Pleural mesothelioma and lung cancer risks in relation to occupational history and asbestos lung burden.

BACKGROUND: We have conducted a population-based study of pleural mesothelioma patients with occupational histories and measured asbestos lung burdens in occupationally exposed workers and in the general population. The relationship between lung burden and risk, particularly at environmental exposure levels, will enable future mesothelioma rates in people born after 1965 who never installed asbestos to be predicted from their asbestos lung burdens. METHODS: Following personal interview asbestos fibres longer than 5 µm were counted by transmission electron microscopy in lung samples obtained from 133 patients with mesothelioma and 262 patients with lung cancer. ORs for mesothelioma were converted to lifetime risks. RESULTS: Lifetime mesothelioma risk is approximately 0.02% per 1000 amphibole fibres per gram of dry lung tissue over a more than 100-fold range, from 1 to 4 in the most heavily exposed building workers to less than 1 in 500 in most of the population. The asbestos fibres counted were amosite (75%), crocidolite (18%), other amphiboles (5%) and chrysotile (2%). CONCLUSIONS: The approximate linearity of the dose-response together with lung burden measurements in younger people will provide reasonably reliable predictions of future mesothelioma rates in those born since 1965 whose risks cannot yet be seen in national rates. Burdens in those born more recently will indicate the continuing occupational and environmental hazards under current asbestos control regulations. Our results confirm the major contribution of amosite to UK mesothelioma incidence and the substantial contribution of non-occupational exposure, particularly in women.

A randomized trial of screening for relationship violence in young women.

OBJECTIVES: We conducted a randomized controlled trial of three screening approaches to assess relationship violence disclosure among young women as well as patient and provider satisfaction. METHODS: Reproductive healthcare patients (n=699) aged 15 to 24 years completed one of three approaches to violence screening, that is, basic, healthy relationship, and bidirectional. Screening was embedded in a comprehensive health history using an audio-assisted computer interview (ACASI). Afterward, the patient met with the provider, who reviewed screening results. The patient and provider independently completed an assessment of the process. RESULTS: Medical and violence screening took about 8 minutes with those in the basic screening finishing significantly more quickly. We did detect a significant difference by screening approach for recent physical violence victimization, but no other significant differences emerged between screening approaches. Although patients' or providers' satisfaction and comfort with the screening process were positive, no differences were detected. CONCLUSIONS: An approach that frames questioning within a birectional context enhances detection of recent physical victimization, and can be completed in busy reproductive healthcare setting. All screens were equally and highly regarded by participants and adequately rated by providers.