The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: estimates of radiation-related cancer risks.

A 15-Country collaborative cohort study was conducted to provide direct estimates of cancer risk following protracted low doses of ionizing radiation. Analyses included 407,391 nuclear industry workers monitored individually for external radiation and 5.2 million person-years of follow-up. A significant association was seen between radiation dose and all-cause mortality [excess relative risk (ERR) 0.42 per Sv, 90% CI 0.07, 0.79; 18,993 deaths]. This was mainly attributable to a dose-related increase in all cancer mortality (ERR/Sv 0.97, 90% CI 0.28, 1.77; 5233 deaths). Among 31 specific types of malignancies studied, a significant association was found for lung cancer (ERR/Sv 1.86, 90% CI 0.49, 3.63; 1457 deaths) and a borderline significant (P = 0.06) association for multiple myeloma (ERR/Sv 6.15, 90% CI <0, 20.6; 83 deaths) and ill-defined and secondary cancers (ERR/Sv 1.96, 90% CI -0.26, 5.90; 328 deaths). Stratification on duration of employment had a large effect on the ERR/Sv, reflecting a strong healthy worker survivor effect in these cohorts. This is the largest analytical epidemiological study of the effects of low-dose protracted exposures to ionizing radiation to date. Further studies will be important to better assess the role of tobacco and other occupational exposures in our risk estimates.

Comparison of road crashes incidence and severity between some French counties.

Our aim is to compare traffic safety among several counties in France, and explore whether observed differences can be explained by differences in road types distribution and by differences in socio-economic characteristics between counties. Traffic safety is measured by incidence and severity, where incidence is defined by the ratio of counts of injury accidents and exposure, measured by the amount of kilometres driven. Severity is measured by the ratio between fatal and injury accidents. These indexes are analysed in the framework of Generalised Linear Models: counts of injury accidents are analysed with a Negative Binomial regression, which accounts for over-dispersion. Severity being the proportion of fatal accidents among injury accidents corresponds to the probability of a Binomial setting and this is modelled by a logistic regression. This modelling provides an easy way to adjust for covariates such as road type, environment (urban/rural) and evolution over time, and to test their possible interactions. We find that the time trend of each indice (incidence and severity) is the same across counties and across road types. There is a significant interaction between county and road type, meaning that, first, differences in traffic safety between counties are not fully explained by different road type distributions, and second, that the "ranking" of counties in term of incidence or severity varies according to the road type considered, and vice-versa. It was planned to explore global characteristics of the counties (driving and socio-economic data) as possible explanatory factors of differences between counties, but the existence of an interaction of county with road types shows the necessity of collecting and exploring characteristics of the sub-levels of road type within county.

A method to assess predominant energies of exposure in a nuclear research centre--Saclay (France).

A study of dosimetric errors is under way within an international collaborative study of cancer risk among workers in the nuclear industry. The objective is to quantify errors in the estimated photon doses to individual organs used for cancer risk estimation. One source of errors is the response of old dosemeters in workplace exposure conditions. As these conditions are not well known, the International Study must rely on expert estimations. This paper describes a method to assess the proportion of the dose from photons in three energy ranges (< 100, 100-300, > or = 300 keV) using the responses under filters of a multi-element dosemeter. The method was tested on experimental and simulated data and provides a good estimate of the proportion of dose from photons below 100 keV, the most critical for dosemeter response. It was applied to personnel readings in one facility, confirming the experts' estimation. Beyond the International Study, the method has implication for the monitoring and protection of workers.

Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries.

OBJECTIVES: To provide direct estimates of risk of cancer after protracted low doses of ionising radiation and to strengthen the scientific basis of radiation protection standards for environmental, occupational, and medical diagnostic exposures. DESIGN: Multinational retrospective cohort study of cancer mortality. SETTING: Cohorts of workers in the nuclear industry in 15 countries. PARTICIPANTS: 407 391 workers individually monitored for external radiation with a total follow-up of 5.2 million person years. MAIN OUTCOME MEASUREMENTS: Estimates of excess relative risks per sievert (Sv) of radiation dose for mortality from cancers other than leukaemia and from leukaemia excluding chronic lymphocytic leukaemia, the main causes of death considered by radiation protection authorities. RESULTS: The excess relative risk for cancers other than leukaemia was 0.97 per Sv, 95% confidence interval 0.14 to 1.97. Analyses of causes of death related or unrelated to smoking indicate that, although confounding by smoking may be present, it is unlikely to explain all of this increased risk. The excess relative risk for leukaemia excluding chronic lymphocytic leukaemia was 1.93 per Sv (< 0 to 8.47). On the basis of these estimates, 1-2% of deaths from cancer among workers in this cohort may be attributable to radiation. CONCLUSIONS: These estimates, from the largest study of nuclear workers ever conducted, are higher than, but statistically compatible with, the risk estimates used for current radiation protection standards. The results suggest that there is a small excess risk of cancer, even at the low doses and dose rates typically received by nuclear workers in this study.

Endometrial cancer following breast cancer: Effect of tamoxifen and castration by radiotherapy.

Tamoxifen, a synthetic antiestrogen, has been shown to be effective in reducing mortality from breast cancer and the occurrence of contralateral breast cancer. Tamoxifen is now being studied as a preventive of breast cancer among healthy women considered to be at high risk; preventive trials are now under way both in the USA and in Europe. We undertook a case-control study in Lyon and Dijon, France, to assess the effect of tamoxifen and other treatments for breast cancer on subsequent endometrial cancer. Through the use of clinicians' surveys in Lyon and a population-based cancer registry in Dijon, we identified 43 cases of endometrial cancer diagnosed at least 1 year after the diagnosis of breast cancer. We matched 177 controls to the cases for age, region, year of diagnosis of breast cancer, and survival from breast cancer. Tamoxifen had been used in 67% of cases and 60% of controls [odds ratio (OR) = 1.4; 95% confidence interval (CI) = 0.60-3.5]. Relative risk of endometrial cancer increased with duration of tamoxifen use: less than 2 years, 1.5; 95% CI = 0.44-4.9; 2-5 years, 1.5; 95% CI = 0.42-5.6; more than 5 years, 3.5; 95% CI = 0.94-12.7. Radiotherapeutic castration increased the risk for endometrial cancer more than tamoxifen (OR = 7.7; 95% CI = 1.8-32.8).

[Orodental hygiene habits in preadolescents and adolescents from 2 urban and 2 rural secondary schools]. / Estudio de hábitos de higiene bucodental en preadolescentes y adolescentes de dos colegios urbanos y dos rurales.

OBJECTIVE: Buccodental health is a problem of high prevalence, including mainly caries, malocclusion and malposition. Dental caries is the principal oral problem of childhood and adolescence. The objective of our study was to know the information, customs and attitudes in relationship to buccodental hygiene of preadolescent and adolescent students. MATERIAL AND METHODS: The design is a cross-sectional epidemiological study of two urban (n = 330 students) and two rural (n = 270 students) schools. We performed an individual interview with the students that included 27 items concerning knowledge, customs and attitudes about buccodental hygiene. RESULTS: The prevalence of caries is 24.5% in our population. We found the best buccodental hygiene in rural students and girls. The adolescents are more problematic than preadolescents. CONCLUSION: It is important to make health examinations and to have health education in school, especially concerning some pathologies with a higher prevalence such as dental caries and other buccodental diseases. The first step towards good health education is to know the reality of the problem. A higher level of sanitary education in rural schools is most likely the cause for better results in this population. The girls have more conscience of this disease. It is necessary to increase the health education about buccodental hygiene, mainly in adolescence.

Recomendaciones en el abordaje diagnóstico y terapéutico del fumador. Documento de consenso / Recommendations in diagnosis and treatment of tobacco cessation. Consensus document

El tabaquismo es la principal causa de muerte evitable en los países desarrollados. Todos los profesionales sanitarios jugamos un papel clave en su control. Es fundamental realizar un correcto diagnóstico de las características de cada fumador para de esa forma ofertarle su tratamiento más adecuado. A lo largo de este documento de consenso entre las sociedades científicas que agrupan a los profesionales sanitarios más interesados en el tabaquismo, hemos definido un grupo de datos clínicos y analíticos que deben ser considerados para establecer el conjunto mínimo de datos diagnósticos en el fumador. Además recomendamos una actividad terapéutica adecuada a las características diagnósticas de cada fumador. Este conjunto mínimo de datos es la base imprescindible para establecer el tratamiento más adecuado a cada individuo con el objetivo de que el paciente progrese en el proceso de abandono del tabaco y consiga la abstinencia tabáquica en el más corto periodo de tiempo posible y con el menor coste personal. Así mismo este conjunto mínimo de datos permite racionalizar la intervención del profesional sanitario conforme a criterios de eficacia y eficiencia (AU)

¿Quién debe tratar al fumador de su adicción? / No disponible

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Características de los fumadores que acuden a una unidad de tabaquismo en régimen ambulatorio / Characteristics of smokers who come to a smoking unit in out patient regime

Objetivo: Conocer las características del paciente fumador que solicitatratamiento en la Unidad, con la finalidad de adaptar las intervencionesy mejorar los resultados.Métodos: Estudio descriptivo sobre una muestra de 251 pacientesque realizaron el cuestionario y la entrevista de evaluación hasta enerode 2003 (15 meses). Se analizan variables sociodemográficas, relacionadascon el hábito de fumar, y otras variables moduladoras.Resultados: El 53,5% son mujeres, la edad media del total de lamuestra es 41,84; el 50,8% han completado estudios primarios; el 74%está casado o en pareja; un 67,5% está activo laboralmente; el 73,2%acuden a tratamiento por decisión personal. El 83,3% se inició en el consumoentre los 13 y los 20 años con una media de 17 años y 24 años fumando,26 cigarrillos/día y 3 intentos previos de abandono. El 47,2%presenta dependencia alta y 56,7% motivación moderada (Test deFagerström y Test de Richmond respectivamente). El 42,1% refieren antecedentesde trastornos depresivos o de ansiedad, el 34,3% han recibidotratamiento psiquiátrico y/o psicológico con anterioridad y un 38,6%están en tratamiento médico en la actualidad.Conclusiones: El perfil de los pacientes atendidos se correspondecon el de un hombre o mujer adulto (alrededor de 40 años), casado, connivel de estudios medio y laboralmente activo, que inició su adicción enla adolescencia, fumador de más de 20 cigarrillos/día y varios intentosde dejar de fumar. Dependencia moderada-alta y relativa motivación paradejar de fumar. Un alto porcentaje presentan antecedentes psicopatológicosde ansiedad o depresión

Methods: A descriptive study based on a sample of 251 patientswho completed the questionnaire and the evaluation interview up toJanuary 2003 (15 months). Sociodemografic and other variables associatedwith the smoking habit are analysed.Results: 53,5% are women; the mean age of the sample is 41,84 years;50,8% had completed primary education; 74% are married or have apartner; 67,5 % are working; 73,2% attend treatment by personal decision;83,3% started the habit between the ages of 13 and 20 years, the mean being17 years; average 24 years smoking; average smoked is 26 cigarrettes/day;average of 3 previous attempts to break the habit. 47,2% exhibit high dependencyand 56,7% moderate motivation (Fagerstrom and Richmond test).42,1% have a history of depression or an anxiety disorder; 34,3%have received previous psychiatric and /or phychological treatment and38,6% are presently under medical attention.Conclusions: The profile of patients is that of: an adult man or womanbetween the age of 40 years, married, with an intermediate level ofeducation and currently at work. Addiction began in adolescence; smokesmore than 20 cigarettes/day and has made various attemps to break thehabit.Moderate to high dependency and relatively well motivated to stopsmoking. A high percentage exhibit prior psychopatological problemsof anxiety or depression

Tabaquismo: primeros pasos / Smoking: The first steps

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Recomendaciones en el abordaje diagnóstico y terapéutico del tabaquismo. Documento de consenso / Guidelines for a diagnostic therapeutic approach to smoking addiction. A consensus report

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Recomendaciones en el abordaje diagnóstico y terapéutico del fumador. Documento de consenso / Recommendations on the diagnostic and therapeutic approach to smokers. Consensus document

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