Aims: To investigate the lagged effects of cold temperature on cardiorespiratory mortality and to determine whether ''wind chill'' is a better predictor of these effects than ''dry bulb'' temperature. Methods: Generalised linear Poisson regression models were used to investigate the relation between mortality and ''dry bulb'' and ''wind chill'' temperatures in the three largest Scottish cities (Glasgow, Edinburgh, and Aberdeen) between January 1981 and December 2001. Effects of temperature on mortality (lags up to one month) were quantified. Analyses were conducted for the whole year and by season (cool and warm seasons). Main results: Temperature was a significant predictor of mortality with the strongest association observed between temperature and respiratory mortality. There was a non-linear association between mortality and temperature. Mortality increased as temperatures fell throughout the range, but the rate of increase was steeper at temperatures below 11˚C. The association between temperature and mortality persisted at lag periods beyond two weeks but the effect size generally decreased with increasing lag. For temperatures below 11˚C, a 1˚C drop in the daytime mean temperature on any one day was associated with an increase in mortality of 2.9% (95% CI 2.5 to 3.4), 3.4% (95% CI 2.6 to 4.1), 4.8% (95% CI 3.5 to 6.2) and 1.7% (95% CI 1.0 to 2.4) over the following month for all cause, cardiovascular, respiratory, and ''other'' cause mortality respectively. The effect of temperature on mortality was not observed to be significantly modified by season. There was little indication that ''wind chill'' temperature was a better predictor of mortality than ''dry bulb'' temperature. Conclusions: Exposure to cold temperature is an important public health problem in Scotland, particularly for those dying from respiratory disease. M ortality rates for cardiovascular and respiratory disease typically exhibit distinct seasonal variation with the highest rates occurring in the winter months.1 For Scotland, the percentage summer to winter difference in weekly all cause mortality rates is estimated to be in the order of 30%.2 The main factor considered to be influencing the observed seasonal pattern is the relation between mortality and temperature. The association between low temperature and increased morbidity and mortality is well recognised.3 4 What is less clear is the exact nature of the relation. Research has shown that the effect of temperature on mortality can exhibit significant variation from region to region. 5 6 For example, some studies have reported a U or V-shaped relation between temperature and mortality with the maximum number of deaths occurring at each end of the temperature scale 7 8 whereas others have reported a more linear or reverse J-shaped relation, with mortality typically increasing as temperature drops.
Objectives-To design a questionnaire for the identification and assessment of severity of back pain for epidemiological purposes, and gain preliminary experience of its use. Methods-A group of specialists, experienced in the epidemiology and clinical assessment of back pain, designed the questionnaire, and tested it individually. It was also given cross sectionally by interview to a population of male coal mine workers. Results-The questionnaire comprised a maximum of 12 questions on the presence, radiation, frequency, and severity of back pain with reference to difficulty with specific activities, interference with normal work, and absence from work. 471 coal miners answered the questionnaire (66% of those invited). 56% (265 men) of the responders reported pain or ache in the back during the previous 12 months, and the incidence of first ever attacks during the same period was reported to be 34%. 690/% reported having had back pain at some time. The responses to the questionnaire were partially validated by comparison with certified sickness absence for two days or more attributed to back pain. In men who were symptomatic in the previous 12 months, for the question relating to absence from work because of back pain, the sensitivity was 82% and specificity was 84%. Conclusion-The questionnaire is easy to administer and generates clear cut data that could be useful for epidemiological or screening purposes. Preliminary, limited, studies of its validity are reasonably encouraging, although further validation is required. It is hoped that researchers will find the questionnaire useful, will extend its validation, and continue to develop it. (Occup Environ Med 1994;51:756-760) Keywords: back pain, questionnaire, epidemiology Although many epidemiological studies of back pain have been conducted, they have been characterised by many methodological difficulties. These include different definitions of back pain, the lack of a standard questionnaire, and inadequate validation. Therefore a need is recognised for a generally accepted standard questionnaire to assess frequency of back pain in groups of individuals and to enable comparisons of frequency with causative and other factors. As no such questionnaire was available, a working group of British specialists experienced in the epidemiology, ergonomics, and clinical assessment of back pain was convened by the Institute of Occupational Medicine (IOM). The principal aim of the working group was to standardize epidemiological studies of frequency of back pain in groups of people. A questionnaire was devised that would identify individuals with back pain, enable studies of the relation of back pain with possible causative and other factors, and provide information on duration, frequency, and severity of pain.
The results suggest a stronger effect of black smoke on mortality among people living in more deprived areas. The effect was greatest for respiratory mortality, although significant trends were also seen for other groups. If corroborated, these findings could have important public health implications.
Difficulties in teaching occupational medicine to undergraduates stem from the reduced availability of teaching time and the perception of the specialty. Recent changes in the General Medical Council curricular framework have permitted the development of a special study module (options course) in occupational medicine, in which a small number of motivated undergraduates elected to participate and which was adequately resourced. This course laid particular emphasis on changing students' attitudes towards the specialty, self-learning techniques, problem-solving and other skills such as workplace assessment. The objectives, content and teaching methods of the course are described, as is a preliminary evaluation. It is suggested that other medical schools should adopt and refine this approach in order to improve the quality of undergraduate training in at least a proportion of the output of medical schools.
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