BMJ  2005;330:E339 (12 February), doi:10.1136/bmj.330.7487.E339

BMJ USA: Minerva

Minerva

The metaphors used for cancer are often military terms such as war on cancer, killer cells, magic bullets, and the need for patients to adopt a fighting spirit. A review in Oncology ( 2004;9: 708-16) discusses striking a balance between this instinct to fight and expressions of healing and acceptance. This is particularly important where the gung-ho attitude of the medical profession may be at complete odds with where the patient and the family are in their journey. Such a mismatch can be harmful all round, falling all too short of a meaningful "victory."

We're in the merry months of seasonal affective disorder, which is commonly followed by mild hypomania in the spring and summer. One hypothesis is that this pattern of hibernation is an adaptive evolutionary mechanism, which enhanced the likelihood of reproductive success for females living at temperate latitudes. Hypomania increases the likelihood of procreation, and becoming pregnant in the summer means giving birth in the spring, when babies would have a higher chance of survival ( Medical Hypotheses 2004;63: 767-72[Medline]).

The cost of a total hip replacement in US hospitals is greater than in Canadian centers, despite significantly shorter inpatient stays in the United States. Some of the biggest differences in cost were for the prosthetic elements used. The countries could learn something from each other: the Canadians could adopt strategies to shorten the length of admissions, and the Americans could seek to control their unit costs ( Journal of Bone and Joint Surgery 2004;86-A: 2435-9).

Some people say that a bowl of porridge oats for breakfast helps to reduce cholesterol levels. A study in the American Journal of Clinical Nutrition ( 2004;80: 1185-93)[Abstract/Free Full Text] now reports that consuming barley as part of a healthy diet may be effective at reducing total cholesterol and low density lipoprotein in men and women with mildly raised lipid levels. Barley proved more effective than other sources of soluble fiber.

A booklet entitled Doctors on the Streets of Paris is a compilation of Parisian streets named after famous and infamous doctors of medicine. The names were found by perusing two street directories of Paris, and the biological details were obtained from various histories of medicine and records of the French Académie de Médecine. For those interested in wandering down rue Charcot or rue Dupuytren and who want more information, contact a.sykes{at}avmail.co.uk.

Adopting personal best peak flow readings into asthma action plans produces better health outcomes than using predicted peak flow targets. But how long after a change of treatment should peak flow readings be assessed? Analysis of data from a trial involving 61 people with poorly controlled asthma at the start found that the most useful way of defining the personal best peak flow is the highest peak flow reading over the previous two weeks. With twice daily monitoring, the peak flow reaches a plateau after just a few weeks ( Thorax 2004;59: 922-4[Abstract/Free Full Text]).

As the dark, gloomy afternoons settle in, spare a thought for the hypothesis that the suppression of melatonin by exposure to light at night may account for higher rates of breast and colorectal cancers in the developed world. Indirect evidence suggests a link between exposure to light at night in shift workers and higher incidences of these cancers. Artificial lighting that only serves visual acuity is no longer acceptable; it also has to be friendly to the circadian clock for the sake of the public's health ( Medical Hypotheses 2004;63: 588-96[CrossRef][Medline]).

People who are depressed respond more negatively to non-verbal communication than people who aren't. A study in general practice has shown that negative responses to facial expression and vocal tone improve after treatment for depression, and are not permanent. Disturbance was most profound among patients who had experienced previous depressive episodes, so teaching people what they do when they're in a depressed state is potentially a useful way of helping them recognize their faulty perceptions so that they can change their behavior ( Primary Care Mental Health 2004;2: 99-106).

After the birth of a child with congenital malformations, one way of looking for the cause is by testing the father's body fluids for organic solvents. Tests are more likely to be positive in men whose occupations are known to expose them to agents of this kind ( Journal of Occupational and Environmental Health 2004;46: 761-7)—which means some predictable increased risk in painters and plumbers, and nowadays in agricultural workers. In this context, organic is a term with negative implications.

A 50 year old man used clobetasol propionate (a highly potent steroid cream) for a facial rash that he described as "redness of both cheeks." Four months later, he was referred urgently with a florid rash typical of severe rosacea. Rosacea is a chronic inflammatory facial dermatosis of unknown etiology characterized by erythema and pustules. Treatment is with topical metronidazole or, in severe cases, systemic tetracycline. In the short term topical steroids can improve the appearance in rosacea, but long term usage may worsen or even induce the condition. Annette Loffeld specialist registrar Annette.loffeld{at}blueyonder.co.uk Chin Y Tan consultant Skin Centre City Hospital Birmingham B18 7QH, UK

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 synchronization 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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