Press releases Monday 14 September to Friday 18 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) Failure to tackle climate change spells a global health catastrophe
(2) Exercise better than shockwave treatment for chronic shoulder pain
(3) Open letter to Senator Kerry
(4) Heart risk factors in middle age can cut life span by up to 15 years
(5) Some ethnic minorities rate medical care worse than white patients
(1) Failure to tackle climate change spells a global health catastrophe
(Editorial: Health and climate change)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3669
(Letter: Politicians must heed health effects of climate change)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3672
An editorial and letter, published simultaneously by the BMJ and Lancet today, warn that failure to agree radical cuts in carbon dioxide emissions at the UN climate change conference in Copenhagen this December spells a global health catastrophe.
The scientific evidence that global temperatures are rising and that man is responsible has been widely accepted since the Intergovernmental Panel on Climate Change's report in 2007, write Lord Michael Jay and Professor Michael Marmot in the editorial. There is now equally wide consensus that we need to act now to prevent irreversible climate change.
So the chances of success should be good but the politics are tough, they say.
The most vocal arguments are about equity: the rich world caused the problem so why should the poor world pay to put it right? Can the rich world do enough through its own actions and through its financial and technological support for the poor to persuade the poor to join in a global agreement?
These arguments need to be tackled head on, but Jay and Marmot believe that what's good for the climate is good for health. For example, a low carbon economy will mean less pollution. A low carbon diet (especially eating less meat) and more exercise will mean less cancer, obesity, diabetes, and heart disease. This is an opportunity too to advance health equity, which is increasingly seen as necessary for a healthy and happy society, they say.
They point out that the threat to health is especially evident in poorest countries, particularly in sub-Saharan Africa, where poverty and lack of resources, infrastructure, and often governance, greatly increase their vulnerability to the effects of climate change.
If we take climate change seriously, it will require major changes to the way we live, reducing the gap between carbon rich and carbon poor within and between countries, they write.
A successful outcome at Copenhagen is vital for our future as a species and for our civilisation. Failure to agree radical reductions in emissions spells a global health catastrophe, which is why health professionals must put their case forcefully now and after Copenhagen, they conclude.
In the accompanying letter, doctors leaders across the world call on politicians to heed the health effects of climate change when they meet in Copenhagen.
They warn that "there is a real danger that politicians will be indecisive, especially in such turbulent economic times as these."
Doctors are still seen as respected and independent, largely trusted by their patients and the societies in which they practise, they write. As such, they urge doctors "to demand that their politicians listen to the clear facts that have been identified in relation to climate change and act now to implement strategies that will benefit health of communities worldwide."
"Politicians may be scared to push for radical reductions in emissions because some of the necessary changes to the way we live won't please voters," said Dr Fiona Godlee, editor in chief of the BMJ. "Doctors are under no such constraint. On the contrary we have a responsibility as health professionals to warn people how bad things are likely to get if we don't act now. The good news is that we have a positive message - that what is good for the climate is good for health."
Contacts:
Editorial: Lord Michael Jay, Chair of the Board of Trustees, Merlin, London, UK
Email: jaymh@parliament.uk
or
Professor Michael Marmot, International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, UK
Email: m.marmot@ucl.ac.uk
Letter: Ian Gilmore, President, Royal College of Physicians, London, UK
Email: linda.cuthbertson@rcplondon.ac.uk
(2) Exercise better than shockwave treatment for chronic shoulder pain
(Research: Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3360
Supervised exercises are more effective than shockwave treatment to relieve chronic shoulder pain, finds a study published on bmj.com today.
Shoulder pain is the fourth most common type of musculoskeletal pain reported to general practitioners and physiotherapists. Treatments often include physiotherapy, non-steroidal anti-inflammatory drugs, and steroid injections. Physiotherapy can include shockwave treatment, ultrasound, exercises and acupuncture.
Several studies have suggested that shockwave treatment may not be effective, but it continues to be used widely.
So a team of researchers based in Oslo, Norway compared the effectiveness of radial extracorporeal shockwave treatment (low to medium energy impulses delivered into the tissue) with supervised exercises in patients with shoulder pain.
The study involved 104 men and women aged between 18 and 70 years attending the outpatient clinic at Ullevaal University Hospital in Oslo with shoulder pain lasting at least three months.
Participants were randomised to receive either radial extracorporeal shockwave treatment (one session weekly for four to six weeks) or supervised exercises (two 45 minute sessions weekly for up to 12 weeks).
Both groups were similar at the start of the study with regard to age, education, dominant arm affected and pain duration.
All patients were monitored at six, 12 and 18 weeks and were advised not to have any additional treatment except analgesics (including anti-inflammatory drugs) during the follow-up period. Pain and disability were measured using a recognised scoring index.
After 18 weeks, 32 (64%) of patients in the exercise group achieved a reduction in shoulder pain and disability scores compared with 18 (36%) in the shockwave treatment group.
More patients in the exercise group returned to work, while more patients in the shockwave treatment group had additional treatment after 12 weeks, suggesting that they were less satisfied.
These results are in agreement with results from previous trials recommending exercise therapy and do not strengthen the evidence for extracorporeal shockwave treatment, say the authors.
They conclude: "Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain."
Contact:
(3) Open letter to Senator Kerry
(Open letter: Setting the record straight about the NHS - not embargoed)
http://www.bmj.com/cgi/content/full/339/sep14_2/b3768
Over 100 NHS professionals and patients have signed an open letter to Senator Kerry addressing head-on some of the myths that have been perpetuated about the UK's healthcare system.
(4) Heart risk factors in middle age can cut life span by up to 15 years
(Research: Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19,000 men in the Whitehall study)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3513
Middle aged men who smoke, have high blood pressure and raised cholesterol levels can expect a 10-15 year shorter life expectancy from age 50 compared with men without these risk factors, concludes research published on bmj.com today.
Death rates from heart disease in the United Kingdom have declined steadily since the early 1970s, resulting in substantial improvements in life expectancy.
These improvements are believed to result from stopping smoking, changes in diet and lifestyle, and better treatment for people with vascular disease. Previous studies have not investigated the extent to which differences in life expectancy can be explained by differences in cardiovascular risk factors.
So researchers led by Dr Robert Clarke from the University of Oxford assessed life expectancy in relation to cardiovascular risk factors recorded in middle age.
Their findings are based on over 19,000 men aged 40-69 years and employed in the civil service in London when they were first examined in 1967-1970 as part of the Whitehall Study.
Participants completed a questionnaire at entry about previous medical history, smoking habits, employment grade and marital status. The initial examination recorded height, weight, blood pressure, lung function, cholesterol, and blood glucose levels.
The records of 18,863 men were traced and 7,044 surviving participants were re-examined in 1997 (around 28 years after their initial examination).
At entry into the study, 42% of the men were current smokers, 39% had high blood pressure and 51% had high cholesterol. At the re-examination, about two thirds had quit smoking and the mean differences in levels of blood pressure and cholesterol had also declined by two thirds over this period.
Despite changes in heart disease risk factors, the presence of three heart disease risk factors recorded on a single occasion in middle aged men compared to men with no risk factors predicted a three times higher risk of vascular mortality and a two times increased risk of non-vascular mortality.
Compared with men without any risk factors, the presence of all three risk factors at entry was associated with a 10 year shorter life expectancy from age 50 (23.7 versus 33.3 years).
The researchers then classified men according to a risk score based on all available risk factors (smoking, diabetes, employment grade, and continuous levels of blood pressure, cholesterol concentration, and body mass index). Compared with men in the lowest 5% of this risk score, men in the highest 5% had a 15 year shorter life expectancy from age 50 (20.2 versus 35.4 years).
Continued public health strategies to lower heart disease risk factors should result in further improvements in life expectancy, conclude the authors.
Contact:
(5) Some ethnic minorities rate medical care worse than white patients
(Research: Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross-sectional analysis of a routine patient survey in English general practices)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3450
(Editorial: Ethnic minorities and their perceptions of the quality of primary care)
http://www.bmj.com/cgi/doi/10.1136/bmj.b3797
Some ethnic minority patients rate certain aspects of their care more negatively than do white patients, according to research published on bmj.com today.
The authors suggest that adjusting survey results for ethnicity may be justified when comparing healthcare providers.
Patient surveys both from the UK and US are increasingly being used as a way of measuring the quality of medical care. Previous studies have consistently shown that ethnic minority patients evaluate their care more negatively than do white patients, but the exact cause of these lower ratings is poorly understood.
So researchers from the universities of Manchester and Cambridge examined why patients from ethnic minorities give poorer evaluations of primary health care than white patients.
They reviewed 188,572 responses to the General Practice Assessment Questionnaire from over 1,000 general practices across England between April 2005 and March 2006.
Patient evaluations of waiting times for general practitioner appointments, time spent waiting in surgeries for consultations to start, and continuity of care were measured. Differences in ratings between white and three ethnic minority groups (Asian, black and Chinese) were analysed, adjusting for socioeconomic status, health need, and standards of care received.
All aspects of care were rated substantially lower by respondents from the three ethnic minority groups than by white patients.
Poorer evaluations appeared to reflect actual experiences, especially time spent waiting for consultations to begin (rated lowest by Asian patients) and continuity of care (rated lowest by Chinese patients).
Substantial differences between white and ethnic minority patients' ratings of appointment waiting times persisted, however, even after adjusting for the actual time patients reported waiting.
This effect disappeared for Chinese and black respondents after adjusting for evaluations of reception staff and doctors' communication skills, but Asian patients' ratings remained significantly lower than those of white respondents, even after adjusting for all the variables.
Important differences in assessments of care exist in different ethnic minority groups, say the authors.
Reasons for these differences vary between ethnic group and between different aspects of care, they add. For all groups, this in part reflects worse care received by these groups. In addition, among black and Chinese patients, some of the negative evaluations may reflect communication issues. Among Asian patients, lower ratings of waiting times for appointments may also reflect different expectations of care, so that equivalent performance is judged differently.
Adjusting survey results for ethnicity may be justified when comparing healthcare providers; however, health services also have a responsibility to meet legitimate patient expectations, conclude the authors.
These results highlight that general practices need to identify and understand the priorities of their communities and tailor their care accordingly, says Professor Aziz Sheikh from The University of Edinburgh in an accompanying editorial. Welcoming the research, he suggests that emphasis needs to be on: "Judging care providers by their success at meeting the needs of their local populations, rather than on adjusting patient evaluations for the ethnic profile of practice populations as we are in this way likely to drive up the quality of services for all sections of society."
Contacts:Editorial: Aziz Sheikh, Professor of Primary Care Research and Development, Centre for Population Health Sciences, University of Edinburgh, UK
Email: aziz.sheikh@ed.ac.uk
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