bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital ethics committees in Israel: structure, function and heterogeneity in the setting of statutory ethics committees
Authors: Wenger N S , Golan O , Shalev C , Glick S 
Published: July 2002

Objectives:Hospital ethics committees increasingly affect medical care worldwide, yet there has been little evaluation of these bodies. Israel has the distinction of having ethics committees legally required by a Patients' Rights Act. We studied the development of ethics committees in this legal environment.Design:Cross-sectional national survey of general hospitals to identify all ethics committees and interview of ethics committee chairpersons.Setting:Israel five years after the passage of the Patients' Rights Act.Main measurements:Patients' rights and informal ethics committee structure and function.Results:One-third of general hospitals have an ethics committee, with committees concentrated in larger facilities. Hospitals without committees tended to lack any structure to handle ethics issues. Committees tend to be interdisciplinary and gender-mixed but ethnic mix was poor. Confidentiality is the rule, however, legal liability is a concern. One-third of patients' rights ethics committees never convened and most committees had considered fewer than ten consults. Access to the consultation process and the consultation process itself varied substantially across committees. Some patients' rights ethics committees attempted to solve cases, others only rendered decisions. Informal committees often refused to consider cases within Patients' Rights Act jurisdiction.Conclusions:Despite statutory requirement, many Israeli patients and clinicians do not have access to ethics committees. The scant volume of cases shows serious discrepancies between practice and Patients' Rights Act regulations, suggesting the need for education or revision of the law. Heterogeneity in committee function demonstrates need for substantial improvement.
Lung function prediction equations derived from healthy South African gold miners
Authors: Hnizdo Eva , Churchyard Gavin , Dowdeswel Rob 
Published: July 2002

OBJECTIVESTo estimate lung function prediction equations and to identify appropriate normal reference values for the population of about 250 000 of South African gold miners.METHODSData from a lung function screening programme conducted at a large South African gold mine from 1994 to 1998 were used to estimate the lung function prediction equations. The most reliable period of lung function testing was identified in a previous study of a temporal pattern in reliability, and lung function tests from this period were used. Miners with a history of pulmonary tuberculosis or with radiological abnormalities were excluded from the study. The prediction equations were estimated cross sectionally on 15 772 black and 2752 white miners, and published reference equations that fitted most closely the observed data were identified.RESULTSThe estimated prediction equations for forced vital capacity (FVC) are as follows: for black men, FVC (l)=− 2.901−0.025×age+4.655×height; and for white men, FVC(l)=−4.407−0.036×age+ 5.940×height. For forced expiratory volume in one second (FEV1) these equations are: for black men, FEV1(l)=−1.654− 0.30×age+3.665×height; and for white men, FEV1(l)= −2.341− 0.038×age+4.314×height. Units are years for age and metres for height. Knudson's and the European Community of Coal and Steel (ECCS) reference values provided the closest fit to the data on lung function of white miners, but the lower limits of normal from the ECCS equations were the closest to the observed one sided lower 95% confidence intervals (95% CIs). For black miners, reference equations that fitted best were derived by Louwet alon asymptomatic black South African men unexposed to occupational dust. There were significant differences between the two groups of miners in the estimated height adjusted mean lung function values for a 40 year old 1.7 m tall man (220 ml (5.2%) for FVC and 110 ml (3.2%) for FEV1); white men had higher FVC and FEV1, but lower FEV1/FVC ratio. The ECCS reference values scaled by a conversion factor of 0.93 for the FVC and 0.95 for the FEV1provided close fits to the data for black miners, but the rate of decline with age was higher than that in the observed data. None of the linear equations provided a good fit for the 20–29 and more than 55 years old age categories.CONCLUSIONThe ECCS and Knudson equations provided the best fit to the data for white miners, whereas the equations by Louwet alestimated on asymptomatic black South African bank workers provided the best fit to the data for black miners. The ECCS reference values scaled by a factor of 0.93 for FVC and by 0.95 for FEV1provided close fits, but the rate of decline with age was higher than that in the data for black miners.
Lung and bladder cancer among workers in a Norwegian aluminium reduction plant
Authors: Romundstad Pål , Haldorsen Tor , Andersen Aage 
Published: July 2002

OBJECTIVETo investigate the relation between exposure to polycyclic aromatic hydrocarbons (PAHs) and the incidence of lung and bladder cancer among aluminium production workers.METHODSThe cohort comprised 1790 men employed for more than 5 years at a Norwegian aluminium plant contributing 36 587 person-years to the study. Historical exposure to PAHs was estimated by the use of industrial hygiene measurements and by a panel of three people familiar with the industry. Cancer incidence was investigated from 1953 to 1995. The observed cases of cancer among men were compared with expected numbers calculated from national rates for men, and dose-response relations were investigated by internal comparison by Poisson regression with age, period, smoking, and cumulative exposure included in the models. The effect of lagging exposure by 10, 20, and 30 years was also investigated.RESULTThe present study showed no increased risk of urinary bladder cancer or lung cancer with increasing cumulative exposure to PAHs. No significant changes in risk were found for different lag times.CONCLUSIONSDue to the small size of this study, a minor increase in risk could not be excluded.
Investigation of an acute chemical incident: exposure to fluorinated hydrocarbons
Authors: Lyons Ronan A , Wright Dorothy , Fielder Hilary M P , McCabe Michael , Gunneberg Andar , Nash Pam , Routledge Phillip , Rees Huw 
Published: July 2002

OBJECTIVESTo assess whether attendance at the site after an incident in a sewer was associated with symptoms in emergency personnel and whether the prevalence of symptoms was associated with estimated levels of exposure to any chemical hazard.METHODSSymptoms experienced by people attending an incident involving two dead sewer workers suggested the presence of a chemical hazard, before environmental sampling confirmed any toxic agent. Self reported symptoms, estimated exposures, and biomarkers of exposure for likely agents from all 254 people who attended the incident and a referent occupational group matching the 83 emergency personnel who went to the Accident and Emergency department (A and E) in the first 48 hours were recorded. The prevalence of symptoms and concentrations of creatine phosphokinase in serum of the 83 early patients at A and E were compared with their referent occupational group. In all workers who attended the incident, the trends in symptom prevalences and concentrations of creatine phosphokinase in serum were examined by distance from the site and predefined exposure category.RESULTSAmong all workers who attended the incident, symptoms of shortness of breath and sore throat were significantly associated with indirect estimates of exposure but not associated with concentrations of creatine phosphokinase. Freon was detected in two blood samples. The early patients at A and E reported more symptoms than their matched reference group and their median concentrations of creatine phosphokinase were higher.CONCLUSIONSThe association between symptoms and concentrations of creatine phosphokinase with attendance at the site indicated the presence of a continuing hazard at the site and led to extra precautions being taken. Comparison values from the referent occupational group prevented unnecessary medical follow up.
Role of skin prick test and serological measurement of specific IgE in the diagnosis of occupational asthma resulting from exposure to vinyl sulphone reactive dyes
Authors: Park J W , Kim C W , Kim K S , Choi S Y , Kang D B , Ko S H , Won J U , Yang J Y , Hong C-S 
Published: July 2002

OBJECTIVESSome patients with occupational asthma resulting from exposure to reactive dyes have skin reactivity to the causative dyes and specific IgE to reactive dyes have been found in these patients. However, the usefulness of skin prick tests (SPTs) and serological measurement of specific IgE in screening, diagnosis, and monitoring the occupational asthma resulting from exposure to reactive dyes have not yet been assessed. In this study, the clinical validation of SPTs and measurement of specific IgE to vinyl sulphone reactive dyes by enzyme linked immunosorbent assay (ELISA) was evaluated.METHODS42 Patients with occupational asthma from reactive dyes (true positive group) were enrolled. In these the causative reactive dye was confirmed by bronchial challenge test. 93 Asymptomatic factory workers with negative challenge to the reactive dye (true negative group) and 16 unexposed controls with negative challenge to the reactive dye were also enrolled. Skin prick tests were done with 10 mg/ml reactive dye in 0.4% phenol/0.9% saline. IgE specific to reactive dye conjugated to human serum albumin (HSA) was measured with enzyme linked immunosorbent assays (ELISAs).RESULTSNone of the unexposed controls had a positive response to SPTs. The sensitivity (76.2%v53.7%), specificity (91.4%v86.0%), positive predictive value (80.0%v62.9%), and negative predictive value (89.5%v80.8%) of SPTs were higher than those of ELISAs. The mean weal size of reaction to reactive dye was weakly correlated with the ELISA optical density of IgE to reactive dye conjugate in patients with occupational asthma from reactive dyes (n=41,r=0.337, p<0.05). In four patients with occupational asthma from reactive dyes and eight control subjects exposed to reactive dye, IgE specific to reactive dye conjugated to HSA was detected with ELISA even though they showed negative skin reactivity. Six patients completely avoided the reactive dye for a mean (SD) 27.8 (10.3) months, IgE specific to reactive dyes decreased in all six patients (p<0.05) during this time.CONCLUSIONSBoth SPTs and detection of IgE specific to reactive dye in serum samples could be valuable for screening, diagnosis, and monitoring occupational asthma resulting from exposure to reactive dyes. These two tests would complement each other.
Detection of workers sensitised to high molecular weight allergens: a diagnostic study in laboratory animal workers
Authors: Meijer E , Grobbee D E , Heederik D 
Published: July 2002

Objectives: To determine whether results from questionnaires, exposure measurements, and laboratory tests, commonly used in occupational health practice, can predict the presence or absence of sensitisation in workers exposed to high molecular weight (HMW) allergens. The study aims to develop and validate a diagnostic rule to predict sensitisation in laboratory animal workers. The main reason for such research is efficiency.Methods: Baseline data from 551 laboratory animal workers participating in an ongoing cohort study, bridging a period of 3 years, were used for diagnostic research. Data from 472 workers participating in the study during the first period were used to develop a prediction rule; these workers represented the derivation set. Data from 79 workers, participating during the second period, were used to evaluate the rule's performance—the validation set. Serum samples were analysed for specific immunoglobulin E (IgE) antibodies against common and laboratory animal allergens. Questionnaire items, exposure determinants, IgE serology, skin prick tests (SPTs), and lung function tests were analysed, corresponding to diagnostic investigation, in a multiple logistic regression model. The accuracy of the model was evaluated by receiver operating characteristic (ROC) curve analysis, and by comparison of the predicted and observed prevalences.Results: Asthmatic symptoms, (work related) allergic symptoms, sex, occupational exposure to rats, and a positive SPT to common allergens, showed the best performance in discriminating workers at high or at low risk of being sensitised.Conclusion: High and low risk categories for work related sensitisation can be distinguished from simple questionnaire data and SPT results. The method can easily be applied in occupational medical practice and may markedly increase the efficiency of occupational health surveillance in laboratory animal workers as well as other workers exposed to HMW allergens.
Psychomotor performance and subjective symptoms at low level toluene exposure
Authors: Zupanic M , Demes P , Seeber A 
Published: July 2002

Objectives: Possible effects of long term occupational exposure to toluene below the level of 100 ppm on psychomotor performance and subjective symptoms were investigated in a cross sectional approach.Methods: From German rotogravure printing plants 278 male workers, mean age 39.8 years, mean duration of employment 14.9 years, were examined. A mean lifetime weighted average exposure (LWAE) of 45.1 ppm toluene in ambient air was found for 154 exposed workers (rotogravure printing area), with a mean current exposure of 24.7 ppm. The corresponding data for a second group of 124 workers with very low exposure (endprocessing area) had LWAE of 9.3 ppm and a current exposure of 3.3 ppm toluene. Psychomotor performance (steadiness, line tracing, aiming, tapping, and peg board) and subjective symptoms were examined.Results: No significant differences between the two exposure groups were found by analysis of variance (ANOVA). By stepwise linear regression analyses there were weak associations of LWAE with one performance variable and two symptoms scales, but the results were not significant after correction for the α error. Psychomotor performance was mostly affected by age (maximum explained variance up to 13%), and handedness (up to 9%), whereas subjective symptoms are mostly affected by anxiety (up to 38%).Conclusions: The weak associations between long term exposure to toluene should be used to indicate further longitudinal investigations. The results of this cross sectional study show no obvious dose response relation for psychomotor functions and subjective symptoms among workers exposed to toluene at a current exposure level of 1–88 ppm.
Permanent pacemaker insertion in a district general hospital: indications, patient characteristics, and complications
Authors: Eltrafi A , Currie P , Silas J H 
Published: July 2002

Abstract
This report reviews the experience of permanent pacemaker insertion in a district general hospital (catchment population of 350 000) and makes a comparison with the national database and other hospitals in the UK.

Methods
The records of all patients receiving a permanent pacemaker in the inclusive period January 1996 to December 1998 were reviewed. Data collected included number of patients paced each year, age, sex, indications, and complications.

Results
In the three years reviewed 200 patients received new permanent pacemakers, a rate of 190 per million population per year, which is similar to the national implantation rate of permanent pacemakers but lower than that of most European countries (see discussion). The majority of patients paced were elderly (75% were above the age of 70 years).
Atrioventricular block (including complete heart block, 45%, and Mobitz type 2 block, 12.5%) was the commonest indication for permanent pacemaker insertion, followed by sick sinus syndrome (25%) and these findings are comparable to those reported previously. However, carotid sinus syndrome was responsible for 16% of the patients paced and this was higher than that reported in the national database (6.5%). Only 1% of the pacemaker modes used was inappropriate and the complication rate was low at 3%.

Conclusions
This report confirms that permanent pacemaker insertion can be effectively and safely provided locally for the increasingly ageing population. The implantation rate both locally and nationally is still much lower than that of some countries in Europe.
Pharyngeal pouch (Zenker's diverticulum)
Authors: Siddiq M A , Sood S , Strachan D 
Published: July 2002

Abstract
Pharyngeal pouches occur most commonly in elderly patients (over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. The aetiology remains unknown but theories centre upon a structural or physiological abnormality of the cricopharyngeus. A diagnosis is easily established on barium studies. Treatment is surgical via an endoscopic or external cervical approach and should include a cricopharyngeal myotomy. Unfortunately pharyngeal pouch surgery has long been associated with significant morbidity, partly due to the surgery itself and also to the fact that the majority of patients are elderly and often have general medical problems. External approaches are associated with higher complication rates than endoscopic procedures. Recently, treatment by endoscopic stapling diverticulotomy has becoming increasingly popular as it has distinct advantages, although long term results are not yet available. The small risk of developing carcinoma within a pouch that is not excised remains a contentious issue and is an argument for long term follow up or treating the condition by external excision, particularly in younger patients.
Prevalence and correlates of smoking on the roof of the world
Authors: Shah Syed MA , Arif Ahmed A , Delclos George L , Khan Asif R , Khan A 
Published: July 2002

OBJECTIVETo determine the prevalence and correlates of cigarette smoking among adults in high mountain rural areas of northern Pakistan.DESIGNCross sectional survey.PARTICIPANTSA sample of 4203 adults (aged 18 years and over) were selected by stratified random sampling from 16 villages.MAIN OUTCOME MEASURESelf reported smoking prevalence; age of smoking initiation; daily cigarette consumption and association between current smoking and sociodemographic variables, use of snuff, wine, body mass index, blood pressure, family history of stroke, and hypertension.RESULTS614/1406 men (43.7%) and 154/2797 (5.5%) women reported smoking cigarettes. The age standardised prevalence of smoking was 40.5% for men and 6.3% for women. Men were more likely (odds ratio (OR) 6.5, 95% confidence interval (CI) 4.75 to 8.79) to be smokers. Smokers were more likely to use snuff (OR 1.39, 95% CI 1.12 to 1.73), drink wine (OR 3.47, 95% CI 2.81 to 4.29), and were more likely to work as farmers (OR 1.55, 95% CI 1.05 to 2.29) or shopkeepers (OR 2.63, 95% CI 1.67 to 4.14). Individuals with college level education and with desirable body mass index were less likely to smoke (OR 0.55, 95% CI 0.35 to 0.87; OR 0.74, 95% CI 0.57 to 0.96).CONCLUSIONCigarette smoking is a major public health problem in this high mountain community of Pakistan, particularly among the male population, the majority of whom begin to smoke quite early in life. A comprehensive tobacco control effort incorporated into the existing community based health infrastructure is needed.
The price of cigarettes in the European Union: Table 1
Authors: Montes Agustín , Villalbí Joan R 
Published: July 2002

BACKGROUNDA major factor influencing tobacco use is its price. Fiscal policies on tobacco are a key ingredient of any comprehensive control strategy, as they can be used to raise prices. The European Union (EU) developed directives to ensure some harmonisation of the fiscal pressure on tobacco across its member states.OBJECTIVESTo provide a simple comparison of tobacco prices in the EU, adjusting for the purchasing power of each currency.DESIGNFor price comparisons, a 20 units pack of Marlboro was the reference product, and data refer to April 2000. Purchasing power parities (PPP) for each member state currency have been compiled. These are currency conversion rates, which convert to a common currency and equalise the purchasing power of different currencies.MAIN OUTCOME MEASURESNominal prices of a Marlboro pack for each member state, and a price index, estimated taking as reference the EU mean. Adjusted prices and an adjusted price index have been estimated using PPP.RESULTSNominal prices show wide variation, with the cheapest pack in Portugal (59) and the most expensive in the UK (196); the range of variation is three-fold. However, PPP adjusted prices reveal a different distribution. In three countries adjusted prices are outliers, but all other countries make two clusters, one around the average EU index of 100, the other around a lower value of 85.CONCLUSIONSThese results suggest that fiscal harmonisation policies in the EU do not have an even effect at reducing availability by its impact in price.
State variation in retail promotions and advertising for Marlboro cigarettes
Authors: Slater Sandy , Chaloupka Frank J , Wakefield Melanie 
Published: July 2002

BACKGROUNDThere is some evidence that tobacco companies marketing efforts undermine the effects of comprehensive tobacco control programmes.OBJECTIVETo determine whether point-of-purchase advertising and promotions are more pervasive in states where comprehensive tobacco control programmes are underway.DESIGNCross sectional survey using 1996 data, with merged records of the existence of local tobacco advertising restrictions.PARTICIPANTS AND SETTING581 tobacco retail stores located in close proximity to high schools in mainland USA.MAIN OUTCOME MEASURESExistence of gift-with-purchase, number of interior advertisements, and exterior store advertisements for Marlboro cigarettes.RESULTSAfter controlling for store type and existence of advertising restrictions, offer of a gift-with-purchase for Marlboro cigarettes was significantly more likely in states with comprehensive tobacco control programmes than those without programmes (odds ratio 2.59, 95% confidence interval 1.57 to 4.26). Although not significant, results show an increase in the number of interior and exterior store advertisements for stores located in states with a comprehensive tobacco control programme than those in other states.CONCLUSIONResults suggest some point-of-purchase tobacco promotions and advertising are more pervasive in states with comprehensive tobacco control programmes. These efforts are likely to act against the objectives of programmes and need to be accounted for in programme evaluations.