bluuebunny/crossref_metadata_2025 huggingface dataset:
Ratings of perceived exertion in braille: validity and reliability in production mode
Authors: Buckley John P , Eston Roger G , Sim Julius
Published: July 2002

Objectives—(a) To assess the validity and reliability of producing and reproducing a given exercise intensity during cycle ergometry using a braille version of Borg's standard 6–20 rating of perceived exertion (RPE) scale, and (b) to determine whether the exercise responses of blind participants, at a given produced RPE, were similar to those reported in recognised guidelines for sighted subjects.

Methods—Ten healthy registered blind volunteer participants (four women, six men; mean (SD) age 23.2 (9.0) years) performed an initial graded exercise cycle test to determine maximal heart rate (HRmax) and maximal oxygen uptake (Vo2max). Three trials of three exercise bouts at RPEs 9, 11, and 13 were then performed in random order on three separate days of the same week, with expired air and heart rate measured continuously. Each exercise bout was followed by 10 minutes of rest. The validity of the scale as a means of producing different exercise intensities was assessed using a two factor (RPE × trial) repeated measures analysis of variance. Intertrial reliability was assessed using intraclass correlation coefficients (ICC) and the bias ±95% limits of agreement (95%LoA) procedure.Results—Participants reported no difficulty in using the braille RPE scale. When asked to produce exercise intensities equating to RPE 9, 11, and 13, they elicited mean %Vo2maxvalues of 47%, 53%, and 63% respectively. Analysis of variance showed no significant differences in either %HRmaxor %Vo2maxbetween trials at each of the three RPEs, but there was a significant difference (p<0.001) in both %HRmaxand %Vo2maxbetween the three RPE levels. All pairwise comparisons of the three different RPEs were significantly different (p<0.016). The ICC between the second and third trial for %HRmaxwas significant (p <0.05) for all three RPEs. Similarly for %Vo2max, the ICC was significant for RPE 9 and 11 but not 13. The 95%LoA decreased for both %HRmaxand %Vo2maxwith each successive trial.

Conclusions—Blind participants were successful in using a braille RPE scale to differentiate exercise intensity on a cycle ergometer. In every trial at RPE 13, all participants achieved %HRmaxand %Vo2maxlevels, which fell within the recommended range for developing cardiorespiratory fitness. Using %HRmaxas a judge of intertrial reliability, the participants were able to repeat similar exercise intensities after two trials at each of the three RPEs (9, 11,13). The same was true for RPE 9 and 11, when %Vo2maxwas used as a judge, but further trials were required to achieve similar reliability at RPE 13. A braille RPE scale can be used by healthy blind people during cycle ergometry, with similar effect to the visual analogue scale recommended for use in healthy sighted people.
Validation of an instrument for injury data collection in rugby union
Authors: McManus Alexandra
Published: July 2002

Objective—To provide the basis for collecting rugby union injury data using a rigorously validated injury report form.

Methods—Seven stages were used to assess face, content, and criterion validity of the rugby union injury report form. A 22 member panel plus four sporting bodies assessed the form for face validity, and an expert panel assessed it for content and criterion validity. Panel members were consulted until consensus was reached. A yardstick developed by an expert panel using the Delphi technique was used to assess the reliability of the form. An independent panel of 10 viewed a series of five videotaped injuries, three times over a five week period to assess inter-rater and intrarater reliability. The form was then trialed by 40 people in situ during four games.

Results—The rugby union injury report form for games and training was developed, and the face, content, and criterion validity successfully assessed. A seven step protocol to create a yardstick was also developed to assist in the validation process. Both inter-rater and intrarater reliability results indicated a 98% agreement. The 40 trialists who completed forms in situ during four games were found to have an inter-rater reliability agreement of 98% for nine injuries.

Conclusions—A measurement instrument for injury data collection in rugby union was successfully developed and validated, providing researchers with a basis for future studies in this area. A procedure to develop future injury data collection instruments in other sports was also developed.
Medical supervision of sport diving in Scotland: reassessing the need for routine medical examinations
Authors: Glen Stephen , White Steven , Douglas James
Published: July 2002

Background—The value of diving medicals in preventing incidents is uncertain and there has been only limited evaluation of the fitness to dive guidelines in a sport diving population.

Objective—To examine the need for routine diving medical examinations in the Scottish Sub-Aqua Club (SSAC) between 1991 and 1998.

Methods—A medical examination of all SSAC divers is performed at entry and then every one to five years based on their age and medical condition This information was analysed in terms of questionnaire findings and examination abnormalities.

Results—There were 2962 medical forms available for analysis. Examination abnormalities were found in 174 subjects (5.9% of the population), with obesity affecting 75 subjects (2.5%). There was a linear increase in mean body mass index (r2= 0.92), and a significant difference between 1991 and 1998 (mean (SD) of 24.1 (3.07) and 25.02 (3.4) respectively, p = 0.002) which was not related to age or sex distribution. There was also a significant increase in the prevalence of smokers (χ2= 4.02, p = 0.045). The most common specialist referral was for evaluation of asthma, with hypertension and obesity as the next most common reasons. Most subjects were allowed to dive, with only 43 (25%) being failed outright. Overall, no examination abnormality alone caused a subject to be classified unfit to dive, and referrals were prompted by the answers in the questionnaire.

Conclusions—No significant unexpected abnormalities were found on clinical examination in this population of sport divers. Conditions that prevented subjects from diving were detected by the questionnaire, and this prompted referral for further assessment by the medical advisors. Routine medical examinations were of little value.
Fishing penetration injuries
Authors: Dudkiewicz I , Salai M , Blankstein A , Chechik A
Published: July 2002

Background—Fishing involves millions of people throughout the world and is considered a pleasant and harmless sport. However, many kinds of injury can occur. Penetrating injuries to the extremities by fishing equipment such as hooks and harpoons, and even by scales, or infection from penetration of scales etc are relatively common although hardly ever reported in the literature.

Methods—Illustrative cases of penetrating fishing injuries are presented and discussed, with suggestions for the recommended management of these types of injury.

Results—Most of these objects are designed to catch and hold resisting fish, so are usually sharp and narrow in the front and wider in the rear with or without spurs. Because of their very irregular shape, simple extraction by pulling is not recommended, because further damage may occur.

Conclusions—The use of the appropriate imaging modalities, a full knowledge of the contours of the object, and careful preplanning of the method of treatment are very important.
Incidence of pubic bone marrow oedema in Australian rules football players: relation to groin pain
Authors: Verrall G M , Slavotinek J P , Fon G T
Published: July 2002

Objectives—To examine the relation between the clinical features of groin pain and groin magnetic resonance imaging (MRI) appearances in a group largely comprising elite Australian Rules football players. The incidence of bone marrow oedema and other MRI findings in the pubic symphysis region was noted. The relation between a past history of groin pain and these other MRI findings was also examined.

Method—In a prospective study, 116 male subjects (89 footballers, 17 umpires, 10 sedentary men) were examined before history taking and groin MRI. The clinical history was not known to the examiner (GMV) and radiologists (JPS, GTF). Clinical evidence of groin pain and examination findings were correlated with the presence of increased signal intensity within the pubic bone marrow. A past history of groin pain was correlated with the presence of other MRI findings such as cyst formation, fluid signal within the pubic symphysis disc, and irregularity of the pubic symphysis.

Results—Fifty two athletes (47 footballers, five umpires) had clinical features of groin pain with pubic symphysis and/or superior pubic ramus tenderness. A high incidence of increased signal intensity (77%) within the pubic bone marrow was identified in this group. There was an association between this group of athletes and the MRI finding of increased signal intensity (p<0.01). There was also an association between a past history of groin pain and the presence of other MRI findings (p<0.01).

Conclusions—Athletes with groin pain and tenderness of the pubic symphysis and/or superior pubic ramus have clinical features consistent with the diagnosis of osteitis pubis. The increased signal intensity seen on MRI is due to pubic bone marrow oedema. An association exists between the clinical features of osteitis pubis and the MRI finding of pubic bone marrow oedema. A high incidence of pubic bone marrow oedema was also noted. Degenerative features visualised by MRI, such as subchondral cyst formation, were associated with a past history of groin pain. A stress injury to the pubic bone is the most likely explanation for these MRI findings and may be the cause of the clinical entity osteitis pubis.
Ankle injuries in basketball: injury rate and risk factors
Authors: McKay G D , Goldie P A , Payne W R , Oakes B W
Published: July 2002

Objectives—To determine the rate of ankle injury and examine risk factors of ankle injuries in mainly recreational basketball players.

Methods—Injury observers sat courtside to determine the occurrence of ankle injuries in basketball. Ankle injured players and a group of non-injured basketball players completed a questionnaire.

Results—A total of 10 393 basketball participations were observed and 40 ankle injuries documented. A group of non-injured players formed the control group (n = 360). The rate of ankle injury was 3.85 per 1000 participations, with almost half (45.9%) missing one week or more of competition and the most common mechanism being landing (45%). Over half (56.8%) of the ankle injured basketball players did not seek professional treatment. Three risk factors for ankle injury were identified: (1) players with a history of ankle injury were almost five times more likely to sustain an ankle injury (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.95 to 12.48); (2) players wearing shoes with air cells in the heel were 4.3 times more likely to injure an ankle than those wearing shoes without air cells (OR 4.34, 95% CI 1.51 to 12.40); (3) players who did not stretch before the game were 2.6 times more likely to injure an ankle than players who did (OR 2.62, 95% CI 1.01 to 6.34). There was also a trend toward ankle tape decreasing the risk of ankle injury in players with a history of ankle injury (p = 0.06).

Conclusions—Ankle injuries occurred at a rate of 3.85 per 1000 participations. The three identified risk factors, and landing, should all be considered when preventive strategies for ankle injuries in basketball are being formulated.
Effect of immersion, submersion, and scuba diving on heart rate variability: Figure 1
Authors: Schipke J D , Pelzer M
Published: July 2002

Background—Heart rate variability (HRV) describes the cyclic variations in heart rate and offers a non-invasive tool for investigating the modulatory effects of neural mechanisms elicited by the autonomic nervous system on intrinsic heart rate.

Objective—To introduce the HRV concept to healthy volunteers under control conditions and during scuba diving. In contrast with more established manoeuvres, diving probably activates both the sympathetic and parasympathetic nervous system through various stimuli—for example, through cardiac stretch receptors, respiration pattern, psychological stress, and diving reflex. A further aim of the study was to introduce a measure for determining a candidate's ability to scuba dive by providing (a) standard values for HRV measures (three from the time domain and three from the frequency domain) and (b) physiological responses to a strenuous manoeuvre such as scuba diving.

Methods—Twenty five trained scuba divers were investigated while diving under pool conditions (27°C) after the effects of head out immersion and submersion on HRV had been studied.

Results and conclusions—(a) Immersion under pool conditions is a powerful stimulus for both the sympathetic and parasympathetic nervous system. (b) As neither the heart rate nor the HRV changed on going from immersion to submersion, the parasympathetic activation was probably due to haemodynamic alterations. (c) All HRV measures showed an increase in the parasympathetic activity. (d) If a physiological HRV is a mechanism for providing adaptability and flexibility, diving should not provoke circulatory problems in healthy subjects. (e) Either a lower than normal HRV under control conditions or a reduction in HRV induced by diving would be unphysiological, and a scuba diving candidate showing such characteristics should be further investigated.
Stress fracture of the clavicle in a young female gymnast
Authors: Fallon K E , Fricker P A
Published: July 2002

Stress fractures of the clavicle are rare. This is the report of one such fracture in a 10 year old female gymnast, who presented with a six week history of medial clavicular pain. Radiographs and a computed tomography scan showed an undisplaced fracture through the medial third of the clavicle extending inferiorly to the rhomboid fossa in the inferior aspect of the clavicle. Pathological fracture was excluded by magnetic resonance imaging. The patient was treated conservatively and was able to return to full training eight weeks later.
Soccer specific aerobic endurance training
Authors: Hoff J , Wisløff U , Engen L C , Kemi O J , Helgerud J
Published: July 2002

Background:In professional soccer, a significant amount of training time is used to improve players' aerobic capacity. However, it is not known whether soccer specific training fulfils the criterion of effective endurance training to improve maximal oxygen uptake, namely an exercise intensity of 90–95% of maximal heart rate in periods of three to eight minutes.

Objective:To determine whether ball dribbling and small group play are appropriate activities for interval training, and whether heart rate in soccer specific training is a valid measure of actual work intensity.

Methods:Six well trained first division soccer players took part in the study. To test whether soccer specific training was effective interval training, players ran in a specially designed dribbling track, as well as participating in small group play (five a side). Laboratory tests were carried out to establish the relation between heart rate and oxygen uptake while running on a treadmill. Corresponding measurements were made on the soccer field using a portable system for measuring oxygen uptake.

Results:Exercise intensity during small group play was 91.3% of maximal heart rate or 84.5% of maximal oxygen uptake. Corresponding values using a dribbling track were 93.5% and 91.7%. No higher heart rate was observed during soccer training.

Conclusions:Soccer specific exercise using ball dribbling or small group play may be performed as aerobic interval training. Heart rate monitoring during soccer specific exercise is a valid indicator of actual exercise intensity.
Variable phenotypic presentation of iron overload in H63D homozygotes: are genetic modifiers the cause?
Authors: Aguilar-Martinez P , Bismuth M , Picot M C , Thelcide C , Pageaux G-P , Blanc F , Blanc P , Schved J-F , Larrey D
Published: July 2002

BACKGROUND

First considered as a polymorphism of the HFEgene, the H63D mutation is now widely recognised as a haemochromatosis associated allele. But few H63D homozygotes with clinical manifestations of hereditary haemochromatosis (HH) have been reported. Concurrently, an increasing number of genes have been shown to interact with HFE in iron metabolism.

AIMS

To describe the clinical expression of iron overload (IO) associated with H63D homozygosity, and search for potential genetic modifiers (within theHFE or other genes) that could explain the variability of the phenotypes.

PATIENTS AND METHODS

We retrospectively analysed the clinical phenotype of 56 H63D homozygotes referred for a personal or family history of IO. For each subject we examined intragenicHFE haplotypes and transferrin receptor (TfR) gene polymorphisms and searched for the Y250X mutation on the TFR2 gene. Additionally, we sequenced theHFE gene of H63D homozygotes with HH.

RESULTS

Fifty of 56 subjects had biological and/or clinical abnormalities of iron metabolism. Up to two thirds of patients (n=34) had no acquired cause of IO. Among these, 12 had a phenotypic diagnosis of HH. In the iron loaded group there was a strong prevalence of male patients. No correlation was found between the potential genetic modifiers and phenotypes. No additional mutation of HFEwas identified.

CONCLUSION

The variable phenotypes associated with H63D homozygosity do not appear to be linked to other HFE mutations, to the TFR2 Y250X mutation, or to HFE or TfR gene intragenic polymorphisms. The exact role of H63D homozygosity in IO and HH needs to be further investigated in unselected populations.
Impact of interferon therapy on the natural history of hepatitis C virus related cirrhosis
Authors: Gramenzi A , Andreone P , Fiorino S , Cammà C , Giunta M , Magalotti D , Cursaro C , Calabrese C , Arienti V , Rossi C , Di Febo G , Zoli M , Craxì A , Gasbarrini G , Bernardi M
Published: July 2002

BACKGROUND

The role of interferon treatment on the natural history of hepatitis C virus related cirrhosis is under debate.

AIM

To evaluate the effect of interferon on the clinical course of compensated hepatitis C virus related cirrhosis.

PATIENTS AND METHODS

Seventy two cirrhotic patients treated with interferon and 72 untreated controls matched treated patients with for quinquennia of age, sex, and Child-Pugh's score were enrolled in a prospective non-randomised controlled trial. Treated patients received leucocytic interferon alfa, with an escalating schedule for 12 months. The incidence and risk (Cox regression analysis) of clinical complications (hepatocellular carcinoma, ascites, jaundice, variceal bleeding, and encephalopathy) and death were calculated.

RESULTS

Over median follow up periods of 55 months for treated and 58 for untreated subjects, seven and nine patients, respectively, died, and 20 and 32, respectively, developed at least one clinical complication (ns). Hepatocellular carcinoma developed in six treated and 19 untreated patients (p=0.018). Seven treated patients showed sustained aminotranferase normalisation and none died or developed complications. Clinical complications were significantly associated with low albumin, bilirubin, and prothrombin activity while hepatocellular carcinoma was significantly related to no treatment with interferon, oesophageal varices, and high α fetoprotein levels. By stratified analysis, the beneficial effect of interferon was statistically evident only in patients with baseline α fetoprotein levels ⩾20 ng/ml.

CONCLUSIONS

Interferon does not seem to affect overall or event free survival of patients with hepatitis C virus related cirrhosis while it seems to prevent the development of hepatocellular carcinoma. Patients who achieved sustained aminotransferase normalisation survived and did not develop any complications during follow up.
Evaluation of a new amplified enzyme immunoassay (EIA) for the detection ofChlamydia trachomatisin male urine, female endocervical swab, and patient obtained vaginal swab specimens
Authors: Tanaka Masatoshi , Nakayama Hiroshi , Sagiyama Kazuyuki , Haraoka Masashi , Yoshida Hiroshi , Hagiwara Toshikatsu , Akazawa Kohei , Naito Seiji
Published: July 2002

Aims—To compare the performance of a new generation dual amplified enzyme immunoassay (EIA) with a molecular method for the diagnosis ofChlamydia trachomatis,using a range of urogenital samples, and to assess the reliability of testing self collected vaginal specimens compared with clinician collected vaginal specimens.

Methods—Two population groups were tested. For the first population group, first void urine samples were collected from 193 male patients with urethritis, and endocervical swabs were collected from 187 high risk commercial sex workers. All urine and endocervical specimens were tested by a conventional assay (IDEIA chlamydia), a new generation amplified immunoassay (IDEIA PCE chlamydia), and the Amplicor polymerase chain reaction (PCR). Discrepant results obtained among the three sample types were confirmed using a nested PCR test with a different plasmid target region. For the second population group, four swab specimens, including one patient obtained vaginal swab, two clinician obtained endocervical swabs, and one clinician obtained vaginal swab, were collected from 91 high risk sex workers. Self collected and clinician collected vaginal swabs were tested by IDEIA PCE chlamydia. Clinician obtained endocervical swabs were assayed by IDEIA PCE chlamydia and Amplicor PCR.

Results—The performance of the IDEIA PCE chlamydia test was comparable to that of the Amplicor PCR test when male urine and female endocervical swab specimens were analysed. The relative sensitivities of IDEIA, IDEIA PCE, and Amplicor PCR on male first void urine specimens were 79.3%, 91.4%, and 100%, respectively. The relative sensitivities of the three tests on female endocervical specimens were 85.0%, 95.0%, and 100%, respectively. The positivity rates for patient collected vaginal specimens and clinician collected vaginal specimens by IDEIA PCE were 25.2% and 23.1%, respectively, whereas those for clinician collected endocervical swabs by PCR and IDEIA PCE were both 27.5%.

Conclusions—IDEIA PCE chlamydia is a lower cost but sensitive alternative test to PCR for testing male urine samples and female endocervical swabs. In addition, self collected or clinician collected vaginal specimens tested by IDEIA PCE chlamydia are a reliable alternative to analysing endocervical specimens.
Should local research ethics committees monitor research they have approved?
Authors: Pickworth Emma
Published: July 2002

The function of local research ethics committees is to consider the ethics of research proposals using human participants. After approval has been given, there is no comprehensive system in place to monitor research and ensure that recommendations are carried out. Some suggest that research ethics committees are ideally placed to fulfil this function by carrying out random monitoring of research they have reviewed. The health service guideline creating local research ethics committees is under review.1This paper suggests that increasing the monitoring role of ethics committees in the present climate would be inappropriate. This is due to the large workload of the committees, their voluntary nature and the change a monitoring role might cause to the relationship between researcher and ethics committee, which might herald an increasing recourse to judicial review. A radical overhaul of the system would be necessary in order for ethics committees adequately to fulfil a monitoring function.
Interpretations, perspectives and intentions in surrogate motherhood
Authors: van Zyl Liezl , van Niekerk Anton
Published: July 2002

In this paper we examine the questions “What does it mean to be a surrogate mother?” and “What would be an appropriate perspective for a surrogate mother to have on her pregnancy?” In response to the objection that such contracts are alienating or dehumanising since they require women to suppress their evolving perspective on their pregnancies, liberal supporters of surrogate motherhood argue that the freedom to contract includes the freedom to enter a contract to bear a child for an infertile couple. After entering the contract the surrogate may not be free to interpret her pregnancy as that of a non-surrogate mother, but there is more than one appropriate way of interpreting one's pregnancy. To restrict or ban surrogacy contracts would be to prohibit women from making other particular interpretations of their pregnancies they may wish to make, requiring them to live up to a culturally constituted image of ideal motherhood. We examine three interpretations of a “surrogate pregnancy” that are implicit in the views and arguments put forward by ethicists, surrogacy agencies, and surrogate mothers themselves. We hope to show that our concern in this regard goes beyond the view that surrogacy contracts deny or suppress the natural, instinctive or conventional interpretation of pregnancy.
Prophylactic interventions on children: balancing human rights with public health
Authors: Hodges F M , Svoboda J S , Van Howe R S
Published: July 2002

Bioethics committees have issued guidelines that medical interventions should be permissible only in cases of clinically verifiable disease, deformity, or injury. Furthermore, once the existence of one or more of these requirements has been proven, the proposed therapeutic procedure must reasonably be expected to result in a net benefit to the patient. As an exception to this rule, some prophylactic interventions might be performed on individuals “in their best interests” or with the aim of averting an urgent and potentially calamitous public health danger. In order to invoke these exceptions, a stringent set of criteria must first be satisfied. Additionally, where the proposed prophylactic intervention is intended for children, who are unlikely to be able to provide a meaningfully informed consent, a heightened scrutiny of any such measures is required. We argue that children should not be subjected to prophylactic interventions “in their best interests” or for public health reasons when there exist effective and conservative alternative interventions, such as behavioural modification, that individuals could employ as competent adolescents or adults to avoid adverse health outcomes. Applying these criteria, we consider the specific examples of prophylactic mastectomy, immunisations, cosmetic ear surgery, and circumcision.
Medical Humanities at the University of Wales Swansea
Authors: Evans Martyn , Greaves David
Published: July 2002

The UK's first taught master's degree in medical humanities involves a field of inquiry that is frequently philosophical, pursuing interests and questions traditionally arising in medical philosophy and ethics, but on a larger interdisciplinary canvas, drawing upon literature and the visual arts, sociology and anthropology, social history and politics, and theological and religious perspectives.
Becoming a doctor
Authors: Finlay Sarah Elise , Fawzy Monica
Published: July 2002

Medical training cannot be equated with merely studying for a degree. It encompasses much more, challenging one's values, self perception and perspective on life itself. During five years at medical school, the individual irreversibly alters to become “a medic”, not just “a student of medicine”, no matter how much detachment from the course and its associated lifestyle the individual has endeavoured to preserve. In the following article, we intend to explore the different stages of training and discuss how each shapes the student. “Becoming a medic” intellectually, emotionally and spiritually is the inevitable consequence of spending five years at medical school, and the assumption of this role is indeed crucial to survival in medical practice. The importance of bringing our own individual qualities to the profession must, however, not be overlooked. Personal flair and abilities should be nurtured, not suppressed during medical school. A diversity of interests serves both to ease the pressures laid upon us at medical school, and to broaden our characters and deepen our understanding of humanity. Medical students, while necessarily adapting to the role of a doctor, should emerge from their training not as narrow “medics” but as enthusiastic, compassionate people equipped to treat patients to the best of their ability.
Qu'un souffle de vent: an exploration of anorexia nervosa
Authors: Giordano S
Published: July 2002

The spread of anorexia nervosa, especially in Western developed countries, is reaching alarming proportions. According to theInternational Classification of Diseases, the central feature of anorexia nervosa is “deliberate weight loss”. This means that anorexia nervosa is a progressivepursuit of lightness. Moving from this observation, I ask why so many people want tolose weight, why some would die, rather thanput on weight. In order to understand whatvaluethese people attach to lightness, I look at contexts where lightness is typically celebrated (music, literature, and arts) and provide an analysis of anorexia nervosa, using both theoretical reflection and empirical observations. This analysis shows that anorexia is much more than a pattern of psychiatric symptoms, and much more than unintelligible behaviour. Anorexic behaviour is insteadmeaningful and coherentbehaviour, andexpressesethical values that are deeply rooted in Western culture.
Body image and the innocent eye
Authors: Sirridge M , Welch K
Published: July 2002

This paper describes the development, content, teaching experience, and impact of the course “The body image in medicine and the arts” which is offered annually in a one-month format for medical students and other upper division students at the University of Missouri-Kansas City (UMKC). Literature, photography, art, anthropology, art history, cultural studies, feminism, modernism, and medicine are all employed in the course as a way of encouraging students to consider the broader cultural interpretations of the human body. Any medical humanities instructor wishing to explore new ideas and themes related to teaching students about past and present body image issues and their impact on contemporary biomedical culture can gain insight through an overview of this course. The purpose of the course is to allow medical students a forum for talking more personally and metaphorically about thebodyas a cultural concept. The teaching faculty involved in this course believe that the majority of students who participate in this class complete it more acutely aware than before of the fact that no single human being, even a “good, caring” doctor, can see with an “innocent eye”. The accomplishment of this goal alone justifies faculty participation in the course.
Escape or instruction? A description of a seminar for general practitioners on literature and medicine
Authors: Elliott C , Misselbrook D
Published: July 2002

We describe the planning and running of a seminar on medicine and literature for general practitioners. This was based on the educational principles of adult learning. We used academic papers, an extract from a novel, a short story, and a cartoon and asked participants to present a piece of literature of their choice. Although the general practitioners (GPs) had not been selected for their specific interest in this area, there was great enthusiasm for this field. Most of the GPs thought literature could contribute to their professional lives and also could be useful for teaching
The role of physical and psychological factors in occupational low back pain: a prospective cohort study
Authors: Feyer Anne-Marie , Herbison Peter , Williamson Ann M , de Silva Indira , Mandryk John , Hendrie Leigh , Hely Max C G
Published: July 2002

OBJECTIVE

To examine risk factors for onset of low back pain (LBP) in healthcare workers.

METHODS

Nursing students, during their 3 year training period, and 1 year after training were studied in a prospective cohort study, with repeated self reported measurements of determinants of LBP at 6 monthly intervals for 3 years during training, and after a 12 month interval there was an additional final follow up.

RESULTS

During training, increased risk of new episodes of LBP was associated with having had LBP at baseline, with part time work, and with a high score on the general health questionnaire (GHQ). A high GHQ score preceded the onset of LBP, in such a way that a high score at the immediately previous follow up increased risk of LBP at the next follow up. 12 Months after training, a history of recurring LBP during training increased the risk of a new episode as did having obtained work as a nurse. A high GHQ score at this follow up was also associated with a concurrently increased risk. Pre-existing GHQ score, either at the end of training or at baseline, had no effect on risk of LBP 12 months after training.

CONCLUSIONS

Other than a history of LBP, pre-existing psychological distress was the only factor found to have a pre-existing influence on new episodes of LBP. Increased levels of psychological distress (as measured by the GHQ) preceded the occurrence of new episodes of pain by only short intervening periods, implying a role for acute distress in the onset of the disorder. This finding suggests that management of the onset of occupational LBP may be improved by management of psychological distress.
Health complaints and immunological markers of exposure to bioaerosols among biowaste collectors and compost workers
Authors: Bünger Jürgen , Antlauf-Lammers Michael , Schulz Thomas G , Westphal Götz A , Müller Michael M , Ruhnau Peter , Hallier Ernst
Published: July 2002

OBJECTIVES

In a cross sectional study, work related health complaints and diseases of 58 compost workers and 53 biowaste collectors were investigated and compared with 40 control subjects. Levels of specific IgG antibodies to moulds and bacteria were measured as immunological markers of exposure to bioaerosols.

METHODS

With a standardised protocol, the participants of the study were interviewed for work related symptoms, conditions of exposure to bioaerosols at their workplaces, exposure to bioaerosols from other sources, atopic diseases, and smoking habits. They were clinically examined by physicians specialised in occupational medicine. Also, concentrations of specific IgG antibodies against antigens of moulds and actinomycetes occurring regularly at these workplaces were measured and compared with the health complaints of the workers.

RESULTS

Compost workers had significantly more symptoms and diseases of the airways (p=0.003) and the skin (p=0.02) than the control subjects. Health complaints of biowaste collectors did not differ significantly from those of the control group. Subjects with atopic diseases were underrepresented in the compost workers (p=0.003). Significantly increased antibody concentrations against fungi and actinomycetes were measured in workers at composting plants. The concentrations in biowaste collectors did not differ significantly from those in the control subjects. A significant association between the diseases and increased antibody concentrations were found in the compost workers.

CONCLUSION

The high exposure to bioaerosols of compost workers is significantly associated with a higher frequency of health complaints and diseases as well as higher concentrations of specific antibodies against moulds and actinomycetes. A healthy worker effect is indicated by the underrepresentation of atopic diseases among the compost workers compared with biowaste collectors and the control group.
How is sex considered in recent epidemiological publications on occupational risks?
Authors: Niedhammer Isabelle , Saurel-Cubizolles Marie-Josèphe , Piciotti Michèle , Bonenfant Sébastien
Published: July 2002

OBJECTIVES

Although women account for almost half the working population in industrialised countries, a sex bias persists in publications on medical research in general and occupational health in particular. The objective was to review recent publications on how sex is considered in epidemiological studies of occupational health, and to answer the following questions: are men and women studied equally, what are the respective characteristics of the studies which comprise only men, only women, and both, and what strategy of data analysis is chosen by the authors to take account of the sex factor in mixed studies.

MATERIALS

This review was based on publications in six journals during the year 1997, and included all the original articles reporting an epidemiological study of occupational health.

RESULTS

In all, 348 articles were reviewed. In 40 articles (11%), the sex of the study population was not specified. In 177 articles (51%), the study population was mixed. In 108 (31%), the population consisted exclusively of men, and in only 23 (7%), exclusively of women. Even when study populations were mixed, they included fewer women than men. The sex composition of the population was related to the occupational risk factor considered, and also to health outcome. Industrial sector workers, and exposure to chemicals were more likely to be studied in samples of men. Mortality and health outcomes such as neoplasms and cardiovascular diseases were also more often studied among men. Surprisingly, study design differed significantly according to the sex of the population, and prospective studies, cohort studies, and exposed versus non-exposed studies were more often carried out in samples of men. Among the 177 mixed studies, sex was not investigated in over a quarter (27%). In 26 articles (15%), sex was not taken into account, but the authors attempted to justify this decision. In 46 mixed studies (26%), the results were adjusted for sex, and in 46 (26%), the authors gave separate results for men and women. In 11 studies (6%), more complete strategies of data analysis were chosen, including research for interactions or adjustment, followed by stratification.

CONCLUSION

This review of recent publications in occupational health epidemiology showed that women are still less often studied than men, and that the sex factor is not investigated in many mixed studies. The results therefore underline the need for further research on occupational hazards among women, and on sex differences.
Exposure to organic solvents and personality
Authors: Chen R , Dick F , Semple S , Seaton A , Walker L G
Published: July 2002

OBJECTIVES

Although cognitive and neuropsychological changes have been found after high cumulative exposures to solvents, it is not clear whether such exposures are associated with personality characteristics. To study this two groups of British and Chinese dockyard painters who had been heavily exposed to paint solvents have been investigated.

METHODS

260 Male dockyard painters in the United Kingdom, 539 local community controls, 109 Chinese dockyard painters, and 255 dockyard controls completed the Eysenck personality questionnaire, neuroticism (N) and social conformity or dissimulation (L) scales. The non-parametric Kruskal-Wallis test was used to evaluate differences in scores of personality traits between painters and controls. Adjusted relative risks for painters having high N and L scores were calculated in a Breslow-Cox regression analysis, and exposure-response relations were examined in multivariate logistic regression analysis. Non-parametric Spearman's correlation was used to examine relations between previously determined neuropsychological symptoms and personality.

RESULTS

Both British and Chinese data showed that mean neuroticism scores of painters were significantly higher than controls, whereas scores of social conformity did not differ. Relative risk of being a painter increased significantly with increasing N scores, but L scores showed no such trend. In a case-control analysis, there were significant exposure-response relations for the N score. In the United Kingdom the odds ratios (ORs) (95% confidence interval (95% CI), were 2.03 (0.79 to 5.22) for 1–4 years of exposure, 2.38 (0.82 to 6.91) for 5–9 years, 7.05 (1.27 to 39.25) for 10–14 years, and 1.76 (0.63 to 4.89) for 15–41 years. In the Chinese painters, ORs were 4.66 (1.38 to 15.75) for 2–14 years, 10.03 (2.96 to 34.04) for 15–18 years, and 13.56 (3.78 to 48.59) for 19–43 years. Neuroticism was significantly positively related to neuropsychological symptoms in all subjects. Social conformity showed no association with neuropsychological symptoms in British painters and a negative relation among the Chinese painters.

CONCLUSION

Increasing symptoms suggesting neuroticism seemed to relate to the duration of painting whereas scores for social conformity and dissimulation did not. The relation between exposure time and response suggests that increased neuroticism may be caused by long term occupational exposure to organic solvents.
An epidemiological study of the relations between exposure to organophosphate pesticides and indices of chronic peripheral neuropathy and neuropsychological abnormalities in sheep farmers and dippers
Authors: Pilkington A , Buchanan D , Jamal G A , Gillham R , Hansen S , Kidd M , Hurley J F , Soutar C A
Published: July 2002

OBJECTIVES

To investigate the hypothesis that chronic low level exposure to organophosphates (OPs) in sheep dips is related to clinically detectable measures of polyneuropathy.

METHODS

The design was a cross sectional exposure-response study of sheep dippers and other non-exposed groups. The study group consisted of 612 sheep dipping farmers, 53 farmers with no sheep dipping experience, and 107 ceramics workers. Retrospective exposure information was obtained by questionnaire based on stable and easily identifiable features of sheep dipping found during the first phase of the study; in particular, estimates of handling concentrate and splashing with dilute dip. Neurological assessments were based on a standard neuropathy symptoms questionnaire, and thermal and vibration quantitative sensory tests.

RESULTS

Adjusted for confounders there was a weak positive association between cumulative exposure to OPs and neurological symptoms, the significance of which was dependent on the inclusion of a few individual workers with extremely high exposure. There was no evidence of an association between cumulative exposure and the thermal or vibration sensory thresholds. However, separating the effects of exposure intensity and duration showed a higher prevalence of symptoms, primarily of a sensory type, among sheep dippers who handled the OP concentrate. There was also evidence that sensory and vibration thresholds were higher among concentrate handlers, the highest exposed group of dippers.

CONCLUSIONS

The findings showed a strong association between exposure to OP concentrate and neurological symptoms, but a less consistent association with sensory thresholds. There was only weak evidence of a chronic effect of low dose cumulative exposure to OPs. It is suggested that long term health effects may occur in at least some sheep dippers exposed to OPs over a working life, although the mechanisms are unclear.
Hospital admissions among male drivers in Denmark
Authors: Hannerz H , Tüchsen F
Published: July 2002

OBJECTIVES

To facilitate decisions about interventions and to establish baseline values for future evaluation of preventive efforts, the aim of the present study was to elucidate the disease pattern among male professional drivers in Denmark. The study differentiated between drivers of goods vehicles and drivers of passenger transport.

METHODS

Cohorts of all 20–59 year old Danish male professional drivers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardised hospital admission ratios (SHRs) and time trends (1981–97) for many diagnostic aggregations.

RESULTS

SHRs for diseases in practically all systems and organs of the body were higher among professional drivers than they were in the male working population at large. Also drivers of passenger transport, compared with drivers of goods vehicles, had significantly high SHRs due to infectious and parasitic diseases, diseases of the circulatory system, and diseases of the respiratory system, and significantly lower rates of injury. For both driver groups, the SHRs for acute myocardial infarction increased with time whereas the SHR for acute gastritis decreased, and for drivers of passenger transport an increasing SHR for chronic obstructive pulmonary disease, was found over time.

CONCLUSION

Drivers of passenger transport and drivers of goods vehicles differ in their disease patterns. The results support the hypothesis that preventive efforts are needed in both groups, but underline that different strategies are required for different categories of drivers.
Health and exposures of United Kingdom Gulf war veterans. Part I: The pattern and extent of ill health
Authors: Cherry N , Creed F , Silman A , Dunn G , Baxter D , Smedley J , Taylor S , Macfarlane G J
Published: July 2002

OBJECTIVES

To assess the health of United Kingdom Gulf war veterans, to compare their health to that of similar personnel not deployed, to describe patterns of ill health in both groups, and to estimate their extent.

METHODS

Main Gulf (n=4795) and validation Gulf (n=4793) cohorts were randomly selected within strata from the population deployed to the Gulf and a non-Gulf cohort (n=4790) from those who were not sent. Seven years after the war subjects completed a questionnaire about their health in the past month, including 95 symptom questions and two manikins on which to shade areas of pain or numbness and tingling. Responses were subjected to a principal component analysis with rotation and to a cluster analysis within each cohort. Mean symptom score was used as a measure of severity. Areas shaded on the manikins were coded to indicate widespread pain and possible toxic neuropathy.

RESULTS

A response of 85.5% was achieved. Those who had been to the Gulf were more troubled by every symptom with a mean severity score (3.0) substantially greater than in the non-Gulf cohort (1.7). Seven factors were extracted accounting for 48% of the variance. The scores on five factors (labelled psychological, peripheral, respiratory, gastrointestinal, and concentration) were significantly worse in those who had been to the Gulf. Symptoms suggestive of peripheral neuropathy were found more often (12.5%) in the Gulf than the non-Gulf (6.8%) cohorts. Widespread pain was also found more often (12.2% Gulf; 6.5% non-Gulf). Those who had been to the Gulf were found disproportionately (23.8%) in three clusters with high mean severity scores; only 9.8% of non-Gulf respondents were in these clusters. There was no evidence of an important excess in the use of alcohol, tobacco, or referral to hospital specialists by those who had been to the Gulf. For the same level of reported ill health those who had been to the Gulf were less likely to be referred to specialists than non-Gulf veterans.

CONCLUSION

7 Years after the war, the Gulf war veterans were more troubled about their health than those who had not been sent, with a substantial subgroup reporting a pattern of symptoms suggestive of a significant decline in health.