THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Issue 1 June 2002
Embargoed 0001 h (London time) 31 May 2002
MAGNESIUM SULPHATE HALVES RISK OF ECLAMPSIA FOR
PREGNANT WOMEN WITH PRE-ECLAMPSIA (pp 1872, 1877)
A landmark international study in this week’s issue of THE LANCET highlights how
magnesium sulphate can substantially reduce the chance of pregnant women who have
pre-eclampsia developing the potentially fatal condition of eclampsia. The striking
findings and low cost of magnesium sulphate ($5 per patient) could result in a
significant change in the clinical management of pre-eclampsia worldwide.
Up to 8% of pregnant women develop pre-eclampsia (pregnancy-induced high blood
pressure which can lead to eclampsia, characterised by convulsions which can cause
maternal death). Eclampsia is more common in less-developed countries, and accounts
for around 50,000 maternal deaths a year worldwide. Anticonvulsants are used for
pre-eclampsia in the belief they prevent eclamptic convulsions; previous research
has suggested that the anticonvulsant magnesium sulphate (first used in obstetric
care in the USA nearly a century ago) offers the best hope for reducing the
development of eclampsia among women with pre-eclampsia, but no adequate trials have
been done.
Lelia Duley from the Institute for Health Sciences, Oxford, UK, led an international
study—Magnesium Sulphate for Prevention of Eclampsia (Magpie)—a randomised trial
where around 10,000 women from 33 countries with pre-eclampsia were randomly
assigned magnesium sulphate or placebo (given intravenously or intramuscularly).
The trial was stopped early when there was conclusive evidence in favour of the
intervention—magnesium sulphate more than halved the risk of eclampsia compared with
placebo (overall 58% reduction in risk). Magnesium sulphate also reduced the
relative risk of maternal death by 45%. A quarter of women given magnesium sulphate
reported side effects compared with 5% of women given placebo.
In an accompanying Commentary—Magnesium for preventing and treating eclampsia: time
for international action(p 1872)— Shirish Sheth from Mumbai, India, and Iain
Chalmers from the UK Cochrane Centre, Oxford, UK, conclude: ‘Women, clinicians, and
researchers have now collaborated in producing reliable evidence showing that
magnesium sulphate can prevent as well as control eclamptic convulsions. It is now
up to those responsible for maternal health services—at local, national, and
international levels—to ensure that this effective, apparently safe, and inexpensive
drug is available to women everywhere when needed.”
* Leading authors of the study will present their findings at a press briefing at
the Medical Research Council, 20 Park Crescent, London W1B 1AL, UK, at 1000 H
Thursday May 30th. For further information please contact the MRC Press Office on +44
(0)20 7637 6011.
Contact: Dr Lelia Duley, Resource Centre for Randomised Trials, Institute of Health Sciences, Headington, Oxford OX3
7LF, UK; T) +44 (0)1865 226642; F) +44 (0)1865 227173; E) lelia.duley@ndm.ox.ac.uk
Dr Shirish S Sheth, Sheth Obstetrics and Gynaecology Nursing Home, 2/2 Navjeevan Society, Lamington Road, Mumbai
4OO OO8, India; T) +91 2230 84949; F) +91 22 2080 404; E) silsal@bom2.vsnl.net.in
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Sir Iain Chalmers, UK Cochrane Centre, NHS R&D Programme, Summertown Pavilion, Middle Way, Oxford, OX2 7LG,
UK; T) +44 (0)1865 516300; F) +44 (0)1865 516311; E) ichalmers@cochrane.co.uk
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Issue 1 June 2002
Embargoed 0001 h (London time) 31 May 2002
DRUG PRESCRIBING BY NURSES IN THE UK –
EDITOR OF THE LANCET URGES CAUTION (p 1875)
The contentious issue of drug prescribing by nurses is assessed by
Richard Horton, Editor of THE LANCET, in a Commentary in this week’s
issue of the journal. He concludes that UK government plans to
introduce unrestricted prescribing rights to nurses over the next few
years could have serious consequences in the provision of health care.
Richard Horton comments: “Nurse prescribing offers enormous benefits
to patients. But the evidence indicates that the rate at which nurse
prescribing is being implemented holds grave dangers if the policy set
out by Milburn [Minister for Health], Jones [Royal College of
Nursing], and others is acted upon – and the first supplementary nurse
prescribers are supposed to be qualified by the end of this year – the
UK will be embarking on a dangerous uncontrolled experiment.”
The Commentary is critical of the motives which underlie current UK
government thinking on drug prescribing. Horton adds: “Nurses are
being manipulated, under the guise of providing quicker and more
efficient access to health care to fill the gaps left by too few
doctors. Prescribing is not a major advance in professional status for
nurses.
It is merely redrawing the boundaries of a profession to
serve an acute political problem, with little regard for the impact it
will have either on nursing or patient care. Moreover, when doctors
prescribe, they make mistakes. Only very recently have we begun to
understand why [see Lancet 2002; 359: 1373-78]. Surely we must learn
more about why errors take place before further widening prescribing
responsibilities. To extend the burden of risk so quickly is
reckless.”
The additional training of nurses required for drug prescribing is
highlighted as a crucial issue, yet there exist major inconsistencies
within current nursing curricula, Horton observes: “If prescribing
rights are extended to all drugs, nurses will need to know basic and
clinical pharmacology – including the mechanism of action of drugs,
pharmacokinetics, pharmacodynamics, and how to appraise evidence from
clinical trials. In other words, we will be training nurses to be more
like doctors. Is that really the future of nursing. This issue is not
a question of retraining interprofessional barriers. It is about
respecting distinctive professional expertise at a time when there is
a serious nursing shortage.”
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Richard Horton concludes: “Taken together, this evidence, and the
uncertainties and arguments that flow from it, send a clear message to
government: slow down the process of widening prescribing rights.
Nurse prescribing has too much to offer patient care to let it founder
through hasty and politically expedient implementation.”
Contact: Dr Richard Horton, c/o Richard Lane, The Lancet Press Office, 32 Jamestown Road, London NW1
7BY, UK; T) +44 (0)20 7424 4949; F) +44 (0)20 7424 4912; E) richard.lane@lancet.com
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Issue 1 June 2002
Embargoed 0001 h (London time) 31 May 2002
NEW DIAGNOSTIC FAECAL TEST
COULD IDENTIFY COLORECTAL CANCER (p 1917)
Authors of a research letter in this week’s issue of THE LANCET
describe a new technique where the detection of a specific protein in
faeces could be a marker for colorectal cancer.
Colorectal cancer is a common disease (causing around 500,000 deaths
each year worldwide), and screening methods that are more reliable
than colonoscopy and faecal-blood assessment are needed for earlier
disease detection. Nicholas Coleman and colleagues from the MRC Cancer
Cell Unit, Cambridge, UK, aim to develop a non-invasive, stool-based
assessment that can identify a specific protein — minichromosome
maintenance protein 2 (MCM2) — which is present in cancerous
colorectal cells but not normal cells.
In a clinical study, the investigators detected MCM2-positive cells
from 37 of 40 patients known to have colorectal cancer; there was no
detection of the protein in any of the 25 healthy individuals (the
control group).
Nicholas Coleman comments: “These findings suggest that detection of
MCM2 in colonocytes retrieved from the faecal surface might be of
value in the non-invasive diagnosis of malignant colorectal disease.
The conditions of this study do not represent those of a general
screening setting, and our findings might have differed in a
population with a higher frequency of cancers of the right-side of the
colon.
Nevertheless,
despite
the
requirement
for
rapid
stool
processing,
our
approach
might
ultimately
prove
suitable
for
population screening, either alone or in combination with other
tests.”
Contact: Dr Nicholas Coleman, MRC Cancer Cell Unit, Hutchison/MRC Research Centre, Cambridge CB2
2XZ, UK; T) +44 (0)1223 763285; M) +44 (0)7900 596465; F) +44 (0)1223 763284; E) nc109@cam.ac.uk
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Issue 1 June 2002
Embargoed 0001 h (London time) 31 May 2002
OLDER AGE OF MALE PARTNERS MAKES YOUNG WOMEN
MORE SUSCEPTIBLE TO HIV-1 INFECTION (p 1896)
Results of a field study in Zimbabwe published in this week's issue of
THE LANCET highlight how cultural aspects of sexual behaviour are
closely associated with an increased rate of HIV-1 infection among
young women compared with young men.
HIV-1 prevalence typically rises more rapidly at young ages in women
than in men in sub-Saharan Africa. The reasons for this are thought to
include the greater susceptibility of women to HIV-1 infection, and
their greater exposure to infection through sexual contact with older
partners.
Simon Gregson from Imperial College, London, UK, and colleagues from
Zimbabwe and UNAIDS, Geneva, Switzerland, investigated the possible
association between age of sexual partners among young men and women
(aged younger than 25 years) in relation to HIV-1 prevalence. Using
data from a field study in rural Manicaland, a province in eastern
Zimbabwe, the investigators assessed the onset and degree of sexual
activity, numbers of partners, concurrent partnerships, condom use,
and partner characteristics from around 10,000 men and women selected
from over 8200 households.
Young women formed partnerships with men 5-10 years older than
themselves, whereas young men were found to have relationships with
women of a similar age or slightly younger. Young men reported more
partners, more infrequent sexual intercourse, and greater condom use
than young women.
Simon Gregson comments: "It has long been suspected that younger women
having relationships with older men contributes to the spread of HIV
infection in young women in sub-Saharan Africa. However, we describe
and provide empirical evidence that shows this effect in a rural
population in Zimbabwe. This aspect of sexual partner networks plays a
pivotal role in the persistence of major HIV epidemics because not
only do large segments of successive cohorts of young women become
infected through this route, but many further infections result when
these women marry and have children. Breaking this link in the pattern
of transmission must become a central focus of HIV prevention
strategies."
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Contact: Dr Simon Gregson, Department of Infectious Disease Epidemiology, Imperial College Faculty of
Medicine, University of London, Norfolk Place, London W2 1PG, UK; T) +44 (0)20 7594 3279; F) +44 (0)20
7594 3927; E) s.gregson@ic.ac.uk
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Issue June 2002
FOR IMMEDIATE RELEASE
THE LANCET INFECTIOUS DISEASES (TLID)
This month’s issue gives extensive coverage to tuberculosis ahead of the
World TB Congress taking place in Washington D.C. from June 3-5.
News desk - Findings from the WHO's 6th annual report on global TB controlThis report states that around 70% of TB cases still remain undetected and
that expanding directly-observed treatments (DOTs) in endemic countries,
together with a huge cash injection are needed if the targets for global TB
control are going to be reached.
News feature - "Russia learns to cope with tuberculosis" looks at the
problems and challenges the country faces in a time when a coherent TB policy
is urgently needed to stop the disease sweeping through the population at the
current rate.
Personal view - Problems and solutions for the STOP TB partnership. Sally
Blower (University of California Los Angeles School of Medicine) and Chuck
Daly (University of California San Francisco) discuss why the goals of the
STOP TB movement for 2005 will not be achieved by the current control
efforts; they recommend strategies on how the targets will be reached.
Leading edge - Sex matters for tuberculosis control. A much under-reported
issue on the impact of sex on this disease. Almost 1 billion women and girls
are infected with tuberculosis worldwide, a 70% excess of male over female TB
cases are reported globally each year and the case fatality rate is much
higher in women than men. The editorial discusses the possible reasons for
this disparity and explores the social, economic, and physical impact the
disease has on women in the developing world. The editorial reminds us that
we must not neglect basic research into the prevalence and epidemiology of TB
if we are to stand a chance against this debilitating disease.
Rabies re-examined
With around 50 000 people dieing from rabies every year, this disease is a
major public-health problem. Charles E Rupprect from the Centers for Disease
Control and Prevention, Atlanta,
USA, and colleagues describe
the
epidemiology and diagnosis of this viral zoonosis. Current medical emphasis
relies heavily on prevention of exposure and intervention before clinical
onset. The authors discuss the current preventative measures and the ways of
controlling if not eliminating this disease, in the absence of a cure. A
companion review of the neurological aspects of rabies appears in the June
issue of The Lancet Neurology.
Other reviews:
Update on Kaposi’s sarcoma
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Therapeutic vaccination against chronic viral infections
Hospital-acquired legionellosis: solutions for a preventable infection
THE LANCET ONCOLOGY (TLO)
CANCER MORTALITY IN CENTRAL–EASTERN EUROPE: FACTS BEHIND THE FIGURES
This review highlights how death from cancer in central-eastern Europe is
still rising, despite the fact that cancer deaths for the whole of Europe
have been falling over the past decade. Differences in lifestyle and
environmental exposure are the most likely causes of cancer death in centraleastern European countries, which are linked to political, social, and
economic inequalities. Lajos Döbrossy, former Regional Advisor for cancer
control in European region of WHO and author of the review, concludes that
even if attempts at cancer prevention are eventually realised, a major cancer
burden will persist in this part of Europe for many decades to come.
Phyto-oestrogens and cancer
In this review, Herman Adlercreutz from the University of Helsinki, Finland,
discusses the consumption of phyto-oestrogen-rich foods such as soy, a source of
isoflavones, and whole grain products, which contain lignans, and their role in the
prevention of breast, prostate, and colon cancer. In women, a soy-containing diet is
more likely to protect against breast cancer if regularly consumed before puberty or
during adolescence.
Hormonal resynchronisation—an occupational hazard
This month’s Leading Edge editorial discusses the effect of jetlag on cancer
risk in light of new data recently presented at the American Association of
Cancer Research. It highlights how destabilised concentrations of the hormone
melatonin (which regulates the ‘body clock’) could increase breast-cancer
risk in female flight attendants. The editorial concludes by emphasising the
need for the consideration of the impact of unsocial shift patterns on longterm health outcomes.
Other Reviews:
Population screening for cancer-related germline gene mutations
Reactivation
of
replication
of
hepatitis
immunosuppressive therapy: an unresolved issue
B
and
C
viruses
after
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com
THE LANCET PRESS RELEASE
32 Jamestown Road
London NW1 7BY
United Kingdom
T) +44 (0)20 7424 4949
F) +44 (0)20 7424 4911
Impact of the Human Genome Project on the clinical management of sporadic
cancers
An oncological view on the blood–testis barrier
Please mention THE LANCET as the source of this material
Issued by Richard Lane, Press & PR Officer, The Lancet T) +44 (0)20 7424 4949; F) +44 (0)20 7424
4911; E) richard.lane@lancet.com