Asbestos-related cancer in naval personnel: findings from participants in the British nuclear tests 1952-1967.

Asbestos-containing materials (ACM) were present in British and Australian naval vessels throughout the twentieth century. The aim of this study was to identify and quantify the incidence of cancer in naval personnel from onboard asbestos exposure. Subjects were four cohorts of subjects who had served in the armed forces of the United Kingdom and Australia in the 1950s and 1960s. All cohorts had previously been studied, three of them in relation to radiation exposures from British nuclear testing. Comparisons of SIRs between services were made to identify cancers attributable to asbestos exposure. Excess mesotheliomas were found in naval personnel in all cohorts. In all but one cohort the lung cancer incidence was highest in navy personnel. Comparison of other smoking-related conditions indicated that the excess in navy personnel was not smoking-related. The relatively high SIRs for mesothelioma and the occurrence of deaths from asbestosis were indicative of high levels of asbestos exposure, with an expectation of cases of asbestos-related lung cancer. The findings are consistent with the occurrence of significant excesses of mesotheliomas. In addition, notwithstanding some inconsistencies in the results between the cohorts, we estimated that approximately 27% of lung cancers in Australian seamen and 12% in British seamen were related to onboard asbestos exposure.

The importance of initial management: a case series of childhood burns in Vietnam.

The success of treatment of childhood burns is critically dependent on how well the initial management is performed. In this case series of 695 children with burns transferred to the National Burn Institute (NBI) in Hanoi from peripheral hospitals, the initial management of each patient was assessed for the following initial management measures: removal of the cause and immediate cooling with water at the accident site; and pain relief, dry dressing, administration of oxygen, and adequate fluid replacement at the peripheral hospital. Overall, 61 of the 695 children died, but of the 95 patients who received all of these initial management measures, all survived. There were no cases of irreversible shock, acute renal failure, or multiple organ failure in the patients who received adequate initial management. Provision of adequate initial management was also significantly protective against septicaemia. Thus in this group of subjects who survived until admission, effective initial management significantly reduced the risk of death and other complications such as irreversible shock, septicaemia and multiple organ failure.

The importance of immediate cooling--a case series of childhood burns in Vietnam.

Numerous experimental studies have shown several benefits of treating burns by the immediate application of cool water. In this study of 695 children with burns, treated in the National Burn Institute (NBI), Hanoi, Vietnam, patients were assessed on admission according to first aid measures at the time of injury, i.e. the removal of the cause and immediate cooling with cold water. A total of 33% of the children who had had immediate cooling of the burn with water had deep burns, compared with 49% of the children who had not had immediate cooling. The prevalence ratio of deep burns was thus 0.68 (95% confidence interval (CI) 0.55-0.85); that is, there was an estimated reduction of 32% in the need for skin grafting, a reduction which was statistically significant. After adjusting for the effect of cooling the burn, removal of the causal agent reduced the odds of requiring skin grafting, but the reduction was not statistically significant. It is concluded that early cooling will prevent a significant percentage of superficial burns from progressing to deep burns. This will not only reduce the probability that skin grafting and expensive treatment will be required, but will reduce the risk of other consequences of deep burns, which may be fatal. Public health programs to promote immediate cooling of burns with cool water are at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children.

Potential risk factors for prolonged recovery following whiplash injury.

A retrospective analysis of insurance data was made of 600 individuals claiming compensation for whiplash following motor vehicle accidents. Three hundred randomly selected claimants who had settled their injury claims within 9 months of the accident were compared with 300 who had settled more than 24 months after the accident. We compared the two groups to identify possible risk factors for prolonged recovery, for which settlement time greater than 24 months was a marker. Variables considered included demographic factors, type of collision, degree of vehicle damage, workers compensation, prior claim or neck disability, treatment and time to settlement. Consulting a solicitor was associated with a highly significant, four-fold increase of late settlement of the claim. A concurrent workers' compensation claim, prior neck disability and undergoing physiotherapy or chiropractic treatment were weakly associated with late settlement. The degree of damage to the vehicle (as indicated by cost of repairs) was not a significant predictor of late settlement. Late settlement may be the direct effect of legal intervention, independent of the severity of the injury. Whilst the financial benefit to the claimant of consulting a solicitor is apparent, the benefit of prolonged disability is not. It may be to the advantage of both insurers and claimants if those likely to proceed to late settlement could be recognised early and their claims settled expeditiously.