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The ill effects of social isolation could in part be hormonally mediated. In mice kept in total isolation for four weeks, expression of 5α-reductase type I—the brain enzyme responsible for producing the stress relieving hormone allopregnanolone—was halved. The enzyme acts on the parts of the brain involved in emotional learning, fear, and stress responses. The researchers say this may account for the anxiety, aggression, and memory impairments that are sometimes seen in socially isolated people (Proceedings of the National Academy of Science 14 November 2007; www.pnas.org/cgi/doi/10.1073/pnas.0709419104).
No matter how fancy and sophisticated surgical technology and procedures become, the tenets of good teaching remain the same. Surgical training still “relies heavily on mentorship, support, and role modelling by committed postgraduate trainers,” says an otolaryngologist in the Bulletin of the Royal College of Surgeons of England (2007;89:346-7; doi: 10.1308/147363507X248587). He says: “You need to be aware of what the trainees' worries or concerns are. They won't always tell you directly so you need to be able to spot the signs.” Just as with patients.
Some studies have indicated that the concentration of fetal haemoglobin (HbF), a possible marker of hypoxaemia before birth, is higher than normal in babies who have died from sudden infant death syndrome. Attempting to resolve this question using optimal technical methods, a US based team now reports that the percentage of fetal haemoglobin in infants who fulfilled rigorous criteria for sudden infant death and in control cases was not significantly different at autopsy (Journal of Forensic and Legal Medicine 2007;14:456-60; doi: 10.1016/j.jflm.2006.11.005).
Last week Minerva mentioned the EQUATOR network for helping researchers access guidelines for optimal reporting. There's also an easy way to look up the STROBE (strengthening the reporting of observational studies in epidemiology) statement directly, as discussed in the BMJ recently (2007;335:806-8; doi: 10.1136/bmj.39335.541782.AD)—go to www.strobe-statement.org/Checklist.html.
When pregnant mothers in Zimbabwe had to “opt out” of being tested for HIV infection, rather than opting in, significantly more cases of HIV were diagnosed and more HIV infected women came forward to collect their results than in the opt-in group. Deliveries by HIV infected women increased, more mother and infant pairs received antiretroviral prophylaxis, and more mother and infant pairs were followed up afterwards. The mothers identified as HIV positive reported low levels of abuse both from their spouse and from others (Bulletin of the World Health Organization 2007;85:843-50; doi: 10.2471/BLT.06.035188).
Data from the Framingham heart study shed interesting light on the influence of high blood pressure and body mass index on the incidence of heart failure later on (Hypertension 2007;50:869-76; doi: 10.1161/HYPERTENSIONAHA.107.095380). Of 3362 people who participated between 1969 and 1994 and were followed up, 518 developed heart failure. Current, recent, and remote systolic blood pressure; pulse pressure; and body mass index in midlife were each associated with new onset heart failure in later life. The burden of heart failure might be cut by recognising and modifying these risk factors earlier.
A two year preventive programme targeting disruptive and aggressive boys at age 7 that used several different approaches seems to have been successful. Follow-up analysis at age 24 shows that significantly more boys in the intervention group completed high school (46% v 32% controls), and generally fewer (22% v 33%) had a criminal record. Early prevention of antisocial behaviour benefits both the individuals and society as a whole, say the authors (British Journal of Psychiatry 2007;191:415-9; doi: 10.1192/bjp.bp.106.030007).
Most patients who need coronary artery bypass grafting are already taking statins to reduce their cholesterol levels. But German researchers wanted to find out whether there were any benefits of giving preoperative statins to those who had high cholesterol levels but were as yet untreated. They found that patients who had untreated high cholesterol before surgery (but not normolipidaemic patients being treated with statins) had an increased risk of major adverse cardiac events in hospital—emphasising the benefits of taking statins before bypass surgery (Journal of Thoracic and Cardiovascular Surgery 2007;134:1143-9; doi: 10.1016/j.jtcvs.2007.07.029).
A study that monitored levels of agitation of people living in nursing homes in two different ways reports that profoundly cognitively impaired residents had higher rates of agitation than moderately impaired residents. Behaviour of the profoundly impaired group became more stable over the first 12 months, but agitation was increased at 18 months. In the moderately impaired group, agitation was stable over 18 months. The study found that computer assisted observations were a more sensitive measure than conventional staff reporting systems (Gerontologist 2007;47:642-9; http://gerontologist.gerontologyjournals.org/cgi/reprint/47/5/642).
A recent BMJ debate (BMJ 2007;335:424; doi: 10.1136/bmj.39308.342639) asked if eponyms should be discontinued, and in the case of Friedrich Wegener (as in Wegener's granulomatosis) it seems as if the Board of Regents of the American College of Chest Physicians thinks they should be. The board unanimously voted to withdraw Wegener's Master Clinician award as he had been an early member of the Nazi Brownshirts, a pupil of a prolific expert on “racial hygiene,” and wanted as a war criminal.