Pregnant women advised to get flu jab

Pregnant women advised to get flu jab – Health News – NHS Choices.

Conclusion

This well conducted study highlights the possible risk to babies of maternal infection with H1N1. The research has some limitations, which mean the results should be interpreted with some caution.

• The researchers used a historical cohort of pregnant women to act as a comparison, some of whom had given birth during 2005-6. It is possible that pregnancy outcomes have changed between this time and the time the infected women gave birth. The researchers point out that this risk is somewhat mitigated by the fact that the national surveillance of perinatal mortality has not identified any changes that were likely to affect these findings.
• Although the researchers adjusted their analysis for confounders, it is possible that both measured and unmeasured confounders affected the results. There are other possible confounders that were not adjusted for, including whether the mother had previously delivered by caesarean, the quality of obstetric care and time between pregnancies.
• Because perinatal mortality is relatively rare, it was difficult for the researchers to adjust even for known confounders.

This study indicates that there may be a higher risk of perinatal mortality for women who contract swine flu. The strength of this connection will need further research however, as will studies to establish how it might have this effect, and whether or not swine flu risk can be reduced by other means.

Despite this need for further research however, influenza is a known risk in pregnancy, and these findings support the recommendation for pregnant women to be vaccinated. Pregnant women are among the high risk group advised to have an annual flu vaccination, which also protects against H1N1. H1N1 is predicted to be one of the main flu viruses circulating during the 2011/12 winter.

 

 

 

 

 

 

 

Links to the headlines

Study finds link between swine flu and stillbirth. BBC News, October 20 2011

Baby deaths five times higher among pregnant women who caught swine flu. Daily Mail, October 20 2011

Pregnant women urged to get flu jab. The Independent, October 20 2011

Links to the science

New study reveals clear link between H1N1 flu virus and stillbirth. Sands press release, 2011

Pierce M, Kurinczuk JJ, Spark P, et al. Perinatal outcomes after maternal 2009/H1N1 infection: national cohort study. BMJ 2011; 342: d3214

Joseph KS, Liston RM. H1N1 influenza in pregnant women. BMJ 2011; 342: d3237

 

Use of mobile phones and risk of brain tumours: update of Danish cohort study

Use of mobile phones and risk of brain tumours: update of Danish cohort study — Frei et al. 343 — bmj.com.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

Objective To investigate the risk of tumours in the central nervous system among Danish mobile phone subscribers.

Design Nationwide cohort study.

Setting Denmark.

Participants All Danes aged ≥30 and born in Denmark after 1925, subdivided into subscribers and non-subscribers of mobile phones before 1995.

Main outcome measures Risk of tumours of the central nervous system, identified from the complete Danish Cancer Register. Sex specific incidence rate ratios estimated with log linear Poisson regression models adjusted for age, calendar period, education, and disposable income.

Results 358 403 subscription holders accrued 3.8 million person years. In the follow-up period 1990-2007, there were 10 729 cases of tumours of the central nervous system. The risk of such tumours was close to unity for both men and women. When restricted to individuals with the longest mobile phone use—that is, ≥13 years of subscription—the incidence rate ratio was 1.03 (95% confidence interval 0.83 to 1.27) in men and 0.91 (0.41 to 2.04) in women. Among those with subscriptions of ≥10 years, ratios were 1.04 (0.85 to 1.26) in men and 1.04 (0.56 to 1.95) in women for glioma and 0.90 (0.57 to 1.42) in men and 0.93 (0.46 to 1.87) in women for meningioma. There was no indication of dose-response relation either by years since first subscription for a mobile phone or by anatomical location of the tumour—that is, in regions of the brain closest to where the handset is usually held to the head.

Conclusions In this update of a large nationwide cohort study of mobile phone use, there were no increased risks of tumours of the central nervous system, providing little evidence for a causal association.

Footnotes

• We thank the steering committee of the Danish cohort study on social inequality and cancer (cancer og social ulighed-CANULI) for providing the cohort data. We thank Lene Mellemkjær and Søren Friis for support with topography and morphology codes, Susanne Oksbjerg Dalton and Kathrine Grell for feedback on the manuscript draft, and Luise Cederkvist Kristiansen for support with drafting figure 2.

• Contributors: JHO and CJ established the nationwide cohort of mobile subscription holders. JS had the idea for this study. PF was responsible for data management and statistical analyses and drafted the article. AHP did data management and statistical analyses. MS-J supported statistical analyses related to the CANULI cohort. All authors commented on and approved the final draft. PF is guarantor.

• Funding: This study was funded by the Danish Strategic Research Council (grant No 09-059984, 09-059045) to cover costs for data linkage. PF received a fellowship for prospective researchers by the Swiss National Science Foundation for this project. AHP was supported by a stipend for PhD students from the Danish Graduate School in Public Health Science. All other authors contributed to this work based on their respective core budget positions.

• Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

• Ethical approval: The study was approved by the Danish ethical committee system (KF 01-075/96), the Danish Data Protection Board (1996-1200-121), and the Danish Ministry of Justice (Jnr. 1996-760-0219).

• Data sharing: No additional data available.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

 

New test to predict breast cancer recurrence

New test to predict breast cancer recurrence.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

This study assessed a new combined test’s ability to predict the risk of disease recurrence in oestrogen-receptor-positive breast cancer patients whose disease had not spread to nearby lymph nodes. The test builds on an existing genetic measure, but adds clinical factors to classify a patient’s risk level.

The researchers found that the new test classified more patients at low risk for disease recurrence compared to the original test. However, it did not improve the ability to predict a patient’s potential benefit from receiving chemotherapy.

The researchers say that planning cancer treatments should be based on both the benefits and risks of treatment for each individual patient. The researchers say that their test is not going to be of benefit for all patients and that those who have been classified as either at low or high risk based on their recurrence scores are unlikely to benefit from the new combined test. Those classified as at intermediate risk based on their RS are more likely to benefit from the new test, as it appears to assess more accurately the recurrence risk for this group of patients.

The researchers conclude that RSPC can aid in making chemotherapy decisions in cases where RS and clinical measures do not agree, for instance, when RS predicts high risk of recurrence, but tumour size and other clinical factors predict low risk.

It should be noted that around one in three breast cancers is negative for oestrogen receptors, and this study cannot tell us about the model’s use on ER-negative cancers or those that have spread.

 Links to the headlines

New breast cancer test could spare thousands chemo. The Daily Telegraph, October 20 2011

Test may save thousands of breast cancer victims from chemotherapy ordeal, but will it be rationed? Daily Mail, October 20 2011

Breast cancer test could save cash and lives. Daily Express, October 20 2011

Links to the science

Tang G, Cuzick J, Costantino JP et al. Risk of Recurrence and Chemotherapy Benefit for Patients With Node-Negative, Estrogen Receptor–Positive Breast Cancer: Recurrence Score Alone and Integrated With Pathologic and Clinical Factors. Journal of Clinical Oncology, October 20 2011

SNP conference: UK government ‘breaking up NHS’

Scotland’s health secretary will accuse the UK government of trying to break up the NHS, in her speech to the SNP conference

via BBC News – SNP conference: UK government ‘breaking up NHS’.

Exclusive: government defending ‘autonomy clause’

Source: Exclusive: government defending ‘autonomy clause’ | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

The government is resisting attempts to scrap the Health Bill’s so called “autonomy clause”, but close to offering a compromise amendment on the duties of the health secretary

 

Ministers’ failure to explain the case for “reforms” has left NHS staff without sense of purpose

Source:Ministers’ failure to explain the case for “reforms” has left NHS staff without sense of purpose — Limb 343 — bmj.com.

An NHS Athens account may be required to view this in full.

The proposed new NHS Commissioning Board “cannot afford to fail,” NHS Confederation chief executive Mike Farrar told a conference

 

GPs, rather than the government, should be blamed for failures in new NHS, MPs are told

Source:GPs, rather than the government, should be blamed for failures in new NHS, MPs are told — O’Dowd 343 — bmj.com.

An NHS Athens account may be required to view this in full.

GPs on the new clinical commissioning groups (CCGs) in the NHS in England should take responsibility for any clinical failures and budget overspends rather than blaming the government, MPs have heard.

 

More to learn on bacteria found in bowel cancers

More to learn on bacteria found in bowel cancers – Health.

NHS Choices examines the science behind the newspaper headlines.

Conclusion

This study reflects a growing focus among researchers on possible associations between inflammation and the development of gastrointestinal diseases including cancer. It has been made possible by the development of genetic analysis methods in the last decade that allow researchers to analyse the relationship between microorganisms and cancer.

However, as the researchers note, it cannot show whether Fusobacterium nucleatum plays a causative role in the development of bowel cancer.

Furthermore, the tissue examined was taken from patients with existing bowel cancer, so the study cannot tell us at what stage the bacteria were first prevalent in the bowel: before, during or after cancer had developed.

To further explore the possible role of infection in the development of bowel cancer, researchers would need to screen healthy patients for the presence of bacteria and look at health outcomes in the period that followed, including the development of bowel cancer.

 

 

 

 

 

 

 

Links to the headlines

Bacterium linked to bowel cancer. BBC News, October 18 2011

Antibiotics could protect against bowel cancer after bug found that may trigger the disease. Daily Mail, October 18 2011

Antibiotics could protect against bowel cancer. The Independent, October 18 2011

Links to the science

Castellarin M, Warren RL, Douglas Freeman J et al. Fusobacterium nucleatum infection is prevalent in human colorectal carcinoma. Genome Research, Published in Advance October 18 2011

Kostic AD, Gevers D, Sekhar Pedamallu C et al. Genomic analysis identifies association of Fusobacterium with colorectal carcinoma. Genome Research, Published in Advance October 18 2011

Exclusive: government defending ‘autonomy clause’

Source: Exclusive: government defending ‘autonomy clause’ | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

The government is resisting attempts to scrap the Health Bill’s so called “autonomy clause”, but close to offering a compromise amendment on the duties of the health secretary

 

Differences in pandemic influenza vaccination policies for pregnant women in Europe

Abstract | Differences in pandemic influenza vaccination policies for pregnant women in Europe.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract (provisional)

 

Background

An important component of the policy to deal with the H1N1 pandemic in 2009 was to develop and implement vaccination. Since pregnant women were found to be at particular risk of severe morbidity and mortality, the World Health Organization and the European Centers for Disease Control advised vaccinating pregnant women, regardless of trimester of pregnancy. This study reports a survey of vaccination policies for pregnant women in European countries.

Method

Questionnaires were sent to European competent authorities of 27 countries via the European Medicines Agency and to leaders of registries of European Surveillance of Congenital Anomalies in 21 countries.

Results

Replies were received for 24 out of 32 European countries of which 20 had an official pandemic vaccination policy. These 20 countries all had a policy targeting pregnant women. For two of the four countries without official pandemic vaccination policies, some vaccination of pregnant women took place. In 12 out of 20 countries the policy was to vaccinate only second and third trimester pregnant women and in 8 out of 20 countries the policy was to vaccinate pregnant women regardless of trimester of pregnancy. Seven different vaccines were used for pregnant women, of which four contained adjuvants. Few countries had mechanisms to monitor the number of vaccinations given specifically to pregnant women over time. Vaccination uptake varied.

Conclusions

Differences in pandemic vaccination policy and practice might relate to variation in perception of vaccine efficacy and safety, operational issues related to vaccine manufacturing and procurement, and vaccination campaign systems. Increased monitoring of pandemic influenza vaccine coverage of pregnant women is recommended to enable evaluation of the vaccine safety in pregnancy and pandemic vaccination campaign effectiveness.

Lords propose greater transparency in new Health Bill changes

Source:Lords propose greater transparency in new Health Bill changes | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Proposed amendments to the Health Bill would effectively subject private and third sector bodies to the Freedom of Information Act by giving commissioners more power to require information from them

 

NHS Blood and Transplant part-privatisation plans dropped

Source: NHS Blood and Transplant part-privatisation plans dropped | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

The government has dropped proposals to part-privatise NHS Blood and Transplant