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Press releases Saturday 11 January 1997
Embargo: Friday 10 January 00.01 Hrs

Childhood Leukaemia link with playing on beach near nuclear reprocessing plant

[Case control of leukaemia among young people near La Hague nuclear reprocessing plant: the environmental hypothesis revisited]

Evidence that playing at the beach near La Hague nuclear reprocessing plant, France, is causally linked with leukaemia in local children appears in this week's BMJ.

In recent years there has been considerable scientific interest and public concern in leukaemia clusters around nuclear installations but the reasons for the increased incidence remain unknown. La Hague on the Normandy coast is one of the world's three nuclear reprocessing plants operating on an industrial scale - the other two are Sellafield and Dounreay in Britain.

Research by Dr Jean-Francois Viel and Dr Dominique Pobel investigated the association between risk factors and childhood leukaemia in 27 cases in the La Hague area compared with 192 matched "Controls" (similar children without the disease). While no link was found with either mothers' or fathers' occupational exposure to radiation, the authors report that some lifestyle factors are associated with the development of leukaemia among young people. This suggests contamination with radiation through an environmental route.

The authors conclude "There is some convincing evidence in childhood leukaemia of a causal role for environmental radiation exposure from recreational activities on beaches. "Children who visited local beaches at least once a month showed almost a three fold increased risk for developing leukaemia. Eating local fish and shellfish at least once a week yielded similar increased risk .

Contact:
Prof Jean-Francois Viel
Dept Public Health
Biostatistics and Epidemiology Unit
Besancon, France.

Tel: 00333 8121 8734 or 8738
Fax: 00333 8121 8735
Mob: +33 6 0762 1459

NB Prof Viel will be in Brussels on Thur 9th @ Hotel Leopold Tel 0032 2 511 1828 on Fri 10th at European Parliament via Tel 0032 2284 2111 room 3C50 Leopold (can be brought to phone)

Blood cholesterol levels reduced by changing diet

[Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies]

To what extent does altering your diet actually bring about changes in cholesterol in your blood? New findings published in this week's BMJ demonstrate the quantitative importance of changing what you eat. The paper reports that blood cholesterol levels could be reduced by 10 to 15 per cent by replacing 60 per cent of the saturated fat in the average British diet by other fats and by avoiding 60 per cent of dietary cholesterol (eg in meat and eggs).

In Britain, saturated fats (chiefly from dairy products, meat, oils, spreads, eggs and confectionery) provide 15 to 17 pr cent of dietary calories. Replacing saturated fats with other types such as polyunsaturated fats or monounsaturated fats , plus cutting down on cholesterol, would typically reduce blood cholesterol by about 0.8mmol/l (equivalent to a 10 to 15 per cent reduction).But, although four fifths of the decrease would be in the amount of "bad" cholesterol in the blood, (ie in the low-density lipoprotein cholesterol), one fifth of the decrease would be in "good" cholesterol.

Contact:
Dr Robert Clarke

e-mail (preferred) :robert.clarke@ctsu.ox.ac.uk
Tel: 01865 557 568 or 241
Fax: 01865 558817

Premature babies - has their survival rate changed?

[Changing prognosis for babies of less than 28 weeks' gestation in the north of England between 1983 and 1994]

Premature babies born after the 24 week gestation "threshold of viability" now have significantly improved chances of survival thanks to modern medical techniques - but the threshold itself has not changed in recent years says a study in this week's BMJ.

Until 20 years ago survival was extremely rare when a baby was born more than 14 weeks early (ie less than 26 weeks gestation) and most very early births were treated as miscarriages. Once a way to support breathing was developed all this changed and it soon became clear that babies could even survive birth 16 weeks early. In 1992 Parliament brought the law defining miscarriage and stillbirth into line with these changed realities.

A collaborative study involving all the maternity units in the North of England set out to see how survival of premature babies had changed between 1983 and 1994. It looked at all babies born more than 12 weeks early. No baby of 22 weeks gestation survived and only 8 of the 197 babies of 23 weeks gestation who were alive when labour started survived for a year.

Less than 4 per cent of the babies in the study who faced delivery more than 16 weeks early (ie before 24 weeks in the womb) survived to be discharged from hospital whatever their birth weight. Half the babies were severely disabled. In contrast, most babies born 14 weeks early (26 weeks gestation) now survive. Three-quarters of them have no major disability, but one in ten is never likely to walk or talk - a disability rate that has not changed in the last 12 years. Age (ie maturity) rather than weight is the best way of judging the likelihood of survival, say the researchers.

Contact:
Dr Win Tin
consultant paediatrician

Tel: 01642 854 871/872/873 (24 hrs)
Fax: 01642 854 636

Twin pregnancy in widow using late husband's sperm

A description of probably the first pregnancy with ICSI (intracytoplasmic sperm injection) in a widow using her dead husband's sperm is given in a letter in this week's BMJ. The case which involved written consent by the husband, is contrasted with the case of Diane Blood the widow refused permission to use her late husband's sperm in the absence of the required consent. The comparison of the two cases illustrates the limitations of the current law says the authors. The widow successfully treated via ICSI (where the sperm is injected directly into the egg) became pregnant with twins after two attempts at insemination had failed. "This case demonstrates that ICSI with frozen sperm should be considered as an early treatment option for a widow provided she fulfils all the requirements of the HFEA (Human Fertilisation and Embryology Authority) say the authors.

Contact:
Dr Kamal Ahuja
Scientific Director

Cromwell IVF & Fertility Centre
Tel: 0171 460 5717
Fax 0171 244 8610

Also in the Letters section: Sir Douglas Black, former Chief Scientist, describes the recent decision to refuse a widow the use of her dead husband's sperm as an act of "corporate tyranny".

Short children - normal adjustment

[Are short normal children at a disadvantage? The Wessex growth study]

Early research generally portrayed short children as psychosocially disadvantaged. This week's BMJ reports on the Wessex growth study which is following 225 children through their school years. In the study, 106 short "normal" children are compared with a cohort of children of average height. Having assessed the children at age 5-6 years and again after entry into secondary school, the authors report that short children displayed normal psychosocial adjustment in terms of behaviour and self esteem up to age 11-13 years.

Although the short children achieved lower scores on reading attainment and basic number skills than the normal height children, these differences disappeared after correcting for social class. More short than normal-height children came from working class homes and social class was a better predictor than height of all measures except body satisfaction.

Contact:
Dr Linda Voss

Tel/Fax: 01822 855 117

Hands up for heart disease

[Prevalence of arm movements in patients with coronary heart disease: case-control study]

Patients with coronary heart disease move their arms about significantly more than patients free of cardiac complaints says a short report in this week's BMJ. Dr Alan Rennie, says this might be because certain personalities are prone both to gesticulation and heart disease, or it could be that people with coronary heart disease move their arms because they are otherwise inactive, or their disease causes them to agitate. "However, my own suspicion is that arm movements over a lifetime may be a factor - combined with other known factors - in the development of coronary heart disease" writes Dr Rennie.

Contact:
Dr Alan Rennie

Tel: 0141 639 5071

Scoring points for treatment

[Editorial: Setting priorities New Zealand-style]

What is the best way to ration health services? An editorial in this week's BMJ says that New Zealand may have found a way forward. Priority criteria using a points scoring system, have been developed to tackle the problem of long waiting lists for non emergency medical procedures.

The criteria take into account clinical factors (such as severity of illness and effectiveness of treatment) which were drawn up by clinicians, and social factors (such as ability to work and to care for dependants). Higher priority patients attract a higher points score which helps clinicians decide who should be treated and when - and who should not. The length of wait for treatment was not deemed to be a priority criterion, in contrast with current British NHS policy amounting to rating by waiting. The authors say the New Zealand initiative is highly relevant to Britain but point out that in NZ the level of funding dictates the number of points at which a patient can expect treatment, rather than the reverse. Cardiologists, for example, agreed that a threshold of 25 points was a reasonable clinical goal for coronary artery bypass grafting, but funding levels permitted surgery to be offered to patients scoring 35 points or more. This left a 10 point gap between what was clinically preferred and what could be afforded.

Contact:
Jennifer Dixon

Tel: 0171 307 2547
Fax: 0171 307 2807
e-mail: injd@kehf.org.uk

NB BMJ carries two papers explaining the New Zealand priority criteria project. More details are available on the Internet - see the BMJ home page: www.bmj.com

Nurse run clinics help patients with epilepsy

[Feasibility and effects of nurse run clinics for patients with epilepsy in general practice: randomised controlled trial]

Patients with epilepsy report that they are not given enough information about their condition and how to cope. This week's BMJ reports on a trial of nurse-run clinics significantly improving the level of advice and drug management given, compared to normal care. Nurse run clinics were set up in six general practices in the South Thames region. In more than a fifth of patients attending, the nurse identified changes in aspects of drug management that could be improved. Attendance was high at the clinics and patients received advice on driving, alcohol intake, self help groups, drug compliance and adverse drug effects.

Contact:
Dr L.Ridsdale

Tel: 0171 735 8882
(Wed 8th & Friday 10th)
Tel/Fax: 0181 398 9596
(Thurs 9th)
Fax: 0171 793 7232

EMBARGO: 00.01 HRS Friday 10 January 1997

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