Objectives-To evaluate whether ceramic workers exposed to silica experience an excess of end stage renal disease. Methods-On the basis of a health surveillance programme, a cohort of 2980 male ceramic workers has been enrolled during the period 1974-91 in Civitacastellana, Lazio, Italy. For each worker, employment history, smoking data, and x ray film readings were available. The vital status was ascertained for all cohort members. All 2820 people still alive and resident in the Lazio region as in June 1994 were searched for a match in the regional end stage renal diseases registry, which records (since June, 1994) all patients undergoing dialysis treatment in public and private facilities of the region. Expected numbers of prevalent cases from the cohort were computed by applying the rate of patients on dialysis treatment by the age distribution of the cohort. Results-A total of six cases was detected when 1.87 were expected (observed/ expected (O/E)=3.21; 95% confidence interval (95% CI) 1.17 to 6.98). The excess risk was present among non-smokers (O=2; O/E=4.34) and smokers (O=4; O/E=2.83), as well as among workers without silicosis (O=4; O/E=2.78) and workers with silicosis (O=2; O/E=4.54). The risk was higher among subjects with <20 years since first employment (O=4; O/E=4.65) than among those employed >20 years. Conclusion-These results provide further evidence that exposure to silica dust among ceramic workers is associated with nephrotoxic eVects. (Occup Environ Med 1999;56:559-561)

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Objectives-To investigate whether indoor radon or radiation might play a part in myeloid leukaemia as suggested by studies based on crude geographical or geological data for exposure assessment. Methods-For six months radon and radiation was measured with solid state nuclear track detectors and thermoluminescent dosimeters in dwellings of 44 adult male cases of acute myeloid leukaemia and 211 controls (all subjects deceased). Conditional logistic regression ORs (ORs) and 95% confidence intervals (95% CIs) were estimated for quartiles of radon and radiation and for municipality and dwelling characteristics. Results-The risk of leukaemia was associated with an increasing urbanisation index (p value for trend=0.008). An increased OR was found among those living in more modern houses (OR 3.0, 95% CI 1.4 to 6.6). Confirming the findings of a previous study in the same area, geological features bore a positive association with myeloid leukemia, even by adjusting for level of urbanisation. Contrary to expectations from the previous study, however, no association appeared between myeloid leukaemia and radon and radiation; for the highest quartiles of exposure, ORs were 0.56 (95% CI 0.2 to 1.4) and 0.52 (95% CI 0.2 to 1.4), respectively. Considering only subjects who had lived >20 years in the monitored home and adjusting for urbanisation, there was still no eVect of exposure to radiation. Conclusions-In view of the limited numbers, the results do not in general refute a possible risk of myeloid leukaemia from exposure to indoor radon or radiation, but decrease the credibility of such a relation in the area studied and also of other studies suggesting an eVect without monitoring indoor radiation. Some other fairly strong determinants have appeared-that is, level of urbanisation and living in modern houses-that might need further consideration. (Occup Environ Med 1998;55:106-110)

Background: Few studies have investigated congenital anomalies in relation to municipal waste incinerators (MWIs) and results are inconclusive. Objectives: To conduct a national investigation into the risk of congenital anomalies in babies born to mothers living within 10 km of an MWI associated with: i) modelled concentrations of PM 10 as a proxy for MWI emissions more generally and; ii) proximity of residential postcode to nearest MWI, in areas in England and Scotland that are covered by a congenital anomaly register. Methods: Retrospective population-based cohort study within 10 km of 10 MWIs in England and Scotland operating between 2003 and 2010. Exposure was proximity to MWI and log of daily mean modelled ground-level particulate matter ≤10 μm diameter (PM 10 ) concentrations. Results: Analysis included 219,486 births, stillbirths and terminations of pregnancy for fetal anomaly of which 5154 were cases of congenital anomalies. Fully adjusted odds ratio (OR) per doubling in PM 10 was: 1•00 (95% CI 0•98-1•02) for all congenital anomalies; 0•99 (0•97-1•01) for all congenital anomalies excluding chromosomal anomalies. For every 1 km closer to an MWI adjusted OR was: 1•02 (1•00-1•04) for all congenital anomalies

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