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BMJ No 7116 Volume 315 This week in brief Saturday 1 November 1997 Scottish melanoma epidemic may have peaked Improved nutrition reduces childhood morbidity in developing countries Income inequality is not linked to health inequalities in Spain Competition has not yet affected productivity in the NHS market Requesting doctors' permission to include patients in studies: how you asks affects the response rate Patients often don't know why they are discharged from outpatients Scottish melanoma epidemic may have peaked Until recently the incidence of cutaneous malignant melanoma has steadily increased in the United Kingdom. This rate of increase has been faster than that for any other malignancy. However, on p 1117 MacKie et al show that in Scotland this trend may have halted, at least in women under 65. They report on over 6,000 patients with invasive cutaneous malignant melanoma who were studied in Scotland from 1979 to 1994 and show that the incidence of melanoma in these younger women has stabilised since 1986. Mortality from melanoma in women shows a downward trend. Improved nutrition reduces childhood morbidity in developing countries Malnourished children have more frequent and severe infections. On p 1122 English et al report the effect of a nutrition project on the incidence and severity of acute respiratory infections and diarrhoeal disease in preschool children in rural Vietnam. The project, which entailed increased home vegetable production and nutrition education of mothers of preschool children, was carried out in 1991-3. In the project commune dietary intakes of the children improved and the incidence of both respiratory infection and diarrhoea decreased, while no change was seen in the control commune. Income inequality is not linked to health inequalities in Spain Several ecological studies have shown that in developed countries an increase in material wellbeing does not much affect the health of the population. Moreover, the degree of inequality in income distribution rather than absolute wealth determines mortality in these countries. On p 1130 Regidor et al investigated the relation between income inequalities and long term disability in the 17 regions of Spain using a national population survey of disabilities. Although the association between income and long term disability was stronger in regions with the lowest incomes, inequality in income was not related to the prevalence of long term disability. Also income inequality did not determine health inequality in many regions. Competition has not yet affected productivity in the NHS market On p 1126 Soderlund et al report on productivity changes in NHS hospitals in England for the first three years of the internal market. They adjusted for differences in casemix, wage costs, non-inpatient activity, episode inflation, and exceptionally long hospital stays. Gaining trust status and increasing patient shares from the host district health authority were associated with greater productivity. Potential for competition between providers in a given area had no observable effect. Requesting doctors' permission to include patients in studies: how you asks affects the response rate Ethics committees often require doctors' consent to their patients' inclusion in studies. On p 1136 Sloan et al performed a randomised trial to assess the effect of different letterheads, different qualifications, and the inclusion of a personalised handwritten note on doctors' agreement to their patients' inclusion in a cancer trial. They found higher response rates (82-88% versus 76-84%) when the covering letter had a cancer agency rather than university letterhead, was signed by a person with a PhD rather than MD, and when the letter included a handwritten note thanking the doctor. The authors point out that doctors who do not reply to requests (or refuse) are not simply protecting patients: they are also responding differentially to the qualifications and affiliations of the investigators. Patients often don't know why they are discharged from outpatients On p 1138 Burkey et al describe their qualitative study of 43 patients to see how they felt about being discharged from long term follow up. Although 16 felt positive, 10 thought they should not have been discharged. Patients needed to feel that the doctor knew and understood their case, and complained of doctors' speaking in coded language, not listening to what the patients were saying, or not making clear why the patient was being discharged or providing information. Though the grade of the doctor didn't affect the patients' views, the way the clinic was organised did, with some seeming too busy and too interrupted to give patients time to ask questions. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline