BMJ  2005;330:E355 (14 May), doi:10.1136/bmj.330.7500.E355

BMJ USA: Minerva

Minerva

Minerva

It's official: job satisfaction is good for your health. A meta-analysis of 485 separate studies reports that job satisfaction is highly correlated with physical and mental well-being. According to the authors, occupational health clinicians should help anyone who has been diagnosed as having psychological problems to critically evaluate their work and to try to find out which bit of their working life is unsatisfactory ( Occupational and Environmental Medicine 2005;62: 119-23[Abstract/Free Full Text]).

Age does bring wisdom, according to a survey conducted by the Department of Health. People aged 45-64 make better health care decisions than younger people when it comes to knowing they should call the emergency services if they experience severe chest pain, or knowing what they should do for minor injuries and illnesses. Examples of inappropriate calls to the emergency services include calling to ask how to defrost a turkey and asking about what to do about a broken artificial nail.

The risk of suicide after self harm is 30 times that in the general population, a prospective cohort study of almost 8000 people attending emergency departments after self harm has found. Four years later, 60 people had committed suicide. Women were more at risk then men, and the six months after self harm seemed to be the most vulnerable time. Independent predictive factors for suicide included trying to avoid being discovered at the time of the original self harm, not living with a close relative, a history of psychiatric treatment, alcohol misuse, and physical health problems ( American Journal of Psychiatry 2005;162: 297-303[Abstract/Free Full Text]).

A new reality show in the United States promises "medical miracles." Apparently the makers of the show will pull together a team of doctors who will "scour the country seeking people who urgently need medical care but do not have the wherewithal to obtain it." Minerva thinks they won't have to look far for deserving patients, and she wonders just how undignified life will be for those who sign up. Usually a desire for fame lies behind people wanting to take part in such shows. In this case it may simply be a desire to go on living.

Travelers who have persistent diarrhea on returning from exotic places don't always carry infection. A case report in the Scandinavian Journal of Gastroenterology ( 2005;40: 112-4)[CrossRef][Medline] describes a 40 year old woman who returned from East Timor with what she was convinced was an unidentified bug. In fact she gave a classic history for a small bowel malabsorption syndrome and responded rapidly and dramatically to a gluten free diet. Infectious organisms may start malabsorption processes, but antiinfectious agents do little to stop them.

Providing clear information about when patients can return to work after inguinal hernia repair has successfully reduced the typical time off work from six weeks to two. Information leaflets urging an early return to work and to sporting activities were given to patients and their doctors two weeks before the operations took place. Of the 78% of patients who were in paid employment, 82% returned to work within two weeks, and 89% of those who drove were driving again by the end of the second week ( Journal of One-Day Surgery 2005;15: 15-7).

Arthritic hips, hands, and backs tend to run in families but, strangely enough, arthritic knees do not. A Dutch study of middle aged sibling pairs with osteoarthritis reported in the Annals of the Rheumatic Diseases ( 2005;64: 438-43)[Abstract/Free Full Text] found that the risk of having arthritis at the same site among siblings was striking for spine and hips, but almost absent for arthritis of the knee. Minerva presumes this suggests more of a genetic component for hips, hands, and spine, and a more mechanical trigger for arthritic knees.

Are Mondays really as bad as we think they are? A meta-analysis didn't find great support for this: 28 studies covering 16 countries and 1.6 million coronary events found that the Monday excess was very small. In a population experiencing 100 coronary events per week, there was just one extra event on Mondays, compared with other days ( Journal of Epidemiology and Community Health 2005;59: 109-14[Abstract/Free Full Text]).

Analysis of data from the Baltimore longitudinal study of aging confirms that blood pressure and cognitive function are not linearly related, but the association is more U shaped or J shaped. Both low and high diastolic pressures in people who are not taking antihypertensive drugs were associated with poorer performance on a battery of cognitive tests, particularly among less educated and older people, and the mechanism may involve inadequate cerebral perfusion ( Hypertension 2005;45: 374-9[Abstract/Free Full Text]).

View larger version (130K): [in this window] [in a new window]   A 15 year old girl presented with pain in her left groin, without systemic symptoms. Examination showed that her abdomen and pelvis were normal. She had a full range of movements of her left hip joint, but they were painful. An x ray of her pelvis showed a radio-opaque shadow with the density of bone. This is the calcification of myositis ossificans traumatica, a disorder in which the muscles (and other soft tissue, such as tendons and ligaments) are affected by ossification or cartilage formation. This particular example is known as rider's bone and is a localized ossification of the inner aspect of the thigh, within the tendon of the adductor longus muscle. It is sometimes found in horseback riders after direct or repeated trauma. Prasad Bane senior house officer dr_prasad_bane{at}rediffmail.com department of neurosurgery Tyrone County Hospital, Omagh BT79 0NS, UK

Michelangelo's sculpture David has a general asymmetry, with the head and upper body proportionally larger than the lower body. He also has deviating eyes, with the left eye fixating on the viewer while the right eye seems to be looking at the far distance. An art critic and an ophthalmologist writing in the Journal of the Royal Society of Medicine ( 2005;98: 75-6)[Free Full Text] say that the exotropic David—a "sublime balance of power, intellect and neoclassical beauty"—would probably have had problems successfully disposing of Goliath with a sling.

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