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Biomedical subjects

D Coggon

Publications and source records attributed to D Coggon.

At least 181 records · Page 10Linked to original sources
PubMed1986

Increase in hospital admissions for torsion of testis.

Data from Hospital Activity Analysis (HAA) for the Wessex Health Region show a 70% increase in hospital admissions for torsion of the testis between 1971 and 1982. The frequency of emergency admission leading to orchidopexy doubled, but there was no increase in the rate of emergency admission followed by orchidectomy. Detailed investigation of records from Southampton hospitals suggests that the trend cannot be explained by errors in the ascertainment of cases by HAA. The rise in admissions could result from a greater awareness of the diagnosis among general practitioners leading to more frequent referral of mild cases, but it seems more likely that it reflects a real increase in the incidence of the disorder.

Adolescent↗
PubMed1986

A survey of cancer and occupation in young and middle aged men. I. Cancers of the respiratory tract.

In a search for clues to previously industrial carcinogens the occupational and smoking histories of young and middle aged men with different types of cancer were compared. The study population comprised men aged 18-54 and resident in the counties of Cleveland, Humberside, and Cheshire (including the Wirral). From hospital and cancer registration records 2942 members of the study population in whom cancers were diagnosed during the period 1975-80 were identified retrospectively. The occupational and smoking histories of these patients were sought by a postal questionnaire addressed either to the patients themselves or, if they had died, to their next of kin. The overall response rate to the questionnaire was 52.1%. Additionally, limited occupational information was obtained for 89% of cases from their hospital notes. Analysis of these data suggests that no serious bias arose as a consequence of the incomplete response to the questionnaire. This paper concentrates on the results for cancers of the respiratory tract and mesothelioma. Mesothelioma was found to cluster in laggers, electricians, and shipyard workers, and nasal carcinoma in woodworkers. Carcinomas of the larynx and of the bronchus were examined by formal statistical techniques, each being compared with a control group made up of all other cancers combined. Several interesting occupational and industrial associations were shown, in particular, an excess of bronchial carcinoma in the leather industry (RR = 2.6, CI 1.2-6.0), in building labourers (RR = 1.7, CI 1.0-2.9) and other construction workers (RR = 1.8, CI 1.0-3.0), in bakers and pastry cooks (RR = 3.6, CI 1.3-10.4). and in cooks (RR = 2.5, CI 1.2-5.1). In addition, a small cluster of lung tumours was observed in men who had worked as dental mechanics.

Adolescent↗
PubMed1986

A survey of cancer and occupation in young and middle aged men. II. Non-respiratory cancers.

In a search for clues to previously unrecognised industrial carcinogens the occupational and smoking histories of young and middle aged men with different types of cancer have been compared. The study population comprised men aged 18-54 and resident in the counties of Cleveland, Humberside, and Cheshire (including the Wirral). Within this population 2942 patients in whom cancers were first diagnosed during the period 1975-80 were identified retrospectively from hospital and cancer registration records. Lifetime occupational and smoking histories were then sought from these subjects (or if they had died by proxy from their next of kin), using a postal questionnaire. The overall response rate was 52.1%. Analysis of limited occupational data obtained from the hospital notes of 89% of the patients suggests that no serious bias arose from the incomplete response to the questionnaire. The present paper describes the findings for non-respiratory cancers. Some tumours did not occur with sufficient frequency to warrant formal statistical analysis. Nevertheless, examination of the histories of patients with these cancers showed several interesting occupational clusters. In particular, five out of 29 patients with acute myeloid leukaemia had worked in electrical trades. The more common cancers were studied by statistical techniques. A large number of possible occupational associations were examined, and some will probably have achieved conventional levels of statistical significance by chance. The results should therefore be interpreted with caution, taking into account evidence from other studies and the biological plausibility of suggested hazards. Among the more interesting findings were an excess of bladder cancer in lorry drivers (RR=1.6, CI 1.0-2.4) and in men employed in the manufacture of vegetable and animal oils and fats (RR = 4.8, CI 1.8-12.9).

Adolescent↗
PubMed1986

Mortality of workers exposed to 2 methyl-4 chlorophenoxyacetic acid.

The authors examined the mortality and cancer incidence of employees at a company which has manufactured, formulated, and sprayed 2 methyl-4 chlorophenoxyacetic acid (MCPA) and other phenoxy acid herbicides. Ninety-eight percent of the 5,784 men employed by the company during 1947-1975 was traced to the end of 1983. The overall mortality of the cohort was less than that of the national population, as was mortality from cancer. When allowance was made for rural residence, the deficit of cancer deaths became a slight excess, but not statistically significantly so. Among workers whose jobs entailed potential exposure to MCPA, there was one death from soft tissue sarcoma (0.6 expected). No further cases of soft tissue sarcoma were registered among living members of the cohort. Three potentially exposed workers died from nasal carcinoma, but this tumor has not previously been associated with phenoxy herbicides and the cluster of cases may have occurred by chance. The findings do not exclude the possibility that MCPA is a human carcinogen, but they suggest that any risk of soft tissue sarcoma is less than that indicated by earlier studies of 2,4,5-T (2,4,5-trichlorophenoxyacetic acid) and 2,4,5-trichlorophenol and is small in absolute terms.

2-Methyl-4-chlorophenoxyacetic Acid↗
PubMed1985

A job-exposure matrix for use in population based studies in England and Wales.

The job-exposure matrix described has been developed for use in population based studies of occupational morbidity and mortality in England and Wales. The job axis of the matrix is based on the Registrar General's 1966 classification of occupations and 1968 classification of industries, and comprises 669 job categories. The exposure axis is made up of 49 chemical, physical, and biological agents, most of which are known or suspected causes of occupational disease. In the body of the matrix associations between jobs and exposures are graded to four levels. The matrix has been applied to data from a case-control study of lung cancer in which occupational histories were elicited by means of a postal questionnaire. Estimates of exposure to five known or suspected carcinogens (asbestos, chromates, cutting oils, formaldehyde, and inhaled polycyclic aromatic hydrocarbons were compared with those obtained by detailed review of individual occupational histories. When the matrix was used exposures were attributed to jobs more frequently than on the basis of individual histories. Lung cancer was significantly more common among subjects classed by the matrix as having potential exposure to chromates, but neither method of assigning exposures produced statistically significant associations with asbestos or polycyclic aromatic hydrocarbons. Possible explanations for the failure to show a clear effect of these known carcinogens are discussed. The greater accuracy of exposures inferred directly from individual histories was reflected in steeper dose response curves for asbestos, chromates, and polycyclic aromatic hydrocarbons. The improvement over results obtained with the matrix, however, was not great. For occupational data of the type examined in this study, direct exposure estimates offer little advantage over those provided at lower cost by a matrix.

Adolescent↗
PubMed1984

Use of job-exposure matrix in an occupational analysis of lung and bladder cancers on the basis of death certificates.

A job-exposure matrix has been applied in a case-control study of lung and bladder cancer on the basis of occupational information abstracted from British death certificates. The expected association between lung cancer and jobs entailing exposure to asbestos was clearly demonstrated (relative risk, 1.5; 95% confidence interval, 1.2-1.9). The effects of three other known industrial carcinogens were not apparent, and reasons for this were discussed. Also included in the matrix were five substances whose carcinogenicity in humans has not been established. Formaldehyde, diesel fumes, and cutting oils were all associated with carcinoma of the bronchus, but the absence of a risk in "high-exposure" occupations was against a causal relationship. Bladder cancer was more common in jobs involving high exposure to printing inks (relative risk, 5.0; 95% confidence interval, 1.0-25.8) and cutting oils (relative risk, 1.5; 95% confidence interval, 0.8-2.8). Use of the job-exposure matrix added considerably to the conventional analysis of cancer risk in individual occupational categories.

Adult↗
PubMed1983

Cimetidine and tranexamic acid in the treatment of acute upper-gastrointestinal-tract bleeding.

We studied the effects of tranexamic acid (an antifibrinolytic agent) and cimetidine on acute upper-gastrointestinal-tract bleeding in a double-blind randomized placebo-controlled trial in 775 patients with hematemesis or melena or both. Mortality was significantly reduced in patients receiving either tranexamic acid (mortality, 6.3 per cent) or cimetidine (7.7 per cent), as compared with patients receiving placebo (13.5 per cent) (P = 0.0092 for tranexamic acid vs. placebo, P = 0.045 for cimetidine vs. placebo). Ninety-nine patients were withdrawn before the code was broken, mainly because their primary illness was considered not to be due to acute upper-gastrointestinal-tract bleeding. Mortality among those withdrawn was high (22 per cent), and their exclusion reduced death rates to 4 per cent in those given tranexamic acid, 8 per cent in those given cimetidine, and 11 per cent in those given placebo (P = 0.0072 for tranexamic acid vs. placebo, P greater than 0.50 for cimetidine vs. placebo). The reduced mortality associated with tranexamic acid was detectable at both participating hospitals and in most of the main subgroups of patients classified according to site of bleeding. However, treatment with this agent was not associated with any decrease in the rate of rebleeding or the need for operation.

Acute Disease↗
PubMed1983

Analgesic intake and the risk of acute upper gastrointestinal bleeding.

A comparison of aspirin and acetaminophen consumption in 346 matched pairs of patients with hematemesis and melena and general population control subjects has shown associations between intake of both drugs and bleeding. The association for acetaminophen was weaker and was not detectable for habitual intake, whereas the association for aspirin was detectable for recent and habitual intake. Taken overall, the results suggest, by reference to acetaminophen, that patients frequently take analgesic drugs because of the symptoms of bleeding, and such intake is not causal of bleeding. Investigators who fail to employ appropriate control subjects to take account of this point exaggerate the possible risks of aspirin consumption.

Acetaminophen↗
PubMed1983

The prevalence of intermittent digital ischaemia (Raynaud's phenomenon) in a general practice.

The prevalence of intermittent digital ischaemia (IDI) has been determined in a sample of 520 patients aged 20-59 selected from the list of a Hampshire general practice. Sixtythree cases were identified using a postal questionnaire (response rate 87 per cent) and, where possible (69 per cent), histories were confirmed by interview. The estimated prevalence of IDI was 8.3 per cent in men and 17.6 per cent in women. A minimum estimate based only on histories confirmed at interview was 5.0 per cent in men and 10.4 per cent in women. Of the 63 cases identified, 12 had consulted their general practitioner because of the problem but only two had been referred to hospital. We conclude that the course of IDI is generally benign.

Adult↗
PubMed1982

Do phenoxy herbicides cause cancer in man?

Two Swedish case-control studies have shown an increased risk of soft-tissue sarcomas in men exposed to phenoxy herbicides and chlorophenols during their application. A high incidence of soft-tissue sarcomas has also been observed among workers employed in the manufacture of these products in the U.S.A. Other studies have failed to demonstrate this association. A third case-control study in Sweden suggests that phenoxy acids and chlorophenols may also predispose to Hodgkin's disease and non-Hodgkin's lymphoma, but as yet there is little support for this theory from other sources. Further research is urgently needed to confirm or refute these associations, to define the extent of the risk (if any), and to identify the carcinogen(s).

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1982

Aspirin, paracetamol, and haematemesis and melaena.

Aspirin and paracetamol consumption have been compared in 346 matched pairs of patients with haematemesis and melaena, and control individuals in the general community. Both aspirin and paracetamol intake were more common in patients than in controls, but the association for aspirin was stronger and was apparent with both recent and habitual intake, whereas for paracetamol the association was not detectable for habitual intake. The results for paracetamol suggests that patients with bleeding take analgesic drugs in part because of symptoms associated with bleeding, and such intake is not necessarily causal of bleeding. Failure to control investigations to take account of this point has exaggerated the possible risks of aspirin consumption.

Acetaminophen↗
PubMed1981

20 years of hospital admissions for peptic ulcer in England and Wales.

Mortality and hospital admission rates for peptic ulcer in England and Wales have fallen in the past twenty years. Within this pattern there has been a wide range of variation. Perforated ulcers have become less common in young adults, and perforated gastric ulcers in young men now occur with between a quarter and a tenth of their previous frequency. Perforated duodenal ulcer has become more common in middle-aged and elderly women. The reasons for these changes are not understood, but they are likely to reflect the impact of environmental influences on people of different ages.

Adolescent↗