ECONOMY OF PAKISTAN
Pakistan is facing certain serious problems now a days including War on Terror, Electricity Crises, Political Instability & High Inflation. Some growth observed in last few years seems to be disappearing. There are many reasons for this poor economic growth but lack of vision and direction by the political leadership can also be mentioned as one of the main reasons. The growth in GDP was about 5% on average in the last few years which is expected to decline in this year. It has reached to a monetary figure of more than Rs. 3,600 Billion. However, the situation is not too disappointing if brighter side of the picture is seen. This is a country of more than 170 million of people who have great untapped potential. The majority of this population belongs to young age group. The need is only to show the direction and exploit the opportunities.
INSURANCE IN PAKISTAN
Main contributors of the economy of Pakistan are Agriculture, Manufacturing/Industrial Sector and Services Sector. After the creation of Pakistan, Agriculture was the main contributor of economy (more than 50%). Now a day, services sector (such as telecommunications, transportation, advertising, and finance & insurance) has taken this place of agriculture. Finance & Insurance constitute about 17% of the GDP as quoted by State Bank of Pakistan in year 2008. The share of Insurance is negligible (only up to 0.9% of the GDP). This emphasizes that this sector is still the neglected sector of the economy. If we compare this share of insurance in GDP with some of the developed countries, this may be more than 5%. Insurance penetration in Pakistan, which is measured as ratio (in per cent) of premium to GDP, is at the lowest level as compared to other countries across the world. The data shows that insurance penetration in Pakistan (life and non-life) is 0.7 per cent of the GDP on the basis of 2005 gross premium numbers. The important non-life insurance sector showed a penetration of 0.44 per cent which is much lower than even regional countries. Non-life insurance penetration of different countries/regions is presented in the table 1 as below.
TABLE 1
Sr. No
Country
Insurance Penetration
1
PAKISTAN
0.44%
2
SRILANKA
0.77%
3
INDIA
0.65%
4
US
5.14%
5
UK
3.68%
6
EUROPE
3.20%
7
AFRICA
1.48%
8
WORLD AVG
3.43%
9
ASIA AVG
1.79%
Pakistan is also at the lowest side in terms of insurance density. Insurance density is measured as ratio (in per cent) of premium to total population.
Insurance density of non-life insurance in Pakistan is 2.2 percent as compared to world average of 220 per cent. The insurance density of various countries /regions is mentioned in the table 2 as below.
TABLE 2
Sr. No
Country
Insurance Density
1
PAKISTAN
2.2 %
2
INDIA
4 %
3
US
2062 %
4
UK
1318 %
5
EUROPE
580 %
6
AFRICA
13 %
7
WORLD AVERAGE
220 %
8
ASIA AVERAGE
47 %
INSURANCE AROUND THE GLOBE
In 2008, world GDP has expanded by 2.3% in real terms. However, there was slight decline in the global insurance premium. This was observed after year 1980 for the 1st time that so much decline in premium was noticed, about 3.5% decrease in life premium and 0.8% decline in non life premium. However, it is also significant to mention that growth in the insurance premium was more than 6 to 8% in some emerging markets for non life and more than 10% for life insurance as shown in the Figure 1 & Figure 2.
FIGURE 1 & 2
GROWTH OF INSURANCE IN PAKISTAN
As discussed earlier, low penetration and density on one hand paints a dismal picture of the insurance industry in Pakistan and its role in economy but on the other hand show the great potential because of the under growth achieved so far. Following are some of the examples that show us the brighter picture of the situation.
· Awareness of insurance in general has enhanced in the masses due to increased literacy rate and advertising campaigns of different companies in various media.
· The auto insurance sector growth has already improved the non-life insurance penetration in Pakistan in previous few years because for the first time cars are being financed by Banks and leasing companies who enforce insurance on all the leaseholders.
· The introduction of crop insurance & live stock insurance as instructed by the government and initiated by few companies.
· Recently government has also announced the introduction of insurance policies in the trade policy that will add some advantage for the attraction of investors in Pakistan.
· Medical insurance is one of the growing sectors as many of the employers prefer to provide their employees a well managed scheme at the optimum cost.
· Life insurance which was not understood by the masses at sometime is also a very attractive product in the market at the individual level.
· Some insurance regulatory & management bodies are very active these days to create and spread awareness regarding insurance.
· Insurance has been started in some of the top educational institutes as a subject to provide the human resources in this field.
Due to these factors, government is expecting that the gross premium of non-life insurance sector will increase four times to Rs105 billion by the end of 2011. The share of insurance in GDP can also be increased from 0.9 to 2 % in the years to come if some attractive policies are offered to this sector. This shows the scope of Insurance Growth in Pakistan. The insurance industry has grown on the average of about 20% in the last 5 years which is good indicator to measure the growth.
In spite of all the favorable factors for insurance as described above, following are some of the neglected areas in this important sector of economy.
· Many of the insurance products present internationally are not available in Pakistan. This may be due to lack of expertise in these particular fields.
· Foreign investment in this sector is not present. If some internationally renowned companies are allowed and convinced to operate in Pakistan, this will not only bring the investment but also expertise and professionalism in this field.
Reference
· Economic Survey of Pakistan 2008-09
· http://www.swissre.com/
· http://www.wikipedia.org/
Sunday, August 2, 2009
Friday, March 20, 2009
Body Mass Index Above Ideal Range Linked to Large Increase in Mortality Rate
News Author: Laurie Barclay, MDCME Author: Désirée Lie, MD, MSEd DisclosuresRelease Date: March 17, 2009; Valid for credit through March 17, 2010
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;Nurses - 0.25 ANCC contact hours (None of these credits is in the area of pharmacology)
To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.
Learning Objectives
Upon completion of this activity, participants will be able to:
Describe the association between increased body mass index and overall and cause-specific mortality.
Describe the association between lower body mass index (< 25 kg/m2) and mortality rate.
Authors and Disclosures
Laurie Barclay, MDDisclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Désirée Lie, MD, MSEdDisclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
Laurie Scudder, MS, NPDisclosure: Laurie Scudder, MS, NP, has disclosed no relevant financial information.
Brande Nicole MartinDisclosure: Brande Nicole Martin has disclosed no relevant financial information.
March 17, 2009 — Body-mass index (BMI) above the ideal range may cause a large increase in mortality rates, according to the results of a collaborative analysis of 57 prospective studies reported in the March 18 Online First issue of Lancet.
"The main associations of...BMI with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people," write Gary Whitlock, and colleagues from The Prospective Studies Collaboration at the University of Oxford, Oxford, United Kingdom. "The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies."
The investigators analyzed the association of baseline BMI with mortality in 57 prospective studies enrolling a total of 894,576 participants, mostly in western Europe and North America, with median recruitment year 1979. Mean age at recruitment was 46 ± 11 years, 61% were men, and mean BMI was 25 ± 4 kg/m². The analyses were adjusted for age, sex, smoking status, and study, and the first 5 years of follow-up were excluded.
During additional follow-up (mean, 8 ± 6 years), there were 66,552 deaths of known cause, with mean age at death of 67 ± 10 years. Cause of death was vascular in 30,416 patients; neoplastic in 22,592; respiratory in 3770; diabetic, renal, or hepatic in 2070; and other cause in 7704.
Mortality rate was lowest with BMI at approximately 22.5 to 25 kg/m² for both men and women. At higher baseline BMI, there were positive associations for several specific causes and inverse associations for none. Absolute excess risks for higher BMI and smoking were approximately additive.
On average, each 5-kg/m² higher BMI was associated with approximately 30% higher overall mortality rate (hazard ratio per 5 kg/m² [HR], 1.29; 95% confidence interval [CI], 1.27 -1.32): 40% for vascular mortality (HR, 1.41; 95% CI, 1.37 - 1.45); 60% to 120% for diabetic (HR, 2.16; 95% CI, 1.89 - 2.46), renal (HR, 1.59; 95% CI, 1·27 - 1·99), and hepatic (HR, 1.82; 95% CI, 1·59 - 2·09) mortality; 10% for neoplastic mortality (HR, 1.10; 95% CI, 1.06 - 1.15); and 20% for respiratory (HR, 1.20; 95% CI, 1.07 - 1.34) and all other mortality (HR, 1.20; 95% CI, 1.16 - 1.25).
BMI less than 22·5 to 25 kg/m² was inversely associated with overall mortality rate, primarily because of strong inverse associations with respiratory disease and lung cancer. Although cigarette consumption per smoker varied little with BMI, these inverse associations were much stronger for smokers vs nonsmokers.
"Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22.5–25 kg/m²," the study authors write. "The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30–35 kg/m², median survival is reduced by 2–4 years; at 40–45 kg/m², it is reduced by 8–10 years (which is comparable with the effects of smoking). The definite excess mortality below 22.5 kg/m² is due mainly to smoking-related diseases, and is not fully explained."
Limitations of this study include lack of data on possible intermediate factors such as fibrinogen, C-reactive protein, and obstructive sleep apnea; possible confounding by diet, physical activity, or socioeconomic status; and lack of measures of central obesity.
"In adult life, it may be easier to avoid substantial weight gain than to lose that weight once it has been gained," the study authors conclude. "By avoiding a further increase from 28 kg/m² to 32 kg/m², a typical person in early middle age would gain about 2 years of life expectancy. Alternatively, by avoiding an increase from 24 kg/m² to 32 kg/m² (ie, to a third above the apparent optimum), a young adult would on average gain about 3 extra years of life."
UK Medical Research Council, British Heart Foundation, Cancer Research United Kingdom, EU BIOMED programme, US National Institute on Aging, and Clinical Trial Service Unit (Oxford, United Kingdom) supported this study.
Gary Whitlock was supported by a Girdlers' Health Research Council of New Zealand Fellowship. Writing committee member Sarah Lewington had a British Heart Foundation Fellowship to coordinate the project. Writing committee member Sarah Parish supplied unpublished analyses of BMI and cotinine. Writing committee member Nawab Qizilbash is a former director of epidemiology at GlaxoSmithKline and now works in Oxon Epidemiology, which has undertaken consultancy work for several pharmaceutical companies (including GlaxoSmithKline, Pfizer, Lilly, Roche, Gilead, and Grunenthal). All other members of the writing committee work in the Clinical Trial Service Unit, which has a policy of staff not accepting fees, honoraria, or consultancies. The Clinical Trial Service Unit is involved in clinical trials with funding from the UK Medical Research Council, British Heart Foundation, and/or various companies (AstraZeneca, Bayer, Merck, Schering-Plough, Solvay) as research grants to (and administered by) the University of Oxford.
Lancet. Published online March 18, 2009.
Clinical Context
An increased BMI is a cause of increased mortality rates from cardiovascular disease and cancer. The average BMI has been rising for several decades with increased concerns about its impact on mortality rates, but studies of the association between BMI and mortality are confounded by comorbidities that lower BMI, such as chronic obstructive pulmonary disease (COPD) or tuberculosis.
This is an analysis of data from the Prospective Studies Collaboration that included 57 studies to examine the association between BMI and all-cause and cause-specific mortality in different countries. Among the studies with BMI information, 92% were from Europe, Israel, the United States, or Australia, and the remaining 8% were from Japan. There were 85% of participants who were recruited in the 1970s and 1980s.
Study Highlights
Median year of recruitment was 1979, and 61% of participants were men.
Mean recruitment age was 46 years, and mean BMI was 24.8 kg/m2, but it was lower in European, Israeli, and Japanese studies.
BMI at baseline was self-reported by participants and defined by the World Health Organization convention of BMI of 30 kg/m2 or higher for "obese."
Excluded were participants with stroke or heart disease at baseline or BMI below 15 kg/m2, leaving 894,576 for analysis.
For men and women, BMI was greatest at baseline at ages 50 to 69 years, with an increase in early adult life and middle age.
The greatest increase was in men younger than 40 years and women younger than 50 years.
BMI was positively linked with increased systolic and diastolic blood pressure, inversely with high-density lipoprotein cholesterol levels and positively with non–high-density lipoprotein cholesterol levels.
Mean BMI was slightly lower in smokers and alcohol drinkers at baseline.
The cause of death was determined from death certificates, medical records, and autopsy findings.
Cross-sectional associations between BMI and risk factors were estimated by linear or logistic regression.
Deaths in the first 5 years of follow-up were excluded to avoid confounders.
During 6.5 million person-years of follow-up, 72,749 deaths occurred.
In both sexes, all-cause mortality rate was lowest at a BMI of 22.5 to 25 kg/m2.
Above this level, all-cause mortality rate was, on average, 30% higher for every increase of 5 units of BMI and was greater at younger ages.
In the lower BMI range of 15 to 25 kg/m2, there was an inverse association between BMI and mortality, but this association was less evident when analysis was for nonsmokers.
Ischemic heart disease accounted for more than one quarter of all deaths, and each increase in BMI of 5 units in the range 20 to 40 kg/m2 was associated with a 40% increase in ischemic heart disease death, stronger in middle age but still evident at ages 80 to 89 years.
Stroke accounted for one third as many deaths as ischemic heart disease, and each increase of 5 units of BMI in the range of 25 to 50 kg/m2 was associated with a 40% increased risk for stroke.
The HR attributable to heart failure was 1.86; for hypertension, 2.03.
In the BMI range of 25 to 50 kg/m2, the HR for death from liver disease was 1.79.
The HR for cancer was lower and the association with BMI was weaker, with a 10% increase in mortality for every 5 units of increase in BMI.
Site-specific HRs included 1.23 for kidney, 1.47 for liver, 1.15 for breast, 1.38 for endometrium, 1.13 for prostate, and 1.20 for large intestine cancers at different ages.
In the lower BMI range of 15 to 25 kg/m2, cancer deaths were inversely linked with BMI, with an HR of 0.52 for upper gastrointestinal tract cancers.
Respiratory tract disease was inversely linked with BMI, with 4 times increase in death from COPD for BMI of 5 units or lower (< 25 kg/m2; HR, 0.31).
In the lower range of BMI, COPD and lung cancer deaths in smokers accounted for the inverse association between BMI and mortality.
In the range of 25 to 50 kg/m2, the effects of BMI and smoking were additive vs multiplicative for vascular and all-cause mortality.
For those with a BMI of 30 to 35 kg/m2, median survival rate was reduced by 2 to 4 years, and for BMI of 40 to 45 kg/m2, survival rate was reduced by 8 to 10 years.
Avoiding an increase in BMI from 28 to 32 kg/m2 in adult life was linked with an added 2 years of life expectancy; avoiding an increase from a BMI of 24 to 32 kg/m2 was linked with 3 extra years of life.
Pearls for Practice
Higher BMI (> 25 kg/m2) is associated with an increase in all-cause and cause-specific mortality rates.
Lower BMI (< 25 kg/m2) is associated with higher all-cause, cause-specific mortality rates for respiratory tract disease and cancer mortality.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;Nurses - 0.25 ANCC contact hours (None of these credits is in the area of pharmacology)
To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.
Learning Objectives
Upon completion of this activity, participants will be able to:
Describe the association between increased body mass index and overall and cause-specific mortality.
Describe the association between lower body mass index (< 25 kg/m2) and mortality rate.
Authors and Disclosures
Laurie Barclay, MDDisclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Désirée Lie, MD, MSEdDisclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.
Laurie Scudder, MS, NPDisclosure: Laurie Scudder, MS, NP, has disclosed no relevant financial information.
Brande Nicole MartinDisclosure: Brande Nicole Martin has disclosed no relevant financial information.
March 17, 2009 — Body-mass index (BMI) above the ideal range may cause a large increase in mortality rates, according to the results of a collaborative analysis of 57 prospective studies reported in the March 18 Online First issue of Lancet.
"The main associations of...BMI with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people," write Gary Whitlock, and colleagues from The Prospective Studies Collaboration at the University of Oxford, Oxford, United Kingdom. "The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies."
The investigators analyzed the association of baseline BMI with mortality in 57 prospective studies enrolling a total of 894,576 participants, mostly in western Europe and North America, with median recruitment year 1979. Mean age at recruitment was 46 ± 11 years, 61% were men, and mean BMI was 25 ± 4 kg/m². The analyses were adjusted for age, sex, smoking status, and study, and the first 5 years of follow-up were excluded.
During additional follow-up (mean, 8 ± 6 years), there were 66,552 deaths of known cause, with mean age at death of 67 ± 10 years. Cause of death was vascular in 30,416 patients; neoplastic in 22,592; respiratory in 3770; diabetic, renal, or hepatic in 2070; and other cause in 7704.
Mortality rate was lowest with BMI at approximately 22.5 to 25 kg/m² for both men and women. At higher baseline BMI, there were positive associations for several specific causes and inverse associations for none. Absolute excess risks for higher BMI and smoking were approximately additive.
On average, each 5-kg/m² higher BMI was associated with approximately 30% higher overall mortality rate (hazard ratio per 5 kg/m² [HR], 1.29; 95% confidence interval [CI], 1.27 -1.32): 40% for vascular mortality (HR, 1.41; 95% CI, 1.37 - 1.45); 60% to 120% for diabetic (HR, 2.16; 95% CI, 1.89 - 2.46), renal (HR, 1.59; 95% CI, 1·27 - 1·99), and hepatic (HR, 1.82; 95% CI, 1·59 - 2·09) mortality; 10% for neoplastic mortality (HR, 1.10; 95% CI, 1.06 - 1.15); and 20% for respiratory (HR, 1.20; 95% CI, 1.07 - 1.34) and all other mortality (HR, 1.20; 95% CI, 1.16 - 1.25).
BMI less than 22·5 to 25 kg/m² was inversely associated with overall mortality rate, primarily because of strong inverse associations with respiratory disease and lung cancer. Although cigarette consumption per smoker varied little with BMI, these inverse associations were much stronger for smokers vs nonsmokers.
"Although other anthropometric measures (eg, waist circumference, waist-to-hip ratio) could well add extra information to BMI, and BMI to them, BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22.5–25 kg/m²," the study authors write. "The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal. At 30–35 kg/m², median survival is reduced by 2–4 years; at 40–45 kg/m², it is reduced by 8–10 years (which is comparable with the effects of smoking). The definite excess mortality below 22.5 kg/m² is due mainly to smoking-related diseases, and is not fully explained."
Limitations of this study include lack of data on possible intermediate factors such as fibrinogen, C-reactive protein, and obstructive sleep apnea; possible confounding by diet, physical activity, or socioeconomic status; and lack of measures of central obesity.
"In adult life, it may be easier to avoid substantial weight gain than to lose that weight once it has been gained," the study authors conclude. "By avoiding a further increase from 28 kg/m² to 32 kg/m², a typical person in early middle age would gain about 2 years of life expectancy. Alternatively, by avoiding an increase from 24 kg/m² to 32 kg/m² (ie, to a third above the apparent optimum), a young adult would on average gain about 3 extra years of life."
UK Medical Research Council, British Heart Foundation, Cancer Research United Kingdom, EU BIOMED programme, US National Institute on Aging, and Clinical Trial Service Unit (Oxford, United Kingdom) supported this study.
Gary Whitlock was supported by a Girdlers' Health Research Council of New Zealand Fellowship. Writing committee member Sarah Lewington had a British Heart Foundation Fellowship to coordinate the project. Writing committee member Sarah Parish supplied unpublished analyses of BMI and cotinine. Writing committee member Nawab Qizilbash is a former director of epidemiology at GlaxoSmithKline and now works in Oxon Epidemiology, which has undertaken consultancy work for several pharmaceutical companies (including GlaxoSmithKline, Pfizer, Lilly, Roche, Gilead, and Grunenthal). All other members of the writing committee work in the Clinical Trial Service Unit, which has a policy of staff not accepting fees, honoraria, or consultancies. The Clinical Trial Service Unit is involved in clinical trials with funding from the UK Medical Research Council, British Heart Foundation, and/or various companies (AstraZeneca, Bayer, Merck, Schering-Plough, Solvay) as research grants to (and administered by) the University of Oxford.
Lancet. Published online March 18, 2009.
Clinical Context
An increased BMI is a cause of increased mortality rates from cardiovascular disease and cancer. The average BMI has been rising for several decades with increased concerns about its impact on mortality rates, but studies of the association between BMI and mortality are confounded by comorbidities that lower BMI, such as chronic obstructive pulmonary disease (COPD) or tuberculosis.
This is an analysis of data from the Prospective Studies Collaboration that included 57 studies to examine the association between BMI and all-cause and cause-specific mortality in different countries. Among the studies with BMI information, 92% were from Europe, Israel, the United States, or Australia, and the remaining 8% were from Japan. There were 85% of participants who were recruited in the 1970s and 1980s.
Study Highlights
Median year of recruitment was 1979, and 61% of participants were men.
Mean recruitment age was 46 years, and mean BMI was 24.8 kg/m2, but it was lower in European, Israeli, and Japanese studies.
BMI at baseline was self-reported by participants and defined by the World Health Organization convention of BMI of 30 kg/m2 or higher for "obese."
Excluded were participants with stroke or heart disease at baseline or BMI below 15 kg/m2, leaving 894,576 for analysis.
For men and women, BMI was greatest at baseline at ages 50 to 69 years, with an increase in early adult life and middle age.
The greatest increase was in men younger than 40 years and women younger than 50 years.
BMI was positively linked with increased systolic and diastolic blood pressure, inversely with high-density lipoprotein cholesterol levels and positively with non–high-density lipoprotein cholesterol levels.
Mean BMI was slightly lower in smokers and alcohol drinkers at baseline.
The cause of death was determined from death certificates, medical records, and autopsy findings.
Cross-sectional associations between BMI and risk factors were estimated by linear or logistic regression.
Deaths in the first 5 years of follow-up were excluded to avoid confounders.
During 6.5 million person-years of follow-up, 72,749 deaths occurred.
In both sexes, all-cause mortality rate was lowest at a BMI of 22.5 to 25 kg/m2.
Above this level, all-cause mortality rate was, on average, 30% higher for every increase of 5 units of BMI and was greater at younger ages.
In the lower BMI range of 15 to 25 kg/m2, there was an inverse association between BMI and mortality, but this association was less evident when analysis was for nonsmokers.
Ischemic heart disease accounted for more than one quarter of all deaths, and each increase in BMI of 5 units in the range 20 to 40 kg/m2 was associated with a 40% increase in ischemic heart disease death, stronger in middle age but still evident at ages 80 to 89 years.
Stroke accounted for one third as many deaths as ischemic heart disease, and each increase of 5 units of BMI in the range of 25 to 50 kg/m2 was associated with a 40% increased risk for stroke.
The HR attributable to heart failure was 1.86; for hypertension, 2.03.
In the BMI range of 25 to 50 kg/m2, the HR for death from liver disease was 1.79.
The HR for cancer was lower and the association with BMI was weaker, with a 10% increase in mortality for every 5 units of increase in BMI.
Site-specific HRs included 1.23 for kidney, 1.47 for liver, 1.15 for breast, 1.38 for endometrium, 1.13 for prostate, and 1.20 for large intestine cancers at different ages.
In the lower BMI range of 15 to 25 kg/m2, cancer deaths were inversely linked with BMI, with an HR of 0.52 for upper gastrointestinal tract cancers.
Respiratory tract disease was inversely linked with BMI, with 4 times increase in death from COPD for BMI of 5 units or lower (< 25 kg/m2; HR, 0.31).
In the lower range of BMI, COPD and lung cancer deaths in smokers accounted for the inverse association between BMI and mortality.
In the range of 25 to 50 kg/m2, the effects of BMI and smoking were additive vs multiplicative for vascular and all-cause mortality.
For those with a BMI of 30 to 35 kg/m2, median survival rate was reduced by 2 to 4 years, and for BMI of 40 to 45 kg/m2, survival rate was reduced by 8 to 10 years.
Avoiding an increase in BMI from 28 to 32 kg/m2 in adult life was linked with an added 2 years of life expectancy; avoiding an increase from a BMI of 24 to 32 kg/m2 was linked with 3 extra years of life.
Pearls for Practice
Higher BMI (> 25 kg/m2) is associated with an increase in all-cause and cause-specific mortality rates.
Lower BMI (< 25 kg/m2) is associated with higher all-cause, cause-specific mortality rates for respiratory tract disease and cancer mortality.
Tuesday, March 17, 2009
Obesity danger 'rivals smoking'
Keeping pounds off may be easier than losing weight once it is gained
Being severely obese is as hazardous to health as a lifetime of smoking, shortening life by a decade, a group of Oxford University experts has warned.
Even moderate obesity cuts life expectancy by about three years, says the Clinical Trial Service Unit.
The findings, published in The Lancet, come from data on almost a million people from around the world.
In the UK, a quarter of adults are now considered obese, with a body mass index (BMI) above 30.
BMI is useful for assessing the extent to which fatty tissue causes ill health.
If you are becoming overweight or obese, avoiding further weight gain could well add years to your life
Dr Gary Whitlock of Oxford University
It is calculated by dividing a person's weight in kilograms by the square of their height in metres.
A person 1.70m (5 ft 7") tall would be considered moderately obese if they weighed 90kg (14 stone) rather than the ideal 70kg (11 stone).
Each incremental rise in BMI above the healthy zone of 20-25 increased premature death risk, the Clinical Trial Service Unit concluded.
Severe obesity - a BMI of 40 to 50, which applies to about 2% of the UK population - reduced life expectancy by about 10 years.
Moderate obesity - a BMI of 30-39, which applies to one in four UK adults - reduced life expectancy by three years.
Much of the obesity-related risk is down to heart disease and stroke, and to a lesser extent cancer.
Amongst middle-aged people in the UK, as many as one in four deaths from heart attack or stroke and one in 16 cancer deaths are due to being overweight or obese, the researchers estimate.
Fat at 40
In adult life, it may be easier to avoid substantial weight gain than to lose that weight once it has been gained, they say.
BODY MASS INDEX
Calculated by dividing weight in kilograms by height in metres squared
Normal: 18.5 - 24.9
Overweight: 25 - 29.9
Obese: Above 30
Calculate your BMIAnd avoiding middle age spread could add years to life.
Professor Peter Weissberg of the British Heart Foundation, which supported the work, said: "This is the latest and most convincing demonstration of the close relationship between being overweight and poor heart health, and confirms that smoking is harmful regardless of your weight.
"We all have a role to play in maintaining a healthy weight ourselves, but this study emphasises the importance of public health measures, such as the recently launched Change 4 Life campaign, as part of a raft of Government initiatives that will be needed to reduce the nation's weight."
Epidemiologist Dr Gary Whitlock of Oxford University, who led the analysis, said: ''Excess weight shortens human lifespan.
"In countries like Britain and America, weighing a third more than the optimum shortens lifespan by about three years.
"For most people, a third more than the optimum means carrying 20 to 30kg of excess weight. If you are becoming overweight or obese, avoiding further weight gain could well add years to your life.''
Sara Hiom of Cancer Research UK said: "Moderate obesity is becoming worryingly common in the UK and these factors combined are great cause for concern.
"We can eat less and move more to reduce weight. But smoking remains the single most significant cause of cancer death - and stopping smoking works."
Being severely obese is as hazardous to health as a lifetime of smoking, shortening life by a decade, a group of Oxford University experts has warned.
Even moderate obesity cuts life expectancy by about three years, says the Clinical Trial Service Unit.
The findings, published in The Lancet, come from data on almost a million people from around the world.
In the UK, a quarter of adults are now considered obese, with a body mass index (BMI) above 30.
BMI is useful for assessing the extent to which fatty tissue causes ill health.
If you are becoming overweight or obese, avoiding further weight gain could well add years to your life
Dr Gary Whitlock of Oxford University
It is calculated by dividing a person's weight in kilograms by the square of their height in metres.
A person 1.70m (5 ft 7") tall would be considered moderately obese if they weighed 90kg (14 stone) rather than the ideal 70kg (11 stone).
Each incremental rise in BMI above the healthy zone of 20-25 increased premature death risk, the Clinical Trial Service Unit concluded.
Severe obesity - a BMI of 40 to 50, which applies to about 2% of the UK population - reduced life expectancy by about 10 years.
Moderate obesity - a BMI of 30-39, which applies to one in four UK adults - reduced life expectancy by three years.
Much of the obesity-related risk is down to heart disease and stroke, and to a lesser extent cancer.
Amongst middle-aged people in the UK, as many as one in four deaths from heart attack or stroke and one in 16 cancer deaths are due to being overweight or obese, the researchers estimate.
Fat at 40
In adult life, it may be easier to avoid substantial weight gain than to lose that weight once it has been gained, they say.
BODY MASS INDEX
Calculated by dividing weight in kilograms by height in metres squared
Normal: 18.5 - 24.9
Overweight: 25 - 29.9
Obese: Above 30
Calculate your BMIAnd avoiding middle age spread could add years to life.
Professor Peter Weissberg of the British Heart Foundation, which supported the work, said: "This is the latest and most convincing demonstration of the close relationship between being overweight and poor heart health, and confirms that smoking is harmful regardless of your weight.
"We all have a role to play in maintaining a healthy weight ourselves, but this study emphasises the importance of public health measures, such as the recently launched Change 4 Life campaign, as part of a raft of Government initiatives that will be needed to reduce the nation's weight."
Epidemiologist Dr Gary Whitlock of Oxford University, who led the analysis, said: ''Excess weight shortens human lifespan.
"In countries like Britain and America, weighing a third more than the optimum shortens lifespan by about three years.
"For most people, a third more than the optimum means carrying 20 to 30kg of excess weight. If you are becoming overweight or obese, avoiding further weight gain could well add years to your life.''
Sara Hiom of Cancer Research UK said: "Moderate obesity is becoming worryingly common in the UK and these factors combined are great cause for concern.
"We can eat less and move more to reduce weight. But smoking remains the single most significant cause of cancer death - and stopping smoking works."
Sunday, March 15, 2009
Pakistan reinstates sacked judge
Iftikhar Chaudhry and other judges were sacked by Gen Musharraf
Pakistan's government has said a sacked Supreme Court chief justice will be reinstated, prompting the opposition to call off a major rally in the capital.
Prime Minister Yousaf Raza Gilani said Iftikhar Chaudhry would resume his old post later in March.
Opposition leader Nawaz Sharif had joined campaigning lawyers in demanding the judge's reinstatement.
Announcing that the march on Islamabad had been called off, Mr Sharif urged supporters to celebrate "with dignity".
Mr Gilani said Mr Chaudry would resume his post following the resignation of the current Chief Justice Abdul Hameed Dogar on 21 March.
"I announce the restoration of all deposed judges including Mr Iftikhar Chaudhry," PM Yousaf Raza Gilani said.
We have said that we will restore the judges and the independent judiciary and by the grace of Allah we have achieved it
Nawaz Sharif
Mr Chaudhry and 60 other judges were dismissed by Gen Musharraf in 2007.
Most have since been reinstated but Mr Chaudhry and a handful have not been allowed to return to their old posts.
His announcement, broadcast on television, triggered scenes of jubilation from Mr Chaudhry's supporters outside his home in Islamabad.
Mr Gilani also said opposition activists and leaders detained over the last week of mounting political disturbances would be freed and a ban on public demonstrations in the capital and several provinces lifted.
On Sunday, Mr Sharif - a former prime minister - had defied an apparent effort to place him under house arrest in the city of Lahore.
His supporters clashed with police, but managed to overcome barriers blocking access to the main highway to Islamabad and Mr Sharif left in a convoy.
Mr Sharif then joined anti-government protesters planning a march on the capital to demand the re-instatement.
But after the prime minister's announcement he called off the march, saying: "Let us celebrate this with dignity".
Speaking from Gujranwala, about 80km (50 miles) north-west of Lahore, he told supporters: "Today the nation has received very happy news.
"We have said that we will restore the judges and the independent judiciary and by the grace of Allah we have achieved it."
Spiralling unrest
The campaign over the judges had turned into a power struggle between Mr Sharif and President Zardari, says the BBC's Barbara Plett in Islamabad.
A crisis about more than judges
In pictures: Pakistan protests
Deja-vu in Pakistan crackdown
The unrest has alarmed the West, which wants Pakistan to focus on the battle against the Taleban on the Afghan border, says our correspondent.
A militant insurgency based in the north-west of Pakistan has shown signs of spreading throughout the country.
Earlier in March, the visiting Sri Lanka cricket team was attacked by gunmen in Lahore. Eight tour members were injured and six policemen were killed.
The tensions between Mr Zardari and Mr Sharif date back to the 1990s, but the two formed a brief partnership in government after parliamentary elections in February 2008.
President Zardari had promised to bring back the judges when he took office last year following his wife's assassination.
But Mr Sharif's party later left the alliance, complaining of reluctance by Mr Zardari's Pakistan People's Party to reinstate them.
The latest crisis was sparked by a Supreme Court decision to ban Mr Sharif and his brother Shahbaz from elected office, and President Zardari's decision to put their stronghold in Punjab province under direct rule from Islamabad.
Pakistan's government has said a sacked Supreme Court chief justice will be reinstated, prompting the opposition to call off a major rally in the capital.
Prime Minister Yousaf Raza Gilani said Iftikhar Chaudhry would resume his old post later in March.
Opposition leader Nawaz Sharif had joined campaigning lawyers in demanding the judge's reinstatement.
Announcing that the march on Islamabad had been called off, Mr Sharif urged supporters to celebrate "with dignity".
Mr Gilani said Mr Chaudry would resume his post following the resignation of the current Chief Justice Abdul Hameed Dogar on 21 March.
"I announce the restoration of all deposed judges including Mr Iftikhar Chaudhry," PM Yousaf Raza Gilani said.
We have said that we will restore the judges and the independent judiciary and by the grace of Allah we have achieved it
Nawaz Sharif
Mr Chaudhry and 60 other judges were dismissed by Gen Musharraf in 2007.
Most have since been reinstated but Mr Chaudhry and a handful have not been allowed to return to their old posts.
His announcement, broadcast on television, triggered scenes of jubilation from Mr Chaudhry's supporters outside his home in Islamabad.
Mr Gilani also said opposition activists and leaders detained over the last week of mounting political disturbances would be freed and a ban on public demonstrations in the capital and several provinces lifted.
On Sunday, Mr Sharif - a former prime minister - had defied an apparent effort to place him under house arrest in the city of Lahore.
His supporters clashed with police, but managed to overcome barriers blocking access to the main highway to Islamabad and Mr Sharif left in a convoy.
Mr Sharif then joined anti-government protesters planning a march on the capital to demand the re-instatement.
But after the prime minister's announcement he called off the march, saying: "Let us celebrate this with dignity".
Speaking from Gujranwala, about 80km (50 miles) north-west of Lahore, he told supporters: "Today the nation has received very happy news.
"We have said that we will restore the judges and the independent judiciary and by the grace of Allah we have achieved it."
Spiralling unrest
The campaign over the judges had turned into a power struggle between Mr Sharif and President Zardari, says the BBC's Barbara Plett in Islamabad.
A crisis about more than judges
In pictures: Pakistan protests
Deja-vu in Pakistan crackdown
The unrest has alarmed the West, which wants Pakistan to focus on the battle against the Taleban on the Afghan border, says our correspondent.
A militant insurgency based in the north-west of Pakistan has shown signs of spreading throughout the country.
Earlier in March, the visiting Sri Lanka cricket team was attacked by gunmen in Lahore. Eight tour members were injured and six policemen were killed.
The tensions between Mr Zardari and Mr Sharif date back to the 1990s, but the two formed a brief partnership in government after parliamentary elections in February 2008.
President Zardari had promised to bring back the judges when he took office last year following his wife's assassination.
But Mr Sharif's party later left the alliance, complaining of reluctance by Mr Zardari's Pakistan People's Party to reinstate them.
The latest crisis was sparked by a Supreme Court decision to ban Mr Sharif and his brother Shahbaz from elected office, and President Zardari's decision to put their stronghold in Punjab province under direct rule from Islamabad.
Thursday, March 12, 2009
Last Word of Nabi Kareem S.A.W...........
Suddenly, there was a person, he said salaam.'May I come in?' he asked.But Fatimah did not allow him enter the room.'I'm sorry, my father is ill,' said Fatimah, turned her body backandclosed the door.She went back to her father who had opened his eyes and asked Fatimah,'Who was he, my daughter?''I don't know, my father. It was the first time for me to seehim,'Fatimah said gently.Then, Rasulullah looked at his daughter with trembled look, as if hewanted to reminisce about every part of her daughter's face.'Know one thing! He is who erases the temporary pleasure; he is whoseparates the companionship in the world.He is the death angel,' said Rasulullah .Fatimah bore the bomb of her cry. The death angel came toward him, ButRasulullah asked why Jibril did not come along with him.Then, Jibril was called. Jibril was ready in the sky to welcome thesoul of Habibullah and the leader of the earth.'O Jibril, explain me about my rights in front of ALLAH?' Rasulullahasked with a weakest voice.'The doors of sky have opened, the angels are waiting for yoursoul.''All jannats open widely waiting for you,' Jibril said.But, in fact, all this did not make Rasulullah relieved, his eyes werestill full of worry..'You are not happy to hear this news?' asked Jibril.'Tell me about the destiny of my people in future?''Don't worry, O Rasul ALLAH. I heard ALLAH tell me: 'I make jannatharam for every one, except the people of Muhammad who are inside it,'Jibril said.It became closer and closer, the time for Malaekat Izrail to do his work.Slowly, Rasulullah's soul was pulled. It was seemed that the body ofRasulullah was full of sweat; the nerves of his neck became tight.'Jibril, how painful this sakaratul maut is!'Rasulullah uttered a groan slowly. Fatimah closed her eyes, Ali satbeside her bowed deeply and Jibril turned his face back.'Am I repugnant to you that you turn your face back o Jibril?'Rasulullah asked the Deliverer of Wahy.'Who is the one who could see the Habibullah in his condition ofsakaratul maut,' Jibril said.Not for a while, Rasulullah uttered a groan because of unbearable pain.'O ALLAH, how great is this sakaratul maut. Give me all these pains,don't give it to my people.'The body of Rasulullah became cold, his feet and chest did not move anymore....His lips vibrated as if he wanted to say something, Ali took his earclose to Rasulullah.'Uushiikum bis shalati, wa maa malakat aimanuku - take care of thesaalat and take care the weak people among you.'Outside the room, there were cries shouted each other, sahabah heldeach other. Fatimah closed her face with her hands and, again, Alitook his ear close to Rasulullah's mouth which became bluish.'Ummatii, ummatii, ummatii?' - 'My people, my people, mypeople.'And the life of the noble man ended.Could we love each other like him? Allahumma salli'ala Muhammad wabaarik wa salim 'alaihi. How deep is Rasulullah's love to us.Note:Send this to all your Muslim friends so that there is an awarenesstowards the love of ALLAH and His Rasul - because - truly - exceptthis love, the other loves, are only fani (not everlasting) thing.Ameen......May Almighty Allah guide all of us to the Right Path and give all ofus the courage to accept the Truth in the light of Qur'an and Sunnahand to reject all things which are in contradiction to the Holy Qur'anand Sunnah.(Ameen!)
Intensive care errors 'frequent'
Errors in the administration of injected medication in intensive care units occur frequently, a study across 27 countries suggests.
Austrian researchers collected data on more than 1,300 patients, 200 of them in the UK, over a 24-hour period.
Of the 441 patients affected, seven suffered permanent harm and five died partly because of the error, the British Medical Journal reported.
Medical staff often cited stress and tiredness as contributing factors.
Data was collected by researchers from Rudolfstiftung Hospital from a total of 113 intensive care units, of which 17 were in the UK.
The administration of injected medication is a weak point in patient safety
Dr Andreas Valentin, lead researcher
Nearly half of the affected patients suffered more than one mistake during the period covered.
The most frequent errors were related to the wrong time of administration and missing doses altogether.
Cases of incorrect doses and wrong drugs being given were also reported.
A total of 69% of the errors occurred during routine care.
Mistakes occurred with many types of drugs, including insulin for diabetics, sedatives and blood-clotting drugs.
The doctors and nurses who took part in the study cited stress and tiredness as a contributing factor in a third of mistakes.
Recent changes in the drug's name, poor communication between staff and violation of protocols were also mentioned.
The odds of an error being made increased significantly for the most severely ill patients. Researchers said this reflected the complexity of their care.
'Worrying'
Lead researcher Dr Andreas Valentin said the problems identified applied to all the health systems involved in the study.
He said just one in five units reported no adverse events during the 24-hour period studied.
"It is a really serious problem. The administration of injected medication is a weak point in patient safety," he said.
"With the increasing complexity of care in critically ill patients, organisational factors such as error reporting systems and routine checks at shift changes can reduce the risk of such errors."
A Patients Association spokesman said: "The findings are worrying. We know staff work really hard in intensive care units, but there are no excuses for errors.
"Protocols must be followed and managers should be carrying audits to make sure they are."
'International problem'
In a statement, the Intensive Care Society said the aim must be to refine care to minimise drug errors.
It said that critically ill patients often required complex care, with the use of many different drugs, some unusual, which were often administered using specialist equipment.
"The urgency of treatment can also mean that these drugs have to be located rapidly, prepared efficiently and administered quickly to prevent further deterioration.
"Unfortunately, this pressure does mean that the combined total incident rate is almost inevitably higher than in care areas where fewer medicines are required."
The society said many units had developed training programmes to increase patient safety, including measures to highlight and learn from "near misses".
Work was also under way to standardise concentrations of some drugs often given to critically ill patients, refine the use of antibiotics and minimise the risk of adverse drug reactions.
The Department of Health said it was working closely with the National Patient Safety Agency (NPSA), professional organisations and pharmacists to reduce the incidence of medication errors, which it described as "clearly an international problem".
Austrian researchers collected data on more than 1,300 patients, 200 of them in the UK, over a 24-hour period.
Of the 441 patients affected, seven suffered permanent harm and five died partly because of the error, the British Medical Journal reported.
Medical staff often cited stress and tiredness as contributing factors.
Data was collected by researchers from Rudolfstiftung Hospital from a total of 113 intensive care units, of which 17 were in the UK.
The administration of injected medication is a weak point in patient safety
Dr Andreas Valentin, lead researcher
Nearly half of the affected patients suffered more than one mistake during the period covered.
The most frequent errors were related to the wrong time of administration and missing doses altogether.
Cases of incorrect doses and wrong drugs being given were also reported.
A total of 69% of the errors occurred during routine care.
Mistakes occurred with many types of drugs, including insulin for diabetics, sedatives and blood-clotting drugs.
The doctors and nurses who took part in the study cited stress and tiredness as a contributing factor in a third of mistakes.
Recent changes in the drug's name, poor communication between staff and violation of protocols were also mentioned.
The odds of an error being made increased significantly for the most severely ill patients. Researchers said this reflected the complexity of their care.
'Worrying'
Lead researcher Dr Andreas Valentin said the problems identified applied to all the health systems involved in the study.
He said just one in five units reported no adverse events during the 24-hour period studied.
"It is a really serious problem. The administration of injected medication is a weak point in patient safety," he said.
"With the increasing complexity of care in critically ill patients, organisational factors such as error reporting systems and routine checks at shift changes can reduce the risk of such errors."
A Patients Association spokesman said: "The findings are worrying. We know staff work really hard in intensive care units, but there are no excuses for errors.
"Protocols must be followed and managers should be carrying audits to make sure they are."
'International problem'
In a statement, the Intensive Care Society said the aim must be to refine care to minimise drug errors.
It said that critically ill patients often required complex care, with the use of many different drugs, some unusual, which were often administered using specialist equipment.
"The urgency of treatment can also mean that these drugs have to be located rapidly, prepared efficiently and administered quickly to prevent further deterioration.
"Unfortunately, this pressure does mean that the combined total incident rate is almost inevitably higher than in care areas where fewer medicines are required."
The society said many units had developed training programmes to increase patient safety, including measures to highlight and learn from "near misses".
Work was also under way to standardise concentrations of some drugs often given to critically ill patients, refine the use of antibiotics and minimise the risk of adverse drug reactions.
The Department of Health said it was working closely with the National Patient Safety Agency (NPSA), professional organisations and pharmacists to reduce the incidence of medication errors, which it described as "clearly an international problem".
Sunday, February 8, 2009
Scans 'no aid for back pain care'
The routine use of scans in patients with lower back pain does not improve their outcomes, US scientists say.
They looked at six trials including more than 1,800 patients and found no benefit from the scans when patients were followed for up to a year.
Previous studies in the UK have shown similar results.
The National Institute for Clinical Excellence (NICE) is expected to publish guidelines on the treatment of lower back pain in May.
The researchers said the results were most applicable to the type of acute lower back pain assessed by a GP.
They looked at pain, function, quality of life, mental health, overall patient-reported improvement and patient satisfaction in the care they received for up to a year after their initial treatment.
All the patients were randomised to receive either immediate scans or standard clinical care.
Some of the standard care group were offered scans if they had not improved within three weeks.
They did not find significant differences between immediate imaging with X-ray or MRI scans and usual clinical care either in the short-term - up to three months later, or the long-term - six to 12 months.
Existing guidelines
Imaging in the first month of low back pain is not recommended in the US or in draft guidelines from NICE that were published in October.
DRAFT NICE GUIDELINES ON BACK PAIN
Consider course of manual therapy
Consider course of acupuncture
Consider structured exercise programme
Do not offer an X-ray
MRI only for suspected spinal fusion or other serious underlying conditionBut
Dr Roger Chou, lead researcher from the Oregon Health and Science University said some doctors still do it routinely, "possibly because they aim to reassure their patients and themselves, to meet patient expectations about tests or because reimbursement structures provide financial incentives to image".
He added: "Clinicians should refrain from routine, immediate lumbar imaging in patients with acute or sub-acute low back pain and without features suggesting a serious underlying condition."
In the paper published in the Lancet, the researchers say rates of MRI scans for back pain are rising according to figures from US medical programme Medicare.
They think patient expectations and preferences for imaging should be addressed, because in one trial 80% of patients with low back pain would undergo radiography if given the choice.
"Educational interventions could be effective for reducing the proportion of patients with low back pain who believe that routine imaging should be done."
UK experience
It is estimated that 40% to 50% of the population in the UK experience back pain in any given year.
With normal clinical care 80% of them will recover within six weeks.
The remaining five million go on to have back pain that needs some sort of help and investigation.
Dr Dries Hettinga, head of research at the UK charity Backcare, said: "While back pain is very common, we still have a very poor understanding of this condition and its causes.
"Health professionals play a vital role in reassuring patients.
"While it may seem that sending patients for an X-ray or MRI can provide this reassurance, the scans often reveal very little.
"With the right information and support, most people are able to manage their pain and find that it gets better within days or weeks."
The draft guidelines from NICE say X-ray and MRI investigations of the spine should be limited to when tumours, breaks, fusions or serious inflammation and infection is suspected.
It advises all people with lower back pain to exercise, if necessary in supervised groups, and that doctors should be able to offer a course of manual therapy or acupuncture.
They looked at six trials including more than 1,800 patients and found no benefit from the scans when patients were followed for up to a year.
Previous studies in the UK have shown similar results.
The National Institute for Clinical Excellence (NICE) is expected to publish guidelines on the treatment of lower back pain in May.
The researchers said the results were most applicable to the type of acute lower back pain assessed by a GP.
They looked at pain, function, quality of life, mental health, overall patient-reported improvement and patient satisfaction in the care they received for up to a year after their initial treatment.
All the patients were randomised to receive either immediate scans or standard clinical care.
Some of the standard care group were offered scans if they had not improved within three weeks.
They did not find significant differences between immediate imaging with X-ray or MRI scans and usual clinical care either in the short-term - up to three months later, or the long-term - six to 12 months.
Existing guidelines
Imaging in the first month of low back pain is not recommended in the US or in draft guidelines from NICE that were published in October.
DRAFT NICE GUIDELINES ON BACK PAIN
Consider course of manual therapy
Consider course of acupuncture
Consider structured exercise programme
Do not offer an X-ray
MRI only for suspected spinal fusion or other serious underlying conditionBut
Dr Roger Chou, lead researcher from the Oregon Health and Science University said some doctors still do it routinely, "possibly because they aim to reassure their patients and themselves, to meet patient expectations about tests or because reimbursement structures provide financial incentives to image".
He added: "Clinicians should refrain from routine, immediate lumbar imaging in patients with acute or sub-acute low back pain and without features suggesting a serious underlying condition."
In the paper published in the Lancet, the researchers say rates of MRI scans for back pain are rising according to figures from US medical programme Medicare.
They think patient expectations and preferences for imaging should be addressed, because in one trial 80% of patients with low back pain would undergo radiography if given the choice.
"Educational interventions could be effective for reducing the proportion of patients with low back pain who believe that routine imaging should be done."
UK experience
It is estimated that 40% to 50% of the population in the UK experience back pain in any given year.
With normal clinical care 80% of them will recover within six weeks.
The remaining five million go on to have back pain that needs some sort of help and investigation.
Dr Dries Hettinga, head of research at the UK charity Backcare, said: "While back pain is very common, we still have a very poor understanding of this condition and its causes.
"Health professionals play a vital role in reassuring patients.
"While it may seem that sending patients for an X-ray or MRI can provide this reassurance, the scans often reveal very little.
"With the right information and support, most people are able to manage their pain and find that it gets better within days or weeks."
The draft guidelines from NICE say X-ray and MRI investigations of the spine should be limited to when tumours, breaks, fusions or serious inflammation and infection is suspected.
It advises all people with lower back pain to exercise, if necessary in supervised groups, and that doctors should be able to offer a course of manual therapy or acupuncture.
Friday, January 30, 2009
Wednesday, January 14, 2009
Surgical checklist 'saves lives'
Using a simple surgical checklist during major operations can cut deaths by more than 40% and complications by more than a third, research has shown.
The National Patient Safety Agency (NPSA) has ordered all hospitals in England and Wales to use it across the board by February 2010.
The checklist, devised by the World Health Organization (WHO), was tested in eight cities around the globe.
The year-long study features online in the New England Journal of Medicine.
Dr Atul Gawande, of Harvard School of Public Health, explains the checks
The checklist is made up of a single page that requires only a few minutes to complete.
It focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent problems such as infection and unnecessary blood loss.
It was tested in hospitals in Seattle, Toronto, London, Auckland, Amman, New Delhi, Manila and Ifakara, Tanzania.
In total data was collected from 7,688 patients, 3,733 before the checklist was implemented, and 3,955 afterwards.
The rate of major complications fell from 11% to 7%, and the rate of inpatient deaths following surgery fell more than 40% from 1.5% to 0.8%.
The National Patient Safety Agency (NPSA) has ordered all hospitals in England and Wales to use it across the board by February 2010.
The checklist, devised by the World Health Organization (WHO), was tested in eight cities around the globe.
The year-long study features online in the New England Journal of Medicine.
Dr Atul Gawande, of Harvard School of Public Health, explains the checks
The checklist is made up of a single page that requires only a few minutes to complete.
It focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent problems such as infection and unnecessary blood loss.
It was tested in hospitals in Seattle, Toronto, London, Auckland, Amman, New Delhi, Manila and Ifakara, Tanzania.
In total data was collected from 7,688 patients, 3,733 before the checklist was implemented, and 3,955 afterwards.
The rate of major complications fell from 11% to 7%, and the rate of inpatient deaths following surgery fell more than 40% from 1.5% to 0.8%.
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