Mortality and disability among cotton mill workers

The mortality and disability of cotton mill workers were studied in five Finnish cotton mills. The population under study comprised all 1065 women exposed to raw cotton dust who had been hired between 1950 and 1971. The minimum exposure period was five years. For the study on disability, the cohort was followed up until the end of 1981. The follow up period for the mortality analysis was from 1950 to 1985. At the end of 1981 the observed number of prevalent disability pensions for respiratory disease was 15, whereas 3.9 were expected (p less than 0.01) on the basis of the national figures for women. There were 46 musculoskeletal diseases (27.7 expected, p less than 0.01), of which 24 were osteoarthritis (14.5 expected) and 13 rheumatoid arthritis (6.6 expected). The incidence rates of disability pensions were calculated for the period 1969-81. Comparison of incidence rates between cotton mill workers and the Finnish female population showed excessive rates for both respiratory diseases (p less than 0.001) and musculoskeletal diseases (p less than 0.01), with an excess of new cases of rheumatoid arthritis (p less than 0.05). By the end of 1985 the number of person-years was 31,678 and the number of deaths 95. The standardised mortality ratios for the total period of follow up (1950-85) showed no excess for respiratory diseases. Mortality from cardiovascular diseases was also lower than expected. The observed number of tumours was 33, the corresponding expected number 32.0. Thirteen tumours were in the digestive organs (6.6 expected, p<0.05) and three were lung cancers (1.9 expected). Five workers had died from renal disease; the expected number was 1.5 (p<0.05).     

National TV smoking cessation program and contest in Finland.

BACKGROUND. In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity. RESULTS: Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001). CONCLUSIONS: The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.     

Significance of false positive syphilis reactions and anticardiolipin antibodies in a nationwide series of pregnant women

The highly sensitive rapid plasma reagin (RPR) and Treponema pallidum hemagglutination tests were used to determine the frequency of false positive syphilis reactions in a nationwide series of pregnant women in Finland. The frequency found was 14/10,000. Two cases of systemic lupus and 2 of undefined connective tissue disease were found during a 20-month period among 134 false positive reactors in a series of 110,000 separate pregnancies. The risk of subsequent fetal loss among false positive syphilis reactors was 7%, similar to the risk in RPR negative controls. Half of the sera in the highest RPR titer groups and 1/3 in the lowest titer groups had elevated levels of anticardiolipin antibodies in solid-phase enzyme immunoassay. This assay did not increase the risk of clinical disease or subsequent fetal loss above the risk of RPR test alone.     

Allogeneic bone marrow transplantation in multiple myeloma: a report of four cases

Allogeneic bone marrow transplantation offers a new and promising form for treatment of multiple myeloma incurable with chemotherapy. We present four cases of advanced multiple myeloma given bone marrow transplantation from HLA-identical and MLC-negative sibling donors. One patient had a recurrent plasmacytoma 8 months later and one died 12 days after the transplantation whereas the other two are in good clinical remission 15 and 19 months post-transplantation.     

Effect of cohort definition and follow-up length on occupational mortality rates

The purpose of this study was to clarify the effects of cohort formation, period of entry, and period of follow-up on occupational mortality figures. The study material comprised three cohorts of metal industry workers (6 415 iron foundry workers, 3 901 metal product workers, and 5 398 workers manufacturing electrical devices). The men, hired between 1950 and 1976, were followed until the end of 1978. The number of person-years was approximately 215 800. Different cohort formation criteria and variations in the follow-up modify the results of occupational mortality studies. A cross-sectionally based cohort (workers employed in a certain year or years) produces results different from those for an open cohort (new workers hired during a certain period of time) although the cohorts are formed from the same workplaces. The cohorts for retrospective cohort studies usually contain various periods of entry, periods of follow-up, and age structures. Increased or decreased mortality in a cohort depends on this internal structure. The structure of the cohort becomes especially important when a certain cause of death is concentrated in certain age classes and/or when a period of latency is required, as for tumors. In an attempt to reveal this internal structure the three cohorts were analyzed in five-year calendar periods and stratified according to the length of follow-up. The mortality pattern remained nearly unchanged when the number of periods of entry increased, and it was also comparable with the mortality pattern of the general male population.(ABSTRACT TRUNCATED AT 250 WORDS)     

Gestational diabetes identifies women at risk for permanent type 1 and type 2 diabetes in fertile age: predictive role of autoantibodies

OBJECTIVE: Our aim was to evaluate the predictive value of gestational diabetes mellitus (GDM), diabetes-associated autoantibodies, and other factors for development of clinical diabetes later in life. RESEARCH DESIGN AND METHODS: In this case-control study the presence of autoantibodies was studied in 435 women with GDM and in healthy matched control subjects. The need for exogenous insulin during GDM was recorded. In the GDM group, the mean follow-up period was 5.7 years and in the control group 6.1 years. RESULTS: Among the subjects with GDM, 20 (4.6%) developed type 1 diabetes and 23 (5.3%) developed type 2 diabetes, whereas none of the control subjects became diabetic. Two-thirds of those who developed type 1 diabetes tested positive initially for islet cell antibodies (ICAs), whereas 56% of them had autoantibodies to GAD (GADAs) and 38% to the protein tyrosine phosphatase-related IA-2 molecule. Only 2 of the 23 women who presented later with type 2 diabetes tested positive for autoantibodies. According to multivariate analysis, initial age < or =30 years, the need for insulin treatment for GDM, and antibody positivity for ICAs and GADAs were associated with increased risk for clinical type 1 diabetes. CONCLUSIONS: Pregnancy seems to identify women who are at risk of developing diabetes later in life. About 10% of Finnish women with GDM will develop diabetes over the next 6 years; nearly half of them develop type 1 diabetes and the other half type 2 diabetes. Age < or =30 years, the need for insulin treatment during pregnancy, and positivity for ICAs and GADAs confer a high risk of subsequent progression to type 1 diabetes in women affected by GDM.     

Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men

PURPOSE: To describe the 30-year cumulative incidence of chronic bronchitis and COPD in relation to smoking habits. The effect of chronic bronchitis on pulmonary function and mortality was also examined. METHODS: Middle-aged men belonging to two rural Finnish cohorts of the Seven Countries Study (n = 1,711 in 1959) were followed up for up to 40 years until 2000. Standard questionnaires were used to measure chronic bronchitis, and repeated spirometry was used to evaluate pulmonary function during the 30 years. Forty-year mortality data were examined. RESULTS: The cumulative incidence of chronic bronchitis and COPD was 42% and 32%, respectively, in continuous smokers, compared to 26% and 14% in ex-smokers and 22% and 12% in never-smokers. During the follow-up, subjects with chronic bronchitis had on average 252 mL (95% confidence interval, 211 to 293 mL) lower forced expiratory volume than those without it. The decrease in forced expiratory volume attributable to chronic bronchitis was most pronounced in those with persistent symptoms and in smokers. In subjects with chronic bronchitis, all-cause mortality was increased by a hazard ratio of 1.30 (95% confidence interval, 1.02 to 1.65). Smokers with chronic bronchitis who decreased their daily cigarette consumption increased their median life span by 2.4 years. CONCLUSIONS: The lifetime risk of chronic bronchitis among smokers is approximately two in five, and almost one half of smokers who have chronic bronchitis also acquire COPD. Chronic bronchitis is related to earlier death, also in never-smokers, probably partly through a rapid decline in pulmonary function.     

Stewart-Hamilton and gamma variate methods in computer analysis of dye curves

The conventional Stewart-Hamilton (SH) principle was compared to the gamma variate function fitting (G) method in on-line computer determination of cardiac output from dye dilution curves on anaesthetized animals (dogs, cats and reindeer). and on an artificial circulation model with known flows. In animal experiments, indicator was injected into the pulmonary artery (n = 674), the coefficient of linear correlation (R_lin) between G and SH was 0.982, and the regression line of G was 1.101 × SH-0.072 l/min. When the right atrium was the site of indicator injection (n = 88). R_lin was 0.982, and the regression line nearly agreed with the line of unity. In the artificial circulation model with the single circulation arrangement (n = 81), R_lin between SH and known flow (Q) was 0.059, and between G and Q it was 0.051; both methods over-estimated the flows, with the over-estimation being greater in the case of G. In the artificial model with recirculation effect (n = 31). R_lin between SH and Q was 0.953, and between G and Q 0.942, G again over-estimating the real flow essentially more than SH. Thus, in most cases the Stewart-Hamilton principle seems to be the more reliable way of analysis of dye dilution curves also in modern computer practice.