Minerva

The benefits of central heating and other stories . . .

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6260 (Published 22 October 2014) Cite this as: BMJ 2014;349:g6260

Sixty years ago, October would have marked the beginning of the British coal fire season. Homes for the next five months would be cold, damp, and smoky. Now, household air pollution has become a problem mostly in lower income countries: a third of the world’s population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting (Lancet Respiratory Medicine 2014;2:823-60, doi:10.1016/S2213-2600(14)70168-7). This is associated with susceptibility to respiratory infections, lung cancer, and chronic obstructive pulmonary disease and may account for 3.5-4 million deaths every year. Central heating has helped Britons to have longer and warmer lives.

Sarcopenia literally means “lack of body.” EWGSOP, the European Working Group on Sarcopenia in Older People, defines it as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes. In an international survey (Age Ageing 2014, doi:10.1093/ageing/afu115), its prevalence in people over 50 was 1-29% in the community and 14-33% in nursing homes. There seems to be surprisingly little evidence to inform its prevention and treatment.

Minerva is saddened and enraged that there should be a brisk market in fake artesunate for malaria in the poorest countries of sub-Saharan Africa and east Asia. It is killing people as surely as fake penicillin killed Viennese children in Orson Welles’s 1949 film, The Third Man. But technology may be coming to the rescue in the form of a new handheld instrument for the detection of counterfeit artesunate by visual fluorescence comparison. Remarkably, it was developed not by a commercial company but by the US Food and Drug Administration Forensic Chemistry Center, and it has just been tested with promising results in the Lao People’s Democratic Republic (American Journal of Tropical Medicine and Hygiene 2014, doi:10.4269/ajtmh.13-0644).

“I wish they would remember that I forget” is the headline on a new paper from the US (Dementia 2014, doi:10.1177/1471301214553236) about the effects of memory loss on the lives of people with mild to moderate dementia. Minerva would like to see narrative studies like this used to illustrate every lecture and review across all clinical topics. It is no good talking about “patient outcomes” without reference to the varied experiences of real patients. And an ideal place to begin is the unequalled free database www.healthtalk.org, which contains a great section on experiences of caring for people with dementia.

“Compassion fatigue” is the subject of a study in Emergency Medicine Journal (2014, doi:10.1136/emermed-2014-203671) that looks at its prevalence in UK emergency medicine consultants. Its counterweight is “compassion satisfaction,” and 98% of respondents reported at least average levels of that. In fact in emergency medicine, very few doctors reported high levels of compassion fatigue or burn-out.

A new science of “nodulology” is being born as low dose computed tomography screening for lung cancer identifies a wealth of incidental lung lesions. An analysis of the NELSON screening trial (Lancet Oncology 2014, doi:10.1016/S1470-2045(14)70389-4) concludes that small nodules (volume <100 mm3 or diameter <5 mm) are not predictive for lung cancer. Immediate diagnostic evaluation is needed for large nodules (≥300 mm3 or ≥10 mm). Volume doubling time assessment is advised for intermediate sized nodules (100-300 mm3 or 5-10 mm).

How multiple is your morbidity? A recent survey in Olmsted County, Minnesota, based its count on the 20 conditions considered public health priorities by the US Department of Health and Human Services (Mayo Clinic Proceedings 2014;89:1336-49, doi:10.1016/j.mayocp.2014.07.010). Like previous UK studies, it found that although the prevalence of multimorbidity increases steeply after the age of 65 years, the bulk of it is still to be found under that age. For Minerva, this raises the question of what this word is meant to convey, and whether it should be used at all. Every so called chronic condition is different, and although they tend to form particular clusters, it is hard to generalise usefully about them. Truly personal medicine will always be an elusive art, and abstract nouns like these do not help.

Cycling is a form of exercise often recommended by cardiologists, but is it safe for cardiologists to cycle? This important question was put to the test when 20 cardiologists decided to cycle all the way from the Netherlands to the 2009 European Society of Cardiology meeting in Barcelona. All of them completed the 1580 km in eight days, with an average speed of 27.9 km per hour (European Journal of Preventive Cardiology 2014, doi:10.1177/2047487314553781). Cardiac damage was looked for using echocardiography (wall motion abnormalities) or a threefold rise in troponins. None was found, although everyone had skeletal muscle damage. And a study like this raises the question of the right collective noun for a gathering of cardiologists. A murmur? A thrill? A fibrillation?

Notes

Cite this as: BMJ 2014;349:g6260

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