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[Serum urate and gout in a young male workforce (author's transl)].

Serum urate levels and history of gout were obtained from 4 663 men aged 20-44 who were employed by a Parisian government agency. Serum urate levels, mean value 62,8 mg/l (374 mumol/l), did not vary with age but were strongly correlated with weight. For constant weight, urate levels decreased with age. By our definition: typical history of gout and either efficacity of colchicine during and attack or serum urate level over 70 mg/l (417 mumol/l) at examination, there were 57 cases of gout, giving a prevalence of 1,1% among men 35-39 and 2,0% among men 40-44 years old. Using the definition by the New York criteria which do not include serum urate level, there were 51 cases of gout, giving a prevalence of 1,5% in the 35-44 year age group. This is about 3 times the prevalence found by O'Sullivan, using the same criteria, in an American town. The higher serum urate levels in the present study may account for much of this difference. The incidsence of new cases of gout was estimated to be 1,6% over 5 years for men 40-44 years old. The site was the great toe in 57% of gouty men with only one attack and in 92% of those with more than one attack. It was not related to the amount of standing or activity at work. Comparison with a study made 7 years earlier showed an augmentation in serum urate values and probably in prevalence of gout. These results are discussed in terms of dietary modification over this time period.

Adult↗

[Indirect morbidity indicators and social differences in the ISTAT quarterly workforce survey].

Information on the health condition job related of the population are often collected in specific studies, usually limited over time and concerned with a small part of the general population. Looking at official statistics, sources such as national health surveys (in Europe and in North America) are rich on health data, but often offer little information on job-conditions, and job history. On the other hand, one also can find official sources, mainly concerned with labour and job related topics, in which information related to the health status of the people interviewed are routinely collected. These are the Labour Force Surveys, carried out in the most of developed countries. In the Italian Labour Force Survey (RTFL) the Italian Statistical Institute (ISTAT) quarterly collects information on health-related sick absence, part-time job and unemployment. Data from RTFL of two Italian regions (Lombardy: 1985, '86, '89 and Veneto: 1985, '86) show differentials by age and job-position that are consistent with expectation, encouraging an extensive use of this source for surveillance purposes at the national and regional level.

Absenteeism↗

Managing a culturally diverse workforce.

The cultural beliefs that exist within a group of nurses influence nursing practice and communication outcomes. Addressing cultural issues begins by identifying personal beliefs and behaviors that are linked to an underlying cultural core. A framework for culturally congruent nursing management leads to a point of understanding and respect for differences, values, beliefs and behaviors.

Cultural Characteristics↗

Physician-workforce and educational planning in Canada: has the pendulum swung too far?

Since the early '80s, and especially since the publication in 1991 of Toward Integrated Medical Resource Policies for Canada (the Barer-Stoddart Report), received wisdom has been that there is an oversupply of physicians in Canada and that medical school enrollment should be cut. In a CMAJ article published July 1, 1994, that described a computer program to forecast the supply and demand of health care resources, Denton, Gafni and Spencer projected a substantial physician surplus in Ontario in the years 2000 and 2010, despite substantial cuts in Ontario medical school enrollment. The author questions the data used in the forecasts and reaches different conclusions. She advances an alternative hypothesis that current medical school admission levels are, in fact, too low.

Education, Medical↗

Impediments to progress in health care workforce policy: license and practice laws.

Any meaningful reform of health care delivery will have to overcome current barriers to effective utilization of nonphysician providers. These barriers include cultural and professional realities, as well as a number of explicit legal impediments. Medical practice acts remain overly broad and indeterminate, with concomitant and unnecessary restrictions in the licensure and practice acts of nonphysician providers. If we are to achieve our goal of offering high-quality care, at an affordable cost, to everyone who needs it, we must ensure that all health care providers are able to practice within the full scope of their professional competencies.

Allied Health Personnel↗

Combined analysis of mortality in three United Kingdom nuclear industry workforces, 1946-1988.

Mortality during 1946-1988 has been analyzed in 75,006 employees of the United Kingdom Atomic Energy Authority, the Atomic Weapons Establishment and the Sellafield plant of British Nuclear Fuels. All-cause mortality was 19% lower than national rates among workers monitored for external radiation exposure and 18% lower among nonmonitored workers. Cancer mortality was also lower than national rates and was similar in the two groups of workers [rate ratio (RR) = 0.96]. Of 29 specific cancer sites examined, only for cancers of the pleura and uterus were there statistically significant excesses of mortality in monitored workers relative to nonmonitored workers [RR = 7.08, two-sided P (2P) = 0.008 and RR = 3.02, 2P = 0.003, respectively]. There was little association between cumulative external radiation and risk of death from all cancers combined 10 or more years after exposure [z for trend = +0.11, one-sided P (1P) = 0.5]. A positive association was observed for leukemia (assuming a 2-year lag between external radiation and increasing risk of death) (1P = 0.009) but not for other cancers associated with external radiation in previous analyses (lung, uterus, prostate and multiple myeloma, all 1P > or = 0.1). Positive associations (1P < or = 0.05) were also observed for melanoma and other skin cancers (1P = 0.03) and ill-defined and secondary cancers (1P = 0.04), but these results are difficult to interpret and, given the number of associations examined, may be chance findings. Estimates of excess relative risk per sievert were -0.02 (95% CI = -0.5-+0.6) for all cancers except leukemia and +4.18 for leukemia (95% CI = +0.4-+13.4). The positive estimates for leukemia contrast with negative values found for workers in the United States, although the confidence intervals obtained in the two studies overlap. While our estimates of risk are compatible with those derived from studies of A-bomb survivors, the statistical uncertainty associated with them is such that the data are consistent with risks ranging from no additional risk to twice the risk for cancers other than leukemia and, for leukemia, from one-fifth to three times the risk in A-bomb survivors.

Cause of Death↗