Previous week's news

Action needed to stem TB drug resistance

Friday May 2nd, 2008

Experts are warning that cases of drug-resistant tuberculosis (TB) are increasing in Britain.

The main causes are the changing population and migration, say Dr Michelle Kruijshaar and colleagues at the Health Protection Agency, London, UK.

There were more than 8,000 cases of TB in England, Wales and Northern Ireland in 2006 - a rise on 2005. Meanwhile, resistance to anti-TB drugs is increasing, especially among "difficult to treat, marginalised groups in urban areas", the experts write in an article published online by the British Medical Journal today (May 2).

They analysed trends in anti-TB drug resistance between 1998 and 2005, based on 28,620 cases recorded in the National Surveillance System. During this time, cases resistant to any first line drug rose from 5.6 to 7.9 per cent.

The proportion of cases resistant to the drug isoniazid rose from five to seven per cent, while the proportion resistant to rifampicin rose from one to 1.2 per cent.

The rise in isoniazid resistance reflects increasing numbers of patients from sub-Saharan Africa and the Indian subcontinent, who might have acquired resistance abroad, and inadequate control of transmission in London," the authors believe. However, "multidrug resistance increased only slightly and seems to be largely associated with problems in individual treatment, rather than transmission".

This study "highlights the need for early case detection, rapid testing of susceptibility to drugs, and improved treatment completion", the authors conclude.

In an editorial, Dr James Lewis of the London School of Hygiene and Tropical Medicine, UK, adds: "Drug resistant TB in the UK cannot be controlled solely with local strategies - a global perspective is needed. This is best summed up by the slogan of World Tuberculosis Day 2007 - 'TB anywhere is TB everywhere'."

Kruijshaar, M. E. et al. Increasing antituberculosis drug resistance in the United Kingdom: analysis of national surveillance data. The British Medical Journal, published online May 2, 2008.

Lewis, J. J. C. and Chihota, V. N. Increasing drug resistant tuberculosis in the UK. The British Medical Journal, published online May 2, 2008.

Trees may boost child health

Thursday May 1st, 2008

Old-fashioned suburban streets lined with trees may provide some children with protection against asthma, researchers reported today.

It is not clear why trees make such a difference to childhood health.

One possibility is that they may improve air quality, soaking up carbon dioxide and monoxide and improving oxygen levels.

But, reporting in the Journal of Epidemiology and Community Health, researchers say another possibility is that tree lined streets are more likely to have places where children can play outside.

The findings come from a study in New York City, USA, where rates of asthma among four and five year olds were analysed along with hospital admission rates of children up to the age of 15.

Some nine per cent of young children had asthma with a city with 613 roadside trees for every square kilometre.

Although tree-lined suburbs are usually linked to relative affluence, the study found that tree densities had an impact of asthma, even when the effects of wealth were taken into account.

The effect of trees was mostly seen in improved health in young children.

Researcher Dr Gina Lovasi, of Columbia University, New York, writes: "Trees may help curb asthma rates by encouraging children to play outdoors more or by improving air quality.

"New York City is also planning to plant one million extra trees by 2017, which could provide the perfect opportunity to discover exactly what impact tree density has on asthma."

Online First J Epidemiol Commun Health 2008; doi 10.1136/jech.2007.071894

Books on Asthma and Allergy Care

Teen gene may save sight

Thursday May 1st, 2008

A British trial of gene therapy has shown promise in reversing a damaging eye condition, it has been announced.

The trial at Moorfields Eye Hospital was made possible by a one million pounds grant from the British department of health.

Researchers say they have seen "major improvement" in the sight of a patient with a condition called Leber's congenital amaurosis, a condition which afflicts teenagers and threatens their sight.

Professor Sally Davies, research director at the Department of Health said: "This is fantastic work by the research team and shows how this country is now leading some of the most exciting health research in the world today.

"The Moorfields Eye Hospital/UCL Institute of Ophthalmology National Institute for Health Research Biomedical Research Centre will continue to provide support, ensuring the full potential of the findings are realised and applied to treat other eye diseases.

"This is precisely the type of translational research that we have established our Biomedical Research Centres and Units to conduct, and will speed up the development of improved treatments for NHS patients."

And public health minister Dawn Primarolo said: "This is a major achievement for British science and the NHS and shows we truly are at the forefront of innovation.

"The success of this research has huge implications for sufferers of this condition, as well as for a much larger group of inherited retinal diseases which affect 1 in 3,000 people."

Sociable children protected from leukaemia

Wednesday April 30th, 2008

Attending a day care centre or playgroups may contribute to reducing a child's chance of developing leukaemia, researchers have reported.

Researchers have found further evidence that children who often mix with other children are at a lower risk of leukaemia.

A team from the University of California, Berkeley, USA, analysed the results of 14 studies including 6,108 children with leukemia and 13,704 unaffected children.

Children who attended day care or playgroups seemed to have approximately a 30 per cent lower risk of developing the most common type of childhood leukemia - acute lymphoblastic leukaemia (ALL). Of the 14 studies, 12 indicated a protective effect of social interaction, whereas the remaining two found no link.

This work supports the theory that children exposed to more infections early in life develop an enhanced protection against ALL. This may be because the immune system must be challenged in early life in order to develop normally. If not, an infection in later years, alongside a genetic predisposition, may trigger ALL.

The latest findings were presented yesterday (April 29) at the "Causes and Prevention of Childhood Leukaemia" conference held in London, UK, by the charity Children with Leukaemia.

Researcher Dr Patricia Buffler said: "Combining the results from these studies together provided us with more confidence that the protective effect is real. Analysing the evidence in this way gives a more reliable answer to the question and a more precise estimate of the magnitude of the effect."

Dr Adrienne Morgan of the charity also investigated the theory. She said: "Putting our review together with the new analysis on social interaction, we can say pretty confidently that childcare, breastfeeding and vaccination are good things. This gives a steer to the biologists looking for what mechanisms might be at play."

Work presented at the second Children with Leukaemia Causes and Prevention of Childhood Leukaemia Conference, held at the Institute of Child Health, London, UK on April 29-30.

Major insights into bowel disease genes

Tuesday April 29th, 2008

British researchers have made significant breakthroughs in understanding the genetic origins of inflammatory bowel disease (IBD).

A team based at several UK centres worked together on a study involving 3,000 UK patients with ulcerative colitis. Using new genome scanning technology, the team were able to carry out "the most detailed investigation of ulcerative colitis genetics ever published".

They identified a new gene, ECM1, which controls a protein that plays a role in maintaining the barrier function of the gut wall. Mutations in this gene could lead to a weaker gut wall, or a "leaky gut", which could then trigger ulcerative colitis.

The team also discovered a set of five genes which appear to increase the risk of both ulcerative colitis and the other major IBD, Crohn's disease. These genes do so via their influence on the immune system.

Lastly, the researchers found that several genes previously linked to a raised risk of Crohn's disease are also relevant to ulcerative colitis. Findings are published in the April 27 issue of the journal Nature Genetics.

Lead researcher Professor Jack Satsangi of Edinburgh University, UK, hopes these findings "will translate directly to safe effective therapeutic strategies".

He said: "This new study sheds more light on the underlying inherited factors that place people at risk of developing ulcerative colitis, and with the discovery of the ECM1 gene involvement highlights the role of gut barrier function.

"This study represents another major step forward in understanding the processes involved in the development of the inflammatory bowel diseases, and extends last year's success in Crohn's disease genetics.

"The results are of real importance to patients and physicians as well as scientists," he adds.

Nurses want improved patient dignity

Monday April 28th, 2008

Most nurses get distressed because they are unable to give patients enough dignity, professional leaders revealed yesterday.

A Royal College of Nursing survey found some 86 per cent of nurses would like to give a greater priority to patient dignity. And two thirds said they do not always have enough time to give patients the right standard of care.

The survey of some 2,000 nurses was released yesterday as the RCN began its annual conference in Bournemouth.

Nurses said their employers mostly treated dignity as a priority but did not realise staff faced many barriers, such as staff shortages, to achieving it.

One nurse wrote: "Patients seem to be becoming numbers not people. I am having to fight against what the system wants in order to provide dignified care to my patients."

RCN general secretary Dr Peter Carter said: "This survey shows that nurses desperately want to give patients the high quality personalised and dignified care they deserve but many simply do not have the time and resources to do so.

"As well as making sure there are enough staff on shift, nurses need to have access to specialist equipment, such as hoists, to make sure they can lift patients in a dignified manner."

A second RCN survey announced today claims that British nurses spend more than a million hours a week on unnecessary paperwork. The survey found that most nurses believe paperwork has increased.

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