MinervaBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7205.328 (Published 31 July 1999) Cite this as: BMJ 1999;319:328
Pregnant women who smoke risk premature delivery, intrauterine growth retardation, and perinatal complications. Even after delivery their babies continue to inhale their mothers' tobacco smoke or ingest it in breast milk (Archives of Pediatrics and Adolescent Medicine 1999;153:689-91). In one study, breastfed babies had five times as much of the metabolite cotinine in their urine than bottle fed babies, if their mothers smoked. This result leaves health educators in a dilemma: if women can't or won't stop smoking, should they be advised to stop breast feeding too?
Cheap and cheerful thiazide diuretics are the best first line treatment for hypertension, according to a systematic review in the Canadian Medical Association Journal (1999;161:25-32). They are consistently better at lowering systolic blood pressure than other classes of drug, and are more acceptable to patients than β blockers, it concludes. More importantly, the review shows that a small dose of a thiazide diuretic prevents more coronary artery disease and stroke and saves more lives than β blockers, calcium channel blockers, or angiotensin converting enzyme inhibitors.
Children need calcium, but nutrition authorities are cautious about how much they recommend for preschool children because of fears that dietary calcium might interfere with iron absorption. At least one study, albeit a small one, shows that it doesn't (American Journal of Clinical Nutrition 1999;70:44-8). In a cross over trial in 11 preschool children, a high calcium diet had no impact on the incorporation of iron into red blood cells. Give them as much calcium as older children, say the authors.
American scientists have developed a protein that could help minimise the brain damage caused by stroke (Science 1999;285:595-9). The molecule blocks the complement cascade, as well as inhibiting the accumulation of white cells and platelets in the ischaemic area, which reduces collateral damage and therefore the volume of the final infarct. Tests in mice look promising, although the agent seems to work best if given before the stroke occurs. This could limit its usefulness in humans.
The prize for daftest research question of the week goes to a team of Japanese researchers who decided to examine how often newscasters blinked. It turns out that newscasters blink nearly four times as often as relaxed volunteers (Lancet 1999;354:308-9). Perhaps they are nervous, suggest the researchers—or it might be the bright lights and dry atmosphere of the studio. The real mystery is how the study ever found its way into a clinical research journal.
Getting back to the mainstream, the Lancet reports that occupational therapy reduces disability and handicap in patients with stroke who remain at home (1999;354:278-80). Nearly 200 patients took part in a randomised trial that compared five months of occupational therapy with “routine” care at home. The occupational therapy produced measurable and clinically important benefits. Between one fifth and three fifths of patients in the United Kingdom are treated exclusively at home after a stroke.
Young women who have heart attacks are more than twice as likely to die as men of the same age, according to the latest study examining sex differences in heart attack mortality (New England Journal of Medicine 1999;341:217-25). Only a third of the difference could be accounted for by differences in early treatment, medical history, and clinical severity. Death rates were highest in women under 50 and declined with increasing age until the sex difference disappeared at around 75 years.
High speed crashes are not the only health hazard for Formula One racing drivers—they also have high rates of vibration injury to the forearm and wrist (British Journal of Sports Medicine 1999;33:270-3). Fourteen out of 22 contestants surveyed at last year's French Grand Prix had symptoms after races, including cramps, numbness, and tingling Three had carpal tunnel syndrome and one had a compartment syndrome At least they don't get palmar irritation from a vibrating gear stick any more—it's been replaced by a knob on the steering wheel.
Money worries have been linked to gum disease in cross sectional study from New York (Journal of Periodontology 1999;70:711-23), but only in people who cope with problems by avoiding them (usually by drinking). People with positive coping strategies have no more gum disease than anyone else. Luckily, oral hygeine is cheap and easy, says the author. So remember to floss, not flap, next time the stock market coughs.
Pravastatin has anti-inflammatory as well as cholesterol lowering effects, according to a subanalysis of the CARE (cholesterol and recurrent events) trial (Circulation 1999;100:230-5). People given pravastatin for five years after a heart attack had much lower serum concentrations of the inflammatory marker C reactive protein than controls given placebo, and the changes were independent of the drug's effects on serum lipids. Two questions remain: which property is it that prevents heart attack? and, do other statins share pravastatin's double effect?
Telemedicine really comes into its own when expertise is a long way from a patient with an acute problem. Two studies in Heart describe how echocardiographic images from neonates can be transmitted via ISDN (integrated service digital network) lines to a waiting paediatric cardiologist, who can diagnose or rule out major heart disease (1999;82:217-21, 222-5). Standard videoconferencing equipment, which costs about £3000 a year to rent, provides good enough images to save a substantial proportion of babies the trauma of a transfer, says a team from Northern Ireland.
Rheumatologists looking for an organic cause for work related forearm pain have discovered that people with diffuse pain have abnormally constricted radial arteries (Rheumatology 1999;38:636-9), Further, their arteries fail to vasodilate with exercise, which points to an ischaemic basis for the pain. The investigators go on to speculate that a shortage of local endothelial nitric oxide is behind it all—an attractive but unproved unifying explanation for this enigmatic disease.