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21 Jul 2004 : Column 367W—continued
Sleep Apnoea
Mr. Burstow: To ask the Secretary of State for Health how many finished consultant episodes there were for (a) paediatric and (b) adolescent obesity-related sleep apnoea treatment in (i) England and (ii) each strategic health authority in each year since 1996. [184100]
Dr. Ladyman: The information requested has been placed in the Library.
Solvent Abuse
Mr. Gray: To ask the Secretary of State for Health what plans he has to require further warnings on aerosol cans of the dangers of solvent abuse. [184586]
Miss Melanie Johnson: The Department has no immediate plans on placing further warnings on aerosol cans advising of the dangers of solvent abuse. Although voluntary, the British Aerosol Manufacturing Association estimates that approximately 90 per cent. of all cans carry warnings.
Mr. Gray: To ask the Secretary of State for Health when he last met (a) Solv-It and (b) Re-Solv to discuss solvent abuse. [184588]
Miss Melanie Johnson: The then Parliamentary Under-Secretary of State (Yvette Cooper) met with Re-Solv in November 2001 to discuss volatile solvent abuse. Departmental officials have continued to meet with Re-Solv.
Mr. Gray: To ask the Secretary of State for Health if he will make a statement on the health effects of solvent abuse. [184589]
Miss Melanie Johnson: Adverse effects vary greatly with the specific substance and mode of administration.
There is a wide range of immediate physical health effects reported including: flushed face and neck; cold sweats; loss of balance, unsteadiness, lack of co-ordination; fainting; headache; nausea and vomiting;
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confusion, dizziness, disorientation; tachycardia, palpitations; drowsiness, sedation, unconsciousness and risk of accidental injury while intoxicated.
There is a range of potential immediate psychological adverse effects reported including: confusional states, disorientation; distorted perceptions, delusions, hallucinations, pseudo-hallucinations, and aggression, agitation or fear.
A number of immediate socially significant adverse effects have been reported including: accidents (road traffic accidents, swimming accidents, fires, falls); disinhibition, possibly leading to engagement in high risk behaviour (dangerous driving, unsafe sexual practices), or the risk of becoming a victim of crime; acute intoxication that may possibly result in aggressive and violent behaviour, or disorderly conduct; relationship problems and impairment of educational achievements in adolescents.
Adverse effects of longer-term use that have been reported include: peripheral neurological damage and brain damage; renal failure; hepatotoxicity; severe gastrointestinal upset; muscle damage, and in the very long term, for example, 10 years or so, lasting impairment of brain function—affecting especially control of movement. Some of these effects may be reversible on stopping use.
Fatal toxicity varies greatly with the specific substance, and the causes of death can be unclear. A number of causes of death through solvent abuse have been described including: most commonly, cardiac arrhythmia or accident; loss of consciousness and death through choking on vomit; suffocation, for example, if a plastic bag is placed over the head to inhale and asphyxiation from blocked airways, (due to intense cooling in mouth) and laryngeal spasm caused by squirting lighter fuel down throat.
Combining use with alcohol and other central nervous system depressants will bring increased risk of asphyxiation and death.
Solitary use in potentially dangerous settings may increase risk of injury.
Tuberculosis (Asylum Seekers)
Dr. Murrison: To ask the Secretary of State for Health what proportion of UK induction centres offer asylum seekers screening for tuberculosis. [184846]
Miss Melanie Johnson: There are two induction centres operating in the United Kingdom: one in East Kent and the other in Yorkshire and Humberside. Both offer screening for tuberculosis.
Ungraded Eggs
Mr. Lidington: To ask the Secretary of State for Health what assessment has been made by the Food Standards Agency of the possible risks to human health of allowing ungraded eggs to be sold unmarked. [184196]
Miss Melanie Johnson:
The microbiological status of eggs does not affect whether they are graded and marked.
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The sale of ungraded eggs, whether marked or not, is subject to the same food safety rules that apply to graded eggs, and in the circumstances, no particular assessment has been made of the possible risks to public health of allowing ungraded eggs to be sold unmarked.
Women's Health
Diana Organ: To ask the Secretary of State for Health (1) how many NHS locations perform (a) hydro thermo ablation, (b) microwave ablation, (c) balloon ablation and (d) uterine fibroid embolisation for the treatment of menorrhagia or uterine fibroids; [181139]
(2) how many people in the last year suffering from menorrhagia or uterine fibroids were treated by (a) hydro thermo ablation, (b) microwave ablation, (c) balloon ablation and (d) uterine fibroid embolisation. [181140]
Miss Melanie Johnson: Information in the form requested is not available. Data from hospital episode statistics (HES) giving counts of admissions to national health service hospitals is shown in the table.
| Operation | Total episodes |
|---|---|
| Endoscopic, theraputic and other operations on uterus | 9,923 |
| b) Microwave ablation | 1,116 |
| c) Balloon ablation | 1,317 |
| d) Uterine fibroid embolisation | 286 |
Notes:
1. A finished admission episode is the first period of in-patient care under one consultant within one healthcare provider. Please note that admissions do not represent the number of in-patients, as a person may have more than one.
2. Figures have not been adjusted for shortfalls in data (i.e. the data are ungrossed).
3. The primary diagnosis is the first of up to 14 (seven prior to 2002–03) diagnosis fields in the HES data set and provides the main reason why the patient was in hospital.
4. The main operation is the first recorded operation in the HES data set and is usually the most resource intensive procedure performed during the episode.
5. Diagnosis Codes
The ICD10 codes for menorrhagia and uterine fibroids are:
Primary Diagnosis
N92.- Excessive, frequent and irregular menstruation.
N95.0—Postmenopausal bleeding.
D25.- Leiomyoma of uterus.
Procedure Codes
a) Hydro thermal ablation
No specific OPCS4 code but would be in either Q16.- or Q17.- (data above provided as background).
b) Microwave ablation
Main Operation
Q16.8 Other specified, other vaginal operations on uterus. Or
Q17.4 Endoscopic destruction of lesion of uterus nec.
Secondary operation
Y11.4 Radiofrequency controlled thermal destruction of organ noc.
c)Balloon ablation
Main Operation
Q16.8 Other specified, other vaginal operations on uterus.
Secondary operation
Y11.8 Other specified, other destruction of organ.
d)Uterine fibroid embolisation
Main Operation
L71.3 Percutaneous Transluminal embolisation of artery nec.
Secondary operation
Z38.8 Specified terminal branch of aorta nec.
Source:
Hospital episode statistics, Department of Health.
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Information relating specifically to hydro thermal ablation is not available. However, this would be included in the count under the heading "Endoscopic, therapeutic and other operations on uterus".
117 trusts performed hydro thermo ablation, microwave ablation, balloon ablation or uterine fibroid embolisation for the treatment of menorrhagia or uterine fibroids, Information on which trusts performed hydro thermo ablation for the treatment of menorrhagia or uterine fibroids is not available.
Yellow Card Scheme
Mr. Burstow: To ask the Secretary of State for Health what assessment he has made of the validity of criticisms of the Yellow Card scheme published in the "International Journal of Risk and Safety of Medicine" (2003, 16, 3–17); what account he has taken of the view of the Medicines and Healthcare Products Regulatory Agency on the matter; and what steps he has taken (a) to ensure that there has been no significant miscoding and misinterpretation of Yellow Card adverse drug reaction reports for paroxetine and (b) to ensure that there has been effective follow-up of reports relating to suspected paroxetine-induced suicidal behaviour. [178431]
Tim Loughton: To ask the Secretary of State for Health what assessment he has made of the Medicines and Healthcare Products Regulatory Agency criticisms of the Yellow Card scheme published in the "International Journal of Risk and Safety of Medicine" (2003, 16, 3–17); and what assessment he has made of (a) the adequacy of the coding and interpretation of Yellow Card adverse drug reaction reports for paroxetine and (b) the effectiveness of the follow-up of reports relating to suspected paroxetine-induced suicidal behaviour. [178696]
Ms Rosie Winterton: The Yellow Card scheme was recently subject to an independent review led by Dr. Jeremy Metters and the recommendations of the review are out to consultation, apart from the recommendation to introduce direct patient reporting, which has been accepted in principle.
The Medicines and Healthcare Products Regulatory Agency (MHRA) has carefully reviewed the criticisms made in the article by Medawar and Herxheimer in relation to follow up and coding of reports of suspected adverse reactions associated with paroxetine (Seroxat) received through the yellow card scheme. Professor Herxheimer and Mr. Medawar contributed to the Metters review.
Yellow cards submitted by health care professionals are held as scanned images and coded data are transposed onto the adverse drug reactions online information tracking (ADROIT) system. This is a relational database of around 500,000 reports, which enables complex analyses to be performed to detect new or changing drug safety hazards. Data from the yellow
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card scheme cannot be used to quantify the risk of an adverse reaction. Standard operating procedures are in place which ensure quality control of data.
Errors in transposition onto the database occur at a low rate and are kept to a minimum by quality checks. These transposition errors do not impact on signal detection and risk evaluation.
The standardised terms used for coding were based on what has become the internationally adopted standard in drug regulation, MedDRA—the medical dictionary for regulatory activities. The ADROIT classification procedure reflects as closely as possible the words used by the reporter rather than introducing further interpretation of the reporter's words. The image of the original yellow card is available alongside the electronic record. This enables the MHRA to assess the totality of the yellow card data, which are routinely examined when risk assessment is undertaken, along with other data sources.
The MHRA will respond directly to the authors of the article and a copy of that reply will be placed in the Library.
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