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(1) Penalty shoot-outs can trigger heart attacks

(2) Centrefold models are becoming more androgynous

(3) No evidence for the existence of the "Mummy's curse"

(4) Black pudding may interfere with cancer screening test

(5) Kyoto will have little effect on global warming

(6) Questioning the humanity of countries that supply arms

(1) Penalty shoot-outs can trigger heart attacks

(Admissions for myocardial infarction and World Cup
football: database survey)
http://bmj.com/cgi/content/full/325/7378/1439

Heart attacks increased by 25% when England lost to
Argentina in a penalty shoot-out in the 1998 World Cup,
concludes a study in this week's Christmas issue of the
BMJ.

These findings support the view that heart attacks can
be triggered by emotional upset, such as watching your
football team lose an important match, particularly
those in which there is a penalty shoot out.

Researchers examined hospital admissions for heart
attack, stroke, deliberate self harm, and road traffic
injuries on the day of, and five days after, England's
World Cup matches, compared with admissions at the
same time in previous and following years and in the
month before the tournament.

Risk of admission for heart attack increased by 25% on
30 June 1998 (the day England lost to Argentina in a
penalty shoot-out) and the following two days. No
excess admissions occurred for any of the other
diagnoses or on the days of the other England matches.
Admissions were slightly higher in men than women.

Given that matches between England and Argentina
always produce intense rivalry, and the fact that it was
a knock out game, football fans would have experienced
a fair amount of tension before and during the match,
say the authors. They suggest that the excess
admissions are attributable to spectators' emotions
during the very tense ending.

If the triggering hypothesis is true, preventive efforts
should consider strategies for dealing with the effects
of acute physical and psychological upheavals, say the
authors. Aside from issues of sporting fairness, perhaps
the lottery of the penalty shoot-out should be
abandoned on public health grounds, they conclude.

Contacts:

Douglas Carroll, Professor of Applied Psychology,
School of Sport and Exercise Sciences, University of
Birmingham, UK

Shah Ebrahim, Professor of Epidemiology of Ageing, MRC
Health Services Research Collaboration, Department of
Social Medicine, University of Bristol, UK

John Macleod, Clinical Research Fellow, Department of
Primary Care and General Practice, University of
Birmingham

George Davey Smith, Professor of Clinical Epidemiology,
Department of Social Medicine, University of Bristol, UK
Email: zetkin@bristol.ac.uk



(2) Centrefold models are becoming more androgynous

(Shapely centrefolds? Temporal change in body
measures: trend analysis)
http://bmj.com/cgi/content/full/325/7378/1447

The shapely body characteristics of centrefold models
have given way to more androgynous ones, concludes a
study in this week's Christmas issue of the BMJ.

Researchers looked at trends in Playboy centrefold
models' body measurements by analysing 577
consecutive monthly issues of Playboy, from the
magazine's inception in December 1953 to December
2001. They extracted centrefolds' anthropometric data:
height, weight, and measurements for bust, waist, and
hip.

From these data, they calculated body mass index,
waist:hip ratio, waist:bust ratio, and an androgyny
index.

All measures except weight showed significant temporal
change. Over time, bust size and hip size decreased,
while waist size increased. Measures of body shape
followed the same trends: body mass index and bust:hip
ratio decreased, while waist:hip ratio, waist:bust ratio,
and androgyny index increased.

These findings suggest notable temporal trends in
measures of body shape in Playboy centrefold models,
say the authors. The typical body mass index of
Playboy centrefolds has further descended below
corresponding population levels, whereas their typical
waist:hip ratio now approaches population levels.

These temporal trends are at odds with claims that
centrefolds' body shapes are still more "hourglass" than
"stick insects" and that the maximally sexually
attractive female waist:hip ratio is stable, they
conclude.

Contact:

Martin Voracek, Research Resident,
Department of Psychoanalysis and Psychotherapy,
University of Vienna, Austria
Email: martin.voracek@akh-wien.ac.at



(3) No evidence for the existence of the "Mummy's
curse"

(The mummy's curse: historical cohort study)
http://bmj.com/cgi/content/full/325/7378/1482

There is no evidence for the existence of the mummy's
curse, reputedly associated with the opening of the
tomb of Tutankhamen in Egypt, between February 1923
and November 1926, finds a study in this week's
Christmas issue of the BMJ.

According to the writings of Howard Carter, 25
Westerners were present at the breach of sacred seals
in a previously undisturbed area of the pharaoh's tomb,
and were therefore potentially exposed to the curse. A
further 19 were in Egypt at the time but not recorded
by him to have been present at the site at the relevant
time.

Mark Nelson of Monash University in Australia
established dates of death for all of those exposed and
11 (58%) of those not. In the 25 people exposed to the
curse, the average age at death was 70 years
compared with 75 in those not exposed.

There was no significant association between exposure
to the mummy's curse and survival and thus no
evidence to support the existence of a mummy's curse,
says the author. Perhaps finally it, like the tragic boy
king Tutankhamen, may be put to rest, he concludes.

Contact:

Mark Nelson, NHMRC Fellow, Department of
Epidemiology and Preventive Medicine, Monash
University, Alfred Hospital, Prahran, Australia Tel
(University):
Email: mark.nelson@med.monash.edu.au


(4) Black pudding may interfere with cancer screening test

(Controlled prospective study of faecal occult blood
screening for colorectal cancer in Bury, black pudding
capital of the world)
http://bmj.com/cgi/content/full/325/7378/1444

Eating black pudding may interfere with a screening
test for colorectal cancer, claim researchers in this
week's Christmas issue of the BMJ.

The Haemoccult test is widely used to screen for
colorectal cancer. It uses blood derivatives passed in
the stool to detect gastrointestinal bleeding. People
testing positive then have a colonoscopy.

The research team identified 10 healthy volunteers from
the Lancashire town of Bury, famed for black pudding (a
regional delicacy consisting of congealed pigs' blood,
fat, and rusk, encased in a length of intestine). All
volunteers were below the age of 35 with no family
history of colorectal cancer. Each participant completed
a Haemoccult test requiring six specimens to be taken
from stools passed over three consecutive days.

Participants then eagerly ate a locally produced 7oz
black pudding and then had a further Haemoccult test.
The tests were analysed at Bury General Hospital. A
positive test result was defined as the occurrence of
one or more positive specimens from the six provided.

Initially all volunteers returned negative tests, but after
consumption of black pudding, four people tested
positive. Ingestion of black pudding resulted in a
significantly higher proportion of positive Haemoccult
test results.

To calculate the effect of this on a population screening
programme, the authors questioned 100 people about
their black pudding consumption. Almost two-thirds
(63%) succumbed to black pudding on occasion. Based
on these figures, the authors calculate that more than
twice the number of people than expected would test
positive and would need further investigation.

As a result, patients should be advised to avoid black
pudding during screening, they conclude.

Contact:

Richard Harvey, Consultant Gastroenterologist,
Frenchay Hospital, Bristol, UK



(5) Kyoto will have little effect on global warming

(How healthy is the world?)
http://bmj.com/cgi/content/full/325/7378/1461

(Commentary: Gilding the global lily)
http://bmj.com/cgi/content/full/325/7378/1461#resp1

Life expectancy and prosperity will continue to rise and
food production should keep up with population growth,
but the Kyoto agreement will have little effect on global
warming according to this week's Christmas issue of the
BMJ.

Using official statistics and global trends, Bj±rn Lomborg,
Director of the Danish Environmental Assessment
Institute and author of The Skeptical Environmentalist
attempts to draw a reasonably good picture of the true
state of the world.

Life expectancy for the developing world has risen from
41 years in 1950 to 64.7 years in 2002, and by 2020 is
expected to pass the 70 years barrier. Prosperity has
also increased by over 200% for both the developed
and the developing world over the past 50 years.

Food production should keep up with population growth
without greatly encroaching on forest area. Even
concerns about use of energy have little merit, says the
author, as available energy resources are increasing.

One important problem with the use of energy,
however, is that the emission of carbon dioxide causes
global warming. The global costs of the Kyoto
agreement to cut carbon emissions will be large, yet the
benefits will be marginal, postponing the temperature
rise a mere six years from 2100 to 2106, warns the
author.

For the same amount of money that the Kyoto protocol
will cost the European Union every year, the UN
estimates that we could provide every person in the
world with access to basic health, education, family
planning, and water and sanitation services, he
concludes.

But are these forecasts valid? In an accompanying
commentary, Anthony McMichael of the Australian
National University argues that Lomborg's views are a
blend of naivety and ignorance.

Lomborg is not only selective in his use of data, but his
trivialising of global climate change shows ignorance
about the profound ecological and social implications of
global environmental changes, he writes. Likewise,
belittling the Kyoto protocol is mischievous. Indeed, its
acknowledged marginal impact on global warming
highlights the need for more radical, and politically
challenging, cuts in emissions over coming decades.

Lomborg has compiled much useful information,
however, he fails to understand the concerns of most
environmental scientists, most ecologists, and many
social scientists, who believe that past economic
practices, technology choices, and exploitation of the
ecosystem are ecologically and socially unacceptable,
he concludes.

Contacts:

Paper: Bj±rn Lomborg, Director, Danish
Environmental Assessment Institute, Copenhagen,
Denmark
Email: bjorn@lomborg.com

Commentary: Anthony McMichael, Director, National
Centre for Epidemiology and Population Health,
Australian National University, Canberra, Australia
Email: tony.mcmichael@anu.edu.au


(6) Questioning the humanity of countries that supply
arms

(Empty arms: the effect of the arms trade on mothers
and children)
http://bmj.com/cgi/content/full/325/7378/1457

Trading in arms is highly detrimental to the health of
mothers and children in the poor countries where armed
conflict occurs. But do the powerful arms trading
countries want to address the problems they are
causing?

Researchers in this week's Christmas issue of the BMJ
reveal the unethical behaviour of powerful countries,
individuals and organisations that have profited from the
arms trade.

Between 1990 and 2001, 16 of the world's poorest 20
countries were engaged in armed conflict, and many
have become saturated with small arms. In 2001, small
arms were killing more than 1,000 people every day, the
majority women and children.

Huge differences in the death rates of mothers and
children exist between rich arms producing countries
and poor arms importing countries. Adjusting each
country to have populations of the same size, the
authors found that 47,000 mothers died each year and
2,000 children died each day in the poorest country
(Sierra Leone) compared with 91 mothers each year and
15 children each day in the country supplying the most
arms (USA).

The authors recommend that legal arms trading should
be the responsibility of and regulated by a newly
configured UN, more representative of poor countries
and less dependent on rich and powerful arms exporting
countries. Arms trading should also conform to "the
international code of conduct" an innovative proposal
produced by Nobel peace laureates and based on
ethical criteria within international humanitarian law.

"Somehow the UN has to find a way of creating a
system that ethically regulates legal arms trading, and
the international community needs to establish a
protection force to address illegal trading," they
conclude.

Contact:

David Southall, Professor of Paediatrics, c/o Child
Advocacy International, Newcastle under Lyme,
Staffordshire, UK
Email: davids@doctors.org.uk

Also in this week's Christmas issue of the BMJ: Ice
cream headaches - how gobbling up ice cream more
than doubles the risk of a headache:
http://bmj.com/cgi/content/full/325/7378/1445

The last Noel? - a cost effectiveness analysis of
Christmas:
http://bmj.com/cgi/content/full/325/7378/1456

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