Press releases Monday 21 February to Friday 27 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) Drinking alcohol in moderation protects against heart disease

(Research: Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis)
http://www.bmj.com/cgi/doi/10.1136/bmj.d671
(Research: Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies)
http://www.bmj.com/cgi/doi/10.1136/bmj.d636

Individuals who drink alcohol in moderation (about one drink a day or less) are 14-25% less likely to develop heart disease compared to those who drink no alcohol at all, finds research led by Professor William Ghali from the University of Calgary, published on bmj.com today.

The first paper, led by Paul Ronksley from the University of Calgary, emphasises that a balance needs to be found between the public health message that consuming large amounts of alcohol is bad for you, and the one that drinking in moderation can have health benefits.

An accompanying paper led by Dr Susan Brien, also from the University of Calgary, finds that moderate consumption of alcohol (up to one drink or 15 g alcohol per day for women and up to two drinks or 30 g alcohol per day for men) is good for health. They say moderate amounts of alcohol significantly increase the levels of 'good' cholesterol circulating in the body and this has a protective effect against heart disease.

Brien and colleagues argue that their study strengthens the case that there is a causal link between alcohol consumption and reduced heart disease.

The authors of both papers acknowledge that a number of previous studies have concluded that moderate alcohol consumption has been associated with a decrease in heart disease. However, they say that the research was out-of-date and there was a need for new material. Professor Ghali says his team's research is the most comprehensive to date.

Ghali and colleagues reviewed 84 studies of alcohol consumption and heart disease. They compared alcohol drinkers with non-drinkers and their outcomes in relation to heart disease, death from heart disease, incidences of stroke and death from having a stroke.

In the companion study, Brien and colleagues reviewed 63 studies and investigated alcohol consumption with known physical markers for heart disease such as cholesterol, levels of inflammation, fat cells and the condition of blood vessels. They also assessed the impact of the type of alcohol consumed (wine, beer and spirits).

Interestingly, Brien's research concludes that it is the alcohol content that provides the health benefits not the type of alcoholic beverage (wine, beer or spirits) that is drunk.

Professor Ghali concludes that the debate between the impact of alcohol on heart disease should now centre "on how to integrate this evidence into clinical practice and public health messages".

He adds "with respect to public health messages there may now be an impetus to better communicate to the public that alcohol, in moderation, may have overall health benefits that outweigh the risks in selected subsets of patients . . . any such strategy would need to be accompanied by rigorous study and oversight of impacts".

Contacts:
Research paper 1: William Ghali, Calgary Institute for Population and Public Health, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Alberta, Canada
Email: wghali@ucalgary.ca
Research paper 2: Susan Brien, Calgary Institute for Population and Public Health, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Alberta, Canada
Email: sbrien@ucalgary.ca

(2) Most new training programmes are failing to widen diversity in medicine

(Research: Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data 2002-6)
http://www.bmj.com/cgi/doi/10.1136/bmj.d918

Most new training programmes designed to widen access to medicine in the UK are failing to increase the diversity of the medical student population, finds a study published on bmj.com today.

It shows that although historic under-representation of women and of minority ethnic groups has been redressed, a large proportion of medical students still come from the most affluent socioeconomic groups in society.

Recent years have seen major initiatives to broaden the demography of the UK medical student population, but it is unclear whether new programmes, such as graduate entry and foundation entry courses, have achieved this.

So a team of researchers at the University of Birmingham set out to determine whether these new routes into medicine have produced more diverse student populations.

They analysed data from the Universities and Colleges Admissions Service (UCAS) on all UK residents admitted to one of the 31 universities offering medical degrees from 2002 to 2006. They compared age, sex, ethnicity, and socioeconomic status of students admitted to traditional (school-leaver) courses with those admitted to graduate entry and foundation courses (these are courses with entry criteria relating to the demographic characteristics of population groups typically under-represented in medicine).

Across all medical schools, they found no significant difference in the proportion of men and women between graduate entry courses and traditional courses.

They found that students on graduate entry courses were, as would be expected, significantly older than students on traditional courses and were more likely to define themselves as white (84% v 70%).

Two fifths of students on traditional courses declared their parental occupation to be higher managerial and professional compared with 27% of students on graduate entry courses.

In contrast, only 23% of students on foundation programmes (where entry is restricted to under-represented groups) defined their ethnicity as white and only 8% defined their background as higher managerial and professional. However, the numbers of places available on these courses are small.

Given that some UK medical schools are clearly trying to modify their admission policies to increase applications from under-represented groups, why are more universities not operating foundation programmes or offering explicit adjusted entry criteria to traditional courses, ask the authors?

One reason may be that foundation programmes are more expensive than other courses to run. Others include over-reliance on aptitude tests that can favour certain groups, the impact of tuition fees on students from poorer backgrounds, and the acceptability of such "affirmative action" admission policies.

The authors conclude: "Evidence of the advantages of increasing diversity is emerging, but the implementation of 'new' admission routes to the profession does not seem to be bringing significant change." They add: "In both the US and UK, the most successful programmes to increase student diversification seem to be those based on explicit affirmative action, yet these programmes are not universally welcomed among the public or the profession."

Contact:
Jonathan Mathers, Research Fellow, School of Health and Population Sciences, University of Birmingham, UK
Email: j.m.mathers@bham.ac.uk

(3) Stress and tension does not stop fertility treatment from working

(Research: Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies)
http://www.bmj.com/cgi/doi/10.1136/bmj.d223

Women undergoing IVF or other assisted reproduction therapy can be reassured that emotional distress caused by their infertility or other life events will not prevent the treatment from working.

Infertility affects up to 15% of the childbearing population and over half of these individuals will seek medical advice in the hope of becoming a parent.

Many infertile women believe that emotional distress (for example stress and tension) is a factor in not getting pregnant naturally or lack of success with fertility treatment. This view is largely based on anecdotal evidence and fertility myths such as 'don't think about it and you'll get pregnant'.

However, doctors are sceptical that stress affects fertility due to the lack of evidence on this issue.

The authors, led by Professor Jacky Boivin from the Cardiff Fertility Studies Research Group, investigated links between the success of fertility treatment and stress by undertaking a large scale review (meta-analysis) of related research.

Fourteen studies with 3,583 infertile women undergoing a cycle of fertility treatment were included in the review. The women were assessed before fertility treatment for anxiety and stress. The authors then compared data for women who achieved pregnancy and those who did not.

The results show that emotional distress was not associated with whether or not a woman became pregnant.

Professor Boivin therefore argues that "these findings should reassure women that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise their chance of becoming pregnant".

Contact:
Jacky Boivin, Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Cardiff, UK
Email: boivin@cardiff.ac.uk

(4) UK stroke care is improving, but inequalities still exist

(Research: Provision of acute stroke care and associated factors in a multiethnic population: prospective study with the South London Stroke Register)
http://www.bmj.com/cgi/doi/10.1136/bmj.d774

The quality of stroke care in the UK is improving, but significant inequalities still exist, warns a new study published on bmj.com today.

Previous reports have suggested that the quality of UK stroke care is improving, but there is limited information on trends of care from population-based studies. So a team of researchers in London assessed the provision of acute stroke care for 3,800 patients registered on the south London stroke register between 1995 and 2009.

They measured the provision of effective acute stroke care, in line with current guidelines, against demographic factors such as age, sex, ethnic origin and socioeconomic status.

The proportion of patients receiving effective acute stroke care interventions increased substantially between 1995 and 2009.

However, between 2007 and 2009, 5% of patients were still not admitted to hospital after an acute stroke, particularly those with milder strokes, and 21% of patients were not admitted to a stroke unit.

They also found a disproportionate access to effective care. For example, compared with white patients, black patients had significantly increased odds of being admitted to a stroke unit and receiving occupational therapy or physiotherapy, independent of age or stroke severity.

The odds of brain imaging were lowest in older patients (aged 75 or more years) and those of lower socioeconomic status, whereas older patients were more likely to receive occupational therapy or physiotherapy.

Despite a government goal of universal access to healthcare, the findings of this study suggest a disproportionate access to acute stroke care, say the authors. They conclude that strategies to minimise these inequalities are urgently needed to increase the chances that all patients receive optimal care with improved outcomes.

Contact:
Juliet Addo, Clinical Research Fellow, King's College London, UK
Email: juliet.addo@kcl.ac.uk

(5) BMJ Group Awards shortlist announced - Voting begins for Lifetime Achievement Award

The BMJ Group has announced the shortlist for the third BMJ Group Awards which recognise Excellence in Health Care.

The awards ceremony, hosted jointly by author and news presenter Gavin Esler and the BMJ's editor-in-chief Dr Fiona Godlee, takes place on 18th May in London. This year there are 13 awards including three new categories: Medical Team in a Crisis Zone; Innovation in Health Care and Sustainable Health Care.

Voting for The Lifetime Achievement Award is now open until 9th April for BMJ readers via bmj.com. The three shortlisted candidates are:

  • Sir George Alleyne, Chancellor of the University of the West Indies, who has played a large part in tackling HIV and non-communicable disease and is an energetic promoter of health equality across the world
  • Professor Sir Richard Peto, codirector of the Clinical Trial Service Unit and the Epidemiological Studies Unit at Oxford University, who has contributed much to the decrease in neoplastic, vascular and respiratory mortality from smoking both in the UK and elsewhere including India and China
  • Dr John Wennberg, Professor Emeritus at Dartmouth Medical School in the US, who has spent more than 40 years studying and documenting large variations in healthcare delivery across the US

Former winners of this Award are Professor Marleen Temmerman for her services to women's health in Belgium and Kenya and Professor Judith Mackay for her campaigns, especially in Asia, to combat the tobacco industry.

Shortlisted for the new Medical Team in a Crisis Award are Medecins Sans Frontieres and Save the Children for their work in Haiti and "Doctors for You" Flood Response Team for their work in Bihar India.

Topics shortlisted for The Research Paper of the Year cover screening for colorectal cancer using flexible sigmoidoscopy; the treatment of severe malaria in African children and the effects of tranexamic acid on death, vascular occlusive events and blood transfusion in trauma patients.

Reflecting the international nature of the Awards, shortlisted entries come from Uganda, Malaysia, India, Australia, the United States and Switzerland as well as from England, Scotland and Wales.

BMJ editor, Dr Fiona Godlee said: "We are delighted with the enthusiastic response to our Awards and we have received over 650 entries from both the UK and across the world. This has helped us identify some of the best practice in health care and the outstanding contributions that are being made to improving outcomes for patients."

Details on the full shortlist are at: http://groupawards.bmj.com/

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

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