孕期环境空气污染物暴露和先天性心脏病关系的Meta分析

目的 探讨孕期空气污染物暴露与先天性心脏病（先心病）发生的关系,为先心病的一级预防提供循证医学证据。方法 收集国内外发表的有关孕期空气污染物暴露与先心病有关的流行病学研究文章,对连续性增长和高浓度对比低浓度的污染物与先心病亚型的关系效应值分别进行合并。使用Stata 12.0软件对文献进行Meta分析。结果 共纳入20篇英文文献。Meta分析结果显示,CO暴露增加法洛四联症的发生风险（高浓度对比低浓度OR=1.22,95%CI：1.03~1.44））;NO₂暴露增加主动脉缩窄的发生风险（浓度每升高10 mm³/m³ OR=1.01,95%CI：1.01~1.20）;O₃暴露增加房间隔缺损的发生风险（浓度每升高10 mm³/m³ OR=1.14,95%CI：1.03~1.26）;PM₁₀暴露增加房间隔缺损的发生风险（浓度每升高10 μg/m³ OR=1.10,95%CI：1.03~1.19）。此外,还发现CO暴露和房间隔缺损的发生,PM₁₀暴露和室间隔缺损的发生存在负相关。结论 孕期暴露于空气污染物CO、O₃、NO₂、PM₁₀可能会增加先心病的发生风险。     

孕期室外空气污染与早产关系的Meta分析

目的 探讨孕期室外空气污染与早产的关系,为减少早产的发生提供循证医学证据。方法 收集国内外已发表的有关孕期空气污染与早产关系的病例对照研究,采用Stata 12.0软件进行Meta分析。结果 共纳入10篇文献,包括病例48556例,对照548495例。Meta分析显示,整个孕期二氧化氮(NO₂)、PM₁₀、一氧化碳(CO)、PM_2.5、氮氧化物(NO)暴露与早产的合并效应OR值分别为0.960(95%CI:0.935~0.985)、1.068(95%CI:1.035~1.103)、1.122(95%CI:1.078~1.168)、1.110(95%CI:1.043~1.181)、0.994(95%CI:0.973~1.016)。空气污染物NO₂、PM₁₀、二氧化硫(SO₂)暴露时期不同对早产的影响不同,在孕早期暴露其合并效应OR值分别为1.117(95%CI:1.052~1.186)、0.968(95%CI:0.812~1.153)、1.258(95%CI:0.758~2.089);孕中期暴露其合并效应OR值分别为1.000(95%CI:0.982~1.019)、1.127(95%CI:0.896~1.416)、0.977(95%CI:0.711~1.342);孕晚期暴露其合并效应OR值分别为1.006(95%CI:1.002~1.010)、1.053(95%CI:0.973~1.139)、1.003(95%CI:1.000~1.006)。结论 整个孕期暴露于PM₁₀、CO和PM_2.5,孕早期暴露于NO₂,孕晚期暴露于NO₂和SO₂可能与早产的发生有关。     

孕前体质指数和孕期增重与子痫前期及其临床亚型的关系

目的 探讨孕前BMI和孕期增重与子痫前期（PE）及其临床亚型的发生风险的关系。方法 选取2012年3月至2016年9月在山西医科大学第一医院妇产科分娩的孕妇,根据纳入排除标准,共纳入9 274例孕妇,901例PE孕妇作为病例组,8 373例非PE孕妇作为对照组。收集一般人口学特征、孕前身高和体重、孕期生活方式、生育史和疾病史等资料,计算孕前BMI及孕期增重。采用非条件logistic回归分析孕前BMI和孕期增重与PE及其临床亚型的关系。结果 PE中早发型PE （EOPE）401例、晚发型PE （LOPE）500例,轻度PE （MPE）178例、重度PE （SPE）723例。PE孕妇和非PE孕妇在年龄、居住地、产次、妊娠期糖尿病及高血压家族史等方面差异有统计学意义（P<0.05）。调整以上因素后,logistic回归分析结果显示,孕前BMI<18.5 kg/m²和孕期增重不足是PE的保护因素（OR=0.74,95%CI：0.56~0.98;OR=0.78,95%CI：0.62~0.99）,孕前BMI ≥ 24.0 kg/m²和孕期增重过多是PE的危险因素（OR=1.82,95%CI：1.54~2.14;OR=1.82,95%CI：1.54~2.15）。对PE临床亚型分析后结果显示,孕前BMI<18.5 kg/m²是EOPE和MPE的保护因素（OR=0.52,95%CI：0.32~0.83;OR=0.47,95%CI：0.23~0.97）,孕前BMI ≥ 24.0 kg/m²和孕期增重过多是PE临床亚型的危险因素。按孕前BMI分层后,孕前18.5 kg/m² ≤ BMI<24.0 kg/m²和孕前BMI ≥ 24.0 kg/m²的孕妇中孕期增重过多（OR=1.86,95%CI：1.51~2.30;OR=1.90,95%CI：1.39~2.60）均是PE的危险因素;孕前BMI ≥ 24.0 kg/m²的孕妇中孕期增重不足（OR=0.55,95%CI：0.34~0.89）是PE的保护因素。孕前BMI<18.5 kg/m²的孕妇中孕期增重过多（OR=4.05,95%CI：1.20~13.69）是EOPE的危险因素;孕前18.5 kg/m² ≤ BMI<24.0 kg/m²的孕妇中孕期增重过多是PE各临床亚型的危险因素;孕前BMI ≥ 24.0 kg/m²的孕妇中孕期增重不足是EOPE和MPE的保护因素（OR=0.39,95%CI：0.19~0.80;OR=0.29,95%CI：0.11~0.77）,孕期增重过多是EOPE、LOPE和SPE的危险因素（OR=1.60,95%CI：1.06~2.42;OR=2.20,95%CI：1.44~3.37;OR=2.28,95%CI：1.58~3.29）。结论 孕前BMI和孕期增重影响PE及其临床亚型的发生风险,且不同孕前BMI人群孕期增重对PE的影响有差异,提倡同时关注孕前BMI和孕期体重变化,从而减少PE发生。     

陕西省妇女既往生育史与末次妊娠早产的相关分析

目的 探讨陕西省单胎活产新生儿早产发生率及母亲既往生育史与其的相关性。方法 采用分层多阶段随机抽样方法,以问卷调查方式收集2010-2013年陕西省怀孕且其结局明确的育龄妇女生育史等相关信息。结果 共调查29 608名育龄妇女及其子女,活产单胎新生儿早产发生率为2.7%。logistic回归分析显示,早产史（OR=7.99,95%CI：5.59~11.43）、末次妊娠年龄≥35岁（OR=2.03,95%CI：1.59~2.59）、出生缺陷史（OR=1.54,95%CI：1.01~2.34）是发生早产的危险因素。妊娠间隔3~4年（与妊娠间隔≤2年者比,OR=0.74,95%CI：0.58~0.93）、妊娠间隔5~6年（与妊娠间隔≤2年者比,OR=0.66,95%CI：0.52~0.82）、妊娠间隔>6年（与妊娠间隔≤2年者比,OR=0.48,95%CI：0.37~0.61）、生产次数1次（与初产者比,OR=0.80,95%CI：0.67~0.95）、生产次数≥2次（与初产者比,OR=0.62,95%CI：0.39~0.97）是早产的保护因素。有序多分类logistic回归分析显示,影响孕周长短的主要因素是早产史、高龄妊娠（≥35岁）及妊娠间隔时间。结论 2010-2013年陕西省单胎活产新生儿早产发生率低于全国平均水平。有早产史、高龄妊娠（≥35岁）、出生缺陷史可能增加早产发生风险;妊娠间隔长、分娩次数多可能降低早产发生风险。     

基于西安城市自然人群的甘油三酯葡萄糖乘积指数与系统免疫炎症指数的关联研究

目的 探索甘油三酯葡萄糖乘积指数（TyG）与机体炎症之间的关系。方法 数据来自2018-2019年建立的中国西北区域自然人群队列中西安城市人群队列基线调查，根据TG和FPG构建反映机体胰岛素抵抗（IR）的TyG及TyG-BMI，以中性粒细胞、淋巴细胞、血小板计数构建反映机体炎症的系统免疫炎症指数（SII），采用logistic回归模型探索TyG与SII之间的关系。结果 共有11 491名研究对象纳入分析，调整协变量后，TyG每增加1个单位，高SII的风险增加21%（OR=1.21，95%CI：1.12~1.30），TyG处于Q₄组人群高SII的风险是Q₁组的1.34倍（OR=1.34，95%CI：1.18~1.52）。敏感性分析和亚组分析进一步证实TyG与SII关联稳定。在BMI位于18.5~23.9 kg/m²的人群中，TyG作为连续变量时每增加1个单位，高SII的风险增加31%（OR=1.31，95%CI：1.18~1.45），作为分类变量时Q₄组高SII的风险是Q₁组的1.52倍（OR=1.52，95%CI：1.27~1.83）；在BMI位于24.0~27.9 kg/m²的人群中，TyG作为连续变量时每增加1个单位，高SII的风险增加20%（OR=1.20，95%CI：1.07~1.35），作为分类变量时无统计学关联。结论 IR水平升高与机体炎症的发展密切相关，BMI可能调节了两者之间的关系。在超重或肥胖前早期预防IR水平升高对于机体炎症的控制可能具有积极作用。     

PM2.5短期暴露对我国死亡和急诊量影响的Meta分析

目的 利用Meta分析定量评价空气中粒径≤ 2.5 μm的颗粒物（PM_2.5）短期暴露与我国居民全因死亡和急诊之间的关系。方法 于2018年3月系统检索中国知网、万方数据知识服务平台、PubMed和EMBASE收集相关文献,提取相对危险度（RR）、超额危险度（ER）及其95% CI,根据异质性检验结果,采用固定或随机效应模型对数据进行合并,并对其进行亚组分析、Meta回归和检验发表偏倚。结果 共纳入33篇原始文献,分别利用39组死亡数据和4组急诊量数据进行Meta分析,结果显示,在47.7~176.7 μg/m³的浓度范围内,PM_2.5每上升10 μg/m³,居民每日全因死亡增加0.49%（95% CI：0.39%~0.59%）,全因急诊量增加0.30%（95% CI：0.10%~0.51%）。对死亡数据的亚组分析显示北方地区（ER=0.42%,95% CI：0.30%~0.54%）合并效应值低于南方地区（ER=0.63%,95% CI：0.44%~0.82%）,研究期间PM_2.5浓度<75 μg/m³地区的合并效应值（ER=0.50%,95% CI：0.37%~0.62%）高于PM_2.5浓度≥ 75 μg/m³的地区（ER=0.39%,95% CI：0.26%~0.52%）。结论 在47.7~176.7 μg/m³的浓度范围内,PM_2.5短期暴露可能与全因死亡和急诊量增加有关。     

1991-2015年中国9省份18~64岁男性吸烟状况与肥胖风险的关系

目的 分析1991-2015年中国9省份18~64岁成年男性居民吸烟状况与肥胖患病风险的关系。方法 利用"中国健康与营养调查"1991-2015年9轮调查资料，选取参加两轮及以上、有完整人口统计学特征、吸烟状况和体格测量数据的18~64岁成年男性居民作为研究对象，共计32 169名。依据研究对象是否吸烟以及吸烟者每日吸烟数量将研究对象分为不吸烟、轻度吸烟（1~14支/d）、中度吸烟（15~24支/d）和重度吸烟（≥ 25支/d）组。观察不同吸烟程度下研究对象的BMI、腰围、全身性肥胖和中心性肥胖的分布情况，利用两水平混合效应线性回归模型和logistic回归模型分析男性吸烟状况与肥胖患病风险的关系。结果 不同吸烟程度下调查对象的BMI、腰围、全身性肥胖和中心性肥胖的患病率呈现逐年上升的趋势。在校正混杂因素后，轻、中和重度吸烟者BMI分别比不吸烟人群减少了0.19 kg/m²（95%CI：-0.27~-0.10）、0.40 kg/m²（95%CI：-0.49~-0.31）和0.36 kg/m²（95%CI：-0.53~-0.19）；腰围分别减少了0.49 cm （95%CI：-0.76~-0.21）、0.80 cm （95%CI：-1.08~-0.51）和0.79 cm （95%CI：-1.38~-0.36）。男性轻、中和重度吸烟者患全身性肥胖的风险分别是不吸烟者的0.70倍（OR=0.70，95%CI：0.62~0.79）、0.61倍（OR=0.61，95%CI：0.55~0.69）和0.78倍（OR=0.78，95%CI：0.65~0.96）；患中心性肥胖的风险分别是不吸烟者的0.78倍（OR=0.78，95%CI：0.73~0.84）、0.74倍（OR=0.74，95%CI：0.70~0.79）和0.84倍（OR=0.84，95%CI：0.76~0.95）。结论 1991-2015年间，男性不吸烟与吸烟（轻、中和重度）居民的BMI、腰围和肥胖患病率均呈现显著上升趋势。成年男性居民吸烟与肥胖患病风险呈显著性负向关联。     

妊娠期并发贫血影响因素的巢式病例对照研究

目的 探讨妊娠期并发贫血的影响因素。方法 将2013年6月至2014年11月在湖南省浏阳市医疗机构接受首次孕期保健,且经体检排除"贫血"的孕妇（怀孕≤ 12周）纳入孕妇人群队列,对观察对象进行基线调查,并随访至孕妇分娩。采用前瞻性巢式病例对照研究,将本次随访期间新发生贫血的380例孕妇作为病例组,按照1：2频数匹配,随机抽取年龄、孕期、常住地基本相同的760例正常孕产妇作为对照组,采用t检验、χ²检验和条件logistic回归分析方法,分析妊娠期并发贫血的影响因素。结果 多因素logistic回归模型分析结果表明,家庭人均年收入低（OR=2.08,95%CI：1.22~3.59）、文化程度低（OR=2.09,95%CI：1.22~3.59）、孕前烫发/染发（OR=2.23,95%CI：1.63~3.05）、早孕呕吐反应（OR=2.51,95%CI：1.56~4.03）是妊娠期并发贫血的危险因素;摄入维生素、微量元素补充剂（OR=0.69,95%CI：0.50~0.94）,肉、鱼、虾、蛋类摄入频率高（OR=0.68,95%CI：0.49~0.92）,豆奶、牛奶摄入频率高（OR=0.51,95%CI：0.27~0.95）是妊娠期并发贫血的保护因素。结论 妊娠期并发贫血与孕妇家庭经济、文化程度、有毒有害物质接触、早孕呕吐反应、营养物质的摄入等因素有关,应加强对孕妇妊娠期发生贫血影响因素的控制。     

吉林省居民中心性肥胖及其前期流行特征的影响因素分析

目的 了解吉林省居民中心性肥胖及其前期的流行特征的影响因素,为制定相关预防与控制策略及措施提供参考依据。方法 本研究以2017-2018年吉林省心血管病高危人群早期筛查与综合干预项目为基础,纳入吉林省6个项目点35~75岁常住居民11 903人为研究对象,进行体格检查、实验室检测和问卷调查。采用χ²检验、趋势χ²检验、F检验计算不同特征人群和健康指标的中心性肥胖及其前期情况,其影响因素采用多因素logistic回归模型分析。结果 吉林省居民中心性肥胖率为33.35%（3 970/11 903）,标化率为31.73%,中心性肥胖前期率为28.79%（3 427/11 903）,标化率为28.86%。多因素分析结果显示,农村居民（OR=1.99,95%CI：1.78~2.23）、女性（OR=1.76,95%CI：1.57~1.97）、65~75岁组（OR=1.21,95%CI：1.03~1.45）、高中/中专文化程度（OR=1.38,95%CI：1.17~1.63）、家庭年收入>10万元（OR=1.65,95%CI：1.20~2.26）、超重（OR=9.27,95%CI：8.26~10.41）、肥胖（OR=82.82,95%CI：62.63~109.52）、正常高值血压（OR=1.49,95%CI：1.27~1.74）、高血压（OR=1.70,95%CI：1.42~2.04）、糖尿病（OR=2.30,95%CI：1.94~2.73）、血脂异常（OR=1.33,95%CI：1.18~1.50）与中心性肥胖及其前期发生风险呈正相关。结论 吉林省居民中心性肥胖及其前期率均处于较高水平,农村居民、女性、年龄大、高中/中专文化程度、高收入、超重、肥胖、正常高值血压、高血压、糖尿病、血脂异常是吉林省居民中心性肥胖及其前期的危险因素。     

抗病毒治疗HIV感染者血脂变化轨迹特征及影响因素分析

目的 分析抗病毒治疗HIV感染者血脂变化轨迹特征及其影响因素。方法 基于回顾性队列研究设计,以浙江省台州市2004年1月至2021年4月抗病毒治疗HIV感染者为研究对象,运用χ²检验分析研究对象社会人口学特征和基线指标情况,应用潜在类别混合模型描述研究对象接受抗病毒治疗后血脂变化轨迹,采用多因素logistic回归分析血脂变化轨迹的影响因素。采用R 3.5.0.软件LCMM软件包进行统计学分析。结果 2 079例HIV感染者中,年龄M（Q₁,Q₃）为31（43,55）岁,以男性（78.1%,1 623/2 079）和已婚（58.7%,1 221/2 079）为主,BMI≥24.0 kg/m²占18.9%（393/2 079）,异性性传播途径占67.7%（1 407/2 079）。血脂变化轨迹分为3种：倒U形（2.3%,48/2 079）、进展型（31.3%,650/2 079）和一般轨迹（U形）（66.4%,1 381/2 079）,倒U形和进展型确定为危险轨迹（33.6%）。多因素logistic回归分析结果显示,相比于抗病毒治疗方案为齐多夫定-替诺福韦-依非韦伦（3TC- TDF-EFV）、基线TC水平<5.2 mmol/L、基线TG水平<1.7 mmol/L、BMI为18.5~23.9 kg/m²、基线CD4⁺T淋巴细胞（CD4）计数<200个/μl和抗病毒治疗时间<5年者,抗病毒治疗方案一直使用齐多夫定-拉米夫定-依非韦伦（3TC-AZT-EFV）（aOR=1.99,95%CI：1.44~2.77）和更换为克力芝（LPV/r）（aOR=3.17,95%CI：2.00~5.01）、基线TC水平分别为5.2~6.1 mmol/L（aOR=2.55,95%CI：1.92~3.39）和≥6.2 mmol/L（aOR=5.89,95%CI：3.76~9.25）、基线TG水平分别为1.7~2.2 mmol/L（aOR=2.00,95%CI：1.53~2.62）和≥2.3 mmol/L（aOR=6.51,95%CI：4.97~8.54）、BMI为≥24.0 kg/m²（aOR=1.44,95%CI：1.11~1.88）的HIV感染者较容易出现血脂变化的危险轨迹。而BMI为<18.5 kg/m²（aOR=0.55,95%CI：0.35~0.86）、基线CD4计数为200~349个/μl（aOR=0.67,95%CI：0.52~0.87）和≥350个/μl（aOR=0.71,95%CI：0.54~0.94）、抗病毒治疗时长为5~9年（aOR=0.74,95%CI：0.56~0.99）和≥10年（aOR=0.53,95%CI：0.22~0.67）的HIV感染者较不容易出现血脂变化的危险轨迹。结论 部分HIV感染者抗病毒治疗后的血脂变化呈危险轨迹状态,与AZT和LPV/r等特定抗病毒药物使用、抗病毒治疗时长、基线CD4计数、TC、TG和BMI显著关联,建议HIV感染者开始抗病毒治疗阶段的同时,加强血脂监测并采取针对性干预措施。     

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.