Minerva Minerva

Minerva

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7349.1344 (Published 01 June 2002) Cite this as: BMJ 2002;324:1344

The lack of “ownership” of ideas at a grass roots level may prove fatal to the delivery of the NHS Plan (the paper that maps out ways of modernising the NHS). In a pamphlet entitled Physician, Heal Thyself (May 2002; Spokeman Books for Socialist Renewal, Nottingham), the former chief training officer of the NHS, Duncan Smith, says that rather than imposing ideas in a top-down manner, what's needed is a means by which the wisdom and dedication of NHS staff can be used to carry out the necessary changes.

In common with many pet owners, Minerva often finds herself talking to her cat with the kind of language and pitch usually reserved for babies. One analysis identified that pitch and affective components are higher in baby and pet-directed speech than in adult communication. Babies are also subjected to exaggerated pronunciation of vowels. The authors say that we intuitively perceive the emotional and linguistic needs of our audience and adjust our use of language accordingly (Science 2002;296:1435).

Dieting is common among young women. Researchers observed from one correlation study of female college students that the frequency of dieting behaviours was strongly associated with negative emotions and symptoms of eating disorders (including body dissatisfaction, preoccupation with exercise, and feelings of insecurity), regardless of the body mass index at any one time (Journal of Psychosomatic Research 2002;52:129-36) Minerva wonders if the use of advertisements to attract interested participants for the study may invalidate these results owing to selection bias.

Teenagers are notorious for their poor diets, but teenage vegetarians seem to do better than their meat eating counterparts. In one analysis of whether American teenagers meet the Healthy People 2010 objectives, the vegetarians did much better on their fat consumption (including saturated fats) and daily fruit and vegetable intake. If these eating patterns are maintained through adulthood, these vegetarian adolescents are well on track to a considerably lower risk of heart disease and cancer (Archives of Pediatrics and Adolescent Medicine 2002;156:431-7).

Some studies suggest that tamoxifen interferes with brain metabolism and cognitive function. Researchers used magnetic resonance spectroscopy to measure the concentrations of metabolites containing N-acetyl in the brains of 76 elderly women (of whom 16 had taken tamoxifen, 27 had taken oestrogen, and 33 had received neither). To their surprise (because tamoxifen is an oestrogen antagonist) they found that tamoxifen has a similar effect to oestrogen; if confirmed, this should alleviate any safety concerns (Journal of the National Cancer Institute 2002;94:592-7).

Hepatitis G virus was characterised in the mid-1990s. It's not a virulent pathogen and doesn't cause or worsen liver disease. A cross sectional epidemiological study evaluated the role of sexual activity and sexually transmitted diseases in the transmission of hepatitis G virus and found a significantly higher prevalence of hepatitis B, C, and G in people who had, compared with those who hadn't, received treatment for a sexually transmitted disease. The implications of this remain unclear (Clinical Infectious Diseases 2002,34:1033-8).

An international survey of patients' satisfaction with general practice in nine countries throws up some interesting findings. The Europep instrument assessed patients' evaluations of five aspects of availability: getting an appointment, getting through on the phone, being able to speak to the doctors on the phone, waiting time in the waiting room, and the provision of emergency appointments. Patients favoured small practices and fulltime general practitioners—contradicting ongoing developments in primary care (International Journal for Quality in Health Care 2002;14:111-8).

The use of soy based baby formulas is increasing. But new evidence suggests they may weaken the immune system. Soy formulas contain high levels of compounds that mimic oestrogen, which itself is a known immune system suppressor. When mice were fed one of these compounds at levels similar to those found in baby feed, the number of immune cells dropped significantly, as did the size of the thymus (Proceedings of the National Academy of Sciences 2002;99:7616-21).

Figure1

A 37 year old man had a renal transplant performed 22 years ago and was taking azathioprine and prednisolone for immunosuppression. He was lost to follow up until he presented with a large squamous cell carcinoma on the dorsum of his right index finger. He subsequently underwent a ray amputation of his finger.

Skin cancer is the most common malignancy in patients with long term immunosuppression. The incidence increases from 10% after 10 years to 40% after 20 years. Patient education in rigorous sun protection and surveillance is critical.

Jin J Bong, senior house officer, Mark Lansdown, consultant, department of surgery, St James's University Hospital, Leeds LS9 7TF

Nitric oxide is a major inhibitory neurotransmitter in the gastrointestinal tract, so scientists hypothesised that sildenafil—which causes nitric oxide to build up—may have a beneficial effect on oesophageal motor function. A small number of healthy male volunteers and others with oesophageal motility disorders took part in an open study. Not surprisingly, sildenafil significantly reduced the pressure of the lower oesophageal sphincter and oesophageal propulsive forces in both groups of subjects. Improvement in symptoms, however, was limited in some by the drug's side effects (Gut 2002;50:758-64).

Despite a lack of conclusive evidence of benefits of prostate cancer screening, one Australian study found that testing for prostatic specific antigen is widespread in the community and in the medical profession. Of male doctors over the age of 49, 55% believed men should be tested for prostate disease at least every two years, compared with 68% of men in the community sample; 45% of the male doctors had been tested for prostate cancer in the past, with 92% of the tests being negative (Internal Medicine Journal 2002;32:215-23).

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