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(2) USED
MATTRESSES MAY INCREASE RISK OF
COT DEATH
(3) EPILEPSY LINKED TO SOCIAL DEPRIVATION
(4) CAESAREAN
DELIVERY OF TWINS MAY
PREVENT DEATHS
(5) DOCTORS
SHOULD PLAY NO PART IN
EXECUTIONS
(1) FREE SMOKE
ALARM PROGRAMMES ARE
FAILING
(Incidence of fires and related injuries
after giving out free
smoke alarms: cluster randomised
controlled trial)
http://bmj.com/cgi/content/full/325/7371/995
(Prevalence of working smoke alarms
in local authority
inner city housing: randomised controlled
trial)
http://bmj.com/cgi/content/full/325/7371/998
(Editorial: Smoke detectors and house
fires)
http://bmj.com/cgi/content/full/325/7371/979
Providing and installing free smoke alarms
to poor, urban
households does not reduce fire related
injuries and may
be a waste of resources, find two studies
in this week's
BMJ.
In the first study, smoke alarms were given
out to 19,950
households in a deprived, multiethnic,
urban community in
inner London. Free installation was offered
and postcards
reminding that the battery should be changed
were sent out
one year later. Control households received
no
intervention.
Giving out free smoke alarms did not reduce
injuries
related to fire, admissions to hospital
and deaths, or fires
attended by the fire brigade. Widespread
implementation
of such programmes may be a waste of resources
and of
little benefit unless alarm installation
and maintenance is
assured, conclude the authors.
In the second study, smoke alarms were
installed in 2,145
local authority households in inner London
to identify
which type of smoke alarm was most likely
to still be
working 15 months later.
Nearly half of the alarms installed were
not working when
tested 15 months later. Forty per cent
were missing or had
been disabled by tenants. Ionising smoke
alarms with long
life lithium batteries were most likely
to remain functioning.
Although the government recommends that
local
authorities install battery powered smoke
alarms in all their
properties, these results cast doubt on
whether installation
programmes are worth while, conclude the
authors.
Contacts:
Ian Roberts, Professor of Epidemiology
and Public Health,
London School of Hygiene and Tropical
Medicine,
London, UK
Email: Ian.Roberts@LSHTM.ac.uk
Carolyn DiGuiseppi, Associate Professor,
Department of
Preventive Medicine and Biometrics, University
of
Colorado Health Sciences Center, Denver,
CO, USA
Email: Carolyn.DiGuiseppi@uchsc.edu
(2) USED MATTRESSES
MAY INCREASE RISK OF
COT DEATH
(Used infant mattresses and sudden
infant death syndrome
in Scotland: case-control study)
http://bmj.com/cgi/content/full/325/7371/1007
(Editorial: Mattresses, microenvironments,
and multivariate
analyses)
http://bmj.com/cgi/content/full/325/7371/981
Babies who routinely sleep on an infant
mattress previously
used by another child may be at increased
risk of cot
death, finds a study in this week's BMJ.
Researchers at the Royal Hospital for Sick
Children in
Glasgow identified 131 infants who died
of sudden infant
death syndrome (cases) and 278 healthy
infants of the
same age (controls). They used a questionnaire
to
compare details of childcare practices
from both case and
control families.
They found that routine use of an infant
mattress previously
used by another child was significantly
associated with an
increased risk of sudden death syndrome,
especially if the
mattress was from another home. They also
found that the
associated risk was particularly high
if the infant was
sleeping on the used mattress at time
of death.
After further analysis to account for any
bias, the authors
conclude that this association is relatively
strong. In
addition, toxigenic bacteria that have
been implicated in
sudden infant death syndrome do reside
in used infant
mattresses, they say. However, insufficient
evidence is
available to judge whether this is a cause
and effect
relation.
Contact:
David Tappin, Clinical Senior Lecturer,
Scottish Cot
Death Trust, Royal Hospital for Sick Children,
Glasgow,
Scotland
Email: goda11@udcf.gla.ac.uk
(3) EPILEPSY LINKED TO SOCIAL DEPRIVATION
(Socioeconomic variation in incidence
of epilepsy:
prospective community based study
in south east England)
http://bmj.com/cgi/content/full/325/7371/1013
People who are socially and economically
disadvantaged
are more likely to develop epilepsy than
those who are
not, conclude researchers in this week's
BMJ.
They identified all new cases of epilepsy
in 20 general
practices in London and south east England
over an 18 or
24 month period. All patients were categorised
using a
standard measure of deprivation, known
as a Carstairs
score.
After adjusting for age and sex, they found
that the
incidence of epilepsy in the most deprived
fifth of the study
population was 2.3 times that in the least
deprived fifth.
This suggests that socioeconomic deprivation
is an
important risk factor for the development
of epilepsy,
although the results may partly reflect
differences in the
incidence of epilepsy within and outside
London, say the
authors.
It is not clear why low socioeconomic status
might
increase risk of epilepsy, but several
other risk factors
such as incidence of birth defects, trauma,
infection, and
poor nutrition are known to be more common
among
socioeconomically deprived populations,
add the authors.
Although children of parents with epilepsy
may be socially
disadvantaged because of their parent's
condition, genes
associated with epilepsy may also be important
in
determining educational achievement and
other aspects of
medical health, they conclude.
Contacts:
Professor Ley Sander, Department of Clinical
and
Experimental Epilepsy, Institute of Neurology,
University
College London, London, UK
Email: l.sander@ion.ucl.ac.uk
Dominic Heaney, Clinical Research Fellow,
Royal London
Hospital, London, UK
(4) CAESAREAN
DELIVERY OF TWINS MAY
PREVENT DEATHS
(Birth order, gestational age, and
risk of delivery related
perinatal death in twins: retrospective
cohort study)
http://bmj.com/cgi/content/full/325/7371/1004
Second twins born at term are at higher
risk of death due
to complications during labour and delivery
than first twins,
but planned caesarean section may prevent
such deaths,
concludes a study in this week's BMJ.
Researchers analysed the births of over
4,500 twins born
in Scotland between 1992 and 1997 and
found
significantly increased risks of death
during labour and
neonatal death among second twins born
at term. No
deaths were recorded among 454 second
twins delivered
at term by planned caesarean section.
The absolute risk of death for second twins
born at term
was approximately 1 in 270 for all causes,
1 in 350 for
death due to lack of oxygen (anoxia) during
the birth, and
1 in 500 for anoxic death due to mechanical
problems.
These absolute risks are high in comparison
with similar
data for singleton term births in Scotland
over the same
period, say the authors.
Since these deaths seem to be attributable
to labour,
planned caesarean delivery may offer some
protection,
suggest the authors.
"We propose that women with twins should
be counselled
about the risk to the second twin and
the theoretical
possibility of a protective effect of
planned caesarean
section when considering mode of delivery
at term," they
conclude.
Contact:
Professor Gordon Smith, Department of Obstetrics
and
Gynaecology, Rosie Maternity Hospital,
Cambridge, UK
Email: gcss2@cam.ac.uk
(5) DOCTORS SHOULD
PLAY NO PART IN
EXECUTIONS
(Lethal injection: a stain on the
face of medicine)
http://bmj.com/cgi/content/full/325/7371/1026
The number of executions in the United
States has soared
over the past two decades as the acceptability
of lethal
injection has increased. In this week's
BMJ Jonathan
Groner describes parallels between America's
use of lethal
injection and Nazi Germany's "euthanasia"
programme,
and argues that doctors should not participate
in
executions under any circumstances.
Lethal injection is now the standard method
used to
perform capital punishment in the United
States and, unlike
other methods of execution, doctors often
have to be
involved. Although medical organisations
in the United
States forbid participation in executions,
most doctors are
unaware of these guidelines and are willing
to participate,
writes the author.
Doctors' involvement in lethal injection
(or any execution)
creates a profound conflict of roles that
is morally
unacceptable, he says. When doctors enter
the death
chamber, they harm not only their relationship
with their
own patients, but the relationships with
all doctors with
their patients.
He believes that, even without doctors'
participation, lethal
injection simulates a medical procedure
and thus has a
deeply corrupting influence on medicine
as a whole. The
Nazis used the imagery of medicine to
justify killing.
Capital punishment in the United States
now depends
solely on the same medical charade, he
writes.
Without the respectability that lethal
injection provides,
capital punishment in the United States
would probably
cease, he concludes.
Contact:
Jonathan Groner, Trauma Medical Director,
Department
of Surgery, Children's Hospital, Columbus,
OH, USA
Email: gronerj@chi.osu.edu
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