Quantum Sufficit

Just Enough



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Am Fam Physician. 2004 Apr 1;69(7):1598-1600.

▪ Your patients with allergies may not be thrilled that prescription-strength allergy medication is now over-the-counter (OTC), according to survey findings cited in American Medical News. Of 239 adults surveyed, more than one half said they spent more money on allergy medications in 2003 after a popular allergy medication was given OTC status in late 2002. Most said they switched to over-the-counter medication because their health insurance plan did not cover prescription allergy medicines or co-payments were increased. About 60 percent of respondents preferred taking their former allergy medication as a prescription.

▪ Patients with chronic pruritus can perceive noxious stimuli as itchiness. In a study published in Neurology, noxious stimuli were applied to the skin of 25 patients with atopic dermatitis (lesional and visually nonlesional areas), nine patients with psoriasis vulgaris (lesional areas), and 20 healthy adults (control subjects). The stimuli included mechanical pinpricks, electrical stimuli, contact heat, and injection of a low-pH solution. The stimuli evoked pain in the control subjects and the patients with psoriasis. However, the patients with atopic dermatitis experienced itch instead of pain. The researchers conclude that there may be central sensitization for itch in patients with chronic dermatitis.

▪ Noise—and a lot of it— may explain why many patients have trouble sleeping in a hospital. According to a press release about a study conducted at Mayo Clinic, Rochester, Minn., a nursing team found that noise dosimeter readings in a thoracic surgery unit were as high as 113 decibels, nearly equivalent to the cacophany made by a jackhammer or chainsaw. The highest level of noise was recorded during the 7 a.m. shift change, but clamor also increased during the 11 p.m. shift change. Noise was reduced by more than 80 percent when the nurses made sleep-promoting changes such as placing foam rubber padding in chart holders on doors and routinely shutting the doors to patients' rooms.

▪ Who are the most conscientious handwashers? A study published in BMJ measured a British primary care team's use of soap from dispensers for one year and found that the two nurses on the team paid greater attention to personal hygiene than the three physicians. The nurse who washed her hands the most did so at least twice as often, or twice as thoroughly, as the physician who washed the most. The researcher notes potential bias because of the traditionally more “hands-on” role of nurses and suggests that the results may not apply to other primary care teams. Even so, it never hurts to wash hands more thoroughly!

▪ A birth-control pill that can be chewed like candy? As reported in a news brief published in Family Practice News, the U.S. Food and Drug Administration (FDA) has approved the use of a chewable, spearmint-flavored version of Ovcon 35, a combination oral contraceptive pill (OCP). The new formulation, which will be marketed under the same trade name, can be chewed and swallowed, or swallowed whole. The FDA indicated that women should drink at least 8 oz of water immediately after chewing the OCP to ensure that all of the pill is fully absorbed from the stomach and that residue is not left in the mouth.

▪ It's a “weighty” matter! Study findings published in the Morbidity and Mortality Weekly Report show that Americans consumed significantly more calories in 2000 than they did in 1971. In an analysis of data from four National Health and Nutrition Examination Surveys (NHANES), the Centers for Disease Control and Prevention found that average daily energy intake increased by 168 kcals in men and 335 kcals in women. The increase was attributed primarily to greater daily carbohydrate intake (a 67.7-g increase in men and a 62.4-g increase in women).

▪ A study published in Neurology showed that women who use supplemental vitamin D have a 40 percent lower risk of developing multiple sclerosis than women who do not use supplements. The study examined two cohorts of women from the Nurses' Health Study (NHS): NHS, 92,253 women followed from 1980 to 2000; and NHS II, 95,310 women followed from 1991 to 2001. Participants completed a comprehensive semiquantitative food frequency questionnaire at baseline and then every four years throughout the study. The study found no association between the incidence of multiple sclerosis and vitamin D intake from food alone. A stated limitation of the study was the inability to assess the effects of vitamin D intake independently from the use of multivitamins.

▪ When your patients with arthritis say they can predict the weather based on their symptoms, are they right? Well, they just might be. As reported in Family Practice News, a study of 147 persons in the Barcelona area compared weather changes with reports of arthritis symptoms. The study subjects included 79 patients with osteoarthritis, 14 patients with fibromyalgia, 12 patients with rheumatoid arthritis, and 42 persons with no history of rheumatic disease. The two-year study showed a link between rising temperatures and decreased joint pain in all patients with rheumatic disease. Rising temperatures also seemed to correlate with improved functional capacity, except in patients with rheumatoid arthritis. Changes in barometric pressure and relative humidity seemed to affect only patients with osteoarthritis.

▪ Scientists have created genetically altered mice that can produce omega-3 fatty acids, the healthy oils usually found in fish, according to a report published in Nature. The mice, when implanted with a gene from the Caenorhabditis elegans roundworm, are able to convert omega-6 fatty acids into omega-3 fatty acids, a process that does not occur naturally in mammals. This finding may help researchers understand the role of omega-3 fatty acids in the prevention and treatment of diseases, and the technology might be adapted to add omega-3 fatty acids to foods such as milk, eggs, and meat.

▪ Study findings released by the Environmental Investigation Agency suggest that postnatal exposure to the high levels of methylmercury in whales and large fish can cause developmental problems in children. The 14-year study conducted in the Danish Faroe Islands also supports concerns about possible irreversible damage caused by prenatal methylmercury exposure. The inhabitants of the Faroe Islands have a seafood-rich diet that exposes them to high levels of mercury and methylmercury.

▪ Can a mathematical chart predict the success of a marriage? According to a study reported in USA Today, researchers can tell which marriages will succeed and which will end in divorce by observing how couples resolve their differences and plotting their interactions on a graph. The 20-year study videotaped more than 600 married couples and gave mathematical values to the ways the husband and wife responded to each other (i.e., what was said, how it was said, body language, facial expression). The researchers found that there are three types of stable marriages: the marriage in which a couple routinely avoids conflict (“avoiders”), the marriage in which a couple argues at the drop of a hat (“volatile arguers”), and the marriage in which a couple is affirming and argues only occasionally (“validators”). Researchers said that marital problems occur when a couple's approaches to conflict resolution do not mesh, as when the husband is a volatile arguer and the wife is an avoider.



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