Long or highly irregular menstrual cycles are a predictor of increased risk for type 2 diabetes mellitus (DM). This result comes from the Nurses Health Study II, in which 101073 American women aged 24-43 years were recruited in 1989, and followed for eight years. At baseline they self-reported on aspects of health, including family history, smoking, body mass index (BMI) and their menstrual cycle at age 18-22 years. Obesity was found to be a major risk factor for type 2 DM, but even after adjusting for BMI the relative risk of developing type 2 DM in women whose menstrual cycles were irregular or ≥ 40 days long was 2.08. Women with this menstrual history may benefit from lifestyle approaches to reduce risk.

JAMA 2001; 286: 2421-2426

Researchers in Australia and the United States have joined forces to highlight the dangers of leaving children to supervise their younger siblings while bathing together. The researchers searched several autopsy databases in each country and found 17 cases of children aged two years and under who drowned while in the bath with another child. Depending on the individual database, this represented between 22% and 58% of all bath drownings in this age group. The victims were younger than the surviving child in every case (mean age, 11.8 v 30.4 months), and all the children had been left unsupervised.

J Paediatr Child Health 2001; 37: 542-544

Although the literature is divided as to whether psychosocial treatments for cancer confer any survival benefit, it seems they may have a role in reducing distress and suffering. A recent multicentre Canadian study¹ examined the addition of supportive-expressive group therapy to standard care for metastatic breast cancer. In this study 158 women were randomly assigned to receive weekly group therapy for at least a year and 77 women acted as controls. Women in the intervention group did not enjoy a survival advantage (median survival of 17.9 months, compared with 17.6 months among the controls). However, group therapy did improve mood and perception of pain, particularly in women who were initially more distressed. The Canadian study was attempting to replicate the results of a previous positive trial, published in 1989. In an accompanying editorial² the author of this earlier trial attributed the different outcome to improvements in medical treatment and the emotional support available to patients with cancer. Citing his new study,³ he concludes that, in group therapy, confronting the possibility of dying from metastatic breast cancer is emotionally helpful and not physically harmful. We await a systematic review.

1. N Engl J Med 2001; 345: 1719-1726
2. N Engl J Med 2001; 345: 1767-1768
3. Arch Gen Psychiatry 2001; 58: 494-501

If the sight of Sharon Stone looking sexily inscrutable as she drew back on a cigarette in Basic Instinct made you feel like lighting up, you're not alone. A study of 4919 adolescents in the United States has found that viewing smoking in movies is associated with trying it in real life. Researchers developed a list of box office hits released between 1988 and 1999. They counted episodes of smoking in each, then asked the youngsters to nominate films they had seen. The prevalence of ever trying smoking increased with increasing exposure to smoking in movies (4.9% in those who saw < 50 occurrences, 13.7% for 51-100 occurrences, 22.1% for 101-150 occurrences and 33.1% for > 150 occurrences). The differences remained significant after adjustment for multiple potential confounders, including age, sex, and parental, personality and social factors.

BMJ 2001; 323: 1394-1397

Researchers in the UK have discovered a possible way of increasing the accuracy of early fetal screening for trisomy 21. Extrapolating from Langdon Down's original observation that people with Down's syndrome had small noses, the researchers used ultrasound to examine the nasal bones of 701 fetuses (11-14 weeks' gestation) who were about to undergo chorionic villous sampling and karyotyping. The nasal bone was absent in 43 of 59 (73%) fetuses with trisomy 21 and three of 603 (0.5%) normal fetuses. The researchers suggest that adding a look at fetal nasal bones to first-trimester screening by maternal age and fetal nuchal translucency thickness could increase the sensitivity of the screen from 75% to 85% and decrease the false positive rate from 5% to about 1%.

Lancet 2001: 358; 1665-1667

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