It's quite difficult to find the words that can describe that rugby match. Final score Wales 31 - 24 Scotland after Shane Williams scored that last minute try in stoppage time to win the game. Scotland were 10 points up with 5 minutes to go. Unbelievable. Having played so well for 75 minutes it all fell apart when one moment of indiscipline led to a yellow card, Scotland a man down, Wales with all of the momentum, then it was all over. Scotland must do better. So well disciplined for the whole match and then one event to lose it all. Scotland won't have a better chance to beat Wales than that again for a long time. Ah well.
Down to some of the most interesting articles from the Student BMJ this month:
The cover article 'Health in the Homeless' was relevant to this week as one of the patients being seen by the community mental health team in Montrose who I'm spending time with this week are invoved in the care of a young woman who is homeless. As health professionals we are in a valuable position to help the homeless, since health services in the UK are still a relatively easy place for people to get access. It's also important that we engage with the homeless as often their ill health is one of the major barriers to getting them off the street, and also we have invaluable contacts with many other agencies who can help these people. Specifically to mental health, homeless people are 8 to 11 times more likely than the general population to be affected with many being admitted to a psychiatric hospital at some point in time. The incidence of suicide in the homeless is 35 times more than the general population. Alcohol dependence and substance misuse are other major co-morbidities in this demographic group. Unfortunately a lack of a permanent address, chaotic lifestyle and no access to public transport are barriers to health and a general mistrust of doctors can make people reluctant to seek help. An admission to hospital for these patients can be extremely beneficial if it leads to re-connecting them to help from social services and other sources of help.
Another interesting article:
Energy Drinks for Children - in the past 10 years there has been a massive increase in the number of 'caffeinated' drinks avaliable on the market, with sales marketing aiming at promoting their associations with power, youth and danger. Whilst caffeine is generally recognised as safe, it does stimulate the central and peripheral nervous system, improving concentration and performance in small amounts. Excess however can lead to GI upset, anxiety, agitation, sleeplessness and arrhythmias. In children these drinks should be avoided if possible and the long term effects of excessive consumption are unknown. Children and adolescents should be advised to stick to water if possible.
There was a section in the journal this month about notifiable diseases which I thought was useful for revision as one of the practice questions I came across this week was on this topic. A list of notifiable diseases can be found in the BNF. In the event that one of these notifiable conditions is identified, it would be one of the responsibilities of the junior doctor to notify a consultant in communicable disease. Further information is avaliable on the Health Protection Website: www.hpa.org.uk.
Finally, a report out this month shows evidence that antidepressants work only against severe depression and have little use in mild or moderate disease. (JAMA 2010;303:47-53). Drug treatment worked little better than placebo in a meta-analysis of patients with mild/moderate disease. All drugs investigated showed greatest benefits for only the most severely depressed.
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