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Autumn seems to have replaced summer this year, at least in the United Kingdom, and the BMJ is already gearing up for Christmas. If you have any contributions that you think will be suitable for the usual melee of wit and verve in our Christmas issue, please submit them by 30 September through Benchpress, our electronic submission process (http://submit.bmj.com).
Patients with chronic heart failure are often undertreated. Analysis of drugs dispensed to people in Denmark over more than 10 years showed that patients who didn't start treatment within three months of being discharged from hospital were unlikely to subsequently start, and patients who do start taking the drugs usually take doses that are only half of the target. Short breaks from drugs were common but didn't deter people from restarting. Non-persistence with renin-angiotensin inhibitors, β blockers, and statins was associated with greater risk of death (Circulation 2007;116:737-44 doi: 10.1161/CIRCULATIONAHA.106.669101).
Minerva was amused to read that coffee beans are placed on perfume counters to help people distinguish between different fragrances. Aware too of the tendency for people to lose their appetites after cooking, US scientists propose that coffee might be useful in refreshing the olfactory receptors after a stint in the kitchen. They report that sniffing coffee beans after cooking improved their appetites. One theory is that some of the 28 different odourants in coffee may be sufficiently intense to detach the food odourants from the receptors, thus restimulating the appetite (Medical Hypotheses 2007;69:508-9 doi: 10.1016/j.mehy.2006.12.048).
Mouse models have helped link the protein SAPAP3 with obsessive-compulsive disorder. Mice with a deleted sapap3 gene showed behaviours similar to those seen in the human disorder. The mice exhibited increased anxiety levels and compulsive grooming leading to loss of facial hair and skin lesions. Selective serotonin reuptake inhibitors alleviated these behaviours. Abnormal physiology in the striatal neural circuits could underlie some aspects of obsessive-compulsive disorder (Nature 2007;448:894-900 doi: 10.1038/nature06104).
Bacterial vaginosis arises from changes in the vaginal flora and may be linked with diet. Analysis of over 1500 women participating in a larger study of vaginal flora found that 42% of them had bacterial vaginosis and 14.9% had severe infection. Bacterial vaginosis was associated with increased consumption of fat, and severe vaginosis was associated with both saturated and monounsaturated fat. Increased intakes of folate, vitamin E, and calcium were inversely related to the risk of severe infection (Journal of Nutrition 2007;137:2128-33 http://jn.nutrition.org).
NHS Direct, the UK's 24 hour healthcare telephone service, has reported a big rise in the number of callers reporting mosquito bites over the past three months. Since the country has not enjoyed much hot weather recently, the mosquito explosion is more likely to be caused by warm and humid conditions, as well as the lakes of standing water left by severe rainstorms. Calls in August about bites are 28% up on the same time last year (www.nhsdirect.nhs.uk).
Last month's Prescriber (2007;18 www.escriber.com) describes a novel idea which the author calls the side effect responsibility search. The idea is that doctors could enter a potential side effect into the general practice computer system and search the patient's prescribed drugs to identify any that are known to cause that effect. A further step would highlight the incidence of the side effect from the drug manufacturers' summary of product characteristics, and it may be possible to incorporate a facility for reporting suspected side effects in real time to the Committee on Safety of Medicines. The author claims his innovation could revolutionise drug prescribing.
A single centre cohort study conducted in a medical intensive care unit reports that a lower nurse to patient ratio is associated with an increased risk of late onset ventilator associated pneumonia. Risk of early onset pneumonia was unaffected. Patients with ventilation associated pneumonia required mechanical ventilation for a median of 11 days compared with three days for those without the condition. Sixty one per cent of episodes were late onset. The median daily nurse to patient ratio during the study was 1.9 (Critical Care 2007;11:R80 doi: 10.1186/cc5974).
Out of body experiences—divine intervention or scientific fact? People who are awake and see their body from a location outside their physical body are said to have an out of body experience. The phenomenon is usually reported by people with a disturbance of brain function—for example, after strokes, partial epileptic seizures, and drug misuse. But scientists have now induced the experience in healthy people by manipulating the perceptual processes of visual perspective (through goggles connected to two video cameras) in conjunction with multisensory stimulation of the body (Science 2007;317:1048 doi: 10.1126/science.1142175).