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BMJ. 2007 July 14; 335(7610): 104.
PMCID: PMC1914487

Minerva

Giving very sick patients nicotine replacement therapy may not be entirely safe, although it is sometimes given to smokers in the intensive care unit (ICU) to prevent withdrawal. A retrospective case-control analysis of this treatment in ICU patients found that it is associated with increased in-hospital mortality—20% in smokers who took the treatment versus 7% in those who did not. Treatment remained independently associated with increased mortality when severity of illness and invasive mechanical ventilation were adjusted for (Critical Care Medicine 2007;35:1517-21 doi: 10.1097/01.CCM.0000266537.86437.38).

What's happening to the price of eggs? A survey of ovum donor compensation rates in the US, set by members of the Society for Assisted Reproductive Technology, reports that the national average rate for standard donor compensation is $4217 (£2090; €3097) with a maximum reported price of $4576. Geographical variation is wide—the most expensive eggs are on the west and east coasts (Fertility and Sterility 2007;87:1001-4 doi: 10.1016/j.fertnstert.2006.12.037).

Delays in surgery for hip fracture have a significant effect on short and longer term outcome. An Israeli multicentre survey conducted over four years found that people who had surgery within two days of fracture had lower mortality while in hospital, and at one month and one year, than did those who waited for more than four days for surgery. Large variations were seen between hospitals, and the authors call for a prompt review of quality improvement (International Journal for Quality in Health Care 2007;19:170-6 doi: 10.1093/intqhc/mzm003).

Elderly European patients with cancer fare worse than younger ones. Of the 16 different cancers investigated, people over 65 years did worse than those aged 55-64. Most of the variation was in the first five years, and it was especially wide within the first year, but after that many cancers had similar survival rates in both age groups. The excess relative risks of death were greater in women, and genitourinary and gynaecological cancers came out worst. Access to health care and late diagnoses are the main determinant of this large prognostic disadvantage in elderly people (International Journal of Cancer 2007;120:2196-201 doi: 10.1002/ijc.22515).

English children are more physically active during the week than they are at weekends, according to data taken from sealed pedometers during three school terms. Boys took more steps each day than girls. Nearly half the girls met or exceeded the body mass index cut off points for health, while 29% of boys did the same. It seems that it is home life that needs to change (Preventive Medicine 2007;44:416-20 doi: 10.1016/j.ypmed.2006.11.019).

Female office workers experience high amounts of neck pain (Pain 2007;129:311-20 doi: 10.1016/j.pain.2006.10.017). Interestingly, 61% of the 333 women who completed the questionnaire reported mild neck symptoms lasting longer than eight days in the past 12 months, and the single psychosocial risk factor identified on multivariate logistic regression analysis was low support from supervisors. Lower support from supervisors was also the factor most strongly associated with severity of pain.

Minerva is always disappointed when an editor returns her work because she hasn't conveyed her intended message sufficiently well. But even public health leaflets designed for lay people can miss the point and leave their readers mystified. The English breast screening programme's information leaflet was tested on a random sample of 100 women. Although the leaflet improved their knowledge, some simple messages were still not understood by everyone (Journal of Public Health 2007;29:173-7 doi: 10.1093/pubmed/fdm007).

Setting up organ donor registers is a hugely expensive task and the benefits are often slim because the chance that the organs of registered people will be suitable for donation is very low. If donor families have the right of refusal, the value of a register falls greatly. The alternative is to “piggy back” on existing registers such as those of drivers' licences (Medical Decision Making 2007;27:243-9 doi: 10.1177/0272989X07299539).

Medical students perform many functions, and this time it's their feet that have been put to good use. A team in India investigated the association between foot length and stature in 250 medical students. They found that length of the right foot, sex, and age predicted 77% of the variations in stature (Journal of Forensic and Legal Medicine 2007;14:279-83 doi: 10.1016/j.jcfm.2006.10.014).


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