- Email: [email protected]
Leishmaniasis in Sudan
488
education in Britain, 1943. From the very
was
start
published in the second issue, in April, the reception overseas was tremendous;
unexpected use to which the Bulletin was put was as an aid for teaching English to Spanish doctors. Details of the conception and development of the Bulletin are given in the first issue of 1993--on contraception. one
Vivien Choo 1. Binnie
GAC, Sadler RL, Thomson WO, White DMD, eds. In England Now. Fifty correspondence in The Lancet. London: The Lancet/Hodder and Stoughton, 1989. 2. Tansey EM, Booth CC. The British Medical Bulletin 1943-1993. A guide to medical science and thought in Britain. In: Baird DT, Drife JO. Contraception. Br Med Bull 1993; 49: 1-17. years of peripatetic
specialty care will be reviewed by six separate working cardiac, cancer, neuroscience, renal, plastic surgery, and paediatric services. Decisions are expected by the end of May, 1993. The Special Health Authorities will enter the "internal market" in April, 1994, and thereafter compete nationally for funding. The London’s
groups
on
Government accepts that medical student numbers in London be reduced by 150 and Tomlinson’s proposal for the formation of multifaculty colleges is strongly endorsed. Staff reductions are inevitable. The report notes that the responsibility for the future of health-service staff lies with employing authorities and not the Government, but a "human resources subgroup" will create a clearing house to help those who cannot find alternative work.
must
Richard Horton
Response to Tomlinson Despite Mrs Virginia Bottomley’s belief that "No change in London is no option", many of the decisions about the future of London’s teaching hospitals have been left unresolved by the publication of the UK Department of Health’s response1 to the Tomlinson report2 on London’s health services. Strategic plans for London’s secondary health care will be made by a newly formed London Implementation Group (LIG), chaired by Mr Tim Chessells. The LIG has the challenging task of securing agreement between interested parties about their future and overseeing implementation of their proposals after making recommendations to ministers. The Secretary of State for Health has successfully devolved responsibility for hospital closures away from her department, thus defusing an increasingly acrimonious political debate. That closures will take place is certain: Bottomley envisages a loss of 2000-2500 beds in London during the next 5 years. Inner London has 4 acute hospital beds per 1000 people, compared with the national average of 2-5, but the calculation does not take account of London’s daily influx of 1 3 million commuters. Her report notes that Charing Cross, St Bartholomew’s, and either St Thomas’s or Guy’s are in a perilous position. If their arguments for survival fail to convince the LIG, then one or more will shut. Tomlinson’s original proposal to move the Royal Brompton and Royal Marsden Hospitals to the Charing Cross site has been rejected and, if the recommendation to close the accident and emergency department at Charing Cross is accepted, the hospital’s future is bleak. Services at Guy’s and St Thomas’s might be merged and this will probably begin with the closure of one casualty department. The local campaign to save St Bartholomew’s has not been in vain. If proposals to convert it either into a specialist centre or into a combined trust with the Royal London Hospital are accepted, then the site will be preserved. Fusion of services at University College and Middlesex Hospitals will continue, and St Mary’s, St George’s, the Royal Free, and Royal London Hospitals will be unaffected in the short term. Decisions about the future of those centres under threat will be made during the next 6 months. Primary care is to receive 170 million over 6 years. This investment programme will be focused within a London Initiative Zone, the formation of which Bottomley describes as a "... landmark in the development of innovative primary care." The London Initiative Zone is intended to focus attention and resources on inner city care. Additionally, the LIG will establish a Primary Health Care Forum to decide on an agenda for urgent action by April 1, 1993. New health centres will be built, existing premises will be modernised, and community resource centres for patients of several practices will be developed. Further training of family doctors will be undertaken and hospital nurses will be transferred into the community. New approaches to the delivery of primary care are to be encouraged--eg, incorporation of facilities into shops, schools, and offices; strengthening of links with the voluntary sector; and opening of polyclinics. The primary care programme will begin with a ;40 million investment for the first 12 months. The chief executive of the King’s Fund, Robert Maxwell, commented that "the funding... is not as much as we would like ... but it is substantial". The Government has rejected calls from opposition political parties to establish a London-wide health authority to oversee these changes.
1993. Pp 27. Available from Health Publications Unit, Manchester Road, Heyward, Lancashire OL10 2PZ, UK. 2. Report of the inquiry into London’s health services, medical education, and research. London: HM Stationery Office, 1992. 1.
Department of Health. Making London better.
Follow-up at Camelford In 1988, 20 000 people in Cornwall, UK, drank water that had been accidentally contaminated by a large quantity of aluminium sulphate.1 Hundreds of them had gastrointestinal symptoms, sore throats, and skin complaints at the time. 2 of the individuals with acute symptoms who still felt unwell 6-7 months later proved to have aluminium in bone,2 a finding not in keeping with the view of the Clayton committee3that poor gut absorption of metals would prevent accumulation and ill-effects. What has happened to these individuals since? A further follow-up report of these 2 patients, and of 8 other residents who had early effects, says that in the ensuing 12-17 months the individuals complained of musculoskeletal problems and impairment of memory. The first 2 individuals no longer had aluminium in the bone, nor did any of the other 6 tested; 3 others had borderlinie osteopenia. Neuropsychological assessment indicated impairment of memory in 8 of 9 patients, and ability to process auditory information quickly was consistent with that recorded for minor head injury. The number of patients who had depression or were anxious increased between first assessment and follow-up (at about 26 months)-from 1 to 4 and from 1 to 6, respectively. The authors of the report believe that the appearance of depression and anxiety 1-2 years after the event is suggestive of a psychological stress response and in accordance with the Clayton committee’s revised view that the accident led to "real mental and physical suffering in the community".5
Stephanie Clark 1. Anon. Water poisoning in Cornwall. Lancet 1988; ii: 465. 2. Eastwood JB, Levin GE, Pazianas M, Taylor AP, Denton J, Freemont AJ. Aluminium deposition in bone after contamination of drinking water supply.
Lancet 1990; 336: 462-64. 3. Water pollution at Lowermoor, North Cornwall. Report of the Lowermoor Incident Health Advisory Group (Chairman: Prof Dame Barbara Clayton), July, 1989. 4. McMillan TM, Freemont AJ, Herxheimer A, et al. Camelford water poisoning accident: serial neuropsychological assessments and further observations on bone aluminium. Hum Exp Toxicol 1993; 12: 37-42. 5. Second report of the Lowermoor Incident Health Advisory Group Water Pollution at Lowermoor in North Cornwall. London: HM Stationery Office, 1991.
Leishmaniasis in Sudan The World Health Organisation is appealing for about US$1 million to purchase and transport drugs, disposable syringes, and basic diagnostic equipment for what is considered to be "one of the largest epidemics of the disease in recorded history".1 The area affected, in the Western Upper Nile province of Southern Sudan, is a war zone, a factor that hampered the implementation of effective control measures for the epidemic, which first became apparent in mid-1988 (although it was initially thought to be an outbreak of typhoid). Reports by Mededns sans Frontieres/Netherlands suggest that 40 000 people may have died and that the population in some villages has fallen by 30--40%. 300 000 to 400 000 people remain at risk. 1. Anon. Leishmaniasis
41-42.
epidemic
in Southern Sudan.
Wkly Epidemiol
Rec
1993; 68:
education in Britain, 1943. From the very
was
start
published in the second issue, in April, the reception overseas was tremendous;
unexpected use to which the Bulletin was put was as an aid for teaching English to Spanish doctors. Details of the conception and development of the Bulletin are given in the first issue of 1993--on contraception. one
Vivien Choo 1. Binnie
GAC, Sadler RL, Thomson WO, White DMD, eds. In England Now. Fifty correspondence in The Lancet. London: The Lancet/Hodder and Stoughton, 1989. 2. Tansey EM, Booth CC. The British Medical Bulletin 1943-1993. A guide to medical science and thought in Britain. In: Baird DT, Drife JO. Contraception. Br Med Bull 1993; 49: 1-17. years of peripatetic
specialty care will be reviewed by six separate working cardiac, cancer, neuroscience, renal, plastic surgery, and paediatric services. Decisions are expected by the end of May, 1993. The Special Health Authorities will enter the "internal market" in April, 1994, and thereafter compete nationally for funding. The London’s
groups
on
Government accepts that medical student numbers in London be reduced by 150 and Tomlinson’s proposal for the formation of multifaculty colleges is strongly endorsed. Staff reductions are inevitable. The report notes that the responsibility for the future of health-service staff lies with employing authorities and not the Government, but a "human resources subgroup" will create a clearing house to help those who cannot find alternative work.
must
Richard Horton
Response to Tomlinson Despite Mrs Virginia Bottomley’s belief that "No change in London is no option", many of the decisions about the future of London’s teaching hospitals have been left unresolved by the publication of the UK Department of Health’s response1 to the Tomlinson report2 on London’s health services. Strategic plans for London’s secondary health care will be made by a newly formed London Implementation Group (LIG), chaired by Mr Tim Chessells. The LIG has the challenging task of securing agreement between interested parties about their future and overseeing implementation of their proposals after making recommendations to ministers. The Secretary of State for Health has successfully devolved responsibility for hospital closures away from her department, thus defusing an increasingly acrimonious political debate. That closures will take place is certain: Bottomley envisages a loss of 2000-2500 beds in London during the next 5 years. Inner London has 4 acute hospital beds per 1000 people, compared with the national average of 2-5, but the calculation does not take account of London’s daily influx of 1 3 million commuters. Her report notes that Charing Cross, St Bartholomew’s, and either St Thomas’s or Guy’s are in a perilous position. If their arguments for survival fail to convince the LIG, then one or more will shut. Tomlinson’s original proposal to move the Royal Brompton and Royal Marsden Hospitals to the Charing Cross site has been rejected and, if the recommendation to close the accident and emergency department at Charing Cross is accepted, the hospital’s future is bleak. Services at Guy’s and St Thomas’s might be merged and this will probably begin with the closure of one casualty department. The local campaign to save St Bartholomew’s has not been in vain. If proposals to convert it either into a specialist centre or into a combined trust with the Royal London Hospital are accepted, then the site will be preserved. Fusion of services at University College and Middlesex Hospitals will continue, and St Mary’s, St George’s, the Royal Free, and Royal London Hospitals will be unaffected in the short term. Decisions about the future of those centres under threat will be made during the next 6 months. Primary care is to receive 170 million over 6 years. This investment programme will be focused within a London Initiative Zone, the formation of which Bottomley describes as a "... landmark in the development of innovative primary care." The London Initiative Zone is intended to focus attention and resources on inner city care. Additionally, the LIG will establish a Primary Health Care Forum to decide on an agenda for urgent action by April 1, 1993. New health centres will be built, existing premises will be modernised, and community resource centres for patients of several practices will be developed. Further training of family doctors will be undertaken and hospital nurses will be transferred into the community. New approaches to the delivery of primary care are to be encouraged--eg, incorporation of facilities into shops, schools, and offices; strengthening of links with the voluntary sector; and opening of polyclinics. The primary care programme will begin with a ;40 million investment for the first 12 months. The chief executive of the King’s Fund, Robert Maxwell, commented that "the funding... is not as much as we would like ... but it is substantial". The Government has rejected calls from opposition political parties to establish a London-wide health authority to oversee these changes.
1993. Pp 27. Available from Health Publications Unit, Manchester Road, Heyward, Lancashire OL10 2PZ, UK. 2. Report of the inquiry into London’s health services, medical education, and research. London: HM Stationery Office, 1992. 1.
Department of Health. Making London better.
Follow-up at Camelford In 1988, 20 000 people in Cornwall, UK, drank water that had been accidentally contaminated by a large quantity of aluminium sulphate.1 Hundreds of them had gastrointestinal symptoms, sore throats, and skin complaints at the time. 2 of the individuals with acute symptoms who still felt unwell 6-7 months later proved to have aluminium in bone,2 a finding not in keeping with the view of the Clayton committee3that poor gut absorption of metals would prevent accumulation and ill-effects. What has happened to these individuals since? A further follow-up report of these 2 patients, and of 8 other residents who had early effects, says that in the ensuing 12-17 months the individuals complained of musculoskeletal problems and impairment of memory. The first 2 individuals no longer had aluminium in the bone, nor did any of the other 6 tested; 3 others had borderlinie osteopenia. Neuropsychological assessment indicated impairment of memory in 8 of 9 patients, and ability to process auditory information quickly was consistent with that recorded for minor head injury. The number of patients who had depression or were anxious increased between first assessment and follow-up (at about 26 months)-from 1 to 4 and from 1 to 6, respectively. The authors of the report believe that the appearance of depression and anxiety 1-2 years after the event is suggestive of a psychological stress response and in accordance with the Clayton committee’s revised view that the accident led to "real mental and physical suffering in the community".5
Stephanie Clark 1. Anon. Water poisoning in Cornwall. Lancet 1988; ii: 465. 2. Eastwood JB, Levin GE, Pazianas M, Taylor AP, Denton J, Freemont AJ. Aluminium deposition in bone after contamination of drinking water supply.
Lancet 1990; 336: 462-64. 3. Water pollution at Lowermoor, North Cornwall. Report of the Lowermoor Incident Health Advisory Group (Chairman: Prof Dame Barbara Clayton), July, 1989. 4. McMillan TM, Freemont AJ, Herxheimer A, et al. Camelford water poisoning accident: serial neuropsychological assessments and further observations on bone aluminium. Hum Exp Toxicol 1993; 12: 37-42. 5. Second report of the Lowermoor Incident Health Advisory Group Water Pollution at Lowermoor in North Cornwall. London: HM Stationery Office, 1991.
Leishmaniasis in Sudan The World Health Organisation is appealing for about US$1 million to purchase and transport drugs, disposable syringes, and basic diagnostic equipment for what is considered to be "one of the largest epidemics of the disease in recorded history".1 The area affected, in the Western Upper Nile province of Southern Sudan, is a war zone, a factor that hampered the implementation of effective control measures for the epidemic, which first became apparent in mid-1988 (although it was initially thought to be an outbreak of typhoid). Reports by Mededns sans Frontieres/Netherlands suggest that 40 000 people may have died and that the population in some villages has fallen by 30--40%. 300 000 to 400 000 people remain at risk. 1. Anon. Leishmaniasis
41-42.
epidemic
in Southern Sudan.
Wkly Epidemiol
Rec
1993; 68: