This week in the BMJ
Volume 329, Number 7459, Issue of 24 Jul 2004Dummies do not affect breast feeding
Dummies do not affect breast feeding
Use of dummies for preterm infants does not affect their breastfeeding habits. Collins and colleagues (p 193) randomised 303 infants to feeding with an artificial bottle or with a cup, with or without also using a dummy, and found that infants who were cup fed were more likely to be fully breast fed on discharge home, but were in hospital for longer. Using a dummy did not affect breast feeding, and compliance to cup feed was poor. After three to six months the proportion of infants being breast fed did not differ among the groups.
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Gulf war veterans have fertility problems
Gulf war veterans are at risk of infertility. Reviewing more than 10 000 Gulf war veterans and more than 7000 matched non-deployed servicemen, Maconochie and colleagues (p 196) found that war veterans were less likely to achieve conceptions or live births than non-deployed servicemen, and pregnancies fathered by veterans not reporting fertility problems took longer to conceive. These results should be interpreted cautiously, say the authors, as this study cannot conclude that the associations are causal.
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Passive smoking increases the risk of heart disease
People exposed to high levels of passive smoking are more likely to develop coronary artery disease. Following up 4729 non-smokers included in the 1978-80 British regional heart study, Whincup and colleagues (p 200) found that those with higher concentrations of serum cotinine were 50-60% more likely to have coronary artery disease, but their risk of stroke was not increased. Studies looking at smoking in partners seem to underestimate the risk of exposure to passive smoking, say the authors.
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NICE faces many challenges
The National Institute for Clinical Excellence undertakes its economic assessments using a cost utility approach and makes decisions on cost effectiveness case by case. Rawlins and Culyer (p 224) explain that NICE's approach to economic evaluation is based on affordability, efficiency, and equity, and on page 227 Maynard and colleagues argue that this approach is creating inflationary pressure that the NHS cannot afford, and that NICE's role is too peripheral to the NHS. Give NICE a real budget, they say; it will encourage NICE to examine the effect of its decisions on the whole NHS.
Ask three questions to detect bacterial conjunctivitis
Three simple questions may help diagnose bacterial conjunctivitis. Rietveld and colleagues (p 206) asked 177 patients with acute conjunctivitis if they had glued eyes, itchy eyes, or a history of conjunctivitis and found that those who had glued eyes and no history of conjunctivitis or itch were more likely to have a bacterial infection. In the absence of "alarm symptoms," antibiotics should not be prescribed, say the authors, and no additional tests are needed.
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Sex on holiday increases the risk of STIs
Sexual encounters on holiday are potentially dangerous, and young people and sex tourists are more at risk than others. On page 214 Rogstad reviews available evidence of people's sexual behaviour while they are on holiday and discusses the management of people who have acquired, or are at risk of acquiring, a sexually transmitted infection on holiday. Screening for gonorrhoea, Chlamydia, syphilis, and HIV should be performed, and chancroid, lymphogranuloma venereum, and granuloma inguinale should be kept in mind when the patient has had sex with someone from a developing country. The authors recommend preventive measures, including information on safer sex and the risks of sex abroad.
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