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Cancer mortality among man-made vitreous fiber production workers.

https://arctichealth.org/en/permalink/ahliterature22108
Source
Epidemiology. 1997 May;8(3):259-68
Publication Type
Article
Date
May-1997
Author
P. Boffetta
R. Saracci
A. Andersen
P A Bertazzi
J. Chang-Claude
J. Cherrie
G. Ferro
R. Frentzel-Beyme
J. Hansen
J. Olsen
N. Plato
L. Teppo
P. Westerholm
P D Winter
C. Zocchetti
Author Affiliation
International Agency for Research on Cancer, Lyon, France.
Source
Epidemiology. 1997 May;8(3):259-68
Date
May-1997
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Confidence Intervals
Europe - epidemiology
Female
Humans
Lung Neoplasms - etiology - mortality
Male
Middle Aged
Mineral Fibers - adverse effects
Neoplasms - etiology - mortality
Occupational Diseases - etiology - mortality
Research Support, Non-U.S. Gov't
Risk
Risk factors
Time Factors
Abstract
We have updated the follow-up of cancer mortality for a cohort study of man-made vitreous fiber production workers from Denmark, Finland, Norway, Sweden, United Kingdom, Germany, and Italy, from 1982 to 1990. In the mortality analysis, 22,002 production workers contributed 489,551 person-years, during which there were 4,521 deaths. Workers with less than 1 year of employment had an increased mortality [standardized mortality ratio (SMR) = 1.45; 95% confidence interval (CI) = 1.37-1.53]. Workers with 1 year or more of employment, contributing 65% of person-years, had an SMR of 1.05 (95% CI = 1.02-1.09). The SMR for lung cancer was 1.34 (95% CI = 1.08-1.63, 97 deaths) among rock/slag wool workers and 1.27 (95% CI = 1.07-1.50, 140 deaths) among glass wool workers. In the latter group, no increase was present when local mortality rates were used. Among rock/slag wool workers, the risk of lung cancer increased with time-since-first-employment and duration of employment. The trend in lung cancer mortality according to technologic phase at first employment was less marked than in the previous follow-up. We obtained similar results from a Poisson regression analysis limited to rock/slag wool workers. Five deaths from pleural mesothelioma were reported, which may not represent an excess. There was no apparent excess for other categories of neoplasm. Tobacco smoking and other factors linked to social class, as well as exposures in other industries, appear unlikely to explain the whole increase in lung cancer mortality among rock/slag wool workers. Limited data on other agents do not indicate an important role of asbestos, slag, or bitumen. These results are not sufficient to conclude that the increased lung cancer risk is the result of exposure to rock/slag wool; however, insofar as respirable fibers were an important component of the ambient pollution of the working environment, they may have contributed to the increased risk.
Notes
Comment In: Epidemiology. 1998 Mar;9(2):218-9; author reply 219-209504299
Comment In: Epidemiology. 1998 Mar;9(2):218; author reply 214-209504298
PubMed ID
9115020 View in PubMed
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Cancer mortality in an international cohort of workers exposed to styrene.

https://arctichealth.org/en/permalink/ahliterature24249
Source
IARC Sci Publ. 1993;(127):289-300
Publication Type
Article
Date
1993
Author
M. Kogevinas
G. Ferro
R. Saracci
A. Andersen
M. Biocca
D. Coggon
V. Gennaro
S. Hutchings
H. Kolstad
I. Lundberg
Author Affiliation
Unit of Analytical Epidemiology, International Agency for Research on Cancer, Lyon, France.
Source
IARC Sci Publ. 1993;(127):289-300
Date
1993
Language
English
Publication Type
Article
Keywords
Cohort Studies
Europe - epidemiology
Female
Humans
Leukemia - chemically induced - mortality
Lymphoma - chemically induced - mortality
Male
Neoplasms - chemically induced - mortality
Occupational Diseases - chemically induced - mortality
Research Support, Non-U.S. Gov't
Styrene
Styrenes - adverse effects
Abstract
Increased risks for leukaemia and lymphoma have been suggested in studies of workers exposed to styrene in the rubber and plastics industry. A historical cohort study was conducted in Denmark, Finland, Italy, Norway, Sweden and the United Kingdom involving 40,683 workers employed in the reinforced plastics industry, where high exposure to styrene occurs. Exposure to styrene was reconstructed through job histories, environmental and biological monitoring data and production records of the plants in the study. Cause-specific national death rates were used as the reference. Among exposed workers, no excess was observed for mortality from all causes (2195 deaths, standardized mortality ratio [SMR], 95; 95% confidence interval [CI], 91-99), from all neoplasms, from lung cancer or from other major epithelial cancers. Mortality from neoplasms of the lymphatic and haematopoietic tissues was not elevated (50 deaths; SMR, 96; CI, 71-126) and was not consistently associated with length of exposure. The rate of mortality from leukaemias and lymphomas increased with time since first exposure. Among subjects who had been exposed for more than one year, a two-fold risk was observed 20 years after first exposure (eight deaths; SMR, 197; CI, 85-387). These results are inadequate to exclude the possibility that styrene causes leukaemia and lymphoma.
PubMed ID
8070875 View in PubMed
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Consumption of added fats and oils in the European Prospective Investigation into Cancer and Nutrition (EPIC) centres across 10 European countries as assessed by 24-hour dietary recalls.

https://arctichealth.org/en/permalink/ahliterature18552
Source
Public Health Nutr. 2002 Dec;5(6B):1227-42
Publication Type
Article
Date
Dec-2002
Author
J. Linseisen
E. Bergström
L. Gafá
C A González
A. Thiébaut
A. Trichopoulou
R. Tumino
C. Navarro Sánchez
C. Martínez Garcia
I. Mattisson
S. Nilsson
A. Welch
E A Spencer
K. Overvad
A. Tjønneland
F. Clavel-Chapelon
E. Kesse
A B Miller
M. Schulz
K. Botsi
A. Naska
S. Sieri
C. Sacerdote
M C Ocké
P H M Peeters
G. Skeie
D. Engeset
U R Charrondière
N. Slimani
Author Affiliation
Unit of Human Nutrition and Cancer Prevention, Technical University of Munich, Alte Akademie 16, D-85350 Freising-Weihenstephan, Germany. j.linseisen@wzw.tum.de
Source
Public Health Nutr. 2002 Dec;5(6B):1227-42
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Diet Surveys
Dietary Fats - administration & dosage - adverse effects
Educational Status
Energy intake
Europe
Female
Humans
Male
Mental Recall
Middle Aged
Neoplasms - etiology
Population Surveillance - methods
Prospective Studies
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To evaluate the consumption of added fats and oils across the European centres and countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: 24-Hour dietary recalls were collected by means of standardised computer-guided interviews in 27 redefined EPIC centres across 10 European countries. SUBJECTS: From an initial number of 36 900 subjects, single dietary recalls from 22 924 women and 13 031 men in the age range of 35-74 years were included. RESULTS: Mean daily intake of added fats and oils varied between 16.2 g (Varese, Italy) and 41.1 g (Malmö, Sweden) in women and between 24.7 g (Ragusa, Italy) and 66.0 g (Potsdam, Germany) in men. Total mean lipid intake by consumption of added fats and oils, including those used for sauce preparation, ranged between 18.3 (Norway) and 37.2 g day-1 (Greece) in women and 28.4 (Heidelberg, Germany) and 51.2 g day-1 (Greece) in men. The Mediterranean EPIC centres with high olive oil consumption combined with low animal fat intake contrasted with the central and northern European centres where fewer vegetable oils, more animal fats and a high proportion of margarine were consumed. The consumption of added fats and oils of animal origin was highest in the German EPIC centres, followed by the French. The contribution of added fats and oils to total energy intake ranged from 8% in Norway to 22% in Greece. CONCLUSIONS: The results demonstrate a high variation in dietary intake of added fats and oils in EPIC, providing a good opportunity to elucidate the role of dietary fats in cancer aetiology.
PubMed ID
12639229 View in PubMed
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Consumption of dairy products in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort: data from 35 955 24-hour dietary recalls in 10 European countries.

https://arctichealth.org/en/permalink/ahliterature18551
Source
Public Health Nutr. 2002 Dec;5(6B):1259-71
Publication Type
Article
Date
Dec-2002
Author
A. Hjartåker
A. Lagiou
N. Slimani
E. Lund
M D Chirlaque
E. Vasilopoulou
X. Zavitsanos
F. Berrino
C. Sacerdote
M C Ocké
P H M Peeters
D. Engeset
G. Skeie
A. Aller
P. Amiano
G. Berglund
S. Nilsson
A. McTaggart
E A Spencer
K. Overvad
A. Tjønneland
F. Clavel-Chapelon
J. Linseisen
M. Schulz
B. Hemon
E. Riboli
Author Affiliation
Section of Medical Statistics, University of Oslo, PO Box 1122, Blindern, N-0317 Norway. anette.hjartaker@basalmed.uio.no
Source
Public Health Nutr. 2002 Dec;5(6B):1259-71
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Dairy Products
Diet
Diet Surveys
Europe
Female
Humans
Male
Mental Recall
Middle Aged
Population Surveillance - methods
Prospective Studies
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVES: To describe and compare the consumption of dairy products in cohorts included in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Data from single 24-hour dietary recall interviews collected through a highly standardised computer-based program (EPIC-SOFT) in 27 redefined centres in 10 European countries between 1995 and 2000. From a total random sample of 36 900, 22 924 women and 13 031 men were selected after exclusion of subjects under 35 and over 74 years of age. RESULTS: A high total consumption of dairy products was reported in most of the centres in Spain and in the UK cohort sampled from the general population, as well as in the Dutch, Swedish and Danish centres. A somewhat low consumption was reported in the Greek centre and in some of the Italian centres (Ragusa and Turin). In all centres and for both sexes, milk constituted the dairy sub-group with the largest proportion (in grams) of total dairy consumption, followed by yoghurt and other fermented milk products, and cheese. Still, there was a wide range in the contributions of the different dairy sub-groups between centres. The Spanish and Nordic centres generally reported a high consumption of milk, the Swedish and Dutch centres reported a high consumption of yoghurt and other fermented milk products, whereas the highest consumption of cheese was reported in the French centres. CONCLUSION: The results demonstrate both quantitative and qualitative disparities in dairy product consumption among the EPIC centres. This offers a sound starting point for analyses of associations between dairy intake and chronic diseases such as cancer.
PubMed ID
12639231 View in PubMed
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Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project.

https://arctichealth.org/en/permalink/ahliterature18549
Source
Public Health Nutr. 2002 Dec;5(6B):1311-28
Publication Type
Article
Date
Dec-2002
Author
N. Slimani
M. Fahey
A A Welch
E. Wirfält
C. Stripp
E. Bergström
J. Linseisen
M B Schulze
C. Bamia
Y. Chloptsios
F. Veglia
S. Panico
H B Bueno-de-Mesquita
M C Ocké
M. Brustad
E. Lund
C A González
A. Barcos
G. Berglund
A. Winkvist
A. Mulligan
P. Appleby
K. Overvad
A. Tjønneland
F. Clavel-Chapelon
E. Kesse
P. Ferrari
W A Van Staveren
E. Riboli
Author Affiliation
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France. Slimani@iarc.fr
Source
Public Health Nutr. 2002 Dec;5(6B):1311-28
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cultural Diversity
Diet
Diet Surveys
Europe
Female
Food Habits
Humans
Male
Mental Recall
Middle Aged
Population Surveillance - methods
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. SUBJECTS: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study. RESULTS: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. CONCLUSIONS: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.
PubMed ID
12639235 View in PubMed
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End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries. EURONIC Study Group.

https://arctichealth.org/en/permalink/ahliterature58736
Source
Lancet. 2000 Jun 17;355(9221):2112-8
Publication Type
Article
Date
Jun-17-2000
Author
M. Cuttini
M. Nadai
M. Kaminski
G. Hansen
R. de Leeuw
S. Lenoir
J. Persson
M. Rebagliato
M. Reid
U. de Vonderweid
H G Lenard
M. Orzalesi
R. Saracci
Author Affiliation
Epidemiology Unit, Burlo Garofolo Children's Hospital, Trieste, Italy. cuttini@burlo.trieste.it
Source
Lancet. 2000 Jun 17;355(9221):2112-8
Date
Jun-17-2000
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Decision Making
Ethics, Medical
Europe
Euthanasia, Passive - psychology
Female
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Logistic Models
Male
Physician's Role
Questionnaires
Research Support, Non-U.S. Gov't
Respiration, Artificial
Abstract
BACKGROUND: The ethical issue of foregoing life-sustaining treatment for newborn infants at high risk of death or severe disability is extensively debated, but there is little information on how physicians in different countries actually confront this issue to reach end-of-life decisions. The EURONIC project aimed to investigate practices as reported by physicians themselves. METHODS: The study recruited a large, representative sample of 122 neonatal intensive-care units (NICUs) by census (in Luxembourg, the Netherlands, and Sweden) or stratified random sampling (in France, Germany, the UK, Italy, and Spain) with an overall response rate of 86%. Physicians' practices of end-of-life decision-making were investigated through an anonymous, self-administered questionnaire. 1235 completed questionnaires were returned (response rate 89%). FINDINGS: In all countries, most physicians reported having been involved at least once in setting limits to intensive care because of incurable conditions (61-96%); smaller proportions reported such involvement because of a baby's poor neurological prognosis (46-90%). Practices such as continuation of current treatment without intensification and withholding of emergency manoeuvres were widespread, but withdrawal of mechanical ventilation was reported by variable proportions (28-90%). Only in France (73%) and the Netherlands (47%) was the administration of drugs with the aim of ending life reported with substantial frequency. Age, length of professional experience, and the importance of religion in the physician's life affected the likelihood of reporting of non-treatment decisions. INTERPRETATION: A vast majority of neonatologists in European NICUs have been involved in end-of-life limitation of treatments, but type of decision-making varies among countries. Culture-related and other country-specific factors are more relevant than characteristics of individual physicians or units in explaining such variability.
Notes
Comment In: Lancet. 2000 Dec 23-30;356(9248):2190-111191568
Comment In: Lancet. 2000 Sep 9;356(9233):94611036927
Comment In: Lancet. 2000 Sep 9;356(9233):94611036928
PubMed ID
10902625 View in PubMed
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Food sources of carbohydrates in a European cohort of adults.

https://arctichealth.org/en/permalink/ahliterature18553
Source
Public Health Nutr. 2002 Dec;5(6B):1197-215
Publication Type
Article
Date
Dec-2002
Author
E. Wirfält
A. McTaggart
V. Pala
B. Gullberg
G. Frasca
S. Panico
H B Bueno-de-Mesquita
P H M Peeters
D. Engeset
G. Skeie
M D Chirlaque
P. Amiano
E. Lundin
A. Mulligan
E A Spencer
K. Overvad
A. Tjønneland
F. Clavel-Chapelon
J. Linseisen
U. Nöthlings
E. Polychronopoulos
K. Georga
U R Charrondière
N. Slimani
Author Affiliation
Department of Medicine, Lund University, Malmö, SE-20502 Sweden. elisabet.wirfalt@smi.mas.lu.se
Source
Public Health Nutr. 2002 Dec;5(6B):1197-215
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Diet Surveys
Dietary Carbohydrates - administration & dosage
Europe
Female
Food Habits
Humans
Male
Mental Recall
Middle Aged
Population Surveillance - methods
Prospective Studies
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To describe the average consumption of carbohydrate-providing food groups among study centres of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Of the 27 redefined EPIC study centres, 19 contributed subjects of both genders and eight centres female participants only (men, women, after exclusion of subjects under 35 and over 74 years of age from the original 36 900 total). Dietary data were obtained using the 24-hour recall methodology using the EPIC-SOFT software. The major sources of dietary carbohydrate were identified, and 16 food groups were examined. RESULTS: The 10 food groups contributing most carbohydrate were bread; fruit; milk and milk products; sweet buns, cakes and pies; potato; sugar and jam; pasta and rice; vegetables and legumes; crispbread; and fruit and vegetable juices. Consumption of fruits as well as vegetables and legumes was higher in southern compared with northern centres, while soft drinks consumption was higher in the north. Italian centres had high pasta and rice consumption, but breakfast cereal, potato, and sweet buns, cakes and pies were higher in northern centres. In Sweden, lower bread consumption was balanced with a higher consumption of crispbread, and with sweet buns, cakes and pies. Overall, men consumed higher amounts of vegetables and legumes, bread, soft drinks, potatoes, pasta and rice, breakfast cereal and sugar and jam than women, but fruit consumption appeared more frequent in women. CONCLUSION: The study supports the established idea that carbohydrate-rich foods chosen in northern Europe are different from those in the Mediterranean region. When comparing and interpreting diet-disease relationships across populations, researchers need to consider all types of foods.
PubMed ID
12639227 View in PubMed
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Lung cancer mortality among European rock/slag wool workers: exposure-response analysis.

https://arctichealth.org/en/permalink/ahliterature21396
Source
Cancer Causes Control. 1998 Aug;9(4):411-6
Publication Type
Article
Date
Aug-1998
Author
D. Consonni
P. Boffetta
A. Andersen
J. Chang-Claude
J W Cherrie
G. Ferro
R. Frentzel-Beyme
J. Hansen
J. Olsen
N. Plato
P. Westerholm
R. Saracci
Author Affiliation
University of Milan, Italy.
Source
Cancer Causes Control. 1998 Aug;9(4):411-6
Date
Aug-1998
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Cohort Studies
Confidence Intervals
Environmental Monitoring - methods
Europe - epidemiology
Humans
Lung Neoplasms - etiology - mortality
Male
Middle Aged
Models, Statistical
Multivariate Analysis
Occupational Exposure - adverse effects - analysis
Poisson Distribution
Research Support, Non-U.S. Gov't
Risk factors
Sex Distribution
Survival Rate
Textile Industry
Abstract
OBJECTIVES: The purpose was to analyze the relationship between semi-quantitative indices of exposure to manmade vitreous fibers and lung cancer mortality among European rock/slag wool (RSW) workers. METHODS: The study population comprised 9,603 male workers employed in RSW production in seven factories in Denmark, Norway, Sweden, and Germany, followed up for mortality as of 1990-91. Estimates of past exposure to respirable fibers were used to calculate cumulative exposure with a 15-year lag and maximum annual exposure based on employment history up to 1977. Rate ratios were estimated via multivariate Poisson regression, adjusting for country, age, calendar year, time since first employment, and employment status. RESULTS: A total of 159 lung cancer deaths were included in the analysis of which 97 among workers with more than one year of employment. We found nonstatistically significant trends in lung cancer risk according to cumulative exposure. Relative risks (RR) in the four quartiles were 1.0 (reference), 1.3 (95 percent confidence interval [CI] = 0.8-2.4), 1.2 (CI = 0.7-2.1), and 1.5 (CI = 0.7-3.0, P test for trend = 0.4). When workers with less than one year of employment were excluded, there was no increased risk; the RRs in the four quartiles were 1.0, 0.9 (CI = 0.4-2.0), 0.8 (CI = 0.3-1.9), and 1.0 (CI = 0.4-2.7). No trend was present according to maximum annual exposure. The results were not consistent among countries. CONCLUSIONS: We found a positive association between exposure to respirable fibers and lung cancer mortality. However, the lack of statistical significance, the dependence of the results on inclusion of short-term workers, the lack of consistency among countries, and the possible correlation between exposure to respirable fibers and to other agents reduce the weight of such evidence.
PubMed ID
9794173 View in PubMed
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Mortality and incidence of cancer of workers in the man made vitreous fibres producing industry: an international investigation at 13 European plants.

https://arctichealth.org/en/permalink/ahliterature26711
Source
Br J Ind Med. 1984 Nov;41(4):425-36
Publication Type
Article
Date
Nov-1984
Author
R. Saracci
L. Simonato
E D Acheson
A. Andersen
P A Bertazzi
J. Claude
N. Charnay
J. Esteve
R R Frentzel-Beyme
M J Gardner
Source
Br J Ind Med. 1984 Nov;41(4):425-36
Date
Nov-1984
Language
English
Publication Type
Article
Keywords
Europe
Female
Glass - adverse effects
Humans
Male
Neoplasms - epidemiology - etiology - mortality
Occupational Diseases - epidemiology - etiology - mortality
Polymers - adverse effects
Research Support, Non-U.S. Gov't
Respiratory Tract Neoplasms - etiology - mortality
Risk
Sex Factors
Time Factors
Abstract
A total of 25 146 workers at 13 plants producing man made mineral fibres (MMMF) in seven European countries (Denmark, Finland, Federal Republic of Germany, Italy, Norway, Sweden, and United Kingdom) were studied in a historical cohort investigation. At 12 of the 13 plants an environmental survey was carried out to determine present day concentrations of airborne man made mineral fibres that showed levels of respirable fibres usually below 1 f/ml and most commonly in the range 0.01 to 0.1 f/ml. Workers were entered into the cohort at the moment of their first employment at one of the 13 factories (which started to operate between 1900 and 1955), and were followed up to at least 31 December 1977. Three per cent of the workers were lost to follow up. National death rates and national cancer incidence rates, where applicable, were used for each of the seven countries for comparison with the workers' cohort. A single death from mesothelioma was reported out of a total of 309 353 person-years of observation. No consistent differences (within and between plants) were noted between observed and expected numbers concerning individual causes of death or individual cancer sites, apart from lung cancer. For this cause a tendency was observed for the standardised mortality ratio (SMR) to increase with time from first employment. When the data from all the plants were pooled a statistically significant raised SMR of 192 (17 observed, 8.9 expected; 95% confidence interval 117-307) appeared in the group with 30 years or more since first employment. The relevance of this finding, to which different factors including uncontrolled confounders such as smoking habits may have contributed, cannot be established at present. The result is suggestive, however, of an increased risk associated with the man made mineral fibres working environment of 30 or more years ago.
PubMed ID
6498106 View in PubMed
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Neonatal end-of-life decision making: Physicians' attitudes and relationship with self-reported practices in 10 European countries.

https://arctichealth.org/en/permalink/ahliterature32477
Source
JAMA. 2000 Nov 15;284(19):2451-9
Publication Type
Article
Date
Nov-15-2000
Author
M. Rebagliato
M. Cuttini
L. Broggin
I. Berbik
U. de Vonderweid
G. Hansen
M. Kaminski
L A Kollée
A. Kucinskas
S. Lenoir
A. Levin
J. Persson
M. Reid
R. Saracci
Author Affiliation
Department of Public Health, Miguel Hernandez University, Alicante, Spain. rebagli@umh.es
Source
JAMA. 2000 Nov 15;284(19):2451-9
Date
Nov-15-2000
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Death
Comparative Study
Data Collection
Decision Making
Ethics, Medical
Europe
Factor Analysis, Statistical
Female
Humans
Infant, Newborn
Infant, Newborn, Diseases - therapy
Internationality
Linear Models
Male
Middle Aged
Neonatology
Palliative Care
Physician's Practice Patterns
Prognosis
Quality of Life
Research Support, Non-U.S. Gov't
Terminal Care
Abstract
CONTEXT: The ethical issues surrounding end-of-life decision making for infants with adverse prognoses are controversial. Little empirical evidence is available on the attitudes and values that underlie such decisions in different countries and cultures. OBJECTIVE: To explore the variability of neonatal physicians' attitudes among 10 European countries and the relationship between such attitudes and self-reported practice of end-of-life decisions. DESIGN AND SETTING: Survey conducted during 1996-1997 in 10 European countries (France, Germany, Italy, the Netherlands, Spain, Sweden, the United Kingdom, Estonia, Hungary, and Lithuania). PARTICIPANTS: A total of 1391 physicians (response rate, 89%) regularly employed in 142 neonatal intensive care units (NICUs). MAIN OUTCOME MEASURES: Scores on an attitude scale, which measured views regarding absolute value of life (score of 0) vs value of quality of life (score of 10); self-report of having ever set limits to intensive neonatal interventions in cases of poor neurological prognosis. RESULTS: Physicians more likely to agree with statements consistent with preserving life at any cost were from Hungary (mean attitude scores, 5.2 [95% confidence interval ¿CI¿, 4.9-5.5]), Estonia (4.9 [95% CI, 4.3-5.5]), Lithuania (5.5 [95% CI, 4.8-6.1]), and Italy (5.7 [95% CI, 5.3-6.0]), while physicians more likely to agree with the idea that quality of life must be taken into account were from the United Kingdom (attitude scores, 7.4 [95% CI, 7.1-7.7]), the Netherlands (7. 3 [95% CI, 7.1-7.5]), and Sweden (6.8 [95% CI, 6.4-7.3]). Other factors associated with having a pro-quality-of-life view were being female, having had no children, being Protestant or having no religious background, considering religion as not important, and working in an NICU with a high number of very low-birth-weight newborns. Physicians with scores reflecting a more quality-of-life view were more likely to report that in their practice, they had set limits to intensive interventions in cases of poor neurological prognosis, with an adjusted odds ratio of 1.5 (95% CI, 1.3-1.7) per unit change in attitude score. CONCLUSIONS: In our study, physicians' likelihood of reporting setting limits to intensive neonatal interventions in cases of poor neurological prognosis is related to their attitudes. After adjusting for potential confounders, country remained the most important predictor of physicians' attitudes and practices. JAMA. 2000;284:2451-2459.
PubMed ID
11074774 View in PubMed
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15 records – page 1 of 2.