BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7567.558 (Published 07 September 2006) Cite this as: BMJ 2006;333:558

Patients with chronic conditions might be presumed to cope better over time as they get used to living with, and managing, their illnesses. But what about those with skin conditions? An 11 year follow-up of people with psoriasis found that concern over health related quality of life issues decreased over time. More surprisingly, those who reported poor health at follow-up scored three times higher in their quality of life scores than those in good health. The effect of psoriasis on quality of life seems to diminish over time and be independent of treatment seeking and psoriasis status (Journal of Investigative Dermatology 2006;126: 1480-9).

A protein encoded by the gene ERBB2 is observed in high concentrations in patients with aggressive breast cancers with poor prognoses. Researchers now think that this protein may have an accomplice. It is β4 integrin, a well known cell adhesion molecule, which seems to be able to boost the dangerous signals from ERBB2. The proteins act together to promote the activity of genes that enhance cell division and disrupt normal tissue architecture. Targeting β4 integrin could therefore greatly improve the efficacy of drugs such as trastuzumab that target ERBB2 (Cell 2006;126: 489-502).

A new journal is being launched this autumn dedicated to community based participatory research. Progress in Community Health Partnerships: Research, Education, and Action aims to disseminate ideas about how lay people can help improve public health and promote community health partnerships, with an emphasis on getting research findings translated into real life (http://pchp.press.jhu.edu/).

Clingfilm has many uses, but apparently it is no good at preventing hypothermia in term infants having phototherapy for prolonged jaundice. Minerva had a vision of the babies in this study being wrapped from head to foot, but in fact the clingfilm was merely used to cover the lower two thirds of the cot (Singapore Medical Journal 2006;47: 757-62).

Sirolimus eluting stents are better than bare metal stents in patients with totally occluded coronary arteries as well as in those with partial occlusions. The PRISON II study (Circulation 2006;114: 921-8) randomised 200 patients with totally occluded arteries to receive either a bare metal stent or a sirolimus eluting stent. The rate of restenosis was 11% in the drug eluting group and 41% in the bare metal stent group (P < 0.001). Patients in the drug eluting stent group also had lower rates of all major adverse cardiac events.

The writer of an article in QJM (2006;99: 641) counted 11 notices on the walls of one general practice waiting room saying don't (don't consume food and drink or chew gum, don't ask the doctor for housing letters, don't compromise your care by asking the doctor to deal with more than one problem). There wasn't one please. He says what is really there is an unwritten notice that says, “We are afraid. Afraid of intimacy, afraid of suffering, afraid of everything we do not understand and cannot cure.”

Male marmosets carry an infant for up to 70% of its first month of life, making them suitable to study the effects of paternalism on the brain. US researchers comparing brain tissue from marmoset fathers with that from adult males living in mating pairs without offspring found that both first time and experienced fathers had a higher density of dendritic spines in their prefrontal cortex than males without babies. The prefrontal cortex is involved in human paternal feelings so these results might apply to humans too (Nature Neuroscience 20 Aug 2006; doi: 10.1038/nn1753).

Risedronate has been approved in Europe and the United States as the first osteoporosis treatment aimed particularly at men. The president of the European Men's Health Forum says osteoporosis is still considered to be a women's disease, but survival rates after a fractured hip are far lower for men than for women, and the condition is often diagnosed late in men (www.emhf.org/index.cfm/item_id/25).

A tennis ball might be just the thing for every general practitioner's room, according to a discussion in CMAJ (2006;175: 471-3). It is the ideal screening tool for developmental coordination disorder. Undiagnosed, this condition can lead to children developing learning, emotional, and behavioural problems, especially once they start school. Children aged 6 or 7 years who can't bounce or catch the ball may need referring to a developmental paediatrician and occupational therapy.

A systematic review previously suggested that antiplatelet drugs reduce the risk of delayed ischaemic neurological deficit in patients who have had a subarachnoid haemorrhage. But a randomised controlled trial inspired by this promising suggestion sadly found that aspirin given after treatment for aneurysm did not appreciably reduce the occurrence of delayed neurological deficit, and the trial was stopped early (Stroke 2006;37: 2326-30).

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A 25 year old woman presented with tender erythematous subcutaneous plaques and nodules restricted to her thighs. She had crops of new lesions throughout the winter. Individual lesions resembled erythema nodosum, although her lower legs were completely spared. Her job involved riding racehorses. She had equestrian cold panniculitis, a well recognised occupational skin disease in rural Devon. The inflammation in the subcutaneous fat is not immunologically mediated but results from a combination of cold weather and tight fitting jodhpurs. This causes reduced blood flow to the skin in areas most exposed to the cold during riding. Her problem resolved with looser clothing and avoiding riding in cold weather.

Anisha Mehta (anisha_mehta1{at}hotmail.com), specialist registrar, Carolyn Charman, consultant, Chris Bower, consultant, department of dermatology, Royal Devon and Exeter Hospital, Exeter EX2 5DW

Being childless in Africa means “you're worth less than a dog,” according to a fertility expert. Infertility is something we don't often associate with sub-Saharan Africa, but it is a “rampant problem” and one which needs some low cost solutions (Nature 2006;442:975-7). Just because in some regions the average couple has five or six children, doesn't mean others should not conceive. However, justifying expensive infertility treatments when resources are scarce and there are other important health issues is a challenge.


Guidance at bmj.com/advice

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