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Press releases Saturday 31 March 2007

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(1) A move to full shift-working could spell bad news for the future health of the NHS

(2) Should the US and Russia destroy their stocks of smallpox virus?

(3) New training scheme threatens overseas working

(4) NAlso on bmj.com this week ... phone monitoring helps patients with chronic heart failure

(1) A move to full shift-working could spell bad news for the future health of the NHS
(Analysis: Implications of shift work for junior doctors)
http://www.bmj.com/cgi/content/full/334/7597/777

The increase in shift-work among junior doctors could have a detrimental effect on the NHS of the future warns a junior doctor in this week±s BMJ.

Dr Yasmin Ahmed-Little says if the health problems associated with shift working are not taken into consideration now, there may not be enough trained junior doctors to adequately staff wards when the European Working Time Directive (EWTD) comes into force fully in 2009.

Changes in working practice and the introduction of the EWTD have led to a much needed reduction in the number of hours junior doctors work. However it has also meant an increase in shift-working. Most full shift rotas require junior doctors to work seven consecutive, 13 hour night shifts, a practice the Royal College of Physicians recently recommended should be avoided.

This increase has caused great dissatisfaction among junior doctors. Many have reported fatigue and poor performance while working nights. Dr Ahmed-Little says this has led to concerns about future recruitment and retention, especially in the acute 24 hour specialties.

Furthermore she says evidence suggests shift-working increases the risks of peptic ulcers, diabetes and coronary heart disease. The situation may also be worse for women. One study from Denmark found a 50% increase in the risk of breast cancer in women who worked regular night shifts. Rates of miscarriages, low birth weight and premature births are also more prevalent amongst shift-workers, and one study has suggested people working night shifts for over six years are more likely to suffer from cardiovascular disease.

These findings, she says, have repercussions for future workforce planning given the rapidly increasing number of women in medicine, many of whom, at some point, will want to work part-time. This means they will do shift-work for many more years than their male colleagues. She warns the societal costs of treating the adverse outcomes of shift work, especially among women, may outweigh the benefits gained.

Dr Ahmed-Little says doctors could be put off agreeing to shift work if they know the potential health risks. In addition it may not be possible to ask senior doctors to work shifts without compromising their health, as tolerance to shift working appears to reduce with age.

Dr Ahmed-Little goes on to suggest ways that hospitals could improve staffs± tolerance to shift working by improving their rostering, for example, by increasing the pool of doctors providing overnight cover. However she stresses the design of rotas must be evidence based to minimise the potential detrimental health effects on employees± health and performance.

She concludes that the NHS has a responsibility to improve rostering to reduce adverse effects and to provide education about the dangers of and the ways to cope with night-shifts.

Contacts:
Yasmin Ahmed-Little, Medical Workforce Manager/ Part time F2 trainee, Manchester, UK
Email: y.ahmed-little@nwpgmd.nhs.uk

(2) Should the US and Russia destroy their stocks of smallpox virus?
(Head to head: Should the US and Russia destroy their stocks of smallpox virus?

http://www.bmj.com/cgi/content/full/334/7597/774
(Editorial: Stockpiling smallpox virus)

http://www.bmj.com/cgi/content/full/334/7597/760

Smallpox was eradicated in 1980, but the virus still exists in WHO controlled depositories. In this week±s BMJ, two experts go head to head over whether these stocks should be destroyed.

The destruction of remaining smallpox virus stocks is an overdue step forward for public health and security that will dramatically reduce the possibility that this scourge will kill again, either by accident or design, argues Edward Hammond of The Sunshine Project, an organisation seeking international consensus against biological weapons.

In 1999 Russia and the US balked at the World Health Assembly resolution calling on them to destroy the virus. Since then, both countries have accelerated smallpox research.

Particularly risky experiments are underway, he says, yet WHO experts have agreed that no valid reason exists to retain smallpox virus stocks for DNA sequencing, diagnostic tests, or vaccine development.

Arguments that smallpox could be used by terrorists or ±rogue states± have also been used to justify retention of virus stocks, yet there is no credible evidence that any terrorist organisation has smallpox virus, says Hammond. He also points out that to acquire the virus, terrorists would have to breach security at one of WHO±s repositories, and that producing quantities of weaponised smallpox is beyond the means of any known terrorist group.

As memory of the horror of smallpox recedes and biotechnology advances, it is important to draw a firm line around smallpox, he writes. ±Instead of courting disaster, we should seek to ensure that possession of this virus is treated as a crime against humanity.±

But John Agwunobi of the US Department of Health and Human Services believes that clandestine stocks almost certainly exist and that destroying the virus would be ±irreversible and short sighted.±

He disagrees with the view that live smallpox virus is no longer needed for research purposes and insists that further study is essential for global security. He points out that we currently have no effective antiviral drugs for smallpox infection.

The development and licensure of better diagnostics, safe and effective drugs, and safer vaccines against smallpox will take time, he writes. Setting an arbitrary date to complete scientific research is premature and short sighted.

As long as there is a possibility that terrorists could use smallpox to wreak havoc, WHO supervised research must continue so scientists can develop the tools needed to combat an outbreak of smallpox effectively and efficiently, he concludes.

Even if smallpox were to be introduced into the population, the number of cases is unlikely to be large, adds Tom Mack, Professor of Preventive Medicine at the University of Southern California in an accompanying editorial.

He warns that other viruses pose greater public health threats. For example, release of the highly virulent recombinant 1918 influenza virus would be a real catastrophe, he says, yet retention and distribution of recombinant strains for study is enthusiastically justified on the basis of the need for effective protection, diagnosis, and treatment.

Contact:
Edward Hammond, Director, The Sunshine Project, Austin, Texas, USA
Email: hammond@sunshine-project.org

John Agwunobi, Assistant Secretary for Health, US Department of Health and Human Services, Washington DC, USA
Email: mark.abdoo@hhs.gov

Editorial: Tom Mack, Professor of Preventive Medicine, University of Southern California, Los Angeles, USA
Email: mack@ccnt.usc.edu

(3) New training scheme threatens overseas working
(Letter: NHS chief must direct that time overseas is an asset)
http://www.bmj.com/cgi/content/full/334/7597/761

Doctors who undertake humanitarian work overseas are facing problems when they return to the UK under the new Modernising Medical Careers training scheme. A letter in this week±s BMJ calls on the chief executive of the NHS to direct that time spent overseas is an asset and that doctors should not be disadvantaged by the new system.

Last month, a report by Lord Nigel Crisp, former chief executive of the NHS, called on the government to strengthen its health links with poor countries through partnership working. It promised new arrangements to ensure better support for NHS staff who wished to volunteer overseas.

But letters sent to the BMJ from the major UK overseas research institutions, medical schools, charities and individual doctors, highlight the disastrous effects of MMC as they are experiencing it.

One response, from the charity Medecins Sans Frontieres, which relies on UK doctors to volunteer overseas, says ±the government has paid lip service to encouraging doctors to work in the developing world while making it virtually impossible to do so.±

Another urges those behind MMC and revalidation to ±create mechanisms that allow doctors to continue humanitarian work without being forced to abandon their career in the UK.±

Ed Cooper, a retired paediatrician, writes: ±The chief executive of the NHS will just have to follow the call of his predecessor, Lord Crisp, and direct that time spent overseas is always to be counted as a strong asset in promotion or entry to further training, and that any NHS trust that has not made an effort to link with an institution overseas is going to have to explain itself to him.±

Contact:
Ed Cooper, Retired Paediatrician, London, UK
Email: edcooper@doctors.org.uk

(4) Also on bmj.com this week: Phone monitoring helps patients with chronic heart failure
(Telemonitoring or structured telephone support programs for patients with chronic heart failure: systematic review and meta-analysis)
http://www.bmj.com/cgi/content/abstract/bmj.39156.536968.55v1

http://www.bmj.com/cgi/content/full/334/7596/705

Monitoring patients' health by phone can make a real difference to people with chronic heart failure, according to a study published on bmj.com.

About 900,000 people in the UK have heart failure. Men are slightly more likely to be affected than women and it is far more common among older people.

The review found that remote monitoring programmes (structured telephone support or telemonitoring by a health professional) reduced admissions to hospital and deaths from all causes by nearly one fifth, while also improving health related quality of life.

The authors conclude that, although remote monitoring should not be seen as a replacement for specialist care, it may be of particular benefit to patients who have difficulty accessing specialised care because of geography, transport, or infirmity.

Contacts:
Simon Stewart, Professor, Preventative Cardiology Unit, Baker Heart Research Institute, Melbourne, Australia
Email: simon.stewart@baker.edu.au

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