[Therapeutic freedom versus scientific mandatory cost saving].
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Biomedical subjects
Publications and source records attributed to A Wienke.
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The influence of humic substances (HS) and calcium (Ca) on cadmium (Cd) toxicity was determined using zebrafish (Danio rerio). Embryo and larvae of the zebrafish were exposed to various Cd concentrations (1.8; 2.8; 4.2; 6.2; 9.3 mg/l Cd) for 144 h. Combinations of low (0.2 mmol/l) and high (2 mmol/l) Ca, +HS (5 mg/l C) or -HS were used during Cd exposure. The toxicity of Cd was affected by (1) exposure concentration; (2) exposure time; (3) presence of HS; and (4) the Ca concentration. The results show that Ca and HS protect against Cd toxicity in zebrafish embryos. The best protection was in the high Ca-HS group, followed by high Ca+HS group and low Ca+HS group. The survival in the low Ca-HS group was the worse. Survival in the high Ca-HS group and the high Ca+HS group was similar with the exception of the highest Cd concentration (9.3 mg/l) where the survival of the high Ca+HS group was less than in the high Ca-HS group. The exposure system was modelled using a chemical equilibrium program (MINEQL+) to determine if the likely mechanism causing the anomalous result in the highest Cd concentration. The equilibrium model cannot explain these results, which suggests that this effect has a kinetic basis, such as time needed for Cd to displace Ca already bound by HS.
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Data of the Danish Twin Registry on monozygotic and dizygotic twins are used to analyse genetic and environmental influences on susceptibility to heart diseases for males and females, respectively. The sample includes 7955 like-sexed twin pairs born between 1870 and 1930. Follow-up was from 1 January 1943 to 31 December 1993 which results in truncation (twin pairs were included in the study if both individuals were still alive at the beginning of the follow-up) and censoring (nearly 40% of the study population was still alive at the end of the follow-up). We use the correlated gamma-frailty model for the genetic analysis of frailty to account for this censoring and truncation. During the follow-up 9370 deaths occurred, 3393 deaths were due to heart diseases in general, including 2476 deaths due to coronary heart disease (CHD). Proportions of variance of frailty attributable to genetic and environmental factors were analyzed using the structural equation model approach. Different standard biometric models are fitted to the data to evaluate the magnitude and nature of genetic and environmental factors on mortality. Using the best fitting model heritability of frailty (liability to death) was found to be 0.55 (0.07) and 0.53 (0.11) with respect to heart diseases and CHD, respectively, for males and 0.52 (0.10) and 0.58 (0.14) for females in a parametric analysis. A semi-parametric analysis shows very similar results. These analyses may indicate the existence of a strong genetic influence on individual frailty associated with mortality caused by heart diseases and CHD in both, males and females. The nature of genetic influences on frailty with respect to heart diseases and CHD is probably additive. No evidence for dominance and shared environment was found.
Medical malpractice may result from a violation of organizational rules, which are supposed to protect the patient. The high requirements of jurisdiction concerning the medical duty of care in organizational sequences lead to increased security and control levels of data transmission within medical networked structures. To achieve an optimized use of telemedical possibilities and to minimize technical error sources, it is necessary to merge the existing communication systems. The store of knowledge that is obtained through telemedicine must not reduce the specialist standard. The telemedical application requires a documented informing and consent of the patient about the extent, the risk and the alternatives of the data transfer.
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BACKGROUND: Despite several case reports describing liver toxicity of nitrosamines and the fact that some N-nitroso compounds are used to induce cirrhosis of the liver in animal models, this association has not been investigated in epidemiological studies. METHODS: A cohort of 2,875 female rubber workers who were active on January 1, 1976, or hired thereafter, and who had been employed for at least 1 year in one of five plants producing tires or technical rubber goods was followed for mortality from January, 1976, through December, 1991. Work histories were reconstructed using routinely documented "cost center codes" and classified into six work areas. Age and calendar year standardized mortality ratios (SMR) and 95% confidence intervals (95% CI) were calculated and stratified by plant, work area, year of hire, and years of employment in the respective work area. RESULTS: The excess mortality from cirrhosis of the liver was most pronounced for nonalcohol-related cirrhosis of the liver (ICD-9 571.4-571.9: 10 deaths, SMR 202; 95% CI 97-372). Mortality from alcohol-related cirrhosis of the liver (ICD-9 571.0-571.3: 3 deaths, SMR 153; 95% CI 31-446) and from other alcohol-related diseases (organic psychoses, injury, and poisoning) was not statistically significantly elevated. All 10 cases of nonalcohol-related cirrhosis had worked in production of technical rubber goods (SMR 279; 95% CI 134-514) and risks increased with earlier years of hire and with longer duration of employment in this work area. DISCUSSION: Although our results must be interpreted with caution, they suggest that the observed excess deaths from cirrhosis of the liver are associated with occupational risk factors. In light of additional evidence from case reports and animal data, exposure to nitrosamines may be a plausible risk factor for the observed excess mortality.
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OBJECTIVES: To determine occupational risk factors for stomach and lung cancer among workers in the German rubber industry. METHODS: A cohort of all male German rubber workers (n = 11,633) who had been employed for at least one year in one of five study plants and who were alive and actively employed or retired on 1 January 1981 was followed for mortality from 1 January 1981 through December 1991. A subcohort of n = 8,933 workers who were hired after 1 January 1950 was defined to focus on working conditions in the more recent rubber industry. Work histories were reconstructed using routinely documented 'cost centre codes' and classified into six work areas as well as subgroups of some work areas. The work areas are: 1. preparation of materials, 2. production of technical rubber goods, 3. production of tyres, 4. storage and dispatch, 5. maintenance, 6. others. Standardized mortality ratios (SMR) and Cox proportional hazards models were calculated for each of the work areas (>1 year of employment in the respective work area). Hazard rate ratios were adjusted for age (time marker) and stratified for year of hire (1950-1959, > or =1960) and years of employment in the respective work area (1-9 years, > or =10 years); years of employment were lagged 10 years to account for latency. RESULTS: Compared to the national reference population mortality from cancer of stomach (observed 44, SMR = 117; 95% CI: 85-157) and lung (observed 154, SMR = 123; 95% CI: 104-144) was slightly increased. Using internal controls we observed excess deaths from stomach cancer in work area 1 (relative risk [RR] = 2.3; 95% CI: 1.2-4.2) and from lung cancer in work areas 1 (RR = 1.7; 95% CI: 1.2-2.3), 2 (RR = 1.5; 95% CI: 1.1-2.1), and 3 (RR = 1.3; 95% CI: 0.9-1.8). On the basis of cumulative years of employment an exposure response relationship was observed for mortality from both cancer sites among a subcategory of work area 1: weighing and mixing. Increased risks were also seen for lung cancer among workers employed in production of technical rubber goods. CONCLUSION: Our results support an association between an excess mortality from stomach and lung cancer and employment in early production stages of rubber manufacturing, especially weighing and mixing. This may point to an aetiologic role of asbestos or carbon black. For stomach cancer additional risk factors, e.g. exposure to dust and talc, deserve further investigation. The results of the present study do not support a causal role of nitrosamines for stomach or lung cancer.
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