Journal of the New Zealand Medical Association, 18-June-2004, Vol 117 No 1196
Of mice and (no) men?
Some insects and reptiles can reproduce via parthogenesis: the unfertilized egg retains two sets of chromosomes and begins to develop as if it had been fertilized. In mammals, though, successful parthenogenesis has been regarded as virtually impossible.
However, a recent report from a group of Japanese scientists has shaken that belief. The first parthenogenesis pup, ‘Kaguya’, grew to be a healthy adult female mouse able to reproduce normally. The key to this feat is a gene knockout, affecting the H19 gene in the oocyte donor, that appears to short-circuit the requirement for paternal imprinting.
Nurse practitioners in general practices
Expansion in the workload of general practitioners has led many countries to shift care to other health professionals, notably nurses. Nurses can undertake health promotion work and routine management of chronic diseases such as asthma, diabetes, and coronary heart disease. A systematic review has shown that nurses can achieve health outcomes that are as good as those of general practitioners and that they may have superior interpersonal skills. It is unclear, however, whether nurses reduce the workload of general practitioners.
In a recent Dutch study involving 34 general practices, the effects of this nursing intervention has been documented. The number of contacts during surgery hours increased in the intervention group compared with the control group (P<0.06), particularly for patients with chronic obstructive pulmonary disease or asthma (P<0.01). The number of consultations out of hours declined slightly in the intervention group compared with the control group, but this difference did not reach significance. Adding nurse practitioners to general practice teams did not reduce the workload of general practitioners. This implies that nurse practitioners are used as supplements, rather than substitutes, for care given by general practitioners.
Medical carousel or czechmate?
Hundreds of Czech medical staff have moved abroad to take up lucrative contracts—and many more are expected to do so when the country becomes a member of the EU (1/5/04).
There are already 700 Czech physicians, working in Germany, which in 2002 became the first European country to begin hiring Czech physicians without requiring them to take additional medical exams.
The migration of medical staff from the east of Europe westwards is already well documented. Doctors in the economically less well-off east of Germany have been leaving to work in the relatively more prosperous west of the country and have been gradually replaced by Czech doctors.
In turn, staff mainly from Slovakia—where health-sector workers’ wages are lower than the Czech Republic—have been taken on to fill the gaps in the neighbouring state.
But with Slovakia also becoming a new member of the EU, Czech doctors fear that their Slovak counterparts will look to western countries where they can now find work that pays far better than equivalent jobs in the Czech Republic.
Polio eradication in Nigeria
The northern Nigerian state of Kano is preparing to reverse its boycott of polio inoculations, which caused a resurgence of the crippling disease and threatened an international campaign to eradicate it. Last year Kano boycotted the World Health Organization (WHO) vaccination campaign because some Muslim clerics had warned that the vaccines were tainted and would make women sterile. Rumours spread that the vaccines were a plot by the West to reduce the Muslim population. The WHO welcomed the news as it opened a week-long conference in Geneva to re-evaluate its chances of eradicating polio worldwide.
Guardian Weekly (UK), 28 May–3 June 2004, p29
Hernia repair—laparoscopic technique gives inferior results
In a recent large, multicenter, randomized trial comparing laparoscopic mesh and open mesh repair of inguinal hernias, men randomly assigned to laparoscopic repair had a higher rate of recurrence at two years and a higher rate of complications than those assigned to open repair.
At two years, the relapse rate in the laparoscopic group was 10.1% vs 4.9% in the open repair group (odds ratio 2.2). The authors concluded that the open technique is superior to the laparoscopic technique fo mesh repair of primary hernias.
N Engl J Med 2004;350:1819–27
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