Minerva

The resurgence of tuberculosis in the United States in the late 1980s and early 1990s was associated with HIV infection and multiple drug resistance. It now seems to have been brought under control (Morbidity and Mortality Weekly Record 1998;47:253-7). The total number of cases reported in 1997 was 19 855, a drop of 7% from the total for 1996 and a 26% decrease from 1992. These results are thought to be due to stronger public health programmes and emphasis on getting patients to complete their treatment.

A randomised placebo controlled trial of fluoxetine and graded exercise for patients with the chronic fatigue syndrome (British Journal of Psychiatry 1998;172:485-90) found that the exercise programme produced improvements in functional work capacity and fatigue while the fluoxetine improved depression only. Only 71% of the 136 patients completed the trial: support and encouragement seem to be important factors in whatever treatment is given.

The costs to the community of back pain amount to 1.7% of the gross national product in the Netherlands—a startling statistic quoted in a review in Pain (1998;75:163-8). Health care accounts for only 7% of the costs, which are mostly due to compensation for time off work. Yet, says the review, multidimensional pain rehabilitation programmes are of proved value in getting people back to work. The key is early intervention in primary care …