Quantum Sufficit

Just Enough



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Am Fam Physician. 2004 May 1;69(9):2050.

▪ A study published in the Archives of Internal Medicine found depression to be an independent risk factor for cardiovascular death (as well as all-cause mortality) in older women without a history of cardiovascular disease. The Women’s Health Initiative Observational Study followed 93,676 postmenopausal women (age range: 50 to 79 years) for an average of 4.1 years. Depression was measured at baseline, with 15.8 percent of study participants reporting current depressive symptoms and 12.3 percent reporting a history of depressive symptoms. After controlling for multiple clinical, demographic, and risk factor covariates, the study showed a 58 percent higher risk of cardiovascular death among women with baseline depression and no history of cardiovascular disease.

▪ To increase survival in persons with cardiac arrest, at least 20 cities across the United States are simplifying instructions provided by 911 dispatchers. As reported in USA Today, dispatchers are recommending simple chest compressions instead of trying to talk callers through mouth-to-mouth resuscitation. In a recent meeting, medical directors of emergency medical services agreed that attempting to talk 911 callers through mouth-to-mouth procedures wasted valuable time. Currently, this change in approach is used only with untrained bystanders. The American Heart Association is considering a similar change to its guidelines.

▪ In taking a family history, it can be important to consider descendants as well as ancestors. In a case report published in The Lancet, a 61-year-old man was referred to a neurology department with a six-year history of deteriorating dexterity and progressive gait disturbance. On examination, the man was somewhat disinhibited; he also had a broad-based gait and an explosive cerebellar dysarthria. The only other remarkable findings were a symmetric coarse flapping tremor and high-amplitude dysmetria on intention. Five years earlier, the man’s five-year-old grandson had been diagnosed with fragile X syndrome. At that time, genetic testing showed that the grandfather had a premutation (a small unmethylated expansion) at the fragile X locus. Late-onset ataxia has been noted in men with this premutation.

▪ Who will live to be 100 years of age? There may be a way to find out. The Alliance for Aging Research’s “Living to 100” calculator determines a person’s life-expectancy potential. The calculator, available at www.agingresearch.org, makes a prediction based on the answers to an online quiz that includes 40 questions about lifestyle (e.g., tobacco use) and hereditary factors (e.g., longevity in family members). Introduced on the Alliance’s Web site in 1999 and updated recently, the calculator was created by a researcher who reviewed epidemiologic studies on aging and good health.

▪ How risky is upper-ear piercing? Definitely more risky than piercing the ear lobe, based on the findings of a cohort study published in JAMA. Researchers examined reports of auricular chondritis in 118 persons who had their ears pierced at a jewelry kiosk in Oregon. Seven cases of Pseudomonas aeruginosa infection were confirmed, all in persons 10 to 19 years of age who had their ear cartilage pierced. Four patients required hospitalization, four needed surgery, and several had cosmetic deformities. The researchers attributed the outbreak to several causes, including use of a P. aeruginosa-contaminated disinfectant bottle and the kiosk workers’ use of an open spring-loaded piercing gun rather than a recommended alternative, such as needle piercing.



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