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PubMed1995

Tuberculosis among urban health care workers: a study using restriction fragment length polymorphism typing.

Cases of tuberculosis identified during 1992-1994 through an active tuberculosis surveillance network among six hospitals that serve New York City (the TBNetwork) were analyzed according to the occupational status of the patients. Clinical data were obtained by review of medical records, and restriction fragment length polymorphism (RFLP) typing of Mycobacterium tuberculosis isolates was performed. No known nosocomial outbreaks of tuberculosis occurred at these hospitals in the study period. Occupational status was known for 142 of 201 patients whose isolates were available for strain typing. Patients infected by organisms with a clustered strain typing pattern, as determined by RFLP analysis, were presumed to have recently acquired disease. RFLP typing revealed that isolates from 13 (65%) of 20 health care workers and 50 (41%) of 122 non-health care workers had a clustered RFLP pattern. The strains infecting eight (89%) of nine health care workers seropositive for human immunodeficiency virus (HIV) had a clustered RFLP pattern. Multivariate analysis of 75 patients with known HIV and occupational status revealed that HIV status (P = .03) and health care worker status (P = .02; RR = 2.77) were independent risk factors for a clustered RFLP strain. These findings suggest that many of the apparently sporadic cases of tuberculosis among health care workers may be due to unrecognized occupational transmission.

Adult↗
PubMed1992

Mortality from respiratory system cancer in New South Wales and Sydney.

Differential and spatial analyses of respiratory system cancer were undertaken for New South Wales and Sydney for the period 1980-1986. The source of data was death certificate information on the unit list mortality file tapes provided by the Australian Bureau of Statistics. Characteristics of persons dying included age, sex, birthplace, occupational status and cause of death (ICD9 classification). The aim was to identify populations at risk from respiratory system cancer, and where they were located. Deaths were disaggregated for the abovementioned categories by cross-tabulation at the state level and for geographical areas having populations with higher levels of respiratory cancer mortality. Never-married males of lower occupational status had higher rates of respiratory cancer, mainly lung cancer. Divorced men also had higher mortality as did widowers who were in lower occupational status work, while married men in managerial work also had significantly high mortality. The marital status variation was mostly not found with females, although significantly high female mortality was found in several low socioeconomic status areas of Sydney. Mortality of both sexes was significantly higher in metropolitan Sydney than in the rest of New South Wales and associations between older age mortality and some industrial areas were found in Sydney.

Adolescent↗
PubMed1995

Outcome after diagnosis of psychogenic nonepileptic seizures.

Information regarding outcome in patients with psychogenic nonepileptic seizures (PNES) is limited. We attempted to contact 72 consecutive patients with PNES confirmed by video-EEG monitoring: 51 of 72 (71%) were reached a mean of 15 months (range 12-27 months) after diagnosis and agreed to answer a structured telephone questionnaire. The questionnaire assessed the number of PNES in the last 6 months, antiepileptic drug (AED) use, occupational status, global self-rating, and extent of psychotherapeutic treatments. PNES had ceased in 18 of 51 (35%), decreased > 80% in 21 of 51 (41%), and decreased < 80% in 12 of 51 (24%). Thirty-three of 51 (65%) were not taking AEDs. Occupational status improved in 20% and did not change in 75%. Overall, 29 of 51 (57%) rated themselves markedly improved and 15 of 51 (29%) rated themselves unchanged or worse. Persisting PNES were associated with longer duration of PNES before diagnosis (p < 0.02) and presence of additional psychiatric disease (p < 0.01). Persisting PNES were not associated with gender, presence of epileptic seizures, or extent of psychotherapeutic treatments after diagnosis. Placebo saline infusion had been administered in some patients to help precipitate PNES. This did not affect the number of psychotherapy visits or outcome. We conclude that PNES cease or significantly decrease in most patients, but occupational status does not improve as often. Earlier diagnosis may improve outcome.

Anticonvulsants↗
PubMed2005

Socioeconomic status and smoking: analysing inequalities with multiple indicators.

BACKGROUND AND AIMS: Socioeconomic differences in smoking have been well established. While previous studies have mostly relied on one socioeconomic indicator at a time, this study examined socioeconomic differences in smoking by using several indicators that reflect different dimensions of socioeconomic position. DATA AND METHODS: Data derive from Helsinki Health Study baseline surveys conducted among the employees of the City of Helsinki in 2000 and 2001. The data include 6243 respondents aged 40-60 years (response rate 68%). Six socioeconomic indicators were used: education, occupational status, household income per consumption unit, housing tenure, economic difficulties and economic satisfaction. Their associations with current smoking were examined by fitting sequential logistic regression models. RESULTS: All socioeconomic indicators were strongly associated with smoking among both men and women. When the indicators were examined simultaneously their associations with smoking attenuated, especially when education and occupational status were considered together, and when income and housing tenure were introduced into the models already containing education and occupational status. After mutual adjustment for all socioeconomic indicators, housing tenure and economic satisfaction remained associated with smoking in men. In women, all indicators except income and economic difficulties were inversely associated with smoking after adjustments. CONCLUSIONS: Smoking was associated with structural, material as well as perceived dimensions of socioeconomic disadvantage. Attempts to reduce smoking among the socioeconomically disadvantaged need to target several dimensions of socioeconomic position.

Adult↗
PubMed1995

Occupational mobility among immigrants: the impact of migration on economic success in Australia.

"By analyzing national survey data collected among immigrants to Australia, this article examines immigrant occupational mobility. For immigrants, the results show economic disadvantages are caused by the act of migration itself rather than by economic experiences in their new country. Occupational status is depressed at the beginning of the immigrants' Australian working career, and this in turn diminishes occupational status throughout the working lives of the immigrants and accounts for the economic disadvantages they face."

Australia↗
PubMed2005

Sex differences in the associations of socioeconomic status with undiagnosed diabetes mellitus and impaired glucose tolerance in the elderly population: the KORA Survey 2000.

BACKGROUND: Sex differences in the associations of socioeconomic status (SES) with prevalence of undiagnosed diabetes mellitus, impaired glucose tolerance (IGT) and known risk factors of type 2 diabetes mellitus were investigated in an elderly population. METHODS: Oral glucose tolerance tests were carried out in 1354 randomly selected subjects (697 men, 657 women) aged 55-74 years in the population-based KORA Survey 2000, Augsburg, Germany. Odds ratios (ORs) and 95% confidence intervals (CIs) for undiagnosed diabetes or IGT by education, occupation and income were estimated using logistic regression controlling for age, waist circumference, blood pressure, triglycerides, physical activity, smoking and alcohol intake. RESULTS: All three SES variables were significantly inversely related to body mass index, waist circumference and low physical activity in women (P < 0.05). In men, these associations were weaker or absent. Using the lowest category as reference, occupational status was significantly associated with undiagnosed diabetes in women (adjusted OR 0.5; 95% CI 0.3-0.8) after controlling for risk factors in multivariate regression. The OR was also reduced with higher income in women (adjusted OR, diabetes: 0.7; 95% CI 0.5-1.03). Among men, no significant relations of the SES indicators with unknown diabetes were observed. However, the odds of having IGT was lower with higher occupational status in men (adjusted OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: Undiagnosed type 2 diabetes was related to low SES defined by occupation or income in women only. In men, low occupational status was independently associated with higher IGT risk. Educational level was not related to glucose disorders in both sexes in the elderly population.

Aged↗
PubMed2001

Prevalence and risk indicators for destructive periodontal diseases in 3 urban American minority populations.

BACKGROUND, AIMS: Destructive periodontal diseases have been reported disproportionately more prevalent and severe in African-Americans relative to other American populations. Differences in subgingival microbiota and host immune response have also been reported for African-Americans, implying that risk factors for disease progression may also differ for these populations. Since it is not clear whether these differences are truly genetic or due to confounding variables such as social economic status, we examined a series of clinical, environmental, demographic, and microbiologic features associated with periodontal disease status in a group of 185 urban minority subjects resident within the greater New York metropolitan area. METHODS: The study population consisted of 56 Asian-American, 71 African-American and 58 Hispanic subjects. Clinical data recorded included pocket depth, attachment level, gingival erythema, bleeding upon probing, suppuration, and the presence of supragingival plaque. Environmental and demographic data recorded included smoking history, years resident in the United States, whether the subject reported a private dentist and occupational status. Subgingival plaque was sampled from the mesial aspect of all teeth exclusive of third molars and the levels of 40 subgingival species enumerated using checkerboard DNA-DNA hybridization. RESULTS: The African-American group had more missing teeth, deeper periodontal pocket depth and more attachment loss than the Asian-American or Hispanic groups. However, the African-American group were less likely to report having a private dentist, had a greater proportion of smokers and a greater proportion of unskilled individuals. The profile of subgingival species differed among the three ethnic/racial groups with A. actinomycetemcomitans, N. mucosa, S. noxia and T. socranskii significantly elevated in the Asian-American group and P. micros significantly elevated in the African-American group. When subset by occupational status, numbers of missing teeth, pocket depth, attachment level and prior disease activity were all found increased in the unskilled relative to the professional group. Local factors including the mean % of sites with plaque, marginal gingival erythema, bleeding upon probing and suppuration were also elevated in the unskilled group. The microbial profile differed among the 3 occupational groups with the unskilled group having elevated numbers of species associated with destructive periodontal diseases. CONCLUSIONS: Although greater destructive periodontal disease prevalence and severity were found in the African-American group, these results suggest that environmental and demographic variables, such as occupational status, may have a greater influence on risk indicators associated with disease prevalence and progression in these populations.

Adult↗
PubMed2005

Neurological and psychosocial outcome after subarachnoid haemorrhage, and the hunt and hess scale as a predictor of clinical outcome.

In a retrospective study, the outcome of 87 patients with ruptured intracranial aneurysm was assessed. Follow-up included neurological examination, grading of the Glasgow Outcome Scale (GOS) of each patient, and answering a psycho-social questionnaire. This questionnaire was answered by the patients themselves or by a relative when the patient was not able to answer. The follow-up was performed more than 12 months after the occurrence of subarachnoid hemorrhage (SAH) in each patient. The psycho-social questionnaire pertained to the degree of independence in everyday activities, household management, stress endurance, memory and concentration, social and leisure activities, social contacts, occupational status, and marital relationships. By summarizing the results of these domains, the quality of life was then determined using the method described by McKenna et al. Neurological deficits in the form of an incomplete paresis of the third cranial nerve and subjective reduction of memory and concentration were identified in 3.5 % and 34.5-39 % of the patients, respectively. Of the 87 study participants, 58.2 % were fully independent, 22.4 % were able to live at home with the support of their relatives, and 5 patients were fully dependent. The occupational status of 21 patients who were fully employed before SAH was unaffected, whereas 3 patients were placed in positions with less responsibility, and 21 patients were either unable to continue working, unemployed, or retired. The quality of life was not reduced in 57.2 %, while a mild reduction in the quality of life was reported by 23.8 % and a severe reduction by 19.0 % of the participants. The ability of the initial Hunt and Hess grade, the initial Fisher grade, the extent of neurological deficits, and the occupational status after SAH to predict the patient's outcome was also evaluated. For statistical analysis, the Kendall-Tau-b-test for non-parametric correlations was applied. Significant correlations were found between the initial Hunt and Hess grade and the initial Fisher grade, between neurological deficits and GOS, between quality of life and occupational outcome, as well as between the GOS and quality of life assessment, but not between initial Hunt and Hess grade and GOS or quality of life, between neurological deficits and quality of life, between initial Hunt and Hess grade and occupational outcome, between initial Fisher grade and occupational outcome, and also not between initial Fisher grade and GOS or quality of life. Our results suggest that neither the initial Hunt & Hess grade nor the initial Fisher grade are suitable parameters for predicting the outcome of patients with ruptured intracranial aneurysms. The fact that GOS and quality of life correlated significantly confirms the use of GOS as a simple method for evaluating patient outcome, although it is not a grading system for evaluating functional disorders such as memory or subtle cognitive impairments.

Adult↗
PubMedDate not supplied

Anxiety and depression after acute myocardial infarction.

OBJECTIVES: To assess the following: (1) symptoms of anxiety and depression in hospitalized patients who had acute myocardial infarction (AMI); (2) the association between sex, infarct severity, history of previous AMI, and symptoms of anxiety and depression in hospitalized patients; (3) symptoms of anxiety and depression during the first year after AMI in a select group of patients; and (4) the association between educational and occupational status and symptoms of anxiety and depression at the time of hospitalization in a select group of patients. DESIGN: Cross-sectional survey (objectives 1 and 2) and prospective trial with random assignment (objectives 3 and 4). SETTING: Six university-affiliated hospitals in a Canadian city. PATIENTS: Seven hundred eighty-five hospitalized patients with AMI, with 1-year follow-up of 201 selected patients from this sample. INSTRUMENTS: State-Trait Anxiety Inventory and the short form of the Beck Depression Inventory. INTERVENTION: Data collection was initiated in the hospital 3 days after AMI, and patients were followed-up 14, 24, 41, and 56 weeks after AMI. RESULTS: Student t tests, analysis of variance, and descriptive statistics were used. When the patients were in the hospital the mean state (S-anxiety) and trait (T-anxiety) scores were 43 and 44, respectively. Ten percent had S-anxiety scores and 14% had T-anxiety scores that were higher than the mean scores reported for psychiatric patients. During the 1-year follow-up in the select group of subjects, the mean S-anxiety and T-anxiety scores were both 48 in-hospital, and decreased to 42 and 46, respectively, by 14 weeks and remained at these levels for the remainder of the year. During the course of the year, 16% of the patients had State-Trait Anxiety Inventory scores consistent with psychiatric conditions. The in-hospital Beck Depression Inventory mean score was 3, and 9% of the patients had scores consistent with moderate to severe depression. During the first 24 weeks, symptoms of moderate to severe depression were reported by 10% of the select group of patients. No associations were found between anxiety and depression and sex, creatine phosphokinase level, previous AMI, education, or occupational status. CONCLUSIONS: Symptoms of anxiety were prevalent among hospitalized patients who had an AMI, whereas depressive symptoms were rare. There was no association between anxiety and depression and sex, infarct severity, history of previous AMI, or educational or occupational status.

Adult↗
PubMed1989

Socio-economic status and pregnancy outcome. An Australian study.

A prospective cohort of 8556 pregnant women attending the Mater Misericordiae Mothers' Hospital in Brisbane was examined to consider the impact of socio-economic status on pregnancy outcome. The indicators of socio-economic status selected were family income, maternal education and paternal occupational status. Pregnancy outcomes considered were preterm delivery, low birthweight, low birthweight for gestational age, and perinatal death. Subsidiary analyses were also undertaken for Apgar scores, time to establish respiration, need for mechanical respiration and admission to intensive care. Before adjustment, the main consistent association was between the occupational status of the father and three measures of perinatal morbidity. Initial adjustment for the mother's socio-demographic background and weight/height ratio reduced the strength and statistical significance of the above associations, while further adjustment for lifestyle variations between the three status groups further reduced the above associations to marginal statistical significance. The findings suggest that observed class differences in pregnancy outcome are attributable to the mother's personal characteristics (height/weight, parity) and her lifestyle.

Body Weight↗
PubMed1995

Australian adult smoking prevalence in 1992.

To estimate the prevalence of smoking among Australian adults in 1992, 6046 adults aged 16 years and over (3063 men and 2983 women) were interviewed. A large market-research firm interviewed the sample, face-to-face in their homes during weekends. Overall, 28.2 per cent of men and 23.8 per cent of women were current smokers; 32.3 per cent of men and 21.9 per cent of women were past smokers. On average, male smokers consumed 22.1 factor-made cigarettes a day and female smokers consumed 19.1 cigarettes a day. The daily tar intake was 179 mg for male smokers and 131 mg for women. The most popular packet size was 25 (40 per cent of smokers) followed by the packet of 50 (17 per cent). Occupational and education status were inversely related to smoking prevalence. Men and women with less education and men in low-status occupations were more likely to use cigarettes from the large packet sizes. Comparison with earlier data suggests that smoking prevalence is still declining, with a significant recent drop in female but not male smoking prevalence. While in 1992, the prevalence of smoking among women was less than that for men, projected estimates suggest that by the year 2001 more women than men will smoke.

Adolescent↗
PubMed1985

Accidental injuries among naval personnel by occupation, duty status, and pay grade.

The relative incidence of accidental injury for Navy enlisted men during 1974-1977 was analyzed for 68 occupations, three pay grade or job responsibility levels, and duty status (on or off duty) at the time of the injury. Thirteen "blue-collar", predominantly sea-going or construction occupations, were significantly higher than the Navy injury rate norm and 26 "white-collar" occupations, typically in clerical, supply, administrative or technical specialties, were significantly lower than the Navy norm. An inverse linear relationship was found between injury rate and job responsibility for all occupations combined. This relationship varied by occupation, however, suggesting that experience and familiarity with the work environment may not moderate risks to the same degree in all occupational fields. Occupations with high on-duty injury rates tended to have high off-duty rates as well, suggesting at least some common causal factors.

Accidents, Occupational↗
PubMedDate not supplied

[Effect of social status on occupational reintegration after lumbar discotomy].

QUESTION: The influence of non somatic factors, especially the social status of the patients' profession on postoperative reintegration following lumbar discectomy is investigated. METHODS: In 511 patients postoperative loss of working time and time till return-to-work after lumbar discectomy were investigated. Patients were interviewed by questionnaire at an average of 7.6 years postoperatively. RESULTS: Patients returned to work at an average of 10.5 weeks after operation. Looking at the social status of the patients we found an average time of 5.4 weeks until return to full work for self employed people. Civil servants took on average 10.2 weeks and regular employees returned to work after 14.0 weeks. The longest time to return to work was seen in workers with 17.2 weeks. Somatic risk factor profile for nucleus pulposus prolaps was identical in the group of self employed and employees. There was a different risk profile in the other two groups. CONCLUSION: We could show a correlation between the length of the return-to-work period and long-term clinical outcome with the social status of the patient. This correlation was most clearly shown in the group of self employed and employees. CLINICAL RELEVANCE: For judgement of the postoperative rehabilitation period, the social status may indicate the pain level and duration of pain that has to be expected.

Absenteeism↗
PubMed1993

Residual cognitive deficits 50 years after lead poisoning during childhood.

The long term neurobehavioural consequences of childhood lead poisoning are not known. In this study adult subjects with a documented history of lead poisoning before age 4 and matched controls were examined with an abbreviated battery of neuropsychological tests including measures of attention, reasoning, memory, motor speed, and current mood. The subjects exposed to lead were inferior to controls on almost all of the cognitive tasks. This pattern of widespread deficits resembles that found in children evaluated at the time of acute exposure to lead rather than the more circumscribed pattern typically seen in adults exposed to lead. Despite having completed as many years of schooling as controls, the subjects exposed to lead were lower in lifetime occupational status. Within the exposed group, performance on the neuropsychological battery and occupational status were related, consistent with the presumed impact of limitations in neuropsychological functioning on everyday life. The results suggest that many subjects exposed to lead suffered acute encephalopathy in childhood which resolved into a chronic subclinical encephalopathy with associated cognitive dysfunction still evident in adulthood. These findings lend support to efforts to limit exposure to lead in childhood.

Cognition Disorders↗
PubMed1978

An epidemiological study of blindness in an Indian rural community.

A house-to-house survey of blindness in an Indian rural community covering a population of 20 134 in 12 villages revealed a prevalence rate of 35 blind and 144 partially blind persons per 10 000 population. Blindness was significantly associated with the age, sex, marital status, occupation, and socioeconomic status of the respondents. Caratact, glaucoma, smallpox and trachoma were the main causes of blindness. Preventive measures can reduce the toll of blindness in such a community.

Adolescent↗
PubMed2004

Smoking status and occupational exposure affects oxidative DNA injury in boilermakers exposed to metal fume and residual oil fly ash.

Epidemiologic studies demonstrate increased cancer incidence among workers exposed to polycyclic aromatic hydrocarbons (PAH) and metals, probably through cumulative oxidative DNA damage in response to carcinogens. Boilermakers are exposed to particulates of residual oil fly ash (ROFA) and metal fume that contain carcinogenic PAH and metals. We conducted a repeated-measures cohort study in boilermakers during the overhaul of an oil-fired boiler to determine a possible association between the level of 8-hydroxy-2'-deoxyguanosine (8-OH-dG; an oxidative injury biomarker) and biomarkers of PAH (1-hydroxypyrene; 1-OHP) and metal exposure. Preshift and postshift urine samples were analyzed for 8-OH-dG, cotinine, 1-OHP, and metals. Generalized estimating equations were used to model the multivariate relationship of 8-OH-dG to the explanatory variables of interest. Biomarker levels were determined for 181 urine samples from 20 male subjects (mean age 45 years, 50% smokers). Metal and 1-OHP levels increased cross-week and were affected by smoking status. Levels of 8-OH-dG were higher in nonsmokers at the start of the workweek yet declined after occupational exposure to similar levels as in smokers. Multivariate analysis indicated that metal x cotinine interaction terms for nickel, vanadium, chromium, and copper were significantly associated with the 8-OH-dG level, but there were differential effects depending on the metal. This study suggests that oxidative DNA damage in boilermakers is influenced by the interaction between occupational exposures and smoking status. In addition, boilermakers may have reduced ability to repair damaged DNA after ROFA and metal fume exposure. This finding has clinical relevance because these exposures may increase the cancer susceptibility of boilermakers.

8-Hydroxy-2'-Deoxyguanosine↗