BMJ  2006;333:866 (21 October), doi:10.1136/bmj.333.7573.866

Minerva

Minerva

The initial results of the World Health Organization's study on domestic violence against women have just been published. Apart from documenting the shocking extent of the problem, it comes up with 15 recommendations. Some, such as promoting sex equality and women's legal rights, may be wishful thinking in the short term. But others, such as using reproductive health services as entry points for identifying and supporting women in abusive relationships, seem eminently practical (www.who.int/gender/violence/who_multicountry_study/summary_report/en/index.html).

A 45 year old woman has had bilateral hyperpigmentation of her upper face for more than 15 years. She was thought to have melasma (chloasma) until she opened her eyes wide enough to draw attention to the congenital blue-black hyperpigmentation of her right conjunctiva. She has naevus of Ota, which is patches of groups of melanocytes in the dermatome of the first and second branches of the trigeminal nerve, rather than patches of excess melanin deposition as in melasma. Charles Quartey-papafio (charles.quartey-papafio{at}cht.nhs.uk), locum consultant dermatology department, Huddersfield Royal Infirmary, Huddersfield HD3 3EA

The hypothesis that a transient excess of plasma free fatty acids is a predisposing factor for ventricular fibrillation and sudden cardiac death shortly after acute myocardial infarction has been around for many years. A commentary in QJM (2006;99: 701-9 doi: 10.1093/qjmed/hcl084[Abstract/Free Full Text]) argues that it never got the attention it deserved during a period when thrombolysis and revascularisation took centre stage and that it is time to reconsider the feasibility of inhibiting lipolysis as soon as the onset of an acute coronary syndrome is suspected.

The Centre for Global Development's initiative, Engaging Fragile States, is trying to improve the effectiveness of foreign aid. In a recent interview, one of its leaders criticised the US response. Although the attacks in the US on 11 September 2001 altered the rhetoric—previously neglected, poor, and fragile states suddenly being seen as a development issue and a potential threat to global security—there has been little improvement either in funding or in working out a coherent strategy (www.cgdev.org/content/general/detail/10102title).

It is sometimes informative to try carotid sinus massage on an elderly patient who reports fainting or falling unexpectedly. But is it a safe thing to do? Retrospective analysis of data collected from two hospitals on over 2000 patients suggests that the risk is low but not negligible. Two patients experienced transient ventricular tachycardia and four more had a stroke or transient ischaemic attack (Age and Ageing 2006;35: 518-20 doi: 10.1093/ageing/afl057[Free Full Text]).

Although it sounds like folklore, the idea that people who take a large size in hats are more intelligent is borne out by several studies. Findings from the Avon longitudinal study suggest that the critical period for head growth is during the first year of life. IQ scores at the age of 8 years were highest in children whose heads had grown most during infancy, even after adjusting for confounders (Pediatrics 2006;118: 1486-92 doi: 10.1542/peds.2005-2629[Abstract/Free Full Text]).

Genetic association studies have reported four polymorphisms of the vitamin D receptor gene that confer an increased risk of type 1 diabetes. But, as so often with this sort of observation, it doesn't stand up to the scrutiny of a systematic review. When data from all 19 published papers on the topic were combined in a meta-analysis, the associations disappeared (American Journal of Epidemiology 2006;164: 711-24 doi: 10.1093/aje/kwj278[Abstract/Free Full Text]).

A senior neurologist describes suddenly losing his ability to read music and to play the piano accurately and expressively after an embolic cerebral infarction (Brain 2006; 129: 2554-61 doi: 10.1093/brain/awl235[Abstract/Free Full Text]). The infarct was located in the right angular and supramarginal gyri. The musical dyslexia was accompanied by a small visual field defect, visual hallucinations, prosopagnosia (inability to recognise faces), topographical disorientation, disturbance of perception of velocity of moving objects, and dyscalculia. The account is all the more moving for the dispassionate way in which it is written.

During the second half of the 20th century, oestrogen was given to many healthy girls to stop them growing too tall. An essay in Archives of Pediatric and Adolescent Medicine (2006;160:1035-9 http://archpedi.ama-assn.org/cgi/content/full/160/10/1035) argues that although this treatment can be seen as a straightforward application of scientific knowledge about this hormone and closure of the growth plates, it also reflected the prevailing societal belief that being a tall girl was disadvantageous, perhaps even deviant. The authors point out that similar considerations might apply today to the use of growth hormone therapy for short boys.

Anyone (of either sex) who has wondered why women are so under-represented in academic medicine might like to visit https://www.surveys.athenaproject.org.uk/ asset2006 to take part in the Women in Academic Medicine Project. Funded by the British Medical Association, the Higher Education Funding Council for England, and the Medical Women's Federation, the study is trying to identify barriers to women's careers, to explore the assumptions about career progression that underlie these barriers, and to provide baseline data so that future studies can evaluate improvements. Of course, it hopes to suggest some solutions too.

Even objective measures of risk and effect can sometimes be presented in ways that lead to unjustifiably positive or negative interpretations. An article in Advances in Psychiatric Treatment (2006;12:320-7 http://apt.rcpsych.org/cgi/content/full/12/5/320) argues that significance testing has been used inappropriately to spin the data on antidepressants so that benefits are exaggerated and harms minimised. An accompanying commentary, on the other hand, reckons that the author of the first article is doing the same thing but in the opposite direction.

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On the naevus of Ota

Daniele Torchia
bmj.com, 4 Nov 2006 [Full text]