Minerva

Minerva

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39233.459699.BD1 (Published 07 June 2007) Cite this as: BMJ 2007;334:1228

Are men and women treated differently in US managed care plans? Apparently so, according to a study of the management of cardiovascular disease and diabetes in Women's Health Issues (2007 Apr 16 doi: 10.1016/j.whi.2007.03.001). Data from 10 commercial and nine Medicare plans show significant differences—for five of 11 measures with Medicare, with four favouring men, and for eight of 11 measures with commercial plans, with six favouring men. The largest disparity was in the control of low density lipoprotein cholesterol in people with diabetes, with women 19% less likely to achieve control in the Medicare group and 16% less likely in the commercial group.

Rashes are quite often reported among patients taking antiepileptic drugs. A study in Neurology claims that the average rate of rash associated with antiepileptic drugs is 2.8% (2007;68:1701-9 doi: 10.1212/01.wnl.0000261917.83337.db). In a multivariate analysis, the only non-drug predictor that was significant was the occurrence of another rash associated with the drugs (odds ratio 3.1, 95% confidence interval 1.8 to 5.1, P<0.0001). The rate in this group was 8.8% compared with 1.7% in patients without another such rash. Rashes were most likely in patients taking phenytoin, lamotrigine, and carbamazepine.

A randomised controlled trial that compared a low fat diet with a weight reduction diet in breast cancer related lymphoedema showed in both groups significant reductions in body weight, body mass index, and skinfold thickness measured at four sites (Cancer 2007;109:1949-56 doi: 10.1002/cncr.22638). A non-significant fall in excess arm volume occurred in both groups. The study found significant correlation between weight loss (regardless of diet followed) and a reduction in excess arm volume.

The more open and emotionally aware you are, and the more curiosity you hold, the longer you'll live with heart disease, independent of all other risk factors and educational attainment, reports a paper in Psychosomatic Medicine (2007;69:319-22 doi: 10.1097/PSY.0b013e318052e27d). Previous studies had concluded that the connection between emotional openness and longevity was related to educational achievement.

Wives' tendency to accept the fiction of fidelity, the discretion of their husbands, and the challenge to such fiction if condoms are used within a marriage, are some of the sociocultural factors that contribute to HIV transmission in many countries. The latest issue of the American Journal of Public Health considers sexual life from a sociocultural perspective (2007;97:971 doi: 10.2105/AJPH.2007.114637). Other factors that promote men's extramarital sexual activity include the need to migrate for work, cultural beliefs and norms, gender inequality, and socioeconomic status.

Dental laboratories are going out of business in the United Kingdom, says the Dental Lab Journal (2007;32:6-11 www.dla.org.uk/news/magazine.php). The cause is, once again, the new NHS dental contract. The new system seems to put dentists into a perverse position in which the more they prescribe the less they earn. The long term fall out for the country is the permanent loss of skills and closure of dental laboratories because dentists trying to cut their costs are looking to use laboratories abroad that are not regulated to the same extent as UK laboratories.

Is it better to knot, or not to knot? A vascular ligation pig model helped surgeons compare braided sutures in a surgeon's knot, monofilament sutures in a granny knot, a metallic clip, a bipolar diathermy system, and an ultrasonically activated scalpel (Annals of the Royal College of Surgeons of England 2007;89:359-62 doi: 10.1308/003588407X183418). All vessels were subjected to more than physiological pressures, and loss of haemostasis was shown by the leaking of coloured perfusion fluid. All the manufacturers' claims were upheld, and all the methods tested performed as well as the traditional surgeon's knot in vessels of 5 mm or less.

An Italian invention for monitoring patients with respiratory disease at home is described in the Annals of Italian National Institute of Health (2007;43:101-9 www.iss.it/binary/publ/cont/STAMPA%20ANN_07_14%20Tura.1180428699.pdf). The instrument directly measures blood oxygen saturation and pulse rate and also digitally records information that comes from several other external instruments, including a spirometer and a capnometer. It connects to all pulmonary ventilators and to the internet, through an internal modem. It was first tested in patients with amyotrophic lateral sclerosis.

Most biological approaches to depression involve the neurotransmitters that mediate traffic between neural synapses. But recent efforts have altered the focus to the possibility of causation being a stem cell neurogenesis. Specifically, declining adult neurogenesis in the hippocampus may be causally connected to depression. A review in the Journal of Psychiatric Research says that this will remain greatly speculative, albeit exciting, unless some critical questions are answered (2007;41:713-23 doi: 10.1016/j.jpsychires.2006.06.007).

People with mild cognitive impairment may do well to drink a glass of wine every day. Data from the Italian longitudinal study on ageing shows that compared with total abstention from alcohol a glass or less a day may reduce the rate of progression to full blown dementia. Heavier drinkers didn't seem worse off than the abstainers either. Minerva wonders if it has to be Italian wine (Neurology 2007;68:1790-9 doi: 10.1212/01.wnl.0000262035.87304.89).

Abdominal crunches are a part of most exercise routines, but beware of taking them too far. An unusual case of empyema in a previously fit and healthy young woman has been ascribed to rupture of a pulmonary sequestration induced by abdominal crunch exercises (CMAJ 2007;176:1577-8 doi: 10.1503/cmaj.061118). These congenital malformations are usually asymptomatic and are found in as many as 17 people per 1000 population. They are segments of lower respiratory tract parenchyma that are non-functional and don't communicate with the rest of the respiratory tree.

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