A report by the WHO Regional Office for Europe, co-funded by the European Commission and launched today at a meeting hosted by the Department of Health in London, provides data not hitherto available on mental health policy and practice across the WHO European Region. It also highlights important information gaps.

Policies and practices for mental health in Europe allows for country-to-country comparisons on indicators such as numbers of psychiatrists, financing, community services, training of workforce, prescription of antidepressants, and representation of users and carers. The data were obtained from ministries of health.

More than 10-fold difference in number of psychiatrists

The report reveals large gaps in treatment and services. The rates for numbers of psychiatrists are indicative of the huge differences in mental health care – they vary more than 10-fold across the European Region, ranging from 30 per 100 000 population in Switzerland and 26 in Finland, to 3 in Albania and 1 in Turkey. The median rate of psychiatrists per 100 000 population in the 41 countries that provided information is 9.

The report indicates that a large majority of countries now have mental health policies and legislation, and many, but not all, are making some progress towards implementing community-based mental health services. However, it also shows clearly that treatment – or lack of treatment – depends on where one lives. The diversity of access, availability, acceptability and quality reflected in the report is not only related to prosperity and investment, but also to diversity of policies, mental health systems and practices. The report makes the case for greater clarity and consistency, and sharing of knowledge and experience.

Dr Marc Danzon, WHO Regional Director for Europe, said, “This report shows overall progress but there are clear inequities across the Region. Often, we know what works but still the gaps in treatment and services are so huge. The quality of services a person with poor mental health receives can vary because of economic conditions, but it is unacceptable that it should vary because of a lack of knowledge about or commitment to best practice.”

The report concludes that:

– much progress has been achieved in policy development, with a clear trend towards supporting deinstitutionalization and establishing services close to where people live;

– countries are gradually accepting the involvement of service users and carers as good practice, and most countries are establishing programmes for the social inclusion of service users;

– there is great diversity across the large majority of variables;

– there is a lack of precise and comparable information, even fundamental information;

– there is lack of consistency in practice and education.

Readjusting spending – drugs, beds or community services?

The 128 tables and figures in this report demonstrate the diversity across the European Region, and the different interpretation of some data. For example, two clusters of countries have the fewest beds. The first seems to group countries with low levels of investment in mental health care and low supply of services, such as Albania and Turkey. The second group, comprising Italy, some provinces of Spain, and the United Kingdom, are in the post-hospital stage, having replaced beds with community services. Some countries such as Belgium, France, Germany and the Netherlands combine a high level of beds with community services. Whether this is the best or worst of both worlds is an important debate.

The report gives powerful arguments for carefully assessing spending priorities for people with mental disorders in residential and social homes. Conditions in some of these places, a lifetime home for some of the most vulnerable people in society, can be shocking. A slight readjustment in spending from, for example, expensive and not always effective prescription drugs to providing care could make a great difference.

The report also gives a clear message about the growing implementation of community-based mental health services. There is a convergence towards supporting deinstitutionalization and establishing services close to where people live. Undeniably, there is still a long way to go, as illustrated by some of the examples of poor institutional practices in this report, but countries now agree that these are no longer acceptable and are introducing alternatives.

Promoting mental health and preventing mental disorders

The findings show that interventions have been introduced to raise awareness and to tackle stigma and discrimination in almost all countries. However, evaluations of impact and effectiveness are rare.

Training and workforce for mental health care

There are striking variations in staff numbers, differences in education and a lack of reliable information available from countries in many areas.

– For nursing education, it is surprising how many countries cannot provide data about numbers. In addition, the training and levels of education differ vastly, raising questions about variation in competences in some countries.

– At a time of great change in service delivery and knowledge, continuing education is important, but the picture is not reassuring. No one would like to be operated on by a surgeon educated 25 years ago who has had no more recent updated training. Continuing education seems to be taking place, but there is little control over content or providers, with a strong reliance on informal self-regulation. Where more formal processes have been put in place, the emphasis seems to be on the process rather than the outcome.

Human rights – neglect and abuse

Findings on monitoring, the existence of protocols and the availability of national data on involuntary admission, restraint and seclusion show considerable variation. Further efforts are needed to collect basic data to allow more in-depth analysis of comparative good practices related to safeguarding the human rights of people with mental disorders. This could include reviewing procedures to prevent poor practices and abuse related to involuntary admission and involuntary treatment, and reviewing the availability and effectiveness of alternatives to restraint or seclusion.

The overall picture

Some European countries lead the world in the vision and quality of activities. Most countries are creating an increasingly diverse and competent workforce. Countries are gradually accepting the involvement of service users and carers as good practice, and most countries are establishing programmes for the social inclusion of service users, if often initially on a small and local scale. The role of primary care in the care of people with mental health problems is growing, and partnerships with other agencies are being established.

Dr Matt Muijen from the WHO Regional Office for Europe said: “This report indicates the need for action. It reveals the lack of reliable indicators and valid information that should support the shaping of progressive mental health programmes and the creation of a competent workforce. The challenge is now to address this need in partnership with our Member States and other intergovernmental agencies.”

For more detail and extracts from the report, see the fact sheet below.

Fact sheet

New Who Report Policies And Practices For Mental Health In Europe – Meeting The Challenges

A report published by WHO Regional Office for Europe and co-funded by the European Commission provides data not hitherto available on mental health policy and practice across the European Region. It also highlights important information gaps. Extracts below give an indication of the kinds of data the report presents from 42 Member States.

— Activity in policy and legislation has flourished in recent years. Since 2005, 57% of countries have adopted new mental health policies or updated existing ones, and 47% have introduced new legislation or updated existing legislation. Only four countries do not yet have a strategy. Five of the countries still have legislation that is more than 10 years old.

— The number of psychiatrists per 100 000 population varies widely: from 30 per 100 000 in Switzerland and 26 in Finland to 3 in Albania and 1 in Turkey. The median rate of psychiatrists per 100 000 population in the 41 countries that provided information is 9.

— Few countries provide figures on spending on promoting mental health and preventing mental disorders, but the data available are consistently very low, at most about 1% of the mental health budget.

— Data on the proportion of disabled people who are receiving social welfare benefits or pensions as a consequence of mental health problems are available for 17 of 42 countries. The countries for which data are available report proportions ranging from 44% in Denmark to 8% in the Russian Federation.

— Social institutions are where care varies most: social institutions for children and adolescents are provided in 31 of 42 countries (74%), in comparable proportions across the groups of countries. This is the area with the largest variation in care. In countries in western Europe, children are often placed in foster homes or small residential facilities. In many countries in south-eastern Europe and of the Commonwealth of Independent States, children with any form of disability are placed in sometimes large and often underfunded social care homes.

— Prescribing of antidepressants – little information and large variation: the survey enquired about the proportion of the population that had been prescribed antidepressants in the last year available. Many countries (26 of 42) reported that they had no information available. Further, data on prescribed antidepressants are not collected consistently.

— For the countries who were able to submit the requested information, the proportion of the population prescribed antidepressants varied from 12% in Moldova and 10% in Spain (Catalonia) to 3% in Lithuania and 1% in Bosnia and Herzegovina (Republika Srpska).

— Visits to mental health facilities show a wide range of differences in access, from 1% to 28% of the population.

— Rates of admission to inpatient units vary 13-fold. At the high end and, are such countries as Romania, Hungary and Estonia, together with such countries as Germany and Sweden. In some cases, the high admission rates could be due to perverse financial incentives within the health system such as payment per admission or payment for a limited period of admission only, encouraging discharge and readmission. In other countries, a large supply of beds could be a factor.

— Intriguingly, there is an overrepresentation of women in outpatient services but almost equal sex distribution in inpatient services.

— Opportunities for the empowerment and representation of service users and carers: the report shows a strong association between trends in mental health expenditure, trends in the development of community mental health services and the involvement of users and carers. These are strongest among the 15 countries that were members of the European Union before 2004 (EU15 countries comprise Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom). In many countries in the eastern part of the WHO European Region, where the institutional model of care still dominates, user and carer movements are in a developmental stage.

— The expectations for general practitioners (GP’s) vary widely and are not always correlated to the degree of education. For example, in Norway, psychological and psychiatric issues are not very prominent in the education of GPs, who are, nevertheless, expected to provide services for people with common mental health problems.

— Funds on research sometimes inefficiently spent: there is a major divide across the European Region between countries with well-developed information systems that also invest in research and dissemination, typically the EU15 countries, and the countries that do not. If these data were cross-tabulated with presence of community services and diversity of workforce, a clear association would be found. Considering the few countries that invest heavily in research, most countries probably have no access to original research. This suggests that many countries are analysing identical research, presumably to publish comparable treatment guidelines. Considerable gains in quality and efficiency could be made through a closer collaboration.

The burden of mental health in Europe – some key facts and figures

Most European countries have recognized mental health as a priority area in recent years. Neuropsychiatric disorders are the second leading cause of disability-adjusted life-years (DALYs) in the WHO European Region, accounting for 19.5% of all DALYs.

According to the most recent available data (2002), neuropsychiatric disorders are the first-ranked cause of years lived with disability (YLD) in Europe, accounting for 39.7% of those attributable to all causes. Unipolar depressive disorder alone is responsible for 13.7% of YLD, making it by far the leading cause of chronic conditions in Europe. Alzheimer’s disease and other forms of dementia are the seventh leading cause of chronic conditions in Europe (Global burden of disease estimates. Geneva, World Health Organization, 2004 (who.int/healthinfo/bodestimates/en/index.html, accessed 8 May 2008), and account for 3.8% of all YLD. Schizophrenia and bipolar disorders are each responsible for 2.3% of all YLD.

Suicide rates are high in the European Region. The average suicide prevalence rate in Europe is 15.1 per 100 000 population, with the highest rates in the countries of the CIS (22.7 per 100 000 population) followed by the countries that have joined the EU since 2004 (15.5 per 100 000 population). The countries that have joined the EU since 2004 comprise Bulgaria, Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Romania, Slovakia and Slovenia.

Background to the study

The health ministries of the participating countries were responsible for delivering the data for this report. Forty-two countries in the WHO European Region participated in this project:

— all 27 EU countries: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United Kingdom;

— seven countries from south-eastern Europe: Albania, Bosnia and Herzegovina (Federation of Bosnia and Herzegovina and Republika Srpska), Croatia, Montenegro, Serbia, the former Yugoslav Republic of Macedonia and Turkey;

— five CIS countries: Azerbaijan, Georgia, Moldova, Russian Federation and Uzbekistan; and
— Israel, Norway and Switzerland.

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Anyone who grew up in a large family likely remembers hearing “Don’t wake the baby.” While it reinforces the message to older kids to keep it down, research shows that sleep also is an important part of how infants learn more about their new world.

Rebecca Gomez, Richard Bootzin and Lynn Nadel in the psychology department at the University of Arizona in Tucson found that babies who are able to get in a little daytime nap are more likely to exhibit an advanced level of learning known as abstraction.

Nadel, a Regents’ Professor at the UA, described the group’s work (Early Learning in Infants May Depend on Sleep) in a session at the American Association for the Advancement of Science annual meeting in San Diego on Sunday, Feb. 21.

In their research, Nadel and his colleagues played recordings of “phrases” created from an artificial language to four dozen 15-month-old infants during a learning session. Their methodology included repeatedly playing phrases like “pel-wadim-jic” until the babies became familiar with them.

These phrases contained three units, with the first and last unit forming a relationship. In this example, the first word, “pel,” predicts the last, “jic.” Even though these are nonsensical sounds, the language created for the test shares some similarity with structure commonly found in subject-verb agreement in English sentences.

Prior to being tested, some infants learning this faux language took their normally scheduled naps. Others were scheduled at a time when they would not nap following the session. When the infants returned to the lab, they again heard the recordings – along with a set of different phrases in which the predictive relationship between the first and last words were new.

By carefully watching the babies’ facial expressions as they listened to both old and new phrases, the researchers were able to rate their level of attention. They found that babies’ longer gazes at a flashing light that coincided with the phrases signaled attention, which indicated that they had learned a particular phrase or relationship.

Differences arose between the infants who had napped and those who had not. The infants who did not sleep after the sessions still recognized the phrases they had learned earlier. But those babies who had slept in between sessions were able to generalize their knowledge of sentence structure to draw predictive relationships to the new phrases. This suggests that napping supports abstract learning – that is, the ability to detect a general pattern contained in new information.

In follow-up work, the UA researchers have shown that infants must have their naps within four hours of listening to the artificial language in order for them to demonstrate this beneficial abstraction effect. Those who failed to nap within that time, but slept normally that evening, failed to show the abstraction effect the next day.

“It’s a fairly nuanced story,” Nadel said. “What we know is that infants have mostly REM sleep, given the type of sleep they have, given how their brains are developed at that point. And they have to get some of that sleep within a reasonable amount of time after inputting information in order to be able to do abstracting work on it. If they don’t sleep within four to eight hours, they probably just lose the entire thing,” he said.

What this should reinforce for parents, he said, is that while it obviously is important to give infants and young children the kind of stimulation that comes from reading, talking and exposing them to lots of words, thise stimuli need to happen within the context of a reasonably well-regulated daily cycle that includes adequate sleep.

Source:
Lynn Nadel
University of Arizona Continue reading →

UroToday – Dr Mani Menon reported his most current robotic prostatectomy data involving 1452 patients. Using his modified technique among this large cohort of men average age 59 years, with mean pre-operative PSA of 5.2 average total OR time was a very rapid 152 minutes with surgical time (less the time for docking of the robot) of only 90 minutes.

Blood loss was below 100cc’s / case. Continence rates were described at 97% at 12 months, consistent with several other centers. In excess of 95% of patients were discharged from hospital within 24 hours and potency rates of 95% among the group with the modified veil of Aphrodite technique were reported.

AUA 2006 – Abstract: 1154 – Sarle et al

Reviewed by UroToday Contributing Editor Gerry Brock, MD

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CVS Caremark has agreed to a $38.5 million settlement in a multistate civil deceptive-practices lawsuit against pharmacy benefit manager Caremark filed by 28 attorneys general, the Chicago Tribune reports. The attorneys general, led by Lisa Madigan (D) of Illinois and Douglas Ganslar (D) of Maryland, allege that Caremark “engaged in deceptive business practices” by informing physicians that patients or health plans could save money if patients were switched to certain brand-name prescription drugs (Miller, Chicago Tribune, 2/14).

However, the switch often saved patients and health plans only small amounts or increased their costs, while increasing Caremark’s profits, Connecticut Attorney General Richard Blumenthal (D) said (Levick, Hartford Courant, 2/15). Pennsylvania Attorney General Tom Corbett (R) said the PBM kept discounts and rebates that should have been passed on to employers and patients (Levy, AP/San Francisco Chronicle, 2/14). In addition, Caremark did not “adequately inform doctors” of the full financial effect of the switch and did not disclose that the switch would increase Caremark’s profits, the lawsuit alleges (Chicago Tribune, 2/14).

Settlement
Under the settlement, Caremark will pay $38.5 million to 28 states and Washington, D.C. (AP/San Francisco Chronicle, 2/14). States will receive $22 million of the settlement, and they must use the funds to benefit low-income, disabled or elderly patients or to educate residents about cost difference among prescription drugs (Harris, Bloomberg/Philadelphia Inquirer, 2/15). Caremark must pay $2.5 million to reimburse plan members for the increased costs associated with switching to certain cholesterol treatments (AP/San Francisco Chronicle, 2/14). Caremark also will pay $16.5 million to reimburse states for the cost of the investigation (Chicago Tribune, 2/14).

In addition, the settlement prohibits Caremark from requesting prescription drug switches in certain cases, such as when the cost to the patient would be higher with the new prescription drug; when the original prescription drug’s patent will expire within six months; and when patients were switched from a similar prescription drug within the previous two years (Hartford Courant, 2/15). Patients also have the ability to decline a switch from the prescribed treatment to the prescription offered by the pharmacy under the settlement, Madigan said (Bloomberg/Philadelphia Inquirer, 2/15).

Response
Caremark said it entered into the agreement to reaffirm its commitment to complying with consumer protection laws (Lade, South Florida Sun-Sentinel, 2/15). Caremark on Thursday said that the company and its subsidiaries have “expressly denied any and all allegations, and there has been no finding of wrongdoing or inappropriate business conduct on their part” (Hartford Courant, 2/15). The settlement “will not result in significant changes to current business practices,” Caremark said (Chicago Tribune, 2/14). CVS Caremark said that the settlement will not affect the company’s 2008 financial outlook (Bloomberg/Philadelphia Inquirer, 2/15).

Corbett said, “Caremark was operating against their clients’ interests by retaining rebates and discounts that they were obligated to pass on to their clients,” adding, “This agreement stops the deceptive business practices and takes the necessary steps to protect health plans and patients” (AP/San Francisco Chronicle, 2/14).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

“Health Care and the Recession,” New England Journal of Medicine: In a perspective roundtable, moderator Thomas Lee, an associate editor of NEJM and network president of Partners Healthcare System; James Mongan, CEO and president of Partners; Jonathan Oberlander, health policy expert and associate professor of social medicine and of health policy and management at the University of North Carolina; and Meredith Rosenthal, an associate professor of health economics and policy at Harvard School of Public Health, discuss how the economic recession has led to an increase in the number of uninsured U.S. residents, which is putting pressure on health care provider organizations. The roundtable participants discuss possible health care measures in the economic stimulus package being considered by Congress, as well as prospects for health reform in the current economic climate. Video of the roundtable is available online (Lee et al., NEJM, 1/22). NEJM also published two perspectives that examine how the economy is affecting efforts to overhaul the U.S. health care system. In one piece, Michael Sparer examines how expanding Medicaid could be the first step in creating a universal health care system (Sparer, NEJM, 1/22). In the other piece, Oberlander examines the expectations about health care reform that face the Obama administration (Oberlander, NEJM, 1/22).

“Online Disclosure of Physician-Industry Relationships,” New England Journal of Medicine: In the perspective, Robert Steinbrook, a national correspondent for NEJM, discusses online disclosure of physicians’ financial ties to the health care industry. According to Steinbrook, “Concerns about privacy notwithstanding, accurate, interpretable, and timely online disclosures can provide immediate access to potentially relevant information and demonstrate that relationships are not being hidden.” He writes, “Disclosure itself does not eliminate bias or conflicts of interest, but it can make financial relationships widely known and be used as a starting point for asking questions,” adding, “Disclosures would be most valuable if interested parties agreed on definitions for categories of relationships and payments, uniform approaches to calculating amounts and standards for information to be made public” (Steinbrook, NEJM, 1/22).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

A newly described virus is not a cause of Kawasaki disease, according to an article by a group of researchers in Denver, Colorado. Their article appears in the Dec. 15 issue of The Journal of Infectious Diseases, now available online.

The cause or causes of Kawasaki disease, an important pediatric infection that may lead to heart disease, have long been elusive. A study published in The Journal of Infectious Diseases last year by Jeffrey S. Kahn, MD, and colleagues at Yale University suggested that Kawasaki disease was associated with a new human coronavirus – one of a family of viruses affecting the respiratory tract. As an accompanying editorial pointed out then, the association required confirmation by other investigators.

Prompted by the Yale findings, Samuel R. Dominguez, MD, PhD, and colleagues at the University of Colorado Health Science Center and The Children’s Hospital in Denver conducted a case-control study comparing nasopharyngeal samples of pediatric patients to determine if infection with the new human coronavirus, also called coronavirus NL63, is associated with Kawasaki disease. They found it was not: The percentage of children infected with coronavirus NL63 was the same–7.7 percent–in children both with and without Kawasaki syndrome,.

As to why the new results diverged from those of Dr. Kahn, Dominguez suggested one possibility could have been an inadvertent selection bias based on the samples available in the previous study. Of the 53 children identified with Kawasaki disease in the previous study, respiratory specimens were only available from 11 children.

Anne H. Rowley, MD, from Northwestern University Feinberg School of Medicine and The Children’s Memorial Hospital in Chicago pointed out in an accompanying editorial other studies testing the association between coronaviruses and Kawasaki disease. The conclusions of these studies are similar to those of Dominguez et al, she said, and “it is now quite clear that the elusive etiological agent of Kawasaki disease is not the new human coronavirus.”

Rowley commented that “finding the cause of Kawasaki disease is a pediatric infectious diseases research priority. Identification of the causative agent(s) would be the most promising step toward developing a diagnostic test and specific therapy, and ultimately preventing the disease.”

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Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines. JID is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Alexandria, Va., IDSA is a professional society representing 8,300 physicians and scientists who specialize in infectious diseases. For more information, visit idsociety/.

Contact: Steve Baragona

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United Auto Workers President Ronald Gettelfinger on Friday in an interview with the Washington Post said… General Motors officials have not produced evidence that the union must make concessions on health benefits to return the company to profitability (Joyce, Washington Post, 7/9). The GM board reportedly had established an internal deadline of June 30 to reach an agreement with UAW on health benefits, but the deadline passed without a deal. GM spokesperson Edd Snyder said that company officials are “no longer talking about deadlines” but remain “committed to ongoing discussions with the union.” GM, which lost $1.1 billion on North American operations in the first quarter of 2005, this year expects to spend $5.6 billion on health benefits for more than one million workers, retirees and family members. Last month, GM CEO and Chair Rick Wagoner announced that the company will eliminate 25,000 hourly manufacturing jobs by 2008 and close an unspecified number of facilities, in part because of health care costs. In recent weeks, Gettelfinger has said that UAW will not reopen the contract with GM, which expires in 2007 (Kaiser Daily Health Policy Report, 6/29). Gettelfinger said on Friday, “We don’t know how big of an issue it is at GM until we study it.” He said that UAW, with the assistance of actuaries and financial advisers, has begun to examine proposals to reduce waste and improve efficiency within the current contract. He added that UAW considers reductions in health benefits for workers or increases in the share they pay for health care a last resort. In addition, Gettelfinger said that UAW will not reopen the contract with GM as long as the company has about $20 billion in cash reserves.

Reaction
Stefan Weinmann, a GM spokesperson, said, “We are in discussions, by all means, and we continue to be in discussions.” Gary Chaison, a professor of industrial relations at Clark University in Massachusetts, said, “I think there’s a tremendous amount of posturing going on, particularly on the part of GM,” adding, “But I think at the last moment parties are going to pull back” (Washington Post, 7/9).

United Auto Workers

Washington Post

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

The health benefits of omega-3 fatty acids are widely proven. But how can these nutrients be absorbed most effectively into the body? And do they have any potentially negative effects? Norwegian researchers are seeking answers to these questions.

Norway is a major player in the production of fish oils and omega-3. Over 40 per cent of the world’s omega-3 oils in food and food supplements originate in Norway. Researchers have clearly documented the beneficial health effects of the marine omega-3 fatty acids, EPA and DHA, but beyond this, little is known.

Useful for consumers, the authorities and the industry

“Consumers, the authorities and the industry are all interested in knowing more about how omega-3 from different products is absorbed into the body, as well as what kind of requirements should be stipulated in terms of freshness,” says Livar Fr??yland, Head of Research at the National Institute of Nutrition and Seafood Research (NIFES). NIFES is a public research institute that carries out specific research tasks relating to seafood for the public administration.

The omega-3 project is being carried out jointly by NIFES, the Department of Nutrition at the University of Oslo, Uppsala University and the Centre for Clinical Studies Bergen AS. The project has received funding under the Research Council’s Food Programme: Norwegian Food from Sea and Land (MATPROGRAMMET).

Fresh versus rancid

In short, Fr??yland and his colleagues are trying to find out if it is healthier to eat fish rather than ingest special products to which omega-3 has been added, or if it is best to down the quintessential spoonful of Norwegian cod’s liver oil as opposed to taking other kinds of omega-3 supplements.

In addition, the project will examine the potential negative health effects of rancid fish oil. While it would seem obvious that fresh fish oil is healthier than old, rancid oil, the actual effects have never been adequately documented.

“Rancid fish oil smells bad and tastes so awful that no-one would want to swallow it. But if the fish oil is in capsules, it is impossible to smell if it is rancid or not. That is why it is important for us to examine whether rancid fish oil is less beneficial to health, or, at worst, harmful to anyone who takes it,” asserts Fr??yland.

Documentation needed

“The health authorities need independent documentation in order to be able to issue advice on the types of fish oil that are beneficial to health and those that may have negative health impacts,” he adds.

One of the possible negative impacts of ingesting rancid fish oil to which Fr??yland is referring is what is known as oxidative stress in the cell membrane, i.e. where oxidants break down the cell membrane.

When the cell membrane is exposed to oxidation a type of molecule is released in the capillaries. Fr??yland explains that these molecules can be traced in the blood, thus serving as biomarkers that indicate whether the antioxidant level has been reduced.

Interesting findings in cell experiments

As a prelude to trials using mice and humans, the University of Oslo carried out a preliminary trial to examine the impact on cells of different sources of omega-3. One of the sources used in the tests was juice to which omega-3 and antioxidants from the company Smartfish AS had been added.

“The tests show that fish oil from capsules caused oxidation of the cell membrane, even when antioxidants had been added and when the capsules still had over a year left before their expiration date. Juice containing omega-3, on the other hand, produced no oxidation,” explains Janne Sande Mathisen, R&D Director at Smartfish.

Independent research more credible

The fish oil in Smartfish products comes from the company Marine Harvest Ingredients AS and is manufactured from the discards from salmon production within an hour of the salmon being slaughtered. According to Mathisen, consumers are growing increasingly concerned with eating food that is as fresh as possible and they believe that the health benefits should be documented by independent researchers.

“NIFES has not been commissioned by us or by any other industrial players. Their research results will therefore be extremely valuable. Their findings will have more credibility than if we had commissioned this project and published the results ourselves,” says Mathisen, who is more than willing to make Smartfish products available for a project such as this.

Mutually beneficial

“The distance from public-oriented to industry-oriented research is small. Sometimes research findings are to the advantage of the authorities, other times it is industry that wins nor is it uncommon for the research to be beneficial to both parties. For NIFES it is essential that the research results we produce can be used by a range of different stakeholders” states Fr??yland.

Source: Research Council of Norway Continue reading →

Responding to Healthy Lives, Healthy People: a strategy for public health in England, Chair of the English Pharmacy Board (EPB) Lindsey Gilpin said:

“The EPB supports the Department of Health’s aim to strengthen public health provision via a new National Public Health Service. Our response provides comments which will assist the development of this service as well as helping pharmacists and other healthcare practitioners engage with this development.

“The EPB believes that the new public health services should utilise the network of community pharmacies as its natural frontline. “Community pharmacists are highly qualified health professionals who lead well trained teams already delivering public health services on a daily basis from very accessible and convenient locations.

“Informal public health provision has been central to pharmacies throughout their history and there is a growing evidence base for good outcomes from their delivery of formal public health services.

“Increasingly, public health interventions will require the use of medication. Pharmacists are the experts in medicines and have a great deal of public health expertise within primary care, especially in service design and improvement, which does not appear to be recognised in this White Paper.”The contributions pharmacists in Great Britain already make at strategic and commissioning levels in wider public health must be recognised and supported in the new NHS structures in England. These include needs assessments, public health policy and planning, quality frameworks, evidence-based delivery and medicines management.

“We look forward to working with the Department of Health on these developments to deliver a first-class public health service.”

Source:

Royal Pharmaceutical Society of Great Britain Continue reading →

Responding to the news that the government is imposing draconian contract terms on GP??s to force them to extend opening hours in a way that will hit patient care, Dr Laurence Buckman, Chairman of the BMA’s GP Committee said:

“The government seems hell bent on tearing up a quality based contract designed to improve the health of patients and save lives less than four years after Gordon Brown approved it as Chancellor.

“These cuts will destabilise general practice and make it difficult for practices to maintain quality. An average practice with 6,000 patients could stand to lose ??36,000 in resources(1). The government is showing a careless disregard for patients with diabetes, chronic lung disease, heart disease and those at risk of strokes – quality markers to improve the care of all these patient groups are being removed by the government to finance longer hours for commuters. GPs will do their best to continue to provide good quality care but Gordon Brown’s political objective will inevitably affect the chronically ill.”

“GPs were prepared to extend their hours and the BMA came up with a workable proposal. Imposing this alternative contract change on GP??s sends a very negative message to all NHS staff about how little the Prime Minister values them. GP??s have hit 95% of the government’s targets through the Quality and Outcomes Framework and their patient satisfaction record is high according to the government’s own survey(2).

“The BMA will poll GPs to seek their views and will continue with talks during the next thirteen weeks to try to achieve a better outcome not just for our members but for the future of the NHS and for patients. The government plans as announced today will destabilise and harm general practice services for patients.”

References

(1) By removing points from the Quality and Outcomes Framework and introducing other changes the government has doubled the financial impact on practices compared to the deal on the table yesterday.

(2) The Government’s GP Patient Survey was published in July 2007. It surveyed over two million people and showed 84% of patients are happy with current opening hours. Only four in every hundred patients wanted extended opening hours in the evening and seven out of every hundred patients wanted Saturday surgeries. The survey cost ??11 million.

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