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Occupational cancer among women: research status and methodologic considerations.

Occupational causes of cancer have not been well-evaluated among women. An increase in the number of women in the work force in jobs with potentially hazardous exposures during the past few decades raises the question as to whether there is a need to enhance our efforts in this area. The inability to evaluate occupational causes of female gynecologic tumors in studies of men, plus the potential for variation in outcome responses between men and women because of gender-based exposure and susceptibility differences, underscore the need for investigations specifically focused on women. Investigations of occupational exposures and cancer risk among women may require design considerations that differ somewhat from studies of men. Issues to consider include the impact of studying outcomes with high survival (e.g., breast cancer), gender-specific exposure patterns and toxicokinetic processing of some chemicals, special limitations in the use of the general population as the referent, and the need to control for established risk factors for gynecologic tumors.

Cohort Studies↗

[Health status during the occupation years--from a family practice at Laksevåg].

Patient records for the period 1940-46 from a "double" family practice at Laksevåg near Bergen were analysed in order to study the occurrence of different diagnoses. The main diagnoses from 8,025 consultations were processed. The panorama of diseases seems to be dominated by infectious diseases and injuries. These complaints were more frequent than in similar records of practice 30 years later. By comparison, cardiovascular, psychiatric and musculosceletal diagnoses were much more rare. On average, the patients were younger than those described, in the records from 30 years later.

Adolescent↗

Occupational radiation studies: status, problems, and prospects.

At least 350,000 workers at U.S. radiation facilities are being followed up to monitor their mortality experience, with particular reference to cancer. Although these studies are expensive, they are needed from the standpoint of public health and radiation protection; they also provide a useful check that the risk extrapolation models based on high dose data are not seriously out of line. Unfortunately, there are a number of problems in interpreting radiation worker studies that stem mainly from the fact that the expected magnitude of effects is small because of the low doses. Problems of falsely positive effects caused by chance or by study biases are difficult to distinguish from real effects. Dose-effect analyses and pooled analyses from several studies offer some improvements in assessing the risk from low doses but do not obviate all the problems. Future studies should explore whether there are biological markers of exposure, damage, or susceptibility that would improve our power to assess individual risk.

Dose-Response Relationship, Radiation↗

[Health status during the occupation years--mortality].

The crude total death rate of the Norwegian population gradually decreased from the early 1930s until 1940. During the German occupation the total death rate increased moderately, but markedly, particularly among males and age groups below 45 years. Children too had a high death rate, due to an extremely high occurrence of infectious diseases. Infant mortality declined, however, particularly in the cities, probably due to increased resources in mother and child health care. In all age groups mortality was generally dominated by injuries and violent causes of death, in addition to infectious diseases. The concept that cardiovascular diseases became less frequent due to favourable changes in diet and life style is doubtful. The statistical decline in mortality from these diseases started before the quality or quantity of the diet was reduced to any extent, and the rise began before diet and nourishment improved. Further, the routines for reporting death, and the nomenclature, were changed already in 1941, making comparisons between the prewar and the war period difficult. The figures may thus be due to artefacts. In addition, the high frequency of violent and unknown causes of death may mask the possible effects of chronic and lethal diseases.

Adolescent↗

Use of hormone replacement therapy in Italian women aged 50-70 years.

OBJECTIVES: The aim of the present cross-sectional analysis was to describe patterns and determinants of use of hormone replacement therapy (HRT) in a large sample of women attending mammographic screening. METHODS: Between 1999 and 2001, 8533 women aged 50-70 years were recruited by 11 screening centres, and structured interviews were made collecting information on socio-demographic characteristics, lifestyle habits, medical and reproductive history (overall response rate 87%). RESULTS: Current HRT use was reported by 6.9% of women (n=585), the average duration of use being 3.5 years; 13.2% were ever HRT users. Binomial and multinomial logistic regression (MLR) analyses showed that younger age, higher educational level, past mammographic examination and history of bilateral oophorectomy were the major predictors of current and ever HRT use. Current use was also more frequently reported by women who were thinner, nulliparae, had had induced menopause, had a later onset of menopause, with history of oral contraceptive use and hysterectomy without bilateral oophorectomy. By contrast, those who were diabetics or had positive history of cardiovascular disease were less likely to be current HRT users. No differences were found in HRT use according to marital status, type of occupation, menopausal status, smoking, history of breast cancer, hypercholesterolemia, hypertension and phlebitis. CONCLUSIONS: Our results support previous findings indicating that HRT use in Italian women is uncommon and of short duration. Current HRT users were less likely than non-users to report several characteristics associated with higher mortality and morbidity, in accordance with the healthy-user phenomenon described in other countries.

Aged↗

Risk factors associated with depression in patients with type 2 diabetes mellitus.

BACKGROUND: This study was undertaken in order to identify the prevalence and factors associated with depression in a group of patients with type 2 diabetes mellitus. METHODS: Our design consisted of a cross-sectional study at the Department of Neurology and Psychiatry of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City. Study units included 189 patients with type 2 diabetes mellitus (DM). Beck Depression Inventory scale was used to measure the presence of depression, while the independent variables evaluated to explain depression were sociodemographic (gender, marital status, religion, education, occupation, socioeconomic status) and characteristics of the disease were disease duration, comorbidity, compliance, and glycemic control. RESULTS: Prevalence of depression was 39% (74 patients). The following risk factors were identified by univariate analysis: being widowed (OR 3.54, confidence interval [CI] 1.56-8.11, p = 0.0007); female (OR 2.95, CI 1.50-5.82, p = 0.006); housewife (OR 2.08, CI 1.10-3.94, p = 0.01); poor compliance (OR 2.14, CI 1.12-4.10, p = 0.01), and presence of comorbidity (OR 5.60, CI 1.51-24.5, p = 0.002). On the other hand, the most constant associations were presence of blood glucose at the last appointment >or=200 (OR 3.23, CI 1.59-6.60, p = 0.0003) and >or=250 (OR 2.15, CI 0.93-5.03, p = 0.05), as the average of the last five blood glucoses >or=200 (OR 3.67, CI 1.76-7.73, p = 0.0001), >or=250 (OR 4.07, CI 1.61-10.49, p = 0.0007) and >or=300 (OR 2.12, CI 1.48-3.02, p = 0.003). Discriminant function analysis of the variables, previously studied in univariate analysis, was carried out for the presence of depression. A stepwise model included the following variables: average of the last five blood glucoses; 2) widowed or divorced, and 3) female. CONCLUSIONS: Frequency of depression in patients with type 2 DM was high (39%). High level of blood glucose stands out as a variable associated with presence of depression. Other associations were presence of comorbidity, being a female, and being widowed or divorced.

Aged↗

Adults with learning disabilities: occupational and social status after college.

Forty-nine adults with learning disabilities who had attended a large public university between 1980 and 1992 were interviewed about their current employment and social status. Most of the respondents had adjusted well to the demands and complexities of adulthood. More than 80% of the participants not still in college at the time of the interview were employed, mostly in white collar jobs. Although most of the participants indicated that their learning disabilities affected them at work or in other facets of their life, they typically did not disclose those disabilities when applying for jobs or once employed. The respondents were also socially active and happy with their social life. Keys and barriers to success are examined, and recommendations are made concerning the issue of discrimination in the workplace.

Adult↗

[Health status of persons occupationally exposed to chromium, nickel, manganese and polycyclic aromatic hydrocarbons].

Occupational environment monitoring and biological-medical monitoring of persons professionally exposed to welding fumes have been performed. Chromium, manganese and polycyclic aromatic hydrocarbons in welding fumes represents an important health risk. Pollutant concentrations found in metal welding fumes represented only fractions of those acceptable ones. Polycyclic aromatic hydrocarbons have been reached the concentration found in a busy road crossing in Hradec Králové (compared with these as in Czech Republic no maximum acceptable levels for PAHs having been declared). Family, personal and occupational history have been taken. Health state including total haematological count, biochemical and cytogenetical changes of 19 stainless steel welders were checked-up. The level of mercapturates in urine were examined as well. The data were statistically compared with those of non exposed (control group). No changes witnessing the above mentioned risk factors influence on the haematological, biochemical and cytogenetical findings were ever proved. In conclusion, our results did not confirm an increased professional risk in this group of welders.

Adult↗

Obstructive sleep apnea, depression, and oral status in elderly occupants of residential homes.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is a sleep disorder characterized by repetitive episodes of upper airway obstruction. Recently, it has been suggested that edentulism worsens sleep apnea; sleeping without dentures is associated with a significant increase in the apnea-hypopnea index. OSAS is also related to depression. The aim of this study was to assess, in a group of elderly occupants in residential homes in the Turin district of Italy, (1) the prevalence of key symptoms and indicators of OSAS and the prevalence of depressive feelings; (2) how the reduction of vertical dimension of occlusion (VDO) influenced the onset of OSAS; and (3) whether a relationship between OSAS and depression was present. MATERIALS AND METHODS: The sample population consisted of 403 people (77% men, 23% women; age range, 65 to 90 years). The subjects underwent the Italian version of the Mini Mental State Examination (MMSE) to assess their mental condition. The remaining collaborating subjects completed 2 questionnaires to assess the risk of OSAS (Berlin Questionnaire) and depressive feelings (Beck Depression Inventory). RESULTS: Of the 403 elderly residents initially evaluated with the MMSE, 97 were excluded from the study, reducing the sample size to 306 subjects (75% women, 25% men; mean age +/- standard deviation, 83.12 +/- 11.10 years). The analysis of these data revealed a statistically significant association between the risk for sleep apnea and the VDO (P < .0001), and between sleep apnea and depressive feelings (P < .05). CONCLUSION: This study revealed that inadequate VDO is closely associated with the risk of OSAS, and that depressive feelings are more present if there is a high risk for OSAS.

Aged↗

[Frequency of depression in patients with diabetes mellitus type 2].

OBJECTIVE: To determine the prevalence of depression in Mexican adult diabetics and to identify factors associated to the depression. RESEARCH DESIGN: Prolective survey. SETTING: Four Mexico City hospitals (Clinica San Pedro de los Pinos IMSS, Centro Medico Nacional Siglo XXI IMSS, Hospital Gea González SSa and Centro de Salud Margarita Chorne SSa). STUDY UNITS: 79 patients with diabetes mellitus type 2. MAIN MEASUREMENTS: The Beck Depression Inventory was used as a measure of depression. We used sociodemographic variables (age, gender, marital status, religion, education, occupation, socioeconomic status) and disease variables (years of diagnosis, other chronic medical conditions and compliance with therapeutic regimens) as the independent variables of depression. RESULTS: Mean age was 59 +/- 11 years (SD) and 58 (73%) were females. The frequency of depression was 46%. Factors associated to depression were: females (OR = 3.67, CI = 1.07-13.3, p = 0.03) and years of diagnosis above 15 (OR = 3.08, CI = 0.91-10.8, p = 0.07). CONCLUSIONS: Frequency of depression was high (46%). Gender and years of diabetes diagnosis were factors associated to depression.

Cross-Sectional Studies↗

Evaluation of decompression safety in an occupational diving group using self reported diving exposure and health status.

BACKGROUND: Many occupational diving groups have substantially different diving patterns to those for which decompression schedules are validated. AIMS: To evaluate tuna farm occupational diving practice against existing decompression models and describe a method for collecting and modelling self reported field decompression data. METHODS: Machine readable objective depth/time profiles were obtained from depth/time recorders worn by tuna farm occupational divers. Divers' health status was measured at the end of each working day using a self administered health survey that produces an interval diver health score (DHS) with possible values ranging from 0 to 30. Depth/time profiles were analysed according to existing decompression models. The contribution of diving exposure and between diver variability to DHS was evaluated using linear regression. RESULTS: The mean risk of decompression sickness was calculated as 0.005 (SD 0.003, n = 383). The mean DHS following diving was 3 (SD 2, n = 383) and following non-diving activities was 1 (SD 1, n = 41). After accounting for between diver variability in intercept, DHS was found to increase one unit for every 1% increase in the risk of decompression sickness. CONCLUSIONS: A method has been established for the collection and analysis of self reported objective decompression data from occupational diving groups that can potentially be used as the basis for development of purpose designed occupational diving decompression schedules.

Decompression↗

Adjustment for smoking, alcohol consumption, and socioeconomic status in the California Occupational Mortality Study.

This paper presents methods for adjusting for smoking, alcohol, and socioeconomic status in death certificate-based occupational mortality surveillance. The methods were applied in the California Occupational Mortality Study, a statewide study of rates based on 180,000 deaths and census estimates of occupations. For each occupation, levels of smoking, alcohol consumption, and socioeconomic status were estimated using National Health Interview Survey and U.S. Census data, and an empirical Bayes procedure was used to improve the stability of smoking and alcohol estimates for small occupations. Expected death rates for occupations were calculated by modeling rates as a function of age, smoking, alcohol, and socioeconomic status with Poisson regression. The effect of adjustment was usually moderate and in the expected direction, and the adjusted mortality ratios were generally closer to 1.0. Full data on agricultural occupations are presented for illustration.

Adolescent↗