Releases Saturday 18 January 2003
No 7381 Volume 326
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(1) BOYS CAUSE MORE PROBLEMS DURING
LABOUR
(2) BABY
MILK MANUFACTURERS ARE
VIOLATING INTERNATIONAL
MARKETING
CODE
(3) MOBILE
PHONES HAVE NOT REPLACED
TEENAGE SMOKING
(4) UK
GOVERNMENT SHOULD ACT NOW TO
REGULATE TOBACCO
(1) BOYS CAUSE MORE PROBLEMS DURING
LABOUR
(Effect of fetal sex on labour and
delivery:
retrospective review)
http://bmj.com/cgi/content/full/326/7381/137
Women are more likely to encounter complications
during labour and delivery when they are
having a
boy, according to researchers in this
week's BMJ.
The study took place in the National Maternity
Hospital, Dublin using data from the delivery
ward
database during 1997 to 2000. All mothers
who were
pregnant for the first time with a singleton
birth and
who spontaneously went into labour at
term were
included.
In the study period 4,070 male and 4,005
female
infants were analysed. Male infants were
significantly
more likely to require oxytocin (a hormone
that
stimulates contractions), blood sampling,
and
instrumental vaginal delivery or caesarean
section.
There was no significant difference between
the sexes
in other variables studied, such as gestation
or
requirement for antibiotics during labour.
Male infants have a significantly larger
head size than
female infants, and this may contribute
to the duration
of labour and the higher incidence of
operative
delivery, say the authors. However, this
factor would
not fully explain the sex difference,
as duration of
labour alone would not account for the
increased
incidence of suspected fetal distress
in males (as
shown by more need for blood sampling
in boys).
"What this study does show is that when
we say "it
must be a boy" as a humorous explanation
of
complications of labour and delivery we
are
scientifically more correct than previously
supposed,"
they conclude.
Contact:
Maeve Eogan, Specialist Registrar, National
Maternity Hospital, Dublin, Republic of
Ireland
Email: maeveeogan{at}eircom.net
(2) BABY MILK
MANUFACTURERS ARE
VIOLATING INTERNATIONAL MARKETING
CODE
(Monitoring compliance with the International
Code of
Marketing of Breastmilk Substitutes
in west Africa:
multisite cross sectional survey
in Togo and Burkina
Faso)
http://bmj.com/cgi/content/full/326/7381/127
(Editorial: Monitoring the marketing
of infant formula
feeds)
http://bmj.com/cgi/content/full/326/7381/113
Manufacturers of formula milk are violating
the
international code of marketing of breast
milk
substitutes in west Africa, say researchers
in this
week's BMJ.
Two survey teams monitored compliance with
the
code, adopted by the World Health Assembly
in
1981 to ensure the proper use of breast
milk
substitutes. The study involved health
facilities, sales
outlets, distribution points, and the
news media in
Togo (a country without legislation on
the marketing
of breast milk substitutes) and Burkina
Faso (which
has such legislation).
Violations included no statement on superiority
of
breastfeeding, no instructions for appropriate
preparation or storage, no warning against
health
hazards of inappropriate use, and pictures,
drawings,
or text idealising use.
The levels of code violations were similar
in both
countries. Six (14%) health facilities
had received
donations of breast milk substitutes.
All donations
were being given to mothers free of charge.
Health
providers in five (12%) health facilities
had received
free samples of breast milk substitutes
and
promotional gifts from manufacturers.
Promotional materials for commercial breast
milk
substitutes were found in seven (16%)
health facilities.
Special displays to market commercial
breast milk
were found in 29 (44%) sales and distribution
points.
Forty commercial breast milk substitutes
violated the
labelling standards of the code: 21 were
manufactured
by Danone, 11 by Nestle, and eight by
other national
and international manufacturers. Most
health providers
(90%) has never heard of the code, and
63% of
mothers had never received any counselling
on breast
feeding by their health providers.
Governments have an obligation to ensure
that
legislation is accompanied by effective
information,
training, and monitoring systems to ensure
compliance
with the code, say the authors. Manufacturers
have an
obligation to comply with the standards
of the code,
they conclude.
Protection of breast feeding from commercial
exploitation should be among the highest
priorities for
the international community, write two
paediatricians
in an accompanying editorial. They discuss
how we
should monitor compliance with the code,
how we
should train health workers, and how we
should
combine support for breast feeding with
a recognition
of the risk of maternally transmitted
HIV infection.
Contacts:
Paper: Victor Aguayo, Regional Nutrition
and Child
Survival Adviser for Africa Tel (in Mali,
Africa): +223
221 5293; Email: vaguayo@hkimali.org
Editorial: Tony Waterston, Consultant Paediatrician,
Newcastle General Hospital, Newcastle
Upon Tyne,
UK
Email: a.j.r.waterston{at}ncl.ac.uk
(3) MOBILE PHONES
HAVE NOT REPLACED
TEENAGE SMOKING
(Letter: Mobile phone use has not
replaced smoking
in adolescence)
http://bmj.com/cgi/content/full/326/7381/161
The theory that the recent decline in teenage
smoking
is linked to the rise in mobile phone
ownership is
challenged in this week's BMJ.
Researchers in Finland surveyed 9,309 adolescents
to
test whether mobile phones are competing
with
cigarettes for their weekly spending money.
Of 6,516 respondents 57% had smoked at
least
twice, 24% smoked daily, and 91% used
mobile
phones. The amount of smoking increased
in
proportion to the use of mobile phones.
Taking into
account the amount of spending money did
not change
the association.
A high proportion of Finnish adolescents
use mobile
phones, but their use is associated with
health
endangering lifestyles indicated by smoking,
say the
authors.
Although this association may not apply
to countries
where parents do not help pay for their
children's
mobile phone costs as much as they do
in Finland, the
symbolic role of mobile phones and smoking
in
modern adolescent cultures needs to be
studied, they
conclude.
Contact:
Leena Koivusilta, Researcher, Department
of Social
Policy, University of Turku, Finland
Email: leena.koivusilta{at}utu.fi
(4) UK GOVERNMENT
SHOULD ACT NOW TO
REGULATE TOBACCO
(Editorial: Levelling the playing
field for regulation of
nicotine)
http://bmj.com/cgi/content/full/326/7381/115
Cigarettes are the deadliest form of nicotine
delivery
available on the market, yet are the least
regulated. An
editorial in this week's BMJ argues that
the British
government should act now to level the
regulatory
playing field for tobacco and nicotine.
It is no coincidence that cigarettes have
so far
managed to escape regulation, writes Professor
Ichiro
Kawachi of Harvard School of Public Health.
The
reason for the cigarette's unique legal
status, at least in
the United States, is that Congress made
sure to insert
a clause that specifically excluded tobacco
from
virtually every major law passed to protect
consumers. As a result, the Food and Drug
Administration lacks the authority to
regulate tobacco.
By contrast, a new report from the Royal
College of
Physicians of London has identified several
existing
pieces of legislation in the United Kingdom
that do not
seem to exclude tobacco. These laws offer
a
promising framework for the regulation
of nicotine,
including tobacco products.
The urgent need for levelling the playing
field in
nicotine regulation is underscored by
the proliferation
of new tobacco products, often marketed
to smokers
as "safer" alternatives to conventional
cigarettes.
An independent nicotine regulatory authority
with
jurisdiction over both new tobacco products
and
other nicotine delivery products would
serve the
interests of both fair competition and
the protection of
public health, he concludes.
Contact:
Ichiro Kawachi, Professor of Health and
Social
Behaviour, Harvard School of Public Health,
Boston,
USA
Email: Ichiro.Kawachi{at}channing.harvard.edu
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