MEDICAL NEWS ARCHIVE

TACKLING THE SPREAD OF MRSA IN THE HOME

One of the main concerns highlighted by new research from the International scientific forum, IFH, commissioned by Domestos, is the potential for transfer of aggressive strains of community acquired MRSA into hospitals.  It seems that nearly half of all respondents surveyed were not aware that it is possible to pick up infections such as MRSA unwittingly in the community.  Although statistically the risks are quite low, good hygiene in the home can help minimise risk.  The full IFH report can be found at http://www.ifh-homehygiene.org/2003/2library/MRSA_expert_report.pdf.

SEX EDUCATION NOT WORKING?

An editorial in the BMJ – 20tth January 2007 - despite increasing provision of school sex education, teenage sexual health in the United Kingdom is in overall decline.  Increasing rates of terminations and sexually transmitted infections in under 18s outweigh recent modest reductions in conception rates in this age group.
Research seems to indicate that rather than improving sexual health, sex behaviour interventions can make it worse.  It seems that most studies on sex education programmes in schools examine intermediate outcomes only, such as pupil satisfaction or reported condom use. This often facilitates premature false claims of success, whereas more robust outcome measures such as rates of terminations, unplanned conceptions, and sexually transmitted infections show no benefit.
The author cites research also published in the BMJ - 20th January 2007 – which reports the effect of theoretically based teacher delivered sex education programme (SHARE) on registered conceptions and terminations.  The trial found no significant difference between the intervention and control groups.http://www.bmj.com/cgi/content/abstract/334/7585/133

DELAYING TYMPANOSTOMY TUBES DOES NOT HARM CHILDREN

Delaying insertion of tympanostomy tubes in children with persistent middle-ear effusion does not affect their cognitive development measured at age 9 to 11, according to a randomized study in the New England Journal of Medicine (January 18th 2007.)

The study included almost 400 children who had persistent middle-ear effusion before age 3. Most had also scored abnormally on at least one hearing test. Tympanostomy tubes were inserted promptly after criteria for persistent effusion were met in about half of the children; for the other children, insertion was delayed for 6 or 9 months. At age 9 to 11, the groups scored no differently on evaluations of literacy, attention, academic achievement, or social skills. Previous reports from the same study found that prompt tube insertion did not improve developmental measures at ages 3, 4, or 6.

An author concludes that there is now "convincing evidence that persistent middle-ear effusion in otherwise normal children does not cause developmental impairments." http://content.nejm.org/cgi/content/short/356/3/248

PANDEMIC INFLUENZA MAY KILL 62 MILLION A YEAR

According to a report in THE LANCET – 23rd December 2006 – researchers predict that 62 million people—96% from the developing world—could die in a year if a pandemic similar to that of 1918- 20 were to occur today.  Potential mortality from a major influenza pandemic have varied from 2 million to 360 million and even up to 1 billion. However, these estimates have been based on historical  accounts rather than quantitative data. In the latest US study, death registration data has been used to calculate excess mortality during the 1918–20 pandemic in 27 countries.

When they extrapolated the 1918–20 mortality rates to the worldwide population of 2004, they found that 51–81 million individuals could die if a similar pandemic were to occur that year. They found that people on high-incomes were less likely to die in a pandemic than poor people. Death rates varied by 30-fold across countries and income per head could explain half this variation.  The researchers conclude that, irrespective of the lethality of the virus, the burden of the next influenza pandemic will be overwhelmingly focused in the developing world.
http://www.thelancet.com/webfiles/images/clusters/thelancet/press_office/Flu.pdf

INHERITED ISCHAEMIC STROKE MORE COMMON IN WOMEN THAN MEN

More women than men inherit ischaemic stroke, irrespective of traditional vascular risk
factors, according to an article  published online (Friday December 22, 2006) by THE LANCET NEUROLOGY.  UK researchers assessed the relation between the sex of patients who had an ischaemic stroke or transient ischaemic attack and history of stroke in their mothers, fathers, and siblings.  They used data reported in the population-based Oxford Vascular Study (OXVASC), which assessed all incident or recurrent transient ischaemic attacks and strokes in a population of 91106 people registered with 63 family physicians in Oxfordshire, UK. Their findings show that the identification of a family history of stroke in a female first-degree relative is an important clinical indicator of an increased risk of stroke in women and the likely age at first stroke.
http://www.thelancet.com/webfiles/images/clusters/thelancet/press_office/TLN_EOP.pdf

COGNITIVE TRAINING MAY AID FUNCTIONING OF OLDER ADULTS

Cognitive training not only can delay cognitive decline in older adults, it may also help them function independently longer, according to a report in JAMA – 20TH December 2006. Researchers randomized 2832 people age 65 or older without dementia to receive either 10 weekly sessions of training in one of three domains (memory, reasoning, or processing speed) or no training.  All trained groups had less subsequent decline in the domain trained than did the other groups. Those with reasoning training also retained more of their abilities in instrumental activities of daily living. http://jama.ama-assn.org/cgi/content/full/296/23/2805

BLACK COHOSH & OTHER BOTANICALS DO NOT STOP MENOPAUSE SYMPTOMS

Black cohosh, alone or with other botanicals, does not relieve hot flushes, according to a randomized, placebo-controlled, double-blind study in ANNALS OF INTERNAL MEDICINE – 19th December 2006. Researchers assigned some 350 menopausal and postmenopausal women aged 45 to 55 to a year of treatment with black cohosh alone; a multibotanical supplement including black cohosh, with or without counseling for a high-soy diet; estrogen with or without progesterone; or placebo. Before treatment, all women had at least two hot flushes or night sweats daily. Symptoms dropped off in all five groups over the course of the trial, but only hormone therapy was significantly more effective than placebo.  http://www.annals.org/cgi/content/full/145/12/869

SHOULD BABIES BE LEFT TO SLEEP IN INFANT CAR SAFETY SEATS?

Young infants should not be left unattended to sleep in standard car safety seats as they may be at risk of hypoxia according to research published in The BMJ – 9th December 2006.  43 consecutive infants were examined who had presented after an acute life threatening event. It was found that nine had been asleep in such seats at the time of a perceived change in colour and breathing. All infants seemed otherwise healthy. Car seats may cause forward flexion of the neck and lead to impaired airway function and oxygen desaturation. 
http://www.bmj.com/cgi/content/short/333/7580/0-b?etoc

NEW YORK CITY IS FIRST TO BAN TRANS FATS IN RESTAURANTS

New York is the first city to ban industrially produced trans fats from restaurant food.  The city health department now requires restaurants to stop using the trans fats for most frying or in spreads by July 1, 2007. They will have an extra year to eliminate them from all other foods, as well as from, in the words of the regulation, "oils or shortenings used for deep frying of yeast dough or cake batter."

In explaining the ban, the health department says: "Because an estimated one third of dietary trans fat comes from foods purchased in restaurants, the continued presence of partially hydrogenated vegetable oils in restaurant foods represents an important contribution to cardiovascular risk for New York City diners."

OCCUPATIONAL THERAPY FOR DEMENTIA IMPROVES FUNCTION

Community based occupational therapy for elderly patients with dementia improves daily function and reduces the burden on carers (See BMJ 9th December 2006.) One hundred and thirty five people over 65 with mild to moderate dementia were randomised to receive 10 sessions of occupational therapy, including cognitive and behavioural interventions, over five weeks or no additional treatment. The positive effect of treatment remained significant seven weeks after the intervention ended despite patients' limited learning abilities. The number needed to treat for a clinical improvement was 1.3.
http://www.bmj.com/cgi/content/short/333/7580/0-a?etoc

COLSTRIDIUM DIFFICILE MORE VIRULENT

The American journal, Annals of Medicine – 21st November 2006 – publishes a narrative review of Clostridium difficile-associated disease (CDAD), particularly relating to the recent increase in cases seen across the world. The author briefly describes the history of CDAD: antibiotic-associated colitis was recognised soon after antibiotics became available and was initially thought to be due to Staph. aureus, however C. difficile was established as the main cause around 30 years ago. Initially it was associated mostly with clindamycin, however cephalosporins soon took over as the main precipitant, and many cases are now associated with fluoroquinolone use.

The strain currently in circulation appears to be more virulent than in the past, and is more difficult to treat. Nevertheless, the basic principles of management are unchanged, and the author emphasizes the need for better diagnostics, early recognition, improved methods to manage severe disease and relapsing disease, and greater attention to infection control and antibiotic restraint.
http://www.annals.org/cgi/content/abstract/145/10/758

SMOKING MAY INCREASE HPV-ASSOCIATED CERVICAL CANCER RISK

Smoking may dramatically increase the risk conferred by HPV-16 for developing cervical cancer in situ (CIS), according to a Swedish study published in Cancer Epidemiology Biomarkers & Prevention. – November 2006.  Using the Swedish cancer registry and archival pap smears, researchers identified 375 women diagnosed with CIS and matched them with a similar number of controls. For both cases and controls, the study included only those women whose first smear during the 25-year study period was cytologically normal. Women who were HPV-16 positive and smoked at the time of their first smear had an adjusted odds ratio for CIS of 14.4, compared to HPV-16 negative smokers. Among nonsmokers, the adjusted odds ratio was 5.6, comparing HPV-16 positive to HPV-16 negative women. http://cebp.aacrjournals.org/cgi/content/abstract/1055-9965.EPI-06-0399v1

LATEST UK STATISTICS FOR HIV, AIDS

A report from the Health Protection Agency – A Complex Picture -  contains the most up-to-date description of HIV, AIDS and sexually transmitted infections in the UK. The report, which has been released for World Aids Day, estimates that 63,500 adults are now living with HIV in the UK.  Commenting on the figures, the fpa (Family Planning Association) has called upon primary care trusts to make sure that money dedicated to sexual health actually reaches front line services and not diverted to fill out other fund deficits.
http://www.hpa.org.uk/publications/2006/hiv_sti_2006/default.htm

ALTERNATIVE HOPE FOR EARLY STAGE ALZHEIMER’S DISEASE

New German research suggests that natural supplements may help in the very early stages of the disease.  According to lead researcher Prof Gunter Siegel, an in vitro study has shown that omega-3 fish oil and ginkgo biloba may delay mental deterioration by inhibiting degenerative processes in the brain.   The combination has apparently succeeded in cutting the formation of early deposits, or ‘nanoplaques’, in the brain by more than 10% and their size  reduced by almost 15% compared with controls.

Explaining the thinking behind the research, Professor Siegel said “One of the hallmarks of Alzheimer’s disease is the accumulation of amyloid-containing plaques in the brain.  We know that fish oils are heart protective and that amyloid plaques are very similar in composition to atherosclerotic plaques found in the arteries of people with heart disease.” 
              
Using a patented process originally designed to investigate atherosclerotic nanoplaques in coronary arteries, the team simulated the formation of amyloid plaques by bringing together the molecules responsible for plaque formation.  In addition to β-amyloid, this process involves cholesterol (particularly oxidised or modified cholesterol), a receptor protein and calcium.  The formation was measured in the absence and in the presence of omega-3 fish oil and ginkgo biloba using a baser-based spectroscopical method.

Comments Professor Siegel:  “Although our findings need to be confirmed, we can conclude from these biosensor assay experiments that the binding to the receptor protein of the molecules responsible for the initiation of nanoplaque formation is inhibited.  This indicates that amyloid plaque formation is slowed down.  It appears that ginkgo biloba’s antioxidant action is involved which reduces the level of the oxidised cholesterol particles.  This is a brain health benefit in addition to those previously recorded and for which ginkgo biloba is so widely used in Germany.”

 He concludes:  “The results are quite clear but do need to be confirmed in a clinical trial.”  Professor Siegel is now recruiting patients whose cholesterol profile puts them at higher risk of Alzheimer’s disease.   Please click here to email for more information.

PHYSICAL ACTIVITY DOES NOT ALTER CHILDREN'S BMI

According to a report in the BMJ – 18-11-2006 - A physical activity intervention designed to prevent obesity in children did not alter body mass index or sedentary behaviour, according to new research. The authors randomised 545 preschool children either to follow an exercise programme at nursery and at home or to no extra activity. Follow-up at six and 12 months showed that the exercise programme improved children's motor skills, which may affect future participation in sport, but had little effect on obesity in the short term.  Please click here to view the abstract.

STUDY SUGGESTS A ROLE FOR LUNG CANCER SCREENING
 
A large, uncontrolled, prospective study of annual lung-cancer screening using spiral CT suggests that the technique detects the disease when it is largely curable, but questions remain about the utility of this approach in real-world settings. Researchers used spiral CT to screen some 30,000 asymptomatic people with various risk factors for lung cancer, then repeated the screening for most of them within 7 to 18 months. The screenings detected lung cancer in almost 500 participants, 85% of whom had stage I disease. Based on a median follow-up of 40 months, the researchers estimate that the 10-year survival rate for participants with stage I cancer was 88%.

Writing in the New England Journal of Medicine, the authors conclude that spiral CT screening of people at risk for lung cancer could prevent some 80% of deaths from the disease. But an editorial cautions that "biases such as lead time and over diagnosis could have been introduced in the final analysis of mortality and the question of cost-effectiveness remains unanswered."
http://general-medicine.jwatch.org/cgi/content/full/2006/1025/1

IRON-DEFICIENT INFANTS -- SUFFER COGNITIVELY

Chronic iron deficiency in infancy is associated with cognitive deficits that persist into young adulthood, and among poorer children those deficits become more pronounced with time, according to research published in Archives of Pediatrics and Adolescent Medicine.

The authors enrolled 185 Costa Rican infants between 12 and 23 months of age and followed their cognitive status at intervals to age 19. Among children of moderate means, researchers found an 8- to 9-point difference between iron-deficient and iron-sufficient infants, using a composite score that combined various cognitive measures (rescaled to a mean of 100 and a standard deviation of 15 to 16). The difference remained stable over time. Importantly, in poorer children the gap grew from 10 points in infancy to 25 points at age 19.

Given the implications for individuals and society, the authors say "it seems reasonable to prevent iron deficiency in infancy and treat it before it becomes chronic or severe."
http://archpedi.ama-assn.org/cgi/content/abstract/160/11/1108

GONORRHOEA GETTING MORE RESISTANT TO ANTIBIOTICS

The Health Protection Agency has released new figures showing that levels of antibiotic resistance in gonorrhoea are on the increase. The levels of resistance to ciprofloxacin have increased from 14% in 2004 to 21.7% in 2005 and to penicillin, from 11.4% in 2004 to 17.9% in 2005.

A researcher with the agency said: “This increasing resistance to penicillin and ciprofloxacin is concerning and highlights the need for anyone who is infected to be treated with the recommended therapy, ceftriaxone or cefixime. The recommendation for treatment with cephalosporin antibiotics was made in 2002 when information from this programme showed that resistance was increasing to fluoroquinolone antibiotics such as ciprofloxacin. Ceftriaxone or cefixime should be used unless laboratory testing has shown that other antibiotics such as ciprofloxacin or penicillin will be effective.”

However, it appears that no treatment failures have been documented with the recommended cephalosporins, ceftriaxone or cefixime and doctors are advised that if patients’ infection does not seem to be clearing up then they should submit samples to a laboratory for antibiotic resistance testing.
http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/061012_gonorrhoea.htm

PEDIATRICS ACADEMY STRESSES BENEFITS OF PLAYTIME

A report of the American Academy of Pediatrics recommends that children be given ample time for play that is "child driven rather than adult directed."  The report notes the trend toward pushing children to take part in organised after-school activities. It says that while these can be helpful for many youngsters, there is also a risk of leaving too little time for creative play.  It says healthcare providers should offer the following guidelines:

• Recommend that children get "ample, unscheduled, independent, nonscreen time to be creative, to reflect and to decompress";

• Discourage parents from offering computer games and other passive entertainment and instead emphasize active play;

• Promote the benefits of toys like blocks and dolls that allow children to use their imaginations;

• Reassure parents regarding the value of unscheduled time with their children and remind them that their love, role modeling, and guidance are more important to success than extracurricular commitments.

VITAMIN D SUPPLEMENTATION MAY NOT PREVENT FRACTURES IN ELDERLY

 A large controlled trial did not show that vitamin D supplements reduced falls or fractures in a group of elderly people in residential accommodation. The authors, reporting in the Journal AGE AND AGEING, note that there is conflicting evidence on whether or not vitamin D supplementation can reduce fractures and falls in the elderly.  They therefore carried out a cluster-randomised trial in 118 residential homes for the elderly to identify whether supplementation was effective in this group. The 118 homes included a total of 223 residential units, which were taken as the unit of randomisation. Participants were randomised to treatment (oral vitamin D as ergocalciferol 2.4mg every three months) or control (no additional treatment); primary outcomes were fracture (reported by care home staff) and falls (from routinely collected data). Baseline and on-treatment serum vitamin D levels were measured in a 1% sample of the treated group.

A total of 3,717 residents (76% women, mean age 85 years) agreed to take part in the study, of whom 1,762 received vitamin D supplements and 1,955 were controls; median follow-up duration was ten months. There was no significant difference between the groups in fractures (3.2% treatment vs. 2.6% controls for non-vertebral fracture), or in falls: the proportions reporting at least one fall were 44% and 43% respectively. Pre-treatment serum vitamin D levels were relatively high, with a median 25-hydroxy vitamin D concentration of 47 nanomol/l. The authors conclude that in their population, there was no evidence that vitamin D supplementation prevents fractures or falls. They discuss some possible factors that might be relevant, including the relatively high-pre-treatment vitamin D levels in this patient group. An accompanying editorial discusses the study
http://ageing.oxfordjournals.org/cgi/content/abstract/35/5/482

LANCET RECOMMENDS HPV VACCINE FOR ALL ADOLESCENTS

An Editorial in THE LANCET - 7th October 2006 - concludes that all adolescents should receive the human papilloma virus (HPV) vaccine to maximise its potential benefits. It notes that support is growing for such an approach. Modelling studies indicate that vaccinating only females would be 25% to 40% less effective in reducing HPV prevalence in women than vaccinating all adolescents; there are also other manifestations of HPV infection that affect both sexes, such as genital warts and anal cancer. There is also the example of the rubella vaccination programme in the UK, which originally included females only but was extended to include boys because there was a rise in the number of rubella infections in pregnant women. The editorial concludes that the trial data involving boys is urgently needed, but long-term eradication of HPV requires all adolescents to be immunised. Meanwhile, it says, all EU states should make it mandatory for 11-12-year old girls.
http://www.thelancet.com/journals/lancet/article/PIIS0140673606694944/fulltext

WEIGHT GAIN BETWEEN PREGNANCIES MAY LEAD TO COMPLICATIONS

Weight gain between pregnancies may lead to complications during pregnancy and the delivery period, according to an Article published in THE LANCET –  30th September 2006.  The study analysed the interpregnancy body-mass index (BMI) change between the first two consecutive pregnancies in over 150 000 Swedish women, as well as the incidence of maternaland perinatal* complications during the second pregnancy. The study found that weight gain during the interpregnancy period is strongly associated with major maternal and perinatal complications, even in women who are not medically overweight. It has been shown that a gain of 3 or more BMI units is associated with an increased risk of: pre-eclampsia; gestational hypertension;  estational diabetes; caesarean delivery; stillbirth and large-for-gestational-age births.
The paper concluded that: “[The results] provide robust epidemiological evidence for advocating weight loss in overweight and obese women who are planning to become pregnant, and to prevent weight gain in the larger population of women with healthy weight.” http://www.thelancet.com

NEW CANCER DRUG EXTENDS LIFE FOR LUNG CANCER PATIENTS

Lung cancer patients treated with an experimental new drug lived over a third longer than patients treated with standard chemotherapy, according to recent date (September 2006). 

The phase II study, carried out by UK biotech company Antisoma plc, looked at 70 patients with non-small cell lung cancer (NSCLC).

Patients treated with AS1404 on top of standard chemotherapy lived over a third longer (14 months) than patients treated with chemotherapy alone (8.8 months).  This is claimed to be one of the largest increases in life expectancy ever seen in a trial adding a new drug to chemotherapy in NSCLC.

Safety data from the trial were also said to be encouraging. The addition of AS1404 to chemotherapy was well tolerated.

These findings extend the positive data announced at a major US cancer conference in June 2006 (http://www.antisoma.com/investor_relations/documents/ASCO_201_lung.pdf), which showed increased tumour response rates, longer time to disease progression and enhanced survival. 

CERVICAL CANCER VACCINE APPROVED

Gardasil, a vaccine that is said to prevent cervical cancer, pre-cancerous cervical lesions, pre-cancerous vulval lesions and genital warts has been granted a European licence.  It targets the four virus types which together account for the majority of genital Human papillomavirus diseases types 6, 11, 16 and 18.

In large clinical trials, involving more than 25,000 women, the new vaccine prevented up to 100% of cervical cancer, pre-cancerous and potentially pre-cancerous cervical lesions, vulval and vaginal pre-cancerous lesions and genital warts due to Human Papillomavirus types 6, 11, 16 and 18.  Consistent efficacy has been reported for up to five years and is expected to be long-lasting.

It is anticipated that Gardasil will be launched in the UK in the coming weeks.  The Joint Committee on Vaccination and Immunisation (JCVI), the expert committee that advises the Government on vaccine policy, is currently reviewing the u se of human papillomavirus vaccines and their potential benefit.  The JCVI will advise on the possible introduction of routine universal vaccination, for example for certain age groups.

In clinical trials, Gardasil is said to have shown 100% efficacy in the prevention of pre-cancerous cervical lesions (high grade, CIN2/3) related to Human Papillomavirus 16 and 18.  In the US, experts have recommended the routine vaccination of 11-12-year-old girls and the vaccination of 13 to 26-year-olds who have not previously been vaccinated.

Gardasil has been developed by Merck & Co Inc and Sanofi Pasteur MSD.  Please click here to email your request for more information.

PROSTATE CANCER THERAPY LINKED TO DIABETES AND HEART DISEASE

Androgen-deprivation therapy for prostate cancer may increase the risk for diabetes and heart disease, according to a study published yesterday in the JOURNAL OF CLINICAL ONCOLOGY.
The observational study identified 73,196 Medicare enrollees diagnosed with locoregional prostate cancer and studied them at a median of 4.55 years after diagnosis. Men who took gonadotropin-releasing hormone (GnRH) agonists had hazard ratios of 1.44 for incident diabetes, 1.16 for incident coronary heart disease, 1.11 for myocardial infarction, and 1.16 for sudden cardiac death, compared with men who didn't take GnRH agonists, after adjustment for numerous socioeconomic and medical variables. Men treated with orchiectomy had an adjusted HR of 1.34 for incident diabetes, but no increased risk for coronary heart disease, MI, or sudden cardiac death.
Given the increasing use of hormone therapy for prostate cancer, the authors urged physicians to weigh its benefits against potential increased risks for diabetes and heart disease.  http://www.jco.org/cgi/content/abstract/24/27/4448

DR CHRIS STEELE LAUNCHES WEB SITE

ABD Member, Dr Chris Steele, the resident doctor from ITVs This Morning, has launched his own health website – http://www.thefamilygp.com - from which he will conduct a weekly online surgery.  The intention is to bring consumers the latest in health news and medical information, commentary and products.  A range of innovative and interactive features are to be incorporated shortly, including videos of self-examination techniques, and surgical procedures.

RCOG REPORT ON ALTERNATIVE THERAPIES

A report from the Royal College of Obstetricians and Gynaecologists (RCOG) examines the use of alternative therapies for symptoms of the menopause. It notes that there is often little to no evidence on the safety and efficacy of these treatments and examines the evidence that is available.  The report highlights some dangers but notes that alternative treatments for menopausal symptoms achieve about 50-60% symptom reduction (compared to 80-90% with HRT). Some, such as red clover and soy, may also have beneficial effects on the skeleton and cardiovascular system. Further research is needed to determine long-term efficacy and safety. It recommends that each woman should be assessed individually, considering the advantages and disadvantages of both alternative and conventional therapies.  For PDF of full report, please click on http://www.rcog.org.uk/resources/Public/pdf/alternatives_to_hrt_sac_paper6.pdf

NATIONAL GYNAECOLOGICAL CANCER AWARENESS CAMPAIGN LAUNCHED

The first national campaign to raise awareness of cancers which kill almost 7,500 women per year takes place from 18 – 22 September 2006.  Every year over 17,000 women are diagnosed with one of the four main gynaecological cancers; ovarian, cervical, endometrial and vulval.   Stigma and embarrassment still surround these cancers, which can lead to a delay in women going to the doctor. Any delay to diagnosis can lead to significantly worse survival rates compared to women who were treated earlier. Called the Venus Appeal, the campaign aims to encourage women to be more aware of the four main gynaecological cancers, and to consult their GP if they have any concerns.

Lucy Smith and colleagues from the University of Southampton investigated why people delay going to the doctor when they have symptoms of cancer.  Writing in a recent paper in THE LANCET they report: “Fear of embarrassment was related to the discussion of sensitive or sexual areas of the body and invasiveness of physical examinations.  Such fears were not reported in studies of women with breast cancer.”  Venus Appeal posters and leaflets are being made available through doctor’s surgeries and online at http://www.venusappeal.org

DRUG COULD PREVENT TYPE 2 DIABETES IN HIGH-RISK INDIVIDUALS

Giving people at high-risk of developing type 2 diabetes a drug called rosiglitazone, along with lifestyle recommendations, could substantially reduce their chances of developing the disease, according to an Online/Article published by THE LANCET - Friday September 15, 2006. In the DREAM trial, Canadian investigators randomised 5269 adults with impaired glucose tolerance or impaired fasting glucose to receive rosiglitazone or placebo daily for three years. At regular intervals throughout the study the researchers emphasised the importance of a healthy diet and lifestyle to the participants. They found that 280 individuals on rosiglitazone and 658 on placebo developed diabetes. There was a small excess risk of non-fatal heart failure in the drug group when compared to the placebo group.  The authors conclude: “The results of this study suggest that the addition of rosiglitazone to basic lifestyle recommendations substantially reduces the risk of developing diabetes by about two-thirds, offering a novel preventive approach. Balancing both the benefits and the risks suggests that for every 1000 people treated with rosiglitazone for 3 years, about 144 cases of diabetes will be prevented, with an excess of four to five cases of congestive heart failure.” 
Click here to email your request for a PDF of the Dream Trial.


VACCINE COULD CUT CERVICAL CANCER DEATHS AND CASES BY 75%

A vaccine against two strains of the human papillomavirus (HPV) could cut the number of cases and deaths from cervical cancer by three-quarters, according to a new study sponsored by GlaxoSmithKline (GSK).  It was presented on September 4th at The International Papillomavirus Conference in Prague (September 1-7 2006).    The study suggests that with 100% coverage, the vaccine could lead to a 76% reduction in cases of cervical cancer and a similar reduction in deaths.  These estimated benefits are in addition to the lives that are already being saved by the UK’s existing cervical screening programme.

A computer model was used in the study to predict the outcome of vaccinating all 12-year-old girls in the United Kingdom (376,385 girls) over their lifetime.  By extrapolating the decrease in cervical cancer cases and deaths seen in the study across the entire UK population, the research indicates that 262 women would die each year from cervical cancer, where currently there are 1,093 deaths. The number of cases of the disease in the UK would also drop from 2,841 to 682, according to the new research.  However, because 100% coverage with the vaccine assumed in the study is unrealistic, the computer model gives alternatives. With 80% of 12 year old girls vaccinated, cancer cases and deaths are predicted to drop by around 61%.

The study also examined the potential impact of vaccination on the precancerous stages of cervical disease.  Over the lifetime of women vaccinated at 12 years of age, vaccination is predicted to reduce the burden of abnormal smears due to cancer-causing HPV by over half (52.4%) and the subsequent need for diagnostic colposcopies by 54.8%.

Vaccination is also predicted to bring a 70% reduction in the more severe pre-cancerous stages of cervical disease due to cancer-causing HPV strains - Cervical Intraepithelial Neoplasia, CIN 2 and 3). This research examined the long-term impact of HPV vaccination using GSK’s candidate HPV vaccine which targets HPV 16 and 18, the two most common HPV strains associated with cervical cancer. Protection against additional cancer-causing strains of HPV was also included in the model.

This inclusion was based on preliminary evidence from GSK clinical trials, showing that the candidate HPV vaccine demonstrates additional protection against infection with the third and fourth most common HPV strains associated with cervical cancer globally, HPV 45 and 31.

Researchers believe that the public health benefits of vaccination may be greater than predicted by the study since it does not look at cancers caused by HPV that affect other parts of the body.  There is evidence that HPV 16 and 18 may play a role in causing other anogenital cancers, including vulval and vaginal cancers.

Further research is now being carried out to look at the overall cost-effectiveness of HPV vaccination to the NHS, which currently spends £157 million a year in England alone on the cervical cancer screening programme. Currently there are still 3,000 women in the UK getting cervical cancer each year – despite a highly efficient screening programme. The peak age for cervical cancer to strike is while women are in their late-30s, but it can occur earlier. Treatments, such as hysterectomy, will prevent them having children, perhaps before they have had a chance to start a family. Please click here to email for more information.

NEW FPA LEAFLET LAUNCHED ON NON-SPECIFIC URETHRITIS
       
The Family Planning Association (fpa) has published a new leaflet on non-specific urethritis (NSU).  It covers the cause of NSU, what it is, how it is transmitted and the signs and symptoms, as well as where to go for help and what happens during treatment. The non-specific urethritis leaflet is available from fpa direct Tel 0845 122 8600 and is sold in units of 50 costing £5.00 plus

ABOLISH THE TERM ASTHMA SAYS THE LANCET

Asthma is unlikely to be a single disease, so we should abolish the term altogether according to an editorial in The Lancet – 26th August 2006.  The word asthma originates from a Greek word that means “to breathe with mouth open or to pant.” Asthma includes a range of different symptoms, such as wheezing, coughing, and difficulty breathing. The underlying cause of asthma is inflammation of the airways, but it is not known what triggers this inflammation and why some people develop asthma and others do not. People with asthma can have a range of different triggers, symptoms, and responses to treatment, and the general consensus now emerging is that asthma is unlikely to be a single disease.  The author’s view is - “So why wait? Rather than confusing scientists, doctors, and patients even further, is it not time to step out of the straightjacket of a seemingly unifying name that has outlived its usefulness? The conclusion should surely be that it is best to abolish the term asthma altogether.”  http://www.thelancet.com

STUDY SHOWS BENEFIT OF CHEMOTHERAPY IN LUNG CANCER

According to an online article in THE LANCET ONCOLOGY new results from the Adjuvant Navelbine International Trialist Association (ANITA) show that treatment with vinorelbine and cisplatin after surgery lengthens survival of patients with early-stage lung cancer. “This is the first trial comparing a third-generation combination chemotherapy to observation after surgery in totally resected patients with all stages of lung cancer”, notes lead author. Researchers did a phase III randomised controlled trial in 840 patients with early-stage, or non-metastatic, non-small-cell lung cancer. Patients who had had their tumours removed surgically were assigned to either observation without further treatment or to 4 months’ treatment with vinorelbine and cisplatin.  Survival was found to improve by 8% with the addition of chemotherapy after surgery with the majority of the effect seen in patients whose disease had spread to the lymph nodes (stage II–III disease), and no effect in patients who had tumours measuring 3 cm or larger that had not spread to the lymph nodes (stage IB).

NICE RECOMMENDATIONS ON HORMONAL THERAPIES FOR BREAST CANCER

After considering the feedback from initial consultation, the National Institute for Health and Clinical Excellence (NICE) has prepared a Final Appraisal Determination (FAD) on the use of hormonal therapies for the adjuvant treatment of early oestrogen-receptor-positive breast cancer.  The guidance applies to the use of the aromatase inhibitors anastrozole, exemestane and letrozole, within the marketing authorisations for each drug at the time of this appraisal:

Anastrozole for primary adjuvant therapy
Exemestane for adjuvant therapy following 2–3 years of adjuvant tamoxifen  therapy
Letrozole for primary adjuvant therapy and extended adjuvant therapy following  standard tamoxifen therapy

The FAD recommends that choice of treatment should be made after discussion between the responsible clinician and the patient about the risks and benefits of each option. Factors to consider when making the choice include whether she has received tamoxifen before, the licensed indications and side-effect profiles of the individual drugs and, in particular, the assessed risk of recurrence. http://www.nice.nhs.uk/page.aspx?o=350617

NEONATAL OUTCOMES AFTER PRENATAL EXPOSURE TO SSRIS

In utero exposure to the antiepileptic drug (AED) valproate poses a much higher risk of foetal death and serious birth defects than the three other most commonly used AEDs, suggests a new study published in NEUROLOGY – 08-08-2006.

The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study was originally designed to assess whether monotherapy with valproate, carbamazepine, lamotrigine, or phenytoin was associated with long-term cognitive and behavioural neurodevelopmental effects. However, as foetal outcomes were tracked, a high rate of serious adverse events, including major congenital abnormalities and foetal death associated with in utero exposure to valproate was detected, although the study was not designed to look for these outcomes. The NEAD study is an ongoing prospective observational study that includes 25 epilepsy centres in the United States and the United Kingdom. From October 1999 to February 2004, pregnant women with epilepsy who were on monotherapy with 1 of the 4 agents were enrolled. A total of 323 women and 333 children were included in the final analysis of the current report, of whom 110 were taking carbamazepine, 98 lamotrigine, 56 phenytoin and 69 valproate.

It was found that valproate appeared to produce an incidence of congenital malformations of over 17.4%, compared to carbamazepine 4.5%, lamotrigine 1.0% and phenytoin 7.1%. The incidence of foetal death was not higher with valproate (2.9%) compared to carbamazepine (3.6%), lamotrigine (0%) and phenyotin (3.6%). The authors conclude that these results combined with several recent studies provide strong evidence that valproate poses the highest risk to the foetus. http://www.neurology.org/cgi/content/abstract/67/3/407

FPA CALL FOR MORE VARIED CONDOM SHAPES AND SIZES

The fpa is launching Sexual Health week with a call for the NHS to provide a wider selection of condoms in different sizes and shapes. It is also asking health professionals to start tackling some of the embarrassment that exists around condom size. Condoms that don’t fit properly are more likely to tear or come off, increasing the risk of unplanned pregnancy or sexually transmitted infections (STIs). New research shows that 35% of current or past users of condoms have experienced a condom splitting or coming off during sex, but 64% of this group did not know why this had happened or what had gone wrong with its use. When questioned, 25% of respondents had no idea that condoms come in different lengths and widths. A further 43% agreed that both men and women don’t talk about condom sizes because they get embarrassed talking about penis size, yet finding the right fit can improve confidence in the method. Poor fit can reduce sexual pleasure and contributes to negative views of condoms.   Click here to email for information from the fpa.

IMPOTENCE MAY BE EARLY WARNING OF HEART DISEASE AND DIABETES

Impotence may be an effective early warning sign of heart disease and diabetes, particularly in men of normal body mass index (BMI) who would otherwise not be considered at risk, new data indicates.  The researchers point out that early signs of heart disease and diabetes are more often missed in men of normal weight than in those who are overweight so erectile dysfunction (ED) could be used to alert doctors to wider health problems. The new study, published in the Journal of Urology, concludes that ED may provide a warning sign and an opportunity for early intervention in men otherwise considered at lower risk for cardiovascular disease or diabetes.

COMMUNITY HOSPITALS COST EFFECTIVE FOR POST-ACUTE CARE

A community hospital is as cost effective as a district general hospital for post-acute care of older people, according to a study published on bmj.com 21 July 2006. It states that previous health economic studies have been methodologically weak and difficult to interpret. This new research compares the cost effectiveness of post-acute care at a community hospital and a district general hospital in Yorkshire. http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38887.558576.7C

YOUNG PEOPLE NEED MORE EXERCISE

International guidelines need to recommend higher levels of physical activity for young people than they currently do in order to lower their risk of cardiovascular disease according to a study in THE LANCET - 22nd July 2006.  Currently, guidelines recommend that young people should participate in physical activity of at least moderate intensity for 1 hour per day. However, the evidence for this advice comes from studies that may have been biased because they relied on children recalling the amount of exercise they do. These studies have also only looked at single risk factors for cardiovascular disease.  The new research suggests that children need 30 minutes more exercise – ie one and a half hours daily. http://www.thelancet.com.

DEMENTIA DRUGS MANUFACTURER CHALLENGES NICE

Eisai Limited, manufacturer of the Alzheimer’s disease treatment donepezil (Aricept®), has announced its referral of the Information Commissioner to the Parliamentary Ombudsman for failure to address the refusal by the National Institute for Health and Clinical Excellence (NICE) to make public key calculations behind its proposal to restrict the use of anti-dementia medicines.  The company states that despite numerous public statements about its commitment to openness and transparency, NICE has repeatedly refused to make available the new mathematical model it used to reach the conclusion that they believe anti-dementia medicines are no longer a cost-effective treatment in the early stages of Alzheimer’s disease.

Despite recommending anti-dementia medicines for both mild and moderate Alzheimer’s disease in 2001, NICE has now proposed that only patients with moderate Alzheimer’s disease be allowed to receive the medicines on the NHS.   This, the company claims, has led to an outcry from doctors, carers and patient groups alike since this means letting people deteriorate from the ‘mild’ stages of the disease to ‘moderate’ before help can be offered.  Please click here to email for more information.

CHILD IMMUNISATION CHANGES

A letter from the CMO detailing important changes to the childhood immunisation programme has been sent out for circulation 13th July 2006. The following changes will come into effect from 4th September 2006:

• Pneumococcal vaccine will be introduced to the routine childhood immunisation programme, and the schedule for MenC and Hib vaccines will be modified

• A new routine schedule will be introduced which requires an additional immunisation visit at 12 months of age

• A pneumococcal vaccine catch-up programme will be carried out for children aged under 2 years.

For the full letter, please click here.


PATIENTS’ GROUPS SHOULD DECLARE PHARMACEUTICAL FUNDING

In the interest of full transparency, patients’ groups should declare all sources of funding prominently, states an Editorial in this week’s issue of THE LANCET - 1st July 2006.  Many patients’ groups would not exist without funding from the pharmaceutical industry, according to the commentary, and those that accept money from pharmaceutical companies have an obligation to declare that funding. The editorial highlights the case of the UK charity, CancerBACUP, who have described the results for trastuzumab (Herceptin) in early breast cancer as “impressive”, and the drug itself as a “breakthrough”, in press releases. However, the charity failed to disclose in these releases the fact that the drug’s manufacturer sponsors the charity. In some releases CancerBACUP also failed to discuss concerns about the drug’s efficacy, adverse events, and cost-effectiveness.  The Lancet comments: “CancerBACUP’s failure to discuss these concerns and to mention its drug-company sponsor in a press release on this topic, undermines the group’s credibility and raises the question in whose interest the group works.  http://www.thelancet.com

SOCIAL MARKETING WOULD BOOST EFFECTIVENESS OF HEALTH CAMPAIGN

The Department of Health should adopt slick marketing techniques used in advertising to promote public health issues in England, says a report published by The National Consumer Council and reported in the BMJ – 1st July 2006.   The report argues that the concept of “social marketing” could help the government improve the efficiency of the NHS and achieve many of its goals in improving public health. The health department commissioned the council’s National Social Marketing Centre to carry out an independent review of the technique. The resulting report says that social marketing, when applied systematically, can significantly improve the effects and effectiveness of health promotion. http://bmj.bmjjournals.com/cgi/content/full/333/7557/10

THE ETHICS OF SHARED ELECTRONIC PATIENT RECORDS

The NHS is planning to make patients' health records more easily accessible using a network of integrated databases.  An editorial in the BMJ – 1st July 2006 - points out that easier access to medical data from a single resource shared by everyone also makes patients vulnerable. Patient records contain sensitive private information that can, if not handled correctly, harm the patient. Should all citizens by default be included in the new electronic records service with the possibility to "opt out" if they prefer, or should people be asked to "opt in" only if they want to? The Royal College of General Practitioners strongly recommends "opt in" with reference to the ethical principle of informed, explicit consent, whereas Connecting for Health, the agency building the new electronic records service, recommends "opt out”.  To read more go to http://bmj.bmjjournals.com/cgi/content/full/333/7557/2


NICE DRAFT GUIDELINES ON CARE DURING LABOUR

Draft  NICE guidelines, published 23rd  June 2006,  set out recommendations on good quality care during labour. The guidelines support choice for women in deciding where to have their baby and set out the information they should be given to help them choose. They aim to make birth as normal as possible, by reducing unnecessary medical interventions, and as safe as possible for mother and baby, by making sure that all the risks are understood and properly managed.

The draft guidelines set out a three-pronged strategy recommending that:

• Women should be able to choose where they give birth.  To support them in this choice they should be given full information about all the risks and benefits of all places of birth. This will allow them to make a fully informed decision about which setting is right for them and their babies.

• Service providers, midwives and doctors, and the organisations they work for, need to agree robust arrangements to provide appropriate care in all settings for birth, within a governing framework. This should include protocols which cover what to do if there is cause for concern about the mother or her baby, or if an emergency arises.

• The outcomes for mothers and babies in different settings should be monitored at a national level so that the information currently available is improved for the future.

        http://www.nice.org.uk/page.aspx?o=334415

EXPANDING DEFINITIONS OF OBESITY MAY HARM CHILDREN

According to a report in the BMJ – 17th June 2006 – a new and expanded definition of childhood overweight and obesity is expected to be established in the United States later this year.  The news is causing concerns that many healthy children may be unnecessarily labeled as having a disease. The International Obesity Task Force, set up in the mid-1990s with grants from three drug companies, aims to portray obesity as a serious medical condition and to promote better prevention and management strategies. It has a high media profile and is very influential.  Two stories – two links: http://bmj.bmjjournals.com/cgi/content/full/332/7555/1412-a
http://bmj.bmjjournals.com/cgi/content/full/332/7555/1412


WANTED SPUNKY TV DOCTOR

The ABD is in the BMJ - 17th June 2006 -  go to:
 http://bmj.bmjjournals.com/cgi/content/full/332/7555/1457


NEW TREATMENT FOR ROTAVIRUS DIARRHOEA & GASTROENTERITIS IN CHILDREN

Researchers have found that a three-day course of nitazoxanide can substantially reduce the duration of severe dehydrating rotavirus diarrhoea and gastroenteritis in children. The results are reported in THE L;ANCET online -Tuesday June 13, 2006.  Around 1 in 40 children younger than 5 years are hospitalised every year because of rotavirus diarrhea and world wide the figure is far higher, especially in poor countries.  In the trials, patients were randomly assigned either nitazoxanide or placebo twice a day for three days.  Symptoms cleared after an average of 31 hours in the nitazoxanide-treated group compared with an average of 75 hours for the placebo group.  http://www.thelancet.com

SEXUAL HEALTH FUNDING SLASHED

According to The British Association of Sexual Health and HIV (Bashh) at least 64 genito-urinary medicine (GUM) providers have been forced to abandon carefully laid service improvement plans because of the financial crisis in the NHS.  This is despite a government pledge to plough a much needed £300m into the sexual health sector.  Colm O’Mahony, GUM consultant at the Countess of Chester Foundation Trust Hospital and head of the media group at Bashh, said: ‘Two years ago we thought that finally, after 20 years, this underprivileged, under funded sector was going to be properly financed. We’ve been pleased about this for one and a half years – it’s been greeted with enthusiasm by all of us, but now we’re told there’ll be no more ring fencing and that PCTs are in terrible debt. Sexual health is still a priority, but in name only.’  Jamie Hardie, president of the Society of Sexual Health Advisers and senior sexual health adviser at Newham General Hospital’s busy walk-in GUM department, said he was ‘extremely concerned’ that current NHS financial problems meant postponement of chlamydia screening locally. He said he was worried this was going to be the pattern in other areas where chlamydia screening was due to have started. http://www.publichealthnews.com/news/showcontent.asp?id={F9F27BFC-D251-4D94-AAB1-F948C22A60A4
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HPA URGE TRAVELLERS TO TAKE MALARIA PRECAUTIONS

June 13th 2006. Following 11 deaths from malaria in 2005, the Health Protection Agency (HPA) is urging the increasing numbers of travellers taking summer holidays in destinations where malaria is prevalent to take precautions against contracting this disease. The majority of those who died took either inappropriate or no preventive drugs. This highlights the need for increased awareness amongst travellers of the importance of taking the right precautions to protect themselves against malaria. Approximately 2000 cases are diagnosed in UK travellers every year and this trend shows no signs of abating, with 1754 cases of imported malaria reported in UK travellers in 2005.
http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060608_Malaria.htm

TOO MANY PEOPLE STILL RISK SUNBURN TO GET A TAN

A new initiative to raise awareness of the dangers of over exposure to summer sunshine - The At Ri-Sk? Campaign - is launched this month (May 06) by ABD Member, Dr Chris Steele, himself a GP and skin cancer sufferer.  Working in collaboration with key Women’s Institute Federations, the campaign aims to educate and encourage partners, family and friends to support each other to aid early diagnosis and successful treatment of solar keratosis.  The survey has revealed a real reluctance to consult doctors about new marks which may appear on the skin, with two in five young adults preferring to turn to friends for advice first.

Over the past 10 years the incidence of skin cancer has doubled and as many as 70,000 people a year are diagnosed with skin cancer.  Thousands more remain undiagnosed and untreated.  Please click here to email for further information.

MIGRAINE PRESCRIPTION MEDICINE NOW AN OTC

A treatment for migraine, Sumatriptan 50mg, previously only available on prescription is now a pharmacy available medicine.  Migraine can have a substantial impact on the life of a sufferer; affecting work, family and social life.

•    Migraine affects c 1-in-7 UK adults.
•    An untreated migraine can last for up to 72 hours.
•    Sufferers compare migraine to, “being hit over the head with a sledge hammer.”
•    Up to 25 million working/school days are lost each year due to migraine.
•    Migraines are up to three times more common in women than men.
•    The class of prescription medicine, triptans, claim to treat the root cause of migraine.

For more information please click here to email.

 FPA HANDBOOK OF SEXUAL HEALTH IN PRIMARY CARE

The Family Planning Association (FPA) has launched a second edition of the popular ‘handbook of sexual health in primary care’. The handbook is aimed specifically at GPs, practice nurses and other professionals delivering sexual health services in primary care settings. It is written by experts, all specialists in their chosen field in sexual health. The resource gives evidence based guidance to practitioners on the best interventions and key messages to use in delivering the best standard of care to patients. In addition to covering subjects like contraception, abortion, sexually transmitted infections, pregnancy planning, diagnosing HIV and sexual dysfunction, other important issues are addressed.

POOR CHECKS FOR BEDSIDE BLOOD TRANSFUSION PUT PATIENTS AT RISK

According to a report in the BMJ – 20-05-06, patients having blood transfusion at the bedside continue to be put at risk of getting the wrong blood or of delayed management of adverse reactions, through misidentifications and lack of observation.  These were the conclusions from an audit of 8054 transfusion episodes from 217 UK hospitals, carried out by the Royal College of Physicians and the National Blood Service. This 2005 audit was designed to assess good practice in identifying patients before bedside blood transfusions and to check on progress in reducing risk to patients since the first audit in 2003. Good practice was defined as compliance with the 1999 British Committee for Standards in Haematology guidelines on the administration of blood and the more recent Health Service Circular 2002/009: Better Blood Transfusion: Appropriate use of Blood. In the new audit, 6% of bed-side blood transfusions were made when patients had no identifying wristbands. In 9% of those cases in which patients had a wristband, key information was missing. Common reasons for not wearing a wristband were that the patient was "well known" or that it was "not day unit policy," says the report. http://bmj.bmjjournals.com/cgi/content/short/332/7551/1171-a?etoc

DEVELOPMENT IMPROVES HEALING OF CRITICALLY DAMAGED BONE

According to a paper in The International Journal of Surgery a totally allogeneic graft material is under development that would eliminate the need for harvesting bone from patients. In experiments with rabbits in which critical size bone defects had been created, the difference in the amount of new bone formation between experimental groups was significant.  No bone formed across the control group.  Commenting on the Hong Kong research, the author of the paper said: “the significance of this work is to enrich commercially available bone matrix with an angiogenic mediator that makes it a potent bone-forming compound. Angiogensis or new blood vessel formation is critical to bone healing and growth. Therefore, whether the patient is young or old, a big part of the healing (bone induction) power can be added to the grafted material.”  http://www.journal-surgery.com

PATIENTS MUST TELL DOCTORS IF THEY USE ALTERNATIVE MEDICINES

The International Journal of Surgery has published US research that illustrates a surprisingly high number of patients use complementary and alternative medicines (CAM). Analysis of 151 consecutive general surgical patients over three months showed that 40% used some form of CAM.  The author commented: "Surgeons should check for use of alternative medical treatments, especially herbal medications, because of potential harmful interactions with anesthesia and other treatments." http://www.journal-surgery.com

 IN VIVO LAPAROSCOPIC ROBOTICS

Also reported in The International Journal of Surgery is news of research in Omaha on robotic laparoscopic surgery that is evolving to include in vivo robotic assistants inserted completely within the human body. The impetus for the development of this technology is to provide surgeons with additional viewpoints and unconstrained manipulators that improve tissue manipulation, safety and reduce patient trauma. Currently available surgical robotic systems are implemented from outside the body and will therefore always be constrained to some degree by the limitations of working through small incisions. A family of robots has been developed to provide vision and task assistance from inside the body. Fixed-base and mobile robots have been designed and tested in animal models with much success. Operations involving the removal of a gall bladder, prostate or kidney have all been performed with the assistance of these robots. These early successful tests show how in vivo laparoscopic robotics may be part of the next advancement in surgical technology. http://www.journal-surgery.com

BABY MILESTONES BY DR CAROL COOPER

A key issue for parents is knowing whether their baby’s progress is normal and healthy.  With Baby Milestones, expert advice is on hand to inform and reassure parents, and to help them bring out the best in their child.

Organized by age, with helpful progress charts for every stage, this book explains the physical, intellectual and emotional development of a young child from birth to three years.   It addresses common concerns and also covers health and safety matters.

Written by ABD Member, Dr Carol Cooper, an experienced GP and mother of three, this book follows on from the author’s previous best-selling childcare books. Price £15.

DOH ADVISE TO PATIENTS ON COSMETIC SURGERY

The Department of Health has produced an information bulletin for patients considering cosmetic surgery and non-surgical cosmetic treatments. The information is aimed at helping patients make an informed decision about whether or not to have surgery or non-surgical treatments and incorporates advice on types of procedures, qualifications of healthcare professionals, what to do if they are not satisfied with the outcomes etc
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/CosmeticSurgery/fs/en

BMJ ONLINE TREATMENT ADVICE FOR PATIENTS

The British Medical Journal (BMJ) has launched a new online health advice website, called BestTreatments.co.uk with evidence based information derived from the BMJ Clinical Evidence series.

The website provides information on symptoms, treatments, questions to ask the doctor, and current evidence on medical research for more than 120 different conditions ranging from long-term disorders such as cancer, back pain and depression, to acid reflux, wisdom teeth and infant colic. The site will be updated frequently with the most current evidence and will continue to expand on the body of information.
http://www.besttreatments.co.uk/btuk/home.jsp

GOOGLE HEALTH INFORMATION SITE

Google has launched a healthcare search engine called ‘Google Health.’ It is part of a larger vertical search product known as Google co-op, a work in progress. As one would expect, there is a strong US bias and currently there is no facility to limit search to UK sites. Users can examine results obtained from this search engine according to drug information, disease state, information for doctors and information type.
http://www.google.com/coop/topic?cx=health_devel

RASHES IN PREGNANCY - HEALTH PROTECTION AGENCY GUIDELINES

The Health Protection Agency has published advisory web pages providing an easily accessible resource for healthcare professionals.  It covers the management of women who become infected with, or are exposed to, a communicable disease during pregnancy. It addresses particularly rubella, parvovirus B19, and varicella-zoster virus infection, and gives the magnitude and degrees of risk to the foetus in terms of outcomes for the gestation at which maternal infection occurs. The guidance aims to help decision-making, has no legal status, and will be updated as and when new evidence becomes available.
http://www.hpa.org.uk/infections/topics_az/pregnancy/rashes/default.htm

EU CLAMPS DOWN ON SUNSCREEN MISINFORMATION

Sunscreens that make exaggerated claims about the amount of protection they give are to be targeted in new European Union (EU) proposals. Concern has been raised about users being mislead into staying out in the sun longer than they should and increasing the risk of developing skin cancer. In particular, the use of words such as 'sunblocker' and boasting "100 per cent anti-UVA/UVB" on sunscreen packaging would be banned, as they imply complete protection from the sun, which is an impossible claim. There are also worries about the current sun protection factor rating system, which experts say only accounts for the sunscreen's ability to prevent sunburn, not stop the harmful carcinogenic UVA rays.

ELIMINATE TRANS FATTY ACIDS AND REDUCE HEART ATTACKS

By virtually eliminating the amount of trans fatty acids in industrially produced food, between 72 000 (6% of the total) and 228 000 (19%) of coronary heart events could be averted each year in the United States.  This is the conclusion of a US and Dutch review study in the NEW ENGLAND JOURNAL OF MEDICINE (N Engl J Med 354;1601-13). The amount of trans fats in packaged snack foods, bakery products, deep fried fast food, margarine, and packaged snacks such as tortilla chips increases consumers’ risk of cardiovascular disease, coronary heart disease, and sudden death from cardiac causes, say the researchers  They go so far as to claim that “The evidence and the magnitude of adverse health effects of trans fatty acids are in fact far stronger on average than those of food contaminants or pesticide residues, which have in some cases received considerable attention.” To view the news report in the BMJ – 23rd April 2006, please click on http://bmj.bmjjournals.com/cgi/content/full/332/7547/931-b

EDUCATION IMPROVES LONG TERM CONTROL OF ECZEMA

Educational programmes targeted at specific age groups of children and adolescents improve the control of atopic dermatitis according to new German research published in the BMJ - 22nd April 2006. In a randomised controlled trial researchers delivered a weekly educational session to parents of children aged 3 months to 7 years and 8-12 years and to adolescents aged 13-18. The control group received no education. Dermatitis was significantly less severe in intervention groups at 12 months. The parents' quality of life also improved—as measured by all five quality of life subscales in parents of children aged less than 7 years and by three subscales in parents of children aged 8-12 years. http://bmj.bmjjournals.com/cgi/content/full/bmj;332/7547/933

WHY ARE PRETERM BIRTHS RISING WORLD-WIDE?

Preterm birth is a major contributor to neonatal and infant mortality. Few interventions have improved outcome, and management remains an important challenge in modern obstetrics. A Danish research paper and an editorial in the BMJ – 22nd April 2006 indicate that preterm delivery rates are increasing, which is a worrying prospect. Preterm deliveries account for fewer than 1 in 10 births but result in 75% of neonatal deaths and most neonatal intensive care admissions.  Preterm birth has considerable impact on long term future health: 1 in 4 survivors born at less than 25 weeks' gestation have severe mental or physical disability. Those born at less than 28 weeks spend 85 times as long in hospital as term babies in the first five years of life, with substantial healthcare costs. Even beyond 32 weeks, when "neurologically intact" survival is good, educational and behavioural problems occur in 1 in 3 children.  For the BMJ editorial click on http://bmj.bmjjournals.com/cgi/content/full/332/7547/924 
For the Research Paper click on
http://bmj.bmjjournals.com/cgi/content/full/332/7547/937

MOBILE PHONES DO NOT INCREASE RISK OF GLIOMA

Mobile phones are not associated with a raised risk of glioma in the short or medium term according to a paper in the BMJ – 15-04-06.  A case control study that included interviews with almost 1000 patients with a glioma found an odds ratio of 0.94 (95% confidence interval 0.78 to 1.13) for glioma for regular phone users compared with those who never or only occasionally used one. Nor was there an association of glioma risk with lifetime years of use, cumulative hours of use, or cumulative numbers of calls. http://bmj.bmjjournals.com/cgi/content/full/bmj;332/7546/883

NICE RESPONSE TO APPEAL COURT RULING ON HERCEPTIN

Commenting on the recent appeal court ruling – 12-04-06 - in Swindon, Andrew Dillon, NICE Chief Executive said: “Today’s ruling is about how Swindon PCT made their decision. It doesn’t reduce the importance of having a system for licensing drugs, to make sure we know they are safe to use, or the work that NICE does, in helping the NHS to use new drugs in the right way. Without these things, we risk exposing patients to risks and the health service to using its money unwisely. “Herceptin still isn’t licensed and it won’t be until the summer. If and when it is, NICE stands  ready to advise patients and those who care for them on the best way to use it. This will be advice for all the women who might potentially benefit from it and for all the primary care trusts who may need to make the funds available to enable its use. It’s only in this way that consistent decisions can be taken to bring an end to the uncertainty that faces both patients and the NHS.”  NICE is expecting to issue guidance to the NHS on the use of Herceptin in July 2006, subject to the drug receiving a license. NICE is actively tracking the licensing process and will be in a position to go public on its recommendations quickly once the drug has been licensed for use in the UK.  http://www.nice.org.uk

HEPATITIS C EPIDEMIC VASTLY UNDERESTIMATED BY GOVERNMENT

There are more than double the number of people infected with the hepatitis C virus (HCV) in England and Wales than the government has estimated, delegates at the British Society of Gastroenterology’s Annual Scientific Meeting were warned (Thursday 23rd March 2006). The government’s Health Protection Agency puts the figure at around 200,000.  But William Rosenberg, Professor of Hepatology at the University of Southampton, claimed that the real number is around 466,000 although it could be as high as a million.  Assuming the figure is around half million then 125,000 people will go on to develop serious liver disease which, by 2008, could be costing the NHS £123 million in liver transplants. Antiviral treatment for hepatitis C is much more successful now than it was a decade ago and patients have at least a 50:50 chance of clearing the infection.  However, 86% of people with the virus are unaware they are infected, Prof Rosenberg warned.

“Unless urgent action is taken, about 116,000 people will die early from cirrhosis caused by hepatitis C that could have been treated,” he said. “The French diagnose five times as many patients as we do and they treat 12 times as many,” said Professor Rosenberg.  “Whereas we manage to treat about 10% of those we diagnose and we don’t diagnose many.”

In France the rising tide of hepatitis C infection has been successfully reversed through anonymous HCV testing clinics and a huge public awareness campaign that has sought to destigmatise the disease, linked to effective treatment centres.  Please click here to email for more information.

PROPORTION OF BABIES BORN IN EUROPE AFTER IVF VARIES 20-FOLD

The BMJ 18-03-2006 reports that more than 2 per cent of babies born in some European countries are now the result of assisted reproductive technology. But there is an almost 20-fold variation in the proportion of babies born by such techniques overall. Denmark has the highest proportion, at 3.9 per cent of all births in 2001, and Latvia has the lowest, at 0.2 percent (International Journal of Andrology 2006; 29:12-16). The average number of treatments per million inhabitants in 2001was 829, but this varied from 49 to 1923, with the United Kingdom the second lowest at 591.
http://bmj.bmjjournals.com/cgi/content/full/332/7542/626-b

DOCTORS CALL FOR BAN ON FORCE FEEDING AT GUANTANAMO

The LANCET – 11th March 2006 reports that 263 doctors from the UK, USA, Ireland, Germany, Australia, Italy and the Netherlands are calling for the US government to abandon force feeding and the use of restraint chairs in accordance with internationally agreed standards.  The World Medical Association specifically prohibits force feeding in the Declarations of Tokyo and Malta, to which the American Medical Association is a signatory. Physicians attending hunger strikers have a responsibility to respect prisoners’ informed decision, even if they disagree. Those breaching the guidelines should be held to account by their professional bodies, state David Nicholl (City Hospital, Birmingham, UK) and colleagues in their correspondence letter.  http://www.thelancet.com/journals/lancet/article/PIIS0140673606683268/fulltext

IMMOBILISATION NOT THE ONLY TRIGGER FOR DVT

The low pressure and low oxygen environment during air travel may contribute to the
development of deep vein thrombosis in some susceptible individuals, suggests a paper published in THE LANCET – 11th March 2006.  Previous studies have found a 2–4-fold increased risk of thrombosis after air travel; with a greater risk after longer flights than after shorter ones. The mechanism of clot formation during air travel, however, is unclear. Scientists think immobilisation for long periods could play a part, but flight-specific factors may also contribute.  Investigators in the Netherlands measured the concentrations of markers of clotting activation in blood samples from 71 healthy volunteers before, during, and immediately after an 8-hour flight. To disentangle specific flight factors from immobilisation alone, they compared the concentrations in the same individuals at the same time points during 8 hours of sitting in a cinema and 8 hours of regular daily activities. 40% of the participants also had an increased risk of thrombosis, by being carriers of a mutation in the factor V gene or taking oral contraceptives. The authors found increased concentrations in markers during flight compared to the other two situations, especially in volunteers with other risk factors for thrombosis. http://www.thelancet.com/journals/lancet/article/PIIS0140673606683396/abstract

BOTTLE-FED BABIES AT RISK OF ADULT OBESITY

Bottle-fed babies are more likely to become obese children, a new UK study has claimed. It suggests that babies who are fed formula rather than breast milk and move onto solids early on consume more calories, thus experiencing weight gain as a young child. The researchers also believe that babies who are breast-fed are better at regulating their own milk intake, stopping when they have had enough – but parents feeding babies from a bottle often make sure they finish it all and do not always reduce the quantity when the child moves onto solids. Scientists at the University of Bristol claim that this increased milk intake, combined with weaning babies onto solids too early, means they are at risk of obesity as they grow older. The study examined the detailed feeding history of 900 mothers and their babies over a 14 year period. It found that babies with a high calorie intake were 50 per cent more likely to be obese at the age of three, with a 25 per cent risk at the age of five. http://www.bris.ac.uk/news/2006/926.html

DEPRESSED CHILDREN MOST LIKELY TO TAKE ECSTASY

Childhood depression may raise the chances of a teenager using ecstasy, according to new Research published in the online BMJ.  It found that children with symptoms of anxiety and depression may have an increased tendency to use ecstasy in later years. Dutch researchers followed 1,580 individuals from 1983, when they were assessed for mental health problems, to 1997 when they were questioned about ecstasy use. They found that individuals with signs of anxiety and depression in 1983 showed an increased risk of starting to use ecstasy. Although use of ecstasy may initially enhance feelings of wellbeing, they caution that over the long-term ecstasy may actually increase symptoms of depression. www.bmj.com

MRI OFFERS NEW HOPE FOR SEVERE EPILEPSY SUFFERERS

A new way of using magnetic resonance imaging (MRI) can detect minute brain lesions in sufferers of severe epilepsy, according to new Canadian research.  Investigators found that automated techniques for improving the detection of brain lesions had been overlooked by conventional radiological inspection. The findings could make surgical treatment available to more severe epilepsy patients, in cases where seizures cannot be controlled by medication. The process works by identifying key features of focal cortical dysplasia (FCD) lesions on MRI scans, such as simultaneous grey matter (GM) thickening, hyper-intense signal, and blurring of the grey and white matter (GM–WM) transition. In all patients studied, the lesion causing epilepsy had at least two out of three of the characteristics identified and 78 per cent of the patients had all three traits present in FCD lesions. The Epilepsia Journal – January 2006.

SHAM ACUPUNTURE BETTER THAN ORAL PLACEBO FOR ARM PAIN

An intriguing study published in the BMJ – 18TH February 2006 - found that treatment with sham acupuncture was more effective for arm pain than treatment with an oral placebo. The study involved 270 adult patients with arm pain due to repetitive use, who were randomised to treatment with a validated sham acupuncture device or a placebo tablet. Primary outcome was arm pain measured on a ten-point pain scale; secondary outcomes included symptom severity, arm function, and grip strength. The study was created as an offshoot of the two-week placebo run-in period for a study comparing acupuncture against sham acupuncture and amitriptyline against placebo in arm pain, and at the end of this period patients were randomised to active treatments or to continue with the sham or placebo. Patients were aware that they might receive placebo throughout the study.
http://bmj.bmjjournals.com/cgi/content/abstract/332/7538/391

MRSA SURVEILLANCE SYSTEM RESULTS

The results of the Department of Health's mandatory methicillin resistant Staphylococcus aureus (MRSA) surveillance system in acute Trusts in England are available via its website. The data on numbers and rates of MRSA bacteraemias per 1000 bed days for individual NHS acute Trusts over the period of April to September 2005 are presented, along with a summary of annual numbers for the four complete years of the surveillance system.  The total number of MRSA bacteraemias in England in April to September 2005 was 3580. The corresponding figure for the same time period in the previous four years was 3616 (2001), 3584 (2002), 3749(2003) and 3525 (2004).  The number of MRSA bacteraemias in the first four complete years of the mandatory recording system was 7247 in 2001/02, 7372 in 2002/03, 7684 in 2003/04 and 7212 in 2004/05. 
http://www.hpa.org.uk/infections/topics_az/staphylo/data.htm

PUBLIC EDUCATION WOULD END RULES PREVENTING MEDICAL RESEARCH

The public needs to know that advances in diagnostics and therapeutics are being held up by bureaucratic regulation designed to protect their privacy, states an Editorial in THE LANCET 28-01-2003.  Large databases of patients’ records are needed for important Medical research, such as that into the causes of disease. But growing concerns about privacy have spawned a great many laws and regulations governing the use of personal data, including the UK’s Data Protection Act, the EU Clinical Trials Directive, and the US’s Health Insurance Portability and Accountability Act (HIPAA). These regulations are complex and can be interpreted in different ways by researchers, which results in important and worthy projects being delayed or blocked entirely.http://www.thelancet.com


NEW BLOOD HEALTH DRINK LAUNCHED

A new type of health drink has just been launched which contains a patented natural extract from tomato, claimed to ‘smooth’ blood platelets and help maintain a healthy heart.  It is approved by the Charity Heart UK. to help keep blood healthy. Director Michael Livingston says “The role of blood clots and blood health in cardiovascular health is less clear to people than the role of cholesterol.  Cholesterol furs arteries and causes narrowing of the arteries BUT it is the thrombus or blood clot, caused by platelet aggregation (clumping together) that causes potentially fatal heart attacks and strokes.  Sirco is a scientific breakthrough in the area of heart health and it has been scientifically proven to help keep your blood healthy, benefit your circulation and so maintain a healthy heart and cardiovascular system.  As part of a healthy diet and lifestyle, products such as Sirco and cholesterol reducing products can work together in helping to maintain heart health”.  For more information, please click here to email your request..

SUDDEN INFANT DEATH SYNDROME – NEW WARNING

The number of sudden infant death syndrome (SIDS) cases that occur when a parent sleeps with their infant on a sofa has increased in recent years, according to a paper published online Wednesday January 18, 2006 by THE LANCET. The authors strongly recommend that parents avoid this sleeping environment. The risk of SIDS is higher for male, pre-term, and low birthweight infants, and those sleeping on their side or front. Smoking during pregnancy and exposure to secondary smoke after birth can also increase the risk of SIDS. In the 1991 UK campaign ‘Back to Sleep’, parents were told to put babies on their back to sleep; death rates from SIDS subsequently fell.  In the latest LANCET study, researchers at The Hospital for Children, Bristol looked at how the campaign has influenced factors that contribute to sudden infant death syndrome over the last 20 years and found that although the number of deaths in the parental bed has fallen, the number of co-sleeping deaths on a sofa has increased fourfold in recent years.

SUDDEN INFANT DEATH SYNDROME MAY BE RECURRENT

Women who have a baby that dies of sudden infant death syndrome (SIDS) have an increased risk of preterm delivery and complications in subsequent pregnancies, concludes an article in THE LANCET - 17th Dec 2005.  As these complications are risk factors for SIDS this could explain why some women have recurrent SIDS in their family, state the authors.  Researchers at Cambridge University looked at data on maternity-hospital discharge and infant deaths for over 258 000 women who had consecutive births in Scotland between 1995 and 2001.  They found that women whose previous infant died were two to three times more likely to deliver an infant who was small for their gestational age, and two to three times more likely to have a preterm delivery. Women who had babies which were small for their age or delivered preterm had a two-fold increased risk of SIDS occurring in their subsequent births.  The investigators found that the association persisted even after they took into account other possible risk factors for SIDS, such as smoking status, maternal age, and marital status.  http://www.thelancet.com/journals/lancet/article/PIIS0140673605678889/abstract

DUMMIES EFFECTIVE IN PREVENTING SID?

New research from the USA indicates that the use of a dummy seems to reduce the risk of sudden infant death syndrome (SID) and possibly reduces the influence of known risk factors during sleep.  The participants were mothers or carers of 185 infants whose deaths were attributed to SIDS and 312 randomly selected controls matched for ethnicity and age.  Use of a dummy was associated with a reduction in risk in every category of sociodemographic characteristics and risk factors examined.  The reduced risk associated with use seemed to be greater with adverse sleep conditions such as sleeping prone or on one side and sleeping with a mother who smoked.  Please click here for abstract, or here to email for a pdf..

GPs MAY HALT PROVISION OF CHILDHOOD VACCINATIONS

A survey conducted by PULSE magazine, based on the first 200 responses, has found that more than 1 in 7 British GPs is considering stopping the provision of childhood vaccinations because of a reduction in fees paid to them for immunisation services.  According to PULSE, recent changes in Government funding amounts to a pay cut of more than £5000 pounds a year for an average practice. http://www.pulse-i.co.uk/paper/

MELATONIN REDUCES CANCER RISK

A new Canadian study highlights a link between melatonin levels and cancer progression, suggesting the protein could have an influence over the spread of the disease. Through analysis of previous studies researchers found large doses of melatonin reduced the risk of death at one year by 34 per cent.  Melatonin helps regulate sleeping patterns and its natural production in the body is stimulated by darkness.  The research was instigated after earlier studies showed a link between shift work and cancer rates. Such  workers melatonin production is disrupted when they sleep during the day.  The findings are published in the JOURNAL OF PINEAL RESEARCH.  

TRAFFIC NOISE LINKED TO HEART ATTACKS

A German study has shown that there is a discernible link between chronic noise exposure and an increased risk of heart attack.  Published in the EUROPEAN HEART JOURNAL, the research suggests that the risk associated with noise appears to be linked more with the physiological effects than the annoyance it causes, though results varied between men and women.  The team have called for the noise level requiring workplace ear protection to be lowered from the current 85 decibels in Europe to between 65 and 75 decibels, particularly for those with existing cardiovascular disease.  The study involved 32 hospitals between 1998 and 2001 and more than 4,000 patients, half of them admitted with heart attacks. The Naromi (Noise and Risk of Myocardial Infarction) research discovered that general environmental noise, such as that of traffic, increased the risk of heart attack by nearly 50 per cent for men and by about three-fold for women.  A similar US study found that working in noisy environments could elevate blood pressure and heart rate. Click here to access the journal

BREASTFEEDING COULD PROTECT AGAINST GLUTEN INTOLERANCE

Breastfeeding could help mothers protect their babies against gluten intolerance, according to a new study. Research by a team at the Manchester Children's University Hospital and published in the journal ‘Archives of Diseases in Childhood,‘ 14th November 2005,  found that the longer children are breast fed the less likely they are to develop celiac disease, the intolerance to proteins found in wheat, rye and barley.  It was also found by breastfeeding during the introduction of solid foods, as well as increasing the time a baby is breastfed for, the chances of developing gluten intolerance were reduced by 52 per cent.
http://adc.bmjjournals.com/cgi/content/abstract/adc.2005.082016v1

SLEEPING PILLS MAY DO MORE HARM THAN GOOD IN ELDERLY

A meta-analysis conducted by Canadian researchers suggests that the risk of using sedatives may outweigh the benefits in elderly patients, particularly if they have additional risk factors for cognitive or psychomotor adverse events.  The investigators selected RCTs of any pharmacological treatment for insomnia taken for at least five consecutive nights in people aged 60 or over, who were otherwise free of psychiatric or psychological disorders.  The research concluded that the magnitude of improvements in sleep with sedative use are statistically significant, but small, whilst the increased risk of adverse events is statistically significant and potentially clinically relevant in older people at risk of falls and cognitive impairment.  http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38623.768588.47v1

FIRST BIRD ‘FLU VACCINE

The Health Protection Agency (HPA) reports that European Union scientists and researchers from Sanofi-Pasteur have developed the first human vaccine for the H7N1 bird flu virus. This new vaccine (‘RD-3’) is the first vaccine to be developed using a new technique called ‘reverse genetics’ and will enter into clinical trials in spring 2006. The project began in September 2001 by taking the H7N1 virus that caused outbreaks in Italian poultry in 1999 and was related to the H7N7 poultry virus in the Netherlands.  The HPA stress that the risk of H7 emerging as a pandemic influenza strain is considered quite low, but it is hoped that this research will be a valuable resource for pandemic vaccine development in the future. http://www.hpa.org.uk/hpa/news/articles/press_releases/2005/051104_flu.htm

CMO’S CONTINGENCY PLAN FOR ‘FLU PANDEMIC SUMMARISED

The British Medical Journal has featured an editorial that discusses the impact of the bird flu and pandemic flu and basically summarises key points from the Chief Medical Officers influenza pandemic contingency plan.  BMJ, doi:10.1136/bmj.38649.389005.DE (published 24 October 2005) http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38649.389005.DEv1

YOUNG DIABETIC PATIENTS WINS TRIATHLON & SPONSORSHIP

Twenty-one year old Gary Blakie, who developed Type 1 diabetes at the age of 12, has won the 2005 Triathlon World Championships in Honolulu, Hawaii.  He completed the gruelling 1.5km swim, 40km bike ride and 10km run in an impressive 2 hrs and 18 minutes.  Commenting on his success he said  “I’m not an athlete who became a diabetic – I was a kid who developed diabetes who became an athlete. My greatest motivation to overcome my diabetes has been to compete in events like this and prove to the world I can succeed and be the best I can be – it makes all the blood, sweat and tears worth while.” Because Gary is such a positive role model for other teenagers and young adults with diabetes, sanofi-aventis has agreed to provide sponsorship for his sporting activities.

The medication that keeps Gary sporting fit  is a combination of long-acting basal insulin analogue to control his background insulin levels and short-acting insulin taken at mealtimes. Gary’s diabetes had previously  been treated with a variety of insulins, but his blood sugar levels were very erratic until he was put on his new regimen.

Commenting on his treatment, Gary said, “With my old insulin I couldn’t get my best performance – if my blood sugar was too low my legs felt like jelly; too high and I felt sick. With the new regimen there are no peak periods, so the insulin supply is constant throughout the event and my performance isn’t impaired. I can push myself to the extremes. I eat better, sleep better, work better and feel better.”  Please click here to email for further details.

USEFUL AVIAN 'FLU LINKS

Keith Nockels, an Information Librarian at the Clinical Sciences Library in the University of Leicester, has compiled a webpage of useful news and resources for information on avian 'flu. Click on http://www.le.ac.uk/li/khn5/birdflu.html

'DOUBLE DEATH RATE' FOR EARLY RETIRERS

People who stop working early are twice as likely to die as people who work for longer, according to new research published in the BMJ.  The US study found that mortality rates were almost twice as high in the first ten years of retirement after 55, compared to those who continued working until 65.  It seems that the long term survival of people who retire early at ages 55 or 60 is no better than that of those who retire at 55.  In the study, mortality improved with increasing age at retirement for people from both high and low socioeconomic groups, defined according to employment grade. http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38586.448704.E0v1

MMR NOT LINKED TO AUTISIM

A large systematic review has found no reliable evidence that the MMR vaccine can trigger long-term harms such as autism or Crohn's disease. It is, however, effective in reducing the rate of the three diseases covered.  The reviewers carried out a comprehensive literature search for high-quality studies on the use of the vaccine, and located 31 (of 139) that were sufficiently robust and unbiased. Analysis of these studies found no credible evidence to link the MMR vaccine and any long-term disability, including Crohn's disease and autism. The authors also conclude that mass use of the vaccine is successful in preventing measles, mumps and rubella in the countries where it has been used, and that the lack of confidence in the vaccine prompted by unreliable evidence has caused great damage to public health. The review can be accessed via http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004407/pdf_fs.html

CHARITY SLAMS SEXUAL HEALTH PRIVACY BREACH

Allowing social workers and police access to the confidential sexual health files of teenagers may make them reluctant to seek sex advice, says the health charity Brook.  It has launched a campaign (October 19th 2005) in response to reports that the government is considering giving police and social workers access to teen sexual health files in an attempt to improve child protection measures.  Brook believes that breaching the confidentiality of files could have the opposite effect to the one desired, as young people will become afraid of being 'found out' if their files lose their confidential nature.  Click here to email for further information.

RA DRUG PROVES EFFECTIVE AGAINST PSORIASIS

A rheumatoid arthritis drug can successfully treat moderate to severe cases of psoriasis, according to the results of a randomised trial published in THE LANCET – 15th October 2005. Manchester researchers recruited 378 patients with moderate to severe psoriasis to intravenously receive infliximab or placebo at 0, 2, and 6 weeks, then every 8 weeks until week 46. The researchers assessed signs of psoriasis using the psoriasis area and severity index (PASI) and nail psoriasis severity index (NAPSI). They found that at week 10, 80% of patients treated with infliximab achieved at least a 75% improvement from their baseline PASI, and 57% achieved at least a 90% improvement, compared with 1% and 3% in the placebo group. The investigators also found that the positive effect of the drug was sustained through to week 24 and up to week 50 for most patients. A quarter of the patients taking the drug had complete clearing of skin psoriasis (PASI of 0) compared with none in the placebo group.  Patients receiving infliximab also experienced a good response in nail psoriasis, which is present in 20–50% of psoriasis patients and is often thought of as sign of treatment-resistant disease. By week 24 of the trial, those receiving the drug were experiencing a 56% average decrease in this condition, and this response was maintained throughout the trial.  http://www.thelancet.com/journals/lancet/article/PIIS0140673605675666/fulltext

PRE-ECLAMPSIA RECURS ACROSS GENERATIONS

According to a paper in the BMJ - 15th October 2005 - increased risk for pre-eclampsia is genetically transmitted from both mother and father. Studying a population based cohort, researchers examined almost 500 000 mother-offspring units and almost 300 000 father-offspring units from the Norwegian medical birth registry. Women born from pre-eclamptic pregnancies were more than twice as likely to develop pre-eclampsia themselves than other women, while the corresponding increased risk in pregnancies fathered by a man who was born from a pre-eclamptic http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7521/877

BCG VACCINE EFFECT AGAINST TUBERCULOSIS INFECTION AND DISEASE

BCG vaccination can protect children from tuberculosis (TB) infection as well as active TB disease, according to a study published online in THE LANCET -Thursday October 13th  2005.  There are about 10 million cases of TB globally each year and 1 in 3 people are infected with the TB bacterium.  According to the report, BCG is the most widely used vaccine worldwide, but its mechanism of protection is poorly understood. It is thought to prevent progression of infection to active TB, but whether it protects against the acquisition of infection itself has not been investigated in humans. The effect of BCG vaccine has been difficult to ascertain because, until recently, the century-old tuberculin skin-prick test (TST) was the only method for detecting infection.  However, TST cannot reliably distinguish between TB infection and BCG vaccination. In the study reported in THE LANCET researchers used the more accurate T-cell based blood test called the ELISpot and TST to assess infection.  UK researchers investigated risk factors for TB infection in 979 children from Turkey. All children taking part shared a household with at least one adult with TB. 770 of the children had a BCG scar. The researchers found that the absence of a BCG scar was a strong, independent risk factor for infection in TB-exposed children, while the presence of a BCG scar was associated with a 24% reduction in risk of being infected. The authors state that this finding furthers our understanding of the biology of TB transmission and has important implications for the development of new TB vaccines.  “Contrary to prevailing theory that BCG vaccination protects only against tuberculosis disease, the results suggest that the vaccine also protects against tuberculosis infection.  Children can be protected against TB infection by vaccination and this opens a new door for the development of new, improved vaccines.”  http://www.thelancet.com.

EARLY STAGE BREAST CANCER PATIENTS TO GET HERCEPTIN

According to the Department of Health, henceforth all women diagnosed with early stage breast cancer will be tested for suitability for treatment with Herceptin (trastuzumab). Apparently, of the 35,000 women diagnosed with breast cancer each year, about 20,000 will be suitable for HER2 testing.
http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases
/PressReleasesNotices/fs/en?CONTENT_ID
=4120630&chk=eihnMJ

SCIENTISTS MAKE IMMUNITY BREAKTHROUGH

A method of dramatically boosting the human immune system, which could lead to improved cancer treatments, has been discovered by researchers in the US.  While researching the immune system responses of healthcare workers accidentally exposed to HIV and had then received antiretroviral therapy (ART) they discovered that ART dramatically increases the production of cells from which the immune system makes disease-attacking T cells.  Furthermore, none of the healthcare workers involved developed HIV infections.  One of the potential uses envisaged is to use the ART treatment as a way to use tumour components to immunize cancer patients against their own cancer cells.  However, the real challenge in immunotherapy is to generate T cells able to identify cancer cells and kill them and not be deceived into ignoring them as acceptable versions of normal cells.

EXERCISE IN MIDLIFE COULD REDUCE THE RISK OF DEMENTIA

Being physically active in midlife could decrease a person’s risk of dementia and Alzheimer’s disease (AD) later in life, concludes an article published online - Tuesday October 4 2005) by THE LANCET NEUROLOGY.  Swedish researchers randomly selected 1449 people aged 65–79 who had been surveyed about their leisure-time physical activity in 1972, 1977, 1982, and 1987 to take part in the study. The investigators re-examined the participants in 1998 and found that individuals participating in leisure-time physical activity at least twice a week had a 60% lower odds of AD compared to sedentary people (individuals participating in physical activity less than twice a week). The active group had 50% lower odds of dementia compared to the sedentary group. The researchers also found that in individuals who are genetically susceptible to AD (carriers of the gene variant APOE _4), physical activity had more pronounced effects against developing dementia or AD in later life.
http://www.thelancet.com/journals/laneur/article/PIIS1474442205701988/fulltext

STUTTERING CAN BE TREATED BY EARLY INTERVENTION
 
Early intervention in the preschool years is effective in treating stuttering, according to a paper published in the BMJ – 24th September 2005.  In a pragmatic, open plan, randomised trial of 54 children, Australian researchers found that children who were treated on an early treatment programme, had significantly fewer stuttered syllables after nine months than children in the control group.  The paper states that although some children who stutter in their preschool years improve without treatment, identifying them in advance is impossible. Treatment should begin in the preschool years because it is more effective then. http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7518/659

RESISTANCE TO ANTI-FLU AGENTS INCREASING WORLDWIDE

Worldwide resistance to drugs used to treat influenza has increased by 12% since the mid nineties, concludes a report published online (Thursday September 21, 2005) by THE LANCET. Adamantanes have been used to treat influenza A virus infections for more than 30 years.  However, in the largest study of adamantane resistance to date, US researchers screened 7000 influenza A isolates for gene mutations known to confer drug resistance. They found that drug resistance increased from 0•4% in 1994–1995 to 12.3% in 2003-2004. They also found that 61% of resistant viruses isolated since 2003 were from people in Asia. Some Asian countries had drug resistance frequencies exceeding 70%.  This is thought to have broad implications for agencies and governments planning to stockpile these drugs for epidemic and pandemic strains of influenza.  Researchers suggest that with the increasing rates of resistance shown in the new research, amantadine and rimantadine will probably no longer be effective for treatment or prophylaxis in the event of a pandemic outbreak of influenza.  http://www.thelancet.com


FLU VACCINES HAVE MODEST EFFECTIVENESS IN ELDERLY PEOPLE

Vaccines against influenza are modestly effective for elderly people in long-term care,
but for those in the community their effectiveness is even less, according to an Italian study published online in THE LANCET - September 21, 2005.  The research concludes that a more comprehensive and perhaps more effective strategy in controlling acute respiratory infections, relying on several preventive interventions that take into account the multi-agent nature of infectious respiratory disease and its context (such as personal hygiene, provision of electricity and adequate food, water and sanitation). http://www.thelancet.com

WOMEN URGED TO TAKE VITAMIN D

A new campaign urging women to take more vitamin D to prevent osteoporosis has been launched (September 2005) after research revealing that 97 per cent of hip fractures occur because of brittle bones.  The campaign, launched by the charity Women's Health Concern (WHC), encourages women to take Vitamin D supplements, claiming that otherwise they would have to eat nine eggs or drink thirty litres of milk to get the recommended daily amount.  The campaign coincides with the launch of a new once-a-month brittle bone treatment called Bonviva, devised to tackle post-menopausal osteoporosis.  Click here to email for more information.

MENTAL HEALTH COMPULSION WARNING

The Government has hugely underestimated the number of people who would undergo compulsory community-treatment should the new mental health bill become law, according to a newly published King's Fund study.  Over the next 10 to 15 years the number of people with mental health problems placed under community-treatment orders may reach several thousands.  The report claims that the Department of Health estimated this figure to start off at just 1,400, since it did not take into account the year-on-year increases that are likely to occur.  According to the mental health charity, Mind, numbers are predicted to be 13,000 or more – ten times the Government estimate.  This could mean, according to the charity, that far too many people will be swept up into compulsory treatment in the community.  Please click here to email for further details.

COPD DEATHS POISED TO OVERTAKE BREAST CANCER

Announcing the results of an NOP survey commissioned to launch The British Lung Foundation’s  new COPD campaign (September 13th 2005), the BLF warns that chronic obstructive pulmonary disease is about to overtake breast cancer as the UK’s fourth biggest killer of women.  Of the 1000 women surveyed, only one per cent ranked COPD as their main health worry.  This percentage was only slightly higher among women who smoked despite the fact that they are at 13 times greater risk of the condition.  The majority of women, the survey revealed, do not even realise that COPD is life threatening and are far more concerned about diseases such as ovarian and cervical cancer, even though they kill just a fraction of the number who die from COPD.  It is now the only major cause of death in women that is rising sharply.  http://www.lunguk.org

CHRONIC STRESS PROTECTS FROM BREAST CANCER

Exposure to chronic stress protects women from breast cancer, probably by impairing endogenous synthesis of oestrogen. A prospective cohort study published in the BMJ – 10th September 2005 - involving 6689 women, showed that women with high levels of stress had a 40% lower risk of getting first time primary breast cancer. Moreover, the researchers found a dose-response relation, and the protective effect of stress was more pronounced in women receiving hormone therapy. Still, the cumulative consequences of stress on health may be disadvantageous, authors warn. http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7516/548

VOCABULARY TEST TO SPOT EARLY ALZHEIMER’S DISEASE

A simple vocabulary test could improve early diagnosis of Alzheimer's disease; a new British study has shown.   It seems that people routinely forget seldom-used words when they enter the initial stages of the disease. Researchers asked 96 Alzheimer's patients and 40 similarly aged healthy volunteers to list as many animals as possible in one minute. They were then asked to list types of fruit in the second minute. Evidence of a shrinking vocabulary in Alzheimer's patients was clear. They could only list between ten and 15 types of animal or fruit on average, while the healthy controls reached 20 to 25.  The results were given at the British Association’s recent Festival of Science in Dublin.

CHICKENPOX IN PREGNANCY AND THE NEWBORN

The September edition of DRUG AND THERAPEUTICS BULLETIN deals with chickenpox (primary varicella virus infection) in pregnancy.  The infection can lead to severe maternal illness and it appears five times more likely to be fatal than in non-pregnant wormen.  The bulletin reviews the risks and key aspects of diagnosis and further management of varicella infection in pregnancy and the neonatal period.  Click here to email for more information, or go to http://www.dtb.org.uk

THIRD OF PATIENTS CANNOT BOOK WITH GP

A new report by the Healthcare Commission has found that 30 per cent of GP patients could not arrange an appointment more than three days in advance.  Their research has also revealed that 12 per cent of patients were unable to see a GP within two working days, although the vast majority said they were happy with the care they received.   In response, Government has announced new measures guaranteeing patients the choice of booking an advance appointment, saying that not allowing them to do so was "unacceptable".

DOH URGE HEALTH PROFESSIONALS TO HAVE ‘FLU JAB

October 3rd 2005 is launch date for the Department of Health’s ‘flu campaign. This year they will be targeting health professionals directly involved in patient care, as well as vulnerable members of the public.  The need to encourage the profession in this way has been highlighted by new research indicating that only 16% of health professionals were vaccinated last year.  All medical professionals as well as people who have serious respiratory, heart, liver or renal disease, diabetes or anyone who has lowered immunity as a result of disease or treatment and all those aged over 65 are all entitled to a free jab.  Please click here to email for background on this year’s ‘flu campaign.

HYPERTENSION CAN BE MONITORED BY PATIENTS

The BMJ – 3rd September 2005 – reports on a trial of patients with hypertension which indicates that self blood pressure monitoring is effective.   Over 400 people were randomised in eight general practices in south Birmingham to the self monitoring intervention or usual practice. After one year, no differences in systolic or diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs were found between the groups, and patients who self monitored lost more weight, rated self monitoring better than being monitored by a doctor or a nurse, and consulted less often.  http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7515/493

CHRONIC PAIN IS POORLY MANAGED

A fifth of adults in Europe have moderate to severe chronic pain, and in many cases their symptoms are inadequately managed, says a recent study in the European Journal of Pain, published online and reported in the BMJ – 3rd September 2005.   The authors say that the problem needs to be taken more seriously by health care providers and those responsible for health care policies and allocations of resources. http://bmj.bmjjournals.com/cgi/content/full/331/7515/476-a?etoc

CLINICAL EFFECTS OF HOMOEOPATHY ARE PLACEBO EFFECTS

The evidence for a specific effect of homoeopathic remedies is weak, according to an article THE LANCET – 27th August 2005.  The authors conclude that the clinical effects of homoeopathy are compatible with placebo effects   Researchers in Switzerland compared 110 placebo controlled, randomised trials of homoeopathy with 110 conventional-medicine trials matched for disorder and type of outcome.  When the analysis was restricted to large trials of high quality there was no convincing evidence that homoeopathy was superior to placebo, whereas for conventional medicine an important effect remained.  A LANCET editorial comments ‘Now doctors need to be bold and honest with their patients about homeopathy’s lack of benefit, and with themselves about the failings of modern medicine to address patients’ needs for personalised care. http://www.thelancet.com

MENTAL HEALTH OF UK HOSPITAL CONSULTANTS IN DECLINE

The prevalence of poor mental health and burnout among hospital consultants in the UK
increased in the period 1994 to 2002, according to a Research Letter in THE LANCET (27TH August 2005).  In 1994, the Cancer Research UK London Psychosocial Group surveyed over 800 UK hospital consultants and found a 27% prevalence of poor mental health. The respondents were from five specialties: gastroenterology, radiology, surgical oncology, clinical oncology, and medical oncology. In 2002, the researchers re-assessed the situation and found that the proportion of consultants with psychiatric illness increased to 32% in 2002. The prevalence of burnout also increased from 32% in 1994 to 41% in 2002.

The survey revealed that an increase in job stress, unmatched by a comparable increase in job satisfaction accounted for the deterioration in mental health over this time period. The researchers found that clinical oncologists had the greatest increase in the prevalence of poor mental health and burnout compared with the other specialties. The authors state that approaches designed to reduce consultants’ workload and enhance their job satisfaction are urgently needed. 

The author of the report, in an unpublished comment, concludes “There seems to be several underlying reasons for this worrying development. It appears in part due to increased stress from being poorly resourced and having responsibility for the quality of the work of other staff, together with trying to meet the expectations of relatives. On top of this, these consultants have an enormous workload coupled with insufficient levels of satisfaction from some areas of their work.

 “The changes that have occurred in the NHS over the 8-year period aim to benefit patients, but appear to have a negative effect on the working lives of consultants.”

An accompanying comment suggests that if the direction and ethos of restructuring of the NHS continue unaltered, consultants will have to adopt to leave the NHS or to compromise their professionalism.”  http://www.thelancet.com

IMPROVING SERVICES FOR CHILDREN WITH CANCER

The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Cancer (NCCC) have today launched guidance which aims to standardise services for children and young people with cancer in England and Wales. Each year in the UK there are approximately 1500 new cases of cancer diagnosed in children under the age of 15, according to the United Kingdom Children’s Cancer Study Group (UKCCSG). Overall survival rates for children are now approximately 70%. This guidance, the seventh in the Improving Outcomes in Cancer Series, provides recommendations for children from birth and young people in their late teens and early twenties presenting with malignant disease, and the whole range of NHS services required to meet their needs.  Key recommendations include:

• All care for children and young people under 19 years old must be provided in age-appropriate facilities.

• All children and young people must have access to tumour specific or treatment-specific clinical expertise as required.

• All aspects of care for children and young people with cancer should be undertaken by appropriately trained staff.

• Appropriately skilled, professional key workers should be identified to support individual children and young people, and their families.  http://www.nice.org.uk/page.aspx?o=269306

ARTHRITIS REPORT REVEALS POOR PATIENT SUPPORT IN PRIMARY CARE

Arthritis Care has published a new report – August 18th 2005 - highlighting the plight of patients concerned about the safety of arthritis drugs. It reveals that fewer than four in ten people with osteoarthritis (OA) are happy with their current medication. 

The charity is calling on GPs to complete reviews for all OA patients within six months rather than working to current government guidance which means that many have to wait over a year for a review of their arthritis and medications.

The report also reveals how the pain of OA impacts people’s everyday lives. Almost half of those surveyed and currently receiving pain relieving medication are in pain most or all of the time. Their pain impacts on a range of activities from household tasks to social activities. 80 per cent of the people surveyed said they wake up at least once during the night because of pain.

Because deciding on the right medication isn’t a black or white decision, Arthritis Care believes that involving patients in the decision making with regular consultations and reviews of treatment should be standard good practice.  This view is endorsed by ABD Member, Dr Mike Smith, a GP who has written extensively on arthritis:  Commenting on the report, he said:

“People with long-term conditions such as OA should be able to sit down regularly with their GP and talk about how their condition is affecting their lives, as well as the risks and benefits of any medications they are taking.”  Furthermore, he went on to emphasise that when there is a public debate about the safety of particular medicines, patients should be invited in for consultation and not just left to wait for the next annual review.  Living with Arthritis – a spotlight on the continuing impact of chronic osteoarthritis pain, was published 18th August 2005. To email for more information, please click here.

PATIENTS GUIDE TO UNDERSTANDING ECZEMA TREATMENT

Consultant Dermatologist and ABD Member, Dr Sarah Wakelin has just published YOUR GUIDE TO ECZEMA as part of the Royal Society of Medicine's 'Your Guide’ series of easy to read information for the general public.  It covers all types of the condition and its treatment including new topical agents and a chapter on allergy tests.  Price: £8.99 from Hodder Arnold, ISBN 0-340-90498-4.  Cost includes a 50p donation to the National Eczema Society.  For more information, please click here to email.

GUIDE FOR MANAGING COPD IN PRIMARY CARE

The British Lung Foundation (BLF) has launched a new resource to provide GPs with practical guidance on managing COPD. The treatment protocol collates recommendations from the British Thoracic Society (BTS) and NICE into a step-wise, evidence-based approach to treating the symptoms and preventing exacerbations.  It is hoped that by bringing together the key steps for primary care, patients will have their conditioned managed more proactively.  Please click here to email for more information.

COGNITIVE BEHAVIOUR THERAPY FOR IRRITABLE BOWEL SYNDROME

The BMJ – 20th August 2005 – has the results of a randomised controlled trial which found that in patients with irritable bowel syndrome (IBS), cognitive behaviour therapy (CBT) provided by primary care nurses gave more benefit than mebeverine only for up to 6 months. However, the effect was reduced after one year. The trial was conducted in 10 general practices in London and involved 149 patients with moderate or severe IBS resistant to mebeverine.  http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7514/435

BUG BUSTING KIT OF COMBS INCREASES ERADICATION OF HEAD LICE

The Bug Buster kit of fine tooth combs, used over two weeks, more effectively eradicates head lice than a single treatment of pediculicides malathion and permethrin bought over the counter.  The BMJ – 13th August 2005 reports on a single blind randomised controlled trial of 133 people aged 2-15, recruited through general practices, pharmacies, and primary schools.  Eradication rates at two to four days after the end of treatment were assessed. . Of those who used the Bug Buster kit 57% had no lice or eggs compared with 13% using pediculicides (relative risk 4.4%, 95% confidence interval 2.3 to 8.5%). The Bug Buster regimen comprises four sequential combings on wet, conditioned hair, three days apart. http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7513/384

LIQUID DETERGENT TABLETS POSE EYE INJURY RISK TO CHILDREN

Liquid tablet forms of washing detergent pose a new household risk to children, state the authors of a letter in THE LANCET 13h August 2005.  A Dublin hospital treated six children, over a 6-month period, with alkali eye injury caused by a liquid detergent tablet.  The children, aged 18 months to 3 years, had squeezed a tablet causing it to burst and spray detergent over their eyes. The children presented with damage to the cells lining the cornea, and four had significant injury to the conjunctiva. All patients were admitted to hospital and stayed for 2 to 5 days. The damaged eye cells eventually healed. The authors note that more serious damage may have resulted if the children had not had prompt irrigation of their eyes after the chemical splash.  The letter states that “Alkali eye injuries are potentially the most severe form of chemical eye injury.  Although the detergent packaging displays a warning that the contents are irritant, and that the products should be kept out of reach of children, the real risk of injury posed may not be appreciated by consumers. We propose that the warning label should be more obvious, and that the packaging should be modified to make it child proof.”
http://www.thelancet.com/journals/lancet/article/PIIS014067360567095X/fulltext

SUPPLEMENTS DON'T PROTECT THE ELDERLY FROM INFECTIONS

According to a trial published in the BMJ – 6th August 2005 - multivitamin and multimineral food supplements don't seem to protect elderly people from infections or improve their quality of life.  The double blind controlled trial randomised 910 people aged over 64 to supplementation or placebo. They found no significant differences in frequency of attending primary care for infection, antibiotic prescriptions, hospital admissions, adverse events, compliance, self reported days of infection, and quality of life. http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7512/324

BREAST CANCER SCREENING DOES NOT SAVE LIVES?

Reported in the BMJ – 6th August 2005 - a US study indicates that breast cancer screening in "real world" situations is not effective in preventing mortality.  The study, one of the largest completed to date looking at the effectiveness of breast cancer screening, was published in THE JOURNAL OF THE NATIONAL CANCER INSTITUTE (2005;97: 1035-43)[  It  looked at the history of screening in the three years before their diagnosis of cancer in 1351 women who died of breast cancer between 1983 and 1998. They compared these screening rates with those in a control group of 2501 cancer-free women, matched for age (40-49 years or 50-65 years) and risk of developing cancer (average risk or greater risk because of family history or a breast biopsy.)  The women were enrolled in six well regarded health plans throughout the US.  The screening was by clinical examination alone, mammography alone, or clinical examination and mammography. Mortality did not differ according to type of screening.  However, although the study showed no advantages for breast screen programmes, the researchers still recommended screening.  An accompanying editorial comments that breast cancer screening in the community may be less effective than in controlled trial situations because of problems implementing programmes.  Click here to view the paper.

NATIONAL BOWEL CANCER SCREENING

Government announced plans – 3rd August 2005 - for a national bowel cancer screening programme, to be phased in from April 2006. Men and women aged 60-69 years old will be screened every two years. The programme will cost £37.5 million in its first two years of roll-out.  Home testing kits will be sent to around two million people in the target group each year to enable them to do the test in the privacy of their own homes.  Click here for more information.

HORMONE THERAPIES BRANDED AS CARCINOGENIC

According to a report in PHARMATIMES, the World Health Organisation's International Agency for Research on Cancer (IARC) has branded combination oestrogen with progestogen products as "carcinogenic to humans." However it consider there to be both beneficial and adverse effects which should be discussed on an individual basis.  The IARC says ‘there is a small increase in the risk of breast cancer amongst users of oral contraceptives, while the risk of cervical cancer increases with duration of use, and liver cancer is also more prevalent in long-term users. However, OCs decrease the chances of developing both endometrial and ovarian tumours’.  For menopausal therapy it adds, ‘the risk of breast and endometrial tumours are raised and increase with duration of use, and there was no evidence to suggest HRT is protective at any site’.
http://www.iarc.fr/ENG/Press_Releases/pr167a.html

ANTI-SOCIAL BEHAVIOUR SMOKING RISK

Mothers who smoke during pregnancy face an increased risk of anti-social behaviour in their children according to new research from the Institute of Psychiatry.  A small but significant independent link between smoking during pregnancy and antisocial behaviour has been found.  The study, published in the British Journal of Psychiatry, also found a link with attention deficit hyperactivity disorder .  Click here for more information.

HEALTH COMMITTEE WARNS OF POTENTIAL DANGERS OF SOYA

The BMJ 30th - July 2005 - reports that the Israeli health ministry has recommended that the consumption of soya products be limited in young children and avoided, if possible, in infants.  They also advise that adults should eat soya only in moderation, pending future studies. Because the research showing problems from soya, which include  a higher risk of cancer and male infertility, is based on animal or retrospective human studies, the recommendations are precautionary. Soya consumption is high in Israel, and use of soya based baby formula is among the world’s highest per capita due to a number of reasons, most prominently kosher food practices. http://bmj.bmjjournals.com/cgi/content/full/331/7511/254-a?etoc

BETA-BLOCKERS INEFFECTIVE ON HEART PATIENTS?

According to a report in the NEW ENGLAND JOURNAL OF MEDICINE – July 28 2005 - new research casts doubt on the practice of giving heart patients beta-blockers before and after major surgery.  It suggests that the drugs may even be harmful to low risk heart patients who, were significantly more likely to die.  However, the research supports the continued use of beta-blockers for high-risk patients having surgery.  The US research analysed medical records of about 664,000 patients with a history of heart-related problems and who were having non-cardiac surgery in 2000 and 2001. They found that in a sample of that group, low-risk patients who received beta-blockers had a 43 per cent increased risk of death. Specialists say two ongoing trials should help further determine whether beta-blockers pose any risk to low-risk patients.  http://content.nejm.org/cgi/content/abstract/353/4/349?

ECHINACEA INEFFECTIVE FOR PREVENTING COLDS

Another report in THE AMERICAN JOURNAL OF MEDICINE -  21ST July 2005 -  suggests that echinacea is ineffective for preventing or treating the common cold.  In this study, researchers evaluated the effect of chemically defined extracts from Echinacea angustifolia roots on rhinovirus infection. Three preparations of echinacea, with distinct phytochemical profiles, were produced by extraction from E. angustifolia roots. They were tested on 437 volunteers randomised to either prophylaxis (starting 7 days before the virus challenge) or treatment (beginning at the time of challenge) with one of these preparations or with placebo.  Data for 399 volunteers challenged with rhinovirus type 39 and observed for five days showed no statistically significant effects of the three echinacea extracts on rates of infection or severity of symptoms. Furthermore, there were no significant effects of treatment on the volume of nasal secretions, on polymorphonuclear leukocyte or interleukin-8 concentrations in nasal-lavage specimens, or on quantitative-virus titre.
http://content.nejm.org/cgi/content/abstract/353/4/341

A  PATIENT-LED NHS WILL NOT IMPROVE HEALTH

 Government’s plans for improving the NHS by making it patient-led and encouraging patients to complain more will not lead to better health, states an editorial in THE LANCET - 30TH July 2005. Treating patients’ feedback in the same way as supermarkets treat customer complaints fails to address the far more difficult issue of strengthening the patient-doctor partnership.  The editorial comments:

“Patients have a wealth of information at their fingertips through the internet. What most do not have, however, is the skill and knowledge to sift useful and valid information and evidence from useless or harmful advice. In a mutually beneficial and effective patient-doctor partnership, medical expertise and knowledge need to be an accepted and valued part of that interaction, just as much as doctors need to have the time and skills to communicate preventive measures and treatment choices to patients appropriately. Patients do not need to complain more. Instead, doctors and patients need to listen to one another more. Naked consumerism will not lead to better health.” www.thelancet.com

PROF MEADOW VERDICT COULD PUT CHILDREN AT GREATER RISK OF ABUSE

The verdict of serious professional misconduct given by the GMC against Professor Roy Meadow last week was not only unjust but will also profoundly damage the future of child protection services in Britain, states a comment in THE LANCET - 23rd July 2005. Richard Horton, Editor, writes that the real danger of the judgment against Prof Meadow is that, by worsening the professional conditions in which child protection services are provided, children will be put at greater risk of abuse and murder. He argues that the GMC's decision removes any incentive for the reform of judicial procedures that fail to deal properly with expert evidence. He states that trainee paediatricians are now less likely to seek a career in child protection, while those in the field may weaken their conclusions about alleged child abuse in court to avoid the aggressive and improper intrusion of the GMC into their work. Horton also accuses the GMC of making an unfair example of Prof Meadow in the wake of the Harold Shipman case in order to protect its own status. He writes: "Many doctors today believe that the GMC is acting more out of self interest than public interest. It is impossible to put into words the low esteem with which the GMC is currently held by many among the rank and file of medicine in the UK today. This is not only bad for doctors; it is also bad for patients." Dr Horton adds: "The real danger of the judgment against Meadow is that, by worsening the professional conditions in which child protection services are provided, children will be put at greater risk of abuse and murder." The lamentable judgment against Prof Meadow is further evidence that this is so. He now has 28 days to appeal the GMC's verdict. On behalf of children and his colleagues working in paediatrics and child protection everywhere, he should certainly feel encouraged and supported in challenging this perverse determination. Justice has yet to be seen to be done in this case." http://www.thelancet.com

ALWAYS READ THE LEAFLET CAMPAIGN

The Medicines and Healthcare products Regulatory Agency (MHRA) and the Committee on Safety of Medicines (CSM) Patient Information Working Group have launched the report "Always read the leaflet - Getting the best information with every medicine". The report is unveiled as part of a programme of talks and workshops launched by the Department of Health's head for Patients and the Public. The report is the culmination of work since 2003 in response to concerns about the quality of patient information leaflets (PILs) and their perceived failure to meet the needs of patients. The report focuses on strategies to improve the quality and accessibility of medicine information and addresses risk communication (empowering patients to understand risks and benefits associated with medicines). It also delivers new guidance and recommendations that will help improve the quality of PILs to benefit patients. http://medicines.mhra.gov.uk/inforesources/publications/Alwaysreadtheleaflet.pdf

VITAMIN A WARNINGS FOR PREGNANT WOMEN IGNORED

An investigation by Oxfordshire county council's trading standards department and birth defects charity BDF Newlife has revealed that many supplements fail to warn of the risk of taking vitamin A in pregnancy. After assessing 60 multivitamin products available between November 2004 and March 2005, the researchers found one third of the supplements did not carry vitamin A warnings. The trading standards department and BDF Newlife are calling for compulsory vitamin A warnings on all multivitamin products. According to the Chief Executive Officer of BDF Newlife, most women eating a balanced diet do not need a vitamin A supplement, unless advised by a doctor or antenatal clinic. They should also avoid vitamin A rich foods, such as liver, kidney, oily fish, diary products and eggs. http://www2.netdoctor.co.uk/news/index.asp?id=119818&D=20&M=7&Y=2005

NICE DELAYS DECISION ON ALZHEIMER'S DRUGS

The National Institute for Health and Clinical Excellence (NICE) has requested more evidence from pharmaceutical companies before publishing the final draft of its review of donepezil, rivastigmine, galantamine and memantine for the treatment Alzheimer's disease. The Institute's Appraisal Committee met on 1 June to consider feedback on the first draft consultation from stakeholder organizations, together with feedback from individual clinicians and the families, friends and carers of those with Alzheimer's disease. At this meeting the Committee agreed that, "based on the evidence currently available, and having taken full account of the response to consultation, they could not change their original conclusion". This means that NICE has not issued new guidance to the NHS on the use of donepezil, rivastigmine, galantamine and memantine for the treatment of Alzheimer's disease, and until final guidance is issued the existing NICE guidance no. 19 continues to apply. Responses to the request for further information will be considered by the Appraisal Committee in October 2005

LUNG CANCER MORTALITY IS DECLINING IN MEN BUT NOT WOMEN

The BMJ reports - 23rd July 2005 that mortality due to lung cancer is now declining in middle aged men in all new European Union states as well as most of the old ones, but it is still increasing among women, reflecting earlier trends in tobacco exposure. The research reported shows trends in age standardised mortality due to lung cancer in the 35-54 age group for all EU member states. The authors emphasise the continuing need for strong antismoking programmes for both sexes. http://bmj.bmjjournals.com/cgi/content/full/bmj;331/7510/189

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