[Do not forget economic interests as driving forces behind scientific fraud].
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Biomedical subjects
Publications and source records attributed to O Axelson.
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Food intake during the preceding 15 years was evaluated in detail in 41 patients treated for colorectal cancer and an equal number of matched control subjects by means of a dietary history technique that permitted quantitation of nutrients. Dietary habits of the control group could be compared against two larger groups of 371 hospital control and 430 population control subjects. Patients with cancer, who were interviewed after complete recovery from surgery, consumed more fat, protein, and carbohydrates, and thus more energy, than control subjects although these differences were not statistically significant. Per unit energy, the habitual diet of patients with cancer contained less cereal fiber (P less than 0.001), less riboflavin (P less than 0.05), less calcium (P less than 0.05), and less phosphorus (P less than 0.05) than the diet of the control subjects. A high intake of either cereal fiber, total fiber, calcium, and phosphorus in relation to energy intake was found to be associated with a reduced risk ratio of colorectal cancer. For colon cancer separately, a high intake of calcium and cereal fiber was associated with a reduced risk ratio. For rectal cancer, a high intake of total fiber and cereal fiber was associated with a reduced risk ratio. High alcohol consumption correlated with an increased risk ratio. These data are compatible with previous Scandinavian studies relating food consumption to the incidence and mortality of colorectal cancer.
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Mortality and cancer incidence was investigated among 2,807 workers, employed for at least one year before 1972, at 11 Swedish companies manufacturing prefabricated wooden houses. A total of 1,068 workers had been exposed to man-made mineral fibers (MMMF) used for insulation. Mortality was followed from 1969 to 1988 and cancer incidence from 1969 to 1985. Exposure conditions were investigated at all plants. There were 14 deaths from lung cancer in the total cohort, whereas 20.7 would be expected (SMR = 68; 95% CI:37-113), based on regional mortality. After a latency of 20 years of more, two lung cancer cases had occurred among all workers exposed to MMMF, whereas 4.3 would be expected (SMR = 46; 95% CI: 5-168). The exposure levels that have prevailed do not seem to be associated with an increased lung cancer rate, but extended follow-up is necessary for a definitive evaluation.
A total of 2,208 male subjects, enrolled as merchant marine seamen at the Civitavecchia (Italy) harbor from 1936 to 1975 were followed up through 1989 in order to evaluate their mortality experience. Available information about the number of sailings made it possible to divide subjects into two subgroups: 948 workers with at least one sailing (cohort A) and 1,260 with no reported sailing (cohort B). Fewer than expected overall deaths were observed in both cohorts (cohort A: SMR = 0.83; cohort B: SMR = 0.81), mainly due to a lower mortality from circulatory, respiratory, and digestive diseases. Lung cancer deaths were significantly increased in cohort A (O = 30, SMR = 1.71, 95% CI = 1.15-2.44), whereas no excess was observed in cohort B (O = 6, SMR = 0.57, 95% CI = 0.21-1.26). Among subjects employed aboard ship, a trend in SMRs for lung cancer increasing with duration of employment was observed. Furthermore, three neoplasms of other parts of the respiratory system (including one mesothelioma) were detected in cohort A (SMR = 5.87), and one in cohort B. The study substantiates an increased risk of respiratory cancer among subjects with an occupational history of sailing; past exposure to asbestos and to other environmental carcinogens aboard could be implicated.
The association between nasal cancer and various occupations was investigated in a case-control study in the provinces of Verona and Vicenza (northeastern Italy) and Siena (central Italy). Cases of malignant epithelial neoplasm of the nasal cavities and paranasal sinuses diagnosed in the years 1982-1987 in the hospitals of Verona, Legnago, Bussolengo, Vicenza, and Siena comprised the study. Controls were patients admitted to the same hospitals as the cases, with any diagnosis except chronic rhino-sinusal disease and nasal bleeding. Age, gender, residency, and date of admission were taken into account by matching. Cases and controls, or their next of kin, were interviewed or required to fill in a mailed questionnaire; the overall response rate was 70%. Altogether, 78 cases and 254 controls provided information on occupational history. Significantly increased risks were associated (in males) with work in the wood industry (odds ratio [O.R.]: 5.8; 90% confidence interval [C.I.]: (2.2-16) and in the leather industry (6.8; 1.9-25). Textile workers, furnacemen, construction workers, and workers with possible exposure to organic dusts showed increased risks even if statistical significance was not reached.
Motor neurone disease (MND) was studied in relation to various determinants in a case-control study covering nine counties in southern Sweden. A questionnaire about occupational exposures, medical history, lifestyle factors etc was given to all cases in the age range 45-79 and to a random sample of 500 population controls in the same age range. The questionnaires were answered by 92 cases and 372 controls, a response rate of 85% and 75% respectively. Among men high Mantel-Haenszel odds ratios (MHORs) were obtained for electricity work (MHOR = 6.7, 95% confidence interval (95% CI) 1.0-32.1), welding (MHOR = 3.7, 95% CI 1.1-13.0), and impregnating agents (MHOR = 3.5, 95% CI 0.9-13.1). Heritability with regard to a neurodegenerative disease or thyroid disease seemed to predispose to a risk of developing MND (OR = 2.1, 95% CI 1.0-4.3). The highest OR was found for the combination of such heritability, exposure to solvents, and male sex (OR = 15.6, 95% CI 2.8-87.0), a combination that occurred for seven cases and three controls. Hereditary factors and external exposures had a different distribution among cases with the spinal type of MND than among cases with involvement of the pyramidal tract or bulbar paresis also.
The association between nasal cancer and work in the metal industry was investigated in a case-control study located in the province of Brescia, north eastern Italy. Thirty five cases of malignant epithelial neoplasms of the nasal cavity and paranasal sinuses who were resident in the province of Brescia and diagnosed or treated by the ear, nose, and throat department and the radiotherapy unit (Centro Alte Energie) of the Brescia Hospital in the years 1980-9 were included in the study. Controls (102) were patients affected by benign and malignant neoplasms of the head and neck who were resident in the Brescia Province and matched the cases by age and sex. All the subjects were interviewed by telephone. Metal workers showed an increased risk of nasal cancer (odds ratio (OR) 3.1; 90% confidence interval (90% CI) 0.48-20); a higher risk was associated with work in foundries (OR 5.9; 90 CI 0.77-46). Work in wood, leather, and textile industries was also associated with increased risk of nasal cancer.
Indications of an increased risk of brain cancer in some, but not all, epidemiologic studies on glassworkers inspired further investigations in a geographically restricted region where the Swedish glass industry is located. Only a small and insignificant excess of brain cancer death was found among glassworkers when compared with the rest of the population in the area. However, when the brain cancer mortality of the glassworkers was compared with that of the whole Swedish population, a rather high risk was found, but an equally high risk was also seen for the rest of the population in this region when compared with national figures. Besides glassworkers, especially farmers, but also other occupational groups had an increased risk of brain cancer that suggested the possibility of an environmental factor affecting the whole population in the region. Hence particular worker groups may sometimes take on a regional mortality pattern that simulates an occupational risk.
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The mortality pattern among Swedish pulp and paper mill workers was evaluated in a case-referent study encompassing 4,070 men decreased during the period 1950-1987. The subjects were identified from the register of deaths and burials in six parishes. A significantly increased mortality was seen for diabetes mellitus and for secondary tumors of the lung and liver among the pulp and paper mill workers. Indications of excess risks were also found for obstructive lung disorders, pulmonary emboli, accidents, and pneumonia, as well as for malignant lymphomas, leukemias, and cancer of the pancreas and stomach. In the only parish where a sulfite process was exclusively used, cancer of the digestive tract and especially of the rectum was found to be in excess. Except for this parish, the sulfate process predominated in the plants included. The mortality pattern found in this study is in reasonable agreement with findings in various studies from this type of industry.
All cases of ALS in Sweden during the period 1970-1983, i.e., 1961 cases, were compared with an age-stratified random sample of 2245 individuals from the Swedish population. On the basis of census information, the male cases were found to be heterogeneously distributed over occupational groups. Significantly more male cases than expected were found among office workers (OR = 1.8; 34 cases) as well as among farm workers (OR = 1.7; 56 cases). There was a cluster of male cases in agricultural work in one south-western county (OR = 3.4; 25 cases). Significantly more female cases than expected were medical service workers (OR = 1.7; 33 cases).
Case series of coeliac disease show that chronic allergic alveolitis (farmers' lung) and fever reactions due to exposure to organic dust (organic dust toxic syndrome) commonly occur among subjects with coeliac disease and dermatitis herpetiformis, these being related disorders. In this case-referent study 105 cases of coeliac disease and dermatitis herpetiformis were compared with 237 referents from the general population by means of a mail inquiry regarding exposure to various environmental factors. Increased odds ratios were obtained with exposure to various farm animals and more clearly for cotton dust, although numbers were few. Animal husbandry in Sweden invariably means heavy exposure to organic dust. The fact that comparatively few persons reported dust exposure may be of doubtful validity in view of the high frequency of exposure to farm animals reported by the cases.
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Two criteria for an interpretation of noneffect are that the relative risk estimate be near unity and that the confidence interval be narrow; lack of statistical significance has no bearing on this issue. A further requirement is that the relative risk estimate not be near the null value as an effect of non-differential exposure misclassification, negative confounding, or some other systematic error. Occasionally, when results are unexpected or difficult to accept, studies are "underinterpreted" as negative or inconclusive on the basis of arguments such as "confounding," "crude exposure assessment," or "lack of a known mechanism." The present paper supports the position that these arguments are commonly invalid. Scientific standards should be used to separate causal associations from noncausal ones, but in public health decisions this practice has to be balanced by the principle that the "benefit of the doubt" should be given to the persons subject to potential risk.