Occupational and

Environmental MedicineAdopted as the Joumnal of the Faculty of

Occupational Medicine of the Royal College ofPhysicians of London

Editor: Anne Cockcroft (United Kingdom)Deputy Editor: T C Aw (United Kingdom)Technical Editor: Judith HaynesEditorial Assistant: Rachel HarveyEditorial Board: R McNamee (United Kingdom) D C Snashall (United Kingdom)F J H Van Dijk (Holland) J Myers (South Africa) G Theriault (Canada)D Heederik (Holland) B Nemery (Belgium). K M Venables (United Kingdom)J Jeyaratnam (Singapore) M J Nieuwenhuijsen (United Kingdom) J-D Wang (Thailand)G Lemasters (United States) T Okubo Japan) Editor, British MedicalJournalG Liss (Canada) H Roels (Belgium)R L Maynard (United Kingdom) M Sim (Australia)

NOTICE TO CONTRIBUTORS Occupational and Environmental Medicineis intended for the publication of original contributions relevant tooccupational and environmental medicine including toxicologicalstudies of chemicals of industrial, agricultural, and environmentalimportance, and epidemiological studies. As well as full papers,short papers dealing with brief or preliminary observations relevantto occupational and environmental medicine will also beconsidered. Case reports should cover substantial new ground tomerit publication. Other articles, including review or positionpapers, will be considered but should not be submitted without firstapproaching the Editor to discuss their suitability for the Journal.Letters to the Editor are always welcome. The website address forthe Journal is:-http://www.bmj.occenvmed.com

INSTRUCTIONS TO AUTHORS Three copies of all submissions shouldbe sent to: The Editor, Occupational and Environmental Medicine,BMJ Publishing Group, BMA House, Tavistock Square, LondonWC 1H 9JR, UK. All authors should sign the covering letter as evi-dence of consent to publication. Papers reporting results of studieson human subjects must be accompanied by a statement that thesubjects gave written, informed consent and by evidence ofapproval from the appropriate ethics committee. These papersshould conform to the principles outlined in the Declaration ofHelsinki (BMJ 1964;ii:177).

If requested, authors shall produce the data on which the manu-script is based, for examination by the Editor.Authors are asked to submit with their manuscript the

names and addresses of three people who they considerwould be suitable independent reviewers. They will not nec-essarily be approached to review the paper.

Papers are considered on the understanding that they aresubmitted solely to this Journal and do not duplicate materialalready published elsewhere. In cases of doubt, where part of thematerial has been published elsewhere, the published materialshould be included with the submitted manuscript to allow theEditor to assess the degree of duplication. The Editor cannot enterinto correspondence about papers rejected as being unsuitable forpublication, and the Editor's decision in these matters is final.Papers should include a structured abstract of not more

than 300 words, under headings of Objectives, Methods,Results, and Conclusions. Please include up to threekeywords or key terms to assist with indexing.

Papers should follow the requirements of the InternationalCommittee of Medical Journal Editors (JAMA 1993;269:2282-6).Papers and references must be typewritten in double spacing on oneside of the paper only, with wide margins. SI units should be used.

Short reports (including case reports) should be not more than1500 words including a brief abstract. They should comprisesections of Introduction, Methods, Results, and Discussion with notmore than one table or figure and up to 10 references. The formatof case reports should be Introduction, Case report, and Discussion.

Illustrations Photographs and photomicrographs on glossy papershould be submitted unmounted. Charts and graphs should becarefully drawn in black ink on firm white paper. Legends to figuresshould be typed on a separate sheet of paper.

References References will not be checked by the editorial office;responsibility for the accuracy and completeness of references lieswith the authors. Number references consecutively in the order inwhich they are first mentioned in the text. Identify references intexts, tables, and legends by Arabic numerals. References cited only

in tables or in legends to figures should be numbered in accordancewith a sequence established by the first identification in the text of aparticular table or illustration. Include only references essential to theargument being developed in the paper or to the discussion of results,or to describe methods which are being used when the originaldescription is too long for inclusion. Information from manuscriptsnot yet in press or personal communications should be cited in thetext, not as formal references.Use the Vancouver style, as in this issue for instance, for a standardjournal article: authors (list all authors when seven or fewer, wheneight or more, list only six and add et al), title, abbreviated title of jour-nal as given in Index Medicus (if not in Index Medicus give in full), yearof publication, volume number, and first and last page numbers.Proofs Contributors will receive one proof. Only minor correctionscan be made at this stage, corrections other than printer's errors maybe charged to the author.

I

Reprints Reprints will be charged for. The number of reprintsrequired should be stated on the form provided with the proofs.Copyright C 1997 Occupational and Environmental Medicine. Thispublication is copyright under the Berne Convention and theInternational Copyright Convention. All rights reserved. Apart fromany relaxations permitted under national copyright laws, no part ofthispublication may be reproduced, stored in a retrieval system, or trans-mitted in any form or by any means without the prior permission ofthecopyright owners. Permission is not, however, required to copyabstracts ofpapers or of articles on condition that a full reference to thesource is shown. Multiple copying of the contents of the publicationwithout permission is always illegal.NOTICE TO ADVERTISERS Applications for advertisement space and forrates should be addressed to the Advertisement Manager, Occupationaland Environmental Medicine, BMJ Publishing Group, BMA House,Tavistock Square, London WC 1H 9JRNOTICE TO SUBSCRIBERS Occupational and Environmental Medicine ispublished monthly. The annual subscription rate (for 1997) is £164(US $244). Orders should be sent to the Subscription Manager,Occupational and Environmental Medicine, BMJ Publishing Group, POBox 299, London WC 1H 9TD. Orders may also be placed with anyleading subscription agent or bookseller. (For the convenience ofreaders in the USA subscription orders with or without payment mayalso be sent to BMJ Publishing Group, PO Box 590A, Kennebunk-port ME 04046, USA. All inquires, however, must be addressed tothe publisher in London). All inquiries regarding air mail rates andsingle copies already published should be addressed to the publisherin London.Subscribers may pay for their subscriptions by Access, Visa, orAmerican Express by quoting on their order the credit or charge cardpreferred together with the appropriate personal account number andthe expire date of the card.

Periodicals postage paid Rahway NJ. Postmaster: send addresschanges to: Occupational and Environmental Medicine, c/o MercuryAirfreight International Ltd Inc. 2323 Randolph Avenue, Avenel, NJ07001, USA.FACULTY OF OC CUPA IONAL MEDICINE The Faculty of OccupationalMedicine of the Royal College of Physicians ofLondon is a registeredcharity founded to promote, for the public benefit, the advancementof knowledge in the field of occupational medicine. The Faculty hasoffices at 6 St Andrew's Place, Regent's Park, London NWI 4LB.ISSN 1351 0711.

Published by BMJ PublishingGroup, and printed inEngland on acid free paperby Thanet Press Limited,Margate, Kent

Mortality of doctors in different specialties

20 World Health Organisation. International classification of dis-eases. 9th ed. Manual ofthe international statistical classifcationof diseases, injuries and causes of death. Vol 1. Geneva: WHO1977.

21 Breslow N, Day N. Statistical methods in cancer research. Vol-ume ii - the design and analysis of cohort studies.Lyon: IARC,1987. (IARC Publ Sci No 82.)

22 Office of Population Censuses and Surveys. Mortalityanalysis system and stage m. London: OPCS.

23 Bailar JC, Ederer F. Significance factors for the ratio of aPoisson variable to its expectation. Biometrics 1964;20:639-43.

24 Carpenter LM. Some observations on the healthy workereffect. BrJInd Med 1987;44:289-91.

25 Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Mortalityin relation to smoking: 40 years' observations on male Brit-ish doctors. BMJ 1994;309:901 -l 1.

26 Office of Population Censuses and Surveys. Occupationalmortality: the Registrar General's decennial supplementpart II 1951. London: HMSO, 1958.

27 Office of Population, Censuses and Surveys and Inter-national Agency for Research on Cancer. Cancer mortalityby occupation and social class 1851-1971. In: Logan WPD,ed. Studies on medical and population subjects. No 44. Lyon:IARC 1982. (IARC Sci Publ No 36.)

28 Caplan RE Stress, anxiety, and depression in hospitalconsultants, general practitioners and senior health servicemanagers. BMJ7 1994;309:1261-3.

29 Bruce DL, Eide KA, Linde HW, Eckenhoff JE. Causes ofdeath among anaesthesiologists: a 20-year survey. Anaesthe-siology 1968;29:565-9.

30 Editorial. Occupational infection among anaesthetists. Lan-cet 1990;336:1 103.

31 Guirguis SS, Pelmear PL, Roy ML, Wong L. Health effectsassociated with exposure to anaesthetic gases in Ontariohospital personnel. BrJInd Med 1990;47:490-7.

32 Vessey MP, Nunn JF. Occupational hazards of anaesthesia.BMJ 1980;281:696-8.

33 Harrington JM. The health of anesthetists. Anaesthesia1987;42: 131-2.

34 Harrington JM, Oakes D. Mortality study of Britishpathologists, 1974-80. BrJ Ind Med 1 984;41: 188-9 1.

35 Matanoski GM, Seltser R, Sartwell PE, Diamond EL, Elli-ott EA. The current mortality rates of radiologists andother physician specialists: deaths from all causes and fromcancer. Am J Epidemiol 1975;101: 188-98.

36 Matanoski GM, Seltser R, Sartwell PE, Diamond EL, Elli-ott EA. The current mortality rates of radiologists andother physician specialists: specific causes of death. Am JEpidemiol 1975;101:199-210.

Vancouver styleAll manuscripts submitted to Occup EnvironMed should conform to the uniformrequirements for manuscripts submitted tobiomedical journals (known as theVancouver style.)

Occup Environ Med, together with manyother international biomedical journals, hasagreed to accept articles prepared in accor-dance with the Vancouver style. The style(described in full in the JAMA') is intendedto standardise requirements for authors,and is the same as in this issue.

References should be numbered consec-utively in the order in which they are firstmentioned in the text by Arabic numeralson the line in square brackets on each occa-sion the reference is cited (Manson[l] con-firmed other reports ... [2] [3] [4] [5] ... ).In future references to papers submitted to

Occup Environ Med should include: thenames of all authors if there are seven orless or, if there are more, the first six fol-lowed by et al; the title of journal articles orbook chapters; the titles of journals abbrevi-ated according to the style of Index Medicus;and the first and final page numbers of thearticle or chapter. Titles not in IndexMedics should be given in full.

Examples of common forms of refer-ences are:

1 International Committee of Medical Journal Editors.Uniform requirements for manuscripts submitted tobiomed journals. JAMA 1993;269:2282-6.

2 Soter NA, Wasserman SI, Austen KF. Cold urticaria:release into the circulation of histamine and eosino-phil chemotactic factor of anaphylaxis during coldchallenge. N EnglJ Med 1976;294:687-90.

3 Weinstein L, Swartz MN. Pathogenic properties ofinvading micro-organisms. In: Sodeman WA Jr,Sodeman WA, eds. Pathologic physiology, mechanisms ofdisease. Philadelphia:W B Saunders, 1974:457-72.

395

In vivo analysis ofcadmium in battery workers

28 Webb MAH, Chettle DR, Al-Haddad IK, Downey SPMJ,Harvey TC. Measurement of cadmium in liver and kidneyusing in vivo techniques. Ann Occup Hyg 1982;25:33-7.

29 Gompertz D, Fletcher JG, Perkins J, Smith NJ, Chettle DR,Mason H, et al. Renal dysfunction in cadmium smelters:relation to in-vivo liver and kidney cadmium concentra-tions. Lancet 1983;1185-7.

30 Ellis KJ, Yuen K, Yasumura S, Cohn SH. Dose-responseanalysis of cadmium in man: body burden v kidneydysfunction. Environ Res 1984;33:216-26.

31 Ellis KJ, Cohn SH, Smith TJ. Cadmium inhalation exposureestimates: their significance with respect to kidney and livercadmium burden. Toxicol Environ Health 1985;15:173-87.

32 Guthrie CJG, Franklin DM, Scott MC, Chettle DR, MasonHJ, Smith NJ, et al. A longitudinal survey of exposure tocadmium fume - preliminary findings from in vivo bodyburden measurements. In: Ellis KJ, Yasumura S, MorganWD, eds. In vivo body composition studies. London: TheInstitute of Physical Sciences in Medicine, 1987:349-56.

33 Mason HJ, Davison AG, Wright AL, Guthrie CJG, FayersPM, Venables KM, et al. Relations between liver cadmium,cumulative exposure, and renal function in cadmium alloyworkers. BrJ IndMed 1988;45:793-802.

34 Franklin DM, Guthrie CJG, Chettle DR, Scott MC, MasonHJ, Davison AG, Newman-Taylor AJ. In vivo neutron acti-vation analysis of organ cadmium burdens. Referent levelsin liver and kidney and the impact of smoking. Biol TraceElem Res 1990;26-27:401-6.

35 Morgan WD, Ryde SJS, Jones SJ, Wyatt RM, HainsworthIR, Cobbold SS, et al. In vivo measurements of cadmiumand lead in occupationally-exposed workers and an urbanpopulation. Biol Trace Elem Res 1990;26-27:407-14.

36 Armstrong R, Chettle DR, Scott MC, Blindt M, Mason HJ.Longitudinal studies of exposure to cadmium. BrJ IndMed1992;49:556-9.

37 Svartengren M, Elinder CG, Friberg L, Lind B. Distribu-tion and concentration ofcadmium in human kidney. Envi-ron Res 1986;39:1-7.

38 Baddeley H, Thomas BJ, Thomas BW, Summers V. Livercadmium concentrations in metal industry workers. BrRadiol 1983;56:449-51.

39 Jirup L, Rogenfflt A, Elinder C-G. Nogawa K, KjellstromT. Biological half-time of cadmium in the blood of workersafter cessation of exposure. Scand Work Environ Health1983;9:327-31.

40 Friberg L, Elinder CG, Kjellstrom T, Nordberg GF. Generalsummary and conclusions and some aspects of diagnosisand treatment of chronic cadmium poisoning. In: FribergL, Elinder C-G, Kjellstrom T, Nordberg GF, eds. Cadmiumand health: a toxicological and epidemiological appraisal. Vol II.Effects and response. Boca Raton: CRC Press, 1986:247-55.

41 Ellis KJ, Vartsky D, Zanzi I, Cohn SH, Yasumura S.Cadmium: in vivo measurement in smokers and non-smokers. Science 1979;205:323-5.

42 Elinder C-G. Normal values for cadmium in human tissues,blood, and urine in different countries. In: Friberg L,

Elinder C-G, Kjellstrom T, Nordberg GF, eds. Cadmiumand health: a toxicological and epidemiological appraisal. Vol I.

Exposure, dose and metabolism. Boca Raton: CRCPress,1985:81-102.

43 SIVARG (Swansea in vivo analysis research group). Bodyburden following exposure to heavy metals. Swansea: Depart-ment of Medical Physics and Clinical Engineering, Single-ton Hospital, May 1990. (Report WEP181/100/2.)

44 Chettle DR, Ellis KJ. Further scientific issues in determin-ing an occupational standard for cadmium. Am Jf Ind Med1992;22:117-24.

45 Lauwerys RR, Bernard AM, Roels HA, Buchet J-P.Cadmium: exposure markers as predictors of nephrotoxiceffects. Clin Chem 1994;40:1391-4.

46 Jarup L, Elinder CG. Decreased glomerular filtration rate insolderers exposed to cadmium. Occup Environ Med1995;52:818-22.

47 Sumino K, Hayakawa K, Shibata T, Kitamura S. Heavymetals in normal Japanese tissues. Arch Environ Health1975;30:487-94.

Rejected manuscriptsFrom February 1994, authors whose sub- be returned to them.The Journal will destroyemitted articles are rejected will be advised of remaining copies of the article but corres-the decision and one copy of the article, pondence and reviewers' comments will betogether with any reviewers' comments, will kept.

431

6Nortier, Bernard, Roels, Deschodt-Lanckman, Gueuning, Lauwervs

2 Shipp MA, Look AT. Hematopoietic differentiation antigensthat are membrane-associated enzymes: cutting is the key.Blood 1993;82:1052-70.

3 Roques BP, Noble F, Daug V, Fournie-Zaluski M-C, Beau-mont A. Neutral endopeptidase 24.11: structure, inhibi-tion, and experimental and clinical pharmacology. Pharma-col Rev 1993;45:87-146.

4 Schulz WW, Hagler HK, Buja LM, Erdos EG. Ultrastruc-tural localization of angiotensin I- converting enzyme (EC3.4.15.1) and neutral metalloendo-peptidase (EC3.4.24.11) in the proximal tubule of the human kidney. LabInvest 1988;59:789-97.

5 Skidgel RA, Schulz WW, Tam LT, Erdos EG. Human renalangiotensin I converting enzyme and neutral endopepti-dase. Kidney Int 1987;31:45-8.

6 Deschodt-Lanckman M, Michaux F, de Prez, AbramowxiczD, Vanherweghem J-L, Goldman M. Increased serum lev-els of endopeptidase 24.11 (enkephalinase) in patients withend-stage renal failure. Life Sci 1989;45:133-41.

7 Nortier J, Abramowicz D, Kinnaert P, Deschodt-LanckmanM, Vanherweghem JL. Pathological release of urinaryendopeptidase 24.11 early after renal transplantation.Enzyme 1992;46:304-8.

8 Berndt WO. Role of transport in chemically-induced neph-rotoxicity. In: Goldberg RS. Alechanisms of injury in renaldisease and toxicity. Ann Arbor: CRC Press, 1994:235 46.

9 Bernard AM, Roels HA, Buchet JP, Cardenas A, LauwerysRR. Cadmium and health: the Belgian experience. In: Nor-dberg GF, Herber RFM, Alessio L. Cadmium in the humanenvironment: toxicity and carcinogenicity. Lyon: IARC, 1992:15-33. (IARC Sci Publ No 118.)

10 Lauwerys RR, Bernard AM, Roels HA, Buchet JP.Cadmium: exposure markers as predictors of nephrotoxiceffects. C/in Chem 1994;40:1391 -4.

11 Nouwen EJ, de Broe M. Human intestinal versus tissue-nonspecific alkaline phosphatase as complementary uronary markers for the proximal tubule. Kidney Int 1994;46:S43-51.

12 Roels HA, Bernard AM, Cardenas A, Buchet JP, LauwerysRR, Hotter G, et al. Markers of early renal changes inducedby industrial pollutants. III Applications to workersexposed to cadmium. BrJ Ind Med 1993;50:37 48.

13 Bernard AM, Thielemans N, Roels HA, Lauwerys RR.Association between NAG-B and cadmium in urine withno evidence of a threshold. Occuip Environ Aled 1995;52:177 80.

14 Staessen JA, Lauwerys RR, Ide G, Roels HA, Vincke G,Amery A. Renal function and historical environmentalcadmium pollution from zinc smelters. Lancet 1994;343:1523 7.

15 Cockcroft DW, Gault MH. Prediction of creatinineclearance from serum creatinine. Nephron 1976;16:31-41.

16 Tucker SM, Boyd PJR, Thompson AE, Price RG.Automatic assay of N-acetyl-p-D-glucosaminidase in nor-mal and pathological human urine. C/in Chini Acta1975;62:333 9.

17 Kritz W, Samaan GJ, Leberre C, Demelier JF, Biou D.Semi-automated fluorimetric assay for total and BN-acetyl-f-D-glucosaminidase: analytical investigation. 7C/in Lab Anaysis 1991;5:1 2.

18 Bernard AM, Lauwerys RR. Continuous flow system for theautomation of latex immunoassay by particle counting.Clitn Chenti 1983;29:1007 11.

19 Roels HA, Lauwerys RR, Buchet JP, Bernard AM, Vos A,Overstvns M. Health significance of cadmium-inducedrenal dysfunction: a five-year follow-up. Br 7 hild A/ed1989;46:755-64.

20 American Conference of Governmental Industrial Hygien-ists. Cadmium, methylisobutylketone and trichloroethyl-ene. Apple Occup Eniviron Hyg 1991;6:703-10.

21 Fels LM, Bundschuh I, Gwinner W, Jung K, Pergande M,Graubaum HJ, et al. Early urinary markers of target neph-ron segments as studied in cadmium toxicity. KidnieV Ihit1994;46:S81-8.

22 Prozialek WC, Nieuwenhuis RJ. Cadmium (Cd ) disruptsintercellular functions and actin filaments in LLC-PK1cells. Toxicol Appl Pharniacol 1991;107:81-97.

23 Kimura 0, Endo T, Sakata M. Comparison of cadmiumuptakes from apical and basolateral membranes ofLLC-PK1 cells. Toxicol Appl Pharmacol 1996;137:301-6.

24 Kellerman PS, Clark RAF, Hoilien CA, Linas SL, MolitorisBA. Role of microfilaments in maintenance of proximaltubule structural and functional integrity. Anii 7 Physic!1990;259:F279-85.

25 Reed DJ. Glutathione: toxicological implications. Ann RevPharmnacol Toxicol 1990;30:603 31.

26 Splittgerber AG, Tappel AL. Inhibition of glutathioneperoxidase by cadmium and other metal ions. Arch BiochernBiophys 1979;197:534-42.

27 Sidhu M, Sharma M, Bhatia M, Awasthi YC, Nath R.Effects of chronic cadmium exposure on glutathioneS-transferase and glutathione peroxidase activities inrhesus monkey: the role of selenium. Toxicology 1993;83:203 13.

28 Prozialek WC, Lamar P. Effects of glutathione depletion onthe cytotoxic actions of cadmium in LLC-PK1 cells. ToxicolApple Pharnriacol 1995;134:285- 95.

Correspondence and editorialsOccupational and Environmental Medicine wel-comes correspondence relating to any of thematerial appearing in the journal. Resultsfrom preliminary or small scale studies mayalso be published in the correspondencecolumn if this seems appropriate. Lettersshould be not more than 500 words in lengthand contain a minimum of references. Tablesand figures should be kept to an absolute

minimum. Letters are accepted on the under-standing that they may be subject to editorialrevision and shortening.The journal also publishes editorials which

are normally specially commissioned. TheEditor welcomes suggestions regardingsuitable topics; those wishing to submit aneditorial, however, should do so only afterdiscussion with the Editor.

436

Self reported respiratory symptoms and diseases among hairdressers

prevention of those respiratory symptomsrelated to work. Detailed studies on workingconditions and exposures in hairdressing sa-lons are needed.

This study was supported by a grant from the Finnish WorkEnvironment Fund. We thank Dr Helena Piirainen, Mr AskoL6tj6nen, the staff of the CATI Unit at the Kuopio RegionalInstitute of Occupational Health for their excellent help with thedata collection and processing, and Ms Terttu Kaustia for thelanguage revision.

1 Meredith S, Nordman H. Occupational asthma: measures offrequency from four countries. Thorax 1995;51:435.

2 Wenninger JA, McEwen GN Jr, eds. International cosmeticingredient dictionary. Washington, DC: The Cosmetic, Toi-letry, and Fragrances Association, 1993:937-97.

3 Palmer A, Renzetti A, Gillam D. Respiratory disease preva-lence in cosmetologists and its relationship to aerosolsprays. Environ Res 1979;19:136-53.

4 Blainey A, Ollier S, Cundell D, Smith R, Davies R. Occupa-tional asthma in hairdressing salon. Thorax 1986;41:42-50.

5 Swift D, Zuskin E, Bouhuys A. Respiratory deposition ofhair spray aerosol and acute lung function changes. Am RevRespir Dis 1976;113(suppl):96.

6 Friedman M, Dougherty R, Nelson SR, White RP, SacknerMA, Wanner A. Acute effects of aerosol hair spray on tra-cheal mucociliary transport. Am Rev Respir Dis 1977;116:281-6.

7 Schlueter DP, Soto RJ, Baretta ED, Herrmann AA,Ostrander LE, Stewart RD. Airway response to hair sprayin normal subjects and subjects with hyperreactive airways.Chest 1979;75:544-8.

8 Zuskin E, Bouhuys A, Beck G. Hair sprays and lungfunction. Lancet 1978;ii:1203.

9 Zuskin E, Loke J, Bouhuys A. Helium-oxygen flow-volumecurves in detecting acute response to hair sprays. Int ArchOccup Environ Health 1981;49:41-4.

10 Borum P, Loekkegaard N, Holten A. Nasal mucociliaryclearance in hairdressers. Clinical Otolaryngology and AlliedSciences 1984;9:329-34.

11 Schwartz HJ, Arnold JL, Strohl KP. Occupational allergicrhinitis in the hair care industry: reactions to permanentwave solutions. J Occup Med 1990;32:473-5.

12 Gaultier R, Gervais P, Mellerio F. Two cases of occupationalasthma and urticaria in hairdressers: persulphate and silk.Archives der Maladies Professionnelles 1966;27:809.

13 Pepys J, Hutchcroft BJ, Breslin ABX. Asthma due to inhaledchemical agents - persulphate salts and henna inhairdressers. Clin Allergy 1976;6:399-404.

14 Pankow W, Hein H, Bittner K, Wichert P. Persulfate asthmain hairdressers. Pneumologie 1989;3:173-5.

15 Schwaiblmair M, Baur X, Fruhmann G. Bronchial asthmacaused by hairbleach in a hairdresser. Dtsch Med Wochenschr1990;18:695-7.

16 Parra FM, Igea JM, Quirce S, Ferrando MC, Martin JA,Losada E. Occupational asthma in a hairdresser caused bypersulphate salts. Allergy 1992;47:656-60.

17 Starr J, Yunginger J, Brahser G. Immediate type I asthmaticresponse to henna following occupational exposure in hair-dressers. Ann Allergy 1982;48:98-9.

18 Stringer G, Hunter S, Bonnabeau R. Hypersensitivity pneu-monitis following prolonged inhalation of hair spray. AmMed AssocJ 1977;238:888-9.

19 Gebbers J-O, Tetzner C, Burkhardt A. Alveolitis due tohair-spray. Virchows Archiv A PathologicalAnatomy and His-topathology 1979;382:323-38.

20 Bergmann M, Flance IJ, Blumenthal H. Thesaurosis follow-ing inhalation of hairspray: a clinical and experimentalstudy. NEnglJyMed 1958;258:471.

21 Gelfand H. Respiratory allergy due to chemical compoundsencountered in the rubber, lacquer, shellac and beauty cul-ture industries.jAllergy 1963;34:374-81.

22 Renzetti A, Conrad J, Watanabe S, Palmer A, Armstrong J.Thesaurosis - from hairspray exposure - a nondisease.Environ Res 1980;22:130-8.

23 Ameille J, Pages MG, Capron F, Proteau J, Rochemaure J.Pathologie respiratoire induite par l'inhalation de laquecapillaire. Rev Pneumol Clin 1985;41:325-30.

24 CASES. Computer-assisted survey methods program: user'sguide to CASES. Berkeley, CA: University of California,1989.

25 Frey JH. Survey research by phone, 2nd ed.New York: SagePublication, 1989. (Sage Library of Social Research 150.)

26 Medical Research Council's Committee on the Aetiology ofChronic Bronchitis. Standardized questionnaires on respi-ratory symptoms. BMJ 1960;ii:1665.

27 SAS I STAT User's guide, version 6, 4th ed. Vol 2. Cary, NC:SAS Institute, 1990.

28 Toren K, Brisman J, Jarvholm B. Asthma and asthma-likesymptoms in adults assessed by questionnaires - a litera-ture review. Chest 1993;104:600-18.

29 Li JTC, O'Connell EJO. Clinical evaluation of asthma. AnnAllergy Asthma Immunol 1996;76: 1 -13.

30 Bakke P, Blondal T, Haahtela T, Lundgren R, RasmussenFV, Walstad R. Care of obstructive lung diseases in theNordic countries. Eur Respir Rev 1995;5:350-5.

31 Terho EO, Husman K, Vohlonen I. Prevalence andincidence of chronic bronchitis and farmer's lung withrespect to age, sex, atopy and smoking. Eur J Respir Dis1987;71:19-28.

Occupational and Environmental Medicine and theelectronic age

OEM has an Email address which is100632.3615@compuserve.com. We wel-come contact by Email, including letters tothe editor. Some of our reviewers alreadysend us their reports by Email, helping tospeed up the peer review process.We are moving towards electronic pub-

lishing and for some months now we havebeen asking authors to send us their revisedpapers on disk as well as a hard copy. I amdelighted to report that nearly all our

authors are managing to comply with thisrequest. Oddly enough, the few authorswho have not sent us a disk version of theirrevised papers have been almost exclusivelyfrom the United Kingdom. I would beinterested in suggestions for why this mightbe. Perhaps United Kingdom based authorsread our correspondence and instructionsless assiduously? Watch for revisedInstructions to Authors.

The Editor

455

Occupational and Environmental Medicine 1997;54:456

BOOK REVIEW

Book review editor: R L Maynard

If you wish to order, or require further infor-mation regarding the titles reviewed here,please write or telephone the BMJ Bookshop,PO Box 295, London WX1H 9TE. Tel: 0171383 6244. Fax: 0171 383 6662. Books are

supplied post free in the UK and for BritishForces Posted Overseas addresses. Overseascustomers should add 15% for postage andpacking. Payment can be made by cheque insterling drawn on a UK bank, or by creditcard (MasterCard, VISA, or American Ex-press) stating card number, expiry data, andyour full name. (The price and availability are

occasionally subject to revision by the Pub-lishers.)

Occupational Medicine, 3rd ed. ZENZ C,

DICKERSON OB, HORVATH EP JR (Pp 1336;

£149) 1994. St Louis: Mosby year book.ISBN 0-8016-6676-7.

About the weight of a small toddler and 1336pages long, this is a large North Americantextbook of occupational medicine. Previouseditions appeared in 1975 and 1988.

It is compendious, with eight sections on

clinical factors, occupational pulmonary dis-eases, the physical occupational environment,the chemical occupational environment, se-

lected work categories of concern, behav-ioural considerations, fundamental disci-plines and related activities for preventionand control, and other special activitieswithin the occupational health setting. There

are nine appendices on a range of topicsincluding, for example, current occupationalexposure limits, a SI conversion table, and a

list of exposures associated with occupationaldermatosis. This leads to an admirable range,from alcohol abuse to zoonoses, air pollutionindoors to zinc toxicity.

Of the 104 authors, over two thirds are

from North America, with a fairly highproportion in corporate occupational healthpractice although there are contributors fromuniversities and regulatory agencies in theUnited States. Almost a further quarter are

from the Nordic countries. A handful only are

from the rest of the world. Some contribu-tions are masterly mini reviews by experts intheir fields.

It is always possible to pick holes intextbooks in areas where one claims a littleknowledge. The respiratory section containsa good chapter on pulmonary function testsbut remarkably little on radiology, and fewillustrations of radiographs. As a specificexample, the chapter on occupational asthmafocuses on diagnosis and medicolegal issues,reflecting North American practice andalthough easy to read and helpful on thesematters, barely covers epidemiology, risk fac-tors, pathogenesis, and rehabilitation. Thechapter starts with an all embracing defini-tion of occupational asthma including RADSand work provoked asthma, but then mainly

discusses allergic occupational asthma. Theunwary reader could be confused and anunhelpful algorithm makes things moreopaque. A description of diagnostic pulmo-nary function testing is superficially detailedbut, on careful reading, could not be used asa basis for clinical practice because of insuffi-cent information. There are errors, includinga repeated statement that skin patch tests areused to define atopy-it should, of course, beprick tests. Other errors are present in thetables of causes of allergic occupationalasthma, including a listing for platinum metalinstead of complex halogenated platinumsalts. Some of the material in this chapteroverlaps with other sections. Platinum com-pounds, for example, are also covered in asection on other metals and their compounds(which includes the unfortunate error ofascribing specific IgE antibodies to a type IVhypersensitivity response). This short sectionis also out of date, with no reference to recentepidemiological surveys or experimental pri-mate work.What is the role for such large multiauthor

textbooks of occupational medicine thesedays? Of course they are heterogeneous inquality and they are often out of date. Thereare excellent short textbooks of occupationalmedicine for the trainee physician or non-clinical occupational health professional whoneeds an overview. Specialist occupationalphysicians usually acquire monographs intheir areas of interest. Literature searching isnow easy with Medline or one of the occupa-tional health databases. The market for largetextbooks must, surely, be smaller althoughthere remains a need for reliable referenceworks in libraries. Part time occupationalphysicians may also find them useful asaides-memoire. Perhaps they are analogousto household encyclopaedias? Browsethrough them, dip into sections, use them asa first resource for reading about a newsubject-but cross check with other sourcesbefore you quote from them.

K M VENABLES

NOTICES

Environmental technology MSc course.

From September 1997. Imperial Collegeof Science, Technology, and Medicine,London.

Environment and Health is a new option in theone year MSc course in Environmental Tech-nology, which starts in September. Theprogramme is designed to provide graduateswith appropriate interdisciplinary training inthe scientific, medical, and policy issueswithin the framework of environment andhealth. Environmental and occupational is-sues will be considered with an emphasis on

pollution and environmental assessment, epi-demiological principles, and methods, evalu-ation of environmental hazards includingtoxicology, and environment and healthpolicy.For information, please contact Ms Alison

Evans 0171-594 9285.

National Occupational Injury ResearchSymposium. 15-17 October, 1997. Appa-lachian Laboratories for OccupationalSafety and Health, Morgantown, WestVirginia, USA.

The organisers of this symposium are theNational Institute for Occupational Safetyand Health (NIOSH), in association with itspublic and private sector partners.

Objectives:* Provide a forum for the presentation of

scientific research findings and methods inthe field of traumatic occupational injury

* Foster collaboration between researchersin the various disciplines and between thepublic and private organizations that con-duct or sponsor traumatic occupationalinjury research

* Identify effective interventions, and in-crease injury prevention efforts based onresearch findings

* Stimulate an increase in the quantity andquality of traumatic occupational injuryresearch

* As well as traditional disciplines and topicareas, explore underused disciplines andtopic areas of traumatic occupationalinjury research -such as the economics ofoccupational injury and other social andbehavioural science fields

* Serve as an element of the implementationof the National Occupational ResearchAgenda (NORA) developed by NIOSHand its partners

The Symposium will consider many impor-tant questions, including:* What are the latest traumatic occupational

injury research findings and methods?* What are emerging problem areas in work-

place trauma?* How is high technology being applied to

occupational injury research and preven-tion?

* Which interventions and preventionstrategies do and do not work, and in whatspecific workplaces and under what cir-cumstances?

* What are the economic costs of occupa-tional injuries and the cost-effectiveness ofprevention strategies?

* What are current and emerging researchareas and disciplines?

* What are the trends in occupational injuryand fatality incidence, in research tools,techniques, methods, in prevention?

* What are the specific workplace risks facedby children and adolescents, older adults,minority workers, non-English speakingworkers, low literacy workers, and otherspecial populations?

* How can researchers and practitioners indifferent sectors and disciplines collaborateand coordinate their activities to reducetraumatic occupational injuries?

* What methods are available for assessing,measuring, and comparing traumatic oc-cupational injury risks?For information contact Martha Brocato at

(404) 634-0804 ext 42; or FAX (404) 634-6040; http:\\www.hgo.net\noirs\noirs.html

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