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Press releases Saturday 29 March 1997
Embargo: Friday 28 March 00.01 Hrs

Early retirement - in sickness or in wealth?

[Retirement on grounds of ill health: cross sectional survey in six organisations in United Kingdom]

Applications for ill health retirement benefits may be influenced more by financial incentives than by illness. A paper in this week's BMJ by Dr. Jon Poole, a consultant occupational physician, reports a study of six large employers (the car company Rover, the fire, police, and ambulance services, the Post Office, and the Teachers' Pensions Agency).

Applications for early retirement have increased over the past 15 years, and of the 45% of people who retire early, about a third do so because of III health.

In four of the six employers studied, peaks in numbers of retirements coincided with enhancements in benefit. Rates of ill health retirement varied dramatically between organisations, and in two cases, geographically within the same organisation. In the two that provided information by sex, women retired at up to five times the rate of men before age 40 and after age 50.

The principal medical reasons for such early retirements were problems in the back or joints and minor mental ill health such as stress, anxiety or depression. These problems tended to occur at the same time as enhancement in benefits. There is a need for some pension schemes to improve their processes for granting ill health retirement benefits and for doctors to be wary of conflicts of interest when advising pension companies about the merits of an application for benefits, says the author.

Contact:
Dr. Jon Poole

Dudley Priority Health NHS Trust
Dudley
West Midlands

Tel: 01384 459 530
Fax: 01384 459 530

Prozac and counselling effective in post natal depression

Both fluoxetine (Prozac) and counselling are effective treatments for postnatal depression, says a paper in this week's BMJ. Louis Appleby and colleagues from Manchester University studied the effects of fluoxetine versus placebo, six sessions versus one session of counselling, and combinations of drugs and counselling in women who were depressed 6-8 weeks after childbirth.

They found a highly significant improvement in all the treatment groups. The improvement in women receiving fluoxetine was significantly greater than in those receiving placebo, and six sessions of counselling had considerably more benefit than one. These differences were evident after one week; an unexpected finding, say the authors, given the widely held belief that there is a wait of two weeks before antidepressant effect of fluoxetine comes into play. The improvement after one week in those who were going to receive (but had not yet received) further counselling suggests that the anticipation of continuing support also has a beneficial effect.

Combining fluoxetine and six sessions of counselling did not produce additional improvement, say the authors, who believe that a single session of counselling plus fluoxetine is the simplest treatment for postnatal depression in primary care. However, many women will prefer not to take a drug treatment, and for them a course of counselling is as effective as an antidepressant.

Contact:
Prof Louis Appleby
Withington Hospital
Manchester

Tel: 0161 445 8111
Fax: 0161 445 9263
e-mail: Louis_A@fs1.wph.man.ac.uk

Dolly - not a threat but a promise of hope

[The promise of cloning for human medicine]

The production of Dolly the cloned sheep should not be seen as a moral threat, but as an exciting challenge, says fertility expert Professor Robert Winston in an editorial in this week's BMJ.

And it also provokes fascinating questions. How old is Dolly? The DNA in the nucleus of the egg from which she developed is adult; but the mitochondria (the outside of the egg which also carries genetic material) are only months old.

What was the role of the cytoplasm (all the material in the cell with the exception of the nucleus) in re-activating the transferred, inactive nucleus? There are likely to be powerful factors in the cytoplasm of the egg that make this happen, says Winston. "Egg cytoplasm is perhaps the new royal jelly." Studying why and how these genes switch on would give important information about both human development and genetic disease.

In human reproduction, says the author, cloning techniques could be used to help sufferers from intractable infertility. "In a society which is still scientifically illiterate, the onus is on researchers to explain the potential good that can be gained in the laboratory", he concludes.

Contact:
Prof Robert Winston

Hammersmith Hospital
London

Tel: 0181 740 3272
Fax: 0181 749 6973

Diabetes home tests innacurate and anxiety-causing

[Self monitoring of glucose by people with diabetes: evidence based practice]

In 1995, £42.6 million was spent on home monitoring of glucose by people with diabetes, says a paper in this week's BMJ. But there is increasing evidence that self monitoring is often a waste of time and may lead to psychological problems.

Marilyn Gallichan, a diabetes specialist nurse at East Cornwall Hospital, tells of a patient who became so anxious if he had not tested his blood within the last few hours that he would have to perform a blood test to discover whether his trembling hands and sweating were due to low blood sugar or to his anxiety.

For some people with insulin-dependent diabetes, the ability to take an instant measurement of blood glucose and act on the result can be enormously helpful. But only 10-15% of diabetic people in the UK have this type of diabetes, says the author, and only a relatively small proportion of them need to make frequent adjustments to their insulin dosage.

Many of those with non-insulin dependent diabetes would do better to drop the practice entirely, says the paper. "Existing evidence suggest that self monitoring does not improve glycaemic control ... tests are often inaccurate and unreliable and inappropriate and unhelpful testing is widespread." Avoiding inappropriate and unnecessary tests will result in enormous cost savings to the NHS, as well as increasing the psychological wellbeing of people with diabetes, concludes the author.

Contact:
Marilyn Gallichan

East Cornwall Hospital
Bodmin
Cornwall

Tel: 01298 251555
Fax: 01208 251585

Should mother and child health services in developing countries be free?

[Examination of attendance patterns before and after introduction of South Africašs policy of free health care for children under 6 years and pregnant women]

President Nelson Mandela's first major policy announcement after his election was that all health care for children under 6 and for pregnant and lactating women would be free in the South African government's health service. Two papers in this week's BMJ examine the effect of this change of policy on attendance at clinics and ask whether it could be introduced in other low income countries.

Dr. David Wilkinson and colleagues from the South African Medical Research Council studied attendance at a mobile clinic in KwaZulu/Natal both before and after the introduction of free health care for younger children and pregnant women. They found significant differences - the number of new patients registering for treatment services and the total number of visits increased substantially after the change of policy, and the proportion of children referred to hospital decreased. Numbers of child visits to clinics for preventive services such as immunisation and growth monitoring ('under 6 clinics'), which had always been free of charge, did not change significantly.

Staff in clinics and hospitals were overworked and stressed by the increased workload, which they perceived to be largely unnecessary. The demand for treatment services is probably almost limitless, say the authors, and may gradually steer important healthcare resources away from preventive services and health promotion.

In a commentary, Anthony Costello, Reader in International Child Health at the Institute of Child Health, London, says that the demand for treatment services in South Africa need not necessarily be limitless if primary maternal and child health services only are considered. In Britain, he argues, universal free care for mothers and children was introduced in 1948 when health and wealth indicators were not dissimilar from those in modern South Africa. Demand at the primary level was contained as the health of the nation improved and family size declined.

However, in the 59 low income countries with a mean gross national product of less than £500 per head such as Rwanda, Mozambique, and Ethiopia, charging schemes will remain the only option to ensure additional investment in primary health care, unless costs are subsidised through international aid.

Contact:
Dr David Wilkinson

Centre for Epidemiological Research in Southern Africa
Hlabisa
South Africa

Tel: 00 27 358 381003
Fax: 00 27 358 381138

Dr. Anthony Costello

Institute of Child Health
London

Tel: 0171 242 9789
Fax: 0171 831 0488

EMBARGO: 00.01 HRS Friday 28 March 1997

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