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Press releases 30 November 2007

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(1) New Chlamydia test quicker and more cost-effective than current tests
(2) Warning over ingesting alcohol hand rubs
(3) Doctors have a duty to help tackle climate change

(1) New Chlamydia test quicker and more cost-effective than current tests
(New point of care Chlamydia Rapid Test - bridging the gap between diagnosis and treatment: performance evaluation study)
http://www.bmj.com/cgi/content/full/bmj.39402.463854.AEv1

A new test for diagnosing Chlamydia is quicker and more cost-effective than current tests, and has the potential to reduce complications and transmission to sexual partners, finds a study published on bmj.com today.

Chlamydia trachomatis infection is the most common sexually transmitted bacterial infection in the world but often has no symptoms. Yet, if left undiagnosed and untreated, it can result in complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility.

Developed countries, including the UK, have national screening programmes in place which tend to use nucleic acid amplification tests to diagnose infection. These tests are more sensitive than the currently available rapid tests, but require costly machines in addition to trained staff and results can take up to two weeks.

In contrast, screening programmes for Chlamydia are almost nonexistent in the developing world.

So researchers assessed the performance of a new Chlamydia Rapid Test compared to the currently available nucleic acid based tests (polymerase chain reaction and strand displacement amplification tests).

Over 1,300 women aged between 16 and 54 years attending one of three clinics in the UK were included in the study.

An information sheet was given to each participant explaining how to collect the vaginal swabs. Swabs and urine cups were then provided and each participant was surveyed about sample collection methods and preferences.

The new Chlamydia Rapid Test achieved relatively high diagnostic sensitivity (83.5%) compared with the more complicated nucleic acid based tests. It also provided results within 30 minutes, allowing all positive individuals to be offered treatment while still at the clinic.

This, say the authors, could reduce the risk of complications and help to prevent onward transmission by sexual contact that occurs during the interval between standard testing and treatment.

It would also be valuable in developing countries, especially those with high risk populations such as female sex workers.

Furthermore, the survey results revealed that 99.4% of young adults participating in the survey found the instructions easy to understand and 95.9% felt comfortable collecting their own vaginal swab specimens. They also showed that 75% of women were willing to wait between 30 minutes and two hours for their results, but only 7% were willing to wait more than one day.

The performance of this new Chlamydia Rapid Test indicates that it would be an effective same-day diagnostic and screening tool for Chlamydia infection of women, conclude the authors. It could also provide a simple and reliable alternative to nucleic acid amplification tests within Chlamydia screening programmes.

Contact:
Helen Lee, Reader in Medical Biotechnology, Department of Haematology, Diagnostics Development Unit, University of Cambridge, UK
Email: hl207@cam.ac.uk 

(2) Warning over ingesting alcohol hand rubs
(Alcohol hand rubs: hygiene and hazard)
www.bmj.com/cgi/content/full/335/7630/1154

Young or confused people and those dependent on alcohol could be at risk from ingestion of alcohol hand rubs in hospitals or care homes, warn doctors in this week's BMJ.

They recommend that large hand rub dispensers are placed in secure holders to prevent accidental or intentional removal of the container by high risk patients.

Healthcare acquired infections are common and alcohol hand rubs are an important component of good hand hygiene, along with other measures (such as rolling up sleeves, minimal jewellery, and removal of wrist watches) to try and reduce healthcare acquired infections. Since April 2005, near patient alcohol-based hand rubs (e.g. attached to bedsides and entrances to wards) have been widely available in NHS hospitals, but no risk assessment has been undertaken involving their accidental or intentional ingestion.

Toxicologists at Guy's and St Thomas' NHS Foundation Trust Poisons Unit compared the number of enquiries to their poisons centre in London from other health professionals during the 16-month periods before and after the widespread introduction of alcohol hand rub. These enquiries related to both children and adults exposed to the rub (both ingestion and eye exposure).

This comparison revealed an increase in the total number (23 versus 50) of enquiries to the unit. There was also a marked increase (7 versus 29) in adult ingestion numbers, 19 of which were thought to be due to intentional ingestion.

All cases of ingestion occurred within hospitals or care homes.

Accidental ingestion occurred in the very young, elderly and where patients were confused, while intentional ingestion only occurred in those with alcohol dependency.

Due to the wide variation of individual response and tolerance to ethanol a "toxic dose" of alcohol hand rub is difficult to establish, say the authors.

In our experience, they say, the more serious effects are seen in those who ingest more than 500ml of hand-rub and this is most likely to occur in the confused (e.g. mistaking it for water) and those with alcohol dependency seeking the desired effect.

They stress that poisoning due to alcohol hand rub remains relatively uncommon, but appears to have increased since their widespread introduction in the UK.

They suggest that in areas that are easily accessible by high risk patients, the larger hand rub dispensers (500ml or more) could be placed within locked secured holders preventing accidental or intentional withdrawal of the container and ingestion.

They conclude that to tackle the relative risks associated with alcohol hand rub ingestion, balanced against the benefits and importance of them in reducing healthcare acquired infection, there needs to be a multidisciplinary and coordinated approach from risk managers, toxicologists and infection control specialists.

Contact:
Katie Fleming, Communications Manager, Guy's and St Thomas' NHS Foundation Trust, London, UK
Email: katie.fleming@gstt.nhs.uk 

(3) Doctors have a duty to help tackle climate change
(Editorial: Doctors and climate change)
www.bmj.com/cgi/content/full/335/7630/1104
(Letter: We must all act now)
www.bmj.com/cgi/content/full/335/7630/1110-a

Health professionals must show leadership in tackling the potentially catastrophic effects of climate change, according to an editorial in this week's BMJ.

Dr Robin Stott of the Climate and Health Council, together with BMJ Editor Fiona Godlee and Lancet Editor Richard Horton, believe that health professionals have a duty to be part of the solution and urge readers to sign the Climate and Health Council declaration at www.climateandhealth.org

The present climate related extinction event, so far a minor one, is caused by humans, they write. Excessive amounts of carbon dioxide are being poured into the atmosphere as a result of human activity, even though we know what the consequences will be.

They warn that alterations in food production; rises in sea levels; the spread of vector borne disease; and water shortages are already aggravating health problems, particularly in poor countries, while the impact of climate change will get much worse, and predictions of a hundred million climate refugees is no longer fanciful.

They outline several ways in which health professionals should act.

Firstly, they say, we should inform our professional colleagues and the wider community about the health consequences of climate change, and the major health benefits that will result from tackling it. Secondly, we should set an example by reducing our personal carbon footprints and ensuring that the organisations we work for do likewise.

Thirdly, health professionals should make a concerted effort to contribute to the post Kyoto framework, and to lobby at the United Nations' conferences on climate change in Bali in December and then in Copenhagen in November 2009.

Fourthly, health professionals should seek innovative approaches to using our many networks, such as specialty associations, to facilitate the necessary changes to recruit as many organisations, institutions, and individuals as possible.

Climate change challenges the health of everybody, they say, but particularly of people with the fewest resources. It is the major challenge of the 21st century. Unless we cap carbon emissions in ways that ensure transfer of resources to the poorer nations, we may all go the way of the dinosaurs, and the going will not be comfortable.

By adding your voice to the he Climate and Health Council and taking the necessary actions, you can help to ensure that health professionals are, in the best of our traditions, part of the solution, they conclude.

The call to act is also reiterated in a letter to this week's BMJ from the Presidents of the Faculty of Public Health, the Royal College of Physicians London, and the Royal College of Paediatrics and Child Health. They write: "Only by firm and decisive action now, can we, as a global community, hope to avert or mitigate an impending public health catastrophe of immense proportions."

Contact:
Robin Stott, Co-chair Climate and Health Council, Medact, London, UK
Email: stott@dircon.co.uk 

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(contact: pressoffice@bma.org.uk)

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)