Cardiovascular risk factors predicting all causes of death in an occupational population sample

A group of 768 men aged 40-59 at entry examination and belonging to an occupational sample of railroad employees in Rome have been examined for the measurement of some risk factors and followed-up for 20 years. In all 676 men, free from life-threatening diseases and with all measurements available, produced 166 fatal events in 20 years. Out of the 27 different personal characteristics considered only six contributed significantly to the multivariate prediction of all causes of death in the Cox proportional hazards computed by the forward stepwise technique. The factors predicting all causes of death were age, cigarette smoking, diabetes, blood pressure, mother's vital status and being on a diet prescribed by a doctor. The relative risk of those located in the upper decile of the estimated risk as compared to the bottom decile was 8.2. The results do not differ much from those obtained in a demographic sample studied in the same way.     

小儿感染性休克死亡相关危险因素分析

目的 探讨感染性休克患儿死亡危险因素,以期采取针对性措施,降低病患死亡率.方法 回顾性调查2003年1月-2011年9月32例感染性休克患儿的临床资料,分析临床特点,研究相关因素,包括年龄、性别、基础疾病、病原菌、临床征象、并发症等变量,采用单因素分析和多因素logistic回归,分析感染性休克死亡相关危险因素.结果 32例患儿中死亡13例,病死率40.63％;细菌学检出病原菌32株,前4位病原菌依次为铜绿假单胞菌、酿脓链球菌、肺炎克雷伯菌及大肠埃希菌,分别占37.49％、15.62％、12.50％和9.38％;单因素分析显示,死亡组与存活组的白细胞计数、血清乳酸值、血糖、血小板计数、多脏器功能失常综合征(MODS)受累脏器数、小儿危重病例评分、抗菌药物应用不当、CRP、白蛋白之间差异有统计学意义(P＜0.05);logistic多因素分析显示血清乳酸值、多脏器功能失常综合征(MODS)受累脏器数及抗菌药物应用不当是感染性休克患儿死亡的独立危险因素.结论 感染性休克患儿病死率高,乳酸水平升高、合并MODS以及抗菌药物应用不当是影响患儿死亡的危险因素,应针对上述因素制定针对性预防措施.     

Models of unexplained symptoms associated with occupational and environmental exposures

Unexplained illnesses characterized by nonspecific, multisystem complaints are often attributed to occupational or environmental chemical exposures. This raises difficulties for the regulatory authorities, who are frequently unable to agree on the existence, nature, or source of such illnesses. It is proposed that many of these difficulties derive from an adherence to a traditional medical model of disease and that the application of a biopsychosocial approach would be more effective for both research and individual case management. A number of models derived from the field of health psychology are discussed in terms of their application to occupational and environmental syndromes. A specific example is described that relates to the health problems experienced by sheep farmers in the United Kingdom who are exposed to organophosphate-based pesticides. The source of their complaints and the responses of the health professionals and the regulatory authorities are discussed within the context of a biopsychosocial approach that focuses on illness rather than on organic disease as the unit of study and explores the interaction between the various physical and psychosocial variables involved. It is proposed that this approach, which is already well established in the fields of human and social sciences, should be adopted more readily by those concerned with occupational and environmental epidemiology.     

Dying at home or in an institution using death certificates to explore the factors associated with place of death

INTRODUCTION: The knowledge of determinants of place of death is important for public health policy aimed at improving the quality of end-of-life care. METHODS: We investigated the influence of clinical, socio-demographic, residential and health care system factors on the place of death, using data from all 55,759 deaths in 2001 in Flanders (Belgium), gathered via official death certificates and data from anonymously linked health care statistics. A multivariate logistic regression was used to examine the associated factors (home versus hospital as dependent categories). RESULTS: Of all deaths in Flanders, 53.7% took place in hospital, 24.3% at home and 19.8% in a care home. The probability of home deaths varied by region, by rural or urban residence and by the hospital bed availability in the region and dying at home was less likely among those suffering from certain non-malignant chronic diseases, the less educated and those living alone. CONCLUSION: Although most people wish to die at home, most deaths in Flanders (Belgium) in 2001 did not take place there. The clinical, socio-demographic and residential factors found to be associated with the place of death could serve as focal points for a policy to facilitate dying in the place of choice, including at home.     

泛耐药鲍氏不动杆菌感染病例死亡危险因素分析

目的 了解泛耐药鲍氏不动杆菌(MDRAB)感染病例的临床特征,分析其感染病例死亡的危险因素.方法 回顾性分析医院2007年4月-7月出现的53例MDRAB感染患者临床特征,采用logistic逐步回归分析法对19例死亡病例和34例非死亡病例的危险因素,包括患者APACHEⅡ评分、呼吸机应用、三代头孢菌素和β-内酰胺抑制剂药物治疗史、住院时间、静脉置管、介入性诊疗措施进行比较.结果 53例MDRAB感染的病例中死亡19例,占35.8％;非死亡病例34例,占64.2％,在APACHEⅡ评分(P=0.0036,OR值1.2448)与大静脉置管应用(P=0.005,OR值0.015)差异有统计学意义(P＜0.01).结论 APACHEⅡ评分较高MDRAB感染患者死亡率高,应用大静脉置管的相关治疗措施可能利于改善MDRAB感染患者预后.     

Psychosocial work environment and cardiovascular risk factors in an occupational cohort in France

STUDY OBJECTIVE: Concordant results have been reported in several studies for the effects of job stress on cardiovascular disease, but the potential mechanisms of these effects have seldom been explored. The aim of this study was therefore to examine, in women and men, the cross sectional relations between psychosocial work variables (psychological demands, decision latitude, and social support) and cardiovascular risk factors (hypertension, hyperlipidaemia, diabetes, overweight, smoking, and alcohol consumption). PARTICIPANTS: The original cohort comprised 20,625 volunteers (men aged from 40 to 50 and women from 35 to 50) employed by the French Company Electricite De France-Gaz De France and followed up yearly since 1989. The study was restricted to the 13,226 volunteers in the cohort who were still working and answered a self administered questionnaire on psychosocial work factors in 1995. DESIGN: Data were based on replies to this questionnaire. Three psychosocial work environment exposure scores were used to assess psychological demands, decision latitude, and social support at work respectively. The main outcome measures were the prevalence of hypertension, hyperlipidaemia, and diabetes within the previous 12 months, overweight, smoking, and alcohol consumption. MAIN RESULTS: Psychosocial work factors were significantly associated with hypertension, hyperlipidaemia, overweight, smoking, and alcohol consumption, but not with diabetes. In men, low decision latitude was associated with hypertension, high decision latitude and high social support with overweight, low decision latitude with alcohol consumption. Moreover, the risk of hyperlipidaemia increased in men exposed to both high psychological demands and low social support. In women, low decision latitude was related to hyperlipidaemia, high psychological demands with overweight, high psychological demands and high decision latitude with smoking, and low social support with alcohol consumption. CONCLUSIONS: These cross sectional results underline the potential effects of psychosocial work characteristics on cardiovascular risk factors and the differences between the effects of job stress in men and women, and confirm the direct mechanisms (through physiological variables) and indirect mechanisms (through behavioural risk factors) potentially involved in the relation between psychosocial work characteristics and cardiovascular disease.

 

     

Risk factors associated with malaria infection in an urban setting

Incidence of malaria in urban settings is a growing concern in many regions of the world and individual risk factors need to be identified to appropriately adjust control strategies. We carried out a cross-sectional study in 1993/94 in an urban area of the largest port of the Pacific Coast of Colombia, where transmission has had an upward trend over the past 5 years. Prevalence of malaria infection was estimated in areas of the city with the highest incidence of disease, and the association between some characteristics of the population and the risk of malaria infection was assessed. Prevalence of malaria infection was 4.4% among the 1380 studied people and we found that it decreased with older age, and with knowledge of disease and preventive measures directed to elimination of breeding sites. In addition, the infection was positively associated with exposure to the forest (P < 0.05), although most of the cases (57/61, 93%) were likely to have been acquired in the urban area. We also found that individuals receiving antimalarial treatment in the previous month had around twice the risk of being infected as compared with those without treatment. In addition, our results suggest that use of bednets could not be a very effective protective measure in settings such as that of our study, and that environmental interventions may be needed to decrease the risk of infection.     

Cancer and other causes of death among a cohort of dry cleaners.

Mortality among 5365 members of a dry cleaning union in St. Louis, Missouri, was less than expected for all causes combined (SMR = 0.9) but slightly raised for cancer (SMR = 1.2). Among the cancers, statistically significant excesses occurred for oesophagus (SMR = 2.1) and cervix (SMR = 1.7) and non-significant excesses for larynx (SMR = 1.6), lung (SMR = 1.3), bladder (SMR = 1.7), thyroid (SMR = 3.3), lymphosarcoma and reticulosarcoma (SMR = 1.7), and Hodgkin's disease (SMR = 2.1). Mortality from emphysema was also significantly raised (SMR = 2.0). Eleven of the 13 deaths from oesophageal cancer occurred among black men. The risk of this cancer showed a significant association with estimated cumulative exposure to dry cleaning solvents (rising to 2.8-fold in the highest category) but not with level or duration of exposure. Mortality from kidney cancer was not excessive as reported in other studies. Excesses for emphysema and cancers of the larynx, lung, oesophagus, bladder, and cervix may be related to socioeconomic status, tobacco, or alcohol use. Although the number of deaths was small, the greatest risk for cancers of the lymphatic and haematopoietic system (fourfold) occurred among workers likely to have held jobs where exposures were the heaviest. Small numbers and limited information on exposure to specific substances complicates interpretation of this association but is unlikely to be due to confounding by tobacco use. It was not possible to identify workers exposed to specific dry cleaning solvents but mortality among those entering the union after 1960, when use of perchloroethylene was predominant, was similar to those entering before 1960.     

Risk factors for death in a cohort of patients with and without healthcare-associated infections in Finnish acute care hospitals

We evaluated risk factors for death among hospitalised patients with healthcare-associated infections (HCAIs) using the McCabe classification and Charlson index to predict mortality. The study consisted of a cohort of 703 patients with HCAIs and 7531 patients without HCAI in acute care hospitals participating in the Finnish national prevalence survey in 2005. We used Centers for Disease Control and Prevention definitions for HCAIs and recorded the McCabe classification for comorbidity. We used the date from the prevalence survey and the patient's national identity code in order to retrieve data from the National Hospital Discharge Registry on discharge diagnoses (International Classification of Diseases-10 codes) for the Charlson index and the dates of death from the National Population Information System. Of all inpatients, 425 (5.2%) died within 28 days from the prevalence survey date; the death rate was higher in HCAI patients than in those without HCAI (9.8% vs 4.7%, P<0.001). In the multivariate regression analysis age >65 years, intensive care, McCabe classification and Charlson index, gastrointestinal system infection and pneumonia/other lower respiratory tract infections were independent predictors for death. The survival analysis, when adjusted by McCabe class or Charlson index, showed that HCAI reduced survival only among patients without severe underlying diseases. Certain types of HCAI increased the risk of death. The McCabe classification had advantages over the Charlson index as a predictor of death, because it was easier to collect from a prevalence survey.     

Time-related factors as potential confounders and effect modifiers in studies based on an occupational cohort

Time-related factors which are potential confounders and effect modifiers in studies based on an occupational cohort are reviewed. The most frequently considered ones include age at first exposure, duration of exposure, interval from exposure to disease recognition, and age at risk. These factors are related to the "healthy worker effect," which appears to be more pronounced among workers with the longest durations of employment and older ages, at date of hire, but weaker with longer length of follow-up and older age at risk. Hence, use of an internal comparison group may not eliminate bias since confounding will occur if the exposed and unexposed groups differ in their distributions across these factors. It is also shown, using the multistage model of carcinogenesis, that these factors may be important effect modifiers. Fortunately, generally straightforward methods of control exist both for stratified analyses and for the commonly used mathematical modeling approaches. Although no firm recommendations can be made, it would appear to be important to control for length of follow-up in the design or analysis of most studies based on an occupational cohort, and controlling for age at first exposure may also be desirable under many circumstances.     

煤工尘肺死亡原因及影响因素分析

目的 探讨煤工尘肺患者死亡规律及主要死亡原因,为进一步开展煤矿尘肺的三级预防提供理论依据。方法 通过回顾性流行病学方法,对825例已经死亡的煤工尘肺患者进行死因分析。结果 死亡原因构成居前4位的是肺心病、恶性肿瘤、肺结核、尘肺;随着煤工尘肺期别的增高,煤工尘肺病死率、结核死亡专率、恶性肿瘤死亡专率有增高趋势;不同工种、不同矿区的煤工尘肺病死率差异有统计学意义。结论 影响尘肺患者身体健康的主要原因是各种并发症,导致煤工尘肺患者死亡的主要原因是尘肺并发症;不同矿区由于煤质、煤田地质构造等不同,其煤工尘肺病死率亦不同。     

橡胶职业暴露与食管癌关系的病例—队列研究

本文对上海某橡胶厂轮胎和胶鞋制造工人进行了２３年（１９７３～１９９５）的随访调查，应用标化死亡率和病例－队列方法，旨在研究橡胶职业暴露与食管癌之间的关系。研究发现，某些工种如成型、机修、胶鞋及炼胶等的食管癌相对危险度升高，并独立于与食管癌可能的非职业危险因素。进一步研究认为，橡胶化合物中的溶剂、滑石和碳黑等的暴露可能与食管癌有关。虽然研究的病例数较少，未有统计学显著性，但所提示的两者间关系值得进一步研究。     

Use of multiple causes of death in the analysis of occupational cohorts--an example from the oil industry.

OBJECTIVES--To examine the efficacy of routine examination of multiple causes of death occurring on death certificates in cohort studies, with an example from the oil industry. METHODS--The underlying and multiple causes were coded for all notified deaths from a cohort of 35,000 men employed at eight oil refineries in the United Kingdom. Matrices of the frequencies of underlying causes by contributory causes were analysed for the total population and by subgroups defined by refinery, occupation, age, and calendar period of death. RESULTS--Over 75% of the 10,128 certificates had two or more causes but this varied by disease. Many ratios of mentions of total to underlying causes were similar to those of England and Wales. Ratios for cancer of the larynx and pneumonia were lower, indicating possible over-reporting of these diseases as the underlying cause. Investigation of an excess of pneumonia deaths at one refinery indicated possible miscoding of the underlying cause or the wrong position of pneumonia on some certificates, particularly in combination with malignancy and stroke. CONCLUSIONS--Routine analysis of multiple causes of death can provide useful additional information in cohort studies.     

Risk factors for occupational injuries among older workers: an analysis of the health and retirement study.

OBJECTIVES: This study examined risk factors for occupational injury among older workers. METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old. RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47). CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.