which this report is aimed, since the working party found "evidence that understanding among members of the medical profession to genetics and genetic disease is insufficient". 1. Our Genetic Future. British Medical Association. Oxford, UK: Oxford Press. 1992. Pp 263. £7.99. ISBN 0 19 286156 5.
Half of the UK’s tobacco-selling retail outlets break the law by selling cigarettes to children. A quarter of 15-year-olds smoke regularly and an additional tenth have a cigarette occasionally. The high prevalence of regular smoking in the 11-16 age-group and lack of any substantial decline in the past decade is alarming, concludes the Royal College of Physicians’ report Smoking and the Young. The picture becomes even more worrying when the effects of environmental tobacco smoke on the young are considered. Children of parents who smoke inhale nicotine in amounts equivalent to their actively smoking 60-150 cigarettes a year. Parental smoking is estimated to be responsible for at least 17 000 admissions to hospital each year of children under the age of 5. The report’s recommendations include a ban on all forms of direct and indirect tobacco promotion and regular increases in the real price of tobacco products through taxation; a raising of the legal age for buying tobacco to 18 years; a licensing system if legislation on sale of tobacco to children is ineffective; health warnings on tobacco products that are tougher and oriented to young people; and strict no-smoking policies in schools and public places. Parents, schools, the media, and doctors are exhorted to teach children that it is not "cool" to smoke. 1.
Smoking and the Young. London: Royal College of Physicians. (plus £1 postage and packing). ISBN 1 873240 42 2.
Pp 130. £10
Worms and learning In parts of the world, infection with the nematode worms Ascaris lumbricoides or Trichuris trichiura is common, infection being particularly prevalent and heavy in school-age children. Worm infection leads to poor nutrition and iron-deficiency anaemia, and these conditions are associated with impaired cognitive function and learning ability. There is a well-recognised correlation between worm infection and educational difficulty, but because both tend to occur in children from poor families it is not known whether the relation is causal or merely a reflection of socioeconomic status. Nokes and colleagues1 sought to resolve this question by testing the cognitive function of nematode-infected Jamaican schoolchildren before and after anthelmintic treatment. 104 children (aged 9-12 years), who on two occasions three months apart had more than 1900 T trichiura eggs/g faeces and little or no infection with the hookworm Necator americanus, were randomly assigned to treatment with three doses of either 400 mg albendazole (62) or matching placebo (42). 56 children who were uninfected on both occasions (the controls) were also given placebo. The cognitive function of all children was measured before and a mean of 63 days (one school term) after intervention. Examination of stool samples from every child not less than 10 days after treatment showed a highly significant reduction in worm burden in the albendazole-treated group. Results of cognitive-function tests were analysed by forward-stepwise multiple linear regression to account for confounding variables. Compared with both the placebo and control groups the treatment group improved significantly more in fluency (scanning and retrieval of long-term memory) and digit-span forwards and backwards (auditory short-
memory). After treatment, the treatment and control groups did not differ significantly in results of these tests of cognitive function. The authors suggest that the detrimental effect of T trichiura infection on some aspects of cognition-which was reversible by therapy-may be due to suboptimum arousal caused by the fatigue and listlessness associated with the infection. term
1. Nokes C, Grantham-McGregor SM, Sawyer AW, Cooper ES, Bundy DAP. Parasitic helminth infection and cognitive function in school children. Proc R Soc Lond
Biol 1992; 247: 77-81
International asthma and
Centres at which asthma and allergies in childhood are treated are being invited to take part in an international study aimed at comparing within and between countries the prevalence and severity of asthma, rhinitis, and eczema in children; at obtaining baseline measures for the assessment of future trends in the prevalence and severity of these diseases; and at providing a framework for further aetiological research into genetic, lifestyle, environmental,and medical care factors affecting these diseases. All centres will have to use a simple core-questionnaire; however, they may use optional supplementary research instruments and study questions of their own interest. Participating centres will have to raise their own funding. Further information may be obtained from: Innes Asher, School of Medicine University of Auckland, Private Bag, Auckland, New Zealand; Ulrich Keil, Ruhr-University Bochum, Overbergstrasse 17, D-4630 Bochum 1, Germany; Ross Anderson, St George’s Hospital Medical School, London SW17 ORE, UK; Femando Martinez, Health Sciences Center, University of Arizona Tucson, Arizona 85724, USA; and Julian Crane, Wellington School of Medicine, Wellington, New Zealand.
Doctors in need The Royal Medical Benevolent Fund ran into a budget deficit of ;C155 582 in 1991, which it had to balance from legacy incomewhich means a reduction in the amount available for investment. The Fund has thus decided to "judiciously advertise outside the medical profession" for donations. The year also saw the institution of three measures to control expenditure-a re-evaluation of the real needs of beneficiaries; the drawing up of strict rules for providing loans, and the decision to spend at Christmas only what had been received at the previous Christmas appeal. The Fund’s clothes room (from which over 270 parcels, valued at about 250 a parcel for an adult are sent out annually) has moved to the Fund’s headquarters at 24 King’s Road, London SW19 8QN, after 62 years at BMA House.
Medical angiology Efforts to get medical angiology recognised as a specialty in Europe are being made by an International Union of Angiology working group. The group hopes to obtain recognition for a training programme in the specialty and to create a medical section within the Union. Further information is obtainable from Prof M. Catalano, L. Sacco Hospital, Via G. B. Grossi 74, 20157, Milan,
Our general surgeon with a special interest in matters intestinal knew that there were quite a few things he could teach me. As I sat in on his clinic, hoping to fill some of the gaps in my surgical knowledge, I doubted very much if he had ever considered that a general practitioner might have anything to teach him. This is unfortunate because our surgical colleagues could improve their therapeutic efficacy by learning even the most basic of communication skills that we teach our vocational GP trainees. The last patient in the clinic was a middle-aged lady who was there for reassurance. Whether it was the patient or her referring GP that needed the reassurance was not clear but it was immediately clear to the surgeon that her right upper quadrant abdominal pain needed no further surgery. "The trouble, my dear", intoned the consultant authoritatively, "is that your cholecystectomy incision was sited too close to your nephrectomy scar causing a nerve
entrapment". "Oh no, doctor, it’s not that", replied the farmer’s wife. "What is it then?", inquired the consultant with an air made up of two parts indulgence and one part condescension. "Well I say things ain’t never been right since they done the second