Minerva Minerva


BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7273.1422 (Published 02 December 2000) Cite this as: BMJ 2000;321:1422

Between December 1944 and April 1945 the official daily food ration for adults in Amsterdam dropped to less than 3350 kJ (800 calories). There is already a clutch of papers reporting the health implications for adults born around the time of the famine, and there are two more papers this week. One found that babies who were exposed to the famine in early gestation were more likely than others to have coronary heart disease in middle age (Heart 2000;84:595-8). The explanation, inexplicably reported in a different journal (American Journal of Clinical Nutrition 2000;72:1101-6), is that these babies developed more atherogenic lipid profiles.

It costs at least £106 a week for a single man between 18 and 30 to live a healthy lifestyle in the United Kingdom, say researchers from London (Journal of Epidemiology and Community Health 2000;54:885-9). They estimate that it costs about £3.00 a week to keep and use a bicycle, or a pair of trainers for jogging. Food costs include the price of two portions of oily fish each week and five portions of fresh fruit or vegetables a day. The national minimum wage just about covers the cost of a healthy lifestyle; social security payments for unemployed men do not.

A gram of snooker chalk contains over 7000 µg of lead—not enough to hurt a snooker player, whose exposure is confined to the dust on his clothes, but more than enough to poison a small child who prefers sucking snooker chalk to eating real food (Archives of Disease in Childhood 2000;83:519-20). It took doctors 18 months to find the source of one 3 year old girl's severe poisoning after a standard environmental assessment drew a blank. Eventually they put two and two together when the parents reported that she was often found with a snooker chalk in her mouth.

Last November the small Belgian town of Kapellen saw one of the country's biggest outbreaks of legionnaires' disease (Eurosurveillance 2000;5:115-9). The authorities were alerted by a respiratory physician less than a week after the close of a large trade fair in the town. Ninety three people who visited the fair or worked there became ill; five of them died. Investigators failed to find the exact source of the outbreak but presume that it originated near the centre of the tent where water features, including a fountain and a whirlpool spa, were clustered.

There's already some evidence that full blown schizophrenia can be preceded by a “prodromal period” of less serious psychiatric illness. A large cohort study of Swedish army recruits confirms this (British Journal of Psychiatry 2000;177:416-20). Nearly 40% of the young men who went on to develop schizophrenia had a psychiatric illness at the age of 18 that was recorded at recruitment screening. Neurosis, substance misuse (including alcohol misuse), and personality disorder were all linked to later psychotic illness.

It's not that easy to count heroin users, but best estimates derived from a variety of ascertainment techniques put the total in Australia at about 74 000 (Medical Journal of Australia 2000;173:528-31). This translates into a population prevalence of 7 per 1000 adults aged 15-54 years—almost exactly the same population prevalence as in Britain. The Australian total has doubled over the past 10 years, possibly because heroin has become cheaper in real terms. The street price has remained stable, but purity has improved dramatically.

A Dutch doctor has developed a mobile abortion clinic for use on board ship so she can sail around the world performing offshore abortions for women who cannot get the service on dry land (New York Times 21 November 2000). If the ship anchors in international waters, the Netherland's liberal abortion laws should prevail. The idea has received a cautious welcome among pro-abortion groups, although some are worried about the safety of women on their trip to and from the ship. Staff for the clinic are all set to go as soon as they can find the $190 000 it costs to charter a ship.

Pregnant women with a high serum haemoglobin concentration at their first antenatal visit (146 g/l or higher) are twice as likely to have a stillborn child as women with a serum haemoglobin concentration of 126-135g/l, according to a study in JAMA (2000;284:2611-7). The researchers studied over 1400 Swedish women, half of whom had had a stillbirth after 28 weeks' gestation. The association between high serum haemoglobin concentration and stillbirth was strongest for preterm deliveries and antepartum deaths in babies who were small for gestational age.

We already know that people with inflammatory bowel disease have a tendency to osteopenia, but is it clinically relevant? A comparative study of 6027 Canadians with inflammatory bowel disease and over 60 000 controls suggests that it is. Participants with inflammatory bowel disease were 40% more likely than controls to break bones, including ribs, hips, wrists, and vertebrae (Annals of Internal Medicine 2000;133:795-9). There are several causes of bone loss in these patients, including treatment with steroids. The next step is to find out which cause predominates and to treat it.

Minerva was interested to read which food fads Boston chefs were tiring of (Stuff@night, 7-20 November 2000). One chef singled out the sudden explosion in food allergies, complaining that “everybody's allergic to something and needs things to be specially made.” Restaurants have survived the withdrawal of their welcome to cigarette smokers; will they now feel emboldened to warn: “This restaurant does not cater for food allergies. Susceptible patrons should bring their own adrenaline”?


A 65 year old woman presented to our department with a six month history of hoarseness. She was a heavy smoker. An unusual looking lesion was noted arising from the posterior third of the left vocal cord. Histology confirmed the diagnosis of verrucous keratosis. The black stained villus projections are probably due to chronic smoke inhalation. The lesion was removed and the appearance of her vocal cords gradually improved after she cut down her smoking.

R S Williams, specialist registrar, N Shehata, associate specialist, G O'Sullivan, consultant, department of ear nose and throat surgery, Arrowe Park Hospital, Merseyside CH49 5PE

Loud snoring in children can be benign, but isn't always. A survey of Portuguese school children found that 8.6% of them frequently snore, and a further 30.6% do so occasionally (www.pediatrics.org/cgi/content/full/106/5/e64). Frequent loud snoring was associated with bedtime problems, daytime sleepiness, irritability, and behavioural disturbances. The survey also confirmed the well established link between snoring and upper respiratory tract infections.


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