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PubMedDate not supplied

[The mortality of a retrospective cohort of workers in a Spanish iron and steel plant. The methodological problems in defining the cohort].

The work environment of an iron foundry involved a large number of exposures related to several health problems, mainly lung cancer. "Altos Hornos del Mediterráneo (AHM)" fron Sagunto is an iron industry that stopped its foundry plant production in 1984. The present paper shows the methodological problems merged during the reconstruction of AHM workers' cohort. From personnel files a male cohort was defined for 7,018 males who worked at least one year and started work between 1950 and 1970, following them through 1991. The cause of death was obtained from de Civil register, Life insurance and reference hospitals. By means of experts the work areas were rated in three exposure levels. 6% of cohort members were lost during the follow-up. 2786 deaths were reported and 88% causes of death were retrieved. The enterprise data files let us to reconstruct the cohort, but the availability of a National Death Index, as there is in other countries would have made easier the job and would have improved the data quality.

Cause of Death↗
PubMed1999

Factor V Leiden: should all women be screened prior to commencing the contraceptive pill?

It has been evident for over 30 years that combined oral contraceptive pills (OCP) increase the risk of venous thromboembolism. Recently, it has been suggested that there is an interaction between combined OCPs and the factor V Leiden mutation with the result that the relative risk of venous thromboembolism (VTE) is higher than expected in women who have this heritable thrombophilic defect using combined oral contraceptive pills. In Caucasian populations, factor V Leiden is very prevalent, being present in between 3 and 7% of Europeans and white North Americans. The high prevalence of the defect and its apparent interaction with combined oral contraceptive pills has led to the suggestion that all women should be screened for factor V Leiden prior to commencing contraceptive pills. Although the relative risk of VTE is very significantly increased in factor V Leiden positive women using contraceptive pills, the absolute incidence of venous thrombotic events is low and fatal pulmonary embolism is rare. It would be extremely costly to screen all women for the factor V Leiden mutation and unlikely to be deemed cost-effective. Widespread screening would result in 3-7% of women being denied the most effective and acceptable form of contraception and may influence negotiations with life insurers. It is suggested that only selected women, i.e. those with a personal history of previous venous thromboembolism and those with a clear family history of VTE are offered screening for thrombophilic defects.

Contraceptive Agents, Female↗
PubMed2000

Work stress among six professional groups: the Singapore experience.

Recent developments in stress research have called for attention to how social structures influence the stress and coping processes. This paper examines the experience of work stress among professionals in Singapore and argues that workers' experiences in the workplace are influenced not only by individual personality and job nature, but also by structural forces shaping the profession, the social organization of work institutions and the development of the economy. Data were collected from a survey of professionals in Singapore conducted in 1989-1990. The sample consisted of 2570 men and women from six different professions and para-professions, namely general practitioners, lawyers, engineers, teachers, nurses and life insurance personnel. Results showed that performance pressure and work-family conflicts were perceived to be the most stressful aspects of work. These two stressors also significantly contributed to the experience of overall work stress. Further, stress arising from work-family conflicts, performance pressure and poor job prospects was negatively associated with the level of work satisfaction. These findings were discussed in the contexts of increasing professionalization and de-professionalization and the growing emphases on productivity and efficiency in a quickly developing economy.

Adult↗
PubMed1998

Testing for drugs of abuse in saliva and sweat.

The detection of marijuana, cocaine, opiates, amphetamines, benzodiazepines, barbiturates, PCP, alcohol and nicotine in saliva and sweat is reviewed, with emphasis on forensic applications. The short window of detection and lower levels of drugs present compared to levels found in urine limits the applications of sweat and saliva screening for drug use determination. However, these matrices may be applicable for use in driving while intoxicated and surveying populations for illicit drug use. Although not an illicit drug, the detection of ethanol is reviewed because of its importance in driving under the influence. Only with alcohol may saliva be used to estimate blood levels and the degree of impairment because of the problems with oral contamination and drug concentrations varying depending upon how the saliva is obtained. The detection of nicotine and cotinine (from smoking tobacco) is also covered because of its use in life insurance screening and surveying for passive exposure.

Biological Transport↗
PubMed1997

Donor reactions and injuries from whole blood donation.

In this review of common and uncommon donor reactions and injuries, donation-associated deaths were found to be extremely rare and generally thought to be coincidental; the rate of coincidental deaths was less than what would be expected based on life insurance tables. Vasovagal reactions, hematomas/bruises, and history of irritation or allergic reaction to adhesive tape or skin preparations are observed daily in a busy blood collection center. Syncopal vasovagal reactions sometimes resemble shock, but unlike shock, they reverse themselves and do not cause death. Through good management, a blood donor organization can minimize the incidence of syncope. Accidental arterial venipuncture is very uncommon (1 in 100,000), and donors with arterial punctures do well if pressure is applied for an extended period of time. Rarely, a pseudoaneurysm results, and this requires surgery. AV fistulas and compartment syndromes can also occur, but these are extremely rare; most experienced blood center physicians have never observed a case. Neurologic needle injuries occur approximately once in every 6,300 donations. Although neurologic needle injury complaints are usually received within 10 days of blood donation, 10% of the injured donors may complain weeks to months later. Most donors with needle injuries recover within a month and many within a day or two, but approximately 30% will have a recovery period of greater than 1 month and an occasional case may exceed 6 months. Donors with neurologic needle injuries generally have a full recovery, even when the recovery period may be extended. Thrombophlebitis has a low incidence (1 in 50,000 to 1 in 100,000), and infection at the phlebotomy site is rare. Both are easily treated and have little impact on the donor's health.

Blood Donors↗
PubMed2003

How to improve organ donation: results of the ISHLT/FACT poll.

BACKGROUND: Worldwide organ shortages remain a long-standing problem. Efforts to address this have ranged from attempts to improve public awareness to modified mandated choice systems; most have been unsuccessful. In the face of this intractable problem, increased consideration has been given to direct and indirect compensation, and in certain countries, black markets for organs have developed. To examine the attitudes of the transplant medical community regarding these issues, we surveyed members of the International Society for Heart and Lung Transplantation (ISHLT) in conjunction with the Foundation for the Advancement of Cardiac Therapies (FACT). METHODS/RESULTS: We asked for opinions about how to improve organ donation. Of 739 respondents, 75% supported presumed consent, and 39% identified it as the single best way to increase donation; improved public education was a distant second (18%). Seventy percent supported indirect compensation (e.g., payment of funeral expenses, donation to a charity of the family's choice), and 66% opposed direct compensation (e.g., tax credit, life insurance benefit). When asked whether next of kin should be consulted regarding organ donation, and 84.2% responded affirmatively. However, of these individuals, 77.2% did not think that consultation should be required if the potential donor already had signed a donor card. MEMBERSHIP: Our membership dramatically favors indirect over direct compensation as a way of increasing organ donation. The majority also favors the wishes of the individual over the family in determining donor status. However, presumed consent is the single best way to significantly improve organ donation, according to the majority of our respondents. More effort should be directed toward policy in these areas as opposed to improving public education, which has failed to yield satisfactory results.

Attitude of Health Personnel↗
PubMed2005

Intracranial aneurysm screening: indications and advice for practice.

The advent of non-invasive methods of imaging intracranial blood vessels has facilitated screening for intracranial aneurysms in people who are at risk. A strong risk factor for intracranial aneurysm, which causes subarachnoid haemorrhage, is a positive family history, defined as two or more first-degree relatives with subarachnoid haemorrhages (relative risk [RR]=6.6). The greatest familial risk is associated with an affected sibling. Another strong risk factor is polycystic kidney disease (RR=4.4). People who have these risk factors are potential candidates for screening. Even if screening does not find abnormality, there is a high risk of new aneurysms 5 years later. Repeated screening might be done, although the optimum interval between screening assessments and the duration of repeated screening is unclear. Patients who have survived a subarachnoid haemorrhage are at increased risk of another from a newly developed aneurysm, but whether screening is beneficial in such patients is not clear. Most occurrences of subarachnoid haemorrhage in the general population are related to the more common risk factors of hypertension (RR=2.8) and smoking (RR=1.9). Therefore, screening of individuals who have a family history of subarachnoid haemorrhage or polycystic kidney disease will have little effect on the incidence of subarachnoid haemorrhage in the general population. When patients present for screening, the construction of a family tree and discussion of the history of relatives with stroke can be revealing. Before referring a patient for non-invasive imaging of the circle of Willis, the physician should discuss the risks and benefits of screening, the implications for holding a licence to drive or fly and for life insurance, and whether or not the patient wants to be informed about other incidental findings.

Genetic Predisposition to Disease↗
PubMed2000

Nutrient intake of working women in Bangkok, Thailand, as studied by total food duplicate method.

OBJECTIVES: To establish a general view of food habits in Thailand, and to make a quantitative assessment of rice dependency of Thai people. DESIGN: Cross-sectional study. SETTING: Community. SUBJECTS: 52 non-smoking and non-habitually drinking adult women in Bangkok participated in the study. METHODS: The participants offered 24 h food duplicates and peripheral blood samples, and underwent clinical examination including anthropometry. The duplicates were subjected to nutritional evaluation taking advantage of the Thai food composition tables (FCTs), and analyzed for eight nutrient elements by inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: The participants took 1630 kcal from 55 g protein (63% from animal sources), 57 g lipid (mostly from vegetable oil), and 224 g carbohydrate (60% from rice) daily. Nutrient intake at lunch was as large as that at dinner. About a half of the women had insufficient energy intake (ie <80% RDA) whereas 4% had an excess (>120%). Protein intake was sufficient in most cases, whereas lipid intake was in excess in more than a half of the women. Ca, Fe, Mg, Zn and possibly P intakes were below the RDA values in many participants. FCT-based estimates agreed well with the ICP-MS measures in cases of Fe and Ca but tended to be greater than the measures by 50% with regard to P. CONCLUSIONS: Lunch as substantial as dinner for Thai urbanites. There was a marked dependency on rice as an energy source. Whereas protein intake is generally sufficient, the intake of Ca (and to a lesser extent Fe) was insufficient in a majority of the study participants. SPONSORSHIP: Dai-ichi Mutual Life Insurance, Japan; the Ministry of Health and Welfare, the government of Japan.

Adult↗
PubMed2000

What criteria reliably distinguish melanoma from benign melanocytic lesions?

The differential diagnosis of melanocytic lesions is fraught with difficulty and a common source of litigation either if a lesion misreported as 'benign' recurs locally or re-presents with nodal metastases or if an atypical naevus is called 'malignant' leading to a cosmetically unsatisfactory wider resection, unwarranted anxiety about prognosis and adverse life insurance prospects. Several authors have claimed that there are valid morphological criteria which, alone or in combination, enable reliable distinction between benign and malignant melanocytic lesions. Others question these criteria and, doubting the extent to which unequivocal diagnoses can be rendered in all cases, believe that the diagnosis is purely subjective and that most diagnostic errors are non-negligent. To address these issues, expert opinions were commissioned from three sets of authors. Okun, Edelstein & Kasznica emphasize that a significant minority of melanocytic lesions are so borderline morphologically that diagnostic uncertainty is allowable and that such uncertainty can be handled responsibly. Kirkham, in favouring the methodical use of criteria, concedes that they are 'largely opinion-based rather than evidence-based, but do go beyond mere subjective pattern analysis'. In agreement with Okun and his colleagues. Slater emphasises that no single feature is reliable by itself and that all aspects, including clinical details, should be interpreted together; he has no hesitation in reporting the diagnosis as 'uncertain' in doubtful cases. In the absence of a specific marker pathognomonic of melanocytic malignancy, the diagnosis will continue to rely on the judicious application of morphological criteria with a small proportion of elusive cases in which diagnostic uncertainty should not be concealed.

Biomarkers, Tumor↗
PubMed2002

Body composition in adults with Type 1 diabetes at onset and during the first year of insulin therapy.

AIMS: To describe body composition in patients with Type 1 diabetes at diagnosis and during the first year after initiation of insulin therapy. RESEARCH DESIGN AND METHODS: In 10 (eight male and two female) newly onset Type 1 patients, age 31.5 +/- 3.2 years (27-37 years) (sd and range), body mass index (BMI) 20.8 +/- 1.6 (19.2-23.4) kg/m2, body composition was estimated by means of dual-energy X-ray absorptiometry (DXA) whole body scanning supplemented by estimation of total body water (TBW) (isotope dilution technique with 3H2O) at diagnosis and after 1, 3, 6 and 12 months of insulin therapy. RESULTS: During the first year after onset of diabetes body weight (BW) increased 4.3 +/- 2.9 (0.1-8.3) kg (P = 0.0012) distributed as a 13.3% (1.6 kg) increase in total fat mass (FM) and 4.9% (2.5 kg) increase in lean body soft tissue mass (LBM). The self-reported weight loss at onset was 6.3 +/- 2.5 kg (1.5-10.0 kg). Compared with two reference populations the Metropolitan Life Insurance Co. and a healthy age and sex-matched local DXA scanned group the initial body composition data demonstrated BW 6.2 kg below ideal weight and a significant reduction of the FM (25% or -0.87 sd), whereas LBM was within the expected range. CONCLUSIONS: During the first year after onset of Type 1 diabetes the mean increase in BW is 6.5% with a 13.3% increase in FM and a 4.9% increase in LBM. Self-reported data on premorbid BW suggest an approximately 10% reduction in BW at onset of Type 1 diabetes. Compared with a healthy reference population initial body composition data demonstrate a 25% reduction of the FM, whereas only a minor and non-significant reduction in the LBM is encountered. These data indicate that uncontrolled diabetes is rather a fat catabolic state than, as previously believed, a protein catabolic state.

Absorptiometry, Photon↗
PubMed1976

The Johns Hopkins experience in Columbia, Maryland.

A university-related prepaid group practice was established in Columbia, Maryland, in 1969, by the Johns Hopkins Medical Institutions with the cooperation of the Connecticut General Life Insurance Company. Objectives were based on the traditional triad of service, teaching and research. The effort continues. There has been visible success in the achievement of each of the objectives. It is evident, however, that the development of the Columbia Medical Plan would have been facilitated if there had been a larger population base in which to market membership in the Plan, if marketing had been under the direction of the health-care provider, and if the burden of the building and running of a hospital had not been assumed. Overall, the experience suggests that the Health Maintenance Organization movement has only modest ultimate potential as an option in health-care delivery in the current economic milieu of American medicine.

Comprehensive Health Care↗
PubMed1992

The relationship of weight-height indices of obesity to body fat content.

The measurement called desirable body weight (DBW) was derived by actuaries to indicate that weight which is associated with the lowest mortality. Percent deviation from DBW has become a standard measure of fatness. A different obesity index, body mass index (BMI), is weight in kilograms divided by the square of height in meters. Many workers consider both measures inferior to the measurement of body fat content (BFC). We compared the three measures of fatness in 40 men aged 18-50 and 48 women aged 21-47, ranging from nonobese to extremely obese. Total BFC was determined by isotope dilution of 3H-labeled water. DBWs used were those listed in the US Air Force Examination Manual of 1971; these approximate the midpoint of the range of medium-frame values in the 1959 Metropolitan Life Insurance Tables, but have the advantage of providing a single value for each height. We found nearly perfect correlation (r = 0.99, p < 0.001) between BMI and percent deviation from DBW in both men and women ranging from 14% below to 305% above DBW. Correlations between percent deviation from DBW and total BFC were extremely high: 0.95 (p < 0.001) for the men and 0.94 (p < 0.001) for the women, essentially the same as correlations between BMI and BFC, which were 0.96 (p < 0.001) for the men and 0.95 (p < 0.001) for the women. It appears that the two technically simple weight-height indices, BMI and percent deviation from DBW, give just as accurate a measurement of fatness as the technically complex measurement of total BFC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1993

Healthy adiposity in women: the Framingham Offspring Study.

This report estimates a threshold for "healthy adiposity" by determining the relationship between subscapular skinfolds thickness, a direct measure of adiposity, and cardiovascular disease risk factors in 1254 nonsmoking adult women who participated in the Framingham Offspring Study. Cardiovascular disease risk factors, including blood pressure, fasting plasma lipoprotein cholesterol, plasma glucose and echocardiographically measured left ventricular mass, were included. The optimal subscapular skinfold for 20-39-year-old women was determined to be < 15 mm. Women aged 20-59 whose subscapular skinfolds were below this level had a mean body mass index (BMI) of 21.1 kg/M2. Weight-for-height estimates for these women corresponded closely to the 1959 Metropolitan Life Insurance Company Desirable Weight table. The probability of having unhealthy adiposity was estimated for all women aged 20-59 for each (rounded) integer value grouping of BMI. The probability of being above the healthy adiposity threshold rises rapidly across BMI levels > 20 and plateaus > 24. Thus, only women with BMI < 24 need assessment for adiposity status.

Adipose Tissue↗
PubMed2004

Can we reduce the burden of depression? The Australian experience with beyondblue: the national depression initiative.

OBJECTIVE: Throughout the Asia Pacific region, there is an urgent need to reduce the burden of depression by increasing depression awareness, reducing stigma and dismantling those social barriers that prevent full participation by people with depression. This paper describes the development and early achievements of the Australian depression initiative, beyondblue. METHODS: A review of the key priorities of beyondblue and their impacts during the first three years of operation (2001-03). RESULTS: Key achievements include: the degree of national recognition of beyondblue; size and scope of media impact; growth in website utilisation; increased reporting of the community's recognition of people with depression; genuine reforms in life insurance and income protection; development of a new national consumer and carer organisation; establishment of major population-based preventative and early intervention programs; system-wide reform of primary care-based mental health services; national educational program uptake by general practitioners; and, development of key awareness and intervention programs for use in schools and the workplace. CONCLUSIONS: In its first three years of operation, beyondblue has had a major impact on depression awareness in Australia and demonstrable gains have been made in reducing stigma and major social barriers. A pre-existing national mental health policy and implementation plan, a substantial funding base and participation by key political, media and community leaders have been essential elements of its short-term success. Its longer-term impact will now depend on more sustainable community and business partnerships as well as the growth of a more influential consumer and carer voice.

Australia↗
PubMed2000

Technical, genetic, and ethical issues in screening and testing of African-Americans for hemochromatosis.

To define more precisely populations in which hemochromatosis is frequent to rare, problems of racial classification are introduced, with particular reference to Europeans and African-Americans. Because the category "Caucasian" includes a multitude of dissimilar peoples, the categories Europeans and European-Americans have been substituted for Caucasian, which is archaic. The background of discrimination in sickle hemoglobin programs for African-Americans are then analyzed, including, discrimination by employers, life insurance, and selective mandatory testing. Discrimination and selective testing of African-American employees of the Lawrence Livermore Laboratory continues today without prior consent, as it has since the 1970s. Dissimilarities between the genetics of hemochromatosis in Europeans and their descendants, Africans, and African-Americans are briefly analyzed. Finally, it is concluded that because hemochromatosis is unlike sickle hemoglobin in that it is potentially preventable and treatable, prevention and treatment principles should apply as in other diseases. Furthermore, because hemochromatosis is so common in European-Americans, discrimination, if practiced, would not be selective for African-Americans.

Black or African American↗
PubMed1976

A nomograph method for assessing body weight.

The ratio of weight/height emerges from varied epidemiological studies as the most generally useful index of relative body mass in adults. The authors present a nomograph to facilitate use of this relationship in clinical situations. While showing the range of weight given as desirable in life insurance studies, the scale expresses relative weight as a continuous variable. This method encourages use of clinical judgment in interpreting "overweight" and "underweight" and in accounting for muscular and skeletal contributions to measured mass.

Adult↗
PubMed1986

Overweight adults in the United States: the behavioral risk factor surveys.

Using data on 19,405 adults from telephone interviews across the US, 1981-1983, we examined the sociodemographic characteristics, health-risk behaviors, body image, and dieting of overweight adults classified by the 1959 Metropolitan Life Insurance tables for weight and height. By self-report, 23% were overweight vs 29% in 1960-62. This modest decline in overweight remained after age-adjusting the 1981-1983 rate to the 1960 population. In 1981-1983, more blacks and Hispanics than whites were overweight [rate ratio (RR) = 1.43]. After adjustment for age and education, more over- than average-weight adults had uncontrolled hypertension, were binge drinking, and had a sedentary lifestyle. Among overweight men and women, 72% and 52%, respectively, were not dieting. Overweight adults acknowledging they were overweight were dieting more often than those without this perception (RR = 1.53). Results are discussed in light of research documenting weight gain and overweight as independent risk factors for cardiovascular disease incidence and mortality.

Adult↗
PubMed1990

Cancer mortality in the U.S. flour industry.

The mortality experience among 22,938 white males who were enrolled in the life insurance program of the American Federation of Grain Millers was assessed for the period 1955 through 1985 in a cohort mortality analysis and in a nested case-control analysis. Significantly fewer deaths were observed among this group than expected for all causes of death combined [standardized mortality ratio (SMR) = 89] compared with the number of deaths observed among the general population of U.S. white males of the same age. Excess risks for developing non-Hodgkin's lymphoma (NHL) (SMR = 149), leukemia (SMR = 136), and pancreatic cancer (SMR = 133) were restricted to workers employed in flour mills, where pesticides are used more frequently than in other segments of the industry. In the nested case-control analysis, excess risks for developing these cancers were also observed in these workers, but the relative risk for developing NHL [odds ratio (OR) = 4.2] was approximately twice that for developing pancreatic cancer (OR = 2.2) and that for developing leukemia (OR = 1.8). Within the flour mills, the workers who had ever worked in the maintenance department (OR = 8.1) or in the elevator department (OR = 2.8) were at particularly elevated risk of developing NHL, suggesting that exposures in these departments should receive further attention.

Case-Control Studies↗