natgillin/translations-raw huggingface dataset:
Ideen i hele opgørelsen er den simple, at hvis eksponeringen giver kræft, så skulle man forvente en større andel af kræftdødsfald blandt alle døde i den eksponerede gruppe.
The idea is that if a given exposure causes cancer, for example, then more people would die of cancer among the exposed compared with the nonexposed.
Andelen af kræftdødsfald iblandt de ansatte i Kentucky var faktisk højere end kræftdødeligheden blandt alle dødsfald blandt mænd i USA.
The proportion of cancer deaths in all those who died in the Kentucky example was higher for the vinyl chloride workers compared with the proportion of cancer deaths among all other males.
Hvis f.eks. 40 % af de eksponerede døde af kræft mod 30 % blandt andre døde, så taler det for at eksponeringen fremkalder kræft.
If 40 per cent of all deceased exposed workers died of cancer, compared with 30 per cent among all other males, the argument is in favour of the idea that the exposure caused the cancer.
Det lyder så enkelt, at det næsten må være for simpelt til at være sandt, og der er da også flere metodologiske problemer knyttet til disse undersøgelser.
There are several problems in a study of the PMR type.
Hovedproblemet er, at man kan få en høj procentdel af f.eks. cancerdødsfald, enten fordi eksponeringen giver cancer, eller fordi eksponeringen beskytter mod andre dødsårsager (f.eks. hjerte-kar-sygdomme, hvis de eksponerede har fysisk krævende arbejde).
The main one is that a high proportion of disease-specific mortality may appear either when the exposure is causally related to the disease, or if the exposure prevents other causes of death.
Hvis man f.eks. forestiller sig, at man kunne forebygge alle hjerte-kar-dødsfald, så ville cancerdødeligheden stige (man skal jo dø af et eller andet).
If the job prevents coronary heart disease, the proportion of cancer deaths could increase for that reason alone.
Proportionen af cancerdødsfald ville i givet fald måske være 50% mod nu ca. 25%. Som detektiv står man med et problem.
If you could prevent all coronary heart disease probably 50 per cent or more of all deaths would be cancer deaths compared with the 25 per cent we see now.
Man vil gerne vide, om man har opdaget en forbrydelse eller en godgørende handling.
As a detective you would like to know if you have caught a criminal or a benefactor.
Erhvervsaktive piloter har f.eks. lav dødelighed af hjerte-kar sygdomme, fordi piloter med risiko for hjerte-kar-sygdomme (f.eks. på grund af hypertension) må overgå til andet erhverv.
Active pilots are likely to have a low mortality from coronary heart disease since pilots at high risk of this disease (pilots with hypertension for example) are likely to be moved to other jobs or to be retired prematurely.
Andelen af cancerdødsfald blandt samtlige dødsfald i gruppen af piloter må alene af denne grund forventes at være høj, også selv om piloters cancerrisiko er normal.
The proportion of cancer deaths among active pilots is therefore likely to be high, even if they have a normal risk of having cancer.
Det er disse tolkningsproblemer der gør, at en PMR-under-søgelse kun bør være første led i en undersøgelseskæde.
That is why the PMR study with an interesting result often only initiates a casecontrol study or a follow-up study.
S Den arbejdsmedicinske detektiv
It is worth mentioning that a PMR study need not be a mortality
portionale pensionsårsagsopgørelser.
Searching for Causes of Work-Related Diseases study.
Det følgende eksempel viser resultaterne fra en PMR-under-søgelse blandt ansatte på et fåreslagteri.
Table 5 shows an example of a PMR study in a sheep-dip factory indicating a high cancer risk for the chemical workers.
Andelen af cancer dødsfald efter ansættelse i %
Table 5. Proportion of cancer deaths of males by occupation in sheep-dip factory
Type af ansættelse
Category of employment
Cancerdøde kemisk eksponering
Cancer deaths chemical workers
Modificeret fra: Schilling, R.S.F. (ed). Occupationel health practice. London, Butterworths 1981.
Modified from: Schilling, R.S.F. (ed). (1981).
Monitorering og bogholderi
MONITORING AND RECORD KEEPING
Epidemiologi spiller en vigtig rolle i arbejdsmedicinen, men de epidemiologiske metoder har dog også deres begrænsninger.
Epidemiology has an important role to play in occupational medicine, but there are limitations to epidemiological studies.
På den anden side kræver det, at alle risici kan forudses og det er langt fra tilfældet, selv om den bedste vilje skulle være til ste de.
In studying the effect of occupational exposure on the health of the workers you look at those events which you would want to have prevented.
Visse typer af arbejde vil - også i fremtiden - uventet vise sig at indebære sundhedsfarer for de ansatte.
On the other hand, not all effects on health can be foreseen and no matter how cautious you are, some exposures or some combination of exposures will turn out to be dangerous for the health of workers.
Når det sker er det til gengæld vigtigt, at det bliver opdaget så hurtigt som muligt for at begrænse skaderne mest muligt. Epidemiologien spiller også her en central rolle.
When that happens, they should be detected as soon as possible in order to reduce the damage to a minimum.
Det er utilfredsstillende, at erhvervssygdomme ofte erkendes ved tilfældigheder.
It is unsatisfactory that occupational causes of diseases are often recognized in a haphazard way.
Alt for mange farlige kemikalier har været anvendt uforsigtigt i industrien i alt for mange år, før nogen under søgte deres helbredskonsekvenser.
Too many dangerous chemicals had been around for too many years before anyone studied what happened to the exposed.
Det er ved hjælp af epidemiolgisk monitorering, at skader kan stoppes på et tidligt tidspunkt.
This is where the idea of monitoring comes in.
Ved epidemiologisk monitorering (helst af meget tidlige syg domstegn) etableres der løbende registrering af eksponeringsforhold.
In monitoring, a running system of recording health data (preferably very early signs of health effects) as well as exposure data is set up.
Ved at følge incidensen àf tidlige sygdomstegn blandt eks ponerede får man mulighed for tidligt at registrere, om noget er galt.
By computing the occurrence of disease according to exposure status one hopes to be able to identify at the earliest opportunity if a given set of exposures has an influence on workers' health.
I monitoreringen kan der indsamles forskellige typer af data.
Monitoring can comprise the collection of several different types of data.
Det kan dreje sig om sygefravær, biologiske markører for sygdom eller en regulær sygelighed eller dødelighed. Med hensyn til eks ponering kan det være alt fra blot en erhvervsbetegnelse til f.eks. målinger af bly i blodet.
Data may range from sick leave or early biological markers to death from cancer or on the exposure side, from the name of the department to the level of lead in blood.
Monitorering forudsætter derfor et præcist mål og en idé om, hvordan man når dette mål. Rækkefølgen i monitoreringen kan være:
Therefore monitoring implies a clear objective and the steps to achieve it.
Monitorering må adskilles fra bogholderi med andet formål (lønudbetaling f.eks.). Det er vigtigt ikke at smide oplysninger (spor) væk, der kan give oplysninger om enkeltpersoners eksponeringer, men blot og bar bogholderi betyder ikke at man har et monitoreringssystem. toreringssystem.
Monitoring has to be distinguished from the record keeping of data which serves a different purpose. (For example salary calculation.)
Undertiden indsamles der blot data, der aldrig analyseres. Undertiden analyseres data, men resultaterne får ingen konsekvenser.
Data are frequently collected and then not properly analysed.
Undertiden sættes en handlingsplan i værk, men den bliver aldrig evalueret.
An action can be taken, but its impact never evaluated.
Rutine-dataindsamling i et monitoreringssystem, der aldrig bruges, har tendens til at blive data af dårlig kvalitet.
Unused routine data from monitoring systems are by definition data of low quality.
Og data af dårlig kvalitet kan ofte ikke bruges til noget.
Data of low quality are of little use.
Del II Øveeksempler for den arbejdsmedicinske detektiv
Epidemiology in practice
Eksempler på epidemiologisk tænkemåde inden for arbejdsmedicinen
Examples of epidemiological 'thinking and acting' in the field of occupational health
Nogle af epidemiologiens grundbegreber er gennemgået i første afsnit.
Some of the principles of epidemiological thought have been introduced in Part I. They are mostly simple, common sense ideas.
De fleste er baseret på almindelig sund fornuft. Der kunne skrives meget mere om disse begreber og det er der også gjort.
Of course there is much more to be said about each subject and some techniques will be described in more detail in the glossary.
Det er muligt, at den moderne detektiv har stor gavn af diverse tekniske hjælpemidler i form af edb og kemiske laboratorier. Lige meget ville det dog hjælpe, hvis ikke nogen forbandt alje oplysninger til et brugbart mønster ved hjælp af almindelig logik.
But common sense is the backbone of any study, and these examples illustrate studies which can and often should be conducted by those responsible for workers' health at the local level.
Den 15. april 1965 ringede en mere end desperat virksomhedsleder til den arbejdsmedicinske klinik, og det blev begyndelsen til et sært forløb, der nær endte i tragedie for den lille virksomhed, der var kulissen for begivenheden.
April 15 1965; a phone call from a more than desperate manager to a department of occupational health was the beginning of the end of a puzzling situation that nearly spelled disaster for the relatively small factory that was the scene of this 'drama'.
20 år tidligere - lige efter 2. verdenskrig - startede den nu værende ejers far - sammen med to brødre - virksomheden, der producerede metaldåser af forskellig slags.
Twenty years ago, just after the Second World War, the father of the present manager, together with two of his brothers, set up a small plant where various kinds of metal cans were manufactured.
Ved hårdt arbejde voksede virksomheden til en lille fabrik med et halvt dusin ufaglærte arbejdere.
Through hard work this family business prospered and developed into a small factory, with half a dozen or so unskilled workers.
Imidlertid svigtede efterspørgslen på metaldåser, og det var på tide at skifte til ny teknologi.
However, the demand for metal cans diminished, and it was thought worthwhile to change to a new technology.
I en ny afdeling begyndte man at fremstille plasticdåser.
A second workshop was opened in which 'plastic' boxes were produced.
„Råmaterialet" i denne produktion blev leveret som store plader, der skulle skæres öp og omsmeltes.
The 'plastic' base material was delivered in large sheets to be cut and moulded.
Ejeren og tre af de ansatte tog en uge til Tyskland for at lære teknikken på en større moderne fabrik. Produktionen startede i februar 1965.
The manager himself and three new unskilled workers spent a week learning the technical procedures in a large factory in Germany, and production started at the end of February 1965.
I begyndelsen gik alt glat og alle var tilfredse.
Initially everything went smoothly and the productivity of the workmen was considered quite good.
Det skulle snart ændre sig.
Then things went wrong.
En voldsom influenzaepidemi, der ramte hele landet, ramte også alle de ansatte på den nye, såvel som den gamle fabrik i begyndelsen af marts.
A fierce nationwide epidemic of influenza put practically all the workers in the metal plant as well as the new plastic workshop off work at the beginning of March.
Produktionen gik helt i stå i plasticafdelingen, da både ejeren og de tre ansatte måtte blive hjemme i næsten to uger.
Production almost came to a standstill in the plastic section as all three of the workers and the manager had ta stay at home for nearly two weeks.
Midt i marts var de dog næsten arbejdsdygtige igen.
The three workers finally returned in the middle of March.
Men trængslerne sluttede dog ikke her.
But then, further difficulties arose.
Alle de tre ansatte blev
All three workers in the plastic plant became ill once again.
igen syge og lægen diagnostiserade en ny influenzaepidemi.
Their physicians' diagnosis was 'a new attack of 'flu'.
Efter endnu en uge var de tilbage på arbejdet, men sygdommen vendte igen tilbage; feber, hovedpine, muskelsmerter, hoste, åndedrætsbesvær. Igen skrev lægen influenza på sygemeldingerne.
Back at work, within a week they had the same symptoms of fever, headache, muscular pain, cough, wheezing; once again the sickness 'certificate mentioned influenza.
Ejeren selv slap dog for disse nye tilfælde af influenza, ligesom de nye tilfælde ikke berørte de ansatte på metalafdelingen.
The manager himself, although working in close contact at the same work place, had no relapse, nor had any other worker at the metal plant.
Og dette fortsatte, selv i april måned, hvor ellers ingen andre havde influenza.
And so it went on, even in April, when no single case of 'flu occurred throughout the whole region.
På dette tidspunkt var alle trætte af influenza og bad om hjælp udefra.
At this point the manager asked for advice and help.
Ejeren havde allerede indsamlet visse nyttige oplysninger i et ringbind, der kunne bruges i efterforskningen.
He already had some valuable information on the situation, and he listed the notification of sickness and absence in the two sections of the factory, Table 6.
Tabellerne stammer fra dette ringbind, hvor sygefraværet i de to afdelinger er opgjort.
(1) The regional influenza epidemic began at the end of February and lasted until mid-March.
Sygefravær i marts-april 1965
Table 6. Notification of sickness—absence March to April 1965
Bemærkninger
Number of spells
Antal sygefraværsgange
Number of days sickness
Alt fravær fra 115 marts
AH absences from 1 to 15 March.
Første fravær i første uge af marts.
First spell is first week of March.
De næste i marts-april
Next ones in March/April.
G H I Ejer
April.
Den regionale influenzaepidemi begyndte i slutningen af februar og varede til medio marts. 2.
Epidemiology in practice
Sygefraværet på metalafdelingen blev begrænset til perioden 115 marts. I plasticafdelingen fortsatte fraværet ind i april måned. 3.
(2) The sickness absence in the metal plant occurred from 1-15 March; in the plastic workshop absence went on into April.
Der var altså visse basale oplysninger om „hvem, hvor og hvor når" inden feltundersøgelsen på virksomheden startede.
So, before starting the 'field-study' at the workshop itself, some exact data on who, when, and where were available in this case.
Tilbage stod dog spørgsmål som „hvad skete der" og „hvorfor?"
The remaining important questions were what happened and why?
Det stod klart, at der var afgørende forskelle på metalafdelingen og plasticafdelingen.
It was clear that there was something really different between the situation in the metal plant and the plastic workshop.
Var det virkelig influenzatilfælde, der optrådte igen og igen,, som lægen sagde?
Were those secondary and tertiary "flu'-spells in the plastic workshop really 'flu infections?
Epidemien var jo brændt ud i resten af landet, og hvorfor blev ejeren ikke syg som de andre?
The epidemic in the region was already burnt-out. Why was the manager not affected by the "flu' virus?
Hvad var forskel len på de ansattes arbejdsforhold i de to afdelinger af virksomheder og hvad var forskellen imellem de ansatte og ejeren i plasticafdelingen?
What was so different between the men in the two work situations? What distinguished the three workers from the manager/co-worker?
Det var nødvendigt at se lidt nærmere på arbejdsforholdene i plasticafdelingen.
To find out, the work situation at the plastic workshop itself had to be examined more closely.
Klinikkens folk foretog et uanmeldt besøg, som ordentlige de tektiver gør.
A visit to the plant was arranged without notifying the manager.
Epidemiologen og toksikologen mødte op på virksomheden mandag morgen.
The epidemiologist and the occupational toxicologist of the department of occupational health arrived at the plant on a Monday morning.
Ejeren tog imod dem med kyshånd, men var dog også synligt nervøs over besøgets mulige konsekvenser.
The manager was very enthusiastic but extremely anxious about the possible consequences of the enquiry.
Han viste de besøgende ringbindet på sit kontor, der var et lille aflukket rum, mærket med „ikke-rygning" skilte.
In his office—a small separate room (with a non-smoking notice)—he displayed a summary of the notified sickness absence.
Den plastic, der blev brugt viste sig at være et polymer kaldet teflon - et polyfourinprodukt.
Inquiry about the basic plastic used in the manufacture of the boxes, as indicated on the delivery documents, revealed that it was a polymer called Teflon, a polyfluorine product.
Virksomheden lignede hundredevis af andre små virksomheder.
The plant was typical of numerous other small workshops.
Der var en venlig og familiær omgangstone uden skarpe klasseskel, men arbejdsforholdene var ringe. 10 hårdt arbejdende mænd - inclusive ejeren - arbejdede i de mest triste lokaler.
On the one hand there was a very familiar lively spirit without any strict hierarchy; on the other hand a group of 10 closely-acquainted hard-working people—including the manager—were at work in a gloomy environment.
Dagslyset trængte kun med besvær igennem de små, støvede vinduer. Den elektriske belysning var ikke imponerende.
Natural light filtered with difficulty through small, dust-blackened, side windows; the artificial light was poor.
Og luften var endnu dårligere. Støvpartikler fra gennemsavet plasticmateriale var overalt i luften.
The air quality was even worse.
Ingen brugte åndedrætsværn og der var ingen ordentlig udsugning i lokalet.
No protective devices were in use and no active dust suppression was provided at the work site itself.
Virksomhedens metalafdeling var adskilt fra plasticafdelingen på grund af støjen fra metalproduktionen.
The metal plant was separated from the plastic workshop because of the noise pollution emanating from the metal work.
Så var det toksikologen sagde: „Influenza problemet er løst.
They were not in a hurry and, while explaining how they carried out their job, they could smoke at ease.
Lad os holde et møde". Alle mødtes og toksikologen satte sig for bordenden.
At this point of the visit, the occupational toxicologist said, 'the '"flu-problem" is solved, let's have a meeting with all the workers'.
Virksomhedsejerens ringbind var udgangspunktet for diskussionen.
The notification list of absences and the specific remarks, as included in the original letter referred from the manager, was the starting point for the discussion.
Der efter fortalte toksikologen, at teflonplader i sig selv er ganske ufarlige og inaktive, skønt deres indhold - monomerne og andre additiver - kunne være mere problematiske.
The toxicologist explained that the Teflon sheets as such were completely harmless and inert although their constituents—monomers and other added blending compounds—could be harmful.
Arbejdsprocesserne medførte, som man kunne se, en masse støvpartikler.
The work procedure, as observed in the workshop, however, produced fine particles and dust.
Når disse partikler opvarmes, går depolymerisationen i gang og der frigøres giftige monomer.
When heated, these particles would de-polymerize and release the monomers.
Denne eksponering fremkalder symptomer, der meget ligner influenza.
It is these monomers which produce symptoms very similar to those of influenza.
Alt sammen meget godt sagde den ene ansatte, men støvpartiklerne varmes ikke op.
One of the workmen pointed out that the procedure followed did not involve heating the Teflon.
Toksikologen måtte derefter forklare, at arbejderne selv sørgede for opvarmningen, der fandt sted i deres selvrullede cigaretter. Temperaturen i glødefeltet i disse cigaretter kommer let op på 500° C. Dette forklarede, hvorfor influenzaepidemien kun gentog sig selv i plasticafdelingen og hvorfor ejeren, der ikke røg, slap med første sygefravær.
The chairman explained that the workers were in fact heating it with their self-rolled cigarettes.
Mødet sluttede med at aftale forbedringer af arbejdspladsen med etablering af udsugningsanlæg og andre arbejdsmiljøforbedringer.
That explains why the so called "flu' relapses occurred only in the plastic plant workers and not in workers in the metal plant and why the manager, being a non-smoker, had no symptoms.
Alle andre havde influenza på samme tid og intet tydede på et arbejdsmedicinsk problem. Kun da influenzaepidemien gentog sig flere gange blev det klart at der var et problem, der skulle løses.
Everyone had 'flu so nothing pointed towards a workrelated problem.
me, og gøre det svært at afdække de bagvedliggende årsager. 3.
Epidemiology in practice
Ved at anvende casekontrol teknikken på bare 3 cases og en kontrol, viste det sig at rygning adskilte de syge fra de raske.
Using a casecontrol approach on just three cases and one control pointed toward tobacco smoking as a factor which occurred more frequently among diseased than not diseased.
Rygning samvirkede med støv eks poneringen og denne iagttagelse kombineret med toksikologisk viden løste gåden.
This factor could interact with the polymer fumes. That information combined with toxicological insight and literature reading solved the problem.
De nødvendige forholdsregler blev taget og problemerne blev løst. 4.
Action was taken and the "flu' epidemic disappeared.
Undertiden er det ikke blot en enkelt faktor man skal være opmærksom på, men kombinationen af flere faktorer.
In the work environment it is sometimes not a single exposure but rather a combination of exposures or events that is important.
Derfor er det vigtigt at være på vagt, selv om stofferne har været testet enkeltvis inden de blev taget i brug.
Therefore, it is necessary to monitor or be aware of clustering of diseases, even when chemicals have been properly tested before being taken into commercial use.
En undersøgelse af barnløse mænd
CASE STUDY OF INFERTILITY IN MALES
Vi befinder os i 1977, hvor en kemisk fabrik i USA producerede gødning og pesticider til landbrug og havebrug.
In 1977 a chemical factory manufactured fertilizers and pesticides for agricultural and household use.
I den ene af deling blandede, fortyndede og pakkede de ansatte pesticider indkøbt fra underleverandører.
In the latter process, workers mixed, diluted, and repacked technical-grade pesticides obtained from chemical manufacturers.
Der blev brugt ca. 100 forskellige kemiske stoffer og produceret mere end 200 forskellige produkter, indeholdende blandinger med organfosfat, halogenerede hydrocarboner og carbamates
Some 100 different chemicals were used in the formulation of approximately 200 different products, including organophosphorus compounds, halogenated hydrocarbons and carbamates.
Selskabet havde fra 1962 etableret en særlig landbrugsafdeling med 39 ansatte: 3 ledere, 24 i produktionen, 4 mekanikere, 2 kontoransatte og 6 laboranter.
Since 1962 the company had established a special Agricultural Chemical Division with 39 employees: three supervisors, 24 production workers, four maintenance mechanics, two clerks, and six laboratory workers.
36 var mænd.
Thirty-six of the group were men.
Problemerne
Problem
Inden for de sidste år havde mændene haft en stadigt stigende fornemmelse af, at noget var galt.
In the 1970s the men had become increasingly aware that few of them had recently fathered children.
De prøvede at sætte dette problem i relation til specifikke eksponeringsforhold, men fandt det svært, fordi de havde job rotation.
Searching for Causes of Work-Related Diseases differences in chemical exposure, but found that impossible since they were assigned interchangeably to different work tasks.
Kun ansættelsestiden synes at være en afgørende faktor. 7 ansatte med lang ansættelsestid var alle barnløse.
Only the length of time they had spent in the Agricultural Chemical Division seemed to be a useful measure of exposure.
På fabrikken blev 1,2 Dibromo 3 Chloropropan (DBCP) fremstillet i store mængder.
In the factory, DBCP was manufactured in large quantities.