Minerva
Death by hanging is the method most commonly chosen by suicidal people from ethnic minorities. A four year sample of people who had committed suicide in England and Wales found that 6% of them were from ethnic minorities, and among this group schizophrenia was the most common diagnosis. The authors say that people from ethnic minorities may have more complex health and social needs, which will have to be addressed in order to reduce suicide rates in this group (British Journal of Psychiatry 2003;183:155-60).
The level of fatigue after cancer treatment is the largest factor in predicting a return to work. Nearly two thirds (64%) of cancer survivors in a prospective cohort study of 235 patients were back at work within 18 months. The duration of sick leave depended on diagnosis, treatment, age, physical complaints, and workload (European Journal of Cancer 2003;39:1562-7).
Prophylactic colectomies have been suggested for patients with ulcerative colitis. But a 10 year follow up of people with ulcerative colitis, with and without low grade dysplasia, does not support such a radical approach (Gut 2003;52:1127-32). The issue is not that malignancies do not develop, but that the diagnosis of low grade dysplasia is unreliable. In this study, agreement between pathologists was uniformly poor.
We are all getting connected to the internet, and the government is eager for general practitioners to use NHS Net. A survey of 141 practices in England found that despite such technological wizardry, only a small minority of practices use a website for booking patients or access to pathology results. More worryingly, no practice websites seemed to pay the necessary attention to data security (Journal of the Royal Society of Medicine 2003;96:395-7).
Neonatal intensive care units tend to be noisy places, and excess auditory stimulation creates negative physiological responses such as increased heart and respiratory rates and reduced oxygen saturation. A review in the Journal of Obstetric, Gynecologic, and Neonatal Nursing (2003;32:447-54) concludes that a lot of changes need to be made to create environments conducive to maturation and recovery from illness. Two suggestions are installing sound absorbing materials and minimising staff chat.
Alarm bells start ringing if a child loses language development. A review of the records of 196 consecutive children referred to a US paediatric neurologist found that the mean age at regression was 21.2 months and in 38% of cases a trigger was identified (these children tended to have a more rapid regression); 74% of the total became non-verbal and 75% were cognitively impaired, and 93% were eventually diagnosed with a more global autistic regression. Although 61% recovered somewhat, only one child made a full recovery (
Developmental Medicine and Child Neurology 2003;45:508-14).
Women take the oral contraceptive pill for all kinds of reasons, but one group of women may be particularly interested in a pilot study in the British Journal of Sports Medicine (2003;37:315-20). A double blind placebo controlled trial in 14 female athletes found that maximal aerobic capacity decreased when triphasic pills were taken rather than placebo. The mechanism is unknown.
Despite the plethora of antidepressants on the market, we are still in the dark about how they actually work on the brain to achieve better moods. A clue comes from animal studies, which have found that antidepressants do not seem to have the usual beneficial effects on behaviour when the gene that promotes new neuron growth around the hippocampus is knocked out in mice. This was observed with both selective serotonin reuptake inhibitors and tricyclic antidepressants (Science 2003;301:805-9).
Even wives endorse wife beating in some countries. In Zimbabwe, a survey of over 6000 women found that women believe beating is justified if a wife argues with her spouse (36%), if she neglects her children (33%), or if she goes out without telling her spouse (30%). Justification tended to be strongest among young poorly educated women living in rural areas. Women who claimed to make joint decisions with their partners were less likely to approve the practice (Bulletin of the World Health Organization 2003;18:501-8).
Fat characters on prime time television loom large in the United States, but they are not as common as in the general population. A quantitative analysis of 1018 major television characters found that 14% of women and 24% of men are overweight or obese. The women were less likely to be considered attractive, interacted less with romantic partners, and displayed less physical affection. The men talked less about dating and were likely to be shown eating (American Journal of Public Health 2003;93:1342-8).
In much of Uganda, one doctor serves 50 000 people. Writing in the
Health Exchange (August 2003:9-12), a palliative care physician who has already introduced palliative care training into three countries argues that without the benefit of antiviral drugs and diagnostic or oncology services, palliative care services are a critical part of healthcare delivery in Africa. She says the training is affordable and culturally acceptable.
Around eight million new cases of tuberculosis were found worldwide in 2000, and the current rate of increase is 1.7% each year. Nearly half of people with a new diagnosis had positive findings on examination of their sputum and so were highly infectious (Annals of Medicine 2003;35:235-43). Part of the recent rise in numbers is due to rapid population growth in Africa and Asia, but two other factors-HIV infection and malnutrition-are remediable to some extent. The review also includes one warning: "doctors who cannot treat TB properly should not treat TB at all."
Having had type 1 diabetes mellitus for 10 years, with relatively poor metabolic control, this 16 year old developed significant reduction in the flexibility of her hands. The picture illustrates the "prayer" sign, one of the earliest and most severe complications seen, particularly in type 1 diabetes. Some studies have shown that the prayer sign correlates with other microangiopathic complications, especially retinopathy.
Shriraam Mahadevan, senior resident
Pavanasam Velayutham, senior resident
Anil Bhansali, associate professor,
Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
studentBMJ 2003;11:349-392 October ISSN 0966-6494
