BMJ  2004;328:1574 (26 June), doi:10.1136/bmj.328.7455.1574

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Aerobic physical fitness is a dynamic process. Rat studies show that cardiac benefits gained over three or four months are lost within a month once training stops. The size of heart muscle cells, contractile capacity, and arterial relaxation are directly related to intensive exercise programmes, suggesting that the changes are brought about by cellular mechanisms ( Circulation 2004;109: 2897-904[Abstract/Free Full Text]).

People often say they don't want flu jabs because they think their last jab caused a flutype illness. But it doesn't really stack up. A randomised controlled trial of acute respiratory illness in patients with chronic obstructive pulmonary disease found that influenza vaccination is highly effective at preventing influenza-related acute respiratory illness, regardless of the severity of the underlying lung disease, comorbidity, age, or smoking status. Vaccination's overall impact on acute respiratory illnesses depends, of course, on what proportion of circulating infections are attributable to influenza ( Chest 2004;125: 2011-20[Abstract/Free Full Text]).

Marriage doesn't suit everyone. Most studies have focused on newlyweds, but an examination of depression and age among married people found that of the three cohorts followed—young, middle aged, and older adults—older people scored significantly higher on marital satisfaction than the others. Untangling things further, this study found that marital satisfaction was more strongly related to depression for older people than for younger adults ( Gerontologist 2004;44: 328-38[Abstract/Free Full Text]).

Writing about his personal frustrations of suffering from lifelong eczema in the Quarterly Journal of Medicine ( 2004;97: 383-4)[Free Full Text], a doctor says that for people who have eczema, it is first and foremost a disease of itch, rather than appearance. At times, it's an itch that "only hot water close to boiling point will crack." His advice to fellow sufferers: be meticulous about applying emollients on newly washed skin that is still slightly damp.

Here's a study that could help women who leave childbearing for rather longer than nature intended. Using transvaginal sonography, a Scottish team have found that "ovarian reserve"—the primordial follicle population that remains—is significantly correlated with ovarian volume in women aged 25 to 51 ( Human Reproduction 2004; 19: 1613-8). The technique could also revolutionise the reproductive management of women who've been treated for childhood cancer and those who need assisted conception.

The leading cause of death in the armed forces and police forces in some African countries is AIDS. In Nigeria, for example, secrecy and multiple sex partnering in the Nigerian navy may be partly responsible for the HIV pandemic in that country. In a survey of 480 Nigerian naval personnel, about a third said they had had sex with a female sex worker and 41% had not used a condom at the last visit. Married men were four times less likely to use a condom than single men ( BMC Public Health 2004; 4: 24[CrossRef][Medline]).

The UK's ageing population could bring 100 000 extra new cases of cancer by 2024. Wales and Scotland are set to see an increase of 23% in the number of over 65s, with England following with 21% and Northern Ireland with 19%. According to projections by Cancer Research UK, the ageing differential will bring cancer inequalities, which in turn means different parts of the country will need resources to match.

Being able to discriminate sounds with overlapping tones and frequencies takes place not in the brain but in the ear itself, and more specifically in the cochlea. Scientists say that cochlear biophysics indicate that auditory "contrast sharpening" is essentially pre-neuronal, and only the final processing occurs upstream in the brain. This differs from visual contrast sharpening, which has long been understood in terms of retinal neuronal wiring ( Proceedings of the National Academy of Sciences 2004;101: 9179-81[Abstract/Free Full Text]).

Nurses may be becoming "too posh to wash" in Britain, but there are some tasks that make their job fairly unpleasant at any time. Smells, for one thing, or dealing with bodily fluids; but what about being asked to remove glass eyes or aversions like a horror of false teeth? Nursing Times (15 June 2004: 20-2) points out that, like doctors, nurses can find career niches that may suit them better. But attempting to "cure" someone to overcome their particular bête noir by overexposure may be counterproductive.

Despite great efforts to make smoking cessation a priority in clinical practice in Britain, the trends show that, if anything, the proportion of smokers recalling receiving help or advice on smoking from health professionals has actually fallen over the past five years ( Journal of Epidemiology and Community Health 2004;58: 569-70[Free Full Text]). The number of people taking up nicotine replacement therapy and help from smoking cessation services, despite their availability on the NHS, remains surprisingly low.

An 81 year old man was referred urgently to the eye clinic with an uncomfortable cicatricial ectropion of his left lower eyelid. Three weeks earlier he had undergone repair to a complex facial laceration below and lateral to this eyelid. This ectropion was repaired using both a rotation flap from the upper lid and a separate free skin graft. Lacerations near to the lower eyelid should be assessed carefully and, whenever possible, closed with the long axis of the wound in a vertical plane. This minimises the risk of wound contracture causing ectropion. If skin loss is suspected, a specialist opinion is warranted, although the wound may be best left to granulate. Jonathan D Rossiter, specialist registrar, Hunter Maclean, consultant, department of ophthalmology, Queen Alexandra Hospital, Portsmouth PO6 3LY

Another area where we've still got a long way to go is persuading men to visit their family doctor. The difference in life expectancy rates between men and women is partly attributable to the fact that early detection rates of serious disease among men are lagging. Public Health News (14 June 2004: 14-6) says many men still don't want to be seen as anything but tough, and that's not an image consistent with admitting physical or emotional vulnerability. Low consultation rates may also be a failure of health services to make themselves more attractive to men.

Becoming bilingual at an early age sets your brain up for life, according to a report in the Times of India (15 June 2004). A study of people who grew up speaking two languages found that juggling languages may help prevent the mental slowing caused by ageing. Bilingual people were better at rapidly changing, complex tasks than people who grew up speaking just one language.

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Rapid Responses:

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Marital satisfaction and depression among elderly population.

Dr. Naseem A. Qureshi MD, IMAPA, LMIPS
bmj.com, 28 Jun 2004 [Full text]

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alex paton
bmj.com, 29 Jun 2004 [Full text]