BMJ  2003;327:E261 (4 October), doi:10.1136/bmjusa.01070007 (published 5 September 2002)

BMJ USA: Minerva

Minerva

Minerva

This article originally appeared in BMJ USA

A two year follow up of 447 Finnish hospital doctors and their senior nurse controls has found that the doctors took about one third of the amount of sick leave taken by their controls. But there were no differences in health outcomes, self rated health status, and the prevalence of chronic illness between the two groups ( Occupational and Environmental Medicine 2001;58:361-366[Abstract/Free Full Text]). Poor teamwork seems to contribute more to doctors' absenteeism than overwork or low job control.

Jet lag may prove more harmful than just making us feel groggy. Researchers from Bristol University used structural magnetic resonance imaging to show that airline workers with several years' experience of disrupted circadian rhythms have smaller temporal lobes than those who have notched up similar flight times on domestic routes ( Nature Neuroscience 2001;4:567-568[CrossRef][ISI][Medline]). They also had chronically higher cortisol levels, which have previously been correlated with smaller temporal lobes and memory impairment. The same may be true for shift workers.

Minerva fortunately lives in an overheated home and rarely suffers coughs and colds. Her experience is borne out by a study of more than 10 000 Finnish students ( Thorax 2001;56:462-467[Abstract/Free Full Text]), which found that those who reported damp living conditions (visible mould and water stains) were 50% more likely to have had four or more colds during the year, compared with those living in dry homes. The risk of asthma, allergic rhinitis, and atopic dermatitis was also significantly higher.

Doctors are beginning to realise that COX 2 inhibitors such as rofecoxib (Vioxx) and celecoxib (Celebrex), which their developers claim cause fewer ulcers than other analgesics, are not all they're cracked up to be. Data presented to the US Food and Drug Administration suggest that patients taking these drugs have a higher risk of heart attacks than patients taking older pain relievers (about four heart attacks per 1000 patients). According to The New York Times (22 May), the Food and Drug Administration is considering adding cardiovascular warnings to the drug labels.

The case for breast screening programmes is now beyond debate. A meticulous report from Sweden covering almost 30 years of screening shows that the overall impact is impressive: 63% reduction in breast cancer deaths in women screened. According to a commentator in the May issue of ( Cancer 2001;91:1699-1703[CrossRef][ISI][Medline]), concerns about false positive and false negative results should be put into perspective and considered secondary to the major public health breakthrough that breast screening has achieved.

Another debate, this time about whether coffee and tea consumption raises the risk of urinary tract cancer, appears in the ( International Journal of Epidemiology 2001;30:353-361[Abstract/Free Full Text]). Some researchers have argued that the association is confounded by smoking, but a systematic review and meta-analysis of 37 epidemiological studies now concludes that the culprit is coffee, increasing urinary tract cancer by about 20%. Tea remains blame free (in this respect).

Little is known about the long term outcome of using proton pump inhibitors to treat gastro-oesophageal reflux. A follow up of a prospective randomised trial of medical and surgical anti-reflux treatment reported in JAMA 2001;285:2331-2338[Abstract/Free Full Text]) concluded that anti-reflux surgery should not be advised with the expectation that patients will no longer need drugs (62% continued to need drugs). Nor should surgery be considered a cancer prevention measure: whether medical or surgical treatment was given made no difference to the rates of cancer.

Black patients with heart failure have a poorer prognosis than their white counterparts. To see if racial differences in response to drug treatment account for this, 1196 white patients were matched with 800 black patients from the studies of left ventricular dysfunction (SOLVD) trials. Researchers observed a 44% reduction in hospital admissions for heart failure in white patients taking enalapril compared with placebo. No significant reduction was seen among the black cohort ( New England Journal of Medicine 2001;344:1351-1357[Abstract/Free Full Text]). Differences in compliance are unlikely to explain the discrepancy, as hospitalisation rates in both placebo groups were similar.

View larger version (58K): [in this window] [in a new window]   A 16 year old girl cut her knee on coral while in Egypt. The representative of the holiday company squeezed lime juice onto the inflamed area to relieve the irritation, and the girl spent the rest of the day sunbathing. She went on to develop acute erythema and blistering extending down the leg, which resolved leaving florid post-inflammatory hyperpigmentation. Lime juice contains psoralens that can photosensitise the skin, leading to phytophoto-dermatitis. It may touch the skin unintentionally or be applied intentionally, as in this case. T A Chave, specialist registrar, R H Thomas, house officer, J E Osborne, associate specialist, R D R Camp, professor, department of dermatology, Leicester Royal Infirmary, Leicester LE1 5WW, UK

Getting smokers with heart disease to take the risks of smoking seriously can be frustrating. So it's a relief to read that a hospital based prevention and rehabilitation programme for all patients presenting for the first time with coronary artery disease seems to have achieved wonders ( Heart 2001;85:533-538[Abstract/Free Full Text]). Of 158 patients who joined the programme, 72% stayed the course. By the end of the 12 week scheme, 92% of these had apparently stopped smoking, and the same percentage remained nicotine free after one year.

Sex drive depends on several factors, and problems can arise when one partner has a higher libido than the other. According to a preliminary, single blind study of 51 women with unexplained low libido, one solution may lie in Zyban (bupropion), the antidepressant more commonly taken in the USA to help people stop smoking ( Journal of Sex and Marital Therapy 2001;27:303-316). After eight weeks, almost 30% of the women taking the drug reported an improvement in their sex drive. Minerva wonders if this could be women's answer to sildenafil.

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