MinervaBMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39513.570313.80 (Published 13 March 2008) Cite this as: BMJ 2008;336:622
Why do patients with progressive supranuclear palsy fall? The answer may be found in their inner ears. It has long been suspected that abnormal vestibulospinal reflexes are partly to blame, but neurologists now think it is more likely to be related to abnormal otolith responses (Neurology 2008;70:802-9 doi: 10.1212/01.wnl.0000304134.33380.1e). The evidence comes from testing the otolith-ocular reflexes in nine patients with this condition. They all had responses that were around 12% of those seen in controls.
While the debate about the National Institute for Health and Clinical Excellence’s advice that all patients undergoing elective hip replacement be given low molecular weight heparin carries on, orthopaedic surgeons in Bristol say their study of mortality after elective total hip replacement strongly suggests that patients should be given aspirin after the operation. At 90 days, with routine administration of aspirin, cardiovascular deaths dropped from 0.75% to zero (Journal of Bone and Joint Surgery [Br] 2008;90-B:306-7 doi: 10.1302/0301-620X.90B3).
A meta-analysis of 21 studies involving children aged 3-18 years found substantial evidence that sublingual immunotherapy for allergic asthma and hay fever is both safe and effective. It is not clear how it works, but sublingual immune mechanisms are thought to be comparable to those induced by subcutaneous methods and are probably safer because, rarely, subcutaneous treatment can produce systemic and fatal anaphylactic responses (Chest 2008;133:589-90 doi: 10.1378/chest.07-2620).
Would you—or a medical student you know—like to learn how to edit the Student BMJ? The job involves all aspects of publishing the award winning international magazine for medical students online and in print, including commissioning, peer reviewing, and editing articles. You should have some clinical experience, excellent written English, and some experience of writing or editing. The job is based at our London offices for a year starting this May and attracts the salary of a first year NHS house officer. See student.bmj.com to apply before 31 March.
Back pain isn’t a communicable disease in the conventional sense, but it may be in other ways. Reanalysis of data from shortly after German reunification and onwards shows that the gap in prevalence of back pain between East and West Germany was initially wide, but fell to almost zero by 2003. Behavioural and social risk factors indicate conflicting trends, so researchers sought other explanations. They alighted on the harmful influence of back related beliefs and attitudes transmitted from West to East Germany via the media and personal contacts as the culprit (International Journal of Epidemiology 2008;37:69-74 doi: 10.1093/ije/dym220).
A study of all incident cases of psychosis over two years in two regions of England found that 11.3% of patients had engaged in self harm before their first presentation to services. The independent correlates with self damaging behaviour were being male, belonging to social class I or II, depression, and a prolonged period before presentation. Increased insight was also associated with self harm. Suicide prevention should focus on reducing treatment delay and changing attitudes to the disease itself (British Journal of Psychiatry 2008;192:178-84 doi: 10.1192/bjp.bp.107.037192).
The “highest achievers” of business, exploration, the military, sport, politics, and the media are being brought together in London on 16 May to contribute their experiences of risk, leadership, and teamwork to inform an international conference entitled “risky business,” which will deal with patient safety. The speakers include an astronaut, a Red Arrows pilot, and a mountaineer who famously cut the cord on his climbing companion to survive (www.riskybusiness2008.com).
Prolonged and exclusive breast feeding offers neither risks nor benefits when it comes to behaviour or emotional adjustment. On the basis of data collected over 6.5 years, from more than 17 000 mother-infant pairs enrolled from 31 Belarussian maternity hospitals, the evidence is clear. No significant treatment effects were seen on either the mothers’ reporting of emotional or behavioural difficulties in their children or on the mothers’ reporting of their relationship with their partner or child (Pediatrics 2008;121:e435-40 doi: 10.1542/peds.2007-1248).
A shortage of health workers and money has brought Fiji's primary healthcare programmes to almost a standstill (Bulletin of the World Health Organization 2008;86:1667 www.who.int/bulletin/volumes/86/3/08-020308.pdf). Part of the problem was caused when the Fiji School of Medicine became a pan South Pacific regional institution in 1995. This “transformation” removed the Fijian government’s insistence that all medical graduates from the school must spend some time working in Fiji after qualifying.
Mobile phone locating systems have improved ambulance response times. The proportion of emergencies reported by mobile phone rose in Central London from 5% in 1999 to 29% in 2004 according to the London Ambulance Service, with emergency injuries being reported by mobile phone more than medical emergencies (41% v 16%, P=0.0063). Of all patients taken to hospital emergency departments by ambulance, 44% had contacted the ambulance service by mobile, and 75% of all calls made from outside the home or office were made on mobile phones. Around 72% of patients said that it would have taken longer to contact the emergency services if they had not used a mobile phone (Annals of the Royal College of Surgeons of England 2008;90:113-6 doi: 10.1308/003588408X242079).