- Email: [email protected]
Better barriers
887
While
Noticeboard
considering the technical aspects of barrier methods, the did not underestimate the role of promotion in using barrier methods, and Dr Ernest Guerrero noted that the percentage
workshop
Decline in sudden infant deaths The UK Department of Health has announced that the number of cases of sudden infant deaths (SID) in England and Wales was 326 during the first nine months of 1992, compared with 732 for the same period in 1991. Whether or not this decrease is due to mothers being advised to lay their babies supine (the Government claims the credit for its "Back to Sleep" campaign, started in 1991) remains unproven. There has been a report from one region of Britain, Avon,! that the fall in SID there coincided with a switch to supine sleeping, although the numbers were too small to allow a definite conclusion. Whatever the reason, the size of decline in these puzzling and tragic deaths is remarkable-55%--and awaits a definitive explanation. John Bignall ’
1. Wigfield RE, Fleming PJ, Berry JP, Rudd TP, Golding J. Can the fall in Avon’s sudden infant death rate be explained by changes in sleeping position? BMJ 1992; 304: 282-83.
Better barriers Interest in barrier methods of contraception has been revived because of their ability to prevent the transmission of sexually transmitted diseases (STDs) as well. However, at a global level only 5% of married couples use a barrier contraceptive and four out of five of these people are condom users. Moreover, in a US study 60% of those claiming they used condoms for contraception reported not using them at their last intercourse. The corresponding figure for those reporting condom use to prevent STDs was 90%. The need for incremental improvements in existing barrier methods and for totally new choices were discussed at a workshop held at Santa Domingo by the Contraceptive Research and Development Program, East Virgina Medical School, on March 22-25. The female condom (RealityfFemidome) recently reached the market place in several countries. Others, such as non-latex condoms, a new sponge (Protectaid), and two new reusable silicone rubber vaginal barriers (Lea’s Shield and FemCap) are undergoing clinical testing. Protectaid contains low concentrations of sodium cholate, nonoxonyl-9, benzylkonium chloride, and a dispersing agent. Lea’s Shield covers the anterior vaginal wall and one size fits all, whereas FemCap covers the vaginal vault and comes in three sizes. The workshop gave much emphasis to accelerating product development and marketing approval. Better preclinical screening methods are needed to speed the selection of candidate substances for further development. It was agreed that clinical trials involving six months’ exposure to pregnancy were sufficient to estimate effectiveness, but pregnancy rates are obviously unsuitable for assessing usefulness in slowing STD and HIV transmission. Special clinical studies of spermicide use are also likely to be valuable. For example, Peter Mason reported that about 20% of women in Zimbabwe in a sample he studied had lactobacilli in the vagina and in about half of these women the lactobacilli produced hydrogen peroxide. About 10% of women with lactobacilli producing H202 seroconverted to HIV, compared with 32-45% of women whose lactobacilli did not produce H202 or who had no lactobacilli. The study needs confirming but raises interesting issues. Perhaps, the strongest message from the Workshop was the need to explore chemical methods women could use when they cannot compel their partner to use a condom. Women are much more likely to acquire an STD or HIV from an infected man than vice versa; the consequences of STDs for women, their fertility, and their children are considerably greater than for men (pelvic inflammatory disease costs an estimated$5 billion a year in the USA); and heterosexual transmission is the most common route in the global spread of HIV. There is increasing evidence that several STDs are also risk factors in HIV transmission and, although the increased relative risk may be low in the case of some co-factors, the high prevalence of certain conditions such as chlamydia and trichomonas may make them numerically important in HIV spread.
of men using condoms in the Santa Domingo sex motels fell from 20% in 1989 to only 12% in 1990, when investment in health education fell.
Malcolm Potts
Women in
drug trials
The US Food and Drug Administration is lifting a 16-year policy forbidding women of "childbearing potential" from participating in early drug trials. Under new rules to be issued later this year, drug companies will be required to include a sufficient number of women subjects in their drug-safety tests to enable assessments of whether the drugs affect women differently from men. To protect fetuses from teratogens, women participating in the studies will be required to sign consent agreements that include the provision that they must either be unable to become pregnant or be using effective contraception. The new FDA rules are part of a three-year-old campaign by US health officials to improve the quality and amount of research done on women’s health problems, which critics charge has been sorely neglected in the past. Michael McCarthy
"Fresh" air not the
answer
The causes of sick building syndrome are unknown, but inadequate ventilation has been thought to be important. A study published last week throws doubt on the need to supply modern office buildings with large volumes of outdoor air.1 No relation was found between symptoms or dissatisfaction with the environment at work and ventilation rates with outdoor air in buildings already supplied with above US standard ventilation rates of 20 ft3 (0-57 m3) per minute per person. "Fresh" air is not, it seems, the answer to improving the office environment. However, as the authors point out, the buildings studied may not have been sick and the participants may not have had sick building syndrome. The WHO defines a sick building as one in which an "excess" frequency of symptoms among occupants occurs, and the sick building syndrome as an excess of work-related irritations of the skin and mucous membranes together with headache, fatigue, or difficulty in concentrating ;2 but no "normal" symptom frequencies are known. Astrid James R, Tamblyn R, Farant J-P, Hanley J, Nures F, Tamblyn R. The effect of varying levels of outdoor-air supply on the symptoms of sick building syndrome. N Engl J Med 1993; 328: 821-27. Indoor air pollutants: exposure and health effects. Copenhagen: World Health Organization, 1983.
1. Menzies
2.
International rescue? Should a doctor’s moral duty to rescue an individual whose life or health is in grave danger be converted into a legal duty? At an international conference on justice and health care at King’s College, London, UK, Prof Dieter Giesen (Berlin) drew attention to the wide variation in the way this question is dealt with by legal systems in different countries. For instance, there is no UK statute or common-law precedent that obliges a doctor to assist an unconcious person with whom they have no connection. In almost every other country in Europe, a doctor who did not act in such a situation would be committing a grave offence. Giesen argued that the latter system is not, as some think, a morally unacceptable appropriation of physicians’ skills. He pointed out that the newly qualified doctor is indebted to society because of both state investment in training and the clinical experience learned on patients. Thus "a doctor required to provide vital treatment in an emergency situation is not ’giving something for nothing"’. Giesen described several measures that have been taken to encourage doctors to provide emergency care, one of which is the enactment of "Good Samaritan" statutes in the USA. These statutes apply only outside hospitals and are intended to encourage doctors to behave like Good Samaritans by, in general, imposing
While
Noticeboard
considering the technical aspects of barrier methods, the did not underestimate the role of promotion in using barrier methods, and Dr Ernest Guerrero noted that the percentage
workshop
Decline in sudden infant deaths The UK Department of Health has announced that the number of cases of sudden infant deaths (SID) in England and Wales was 326 during the first nine months of 1992, compared with 732 for the same period in 1991. Whether or not this decrease is due to mothers being advised to lay their babies supine (the Government claims the credit for its "Back to Sleep" campaign, started in 1991) remains unproven. There has been a report from one region of Britain, Avon,! that the fall in SID there coincided with a switch to supine sleeping, although the numbers were too small to allow a definite conclusion. Whatever the reason, the size of decline in these puzzling and tragic deaths is remarkable-55%--and awaits a definitive explanation. John Bignall ’
1. Wigfield RE, Fleming PJ, Berry JP, Rudd TP, Golding J. Can the fall in Avon’s sudden infant death rate be explained by changes in sleeping position? BMJ 1992; 304: 282-83.
Better barriers Interest in barrier methods of contraception has been revived because of their ability to prevent the transmission of sexually transmitted diseases (STDs) as well. However, at a global level only 5% of married couples use a barrier contraceptive and four out of five of these people are condom users. Moreover, in a US study 60% of those claiming they used condoms for contraception reported not using them at their last intercourse. The corresponding figure for those reporting condom use to prevent STDs was 90%. The need for incremental improvements in existing barrier methods and for totally new choices were discussed at a workshop held at Santa Domingo by the Contraceptive Research and Development Program, East Virgina Medical School, on March 22-25. The female condom (RealityfFemidome) recently reached the market place in several countries. Others, such as non-latex condoms, a new sponge (Protectaid), and two new reusable silicone rubber vaginal barriers (Lea’s Shield and FemCap) are undergoing clinical testing. Protectaid contains low concentrations of sodium cholate, nonoxonyl-9, benzylkonium chloride, and a dispersing agent. Lea’s Shield covers the anterior vaginal wall and one size fits all, whereas FemCap covers the vaginal vault and comes in three sizes. The workshop gave much emphasis to accelerating product development and marketing approval. Better preclinical screening methods are needed to speed the selection of candidate substances for further development. It was agreed that clinical trials involving six months’ exposure to pregnancy were sufficient to estimate effectiveness, but pregnancy rates are obviously unsuitable for assessing usefulness in slowing STD and HIV transmission. Special clinical studies of spermicide use are also likely to be valuable. For example, Peter Mason reported that about 20% of women in Zimbabwe in a sample he studied had lactobacilli in the vagina and in about half of these women the lactobacilli produced hydrogen peroxide. About 10% of women with lactobacilli producing H202 seroconverted to HIV, compared with 32-45% of women whose lactobacilli did not produce H202 or who had no lactobacilli. The study needs confirming but raises interesting issues. Perhaps, the strongest message from the Workshop was the need to explore chemical methods women could use when they cannot compel their partner to use a condom. Women are much more likely to acquire an STD or HIV from an infected man than vice versa; the consequences of STDs for women, their fertility, and their children are considerably greater than for men (pelvic inflammatory disease costs an estimated$5 billion a year in the USA); and heterosexual transmission is the most common route in the global spread of HIV. There is increasing evidence that several STDs are also risk factors in HIV transmission and, although the increased relative risk may be low in the case of some co-factors, the high prevalence of certain conditions such as chlamydia and trichomonas may make them numerically important in HIV spread.
of men using condoms in the Santa Domingo sex motels fell from 20% in 1989 to only 12% in 1990, when investment in health education fell.
Malcolm Potts
Women in
drug trials
The US Food and Drug Administration is lifting a 16-year policy forbidding women of "childbearing potential" from participating in early drug trials. Under new rules to be issued later this year, drug companies will be required to include a sufficient number of women subjects in their drug-safety tests to enable assessments of whether the drugs affect women differently from men. To protect fetuses from teratogens, women participating in the studies will be required to sign consent agreements that include the provision that they must either be unable to become pregnant or be using effective contraception. The new FDA rules are part of a three-year-old campaign by US health officials to improve the quality and amount of research done on women’s health problems, which critics charge has been sorely neglected in the past. Michael McCarthy
"Fresh" air not the
answer
The causes of sick building syndrome are unknown, but inadequate ventilation has been thought to be important. A study published last week throws doubt on the need to supply modern office buildings with large volumes of outdoor air.1 No relation was found between symptoms or dissatisfaction with the environment at work and ventilation rates with outdoor air in buildings already supplied with above US standard ventilation rates of 20 ft3 (0-57 m3) per minute per person. "Fresh" air is not, it seems, the answer to improving the office environment. However, as the authors point out, the buildings studied may not have been sick and the participants may not have had sick building syndrome. The WHO defines a sick building as one in which an "excess" frequency of symptoms among occupants occurs, and the sick building syndrome as an excess of work-related irritations of the skin and mucous membranes together with headache, fatigue, or difficulty in concentrating ;2 but no "normal" symptom frequencies are known. Astrid James R, Tamblyn R, Farant J-P, Hanley J, Nures F, Tamblyn R. The effect of varying levels of outdoor-air supply on the symptoms of sick building syndrome. N Engl J Med 1993; 328: 821-27. Indoor air pollutants: exposure and health effects. Copenhagen: World Health Organization, 1983.
1. Menzies
2.
International rescue? Should a doctor’s moral duty to rescue an individual whose life or health is in grave danger be converted into a legal duty? At an international conference on justice and health care at King’s College, London, UK, Prof Dieter Giesen (Berlin) drew attention to the wide variation in the way this question is dealt with by legal systems in different countries. For instance, there is no UK statute or common-law precedent that obliges a doctor to assist an unconcious person with whom they have no connection. In almost every other country in Europe, a doctor who did not act in such a situation would be committing a grave offence. Giesen argued that the latter system is not, as some think, a morally unacceptable appropriation of physicians’ skills. He pointed out that the newly qualified doctor is indebted to society because of both state investment in training and the clinical experience learned on patients. Thus "a doctor required to provide vital treatment in an emergency situation is not ’giving something for nothing"’. Giesen described several measures that have been taken to encourage doctors to provide emergency care, one of which is the enactment of "Good Samaritan" statutes in the USA. These statutes apply only outside hospitals and are intended to encourage doctors to behave like Good Samaritans by, in general, imposing