Driving blind?

Sydney researchers suggest that doctors are not formally assessing their patients' visual function in everyday clinical practice and/or are gaining incorrect impressions of patients' abilities. They were commenting on some of their findings in a study of 111 patients recruited prior to cataract surgery, which examined various patient-centred outcomes. The researchers found that 10 of the 43 patients who were driving motor vehicles before surgery were doing so illegally, with the patients' best eye’s visual acuity worse than 6/12. After surgery, 57 study patients reported driving — all legally.

Clin Exp Ophthalmol 2004; 32: 388-392

Peak performance

International experts warn that it is premature for adventurers to try out sildenafil (Viagra) (now known to mimic the features of a selective pulmonary vasodilator), as a performance-enhancing drug when mountaineering or hiking.1 Their caution accompanies the report of a small but impressive placebo-controlled cross-over study conducted in 14 healthy volunteers at the high altitude Mount Everest Base Camp. The study found that a single dose of 50 mg sildenafil led to several beneficial effects, including increased exercise capacity. However, sildenafil can cause headache, one of the symptoms of acute mountain sickness, and, the experts say, we do not yet understand the mechanisms responsible for the effects described.

1. Ann Intern Med 2004; 141: 233-235
2. Ann Intern Med 2004; 141: 169-177

"Brief" relief

In managing osteoarthritis, topical therapy with NSAIDs is best used for short periods (up to two weeks) during flare-ups, say UK authors. Their advice follows a meta-analysis of 13 randomised controlled trials comparing topical NSAIDs with placebo or oral NSAIDs, which found that topical NSAIDs were superior to placebo in relieving pain due to osteoarthritis in only the first two weeks (of up to four weeks) of treatment. However, the meta-analysis also suggested that, rather than being a class effect, this beneficial effect could depend on the specific NSAID used.

1. BMJ 2004; 329: 304-305
2. BMJ 2004; 329: 324-326

Fair’s fair

US editorialists say that the medical profession should be mortified that no other profession in their country exhibits greater gender disparities when it comes to position and pay.1 They were commenting on a US national survey of 1814 full-time faculty members of 24 medical schools in the mid-1990s, which found that female faculty members neither advanced as rapidly nor were compensated as well as male colleagues who were professionally similar (eg, in terms of total career publications, hours worked per week, type of department).2 Further, the differences in pay became greater with increasing seniority.

The female editorialists said that, in the past, they had learnt that their own salaries were in the lowest 5% for their rank after reviewing grant applications and following up a colleague’s tip-off about a relevant US report about salary ranges for academic faculty.

1. Ann Intern Med 2004; 141: 238-240
2. Ann Intern Med 2004; 141: 205-212

Columbine’s legacy

According to surveys of US high school students, the USA may well achieve two of its national health objectives for 2010: physical fighting among adolescents is down from 42.5% in 1991 to 33.0% in 2003 (2010 target, <32%), and weapon carrying on school property is down from 11.8% in 1993 to 6.1% in 2003 (2010 target, < 4.9%). However, significantly more children are now reporting not going to school because of safety concerns (either at school or on the way to or from school), up from 4.4% in 1993 to 5.4% in 2003. High-profile, school-associated, multivictim homicides in the 1990s are thought to be responsible for a heightened sense of vulnerability among students.

MMWR Morb Mortal Wkly Rep 2004; 53: 651-655

Dr Ann Gregory, MJA