{"id":19692,"date":"2021-01-03T04:50:00","date_gmt":"2021-01-02T20:50:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19692"},"modified":"2021-01-07T06:15:23","modified_gmt":"2021-01-06T22:15:23","slug":"bmj%e5%9c%a3%e8%af%9e%e4%b8%93%e5%88%8a-%e5%8d%b1%e5%ae%b3%e4%b8%8e%e5%9c%a3%e8%af%9e%e8%8a%82%e5%9b%a0%e7%b4%a0","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19692","title":{"rendered":"[BMJ\u5723\u8bde\u4e13\u520a]: \u5371\u5bb3\u4e0e\u5723\u8bde\u8282\u56e0\u7d20"},"content":{"rendered":"\n

Feature<\/strong> Christmas 2020: The Citadel<\/p>\n\n\n\n

Harms and the Xmas factor<\/h1>\n\n\n\n

Robin E Ferner,\u00a0Jeffrey K Aronson<\/h3>\n\n\n\n

BMJ<\/em>\u00a02020;\u00a0371: m4067 (Published 16 December 2020)\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj.m4067<\/a><\/h3>\n\n\n\n

The Christmas season is associated with preventable harms from cards, tree decorations, and presents, as well as overeating and overdrinking. Given the balance of benefits and harms, Christmas may not be cost effective.<\/p>\n\n\n\n

We hope you\u2019re well, that you\u2019ve posted the last of your Christmas cards, decorated the house, and settled down before the fire. Days of feasting and merriment beckon. But what of the harms? A rummage through the archives confirms the existence of several festive health risks.<\/p>\n\n\n\n

In our foraging, we ignored Christmas disease (haemophilia B), and reports by authors named Christmas, Chrismas [sic], or Noel. We also ignored festively inspired acronyms such as NO Effect Level and Natural Orifice EndoLuminal technique. Nevertheless, our findings raise concerns.<\/p>\n\n\n\n

Causes of Christmas harms<\/h3>\n\n\n\n

Christmas cards are a source of potential harm. In 1876 a young man painted large festive cards \u201cwith colours chiefly of a bright green\u201d and developed acute arsenic poisoning. The paint was Scheele\u2019s Green, copper hydrogen arsenite.1<\/a> Posting cards is also dangerous, as the spring-loaded flap of a letter box can amputate the finger tip.2<\/a><\/p>\n\n\n\n

A Christmas break may be just that, after falls either in the home3<\/a> or outside while decking the house with Christmas lights4<\/a>\u2014a Canadian custom ill suited to the climate and a reminder not to get tight on ladders\u2014they may tip when you\u2019re tipsy. Light-emitting diode bulbs from Christmas lights,5<\/a> sharp pointed confetti stars,6<\/a>Christmas tree shaped decorations,7<\/a>8<\/a> and metal clips to hold them,9<\/a> have all found their way into toddlers\u2019 bronchi or pharynges, requiring endoscopic or surgical removal.<\/p>\n\n\n\n

Those who pine for Christmas trees may find that contact dermatitis can ensue.10<\/a>11<\/a> Needles from Christmas trees can penetrate the bronchial tree, causing breathing difficulties.12<\/a> And branches can poke you in the eye, causing corneal abrasion,13<\/a> although that is not a cause of \u201cChristmas tree\u201d cataract.14<\/a> It is customary to light candles on Christmas trees in Switzerland: burns are therefore common, at least in Bern.15<\/a><\/p>\n\n\n\n

Christmas presents pose unforeseen dangers. Cricetids at Christmas can cause concern\u2014a pet hamster, acquired as a Christmas present, spread lymphocytic choriomeningitis virus in an outbreak that affected 57 people in New York state.16<\/a> This may resonate with those who received Christmas presents of Haitian bongo drums with anthrax bacilli in their goatskin hides.17<\/a> The danger of \u201cThe propagation of syphilis by toys\u201d such as trumpets, however\u2014which the BMJ<\/em> noted in 187918<\/a>\u2014seems to have receded. <\/p>\n\n\n\n

Festive feasting is universal, \u201cdoubtless because it usually conduces to contentment and a happy frame of mind \u2026\u201d19<\/a> In 1946, with postwar rationing still in place, the BMJ<\/em> described a Christmas pudding providing more than 58\u2009000 kilocalories\u201420 times the recommended daily intake (fig 1<\/a>)\u2014and commented \u201cThe mind is enriched and tranquil after such a meal\u2026,\u201d20<\/a>21<\/a> a rather positive view of the torpor that signals postprandial diversion of blood supply from the brain to the digestive tract. Christmas dinner may even be good for the heart, at least in the short term: a \u201cstandard festive meal of poultry, mince pies, and a glass of wine\u201d increased cardiac output in six healthy volunteers.22<\/a><\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

Fig 1<\/strong> A recipe for Christmas pudding, reported enviously in a\u00a0BMJ<\/em>\u00a0editorial in 1946.20<\/a>\u00a0The article was reprinted in 1973 and provided question 7 in that year\u2019s Christmas quiz21<\/a><\/p>\n\n\n\n

Christmas is consequently a time of weight gain and increased serum cholesterol concentrations.23<\/a>R\u00e6stur fiskur<\/em>\u2014Faroese air dried fermented fish, traditionally eaten on Christmas Eve with garnat\u00e1lg<\/em>, \u201ctallow from around the left colon\u201d of a sheep,24<\/a> is a more recondite recipe for obesity and hypercholesterolaemia. As the late John Garrow said, \u201cOverfeeding was not an eventuality the Great Physiologist foresaw \u2026\u201d25<\/a><\/p>\n\n\n\n

Infective sequelae may be more immediately apparent. \u201cChristmas wrapped chocolate balls\u201d once led to an outbreak of Salmonella eastbourne<\/em> enteritis.26<\/a> Of 192 people who ate at a Christmas reception at the National Institute of Public Health-National Institute of Hygiene in Warsaw, 97 developed norovirus gastroenteritis from the salad.27<\/a> In Switzerland, chicken fondue, traditionally eaten at Christmas and New Year, can transmit Campylobacter<\/em>infection.28<\/a>29<\/a><\/p>\n\n\n\n

Drinking too much alcohol can provoke atrial fibrillation\u2014the \u201choliday heart syndrome.\u201d Of the cases originally described, 22% occurred between Christmas Eve and New Year\u2019s Day.30<\/a><\/p>\n\n\n\n

Some people take advantage of the Christmas holidays to enjoy outdoor pursuits, at least in warmer climes. The BMJ<\/em>announced with regret \u201ca most serious accident\u201d that befell Major Manifold of the Indian Medical Service and his mahout while tiger hunting at Christmas 1900: an injured tiger sprang on the Major\u2019s elephant and severely wounded both men.31<\/a> \u201cThe unfortunate officer bore his injuries with the greatest fortitude.\u201d In Australia, Christmas brings an increase in catastrophic injuries from jet skiing.32<\/a><\/p>\n\n\n\n

Discussion<\/h3>\n\n\n\n

Is it worth it? In 2002 Isaacs and Fitzgerald analysed the cost effectiveness of Christmas \u201cusing clinical and economic variable estimates, derived by inspired guesswork.\u201d33<\/a> They did not calculate QALYs, JOLLYs (\u201cjoyous outcomes living longer at yuletide\u201d), or HOLLYs (\u201chappiness outweighs less lean years\u201d), but nevertheless concluded that \u201cChristmas is not cost effective.\u201d They were criticised for failing to undertake a cost-benefit<\/em> analysis, having ignored the value of eternal life.34<\/a> However, the only harm they assessed was food poisoning; their conclusion might have been strengthened by including the harms we have identified here.<\/p>\n\n\n\n

But cost-effectiveness is not everything. Most of our sources are anecdotal, and we did not find strong evidence of widespread adverse effects. So we will leave you to decide whether the benefits of Christmas outweigh its harms.<\/p>\n\n\n\n

Conclusion<\/h3>\n\n\n\n

Stay safe, keep calm, carry on, and enjoy a very Merry Christmas!<\/p>\n","protected":false},"excerpt":{"rendered":"

Feature Christmas 2020: The Citadel Harms and the […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19692"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19692"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19692\/revisions"}],"predecessor-version":[{"id":19693,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19692\/revisions\/19693"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19692"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19692"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19692"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}