NEWS
New resource to tackle TB in under-served populations
Tuberculosis (TB) is a disease still associated with social deprivation. In 2015, rates of TB among people living in the most deprived areas of England were nearly six times as high as those of people living in wealthier areas, with a clear trend of an increasing rate of TB with increasing deprivation. Among people living in communities with high rates of TB are those with multiple complex health and social care needs. For many such people, services as currently constructed and delivered simply do not reach them. They therefore often miss the opportunity for early diagnosis of TB, may miss out on treatment and so suffer avoidable health consequences themselves as well as potentially spreading infection to others. These people are described as under-served populations (USPs). Tackling TB among USPs is one of the key areas for action identified in the Collaborative TB Strategy for England. Public Health England (PHE), working in partnership with TB Alert and NHS England, has published a new resource for TB control boards and their partners for tackling TB among USPs. The work specifically considers the needs of: l People who are homeless. l Those who misuse drugs and/or alcohol. l People in contact with the criminal justice system.
l Some migrant populations at higher risk of TB (including refugees, asylum seekers and those in immigration detention).
l Some people living with mental health problems.
Many people at risk of TB will belong to more than one of these categories. The purpose of
the resource is to improve understanding of the health needs of USPs in relation to TB, and to support the design and delivery of multi-agency programmes and services to better meet those needs. This resource provides TB control boards and their partners with a framework around which to build collaborative programmes of work to reduce the burden of TB among USPs in their area. The resource offers practical examples of successful initiatives which have been implemented to reach these communities. This will not only improve the health of these populations but will protect the health of the wider population and contribute significantly to the aims of the Collaborative TB Strategy for England.
Mike Mandelbaum, chief executive of
TB Alert, said: “Tuberculosis disproportionately affects some of the most vulnerable people in society, who often have least access to healthcare. This is as true in England as in developing countries, which explains the need for services which respond to the specific challenges involved in tackling TB among under- served populations. “The key to improved health outcomes among these populations is partnership working involving health services, local authorities, the third sector and affected populations themselves. This resource provides a framework for commissioning and delivering services based on those partnerships, and for reversing the pattern of health inequalities so commonly associated with TB.” To download the resource, visit:
https://www.gov.uk/government/publications /tackling-tuberculosis-in-under-served- populations
Revised and expanded confidentiality
guidance published by the GMC The General Medical Council (GMC) has published revised, expanded and reorganised guidance on confidentiality for all doctors practising in the UK. The guidance – Confidentiality: Good practice in handling patient information – comes into effect from 25 April 2017. Revisions have been made to the guidance, last published in 2009, following an extensive consultation exercise. While the principles of the current GMC guidance remain unchanged, it now clarifies: l The public protection responsibilities of doctors, including when to make disclosures in the public interest.
l The importance of sharing information for direct care, recognising the multi-disciplinary and multi-agency context doctors work in.
l The circumstances in which doctors can rely on implied consent to share patient information for direct care.
l The significant role that those close to a patient can have in providing support and care, and the importance of acknowledging that role.
The GMC has also published a decision- making flowchart and explanatory notes to show how the new guidance applies to situations doctors may encounter and find hard to deal with, such as reporting gunshot and knife wounds or disclosing information about serious communicable diseases. The GMC’s new app – My GMP – signposts to the revised guidance. When the guidance comes into effect in April, additional resources and case studies will be published for doctors and patients.
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Melanoma death rates predicted to fall by 2050 By 2050, the death rates from malignant
melanoma will have decreased from their current levels, but the number of people dying from the disease will have increased due to the ageing population. However, if new treatments for the deadly skin cancer prove to be effective, the number of deaths could fall too, according to research presented at the European Cancer Congress 2017. Ms Alice Koechlin, from the International
Prevention Research Institute in Lyon, France, told the meeting that people who were at highest risk of dying from melanoma were those born between 1900 and 1960 when not only were the dangerous effects of exposure to ultraviolet (UV) radiation from sunlight largely unknown, but health professionals also believed that sunshine was positively beneficial. Ms Koechlin concluded: “Our findings clearly show that most of the death toll due to melanoma has been caused by medically- backed exposures to highly carcinogenic UV radiation between 1900 and 1960. They also show that UV-protection of children pays off because rates of melanoma death keep going down, from around 1960 to the current day as the UV protection of children based on clothing, shading and avoidance of excessive sun exposure has spread in most light- skinned populations, starting in Australia. “Skin screening, based on the
opportunistic early detection of skin cancers, does not affect melanoma mortality and our analyses confirm this evidence. So, generations that have been over-exposed to high UV doses keep the high probability of developing a deadly melanoma at some stage in their lives. The good news is that the risk declines rapidly as skin protection increases, and that effective treatments are starting to be available. But we still have a long way to go before we will have affordable therapies able to prolong survival from advanced melanoma by several years with a decent quality of life.”
Chair of the Congress and president of
ECCO, Professor Peter Naredi, from the Sahlgrenska Academy, University of Gothenburg, Sweden, who was not involved with the research, commented: “This study by Autier and colleagues is very interesting. Malignant melanoma is one of our most common cancers and we have tried different ways to increase awareness about protection and early diagnosis. If the predictions are right, protection from sun exposure is one of the best examples of primary prevention and this study proves all efforts to protect a population from unhealthy amounts of sun exposure are worthwhile.”
MARCH 2017
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