This week in the BMJ
Volume 328, Number 7455, Issue of 26 Jun 2004What happens to doctors who smoke?
What happens to doctors who smoke?
Men born between 1900 and 1930 who smoked cigarettes 50 years ago, and who continued to smoke, died on average 10 years younger than lifelong non-smokers. Fifty years after the publication of their original study, which we republish in this issue (p 1529), Doll and colleagues (p 1519) analysed the mortality of 34 439 male British doctors in relation to their smoking habits. They found that more than half of the young doctors in the 1950s who continued to smoke cigarettes were killed by their habit. Among men born in 1920, prolonged smoking tripled age specific mortality, but stopping smoking at age 50 halved the hazard, and stopping at age 30 avoided almost all of it.
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Discharged psychiatric patients are unlikely to commit violence
Only 6% of patients are convicted for violent offences in the two years after discharge from medium secure psychiatric units. Analysing clinical data on all 959 patients discharged from medium secure units in England and Wales in 1997-8, Maden and colleagues (p 1534) found that 15% were convicted within two years after discharge. Only 6% committed violent offences, and the strongest association with reoffending was previous offending, not psychiatric variables.
CT genotype increases the risk of neural tube defect
Being heterozygous for the T allele of the MTHFR gene (for the folate dependent enzyme 5,10 methylenetetrahydrofolate reductase) raises the risk of neural tube defect. Analysing the DNA sequences of 395 people with neural tube defect and 848 controls in Ireland, Kirke and colleagues (p 1535) confirmed that the risk is increased for carriers of the homozygous TT genotype, and also for the CT genotype. Heterozygosity may be a risk factor for conditions common in homozygosity, such as ischaemic heart disease, say the authors.
Smokeless tobacco use affects babies
Mothers' consumption of smokeless tobacco during pregnancy decreases babies' birth weight and gestational age at birth. Analysing the use of smokeless tobacco in 1217 pregnant women from Mumbai, Gupta and Sreevidya (p 1538) found that the decrease in birth weight was independent of gestational age, sex of baby, and maternal characteristics, and the risk for preterm delivery was increased. The authors say that mothers' use of smokeless tobacco should receive specific attention as part of routine prenatal care.
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Working class students see medical school as alien...
Pupils from poorer backgrounds are less confident in their ability to enter and complete medical school than those from higher socioeconomic groups. Greenhalgh and colleagues (p 1541) interviewed 68 academically able pupils aged 14-16 years and found that pupils from working class backgrounds see medical school as distant, unreal, and culturally alien. They associate medical education with prohibitive personal risk and greatly underestimate the chances of their applications being successful.
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... and medical school admissions show inequalities
Admissions to medical school vary among ethnic groups and social classes. Analysing data on UK admissions from 1996 to 2000, Seyan and colleagues (p 1545) found that the most over-represented group in medical schools (Asians in social class 1) are around 600 times more likely to gain a place than the most under-represented group (blacks in social classes IV and V), mainly because very few black students apply. The authors suggest a new index of widening participation—the standardised admission ratio—which reflects both the lower aspirations of non-traditional groups and any discrimination at application stage.
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