BMJ  2003;327:E235 (4 October), doi:10.1136/bmjusa.03060008 (published 3 July 2003)

BMJ USA: Minerva

Minerva

From BMJ USA 2003;June:342

Minerva does a lot of housework (yes, even goddesses have to clean the toilet), so she immediately noticed the paper "unintentional fatal injuries arising from unpaid work at home," thinking it would be something to do with bleach or terrible accidents while making beds. In fact the Australian study of coroners' reports shows that deaths at home are mostly caused by poorly braced ladders, inadequately jacked up cars, and an ignorance of electrical circuitry ( Injury Prevention 2003;9:15-19[Abstract/Free Full Text]). Casualties are nearly all men.

Three quarters of US men aged over 50 years have been screened for prostate cancer with a test for prostate specific antigen, according to a national telephone survey of nearly 50 000 men ( JAMA 2003;289:1414-1420[Abstract/Free Full Text]). Fewer (63%) have been screened for colorectal cancer. The difference is at serious odds with the evidence of benefit, which is practically non-existent for the prostate screening test, say the authors.

In total 186 studies have looked at smiling in men and women. A lengthy meta-analysis confirms that in general women smile more than men, but not much ( Psychological Bulletin 2003;129:305-334[CrossRef][ISI][Medline]). The extent of the difference reported depends on many things, including age (the difference peaks in teenagers), nationality (smaller differences in England and Australia than in the United States), and the sex of a paper's first author (bigger difference in papers written by men).

Humans have a pathetic sense of smell because over half of the 1000 genes coding for our olfactory receptors don't work. And it can only get worse. Recent experiments show that we are accumulating inactive genes four times faster than our nearest primate relatives ( Proceedings of the National Academy of Sciences 2003 ;100:3324-3327[Abstract/Free Full Text]). The scientists, three molecular geneticists and an evolutionary anthropologist, say we are losing it because we have stopped using it, whereas other primates use their sense of smell to choose a mate.

Primary care doctors don't have all day to counsel well people about their lifestyles, organize screening tests, and discuss the latest research on vitamin supplements and drinking. But all day is exactly what they need, says a study in the American Journal of Public Health (2003;93:635-641[Abstract/Free Full Text]). Researchers calculated it would take 7.4 hours of every working day for primary care physicians to complete all the preventive services recommended for all their patients. So they don't.

A Canadian doctor was baffled when a 40 year old man presented with gross painless hematuria, and extensive investigations drew a blank. He was less baffled after the patient explained that he had just ridden 310 miles on a snowmobile ( Canadian Medical Association Journal 2003;168:670-672[Free Full Text]). The long and bumpy ride had traumatized his bladder.

Californians are slowly getting used to the idea that their bars should be smoke free. A recent survey of bar owners shows that three quarters of them are now happy to ban smoking on their premises ( American Journal of Public Health 2003;93:611-617[Abstract/Free Full Text]). In a previous survey in March 1998, two months after the ban became law, only half the respondents approved, and nearly a quarter of bar owners said they would ignore it.

A national survey shows that community based doctors are prescribing fewer antibiotics in total, but at least 40% of prescriptions are for broad spectrum drugs such as the quinolones, clarithromycin, and the latest cephalosporins ( Annals of Internal Medicine 2003;138:525-533[Abstract/Free Full Text]). This can only increase antibiotic resistance, warns one commentator in an accompanying editorial (pp 605-606). He notes that drugs such as penicillin and erythromycin are no longer marketed by drug companies. Billions of dollars are spent marketing the rest.

A large randomized trial of atorvastatin in people with hypertension was stopped early because interim analysis three years into the five year trial showed that the statin reduced the incidence of strokes and coronary events by up to a third relative to placebo ( Lancet 2003;361:1149-1158[CrossRef][ISI][Medline]). There were significantly fewer deaths in the treatment arm. Participants had a moderately high risk for strokes and coronary events but were "not conventionally dyslipidemic." All had serum cholesterol concentrations of less than 251 mg/dL.

View larger version (102K): [in this window] [in a new window]   An 11 year old girl presented with a two week history of increasing redness around her left eye. She said she had been hit in her eye with a rubber band fired by her sister. On ophthalmological examination she had an unaided vision of 6/5 in both eyes and a bright red periorbital discoloration around the left eye. Examination with a dermatoscope showed flecks of colored pigment around the left eye that could be easily wiped off with a tissue. The red eye was "instantly cured." We assume that the girl had used a coloring agent on her skin to accentuate her symptoms. S Srinivasan, specialist registrar in ophthalmology, Graham R Sharpe, consultant dermatologist, Arvind Chandna, consultant ophthalmologist, Royal Liverpool Children's Hospital, NHS Trust, Alder Hey, Liverpool L12 2AP, UK

Manufacturers recommend monitoring the serum concentration of transaminases in anyone taking statins. In a retrospective look at over a thousand patients from primary care, only a handful had abnormal results and most of those were not caused by the drug ( Archives of Internal Medicine 2003;163:688-692[Abstract/Free Full Text]). Interestingly, half the patients taking statins in this real world study were women. In the Lancet's atorvastatin trial only a fifth of the participants were women.

A comprehensive search found more than 500 studies evaluating neurosurgery in people with Parkinson's disease ( Journal of Neurology, Neurosurgery, and Psychiatry 2003;74:519-521[Abstract/Free Full Text]). But only seven of them were randomized trials, and they averaged only 30 patients each. Poor reporting and inadequate analysis limited the data even further. So despite a body of "evidence" from over 10 000 patients, we still have no clear idea of whether this treatment works.

A sanitation and hygiene education project set in several villages in northern Pakistan seems to have been quite successful. After known confounding factors were controlled for, the project accounted for an estimated 25% reduction in the incidence of diarrhea in children ( Bulletin of the World Health Organization 2003 ;81:160-165[ISI][Medline]).

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