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Press releases Saturday 26 April 2008
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(1) Uptake of HPV vaccine in adolescent girls is 'encouraging' (2) Seven in ten patients who need test for early stage heart disease do not receive one (3) Warning over quality of health care across the European Union
(1) Uptake of HPV vaccine in adolescent girls is 'encouraging' (Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study) www.bmj.com/cgi/content/short/bmj.39541.534109.BE (Editorial: HPV vaccination in the UK) www.bmj.com/cgi/content/short/bmj.39555.668229.80
Seven in ten girls are likely to be vaccinated against the human papillomavirus (HPV) when a £100m national UK vaccination programme comes into effect in the autumn, according to a fast tracked study published on bmj.com today.
The Manchester-based pilot study is the first to look at whether the vaccine will be accepted by enough parents to ensure the success of a national UK immunisation programme, and how easy it is to deliver such a programme to adolescent girls.
The vaccination prevents two types of HPV that are sexually transmitted and associated with about 70% of cervical cancers. From September 2008, all schoolgirls in the UK aged between 12 and 13 years old (Year 8) will be offered the vaccination.
In February 2007, two Primary Care Trusts (PCTs) in Manchester agreed to take part in a study led by researchers from the University of Manchester. Each PCT was responsible for delivering the vaccine to all secondary schools in its catchment area.
The HPV vaccine was offered to 2 817 girls aged between 12 and 13 years old attending 36 secondary schools. Parents were fully informed about the study and were invited to information evenings. They were asked to give their consent for vaccination or, if they refused, to give their reasons.
The researchers report the number of girls who received the first two doses of the vaccine. In order for the vaccine to be fully effective three doses are needed at 0, 1 and 6 months. In total, 1 989 (70.6%) received the first dose and 1 930 the second (68.5%).
The authors found that delivery of the vaccination was challenging, partly because doses needed to be delivered at the start of the academic year when schools were busy, but also because a significant proportion of girls missed the appointment times for their first and second doses (16.3% and 23.6% respectively), and therefore had to be offered alternative times.
They also noted that the main reason given by parents for refusing to allow vaccination was insufficient information about the vaccine and its long term safety (36%). Only a few parents mentioned the age for vaccination (10%) or the vaccine's possible effect on adolescent sexual behaviour (3%).
The researchers conclude: "These are encouraging results for the forthcoming national HPV vaccine programme but the final criterion for success will be the proportion of girls who receive all three vaccine doses."
In the wake of the measles, mumps, and rubella (MMR) vaccine debate, more needs to be done to restore public confidence in immunisation, say Jo Waller and Jane Wardle from Cancer Research UK, in an accompanying editorial.
20% of parents in the study refused the vaccine giving no reason. More work is therefore needed to understand the motives for refusal and the practical barriers to providing consent, they conclude.
Contacts: Loretta Brabin, Reader in Women's health, University of Manchester, UK Email: loretta.brabin{at}manchester.ac.uk Editorial: Jo Waller, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK. Email: j.waller{at}ucl.ac.uk
(2) Seven in ten patients who need test for early stage heart disease do not receive one (Inequity of access to investigation and effect on clinical outcomes: prognostic study of coronary angiography for suspected stable angina pectoris) www.bmj.com/cgi/content/short/bmj.39534.571042.BE
Seven in ten patients who have suspected angina are not given appropriate testing and are more likely to suffer from serious heart problems as a result, according to a study published on bmj.com today.
Women, older people, patients from ethnic minorities and the poor are the most likely to miss out on testing.
The researchers, led by Professor Gene Feder from the University of Bristol, decided to look into whether patients had equal access to coronary angiography (a specialist x-ray examination in which a contrast agent is injected into the aterieries around the heart to show the extent and severity of the narrowing of the arteries around the heart). They wanted to find out if not having an angiography in the early stages of heart disease, when a person presents with suspected stable angina (pains in the chest after exertion), has a long term impact on patients' health.
The researchers studied 10 634 patients with suspected stable angina attending six chest pain clinics in England, between January 1996 and December 2002. The sample included white and south Asian patients with chest pain and no known coronary heart disease.
An independent panel of doctors found that 1 375 of these patients needed an angiography. Each patient was followed up three years later to find how and if heart disease had progressed, for example whether they had developed unstable angina, or suffered a heart attack or other heart related problems.
They found that overall 69% of patients deemed appropriate for angiography had not had one. In addition, people over 65, women, south Asian patients, and those in the most deprived fifth of the population were less likely to receive the test compared with those aged under fifty, men, white patients, and those living in the less deprived areas, respectively.
Importantly, deaths from heart disease and admissions for heart attacks and unstable angina were more common in the group who had not had an angiography.
The researchers do not know the reasons for this and say that there could be a number of possible explanations. For example, the variation could occur because of different referral methods or because some patients may choose not to undergo the procedure.
They conclude that further research is needed to support doctors in improving their decisions about further investigation of patients with new angina.
Contacts: Gene Feder, Primary Health Care, University of Bristol, Bristol, UK Email: gene.feder{at}bristol.ac.uk Hannah Johnson, Press Office, University of Bristol, UK Email: hannah.johnson{at}bristol.ac.uk
(3) Warning over quality of health care across the European Union (Analysis: How can quality of health care be safeguarded across the European Union?) www.bmj.com/cgi/content/short/336/7650/920
At present, European citizens cannot be guaranteed that the care they will receive in another part of the European Union (EU) is of high quality, warn researchers in this week's BMJ.
They call on national governments and other stakeholders to help bring about change.
There is an assumption that health services provided according to national regulations in any EU country will be of adequate quality, write Professor Martin McKee and colleagues. Yet within Europe the approach to assuring quality in different countries varies.
These differences are becoming increasingly important due to growing professional and patient movement within the EU. So can Europe's citizens be confident that care received in another EU country will be safe and of high quality, they ask?
The authors identify several initiatives that illustrate both the similarities and the diversity within European health systems. They point out that, while there are policies to ensure consistent quality of some elements of health care at a European level (for example by the creation of centralised drug approval systems) for many others, such as the quality of healthcare systems, organisations and clinical processes, there is no co-ordination.
This reflects diversity among countries. While some have well developed quality assurance systems, in others there is very little evidence of any concrete progress, and often what exists has little impact on the majority of health professionals, they argue.
The delivery of health care is a national responsibility but, in a Europe characterised by free movement, national governments and other stakeholders must take account of the wider European context in health policymaking and planning, they write.
Europe-wide legislation to mandate a single approach to quality of care is not a realistic possibility, they say. How a country assures quality of care is a matter for it to determine; what is important is that it does so.
In the medium term, they argue, there is a need to support the emerging informal mechanisms, many led by professional bodies, that are designed to assure the quality and safety of care for European citizens.
Contact: Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine, London, UK Email: martin.mckee{at}lshtm.ac.uk
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Student BMJ
Intimate examinations
Israeli students are refusing to perform intimate examinations on anaesthetised women without their informed consent.
