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PubMed2001

To tell or not to tell-comparison of older patients' reaction to their diagnosis of dementia and depression.

OBJECTIVE: Investigation of the reaction of elderly patients to the disclosure of their diagnosis of dementia compared with depression. DESIGN: Elderly patients suffering from dementia and depression were asked to complete a questionnaire about the diagnosis and other aspects of their clinical summary sent to them by post. Demographic data included age, gender, marital status and occupation; degree of dementia or depression was established by administering the mini-mental state examination and the geriatric depression scale, respectively. SETTING: Patients were consecutive attendees of outpatient clinics (old age psychiatry) located in two suburban areas near London. MEASURES: Demographic data included age, gender, marital status and occupation; degree of dementia or depression was established by administering the mini-mental state examination and the geriatric depression scale, respectively. RESULTS: One hundred cases were recruited, 53 with dementia and 47 with depression. Most depressed and dementia patients ( > 75%) liked the idea of reading their diagnosis but 25% of dementia cases felt upset. Within the dementia group, the majority of patients with mild or severe dementia welcomed the idea of knowing their diagnosis; and 13 (100%) of the patients with vascular dementia wished to know (compared with 68% cases with Alzheimer's disease). None felt upset, and only 39% of them felt pessimistic after reading their own clinical summary. However, among dementia patients who also happened to be depressed, a higher proportion (60%) expressed an unfavourable view towards knowing their diagnosis, but only a minority (40%) of them were actually upset. Most older married females, especially those with depression and Alzheimer's disease, felt pessimistic afterwards. CONCLUSIONS: There was no significant difference between patients with dementia or depression in their wish to know their diagnosis. Patients with severe dementia, even if they felt upset, preferred to be told their diagnosis. Patients with vascular dementia tended to express a more favourable view.

Aged↗
PubMed1995

Smoking and low back pain: is the association real?

STUDY DESIGN: A review was made of the epidemiological literature on the association between smoking and low back pain (LBP). OBJECTIVES: The first objectives was to identify studies that challenged their preliminary results with additional test factors and to see what effect this had on the outcomes. The second objective was to identify test factors that were unique to studies in which the original association disappeared after multivariate analysis. SUMMARY OF BACKGROUND DATA: The literature on this subject is confusing and no systemic investigation seems to have been made on the possibility of spurious data interpretation. METHODS: Twenty-four articles reporting on 126 epidemiological studies (in 24 reports) on the association between smoking and LBP were systematically reviewed by the authors, independently and jointly. RESULTS: In eight of the thirteen studies that tested a preliminary positive association between smoking and LBP, this association remained after multivariate analysis, whereas it disappeared in after analysis in five. Two variables, marital status and occupation, were uniquely present in some of the studies in which the initial positive association was lost. However, their study samples were probably nonrepresentative of the general population. CONCLUSIONS: A more strategic approach is needed in the study of the role of extraneous factors. In particular, marital status and occupation should be further investigated.

Epidemiologic Methods↗
PubMed2005

Ill-health retirement among healthcare workers in the Southern Health Board of the Republic of Ireland.

AIM: To determine the incidence rates, trends and medical causes of ill-health retirement (IHR) among different occupational classes in the Southern Health Board (SHB). METHODS: The 14 702 permanent employees of the SHB were divided into six occupational classes based on socio-economic status and occupational demands. The occupational classes were compared for incidence rates of IHR, age at IHR, years of service and medical causes of IHR. The total group of employees was used as the standard for statistical comparison. Incidence rates were compared using standardized IHR ratios (SIHRRs). Medical causes were compared using proportional ill-health retirement ratios (PIHRRs). RESULTS: Three hundred and three employees were granted IHR from 1994 to 2000. The overall incidence rate of IHR was 2.9 per 1000 employees per annum. The highest SIHRRs occurred in male maintenance staff at 345 (CI: 221-513) and female support staff at 158 (CI: 123-201). With regard to age and years of service, IHR peaked at a time that coincided with enhancement to pension entitlements. The common causes of IHR were musculoskeletal disorder (38%), mental illness(17%), circulatory disorder (12%) and neoplasia (8%). PIHRRs did not vary significantly between the classes. CONCLUSION: IHR was more common among manual healthcare workers. The structure of the pension scheme appeared to influence the timing of IHR. Occupational class did not appear to influence the medical causes of IHR.

Female↗
PubMed1978

Psychosocial correlates of chronic cannabis use.

The psychosocial effects of chronic heavy use of cannabis were studied in a rural population of males in north India. The user group comprised thirty persons who had been taking only cannabis at least 11 times a month over a period of five years or more. The controls were fifty subjects selected from among the general population to which the users belonged. The controls had not been using any drugs. The subjects had similar age distribution, occupation, socioeconomic status, and educational background. Psychosocial adaptation was assessed by enquiries into such areas as self-aspiration, present occupation, occupational satisfaction, marital status, marital relationships, sexual behaviour, self-reported deviant behaviour, and future planning for children. On no variable were the present users found to be different from the non-user control group.

Adult↗
PubMed2000

Validity of self-reported weight and height in the French GAZEL cohort.

OBJECTIVE: To examine the validity of self-reported weight and height and the resulting body mass index (BMI), and to explore the associations between demographic, socioeconomic, and health-related factors on the one hand and bias in self-reported weight and height on the other, in order to determine the groups most likely to exhibit bias. DESIGN: Prospective cohort study. SUBJECTS: 7350 middle-aged subjects, 5445 men and 1905 women, from the GAZEL cohort, who have been followed up since 1989 and work at the French national company Electricité De France-Gaz De France (EDF-GDF) in various occupations. MEASUREMENTS: Self-reported weight and height were based on information from yearly mailed questionnaires, and measured weight and height, used here as true values, were provided by occupational physicians from 1994 to 1997. Sex, age, marital status, education, occupation, history of ischemic heart disease, and treatment for cardiovascular risk factors were obtained from the mailed questionnaires or from data provided by the Company's personnel and medical departments. RESULTS: Strong correlations were found between measured and self-reported values, but self-reported weight and height displayed significant systematic errors. Weight was significantly underestimated for men (0.54 kg) and for women (0.85 kg), and height overestimated for men (0.38 cm) and women (0.40 cm). These biases led to significant underestimations of BMI (0.29 and 0.44 kg/m2 for men and women respectively). Consequently, the prevalence of overweight, defined as BMI > 26.9 kg/m2 for women and BMI > 27.2 kg/m2 for men, was also underestimated, by 13% for men and 17% for women. The five factors associated with bias in self-reported weight and height were: overweight status, end-digit preference, age, educational level and occupation. CONCLUSION: These findings suggest that self-reported weight and height should be treated with caution, because of biases leading to misclassification for overweight and obesity, especially in certain segments of the population.

Adult↗
PubMed1988

Selenium status in females with occupational cervico-brachial complaints.

A hypothesis that selenium deficiency predisposes the development of occupational cervicobrachial complaints was tested in 134 females working in an assembly factory, with constrained work postures and repetitive work tasks. Seventeen subjects, who reported intake of selenium tablets, had higher plasma selenium levels than the others (104 vs 89 micrograms/l, P = 0.01). Among those who did not take selenium tablets, 21% reported symptoms from the upper back during the last 7d, 21% from the neck, 38% from the shoulders, 15% from the elbows, and 27% from the hands. Subjects with pain in their elbows had slightly, but significantly, lower plasma selenium levels than asymptomatics (84 vs 90 micrograms/l, P = 0.048). For the other anatomical regions, there were no statistically significant differences. Thus, there was no major association between selenium status and pain; conclusions regarding any minor association must await further studies.

Adult↗
PubMedDate not supplied

Infant health consequences of childbearing by teenagers and older mothers.

The association of childbearing at early and late ages with various adverse outcomes of pregnancy was explored in data collected in the 1980 National Natality and Fetal Mortality Surveys. The characteristics of interest for teenage mothers were marital status at conception and the trimester of pregnancy in which prenatal care was begun. For married mothers aged 30 years and older, the variables considered were employment status and occupation during the year preceding childbirth and smoking status before and during pregnancy. The pregnancy outcome variables analyzed were the same for both groups of mothers: fetal loss, low birth weight, and low 1-minute Apgar scores. Although more than half of all births to teenage mothers were to unmarried women, an additional one-quarter of these births were to women who married between the time of conception and the birth of the child. Generally there was little difference in outcomes for teenage mothers who were married at the time of delivery, regardless of their marital status at the time of conception. Pregnancy outcomes for teenagers who did not marry prior to delivery were considerably less favorable. Nearly 90 percent of women aged 30-34 years who had a first birth in 1980 were employed during the year before delivery, an extraordinarily high labor force participation rate. More than half of these employed mothers were in professional occupations, consistent with their very high levels of educational attainment. Although the analysis is limited by the small numbers of births involved, it appears that professionally employed women generally have the best pregnancy outcomes. When mother's smoking status is taken into account,nonsmokers had more favorable outcomes, with births to professionally employed mothers generally most favored.

Adolescent↗
PubMed1979

Long-term outcome of major psychoses. II. Schizoaffective disorder compared with schizophrenia, affective disorders, and a surgical control group.

Eighty-five patients with both schizophrenic and affective features at the time of admission to the University of Iowa Psychiatric Hospital between 1934 and 1944 were selected for a 30- to 40-year outcome study. Comparison groups were 200 schizophrenic and 325 affective disorder patients, selected by the Feighner et at criteria, and 160 psychiatric symptom-free surgical patients. We assessed marital, residential, occupational, and psychiatric status to evaluate the outcome of these patients at the time of field follow-up. We used multivariate analysis of covariance to analyze the data by taking admission marital and occupational status into consideration. Patients with schizoaffective disorders had a significantly better outcome than those with schizophrenia, but a significantly poorer outcome than those with affective disorders and surgical conditions. Schizoaffective disorder fell somewhere in between the schizophrenia and mania group. Before final conclusions could be made about the nature of schizoaffective disorders, more research should be done.

Adult↗
PubMedDate not supplied

Chronic osteomyelitis of long bones: reasons for delay in presentation.

BACKGROUND: Chronic osteomyelitis is a common orthopaedic infection and a major medical problem in developing countries. Time is a critical factor in the evolution of the chronic disease as most of our cases are a progression from acute haematogenous osteomyelitis. Our patients present very late. OBJECTIVE: To identify the reasons for this delayed presentation and suggest possible solutions. METHOD: Over three years (2000-2003) in a multi-centre study (2000-2003), we prospectively evaluated patients with both clinical and radiological diagnosis of chronic osteomyelitis. Besides personal data, mode of onset, duration of illness, father's educational status and occupation and reasons for delayed presentation were documented using a questionnaire. Previous surgery was an exclusion criterion. RESULTS: One hundred and thirty-six patients comprising 81 males and 55 females with a mean age of 17.7(2-55) years were recruited. The mean duration between onset of disease and presentation for treatment was 13.3(2-120) months. Sixty-one (44.9%) presented to a health facility were misdiagnosed and inappropriately treated; ignorance was the reason in 37(27.2%) and lack of finances in 32(23.2%). There was no statistically significant association between the father's educational status and occupation and the attitude to hospital attendance. CONCLUSION: Misdiagnosis, ignorance and poverty are the reasons for delayed presentation in patients with chronic osteomyelitis in this environment. A high index of suspicion, accurate diagnosis and appropriate therapy offer the only hope in containing the acute phase. Continuing medical education, improvement in social and medical amenities and the national health insurance scheme are possible ways of overcoming undue delay in presentation for specialist consultation.

Adolescent↗
PubMed1997

The trends in histological types of lung cancer during 1980-1988, Guangzhou, China.

Five thousand five hundred and forty six cases of all lung cancer patients who died during 1980-1988 in Guangzhou, China were investigated retrospectively with a standardized 31-item questionnaire administered to their next of kin. The data of 1093 lung cancer patients(20%, 1093/5546) who had a histological record was analyzed to investigate the changes in histological types and the possible etiologic causes. The difference between the lung cancer deaths with and without histological record is not significant in age, location (peripheral or central) of tumour and status of occupation (P > 0.05), but the difference in sex is significant (P < 0.01). We analyzed the data of 1093 cases by sex and by 3-year period. There had been a shift in the histology pattern with an increase in the percentage of adenocarcinoma (P = 0.0011) and a decrease in percentage of squamous cell carcinoma (P = 0.0027) in males, inversely, there has been an absolute and a relative decrease of percentage in adenocarcinoma in females (P = 0.0028). The percentage of smokers, age of starting to smoke and type of tobacco smoking were nearly constant in both sexes during the studied periods. The pack-years of smoking decreased in males (P = 0.0396), and seemed increase in females (P = 0.1576, no significance). The analysis of occupation and dietary habits among 5546 cases were performed. The proportion of housewives decreased with time (P < 0.001) while the percentage of chemists in females increased (P < 0.001) with time. The dietary habits are changing with an increase in roast food intake for males (P = 0.0055) and in vegetable intake for males (P < 0.0001), females (P < 0.0001), and for patients with lung squamous cell carcinoma and adenocarcinoma in both sexes (P < 0.001). Perhaps the changes in pack-years of smoking may be responsible for the percentage change of lung cancer histological types observed in our study. The role that changes in dietary habits and status of occupations play in the changing trends of lung cancer histological types in our study need further study.

Adenocarcinoma↗
PubMed2005

Predictors of elevated blood lead levels among 3-year-old Ukrainian children: a nested case-control study.

OBJECTIVES: Lead is common in the general population. However, data are lacking for the Ukraine and many other countries from the former Soviet Union (FSU). In this study we evaluate the level of blood lead among 212 Ukrainian children and determine predictors of elevated lead levels. We also describe the health effects associated with elevated blood lead. METHODS: A nested case-control study from a prospective cohort of Ukrainian 3-year-old children was conducted in March 1998. Blood assays were analyzed for lead by labs at the Centers for Disease Control and using portable examination kits. We evaluated predictors of elevated blood lead (blood levels in the upper quartile >4.65 microg/dL) using a multivariable logistic regression model. The model included socioeconomic status, parent occupation, environmental tobacco smoke, hygiene, diet, and health status. RESULTS: The geometric mean lead level was 3.15 microg/dL (range, 0.7--22.7). In our adjusted model, we observed a strong association between lead levels in the upper quartile and children whose fathers worked manual labor jobs in industries associated with lead exposures [adjusted odds ratio (OR)=2.25; P=0.025] and mothers who smoke indoors (adjusted OR=2.87; P=0.047). Daily hygiene and dietary habits were not associated with elevated lead levels. No increased risks of overall morbidity or lead-associated illness were observed (anemia, dental caries, renal disease, cardiovascular diseases, and musculoskeletal complaints). CONCLUSION: This is the first study to describe lead levels and associated variables among Ukrainian children in the peer-reviewed literature. Elevated lead levels in these children were associated with paternal occupation and mothers smoking indoors. At age 3 no adverse health effects were observed. More data are needed to determine the level of heavy metal contamination in children from the Ukraine and many other former Soviet nation-states.

Adult↗
PubMed1992

Deaths from heart disease as analyzed according to occupation.

"In order to analyze the deaths from heart disease associated with various occupations, we examined [1985 vital statistics for Japan] and calculated the risk ratio as well as the attributable risk percent (ARP), for deaths from all forms of heart disease, from ischemic heart disease, [and] from heart failure. The risk ratio for all forms of heart disease was highest in Group E (agricultural, forestry and fisheries workers) and Group F (mining workers) in most age groups. The second highest ratio was seen in Group J (service workers), especially those in their 30s and over. The ratio was also higher in Group D (sales workers) in their 50s and over."

Age Factors↗
PubMed1991

[Relation between health status of female assemblers and the degree of occupational fatigue].

Fatigue, the functional status and morbidity of women-assemblers of the watches and shoes have been investigated. Assessment of fatigue was based on the subjective parameters. Reliable changes in morbidity were not observed in women of 20-30 years of age with a high degree of fatigue, while in the group of women of 31-40 years of age an increase in the frequency of diseases of cardio-vascular, bone-muscular and peripheral nervous systems were observed. Correlation coefficients of the degree of fatigue were 0.42 for the frequency, and 0.37 for the number of days of staying at home due to the loss of the working ability. In the group of women of 41-50 years of age this correlation is less expressed, though the morbidity level is high. The leading factors of fatigue and morbidity in these professional groups are as follows: volume and intensity of work, visual stress and low-mobility position.

Adult↗
PubMed1987

Alcohol-related problems of children of heavy-drinking parents.

Alcohol-related problems that are experienced by sons and daughters of heavy-drinking parents (either father or mother) are examined using data from a 1978 household sample of employed adults in metropolitan Detroit. Adult children with heavy-drinking parents were found to have a higher percentage of dependent problem drinking than those without heavy-drinking parents. Also, adult children with low status (blue-collar) occupations were found to have a higher percentage of dependent problem drinking than those with high status (white-collar) occupations. Although it was not possible to disentangle the genetic processes from the social processes in this study, the results support the hypothesis that having both heavy-drinking parents and low occupational status places sons and daughters at elevated risk for alcohol-related problems. Implications for future epidemiological studies are discussed.

Alcohol Drinking↗