Reviews Minerva


BMJ 2001; 322 doi: (Published 26 May 2001) Cite this as: BMJ 2001;322:1314

A two year follow up of 447 Finnish hospital doctors and their senior nurse controls has found that the doctors took about one third of the amount of sick leave taken by their controls. But there were no differences in health outcomes, self rated health status, and the prevalence of chronic illness between the two groups (Occupational and Environmental Medicine 2001;58:361-6). Poor teamwork seems to contribute more to doctors' absenteeism than overwork or low job control.

Giving birth to twins is hard enough, without also trying to run a state with more than six million residents, but this is exactly what the acting governor of Massachusetts was doing last week. Confined to a hospital bed while experiencing regular contractions, she answered calls, signed letters, and met with aides. A spokesman said of the overly dutiful governor that “she would not describe this as the optimal situation” but “if she can continue her job, she will” (New York Times 11 May).

Jet lag may prove more harmful than just making us feel groggy. Researchers from Bristol University used structural magnetic resonance imaging to show that airline workers with several years' experience of disrupted circadian rhythms have smaller temporal lobes than those who have notched up similar flight times on domestic routes (Nature Neuroscience 2001;4:567-8). They also had chronically higher cortisol levels, which have previously been correlated with smaller temporal lobes and memory impairment. The same may be true for shift workers.

Minerva fortunately lives in an overheated home and rarely suffers coughs and colds. Her experience is borne out by a study of more than 10 000 Finnish students (Thorax 2001;56:462-7), which found that those who reported damp living conditions (visible mould and water stains) were 50% more likely to have had four or more colds during the year, compared with those living in dry homes. The risk of asthma, allergic rhinitis, and atopic dermatitis was also significantly higher.

Rheumatologists hopeful that autologous stem cell transplantation will benefit patients with intractable systemic sclerosis can read about the pros and cons of taking such a dramatic approach in a report of the first phase I/II trial of 40 patients (Annals of the Rheumatic Diseases 2001;60:548-9). Skin disease improved considerably in many, though it was not cured, and lung function improved in a few. But there was no improvement in major organ involvement, and mortality related to the procedure was about 17%.

Evolutionary biologists concerned that bacteria may be sneakily manipulating the human genome for their own benefit can rest easy. A new study from the Institute for Genomic Research reports that humans carry up to only 41 genes in common with bacteria, rather than the 223 previously reported ( Plausible explanations for these “bacteria to vertebrate transfers” include the suggestion that other eukaryotes have simply lost these shared genes along the way.

Minerva thought poor compliance with antimalarials was due to their bitter taste. But researchers say in this month's Bulletin of the World Health Organization (2001;79:394-9) that poor compliance in Ghana is largely explained by the high costs of excessive prescribing and dispensing, in addition to long waiting times at dispensaries. They tested this by providing prepackaged antimalarials and found that costs went down by 50%—and compliance improved by 50%.

Heart attack care has changed dramatically worldwide in the past decade. More intensive and expensive procedures are now being used. The way in which practice has changed, however, depends on the country. According to a review in Health Affairs (2001;20:25-42), the United States and Japan demonstrated an early start, fast growth pattern for intensive procedures; countries including Australia and Singapore adopted a late start, fast growth pattern; and Britain and Scandinavia took up the rear with a late start, late growth pattern.

Painful bunions make life miserable, but many doctors suggest leaving well alone rather than undergoing surgery. A randomised controlled trial comparing surgery, wearing orthotics, and watchful waiting (JAMA 2001;285:2474-80) has found that painful days, cosmetic disturbance, and footwear problems were reported less often in patients who had had surgery. Patients in the orthotics group reported substantial relief for the first six months only; those who received no intervention were least happy.

Minerva has a new statistic to contribute to the debate on Nottingham University taking £3.8m from British American Tobacco. Being businessmen, the managers of the company will have calculated they can increase their profits by at least £3m and probably by up to £6m as a result of the deal. In 2000 BAT made £2.5bn profit and sold 800 billion cigarettes. So they make about 3p profit on each cigarette. They will thus expect to sell 100–200 million extra cigarettes as a result of the Nottingham deal. This means, says Richard Peto, one of Britain's leading statisticians, 100–200 extra deaths. Quite a burden for the conscience of Nottingham University.


A 16 year old girl cut her knee on coral while in Egypt. The representative of the holiday company squeezed lime juice onto the inflamed area to relieve the irritation, and the girl spent the rest of the day sunbathing. She went on to develop acute erythema and blistering extending down the leg, which resolved leaving florid post-inflammatory hyperpigmentation. Lime juice contains psoralens that can photosensitise the skin, leading to phytophotodermatitis. It may touch the skin by accident or be applied intentionally, as in this case.

T A Chave, specialist registrar, R H Thomas, house officer, J E Osborne, associate specialist, R D R Camp, professor, department of dermatology, Leicester Royal Infirmary, Leicester LE1 5WW

Ever since the BRCA1 gene was cloned scientists have been trying to find out how the normal product of this gene prevents breast and ovarian cancer. By creating a recombinant human BRCA1 protein and watching what happens, US researchers have discovered that the protein binds directly to DNA, especially the branching strands that result from damaged double stranded DNA (Proceedings of the National Academy of Sciences 2001;98:6086-91). BRCA1's role seems to be to initiate repair to damaged DNA.

Many thanks to the 100 or so doctors who joined the BMJ's Career Focus chronic illness matching scheme last week. To ensure its continued success we need as many doctors as possible to sign up—with or without a chronic condition. So please keep applying by going to and submitting a form.


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