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Press releases Saturday 27 January 2007

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Folic acid cuts risk of cleft lip
Reducing caffeine intake has no effect on birth weight or length of pregnancy
Prior information about normal test results can help reassure patients
How would you save the NHS?

(1) Folic acid cuts risk of cleft lip
(Folic acid supplements and risk of facial clefts: national population based case-control study)
www.bmj.com/onlinefirst_date.dtl

Taking folic acid supplements in early pregnancy seems to substantially reduce the risk of cleft lip, finds a new study published on bmj.com.

It is widely known that taking folic acid in early pregnancy reduces the risk of neural tube defects, such as spina bifida. The current recommended daily dose is 400±g starting before conception.

Some studies have suggested that folic acid may also help prevent facial clefts, but the question remains unresolved. So researchers set out to asses the possible effects of folic acid on facial clefts in Norway, which has one of the highest rates of facial clefts in Europe.

They identified infants born from 1996 to 2000; 377 with cleft lip (with or without cleft palate), 196 with cleft palate only, and 763 healthy controls.

All mothers were surveyed about their reproductive history, smoking, alcohol, drugs, and other exposures during early pregnancy. They were also asked to recall their diet during the first three months of pregnancy, whether they took folic acid supplements and, if so, when and how often they took them.

Women were asked similar questions about multivitamins, and the researchers then estimated each woman±s total folic acid intake.

After adjusting for smoking and other confounding factors, they found that folic acid supplementation of 400±g or more a day reduced the risk of cleft lip with or without cleft palate by 40%.

Independent of supplements, diets rich in fruits, vegetables, and other high folate containing foods reduced the risk by 25%. The lowest risk of cleft lip was among women with folate rich diets who also took folic acid supplements and multivitamins. Folic acid provided no protection against cleft palate alone, according to the results.

The authors acknowledge that their study alone cannot show that folic acid definitely prevents cleft lip. Combined with alll the previous evidence, however, their work does suggest a real preventive effect.

If folic acid is able to prevent a major birth defect in addition to neural tube defects, this benefit should be included among the risks and benefits of fortifying foods with folic acid, a matter of ongoing controversy in many countries, they conclude.

Contacts:
Allen Wilcox, Senior Investigator, National Institute of Environmental Health Sciences, NIH, Durham, North Carolina, USA
Email: wilcox@niehs.nih.gov

Robin Mackar, Office of Communications and Public Liaison, National Institute of Environmental Health Sciences, NIH, Durham, North Carolina, USA
Email: rmackar@niehs.nih.gov


(2) Reducing caffeine intake has no effect on birth weight or length of pregnancy
(Effect of reducing caffeine intake on birth weight and length of gestation: randomised controlled trial)
www.bmj.com/onlinefirst_date.dtl

There is no evidence that moderate levels of caffeine consumption during pregnancy lead to a greater risk of premature births and underweight babies despite warnings from some public health officials, finds a new study on bmj.com today.

Previous research has puzzled public health authorities. While some studies have suggested that a high caffeine intake can lead to lower average birth weights of as much as 100 ± 200g and an increased chance of preterm babies, others have found no connection between caffeine and problems with foetal development.

Danish researchers sought to clarify this confusing picture by monitoring the pregnancies of 1,207 healthy women who drank more than three cups of coffee a day ± a high caffeine intake - and who were less than twenty weeks pregnant.

This large group was divided randomly into two equal groups who received either caffeinated or decaffeinated coffee. Each participant was regularly interviewed to monitor their caffeine intake, including contributions from other drinks, such as tea and cola. Information was collected on their length of gestation and baby±s weight at the conclusion of their pregnancy.

Importantly, the researchers took a number of precautions to ensure that the study±s findings were not corrupted by outside factors. Those taking part were not told what type of coffee they were drinking. During the analysis phase, adjustments were made for other factors, such as age, pre-pregnancy weight and the smoking status of the participants.

The final results showed that there was no real difference in either the length of pregnancy or birth weight between the two groups.

Women drinking caffeinated coffee recorded a mean (average) birth weight of 3539g while those consuming decaffeinated coffee had a mean birth weight of 3519g, a difference of just 20g that was not statistically meaningful.

There were no other important differences between pregnancies in the two groups. In the caffeinated group, 4.2% of infants were born prematurely and 4.5% were small for their gestational age, compared to 5.2% premature births and 4.7% underweight babies in the decaffeinated groups.

The report±s authors conclude that decreasing caffeine intake during the later stages of pregnancy has no overall effect on birth weight and length of pregnancy.

Contacts:
Bodil Hammer Bech, Assistant Professor, Institute of Public Health, Department of Epidemiology, University of Aarhus, Denmark
Email: bhb@soci.au.dk

J±rn Olsen, Department of Epidemiology, University of California, Los Angeles, USA
Email: jo@ucla.edu


(3) Prior information about normal test results can help reassure patients
(Effect of providing information about normal test results on patients± reassurance: randomised controlled trial)
www.bmj.com/onlinefirst_date.dtl

Giving patients prior information about diagnostic tests can help improve patient outcomes and give reassurance, says a new BMJ study.

Providing reassurance is a large part of doctors± and other health professionals± roles. Yet many patients remain anxious about their condition even after the results of investigative tests come back ±normal± (i.e. the test does not reveal any particular problems).

These patients often continue to be concerned about their condition, use drugs inappropriately and seek medical help from other health professionals for their symptoms. Previous research suggests that by the time patients undergo tests they have already developed negative ideas and beliefs about their symptoms ± thereby making any post-test reassurance from doctors less effective.

Researchers in New Zealand set out to analyse whether giving patients information about the meaning of normal results prior to testing would improve reassurance following medical testing.

Ninety-two patients with chest pain referred for a diagnostic exercise stress test took part in the study. They were split into three groups ± the first received the normal sheet of information on the test, the second received a pamphlet, which detailed the test and included an explanation of the meaning of negative test results. The final group received the pamphlet and met with a health psychologist to discuss the test and the meaning of results before testing occurred.

Before the test, patients were asked to complete a questionnaire and rate how worried they were about their health. Patients who received a normal test result were then asked to complete another, similar, questionnaire. One month on the same patients took part in a follow-up interview.

At follow-up patients in the third group (pamphlet and discussion) reported less chest pain, were more reassured by the test and tended not to be taking cardiac drugs compared to patients in the other groups. After a month, most patients in the first group (usual information only) were not reassured by the investigation and overall reassurance was more likely to decline with time.

The authors conclude that providing patients with explanations of negative test results before the test takes place are more likely to have improved rates of reassurance and reduced the likelihood of future symptoms.

Contact:
Keith Petrie, Department of Psychological Medicine, University of Auckland, New Zealand
Email: kj.petrie@auckland.ac.nz


(4) How would you save the NHS?
(One year to save the NHS - what would you do?)
http://www.bmj.com/cgi/content/full/334/7586/180

The NHS needs to learn from organisations like the John Lewis Partnership that show what can be achieved when employees see that their actions benefit themselves, the organisation they work for, and customers, says Professor Chris Ham in this week±s BMJ.

This is just one of several responses to the question: what would you do to save the NHS?

The chaos currently engulfing the NHS is due entirely to its ±marketisation,± argues Allyson Pollock, Head of the Centre for International Public Health Policy at the University of Edinburgh.

She believes that what is needed to save the NHS is ±a total abolition of the market and market mechanisms like payment by results, foundation trusts, and commissioning within healthcare, and the abolition of all contracts with private providers, including the compulsory repurchase of PFI hospitals.±

But Jennifer Dixon, Director of Policy at the King±s Fund backs current health policy as ±going in the right general direction.± She believes that the principle of introducing new incentives to try and improve performance is the right one. However, she admits that there are ±teething problems± in other areas of the health services that need ±modification or amelioration.±

Peter Carter, General Secretary at the Royal College of Nursing calls for an end to short term cuts and the development of a long term recovery plan. He also urges ministers to safeguard education and training budgets and improve nursing recruitment and retention levels. ±We need to stop treating our NHS workers like overheads to be cut and start treating them like assets to be valued,± he says.

A US view comes from Donald Berwick at the Institute for Healthcare Improvement in Massachusetts. He chooses not to dwell on the sense of distress and demoralisation that is circulating through the NHS at the moment, preferring to focus instead on the ±tremendous amount of progress± that has been made in the eight years he has been watching the modernisation of the UK±s health services. He calls for better collaborative patient management but, in the long run, he is very optimistic about the NHS being a star among international health services.

Finally, Steven Ford, a GP in Northumberland argues that the NHS never has been and can never be a business. He would like to see ±wholesale localisation± introduced throughout the NHS. ±A coherent, locally responsive service, answerable to users directly is preferable to a national business failure with a demoralised workforce,± he says. ±Let diversity flourish and to hell with the market.±

Contacts:
Chris Ham, Health Service Management Centre, University of Birmingham, UK
Email: c.j.ham@bham.ac.uk

Allyson Pollock, Head, Centre for International Public Health Policy University of Edinburgh, Scotland, UK
Email: allyson.pollock@ ed.ac.uk

Jennifer Dixon, Director of Policy, King±s Fund, London, UK
Email: d.reynolds@kingsfund.org.uk

Peter Carter, General Secretary, Royal College of Nursing, London, UK
Email: press.office@rcn.org.uk

Donald Berwick, President, Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
Email: dberwick1@ihi.org

Steven Ford, GP, Haydon and Allen Valleys Medical Practice, Hexham, Northumberland, UK
Email: doctor.ford@virgin.net



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