BMJ  2003;327:E148 (4 October), doi:10.1136/bmjusa.02090008 (published 27 November 2002)

BMJ USA: Minerva

Minerva

From BMJ USA 2002;September:530

The letters page of the Mayo Clinic Proceedings (Mayo Clinic Proceedings;2002:77-600) carries a discussion about religion and health. One writer says that appropriate spiritual support should be available to all patients who desire it, in the same way as meals and warm bedding. Raising a null hypothesis to question which, if any, spiritual intervention is best, he says, serves no purpose. The answer to this research question lies within the heart and soul of the individual, and evidence based medicine plays no role.

Minerva's mental health is sometimes affected by her noisy neighbors. A study of neighborhood noise and children found that exposure to ambient noise (from road and rail) is associated with small reductions in children's mental health and poorer behavior in the classroom. The correlation is stronger in children with an additional early biological risk, such as low birth weight and preterm birth ( Occupational and Environmental Medicine 2002;59:380-386[Abstract/Free Full Text]).

By totaling the area globally available for crop growth, animal grazing, timber harvesting, carbon dioxide absorption produced by fossil fuel burning, and marine fishing, and by calculating the area required to sustain human demand, researchers have estimated that in the mid-1970s demand reached total global supply. But by 1999, demand exceeded supply by at least one quarter. In real terms this means it takes our biosphere one year and three months to renew what humanity uses in a single year (www.pnas.org/cgi/content/abstract/142033699v1).

Receiving a blow to the head can be traumatic, and much more so in elderly people. In one retrospective analysis of people with isolated brain injuries admitted to two trauma centers in the United States, age turned out be an independent predictor of mortality and poor early outcome, regardless of the severity of the injury. The long term outcome in this elderly group of patients remains unknown, as is the cause of the increased mortality ( Trauma 2002;52:907-911[ISI][Medline]).

Case reports and a single epidemiological study have thrown up the possibility that statins may harm the peripheral nervous system. Using a population based patient registry to identify first cases of idiopathic polyneuropathy over a period of five years, and identifying appropriate controls, the authors of a study in Neurology (Neurology;2002:58-1333) estimated that idiopathic polyneuropathy was 26 times more likely in people who had taken statins for more than two years. The benefits of statins outweigh the risks, but continued use of the drug should be questioned if neurological symptoms occur.

It may not be too remarkable that horse riders are more likely to be injured than motor cyclists, but Minerva was surprised to read in Spinal Cord (Spinal Cord;2002:40-267) that a motor cyclist may expect a serious incident once in every 7000 hours on his or her bike, whereas a horse rider may expect one every 350 hours.

In her long career Minerva has witnessed a good many 180 degree turns in the management of common disorders. One of the most dramatic has been the abandonment of bed rest as a treatment for low back pain and its replacement by early activity and exercise. Some doubts persist about the value of exercise, but experience with athletes has shown ( Southern Medical Journal 2002;95:642-646[ISI][Medline]) that active participation by the patient is crucial for the success of exercise, which should be started early and be progressive in intensity. In other words, the patient has to want to get better fast.

Is there a link between empathy and academic ability? A study of medical students in Medical Education (Medical Education;2002:36-522) operationalized empathy into a 20 point scale and compared empathy scores to the students' performance in examinations and to grades given by the medical school faculty. Women scored higher on empathy, but overall the researchers did not find that empathic students had a better knowledge base. They were, however, judged to be more clinically competent by their lecturers. Are these results saying that empathic students can pull the wool over lecturers' eyes?

The speed and use of small boats and watercraft have increased dramatically in recent years. These watercraft include jet skis or wave runners, of which there are more than a million in the United States. Rates of injury in these are up to eight times higher than in other motorized craft, and children involved in accidents with jet skis tend to be more severely injured than those injured in other boating accidents ( American Surgeon 2002;68:535-538[Medline]). Because of the growing popularity of what the Americans call "personal watercraft" and their use, even in shallow water, injury rates are likely to increase.

View larger version (81K): [in this window] [in a new window]   A 67 year old Zambian woman presented to our mission hospital with diarrhea, dementia, and dermatitis, which are the classic features of pellagra. Her diet consisted almost exclusively of maize flour, which is low in biologically available niacin. Chronic thickening, dryness, and pigmentation of her skin had developed in areas exposed to the sun. Casal's necklace is the term given to the skin lesion around her neck. She also had painful glossitis and angular stomatitis. Her symptoms improved markedly when she was provided with nicotinamide 300 mg daily, vitamin B complex, and a better diet. Pellagra is not uncommon in Zambia. It is either solely the result of a poor diet or of the treatment for tuberculosis with isoniazid. This leads to a deficiency of vitamin B-6 (pyridoxine), which is needed for the synthesis of nicotinamide from tryptophan within the body. D Elphick, specialist physician, H Elphick, specialist physician St Francis's Hospital, Katete, Zambia

Drugs that are used to boost memory in Alzheimer's patients may also augment the performance of airline pilots. A study of 18 pilots with an average age of 52 ( Neurology 2002;59:123-125[Abstract/Free Full Text]) shows that pilots who took donepezil for 30 days retained training on a flight simulator test better than those who took placebo. "Many older adults who never develop Alzheimer's have cognitive impairments that impact on their daily lives and the demand is increasing for therapies to address this," says the author. Another example, perhaps, of Americans wanting to be forever young.

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