Eero Pukkala, Anssi Auvinen, Gunilla Wahlberg
Abstract
Objective - To assess whether occupational exposure among commercial airline cabin attendants are associated with risk of cancer.
Design - Record linkage study.
Setting - Finland.
Subjects - 1577 female and 187 male cabin attendants who had worked for the Finnish airline companies.
Main outcome measures - Standardised incidence ratio; expected number of cases based on national cancer incidences.
Results - A significant excess of breast cancer (standardised incidence ratio 1.87 (95% confidence interval 1.15 to 2.23)) and bone cancer (15.10 (1.82 to 54.40)) was found among female workers. The risk of breast cancer was most prominent 15 years after recruitment. Risks of leukaemia (3.57 (0.43 to 12.9)) and skin melanoma (2.11 (0.43 to 6.15) were not significantly raised. Among men, one Iymphoma and one Kaposi's sarcoma were found (expected number of cases 1.6).
Conclusions - Although the lifestyle of cabin attendants is different from that of the reference population - for example, in terms of social status and parity - concentration of the excess risks to primary sites sensitive to radiation suggests that ionising radiation during flights may add to the cancer risk of all flight personnel. Otherwise the lifestyle of cabin attendants did not seem to affect their risks of cancer. Estimates of the effect of reproductive risk factors only partly explained the increased risk of breast cancer. If present estimates of health hazards due to radiation are also valid for cosmic radiation, then the radiation doses of cabin attendants seem too small to account entirely for the observed excess risk.
Finnish Cancer Registry Liisankatu 21 B FIN-00170 Helsinki Finland Eero Pukkala researcherFinnish Centre for Radiation Nuclear Safety PO Box 14 FIN-00881 Helsinki Anssi Auvinen senior scientist
Finnish Flight Attendants Association Rautatielaisenkatu 6 FIN-00520 Helsinki Gunilla Wahlberg service chief
Correspondence to: Dr Pukkala.
Josephine Vespa, Fiona Watson
Abstract
Objective - To monitor nutritional status and food security in order to identify nutritionally vulnerable groups.
Design - Members of five different household groups (urban and rural residents, displaced people in collective centres and private accommodation, elderly people living without younger family) and all residents of two old people's homes were prospectively followed. Households were selected from 20 local communities and nine collective centres.
Setting - Monitoring carried out in three besieged areas of Bosnia-Hercegovina (Sarajevo, Tuzla, and Zenica).
Subjects - 1739 individuals sampled.
Interventions - Data collected every month from December 1993 to May 1994. Information on household food security was collected through structured questionnaires. All subjects were weighed and their heights measured. Weight for age Z scores were calculated for children; body mass index was calculated for adults and elderly people.
Results - From December 1993 to February 1994, before a temporary cease fire, access to food was reduced. In February 1994 no significant signs of undernutrition were detected among children or adults, but elderly people had higher than expected Ievels of undernutrition (15.5% with body mass index less than 18.5), a higher rate of weight loss than adults (1.2 kg over two months), and a higher prevalence of self reported illness.
Conclusions - Elderly people in Bosnia-Hercegovina are at greater risk of undernutrition than other age groups. Undernutrition may be precipitated in elderly people - by sickness, cold, stress, and problems related to food preparation. The health and welfare of elderly people during the emergency in Bosnia-Hercegovina require special attention, and integrated age care programmes are needed.
World Health Organisation Regional Office for Europe Zagreb Area Office 4100 Zagreb Croatia Josephine Vespa consultant nutritionist Fiona Watson consultant nutritionist
Correspondence to: Ms Watson, Centre for International Child Health, Institute of Child Health London WC1N 1EH. cich@ich.bpmf.ac.uk
Susanne Lanng, Annelise Hansen, Birger Thorsteinsson, J¿rn Nerup, Christian Koch
Abstract
Objectives - To study prevalence and incidence of diabetes mellitus in patients with cystic fibrosis.
Design - Five year prospective study with annual oral glucose tolerance tests.
Setting - CF Center Copenhagen, Denmark.
Subjects - 191 patients with cystic fibrosis aged above 2 years.
Main outcome measures - Glucose tolerance, plasma glucose concentrations after fasting and after glucose loading, and haemoglobin Alc levels.
Result - Prevalence of diabetes increased from 11% (n=21) to 24% (n=46) during study, with annual age dependent incidence of 4.9%. Diabetes was diagnosed at median age of 21 (range 3-40). At diagnosis of diabetes, symptoms of hyperglycaemia were present in 33% of patients, fasting hyperglycaemia (more than 7.8 mmol/l) was seen in 16%, and i~creased haemoglobin Alc levels (greater than 6.4%) were seen in 16%. Impaired glucose tolerance implied higher risk for development of diabetes than normal glucose tolerance (odds ratio 5.6). In 58% of cases with impaired glucose tolerance, however, glucose tolerance was normal at next annual test. Normal glucose tolerance was found in only 37% of patients at all five tests. Within this group of patients, median plasma glucose concentrations after fasting and after glucose loading and haemoglobin Alc levels increased by 6-8% during study.
Conclusions - Prevalence and incidence of diabetes in cystic fibrosis patients was high and increased with age. Since hyperglycaemic symptoms, fasting hyperglycaemia, and increased levels of glycated haemoglobin did not reliably identify diabetes mellitus, we recommend annual oral glucose tolerance tests in all cystic fibrosis patients aged over 10 years.
CF Center Copenhagen Department of Paediatrics Rigshospitalet Copenhagen Denmark Susanne Lanng research fellow Annelise Hansen nurse Christian Koch consultantCorrespondence to: Dr Lanng.Department of Medicine F Hillerod Hospital Hillerod Denmark Birger Thorsteinsson consultant
Steno Diabetes Center Gentofte Denmark J¿rn Nerup professor
J O Warner
Abstract
Objective - To review treatment prescribed to asthmatic children in Great Britain during the 12 months after publication of the first guidelines and to assess effectiveness of prophylactic treatment.
Design - Review of prescribing information from January 1990 to June 1991 in a representative sample of general practices in Great Britain with a Compufile/AAH Meditel computer.
Subjects - 17846 children with asthma aged 4-17 years.
Main outcome measures - Numbers of children prescribed different asthma treatments; estimated use of inhaled beta agonists in those receiving prophylactic treatment.
Results - From January to December 1990, 9362 (52.5%) children were prescribed preventive treatments. 16211 (90.8%) children were prescribed bronchodilators of some kind. 3055 (17.1%) were prescribed sodium cromoglycate, and the proportion decreased significantly during the study (from 19.5% (95% confidence interval 18.6% to 20.4%) to 17.2% (16.4% to 18.1%), P less than 0.001, in children aged 4-11 years and from 14.9% (14.)% to 15.9%) to 11.3% (10.4% to 12.2%), P is less than 0.001, in those aged 12-17 during January-July 1991). 6952 (39.0%) were prescribed inhaled steroids, and the proportion increased during the study (from 35.1% (34.0% to 36.2%) to 44.1% (43.0% to 45.2%), P less than 0.001, in children aged 4-11 years and from 38.7% (37.4% to 40.0%) to 44.1% (42.7% to 45.5%), P less than 0.001, in those aged 12-17 during January-July 1991). Only 1358 of the 9362 children (14.5%) received sufficient repeat prescriptions to suggest that they might be taking the prophylactic treatment regularly. Among these children short acting inhaled ,beta agonists were being used on average four to eight times a day.
Conclusions - These results are useful baseline data for audit of the impact of published clinical guidelines, particularly in terms of reducing the need for short acting inhaled ,beta agonists with prophylactic treatment.
Department of Child Health University of Southampton Southampton General Hospital Southampton S09 4XY J O Warner professor