eMJA: In Other Journals, 17 March 2008

Watching exciting soccer games can be dangerous to your health, according to German researchers. Acute cardiovascular events involving over 4000 people were analysed during the World Cup soccer tournament of 2006 and compared to a control period. The incidence of cardiac emergencies, including myocardial infarction, unstable angina, and cardiac arrhythmia, increased significantly (by a factor of 2.66) on days when the German team were playing in matches. The proportion of cardiac emergency patients with known coronary heart disease was also greater on these days compared with the control period. Although the study did not allow the identification of the exact triggers provoking the additional observed cardiovascular events, the authors hypothesise that the additional emergencies were triggered by emotional stress related to watching soccer matches involving the national team.

Lighter not brighter

Commercial skin-lightening creams can have dangerous side effects for users who are unaware of the components. These creams can potentially contain toxic substances such as steroids and hydroxyquinone. In a report by UK authors, a 28-year-old woman presented to clinicians suffering from symptoms and signs of apparent Cushing’s syndrome, including central obesity, pigmented striae, thin, bruised skin, infertility and hirsutism. On investigation, the patient was found to have very low levels of cortisol and corticotropin. The diagnostic dilemma deepened when she denied taking any medications or illicit drugs, but was eventually solved when she admitted to using a skin-lightening cream daily for 7 years. The cream had been bought from an unauthorised source and was found to contain clobetasol, a potent topical corticosteroid. The authors warn clinicians that the use of skin-lightening agents is common, and that the potential for toxic additives causing health problems should be considered.

Lancet 2008; 371: 596

Stents v grafting

Since their introduction in 2003, the use of drug-eluting stents has provoked considerable controversy. In an observational study involving over 17 000 patients, US researchers have compared the adverse outcomes for patients receiving drug-eluting stents and those undergoing coronary artery bypass grafting (CABG). Patients with three-vessel and two-vessel disease were studied, and data analysed for rates of mortality and myocardial infarction. In comparison with the use of a drug-eluting stent, CABG appeared to be associated with lower rates of death and of myocardial infarction over 18 months in patients with multivessel disease. Lower rates of repeat revascularisation were also apparent in the group undergoing CABG. The authors comment that they used analyses aimed at overcoming the potential bias of such observational studies, after which the relative outcomes associated with the two procedures remained about the same.

N Engl J Med 2008; 358: 331-341

Here kitty

A kitten with rabies caused a public health nightmare in South Carolina when it was taken to a softball tournament, potentially exposing hundreds of people to the disease. In a report from the Centers for Disease Control and Prevention, the convoluted story of the movements and subsequent euthanasia of the animal is used to illustrate the importance of a coordinated multistate investigation in such cases of exposure. Interestingly, it was the mother of one of the children involved, herself having been bitten by the animal, who alerted authorities and instigated the investigation. Eventually, 27 people were considered potentially at risk and given post-exposure prophylaxis. The report is also a timely reminder for Australian travellers that rabies is still alive and well in the United States.

Not the supernanny

A program aimed at improving problem parenting appears to have a modest but limited value, Australian researchers have found. A randomised trial set in Melbourne studied the responses of over 600 mothers of children ranging in age from 8 to 15 months over the study period. The intervention group attended a three-session course targeting parenting risk factors for childhood behavioural problems, including unreasonable expectations, harsh parenting, and lack of nurturing parenting. The control group received the usual care from a child health centre. Main outcome measures were maternal mental health, parenting style, and maternal report of child externalising behaviour, such as oppositional defiance and aggression. After 24 months, child behaviour scores, nurturing parenting, and maternal mental health were similar in the two groups but intervention group parents were slightly less likely to report harsh or abusive parenting.

BMJ 2008; 336: 318-321

Dr Tanya Grassi, MJA

The Medical Journal of Australia eMJA