Press releases Monday 12 July to Friday 16 July 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) Criminalisation of drugs and drug users fuels HIV. Laws should be reviewed, say experts (2) Method of attempted suicide influences risk of eventual suicide (3) Supportive community programmes can prevent women from gaining weight (4) Risk of death higher for babies born outside normal working week in Scotland (5) When does obesity become a child protection issue? (6) Simple screening test reduces invasive examinations for suspected bowel disease
(1) Criminalisation of drugs and drug users fuels HIV. Laws should be reviewed, say experts
(Analysis: An alternative to the war on drugs)
http://www.bmj.com/cgi/content/extract/341/jul06_1/c3579
(Analysis: Policy resistance to harm reduction for drug users and potential effect of change)
http://www.bmj.com/cgi/content/extract/341/jul06_1/c3579
(Feature: How Ukraine is tackling Europe’s worst HIV epidemic)
http://www.bmj.com/cgi/content/extract/341/jul06_1/c3579
(Research: Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment)
http://www.bmj.com/cgi/content/extract/341/jul06_1/c3579
(Editorial: Evidence based policy for illicit drugs)
http://www.bmj.com/cgi/content/extract/341/jul06_1/c3579
(Personal View: Knowing the score: a doctor addict tells his story)
http://www.bmj.com/cgi/content/extract/341/jul06_1/c3579
Strict laws on the criminalisation of drug use and drug users are fuelling the spread of HIV and other serious harms associated with the criminal market and should be reviewed, say experts in a series of articles published on bmj.com today to coincide with the 18th International AIDS Conference in Vienna, 18-23 July 2010.
Countries most affected include Russia and Ukraine, which operate strict drug laws and remain resistant to evidence-based harm reduction services like opiate substitution therapy and needle exchange programmes.
Professor Tim Rhodes and colleagues estimate that Russia could cut HIV rates by up to 55% if it legalised and scaled-up opiate substitution therapy and call for legal change to enable such treatment to tackle drug related harms.
Research shows that opioid substitution treatment can reduce risk of HIV infection by 60-84%, say Rhodes and colleagues. The World Health Organization promotes it as an “essential medicine” and methadone or buprenorphine substitutes are prescribed to over 650,000 people in Europe. Opioid substitution treatment is a core harm reduction intervention alongside distributing clean needles and providing easy access to HIV treatment.
Yet Russia prohibits opioid substitution treatment and has only about 75 needle and syringe programmes for its two million injecting drug users. It also has one of the fastest growing HIV epidemics in the world. A strong emphasis on the criminalisation of drug users hampers HIV prevention.
Using mathematical models, Rhodes and his team estimate that “Russia could substantially reduce the incidence of HIV infection if it permitted the use of opioid substitution treatment.”
“The roots of resistance to harm reduction in Russia are complex,” they add, “and show why efforts to bring about structural changes in national laws and policies should be at the forefront of global efforts to scale-up HIV prevention.” The prohibition of opioid substitution treatment “limits rights of access to evidence-based health care, as championed by the UN and other international agencies.”
In a second article, Stephen Rolles, Senior Policy Analyst at Transform Drug Policy Foundation argues that we need to end the criminalisation of drugs and instead set up regulatory models that will control drug markets and reduce the health and social harms caused by current policy.
He outlines Transform’s blueprint for regulating drug availability and points to evidence that less punitive approaches do not necessarily lead to increased use. “Transform’s blueprint does not seek to provide all the answers but to move the debate beyond whether we should end the war on drugs to what the world could look like after the war on drugs," he says. "It is a debate that the medical and public health sectors have failed to engage with for far too long."
In an accompanying feature, Richard Hurley of the BMJ reports on the situation in Ukraine, which has an estimated 290,000 drug injectors and possibly the highest prevalence of HIV in Europe. Despite entrenched corruption and police interference, he explores how community organisations are leading the fight against HIV among drug injectors and sex workers.
A linked study of injecting drug users in Edinburgh finds that while long term opiate substitution treatment reduces the risk of death, it does not reduce the overall duration of injecting. An editorial believes that doctors and scientists working in the field of drug addiction have an ethical obligation to speak out about the need for evidence based approaches to tackle drug related harms.
Finally a doctor and former heroin user gives a personal and candid account of his addiction. Writing anonymously, he says, “It has made me a better doctor, more understanding of human frailty because my own frailty is so stark.”
Contacts:
Tim Rhodes, Professor of Public Health Sociology, Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
Email: tim.rhodes@lshtm.ac.uk
Stephen Rolles Senior Policy Analyst, Transform Drug Policy Foundation, Bristol, UK
Email: steve@tdpf.org.uk
(2) Method of attempted suicide influences risk of eventual suicide
(Research: Method of attempted suicide as predictor of subsequent successful suicide: national long term cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3222
(Editorial: Completed suicide after attempted suicide)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3064
The method that people use to attempt suicide has a large influence on the risk of later completed suicide, according to a new study published on bmj.com today.
A Swedish study found that suicide attempts involving hanging or strangulation, drowning, firearm, jumping from a height, or gassing are moderately to strongly associated with an increased risk of suicide compared with poisoning or cutting.
Suicide is a leading cause of death and the risk of suicide following a suicide attempt is around 10% over follow-up of five to 35 years. However, there has been little research so far into the characteristics of a suicide attempt – such as being well planned, drastic or violent – and whether those have a bearing on the risk of a later completed suicide.
Researchers from the Karolinska Institute in Stockholm used national registers to carry out a study of 48,649 people admitted to hospital in Sweden due to a suicide attempt between 1973 and 1982.
They studied how the method of the suicide attempt might predict a completed suicide during a follow-up of 21-31 years, to the end of 2003.
The results showed that during follow up, 5,740 people (12%) went on to commit suicide and that suicide risk varied substantially by the method used at the previous suicide attempt.
Attempted suicide by poisoning was the most common method (84% of attempters) and was therefore linked to the majority of later suicides (4,270). However, the researchers found that the highest risk for eventual suicide (54% in men and 57% in women) was found for attempted suicide by hanging, strangulation, or suffocation.
People were around six times more likely to successfully commit suicide if they had attempted suicide by these methods previously, after adjusting for age, gender, education, immigrant status, and psychiatric illness.
More than 85% of these suicide cases died within one year following the prior suicide attempt.
For other methods such as gassing, jumping from a height, using a firearm or explosive, and drowning; the risks were significantly lower than for hanging, but were still higher at 1.8 times to 4 times more likely to successfully commit suicide.
People whose suicide attempt involved poisoning or cutting led to 12.3% or 13% respectively of later suicides.
The authors conclude: “The method used at a suicide attempt predicts later completed suicide also when controlling for sociodemographic confounding and co-occurring psychiatric disorder. Intensified aftercare is warranted after suicide attempts involving hanging, drowning, firearms or explosives, jumping from a height, or gassing.”
In an accompanying editorial, Keith Hawton, Professor of Psychiatry at Warneford Hospital in Oxford, says that the results of this study have important implications for assessment and aftercare of patients who self harm. However, he warns that, “although use of more lethal methods of self harm is an important index of suicide risk, it should not obscure the fact that self harm in general is a key indicator of an increased risk of suicide.”
Contacts:
Research: Bo Runeson, Professor of Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Division of Psychiatry, St Göran, Stockholm, Sweden
Email: bo.runeson@ki.se
Editorial: Keith Hawton, Professor of Psychiatry, Warneford Hospital, Oxford, UK
Email: keith.hawton@psych.ox.ac.uk
(3) Supportive community programmes can prevent women from gaining weight
(Research: A low intensity, community based lifestyle programme to prevent weight gain in women with young children: cluster randomized controlled trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3215
(Editorial: Strategies to prevent suicide)
Women who attend programmes with ongoing support about healthy eating are less likely to gain weight and be more physically active than women who receive a one-off information session on dietary guidelines, finds an Australian study published on bmj.com today.
Health problems related to obesity are major issues in developed countries. In Australia 60% of adults are overweight or obese. The World Health Organisation has recommended that weight management initiatives should include efforts to try and help adults from gaining weight, even if they are in an acceptable range.
The study investigated whether women who attended the HeLP-her community lifestyle programme gained more or less weight than women who attended a single thirty minute group lecture about the benefits of following dietary and physical activity guidelines.
Women of reproductive age are an important target group, says the study, as they are prone to weight gain and they also have a strong influence on what their partners and children eat.
Two hundred and fifty adult women with an average age of 40 took part in the research, led by Professor Helena Teede from the Jean Hailes Foundation Research Group at Monash University in Melbourne. Women within the healthy weight range were included as well as overweight and obese women.
One group (intervention) of 127 women attended the HeLP-her programme. This consisted of four one hour group sessions of 10-30 participants at a local primary school. The women were weighed, measured and completed questionnaires. Simple messages about food intake and physical activity were discussed, as were behavioural strategies such as problem solving, relapse prevention, self monitoring and personal goals. Follow-up support included regular personalised text messages. Participants returned after 12 months and were weighed and measured again.
The other group (control) consisted of 123 women who attended a lecture about healthy eating and the benefits of physical activity. No individual advice was given but participants were weighed and measured. The women were given a pedometer to use if they wanted to but were not set any personal goals. The participants were measured again 12 months later.
The results show that on average the control group gained 0.83kg (nearly 2 pounds) and this was not seen in the intervention group. Participants in the control group who were less than 40 with a healthy body mass index gained the most weight (1.72kg or over 3.5 pounds). In contrast, young participants in the intervention group lost around 0.27kg (half a pound).
After 12 months, the intervention group reported more vigorous physical activity than the control group. This group also had better results for tests linked to heart disease, such as cholesterol levels.
In conclusion, the researchers say: “Our findings suggest that excess weight gain in women may be prevented by using a low intensity community based programme that promotes self management and includes personal contact with ongoing remote support.”
They add: “The HeLP-her intervention potentially bridges the gap between intensive treatment programmes and broad population health strategies.”
Contacts:
Catherine Lombard, Healthy Lifestyle program Director and Helena Teede, Professor in Women’s Health, The Jean Hailes Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Email: Aleeza.Zohar@jeanhailes.org.au
(4) Risk of death higher for babies born outside normal working week in Scotland
(Research: Time of birth and risk of neonatal death at term: retrospective cohort study)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3498
(Editorial: Neonatal outcomes in babies born out of hours)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3087
Babies born outside normal working hours of 9am to 5pm Monday to Friday are at an increased risk of death due to lack of oxygen (intrapartum anoxia), according to a study from Scotland published on bmj.com today.
Many studies have sought to determine whether the risk of perinatal mortality (death before, during or shortly after birth) varies in relation to time and day of birth, but findings have been inconsistent.
Using detailed data from Scottish national registers, researchers led by Professor Gordon Smith at the University of Cambridge analysed over one million births and infant deaths in Scotland between 1985 and 2004.
Birth was classified as occurring during the normal working week (Monday to Friday, 09.00-17.00) or out of hours (all other times). Neonatal death was defined as death during the first four weeks of life unrelated to congenital abnormality.
Results were adjusted for factors such as infant age, sex, and birth weight, maternal age, socioeconomic deprivation, onset of labour and hospital throughput (total number of births recorded for the hospital over the given year).
A total of 539 neonatal deaths were identified. The risk of neonatal death was 4.2 per 10,000 live births during the working week and was 5.6 per 10,000 at all other times.
This represents a relatively small but significant risk of one to two extra deaths per 10,000 live births, due to intrapartum anoxia, say the authors. Morever, the additional risk associated with delivering out of hours was estimated to account for approximately 1 in 4 of this type of death.
This association can be explained by many different variables, say the authors, such as the total number or the profile of staff at different times of the day, in particular the immediate availability of senior clinicians. It could also be related to access to clinical facilities, such as obstetric operating theatres.
They suggest that improving the level of clinical care for women delivering out of normal working hours might reduce overall rates of perinatal death.
It is reasonable to assume that these results can be generalised to the rest of the UK and perhaps other countries, say David Field and Lucy Smith from the University of Leicester in an accompanying editorial. However, the data leave several policy questions unanswered, such as where does the problem lie and is the difference in performance related to the numbers of staff available or their level of experience?
Contacts:
Research: Gordon Smith, Professor of Obstetrics and Gynaecology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
Email: gcss2@cam.ac.uk
Editorial: David Field, Professor of Neonatal Medicine, Department of Health Science, University of Leicester, UK
Email: df63@le.ac.uk
(5) When does obesity become a child protection issue?
(Analysis: Childhood protection and obesity: framework for practice)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3074
Childhood obesity alone is not a child protection concern, nor is failure to control weight. But consistent failure to change lifestyle and engage with outside support indicates neglect, particularly in younger children, say experts in a paper published on bmj.com today.
The suggestion that childhood obesity may raise child protection concerns is highly contentious, but there is little published evidence on the issue and no official guidelines for professionals.
So a group of child health experts, led by Dr Russell Viner at the UCL Institute of Child Health in London, set out to review existing evidence and propose a framework for practice.
They found increasing evidence linking adolescent and adult obesity with childhood sexual abuse, violence, and neglect, but found no studies examining the relation between child protection actions and childhood obesity. Data are also lacking on the long term outcomes of child protection strategies in relation to weight control, other metabolic disorders such as diabetes, and psychological health.
In the absence of evidence, the authors suggest that child protection actions are not warranted for childhood obesity alone or failure to control weight. “The aetiology of obesity is so complex that we believe it is untenable to institute child protection actions relating parental neglect to the cause of their child’s obesity” or “to criticise parents for failing to treat it successfully, if they engage adequately with treatment,” they write.
However, they do believe that consistent failure by parents to change lifestyle and engage with professionals or with weight management initiatives would constitute neglect. This is of particular concern if an obese child is at imminent risk of disorders like obstructive sleep apnoea, hypertension, type 2 diabetes or mobility restrictions, they say.
Where child protection concerns are raised, the authors suggest that obesity is likely to be one part of wider set of concerns about the child’s welfare. It is therefore essential to evaluate other aspects of the child’s health and wellbeing and determine if concerns are shared by other professionals, they say.
Finally, in cases of severe childhood obesity, they recommend a wider assessment of family and environmental factors.
“In all areas of child health, we have a duty to be open to the possibility of child neglect or abuse in any form,” they conclude. “Guidelines for professionals are urgently needed, as is further research on the outcomes of child protection actions in obesity and links between early adversity and later obesity.”
Contact:
Hayley Dodman, press officer
Email: dodmah@gosh.nhs.uk
(6) Simple screening test reduces invasive examinations for suspected bowel disease
(Research: Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3369
(Editorial: Faecal calprotectin for the diagnosis of inflammatory bowel disease)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3636
A simple screening test identifies patients who are most likely to have inflammatory bowel disease and reduces the need for expensive, invasive and time consuming endoscopies, finds a study published on bmj.com today.
Endoscopy is a procedure that involves passing a camera on the end of a flexible tube through the rectum to examine the bowel.
Rates of inflammatory bowel disease are rising in both adults and children. The major types are Crohn’s disease and ulcerative colitis and symptoms can include abdominal pain, diarrhoea, rectal bleeding and weight loss.
A diagnosis is generally made using endoscopy and taking small tissue samples (biopsies), but this process is expensive, invasive and time consuming and, for many patients, the results are negative.
A simple, non-invasive and cheap screening test would help doctors identify patients who are most likely to have inflammatory bowel disease and thus avoid unnecessary endoscopies in other patients.
Measuring calprotectin levels (a protein found in inflammatory cells) in stools could be a good screening test, but its accuracy is largely unknown.
So researchers based in the Netherlands set out to determine whether faecal calprotectin can serve as a screening test to limit the number of people undergoing invasive endoscopy.
They analysed the results of six adult (670 patients) and seven child studies (371 patients) comparing faecal calprotectin with endoscopy in patients with suspected inflammatory bowel disease.
Inflammatory bowel disease was confirmed in 32% of the adults and 61% of the children
Screening with faecal calprotectin reduced the number of endoscopies by 67% in adults and 35% in children, but it also delayed diagnosis in 6% (2 in 32) of the affected adults and 8% (5 in 61) of the affected children.
The clinical consequences of missing patients with inflammatory bowel disease should be balanced against those patients without the disease who are subjected to endoscopy, say the authors.
Despite some differences in the design and quality of the studies, they conclude that faecal calprotectin is a useful screening tool for identifying patients who are most likely to need endoscopic evaluation for suspected inflammatory bowel disease.
The ability of the test to safely exclude inflammatory bowel disease (its specificity) is significantly better in adult studies than in paediatric studies, they add.
In an accompanying editorial, Robert Logan, consultant gastroenterologist at Kings College Hospital in London says that these findings support more widespread use of the test in secondary care, but that there is not yet enough evidence to support its use in primary care.
“If studies conducted in primary care find a high diagnostic accuracy of the faecal calprotectin test it will be an important step forward in how inflammatory bowel disease is diagnosed,” he writes.
Contacts:
Research: Patrick van Rheenen, Paediatric Gastroenterologist, Beatrix Children's Hospital, University Medical Center Groningen, the Netherlands
Email: p.f.van.rheenen@bkk.umcg.nl
Editorial: Robert Logan, Consultant Gastroenterologist, Kings College Hospital, London, UK
Email: robert.logan@nhs.net
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)
[[$FOOTER]]
http://intranet.bmj.com/departments/dept-bmj/bmj-team-resources/web-team-resources/General_blogging_principles.doc