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Hospitality workers breathe in environmental tobacco smoke whether they like it or not. Saliva samples taken before and after a typical work shift found significantly higher cotinine concentrations in those working in places where smoking is permitted than in smoke-free premises. They also reported a higher prevalence of respiratory and irritation symptoms. The cotinine concentrations reported in this study have been linked with substantial involuntary risks for cancer and heart disease (Tobacco Control 2002;11:125-9).

Myths about contraceptive coils and pelvic infection persist despite evidence that the risk of pelvic inflammatory disease rises above the background population rate in only the first 20 days after the coil is inserted, thereafter dropping back to the background rate. The authors of a review in the Journal of Family Planning and Reproductive Health Care (2002;28:61-8) conclude that drawing together the evidence about success rates is difficult, but the T380A device remains the gold standard, offering the best protection against pregnancy.

Whats the best way to tackle neck pain? A Dutch group compared once weekly manual therapy (specific mobilisation techniques) with twice weekly exercise therapy and continued care by a general practitioner (painkillers, counselling, and education). Patients favoured manual therapy over the other two, although differences in success rates and disability scores were not statistically significant (Annals of Internal Medicine 2002;136:713-22).

A case report in the Scottish Medical Journal (2002;47:34-5) highlights the contentious issue of routine serum biochemistry testing of patients who have had a fit (as opposed to simply relying on a good witness account and clinical judgment). A patient who had sustained two generalised tonic-clonic seizures was given anti-epilepsy treatment and referred to the local first fit clinic. While there she underwent routine biochemistry testing and was discovered to be low in calcium. Once this was corrected she had no further need for the epilepsy drugs.

Were discovering that more and more organs are influenced by the positive effects of oestrogen. A study in Obstetrics and Gynecology (2002;99:726-30) investigated whether hearing sensitivity in older women is associated with serum oestradiol concentrations. A multiple logistic regression analysis found that age and hearing loss were positively associated, as was oestradiol concentration and hearing loss. Minerva wonders if one day women will be given a choice between wearing a hearing aid or taking hormone replacement therapy.

General practitioners are encouraged to investigate any child who presents with a urinary tract infection. Reviewing the use of renal ultrasonography and voiding cystourethrograms in children with their first urinary tract infection, a study in Archives of Disease in Childhood (2002;86:419-21) concludes that ultrasound findings are neither sensitive nor specific for vesicoureteral reflux. The positive predictive value of ultrasonography in determining reflux was 32%; the negative predictive value was 82%.

Now heres a sensitive subject. An osteopath writing in the Osteopath (2002;5:30) says that some practitioners have been experiencing frontal headaches, sinus pain, dry mouth, and exhaustion, due—they suspect—to an irritating chemical solvent base used to carry modern perfumes and deodorants. Asking patients not to wear perfumes and deodorants has lost his clinic two clients to date, but hes also concerned about liabilities for staff health.

Minerva was interested to read another piece of evidence that atherosclerosis has its origins in inflammation. A 20 year case-control follow up study of men in the Honolulu heart programme has found that C reactive protein in serum, measured over time (starting when the men were free of prevalent disease), rises in line with the odds of having a myocardial infarction. The link was seen as early as five years into the study, becoming more modest after 15 years (Journal of Clinical Epidemiology 2002;55:445-51).

A 49 year old woman was making steady progress after a subarachnoid haemorrhage. She was receiving nutrition through a nasogastric tube. On the morning ward round the nurses mentioned that she had vomited earlier, and there was evidence of fresh vomit on her sheets. When she was cleaned, a superficial burn was noted where the vomit had come into contact with her skin. She was given a proton pump inhibitor and the burn was treated successfully. Patients being fed via a nasogastric tube should take a gastric protecting agent.

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