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THE FUTURE OF PUBLISHING
Editors often discuss and are asked to predict the future of publishing. As many of you are aware, during the past decade the greatest debate has centered on “open-access”—that is, should all scientific material be free to the public and scientific community. We have settled into a steady state with respect to this issue—most journals still require some form of payment, grant unlimited access after 6–12 months, but are free immediately to the poorest countries in the world. What about other issues? Certainly the registering of clinical trials has become important – in part to safe guard against any manipulation of data. Will the print edition of journals survive? A recent article in NEJM indicates that there has been a significant decline in the money spent by the pharmaceutical industry on advertising in journals.1 Nevertheless adverts do remain a substantial source of income for some journals. Publishing groups are just beginning to learn how to harness ads in their electronic version to generate income. The comfort of reading a journal and environmental concerns are two other issues related to print editions. I still like taking a print copy of journals on trips, to bed, or to some meetings. My laptop doesn’t work quite so well in those settings. I am more struck by the growing concern around carbon footprints and the environment. I can imagine that more and more subscribers will want to opt out of print editions because of their concern about the environment. However, if they were then to print a copy of many articles, I doubt there would be much “environmental-saving.” What about the communication of information? In this issue, Bob Phillips and Ian Wacogne introduce you to Web 2.0 and blogging at ADC. Bob will write about Archimedes and Ian about the content of ADC. I urge you to join in the discussion. Unlike some sites, the exchanges will be monitored by Bob and Ian before “posting” to ensure an appropriate discussion. However, our goal is to continue to explore novel ways to present and discuss the content of ADC. We seek a lively journal that meets the varied needs of our readers and helps all of us to make better decisions on behalf of our patients.
See pages 941
PHYSICAL ACTIVITY IN CHILDREN
Many of us believe children are not as active today as they were in the past. More cars and sedentary behaviours—TV, computer games, the use of mobile phones—likely contribute to this impression. Riddoch and colleagues report, using an objective measure of physical activity—an accelerometer, that only 5.1% of 2662 British boys and 0.5% of 2993 British girls meet internationally recognised recommendations for physical activity. I find those figures astonishing. Are the recommendations correct, was all physical activity measured, or are the data accurate? Even assuming some error, the lack of activity detected in this study is alarming. Parents and schools need to be aware of the importance of increasing physical activity levels.
See pages 963
REDUCING EXPOSURE TO PEANUTS IN SCHOOLS
It is rare that simple interventions work. In a study from Montreal, Banerjee and colleagues assessed the impact of peanut-free guidelines (PFG) on the content of children’s lunch boxes. Only .6% (5 of 861) of lunches in the PFG schools contained peanuts compared with 9.9% (84 of 845) in those without PFG. As the authors acknowledge, the study was not designed to assess accidental peanut exposure in schools. Nevertheless, it seems like parents “hear” the concern about peanut allergy and are willing to help make schools “peanut-free.”
See pages 980
TREATING CONSTIPATION IN CHILDREN
Chronic constipation remains a common problem in paediatrics—with a prevalence of about 5%. In a double-blind, placebo-controlled, crossover study, 51 children (age range 24 months to 11 years) with chronic constipation (fewer than three complete bowel movements per week and at least one associated sign of disease, such as straining) received either polyethylene glycol 3350 plus electrolytes or placebo. During the active treatment phase the number of stools was 3.12 per week compared with 1.45 when the children were on placebo. The results of this study are not surprising—polyethylene glycol is excellent in reducing constipation. How long children need to remain on the drug is the unanswered question.
See pages 996
THIS MONTH IN FETAL AND NEONATAL EDITION
Prophylactic fluconazole is known to reduce the incidence of invasive fungal infection in very low birth weight infants. Its use, however, may be associated with antifungal resistance. In a retrospective study from Royal Maternity Hospital, McCrossan and colleagues found that no resistance emerged following the introduction of fluconazole. This must be viewed as a preliminary study—larger numbers and longer follow-up is necessary to confirm the findings. See page F454
Evidence-based physical examination—can physicians agree on their findings and are they valid—is just emerging as an important science. In a provocative study from Ireland, 27 clinicians viewed video clips of 20 infants. They could not agree if infants appeared pink, and there was wide variation in Spo2 when clinicians perceived infants to be pink. See page F465
Martin Ward Platt—in a perspective—reviews a research report from Glazebrook et al regarding the Parent Baby Interaction Programme. Unfortunately, the programme—a supportive, education intervention delivered by research nurses—did not impact on infant neurobehavioural function, mother-child interaction or parenting stress. The authors are to be congratulated for the design, a cluster-randomised trial with a washout-period, and Martin for emphasising the importance of this and other “negative” studies. See pages F427 and F438