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Gujarati people of South Asian origin in Leicester, UK, have low bone mineral density (BMD) and vitamin D levels compared with white people in the area. Using an observational cross sectional study of randomly selected Gujarati and white volunteers aged between 20 and 40, the authors found that the BMD difference was particularly pronounced between Gujarati and white women, and that a much higher proportion of Gujarati men and women had vitamin D levels that were not measurable. Noting the potential public health implications of the increased risk of fractures in the Gujarati population, the authors suggest that “appropriate interventional measures will be required to address this particular health issue in South Asians”. (



Most of the world has a higher risk of experiencing an acute myocardial infarction on a Monday, as we undergo the stress of returning to work after the weekend. Japanese women, however, who Confucian ethics and inherent Far East patriarchism dictate take full responsibility for housekeeping duties (whether working full time or not), are at a greater risk on Saturdays. The authors recommend that the next step should be to assess in detail the cultural factors and activity patterns that lie behind the trend, and how best to minimise their negative effect on the health of Japanese women. (



One third of the world population has been infected by M tuberculosis and in 2000 two million deaths were attributed to it. Some 95% of all cases and 98% of all deaths occur in developing countries where the incidence is parallel to that of HIV/AIDS. Although the incidence of tuberculosis in western Europe is decreasing the authors review the current epidemiology, diagnosis, and therapeutic aspects of tuberculosis in Germany where a migrant population and elderly people are usually those most affected. The use of nucleic acid amplification techniques for the detection of mycobacteria is increasing because of its high specificity. The authors hope that the role of preventative chemotherapy in German adults can be strengthened. (



Infants under 3 months have a disproportionately high mortality rate in one Kenyan district hospital despite the fact that few deaths in the age group are recorded: most occur unrecorded in the community. Mortality was 18% overall, but 34% for children under 1 week, with severe infection and prematurity the main causes of death. The lack of clear data up to this point, particularly for cost effectiveness, has hampered the ability to make policy decisions on health interventions for this vulnerable group, but the authors hope their data can both help to fill the research gap and to act as a spur towards the introduction of large intervention trials. (



Parents strongly oppose relinquishing decision making to doctors over whether their newborn should be enrolled into a clinical research trial. Recruitment into neonatal research can be problematic, so researchers from Canada decided to examine possible ways of simplifying the process. One possible method they identified was to remove the decision regarding enrolment into trials from the parents, and give it to doctors. Although this faltered, most parents studied did not feel that recruitment added stress to an already stressful situation, and 90% felt that they had made an informed decision regarding their child’s enrolment (or not) into a clinical trial. (



UK preterm infants are sicker and have poorer outcomes despite receiving a more specialist intensive care service compared with those in Denmark. Information was recorded about the course of every liveborn infant <28 weeks gestation, and/or <1000 g birth weight and ⩾21 weeks gestation from two ongoing perinatal studies in both countries. Danish babies are more likely to be delivered by caesarean section. Despite receiving more antenatal corticosteroids UK babies have higher levels of disease severity. The findings may be an accurate reflection of the reproductive health in the two countries but the authors believe that they are not attributable to the organisation of perinatal care services. (



A recent study based on Swedish practice suggests that telemedically supervised, paramedic delivered thrombolysis could significantly improve the outcome of acute myocardial infarction (AMI). Two thirds of Swedish hospitals implement some form of prehospital thrombolysis and in one county this has resulted in a decrease in time between the call for help and administration of thrombolytics by nearly an hour. The study found no evidence that prehospital thrombolysis leads to increased complications and, in fact, incidence of inhospital complications was halved as a result. The authors acknowledge that, while these findings cannot be automatically extrapolated to the UK, valuable lessons can be learnt to improve the care of the 300 000 people who suffer from AMI each year. (



Osteoarthritis (OA) is the single most common musculoskeletal disease in the world, and its prevalence increases with age. Worldwide incidence varies, but a population based study in Italy found that one third of community dwelling people over the age of 65 had symptomatic peripheral OA, and that hip OA—while being less prevalent than knee and hand OA—was the most strongly associated with disability. Knee and hand OA, which may have been more common because of the rural location of the group, were not associated with disability. (