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(2) IN
SOME CIRCUMSTANCES PARENTS SHOULD
AVOID SHARING
A BED WITH THEIR BABY
(3) LOW
LEVELS OF RUBELLA IMMUNISATION
AMONG YOUNG
CHILDREN MAY INCREASE THE
RISK OF CONGENITAL
RUBELLA IN BABIES
(1) NEW QUESTIONNAIRE
HELPS IDENTIFY EATING
DISORDERS IN WOMEN
(The SCOFF questionnaire: assessment
of a new screening
tool for eating disorders)
http://www.bmj.com/cgi/content/full/319/7223/1467
A team of researchers have designed a questionnaire
to help
detect eating disorders in women. Dr John
Morgan et al from
St George's Hospital Medical School report
that the five
questions they have devised are simple,
memorable and easy
to apply and they say that there is sufficient
evidence to
suggest that it be used routinely in all
patients considered at
risk of eating disorders.
The questions are:-
• Do you make yourself Sick because
you feel uncomfortably full?
• Do you worry you have lost Control
over how much you eat?
• Have you recently lost more than
One stone in a three month period?
• Do you believe yourself to be
Fat when others say you are too thin?
• Would you say that Food dominates
your life?
The questionnaire was evaluated on 116
women aged 18-40
years who were confirmed as having either
anorexia or
bulimia and also in 96 women who were
confirmed as not
having an eating disorder. The authors
say that all participants
found the questions and the term "SCOFF"
acceptable.
Morgan et al suggest that two or more positive
answers to all
five questions denote a possible case
of an eating disorder.
They found that the questionnaire picked
up 100 per cent of
the anorexia and bulimia cases, but also
had a false positive
rate of 12.5 per cent, which the authors
say is an acceptable
trade off for the very high sensitivity
of the method.
They conclude that the SCOFF questionnaire
seems to be
highly effective as a screening instrument
for detecting eating
disorders and that it is designed to raise
suspicion of a likely
case rather than to diagnose. They suggest
that further work
is needed to validate it among a wider
population, but none
the less there is sufficient evidence
for it to be routinely used
in all patients at risk of eating disorders.
Contact:
Professor Hubert Lacey, Department of Psychiatry,
St
George's Hospital Medical School, London
Email: jmorgan@sghms.ac.uk
(2) IN SOME CIRCUMSTANCES
PARENTS SHOULD
AVOID SHARING A BED WITH THEIR BABY
(Babies sleeping with parents: case-control
study of factors
influencing the risk of the sudden
infant death syndrome)
http://www.bmj.com/cgi/content/full/319/7223/1457
(Commentary: Cot death–the story
so far)
http://www.bmj.com/cgi/content/full/319/7223/1457#resp1
While the benefits of babies sleeping on
their backs are now
clear in relation to sudden infant death
syndrome, there is
conflicting evidence on the effect of
infants sharing a bed with
their parents. A study in this week's
BMJ concludes that it is
not bed sharing per se that is hazardous,
but rather the
particular circumstances in which bed
sharing occurs.
However, commenting on these findings
a paediatrician from
New Zealand argues that the greatest risk
of all is when
mothers who smoke or smoked in pregnancy
sleep in the
same bed as their infant and he says that
"it is time to
recommend that mothers who smoke should
not share a bed
with their babies."
Dr Peter Blair from the Royal Hospital
for Children in Bristol,
along with colleagues from Leeds and Newcastle,
investigated the risks of sudden infant
death syndrome and
the factors that might contribute to unsafe
sleeping
environments. They studied a population
of 17 million people,
which included 325 babies who died and
1,300 infants who
did not.
They found that sleeping with an infant
on a sofa was
associated with a particularly high and
previously
unrecognised risk of sudden infant death
syndrome but that
sharing a room with parents was associated
with a lower risk.
They also found that there was no increased
risk associated
with bed sharing when an infant was placed
back in his or her
cot for the remainder of their sleep.
They conclude that there is no evidence
that bed sharing is
hazardous for infants of parents who do
not smoke, however
among those infants who died and who had
shared a bed
with parents (the majority of whom smoked),
the risk seemed
to be associated with recent parental
consumption of alcohol,
overcrowded housing conditions, extreme
parental tiredness
and the infant being under a duvet.
In a commentary on Blair's paper Professor
Ed Mitchell
from the University of Auckland in New
Zealand says that
infants who suffer sudden infant death
syndrome while sharing
a sofa with a parent account for only
six per cent of cases in
contrast to the 23 per cent of deaths
which occurred among
cosleeping infants of mothers who smoke.
He also notes that a recent review of studies
found that
infants of mothers who smoked during pregnancy
are at
almost a fivefold increased risk of the
sudden infant death
syndrome compared with infants of non-smokers.
This
review also found that when the mother
did not smoke, but
the father did, the risk was increased
1.4-fold, says Mitchell.
"Now that few infants sleep prone [on
their fronts], maternal
smoking is the major risk factor" for
sudden infant death
syndrome, he says.
"The challenge is to develop effective
strategies to reduce
smoking in pregnancy, as simply telling
mothers that their
babies are at increased risk of the sudden
infant death
syndrome is ineffective in changing behaviour,"
claims the
author and he concludes that "it is time
to recommend that
mothers who smoke should not share a bed
with their
babies."
Contact:
Professor Peter Fleming, Professor of Infant
Health and
Developmental Physiology, Royal Hospital
for Children,
Bristol
Email: peter.fleming@bris.ac.uk
Professor Ed Mitchell, Associate Professor
in Paediatrics,
Department of Paediatrics, Faculty of
Medicine and Health
Sciences, University of Auckland, New
Zealand
Email: ed.mitchell@auckland.ac.nz
(3) LOW LEVELS
OF RUBELLA IMMUNISATION
AMONG YOUNG CHILDREN MAY INCREASE THE
RISK OF CONGENITAL RUBELLA IN BABIES
(Increase in congenital rubella occurrence
after immunisation
in Greece: retrospective survey
and systematic review)
http://www.bmj.com/cgi/content/full/319/7223/1462
In 1993 a major rubella epidemic took place
in Greece,
which was followed by the birth of a large
number of babies
with congenital rubella. In this week's
BMJ a team of
researchers from Athens suggest that this
situation arose
because vaccination rates among young
children were too
low.
Dr Takis Panagiotopoulos and colleagues
from the Institute of
Child Health explain that vaccination
of young children for
rubella interrupts viral transmission
and elevates the age at
infection of the non-immunised, because
they now have few
opportunities to acquire natural immunity.
If vaccination
coverage is low, this can lead to an increase
in the proportion
of young adults (including women of child-bearing
age) who
are susceptible to rubella and thus to
an increase in congenital
rubella occurrence.
In an accompanying science commentary,
Dr Abi Berger
explains that in order to achieve 100
per cent protection
against a highly infectious disease such
as measles in the UK,
the uptake of immunisation must be about
95 per cent. This is
the concept of "herd immunity" which means
that not every
single person in a population has to be
immunised in order to
protect everyone in that population "
so long as a sufficient
number are immunised, protection will
be conferred on
everybody " explains Berger.
Panagiotopoulos et al investigated the
events leading to the
epidemic of congenital rubella syndrome.
Their study of the
population of Greece found that during
the late 1970s (the
rubella vaccine had been introduced in
1975) and the 1980s
vaccination coverage of children did not
reach 50-60 per
cent until 1990.
Panagiotopoulos et al suggest that a vaccination
programme
of young children that doesn't achieve
high coverage may
increase the risk of congenital rubella
syndrome. They
conclude that in Greece this was due to
inconsistent
immunisation policies and that their findings
emphasise the
need to attain and sustain high immunisation
coverage if
vaccination of young children is introduced.
Contact:
Dr Takis Panagiotopoulos, Senior Researcher,
Department
of Social Paediatrics, Institute of Child
Health, Athens
Email: tpan@ath.forthnet.gr
Dr Abi Berger, General Practitioner, c/o
BMJ Press Office
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