MinervaBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6947.138 (Published 09 July 1994) Cite this as: BMJ 1994;309:138
Americans, who obtain a third of their total fats from meat (mainly hamburgers, cheeseburgers, meat loaf, hot dogs, ham, beef, and luncheon meat), will be relieved that they don't have to swap beef for chicken in low cholesterol diets (Archives of Internal Medicine 1994;154:1261-7). The step 1 diet, restricting saturated fats to between 8% and 10% of total energy, is equally successful at lowering cholesterol concentration whether it includes beef or chicken. Greasy hamburgers, however, are out: the beef must be lean.
Another attempt to balance the risks and benefits of use of oral contraceptives is reported in “Annals of Internal Medicine” (1994;120: 821-6). Follow up of over 150000 nurses for 12 years showed no difference in death rates between women who had ever taken the pill and women who had never taken the pill. Duration of past use did not affect mortality either, prompting the authors to conclude that using the most effective method of contraception is safe.
A new newsletter raising the profile of social inequalities in health landed on Minerva's desk this week. Aimed at politicians, policymakers, and the public, the first issue (Society and Health 1994 June) summarises the key health inequalities in Britain, which cut the life expectancy of the most deprived group by eight years compared with the most privileged group. The newsletter is produced jointly by the King's Fund Institute and the Centre for Health and Society and is available free from the King's Fund Institute, 14 Palace Court, London W2 4HT (tel 071 243 8848).
Cancer of the pancreas remains a dismal diagnosis. Most patients are unfit for radical surgery, and survival is on average only three months. Surgery is, anyway, rarely curative. Results of controlled clinical trials of chemotherapy with one agent have also been disappointing, but combined treatment with fluorouracil, adriamycin, and mitomycin looks more hopeful. In a controlled clinical trial (“British Journal of Surgery” 1994;81:882-5) chemotherapy prolonged survival to 33 weeks. Untreated patients survived only 15 weeks.
Contact lenses may satisfy a wearer's vanity, but bacterial keratitis is a high price to pay. A survey of lens hygiene in west central Scotland (Journal of Infection 1994;28:293-304) found that half of lenses cases were contaminated with at least one micro-organism, including bacteria, amoebas, and yeasts. Disinfecting soft lenses with solutions of chlorine was associated with contamination, as was using tap water to clean hard lenses.
Snoring, whether or not it interferes with breathing, can be treated with nasal continuous positive airway pressure. In sufferers who just snore, however, the inconvenience of wearing a mask connected to a compressor every night usually outweighs the benefit. The effects of positive airway pressure continue after the treatment has stopped (“Thorax” 1994;49: 562-2), but, unfortunately for these snorers and their bed partners, the intensity of snoring returns to usual levels within 10 days. Intermittent treatment is probably not the answer.
Good hospitals for people with learning disabilities don't seem like hospitals at all. Minerva visited one in King's Lynn last week. The local consultant, Debrata Chakraborti, whose patients now live in their own rooms in small bungalows, is concerned, however, that few other learning disciplines around the country have such good facilities and that the NHS may be pulling out of providing services for them.
Vitamin A deficiency may contribute to the transmission of HIV from mother to child, according to a study of over 300 affected women in Malawi (“Lancet” 1994;343:1593-7). Vitamin A deficiency during pregnancy, present in two thirds of the women, was associated with a threefold to fourfold increase in the risk of vertical transmission. The authors speculate that the role of vitamin A in maintaining mucosal surfaces and that immune function could be important in decreasing the chance of passing on the virus.
Chinese women working rotating shifts in textile mills during pregnancy tend to have smaller babies and shorter gestations than women working regular hours. A study in Occupational and Environmental Medicine (1994;51:470-4) looked at 845 women, three quarters of whom worked rotating shifts including nights. Preterm delivery and low birth weight were both commoner in the women who worked rotating shifts, adding to mounting evidence that shift work is bad for you.
A disturbed 16 year old girl was repeatedly admitted to hospital for acts of deliberate self harm, including eating cling film and a torch bulb (British Heart Journal 1994;72:92-3). After her 11th discharge in two months she went back to the secure unit where she lived and ate several leaves off the yew tree in the garden—the most toxic tree in Britain. She survived the ensuing cardiac arrythmias, but the yew tree was felled, only to be eaten by four other residents while it was awaiting disposal in the grounds of the unit. They too survived.
The American Federal Aviation Authority retires all its pilots at 60 and rules that pilots mustn't fly if they have had a drink within the past eight hours. Both rules are controversial. A study in the Journal of the American Geriatrics Society (1994;42:577-82) found that pilots were still impaired eight hours after a drink and that younger pilots performed no better than older ones. The authors conclude that an eight hour delay “from bottle to throttle” isn't enough.