北京市2013-2014年禽流感疫情期间居民活禽暴露调查

目的 了解北京市居民在第二波人感染H7N9禽流感疫情期间的活禽暴露（饲养和购买活禽行为）及其影响因素,为禽流感防控提供科学依据。方法 采用多阶段分层抽样方法,对7 366名≥ 18岁居民进行问卷调查。应用非条件logistic回归分析活禽暴露的影响因素。结果 北京市居民在过去1年活禽饲养率和购买率分别为5.3%（95% CI：4.8%~5.8%）和6.0%（95% CI：5.5%~6.5%）。logistic回归分析结果显示,饲养活禽的危险因素包括小学及以下文化程度者（比大学及以上文化程度者,OR=1.82,95% CI：1.22~2.72）;农民（比在职人员,OR=2.49,95% CI：1.89~3.29）和待业（比在职人员,OR=1.65,95% CI：1.08~2.52）;非北京出生（比北京出生者,OR=1.54,95% CI：1.10~2.16）;住在郊区（比城市居民,OR=2.36,95% CI：1.77~3.16）;家庭有1名儿童（比没有儿童的家庭,OR=1.76,95% CI：1.42~2.17）或≥ 2名儿童（比没有儿童的家庭,OR=2.15,95% CI：1.43~3.22）。购买活禽的危险因素包括农民（比在职人员,OR=1.61,95% CI：1.27~2.02）;非北京出生（比北京出生者,OR=1.76,95% CI：1.31~2.35）;住在郊区（比住在城区,OR=2.05,95% CI：1.61~2.61）;家庭有1名儿童（比没有儿童的家庭,OR=1.24,95% CI：1.02~1.52）或≥ 2名儿童（比没有儿童的家庭,OR=1.78,95% CI：1.21~2.63）。结论 北京市居民仍然存在活禽暴露的情况,应针对不同对象特征采取措施减少活禽暴露。     

四川省HIV感染孕产妇所生围产儿死亡现状与影响因素研究

目的 了解HIV感染孕产妇所生围产儿死亡情况，探讨影响围产儿死亡的因素，为降低四川省HIV感染孕产妇所生围产儿死亡水平和减少艾滋病母婴传播提供参考依据。方法 在四川省2005－2016年开展预防艾滋病母婴传播的183个县（市、区）医疗保健机构，选取HIV感染孕产妇4 734例及其所生围产儿4 786例作为研究对象。收集其母亲孕产期及围产儿相关流行病学调查资料，采用单因素χ²检验和多因素logistic回归，分析围产儿死亡情况及其影响因素。结果 HIV感染孕产妇所生围产儿死亡率为25.7‰（123/4 786），呈逐年下降趋势（趋势χ²=32.220，P=0.000），凉山州围产儿死亡率高于四川省其他地区（χ²=4.130，P=0.042），凉山州死胎/死产较多、四川省其他地区7 d内死亡较多（χ²=29.626，P=0.000）。多因素logistic回归分析结果显示，母亲怀孕1~2次及3~4次的围产儿死亡率低于怀孕≥5次者（1~2次的OR=0.417，95% CI：0.184~0.943；3~4次的OR=0.447，95% CI：0.223~0.895），孕产期使用基于以洛匹那韦/利托那韦（克力芝，LPV/r）为主的蛋白酶抑制剂（PI）三联抗病毒治疗方案的HIV感染孕产妇所生围产儿更容易避免死亡（OR=0.530，95% CI：0.285~0.986），医疗机构分娩的围产儿死亡率低于家中或途中分娩者（市级及以上助产机构OR=0.222，95% CI：0.098~0.499；县级助产机构OR=0.282，95% CI：0.166~0.480；乡级助产机构OR=0.134，95% CI：0.031~0.586），早产、新生儿窒息导致围产儿死亡的危险性增加（早产OR=8.285，95% CI：5.073~13.533；新生儿窒息OR=9.624，95% CI：4.625~20.028）。结论 四川省HIV感染孕产妇所生围产儿死亡率远高于全国、四川省孕产妇所生围产儿死亡率，应减少HIV感染孕产妇的孕次、采用基于LPV/r的三联抗病毒治疗方案，提倡住院分娩，减少围产儿发生早产和新生儿窒息。     

河南省2002-2013年HIV母婴阻断效果分析

目的 了解河南省2002-2013年感染HIV孕产妇分娩婴儿的母婴传播情况,分析其影响因素。方法 采取随访研究的方法,分别在婴儿满1、3、6、9、12、18月龄时进行随访,收集2002-2013年度孕产妇检测及感染HIV孕产妇所分娩婴儿的有关干预信息,包括一般人口学特征、妊娠分娩、抗病毒药物应用、婴儿存活及18月龄HIV检测等情况,采用logistic回归对影响HIV母婴传播的有关因素进行分析。结果 2002年1月1日至2013年12月31日,共对8 621 554名孕产妇进行了HIV抗体检测,发现阳性孕产妇共2 264人,检测阳性率0.03%,孕产妇HIV检测阳性率呈现逐年递减趋势（χ²=4.871,P=0.027）。所分娩的1 530名婴儿中,有1 384人存活且满18月龄,已死亡婴儿92人,失访54人。已经检测的满18月龄的1 384名婴儿中阳性60人,阴性1 324人,存活婴儿累计母婴传播率4.34%,校正累计母婴传播率6.33%。产妇孕早期接受预防艾滋病母婴传播服务（OR=0.26,95% CI：0.09～0.77）,产妇及婴儿进行抗病毒药物阻断（OR=0.42,95% CI：0.21～0.82）,婴儿采取人工喂养（OR=0.06,95% CI：0.02～0.21）是预防艾滋病母婴传播的保护因素,产妇分娩过程采取侧切操作（OR=3.91,95% CI：1.74～8.80）是其危险因素。结论 河南省孕产妇HIV检测阳性率保持在较低水平,并呈现逐年递减趋势,HIV的母婴传播率较高,应进一步加强并完善预防艾滋病母婴传播的综合干预措施。     

天津市男男性行为人群随访干预的效果评价

目的 评价天津市MSM人群随访干预效果,为后续研究的开展提供参考依据。方法 2013年4月至2017年9月,在天津市通过MSM活动场所和移动互联网招募MSM,建立前瞻性开放队列,并每6个月施加随访干预,评价随访干预效果。结果 基线共招募MSM 1 822人,符合纳入标准1 007人,累积随访干预时间为2 216.96人年,HIV共阳转39例,HIV阳转密度为1.76/100人年。梅毒阴性934人,累计随访观察时间为1 959.94人年,梅毒阳转100例,梅毒阳转密度为5.10/100人年。艾滋病知识知晓率随着宣传和干预活动很快发生改善;与同性性伴、同性固定性伴、同性临时性伴发生肛交的比例在干预后增加,但肛交安全套的使用率也有所增加;随访干预超过3次后安全套使用率有所下降。广义估计方程（GEE）分析结果显示,大专及以上文化程度（aOR=0.81,95% CI：0.68～0.98）,艾滋病知识知晓（aOR=0.52,95% CI：0.36～0.75）,最近6个月曾接受过安全套宣传（aOR=0.60,95% CI：0.49～0.74）,样本来源为移动互联网（aOR=0.85,95% CI：0.73～1.00）,累计干预1次（aOR=0.55,95% CI：0.45～0.66）、2次（aOR=0.38,95% CI：0.30～0.49）、3次（aOR=0.26,95% CI：0.20～0.35）、≥4次（aOR=0.24,95% CI：0.17～0.33）是无保护肛交的保护因素;最近6个月曾被诊断为性病（aOR=1.43,95% CI：1.06～1.96）,最近6个月使用过助性剂（aOR=1.22,95% CI：1.02～1.47）是无保护肛交的危险因素。结论 经过随访干预后,天津市MSM队列HIV和梅毒感染处于低水平;艾滋病知识知晓率发生改善,肛交安全套使用率有所提升;但MSM人群发生无保护肛交的影响因素很多,建议专门开展MSM人群无保护肛交的持续干预。     

山东省2015年艾滋病防治策略“三个90%”目标进展状况分析

目的 分析山东省2015年艾滋病防治策略"三个90%"（即90%诊断、90%治疗及90%有效）"目标的进展情况及相关影响因素。方法 收集山东省现存活HIV感染者/AIDS患者（HIV/AIDS）检测发现、接受高效抗反转录病毒治疗（HAART）服务的相关信息,分析进展情况。采用χ²检验进行单因素分析,多因素logistic回归模型进行多因素分析。结果 2015年12月31日,山东省估计现存活HIV/AIDS有11 700例,检测发现率61.2%,HAART率74.4%,病毒载量（VL）抑制率81.8%。经同性传播的HIV/AIDS检测发现比例较低（P<0.05）。青岛市（OR=1.30,95% CI：1.05~1.60）、烟台市（OR=1.53,95% CI：1.02~2.31）和威海市（OR=1.96,95% CI：1.07~3.58）的HIV/AIDS接受HAART的比例较高;同性传播（OR=0.12,95% CI：0.06~0.24）、异性传播（OR=0.13,95% CI：0.07~0.26）、注射吸毒传播（OR=0.08,95% CI：0.03~0.17）,羁押场所检测发现（OR=0.29,95% CI：0.21~0.41）的HIV/AIDS接受HAART比例较低;医疗机构接受HAART服务的HIV/AIDS（OR=1.81,95% CI：1.05~3.47）的VL抑制比例较高;同性传播（OR=0.43,95% CI：0.25~0.75）、异性传播（OR=0.49,95% CI：0.28~0.81）,羁押场所检测发现（OR=0.48,95% CI：0.28~0.80）的HIV/AIDS的VL抑制比例较低。结论 山东省2015年现存活HIV/AIDS的检测发现率、HAART率和VL抑制率与2020年实现的艾滋病防治策略"三个90%"目标仍有一定差距,尤其是检测发现目标。需加强检测和艾滋病综合关怀服务。     

江西省农村地区HIV感染者接受基层医疗卫生机构随访管理现状及相关因素分析

目的 了解江西省农村地区现存活的HIV感染者接受基层医疗卫生机构随访管理（随访下沉）现状及相关因素,为推动艾滋病随访下沉工作提供参考。方法 研究现场为江西省新建县、玉山县和贵溪市（目前仅在辖区内6个乡镇开展随访下沉工作）。调查对象纳入标准为截至2017年12月31日检测发现并确证为HIV感染者,年龄≥ 18岁,首次流调后随访管理≥ 1次,现存活。收集调查对象人口学信息、HIV感染情况等信息。采用logistic回归分析HIV感染者随访下沉的相关因素。结果 共调查373例HIV感染者,年龄（53.06±16.15）岁;男性占70.0%（261/373）;文盲及小学占54.7%（204/373）。HIV感染者的随访下沉率为55.8%（208/373）,异性性传播的HIV感染者随访下沉率为58.5%（190/325）。多因素logistic回归分析结果显示,务农者比非务农者（OR=7.36,95% CI：2.52~21.45）、家人支持随访下沉者比家人不支持者或无家人者（OR=16.01,95% CI：2.25~49.73）、不担心随访下沉遭受歧视者比担心者（OR=12.97,95% CI：4.75~35.42）、信任基层随访人员者比不信任者（OR=5.07,95% CI：2.19~11.76）、有艾滋病临床症状者比无症状者（OR=10.58,95% CI：2.25~49.73）,更容易接受随访下沉。结论 江西省农村地区现存活的HIV感染者随访下沉率较高。在这些地区开展随访下沉工作是一种切实可行的管理模式。是否务农、家人是否支持随访下沉、是否担心随访下沉遭受歧视、是否信任基层随访人员、是否有艾滋病临床症状是影响HIV感染者随访下沉的相关因素。     

男男性行为人群HIV暴露后预防服务的使用意愿调查

目的 分析MSM对HIV暴露后预防（PEP）服务的使用意愿及其相关因素。方法 采用横断面调查方法,2019年9-11月通过“i卫士”微信公众号招募年龄≥18岁、最近6个月发生同性肛交或口交的男性为研究对象。结果 研究对象MSM共1 517人,听说过PEP服务的研究对象占72.5%（1 100/1 517）,PEP服务的使用意愿为87.9%（1 333/1 517）。多因素logistic分析结果显示,更愿意使用PEP服务的因素包括年龄>25岁（OR=1.807,95%CI：1.090~2.995）、曾经做过HIV检测（OR=1.953,95%CI：1.171~3.256）、至少了解1条PEP知识（OR=2.163,95%CI：1.468~3.186）;不了解性伴HIV感染状况者（OR=0.602,95%CI：0.407~0.890）的PEP服务的使用意愿较低。在听说过PEP服务的MSM中,更愿意使用PEP服务的因素包括居住地为浙江省（OR=1.942,95%CI：1.097~3.438）、年龄>25岁（OR=2.431,95%CI：1.331~4.439）、至少了解1条PEP知识（OR=3.714,95%CI：1.532~9.007）、通过MSM社区组织/志愿者/卫生专业机构了解PEP服务（OR=1.902,95%CI：1.096~3.301）。结论 MSM对PEP服务的使用意愿较高,年龄、PEP知识、是否了解性伴HIV感染状况是其相关因素。MSM社区组织、志愿者及卫生专业机构是开展PEP服务宣传和推广的重要途径。     

杭州市2015-2017年非婚非商业的异性性传播新报告艾滋病病毒感染者特征分析

目的 了解2015-2017年杭州市经非婚非商业异性性传播的新报告HIV感染者特征及其相关因素。方法 利用我国艾滋病综合防治基本信息系统,研究对象为2015年1月1日至2017年12月31日新报告HIV感染者,且现住址为杭州市、传播途径为非婚异性性传播。采用SPSS.20软件统计分析,比较不同特征的感染者经非婚异性性传播的比例,采用多因素logistic回归模型分析非婚非商业异性性传播感染HIV的相关因素。结果 新报告HIV感染者中的非婚异性性传播占38.03%（1 393/3 663）,其中,非商业性传播占非婚异性性传播的50.83%（708/1 393）,商业性传播占非婚异性性传播的49.17%（685/1 393）。男女性别比为3.51：1（1 084/309）。男性以非婚商业性传播为主（61.81%,670/1 084）,女性以非婚非商业性传播为主（95.1%,294/309）。多因素分析结果显示,非婚非商业异性传播的相关影响因素包括女性（aOR=48.25,95% CI：26.94~88.44）、年龄<30岁组（aOR=2.43,95% CI：1.31~4.51）、30~岁组（aOR=1.92,95% CI：1.11~3.33）、40~岁组（aOR=1.80,95% CI：1.08~3.00）、已婚和未婚（与离异或丧偶相比,aOR=1.57,95% CI：1.10~2.24;aOR=1.78,95% CI：1.15~2.78）、高中及以上文化程度（与小学及以下相比,aOR=1.82,95% CI：1.18~2.80）、职业为干部/职员（与农民相比,aOR=2.03,95% CI：1.04~1.91）、非婚性伴数<5个（与非婚性伴数≥ 5个相比,aOR=10.65,95% CI：6.41~17.42）。结论 2015-2017年杭州市非婚异性性传播HIV感染者比例高,不同性别、年龄、婚姻状况、文化程度和职业的HIV感染者在非婚非商业异性性传播的风险上存在差异,应采取针对性的防治措施。     

北京市2017－2019年经报告机构转介的HIV/AIDS抗病毒治疗情况及影响因素分析

目的 了解2017-2019年北京市经报告机构转介的HIV/AIDS抗病毒治疗（ART）情况,并探讨其影响因素。方法 利用我国艾滋病防治基本信息系统中2017-2019年北京市4 917例HIV/AIDS报告卡数据及ART机构数据,无ART记录者记为ART转介失败,确证报告至启动ART的日期间隔>15 d记为ART延迟,分析ART情况及其影响因素。结果 4 917例HIV/AIDS中,16.53%（813/4 917）未成功接受ART;接受ART的4 104例HIV/AIDS中,30.63%（1 257/4 104）发生ART延迟,启动时间中位数为27（P₂₅~P₇₅：19~42）d。多因素logistic回归分析显示,由综合性医院报告（相比于ART机构,OR=1.65,95% CI：1.30~2.08）、病程阶段为HIV（相比于AIDS,OR=1.68,95% CI：1.34~2.11）、初中及以下文化程度（相比于大专及以上,OR=1.42,95% CI：1.13~1.79）、无业（相比于干部职员,OR=1.32,95% CI：1.02~1.70）、异性性传播（相比于同性性传播,OR=1.40,95% CI：1.15~1.72）、来源于专题调查和无偿献血（相比于检测咨询,OR=1.87,95% CI：1.34~2.60;OR=3.52,95% CI：1.79~6.92）者ART转介失败比例较高;由CDC（相比于ART机构,OR=1.43,95% CI：1.07~1.92）或综合性医院报告（相比于ART机构,OR=1.62,95% CI：1.32~1.98）、报告机构在郊区（相比于城区,OR=1.24,95% CI：1.01~1.52）、病程阶段为HIV（相比于AIDS,OR=1.42,95% CI：1.19~1.70）、外省户籍（相比于北京市户籍,OR=1.26,95% CI：1.07~1.48）、来源于无偿献血（相比于性病门诊,OR=2.74,95% CI：1.21~6.22）者延迟比例较高。结论 不同特征HIV/AIDS的ART转介失败及延迟比例不同,需采取有效措施进一步推进ART工作,减少ART转介失败及延迟。     

抗病毒治疗HIV感染者神经认知损伤与认知表现特征研究

目的 联合应用两种神经认知评价量表,探讨接受抗病毒治疗（ART）的HIV感染者神经认知损伤患病率、影响因素及其神经认知表现特征。方法 纳入浙江省台州市开展的HIV与衰老相关疾病前瞻性队列研究中2 250例接受ART的HIV感染者。使用中国版简易智能精神状态检查量表（MMSE）和国际HIV相关性痴呆量表（IHDS）评价其神经认知损伤情况,并对2个量表中的7个神经认知域进行聚类分析。结果 在接受ART的HIV感染者2 250例中,年龄集中在45~89岁（48.0%,1 080/2 250）,男性占79.2%（1 782/2 250）,小学及以下文化程度者占37.8%（852/2 250）。MMSE和IHDS判断的神经认知损伤的患病率分别为14.3%（321/2 250）和31.8%（716/2 250）。多因素logistic回归分析结果显示,HIV感染者MMSE判断的神经认知损伤危险因素包括60~89岁（aOR=2.63,95%CI：1.52~4.56）、抑郁症状（aOR=5.58,95%CI：4.20~7.40）和使用依非韦伦（EFV）治疗（aOR=2.86,95%CI：1.89~4.34）;男性（aOR=0.71,95%CI：0.51~1.00）、偏胖（aOR=0.63,95%CI：0.44~0.89）和文化程度较高（aOR=0.11,95%CI：0.05~0.25）为保护因素。IHDS判断的神经认知损伤危险因素包括60~89岁（aOR=3.10,95%CI：2.09~4.59）、抑郁症状（aOR=1.78,95%CI：1.44~2.20）和使用EFV治疗（aOR=1.79,95%CI：1.41~2.29）;男性（aOR=0.75,95%CI：0.58~0.97）、偏瘦（aOR=0.67,95%CI：0.47~0.96）、基线CD4⁺T淋巴细胞（CD4）计数≥350个/μl（aOR=0.69,95%CI：0.53~0.91）和文化程度较高（aOR=0.23,95%CI：0.14~0.39）是保护因素。HIV感染者的神经认知表现分为4种主要类型,在年龄、性别、文化程度、饮酒、抑郁症状、腰臀比、高血压病史、糖尿病病史、基线CD4计数和使用EFV治疗的差异有统计学意义（均P < 0.05）。结论 接受ART的HIV感染者神经认知表现分为4种类型,神经认知损伤患病率较高,需对不同类型者采取针对性的监测、预防与控制措施。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.