This Week in BMJ | Editor's Choice | Press releases

379 Hostility and the heart
Martha C Whiteman, F Gerald R Fowkes, Ian J Deary

380 Consent for transfusion
F G Williams

381 Developing high quality clinical databases
Nick Black

382 Do professions have a future?
Julia Abelson, P H Maxwell, R J Maxwell

383 Helicobacter pylori genome sequenced
Gene mutation protects against AIDS
US bans smoking on federal property
Britain has become less equal in death
French scientist resigns in nuclear row
Drug resistant bacteria become sensitised
Death rates rise sharply in Russia
Road injury fees to be enforced in UK
Health of German heroin misusers worsens
Ban on forcing doctors into remote areas
Three day recovery time for head injuries
Stephen Proctor profiled

389 Sporadic Creutzfeldt-Jakob disease in the United Kingdom: analysis of epidemiological surveillance data for 1970-96
S N Cousens, M Zeidler, T F Esmonde, R De Silva, J W Wilesmith, P G Smith, R G Will

395 Commentary: Age related exposure of patients to the agent of BSE should not be downplayed
Sheila M Gore

396 Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976
Janet W Rich-Edwards, Meir J Stampfer, JoAnn E Manson, Bernard Rosner, Susan E Hankinson, Graham A Colditz, Walter C Willett, Charles H Hennekens

401 Birth weight and cognitive function in young adult life: historical cohort study
Henrik Toft Sørensen, Svend Sabroe, Jørn Olsen, Kenneth J Rothman, Matthew W Gillman, Peer Fischer

403 Association between raised body temperature and acute mountain sickness: cross sectional study
Marco Maggiorini, Peter BÍ3rtsch, Oswald Oelz

404 Age related dietary exposure to meat products from British dietary surveys of teenagers and adults in the 1980s and 1990s
Sheila M Gore, Sheila Bingham, Nicholas E Day

406 Is histological examination of tissue removed by general practitioners always necessary? Before and after comparison of detection rates of serious skin lesions
Adam Lowy, Diane Willis, Keith Abrams

409 Fortnightly review: Environmental control systems for people with a disability: an update
D J Wellings, J Unsworth

413 ABC of mental health: Mental health in old age
A J D Macdonald

418 Personal paper: Beliefs and evidence in changing clinical practice
Richard Grol

422 How to read a paper: Statistics for the non-statistician. II: "Significant" relations and their pitfalls
Trisha Greenhalgh

426 Bovine spongiform encephalopathy threatens drugs in European Union
A Earl-Slater

426 Figures given for bed complement in Edinburgh were wrong
R J Aitken and P Gabbitas

426 Delays in diagnosing oesophagogastric cancer
J G Schmidt; W Gillison and others; J Galloway and P Evans; A Renehan and D E Tweedle; J Wayman and others

428 Screening for mannose binding protein gene in routine practice is unnecessary
C Hawke

429 Sexual medicine
M Thomas; S Rowlands and S Randall; P Kell and W Dinsmore

429 Safety in acupuncture
Earl Baldwin of Bewdley; J Hicks and others; J Uddin

430 Association between voting patterns and mortality remains
G Davey Smith and D Dorling

431 Changes in laws are necessary to allow patients detained under Mental Health Act to vote
H Smith and M Humphreys

432 H J Done, D A J Ebrill, C D Falconer, P M Jeavons, M Koeman, B Lennox, G M Lloyd, M P Menzies, J N Twohig

Soundings

434 Diagnosing trees and men
George Dunea

434 We should look at complaints again
Graham Neale

Enuresis - the cause that dares not speak its name
John Gosnell

436 Abrams' Angiography: Volume III: Interventional Radiology
Ed Stanley Baum, Michael Pentecost
D J Allison

Health Care Reform: Learning from International Experience
Ed C Ham
Martin McKee

Britain Divided: the Growth of Social Exclusion in the 1980s and 1990s
Ed Alan Walker, Carol Walker
Steve Iliffe

Classic Teachings in Clinical Cardiology: a Tribute to W Proctor Harvey
Ed Michael A Chizner
J F Goodwin

438

Editor's choice

"Calm down, dear, you'll have a heart attack"

We already know, for example, of the link between coronary heart disease and a type A personality. In their editorial Martha Whiteman and colleagues describe how recent research has identified the "toxic" component of the type A pattern as hostility (p 379). Research is now focusing on what component of hostility is responsible for the raised risks of myocardial infarction. Until we know, the authors suggest, at least we have a good reason to be nice to one another.

On p 389 S N Cousens and colleagues describe their careful analysis of changes in Creutzfeldt-Jakob disease that might be related to the epidemic of bovine spongiform encephalopathy. They examined all 662 British cases of sporadic disease reported in 1970-96 and found the greatest increase in people over 70, an excess among dairy farmers, and the by now familiar cluster of cases of new variant Creutzfeldt-Jakob disease in people aged under 30. Although all these changes may have occurred if exposure to bovine spongiform encephalopathy had caused Creutzfeldt-Jakob disease in humans, the authors are cautious: the increase among elderly people may be due to better ascertainment, and the excess risk among dairy farmers also occurs in Europe, where bovine spongiform encephalopathy is rare. For the cases in young people the most likely cause remains exposure to bovine spongiform encephalopathy, though Cousens et al are puzzled at the lack of cases among older people: they identified no exposure that showed a strong link with age.

Sheila Gore and colleagues suggest one such exposure (p 395). They used dietary surveys to prove what many have long suspected: that teenagers eat more burgers than their grandparents. They found a striking age gradient in the consumption of some sorts of mechanically recovered meat.

It has been known since 1891, when Dr Jacottet died on Mont Blanc of presumed pulmonary oedema with a temperature of 38.3 degrees C, that fever is associated with acute mountain sickness. But this week Marco Maggiorini and his colleagues show in a study of 60 Alpine climbers that body temperature is closely related to the severity of hypoxaemia and acute mountain sickness (p 403).

George Dunea also reminds us of something we know well. His Soundings this week (p 434) is an appreciation of the infinite variety of trees and the rewards that repay years of study: "It all takes time, patience, perseverance, and ultimately experience, which is why it takes so long to truly become a specialist in any field."