Mothers’ kisses and other stories . . .

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7974 (Published 05 December 2012) Cite this as: BMJ 2012;345:e7974

A “mother’s kiss” can dislodge foreign bodies from children’s nostrils. A systematic review found it useful as a first line option and safe. The trusted adult’s mouth forms a closed seal over the child’s open mouth; while occluding the unaffected nostril with a finger, the adult blows until resistance is felt when the child’s glottis closes. The adult then exhales sharply, delivering a short puff of air into the child’s mouth. The air passes through the nasopharynx, out through the unoccluded nostril, hopefully expelling the foreign body (CMAJ 2012;184:E904-12, doi:10.1503/cmaj.111864).

The concept of the “contagious yawn” also applies to the itch. Thirty volunteers were shown itch evoking images (of ants, fleas, or skin conditions) and asked how itchy they felt looking at the images and how itchy they thought the person in the images felt. Researchers also recorded the number of times the volunteers scratched themselves. Visual cues alone elicited itch sensations, but watching another person scratch themselves caused unconscious scratching (British Journal of Dermatology 2012, doi:10.1111/bjd.12132).

A systematic review of predictors of surgical performance reports that intermediate and high level visual-spatial perception, as well as psychomotor aptitude (using two dimensional information to achieve a three dimensional solution), can be used to assess candidates for surgical training. Visual-spatial perception correlated with operative ability at the end of training, but not in experts. Psychomotor aptitude correlated with rate of skill acquisition. Academic achievement predicted completion of surgical training and passing of final examinations, but not clinical performance (British Journal of Surgery 2012;99:1610-21, doi:10.1002/bjs.8893).

The sexual side effects of finasteride, a testosterone blocking compound used to treat male pattern baldness, seem to depend on hand preference (British Journal of Urology International 2012, doi:10.1111/j.1464-410X.2012.11580.x). “Handedness” of male participants was recorded with sexual functioning, as measured by the International Index of Erectile Function, before and after starting 1 mg finasteride treatment over four weeks. On most subscales of sexual functioning, right handed men had no effect or reduced sexual function, but left handed men reported no effect or improved sexual function.

Can videos help improve decision making and the validity of patient consent? Women waiting for vaginal hysterectomy with vaginal vault support over five years in one UK hospital were offered a video of their proposed procedure before making a final decision and consenting. Of 96 follow-up questionnaires posted, 71 were returned and analysed. A substantial proportion of women took up the offer and found the video beneficial; 65% reported that the video enforced their decision to proceed to surgery (Journal of Obstetrics and Gynaecology 2012;32:680-2, doi:10.3109/01443615.2012.698329).

Do “Do Not Resuscitate” (DNR) orders lead to less aggressive treatment and poorer care in patients with stroke? A cohort study of almost 4000 patients with ischaemic stroke identified that 13.5% had a DNR code. Overall, 4.9% of the cohort died in hospital or were discharged to a hospice; these outcomes were significantly higher in patients with DNR orders. But after adjusting for confounding factors, few associations existed between DNR order and 14 quality indicators, apart from early ambulation in those with DNR orders (Neurology 2012;79:1990-6, doi:10.1212/wnl.0b013e3182735ced).

Minerva plans to stick to a Mediterranean style diet for as long as she can. An Italian longitudinal study of 690 older adults living in the community concludes that good adherence to a Mediterranean diet (high in vegetables, legumes, fruit, cereal, fish, and monounsaturated fats) leads to significantly less frailty than poor adherence. Higher adherence was also associated with a lower risk of low physical activity and low walking speed, but not with feelings of exhaustion and poor muscle strength (Journal of Nutrition 2012;142:2161-6, doi:10.3945/jn.112.165498).

A psychiatrist who gave legal advice on a proposed clitoridectomy after a previously unsatisfactory cosmetic labiaplasty has been criticised by a gynaecologist in the Archives of Sexual Behaviour (2012, doi:10.1007/s10508-012-0044-2). The gynaecologist asks whether such cosmetic surgery is necessary for mental health or are we “witnessing the emergence of new culturally determined customs and rituals”? The psychiatrist deemed the clitoridectomy could be exempted from the Female Genital Mutilation Act 2003 “for cosmetic reasons.” The gynaecologist says that conclusion is wrong, and that legitimacy should be decided by the courts.

A US team used data for 628 healthy children to compare birth weight with brain structure, area, and volume. After controlling for age, sex, household income, and genetic ancestry, heavier children at birth had greater surface area and total volume of the brain than healthy, lighter babies. Some parts of the brain most highly correlated to birth weight are networked together and are responsible for resolving cognitive conflicts, although the team did not find a link between birth weight and cognitive function (Proceedings of the National Academy of Sciences 2012, doi:10.1073/pnas.1208180109).


Cite this as: BMJ 2012;345:e7974


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