BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4309 (Published 18 August 2010) Cite this as: BMJ 2010;341:c4309

Rising levels of free thyroxine are a risk factor for a first venous thrombosis. Using data from a Dutch case-control study on leg vein thrombosis, researchers estimated risk of venous thrombosis according to several thresholds of thyroxine derived from plasma concentrations observed in controls. In the absence of traditional risk factors, levels of free thyroxine over 17 pmol/l yielded a sex and age adjusted odds ratio of 2.2 (95% confidence interval 1.2-4.2) for deep vein thrombosis (Blood 2010;115:4344-9 doi:10.1182/blood-2009-11-253724).

The EQUATOR network (an online library of guidelines for reporting research such as CONSORT, found at www.equator-network.org) will be translated into Spanish to help raise the quality of papers from Latin America with the help of the Pan American Health Organization (PAHO). The plan is to expand coverage to other languages and aspects relevant to the objectives of PAHO’s policy on research for health, which is available in official and colloquial language abridged version at www.paho.org/researchportal/policy.

French neurologists and psychiatrists mobilised during the First World War were confronted with soldiers with war neuroses, but because of pre-existing theories, they were thought to be malingerers. They advocated aggressive therapies to enable the soldiers to return promptly to the battlefield, of which “torpillage” was one. This involved a “persuasive” form of psychotherapy using electric currents. Not surprisingly, it led to refusal of treatment and the first open discussions about the patient’s right to refuse treatment (Neurology 2010;75:279-83 doi:10.1212/wnl.0b013e3181e8e6fd).

A prevalent cohort study reports that depressive symptoms are an independent predictor of mortality in patients after kidney transplantation (Psychosomatic Medicine 2010;72:527-34 doi:10.1097/psy.0b013e3181dbbb7d). Among 840 transplanted patients the prevalence of depression was 22%, and mortality was higher in patients with depression than in those without (21% versus 13% P=0.004).

The US healthcare debate continues to rage and attention is persistently drawn to the perceived shortcomings of the UK health service (JRSM 2010;103:283-7 doi:10.1258/jrsm.2010.100126). However, a gap genuinely exists between cancer survival in the US and the UK, with better outcomes among older patients. However, young people in the US with chronic diseases fare worse. Ironically, those parts of the US health system with the best results are those that most closely resemble the British NHS system, although they are funded somewhat more generously.

Clean water holds specific meaning for women where it is scarce. Pregnant women may have to go far to find water for their own deliveries, and it becomes critical when it is time to wean children, because of the strong link between water induced diarrhoea and malnutrition. Becoming ill from water-borne infections can curb education, as can inadequate facilities at school for menstrual hygiene. Clean water allows women to take a bigger part in their community’s development, including decision making and management of water systems (Bulletin of the World Health Organization 2010;88:482 doi:10.2471/blt.10.080077).

Minor head injuries among young children are very common, but the risk of these injuries leading to a late diagnosis of severe intracranial bleeding is unknown. An eight year retrospective study in Canada involved almost 18 000 children presenting to emergency departments with minor head injuries. It reports that the proportion of delayed diagnosis of intracranial haemorrhage after head injuries, with and without deterioration in level of consciousness, were 0% and 0.03%, respectively (0 and 5 of 17 962) (Pediatrics 2010;126:e33-9 doi:10.1542/peds.2009-0692).

Post-marketing surveillance of the smoking cessation drug varenicline (Champix) reveals disturbing acts of aggression and violence towards others. The Food and Drug Administration holds 78 reports of adverse event, while others are reported in the literature. Researchers of a study in the Annals of Pharmacotherapy say there is a clear temporal relationship between the drug being taken and subsequent aggressive acts, as well as a lack of history of such behaviour, making it imperative that patients should be warned before they take the drug (2010;44 doi:10.1345/aph.1P172). Minerva wonders if packets of varenicline should include a government health warning.


Cite this as: BMJ 2010;341:c4309

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