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(2) Breast feeding
rates in Scottish mothers improve but will fail
to hit Government
targets
(3) Can voting
Labour lead to an early demise?
(4) Probiotic milk
may help prevent common childhood
infections
(1) Time targets for
urgent caesarean delivery are difficult to
achieve but may not be necessary
(Interval between decision and delivery
by caesarean section
-- are current standards achievable?
Observational case
series)
http://bmj.com/cgi/content/full/322/7298/1330
(Prospective 12 month study of 30
minute decision to
delivery intervals for "emergency"
caesarean section)
http://bmj.com/cgi/content/full/322/7298/1334
(Editorial: Caesarean section for fetal
distress)
http://bmj.com/cgi/content/full/322/7298/1316
Two papers and an editorial in this week's
BMJ describe the
difficulties in meeting the target of
30 minutes between the
decision that an urgent caesarean section
is necessary and
delivering the baby.
However the failure to meet the 30 minute
recommendation
in routine practice does not seem to increase
neonatal death.
Tuffnell, Wilkinson and Beresford from
the maternity unit at
Bradford NHS Trust describe three audit
cycles over four
years, followed by a continuous audit
of deliveries over 32
months in a district general hospital
delivering 5,500 babies
per year.
The authors describe the obstacles to meeting
the 30 minute
target which were uncovered by audit and
the steps taken to
address them. Making prepacked spinal
anaesthesia
equipment available was one reform introduced
to reduce
delay. Ensuring that a second operating
theatre would be
opened if clinicians had concerns that
a second woman might
require urgent caesarean delivery was
another reform and
reducing the delay in moving the woman
to theatre was a
further initiative designed to help meet
the 30 minute target.
Many national bodies recommend that when
a decision is
made to deliver a baby by caesarean section
because of fetal
distress, the baby should be delivered
within 30 minutes. This
study found that delivery within 30 minutes
was achievable in
only two out of three cases but delay
in delivery made no
difference to the rate of admission to
special care for babies
over 36 weeks' gestation. The authors
question whether
failure to meet the standard should be
regarded as
"unreasonable" medico-legally.
In a second paper, MacKenzie and Cooke
from the
Department of Obstetrics and Gynaecology
at the John
Radcliffe Hospital in Oxford also question
the benefit and
wisdom of aiming to achieve delivery in
all cases within 30
minutes. The authors say there is little
objective evidence to
support the 30minute recommendation.
Contacts:
Derek Tuffnell, Consultant, Maternity Unit,
Bradford NHS
Trust, Bradford, UK
Email: derek.tuffnell@bradfordhospitals.nhs.uk
I Z MacKenzie, Clinical Reader in Obstetrics
and
Gynaecology, University of Oxford John
Radcliffe Hospital,
Oxford, UK
(2) Breast feeding rates
in Scottish mothers improve but will fail
to hit Government targets
(Comparison of breastfeeding rates
in Scotland in 1990-1
and 1997-8)
http://bmj.com/cgi/content/full/322/7298/1335
In 1994 the Scottish Office set a target
that by 2005, half of
all mothers should still be breastfeeding
when their babies
are six weeks old.
A paper in this week's BMJ by Tappin and
colleagues shows
that breastfeeding at seven days has increased
by 6.4 per
cent between 1990-1 to 1997-8. However
some of this
increase is explained by a higher proportion
of older mothers,
who are more likely to breastfeed.
Whilst saluting this success, the authors
note a rapid 10 per
cent fall off in breastfeeding between
seven days and six
weeks and warn that by 2005, only 36 per
cent of mothers
are likely to be breastfeeding when their
babies are six weeks
old rather than the target of 50 per cent.
The authors suggest that a more detailed
analysis by
maternity unit, documenting attempts to
promote
breastfeeding, such as participation in
the Baby Friendly
Hospital Initiative, may allow the effectiveness
of health
promotion campaigns to be assessed.
Contact:
David M Tappin, Clinical Senior Lecturer,
Royal Hospital for
Sick Children, Glasgow, Scotland
Email: goda11@udcf.gla.ac.uk
(3) Can voting Labour lead to an early demise?
(Analysis of trends in premature
mortality by Labour voting in
the 1997 general election)
http://bmj.com/cgi/content/full/322/7298/1336
In this week's BMJ, Dorling, Davey Smith
and Shaw
describe how mortality relates to voting
patterns in different
areas. Generally, mortality is higher
in Labour areas,
reflecting underlying socio-economic and
health inequality.
In 1997, the incoming Labour government
made the
reduction of health inequality a principal
policy aim. The
authors warn that the targets will be
difficult to achieve for
two reasons. Firstly, factors influencing
inequalities in child
health act from an early age and may not
respond rapidly to
social change; secondly the Labour government
has not yet
succeeded in reducing social inequality.
The authors use premature death as an indicator
of which
groups have fared best under the present
government and
find that, in absolute terms, mortality
has improved. However
mortality has tended to improve most in
areas with the fewest
Labour voters.
In the tenth of the population with the
second highest Labour
vote, death rates have actually increased.
Relatively, things
have got worse for people in Labour voting
areas, mirroring
trends in income inequality which have
increased during the
period of the Labour government.
Contacts:
George Davey Smith. Professor of Clinical
Epidemiology,
Department of Social Medicine, University
of Bristol, Bristol,
UK
Email: george.davey-smith@bristol.ac.uk
or Dr Mary Shaw;
Email: Mary.shaw@bristol.ac.uk
or Professor Danny Dorling
(4) Probiotic milk may
help prevent common childhood
infections
(Effect of long term consumption
of probiotic milk on
infections in children attending
day care centres: double blind,
randomised trial)
http://bmj.com/cgi/content/full/322/7298/1327
(Do probiotics prevent childhood
illnesses?)
http://bmj.com/cgi/content/full/322/7298/1318
Probiotic milk (milk containing bacteria
that colonise the
intestine and stimulate antibody production)
may slightly
reduce respiratory infections among children
attending day
care centres, finds a study in this week's
BMJ. These findings
suggest that these bacteria may help prevent
common
infections, particularly in high risk
children.
Over a seven month winter period, 571 children
attending
day care centres in Helsinki, Finland
received milk with or
without the probiotic bacteria strain
Lactobacillus GG. During
the study, parents recorded any respiratory
symptoms (fever,
runny nose, sore throat, cough, chest
wheezes, earache)
gastrointestinal symptoms (diarrhoea,
vomiting, stomach
ache) and absences from the day care centre.
Although there were no significant differences
between the
groups in the number of days with respiratory
or
gastrointestinal symptoms, the actual
number of days with
symptoms was lower in the Lactobacillus
group. Children in
the Lactobacillus group also had fewer
days of absence
because of illness and required less antibiotic
treatment.
Although encouraging, we do not yet have
a final answer on
whether probiotics are sufficiently effective
in preventing
common childhood diseases that they can
be routinely
recommended, writes Professor Christine
Wanke of Tufts
University School of Medicine in Boston,
USA. However,
she concludes: "the accumulating data
suggest that these
organisms may help prevent both respiratory
and diarrhoeal
diseases in children at increased risk
of such infections, such
as those in day care facilities or living
in developing
countries."
Contacts:
[Paper]: Riitta Korpela, Assistant Professor,
Foundation for
Nutrition Research, Helsinki, Finland
Email: riitta.korpela@valio.fi
[Editorial]: Christine Wanke, Associate
Professor, Tufts
University School of Medicine, Boston,
MA, USA
Email: christine.wanke@tufts.edu
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