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News - February 2011

Contents

NICE publishes guidance on prevention of skin cancer

Exposure to sunlight can be good for a person’s wellbeing but exposure to ultraviolet (UV) radiation from the sun, or artificially from sunbeds and lamps, is the main cause of skin cancer. There are two main types of skin cancer—non-melanoma and malignant melanoma. Non-melanoma affects an estimated 100,000 people each year and malignant melanoma accounts for 2500 deaths a year. The NICE public health guidance, Skin cancer: prevention using public information, sun protection resources and changes to the environment, focuses on how the NHS and local authorities can help prevent skin cancer while aiming to ensure that these preventive measures do not discourage outdoor physical activity. The recommendations cover:

  • information campaigns
  • the protection of children, young people, and outdoor workers
  • provision of shade.

The recommendations focus on preventing the first occurrence of skin cancer and aim to raise and maintain awareness of the risks of UV exposure, influence attitudes, and prompt behavioural change.

www.nice.org.uk

NICE releases guideline on generalised anxiety disorder

Generalised anxiety disorder (GAD) is a common disorder of which the central feature is excessive worrying about a number of different events associated with heightened tension. The NICE guideline, Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults, covers both ‘pure’ GAD, in which no co-morbidities are present, and GAD that is co-morbid with other anxiety and depressive disorders in which GAD is the primary diagnosis. The guideline also covers panic disorders, which it describes as recurring, unforeseen panic attacks followed by at least 1 month of persistent worry about having another attack or the consequences of another attack, or a significant behavioural change related to the attacks.

Panic disorder and GAD vary in severity and complexity and this has implications for response to treatment. Therefore, when undertaking a diagnostic assessment it is important to consider:

  • symptom severity
  • duration
  • the degree of distress
  • functional impairment
  • personal history
  • co-morbidities.

The guideline includes stepped-care models for both GAD and panic disorder. Each model is specific to the particular disorder it covers, but both models cover:

  • diagnosis
  • pharmacological and psychological interventions
  • review of prior treatments and consideration of alternative interventions.

Panic disorder and GAD can follow both chronic and remitting courses and interventions should aim to achieve the complete relief of symptoms, which is associated with a lower likelihood of relapse.

www.nice.org.uk

Mental Health Strategy released by the Department of Health

Mental health problems represent up to 23% of the total burden of ill health and at least one in four people experience a mental health problem at some point in their life. The Mental Health Strategy, No health without mental health, outlines the importance of early intervention and prevention to tackle the underlying causes of mental health. Central to the plans outlined in the strategy will be an additional investment of £400 million by the Government, to improve access to psychological therapies over the next 4 years.

www.dh.gov.uk

Commissioning guide for smoking published

The latest commissioning guide from NICE aims to help pregnant women who smoke during pregnancy and after childbirth to quit. The guide provides support for the local implementation of NICE guidance through commissioning.

Referral to NHS stop smoking services is recommended in NICE Public Health Guidance 26, How to stop smoking in pregnancy and following childbirth, and the commissioning guide stresses the importance of increasing referral routes to lower smoking prevalence. It is recommended that the guide be read alongside this public health guidance.

www.nice.org.uk

NICE has reassessed the use of strontium ranelate in Technology Appraisal (TA) 160 and 161

at the request of the Court of Appeal and has found no reason to change the current recommendations. Both TAs remain unchanged.

www.nice.org.uk

NICE recommends the use of aripiprazole as a treatment option for people aged 15 to 17 years with schizophrenia

who are unable to take risperidone for medical reasons or whose schizophrenia is not controlled with risperidone.

www.nice.org.uk

Erratum

Melvin L. Contraceptive choice for over 40s depends on risk–benefit profile. Guidelines in Practice 2011; 14 (1): 10–16. In Table 1 (p.11), the UKMEC category for smoking for:

  • POP, IMP, DMPA and NET-EN, Cu-IUD, and LNG-IUS should have been '1'
  • CHC should have been 2, 3, or 4 (depending on smoking age, number of cigarettes smoked, and time elapsed since quitting).

These corrections have been made to the online version as of 11 February, 2011.
UKMEC=UK medical eligibility criteria; POP=progestogen-only pill; IMP=implant (progestogen-only); DMPA=depot medroxyprogesterone acetate; NET-EN=norethisterone enantate; Cu-IUD=copper-bearing intrauterine device; LNG-IUS=levonorgestrel-releasing intrauterine system; CHC=combined hormonal contraception

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