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  1. Keith Palmer, Editor

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    Occupational eye injuries are an important avoidable source of morbidity. Mancini et al1 have investigated the effectiveness of a prevention campaign, conducted with local employers’ associations and trades unions, and aimed at 237 metal craft factories in Imola, Italy. The interventions included primary control measures, aid in selecting personal protective equipment, educational booklets, and media publicity by experts in the field. Eye injury rates were assessed in the four years before intervention, the two years around intervention, and over an extended follow up that spanned the next decade. A substantial reduction in eye injury rates was found following the main intervention. The authors suggest that careful and comprehensive programmes can have an impact on the burden of work related eye injuries. An accompanying editorial2 discusses the importance of observational research in evaluating such interventions.

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    The proportion of patients with acute back pain who develop a chronic state varies over a range of 16-fold. To investigate the factors underlying such variation, Steenstra et al3 have conducted a systematic review of studies of return to work in those sick listed with acute low back pain. Inception cohorts with symptoms lasting <6 weeks at the onset of sick leave were included. Among the 18 publications (14 cohorts) that met the inclusion criteria, 79 prognostic factors in eight grouped categories were investigated. Long duration of sick leave was associated with “specific” low back pain, being female or older, social dysfunction, social isolation, heavier work, and receiving compensation. The role of psychosocial factors proved challenging to assess, however, as the measured constructs often differed between studies.

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    Are people who stand or walk for much of the day hospitalised more often for varicose veins? To assess this a random sample of over 8600 working aged adults from a national population register were interviewed by telephone; risk rates for hospitalisation were estimated with adjustment for various factors including body mass index, lifting, and (in women) parity.4 The outcome was ascertained by record linkage between three national registers, with follow up extended over 12 years. The pooled estimate of relative risk for those standing ⩾75% of the time versus less was 1.8 (95% CI 1.2–2.7), an estimated aetiological fraction of about 23%. The study did not identify a threshold limit for occupational standing, and a practical need remains for research to address this question.

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    Dichlorodiphenyl trichloroethane (DDT) and its major stable metabolite DDE are structurally similar to oestrogens. Concerns about their capacity to cause reproductive effects has led to their ban for wide scale use in many countries and settings. The effect of DDT on age at menarche and length of menstrual cycle has rarely been studied. Ouyang et al5 take up this problem in a cross-sectional study in young newly married nulliparous Chinese textile workers. Serum DDT levels were measured in participants, who were interviewed regarding their menstrual history. Relative to those in the lowest quartile of serum DDT, the adjusted mean age at menarche was shortened in the top quartile by more than a year, while the odds of having a short menstrual cycle in the past 12 months were increased nearly threefold. Interpretation is tempered by a number of caveats, but the study offers further cause for concern regarding these chemical exposures.

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