Sickness absence and other stories . . .A survey of sickness absence in eight European countries from1980 to 2010 (European Journal of Public Health 2014, doi:10.1093/eurpub/cku075) shows that, contrary to stereotype, formost of this period the Dutch have taken four times as muchsick leave as the Italians and Irish. Women are off sick morethan men in every country, but especially in the Netherlands,and the gap is widening in five of the eight countries. This isnot due to increased labour force participation by mothers ofsmall children, and neither can it be explained by changes inthe distribution of women and men across occupations orindustries.A long term follow-up study of 24 hour blood pressuremeasurements done more than 11 years ago in 12 randomlyselected populations shows that different patterns carry differentrisks at different ages (Circulation 2014, doi:10.1161/CIRCULATIONAHA.113.004876). Below 50 years of age, 24hour diastolic pressure predicts coronary events, whereas overthat age, isolated systolic and mixed hypertension are thepredominant risk factors.Minerva finds that when doctors use the term “idiopathic” it isoften because they haven’t looked hard enough for the cause.Idiopathic remitting diabetes was diagnosed in 11 patients aged0.5-35 years who were referred to the molecular geneticsdepartment at the Royal Devon and Exeter Hospital between2000 and 2012. By digging into the hospital records, theinvestigators found that two did not have a confirmed diagnosisof diabetes, and eight others had alternative explanations fortheir remission. That left one 15 year old girl who fulfilled thecriteria for this rare condition (BMC Endocrine Disorders2014;14:45, doi:10.1186/1472-6823-14-45).Communicating risk to people is an art that doctors are rarelytaught, and a qualitative study (BMC Family Practice2014;15:106, doi:10.1186/1471-2296-15-106) of howAustralianGPs go about it shows a variety of personalised approaches.GPs used absolute cardiovascular risk within three differentcommunication strategies: “positive,” “scare tactic,” and“indirect,” according to their instinct for what might work best.Minerva looks forward to a revolution in medical training thatwill equip doctors to hone a range of new skills in sharingdecisions about risk management with patients.“Will my bottom look fat with these pills, doctor?” may be anunspoken question when people are offered a choice ofantidepressants. A survey of electronic health records in JAMAPsychiatry (2014, doi:10.1001/jamapsychiatry.2014.414) showsthat all serotonin reuptake inhibitors are associated with a similardegree of weight gain, which is slightly greater than withtricyclic drugs. The most neutral is bupropion, which is licensed

for depression in the US but unaccountably only for smokingcessation in the UK.When seals dive into cold water, they go into bradycardia owingto a change in vagal tone. The human dive reflex manoeuvreexploits a similar phenomenon, induced by applying cold to theface. But for a superior vagal tone, this does not equal theValsalva manoeuvre, according to a trial on Australian studentvolunteers (Emergency Medicine Journal 2014, doi:10.1136/emermed-2013-203299). And it doesn’t matter whether you doit head up or down. Remember this next time you want to abortsupraventricular tachycardia in an otherwise healthy person.Once you reach 100 years old, you are more likely to die frompneumonia or frailty than from cancer or ischaemic heartdisease, according to a recent UK survey (PLOSMedicine 2014,doi:10.1371/journal.pmed.1001653). For the coming wave ofcentenarians, the authors suggest we need wider provision ofanticipatory care to enable people to remain in their usualresidence, and greater bed capacity in care homes.And if you want to live to 100 in Denmark, your chances aregreater if you have basal cell carcinoma of the skin. The authorswho pointed this out in the International Journal ofEpidemiology (2014;43:972-3, doi:10.1093/ije/dyu102) cameunder attack for introducing immortal time bias into theircalculations. Minerva has insufficient space to explain thisconcept, which is of little interest to her because she is immortalanyway. But she likes the idea that Danes who make the mostof their rare sunshine live longer, even if they get more basalcell carcinomas.Sagging eyelids are not necessarily a blemish: they lent a greatair of sagacity to the late Lord Macmillan, for example. Butthey can get in the way. According to the first comprehensiveobservational study in JAMADermatology (2014, doi:10.1001/jamadermatol.2014.27), they are not only associated with oldage but also with male sex, genetic variants, lighter skin colour,high body mass index, and possibly current smoking.The main carbohydrate source driving obesity in America hasbeen identified as the potato, but in Korea this dubious accolademay go to the instant noodle. A dietary survey found thatconsumption of these noodles was associated with metabolicsyndrome in women but not men (Journal of Nutrition 2014,doi:jn.113.188441). Koreans, avoid noodle with your poodle:brown rice is just as nice.

Let Minerva know what you think of this week’s offerings atminerva@bmj.com.

Cite this as: BMJ 2014;349:g4423© BMJ Publishing Group Ltd 2014

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BMJ 2014;349:g4423 doi: 10.1136/bmj.g4423 (Published 9 July 2014) Page 1 of 1

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