“Job strain” may be associated with unhealthy diet pattern, which
usually includes high sodium intake—a major risk factor of hypertension.
Moreover, high sodium intake is always associated with high fat and high
energy intake, and further associated with high BMI level.
Therefore, it would be interesting to see whether there is any
association between “Job constraints” and overweight among th...
“Job strain” may be associated with unhealthy diet pattern, which
usually includes high sodium intake—a major risk factor of hypertension.
Moreover, high sodium intake is always associated with high fat and high
energy intake, and further associated with high BMI level.
Therefore, it would be interesting to see whether there is any
association between “Job constraints” and overweight among the subjects in
this study.[1]
Reference
1. Radi, S., et al., Job constraints and arterial hypertension:
different effects in men and women: the IHPAF II case control study. Occup
Environ Med, 2005. 62(10): p. 711-7.
Dr Loomis draws attention to the potential dangers of the rigid use
of checklists and guidelines to judge occupational and environmental
research. I agree with these sentiments, in particular the concerns about
the increasing number of papers that use compliance with these guidelines
as a justification for conclusions regarding causality. There is, however,
one rapidly expanding area of research that...
Dr Loomis draws attention to the potential dangers of the rigid use
of checklists and guidelines to judge occupational and environmental
research. I agree with these sentiments, in particular the concerns about
the increasing number of papers that use compliance with these guidelines
as a justification for conclusions regarding causality. There is, however,
one rapidly expanding area of research that would benefit from the
development of minimum standards for presentation of results. This is the
field of epidemiological meta-analysis, in which data are generally
abstracted from published papers. Difficulties can arise in deriving a
common set of definitions for variables. For example, in a meta-analysis
of oral contraceptive use and breast cancer risk,[1] 42 different
categorisations of duration of oral contraceptive use were published in
the 24 papers analysed for this variable. Debate within the scientific
community is needed to decide categorisations that are most useful.
Editors could then encourage authors either to use these in their papers
or at least be prepared to make them available on request.
Reference
1. Rushton L, Jones DR. Oral contraceptive use and breast cancer
risk: a meta-analysis of variations with age at diagnosis, parity and
total duration of oral contraceptive use. Br J Obs Gyn 1992;99:239-246.
We thank Mr. Wenbin Liang for comments on our paper.
The first part of the comments concerned criticism on our Figure 1
and handling of exposure data. Our
Figure 1 is a schematic drawing. It was aimed only to portray how the
explanatory variables precede the response variables in our two-stage
model. The purpose of our study was not to investigate does "dust exposure
increase the risk of IHD a...
We thank Mr. Wenbin Liang for comments on our paper.
The first part of the comments concerned criticism on our Figure 1
and handling of exposure data. Our
Figure 1 is a schematic drawing. It was aimed only to portray how the
explanatory variables precede the response variables in our two-stage
model. The purpose of our study was not to investigate does "dust exposure
increase the risk of IHD among patients who already had respiratory
diseases". Therefore, the figure was not intended to express that
question. The aim of our study was concentrated on the intermediate role
of the respiratory diseases in the association of dust exposure with IHD.
To predict IHD with the two-stage model we first used respiratory diseases
and dust exposure as explanatory variables. Second, we studied respiratory
diseases as response variables. The respiratory disease and exposure
variables were time dependent in the model predicting IHD just due to the
importance of the timing.
All the cohort members have been followed up until the end of the
whole follow-up period. Although the workers had moved to other jobs,
e.g., to those of lower dust exposure, they remained in our cohort.
Lifelong occupational histories (including confounding exposures) were
collected via questionnaires. In the model, cumulative exposure to dust
was considered until the diagnosis date of ischaemic heart disease (IHD)
regardless of the diagnosis date of any respiratory disease. In the model
where respiratory diseases were predicted, exposure was considered only
until the occurrence of each respiratory disease.
Changing out of dusty jobs does not remove the effect of earlier dust
exposure on IHD as well as on respiratory diseases, because both of these
diseases have developed as disease processes and are continuously
developing. The date of diagnosis is just one time point during the
development. In addition, some of the workers with a respiratory disease
had continued working in their dusty jobs.
Workers with a respiratory disease may have an increased risk to get
IHD due to an additional dust exposure after the respiratory disease
diagnosis. However, it is important to remember that those workers who
don't yet have a diagnosis but who are under the process to develop a
respiratory disease may have the same increased risk. Thus, it is more
reasonable to use the cumulative dust exposure up to the date of IHD
diagnosis. Further, if we had analyzed the exposure data only including
dust exposure after the diagnosis of a respiratory disease, the resulted
effect of dust exposure on IHD would have been small.
The most important reason for the observed small effect of dust
exposure on IHD seemed to be homogeneity in the exposure variable. This
has been thoroughly discussed in our article.
The second part of the comments concerned smoking. It is well known
that smoking is a great risk factor for both respiratory disease and IHD.
The following data on smoking were collected via questionnaires: age when
started to smoke and age when stopped, current smoking (amount of
cigarettes per day), lifelong smoking (amount of cigarettes per day,
smoking years). The comparison of the different smoking variables (tables
and models) showed that the classified variable lifelong smoking was the
most suitable for this material. Further, we have not reported any results
on the effect of interaction between smoking and respiratory diseases on
incidence of IHD. Of course we studied in the models interaction between
smoking and dust exposure as well as interaction between smoking and
different respiratory diseases but these interactions seemed to be non-
significant.
Chronic hand vibration exposure is now a well-described cause of
Raynaud's phenomenon. According to Palmer et al, it is estimated that
220,000 cases of Raynaud's phenomenon are attributable to vibration
exposure in Great Britain.[1] These epidemiological data, based on a
questionnaire, are considered reasonably accurate.[2] About 4.2 million
workers are exposed to hand transmitted vibration but the real...
Chronic hand vibration exposure is now a well-described cause of
Raynaud's phenomenon. According to Palmer et al, it is estimated that
220,000 cases of Raynaud's phenomenon are attributable to vibration
exposure in Great Britain.[1] These epidemiological data, based on a
questionnaire, are considered reasonably accurate.[2] About 4.2 million
workers are exposed to hand transmitted vibration but the real health and
economic impact is unknown.[3] More precise clinical data are therefore
necessary before implementing a large preventive program.
The hand-arm vibration syndrome encompass a wide range of disorders being
responsible for digital blanching and paresthesias.[4] Different vascular
problems such as a pure vasospastic phenomenon, a digital organic
microangiopathy or an occlusive arterial thrombosis can be observed. A
diffuse vibration neuropathy with mechanical skin receptors involvement or
a carpal tunnel syndrome are also often associated.[5] The relationship
between these neurovascular disorders is not clear but autonomic
dysfunction in carpal tunnel syndrome can induce a Raynaud's phenomenon
which is curable with surgery.[6] The prognosis of these neurovascular
troubles is dependant on the underlying trouble and cannot be evaluated
with a simple questionnaire. As no single test can reliably stage the
vascular and neurological component, the use of a battery of tests is
necessary. Digital capillaroscopy and plethysmography with nerve
conduction studies are recommended as the basic tests. Cold provocation
tests are effective for grading a pure vasospastic Raynaud's phenomenon
but is less reliable in other forms of vibration-induced white finger
explaining why this test is not always well correlated with the vascular
symptoms.[7][8] Doppler and duplex studies are useful to assess the
severity of an occlusive arterial disease.
Workers using hand-held vibrating tools are also exposed to diverse
environmental and occupational factors accounting for the wide clinical
spectra of the disease. Epidemiological studies have pointed out that the
prevalence of vibration-induced white finger is very wide, ranging from 0-
5% in warm climate to 80-100% in northern climate.[9] In the pure
vasospastic Raynaud's phenomenon, cold exposure is probably the most
important triggering factor and cold protection the most effective
preventive measure. In the case of digital blanching associated with
carpal tunnel syndrome, other ergonomic factors such as repetitive
forceful use of the hands are likely to play a dominant role and a
workplace ergonomic modification is indicated.[10] Hypothenar hammer
syndrome is a another frequent cause of digital blanching in mechanics and
carpenters requiring prevention of repetitive hand trauma.[11][12] For the
digital organic microangiopathy and the diffuse vibration neuropathy,
vibration exposure is the only identified factor and suppression of the
exposition is essential. In consequences, a detailed and precise clinical
diagnosis with objective tests is important to determine the real cause of
the vascular symptoms. The impact of vibration exposure on health will be
more precisely evaluated and prevention will be more effective.
1. Palmer KT, Griffin MJ, Syddall H, et al. Prevalence of Raynaud's
phenomenon in Great Britain and its relation to hand transmitted
vibration: a national postal survey. Occup Environ Med 2000;57:448-52.
2. Palmer KT, Haward B, Griffin MJ, et al. Validity of self reported
occupational exposures to hand transmitted and whole body vibration. Occup
Environ Med 2000;57:237-41.
3. Palmer KT, Griffin MJ, Bendall H, et al. Prevalence and pattern of
occupational exposure to hand transmitted vibration in Great Britain:
findings from a national survey. Occup Environ Med 2000;57:218-28.
4. Noel B. Pathophysiology and classification of the vibration white
finger. Int Arch Occup Environ Health 2000;73:150-5.
5. Stromberg T, Dahlin LB, Rosen I, et al. Neurophysiological findings in
vibration-exposed male workers. J Hand Surg [Br] 1999;24:203-9.
6. Verghese J, Galanopoulou AS, Herskovitz S. Autonomic dysfunction in
idiopathic carpal tunnel syndrome. Muscle Nerve 2000;23:1209-13.
7. McLafferty RB, Edwards JM, Ferris BL, et al. Raynaud's syndrome in
workers who use vibrating pneumatic air knives. J Vasc Surg 1999;30:1-7.
8. McGeoch KL, Gilmour WH. Cross sectional study of a workforce exposed to
hand-arm vibration: with objective tests and the Stockholm workshop
scales. Occup Environ Med 2000;57:35-42.
9. Bovenzi M. Exposure-response relationship in the hand-arm vibration
syndrome: an overview of current epidemiology research. Int Arch Occup
Environ Health 1998;71:509-19.
10. Gemne G. Diagnostics of hand-arm system disorders in workers who use
vibrating tools. Occup Environ Med 1997;54:90-5.
11. Little JM, Ferguson DA. The incidence of the hypothenar hammer
syndrome. Arch Surg 1972;105:684-5.
12. Ferris BL, Taylor LM Jr, Oyama K, et al. Hypothenar hammer syndrome:
proposed etiology. J Vasc Surg 2000 Jan;31:104-13.
The recent article by Vyas, et al.[1] raises some concerns to which I
would be grateful if they could respond.
1) In the abstract one of the objectives is stated as finding the
nature and incidence of symptoms experienced by a large sample of hospital
endoscopy nurses. The study design is cross-sectional and used an adapted
version of the MRC questionnaire for respiratory symptoms. This study
design normally re...
The recent article by Vyas, et al.[1] raises some concerns to which I
would be grateful if they could respond.
1) In the abstract one of the objectives is stated as finding the
nature and incidence of symptoms experienced by a large sample of hospital
endoscopy nurses. The study design is cross-sectional and used an adapted
version of the MRC questionnaire for respiratory symptoms. This study
design normally records disease prevalence rather than incidence.[2] It
would be helpful to know if the questionnaire sought information on new
symptoms in a given time period in the past, or the presence of symptoms.
2) For the purposes of the study, work related symptoms (WRSs) of
contact dermatitis were defined as contact skin rash, which occurred when
working on the endoscopy unit and could not be attributed to known non-occupational agents. It is not clear what validation process was performed
prior to using this section of the questionnaire in the study. The authors
have indicated that 8 of the 13 subjects with a positive test to IgE
specific to latex had WRSs of dermatitis, and indicate this is non-significant. The authors definition of contact dermatitis would have
resulted in staff with contact urticaria answering positively to this
section. As such, the presence of IgE specific to latex could well be of
significance as staff would have used latex gloves.
3) Cross-sectional studies are enhanced by the inclusion of ex-employees. In this study only 18 of 68 ex-employees participated in this
study. All 18 were among 26 staff who had left within the past five years
for health reasons. As such a selection bias exists and the interpretation
of the frequency of WRSs in ex-employees should be cautious. In addition, it is noted that 8 of the 18 ex-employees continue to work as
nurses and may experience WRSs from circumstances related to current
workplaces rather than endoscopy suites. The absence of a control group of
nurses working in areas without exposure to glutaraldehyde would have been
of help in interpreting the results obtained.
References
1. A Vyas, C A C Pickering, L A Oldham, H C Francis, A M Fletcher, T Merrett, and R McL Niven.
Survey of symptoms, respiratory function, and immunology and their relation to glutaraldehyde and other
occupational exposures among endoscopy nursing staff
Occup Environ Med 2000;57:752-759
2. Last JM. A Dictionary of Epidemiology. Oxford: Oxford
University Press, 1995
We thank Dr. Seilkop for his comment and have, in essence, not much
to
add to it. The study by Shannon et al.[1] had obviously been overlooked
and the study by Arena et al.[2] was published after our deadline
for the inclusion of studies.
Dr. Seilkop´s Table has errors for the study by Andersson et al.[3]
The number of
pacreatic cancer deaths should be 2; relative risk should be 1.2; and
95% conf...
We thank Dr. Seilkop for his comment and have, in essence, not much
to
add to it. The study by Shannon et al.[1] had obviously been overlooked
and the study by Arena et al.[2] was published after our deadline
for the inclusion of studies.
Dr. Seilkop´s Table has errors for the study by Andersson et al.[3]
The number of
pacreatic cancer deaths should be 2; relative risk should be 1.2; and
95% confidence interval should be 0.1 - 4.5.
References
1. Shannon HS, Walsh C, Jadon N, et al. Mortality of 11,500 nickel
workers - extended follow up and relationship to environmental
conditions. Toxicol Ind Health 1991;7:277-94.
2. Arena VC, Sussman NB, Redmond CK, et al. Using alternative
comparison populations to assess occupation-related mortality risk. J
Occup Environ Med 1998;40:907-16.
3.Andersson VC, Elinder CG, Hogstedt C, et al. Mortality among
cadmium
and nickel-exposed workers in a Swedish battery factory. Current Topics
in Environmental and Toxicological Chemmistry 1985;399-408.
As victims of bullying and proponents of emotional intelligence in
the health profession we read with interest your article on workplace
bullying.[1]
Kavimaki et al[1] did not mentioned whether the responses were
anonymous. Identified responses may underestimate the incidence of
bullying in the cohort. Given that previous studies (mentioned by the
authors in the discussion) have shown a consid...
As victims of bullying and proponents of emotional intelligence in
the health profession we read with interest your article on workplace
bullying.[1]
Kavimaki et al[1] did not mentioned whether the responses were
anonymous. Identified responses may underestimate the incidence of
bullying in the cohort. Given that previous studies (mentioned by the
authors in the discussion) have shown a considerable percentage of victims
deciding to resign as a result of bullying, it is a pity that the article
by Kivimaki et al did not contain similar data. The other two issues that should have been included were the duration of being bullied, and how many
bullies are actually are aware that they are bullies. These can be addressed by asking
the question: Have you subjected your colleagues to such bullying
behaviour?
With doctors and nurses constituting 58% of the victims, we wonder
whether the authors could reanalyse their data to see whether there is a
higher incidence of bullying in the high stress specialities such as adult
intensive care and neonatal intensive care.[2] We would also like to
know whether the victims in their study were offered any counselling by
their institutions, and if so, the nature and impact of the counselling.
Emotional intelligence is defined by the five emotional quotients of
self awareness of feelings, emotional self regulation, self monitoring and
goal setting, empathy, and social and communication skills.[3] According
to Goleman, “The rules for work are changing, we’re being judged by a new
yardstick: not just how smart we are, or our expertise, but also how well
we handle ourselves and each other.”[4] Emotional intelligence is
considered more important than IQ in enabling people to function well in
society.[5] We would like to suggest that emotional intelligence, which
can be taught, can be an important solution to reducing the incidence of
bullying in the workplace.[6]
References:
1. Kivimaki M, Elovainio M, Vahtera J Workplace bullying and sickness absence in hospital staff. Occup Environ Med 2000;57:656-60
2. Rosenthal SL, Schmid KD, Black MM. Stress and coping in a NICU.
Res Nurs Health 1989;12:257-65
3. Goleman D. Emotional intelligence. Why it can matter more than IQ. London: Bloomsbury Publishing Plc, 1995
4. Goleman D. Working with Emotional Intelligence. London: Bloomsbury Publishing Plc, 1998
5. Goleman D. What makes a leader? Harv Bus Rev 1998;76:93-102
6. Koh TS, Koh THHG. Disruptive doctors: emotion based medicine is as important as evidence based medicine. MJA (in press)
I was not against figure 1. Instead, I was concerning the second
scenario in figure 1: people who had respiratory diseases would have a higher
rate of IHD if they kept exposure to dust—there might be an interaction
between respiratory diseases and dust exposure after. In the discussion of
the paper it states that “The direct independent effect of dust exposu...
I was not against figure 1. Instead, I was concerning the second
scenario in figure 1: people who had respiratory diseases would have a higher
rate of IHD if they kept exposure to dust—there might be an interaction
between respiratory diseases and dust exposure after. In the discussion of
the paper it states that “The direct independent effect of dust exposure
on IHD and other CVDs was small”, but many people who had been diagnosis
for respiratory diseases would be removed from the dust exposure job (I am
sorry that I express it as “cohort” in the last letter). Thus most
people who already had been diagnosed for respiratory disease, were not
exposed to dust exposure after they had been diagnosed, even the
“cumulative exposure to dust was considered until the diagnosis date of
ischaemic heart disease (IHD)” .
However as the reply showed that "the exposure data only including
dust exposure after the diagnosis of a respiratory disease," had a small
effect, my question is answered.
I thank the authors so much to give more detail on the information on
smoking. Eletter is a great way to reduce the information lost which is
due to limited space in paper journals. Would it be appropriate to
encourage authors to add more detail on journal websites?
The interesting results of Delphi study (OEM 2005; 62: 406-413)
underline the increasing importance of a specific training for physicians
involved in the prevention of accidents and other work-related disorders
and diseases. Although EU countries have similar legislation concerning
activities and individual prevention on the workplace, training curricula
for doctors involved in the health activities...
The interesting results of Delphi study (OEM 2005; 62: 406-413)
underline the increasing importance of a specific training for physicians
involved in the prevention of accidents and other work-related disorders
and diseases. Although EU countries have similar legislation concerning
activities and individual prevention on the workplace, training curricula
for doctors involved in the health activities are variable in different
countries. In Italy for instance a legislation approved by the Italian
Parliament in 2001 has extended to specialists in Hygiene and preventive
medicine and in Forensic medicine (“medicina legale”) the licence to
practice health surveillance in the workplace (become “competent” doctor
or “medico competente”), an undertaking so far reserved to specialists in
Occupational medicine.[2,3]
Occupational Medicine training was mainly oriented in the past
decades to clinical occupational medicine only which, though important,
does not give a full response to the needs for expertise in a preventive
workplace-oriented occupational health service, as underlined also in a
recent WHO report.[4]
The post-graduate training for specialists in Hygiene and preventive
medicine is mainly oriented to environmental hygiene and environmental
health, management, communication, health education, epidemiology and
medical statistics.[2]
The curriculum of the specialist in Forensic medicine is oriented to
health legislation, legal obligations of physicians and health personnel,
writing reports about health problems other than more specific training in
forensic medicine.[3]
Although the extension to the two new specialities was not well
accepted by the specialists in Occupational medicine[5], it seems that
the recent results of the Delphi study[1,6], as well as other
recommendations[4,7], stress the importance of the latter two post-
graduate curricula. In fact, according to customer opinions, the four most
important areas of competency of occupational physicians are law, hazards,
fitness and communication. For the training in these competencies the
present curricula in Hygiene and preventive medicine and in Forensic
medicine seem appropriate for the training of the “competent” doctor in
Italy. An additional analysis of the results, which took into
consideration the specific competencies required by the Occupational
physician, show that the activities which obtained the highest scores were
much more present in the curricula of the two post-graduated programmes
(Hygiene and Forensic medicine) introduced in 2001: applying legal and
other ethical requirements for confidentiality (score of 4.48 in Delphi
study); being well informed about acts, regulations, codes of practice
(4.36); identifying the occupational needs (4.25); understanding the
differences between work related and environmental related diseases
(4.11); assessing the work environment and evaluating risks (4.11).
In conclusion the results of Delphi study applied to training
programmes and continuing professional education in Italy indicate that
the most profitable way for the implementation of curricula for
Occupational physicians (“competent” doctors) is the co-operation between
the scientific associations of Occupational medicine, Hygiene and
preventive medicine and Forensic medicine. This in order to adopt common
initiatives to better match the modern training needs of trade unions,
companies and workers and to create in a short time a cadre of
appropriately skilled doctors.
Carlo Signorelli, PhD
Full Professor of Hygiene
University of Parma
Dept. of Public Health
Via Volturno, 39 – 43100 PARMA
References
1. Reetoo KN, Harrington JM, Macdonald EB. Required competencies of
occupational physicians: a Delphi survey of UK customer. Occup Environ Med
2005; 62: 406-413.
2. Carreri V, Signorelli C, Marinelli P, Fara GM, Boccia A. New
opportunities to improve occupational health in Italy. Lancet 2002; 360:
723.
3. Tomassini A. New opportunities to improve occupational health in
Italy. Lancet. 2002 Aug 31;360(9334):723-4.
4. WHO. Global Strategy on Occupational Health for All.
Recommendation of the Second Meeting of the WHO Collaborating Centres in
Occupational Health, Beijing, China, 11-14 October 1994.
5. Manno M, , Mutti A, Apostoli P, Bartolucci B, Franchini I.
Occupational medicine at stake in Italy. Lancet. 2002;359: 1865.
6. Macdonald EB. Ritchie KA, Murrey KJ, Gilmpur WH. Requirements for
occupational training in Europe: a Delphi study. Occup Environ Med 2000;
57: 98-105.
7. Turner S, Hobson J, D’Auria D, Beach J. Continuing professional
development of occupational medicine practitioners: a needs assessment.
Occupational Medicine 2004; 54: 14-20.
We thank Helen C Francis for the interest in our article
“Mould/dampness exposure at home is associated with respiratory disorders
in Italian children and adolescents: the SIDRIA-2 Study” [1] and we
appreciate her comments reported in the letter “The validity of self-
reported measures of mould/dampness”, 21 September, 2005.
We think it is difficult to compare our findings with those of Tavernier
and co...
We thank Helen C Francis for the interest in our article
“Mould/dampness exposure at home is associated with respiratory disorders
in Italian children and adolescents: the SIDRIA-2 Study” [1] and we
appreciate her comments reported in the letter “The validity of self-
reported measures of mould/dampness”, 21 September, 2005.
We think it is difficult to compare our findings with those of Tavernier
and colleagues [2] for the following reasons:
1. that study regards a relatively little (n=200) sample of subjects,
aged 4 to 17 years, whereas we studied thousands of children and
adolescents, separately;
2. that study regards current exposure, whereas we compared the
effects of current and early exposure.
In addition, as regard the current exposure, the findings by
Tavernier and colleagues do not seem to disagree with our results. We also
did not find a significant association between asthma and current
exposure, among the adolescents, and the association was not so strong, as
indicated by 95%CI (1.00-1.93), among the children.
It is not surprising to find controversial results in the literature.
Although some studies showed a poor concordance between self-reported
dampness and objective measures [2, 3], other authors confirmed the
validity of questionnaires. For instance, Belanger et al report that “the
association of reported mold and wheeze was confirmed by measured levels
of fungi and wheeze, suggesting that reports of mold were not biased”[4].
The fact that some studies suggest “an almost complete disagreement
between self-reported dampness, visual inspection by a trained
investigator and measurement using an industrial dampmeter” might even
suggest that objective measurements are not completely reliable. As we
reported in our article, although studies that objectively assess exposure
would be desirable, there are problems with accurate air sampling [5]. The
measurements currently used might not accurately represent the variability
of concentration over time, because the measurement periods are too short
and the variability in repeated measures is elevated over a very short
period of time. Thus, both self-report and direct measurement would be
desirable. However, our study focused on the comparison between possible
effects by current or by early exposure and, obviously, early exposure
assessment could only be assessed through the questionnaire.
References
1. Simoni M, Lombardi E, Berti G et al. Mould/dampness exposure at
home is associated with respiratory disorders in Italian children and
adolescents: the SIDRIA-2 study. Occup Environ Med 2005; 62:616-622.
2. Tavernier GO, Fletcher GD, Frencis HC et al. Endotoxin exposure in
asthmatic children and matched healthy controls: results of IPEADAM study.
Indoor Air 2005; 15 suppl 10:25-32.
3. Dales RE, Miller D, Mc Mullen ED. Indoor air quality and health:
validity and determinats of reported home dampness and moulds. Int J
Epidemiol 1997; 26:120-125.
4. Belanger K, Beckett W, Triche E, et al. Symptoms of wheeze and
persistent cough in the first year of life: association with indoor
allergens, air contaminants, and maternal history of asthma. Am J
Epidemiol 2003;158:195-202.
5. Douwes J, Pearce N. Is indoor mold exposure a risk factor for
asthma? Am J Epidemiol 2003;158:203-6.
Dear Editor,
“Job strain” may be associated with unhealthy diet pattern, which usually includes high sodium intake—a major risk factor of hypertension. Moreover, high sodium intake is always associated with high fat and high energy intake, and further associated with high BMI level.
Therefore, it would be interesting to see whether there is any association between “Job constraints” and overweight among th...
Dear Editor
Dr Loomis draws attention to the potential dangers of the rigid use of checklists and guidelines to judge occupational and environmental research. I agree with these sentiments, in particular the concerns about the increasing number of papers that use compliance with these guidelines as a justification for conclusions regarding causality. There is, however, one rapidly expanding area of research that...
Dear Editor,
We thank Mr. Wenbin Liang for comments on our paper.
The first part of the comments concerned criticism on our Figure 1 and handling of exposure data. Our Figure 1 is a schematic drawing. It was aimed only to portray how the explanatory variables precede the response variables in our two-stage model. The purpose of our study was not to investigate does "dust exposure increase the risk of IHD a...
Editor
Chronic hand vibration exposure is now a well-described cause of Raynaud's phenomenon. According to Palmer et al, it is estimated that 220,000 cases of Raynaud's phenomenon are attributable to vibration exposure in Great Britain.[1] These epidemiological data, based on a questionnaire, are considered reasonably accurate.[2] About 4.2 million workers are exposed to hand transmitted vibration but the real...
The recent article by Vyas, et al.[1] raises some concerns to which I would be grateful if they could respond.
1) In the abstract one of the objectives is stated as finding the nature and incidence of symptoms experienced by a large sample of hospital endoscopy nurses. The study design is cross-sectional and used an adapted version of the MRC questionnaire for respiratory symptoms. This study design normally re...
Editor
We thank Dr. Seilkop for his comment and have, in essence, not much to add to it. The study by Shannon et al.[1] had obviously been overlooked and the study by Arena et al.[2] was published after our deadline for the inclusion of studies.
Dr. Seilkop´s Table has errors for the study by Andersson et al.[3] The number of pacreatic cancer deaths should be 2; relative risk should be 1.2; and 95% conf...
Editor
As victims of bullying and proponents of emotional intelligence in the health profession we read with interest your article on workplace bullying.[1]
Kavimaki et al[1] did not mentioned whether the responses were anonymous. Identified responses may underestimate the incidence of bullying in the cohort. Given that previous studies (mentioned by the authors in the discussion) have shown a consid...
Dear Editor,
I thank the authors for they reply.
I was not against figure 1. Instead, I was concerning the second scenario in figure 1: people who had respiratory diseases would have a higher rate of IHD if they kept exposure to dust—there might be an interaction between respiratory diseases and dust exposure after. In the discussion of the paper it states that “The direct independent effect of dust exposu...
Dear Editor,
The interesting results of Delphi study (OEM 2005; 62: 406-413) underline the increasing importance of a specific training for physicians involved in the prevention of accidents and other work-related disorders and diseases. Although EU countries have similar legislation concerning activities and individual prevention on the workplace, training curricula for doctors involved in the health activities...
Dear Editor
We thank Helen C Francis for the interest in our article “Mould/dampness exposure at home is associated with respiratory disorders in Italian children and adolescents: the SIDRIA-2 Study” [1] and we appreciate her comments reported in the letter “The validity of self- reported measures of mould/dampness”, 21 September, 2005. We think it is difficult to compare our findings with those of Tavernier and co...
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