Interesting

An article about the impact of the 'impact factor' on scientific journals.

Breast feeding and intelligence

There are many advantages to breast feeding - to mother and baby. These include the effect of colostrum on immunity, fewer diarrhoeal diseases, the benefits of omega 3 fatty acids on visual developments in small infants, as well as improved bonding and less breast diseases later. It remains unclear whether the child's intelligence is affected by breast feeding, although it remains an unequaled way of providing ideal nutrition.

To look at the effect of breast feeing on IQ, Der et al defined the known variables in over 5 000 children and teased out factors such as education, race, wealth, smoking, birth order, birth weight and home environment (BMJ 2006;333:945-8). In general, breast-fed babies scored four points higher in testing than formula-fed infants, but almost all this effect was attributable to the mother's IQ. In other words, inheriting the mother's cognitive abilities was more important than being fed her breast milk as measured by intelligence tests.

These findings can be used to reassure mothers who cannot breast feed, but in no way detract from the many other plus factors which should persuade as many women to breast feed as possible for at least six months.

Chemotherapy for breast cancer

Thirty years ago, Bonadonna and his colleagues proved that adjuvant chemotherapy made a difference to survival following initial surgery in women with early breast cancer (Levine & Whelan NEJM 2006;355:1920-2). The original agents, cyclophosphamide, methotrexate and flurouracil (CMF) have been the gold standard against which newer drugs are assessed.

There have been numerous trials of chemotherapy mainly studying anthracyclines and taxanes in various combinations which are of interest to oncologists, but gynaecologists and GPs need to know that:

* adjunct postoperative chemotherapy has a modest benefit on survival
* it has considerable toxicity and is expensive
* its use is determined by the risk of recurrence which in turn depends on tumour size, axillary node status and pathology grade
* receptor status for human epidermal growth factor (HER2) and treatment with trastuzumab is a promising development
* oestrogen receptor status and hormonal treatment with tamoxifen greatly reduces recurrence.

Trials like that of Poole et al (pp 1851-62) will continue to refine the best combination of agents but the next major step forward will be the use of microarray techniques to identify each tumour's gene profile and then tailor the therapy individually.

December JASS out

JASS started in early 1997 so this is our tenth birthday.

It has gone from strength to strength and is now subscribed to in 44 countries.

We thank you for your support and will be offering even better opportunities in 2007. May we remind you that if you belong to an academic institution you may wish to enquire about our corporate subscription rates which allow for onward distribution to staff at attractive rates.

The year ends with global concerns about the lack of progress in women's health in developing nations and generally the ever-widening gap between the haves and the have-nots. The have-nots get the worst deals from the pharmaceutical industry, bear the largest burden of disease with the fewest resources, lose their health care workers to richer countries and seen to have less wise leadership.

Perhaps the new WHO leadership under Dr Chan from China will make a difference.

For those wishing JASS to supply CPD certificates, please complete the 2006 Annual Answer Sheet for the year and send it to us for review and points allocation.

We wish you good health personally from Team JASS and a peaceful New Year.