Apportionment in asbestos-related disease for purposes of compensation

Workers' compensation systems attempt to evaluate claims for occupational disease on an individual basis using the best guidelines available to them. This may be difficult when there is more than one risk factor associated with the outcome, such as asbestos and cigarette smoking, and the occupational exposures is not clearly responsible for the disease. Apportionment is an approach that involves an assessment of the relative contribution of work-related exposures to the risk of the disease or to the final impairment that arises for the disease. This article discusses the concept of apportionment and applies it to asbestos-associated disease. Lung cancer is not subject to a simple tradeoff between asbestos exposure and smoking because of the powerful biological interaction between the two exposures. Among nonsmokers, lung cancer is sufficiently rare that an association with asbestos can be assumed if exposure has occurred. Available data suggest that asbestos exposure almost invariably contributes to risk among smokers to the extent that a relationship to work can be presumed. Thus, comparisons of magnitude of risk between smokers and nonsmokers are irrelevant for this purpose. Indicators of sufficient exposure to cause lung cancer are useful for purposes of establishing eligibility and screening claims. These may include a chest film classified by the ILO system as 1/0 or greater (although 0/1 does not rule out an association) or a history of exposure roughly equal to or greater than 40 fibres/cm3 x y. (In Germany, 25 fibres/cm3 x y is used.) The mere presence of pleural plaques is not sufficient. Mesothelioma is almost always associated with asbestos exposure and the association should be considered presumed until proven otherwise in the individual case. These are situations in which only risk of a disease is apportioned because the impairment would be the same given the disease whatever the cause. Asbestosis, if the diagnosis is correct, is by definition an occupational disease unless there is some source of massive environmental exposure; it is always presumed to be work-related unless proven otherwise. Chronic obstructive airways disease (COAD) accompanies asbestosis but may also occur in the context of minimal parenchymal fibrosis and may contribute to accelerated loss of pulmonary function. In some patients, particularly those with smoking-induced emphysema, this may contribute significantly to functional impairment. An exposure history of 10 fibre x years is suggested as the minimum associated with a demonstrable effect on impairment, given available data. Equity issues associated with apportionment include the different criteria that must be applied to different disorders for apportionment to work, the management of future risk (eg. risk of lung cancer for those who have asbestosis), and the narrow range in which apportionment is really useful in asbestos-associated disorders. Apportionment, attractive as it may be as an approach to the adjudication of asbestos-related disease, is difficult to apply in practice. Even so, these models may serve as a general guide to the assessment of asbestos-related disease outcomes for purposes of compensation.     

Concordance of disease form in kindreds ascertained through affected individuals

When designing or conducting genetic epidemiological studies of a disease with several distinct forms, it is useful to know whether susceptibilities to the different forms are conferred by different genes or whether there are genes that confer susceptibility to multiple forms. A natural approach to exploring these issues is to examine how the disease forms cluster in kindreds. When inclusion in the study is based on the affection status of multiple relatives, however, distorted patterns of familial clustering of disease form can be evident. The purpose here is to present statistical methods for adjusting for this distortion. In particular, approaches to testing two null hypotheses are presented: a null hypothesis that corresponds to all genes acting in the same way on the relative risk of the different disease forms, and a null hypothesis that corresponds to each gene conferring susceptibility to distinct disease forms. The approaches are illustrated through an application to the generalized and localization-related forms of epilepsy.     

Obstructive pulmonary disease in old age among individuals born preterm

There are only few studies of the association between preterm birth and risk of chronic lung disease in old age. The aim of this study was to assess the association between poor fetal growth, preterm birth, sex and risk of asthma and Chronic Obstructive Pulmonary Disease (COPD) in adulthood. We have followed up a cohort of all infants born preterm (<35 weeks) or with low birth weight (<2,000 and <2,100 g for girls and boys, respectively) and an equal number of controls in a source population of 250,000 individuals born from 1925 through 1949 in Sweden (6,425 subjects in total). Cases of asthma and COPD were identified through the Swedish Patient Register and we considered cohort subjects as cases if they had a main or additional discharge diagnosis of asthma or COPD. For any obstructive airways disease, there was a statistically significant increase in risk with decreasing birth weight and gestational duration among women but not among men. Compared to women born at term, women born before 32 weeks of gestation had a hazard ratio for any obstructive airways disease and asthma of 2.77 (95 % CI 1.39–5.54) and 5.67 (1.73–18.6), respectively. Low birth weight and preterm birth are risk factors for obstructive airways disease also among the old, but the importance of these risk factors differs between the sexes.     

Serum cytokine concentrations in alcohol-dependent individuals without liver disease.

In the current study, our aim was to evaluate and investigate the influence of heavy alcohol intake on serum interleukin (IL)-6, IL-8, IL-10, IL-12, and tumor necrosis factor-alpha (TNF-alpha) concentrations. The selection of cytokines was based on their presumptive role in the pathophysiology of alcohol dependence. On admission to the Drug-Free Substance Addiction Detoxification clinic ("ATHENA"), blood samples were obtained from study participants, and serum cytokine concentrations were measured by using a commercial sandwich enzyme-linked immunosorbent assay technique. Alcohol dependence, as diagnosed according to DSM-IV [Diagnostic and Statistical Manual of Mental Disorders (4th ed.)] criteria for alcohol dependence and estimated by using the Composite International Diagnostic Interview (CIDI), was characterized by increased serum IL-6 concentration. Interleukin-8, IL-10, IL-12, and TNF-alpha concentrations were comparable to those found in control subjects (P>.05). These results indicate that in alcohol-dependent individuals there is a significant increase in the serum IL-6 concentration (P <.05).     

慢性病同伴支持模式的研究进展

慢性病已成为全球第一位的疾病,自我管理作为慢性病控制的中心策略,可以提高医疗质量,减少资源利用[1]。自我管理过程中患者需要面对诸多问题,单纯医务人员不能满足患者的所有需求,同伴支持作为一种社会支持形式[2],在慢性病自我管理中越来越受到重视。2004年Newman[3]进行的糖尿病、关节炎和哮喘患者的62个自我管理项目分析中,仅有3个研究是同伴支持项目,但     

Fasting in healthy individuals and adaption to undernutrition during chronic disease

During long-term fasting, gluconeogenesis from amino acids was thought to lessen, when ketone bodies from lipolysis became a major fuel source. Thus, muscle mass is conserved. However, recent studies show that this adaptation does not occur in chronic undernourishment. In cancer, chronic undernutrition without disease, and HIV infection, carbohydrate utilization is high. Enhanced hepatic glucose production occurs in active inflammatory bowel disease and in underweight cancer patients. Repletion of tissue after undernutrition is energetically inefficient because of enhanced diet induced thermogenesis (following anorexia nervosa) and decreased fat, and increased protein, oxidation (in tuberculosis).     

Source Apportionment of Volatile Organic Compounds in Tehran, Iran

Identifying the sources of volatile organic compounds (VOCs) is key issue to reducing ground-level ozone and PAN. A multivariate receptor model (Unmix) was used for the determination of the contributions of VOCs sources in Tehran-Iran. Concentrations of ambient C₂–C₁₀ VOCs were measured continuously and online at the center of Tehran city during the winter of 2012. A high correlation coefficient existed between measured and predicted values (R ² = 0.99), indicating that the data were well modeled. Five possible VOCs source categories were identified and mobile sources such as vehicle exhaust (61 %) and fuel evaporation (12 %) more than half of the total VOC concentration. City gas and CNG sources, biogenic source, and industrial solvent source categories accounted for 17 %, 8 % and 2 % of the total VOC, respectively. Result showed Unmix for VOCs source apportionment can be used to analyze and generate air pollution control strategies and policies.     

Reaching individuals at risk for cardiovascular disease through community outreach in Colorado

Objective

The aim of this program was to (1) increase awareness of individual cardiovascular disease (CVD) risk in underserved communities, (2) educate participants about lifestyle modifications to reduce CVD risk, and (3) link individuals at moderate to high risk with healthcare. Community health workers (CHWs) delivered the program in 14 urban, rural and frontier Colorado communities.

Method

We analyzed data from CVD screenings of 17,995 individuals throughout Colorado between 2006 and 2009 in order to understand the reach and impact of the program on reaching target populations, identifying at-risk individuals and improving awareness of CVD risk.

Results

In 3 years, 15 CHWs screened 17,995 clients for CVD risk, of which, almost 60% were racial and ethnic minorities and 42% were uninsured. Twenty-nine percent of participants had medium or high Framingham Risk Scores. Over three-quarters were overweight or obese, over one-fifth had mildly to severely high blood pressure, and 42% had borderline high or high cholesterol. Significantly, 82% had no knowledge of their CVD risk prior to screening.

Conclusion

This program is a replicable model for reaching minority and medically underserved populations who are at risk for CVD in urban, rural and frontier communities.     

Source Apportionment of Wastewater Pollutants Using Multivariate Analyses

A faster and cost-effective methodology has been developed to estimate the spatial and seasonal variations in wastewater quality and apportion the influencing sources through multivariate statistical techniques, cluster analysis and principal component analysis (PCA). Partially treated or untreated wastewater is released into the river from various industrial and domestic sources, which poses a serious threat to human health. Wastewater samples were collected from five stations along the river bank. PCA performed on overall wastewater samples revealed that in present study all the five sampling stations were influenced by sewage and industrial effluents mixed together. However, the pollutant levels were significantly different in the three groups of wastewater samples, which were confirmed by univariate analysis of principal component (PC) scores. Based on wastewater similarities, cluster analysis identified three groups (central, upstream and downstream) of sampling stations, which further confirmed univariate analysis of PCs scores. Spatial variations in wastewater quality reveled that the highest pollutant concentration was noted for group 1 and lowest for group 2. Seasonal variations in the wastewater quality revealed that highest values of pollutants were observed in low flow and lowest in high flow. Results of the present study obtained through multivariate analyses may be used to classify wastewater and identify the influencing sources of pollutants. The present study may be useful in reducing 11 % of the cost in future investigations. Thus, in future quality estimation of the representative wastewater samples would be faster as well as cost-effective approach.     

宁夏居民慢性阻塞性肺疾病认知行为的现况调查

目的了解宁夏居民慢性阻塞性肺疾病（COPD）认知行为的现状,探讨影响居民认知水平的相关因素,为制定COPD干预措施提供依据。方法采用多阶段分层整群随机抽样方法,在宁夏回族自治区4个地级市抽取12个调查点,对40岁以上居民4268例进行COPD问卷调查。整理数据资料,采用多因素线性回归方法分析COPD认知水平的影响因素。结果实际调查4200例,有效问卷4056份,有效应答率96．57％。其中,仅6．51％（264／4056）听说过COPD,13．88％（563／4056）认为吸烟是慢支、肺气肿的危险因素,6．39％（259／4056）知晓肺功能检测。影响认知的主要因素是收入水平、城乡、文化程度、民族。宁夏40岁以上人群的吸烟率为28．80％（1168／4056）,回族低于汉族（20．40％VS34．63％,P〈0．05）。回汉吸烟人群中,吸烟指数及重度吸烟者所占比例无明显差异（P〉0．05）。结论宁夏居民对COPD缺乏认识,防治意识差,推行健康教育工作刻不容缓。回族人群吸烟率虽然低于汉族,但对COPD缺乏认识仍是不可忽视的问题。     

Systematic review of the effects of black carbon on cardiovascular disease among individuals with pre-existing disease

Objectives

Recent interest has developed in understanding the health effects attributable to different components of particulate matter. This review evaluates the effects of black carbon (BC) on cardiovascular disease in individuals with pre-existing disease using evidence from epidemiologic and experimental studies.

Methods

A systematic literature search was conducted to identify epidemiologic and experimental studies examining the relationship between BC and cardiovascular health effects in humans with pre-existing diseases. Nineteen epidemiologic and six experimental studies were included. Risk of bias was evaluated for each study.

Results

Evidence across studies suggested ambient BC is associated with changes in subclinical cardiovascular health effects in individuals with diabetes and coronary artery disease (CAD). Limited evidence demonstrated that chronic respiratory disease does not modify the effect of BC on cardiovascular health.

Conclusions

Results in these studies consistently demonstrated that diabetes is a risk factor for BC-related cardiovascular effects, including increased interleukin-6 and ECG parameters. Cardiovascular effects were associated with BC in individuals with CAD, but few comparisons to individuals without CAD were provided in the literature.     

医院成本核算系统中成本的分摊及配比计算方法

研究了全成本核算中成本的合理分摊问题,叙述了具体的分摊策略。根据医院的具体情况,应用四级分摊方式将不同成本项目依据不同分摊原则进行分摊。通过对成本项目的合理分摊,分摊后医院的成本数据真实反映了全院和科室的深层收支情况。     

Screening of asymptomatic individuals for coronary disease using CT-calcium measurement in the coronary arteries

Coronary calcification is a specific marker for coronary atherosclerosis. It is therefore reasonable to assume that the risk ofcardiac events can be assessed by the quantification of the extent of coronary calcium. Until now, the predictive value of coronary calcium and its advantage over conventional risk factors has not been proven by any of the available prospective cohort studies. It is particularly likely that assessment of coronary atherosclerosis will help in the decision to initiate or discard a specific therapy in patients with an intermediate risk for cardiac events. Recently it has been suggested that the Framingham risk score (FRS) be replaced by a score corrected by assessing the amount of coronary calcium, which can be obtained by multislice spiral computed tomography (MSCT). To this end, the Commission Law Population Investigation has approved a study proposal to evaluate the effects of coronary-calcium screening in 4000 asymptomatic individuals with an intermediate likelihood of coronary artery disease. Based on the amount of calcium (calcium score > 100) obtained by MSCT, different treatment strategies will be initiated over a period of 5 years. Hard endpoints will be myocardial infarction, stroke and mortality due to cardiovascular disease.     

正常人及慢性阻塞性肺病患者的静息能量消耗

为进一步评价Harris-Benedict公式估算能量消耗的临床应用价值，采用开放式间接代谢测定仪测定65例健康成人及35例稳定期慢阻肺（COPD）患者的静息能量消耗（REE）。结果表明，65例健康成人REE为1492．15±250．83Kcal／d，比Harris-Benedict公式估算的基础能量消耗（BEE）高4．3％（P＜0．05）。35例稳定期COPD患者REE为1521．29±208．33Kcal／d，比BEE高20．39（P＜0．001），COPD患者公斤体重REE明显高于对照组（P＜0．001），且与体重占理想体重百分比及第一秒时间肺活量占预计值百分比呈显著负相关（γ值分别为－0．6，－0．57，P＜0．001）。提示CDPD患者静息能量消耗增高，且随体重及气道阻力的变化差异增大，应用HBE公式时需对其矫正。     

High neighborhood incarceration rate is associated with cardiometabolic disease in nonincarcerated black individuals

Purpose

To examine the association between residence in neighborhoods with high rates of incarceration and cardiometabolic disease among nonincarcerated individuals.