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Press releases Saturday 6 September - Friday 12 September 2008

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(1) Patients will face delays in getting diagnostic scans due to severe shortage of imaging agents
(2)Misleading labelling putting infant’s health at risk in South Asia
(3)Smoking cessation services failing to reach young people
(4)A strict Mediterranean diet can help reduce deaths from major chronic diseases

(1) Patients will face delays in getting diagnostic scans due to severe shortage of imaging agents
(Letter: Medical isotope supplies and nuclear medicine services)
http://www.bmj.com/cgi/content/extract/337/sep05_2/a1577

A global shortage of medical isotopes* used in over 80% of routine diagnostic nuclear imaging procedures such as heart imaging, bone scans and some cancer detection procedures, will cause delays and cancellations to diagnostic examinations across the UK and Europe in the next few weeks, predict experts on bmj.com today.

UK hospitals are receiving less than 50% of expected supplies and rations are expected to drop still further in the coming weeks, write Alan Perkins and colleagues from the British Nuclear Medicine Society.

According to the European Association of Nuclear Medicine European hospitals are already limited to only 20-40% of normal nuclear medical activities.

The authors warn that if NHS managers in the UK aim to meet the six-week target for diagnostic waiting times by altering bookings on the basis of waiting times rather than clinical priority, some patients may receive sub-optimal treatment.

Currently Europe's three isotope production reactors are all shut down because of maintenance issues and European producers only have enough radioisotopes to last until September 8.

In addition, other reactors in Canada and South Africa have also been temporarily closed, leaving just the Australian reactor which, according to the authors, does not have enough potential to significantly increase supply to the world market.

The closure of the Canadian reactor for two months in 2007 for safety reasons affected over 50 000 patient examinations in the US.

The authors point out that this is not just a short term emergency. Most of the commercial reactors are around 40 years old and new production capacity is urgently needed to meet the increasing demands of isotopes for research, diagnosis and treatment.

They warn that urgent global investment in new reactor facilities is essential or these problems will continue and it will be the patients that suffer.

Notes to Editors:
*Medical isotopes are small quantities of radioactive substances (radiopharmaceuticals) used in the imaging and treatment of disease. Radiopharmaceuticals are delivered directly to the site of diseased cells and can be tracked by imaging equipment providing additional information to procedures that just take an anatomical picture.

Contact:
Alan Perkins, Honorary Secretary, British Nuclear Medicine Society, London, UK
Email: Alan.Perkins@nottingham.ac.uk

(2) Misleading labelling putting infant’s health at risk in South Asia
(Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos)
http://www.bmj.com/cgi/content/abstract/337/sep09_2/a1379

Use of the Bear Brand logo (a cartoon baby bear held by its mother in the breast feeding position) on coffee creamer is misleading to the local population of Laos and and risks implying that the product is suitable for young infants, placing their health at risk, warns a study published on bmj.com today.

Because it is easily misinterpreted, the Bear Brand logo should not be permitted on products that are not infant formula, say the authors.

Bear Brand is a popular creamer intended for use in coffee and is nutritionally inadequate for infants.

The creamer has an illustration of an infant feeding bottle with a cross through it and a warning on the can which states "This product is not to be used as breast milk substitute" in English, Thai, and Lao. However, many people in Laos do not speak any of these languages - more than 45 languages are spoken in the country - and there are high rates of illiteracy in the region, particularly in rural areas.

The company also uses the same Bear Brand logo on infant formula products for infants from 6 months and on its sterilised cow's milk product.

Hubert Barennes and colleagues from the Institut de la Francophonie pour la Médecine Tropicale in Laos encountered first hand a number of children and infants admitted to hospital with malnutrition who had been fed the Bear Brand creamer exclusively.

In light of these findings they conducted two surveys to determine how widespread the practice of feeding this coffee creamer to infants was in Laos and to understand people's perception of the cartoon logo.

In 2006 they interviewed 26 paediatricians working in eight of the 17 provinces in Laos to collect information on parents' use of the Bear Brand coffee creamer as a substitute for breast milk. In 2007 they conducted a sample survey in five representative provinces randomly selecting villages and households to answer questions about their knowledge and use of the Bear Brand coffee creamer.

The authors found that the Bear Brand coffee creamer is a well recognised and widely distributed product. Nearly half of the adults surveyed believed that the product is "good for infants" or a "replacement for breast milk", and nearly a fifth of parents had given the product to their young infants, often when mothers returned to work or when the mother was ill or died.

Nearly half of respondents did not notice the written warning on the label or the picture of the baby's bottle with a cross through it. 12% did not understand the meaning of the cross through the bottle.

The authors warn that the cartoon bear and cub logo may mislead parents into believing that the coffee creamer is a suitable breast milk substitute despite the warnings on the label to the contrary.

They conclude: "The sale of coffee creamer with this logo places the health of infants and children at risk in a developing nation that already has extreme levels of malnutrition."

Contacts:
Hubert Barennes, Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Laos
Email: hubert.barennes@auf.org

(3) Smoking cessation services failing to reach young people
(Editorial: Smoking cessation services for young people )
http://www.bmj.com/cgi/content/extract/337/sep09_2/a1394

Interventions aimed at young people to help them stop smoking have had only limited success and there is an urgent need for innovative and effective programmes to which young people will subscribe, says an editorial published on bmj.com today.

Although many smoking cessation interventions for young people have been tested, the evidence of their effectiveness in helping young people quit before smoking becomes addictive and ingrained is poor, write Gill Grimshaw from the University of Warwick and Alan Stanton from the Solihull Care Trust.

In the UK around 12% of teenagers are regular smokers and this rises to 35% in some parts of the world. It is well known that people who start smoking at a young age are more likely to smoke for a long time and are more likely to die prematurely from smoking related disease.

Research has shown that young smokers make repeated attempts to quit and around 70% express a desire to quit shortly after taking up the habit.

So why are interventions to help young people quit smoking not working?

Data published in 2006 showed that there is a lack of good quality evidence available to show what works or to recommend widespread implementation of any one programme.

The authors point to a review of several Scottish NHS programmes which found that a key problem was recruiting young people into the programmes. After one year, only 11 young people (2.4%) from all seven projects had managed to quit long term. These findings and others from studies outside the UK suggest that one of the main barriers to implementing smoking cessation interventions is the practicalities of working with organisations and young people.

According to the authors, part of the problem is that young people do not see themselves as lifelong smokers and quitting is not an urgent priority, while smoking cessation services are often viewed as being for older more addicted smokers.

In addition, only nicotine replacement therapy is currently licensed for use in young people, and because it is well known that smokers tend not to reuse strategies that have failed them previously, they suggest that it may be better to save these strategies for when success is more likely.

The authors conclude that although we don't know what works, young people still need support when making attempts to quit, and privacy, confidentiality, respect and an absence of pressure are also important.

Contacts:
Gill Grimshaw, Warwick Medical School, Medical Teaching Centre, University of Warwick, Coventry, UK
Email: gill.grimshaw@warwick.ac.uk
Kelly Parkes-Harrison, Warwick Medical School Communications Officer
Email: k.e.parkes@warwick.ac.uk

(4) A strict Mediterranean diet can help reduce deaths from major chronic diseases
(Adherence to Mediterranean diet and health status: meta-analysis)
http://www.bmj.com/cgi/content/abstract/337/sep11_2/a1344

Sticking to a full Mediterranean diet provides substantial protection against major chronic diseases including heart disease, cancer and Parkinson's and Alzheimer's disease, according to a study published on bmj.com today.

A 'score' based on adherence to the Mediterranean diet could be used as an effective preventive tool for reducing the risk of premature death in the general population, say the authors.

The Mediterranean diet from populations bordering the Mediterranean Sea has a reputation for being a model of healthy eating and contributing to better health and quality of life. It is rich in olive oil, grains, fruits, nuts, vegetables, and fish, but low in meat, dairy products and alcohol.

Previous research on the Mediterranean diet suggests that it has a protective role in cardiovascular disease and cancer, but no study has reviewed all the available data for a possible association between sticking to the Mediterranean diet, premature death, and the occurrence of chronic diseases in the general population.

A team of researchers from the University of Florence assessed 12 international studies, which collectively included more than 1.5 million participants whose dietary habits and health were tracked for follow-up periods ranging from three to 18 years.

All the studies examined the concept of using a numerical score to estimate how much people stuck to the diet, called an 'adherence score'.

The researchers found that people who stuck strictly to a Mediterranean diet had significant improvements in their health, including a 9% drop in overall mortality, a 9% drop in mortality from cardiovascular disease, a 13% reduction in incidence of Parkinson and Alzheimer's disease, and a 6% reduction in cancer.

The researchers suggest that keeping an 'adherence score' based on "a theoretically defined Mediterranean diet could be an effective preventive tool for reducing the risk of mortality and morbidity in the general population."

The results of this study have important implications for public health, particularly for reducing the risk of premature death in the general population, conclude the authors.

The findings confirm the current guidelines and recommendations from all major scientific institutions that encourage a Mediterranean-like dietary pattern for the prevention of major chronic diseases.

Contact:
Francesco Sofi, Department of Medical and Surgical Critical Area, Thrombosis Centre, University of Florence, Italy
Email: francescosofi@gmail.com

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