eMJA: In Other Journals, 3 September 2007

An estimated 250 000 child soldiers currently suffer from abuse around the world. Some children exposed to traumatic events as child soldiers are more likely to experience feelings of revenge and are less open to the idea of reconciliation, according to German researchers. A total of 169 Ugandan and Congolese former child soldiers were interviewed in African rehabilitation centres, and symptoms of post-traumatic stress disorder (PTSD) were assessed. The mean age of the participants was 15.3 years and the mean age of recruitment into the armed forces was 12.1 years. Reported traumatic experiences included being a witness to shooting or wounding, and having been beaten or forced into sexual contact. Over half reported having killed someone.

Children who showed more PTSD symptoms were significantly less open to reconciliation and experienced significantly more feelings of revenge. The authors comment that post-traumatic stress may hamper the process of overcoming feelings of hate and revenge in former child soldiers, and that such children may see retaliation as an appropriate method of regaining their integrity.

Cannabis and mental health

Regular users of cannabis have a higher than average risk of developing psychosis beyond the transient intoxication stage, suggests a recent systematic review. The evidence for an association between cannabis and affective disorders including depression and anxiety was less strong but still present. Despite the possibility of confounding factors or bias affecting the result, the researchers conclude that the evidence is consistent enough to provide a clear association between use of the drug and psychotic symptoms, including severe psychotic disorders. They comment that young people should be warned of the increased risk of developing a psychotic illness if they use cannabis.

Lancet 2007; 370: 319-328

Progesterone prolongs pregnancy

Administration of progesterone appears to reduce the rate of spontaneous early preterm delivery in women with a short cervix, according to a large British randomised trial. Over 24 000 pregnant women were screened to determine cervical length, with 413 found to fulfil the criteria for a short cervix (15 mm or less). From 24 to 34 weeks’ gestation, these women were randomly assigned to receive either 200 mg per night of vaginal progesterone, or a placebo. Spontaneous delivery before 34 weeks’ gestation was significantly less frequent in the progesterone group. The authors advocate routine ultrasonographic screening for cervical length in pregnant women, with administration of prophylactic progesterone to those found to have a short cervix.

N Engl J Med 2007; 357: 462-469

Cocaine kitty

Sydney veterinarians treating an anxious moggy found more than they bargained for when they performed toxicological studies on the fractious feline. The 8-month-old cat was presented with a history of agitation and on examination was tachycardic with dilated pupils. The animal paced incessantly, climbing the bars of its cage and reacting nervously to any approach. A urinary toxicology screen revealed cocaine metabolites and benzodiazepines. Astute veterinary clinicians quizzed the cat’s owners and learned of a recent dinner party where cocaine was available “on plates” and at which it seemed the cat had been present. Treatment with a cardioselective b-antagonist was commenced and the cat’s condition improved substantially. The authors comment that although there are few documented reports of cocaine intoxication in companion animals, urinary drug screening is a valuable adjunct in the investigation of veterinary patients with unexplained neurological and cardiovascular signs.

J Feline Med Surg 2007; 9: 265-270

Doctors’ work hours affect mortality

A US study suggests that changes in work-hour regulations for hospital medical residents appear to be associated with reduced patient mortality. Researchers analysed the hospital stay data of over 1.5 million people over a 4-year period, before and after the introduction of restricted work hours for junior hospital doctors. Non-teaching hospital patients were used as a control group. After restriction of work hours to 75 hours per week in 2003, there was a 0.25% reduction in absolute mortality and a 3.7% reduction in relative risk for death. The changes applied only to medical patients, with death rates in surgical patients remaining unchanged. The improvement in mortality rates was more pronounced in older patients, in people admitted with infectious diseases, and in those with congestive heart failure and gastrointestinal bleeding.

Despite admitting a number of limitations, including the possibility of confounding variables affecting mortality rates, the researchers suggest that the work-hour regulations may have shifted care to more experienced clinicians, resulting in better outcomes for patients.

Ann Intern Med 2007; 147: 73-80

Dr Tanya Grassi, MJA

The Medical Journal of Australia eMJA