Economic consequences of occupational disorders in women with repetitive industrial work

Background: In a previous study, we found a three to four timesincrease in sick listing and disability pensioning among 269women in industrial repetitive work, as compared to 290 referentwomen in varied work. Methods: Here, by using an economic model,we estimated the costs for society of the work-environment dysfunctionsin the industrial group. Results: The costs for disability pensionsin the exposed group were 38.8 kSEK per person year at riskand for sick-leave 27.2 kSEK per person year, while the directcosts for health care were 2.2 kSEK per person year. Among referents,the sums were much lower: 5.6 kSEK per person year for disabilitypensions and 7.9 kSEK per person year for sick-leave and costsfor health care were 0.9 kSEK per person year. The costs (lossesin production) per person year of employment were 4.7 timeshigher for the exposed women than for the referents. The differencewas 53, 800 SEK (1 ECU = 8.74 SEK), of which disability pensioningwas 62%, sick-leave 35% and healthcare 3%. The actual transfersin the social insurance system corresponded to 45.1 MSEK amongthe exposed workers, as compared to 9.1 MSEK for the referents.Conclusions: Repetitive industrial work results in huge costs.Hence, preventive and other measures are needed.     

Left bundle branch block: prevalence, incidence, follow-up and outcome

In a randomly selected population screening study of 8450 menand 9039 women 33 to 71 years of age conducted in Iceland in1967–1977, 27 men and 17 women were found to have leftbundle branch bock (LBBB). The prevalence of LBBB at that timewas 0.43% for men and 0.28% for women. The incidence of LBBBwas 3.2 per 10 000 per year for men and 3.7 per 10 000 per yearfor women.All except one of 37 alive patients with LBBB wereexamined in 1984 including chest X-ray, echocardiography andexercise testing (Bruce protocol). Eight men had had myocardialinfarction (P<0.05), 12 had angina pectoris, 15 had hypertension,7 had cardiomyopathy, 13 had primary conduction disease, and3 had pacemakers. Five men and two women had died in comparisonwith 18 men and 1 woman in an age-matched control group of 176people (P ns). Three of 5 decreased LBBB men had cardiomyopathyat autopsy. Three men died suddenly. The two women died of noncardiaccauses. Only one patient in the control group had cardiomyopathy(P< 0.01). There was no significant difference in other cardiacdiagnoses between the groups. Eleven LBBB women out of thirteenhad a normal exercise duration (6 min) and 11/17 men exercisednormally (7 min). In comparison with the control group, theLBBB patients had an increased LV diameter 2.85±0.38vs 2.58±0.38 cm m^-2 body surface area (P<0.01). Therewas no difference between the groups in left atrial diameteror LV wall thickness.In conclusion, the prevalence of LBBB was0.43% for men and 0.28% for women of middle age. The incidencewas 3.2 per 10 000 per year for men and 3.7 per 10 000 per yearfor women. The prognosis of LBBB is relatively benign apartfrom its association with dilated cardiomyopathy. Few patientsrequire pacemakers. The mean LV diameter is increased in randomlyselected patients with LBBB, but only those with an underlyingdisorder.     

Mortality due to pulmonary embolism,myocardial infarction,and stroke among incident dialysis patients

See also Zoccali C, Mallamaci F. Pulmonary embolism in chronic kidney disease: a lethal, overlooked and research orphan disease. This issue, pp 2481–3. Summary. Background: It is has been suggested that dialysis patients have lower mortality rates for pulmonary embolism than the general population, because of platelet dysfunction and bleeding tendency. However, there is limited information whether dialysis is indeed associated with a decreased mortality risk from pulmonary embolism. Objective: The aim of our study was to evaluate whether mortality rate ratios for pulmonary embolism were lower than for myocardial infarction and stroke in dialysis patients compared with the general population. Methods: Cardiovascular causes of death for 130 439 incident dialysis patients registered in the ERA‐EDTA Registry were compared with the cardiovascular causes of death for the European general population. Results: The age‐ and sex‐standardized mortality rate (SMR) from pulmonary embolism was 12.2 (95% CI 10.2–14.6) times higher in dialysis patients than in the general population. The SMRs in dialysis patients compared with the general population were 11.0 (95% CI 10.6–11.4) for myocardial infarction, 8.4 (95% CI 8.0–8.8) for stroke, and 8.3 (95% CI 8.0–8.5) for other cardiovascular diseases. In dialysis patients, primary kidney disease due to diabetes was associated with an increased mortality risk due to pulmonary embolism (HR 1.9; 95% CI 1.0–3.8), myocardial infarction (HR 4.1; 95% CI 3.4–4.9), stroke (HR 3.5; 95% CI 2.8–4.4), and other cardiovascular causes of death (HR 3.4; 95% CI 2.9–3.9) compared with patients with polycystic kidney disease. Conclusions: Dialysis patients were found to have an unexpected highly increased mortality rate for pulmonary embolism and increased mortality rates for myocardial infarction and stroke.     

Sick-leave and disability pensions among female assembly workers

Sick-leave in 1984–1989 was higher in 269 women with industrialwork involving repetitive movements (total 76,540 days), thanin 290 referents with varying work tasks (26,421 days). Themedians of the individual ratios of the observed number of daysof illness versus expected (according to background population)were 1.26 and 0.24 respectively. Sick-leave with diagnoses inthe musculoskeletal system dominated in the exposed group, particularlyfor neck/shoulders (5.3 versus 0.6% of observed time, p<0.001)and arms/hands (2.4 versus 0.5%, p<0.001). Women leavingfor new jobs had, during the exposed employment, a higher sick-leavethan those who stayed (‘healthy worker selection’),and afterwards lower sick-leave. The risk of disability pensioning1980–1989 (observed/expected: 2.8 versus 0.7) was alsohigher among exposed women. Repetitive, industrial work causesextensive suffering and huge costs. Preventive measures areurgently needed.     

Effects of dopamine, dopexamine and dobutamine on renal excretory function during experimental sepsis in conscious rats

Background: Acute renal failure is a frequent complication in human sepsis. Various inotropic drugs are often used to improve central haemodynamics and renal function. The differential preservative role of the most commonly used inotropic drugs on renal function, in this condition, has previously not been extensively studied. The aim of this experimental animal study was therefore to compare the preserving effects of dopamine, dopexamine, dobutamine and saline on renal excretory function, after induction of sepsis in conscious rats. Method: The effects of dopamine (DA) (2.5 μg · kg^-1 · min^-1; n= 11), dopexamine (DX) (1 μg·kg^-1· min^-1; n=10), dobutamine (DB) (5 μg·kg^-1· min^-1; n=10) and saline (n=13) on the glom-erular filtration rate (GFR), urine flow (UF), sodium excretion (SE) and fractional urinary excretion of sodium (FUE_Na) were studied and compared in conscious rats subjected to a 1-h infusion of live E. coli bacteria (10⁹/h). Results: In the saline-treated control group, bacteria infusion decreased GFR, UF, SE and FUE_Na by 31%, 53%, 51% and 36% respectively, associated with a 16% decrease in mean arterial pressure (MAP), and a 10% increase in heart rate (HR). In the post-E. coli treatment period, the fall in MAP was less pronounced with DX compared to both DB and control, while there was no difference between DX and DA. The increase in HR was most pronounced with DB. GFR decreased to a lesser extent with DX compared to DA, DB and control. UF and SE were better maintained with DX compared to DB and control, while there was no difference in FUE_Na between the groups. Conclusion: We conclude that dopexamine, to a greater extent than dopamine and dobutamine, improves renal excretory function in experimental septic shock.     

Left bundle branch block: prevalence, incidence, follow-up and outcome

In a randomly selected population screening study of 8450 menand 9039 women 33 to 71 years of age conducted in Iceland in1967–1977, 27 men and 17 women were found to have leftbundle branch bock (LBBB). The prevalence of LBBB at that timewas 0.43% for men and 0.28% for women. The incidence of LBBBwas 3.2 per 10 000 per year for men and 3.7 per 10 000 per yearfor women.All except one of 37 alive patients with LBBB wereexamined in 1984 including chest X-ray, echocardiography andexercise testing (Bruce protocol). Eight men had had myocardialinfarction (P<0.05), 12 had angina pectoris, 15 had hypertension,7 had cardiomyopathy, 13 had primary conduction disease, and3 had pacemakers. Five men and two women had died in comparisonwith 18 men and 1 woman in an age-matched control group of 176people (P ns). Three of 5 decreased LBBB men had cardiomyopathyat autopsy. Three men died suddenly. The two women died of noncardiaccauses. Only one patient in the control group had cardiomyopathy(P< 0.01). There was no significant difference in other cardiacdiagnoses between the groups. Eleven LBBB women out of thirteenhad a normal exercise duration (6 min) and 11/17 men exercisednormally (7 min). In comparison with the control group, theLBBB patients had an increased LV diameter 2.85±0.38vs 2.58±0.38 cm m^-2 body surface area (P<0.01). Therewas no difference between the groups in left atrial diameteror LV wall thickness.In conclusion, the prevalence of LBBB was0.43% for men and 0.28% for women of middle age. The incidencewas 3.2 per 10 000 per year for men and 3.7 per 10 000 per yearfor women. The prognosis of LBBB is relatively benign apartfrom its association with dilated cardiomyopathy. Few patientsrequire pacemakers. The mean LV diameter is increased in randomlyselected patients with LBBB, but only those with an underlyingdisorder.     

Additive Effects of Moderate Dietary Salt Reduction and Captopril in Hypertension

ABSTRACT In a randomized, cross-over study 27 patients had diastolic blood pressure of ≥ 96 mmHg during four visits without treatment. Following captopril 25 mg b.i.d. nine patients' blood pressure was ≤ 90 mmHg. The remaining 18 were randomized into two treatment modalities, captopril and moderate dietary salt reduction, and captopril and hydrochlorothiazide 25 mg daily. Following a wash-out period the groups crossed over to the alternative treatment. At the end of the control period the average blood pressure was 151/100 ± 12/6 mmHg recumbent and 140/91 ± 11/7 standing, following captopril 144/94 ± 13/5 and 132/92 ± 12/6, respectively, with low salt diet addded to captopril 140/91 ± 12/6 and 128/89 ± 11/6 and with hydrochlorothiazide and captopril 133/86 ± 12/7 and 120/84 ± 11/7 mmHg supine and erect, respectively. It is concluded that moderate dietary salt reduction, which is easily advised, will significantly potentiate the blood pressure fall following captopril treatment in moderate arterial hypertension.