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Press releases Saturday 2 June 2007

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(1) Decision aid tool could cut the number of caesarean sections by 4000 a year

(2) Transformation for AIDS sufferers on the horizon

(3) Targeted initiatives can encourage people to walk more

(1) Decision aid tool could cut the number of caesarean sections by 4000 a year
(Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial)
BMJ Online First

A computerised decision analysis programme which helps women decide on the type of birth that is most appropriate for them could cut the number of caesarean sections performed in England and Wales by 4000 a year, according to a study published on bmj.com today.

Rates of caesarean section in the UK are rising - from 9% of births in 1980 to 21% in 2001.

Researchers from the Universities of Bristol and Dundee recruited 742 women at four maternity units in the UK where the rates of caesarean section ranged from 22%-25% - approximately the UK average. Each woman had had one previous caesarean section. They were split into three randomised groups.

The first group were given the usual care a woman would expect from obstetric and midwifery staff. The second also had access to a computer based information programme which gave them descriptions and the risks of likely clinical outcomes of a normal delivery, an elective caesarean section and an emergency caesarean section.

The third group had access to a more complex computer based decision analysis programme. They were given descriptions of the outcomes associated with a planned normal birth, elective caesarean section and emergency caesarean section. They were then asked to consider the value they attached to each possible outcome using a ratings system. From that the programme produced a recommended "preferred option" which the woman could print out and discuss with her midwife.

Dr Montgomery and his colleagues found a higher proportion of the decision analysis group (37%) had a vaginal birth compared with the usual care group (30%) and the information programme group (29%).

The women in the two intervention groups also had lower anxiety scores and higher knowledge scores than those in the usual care group. Satisfaction was also higher in the decision-analysis group.

The study found that computer based decision aids can reduce decisional conflict among pregnant women with one previous caesarean section. The researchers say: "this is an important finding, as detailed descriptions and probability information about obstetric complications might be considered as potentially alarming."

They also acknowledge the mode of delivery results are intriguing and ask why should a more complex decision aid influence the mode of delivery?

"Ongoing parallel qualitative work indicates that explicit consideration of personal values attached to potential outcomes challenges women±s perceptions of the optimal decision and this may influence their resolve to achieve a vaginal birth."

They conclude: "Although the content was carefully designed to not favour one mode of delivery over another, even a small absolute change in decisions could have a substantial impact on national rates of caesarean section."

Contacts:
Deirdre Murphy Academic Department of Obstetrics and Gynaecology,Trinity College Dublin, Coombe Women±s Hospital, Dublin 8, Republic of Ireland
Email: deirdre.j.murphy@tcd.ie

(2) Transformation for AIDS sufferers on the horizon
(Drug resistant HIV: Promising research on three new drugs gives hope for chronically infected patients)
http://www.bmj.com/cgi/content/short/334/7604/1124

A major breakthrough for people infected with AIDS is on the horizon, according to an editorial in this week±s BMJ .

Three new drugs are predicted to help transform the long-term prognosis for people with the AIDS virus, says an editorial in the journal, which points towards highly promising results from trials of three new drugs.

HIV patients in "deep salvage" - meaning those people who have developed multidrug resistant HIV that does not respond to drug combination therapy - could benefit the most.

"This year, we may witness a dramatic shift in how these patients are managed," says the editorial written by Hiroyu Hatano, infectious diseases fellow and Steven Deeks, associate professor of medicine, both of San Francisco General Hospital, University of California, USA.

For the first time in the HIV epidemic, three new agents have been developed for the management of the drug resistant virus, they say.

"Hence for patients in deep salvage, 2007 may be comparable to the landmark events of 1996, when the near miraculous effects of combination therapy were first observed," they write.

The drugs are the HIV integrase inhibitors, R5 inhibitors, and etravirine (TMC125) 0- a second generation non-nucleoside reverse transcriptase inhibitor.

Some caution is necessary about potential hype around new treatments for these patients, they warn, and add that it is not possible to predict the end of deep salvage for all people with HIV.

But within the next year, the world will "probably" see a remarkable transformation in the long-term prognosis for a generation of chronically ill, HIV-infected adults, they conclude.

Contact:
Hiroyu Hatano, infectious diseases fellow, San Francisco General Hospital, University of California, San Francisco, USA

Steven Deeks, associate professor of medicine
Email: sdeeks@php.ucsf.edu

(3) Targeted initiatives can encourage people to walk more
(Interventions to promote walking: systematic review)
BMJ Online First

People can be encouraged to walk for up to 30-60 minutes more per week if they are given the right kind of help, finds a study published on bmj.com today. This could make a valuable contribution to improving public health.

Physical activity reduces the risk of heart disease, diabetes and cancer of the colon, write David Ogilvie and colleagues for the Scottish Physical Activity Research Collaboration (SPARColl). Walking is a free and convenient way to be active, and most people can continue walking into old age. Promoting walking could therefore help tackle the health problems linked to today's inactive lifestyles.

The authors reviewed 48 studies of different approaches to promoting walking. The most successful were tailored to people±s needs and targeted at sedentary people or at those most motivated to change. These increased walking in the target groups by up to 30-60 minutes a week on average, at least in the short term. Given how little exercise most people take, this amounts to a substantial increase, say the authors.

The authors found that walking could be encouraged in a variety of ways. Examples included giving face to face advice or telephone support, using pedometers, or promoting walking as an environmentally friendly mode of transport. Different people may respond to different approaches, say the authors. One size may not fit all, and a range of options should be offered, they conclude.

Contact:
David Lyon, communications officer, NHS Health Scotland
Email: david.lyon@health.scot.nhs.uk

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