Suspected nasopharyngeal carcinoma in three workers with long-term exposure to sulphuric acid vapour

Sulphuric acid vapour has been suspected of being an industrial carcinogen. In this study, a cluster is presented of three patients with nasopharyngeal carcinoma (NPC) who worked in the same building of a telecommunications conveyance station in southern Taiwan with long term exposure to sulphuric acid vapour concentrations as high as 0.18 mg/m3. All three workers were diagnosed with NPC within a 5 month period between September 1992, and March 1993. Compared with 19 other healthy workers from the same building, these three workers with NPC had worked significantly longer in this building than had the others (mean (SD) (years): 12.7 (0.6) v 7.4 (4.4); p = 0.01). With an in situ nucleic acid hybridisation and immunostaining method for colocalised Epstein-Barr virus (EBV) and secretory component (SC) protein among biopsy specimens of these three patients with NPCs, it was found that some tumour cells did not contain EBV and SC protein staining signals. These results indicate that EBV infection is not the only risk factor for NPC and long term exposure to relatively low concentrations of sulphuric acid vapour may be associated with the development of NPC.

 

     

家族性和散发性鼻咽癌患者的危险因素及肿瘤家族史的比较

目的 研究广东地区家族性鼻咽癌患者与散发性鼻咽癌患者发病因素间存在的差异及其一级亲属恶性肿瘤发病情况,为鼻咽癌患者家庭成员的遗传咨询和筛查策略提供依据.方法 选取2005年10月至2007年10月中山大学肿瘤防治中心收治的广东籍新发鼻咽痛患者作为研究对象,共收集1877例鼻咽痛患者,包括181例家族性鼻咽痛患者和1696例散发病例.对两组患者的人口学特征、临床特征、危险因素及一级亲属肿瘤家族史进行比较分析,并对家族性鼻咽癌患者受累一级亲属的分布及其与先证者发病的时间间隔进行分析.结果 1877例鼻咽癌患者中181例(9.64%)有一级亲属受累;在受累的一级亲属中有58.49%(124/212)为同胞,41.51%(88/212)为父母.同胞与先证者发病的时间间隔为(7.40±5.41)年,而父母与先证者发病的平均时间间隔为(15.55±10.61)年,两者间差异有统计学意义(t=-5.78,P<0.01).两组患者确诊时80%以上临床分期已进入晚期(Ⅲ期以上).无论是患病前还是儿章时期,两组在咸鱼(OR=1.01;95%CI:0.59～1.75 vs OR=1.31;95%CI:0.92～1.86)、腌菜(OR=0.93;95% CI:0.58～1.49 vs OR=1.12;95%CI:0.80～1.57)、酱类(OR=0.37;95%CI:0.14～1.01 vs OR=1.61;95% CI: 0.99～2.48)、新鲜水果(OR=0.87;95%CI: 0.60～1.26 vs OR=0.65;95% CI:0.20～2.12)、腊味(OR=1.26;95%CI:0.87～1.83 vs OR=1.28,95%CI: 0.71～2.30)等饮食因素方面差异均无统计学意义(P值均>0.05).两组患者在吸烟(OR=0.99;95%CI:0.68～1.45)及其一级亲属患其他肿瘤的风险方面(OR=0.85;95%CI:0.56～1.28)差异也无统计学意义(P值均>0.05).结论 在中国广东地区的鼻咽癌患者中,家族性鼻咽癌约占9.64%.在高发家系中,同胞与先证者发病的时间间隔短于父母与先证者发病的时间间隔.大多数患者就诊时已到晚期,建议确诊的鼻咽癌患者的一级亲属,特别是同胞,应根据具体情况定期进行鼻咽癌筛查.     

Fiber Intake and Risk of Nasopharyngeal Carcinoma: A Case-Control Study

Some studies examined the inverse relation between nasopharyngeal carcinoma (NPC) risk and dietary fibers in endemic populations. By means of a hospital-based case-control study, we verified whether this association was also present in Italy in connection with various types of dietary fibers. Cases were 198 patients with incident, histologically confirmed, NPC admitted to major teaching and general hospitals during 1992–2008. Controls were 594 patients admitted for acute, nonneoplastic conditions to the same hospital network of cases. Information was elicited using a validated food frequency questionnaire including 78 foods, food groups, or dishes. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were estimated for quartiles of intake of different types of fiber after allowance for energy intake and other potential confounding factors. Total fiber intake was inversely related to risk of NPC (OR = 0.58 for the highest vs. the lowest quartile of intake; 95% CI: 0.34–0.96). We found an inverse association for total soluble (OR = 0.58; 95% CI: 0.35–0.96) and total insoluble fiber (OR = 0.56; 95% CI: 0.33–0.95), in particular cellulose (OR = 0.57; 95% CI: 0.33–0.96), and lignin (OR = 0.51; 95% CI: 0.31–0.85). In conclusion, this study suggests that dietary intake of soluble and insoluble fibers is inversely related to NPC risk in a nonendemic southern population.     

老年慢性病患者社会化住院现状调查及影响因素分析

目的 调查老年慢性病患者社会化住院现状及其影响因素。方法 便利抽样某三甲医院于2018年1月 - 2019年1月收治866例老年慢性病患者作为调查对象,logistic回归分析其影响因素。结果 866例老年慢性病患者符合“社会化住院”标准人数252例,比例为29.09%,住院阶段转科室（OR = 4.403,95%CI:2.855～6.789）、入院时ADL水平（OR = 1.478,95%CI:1.151～1.897）、达到出院标准ADL水平（OR = 1.359,95%CI:1.074～1.718）、年龄（OR = 1.128,95%CI:1.084～1.173）、家庭人均收入（OR = 2.484,95%CI:1.990～3.101）、医院获得性感染（OR = 2.078,95%CI:1.301～3.320）、入院途径（OR = 2.222,95%CI:1.424～3.467）、合并其他慢性病（OR = 3.743,95%CI:2.373～5.902）、抑郁（OR = 2.336,95%CI:1.485～3.674）、焦虑（OR = 2.272,95%CI:1.471～3.509）、认知障碍（OR = 1.970,95%CI:1.230～3.156）、病程（OR = 1.121,95%CI:1.057～1.189）、公费（OR = 3.116,95%CI:1.041～ 9.326）、新农合（OR = 0.376,95%CI:0.142～ 0.991）、自费（OR = 0.117,95%CI:0.029～0.473）均是“社会化住院”的显著影响因素（P＜0.05）。结论 老年慢性病患者“社会化住院”程度较高,其受到入院途径、医院内感染、生理、心理、精神状态、对他人依赖程度、经济收入和医保类型影响。     

刍议院报加强医院文化建设的主要作用

院报作为医院文化建设的重要阵地,集中反映了医院发展建设的内涵,真实记载了医院发展建设和改革的进程,如实记录了医院各项工作动态,反映了职工思想动态,是展示医院文化的重要窗口。本文就如何办好院报的经验做法进行了探讨:围绕中心工作,坚持正确的舆论导向;凝练医院精神,培育医院文化;树典型,造氛围,活跃医院文化;贴近读者,为读者服务;运用报纸语言,赢得宣传效果;活用"通版",增强宣传效果;规范制作流程,切实提高报纸质量;建设优秀通讯员队伍,强化通讯员队伍管理。     

新建康复医院医院感染发病率及危险因素前瞻性研究

目的了解新建康复医院医院感染的流行病学特点及其危险因素。方法采用前瞻性调查方法,监测2011年1月-2014年12月入住某新建康复医院的所有住院患者医院感染情况,收集相关资料并进行统计分析。结果共监测出院患者22 126例,男性12 023例,女性10 103例,年龄 4月～100岁。发生医院感染720例、738例次,医院感染发病率为3.25%,例次发病率为3.34%。脊髓康复科发病率最高（9.76%）;医院感染部位主要为下呼吸道（388例次,52.57%）;共检出病原菌186株,其中革兰阴性（G-）菌154株（占82.80%）,革兰阳性（G+）菌25株（占13.44%）,真菌7株（占3.76%）。多因素logistic回归分析表明,瘫痪［OR(95% CI):1.77(1.24～2.53)］、住院时间≥60 d［OR(95% CI):4.62(3.28～5.10)］、年龄≤10岁［OR(95% CI):1.55(1.33～2.93)］、年龄≥60岁［OR(95% CI):4.59(1.02～20.59)］、有慢性基础疾病［OR(95% CI):1.56(1.37～11.34)］、有侵入性操作［OR(95% CI):3.33(1.21～6.86)］及昏迷［OR(95% CI):6.77(5.41～7.05)］是康复医院患者发生医院感染的主要危险因素。结论对新建康复医院进行调查,有助于了解其医院感染发病情况,医务人员可针对其主要危险因素采取相应的预防与控制措施。     

A proportional mortality study of a group of newspaper workers

Greenberg, M. (1972).Brit. J. industr. Med.,29, 15-20. A proportional mortality study of a group of newspaper workers. In investigating an anecdotal report of a high incidence of bladder cancer at a London newspaper printing factory, death certificates for 670 workers relating to the years 1954-66 were studied. While an increased incidence of carcinoma of the urinary organs could not be demonstrated, the total of all malignancies was greater than predicted and carcinoma of the bronchus accounted for much of the excess. Only death by suicide occurred to excess among causes of death other than malignancy.

The smoking habits of subjects are not known but if tobacco habit contributed to bronchial carcinoma it had no observable effect on the incidence of chronic bronchitis and ischaemic heart disease in early middle age.

It is concluded that a prospective study would be required if occupation is to be implicated as a hazard.

     

Relation between job strain and myocardial infarction: a case-control study

OBJECTIVES: To study the influence of different job related and socioeconomic factors for development of myocardial infarction (MI). METHOD: The study was a case-control study of 76 male wage earners who had been admitted to hospital with MI. As a control group 176 male wage earners not admitted to hospital who were residents of the same county were used. Both groups were interviewed with an extensive questionnaire on job related conditions. Several indices on job related psychosocial factors were established in accordance with Karasek's job strain model as well as the extension of the model, the isostrain model. RESULTS: The most significant findings were consistent with Karasek's job strain model in that mean with a high degree of demand combined with a low degree of control at work had a significantly increased odds ratio (OR) 95% confidence interval (95% CI) of 2.1 (1.2 to 3.8) for MI after adjustment for age compared with men with a low degree of demand and a high degree of control at work. Further adjustment for smoking, socioeconomic status, employment sector, job category, and social network did not affect the OR substantially (OR 2.3 (1.2 to 4.4)). Other factors significantly associated to MI were job category (blue collar workers v white collar workers, OR 2.8 (1.6 to 5.8)), and employment sector (private v public, OR 3.1 (1.8 to 6.1)). CONCLUSIONS: Thus, the study confirmed the job strain model as well as the well known association between socioeconomic status and risk of MI, whereas the finding of an increased risk among employees in the private sector has not previously been described.

 

     

Circadian rhythms in plasma concentration of 11-hydroxycorticosteroids in men working on night shift and in permanent night workers

Conroy, R. T. W. L., Elliott, Ann L., and Mills, J. N. (1970).Brit. J. industr. Med.,27, 170-174. Circadian rhythms in plasma concentration of 11-hydroxycorticosteroids in men working on night shift and in permanent night workers. Blood samples have been collected for estimation of plasma 11-hydroxycorticosteroids from three groups of workers - day and night shift workers in a light engineering factory, and night workers in a newspaper printing works. Up to five samples were collected over 24 hr, or two samples per 24 hr were collected for three days. In conformity with the observations of others, day workers showed maximal concentrations in the morning around the time when they started work. In the newspaper workers maximal concentrations were found when they awoke around 14·00 hr. Night shift workers in the engineering works showed a greater variety of pattern, some showing the pattern usual in a day worker, some showing a maximum concentration about midnight and a minimum around 06·00 hr and a large proportion showing no clear circadian rhythm.

In the newspaper workers the rhythm was thus well adapted to their pattern of nocturnal work, whereas relatively few of the night shift workers in the engineering works showed such adaptation. It appears that the adrenal cortical rhythm can be adapted to night work in a community in which this is universal, accepted and lifelong, but that such adjustment is unusual in men on night shift work for limited periods, and whose associates are mainly following a usual nycthemeral existence.

     

Hospitalizations for infectious diseases in Jewish and Bedouin children in southern Israel

Two different population groups reside in the Negev region of southern Israel and have equal, and free from financial barrier, access to tertiary care at a single regional hospital. The Jewish population has a largely urban and industrialized lifestyle, while the Moslem Bedouins are in transition from their traditional nomadic life to settlement. To examine the differences in morbidity patterns reflected in hospitalizations, the computerized hospitalization records of children <15 years of age, for 1989–1991 were used (n = 15,947). Rates of hospitalizations for infectious diseases were significantly higher for Bedouins in comparison to Jews (250 and 121/10,000 child years, respectively, odds ratio (OR): 2.1, 95% confidence interval (CI): 2.0–2.2, p < 0.001). Rates of hospitalization per 10,000 child years in Bedouins and Jews for diarrhea were 114 and 32 (OR: 3.7, 95% CI: 3.3–4.0, p < 0.001), respectively, and for pneumonia 55 and 19 (OR: 2.9, 95% CI: 2.6–3.3, p < 0.001), respectively. In infants the differences were even more pronounced, especially for diarrheal diseases. In Bedouin children infectious diseases were associated with longer hospital stay, more pediatric Intensive Care hospitalizations (OR: 2.7, 95% CI: 1.7–4.5, p < 0.001), and higher in-hospital mortality (OR: 5.7, 95% CI: 2.8–12.2, p < 0.001). Thus, Bedouin children are at higher risks of hospitalizations for infectious diseases in early childhood, as compared to Jewish children. This may reflect the differences in lifestyle, environmental and social conditions of the two populations.     

Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 Northern Finland general population birth cohort

We studied the comorbidity of psychiatric and physical disorders in a sample (n = 11017) from the unselected, general population, Northern Finland 1966 Birth Cohort. During the period 1982–1994, hospital-treated psychiatric patients were more likely than people without psychiatric diagnoses to have been treated for physical disease in hospital wards, 298 out of 387 (77.0%) vs 6687 out of 10 630 (62.9%) (OR = 2.0, 95% CI = 1.6−2.5). Injuries, poisonings and indefinite symptoms were a more common reason for hospital treatment in people with schizophrenia or other psychiatric disorder as compared with people without a psychiatric disorder. Men with psychiatric disorder had more than a 50-fold risk for poisoning by psychotropic drugs (OR = 52.6, 95% CI = 27.7−99.8), women with psychiatric disorder a 20-fold risk (OR = 19.0, 95% CI = 9.5–38.1) and schizophrenics more than a 30-fold risk (OR = 37.5, 95% CI = 19.1–73.8). Men with psychiatric disorders were more commonly hospitalised for a variety of gastrointestinal disorders and circulatory diseases (OR = 2.3, 95% CI = 1.2–4.4), as compared with men with no psychiatric disorder. Respiratory diseases (OR = 2.2, 95% CI = 1.2–4.2), vertebral column disorders (OR = 4.2, 95% CI = 1.8–9.9), gynaecological disorders (OR = 2.1, 95% CI = 1.2–3.6) and induced abortions (OR = 1.8, 95% CI = 1.2–2.7) were more prevalent in women with psychiatric disorder than in other women. Epilepsy was strongly associated with schizophrenia (OR = 11.1, 95% CI = 4.0–31.6). Nervous and sensory organ diseases in general (OR = 2.5, 95% CI = 1.1–5.8) and inflammatory diseases of the bowel (OR = 12.8, 95% CI = 3.8–42.7) were also overrepresented in schizophrenia when compared with people without a psychiatric disorder. Our results indicate that physicians must be alert for psychiatric disorder, and mental health professionals must be aware of the considerable physical morbidity in their patients.     

A Multicenter Study of Multimorbidity in Older Adult Inpatients in China

Objectives

Multimorbidity is common in older hospitalized adults. To date, however, few studies have addressed multimorbidity in the older population of Chinese inpatients. We aimed to investigate the multimorbidity rate and associated risk factors in older adult inpatients in China.

Design, Setting, Participants

This study was conducted in the medical wards of a tertiary-care hospital from. The patients were recruited aged between 60 to 101 (74.14±8.46) years.

Measurements

Data were obtained from the China Comprehensive Geriatric Assessment Study, conducted in 2011–2012 in China. A total of 4,633 inpatients older than 60 years was recruited from 12 hospitals in 7 cities throughout China. The prevalence of comorbidity, distribution of common chronic diseases, and the associated risk factors were studied.

Results

A total of 4,348 people aged 60 to 101 (74.14±8.46) years completed questionnaires. The average frequency of multimorbidity was 69.3% (95% CI, 67.9% to 70.6%). The prevalence of multimorbidity increased with age and was higher in men (71.6%; 95% CI, 69.9% to 73.3%) than in women (65.3%, 95% CI 63.0% to 67.6%), and higher in the northern region (71.7%, 95% CI 69.9% to 73.5%) than in the southern region (66.0%; 95% CI, 63.8% to 68.1%). The most frequent chronic diseases were hypertension, coronary heart disease, diabetes, cataract, and stroke. Area (OR=0.556; 95% CI, 0.465 to 0.666), region (OR=0.834; 95% CI, 0.723 to 0.962), body mass index (BMI) (OR=1.124; 95% CI, 1.017 to 1.242), and impairment of activities of daily living (OR=0.911; 95% CI, 0.855 to 0.970) were independent factors associated with multimorbidity.

Conclusions

Multimorbidity is common in older Chinese inpatients with a national prevalence of 69.3% that increases in line with age. Age, region, area, BMI, and daily activities were independent factors significantly associated with multimorbidity in older inpatients. Clinicians should therefore focus more attention on multimorbidity.

     

Mortality of workers at a nickel carbonyl refinery, 1958-2000

Background: Excess risks of respiratory cancer have been shown in some groups of nickel exposed workers. It is clear, however, that not all forms of nickel exposure are implicated in these excess risks.

Aim: To determine whether occupational exposures received in a modern nickel carbonyl refinery lead to increased risks of cancer, in particular nasal cancer and lung cancer.

Methods: The mortality experienced by a cohort of 812 workers employed at a nickel refinery was investigated. Study subjects were all male workforce employees first employed in the period 1953–92 who had at least five years' employment with the company. Observed numbers of cause specific deaths were compared with expectations based on national mortality rates; SMRs were also calculated by period from commencing employment, year of commencing employment, and type of work.

Results: Overall, standardised mortality ratios (SMRs) were close to 100 for all causes (Obs 191, SMR 96, 95% CI 83 to 111), all neoplasms (Obs 63, SMR 104, 95% CI 80 to 133), non-malignant diseases of the respiratory system (Obs 18, SMR 97, 95% CI 57 to 153), and diseases of the circulatory system (Obs 85, SMR 94, 95% CI 75 to 116). There were no significantly increased SMRs for any site of cancer. There was a non-significant excess for lung cancer (Obs 28, Exp 20.17, SMR 139, 95% CI 92 to 201), and in subgroup analyses a significantly increased SMR of 231 (Obs 9) was found for those 142 workers with at least five years' employment in the feed handling and nickel extraction departments. In the total cohort there was a single death from nasal cancer (Exp 0.10).

Conclusions: The non-significant excess of lung cancer deaths may well be a chance finding, but in light of previous studies some role for nickel exposures cannot be excluded.

     

Occupational risk factors for sinonasal cancer: a case-control study in France.

A case-control study was conducted in France to examine occupational risk factors for sinonasal cancer; 207 cases and 409 controls were included in the study. Detailed information was collected on occupational history and other potential risk factors for nasal cancer. Results are presented for three histologic types: adenocarcinoma, squamous cell carcinoma, and others. Among males, the risk of adenocarcinoma was significantly elevated for cabinetmakers (odds-ratio = 35.4, 95% confidence interval = 18.1-69.3), carpenters and joiners (OR = 25.2, 95% CI = 14.6-43.6), and wood-working machine operators (OR = 7.4, 95% CI = 3.4-15.8), whereas the odds-ratios were less than 1 for loggers and wood preparation workers. Odds-ratios associated with cabinetmakers (OR = 11.2, 95% CI = 2.7-45.9)) and carpenters and joiners (OR = 5.8, 95% CI = 1.8-18.6) were also significantly elevated for the other-histologic-types category. Significant excesses in risk of squamous cell cancer were noted for "bakers, pastry cooks, grain millers" (OR = 3.9, 1.2-12.8), construction workers (OR = 3.7, 95% CI = 1.7-8.0), and carpenters and joiners having worked for at least 15 years in the wood manufacturing industry (OR = 8.1, 95% CI = 1.3-50.3). Among females, a significant increase in risk of squamous cell carcinoma (OR = 9.5, 95% CI = 1.7-54.1) and a moderate increase in risk of adenocarcinoma (OR = 4.0, 95% CI = 0.7-23.5) was observed for textile workers. Elevated risks of squamous cell cancer were noted for farm workers of both sexes (males: OR = 2.2, 95% CI = 1.1-4.4; females: OR = 4.9, 95% CI = 1.0-24.9).     

Adherence to Mediterranean-Style Dietary Pattern and Risk of Esophageal Squamous Cell Carcinoma: A Case-Control Study in Iran

Objective: The benefit of adherence to a Mediterranean-style dietary pattern in relation to the risk of esophageal squamous cell carcinoma (ESCC) has not been investigated among non-Mediterranean high-risk populations. The objective of the present study was to examine the association of compliance with the Mediterranean dietary pattern as measured by Mediterranean-Style Dietary Pattern Score (MSDPS) and the risk of ESCC in Iranian population.

Methods: This case-control study was conducted on 47 ESCC cases and 96 hospital controls aged 40–75 years. Participants were interviewed using validated questionnaires, and dietary patterns were characterized using the MSDPS.

Results: Generally, the mean MSDPS in this population was low (30.84 ± 8.58). MSDPS showed content validity through having expected positive associations with several lifestyle characteristics and dietary intakes. Being in the highest quartile category of MSDPS, compared to the lowest, was independently associated with 37% reduction in risk of ESCC. Two-unit and 3-unit increases in the MSDPS resulted in 41% and 47% reduction in risk of ESCC, respectively. Higher intakes of olive oil (odds ratio [OR] = 0.15, 95% CI: 0.01–0.49), fish and other seafood (OR = 0.48, 95% CI: 0.23–0.98), whole grain (OR = 0.57, 95% CI: 0.28–0.76), and fruits (OR = 0.77, 95% CI: 0.38–0.86) were significantly associated with reduced ESCC risk. In contrast, higher sweet (OR = 1.86, 95% CI: 1.04–2.12) and meat intakes (OR = 1.61, 95% CI: 1.25–2.49) were associated with higher ESCC risk.

Conclusion: Consuming a diet in concordance with the principles of the Mediterranean dietary pattern may protect against ESCC. Preventive strategies to reduce ESCC risk in high-risk countries should focus on overall dietary pattern and dietary habits to be effective.     

The Effect of Inpatient Hospice Units on Hospice Use Post-Admission

ABSTRACT

The objective of this study was to determine whether having a hospice unit within the hospital increases the proportion of terminally ill patients who use hospice services (including home, nursing home, or inpatient hospice) post-admission. Using medical record data abstracted for 232 randomly selected patients with terminal cancer admitted to six community hospitals in Connecticut, we found that patients admitted to a hospital with a hospice unit were more likely to use hospice services (i.e., home hospice, nursing home hospice, or inpatient hospice) post-admission than patients admitted to a hospital without a hospice unit (unadjusted OR 5.7, 95% CI 3.1, 10.6). This effect persisted after adjusting for patient age, gender, marital status, documented discussions of prognosis, prior hospice use, and type of cancer.     

Predictors of short-term readmission of asthmetic children

BACKGROUND: Bronchial asthma admission rate has increased dramatically all over the world. Part of this increase in hospital admissions is due to patients' readmission. OBJECTIVE: Determining what risk factors are associated with short-term hospital readmission of pediatric patients with asthma within two months of the last hospital admission. METHODS AND SETTING: A retrospective case-control study using registration books of both admissions and discharges to identify patients groups. All hospital records were reviewed for patients admitted from August 1998 through December 2002 at Assir Central Hospital, southwestern of Saudi Arabia. Patients who were admitted at this period of study and they were readmitted to the hospital within two months constituted the study group (n = 28) and those patients who were admitted within the same period but not readmitted within two months constituted the control group (n = 45). Demographic variables, route of admission, patient previous medical history, clinical assessment, hospital treatment as well as discharge treatment were extracted from medical records. RESULTS: twenty eight patients were readmitted within two months of the discharge from hospital (17 boys and 11 girls), seventy percent of these were below four years of age. Significant predictors of readmission were; prior history of asthma admission (adjusted OR 1.81 (1.20-2.73), NICU graduate (adjusted OR 4.44 (1.67-6.34), chronic lung disease (adjusted OR 3.06, 95% CI 2.01-4.95), tracheosphageal fistula (Adjusted OR 3.19, 95% CI 1.08-8.74), recurrent aspiration (adjusted OR 3.14, 95% CI 1.90-4.27), duration of asthma symptoms more than four days (adjusted OR 0.23, CI 0.21-0.42), moderate to severe clinical assessment (adjusted OR 1.67-95% CI 1.15-3.04), intensive care admission (adjusted OR 2.96, 95% CI 1.09-8.63), intravenous steroids ( adjusted OR 2.21,95% CI 1.36-4.67), and chest x-ray findings (adjusted OR 0.39, 95% CI:0.20-0.64). CONCLUSION: Previous NICU admission, bronchopulmonary dyspalsia, and history of previous asthma admissions, tracheosophageal fistula, recurrent aspirations, intensive care admission, intubation and intravenous steroids were significant predictors of asthma short readmission.     

Why most workers with occupational repetitive trauma do not file for workers' compensation

Despite the availability of no fault insurance for wage replacement and medical care costs, the majority of workers diagnosed with an occupational disease do not apply for workers' compensation. The objective of the study was to determine the reasons why workers diagnosed with work-related musculoskeletal disease did not apply for workers' compensation benefits. A cross-sectional study of 1598 individuals diagnosed with neck, upper extremity, and low back work-related musculoskeletal disease from April to June 1996 was performed. All individuals were interviewed over the telephone using a standardized questionnaire. The questionnaire included questions about the precipitating event; demographics; health limitations; mood; pain level; and attitudes toward their health care provider, fellow workers, management, work environment, and filing for workers' compensation. Whenever possible, standardized questions from previous surveys were used. The interviewed individuals with work-related musculoskeletal disease were reported by health care practitioners as required by the state of Michigan's occupational disease reporting law. Workers reported during 12 weeks in the spring of 1996 by a Michigan health care professional as having a neck, back, or upper extremity musculoskeletal disorder were eligible to participate. Among the 2703 reports received, 490 individuals could not be reached, 22 did not speak English, 12 had died or were too incapacitated by other medical conditions, and 581 refused. We interviewed 59% of all eligible workers and 73% of all workers who were reachable and capable of responding in English. Only 25% of workers diagnosed with musculoskeletal disease filed a workers' compensation claim. The factors significantly associated with filing a claim were (1) increased length of employment (> 21 years: odds ratio [OR], 3.01, 95% confidence interval [CI], 1.31 to 6.90); 11 to 20 years: OR, 2.34, 95% CI, 1.01 to 5.47; 6 to 10 years: OR, 1.76, 95% CI, 0.73 to 4.25; 1 to 5 years: OR, 2.36, 95% CI, 1.03 to 5.42; < 1 year: OR, 1.00; (2) lower annual income (< $40,000: OR, 1.75, 95% CI, 1.06 to 2.88 vs > or = $80,000: OR, 1.00); (3) workers' dissatisfaction with coworkers (OR, 1.76, 95% CI, 1.01 to 3.06); (4) physician restrictions on activity (OR, 2.16, 95% CI, 1.55 to 3.00); (5) type of physician providing treatment (specialist, including surgeon or orthopedist: OR, 3.63, 95% CI, 2.37 to 5.55); physical and occupational therapist: OR, 2.15, 95% CI, 1.35 to 3.43); family practitioner: OR, 1.33, 95% CI = 0.89 to 2.01; company physician: OR = 1.00); (6) off work > or = 7 days (OR, 14.85, 95% CI, 10.57 to 20.85); (7) decreased current health status (OR, 0.82, 95% CI, 0.70 to 0.96); and (8) increased severity of illness (OR, 1.24, 95% CI, 1.06 to 20.88). This study showed that only 25% of workers with a work-related musculoskeletal condition filed for workers' compensation and refutes the common perception that an individual with a work-related problem is likely to file a workers' compensation claim. The strongest predictors of who would file were those factors associated with the severity of the condition. Other factors were increasing length of employment, lower annual income, and worker dissatisfaction with coworkers. Our study population consisted mainly of unionized autoworkers, and our findings may not be generalizable to the total workforce.     

中国南方地区鼻咽癌家族史危险因素的Meta分析

目的综合评价鼻咽癌家族史在中国南方地区鼻咽癌发病中的作用。方法应用Meta分析对国内9篇鼻咽癌家族史危险因素的病例对照研究文献进行定量综合分析。结果家族史危险因素单因素合并OR值为5.05,95%CI为3.49~7.32;多因素合并OR值为7.20,95%CI为4.52~11.46。结论遗传是中国南方地区人群鼻咽癌的重要危险因素,加权计算合并家族史OR值可以综合评价遗传因素的作用。     

Association between greenhouse working exposure and bronchial asthma: A pilot,cross-sectional survey of 5,420 greenhouse farmers from northeast China

Long-term exposure to greenhouse environments exposes greenhouse workers to inhalation of antigens that can cause respiratory diseases. This study was conducted to investigate the prevalence and potential risk factors for bronchial asthma among the Chinese greenhouse workers based on questionnaire and spirometry data. This was an observational cross-sectional study, performed via stratified-cluster-random sampling. It was conducted in Liaoning Province from the northeast of People’s Republic of China, using a population-based sample of 5,880 workers at 835 plastic film greenhouses. All subjects were interviewed using a standardized questionnaire and underwent pulmonary function tests. Multiple logistic regression analysis was conducted to assess associations between self-reported factors of greenhouse worker exposure and bronchial asthma and to identify potential risk factors for this disease. A total of 5,420 questionnaires were completed. The overall prevalence of asthma in greenhouse workers was 19.2% (1040/5420). Multiple logistic regression analysis revealed that the use of multiple pesticides (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.03–1.49), bad odors in the greenhouse (OR = 1.26, 95% CI = 1.07–1.49), and report of the onset of cough when entering the greenhouse (OR = 1.25, 95% CI = 1.09–1.44) were associated with the development of asthma. In contrast, a higher body mass index (BMI >18.5?kg/m^2, OR = 0.93, 95% CI = 0.90–0.95), planting flowers (OR = 0.92, 95% CI = 0.87–0.98), open sidewall to outside (natural ventilation) for at least 30?min per event (OR = 0.82, 95% CI = 0.69–0.96), living in greenhouse (OR = 0.85, 95% CI = 0.73–0.99), and experiencing cough before 14 years old (OR = 0.61, 95% CI = 0.43–0.84) were protective factors to the presentation of asthma among greenhouse workers. Our results suggest that asthma is a major public health problem among Chinese greenhouse workers and more attention should be devoted to preventive measures and management of this disease.