Volume 193 - Issue 8
In Other Journals
Author: Alison Williams
Med J Aust 2010; 193 (8): 482. || doi: 10.5694/j.1326-5377.2010.tb04008.x
Published online: 18 October 2010
Published online: 18 October 2010
Cast or splint?
A recent randomised controlled trial in children has shown that using a removable splint may be just as effective as a cast in treating minimally angulated fractures of the distal radius, and is preferred by patients and parents. Ninety-six children aged between 5 and 12 years were randomly assigned to either a cast, or a prefabricated splint which could be removed only for bathing or hygiene reasons. At six weeks, there were no significant differences between the groups in physical function, degree of angulation, pain, or side effects such as irritation and discomfort. In terms of patient and parent preference, use of the splint was superior to the cast — among the splint group, 12% of children and 5% of parents indicated that they would have preferred a cast; while among the cast group, 68% of children and 60% of parents would have preferred a splint.
CMAJ 2010. doi:10.1503/cmaj.100119
A walk in the park
“Green” exercise (physical exercise undertaken in natural environments) can lift mood and self-esteem, and this may be achieved in as little as 5 minutes a day, suggest UK researchers. The multistudy analysis pooled data from 1252 participants and showed that green exercise was associated with significant improvements in mood and self-esteem — and that these effects were evident in participants with and without a history of mental illness. While all green environments, including “urban green”, countryside and woodlands, were beneficial, the strongest effect was seen with waterside habitats. The authors conclude that access to natural places should be considered by planners and architects, that green exercise could also be considered as a therapeutic tool, and “that the environment provides an important health service”.
Environmental Science and Technology 2010; 44: 3947-3955. doi 10.1021/es903183r
Lifting the stigma
Depressed medical students report beliefs endorsing stigma associated with this illness more often than their non-depressed peers, and such beliefs represent a considerable barrier to seeking treatment, according to a recent survey.1 Just over half of students who self-reported symptoms of moderate to severe depression believed that that their fellow medical students would respect them less, and 83% had concerns that faculty members would question whether they could handle responsibilities. Depressed students felt more strongly that telling a counsellor would be risky, and less than half indicated that they would seek treatment for depression, while 87% of their peers reported that they would seek treatment if they had depression. On the positive side, belief in stigma associated with depression decreased significantly as students progressed through medical school. The author of a linked editorial suggested that this may be due to “the iterative experiences of medical training [which] may inspire more accurate and empathic understanding of the illness experience, whether in a patient or a colleague”.2
1 JAMA 2010; 304: 1181-1190 doi:10.1001/jama.2010.1300
2 JAMA 2010; 304: 1231-1233 doi:10.1001/jama.2010.1347
Flu vaccination and first heart attack
Results of a recent UK study reinforce current recommendations for annual influenza vaccination in patients with medical risk factors, and suggest that there may be additional benefits in preventing myocardial infarction in those without established cardiovascular disease. The case-control study enrolling 16 012 patients aged over 40 years with a first myocardial infarction found that flu vaccination was associated with a 19% reduction in myocardial infarction. While vaccination early in the flu season (before mid November in the northern hemisphere) conferred the most benefit (adjusted OR, 0.79), vaccination after this time was still advantageous (adjusted OR, 0.88). Although pneumococcal vaccination was also included in the analysis, it was not associated with a reduced risk of myocardial infarction (OR 0.96, 95% CI 0.91-1.02).
CMAJ 2010. doi.10.1503/cmaj.091891
Blame it on the weather
Stroke incidence has been shown to vary according to geographical location (such as the “stroke belt” in south-eastern USA); however, a recent Japanese study suggests that, in women, this variation may be explained solely by the weather. The cohort study involving 12 communities identified a total of 450 stroke events over about 10 years of follow-up. On multivariate analysis, the association between stroke and low average temperatures and high annual rainfall was independent of conventional risk factors for stroke, as well as geographic and demographic factors. The authors hypothesise that this could be due to increases in coagulation factors in cold temperatures, and the gender difference explained by oestrogen-mediated increases in vascular reactivity.
Rural and Remote Health 2010 online:1493