In brief

Safer environment: Fifty countries in the WHO's European region have signed up to the protocol on water and health, a legal instrument for the protection of clean, safe water. At the WHO's third ministerial conference on environment and health, ministers adopted a charter on transport, environment and health—which recognises that current transport patterns in Europe are unsustainable and unhealthy—and promised to investigate the possibility of new legislation.

Kaiser Permanente closes division: Kaiser Permanente, one of the largest US health management organisations, will close its northeast division at the end of the year. The closure will affect 575000 members in four states—New York, Connecticut, Vermont, and Massachusetts—including 28000 Medicare beneficiaries in New York.

Ireland reports its first case of variant CJD: St Vincent's Hospital, Dublin, has confirmed that a female patient who had undergone gastroscopy has variant Creutzfeldt-Jakob disease (vCJD). The hospital is contacting 49 other patients who underwent gastroscopy at the same time as the patient in case of possible cross contamination from the device. Of the more than 40 cases of vCJD recorded since 1996, one was in France, one was in Northern Ireland, and the rest were in Great Britain. The hospital noted that the patient diagnosed in the Republic of Ireland had lived in the United Kingdom for an extended period.

US clears silicone breast implants: A committee appointed by the Institute of Medicine, the medical arm of the National Academy of Sciences, has concluded that silicone breast implants do not cause serious diseases such as cancer, after reviewing all available evidence. They said that women with silicone breast implants are no more likely to develop chronic disease than women without implants. However, members agreed that the trauma of surgically implanting material into the breast can cause problems.