Epidemiologic studies of Scottish oil shale workers: III. Causes of death

In a mortality study of a population of 6,359 male Scottish oil shale workers, the vital status of 6,145 (96.6%) was determined. Sufficient data on occupational histories for analyses of mortality in relation to jobs held were available for 6,064 (95.4%) of the workers. No significant excess of mortality from any disease was found in relation to any jobs in the industry. Comparison of the mortality experience of those 3,161 men who joined the population prior to 1953 with that of the whole Scottish population showed an excess of deaths from skin cancer but no significant excess that was due to other disease. Comparisons with the population of the counties in which the industry was situated showed no significant excess of deaths from any cause examined. A case-control study of lung cancer in the shale area showed no excess risk of this disease in association with work in the industry.     

A mortality study of lead workers 1925-76.

The principal causes of mortality of 754 individuals from a population of 1898 pensioners from four lead acid battery factories during the period 1 January 1925 to 31 December 1976 were studied. In addition the causes of 553 deaths occurring before retirement was also studied. All subjects were placed into one of three groups according to their history of lead exposure. Group 1 had no occupational lead exposure, group 2 low, and group 3 the highest. Mortality was studied in 16 principal disease groups as well as all causes combined. A significant excess of deaths from cerebrovascular accidents was found among pensioners dying between 1925 and 1976 in group 3 but not among men in the same exposure group dying in employment. There was also a significant excess of deaths from renal disease among this group. After 1958, however, the causes of most of the deaths from renal disease were not those likely to be associated with exposure to lead. There was no significant excess of deaths from all causes, nor was there a significant excess of deaths in any of the exposure groups from cancer, hypertensive disease, nor any other circulatory disease. There was no excess of observed to expected deaths among any of the three groups of women in any of the cause groups examined. After the introduction of regular blood lead analysis in 1964 the blood lead distribution in men in group 3 had by 1976 come down to roughly the same level as group 2 in 1965-7. Since there was no excess of deaths in any of the 16 categories studied among group 2 subjects present conditions are probably now adequate to prevent any excess of mortality in any of the three groups.     

Discrepancies in the detection and management of spontaneous pneumothorax: eight years after publication of guidelines.

The British Thoracic Society (BTS) guidelines for the detection and management of spontaneous pneumothorax have been published for over eight years. The condition continues to be managed by surgical and medical staff, especially in DGH settings. This study evaluates any recognition and initial management discrepancies in a uncomplicated pneumothorax case and documents any deviancies from guidelines A study involving 112 staff was performed in a DGH. Results showed poor overall recognition of any published guidelines (32%) with only six staff correctly identifying BTS guidelines. There was no difference between medical and surgical or consultant and junior staff in the management strategy. A tendency to initially over-treat the condition with invasive chest drainage rather than aspiration was noted. Also, there was a tendency to underestimate the size of collapse using percentages. The need for greater appreciation of detection and management of this common condition remains extant and must be addressed aggressively.     

Low-income children's preventive services use: implications of parents' Medicaid status

This article examines the effect of parents' Medicaid status on the use of preventive health services by young children. Using data from the 1996 Medical Expenditure Panel Survey (MEPS), we analyzed a logit model for receipt of any well-child visits (WCVs) that compared three groups of low-income children. The three groups, defined by the joint insurance status of children and their parents, involved Medicaid pairs (both the child and the parent had Medicaid throughout the year), mixed pairs (the child had Medicaid and the parent was uninsured), and uninsured pairs (both child and parent were uninsured). Medicaid coverage for children was positively associated with receipt of any WCVs. However, the utilization effect of Medicaid coverage for children was significantly larger when the parent was also on Medicaid instead of being uninsured. Considering uninsured children with uninsured parents in 1996, enrolling only the children in Medicaid would have increased the percentage with WCVs from 29 to 43 percent according to simulations with the logit model. If the parents were enrolled in Medicaid as well, the percentage of children with any WCVs would have increased to 67 percent.     

Laxative withdrawal in eating disorders: treatment protocol and 3 to 20-month follow-up

OBJECTIVE: This article describes a treatment protocol for laxative withdrawal and presents some preliminary information about response to treatment at 3 to 20-month follow-up. METHOD: Patients were contacted 3 to 20 months after admission and evaluated with a shortened form of the Eating Disorders Examination (EDE). RESULTS: Fifty-seven percent of patients were abstinent from laxatives at follow-up and there were significant reductions in laxative-related symptom variables. Abstinence from laxatives was not accompanied by any other changes in eating behavior and was not associated with any pretreatment variables that were assessed. DISCUSSION: It appears to be feasible to withdraw patients from laxatives as an isolated intervention with a reasonably high rate of success.     

Respiratory symptoms and long-term risk of death from cardiovascular disease, cancer and other causes in Swedish men

BACKGROUND: Depressed respiratory function and respiratory symptoms are associated with impaired survival. The present study was undertaken to assess the relation between respiratory symptoms and mortality from cardiovascular causes, cancer and all causes in a large population of middle-aged men. METHODS: Prospective population study of 6442 men aged 51-59 at baseline, free of clinical angina pectoris and prior myocardial infarction. RESULTS: During 16 years there were 1804 deaths (786 from cardiovascular disease, 608 from cancer, 103 from pulmonary disease and 307 from any other cause). Men with effort-related breathlessness had increased risk of dying from all of the examined diseases. After adjustment for age, smoking habit and other risk factors, the relative risk (RR) associated with breathlessness of dying from coronary disease was 1.43 (95% CI : 1.16-1.77), from stroke 1.77 (95% CI: 1.07-2.93), from any cardiovascular disease 1.48 (95% CI : 1.24-1.76), cancer 1.36 (95% CI : 1.11-1.67) and from any cause 1.62 (95% CI: 1.44-1.81). An independent effect of breathlessness on cardiovascular death, cancer death and mortality from all causes was found in life-time non-smokers, and also if men with chest pain not considered to be angina were excluded. An independent effect was also found if all deaths during the first half of the follow-up were excluded. Men with cough and phlegm, without breathlessness, also had an elevated risk of dying from cardiovascular disease and cancer, but after adjustment for smoking and other risk factors this was no longer significant. However, a slightly elevated independent risk of dying from any cause was found (RR = 1.18 [95% CI: 1.02-1.36]). CONCLUSION: A positive response to a simple question about effort related breathlessness predicted subsequent mortality from several causes during a follow-up period of 16 years, independently of smoking and other risk factors.     

STD exclusion in insurance policy seen as ambiguous

A three-judge panel of the 3rd U.S. Circuit Court of Appeals vacated a judgement against General Star Indemnity Company after finding that its policy excluding claims arising from sexually transmitted disease (STDs) was ambiguous. The lower court was directed to conduct a hearing to determine whether the STD exclusion barred coverage for any claim involving AIDS, or just those in which HIV was transmitted through sexually contact. The insurance dispute originated from a lawsuit filed by a patron against the 12th Street Gym in Philadelphia, PA. Irving Silverman, who had AIDS, claimed he was ejected from the gym based on his illness. Silverman sued the gym for deprivation of rights under the Americans with Disabilities Act (ADA). The gym agreed to settle with Silverman's estate, but the insurer, General Star, refused to pay to defend the suit or cover any judgment because of the policy's STD exclusion. The court found that because Silverman's claims were based on the fact that he had AIDS and not any allegation that he exposed someone to the virus through sexual contact, the gym could expect its insurer to pay.     

Retrospective cohort mortality study and nested case-control study of workers exposed to creosote at 11 wood-treating plants in the United States

OBJECTIVE: The objective of this study was to assess both malignant and nonmalignant mortality risks of workers exposed to creosote. For background, a literature review is also presented. MATERIALS AND METHODS: The retrospective cohort study consisted of 2179 employees at 11 plants in the United States where wood (primarily railroad ties and utility poles) is treated with creosote-based preservatives. The observation period covered 1979-2001. Mortality data in the cohort study were analyzed in terms of cause-specific standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs), with expected deaths based on U.S. national cause-, gender-, race-, year-, age-specific mortality rates. In addition to the cohort investigation, a nested case-control study of lung cancer and multiple myeloma was conducted. Information on tobacco consumption and detailed employment (job titles) was obtained for cases and matched controls. Jobs were classified into 5 categories according to potential for exposure to creosote. Odds ratios (ORs) and 95% CIs were calculated for job categories and length of exposure. RESULTS: Overall mortality for the entire cohort was lower than expected (293 observed deaths vs. 325.37 expected, SMR = 90.1, 95% CI = 80.0-101.0). Close to 90% employees were hourly, whose potential for exposure was generally much higher than that of salaried employees. Among hourly employees, except for multiple myeloma, none of the specific cancer sites showed any significant increase. Furthermore, detailed analysis by length of employment did not reveal any significant mortality excess or upward trend. Six deaths were from multiple myeloma, whereas 1.50 deaths were expected (SMR = 401.1, 95% CI = 147.2-873.1). However, analysis by length of employment did not show any upward trend for multiple myeloma. No significant mortality increase was reported for any nonmalignant disease, and analysis by length of employment did not reveal any upward trend. In the case-control study, an increased risk of lung cancer was associated with tobacco consumption (OR = 4.92) but not with any job/exposure category. For example, the lung cancer odds ratio for routine exposure to creosote-based wood preservatives was 0.58 (95% CI = 0.11-3.03). Similarly, case-control analyses of multiple myeloma did not reveal any association with employment at the plants or with exposure to creosote-based wood preservatives or to creosote-treated products. CONCLUSION: Based on the present investigation and other studies, there was no evidence that employment at the 11 wood-treating plants or exposure to creosote-based wood preservatives was associated with any significant mortality increase from site-specific cancers or nonmalignant diseases. Some results should be interpreted with caution because they were based on small numbers.     

Incidence of childhood leukaemia and non-Hodgkin''s lymphoma in the vicinity of nuclear sites in Scotland, 1968-93.

OBJECTIVES: The primary aims were to investigate the incidence of leukaemia and non-Hodgkin's lymphoma in children resident near seven nuclear sites in Scotland and to determine whether there was any evidence of a gradient in risk with distance of residence from a nuclear site. A secondary aim was to assess the power of statistical tests for increased risk of disease near a point source when applied in the context of census data for Scotland. METHODS: The study data set comprised 1287 cases of leukaemia and non-Hodgkin's lymphoma diagnosed in children aged under 15 years in the period 1968-93, validated for accuracy and completeness. A study zone around each nuclear site was constructed from enumeration districts within 25 km. Expected numbers were calculated, adjusting for sex, age, and indices of deprivation and urban-rural residence. Six statistical tests were evaluated. Stone's maximum likelihood ratio (unconditional application) was applied as the main test for general increased incidence across a study zone. The linear risk score based on enumeration districts (conditional application) was used as a secondary test for declining risk with distance from each site. RESULTS: More cases were observed (O) than expected (E) in the study zones around Rosyth naval base (O/E 1.02), Chapelcross electricity generating station (O/E 1.08), and Dounreay reprocessing plant (O/E 1.99). The maximum likelihood ratio test reached significance only for Dounreay (P = 0.030). The linear risk score test did not indicate a trend in risk with distance from any of the seven sites, including Dounreay. CONCLUSIONS: There was no evidence of a generally increased risk of childhood leukaemia and non-Hodgkin's lymphoma around nuclear sites in Scotland, nor any evidence of a trend of decreasing risk with distance from any of the sites. There was a significant excess risk in the zone around Dounreay, which was only partially accounted for by the sociodemographic characteristics of the area. The statistical power of tests for localised increased risk of disease around a point source should be assessed in each new setting in which they are applied.     

Childhood cancer and paternal exposure to ionizing radiation: A second report from the oxford survey of childhood cancers

Paternal occupational data already collected as part of the Oxford Survey of Childhood Cancers have been reviewed. Information on paternal occupation was available for 14.869 children dying from cancer in England, Wales, and Scotland in the period 1953-81 and for an equal number of matched controls. The importance of fathers working, at any time before or after conception of the survey child, in any of the following occupations was assessed: radiologists (clinical), surgeons and anesthetists, veterinary surgeons, dental surgeons, nuclear industry workers, industrial radiographers. There was no indication that preconception employment in any of these occupations was more important than postconception employment with regard to the risks of all childhood cancers or all childhood leukemias. Findings were consistent with neither paternal preconception exposure to external ionizing radiation nor exposure to unsealed sources of radionuclides being an important risk factor for childhood leukemia or for the overall grouping of all childhood cancers. © 1995 Wiley-Liss, Inc.     

Cultural and social network predictors of drinking among Korean American women

This study estimated the association of cultural and social mechanisms with Korean American women’s drinking behaviors. Data were drawn from telephone interviews with 591 Korean women selected from a random sample of households in California with Korean surnames during 2007. About 62% of eligible respondents completed the interview. Respondents reported any lifetime drinking (yes/no), drinking volume (typical number of drinks consumed on drinking days), level of acculturation, and described their social network by assessing who encouraged or discouraged drinking (drinking support) or drank (drinking models). Multivariable regressions were used for analyses. About 70% (95% confidence interval [95%CI]:, 67, 74) of Korean American women reported any lifetime drinking and current drinkers drank 1.18 (95%CI: 1.07, 1.28) drinks on drinking days. Acculturation was not significantly associated with any lifetime drinking or drinking volume, whereas models and support for drinking were statistically significantly associated with a higher probability of any lifetime drinking and drinking more on drinking days. Each additional encourager, or one or fewer discourager, for drinking in women’s social networks was associated with a 2% (95%CI: 1, 3) higher probability of any lifetime drinking and drinking 0.25 (95%CI: −0.53, 1.18) more drinks on drinking days. Each additional drinker in women’s networks was associated with a 4% (95%CI: 1, 8) higher probability of any lifetime drinking and drinking 0.26 (95%CI: −0.05, 0.60) more drinks on drinking days. Korean American women’s drinking appears to be strongly related to their social networks, although how women take on traits of their new environment was not.     

Stool viruses in babies in Glasgow 2. Investigation of normal newborns in hospital.

The stools of 37 newborn babies born in hospital were examined for the presence of virus. An extract of every stool passed by each baby was examined in the electron microscopy and inoculated into cell cultures. The babies were delivered in four separate maternity units (A-D). All the babies from unit A and C(9 babies) were found to be excreting rotavirus though none showed any evidence of diarrhoea. Two of the babies also excreted astrovirus. Subsequently unit A was closed for cleaning and, on reopening with more restrictions on visitors, a further 19 babies were examined. No virus was found in any of their stools, nor was virus observed in the stools of babies from units B and D, where visiting was also more restricted. Visiting restrictions in these units excluded older siblings of the babies. No virus was cultured from any stools in this study.     

Determination of HIV protein 24 in feces of Triatoma infestans fed with blood from AIDS patients

OBJECTIVE: To verify any possibility of the elimination of p24 in feces of Triatoma infestans, p24 being an antigen and one of the markers of HIV infection. The purpose of the study was the evaluation of any risk of contamination by laboratory staff who work with activities related to this particular insect, and also investigate any mechanism that might thus lead to the dissemination of HIV. METHOD: Triatoma infestans were fed with p24-marked blood from 23 AIDS patients. Twenty-four and 48 hours later, their feces were examined in order to verify the presence of the antigen. The search for p24 was performed by means of the immunoenzymatic technique. RESULT AND CONCLUSION: No protein 24 was detected in any of the samples. In accordance with the applied methodology, the purpose of showing that the elimination of p24 does not occur, was obtained. Were this question approached in other ways different results might reveal new information in terms of risks of HIV dissemination.     

Determinants of contraceptive method among young women at risk for unintended pregnancy and sexually transmitted infections

The objective of this study was to examine the relationship between contraceptive method choice, sexual risk and various demographic and social factors. Data were collected on 378, 15- to 24-year-old women, recruited from health clinics and through community outreach in Northern California. Logistic regression analysis was used to estimate the association of predictors with contraceptive method used at last sex. Asian and Latina women were less likely to use any method. Women who were raised with a religion, or thought they were infertile, were also less likely to use any method. Women with multiple partners were generally less likely to use any method, but were more likely to use barrier methods when they did use one. Few women (7%) were dual method users. Women appear to act in a rational fashion within their own social context and may use no methods at all or use methods that are less effective for pregnancy prevention but offer more protection from sexually transmitted infections.     

Colonization of Candida albicans in vagina, rectum, and mouth

To better understand the frequency of appearance, the density of growth, and the most common sites in which female patients harbor Candida albicans, a study was initiated of all patients receiving a pelvic examination for any reason at a solo family practice office. From February 1980 to November 1981, 341 pelvic examinations were accompanied by cultures and colony counts of the vagina, rectum, and mouth. A semiquantitative method adapted to Microstix-Candida (Ames Company) was utilized. Only 39 percent of all examinations had negative cultures in all three sites. Twenty-three percent of the positive cultures for C albicans were found from the vagina, 41 percent from the rectum, and 34 percent from the mouth. Incidence of colonization in any site did not vary significantly from 16 to 75 years of age. Negative rectal colonization was associated with lower vaginal colony counts and less frequent vaginal symptomatology. Relatively high vaginal colony count was associated with symptomatic vaginal candidiasis.     

An updated cohort mortality study of workers exposed to styrene in the reinforced plastics and composites industry.

Mortality data have been updated for a further 12 years for a cohort of workers in the reinforced plastics and composites industry with exposures to styrene monomer and other chemicals. The cohort consisted of 15,826 male and female employees who were exposed to styrene for at least six months between 1948 and 1977 at 30 participating manufacturing plants in the United States. A total of 1628 deaths were reported during the extended observation period, 1948-89. Mortality from several causes showed significant increases--namely, all causes, all cancers, oesophageal cancer, lung cancer, cancer of the cervix uteri, cancer of other female genital organs, hypertensive heart disease, certain non-malignant respiratory diseases, motor vehicle accidents, and homicides. When, however, mortality data were examined in terms of duration of employment, durations of styrene exposure, and cumulative styrene exposure no upward trend was detected in any of these causes of death. Most of the increases in mortality were among workers who were employed for only six months to a year or who had very low cumulative exposure (< 10 ppm-years). Therefore, the increased mortality was not likely to be related to exposure to styrene. Several explanations for the increased mortality are offered, including low socioeconomic class, smoking, and lifestyle factors characteristic of short term workers. There was no increased mortality from lymphatic and haematopoietic cancers overall or from any specific haematological malignancies. In particular, no increase in mortality from non-Hodgkin's lymphoma, Hodgkin's disease, multiple myeloma, or leukaemia was found. Furthermore, detailed exposure-response analyses did not show any relation between exposure to styrene and any of these haematological malignancies. The lack of an exposure-response relation further supports the conclusion that workers in the reinforced plastics industry in this study did not experience any increased risk of lymphatic and haematopoietic cancers as a result of their exposure to styrene.     

Prevalence,risk factors,and complications of violence against pregnant women in a hospital in Peninsular Malaysia

Violence against women is a worldwide public health problem and becomes more crucial when it involves pregnant women. The primary aim of this study was to determine the prevalence of violence against pregnant women (VAPW), while the secondary aim was to identify the factors associated with violence and complications of violence during pregnancy. This was a cross-sectional study conducted in 1,200 postnatal women from March 1, 2015 through August 31, 2015 using a validated Malay Version of the WHO Women’s Health and Life Experiences Questionnaire. Data on pregnancy complications were obtained from antenatal records and discharge summaries. The prevalence of any form of VAPW was 35.9%, consisting of: any psychological (29.8%); any physical (12.9%); and any sexual (9.8%) violence. VAPW was significantly associated with: (1) women’s use of drugs, having had exposure to violence during childhood, having a violence-supporting attitude, having two or more children; and (2) having partners who were smokers, alcohol drinkers, or had controlling behavior. VAPW was significantly associated with anemia, urinary tract infection, premature rupture of membranes, antepartum hemorrhage, poor weight gain during pregnancy, low birth weight, and prematurity. In conclusion, the high prevalence of violence requires further research on preventive strategies for VAPW.     

Mortality of Reserve Mining Company employees in relation to taconite dust exposure

Analysis of mortality among men who were employed by Reserve Mining Company from 1952 to 1976 has been carried out. Follow-up was conducted with standard methods, including searches by the Social Security Administration. Occupational exposures to dust were based on personal samples taken over the past five years by the industrial hygiene department of the company. Smoking habits were obtained by mailed questionnaires or telephone interviews. A modified life table method was used to compare death rates of the employees with those expected for white males in the state of Minnesota. Comparisons were also made with US rates for white males. The results showed that the death rates for all causes were significantly below expectation. Deaths from malignant diseases were marginally below those expected for the state. Exposures to total dust, to silica dust, or to fiber were low. There was no relationship between mortality and estimated lifetime dust exposures, nor was there any suggestion that deaths from malignant neoplasms were increased after 15 to 20 years latency. In contrast, there was a strong relationship between smoking habits and mortality from all causes, from cardiovascular diseases, and from cancer. This study does not suggest any increase in cancer mortality from taconite exposure.     

Daily alcohol consumption and fatal coronary heart disease

For a series of 568 married white men who died from coronary heart disease (CHD) and an equal number of matched controls, information was collected on a large number of variables, including daily alcohol consumption. The crude matched pair ratio estimate for any versus no daily drinking was 0.6 (95% confidence limits 0.4 to 0.7). After controlling for additional confounding variables the risk ratio for any versus no daily alcohol consumption was 0.6 (0.5--0.8). This preventive effect was restricted to light drinkers, defined as those who drank less than or equal to 59.2 ml (2 oz) of alcohol daily. These data provide strong evidence against a causal role of daily alcohol consumption in fatal CHD and are consistent with a small preventive effect of any versus no daily drinking which is attributable only to light but not heavy drinkers.     

Socioeconomic status and risk of cancer, cerebral stroke, and death due to coronary heart disease and any disease: a longitudinal study in eastern Finland.

The association of socioeconomic status with the risk of death from ischaemic heart disease and any disease as well as the risk of cerebral stroke and any cancer was studied in 3644 men aged 30-59, based on a random sample from the population of eastern Finland. Age, smoking, blood pressure, and serum cholesterol concentration were allowed for in multiple logistic models. On the basis of these data, not being married, short education, and low income are associated with an excessive risk of death from ischaemic heart disease and any disease. The data also indicated that men who were not married and who lived in urban areas might have an increased risk of cerebral stroke and those with a short education an increased risk of cancer.