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PubMed1996

Occupation and ischemic heart disease in the European Community: a comparative study of occupations at potential high risk.

Four longitudinal studies of mortality and morbidity by occupation based on individual record linkage of information and two cross-sectional studies of mortality were compared in order to identify occupations at high risk of ischemic heart disease. In more than one country an increased risk of ischemic heart disease was found in drivers of buses, taxies, and lorries, in bakers, in naval officers and fishermen, in hotel and restaurant workers, in senior police, customs, and other uniformed men, in barbers and hairdressers, in warehouse and wholesale staff, as well as in laboratory assistants and in radio and telegraph operators. Occupations found at high risk in Denmark were also found at high risk in Great Britain and Italy. These occupations may be at genuine high risk. None of these groups work day-work only and several of the groups have psychologically demanding work but unsatisfactory decision authority. Identification of occupations at high risk may help to develop focused preventive strategies.

Adolescent↗
PubMed1993

Evaluation of the gynaecological oncology situation in the European Community countries.

At the end of 1991 an enquiry was sent to 40 doctors recognized as experts in Gynaecological Oncology in the E.C. countries to establish the situation of this sub or superspecialty and 32 (80%) answers were received. Inside the E.C. countries only the United Kingdom recognized the subspecialty of Gynaecological Oncology. Concerning the other 11 countries, except Denmark, their experts (invited to answer the questionnaire) consider it is necessary to individualize Gynaecological Oncology as a sub or a superspecialty. Before a training period of 24 or 36 months in Gynaecological Oncology, it is necessary to have the specialty of Obstetrics/Gynaecology. The training period must include 50% or 60% in diagnosis and surgical treatment, 10% in radiotherapy (only theoretical), 10% or 20% in medical oncology (theoretical and practical), 5% or 10% in oncological pathology, basic sciences and general aspects of cancer. Breast diseases, including breast cancer, must be a part of the training in Gynaecological Oncology and at the end of this period an evaluation test must be made. Lastly, the health authorities, of each country, are the best able to recognize the individualization of Gynaecological Oncology.

Curriculum↗
PubMed1995

New beverages, new drinking contexts? Signs of modernization in Finnish drinking habits from 1984 to 1992, compared with trends in the European Community.

The dynamics of change in drinking patterns is discussed using the data from the drinking habits surveys conducted in Finland in 1984 and 1992. The results are compared with a respective analysis on the EU countries from 1988 by Hupkens, Knibbe & Drop (1993). The analysis is based on changes in beverage preferences. In the Finnish case, both wine and mild beer appear as new beverages, gaining popularity in the late 1980s. For beer, both the elites and the population at large were involved in that process. For wine, the interest in the new beverage was stronger among the elites. There were notable gender differences in adopting the new beverage. Some of the differences were related to the older cultural patterns of wine as a woman's drink and beer as a male beverage. The results also point to difficulties in analysing the dynamics of change on the basis of cross-sectional data, as was done in the earlier analysis on the EC countries. The Finnish data shows that even the inter-group dynamics of drinking patterns may change over a relatively short period of time.

Adolescent↗
PubMed1991

Considerations regarding the development of individual nonclinical test strategies in the European Community.

The wish of pharmaceutical companies to be given the most binding possible preclinical test programmes for a new product, and the tendency of authorities to regulate to a great extent the preclinical testing of new drugs (especially at a multinational level), has led to differing requirements and practices in preclinical testing in different areas of the world. These differing requirements and practices have of necessity brought in their wake varying scientific criteria, with particular regard to animal protection, ethical standards, as well as imposing apparently unjustified extra financial costs. In order to improve this situation, the development of drug-specific preclinical test strategies is proposed in a drafted E. C. Note for Guidance, which incorporates already existing drug-testing guidelines and method recommendations. This draft Note for Guidance points to general methods of analysing problems and reaching decisions and thus appears to be worthy of recommendation as practical and desirable. It requires the co-operation of drug producers and supervisory authorities at a high scientific and ethical level. With regard to the state-of-the art and the socio-political background, the fulfillment of these requirements would appear not only to be appropriate but also imperative. To put them into practice would contribute enormously to the improvement of drug development and to de-emotionalization of the public debate. Therefore, comments on these draft guidelines from societies and associations are urgently sought and awaited with keen interest.

Animals↗
PubMedDate not supplied

[Ischemic stroke associated with atrial fibrillation: the demographic and clinical characteristics and 30-day mortality in a hospital stroke registry. The European Community Stroke Project, Florence Unit].

The importance of atrial fibrillation (AF) as a risk factor for stroke is well known. The role of AF as a prognostic indicator of outcome in the acute phase of stroke has been less thoroughly investigated. We considered the 635 patients admitted over a 1-year period to two general hospitals in the area of Florence (Italy), in order to examine the demographic and clinical characteristics, risk factors of the patients presenting with stroke and AF, and to evaluate their post-stroke mortality rate. Of the 447 patients diagnosed as affected by ischemic stroke, 103 (23.05%) had AF. These patients were older, more often female, and had fewer risk factors for factors for atherosclerosis than patients without AF. The risk of death at 30 days after stroke was about double in patients with AF as compared to those without AF after control by Cox regression analysis for the effect of the other prognostic indicators of mortality. Demographic variations anticipated for the future in our country (progressive ageing of the population) would lead us to predict a proportional increase of these forms in the coming decades. Therapeutic measures of proven effectiveness for primary prevention of stroke in patients with AF seem to be taken to an extremely limited degree in Italy. Our data could thus serve as a stimulus to the reconsideration of therapeutic guidelines and may be useful for the establishment of health care policy orientations.

Acute Disease↗
PubMed1995

Factors affecting results obtained with European Community tests for pasteurized milk sampled at the heat treatment establishment.

A total of 3000 samples of pasteurized milk taken at the heat treatment establishment over a 1-year period were examined for the presence of phosphatase and by a plate count at 30 degrees C, a coliform count at 30 degrees C, and a plate count at 21 degrees C after pre-incubation of the sample for 5 days at 6 degrees C, performed as prescribed in EC Directive 85/397/EEC. Samples were also examined for presence of Listeria species. Of 2690 samples (1713 from small dairies and 977 from large commercial premises) received at 4 degrees C or less, 96 (3.6%) has a plate count at 30 degrees C exceeding 30,000 organisms per ml, 608 (22.6%) contained 1 or more coliforms per ml, and in 1327 (49.3%) the pre-incubated count exceeded 100,000 organisms per ml. Thirty two samples from 23 dairies contained phosphatase. Listeria species were detected in 25 samples; only three of these strains were identified as Listeria monocytogenes. Results were analysed to determine relationships between factors which might affect test results. Samples from small dairies showed significantly higher coliform counts and pre-incubated plate counts than did those from large commercial premises. They were also more likely to contain phosphatase or Listeria species. Samples were significantly more likely to contain coliforms when taken in the July-September quarter or if received in glass containers.

Animals↗
PubMed1992

Trace element reference values in tissues from inhabitants of the European Community. II. Examples of strategy adopted and trace element analysis of blood, lymph nodes and cerebrospinal fluid of Italian subjects.

The EURO TERVIHT (Trace Element Reference Values in Human Tissues), recently initiated, aims to establish and compare trace metal reference values in inhabitants from the different EC countries. The project anticipates international cooperation of specialized chemical and toxicological laboratories in Western Europe. In order to overcome the well known and intolerable high fluctuation in published trace metal concentrations in body fluids and tissues, which are mostly due to poor analysis, this paper gives recommendations and strategies for approaching 'background' values measurement practised in the EURO TERVIHT. The focus of the paper is more on quality rather than on quantity of data with particular aspects: (i) well-described protocol for the selection/composition of reference groups (extended epidemiological data plus clinical status); (ii) numerous pre-analytical factors, among which are of paramount importance are ultraclean laboratory air, container material, storage conditions at -20 degrees C; (iii) statistical treatment of the data and the expression of the analytical results (use of refined statistical analysis such as the Lilliefors test to define the type of distribution, normal or log-normal). Results reported here concern the determination of trace elements in whole blood of more than 350 Italian subjects which allowed the proposal of 'reference values' for 12 elements. In lymph nodes and cerebrospinal (CSF) the degree of information acquired is only sufficient to suggest 'indicative' of 'informative' values.

Computers↗
PubMed1992

Trace element reference values in tissues from inhabitants of the European Community. III. The control of preanalytical factors in the biomonitoring of trace elements in biological fluids.

In the context of a programme concerning the determination of trace elements in body fluids and tissues to establish trace element reference values, research has been undertaken on the control of preanalytical factors in order to develop sufficiently accurate and precise guidelines to be applied in routine work by using techniques such as graphite furnace atomic absorption spectroscopy (GFAAS). Aspects investigated are related to the risk of contamination during blood collection and the use of anticoagulants; the risk of losses during storage and freeze-drying as well as the possible risk of contamination arising from trace elements in airborne particulates of the laboratory environment. For the analysis of Al, Ba, Cd, Co, Cr, Mn, Mo, Ni, Sb, W, V and Zn in blood, Teflon cannula is the method of choice. The anticoagulants do not introduce disturbing contaminations of Rb, Se, Zn, while contaminations were observed for Co, Cr, Mn. Radiotracers in 'metabolized form' (radiolabelled rat or rabbit tissues from animals administered with radioisotopes) show that samples stored for 1 month at -20 degrees C have no significant trace metal losses. Strict ambient air quality standard has to be respected (continuous monitoring) due to the possibility of element contaminations inside the laboratory. The use of matrix modifiers could represent a toxicological risk to the operators. Critical factors should be considered ('metal sheets') for each element in each matrix. For instance 27 factors for Cr in serum have been suggested.

Air Pollutants, Occupational↗
PubMed1994

Current status of economic appraisal of health technology in the European Community: report of the network. The EC Network on the Methodology of Economic Appraisal of Health Technology.

The use of economic evaluation to assess the costs and consequences of health care technologies has steadily increased in recent years. However, little is known about the influence economic studies have on health care decision makers or policy at local and national level. This paper reports the results of a survey of economic evaluations in EC countries to identify the impact of the results on decision and policy making in health care. Health service researchers in 10 EC countries were identified and asked to participate in the survey. The researchers were asked to locate economic evaluations in their country and complete a standardised questionnaire for each study. The criteria for inclusion in the survey were first, the studies should have been started or reported since 1987, second, the evaluations should include a comparison of the cost and consequences of the technologies assessed and finally, the appraisals should include a comparison of alternative health care technologies or programmes. A total of 66 studies which met the survey criteria were reported. Of these, 27% were thought to have influenced health care decision makers or policy. The results suggested that method of dissemination, source of funding and purpose of the study may be important determinants of whether an economic evaluation will be used in health care policy or decision making. The results of the survey suggest that economic evaluation currently has a relatively low impact on health care policy or decision making.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1995

[Screening program for selection of hearing loss in newborn infants instituted by the European Community].

Early identification of hearing impairment in children poses a major problem for clinical research and development. In the last two years we determined the hearing sensitivity of 1202 newborns, small infants and children. 52.4% of the children exhibited risk factors for hearing impairment in their medical history. The majority of children was referred to our department by pediatricians (52%), who first suspected hearing impairment, 40% by parents, 3.5% by otolaryngologists, 3% by educators, and 1.5% by general practitioners. The following examinations were performed: transiently evoked otoacoustic emissions (TEOAE), impedance audiometry, auropalpebralreflex, behavioral observation audiometry, and, if necessary, auditory brain stem response (ABR) with air and bone-conducted clicks as well as frequency-following responses at 500 Hz tone burst. In 378 children TEOAE were recorded on both sides, in 151 at least on one side. These results were confirmed by the other techniques. Only three children presented false negative results of TEOAE on one side. Two of these children had a middle ear effusion and a threshold of 35 dB, one had retrocochlear hearing loss. The absence of TEOAE in both ears in 155 children as well as in one ear in 16 children was detected by ABR. Seventy-seven patients showed no response on both sides, 25 on one side, although a hearing impairment more than 25 dB could not be verified by ABR. This high number of false positive results is explained in 77 cases (76%) by a middle ear dysfunction during the recording of TEOAE, when ABR was performed following adenotomy and paracentesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Critical evaluation of the toxicological documents produced for the authorization of drugs according to the Commission of the European Communities Directives.

The documents concerning the experimental safety evaluation of drugs are evaluated in France by an advisory board of the Ministry of Health which expresses an opinion on their accuracy, indispensable for the authorization of sale. The data reported here concern 95 documents examinated between 1978 and 1981. They are related: - To the form of presentation of the documents: 14 main kinds of defects are pointed out (lack of justification of the protocols, inadequate experimental data, etc.). - To the substance of the experiments: 21 main kinds of defects are emphasized (erroneous choice of the doses, poor clinical examination of the animals, etc.). In conclusion, a real effort to obtain a large and constructive exchange of information between all the parties concerned, the manufacturers, the experts, the Ministries of Health, must be continued.

Animals↗