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Press releases Saturday 12 April 2008

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(1) Moving to the UK worsens maternal health behaviours
(2) Does the internet really influence suicidal behaviour?
(3) Give patients NHS money to buy their own care
(4) Cognitive tests are the best way to select medical students

(1) Moving to the UK worsens maternal health behaviours
(Influence of moving to the UK on maternal health behaviours: prospective cohort study)
http://www.bmj.com/cgi/content/short/bmj.39518.463206.25
(Editorial: Migration and subsequent health behaviours in pregnancy)
http://www.bmj.com/cgi/content/short/bmj.39533.358252.BE

After women immigrate to the UK their maternal health behaviours worsen as their length of residency increases. The longer ethnic minority women live in the UK the more likely they are to smoke during pregnancy or give up breastfeeding early, concludes a study published on bmj.com today.

These findings will have public health implications for countries with large migrant populations, say the authors.

The UK has experienced an increase in immigration over the past 50 years. Previous studies have show that compared with British/Irish white women, women from ethnic minority groups are more likely to breast feed. However, no studies have compared their use of alcohol or tobacco during pregnancy, or whether women's behaviours change with acculturation*.

So researchers from the UCL Institute of Child Health in London compared health behaviours during pregnancy (smoking and alcohol consumption) and after birth (initiation and duration of breast feeding) between British/Irish white mothers and mothers from ethnic minority groups.

The study involved over 8588 mothers with singleton children from the millennium cohort study. 6478 British/Irish white mothers and 2110 mothers from ethnic minority groups were interviewed about their maternal health behaviours, generational status and length of residency in the UK.

The researchers found that compared with British/Irish white mothers, mothers from ethnic minority groups were less likely to smoke (15% v 37%) or consume alcohol (14% v 37%) during pregnancy, and were more likely to start breast feeding (86 v 69%) and breast feed for at least four months (40% v 27%).

They also found that among mothers from ethnic minority groups, first and second generation mothers were more likely to smoke during pregnancy, but were less likely to start breast feeding, and less likely to continue breast feeding than immigrants.

Importantly, for every additional five years spent in the UK, immigrant mothers were 32% more likely to smoke during pregnancy and 5% less likely to breast feed for at least four months.

The authors warn that health professionals should not underestimate the likelihood of women engaging in risky health behaviours because of their ethnicity.

National policies should ensure that all mothers can achieve recommendations to foster their own and their children's health, they conclude.

As the number of international migrants continues to increase worldwide, smoking and alcohol consumption patterns among women in developing countries will have consequences for medical providers throughout Europe and North America, warn the authors of an accompanying editorial.

This research "is an important first step in developing programmes and policies that promote the health of immigrant women and their children", they conclude.

Notes to Editors:
*Acculturation is the adoption of health behaviours from the new dominant culture and loss of health behaviours from the original culture.

Contacts:
Catherine Law, Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
Email: coxs@gosh.nhs.uk
Editorial: Krista Perreira, Carolina Population Center and Department of Public Policy, University of North Carolina, USA
Email: perreira@email.unc.edu

(2) Does the internet really influence suicidal behaviour?
(Feature: Suicide and the internet)
www.bmj.com/cgi/content/short/336/7648/800

People searching the Internet for information about suicide methods are most likely to come across sites that encourage suicide rather than sites offering help and support, finds a study in this week's issue of the BMJ.

Media reporting of suicide and its portrayal on television are known to influence suicidal behaviour, particularly the choice of method used, but little is known about the influence of the internet.

Recent reports in the popular press have highlighted the existence and possible influence of internet sites that promote suicide and web forums that may encourage suicide in young people.

But despite these recent controversies, the ease with which these sites may be found on the internet has not been systematically documented nor the kind of information they contain been described.

Researchers from the Universities of Bristol, Oxford and Manchester set out to replicate a typical search that might be undertaken by a person looking for instructions and information about methods of suicide using the four most popular search engines - Google, Yahoo, MSN, and Ask - and 12 simple search terms.

They analysed the first ten sites from each search, giving a total of 480 hits.

Altogether 240 different sites were found and just under half of these provided some information about methods of suicide. Almost a fifth of hits (90) were for dedicated suicide sites, of which half were judged to be encouraging, promoting, or facilitating suicide.

Sixty-two (13%) sites focused on suicide prevention or offered support and 59 (12%) sites actively discouraged suicide.

Almost all dedicated suicide and factual information sites provided information about methods of suicide. But, a fifth (21%) of support and prevention sites and over half (55%) of academic or policy sites, and all news reports of suicides also provided information about methods.

Overall, Google and Yahoo retrieved the highest number of dedicated suicide sites, whereas MSN had the highest number of prevention or support sites and academic or policy sites.

In addition, the three most frequently occurring sites were all pro-suicide, whereas the information site Wikipedia was fourth. All top four sites evaluated methods of suicide including detailed information about speed, certainty, and the likely amount of pain associated with each method.

However, there is currently no regulation of suicide sites in the UK because they are not illegal.

Self-regulation by internet providers and use of filtering software by parents to block sites are the main approaches to reducing potential harm from suicide sites. However, efforts to remove some of the most detailed technical descriptions of suicide methods may be easily circumvented, say the authors.

They conclude that service providers might pursue website optimisation strategies to maximise the likelihood that sites aimed at preventing suicide are preferentially sourced by people seeking information about suicide methods rather than potentially harmful sites.

Contact:
Hannah Johnson, Press office, University of Bristol, UK
Email: hannah.johnson@bristol.ac.uk

(3) Give patients NHS money to buy their own care
(Analysis: Let patients control the purse strings)
www.bmj.com/cgi/content/short/336/7648/807

Patients with long term, chronic conditions should be given money to organise and purchase their own care, according to an article in this week's BMJ.

Direct payments for social care were introduced in the UK in 1996. They are available to disabled adults, the elderly and carers of disabled children and allow services to be more accurately tailored to individual needs.

Vidhya Alakeson, an expert in healthcare policy at the US Department of Health and Human Services, believes that this scheme should be piloted in health care.

Instead of receiving services organised and provided by a local authority, direct payments and individual budgets give patients greater say over the types of treatments and services they receive and have been shown to improve satisfaction and outcomes, and reduce costs for local authorities.

Piloting individual budgets in the NHS would signal a real commitment from the government to creating patient-centred healthcare, says Alakeson.

Yet scepticism remains about an expansion of this individualised funding into the NHS.

However, early evidence from pilots in the US suggests that much of this is misplaced, she says.

She acknowledges that individual budgets would not be appropriate for all types of healthcare, but at the boundary between health and social care, patients are strongly in favour of including NHS resources within individual budgets and ending the arbitrary divide between health and social care, she says.

Indeed, one study found that people with both health and social care needs were already unofficially using their direct payments to purchase a range of services that would be defined as healthcare, such as physiotherapy, injections, and pain management. Their reasons for doing so were to overcome capacity constraints in the NHS and to integrate healthcare tasks better into their daily routine.

Giving patients greater choice over who provides their care goes some way to meeting the objectives set out in the 'Our Health, Our Care, Our Say' White Paper, writes Alakeson.

The time has come for governments to match their rhetorical commitment to a patient-centred healthcare system that delivers high quality, integrated care for long term conditions, to a real commitment to pilot individual budgets in healthcare, she concludes.

Contact:
Vidhya Alakeson, Harkness Fellow in Healthcare Policy, US Department of Health and Human Services, Washington DC, USA
Email: vidhya.alakeson@hhs.gov

(4) Cognitive tests are the best way to select medical students
(Editorial: Selecting medical students)
www.bmj.com/cgi/content/short/336/7648/786

Cognitive ability tests are the best way for medical schools to select their entrants, rather than interviews and psychological tests, says an editorial in this week's BMJ.

The selection of tomorrow's doctors is an issue of enduring interest because it raises questions about predicting the characteristics of a good doctor, write Celia Brown and Richard Lilford from the University of Birmingham.

Society pays around £200,000 to train each medical student, but the cost of getting it wrong is much greater.

According to the authors, doctors should have three broad attributes - cognitive ability, humanity, and diligence. While it would be desirable to screen potential doctors for all these attributes, the evidence suggests that only cognitive ability can be assessed with reasonable accuracy in the context of mass selection.

School examination results have been shown to predict academic performance at medical school, but some argue that British A-Levels are not helpful for selecting medical students because most candidates applying for medical school achieve the top grades and they favour students from more privileged backgrounds.

The authors suggest that these criticisms could be rectified by basing selection on actual marks awarded rather than on course grades and adjusting entry requirements according to the applicant's background.

Despite these solutions, say the authors, some medical schools have introduced 'aptitude' tests that do not appear to predict clinical performance, casting considerable doubt on their value as predictors of performance beyond medical school. They are also costly for both candidates and universities and there is no evidence that selection based on such tests results in improved prediction compared to the use of school examination marks alone.

In addition, psychological tests and tests to measure 'empathy' are not adequate for selection, claim the authors, as we simply do not know the mixture of traits that are favourable for both diligent service and personal progression. And, unlike IQ or examination results, they can be manipulated to provide socially desirable answers.

Interviews also have a low predictive accuracy, they add. They often let through the people they are supposed to eliminate and appear to be biased towards people with a pleasing appearance.

The authors therefore suggest that tests of cognitive ability are the best way to select medical students because the processes they test are similar to those used in clinical practice - the application of knowledge to a problem.

Many European countries use a lottery, weighted by school-leaving examination results. Such a random process, while not the authors' preferred option, at least avoids the illusion of scientific probity, they conclude.

Contact:
Celia Brown, Research Fellow, Department of Public Health and Epidemiology, University of Birmingham, UK
Email: c.a.brown@bham.ac.uk

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