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  1. Keith Palmer, Editor

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    The relation between twin pregnancies and environmental exposures has rarely been investigated. However, the study by Obi-Osius et al (p. 482) adds to a small but growing body of evidence that twinning rates may be higher in residents living near toxic waste incinerators. The frequency of twinning was compared in different municipalities of Hess, Germany by two different means: a cross-sectional interview of mothers (and children) to obtain a lifetime residency and reproductive history, and a separate analysis of some 20 600 births coded using the HEPS (Hessian Perinatal Study) birth records database. In each investigation, mothers were classified according to their place of residence. As judged by interviews, twinning was two to three times more common in women living near a toxic waste incinerator, while in the study of birth records the incidence of twinning was almost twice as high (1.4–1.6 v 0.8 per 100 births). Higher rates of twinning have previously been reported in studies from Scotland and Belgium, but no association was found in a Swedish survey. The mechanism of effect remains conjectural, but endocrine disruption might play a part, conceivably through increased dizygotic twinning.

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    A review by Soutar et al (p. 477), following 38 years of data collection in the British coal industry (the Pneumoconiosis Field Research), summarises the most recent estimates of exposure-response for damaging respiratory effects of coal dust. The outcomes reviewed include simple pneumoconiosis, progressive massive fibrosis, impaired FEV1, and category II silicosis. Soutar et al suggest that control standards in the mines sufficient to avoid category II simple pneumoconiosis should prevent most other adverse respiratory outcomes, but that stricter controls are required when the dust is rich in silica.

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    Over the French network some 500 to 600 “person under the train” accidents occur annually. Cothereau et al (p. 488) have investigated the consequences to the mental health of 202 train drivers involved in such incidents, using 186 other train drivers as a comparator. Some 4% were deemed to have post-traumatic stress disorder at their first post-incident evaluation. They also had worse GHQ-28 scores than controls overall (score ⩾ 5, 32% v 6%), and for subscales measuring somatic and anxiety symptoms, sleep disturbance, and impaired psychosocial functioning. In spite of this, over 95% remained fit to drive and no difference from controls was found at follow up a year later. It seems that drivers’ careers are not wrecked, despite their frightful experience.

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    A great deal of public concern has been voiced over the potential hidden health effects of new technology. One much publicised anxiety concerns the risk in mobile phone users of cancers of the head and neck. Evidence of even a small additional risk would have great public health significance, given the high prevalence of exposure. As Kundi puts it (p. 560), “Never before in history has a device been used that exposes such a great proportion of the population to microwaves in the near field and at comparatively high levels”. But as the author also points out, any potential harm needs to be weighed against the lives saved by mobile phone calls in emergency situations. Should mobile phone users be concerned? Read Kundi’s review and draw your own conclusions. Phone a friend if you wish, and tell them about the review and its findings.

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    This month’s journal also features a survey of occupational injury rates among 10–14 year olds working under circumstances not covered by existing child labour laws; a prospective cohort study of neck pain in VDU users; a report on oxidative stress in workers who stand a lot occupationally; a prospective cohort study estimating exposure-response relationships for work related respiratory symptoms in bakers exposed to α-amylase; and a survey of work related violence in nurses from Minnesota.

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