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BMJ. 2007 April 28; 334(7599): 908.
PMCID: PMC1857757

Minerva

Spanish doctors are more likely to drink and drive than other university graduates, according to a study of self reported behaviour in BMCPublic Health (2007;7:55, doi: 10.1186/1471-2458-7-55). Nurses of both sexes and female doctors were 1.2 times as likely to “drink-drive” as non-health workers. But male doctors were even less responsible, being twice as likely to drink-drive as non-health workers. Drink-driving behaviour was related to other “unsafe” practices, such as binge drinking, drinking every day, not wearing seat belts, and being a former smoker.

Men may have a biological clock ticking away after all. Scientists say that current studies in animals are confirming that ageing can affect male as well as female fertility (Science 2007;316:383-4, doi: 10.1126/science.1142201). In species in which females mate with many males it seems advantageous to mate with males of intermediate age, whose sperm is likely to win in competition with younger and older males. When older males do successfully mate, the offspring may end up genetically less fit.

An intriguing article in the Pharmaceutical Journal proposes getting rid of the dispensing fee that is paid to pharmacies per item and suggests instead reimbursing them with a sum dependent on the number of patients registered (2007;278:394, www.pjonline.com/pdf/spectrum/pj_20070407_polypharmacy.pdf). Pharmacists would then have a “vested interest in reducing polypharmacy and delivering health education because it would result in less work and increased profitability.”

To try to reduce the risk of aspiration after treatment for locally advanced head and neck cancer, a US team devised a study to assess the benefits of offering “swallowing therapy” (Oral Oncology 2007;43:352-7, doi: 10.1016/j.oraloncology.2006.04.002). All patients were free of cancer at the time of follow-up, a median of 25 months later. Swallowing therapy improved the severity of dysphagia and reduced the need for tube feeding, but a significant number of patients still had chronic severe aspiration. A better outcome requires new strategies, say the authors.

Disrupting the environmental transmission of the flu virus may be the only viable way to protect the public in an influenza pandemic, especially where antiviral drugs and vaccines might be in short supply. Two obvious ways to do this are to use facemasks and ultraviolet light. Reusable facemasks should be stockpiled, say the authors, because the supplies of disposable ones are likely to be inadequate. Ultraviolet light directed overhead may be useful in hospitals and nursing homes (American Journal of Public Health 2007;97(supp 1):S32-7, doi: 10.2105/AJPH.2006.096214).

A former British Airways pilot says that doctors and dentists can learn a thing or two from the aviation industry (Summons:Journal of the Medical and Dental Defence Union of Scotland, spring 2007: 8-9). Health care and aviation have two key similarities—both operate in environments that are unforgiving of error, and both require effective teamwork. Health care should note from aviation how to shorten the “learning timeframe,” he says. “Safety is not a single event or even something that we ‘do.' Safety is a notion which should inform our every action.”

Bariatric surgery—laparoscopic or open stomach banding—brings about far more positive outcomes than simple weight loss (British Journal of Surgery 2007;94:449-56, doi: 10.1002/bjs.5607). Measures of health related quality of life, including wellbeing, health distress, depression, perceived attractiveness, and self worth, all improved over five years even though not all excess weight was lost. Productivity at work and physical activity also increased. Where the body mass index fell to less than 30, quality of life scores were similar to people of normal weight.

The emergence of community acquired methicillin resistant Staphylococcus aureus (MRSA) in Northern Ireland offers worrying implications for the population. An otherwise healthy teenager presented with a cellulitic toe and, rather unusually for MRSA, the bug turned out to be sensitive to ciprofloxacin on in vitro testing (Ulster Medical Journal 2007;76:68-71, www.users.zetnet.co.uk/jil/ums/umj076/076(2)068.pdf).

A consultant writing in the QJM says that his team is officially “overperforming” (2007;100:251-2, doi: 10.1093/qjmed/hcm011). They'd done more work than predicted and were asked to work less hard for the remainder of last financial year. The trouble is that they were only “in breach” of one of a number of local contracts, so for patients living in a different catchment area it was business as usual. Not only did this introduce another form of postcode discrimination, the writer says, “it's beginning to resemble totalitarianism.”

Patients who get nosebleeds severe enough to warrant nasal packing are usually admitted to hospital—but is this necessary? A retrospective review of 116 patients who were managed after the implementation in 2004 of a local protocol, which is followed by junior doctors in the emergency department, found that only 17 patients needed admitting (Journal of Laryngology and Otology 2007;171:222-7, doi: 10.1017/S0022215106003148). Forty six had been discharged with nasal packing in situ, and only seven patients returned because of bleeding. In all, 39 admissions had been prevented, avoiding the risk of hospital acquired infection.

Minerva has a tendency to monitor her own bowel habit, but very little is known about what constitutes a “normal” bowel habit in women. A large survey of women with no bowel disease found a huge diversity in what is considered normal (Diseases of the Rectum and Colon 2007;50:351-8, doi: 10.1007/s10350-006-0758-0). Indeed, one daily bowel movement is not the norm. Older women and women who've had children report more flatal incontinence, and one third of all women experience some faecal incontinence. Disturbances to the usual pattern were most commonly caused by foods, followed by menstruation, stress, and childbirth.


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