Press releases Monday 3 August to Friday 7 August 2009
Please remember to credit the BMJ
as source when publicising an article and to tell your readers that they can
read its full text on the journal's website (http://www.bmj.com).
(1) Infant deaths higher among deprived communities and ethnic minorities
(2) Do not-for-profit nursing homes provide better quality care?
(3) Men with angina at twice the risk of heart attack and death compared with women
(4) Single dose of steroids speeds up relief of sore throat
(1) Infant deaths higher among deprived communities and ethnic minorities
(Research: What factors predict differences in infant and perinatal mortality in primary care trusts in England? A prognostic model)
http://www.bmj.com/cgi/doi/10.1136/bmj.b2892
Rates of infant death remain high in parts of England, largely among deprived communities and ethnic minorities, finds a study published on bmj.com today.
Despite government targets to reduce the gap in infant mortality, recent data indicate that the rates of both infant and perinatal mortality (death before, during or shortly after birth) remain high in many primary care trusts (PCTs) across England.
PCTs with the worst infant mortality rates have been assigned "Spearhead" status by the Department of Health, but it is unclear whether such outcomes arise from poor service provision and lack of expenditure or from patient demographics such as deprivation or ethnicity.
So a team of researchers obtained data on the number of infant and perinatal deaths, ethnicity, deprivation, maternal age, spending on maternal services, and "Spearhead" status for all 303 PCTs in England.
They used this data to explain differences in infant and perinatal mortality between PCTs and identify outlier trusts where outcomes were worse than expected.
Over a three-year study period, they found rates of infant mortality varied by PCT from 1.4 to 10.83 deaths per 1,000 live births, and perinatal mortality varied from 3.93 to 16.66 per 1,000 births.
A combination of deprivation, ethnicity and maternal age explained 80.5% of the differences in outcome between PCTs. In contrast, variation in PCT spending on maternal services did not explain any of the observed differences.
Two PCTs had higher than expected rates of perinatal mortality, but neither had "Spearhead" status. The reasons for this are not clear, say the authors, and further local scrutiny is required in order to ascertain the likely causes and potential solutions for these extreme results.
On the basis of these findings, most PCTs can be confident that the social conditions and ethnicity of the communities they serve are more important determinants of these particular health outcomes than current variation in levels of expenditure on maternity services, say the authors.
Nevertheless, the absolute rates of infant and perinatal mortality remain high in parts of England, and the burden of avoidable deaths remains largely with deprived communities and ethnic minorities, they conclude.
Contacts:
Nick Freemantle, Professor of Clinical Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, UK
Email: n.freemantle@bham.ac.uk
On average, not-for-profit nursing homes deliver higher quality care than do for-profit nursing homes, according to a study published on bmj.com today.
However, the authors stress that many factors may influence this relation and more work is needed to explore the impact of profit status on the quality of care delivered.
Concerns about quality of care in nursing home care are widespread. In the United States two thirds of nursing homes are for-profit institutions, while in Canada, just over half of nursing homes are in for-profit ownership. Similarly, in the UK, more than half of healthcare beds belong to independent nursing homes for older people, most of which are operated by for-profit institutions.
So a team of researchers based in Canada analysed the results of 82 studies spanning 1965 to 2003 comparing quality of care in for-profit and not-for-profit nursing homes. Most of the studies were carried out in the US and Canada.
Differences in study design and quality were taken into account to minimise bias.
Forty studies showed significantly better quality in not-for-profit homes, while three studies favoured quality of care in for-profit homes. The remaining studies had mixed results suggesting that, although the average effect is clear, there is substantial variation across institutions.
Further analysis suggested that not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently used quality measures: more or higher quality staffing and lower pressure ulcer prevalence.
The analysis also favoured not-for-profit homes in the other two measures: use of physical restraint and lower regulatory agency deficiencies. But these results were not statistically significant.
Based on these findings, the authors estimate that nursing home residents in Canada would receive roughly 42,000 more hours of nursing care per day and those in the United States would receive 500,000 more hours of nursing care per day if not-for-profit institutions provided all nursing home care.
Similarly, they estimate that 600 of 7,000 residents with pressure ulcers in Canada, and 7,000 of 80,000 residents with pressure ulcers in the United States are attributable to for-profit ownership.
These findings provide insight into average effects and suggest a trend towards higher quality care in not-for-profit facilities than for-profit homes, write the authors. However, more work is now required to explore the factors that influence this relationship, they conclude.
This view is supported by Professor Tamara Konetzka from the University of Chicago in an accompanying editorial, who believes that more data are needed to increase our understanding of the association between profit status and the quality of nursing homes.
But she points out that many factors other than profit status have been strongly linked to the quality of nursing home care, and warns that, "if differences in quality between for-profit and not-for-profit nursing homes stem at least in part from differences in revenues rather than mission, eliminating for-profit homes may do little to eliminate differences in quality."
Contacts:
Research: Professor Philip Devereaux, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Email: philipj@mcmaster.ca
Editorial: Professor Tamara Konetzka, Department of Health Studies, University of Chicago, Chicago, IL, USAv
Email: konetzka@uchicago.edu
Men with angina are twice as likely to have a heart attack and almost three times as likely to suffer a heart disease-related death than women with the same condition, finds a study published on bmj.com today.
The study is the first to link primary and secondary care data with mortality records to assess the risks of angina among men and women.
In the United Kingdom, angina is common and is often the first manifestation of ischaemic heart disease. Recent estimates suggest that 4.8% of men and 3.4% of women aged over 16 in England have the condition, while in Scotland angina is reported to occur in 6.6% of men and 5.6% of women.
It is therefore important for both patients and their clinicians to understand the risks following a diagnosis of angina.
Researchers led by Dr Brian Buckley of the National University of Ireland, Galway, identified 1,785 patients (average age 62 years) from 40 primary care practices in Scotland who were newly diagnosed with angina between January 1998 and December 2001.
Underlying conditions, such as diabetes and high blood pressure, were recorded and cardiovascular risk factors, such as smoking and obesity, were also assessed. The postcode of each patient was also used to assign a deprivation status.
Participants were tracked for five years. Being male, older and a smoker was associated with an increased risk of having a heart attack, while being male, older, obese and a smoker were each associated with an increased risk of death from heart disease or any cause.
The likelihood of having a procedure to open up blocked arteries, known as angioplasty (PTCA) or coronary artery bypass surgery (CABG), was also higher in men than in women. But, interestingly, neither procedure was associated with significantly improved survival.
This study has shown that a number of characteristics, including male sex, age, smoking and obesity, in people with a first diagnosis of angina are strongly associated with subsequent risk of a number of cardiac outcomes, say the authors.
These results suggest that appropriate control of risk factors and optimal use of preventative medical treatments should be aggressively pursued in patients with angina, they conclude.
Contact:
Dr Brian Buckley, Cochrane Research Fellow, Department of General Practice, National University of Ireland, Galway, Ireland
Email: bsbuckley@iol.ie
(3) Single dose of steroids speeds up relief of sore throat
(Research: Corticosteroids for pain relief in sore throat: systematic review and meta-analysis)
http://www.bmj.com/cgi/doi/10.1136/bmj.b2976
(Editorial: Sore throat in primary care)
http://www.bmj.com/cgi/doi/10.1136/bmj.b2476
Giving a single dose of corticosteroid drugs alongside antibiotics to adults with severe sore throat can relieve pain quicker and more effectively than with antibiotics alone, finds a study published on bmj.com today.
The study found no evidence of significant benefit in children.
Sore throat is a common reason for people to seek medical care, yet antibiotics have only a modest beneficial effect in reducing symptoms and fever. High rates of antibiotic prescriptions also lead to resistance and recent guidelines recommend that antibiotics should not be prescribed for sore throat.
So Dr Matthew Thompson at the University of Oxford and colleagues tested the theory that corticosteroids could effectively relieve symptoms of a sore throat due to their anti-inflammatory effects.
They analysed the results of eight trials comparing corticosteroids to placebo in adults or children. The trials involved a total of 743 patients (369 children and 374 adults) with symptoms of severe sore throat.
Differences in study design and quality were taken into account to minimise bias.
Patients given corticosteroids in addition to antibiotics were three times more likely to report complete resolution of pain at 24 hours than patients given placebo. This effect on pain was less apparent by 48 hours, suggesting that a single dose of corticosteroids may be sufficient, say the authors.
Corticosteroids also reduced the average time to pain relief by about six hours. However, the authors point out that significant effects were seen only in adult patients and only in those receiving oral corticosteroids. Use of simple painkillers made no difference in the trials where this was measured.
These findings suggest that, in patients with severe sore throat, pain can be reduced and resolution hastened by use of corticosteroids in conjunction with antibiotic therapy, say the authors. These results may also help to prevent antibiotic use, particularly in the context of delayed prescribing. Future research should focus on the effect of corticosteroids independent of antibiotics, they conclude.
An accompanying editorial warns that, although steroids reduce pain in the first day, data on harms are lacking.
Contact:
Research: Dr Carl Heneghan, Deputy Director CEBM & Clinical Lecturer, DPHC, University of Oxford, UK
Email: Carl.Heneghan@dphpc.ox.ac.uk
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