The attitude of 126 occupational physicians to the employment problems of patients with intestinal stomas were assessed by a postal questionnaire. Heavy work and work in hot places were commonly (65 and 49 per cent of respondents respectively) considered 'unsuitable'. Work as a food handler, handling toxic chemicals and driving duties was thought to be 'unsuitable' by 35, 14 and 10 per cent of respondents respectively and actually forbidden by a few physicians. Risk of spread of infection was perceived to be greater than normal for someone with a stoma by 28 per cent of respondents. This attitude was significantly more common (p less than 0.05 Chi square) among the associate members compared to full members of the Faculty of Occupational Medicine. Attitudes to people with either an ileostomy or a colostomy were similar. Most respondents (87 per cent) expected more sickness absences than normal for people with inflammatory bowel disease without a stoma but half appreciated that the creation of a stoma would result in normal amounts of sickness absence. The Occupational Physicians' views of which jobs within their industry were unsuitable for stoma patients were inconsistent. In practice most tasks can be performed normally by someone with a stoma so that each case should be assessed on an individual basis. There is a need for greater understanding and awareness by doctors of the good employment potential of people with intestinal stomas. The reasons for present attitudes are reviewed and new guidelines suggested.

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BackgroundThe molecular mechanisms initiating vertebrate cranial dermal bone formation is a conundrum in evolutionary and developmental biology. Decades of studies have determined the developmental processes of cranial dermal bones in various vertebrate species, finding possible inducers of dermal bone. However, the evolutionarily derived characters of current experimental model organisms hinder investigations of the ancestral and conserved mechanisms of vertebrate cranial dermal bone induction. Thus, investigating such mechanisms with animals diverging at evolutionarily crucial phylogenetic nodes is imperative.ResultsWe investigated the cellular and molecular foundations of skull frontal bone formation in the spotted gar Lepisosteus oculatus, a basally branching actinopterygian. Whole-mount bone and cartilage stainings and hematoxylin-eosin section stainings revealed that mesenchymal cell condensations in the frontal bone of spotted gar develop in close association with the underlying cartilage. We also identified novel aspects of frontal bone formation: Upregulation of F-actin and plasma membrane in condensing cells, and extension of podia from osteoblasts to the frontal bone, which may be responsible for bone mineral transport.ConclusionThis study highlights the process of frontal bone formation with dynamic architectural changes of mesenchymal cells in spotted gar, illuminating supposedly ancestral and likely conserved developmental mechanisms of skull bone formation among vertebrates.