Minerva

BMJ Open is officially launched—it’s an open access journal of general medical research, using fully open (signed and published) peer review, and it publishes all types of study. One of the first papers looks at the wellbeing of patients with locked-in syndrome (doi:10.1136/bmjopen-2010-000039) and another looks at how free text information is used to explore how and when GPs code a diagnosis of ovarian cancer (doi:10.10.1136/bmjopen-2010-000025). To visit the journal online go to http://bmjopen.bmj.com.

Lower urinary tract symptoms (LUTS) in men may be related to micronutrients involved in prevention of oxidative damage or cell growth; specifically, it’s been postulated that levels of carotenoids, vitamins A, and vitamin C are inversely associated with total LUTS, voiding, and storage symptoms. A multivariate analysis found that higher dietary intake of carotenoids and vitamin A was associated with a decreased risk of LUTS, but intake of supplemental nutrients was not. High dose supplemental vitamin C was positively associated with LUTS (Journal of Nutrition 2011;141:267-73, doi:10.3945/jn.110.132514).

Hospital admission for infection in infancy—specifically chest and gut infections—is a significant risk factor for aggressive B cell lymphomas, but no such effect is observed for Hodgkin’s lymphoma, reports an article in Blood (2011;117:1670-2, doi:10.1182/blood-2010-09-306274). The link could be related to the actual infection, its treatment, or an underlying immune defect. We don’t know whether the same relation exists for non-Hodgkin’s lymphoma later in life, and whether better survival of people with immune defects is leading to the higher rates of non-Hodgkin’s lymphoma currently seen in adults, compared with stable rates in children.

Numerical rating scores for pain when used with children are useful for some aspects of care, but not others. A study in Anaesthesia and Analgesia produced evidence that numerical scales are a valid measure of pain intensity with regard to the child’s perception of a need for medicine and pain relief, and their perceived satisfaction immediately after surgery (2011;112:415-21, doi:10.1213/ANE.0b013e318203f495). But the variability of numerical scores in relation to other clinically meaningful outcomes renders them limited when it comes to using cut-off points for making individual treatment decisions.

Need a condom in a hurry? New York City’s health department have launched an app for the iPhone and Android phones that makes use of the city’s database of over 1000 locations where free condoms can be obtained. The city’s assistant health commissioner was reported as saying “a lot of people come here for that [sex] so we want them to practice safer sex”. New York distributes an average of three million free condoms each month (www.guardian.co.uk, 14 February 2010).

A little known fact: the “father of stress”, Hans Selye, had the tobacco industry as one of his main allies. It turns out that Selye received extensive funding from the tobacco industry, and his research on stress and health was used in litigation to defend the industry’s interests and to argue against a causal role for smoking in heart disease and cancer. If nothing else, this revelation strengthens the case for improved disclosure of all industry influence on research (American Journal of Public Health 2011;101:411-8, doi:10.2105/AJPH.2009.177634).

A study examined whether sun exposure and vitamin D status are associated with the risk of first demyelinating events, which are a common precursor of multiple sclerosis. As predicted, higher levels of sun exposure in leisure time were associated with a reduced risk fo such events; actinic skin damage and serum vitamin D status were also independently associated with decreased risk. The researchers found that leisure time sun exposure, vitamin D levels, and skin type additively accounted for the almost 33% increase in the incidence of first demyelinating events between the low and high latitude regions in Australia (Neurology 2011;76:540-8, doi:10.1212/WNL.0b013e31820af93d).

Western society is described as a “death-denying” culture, so what do those who work in palliative care services make of their chosen field? An ethnographic inquiry identified 11 specific themes. Early life experiences with death were a common and prominent feature among professionals’ choice of career, and clinical exposure to death and dying allowed palliative care professionals to live more fully in the present, to cultivate a spiritual life and a curiosity about the continuity of life, and to reflect on their own mortality (CMAJ 2011;183:180-7, doi:10.1503/cmaj.100511).

Be careful how you split household responsibilities—a study in Psychosomatic Medicine reports that the greater the perceived responsibility for household tasks, the higher the ambulatory blood pressure, with this finding being more pronounced among those who earn less money (2011;73:200-5, doi:10.1097/PSY.0b013e3182080e1a). The sample was 113 employed adults with hypertension who were not taking medication. Blood pressure was higher in those who perceived their responsibility to be greatest, but was not related to the number of actual hours spent doing household tasks. No interactions with sex were observed.

Complications after joint arthroplasty arise for a number of reasons, one of which is alcohol misuse. A study of 185 men who reported at least some drinking in the year before undergoing total joint replacement found that 32 (17%) had a score that indicated alcohol misuse; six of the 32 patients had one complication, four had two complications, and two had three complications. Regression analysis showed a 29% increase in the expected number of complications with every additional point of the screening score above one (Journal of Bone and Joint Surgery (American Edition) 2011;93:321-7, doi:10.2106/JBJS/I.01560).