natgillin/translations-raw huggingface dataset:
Er der for mange spontane aborter? 84 - Står bedriftssygeplejersken med et arbejdsmedicinsk problem? 85 - Selektion 86 - Confounding: At søge at udelukke alternative forklaringer 86 - Arbejdspladsundersøgelsen 87 - Til fældighedernes spil 88 - Konklusion 88 - Bemærkninger 89
The Panel for Epidemiology and Social Medicine in the European Community represents the academic societies working in this field within the Community. It attempts to advise the Commission on areas within its sphere of competence and reacts to Commission requests for advice.
Byssinose og kronisk bronchitis på et hørspinderi 91
The investigation of occupational hazards is a concern for all Community countries.
Undersøgelsen 94 - Resultaterne 95 - Diskussion 95 - Nye studier 96 -Konklusion 96
In that programme specific targets are suggested to be reached before the year 2000.
Lungecancer-dødelighed blandt udsatte for kromaltholdige pigmenter 98
Research into causes and methods of evaluation of results usually have to be based on epidemiological principles.
Baggrunden for undersøgelsen 98 - Undersøgelsen og dens resultater 98 -Efter undersøgelsen 99 - Bemærkninger 100
This book is written for people engaged in health promotion at the work site who have no formal training in epidemiology.
Jørn Olsen Socialmedicinsk Institut Aarhus Universitet Danmark
This book is an appetizer, a gentle introduction to a subject which is often considered to be complicated and abstract.
Lucien Karhausen tidligere EF Luxembourg
Is this related to the work they do?
Karel Vuylsteek tidligere afd. for Arbejds- og Socialmedicin Gent universitet Belgien
Part two works through some typical examples of epidemiological studies in the work place.
Ved udarbejdelsen af manuskriptet er der modtaget hjælp fra mange kolleger i Europa.
Should aspects of the problems become too complicated, you will need help from experienced epidemiologists.
Forfatterne har naturligvis ansvaret for den endelige tekst, men vi ønsker at takke følgende for værdifuld kritik: Guy De Backer, Marco Biocca, Giuseppe Costa, Alan Dalton, Tony Fletcher, John Fox, Elsebeth Lynge, Walter Holland, Svend Sabroe, Seb Schmoller, Benedetto Terracini og Michal Van Hoorne.
However, if you understand the basic principles you will be much better suited to be a co-worker and both parties will benefit.
Panelet har desuden til opgave at gøre op mærksom på områder, hvor der er behov for uddannelse.
This project was supported by the Commission of the European Communities, Contract 86/036.
Udforskningen af arbejdsbetingede sygdomme vedrører alle lande i fællesskabet og denne lille bog giver en fremragende beskrivelse af, hvordan epidemiologiske teknikker kan bruges i det te arbejde.
We are most grateful to Walter Holland and to all members of the Panel for Social Medicine and Epidemiology in the European Economic Communities for useful discussions, encouragement, and support.
Arbejdet med bogen blev gjort i et samarbejde mellem personer fra en række europæiske lande.
We would like to thank a number of people for useful comments and criticism on early drafts of the book.
Det viser, at forskere også kan samarbejde for at skabe en håndbog til gavn for dem, der har ansvaret for arbejdernes helbred.
As authors we are responsible for the content of the book.
have gavn af bogen.
Contents
Bogen falder i tre dele.
INTRODUCTION
Hvordan læses bogen?
What is epidemiology?
Første del er let læst.
PART I
Eksemplerne er taget fra det virkelige liv og
CONCEPTS OF EPIDEMIOLOGY
Hvad er epidemiologi?
WHAT IS EPIDEMIOLOGY?
Der er næppe én definition på epidemiologi, alle kan enes om, men alle definitioner indeholder det element, at faget handler om at studere sygdomsforekomst i grupper af personer, såkaldte populationer. De fleste definitioner går en tak videre og taler om epidemiologi som den disciplin, der forsøger at forklare, hvorfor sygdom varierer i forskellige befolkningsgrupper.
Several definitions of epidemiology have been suggested. The simplest is that epidemiology is the study of the occurrence of disease or other health-related characteristics in human populations.
Det er en samfundsmedicinsk opfattelse, at sygdom ikke skyldes guddommelig vrede, og ej heller er resultatet af sort uheld i et lotteri.
Diseases do not occur at random; they have causes, quite often man-made causes, which are avoidable.
Samfundsmedicinerne mener, at sygdomme har årsager, ofte menneskeskabte årsager, der undertiden - hvis man da kender disse årsager - kan fjernes, og dermed kan visse sygdomme forebygges. ges.
Thus, many diseases may be prevented if the causes are known.
Mange forskeluge fagprofessioner beskæftiger sig med syg dom, og epidemiologi er derfor langt fra en disciplin, der alene kan overlades til professionelle epidemiologer.
Many people are affected by the occurrence of diseases and their causes.
Epidemiologiske principper bruges af mange andre, hvoraf nogle knap nok kender ordet.
Epidemiology is, therefore, not a discipline used only by professional researchers.
Mange tror epidemiologi kun handler om smitsomme syg domme, men sådan er det ikke.
The principles of epidemiological research are used by many people who do not even consider themselves epidemiologists.
I moderne epidemiologi studeres en lang række sygdomsdeterminanter - eller risikofaktorer - for en lang række forskellige helbredsforhold fra rygsmerter til levercancer eller AIDS i befolkningsgrupper.
Modern epidemiology is a broad discipline which deals with determinants or risk indicators of a variety of health-related events in human populations.
Faktisk er det sådan, at meget af vor viden om disse sygdommes årsager kan tilskrives epidemiologi.
Much of our present knowledge in occupational medicine is drawn from epidemiological studies.
Mange epidemiologiske undersøgelser inden for arbejdsmiljø-
Many epidemiological studies in the field of occupational health start with the experience of the workers themselves.
området starter ofte med de ansattes egne helbredsoplevelser. Of te vidste de ansatte - de eksponerede som epidemiologer ynder at kalde dem - at noget var galt længe før dette blev bekræftet i forskningen.
Searching for Causes of Work-Related Diseases depends to a large extent on ensuring that the 'exposed' participate in obtaining and interpreting the results.
Hvilke problemer skal løses?
WHERE ARE THE PROBLEMS?
Hvem løser dem?
WHO WILL SOLVE THEM?
Ansatte og folk med ansvar for andres helbred, hvad enten de tilhører sundhedspersonalet eller ej, vil på et eller andet tids punkt få stillet spørgsmål af følgende type:
Workers and people in charge of workers' health, whether health professionals or not, may one day be confronted with problems such as:
Flere lastbilchauffører klager over ondt i ryggen - kan det skyldes de nye sæder i førerkabinen?
• A number of truck drivers complain of low back pain.
Seks svejsere er nu behandlet for strubekræft - kan det skyldes svejserøgen?
Could this be caused by new cabin seats? • Six welders have now been treated for laryngeal cancer.
Efter vi fik indført skærmterminaler på kontoret, har fire kvinder aborteret - kan der være en sammenhæng?
Could this be the result of exposure to welding fumes? • Since video-display terminals were introduced into the office, four women have had miscarriages.
Renseriarbejdere skal til at bruge nye kemikalier - er de sikre at arbejde med?
Could there be a connection? • A new chemical is used by the dry-cleaners.
Sådanne spørgsmål opstår hele tiden og hvis ikke svarene kendes, må der ofte iværksættes en undersøgelse.
The history of occupational medicine shows clearly that the observations of the workers themselves are of importance.
Mange af disse under søgelser vil blive iværksat på arbejdspladserne affolk der er ansat
Later, epidemiologists and toxicologists found that the culprit was mercury—a compound of which was used in the felting process.
Den arbejdsmedicinske historie viser med al tydelighed, at de ansattes egne observationer har haft stor værdi.
Many studies start at the work site and important parts of the research work cannot take place anywhere else.
I den folkelige litteratur optræder visse faggrupper på en måde, der måske afspejler faggruppens erhvervsrisiko.
Key materials often lack in an investigation because there are inadequate exposure registers to match the registers of deaths and diseases.
På engelsk finder man udtrykket „gal som en hattemager" blandt andet i Alice i Æventyrland.
Research would be much aided if there was access to data on workers' past exposure.
Det afspejler måske kendskab til filt-hattemagernes høje risiko for pyskisk sygdom. Senere fandt man ud af, at kviksølvet i arbejdsprocessen var det skadelige stof, alligevel gik der 80 år (!) inden kviksølvet blev fjernet fra arbejdsprocessen (i 1941), og det skete, fordi kviksølv skulle bruges i den engelske krigsindustri!
If working with a certain epoxy glue did cause cancer, that information would emerge immediately if all workers exposed to that glue in the previous 10-30 years could be identified.
Denne historiske erfaring er en vigtig grund til at involvere de ansatte selv mere direkte i den epidemiologiske forskning.
In occupational health, any delay in identifying a problem can translate itself into an illness or even death.
Desværre mangler de ofte, for di de ikke forekom af betydning for de ukyndige, eller måske fordi nogen havde set deres interesse i at fjerne sådanne spor.
This book will prove useful when the question is asked: 'could this cluster of disease be caused by the work we do, or the work we have done?'
Meget ofte har vi langt bedre oplysninger om sygdomme end vi har om de arbejdsforhold der førte til disse sygdomme.
We recommend that the basic principles of problem solving should be applied to the daily work of maintaining workers health:
Om det virkelig forholder sig sådan kunne vi sandsynligvis finde ud af meget hurtigt, hvis vi havde fået oplyst, hvem der havde arbejdet med denne lim de sidste 10-30 år.
(2) Define the goal: (a) If the nature of the problem is known, describe what to do and set a goal for the outcome of this process; (b) If the nature of the problem is not known, set up a study plan for further investigation.
Vi håber denne bog
(7) Was the goal achieved?
vil være med til at fjerne sådanne unødvendige forsinkelser, når problemerne opstår og når man skal svare på spørgsmålet: Kan denne ophobning af sygdomstilfælde skyldes forhold på arbejdspladsen?
All of us, whether occupational health professionals, employees, captains of industry, or epidemiologists, if we are to fulfil our role in preventive health, need to ask questions.
Epidemiologiske principper kan også bruges i målrettet arbejde for at bevare de ansattes helbred.
We need to be suspicious about diseases and injuries which occur to working people and about processes and substances, both old and new, which are used at work.
Sættes et sådant målrettet arbejde på skematisk form lyder det:
We must also question peoples' habits, their diets, their hobbies, and their motives for behaving in a particular way at work or in volunteering that they are suffering from a particular disease.
Sæt mål for det videre arbejde: - Kendes problemets årsager, angiv hvad der skal gøres og sæt mål for hvad der skal opnås. - Kendes problemets årsager ikke, så udtænk en undersøgel sesplan. 3.
There may of course be 'political' objections to anyone trying to investigate this kind of outbreak and the best thing, if possible, is to bring the subject up at a health and safety meeting attended by representatives of management and unions.
Undersøg om planen følges. 5.
The management themselves might wish some investigation to be made into the matter.
Alle der har et ansvar for helbredsforhold på arbejdspladsen er nødt til at være forsigtige og mistænksomme.
They may refer the enquiry to an employment medical adviser who is usually a doctor experienced in disentangling such problems.
Det gælder epidemiologer, de ansatte, direktører, sundhedspersonalet, sikkerhedsrepræsentanter, medlemmer af fagforeninger etc. Skal vi udfylde vor plads i den forebyggende medicin, må vi være opmærksom me på de sygdomme der opstår blandt de ansatte, deres arbejdsforhold, deres levevaner og levekår.
You will want to know the size, age range and sex of the work force. In the absence of a finance department or a personnel department you may simply have to piece the information together as best you can so that the number of persons off work and the amount of time for which they have been off work can be computed.
Al vor viden stammer fra nysgerrighed og opmærksomhed og uden disse egenskaber kom mer vi ikke videre.
There will undoubtedly be records available on these aspects held either centrally or at shopfloor manager level.
Systematisk og kritisk analyse skal være det, der adskiller sande problemer fra dagspressens tvivlsomme rædselshistorier om skærmterminaler, elektromagnetiske stråler osv.
Then the diagnosis which has probably been decided upon either by the employees themselves, their general practitioners, or specialists needs to be checked.
Når der opstår en reel mistanke om, at en ophobning af syg domstilfælde skyldes forhold på arbejdspladsen, bør sundhedspersonalet - f.eks. i bedriftssundhedstjenesten - være de første til at indsamle de relevante oplysninger.
The diagnosis should be confirmed by a doctor for reasons of confidentiality and because many different names may be given to this condition, usually termed 'repetitive strain injury' (RSI).
Uden sådanne pålidelige oplysninger nytter det kun lidt at råde over avancerede computere og statistiske eksperter.
In this way you can build-up a picture of the type of injury, the number of people who have it and for how long they have had it.
Sæt nu sygefraværet stiger på et kyllingeslagteri efter at en ny slags pakkemaskine er taget i brug.
The other part of the cause-and-effect equation is to look at what the people who have the injury do as part of their work and what the rest of the people who do not have the injury do as part of their work.
Antallet af kyllinger der slagtes sættes op for at tilpasses denne maskines kapacitet og de ansatte klager over smerter i håndleddene.
Certain people will know when the new processes for chicken-packing were brought in and others will know the rate of injury.
Disse problemer bør diskuteres i sikkerhedsudvalget, hvor man også bør diskutere mulighederne for at gennemføre en undersøgelse af problemets om fang, og de mulige „politiske" forhindringer der kan være for en sådan undersøgelse.
With all this information about the individuals, their medical condition, and the processes which might have caused this condition collected as accurately as possible from the various sources mentioned, a case can be made as described elsewhere (p.
Også fagforeningen eller virksomhedsledelsen kan have interesse i, at der iværksættes en undersøgelse.
47) in this book and your suspicions of the cause of the problem confirmed or squashed.
2 Den arbejdsmedicinske detektiv
Local information might be helpful from, for example company pension records, trades
Skulle ingen lokalt være interesseret i at tage initiativet, kan man kontakte en af de arbejdsmedicinske klinikker, hvor de ansatte læger har den nødvendige uddannelse til at iværksætte en undersøgelse, som dog kun kan gennemføres med bistand fra de berørte selv.
Searching for Causes of Work-Related Diseases union pension records, or occupational health records held by the company.
I undersøgelsen skal der indhentes en række op lysninger, som kun kan skaffes lokalt.
Cases of certain diseases which are rare such as leukaemia in a particular area have even been traced by meticulously working through obituaries in local newspapers and checking these against death certificates.
Arbejdsstyrkens størrelse, fordelt på køn og alder må kendes.
Local doctors may help to complete the picture and there may be lists of people who used to work in the company and who receive newsletters etc.
Sygefraværets varighed må kendes, og disse oplysninger kan sikkert skaffes fra virksomheden.
These amateur detective techniques are all useful in building up a crude picture of a suspiciously high disease rate.
Ved længere varende sygefravær kan det måske blive nødvendigt at søge tilladelse til at indhente oplysninger fra de sociale forvaltninger.
For a specific industry there is often a body of information held by the appropriate trades federation or trades union or society of interested members from whom you can get some ideas.
Der skal måske gennemføres lægeundersøgelser, eller eksisterende lægeundersøgelser skal gennemgås og bedømmes.
Alternatively, a medical library, medical school, department of community health or environmental health, or the Health and Safety Executive may be able to help.
Dette arbejde bør udføres af den læge, der kender de diagnostiske problemer.
These institutions can arrange computer searches which may give you some of the information you are looking for.
På denne måde kan man skaffe sig et overblik over sygdom mens omfang og varighed, og indhentes der oplysninger om hvornår pakkemaskinerne blev indført, kan disse oplysninger sammenlignes.
One of the most satisfactory ways of finding out the cause of death is from the death certificate.
Arbejdsforholdene for de syge kan sammenlignes med arbejdsforholdene for de ikke-syge.
In Britain (although this is not the case in all countries, including some European ones) this is not a private document.
Sådanne simple opgørelser kan ofte gøres uden megen hjælp udefra og problemerne kan ofte løses på lokalt niveau.
Relatives of the deceased may have a copy of the death certificate as may personnel departments, medical departments, or pension departments of certain companies.
Ved simpelthen at følge med i arbejdspladsens sygefravær fremover kan man måske sikre, at problemerne faktisk blev løst.
Death certificates may also be obtained from the Office of Population Census and Surveys (OPCS), a service which has to be paid for.
Problemerne er dog langt større, hvis det drejer sig om alvorlige sygdomme, langvarige sygdomme eller sygdomme, der er dø delige.
Even though they are the most accurate record of disease leading to death that we are likely to have they are unfortunately not always as accurate as one would like and are sometimes difficult to interpret—you may need a doctor or epidemiologist to do this for you.
Her er det nødvendigt med meget præcise oplysninger, især hvis disse sygdomme opstår efter lang tids påvirkning.
In the case of a prolonged disease you will not be interested only in those people who have died from the disease, but also those who have suffered from it without dying or before dying from it.
Lønningslister eller andre lister over ansatte, fagforeningsarkiver, pensionsdata, arbejdsmedicinske journaler, arbejdspladsmålinger, adresselister for fagforeningsblade, lister over momsregistrerede virksomheder, telefonbøger, ATP-registre osv., kan alt sammen være nyttige og nødvendige redskaber, hvis alvorlige sundhedsskadelige påvirkninger skal findes og stoppes.
This information is more difficult to obtain, but there are records available in hospitals, and certain registers of disease (such as cancer) are kept available usually only to professional researchers or epidemiologists.
Ejendommeligt nok har meget af den etiske debat handlet om pro blemerne ved at bruge sådanne oplysninger, langt mere end pro-
These lists are of course extremely valuable and can help to substantiate your crude measures of disease. If you
Man kan måske også få hjælp af embedslægerne, Sundhedsstyrelsen, Danmarks Statistik eller Cancerregisteret, hvis det drejer sig om kræftsygdomme. Socialforskningsinstituttet, DI KE og andre forskningsinstitutter er mulige rådgivere i det vide re arbejde.
7 think that a particular disease in your particular study population in a factory for example is higher or lower than 'normal' you will need to know what the 'normal' disease incidence is in, for example, the general population or perhaps a population of similar workers in another factory.
Visse fagforeninger har ansat lægelige konsulenter med epidemiologisk viden.
This kind of information on disease rates is also available from OPCS.
Arbejdspladsen
The work place
Hvis formålet er at undersøge, om forhold på arbejdspladsen før te til sygdom, så må oplysninger om arbejdspladsen vurderes nøje.
If it is intended to try to make a link between diseases or accidents and substances or processes then knowledge about the work place must be gleaned as accurately as possible.
Det er ofte nødvendigt at skaffe sig både fagforeningens og virksomhedsledelsens støtte i dette arbejde.
Again it is important to have the backing of a trade union or management before embarking on this kind of investigation and, depending on the size of the organization in question, information on these aspects of the work will come from different areas.
De oplysninger, der skal bruges, kan komme fra flere kilder.
Information on processes may come from trade federations or from organizations which represent whole industries e.g. glass-making, ceramics etc.
Arbejdstilsynet har visse oplysninger, måske ligger bedriftssundhedstjenesten inde med brugbare data, men de fleste oplysninger skal almindeligvis ind samles lokalt, på arbejdspladsen.
Information on the factory in question is more likely to come from personnel departments, finance departments (often a useful guide to how many people there are, and when they started and finished).
Kun enkelte personalegrupper får løbende registreret deres eksponering (det gælder f.eks. folk der arbejder med røntgen) og undertiden er man nødt til at nøjes med jobtitlen som eneste eksponeringsoplysning.
Engineering and works departments in certain industries keep technical data and in some factories records on individual exposure have been kept for many years. However, the methods for collecting exposure information have varied greatly over the years and not all the information is of good quality.
Ikke alle op lysninger kan dog bruges og visse oplysninger har sikkert så dårlig kvalitet, at de kan gøre mere skade end gavn.
Exposure may be recorded as the concentration in air of a chemical in a particular laboratory or information taken from personal sampling instruments or regular biological tests on the workers themselves.
Bedre mærkningsregler for farlige kemiske stoffer vil sandsynligvis øge vore muligheder for at skaffe lokale eksponeringsoplysninger.
This information has to be kept for 50 years and so will be a useful source of records for the future.
Central registrering af nye kemiske stoffer vil også være af stor værdi i den arbejdsmedicinske epidemiologi.
In many industries exposure records may be missing for a variety of reasons, for example the industry may have ceased to exist and its records may have been lost or destroyed.
På den anden side findes en lang række sygdomsregistre, ofte af høj kvalitet.
Information on substances used at the work place can often be obtained from a supplies department or a safety department, if one exists.
Alle cancersyge registreres, det samme gælder medfødte misdannelser og en lang række andre sygdomme.
All substances used in industry now have to be labelled properly, and there is a hazard sheet available from the manufacturers on each one.
Faktisk registreres alle hospitalsindlæggelser, og registeret over dødsårsager går mange årtier tilbage og det har været brugt i en lang række arbejdsmedicinske studier.
There may be health records on employees which list previous occupations and exposures and give an idea of current or past exposures in the present employment.
Men hvis der skal indsamles flere oplysninger fra centrale kilder, så må den arbejdsmedicinske detektiv ofte søge hjælp hos andre.
Much of the basic information on diseases, processes, and substances can be collected by the nonprofessional at the work place or the occupational health professional.
Er dette tilfældet, så søg hjælp så tidligt som muligt.
In the simpler cases involving a small number of people the methods described in this book will enable you to come to a fair conclusion on the likelihood of disease and exposure being linked.