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Three women who were desperate to preserve their reproductive capacity—but knew that they were at risk of bleeding and need for hysterectomy when giving birth—took the unusual step of giving birth not in a delivery suite or in an operating theatre but in an interventional radiology suite. All three had caesarean sections after placement of a balloon or embolotherapy in the uterine artery, which successfully minimised blood loss in delivery (Anesthesia and Analgesia 2007;104:1193-4 doi: 10.1213/01.ane.0000260264.89337.9e).
Chronic stress, such as in unemployment, is linked to persistent impairment of natural killer cells, resulting in a reduced immune function. But the good news is that almost normal function resumes once the source of stress is removed. Once unemployed people found new jobs, 44-73% of their immune function was rapidly restored compared with people who were continually employed. Men and women showed the same thing (Psychosomatic Medicine 2007;69:225-34 doi: 10.1097/PSY.0b013e31803139a6).
To prove how much medical practice is not based on evidence, five clinical vignettes relating to choices of treatment for atrial fibrillation and prevention of stroke were presented to 14 senior doctors in cardiology, geriatrics, and general medicine (QJM 2007;100:263-9, doi: 10.1093/qjmed/hcm016). Not only was there wide variation in the choice of antithrombotic treatment, the doctors' perception of risk of stroke and bleeding also varied widely.
Doctors who think they're good listeners may be interested in the Patient Voices Programme. Digital technology is used to superimpose a patient's personal story, told in surprisingly few words and in their own voice, on to digital images chosen by the patient as illustration. Minerva recently attended a digital storytelling class and confesses she was ashamed to discover how much better she listened to such a digital presentation compared with how she sometimes manages in a busy clinic. See www.patientvoices.org.uk.
A Lebanese study shows some interesting observations about the continuing sexual revolution (American Journal of Public Health 2007;97:860-6 doi: 10.2105/AJPH.2005.080374). This population based study examined husbands' involvement in housework and their wives' psychosocial health. Involvement of a husband was negatively associated with wives' psychological distress, marital dissatisfaction, and overall unhappiness, after adjusting for relevant risk factors. Compared with wives whose husbands were highly involved in housework, wives whose husbands were minimally involved were 2.69 times more likely to be unhappy, 2.96 times more likely to be uncomfortable with their husbands, and 1.6 times more likely to be distressed.
A reader who has been investigating Computer Sciences Corporation, his local “connecting for health” provider, has pointed out that much of its work is with the US government and, in particular, the US National Security Agency (www.csc.com/industries/government/news/1456.shtml). His concern that they might be able to listen to his conversations and read his emails met this reassuring response from a US commercial expert: “If they can't find Bin Laden, they won't be able to find your case notes.”
Menstruation is blamed for many things but, apparently, should not be blamed for cyclical differences in knee injuries, such as rupture of the anterior collateral ligament sustained during jumping and landing. Knee and hip joint loading was unaffected by cyclical variations in hormones, so the observed difference in rates of injury is likely to be because of persistent differences in strength, neuromuscular coordination, or properties of ligaments (American Journal of Sports Medicine 2007;35:793-800 doi: 10.1177/0363546506297537).
Rescue workers who were followed up for four years after a Dutch fireworks depot exploded in May 2000 were found to take significantly more sick leave in the 18 months after the incident than before it. Reasons commonly stated for long term ill health were psychological distress and respiratory problems, although in the immediate aftermath musculoskeletal problems were also common. Neurological problems started showing one year after. Rates of sick leave for respiratory and musculoskeletal problems remained raised for three years, but leave for psychological problems and other ill health had by then reverted to pre-disaster levels (CMAJ 2007;176:1279-83 doi: 10.1503/cmaj.060626).
EMLA is a specific (eutectic) mixture of local anaesthetics that is commonly used to prevent pain in children who are about to have blood samples taken. A Turkish team trialled the use of EMLA in adult patients attending a thyroid outpatient clinic who needed fine needle aspiration biopsies. It was effective and, of course, non-invasive (Clinical Endocrinology 2007;66:691-4 doi: 10.1111/j.1365-2265.2007.02802.x).