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The new look at ADC
This issue introduces a redesign of ADC. You probably noticed a change 6 months ago when we adopted a different page size. Now comes a more substantial makeover—different covers, fonts, and page and table layouts. This is part of the continued branding of the BMJ Publishing Group. All 25 publications, other than BMJ, will have a similar look and feel. The intent is to give ADC a more modern appearance that is easier to read.
Disparities in social services
Ellis and colleagues detail a disturbing problem in the provision of a social service, Disability Living Allowance (DLA), for children with Down syndrome. Although 82% of parents were successful in obtaining DLA, parents who were ethnic minority or spoke English as a second language were significantly less likely to obtain DLA. Despite the universality of both the UK health care system and numerous social services, like many other countries, persistent disparities continue to exist. This was highlighted by a recent study which reported that compared with white infants, Asian and Black infants were almost twice as likely to be born low birth weight in both England and the US.1 In general, minorities and those that don’t speak the “national” language of a particular country are usually most affected by disparities. In an accompanying perspective, Liz Marder from Nottingham discusses the issue of caring for disabled children in the UK, particularly in light of an increasingly multi-ethnic population.
The pain of acute otitis media
I recall fondly when I dispensed codeine to a 5-year-old child with acute otitis media (AOM). I was working in the emergency department; it was 1 am—I made the diagnosis and gave the parents a prescription for an antibiotic. They asked if it would help the pain, since that was why they brought their child to the emergency department. Realising that the antibiotic would not help relieve the pain, I asked the nurse to give the child a dose of codeine and an extra pill for the early morning. Later that day the parents called me and thanked me, not for the antibiotic, but the codeine, since the entire family got a good night’s sleep. The moral of this story, AOM can be quite painful. Bolt and colleagues from Australia describe a double-blind placebo-controlled randomised trial, in which 63 children with AOM received either 2% lignocaine eardrops or placebo. The lignocaine eardrops provided rapid and significant pain relief.
See pages 40
A picture is worth a 1000 words (or in this case the 258 that appear below)
We have heard from numerous readers about two recent covers. The Fetal and Neonatal cover in September, 2007 depicting a severely jaundiced infant with a nasogastric tube in place with a bottle, provoked concern about promoting bottle feeding. The October, 2007 cover of ADC, in which a girl is shown using an inhaler, but without a spacer, led to a discussion on the College website, and a few letters to us, suggesting that this was inappropriate, since all children should use an inhaler with a spacer. There was some disagreement about the “age” of the child and whether she could appropriately use an inhaler.
What have I learned from this correspondence? Just as narrative influences healthcare policy, pictures convey powerful messages. As I have written numerous times in these pages, I endorse breastfeeding, but more importantly, the implementation of Baby-Friendly in all hospitals. Unfortunately, some infants will require bottle feeding. With respect to the second picture, inappropriately, I did not consider the age of the child and use of a spacer, I assumed she was old enough to use an inhaler appropriately.
When I first became editor someone suggested we add obituaries. I sought counsel from numerous BMJ staff, and Harvey Marcovitch, former editor of this journal. They were adamant in their advice—obituaries were to be avoided at all costs—it would be impossible to satisfy most of our readers regarding who we wrote about and what we said. Perhaps the same is true for cover photos—although admittedly I will be more careful in the future.
This month in Fetal & Neonatal Edition
The appropriate diet for pregnant women is very unclear. The primary goal is to ensure intake of key nutrients and food groups to ensure optimal fetal development. Dunstan and colleagues from Australia report the impact of maternal fish oil supplementation in pregnancy on cognitive development in their offspring. King and Fewtrell from the Hammersmith elaborate on the impact of maternal intake of docosahexaenoic acid on cognitive development. See pages F4 and F45
NICE recently released an elaborate “guideline” on routine postnatal infant care. Drs Sellwood and Huertas-Ceballos review this lengthy document. See page F10
Hosono and colleagues from Japan describe the effect of umbilical cord milking on red cell transfusion in a group of 40 infants born between 24 and 28 weeks’ gestational age. In this randomised clinical trial they found that vigorous milking of about 20 centimeters of the umbilical cord toward the umbilicus significantly increased initial haemoglobin values and reduced the need for red blood cell transfusion. This should be viewed as a preliminary report, since the sample is too small to detect possible side effects, such as polycythaemia. See page F14