Occupational skin diseases (OSDs) often have considerable medical and occupational consequences. Previous data on prognostic factors have been derived from studies with fairly small sample sizes.
To determine the medical and occupational outcome in 1048 patients diagnosed with OSD at the Finnish Institute of Occupational Health and to identify the prognostic risk factors for the continuation of OSD.
Patients examined in 1994-2001 filled out a follow-up questionnaire 6 months after the diagnosis. Data on atopy, contact allergies, and occupation were analysed.
Six months after the diagnosis the skin disease had healed in 27% of the patients. The OSD had cleared up in 17% of those with no changes at work, and in 34% of those who had changed their job/occupation. The best clearing had occurred in the patients with contact urticaria (35%), whereas the healing of allergic (27%) and irritant (23%) contact dermatitis was similar. The risk factors for continuing occupational contact dermatitis (OCD) were no changes in work, age > 45 years, food-related occupations, respiratory atopy, and male sex.
The healing of OSD was associated with discontinuation of the causative exposure. A change in work and the presence of easily avoidable work-related allergies were associated with a good prognosis.
BACKGROUND: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. METHODS: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CI) were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. RESULTS: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-12.8), lung cancer (IRR, 2.2; 95% CI, 0.8-5.9), and smoking-related cancer overall (IRR, 1.4; 95% CI, 0.7-2.5) tended to be increased among nonparticipants relative to participants. Standardized incidence ratios for most of the studied cancers tended to be >1.0 among nonparticipants and
BACKGROUND: The Edinburgh randomised trial of breast-cancer screening recruited women aged 45-64 years from 1978 to 1981 (cohort 1), and those aged 45-49 years during 1982-85 (cohorts 2 and 3). Results based on 14 years of follow-up and 270,000 woman-years of observation are reported. METHODS: Breast-cancer mortality rates in the intervention group (28,628 women offered screening) were compared with those in the control group (26,026) with adjustment for socioeconomic status (SES) of general medical practices. Rate ratios were derived by means of logistic regression for the total trial population and for women first offered screening while younger than 50 years. Analyses were by intention to treat. FINDINGS: Initial unadjusted results showed a difference of just 13% in breast-cancer mortality rates between the intervention and control groups (156 deaths [5.18 per 10,000] vs 167 [6.04 per 10,000]; rate ratio 0.87 [95% CI 0.70-1.06]), but the results were influenced by differences in SES by trial group. After adjustment for SES, the rate ratio was 0.79 (95% CI 0.60-1.02). When deaths after diagnosis more than 3 years after the end of the study were censored the rate ratio became 0.71 (0.53-0.95). There was no evidence of heterogeneity by age at entry and no evidence that younger entrants had smaller or delayed benefit (rate ratio 0.70 [0.41-1.20]). No breast-cancer mortality benefit was observed for women whose breast cancers were diagnosed when they were younger than 50 years. Other-cause mortality rates did not differ by trial group when adjusted for SES. INTERPRETATION: Our findings confirm results from randomised trials in Sweden and the USA that screening for breast cancer lowers breast-cancer mortality. Similar results are reported by the UK geographical comparison, UK Trial of Early Detection of Breast Cancer. The results for younger women suggest benefit from introduction of screening before 50 years of age.
Comment In: Lancet. 1999 Jun 5;353(9168):1896-710371561
Viral hepatitis has been known to occur among the Greenland population endemically as well as in smaller and larger epidemics. A large epidemic of acute hepatitis comprising around 9% of the entire population, viz. more than 4000 notified cases, swept through Greenland between October 1970 and December 1972. 996 verified cases were seen in the Godthaab district and subjected to more detailed studies. Most of the Godthaab cases were seen among children and adolescents, and no disease was observed in children less than one year of age. Out of 996 diagnosed cases 9 showed acute hepatic failure with coma. Two further cases of hepatic coma were referred for treatment from outside the district. Three of these 11 patients recovered spontaneously. Of the residual 8 cases 6 were treated with exchange transfusions and steroids. Four of these survived and recovered completely. No lasting sequelae had been registered in any of the surviving cases of the epidemic up to June 1975 (2 1/2 years after cessation of the epidemic). Prophylaxis with gamma-globulin was undertaken in a medium-sized settlement in which practically the entire population received gamma-globulin when the first case of hepatitis was diagnosed. In this settlement only 7 out of 297 inhabitants contracted hepatitis. By contrast, in a similar settlement where no gamma-globulin was given, more than 30% of the population developed icteric hepatitis. The clinical features and the prophylactic effect of gamma-globulin seem to indicate that the epidemic was caused by the hepatitis A virus. In accordance with this, transitory Australia-antigenaemia was demonstrated in the acute phase in only 2.6% of the cases, possibly inidicating a small admixture of acute hepatitis type B to the epidemic predominantly caused by hepatitis A virus.
To revise and expand the 1992 edition of the clinical practice guidelines for the management of diabetes in Canada incorporating recent advances in diagnosis and outpatient management of diabetes mellitus and to identify and assess the evidence supporting these recommendations.
All aspects of ambulatory diabetes care, including organization, responsibilities, classification, diagnosis, management of metabolic disorders, and methods for screening, prevention and treatment of complications in all forms of diabetes were reviewed, revised as required and expressed as a set of recommendations.
Reclassification of types of diabetes based on pathogenesis; increased sensitivity of diagnostic criteria; recommendations for screening for diabetes; improved delivery of care; recommendations for tighter metabolic control; and optimal methods for screening, prevention and treatment of complications of diabetes.
All recommendations were developed using a justifiable and reproducible process involving an explicit method for the citation and evaluation of the supporting evidence.
All recommendations were reviewed by an expert committee that included people with diabetes, family physicians, dietitians, nurses, diabetologists, as well as other subspecialists and methodologists from across Canada.
More aggressive screening strategies and more sensitive testing and diagnostic procedures will allow earlier detection and management of diabetes. Cost-effectiveness analyses suggest that this will lead to savings in health care costs relating to diabetes care by reducing the incidence of complications of diabetes. Similarly, tighter metabolic control in most people with diabetes, through intensive diabetes management, seeks to reduce the incidence of complications and, hence, their associated social and economic burdens.
This document contains numerous detailed recommendations pertaining to all aspects of ambulatory diabetes care, ranging from service delivery to prevention and treatment of diabetes-related complications. The terms "insulin-dependent diabetes mellitus" and "non-insulin-dependent diabetes mellitus" should be replaced by the terms "type 1" and "type 2" diabetes. Testing for diabetes using fasting plasma glucose (FPG) level should be performed every 3 years in those over 45 years of age. More frequent or earlier testing should be considered for people with additional specific risk factors for diabetes. The FPG level at which diabetes is diagnosed should be reduced from 7.8 to 7.0 mmol/L to improve the sensitivity of the main diagnostic criterion and reduce the number of missed diagnoses. Depending on the type of diabetes and the therapy required to achieve euglycemia, people with diabetes should generally strive for close metabolic control to achieve optimal glucose levels. This entails receiving appropriate diabetes education through a diabetes health care team, diligent self-monitoring of blood glucose, attention to lifestyle and adjustments in diet and physical activity, and the appropriate and stepwise use of oral agents and insulin therapies needed to maintain glycemic control. Also highlighted is the need for appropriate surveillance programs for complications and management options.
All recommendations were graded according to the strength of the evidence and consensus of all relevant stakeholders. Collateral efforts of the American Diabetes Association and the World Health Organization and the input of international experts were also considered throughout the revision process.
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The objective of this study was to evaluate the impact of the 2005 British Columbia Ministry of Health Smoking Cessation Mass Media Campaign on short-term smoking behavior.
National cross-sectional data are used with a quasi-experimental approach to test the impact of the campaign.
Findings indicate that prevalence and average number of cigarettes smoked per day deviated upward from trend for the rest of Canada (P = .08; P = .01) but not for British Columbia. They also indicate that British Columbia smokers in lower risk groups reduced their average daily consumption of cigarettes over and above the 1999-2004 trend (-2.23; P = .10), whereas smokers in the rest of Canada did not, and that British Columbia smokers in high-risk groups did not increase their average daily consumption of cigarettes over and above the 1999-2004 trend, whereas smokers in the rest of Canada did (2.97; P = .01).
The overall poorer performance of high-risk groups is attributed to high exposure to cigarette smoking, which reduces a smoker's chances of successful cessation. In particular, high-risk groups are by definition more likely to be exposed to smoking by peers, but are also less likely to work in workplaces with smoking bans, which are shown to have a substantial impact on prevalence. Results suggest that for mass media campaigns to be more effective with high-risk groups, they need to be combined with other incentives, and that more prolonged interventions should be considered.