Patterns of healthy lifestyle and positive health attitudes in older Europeans

Objectives: To determine (i) the extent to which recommended lifestyle healthy behaviors are adopted and the existence of positive attitudes to health; (ii) the relative influence of socio-demographic variables on multiple healthy lifestyle behaviors and positive attitudes to health; (iii) the association between healthy lifestyle behaviors and positive attitudes to health.Design: two distinct healthy behavioral measures were developed: (i) healthy lifestyles based on physical activity, no cigarette smoking, no/moderate alcohol drinking, maintaining a “healthy” weight and having no sleeping problems and (ii) positive health attitudes based on having positive emotional attitudes, such as: self-perceived good health status, being calm, peaceful and happy for most of the time, not expecting health to get worse and regular health check-ups. A composite healthy lifestyle index, ranging from 0 (none of behaviors met) to 5 (all behaviors met) was calculated by summing up the individual’s scores for the five healthy lifestyle items. Afterwards, each individual’s index was collapsed into three levels: 0–2 equivalent to ‘level 1’ (subjectively regarded as ‘too low’), a score of 3 equivalent to ‘level 2’ (‘fair’) and 4–5 as ‘level 3’ satisfactory ‘healthy lifestyle’ practices. The same procedure was applied to the positive health attitudes index. Multinomial logistic regression analyses by a forward selection procedure were used to calculate the adjusted odds ratio (OR) with 95% confidence interval (95% CI).Participants: a multi-national sample consisting of 638 older Europeans from 8 countries, aged 65–74 and 75+, living alone or with others.Results and conclusions: maintaining a “healthy” weight was the most frequently cited factor in the healthy lifestyles index and therefore assumed to be the most important to the older Europeans in the study; positive attitudes to health were relatively low; participants achieved a ‘satisfactory’ level for healthy lifestyles index (level 3) more frequently than a satisfactory level for positive attitudes to health; having a satisfactory ‘healthy lifestyle’ was directly related to having a satisfactory level of positive attitudes to health based on the positive health attitudes index; income and geographical location in Europe appeared to be key predictors for meeting both the recommended healthy lifestyle factors in the index and having positive health attitudes however, the composition and nature of the study sample should be taken into consideration when considering the impact of the location on healthy lifestyles and attitudes to health across Europe. more details at www.foodinlaterlife.org.     

Electron microscopic studies on bactericidal effects of electrolyzed acidic water on bacteria derived from kendo protective equipment

Objectives Kendo protective equipment is used without washing for a long time.Staphylococcus saprophyticus, Micrococcus luteus, andBacillus sphaericus are frequently isolated from the mask (‘men’ in Japanese) of kendo protective equipment during one year. To investigate the bactericidal effects of electrolyzed acidic water on these three bacteria, we observed their cellular structures by electron microscopy after treatment with such water. Methods Each bacterium isolated from ‘men’ was treated with electrolyzed acidic water and then observed under scanning and transmission electron microscopes. Results WhenS. saprophyticus was treated with electrolyzed acidic water and its cellular structures were observed under a transmission electron microscope, ghost cytoplasm was observed, in which no ribosomal granules or fibrous DNA structures were present, and the cell wall inner layer was detached from the outer layer. Under a scanning electron microscope, the structure of the cell wall surface layer was wrinkled, and round pores were partially formed, indicating that the cytoplasmic structures were flushed out of the cells treated with electrolyzed acidic water through the pores formed in the cell wall. InM. luteus, the destruction of ribosomal granules and that of DNA fibers were observed to be similar to those ofS. saprophyticus. ForB. sphaericus, the effect of electrolyzed acidic water was investigated using vegetative cells. A dissociation between the cytoplasm and cell wall wrinkled the cell surface layer. Conclusion On the basis of above findings, electrolyzed acidic water was found to destroy the cellular structures of the three bacterial species frequently isolated from kendo men within a short time. Electrolyzed acidic water may be useful for disinfecting of kendo equipment.     

Genetic Testing and Private Insurance – A Case of “Selling One’s Body”?

Arguments against the possible use of genetic test results in private health and life insurance predominantly refer to the problem of certain gene carriers failing to obtain affordable insurance cover. However, some moral intuitions speaking against this practice seem to be more fundamental than mere concerns about adverse distributional effects. In their perspective, the central ethical problem is not that some people might fail to get insurance cover because of their ‘bad genes’, but rather that some people would manage to get insurance cover because of their ‘good genes’. This paper tries to highlight the ethical background of these intuitions. Their guiding idea appears to be that, by pointing to his favourable test results, a customer might make an attempt to ‘sell his body’. The rationale of this concept is developed and its applicability to the case at issue is critically investigated. The aim is to clarify an essential objection against the use of genetic information in private insurance which has not yet been openly addressed in the academic debate of the topic.     

First experiences with DIN ISO 14835-1 in the context of vibration-induced white finger disease

Objectives: In order to establish an international standard of cold provocation test in the assessment of vibration-induced white finger (VWF) disease, an ISO-working group tentatively created the DIN ISO 14835-1. Based on this new standard, previously existing testing conditions had to be modified. Since a comparison of current and previous evaluation procedures is necessary for both the individual assessment and the performance of metaanalyses, the revision and validation of criteria for the examination of the cold provocation tests are appropriate and necessary. Methods: Twenty-one individuals suffering from VWF disease whose disorder was accepted as an occupational disease underwent the cold provocation test on two successive days following a 2- and a 5-min-long exposure to the cold. As a benchmark for classification as ‘normal’ or ‘pathological’, the 15-min mark after a 2-min-long exposure was chosen. A skin temperature of 28°C was selected for discrimination between ‘non-pathological’ (at least 28°C) and ‘pathological’ test results. Results: It could be shown, that exposures to cold water (12°C) over 2 and 5 min lead to similar rewarming profiles, who differ in median systematically by 1°C. A modification of the former classification rule should be considered. After a 5 min exposure, the classification criterion can be based on the temperature assessments measured after 20 min; alternatively the cut point can be reduced from 28 to 27°C while maintaining the previous assessment time of t=15 min. Conclusions: The shown results represent the first attempt of modifying the previous classification criteria of the cold provocation test within the scope of the VWF disease. In view of the described problems of the study design there is no doubt that continuing modifications and their validation on the base of larger collectives groups are necessary.     

Psychometric properties of the RAND-36 among three chronic disease (multiple sclerosis,rheumatic diseases and COPD) in the Netherlands

Objective: In this article, psychometric properties both of the total RAND-36 and of its subscales, such as unidimensionality, differential item functioning (DIF or item bias), homogeneity and reliabilities, are examined. Methods: The data from populations with three chronic illnesses, multiple sclerosis (n = 448), rheumatism (n = 336) and COPD (n = 259), have been collected in different parts of the Netherlands. The main technique used was Mokken scale analysis for polytomous items. Results: All subscales of the RAND-36 appeared to be unidimensional. For the sub scales ‘mental health’ and ‘general health perceptions’ some minor indications of DIF for the different chronic illnesses were found. Reliabilities of almost all subscales in all subpopulations were higher than 0.80, while the homogeneities of almost all subscales in all subpopulations were higher than 0.50, indicating ‘strong unidimensional, hierarchical scales’. Conclusions: In general, the subscales of the RAND-36 can be used to compare persons with different chronic illnesses. The subscale ‘general health perceptions’ did not function as well as would be preferred. This revised version was published online in June 2006 with corrections to the Cover Date.     

Is Psychometric Scoring of the McNew Quality of Life After Myocardial Infarction Questionnaire Superior to the Clinimetric Scoring? A Comparison of the Two Approaches

Objective: ‘Clinimetric’ and ‘psychometric’ approaches are currently used to develop health related quality of life questionnaires. The Quality of Life after Myocardial Infarction questionnaire (QLMI) was originally developed using ‘clinimetric’ criteria; it was subsequently modified (McNew QLMI) and a new domain structure was defined using factor analysis. The objective of this study was to compare the measurement properties of the McNew QLMI scores when both approaches for scoring are used. Methods: The McNew QLMI and SF-36 were administered to patients 2 weeks and 2 months after myocardial infarction. Two sets of scores for the McNew QLMI were computed using the original ‘clinimetric’ and the subsequent ‘psychometrically’ derived scoring systems. Reliability statistics for the two sets of domains were compared and construct validity was assessed by establishing a priori hypotheses on the expected correlation between each score and the dimensions of the SF-36. Results: Both sets of scores had similar reliability (Cronbach’s α between 0.64 and 0.93) and responsiveness (SRMs between 0.17 and 0.87) while validity was better for the ‘clinimetric’ set of scores (concordance between observed and expected correlations was moderate for the ‘clinimetric’ scores and fair for the ‘psychometric’ scores). Conclusion: Since overall measurement properties of the ‘clinimetrically’ scored McNew QLMI are better than the ‘psychometrically’ scored version, we suggest that either the original ‘clinimetric’ system is used or that an improved ‘psychometric’ version is developed.     

Waddell’s Symptoms as Indicators of Psychological Distress, Perceived Disability, and Treatment Outcome

Introduction Waddell’s signs and symptoms have been described as patient presentations not within usual anatomic patterns of injury pathology. Waddell’s signs were thought to indicate psychological distress and were termed “non-organic findings”; similarly, Waddell’s symptoms were described as inappropriate and attributable to psychological features. Endorsement of more than two of Waddell’s symptoms is thought to be associated with psychological distress, disability, and poor treatment outcomes; however, this has not been empirically assessed. Methods The current study used a sample of patients (n = 108; 30% women) involved in a multi-disciplinary work hardening program provided by a third-party insurer. Patients who endorsed more than two of Waddell’s symptoms were compared with those who did not on demographic variables as well as self-report measures of psychological distress, disability, and treatment outcome. Results Patients who endorsed more than two of Waddell’s symptoms reported higher levels of psychological distress, perceived disability, pain intensity, and pain durations. Moreover, consistent with previous research on Waddell’s symptoms, patients endorsing more than two symptoms were also less likely to return to work. Conclusions Waddell’s symptoms were associated with increased perceived disability and pervasive pain interference. Patients who endorsed more than two symptoms were significantly less likely to return to work than those who endorsed zero, one, or two symptoms. Patients who endorsed more than two symptoms may indeed be affected by factors beyond tissue pathology that nonetheless warrant clinical attention. Waddell’s symptoms appear to have promise as a quick indicator of treatment complexity and outcome.     

Conceptualising Health: Insights from the Capability Approach

This paper suggests the adoption of a ‘capability approach’ to key concepts in healthcare. Recent developments in theoretical approaches to concepts such as ‘health’ and ‘disease’ are discussed, and a trend identified of thinking of health as a matter of having the capability to cope with life’s demands. This approach is contrasted with the WHO definition of health and Boorse’s biostatistical account. We outline the ‘capability approach’, which has become standard in development ethics and economics, and show how existing work in those areas can profitably be adapted to healthcare. Cases are used to illustrate the value of adopting a capability approach.

The fragmented discourse of the ‘knowledgeable doer’: nursing academics’ and nurse managers’ perspectives on a master’s education for nurses

There has been a proliferation of taught masters’ degrees for nurses in recent years, and like masters’ programmes in other disciplines, the aspirations of such educational endeavours are far from unanimous. This article reports on part of a wider study, and focuses on a qualitative analysis of the perspectives of two key sets of stakeholders, namely academic education providers, and senior clinical nursing personnel, on masters’ education for nurses. Fifteen participants were interviewed in depth, and data were subjected to a qualitative content analysis. Findings indicated that while both sets of participants invoked the discourse of the ‘knowledgeable doer’, that is, the notion of amalgamating a high level of theoretical knowledge with practical know how, there were also differences in how each group deployed this discourse. Academics tended to emphasise the ‘knowing that’ or theoretical aspect of the discourse, whereas those in senior clinical roles adduced the practical component more strongly. We argue that the discourse of the ‘knowledgeable doer’ is far from stable, unified and universally agreed, but rather comprises competing elements with some emphasised over others according to the subject position of the particular individual. We locate the diverse perspectives of the two sets of stakeholders within debates about the status of masters’ programmes in relation to vocational and liberal education.

Absorption and DNA protective effects of flavonoid glycosides from an onion meal

Summary Background. It is widely believed that antioxidant micronutrients obtained from fruit and vegetables afford significant protection against cancer and heart disease, as well as ageing. Flavonoids are potential antioxidants found in food such as onions; information on their effectiveness in vivo is so far lacking. Aims. To determine uptake as well as in vivo antioxidant effects of flavonoids from foods. Methods. Six healthy non-obese normocholesterolaemic female volunteers in the age range 20–44 years participated in a randomised two-phase crossover supplementation trial to compare the antioxidant effects associated with (a) a meal of fried onions and (b) a meal of fried onions and fresh cherry tomatoes. Plasma flavonoids, lymphocyte DNA damage, plasma ascorbic acid, tocopherols and carotenoids, urinary malondialdehyde and 8-hydroxy-2’-deoxyguanosine were determined to assess flavonoid absorption and antioxidant efficacy. Results. Flavonoid glucosides (quercetin-3-glucoside and isorhamnetin-4-glucoside) were significantly elevated in plasma following ingestion of the onion meal and the increases were associated with an increased resistance of lymphocyte DNA to DNA strand breakage. A significant decrease in the level of urinary 8-hydroxy-2’-deoxyguanosine was evident at 4 h following ingestion of the onion meal. After the combined tomato and onion meal, only quercetin was detected in plasma. Endogenous base oxidation was decreased but resistance to strand breakage was unchanged. There was no significant change in the excretion of urinary malondialdehyde following either meal. Conclusion. Both meals – onions, and onions together with tomatoes – led to transient decreases in biomarkers of oxidative stress, although the particular biomarkers affected differ. It is possible that the differences in patterns of response reflect the different uptakes of flavonoids but the underlying mechanism is not understood. Received: 1 April 2000, Accepted: 1 August 2000     

Hero or has-been: Is there a future for altruism in medical education?

The term ‘altruism’ is often used without definition, leading to contradictions in what we expect from medical students. In this reflection paper, we critique the concept of ‘altruism’ from the perspective of moral philosophy and social psychology and challenge its unquestioned usage within the medical education literature, especially that emerging from the USA. We will argue that ‘altruism’ is a social construction with a particular history, stemming from Kantian philosophy and perpetuated within newer disciplines such as social psychology. As it currently stands, ‘altruism’ seems to mean utter self-sacrifice—a position contradictory to recent recommendations by regulatory bodies in the UK, which suggest that graduates should look after the ‘self’ and achieve a work-life balance. In this article, we argue that it is undesirable to have ‘altruism’ as a learning outcome for medical students and we also argue that ‘altruism’ is not an observable behavior that can be measured. Instead, we suggest that medical educators should employ a more balanced term, borrowed from the social psychology literature i.e. pro-social behavior. We argue that whilst ‘pro-social behavior’ focuses on actions that benefit others, it does not do so at the expense of the self. In addition, it focuses on students’ observable behaviors rather than their inner motivations, so is measurable. We conclude our article by discussing the formation of physicians based upon a virtue ethics, where society and the profession are in dialogue about the telos of medicine and its virtues, and where the character of the young physician is formed within the crucible of that dialogue. Thus, central to this pro-social behavior is the concept of phronesis or prudence, including the balancing of self-interest such as self-care, and the interests of the other.     

Is a Generic Quality of Life Instrument Helpful for Evaluating Women with Urinary Incontinence?

Objectives: The aim of this study was to determine whether a generic health outcome instrument would be helpful for evaluating women with stress urinary incontinence (UI) combined with or without urge UI. Methods: A total of 109 women with UI and 80 controls participated in the study. Health-related quality of life (QOL) was measured using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and the Incontinence Quality of Life (I-QoL) questionnaire. Results: Among eight domains of the SF-36 questionnaire, only four domains, namely, ‘role-physical functioning’ (p<0.05), ‘vitality’ (p<0.05), ‘mental health’ (p<0.05) and ‘bodily pain’ (p<0.05) were significantly different between the groups. Comparing the I-QoL sores in the two groups, patients with UI had significantly poorer subscale scores of I-QoL than the controls (p<0.05 for all domains). When women with UI were subdivided into groups of stress and mixed UI, only 2 domains of the SF-36 questionnaire, ‘role-physical functioning’ (p<0.05) and ‘bodily pain’ (p<0.05), were significantly different. The mixed UI group had higher scores only on these two domains compared to the stress UI group. In the ‘role-physical functioning’ domain, there was no significant difference between the mixed UI group and the controls. In ‘bodily pain’ domain, there was no significant difference between the stress UI group and the controls. The mixed group had the highest scores observed. Patients with mixed UI had significantly lower total scores compared to those with stress UI, including the subscale score of ‘avoidance behavior’ of the I-QoL. Among eight domains of the SF-36, only ‘physical functioning’ (r = 0.281, p<0.01) and ‘social functioning’ (r = 0.239, p<0.05) were weakly correlated with ‘psychological impact’ of the I-QoL. Conclusion: Our findings show that the generic QOL instrument is not sensitive measure of QOL in women with UI.     

Attending to audience: comparing optometry student talk with and about patients

We explored mediating concepts that affect clinical novices shifting between their talk with patients in eye examinations and their talk about patients in case presentations (nCPs). In a Canadian optometry teaching clinic, patient ‘chief concern or request’, ‘illness experience’, and ‘management’ utterances were observed in ten eye examinations and nCPs. Twenty-three participants (8 students, 5 instructors, and 10 patients) were observed; 22 were subsequently interviewed. Of 10 nCPs, the ‘chief concern or request’ was absent in four, the ‘illness experience’ was incomplete or absent in 9 and 5 of 19 (35.7%) ‘management’ topics were not discussed with patients. During eye exams, 17 of 31 (54.8%) ‘management’ discussions with patients were not discussed with instructors during nCPs. Instructional ‘scaffolding’ (Bruner and Sherwood in Play: its role in development and evolution, p. 280, 1976) appeared limited regarding talk with and about patients. The limited and recontextualized reporting of patient concerns and experiences in nCPs represented lost opportunities to provide and learn patient-centered care. While Goffman’s (The presentation of the self in everyday life, p. 114, 1969) ‘front stage’ performances and Mishler’s (The discourse of medicine: dialectics of medical interviews, p. 14, 1984) healthcare ‘voices’ suggest separate worlds of talk before patients and instructors, we found these worlds were not wholly separate for neophyte speakers. Mediating concepts that influence clinical novices shifting their performances before their audiences, included: (1) pedagogical inconsistencies, (2) incompatible values associated with talk, (3) discordance between patient care and student education, (4) time limitations for teaching, and (5) insufficient instructional ‘scaffolding’ about talk.     

‘Healthy Ageing’ policies and anti-ageing ideologies and practices: on the exercise of responsibility

This paper explores how the exercise of the ethics of ‘responsibility’ for health care advanced through ‘healthy ageing’ and ‘successful ageing’ narratives in Western countries animates an array of ‘authorities’, including the ‘anti-ageing medicine’ movement as a strategy to address the anxieties of growing old in Western societies and as a tool to exercise the ethos of ‘responsibility’. The choice of this type of authority as a source of guidance for self-constitution and the exercise of the ‘responsible self’, this paper will argue, enables the enactment of a type of late modernity notion of citizenship for ageing individuals based on principles of agelessness, health, independence and consumption power. Through interviews with anti-ageing consumers, however, it is also possible to argue the existence of tensions and contradictions that such a rigid model of self-constitution in later life produces, and the potential forms of resistance and contestations that may emerge as a result. In this way the current ‘war on anti-ageing medicine’ (Vincent 2003) becomes also symptomatic of bigger ‘wars’ taking place not only between institutions competing for control over knowledge and management of ageing, but between those in favour and against the homogenisation of life under the language of universal science, reason and market rationality.     

Magnesium balance studies in premature and term infants

Summary Background: The knowledge of magnesium requirements of premature infants is still very limited, although it is essential for the optimal composition of suitable formulas. Aim of the study: The study concept was 1) to assess physiological magnesium balance data of healthy term infants and longitudinal results from formula-fed premature infants and 2) to deduce conclusions on the magnesium content of the formulas. Methods: Premature infants (n = 14, birth weight ≤ 1500 g, gestational age ≤ 32 weeks) were studied in conventional balance trials with 1) a semi-elemental diet (A), 2) preterm infant formula (B), and 3) infant formula (C). In addition, healthy term formula-fed (n = 11, D) and breast-fed (n = 14, E) infants were investigated. Analysis was performed by flame atomic absorption spectroscopy. Results: The median magnesium intake ranged between 4.84 mg/kg × d⁻¹ (breast-fed infants) and 16.33 mg/kg × d⁻¹ (premature infants). The term breast-fed infants retained nearly as much magnesium as term formula-fed infants (3.37 vs. 3.97 mg/kg × d⁻¹), due to a low percental fecal and urinary excretion. A higher magnesium retention was observed in the premature group: A: 7.97 mg/kg × d⁻¹, B. 5.3 mg/kg × d⁻¹, 3.) 5.54 mg/kg × d⁻¹. Conclusion: In view of the high percental magnesium retention in formula-fed premature infants, excessive supply should be avoided. The long-term effects of lower intakes have to be monitored. Received: 23 July 1999, Accepted: 2 February 2000     

Understanding VAS Valuations: Qualitative Data on the Cognitive Process

Eliciting people’s value is a central pursuit in health economics. We explored approaches to valuing a health state on a visual analog scale (VAS). Additionally, we examined whether dual processing (an interaction between automatic and controlled information processing) occurred during VAS valuation. In the first experiment, respondents were probed for their approach after valuation on a VAS. After inductive generalization, we grouped the approaches: (1) ‘Sort-of ’ (automatic processing), (2) ‘Bisection of line first’, (3) ‘Numerical expression’, and (4) ‘Dividing into smaller segments’. In the second experiment, a short questionnaire followed the VAS in which these approaches were systematically assessed, as was awareness of the approach used, intention to re-use the approach the next time (confidence), and basis of the approach. Data showed that the ‘Sort-of’ approach was used most often, followed by the ‘Bisection-first’ approach. We argue that dual processing occurs during performance on the VAS. Awareness of the approach used was lower when an intuitive approach was used. A reasoned approach had a higher correlation with confidence. Thus, awareness of approach may improve reliability. Reducing the number of health states to be valued concurrently diminishes the complexity of the task; this may enhance the validity of the VAS.     

Early life patterns of common infection: a latent class analysis

Early life infection has been implicated in the aetiology of many chronic diseases, most often through proxy measures. Data on ten infectious symptoms were collected by parental questionnaire when children were 6 months old as part of the Avon Longitudinal Study of Parents and Children, United Kingdom. A latent class analysis was used to identify patterns of infection and their relationship to five factors commonly used as proxies: sex, other children in the home, maternal smoking, breastfeeding and maternal education. A total of 10,032 singleton children were included in the analysis. Five classes were identified with differing infectious disease patterns and children were assigned to the class for which they had a highest probability of membership based on their infectious symptom profile: ‘general infection’ (n = 1,252, 12.5%), ‘gastrointestinal’ (n = 1,902, 19.0%), ‘mild respiratory’ (n = 3,560, 35.5%), ‘colds/ear ache’ (n = 462, 4.6%) and ‘healthy’ (n = 2,856, 28.5%). Females had a reduced risk of being in all infectious classes, other children in the home were associated with an increased risk of being in the ‘general infection’, ‘mild respiratory’ or ‘colds/ear ache’ class. Breastfeeding reduced the risk of being in the ‘general infection’ and ‘gastrointestinal’ classes whereas maternal smoking increased the risk of membership. Higher maternal education was associated with an increased risk of being in the ‘mild respiratory’ group. Other children in the home had the greatest association with infectious class membership. Latent class analysis provided a flexible method of investigating the relationship between multiple symptoms and demographic and lifestyle factors.     

Occupational exposures and risk of pancreatic cancer

The objective was to analyze the relationship between occupation (and specific occupational exposures) and risk of exocrine pancreatic cancer (EPC). We conducted a multicenter hospital-based case–control study in Eastern Spain. We included 161 incident cases of EPC (59.6% men, 94 with histological confirmation, of whom 80% had ductal adenocarcinoma). Cases were frequency-matched with 455 controls by sex, age and province of residence. Information was elicited using structured questionnaires. Occupations were coded according to the Spanish version of the International Standard Classification of Occupations 1988. Occupational exposure to a selection of carcinogenic substances was assessed with the Finnish Job-Exposure Matrix (FINJEM). Odds ratios (OR) and 95% confidence intervals (CI) were estimated by multiple logistic regression, adjusting for sex, age, province, education, alcohol and smoking. A higher risk of EPC was associated with having worked as ‘Miners, shotfirers, stone cutters and carvers’, ‘Machinery mechanics and fitters’, ‘Building trades workers’ and ‘Motor vehicle drivers’ in men, ‘Office Clerks’ in women, and ‘Waiters’ in both sexes. Cases with ductal adenocarcinomas were more likely to have been exposed to chlorinated hydrocarbon solvents (OR = 4.1, 95% CI: 1.1–15.2, p-trend = 0.04). We also observed significant associations with exposure to ‘synthetic polymer dust exposure’ and ‘ionizing radiation’. Suggestive increases in risk were observed for ‘pesticides’, ‘diesel and gasoline engine exhaust’, and ‘hydrocarbon solvents’. Results support the hypothesis that occupational exposure to chlorinated hydrocarbon solvents is associated with exocrine pancreatic cancer.