BMJ family highlights

	Patients' reports of enlarged lymph nodes may be false

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A physician examined 10 patients who fulfilled diagnostic criteria for chronic fatigue syndrome and reported swollen neck glands. No glands were palpable, so it might be that previously both patients and doctors have misinterpreted the tenderness of fibromyalgia as lymphadenopathy. The author urges caution in interpreting any published prevalence study of lymphadenopathy where the diagnosis was based on history alone. Predictably, nine of the patients had been investigated previously by other specialists for unexplained symptoms and seven have subsequently been referred by their general practitioners to another clinic.

Postgraduate Medical Journal 2003;79:59-60 [Abstract/Free Full Text]

The interlocking finger test: asking patients to mimic the four positions shown above is a fast and simple bedside screen for parietal lobe dysfunction. Journal of Neurology, Neurosurgery and Psychiatry 2003;74:530-2 [Abstract/Free Full Text]

	Oesophagitis is linked with coeliac disease

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Adults with coeliac disease had twice the risk of reflux oesophagitis (19%) as those without who had endoscopy because of upper gastrointestinal symptoms. Both groups responded well to eight weeks of omeprazole. People with coeliac disease who remained on a gluten free diet were much less likely to have relapsed at 1 year follow up. This suggests that the oesophagitis is directly related to the coeliac state, possibly due to a specific mucosal immune response to a noxious agent.

Gut 2003;52:514-7 [Abstract/Free Full Text]

	Is retirement good for you?

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The physical and mental health of about 8000 London based civil servants was analysed at age 54-59 and again when they had retired (at 60) or were still working. Physical functioning deteriorated in both groups, as might be expected simply due to the infirmities of age but mental functioning had improved in those who had retired and deteriorated in those who continued to work. Further analysis showed that the improvement was confined to those who had been in higher employment grades, perhaps because of greater lifestyle choice from a higher pension or relief from the stress of work-related decision making.

Journal of Environmental and Community Health 2003;57:46-9 [Abstract/Free Full Text]

	Nicotine patches alone help smokers quit

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Over the counter nicotine replacement therapy works just as well as normal prescription practice, even when prescription is combined with a behavioural programme. A systematic review of trials of over the counter therapy shows that long term abstinence rates are similar to prescribed nicotine replacement, although the absolute rate is modest (7%). Governments that provide nicotine replacement only through doctors or require complementary psychosocial treatment may be putting barriers in the way of people who want to stop smoking.

Tobacco Control 2003;12:21-7 [Abstract/Free Full Text]

Farming and "fatalism" may be related English farmers have a high risk of suicide. A questionnaire completed by more than 425 farmers shows that nearly 6% have important psychiatric morbidityfewer than in a previously reported national population survey. However, farmers were much more likely to report thinking that life is not worth livin than were controls from a rural population. Small farmers were no more likely to report morbidity than those with large farms, nor was there a difference between arable and livestock farmers. The reasons for excess suicides therefore remain unexplained but may be related to an apparently gloomy view of life (the authors call it "fatalistic") combined with easy access to firearms and toxic chemicals. The survey was conducted before the foot and mouth epidemic, so the authors recommend repeating the exercise to ascertain the effect of the extra stress this imposed. Occupational and Environmental Medicine 2003;60:181-6 [Abstract/Free Full Text]   (Credit: PATRICK FRILET/REX)

Harvey Marcovitch. 

BMJ syndication editor
(h.marcovitch{at}btinternet.com)