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Press releases Saturday 28 April 2007

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(1) Taking pills to prevent diabetes cannot be justified, say experts

(2) Low dose aspirin does not protect women against cognitive decline

(3) Teens can perform CPR as well as adults and should be taught from an early age

(4) Health gap between social groups widens in later life

(5) Local councils should be responsible for tackling health inequalities

(1) Taking pills to prevent diabetes cannot be justified, say experts
(Waking up from the DREAM of preventing diabetes with drugs)
http://www.bmj.com/cgi/content/full/334/7599/828

Taking prescription drugs to prevent diabetes cannot be justified, say researchers in this week±s BMJ.

They argue that lifestyle changes, such as modest weight loss and physical activity, are equally effective much safer, and cheaper.

Diabetes affects about 4% of the world population and is associated with high financial and human costs. This makes preventing diabetes a public health priority.

A recent trial showed that the drug rosiglitazone reduced the risk of diabetes in people at risk. The results have prompted aggressive promotion of rosiglitazone as a preventive therapy. But Professor Victor Montori and colleagues warn that this strategy will bring harms and additional costs while the benefits for patients remain questionable.

Several trials have assessed the ability of drugs to prevent diabetes, but none have shown that prevention with drugs improves outcomes important to patients. Evidence is also emerging of serious side effects of glitazones.

If clinicians offer patients glitazones to prevent diabetes, they are offering certain inconvenience, cost, and risk for largely speculative benefit, say the authors. Lifestyle changes are at least as effective as glitazones and can be implemented considerably more cheaply.

They conclude: "Clinical use of glitazones to prevent diabetes is, at present, impossible to justify because of unproved benefit on patient important outcomes or lasting effect on blood glucose levels, increased burden of disease labelling, serious adverse effects, increased economic burden, and availability of effective, less costly lifestyle measures."

Contacts:
Victor Montori, Associate Professor, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
Email: montori.victor@mayo.edu

(2) Low dose aspirin does not protect women against cognitive decline
(Low dose aspirin and cognitive function in the women±s health study cognitive cohort)
BMJ Online First

Taking low dose aspirin does not protect older women against cognitive decline, finds a large study published on bmj.com today.

Identifying ways to prevent dementia is a public health priority. Evidence suggests that aspirin and other anti-inflammatory drugs may protect against dementia, but data from randomised studies to date have been inconclusive. So researchers in the US decided to test the effect of long term use of low dose aspirin on overall cognitive decline among a large sample of women.

Jae Hee Kang and colleagues at Brigham and Women's Hospital in Boston, Massachusetts identified 6,377 women aged 65 years or more, who were taking part in the Women±s health study between 1998 and 2004.

The women were randomly divided into two groups. Over a period of nearly 10 years, the first group took low dose aspirin (100 mg on alternate days) and the second group took a placebo pill. Each woman had three cognitive assessments at two year intervals to measure general cognition, verbal memory, and category fluency.

At the initial assessment (after 5.6 years of treatment) cognitive performance in the aspirin group was similar to that of the placebo group. Average performance across all tests from the first to the final assessment (after 9.6 years of treatment) was also similar in the aspirin group compared with the placebo group. The risk of substantial decline was also comparable between the groups.

There was some suggestion that women in the aspirin group performed better in the category fluency test than women in the placebo group. However, the authors stress that this result should be interpreted with caution.

They conclude: "In this study, we observed no apparent benefit of low dose aspirin in slowing cognitive decline over four years. Other methods for preserving cognitive function in older people need to be investigated."

Contact:
Jessica Podlaski, Media Relations Coordinator, Brigham and Women's Hospital, Boston, MA, USA
Email: jpodlaski@partners.org

(3) Teens can perform CPR as well as adults and should be taught from an early age
(At what age can schoolchildren provide effective chest compressions? A Prospective observational study from the Heartstart UK schools training programme)
BMJ Online First

Thirteen year olds can perform cardiopulmonary resuscitation (CPR) as well as adults, finds a study published on bmj.com today. The authors suggest that children as young as nine years old should be taught CPR skills including chest compressions.

Bystander CPR more than doubles the chance of survival for victims of sudden cardiac arrest. Chest compressions are thought to be the most important component of CPR, but they are physically demanding.

The ±Heartstart Schools± training programme, developed by the British Heart Foundation, introduces chest compression at age 11, but the age at which children can perform effective chest compressions is not known.

So researchers in Cardiff, Wales investigated when children can provide effective chest compressions.

Children in three school year groups (ages 9-14) were taught basic life support as part of the Heartstart programme. The effectiveness of chest compressions was assessed during three minute±s continuous chest compression on a manikin.

No year 5 pupil (age 9-10) was able to compress the manikin±s chest to the depth recommended in guidelines ± one and a half to two inches (38-51mm). Nineteen per cent of pupils in year 7 (age 11-12) and 45 per cent in year 9 (age 13-14) achieved adequate compression depth.

Only the 13-14 year olds performed chest compression as well as adults in other studies.

Although the younger children were not strong enough to compress the chest sufficiently, they learned the theory of the technique (correct hand position and correct rate of compressions) just as well as the older children.

This suggests that chest compressions can be introduced early in school CPR training programmes, say the authors.

Contact:
Michael Colquhoun, Senior Lecturer, PreHospital Emergency Research Unit, Cardiff University, Wales College of Medicine, Cardiff, Wales
Email: mcc@mcolquhoun.plus.com

(4) Health gap between social groups widens in later life
(Do social inequalities in self-reported health increase in early old age?)
BMJ Online First

The health divide between the most affluent and the worst off in society increases in later life, finds a study published on bmj.com today.

This has important implications for government policies to tackle health inequalities.

Researchers looked at over 10,000 British civil servants aged between 35 and 55, who were taking part in the Whitehall II study. The employees worked in 20 different departments and were from all occupational grades. They were surveyed five times between 1985 and 2004 on their physical, psychological and social functioning.

Occupational grade was measured each time and participants were asked to classify their employment status (employed or retired).

The results show that physical health declines with age in all groups, while mental health tends to improve with age.

However, physical health declined more rapidly with age in the lower occupational grades, resulting in a widening of health inequalities with age. For example, the average physical health of a 70 year old high grade man or woman was similar to the physical health of a low grade person around 8 years younger. In mid-life, this gap was only 4.5 years.

Although mental health improved with age for all occupational groups, the rate of improvement was slower for low occupational grades, resulting in widening health inequalities in early old age. This gap was explained by better mental health attained by the high occupational grades after retirement. However, retirement was not associated with a similar improvement in mental health for the low grades.

This study shows that inequalities in self-reported health increase from mid-life to early old age, say the authors. These results appear to contradict other studies, which show converging relative health inequalities in later life.

Occupational class continues to affect the health and functioning of older people well into their retirement. Helping people from disadvantaged social classes to achieve the good health that is attained by more advantaged groups would help to reduce need and prevent the growing crisis in health care inequalities among the elderly as the population ages, they conclude.

Contact:
Contact authors via Ruth Metcalfe, Media Relations Manager, UCL Development & Corporate Communications Office, London, UK
Tel: +44 (0)20 7679 9739; Mobile: +44 (0)7990 675 947

The responsibility and resources for public health and tackling health inequalities should lie with local councils rather than with the NHS, argues an expert in this week±s BMJ.

Professor Tim Blackman of Durham University says that partnerships between local government and the NHS would then become a true meeting of the two sides of health prevention and treatment.

There is little doubt that inequalities in health are difficult to tackle, he writes. In England the gap in life expectancy has continued to widen, and the government±s strategy for health inequalities is now more akin to redistributing health than to redistributing income or wealth.

Drugs seem to offer an opportunity to redistribute health, and quickly. The looming 2010 target for narrowing the life expectancy gap in England by 10% is focusing effort on pharmacological interventions, such as statins and antihypertensives, among people in their 50s and 60s.

Although extending these treatments as widely as needed is laudable, having so many people taking drugs can hardly be regarded as a public health achievement, he says. Yet the NHS is proving remarkably good at these approaches.

The reason for this, he explains, is because the NHS is a sickness service, which is what it is good at and what it should focus on.

Every attempt to push public health up the NHS agenda gets undermined by acute services trumping public health in budgetary, political, and media contests, or additional tranches of money getting diverted to priorities that are always more urgent than the slow and unglamorous interventions needed to improve the public±s health.

So where should the responsibility and resources for public health and tackling health inequalities lie, he asks?

The obvious answer is with local councils, beyond the appetite of acute services, beyond the quick fix of statin prescriptions, and in the clarity of a single organisation with clear accountability and leadership as an agent of public health.

He suggests that the extra resources could come from acute care. Local councils would then decide whether to transfer it back to the NHS or to use it, for example, to cut the local waiting list for social housing or to improve school meals.

Whatever it did, it would have to be mindful of its health inequality targets, which would now lie clearly with the local council as its responsibility, he concludes.

Contact:
Tim Blackman, Professor of Sociology and Social Policy, Durham University, UK
Email: tim.blackman@dur.ac.uk

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