natgillin/translations-raw huggingface dataset:
Måske står det klart, at de skyldige skal findes andre steder. Desværre sker det kun sjældent, at resultaterne er helt entydige.
You may get some idea of one who is already interested in the particular problem you are investigating by asking the appropriate trades union or Health and Safety Executive to recommend somebody who could help.
Ofte er der behov for en mere dybtgående udforskning, f.eks ved at de epidemiologiske undersøgelser suppleres med toksikologiske under søgelser, dyreforsøg og lignende.
There are departments of occupational health throughout the UK and the rest of Europe who may be able to give epidemiological assistance.
I visse tilfælde fører de lokale, hurtige undersøgelser til et entydigt svar, og fremtidige sygdoms tilfælde kan forhindres.
Departments of public health, community medicine or environmental medicine often contain such experts.
Når det lykkes er det en stor tilfredsstillelse, og det daglige arbejde som „amatørdetektiv" forlenes med en professionel holdning.
Trades unions and other industrial organizations may have international links
Problemer og mulige løsninger
PROBLEMS AND POSSIBLE SOLUTIONS
En epidemiologisk undersøgelse starter ofte, fordi der opstår hel bredsproblemer, der må løses.
An epidemiological study is often begun because a health problem exists and a solution is needed.
Naturligvis er det bedst helt at forhindre disse helbredsproblemer i at opstå, og det er undertiden muligt.
The best solution would be to prevent diseases from occurring at the work place and sometimes that is possible.
Nye kemiske stoffer og materialer bør testes inden de bruges på arbejdspladsen, men desværre giver det ikke fuld sikkerhed.
New chemicals or processes should ideally be tested before being used.
Disse test kan udføres på celler, bakterier eller måske forsøgsdyr, men det giver ikke nødvendigvis viden om, hvordan stofferne virker på mennesker.
However, no test based upon cells, bacteria, or animals will guarantee that the actual exposure is harmless for man.
Ydermere er det sådan, at visse stoffer indgår i komplicerede blandinger, eller de opvarmes og lignende, og helt nye eksponeringer kan opstå, hvis helbredseffekt er umulig at forudsige.
Chemical compounds can lead to very complex exposures and the damaging effect of this on health is difficult to predict or even document.
Den næstbedste løsning er derfor at sikre, at helbredsproblemer opdages så hurtigt som muligt, så skadernes omfang i det mindste begrænses.
The second best solution to work site health problems is to try to detect them as soon as they appear; but to implement a monitoring system, good company records are needed.
Hertil behøves et overvågningssystem, eller i det mindste, at oplysninger opbevares på arbejdspladsen.
Even if the concern is not about a current problem, proper record systems should be maintained.
Disse oplysninger kan vise sig at være de afgørende spor, hvis noget går galt.
These data may turn out to be the essential clues if something goes wrong.
Du får brug for disse oplysninger, hvis der pludselig dukker uventede sygdomstilfælde op.
• You will need these facts if an unexpectedly high number of health problems occurs. • You will need good records, if a new—potentially harmful— work process is introduced. • You have to think ahead of time.
Du har brug for ordentlige oplysninger, hvis der indføres ny teknologi, der måske kan skade de ansatte.
What could happen in the future?
Du bliver nødt til at tænke fremad.
In real life you are sometimes confronted with a cluster of diseases which might be related to an exposure at work.
Du bliver nødt til at tænke på, hvad der kan ske i fremtiden.
If a number of people become ill and that number exceeds what would normally be expected, you will want to know if the cause is related to the work environment.
Dette arbejde ligner detektivens.
Searching for Causes of Work-Related Diseases detective.
Man vil gerne vide „hvem der gjorde det" for at forebygge flere tilfælde.
Like a detective you want to know 'who did it' in order to stop further damage.
Som andet detektivarbejde gribes det systematisk an, kritisk og med et åbent og nysgerrigt sind.
Like a detective you have to work systematically, critically, and with an open mind.
I det følgende gives nogle „tommelfingerregler", der kan bruges i efterforskningen.
Some rules of thumb can be given and are presented in some detail in this book.
Ingen ønsker at spilde mere tid på falske spor end højst nødvendigt.
Most of all you do not want to spend more time following false clues than is necessary.
Er der en forbrydelse?
Is there a problem?
Sygdomme er naturligvis et problem for de syge, men de udgør ikke nødvendigvis et arbejdsmedicinsk problem.
Contracting a disease is always a problem for those involved but it is not necessarily a workrelated problem.
Kun få forbliver raske livet igennem og til slut må vi alle dø, hvad enten vi har den ene type arbejde eller den anden.
Only a few people go through life without having any diseases and in the end we all have to die, regardless of the work we do.
Mere end hver fjerde får cancer på et eller andet tidspunkt. Hver tredie vil få en blodprop i hjertet.
More than one person in four contracts cancer during their lifetime.
Næsten alle får rygsmerter, hovedpine, mavesmerter eller lignende nu og da.
Almost all will suffer from low back pain at some time.
Sygdomstilfælde er ikke i sig selv tegn på arbejdsmiljøproblemer.
The mere existence of diseased workers does not imply that the problem is work-related.
Problemerne opstår, når der er „for mange" syge.
Comparing the observed number of cases with an expected number is one of the key techniques of epidemiology.
Hvis vi er vidner til „uventet" mange flere sygdomstilfælde, så står vi måske med et arbejdsbetinget problem.
When an epidemiologist hears that a number of people are sick, he or she will ask 'how many sick workers would you expect, had the employees not been exposed to anything at work?'
Observerede og forventede syge
A factory in Kentucky
Det at sammenligne observerede sygdomstilfælde med det antal, man skulle forvente i en given gruppe af ansatte, er et nøglebegreb i epidemiologien.
At a factory in Kentucky, USA, four cases of a rare type of liver cancer were found within a short time among the 500 workers employed.
På en måde er det faktisk dét, hele epidemiologien handler om.
In fact, it is so far above the expected number of cases, that one would first have to question the diagnoses.
Når en epidemiolog hører, at så mange har
But the diagnoses were confirmed, the problem
På en virksomhed i Kentucky i USA med 500 ansatte opstod der 4 nye tilfælde af en sjælden form for leverkræft indenfor en kort periode.
When the number of diseased persons exceeds the expected number to this extent a reason should be found.
Denne form for leverkræft er virkelig sjælden.
The occurrence of disease varies from time to time and from population to population.
I hele USA's befolkning på mere end 200 millioner ser man kun 20-30 nye tilfælde pr. år.
It may reflect random or chance variation.
I dette tilfælde er der ingen tvivl om, at 4 tilfælde blandt 500 ansatte er flere end man skulle forvente.
Sometimes the occurrence even exceeds a level which makes chance variation a likely explanation but before any study starts we need to ask a few basic questions.
Her behøves ingen komplicerede beregninger.
We need to know something about the diseased.
Faktisk var det så mange flere tilfælde endforventeligt, at man med rette tvivlede på om diagnoserne var korrekte.
If you have an accident in a certain car, it does not necessarily follow that that particular car is more unsafe than any others.
Men pro blemet var reelt nok.
All types of cars have accidents now and then.
Diagnoserne kunne bekræftes af andre, og pro blemet viste sig senere at skyldes høj eksponering for en vinylchlorid moner (råstoffet der bruges til at fremstille PVC).
But if a particular type of car has twice as many accidents as other types, then the production company and the drivers might have a problem.
Når antallet af syge klart overstiger hvad man skulle forvente, er tiden kommet til at finde en løsning.
Epidemiology compares the occurrence of diseases in two different groups of people.
Især når antallet af syge overstiger, hvad måske blot kan skyldes tilfældig variation.
The number of new diseased individuals in a particular group of people depends upon the number of people in the group and the time period over which new cases are recorded.
Sygdomshyppigheden varierer over tid og fra befolkningsgruppe til befolkningsgruppe uden at dette nødvendigvis afspejler arbejdsmiljøforhold. miljøforhold.
Thus the size of the group and the duration of the study is important. In epidemiology the occurrence of disease is described as a rate (an incidence rate) which is the number of new cases divided by the time during which each individual in the group has been under observation (from starting to record new cases until the end of our recording or until a person contracts the disease, see incidence rate in glossary).
Men før efterforskningen starter er det nødvendigt at stille et par spørgsmål og holde notesbogen parat og forstørrelsesglasset i baglommen.
An incidence rate depends upon the average risk of getting the disease during a particular time period. It is useful to know if one group has a risk which differs from a comparable group.
Det var 4 tilfælde af levercancer blandt 500 personer over en kort tidsperiode, der var uventet og alarmerende.
Searching for Causes of Work-Related Diseases the 'exposed' workers by the incidence rate among those notexposed.
Hyppigheden af nye sygdomstilfælde, divideret med den samlede observationstid for personer i populationen med risiko for at få sygdommen, kaldes incidensraten (se s. 106).
This is a relative rate and it reflects how many times the risk among the exposed is higher than the risk among the not exposed.
Måske er det lettere at forstå dette ratebegreb, hvis man tænker på risiko for sygdom. Raten afhænger af sygdomsrisikoen i den periode, gruppen er blevet fulgt.
Were this calculated in the example from Kentucky it would show that the risk of liver cancer among the workers was many times higher than the risk of this cancer in the population at large.
Oftest beregnes en sygdomsrate - en incidensrate - i grupper, der er udsat for mulige sundhedsskadelige stoffer og i en kontrolgruppe (sammenligningsgruppe). Ved at dividere disse rater med hinanden fås en relativ risiko, som viser hvor mange gange større sygdomsrisikoen
However, this partly reflects the fact that the risk among those not exposed is very low and when dividing any number by another number close to zero, the relative rate becomes very high.
er blandt de eksponerede i forhold til de ikkeeksponerede.
To some extent this could be misleading and hide the fact that still only a few (in absolute. numbers) among the exposed get the disease.
Havde man beregnet en sådan relativ risiko i Kentucky-eksemplet, ville den have været meget, meget høj, hvilket blandt andet skyldes, at incidensraten i en kontrolgruppe uden den pågældende eksponering ville have været tæt på 0, og man får nu engang me get høje tal, når man dividerer med nul eller næsten nul.
By presenting the risk among the workers compared with the population at large—not as a relative rate but as a rate difference—the rate among exposed minus the rate among the not-exposed, a more realistic idea of the excess risk is given.
På en vis måde vil denne relative risiko være misvisende. Den viser f.eks. ikke, at der trods alt kun vil være ret få af de 500 ansatte, der vil få den pågældende kræftsygdom. Ved at trække de to incidensrater fra hinanden (i stedet for at dividere dem med hinanden), ville man få et mere realistisk skøn over de ansattes faktiske risiko.
Even though we are basically interested in comparing such rates in different groups we often start with something which at first seems to be quite different.
Vi starter simpelthen vor efterforskning med de syge.
Useful and necessary information
Nyttige og nødvendige oplysninger Selv om epidemiologer almindeligvis indsamler oplysninger om grupper af personer, så består disse grupper af enkeltpersoner, og oplysninger om enkeltpersoner er nødvendige.
The epidemiologist usually collects information about groups of people, but basic information about individuals is also necessary.
I det mindste må man skaffe sig følgende oplysninger om de syge:
If you have a cluster of diseased, you should at least find out the following facts about them.
Navn, adresse og helst CPR. 2.
(2) Date of birth, sex, and address.
Du mangler at vide om de syge har noget tilfælles med hensyn til deres arbejde, og hvis de har det, om det så adskiller dem fra de personer, der ikke blev syge.
(6) Job history—as detailed and comprehensive as possible, especially concerning the timing of exposure.
I første omgang er det dog mindre vigtigt. Det vigtigste er om pro blemet eksisterer eller ej.
(7) Important health-related lifestyle factors—for example smoking.
På samme måde vil epidemiologen gerne vide om en bestemt arbejdsproces er skyld i hele skaden.
Having obtained these data you will be able to answer the first question: Who is ill?
Hvad adskiller de syge fra de raske?
How many are ill?
seedforhold.
Often this simple, basic information can be very useful.
DBCP-eksponeringen havde været langt mere intens i case-gruppen end i kontrolgruppen.
In the Kentucky example it was very useful to know that liver cancer occurred at the beginning of the 1970s, in a factory producing polyvinyl chloride and among men who had been exposed to vinyl chloride for 10-20 years.
De 11 cases havde arbejdet med DBCP i gennemsnit i 8 år, mens eksponeringsvarighedenfor kontrolgruppen var 0,1 år (Whorton, D. et al. Lancet 1977;2:1259-61).
As a detective you have some major suspicions but no proof which would stand up in court. You need to know something about those who were affected by the disease, and those who were not.
Hvis du påstår at et givet stof giver barnløshed eller eksem, får du sikkert stillet spørgsmål, såsom: Knud har aldrig arbejdet med stoffet og han har eksem, og Søren har arbejdet med det i årevis uden problemer, hvordan kan det nu være?
Initially, it looks as if this information could not tell you anything about the risk among exposed compared with that among nonexposed, the number of not-exposed, nor the exact time of observation.
Samme spørgsmål kender vi fra når rygningens skadevirkninger diskuteres.
You have to start off by collecting information on the diseased only.
Nogle ryger som skorstene livet igennem og påfører måske andre en lungecancer, men får ikke selv sygdommen.
However, it turns out to be just one step in estimating relative rates among exposed versus nonexposed.
Andre får lungecancer uden nogensinde at have røget og måske også uden at have været passive rygere.
To begin with the magnitude of the problem is of secondary importance; whether a problem exists or not, comes first.
Årsager til dette paradoks ligger i den kendsgerning, at syg dommen har flere årsager, og kun i sjældne tilfælde er en enkelt eksponering alene i stand til at fremkalde sygdom.
Like the detective who, faced with a number of similar crimes, would like to know if all the criminal acts were performed by the same person, the epidemiologist would like to know if a specific job or work process is responsible for all, or most of the damage.
Stoffet er der for ikke den eneste årsag til eksem i befolkningen.
The epidemiologist looks for common exposures, common habits, common residence, etc.
Søren har må ske ikke været udsat for de andre årsager (eller han har måske ikke den nødvendige genetiske sårbarhed).
Most, if not all, diseases have several causes, and there may be more than one factor in common among the diseased.
Knud har måske været udsat for andre årsager til eksem.
It might be that specific types of welding fume cause lung cancer, but so do a number of other exposures, tobacco smoke for example.
Iblandt de ansatte med sygdommen må eksponeringen stort set have været den eneste årsag, og derfor er eksemplet meget usædvanligt i arbejdsmedicinen.
The non-diseased may have had similar exposure to the diseased.
Bemærk dog, at vinylchlorid-ekspo-nering ikke altid fører til sygdom - langt fra alle udsatte fik syg dommen.
All the diseased breathe air, eat, drink water and so on, and so do the non-diseased.
Epidemiologer ville sige, at årsagen ikke er tilstrækkelig, andre eksponeringer - eller måske genetisk sårbarhed - må være til stede før sygdommen opstår.
This information is not very helpful in our effort to try to identify why the diseases occur in the first place. It would
Opstår der et „cluster" af syge - dvs. en usædvanlig ophobning inden for en kort tidsperiode - på arbejdspladsen, så kan det skyldes det vi kalder tilfældigheder, det vil sige sammenfald af ukendte begivenheder, der ikke har noget med arbejdsforholdene at gøre.
Men working with a worm-killing substance (l,2-dibromo-3-chloropropane, DBCP) recognized among themselves that few had recently fathered children.
Det kan dog også skyldes forhold på arbejdspladsen.
On investigation, 11 men were found to have very low sperm counts.
For den arbejdsmedicinske detektiv er „tilfældighedsforklaringen" den sidste han tyer til.
After recognition of this 'outbreak' of infertility, a casecontrol comparison was made among all workers who used DBCP.
Heller ikke den rigtige detektiv ville vinde berømmelse ved at påstå, at tilfældigheder var årsag til bankkuppet i Unibanken.
The cases, those with low sperm counts, were older and had worked for a longer time period with DBCP than had the controls.
Først skal andre muligheder efterprøves, og hvis alle fornuftige muligheder viser sig usandsynlige, så skyldes ophobningen måske blot „tilfældighedernes spil", hvad det så end betyder.
DBCP exposure seemed to be more frequent in the cases than in the non-cases.
Men inden du går i gang med større undersøgelser, så begynd med at sikre dig, at sygdomsophobningen faktisk eksisterer.
If you claim that, for example, a particular compound causes skin problems you have to answer questions like: John has never worked with that compound, yet he has the skin disease—and Peter has been using the compound for years, and he has no problem.
Er sygdomstilfældene reelle eller blot baseret på løse rygter?
How can the compound then be the cause?
En række ulykker i et givet vejkryds over en kortere tidsperiode kan være tilfældige, men der er måske også andre forklaringer.
The same argument is applied to the case of life-long heavy smokers who never get lung cancer compared with nonsmokers who do.
Når du har sikret dig at de syge faktisk var (er) syge skal de indgå i case-gruppen.
17 necessary to cause the disease.
Dernæst må du sikre dig, at du har alle syge med i under søgelsen.
Peter might only be exposed to one, not all, of the causes—or he might be less susceptible to the disease.
Alle fra den gruppe af ansatte og den tidsperiode, der skal indgå i undersøgelsesgruppen.
John might have acquired the disease from another set of causes.
Det er nu på tide at overveje, hvad undersøgelsesgruppen er.
The liver cancer case from Kentucky is unusual in that this particular type of liver cancer seems to have causes which occur with a very low frequency in the USA.
Det er dels den gruppe af personer (ansatte), der blev udsat, dels den gruppe, der ikke blev udsat for de forhold vi ønsker at undersøge.
In the factory area, vinyl chloride exposure must have been the most common cause.
Undersøgelsesgruppen består således af de person grupper, hvis sygelighed vi ønsker at sammenligne.
However, vinyl chloride exposure alone was not enough—not all those exposed to it developed cancer.
Da sygdom me udvikles over tid omfatter definitionen også en tidsperiode.
Epidemiologists would say that vinyl chloride is not a sufficient cause; other exposures or perhaps genetic susceptibility must also be present for the disease to develop.
Der er endnu kun givet en vag idé om, hvordan en casekontrol undersøgelse bør gennemføres, og det er heller ikke her målet at give nogen udtømmende beskrivelse.
If a cluster—that is an unusual gathering of a specific disease, usually within a rather short time span—occurs at a given work site, this might of course be due to chance, but it could also be the result of a given set of exposures.
Større casekontrol under søgelser bør gennemføres af personer med den nødvendige ud dannelse og øvelse, men lidt mere skal der dog siges.
For the workplace detective facing an outbreak of disease, the chance explanation is the last conclusion to be reached.
Casekontrol undersøgelsens historie går mere end hundrede år tilbage i tid.
If all other explanations have been ruled out, chance might remain as the last likely explanation, but other possible explanations should be considered and excluded first.
Ideen om at se hvad der måtte være fælles for de syge og hvad der adskiller de syge fra de raske, har rødder i filosofien.
Or, in the words of that excellent detective, Sherlock Holmes 'When you have eliminated the impossible whatever remains, however improbable, must (may) be the truth'.
Kunne man finde sådanne faktorer, så måtte de være mulige årsager til sygdomme.
If a cluster of diseases occurs, start by making sure that the cluster is real—that the diseases did occur.
At sammenligne syge og raske er langt fra nogen ny metode.
Then start thinking of possible explanations for the clustering.
Principperne for valg af kontrolgrupper er dog nye, og de har rod i vort ønske om at beregne, hvor stærk sammenhængen måtte være mellem eksponeringen og sygdommen.
The recognition of a cluster of disease often comes by chance— often by a shrewd observation by a clinical doctor, (as for example, in the recognition of excess nasal cancer in furniture workers or the DBCP example) or even by astute journalists (such as was the case with childhood leukaemia cases in the vicinity of the Sellafield Nuclear Reprocessing Plant).
Vi vil sammenligne hyppigheden af forskellige mulige arbejdsforhold (og andre forhold) i case-gruppen af de syge og i kontrol gruppen.
In the schedule for the study you have to consider how to select cases and controls, what information you need, how to obtain it, and how the results are to be analysed.
Vi ønsker ikke blot at foretage tilfældige sammenlig ninger, men vil gerne kunne bruge resultaterne til noget fornuftigt.
The purpose of the exercise is to narrow down the possible explanations for the unexpectedly high number of diseased.
Visse principper må derfor følges.
Did many of the diseased work with a new chemical compared with the nondiseased, for example?
Et af de vigtigste principper omfatter definition af undersøgel sesgruppen.
As cases, you used the diseased which came to your attention, but first you should make sure they actually have the disease in question.
Vi skal foretage disse sammenligninger inden for den gruppe af personer, hvor sygdomstilfældene opstod, men ofte er det umuligt at få hver enkelt identificeret. Kun de syge kender vi direkte til. Undersøgelsesgruppen defineres derfor som alle om hvem det kan siges, at de ville være i casegruppen, hvis de havde fået sygdommen, som undersøgelsen gælder.
Next you have to make sure you have all the diseased presenting over a given time period in the group you want to study.
Temmelig abstrakt måske, men sommetider giver det dog sig selv.
You should then think of how to define your study base (see glossary).
Der skal tages stilling til, om man kun er interesseret i personer der nu er ansat, hvilket måske er rimeligt, hvis sygdommen udvikles over kort tid og ikke påvirker evnen til at fortsætte arbejdet.
In the present context only a very general idea about how to conduct casecontrol studies is given. Large-scale casecontrol studies are for professional epidemiologists.
Er det ikke tilfældet bør man også medtage tidligere ansatte, der kunne være udsat for det, man gerne vil studere.
The original idea of the casecontrol study goes back many hundreds of years.