Minerva

Motorcyclists’ clothes and other stories . . .

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.e8498 (Published 02 January 2013) Cite this as: BMJ 2013;346:e8498

What motorcyclists wear could mitigate the long term consequences of injury. In the six months after a crash, drivers who were protected fully (motorcycle jacket and trousers) or partly (jacket only) reported less pain immediately after the crash and spent fewer days in hospital than unprotected riders. After two months, fully and partly protected riders were less likely to have disabilities or reduced physical functioning. At six months, both protected groups were more likely to be fully recovered and back at work than unprotected riders (Injury 2012;43:2035-45, doi:10.1016/j.injury.2011.10.025).

Did the 1986 accident at the Chernobyl nuclear power plant create health problems for those left to clean up the mess? A case-control study of over 110 000 Ukrainian clean-up workers found a linear dose-response between exposure to radiation and leukaemia. Altogether, 18% of chronic lymphocytic leukaemia (CLL) cases and 15% of non-CLL cases were attributed to exposure to low dose radiation after the clean up. These rates are similar to estimates for survivors of the Japanese atomic bomb, underlining the connection between exposure to radiation and leukaemia (Environmental Health Perspectives 2012, doi:10.1289/ehp.1204996).

Minerva thinks women really shouldn’t smoke. A prospective cohort of women without heart disease showed a strong dose-response association between cigarette smoking and risk of sudden cardiac death (351 deaths among 101 018 women over 30 years). Compared with never smokers, current smokers had a 2.44-fold increased risk of sudden cardiac death after controlling for coronary risk factors. Continued smoking of more than five years was associated with an 8% increase in risk. Stopping smoking significantly reduced this excess risk, eliminating it after 20 years (Circulation: Arrhythmia and Electrophysiology 2012, doi:10.1161/circep.112.975219).

Medical bodies such as the royal colleges should remain neutral on the subject of assisted dying and not impose the beliefs of some of their members on patients and carers. Expressing her personal views, and not those as chair of council for the Royal College of General Practitioners, Clare Gerada argues that the decriminalisation of assisted dying is a matter for society as a whole to decide, using established parliamentary processes. Medical bodies should help implement law, not help create it (British Journal of General Practice 2012, doi:10.3399/bjgp12X659376).

Dietary supplements of micronutrients could improve sperm quality in older men (Fertility and Sterility 2012;98:1130-7, doi:10.1016/j.fertnstert.2012.07.1126). Less genetic damage was seen in sperm produced by men older than 44 years with higher dietary and supplemental intake of vitamin C, vitamin E, folate, and zinc. Micronutrient supplementation did not alter the quality of sperm in younger men. The authors believe their observations are also relevant to the protection of somatic cells from age related genomic damage.

People who undergo total knee replacement may receive periarticular injections of local anaesthetic or femoral nerve blocks to dull postoperative pain. In a randomised trial, researchers investigated local anaesthetic concentrations in the blood and in the knee drain fluid after surgery. Anaesthetic levels were clinically relevant in patients who received periarticular injections, but were undetectable in those who underwent femoral nerve blocks. After reinfusion of drain fluid to minimise blood loss, neither group had clinically relevant levels of local anaesthetic in their blood (Journal of Bone and Joint Surgery 2012;94:1632-6, doi:10.1302/0301-620X.94B12.29357).

People with mental health problems and their psychiatrists experience stigma from other healthcare professionals; such “stigma by association” can affect patient care. Researchers surveyed 72 liaison psychiatry staff in general hospitals in the United Kingdom. Over three quarters of respondents had experienced stigmatising behaviour directed at them from hospital colleagues, and two thirds said that these negative attitudes had adversely affected patient care (The Psychiatrist 2012;36:450-4, doi:10.1192/pb.bp.112.038646).

Carotid plaque characteristics shown on ultrasonography have a strong genetic influence. A multinational study of 192 identical and 83 non-identical twin pairs showed that heritability for these characteristics is high. Researchers found that unshared environmental effects accounted for a modest portion of the variance, and shared environmental factors had no role at all. They suggest that it is time to look for the specific genes responsible for these traits (Stroke 2012;43:3168-72, doi:10.1161/strokeaha.112.666016).

Impaired insulin sensitivity, increased visceral abdominal fat, and increased liver fat are all characteristic of men with obstructive sleep apnoea. A sham controlled study of continuous positive airway pressure (CPAP) in 65 men without diabetes was designed to test whether CPAP reverses these changes. Researchers found no differences between the groups at 12 weeks. After 12 weeks, both groups received true CPAP for a further 12 weeks. At 24 weeks insulin sensitivity, but not visceral or liver fat, was improved compared with baseline in the whole study group (Thorax 2012;67:1081-9, doi:10.1136/thoraxjnl-2011-201420).

Notes

Cite this as: BMJ 2013;346:e8498