BMJ  2004;329:1054 (30 October), doi:10.1136/bmj.329.7473.1054

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Does anorexia nervosa exist in cultures where the pressure to be thin is less pervasive than in the West? A study of 668 students in two schools in Ghana identified 10 women with a body mass index (kg/m²) < 17.5 in whom "self starvation" seemed to be the only cause for their low weight. Although these students did not seem to have the typical Western anorexic concerns about weight or shape, they did hold beliefs about self control and hunger denial, and they all viewed their food restriction positively and in religious terms ( British Journal of Psychiatry 2004;185: 312-7[Abstract/Free Full Text]).

Toast lovers in Norfolk will be relieved to hear that toast is once more on the menu at the Norfolk and Norwich University Hospital. It was removed in 2000 when a "risk assessment" deemed that the smoke detectors and sprinklers used in the hospital were too sensitive to cope with burnt toast. Installation of a more sophisticated alarm system has delighted patients and staff alike ( Health Service Journal, 23 September 2004: 9).

In Britain the legal responsibility for determining a person's fitness to drive rests with the Driver and Vehicle Licensing Authority, but it says it need not be notified after an operation or an injury unless the disability is likely to become permanent ( Injury 2004;35: 888-90[Medline]). Patients who have recovered from surgery are told to decide for themselves after discussion with their doctors. The BMA will say, however, that doctors cannot forecast future health. What they can do is to tell their patients what has happened in the past. After a hip joint replacement, for example, most people can drive after eight weeks. A few patients have found that eight weeks is too soon after an operation on the right hip.

Staying with arthroplasties, degenerative joint disease of the knees is more common in obese people, and so it is not surprising that many patients who have knee replacements are obese and some are morbidly obese. A comparison of the outcome in 68 such patients with that in controls of normal weight found that 69 of the 78 joint replacements in the obese patients had a successful outcome, but nine were failures ( Journal of Bone and Joint Surgery 2004;86A: 1609-15). All but one of the controls had a good result. The message is clear.

A survey in Sweden of all parents who had lost a child to cancer between 1982 and 1991 got responses from 449 of the 501 eligible parents ( New England Journal of Medicine 2004;351: 1175-86[Abstract/Free Full Text]). These showed that none of the 147 parents who had talked with their children about death regretted it afterwards, whereas 69 of the 258 who had not talked about death later wished they had done so.

Japanese encephalitis is a threat to the health of travellers in Asia, Nepal, India, and Papua New Guinea. Infection may be asymptomatic but may be fatal or leave neurological deficits ( Medical Journal of Australia 2004;181: 269-70[Medline]). A vaccine is available at a material cost of $A300 (£120; $220; 175) a head—enough to discourage young adults looking for a cheap holiday in an exotic location. At present, vaccination is recommended for long term residents and travellers who will either spend a long time in the region or be in high risk rural areas. Prospective travellers should get some local advice if possible.

A survey conducted by the charity Developing Patient Partnerships on missed appointments in NHS general practice after its "Keep it or Cancel it" campaign reports that almost nine million appointments with general practitioners and just under four million appointments with practice nurses are missed each year. This is a decrease of 3.5 million compared with last year. The charity says many practices are now striking repeat offenders off their registers and that 64% of practices support the idea of charging for wasted time ( Healthy Partnerships 2004;25: 3).

A woman presented to her optician for routine eye testing. She was found to have bilateral temporal field deficits and was referred for a neurological opinion. Examination and magnetic resonance imaging did not suggest a cause. The diagnosis of tilted optic discs was made after an ophthalmology review. Tilted disc is a congenital anomaly of the optic nerve head, associated with segmental hypoplasia of the retina and choroid. The condition occurs in 3-4% of the population, and 80% of cases are bilateral. Although the presence of a tilted disc does not exclude a simultaneous chiasmal or intracranial disorder, it should be considered as an important differential diagnosis, as early recognition may obviate the need for unnecessary investigation. Shveta Bansal, senior house officer in ophthalmology, Timothy Gillow, consultant ophthalmologist, Israr ul Haq, consultant radiologist, North Staffordshire University Hospital ST4 7LN, Shabir Mohamed, specialist registrar in ophthalmology, Birmingham Eye Hospital

Reciting Homer's Iliad or Odyssey could offer great benefits to your health, according to an article in Scientific American ( 2004;October: 13). German physiologists have shown that such poetry can get your heart beating in time with your breathing, and such synchronisation could improve gas exchange in the lungs as well as the body's responsiveness to changes in blood pressure. The type of poetry is critical, however. The original hexametric pace of the verse, as maintained by the German translation, was chosen because of its known "feel good" effects on readers and listeners.

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Pieter J. Carpentier
bmj.com, 19 Nov 2004 [Full text]