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BMJ. 2008 January 12; 336(7635): 104.
PMCID: PMC2190285

Abandoned younger children who were moved from Romanian orphanages into foster homes had better cognitive development than those who were left in orphanages, and the greatest differences were seen in children who were fostered at a younger age (Science 2007;318:1937-40; doi: 10.1126/science.1143921). The study began when Romania did not have a foster care system, and the authors say their initial results led to the Romanian government prohibiting the institutionalisation of children younger than 2 years unless they are severely disabled.

In nulliparous women with breech presentation, external cephalic version performed by an experienced obstetrician was more successful at turning babies around when performed under spinal analgesia than with no analgesia. A prospective randomised controlled trial from Israel reported a 66.7% success rate under spinal block compared with 32.4% with no block (P=0.004). Placental position, estimated fetal weight, and maternal weight did not contribute to the success rate when analgesia was used, and no cases of placental abruption or fetal distress were seen (Obstetrics and Gynecology 2007;110:1343-50).

Investigations into the ability of humans to generate random numbers produce conflicting results. A study in Medical Hypotheses (2008;70:182-5; doi: 10.1016/j.mehy.2007.06.038) found that under experimental conditions the random sequences generated by humans are much “weaker” (more biased) than those generated by standard software. The researchers noted, however, that the results obtained from people with a scientific background were so different from those without one that they might be regarded as a “different species.”

Patients with decompensated heart failure may lose out on the beneficial effects of oral furosemide because of delayed drug absorption. In a crossover trial of 11 healthy men, 20 mg furosemide was given intravenously, orally, and sublingually. Compared with oral administration, sublingual absorption over five minutes was associated with a 43% higher maximal plasma concentration and a higher bioavailability, and sodium excretion was higher. Urine volume was similar with the two modes of administration (British Journal of Clinical Pharmacology 2007;64:804-9; doi: 10.1111/j.1365-2125.2007.03035.x).

A hospital in the Gambia accepted a donation of oxygen concentrators from philanthropists in the US. But the machines broke down and were put into storage. Analysis of what went wrong found that the hospital didn’t have the necessary expertise to assess or maintain the equipment, and that all the concentrators had the wrong voltage and frequency, which caused overheating and breakdown. One of the most useful outcomes of the analysis was the setting up of a hospital committee to oversee future donations (Bulletin of the World Health Organization 2008;86:52-6; doi: 10.2471/BLT.07.042994).

People with high blood pressure and no history of cerebrovascular disease can have microbleeds in the brain, which are indicative of cerebral small vessel disease. Regression analysis in a trial of 218 such people showed that the frequency of bleeds increased by 1.8-1.9-fold with each standard deviation increase in blood pressure—whether the person was awake or asleep. People with nocturnal hypertension had a five to six times greater risk of cerebral microbleeds. Nocturnal dipping was not associated with bleeds (Hypertension 2008;51:61-8; doi: 10.1161/HYPERTENSIONAHA.107.100610).

As a cat person, Minerva is definitely not as fit as her dog owning friends. An Australian cross sectional survey of 1813 adults reports that although only 23% of dog owners walked their dogs five or more times a week, the odds of achieving sufficient levels of activity and walking were 57-77% higher in dog owners than in people without dogs. This was independent of all other known correlates of physical activity and walking, such as demographic, environmental, and intrapersonal factors (American Journal of Public Health 2008;98:66-9; doi: 10.2105/AJPH.2006.103499).

Men are missing out on bone protection advice. A review of more than 2000 men aged over 50 who presented with fractures reports that the prevalence of osteoporosis ranged from 17.5% in those with ankle fractures to 57.8% in those with broken hips. The main risk factors, especially in men with hip fractures, were smoking, excessive alcohol drinking, a body mass index less than 21, and a family history of osteoporosis—all of which present opportunities for prevention (Journal of Bone and Joint Surgery (British) 2008;90-B:72-7; doi: 10.1302/0301-620X.90B1.18773).

A one-off oral dose of the antidepressant, mirtazapine, is a useful premedication adjunct before a general anaesthetic (Anesthesia and Analgesia 2008;106:109-13; doi: 10.1213/01.ane.0000289636.09841.bc). Because the drug blocks 5-hydroxytryptamine type 2 and 3 receptors, it was proposed as an agent for preventing preoperative anxiety and postoperative nausea and vomiting. Compared with placebo, a single 30 mg dose of mirtazapine effectively reduced preoperative anxiety and late onset (2-24 hours) nausea in women at moderate to high risk undergoing gynaecological surgery.


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