Online First articles may not be available until 09:00 (UK time) Friday.

Press releases Monday 15 to Friday 19 December 2008

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://www.bmj.com).

(1) It's a shocker for rockers
(2) Should the Pope be worried that Wales won the rugby Grand Slam this year?
(3) Medical myths exposed
(4) Contraception doesn't go better with Coca-cola
(5) People more likely to attend cancer screening close to Christmas and birthdays
(6) Please, sir, I'm stuffed
(7) Txtng bk 2 hlth
(8) Low doses of melamine not associated with severe kidney problems in children
(9) Other items of interest on bmj.com

(1) It's a shocker for rockers
(Research paper: Head and neck injury risks in heavy metal: head bangers stuck between rock and a hard bass)
http://www.bmj.com/cgi/doi/10.1136/bmj.a2825

Head banging increases the risk of head and neck injury, but the effects may be lessened with reduced head and neck motion, head banging to lower tempo songs or to every second beat, and using protective equipment such as neck braces, finds a study in the Christmas issue published on bmj.com today.

What began in 1968 at a Led Zeppelin concert with fans banging their heads on the stage, has developed into a collection of distinctive styles including the up-down, the circular swing, the full body and the side-to-side.

Anecdotal reports of head banging induced injury include hearing loss, stroke and mild traumatic brain injury, but there has been little formal research into head banging.

Declan Patton and Professor Andrew McIntosh from the University of New South Wales, analysed the injury risk from head banging and examined possible ways to protect against these injuries.

The researchers attended hard rock and heavy metal concerts including Motörhead, Ozzy Osbourne and Skid Row, and identified that the up-down style was the most common head banging technique. They constructed a theoretical head banging model of this popular style to examine the effect the range of head and neck motion has on injury severity. A focus group of ten musicians was used to calculate the average tempo of their favourite head banging songs.

The authors found that there is an increasing risk of neck injury beginning at tempos of 130 beats per minute related to the range of motion in the head banging style.

The average head banging song has a tempo of about 146 beats per minute. The authors suggest that at this tempo head banging may cause headaches and dizziness if the range of movement of the head and neck is more than 75º. They report that at higher tempos and greater ranges of motion there is an additional risk of neck injury.

So could someone render themselves unconscious while head banging? Unlikely, say the authors, unless they are banging their head on the stage or connect with someone else's head.

And what of two of the most famous head bangers, Beavis and Butt-head? When head banging at a tempo of 164 beats per minute to "I Wanna be Sedated" the range of motion of Beavis' head and neck is about 45º, say the authors, so he would be unlikely to sustain any injury. But the news for Butt-head may not be so rosy. Preferring to head bang at a range of motion of 75º, he may well experience symptoms of headaches and dizziness.

Luckily, there are a number of possible ways to protect against these injuries, write the authors. These include calling for bands such as AC/DC to play songs such as "Moon River" instead of "Highway to Hell," public awareness campaigns headed by musicians such as Cliff Richard and the labelling of music packaging with anti-head banging warnings.

Contacts:
Professor Andrew McIntosh, University of New South Wales, Sydney, Australia
Email: a.mcintosh@unsw.edu.au

Doctors in the Christmas issue published on bmj.com today are urging the Vatican's medical team to keep a special watch over the Pope this Christmas, after their research investigating the link between papal deaths and Welsh rugby performance suggests that he has about a 45% chance of dying by the end of 2008.

Dr Gareth Payne and his team from Cardiff found no evidence to support the urban legend that "every time Wales win the rugby Grand Slam, a Pope dies," but they did find limited data linking Welsh rugby performance and papal deaths. Worryingly for Pope Benedict XVI, Wales won the Grand Slam in 2008.

The researchers charted all northern hemisphere rugby championships since 1883, but discarded the years 1885, 1888-9, 1897-8 and 1972 because not all the scheduled matches were played. For the purposes of their research, a Grand Slam was defined as one nation beating all other competing teams.

Since 1883, eight Pontiffs have died, five in Grand Slam years - three deaths happened when Wales completed the sweep, and two others occurred when Wales won the tournament but not the Grand Slam.

Interestingly, say the authors, although the deaths did not always coincide with a Welsh Grand Slam win, they did correspond with a victory of a predominantly Protestant nation (England, Scotland or Wales), rather than a Roman Catholic nation (France, Ireland, or Italy).

The authors comment that the link between Popes and Grand Slams "is nothing more than an urban myth ... This comes as something of a relief as we are at a loss to see how the events could be linked, especially given the continuing rapprochement between Catholic and Protestant churches."

However, given that the research suggests a link between the success of the Welsh rugby union team and papal deaths, the authors believe that the Vatican medical staff "can't fully relax until the new year arrives."

Contact:
Dr Gareth Payne, University Hospital Wales, Cardiff, UK Email: garethpayne@doctors.org.uk 

Does sugar make kids hyperactive?
Do we lose most of our body heat through our head?
Will eating at night make you fat?
Do suicides increase over the holidays?
Are poinsettias toxic?
Hangovers cures, do they work?

These are some of the common myths that are fictitious, according to an article in the Christmas issue published on bmj.com today.

Researchers from the Indiana University School of Medicine looked at six myths related to the holiday and winter seasons. The authors, Rachel Vreeman and Aaron Carroll, then analysed the evidence to find out if the myths were true or false.

While parents may be convinced that sugary drinks, sweets and chocolate make their children hyperactive at least 12 studies have shown that there is no evidence to support this belief. Yet parents are so convinced about this myth that when they think their children have been given a drink containing sugar (when it is actually sugar-free) they rate their children's behaviour as more hyperactive. In fact, the difference in behaviour is all in the parents' mind.

As the Christmas and New Year cold weather approaches many people start wearing hats because of the strongly held belief that we lose 40-45% of our body heat through our head. Not so, say the authors, who argue that there is nothing special about the head and heat loss and "if this were true, humans would be just as cold if they went without trousers as if they went without a hat." If it's cold outside it makes sense to wrap up warm but covering your head does not make a big difference.

Some people swear by the rule that if you don't eat at night you won't get fat. Hogwash say the authors. One Swedish study seemed, at first glance, to support this theory as obese women reported eating more at night than non-obese women. However, in reality the women were not just "night eaters" but were generally eating more meals. The simple truth is that people put on weight because they consume more calories than they burn - there is no getting round this, say the authors.

The research also finds that suicides do not increase over the holidays, poinsettias are not toxic and that hangover cures do not work. The only way to avoid a hangover over Christmas is to drink in moderation or not at all!

Contacts:
Cindy Fox Aisen, Press officer, Indiana University School of Medicine, Indianapolis, USA
Email: caisen@iupui.edu 
Or
Professor Rachel Vreeman, Indiana University School of Medicine, Indianapolis, USA
Email: rvreeman@iupui.edu 

(4)Contraception doesn't go better with Coca-cola
(Feature: Coca-Cola douches and contraception)
http://www.bmj.com/cgi/doi/10.1136/bmj.a2873

One of the reasons why Coca-cola is not an effective spermicide is because sperm are faster and may reach an egg in time to fertilise it, says an expert in the Christmas issue published on bmj.com today.

The author, Deborah Anderson, a professor in obstetrics and gynaecology at Boston University and Harvard Medical School, writes that Coca-cola douches were allegedly used during the 1950s and 60s as a contraceptive when other methods were not easily available. The acidity alledgedly worked as spermicide to kill sperm and the classic coke bottle shape lent itself to a "shake and shoot" applicator!

In this analysis, Professor Anderson provides eight reasons why you're better off not reaching for a Coca-cola after sex, unless you want to drink it:

1. Coca-cola is not very effective in killing sperm.
2. Sperm are faster than Coca-cola and could escape douching and reach the cervical canal.
3. Coca-cola may be good for tenderising steaks and removing corrosion from car bumpers but is not good news for vaginal tissue. Coca-cola damages the top layers of cells and could make a woman more prone to sexually transmitted infections.
4. The good bacteria that keep vaginas healthy could be adversely affected by coke and this could result in fungal and bacterial infections.
5. Douching could lead to pelvic inflammatory disease and ectopic pregnancy.
6. The Coca-cola formula is a secret so this means no research has been done on whether it would cause birth defects.
7. You need skill to douche effectively with Coca-cola - not practical, especially in the dark when bottle caps can go dangerously astray.
8. There are much more effective and easy to use methods of contraception around.

Contact:
Dr Deborah Anderson, Boston University, Boston, USA
Email: Deborah.Anderson@BMC.org 

(5) People more likely to attend cancer screening close to Christmas and birthdays
(Research paper: The impact of appointments timed in proximity to annual milestones on compliance with screening: randomised controlled trial)
http://www.bmj.com/cgi/doi/10.1136/bmj.a2794

Cancer screening programmes could increase attendance by inviting people for screening close to birthdays or other annual milestones such as Christmas and the New Year, finds a study in the Christmas issue published on bmj.com today.

Colorectal cancer (bowel cancer) is the third most common cancer in the UK and the second leading cause of cancer deaths in Europe and the US. But despite the promotion of screening programmes in many western countries, attendance is generally low. Previous studies have identified barriers to attendance including anxiety and lack of knowledge about the test's risks and benefits, but the influence of age as a motivating factor, and the timing of invitations on screening attendance has never been tested.

Professor Geir Hoff and Michael Bretthauer from The Cancer Registry of Norway, examined whether tailoring the timing of colorectal cancer screening invitations to annual milestones such as birthdays, Christmas and the New Year, can improve attendance.

They randomly recruited 20,780 men and women aged 50-64 years from the population registry in Norway, and randomly assigned a screening appointment to them. The attendance rates for each week and month of assigned appointments were compared to participants' week/month of birthday. The overall attendance was 12,960 out of 20,003 (64.7%).

The researchers found that attendance rates were significantly higher in December compared to the rest of the year (72.3% versus 64.2%), and for individuals receiving their letter of invitation in the week of their birthday or assigned to screening 1-2 weeks after their birthday (67.9% versus 64.5%).

Age, being female, screening method, and geographical area of living were also independent predictors of attendance.

The authors suggest that invitation to screening close to the date of individuals' birthdays and to the month of December may improve attendance at screening programmes as well as its effectiveness for the prevention and early detection of disease.

Although the reasons for this are unknown, they may relate to annual reminders of ageing triggered by annual milestones such as birthdays and Christmas and the New Year, conclude the authors.

Contact:
Dr Gier Hoff, The Cancer Registry of Norway, Oslo, Norway
Email: hofg@online.no 

(6) Please, sir, I'm stuffed
(Feature: Please, sir, I want some more?)
http://www.bmj.com/cgi/doi/10.1136/bmj.a2722

Doctors writing in the Christmas issue published on bmj.com today, believe that while the 1830s workhouse diet may have been dull it was nutritionally sufficient and question whether Oliver really needed more.

Sue Thornton and colleagues compared menus and other historical material on workhouse diets with Dickens' fictional description of what Oliver ate: "three meals of thin gruel a day, with an onion twice a week and half a roll on Sunday." And on feast days, the inmates received an extra two and a quarter ounces of bread.

Dickens' invented diet, say the authors, would have been completely inadequate for health and growth.

The authors used a computer programme to compare the nutritional content and population requirements in Dickens' diet to Dr Jonathan Pereira's "workhouse dietaries." Interestingly, the authors note that historians have suggested that modern dieticians might approve of workhouse diets because of the coarse, less refined, workhouse bread.

Unlike Dickens' description of gruel, the recipe analysed by the authors is substantial - each pint contains 1.25 oz of the best Berwick Oatmeal. The Pereira diet would sustain growth in a nine-year-old child unless very physical activity took place everyday. Other historical data also shows that large quantities of meat (beef and mutton) were delivered to London workhouses.

The authors conclude that assuming the workhouse children received the amount of food they were due then "the diet was not as bad or harmful as that related by Dickens." They point out that while the New Poor Laws obviously made Dickens very angry and perhaps brought back childhood memories of his own hardship and deprivation, historical evidence does not back up some of the claims he makes in his novel

Contact:
Sue Thornton, Northampton General Hospital, Northampton, UK
Email: sue.thornton@northants.nhs.uk 

(7) Txtng bk 2 hlth
(Filler: Texting shows recovery after faint?)
http://www.bmj.com/cgi/doi/10.1136/bmj.a2723

Medical staff working at music festivals are using a patient's ability to send a text message as a sign that they may be fit for discharge, according to an article in the Christmas issue published on bmj.com today.

Staff from the Festival Medical Services charity, who provide a resuscitation service to the audience at festivals such as Glastonbury and Reading, noticed that teenagers who fainted or had panic attacks were likely to text their friends as soon as they were able.

The ability to send a text message, however little sense they make, requires a certain level of dexterity, coordination and consciousness, that may indicate a patient has recovered and is no longer in need of medical treatment.

For the past two years, the researchers have been using this "Text Messaging Sign" as a tool for considering that a patient may be ready to be discharged back to the festival.

Indeed, it has been so successful that only 6-8 medical staff were needed to treat an influx of 130 patients within 90 minutes, during a set by the band "Rage Against the Machine" at this year's Reading festival.

The authors call for further research into the "Text Messaging Sign" as a valid sign of recovery following fainting and panic attacks and its potential for use in overloaded A & E departments.

Contact:
Dr Mike Sinclair, Festival Medical Services, Somerset, UK
Email: mikesinclair@ntlworld.com 

(8) Low doses of melamine not associated with severe kidney problems in children
(Research paper: Renal screening in children after exposure to low dose melamine in Hong Kong: cross sectional study)
http://www.bmj.com/cgi/doi/10.1136/bmj.a2991

Exposure to low dose melamine in contaminated food products is not associated with severe kidney problems such as acute renal failure, concludes a study published on bmj.com today.

Large scale screening programmes for populations exposed to low dose melamine, such as those undertaken in Hong Kong after the recent tainted milk scandal in China, may not be worthwhile and are unlikely to lead to any health benefits, say the authors.

By late September, at least four babies in China died and thousands more became ill after consuming milk containing high doses of melamine. Melamine was added to a wide range of food products to make them appear to have a higher protein content and to pass food quality tests.

Contaminated milk and other food products were also sold in Hong Kong, although they contained much lower concentrations of melamine. For example, milk products in China were found to contain up to 2563mg/kg of melamine, compared to up to 68mg/kg in Hong Kong*.

Little is known about the consequences of exposure to low dose melamine in humans.

Professor Hugh Lam and colleagues from the Chinese University of Hong Kong examined 3170 children aged 12 years or less, referred from a Hong Kong government initiated territory wide screening programme for renal complications in response to the contaminated milk scandal.

All children who had consumed milk products tainted with melamine for one month or more underwent renal ultrasonography and tests on their urine.

Overall, only a small percentage (0.2%) of children exposed to relatively low dose melamine were affected. And none of the children developed acute kidney failure, urinary tract obstruction, or needed treatment.

The researchers report that one child had a renal stone and seven had possible melamine related renal deposits. In addition, 208 (6.6%) children were positive for blood in their urine, although only 7.4% of these were confirmed by microscopy, suggesting an overall prevalence of less than 1% for haematuria (red blood cells in the urine, a sign of possible kidney problems).

The authors suggest that the considerable differences in outcomes for the children in China and Hong Kong is likely to be due to the large differences in levels of exposure to melamine in the milk products consumed.

The authors conclude by saying that the severe complications observed in the Chinese mainland are unlikely to occur elsewhere, but call for research to assess the long term public health impact of consuming melamine contaminated products.

Notes to Editors:
*The US Food and Drug Administration tolerable daily intake is 0.63 mg/kg/day.

Contact:
Professor Hugh Lam, Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
Email: hshslam@cuhk.edu.hk 

(9) Other items of interest on bmj.com (available from Friday 19 December)

To mark this year's Christmas BMJ, we're launching the first of our regular weekly podcasts, bringing you the latest news, views, and interviews with authors of key papers. In keeping with the seasonal theme, the podcast will include an interview with Edzard Ernst about his systematic review of the medical effects of frankincense, one of the first ever Christmas gifts. Ignobel awardwinner Deborah Anderson talks about why you shouldn't use Coca-cola as a contraceptive. And you'll also hear details of ghostly goings-on up the world's highest peak. To listen, go to http://podcasts.bmj.com/bmj/ or download it from iTunes.

For those of you wanting more, we've also commissioned a short video to illustrate the nutritional analysis of workhouse food. It was filmed at a Dickensian location in deepest Northamptonshire, where, despite the lack of evidence, we at the BMJ like to think Oliver lived before fleeing Mr Bumble and Mrs Sowerberry.