BMJ  2003;327:878 (11 October), doi:10.1136/bmj.327.7419.878

Minerva

If you're interested in how best to communicate information about the effects of health care, you might be interested in the HIPPO (Health Information Project: Presentation On-Line) project. It's a series of randomised trials on the internet, aimed at finding out how to help people make choices that are consistent with their own values. To participate in the first HIPPO study, which is about helping people to decide whether they should take lipid lowering drugs, go to www.icru.no/hippo/cholesterol/

Some patients are deeply suspicious of flu vaccines, believing that they're bound to get ill immediately after having one. Older people with chronic obstructive pulmonary disease or asthma are particularly targeted in flu vaccine campaigns, so it's reassuring that a cohort study in Thorax ( 2003;58: 835-9)[Abstract/Free Full Text] found no increased risk of adverse acute outcomes in the first two weeks after vaccination and no increase in the number of prescriptions given for oral steroids.

Continuous complaints of tiredness during daily activities should be taken seriously because a five year prospective study in Psychosomatic Medicine ( 2003;65: 771-7)[Abstract/Free Full Text] shows that it is an early sign of functional decline in elderly people. The study followed up 226 men and women aged 75 at five and ten years. Analysis of the survivors found that those who reported sustained tiredness from the age of 75 to 80 were at a significantly larger risk of functional decline from the age of 80 to 85.

As Minerva struggles with the onset of her autumnal lethargy, she's been inspired to take up some much needed exercise. Exercise dependence, however, is another matter altogether ( British Journal of Sports Medicine 2003;37: 393-400)[Abstract/Free Full Text]. When 56 female exercisers were interviewed about their behaviour and attitudes regarding exercise, two diagnostic criteria for dependence emerged: impaired functioning (in any two of four areas: psychological, social and occupational, physical, and behavioural) and withdrawal (as evidenced by an adverse reaction to the interruption of exercise or unsuccessful attempts at exercise control).

The United Kingdom is becoming a nation of extremes. According to a report from a business information company, Datamonitor (www.datamonitor.com), the number of people polarising to each end of the weight spectrum is growing. At the same time, our cardiovascular health is deteriorating while our consumption of vitamins and supplements bought over the counter is climbing dramatically. The report forecasts that the number of people choosing to "downshift" into less stressful lives will rise by 42% to 3.7 million people in 2007.

View larger version (75K): [in this window] [in a new window]   A 69 year old woman, who did not have diabetes, required resuscitation from hypoglycaemia. On recovery, she berated herself for having taken two of her husband's gliclazide tablets by mistake, instead of her two 75 mg aspirin tablets. I thought her mistake was understandable. The prescribing doctor could not have foreseen this either. Professionals often presume that the correct medicines are taken at the correct dose, at the correct time, and by the correct patient. Simple but clinically important errors in concordance may occur with medicines in similar packaging. Alan K Fletcher, specialist registrar, in emergency medicine and general medicine, Northern General Hospital, Sheffield

What is the optimal level of exercise to help people to lose weight? In this study, over-weight men or women were randomly assigned to either a standard behaviour therapy or a high physical activity (HPA) treatment. The HPA group achieved increases in physical activity that were twice as high as in the other group and maintained this for 18 months. Weight loss, however, was no different between the two groups at six months, but the HPA group had lost significantly more weight at 18 months ( American Journal of Clinical Nutrition 2003;78: 684-9[Abstract/Free Full Text]).

If we can't easily measure the size of a lesion, we often record a "guestimate." But when 10 forensic clinicians were asked to guestimate the size of 10 test objects their performance was no better than 13 participants from another profession. For three objects (a balloon, a scratch, and a coin) all participants significantly overestimated size by up to 22%. The authors suggest using a ruler when at all possible ( Journal of the Royal Society of Medicine 2003;96: 497-8[Abstract/Free Full Text]).

Breastfed girls fend off more neonatal respiratory infections than breastfed boys. The protective effects of breast feeding on the risk of infections during infancy are well documented. This unmatched nested case-control study shows that breast feeding confers protection against community acquired infections as early as the first month of life ( Pediatrics 2003;112; e303-7[Abstract/Free Full Text]).

A study of cervical smears in primary care found that the simple measure of cleaning the cervix with a dry, oversized cotton bud successfully reduced the number of smears that were returned with reports of inflammatory exudates or inadequate numbers of endocervical cells. Inflammatory exudate was reported in just 0.3% of the 334 study smears and 11% of the 652 control smears. Just over 3% of the study smears and nearly 14% of the controls were reported as inadequate ( Canadian Medical Association Journal 2003;169; 666-9[Abstract/Free Full Text]).

Abusive experiences leave their mark on people's lives. In this London based self reporting study of women, domestic violence showed the strongest associations with mental health measures. Compared with physical abuse in childhood, sexual abuse in childhood had few associations with adult mental health measures. Sexual assault in adulthood was associated with substance misuse, whereas rape was associated with anxiety, depression, and post-traumatic stress disorder but not substance abuse ( British Journal of Psychiatry 2003;183: 332-9[Abstract/Free Full Text]).

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Rapid Responses:

Read all Rapid Responses

Packaging for different drugs should be easily discernable

Samantha J Line
bmj.com, 11 Oct 2003 [Full text]