A multi-cancer site, multi-factor, case-referent study was undertaken to generate hypotheses about possible occupational carcinogens. About 20 types of cancer were included. Incident cases among men aged 35-70 years and diagnosed in any of the major Montreal hospitals were eligible. Probing interviews were carried out for 3 726 eligible cases. The interview was designed to obtain detailed lifetime job histories and information on potential confounders. Each job history was reviewed by a team of chemists who translated it into a history of occupational exposures. These occupational exposures were then analyzed as potential risk factors in relation to the sites of cancer included. For each site of cancer analyzed, referents were selected from among the other sites in the study. The analysis was carried out in stages. First a Mantel-Haenszel analysis was undertaken of all cancer-substance associations, stratifying on a limited number of covariates, and, then, for those associations which were noteworthy in the initial analysis, a logistic regression analysis was made taking into account all potential confounders. This report describes the fieldwork and analytical methods.
Coronary risk factors and levels of physical activity at leisure were measured in a random sample of 3975 men 25-64 years of age residing in four areas of Finland. An index of leisure-time physical activity (LTPA) as the product of weekly exercise sessions times their usual intensity (expressed as metabolic equivalents) was computed. It showed a graded, inverse association with mean arterial blood pressure, smoking and serum thiocyanate, coronary heart disease risk estimate (combining blood pressure, total cholesterol and smoking), and a nonlinear favorable association with serum lipoproteins. In multiple regression analysis, LTPA contributed significantly and independently to the variation in mean arterial pressure; the standardized regression coefficients were -0.06 for LTPA, 0.09 for weekly alcohol consumption, 0.25 for body mass index, 0.25 for age. In the regression of coronary risk estimate, the standardized regression coefficients were -0.19 for LTPA, 0.22 for weekly alcohol consumption, 0.09 for body mass index, 0.15 for age. There was no evidence that LTPA above 2000 kcal of weekly energy expenditure was associated with further reduced coronary risk factor levels. These findings thus support the inverse direction of the association between exercise and coronary risk factors but they also point towards an independent, but modest, role of leisure-time physical activity as a determinant of coronary risk estimate and blood pressure.
After two cases of acute hepatitis B infection occurred in phlebotomists at The Hospital for Sick Children in 1985, a seroprevalence survey of hepatitis B virus markers was undertaken. Directors in high-risk areas were advised by phone and memorandum to screen employees. Participation was entirely voluntary, and employees who did not respond were contacted six weeks after initial notification. Information obtained from each participant through a self-administered questionnaire included age, duration of employment in current pediatric occupation, history of blood transfusions, immune globulin prophylaxis, needlestick injury, and country of birth (North America/United Kingdom or other). Sera identified by code were tested by radioimmunoassay. Interactions were analyzed by using a multiple logistic regression model. A total of 10% of the personnel in high-risk areas, in which there was frequent exposure to blood or blood products, had hepatitis B markers in their blood, compared with 2% who did not have this exposure. Birthplace and occupation have independently significant effects on the likelihood of having hepatitis B markers. There appears to be an increased risk to employees in pediatric units, depending on the patient (and parent) population being served, although the risk may be lower than in adult hospitals.
Air pollution data from 17 sampling stations between Windsor and Peterborough in Southern Ontario, for January, February, July, and August in 1974 and 1976 to 1983, have been analyzed. Each station reported O3, NO3, SO2, and the coefficient of haze (COH) every hour and aerosol sulfates for a 24-hr period every sixth day using glass-fiber filters. Data on mean daily temperature and relative humidity for the region were also recorded. It is shown that there are high correlations between different pollutants and between these and temperature in the summer. In the summer, sulfate levels were significantly correlated with relative humidity. In winter, the highest correlation was between COH and NO2. Over the 9-year period, SO2 levels in both winter and summer have fallen considerably; there have been no significant trends in O3, NO3, or COH data. Aerosol sulfates increased between 1976 and 1980 in both summer and winter and have since declined slightly. Hospital admission data for the 79 acute care hospitals serving the region, which contains about 5.9 million people, have been analyzed on a daily basis for the same months of the same years. Total admissions and total respiratory admissions have declined about 15% over the period, but asthma admissions appear to have risen. The asthma category of admissions is complicated by the effects of a change in ICD coding in 1979. It has been shown that significant correlations exist between O3, SO4, SO2, and temperature, on the one hand, and deviations from the mean respiratory admissions for that day of the week, for that season, for that year, on the other. These correlations exist if asthma is excluded from the diagnoses. In winter, asthma admissions are correlated with temperature only. A group of nonrespiratory conditions showed no correlations with air pollutants in winter or summer. Stepwise multiple regression analysis based on each year considered individually indicates that in summer SO4 and temperature account for about 5% of the variance in respiratory or asthma admissions. It is shown that the mean of the hourly ozone maxima has a high correlation with the maximal 8-hr average for ozone, and that using this index instead of the mean of the hourly maxima does not increase the correlation coefficient with respiratory disease. Another analysis has been performed by grouping the hospitals and sampling stations into nine separate regions.(ABSTRACT TRUNCATED AT 400 WORDS)
Repeat coronary angiography was performed within 6 months after successful percutaneous transluminal coronary angioplasty (PTCA) in 178 of our first 181 patients (98%). The remaining 3 patients were symptom free, had negative treadmill exercise test results and were considered not to have had restenosis. A second follow-up angiogram was performed in 107 patients (59%), including all patients with persistent or recurrent anginal symptoms, between 7 and 18 months after PTCA. Fifty-one of the 181 patients (28%) had restenosis on 51 of 205 successfully dilated segments (25%). The stenosis was greater than or equal to 70% in 49 of these 51 segments; it was 65% and 55%, respectively, in the 2 remaining patients. Restenosis was documented angiographically at a median time of 4.7 +/- 4 months. However, 47 patients (92%) had restenosis documented within 6 months, 2 between 7 and 12 months and 2 between 13 and 18 months after PTCA. Stepwise logistic regression analysis selected the following factors as independent predictors of restenosis after PTCA: variant angina, multivessel disease, severity of residual stenosis and less reduction in the diameter of the stenosis on the angiogram immediately after PTCA. Of these 4 factors, the degree of residual stenosis immediately after PTCA was by far the most significant. It is concluded that restenosis occurs in approximately 25% of patients, almost always within the first 6 months, after successful PTCA. The degree of residual stenosis after PTCA is the most important predictor of restenosis. Increased experience and improved instrumentation may eventually lead to less residual stenosis and better late results after PTCA.
This study employs the individual as the unit of analysis to examine the relative importance of medical need, sociodemographic and economic factors in determining the use or non-use of hospital care and the volume of service consumed by those who experienced an episode of hospitalization during the study period. The data were derived from the Canada Health Survey which is a stratified, multistaged sample of the entire population. The results of the discriminant and weighted regression analyses indicate that the use or non-use of hospital care and the volume of service consumed are largely determined by medical need and not by income. The findings are supportive of the view that the national health insurance scheme in Canada has resulted in a more equitable distribution of hospital care.
Low vitamin D status increases the risk of death. Magnesium plays an essential role in vitamin D metabolism and low magnesium intake may predispose to vitamin D deficiency and potentiate the health problems. We investigated whether magnesium intake modifies the serum 25(OH)D3 concentration and its associations with mortality in middle-aged and older men. We included 1892 men aged 42-60 years without cardiovascular disease or cancer at baseline in 1984-1989 from the prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor Study. Serum 25(OH)D3 was measured with the high-performance liquid chromatography using coulometric electrode array detection. Magnesium intake was assessed with 4-day food recording. Deaths were ascertained by a computer linkage to the national cause of death register. Deaths due accidents and suicides were excluded. Cox proportional hazards regression models were used to analyze the associations. The multivariate-adjusted hazard ratio (HR) for death in the lowest (49.4 nmol/L) serum 25(OH)D3 tertile was 1.31 (95 % CI 1.07-1.60, Ptrend = 0.01). Stratified by the magnesium intake, the higher risk was observed only in the lower magnesium intake median (
There is little research-based documentation on the services provided by drug information centres (DICs). The aim of this multi-centre study was to explore for the first time the factors associated with time consumption when answering drug-related queries at eight different but comparable DICs.
During an 8-week period, staff members at eight Scandinavian DICs recorded the number of minutes during which they responded to queries. Mixed model linear regression analyses were used to explore the factors associated with time consumption when answering queries.
The mean time consumption per query was 178 min (range 4-2540 min). The mean time consumed per query increased by 28 (95 % confidence interval (CI) 23 to 33, p?
Cites: Am J Hosp Pharm. 1986 May;43(5):1226-93717179
Common mental disorders (CMD) have become one of the leading causes for disability pension (DP). Studies on predictors of adverse health outcome following DP are sparse. This study aimed to examine the association of different socio-demographic factors and health care consumption with subsequent suicidal behaviour among individuals on DP due to CMD.
This is a population-based prospective cohort study based on register data. All individuals aged 18-64 years, living in Sweden on 31-Dec-2004 who in 2005 were on DP due to CMD (N?=?46 745) were followed regarding suicide attempt and suicide (2006-10). Univariate and multivariate hazard ratios (HR) and 95% confidence intervals (CI) for suicidal behaviour were estimated by Cox regression.
During the five-year follow-up, 1 046 (2.2%) and 210 (0.4%) individuals attempted and committed suicide, respectively. Multivariate analyses showed that young age (18-24 years) and low education predicted suicide attempt, while living alone was associated with both higher suicide attempt and suicide (range of HRs 1.23 to 1.68). Combined prescription of antidepressants with anxiolytics during 2005 and inpatient care due to mental diagnoses or suicide attempt (2001-05) were strongly associated with suicide attempt and suicide (range of HRs 1.3 to 4.9), while inpatient care due to somatic diagnoses and specialized outpatient care due to mental diagnoses during 2001-05 only predicted suicide attempt (HR 1.45; 95% CI: 1.3-1.7; HR 1.30; 95% CI: 1.1-1.7).
Along with socio-demographic factors, it is very important to consider type of previous healthcare use and medication history when designing further research or intervention aiming at individuals on DP due to CMD. Further research is warranted to investigate both characteristics of disability pension due to CMD, like duration, diagnoses and grade as well as mechanisms to subsequent suicidal behavior, taking potential gender differences into consideration.
Cites: Scand J Public Health Suppl. 2004;63:207-1515513658
Cites: Eur J Public Health. 2010 Jun;20(3):265-7019933779
Cites: BMC Public Health. 2011;11:45021658213
Cites: Psychiatry Res. 2011 Dec 30;190(2-3):265-7021890214
Having a low level of education has been associated with worse physical performance. However, it is unclear whether this association varies by age, gender or the occupational categories of manual and non-manual work. This study examined whether there are education-related differences across four dimensions of physical performance by age, gender or occupational class and to what extent chronic diseases and lifestyle-related factors may explain such differences.
Participants were a random sample of 3212 people, 60 years and older, both living in their own homes and in institutions, from the Swedish National Study on Aging and Care, in Kungsholmen, Stockholm. Trained nurses assessed physical performance in grip strength, walking speed, balance and chair stands, and gathered data on education, occupation and lifestyle-related factors, such as physical exercise, body mass index, smoking and alcohol consumption. Diagnoses of chronic diseases were made by the examining physician.
Censored normal regression analyses showed that persons with university education had better grip strength, balance, chair stand time and walking speed than people with elementary school education. The differences in balance and walking speed remained statistically significant (p?