Database

There are currently 600,000 with Chronic Obstructive Pulmonary Disease (COPD) in the UK. Vocational rehabilitation would be more successful if the suggested options were employed.  Evidence from: A statement made by the British Thoracic Society. Thorax. November (2001) Vol.56 #11 p 827 The Radar report is available to subscribers: 1#10 20

IARC have produced a monograph on the subject of lung cancer and man-made vitreous fibres. IARC monographs programme: Carcinogenic risks from airborne man-made vitreous fibres [glass wool, rock wool, and slag wool] Man-made vitreous fibres in the form of wools are widely used in thermal and acoustic insulation and in other manufactured products in Europe and North America. These products, including glass wool, rock (stone) wool, and slag wool, have been in use for decades and have been extensively studied to establish whether fibres that are released during manufacture, use, or removal of these products present a risk of cancer when inhaled. Andrew Auty prepared a report for ABI in 1999 and concluded that the case for carcinogenicity had not been made, but that these wools should be classed as irritants. [A small proportion of people in physical contact with these wools have a strong, short-term inflammatory reaction]. An earlier IARC review (1988) provide no evidence of increased risk

Short term effects of exposure are well-known and usually reversible. This study sought an association between cumulative exposure and signs of peripheral nerve symptoms (PNS). Evidence from: A Pilkington et al. Occupational and Environmental Medicine. November (2001) Vol.58 # 11 p 702. Short term effects were observed as expected. The Radar report is available to subscribers: 1#10 17

If shift work increased the intensity of heart disease risk factors by some non-volitional mechanism then there would be a good case for controlling shift work in a way which counteracts that mechanism. But first, is there a significant effect on risk factors? Evidence from: B Karlsson et al. Occupational and Environmental Medicine. November (2001) Vol.58 # 11 p 747. A study of known risk factors for heart disease and their association with shift work. 27,485 Swedish workers took part. Blood and build were analysed. Obesity was found to be more prevalent among all ages of women shift workers, but only two age groups of men. Increased triglycerides (>1.7 mmol/l) were found for two groups of shift working women but not men. Impaired glucose tolerance was found among 60-year old women shift workers. Comment The authors conclude that shift work presents an increased risk of heart disease. However, risk factors for disease are not indicators that disease will necessarily occur. Strengths

If BMI is a risk factor for asthma then it should also be a risk factor for atopy. But it isn’t, according to this study. The suggestion is that either atopy or asthma may be being misdiagnosed. Atopy is diagnosed by objective tests. Evidence from: E von Mutius et al. Thorax. November (2001) Vol.56 #11 p 835. Does body mass index (BMI) correlate with diagnosis of childhood asthma? 7505 children aged between 4 – 17 took part in the study. Extensive background details and medical exam for status. Physician diagnosis or treatment for asthma was used to identify asthmatics. Relative to lowest quartile, BMI, top quartile OR = 1.77 (95% CI = 1.44 to 2.19) BMI was not correlated with atopy. Comment Possible explanations include a high rate of false diagnosis (activity intolerance is used by many physicians as a clear sign of asthma or direct effect of being overweight on breathing or sensitisation of an inflammatory mechanisms?

The research report referenced here examines the feasibility of providing written instruction informing about signs and personalised care for each child with a known predisposition. It finds that such personalised programmes can be obtained and managed successfully. Evidence from: DA Moneret-Vautrin et al. Allergy. November (2001) Vol. 56 # 11 p 1071 Allergy prevention and response would seem to be reasonably practicable in schools. The Radar report is available to subscribers: 1#10 14