Airline crews are occupationally exposed to cosmic radiation. Pukkala et al (p 649) studied whether cabin crews' exposure to radiation is associated with an increased risk of cancer. They followed up a cohort of all Finnish airline cabin attendants occupationally exposed to cosmic radiation of 2-3 mSv a year for incidence of cancer. Female workers had a significant 1.9-fold risk of breast cancer and a 15-fold risk of bone cancer. These excesses cannot be explained by differences in lifestyle (such as social class and parity) between cabin attendants and the reference population. A concentration of excess risks in cancer sites sensitive to radiation suggests that ionising radiation during flights may add to the cancer risk of all flight personnel. However, on the basis of the present estimates of health hazards due to radiation (based on survivors of the atomic bomb and of people occupationally exposed to y radiation, not on cosmic radiation), the radiation doses seem too small to account entirely for the observed excess risk.
Vespa and Watson followed a total of 1739 residents and displaced people from selected households in three besieged areas of Bosnia between December 1993 and May 1994 (p 652). Every month, a household food security questionnaire was administered and household members were weighed and had their heights measured. 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 levels 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. The authors conclude that elderly people in Bosnia-Hercegovina are at greater risk of undernutrition than other age groups. Undernutrition may be precipitated in the elderly by sickness, cold, stress, and problems related to food preparation. The health and welfare of the elderly during the emergency in Bosnia require special attention.
As the life span of patients with cystic fibrosis has increased, diabetes mellitus has evolved as a common complication. Since diabetes in cystic fibrosis is associated with deterioration in overall clinical status and late diabetic complications may develop, and since insulin treatment can improve lung function and reduce the number of lung infections, such patients should be identified. Lanng et al (p 655) conducted a five year study of patients with cystic fibrosis, performing annual glucose tolerance tests, and found a cumulative incidence of diabetes of 24% in patients aged 20 years and 76% in those aged 30. However, the presence of hyperglycaemic symptoms, fasting hyperglycaemia, and increased levels of glycated haemoglobin did not reliably identify diabetes mellitus in these patients. The authors therefore recommend annual screening with oral glucose tolerance test for all cystic fibrosis patients aged over 10 years.
There are few data on prescribing practices for children with asthma. On p 663 Warner reviews prescriptions in Great Britain in 1990 to over 17000 asthmatic children aged 14-17. Half of them were receiving preventive treatment, but nearly all of them (90%) were prescribed bronchodilators in some form. Repeat prescriptions sufficient to imply regular use of prophylactic treatment were issued to only 14.5% of those given at least one prescription for a prophylactic drug. Even among these children, short acting inhaled beta agonists were still used frequently - an average of four to eight times a day. These data will be useful for audit of the impact of clinical guidelines on asthma treatment in 1990.