No fewer than 65% of university graduates in Singapore have myopia. This figure is quoted in a commentary in the British Journal of Ophthalmology (1998;82:210-1) that reviews the evidence that the prevalence of myopia is closely associated with the number of years spent in full time education. The challenge for ophthalmologists is to prevent or cure myopia by addressing its cause.

The British Journal of Psychiatry (1998;172:218-26) contains a review of 1740 patients detained in the three special hospitals (Ashworth, Broadmoor, and Rampton) that provide high security for people with mental disorders and dangerous, criminal, or violent propensities. It found that 58% had a functional psychosis and more than three quarters of these had been driven to offend by their delusions.

Children who have had micturating cystourethrography often have prolonged anxiety afterwards. Research in Nottingham has shown, however, that their distress may be greatly reduced by preparation (Acta Paediatrica 1998;87:175-9). Children who were supplied with a story booklet that described coping strategies had far lower levels of distress during the procedure and afterwards. Play preparation in which dolls were used also helped, but the booklet alone was highly effective.

In a Canadian trial of finasteride in the treatment of symptoms attributed to benign prostatic hyperplasia most of the patients in the placebo arm continued taking their placebo for as long as 25 months—and continued to have their symptoms relieved even though their prostate glands had increased in size (British Journal of Urology 1998;81:383-7). The best responses were in patients with small or normal sized prostate glands.

Guinea pigs with ascorbic acid deficiency have an increased risk of developing gall stones—an observation that led to a report in the Journal of Clinical Epidemiology (1998;51:257-65) on the prevalence of gall bladder disease in 2744 women. Those who had taken regular supplements of ascorbic acid had lower rates of gall stones than the remainder, but for reasons obscure this protection was limited to women who also drank alcohol regularly.

People who bathe in tropical seas run a risk of seabather’s eruption, a rash of pruritic erythematous papules that results from trapping of larvae of jelly fish and corals in the material of tight swimwear. The condition was described in swimmers in the Caribbean in the BMJ (1996;312:957-8) but passed unnoticed by Minerva: she has caught up with it with a report from Papua New Guinea in Tropical Doctor (1998;28:53).

Many rheumatologists believe that the best way of preventing disability in patients with rheumatoid arthritis is to start aggressive treatment with disease modifying drugs early in the illness. Evidence to support this approach has come from a study in Glasgow (Annals of the Rheumatic Diseases 1998;57:88-93) of patients treated with gold. Those in whom treatment was started within two years of the onset of their illness showed improvement in their functional status, whereas those who had had their illness for longer before the gold was started showed no evidence of improvement.

A study in the United States of 290 patients (mean age 62) on a general medical ward found that 164 had low serum concentrations of 25-hydroxyvitamin D; 65 were assessed as being severely deficient (New England Journal of Medicine 1998;338:777-83). The main causes were thought to be staying indoors and a poor dietary intake of the vitamin. Deficiency of vitamin D increases the risk of hip and other fractures, and as public interest in osteoporosis has been stimulated, too much attention may have been focused on calcium and not enough on vitamin D.

The symptoms of inoperable cancer of the pancreas can be relieved by minimally invasive techniques, so surgeons try their best to avoid doing a laparotomy in patients in whom the disease has spread beyond the pancreas. In assessing operability, computed tomography provides the most reliable information (Journal of the American College of Surgeons 1998;186:35-40), and an analysis from Sweden argues forcefully that laparoscopy is less discriminating.

Minerva’s scattered grandchildren have started at primary school at various ages from 4 to 7. Research on owls (Science 1998;279:1451-2) has now provided further evidence that the developing brain of a child (or at least a baby owl) can acquire neural pathways with great ease—and that these can lie dormant for years before being reactivated. So should we all learn several languages in infancy?

Idiopathic pregnancy-associated osteoporosis may lead to a loss in height of as much as 5 cm by the end of pregnancy (Southern Medical Journal 1998;91:33-8). The prognosis is, however, good. The back pain and the radiological changes usually resolve within a few months. The aetiology of this condition remains unknown.

Further evidence that the outcome of surgery for cancer depends on the experience and training of the surgeon has come from an audit in Canada of 663 patients with potentially curable colorectal cancer (Annals of Surgery 1998;227:157-67). Their operations were done by 52 surgeons of varying experience. Follow up showed that the risk of local recurrence was doubled in patients operated on by the surgeons who had performed fewer than 21 of the operations. Survival was higher in patients treated by surgeons who had had colorectal subspecialty training.

Lack of iron in the diet is the developing world’s most common nutritional deficiency. Yet many studies in both children and pregnant women have shown little benefit from treatment with iron supplements. Remedying iron deficiency should, says a review in the British Journal of Nutrition (1998;79:227-35), have low priority in comparison with other public health needs such as treating protein energy malnutrition in the very young and providing safe water supplies.

Figure.

A woman aged 37 went on a roller coaster ride, and at the moment of maximum descent felt a click in the region of her right scapula. Her shoulder remained painful for two weeks. Eight months later she was referred to the rheumatology clinic complaining of weakness of the shoulder, but she was free of pain. Examination showed winging of the right scapula due to injury to the brachial plexus damaging the long thoracic nerve.

A B Bhanji, rheumatologist, Crawley Hospital, West Sussex RH11 7DH

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