Press releases Monday 31 August to Friday 4 September 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) Large thighs protect against heart disease and early death
(2) Current national primary care policies for childhood obesity need to be improved
(3) Market based reforms have not harmed equity in the NHS, say researchers
(4) Was the public health response to swine flu alarmist?
(5) BMJ joins the 10:10 climate change campaign
(1) Large thighs protect against heart disease and early death
(Research: Thigh circumference and risk of heart disease and premature death: cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3292
(EEditorial: Thigh circumference and risk of heart disease and premature death)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3302
Men and women whose thighs are less than 60cm in circumference have a higher risk of premature death and heart disease, according to research published on bmj.com today. The study also concluded that individuals whose thighs are wider than 60cm have no added protective effect.
Lead author, Professor Berit Heitmann, based at Copenhagen University Hospital, says his research may help GPs identify patients who are at an increased risk of early death and developing heart disease.
While several studies have already demonstrated that being either very overweight or underweight are related to premature death and disease, this is the first to investigate the implications of thigh size on health.
Almost 3000 individuals took part in the study in Denmark - this included 1463 men and 1380 women. Participants were examined in 1987/88 for height, weight, thigh, hip and waist circumference and body composition. They were then followed up for 10 years for incidence of heart disease and 12.5 years for total number of deaths.
During the follow-up period 257 men and 155 women died, also 263 men and 140 women experienced cardiovascular disease and 103 men and 34 women suffered from heart disease. When assessing the results, the authors found that the survivors had higher fat-free thigh circumference levels.
The relationship between thigh size and early death and disease was found after taking body fat and other high risk factors (such as smoking and high cholesterol) into account. The authors therefore suggest that the risk from narrow thighs could be associated with too little muscle mass in the region. This is problematic because it may lead to low insulin sensitivity and type 2 diabetes and, in the long run, heart disease, they explain.
The authors conclude that the study "found that the risk of having small thighs was associated with development of cardiovascular morbidity and early mortality. This increased risk was found independent of abdominal and general obesity, lifestyle and cardiovascular risk factors such as blood pressure and lipids related to early cardio vascular morbidity and mortality".
The authors believe that doctors could use thigh size as an early marker for at risk patients and suggest that individuals increase lower body exercise in order to increase the size of the their thighs if necessary. Further research would be needed, however, to assess whether this approach was worthwhile.
An accompanying editorial supports the need for more research to test the strength of this association.
Contact:
Professor Berit L Heitmann, Research Unit for Dietary Studies at the Institute of Preventive Medicine, Copenhagen, Denmark
Email: blh@ipm.regionh.dk
(2) Current national primary care policies for childhood obesity need to be improved
(Research: Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3308
Current primary care policies aimed at reducing obesity and increasing physical activity in children do not work and are very costly to run, according to research published on bmj.com today.
Family doctor screening and brief counselling is part of national policy to tackle childhood obesity in a number of countries including the UK, US and Australia. While the programmes do not harm children, research led by the Murdoch Childrens Research Institute in Melbourne, Australia, questions whether resources would be better spent on prevention and improving treatment for obesity.
The global long-term physical, emotional, social, reproductive and economic consequences of childhood obesity are likely to be extremely serious, says the study. This has led many countries to endorse screening and counselling programmes aimed at children. However, say the authors, very little evidence exists to show this kind of intervention works.
Lead author, Professor Melissa Wake of the Royal Children's Hospital and Murdoch Childrens Research Institute in Melbourne carried out a large trial (LEAP 2) that tracked the effectiveness of this anti-obesity approach in overweight and obese children.
Wake and her team surveyed almost 4000 children who visited their GP between May 2005 and July 2006. Over 250 overweight or mildly obese children were then selected to be part of the trial, 139 were entered into the intervention group and 119 into the control group. Participants in the intervention group received counselling over a 12-week period and their families were helped to set goals that focussed on changing eating habits and increasing physical activity.
While parents reported that children in the intervention group drank fewer soft drinks, there were no significant differences in the amounts of fruit, vegetables, fat or water consumed. There were no major differences in body mass index (BMI), overall nutrition and physical activity.
The authors conclude that "brief, physician-led primary care intervention produced no long-term improvement in children's BMI, physical activity or nutrition" and they add that "resources may be better divided between primary prevention at the community and population levels, and enhancement of clinical treatment options for children with established obesity."
Contacts:
Eszter Vasenszky, Media Officer, Murdoch Childrens Research Insitute, The Royal Children's Hospital, Victoria, Australia
Email: eszter.vasenszky@mcri.edu.au
(3) Market based reforms have not harmed equity in the NHS, say researchers
(Research: Equity, waiting times, and NHS reforms: retrospective study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3264
Recent NHS reforms, such as the introduction of patient choice and provider competition, have not had a deleterious impact on equity with respect to waiting times for elective surgery in England, concludes a study published on bmj.com today.
Until recently, hospital waiting times were seen as a significant problem for the NHS. However, over the past 10 years, as the government increased the supply of doctors, increased funding for the health service, set rigid waiting time targets, and, more recently, introduced market based reforms, waiting times have dropped considerably.
Yet little was known about whether the drop in waiting times had been equitably distributed with respect to socioeconomic status.
So a team of researchers, led by Zack Cooper and Julian Le Grand of the London School of Economics & Political Science, examined changes in waiting times for patients undergoing three key elective procedures in England between 1997 and 2007 (hip replacement, knee replacement and cataract repair). They then analysed the distribution of those changes between socioeconomic groups.
Waiting times were measured as days waited from referral for surgery to surgery itself. Results were then linked to patient postcodes and socioeconomic status was calculated using a recognised index of deprivation.
They found that average waiting times rose initially and then fell steadily over time. By 2007, there was far less variation in waiting times across the population.
In 1997, those from more deprived areas waited longer for treatment than those from more affluent areas. But, by 2007, this phenomenon had disappeared. In fact, in some cases, patients from more deprived areas were waiting less time than patients from more affluent areas.
While many feared that the government's NHS reforms would lead to inequity or injustice, these findings show that inequity with respect to waiting times did not increase. Indeed, if anything, it substantially decreased, say the authors.
While these findings cannot prove what policy mechanisms led to reductions in waiting times and improvements in equity, they do confirm that these reforms did not lead to the inequitable distribution of waiting times across socioeconomic groups that many had predicted, the authors add.
As the government continues to emphasise the importance of choice and competition, these findings should be incorporated into the discussion of whether these reforms will necessarily lead to greater equity or inequity.
Contact:
Zack Cooper, Health Economist, London School of Economics, London, UK
Email: z.cooper@lse.ac.uk
(4) Was the public health response to swine flu alarmist?
(Analysis: Calibrated response to emerging infections)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3471
The public health measures taken in response to swine flu may be seen as alarmist, overly restrictive, or even unjustified, says a US expert in a paper published on bmj.com today.
Peter Doshi, a doctoral student at the Massachusetts Institute of Technology, argues that our plans for pandemics need to take into account more than the worst case scenarios, and calls for a new framework for thinking about epidemic disease.
Over the past four years, pandemic preparations have focused on responding to worst case scenarios. As a result, we responded to the H1N1 outbreak as an unfolding disaster. Some countries erected port of entry quarantines. Others advised against non-essential travel to affected areas and some closed schools and businesses.
Pandemic A/H1N1 is significantly different than the pandemic that was predicted, says Doshi. Pandemic A/H1N1 virus is not a new subtype but the same subtype as seasonal H1N1 that has been circulating since 1977. Furthermore, a substantial portion of the population may have immunity.
Actions in response to the early H1N1 outbreak were taken in an environment of high public attention and low scientific certainty, he argues. The sudden emphasis on laboratory testing for H1N1 in the first weeks of the outbreak helped to amplify the perceived risk.
He also points out that, since the emergence of A/H1N1, the World Health Organisation has revised its definition of pandemic flu.
The wisdom of many of these responses to pandemic A/H1N1 will undoubtedly be debated in the future, he writes. What the early response to the pandemic has shown, however, is that the public health response to, as well as impact and social experience of a pandemic, is heavily influenced by longstanding planning assumptions about the nature of pandemics as disaster scenarios.
If the 2009 influenza pandemic turns severe, early and enhanced surveillance may prove to have bought critical time to prepare a vaccine that could reduce morbidity and mortality, says Doshi. But if this pandemic does not increase in severity, it may signal the need to reassess both the risk assessment and risk management strategies towards emerging infectious diseases.
He suggests that future responses to infectious diseases may benefit from a risk assessment that broadly conceives of four types of threat based on the disease’s distribution and clinical severity.
For example, the 1918 pandemic was a type 1 epidemic (severe disease affecting many people), while SARS was a type 2 epidemic (infecting few, mostly severe disease), and the H1N1 pandemic may prove to be type 3 (affecting many, mostly mild).
Public health responses not calibrated to the threat may be perceived as alarmist, eroding the public trust and resulting in the public ignoring important warnings when serious epidemics do occur, he warns.
The success of public health strategies today depends as much on technical expertise as it does on media relations and communications. Strategies that anticipate only type 1 epidemics carry the risk of doing more harm than they prevent when epidemiologically limited or clinically mild epidemics or pandemics occur, he concludes.
Contact:
Peter Doshi, Doctoral Student, Program in History, Anthropology, and Science, Technology and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
Email: pnd@mit.edu
Or
Email: jefferson.tom@gmail.com
(5) BMJ joins the 10:10 climate change campaign
The BMJ has joined thousands of individuals and organisations from across the country to unite behind one simple idea: a 10% cut in carbon emissions during 2010. The campaign has been launched to encourage people to show the government that they have got a mandate to reduce carbon emissions.
"Cutting 10% in one year is a bold target, but for most of us it's an achievable one, and is in line with what scientists say we need right now," says BMJ Editor, Dr Fiona Godlee. "By signing up to 10:10 we're not just promising to reduce our own emissions - we're becoming part of a national drive to hit this ambitious goal in every sector of society."
Several high profile individuals and organisations have already signed up, including Tottenham Hotspur Football Club, the actors Gillian Anderson and Pete Postlethwaite, and Nicholas Stern, former head of the Government Economic Service and author of the influential report on the economics of climate change, published in 2006. Ten NHS organisations have also committed to the 10% carbon reduction next year.
Click here for the 10:10 website: http://www.1010uk.org/
Click here to view an open letter to NHS organisations yet to sign up to the 10:10 Campaign: http://www.bmj.com/cgi/eletters/338/mar25_1/b1214#219534
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