Press releases Monday 22 February to Friday 26 February 2010

Please remember to credit the BMJas 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) Physical activity in schools can improve children's fitness
(2) HPV testing best option for women with abnormal smears
(3) Airport body scanners pose little risk, but concerns about privacy remain
(4) New study casts doubt over ME virus link
(5) Methods for abandoning old drugs in favour of new must be improved
(6) Could a new UN resolution end doctors’ participation in torture?

(1) Physical activity in schools can improve children's fitness
(Research: Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial)
http://www.bmj.com/cgi/content/full/340/feb23_1/c785
(Editorial: Preventing obesity in primary schoolchildren)
http://www.bmj.com/cgi/content/full/340/feb23_1/c819

A structured physical activity programme at school can improve children,s fitness and decrease body fat, a study published on bmj.com today shows.

Researchers in Switzerland studied 540 seven and 11-year olds in 15 schools. Over nine months, pupils randomly allocated to an intervention group underwent a physical activity programme designed by experts. This involved structuring their existing three physical education lessons and adding two extra lessons a week. They were also given daily short activity breaks and physical activity homework. Pupils randomly allocated to a control group continued to receive their existing three lessons only.

Researchers reported a relative decrease in body fat, improved aerobic fitness, higher levels of in-school physical activity, smaller increases or larger reductions in body mass index (BMI), and lower cardiovascular risk in the intervention group. However, overall daily physical activity and quality of life did not change significantly.

Ninety per cent of the children and 70% of the teachers enjoyed the five physical education lessons and wanted them to continue. The researchers attribute the success of the programme to its use of experts, attractiveness to both children and teachers, intensity, and integration into the school curriculum.

They say the study offers a practical way of implementing a physical activity programme in schools. This is important since childhood obesity and cardiovascular disease are increasingly common, and many children are not responsive to programmes aimed at increasing out-of-school physical activity.

As well as improving the health and fitness of children, such programmes can improve health in later life by reducing cardiovascular and other diseases, they conclude. Since the population of Switzerland is considered representative for central Europe, the results may apply to many other Western countries.

School based physical activity programmes are promising, but may be difficult to sustain in the long term, say researchers in an accompanying editorial. Wider implementation of this intervention would substantially add to the school timetable, and further research into the feasibility and acceptability of such a strategy in different countries is needed, they conclude.

Contacts:

Research: Susi Kriemler, Assistant Professor for Pediatric Sports Medicine, Institute of Exercise and Health Sciences, University of Basel, Switzerland
Email: susi.kriemler@unibas.ch
Editorial: Esther van Sluijs, Investigator Scientist, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
Email: esther.vansluijs@mrc-epid.cam.ac.uk

(2) HPV testing best option for women with abnormal smears
(Research: Psychosocial outcomes of three triage methods for the management of borderline abnormal cervical smears: an open randomised trial)
http://www.bmj.com/cgi/content/full/340/feb23_1/b4491

For women with an abnormal smear test result, HPV testing is better for their psychosocial wellbeing compared with conventional repeat smear testing, finds new research published on bmj.com today.

HPV testing for women with borderline cervical abnormalities is available in the US and Europe and will soon be introduced into the cervical screening programme in England and Wales.

HPV testing has advantages but also potential downsides with respect to women's quality of life and psychosocial wellbeing, but these outcomes, and the option of offering women informed choice of management, have not been adequately assessed.

So researchers at the University of Sydney set out to assess which of three strategies for women with a borderline abnormal smear results in the best psychosocial outcomes over one year.

The study involved 314 women across Australia aged 16 to 70 years with a borderline smear who were randomised to one of three triage arms: HPV DNA testing, a repeat smear test at six months, or the patient's informed choice of either test supported by a decision aid.

Psychosocial outcomes were assessed at regular time points over 12 months. These included worry about cervical cancer, intrusive thoughts, and anxiety about the abnormal smear.

Demographic variables, such as age, education, employment, marital and relationship status, children and ethnicity were also measured.

After two weeks, some psychosocial outcomes were worse for women allocated to HPV testing compared with those in the smear testing group. However, over 12 months, distress about the abnormal smear was lowest in women allocated to HPV testing and highest in the repeat smear testing group.

Women in the HPV group and the informed choice group were more satisfied with their care than women allocated to repeat smear testing. However, the benefit of giving women an informed choice of either HPV testing or repeat smear testing supported by a decision aid is still uncertain, say the authors.

They conclude: Although the psychosocial effect was initially worse for women allocated to HPV triage, over the full year of follow-up this intervention was better for women's psychosocial health than repeat smear testing. These findings support the move towards HPV triage in the UK for women with borderline smear results.

Contact:

Kirsten McCaffery, Screening and Test Evaluation Program, School of Public Health, University of Sydney NSW, Australia
Email kirstenm@health.usyd.edu.au

(3) Airport body scanners pose little risk, but concerns about privacy remain
(Editorial: Use of full body scanners at airports)
http://www.bmj.com/cgi/content/full/340/feb23_1/c993

The medical risk of airport body scanners is negligible, but concerns about privacy remain, says a radiology expert in an editorial published on bmj.com today.

Since the attempted bombing of a US airliner on Christmas Day, several countries, including the UK, have started using full body scanners to screen passengers at airports, while other countries are considering their use.

Concerns about the use of full body scanners include the effects of radiation exposure and infringement of personal privacy. But are these concerns justified?

Full body scanners use either radio waves (millimetre radio wave systems) or low intensity x rays (backscatter systems) to generate an image, explains Professor Mahadevappa Mahesh from Johns Hopkins University School of Medicine in the United States.

Radiation doses from backscatter systems are typically between 0.05 and 0.1 µSv per scan (micro-sievert - a measure of radiation dose). A person would therefore have to undergo 1000-2000 backscatter scans before receiving a dose equivalent to a medical chest x ray (100 µSv).

The US Nuclear Regulatory Commission recommends an annual radiation dose limit to the public of 1000 µSv, and 250 µSv a year from any single source or practice. To exceed 250 µSv a year, a traveller would need to have 2500-5000 backscatter scans, which is highly unlikely.

Routine maintenance of scanners and quality checks by trained professionals is also essential, says the author, as is radiation safety training for operators to avoid any inadvertent exposure.

Infringement of personal privacy is also a major concern because of the detailed images produced, and has led to the term "virtual strip search," he adds. But these concerns can be mitigated by having the image viewing stations at remote locations, not next to the scanners, and also ensuring the system cannot save the images in the long term.

Currently, the use of full body scanners is optional, but when it becomes mandatory, the alternative measures for people who decline to go through these scanners are complete physical pat-downs and other technologies that may be even more intrusive and cumbersome, warns the author.

Current calculations indicate that backscatter systems are safe for general use, even in infants and children, pregnant woman, and people with genetically based hypersensitivity to radiation. When considered in the context of a potential increase in security, the benefits outweigh the potential for harm, he concludes.

Contact:

Mahadevappa Mahesh, Chief Physicist and Associate Professor of Radiology, Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
Email mmahesh@jhmi.edu

(4) New study casts doubt over ME virus link
(Research: Prevalence of xenotropic murine leukaemia virus-related virus in patients with chronic fatigue syndrome in the Netherlands: retrospective analysis of samples from an established cohort)
http://www.bmj.com/cgi/content/abstract/340/feb25_1/c1018
(Editorial: Chronic fatigue syndrome and human retrovirus XMRV)
http://www.bmj.com/cgi/content/extract/340/feb25_1/c1099

A new study published on bmj.com today casts doubt on recent claims that a human retrovirus known as XMRV is linked to chronic fatigue syndrome or ME (myalgic encephalitis).

This is the third study to refute the original US study reporting the link.

Chronic fatigue syndrome is a debilitating condition that affects millions of people worldwide with disabling physical and mental fatigue that does not improve with rest. Its causes remain unclear, but many people say their illness started after a viral infection.

A recent study from the United States detected XMRV in two thirds of patients with chronic fatigue syndrome, but could not conclusively prove a direct (causal) link between the virus and the disease.

In January 2010, another research team found no evidence of XMRV in 186 patients with chronic fatigue syndrome in the United Kingdom. A third study, published earlier this month, also failed to identify XMRV in 170 patients.

So a team from the Netherlands, led by Professors Frank van Kuppeveld and Jos van der Meer, investigated whether this link could be confirmed in an independent European group of patients with chronic fatigue syndrome.

They examined the DNA from XMRV in the blood cells of 32 Dutch patients with chronic fatigue syndrome and 43 healthy controls, matched by age, sex and geographical area. Two highly sensitive tests were performed on two different target genes.

They found no evidence of XMRV in any of the patients or the controls, adding to the negative evidence in the two previous studies.

"Although our patient group was relatively small and we cannot formally rule out a role of XMRV, our data cast doubt on the claim that this virus is associated with chronic fatigue syndrome in the majority of patients," say the authors.

One reason why these results contradict the original findings may be that the US study involved patients from a specific outbreak of chronic fatigue syndrome in the mid-80s that has already been linked to several viruses, explain the authors. It is possible that XMRV is implicated in this outbreak, but does not play a substantial role in most cases of chronic fatigue syndrome elsewhere, they conclude.

To reconcile these different findings, other US laboratories are currently investigating XMRV and chronic fatigue syndrome, and the results are eagerly awaited, say researchers from Imperial College London and King's College London in an accompanying editorial.

"If the link fails to hold up, it will be another bitter disappointment to affected patients. Nonetheless, the current debate will still bring critical attention to the causes of chronic fatigue syndrome, and XMRV may turn out to be important in the pathogenesis of other diseases," they conclude.

Contact:

Research: Frank van Kuppeveld, Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
Email f.vankuppeveld@ncmls.ru.nl

Editorial: Myra McClure, Professor of Retrovirology and Honorary Consultant in Genitourinary Medicine, Jefferiss Research Trust Laboratories, Wright-Fleming Institute, Faculty of Medicine, Imperial College London, UK
Email m.mcclure@imperial.ac.uk

(5) Methods for abandoning old drugs in favour of new must be improved
Analysis: New drugs for old: disinvestment and NICE
http://www.bmj.com/cgi/content/extract/340/feb25_1/c572

Decisions about which drugs to abandon to fund new treatments recommended by the National Institute for Health and Clinical Excellence (NICE) are inconsistent and may be contributing to the postcode lottery - one of the key issues that NICE was set up to tackle, warn experts on bmj.com today.

Dyfrig Hughes and Robin Ferner argue that the methods for identifying drugs that can be discontinued need to be as rigorous as those for assessing potential new treatments to ensure best use of NHS resources.

The aim of NICE guidance on medicines and other health technologies is to derive the maximum health benefit from finite NHS resources, explain the authors.

The NHS in England and Wales is legally obliged to fund treatments recommended by NICE but does not receive extra money to do so. This means that the funding of new, expensive medicines relies increasingly on releasing funds by displacing other treatments, but NICE does not specify which.

But if the treatments being displaced are not the least effective, overall population health is reduced. So how should we establish which medicines to discontinue, ask the authors?

Obvious targets for disinvestment include treatments that have been superseded by newer, more effective medicines and others that bring only trivial benefits over existing therapies while costing much more. Meanwhile, new measures to increase rates of generic prescribing are expected to produce annual savings of £72m by 2013.

However, the authors point out that sometimes it makes sense to maintain an older treatment that is only marginally less effective but much cheaper than a new drug. Disinvestment is also impractical when new treatments are not substitutes for old ones but are used in addition, or in sequence.

The authors acknowledge that implementing guidance on the withdrawal of NHS use of existing medicines on the grounds of cost effectiveness poses a different challenge from adoption of approved treatments. However, they argue that NICE is well positioned to recommend candidates for disinvestment.

As such, they call for an explicit framework for the identification and appraisal of medicines for disinvestment to provide better value for money while reducing inequity.

Contact:

Dyfrig Hughes, Pharmacologist, Centre for Economics and Policy in Health, Institute for Medical and Social Care Research, Bangor University, Bangor, Wales
Email d.a.hughes@bangor.ac.uk

(6) Could a new UN resolution end doctors' participation in torture?
Analysis: Helping to stop doctors becoming complicit in torture
http://www.bmj.com/cgi/content/full/340/feb25_1/c973

A new UN resolution has the potential to fight torture and cruelty say experts on bmj.com today.

The resolution, passed in March 2009, goes further than previous rulings, say the authors and spells out that "states must never request or require anyone, including medical or other health personnel, to commit any act of torture or other cruel, inhuman or degrading treatment or punishment".

Lead author, Dr Peter Polatin from the Rehabilitation and Research Centre for Torture Victims in Denmark, says there is substantial evidence that health professionals have been involved in torture around the world, for example in Saddam Hussein's regime in Iraq in the mid-1990s, in Israel and in Guantanamo Bay.

Polatin argues that doctors' involvement could either mean directly participating in torture or assessing detainees to ensure that they will not die from the torture practices they are being subjected to. He adds that doctors working for the state, military, prison or police service "may be obliged to serve the interests of their employer, to the detriment of medical ethics".

The new UN resolution could help the fight against torture "because it targets states, urging them to act to prevent health workers from becoming involved in torture and to protect those who stand out against it" says the paper. In addition to this, the resolution calls upon the UN special rapporteur on torture to give special attention to "medical complicity".

In conclusion, the authors emphasise the need to enforce the powers of the resolution. This could be by strengthening the investigative function of the rapporteur to "ensure that more cases of medical complicity will be subject to the public scrutiny and that violators will face disciplinary action, including suspension of their professional licence".

Contact:

Peter Polatin, Health Programme Manager, International Department, Rehabilitation and Research Centre for Torture Victims, Copenhagen, Denmark
Email pp@rct.dk

FOR ACCREDITED JOURNALISTS

For more information please contact:

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
British Medical Association
BMA House, Tavistock Square, London WC1H 9JP

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)
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