- Email: [email protected]
Support for condoms In American schools
UK update on silicone breast implants
updated analysis,’ from the UK Department of Health, of work examining
An
the relation between connective tissue disease and silicone gel breast implants, has led to the same conclusion drawn after the review published in 1993-that there is no evidence that the implants increase risk of connective tissue disease. : The current analysis covers about 270 papers published between the end of 1991 and July, 1994. Because of the poor standard of many of the papers examined, the: report discusses in some detail parts of the work that has been reviewed. : The report points out that review articles that have found support for a link between connective tissue disease and silicone gel have tended to be selective in the data assessed and sometimes seem to have ignored the generally accepted criteria of proof. Most review articles have concluded that no causal link has been shown. : And none of the controlled clinical trials published so far has contained adequate controls. There has been further evidence that certain silicones elicit an antibody response, but the presence of antibodies in low titres in non-recipients raises doubts about their significance; further study is needed to define the antigenic determinant before conclusions can be drawn. : Epidemiological studies are still in their early stages. None of the thirteen for which preliminary results have been published has shown an increased risk of connective tissue disease. The report says that it is unlikely that any individual epidemiological study will be sufficiently large to provide a definitive answer. Worse, differences in study design might preclude
meta-analysis.
The difference can be explained by the greater use of peritoneal dialysis (50%) in the UK than France (7-8%). IGAS also notes that about 10% of the cost of dialyThe French Inspectorate General of sis (FFr 35 000 per person each year) Social Affairs (IGAS) has strongly critigoes on transport, which is chargeable to cised the country’s haemodialysis services. sickness insurance. IGAS has also brought Its inquiry had been ordered by Simone to light a problem with infection control. Veil, Minister for Social Affairs and It reports that, to increase the number of Health. Only 8000 to 9000 of the 29 000 patients they can treat, some private people in France with chronic renal failhaemodialysis clinics disregard regulations ure, will receive renal transplants, leaving governing sterilisation and cleanliness. some 20 000 on dialysis. This treatment "In the context of nosocomial infection accounts for about 1.5% of sicknessand viral hepatitis, it is inexcusable to insurance expenditure of FFr 7-8 billion. : ignore these regulations", says the IGAS According to IGAS, dialysis in France . report. is costly compared with that in other industrialised countries, notably the UK.: Jean-Yves Nau
French haemodialysis services criticised
:
Support
for condoms In American schools
showing widespread support by adults for condom distribution in schools, only a small proportion of school-based clinics
The American Academy of Pediatrics Committee on Adolescence is recommending that, "in the interest of public . health, restrictions and barriers to condom availability should be removed". And e entering into a political battle that has divided school districts, officials, and parents across the USA, the Committee further asserts that "schools are an . for the site appropriate availability of condoms". But the report is careful to recommend against school condom distribution programmes as being adolescents’ only exposure to sex education. Rather, it . believes such programmes should be combined with "comprehensive sequential . sexuality education" beginning in the earliest year of formal education and continuing to grade 12, and suggests that condom distribution in schools be developed as part of a "collaborative community process". Despite a 1991 survey
hand them out. The committee report (Pediatrics 1995; 95: 281-85) is careful to preface its recommendations with a review of the problems of American adolescent sexuality (see Lancet 1995; 345: 577). Despite comparable rates of sexual intercourse among European and Canadian adolescents (where sex education and condoms are often more easily obtained), the USA has higher rates of teenage pregnancy. Nearly a third of the 20 000 000 cases a year of sexually transmitted diseases in the USA occur among school-aged youth. 1 in 4 contracts a sexually transmitted disease before graduating from high school. Only half are using condoms consistently. As the committee notes, less than 10% of US children receive comprehensive sex education. David H Frankel
sufficiently robust
to
determine national
emphasises that the safety of Confusion over intensive or local policy. The centre drew attention polyurethane-coated implants has no care for UK children to a "significant diversity" of professional bearing on the debate over the link opinion over the details of intensive-care between silicone implants and connective A report’ commissioned by the National provision for children and also emphatissue disease. Another point emphasised : Health Service and published last week sised the lack of British research into how is that there are flaws in the arguments has sent out confused messages over the to organise and staff services for critically in The report
link between breastfeeding by women with silicone implants and gastric : problems in their children. Because the confusion over the chemical relations between silicon, silica, and silicone has caused muddled interpretation of research findings, the report has an appendix explaining the similarities and differences between these substances. A compilation of detailed critical summaries might be produced if there is a demand. :
suggesting
a
Vivien Choo 1
Gott DM, Tinkler JJB. Silicone implants and connective tissue disease. London: Medical Devices Agency (14 Russell Square, London WC1B 5EP). 1994: Pp 62. £75 (for bulk orders and NHS on application). ISBN 1-85839-347-7).
642
future of paediatric intensive care the ill children. UK. In it, an NHS research centre critiBut the BPA, who reply in an appendix cises previous recommendations by the to the centre’s report, are equally fierce in British Paediatric Association. : their criticism of the centre’s research The BPA recommendations were based methods and conclusions. They accuse on the results of a national postal survey, the centre for consistently ignoring or miswhich looked at the present provision of representing reviews of their report by intensive-care facilities for children and independent experts. They argue that concluded that, among the many deficienthere is no fundamental disagreement cies in such care, there were too few beds between their findings and those of indeand too few nurses to staff the beds. The pendent reviewers that urgent changes are BPA also concluded that critically ill chilneeded to improve the provision of paedidren are best cared for by specialist staff atric intensive-care services. in paediatric intensive-care units. At the request of the Department of Sarah Ramsay Health, the NHS Centre for Reviews and Dissemination examined the BPA survey 1 Which way forward for the care of critically and recommendations. The centre found ill children? Available from the NHS Centre for Reviews and Dissemination, University that, while the BPA’s results were a "useof York, Heslington, York Y01 5DD, UK ful" information source, they were not
updated analysis,’ from the UK Department of Health, of work examining
An
the relation between connective tissue disease and silicone gel breast implants, has led to the same conclusion drawn after the review published in 1993-that there is no evidence that the implants increase risk of connective tissue disease. : The current analysis covers about 270 papers published between the end of 1991 and July, 1994. Because of the poor standard of many of the papers examined, the: report discusses in some detail parts of the work that has been reviewed. : The report points out that review articles that have found support for a link between connective tissue disease and silicone gel have tended to be selective in the data assessed and sometimes seem to have ignored the generally accepted criteria of proof. Most review articles have concluded that no causal link has been shown. : And none of the controlled clinical trials published so far has contained adequate controls. There has been further evidence that certain silicones elicit an antibody response, but the presence of antibodies in low titres in non-recipients raises doubts about their significance; further study is needed to define the antigenic determinant before conclusions can be drawn. : Epidemiological studies are still in their early stages. None of the thirteen for which preliminary results have been published has shown an increased risk of connective tissue disease. The report says that it is unlikely that any individual epidemiological study will be sufficiently large to provide a definitive answer. Worse, differences in study design might preclude
meta-analysis.
The difference can be explained by the greater use of peritoneal dialysis (50%) in the UK than France (7-8%). IGAS also notes that about 10% of the cost of dialyThe French Inspectorate General of sis (FFr 35 000 per person each year) Social Affairs (IGAS) has strongly critigoes on transport, which is chargeable to cised the country’s haemodialysis services. sickness insurance. IGAS has also brought Its inquiry had been ordered by Simone to light a problem with infection control. Veil, Minister for Social Affairs and It reports that, to increase the number of Health. Only 8000 to 9000 of the 29 000 patients they can treat, some private people in France with chronic renal failhaemodialysis clinics disregard regulations ure, will receive renal transplants, leaving governing sterilisation and cleanliness. some 20 000 on dialysis. This treatment "In the context of nosocomial infection accounts for about 1.5% of sicknessand viral hepatitis, it is inexcusable to insurance expenditure of FFr 7-8 billion. : ignore these regulations", says the IGAS According to IGAS, dialysis in France . report. is costly compared with that in other industrialised countries, notably the UK.: Jean-Yves Nau
French haemodialysis services criticised
:
Support
for condoms In American schools
showing widespread support by adults for condom distribution in schools, only a small proportion of school-based clinics
The American Academy of Pediatrics Committee on Adolescence is recommending that, "in the interest of public . health, restrictions and barriers to condom availability should be removed". And e entering into a political battle that has divided school districts, officials, and parents across the USA, the Committee further asserts that "schools are an . for the site appropriate availability of condoms". But the report is careful to recommend against school condom distribution programmes as being adolescents’ only exposure to sex education. Rather, it . believes such programmes should be combined with "comprehensive sequential . sexuality education" beginning in the earliest year of formal education and continuing to grade 12, and suggests that condom distribution in schools be developed as part of a "collaborative community process". Despite a 1991 survey
hand them out. The committee report (Pediatrics 1995; 95: 281-85) is careful to preface its recommendations with a review of the problems of American adolescent sexuality (see Lancet 1995; 345: 577). Despite comparable rates of sexual intercourse among European and Canadian adolescents (where sex education and condoms are often more easily obtained), the USA has higher rates of teenage pregnancy. Nearly a third of the 20 000 000 cases a year of sexually transmitted diseases in the USA occur among school-aged youth. 1 in 4 contracts a sexually transmitted disease before graduating from high school. Only half are using condoms consistently. As the committee notes, less than 10% of US children receive comprehensive sex education. David H Frankel
sufficiently robust
to
determine national
emphasises that the safety of Confusion over intensive or local policy. The centre drew attention polyurethane-coated implants has no care for UK children to a "significant diversity" of professional bearing on the debate over the link opinion over the details of intensive-care between silicone implants and connective A report’ commissioned by the National provision for children and also emphatissue disease. Another point emphasised : Health Service and published last week sised the lack of British research into how is that there are flaws in the arguments has sent out confused messages over the to organise and staff services for critically in The report
link between breastfeeding by women with silicone implants and gastric : problems in their children. Because the confusion over the chemical relations between silicon, silica, and silicone has caused muddled interpretation of research findings, the report has an appendix explaining the similarities and differences between these substances. A compilation of detailed critical summaries might be produced if there is a demand. :
suggesting
a
Vivien Choo 1
Gott DM, Tinkler JJB. Silicone implants and connective tissue disease. London: Medical Devices Agency (14 Russell Square, London WC1B 5EP). 1994: Pp 62. £75 (for bulk orders and NHS on application). ISBN 1-85839-347-7).
642
future of paediatric intensive care the ill children. UK. In it, an NHS research centre critiBut the BPA, who reply in an appendix cises previous recommendations by the to the centre’s report, are equally fierce in British Paediatric Association. : their criticism of the centre’s research The BPA recommendations were based methods and conclusions. They accuse on the results of a national postal survey, the centre for consistently ignoring or miswhich looked at the present provision of representing reviews of their report by intensive-care facilities for children and independent experts. They argue that concluded that, among the many deficienthere is no fundamental disagreement cies in such care, there were too few beds between their findings and those of indeand too few nurses to staff the beds. The pendent reviewers that urgent changes are BPA also concluded that critically ill chilneeded to improve the provision of paedidren are best cared for by specialist staff atric intensive-care services. in paediatric intensive-care units. At the request of the Department of Sarah Ramsay Health, the NHS Centre for Reviews and Dissemination examined the BPA survey 1 Which way forward for the care of critically and recommendations. The centre found ill children? Available from the NHS Centre for Reviews and Dissemination, University that, while the BPA’s results were a "useof York, Heslington, York Y01 5DD, UK ful" information source, they were not