tbuckley/cabot-search huggingface dataset:
Food allergy and intolerance: what are the facts?
Authors: Judy Buttriss
Journal: BMJ (2001)

In the second article in our series on nutrition, Judy Buttriss explains the science behind the most common food allergies and intolerances

A casual glance through the tabloid press and weekend supplements could easily leave you thinking that we have a major food allergy epidemic in Britain. But is this really true? The reality is that most people can eat a wide range of foods without any problems, although they may have likes or dislikes that influence what they choose. However, some people--a small minority--react badly to certain everyday foods and eating them may cause uncomfortable symptoms or, in rare cases, a severe illness. Next month's article will focus on food intolerance myths, so in this one I will concentrate on the different types of food intolerances.

Food intolerance is the general term used to describe a range of reproducible adverse responses to a specific food or food ingredient which can occur whether or not the person realises they have eaten the food.12 This general term includes allergic reactions that by definition involve the immune system (such as peanut allergy or coeliac disease); adverse reactions resulting from enzyme deficiencies (such as lactose intolerance or hereditary fructose intolerance); pharmacological reactions (such as caffeine sensitivity); and other non-defined responses. Food intolerance does not include food poisoning from bacteria and viruses, moulds, chemicals, toxins, and irritants in foods, nor does it include food aversion (dislike and subsequent avoidance of various foods). (See figure.) True food intolerance is estimated to affect 5-8% of children, most of whom outgrow the condition, and less than 1-2% of adults. However, the paradox is that as many as 20% of adults believe that they are food intolerant.3



An allergic reaction to a food is an inappropriate reaction by the body's immune system to the ingestion …
Job market needs revamping
Authors: Fiona Martin
Journal: BMJ (2005)

Editor - Trevor Pickersgill highlights a common problem at all levels of the medical profession when job hunting.1 I am beginning to think that many consultants are not actually living in the real world and have an image of juniors applying for their advertised post as if it were the only job out there. Several of my friends have bemoaned this exact issue whereby consultants and trust managers seem to think that people should apply for only one post, wait by the phone to see if they have got it, and then accept immediately. Presumably, if unsuccessful (as is quite likely to be the case with most popular specialties), the would-be applicant is required to spend months going to consecutive job interviews in only their ideal areas. If they happen to be applying for jobs along with several hundred other hopefuls, that could take a very long time indeed.

Pickersgill quite rightly points out that the practice of accepting jobs and then abandoning them is becoming commonplace. When applicants are being forced to give quick answers and accept posts immediately, …
Students protest at drug company's actions
Authors: Navin Chohan
Journal: BMJ (2001)

Law students at Yale University in the United States have formed a pressure group after the institution licensed exclusive production of an AIDS drug to a pharmaceuticals firm for $40m (£28.5m) a year, reported Julian Borger in a recent article in the Guardian.

Yale holds the patent for the drug d4T, an antiretroviral also known as stavudine, which was invented by Professor William Prusoff, a member of the university's academic staff. The antiHIV drug is manufactured under the brand name Zerit by Bristol-Myers Squibb, the …
Just a guinea pig
Authors: Seye Abimbola
Journal: BMJ (2006)

I am at best a guinea pig, a participant in a grand experimental design. How else can you explain that after four years in medical school, after you've realised that medicine is not really for you and your interests lie elsewhere, you have no option other than going on. No matter how long you spend in medical school, if you don't sit the final exam, you'll get absolutely nothing to show for it. Even participants in randomised controlled trials can opt out.



DAN CALLISTER/REX FEATURES



Many of us are disillusioned medical students, held up, claustrophobic, within a foreign territory. We got in to medical school with naive excitement and great expectations as impressionable school leavers. We had been cajoled and coaxed by peers and parents, when we hardly knew what being a doctor meant.

The way to prevent this is to turn medical school into a graduate programme. At least we are sure that medical students will be better suited for the peculiar demands of medical school if they have a proved record of successful performance at university. …
Abstract 15729: Determinants of Vascular Improvement Following Bariatric Weight Loss Surgery
Authors: Melissa G Farb, Shakun Karki, Alyssa Dobyns, Elaina Zizza, Samantha Saggese, Joseph N Palmisano, Naomi M Hamburg, Noyan Gokce
Journal: Circulation (2017)

Introduction: Bariatric surgery is the weight loss intervention that reduces cardiovascular mortality, but mechanisms are incompletely understood. We sought to identify variables associated with vascular improvement after bariatric surgery and examined the effect of surgical intervention type. Methods: We prospectively followed 375 subjects (BMI≥35 kg/m2) undergoing Roux-en-Y gastric bypass, LAP-BAND or sleeve gastrectomy. We measured plasma metabolic markers and vascular function using ultrasound at baseline and up to four visits after surgery. We used linear regression models to investigate the association between the change in vascular measures and clinical predictors over one-month change, at 3- and 12-months after surgery. We included bariatric surgery type as a predictor of vascular outcome. Results: Subjects were obese (BMI 46±8 kg/m2, age 42±12 years) and lost 17±5% weight at 3-months and 28±11% at 12-months. Brachial artery macro-vascular flow mediated dilation (FMD %, β:0.11 p=0.001) improved af...
A transcriptome-wide association study of high-grade serous epithelial ovarian cancer identifies new susceptibility genes and splice variants
Authors: Alexander Gusev, Kate Lawrenson, Xianzhi Lin, Paulo C. Lyra, Siddhartha Kar, Kevin C. Vavra, Felipe Segato, Marcos A. S. Fonseca, Janet M. Lee, Tanya Pejovic, Gang Liu, Beth Y. Karlan, Matthew L. Freedman, Houtan Noushmehr, Alvaro N. Monteiro, Paul D. P. Pharoah, Bogdan Pasaniuc, Simon A. Gayther
Journal: Nature Genetics (2019)
World Medical Association ‘appalled’ at oral mutilation in Africa
Authors: Chibuzo Odigwe
Journal: BMJ (2004)

The World Medical Association has called for an end to the traditional practice of oral mutilation of infants and has lent its voice to the call for improved dental care services in Africa. The call was made last week in Nairobi by the association's president, James Appleyard, at the first ever planning conference for oral health in the African region.

He said, “One of the most appalling customs, referred to as infant …
To be a doctor
Authors: Neil Patel
Journal: BMJ (2006)

After passing my finals, I have been asked many times by friends and family, “So, what's it like being a doctor now?” But I'm not sure how to answer. Has my life really changed that much? Of course, passing was a big relief, but my usual response is, “Well, it's a bit like being a medical student, really.” I expected my preregistration house officer job to be similar to my final year at medical school-but with more responsibility and a salary.

A few weeks later, I found myself sitting …
The legal determinants of health: harnessing the power of law for global health and sustainable development
Authors: Lawrence O Gostin, John T Monahan, Jenny Kaldor, Mary DeBartolo, Eric A Friedman, Katie Gottschalk, Susan C Kim, Ala Alwan, Agnes Binagwaho, Gian Luca Burci, Luisa Cabal, Katherine DeLand, Timothy Grant Evans, Eric Goosby, Sara Hossain, Howard Koh, Gorik Ooms, Mirta Roses Periago, Rodrigo Uprimny, Alicia Ely Yamin
Journal: The Lancet (2019)
Managing challenging behaviour in children with possible learning disability
Authors: Michael Absoud, Holly Wake, Miriam Ziriat, Angela Hassiotis
Journal: BMJ (2019)

### What you need to know

A mother visits her general practitioner with her 3 year old daughter. She is concerned that the child is having regular “melt downs” and has become defiant when, for example, getting dressed or putting on her shoes. Her daughter is physically aggressive towards her and other family members. This happens often and sometimes lasts for up to an hour. The family has tried reward charts, time outs, and positive reinforcement. 

Challenging behaviour is commonly defined as behaviour that is of an intensity, frequency, or duration that threatens the physical safety of the person or others or restricts access to community facilities.12 Challenging behaviour can first occur in childhood and can be difficult for parents, carers, and family members to understand and manage. Parents and carers may present to healthcare services, including their GP, with concerns about their children’s behaviour.

In some cases, challenging behaviour may be a sign of a known or an undiagnosed learning disability. This article gives particular advice about how to identify and manage children where a learning disability might be a contributing factor.

Often, behaviours perceived as challenging serve a purpose for the child or young person, such as producing sensory stimulation, attracting attention, and avoiding demands.3 Some behaviours may be a form of communication which needs to be understood.

Examples of challenging behaviours, sometimes reported by parents as “melt downs” or “defiance,” are

• Physical aggression (biting, scratching, hitting)

• Self injury (head banging, biting hands)

• …
Stress for success
Authors: Zhaleh Khaleeli
Journal: BMJ (2001)

There are few things less reassuring during revision than someone who hardly knows you saying, “you'll be fine,” “they want you to pass,” and “it's just like a driving test.” The last comment was particularly alarming to me as I failed my driving test four times. And yet, horribly, in a year's time you yourself will change into someone who blithely chants “it's really hard to fail.” What gives a house officer this new found assurance is not only the knowledge that general expectation of their talents has returned to zero. It's also the certainty of survival.

A large amount of time at medical school does seem to be specifically and cruelly designed to cause maximum stress, and this is often justified by the fact that you are being prepared for a …
Plastic fantastic: Professor Gunther von Hagens
Authors: Nigel Lane
Journal: BMJ (2002)

Gunther von Hagens's controversial Bodyworlds exhibition is busy touring the globe, but what drives this pioneering man? Nigel Lane finds out

Gunther von Hagens's interest in all things three dimensional began when, as a child, he'd build cardboard aeroplanes in East Germany. He was also greatly excited by having a neighbour who was a sculptor.

At the age of six, he was in hospital for six months with haemophilia A. He remembers: “One day my head felt really heavy. I touched my forehead, and it was full of blood under the skin. Eventually, I was taken to the operating room where I heard the doctors say that they thought I would die.” This was obviously a frightening experience, but it influenced his future decision to study medicine.

At 16, however, he was deemed “not clever enough” to continue in mainstream education so he started work. He recalls: “I was a hospital elevator attendant, postman, and later an assistant male nurse.” His nursing job fuelled his interest in medicine, and it soon became clear to him that he did not want to …
Philosophical Medical Ethics
Authors: Andrew N Papanikitas
Journal: BMJ (2001)

The media have not been kind to the medical profession lately. The General Medical Council and BMA students have been quick to issue guidelines on ethical matters ranging from cheating at exams to euthanasia. Deluged from all sides by corporate condemnation and prescriptive guidance it is difficult to know what to read, and what it means, or where lofty guidelines meet real life. What should have been done does not always bear much resemblance to what was done. The core fact emerging from this whirlwind of papers and handbooks is that we must always be prepared to justify …
Natriuretic Response Is Highly Variable and Associated With 6-Month Survival
Authors: Daniel Z Hodson, Matthew Griffin, Devin Mahoney, Parinita Raghavendra, Tariq Ahmad, Jeffrey Turner, F Perry Wilson, W H Wilson Tang, Veena S Rao, Sean P Collins, Wilfried Mullens, Jeffrey M Testani
Journal: JACC Heart Failure (2019)
B-Cell Differentiation Dependent Classification of Diffuse Large B-Cell Lymphoma By the Nanostring Technology
Authors: Thomas Yssing Michaelsen, Rasmus Froberg Brøndum, Julia Richter, Wolfram Klapper, Mads Albertsen, Hans Erik Johnsen, Karen Dybkær, Tarec Christoffer El-Galaly, Martin Bøgsted
Journal: Blood (2017)
A guide to medical etiquette: how to revise
Authors: David McAllister
Journal: BMJ (1999)

By now most of you will be aware that it is considered very bad form to relate for how long you actually study. Instead, when talking to your colleagues, alternate between ridiculous understatement and gross exaggeration. The aim of this is to produce in them wild oscillations between inappropriate complacency and abject terror.

Of course, as with much of life it is the quality, rather than the quantity, of revision that is important. Guides on how to revise abound. Ignore these and instead assimilate the following. When you study is crucial. The most effective students study both before and during their exam period. Those who study after this time are considerably less successful, and …
Evidence based medicine
Authors: Jose Andres Calvache
Journal: BMJ (2006)

The website of the University of Toronto's Centre for Evidence Based Medicine (www.cebm.utoronto.ca) offers multiple tools to help develop, disseminate, and evaluate resources that can be used in practice and for teaching evidence based medicine (EBM) to undergraduate and postgraduate students. Answers are given to questions such as “What is EBM?” and “Why the sudden interest in EBM?” and so on. The practice sections contain information on common clinical questions and the search for evidence. One section is called …
Vascular Regenerative Cell Exhaustion in Diabetes: Translational Opportunities to Mitigate Cardiometabolic Risk
Authors: Daniella C. Terenzi, Justin Z. Trac, Hwee Teoh, Hertzel C. Gerstein, Deepak L. Bhatt, Mohammed Al-Omran, Subodh Verma, David A. Hess
Journal: Trends in Molecular Medicine (2019)
Why cost must influence thought
Authors: Yatan Pal Singh Balhara
Journal: BMJ (2006)

“Sir, this patient has a case of cerebral palsy” said the resident after presenting the history and examination findings of a 12 year old boy, poorly built, and in ill kempt, dirty, and torn clothes. By the side of the patient stood his 30 year old father, equally frail, and dressed as poorly as the patient. “What's your line of management?” asked the consultant. The resident replied, “I would like routine blood investigations, renal and liver function tests, and an x ray of the chest and …
Churchill's Pocketbook of Differential Diagnosis
Authors: James S Dawson
Journal: BMJ (2001)

The best way to evaluate a new book is to use it. So for the past two weeks I have carried this little text around with me in my white coat, leafing through it while waiting for a clinic to start or to help me write patient portfolios.

This 500 page text centres around signs and symptoms that patients present with to us as health professionals. There is no chapter on cardiac failure, though there are numerous …
Impact of Patient Characteristics, Prior Therapy, and Sample Type on Tumor Cell Programmed Cell Death Ligand 1 Expression in Patients with Advanced NSCLC Screened for the ATLANTIC Study
Authors: Anne-Marie Boothman, Marietta Scott, Marianne Ratcliffe, Jessica Whiteley, Phillip A. Dennis, Catherine Wadsworth, Alan Sharpe, Naiyer A. Rizvi, Marina Chiara Garassino, Jill Walker
Journal: Journal of Thoracic Oncology (2019)
Medicine and magic
Authors: Clare Hughes, Chris French
Journal: BMJ (2002)

Thousands of people wear a lucky T shirt in exams, blow on dice before rolling them, and cross their fingers for good luck. Yet how many people believe that these little rituals can have a palpable effect on health? <b>Clare Hughes</b> and <b>Chris French</b> think that the inadvertent health effects of superstitions should not be overlooked
NUS says students' living conditions are “second class”
Authors: Siân Knight
Journal: BMJ (2001)

Sixteen per cent of students live in vermin infested houses, according to a survey by the National Union of Students (NUS). The findings, published as part of the NUS Housing and Health Survey 2001, showed that half of students live in houses which have damp and 40% reported mould growing in bedrooms, bathrooms, and kitchens. Basic safety precautions were often neglected by landlords: 20% cent …
Should I give up medicine?
Authors: Jessie Colquhoun
Journal: BMJ (2009)

“Should I give up medicine?” was our most viewed (and hopefully read) article this month on student.bmj.com, with 2026 page views (doi:10.1136/sbmj.b2174). The thought has probably crossed every medical student’s mind at some point, but I was still rather surprised. Despite its title, the first piece of advice in this article is to finish your degree, and the second is to try to find a specialty to suit you. Don’t give up on medicine just yet.

Is obsessive-compulsive disorder a condition of the medical profession? This idea seems to be part of medical folk law. Is it because we are …
Sounding: Risky Business
Authors: Carl Morris
Journal: BMJ (2000)

Oops, almost slipped there and impaled myself on this pen. Very nasty. You could have someone's eye out like that, you know. And why wasn't I warned? Surely the Student BMJ should send some kind of information to its contributors about the potential hazards of being a columnist. What if I develop repetitive strain injury from word processing the article? What if I fall off my chair?

The fact is, just about everything we do carries a risk. Some risks …
Long-Term All-Cause and Cause-Specific Mortality in Asymptomatic Patients With CAC ≥1,000
Authors: Allison W. Peng, Mohammadhassan Mirbolouk, Olusola A. Orimoloye, Albert D. Osei, Zeina Dardari, Omar Dzaye, Matthew J. Budoff, Leslee Shaw, Michael D. Miedema, John Rumberger, Daniel S. Berman, Alan Rozanski, Mouaz H. Al-Mallah, Khurram Nasir, Michael J. Blaha
Journal: JACC. Cardiovascular imaging (2019)
Abstract 19090: Patient Characteristics and Lipid Lowering Treatment of Early Adopters of PCSK9i Therapies in the United States
Authors: Katie Mues, Emily Bratton, Heidi S Wirtz, Juan F Maya, Paul M Muntner, Tracy Y Wang
Journal: Circulation (2017)

Purpose: To describe patient characteristics and use of lipid lowering therapies (LLT) before and after initiation of PCSK9 inhibitor (PCSK9i) therapy. Methods: We conducted a retrospective cohort study among US commercial insurance beneficiaries identified as new users of either alirocumab or evolocumab from the date of FDA approval mid 2015 through December 31, 2016 in the MarketScan EarlyView database. Demographics and medication use among new users with at least 365 days of continuous insurance enrollment prior to the PCSK9i index date were calculated. The rates of statin discontinuation and PCSK9i interruption (no fills for at least 30 days during follow-up) were described among new users with at least 90 days of follow-up after PCSK9i initiation. Results: Among 3,968 patients initiating PCSK9i therapy, the average age was 63 years and 55% were male. Diagnoses of prior atherosclerotic cardiovascular disease were present in 76% of PCSK9i initiators, including 71% with prior myocardial infarction, 14% ...
Stem Cells in the Treatment of Disease
Authors: Helen M. Blau, George Q. Daley
Journal: New England Journal of Medicine (2019)

Interview with Dr. Helen Blau on stem cells in the treatment of disease. (09:12)Download Stem cells have been the focus of hope, hype, and a great deal of research. But what exactly is a stem cell, and what are its uses? This review describes the different types of stem cells, their applications, and hurdles in the path leading to major clinical influence. The article is accompanied by a slide show, an illustrated glossary, and an audio interview with one of the authors.
Globalization: A Very Short Introduction
Authors: Irina Haivas
Journal: BMJ (2003)

The term ‘globalisation’ is widely debated and overused. We find it in the media, in books, and in our conversations. Yet, many of us still do not fully understand what globalisation means and how this process affects our lives. Martin Steger provides a clear, lively, and concise insight into the main aspects of globalisation and the surrounding debate.

‘Globalisation is a set of processes that operate simultaneously …
German junior doctors are leaving clinical medicine
Authors: Annette Tuffs
Journal: BMJ (2005)

Roland magunia/afp/getty.



Being a medical doctor is still by far the most popular and trustworthy profession in Germany, according to a recent opinion poll. About 70% of the German population voted for the medical profession, followed by priests with 38% (multiple votes were possible). Also, every year about four candidates apply for each of the several thousand places in the 34 German medical schools, making medical careers some of the most sought after.

The initial enthusiasm of students for clinical medicine does not last until the end of their studies, however. Confronted with hospital reality, about 40% avoid working in exhausting jobs on the ward or in the outpatient department after their final exam in preference for office jobs in hospital quality management, health insurance companies, consultancy firms, or the pharmaceutical industry.

Also, a steady exodus of junior doctors towards other European countries, such as the United Kingdom, or Scandinavia, the United States, Australia, and Canada is threatening to drain Germany of its badly needed medical workforce. Currently about 6000 doctors are working the UK, many of them head hunted …
Abstract 132: Effects of a 2-hours BLS Course With and Without a Supplementary 7-min Training Video on Resuscitation Performance During Simulated Cardiac Arrest
Authors: André Eichelkraut, ResQer, Cynthia Poenicke, Susann Karg, Christian Rudolph, Norbert Papkalla, Torsten Richter, Thea Koch, Hermann Koerndle, Susanne Narciss, Michael P Mueller
Journal: Circulation (2013)

Background: The 2010 guidelines for cardiopulmonary resuscitation recommend high quality chest compressions without unnecessary interruptions. This emphasizes the importance of new teaching strateg...
Minerva: August 2002
Authors: M Mottahedeh, J K Pye
Journal: BMJ (2002)

A young woman aged 16 presented with iron deficiency anaemia and a palpable mass the size of an orange in the left upper quadrant of her abdomen. An ultrasound scan showed a distended abdomen with no abnormality. This led us to investigate further with a barium meal (top), which indicated a trichobezoar (hair ball of the stomach). The trichobezoar formed a cast of the stomach and was removed at laparotomy (bottom). The patient made a good recovery and was discharged from the clinic four months later.

Anorexia nervosa is spreading frighteningly in Western countries. Its classified as deliberate weight loss and is a progressive ‘pursuit of lightness.’ Looking at contexts where lightness is celebrated—in music, literature and the arts—one writer suggests anorexic behaviour is much more than a pattern of psychiatric symptoms. Instead, he says, it should be thought of a meaningful behaviour expressing ethical values deeply rooted in Western culture ( Medical Humanities 2002;28:3 8).

Haemodialysis patients say they notice poor saliva production, which can be distressing. In an effort to identify the most important factors associated with stimulated salivary flow, 50 …