Biomedical subjects

D Kielkowski

Publications and source records attributed to D Kielkowski.

23 records · Page 2Linked to original sources

PubMed1989

Life after death--mortality statistics and the public health.

The process by which mortality statistics are compiled in the RSA and the potential impact on public health are discussed. The use of the international death certificate is outlined; this is compared with the South African death certificate to illustrate the importance of establishing the chain of events leading to death. The distinction between underlying and direct causes of death in compiling mortality statistics and planning public health intervention is considered. The major part played by medical practitioners in the death certification process is emphasised, and some of the areas in which mortality data could be improved are highlighted.

Cause of Death↗

PubMed1989

Mesothelioma in South Africa, 1976-84: incidence and case characteristics.

Malignant mesothelioma is a rare tumour known to be associated with prior exposure to asbestos. Previous studies have described the occupational and clinical features of cases of mesothelioma in the Republic of South Africa (RSA) but none has set out to determine incidence of this disease. To estimate incidence, a case register was compiled for 1976-84 by contacting all medical practitioners and institutions likely to have seen cases of mesothelioma in this period; demographic, diagnostic and exposure details were sought. Cases were accepted if they provided evidence of histological diagnosis of mesothelioma. Fifty-two per cent of 1347 cases identified were in whites, 31% in blacks, 16% in coloureds and 1% in Asians. Seventy-three per cent of cases occurred in males. The majority of whites were aged 51-70 years, while the majority in other race groups were aged 41-60 years. The ratio of only pleural to only peritoneal mesothelioma was 11:1, although there were marked differences by race. Eighty-five per cent of males with exposure information available had prior exposure to asbestos, mostly occupational. A similar proportion of women had contact with asbestos but mostly through other types of exposure. Standardized incidence rates per million population aged 15 years and over were calculated for sex-race subgroups and were highest in white males (32.9 per million per year, 95% Cl 22.7-46.4), coloured males (24.8 per million per year, 95% Cl 16.2-36.9) and coloured females (13.9 per million per year, 95% Cl 7.7-23.5). These incidence rates are amongst the highest ever reported for a national population. Age-specific standardized incidence rates were highest in white males (over 100 per million per year in men over 55 years). Reasons for the differing rates by population group are likely to include differential access to health services. More rigorous control of asbestos exposure in the RSA is recommended.

Aged↗

PubMed1988

Occupational health services in South African manufacturing industries: a pilot survey.

A pilot survey of the distribution and content of occupational health services in South African manufacturing industries was carried out in the Germiston area of the Witwatersrand using the records of the Workmens' Compensation Commissioner as a sampling frame. All establishments with 50 or more workers and a stratified random sample of smaller ones (495 in all) were contacted. The overall response rate was 56% and was positively related to work force size, the larger establishments showing higher response rates. The offering of health services, defined minimally as at least a part-time nurse or doctor employed on the premises, was reported in 11% of work places employing 52% of the work force and was also positively related to work force size. Seventeen percent of establishments had ever monitored environmental conditions, and all classes of industry in the study area fell short of government recommendations. The advantages of the study approach used here, based on a countrywide sampling frame and a mail questionnaire, include 1) the relatively modest cost; 2) the creation of an information framework to which can be added additional information obtained from other sources e.g., factory visits; and 3) the use of a database for sampling that is countrywide, regularly updated, and versatile, with the potential for extending the observations with a similar (geographic) or different focus, for instance, by industrial class or work force size.

Employment↗

PubMed1987

The predictors of emphysema in South African gold miners.

Environmental and host factors have been implicated in the pathogenesis of emphysema. To assess the role of gold mining exposure (an environmental factor) and of various clinical features recorded early in a miner's career (host factors), a case control study was carried out as follows. From whole lung sections made routinely at all full autopsy examinations on South African gold miners, we selected 44 cases of emphysema and 42 controls without emphysema from among men 51 to 71 yr of age who died during 1980 and 1981. Exposure information was gathered and clinical records were reviewed for smoking history, symptoms, and the presence of rhonchi by decade before death. The presence and grade of silicosis (abstracted from the routine autopsy reports) was similar in both groups; so was bronchitis in the 49 cases and controls with histologic material adequate for review. However, cases were on average older, had worked more shifts in high dust, and had smoked more than controls; they had also exhibited symptoms and rhonchi more frequently before 1950, i.e., 30 yr before death. When these factors were examined in a multiple logistic regression analysis, shifts worked in high dust, smoking, and age were all shown to be strong and independent predictors of emphysema at autopsy; prediction, however, was not improved by addition of any of the clinical features examined. These findings agree with previous cross-sectional studies in South African gold miners showing an exposure response relationship between mining service and air-flow limitation measured by lung function tests in life.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

Occupational health indicators for South Africa.

Indicators, statistics gathered from a larger pool because they have the power to summarize or to serve as indirect or proxy measures for information that is lacking, would be valuable in appraising occupational health status in a country provided data are both feasible and relatively inexpensive to collect. A generally accepted set of occupational health indicators does not exist. This project aimed to compile a set for South Africa. An initial set of possible indicators was compiled and then rated by key informants. A committee of the National Centre for Occupational Health selected a final set of 16 indicators. The indicators and limited data collected on some of them are presented with commentary. The validity and the impact of the indicators need to be formally assessed.

Accidents, Occupational↗