cancer is relatively common among women of childbearing age. Although the
importance of communication with patients and their families has been
recognised, relatively little has been published about communication with
children when their parent is newly diagnosed as having cancer.
To explore how children are affected by breast cancer in the family, researchers
in Oxford interviewed 37 mothers with early breast cancer and 31 of their
children aged between 6 and 18 years.
They found that, even before their mother±s diagnosis, children were much more
aware of cancer as a life threatening illness than their parents and other
adults realised.
The main sources of their information were television soap operas, health
campaigns, and celebrities, as well as direct experience of relatives or
friends± parents with cancer.
Parents sometimes misunderstood their children±s reactions and underestimated
the emotional impact or did not recognise the children±s need for more
preparation and information about the illness and its treatment.
Parents are often unaware how much their children know and, often reeling from
the diagnosis themselves, may not be in the best position to decide what and how
to tell their children, say the authors.
As part of their care, parents newly diagnosed with a life threatening illness
need to be supported to think about how they will talk to their children, say
the authors. General practitioners, hospital specialists, and nurses are well
placed to help with these concerns, and if necessary to be involved in
discussions with the children, they add.
Further work is also needed to develop and evaluate information for children of
parents with cancer about cancer and its treatments, they conclude.
Contact:
Gillian Forrest, Senior Research Fellow, Section of Child and Adolescent
Psychiatry, University of Oxford, Park Hospital for Children, Oxford, UK
Email: gillian.forrest@psych.ox.ac.uk
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