natgillin/translations-raw huggingface dataset:
Ofte finder man ikke nogen indlysende forklaring på ophobede sygdomstilfælde, og „tilfældighedernes spil" kan synes at være den eneste rimelige forklaring.
Quite often no immediate solution will be found because a clustering of disease could be a purely chance phenomenon.
Den rette holdning er dog at betragte et problem som reelt indtil det modsatte er „bevist" (sandsynliggjort).
But the proper attitude is to assume that the problem is real
Tvivlen må komme de eksponerede til gode. 2.
The exposed should be given 'the benefit of the doubt'.
Simple epidemiologiske redskaber blev brugt til at sætte tal på problemets omfang.
Again simple epidemiological principles were used to quantify the potential problem.
Casekontrol teknikken blev brugt til at belyse mulige årsager ved at sammenligne arbejdsforhold og levevaner blandt kvinder, der aborterede, og kvinder, der fødte. 3.
The casecontrol approach helped to identify possible exposures of interest, by comparing working conditions and other habits and exposures between the women who had spontaneous abortions (cases) and women with normal pregnancies (controls).
Undersøgelsen her var alt for lille til at „bevise" noget, men den gav interessante oplysninger om en ophobning af spontane aborter og igangsatte en egentlig undersøgelse. 4.
The number of women in this study is far too small to 'prove' anything, but it provides an important report of a cluster. A full-scale investigation is certainly called for.
4 aborter ud af 12 graviditeter ses nu og da, selv om man kun skulle vente 1-2.
As mentioned before, only a small number of spontaneous abortions occurred.
Slås der plat og krone 12 gange, får man heller ikke altid 6 plat og 6 krone.
If statistical-significance testing (a test that would state the probability of the excess finding of spontaneous abortions, had it occurred by chance alone) had been performed, no significant result would have been found (no result with such a probability less than 5 per cent).
Husk dog på, at manglende statistisk signifikans ikke er noget bevis på, at „tilfældighedernes spil" er forklaringen, blot at det er en mulighed, der skal tages i betragtning.
However, lack of statistical significance is no 'proof of lack of causeeffect relationships.
Epidemiologer interesserer sig i deres undersøgelser mere for grupper af personer end enkeltpersoner.
Epidemiologists are mainly interested in groups of people rather than in individuals.
Det første led kan bestå i at sammenligne, hvad man har observeret med hvad man skulle forvente i en tilsvarende gruppe af samme størrelse og sammensætning.
Therefore the first part of any epidemiological study will usually be to compare the observed number of cases with what would have been expected in a similar nonexposed group of people.
Er der for mange syge må man søge efter forklaringer. Disse forklaringer kan søges i bias, f.eks. på
If an excess is identified, the next step is to look for its reasons.
grund af selektion, eller på grund af forskelle i levevaner, leve kår, eller lignende (confounding).
Epidemiology in practice
Byssinose og kronisk bronchitis på et hørspinderi
BYSSINOSIS AND CHRONIC BRONCHITIS IN A FLAX-MILL
I januar 1965 blev fagforeningen klar over, at der var helbredsproblemer på to hørspinderier.
In January 1965 a member of a trade union was delegated by his organization to ask for advice on an alleged health problem in two flax-weaving mills.
Da der ikke fandtes nogen bedriftssundhedstjeneste sendte fagforeningen en repræsentant til det nærmeste medicinske fakultet for at bede om råd ved den epidemiologiske afdeling.
As the plants had at that time no organized health service, the workers union took the initiative and made contact with the occupational health department of the nearby medical faculty.
De to spinderier og væverier producerede canvas til telte. De havde været i gang i 15 år.
The two weaving mills processed dry spun flax producing heavy linen canvas for tent material; they had been in operation for about 15 years.
Næsten alle de ansatte havde klager over hoste og åndenød, som de mente skyldtes hørstøv.
Many, but not all, of the workmen in the plant complained of an irritating cough and wheezing which they said was caused by the flax dust.
Også ledelsen klagede, men mest over det høje sygefravær, som især var slemt om mandagen, og den alt for hurtige udskiftning af ansatte.
The plant owners, on the other hand, complained of a disturbingly high absence rate—especially on Mondays—and a huge turnover of staff.
194 af de ansatte havde forladt virksomheden inden for de sidste 15 år.
They produced a list of 194 persons who had left the plant in the last 15 years.
Universitetslægerne var med det samme klar over, at de ansatte havde ret. Åndedrætsproblemerne skyldtes hørstøv.
The physician in the department of occupational health could easily agree with the workers' hypothesis that the flax dust was the cause of the chest complaints.
Det er velkendt at dette støv kan fremkalde den luftvejslungesygdom, der kaldes byssinose.
It is well known that inhalation of flax dust may provoke a specific broncho-pulmonary disease, called byssinosis.
Universitetslægerne aftalte et møde med de ansattes repræsentanter, samt ingeniøren, produktionschefen og direktøren, hvor man blev enige om at undersøge, hvor udbredt lungesygeligheden var blandt de ansatte. Man kunne også enes om, at arbejdsmiljøet skulle forbedres.
The research team organized a meeting with the workers' delegate, the engineer, the chief technician, and the head of administration.
Alle de ansatte på de to virksomheder blev interviewet om deres lungesymptomer og helbredsundersøgt, og 28 ud af 155 ansatte havde byssinose.
All workers at the two mills were questioned about chest complaints and out of 155 workers, 28 were diagnosed as having byssinosis.
Da virksomheden også havde en liste over de 194 ansatte, som havde forladt virksomheden, kunne også de ind kaldes til undersøgelse.
Since the administration had a list of all 194 persons who had left the plant in the last 15 years, it was also possible to study those who had left the factory.
For 52 af de tidligere ansatte kunne man dog ikke finde deres aktuelle bopæl, men af de resterende 142 havde 79 byssinose.
Fifty-two of them could not be traced, but of the remaining 142, 79 were diagnosed as having byssinosis.
Prævalensen af byssinose var således meget højere blandt tid ligere ansatte (56 %), end blandt de nuværende ansatte (18 %).
The proportion of cases with the disease was much higher (56 per cent) among workers who had left the factory than among
En vis helbredsselektion havde fundet sted og en del jobskift havde tilsyneladende været helbredsbetingede.
It was obvious that selection had taken place and that turnover had been partly determined by having developed the disease.
Under søgelsens formål var ikke at afdække årsagerne til de ansattes lungesygdomme, men at få et overblik over sygdommens ud bredelse.
The purpose of the study was not to elaborate causal hypotheses but rather to estimate the size of the problem.
En anden opgave bestod i at kortlægge virksomhedens arbejdsmiljø og angive tekniske løsningsmuligheder.
Another task was to monitor the health and safety record at the plant which turned out to be unsatisfactory.
Det var klart, at arbejdsmiljøet skulle forbedres med det samme, og de epidemiologiske undersøgelser skulle ikke bruges som undskyldning for at udsætte disse tekniske forbedringer. 3.
In a situation like this it is obvious that improvements in the working conditions should be initiated immediately.
Undersøgelsen var af tværsnitstypen og man undersøgte ikke incidensen, men prævalensen af byssinose.
The study should not be made an excuse to delay necessary action.
I undersøgelsen over tidligere ansatte var bortfaldet ganske stort.
The study is of the crosssectional type and it is the prevalence of byssinosis which is studied.
Havde virksomheden haft de ansattes personnumre, havde det formentligt været muligt at finde deres nuværende adresser.
The limitations of crosssectional studies would have been even more apparent had the study base been restricted to present workers, as is often the case.
Hjerte-kar-sygdomme på et kraftværk
CASE STUDY IN A POWER PLANT
Arbejdstilsynet modtog et brev fra fagforeningen i marts 1979 med indberetninger fra flere kraftværker.
In March 1979 the factory inspectorate received a letter from a group of unions who had received by mail a number of reports from several power plants.
Disse indberetninger fortalte om præmature dødsfald på grund af hjerte-kar-sygdomme blandt adskillige fagforeningsmedlemmer; På 2 kraftværker, hvor ca. 250 fagforeningsmedlemmer var ansat, havde der været 20 dødsfald over en 12 års periode.
In two plants, eiriploying about 250 union members, there had been 20 deaths irt a 12 year period.
Deres alder ved døden var i gennemsnit 60 år og de havde været ansat på værkerne i 14-16 år.
The average age of the deceased was 60 years and the average length of employment was 14-16 years.
På et andet kraftværk havde der været 28 dødsfald, 70% af disse var medlemmer af samme fagforening, skønt denne fagforening kun dækkede 1/3 af de ansatte.
In another plant there had been 28 deaths in the period 1968-78 and 70 per cent of the deceased were union members. Union members, however, only accounted for one-third of the total employed at the power plant.
I brevet stod der, at de ansatte ofte var udsat for støj og vibrationer, og fagforeningen bad om en undersøgelse.
In the letter it was stressed that the workers were often exposed to noise and vibration, and the union asked for a further investigation of the problem.
Brevets oplysninger var naturligvis interessante, men der manglede en lang række informationer.
It was obvious that the data presented in the letter were interesting, but much information was lacking.
Havde det drejet sig om en sjælden sygdom, så havde oplysningerne måske været tilstrækkelige til at overbevise brevets modtager om, at der var et arbejdsmedicinsk problem.
Had the cause of deaths been a very rare disease, the data
samme alder og køn som fagforeningsmedlemmerne på kraftværkerne. Disse oplysninger kan hentes i rutinestatistikker over dødsfald i Danmark, som publiceres hvert år af Sundhedsstyrelsen.
The expected number of deaths from cardiovascular disease in a population of a similar age structure to the employed power plant workers should be available from national statistics.
Det ville derefter være nødvendigt at sikre sig, at man havde oplysninger om samtlige dødsfald blandt medlemmerne på de omtalte kraftværker, og fremskaffe kopier af deres dødsattester fra Sundhedsstyrelsen for at identificere dødsfald på grund af hjerte-kar-sygdomme.
It would then be necessary to identify all the deaths of plant workers and their causes and to extract those due to cardiovascular disease.
Antallet af hjerte-kar-dødsfald divideres med det totale antal dødsfald, og denne proportionale dødelighed sammenlignes med en tilsvarende proportional dødelighed for den øvrige befolkning.
The number of deaths due to cardiovascular disease is then divided by the total number of deaths amongst power plant workers and compared with the expected rate {see glossary).
Det viste sig efter denne undersøgelse, der kunne gennemføres på en eftermiddag efter at oplysningerne var indsamlet, at den observerede proportion af hjerte-kar-dødelighed var som den for ventede proportion (det vil sige den andel, der var gældende for den øvrige befolkning). Faktisk viste det sig, at den observerede proportion var lidt mindre end forventet.
The observed proportion of cardiovascular deaths was actually less than the proportion found among all deceased males in the country that is, the observed was similar to the expected.
Disse fund kunne skyldes, at der ikke var arbejdsbetingede risici for hjerte-kar-sygdomme på kraftværkerne. 2.
(2) Working at the power plant increased the risk of cardiovascular and other diseases.
Til trods for en generel øget dødelighed, kunne andelen af hjerte-kar dødsårsager forblive uændret.
In spite of an increased mortality rate, the proportion of all deaths will remain unchanged.
Nye studier
New studies
Der blev iværksat en ny proportional dødelighedsundersøgelse, men denne gang med ansatte i en anden industri som reference. Den observerede proportion var stadig som forventet.
A proportional mortality study was conducted, using data from basic vital statistics as a reference.
Den tredie forklaring synes usandsynlig.
The third explanation then seemed unlikely.
Alle ansatte på et givet tidspunkt tilbage i tid på en række kraftværker blev derefter identificeret.
All employed workers at a number of power plants were then identified in a given time period.
Den observerede dødelighed blev opgjort, og den forventede dødelighed blev beregnet med basis i statistiske oplysninger fra befolkningen som helhed og fra andre erhvervsaktive.
The observed mortality in the group was tallied, and the expected mortality was calculated using mortality rates from the 'general population and other employed groups.
Ingen overdødelighed blev fundet og forklaring nummer to synes også usandsynlig.
Again no excess risk of cardiovascular disease was found and the second explanation did not seem to be likely.
Ingen yderligere undersøgelser blev planlagt.
Further studies were not planned.
Det er vigtigt at opbevare arkiver over ansatte med henblik på epidemiologiske studier.
Record-keeping is very important in epidemiological studies.
Hvis de nødvendige data er til rådighed i forskningen, kan vigtige spørgsmål besvares inden for en kort tidsfrist.
If the necessary data are available for research, important questions may be answered in a short time span.
Ved at bruge let tilgængelige oplysninger kunne man hurtigt
In spite of the limitations of PMR studies, the insights obtained were later confirmed by a more appropriate study.
beregne en proportional dødelighedsratio. Denne undersøgel se har sine begrænsninger, men viste sig at give korrekte resultater i dette eksempel.
In this example, the reference group is used to estimate the expected cardiovascular mortality among the power plant workers.
Er denne betingelse opfyldt vil det observerede antal døde, divideret med de beregnede, forventede antal være tæt på 1,0.
If no occupational hazards existed a mortality ratio of 1 should be expected.
Ofte finder man dog værdier mindre end 1, der enten betyder at arbejdet mindsker dødsrisikoen, eller at der er valgt en forkert referencegruppe (healthy worker selection).
Quite often values less than 1 are found, due to lack of comparability between workers and the general population.
7 Den arbejdsmedicinske detektiv
This is the healthy worker effect mentioned in the example.
Lungecancer-dødelighed blandt udsatte for kromaltholdige pigmenter
LUNG CANCER MORTALITY AMONG WORKERS EXPOSED TO CHROMATE PIGMENTS
Baggrunden for undersøgelsen
Motivation for study
De ansatte på en virksomhed, der fremstillede bly- og zink-pigment, meddelte om flere dødsfald på grund af lungecancer blandt arbejdskammeraterne.
Workers involved in the manufacture of zinc and lead Chromate pigments drew the attention of the occupational physician to several fatal cases of lung cancer among their co-workers.
Bedriftslægen på den lille virksomhed med blot 92 ansatte nøjedes dog med at bemærke, at alle de døde var rygere, og at han ikke betragtede disse lungecancertilfælde som arbejdsbetingede.
The occupational physician in charge of this small plant (92 workers) first noted that all the cases were smokers and considered that the condition was not related to occupation.
I 1974 kom der imidlertid 2 nye tilfælde og endnu et i 1976. Lægen var ikke længere så sikker i sin sag, og han besluttede at kontakte det arbejdsmedicinske institut for at iværksætte en undersøgelse af forholdene.
In 1974 two new cases and in 1976 a third one changed that point of view and the physician decided to consult the Institute of Occupational Medicine to set up a study to determine if an occupational hazard was involved.
Undersøgelsen og dens resultater
Study and results
Alle ansatte, der havde arbejdet i mindst 6 måneder på virksomheden i perioden 1958 til 1978, blev udvalgt til undersøgelse.
All 251 workers who had worked for six months or more in the plant between 1958 and 1978 were included in the study.
Dødsattesterne kunne ikke fremskaffes, og oplysninger om den mest sandsynlige dødsårsag måtte derfor baseres på oplysninger fra familien, den praktiserende læge, eller ved kontakt til hospitalerne i regionen.
Causes of death could not be obtained from death certificates in the country where the study was conducted and were therefore obtained from families, physicians, hospitals, or pathologists.
net med lungecancer-dødeligheden for regionen. Sidstnævnte op lysninger blev givet fra det nationale dødsregister og kombineret med folketællingsoplysninger fra 1954,1962,1968 og 1975.
Lung cancer mortality was compared with local lung cancer mortality among men, using numbers of deaths obtained from the National Institute of Medical and Health Research and demographic data from the 1954, 1962, 1968, and 1975 censuses.
Sammenligningen blev foretaget inden for 10 års aldersgrupper.
In all cases 10 year age bands were used.
Der havde været 53 dødsfald i undersøgelsesgruppen, men kun for de 32 kunne dødsårsagerne oplyses. 13 af disse 32 var døde af lungecancer.
Of the total of 53 deaths among workers at the plant, only 32 causes could be ascertained, and 13 of these were cases of lung cancer.
Havde undersøgelsesgruppen haft samme lungecancer-dødelighed som den øvrige befolkning i samme region, skulle man have forventet 2,6 lungecancer-dødsfald (det vil sige 23 døde).
Assuming that none of the unknown causes of death was due to lung cancer, this number was compared with the expected number of 2.6, which is based on the lung cancer mortality rate in the general population.
Der var altså 5 gange så mange lungecancer-dødsfald som forventet, selv under forudsætning af, at ingen med ukendt dødsårsag var døde af lungecancer.
The five fold excess of observed to expected was large and statistically significant.
En forskel af denne størrelsesorden skyldes næppe tilfældighedernes spil.
Had the basic risk of lung cancer deaths amongst the workers in fact been similar to what was seen for others of similar age and sex,
Forskellen var også så stor, at den næppe heller kunne forklares ved forskelle imellem rygevaner blandt de ansatte og den øvrige befolkning.
Searching for Causes of Work-Related Diseases the probability of this excess being due to random fluctuations alone was small, less than five per cent.
Efter undersøgelsen
After the study
Kromeksponeringen på virksomheden havde altid været over den tilladte grænseværdi på 50mg/m3.
Chrome exposure in this plant had always exceeded the allowed maximum level, the threshold limit value of 50 mg/m3.
På grund af denne under søgelse og andre lignende blev kromeksponeringen anset for en af årsagerne til de mange lungecancer-dødsfald. Dette blev også officielt anerkendt, og ansatte med lungecancer i produktionen af bly- og zink-kromatpigmenter fik erstatning, som en fattig trøst for deres ødelagte helbred (lungecancer er en hæslig sygdom med dårlig prognose).
It was considered from the results of the follow-up study and comparable studies in other countries leading to similar results that this exposure was responsible for the excess number of cases of lung cancer.
De ansatte blev naturligvis informeret om undersøgelsens re sultater, og der blev målt eksponeringsværdier i indåndingszonen.
Workers at the plant were informed of the results of the survey. Exposure levels in the environment as well as in the blood and urine of workers were determined.
Disse målinger viste meget høje værdier, flere hundrede gange over grænseværdien.
They showed that environmental levels were occasionally extremely high (more than 2000 mg/m3).
Målingerne i de ansattes blod og urin var også høje.
Blood and urine levels were also high.
En del af arbejdsprocesserne blev automatiserede og ventilationsanlæg bragte eksponeringerne under den tilladte grænseværdi.
High risk posts were automated; or exposure was reduced to less than 50 mg/m3 using ventilation equipment.
9 af de ansatte måtte dog bruge åndedrætsværn.
Nine workers used masks.
Det blev besluttet løbende at monitorere nye tilfælde af lungecancer blandt de ansatte for at sikre, at incidensen kom tilbage til normale værdier efter sanering af arbejdspladsen.
It was decided to monitor the death rate from lung cancer in this plant to check whether the protective measures were relevant and efficient in eliminating the risk of lung cancer in the plant.
Virksomheden havde heidivis gemt alle ansættelsesoplysninger og disse kunne bruges i en historisk opfølgningsundersøgelse. 2.
Fortunately, all records on employees were kept and could be used in a historical follow-up study.
Selv om der kun kunne fremskaffes dødsårsager for 32 ud af 53, så viste disse oplysninger sig alligevel nyttige. 3.
However, only a fraction (32/53) of the causes of death could be identified, but the study still provided useful information.
Det er sandsynligt, at flere døde af lungecancer, og den SMR-værdi der blev beregnet, er sikkert for lav i forhold til den sande værdi (bias). 4.
If so the true ratio of observed lo expected would have been even higher and the SMR presented by the investigators would have been an underestimate.
Bedriftslægen anså i første omgang rygning for den eneste år sag til lungecancer, og det er da også rigtigt, at rygning er en vigtig årsag, men det er ikke den eneste.
The occupational physician in charge of the plant first noted that all cases were smokers and considered that the health problems were not related to occupation.
Langt de fleste rygere vil aldrig få lungecancer - rygning er ikke tilstrækkelig årsag til lungecancer.
Keep in mind that in spite of the fact that smoking is an important cause of lung cancer, still the majority of smokers will never develop lung
(For læsere der er yderligere interesseret i dette emne henviser vi til Axelson, O.: Aspects of confounding in occupational health epidemiology. Scand. J. Work Environ Health 1978;4:85-9). ~
The evaluation of protective measures should always be part of an epidemiological investigation, particularly in this example, where the carcinogen is still in the work environment.
Det er især vigtigt, når det toksiske stof ikke fjernes helt, og når skaderne er så alvorlige som her.
The most simple formulas for attributable risks in the population (ARp) and among exposed (ARC) are:
ANAMNESE Oplysninger fra en person selv, f.eks. om tidligere sygdomme eller tidligere arbejdsforhold.
Thus 67 per cent of chronic brain damage in this group could be prevented by eliminating the exposure.
BIAS Angiver systematiske fejl, der kan opstå i undersøgelsens plan lægning, udførelse og ved fortolkningen af resultaterne.
A systematic error which can occur during the design, conduct, and interpretation of an investigation.
Bias fører til at undersøgelsens resultat afviger fra hvad det burde være.
Bias will cause results to depart from true values.
Der er mange typer af bias. Et eksempel er hukommelses-bias.
There are several types of bias.
For eksempel vil mødre til børn med medfødte misdannelser måske bedre huske, hvad de blev udsat for under graviditeten end mødre til raske børn.
Mothers of children with a congenital malformation may be more likely than mothers of healthy newborns to remember details of chemical exposures during pregnancy.
Af denne grund alene vil man måske få en mere fyldestgørende liste over f.eks. kemiske eksponeringer under graviditeten blandt mødre til syge børn end blandt andre.
A higher frequency of exposures to chemicals in the mothers of malformed children would then be expected.
I datamaterialet - fra en casekontrol undersøgelse - vil der eksistere en sammenhæng mellem eksponering og misdannelser, men ikke nødvendig i virkeligheden. keligheden.
That is, an association between fetal exposure to chemicals and malformations would exist in our data, even if in reality the two groups had been equally exposed.