This week in the BMJ
Volume 331, Number 7513, Issue of 13 Aug 2005Pregnant smokers don't quit after motivational interviews
Pregnant smokers don't quit after motivational interviews
Motivational interviewing by specially trained midwives does not help pregnant smokers quit or cut down. In a randomised controlled trial of 762 women by Tappin and colleagues (p 373), the intervention group received two to five motivational interview sessions from a midwife in their own homes; the control group received standard health promotion alone. The authors found no significant difference in women who quit or cut down smoking, although fewer women in the intervention group reported smoking more. Birth weight did not differ significantly.
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Acupuncture cuts days with tension-type headache
Acupuncture for tension-type headache is more effective than being on a waiting list, but no more effective than minimal acupuncture. In a three armed trial, Melchart and colleagues (p 376) randomised 270 patients to acupuncture, minimal acupuncture (superficial needling at non-acupuncture points), or waiting list control.
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People receiving acupuncture had significantly fewer days with a headache than those on the waiting list, but the difference compared with people receiving minimal acupuncture did not reach significance. Acupuncture was well tolerated, and improvements lasted several months after cessation of treatment.
Russian doctors vary widely in interpreting chest x rays
Agreement between Russian clinicians in interpreting chest radiographs is limited. Balabanova and colleagues (p 379) assessed the interobserver and intraobserver agreement between 101 clinicians involved in the care of tuberculosis and respiratory diseases on the interpretation of 50 chest radiographs. On a scale of poor, fair, moderate, and good to very good agreement, agreement was fair on the presence or absence of an abnormality, moderate for localisation of the abnormality, and fair for a diagnosis of tuberculosis. Radiologists had the highest levels of agreement. The results may have implications for the effectiveness of radiological screening programmes in general.
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Twin and preterm births fell after change in IVF
The rate of twin births in Sweden after in vitro fertilisation fell from 29% in 1991 to 18.5% in 2001, corresponding to a reduction in preterm births of 72%. The trend follows the decision in the early 1990s to transfer two embryos instead of three to the uterus during in vitro fertilisation. From the Swedish medical birth register Källén and colleagues (p 382) identified 16 280 infants born by in vitro fertilisation between 1982 and 2001. The adjusted odds ratio for preterm birth after in vitro fertilisation was 4.6 in 1991 and 1.33 in 2001.
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Bug busting kit of combs increases eradication of head lice
The Bug Buster kit of fine tooth combs, used over two weeks, more effectively eradicates head lice than a single treatment of pediculicides malathion and permethrin bought over the counter. In a single blind randomised controlled trial, Hill and colleagues (p 384) recruited 133 people aged 2-15 through general practices, pharmacies, and primary schools. They assessed eradication rates at two to four days after the end of treatment. Of those who used the Bug Buster kit 57% had no lice or eggs compared with 13% using pediculicides (relative risk 4.4%, 95% confidence interval 2.3 to 8.5%). The Bug Buster regimen comprises four sequential combings on wet, conditioned hair, three days apart.
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