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A prospective, population based study assessed the predictability of three factors related to a first ever myocardial infarct—carotid intima media thickness, total plaque area, and plaque echogenicity—and followed up more than 6200 adults aged 25 to 84 for six years. It turns out that carotid plaque area is a stronger predictor of first-ever myocardial infarction than is intima media thickness and, overall, carotid atheroma is a stronger risk factor for myocardial infarction in women than in men (Stroke 2007;38:2873-80; doi: 10.1161/STROKEAHA.107.487264).
Visual estimates of blood loss are, surprisingly, usually underestimates rather than overestimates. A study that compared vaginal delivery drapes with and without volume calibrations at a simulated vaginal delivery showed that the calibrated drapes improved estimates of blood loss (300, 500, 1000, and 2000 ml) and the error was less than 15% at all volumes. With non-calibrated drapes, estimates were less accurate at the larger volumes, with a 16% error at 300 ml and 41% at 2000 ml (Anesthesia and Analgesia 2007;105:1736-40; doi: 10.1213/01.ane.0000286233.48111.d8).
“Neurasthenia” (shenjing shuairuo) used to be a hugely popular diagnosis among psychiatrists in China. The concept of “somatisation” does not exist in traditional Chinese medicine, but since 1980 the Diagnostic and Statistical Manual of Mental Disorders (with its recognition of “somatoform disorder”) and other sociocultural forces have influenced the Chinese concept of their own diagnosis. Neurasthenia has been transformed into the Western disease of depression—but in China the stigma of being given a diagnosis of depression is far greater than when it was called neurasthenia (Psychosomatic Medicine 2007;69:846-9; doi: 10.1097/PSY.0b013e31815b0092).
US citizens have long enjoyed their liberty to move around their own country and settle where they like. But mortality data collected, by county, over 35 years show both temporal and spatial clustering of high and low mortality rates. Counties with high mortality rates and those with low mortality rates both experienced migration of younger people out of their boundaries, were in economic decline, and were mostly rural. Mortality patterns have remained largely unchanged by policies aimed at alleviating socioeconomic inequality, advances in medicine, and regional population restructuring (American Journal of Public Health 2007;97:2148-50; doi: 10.2105/AJPH.2006.093112).
A randomised trial of goserelin versus control after adjuvant chemotherapy for breast cancer in premenopausal women reports no benefit from goserelin after a median follow-up of 4.7 years in either group. The adjusted estimated hazard ratio for event-free survival in the negative group was 1.01 (95% CI 0.72 to 1.42) and 0.77 (0.47 to 1.24) in the positive group. The authors say that although goserelin remains an attractive option for premenopausal women with hormone receptor positive tumours when used alone, their results don’t support the use of goserelin after chemotherapy in this group (European Journal of Cancer 2007;43:2351-8; doi: 10.1016/j.ejca.2007.08.012).
Do patients who are left to their own devices and monitor their blood pressure at home need fewer antihypertensive drugs, without losing control of their blood pressure? The answer seems to be yes. Compared with a group monitored in the clinic, a group measuring their own blood pressure used fewer drugs, and saved money, but had similar systolic and diastolic blood pressure (measured in the clinic), left ventricular mass index, and urinary microalbumin concentrations. At the end of the trial, however, 24 hour ambulatory blood pressure was slightly higher in the self measurement group (Hypertension 2007;50:1019-25; doi: 10.1161/HYPERTENSIONAHA.107.094193).
A total of 46 million bed nets have been given to families at risk of contracting malaria in Africa by the Global Fund to Fight AIDS, Tuberculosis and Malaria. The organisation also funds treatment for around 44 million people with malaria. The fund is a global public-private partnership dedicated to attracting and disbursing additional resources to prevent and treat these three diseases, working closely with other agencies in the field such as WHO and Roll Back Malaria (www.theglobalfund.org).
Minerva would like to remind readers about the Health Intelligence website, which brings together evidence on population based interventions and data on mortality and morbidity—and to put out a call for people to write up any local initiatives aimed at improving health in their community. Information should be sent to firstname.lastname@example.org. To read about the local projects already on the site, go to http://healthintelligence.bmj.com/hi/do/projects/home.
Dark chocolate hits the news again. This time, the action of the flavonoids in dark chocolate is under scrutiny. In particular, it’s their potential benefits on coronary vasculature and platelet function which European researchers have been assessing. Coronary artery diameter was significantly increased two hours after participants ate flavonoid-rich dark chocolate, but remained unchanged after they ate control (cocoa-free) chocolate. Platelet adhesion decreased in the dark chocolate group and remained unchanged in the control group. Both beneficial effects were associated with a significant reduction in oxidative stress (Circulation 2007;116:2376-82; doi: 10.1161/CIRCULATIONAHA.107.713867).