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Press releases Monday 15 September - Friday 19 September 2008

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(1) A healthy lifestyle halves the risk of premature death in women
(2)Increasing general practice opening hours could prevent recurrent strokes
(3)We are facing a global pandemic of antibiotic resistance, warn experts

(1) A healthy lifestyle halves the risk of premature death in women
(Combined impact of lifestyle factors on mortality: a prospective cohort study in US women)
http://www.bmj.com/cgi/content/abstract/337/sep16_2/a1440

Over half of deaths in women from chronic diseases such as cancer and heart disease could be avoided if they never smoke, keep their weight in check, take exercise and eat a healthy diet low in red meat and trans-fats, according to a study published on bmj.com today.

It is well known that diet, lack of physical activity, being overweight, alcohol consumption and smoking increase the risk of disease including cancer and diabetes, but little research has examined combinations of lifestyle factors in younger populations and women.

Dr Rob van Dam and his team from the Harvard School of Public Health and Brigham and Women's Hospital, recruited nearly 80 000 women aged 34 to 59 years in 1980 who were part of the Nurses' Health Study in the US. They analysed the data of over 1.5 million person - years follow up over a 24 year period.

Participants completed detailed follow-up questionnaires every two years about their diet, frequency of physical activity, alcohol intake, weight, how much they smoked, and disease history. Deaths were confirmed by next of kin and the National Death Index.

Over the follow-up period the authors documented 8 882 deaths including 1 790 from heart disease and 4 527 from cancer.

The authors estimated that 28% of these deaths could have been avoided if women had never smoked and that 55% could have been avoided if women had combined never smoking, regular physical activity, a healthy diet and maintaining a healthy weight. Alcohol intake did not substantially change this estimate, although heavy alcohol consumption is linked to an increased risk of dying from cancer.

Smoking was found to be the biggest cause of premature death but all the other factors also contributed.

Interestingly, women with light-to-moderate alcohol consumption (up to 1 drink a day) were less likely to die from cardiovascular diseases than alcohol abstainers.

The authors believe the results of this research indicate that more needs to be done to eradicate smoking and to encourage individuals to take regular exercise and eat healthily.

They conclude that "even modest differences in lifestyle can have a substantial impact on reducing mortality rates".

Contact:
Rob van Dam, Department of Nutrition, Harvard School of Public Health, Boston, USA
Email: rvandam@hsph.harvard.edu

(2) Increasing general practice opening hours could prevent recurrent strokes
(Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study)
http://www.bmj.com/cgi/content/abstract/337/sep18_3/a1569
(Editorial: Delays in accessing primary care)
http://www.bmj.com/cgi/content/extract/337/sep18_3/a1435

Increasing general practice opening hours would improve the opportunity for assessment and urgent referral to specialist care of patients with a transient ischaemic attack (TIA) or minor stroke, which could prevent over 500 recurrent strokes a year in England alone, concludes a study published on bmj.com today.

Recent research shows that early assessment and treatment after a TIA and minor stroke can significantly reduce the risk of recurrent disabling or fatal stroke. The national stroke strategy and guidance from the National Institute of Health and Clinical Excellence (NICE) recommend that high risk patients must be seen within 24 hours of symptom onset.

In the UK, most patients choose to seek help from their general practice after TIA or minor stroke rather than via the emergency services.

Recent proposals to change the GP contract and increase general practices' opening hours from office hours (8am-6.30pm Monday to Friday) to include evenings and weekends, could improve access to primary care and may influence patients' healthcare seeking behaviour and affect clinical outcomes, particularly in emergency cases such as patients with TIA and minor stroke.

Dr Daniel Lasserson and colleagues from the University of Oxford assessed the potential impact on stroke prevention of increasing primary care opening hours to 8am-8pm daily. They analysed the healthcare seeking behaviour of 91,000 patients registered at nine general practices in Oxfordshire between 1 April 2002 and 31 March 2006.

The researchers recorded the time of symptom onset, time to calling healthcare services, and the choice of healthcare provider in patients with a definite or probable TIA or minor stroke.

They found that current opening hours can increase the delay in assessment. Most patients who had a TIA or minor stroke out of hours delayed seeking health care until their registered general practice was open, causing long delays in seeking treatment, particularly at weekends.

Among 359 patients with TIA and 434 with minor stroke the median time to calling a general practitioner after symptom onset was 4 hours during surgery opening hours and 24.8 hours during out of hours.

Thirteen patients who presented with a stroke had a previous TIA or minor stroke out of hours and did not seek emergency care.

The researchers report that a primary care centre open seven days a week from 8am-8pm would have offered cover to 73 patients who waited until surgery opening hours to call their general practitioner, reducing median delay from 50.1 hours to 4.0 hours, and increasing those calling within 24 hours from 34% to 68%.

The authors conclude by calling for studies to examine the reasons for patients' choice of healthcare provider after TIA and minor stroke, and the reasons for the delay in seeking health care which could help inform effective public health awareness campaigns.

In an accompanying editorial, Moyez Jiwa from the Curtin Health Innovation Research Institute in Perth and Andrew Knight from the University of Sydney, say that the findings confirm that delay in access to health services has serious consequences and should be a target for improvement.

However, they suggest that public health messages alerting patients with symptoms of TIA to the need for emergency care would be of more benefit than extending general practice opening hours.

Contacts:
Daniel Lasserson, Department of Primary Health Care, University of Oxford, Oxford, UK
Email: Daniel.lasserson@dphpc.ox.ac.uk
Moyez Jiwa, Curtin Health Innovation Research Institute, Perth, Australia
Email: m.jiwa@curtin.edu.au

(3) We are facing a global pandemic of antibiotic resistance, warn experts
(Analysis: Antibiotic resistance)
http://www.bmj.com/cgi/content/extract/337/sep18_3/a1438

Vital components of modern medicine such as major surgery, organ transplantation, and cancer chemotherapy will be threatened if antibiotic resistance is not tackled urgently, warn experts on bmj.com today.

A concerted global response is needed to address rising rates of bacterial resistance caused by the use and abuse of antibiotics or "we will return to the pre-antibiotic era", write Professor Otto Cars and colleagues in an editorial.

All antibiotic use "uses up" some of the effectiveness of that antibiotic, diminishing the ability to use it in the future, write the authors, and antibiotics can no longer be considered as a renewable source.

They point out that existing antibiotics are losing their effect at an alarming pace, while the development of new antibiotics is declining. More than a dozen new classes of antibiotics were developed between 1930 and 1970, but only two new classes have been developed since then.

According to the European Centre for Disease Prevention and Control, the most important disease threat in Europe is from micro-organisms that have become resistant to antibiotics. As far back as 2000, the World Health Organisation was calling for a massive effort to address the problem of antimicrobial resistance to prevent the "health catastrophe of tomorrow".

So why has so little been done to address the problem of resistance, ask the authors?

Antibiotics are over prescribed, still illegally sold over the counter in some EU countries, and self medication with leftover medicines is commonplace.

There are alarming reports about serious consequences of antibiotic resistance from all around the world. However, there is still a dearth of data on the magnitude and burden of antibiotic resistance, or its economic impact on individuals, health care, and society. This, they suggest, may explain why there has been little response to this public health threat from politicians, public health workers, and consumers.

In addition, there are significant scientific challenges but few incentives to developing new antibiotics, state the authors.

The authors believe that priority must be given to the most urgently needed antibiotics and incentives given for developing antibacterials with new mechanisms of action. In addition, "the use of new antibiotics must be safeguarded by regulations and practices that ensure rational use, to avoid repeating the mistakes we have made by overusing the old ones", they say.

They point out that reducing consumer demand could be the strongest force to driving change - individuals must be educated to understand that their choice to use an antibiotic will affect the possibility of effectively treating bacterial infections in other people.

But, they claim, the ultimate responsibility for coordination and resources rests with national governments, WHO and other international stakeholders.

Not only is there an urgent need for up-to-date information on the level of antibiotic resistance, but also for evidence of effective interventions for the prevention and control of antibiotic resistance at national and local levels, while more focus is needed on infectious diseases, they conclude.

Contacts:
Otto Cars, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
Email: otto.cars@medsci.uu.se
Goran Tomson, International Health Systems Research, IHCAR Div International Health, Stockholm, Swede
Email: Goran.Tomson@ki.se

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