Quantifying Potential Health Impacts of Cadmium in Cigarettes on Smoker Risk of Lung Cancer: A Portfolio-of-Mechanisms Approach

This article introduces an approach to estimating the uncertain potential effects on lung cancer risk of removing a particular constituent, cadmium (Cd), from cigarette smoke, given the useful but incomplete scientific information available about its modes of action. The approach considers normal cell proliferation; DNA repair inhibition in normal cells affected by initiating events; proliferation, promotion, and progression of initiated cells; and death or sparing of initiated and malignant cells as they are further transformed to become fully tumorigenic. Rather than estimating unmeasured model parameters by curve fitting to epidemiological or animal experimental tumor data, we attempt rough estimates of parameters based on their biological interpretations and comparison to corresponding genetic polymorphism data. The resulting parameter estimates are admittedly uncertain and approximate, but they suggest a portfolio approach to estimating impacts of removing Cd that gives usefully robust conclusions. This approach views Cd as creating a portfolio of uncertain health impacts that can be expressed as biologically independent relative risk factors having clear mechanistic interpretations. Because Cd can act through many distinct biological mechanisms, it appears likely (subjective probability greater than 40%) that removing Cd from cigarette smoke would reduce smoker risks of lung cancer by at least 10%, although it is possible (consistent with what is known) that the true effect could be much larger or smaller. Conservative estimates and assumptions made in this calculation suggest that the true impact could be greater for some smokers. This conclusion appears to be robust to many scientific uncertainties about Cd and smoking effects.     

ASSESSING THE RELATIONSHIP BETWEEN SYMPTOMS OF ALLERGIC RHINOCONJUNCTIVITIS AND POLLEN COUNTS

The relationship between daily pollen counts during the peak pollen season and hay fever symptoms in known sufferers of pollen allergy was investigated in a Sydney hospital‐based study. This paper develops statistical models for both the short term (day to day) associations and the longer term relationships between these time series. Possible effects of asthma status are investigated. The analyses illustrate how different relationships between time series may be explored in a simple way by working on different time scales with suitably transformed variables.     

Work-related violence—is national reporting good enough?

Throughout Europe there are relatively few statistics, gathered a national level, which deal specifically with the problem of violence at work. In the UK, the revised Reporting of Injuries. Discases and Dangerous Occurrences Regulations (RIDDOR) 1995 now require that certain violent incidents are reported on a national basis. The criteria for reporting, which are entirely dependent on the physical outcome of incidents. are discussed. It is recommended that employing organizations should establish their own internal systems for reporting and recording a wider range of violent, and potentially violent. incidents. These should then be used to inform risk assessment and risk management.