The Ministry of Defence's equal opportunities policy, which was introduced in 1993, means that female recruits to army training regiments have been exposed to the same rigorous, physically demanding exercise as men. We noticed a fourfold increase in referrals between 1994 and 1996 and decided to investigate whether this reflected increased referral of women. Subjects, methods, and resultsAlthough radiography is the main diagnostic tool for detecting bone trauma, radionuclide bone scanning is more effective at showing stress fractures, shin splints, and covert fractures. We studied the bone scans of all recruits of an army training regiment who were referred with suspected trauma from 1 April 1995 to 31 March 1997. During this time 4222 recruits (3367 men and 855 women) carried out basic fitness training and were assessed at the regiment.On referral each patient was assessed to determine the site of injury and for the symptoms and signs of bone pain, tenderness, and swelling. A gamma camera was used to take static bone scans of the pelvis and lower limbs three hours after an injection of 555 MBq technetium-99m oxidronate. Scans were reported routinely by one of two nuclear medicine consultants (MAM and CA).In 1997 the scans of all people referred from the training regiment were retrieved and all identifying information removed. Scans were then reassessed and reported blind by MAM. Scans were classified as abnormal if stress fractures or shin splints were present. To test intraobserver agreement MAM reviewed 50 randomly selected scans four weeks later. Agreement on normality was found in 42 out of 50 cases (84%, = 0.66). For interobserver agreement the same scans were assessed by a second consultant (CA) unaware of the patients' identity and previous results. There was agreement in 44 out of 50 cases (88%, = 0.74).A total of 143 men and 121 women were referred with signs and symptoms of lower limb trauma for routine diagnostic radionuclide bone scanning during the study period. The age range was 16-26 (mean 19.5, SD 2.1) for men and 16-30 (20.1, 2.6) for women (P > 0.05 by Student's t test). Nine recruits (three men and six women) were referred twice as a result of repeat injury, resulting in 273 scans.The table shows the numbers of stress fractures and shin splints in men and women. In all, 71% (103/146) of scans were abnormal for men and 76% (97/127) for women, suggesting that no significant sex bias exists in the referral pattern ( 2 = 1.07; P > 0.2). For the nine subjects who had two scans we classified the results as abnormal if either or both of the scans showed an abnormality. This gave an abnormality rate of 71% (101/143) for men and 77% (93/121) for women.The rate of referral for bone scanning was 4.2% (143/3367) for men and 14.2% (121/855) for women (difference 10%, 95% confidence interval 7.5% to 12.3%). A two tailed 2 test with Yates's correction showed that this difference was highly significant ( 2 = 112.4, P < 0.001). Similarly, the difference in the percentage of male and female recruits with abnor...

If these data elements are accurate and well-reported, their addition to birth, fetal death, and other health records may aid in environmental public health tracking.

Emerging hypotheses suggest a causal role for prenatal androgen exposure in some cases of autism spectrum disorders (ASD). The ratios of the lengths of the bones of the 2 nd to the 4 th digit (2D:4D) are purported to be markers for prenatal androgen exposure and to be established early in gestation. Elongation of the 4 th digit in response to testosterone is said to reduce 2D:4D in males versus females. We examined the ratios of bones from the left hand radiographs of 75 boys and 6 girls 4-8 years of age, diagnosed with ASD, to evaluate digit ratio as a marker for gestational androgen exposure. Contrary to our expectations, girls had reduced 2D:4D compared to boys but the difference was not significant (Cohen's D 0.51-0.66, P>0.05). The limited sample size for this study and the absence of a referent group precluded providing robust estimates for girls and identifying possible statistical differences between the sexes. Tanner-Whitehouse 3 (TW3) rating of finger bone growth suggested relative immaturity of the 4 th relative to the 2 nd digits. Positive correlations were detected for 2D: 4D ratios, body mass index (r=0.23, P=0.039), chronologic age (r=0.35, P=0.001), and skeletal age (r=0.42, P<0.0001). The TW3 ratings and associations between 2D:4D ratios and indicators of growth suggest that digits develop at different rates. This asynchronous development may produce differences in 2D:4D over time which could lead to erroneous interpretation of androgen exposure in utero among young ASD children.