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Small steps among the landmines
THE LANCET I
Small steps among the landmines K E von MOhlendahl
There have been no giant steps in paediatrics this year, but there were noteworthy investigations and reflections. Paediatricians are still discussing whether neonates and infants feel pain and need anaesthesia for surgery (Lancet 1997; 349:599 and Eur J Pediatr 1997; 156: 173). Wellcontrolled studies established nitrous oxide as a useful drug for respiratory disorders in neonates (N Engl J Med 1997; 336:597 and 605; J Pediatr 1997; 131: 55, 63, and 70). More than one in ten boys has a varicocele. Should only those with arrested testicular growth, which puts them at risk of infertility, be operated on (Pediatrics 1997; 100: 112)? A large cross-sectional study in the USA found signs of the onset of puberty in about 50% of black and 15% of white girls aged 8: so the definition of precocious puberty may need to be revised (Pediatrics 1997; 99: 505). Infants with lacrimal duct stenosis, which is common and usually self-limiting, do not require invasive treatment (BMJ 1997: 315: 293). There is continuing interest in the relation between birthweight and various conditions in later life, such cardiovascular disease, impaired cognitive function, and high blood pressure (BMJ 1997; 341: 475, 396, 401, and 475). Research into the increase in atopic diseases found pebbles here and gems there, including indoor allergens, feeding habits, and number of siblings. The reduction of infections early in life is a serious candidate. B C G vaccination and positive tuberculin reactivity may (Science 1997; 275: 41; 77) or may not (Lancet 1997; 350: 380; 400) prevent the development of atopic diseases. These are not trivial issues, but they may appear so compared with the difficulties faced by children in developing countries. Every year landmines kill about 26 000 people (often children) and leave many more pitifully crippled (Pearn). The Oslo conference raised hopes that widespread agreement to ban anti-personnel mines would be reached in Ottawa in December, 1997. But the USA, Russia, India, and China, and several developing countries, are still resisting, symbolising autoaggressivity as one plague of mankind. Integrated Management of Childhood Illness promises to have a great impact in developing countries. W H O has implemented this programme in 21 developing countries and is expanding it to others. Reduction of childhood mortality is sought not through high-tech medicine, but by strengthening the capacities of basic health workers, communities, and families. A useful database is available at the Division of Child Health and Development, WHO. Environmental questions continue to make headlines. The observation of increased leukaemia rates around a nuclear reprocessing plant (Pobel, McNamee) refocused attention on unresolved and disquieting questions about the possible dangers of low-dose ionising radiation. A thorough, well-controlled investigation based on measurements of electromagnetic fields ( E M F ) in Lancet 1997; 350 (suppl III): 19 Kinderhospital, D49082 OsnabrLick,Germany (K E von ML~htendahl MD)
End O f Year Review • 1997
Chair designed by David Berset, on the Place des Nations in Geneva, Switzerland
households showed that there is no important association between leukaemia and E M F (Linet). Epidemiologists will continue, predictably, to probe this unpromising terrain when it would be better to focus attention and investigations on important issues with a long-term impact such as smog and atmospheric ozone, stratospheric ozone depletion and global warming, and loss of forests. Everybody knows that clearing landmines will take many decades. Nevertheless, banning their production and distribution would be a welcome sign. Paediatricians are used to encouraging small steps. Key references for 1997 Division o f C h i l d H e a l t h and Development, W H O , 20 Avenue Appia~ C H 1211 G e n e v a 27, S w i t z e r l a n d (fax ÷41-227914853). Linet et al. Residential exposure to magnetic fields and acute l y m p h o b l a s t l c l e u k e m i a in children. N EnglJMed 1997; 337: 1-7. M c N a m e e D, H o r t o n R. Childhood leukaemia near nuclear sites r e - e x a m i n e d . Lancet 1997; 349: 969-70. Pearn J. Recent advances. P a e d i a t r i c s - I : I n f a n c y and early childhood and II-Childhood and adolescence. B M J 1997; 314: 801-05 a n d 1099-102. P o b e l D, Viel JF. Case-control study o f leukaemia a m o n g young people near L a H a g u e nuclear reprocessing plant: the environmental hypothesis revisited. BMJ 1997; 314:101-06 and B M J 1997; 314: 1553-55; a n d 315: 1232-35.
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Small steps among the landmines K E von MOhlendahl
There have been no giant steps in paediatrics this year, but there were noteworthy investigations and reflections. Paediatricians are still discussing whether neonates and infants feel pain and need anaesthesia for surgery (Lancet 1997; 349:599 and Eur J Pediatr 1997; 156: 173). Wellcontrolled studies established nitrous oxide as a useful drug for respiratory disorders in neonates (N Engl J Med 1997; 336:597 and 605; J Pediatr 1997; 131: 55, 63, and 70). More than one in ten boys has a varicocele. Should only those with arrested testicular growth, which puts them at risk of infertility, be operated on (Pediatrics 1997; 100: 112)? A large cross-sectional study in the USA found signs of the onset of puberty in about 50% of black and 15% of white girls aged 8: so the definition of precocious puberty may need to be revised (Pediatrics 1997; 99: 505). Infants with lacrimal duct stenosis, which is common and usually self-limiting, do not require invasive treatment (BMJ 1997: 315: 293). There is continuing interest in the relation between birthweight and various conditions in later life, such cardiovascular disease, impaired cognitive function, and high blood pressure (BMJ 1997; 341: 475, 396, 401, and 475). Research into the increase in atopic diseases found pebbles here and gems there, including indoor allergens, feeding habits, and number of siblings. The reduction of infections early in life is a serious candidate. B C G vaccination and positive tuberculin reactivity may (Science 1997; 275: 41; 77) or may not (Lancet 1997; 350: 380; 400) prevent the development of atopic diseases. These are not trivial issues, but they may appear so compared with the difficulties faced by children in developing countries. Every year landmines kill about 26 000 people (often children) and leave many more pitifully crippled (Pearn). The Oslo conference raised hopes that widespread agreement to ban anti-personnel mines would be reached in Ottawa in December, 1997. But the USA, Russia, India, and China, and several developing countries, are still resisting, symbolising autoaggressivity as one plague of mankind. Integrated Management of Childhood Illness promises to have a great impact in developing countries. W H O has implemented this programme in 21 developing countries and is expanding it to others. Reduction of childhood mortality is sought not through high-tech medicine, but by strengthening the capacities of basic health workers, communities, and families. A useful database is available at the Division of Child Health and Development, WHO. Environmental questions continue to make headlines. The observation of increased leukaemia rates around a nuclear reprocessing plant (Pobel, McNamee) refocused attention on unresolved and disquieting questions about the possible dangers of low-dose ionising radiation. A thorough, well-controlled investigation based on measurements of electromagnetic fields ( E M F ) in Lancet 1997; 350 (suppl III): 19 Kinderhospital, D49082 OsnabrLick,Germany (K E von ML~htendahl MD)
End O f Year Review • 1997
Chair designed by David Berset, on the Place des Nations in Geneva, Switzerland
households showed that there is no important association between leukaemia and E M F (Linet). Epidemiologists will continue, predictably, to probe this unpromising terrain when it would be better to focus attention and investigations on important issues with a long-term impact such as smog and atmospheric ozone, stratospheric ozone depletion and global warming, and loss of forests. Everybody knows that clearing landmines will take many decades. Nevertheless, banning their production and distribution would be a welcome sign. Paediatricians are used to encouraging small steps. Key references for 1997 Division o f C h i l d H e a l t h and Development, W H O , 20 Avenue Appia~ C H 1211 G e n e v a 27, S w i t z e r l a n d (fax ÷41-227914853). Linet et al. Residential exposure to magnetic fields and acute l y m p h o b l a s t l c l e u k e m i a in children. N EnglJMed 1997; 337: 1-7. M c N a m e e D, H o r t o n R. Childhood leukaemia near nuclear sites r e - e x a m i n e d . Lancet 1997; 349: 969-70. Pearn J. Recent advances. P a e d i a t r i c s - I : I n f a n c y and early childhood and II-Childhood and adolescence. B M J 1997; 314: 801-05 a n d 1099-102. P o b e l D, Viel JF. Case-control study o f leukaemia a m o n g young people near L a H a g u e nuclear reprocessing plant: the environmental hypothesis revisited. BMJ 1997; 314:101-06 and B M J 1997; 314: 1553-55; a n d 315: 1232-35.
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