BMJ  2006;333:506 (2 September), doi:10.1136/bmj.333.7566.506

Minerva

Minerva

One of two general practitioner representatives on the Caldicott Commission (which reported on issues of patient confidentiality in England) says he has opted out of having his medical records included in the common health record (British Journal of General Practice 2006;56: 640). Despite all he has heard, he remains sufficiently concerned about the confidentiality of computerised medical records not to give consent. He may be alone in doing so. Last year he received a routine mailing about the common record, offering him the opportunity of opting out but "cleverly disguised" as junk mail, which may account, he says, for his failing to meet anyone else who has taken the same decision.

Although it's commonly thought that long term use of hormone replacement therapy benefits brain function, studies show inconsistent results. A six year single blinded follow-up study of 60 postmenopausal women who took oestrogen regularly, irregularly, or never says that long term use didn't influence cognition either way (Neurology 2006;67: 706-9[Abstract/Free Full Text]). The cognitive function of all participants was well maintained.

Moving from full time paid work to full retirement seems to be more of a process than an event. An American study of retirement patterns found that most older Americans in work retire gradually, with "bridge jobs," rather than doing it overnight. Younger people, those without defined pension plans, and, interestingly, people at both ends of the wage distribution scale are more likely to take on bridge jobs (Gerontologist 2006; 46: 514-23[Abstract/Free Full Text]).

Women with a history of gestational diabetes could be missing out on opportunities to be screened for type 2 diabetes. A study in the American Journal of Public Health (2006;96: 1643-8[Abstract/Free Full Text]) concludes that most of the 570 women with gestational diabetes who gave birth at one hospital were not screened or even advised to have a fasting glucose test within six weeks after delivery. Married women were more likely to get tested, as were women who had more than one postnatal visit with a healthcare professional or who were seen by an endocrinologist after delivery.

Making dietary changes to lower your personal risk of cancer is fraught with danger when evidence from large epidemiological studies is extrapolated to individuals. For example, an Israeli team report that their results suggest that substituting nonanimal fat for animal fat during adult life might reduce the risk of ovarian cancer. They say "might" because prospective studies are needed to confirm their retrospective case-controlled findings (Journal of Nutrition 2006;136: 2362-7[Abstract/Free Full Text]).

An 84 year old woman admitted with a swollen ankle was found to have linear ridges on both her thumbnails. When questioned, she admitted scratching her nails at times of stress. She had done it since her teenage years, and it had developed into a habit. Her other nails didn't show any abnormality. This habit-tic deformity is often confused with onychomycosis. It is often found on the thumb of the dominant hand, but in this patient it was bilateral. M Fuad Hameed (fhameed{at}nhs.net), specialist registrar, Charles Chithila, associate specialist, department of elderly medicine, Woodend Hospital, Aberdeen, AB15 6XS

Fascinating findings are reported in the British Journal of Pharmacology (advance online publication 21 Aug 2006; doi: 10.1038/sj.bjp.0706862). Two days of pre-treatment with simvastatin in an animal model of infarction reduced the area of "no reflow" (areas of impaired blood flow that remain even after the vessels have been reopened after an infarct). Ventricular function was also better preserved, and the area of necrosis decreased compared with that in the control and placebo groups. Scientists say simvastatin acts by opening ATP sensitive potassium channels in mitochondria. Long term treatment with statins not only reduces the chance of a heart attack but also seems to allow the heart to recover more fully after infarct.

China, India, and the Russian Federation account for 62% of the estimated global burden of multidrug resistant tuberculosis. In 2004, 181 408 cases were estimated to have occurred in people who had been previously treated for tuberculosis, and 4.3% of all new and previously treated cases of tuberculosis were multidrug resistant. According to the World Health Organization, these updated figures call for an urgent plan of action in low resource settings (Journal of Infectious Diseases 2006;194: 479-85).

The UK and US medical workforce is becoming female heavy. So is medicine being practised in a more feminine way? Are we becoming more patient centred and better at listening, moving away from the more masculine traits of curing, dictating to patients, and being provider centred? The answer, according to a large study of the sex of doctors and patient satisfaction in primary care, is a resounding "no" (Quality Management in Health Care 2006;15: 96-103[Medline]). After age and satisfaction with the premises had been adjusted for, the sex of neither the patient nor the doctor was associated with patient satisfaction.

Breast reduction surgery is carried out for various reasons, and poor lung function doesn't usually feature at the top of the list. But a randomised controlled trial of 65 women reports a direct correlation between improvement in lung function and the weight of tissue resected (Plastic and Reconstructive Surgery 2006;118: 1-6[CrossRef][ISI][Medline]). Commenting on the findings, a surgeon says it might be useful to keep reprints of the study handy, especially when trying to persuade insurance companies, or even the NHS, to cover such procedures.

A word of advice for anyone designing flu vaccine programmes in countries where flu presents mainly between December and early March: try not to vaccinate later than mid-November. Late vaccination is less beneficial. In one study, people vaccinated in late November tended to be younger, with a lower burden of illness, yet had higher rates of hospital admission and longer hospital stays during the following winter. No differences were noted during the following summer (Preventive Medicine 2006;43: 71-6[CrossRef][ISI][Medline]).

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