Lung function in workers refining phosphorus rock to obtain elementary phosphorus.

Elevated levels of phosphoric acid, phosphorus pentoxide, fluorides and coal tar pitch volatiles were present in workplace air of a two-oven industrial refinery. One hundred thirty-one workers prospectively underwent annual pulmonary function testing (forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow). Regression of these spirometric data, analyzed longitudinally over 3 to 7 years and also cross-sectionally reveals no residual significant effect of industrial exposure after adjusting for the effect of age and smoking. This industrial exposure contributes only weakly and inconsistently to the well-documented reduction of spirometric lung function that occurs from smoking alone. No significant reductions of spirometry occurred in exposed nonsmokers or former smokers.

Teaching epidemiology and biostatistics through interactive problem solving.

Medical education should prepare students for the reasoning and decision making that are required in a physician's clinical work. The disciplines of epidemiology and biostatistics, as combined in clinical epidemiology, lend themselves very well to this purpose. A lecture course in epidemiology and biostatistics was redesigned to emphasize interactive learning through problem-solving workshops in which students worked with actual data from two epidemiologic studies. A third workshop provided experience in the critical appraisal of an epidemiologic study from the current literature. Students respond favorably to these active learning experiences, which deal with relevant contemporary health problems. The concepts of clinical epidemiology should be integrated into clinical teaching in all stages of training.