Short Cuts

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BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.a173 (Published 29 May 2008) Cite this as: BMJ 2008;336:1212

Smokers are becoming marginalised in the US

When researchers first began the Framingham heart study back in 1948, they asked participants for the contact details of close friends to help them keep track of the cohort. More than half a century later, other researchers are using these incidental data to study the spread of behaviours such as smoking through social networks.

The latest study, analysing data between 1971 (the children of the original cohort) and 2000, makes it clear that as the prevalence of smoking falls smokers are becoming increasingly marginalised. By 2000, they tended to cluster at the edge of social networks and associate mainly with other smokers. The same network analysis shows that groups of smokers seem to quit roughly at the same time, and that spouses, siblings, friends, and colleagues can all influence a person to quit smoking. Having a spouse who quit decreased a person’s chance of smoking by 67% (95% CI 59% to 73%), for example. Friends and close colleagues in small firms helped reduced the chance of someone smoking by around a third.

Social pressure to quit may be a good thing, but driving hardcore smokers to the edge of society probably isn’t, says a linked editorial (p 2284) The isolation and stigma that go with marginalisation could make smokers even harder to reach.

Self immolation is an increasing problem in women in Afghanistan

Afghanistan is in an almost permanent state of conflict. For most of the population that means unemployment, illiteracy, and a low life expectancy. Women in Afghanistan must also endure early forced marriage (70-80%); an average of 7.5 pregnancies each, with little or no skilled help during births; high maternal mortality; and sexual and physical violence from husbands and their families, says a comment article. An increasing number of women and girls see self immolation—the act of setting fire to yourself often using petrol—as the only way out. One German medical organisation reports that the number of cases doubled between 2005 and 2006.

Reliable data are hard to come by, but researchers at Medica Mondiale found 77 cases admitted to just three hospitals in Kabul, Herat, and Wardak, mostly in 2005 and 2006. Four fifths of them died. More than half were teenagers. Almost all were illiterate. Interviews with contacts and the few survivors suggested that forced marriage or engagement in childhood was the most common precipitating factor (29%). Forced marriage to settle conflicts between tribes or families was another predominant feature (18%), so was abuse from in-laws (16%).

The human rights conventions, agreements, and development strategies already signed by the Afghan government have not yet reached the women they were designed to protect, the article concludes.

Giving blood is riskier for younger teenagers

Teenagers aged 16 or 17, who donate almost a tenth of the whole blood collected by the American Red Cross, have a significantly higher risk of complications related to donation than older teenagers and adults. In blood centres run by the Red Cross, 10.7% of 16 and 17 year olds, 8.3% of 18 and 19 year olds, and 2.8% of adults had some kind of complication in 2006, usually minor bruising, pallor, or light headedness. Far fewer lost consciousness and fewer still sustained injuries or needed outside medical help, but the risks were still highest in the youngest donors, in an analysis of data from nine donation centres. Rates of injury secondary to fainting were 5.9 per 10 000 in 16 and 17 year olds, 2.4 per 10 000 in 18 and 19 year olds, and 0.4 per 10 000 in adults aged at least 20. The odds of injury were 14 times higher for the youngest donors relative to adults (odds ratio 14.46, 95% CI 10.43 to 20.04).

In this study, 16 year olds who had even a minor complication were less likely than others to donate again that year (52% v 73%; 0.40, 0.36 to 0.44).

Incidence of type 1 diabetes accelerates in Finnish children

The incidence of type 1 diabetes in Finnish children has doubled since 1980, according to a time trends analysis. The rate increased each year between 1980 and 2005 and seemed to be accelerating, particularly in children under 5. If the same trend continues, the incidence in children under 15 could reach 80 new cases per 100 000 by 2010, up from 34.3 per 100 000 in the early 1980s. Boys and girls were affected equally until puberty, when the sexes diverged as expected, with a greater increase in incidence in boys.

The authors say that the implications of these trends are clear—more adults will have serious complications of diabetes, including renal failure. The cause of the surge in diabetes is less obvious, but the short time scale suggests that environmental changes are likely to be responsible. Finnish babies are gaining weight faster than they used to, say the authors, and this can accelerate the autoimmunity characteristic of type 1 diabetes. A linked editorial (p 1730) has another theory—early feeding with root vegetables contaminated with toxins from common potato scab (Streptomyces sp). One in three Finnish babies is given root vegetables with their first solid food.

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