BMJ  2004;328:116 (10 January), doi:10.1136/bmj.328.7431.116

Minerva

It's more than 10 years since the first transplantation of cord blood from an unrelated donor for leukemia. But does this work in children? The answer is "maybe." A study in Blood ( 2003;102: 4290-7)[Abstract/Free Full Text] reviewed the outcome of 95 children with acute myeloid leukaemia after cord blood transplantation. The naive immune system of cord blood seems to reduce the risk of graft versus host disease substantially, and the authors also report a two year leukaemia-free survival for half of patients who underwent transplantation in second remission.

People with high blood pressure are warned to check with their doctor before using a jacuzzi or hot tub, although there's little evidence for such warnings. When 21 patients with stable, treated hypertension were immersed in a hot tub for 10 minutes their blood pressure lowered, but no more than in normotensive controls. Blood pressure returned towards baseline within 10 minutes after they got out of the tub. Heart rates rose in both groups ( CMAJ 2003;169: 1265-8[Abstract/Free Full Text]).

The religious orders study is a longitudinal observation of Alzheimer's disease in older members of the Catholic clergy. In 141 autopsies of people without focal neurological disease, 57 probably had Alzheimer's disease. A complex statistical analysis suggests an association between "distress-proneness" (neuroticism) and Alzheimer's disease, but the autopsy data show that the link is not with brain pathology but with the expression of dementia in people with such pathology ( Neurology 2003;61: 1479-85[Abstract/Free Full Text]).

Continuing on the theme of cognitive decline, Minerva has found a study in Brain ( 2003;126: 2273-8)[Abstract/Free Full Text] that suggests that the optimum time for brain development is not in utero, or at birth, but during infancy and early childhood. Epidemiologists found that adults with big heads fare better in their later years than those with smaller heads, in terms of preservation of cognitive abilities. Head circumference at age 6 years is about 93% of its final size.

The guilt of mothers who find themselves unable to breast feed their babies may be further fuelled by a study in the Journal of Nutrition ( 2003;133: 4243-5)[Abstract/Free Full Text] showing that exclusive breast feeding of healthy term infants for at least six weeks seems to improve their neurological condition. Movement quality is a sensitive marker of neurological condition, and the data show a positive association between duration of breast feeding and movement quality, with a saturation effect at the age of about 6 weeks.

Some emergency medicine residency programmes include training for helicopter emergency medical services. In most cases, a resident works with one other crew member, typically a nurse or paramedic. But a survey of programmes known to provide this training found a huge variety in the quality and quantity of the training available. The amount of flight hours for residents, for example, ranged from 25 to 500, and the number of flights ranged from five to 225 ( Academic Emergency Medicine 2003;10: 1404-6[CrossRef][ISI][Medline]).

Using living close to roads as a proxy for exposure to road traffic pollution (a factor known to be linked with stroke), a geographical study in England and Wales concludes that road traffic pollution is associated with an excess risk of death from stroke. If causality is assumed, almost 990 stroke deaths a year might be attributable to road traffic pollution ( Stroke 2003;34: 2776-80[Abstract/Free Full Text]).

People have said that receiving bad news has had the effect of making them make important decisions about how they spend the rest of their lives. A woman who has now been living with cancer for years quickly changed her career on learning of her diagnosis. Her elderly father, on the other hand, on being told he had a blockage in his bowel (without any further explanation) went out and shot himself that same day ( Oncologist 2003;8: 587-96[Abstract/Free Full Text]).

The assertion that social justice is the foundation of public health is controversial. When it's translated to the realms of theory and action, the premise that societal arrangements of power and property shape the public's health can be a motivating force for identifying and rectifying social inequalities in health. "Latin American Medicine" is designed to encourage dialogue across the Americas (from South to North, and across Latin America) by increasing access to the Latin American social medicine literature via the internet (http://hsc.unm.edu/lasm).

When pill taking becomes "routinised," episodic compliance and non-compliance with medication is better understood. A qualitative analysis of HIV positive patients identified that pill taking routines, linked with a person's ability to maintain these routines (time of day of scheduled dose, location of person at that time of day), affect whether medication gets taken. Having an unpredictable social life can act as a barrier to adherence ( AIDS Care 2003;15: 795-806[CrossRef][ISI][Medline]).

Pleural malignant mesothelioma is challenging to diagnose, and seeding of biopsy channels with malignant cells should be anticipated with radiotherapy. The converse was true in a middle aged builder who presented with a rock hard mass on the left lateral chest wall. Five months earlier he had had a chest drain inserted for a spontaneous pneumothorax. No manifestations of mesothelioma had been recorded at the time, hence nothing was done to prevent this typical implantation metastasis from slowly growing through the incision site. A Diacon, consultant, J Theron, specialist registrar, M Schuurmans, research fellow, department of internal medicine, Tygerberg Hospital, Cape Town, South Africa

Chaperoning of patients in genitourinary clinics and elsewhere remains variable, and there's a lot of anecdotal evidence that female patients are more often chaperoned than males. A letter published in Sexually Transmitted Infections ( 2003;79: 498)[Free Full Text] contends that the issue of funding for chaperoning could be argued under the remit of professional safety. For the patient, having a nominated chaperone (ideally a nurse) from the outset of treatment offers continuity of care.

Sledging accidents in Britain cause a multitude of injuries, including spinal trauma. Increased flexion of the spine (a position often used when parents try out their child's sledge or when improvised equipment is used) predisposes to injury. A case series discussed in Injury ( 2003;34: 940-1)[CrossRef][ISI][Medline] finds that most inpatients don't need referrals to specialist centres, but the costs of such injuries can mount up, especially when plaster jacket immobilisation is needed.

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cricket semantics

David J Brookman
bmj.com, 18 Jan 2004 [Full text]