Press releases Monday 31 January to Friday 4 February 2011

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) Common cold-like virus strongly linked to diabetes
• (2) Swine flu vaccine highly effective in children and young adults, says study
• (3) Quality of NHS care has improved, but new patient safety programme had less impact than expected

(1)Common cold-like virus strongly linked to diabetes

(Research: Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies)
http://www.bmj.com/cgi/doi/10.1136/bmj.d35
(Editorial: Enteroviruses and type 1 diabetes)
http://www.bmj.com/cgi/doi/10.1136/bmj.c7072

People with diabetes are almost 10 times more likely to have a cold-like enterovirus infection, according to a new study published on bmj.com today.

The study found a strong association between enterovirus infection and type 1 diabetes in what claims to be the first review of molecular studies in this area.

Type 1 diabetes is thought to come from a mixture of genetic predisposition, the immune system and environmental factors. Enteroviruses are common viruses especially found in infants and children, which can lead to cold or flu symptoms, fever, muscle aches, a rash, or in more severe cases, meningitis.

Recently, there has been a sharp rise in the incidence of childhood type 1 diabetes worldwide, especially in those under the age of five.

Some previous studies have found a link between enteroviruses and type 1 diabetes, but findings have been contradictory and no reviews of molecular studies have been carried out.

So, researchers from Australia reviewed 24 studies and two abstracts involving 4,448 participants.

In these studies of enteroviruses - which are made of ribonucleic acid (RNA) and protein - researchers had measured the RNA levels or protein in the blood, stool or tissue of pre-diabetic and diabetic patients and compared them with non-diabetic patients.

The researchers found a strong association between enterovirus infection and type 1 diabetes, particularly in children.

Children with type 1 diabetes were almost 10 times more likely to have the enterovirus infection as other children. In addition, children with pre-diabetes were around three times more likely to have the infection than other children.

However, this type of observational research cannot prove cause and effect, and the researchers could not completely rule out other factors, such as genetic risk, that might have affected the relationship between infection and type 1 diabetes.

They conclude: "Larger prospective studies are needed to establish a clear temporal relation between enterovirus infection and the development of autoimmunity and type 1 diabetes."

In an accompanying editorial, Professor Didier Hober and Famara Sane from the University of Lille in France, say that enteroviruses and type 1 diabetes are clearly linked, but the mechanism is yet to be explained. They conclude: "The association between enteroviruses and type 1 diabetes opens up the possibility of developing new preventive and therapeutic strategies to fight this disease."

Contacts:
Research: Maria Craig, Associate Professor, Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Sydney, Australia
Email: m.craig@unsw.edu.au
Editorial: Didier Hober, Professor of Virology, University Lille 2, Faculty of Medicine, CHRU Lille, France
Email: didier.hober@chru-lille.fr

(2) Swine flu vaccine highly effective in children and young adults, says study

(Research: Effectiveness of AS03-adjunvanted pandemic H1N1 vaccine: case-control evaluation based on sentinel surveillance system in Canada, autumn 2009)
http://www.bmj.com/cgi/doi/10.1136/bmj.c7297

A single dose of the H1N1 vaccine was over 90 % effective during the 2009 pandemic, finds a study from Canada published on bmj.com today.

The findings are relevant to the evaluation of pandemic vaccination efforts not only in Canada but in other countries where vaccines were used, and may help inform the further development of influenza vaccine options, say the authors.

Using a well-established influenza surveillance system in Canada, a research team led by Danuta Skowronski at the British Columbia Centre for Disease Control in Vancouver, tested the effectiveness of the pandemic influenza H1N1 vaccine used in Canada during autumn 2009.

Of 552 patients who visited a clinic with flu-like illness in four provinces across Canada between 8 November and 5 December 2009, pandemic H1N1was detected in 209 (38%) and was highest in young children and adults (40%) and lowest (9%) in the over 65s. Those who tested negative for influenza A and B were used as controls.

Two out of the 209 pandemic H1N1 flu cases (1%) received a single dose of pandemic H1N1 vaccine at least two weeks prior to illness onset compared with 58 (17%) of controls. Vaccine effectiveness was high (93% overall) with few vaccine failures identified. More than 80% of participants were under 50 years of age so evidence for effectiveness in the elderly is still needed, they conclude. But for children and young adults, the vaccine was shown to protect very well.

Contact:
Danuta Skowronski, Epidemiologist, BC Centre for Disease Control, Vancouver, BC, Canada
Email: danuta.skowronski@bccdc.ca

(3) Quality of NHS care has improved, but new patient safety programme had less impact than expected

(Research: Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluation)
http://www.bmj.com/cgi/doi/10.1136/bmj.d195
(Research: Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase)
http://www.bmj.com/cgi/doi/10.1136/bmj.d199
(Editorial: Is quality of care improving in the UK?)
http://www.bmj.com/cgi/doi/10.1136/bmj.c6646

Quality and safety of NHS care has shown a clear improvement, but a specially designed patient safety programme in hospitals selected from all parts of the UK had less of an impact on frontline medical staff and clinical outcomes than expected, according to two large evaluation studies published on bmj.com today.

In 2005, the Health Foundation (a British charity dedicated to improving the quality of health care) launched the Safer Patients Initiative (SPI) to test ways of delivering safer care on an organisation-wide basis.

The first phase of the study involved four NHS hospitals (one in each country in the UK) and 18 control hospitals over an 18-month period. In an innovative study design, the second phase of the study included nine SPI and nine control hospitals.

The aim of the programme was to improve frontline care processes in designated clinical areas, and build leadership and expertise in patient safety to change the culture of organisations.

Although the researchers found improvements in quality and safety across the NHS, no additional effect of the Safer Patients Initiative could be detected.

Essentially, quality of care and patient safety improved to the same extent in both intervention and control hospitals.

The authors conclude that the considerable improvements in quality seen across the NHS "may have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI may be observable only in the longer term."

An accompanying editorial says these studies "should be a wakeup call to those implementing patient safety programmes." Three US experts argue that the quality improvement field "needs to embrace science, favour evidence over anecdote, and move beyond using only one generic framework for improvement." They also point out the importance of having "buy-in" from clinicians to lead patient safety efforts.

Contacts:
Research: Richard Lilford, Professor of Clinical Epidemiology, School of Health and Population Sciences, University of Birmingham, UK
Email: r.j.lilford@bham.ac.uk
Editorial: Professor Peter Pronovost, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Email: ppronovo@jhmi.edu

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

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