Journals Watch - Sleep, otitis media and smoking

Too busy to read through the journals? Allow Dr Jonathan Holliday to be your guide.


Which disturbs parents' sleep more: childhood eczema or asthma? Now we can put an end to the dinner-party arguments: eczema is more disturbing to parental sleep than asthma and apparently it is the fathers who lose more sleep over it.

This small study involved 92 parents of 55 children who answered prospective questionnaires in the setting of a regional asthma and eczema unit in a UK tertiary paediatric hospital. The researchers concluded that chronic atopic eczema was associated with greater parental sleep disturbance.


The Global Youth Tobacco Survey (GYTS) is a school-based survey of students aged 13-15 at 395 sites in 131 countries across the world.

The difference in current cigarette smoking between boys and girls was narrower than expected in many areas. As many as one in five non-smoking students considered that they were vulnerable to starting within the next year. Exposure to second-hand smoke was high at home (more than four in 10) and in public places (more than five in 10). Never-smokers were significantly less likely to have been exposed to second-hand smoke at home.

The authors call for a redoubling of effort which I think we would all concur with. But where that effort should be directed, and how, is not such an easy question. With over 90 per cent of smokers having started before their 18th birthday, smoking and youth is clearly a heady mix.


Acute otitis media is not only one of the commonest childhood infections, it must also be one of the commonest causes for consulting a GP. An immunisation that may reduce both therefore seems to me to be a win-win situation for both doctor and patient.

This study assessed the efficacy of a novel vaccine that contained polysaccharides from 11 different Streptococcus pneumoniae serotypes each conjugated to Haemophilus influenzae-derived protein D. Four doses were given at three, four, five and 12 months of age.

The trial involved almost 5,000 infants, and showed the vaccine reduced the incidence of acute otitis media by 33 per cent. Fluid was obtained from the middle ear of children who presented with an abnormal tympanic membrane or with serous effusion in the middle ear space. Vaccine efficacy was shown not just for pneumococcal serotypes that were included in the vaccine (53 per cent), but also for episodes of acute otitis media caused by non-typable H influenzae (35 per cent).

This is one vaccine I will certainly encourage.

HIP PROTECTORS DO NOT CUT FRACTURE RISK - BMJ; doi:1136/bmj.38753.375324.7C

It always seemed a bit improbable that wearing something over the outside of the hips would give real protection from fracture in the event of a fall. This paper presents the results of a meta-analysis of completed randomised trials on the effectiveness of hip protectors and finds them wanting.

In the nursing or residential care setting there is a marginally reduced incidence of hip fracture (relative risk 0.77, 95 per cent confidence interval) but pooling of data from three trials involving 5,137 'community dwelling participants' showed no reduction in hip fracture incidence.

The authors conclude that hip protectors are an ineffective intervention for those living at home and that their effectiveness in an institutional setting is uncertain. Although there were no important adverse effects to wearing one, compliance, particularly in the long term, was poor.

- Dr Holliday is a GP in Eton, Berkshire and a member of our team who review the journals


Chronic atopic eczema is associated with greater parental sleep disturbance.

Non-smoking students feel vulnerable to starting smoking.

Acute otitis media incidence was cut by a third with a vaccine.

Hip fracture in the elderly is not reduced by wearing hip protectors.


Overdiagnosis of breast cancer; BMJ doi:10.1136/bmj.38764.572569.7C

Fifteen years after the end of the Malmo mammographic screening trial the investigators went back to look at the rate of over-diagnosis of breast cancer, in situ and invasive.

They found that in the group of women aged 55-69 years at randomisation the rate was 10 per cent. The follow-up study was large, with over 42,000 women involved, which makes the results even more relevant.

The accompanying commentary identified the anticipation of diagnoses and excess diagnoses as factors for overdiagnosis.

The authors of the commentary suggest that the results of the follow-up study should be considered when looking at the introduction of screening programmes for other cancers.

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