Ruaraidh Hill

Reactions to a New Technology: students’ ideas about genetically engineered foodstuffs

Abstract This study explores the prevalence of ideas among 16‐19 year old students about the application of a rapidly expanding technology, genetic engineering, to food production. A closed‐form questionnaire with items about genetically engineered vegetables and animals was completed by 386 students from 13 further education institutes. The most common ideas about the advantages of genetically engineered foods were those of improved storage and increased productivity; fewer students thought that such foods would be better tasting, cheaper or healthier. Few thought that genetically engineered foodstuffs were unsafe for the environment or for the consumer, although almost all wanted such foodstuffs to be labelled. Approximately half thought that genetically engineered foodstuffs were ‘unnatural’, although fewer thought that it was wrong to produce such organisms and even fewer gam religious beliefs as their reason. There was a suggestion that greater understanding of genetic engineering increases confidenc...

Animal experimentation needs dissection.

8 Sir — In a recent Commentary article, Nicholas Mrosovsky criticized the International Union for the Conservation of Nature (IUCN) for the lack of documentation supporting the listing of the hawksbill turtle (Eretmochelys imbricata) as ‘critically endangered’ in the 1996 IUCN Red List of Threatened Animals. The listing of the hawksbill as critically endangered was based on a rigorous evaluation by IUCN Marine Turtle Specialist Group members involved in preparing the status justification. I am a member of that group, and a hawksbill specialist. Population declines of 80% over three generations are evident or can be inferred in all ocean basins throughout the species’ circumtropical range. The species has been listed by IUCN as endangered since 1968. Publication of a summary of all the data considered in the listing process is timeconsuming, and our working group (all volunteers) is moving forward as fast as possible. It should be pointed out that all the documents we are reviewing are freely available in the literature, including a 601-page review of the hawksbill’s status sponsored by the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). An unfortunate effect of Mrosovsky’s Commentary will be to impart doubt that the hawksbill deserves listing as critically endangered. A few facts are in order. Population declines of the hawksbill have occurred against a backdrop of high levels of international trade in hawksbill shell (tortoiseshell). Estimates of tortoiseshell imports into Japan from 1970 to 1992 (when Japan stopped trading) exceeded 754 tonnes, representing approximately 712,000 hawksbills. In 1990, hawksbill experts meeting in Nagasaki, Japan, estimated that there were approximately 15,000 hawksbills nesting annually worldwide. Exploitation of hawksbills for tortoiseshell, meat and eggs continues worldwide. Perhaps the most striking indication of the hawksbill’s plight is a recent communication by Colin Limpus of the Queensland Department of Environment and Heritage, that researchers in the Solomon Islands are discovering that more than 90% of the nesting hawksbills are first-time breeders (identified by laparoscopy). Thus most females of this long-lived species are not surviving to nest for more than one season. The only “controversy” about the hawksbill’s status is that being created by those who wish to resume international trade in this species. The Cuban hawksbill proposal presented at the CITES meeting in Zimbabwe last June would have allowed resumption of the harvest of wild hawksbills to supply the luxury tortoiseshell trade between Cuba and Japan. It would also have allowed the sale of all hawksbill shell stockpiled by Cuba since 1992. Both actions would have signalled the resurrection of the destructive tortoiseshell market, which took decades to shut down. Ironically, Japan’s need for Cuban stockpile was not even clear — the reported inventory of tortoiseshell in Japan in 1995 was 188 tonnes. The Cuban hawksbill proposal was defeated, but those who orchestrated its presentation in Zimbabwe are already positioning themselves for their next attempt to reopen the trade in tortoiseshell. Mrosovsky’s suggestion that hawksbills should be placed in the ‘data deficient’ category in the Red List is an obfuscating tactic and is appalling in its transparency. Anne Meylan Florida Department of Environmental Protection, Florida Marine Research Institute, 100 8th Avenue SE, St Petersburg, Florida 33701-5095, USA e-mail: meylan_a@harpo.dep.state.fl.us

Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

Tuberculosis is over-represented in hard-to-reach (underserved) populations in high-income countries of low tuberculosis incidence. The mainstay of tuberculosis care is early detection of active tuberculosis (case finding), contact tracing, and treatment completion. We did a systematic review with a scoping component of relevant studies published between 1990 and 2015 to update and extend previous National Institute for Health and Care Excellence (NICE) reviews on the effectiveness of interventions for identifying and managing tuberculosis in hard-to-reach populations. The analyses showed that tuberculosis screening by (mobile) chest radiography improved screening coverage and tuberculosis identification, reduced diagnostic delay, and was cost-effective among several hard-to-reach populations. Sputum culture for pre-migration screening and active referral to a tuberculosis clinic improved identification. Furthermore, monetary incentives improved tuberculosis identification and management among drug users and homeless people. Enhanced case management, good cooperation between services, and directly observed therapy improved treatment outcome and compliance. Strong conclusions cannot be drawn because of the heterogeneity of evidence with regard to study population, methodology, and quality.

Angioplasty and stents in coronary artery disease: a systematic review and meta‐analysis

Objectives—To undertake a systematic review of the clinical effectiveness of routine percutaneous transluminal coronary angioplasty (PTCA) plus stenting vs PTCA alone. Data sources—MEDLINE; EMBASE; Science Citation Index; The Cochrane Library; cardiovascular journals and conference proceedings; Internet resources (including industry supported web pages); and reference lists of included studies and relevant reviews. Review methods—Study selection included published and unpublished randomized controlled trials (RCTs) comparing the use of coronary stents to PTCA. Outcome measures assessed included death, acute myocardial infarction (AMI), event rate (such as major cardiac adverse events (MACE) or other composite measures), and binary restenosis (BR). Data extraction and quality assessment were conducted according to internationally recognized methods. Data synthesis included meta‐analysis of assessed outcomes, reported as odds ratios (ORs). Results—Fifty RCTs involving 16 500 patients met the inclusion criteria (39 full articles, 11 abstracts). Of these, 23 studies compared stenting with PTCA in patients with non‐specific coronary artery disease (CAD), 11 compared stents with PTCA following AMI, 8 included patients with small coronary arteries and 8 included patients whose vessels had chronic total occlusion. There were no differences in rates of death or AMI. There were reductions in the rates of MACE (death, AMI or revascularization) with stents compared to PTCA (at 6 months, for non‐specific group OR: 1.64, 95% CI 1.44–1.87; for AMI group OR: 2.36, 95% CI 1.92–2.89; for small vessel group OR: 1.38, 95% CI 1.10–1.74; at 12 months, for non‐specific group OR: 1.31, 95% CI 1.11–1.55; for AMI OR: 2.26, 95% CI 1.47–3.46). Reporting of combined major adverse cardiac events was inconsistent across studies. Most events were revascularizations that may have been partly driven by protocol‐required angiograms. Stents reduced BR rates at angiogram at 6 months compared to PTCA in all groups. Conclusion—We found no differences in mortality or AMI, but the studies were not powered to identify changes in these endpoints. Coronary stenting is associated with reduced restenosis and combined adverse cardiac events, primarily revascularizations. However, the frequency of revascularization may have been distorted by protocol‐dictated angiography.

Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature

Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.

Prasugrel for the treatment of acute coronary syndromes with percutaneous coronary intervention: NICE technology appraisal guidance

Prasugrel (Efient, Eli Lilly) is an oral inhibitor of platelet activation and aggregation. Prasugrel, coadministered with acetylsalicylic acid, has marketing authorisation for the prevention of atherothrombotic events in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance on the use of prasugrel for patients undergoing PCI was published in October 2009.1 Prasugrel, in combination with aspirin, is recommended as an option for patients when: The following sections present evidence on use of prasugrel and an overview of the independent advisory Appraisal Committees considerations in developing its guidance for NICE. The importance of expert and stakeholder involvement in the development of NICE guidance is also explained. Prasugrel was considered under the NICE single technology appraisal process.2 In this process, the manufacturer provides an evidence submission, which comprises a report (structured according to a template set by NICE) and economic model. The structured report sets out the evidence base for the drug, and the economic model assesses its cost-effectiveness compared to current standard practice – in this case the use of clopidogrel. The manufacturers submission, therefore, forms the core evidence source for the Appraisal Committees considerations. In addition, an academic group, the Evidence Review Group (in this case, the Liverpool Reviews and Implementation Group, University of Liverpool) is commissioned to critique the manufacturers submission, and produce a report of its findings.3 The Evidence Review Group may also undertake exploratory analyses using the submitted materials and report these to the Appraisal Committee. The Appraisal Committee developed recommendations for the use of prasugrel in two stages. First, it met to consider the available evidence and the …

Genetically engineered foodstuffs: school students’ views

Genetically engineered foodstuffs are now becoming commercially available. A closed‐form questionnaire to explore how such foods might be received was completed by 416 school students in English National Curriculum Years 7 (age 11–12 years), 9 (age 13–14) and 11 (age 15–16). The most commonly perceived benefits of genetically engineered foodstuffs were improved productivity and extended storage; few students thought they would be cheaper, healthier to eat or taste better. About a third thought that genetic engineering of foodstuffs would present health or environmental risks. Approximately half thought genetic engineering was unnatural, and a similar proportion felt that mankind had no right to produce such organisms for food; few of these objections were based on religious views. About a quarter thought that genetic engineering was needed to produce enough food for the world, but about half thought it unnecessary. About half of the group felt that genetic engineering for foodstuffs would increase the cha...

Biology students' understanding of cystic fibrosis, gene therapy, and gene screening

The ideas of 290 Year 1 biology undergraduate students about cystic fibrosis, gene therapy, and gene screening have been explored using a multiple-choice-type questionnaire. Students were reasonably informed about the nature of cystic fibrosis disease, although many underestimated its prevalence. Fewer of the students understood the mechanism of inheritance of cystic fibrosis. Only a third of the students appreciated the way in which gene therapy is currently effected; many thought that ‘faulty’ genes could be removed and some even imagined that they could be repaired and replaced. A quarter of the students thought that testing for the cystic fibrosis gene would produce medical side-effects. In the affective domain, about half the group would wish to be tested, but a third were uncertain.

Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review

Objective To determine which service models and organisational structures are effective and cost-effective for delivering tuberculosis (TB) services to hard-to-reach populations. Design Embase and MEDLINE (1990–2017) were searched in order to update and extend the 2011 systematic review commissioned by National Institute for Health and Care Excellence (NICE), discussing interventions targeting service models and organisational structures for the identification and management of TB in hard-to-reach populations. The NICE and Cochrane Collaboration standards were followed. Setting European Union, European Economic Area, European Union candidate countries and Organisation for Economic Co-operation and Development countries. Participants Hard-to-reach populations, including migrants, homeless people, drug users, prisoners, sex workers, people living with HIV and children within vulnerable and hard-to-reach populations. Primary and secondary outcome measures Effectiveness and cost-effectiveness of the interventions. Results From the 19 720 citations found, five new studies were identified, in addition to the six discussed in the NICE review. Community health workers from the same migrant community, street teams and peers improved TB screening uptake by providing health education, promoting TB screening and organising contact tracing. Mobile TB clinics, specialised TB clinics and improved cooperation between healthcare services can be effective at identifying and treating active TB cases and are likely to be cost-effective. No difference in treatment outcome was detected when directly observed therapy was delivered at a health clinic or at a convenient location in the community. Conclusions Although evidence is limited due to the lack of high-quality studies, interventions using peers and community health workers, mobile TB services, specialised TB clinics and improved cooperation between health services can be effective to control TB in hard-to-reach populations. Future studies should evaluate the (cost-)effectiveness of interventions on TB identification and management in hard-to-reach populations and countries should be urged to publish the outcomes of their TB control systems. PROSPERO registration number CRD42015017865.