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Press releases Saturday 20 May 2006

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(1) STUDY SUGGESTS NEW HUMAN GENOTYPE MAY BE PRONE TO vCJD

(2) SAFE SEX MESSAGES IN SCHOOLS DON’T CHANGE BEHAVIOUR

(3) DECENT NHS CARE FOR OLDER PEOPLE STILL TOO PATCHY

(4) USE MARKETING TO IMPROVE HEALTH, SAY EXPERTS


(1) STUDY SUGGESTS NEW HUMAN GENOTYPE MAY BE PRONE TO vCJD

(Variant Creutzfeldt-Jakob disease: prion protein genotype analysis of positive appendix tissue samples from a retrospective prevalence study)
http://bmj.com/cgi/content/full/332/7551/1186

(Editorial: A new human genotype prone to variant Creutzfeldt-Jakob disease)
http://bmj.com/cgi/content/full/332/7551/1164

A small study in this week’s BMJ suggests a new human genotype may be prone to variant Creutzfeldt-Jakob disease (vCJD).

Although this new evidence may rekindle fears of a larger epidemic, others warn that it is important to be cautious in interpreting these results.

Since the initial discovery of vCJD in the United Kingdom a decade ago, there has been concern about the ultimate extent of the epidemic. Fortunately the magnitude of the epidemic at present seems to match the lower limit of the early estimates, with 161 definite or probable cases in the UK.

Researchers at the University of Edinburgh analysed DNA from two tissue samples that harboured prion proteins (a marker for vCJD infection) to identify the genetic make-up (genotype) of the patients.

So far, all clinical cases of vCJD have occurred in individuals with the homozygous methionine (MM) genotype, and it was hoped that this was the only susceptible population group. But both these samples carried the homozygous valine (VV) genotype, suggesting that individuals with the VV genotype may also be susceptible to vCJD infection.

The fear is that individuals with this genotype may be at risk of developing the condition, possibly with longer incubation periods, say the authors. Alternatively, these people may be asymptomatic carriers who might transmit the condition to other susceptible individuals by blood transfusion or surgery.

Though they warn against over-interpreting data from only two positive cases, they conclude that these uncertainties further underline the need for continued surveillance of vCJD in the UK.

It is important to be cautious in interpreting the results of this study, warn experts from Canada in an accompanying editorial. The study shows the existence of the prion protein in two tissue samples, not clinical evidence of vCJD in two patients. The study also provides no evidence to suggest that tissue from these two people could transmit vCJD to others.

“Studies such as this are essential to the continuing effort to control the extent of the epidemic and highlight the urgent need for ongoing surveillance for vCJD,” they add. “They also pose challenges to health officials who have to formulate policies comprising difficult trade-offs based on uncertain evidence.”

Contacts:

Paper: James Ironside, Professor of Clinical Neuropathology, National Creutzfeldt-Jakob Disease Surveillance Unit, University of Edinburgh, Western General Hospital, Edinburgh, Scotland
Email: james.ironside@ed.ac.uk

Editorial: Kumanan Wilson, Associate Professor, Department of Medicine, Toronto General Hospital, Toronto, Canada
Email: kumanan.wilson@uhn.on.ca


(2) SAFE SEX MESSAGES IN SCHOOLS DON’T CHANGE BEHAVIOUR

(HIV prevention in Mexican schools: prospective randomised evaluation of intervention)
http://bmj.com/cgi/content/full/332/7551/1189

Current efforts to combat sexually transmitted infections and unplanned pregnancy in schools do not change sexual risk behaviour, concludes a study in this week’s BMJ.

Most recent efforts to prevent sexually transmitted infections (including HIV) and pregnancy in adolescents have been school based projects that promoted either condoms or abstinence. Studies have produced mixed results, with only some interventions delaying the onset of sexual activity, increasing condom use, or decreasing unplanned pregnancy

Nearly 11,000 students at 40 public high schools in Mexico participated in this study to assess the effects of an HIV prevention programme that promoted condom use and emergency contraception.

Fifteen schools received the HIV prevention course that promoted condom use. Another 15 schools received the same course plus a module on emergency contraception, and ten schools acted as controls and continued with the existing sex education course. Students were surveyed at the start of the study and again at four months and 16 months.

Neither strategy had any affect on reported condom use or sexual behaviour. However, students who received emergency contraception education also reported increased use of emergency contraception.

Knowledge of HIV improved in both intervention groups, and knowledge of emergency contraception improved in students who received the additional module.

“Our study adds to the growing body of evidence that current HIV prevention efforts based in school do not alter sexual risk behaviour, and suggests that current interventions educate effectively but may not change sexual risk behaviour,” say the authors.

The study results also suggest that there is no risk in combining condom promotion messages with emergency contraception education.

“New strategies are urgently needed to combat HIV and other sexually transmitted diseases and unplanned pregnancy among adolescents,” they conclude.

Contact:

Dilys Walker, Division of Reproductive Health, National Institute of Public Health, Morelos, Mexico
Email: dwalker@correo.insp.mx


(3) DECENT NHS CARE FOR OLDER PEOPLE STILL TOO PATCHY

(Editorial: Decent health care for older people)
http://bmj.com/cgi/content/full/332/7551/1166

Good, respectful NHS care for older people is still too patchy, argue senior members of the British Geriatrics Society in this week’s BMJ.

Last month’s government report A New Ambition for Old Age examined how the national service framework (NSF) for older people is being implemented and announced new aims and targets under three themes: dignity in care, joined up care, and healthy ageing.

So what has improved since the framework was launched five years ago, ask the authors?

A third of older people needing intensive daily help in England now receive this in their own homes rather than in residential care; delayed discharge from acute hospitals has been reduced by more than two thirds; and specialist services for people with stroke and for those prone to falls continue to improve.

But such health gains now need to be built on, say the authors. Despite older people being the prime users of health care and social services, investments have not been made in more specific services, such as general hospital care for older people.

Care for older people is still not sufficiently integrated, they add. The increasing emphasis in the NHS on moving patients rapidly through the emergency system towards discharge may benefit younger people at the expense of effective planning and specialist assessment of the frail and old.

The separation in the NHS of medical specialties from psychiatry is also hampering the provision of effective, humane, and responsive services for older people with mental health problems, such as dementia and depression.

They suggest that better coordination of care for people with complex needs will be achieved by strengthening commissioning arrangements between the NHS and local authorities, to ensure that social care is not provided without medical problems being treated.

The dignity of older frail patients is also infringed every day in many different ways, they warn. The establishment of a seven point plan to improve dignity in care is to be welcomed.

“This report contains much that is praiseworthy,” they conclude. “We hope that the levers set out in this report really convince providers of health and social care to reorganise their priorities.”

Contacts:

Jacqueline Morris, Chair, British Geriatrics Society Policy Committee
Email: Jacqeline.morris@ukgateway.net

or

David Oliver, Deputy Honorary Secretary, British Geriatrics Society


(4) USE MARKETING TO IMPROVE HEALTH, SAY EXPERTS

(What social marketing can do for you)
http://bmj.com/cgi/content/full/332/7551/1207

(Putting social marketing into practice)
http://bmj.com/cgi/content/full/332/7551/1210

Health services should borrow marketing ideas from big companies like Nike and Coca-Cola to improve people’s health, say experts in this week’s BMJ.

The concept, known as social marketing, applies commercial marketing strategies to social good and has already been shown to be effective in changing health behaviour.

Australia, New Zealand, Canada, and the United States all have social marketing facilities embedded high within their health services, and the UK government is about to develop the first social marketing strategy for health in England.

Studies show that social marketing campaigns are successful at the population level, for example in tackling alcohol, tobacco, and drug use.

And healthcare professionals have a crucial role in developing and implementing these projects. For example, the West of Scotland cancer awareness project, designed to encourage disadvantaged people with symptoms of bowel or mouth cancer to seek advice more quickly, involved over 2000 healthcare professionals.

Like commercial marketing, social marketing should aim to build ongoing, mutually beneficial relationships with us, say the authors. For example, stop smoking services could offer a Tesco-style loyalty card to successful quitters so they could persuade friends and family to use the services and be encouraged to think about their other health behaviours.

For decades, the health sector has watched as big companies have used marketing to wreak havoc on public health, write the authors. Social marketing enables us to fight fire with fire.

And health professionals can help by reinforcing social marketing messages during their direct and indirect contact with patients, they conclude.

Contacts:

William Douglas Evans, Vice President, Health Promotion Research, Washington, USA
Email: devans@rti.org

or

Gerard Hastings, Director, Institute for Social Marketing, Stirling and the Open University, Scotland, UK Tel (via Sophy Gould, Cancer Research UK Press Office): +44 (0)20 7061 8318 or (out of hours): +44 (0)70 5026 4059 Email: sophy.gould@cancer.org.uk

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