BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7100.136 (Published 12 July 1997) Cite this as: BMJ 1997;315:136

Most of the publicity about the dangers of exposure to sunlight has focused on the prevention of skin cancers. Less emphasis has been given to the prevention of cataracts. Fewer than one third of Australians wear hats (Medical Journal of Australia 1997;166:671), and they wear sunglasses for only one third of their time out of doors—yet the evidence linking ultraviolet light to cataracts is just as compelling as that for skin cancer.

A review of sex workers and sexually transmitted disease in Genitourinary Medicine (1997;73:161-8) includes the information that in Britain 6.8% of men have ever paid a woman for sex. Customers of sex workers were more likely to be unmarried and to work away from home. One study in London found that one third of these men had had sex with men as well as with women.

Oxford University's magazine Oxford Today (1997;9(3):24-6) has a long review commenting on the problems of funding and its link with research ratings. Seventeen universities in the United States have larger endowments than Oxford, but if the university puts all its efforts into research to attract more money it may miss out on teaching. “The danger,” says the review, “is that in world terms Oxford could end up as a second level research university.”

Ocular toxicity is a known side effect of tamoxifen, but a paper in Eye (1997;11:295-7) gives some reassuring data. Careful follow up of 274 women treated for breast cancer with tamoxifen for up to 12 years found that only three developed retinal changes and none of them had symptoms. No retinal changes were found in patients treated with tamoxifen for less than three years.

Half of the recurrences of inguinal hernia after surgical repair occur—or are detected—five years or more after surgery (Canadian Journal of Surgery 1997;40:185-91). Laparoscopic techniques for the repair of hernias are still being developed and probably improved, so any final verdict on the long term success of these new methods of treatment will be delayed well into the next century.

A study of skeletons stored beneath the crypt of St Stephen's Monastery in Jerusalem has shown that almost all the monks had arthritis of their knees (The Sciences 1997;37(4):11). The skeletons are about 1500 years old. The assumption must be that the damage was associated with frequent kneeling as the monks went through their daily pattern of worship. Present day monks mostly stand during prayers.

No one seems to know the cause of the dramatic epidemic of cardiovascular disease affecting eastern Europe, but its 400 million citizens now have death rates from cardiovascular causes that are much higher than those ever reached in western Europe or the United States (New England Journal of Medicine 1997;336:1915-6). The estimated 500 in 100 000 men who die prematurely of heart disease in the Russian Federation gives a rate twice as high as the maximum reached in the United States in the 1960s.

Around 7% of people living in the United States have been homeless at some time, living in shelters, abandoned buildings, or bus stations. Cuts in aid programmes are expected to lead to a substantial rise in the total. A review in Annals of Internal Medicine (1997;127:973-5) calls on health professionals to commit themselves to changing public policies that perpetuate homelessness.

A study in Sweden of the progress of HIV infection in 63 homosexual men and 125 intravenous drug users found that after 10 years 54% of the homosexuals had developed AIDS and 51% had died from it; the figures for the drug users were 26% and 15% (AIDS 1997;11:1007-12). Overall mortality was the same in the two groups because of the high mortality from drugs related conditions. The authors say that the route of initial infection might affect the initial immunological response.

Argument continues about whether the incidence of stroke could be reduced substantially by treatment with statins to lower serum cholesterol concentrations. A meta-analysis published in Archives of Internal Medicine (1997;157:1305-10) concludes that the evidence available from trials shows that the most benefit from this treatment comes in people with known coronary heart disease. Reducing the severity of extracranial atherosclerosis is probably more important in preventing stroke than any effect on the arteries within the skull.

The main problem in the treatment of patients with extensive deep burns is the provision of skin cover. Culture of autologous skin cells for grafting takes three weeks. Prospects for the future, reviewed in the British Journal of Dermatology (1997;136:809-16), include genetic modification of pig skin and the preparation in the laboratory of reconstructed skin made from non-immunogenic allogeneic fibroblasts and keratinocytes treated by “knock out” of their histocompatibility genes.

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A man aged 46 was undergoing magnetic resonance imaging for a knee problem when he developed severe pain in the tip of his left thumb. A radiograph showed a metal foreign body in the thumb. He then remembered having struck his thumb while hammering at work 15 years previously; he had not realised that any metal had entered the wound. The foreign body was removed under a ring block.

Paul Alfonsi, senior registrar, Angela Dancocks, consultant, accident and emergency department, Northampton General Hospital, NN1 5BD

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At least a tenth of people who have attempted suicide will do so again; in some studies the repeat rate has been as high as one quarter. A controlled trial in the Netherlands compared the effects of intensive inpatient psychiatric treatment and follow up by a community psychiatric nurse with basic clinical care and found no differences in the outcome (British Journal of Psychiatry 1997;171:35-41). The authors conclude that further research is needed, probably focusing on subgroups of patients at increased risk of repeating.

Not all of the health benefits of eating fresh fruit are predictable from its content of vitamins and fibre. Minerva was surprised to read that eating fruit improves lung function. In 2650 schoolchildren (Thorax 1997;52:628-33), those who never ate fresh fruit had lower forced expiratory volumes in one second than those who ate fruit more than once a day. The association between fruit and lung function was strongest in children who wheezed. The links between fruit and the lungs have been shown in adults too, but the mechanism remains a puzzle.

Many doctors urge their patients to take more exercise, and some encourage them to enrol in exercise programmes. A report in the British Journal of General Practice (1997;47:367-9) describes 157 schemes in general practice. Two thirds were linked with commercial leisure centres and private health clubs. In many cases the leisure services had canvassed general practitioners, encouraging them to refer patients—and the authors observe that “few schemes implemented long term behaviour change strategies.”

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