Providing clear information about when patients can return to work after inguinal hernia repair has successfully reduced the typical time off work from six weeks to two. Information leaflets urging an early return to work and to sporting activities were given to patients and their doctors two weeks before the operations took place. Of the 78% of patients who were in paid employment, 82% returned to work within two weeks, and 89% of those who drove were driving again by the end of the second week (Journal of One-Day Surgery 2005;15: 15-7).

Synthetic tooth enamel developed by Japaese scientists may do away with the type of fillings typically used to treat dental caries, especially for very early lesions. The crystalline white paste of modified hydroxyapatite is chemically and structurally similar to natural tooth enamel and repairs early lesions by nanocrystalline growth. Not only does this remove the need to dig out the surrounding healthy tooth first, but it also prevents further lesions developing by strengthening the natural enamel (Nature 2005;433: 819.).

A staggering 38% of women who die in childbirth in the US state of Maryland cannot be identified from death certificates. An analysis of data taken from multiple sources came up with a mortality of 22.2 per 100 000 live births, which is 61% higher than the rate of 13.8% deduced from death certificates alone. The author says that such under-reporting is probably happening country-wide, making it unlikely that the US government's target of 3.3 deaths per 100 000 by the year 2010 will be achieved (American Journal of Public Health 2005;95: 478-82).

Obtaining central venous access via the subclavian vein is common practice but often involves manipulating the patient into different positions or taking anatomical measurements to get it right. A study in Anesthesia and Analgesia ( 2005;100: 623-8) offers the clavicle's tuberosity as an alternative anatomical landmark to simplify cannulation, and this doesn't involve moving the patient around or taking measurements. But before everyone changes their technique take note: the study was too small to determine the incidence of rare complications such as pneumothorax, and it didn't look at children.

A large, population based twin study from Denmark found that people who have migraine don't experience any greater loss of cognitive function over time than people who don't have migraine. This is reassuring in light of a recent neuroimaging study that reported that deep white matter lesions, which are usually associated with cognitive decline and dementia, were more common in women with migraine than controls (Neurology 2005;64: 600-7).

Despite the high proportion of women who enter medical school, there's a spectacular lack of women in cardiology: women make up just 16.8% of trainees and 7.4% of consultants in cardiology. The reasons? According to a survey carried out by the British Cardiac Society, it's the family unfriendly hours, the unavailability and active discouragement of flexible training arrangements and part-time consultant posts, and the paucity of female role models. But an improvement in flexibility and support probably won't occur until there's a critical mass of female cardiologists and mentors to bring about the changes in the first place (Heart 2005;91: 283-9).

A case-control study from Cuba supports the hypothesis that prostate cancer may be linked with an infectious factor related to sexual behaviour. The risk of prostate cancer was significantly increased in men with a history of a sexually transmitted disease, and there was a tendency (although it didn't reach statistical significance) for the cases to report having had sex with prostitutes. The authors point out, however, that their data couldn't rule out a role for hormonal factors related to sexual activity (International Journal of Epidemiology 2005;34: 193-7).

Long before its formal recognition in 1943, the concept of autism appeared in folklore. Fairytales from Europe and Scandinavia talk about children who exhibit sudden changes of behaviour. Supernatural powers were often held responsible for replacing normal children with children who were unresponsive, resistant to physical affection, and unable to express emotion. Some were said to display unexplained crying and were unable to speak. Such stories lend force to the argument that autism is not simply a product of recent technologies (Archives of Disease in Childhood 2005;90: 271.).

The British Board of Film Classification recently updated its guidelines about behaviours being displayed in film. Racial abuse, sexual violence, and the glamorisation of drugs remain great concerns, and smoking is mentioned for the first time. Harry Potter is banned from smoking, but James Bond can still get away with it. Minerva wonders when driving under the influence of alcohol will come into the spotlight. Like many others, she recently enjoyed the Oscar-winning film Sideways but was shocked by the number of scenes depicting the heroes drinking and driving.

Figure 1.

This 2000g neonate was born at term to a 20 year old primiparous unbooked mother, and had a generalised vesiculobullous eruption. Although the initial clinical diagnosis was epidermolysis bullosa, the metaphyseal osteochondritis made us suspect congenital syphilis, and this diagnosis was confirmed by positive maternal VDRL test for syphilis, and a positive VDRL test of the baby's cerebrospinal fluid. The lesions completely resolved after treatment with intravenous penicillin. Neonatal syphilitic pemphigus is rare, but practitioners in developing countries should remain vigilant so as not to miss this eminently treatable condition.

G Karthikeyan (drgkarthikeyan@yahoo.co.uk), assistant professor of neonatology, R Muthukumaran, assistant professor of dermatology, Coimbatore Medical College Hospital, Coimbatore, India.

Age does bring wisdom, according to a survey conducted by the Department of Health. People aged 45-64 make better healthcare decisions than younger people when it comes to knowing they should call the emergency services if they experience severe chest pain, or knowing what they should do for minor injuries and illnesses. Examples of inappropriate calls to the emergency services include calling to ask how to defrost a turkey and asking about what to do about a broken false nail.