JONES RD, SMITH OM, THOMAS PG. A mortality study of vinyl chloride monomer workers employed in the United Kingdom in 1940-1974. Scand J Work En viron Health 14 (1988 153-160. The mortalit y experience of 5 498 male wor kers emp loyed for at least one year during 1940-1 974 in th e vinyl chloride indu str y of the United Kingdom was followed through to 31 December 1984. Th ere was a significant excess of nonsecondary liver tumors with II deaths, of which seven were ang iosar coma s. All the an giosarcoma deaths occurred in auto clave workers with a median lat ency of 25 years from date of first exposur e. A strong health y worker effect was seen. Oth er than that for liver cancer, no increased incidence of cancer death s attributa ble to vinyl ch loride mon omer exposure was found . There was no evidence of increased mortality from chronic liver d isease. T he incidence of death from respirat ory disease was low and was not af fected by polyvinyl chlo ride dust exposure.

This article describes the surgery of tropical pancreatitis as practiced in a region of high incidence, based on the experience at 2 centers: the Department of Surgical Gastroenterology and Proctology, Government General Hospital, Madras, Tamilnadu (a tertiary-care referral unit) where 52 patients were diagnosed and 40 were operated on between 1982 and 1987; and the Department of Gastroenterology, Deva Matha Hospital, Koothattukulam (a specialized center located in the main endemic area of Kerala), where 116 patients were diagnosed and 33 operated on between 1983 and 1988. The latter series is described in detail with emphasis on the preoperative imaging, operative findings, surgical procedures, complications, and results of surgery. The experience of other centers in southern India is summarized and discussed. The disease is obviously different from chronic pancreatitis in the West. Special problems of tropical pancreatitis, particularly the management of diabetes and the association of pancreatic carcinoma at a young age, are discussed.

In patients with bleeding gastric varices from causes other than splenic vein thrombosis, endoscopic sclerotherapy and ablative surgery have yielded poor results. Over a 3-year period starting in June 1989, a total of 30 distal splenorenal shunts were performed prospectively on 19 paediatric and 11 adult patients with bleeding gastric varices and good liver function. The mean (s.d.) age was 17(12) (range 6-50) years; there were 20 male and ten female patients of whom six had cirrhosis, four non-cirrhotic portal fibrosis and 20 portal vein thrombosis. Two patients died and two more had shunt thrombosis; all four were considered failures of treatment. Hypersplenism was present in 15 patients but reverted to normal in 13. In 26 patients the gastric varices disappeared. Concomitant oesophageal varices were present in 22 patients and showed marked regression, with no rebleeding over a mean (s.d.) follow-up of 21(10) (range 7-39) months. A distal splenorenal shunt was effective in controlling gastric variceal haemorrhage in 26 of 30 patients in whom liver function was well preserved.

JONES RD, SMITH DM, THOMAS PG. Mesothelioma in Great Britain in 1968-1983. Scand J Work En viron Health 14 (1988 145-152. The British mesothelioma register records deaths in Great Britain when the word " mesothelioma" is on the death certificate. In 1968-1983 the mesotheliomadeaths among men increased from 114 to 467, while those among women increased from 38 to 90. In 1983 the crude mesothelioma death rates were 17.5 per millionand 3.2 per million for the men and women, respectively . The Northern region had the highest crude rates. At the county level, the highest crude deaths rates in 1976-1983 were recorded for the men in Devon and for the women in Lancashire. Marked differences occurred in the ratio of deaths among men to deaths among women for mesothelioma of the pleura (4.6 : I) and for mesothelioma of the peritoneum (2: I). The age-specific death rates for men and women diverged markedly for pleural mesothelioma but not for peritoneal mesothelioma. Trends in the use of asbestos and in age-and sex-specific death rates suggest that the annual number of mesothelioma deaths will continue to increase, possibly until the turn of the century. This increase will be concentrated among the men as the main asbestos exposure of women occurred during the war and the annual deaths due to this exposure may have already peaked.

Surgery in tropical pancreatitis

Nineteen consecutive patients, 7 male and 12 female, underwent pancreaticoduodenectomy for malignancy during the 3‐year period 1985‐88. The pancreatic remnant in the first 12 patients (Group 1) was managed alternately by pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Patients undergoing PJ and PG (6 each) were comparable in age, biochemical parameters and nature and extent of disease. Three patients, all in the PJ subgroup, died (25% mortality) due to pancreatic leak, biliary leak and hepatocellular failure. In view of the high complication rate following PJ, the remaining 7 patients (Group 11) underwent PG. For patients undergoing PG, the hospital stay was shorter, complications were fewer and there was no anastomotic leak or death (0% mortality). This study represents the first attempt at comparison of PJ with PG in reconstruction following the Whipple procedure by the same team. The results suggest that PG deserves wider application.

Background: The National Rural Health Mission (NRHM) aimed to bridge the gap in rural health care with the introduction of the Accredited Social Health Activist (ASHA) in 2005. It is essential to identify the motivators and barriers to work performance by the ASHAs in order to facilitate better health care in the community. Objective: To identify the motivators and barriers to the work performance of ASHAs in the Solur PHC area, Ramanagara district, Karnataka. Material & Methods: A qualitative study was conducted in one PHC area of Ramanagara District, Karnataka. Four KIIs with government health functionaries and one FGD with nine ASHAs were conducted. A thematic frame-work approach was used for data analysis. Results: The main personal motivators were altruism and intrinsic satisfaction, while social support and team-work were important environmental motivators. De-motivating factors were financial problems such as insufficient pay and irregular financial incentives, as well as logistic difficulties, including transportation and safety. Conclusion: Personal, cultural, financial considerations and working conditions affect the performance of an ASHA. It is essential to address relevant issues faced by these health workers in order to improve their work satisfaction and efficiency.