1. J Allied Health. 2009 Fall;38(3):e84-91.

Characterizing job satisfaction and intent to leave among nationally registered
emergency medical technicians: an analysis of the 2005 LEADS survey.

Patterson PD, Moore CG, Sanddal ND, Wingrove G, LaCroix B.

Department of Emergency Medicine, University of Pittsburgh School of Medicine,
230 McKee Place, Suite 400, Pittsburgh, PA, USA. pattersond@upmc.edu

The primary purpose of this study was to characterize job satisfaction with
opportunities for advancement, job satisfaction with pay and benefits, and intent
to leave the EMS profession among Nationally Registered EMT-Basics and
EMT-Paramedics. A secondary data analysis was performed on the National Registry 
of EMTs Longitudinal Emergency Medical Technician Attributes and Demographic
Study Project (LEADS) 2005 core survey. We used chi-square and multiple logistic 
regression analyses to test for differences in job satisfaction with
opportunities for advancement, job satisfaction with pay and benefits, and intent
to leave the EMS profession across years of experience and work location. Among
11 measures of job satisfaction, NREMT-Basics and NREMT-Paramedics were least
satisfied with opportunities for advancement and pay and benefits (67.8 and
55.2%, respectively). Nearly 6% of respondents reported intentions of leaving the
profession within 12 months. In univariate analyses, job satisfaction with
advancement opportunities varied across years of experience and work location.
Job satisfaction with pay and benefits varied across years of experience and work
location. The proportion reporting intentions of leaving the profession did not
vary across the two independent variables of interest. In multivariable logistic 
regression, statistical differences observed in univariate analyses were
attenuated to non-significance across all outcome models. Income, personal
health, level of EMS certification, and type of EMS work were significant in
several outcome models. EMS workforce research is at its infancy, thus our study 
adds to a limited but growing body of knowledge. In future and replicated
research, one will need to consider different person and organizational variables
in predicting different measures of job satisfaction among EMS personnel.

PMID: 19753419 [PubMed - indexed for MEDLINE]


2. J Am Geriatr Soc. 2009 Oct;57(10):1868-73. Epub 2009 Aug 20.

Older drivers in Australia: trends in driving status and cognitive and visual
impairment.

Ross LA, Anstey KJ, Kiely KM, Windsor TD, Byles JE, Luszcz MA, Mitchell P.

Centre for Mental Health Research, Ageing Research Unit, Australian National
University, Canberra, Australia. LesleyARoss@gmail.com

OBJECTIVES: To investigate self-reported driving status within three Australian
states; associations between demographic, health, and functional factors and
driving status; and the extent to which remaining a driver in spite of cognitive 
and visual impairments varies as a function of sex. DESIGN: Secondary data
analysis of a pooled data set. SETTING: Australian communities. PARTICIPANTS:
Adults aged 65 to 103 (N=5,206) from the Dynamic Analyses to Optimise Ageing
(DYNOPTA) project. DYNOPTA is a unique data set created through the harmonization
and pooling of data across nine separate Australian longitudinal studies of aging
conducted between 1990 and 2007 (N=50,652). MEASUREMENTS: Driving status,
demographic characteristics, Mini-Mental State Examination score, visual acuity, 
physical activity, and occupation. RESULTS: Men and participants with
higher-level occupations had greater odds of driving. Older age, more medical
conditions, and poorer vision increased the odds of not driving. Persons who were
divorced, widowed, or never married were at a greater risk than married adults of
not driving. Descriptive analyses revealed a large proportion of men with
probable visual or cognitive impairments who reported driving. Subsequent
comparative analyses between the DYNOPTA sample and other published U.S. and
Canadian data revealed lower proportions of current drivers among Australian
women and those at older ages, although there were consistently lower proportions
of drivers within Australia and Canada than in the United States. CONCLUSION: The
rate of men with probable dementia or visual impairments who reported driving is 
of particular concern. Research and policy need to focus on evidence-based
assessment of older drivers and development of appropriate interventions and
programs to maintain the mobility and independence of older adults.

PMID: 19694871 [PubMed - indexed for MEDLINE]


3. Arch Bronconeumol. 2009 Oct;45(10):481-6. Epub 2009 Jun 13.

[Economic cost of treating the patient with asthma in Spain: the AsmaCost study]

[Article in Spanish]

Martínez-Moragón E, Serra-Batllés J, De Diego A, Palop M, Casan P, Rubio-Terrés
C, Pellicer C; por el Grupo de Investigadores del estudio AsmaCost.

Collaborators: Alvarez JL, Sánchez JA, Muñoz AA, Forns SB, González TB, López RB,
Clau LB, Vizuete JA, Rivas PC, Serrano CV, Damiá Ade D, Garde MJ, Fabrellas EF,
Clemente MM, García SG, García MT, Villaescusa MC, Estarriol MH, García JM, Viña 
AL, Villasclaras JJ, García MA, González CM, Moragón EM, Velasco JA, Moreno CM,
Galo AP, Ciscar CP, Vega AP, Rivas P, Moral VP, Trigo GR, Cobos MA, Quiroga MA,
Batllés JS, González MA, Cataluña JJ, Fernández-Montes CV.

Servicio de Neumología, Hospital de Sagunto, Valencia, España.
emm01v@saludalia.com

Comment in:
    Arch Bronconeumol. 2009 Oct;45(10):475-7.

OBJECTIVE: This analysis of the cost of asthma in Spain includes both direct
health care costs and indirect costs arising from illness. PATIENTS AND METHODS: 
Prospective, 12-month observational cohort study of adult patients with asthma
diagnosed according to the guidelines of the Global Initiative for Asthma (GINA) 
and the adapted Spanish criteria (GEMA). We recorded information on health care
resources utilized (medications, medical visits, emergency care, hospital
admissions, and tests) and indirect costs (patient travel or transfer costs and
workdays lost). RESULTS: A total of 627 patients throughout Spain were studied.
Of these, 21.2% had intermittent asthma, 24.6% mild asthma, 27.6% moderate
asthma, and 26.6% severe asthma. The total societal cost of asthma (including
indirect costs) was euro1726 (95% confidence interval [CI], euro1314-euro2154)
per patient annually. Indirect costs accounted for 11.2% of the total. The cost
to the National Health Service was euro1533 (95% CI, euro1133-euro1946) per
patient annually. The cost of asthma was higher for patients older than 65 years 
(euro2079) and for those with more severe disease (euro959 for intermittent
asthma; euro1598, mild asthma; euro1553, moderate asthma; and euro2635 severe
asthma). Based on these findings, the total annual cost of asthma in Spain is
estimated to be euro1480 million (95% CI, euro382-euro2565 million) for patients 
with demonstrated bronchial hyperreactivity and euro3022 million (95% CI,
euro2472-euro3535 million) for patients diagnosed based on symptoms alone.
CONCLUSIONS: The average annual cost of asthma in adults in Spain comes to
euro1726 per patient, considering both direct and indirect costs. The average
annual cost per patient to the National Health Service is euro1533.

PMID: 19525051 [PubMed - indexed for MEDLINE]


4. J Psychosom Res. 2009 Jan;66(1):75-83. Epub 2008 Nov 22.

Effort-reward imbalance at work and risk of sleep disturbances. Cross-sectional
and prospective results from the Danish Work Environment Cohort Study.

Rugulies R, Norborg M, Sørensen TS, Knudsen LE, Burr H.

National Research Centre for the Working Environment, Copenhagen, Denmark.
rer@nrcwe.dk

OBJECTIVES: This study aimed to analyze if adverse psychosocial working
conditions, defined by the model of effort-reward imbalance (ERI), increase the
risk of sleep disturbances in the Danish workforce. METHODS: Analyses were
conducted both cross-sectionally and prospectively in a representative sample of 
Danish employees. The cross-sectional sample included 2614 participants (50%
women) aged 18-59 years, of whom 263 had sleep disturbances. Of the 2351
participants initially free of sleep disturbances, 304 (12.9%) developed sleep
disturbances during the 5-year follow-up. Data were analyzed with
gender-stratified, multivariate logistic and linear regression analyses, adjusted
for numerous covariates. RESULTS: Cross-sectionally, a 1 S.D. increase in the ERI
ratio was associated with sleep disturbances among both men [odds ratio
(OR)=1.65, 95% confidence interval (CI)=1.20-2.27] and women (OR=1.82, 95%
CI=1.46-2.28). In the prospective analysis, a 1 S.D. increase of the ERI ratio at
baseline predicted the onset of sleep disturbances among men (OR=1.39, 95%
CI=1.03-1.87) but not among women (OR=0.97, 95% CI=0.76-1.24). CONCLUSION: Among 
men, ERI is a risk factor for the development of sleep disturbances in the Danish
workforce. Among women, an association between ERI and sleep disturbances was
restricted to the cross-sectional sample. Improving psychosocial working
conditions might reduce the risk of sleep disturbances and subsequently also help
to prevent clinical disorders related to sleep disturbances.

PMID: 19073297 [PubMed - indexed for MEDLINE]


5. Ann Epidemiol. 2009 Jan;19(1):42-8.

A population-based cohort study of occupational exposure to magnetic fields and
cardiovascular disease mortality.

Cooper AR, Van Wijngaarden E, Fisher SG, Adams MJ, Yost MG, Bowman JD.

Department of Community and Preventive Medicine, University of Rochester School
of Medicine and Dentistry, New York 14642, USA.

PURPOSE: This cohort study aims to examine cardiovascular disease (CVD) mortality
risks among workers in occupations potentially exposed to magnetic fields (MF).
METHODS: Risks for major CVD mortality by potential job-related MF exposure were 
examined in a sample of U.S. workers from the National Longitudinal Mortality
Study using multivariate proportional hazards models. RESULTS: After adjustment
for demographic factors, there were no significant excess risks between
individuals with medium (0.15 to <0.20 microT), high (0.20 to < 0.30 microT), or 
very high (>/= 0.30 microT) exposure levels as compared with individuals with
background exposure levels of MF (<0.15 microT) for the CVD mortality outcomes.
Indirect adjustment for potential confounding by current smoking prevalence did
not change the pattern of these results. CONCLUSION: Our study does not provide
evidence for an association between occupational MF exposure and CVD mortality
risk.

PMID: 19064188 [PubMed - indexed for MEDLINE]


6. Cerebrovasc Dis. 2009;27(2):123-30. Epub 2008 Nov 28.

Handicap 5 years after stroke in the North East Melbourne Stroke Incidence Study.

Gall SL, Dewey HM, Sturm JW, Macdonell RA, Thrift AG.

National Stroke Research Institute, Austin Health-Repatriation Campus, Heidelberg
Heights, University of Melbourne, Austin Health, Melbourne, Victoria, Australia. 
Seana.Gall@utas.edu.au

BACKGROUND: Handicap is rarely comprehensively examined after stroke. We examined
handicap among 5-year stroke survivors from an 'ideal' stroke incidence study.
METHODS: Survivors were assessed with the London Handicap Scale [LHS, score
range: 0 (greatest handicap) to 100 (least handicap)]. Multivariable regression
was used to examine demographic, risk and stroke-related factors associated with 
handicap. RESULTS: 351 of 441 (80%) survivors were assessed. Those assessed were 
more often Australian born than those not assessed (p < 0.05). The mean LHS score
was 73 (SD = 21). The greatest handicap was present for physical independence and
occupation/leisure items. Handicap was associated with older age, manual
occupations, smoking, initial stroke severity, recurrent stroke and mood
disorders. CONCLUSION: Reducing recurrent stroke, through better risk factor
management, is likely to reduce handicap. The association between handicap and
mood disorders, which are potentially modifiable, warrants further investigation.
Copyright (c) 2008 S. Karger AG, Basel.

PMID: 19039216 [PubMed - indexed for MEDLINE]


7. Am J Addict. 2008 Nov-Dec;17(6):459-62.

Outcomes of DATA 2000 certification trainings for the provision of buprenorphine 
treatment in the Veterans Health Administration.

Gordon AJ, Liberto J, Granda S, Salmon-Cox S, Andree T, McNicholas L.

Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare
System, Pittsburgh, Pennsylvania 15206, USA. adam.gordon@va.gov

Comment in:
    Am J Addict. 2009 Jul-Aug;18(4):336; author reply 337-8.

Despite the high numbers of veterans with opioid dependence, few receive
pharmacologic treatment for this disorder. The adoption of buprenorphine
treatment within the Veterans Health Administration (VHA) has been slow. To
expand capacity for buprenorphine treatment, the VHA sponsored two eight-hour
credentialing courses for the Drug Addiction Treatment Act of 2000. We sought to 
describe the outcomes of such training. Following the training sessions, 29
participants (18 physicians) were highly satisfied with course content and
affirmed their intention to prescribe buprenorphine; after nine-month follow-up, 
two physicians were prescribing. We conclude that providing credentialing
courses, while popular, did not markedly promote the prescription of
buprenorphine.

PMID: 19034736 [PubMed - indexed for MEDLINE]


8. Soc Sci Med. 2009 Jan;68(1):49-59. Epub 2008 Nov 17.

A multi-group cross-lagged analyses of work stressors and health using Canadian
National sample.

Ibrahim S, Smith P, Muntaner C.

Institute for Work and Health, 481 University Avenue, Suite 800, Toronto, Canada 
M5G 2E9. sibrahim@iwh.on.ca

This article examines the reciprocal relationships between work variables and
health outcomes and if these relationships differ by social class (measured by
occupational grouping). We used longitudinal data from the 1994/95--2002/03
Canadian National Population Health Survey (NPHS). Karasek's work stress
variables were measured in the 1994/95 (cycle 1, time 1), 2000/01 (cycle 4, time 
2) and 2002/03 (cycle 5, time 3) surveys. Analyses were limited to 2556
respondents aged 18-56 at time 1 and who remained in the same social class (as
defined by occupational position) for all the three time points. Work variables
used were job strain ratio, work social support and job insecurity. Health
outcomes used were distress, depression and self-rated health. Multi-group path
analyses were used to investigate the reciprocal relationships between work and
health variables and if these relationships differed by social class. Analyses
controlled for age, gender, marital status and work status. We find there is a
differential burden of work psychosocial factors and health outcomes by social
class. The cross-lagged relationships between work and health depended on the
outcome, social class and time lag. More significant paths from work to health
were observed than reverse paths from health to work. More significant
relationships between work and health were observed for the shorter time lag (2
years) compared to longer time lags (6 years). Low work social support and job
insecurity were more detrimental to health for respondents in lower social class 
positions. Findings from this study highlight the importance of time lag, and to 
some extent social class, in the reciprocal relationships between work and
health.

PMID: 19010577 [PubMed - indexed for MEDLINE]


9. Int J Tuberc Lung Dis. 2008 Oct;12(10):1160-5.

Factors contributing to treatment success among tuberculosis patients: a
prospective cohort study in Bangkok.

Okanurak K, Kitayaporn D, Akarasewi P.

Department of Social and Environmental Medicine, Faculty of Tropical Medicine,
Mahidol University, Bangkok, Thailand. tmkok@mahidol.ac.th

SETTING: Chest Clinic, Ministry of Public Health and health care centres, Bangkok
Metropolitan Administration. OBJECTIVE: To determine patient factors predicting
successful tuberculosis (TB) treatment. DESIGN: A prospective cohort was
conducted during May 2004 to November 2005. Newly diagnosed TB patients aged > or
= 15 years were recruited after giving informed consent. Three sets of
questionnaires were used to collect data from the patients three times. Data were
also gathered from treatment cards. RESULTS: Of 1241 patients, 81.1% were
successfully treated. Bivariate analysis indicated that patients' sex, education,
occupation, level of knowledge about TB and adverse effects were associated with 
treatment success. Unconditional logistic regression analysis showed that females
had a higher success rate than males (OR = 1.9, 95%CI 1.2-2.9). Patients with
regular incomes had twice the likelihood of success of the unemployed (OR = 2.0, 
95%CI 1.1-3.5). Patients with high knowledge levels were more likely to complete 
treatment (OR = 2.0, 95%CI 1.2-3.4), while those with adverse effects were less
likely to adhere (OR = 0.6, 95%CI 0.4-0.9). CONCLUSION: The current low treatment
success rate may be partly due to inadequate knowledge about TB among patients.
Improvements in health education and early detection and management of adverse
effects should be prioritised by the National Tuberculosis Programme.

PMID: 18812046 [PubMed - indexed for MEDLINE]


10. Occup Environ Med. 2009 Mar;66(3):150-3. Epub 2008 Sep 19.

Socio-economic differences in the association between sickness absence and
mortality: the prospective DREAM study of Danish private sector employees.

Lund T, Kivimäki M, Christensen KB, Labriola M.

Danish National Centre for Social Research, Herluf Trolles Gade 11, Copenhagen,
Denmark. tlu@sfi.dk

OBJECTIVES: To examine duration of sickness absence as a risk marker for future
mortality by socio-economic position among all private sector employees in
Denmark in 1998-2004. METHODS: All residents in Denmark employed in the private
sector receiving sickness absence compensation in 1998 were investigated in a
prospective cohort study. 236 207 persons (38.2% women, 61.8% men, age range
18-65, mean age 37.8 years) alive on 1 January 2001 were included in the study.
Mortality from 1 January 2001 to 31 December 2004 was assessed using national
register data. Deaths in 1999 and 2000 were excluded to determine the status of
sickness absence duration as an early risk marker. For analyses within
occupational grades, data were available for a sub-population of 137 607 study
participants. RESULTS: 3040 persons died during follow-up. The age-adjusted risk 
of future mortality increased by duration of sickness absence in a graded fashion
among men and non-blue collar workers. Among women and blue collar workers, there
was no association of mortality with duration of sickness absences below 6 weeks.
However, employees with > or =6 weeks of absence compared to those with 1-week
absence had a substantial excess risk of death in all groups: adjusted hazard
ratio 2.2 (95% CI 1.8 to 2.7) for women, 2.1 (95% CI 1.8 to 2.4) for men, 3.7
(95% CI 1.9 to 7.2) in white collar occupations, 3.3 (95% CI 2.2 to 5.0) in
intermediate grade occupations and 2.0 (95% CI 1.7 to 2.3) in blue collar
occupations. CONCLUSION: Administratively collected data on sickness absence
compensation for periods > or =6 weeks identified "at risk" groups for future
excess mortality in male and female private sector employees across occupational 
grade levels.

PMID: 18805885 [PubMed - indexed for MEDLINE]


11. Occup Environ Med. 2009 Mar;66(3):175-81. Epub 2008 Sep 19.

Lung cancer mortality and iron oxide exposure in a French steel-producing
factory.

Bourgkard E, Wild P, Courcot B, Diss M, Ettlinger J, Goutet P, Hémon D, Marquis
N, Mur JM, Rigal C, Rohn-Janssens MP, Moulin JJ.

Département Epidémiologie en Entreprise, Institut National de Recherche et de
Sécurité, Vandoeuvre Cedex, France. eve.bourgkard@inrs.fr

OBJECTIVE: To study the possible association between iron oxide exposures and
lung cancer risk among workers in a French carbon steel-producing factory.
METHODS: 16 742 males and 959 females ever employed for at least 1 year between
1959 and 1997 were followed up for mortality from January 1968 to December 1998. 
Causes of death were ascertained from death certificates. Job histories and
smoking habits were available for 99.7% and 72.3% of subjects, respectively.
Occupational exposures were assessed by a factory-specific job-exposure matrix
(JEM) validated with atmospheric measurements. Standardised mortality ratios
(SMRs) were computed using local death rates (external references). Poisson
regressions were used to estimate the relative risks (RRs) for occupational
exposures (internal references), adjusted on potential confounding factors.
RESULTS: Among males, observed mortality was lower than expected for lung cancer 
compared to the local population (233 deaths, SMR 0.89, 95% CI 0.78 to 1.01) and 
higher than expected compared to the French population (SMR 1.30, 95% CI 1.15 to 
1.48) No lung cancer excess was observed for exposure to iron oxides (RR 0.80,
95% CI 0.55 to 1.17) and no dose-response relationship with intensity, duration
of exposure or cumulative index was found. A significant bladder cancer excess
was observed among workers exposed to oil mist (RR 2.44, 95% CI 1.06 to 5.60),
increasing significantly with intensity, duration of exposure and cumulative
index. CONCLUSION: This study did not detect any relationship between exposure to
iron oxides and lung cancer mortality. An excess of mortality from bladder cancer
was found among workers exposed to oil mist.

PMID: 18805881 [PubMed - indexed for MEDLINE]


12. Scand J Work Environ Health. 2008 Jun;34(3):206-12.

Cardiovascular risk factors and primary selection into shift work.

Nabe-Nielsen K, Garde AH, Tüchsen F, Hogh A, Diderichsen F.

The National Research Centre for the Working Environment, Lerso Parkallé 105,
DK-2100 Copenhagen, Denmark. knn@nrcwe.dk

OBJECTIVES: This study examined differences between future shift workers and
future day workers as regards cardiovascular risk factors before they began
different work schedules and the differences that remained after control for
sociodemographic factors and general self-efficacy. METHODS: Altogether 2870
newly educated social and health care workers filled out a questionnaire a few
weeks before finishing their formal training and again 1 year after graduation.
They answered questions on diabetes, hypertension, lifestyle habits,
sociodemographic factors, and general self-efficacy. RESULTS: In the unadjusted
analyses, baseline obesity was associated with fixed evening work at follow-up.
Minimal or light-to-moderate leisure-time physical activity was associated with a
decrease in the odds ratio (OR) for two or three shifts including night work.
Smoking status was associated with fixed evening work, fixed night work, and two-
or three- shift work including night work. After adjustment for sociodemographic 
factors and general self-efficacy, smoking was prospectively associated with
fixed evening work [OR 1.56, 95% confidence interval (95% CI) 1.21-2.02] and
fixed night work (OR 1.64, 95% CI 1.04-2.56). Being an ex-smoker was associated
with two- or three-shift work including night work (OR 1.85, 95% CI 1.28-2.68).
The association between two- and three-shift work and smoking was only of
borderline significance (OR 1.37, 95% CI 1.00-1.87). CONCLUSIONS: Compared with
future day workers, fixed evening or fixed night workers already smoked more
before they began shift work. Being an ex-smoker was significantly associated
with two- or three-shift work including night work. These results indicate that
smoking status should not solely be treated as a mediator between some variants
of shiftwork schedules and cardiovascular diseases but should also be considered 
a confounder.

PMID: 18728910 [PubMed - indexed for MEDLINE]


13. Health Econ. 2009 May;18(5):535-48.

Weight and wages: fat versus lean paychecks.

Han E, Norton EC, Stearns SC.

Institute for Health Research and Policy, University of Illinois at Chicago,
Chicago, IL 60608, USA. eunahan@uic.edu

Past empirical work has shown a negative relationship between the body mass index
(BMI) and wages in most cases. We improve on this work by allowing the marginal
effect of non-linear BMI groups to vary by gender, age, and type of interpersonal
relationships required in each occupation. We use the National Longitudinal
Survey of Youth 1979 (1982-1998). We find that the often-reported negative
relationship between the BMI and wages is larger in occupations requiring
interpersonal skills with presumably more social interactions. Also, the wage
penalty increases as the respondents get older beyond their mid-twenties. We show
that being overweight and obese penalizes the probability of employment across
all race-gender subgroups except black women and men. Our results for the
obesity-wage association can be explained by either consumers or employers having
distaste for obese workers. (c) 2008 John Wiley & Sons, Ltd.

PMID: 18677723 [PubMed - indexed for MEDLINE]


14. J Trauma. 2008 Jul;65(1):94-102.

Prospective randomized comparative study of antegrade and retrograde locked
nailing for middle humeral shaft fracture.

Cheng HR, Lin J.

Department of Orthopedic Surgery, National Taiwan University Hospital, Yun-Lin
Branch, Taipei, Taiwan.

BACKGROUND: Humeral shaft fractures can be effectively treated by either
antegrade or retrograde locked intramedullary nailing, but these two methods have
not been adequately compared. The present study compared the effectiveness and
potential risks of these two approaches on middle humeral shaft fractures using
the same locked nails. METHODS: In this prospective comparative study, 92
fractures in 92 patients with middle humeral shaft fractures were randomly
allocated to receive either antegrade or retrograde locked nailing by
sealed-envelope technique. The clinical outcomes of fracture healing, time to
healing, complications, elbow and shoulder functional recovery, and time for
functional recovery were compared. RESULTS: Retrograde nailing required
significantly longer time than antegrade nailing (64.8 vs. 51.3 minutes; p <
0.01) Except for three patients lost to follow-up, the average follow-up time was
18.6 months for 44 fractures in the antegrade group and 19.8 months for 45
fractures in the retrograde group. The fracture healed in 42 fractures (95%) in
the antegrade group versus 42 fractures (93%) in the retrograde group, and this
difference was not significant. After exclusion of two patients with brachial
plexus injury and three with head injury, functional recovery was compared
between 41 patients with antegrade and 43 with retrograde nailing. For shoulder
joints, the difference in the average Neer shoulder score between the two groups 
was statistically significant (90.8 vs. 93.5; p = 0.03). However, if four elderly
patients were excluded, the average score in the antegrade group was 91.9, and
the difference became insignificant (p = 0.1). Still, the antegrade group needed 
significantly longer time for shoulder functional recovery (16.4 vs. 8.3 weeks; p
< 0.01). For elbow joints, the average postoperative Mayo elbow performance score
(96.3 vs. 94.8; p = 0.16) did not differ significantly between these two
approaches, but the retrograde approach needed significantly longer time for
elbow functional recovery (3.9 vs. 8.8 weeks; p < 0.01). All patients, except
those with associated injuries, resumed their pretrauma occupations or
activities. CONCLUSION: With proper patient selection, antegrade and retrograde
nailing have similar treatment results, including healing rate and eventual
functional recovery for middle humeral fractures. It is recommended that
retrograde nailing be used in patients with a wide medullary canal or preexisting
shoulder problems and antegrade nailing be used in patients with young age or a
small medullary canal. In critically ill patients, antegrade nailing is preferred
because of shorter operation time.

PMID: 18580523 [PubMed - indexed for MEDLINE]


15. BMC Public Health. 2008 May 19;8:164.

The longitudinal relationship between job mobility, perceived organizational
justice, and health.

Liljegren M, Ekberg K.

National Centre for Work and Rehabilitation, Department of Medicine and Health
Sciences, Linköping University, SE-581 83 Linköping, Sweden.
mats.liljegren@ihs.liu.se

BACKGROUND: The main purpose of the present study was to examine the 2-year
longitudinal and reciprocal relationship between job mobility and health and
burnout. A second aim was to elucidate the effects of perceived organizational
justice and turnover intentions on the relationship between job mobility (non-,
internally and externally mobile), and health (SF-36) and burnout (CBI). METHODS:
The study used questionnaire data from 662 Swedish civil servants and the data
were analysed with Structural Equation Modeling statistical methods. RESULTS: The
results showed that job mobility was a better predictor of health and burnout,
than health and burnout were as predictors of job mobility. The predictive
effects were most obvious for psychosocial health and burnout, but negligible as 
far as physical health was concerned. Organizational justice was found to have a 
direct impact on health, but not on job mobility; whereas turnover intentions had
a direct effect on job mobility. CONCLUSION: The predictive relationship between 
job mobility and health has practical implications for health promotive actions
in different organizations.

PMCID: PMC2408581
PMID: 18489747 [PubMed - indexed for MEDLINE]


16. Soc Sci Med. 2008 May;66(9):1967-78. Epub 2008 Mar 11.

The effect of income and occupation on body mass index among women in the Cebu
Longitudinal Health and Nutrition Surveys (1983-2002).

Colchero MA, Caballero B, Bishai D.

Department of Health Economics and Evaluation, National Institute of Public
Health, Cuernavaca, Mexico. acolchero@correro.insp.mx

We assessed the effects of changes in income and occupational activities on
changes in body weight among 2952 non-pregnant women enrolled in the Cebu
Longitudinal Health and Nutrition Surveys between 1983 and 2002. On average, body
mass index (BMI) among women occupied in low activities was 0.29 kg/m(2)
(standard error 0.11) larger compared to women occupied in heavy activities. BMI 
among women involved in medium activities was on average 0.12 kg/m(2) (standard
error 0.05) larger compared to women occupied in heavy activities. A one-unit
increase in log household income in the previous survey was associated with a
small and positive change in BMI of 0.006 kg/m(2) (standard error 0.02) but the
effect was not significant. The trend of increasing body mass was higher in the
late 1980s than during the 1990s. These period effects were stronger for the
women who were younger at baseline and for women with low or medium activity
levels. Our analysis suggests a trend in the environment over the last 20 years
that has increased the susceptibility of Filipino women to larger body mass.

PMID: 18336975 [PubMed - indexed for MEDLINE]


17. Am J Public Health. 2008 Dec;98(12):2258-63. Epub 2008 Jan 30.

Racial/ethnic and gender differences in individual workplace injury risk
trajectories: 1988-1998.

Berdahl TA.

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and
Quality, Rockville, MD 20850, USA. terceira.berdahl@ahrq.hhs.gov

OBJECTIVES: I examined workplace injury risk over time and across racial/ethnic
and gender groups to observe patterns of change and to understand how
occupational characteristics and job mobility influence these changes. METHODS: I
used hierarchical generalized linear models to estimate individual workplace
injury and illness risk over time ("trajectories") for a cohort of American
workers who participated in the National Longitudinal Survey of Youth
(1988-1998). RESULTS: Significant temporal variation in injury risk was observed 
across racial/ethnic and gender groups. At baseline, White men had a high risk of
injury relative to the other groups and experienced the greatest decline over
time. Latino men demonstrated a pattern of lower injury risk across time compared
with White men. Among both Latinos and non-Latino Whites, women had lower odds of
injury than did men. Non-Latino Black women's injury risk was similar to Black
men's and greater than that for both Latino and non-Latino White women.
Occupational characteristics and job mobility partly explained these differences.
CONCLUSIONS: Disparities between racial/ethnic and gender groups were dynamic and
changed over time. Workplace injury risk was associated with job dimensions such 
as work schedule, union representation, health insurance, job hours, occupational
racial segregation, and occupational environmental hazards.

PMID: 18235072 [PubMed - indexed for MEDLINE]


18. Psychosom Med. 2008 Jan;70(1):85-91. Epub 2007 Dec 24.

Do changes in job control predict differences in health status? Results from a
longitudinal national survey of Canadians.

Smith P, Frank J, Bondy S, Mustard C.

Institute for Work and Health, 481 University Avenue, Suite 800, Toronto, ON,
Canada M5G 2E9. psmith@iwh.on.ca

OBJECTIVE: To examine the effect of changes in job control on health behaviors,
psychological distress and health status. METHODS: Using a path analysis model,
we examined the effects of change in job control over a 4-year period on levels
of physical activity, smoking, and psychological distress; and on self-rated
health over an additional 2 years, among a representative sample of 2221
Canadians. RESULTS: Over the 4-year period, 280 respondents reported decreases in
job control, and 256 reported increases in job control. Health at baseline was
not associated with the likelihood of changes in job control. We found a graded
relationship between change in job control and levels of physical activity and
psychological distress over a 4-year period; and levels of self-rated health over
a 6-year period, with positive change in job control associated in higher levels 
of physical activity and self-rated health and lower levels of distress.
CONCLUSIONS: The results of this study suggest that both level of job control and
changes in job control have direct and indirect effects on health status over
time. Future research should focus on developing precise measures of work
exposures, and examine differences between changes in job control due to only
changes in perceptions and changes due to work redesign.

PMID: 18158374 [PubMed - indexed for MEDLINE]


19. Ann Epidemiol. 2007 Aug;17(8):608-14. Epub 2007 May 23.

Socioeconomic position in childhood and adulthood and weight gain over 34 years: 
the Alameda County Study.

Baltrus PT, Everson-Rose SA, Lynch JW, Raghunathan TE, Kaplan GA.

National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA.
pbaltrus@msm.edu

PURPOSE: Socioeconomic position (SEP) has been shown to be related to obesity and
weight gain, especially among women. It is unclear how different measures of
socioeconomic position may impact weight gain over long periods of time, and
whether the effect of different measures vary by gender and age group. We
examined the effect of childhood socioeconomic position, education, occupation,
and log household income on a measure of weight gain using individual growth
mixed regression models and Alameda County Study data collected over thirty four 
years(1965-1999). METHODS: Analyses were performed in four groups stratified by
gender and age at baseline: women, 17-30 years (n = 945) and 31-40 years (n =
712); men, 17-30 years (n = 766) and 31-40 years (n = 608). RESULTS: Low
childhood SEP was associated with increased weight gain among women 17-30 (0.13
kg/year, p < 0.001). Low educational status was associated with increased weight 
gain among women 17-30 (0.14 kg/year, p = 0.030), 31-40 (0.14 kg/year, p =
0.014), and men 17-30 (0.20 kg/year, p = 0.001). CONCLUSION: Log household income
was inversely associated with weight gain among men 31-40 (-0.10 kg/yr, p =
0.16). Long-term weight gain in adulthood is associated with childhood SEP and
education in women and education and income in men.

PMID: 17521922 [PubMed - indexed for MEDLINE]


20. Arch Phys Med Rehabil. 2007 May;88(5):560-8.

How gender impacts career development and leadership in rehabilitation medicine: 
a report from the AAPM&R research committee.

Wagner AK, McElligott J, Chan L, Wagner EP 2nd, Segal NA, Gerber LH.

Department of Physical Medicine and Rehabilitation, University of Pittsburgh,
Pittsburgh, PA 15213, USA. wagnerak@upmc.edu

Comment in:
    Arch Phys Med Rehabil. 2007 May;88(5):683-6.

OBJECTIVE: To examine the role that gender plays in meeting the medical academic 
mission by assessing career development, leadership, and research productivity
among rehabilitation researchers. DESIGN: Prospective, cross-sectional cohort
study. SETTING: National survey. PARTICIPANTS: Three hundred sixty rehabilitation
professionals linked to the American Academy of Physical Medicine and
Rehabilitation, Association of Academic Physiatrists, and/or the American
Congress of Rehabilitation Medicine. INTERVENTION: Online or paper survey. MAIN
OUTCOME MEASURES: Research skills, resources and productivity, salary,
leadership, and academic advancement. RESULTS: Results suggested that women rated
themselves as being less skilled and having fewer resources for research compared
with their male counterparts. Additionally, significantly fewer women applied for
grant funding and had a lower publication rate compared with men. A
proportionally larger number of women remained at lower academic ranks than men, 
and fewer women achieved senior academic ranks or positions of leadership. Even
after adjusting for potential confounding factors, female sex remained a
significant variable associated with lower salaries and lower manuscript
production. Unlike men, female respondents tended to believe that being a woman
was a negative factor with respect to academic advancement, leadership
opportunities, salary, and resources. CONCLUSIONS: Female rehabilitation
researchers were less developed professionally than their male counterparts and
saw themselves as disadvantaged. These findings have potential implications for
attracting women into rehabilitation research and the rehabilitation research
community's efforts to sustain its academic mission, to improve research
capacity, and to meet the needs of the 52 million people in the United States
with disabilities.

PMID: 17466723 [PubMed - indexed for MEDLINE]


21. Am J Nurs. 2007 May;107(5):60-70; quiz 71.

Educational mobility of RNs in North Carolina: who will teach tomorrow's nurses? 
A report on the first study to longitudinally examine educational mobility among 
nurses.

Bevill JW Jr, Cleary BL, Lacey LM, Nooney JG.

bbevill@northcarolina.edu

Comment in:
    Am J Nurs. 2007 May;107(5):11.

OBJECTIVE: Affected by the current nursing shortage, schools of nursing cite a
lack of qualified nursing faculty as a primary barrier to program expansion. We
sought to identify patterns in how nurses' entry-level degrees and other
individual characteristics correlated with the timing and achievement of
subsequent advanced nursing education. METHODS: Using longitudinal analysis of
data gathered as part of North Carolina's licensing renewal process, we studied
the educational mobility of newly graduated RNs with a variety of entry degrees
in this state. We followed one cohort of 3,384 new graduates who were licensed in
1984 (2,850 remained active and in the study at the 10-year point, and 2,418
remained active and in the study at the 20-year point) and another cohort of
5,341 new graduates who were licensed in 1994 (4,211 remained active and in the
study at 10 years). Demographic data for a third cohort of 5,400 new graduates
who were licensed in 2004 were included and considered along with data gathered
by the National League for Nursing for nursing education research, to assist us
in making comparisons between North Carolina and other states. RESULTS: Only 26% 
of the 2,418 members of the 1983-84 cohort at 20 years and 17% of the 4,211
members of the 1993-94 cohort at 10 years pursued higher degrees, and just 19%
and 12% of the respective cohorts did so in nursing. More than 80% of all nurses 
in either cohort who attained a master's degree in nursing or a doctorate in any 
field began their nursing career with a bachelor's degree. Younger age at entry
into nursing, male sex, and belonging to a racial or ethnic minority were
associated with being more likely to pursue higher academic degrees. CONCLUSIONS:
Based on our findings, we suggest that increasing the number of graduates with a 
bachelor of science in nursing degree, especially those who are men or members of
a racial or ethnic minority, will have the most immediate effect on increasing
the potential nursing faculty pool.

PMID: 17443081 [PubMed - indexed for MEDLINE]


22. Child Care Health Dev. 2007 May;33(3):340-6.

Career choices for paediatrics: national surveys of graduates of 1974-2002 from
UK medical schools.

Turner G, Lambert TW, Goldacre MJ, Turner S.

UK Medical Careers Research Group, Department of Public Health, Oxford
University, Old Road Campus, Oxford, UK.

BACKGROUND: Knowledge of UK doctors' career intentions and pathways is essential 
for understanding future workforce requirements. The aim of this study was to
report career choices for and career progression in paediatrics in the UK.
METHODS: Postal questionnaire surveys of qualifiers from all UK medical schools
in nine qualification years since 1974. RESULTS: In total, 74% (24 621/33 412)
and 73% (20 720/28 459) of doctors responded at 1 and 3 years after graduation.
Choices for paediatrics 1 year after qualifying fell from 7.8% of 1974 graduates 
to 5.0% of 1983 graduates, increased to 7.2% of 1993 graduates, and since the
level has remained fairly constant. Approximately twice the percentage of women
graduates than men graduates indicated a long-term career choice for paediatrics.
A total of 44% of those who chose paediatrics 1 year after graduation were
working in it 10 years after qualifying. Experience of the subject as a student, 
and enthusiasm/commitment: what I really want to do, affected long-term career
choices more for paediatrics than for other medical careers. CONCLUSIONS: The
proportion of junior doctors wishing to become paediatricians has not changed
much during the last 30 years. The planned increase in the number of medical
school graduates is necessary to increase the number of UK-trained consultant
paediatricians. Medical students who experience enthusiastic and stimulating
training in paediatrics may be more likely to become paediatricians.

PMID: 17439449 [PubMed - indexed for MEDLINE]


23. Adolescence. 2006 Winter;41(164):723-37.

Teachers' modeling advantage and their modeling effects on college students'
learning styles and occupational stereotypes: a case of collaborative teaching in
technical courses.

Chiou WB, Yang CC.

General Educational Center, National Kaohsiung Hospitality College, Taiwan,
Republic of China.

In this study, modeling advantage that depicts the likelihood of a teacher model 
being imitated by students over other competing models in a particular class was 
developed to differentiate the rival modeling of two kinds of teachers (the
technical teachers vs. the lecturing teachers) between college students' learning
styles and occupational stereotypes in the collaborative teaching of technical
courses. Results of a one-semester longitudinal study indicated that the students
perceived a greater modeling advantage of the technical teachers than that of the
lecturing teachers. Both the students' learning styles and occupational
stereotypes were in accordance with those teachers as their role models. In
general, the impact of the teachers' learning styles and occupational stereotypes
on students appeared to be mediated by the teachers' modeling advantage.
Administrators and curriculum designers should pay attention to the fact that the

technical teachers appeared to exhibit greater modeling effects than the
lecturing teachers in collaborative teaching.

PMID: 17240777 [PubMed - indexed for MEDLINE]


24. Arch Phys Med Rehabil. 2006 Dec;87(12):1576-82.

Occupational categories and return to work after traumatic brain injury: a
multicenter study.

Walker WC, Marwitz JH, Kreutzer JS, Hart T, Novack TA.

Department of Physical Medicine and Rehabilitation, Virginia Commonwealth
University, Richmond, VA 23298-0661, USA. wcwalker@mail2.vcu.edu

OBJECTIVE: To further evaluate determinants of return to work (RTW) after
traumatic brain injury (TBI), with focus on the relation between preinjury
occupational category and RTW outcome. DESIGN: Prospective collaborative cohort
study. SETTING: Seventeen National Institute on Disability and Rehabilitation
Research-designated Traumatic Brain Injury Model Systems. PARTICIPANTS:
Consecutive sample of 1341 patients (age range, 18-62y) who were hospitalized
with a TBI diagnosis, received both acute neurotrauma services and inpatient
rehabilitation services, consented to participate, were employed before injury,
and completed a 1-year follow-up assessment. INTERVENTION: An inpatient
interdisciplinary brain injury rehabilitation program. MAIN OUTCOME MEASURE:
Competitive employment at 1 year postinjury. RESULTS: Participants were
categorized into 1 of 3 groups depending on preinjury occupational title:
professional/managerial (n=192), skilled (n=751), or manual labor (n=398).
Chi-square analyses were computed to examine changes across occupation groups
between preinjury occupation group and postinjury RTW. The rate of successful RTW
was greatest for professional/managerial (56%), lower for skilled (40%), and
lowest for manual labor (32%), yielding an odds ratio of 2.959 between the
highest and lowest groups. Of those with successful RTW, most did so within the
same occupational category grouping. A multiple logistic regression showed that
preinjury occupation, education level, discharge FIM score, age, sex, marital
status, and hospital length of stay each influenced RTW. CONCLUSIONS: Prior
research has shown that preinjury employment status (employed vs unemployed)
greatly influences the odds of successful RTW after TBI. A related hypothesis,
that occupational classification also influences RTW outcome, has been
understudied and has yielded conflicting results. The current study shows
convincingly that the type of occupation influences RTW outcome, with the best
prospect for RTW among people with professional/managerial jobs. Occupational
category should be examined in the future development of predictive models for
RTW after TBI.

PMID: 17141636 [PubMed - indexed for MEDLINE]


25. Health Rep. 2006 Oct;17(4):11-29.

Stress and depression in the employed population.

Shields M.

Health Statistics Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.
Margot.Shields@statcan.ca

OBJECTIVES: This article describes stress levels among the employed population
aged 18 to 75 and examines associations between stress and depression. DATA
SOURCES: Data are from the 2002 Canadian Community Health Survey: Mental Health
and Well-being and the longitudinal component of the 1994/95 through 2002/03
National Population Health Survey. ANALYTICAL TECHNIQUES: Stress levels were
calculated by sex, age and employment characteristics. Multivariate analyses were
used to examine associations between stress and depression in 2002, and between
stress and incident depression over a two-year period, while controlling for age,
employment characteristics, and factors originating outside the workplace. MAIN
RESULTS: In 2002, women reported higher levels of job strain and general
day-to-day stress. When the various sources of stress were considered
simultaneously, along with other possible confounders, for both sexes, high
levels of general day-to-day stress and low levels of co-worker support were
associated with higher odds of depression, as was high job strain for men. Over a
two-year period, men with high strain jobs and women with high personal stress
and low co-worker support had elevated odds of incident depression.

PMID: 17111591 [PubMed - indexed for MEDLINE]


26. Am J Ind Med. 2006 Dec;49(12):997-1004.

Twenty-three years of hypersensitivity pneumonitis mortality surveillance in the 
United States.

Bang KM, Weissman DN, Pinheiro GA, Antao VC, Wood JM, Syamlal G.

National Institute for Occupational Safety and Health, Centers for Disease
Control and Prevention, Morgantown, West Virginia 26505, USA. kmb2@cdc.gov

BACKGROUND: There are few population-based studies addressing hypersensitivity
pneumonitis (HP) in the United States. The National Institute for Occupational
Safety and Health (NIOSH) has nationally comprehensive longitudinal mortality
data that can contribute to a better understanding of the epidemiology of HP.
METHODS: The National Center for Health Statistics multiple cause-of-death data
were analyzed for the period 1980-2002. Annual death rate was age-adjusted to the
2000 U.S. standard population. Death rate time-trends were calculated using a
linear regression model and geographic distribution of death rates were mapped by
state and county. Proportionate mortality ratios (PMRs) by usual industry and
occupation adjusted for age, sex, and race, were based on data from 26 states
reporting industry and occupation during 1985-1999. RESULTS: Overall age-adjusted
death rates increased significantly (P < 0.0001) between 1980 and 2002, from 0.09
to 0.29 per million. Wisconsin had the highest rate at 1.04 per million. Among
industries, PMR for HP was significantly high for agricultural production,
livestock (PMR, 19.3; 95% CI, 14.0-25.9) and agricultural production, crops (PMR,
4.3; 95% CI, 3.0-6.0). Among occupations, PMR for HP was significantly elevated
for farmers, except horticulture (PMR, 8.1; 95% CI, 6.4-10.2). CONCLUSIONS: These
findings indicate that agricultural industries are closely associated with HP
mortality and preventive strategies are needed to protect workers in these
industries.

PMID: 17096370 [PubMed - indexed for MEDLINE]


27. Am J Ind Med. 2007 Jan;50(1):13-21.

Industrial sectors with high risk of women's hospital-treated injuries.

Kines P, Hannerz H, Mikkelsen KL, Tüchsen F.

National Institute of Occupational Health, Lersø Parkallé, Copenhagen, Denmark.

BACKGROUND: Women's occupational injury rates are converging with those of males.
Associations between female workers' hospital treated injury rates, industrial
sector and injured body area were analyzed to provide for better-focused injury
prevention of women's hazardous jobs. METHODS: Females' standardized hospital
treatment ratios (SHR) and the excess fraction for five body regions (head/neck, 
thorax, back, upper and lower extremities) were calculated for 58 industrial
sectors for 1999-2003. RESULTS: Five industrial sectors, "Cleaning, laundries and
dry cleaners," "Transport of passengers," "Hotels and restaurants," "Hospitals"
and "Transport of goods" had significantly high SHRs for all five body regions.
The excess fraction for upper extremity injuries revealed that 14%-27% of
injuries could theoretically have been avoided. CONCLUSIONS: There is strong
evidence for an association between women's hospital treated injuries and
industrial sector. The results justify the need for gender-sensitive analyses to 
orient injury prevention programs. (c) 2006 Wiley-Liss, Inc.

PMID: 17096369 [PubMed - indexed for MEDLINE]


28. J Adv Nurs. 2006 Dec;56(5):532-41.

Determinants of tenure in allied health and nursing education.

Balogun JA, Sloan PE, Germain M.

Professor and Dean, College of Health Sciences, Chicago State University,
Illinois, USA.

AIM: This paper presents a prospective cross-sectional study that investigated
the tenure rate and the primary criterion use in granting tenure in nursing and
allied health education in the United States of America. BACKGROUND: Given the
recent trend by highly skilled professionals to seek employment in other
countries, a clear understanding of the conditions of service in higher education
is important to educators contemplating the relocating to another country. The
preponderance of the published literature on academic tenure is from the United
States of America, where educators continue to debate the value of the tenure
system and the criteria to be used in tenure decisions. METHOD: We surveyed the
deans of National League for Nursing accredited programmes (n = 187) and deans of
allied health programmes belonging to the association of schools of allied health
professions (n = 75) in the United States of America. The questionnaire sought
demographic and institution-related information, tenure rate and weightings
attached to teaching, scholarship and service in tenure decision. The data were
collected in 2002. FINDINGS: Allied health and nursing educators had 47% and 35% 
tenure rates, respectively. The overwhelming majority of the deans in our study, 
77%, ranked teaching as the primary criterion used in tenure decisions in their
institutions. On the other hand, fewer than 25% rated scholarship and fewer than 
5% rated service as the most important criterion used for tenure in their
institution. The responses of the deans were modulated by the type and ownership 
of the institution in which they were employed and the characteristics of the
educators. CONCLUSION: The implications for preparing future educators in the
United States of America for long-term careers in allied health and nursing
professions are that: (1) teaching is less highly valued in research-oriented
universities; and (2) heavy teaching workloads may be detrimental to the chances 
of obtaining tenure. Replication of the study in other countries would have the
potential to facilitate the employment mobility and educator exchange.

PMID: 17078828 [PubMed - indexed for MEDLINE]


29. Am J Public Health. 2006 Dec;96(12):2216-21. Epub 2006 Oct 31.

Social circumstances and education: life course origins of social inequalities in
metabolic risk in a prospective national birth cohort.

Langenberg C, Kuh D, Wadsworth ME, Brunner E, Hardy R.

International Centre for Health and Society, Department of Epidemiology and
Public Health, University College London, London, England, United Kingdom.
c.langenberg@ucl.ac.uk

OBJECTIVES: We investigated the relative importance of education and childhood
and adult social class in the risk of metabolic syndrome. METHODS: We conducted a
prospective birth cohort study of 1311 men and 1318 women aged 53 years in 1999, 
when metabolic syndrome components were measured. Logistic regression analyses
were used to calculate relative index of inequality estimates. RESULTS: Relative 
to men and women at the highest education levels, men (odds ratio [OR]=2.0; 95%
confidence interval [CI]=1.2, 3.2) and women (OR=2.7; 95% CI=1.5, 4.6) with the
least education were at twice the risk or more of having the metabolic syndrome. 
Adjustment for childhood and adult social class strengthened this result among
men and weakened it among women. Childhood social class was independently
associated with the metabolic syndrome in women (OR=2.0; 95% CI=1.1, 3.6) but not
in men (OR=1.1; 95% CI= 0.7, 1.8). Associations between adult social class and
the metabolic syndrome or its components were largely accounted for by childhood 
socioeconomic measures. CONCLUSIONS: Educational differences should be considered
in the design of interventions aimed at reducing the burden of the metabolic
syndrome in socially disadvantaged groups.

PMCID: PMC1698170
PMID: 17077402 [PubMed - indexed for MEDLINE]


30. Health Econ. 2007 Apr;16(4):407-19.

The economic cost of teen drinking: late graduation and lowered earnings.

Renna F.

Department of Economics, The University of Akron, USA. Frenna@uakron.edu

This paper analyzes the effect that binge drinking has on the probability of
graduating on time from high school and on future earnings. The analysis is
conducted on students in their senior year of high school using data from the
National Longitudinal Survey of Youth 1979. Importantly, the usual instruments
used to correct for the endogeneity of the drinking variable are found to be
robust only for women. This paper finds that heavy drinking decreases the
probability of graduating on time. Binge drinking does not have a direct impact
on adults' labor earnings, but graduating late results in lower labor income.
Because of a late graduation, young men who binge in high school will face an
earnings penalty of 1.5-1.84 percentage points. Women also face a penalty, but
this seems mostly due to the fact that women who graduate late work in industries
and occupations that pay less. Copyright (c) 2006 John Wiley & Sons, Ltd.

PMID: 17031781 [PubMed - indexed for MEDLINE]


31. Atherosclerosis. 2007 Oct;194(2):490-7. Epub 2006 Sep 18.

Occupational, commuting and leisure-time physical activity in relation to
coronary heart disease among middle-aged Finnish men and women.

Hu G, Jousilahti P, Borodulin K, Barengo NC, Lakka TA, Nissinen A, Tuomilehto J.

Department of Epidemiology and Health Promotion, National Public Health
Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. hu.gang@ktl.fi

OBJECTIVE: To examine the association of different levels of occupational,
commuting, and leisure-time physical activity with the risk of coronary heart
disease (CHD) events. METHODS AND RESULTS: The study comprised 47,840 Finnish
participants aged 25-64 years without history of CHD and stroke at baseline.
During a mean follow-up of 18.9 years, 4660 new CHD events were documented. The
multivariable-adjusted (age, body mass index, systolic blood pressure, total
cholesterol, education, alcohol consumption, smoking, history of diabetes, and
other two types of physical activity) hazard ratios (HRs) of CHD events
associated with low, moderate, and high occupational activity were 1.00, 0.87,
and 0.90 (P(trend)=0.019) for men, and 1.00, 0.75, and 0.80 (P(trend)<0.001) for 
women, respectively. The multivariable-adjusted HRs of CHD events associated with
low, moderate, and high leisure-time physical activity were 1.00, 0.95, and 0.84 
(P(trend)=0.026) for men, and 1.00, 0.85, and 0.77 (P(trend)=0.003) for women,
respectively. Active commuting had a significant inverse association with the
risk of CHD events in women but not in men. CONCLUSION: Moderate or high levels
of occupational or leisure-time physical activity are associated with a reduced
risk of CHD. Daily walking or cycling to and from work is associated with a
decreased risk of CHD among women.

PMID: 16979645 [PubMed - indexed for MEDLINE]


32. Occup Environ Med. 2006 Dec;63(12):820-7. Epub 2006 Aug 15.

Occupational and other risk factors for hand-grip strength: the Honolulu-Asia
Aging Study.

Charles LE, Burchfiel CM, Fekedulegn D, Kashon ML, Ross GW, Sanderson WT,
Petrovitch H.

Biostatistics and Epidemiology Branch, Health Effects Laboratory Division,
National Institute for Occupational Safety and Health, Centers for Disease
Control and Prevention, Morgantown, WV 26505-2888, USA. lcharles@cdc.gov

BACKGROUND: In certain occupations, including farm work, workers are exposed to
hazardous substances, some of which are known to be toxic to the nervous system
and may adversely affect muscle strength. Measurement of hand-grip strength may
be useful for detecting neurotoxic exposure. METHODS: The authors studied 3522
participants of the Honolulu Heart Program and the Honolulu-Asia Aging Study to
determine whether occupational exposures to pesticides, solvents, and metals
assessed at exam I (1965-68) are associated with hand-grip strength at exam IV
(1991-93) and change in hand-grip strength over 25 years. Correlation, analysis
of variance and covariance, and linear regression were used to evaluate the
associations. RESULTS: At exam IV, participants ranged in age from 71-93 years;
mean hand-grip strength was 39.6 kg at exam I and 30.3 kg at exam IV. Over 25
years, the decline in hand-grip strength was an average of 8-9 kg for all
exposures. Hand-grip strength was inversely associated with age and glucose but
directly associated with cognitive function, BMI, and haemoglobin level. No other
exposures were associated with hand-grip strength. CONCLUSION: This study did not
provide evidence that occupational exposure to pesticides, solvents, and metals
adversely affected hand-grip strength in this population, but confirmed other
important associations with hand-grip strength.

PMCID: PMC2078007
PMID: 16912086 [PubMed - indexed for MEDLINE]


33. J Psychosom Res. 2006 Aug;61(2):275-8.

Alexithymia behaves as a personality trait over a 5-year period in Finnish
general population.

Salminen JK, Saarijärvi S, Toikka T, Kauhanen J, Aärelä E.

Laboratory for Population Research, Department of Health and Functional Capacity,
National Public Health Institute, Turku, Finland. jouko.salminen@ktl.fi

OBJECTIVE: Temporal stability is a basic assumption underlying any personality
trait construct. Previous research on the stability of alexithymia has led to a
controversy over whether alexithymia should be viewed as a state-dependent
phenomenon or as a stable personality trait. The aim of this 5-year longitudinal 
study was to examine the temporal stability of alexithymia in the general
population in Finland. METHODS: Alexithymia was measured with the 20-Item Toronto
Alexithymia Scale (TAS-20) at the baseline and 5 years later. RESULTS: The
test-retest correlations of the TAS-20 total and factor-specific scores at the
baseline and at the 5-year follow-up ranged from moderate to high in both
genders, reflecting a rather high relative stability of the TAS-20 scores over a 
period of 5 years. CONCLUSIONS: The findings of our study suggest that
alexithymia behaves like a stable personality trait in the general population.

PMID: 16880032 [PubMed - indexed for MEDLINE]


34. J Psychosom Res. 2006 Aug;61(2):271-4.

Justice at work and cardiovascular mortality: a prospective cohort study.

Elovainio M, Leino-Arjas P, Vahtera J, Kivimäki M.

National Research and Development Center for Welfare and Health, P.O. Box 220,
FIN-00531 Helsinki, Finland. marko.elovainio@stakes.fi

OBJECTIVES: Previous studies have suggested that the extent to which employees
are treated with justice at the workplace contributes to their health. We
examined whether justice at work predicted incidence of deaths from
cardiovascular disease. METHODS: Participants were 804 factory workers whose
mortality data were collected from the Finnish national mortality register (73
deaths; mean follow-up, 25.6 years). Justice perceptions of the participants were
measured using a postal survey at baseline year 1973. RESULTS: Cox proportional
hazards models adjusted for conventional risk factors and other psychosocial
factors at work showed that employees reporting high justice at work had a 45%
lower risk of cardiovascular death than their counterparts experiencing low or
intermediate justice (P=.05). CONCLUSIONS: Justice at work, fair decision-making 
procedures, and managerial skills are important factors in an effort to develop
healthy and well-functioning workplaces.

PMID: 16880031 [PubMed - indexed for MEDLINE]


35. Arch Dermatol. 2006 Mar;142(3):305-11.

Prognosis of occupational hand eczema: a follow-up study.

Cvetkovski RS, Zachariae R, Jensen H, Olsen J, Johansen JD, Agner T.

Department of Dermatology, Gentofte Hospital, University of Copenhagen, Hellerup,
Denmark.

Comment in:
    Arch Dermatol. 2006 Mar;142(3):362-4.

OBJECTIVE: To identify prognostic risk factors in patients with occupational hand
eczema (OHE). DESIGN: Cohort study with 1-year follow-up. SETTING: Danish
National Board of Industrial Injuries Registry. PATIENTS: All patients with newly
recognized OHE (758 cases) from October 1, 2001, through November 10, 2002.
INTERVENTIONS: Participants received a questionnaire covering self-rated
severity, sick leave, loss of job, depression, and health-related quality of
life. One year after the questionnaire was returned, all responders (N = 621)
received a follow-up questionnaire, and 564 (91%) returned it. MAIN OUTCOME
MEASURES: Persistently severe or aggravated OHE, prolonged sick leave, and loss
of job after 1-year follow-up. RESULTS: During the follow-up period, 25% of all
patients with OHE had persistently severe or aggravated disease, 41% improved,
and 34% had unchanged minimal or mild to moderate disease. Patients with atopic
dermatitis fared poorly compared with other patients. Patients younger than 25
years fared clearly better than older groups. Furthermore, severe OHE, age 40
years or greater, and severe impairment of quality of life at baseline appeared
to be important predictors of prolonged sick leave and unemployment. Patients
with lower socioeconomic status also had a high risk of prolonged sick leave, job
change, and loss of job. Contact allergy was not found to be a risk factor for
poor prognosis. CONCLUSIONS: Atopic dermatitis, greater age, and low
socioeconomic status may be reliable prognostic factors in early OHE. Quality of 
life and standardized severity assessment may also be valuable tools to identify 
patients at high risk of prolonged sick leave and unemployment.

PMID: 16549705 [PubMed - indexed for MEDLINE]


36. Neurotoxicology. 2006 May;27(3):445-9. Epub 2006 Feb 14.

A retrospective cohort study of Parkinson's disease in Korean shipbuilders.

Park J, Yoo CI, Sim CS, Kim JW, Yi Y, Shin YC, Kim DH, Kim Y.

Occupational Safety and Health Research Institute, Korea Occupational Safety and 
Health Agency, Incheon, South Korea.

OBJECTIVE: We performed a retrospective cohort study in South Korea to clarify
the role of occupational exposure, especially to welding, in the etiology of
Parkinson's disease (PD). METHODS: We constructed a database of subjects
classified into an exposure group (blue-collar workers) and a non-exposure group 
(white-collar workers) in two shipbuilding companies. Jobs of blue-collar workers
were categorized into the first group of welding, the second group of fitting,
grinding and finishing, cutting, and the other group. To determine new cases of
PD during the follow-up period (1992-2003), we used the physician billing claims 
database of the National Health Insurance Corporation. For the detected PD
patients in the physician billing claims database, a neurologist in our research 
team confirmed the appropriateness of each diagnosis by reviewing medical charts.
Based on the review, we confirmed the numbers of new cases of PD and calculated
the relative risk (RR) and the 95% confidence intervals (CI) by Cox regression
analysis. RESULTS: In a backward selection procedure, 'age' was a significant
independent variable but exposure was not. Furthermore, the RR in welders (high
exposure group) was also insignificant and less than that in others (very low
exposure group). CONCLUSION: This longitudinal study of shipbuilding workers
supports our previous case-control studies suggesting that exposure to manganese 
does not increase the risk of PD.

PMID: 16483661 [PubMed - indexed for MEDLINE]


37. J Child Health Care. 2006 Mar;10(1):55-68.

Developing the children's nursing workforce: profile, first jobs and future plans
of newly qualified diplomates.

Robinson S, Cox S, Murrells T.

Nursing Research Unit, King's College, University of London, UK.
sarah.robinson@kcl.ac.uk

Concerns regarding the number of children's nurses persist despite initiatives
designed to reverse this trend. Recruiting and retaining a diverse nursing
workforce is high on the policy agenda, particularly since the publication of the
National Service Framework for Children, Young People and Maternity Services.
This article reports findings from the first phase of a longitudinal study
investigating the careers of child branch diplomates, focusing on the cohort's
profile, first jobs and future plans. Findings suggest there is considerable
scope to increase diversity in the children's nursing workforce. Child health
diplomates indicate little sign of early attrition from nursing at qualification.
Continuing professional development is a high priority for many child health
nurses at the outset of their careers. These findings provide an important
benchmark for later stages of child branch nurses' careers.

PMID: 16464933 [PubMed - indexed for MEDLINE]


38. Br J Gen Pract. 2006 Feb;56(523):134-6.

Workforce trends in general practice in the UK: results from a longitudinal study
of doctors' careers.

Jones L, Fisher T.

National Collaborating Centre for Women's and Children's Health, Royal College of
Obstetricians and Gynaecologists, 27 Sussex Place, Regent's Park, London NW1 4RG,
UK. ljones@ncc-wch.org.uk

The career paths of 544 UK medical school graduates were followed for 10 years.
Although general practice was not attractive to graduates initially, it became
popular in subsequent years, mainly because it was seen as offering a superior
quality of life. Once in general practice both men and women chose to work
reduced hours and/or in non-principal posts. The findings suggest the need to
look more closely at the nature of these trends and the implications for patient 
care and service provision.

PMCID: PMC1828220
PMID: 16464328 [PubMed - indexed for MEDLINE]


39. Scand J Public Health. 2005;33(6):447-54.

Does occupational social class predict coronary heart disease after retirement? A
12-year follow-up study in Sweden.

Sundquist K, Johansson SE, Qvist J, Sundquist J.

Karolinska Institutet, Family Medicine, Stockholm, Sweden.
Kristina.Sundquist@klinvet.ki.se

AIMS: To examine whether socioeconomic status and coronary heart disease (CHD)
risk factors remain significant predictors of CHD among people aged >or=65 years.
Previous studies in this age group are few and inconsistent. METHODS: Follow-up
study of a simple random sample of Swedish women and men aged >or=65 years
interviewed in a national survey 1988-89 and followed up until 31 December 2000, 
for CHD incidence rates. Cox regression was used to study the association between
socioeconomic status (occupation) and CHD, after adjustment for age, sex,
physical activity, smoking, BMI, diabetes, and hypertension. Participants with
CHD hospitalization two years before the start of the study and those who rated
their general health as poor were excluded. RESULTS: Among manual workers and
lower-level employees the risk of CHD was significantly higher than among
middle-level employees and professionals (49% and 50%, respectively), after
adjustment for age and sex. The association between low socioeconomic status and 
increased CHD risk disappeared after adjustment for the CHD risk factors, which
were more prevalent among those with low socioeconomic status. All the CHD risk
factors (with the exception of BMI) were associated with increased CHD incidence 
rates. CONCLUSIONS: Low socioeconomic status remains a significant predictor of
CHD among people aged >or=65 years. Healthcare policies among elderly patients
should encourage physical activity and smoking cessation in all socioeconomic
groups.

PMID: 16392167 [PubMed - indexed for MEDLINE]


40. Int J Ment Health Nurs. 2005 Dec;14(4):230-42.

Retaining the mental health nursing workforce: early indicators of retention and 
attrition.

Robinson S, Murrells T, Smith EM.

Nursing Research Unit, King's College, London, London, UK.
sarah.robinson@kcl.ac.uk

In the UK, strategies to improve retention of the mental health workforce feature
prominently in health policy. This paper reports on a longitudinal national study
into the careers of mental health nurses in the UK. The findings reveal little
attrition during the first 6 months after qualification. Investigation of career 
experiences showed that the main sources of job satisfaction were caregiving
opportunities and supportive working relationships. The main sources of
dissatisfaction were pay in relation to responsibility, paperwork, continuing
education opportunities, and career guidance. Participants were asked whether
they predicted being in nursing in the future. Gender and ethnicity were related 
to likelihood to remain in nursing in 5 years time. Age, having children,
educational background, ethnic background, and time in first job were associated 
with likelihood of remaining in nursing at 10 years. Associations between
elements of job satisfaction (quality of clinical supervision, ratio of qualified
to unqualified staff, support from immediate line manager, and paperwork) and
anticipated retention are complex and there are likely to be interaction effects 
because of the complexity of the issues. Sustaining positive experiences,
remedying sources of dissatisfaction, and supporting diplomats from all
backgrounds should be central to the development of retention strategies.

PMID: 16296990 [PubMed - indexed for MEDLINE]


41. Southeast Asian J Trop Med Public Health. 2005 Jul;36(4):822-31.

Surveillance of imported bancroftian filariasis after two-year multiple-dose
diethylcarbamazine treatment.

Koyadun S, Bhumiratana A.

Office of Disease Prevention and Control 11, Nakhon Si Thammarat, Department of
Disease Control, Ministry of Public Health, Nakhon Si Thammarat, Thailand.

Myanmar migrants are at increased risk for nocturnally periodic Wuchereria
bancrofti causing imported bancroftian filariasis. They have a significant
influence on the effectiveness of diethylcarbamazine (DEC) mass treatment at the 
provincial level in the National Program to Eliminate Lymphatic Filariasis (PELF)
during the fiscal years (FY) 2002-2006, in Thailand. Two oral doses of DEC 6
mg/kg are given twice a year to the eligible Myanmar migrants (> or = 2 years
old). A 300 mg DEC provocation test is given once a year to all Myanmar migrants 
with work permits. Effectiveness evaluation parameters, such as cumulative index 
(CI) and the effectiveness ratio (ER), were obtained after 2 years of the
multiple-dose DEC treatment program in Ranong Province, Southern Thailand. By
cross-sectional night blood surveys at the end of FY 2003 in two districts of
Ranong Province, the microfilarial positive rates (MPR) were 0.8% and 1.2% for
Mueang Ranong and Kra Buri, respectively. The MPR in the agricultural (1.5%) and 
industrial (0.4%) occupations were not significantly different from each other.
Our findings suggest that most untreated microfilaremics working in agriculture, 
with short-term residency in Thailand, may have delayed multiple-dose DEC
treatment.

PMID: 16295532 [PubMed - indexed for MEDLINE]


42. Ann Epidemiol. 2006 Mar;16(3):170-9. Epub 2005 Sep 21.

Methodologic issues in follow-up studies of cancer incidence among occupational
groups in the United States.

Bender TJ, Beall C, Cheng H, Herrick RF, Kahn AR, Matthews R, Sathiakumar N,
Schymura MJ, Stewart JH, Delzell E.

Department of Epidemiology, School of Public Health, University of Alabama at
Birmingham, Birmingham, AL 35294, USA. bender@uab.edu

PURPOSE: Incidence studies of occupational factors and cancer in the United
States are problematic because the use of population-based registries to identify
cases requires development of historical data on subjects' residences and often
severely restricts the time period of follow up. This article describes
procedures for addressing these challenges. METHODS: We used data from studies of
cancer incidence and mortality among microelectronics industry employees to
assess various methods for developing residential histories and the relative
informativeness of the two studies. RESULTS: We developed residential histories
for 98% of 99,229 mortality study subjects. Analyses making alternative
assumptions about residential histories yielded standardized incidence ratios
varying by at most 6%. Use of postemployment residential histories increased
person-years by up to 62% and increased the observed number of cancers by up to
28%. The proportion of mortality study person-years included in the cancer
incidence study ranged from 40% to 77% among work activity subcohorts. The number
of observed cancer cases in the incidence study was 60% higher than the number of
observed cancer deaths in the mortality study. CONCLUSIONS: Assumptions about
residential history had little impact on validity. Use of information sources
with national coverage to develop residential histories increased the incidence
study's precision. Despite geographic and temporal restrictions, incidence
studies provide more data than mortality studies on cancers with good survival.
However, the potential for selection bias in incidence studies may vary
considerably among subcohorts, indicating the need for cautious interpretation of
such research.

PMID: 16181790 [PubMed - indexed for MEDLINE]


43. Stroke. 2005 Sep;36(9):1994-9. Epub 2005 Aug 4.

Leisure time, occupational, and commuting physical activity and the risk of
stroke.

Hu G, Sarti C, Jousilahti P, Silventoinen K, Barengo NC, Tuomilehto J.

Department of Epidemiology and Health Promotion, National Public Health
Institute, Helsinki, Finland. hu.gang@ktl.fi

BACKGROUND AND PURPOSE: The role of physical activity, especially that of
occupational and commuting physical activity, in the prediction of stroke risk is
not properly established. We assessed the relationship of different types of
physical activity with total and type-specific stroke risk. METHODS: We
prospectively followed 47 721 Finnish subjects 25 to 64 years of age without a
history of coronary heart disease, stroke, or cancer at baseline. Hazard ratios
(HRs) for incident stroke were estimated for different levels of leisure time,
occupational, and commuting physical activity. RESULTS: During a mean follow-up
of 19.0 years, 2863 incident stroke events were ascertained. The
multivariate-adjusted (age, sex, area, study year, body mass index, systolic
blood pressure, cholesterol, education, smoking, alcohol consumption, diabetes,
and other 2 types of physical activity) HRs associated with low, moderate, and
high leisure time physical activity were 1.00, 0.86, and 0.74 (Ptrend<0.001) for 
total stroke, 1.00, 0.87, and 0.46 (Ptrend=0.011) for subarachnoid hemorrhage,
1.00, 0.77, and 0.63 (Ptrend=0.024) for intracerebral hemorrhage, and 1.00, 0.87,
and 0.80 (Ptrend=0.001) for ischemic stroke, respectively. The
multivariate-adjusted HRs associated with none, 1 to 29, and > or =30 minutes of 
active commuting were 1.00, 0.92, and 0.89 (Ptrend=0.043) for total stroke, and
1.00, 0.93, and 0.86 (Ptrend=0.028) for ischemic stroke, respectively.
Occupational activity had a modest association with ischemic stroke in the
multivariate analysis (Ptrend=0.046). CONCLUSIONS: A high level of leisure time
physical activity reduces the risk of all subtypes of stroke. Daily active
commuting also reduces the risk of ischemic stroke.

PMID: 16081862 [PubMed - indexed for MEDLINE]


44. Sociol Health Illn. 2005 Jul;27(5):602-27.

Do occupation and work conditions really matter? A longitudinal analysis of
psychological distress experiences among Canadian workers.

Marchand A, Demers A, Durand P.

Health and Prevention Social Research Group, University of Montreal, Canada.
amarchan@alcor.concordia.ca

This study analyses the relationship between occupation, work conditions and the 
experience of psychological distress within a model encompassing the stress
promoted by constraints-resources embedded in macrosocial structures
(occupational structure), structures of daily life (workplace, family, social
networks outside the workplace) and agent personality (demography, physical
health, psychological traits, life habits, stressful childhood events).
Longitudinal data were derived from Statistics Canada's National Population
Health Survey and comprised 6,359 workers nested in 471 occupations, followed
four times between 1994-1995 and 2000-2001. Discrete time survival multilevel
regressions were conducted on first and repeated episodes of psychological
distress. Results showed that 42.9 per cent of workers had reported one episode
of psychological distress and 18.7 per cent had done so more than once. Data
supported the model and challenged the results of previous studies. The
individual's position in the occupational structure plays a limited role when the
structures of daily life and agent personality are accounted for. In the
workplace, job insecurity and social support are important determinants, but
greater decision authority increases the risk of psychological distress.
Workplace constraints-resources are not moderated either by the other structures 
of daily life or by agent personality.

PMID: 16078903 [PubMed - indexed for MEDLINE]


45. Menopause. 2005 Jul-Aug;12(4):475-82. Epub 2005 Jul 21.

Childhood cognitive ability and age at menopause: evidence from two cohort
studies.

Kuh D, Butterworth S, Kok H, Richards M, Hardy R, Wadsworth ME, Leon DA.

MRC National Survey of Health and Development, Department of Epidemiology and
Public Health, Royal Free and University College Medical School, London.
d.kuh@nhsd.mrc.ac.uk

OBJECTIVE: To investigate whether poorer cognitive ability in childhood is
associated with an earlier menopause. DESIGN: Two cohorts were included: a
nationally representative British birth cohort study of 1,350 women born in March
1946 and followed up to age 54 years, and an Aberdeen cohort study of 3,465 women
born in Aberdeen from 1950 to 1956 and followed up to age 44 to 50 years. Both
cohorts had prospective information on childhood cognitive ability at age 7 or 8 
years. RESULTS: In both cohorts, women with lower cognitive scores in childhood
reached menopause earlier than women with higher scores. With follow-up of
menopause to 49 years, the hazard ratio (HR) for one standard deviation of the
cognitive score was 0.80 (95% CI, 0.72-0.90) in the Aberdeen cohort and 0.84 (95%
CI, 0.73-0.97) in the older 1946 birth cohort. The effect was still evident in
the 1946 birth cohort with follow-up of menopause to 53 years (HR = 0.87; 95% CI,
0.79-0.95). These ratios were weakly attenuated by adjustment for potential
confounding effects of lifetime socioeconomic circumstances, parity, and smoking.
CONCLUSIONS: The association between early cognitive ability and timing of
menopause only partially reflects common risk factors, although residual
confounding remains a possibility. Alternatively, early environmental or genetic 
programming may explain this association, perhaps through setting lifelong
patterns of hormone release or causing transient hormonal changes at sensitive
periods of development. These findings have implications for the interpretation
of studies investigating an association between age at menopause and adult
cognitive function.

PMID: 16037764 [PubMed - indexed for MEDLINE]


46. Br J Anaesth. 2005 Sep;95(3):332-8. Epub 2005 Jul 8.

Career choices for anaesthesia: national surveys of graduates of 1974-2002 from
UK medical schools.

Turner G, Goldacre MJ, Lambert T, Sear JW.

UK Medical Careers Research Group, Department of Public Health, University of
Oxford, Old Road Campus, Oxford OX3 7LF, UK.

Comment in:
    Br J Anaesth. 2005 Sep;95(3):284-6.

BACKGROUND: Knowledge about UK doctors' career intentions and pathways is
essential for understanding future workforce requirements. The aim of this study 
was to report career choices for and career progression in anaesthesia in the UK.
METHODS: Postal questionnaire surveys were undertaken of qualifiers from all UK
medical schools in nine qualification years since 1974. RESULTS: 74%
(24623/33417) and 73% (20709/28468) of doctors responded at 1 and 3 yr after
qualification. At 1 and 3 yr after qualification, on average, 8% of doctors chose
anaesthesia. Between 1974 and 2002 the percentage of doctors choosing
anaesthesia, 1 yr after qualification, increased from 5 to 12%. A majority of
doctors who chose anaesthesia 1 and 3 yr after qualification were working in
anaesthesia 10 yr after qualification. In addition to doctors' enthusiasm for the
specialty, career choices for anaesthesia were positively influenced by their
perception of working hours, conditions of work, and career and promotion
prospects. CONCLUSIONS: Anaesthesia has become increasingly popular as a career
choice in the UK. Training numbers could be increased in the short term to speed 
up the process of providing a consultant-delivered service.

PMID: 16006486 [PubMed - indexed for MEDLINE]


47. Am J Public Health. 2005 Jul;95(7):1226-32.

Occupational injury and absence from work among African American, Hispanic, and
non-Hispanic White workers in the national longitudinal survey of youth.

Strong LL, Zimmerman FJ.

Department of Health Services, School of Public Health and Community Medicine,
University of Washington, Seattle, 98109, USA. lstrong@u.washington.edu

OBJECTIVES: We examined how race and ethnicity influence injury and illness risk 
and number of days of work missed as a result of injury or illness. METHODS: We
fit logistic regression and negative binomial regression models using generalized
estimating equations with data from 1988 to 2000 on currently employed African
American, Hispanic, and non-Hispanic White participants in the National
Longitudinal Survey of Youth. RESULTS: Occupational factors-having a blue-collar 
occupation, working full-time, having longer tenure, working 1 job versus 2, and 
working the late shift-were associated with increased odds of an occupational
injury or illness. Although racial/ethnic minority workers were no more likely
than Whites to report an occupational injury or illness, they reported missing
more days of work. African American and Hispanic men missed significantly more
days of work than non-Hispanic White men, and African American women missed
significantly more days of work than non-Hispanic White women. CONCLUSIONS:
Factors associated with occupational health are multifaceted and complex. Our
findings suggest that race/ethnicity influences the duration of work absence
owing to injury or illness both indirectly (by influencing workers' occupational 
characteristics) and directly (by acting independently of occupational factors).

PMCID: PMC1449344
PMID: 15983275 [PubMed - indexed for MEDLINE]


48. Georgian Med News. 2005 Apr;(121):56-8.

Psychosocial work environment and coronary heart disease.

Danelia M, Trapaidze D.

National Institute of Health; Institute of Clinical and Experimental Cardiology, 
Georgia.

In Georgia, like the other post Soviet republics, CHD morbidity is increasing,
especially among young and middle aged people-- i.e. among those who should have 
the most working ability-- that points at both individual and social significance
of the problem. CHD is becoming more and more common among rural inhabitants,
different professional groups involved not only in mental but also in physical
work. The longstanding observation that rates of coronary heart disease vary
markedly among occupations more than can be accounted for by conventional risk
factors for coronary heart disease has generated a quest for specific components 
of work that might be of etiological importance. Especially when according to
structural changes in society the role of social and psychological factors
increased. Case-control study was carried out based on Karasek model. Our results
indicate that jobs characterized by low decision latitude, high job strain and
low social support at work may be associated with an increased risk of acute
coronary events.

PMID: 15908726 [PubMed - indexed for MEDLINE]


49. Int J Epidemiol. 2005 Aug;34(4):827-34. Epub 2005 Mar 31.

When aspirations and achievements don't meet. A longitudinal examination of the
differential effect of education and occupational attainment on declines in
self-rated health among Canadian labour force participants.

Smith P, Frank J.

Institute for Work and Health, 481 University Avenue, Toronto, Ontario M5G 2E9,
Canada. psmith@iwh.on.ca

Comment in:
    Int J Epidemiol. 2005 Aug;34(4):835-6.

BACKGROUND: To examine the association of a mismatch between educational
qualifications and occupational attainment and subsequent declines in self-rated 
health (SRH) in a longitudinal nationally representative Canadian population
sample. METHODS: This study used longitudinal data from 4045 healthy, working
respondents of the Canadian National Population Health Survey. Respondents were
categorized as either qualified, overqualified, or underqualified based on the
match between their education and the skills required for their current
occupation over a 2-year period. Logistic regression analysis estimated the odds 
of decline in SRH over the following 4-year period, using the match between
occupation and education as the main independent variable. Analyses were
controlled for a number of confounding variables including health behaviours,
mental health, self-esteem, job control, and demographic information. RESULTS:
Relative to respondents with university education working in occupations for
which they were qualified, respondents with university education, working in
occupations for which they were overqualified had a significant risk of decline
in SRH between 1996 and 2000, even after adjusting for a number of potential
confounders (OR = 2.08, 95% CI 1.11-3.91). In respondents with secondary
education or less, differences in occupational attainment were not associated
with differences in the odds of decline in SRH. CONCLUSIONS: The effect of
occupational attainment on health is important for individuals who have invested 
the most time in their education. Conversely, differential occupational
attainment is not associated with differences in the odds of decline in health
for participants with lower levels of education.

PMID: 15802380 [PubMed - indexed for MEDLINE]


50. Int J Rehabil Res. 2005 Mar;28(1):33-42.

Disability pension despite vocational rehabilitation? A study from six social
insurance offices of a county.

Ahlgren A, Broman L, Bergroth A, Ekholm J.

Department of Nursing and Health, Mid Sweden University, Ostersund, Sweden.
asa.ahlgren@miun.se

Many long-term sick-listed individuals move from vocational rehabilitation to
pension, rather than reaching the goal of return to work. There is thus reason to
consider whether rehabilitation resources are being used optimally. Individuals
receiving disability pensions are consuming financial and personnel resources at 
the insurance offices and also consume a large amount of health care. The general
objective of the study was to evaluate the proportion of individuals granted
vocational rehabilitation but then obtaining temporary or permanent disability
pensions. All persons receiving any kind of rehabilitation and attending one of
six local national insurance offices in a county in Sweden in 1998 and 1999 were 
studied. A 2-year follow-up was carried out to assess changes in status among
those who had received temporary disability pensions. Of all individuals
receiving rehabilitation, 46.2% ended up with a disability pension allowance. In 
addition, a large portion of the temporary disability pensions was transformed to
permanent disability pensions within 2 years. For clients with a temporary
disability pension, the rate of resuming work was close to nil. Among
rehabilitation measures, investigation showed the lowest figures of work
resumption while job training showed the best outcome in this respect. The study 
concluded that a large portion of the financial and personnel resources allocated
by the national insurance offices to rehabilitation resulted in disability
pensions.

PMID: 15729095 [PubMed - indexed for MEDLINE]


51. Scand J Work Environ Health. 2004 Oct;30(5):362-70.

Central nervous system effects of acute organophosphate poisoning in a two-year
follow-up.

Delgado E, McConnell R, Miranda J, Keifer M, Lundberg I, Partanen T, Wesseling C.

Department of Preventive Medicine, Occupational Health Program, National
Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua.

OBJECTIVES: Patients hospitalized for acute organophosphate poisoning in León,
Nicaragua, were followed for effects on the central nervous system (CNS) over a
2-year period. METHODS: Immediate verbal memory (Rey verbal learning), visuomotor
performance (digit symbol), and neuropsychiatric symptoms (Q-16) were assessed
for 53 poisoned persons at the time of hospital discharge, 7 weeks postpoisoning,
and 2 years postpoisoning, and, at the same time intervals, for 28 persons who
had never been poisoned. The poisonings were classified as moderate occupational 
(31), severe occupational (15), and severe through the oral route (7),
representing low, medium, and high exposure, respectively. Longitudinal
confounder-adjusted between-category comparisons and longitudinal analyses of
variance and covariance were used to assess the effects of the exposure. RESULTS 
:Immediate verbal learning showed deficits in the high-exposure group, in
particular at the time of discharge, but the estimate of the difference when
compared with the values of the unexposed was imprecise. Visuomotor performance
showed a deficit at 7 weeks in the medium-exposure group, but it had improved
after 2 years relative to that of the unexposed, for whom improvement had
occurred at 7 weeks and persisted during the 2 years of follow-up, possibly a
test-retest effect. Neuropsychiatric symptoms were in excess 2 years after the
hospital discharge in the low- and medium-exposure groups and all the groups
combined. All the results were imprecise for the small high-exposure group.
CONCLUSIONS: Visuomotor performance and possibly short-term verbal memory seem to
be affected early after severe acute organophosphate poisoning and recover,
either truly or by some compensatory mechanism. Neuropsychiatric symptoms seem to
increase after a longer latency period.

PMID: 15529800 [PubMed - indexed for MEDLINE]


52. J Learn Disabil. 1999 Nov-Dec;32(6):533-52.

Occupational and educational aspirations and attainment of young adults with and 
without LD 2 years after high school completion.

Rojewski JW.

Department of Occupational Studies, University of Georgia, Athens 30602, USA.

A national longitudinal database was used to compare the aspirations and
attainment of individuals with and without learning disabilities (LD) 2 years
after high school completion. Analyses revealed that individuals with LD reported
lower graduation rates, were more likely to aspire to moderate- (men) or
low-prestige (women) occupations, and were more likely to be employed and less
likely to be enrolled in some type of postsecondary education program than their 
nondisabled peers. High educational aspirations in Grade 12 and successful
completion of an academic or college-prep high school program were equally
important in predicting 2-year postsecondary status for adolescents enrolled in
postsecondary education regardless of disability status. However, depending on
disability status, different predictors were identified for individuals who were 
either employed or out of the workforce. These results point to a continued need 
for transition planning and support for young adults with LD and suggest ways in 
which professionals can anticipate and adjust for identified differences in
aspirations and postsecondary attainment.

PMID: 15510441 [PubMed - indexed for MEDLINE]


53. Sex Transm Dis. 2004 Sep;31(9):533-41.

Family socioeconomic status and self-reported sexually transmitted diseases among
black and white american adolescents.

Newbern EC, Miller WC, Schoenbach VJ, Kaufman JS.

Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel
Hill, North Carolina 27599-7435, USA.

OBJECTIVE: The objective of this study was to assess associations between
socioeconomic status (SES) and adolescent sexually transmitted diseases (STDs)
stratified by race and gender. STUDY: In cross-sectional analyses of the National
Longitudinal Study of Adolescent Health Wave One (1995), unadjusted and adjusted 
associations between 4 family SES indicators and STD reports for black and white 
7th through 12th graders were examined. RESULTS: Lower maternal education and
nonprofessional maternal occupations were associated with higher STD reports in
all groups except white females. Generally, STD reports were higher for
adolescents not living in 2-parent homes, and lower income was only associated
for black males. CONCLUSION: Overall, SES is only a weak to moderate marker for
adolescent STD risks. The relationship of SES and STDs varies by the SES measure 
used and differs across race-gender groups. Other individual factors such as risk
behaviors or community factors such as income inequality could play a more
critical role for adolescent STDs than family SES.

PMID: 15480114 [PubMed - indexed for MEDLINE]


54. Occup Med (Lond). 2004 Sep;54(6):387-94. Epub 2004 Sep 3.

Silicosis and lung cancer: a mortality study of compensated men with silicosis in
New South Wales, Australia.

Berry G, Rogers A, Yeung P.

School of Public Health, Edward Ford Building (A27), University of Sydney, New
South Wales 2006, Australia. geoffb@health.usyd.edu.au

BACKGROUND: Lung cancer mortality has been found to be in excess in several
groups with silicosis, but allowance for smoking was not always possible. We
investigated the lung cancer mortality in men with silicosis in New South Wales, 
Australia, who were compensated, making allowance for smoking habits. METHODS: A 
mortality study of 1467 men with silicosis in New South Wales who were
compensated was carried out comparing observed mortality with that expected from 
the New South Wales death rates adjusting for age and period. Their smoking
habits were compared with national survey smoking rates and the expected number
of lung cancer deaths adjusted for smoking. Cases were coded for occupation and
industry. RESULTS: The observed mortality was higher than expected, but the only 
site of cancer showing a significant excess was the lung. The group with
silicosis had smoked more than the national rates. After adjusting for smoking
the standardized mortality ratio for lung cancer was 1.9 (95% confidence interval
1.5-2.3). Although there were differences in lung cancer mortality between
industries and occupations, these differences were not statistically significant.
CONCLUSIONS: The excess lung cancer death rate may not be entirely due to silica 
exposure because compensation may have been influenced by the presence of chronic
obstructive respiratory disease and there is some evidence that the presence of
this disease increases lung cancer risk independently of smoking.

PMID: 15347775 [PubMed - indexed for MEDLINE]


55. Eur J Epidemiol. 2004;19(6):533-40.

Cancer incidence, mortality from cancer and survival in men of different
occupational classes.

Rosengren A, Wilhelmsen L.

Section of Preventive Cardiology, Sahlgrenska University Hospital/Ostra,
Göteborg, Sweden. Annika.Rosengren@hjl.gu.se

Low social class is associated with higher mortality from cancer at several sites
and in patients with cancer low social class is known to be associated with a
poorer chance of survival. Social differences in cancer incidence are less
consistent. The present study was undertaken to assess the relation between
occupational class and cancer incidence, mortality and survival from cancer in a 
large population of 7001 men aged 51-59, free of diagnosed cancer at baseline in 
1970--1972. The main outcome measures were cancer incidence and cancer mortality 
until 1992 according to the Swedish national cancer and cause-specific death
registries. Cancer survival was analysed in a subgroup of 904 men diagnosed with 
cancer before 1990. There were 1329 incident cases of cancer including 620 deaths
from cancer. Overall cancer incidence during follow-up did not vary significantly
by occupational class, but respiratory cancers were significantly more common
among men with manual occupations; p = 0.0004. This was not be explained by
differences in tobacco smoking, which were minor at the start of the study and
did not increase much during follow-up. Overall mortality from cancer was
significantly higher among men with manual occupations. Among professionals and
higher officials 336 per 100,000 observation years died from cancer, compared to 
391 among intermediate officials, 509 among lower officials, 474 among skilled
and 548 among non-skilled workers; p for trend = 0.0003. This difference was
mainly due to mortality from respiratory cancer, with a threefold difference
between manual workers and professionals; this did not change after adjustment
for smoking. Among the 904 men diagnosed before 1990 with cancer at any site
(except non-melanoma skin cancer) the adjusted relative risk of dying from cancer
was 1.75 (95% confidence interval 1.22-2.50) in unskilled workers compared to
higher officials (p for trend 0.015).

PMID: 15330125 [PubMed - indexed for MEDLINE]


56. Circulation. 2004 Aug 10;110(6):666-73. Epub 2004 Jul 26.

Occupational, commuting, and leisure-time physical activity in relation to total 
and cardiovascular mortality among Finnish subjects with type 2 diabetes.

Hu G, Eriksson J, Barengo NC, Lakka TA, Valle TT, Nissinen A, Jousilahti P,
Tuomilehto J.

Department of Epidemiology and Health Promotion, National Public Health
Institute, Helsinki, Finland. hu.gang@ktl.fi

BACKGROUND: Some previous studies have assessed the association between
leisure-time physical activity and mortality among patients with diabetes, but
the potential effect of occupational and commuting physical activity remains
uncertain. METHODS AND RESULTS: We prospectively followed up 3316 Finnish
participants 25 to 74 years of age with type 2 diabetes. The association of
different types of physical activity with mortality was examined with Cox
proportional-hazard models. During a mean follow-up of 18.4 years, 1410 deaths
were recorded, 903 of which were due to cardiovascular disease (CVD). The
multivariate-adjusted (age, sex, study year, body mass index, systolic blood
pressure, cholesterol, smoking, and the 2 other types of physical activity)
hazard ratios associated with light, moderate, and active work were 1.00, 0.86,
and 0.60 (P(trend)<0.001) for total mortality and 1.00, 0.91, and 0.60
(P(trend)<0.001) for CVD mortality, respectively. The multivariate-adjusted
hazard ratios associated with low, moderate, and high leisure-time physical
activity were 1.00, 0.82, and 0.71 (P(trend)<0.001) for total mortality and 1.00,
0.83, and 0.67 (P(trend)=0.005) for CVD mortality, respectively. Active commuting
had significant inverse associations with total and CVD mortality, but these
relations were no longer significant after additional adjustment for occupational
and leisure-time physical activity. CONCLUSIONS: Moderate or high levels of
physical activity reduce total and CVD mortality among patients with type 2
diabetes. Not only leisure-time physical activity but also occupational and
commuting physical activities are important components of a healthy lifestyle
among patients with diabetes.

PMID: 15277321 [PubMed - indexed for MEDLINE]


57. Br J Sociol. 1999 Jun;50(2):217-49.

Routes of success: influences on the occupational attainment of young British
males.

Bond R, Saunders P.

Sociology and Social Psychology Subject Group, University of Sussex.

Using data from the National Child Development Study, the paper develops a
complex path model predicting the occupational grade achieved by 4,298 employed
British males at age 33. Most British social mobility research has been based in 
the 'class structurationist' tradition, and the paper begins by comparing this
with the 'status attainment' tradition, which is more common in the USA. The
class structurationist approach has rarely analysed the factors influencing
individual occupational attainment, and those working in this tradition in
Britain have often assumed that people from working-class origins fare worse on
average than those from the middle class because of factors associated with their
class disadvantage rather than any difference in individual characteristics such 
as ability or ambition. Status attainment research, however, has generally found 
that individual ability and motivation are the key factors influencing
occupational attainment, and that class origins count for comparatively little.
Using various measures of class origins, parental support, qualifications, and
individual ability and ambition, the paper goes on to develop a linear structural
equations model which achieves a good fit to the data. The model demonstrates
that individual ability is by far the strongest influence on occupational
achievement, that motivation is also important, and that factors like class
background and parental support, while significant, are relatively much weaker.
The paper concludes that occupational selection in Britain appears to take place 
largely on meritocratic principles.

PMID: 15260024 [PubMed - indexed for MEDLINE]


58. Scand J Work Environ Health. 2004 Jun;30(3):234-40.

Incidence of ulnar nerve entrapment at the elbow in repetitive work.

Descatha A, Leclerc A, Chastang JF, Roquelaure Y; Study Group on Repetitive Work.

Institut National de la Santé et de la Recherche Médicale (National Institute for
Health and Medical Research), U88-IFR 69, Saint-Maurice, France.

OBJECTIVES: Despite the high frequency of work-related musculoskeletal disorders,
the relation between work conditions and ulnar nerve entrapment at the elbow has 
not been the object of much research. In the present study, the predictive
factors for such ulnar nerve entrapment were determined in a 3-year prospective
survey of upper-limb work-related musculoskeletal disorders in repetitive work.
METHODS: In 1993-1994 and 3 years later, 598 workers whose jobs involved
repetitive work underwent an examination by their occupational health physicians 
and completed a self-administered questionnaire. Predictive factors associated
with the onset of ulnar nerve entrapment at the elbow were studied with bivariate
and multivariate analyses. RESULTS: The annual incidence was estimated at 0.8%
per person-year, on the basis of 15 new cases during the 3-year period. Holding a
tool in position was the only predictive biomechanical factor [odds ratio (OR)
4.1, 95% confidence interval (95% CI) 1.4-12.0]. Obesity increased the risk of
ulnar nerve entrapment at the elbow (OR 4.3, 95% CI 1.2-16.2), as did the
presence of medial epicondylitis, carpal tunnel syndrome, radial tunnel syndrome,
and cervicobrachial neuralgia. The associations with "holding a tool in position"
and obesity were unchanged when the presence of other diagnoses was taken into
account. CONCLUSIONS: Despite the limitations of the study, the results suggest
that the incidence of ulnar nerve entrapment at the elbow is associated with one 
biomechanical risk factor (holding a tool in position, repetitively), overweight,
and other upper-limb work-related musculoskeletal disorders, especially medial
epicondylitis and other nerve entrapment disorders (cervicobrachial neuralgia and
carpal and radial tunnel syndromes).

PMID: 15250652 [PubMed - indexed for MEDLINE]


59. J Biosoc Sci. 2004 May;36(3):333-49.

Cognitive ability and occupational status in a British cohort.

Thienpont K, Verleye G.

Department of Population Studies, Ghent University, Belgium.

The relation between individual trait differences, social mobility and social
structure is central to social biology. Because genetic variance underlies
phenotypic variance in some of these traits, for example IQ, several mechanisms
determine the population variance. Polygenic inheritance is the basic mechanism. 
Social mobility and assortative partner choice distribute the trait variance
within generations. This feedback circle is constrained by sociological
conditions at several levels of analysis. Fundamental to this theory of social
assortment is the relation between social-biological traits and social class on
the one hand, and these traits and social mobility on the other hand. The focus
here is on the relation between social class, social mobility and cognitive
ability. The National Child Development Study is drawn upon, including the last
follow-up (1999-2000). By approaching this relationship through various methods, 
both social-biological and sociological aspects of this research question can be 
assessed.

PMID: 15164940 [PubMed - indexed for MEDLINE]


60. Public Health Nutr. 2004 May;7(3):443-52.

How well do Australian women comply with dietary guidelines?

Ball K, Mishra GD, Thane CW, Hodge A.

School of Health Sciences, Deakin University, 221 Burwood Highway, Burwood,
Victoria 3125, Australia. kball@deakin.edu.au

OBJECTIVE: To investigate the proportion of middle-aged Australian women meeting 
national dietary recommendations and its variation according to selected
sociodemographic and behavioural characteristics. DESIGN: This cross-sectional
population-based study used a food-frequency questionnaire to investigate dietary
patterns and compliance with 13 commonly promoted dietary guidelines among a
cohort of middle-aged women participating in the Australian Longitudinal Study on
Women's Health. SETTING: Nation-wide community-based survey. SUBJECTS: A total of
10,561 women aged 50-55 years at the time of the survey in 2001. RESULTS: Only
about one-third of women complied with more than half of the guidelines, and only
two women in the entire sample met all 13 guidelines examined. While guidelines
for meat/fish/poultry/eggs/nuts/legumes and 'extra' foods (e.g. ice cream,
chocolate, cakes, potatoes, pizza, hamburgers and wine) were met well, large
percentages of women (68-88%) did not meet guidelines relating to the consumption
of breads, cereal-based foods and dairy products, and intakes of total and
saturated fat and iron. Women working in lower socio-economic status occupations,
and women living alone or with people other than a partner and/or children, were 
at significantly increased risk of not meeting guidelines. CONCLUSIONS: The
present results indicate that a large proportion of middle-aged Australian women 
are not meeting dietary guidelines. Without substantial changes in their diets,
and help in making these changes, current national guidelines appear unachievable
for many women.

PMID: 15153275 [PubMed - indexed for MEDLINE]


61. Transplantation. 2003 Dec 27;76(12):1699-704.

Quality of life in adult survivors beyond 10 years after liver, kidney, and heart
transplantation.

Karam VH, Gasquet I, Delvart V, Hiesse C, Dorent R, Danet C, Samuel D,
Charpentier B, Gandjbakhch I, Bismuth H, Castaing D.

Centre Hépato Biliaire, Hôpital Paul Brousse, 4 Avenue Paul Vaillant-Couturier,
94804 Villejuif Cedex, France. vincent.karam@pbr.ap-hop-paris.fr

BACKGROUND: The yearly increasing survival rates testify to the success of
transplantation, but questions remain relating to the quality of life (QOL)
associated with long-term survival. METHODS: A sample of 126 liver recipients
(Liver-R), 229 kidney recipients (Kidney-R), and 113 heart recipients (Heart-R)
with more than 10 years posttransplant follow-up were included in the study with 
a response rate of 86%. Respondents were matched with healthy subjects recruited 
from general population (GP). The three groups of recipients and GP subjects
completed a French version of the questionnaire used by the National Institute of
Diabetes and Digestive and Kidney Disease, Pittsburgh, PA, and were compared for 
each score, with adjustments for age and sex. RESULTS: Personal function and
measures of disease by the transplant recipients were significantly worse than in
the GP (P<0.0001), with the worst score in Kidney-R. No difference, either
between organs or between organs and GP, was found regarding the perceived social
and role function. However, for psychologic status and general health perception,
Kidney-R had the least favorable performance when compared with GP (P<0.01) and
also when compared with Liver-R (P<0.05). With the exception of Kidney-R, the
well-being index of Liver-R and Heart-R was significantly better than the GP
(P<0.001 and P<0.05, respectively). CONCLUSIONS: The QOL beyond 10 years after
liver, heart, and kidney transplantation is quite similar to the GP, with
Kidney-R starting out as the worst, Heart-R as intermediate, and Liver-R the
best.

PMID: 14688519 [PubMed - indexed for MEDLINE]


62. Int J Occup Saf Ergon. 2003;9(4):405-418.

Symptoms and clinical findings from the musculoskeletal system among operators at
a call centre in Sweden--a 10-month follow-up study.

Toomingas A, Nilsson T, Hagberg M, Hagman M, Tornqvist EW.

Department for Work and Health, National Institute for Working Life, Stockholm,
Sweden. allan.toomingas@niwl.se

The musculoskeletal health among 57 operators at 1 call centre in Sweden was
studied with 10 monthly follow-ups, parallel to a reference group of 1,226
professional computer users in other occupations. Operators at this call centre
were more symptom-loaded than the other professional computer users in spite of
their younger age and shorter exposure to computer work. Symptoms were
long-lasting or recurrent. Muscle tenderness and nerve affections in the
neck-shoulder region were the most common specific findings and diagnoses at
medical examination of incident symptom cases. More extensive studies should be
done on the working conditions and health status among call centre workers.

PMID: 14675512 [PubMed - indexed for MEDLINE]


63. J Child Health Care. 2003 Dec;7(4):258-76.

Planning a career as a children's nurse: the availability of career guidance
during the nurse diploma course.

Cox SJ, Robinson S, Murrells T.

Nursing Research Unit, King's College, University of London, London, UK.
susanne.cox@kcl.ac.uk

The recruitment and retention of registered children's nurses is paramount to the
implementation of the national service framework for children's services. In
recent years there have been increased career opportunities for children's nurses
and a diversity of career pathways. Career guidance has a potential contribution 
to make to the effective management of nurses' careers. This article presents
findings on child health diplomates' experiences of career guidance during the
nurse diploma course. Findings indicate a substantial unmet demand for career
guidance. The implications of the findings for child health nurses' careers are
discussed and considered in relation to two key questions: should efforts be
directed towards ensuring greater provision of career guidance, and if so, by
whom?

PMID: 14636431 [PubMed - indexed for MEDLINE]


64. Int J Obes Relat Metab Disord. 2004 Jan;28(1):99-104.

Physical activity in relation to development and maintenance of obesity in men
with and without juvenile onset obesity.

Bak H, Petersen L, Sørensen TI.

Danish Epidemiology Science Centre at the Institute of Preventive Medicine,
Copenhagen University Hospital, Denmark.

OBJECTIVE: To examine long-term effects of leisure time physical activity (ltpa) 
and occupational physical activity (opa) on later obesity, and to examine the
effect of body weight on later physical inactivity in men with and without
juvenile onset obesity. DESIGN: Population-based longitudinal study of obese and 
nonobese men, who were identified as draftees of median age of 19 y in 1943-77
and later examined at general health surveys in 1982-84, and in 1991-93. SETTING:
Copenhagen and adjacent regions, Denmark. PARTICIPANTS: In all, 1143 juvenile
obese men with a BMI > or =31 kg/m2 (corresponding to 35% overweight by an
originally used national standard) at draft board examination, and, as a nonobese
control group, 1278 men selected as a 0.5% random sample of the approximately
255,600 men examined at the draft board and thus representing the study
population. MAIN OUTCOME MEASURES: Obesity, defined as BMI > or =30 kg/m2, and
physical inactivity at the last survey. RESULTS: In the cross-sectional analyses,
there were strong concurrent inverse associations between ltpa and prevalence of 
obesity in both groups, whereas there was no relation to opa. In logistic
regression analyses of obesity at the last survey, including both ltpa and opa as
well as age, BMI at draft board examination, BMI at first follow-up, length of
education, smoking and drinking habits, there were no significant effects of ltpa
and opa on the risk of development of obesity in the nonobese group or
maintenance of obesity in the obese group. Similar analyses of physical
inactivity at the last follow-up as outcome showed a significant direct effect of
BMI at first follow-up, with a significant trend in the nonobese group, but not
in the obese group and no effects on opa. CONCLUSION: There is no long-term
influence of physical activity on development and maintenance of obesity in men, 
whereas greater body weight increases risk of later physical inactivity during
leisure time.

PMID: 14610530 [PubMed - indexed for MEDLINE]


65. J Epidemiol Community Health. 2003 Nov;57(11):901-6.

Occupational mobility and risk factors in working men: selection, causality or
both? Results from the GAZEL study.

Ribet C, Zins M, Gueguen A, Bingham A, Goldberg M, Ducimetière P, Lang T.

INSERM U258, Villejuif, France. ribet@vjf.inserm.fr

OBJECTIVE: To explore the relation between risk factors (RF) and occupational
mobility in working men. SETTING: 20 000 volunteers working at the French
National Electricity and Gas Company (GAZEL cohort). PARTICIPANTS: Men aged 43 to
53 years in 1992. DESIGN: Three designs were used for analysis. (1) The
association between occupational mobility experienced before 1992 and RF reported
at that date was analysed among 10 383 men. (2) The predictive role of RF on
occupational mobility over 1992-1999 was studied in a subsample of 4715 men. (3) 
Reciprocally, occupational mobility in 1985-1992 was analysed in relation to RF
changes over 1993-1999. MAIN OUTCOME MEASURES: Self reported smoking status,
excessive alcohol consumption, arterial hypertension, and overweight.
Occupational mobility defined by any upward transition between senior executives 
and professionals/middle executives/employees, and workers. RESULTS: (1) Cross
sectionally, non-mobile men as their entry into the company had a higher risk of 
being smokers, excessive alcohol drinkers, and overweight in 1992 than mobile
men. (2) Longitudinally, smokers and excessive alcohol drinkers in 1992 had a
higher risk of non-mobility than, respectively, non-smokers and non-excessive
alcohol drinkers. (3) Non-mobile men in 1985-1992 had a higher risk of becoming
smokers, excessive alcohol drinkers, and hypertensive in 1993-1999 than upwardly 
mobile men. CONCLUSION: These results suggest a complex relation between RF and
occupational mobility. A high level of RF, particularly health behaviours, might 
account for a selection process reducing upward occupational mobility. In turn, a
lack of upward occupational mobility might be associated with an increased
incidence of RF.

PMCID: PMC1732330
PMID: 14600118 [PubMed - indexed for MEDLINE]


66. Int J Epidemiol. 2003 Oct;32(5):830-7.

Widening socioeconomic inequalities in mortality in six Western European
countries.

Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemström
O, Valkonen T, Kunst AE.

Department of Public Health, Erasmus Medical Center, PO Box 1738, 3000 DR
Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl

Comment in:
    Int J Epidemiol. 2003 Oct;32(5):838-9.

OBJECTIVES: During the past decades a widening of the relative gap in death rates
between upper and lower socioeconomic groups has been reported for several
European countries. Although differential mortality decline for cardiovascular
diseases has been suggested as an important contributory factor, it is not known 
what its quantitative contribution was, and to what extent other causes of death 
have contributed to the widening gap in total mortality. METHODS: We collected
data on mortality by educational level and occupational class among men and women
from national longitudinal studies in Finland, Sweden, Norway, Denmark,
England/Wales, and Italy (Turin), and analysed age-standardized death rates in
two recent time periods (1981-1985 and 1991-1995), both total mortality and by
cause of death. For simplicity, we report on inequalities in mortality between
two broad socioeconomic groups (high and low educational level, non-manual and
manual occupations). RESULTS: Relative inequalities in total mortality have
increased in all six countries, but absolute differences in total mortality were 
fairly stable, with the exception of Finland where an increase occurred. In most 
countries, mortality from cardiovascular diseases declined proportionally faster 
in the upper socioeconomic groups. The exception is Italy (Turin) where the
reverse occurred. In all countries with the exception of Italy (Turin), changes
in cardiovascular disease mortality contributed about half of the widening
relative gap for total mortality. Other causes also made important contributions 
to the widening gap in total mortality. For these causes, widening inequalities
were sometimes due to increasing mortality rates in the lower socioeconomic
groups. We found rising rates of mortality from lung cancer, breast cancer,
respiratory disease, gastrointestinal disease, and injuries among men and/or
women in lower socioeconomic groups in several countries. CONCLUSIONS: Reducing
socioeconomic inequalities in mortality in Western Europe critically depends upon
speeding up mortality declines from cardiovascular diseases in lower
socioeconomic groups, and countering mortality increases from several other
causes of death in lower socioeconomic groups.

PMID: 14559760 [PubMed - indexed for MEDLINE]


67. Soc Sci Med. 2003 Dec;57(11):2115-25.

Health inequality and users' risk-taking: a longitudinal analysis in a French
reproductive technology centre.

Tain L.

Demographic Study Centre, Faculté de sociologie, Université Lumière-Lyon 2, 5,
avenue Pierre Mendès, Bron Cedex 11 69676, France. ltain@univ-lyon2.fr

This article sets out to provide a demographic analysis of the production of
social inequality through IVF trajectories in a reproductive technology centre of
a French hospital. However specific this example may be, it reveals one of the
paradoxes of social inequalities in health: lay experience of risk in
reproductive technology shows profound inequalities related to social status,
despite the fact that equality would seem to be guaranteed in France, since the
social security system covers the full cost of the treatments. We will try to
understand this paradox through a lifecourse approach. Thus, it will be shown
that social inequality in reproductive health is deeply rooted in social
scenarios of infertility that lead to differentiated medical experience: there is
little benefit and even a worsening in the situation of lower class women, who
were faced with unpredictable risks related to the collective testing of these
new technologies. Conversely, the possibility of inventing new lifestories, which
may or may not include motherhood, was given to upper class women who take
calculated risks to delay the scheduling of their pregnancies. In short, this
study confirms that the production of social inequality in reproductive health
can only be understood in connection with the social dynamics of lifestyles,
resulting in specific medical patterns. This paper also leads to the assumption
that these social scenarios are related to attempts to enhance the different
forms of capital: economic, cultural and social capital. In addition, the
presence of risks aggravates this inequality process. This raises another
question: do reproductive technologies result in reinforcing social inequality?

PMID: 14512242 [PubMed - indexed for MEDLINE]


68. Arch Gerontol Geriatr. 2003 Sep-Oct;37(2):173-93.

Late life cognition among men: a life course perspective on psychosocial
experience.

Wight RG, Aneshensel CS, Seeman M, Seeman TE.

Department of Community Health Sciences, University of California, Los Angeles,
CA 90095-1772, USA. rwight@ucla.edu

This report assesses associations between trajectories of psychosocial experience
over the life course and cognitive function in late life men. Survey data from
the National Longitudinal Study of Older Men, a community sample of 1835 United
States men aged 45-59 years in 1966, are used to explore the cognitive effects of
personality (locus of control) and emotion (affect) as these attributes evolve
from middle age to late life. Locus of control is very stable over time, whereas 
negative and positive affect fluctuate. Inverse relationships are found between
cognitive function and external locus of control, enduring negative affect, and
the absence of positive affect. Levels of education also moderate these effects. 
Low educational attainment appears to intensify the risk for poor cognitive
function associated with mixed internal-external locus of control and poor
emotional state over time. The connection between education, usually completed
early in the life course, and late life cognitive outcomes emphasizes the
importance of promoting educational attainment among young people. Among older
men with low educational attainment, the identification of mood disorders and
personality attributes that negatively impact cognition may lead to the
development of appropriate interventions.

PMID: 12888230 [PubMed - indexed for MEDLINE]


69. Neurotoxicol Teratol. 2003 Jul-Aug;25(4):503-8.

Prognosis of adult men with heat exhaustion with regard to postural stability and
neurobehavioral effects: a 6-month follow-up study.

Chia SE, Teo KJ.

Defence Medical Research Institute, Defence Science and Technology Agency and
Department of Community, Occupational and Family Medicine, National University of
Singapore, Singapore, Singapore. cofcse@nus.edu.sg

The medical complications of heat disorders, including hematological,
cardiovascular and renal damage, have been well documented. However, very little 
has been written on its neurological complications. In an earlier study, we
reported that men with heat exhaustion, studied 2 weeks after the acute episode, 
had significantly more symptoms of neurasthenia, poorer performance in short-term
memory and slower reaction time. The cases (as a group) had significantly poorer 
postural stability. The objective of this study was to assess the prognosis of
men with heat exhaustion with regard to postural stability and neurobehavioral
functions 12, 3 and 6 months after the acute episode. The study is prospective in
design and spans a 2-year period. All soldiers who were diagnosed to have heat
exhaustion (cases) from 1 March 1998 were included in the study. For each case, a
healthy soldier (matched for age, ethnicity, years of education and military
vocation) was recruited to serve as control. Each subject had a neurobehavioral
assessment by using the Swedish Performance Evaluation System (SPES), a
computerized test battery. The postural stability of the subjects was assessed
using a computerized postural sway system. Each subject took the test 2 weeks
after the acute episode and repeated the test 3 and 6 months later for duration
of 2 years. We report here the findings of 21 heat exhaustion cases and 18
controls, which completed all the three tests (i.e. done 2 weeks after the acute 
episode and 3 and 6 months later). Significant differences were only detected in 
some of the neurobehavioral and neurophysiological parameters between the cases
and the control for first two tests but not the third test. The prognosis of
adult with heat exhaustion is good. There were no significant differences in
neurobehavioral tests and postural stability among the cases and controls 612
months after the episode.

PMID: 12798967 [PubMed - indexed for MEDLINE]


70. Am J Public Health. 2003 Jun;93(6):994-8.

Cigarette smoking and cognitive decline in midlife: evidence from a prospective
birth cohort study.

Richards M, Jarvis MJ, Thompson N, Wadsworth ME.

Medical Research Council, National Survey of Health and Development, University
College London, London, England. m.richards@ucl.ac.uk

OBJECTIVES: The authors investigated the effects of cigarette smoking on midlife 
cognitive performance. METHODS: Multiple regression was used to test the
association between cigarette smoking and changes in cognitive test scores among 
male and female members of the British 1946 birth cohort aged between 43 and 53
years. RESULTS: Smoking was associated with faster declines in verbal memory and 
with slower visual search speeds. These effects were largely accounted for by
individuals who smoked more than 20 cigarettes per day and were independent of
sex, socioeconomic status, previous (adolescent) cognitive ability, and a range
of health indicators. CONCLUSIONS: The present results show that heavy smoking is
associated with cognitive impairment and decline in midlife. Smokers who survive 
into later life may be at risk of clinically significant cognitive declines.

PMCID: PMC1447882
PMID: 12773367 [PubMed - indexed for MEDLINE]


71. Soz Praventivmed. 2003;48(1):44-54.

[Educational status and occupational training, occupational status and ischemic
heart diseases: a prospective study with data from statutory health insurance in 
Germany]

[Article in German]

Peter R, Yong M, Geyer S.

Abteilung Epidemologie, Arbeitsgruppe Medizinische Soziologie, Universität Ulm.
richard.peter@medizin.uni-ulm.de

OBJECTIVES: To study associations between education, occupational position, and
incidence of ischemic heart disease (ICD-9 410-414). METHODS: A cohort of 151,471
male and female members of a German statutory health insurance company aged
between 25 and 65 years was investigated. The cohort comprised all members
between 1987 and 1996. Information on ischemic heart disease was derived from
clinical diagnosis. Education, training, and occupational position according to
the British Registrar General defined the indicators of social status. RESULTS:
After adjustment for age and length of observation period, education and training
as well as occupational position were associated with the incidence of ischemic
heart disease in both men and women. Whereas a gradient was observed in men
regarding education and training (odds ratios (OR): 3.41-6.02) men with lower
occupational position had higher risk estimates as compared to the highest
occupational status group (OR: 1.73-3.05). Among women a gradient was observed
concerning education and training (OR: 1.75-3.78). With regard to occupational
status position female members of the highest group showed the lowest risk as
compared to the lower status groups (OR: 1.58-2.19). CONCLUSIONS: Social
inequality in ischemic heart disease morbidity was observed among male and female
members of a German statutory health insurance. Findings are of importance for
health policy and call for preventive action.

PMID: 12756888 [PubMed - indexed for MEDLINE]


72. Am J Psychiatry. 2003 May;160(5):939-46.

Family disruption in childhood and risk of adult depression.

Gilman SE, Kawachi I, Fitzmaurice GM, Buka SL.

Department of Maternal and Child Health, Harvard School of Public Health, 677
Huntington Avenue, Boston, MA 02115, USA. sgilman@hsph.harvard.edu

OBJECTIVE: The authors examined the risk that family disruption and low
socioeconomic status in early childhood confer on the onset of major depression
in adulthood. METHOD: Participants were 1,104 offspring of mothers enrolled
during pregnancy in the Providence, R.I., site of the National Collaborative
Perinatal Project. Measures of childhood family disruption and socioeconomic
status were obtained before birth and at age 7. Structured diagnostic interviews 
were used to assess respondents' lifetime history of major depressive episode
between the ages of 18 and 39. Survival analysis was used to identify childhood
risks for depression onset. RESULTS: Parental divorce in early childhood was
associated with a higher lifetime risk of depression among subjects whose mothers
did not remarry as well as among subjects whose mothers remarried. These effects 
were more pronounced when accompanied by high levels of parental conflict.
Independent of the respondents' adult socioeconomic status, low socioeconomic
status in childhood predicted an elevated risk of depression. CONCLUSIONS: Family
disruption and low socioeconomic status in early childhood increase the long-term
risk for major depression. Reducing childhood disadvantages may be one avenue for
prevention of depression. Identification of modifiable pathways linking aspects
of the early childhood environment to adult mental health is needed to mitigate
the long-term consequences of childhood disadvantage.

PMID: 12727699 [PubMed - indexed for MEDLINE]


73. Demography. 2003 Feb;40(1):127-49.

Cohabiting and marriage during young men's career-development process.

Oppenheimer VK.

Department of Sociology, 264 Haines Hall, 1551, University of California, Los
Angeles, CA 90095, USA. valko@ucla.edu

Using recently released cohabitation data for the male sample of the National
Longitudinal Survey of Youth, first interviewed in 1979, I conducted multinomial 
discrete-time event-history analyses of how young men's career-development
process affects both the formation and the dissolution of cohabiting unions. For 
a substantial proportion of young men, cohabitation seemed to represent an
adaptive strategy during a period of career immaturity, whereas marriage was a
far more likely outcome for both stably employed cohabitors and noncohabitors
alike. Earnings positively affected the entry into either a cohabiting or marital
union but exhibited a strong threshold effect. Once the men were in cohabiting
unions, however, earnings had little effect on the odds of marrying. Men with
better long-run socioeconomic prospects were far more likely to marry from either
the noncohabiting or cohabiting state, and this was particularly true for blacks.

PMID: 12647517 [PubMed - indexed for MEDLINE]


74. Soc Sci Med. 2003 Apr;56(8):1817-30.

Social relations and self-reported health: a prospective analysis of the French
Gazel cohort.

Melchior M, Berkman LF, Niedhammer I, Chea M, Goldberg M.

Department of Health and Social Behavior, Harvard School of Public Health,
Boston, MA, USA. mmelchio@hsph.harvard.edu

Social networks and social support are strongly associated with health, yet the
pathways between social relations and health are not well understood. In one of
the very few studies on this issue conducted in France, we used data from the
French GAZEL cohort of employees of the national gas and electricity company, to 
(1) explore the relationship between the structure and function of the social
environment upon self-reported health and (2) test the hypothesis that social
relations directly affect health. In a prospective analysis over a 12-month
follow-up period, we found that a lack of social support and dissatisfaction with
social relations are predictive of poor health status, while weak social networks
are not. Thus, functional aspects of social relations are better predictors of
poor health than the structure of social interactions. Low social support was an 
independent risk factor for poor health in men and women: for men the effect was 
strongest among individuals who held a high occupational status, for women among 
those in high and low occupational groups. This study suggests that in France
social relations exert an independent effect on health, modified by gender and
socio-economic factors. Our results indicate that both clinicians in their
practice and researchers may do well to focus increased attention on the health
impact of social support.

PMID: 12639598 [PubMed - indexed for MEDLINE]


75. Scand J Public Health. 2003;31(1):63-8.

Duration of employment is not a predictor of disability of cleaners: a
longitudinal study.

Gamperiene M, Nygård JF, Brage S, Bjerkedal T, Bruusgaard D.

University of Oslo, Department of General Practice and Community Medicine,
Norway. migle.gamperiene@samfunnsmed.uio.no

AIMS: Cleaning is a high-risk occupation for developing musculoskeletal
disorders. Sickness absence is twice as high as in other occupations. Disability 
pensions for musculoskeletal disorders are twice as high in cleaners as in other 
employed women. However, a result from Norwegian and Danish studies shows that
female cleaners do not report higher morbidity of musculoskeletal disorders than 
other women. The objective was to analyse whether female cleaners have a higher
risk of obtaining a disability pension than women in other unskilled occupations 
and whether the length of employment influences the risk. METHODS: The material
is from the National Census in 1980 and 1990 and supplemented with disability
pensioning data from the National Insurance Administration and the Population
registry. Women aged 20-49, working as cleaners, seamstresses, nursing, kitchen, 
or shop assistants in 1980 were followed until 1990 or until receiving disability
pension. Female cleaners aged 30-59 years in 1990 were categorized into two
cohorts by occupation in 1980. They were followed from 1991 to 1994, to the date 
they died, or received disability pension. Incidence rates and incidence rate
ratio for disability pension and mortality was calculated by Poisson regression. 
Cox regression calculated the relative risk of obtaining disability pension.
RESULTS: Disability pension rates were higher among cleaners than among other
women in unskilled occupations (1.4 per 1,000 person years (CI 95% 1.35-1.46)),
but the risk of obtaining disability pension did not increase with increasing
exposure to cleaning (HR 0.8 (CI 95% 0.6-1.2)). CONCLUSIONS: The cleaning
occupation has high disability rates compared with other unskilled occupations. A
contribution factor to these high rates is a selection of women with poor health 
into the occupation.

PMID: 12623527 [PubMed - indexed for MEDLINE]


76. IARC Sci Publ. 2002;156:119-21.

How vegetables are eaten in Italy EPIC centres: still setting a good example?

Pala V, Berrino F, Vineis P, Palli D, Celentano E, Tumino R, Krogh V.

Epidemiology Unit, National Cancer Institute, Milan, Italy.

PMID: 12484142 [PubMed - indexed for MEDLINE]


77. Bull Soc Pathol Exot. 2002 Aug;95(3):167-71.

[Epidemiology of snake bites in the Republic of Ivory Coast]

[Article in French]

Chippaux JP.

Institut de recherche pour le développement (IRD), B. P. 1 386, Dakar, Sénégal.
chippaux@ird.sn

A national survey was carried out in Côte d'Ivoire in 1979 in order to evaluate
the incidence, morbidity and mortality of snakebites. This unpublished survey has
not been renewed to our knowledge. Although 20 odd years have passed since, the
survey is not obsolete and can be usefully presented at this congress. We
associated a retrospective survey using health centre registers and a prospective
survey performed in 7 health centres between 1972 and 1979. The incidence,
estimated prospectively for rural areas, exceeded 200 bites for 100,000
inhabitants. This evaluation could be an underestimation because many victims
consulted traditional practitioners. Annual morbidity was higher in forest areas 
(195 envenomations per 100,000 inhabitants) than in the savannah (130
envenomations per 100,000 inhabitants). Conversely, the case fatality rate was
higher in the savannah (3.1%) than in forest areas (2%). More than half of the
bites involved men aged 15 to 50 years. The risks were significantly higher for
farmers, particularly in industrial plantations, where 27% of the total of number
of bites involved 1.5% of the population. At the beginning of the 1980s,
envenomations could be estimated at over 13,000 per 8 million inhabitants and the
number of deaths 200 per annum.

PMID: 12404862 [PubMed - indexed for MEDLINE]


78. Prehosp Emerg Care. 2002 Oct-Dec;6(4):433-9.

Longitudinal Emergency Medical Technician Attribute and Demographic Study
(LEADS): an interim report.

Brown WE Jr, Dickison PD, Misselbeck WJ, Levine R.

National Registry of Emergency Medical Technicians, Columbus, Ohio 43229, USA.

OBJECTIVES: This ten-year longitudinal study examines various attributes and
demographic characteristics of emergency medical technicians (EMTs) and
paramedics to identify factors that influence their careers, to identify trends
in emergency medical services (EMS), and to provide data on why individuals
report leaving the EMS career field. METHODS: A 46-item core survey and a 16-item
cross-sectional survey were administered to EMT-basics and EMT-paramedics who
were randomly selected and placed in cohort groups stratified by duration of
continuous registration at each level and by race. The core survey focused on
five broad areas of attributes and demographics, including general, professional,
educational, personal, and financial. Case weights were calculated for
respondents in each stratum, reflecting the individual's probability of
selection. These case weights were adjusted, within strata, for nonresponse. The 
survey will be administered annually. The cross-sectional survey focused on EMS
education. RESULTS: This interim report is descriptive of the overall responses
of EMT-basics and EMT-paramedics to core survey items. The demographic
characteristics of EMT-basics and EMT-paramedics are described as well as a
description of their work activities, working conditions, and job satisfaction
CONCLUSIONS: The initial EMT and paramedic attribute and demographic data have
been collected, analyzed, and reported. The longitudinal nature of this study
requires further data collection and analysis to accurately present trends in
EMS, as well as correlations and associations between identified attributes and
other factors that influence the careers of EMTs and paramedics. Further reports 
of the findings will be necessary.

PMID: 12385612 [PubMed - indexed for MEDLINE]


79. J Acquir Immune Defic Syndr. 2002 Sep 1;31(1):106-14.

Voluntary HIV counseling and testing: experience among the sexually active
population in Bangui, Central African Republic.

Grésenguet G, Séhonou J, Bassirou B, Longo Jde D, Malkin JE, Brogan T, Bélec L.

Centre National de Référence des Maladies Sexuellement Transmission et du SIDA,
Bangui, République Centrafricaine.

OBJECTIVES: In July 1997, the National Reference Center for Sexually Transmitted 
Diseases of Bangui, Central African Republic (CAR), was expanded by the creation 
of an anonymous and voluntary counseling and testing (VCT) unit for HIV
infection, the Anonymous Surveillance Unit (Unité de Dépistage Anonyme [UDA]).
The goal of the UDA was to initiate and promote voluntary HIV testing in the
general adult population of Bangui. We carried out an observational and
comprehensive survey over a 4-year period to document and analyze the experience 
of VCT in the UDA, with special attention to risk factors associated with HIV
infection. METHODS: All clients for VCT were given adequate pretest counseling by
trained counselors focused on knowledge about HIV infection and sexually
transmitted infections, individual risks of acquiring HIV, and anticipation of
the client's attitude about test results. After consent was obtained, a blood
sample was drawn and tested for HIV by two ELISAs in parallel. The client paid a 
standard cost of $1.20 at the initial visit. After a week, test results were
given to the client during the posttest visit, at which time HIV-seropositive
individuals received emotional support and were referred to specific social or
medical structures. Seronegative clients received reinforcement of prevention
messages and were asked to come back for serologic follow-up free of charge after
3 (M3) and 12 (M12) months. RESULTS: From July 1997 to March 2001, 5686
individuals aged 14 to 65 years (mean age, 27 years) had an initial visit for VCT
(V1). Peaks of UDA visitation (250-450 clients) were observed on the annual AIDS 
Day in the CAR, at which time HIV serologic testing was offered free of charge. A
total of 5060 (89%) clients came back for a second visit (V2) to receive test
results. Among those, 18.3% were infected with HIV type 1. Multivariate analysis 
of risk factors demonstrated marked association of HIV seropositivity with age,
female gender, widowed/divorced women, poor or low education level, occupations
such as civil servants or merchants, presence of symptoms of sexually transmitted
infections, and lack of systematic condom use. Single young women were at higher 
risk for HIV infection compared with men of the same age (OR = 7.7 for women aged
15-24 years, 95% CI: 4.0-14.0; OR = 2.8 for women aged 25-34 years, 95% CI:
1.7-4.5). Widowed women older than 44 years of age were more likely to be
HIV-seropositive than men (OR = 10.0; 95% CI: 1.7-83.6). A total of 885 (21%)
HIV-seronegative individuals returned for follow-up at 3 months (M3; 0.45% rate
of seroconversion). Seventy-nine (9%) individuals returned at 12 months (M12),
without any new cases of HIV infection. HIV-negative clients consulting at M3 and
M12 showed a significant reduction in unprotected intercourse with occasional
sexual partners. CONCLUSION: This experience demonstrates that VCT for HIV
infection is feasible in Central Africa.

PMID: 12352157 [PubMed - indexed for MEDLINE]


80. Ment Retard. 2002 Apr;40(2):132-41.

Employment and income status of adults with developmental disabilities living in 
the community.

Yamaki K, Fujiura GT.

Department of Disability and Human Development, College of Applied Health
Sciences, University of Illinois at Chicago, 1640 W. Roosevelt Rd., Chicago, IL
60608, USA.

A comprehensive national portrait of employment and income status of adults with 
developmental disabilities was estimated through secondary analyses of the 1990
and the 1991 Survey of Income and Program Participation. Results indicate that
the majority of adults with developmental disabilities had very limited economic 
resources, even when earnings from employment and benefits from governmental
income support programs were both included. The minority, who worked in a variety
of occupations, were earning higher incomes than previous estimates. The
overwhelming majority were unemployed. Implications of the low-income profile and
potential underutilization of employment services was discussed.

PMID: 11925267 [PubMed - indexed for MEDLINE]


81. Zhonghua Yan Ke Za Zhi. 2001 May;37(3):218-21.

[A survey and treatment of blindness in Gejiu City of Yunnan Province]

[Article in Chinese]

Li N, Wang C, Wang C.

Department of Opbthalmololgy, Gejiu People's Hospital, Gejiu 661000, China.

OBJECTIVE: To calculate the percentage of blindness in the mass and evaluate the 
current conditions of treatment for cataract. METHODS: In accordance with the
national unified standards and procedures, a clue survey of the people aged under
40 years and a general survey of the people over 40 years in Gejiu city, Yunnan
province were carried out. In the mean time, operations were performed for the
patients with cataract. RESULTS: Of the total 361 214 persons being surveyed,
there were binocular blindness in 1 037 cases (0.29%) and monocular one in 983
cases (0.27%). Of the cases with binocular blindness, 593 cases (57.18%), and of 
the monocular blindness, 617 cases (62.77%) could be treated. The leading causes 
of 1037 cases with binocular blindness were cataract (51.98%), injuries of the
eye (19.96%), corneal opacity (16.00%), glaucoma (10.03%), refractive error and
other ocular diseases (2.03%). The average prevalence rate in the female cases
was higher than that of male cases (chi(2) = 53.48, P < 0.01). Blindness was
associated with older age There were variations in the prevalence rates in
different aboriginals and in cases with different occupations. Cataract was the
main disease to cause both the monocular and binocular blindness. Among the
patients with cataract 539 cases (90.98%) of binocular blindness and 500 cases
(81.03%) of monocular blindness were curable. The cataract operation was
performed on 738 cases with cataract, including 396 cases with binocular
blindness and 342 cases with monocular blindness. At postoperative 3 months, the 
rate of the best corrected visual acuity (eye sight > 0.05) was accounted for
97.73%, the rate of the eye sight > 0.3, 86.36% and the rate of wearing glasses
(including implantation of intraocular lens), 85.60%. CONCLUSION: The prevalence 
of blindness is associated with the aboriginal, occupation, age and the sex. The 
leading cause of blindness is cataract. So the surgical restoration of vision in 
cases with cataract is the main measure in the prevention of blindness.

PMID: 11864427 [PubMed - indexed for MEDLINE]


82. Gesundheitswesen. 2002 Jan;64(1):3-10.

[Social characteristics influencing the mortality of male members of an insurance
company in the years 1989 to 2000 -- A longitudinal study for the birth cohorts
1940-1949 of the Gmuend statutory insurance body]

[Article in German]

Helmert U, Voges W, Sommer T.

Abteilung Gesundheitspolitik, Arbeits- und Sozialmedizin, Zentrum für
Sozialpolitik, Universität Bremen. uhelmert@zes.uni-bremen.de

The study goal is to analyse the association between social and occupational
characteristics and mortality. Data are from a longitudinal register for the
members of a statutory insurance body 'Gmuender Ersatzkasse' (GEK) for the period
1989 to 2000. Included are males, born 1940 - 1949, who were GEK-members on
January 1, 1989 (n = 58 705). The dependent variable is defined as 'reason for
end of health insurance: deceased' (n = 2283). Independent variables are: age,
occupational group, family status, nationality and insurance status. The
statistical analysis was performed with the software package 'Transitional Data
Analysis' (TDA). It included cumulative mortality rates based on the Kaplan-Meier
method and the multivariate analysis in order to assess hazard rates (maximum
likelihood estimation). Statistically significant increased mortality rates for
the 12-year observation period were found for non-married persons, for persons
with less qualified occupations, and for mandatory health insurance members. No
significant difference was observed between study subjects with and without
German nationality. The observed strong social gradient in the overall mortality 
rates for male members of the GEK underline the challenge to reduce the social
inequities in health chances which has recently been placed on the political
agenda for the German health insurance companies.

PMID: 11791196 [PubMed - indexed for MEDLINE]


83. J Epidemiol. 2001 Oct;11(6 Suppl):S8-23.

Geographic characteristics and mortality profiles in the JPHC study. Japan Public
Health Center-based Prospective Study on Cancer and Cardiovascular Diseases.

Yamamoto S, Watanabe S.

Cancer Information and Epidemiology Division, National Cancer Center Research
Institute, Tokyo, Japan.

The study areas of the Japan Public Health Center-based Prospective Study on
Cancer and Cardiovascular Diseases (JPHC Study) are distributed throughout Japan 
and represent both rural and urban communities. These geographical differences
yield considerable difference in population, culture, and lifestyle. The
mortality rates in the study areas were apparently influenced by these factors.
The pattern of standardized mortality ratios (SMRs) for all causes of death
(cancer, heart diseases, ischemic heart disease, and cerebrovascular diseases) in
each area was different. Age-standardized site-specific cancer mortality rates
showed large variation even when compared with corresponding figures of
prefectures in Japan. The areas of the JPHC study showed different patterns of
SMR for major causes of death. The differences in site-specific cancer mortality 
rates for most of the sites are sufficient for epidemiological analyses.

PMID: 11763142 [PubMed - indexed for MEDLINE]


84. Am J Respir Crit Care Med. 2001 Dec 1;164(11):2031-5.

Role of snoring and daytime sleepiness in occupational accidents.

Lindberg E, Carter N, Gislason T, Janson C.

Department of Medical Sciences, Respiratory Medicine and Allergology, Akademiska 
sjukhuset, Uppsala, Sweden. eva.lindberg@medsci.uu.se

To establish whether snoring and excessive daytime sleepiness (EDS), the main
symptoms of obstructive sleep apnea syndrome, influence the risk of occupational 
accidents a population-based, prospective study was performed. In 1984, 2,874 men
aged 30-64 answered questions on snoring and EDS. Ten years later 2,009 (73.8% of
the survivors) responded to a follow-up questionnaire including work-related
questions and potential confounders. Information on occupational accidents during
1985-1994 was obtained from national register data. A total of 345 occupational
accidents were reported by 247 of the men (12.3%). Multivariate analysis revealed
that men who reported both snoring and EDS at baseline were at an increased risk 
of occupational accidents during the following 10 yr, with an adjusted odds ratio
of 2.2 (95% CI 1.3-3.8) after adjusting for age, body mass index, smoking,
alcohol dependence, years at work, blue-collar job, shift work, and exposure to
noise, organic solvents, exhaust fumes, and whole-body vibrations. However, no
significant increased risk was found for snorers without EDS or nonsnorers with
EDS. We conclude that sleepy, male snorers have an increased risk of occupational
accidents. The results indicate that early identification and treatment of
sleep-disordered breathing may reduce the number of injuries at work.

PMID: 11739131 [PubMed - indexed for MEDLINE]


85. Ann Epidemiol. 2001 Nov;11(8):554-62.

Incidence of testicular cancer and occupation among Swedish men gainfully
employed in 1970.

Pollán M, Gustavsson P, Cano MI.

Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute 
of Health, Madrid, Spain.

PURPOSE: To estimate occupation-specific risk of seminomas and nonseminoma
subtypes of testicular cancer among Swedish men gainfully employed in 1970 over
the period 1971-1989. METHODS: Age-period standardized incidence ratios were
computed in a dataset linking cancer diagnoses from the Swedish national cancer
register to occupational and demographical data obtained in the census in 1970.
Log-linear Poisson models were fitted, allowing for geographical area and town
size. Taking occupational sector as a proxy for socioeconomic status,
occupational risks were recalculated using intra-sector analyses, where the
reference group comprised other occupations in the same sector only. Risk
estimators per occupation were also computed for men reporting the same
occupation in 1960 and 1970, a more specifically exposed group. RESULTS:
Seminomas and nonseminomas showed a substantial geographical variation. The
association between germ-cell testicular tumors and high socioeconomic groups was
found mainly for nonseminomas. Positive associations with particular occupations 
were more evident for seminomas, for which railway stationmasters, metal
annealers and temperers, precision toolmakers, watchmakers, construction smiths, 
and typographers and lithographers exhibited a risk excess. Concrete and
construction worker was the only occupation consistently associated with
nonseminomas. CONCLUSIONS: Among the many occupations studied, our results
corroborate the previously reported increased risk among metal workers,
specifically related with seminomatous tumors in this study. Our results confirm 
the geographical and socioeconomical differences in the incidence of testicular
tumors. These factors should be accounted for in occupational studies. The
different pattern of occupations related with seminomas and nonseminomas support 
the need to study these tumors separately.

PMID: 11709275 [PubMed - indexed for MEDLINE]


86. J Epidemiol Community Health. 2001 Nov;55(11):831-5.

Wellbeing of professionals at entry into the labour market: a follow up survey of
medicine and architecture students.

Virtanen P, Koivisto AM.

Medical School, 33014 University of Tampere, Finland. pekka.j.virtanen@uta.fi

STUDY OBJECTIVE: Knowledge about changes in wellbeing during the passage from
professional studies to working life is scarce and controversial. This study
examined these changes among university graduates with good and poor employment
prospects. DESIGN: A longitudinal study with four postal questionnaire surveys of
a closed cohort. SETTING: Cohorts of graduating Finnish physicians and architects
were followed up from 1994 to 1998. In 1994 Finland's national economy was still 
struggling to break loose from a period of severe recession, and unemployment
rates were high even among educated professionals. As economic growth eventually 
got under way the unemployment situation began to ease for physicians but not for
architects. PARTICIPANTS: Architecture students (n = 189) from Finland's three
technical universities and medical students (n = 638) from Finland's five medical
faculties. Both had started their studies in 1989. RESULTS: In the first
questionnaire survey there were no differences between the professions in strain 
resistance resources, as indicated by Sense of Coherence (SOC), or in
psychological distress, as indicated by General Health Questionnaire (GHQ).
Profession emerged as a significant between subject factor in analysis of
variance for repeated measures of both SOC and GHQ. Physicians' scores on the 13 
item SOC questionnaire improved during the follow up from 62.6 to 67.5 and on the
12 item GHQ questionnaire from 24.2 to 22.2. Among architects the corresponding
scores remained unchanged (62.5-62.2 and 23.1-22.6). The significance of
profession remained unchanged when gender and individuals' graduation and total
work experience were introduced to the statistical models as between subject
factors. CONCLUSIONS: Improved SOC in physicians but not in architects supports
the hypothesis that good employment prospects are important to employee
wellbeing. Although less consistent, indicating fluctuations in day to day
psychological distress, GHQ findings are also in line with the hypothesis. In
both professions the indicators studied were independent of individuals'
graduation and career. It is concluded that rather than individually, the
mechanisms that connect employment prospects with wellbeing operate collectively 
within the whole profession. Highly educated professionals do not complete their 
studies until almost 30, and if for reasons of insecure employment they are
unable to develop their SOC to the optimum level at that age, their resources for
resisting health endangering strain may remain permanently poor.

PMCID: PMC1763309
PMID: 11604440 [PubMed - indexed for MEDLINE]


87. Am J Ind Med. 2001 Oct;40(4):363-70.

A historical cohort mortality study among shipyard workers in Genoa, Italy.

Puntoni R, Merlo F, Borsa L, Reggiardo G, Garrone E, Ceppi M.

Environmental Epidemiology and Biostatistics, National Cancer Institute, Largo
Rosanna Benzi 19, 16132 Genoa, Italy. puntonir@hp380.ist.unige.it

BACKGROUND: A historical cohort mortality study was conducted among 3984 shipyard
workers assigned to ship repair, refitting, and construction in the harbor of
Genoa, Italy, between 1960 and 1981. These workers were exposed to asbestos
fibers, welding fumes and gases, silica dust, polycyclic aromatic hydrocarbons,
and solvents. METHODS: Workers were classified in 20 different job-titles
depending upon the type of activity. Standardized mortality ratios (SMRs) were
computed using male residents of the Province of Genoa as the referent
population. RESULTS AND CONCLUSIONS: For the whole cohort significantly increased
SMRs were detected for all causes, all cancers, liver, larynx, lung, pleural and 
bladder cancers, respiratory tract diseases, and cirrhosis of the liver. The
analysis by job-title showed increased SMRs not only for pleural cancer, but also
for lung, laryngeal cancers and respiratory tract diseases in occupations
entailing heavy asbestos exposure. Bladder and liver cancers and liver cirrhosis 
mortality also appeared to be related to occupational exposure. Copyright 2001
Wiley-Liss, Inc.

PMID: 11598985 [PubMed - indexed for MEDLINE]


88. Scand J Work Environ Health. 2001 Aug;27(4):268-78.

Upper-limb disorders in repetitive work.

Leclerc A, Landre MF, Chastang JF, Niedhammer I, Roquelaure Y; Study Group on
Repetitive Work.

INSERM (National Institute on Health and Medical Research), Unité 88, Saint
Maurice, France. a.leclerc@st-aurice.inserm.fr

OBJECTIVES: A longitudinal study was conducted to determine the predictability of
personal and occupational factors with respect to the incidence of upper-limb
disorders in occupations requiring repetitive work. METHODS: A sample of 598
workers in five activity sectors completed a self-administered questionnaire; the
workers were examined by an occupational health physician in 1993-1994 and 3
years later. Three disorders were considered, carpal tunnel syndrome (CTS),
lateral epicondylitis and wrist tendinitis. RESULTS: The results of this
longitudinal study indicated that the following three sets of risk factors
independently affect the incidence of upper-limb disorders: (i) biomechanical
constraints, (ii) psychosocial factors, and (iii) personal factors. The
combination of risk factors differed between CTS, lateral epicondylitis, and
wrist tendinitis. The presence of psychosomatic problems was a strong predictor
of wrist tendinitis. Social support at work was also associated with the
incidence of wrist tendinitis. The presence of depressive symptoms and other
upper-limb disorders predicted the first occurrence of lateral epicondylitis. Age
was associated only with epicondylitis. The results were consistent with those
concerning the role of forceful movements of the elbow for epicondylitis and
confirmed the role of forceful movements for CTS. CONCLUSIONS: This study
considered different sets of risk factors simultaneously with a longitudinal
approach, in a population with a high level of occupational exposure. The results
indicate that three sets of risk factors independently affect the incidence of
upper-limb disorders. In addition to biomechanical constraints, psychosocial and 
personal factors play a role.

PMID: 11560341 [PubMed - indexed for MEDLINE]


89. Br J Dermatol. 2001 Sep;145(3):453-62.

Occupational skin diseases in Northern Bavaria between 1990 and 1999: a
population-based study.

Dickel H, Kuss O, Blesius CR, Schmidt A, Diepgen TL.

Department of Clinical Social Medicine, Centre of Occupational and Environmental 
Dermatology, University Hospital of Heidelberg, Thibautstr. 3, D-69115
Heidelberg, Germany.

BACKGROUND: Occupational skin diseases (OSDs) account for a large portion of
occupational diseases in Europe, but population-based epidemiological studies are
missing. OBJECTIVES: We analysed the initial reports of OSDs in our register of
OSDs in Northern Bavaria (BKH-N). METHODS: A total of 5285 cases were assessed
prospectively and registered from 1990 to 1999. As the German Federal Employment 
Office provides specific occupational data in relation to the total employed
population of Northern Bavaria, it was possible to conduct a population-based
study that investigated the trend in incidence rates between two study periods
(1990-92 and 1993-99) in 24 different occupational groups. RESULTS: A total of
3097 cases of OSD (median age 25 years) were recorded in the 24 occupational
groups. There was a significant decline (P < 0.001) in the overall incidence rate
of OSD with 10.7 cases per 10,000 workers per year for the first study period and
4.9 cases per 10,000 workers per year for the second study period. This general
trend in incidence rates was also significant for hairdressers and barbers,
bakers, health-care workers, cooks and metal processors. CONCLUSIONS: The BKH-N
provides national data based on the notification of OSDs in Germany. The results 
demonstrate the rank of occupations hazardous for the skin and are helpful for
defining target groups for prevention.

PMID: 11531836 [PubMed - indexed for MEDLINE]


90. Am J Respir Crit Care Med. 2001 Aug 15;164(4):565-8.

Work is related to a substantial portion of adult-onset asthma incidence in the
Finnish population.

Karjalainen A, Kurppa K, Martikainen R, Klaukka T, Karjalainen J.

Finnish Institute of Occupational Health, Department of Epidemiology and
Biostatistics, Helsinki, Finland. antti.karjalainen@occuphealth.fi

There are no population-based follow-up studies to estimate the fraction of
asthma incidence that is attributable to work. In Finland, individuals with
clinically well-established persistent asthma are registered for reimbursement of
medication from the national health insurance scheme. We combined, at an
individual level, these data with the population census data of 1985, 1990, and
1995 to estimate the attributable fraction of work in adult-onset persistent
asthma. Our follow-up study covered the entire 25- to 59-yr-old employed
population of Finland in 1986-1998. Relative risks (RR) for occupational
categories were estimated in comparison to those employed in administrative work.
There were 49,575 incident cases of asthma. The attributable fraction of
occupation was 29% (95% CI 25-33%) for men and 17% (95% CI 15-19%) for women. The
risk was increased especially in agricultural work, manufacturing work, and
service work. In addition to already established risk occupations of occupational
asthma, such as food and beverage work, the analysis identified a large number of
occupations with significant excess of asthma incidence. The results indicate
that the impact of occupational factors in the inception of adult-onset
persistent asthma, and consequently the potential for prevention, is much larger 
and more widely spread than generally assumed.

PMID: 11520716 [PubMed - indexed for MEDLINE]


91. Am J Epidemiol. 2001 Aug 15;154(4):373-84.

Socioeconomic, demographic, occupational, and health factors associated with
participation in a long-term epidemiologic survey: a prospective study of the
French GAZEL cohort and its target population.

Goldberg M, Chastang JF, Leclerc A, Zins M, Bonenfant S, Bugel I, Kaniewski N,
Schmaus A, Niedhammer I, Piciotti M, Chevalier A, Godard C, Imbernon E.

INSERM Unité 88, Hôpital National de Saint-Maurice, Saint-Maurice, France.

The purpose of this paper is to examine personal and health factors, both at the 
beginning of the study and thereafter, associated with participation in the GAZEL
cohort, set up in 1989 in a large French company. The authors used logistic
regression to analyze the associations between participation and data available
for both participants (n = 20,093) and nonparticipants (n = 24,829). Higher
participation was associated with male sex, marriage, children, managerial
status, and residence in particular regions. Among men, lower participation was
associated with sick leave in the year before recruitment and afterwards. During 
follow-up, participation was negatively associated with several groups of
diseases, especially those associated with alcohol consumption. The risk of upper
respiratory and digestive tract and lung cancer during follow-up was higher among
nonparticipants. The same phenomenon occurred among women, but less markedly, for
cancers of the breast and genital organs. During follow-up, mortality among men
was higher among nonparticipants, especially for alcohol-related diseases. The
association among women was less strong. Among men, but not among women, diseases
caused by alcohol, smoking, or dangerous behavior were the primary reason for the
health differences observed between participants and nonparticipants. Overall,
the most important determinants of participation were cultural factors and
lifestyle behaviors.

PMID: 11495861 [PubMed - indexed for MEDLINE]


92. Arch Mal Coeur Vaiss. 2001 May;94(5):479-85.

[Socio-professional acclimation of children operated on for cardiac disease]

[Article in French]

Martinez J.

Clinique Pasteur, 45, avenue de Lombez, 31076 Toulouse.

In order to assess the socio-professional insertion of children operated for
cardiac disease, 177 patients over 20 years of age completed a questionnaire
about their scholastic achievements, training and socio-professional categories. 
This formation was compared with that of the French population based on the
statistics of the "Institut national de la Statistique et des Etudes Economiques"
(INSEE). The cardiac patients were more likely to have technical occupations than
the general population and their level of scholastic achievement reflected this
tendency. They attained better professional situations than commonly thought. The
analysis of the conditions of surgical treatment indicated that a single,
curative and early operation is the best guarantee for future achievements.
However, the foundation of a family is much more difficult for operated cardiac
patients than for the general French population. Failure of socio-professional
insertion is far from being a fatality and psychological problems play an
important role, implicating the practitioner at three levels: patient, family and
society. In order to be totally convincing, the study of the future of operated
patients requires analysis of many different factors.

PMID: 11434016 [PubMed - indexed for MEDLINE]


93. Infect Control Hosp Epidemiol. 2001 Apr;22(4):206-10.

Risk of exposure to bloodborne infection for Italian healthcare workers, by job
category and work area. Studio Italiano Rischio Occupazionale da HIV Group.

Puro V, De Carli G, Petrosillo N, Ippolito G.

Centro di Riferimento AIDS, National Institute for Infectious Diseases--IRCCS
Lazzaro Spallanzani, Rome, Italy.

OBJECTIVE: To analyze the rate of occupational exposure to blood and body fluids 
from all sources and specifically from human immunodeficiency virus
(HIV)-infected sources among hospital workers, by job category and work area.
DESIGN: Multicenter prospective study. Occupational exposure data (numerator) and
full-time equivalents ([FTEs] denominator) were collected over a 5-year period
(1994-1998) and analyzed. SETTING: 18 Italian urban acute-care hospitals with
infectious disease units. RESULTS: A total of 10,988 percutaneous and 3,361
mucocutaneous exposures were reported. The highest rate of percutaneous exposure 
per 100 FTEs was observed among general surgery (11%) and general medicine
(10.6%) nurses, the lowest among infectious diseases (1.1%) and laboratory (1%)
physicians. The highest rates of mucocutaneous exposure were observed among
midwives (5.3%) and dialysis nurses (4.7%), the lowest among pathologists (0%).
Inadequate sharps disposal and the prevalence of sharps in the working unit
influence the risk to housekeepers. The highest combined HIV exposure rates were 
observed among nurses (7.8%) and physicians (1.9%) working in infectious disease 
units. The highest rates of high-risk percutaneous exposures per 100 FTE were
again observed in nurses regardless of work area, but this risk was higher in
medical areas than in surgery (odds ratio, 2.1; 95% confidence interval, 1.9-2.5;
P<.0001). CONCLUSION: Exposure risk is related to job tasks, as well as to the
type and complexity of care provided in different areas, whereas HIV exposure
risk mainly relates to the prevalence of HIV-infected patients in a specific
area. The number of accident-prone procedures, especially those involving the use
of hollow-bore needles, performed by job category influence the rate of exposure 
with high risk of infection. Job- and area-specific exposure rates permit
monitoring of the effectiveness of targeted interventions and control measures
over time.

PMID: 11379710 [PubMed - indexed for MEDLINE]


94. Ann Epidemiol. 2001 Apr;11(3):194-201.

Occupational hierarchy, economic sector, and mortality from cardiovascular
disease among men and women. Findings from the National Longitudinal Mortality
Study.

Muntaner C, Sorlie P, O'Campo P, Johnson N, Backlund E.

Department of Behavioral and Community Health Nursing, University of Maryland,
University of Maryland-Baltimore, Baltimore, MD 21205, USA

PURPOSE: Although socioeconomic position has been identified as a determinant of 
cardiovascular disease among employed men and women in the U.S., the role of
economic sector in shaping this relationship has yet to be examined. We sought to
estimate the combined effects of economic sector-one of the three major sectors
of the economy: finance, government and production-and socioeconomic position on 
cardiovascular mortality among employed men and women. METHODS: Approximately
375,000 men and women 25 years of age or more were identified from selected
Current Population Surveys between 1979 and 1985. These persons were followed for
cardiovascular mortality through use of the National Death Index for the years
1979 through 1989. RESULTS: In men, the lowest cardiovascular mortality was found
for professionals in the finance sector (76/100,000 person/years). The highest
cardiovascular mortality was found among male non-professional workers in the
production sector (192/100,000 person years). A different pattern was observed
among women. Professional women in the finance sector had the highest rates of
cardiovascular mortality (133/100,000 person years). For both men and women, the 
professional/non-professional gap in cardiovascular mortality was lower in the
government sector than in the production and finance sectors. These associations 
were strong even after adjustment for age, race and income. CONCLUSIONS:
Characteristics of government, finance and production work differentially
influence the risk of cardiovascular disease mortality. Men, women, professionals
and non-professionals experience this risk differently.

PMID: 11248583 [PubMed - indexed for MEDLINE]


95. J Rheumatol. 2001 Jan;28(1):54-61.

Becoming a disability pensioner with rheumatoid arthritis in Norway 1971-1990.

Holte HH, Tambs K, Bjerkedal T.

Section for Epidemiology, National Institute of Public Health, and the National
Insurance Administration, Oslo, Norway.

OBJECTIVE: Physically demanding occupations have been associated with becoming a 
disability pensioner with rheumatoid arthritis (DPRA), but not with the disease
of RA. The association with becoming DPRA probably reflects that patients with RA
have difficulties in maintaining employment in a physically demanding occupation.
However, the attitudes of the employers concerning employment of persons with RA 
might vary. For example, the patient's age may influence the strength of the
association between a physically demanding occupation and becoming DPRA. We
assessed whether the association between the predictors and becoming DPRA was
stronger for the youngest or the oldest age group. METHODS: The study was
prospective with data on persons in Norway 30-56 years old either in the census
of 1970 or 1980. All new cases of DPRA during the 2 followup periods 1971-80 and 
1981-90 were identified and analyzed by logistic regression. RESULTS: For women
the predictors employment, low level of education, and period ( 1981-90 compared 
to 1971-80) were more strongly associated with becoming DPRA for the youngest
compared to the oldest persons, while manual work and part time work were not
predictors of becoming DPRA. For men, all the predictors in the study were more
strongly associated with becoming DPRA for the youngest compared to the oldest
age group. CONCLUSION: The higher risk of becoming DPRA was associated with most 
predictors for persons aged 30-39 years than the group aged 50-56 years. Our
results appear to indicate that the consequences of having RA in the labor market
are greater for the youngest age group.

PMID: 11196543 [PubMed - indexed for MEDLINE]


96. Health Serv Res. 2000 Dec;35(5 Pt 2):1159-79.

An instrumental variables approach to measuring the effect of body weight on
employment disability.

Cawley J.

University of Michigan, Ann Arbor 48109-2029, USA.

OBJECTIVE: To measure the effect of body weight on employment disability. DATA
SOURCES: Female respondents to the National Longitudinal Survey of Youth (NLSY), 
a nationally representative sample of American youth, surveyed from 1979 to 1998,
merged with data from the child sample of the NLSY. STUDY DESIGN: A series of
probit models and probit models with instrumental variables is estimated with the
goal of measuring the effect of body weight on employment disability. The two
outcomes of interest are whether a woman reports that her health limits the
amount of work that she can do for pay, and whether she reports that her health
limits the kind of work that she can do for pay. The models control for factors
that affect the probability of health limitations on employment, such as
education, cognitive ability, income of other family members, and characteristics
of children in the household. Self-reports of height and weight are corrected for
reporting error. PRINCIPAL FINDINGS: All else being equal, heavier women are more
likely to report employment disability. However, this overall correlation may be 
due to any or all of the following factors: weight causing disability, disability
causing weight gain, or unobserved factors causing both. Instrumental variables
estimates provide no evidence that body weight affects the probability of either 
type of employment disability. CONCLUSIONS: This study finds no evidence that
body weight causes employment disability. Instead, the observed correlation
between heaviness and disability may be due to disability causing weight gain or 
unobservable factors causing both disability and weight gain.

PMCID: PMC1089168
PMID: 11130815 [PubMed - indexed for MEDLINE]


97. Int J Obes Relat Metab Disord. 2000 Dec;24(12):1642-7.

Determinants of overweight tracking from childhood to adolescence: a 5 y
follow-up study of Hat Yai schoolchildren.

Mo-suwan L, Tongkumchum P, Puetpaiboon A.

Department of Pediatrics, Faculty of Medicine, Prince of Songkhla University,
Thailand. mladda@ratree.psu.ac.th

OBJECTIVE: To study the determinants of overweight tracking from childhood to
adolescence of Hat Yai schoolchildren. DESIGN: A longitudinal study. SETTING:
Primary and secondary schools of Hat Yai municipality, southern Thailand.
SUBJECTS: 2252 schoolchildren recruited in 1992 and follow-up for 5y.
MEASUREMENTS: Child's annual body mass index (BMI, kg/m2) from 1992 to 1997;
parental BMIs, parental income, and family history of diseases by a questionnaire
completed by parents in 1992. RESULTS: Prevalence of overweight of males using
the 85th percentile of the U S First National Health and Nutritional Examination 
Survey reference for age and sex as a cut-off point increased from 12.4% in 1992 
to 21% in 1997, whereas that of females went down from 15.2 to 12.6. At the end
of the fifth year, 11.8% of children remained overweight while 4.5% became
overweight. Comparing to the non-overweights, the risk for becoming an overweight
adolescent of an overweight boy was 8.2 (95% confidence interval (CI) = 6, 11.2) 
whereas that of the overweight girls was 20 (95% CI = 12.4, 32.3). The
generalized estimating equations model predicted an increase in child BMI
associated with having a father or a mother with high BMI, a family history of
obesity, a monthly income greater than 5000 baht, and a lower level of exercise
than their peers. Secular increase in BMI was also observed. CONCLUSION:
Predictors of overweight tracking found in this study would be useful to select
children at risk for preventive intervention.

PMID: 11126218 [PubMed - indexed for MEDLINE]


98. Am J Public Health. 2000 Nov;90(11):1765-70.

Psychosocial work environment and depression: epidemiologic assessment of the
demand-control model.

Mausner-Dorsch H, Eaton WW.

Department of Health Policy and Management, Johns Hopkins University School of
Public Health, Baltimore, MD 21205, USA. hmausner@jhsph.edu

Erratum in:
    Am J Public Health 2001 May;91(5):828.

OBJECTIVES: This study examined the relation between occupational variables and 3
forms of depression (major depressive episode, depressive syndrome, and
dysphoria). It was hypothesized that individuals working in occupations with high
psychologic strain (high psychologic demands and low decision authority) would
have a higher prevalence of depression relative to those working in occupations
with the other 3 possible conditions. METHODS: The analysis was based on data for
905 respondents who were employed full-time in the year before the follow-up
interview for the Epidemiologic Catchment Area Program in Baltimore, Md, between 
1993 and 1996. Psychosocial work environment, sociodemographic variables, and
psychopathology were assessed in a household interview that included the National
Institute of Mental Health Diagnostic Interview Schedule. Subscales for the
demand-control model for psychosocial work environment were modified slightly
after factor analysis. RESULTS: High job strain was associated with greater
prevalence of all 3 forms of depression, especially major depressive episode. The
results were stronger for women; for men, being unmarried was the strongest
prevalence correlate. CONCLUSIONS: Major depressive episode, depressive syndrome,
and dysphoria are strongly associated with the psychosocial dimensions of the
demand-control model.

PMCID: PMC1446399
PMID: 11076247 [PubMed - indexed for MEDLINE]


99. J Occup Environ Med. 2000 Oct;42(10):993-1005.

Semen quality and hormone levels among radiofrequency heater operators.

Grajewski B, Cox C, Schrader SM, Murray WE, Edwards RM, Turner TW, Smith JM,
Shekar SS, Evenson DP, Simon SD, Conover DL.

National Institute for Occupational Safety and Health, Centers for Disease
Control and Prevention, Cincinnati, OH 45226, USA.

Comment in:
    J Occup Environ Med. 2002 Apr;44(4):305-7; author reply 307.

Approximately 9,000,000 US workers are occupationally exposed to radiofrequency
(RF) radiation; over 250,000 operate RF dielectric heaters. Our purpose was to
determine whether male RF heater operators experience increased adverse
reproductive effects reflected in reduced semen quality or altered hormone
levels. We measured incident RF heater radiation exposures and RF-induced foot
currents at four companies. For 12 male heater operators and a comparison group
of 34 RF-unexposed men, we measured 33 parameters of semen quality and four serum
hormones. Despite wide variation in individual exposure levels, near field
strengths and induced foot currents did not exceed current standard levels and
guidelines. We observed minor semen quality and hormonal differences between the 
groups, including a slightly higher mean follicle-stimulating hormone level for
exposed operators (7.6 vs 5.8 mIU/mL). Further occupational studies of RF-exposed
men may be warranted.

PMID: 11039163 [PubMed - indexed for MEDLINE]


100. Am Ann Deaf. 2000 Oct;145(4):303-14.

Long-term career attainments of deaf and hard of hearing college graduates:
results from a 15-year follow-up survey.

Schroedel JG, Geyer PD.

Rehabilitation Research and Training Center for Persons Who are Deaf or Hard of
Hearing, University of Arkansas, Little Rock, USA.

This article reports on the results of a national longitudinal survey of 240
college graduates with hearing loss. Results confirm that economic benefits
resulted from these alumni's postsecondary training. Most respondents were
relatively successfully employed and satisfied with life. Over time, increasing
numbers had completed higher degrees and secured white-collar positions. Between 
1988 and 1998, men in the study sample made more consistent earnings gains than
their female counterparts. Larger proportions of deaf alumni had earned advanced 
degrees and secured white-collar jobs than hard of hearing alumni. Deaf alumni
also earned more. Results also showed that recipients of associate's degrees
earned more than recipients of bachelor's degrees. Implications of the findings
for secondary educators, vocational rehabilitation counselors, and postsecondary 
service providers are discussed. Recommendations are made on how to improve
career decision making by deaf and hard of hearing adolescents, enrich the career
potential of deaf and hard of hearing women, and increase the productivity of
workers with hearing loss.

PMID: 11037064 [PubMed - indexed for MEDLINE]








101. Int J Obes Relat Metab Disord. 2000 Sep;24(9):1111-8.

Validity of self-reported weight and height in the French GAZEL cohort.

Niedhammer I, Bugel I, Bonenfant S, Goldberg M, Leclerc A.

INSERM Unit 88, Hôpital National de Saint-Maurice, France.
i.niedhammer@st-maurice.inserm.fr

OBJECTIVE: To examine the validity of self-reported weight and height and the
resulting body mass index (BMI), and to explore the associations between
demographic, socioeconomic, and health-related factors on the one hand and bias
in self-reported weight and height on the other, in order to determine the groups
most likely to exhibit bias. DESIGN: Prospective cohort study. SUBJECTS: 7350
middle-aged subjects, 5445 men and 1905 women, from the GAZEL cohort, who have
been followed up since 1989 and work at the French national company Electricité
De France-Gaz De France (EDF-GDF) in various occupations. MEASUREMENTS:
Self-reported weight and height were based on information from yearly mailed
questionnaires, and measured weight and height, used here as true values, were
provided by occupational physicians from 1994 to 1997. Sex, age, marital status, 
education, occupation, history of ischemic heart disease, and treatment for
cardiovascular risk factors were obtained from the mailed questionnaires or from 
data provided by the Company's personnel and medical departments. RESULTS: Strong
correlations were found between measured and self-reported values, but
self-reported weight and height displayed significant systematic errors. Weight
was significantly underestimated for men (0.54 kg) and for women (0.85 kg), and
height overestimated for men (0.38 cm) and women (0.40 cm). These biases led to
significant underestimations of BMI (0.29 and 0.44 kg/m2 for men and women
respectively). Consequently, the prevalence of overweight, defined as BMI > 26.9 
kg/m2 for women and BMI > 27.2 kg/m2 for men, was also underestimated, by 13% for
men and 17% for women. The five factors associated with bias in self-reported
weight and height were: overweight status, end-digit preference, age, educational
level and occupation. CONCLUSION: These findings suggest that self-reported
weight and height should be treated with caution, because of biases leading to
misclassification for overweight and obesity, especially in certain segments of
the population.

PMID: 11033979 [PubMed - indexed for MEDLINE]


102. J Adv Nurs. 2000 Aug;32(2):343-51.

British nurses in behavioural psychotherapy: a 25-year follow-up.

Gournay K, Denford L, Parr AM, Newell R.

Department of Health Services Research, Institute of Psychiatry and Maudsley
Hospital, Denmark Hill, London, England. spjukjg@iop.kcl.ac.uk

BACKGROUND: The National Service Framework for Mental Health has emphasized the
need to prioritize the provision of cognitive behaviour therapy as the central
evidence-based non-pharmacological intervention for mental health problems. For
25 years one programme (English National Board Course No. 650--Diploma in
Behavioural Cognitive Therapy, formerly called Nursing in Behavioural
Psychotherapy) has trained nurses in such methods. This is the only programme in 
nursing which qualifies graduates to be fully certified as a cognitive behaviour 
therapist by the British Association of Behavioural Psychotherapy and by the
United Kingdom Council for Psychotherapy. The practice of these nurse therapists 
(most commonly known as nurse behaviour therapists, NBTs) is the most rigorously 
evaluated in mental health nursing, with several randomized controlled trials to 
testify to clinical and economic efficacy. AIM: The aim of this study is to
continue the systematic follow-up of all NBT graduates previously undertaken in
two earlier surveys published in 1986 and 1994. These previous surveys examined
clinical practice, organizational context and career and professional development
issues. This up-to-date picture of NBTs will provide useful baselines for the
implementation of the National Service Framework, and may be used by the
Department of Health, education providers and services. METHOD: A postal survey
(using the same template for categories of information as the two earlier
surveys) was used and questionnaires were sent to 237 of the 274 trained NBTs
whose name appears on the Central NBT Register, maintained at the Institute of
Psychiatry/Maudsley Training Centre. RESULTS: One hundred and five of 230
eligible respondents (45.6%) returned questionnaires and additional data were
obtained from 27 NBTs who provided information to the Register in the year before
the survey. Thus, some data were available for 57% of the sample. As in earlier
surveys, it was found that the majority of therapists remain in clinical
practice, undertake substantial further education and training and are involved
in research and teaching as part of their overall role. The two central
developments are an increasing move towards working in primary care and an
increased emphasis on cognitive interventions. NBTs complete a substantial number
of treatments per year and increasingly treat clients with difficulties not
encountered during their basic training. NBTs now receive much more supervision
than in previous surveys and continue to use valid and reliable measures of
change in practice. However, the number of NBTs remains small and the impact on
potential populations who would benefit from effective psychological
interventions is minimal. This paper discusses the implications for service
delivery.

PMID: 10964181 [PubMed - indexed for MEDLINE]


103. Int J Occup Environ Health. 2000 Jul-Sep;6(3):194-202.

Cancer mortality among males in relation to exposures assessed through a
job-exposure matrix.

Weston TL, Aronson KJ, Siemiatycki J, Howe GR, Nadon L.

Bureau of Biostatistics and Computer Applications, Health Protection Branch,
Health Canada, Banting Building PL:2203B, Tunney's Pasture, Ottawa, Ontario K1A
0L2, Canada. anya_weston@hc-sc.gc.ca>

To identify potential associations between workplace exposures and cancer
mortality risks, job titles collected from 1965 to 1971 for 58,678 men (a subset 
of a large representative sample of the Canadian workforce) were transformed into
probable chemical exposures using a job-exposure matrix developed in Montreal.
Mortality follow-up was determined through computerized record linkage with the
National Mortality Database in Canada for 1965-1991. Cancer mortality risk was
evaluated at two levels of exposure, any and substantial, using Poisson
regression controlling for age, calendar period, and social class. Among the
58,678 men, 3,160 died of cancer. Using a liberal reporting criterion, relative
risk (RR) >1.0, five or more exposed cancer deaths, p < or = 0.100, several
potential associations were identified, including: lung cancer and any exposure
to abrasives dust (RR = 2.84), prostate cancer and any exposure to calcium
carbonate (RR = 2.46), and prostate cancer and substantial exposure to metallic
dust (RR = 2.13).

PMID: 10926723 [PubMed - indexed for MEDLINE]


104. Int J Epidemiol. 2000 Jun;29(3):487-94.

Manual work as predictor for disability pensioning with osteoarthritis among the 
employed in Norway 1971-1990.

Holte HH, Tambs K, Bjerkedal T.

The National Institute of Public Health, Section for Epidemiology, Oslo, Norway.

BACKGROUND: Manual work is reported to be a risk factor for becoming a disability
pensioner due to osteoarthritis. This association may be due to covariation with 
other variables. We wanted to assess if manual work remained a risk factor after 
adjusting for number of hours worked, income, level of education, gender and
marital status, and if the risk associated with manual work was equal in the
1970s and the 1980s. METHODS: In a prospective study, data on all new disability 
pensioners with osteoarthritis in Norway during the two follow-up periods,
1971-1980 and 1981-1990, were analysed by logistic regression. The study include 
data on all subjects living in Norway and registered as 50-56 years old and
employed either in the census collected in 1970 or in the census of 1980.
RESULTS: Manual workers have nearly twice the probability of becoming a
disability pensioner with osteoarthritis compared to professionals after
adjusting for part-time work, income, level of education, marital status and
gender. Adjusted for other risk factors, the probability of becoming a disability
pensioner with osteoarthritis was three times higher in the 1980s compared to the
1970s. CONCLUSION: The relatively strong association between manual work and
disability pensioning with osteoarthritis suggests difficulties in adjusting
manual work patterns for a person with osteoarthritis, which may have increased
during the study period as implied by the separate effect of the 1980s.

PMID: 10869321 [PubMed - indexed for MEDLINE]


105. Am J Ind Med. 2000 Apr;37(4):390-9.

Analysis of construction injury burden by type of work.

Lowery JT, Glazner J, Borgerding JA, Bondy J, Lezotte DC, Kreiss K.

Department of Preventive Medicine and Biometrics, University of Colorado Health
Sciences Center, Denver, Colorado 80262, USA.

BACKGROUND: To lay groundwork for identifying patterns of injury etiology, we
sought to describe injury experience associated with types of work performed at
construction sites by examining workers' compensation (WC) claims for the 32,081 
construction workers who built Denver International Airport (DIA). METHODS:
Injury rates and WC payment rates were calculated for 25 types of work based on
claims and payroll data reported to DIA's owner-controlled insurance program
according to National Council on Compensation Insurance job classifications. By
linking DIA claims with corresponding lost-work-time (LWT) claims filed with
Colorado's Workers' Compensation Division, we were also able to obtain and
examine both total and median lost days for each type of work. RESULTS: Injury
experience varied widely among the types of construction work. Workers building
elevators and conduits and installing glass, metal, or steel were at particularly
high risk of both LWT and non-LWT injury. Median days lost by injured workers was
highest (202 days) for driving/trucking. Median days lost for most types of work 
was much greater than previously reported for construction: 40 days or more for
18 of the 25 types of work analyzed. WC payment rates reflect both number and
severity of injuries and were generally not significantly different from expected
losses. They were, however, significantly higher than expected for
driving/trucking, metal/steel installation, inspection/analysis, and elevator
construction. CONCLUSIONS: Analysis of injury data by type of work allows
targeting of safety resources to high risk construction work and would be useful 
in prospective surveillance at large construction sites with centrally
administered workers' compensation plans. Copyright 2000 Wiley-Liss, Inc.

PMID: 10706751 [PubMed - indexed for MEDLINE]


106. Ann N Y Acad Sci. 1999;896:406-8.

Longitudinal effects of occupational, psychological, and social background
characteristics on health of older workers.

Mulatu MS, Schooler C.

Section on Socio-Environmental Studies, National Institute of Mental Health,
Bethesda, Maryland 20892-9005, USA. Mesfin.Mulatu@nih.gov

PMID: 10681936 [PubMed - indexed for MEDLINE]


107. Soz Praventivmed. 1999;44(6):264-71.

[Migrant populations at the Hôpital de l'Enfance of Lausanne (HEL): evaluation
inquiry, taking care and contribution of cultural mediators-translators]

[Article in French]

Gehri M, Hunziker B, Géraud F, Rouffaer D, Sopa S, Cruz CS, Métraux JC.

Hôpital de l'Enfance de Lausanne.

The number of patients belonging to migrant populations who consult Lausanne's
Hôpital de l'Enfance (HEL) has increased massively in an exponential manner. HEL 
is a facility dedicated to children with a vocation of public health and training
in a university setting and it has to make a point of developing an adequate and 
pertinent health care system for these populations. In order to do this, a study 
was undertaken in the form of a prospective survey including over a thousand
ambulatory patients. Administrative data (origin, date of migration, nature of
the permit and legal situation), social data (home language, professional
situation, number of siblings), medical (diagnosis) and psychosomatic data
(sleep, enuresis) was recorded as well as data testing the level of understanding
between carrier and patient. The study allowed us to define priorities of
intervention: introduction of a service of translators--cultural mediators
trained by the association "Appartenances" (as well as on going follow-up and
assessment of this service), training of health care workers in the fields of
cultural mediation and the different aspects of migrant population medicine and, 
finally, the creation of a steering group within the Institution. Having allowed 
rapid and spectacular improvement in the quality of the service provided by the
HEL, this process is also included in the will to improve health care given to
migrant populations at local and national levels in accordance with the
priorities defined by the WHO in this domain. It is this experience which is
reported in this paper.

PMID: 10674319 [PubMed - indexed for MEDLINE]


108. Hum Factors. 1999 Sep;41(3):487-94.

Effectiveness of an intervention to increase construction workers' use of hearing
protection.

Lusk SL, Hong OS, Ronis DL, Eakin BL, Kerr MJ, Early MR.

School of Nursing, University of Michigan, Ann Arbor 48109-0482, USA.

In this project we tested the effectiveness of a theory-based intervention
(video, pamphlets, and guided practice session) to increase the use of hearing
protection devices (HPDs) among Midwestern construction workers and a national
group of plumber/pipefitter trainers. Posttest measures were collected 10-12
months following this intervention. Pender's Health Promotion Model (1987)
provided the conceptual basis for development of the training program. A total of
837 high-noise-exposed workers were included in the analysis: 652 regional
Midwestern construction workers and 185 national plumber/pipefitter trainers.
Effectiveness of the intervention was determined through the sequence of analyses
recommended by Braver and Braver (1988) for the Solomon Four-Group Design.
Analysis of variance and covariance of postintervention use and intention to use 
HPDs and a meta-analytic test were done. These analyses indicated that the
intervention significantly increased use of HPDs but had no effect on intention
to use HPDs in the future. Pretesting had no effect on use. Actual or potential
applications of this research include guidance in the development of successful
theory-based interventions to increase use of HPDs.

PMID: 10665215 [PubMed - indexed for MEDLINE]


109. J Health Adm Educ. 1999 Winter;17(1):1-14.

A review of the evaluation literature on health professions training and
enrichment programs for minority/disadvantaged students.

Weppner RS, Bowman SY, Balsley RD.

Health Care Administration Department, Idaho State University, Pocatello 83209,
USA.

This paper includes the authors' review of the outcome evaluation articles of
federal and non-federal training programs to prepare minority/disadvantaged
students for entry into health programs as managers and practitioners. It
provides information from the senior author's 1987-1993 Health Careers
Opportunity Program grant for comparison purposes. The paper makes an argument
for the standardization of outcome variables so that cross-program comparisons
may be made. Until now, the variables reported in the literature have been very
disparate. This paper suggests which kind of training program may have the most
chance for success. Finally, it provides information rarely found in the
evaluation literature: success rates for different ethnic groups and costs for
running such programs. These data are provided for Health Care Administration
faculty who could use planning information for similar grant applications.

PMID: 10538546 [PubMed - indexed for MEDLINE]


110. Am J Epidemiol. 1999 Oct 15;150(8):825-33.

Risk factors for back injury in 31,076 retail merchandise store workers.

Gardner LI, Landsittel DP, Nelson NA.

Division of Safety Research, National Institute for Occupational Safety and
Health, Morgantown, WV, USA.

Risk factors for work-associated strain or sprain back injuries were investigated
in a cohort of 31,076 material handlers from 260 retail merchandise stores in the
United States. The workers studied were those with significant material-handling 
responsibilities--daily lifting and movement of merchandise. Workers in jobs with
the greatest physical work requirements had an injury rate of 3.64 per 100
person-years versus 1.82 in workers with lesser work requirements. The unadjusted
injury rate for males was 3.67 per 100 person-years compared with 2.34 per 100
person-years for females, but the excess for males was confounded by higher
physical work requirements for men in the stocker/receiver job category. The
injury rate ratio for short versus long duration of employment was 3.53 (95%
confidence interval: 2.90, 4.30); for medium versus long duration of employment, 
it was 1.38 (95% confidence interval: 1.18, 1.62). The elevated rate ratios were 
maintained when the data were stratified by subsets with different rates of
turnover. The results suggest that workers with the greatest physical work
requirements and those with the shortest duration of employment are at the
highest risk of back injuries. However, selection forces causing worker turnover 
within this cohort of active workers are not well characterized and have the
potential to bias the measures for time-related factors such as duration of
employment.

PMID: 10522653 [PubMed - indexed for MEDLINE]


111. J Epidemiol. 1999 Aug;9(4):268-74.

Possible protective effect of milk, meat and fish for cerebrovascular disease
mortality in Japan.

Kinjo Y, Beral V, Akiba S, Key T, Mizuno S, Appleby P, Yamaguchi N, Watanabe S,
Doll R.

Cancer Information and Epidemiology Division, National Cancer Center Research
Institute, Tokyo, Japan.

Cerebrovascular disease was a leading cause of death from 1955 to 1980 in Japan. 
The mortality rate from this disease has decreased sharply in recent decades.
This downward trend seems to correspond to the dietary habits of Japanese. Data
from a large prospective cohort study were analyzed to examine the association
between dietary habits and cerebrovascular disease mortality in Japan. The
subjects for this analysis were 223,170 men and women aged 40 to 69 at baseline
in December 1965. There were 6,168 deaths in men and 4,862 deaths in women due to
cerebrovascular disease (ICD7: 330-334) during the follow-up period from January 
1966 to December 1981. Rate ratio (RR) and 95% confidence interval (95% CI)
adjusted for sex, attained age, follow-up period, prefecture, cigarette smoking, 
alcohol drinking and occupation was used for comparison. In this study, the risk 
of mortality from cerebrovascular disease was inversely associated with dairy
milk, meat and fish consumption. Therefore the joint effect of dairy milk, meat
and fish (DMF) as animal fat and protein was of interest. In the binary analysis,
DMF (D, M, F) means the combination of dairy milk (1-3 times/week or more), meat 
(1-3 times/week or more) and fish (4 times/week or more). Thus DMF (d, m, f) was 
the reference group having dairy milk (less than 1 time/week), meat (less than 1 
time/week) and fish (less than 4 times/week). For the disease, the RR of DMF (D, 
M, F) was 0.68 with 95% CI of 0.63 to 0.74, relative to the reference group.
Furthermore the joint effect of DMF was more strongly associated with cerebral
haemorrhage (ICD7: 331, DMF (D, M, F); RR: 0.63, 95% CI: 0.55-0.70) than with
cerebral embolism and thrombosis (ICD7: 332, DMF (D, M, F); RR: 0.79, 95% CI:
0.70-0.89). These findings suggest that the increasing intake of animal fat
and/or protein may have played a key role in reducing cerebrovascular disease in 
Japan.

PMID: 10510585 [PubMed - indexed for MEDLINE]


112. Int J Epidemiol. 1999 Aug;28(4):769-75.

Predictors and impact of losses to follow-up in an HIV-1 perinatal transmission
cohort in Malawi.

Ioannidis JP, Taha TE, Kumwenda N, Broadhead R, Mtimavalye L, Miotti P, Yellin F,
Contopoulos-Ioannidis DG, Biggar RJ.

HIV Research Branch, Division of AIDS, National Institute of Allergy and
Infectious Diseases, NIH, Bethesda, MD, USA. jioannid@otenet.gr

BACKGROUND: Large simple trials which aim to study therapeutic interventions and 
epidemiological associations of human immunodeficiency virus (HIV) infection,
including perinatal transmission, in Africa may have substantial rates of loss to
follow-up. A better understanding of the characteristics and the impact of women 
and children lost to follow-up is needed. METHODS: We studied predictors and the 
impact of losses to follow-up of infants born in a large cohort of delivering
women in urban Malawi. The cohort was established as part of a trial of vaginal
cleansing with chlorhexidine during delivery to prevent mother-to-infant
transmission of HIV. RESULTS: The HIV infection status could not be determined
for 797 (36.9%) of 2156 infants born to HIV-infected mothers; 144 (6.7%) with
missing status because of various sample problems and 653 (30.3%) because they
never returned to the clinic. Notably, the observed rates of perinatal
transmission were significantly lower in infants who returned later for
determination of their infection status (odds ratio = 0.94 per month, P = 0.03), 
even though these infants must have had an additional risk of infection from
breastfeeding. In multivariate models, infants of lower birthweight (P = 0.003)
and, marginally, singletons (P = 0.09) were less likely to return for follow-up. 
The parents of infants lost to follow-up tended to be less educated (P < 0.001)
and more likely to be in farming occupations, although one educated group,
teachers and students, were also significantly less likely to return. Of these
variables, infant birthweight, twins versus singletons, and maternal education
were also associated with significant variation in the observed risk of perinatal
transmission among infants of known HIV status. CONCLUSIONS: Several predictors
of loss to follow-up were identified in this large HIV perinatal cohort. Losses
to follow-up can impact the observed transmission rate and the risk associations 
in different studies.

PIP: Predictors and the impact of losses to follow-up of infants born to a large 
HIV- infected cohort of delivering women in urban Malawi were studied. The women 
enrolled in an intervention trial including vaginal cleansing with chlorhexidine 
at the time of delivery. Findings showed that of the 2156 infants born to HIV-
infected mothers, about 1359 (63.1%) had been diagnosed with HIV infection, 797
(36.9%) with undetermined status, 144 (6.7%) with missing status, and about 653
(30.3%) were never brought back for follow-up. The odds of HIV positivity
decreased in the determination of infectious status (P = 0.03) despite the
probability of additional transmission from breast-feeding. Late-coming and lost 
children of less educated parents had similar birth weight (P = 0.50) and were
likely less to return. This was probably due to the fact that the fathers of the 
lost children were farmers. Besides, infant birth weight, twins vs. singletons,
and maternal education were affiliated with significant variation in the observed
risk of perinatal transmission among HIV-positive infants. Thus, with regard to
the intervention trial, the LFU were approximately equal in both groups. There
was no evidence that the losses were unbalanced between arms in relation to the
predictors of transmission.

PMID: 10480709 [PubMed - indexed for MEDLINE]


113. Demography. 1999 Aug;36(3):355-67.

The impact of specific occupation on mortality in the U.S. National Longitudinal 
Mortality Study.

Johnson NJ, Sorlie PD, Backlund E.

Demographic Statistical Methods Division, U.S. Bureau of the Census, Washington, 
DC 20233, USA. norman.j.johnson@ccmail.census.gov

We compare mortality differences for specific and general categories of
occupations using a national cohort of approximately 380,000 persons aged 25-64
from the U.S. National Longitudinal Mortality Study. Based on comparisons of
relative risk obtained from Cox proportional-hazards model analyses, higher risk 
is observed in moving across the occupational spectrum from the technical, highly
skilled occupations to less-skilled and generally more labor-intensive
occupations. Mortality differences obtained for social status groups of specific 
occupations are almost completely accounted for by adjustments for income and
education. Important differences are shown to exist for selected specific
occupations beyond those accounted for by social status, income, and education.
High-risk specific occupations include taxi drivers, cooks, longshoremen, and
transportation operatives. Low-risk specific occupations include lawyers, natural
scientists, teachers, farmers, and a variety of engineers.

PMID: 10472499 [PubMed - indexed for MEDLINE]


114. Occup Environ Med. 1999 May;56(5):315-21.

Cohort mortality study of 57,000 painters and other union members: a 15 year
update.

Steenland K, Palu S.

National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH
45208, USA.

OBJECTIVES: To study mortality patterns in the largest existing cohort of
painters. METHODS: 15 years of follow up were added to a study of 42,170 painters
and 14,316 non-painters based on union records. There were 23,458 deaths,
compared with 5313 in the earlier follow up. RESULTS: Comparisons with the United
States population showed significantly increased rates in painters for lung
cancer (standardised mortality ratio (SMR) 1.23, 95% confidence interval (95% CI)
1.17 to 1.29), bladder cancer (SMR 1.23, 95% CI 1.05 to 1.43), liver cancer (SMR 
1.25, 95% CI 1.03 to 1.50), and stomach cancer (SMR 1.39, 95% CI 1.20 to 1.59).
However, in direct comparisons with non-painters only the excesses for lung
cancer (SRR 1.23, 95% CI 1.11 to 1.35, increasing to 1.32, 95% CI 16 to 1.93 with
20 years latency) and bladder cancer (SRR 1.77, 95% CI 1.13 to 2.77) were
confirmed. Some confounding by smoking may affect these two outcomes,
particularly with external referents. Cirrhosis of the liver was increased for
both painters and non-painters (SMRs 1.21, 95% CI 1.07 to 1.35, and 1.26, 95% CI 
1.03 to 1.51, respectively), possibly indicating high alcohol consumption.
Suicide (SMR 1.21, 95% CI 1.05 to 1.38) and homicide (SMR 1.36, 95% CI 1.04 to
1.75) were increased for painters but not for non-painters; neuropsychiatric
diseases have been associated with painters in earlier studies. CONCLUSIONS: The 
results suggest modest occupational risks for lung and bladder cancer; these
results are consistent with existing publications. The International Agency for
Research on Cancer has classified painting as an occupation definitely associated
with cancer.

PMCID: PMC1757737
PMID: 10472305 [PubMed - indexed for MEDLINE]


115. Spine (Phila Pa 1976). 1999 Jul 15;24(14):1455-62.

One-year predictive factors for various aspects of neck disorders.

Leclerc A, Niedhammer I, Landre MF, Ozguler A, Etore P, Pietri-Taleb F.

INSERM U88, Hôpital National de Saint-Maurice, Saint-Maurice, France.
a.leclerc@st-maurice.inserm.fr

STUDY DESIGN: A longitudinal epidemiologic study conducted over 12 months among
active workers in different occupations. The study was primarily designed to
evaluate intervention for prevention of low back and other spinal disorders.
OBJECTIVE: To determine factors that predict incidence, recurrence, and
persistence of neck disorders (ND), taking into account various dimensions of ND.
SUMMARY OF BACKGROUND DATA: Neck pain is often supposed to have essentially the
same risk factors as back pain; however, there is comparatively little data
relevant to this issue. Moreover, there is a lack of prospective studies that
take into account a diversity of predictive factors. METHODS: The Nordic
questionnaire for the analysis of musculoskeletal symptoms was completed twice at
a 12-month interval by 568 workers. Predictive factors were studied with logistic
models for four dimensions of ND from the second questionnaire: 1) any ND in the 
past 6 months; 2) ND for more than 30 days; 3) treatment for ND; and 4) visit to 
a health care professional for ND. The predictive factors were obtained from the 
first questionnaire and included gender, age, occupational group, level of
psychological distress and psychosomatic problems, and ND at baseline. RESULTS:
Female gender and older age were predictors of ND. Headaches or pain in the head,
psychological distress, and psychosomatic problems were predictors for all
dimensions of ND. These effects were observed for both incidence and persistence 
of ND. CONCLUSIONS: The results emphasize the role of psychosomatic and
psychological factors in the occurrence and course of ND for various dimensions
of the disorder.

PMID: 10423791 [PubMed - indexed for MEDLINE]


116. J Neurosurg. 1999 Jan;90(1):59-64.

Resumption of work after aneurysmal subarachnoid hemorrhage in middle-aged
Japanese patients.

Nishino A, Sakurai Y, Tsuji I, Arai H, Uenohara H, Suzuki S, Li JH.

Department of Neurosurgery, Stroke Center, Sendai National Hospital, Japan.

OBJECT: Previous reports on the results of treatment for aneurysmal subarachnoid 
hemorrhage (SAH) have been based only on activities of daily living after
discharge, whereas resumption of work has received insufficient attention. Most
Japanese work under a lifetime employment system, and it is best for those who
have recovered from SAH to return to work for their previous employer. The
present study was conducted to determine the extent to which discharged patients 
who have suffered an SAH resume their former occupations in Japan, focusing on
those between 40 and 49 years of age, who usually have a strong desire to return 
to work. METHODS: The participants consisted of 193 patients with SAH. Based on
the results of telephone interviews or written questionnaires, their work status 
at 1 year after onset was analyzed. The work resumption rates for patients with
Hunt and Kosnik neurological Grades 1 or 2 on admission were higher than for
those with Grades 3 or 4 (p = 0.015) and lower for patients with basilar artery
aneurysms than for those with aneurysms at other sites (p = 0.028). With regard
to premorbid occupation, the work resumption rates were high (80%) for
professionals and engineers, many of whom were public servants, or teachers at
junior or senior high schools. The resumption rates were also high for primary
industry workers (80%), but lowest (20%) for professional drivers (p =
0.04-0.001). The work resumption rate was lower for women than for men (p =
0.01). CONCLUSIONS: These findings indicate that resumption of work is determined
not only by medical factors, but also by social factors including gender, type of
occupation, employment system, and socioeconomic background.

PMID: 10413156 [PubMed - indexed for MEDLINE]


117. Am J Ind Med. 1999 Jul;36(1):83-9.

Ovarian cancer and occupational exposures in Finland.

Vasama-Neuvonen K, Pukkala E, Paakkulainen H, Mutanen P, Weiderpass E, Boffetta
P, Shen N, Kauppinen T, Vainio H, Partanen T.

Department of Epidemiology and Biostatistics, Finnish Institute of Occupational
Health, Helsinki. kvas@occuphealth.fi

BACKGROUND: No single occupational or environmental agent has been established as
causing ovarian cancer, existing studies often being based on ecologic or
proportional mortality data in which potential confounders related to
reproductive history have not been taken into account. METHODS: This study linked
324 job titles of occupationally active Finnish women (n = 892,591) at 1970
census with incidence of ovarian cancer (Finnish Cancer Registry, 5,072 cases)
during 1971-1995 (over 15 million person-years). The job titles were converted
into indicators of exposure to 33 agents, using a national job-exposure matrix
based on measurements and surveys (FINJEM). Poisson regression analyses were
performed with stratification by birth cohort, follow-up period, and
socioeconomic status, and adjusted for mean number of children, mean age at first
delivery, and turnover rate for each job title. RESULTS: We found indications of 
elevated risks for aromatic hydrocarbon solvents (standardized incidence ratio
1.3 (95% CI 1.0-1.7), leather dust (1.4; 0.7-2.7), man-made vitreous fibers (1.3;
0.9-1.8), and high levels of asbestos (1.3; 0.9-1.8), and diesel (1.7; 0.7-4.1), 
and gasoline (1.5; 1.0-2.0) engine exhausts). Previously reported findings for
hairdressers and women in the printing industry were supported in our data, but
not for women in dry cleaning jobs. CONCLUSIONS: Given the various drawbacks in
linkage studies and job-exposure matrices, the excesses found in this study need 
confirmation in individual-level studies.

PMID: 10361591 [PubMed - indexed for MEDLINE]


118. Am J Public Health. 1999 Jun;89(6):875-81.

High-risk occupations for breast cancer in the Swedish female working population.

Pollán M, Gustavsson P.

Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute 
of Health, Madrid, Spain. mpollan@isciii.es

OBJECTIVES: The purpose of this study was to estimate, for the period 1971
through 1989, occupation-specific risks of breast cancer among Swedish women
employed in 1970. METHODS: Age-period standardized incidence ratios were
computed. Log-linear Poisson models were fitted, with geographical area and town 
size taken into account. Risks were further adjusted for major occupational
group, used as a proxy for socioeconomic status. Risk estimators were also
calculated for women reporting the same occupation in 1960 and 1970. RESULTS:
Most elevated risks among professionals, managers, and clerks were reduced when
intragroup comparisons were carried out, indicating the confounding effect of
socioeconomic status. Excess risks were found for pharmacists, teachers of
theoretical subjects, schoolmasters, systems analysts and programmers, telephone 
operators, telegraph and radio operators, metal platers and coaters, and
hairdressers and beauticians, as well as for women working in 1960 and 1970 as
physicians, religious workers, social workers, bank tellers, cost accountants,
and telephonists. CONCLUSIONS: While the high risks observed among professional, 
administrative, and clerical workers might be related to lower birth rates and
increased case detection, excess risks found for telephone workers and for
hairdressers and beauticians deserve further attention.

PMCID: PMC1508661
PMID: 10358678 [PubMed - indexed for MEDLINE]


119. Occup Environ Med. 1999 Jan;56(1):59-66.

Risk factors for neck and upper limb disorders: results from 24 years of follow
up.

Fredriksson K, Alfredsson L, Köster M, Thorbjörnsson CB, Toomingas A, Torgén M,
Kilbom A.

Department for Work and Health, National Institute for Working Life, Solna,
Sweden. Kerstin.Fredriksson@niwl.se

Erratum in:
    Occup Environ Med 1999 May;56(5):358.

OBJECTIVES: To investigate associations between different potential risk factors,
related and not related to work, and disorders of the neck and upper extremities 
occurring up to 24 years later. METHODS: The study comprised 252 women and 232
men, Swedish citizens, 42-59 years of age and in a broad range of occupations.
Information about potential risk factors was available from a former study
conducted in 1969. Data on disorders of the neck, shoulder, and hand-wrist
disorders were obtained retrospectively for the period 1970-93. RESULTS: Risk
factors were found to differ between the sexes. Among women over-time work, high 
mental workload, and unsatisfactory leisure time were associated with disorders
in the neck-shoulder region. Interaction was found between high mental workload
and unsatisfactory leisure time. Neck symptoms earlier in life were associated
with recurrent disorders. Hand and wrist disorders were associated mainly with
physical demands at work. Among men blue collar work and a simultaneous presence 
of high mental workload and additional domestic workload predicted disorders in
the neck-shoulder region. CONCLUSIONS: Factors related and not related to work
were associated with disorders of the neck, shoulders, and hands and wrist up to 
24 years later in life. These included factors related to working hours which
previously have not been noted in this context. Interactions between risk factors
both related and not related to work were commonly found.

PMCID: PMC1757647
PMID: 10341748 [PubMed - indexed for MEDLINE]


120. Soc Sci Med. 1998 Dec;47(12):2055-66.

Mortality variations in England and Wales between types of place: an analysis of 
the ONS longitudinal study. Office of National Statistics.

Ecob R, Jones K.

MRC Medical Sociology Unit, Glasgow, UK. russell@msoc.mrc.gla.ac.uk

This study investigates the extent to which individuals, in England and Wales, in
different types of place experience differential mortality once account is taken 
of personal (individual and household) social circumstances. Data comes from the 
Longitudinal Study of England and Wales of the Office of National Statistics, the
respondents being a one percent national random sample of people aged between 25 
and 74 at the 1971 census, followed until the end of 1985. For males and females 
separately, differences in mortality are found for the 36 types of Craig-Webber
classification in models which include, at the individual level, a number of
demographic and socio-economic variables (women being classified by their own
occupation). In general, for both males and females, the same types of place have
elevated or lowered mortality. For males a (cross-level) interaction exists
between the proportion in the area in professional social classes and individual 
social class, the effects of individual social class being larger in areas
containing a higher proportion of those in professional occupations. For females 
mortality is negatively related to the proportion of car-ownership in the area.

PMID: 10075246 [PubMed - indexed for MEDLINE]


121. Soc Sci Med. 1998 Dec;47(12):2043-53.

Social class, assets, organizational control and the prevalence of common groups 
of psychiatric disorders.

Muntaner C, Eaton WW, Diala C, Kessler RC, Sorlie PD.

Institute of Occupational and Environmental Health and Prevention Research
Center, West Virginia University, Morgantown 26506-9190, USA.

This study provides an update on the association between social class and common 
types of psychiatric disorder in the US. In addition to usual measures of social 
class, we provide hypotheses for the expectation that assets and organizational
control are associated with specific varieties of psychiatric disorders (mood,
anxiety, alcohol and drug use disorders). We analyzed two surveys. The National
Comorbidity Survey conducted in 1990-1992 yielded 12-month prevalence rates in a 
probability sample of 8098 respondents in the 48 contiguous states. The
Epidemiologic Catchment Area Follow-up conducted in 1993-1996 provided similar
rates among 1920 East Baltimore residents. Analyses of the National Comorbidity
Survey showed an inverse association between financial and physical assets and
mood, anxiety, alcohol, and drug disorders. The Epidemiologic Catchment Area
Followup provided additional evidence for the inverse association between
financial and physical assets and anxiety, alcohol and drug disorders. Also in
the Epidemiologic Catchment Area, lower level supervisors presented higher rates 
of depression and anxiety disorders than higher level managers. Inequalities in
assets and organizational control, as well as typical measures of social class,
are associated with specific psychiatric disorders. These constructs can provide 
additional explanations for why social inequalities in psychiatric disorders
occur.

PMID: 10075245 [PubMed - indexed for MEDLINE]


122. Int J Epidemiol. 1998 Dec;27(6):1026-32.

Permanent work incapacity, mortality and survival without work incapacity among
occupations and social classes: a cohort study of ageing men in Geneva.

Gubéran E, Usel M.

Institute of Occupational Health Sciences, IST, Lausanne, Switzerland.

BACKGROUND: The objective of this retrospective cohort study was to investigate
the burden of disability and death in men, from middle age to age of retirement, 
among occupational groups and classes in Geneva. METHODS: Men were included if
they resided in the Canton of Geneva, were 45 years of age in 1970-1972, and were
not receiving a disability pension at the start of the follow-up. The cohort of
5137 men was followed up for 20 years and linked to national registers of
disability pension allowance and of causes of death. RESULTS: There was a steep
upward trend in incidence of permanent work incapacity with lower social class
for all causes as well as for the seven causes of disability studied. Compared
with professional occupations (social class I), the relative risk (RR) of
permanent work incapacity was 11.4 for partly skilled and unskilled occupations
(class IV+V) (95% confidence interval [CI]: 5.2-28.0). The social class gradient 
in mortality was in the same direction as that in work incapacity although much
less steep (RR class IV+V to class I = 1.6, 95% CI : 1.1-2.2). Survival without
work incapacity at the time of the 65th birthday ranged from only 57% in
construction workers and labourers to 89% in science and related professionals.
Unemployment in Geneva was below 1.5% during almost all the study period.
CONCLUSIONS: Medically-ascertained permanent work incapacity and survival without
work incapacity have shown considerably greater socioeconomic differentials than 
the mortality differentials.

PMID: 10024198 [PubMed - indexed for MEDLINE]


123. Am J Public Health. 1999 Jan;89(1):47-53.

Occupational class and ischemic heart disease mortality in the United States and 
11 European countries.

Kunst AE, Groenhof F, Andersen O, Borgan JK, Costa G, Desplanques G, Filakti H,
Giraldes Mdo R, Faggiano F, Harding S, Junker C, Martikainen P, Minder C, Nolan
B, Pagnanelli F, Regidor E, Vågerö D, Valkonen T, Mackenbach JP.

Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
kunst@mgz.fgg.eur.nl

OBJECTIVES: Twelve countries were compared with respect to occupational class
differences in ischemic heart disease mortality in order to identify factors that
are associated with smaller or larger mortality differences. METHODS: Data on
mortality by occupational class among men aged 30 to 64 years were obtained from 
national longitudinal or cross-sectional studies for the 1980s. A common
occupational class scheme was applied to most countries. Potential effects of the
main data problems were evaluated quantitatively. RESULTS: A north-south contrast
existed within Europe. In England and Wales, Ireland, and Nordic countries,
manual classes had higher mortality rates than nonmanual classes. In France,
Switzerland, and Mediterranean countries, manual classes had mortality rates as
low as, or lower than, those among nonmanual classes. Compared with Northern
Europe, mortality differences in the United States were smaller (among men aged
30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS: The
results underline the highly variable nature of socioeconomic inequalities in
ischemic heart disease mortality. These inequalities appear to be highly
sensitive to social gradients in behavioral risk factors. These risk factor
gradients are determined by cultural as well as socioeconomic developments.

PMCID: PMC1508498
PMID: 9987464 [PubMed - indexed for MEDLINE]


124. Occup Environ Med. 1998 Nov;55(11):735-41.

Psychosocial factors at work and sickness absence in the Gazel cohort: a
prospective study.

Niedhammer I, Bugel I, Goldberg M, Leclerc A, Guéguen A.

INSERM Unit 88, Hôpital National de Saint-Maurice, France.
i.niedhammer@st-maurice.inserm.fr

OBJECTIVE: To test whether psychosocial factors at work are predictors of rates
of sickness absence. METHODS: The study population consisted of middle aged men
and women employed by the French national electricity and gas company (EDF-GDF)
in various occupations and followed up since 1989 by annual self administered
questionnaires and independent data obtained from the medical and personnel
departments of EDF-GDF. The 1995 questionnaire provided information about three
psychosocial work factors: psychological demands, decision latitude, and social
support at work. Sick-ness absence data were provided by the company's social
security department. The occurrence of spells and days of absence in the 12
months after completion of the 1995 questionnaire was studied. Potential
confounding variables were age, smoking, alcohol, and marital status, assessed in
the 1995 questionnaire, and educational level and occupation, assessed from data 
provided by the personnel department. This study was restricted to the 12,555
subjects of the initial cohort who were still working and answered the self
administered questionnaire in 1995. RESULTS: Low levels of decision latitude were
associated with more frequent and longer sickness absences among men and women.
Low levels of social support at work increased the numbers of spells and days of 
absence among men only. These associations weakened after adjustment for
potential confounding factors, but remained significant. CONCLUSION: The study
indicates that psychosocial factors at work, especially decision latitude, are
predictive of sickness absence.

PMCID: PMC1757529
PMID: 9924449 [PubMed - indexed for MEDLINE]


125. Age Ageing. 1998 Jul;27(4):477-83.

Occupation type as a predictor of cognitive decline and dementia in old age.

Jorm AF, Rodgers B, Henderson AS, Korten AE, Jacomb PA, Christensen H, Mackinnon 
A.

NH and MRC Psychiatric Epidemiology Research Centre, The Australian National
University, Canberra, ACT. Anthony.Jorm@anu.edu.au

OBJECTIVE: To assess whether an individual's main occupation predicts cognitive
decline or dementia. METHODS: The data were taken from a longitudinal study of
518 men aged 70 or over. Main occupation was coded into one of John Holland's six
occupational categories. The subjects completed four cognitive tests and were
diagnosed for dementia on two occasions three and a half years apart. The
cognitive tests were the Mini-Mental State Examination, Episodic Memory Test,
Symbol-Letter Modalities Test and National Adult Reading Test. Informants also
completed the Informant Questionnaire on Cognitive Decline in the Elderly.
Dementia was diagnosed by the American Psychiatric Association Diagnostic and
Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R) and
ICD-10 criteria using the Canberra Interview for the Elderly. RESULTS:
Cross-sectional analysis of the wave 1 data showed that the realistic
occupations, which include trade, technical and some service occupations, had
poorer cognitive performance and a higher prevalence of DSM-III-R dementia. These
differences held even when age, education and native English were statistically
controlled. The greatest occupational difference was on the National Adult
Reading Test, which estimates pre-morbid ability. By contrast, there were no
occupational differences in longitudinal change in cognitive test performance,
informant reports of cognitive decline or incident cases of dementia over three
and a half years. CONCLUSION: Cross-sectional occupational differences on
cognitive tests and in dementia prevalence are due to differences in pre-morbid
ability rather than to differences in rate of cognitive decline.

PMID: 9884005 [PubMed - indexed for MEDLINE]


126. Am J Prev Med. 1998 Nov;15(4):344-61.

Worksite physical activity interventions.

Dishman RK, Oldenburg B, O'Neal H, Shephard RJ.

Department of Exercise Science, University of Georgia, Athens 30602-6554, USA.

BACKGROUND: National objectives for public health have targeted worksite as
important settings for interventions to increase physical activity. However,
expert reviews reveal no scientific consensus about the effectiveness of worksite
interventions for increasing physical activity or fitness. METHODS: We judged the
quantity and quality of existing evidence against scientific standards for the
internal and external validity of the research design and the validity of
measurements. Meta-analytic methods were used to quantify the size of effects
expressed as Pearson correlation coefficients (r). Variation in effect was
examined in relation to several features of the studies deemed important for
implementing successful worksite interventions. Pre-experimental cohort studies
were excluded because they are sensitive to secular trends in physical activity. 
RESULTS: Twenty-six studies involving nearly 9,000 subjects yielded 45 effects.
The mean effect was heterogeneous and small, r = 0.11 (95% CI, -0.20 to 0.40),
approximating 1/4 S.D., or an increase in binomial success rate from 50% to 56%. 
Although effects varied slightly according to some of the study features we
examined, effects were heterogeneous within levels of these features. Hence, the 
moderating variables examined did not explain variation in the effects (P >
0.05). The exception was that effects were smaller in randomized studies compared
with studies using quasi-experimental designs (P < 0.05). CONCLUSIONS: Our
results indicate that the typical worksite intervention has yet to demonstrate a 
statistically significant increase in physical activity or fitness. The few
studies that have used an exemplary sample, research design, and outcome measure 
have also yielded small or no effects. The generally poor scientific quality of
the literature on this topic precludes the judgment that interventions at
worksites cannot increase physical activity or fitness, but such an increase
remains to be demonstrated by studies using valid research designs and measures.

PMID: 9838977 [PubMed - indexed for MEDLINE]


127. Soc Sci Med. 1998 Nov;47(10):1399-405.

Explanations of social class differences in alcoholism among young men.

Hemmingsson T, Lundberg I, Diderichsen F, Allebeck P.

Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.

The aim of this study was to analyse the role of differences in alcohol
consumption and other risk factors for alcoholism established in late
adolescence, for later differences in the distribution of alcoholism between
social classes among young men. Data on risk factors in childhood and
adolescence, e.g. risk use of alcohol, was collected among 49,323 men, born
1949-1951, at conscription for compulsory military training 1969/1970. Data on
socio-economic group was obtained from the 1975 census and data on alcoholism
diagnoses from the national in-patient care register 1976-1983. Several risk
factors for alcoholism, such as risk use of alcohol, psychiatric diagnosis at
conscription, parental divorce, low emotional control and contact with police and
child care authorities, seemed to be more common among those who were recruited
to blue-collar occupations compared to those who were recruited to non-manual
occupations. In multivariate analyses, taking the background variables into
consideration, the increased relative risks among manual workers for alcoholism
diagnoses, found in univariate analyses, diminished considerably. Several risk
factors had a stronger effect on the outcome among unskilled workers compared
with non-manual employees at medium or higher degree. It is concluded that risk
factors for poor health established in late adolescence could explain much of the
increased relative risk of alcoholism among young unskilled and skilled male
workers in this study.

PMID: 9823036 [PubMed - indexed for MEDLINE]


128. Scand J Work Environ Health. 1998 Jun;24(3):197-205.

Psychosocial factors at work and subsequent depressive symptoms in the Gazel
cohort.

Niedhammer I, Goldberg M, Leclerc A, Bugel I, David S.

INSERM (National Research Institute on Health and Medicine), Unit 88, Hôpital
National de Saint-Maurice, France. i.niedhammer@st-maurice.inserm.fr

OBJECTIVE: This study attempted to establish whether psychosocial factors at work
are predictors of depressive symptoms in a prospective cohort of men and women
employed in a wide variety of occupations by the French national company
Electricité De France - Gaz De France (EDF-GDF). METHODS: This prospective cohort
study followed the Gazel cohort by means of annual self-administered
questionnaires and independent data obtained from the medical and personnel
departments of the company. The self-administered questionnaire, in 1995,
provided information about the psychosocial work environment characteristics,
psychological job demands, decision latitude, and social support at work.
Depressive symptoms were assessed by the Center for Epidemiologic Studies
Depression (CES-D) Scale in the 1996 questionnaire. Potential confounding
variables were age, marital status, and number of children, assessed in the 1995 
questionnaire, stressful personal and occupational events during the previous 12 
months, assessed in the 1996 questionnaire, and educational level, occupation and
previous absenteeism for mental disorders, assessed from the independent data
provided by EDF-GDF. The subjects were 11 552 workers (8422 men aged 46-56 years 
in 1995 and 3130 women aged 41-56 years) who answered the 1995 and 1996
questionnaires and were working during this period. RESULTS: High levels of
psychological demands, low levels of decision latitude, and low levels of social 
support at work were significant predictors of subsequent depressive symptoms in 
both the men and the women. These results were unchanged after adjustment for
potential confounding variables. CONCLUSIONS: The results strongly support the
possibility that psychosocial factors at work are predictive of depressive
symptoms.

PMID: 9710372 [PubMed - indexed for MEDLINE]


129. Psychother Psychosom. 1998 Jul-Oct;67(4-5):226-40.

What prevents professional drivers from following physicians' cardiologic advice?

Emdad R, Belkic K, Theorell T, Cizinsky S.

Division for Psychosocial Factors and Health, Department of Public Health
Sciences, Karolinska Institute, and the National Institute for Psychosocial
Factors and Health, Stockholm, Sweden.

BACKGROUND: There is a scarcity of published studies of the effects of cardiac
counselling among professional drivers (PD). Aims of the study were: (1) to
examine explanatory variables for two classical 'driver' risk factors - body mass
index (BMI), and smoking - and to analyse the interrelations among smoking
cessation, losing weight and work-related life changes; (2) to assess the
effectiveness of risk factor counselling after 6 months, and (3) to gain insight 
into possible discrepancies between PD perception of needed changes and
compliance with the physician's advice. METHODS: There were 4 groups of male PD: 
13 with ischemic heart disease, 12 hypertensives, 10 borderline hypertensives and
34 normotensives. Baseline cardiovascular risk factors as well as occupational
and behavioral data were assessed via questionnaire. The counselling was aimed at
smoking cessation, weight loss and promoting leisure-time physical activity.
Qualitative methods were used to assess PD perceptions about the work environment
and health promotion. RESULTS: Baseline smoking intensity was best predicted by
the total burden of occupational stress and number of smoking years. Baseline BMI
was best predicted by long work hours behind the wheel, low availability of
attachment outside work and low self-reported job strain. Self-initiated smoking 
cessation was best predicted by few smoking years, low coffee intake and
admitting fear during driving. Physical activity was significantly increased
after 6 months. Losing weight was associated with: quitting or diminishing
smoking and making other, work-related, life changes. None of the heavy smokers
decreased their daily number of cigarettes after 6 months, although expressing
the need to do so in self-generated statements. CONCLUSIONS: Exposure to
occupational stressors, mainly, long work hours and the concomitant denial of job
strain, in combination with low availability of social attachment outside work,
could contribute to maintenance of maladaptive behavior in PD. These findings
could serve as a basis for designing standardized intervention trials and suggest
that modification of the work environment, with participation of the drivers, is 
a needed component of such trials. Particular attention should be paid to the
length and scheduling of work shifts.

PMID: 9693350 [PubMed - indexed for MEDLINE]


130. Pediatrics. 1998 Aug;102(2):e25.

Parental literacy level and understanding of medical information.

Moon RY, Cheng TL, Patel KM, Baumhaft K, Scheidt PC.

Department of General Pediatrics, Children's Research Institute, Children's
National Medical Center, Washington, DC 20010, USA.

OBJECTIVE: To ascertain the impact of literacy level on parents' understanding of
medical information and ability to follow therapy prescribed for their children. 
DESIGN/METHODS: A prospective cohort of parents accompanying their children for
acute care. Parents were interviewed about demographic status, their child's
health, and use of pediatric preventive services. The Rapid Estimate of Adult
Literacy in Medicine (REALM) test was used to assess parental literacy. The same 
parent was interviewed 48 to 96 hours later and asked to recall the child's
diagnosis, any medication prescribed, and instructions. RESULTS: A total of 633
patients were enrolled. Follow-up was obtained in 543 patients (85.8%). Mean
parental age was 32.43 years (SD = 9.07). Mean REALM score was 57.6 (SD = 10.9), 
corresponding to a 7th- to 8th-grade reading level, with a mean parental
educational level of 13.43 years (SD = 2.09). Low REALM score was significantly
correlated with young parental age and parental education. African-American race 
was associated with lower REALM scores. After controlling for these variables,
REALM score significantly correlated with parental perception of how sick the
child was, but not with use of preventive services, comprehension of diagnosis,
medication name and instructions, or ability to obtain and administer prescribed 
medications. CONCLUSIONS: Parental literacy level did not correlate with use of
preventive services or parental understanding of or ability to follow medical
instructions for their children.

PMID: 9685471 [PubMed - indexed for MEDLINE]


131. Soc Sci Med. 1998 Jun;46(11):1459-76.

Mortality by occupational class among men 30-64 years in 11 European countries.
EU Working Group on Socioeconomic Inequalities in Health.

Kunst AE, Groenhof F, Mackenbach JP.

Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus
University, Rotterdam, The Netherlands.

This study compares eleven countries with respect to the magnitude of mortality
differences by occupational class, paying particular attention to problems with
the reliability and comparability of the data that are available for different
countries. Nationally representative data on mortality by occupational class
among men 30-64 years at death were obtained from longitudinal and
cross-sectional studies. A common social class scheme was applied to most data
sets. The magnitude of mortality differences was quantified by three summary
indices. Three major data problems were identified and their potential effect on 
inequality estimates was quantified for each country individually. For men 45-59 
years, the mortality rate ratio comparing manual classes to non-manual classes
was about equally large for four Nordic countries, England and Wales, Ireland,
Switzerland, Italy, Spain and Portugal. Relatively large ratios were only
observed for France. The same applied to men 60 64 years (data for only 5
countries, including France). For men 30-44 years, there was evidence for smaller
mortality differences in Italy and larger differences in Norway, Sweden and
especially Finland (no data for France and Spain). Application of other summary
indices to men 45-59 years showed slightly different patterns. When the
population distribution over occupational classes was taken into account,
relatively small differences were observed for Switzerland, Italy and Spain. When
national mortality levels were taken into account, relatively large differences
were observed for Finland and Ireland. For each summary index, however, France
leads the international league table. Data problems were found to have the
potential to bias inequality estimates, substantially especially those for
Ireland, Spain and Portugal. This study underlines the similarities rather than
the dissimilarities between European countries. There is no evidence that
mortality differences are smaller in countries with more egalitarian
socio-economic and other policies.

PMID: 9665576 [PubMed - indexed for MEDLINE]


132. BMJ. 1998 May 30;316(7145):1636-42.

Occupational class and cause specific mortality in middle aged men in 11 European
countries: comparison of population based studies. EU Working Group on
Socioeconomic Inequalities in Health.

Kunst AE, Groenhof F, Mackenbach JP, Health EW.

Department of Public Health, Erasmus University, PO Box 1738, NL-3000 DR
Rotterdam, Netherlands. kunst@mgz.fgg.eur.nl

Comment in:
    BMJ. 1998 Dec 12;317(7173):1659.
    BMJ. 1998 May 30;316(7145):1620-1.

OBJECTIVES: To compare countries in western Europe with respect to class
differences in mortality from specific causes of death and to assess the
contributions these causes make to class differences in total mortality. DESIGN: 
Comparison of cause of death in manual and non-manual classes, using data on
mortality from national studies. SETTING: Eleven western European countries in
the period 1980-9. SUBJECTS: Men aged 45-59 years at death. RESULTS: A
north-south gradient was observed: mortality from ischaemic heart disease was
strongly related to occupational class in England and Wales, Ireland, Finland,
Sweden, Norway, and Denmark, but not in France, Switzerland, and Mediterranean
countries. In the latter countries, cancers other than lung cancer and
gastrointestinal diseases made a large contribution to class differences in total
mortality. Inequalities in lung cancer, cerebrovascular disease, and external
causes of death also varied greatly between countries. CONCLUSIONS: These
variations in cause specific mortality indicate large differences between
countries in the contribution that disease specific risk factors like smoking and
alcohol consumption make to socioeconomic inequalities in mortality. The
mortality advantage of people in higher occupational classes is independent of
the precise diseases and risk factors involved.

PMCID: PMC28562
PMID: 9603745 [PubMed - indexed for MEDLINE]


133. Am J Public Health. 1997 Dec;87(12):2012-4.

Incidence of tuberculosis infection among New York State prison employees.

Steenland K, Levine AJ, Sieber K, Schulte P, Aziz D.

National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226,
USA.

OBJECTIVES: This study examined tuberculosis skin test conversions among 24,487
New York State prison employees in 1992. METHODS: Conversions were analyzed by
prison and by job category. RESULTS: The conversion rate was 1.9%. Employees in
prisons with low and high numbers of prisoner cases had odds ratios for
conversion of 1.67 (95% confidence interval [CI] = 1.27, 2.19) and 2.20 (95% CI =
1.69, 2.87), respectively, relative to employees in prisons with no prisoner
cases. In prisons with cases, guards and medical personnel had odds ratios of
1.64 (95% CI = 1.11, 2.43) and 2.39 (95% CI = 1.40, 4.08), respectively, relative
to employees with little prisoner contact. CONCLUSIONS: In 1992, approximately
one third of new infections among New York State prison employees were due to
occupational exposure.

PMCID: PMC1381246
PMID: 9431293 [PubMed - indexed for MEDLINE]


134. Am J Ind Med. 1997 Nov;32(5):535-9.

Mortality in employees of a Scottish paper mill.

Coggon D, Wield G, Pannett B, Campbell L, Boffetta P.

MRC Environmental Epidemiology Unit, University of Southampton, United Kingdom.

To assess possible health risks associated with the manufacture of paper, we
carried out a retrospective analysis of mortality among 4,242 men and women
employed at a Scottish paper mill between 1955 and 1992. During follow-up to
1994, 959 subjects had died giving an SMR of 0.85 (95% CI 0.80-0.90) in
comparison with the national population. Mortality from all cancer (SMR 0.77, 95%
CI 0.68-0.88) and particularly from lung cancer (SMR 0.64, 95% CI 0.50-0.81) was 
lower than expected. An excess of lymphatic and hematopoietic cancer (11 deaths, 
SMR 2.17) was observed in the making department. These findings do not support an
occupational hazard of lung cancer as suggested by several earlier studies. The
excess of lymphatic and hematopoietic cancer in the making department was
unexpected, and may be a chance occurrence.

PMID: 9327079 [PubMed - indexed for MEDLINE]


135. Am J Public Health. 1997 Sep;87(9):1472-5.

The effects of occupation-based social position on mortality in a large American 
cohort.

Gregorio DI, Walsh SJ, Paturzo D.

Department of Community Medicine and Health Care, University of Connecticut
School of Medicine, Farmington 06030-1910, USA.

Comment in:
    Am J Public Health. 2002 Feb;92(2):156.

OBJECTIVES: Four occupation-based measures were used to derive estimates of
social position's effect on all-cause mortality among men and women in a large
national cohort. METHODS: The National Longitudinal Mortality Study provided
information on principal occupation and 9-year follow-up for 229,851 persons aged
25 through 64 years. Cox's proportional hazards model was used to estimate the
age-adjusted risk of death relative to six ordinal categories of social position.
The Slope Index of Inequality described average change in death rates across
categories. RESULTS: Risk of death was consistently elevated among persons at
lower positions in the social hierarchy. Estimates comparing lowest with highest 
categories varied within a narrow range (1.47-1.92 for men and 1.23-1.55 for
women). However, several discrepancies among analyses were noted. The analysis by
US census groups revealed nonlinear associations, whereas those using other
scales found incremental increases in risk. Effect modification by sex was
observed for analyses by two of the four measures. Race/ ethnicity did not modify
the underlying association between variables. CONCLUSIONS: Our analysis
complements previous findings and supports, with few qualifications, the
interchangeability of occupation-based measures of social position in mortality
studies. Explanations for why relative risk estimates were modified by sex are
offered.

PMCID: PMC1380972
PMID: 9314799 [PubMed - indexed for MEDLINE]


136. Metabolism. 1997 Jun;46(6):625-33.

Prospective 10-year evaluation of hypobetalipoproteinemia in a cohort of 772
firefighters and cross-sectional evaluation of hypocholesterolemia in 1,479 men
in the National Health and Nutrition Examination Survey I.

Glueck CJ, Kelley W, Gupta A, Fontaine RN, Wang P, Gartside PS.

Cholesterol Center, Jewish Hospital of Cincinnati, OH 45229, USA.

Our specific aim in a 10-year prospective study of 772 Cincinnati firemen
(predominantly aged 26 to 46 years) was to determine the prevalence, attributes, 
and etiology of persistent hypobetalipoproteinemia, defined by entry low-density 
lipoprotein cholesterol (LDLC) less than 75 mg/dL. A second specific aim was to
cross-sectionally assess hypocholesterolemia (defined by total serum cholesterol 
[TC] < 130 mg/dL) in 1,314 white and 165 black men aged 26 to 46 years in the
National Health and Nutrition Examination Survey (NHANES I). The 141 black and
631 white firemen had 4,973 person-years of follow-up time (median, 7.1 yr/man). 
Of 772 men, 44 (5.7%) had entry LDL levels less than 75 mg/dL; they had a mean
follow-up time of 7.3 yr/man. Of these 44 men, there were 12 (1.8% of the cohort)
with entry LDLC less than 75 mg/dL, and at least 67% of their follow-up LDLC
levels were less than 75. Their mean entry TC and LDLC levels were low (130 and
58 mg/dL), mean triglyceride (TG) was low (63 mg/dL), and mean high-density
lipoprotein cholesterol (HDLC) was high (60 mg/dL), LDLC remained at less than 75
mg/dL in 81% of their follow-up samples. Their mean entry and follow-up
cholesterol and LDLC did not differ (P > .1, 130 v 133 mg/dL and 58 v 63 mg/dL). 
Compared with 32 men with entry LDLC less than 75 mg/dL but with less than 87% of
follow-up LDLC less than 75 mg/dL, the 12 men with persistently low LDLC had
lower mean Quetelet indices and diastolic blood pressure at entry (2.36 v 2.58, P
= .056; 73 v 80 mm Hg, P = .03) and on follow-up study (2.45 v 2.69, P = .04; 72 
v 79 mm Hg, P = .05). Of 12 men with persistently low LDLC, two had truncated
apolipoprotein (apo) B (familial hypobetalipoproteinemia, two had the apo E
genotype 2/3, and two had acquired hypobetalipoproteinemia that antedated
mortality from melanoma by 9 years and from alcoholism by 2 years. Comparable to 
white and black firemen aged 26 to 46 years, 2.9% and 3.6% of whom had entry
serum TC less than 130 mg/dL, of 1,314 white and 165 black men in the NHANES I
study (aged 26 to 46), 1.8% and 3.6% had hypocholesterolemia (entry TC < 130
mg/dL). Daily mean calorie, fat, and protein intake (grams per day) did not
differ (P > .05) in men with entry TC less than 130 mg/dL compared with those
with TC 130 to 230 or greater than 230 mg/dL. Hypocholesterolemia in white and
black men in NHANES I could not be attributed to hypocaloric intake or to
protein, fat, or carbohydrate undernutrition. There appear to be racial
differences in the prevalence of hypocholesterolemia. Blacks comprised 18% of the
firemen's cohort but 42% of those with persistent hypobetalipoproteinemia; among 
NHANES I subjects, 3.6% of blacks were hypocholesterolemic versus 1.8% of whites.
Unless persistent hypobetalipoproteinemia reflects an underlying disease,
alcoholism, etc., it is often heritable, and may be associated with a reduced
likelihood of coronary heart disease (CHD) and with increased longevity.

PMID: 9186296 [PubMed - indexed for MEDLINE]


137. J Health Soc Behav. 1997 Mar;38(1):72-86.

The intergenerational costs of parental social stressors: academic and social
difficulties in early adolescence for children of young mothers.

Menaghan EG, Kowaleski-Jones L, Mott FL.

Ohio State University, Columbus, USA. menaghan.1@osu.edu

Social stressors embedded in parents' occupational and family roles have been
shown to have effects on family interaction and the cognitive and emotional
development of young children. Here we consider whether these patterns also hold 
for children in early adolescence. We study 1,158 10 to 14-year-old children born
to the early childbearers among the female respondents of the National
Longitudinal Survey of Youth cohort. We find that both poor quality of parental
employment and low quality of mothers' relationships with their partners have
adverse effects on the cognitive stimulation and maternal warmth children
receive; living in informal unions is also associated with poorer parent-child
interaction. These family interaction patterns in turn both buffer the effects of
stressful family conditions and shape academic and behavior outcomes directly.
Some work and family conditions interact in their effects: In particular, single 
mothering has less adverse effects on cognitive stimulation and behavior problems
when mothers are employed in occupations providing higher complexity. The effects
of current conditions are diminished but seldom eliminated when we control for
possible selection effects by using data from earlier waves to control for
earlier levels of child problems. These findings suggest that current parental
social stressors continue to have consequences for both academic and behavioral
outcomes during early adolescence.

PMID: 9097509 [PubMed - indexed for MEDLINE]


138. J Adv Nurs. 1997 Mar;25(3):602-14.

Constructing career pathways in nursing: some issues for research and policy.

Robinson S, Murrells T, Marsland L.

Nursing Research Unit, King's College, London, England.

Nurses currently construct careers in a climate of continuing occupational and
organizational change. A longitudinal project is in progress which is documenting
the post-qualification histories of a cohort of registered general nurses, and
studying the extent to which their careers represent occupational choice, a
response to organizational constraints, or a combination of both. Three elements 
comprise the core of the research: questions which provide information on the
cohort's career plans, charts which document their career histories and questions
which explore the relationship between the two. The basis of the design is the
first element, and this paper focuses on the problems encountered in designing
the questions and routing structures which enabled all cohort members to describe
their plans for the future. The importance of extensive pilot work is
demonstrated in the development of options tailored for each potential career
pathway and to allow expressions of uncertainty to emerge at points when
appropriate to respondents. Of the 1164 members of the cohort, 1015 returned the 
questionnaire; a response rate of 87%. Findings are presented on the cohort's
plans at qualification. The majority of respondents (86%) saw themselves as
remaining in nursing and in clinical practice in the early post-qualification
period. Eighteen per cent said they intended to practise abroad at some point,
30% foresaw a likelihood of working in the private sector, 59% wanted to take one
or more English National Board courses and 42% expressed interest in obtaining an
undergraduate or postgraduate degree.

PMID: 9080289 [PubMed - indexed for MEDLINE]


139. Am J Ind Med. 1997 Feb;31(2):256-60.

A follow-up study of job strain and heart disease among males in the NHANES1
population.

Steenland K, Johnson J, Nowlin S.

National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio
45226, USA. kns1@nioshe1.em.cdc.gov

Several studies have associated heart disease with job strain, defined as low job
control and high job demands. We have studied incident heart disease (519 cases) 
and job strain among 3,575 males in NHANES1 survey who were currently employed at
baseline in the early 1970s, and followed through 1987. Scores for job control
and job demands were assigned to each subject based on current occupation at
baseline. Controlling for conventional risk factors, we found no excess risk for 
those with the highest strain (lowest control and highest demands, rate ratio
1.08). Those with highest job control did have significantly decreased risk (rate
ratio 0.71, 95% CI 0.54-0.93). In blue-collar workers (58% of subjects) there was
a significant inverse trend in risk with increasing job demands. Control for
level of physical activity did not change this finding. A combination of high
control and demand was protective among blue-collar workers (odds ratio 0.69,
0.48-0.99). Our findings suggest that class-specific analyses are needed in
studying job stress, and that "active" blue-collar workers with high control and 
high demand are protected against heart disease. The "job demand" variable may
measure whether work is challenging rather than fast-paced. Our findings are
limited by the use of assigned job scores based on job title.

PMID: 9028443 [PubMed - indexed for MEDLINE]


140. Int Ophthalmol. 1997;21(3):127-30.

Clinical and microbial spectrum of fungal keratitis in Singapore: a 5-year
retrospective study.

Wong TY, Fong KS, Tan DT.

Singapore National Eye Center, Singapore.

BACKGROUND: The epidemiology of fungal keratitis varies geographically, but
commonly occurs in warm, tropical climates. To determine the microbial and
clinical characteristics of this disease in Singapore, we conducted a 5-year
hospital-based retrospective study. METHODS: A retrospective review of
culture-positive fungal keratitis at the Singapore National Eye Center and
Singapore General Hospital, from January 1991 to December 1995. RESULTS:
Twenty-nine consecutive cases of culture-positive fungal keratitis were seen over
the study period. The mean age of the cases was 41 years and 23 were males.
Amongst the varied occupations, 9 were construction workers. The most common
cultured organisms were Fusarium sp. (52%) and Aspergillus flavus (17%). More
than half had a history of ocular trauma prior to the development of keratitis,
while a quarter had antecedent topical corticosteroid therapy. In contrast, only 
2 patients were contact-lens wearers. Despite medical therapy, 10 patients
eventually required therapeutic penetrating keratoplasties; of these, 6 were
caused by Fusarium species. CONCLUSION: Fusarium is the commonest cultured
organism in fungal keratitis in Singapore and is associated with significant
ocular morbidity.

PMID: 9587828 [PubMed - indexed for MEDLINE]


141. Neurosurgery. 1997 Jan;40(1):82-7.

Spinal intramedullary cysticercosis.

Mohanty A, Venkatrama SK, Das S, Das BS, Rao BR, Vasudev MK.

Department of Neurosurgery, National Institute of Mental Health and
Neurosciences, Bangalore, India.

OBJECTIVE: Spinal intramedullary cysticercosis is an uncommon manifestation of
neurocysticercosis. We review our experience with eight cases of intramedullary
cysticercosis. METHODS: Eight patients who were surgically treated for spinal
intramedullary cysticercosis between 1982 and 1991 were retrospectively reviewed,
and the final outcomes were assessed. RESULTS: In six patients, the cysticercosis
involved the thoracic cord, whereas in the other two, the cysticercosis was
cervical in location. Only one patient had multiple soft tissue calcifications,
as revealed by plain radiography. Myelography indicated an intramedullary lesion 
in each of seven patients; two of the seven patients had partial myelographic
block, suggesting the segmental nature of the lesion. Cerebrospinal fluid studies
were noncontributory. One patient had three cysts, whereas the other seven had
one cyst each. Four patients had adjacent soft purulent materials, which were
revealed by histopathological examination to be granulation tissue. The
neurological statuses of seven patients improved after surgery. Six patients were
followed up for a mean of 30.6 months (3 mo-5 yr). Three could resume their
previous occupations, two others could manage their daily activities, and one
required only minimal assistance for daily activities. CONCLUSION: The outcome of
intramedullary cysticercosis is not as dismal as reported earlier, and patients
with paraplegia also have favorable outcomes. A preoperative diagnosis of
cysticercosis can be suspected in an endemic area in the presence of multiple
soft tissue calcifications and segmental lesions revealed by myelography or
magnetic resonance imaging studies.

PMID: 8971828 [PubMed - indexed for MEDLINE]


142. Spine (Phila Pa 1976). 1996 Oct 15;21(20):2352-5.

Prolapsed cervical intervertebral disc in male professional drivers in Denmark,
1981-1990. A longitudinal study of hospitalizations.

Jensen MV, Tüchsen F, Orhede E.

Department of Occupational Medicine, National Institute of Occupational Health,
Denmark, Copenhagen, Denmark.

STUDY DESIGN: This study of professional drivers is a part of a longitudinal
record linkage study of all economically active men in Denmark, identified on
January 1, 1981. Information about the main occupation was identified in 1980.
The cohort was followed for first hospitalization with prolapsed cervical
intervertebral disc until December 31, 1990. OBJECTIVES: To examine the risk of
prolapsed cervical intervertebral disc in all Danish professional drivers, and to
analyze exposures of the male drivers in a sample of all Danish male drivers.
SUMMARY OF BACKGROUND DATA: Only a few studies on occupation and prolapsed
cervical intervertebral disc have been published. These studies suggest that
professional driving may be a risk factor for development of prolapsed cervical
intervertebral disc. Drivers are exposed to whole-body vibrations, heavy lifting,
and a sedentary position. Other potential exposures are accelerations and
decelerations and whiplash accidents. Such exposure may be involved in the
causation of prolapsed cervical intervertebral disc. METHODS: A standardized
hospitalization ratio was calculated for each subgroup of drivers using all
economically active people as the standard. Additional exposure information was
extracted from a national survey on work environment. RESULTS: Almost all men in 
occupations involving professional driving had a statistically significant
elevated risk of being hospitalized with prolapsed cervical intervertebral disc. 
CONCLUSIONS: Professional driving is a risk factor for prolapsed cervical
intervertebral disc.

PMID: 8915070 [PubMed - indexed for MEDLINE]


143. Am J Ind Med. 1996 Oct;30(4):407-14.

Occupation and ischemic heart disease in the European Community: a comparative
study of occupations at potential high risk.

Tüchsen F, Andersen O, Costa G, Filakti H, Marmot MG.

National Institute of Occupational Health, Denmark, Copenhagen.

Four longitudinal studies of mortality and morbidity by occupation based on
individual record linkage of information and two cross-sectional studies of
mortality were compared in order to identify occupations at high risk of ischemic
heart disease. In more than one country an increased risk of ischemic heart
disease was found in drivers of buses, taxies, and lorries, in bakers, in naval
officers and fishermen, in hotel and restaurant workers, in senior police,
customs, and other uniformed men, in barbers and hairdressers, in warehouse and
wholesale staff, as well as in laboratory assistants and in radio and telegraph
operators. Occupations found at high risk in Denmark were also found at high risk
in Great Britain and Italy. These occupations may be at genuine high risk. None
of these groups work day-work only and several of the groups have psychologically
demanding work but unsatisfactory decision authority. Identification of
occupations at high risk may help to develop focused preventive strategies.

PMID: 8892545 [PubMed - indexed for MEDLINE]


144. Am Ind Hyg Assoc J. 1996 Oct;57(10):918-23.

Worker exposures to nitrosamines in a rubber vehicle sealing plant.

Reh BD, Fajen JM.

Division of Surveillance, Hazard Evaluations and Field Studies, National
Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA.

Occupational nitrosamine exposures were measured during a National Institute for 
Occupational Safety and Health (NIOSH) health hazard evaluation at a rubber
vehicle sealing plant. All of the 28 personal breathing zone samples had
detectable concentrations of nitrosodimethylamine (NDMA), nitrosodiethylamine,
nitrosopiperidine (NPIP), and nitrosomorpholine; and 27 of the 28 samples had
detectable concentrations of nitrosopyrrolidine. The NDMA exposures were the
highest, ranging from 0.47 to 11.44 micrograms/m3. The next highest exposures
were to NPIP, ranging from 0.20 to 4.39 micrograms/m3. Several general area air
samples were also collected, which revealed concentrations of NDMA ranging from
2.29 to 88.47 micrograms/m3 at the drills along the salt bath lines. The salt
bath curing process appears to be the primary source of nitrosamine formation,
and personal exposures were highest for the salt bath line operators and
assistant operators. Although there are no numerical occupational nitrosamine
standards in the United States to reference, the exposures in this plant were
much higher than the German standard of 1 micrograms/m3 total nitrosamines for
general industry and 2.5 micrograms/m3 total nitrosamines for certain processes
such as vulcanization. NIOSH investigators recommended that the ventilation
systems be improved to reduce the exposures to the lowest feasible concentrations
until the process can be redesigned so that nitrosamines are not formed.

PMID: 8865601 [PubMed - indexed for MEDLINE]


145. Am J Ind Med. 1996 Sep;30(3):241-51.

Screening for asbestos-induced diseases in Finland.

Koskinen K, Rinne JP, Zitting A, Tossavainen A, Kivekäs J, Reijula K, Roto P,
Huuskonen MS.

Finnish Institute of Occupational Health, Helsinki, Finland.

Screening for asbestos-induced diseases in Finland was carried out in 1990-1992
as a part of the Asbestos Program of the Finnish Institute of Occupational
Health. The aim of the present study was to find the workers who had developed an
asbestos-induced disease in certain occupations. Examination of active or retired
workers included a personal interview on work history and asbestos exposure, and 
a chest X-ray. The target group for the screening comprised workers under 70
years of age who had worked at least for 10 years in construction, 1 year in a
shipyard or in the manufacture of asbestos products. A preliminary questionnaire 
was sent to 54,409 workers, 18,943 of whom finally participated in the screening 
examination. The mean age of the workers was 53 years; 95% were employed in
construction, 2% in shipyards, and 3% in the asbestos industry. The criteria for 
a positive screening result were (1) a radiographic finding clearly indicating
lung fibrosis (at least ILO category 1/1), (2) a radiographic finding indicating 
mild lung fibrosis (ILO category 1/0) with unilateral or bilateral pleural
plaques, (3) marked abnormalities of the visceral pleura (marked adhesions with
or without pleural thickening), or (4) bilateral pleural plaques. The positive
cases totalled 4,133 (22%) and were sent for further investigation. In addition
to the screening, information on the presence of asbestos in the work
environment, prevention of asbestos exposure, as well as on the health effects of
asbestos exposure and smoking were given to the participating workers. The
screening acted as a preliminary survey to prompt further national follow-up of
asbestos-induced diseases among the workers who have been exposed to asbestos.
This article presents the material, methods, and overall results of the
screening.

PMID: 8876791 [PubMed - indexed for MEDLINE]


146. Lancet. 1996 Aug 31;348(9027):567-72.

Symptoms of chronic bronchitis and the risk of coronary disease.

Jousilahti P, Vartiainen E, Tuomilehto J, Puska P.

Department of Epidemiology and Health Promotion, National Public Health
Institute, Helsinki, Finland.

Comment in:
    Lancet. 1996 Nov 16;348(9038):1389.
    Lancet. 1996 Nov 16;348(9038):1388-9.

BACKGROUND: Experimental and epidemiological studies show a positive association 
between coronary disease and various infections in different organs, both viral
and bacterial and both acute and chronic. Most attention has been paid to dental 
infections and infections in the respiratory tract. We have studied how chronic
respiratory infection predicts coronary disease. METHODS: We defined chronic
respiratory infection by the occurrence of symptoms of chronic bronchitis. We
also analysed whether any association with coronary disease incidence and
mortality is independent of the known major cardiovascular risk factors and
whether it is similar among persons in different occupations. Our cohort study
was a 13-year follow-up of 19,444 randomly selected eastern Finnish men and women
born between 1913 and 1947 and examined in either 1972 or 1977. FINDINGS: During 
follow-up, there were 1419 first coronary events, either fatal or non-fatal, and 
614 coronary deaths. Among men, the age-adjusted and study-year-adjusted risk
ratio of long lasting-symptoms of chronic bronchitis (during as much as 3 months 
in a year) was 1.52 (95% CI 1.33-1.75) for coronary disease and 1.74 (CI
1.43-2.11) for coronary death. Among women the risk ratios were 1.38 (1.07-1.78) 
and 1.49 (0.98-2.27), respectively. Inclusion of smoking, serum cholesterol, and 
systolic blood pressure into the models decreased risk ratios to 1.36 (1.17-1.56)
and 1.55 (1.26-1.90) in men and to 1.34 (1.04-1.74) and 1.41 (0.92-2.16) in
women, respectively. The risk of coronary disease associated with the symptoms of
chronic bronchitis was similar among blue-collar and white-collar workers but the
association was not found among farmers. INTERPRETATION: Symptoms of chronic
bronchitis predicted the risk of coronary disease independently from the known
major cardiovascular risk factors. If the observed association is causal,
prevention and improved management of chronic infections may have played a role
in the decrease in coronary disease mortality observed in eastern Finland in the 
past two decades.

PMID: 8774568 [PubMed - indexed for MEDLINE]


147. JAMA. 1996 Jul 17;276(3):216-20.

Hospital care in later life among former world-class Finnish athletes.

Kujala UM, Sarna S, Kaprio J, Koskenvuo M.

Unit for Sports and Exercise Medicine, University of Helsinki, Finland.

OBJECTIVE: To investigate the use of hospital care from all causes among former
top-level athletes from different vigorous sports to determine whether health
benefits or adverse effects have the greater influence. DESIGN: National,
population-based cohort study with a 21-year follow-up. SETTING: Finland.
SUBJECTS: A total of 2049 male athletes who had represented Finland during 1920
to 1965, and 1403 male controls classified healthy at 20 years of age. MAIN
OUTCOME MEASURE: In-hospital care from all causes was extracted from the national
hospital discharge registry for the period 1970 through 1990 expressed as
hospital days per person-years of exposure. RESULTS: Compared with controls, the 
rate ratios (RRs) for all-cause hospital days per person-years of exposure were
lower in athletes from endurance sports (RR, 0.71; 95% confidence interval [Cl], 
0.70-0.73), mixed sports (including endurance and weight training) (RR, 0.86; 95%
Cl, 0.85-0.87), and power sports (RR, 0.95; 95% Cl, 0.94-0.96) (P < .001 for all 
comparisons) after adjustment for age and occupational group. The lower RR among 
athletes from endurance sports and other sports involving aerobic activity was
largely explained by lower rates of hospital care for heart disease, respiratory 
disease, and neoplasms, but not for musculoskeletal disorders. CONCLUSIONS:
Former elite athletes, particularly those in aerobic sports, use less hospital
care. Other beneficial health habits are known to be associated with a physically
active lifestyle.

PMID: 8667566 [PubMed - indexed for MEDLINE]


148. J Bone Joint Surg Am. 1996 Jul;78(7):1015-23.

Isolated rupture of the subscapularis tendon.

Gerber C, Hersche O, Farron A.

Department of Orthopaedics, Hôpital Cantonal, Fribourg, Switzerland.

Sixteen consecutive patients were managed operatively for repair of an isolated
traumatic rupture of the subscapularis tendon in the absence of avulsion of the
lesser tuberosity. All of the patients were men. The diagnosis was made for each 
patient on the basis of the clinical examination and was confirmed by imaging
studies and operative exploration. The operative treatment consisted of
mobilization of the subscapularis after exploration and protection of the
axillary nerve, transosseous reinsertion of the tendon to a trough created at the
lesser tuberosity, closure of the rotator interval, and protection of the
shoulder for six weeks postoperatively. The average duration of follow-up was
forty-three months (range, twenty-four to eighty-four months). Thirteen patients 
subjectively rated the result as excellent or good. The average functional score 
of the shoulder, as assessed according to the system of Constant, was 82 per cent
of the average age and gender-matched normal value. Active flexion was normal in 
twelve patients, was decreased by 15 degrees or less in three, and was severely
limited in one patient. The capacity of the patients to work in their original
occupations had increased from an average of 59 per cent of full capacity
preoperatively to an average of 95 per cent postoperatively (p = 0.006).
Operative treatment proved to be economically sound within the Swiss National
Accident Insurance system. The quality of the result did not depend on the
capacity for work at the time of the operation, on the type of work in which the 
patient was engaged, on the state of the biceps, or on the duration of follow-up.
Conversely, the results were less successful when there was an increased delay
from the time of the injury to the time of the operative repair.

PMID: 8698718 [PubMed - indexed for MEDLINE]


149. Am J Psychiatry. 1996 May;153(5):645-9.

Description and evaluation of the Iowa Depression Awareness, Recognition, and
Treatment Program.

O'Hara MW, Gorman LL, Wright EJ.

Department of Psychology, University of Iowa, Iowa City 52242, USA.

Comment in:
    Am J Psychiatry. 1997 May;154(5):717-8.

OBJECTIVE: The National Institute of Mental Health developed the Depression
Awareness, Recognition, and Treatment Program to provide up-to-date information
and training to health, mental health, and social service professionals regarding
the identification and treatment of depression. This study was undertaken to
evaluate a series of these programs for professionals who provide services to
rural residents in the Midwest. METHOD: The 18 2-day training programs were
attended by a total of 1,221 participants, physicians, psychologists, social
workers, and nurses. Participants' knowledge regarding depression was assessed
both before and after each program. Practice characteristics and perceived
ability to assess and treat depression were assessed. Finally, 6-month follow-up 
evaluations of the usefulness of the training to the participants were
undertaken. RESULTS: Following the programs, participants evidenced significant
increases in levels of knowledge of depression and a high degree of satisfaction 
with most elements of the program. Six-month follow-up evaluations indicated a
continued positive evaluation of the program. CONCLUSIONS: These outcomes suggest
that the goals of the Depression Awareness, Recognition, and Treatment Program
were met and provide support for the wider dissemination of these training
programs.

PMID: 8615409 [PubMed - indexed for MEDLINE]


150. Contact Dermatitis. 1996 Apr;34(4):268-71.

Outcome of job change in patients with occupational chromate dermatitis.

Lips R, Rast H, Elsner P.

Medical University of Zürich, Switzerland.

Patients with allergic contact dermatitis due to dichromate are reputed to have a
bad prognosis. Based on the Swiss Law on Accidents Insurance, the Swiss National 
Accidents Insurance Organization (SNAIO) may issue a declaration of medical
inability (DMI) in cases of severe occupational dichromate dermatitis. With such 
a DMI, an employee is not allowed to perform any further work in contact with
dichromate or cement. In this study, we reviewed medical records from 88
construction workers with DMI due to occupational dichromate dermatitis, between 
1986 and 1989. Follow-up was performed by standardized questionnaire. 63 patients
(72%) healed in the first few years after DMI. These patients mostly changed
industry and strictly avoided all contact with cement or chromium salts. A few
retired early. The outcome of our study is favorable in comparison to studies
from other countries without the DMI mechanism. We conclude that strict allergen 
avoidance enforced by authorities, and financial support in the case of job
change, are important factors in improving the prognosis in occupational
dichromate dermatitis.

PMID: 8730165 [PubMed - indexed for MEDLINE]


151. Bull N Y Acad Med. 1996 Winter;73(2):370-97.

Occupations, cigarette smoking, and lung cancer in the epidemiological follow-up 
to the NHANES I and the California Occupational Mortality Study.

Leigh JP.

Department of Economics, San Jose State University, CA 95192-0114, USA.

What jobs are associated with the highest and lowest levels of cigarette use and 
of lung cancer? Are there gender differences in these jobs? Two data sets-the
Epidemiological Follow-up to the National Health and Nutrition Examination Survey
(NHEFS) and the California Occupational Mortality Study (COMS) were analyzed to
answer these questions. For females, the broad occupations ranking from highest
to lowest cigarette use in the NHEFS was: transportation operators, managers,
craft workers, service workers, operatives, laborers, technicians, administrative
workers, farm owners and workers, sales workers, no occupation, and
professionals. The corresponding ranking for males was: transportation operators,
no occupation, laborers, craft workers, service workers, technicians, and
professionals. The highest-ranking jobs in the COMS were waitresses, telephone
operators, and cosmetologists for women, and water-transportation workers,
roofers, foresters and loggers for men. Teachers were especially low on all four 
lists. This study could not determine whether employment within any occupation
encouraged smoking or if smokers selected certain occupations.

PMCID: PMC2359318
PMID: 8982527 [PubMed - indexed for MEDLINE]


152. Curr Probl Dermatol. 1996;25:154-62.

Prognosis of contact dermatitis following secondary preventive measures.

Goh CL.

Institute of Dermatology, Singapore National Skin Centre.

PMID: 8787599 [PubMed - indexed for MEDLINE]


153. J Occup Environ Med. 1995 Oct;37(10):1199-203.

Occupational injury and stress.

Johnston JJ.

National Institute for Occupational Safety and Health, Morgantown, West Virginia 
26505-2888, USA.

A literature search was conducted to identify studies that measured the
relationship between stress and occupational injury. Studies that provided a
quantitative measure of stress and occupational injury and a quantitative
assessment of the relationship between these two factors were selected for this
review. Twenty studies were identified, and all had P values of less than .05 or 
odds ratios ranging from .3 to 4.6. Twelve of 17 measures had odds ratios greater
than 1.0. Several factors limit the generalizability of these results, however,
and these include methodological differences in the assessment of stress and
injury, study design, and limited representation of occupations.

PMID: 8542339 [PubMed - indexed for MEDLINE]


154. Am J Public Health. 1995 Jul;85(7):949-56.

US mortality by economic, demographic, and social characteristics: the National
Longitudinal Mortality Study.

Sorlie PD, Backlund E, Keller JB.

Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute,
Bethesda, MD 20892, USA.

Comment in:
    Am J Public Health. 1995 Jul;85(7):903-5.

OBJECTIVES. A large US sample was used to estimate the effects of race,
employment status, income, education, occupation, marital status, and household
size on mortality. METHODS. Approximately 530,000 persons 25 years of age or more
were identified from selected Current Population Surveys between 1979 and 1985.
These individuals were followed for mortality through use of the National Death
Index for the years 1979 through 1989. RESULTS. Higher mortality was found in
Blacks than in Whites less than 65 years of age; in persons not in the labor
force, with lower incomes, with less education, and in service and other lower
level occupations; and in persons not married and living alone. With occasional
exceptions, in specific sex and age groups, these relationships were reduced but 
remained strong and statistically significant when each variable was adjusted for
all of the other characteristics. The relationships were generally weaker in
individuals 65 years of age or more. CONCLUSIONS. Employment status, income,
education, occupation, race, and marital status have substantial net associations
with mortality. This study identified segments of the population in need of
public health attention and demonstrated the importance of including these
variables in morbidity and mortality studies.

PMCID: PMC1615544
PMID: 7604919 [PubMed - indexed for MEDLINE]


155. J Paediatr Child Health. 1995 Jun;31(3):200-6.

A profile of heart disease risk factors and their relation to parents' education,
fathers' occupation and family history of heart disease in 843 South Australian
families: the Adelaide Children's WHO Collaborative Study.

Boulton TJ, Cockington RA, Hamilton-Craig I, Magarey AM, Mazumdar J.

University of Newcastle, New South Wales, Australia.

OBJECTIVE: A study was conducted to determine whether the prevalence of risk
factors among pre-adolescent children is associated with their parents' risk
factor status and what influence family history of ischaemic heart disease (IHD) 
and socio-economic status (SES) had. METHODOLOGY: This was a cross-sectional
study of 856 children, mean age 8.6 years, and their parents who underwent the
World Health Organization and National Heart Foundation protocols for the study
of arteriosclerosis precursors. Historical, demographic, anthropometric, clinical
and biochemical outcome measures were used. RESULTS: There was the expected
burden of illness reported for the grandparents and parents, with the latter
conforming to their expected age group's heart disease risk factor status. The
mean serum total cholesterol (TC) level for boys was 4.43 (+/- 0.79) mmol/L and
girls 4.62 (+/- 0.84) mmol/L, with the 95th percentile for boys and girls
combined being 5.88 mmol/L. The level corresponding to two standard deviations
above the mean was 6.0 mmol/L. Childrens' IHD risk factor status reflected their 
parents' with TC, skin fold thickness and body mass index most closely
correlated, followed by blood pressure. The greatest correlation was between the 
childrens' TC and their mothers'. Socio-economic status as assessed by the
parents' education level and fathers' occupational status produced differences in
their childrens' risk factors, with mother's level of education having the major 
influence. There was no impact of family history of IHD. CONCLUSIONS: From these 
results it would appear that screening of the pre-adolescent may be appropriate
but longitudinal study will be important to establish this by documenting
persistence of risk factor status. Also, it would appear that a child's future
risk from IHD morbidity may be due to environmental influences mediated through
differences in SES. As the level of IHD risk factors is reduced within the
community, the extent of parent-child transmission of measurable IHD risk factors
in families of high IHD risk may be reduced.

PMID: 7669380 [PubMed - indexed for MEDLINE]


156. Br J Psychiatry. 1995 Jun;166(6):759-67.

Socio-economic mobility among patients with schizophrenia or major affective
disorder. A 17-year retrospective follow-up.

Aro S, Aro H, Keskimäki I.

National Research and Development Centre for Welfare and Health, Health Services 
Research Unit, Helsinki, Finland.

BACKGROUND. Social mobility among patients with schizophrenia or major affective 
disorder was compared with that among the general population. METHOD. Mobility
was studied retrospectively from 1970 to 1987. Socio-economic status (SES) was
defined by occupation as in the population census (upper white-collar, lower
white-collar, blue-collar, entrepreneur, farmer, unemployed). All patients aged
30-60 years at discharge (2901 men and 3620 women) in 1987-88 in Finland were
included in the study. The SES structure of the general population was used for
comparisons. RESULTS. Among patients with schizophrenia there was a constant
downward drift, commonly to unemployment. This risk was higher among men than
women. In the youngest age group a marked decline from the parents' social status
was observed. Among patients with major affective disorder the distribution of
SES in 1970 was similar to that of the general population. By 1987, a downward
drift was again observed, mainly to unemployment regardless of the initial SES
group. The number of patients in occupational categories were usually 30-50%
lower than expected. CONCLUSIONS. Schizophrenic patients had a high risk of
social drop-out. Among patients with major affective disorder the downward drift 
was much less.

PMID: 7663824 [PubMed - indexed for MEDLINE]


157. Am J Ind Med. 1995 Jun;27(6):793-805.

A detailed analysis of work-related injury among youth treated in emergency
departments.

Knight EB, Castillo DN, Layne LA.

Division of Safety Research, National Institute for Occupational Safety and
Health, Morgantown, West Virginia 26505, USA.

Telephone interviews were conducted with 146 14- to 16-year-olds who incurred an 
occupational injury treated in an emergency department during the period July
through September 1992. Thirty-two percent of the injuries occurred as the result
of using equipment. Over half the workers reported not having received prior
training on how to avoid injury. The injury limited normal activities for at
least 1 day for 68% of the youth and for more than a week for 25%, corresponding 
to an estimated 6,208 (95% CI: 4,277, 8,139) and 2,639 (95% CI: 1,580, 3,699)
youths nationwide, respectively. Employment in retail trades, equipment use, lack
of training, and burn injuries were associated with increased limitation of
normal activities. Nineteen percent of the youths appear to have been injured in 
jobs declared to be hazardous, or typically prohibited for their age (14- and
15-year-olds) under federal child labor laws. The prohibited job directly
contributed to the injury in 64% of these cases.

PMID: 7645574 [PubMed - indexed for MEDLINE]


158. Occup Med. 1995 Apr-Jun;10(2):261-8.

Morbidity and mortality patterns in Sweden.

Engholm G, Englund A.

Department of Provincial and Regional Health and Medical Care, National Board of 
Health and Welfare, Stockholm, Sweden.

This extensive review of morbidity and mortality patterns cites data from
Bygghälsan, a Swedish program that has followed a quarter of a million
construction workers for two decades. Comparisons are made among different types 
of workers, and standardized mortality ratios and standardized incidence ratios
are presented.

PMID: 7667739 [PubMed - indexed for MEDLINE]


159. Occup Environ Med. 1995 Mar;52(3):157-9.

Mortality of butchers and cooks identified from the 1961 census of England and
Wales.

Coggon D, Wield G.

MRC Environmental Epidemiology Unit, University of Southampton, Southampton
General Hospital.

OBJECTIVES--To explore a suspected hazard of lung cancer in butchers and cooks.
METHODS--4018 male butchers and 2062 male cooks were identified from the 1961
census of England and Wales. 4857 (79.9%) of these men were traced through the
National Health Service Central Register, and 3518 deaths were recorded during
follow up to the end of 1992. Mortality from lung cancer and other causes was
compared with that of the general population by the person-years method.
RESULTS--Mortality from all causes was significantly below that of the national
population in both butchers (standardized mortality ratio (SMR) 0.94, 95%
confidence interval (95% CI) 0.90-0.98) and cooks (SMR 0.89, 95% CI 0.84-0.95).
When allowance was made for a latency of 20 years from entry to follow up, the
deficit in butchers was reduced, but that in cooks persisted, and was largely
explained by a shortfall of deaths from cancer and circulatory disease. Mortality
from lung cancer was close to expectation in the butchers (SMR 1.01, 95% CI
0.90-1.13) and below expectation in the cooks (SMR 0.93, 95% CI 0.75-1.13). Cooks
had increased mortality from cancers of the oral cavity (SMR 5.57) and pharynx
(SMR 2.66). CONCLUSIONS--The findings provide no support for an occupational
hazard of lung cancer in either butchers or cooks. The possibility of excess risk
in sub-groups of these occupations cannot be discounted. The high rates of oral
and pharyngeal cancer in cooks are probably a consequence of high alcohol
consumption.

PMCID: PMC1128179
PMID: 7735386 [PubMed - indexed for MEDLINE]


160. J Acoust Soc Am. 1995 Feb;97(2):1196-205.

Gender differences in a longitudinal study of age-associated hearing loss.

Pearson JD, Morrell CH, Gordon-Salant S, Brant LJ, Metter EJ, Klein LL, Fozard
JL.

Longitudinal Studies Branch, National Institute on Aging, Baltimore, Maryland
21224.

Current studies are inconclusive regarding specific patterns of gender
differences in age-associated hearing loss. This paper presents results from the 
largest and longest longitudinal study reported to date of changes in pure-tone
hearing thresholds in men and women screened for otological disorders and
noise-induced hearing loss. Since 1965, the Baltimore Longitudinal Study of Aging
has collected hearing thresholds from 500 to 8000 Hz using a pulsed-tone tracking
procedure. Mixed-effects regression models were used to estimate longitudinal
patterns of change in hearing thresholds in 681 men and 416 women with no
evidence of otological disease, unilateral hearing loss, or noise-induced hearing
loss. The results show (1) hearing sensitivity declines more than twice as fast
in men as in women at most ages and frequencies, (2) longitudinal declines in
hearing sensitivity are detectable at all frequencies among men by age 30, but
the age of onset of decline is later in women at most frequencies and varies by
frequency in women, (3) women have more sensitive hearing than men at frequencies
above 1000 Hz but men have more sensitive hearing than women at lower
frequencies, (4) learning effects bias cross-sectional and short-term
longitudinal studies, and (5) hearing levels and longitudinal patterns of change 
are highly variable, even in this highly selected group. These longitudinal
findings document gender differences in hearing levels and show that
age-associated hearing loss occurs even in a group with relatively low-noise
occupations and with no evidence of noise-induced hearing loss.

PMID: 7876442 [PubMed - indexed for MEDLINE]


161. Paraplegia. 1994 Nov;32(11):715-22.

Epidemiology of spinal injuries in Romania.

Soopramanien A.

Royal National Orthopaedic Hospital, Stanmore, Middlesex, England.

Retrospective and prospective epidemiological studies in Bucharest indicated a
high rate of spinal injuries (about 28.5 per million population per year) in
Romania. Most patients were poor, male, manual workers. Half of them were aged
less than 40. Falls, particularly from horse-drawn carts, and road traffic
accidents were the most frequent causes of injury. In summer, diving accidents
were a common cause of spinal injuries. Sixty per cent of the patients had
cervical injuries. Pressure sores became less frequent as staff and relatives
were trained to turn and position patients. Because gastroduodenal bleeding and
deep vein thrombosis were rare, the systematic use of drugs to prevent these
conditions was deemed to be unnecessary, given the financial constraints. A
shortage of beds and facilities made it difficult to manage associated injuries
in a neurosurgical clinic in Bucharest or to admit all patients for
rehabilitation. Thirty-nine per cent of all patients admitted with spinal
injuries had spinal surgery (61% of those with neurological impairment). Bone
grafting was the most common procedure for cervical injuries; surgical
stabilisation was not commonly performed due to the shortage of plates and
screws. The mortality rate in the early days post injury decreased from 22%
(1985-1991) to 10.1% (1992) as medical management improved and the relatives
helped with care in the acute phase. A programme is needed in Romania to prevent 
the accidents that cause spinal injuries and to improve clinical management. As a
result of this study, three films were made to aid the prevention of accidents
and to train staff and relatives in the care of those with spinal cord injuries.

PMID: 7885713 [PubMed - indexed for MEDLINE]


162. Am J Ind Med. 1994 Oct;26(4):511-20.

Occupation and stomach cancer in a cohort of Swedish men.

Chow WH, McLaughlin JK, Malker HS, Weiner JA, Ericsson JL, Stone BJ, Blot WJ.

National Cancer Institute, Division of Cancer Etiology, Bethesda, MD 20892.

Using the Cancer-Environment Registry of Sweden, which links the 1960 census
information on employment with cancer incidence data from 1961-1979, we conducted
a systematic, population-based assessment of stomach cancer incidence by industry
and occupation for men in Sweden. Nearly 17,000 stomach cancer cases were
diagnosed during the 19 years of follow-up. Stomach cancer incidence was elevated
among miners and quarrymen, farmers and fishermen, and craftsmen and production
workers. Men who held white collar jobs, including professional and technical,
administrative and management, clerical, and sales jobs, had a reduction in
stomach cancer incidence. Examination of specific jobs revealed generally
elevated rates of stomach cancer among men who may be exposed to dusty work
environments, such as quarry workers, stone cutters, circular and plane
operators, construction workers, crane operators, heavy laborers, and shop and
construction metal workers. These occupational associations mostly were observed 
for stomach cancers of noncardia origin, and no significant associations were
found with cardia cancers. We had no information on dietary or other potential
confounding factors and cannot make inferences about the role of occupation per
se, but the current findings support those of earlier investigations and add to
the evidence of a small but significant occupational role in stomach
carcinogenesis.

PMID: 7810549 [PubMed - indexed for MEDLINE]


163. J Clin Epidemiol. 1994 Oct;47(10):1163-71.

Descriptive study of lipid-modulating drug use in a French professional
population.

Boumendil EF.

INSERM, Unit 88, Paris, France.

The objectives of this cross-sectional study presented as the first stage of a
cohort follow-up pharmacoepidemiological study of lipid modulators, are to
determine the extent and pattern of use of antihyperlipidemics and concomitant
drugs and to compare antihyperlipidemic subgroups. The study population are the
17,244 respondents to the 1991 questionnaire in which questions on drug
utilization were asked for the first time. It comprises 40.5% of the men and 32% 
of the women of the population originally targeted in 1989, i.e. the entire
workforce of a national company within an age range of 35-45 years for men and
35-50 years for women. Self-reported health events and drug use over the previous
year were measured. Overall 1 year prevalence of use of lipid lowering drugs was 
7.7% (9.5% in men and 2.7% in women). Most antihyperlipidemics were fibrates (n =
878), with fenofibrate ranking above ciprofibrate, as opposed to HMG-CoA
reductase inhibitors (n = 436), principally simvastatin. Only 60% of
antihyperlipidemic drug users were following a prescribed lipid-lowering diet;
over half were taking other drugs concomitantly, most often b-blockers. The
simvastatin group differs from the fibrate group by an excess of prevalent
thyroid disease. The link between simvastatin and thyroid disease may be
indication-related. In conclusion, the relevant features of this study are the
extensive use of antihyperlipidemics, frequently, without concomitant diet, and
the marked preference for antihyperlipidemics for which long term safety is
unknown. Extent of use and choices of antihyperlipidemics are corroborated by
estimations in the general middle-aged population.

PMID: 7722549 [PubMed - indexed for MEDLINE]


164. Acad Emerg Med. 1994 Sep-Oct;1(5):443-7.

Emergency medicine career change: associations with performances in medical
school and in the first postgraduate year and with indebtedness.

Xu G, Hojat M, Veloski JJ.

Center for Research in Medical Education and Health Care, Thomas Jefferson
University Jefferson Medical College, USA.

OBJECTIVE: Emergency medicine has been identified as the specialty that has
gained the most young physicians who have changed their careers. To identify
factors that may have contributed to such career changes, the authors compared
the characteristics of three groups of physicians trained at their medical
school: those who chose and stayed in emergency medicine, those who migrated into
emergency medicine from other specialties, and those who moved out of emergency
medicine. METHODS: A prospective longitudinal study was conducted. The sample
consisted of physicians who chose emergency medicine as their careers at
graduation and stayed in the specialty (n = 24), those who migrated from other
specialties into emergency medicine (n = 51), and those who moved out of
emergency medicine (n = 10). This sample was obtained from a total of 2,173
graduates of Jefferson Medical College between 1978 and 1987. The three groups of
physicians were compared according to their academic performances both during
medical school and after graduation. The dependent variables were freshmen and
sophomore grade point averages (GPAs), written clinical examination scores,
scores on National Board of Medical Examiners examination (Parts I, II, and III),
and residency program directors' ratings. Age and indebtedness at medical school 
graduation and board certification status also were examined. RESULTS: Those
physicians who stayed in emergency medicine and those who migrated from other
specialties into emergency medicine had similar measures of academic performance,
but both of these groups had higher academic performance measures and higher
board certification rates than did the physicians who moved out of emergency
medicine. Those who stayed in emergency medicine had the highest mean debt in the
senior year of medical school. CONCLUSIONS: High academic performance and high
indebtedness are factors associated with choosing or staying in the specialty of 
emergency medicine.

PMID: 7614301 [PubMed - indexed for MEDLINE]


165. Am J Epidemiol. 1994 Aug 15;140(4):361-7.

Risk factors for wrist fracture: effect of age, cigarettes, alcohol, body height,
relative weight, and handedness on the risk for distal forearm fractures in men.

Hemenway D, Azrael DR, Rimm EB, Feskanich D, Willett WC.

Department of Health Policy and Management, Harvard School of Public Health,
Boston, MA 02115.

Fractures of the distal forearm (wrist) are among the most common of all
fractures. While evidence exists concerning risk factors for wrist fracture among
women, little is known about risk factors among men. This study examines the
relation of lifestyle characteristics (cigarette smoking, alcohol consumption,
relative weight) as well as body height and handedness to the risk for fracture
in a male population that has been followed up for 6 years. The 51,529 men, who
were between the ages of 40 and 75 years in 1986, were participants in the Health
Professionals Follow-up Study, a national prospective cohort study. In 271,552
person-years of follow-up, 271 respondents reported a wrist fracture. The risk
for wrist fracture in this population did not vary with age. Cigarette smoking,
alcohol consumption, body height, and relative weight also were not related to
risk for wrist fracture. Handedness, which was divided into four mutually
exclusive categories (right-handed, left-handed, forced to change, and
ambidextrous), was significantly associated with wrist fracture. Left-handers had
a multivariate relative risk for wrist fracture 1.56 times that of right-handers 
(95% confidence interval 1.02-2.37), and men who reported they had been forced to
change from left-handed to right-handed had a multivariate relative risk 2.47
times greater than right-handers (95 percent confidence interval 1.21-5.04).

PMID: 8059771 [PubMed - indexed for MEDLINE]


166. J Gerontol. 1994 May;49(3):S117-24.

Shunning retirement: work experience of men in their seventies and early
eighties.

Parnes HS, Sommers DG.

Department of Economics, Ohio State University.

Using data from the National Longitudinal Surveys (NLS) of Older Men, this study 
examined the extent and character of the work experience of men who opt to
continue labor force participation well beyond conventional retirement age.
Logistic regression results showed that good health, a strong psychological
commitment to work, and a corresponding distaste for retirement are among the
most important characteristics related to continued employment into old age. The 
probability of employment was also found to be positively related to educational 
attainment and being married to a working wife; it was negatively related to age 
and level of income in the absence of work. Of the men in the sample who were not
working, very few gave evidence of a desire to do so. Policy implications of the 
findings are explored.

PMID: 8169346 [PubMed - indexed for MEDLINE]


167. Am J Ind Med. 1994 Apr;25(4):527-36.

Outcome of carpal tunnel surgery in Washington State workers' compensation.

Adams ML, Franklin GM, Barnhart S.

Department of Environmental Health, University of Washington School of Public
Health and Community Medicine, Seattle 98195.

All cases of occupational carpal tunnel syndrome (OCTS) who received surgery for 
this condition in the Washington State workers' compensation system were
identified using claim and physician billing databases. One hundred ninety-one
incident surgical cases were identified between July 1, 1987 and December 31,
1987, and were followed up a mean of 3 years postoperatively for clinical,
disability, and return to work outcomes. Medical record and claim file review was
required for clinical and employment information. The mean age of all patients
was 36.6 years, 48% were female, and 40% received bilateral surgery. The mean
time from claim filing to surgery was 187 days. Ninety-eight percent of cases met
the National Institute for Occupational Safety and Health (NIOSH) case definition
for OCTS. Relief of pain was complete or modest in 86% (124/145) and only 14% of 
cases reported no improvement in symptoms. Mean duration of disability (time
loss) postoperatively was nearly 4 months, and 8% of cases exceeded 1 year of
time loss. The majority of cases returned to their same job (67%) or to a
different job (15%). Workers in high risk occupations were less likely to return 
to the same job after CTS surgery compared to those in lower risk occupations
(61% vs. 75%, p = 0.08). In this population, no association was seen between any 
outcome and age, gender, marital status, or baseline wage. Duration of disability
was not significantly related to preoperative severity of OCTS or to more
specific case criteria for this condition.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 8010295 [PubMed - indexed for MEDLINE]


168. J Clin Epidemiol. 1994 Apr;47(4):363-74.

Association of education with incidence of cognitive impairment in three
established populations for epidemiologic studies of the elderly.

White L, Katzman R, Losonczy K, Salive M, Wallace R, Berkman L, Taylor J,
Fillenbaum G, Havlik R.

Epidemiology, Demography, and Biometry Program, National Institute on Aging,
Bethesda, MD 20892, USA.

We analyzed the association of education, occupation, and sex with incidence of
cognitive impairment using data from three communities in the Established
Populations for Epidemiologic Studies of the Elderly (EPESE) projects (New Haven,
East Boston, and Iowa). Participants were initially interviewed in 1981-1983,
with follow-up 3 and 6 years later. Incident cognitive impairment was defined on 
the basis of either: (1) increase in the number of errors in Short Portable
Mental Status Questionnaire (SPMSQ) (i.e. from a baseline level below the cutoff 
value to a score above the cutoff), or (2) inability to respond to interview
questions at a follow-up contact (requiring a proxy informant), or (3) death with
a recorded diagnosis of a dementing illness. In multiple logistic regression
models, the major factors predicting the development of cognitive impairment were
advanced age, any errors on baseline SPMSQ, 8 or fewer years of education, and
occupation. Education and occupation remained significant predictors after
controlling for age, site, sex, stroke, and baseline SPMSQ score.

PMID: 7730861 [PubMed - indexed for MEDLINE]


169. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):584-90.

Cotton dust and across-shift change in FEV1 as predictors of annual change in
FEV1.

Glindmeyer HW, Lefante JJ, Jones RN, Rando RJ, Weill H.

Department of Medicine, Tulane University Medical Center, New Orleans, LA
70112-2699.

In this report of a 5-yr longitudinal study of workers employed at six cotton
textile mills, exposure and across-shift FEV1 change were evaluated as possible
predictors of the annual change in FEV1 for yarn manufacturing workers. A total
of 611 workers had three repeatable spirometric tests, over at least 3 yr, and at
least one (average of three) across-shift test, while always working the same
shift. The "same shift" criterion controlled for the effect of diurnal variation.
Average exposure was determined from measures of lint-free elutriated cotton dust
in combination with job histories. This study found a significant association
between the acute and chronic effects of cotton dust exposure. Both exposure and 
across-shift change proved to be significant predictors of annual change, and
excess annual declines in FEV1 were predicted even for exposures of 200
micrograms/m3 and across-shift drops in FEV1 of 200 ml. These results suggest
that, to prevent dust-related chronic decline in lung function, current smokers
should be excluded from yarn manufacturing work and exposures should be reduced
below 200 micrograms/m3, to approximately 100 micrograms/m3.

PMID: 8118622 [PubMed - indexed for MEDLINE]


170. Prev Med. 1994 Mar;23(2):235-41.

Cigarette smoking among former military service personnel: a neglected social
issue.

Feigelman W.

Department of Sociology, Nassau Community College, Garden City, New York 11530.

BACKGROUND. This article investigates cigarettes smoking among active military
personnel, veterans, and comparable civilian populations. METHODS. It is based on
secondary analysis of archival data from the General Social Surveys and the
National Longitudinal Surveys of Youth. RESULTS. Findings were consistent with
past research, indicating higher smoking rates for current active military
personnel than for civilians. Among men and women who were in their thirties
during the early 1980s, findings suggest that military personnel and civilians
alike exhibited the same tendency toward cigarette use and initiated smoking at
approximately the same ages. General Social Surveys and National Longitudinal
Surveys of Youth data suggest that military smoking did not appear to be a
situational behavior which occurred only during a recruit's tour of duty; results
also suggest that previous military experience was associated with higher
lifelong patterns of cigarette consumption, compared to those who had never been 
in the armed services. CONCLUSIONS. This evidence suggests that the military--as 
the nation's largest employer, with an immense influence upon civilian
relations--exerts a force of considerable magnitude thwarting national goals to
achieve reduced cigarette consumption.

PMID: 8047531 [PubMed - indexed for MEDLINE]


171. Singapore Med J. 1993 Dec;34(6):515-7.

Follow-up study of transsexuals after sex-reassignment surgery.

Tsoi WF.

Department of Psychological Medicine, National University Hospital, Singapore.

INTRODUCTION: This is a follow-up study of 45 male and 36 female sex reassigned
transsexuals. METHOD: The subjects were interviewed before and 1 to 8 years
following sex reassignment surgery. RESULTS: When first seen the males (mean age 
23.8 years) were slightly younger than females (mean age 24.9 years). The males
had less education and held lower level jobs. They started their sexual life
about 1-2 years earlier, but they cross-dressed 4-7 years later than the females.
The follow-up results showed that 35% were married and all of them had no
problems adjusting to their new life. The overall results were 56% very good and 
44% good. There is no pre-operative variables that can predict good adjustments
for female transsexuals. For male transsexuals, earlier age of transsexual
manifestation was related to good post-operative adjustments. DISCUSSION: The
females were less satisfied with the surgery, but they adjusted well as the
males. The results were comparable with those from previous studies.

PMID: 8153713 [PubMed - indexed for MEDLINE]


172. Scand J Prim Health Care. 1993 Dec;11(4):234-40.

A clinical follow up of unemployed. II: Sociomedical evaluations as predictors of
re-employment.

Claussen B.

National Institute of Public Health, Unit for Health Services Research, Oslo,
Norway.

OBJECTIVE--To frame and study sociomedical evaluations in clinical work with
unemployed people. DESIGN--In a two-year follow up of routine health
examinations, three sociomedical evaluations were set up. The first was the
direct conclusion of the check-up, based on sickness and possibilities of
treatment. The second dealt with work identity, and the last was a diagnostic set
of main unemployment problem. SETTING--The four municipalities of Grenland,
Norway. PARTICIPANTS--A representative sample aged 16 to 63 who had been
registered with the labour market authorities for more than 12 weeks.
RESULTS--21% of the unemployed needed further treatment. 7% were classified as
"discouraged", being on their way out of the labour market, while the majority of
the study group was healthy job seekers. Work identity seemed to be wage earning 
for 83%, homemaking for 9%, cultural work for 3%, and being a pensioner for 5%.
The main unemployment problem was lack of work for 46% of the examined. Other
problems were poor health, being less attractive workers, or having little
courage for job search. The evaluations predicted re-employment after two years. 
They divided the unemployed in groups with from five to seven times difference in
re-employment rate. CONCLUSION--These standardized sociomedical evaluations seen 
to be useful in clinical work with unemployed people.

PMID: 8146506 [PubMed - indexed for MEDLINE]


173. Vital Health Stat 2. 1993 Nov;(118):1-53.

Comparability of the death certificate and the 1986 National Mortality Followback
Survey.

Poe GS, Powell-Griner E, McLaughlin JK, Placek PJ, Thompson GB, Robinson K.

PMID: 8303839 [PubMed - indexed for MEDLINE]


174. Int J Epidemiol. 1993 Oct;22(5):848-54.

The relationship between dyspnoea and main lifetime occupation in the elderly.

Nejjari C, Tessier JF, Dartigues JF, Barberger-Gateau P, Letenneur L, Salamon R.

Inserm U330, Université de Bordeaux II, France.

PAQUID is a prospective epidemiological study of mental and functional ageing.
Based on the data collected during the baseline screening of this cohort, the
present paper will examine the relationship between main lifetime occupation and 
the presence of dyspnoea in a representative sample of 3777 subjects aged > or = 
65 years; living at home in the south-west of France. Subjects were considered
dyspnoeic if they had a dyspnoea level 3, 4 or 5 according to the Fletcher
classification. Occupational categories were determined according to the
classification of the French 'Institut National de la Statistique et des Etudes
Economiques,' and to the type of occupation for blue-collar workers. The
proportion of dyspnoeic subjects varied significantly according to the
occupational categories (from 13% for teachers to 37% for farm workers) and to
the type of work (from 18% for printing workers to 41% for building workers).
When age, sex, weight, smoking history, place of residence, educational level and
some concurrent diseases were adjusted for, former farm workers (odds ratio [OR] 
= 3.3, 95% confidence interval [CI]: 2.0-5.6), farm managers (OR = 2.1, 95% CI:
1.3-3.5), domestic service employees (OR = 1.9, 95% CI: 1.2-3.6) and blue-collar 
workers (OR = 1.9, 95% CI: 1.3-3.0), had a higher risk of dyspnoea than subjects 
who used to have an intellectual occupation. The risk was not significant for
other professional categories. These results demonstrate the important long-term 
effect of previous professional activities on respiratory health in the elderly.

PMID: 8282464 [PubMed - indexed for MEDLINE]


175. J Psychosom Res. 1993 Sep;37(6):653-9.

On physiological effects of positive and negative life changes--a longitudinal
study.

Theorell T, Emlund N.

National Institute for Factors and Health, Stockholm, Sweden.

A sample of working men and women were followed longitudinally on four occasions 
during a year with regard to serum triglycerides, plasma prolactin and systolic
and diastolic blood pressure at rest. Participants were asked about life changes 
that they had gone through during the examination year. They were also asked to
rate the importance and the direction (positive and negative, respectively) of
the changes. On the basis of this information participants were divided into a no
event group (N = 20), a positive event group (N = 11) and a negative event group 
(N = 11). Statistical analyses revealed that prolactin levels tended to increase 
in the negative event group whereas blood pressure as well as serum triglycerides
increased in the negative event group and decreased in the positive event group.

PMID: 8410751 [PubMed - indexed for MEDLINE]


176. Scand J Rehabil Med. 1993 Mar;25(1):16-24.

A three-year follow-up of 195 reported occupational over-exertion injuries.

Kemmlert K, Orelius-Dallner M, Kilbom A, Gamberale F.

National Institute of Occupational Health, Department of Physiology, Solna,
Sweden.

Three years after reporting occupational over-exertion injuries, 181 persons took
part in a follow-up study by questionnaire. The objective was to study these
persons with respect to their current status of health, well-being and functional
capacity and when possible compare collected data to reference data from the
"normal population". The studied group reported more physical and psychological
symptoms than the reference groups. More than 50% reported difficulties in
activities of daily living. Long sick-leaves in the year following the reported
injury were associated with remaining pain and low rate of employment. Three
years after the injury, 109 persons were in employment. Almost one third of these
had changed occupations and now had more varied tasks than at the time of the
report. Those whose work loads had been reduced after the injury, did not report 
less musculoskeletal disorders than others. However, access to social support was
positively related with health and psychological well-being.

PMID: 8465161 [PubMed - indexed for MEDLINE]


177. J Popul Econ. 1993 Feb;6(1):1-30.

Fertility timing, wages, and human capital.

Blackburn ML, Bloom DE, Neumark D.

PIP: This theoretical model posits that women who delay child bearing will be
more likely to invest in human capital (training that enhances productivity but
is costly). This investment is conditioned by a greater discount rate than an
economy-wide growth rate of wages for non-human capital investor women. The aim
of the model is to present a more unified view of relationships between wages and
fertility timing identified in earlier research. The empirical analyses, using
ordinary least squares techniques, was based on data from the National
Longitudinal Survey of Young Women, 1968-82 annually, for a sample of 1817 White 
working women aged 28-38 in 1982. Data were available for wages, education, work 
experience, age, number of children, and the percentage in occupations (manager, 
professional, administrative, service, and blue collar). First wages of women not
in school and without a first birth were obtained for 991 women in the sample.
Descriptive statistics revealed that the average early wage of late child bearers
was 37% higher than the average early wage of early child bearers and 43% higher 
for 1982 wages. Childless women, compared to early child bearers, experienced a
growth in wages from 31-38%. The assumptions in the theoretical model were 1)
that all women were equally productive in the labor market in the beginning; 2)
that women bore only one child; 3) that women worked continuously for a period of
time, except for time out for child bearing; 4) that all women had the option of 
investing in one type of human capital, which cost the same for all women; 5)
that the only source of income was the woman's own earnings; and 6) that a
woman's lifetime utility was a function of the present value of her lifetime
income and the intervening time period for child birth. Differences in education,
experience, tenure, and wages were strongly associated with differences in
fertility timing. The results revealed that wages were higher for delayed child
bearers, primarily because of larger accumulations of human capital, assuming
joint human capital and fertility timing decisions. The interpretation of
regressions to test family influence was that unobserved heterogeneity partly
explained the empirical relationship. Wages were affected by education,
experience, and tenure, as proxies for human capital. Results were consistent
with the hypothesis but did not confirm the theory.

PMID: 12345020 [PubMed - indexed for MEDLINE]


178. Int J Nurs Stud. 1993 Feb;30(1):81-90.

From diploma to degree: follow up of R.N.-B.A. graduates of Tel Aviv University.

Ehrenfeld M, Ziv L, Bergman R.

Department of Nursing, Tel Aviv University, Israel.

The Tel Aviv University post-basic nursing program, established in 1968, was the 
first step of nursing academization in Israel. Since then, one-third of the
nursing schools in Israel have been academized. The objectives of the present
study were to document changes in the worklife of the graduates since completion 
of the program, to learn about the influence of the program, and to identify
factors promoting or impeding study in the program. A mailed questionnaire to 709
graduates produced a 46.8% response. At the time of this study 93% were working, 
almost half of them in hospital. Data also showed upward mobility, with 38%
employed at the institutional to national supervisor level. Recommendations
include continuation of the post-basic program, expansion of the clinical
content, and enhanced interaction between students, graduates and faculty.

PMID: 8449660 [PubMed - indexed for MEDLINE]


179. J Assoc Acad Minor Phys. 1993;4(4):116-26.

Effective strategies and programs to increase minority participation in the
health professions for the 21st century.

Epps AC, Cureton-Russell MT, Kitzman HG.

Office of Student Services and MEdREP, Tulane University School of Medicine, New 
Orleans, LA 70112-2699.

Efforts in the 1960s and early 1970s aggressively met the national health care
challenge to increase minority enrollment in health professions schools. These
efforts resulted from an academic and community-based collaboration supported by 
public and private funding. This review was undertaken to inventory the
strategies and programs of that period and to highlight effective strategies. A
literature review of minority program studies was conducted to catalog specific
strategies and programmatic activities. Criteria used to evaluate effectiveness
were also assessed. Publication of any studies and evaluations of these programs 
are limited; longitudinal studies are scarce. Evaluative criteria of that time
combined quantitative and qualitative measures that were not applied uniformly
and consistently. The inventory of programmatic activity ranged from career
awareness days to establishment of health career "magnet" schools. The review
found that three strategies--awareness development, enrichment/reinforcement, and
prematriculation--were effectively applied in programs across all areas of the
health professions studied, that is, MODVOPP (medicine, optometry, dentistry,
veterinary science, osteopathy, podiatry, and pharmacy), nursing, and allied
health. Today these strategies continue to be effectively applied, but the
hostile social climate and dwindling funding threaten the progress made.
Revitalization of past efforts is imperative.

PMID: 8251706 [PubMed - indexed for MEDLINE]


180. IARC Sci Publ. 1993;(124):341-7.

Monitoring occupational exposure to carcinogens.

Schoket B.

Department of Biochemistry, Johan Béla National Institute of Public Health,
Budapest, Hungary.

32P-Postlabelling has been used for biomonitoring occupational exposure to
complex mixtures of polycyclic aromatic hydrocarbons in iron foundries, coke oven
and aluminium plants and among roofers and surface-coating workers. Enhanced
levels of aromatic DNA adducts have been detected in exposed populations in
comparison to controls. Dose-related adduct formation has been found in iron
foundry and coke-oven workers and roofers. The importance of longitudinal
biomonitoring has been shown in two aluminium plants. Comparison between
32P-postlabelling and immunoassays revealed wide variations. DNA adduct levels
obtained by the current methods should thus be regarded as relative values
between individuals and control and exposure groups.

PMID: 8225504 [PubMed - indexed for MEDLINE]


181. Am Ann Deaf. 1992 Oct;137(4):315-25.

The career status of deaf women. A comparative look.

MacLeod-Gallinger JE.

Center for Postsecondary Career Studies in Deafness, National Technical Institute
for the Deaf, Rochester, New York.

Discrepancies in labor force, occupation, and earnings outcomes were observed
between men and women in a follow-up study of 4,900 deaf high school graduates
who had responded to annual surveys conducted from 1982 to 1989. Reasons for the 
disparities were sought by further examination of the postsecondary programs
undertaken, degrees earned, labor force activities, jobs held, and socioeconomic 
status. Despite efforts to expand career awareness and postsecondary programs for
deaf people, deaf women continue to pursue a relatively narrow range of programs,
leading to stereotypical female careers. Moreover, when women earn less than a
bachelor's degree, they experience high underemployment and unemployment relative
to deaf men and hearing peers. Without concerted intervention, this condition may
be exacerbated as the labor market demands that workers be more professionally
and technically trained in career areas where deaf females are yet
underrepresented.

PMID: 1471588 [PubMed - indexed for MEDLINE]


182. JAMA. 1992 Sep 23-30;268(12):1552-8.

The comparative retention of National Health Service Corps and other rural
physicians. Results of a 9-year follow-up study.

Pathman DE, Konrad TR, Ricketts TC 3rd.

North Carolina Rural Health Research Program, Cecil G. Sheps Center for Health
Services Research, University of North Carolina, Chapel Hill 27599-7590.

Comment in:
    JAMA. 1992 Sep 23-30;268(12):1597-8.

OBJECTIVE--To contrast the retention of physicians serving National Health
Service Corps (NHSC) Scholarship Program obligations in rural settings to that of
non-NHSC physicians working in the same or similar practices, and to identify
promising retention-enhancing strategies. DESIGN--Cohort study.
PARTICIPANTS--Four hundred twelve primary care physicians initially identified
during an earlier study as working in a national stratified random sample of 178 
externally subsidized rural clinics in 1981. Thirty-six percent were serving
obligations to the NHSC, nearly all through the NHSC's Scholarship Program. The
NHSC and non-NHSC inception cohorts (those first coming to their 1981 [or
"index"] practices from May 1979 through December 1981) were created from within 
the entire group for use in most analyses. INTERVENTION--In 1990, physicians were
resurveyed to learn of their backgrounds, experiences in their index practices,
and their subsequent career moves. RESULTS--By 1984 and in each year thereafter, 
fewer NHSC than non-NHSC physicians of the entire respondent cohort remained (1) 
in their index practices, (2) in their index communities, and (3) in practice in 
any rural county (P less than .001). In the inception cohort, fewer NHSC than
non-NHSC physicians were retained within all three settings by the third year
after their initial dates of employment (P less than or equal to .01). After 8
years of employment, group retention rates for NHSC and non-NHSC inception cohort
physicians were 12% vs 39% in the index practice and 29% vs 52% in
nonmetropolitan practice. Physicians in both NHSC and non-NHSC groups who left
their index practices generally left rural practice altogether. CONCLUSIONS--When
compared to non-NHSC physicians working in comparable rural settings, the
retention of rural NHSC physicians is seen to be poor and only partially
explained by fixed physician, practice, or community variables. Long-term
retention of NHSC providers is now receiving much needed attention at the federal
level.

PMID: 1518110 [PubMed - indexed for MEDLINE]


183. Neurology. 1992 Sep;42(9):1697-701.

Occupation during life and memory performance in nondemented French elderly
community residents.

Dartigues JF, Gagnon M, Mazaux JM, Barberger-Gateau P, Commenges D, Letenneur L, 
Orgogozo JM.

Unité INSERM 330, Bordeaux, France.

Using data obtained during the baseline screening of the PAQUID cohort, an
epidemiologic study on brain aging conducted in the Bordeaux area of France, we
studied the relationship between lifetime occupation and memory performance in
visual recognition (Benton Visual Retention Test; BVRT) and verbal induced recall
(Wechsler Paired Associates Test; WPAT) in 2,720 elderly community residents.
Occupational category was strongly correlated with poor memory performance for
both the BVRT and the WPAT. Independent of the educational level, the risk of
having poor memory performance was two to three times greater for farmers,
domestic service employees, and blue-collar workers than for
professionals/managerials. Occupational category should be taken into account in 
future cross-national studies on brain aging.

PMID: 1513456 [PubMed - indexed for MEDLINE]


184. Am J Epidemiol. 1992 Jul 1;136(1):81-8.

Incidence of cancer in Norwegian workers potentially exposed to electromagnetic
fields.

Tynes T, Andersen A, Langmark F.

Cancer Registry of Norway, Institute of Epidemiological Cancer Research, Oslo.

The risk of cancer was investigated in a cohort of 37,945 male Norwegian
electrical workers for whom information on job description was collected from
1960 census data and linked to the 1970 census data. The standardized incidence
ratio was calculated for all cancer sites in the overall cohort by comparison
with national incidence rates for economically active men at the 1960 census. The
standardized incidence ratios for cancers of the breast, pleura (mesothelioma),
larynx, and bladder and for soft tissue sarcoma were elevated, while those for
non-Hodgkins and Hodgkins lymphoma were lower. The standardized incidence ratio
for leukemia for electrical workers with 10 or more economically active years was
1.41. The standardized incidence ratio for brain tumors in this subgroup of
electrical workers was 1.14. These results from a large, national,
population-based study at the Cancer Registry of Norway give support to previous 
findings of a possible association between electrical work and the risk of
leukemia.

PMID: 1415133 [PubMed - indexed for MEDLINE]


185. Cancer Causes Control. 1992 May;3(3):247-54.

A cohort study of tobacco use, diet, occupation, and lung cancer mortality.

Chow WH, Schuman LM, McLaughlin JK, Bjelke E, Gridley G, Wacholder S, Chien HT,
Blot WJ.

Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD
20892.

In 1966, a cohort of White males aged 35 or over, who were policy-holders with
the Lutheran Brotherhood Insurance Society (United States), completed a mail
questionnaire on tobacco use, diet, and demographic characteristics. During the
20 years of follow-up, 219 lung cancer deaths occurred. Besides the strong
relationship with cigarette smoking, we observed an effect on lung cancer risk
among current users of cigars or pipes who were nonsmokers of cigarettes
(relative risk [RR] = 3.5, 95 percent confidence interval [CI] = 1.0-12.6) or who
were past/occasional users of cigarettes (RR = 2.7, CI = 1.4-5.3). In addition,
elevated risks (from 1.5 to 2.6) of lung cancer were found among craftsmen and
laborers, with the highest risks among subjects who worked in the mining or
manufacturing industry. No association between current (as of 1966) use of beer
or hard liquor and lung cancer was observed, although past users were at elevated
risk. An inverse association between lung cancer and intake of fruits was
observed, and risks of lung cancer were lower among persons in the highest
dietary intake quintiles of vitamins A and C. Except for oranges, however, none
of the inverse associations with fruits or dietary nutrients had statistically
significant trends. The findings from this cohort study add to the evidence of an
adverse effect of cigar/pipe smoking and possibly protective effect of dietary
factors on lung cancer risk.

PMID: 1610971 [PubMed - indexed for MEDLINE]


186. East Afr Med J. 1992 Feb;69(2):55-7.

Unusual form of motor neuron disease in Kenya.

Adam AM.

Department of Medicine, College of Health Sciences, University of Nairobi, Kenya.

Comment in:
    East Afr Med J. 1992 Feb;69(2):53-4.

Over the period November 1978 to October 1988, 46 cases of motor neuron disease
were seen at Kenyatta National Hospital, Nairobi. One case was seen in private
practice. A bimodal age distribution of the disease was identified with a peak in
the fourth decade of life and another peak in the sixth decade of life. The
disease seen in the fourth decade of life was different as seen in other parts of
the world in that the majority of patients tended to present with very rapidly
progressive disease despite the primary presentation with limb symptoms and
signs. Serum cholinesterase activity in five of these patients and five of the
classical motor neuron disease revealed no abnormalities. This unusually rapidly 
progressive disease in young adults has not been described anywhere. The disease 
seen in older age groups and especially in patients over fifty years of age was
not different from the one seen in other parts of the world.

PMID: 1505388 [PubMed - indexed for MEDLINE]


187. Rev Epidemiol Sante Publique. 1992;40 Suppl 1:S7-16.

Epidemiology of occupational neurobehavioural hazards. Methodological experiences
from organic solvent research.

Hogstedt C, Lundberg I.

Division of Occupational Medicine, National Institute of Occupational Health,
Solna, Sweden.

Neurobehavioral hazards have been identified since long in occupational health,
e.g. lead, mercury, certain solvents, and many others agents. There are reviews
and books on "Occupational neurology" or "Prevention of neurotoxic illness in
working populations". Many methods have been applied for studies of the central
and peripheral nervous systems in humans: registered diagnoses, questionnaire
ratings, clinical evaluation, psychometric tests, neurophysiological and
neuroradiological methods, cerebrospinal fluid components etc. Some neurological 
disorders are well defined, while neuropsychiatric syndromes often are less
precisely diagnosed. Decreased subclinical test results in exposed groups might
predict an increased risk for later, more serious disorders but the longitudinal 
information on clinical importance is often lacking. Some historical lessons from
the epidemiology of occupational neurology will be repeated and a few reflections
on the suitability of different diagnostic entities for epidemiological research 
shall be made. Since the beginning of the 1970s' a number of studies from the
Scandinavian countries have demonstrated long-term neurobehavioral effects from
working conditions with relatively moderate exposure to organic solvents. Similar
findings have been verified in studies from some countries outside Scandinavia
while other studies have been inconclusive. Those results have caused
considerable controversy and have been discussed at international conferences and
in scientific journals. Very different outcomes have been investigated in those
solvent studies, however, and most studies have had a cross-sectional design with
inherent problems. The exposure has been assessed in different ways, e.g. by
years of occupation, hygienic measurements of the present working conditions,
biological monitoring, retrospective assessments on qualitative or
semi-quantitative scales. Sometimes single solvent exposures have been studied
but most of the studies concern mixtures of solvents from aromatic and aliphatic 
hydrocarbons. As the designs have varied the exposure assessment has been crude
and many different outcomes have been studied, it is hardly surprising that the
results and the interpretations have differed. The first results from a
comprehensive investigation on 135 solvent exposed painters and 71 carpenters as 
referents, selected from active members of the respective trade union 1965-70 and
investigated in the late 80s, will be presented. Clinical, including psychiatric,
diagnostic work up and neuropsychological as well as neurophysiological tests
have been performed. Psychological test results from military conscripts at age
19 were available for all. The individual exposure history has been carefully
assessed.(ABSTRACT TRUNCATED AT 400 WORDS)

PMID: 1626108 [PubMed - indexed for MEDLINE]


188. Women Health. 1992;19(2-3):87-105.

Health status and health care utilization among New York City home attendants: an
illustration of the needs of working poor, immigrant women.

Weitzman BC, Berry CA.

NYU Wagner Graduate School of Public Service.

In this paper, the health needs and health care utilization patterns of home
attendants and their families have been studied as an illustration of those
likely to be found among working poor, immigrant women and their children.
Despite tremendous growth in the number of immigrants, studies to date provide
only limited information regarding the specific health needs and patterns of
health care utilization among such women and their children. As part of a
longitudinal study on the impact of insurance on health status and health care
utilization, 387 female, immigrant home attendants were interviewed. Data were
also gathered on 355 of their minor children. These women and children were found
to be less likely than other Americans to make use of basic health services,
despite the fact that they are more likely to indicate fair or poor health
status. This is true even in comparison to poor or uninsured Americans. Immigrant
attendants in fair or poor health report an average annual visit rate of 4.1
ambulatory care visits for themselves and 2.2 for their children, as compared to 
8.4 for poor adults and 4.4 for poor children in national samples. These findings
illustrate the likelihood that poor, immigrant women make limited use of American
medical care, and face barriers to health care that appear even greater than
those faced by the uninsured and the poor.

PMID: 1492413 [PubMed - indexed for MEDLINE]


189. Br J Ind Med. 1991 Sep;48(9):597-603.

Incidence of leukaemia and brain tumours in some "electrical occupations".

Törnqvist S, Knave B, Ahlbom A, Persson T.

Department of Neuromedicine, National Institute of Occupational Health, Solna,
Sweden.

Comment in:
    Br J Ind Med. 1992 May;49(5):375.

A 19 year follow up study was conducted to explore the association between
occupations expected to be exposed to electromagnetic fields and the occurrence
of leukaemia and brain tumours. Incidence of cancer between 1961-79 was
calculated and the standardised morbidity ratio (SMR) with a 95% confidence
interval (95% CI) was related to that of all Swedish working men. For all the
selected "electrical occupations" the SMRs for total leukaemia and brain tumours 
were near unity. Increased risks were noted for all leukaemia among
electrical/electronic engineers and technicians, (SMR 1.3; 95% CI 1.0-1.7) as
well as in the sub-groups of telegraph/telephone (2.1; 1.1-3.6) and machine (2.6;
1.0-5.8) industries. Risk for chronic lymphoid leukaemia was increased in the
same occupational category (1.7; 1.1-2.5) and in the sub-group of machine
industry (4.8; 1.0-14.0), as well as for all linesmen (2.0; 1.0-3.5) and power
linesmen (2.8; 1.1-5.7). Risk for acute myeloid leukaemia was increased among all
miners (2.2; 1.0-4.1) and miners working in iron/ore mines (5.7; 2.1-12.4).
Increased risk for all brain tumours (2.9; 1.2-5.9) and glioblastomas (3.4;
1.1-8.0) appeared among assemblers and repairmen in radio and TV industry. Raised
risk for all brain tumours was seen for all welders (1.3; 1.0-1.7) and welders in
iron/steel works (3.2; 1.0-7.4) and risk for glioblastomas was also increased for
all welders (1.5; 1.1-2.1). No major changes in relative risk estimates were
noted after the exclusion of persons who were over 65 at the time of diagnosis.
Although a homogeneous pattern of increased risks of leukaemia or brain tumour
was not noted, the hypothesis that magnetic fields might play a part in the
origin of cancer cannot be rejected.

PMCID: PMC1035431
PMID: 1911402 [PubMed - indexed for MEDLINE]


190. J Biocommun. 1991;18(3):20-7.

Videodisc technology trends in the health sciences: revisited.

Singarella T, Ramagli HJ, Bader S.

Department of Health Informatics, University of Tennessee, Memphis.

This paper describes a national study to determine levels and kinds of videodisc 
utilization in health science institutions throughout North America. In the
winter of 1989, 922 surveys were mailed to six different health science
professional groups; 244 (26%) completed survey forms were returned. A comparison
between this survey and one conducted by the authors in 1987 clearly shows that
videodisc technology for medical education is varied and expanding within
academic health science centers in North America.

PMID: 1939034 [PubMed - indexed for MEDLINE]


191. Ann Intern Med. 1990 Nov 15;113(10):740-6.

Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1)
associated with clinical exposures. A prospective evaluation.

Henderson DK, Fahey BJ, Willy M, Schmitt JM, Carey K, Koziol DE, Lane HC, Fedio
J, Saah AJ.

Clinical Center, National Institutes of Health, Bethesda, Maryland.

Comment in:
    Ann Intern Med. 1990 Nov 15;113(10):729-30.

OBJECTIVES: To summarize the results of a 6-year, ongoing, prospective study of
the risk for human immunodeficiency virus type 1 (HIV-1) transmission among
health care workers, and to estimate the magnitude of the risk for HIV-1
infection associated with different types of occupational exposures. DESIGN:
Prospective cohort study; the median follow-up for employees sustaining
parenteral exposures was 30.2 months (range, 6 to 69 months). SUBJECTS: Health
care workers at the Clinical Center, National Institutes of Health, including
those reporting parenteral and nonparenteral occupational exposures to HIV-1.
MEASUREMENTS AND MAIN RESULTS: One thousand three hundred and forty-four clinical
health care workers reported 179 percutaneous and 346 mucous membrane exposures
to fluids from HIV-1-infected patients during a 6-year period. Responding to a
supplementary questionnaire, 559 of these workers reported 2712 cutaneous
exposures to blood from HIV-1-infected patients and more than 10,000 cutaneous
exposures to blood from all patients during a 12-month period. Occupational
transmission of HIV-1 occurred in a single worker after a parenteral exposure to 
blood from an HIV-1-infected patient. No infections occurred after either mucous 
membrane or cutaneous exposures to blood from HIV-1-infected patients. Use of
newer diagnostic technologies (for example, antigen detection, gene
amplification) has not resulted in the identification of occupationally
transmitted seronegative infections. CONCLUSIONS: Combining our results with
those of other prospective studies, the risk for HIV-1 transmission associated
with a percutaneous exposure to blood from an HIV-1-infected patient is
approximately 0.3% per exposure (95% CI, 0.13% to 0.70%); the risks associated
with occupational mucous membrane and cutaneous exposures are likely to be
substantially smaller. These data support the use of barrier precautions and
suggest a need for strategies that change health care providers' attitudes and
behaviors.

PMID: 2240876 [PubMed - indexed for MEDLINE]


192. Am J Obstet Gynecol. 1990 Nov;163(5 Pt 1):1450-6.

The effect of physical activity during pregnancy on preterm delivery and birth
weight.

Klebanoff MA, Shiono PH, Carey JC.

Division of Prevention Research, National Institute of Child Health and Human
Development, National Institutes of Health, Bethesda, MD 20892.

The relationship between physical activity during pregnancy, preterm birth, and
gestational age-adjusted birth weight was investigated prospectively in a cohort 
of 7101 women. This study is one of few to evaluate both employment- and
non-employment-related physical activity. Prolonged periods of standing were
associated with a modestly increased risk of preterm delivery (adjusted odds
ratio for greater than or equal to 8 hours/day of standing = 1.31). Heavy work or
exercise was not associated with preterm delivery (adjusted odds ratio for
greater than or equal to 4 hours per day of heavy work = 1.04). The proportion of
infants born preterm did not differ among women working in predominantly
standing, active, and sedentary occupations. Physical activity was not associated
with gestational age-adjusted birth weight after controlling for confounding
variables. These data suggest that unmeasured socioeconomic differences among
women reporting different levels of activity may account for previously described
associations between physical activity and pregnancy outcome. Most pregnant women
who report increased levels of physical activity are not at increased risk of
preterm delivery or reduced intrauterine growth. However, these data do not
address the role of activity restriction in the management of selected women at
high risk for adverse pregnancy outcome.

PMID: 2240086 [PubMed - indexed for MEDLINE]


193. Am J Epidemiol. 1990 Aug;132(2):293-303.

Incidence of leukemia in occupations with potential electromagnetic field
exposure in United States Navy personnel.

Garland FC, Shaw E, Gorham ED, Garland CF, White MR, Sinsheimer PJ.

Naval Health Research Center, San Diego, CA 92186-5122.

Leukemia is the fourth most commonly occurring cancer in the United States
population between the ages of 17 and 34 years, an age group heavily represented 
in the US Navy. Historical computerized military career records maintained at the
Naval Health Research Center, San Diego, California, were used to determine
person-years at risk (total, 4,072,502 person-years) by demographic
characteristics and occupation for active-duty naval personnel during 1974-1984. 
Computerized inpatient medical records were searched for first hospitalizations
for leukemia. Cases of leukemia (n = 102) were verified by using pathology
reports or Navy Medical Board or Physical Evaluation Board findings. For
comparisons, age-adjusted incidence rates and standardized incidence ratios were 
calculated by using rates for the US population provided by the Surveillance,
Epidemiology, and End Results program of the National Cancer Institute. The
overall age-adjusted incidence rate of leukemia in active-duty naval personnel
was found to be very close to that of the Surveillance, Epidemiology, and End
Results program population (6.0 vs. 6.5 per 100,000 person-years). Only one
occupation, electrician's mate, emerged with a borderline statistically
significant excess risk of leukemia (standardized incidence ratio compared with
the Surveillance, Epidemiology, and End Results program population = 2.4, 95%
confidence interval 1.0-5.0). This finding is intriguing in the light of several 
studies showing an excess risk of leukemia associated with exposure to
electromagnetic fields.

PMID: 2372008 [PubMed - indexed for MEDLINE]


194. Infect Control Hosp Epidemiol. 1990 Jul;11(7):371-9.

Risky business: using necessarily imprecise casualty counts to estimate
occupational risks for HIV-1 infection.

Beekmann SE, Fahey BJ, Gerberding JL, Henderson DK.

Hospital Epidemiology Service, National Institutes of Health, Bethesda, MD 20892.

Although the genesis of healthcare worker anxiety regarding occupational risks of
HIV-1 infection is clear, the reasons for continued insistence on a meticulous
"casualty count" become less clear with time. One could, in fact, argue that the 
precise number of such infections has become virtually meaningless, because the
routes of occupational/nosocomial transmission of HIV-1 and the magnitude of risk
for infection following an adverse exposure in the healthcare setting have been
well-characterized. Nevertheless, with the substantial limitations of these data 
clearly in mind, we have summarized the numbers of healthcare workers reported to
have HIV-1 infection in each of the above categories in Table 2. The likelihood
that an individual case represents true occupational infection decreases as one
moves down the table. Having waded through the depths of this literature, we have
reached the conclusion that, of the available data, the magnitude of risk for
occupational HIV-1 infection remains the single most useful and instructive
statistic available. Longitudinal cohort studies of HCWs involved in the
day-to-day care of HIV-1-infected patients and in the handling and processing of 
specimens from such patients provide the best available evidence regarding the
magnitude of risk for transmission of this virus in the healthcare setting.
Fourteen prospective studies are currently in progress, with approximately 2,000 
HCWs enrolled (Table 4). Six HCWs enrolled in these studies have developed
serologic evidence of HIV-1 infection following percutaneous exposures, yielding 
an infection rate per participant of 0.32% and an infection rate per exposure of 
0.31%.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 2165506 [PubMed - indexed for MEDLINE]


195. Jpn J Clin Oncol. 1990 Jun;20(2):128-33.

Multiple primary cancers in patients with initial laryngeal cancer.

Kobayashi Y, Arimoto H, Ono I, Watanabe S.

Epidemiology Division, National Cancer Center Hospital, Tokyo.

The risk of a person developing a second primary cancer was evaluated in 1,215
patients with laryngeal cancer at the National Cancer Center Hospital. Overall,
92 (8.2%) of the male patients and 5 (5.7%) of the female patients developed a
second cancer, compared with 83.0 and 3.7, respectively, expected on the basis of
general population rates, resulting observed: expected values (O/E) to be 1.1 and
1.3. The numbers of second cancers of the lung (O/E = 1.9), oropharynx (O/E =
8.8) and esophagus (O/E = 2.8) were significantly in excess of those expected,
while the number of second stomach cancers (O/E = 0.5) was far below expectation.
Synchronous second cancers were significantly higher than expected (O/E = 4.6).
Smoking, especially heavy smoking, was related to second lung cancers, but
alcohol drinking featured less. Histories of benign respiratory tract and
digestive organ diseases were related to second oropharyngeal cancers. Alcohol
drinking was related to second stomach cancers. Radiation therapy for the initial
laryngeal cancer was related to second oropharyngeal cancers, while hazardous
occupations related to noxious agents for respiratory systems featured more
prevalently in cases of second lung cancer. Further analytical studies should
clarify the roles of smoking, drinking, occupation and various forms of therapy
on the risk of developing a different second cancer following laryngeal cancer.

PMID: 2370690 [PubMed - indexed for MEDLINE]


196. J Biosoc Sci. 1990 Apr;22(2):213-23.

Seasonality of births among Bedouin Arabs residing in the Negev Desert of Israel.

Guptill K, Berendes H, Forman MR, Chang D, Sarov B, Naggan L, Hundt GL.

Prevention Research Program, National Institute of Child Health and Human
Development, Bethesda, Maryland.

From 1 January 1981 to 31 December 1982 information on all births to Bedouin Arab
women residing in the Negev Desert of Israel showed a previously unreported
seasonal pattern. The peak season, November-February, coincided with the period
of cool temperatures and the Bedouin Arab cultural seasons of winter and spring. 
This pattern is different from those of Jewish and Christian groups in the same
region, a difference not attributable to religion alone. Sociodemographic factors
associated with the peak season of birth include traditional occupations of
fathers, multiparae 2+, and traditional place of residence. This pattern has
persisted over the past 15 years although it is less apparent among the more
recently sedentarized Bedouin Arabs.

PIP: From 1 January 1981 to 31 December 1982 information on all births to Bedouin
Arab women residing in the Negev desert of Israel showed a previously unreported 
seasonal pattern. The peak season, November- February, coincided with the period 
of cool temperatures and the Bedouin Arab cultural seasons of winter and spring. 
This pattern is different from those of Jewish and Christian groups in the same
region, a difference not attributable to religion alone. Sociodemographic factors
associated with the peak season of birth include traditional occupations of
fathers, multiparae 2+, traditional place of residence, timing of breastfeeding
and weaning, and dates of marriage. The question of how the transition from a
non-seasonal pattern to a seasonal pattern was achieved has yet to be answered.
This pattern has persisted over the past 15 years although it is less apparent
among the more recently sedentarized Bedouin Arabs.

PMID: 2335542 [PubMed - indexed for MEDLINE]


197. Br J Educ Psychol. 1990 Feb;60 ( Pt 1):23-36.

Occupational outcomes of truancy.

Hibbett A, Fogelman K, Manor O.

Employment Department, London.

This paper presents some findings of a study into early adult outcomes of
truancy, which was based on the National Child Development Study, a longitudinal 
survey of all people in Great Britain born in the week 3rd-9th March 1958. It was
found that truancy is associated with lower status occupations, less stable
career patterns and more unemployment. Among those who were working, former
truants' incomes were not lower, but they were considerably less well off once
their family situation was taken into account. Differences remained after
controlling for the effects of social background, educational ability, poor
attendance due to other reasons, and end-of-school qualifications. The authors
conclude that truancy is a predictor of employment problems, and of a more severe
kind than will be experienced by others who share the disadvantaged background
and low attainment which typify the truant.

PMID: 2344431 [PubMed - indexed for MEDLINE]


198. Prog Clin Biol Res. 1990;340C:357-66.

A Nordic prospective study on the relationship between peripheral lymphocyte
chromosome damage and cancer morbidity in occupational groups. Nordic Study Group
on the Health Risk of Chromosome Damage.

Reuterwall C.

Department of Occupational Medicine, National Institute of Occupational Health,
Solna, Sweden.

PMID: 2381934 [PubMed - indexed for MEDLINE]


199. Int J Gynaecol Obstet. 1989 Dec;30(4):305-11.

Pregnancy outcome in unmarried teenage nulligravidae in Singapore.

Kurup A, Viegas O, Singh K, Ratnam SS.

Department of Obstetrics and Gynaecology, National University of Singapore,
National University Hospital.

Singapore, like other newly industralized countries, has seen a dramatic
transformation in the social standards of its population in a particularly short 
space of time. Unfortunately, this period of development has been accompanied by 
an escalation in the number of pregnancies to unmarried teenage girls. This paper
examines the obstetric and social implications of 150 such pregnancies in younger
and older teenagers. Poor intrauterine growth in the younger teenager appears to 
be the most important adverse obstetric outcome in that mean birthweight was
significantly reduced (2738 g compared to 3054 g; P less than 0.02). We believe
this to be an important explanation for the five-fold increase in perinatal
mortality seen in this group of mothers. Unlike some other reports, we found no
significant increase in the incidence of cephalopelvic disproportion, anemia or
pregnancy induced hypertension in these mothers. The social implications of
teenage pregnancy in Singapore are also examined and recommendations made for
methods to curb the problem.

PIP: Singapore, like other newly industrialized countries, has seen a dramatic
transformation in the social standards of its population in a particularly short 
space of time. Unfortunately, this period of development has been accompanied by 
an escalation in the number of pregnancies to unmarried teenage girls. This paper
examines the obstetric and social implications of 150 such pregnancies in younger
and older teenagers. Poor intrauterine growth in the younger teenager appears to 
be the most important adverse obstetric outcome in that mean birthweight was
significantly reduced (2738 g compared to 3054 g; p 0.02). We believe this to be 
an important explanation for the 5-fold increase in perinatal mortality seen in
this group of mothers. Unlike some other reports, we found no significant
increase in the incidence of cephalopelvic disproportion, anemia, or pregnancy
induced hypertension in these mothers. When adolescents become mothers, they tend
to follow a social path of failure: they do not remain in school, they do not
limit family size, establish a stable family, establish a vocation, have healthy 
infants, or have children who fulfill their potential. Education of the teenagers
in Singapore is recommended to reduce the teenage pregnancy problem. author's
modified

PMID: 2576537 [PubMed - indexed for MEDLINE]


200. Am J Public Health. 1989 Sep;79(9):1247-50.

Does maternal employment affect breast-feeding?

Kurinij N, Shiono PH, Ezrine SF, Rhoads GG.

Collaborative Clinical Vision Research Branch, National Eye Institute, Bethesda, 
MD 20892.

A prospective survey of maternal employment and breast-feeding initiation and
duration was conducted among 668 Black and 511 White women who delivered their
first child in Washington, DC. Ninety-one percent of White women (n = 511) and 80
percent of Black women (n = 668) reported working during pregnancy. Black women
who planned to return to work part time vs full time were more likely to
breast-feed rather than formula-feed (adjusted odds ratio, 2.3; 95% confidence
intervals (CI) = 1.4, 3.7). Using Cox regression, Black women who returned to
work had a shorter duration of breast-feeding than those not returning to work
(hazard ratio = 0.5 (CI = 0.3, 0.9]. Black and White women returning to
professional occupations had a longer duration of breast-feeding compared to
women returning to sales or technical positions (hazard ratio for Black women =
2.4 (CI = 1.4, 44); hazard ratio for White women = 1.6 (CI = 1.0, 2.5]. In
addition, White women in professional occupations had a longer duration of
breast-feeding than women in clerical positions (hazard ratio = 1.7 (CI = 1.1,
2.6]. Until employers in the United States develop a maternity policy which does 
not discourage breast-feeding, the recommended six months of breast-feeding will 
be difficult to achieve for most employed women.

PMCID: PMC1349698
PMID: 2764202 [PubMed - indexed for MEDLINE]