Smaller Analgesic  Packs

Legislation to limit the size of packs of paracetamol, salicylates, and their compounds sold over the counter was introduced in the UK in September 1998. The legislation reduced the previously unrestricted sale limit for pharmacies to a maximum of 32 tablets and for other retail outlets from 24 to 16 tablets. The aim was to reduce household stocks of analgesics and the danger of overdoses from these supplies.

 Declines in numbers of large overdoses, deaths from paracetamol and salicylate overdose, and paracetamol related liver transplants in the year after the legislation was introduced have already been shown. The authors have now assessed the legislation's longer term effect and investigated possible substitution of overdose method with the non-steroidal anti-inflammatory drug ibuprofen, which was not included in the legislation.

This was a before and after study, which studied suicides in England and Wales, data from six liver units in England and Scotland and five general hospitals in England, and UK data on sales of analgesics, between September 1993 and September 2002.

The study measured deaths by suicidal overdose with paracetamol, salicylates, or ibuprofen; numbers of patients admitted to liver units, listed for liver transplant, and undergoing transplantations for paracetamol induced hepatotoxicity; non-fatal self poisonings with analgesics and numbers of tablets taken; and sales figures for analgesics.

It showed that suicide deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths.

The study concluded that legislation restricting pack sizes of analgesics in the United Kingdom has been beneficial. A further reduction in pack sizes could prevent even more deaths.

Source: Web

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The Public Health White paper

The new Public Health White Paper says:

· Smoking will be banned in all enclosed public places by the end of 2008. Private members' clubs and pubs that do not serve food are excluded

· By 2007, the National Institute for Clinical Excellence (NICE) will prepare guidance on the prevention, identification, management, and treatment of obesity. This will be backed by new initiatives to implement the guidance

· Sure Start will develop new programmes next year to improve support for parents to help them understand the things that impact on their children's social, emotional, and physical development in the early years

· By 2007, volunteers will be available to visit families under stress

· Guidelines on managing mild to moderate mental illness in the workplace to be published in 2005

· More school nurses are promised. By 2010, every school cluster will have access to a team led by a qualified school nurse

· NHS accredited heath trainers will be available from 2006 to give support to people who want to change their lifestyle in the areas of highest need. The service will be rolled out across England from 2007

· New cycle routes, improved parks and other public spaces, free swimming, and other sports initiatives will be available

· Doctors and other heath professionals will be encouraged to give out pedometers to help increase activity among patients

· Local authorities are being given guidance on how to deal with shopkeepers who sell tobacco to underage children. New legislation is planned to strengthen these powers

· Work is planned with the Portman Group to tackle binge drinking. Other measures to promote sensible drinking are to be agreed with industry

Source: Web

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Why has stroke incidence reduced?

In 1981-84 the Oxford Community Stroke Project examined stroke in people registered with family doctors in Oxfordshire. The Oxford Vascular Study repeated the exercise for 2003-4, using similar  methods.

Patients were assessed as soon after the event as possible, with a standard clinical history and examination, with scanning in every case. Diagnosis and clinical subtyping in the more recent study were as close as possible to those in the earlier study.

Both studies involved populations of about 90,000. Significant reductions in stroke incidence for 2004 compared with 1981-4 occurred overall, in men and women, and in all patients aged less than 85 years. Significant reductions occurred in ischaemic and haemorrhagic stroke, but not subarachnoid haemorrhage. Strokes in 2004 were significantly less severe than those occurring in 1981-4 and many more patients were receiving anti-hypertensives, antiplatelets, and lipid lowering agents.

Risk factors were also lower. Fewer people had high cholesterol or blood pressure, or were current smokers. Compared with 1981-4, cholesterol levels in those with a first event were lower by about 1 mmol/L, mean systolic blood pressure by about 10 mmHg, and mean diastolic blood pressure by about 6 mmHg.

Both treatment of pre-morbid conditions, and improved risk factors contributed, but how much by each is not clear.

Oxfordshire probably does as well as most places in implementation of preventative medicine, and many people have taken on board healthy living advice. Together these have resulted in reducing the number of strokes in the population of 2004 by about 55 per 100,000 people over what would have been expected without them.

Source Bandolier 126

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