This week in the BMJ

Volume 333, Number 7575, Issue of 4 Nov 2006

[Down]Breast feeding does not increase children's intelligence
[Down]beta radiation improves success of glaucoma surgery
[Down]Delayed cord clamping reduces infant anaemia
[Down]Best treatment for tennis elbow?
[Down]Acne should be actively treated

Breast feeding does not increase children's intelligence

Despite its many advantages, breast feeding has little effect on children's intelligence. In a cohort study of 3161 mothers and 5475 children, Der and colleagues (p 945) found that breast feeding was associated with higher IQ in children, but that this effect was almost entirely accounted for by maternal IQ. More intelligent mothers were more likely to breast feed, and maternal IQ was more predictive of feeding choice than mothers' age, education, home environment, and antenatal smoking status, or children's birth weight and birth order.


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 Credit: BSIP/ASTIER/SPL

 



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beta radiation improves success of glaucoma surgery

Intraoperative beta radiation greatly reduces the recurrence of raised intraocular pressure after trabeculectomy in black African patients. In this double blind randomised controlled trial of 450 patients, Kirwan and colleagues (p 942) estimated the risk of operative failure to be 5% (95% confidence interval 2% to 10%) in the intervention group compared with 30% (22% to 38%) in the group that underwent surgery alone. Treatment with beta radiation was associated with a significantly higher incidence of cataract requiring surgery at two years, however. Visual acuity was similar in both groups.


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 Credit: GEOFF TOMPKINSON

 



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Delayed cord clamping reduces infant anaemia

Delayed umbilical cord clamping after delivery, combined with oxytocin administration to reduce maternal blood loss, is recommended in any resource poor setting say van Rheenen and Brabin (p 954). Meta-analyses of randomised controlled trials found that in term babies delayed cord clamping reduced infant anaemia and improved survival. In preterm babies it reduced the number of neonatal blood transfusions. The authors recommend that cord clamping should be delayed for three minutes for optimal placental transfusion and for at least 60 seconds when newborns appear distressed.


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 Credit: JOHN HESELTINE/SPL

 



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Best treatment for tennis elbow?

All patients receiving treatment for tennis elbow reported successful outcomes at one year regardless of treatment type, but those receiving physiotherapy sought significantly less additional analgesia. Bisset and colleagues (p 939) randomised 198 patients with untreated tennis elbow to receive one of three interventions: corticosteroid injections, physiotherapy comprising manipulation and taught exercises, and "wait and see" with advice on symptom relief. Corticosteroid injections gave the best results at six weeks but in 72% symptoms recurred and recovery was delayed. Physiotherapy yielded better outcomes in the long term.


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 Credit: FAY NORMAN/SPL

 



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Acne should be actively treated

Acne ought to be treated to alleviate pain, reduce unsightly scarring, and minimise psychological morbidity, say Purdy and der Berker (p 949). This skin disorder affects more than 80% of people at some point in their lives and accounts for 3.1% of GP consultations in people aged 13-25. Genetics seems to contribute more to the development of acne than environmental and unique factors (81% v 19%). The authors discuss treatments such as topical agents, antibiotics, oral contraceptives, retinoids, and laser therapy, as well as management of scars and counselling support.


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 Credit: P MARAZZI/SPL

 



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