Releases Saturday 05 January 2002
No 7328 Volume 324
Please remember to credit the BMJ as source when publicising an
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(1) SMOKING IN PREGNANCY LINKED TO DIABETES AND OBESITY IN OFFSPRING
(2) LEVEL OF EDUCATION CAN PREDICT DEATH IN THE UNITED STATES
(3) TEENAGE PREGNANCIES LINKED TO ONE PARENT FAMILIES
(4) NEW ANTIBIOTIC PRESCRIBING POLICIES NEEDED TO CURB RESISTANCE
(5) DOCTORS ARE LAYING THEMSELVES OPEN TO NEGLIGENCE CLAIMS
(1) SMOKING IN PREGNANCY LINKED TO DIABETES AND OBESITY IN OFFSPRING
(Smoking during pregnancy and diabetes
mellitus in a British longitudinal birth cohort)
http://bmj.com/cgi/content/full/324/7328/26
Smoking during pregnancy increases the risk
of the child developing
diabetes and obesity in later life, find researchers
from Sweden in this
week's BMJ. They also show that cigarette smoking
as a young adult is
associated with an increased risk of subsequent
diabetes.
The authors used British data on about 17,000
births from 3 to 9 March 1958
to conduct their study. At birth, midwives
recorded information on smoking
during pregnancy (after the 4th month). Details
of maternal smoking were
again recorded in 1974. The group's own smoking
behaviour was recorded
during an interview at age 16.
Medical examinations and record reviews were
conducted at ages 7 and 16
years, and a personal interview at age 33 years
asked about diabetes. Among
those followed fully throughout childhood and
adolescence to age 33, the
authors identified 15 men and 13 women who
had developed diabetes between
16 and 33 years, and 602 individuals (10%)
who were obese at age 33.
The association of diabetes with maternal
smoking specifically during
pregnancy suggests that it is a true risk factor
for early adult onset
diabetes, say the authors. Cigarette smoking
as a young adult was also
independently associated with an increased
risk of subsequent diabetes.
Study members without diabetes, but whose mothers
smoked during pregnancy,
were significantly more likely to be obese
or overweight by age 33 years.
They suggest that in utero exposure to smoking
results in lifelong
metabolic dysregulation, possibly due to fetal
malnutrition or toxicity,
and stress that smoking during pregnancy should
always be strongly
discouraged.
Contact:
Scott Montgomery, Principal Research Fellow,
Enheten for Klinisk
Epidemiologi, Stockholm, Sweden
Email: Scott.Montgomery{at}medks.ki.se
(2) LEVEL OF EDUCATION CAN PREDICT DEATH IN THE UNITED STATES
(Education, income inequality, and
mortality: a multiple regression analysis )
http://bmj.com/cgi/content/full/324/7328/23
Lack of high school education is a powerful
predictor of death in the
United States, concludes a study in this week's
BMJ.
Using census statistics for the years 1989
and 1990 for all US states,
Professor Andreas Muller tested whether the
relation between income
inequality and probability of dying in the
United States was because of
different levels of formal education.
He found that a 20% increase in people aged
18 years or over without a high
school diploma was associated with an increase
of 2.1 deaths per 1,000
population.
Despite some study limitations, this finding
suggests that lack of high
school education accounts for the income inequality
effect and is a
powerful predictor of variation in death rates
among US states, says the
author.
Further analysis indicated that lack of high
school education was related
to lack of health insurance, belonging to economically
depressed minority
groups, working in jobs with high risk of injury,
and smoking. These
results suggest that lack of material resources,
risk of occupational
injury, and learnt risk behaviour might be
reflected in the large
education-mortality effect, he concludes.
Contact:
Andreas Muller, Department of Health Services
Administration, University of
Arkansas at Little Rock, USA
Email:axmuller{at}ualr.edu
(3) TEENAGE PREGNANCIES LINKED TO ONE PARENT FAMILIES
(Teenage pregnancies are influenced
by family structure )
http://bmj.com/cgi/content/full/324/7328/51/a
Without better marriage education and support
in the United Kingdom,
teenage pregnancy rates are likely to remain
high even with increasing
availability of contraceptives, suggests a
letter in this week's BMJ.
Trevor Stammers of St George's Hospital Medical
School in London reports
that young people aged 14-17 who live in a
two parent family are less
likely to have ever had sexual intercourse
than young people living in any
other family arrangement, even after factors
such as race, age, and
socioeconomic deprivation are taken into account.
This is hardly surprising, as children whose
parents talk to them about
sexual matters and provide sexuality education
at home are more likely than
others to postpone sexual activity, he suggests.
Cohabitations are four times more likely
to break up than marriages and
less than 4% of cohabitations last 10 years
or more, so children born
outside of marriage stand little chance in
their teenage years of being in
the optimal family structure associated with
the lowest risk of unplanned
pregnancy, he concludes.
Contact:
Trevor Stammers, Tutor in General Practice,
St George's Hospital Medical
School, London, UK
Email: stammtg{at}globalnet.co.uk
(4) NEW ANTIBIOTIC PRESCRIBING POLICIES NEEDED TO CURB RESISTANCE
(Effect of B lactam antibiotic
use in children on pneumococcal resistance to penicillin: prospective cohort
study )
http://bmj.com/cgi/content/full/324/7328/28
The likelihood of children carrying a resistant
bug is related to the
amount of antibiotics they take, finds a study
in this week's BMJ. If these
drugs are to retain their clinical usefulness,
new prescribing policies are
needed, argue the authors.
The research team identified 461 children,
aged under 4 years, living in
Canberra, Australia to take part in the study.
Parents were asked to keep a
daily diary of the children's respiratory symptoms,
visits to the doctor,
and use of drugs, for two years. Nasal swabs
were collected from the
children every six months, and pneumococci
bacteria were identified and
tested for antibiotic resistance.
A total of 631 pneumococcal isolates were
found, of which 14% were
resistant to penicillin. The likelihood of
carrying penicillin resistant
bacteria was doubled in children who had taken
a B lactam antibiotic in the
two months before each swab collection. The
odds of carrying penicillin
resistant bacteria was 4% higher for each additional
day of B lactam use in
the six months before swab collection.
Our results suggest that a substantial reduction
of B lactam use in
preschool children could quickly reduce the
carriage rates of penicillin
resistant bacteria, say the authors. In view
of the propensity of these
organisms to be spread among children in the
community, the prevalence of
penicillin resistant organisms may fall as
a consequence, they conclude.
Contact:
Peter J Collignon, Director, Infectious Diseases
Unit and Microbiology
Department, Canberra Hospital, Canberra, Australia
(5) DOCTORS ARE LAYING THEMSELVES OPEN TO NEGLIGENCE CLAIMS
(Informed consent: lessons from Australia
)
http://bmj.com/cgi/content/full/324/7328/39
In the past decade, both English and Australian
courts have adopted a more
patient centred standard in deciding what risks
doctors must disclose to
patients. Yet, in Australia many doctors still
do not understand their
legal duties and many are being held liable
for their failure to inform,
argue Loane Skene and Richard Smallwood in
this week's BMJ.
They suggest that there are probably lessons
here for Britain, and other
countries with similar legal systems.
Recent judgements in both English and Australian
courts suggest that judges
are moving away from accepting what "a reasonable
body of doctors" might do
to supporting what "a reasonable patient" might
expect. This practice is
part of a wider social movement in both countries
to give greater weight to
individual rights, and professional bodies
in each country have issued
guidelines to help explain the law to doctors.
Yet, despite these guidelines, and several
high profile negligence cases in
Australia, a recent survey of doctors in Victoria
and Tasmania found that
many still did not know, or misunderstood,
their legal obligations.
A similar survey of British doctors' knowledge
and practice might be
useful, say the authors. The Australian experience
suggests that there is
still much work needed to minimise future litigation
and promote patient
care, they conclude.
Contact:
Loane Skene, Professor of Law, University
of Melbourne, Victoria, Australia
Email: l.skene{at}unimelb.edu.au
FOR ACCREDITED JOURNALISTS
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(http://www.eurekalert.org
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