Occupation-related cancer in a Nordic copper smeltery.
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Copper↗
Biomedical subjects
S Wall
Publications and source records attributed to S Wall.
Granulocytic sarcoma presenting as pulmonary nodules and lymphadenopathy.
A patient presented with anterior and posterior cervical lymphadenopathy as well as widespread intrapulmonary nodules. Histologic sections of both lymph node and lung revealed dense infiltration by sheets of cells which were cytochemically positive for chloroacetate esterase and myeloperoxidase, thus suggesting a diagnosis of granulocytic sarcoma. The patient was initially treated with daily hydroxyurea. After 6 weeks, when progression of the disease was apparent, hydroxyurea was discontinued and the patient was placed on mithramycin, an agent reported to induce differentiation of myeloid precursor cells both in vitro and in vivo. On this latter agent, a dramatic response has been noted with a decrease in the pulmonary symptoms, and a marked reduction in the size of the lymph nodes and lung nodules. The authors report this case because it represents a rare presentation of an uncommon disease and because of the striking improvement that followed the initiation of a novel therapeutic modality.
Aged↗
[Islet cell antibodies in children with diabetes in Sweden--a preliminary report].
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Adolescent↗
Anthropometry and subsequent mortality in groups of children aged 6-59 months in Guinea-Bissau.
To assess the importance of nutritional status for subsequent survival, 2228 children aged 6-59 mo were followed for 8-12 mo in four different areas of Guinea-Bissau. The overall death rate was 0.62/100 child-months of follow-up (126 deaths) and 0.63 for the 1756 children who were examined on entering the study (109 deaths). Mortality was twice as high in the periurban as in the rural areas due to an outbreak of measles. In a bivariate analysis the relationship between nutritional status indicators and mortality was confounded by the age dependence of both. Using Cox's regression technique, height-for-age but not weight-for-height was positively correlated with survival. The number of children in the household was a better discriminator for death from measles than was nutritional status. Long-term factors, probably of multiple social origin, are likely causes of both relatively short stature and high mortality.
Body Height↗
Histological types of lung cancer among smelter workers exposed to arsenic.
The histological distribution of lung cancer was investigated in 93 men who had worked at a Swedish smelter with high levels of arsenic. A comparison was made with a group of 136 patients with lung cancer from the county where the smelter was located. Company records provided information on occupational exposure and data on smoking habits were obtained from a next of kin of each subject. No pronounced differences in the histological types of lung carcinomas between smelter workers and the reference group could be seen for smokers. Some analyses indicated an increased proportion of adenocarcinomas among the smelter workers, which confirmed earlier data, but these findings were difficult to interpret. Cases among smelter workers who had never smoked showed a histological distribution resembling that in smokers, indicating that the work environment at the smelter and smoking had a similar influence on the risk for different types of lung cancer.
Adenocarcinoma↗
Water supply, sanitation and health education programmes in developing countries: problems of evaluation.
There are several methodological problems related to evaluating the impact that improved water supply, sanitation and health education projects have on public health. Fifteen studies of intervention programmes, one by the present authors, are discussed. Since non-intervention studies of water supply are difficult to assess, a valid study design must include an intervention programme, even though such studies are more costly and time-consuming. Detailed descriptions of programmes, study plans, and analytical methods are often lacking, and different studies reach greatly diverging conclusions. It may be proposed that studies based on "weak" methodology give a more positive impression of improved public health after improvement of water supply than do before-after studies using comparison groups.
Developing Countries↗
Smoking habits and their confounding effects among occupational groups in Sweden.
Smoking habits among different occupational groups in Sweden were estimated from nation wide surveys of living conditions in 1977 and 1980/81. These surveys were conducted by Statistics Sweden and consist of interviews covering the Swedish population aged 16-74 years. The sample includes about 12,000 persons for each of the two investigations. The results show that those who may be exposed to excess risks in their work environment, smoke more than those in other occupational groups. Transport and manufacturing workers, miners, wood and paper workers and painters, for example, have higher rates of daily smokers than the national average. The highest rates, however, were found among the category of early retired or unemployed. These findings confirm that an appropriate evaluation of occupationally-related diseases affected by smoking must take smoking data into consideration. If smoking data are available from other sources, adjusted work-related risks could be calculated. This presumes the absence of interaction effects. Procedures are given and illustrated. The paper also discusses the declining trends in smoking habits between 1977 and 1980/81 and possible reasons for differences in smoking habits between occupations.
Adolescent↗
Health problems and care in young families--load of illness and patterns of illness behaviour.
During a winter month 185 young suburban families reported in a diary on perceived health problems and measures taken in response to these problems. Information on socio-economical factors, medical experience and structure of the social network was obtained from a mailed questionnaire. As a mean every fourth individual-day a health problem was recorded. The majority (61%) of symptoms were infections and only 14% of illness days were classified as severe. On every sixth of all reported individual days measures were taken to handle health problems. Seven per cent of measures taken in response to a perceived health problem were taken in collaboration with the social network and in less than 1/10 of reported symptom days and 1/5 of reported illness episodes the professional medical system was contacted. For health problems in children 1/3 of the contacts were taken by telephone and often with the child welfare nurse. The demands for professional help was dependent on type and severity of symptoms, duration of illness episodes as well as on the category of family member. Within the family the health problems were preferentially handled by the mother and the dominating type of treatment was medication (73% of total activity). It is concluded that young families perceive and handle a huge amount of health problems without communication with the professional health care system.
Adolescent↗
Studies on dental and periodontal conditions in normal mice and mice with genetic disorders. I. The effect of a hard diet or a soft sucrose-rich diet in the absence or presence of Streptococcus mutans in the normal (non-gnotobiotic) mouse, strain C57BL/6J.
Periodontal bone loss and caries development were studied in 45 pigmented mice of the C57BL/6J strain. At the age of 22-30 days the animals were divided into three groups. After 4.5 months one group, which received a hard pellet diet, presented no caries lesions. A second group, which received a soft sucrose-rich diet, had only 2 superficial caries lesions. The animals of the third group, finally, which also received a soft sucrose-rich diet but in addition were exposed to Strep. mutans, had all decayed teeth with only one exception. From this single mouse, Strep. mutants was not recovered. By using a scoring system for periodontal bone loss it could be shown that mice infected with Strep. mutans presented an increased distance between the cemento-enamel junction (CEJ) and the alveolar crest compared with non-infected mice receiving the same soft sucrose-rich diet. Mice kept on the hard pellet diet showed an even greater distance between CEJ and bone crest. This increased distance is suggested to be a result of both increased periodontal bone resorption and of an accelerated tooth eruption, the later probably due to an increased wear of the teeth, especially in the hard diet group, and a compensating elongation of the roots. The experimental model, using mice infected with Strep. mutans and given a sucrose-rich diet combined with the scoring system presented, is suggested to be useful in the study of the influence of endogenous factors on dental and periodontal tissues.
Alveolar Process↗
Exposure to welding fumes and chronic renal diseases, a negative case-referent study.
It was observed that some patients with glomerulonephritis or interstitial nephritis were welders. A hypothesis that welding fumes were an occupational hazard was put forward and initiated the following case-referent study. 143 cases were defined as living males, age 25 to 65 years, with renal disease which caused renal biopsy from 1976-1982. Three population-based referents for each case were selected from the national register of the total population matched by sex, age and community. Exposure was assessed by means of a questionnaire. Only 7% of the cases and 12% of the referents did not answer the questionnaire. There were no differences in exposure rates between cases and referents, even if exposure restrictions were applied. The power of the case-referent study was high.
Adult↗
The impact of early medical technology on maternal mortality in late 19th century Sweden.
The prevention of fatal complications of childbirth is a priority of health care in the developing countries. This historical study of maternal deaths in Sweden analyses the decline in mortality between 1751-1900 and during this years maternal mortality was reduced by 76% whereas the female mortality dropped only by 33% The decline was especially pronounced during the period 1861-1900, when maternal mortality declined from 567 to 227 per 100,000 live births. The potential impact of medical technology was analysed by epidemiological methods for the period 1861-1900. The introduction of antiseptic technique was estimated to reduce septic maternal mortality 25-fold in lying-in hospitals and 2.7-fold in rural home deliveries, implying that 49% of the septic maternal deaths were thus "prevented". In addition, licensed midwives assisting at home deliveries were estimated to reduce non-septic mortality 5-fold, thus "preventing" 46% of the non-septic maternal deaths. This could be one explanation why Sweden had a lower maternal mortality than the U.S. and the U.K. in the beginning of the 20th century.
Antisepsis↗
Mortality and lead exposure: a retrospective cohort study of Swedish smelter workers.
The study is based on the work histories and mortality data for 3832 male workers first employed before 1967 at a copper smelter in northern Sweden and followed up from 1950 to 1981. From the 3832 workers a lead cohort consisting of 437 workers employed for at least three years at sites with considerable lead exposure during 1950-74 was selected. These workers had regularly had blood lead measurements performed since 1950. Based on the cumulative blood lead dose 1950-74 and peak blood lead values, the cohort was subdivided into high mean, low mean, high peak, and low peak groups. Standardised mortality ratios (SMR) were calculated for the six groups using general and local reference populations. The original cohort of 3832 workers showed considerable excess of deaths for total mortality, malignant neoplasms especially lung and stomach cancer, ischaemic heart diseases, and cerebrovascular diseases when compared with the general population. In the lead cohort where the workers had been subjected to a considerable lead exposure only the raised SMR for lung cancer was sustained (SMR = 162; not significant). No significant differences were found between high lead and low lead exposed smelter workers.
Adolescent↗
Why are diabetes, stomach cancer and circulatory diseases more common in Northern Sweden?
Why does a greater proportion of the population of northern Sweden suffer from such diseases as diabetes, stomach cancer and those of the circulatory system than people living in the southern part of the country? Are there any environmental factors that can explain these circumstances? It can be concluded from this study that the regional mortality pattern displayed here cannot be disregarded. The consistency of the finding is supported by the joint analysis of several data sources. The analyses in this study indicate that dietary habits, water hardness, and seasonal variations--rather than smoking habits or alcohol abuse--could be causal explanations for the regional mortality pattern in circulatory diseases. Diet and genetic factors may explain the regional variations in diabetes, while there is so far no evidence for associations between stomach cancer and any environmental factors. Thus, there is no correlation between stomach cancer and waterborne nitrate level in the 24 Swedish counties. This calls for further studies on the connections between stomach cancer and intake of salt, vitamins or trace elements. The preparation of foods could also have some impact on the incidence of stomach cancer.
Cardiovascular Diseases↗
Mortality and cancer incidence among Swedish dock workers--a retrospective cohort study.
The study originates from the arousal of suspicions that, in connection with loading and unloading work involving the use of trucks, exposure to diesel exhaust fumes may be carcinogenic. This report describes a register study in which a broad mapping of the cause-of-death pattern and cancer morbidity has been carried out through the matching of locally compiled personal data with those from a central register, the Cause-of-Death Register, and the Cancer Register. The results obtained thus far show a low total mortality--irrespective of cause of death--but a tendency towards an excess risk for cancer morbidity, mainly due to lung cancer.
Humans↗
Coordination of Ca2+ regulating and Ca2+ regulated processes in the study of muscle function.
The self-organization of biological systems is, in part, described by dynamical order and cooperativity of system elements. Consideration of this, therefore, should form the infrastructure of future Exercise/Sport Biochemistry Research in Canada since a solely elemental focus, in its' interpretation, may not be meaningful if the synergy among system elements is not appreciated. This approach is illustrated through a description of the central role of Ca2+ metabolism in coordinating subcellular events associated with muscle contraction. The decline in force generating capabilities associated with extreme muscle use (e.g. endurance type exercise) is, in our view, due to an uncoupling of excitation-contraction coupling leading a Ca2+ imbalance. The observed dissolution of the myofibril ultrastructure and altered SR function reflect a loss of normal order and synergy amongst Ca2+ regulated and Ca2+ regulating processes which will lead to an upcoupling of oxidative phosphorylation. These apparently catastrophic events may, paradoxically, establish a new order in which energy utilizing systems attempt to keep pace with the abbreviated energy production system.
Animals↗
Determinants of microangiopathy in growth-onset diabetes. With special reference to retinopathy and glycaemic control.
In a quasi-experiment all diabetic children in a defined area were exposed either to an intense clinical treatment or served as a constructed control. The cohort of 146 diabetics was observed prospectively for at least 15 years as to diabetic control, mainly glycosuria, and cross-sectionally examined for microangiopathy on four occasions. Data on family background, social situation, smoking, blood pressure, biochemical status, anthropometry, HLA factors and mortality were also gathered. Throughout the analysis duration was considered and treated as a concomitant variable. Two different strategies have been followed in the analysis, one trying to predict microangiopathy at a fixed and predetermined duration, the other to study determinants of the pattern of microangiopathy occurrence over time. Multiple logistic regression and Cox analysis have been used to fit these strategies. The prevalence of microaneurysms or more advanced stages of retinopathy at 10 years duration was 30 per cent and within 20 years 81 per cent. About 52 per cent had haemorrhages after 20 years. Mild and severe nephropathy after 20 years have been contracted by 50 and 15 per cent respectively. No clear sex differences were seen. Variables significantly explaining retinopathy within 10 years were post-pubertal duration, blood pressure, place of medical supervision and the HLA/DR4 marker. The mean glycosuria was high during puberty irrespective of age at onset. The overall pattern of retinopathy occurrence seemed to be influenced by place of medical supervision, age at onset, blood pressure, family history of ischaemic heart disease and glycemic control. For the progression of retinopathy the role of factors reflecting medical supervision and control of diabetes seemed even greater. Even after accounting for degree of diabetic control the experimental group had a more favourable outcome, suggesting additional quality of care components. Mild nephropathy was less predictable from the above risk factors while previous findings of the important role of elevated blood pressure for severe nephropathy was confirmed. We estimate that half of retinopathy cases were preventable by the "experimental" care and conclude the near-normalization of glycaemia under routine conditions favourably influences the development of diabetic retinopathy.
Adolescent↗
Secular trends in maternal mortality in Sweden from 1750 to 1980.
Mortality statistics have been kept continuously in Sweden since 1750 and reveal that the maternal mortality rate declined from 900 to 6 per 100 000 live births over the period 1750 to 1980. Two-thirds of this decrease occurred during the 19th century and the remainder in the 20th century. In the 18th century, 10% of deaths among women aged between 15 and 49 years were due to complications at parturition, but today this accounts for only 0.2% of deaths in women of this age group. Life-table analysis indicates that 1 out of 29 women in Sweden lost her life in parturition during the 18th century, while today only 1 out of 1000 women dies as a result of complications during pregnancy and parturition.
Adolescent↗
Age and parity as determinants of maternal mortality--impact of their shifting distribution among parturients in Sweden from 1781 to 1980.
The reduction in maternal mortality in Sweden between 1781 and 1980 is analysed with respect to changes in the distribution of age and parity among parturients over this period. Changes in maternal age contributed to almost 3% of the reduction in mortality over the period 1781-1911 and to 5% between 1911 and 1980. From 1965 to 1980, however, about 50% of the reduction in mortality was caused by a decrease in maternal age. Changes in parity have had the opposite effect. Maternal deaths attributable to the risk factors of age and parity increased from 46% during the 19th century to 80% from 1951 to 1980.
Adolescent↗