孕前体重指数及孕期增重与小于胎龄儿的关系

目的 探讨孕前BMI、孕期增重与小于胎龄儿(small for gestational age,SGA)的关系,为预防小于胎龄儿的发生提供理论依据.方法 以2012年3月至2014年7月在山西医科大学第一医院产科分娩的4 754例单胎孕妇为研究对象,收集其一般人口学特征及健康状况、分娩情况等资料,测量其孕前身高、体重和分娩前体重,计算孕前BMI及孕期增重并分组,收集新生儿出生结局,了解孕前BMI和孕期增重对SGA的影响.结果 SGA发生率为9.26%(440/4 754).孕前体重较低组、正常组及超重/肥胖组SGA发生率为9.85%、8.54%和9.45%,调整孕妇年龄、孕产史等因素后,孕前BMI过高和超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇(OR=0.714,95%CI:0.535～0.953);不同孕期增重组SGA发生率分别为孕期增重低于美国医学研究所(IOM)建议范围下限组12.20%、增重在建议范围组9.23%、增重超过建议范围上限组8.45%;调整孕妇年龄、孕产史等因素后,孕期增重低于IOM建议范围下限增加SGA的发生风险(OR=1.999,95%CI:1.487～2.685),无论是孕前BMI较低、适宜还是超重/肥胖,分别以增重适宜作为参照,孕期增重低于IOM建议范围下限均增加SGA的发生风险,OR值分别为2.558(95%CI:1.313～4.981)、1.804(95%CI:1.258～2.587)、3.108(95%CI:1.237～7.811).孕前高BMI和孕期增重不足间未发现相加和相乘交互作用.结论 孕前BMI超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇,孕期增重不足增加SGA的发生风险,无论孕前BMI较低、正常还是超重/肥胖的孕妇增重均应避免低于IOM推荐的增重范围下限,以减少SGA的发生.     

母亲孕前体质指数及孕期增重与学龄前儿童超重肥胖的关系研究

目的 探讨母亲孕前BMI及孕期增重与学龄前儿童超重肥胖的关系。方法 2016年6-11月,以广州市4 303名3~5岁学龄前儿童为研究对象,根据WHO标准和中国成人肥胖标准分别判断儿童和母亲孕前体重状态,参照美国医学研究所孕期增重推荐值判断母亲孕期增重情况。应用多因素二分类非条件logistic回归模型和协方差分析母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的关系。结果 矫正混杂因素后,logistic回归分析显示,母亲孕前超重肥胖的儿童发生超重肥胖的风险是母亲孕前体重正常儿童的1.820倍（OR=1.820,95% CI：1.368~2.422）;与母亲孕期增重适宜的儿童相比,母亲孕期增重过度的儿童超重肥胖发生风险增加（OR=1.296,95% CI：1.007~1.667）。协方差分析结果也显示,母亲孕前体重超重肥胖和母亲孕期增重过度均增加儿童BMI Z值。根据母亲孕前BMI分为3组进行分层分析,结果显示,不同孕期增重组间儿童超重肥胖发生风险差异无统计学意义（P>0.05）。但与母亲孕前BMI适宜且孕期增重适宜组相比,母亲孕前超重肥胖且孕期增重过度组的儿童发生超重肥胖的风险增加（OR=1.574,95% CI：1.029~2.409）。结论 母亲孕前超重和孕期增重过度均增加学龄前儿童超重肥胖的风险,且母亲孕前超重较孕期增重过度对学龄前儿童超重肥胖发生的影响更大。     

孕前BMI、妊娠期糖尿病与儿童4岁时肥胖相关指标关联的出生队列研究

目的 探讨孕前BMI、妊娠期糖尿病（GDM）与儿童4岁时肥胖相关指标的关联。方法 基于已经建立的“马鞍山市优生优育队列”,对2013年10月至2015年4月出生的单胎活产儿,随访至4岁。在孕期首次填写问卷调查孕前身高、体重,在24～28周接受75 g口服糖耐量试验进行GDM诊断。在儿童4岁时测量身高、体重、腰围和体成分。组间比较采用χ²检验、方差分析或t检验,采用logistic回归模型与广义线性模型分析孕前超重/肥胖、孕前患有GDM与儿童肥胖相关特征的关系。结果 儿童4岁时超重、肥胖率分别为13.08%、6.03%。控制孕期和儿童人口统计学变量后,孕前母亲超重/肥胖者儿童在4岁时发生肥胖、腰围超标、腰围身高比超标的风险要高,其OR值（95% CI）分别为3.27（2.15～4.98）、2.32（1.72～3.14）和2.29（1.73～3.02）;且与体成分指标（骨骼肌、体脂肪、体脂百分比）相关（P<0.05）。孕期母亲患有GDM者,儿童4岁时肥胖发生风险要比母亲未患有GDM者高1.78倍（OR=1.78,95% CI：1.14～2.79）;但是孕期母亲患有GDM对4岁儿童腰围超标、腰围身高比超标发生风险并无影响,与体成分指标（骨骼肌、体脂肪、体脂百分比）无统计学关联。结论 孕前母亲超重/肥胖、孕期患有GDM是4岁儿童肥胖的独立危险因素,且孕前BMI与儿童体成分的各项指标相关。     

西南3省妇女孕前体质指数和孕期增重对新生儿出生体重影响的前瞻性队列研究

目的 探讨孕妇孕前BMI、孕期增重对新生儿出生体重的影响。方法 以来自西南3省的5 395名孕妇为研究对象,根据WHO推荐的BMI分类标准将孕妇分为孕前低体重组、正常体重组、超重组以及肥胖组。按照美国医学研究院推荐的孕期增重标准定义各组孕妇孕期增重是否适宜。采用无序多分类logistic回归模型分析孕前BMI和孕期增重与新生儿出生体重的关系。结果 调整相关混杂因素后,孕前BMI较低（OR=1.91,95% CI：1.47~2.50）是分娩小于胎龄儿（SGA）的危险因素,但可降低分娩大于胎龄儿（LGA）的风险（OR=0.55,95% CI：0.47~0.66）。孕期增重不足会使SGA的发生风险增加（OR=1.57,95% CI：1.21~2.03）,分娩LGA的风险降低（OR=0.48,95% CI：0.41~0.57）。孕前超重肥胖（OR=1.85,95% CI：1.58~2.17）以及孕期增重过多（OR=1.87,95% CI：1.67~2.11）与LGA的发生风险呈正相关。分层分析显示孕期增重不足仅会使孕前BMI较低和正常的孕妇分娩SGA的风险升高,对孕前超重肥胖的孕妇分娩SGA的风险没有影响。结论 孕前BMI和孕期增重是新生儿出生体重的重要影响因素,应加强孕妇健康教育、合理控制孕期增重。     

母亲孕前BMI和孕期增重与子代孤独症之间关系的研究

目的 探讨母亲孕前BMI和孕期增重与子代孤独症之间的关系。方法 选取2013－2014年经医疗机构确诊的181例1～5岁孤独症儿童为病例组,采用1 ∶ 1病例对照研究方法选择同地区、同性别、同年龄发育正常的儿童作为对照组。按母亲孕前BMI值分为低、正常和高3组,孕期增重根据美国医学研究所标准分为低、正常和高3组,采用SPSS 18.0软件进行χ²检验和logistic回归分析。结果 两组儿童年龄和性别分布均衡(χ²=0.434,P >0.05)。病例组母亲孕前BMI平均值为(21.28±3.80)kg/m²,高于对照组的(19.87±2.83)kg/m²,差异有统计学意义(χ²=9.580,P< 0.05);病例组母亲高BMI人数(10.5%)多于对照组(2.8%);随着孕前BMI增加,子代孤独症患病风险逐渐增大,高BMI组子代孤独症发病风险是正常BMI组的3.7倍(OR=3.71,95%CI:1.34～10.24);病例组正常BMI母亲孕期增重过度(44.1%)高于对照组(33.9%);病例组高BMI母亲孕期增重过度(52.6%)明显高于对照组(20.0%),正常BMI(χ²=8.690,P< 0.05)和高BMI(χ²=4.775,P< 0.05)母亲孕期增重过度与孤独症发病有关。logistic回归分析显示,母亲孕前高BMI(调整前OR=1.89,95%CI:1.26～2.85;调整后OR=1.52,95%CI:1.19～2.27)和孕期增重过度(调整前OR=1.63,95%CI:1.08～1.25;调整后OR=1.64,95%CI:1.21～2.21)是子代孤独症发生的危险因素。结论 母亲孕前超重/肥胖和孕期增重过度与子代孤独症发生有一定的关系,可能是孤独症的危险因素。     

孕前体重指数、孕期增重对泌乳时间影响的纵向研究

目的 探讨孕前BMI和孕期增重对泌乳时间的影响。方法 采用纵向研究方法, 于2013年3-9月选取成都市妇幼医疗机构产前门诊751名单胎健康孕妇作为基线调查对象, 在其分娩前后各随访一次, 最终以473名孕妇作为研究对象, 通过问卷调查和病历记录获得其孕前体重、分娩方式、新生儿出生体重、泌乳时间及基本信息, 测量身高和分娩前体重, 计算孕期增重;控制分娩方式、母亲年龄等混杂因素后, 采用多因素有序logistic回归模型分析孕前BMI和孕期增重与泌乳时间的关系。 结果 调查对象泌乳时间<1、1~、24~、48~和≥72 h的构成比分别占16.3%、37.0%、17.5%、18.6%和10.6%。与孕前体重正常组相比, 孕前消瘦和孕前超重或肥胖均是泌乳时间延长的危险因素, OR值(95%CI)分别为2.85(1.91~4.27)和 3.42(1.69~6.90)。与孕前体重正常且孕期增重适宜组相比, 孕前消瘦且孕期增重适宜和过多均是泌乳时间延长的危险因素, OR值(95%CI)分别为2.34(1.31~4.18)和3.42(1.67~7.00);孕前超重或肥胖且孕期增重过多是泌乳时间延长的危险因素, OR值(95%CI)为3.10(1.15~8.37)。结论 孕前BMI是泌乳时间的独立影响因素, 孕期增重需联合孕前BMI对泌乳时间产生影响。     

孕前超重、孕期过度增重与巨大儿发生风险的前瞻性队列研究

目的 探讨巨大儿发生与孕前超重、孕期过度增重的直接关联及关联强度。方法 2015年1月起在上海市浦东新区妇幼保健院建立孕妇队列,创建孕妇健康档案,收集孕期及分娩信息,包括一般人口学特征、孕前体重、孕期增重、分娩体重、孕期健康状况及各种孕期并发症、分娩情况等,计算孕前BMI及孕期增重,收集新生儿出生体重,了解巨大儿发生与孕前超重、孕期过度增重之间的关系。结果 巨大儿发生率为6.6%（149/2 243）。不同孕前BMI组巨大儿发生率差异有统计学意义（P=0.001）。在控制了孕妇年龄、孕产史等因素后,logistic回归分析结果显示,与孕前BMI适宜的孕妇比,孕前BMI超重以及肥胖的孕妇生产巨大儿的风险均增加（OR=3.12,95%CI：1.35~7.22,P=0.008; OR=2.99,95%CI：1.17~7.63,P=0.022）。不同孕期增重组巨大儿发生率差异有统计学意义（P=0.002）。在控制了孕妇年龄、孕产史、孕期并发症等因素后,logistic回归分析结果显示,与孕期增重适宜的孕妇比,孕期增重不足的孕妇生产巨大儿的风险降低（OR=0.52,95%CI：0.30~0.90,P=0.019）。而孕期过度增重在调整了各种孕期指标后,与孕期增重适宜的孕妇比,巨大儿发生风险差异有统计学意义（OR=1.41,95%CI：0.96~2.09,P=0.084）。结论 孕前超重或肥胖是巨大儿发生的风险因素。     

孕前体重和孕期增重对新生儿出生结局及孕产妇围产结局的影响

目的 探讨孕前体重和孕期增重对妊娠结局的影响。方法 采用前瞻性队列研究和整群抽样,对福建省妇幼保健院围产营养门诊既往无高血压、糖尿病、血脂异常等病史,且本次妊娠未发现心脏、肝脏、肾脏、甲状腺等器官疾病的单胎妊娠孕妇进行问卷调查,追踪其围产过程并发症、分娩方式及新生儿出生结局等。采用相关分析、χ²检验和logistic 回归分析孕前体重、孕期增重与妊娠结局的关系。结果 623 名孕妇纳入分析592 名（95%）。多因素logistic 回归分析显示,在控制相关混杂因素后,相比孕前适宜体重孕妇（BMI 18.5～24.0 kg/m²）,孕前低体重（BMI＜18.5 kg/m²）是低出生重量指数（PI）的危险因素（OR＝2.34,95%CI：1.24～4.42）,孕前超重（BMI＞24.0 kg/m²）是高出生PI 的危险因素（OR＝2.73,95%CI：1.12～6.68）。相比孕期增重适宜（孕期增重P₁₅～P₈₅）、增重不足（孕期增重＜P₁₅）的孕妇,发生早产、低出生体重儿、妊娠糖尿病和低出生PI的OR 值（95%CI）分别为4.85（1.35～17.51）、10.30（2.29～46.35）、2.29（1.07～4.93）和2.65（1.24～5.68）;孕期增重过多孕妇（孕期增重＞P₈₅）生产巨大儿、高出生PI 和妊娠糖尿病的OR值（95%CI）分别为3.83（1.74～8.44）、2.39（1.14～5.01）和2.21（1.07～4.55）。结论 孕前低体重和超重均影响新生儿出生PI。孕期增重不足是早产、低出生体重儿、妊娠糖尿病和低出生PI 的危险因素,孕期增重过多是高出生PI 和妊娠糖尿病的危险因素。     

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。     

孕前BMI和妊娠期糖尿病对儿童脂肪重积聚时相提前的独立和联合效应

目的 探讨孕前BMI、妊娠期糖尿病（GDM）与儿童脂肪重积聚（AR）时相提前的关联。方法 基于已经建立的马鞍山优生优育队列，本研究共纳入2 896对母子对，收集孕妇孕前身高、体重、24~28周GDM情况，在婴儿42天、3月龄、6月龄、9月龄以及1岁后每6个月进行1次随访，连续追踪随访至6岁，获得其身长/高、体重等资料。采用多因素logistic回归分析孕前BMI、GDM与儿童AR时相提前的关联强度，并通过相乘、相加模型分析孕前BMI及GDM对于儿童AR时相提前的发生是否存在交互作用。结果 母亲孕前体重不足、体重正常、超重和肥胖者分别占23.2%（672例）、66.4%（1 923例）、8.7%（251例）和1.7%（50例）；GDM患病率为12.4%。儿童AR年龄为（4.38±1.08）岁，AR时相提前的儿童占39.3%。多因素logistic回归结果显示，孕前超重（OR=1.67，95%CI：1.27~2.19）、肥胖（OR=3.05，95%CI：1.66~5.56）以及孕期患有GDM（OR=1.40，95%CI：1.11~1.76）是AR时相提前发生的危险因素，而孕前体重不足（OR=0.60，95%CI：0.49~0.73）是AR时相提前发生的保护因素。与仅孕前超重/肥胖或孕期患有GDM相比，孕前超重/肥胖与孕期患有GDM并存，AR时相提前的发生风险更高，OR值（95%CI）分别为2.03（1.20~3.44）、3.43（1.06~11.12）。相乘模型和相加模型分析显示，孕前BMI和孕期患有GDM对儿童AR时相提前无交互作用。结论 母亲孕前较高的BMI和孕期患有GDM是儿童AR时相提前发生的独立危险因素，两者并存的风险更高，但无统计学交互作用。     

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.