eMJA: In Other Journals, 15 August 2005

It seems that women are likely to remain a mystery for some time to come — at least where sexual satisfaction is concerned. In a study of more than 1000 women, Australian researchers have found that self-reported low libido is not linked to low serum testosterone levels. Further, although women who reported low sexual responsiveness were more likely to have low serum dehydroepiandrosterone sulfate (DHEAS) levels, most of the women with a low DHEAS level did not report low sexual function.
All in all, the researchers said no serum androgen level could define the cluster of symptoms that characterise “female androgen insufficiency”.

Men Down Under

Most men with erectile dysfunction have not sought medical advice about treatment, according to the Men in Australia Telephone Survey. The survey involved nearly 6000 men from around Australia, aged from 40 to 98 years of age, who were asked via a computer-assisted interview to answer 90 questions about a range of issues, including erectile function, lower urinary tract symptoms and prostate health, as well as their beliefs about male reproductive health. Overall, one in five men reported moderate or severe erectile dysfunction, with higher rates reported in older age groups. Although 90% of all the men surveyed had visited a doctor in the past year, only one in three men with significant erectile dysfunction had spoken to a health professional about it. The researchers say public education campaigns and additional resources will be needed for men to seek medical assistance for reproductive health problems, including erectile dysfunction.

Lancet 2005; 366: 218-224

Don’t drive and dial ...

If you think you can reduce your risk of having (and getting injured in) a car crash by using a hands-free rather than a hand-held mobile phone when you drive, you may need to think again. Researchers gained the cooperation of 456 mobile-phone owning Australian drivers who had presented at major Perth hospitals after a road crash, as well as their call records from major networks. They then compared mobile phone activity just before a crash with the drivers’ phone activity during other time periods (also while driving). Use of either type of mobile phone device, hands-free or hand-held, 10 minutes before a crash was linked to a fourfold increase in the odds of crashing.

BMJ Online First (www.bmj.com)

Stop seizures easily

Buccal midazolam is not only more likely to be easier and less embarrassing to administer to a child having an acute seizure than rectal diazepam — it may also be more effective. A randomised controlled study conducted in UK hospital emergency rooms compared these two strategies in 177 children older than 6 months of age, finding that more stopped seizing within 10 minutes if they received buccal midazolam rather than rectal diazepam. Further, fewer children experienced recurrence of the seizure within the next hour.

Lancet 2005; 366: 205-210

Unexpected deaths declared

Doctors have been warned by the US Food and Drug Administration (FDA) and Health Canada that atypical antipsychotic agents, such as risperidone and olanzapine, may lead to an increased risk of death when used in patients with severe dementia. An FDA advisory described 17 trials involving more than 5000 patients with dementia taking either placebo or one of four atypical antipsychotic agents. Although the trials averaged only 10 weeks in duration, mean mortality in the treatment groups was 4.5% compared with 2.6% in the placebo groups. Deaths were largely due to cardiovascular events or infection. The CMAJ report suggested that education of families and staff and specialised dementia wards may be more preferable ways of managing behavioural disturbances in patients with severe dementia than the use of atypical antipsychotic agents.

CMAJ 2005; 173: 252

Care for a coffee?

Looking for a reason to justify that extra coffee? According to a systematic review, a higher daily consumption of coffee is linked to a lower risk of developing type 2 diabetes. The reviewers analysed data from 15 epidemiological studies conducted around the world, including in Europe, the US and Japan. Irrespective of geography, trial participants who drank the greatest number of cups of coffee a day — six or seven or more — were about 35% less likely to develop diabetes than those who only drank up to two cups a day. Unfortunately, for the coffee connoisseurs among us, the reviewers say it would be premature for us to start telling our patients to drink more coffee. The connection between coffee and glucose metabolism is not fully understood; and, as always, any potential health benefits of coffee drinking need to be weighed against the possible harms.

JAMA 2005; 294: 97-104

Dr Ann Gregory, MJA

The Medical Journal of Australia eMJA