BMJ  2006;333:798 (14 October), doi:10.1136/bmj.333.7572.798

BMJ family highlights

What's new this month in BMJ Journals

Condom using youngsters still at risk

Young people using condoms often do so in a way that it is not properly protective. Of 1373 teenagers aged 16-18 years who were questioned, 375 reported engaging in vaginal sex using condoms. Of these, 108 were asked to keep a diary of sexual encounters over six months. In 7% of sex episodes a condom was applied after initial penetration, and in 2% of cases a condom was removed early. In all, nearly a third of the respondents recalled at least one episode of inadequate use. They were more likely to rely also on other methods of contraception; intriguingly, young men who reported a close maternal relationship in their teenage years were more likely to use condoms efficiently.

The authors recommend that it is not enough that programmes designed to improve sexual health and prevent sexually transmitted infection advocate condom use. They need to emphasise correct use.

Sex Transm Infect 2006 (Aug), doi:10.1136/sti:2006.021410

Are we ready for the next 7/7?

A majority of "front line" doctors in UK hospitals are not aware of their role in the event of a major incident. In a recent survey, researchers questioned a sample of 179 registrars in surgery, accident and emergency, and anaesthetics departments in large, city NHS hospitals. Only a third had read their unit's major incident plan in full, and a further 47% had not read any of it. Just over half felt confident of their role in an incident. The least informed specialty was surgery, with half of registrars not even knowing where to find the necessary information.

The researchers reported that it was "remarkably difficult" to get responses from major incident coordinators despite persistent efforts. Twenty four per cent of hospitals said they provided no major incident planning at induction sessions for new medical staff—respondents cited lack of funds, time, and technology.

Despite recent terrorist attacks, hospitals' readiness seems not to have improved since the last similar survey—in 1994.

Emerg Med J 2006;23: 709-12[Abstract/Free Full Text]

Mixed benefits from sulfasalazine

Sulfasalazine proved no more effective than placebo in treating back pain caused by undifferentiated spondyloarthritis. A multicentre randomised controlled trial involving 230 patients given 2 g a day for six months did show some benefit, however, for the subgroup with inflammatory back pain but no peripheral arthritis.

Ann Rheum Dis 2006;65: 1147-53[Abstract/Free Full Text]

Faints in under 50s not due to carotid sinus

Carotid sinus hypersensitivity is highly unlikely to be a cause of syncope in those aged under 50 years but is likely to be a major cause in those over 70. Researchers performed carotid sinus massage on all 386 patients referred with syncope in whom cardiac, neurological, and initial autonomic investigations were negative. Many patients had no warning they might faint, and nearly half had sustained injuries. Only 16% reported neck movements as a precipitating event.

None of 65 patients aged under 50, and only two of 82 aged 50-59, were found to have carotid sinus hypersensitivity. The condition became more common with increasing age (9%, 21%, and 40% respectively for each succeeding decade over 60). The findings contradict current guidelines from the European Society of Cardiology, which advise testing for carotid sinus hypersensitivity in patients aged over 40 with unexplained syncope.

J Neurol Neurosurg Psychiatry 2006 (May), doi:10.1136/jnnp.2006.093518

No yolk if the eyes have it

During a 12 month period, 13 patients in Liverpool received eye injuries from eggs thrown at them; six of the injuries happened in October and November. An apparently fashionable Hallowe'en "trick" resulted in four of these patients having sequelae, including retinal detachment, corneal scar, and (in two cases) risk of glaucoma. The authors of the article reporting these findings expressed dismay at an advertising stunt by a major supermarket in the United Kingdom, which has rebranded its eggs as "mischief eggs" for Hallowe'en.

Credit: SALLY FLANAGAN/REX

Emerg Med J 2006;23: 756-8[Abstract/Free Full Text]

A spoonful (or 10) of sugar...

A 330 ml container of a soft drink has on average (unless designed to be sugar-free) the equivalent of 10 teaspoonsful of sugar in it. Four years ago, the Food Standards Agency nutritional survey of young people reported that intake of such sugars contributes to 16.7% of their energy intake. Given that over 30% of children in the United Kingdom are overweight and half of those are obese, a correspondent based at the University of Bristol calls for a simple health promotion campaign to improve the public's awareness of how much sugar there is in soft drinks, to encourage changing to alternatives.

J Epidemiol Community Health 2006;60: 750[Free Full Text]

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