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Biomedical subjects

K Ringen

Publications and source records attributed to K Ringen.

18 recordsLinked to original sources
PubMed1990

Karl Evang: a giant in public health.

Karl Evang (1902-1981) was one of the leading figures in public health in the post-World War II era. His first contributions were in social epidemiology in the 1920s-30s, and his studies on sexually transmitted diseases, nutrition and health, and occupation and health, were seminal. He was instrumental in framing the constitutions of two key U.N. agencies, the Food and Agricultural Organization and the World Health Organization, and he helped shape the WHO definition of health. Following the war, as Norway's Director General of Health, he helped create one of the preeminent humanitarian democracies and its welfare state. He and his generation of public health workers were so effective because of ties to the dominant labor parties, the need for government intervention as a result of the Great Depression and the Second World War, and the humanistic reaction to the Nazi horrors. At the same time, their excessive emphasis on medical care, and the role of the physician in health policy, resulted in the great medical costs of today. Those who believe in activist government and the goal of equality in health status owe an enormous debt to Evang and his generation.

History, 20th Century↗
PubMed1989

The case for worker notification.

There is currently a heated debate about whether the U.S. Congress should enact the High Risk Occupational Disease Notification and Prevention Act. This Act would set up an orderly system for identifying, notifying, and assisting workers at high risk of occupational disease. Significant underpinning for this legislation comes from three pilot projects conducted by the National Institute for Occupational Safety and Health and the Workers' Institute for Safety and Health. These projects demonstrate that notification and intervention for occupational high-risk groups can be implemented feasibly within the existing structures of community health and labor management relations. These projects also suggest that, contrary to the views of opponents of current legislation, it is the absence of systematic programs that leads to massive litigation and high costs. At present, these costs are borne by workers and society.

Humans↗
PubMed1988

DNA hyperploidy as a marker for biological response to bladder carcinogen exposure.

A marker for biological response to bladder carcinogen exposure was evaluated in a cross-sectional study of 504 workers at high risk due to a range of exposures to various carcinogenic aromatic amines, primarily 2-naphthylamine. A quantitative fluorescence cytology method using the DNA-binding dye, acridine orange, was employed to measure DNA in exfoliated urothelial cells. DNA hyperploidy (greater than 5 C) was observed in 16 (21.6%) of 74 workers who had been exposed compared with 15 (3.5%) of 430 workers who had not (p less than 0.001). The prevalence of DNA hyperploidy increased in a dose-response manner from 3.5% to 60% with increasing duration of exposure. The association between DNA hyperploidy and exposure persisted when adjustment was made for age and cigarette smoking (p = 0.0001). The prevalence of the marker was greatest for exposed workers who smoked (23%), and lowest for those who had no exposure and who had not smoked (2%). This study indicates that DNA hyperploidy can serve as a marker for identifying workers who are at increased risk in occupational groups exposed to bladder carcinogens.

Adult↗
PubMed1987

Health policy: gaps in access, delivery, and utilization of the Pap smear in the United States.

Emergence of cervical cancer as a public health problem is largely a twentieth-century phenomenon; although primary prevention remains elusive, secondary prevention--through use of Pap smears--has markedly reduced mortality. Yet, major differences persist in both incidence and mortality between black and white women. The "routine" policies of identifying age groups, timing, and sites for Pap testing will have to yield to more targeted approaches. Both providers and individuals at risk have challenges and responsibilities.

Adult↗
PubMed1986

Risk factors for bladder cancer in a cohort exposed to aromatic amines.

Occupational and nonoccupational risk factors for bladder cancer were analyzed in a cohort of 1385 workers with known exposure to a potent bladder carcinogen, beta-naphthylamine. Bladder cancer was approximately seven times (95% confidence interval [CI] = 3.9, 12.4) more likely in exposed rather than nonexposed individuals, yet, otherwise, the groups were generally similar in other exogenous or hereditary risk factors. A total of 13 cases of bladder cancer were identified. After the first year of a screening program involving 380 members of the cohort, 9 of the 13 cases of bladder cancer and 36 persons with atypical bladder cytology, histology, or pathology were compared with 335 noncases for distributions of different variables. Occupational variables were significant in a multivariate model that controlled for age, cigarette smoking history, and source of drinking water. The estimated odds ratio for the association for bladder cancer and the duration of employment, when controlling of these other variables, is 4.3 (95% CI = 1.8, 10.3). In addition to the occupational factors, age was significant in the multivariate analysis. Other potential risk factors, such as consumption of coffee or artificial sweeteners, use of phenacetin, or decreased use of vitamin A were not found to be significantly different in cases and noncases.

1-Naphthylamine↗
PubMed1986

Optimal management of asymptomatic workers at high risk of bladder cancer.

Many cohorts of industrial workers at increased risk of occupationally induced bladder cancer are still in the preclinical disease stage. A large proportion of workers in these populations have been exposed to aromatic amines, but have not yet experienced the average latent period for bladder cancer. A need exists for definition of what constitutes optimal management for asymptomatic workers in these cohorts. Promising advances in the epidemiology, pathology, detection, and treatment of bladder cancer pressure for a reassessment of current practices and the application of the most current scientific knowledge. Some of these apparent advances, however, have not yet been rigorously evaluated. The time has come to evaluate these advances so that their application can occur while high risk cohorts are still amenable to and likely to benefit from intervention. This commentary calls for such an evaluation leading to a comprehensive approach to managing cohorts at high risk of bladder cancer.

Amines↗
PubMed1986

Interventions in high-risk occupational cohorts: a cross-sectional demonstration project.

In 1980, the Workers' Institute for Safety and Health began a demonstration project designed to develop a model program of community-based intervention in three cohorts with different workplace exposures and target cancer sites. Program components included identification, notification, medical surveillance, education, social support services (eg, psychosocial, legal, financial, etc), and evaluation. The three cohorts included the Augusta cohort, a group at risk for bladder cancer due to workplace exposure to beta-naphthylamine; the Port Allegany cohort, a group at high risk of cancer associated with a workplace exposure to asbestos; and the Pattern Makers cohort, a group shown to be at increased risk of colorectal cancer. Together, these three projects give a cross-sectional view of possible approaches to educational and medical intervention strategies in diverse situations.

Asbestosis↗
PubMed1985

Notification of a cohort of workers at risk of bladder cancer.

Surviving members of occupational cohorts studied in retrospective analyses of mortality usually are not notified individually of positive study results. However, concern has arisen that such results may contain risk information pertinent to study subjects. To evaluate the effects and implications of individually notifying survivors of such cohorts, we conducted a pilot notification study. Members of a cohort of 1,385 chemical workers who had handled carcinogenic amines were notified by mail that they were likely to be at increased risk of bladder cancer. Also a bladder cancer screening and follow-up program was established. The study demonstrated that notification is a complex action and that much care needs to be taken when communicating information on risk. Notification requires development of (1) criteria as to what constitutes a notifiable risk and (2) programs to meet the medical and social needs of the various parties involved in notification.

Carcinogens↗
PubMed1985

Risk assessment of a cohort exposed to aromatic amines. Initial results.

A cohort of 1,385 workers potentially exposed to carcinogenic amines was evaluated to determine the extent of its risk for bladder cancer. The cumulative incidence of bladder cancer was determined from death certificates, from interviews with community urologists, and from a screening program. A total of 13 confirmed cases of bladder cancer were identified at the conclusion of the first year of study. The entire cohort has approximately a fourfold excess risk of bladder cancer; however, black workers with more than 10 years of employment had a risk ratio of 111 (based on three cases). The onset of disease occurred, on the average, 15 years earlier in these black workers than in the general U.S. population. The cumulative incidence of bladder cancer increased with the duration of employment, ranging from 0.4% for workers with five or fewer years of employment to 36% for those with greater than 20 years. No significant differences were found between cases and noncases for cigarette smoking, coffee drinking, use of artificial sweeteners, or prior employment in high-risk occupations. More cases of bladder cancer are expected in this cohort because many members have not yet achieved the average latency found for the confirmed cases.

Adolescent↗
PubMed1979

Edwin Chadwick, the market ideology, and sanitary reform: on the nature of the 19th-century public health movement.

This article is an attempt to place the origin of sanitary legislation in England, and its chief proponent, Edwin Chadwick, in the overall dynamics of 19th-century social development. It examines the public health movement in light of the transition of English society into the domination of the market ideology, and the effect that this had on health. Emphasis is placed on explaining the utilitarian movement, of which Chadwick was an instrumental part, and its role in promoting the market system through the enactment of the New Poor Law in 1834. The article suggests that the enactment of sanitary reform in the 1848 Public Health Act was the unplanned reaction to the detrimental effects that the market ideology had on health in the industrial centers. The main intent of this article is to go beyond the prevailing belief that sanitary reform was a humane contribution of publicly spirited men. It concludes that this state intervention was materially necessitated: it was forced by the contradictions inherent in the market system.

England↗