eMJA: In Other Journals, 20 March 2006

Saw palmetto, a widely used herbal preparation, may be no more effective than placebo in reducing the symptoms of benign prostatic hyperplasia (BPH), according to a US study. Bent and colleagues conducted a year-long, randomised controlled double-blind study in 225 men, aged over 49 years of age, with moderate-to-severe symptoms of BPH, comparing the effects of a saw palmetto extract (160 mg twice a day) with placebo. Both placebo and saw palmetto led to a similar small, clinically insignificant reduction in lower urinary tract symptoms. The researchers could not address the possibility of whether the level of active ingredient in the extract used was insufficient in this study as this ingredient, if it exists, has not been identified.

Keeping track of diabetes

According to New York City’s Health Commissioner, Thomas Frieden, diabetes is the only major health problem in the US that is getting worse, and getting worse rapidly. About 9% of New York adults have been diagnosed with diabetes; in the South Bronx the figure is even higher — 18%. However, it is not known how many have poorly controlled diabetes or who cares for them. Frieden has previously said that the city’s local public health infrastructure had not kept pace with the transition in common causes of death over the last century from communicable to non-communicable diseases. Now, in an effort to “get a better handle” on the situation, the Big Apple has introduced novel, mandatory electronic reporting of glycosylated haemoglobin values by laboratories to the city’s Department of Health and Mental Hygiene. The test results and other identifying information will be confidential. The department hopes to use this registry data to implement and evaluate a pilot intervention program in the South Bronx.

N Engl J Med 2006; 354: 545-548

Bugged mobile phones

Health care workers’ mobile phones could pose an infection risk, say UK researchers. Brady and colleagues swabbed more than 100 mobile phones carried by doctors and nursing staff at one district general hospital. On culture, most of the phones demonstrated bacterial contamination, with swabs from about one in five phones growing three or more different species. Of concern, swabs from 15 of the phones sampled grew bacteria known to cause nosocomial infection, including methicillin-resistant Staphylococcus aureus.

The researchers say that the potential of mobile phones to spread infection is an important argument to consider when debating whether restrictions on mobile phone use in hospitals should be relaxed.

J Hosp Infect 2006; 62: 123-125

Chronic work stress linked to the metabolic syndrome

Do you have job strain — that is, does your job have high demands, with little that can be controlled, and no support? If so, you may be at increased risk of developing the metabolic syndrome. UK researchers measured work stress on four separate occasions over 14 years in more than 10 000 London-based civil servants. They also determined who had developed metabolic syndrome by the end of follow-up, and found a dose-response relationship existed between work stress and the risk of metabolic syndrome. Civil servants with chronic work stress (ie, three or more exposures to work stress) were more than twice as likely to have developed the metabolic syndrome than those without work stress.

BMJ Online First, 14 Feb 2006

Moving movies

Emotions evoked by watching a movie can affect endothelial function, say US researchers. Impaired endothelial function may contribute to an increased risk of coronary heart disease.

The researchers asked 20 healthy adult volunteers to watch at least part of a 15-30 minute segment of two movies, one designed to induce mental stress (eg, the opening scene of Saving Private Ryan) and the other to induce laughter (eg, There’s something about Mary). Subjects were instructed to watch each movie segment until they felt they had been affected by viewing it.

The researchers found that the subjects’ average brachial artery flow mediated endothelial dependent vasodilatation (FMD) was increased 22% by laughter and reduced 35% by mental stress. The overall difference in brachial artery FMD between the mental stress and laughter phases exceeded 50%. The mechanism responsible for this effect is not, as yet, known.

Heart 2006; 92: 261-262

Lupus: a salvage solution

Patients with severe systemic lupus erythematosus that is refractory to all drug treatments may benefit from a salvage regimen which involves autologous haemopoietic stem cell transplantation (HSCT) in addition to immunosuppressive agents. US authors reported a series of 50 such patients with organ- or life-threatening visceral involvement who were treated with cyclophosphamide, anti-thymocyte globulin and autologous HSCT. Disease-free survival at 5 years was 50%; the longest continuous duration of remission has been 7.5 years. The stem cell infusion shortens the duration of cyclophosphamide-induced neutropenia and thus decreases the risk of infection.

JAMA 2006; 295: 527-535

Dr Ann Gregory, MJA

The Medical Journal of Australia eMJA