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Entering the unresolved debate between alcohol consumption and bladder cancer, epidemiologists analysed data from an Italian case-control study and concluded that even in populations that drink a lot (in this case, wine) there is no significant association between the two. Its possible that confounding factors such as smoking, coffee drinking, and occupation (allowed for in this analysis) may have given rise to earlier inconsistent results (Journal of Clinical Epidemiology 2002;55:637-41).

Summer sunburn seems to be the norm among American teenagers despite high sunscreen use. With 72% of teenagers experiencing at least one sunburn during the summer, public health campaigns should probably be paying more attention to getting the message across about hat wearing, protective clothing, and avoiding peak exposure times in the war against skin cancer (Pediatrics 2002;110:27-35).

Minervas concentration usually wanes during the afternoon, and she has to turn to coffee. A Swedish team has discovered that a protein called DARPP-32 is critical to the action of caffeine. Low doses of caffeine seem to trigger a positive feedback loop, keeping DARPP-32 phosphorylated. In this form DARPP-32 blocks the inhibition of nerve activity, keeping us hyperactive. In effect, phosphorylated DARPP-32 keeps us going between cups of coffee (Nature 2002;418:774-8).

Minimum requirements to stop a bleeding nose are nasal specula, suction facilities, a good light, and the availability of nasal cautery. But bleeding noses often end up in accident and emergency departments, where, according to a telephone survey in the Journal of Laryngology and Otology (2002;116:597-600), both the available equipment and senior house officer training are inadequate for dealing with this emergency. The otolaryngologists responsible for the study suggest its up to their own specialty to provide the training.

Nurses typically endure physically heavy work. When student nurses and a control group of workers were followed over six months, serum markers of collagen metabolism reflected a greater build up of type I collagen in the nurses. Further analysis of the effect of the number of patient-handling activities revealed that greater physical effort was associated with highly effective synthesis of type I collagen, although the study wasnt able to show a temporal correlation (Scandinavian Journal of Work, Environment and Health 2002;28:168-75).

Patients undergoing surgery for lung cancer tend to lead fairly impaired lives before surgery, and a substantial proportion die after surgery. For those who survive, pain and poor functioning tend to persist. Whats interesting is that quality of life measures recorded at the six month postoperative review dont seem to be related to having undergone preoperative radiotherapy, the extent of the resection, or having had postoperative complications, but can be predicted only by the preoperative diffusion capacity of the lung for carbon monoxide (Chest 2002;122:21-30).

This venous blood sample was taken from a 26 year old woman who was 28 weeks pregnant with her second child. She presented with chest and epigastric pain and vomiting. Routine blood tests revealed a cholesterol concentration of 34.6 mmol/l and triglyceride concentration of 99.45 mmol/l. Serum amylase was 60 IU/l, but the validity of this result was questioned because of the lipaemic sample. Concomitant urinary amylase was 1911 IU/l, resulting in a diagnosis of acute pancreatitis, confirmed on ultrasound. Treatment with insulin and omega-3 marine triglycerides brought her triglyceride level below 10 mmol/l, and the rest of her pregnancy proceeded without incident. Her postnatal glucose tolerance test was normal, and her cholesterol:HDL ratio was 3.7 with a triglyceride level of 2.7 mmol/l without any drugs.

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Despite all the efforts made to get people whove had a heart attack to stick to the drug regimens theyve been started on in hospital, many dont. One large Scottish study found that only 7.7% of patients continued to take statins after their myocardial infarction. But theres a definite penalty for stopping. Those who took statins enjoyed a significant reduction in their risk of a further infarct compared with those who didnt (Heart 2002;88:229-33).

Minerva was amused by an outburst in Practice Nurse (16 August 2002, p 18). The strength of practice nurses, says the writer, is that the care they offer patients is based on research rather than the ritualistic undertaking of tasks allocated by general practitioners. But the new general practitioner contract disagrees, apparently encouraging a return to the days when practice nurses were considered the handmaidens to doctors, and suggests that nurses may take on any task that “doctors no longer wish to undertake.”