山东省抗病毒治疗HIV/AIDS生存状况及影响因素分析

目的 了解山东省抗病毒治疗HIV/AIDS的生存状况及影响因素。方法 运用Kaplan-Meier（K-M）法及累积发生函数（CIF）估算2003-2015年山东省抗病毒治疗HIV/AIDS的艾滋病相关死亡发生率、部分分布比例风险回归模型（F-G模型）分析生存状况及影响因素。结果 竞争风险存在时,K-M法计算艾滋病相关死亡累积发生率高于CIF。CIF估算5 593例治疗HIV/AIDS随访1、3、5、10年艾滋病相关死亡累积发生率分别为3.08%、4.21%、5.37%和7.59%。大专及以上文化程度（HR=0.40,95% CI：0.24~0.65）HIV/AIDS的艾滋病相关死亡发生危险较低,现住址在鲁西地区（HR=1.33,95% CI：1.01~1.89）、医疗机构检测发现（HR=1.39,95% CI：1.06~1.80）、治疗基线方案含NVP（HR=1.36,95% CI：1.03~1.88）、治疗基线临床症状Ⅲ/Ⅳ期（HR=2.61,95% CI：1.94~3.53）、诊断1年后接受随访（HR=2.02,95% CI：1.30~3.15）、诊断基线CD₄⁺T淋巴细胞计数（CD₄）≤ 200个/μl（HR=3.41,95% CI：2.59~4.59）、治疗基线CD₄ ≤ 350个/μl（HR=5.48,95% CI：2.32~12.72）的HIV/AIDS发生艾滋病相关死亡风险高。结论 竞争风险存在时,K-M法高估艾滋病相关死亡累积发生率,优选竞争风险模型进行生存分析;早诊断、及时随访、早治疗可降低HIV/AIDS艾滋病相关死亡。     

贵州省1995－2018年HIV/AIDS生存时间及其影响因素分析

目的 了解1995-2018年贵州省HIV/AIDS生存时间及影响因素。方法 采用回顾性队列研究的方法,从"艾滋病防治基本信息系统"中下载1995-2018年贵州省报告的所有现住址为贵州省的HIV/AIDS报告卡。进行统计分析,运用寿命表法计算生存率、Kaplan-Meier法计算生存时间、Cox比例风险模型分析HIV/AIDS生存时间的影响因素。结果 纳入研究对象HIV/AIDS 53 232例,死亡率为8.53/100人年(14 210/166 679.18);生存时间中位数为10.20(95%CI:9.91~10.48)年,第1、5、10、20年的累积生存概率分别为0.85、0.68、0.51、0.36、0.19;多因素Cox比例风险模型分析结果显示,男性(与女性相比,aHR=0.757,95%CI:0.727~0.788)、未接受过抗病毒治疗(与接受过抗病毒治疗相比,aHR=0.173,95%CI:0.165~0.181)、首次CD₄⁺T淋巴细胞(CD₄)<200个/μl(与首次CD₄ ≥ 200个/μl者相比,aHR=0.410,95%CI:0.387~0.435)、≥ 45岁 (与<45岁者相比,aHR=1.506,95%CI:1.193~1.901)、文盲(与高中及以上学历者相比,aHR=0.904,95%CI:0.832~0.982)、未婚(与离异或丧偶者相比, aHR=0.896,95%CI:0.848~0.946)、异性性传播(与同性性传播者相比,aHR=0.555,95%CI:0.487~0.632)、苗族等少数民族(与汉族相比,aHR=1.185,95%CI:1.114~1.262)、农民/民工(与家政/待业者相比, aHR=0.874,95%CI:0.834~0.916)均是影响病例生存时间的因素。结论 贵州省HIV/AIDS死亡率较高,近年来并未出现明显的下降趋势,男性、≥ 45岁、文化程度较低、少数民族、首次CD₄检测<200个/μl等是影响HIV/AIDS生存时间的因素。应该针对具有这些特征的病例加强治疗和随访管理,以提高其生存质量。     

甘肃省1997-2018年HIV/AIDS生存时间及影响因素分析

目的 了解1997-2018年甘肃省HIV/AIDS生存时间与影响因素。方法 利用国家艾滋病防治基本信息系统1997-2018年甘肃省疫情资料,采用回顾性队列研究方法,用寿命表法计算生存率,用Kaplan-Meier法绘制生存曲线并计算平均生存时间,用Cox比例风险回归模型分析HIV/AIDS的艾滋病相关死亡的影响因素。结果 6 813例HIV/AIDS中,715例（10.5%）死于艾滋病相关疾病,平均生存时间为195.9（95%CI：189.7~202.2）个月,12、60、120和180个月的累积生存率分别为91.5%、86.1%、79.9%和73.8%。Cox比例风险回归模型分析结果显示,在艾滋病相关死亡风险方面,诊断时的年龄≥ 51岁组是≤ 25岁组的1.906倍（95%CI：1.353~2.685）;其他传播途径病例是同性性传播病例的1.593倍（95%CI：1.226~2.069）;通过入院就诊、受血/血制品及术前检测发现的病例是通过出入境、婚/孕前检测及新兵体检发现病例的5.113倍（95%CI：2.083~12.547）;诊断时病程阶段为艾滋病的病例是HIV感染病例的4.012倍（95%CI：3.401~4.732）;未检测CD₄⁺T淋巴细胞（CD₄）的病例是首次CD₄值≥ 350个/μl病例的5.446倍（95%CI：3.835~7.732）;未接受抗病毒治疗的病例是已接受抗病毒治疗病例的12.019倍（95%CI：9.861~14.648）。结论 1997-2018年甘肃省HIV/AIDS平均生存时间超过16年。诊断时年龄≥ 51岁、通过入院就诊、受血/血制品及术前检测发现、诊断时病程阶段为艾滋病、未检测CD₄、未接受抗病毒治疗的HIV/AIDS死亡风险更高。应早发现、早诊断、早治疗,提高CD₄检测率及治疗率,延长HIV/AIDS的生存时间。     

北京市1995-2015年艾滋病病例诊断后生存时间与影响因素分析

目的 分析1995-2015年北京市HIV感染者/AIDS患者（HIV/AIDS）诊断后生存时间及影响因素。方法 运用回顾性队列研究方法,对1995-2015年中国艾滋病综合防治信息系统中报告的12 874例HIV/AIDS的数据资料进行分析,应用寿命表法计算生存率,采用Cox比例风险模型分析生存时间的相关因素。结果 12 874例HIV/AIDS中,303例（2.4%）死于艾滋病及相关疾病,接受抗病毒治疗9 346例（72.6%）。平均生存时间为226.5个月（95% CI：223.0~230.1）,1、5、10、15年生存率分别为98.2%、96.4%、93.2%、91.9%。Cox比例风险模型分析结果显示,艾滋病死亡风险较高的因素包括诊断时为艾滋病患者（比HIV感染者,HR=1.439,95% CI：1.041~1.989）;异性传播（比同性传播,HR=1.646,95% CI：1.184~2.289）;现有或曾有配偶（比未婚,HR=2.186,95% CI：1.510~3.164）;诊断时年龄≥ 60岁（比≤ 30岁,HR=6.608,95% CI：3.546~12.316）;诊断后首次CD₄⁺T淋巴细胞计数（CD₄）<350个/μl（比≥ 350个/μl,HR=8.711,95% CI：5.757~13.181）;未抗病毒治疗（比抗病毒治疗,HR=18.223,95% CI：13.317~24.937）。结论 1995-2015年北京市HIV/AIDS诊断后的平均生存时间为226.5个月。诊断为HIV感染、同性传播、未婚、≤ 30岁、首次CD₄ ≥ 350个/μl、接受抗病毒治疗的HIV/AIDS生存时间较长。相反,诊断为AIDS、异性传播、现有或曾有配偶、年龄≥ 60岁、CD₄<350个/μl、未抗病毒治疗的死亡风险较高。     

2010年全国新报告HIV感染者/AIDS病例生存时间及其相关因素分析

目的 分析全国2010年新报告HIV感染者/AIDS病例（HIV/AIDS）生存时间及影响因素。方法 使用艾滋病综合防治数据信息系统截至2015年12月31日的病例报告历史卡片和随访定时数据库,筛选出2010年新报告HIV/AIDS并整理出随访结局数据,以寿命表法计算其生存率,采用Kaplan-Meier法拟合不同状态下的生存曲线,Cox比例风险模型分析HIV/AIDS生存时间的影响因素。结果 40 335例HIV/AIDS中,11 975例因艾滋病及相关疾病死亡;截至观察终点时,中位生存时间为63.1（95%CI：63.0~63.2）个月,1年和5年生存率分别为81.2%和69.9%;多因素Cox比例风险模型分析结果显示,艾滋病死亡的风险随年龄增加而增加,25~34、35~44、45~54和≥55岁组因艾滋病死亡的风险分别是15~24岁组的1.41倍（95%CI：1.29~1.54）、1.90倍（95%CI：1.74~2.07）、2.24倍（95%CI：2.04~2.46）和2.81倍（95%CI：2.57~3.08）;HIV/AIDS首次检测CD₄^＋T淋巴细胞（CD₄）值≥500个/μl是CD₄值<200个/μl 的0.12倍（95%CI：0.11~0.13）;接受抗病毒治疗者是未接受治疗者的0.11倍（95%CI：0.10~0.12）。结论 确诊时年龄、确诊时CD₄值水平、是否接受抗病毒治疗是HIV/AIDS生存时间的主要影响因素,应及早进行艾滋病检测、接受抗病毒治疗,以延长HIV/AIDS生存时间。     

四川省1991-2017年HIV/AIDS生存分析

目的 分析1991-2017年四川省HIV/AIDS生存时间及其影响因素。方法 运用回顾性队列研究方法,对全国艾滋病综合防治数据信息系统中1991-2017年四川省新报告的143 988例HIV/AIDS的资料,采用寿命表法计算生存概率,用Cox比例风险模型分析生存时间的影响因素。结果 143 988例HIV/AIDS中,30 420例死于艾滋病及相关疾病（21.1%）,平均生存时间为11.51年（95% CI：11.39~11.64）;多因素Cox比例风险模型分析结果显示,HIV/AIDS生存的相关影响因素包括性别（男比女：HR=1.35,95% CI：1.32~1.40）、文化程度（小学及以下比初中及以上：HR=1.15,95% CI：1.12~1.18）、民族（汉族比其他：HR=1.46,95% CI：1.41~1.52）、职业（农民比其他：HR=1.26,95% CI：1.22~1.29）、诊断时年龄（≥ 55岁比15~24岁：HR=3.18,95% CI：3.02~3.36）、诊断时疾病状态（艾滋病比HIV感染：HR=1.44,95% CI：1.39~1.48）、抗病毒治疗（ART）（接受ART者比未接受ART者：HR=0.20,95% CI：0.19~0.20）、首次CD₄⁺T淋巴细胞计数（CD₄）（>500个/μl比<200个/μl：HR=0.42,95% CI：0.40~0.45）。结论 1991-2017年四川省HIV/AIDS诊断后平均生存时间为11.51年。男性、小学及以下文化程度、汉族、农民、诊断时较大年龄、诊断时为艾滋病状态是HIV/AIDS生存的危险因素,接受ART、首次CD₄水平高是HIV/AIDS生存的保护因素。     

湖北省荆州市1996-2021年HIV/AIDS病死率及其影响因素回顾性队列研究

目的 分析荆州市HIV/AIDS病死率及其影响因素。方法 资料来源于中国疾病预防控制信息系统的艾滋病综合防治信息系统,选取现住址为荆州市、确诊时年龄≥15岁、确诊时间为1996-2021年的HIV/AIDS作为研究对象。采用乘积极限法绘制死亡曲线,Cox比例风险回归模型识别死亡的影响因素。结果 HIV/AIDS共3 304例,随访16 091.5人年,死亡893例,病死率为5.5/100人年。HIV/AIDS确诊后1、5和10年的累积死亡概率分别为15.4%、25.0%和34.6%,参加抗病毒治疗者1、5和10年的累积死亡概率为6.9%、14.4%和23.7%,未参加抗病毒治疗者1、5和10年的累积死亡概率为68.0%、90.1%和98.7%。Cox比例风险回归模型分析结果显示,未参加抗病毒治疗者的死亡风险高于参加抗病毒治疗者（aHR=9.85,95%CI：8.19~11.85）;参加抗病毒治疗者死亡的危险因素包括男性（aHR=1.64,95%CI：1.29~2.08）、确诊时年龄≥60岁（aHR=3.52,95%CI：2.38~5.20）、注射吸毒/其他途径感染（aHR=2.38,95%CI：1.30~4.34）、医疗机构发现（aHR=1.53,95%CI：1.11~2.11）和首次CD4⁺T淋巴细胞（CD4）计数<50个/μl（aHR=2.58,95%CI：1.87~3.58）,死亡的保护因素是较高文化程度（高中/中专：aHR=0.64,95%CI：0.46~0.90;大专及以上：aHR=0.42,95%CI：0.24~0.73）。未参加抗病毒治疗者死亡的危险因素包括确诊时年龄较大（30~岁：aHR=2.32,95%CI：1.40~3.84;45~岁：aHR=2.61：95%CI：1.59~4.27;≥60岁：aHR=3.31,95%CI：2.01~5.47）、首次CD4计数较低（<50个/μl：aHR=10.47,95%CI：6.47~16.56;50~199个/μl：aHR=2.31,95%CI：1.08~4.94;200~349个/μl：aHR=2.35,95%CI：1.46~3.79）。结论 1996-2021年荆州市HIV/AIDS病死率较高,首次CD4计数、抗病毒治疗和确诊时年龄是影响HIV/AIDS死亡的主要因素,应进一步坚持扩大检测和“发现即治疗”政策,提升抗病毒治疗效果和HIV/AIDS生存率。     

山西省南部地区HIV/AIDS病死率及其影响因素分析

目的 探索HIV/AIDS病死率的影响因素和提高抗病毒治疗效果的方法。方法 采用回顾性队列研究方法,通过艾滋病综合防治信息系统,选择山西省南部4市截至2012年底的HIV/AIDS病例报告和抗病毒治疗信息,收集资料补充调查,计算病死率、治疗比例,采用Cox比例风险回归模型进行分析。结果 共收集HIV/AIDS确诊病例4 040例,平均年龄为(36.0±12.9)岁,男性占65.3%,已婚者占56.5%,文化程度初中及以下占73.5%,农民占58.4%,经性传播占54.3%(其中异性传播占40.1%、同性传播占14.2%)、经血传播占38.9%(其中采血浆占20.2%、输血/血制品占16.2%、注射毒品占2.4%)。接受抗病毒治疗比例由2004年的14.8%上升到2012年的63.4%,同期HIV/AIDS病死率从40.2/100人年降低到6.3/100人年。Cox回归分析显示:最主要死亡风险是未接受抗病毒治疗(RR=14.9,95%CI:12.7～17.4)。对1 938例接受抗病毒治疗病例进行Cox回归分析显示:治疗前BMI过低和肥胖病例的死亡风险高于正常和超重病例(RR=2.7,95%CI:1.6～4.5)、治疗前CD₄⁺T淋巴细胞≤50 cell/μl者的死亡风险高于>50 cell/μl者(RR=2.6,95%CI:1.5～4.5)。对2 102例未接受抗病毒治疗病例Cox回归分析显示:首次诊断为AIDS的死亡风险高于首次诊断为HIV病例(RR=3.4,95%CI:2.9～4.0)。结论 抗病毒治疗显著降低了HIV/AIDS的病死率,提示强化抗病毒治疗工作可进一步降低病死率。     

四川省凉山州2004－2012年接受抗病毒治疗的艾滋病患者生存状况分析

目的 分析四川省凉山州首次接受抗病毒治疗艾滋病患者的生存时间及其影响因素.方法 运用回顾性队列研究方法,分析2004－2012年中国艾滋病抗病毒治疗信息管理系统中的凉山州艾滋病患者资料,应用寿命表法计算生存率,采用Cox比例风险模型分析生存时间的影响因素.结果 5 525例研究对象平均年龄(34.5±9.0)岁,男性占73.9%,经静脉吸毒感染占65.8%;从确认HIV抗体阳性到接受抗病毒治疗平均时间为(23.0±20.1)个月.死于艾滋病相关疾病的287例治疗平均时间为(12.7±10.6)个月,其中32.8%是在治疗开始后的6个月内病死.接受抗病毒治疗第1、2、3、4、5 年的生存率分别为97%、93%、89%、88%、84%.Cox比例风险回归模型分析显示,女性艾滋病患者病死的风险低于男性(HR=0.556,95%CI:0.367～0.872);静脉吸毒感染艾滋病的患者病死风险高于异性性传播感染(HR=1.569,95%CI:1.061～2.321);首次CD₄⁺T淋巴细胞计数检测结果<50 cell/mm³(HR=11.996,95%CI:6.714～21.435)、50～200 cell/mm³(HR=2.481,95%CI:1.620～3.798)的患者病死风险均高于≥350 cell/mm³的患者;治疗前最近1年无肺结核的艾滋病患者病死风险低于患有肺结核的患者(HR=0.511,95%CI:0.330～0.791).结论 凉山州艾滋病患者接受抗病毒治疗延长了生存时间,提高了生存率;艾滋病患者应定期进行随访和CD₄⁺T淋巴细胞检测,及时接受抗病毒治疗.     

河南省2008-2015年15岁及以上HIV/AIDS生存状况回顾性队列研究

目的 了解河南省HIV感染者/AIDS患者（HIV/AIDS）确诊AIDS后生存状况及其影响因素。方法 从国家艾滋病综合防治信息系统下载河南省相关数据库，筛选出2008-2015年间确诊为AIDS且≥15岁患者，进行回顾性研究。结果 纳入25 525例研究对象，观察期内病死率为24.9%，其中接受高效抗反转录病毒治疗（HAART）为14.4%。治疗比例从2008年的72.1%上升到2015年的92.8%，同期病死率从21.2%下降到4.1%，其中接受HAART者从9.2%下降到2.6%。多因素分析显示，确诊AIDS时CD₄⁺T淋巴细胞（CD₄）计数<50个/μl的患者死亡风险大（aHR=2.45）；接受HAART的患者死亡风险低（aHR=0.13）。在接受HAART患者中，有复方磺胺甲恶唑（TMP-SMZ）服用史的患者死亡风险低（aHR=0.76）；确诊AIDS时CD₄计数50~个/μl组和<50个/μl组死亡风险高（aHR值分别为1.26和1.97）；基线CD₄计数50~个/μl、<50个/μl组死亡风险高（aHR值分别为1.44和1.84）。结论 抗病毒治疗是影响HIV/AIDS生存时间的重要因素，加强HIV/AIDS的CD₄检测，尽早纳入HAART，同时及时开展TMP-SMZ预防治疗，是减少患者AIDS相关疾病死亡的有效途径。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

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.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.