bluuebunny/crossref_metadata_2025 huggingface dataset:
Response of normal human keratinocytes to sulfur mustard (HD): cytokine release using a non-enzymatic detachment procedure
Authors: Arroyo C M , Schafer R J , Kurt E M , Broomfield C A , Carmichael A J
Published: July 2017

Cytokines play a major role in both acute and chronic inflammatory processes, including those produced by sulfur mustard (HD). This study describes responses of normal human epidermal keratinocyte (NHEK) cells to 2,2′-dichlorodiethyl sulfide, sulfur mustard (HD), defined by interleukin-1 beta (IL-1β), interleukin-6 (IL-6), inter-leukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-α) release. A new method for detaching cell to cell adhesion between keratinocytes has been applied. This method permits the characterization of endogenous fluid from cellular content that could be applied for the development of therapeutic intervention. NHEK (typical average cell density 4.4×106 cells/mL) were exposed to HD (100 and 300 μM) in keratinocyte growth medium (KGM) for 24 h at 37°C in humidified air. Commercially available enzyme-linked immunosorbent assay (ELISA) kits were used to measure the cytokine release in NHEK during exposure to 100 and 300 μM of HD. Exposure to 100 μM HD increased release of cytokines. IL-1β (exposed: 1.41×10-5 pg/ cell±1.60×10-6 pg/cell: control 7.10×10-6 pg/ cell±1.20× 10-6 pg/cell), TNF-α (exposed: 1.06× 10-5 pg/cell±7.3× 10-7 pg/cell; control: 4.04×10-6±2.80×10-7 pg/cell) and IL-8 (exposed: 3.71×10-5 pg/ cell±3.26×10-6 pg/cell; control: 2.99×10-6 pg/cell±8.80×10-7 pg/cell) were significantly enhanced when NHEK cells were detached from culture flasks by non-enzymatic procedures. Cell suspensions of NHEK released low amounts of IL-6 when exposed to 100 μM for 24 h (exposed: 1.47×10-6±1.60×10-7 pg/cell; control: 1.28×10-6± 8.40×10-8 pg/cell). However, cell suspensions of NHEK increased levels of IL-6 after exposure to 300 μM HD (4.67×10-5 pg/cell±3.90×10-6 pg/cell; control: 3.99× 10-6 pg/cell±5.50×10-7 pg/cell). The amount of IL-8 and TNF-α present in cell suspensions increased up to 59-fold and fourfold, respectively, above control levels when NHEK cells were exposed to 300 μM HD. Exposure of NHEK to 300 μM HD had a highly variable effect on the release of IL-1β, where sometimes the secretion of IL-1β increased above baseline level and other times decreased in cell suspensions. Supernatants were collected from cell culture flasks 24 h after exposure of 100 and 300 μM and significantly increased levels of IL-6 were observed. IL-6 was released in a concentration-dependent manner, 3.6- fold up to 8.4-fold, respectively, in supernatant. These proinflammatory mediators IL-1β, IL-8, TNF-α and IL-6 may play an important role in HD injury. The present findings suggest that cytokine changes detected could be used as potential biomarkers of cutaneous vesicant injury.
Relationship of dose intensity to the induction of palmar-plantar erythrodysesthia by pegylated liposomal doxorubicin in dogs
Authors: Amantea M , Newman M S , Sullivan T M , Forrest A , Working P K
Published: July 2017

1 The multiple dose pharmacokinetics of pegylated liposomal doxorubicin (PL-DOX), known as DOXIL® (US) and CAELYX® (EU), was characterized in dogs and a pharmacokinetic/pharmacodynamic model to identify a relationship between drug exposure and the probability of observing treatment-related palmarplantar erythrodysesthesia (PPE) was developed.

2 Twenty dogs were assigned to PL-DOX groups (2/sex/ group) that received intravenous PL-DOX doses of 0.5 mg/kg q1, 2, or 4 weeks; 1.0 mg/kg q2weeks; or 1.5 mg/kg q4weeks for 12 weeks. Blood was collected for HPLC analysis of doxorubicin concentration pre-dose and periodically up to 120 h after dosing three times during treatment.

3 Plasma drug concentration was modeled using iterative 2-stage analysis. Dermal lesions (PPE) were scored twice weekly for six regions of each dog using a 0-6 severity scale; maximum severity was 36. PPE score data were modeled using an approach in which the% probability of PPE was related to a hypothetical effect site by a series of Hill-type functions.

4 Pharmacokinetics were best modeled as a one-compartment open model. Vss (ml/kg), CLt (ml/hr/kg) and half-life (h) were 44.1, 1.39 and 23.1, respectively. Cmax increased linearly with dose. CLt decreased with repeated doses.

5 A two-compartment pharmacodynamic model, which correctly predicted 97% of the observed lesion severity, was developed to establish the relationship of lesion severity to dose intensity (a measure of drug exposure incorporating the effect of both dose level and dosing frequency, which can be expressed in units of mg/kg/week). The model demonstrated that maximal PPE was positively correlated with dose intensity, the major factor that affects the incidence and severity of dermal lesions.

6 The model can be used to predict acceptable dose intensities in humans utilizing body surface area conversion factors and comparative AUCs for dogs and humans. It predicts that a dose intensity of 10-12.5 mg/m2 of PL-DOX will be well tolerated in patients. The results of recent clinical studies are consistent with this prediction.
Immunotoxicological examination of repeated dose combined exposure by dimethoate and two heavy metals in rats
Authors: Institóris L. , Siroki Olga , Dési I , Ündeger Ülkü
Published: July 2017

The immunotoxicity of 28 days combined oral exposure by dimethoate (DM) and two heavy metals (Pb or Cd) was investigated in male Wistar rats. Immunotoxic and no-effect doses of DM (28.2 and 7.04 mg/kg) were combined with immunotoxic and no-effect doses of CdCl2 (6.43 and 1.61 mg/kg) or lead acetate (80.0 and 20.0 mg/kg) in such a way that the high dose of each substance was given in combination with the no-effect dose of the other. To examine the interactions of these agents, general toxico-logical (body weight gain, organ weights), haematological (absolute and differential WBC, RBC, MCV, Ht, cell content of the femoral bone marrow), and immune function (splenic PFC number, DTH reaction) parameters were measured. Treatment with the combination of Pb or Cd and DM did not result in a reduction of humoral (PFC) and cellular (DTH) immune responses, whereas treatment with the substances alone did result in immune suppression. This protecting effect can probably be attributed to an effect on the kinetics of the compounds tested rather than on the immune system itself. Further interactions were found in both combinations, DM-Cd and DM-Pb, in the body weight gain and in the relative liver weight; the DMPb combination also affected the relative thymus weight and the MCV value. These findings show that the immunotoxic effects of the investigated materials, including their detectability and health consequences, can be modified in case of combined exposure.
Cardiovascular regulation in multiple sclerosis
Authors: Diamond BJ , Kim H , DeLuca J , Cordero DL
Published: July 2017

Traditional assessments of autonomic nervous system function have depended on invasive and complex procedures. Vagal power, which is the respiratory component of heart rate variability (HRV) is an alternative and non-invasive measure for indexing autonomic nervous control of the heart In the current study, 18 multiple sclerosis (MS) and 20 healthy subjects matched with respect to age, education and intelligence served as subjects. The MS group showed significantly lower vagal power during natural and paced breathing than healthy subjects. Importantly, heart rate did not differ between the two groups. If MS patients exhibit abnormalities in mechanisms mediating cardiac parasympathetic control, the impact on quality of life and vulnerability to adverse cardiac events need to be further evaluated. The results of this study may have implications with respect to the feasibility of using HRV as both a diagnostic and prognostic tool for evaluating parasympathetic nervous system dysfunction and in providing valuable information for developing more effective treatment and rehabilitation strategies.
Laryngeal Uhthoffs phenomenon: a case report
Authors: Pringle CE , McEwan LM , Ebers GC
Published: July 2017

An Uhthoff-like phenomenon was recently observed in a patient with clinically definite MS who experienced transient dysphonia brought on by exertion and relieved by cooling. The patient's dysphonia was felt to be related to intermittent temperature-dependent conduction block associated with a demyelinating plaque in the region of the left nucleus ambiguus. We have termed the patient's intermittent dysphonia ‘laryngeal Uhthoffs phenomenon'.
PCR typing of two Short Tandem Repeat (STR) structures upstreams of the human Myelin Basic Protein (MBP) gene; the genetic susceptibility in multiple sclerosis and monosymptomatic idiopathic optic neuritis in Danes
Authors: Nellemann LJ , Frederiksen J , Morling N
Published: July 2017

We investigated two short tandem tetranudeotide (TGGA) repeat polymorphisms upstreams of the myelin basic protein (MBP) gene. The region was amplified by the polymerase chain reaction (PCR) and the two repeat systems were separated by cutting with the restriction enzyme NlaJM. The lengths of the DNA fragments were analyzed by vertical electrophoresis in Polyacrylamide gels followed by silver staining. We compared the DNA fragment frequencies of the two MBP regions in 34 patients suffering from multiple sderosis and in 78 suffering from monosymptomatk idiopathic optic neuritis to those in 200 healthy controls. We found no significant differences between the MBP fragment frequendes in either of the patient groups and in the control group.
Do common symptoms in women predict long spells of sickness absence? A prospective community-based study on Swedish women 40 to 50 years of age
Authors: Krantz Gunilla , Östergren Per-Olof
Published: July 2017

Aims: To investigate whether a high level of commonly experienced physical and mental symptoms could predict long spells of sickness absence in Swedish women and, further, to investigate the causal pattern of socioeconomic and psychosocial factors in relation to long spells of sickness absence. Methods: A questionnaire containing items on socioeconomic and psychosocial variables was sent to a random population of women, 40 to 50 years of age, living in a rural Swedish community. The response rate was 81.7% (397 women). Data on long spells of sickness absence (> 14 days) for the year following the baseline survey were obtained from the social insurance office. Odds ratios (OR) were used to estimate bivariate associations. Multiple logistic regression analysis was used to test for confounding and effect modification. Results: Women suffering from a high level of common symptoms were at risk of subsequent long spells of sickness absence, OR = 3.39 (1.86-6.17). High demands at work and an active job position (i.e. the combination of high demands and a high degree of job control) were both associated with long spells of sickness absence, OR = 2.16 (1.12-4.17) and OR=1.92 (1.01-3.67). The combined exposure (high level of common symptoms and an active job position) increased the odds for long spells of sickness absence (OR = 9.13; 3.39-24.58) with synergy noted. Conclusions: The finding that women with common symptoms are at risk of future sickness absence is of particular importance in a primary health care setting. The finding that women in active job positions had a higher risk of sickness absence might be an effect of modern working conditions for women.
Social network, social support and the rate of decline of CD4 lymphocytes in asymptomatic HIV-positive homosexual men
Authors: Persson Leif , Östergren Per-Olof , Hanson Bertil S. , Lindgren Anna , Naucler Anders
Published: July 2017

Aims: To test a stress-disease hypothesis by investigating the influence of social network and social support factors on the course over time of the CD4 lymphocytes in an HIV-positive population of gay men. Methods: The study is a prospective cohort study of a representative population of HIV-positive gay men, undertaken at the Department of Infectious Diseases, Malmö University Hospital. This is the only clinic providing care for HIV-positive individuals in the city of Malmö in southern Sweden (population 248,000). A total of 115 HIV-positive homosexual men, who had not received an AIDS diagnosis, were invited to take part in the study. Seventy-five men (65%) accepted to be interviewed and 64 men (56%) fulfilled the inclusion criteria for the statistical analysis. Results: In a multivariate analysis adjustments were made for age, level of the first CD4 count and time since first contact with the clinic. Men with high family contact frequency had a longer half-life (20.3 years) of the CD4 lymphocyte count than men with a low family contact frequency (7.4 years) ( p=0.03). Men with high social participation also had a longer half-life of CD4 lymphocyte count (14.7 years), compared with men with low social participation (6.3 years, p=0.10). Conclusions: The findings of this study imply the importance of social support and social network factors as modifiers of the rate of decline of the CD4 lymphocyte level, which is an important prognostic marker of survival in HIV-positive homosexual men.
An explorative, population-based study of female disability pensioners: the role of childhood conditions and alcohol abuse/dependence
Authors: Upmark Marianne , Thundal Kajsa-Lena
Published: July 2017

Aims: This study investigates the association in women between conditions during childhood and adolescence and alcohol dependence or abuse in adulthood on the one hand, and disability pensions and long-term sickness absence on the other. Methods: A stratified population-based sample of women in Göteborg was interviewed. For analyses in this study the following variables were selected from the interview protocol: childhood and adolescence, education, employment, social class, self-rated physical health and alcohol dependence or abuse (ADA), with diagnoses assessed according to DSM-III-R. Information on disability pension and sickness absence was obtained from the local Social Insurance Office. Results: Unfavourable conditions during childhood and adolescence and school difficulties as well as early deviant behaviours predicted disability pension and long-term sickness absence in adulthood. For most risk factors ADA could explain only a minor part of the odds ratios found in crude and age-adjusted analyses. Conclusion: It is concluded that conditions early in life are predictors in women of disability pension and long-term incapacity to work. There are similarities in the pattern of early risk factors for later alcohol dependence or abuse and for disability pension/long-term sickness absence.
Mortality in relation to early retirement in Denmark: a population-based study
Authors: Quaade Thomas , Engholm Gerda , Johansen Anne Mette T. , Møller Henrik
Published: July 2017

Aims: The aim of this study was to examine whether early retirement is gained by persons with poor health or whether retirement leads to negative changes in health. Mortality for persons in Denmark using one of two publicly financed retirement schemes was investigated. Disability benefit (førtidspension) was granted for health reasons mainly, while early retirement benefit (efterløn) was earned through long-term membership of an unemployment benefit scheme. Methods: Data from Danish population-based registers were used for each year in the period 1986-96. The study setting was the population of Denmark, born between 1926 and 1936. Results: the standardized mortality ratio in employed persons was low (0.59 and 0.51 for men and women, respectively) and high in disability benefit recipients (2.31 and 1.66). The mortality in the early retirement benefit recipients (0.88 and 0.72) was in between the mortality for the disability benefit recipients and the employed persons. Disability benefit recipients had a high relative risk of death immediately after retirement. In early retirement recipients the relative risk of death increased with time since retirement. Conclusions: Disability benefit was mainly gained by persons with poor health. In contrast, the increasing mortality of the early retirement recipients is consistent with an adverse effect on health of retirement itself, but may also be due to the cessation of health selection in the group of disability benefit recipients after retirement. It is difficult to disentangle the effects of a change in activity following retirement from the effects of an earlier health-associated selection into the two retirement schemes.
Subjective health complaints in adolescence: dimensional structure and variation across gender and age
Authors: Hetland Jorn , Torsheim Torbjorn , Aarø Leif E.
Published: July 2017

Aims: The aim of this study is to investigate dimensional structures in subjective health complaints in adolescents and to examine the variation in levels and dimensionality across gender and age groups. Methods: Data from two studies were used: (1) a study based on a convenience sample, consisting of 1427 Norwegian students (11- to 15-year-olds) from schools participating in the European Network of Health Promoting Schools; (2) a nationwide survey amongst 7,059 Norwegian students (aged 11, 13, 15, and 16) from the Health Behaviour in School-aged Children (HBSC) study. Subjective health complaints were measured by revised versions of the HBSC symptoms checklist (HBSC-SCL). Results: In study 1 confirmatory factor analysis revealed that a model of two highly correlated factors, which can be labelled somatic and psychological, fitted the data reasonably well (CFI = 0.91). This two-factor model was applied in study 2 and latent means were tested across sub-samples defined by gender and age. The results indicate that girls show higher mean levels compared with boys on both factors. There is also an indication of an increase in these factors with age amongst girls, while amongst boys there is less, if any, difference across age groups. The correlation between the somatic and psychological factors was virtually constant across age groups and gender. Conclusions: The identification of a somatic and a psychological factor indicates the existence of two different dimensions that may have different aetiologies. The gender difference in latent means across age groups may suggest a different developmental pattern amongst girls and boys.
Life expectancy in the province of Halland, Sweden, 1911-50: the progress of public health in a long-living population
Authors: Baigi Amir , Högstedt Benkt , Odén Anders , Isacsson Sven-Olof , Herrström Per
Published: July 2017

Background: Life expectancy in Sweden is currently one of the longest in the world. The population of Halland has the longest life expectancy in Sweden. Aim: Life expectancy in the province of Halland and Sweden as a whole during 1911-50 was studied and the findings are discussed in the light of local historical data. Method: A trend analysis of risk ratio of death and life expectancy for Halland and Sweden was done for the period 1911-50 with regard to calendar year, age, and sex using a Poisson model. Results: The risk ratio between Halland and Sweden was 0.83 for 1911 and 0.76 for 1950. The risk ratio of death for women was lower compared with men and this difference increased over time. At the start of the study period life expectancy for men and women was higher in Halland (58.5 and 60.1 years, respectively) compared with Sweden (54.7 and 56.4 years, respectively) with a difference of approximately 3.8 years. At the end of the study period this difference in life expectancy for men and women in Halland (71.3 and 72.3 years, respectively) and the nation (68.0 and 69.2 years, respectively) had decreased to approximately 3.3 years. Conclusion: The long life expectancy seen in Halland today can be traced back to the early twentieth century. The starting point for this development seems to be a lower infant mortality in Halland compared with Sweden as a nation during the 1880-90. The basis for this might have been a greater increase of food production during the whole nineteenth century as well as other socioeconomic characteristics of Halland compared with the rest of the country.
Parents' Experiences of Child Health Centers
Authors: Sundelin Claes
Published: July 2017

Improved techniques for counselling parents can be achieved through a knowledge of the parents' experience of existing child health care. The author has studied the parents' experience of child health centers with regard to contact with the staff, information received, and general organization. A questionnaire was sent to one-third, 478, of all parents in the urban district of Uppsala with children 1/2–1 1/2 years old. The children were registered at 14 separate child health centers. The results showed that the essential prerequisites for good contact with the staff were, a limited number of children registered, and the presence of a permanent physician at the health center. The level of information concerning measures undertaken in child health care was mainly related to social grouping. One or more behavior problems were noted to have existed in 21% of the cases. About 60% of all parents concerned had sought advice at the child health center with varying degrees of success for different kinds of problems. An important objective in the child health care system would be to study the clients' attitudes. This would be the method to identify information problems and conditions influencing the contact between parents and staff. A constructive parental attitude to the staff is in fact necessary for successful guidance and psycho-social care, tasks of great significance for child health care in our type of community.
Morbidity among Female Alcoholics
Authors: Medhus Asbjörn
Published: July 2017

With data from the public health insurance societies, 71 female alcoholics were studied for a period lasting from the sixth year before, to the fourth year after the first compulsory treatment by the Temperance Board. The control group consisted of 71 women, matched for age. The disability rate for the proband group rose markedly up to the year before the intervention, reflecting principally an increasing frequency rate. At the same time, the proportion not sick among the probands decreased markedly. The increase in the disability rate represented mainly the diagnostic categories accidents and mental disorders. During the last five years of the observation period, no other changes occurred concerning the morbidity. However, the proportion not insured for daily allowance, i.e. those in class 0 and those with disability pensions, showed a somewhat different pattern: an increase after the compulsory intervention. Three probands developed tuberculosis of the lungs during the observation period—about thirty times the expected incidence.
A New Method for Investigating the Relation between Change and Initial Value in Longitudinal Blood Pressure Data: I. Description and Application of the Method
Authors: Svärdsudd Kurt , Blomqvist Nils
Published: July 2017

The relation between change and initial value is of great interest in longitudinal studies. With variables containing random errors (short-term intra-individual variations and measurement errors) the directly computed relation is however, biased by the regression towards the mean phenomenon. Earlier proposed solutions of the problem are unsatisfactory. In this paper the regression towards the mean phenomenon is described and a new method is proposed by which the error caused by the regression towards the mean is avoided. The method is applied to a set of longitudinal blood pressure data. It is shown that the observed, biased relation in this case is significantly negative, while the correct relation obtained with this method is significantly positive. Since random errors are present in most biological variables, similar erroneous conclusions may easily be drawn also in other cases if the regression towards the mean phenomenon is not corrected for. In this analysis, random errors constitute 65–80% of the observed blood pressure change. To reduce this dominance, recommendations about study design for future studies of change/initial value relationships are given.
A Multiphasic Screening Programme at the Health Centre Level: the Säkylä-Köyliö Project: Variables, Methods and Participation
Authors: Takala Jorma , Sievers Kai , Takala Anneli
Published: July 2017

The Säkylä-Köyliö Project concerned the investigation and evaluation of different screening programmes and the possibilities for providing the necessary treatment and follow-up at the health centre level. The variables studied consisted of anaemia, bacteriuria, high blood pressure, and mental health problems; an epidemiologic screening for sight and hearing defects and diseases of the musculoskeletal system was carried out as well. The use of health services, together with the relationships between objectively and subjectively determined morbidity, was also studied. A total of 2268 inhabitants of the municipalities of Säkylä and Köyliö, i.e. 93.2 % of the 40-to 64-year-old female population and 93.4% of the males in the same age range, participated in the screening programme conducted by the Säkylä-Köyliö Project between 9 September 1973 and 11 January 1974. Only one-fifth (1.9%) of the non-respondents to the first invitation (8.6%) participated in the screening programme after they received a second invitation. This result demonstrates that those who do not participate for some reason cannot, to any great extent, be influenced by a renewed invitation. Since the non-participation rate was insignificant, the material examined may, from the epidemiologic point of view, be considered as representative of the middle-aged population of the two municipalities, which together form a health centre district in Southwest Finland. The high participation percentage also shows that the prerequisite of screening, namely, a positive attitude on the part of the population, was as well fulfilled in the present project.
Child Traffic Accidents: An Investigation of Accident Factors
Authors: Wallin Johan A.
Published: July 2017

With the aim of examining accident factors in detail, 124 children aged 0–14 years were investigated; these comprised 90.5% of all children in the Odense area who in 1974 collided with a motor vehicle either as pedestrian or cyclist, and were seen at the casualty ward, Odense University Hospital. There were 82 boys and 42 girls, 64 cyclists and 60 pedestrians. 56.6% of accidents occurred in residential areas on roads with light traffic. 58% of bicycle accidents occurred at junctions, 61% of pedestrian accidents on a straight stretch of road. In 76.6% of pedestrian accidents the child suddenly ran out into the road. 42% of accidents occurred on the way home, only 21% occurred on the way from home. 19.8% of accidents involving school-age children occurred on the way to or from school. In 49.2% of accidents the child was accompanied by other children, only in 10.5% of accidents by an adult. The majority of pedestrians aged 5 or over and the majority of cyclists aged 7 or over had been given permission to go alone in traffic. Playing was found to be a factor in 9.7% of the accidents. The most common accident situation for pedestrians was found to be: stepped out in front of or from behind a parked car; for cyclists: left-hand turn in front of oncoming vehicle (Denmark has right-hand traffic). The most important single accident factor was perception-hindering elements: hedges, parked cars, etc. were causal factors in 38.7% of accidents.
Incidence and Prevalence of Ischaemic Heart Disease among Urban Busdrivers in Copenhagen
Authors: Netterstrøm Bo , Laursen Peter
Published: July 2017

A 5-year follow-up study was conducted among all male busdrivers in Copenhagen, Denmark, in addition to a cross-sectional study. In the follow-up study, the SMR for death due to ischaemic heart disease (ICD 410–414) was 144 and SMR for first clinical episode of acute myocardial infarction (ICD 410) was 139, with men in Copenhagen as controls. 80% of the busdrivers (1396 men) participated in the cross-sectional study. The prevalence of questionnaire-positive angina pectoris was 4.9%; in all age groups this was higher than among the controls, locomotive drivers in Denmark. The high health-related selection of bus-drivers is assumed to cause an underestimation of the relative occurrence of ischaemic heart disease. Possible explantions for the findings in this study are discussed.
Excess Mortality among Male Unskilled and Semi-Skilled Workers
Authors: Lynge Elsebeth , Jeune Bernard
Published: July 2017

Mortality for male unskilled and semi-skilled workers in Denmark, Norway, and England and Wales is 40–50%—about the average for all men with equivalent economic status in the younger age groups, but declines towards the average at pensionable age. The negative slope of the graph for relative mortality with age would seem to be due to an excess mortality deriving from accidents and violent deaths predominantly in the younger age groups, to an unfavourable recruitment into the labour force, health-wise, to an exclusion of older, unhealthy persons from the labour force and to a mortality from circulatory diseases almost equal to the average for other social groups. Finally, movements between social groups should be taken into account in the analysis of mortality differences.
Occupational Morbidity Based on Social Insurance Records in Finland
Authors: Vinni Kari
Published: July 2017

Daily allowances and invalidity pensions were studied in order to identify morbidity differences between different occupational groups. The highest age-standardized number of daily allowances was found in ‘industry’ (males 257/1 000, females 373/1 000), and the lowest in administration (males 116/1000, females 170/1 000). The greatest number of new invalidity pensions for males was also in industry (20.3/1 000), and was 2.9 times as high as in administration. The greatest number of invalidity pensions to females was found in agriculture (18.3/1 000), and was 2.8 times as high as administration. These invalidity pension and daily allowance data measure the morbidity, which is closely associated with socio-economic development and the advances made in the insurance system of the country. Occupational differences in invalidity pensions and daily allowances can be affected by differences in working conditions or by differences in social conditions and life style. The morbidity differences are also affected by selection and survival processes. However, there were also real morbidity differences between occupational groups even after adjusting for bias and errors.
Smoking among Schoolteachers in Estonia 1980
Authors: Raudsepp Jyri , Rahu Mati
Published: July 2017

In the autumn 1980 schoolteachers in the Estonian SSR received a questionnaire concerning smoking habits and attitudes to health risks related to smoking. Responses were received from 8347 teachers (82% response rate). Of the 1336 men studied, 40% were current smokers and 15% ex-smokers. Of the 7011 women, 11% were current smokers and 4% ex-smokers. Among men in the age groups below 30, 30–39, 40–49, 50–59 and above 59 years the percentages of current smokers were 44, 44, 36, 38 and 45, respectively. For female schoolteachers the corresponding figures were 20, 15, 7, 6 and 2. There were no differences in the rates of smoking between Estonian (40% current smokers) and Russian (40%) men. Among Estonian females there were more current smokers (13%) than among Russian females (5%) studied. Of male schoolteachers who were current smokers, 92 smoked cigarettes only; among females this percentage was 99. Two percent of male and 15% of female cigarette smokers smoked a few cigarettes per month; the proportions of heavy smokers (20 or more cigarettes per day) were 10% and 1%, respectively. The belief that smoking is associated with coronary heart disease, lung cancer, chronic bronchitis and lung emphysema was more widespread among ex-smokers and non-smokers as compared with current smokers.
Dealing with the Exposure Variable in Occupational and Environmental Epidemiology
Authors: Axelson Olav
Published: July 2017

Whereas the outcome variable in epidemiologic research is usually well-defined, the exposure is more diffuse, complex and variable, involving components of both intensity and duration. Usually, the time integral of the intensity has been used as a measure of exposure, e.g. working level months, fibre-years, etc. Toxicological models have suggested, however, that greater importance should be accorded to early exposure in cancer epidemiology, while the recent exposure may be more important as regards the development of some other types of disorders. A simplified approach in cancer epidemiology would be to consider the exposure within a time-window or otherwise allow for induction–latency time. For the practical assessment of exposure, so-called job exposure matrices might be of value, especially if recall bias is suspected, but on the other hand, there is rather little objective indication in the literature that serious recall bias is a major problem in case-referent studies.
Self-Reported Data on Spontaneous Abortions Compared with Data Obtained by Computer Linkage with the Hospital Registry
Authors: Heidam Lene Zeuthen , Olsen Jørn
Published: July 2017

In a study of occupational causes of spontaneous abortions, based upon self-reported data and data from the hospital registry, evidence of differential misclassification was noted. Among those exposed a larger proportion of the self-reported spontaneous abortions were identified in the hospital registry, compared with what was found in the control group. This could be due to recall bias of the questionnaire data masking an effect of exposure, or a lower threshold for hospitalization among those exposed vis-à-vis controls, which would exaggerate the effect of exposure, if any. The analysis tended to support the idea of a less accurate recall of spontaneous abortions among controls, especially for abortion that occurred more than 3 years before the questionnaires were sent out. A second questionnaire was sent out to a subset of the participants 3 1/2 years after the first questionnaire. 17% reported fewer spontaneous abortions in this second questionnaire compared with the situation in the first questionnaire, for the period 1973 to 1980.
Morbidity among Self-Employed Farmers in Norway
Authors: Almås Reidar , Ødegård Jørn
Published: July 2017

A health survey among 923 self-employed Norwegian farmers was carried out in 1982 to investigate the state of non-hospital morbidity in the agricultural community. 85% of the nation-wide representative sample of active farmers answered the questionnaire. A disease was recorded, according to the International Classification of Diseases (ICD, 8th revision), when the farmer had (1) been confined to bed/had reduced activity, or (2) had consulted a medical practitioner, or (3) used medication, all during the last 14 days. (4) Congenital diseases were also recorded. The following findings were elicited:

– 56% of all morbidity came under the three headings cardiovascular diseases, musculoskeletal diseases, injuries – the incidence of cardiovascular diseases is rising in spite of the reduced average age of the agricultural population – within agriculture the following groups have the highest work-related morbidity: full-time farmers, grain-growing farmers, those farmers who have the greatest daily work load, and farmers who are physically exhausted at the end of the day.
Factors Associated with Changes in Body Weight during a Five-Year Follow-Up of a Population with High Blood Pressure
Authors: Tuomilehto Jaakko , Jalkanen Laura , Salonen Jukka T. , Nissinen Aulikki
Published: July 2017

In 1972 a cardiovascular disease prevention programme was started in North Karelia in Eastern Finland. At the outset of the programme a random sample comprising 10 940 persons aged 25 to 59 years was studied. Those subjects whose systolic blood pressure was ≥175 and/or diastolic ≥100 mmHg or who were undergoing antihypertensive treatment, were re-examined in 1977. Their body weight was measured both in 1972 and 1977. The changes in their physical activity, smoking and eating habits were also interviewed. The men aged 25 to 49 years had increased their body mass index by 0.4 kg/m2 and the men aged 50 to 59 years by 0.2 kg/m2, on average. In women (aged 25 to 49 years) body mass index had increased by 0.5 kg/m2 but decreased in the age group 50 to 59 years by 0.2 kg/m2, on average. In men the change in body weight exerted the strongest partial regression on the change in smoking, age and physical activity (both in leisure time and at work). In women aged 25 to 49 years the reasons for increased body weight were the same as in men. In older women, aged 50 to 59 years the decrease in body weight was associated with age, change in amount of smoking and initiation of antihypertensive drug therapy.
Differences in Height between Socially more and Less Privileged 10 year old Stockholm Children Born in 1933–1963
Authors: Cernerud Lars
Published: July 2017

The change of the difference in height between two socially extreme groups of 10 year old Stockholm children born in 1933, 1943, 1953 and 1963 was analysed. Data on height and social conditions were taken from the school health records. The two groups were established on the basis of the father's occupation and the number of children in the family. The height of the 10 year old children in the more privileged group born in 1933, 1943 and 1953 was virtually unchanged, but the height in the less privileged group increased gradually. The difference between the two groups was levelled out in the 1953 cohort. However, it reappeared in the 1963 cohort, mainly as a result of increasing height in the more privileged group and fairly unchanged height in the less privileged group.
Management of Occupational Risk to Reproduction in a Danish County
Authors: Larsen Anders I. , Schaumburg Inger , Larsen Anni L.
Published: July 2017

In Denmark pregnant women are entitled to receive maintenance allowances if the working conditions are suspected to be harmful to the fetus. The aim of the study was to evaluate these preventive measures taken to reduce occupational hazards to reproduction in Denmark. In 1985 1,247 pregnancies were identified in Ribe county during a 6-month period. Three hundred and fortyfive women employed at the beginning of the pregnancy in manufacturing industries, construction work, health services, or agriculture were interviewed by telephone concerning their working conditions and the measures taken to reduce possible occupational risks. The response rate was 85%. On the basis of the interviews the risks and the preventive measures were assessed. Out of 200 women who had no changes in the working conditions during pregnancy, 46 (23%) had a working situation which was considered potentially harmful. For 57 the working situation was changed during the first months of pregnancy because of an assumed risk. The remaining 37 were out of work or received maintenance allowances because of occupational hazards. In this study a greater awareness than expected about possible occupational risks was found, but in some instances occupational risks were overlooked or neglected.
Physicians and Alternative Medicine – An Investigation of Attitudes and Practice
Authors: Lynöe Niels , Svensson Tomas
Published: July 2017

In the present paper, the attitudes of three different groups of physicians toward treatment with alternative medicine have been investigated. One of the groups studied consisted of randomly selected licenced physicians from the Swedish National Board of Health and Welfare. The other two groups conprised two different associations of physicians involved with alternative medicine. One third of the former groups were positively disposed toward one or more of the alternative medical technologies, while the latter groups were more positive toward alternative medicine in general. Attitudes, along with motives for such interest, varied depending on the orientations of the different interest groups. The most common motives for expressing interest in alternative medicine included a feeling of clinical powerlessness in the face of certain problems for which patients consult a physician, and a dissatisfaction with the scientific approach of academic medicine. A minority stated that their interest in alternative medicine pre-dated their medical education. Physicians' interest in alternative medicine can be understood both as a critical reaction to academic medicine and as evidence that some alternative medical technologies are effective. Hence there is a need to determine whether there are shortcomings to be found in academic medical education and scientific ideals, and also to assess alternative medical technologies at regular intervals.
Drug-Induced Lupus Due to Phenytoin
Authors: Siragusa Robert J , Ramos-Caro Francisco A , Edwards N Lawrence , Flowers Franklin P
Published: July 2017

Objective:

To report a case of lupus erythematosus induced by long-term use of phenytoin and to discuss the clinical aspects of drug-induced lupus.

Case Summary:

A 67-year-old white man who had been taking phenytoin for approximately 15 years was hospitalized due to fever, pericarditis, severe abdominal pain, malaise, and weight loss. Laboratory studies revealed a positive antinuclear antibody assay in a titer of 1:80 in a homogeneous pattern, a strong positive antihistone antibody test, an elevated erythrocyte sedimentation rate (115 mm/h), and neutrophilia (20,800 cells/mm3). All symptoms and signs disappeared, and the laboratory abnormalities returned to normal within a few weeks after discontinuing phenytoin. The patient was not rechallenged.

Discussion:

Drug-induced lupus has been reported to typically occur within a few years after starting the medication responsible. Musculoskeletal complaints are the most common manifestations of drug-induced lupus. Pleural effusions, pericarditis, and pulmonary infiltrates have also been reported. Cutaneous findings are uncommon, and renal involvement is rare.

Conclusions:

Our case is unusual in that the patient had been taking phenytoin for approximately 15 years before developing lupus.
Influence of Storage at Low Temperatures on the Aerosol Output from Metered-Dose and Dry-Powder Inhalation Devices
Authors: Ramón Mercedes , Juan Gustavo , Torrejón José M , Martí-Bonmatí Ezequiel , Cortijo Julio , Morcillo Esteban J , Marín Julio
Published: July 2017

Objective:

To determine whether storage at low temperatures affects the drug delivery efficacy of a chlorofluorocarbon (CFC)-free aerosol and a dry-powder inhaler (DPI).

Design:

Aerosol output from a CFC-free hydrofluoroalkane (HFA-134a) metered-dose inhaler (albuterol) and a multidose DPI (terbutaline) were examined at different ambient temperatures and canister loads.

Results:

After the HFA-134a formulation was stored at low temperatures for 24 hours, a small decrease of aerosol output (2.1–2.7% at 0 °C, 5.0–8.0% at −10 °C; p < 0.05 from 22 °C) was observed. In addition, the aerosol output from devices with one-half or one-fifth the initial content was marginally decreased compared with output from inhalers with full content. Image analysis techniques applied to fully formed aerosol plume emitted from the HFA-134a formulation showed that the product could still be aerosolized at 10 °C, but there was a reduction of the distance reached by the aerosol. In contrast, condensed droplets markedly altered the aerosols formed from CFC inhalers at −10 °C. Aerosol output from the DPI apparently was not altered following 24-hour storage at −10 °C.

Conclusions:

Aerosols emitted by the HFA-134a and DPIs studied were less affected by exposure to cold temperatures compared with those from marketed CFC devices.
Rifapentine: Its Role in the Treatment of Tuberculosis
Authors: Temple Mary E , Nahata Milap C
Published: July 2017

Objective:

To review the pharmacokinetics, efficacy, adverse effects, and cost of the newest antitubercular drug, rifapentine.

Data Sources:

A MEDLINE search using key terms such as rifapentine, rifampin, isoniazid, Mycobacterium tuberculosis, and pyrazinamide was conducted for the time period 1966-November 1998.

Study Selection:

Animal data were used for basic information and human studies were selected for inclusion if they were randomized, controlled studies assessing efficacy, or if they were single- or multiple-dose studies assessing the pharmacokinetics of rifapentine. Background articles on the pathophysiology of tuberculosis and cost of care and noncontrolled studies assessing drug interactions were also included.

Data Synthesis:

Compared with an oral solution, the relative bioavailability of rifapentine is 70% following oral administration of tablets. Food increased bioavailability by 55%. Rifapentine accumulated significantly in human macrophages, and its elimination half-life was longer than that of rifampin. Comparative studies of rifapentine and rifampin in humans during intensive- and continuation-phase treatment of tuberculosis suggest that at currently accepted doses, rifapentine was slightly less effective than rifampin. The most significant drug interaction with rifapentine involves indinavir. Adverse events of rifapentine may occur less frequently at the currently recommended 600-mg dose compared with rifampin; however, the difference was not statistically significant. If only drug costs were evaluated during the six-month treatment of tuberculosis, rifapentine is more expensive than rifampin.

Conclusions:

Rifapentine can be administered twice weekly during the intensive phase of tuberculosis treatment and then once weekly during the continuation phase of treatment. This may improve patient adherence over some other treatments and possibly reduce costs of treatment by preventing development of resistant tubercular strains due to non-adherence. Rifapentine is well tolerated, with most patients experiencing adverse effects at a similar rate as rifampin. Rifapentine induces cytochrome P450 somewhat less than rifampin, although few drug interaction studies have been done with rifapentine. Its efficacy at the currently approved dosage of 600 mg may be slightly lower than that of rifampin. Studies are needed to determine whether equal or greater efficacy can be achieved with higher doses of rifapentine. Rifampin is less expensive than rifapentine. Further pharmacoeconomic studies are needed to evaluate costs of relapse and failure in patients receiving these agents.
Economic Outcomes of Risperidone in Comparison to Typical Neuroleptic Agents for Treatment-Resistant Psychosis: A Community-Based Study
Authors: Ghaemi S Nassir , Kirkwood Cynthia K , Sambur Marinie R , Ko James Y , Howden Kimberly L , Duong Quynh-Van , Goodwin Frederick K
Published: July 2017

Objective:

To compare the costs of treatment for psychosis with risperidone and typical neuroleptics in severely ill outpatients treated in a community mental health setting.

Methods:

This was an open, retrospective, controlled cohort comparison of actual costs of psychiatric treatment in a group of 17 patients treated with risperidone for psychotic disorders and 15 typical neuroleptic-treated controls matched for severity of illness. Assignment to the two groups was nonrandomized, and outcome data were gathered for the duration of the study for each subject, with dropouts included.

Results:

Risperidone use did not lead to increased treatment expenses compared with typical neuroleptic use in a mean of approximately nine months follow-up. The median overall cost per patient per year was $2,703 in the risperidone group, compared with $2,551 in the typical neuroleptic group (p = 0.64). Increased drug costs (mean expenses per patient per year: $1,631 for risperidone vs. $357 for typical neuroleptics; p = 0.005) were offset by reduced expenses due to decreased hospitalization rates (mean expenses per patient per year: $1,379 for risperidone vs. $3,920 for typical neuroleptics; p = 0.04). Use of other outpatient services did not significantly differ between the two groups.

Conclusions:

Use of risperidone led to lower hospitalization rates in this severely ill sample and did not lead to greater overall expense than typical neuroleptic use.