BMJ  2006;333:191 (22 July), doi:10.1136/bmj.333.7560.191

Practice

BMJ family highlights

What's new this month in BMJ Journals

Irish smokers accept smoke-free pubs and bars

Surveys of a cohort of Irish smokers before and after the ban on smoking in public places have shown that they have largely accepted the new law. Compliance was very high nine months after the ban, with smoking continuing in just 5% of public houses, 3% of restaurants, and 14% of workplaces. In the UK, by comparison, there have been only minor reductions over the same period. Permission to smoke at home has declined by about 5% in both countries.

Now, 83% of Irish smokers regard the law as a "good" or "very good" thing. Nearly half report visiting pubs less often than before the ban and spending less time there when they do. The study did not investigate economic consequences but quotes the experience of New York city; a similar decline was offset by the rise in visits of the majority non-smoking population.

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The authors conclude that the Irish government's pre-legislation campaign was successful in reducing criticism and countering the arguments of opponents.

Tobacco Control 2006;15(suppl 3): 51-8

Norwegian waiters and barmen cough and wheeze less after smoking ban

Norway banned smoking in restaurants, bars, and hotels in June 2004. A random sample of 1525 employees compared respiratory symptoms before and five months after the ban. The prevalence of cough, "phlegm cough," dyspnoea, and wheezing all reduced significantly. Improvement was greatest in those who previously smoked but had now quit and those who had had a positive attitude to the ban when questioned before its introduction.

Credit: PAUL WHITEHILL/SPL

Tobacco Control 2006;15: 242-6[Abstract/Free Full Text]

Lubricating plastic speculums does not affect microbiology

The widespread practice of not lubricating plastic vaginal speculums because of fears of interfering with bacteriological sample processing has been shown to be invalid. A water based lubricant, Aquagel, had no effect on colony counts when different dilutions of Neisseria gonorrhoeae were cultured, nor did the gel alter the results of standard assays for Chlamydia spp. Without lubrication, plastic speculums are more difficult to insert and cause more discomfort, so should no longer be used in this way.

Sex Transm Infect 2006;82: 263-4[Abstract/Free Full Text]

Probiotic found to be unhelpful in Crohn's disease

The probiotic Lactobacillus johnsonii LA1 (Nestlé, Switzerland) given daily for six months after operation in Crohn's disease was little or no better than placebo in decreasing the endoscopic recurrence rate. In a placebo controlled trial involving 98 patients within 21 days of surgical resection of all macroscopic lesions (but limited to < 1 m overall), endoscopy found recurrence in 30 of 47 controls and 21 of 43 treated patients (odds ratio 1.85; 95% CI 0.80 to 4.30). Severe recurrence was present in 12 and nine patients respectively. Three taking placebo and four taking the probiotic relapsed clinically. The authors regarded the differences as not reaching a "clinically interesting level" and do not recommend treatment with this probiotic, but it remains to be determined whether a combination of probiotics—or adding antibiotics or synbiotics—might be more effective.

Gut 2006;55: 842-7[Abstract/Free Full Text]

An unusual rugby injury

A man injured in a rugby tackle presented with severe pain and inability to move his left hip. Radiography showed obturator dislocation of the left hip (left). After manipulation under propofol sedation, the femoral head was relocated (right). The next day, a knee effusion proved to be due to anterior cruciate ligament damage.

Emerg Med J 2006;23: e40[Abstract/Free Full Text]

It's hard to comply with eye patching

Interviews with 25 families in whom occlusion therapy had been prescribed for a child with amblyopia has identified why compliance is generally low. Parents' insistence on patching often provoked major emotional reactions in their children, straining family relationships. Teasing at school was seen as a problem, and children and parents were often baffled by the explanations given in clinics of the need for treatment. The authors recommend focusing on psychosocial wellbeing. Strategies suggested include providing understandable explanations, customising bland pink patches ("pirate kings," for example), giving rewards, and enlisting support of teachers and other contacts and establishing a daily routine.

Arch Dis Child 2006;91: 491-4[Abstract/Free Full Text]

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