BMJ  2003;327:E225 (4 October), doi:10.1136/bmjusa.03050005 (published 1 June 2003)

BMJ USA: Minerva

Minerva

From BMJ USA 2003;May:290

Humans are still way ahead of sharks in the competition to be top predator. Last year, while thousands of sharks were eaten by people, only 60 people were bitten by sharks, 20% fewer than the previous year. The international file on shark attacks, compiled in Florida, reported only three deaths worldwide (www.flmnh.ufl.edu/fish/sharks/statistics/2002attacksummary.htm). Sharks have always preferred surfers to other water users (56% of attacks), but the odds against injury are still stacked in the surfers' favor.

Sir Isaac Newton, one of Britain's greatest scientists, was no stranger to spin. An essay in Science (2003;299:831-832[Abstract/Free Full Text]) says he manipulated his public image by releasing different portraits to different audiences. To some he appeared as a country gentleman, to others a visionary Roman swathed in fine robes (his favorite). The solitary troubled genius painted by Godfrey Kneller, now his most famous image, wasn't seen in public until after his death.

Recent studies show that ibuprofen interferes with the effect of aspirin on platelet aggregation. Ibuprofen may limit related benefits in people, according to a Scottish cohort study ( Lancet 2003 ;361:573-574[CrossRef][ISI][Medline]). People with cardiovascular disease who were discharged from the hospital with prescriptions for aspirin and ibuprofen died sooner (on average) than patients taking aspirin alone. The effect seems confined to ibuprofen: other non-steroidal anti-inflammatory drugs had no impact on mortality in this cohort.

Old myths about colds simply refuse to die, at least in Boston, where a recent survey shows that 60% of parents believe colds are caused by changes in the weather, and 40% of parents think you can catch a cold by going out with wet hair ( Pediatrics 2003 ;111:231-236[Abstract/Free Full Text]). Two thirds of parents think bacteria can cause colds, and over half believe antibiotics are a useful treatment. Parents who believe in antibiotics are more likely than other parents to take their children to a doctor.

Between March 1997 and August 1998, 97 patients discharged themselves from a Toronto hospital against the advice of a doctor. 70% were men, 68% had a history of alcohol misuse, and 21% were back in the hospital less than two weeks after they left ( Canadian Medical Association Journal 2003;168:417-420). Only 3% of controls matched for age, sex, and primary diagnosis were readmitted during the same period.

A cure for the common cold would save the US economy about $40bn a year, according to recent estimates in Archives of Internal Medicine (2003;163:487-494). Absence from work accounts for about $23bn of this enormous bill, and over the counter drugs, visits to the doctor, and antibiotics ($1.1bn) account for the rest. This makes colds far more expensive than high profile chronic diseases such as asthma, heart failure, and emphysema, say the authors.

Intensive inpatient rehabilitation can help stroke survivors recover at least some of their quality of life. Six months after discharge, though, most of the gains have been lost, say researchers from Canada ( Stroke 2003;34:801-805[Abstract/Free Full Text]). Patients and carers from their longitudinal study blamed fatigue, lack of support (social and professional), mood swings, and unrealistic expectations for the unexpectedly disappointing results.

There's limited evidence that occupational therapy can help stroke survivors too, mostly with activities of daily living. There's a lot more work to be done, however. A recent meta-analysis combined 32 studies, but only a third of them were of decent quality and none extended beyond the end of the interventions. Worse, the interventions varied wildly between studies, limiting the results still further ( Stroke 2003;34:676-687[Abstract/Free Full Text]).

Marriage makes most people happier, according to a longitudinal study ( Journal of Personality and Social Psychology 2003 ;84:527-539[CrossRef][ISI][Medline]). But not by much, and not for long. Researchers studying 24 000 Germans detected a small increase in happiness after marriage (0.1 points on a scale of 1 to 10), but it quickly disappeared. They blame adaptation — a theory which says that happiness is more or less preset, like a thermostat. Whatever happens, we all return to baseline eventually.

A study in over 15 000 women shows convincingly that women who have their babies "naturally" are more likely to develop incontinence than women who have cesarean sections ( New England Journal of Medicine 2003;348:900-907[Abstract/Free Full Text]). Insisting on a cesarean section every time reduces a woman's risk from about 10% to about 5%. The researchers make a plea (probably in vain) for women and their obstetricians not to use these data to increase rates of cesarean section yet further.

View larger version (85K): [in this window] [in a new window]   A 45 year woman presented with a progressive red-pink shiny painless vulval ulcer of six months' duration. She had no medical history and was not taking any medication. Lymphadenopathy was not present. Screening tests for herpes simplex virus and syphilis were negative. Biopsy from the edge of the ulcer showed vulval intraepithelial neoplasia grade III. T Aldeen, specialist registrar, Genitourinary Medicine Department, St George's Hospital, London SW17 0QT, UK

A young woman with an allergy to shrimp and lobster unwisely took a job in a seafood restaurant ( Mayo Clinic Proceedings 2003 ;78:221-222[ISI][Medline]). Apart from a little superficial urticaria, she was fine until she fell in love with one of the staff. One night, a passionate goodnight kiss left her flushed and breathless, but also wheezing, edematous, hypotensive, and in urgent need of intravenous epinephrine. Her boyfriend had eaten a few shrimps less than an hour before.

A link between asthma and thunderstorms has been reported in several countries, including England and Australia. Thunderstorm asthma also happens in Canada, according to a study in Chest (2003;123:745-750[Abstract/Free Full Text]). The number of patients with asthma visiting one emergency department in Ontario went up (in line with atmospheric concentrations of fungal spores) by 15% during the 151 thunderstorms between 1993 and 1997.

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