Age and Lymph Node Positivity in Patients With Colon and Rectal Cancer in the US Military Health System.

BACKGROUND: Young age may be associated with an increased risk of lymph node involvement at diagnosis of colorectal cancer. Accessibility to care, which is related to cancer detection, tumor stage, and therefore lymph node positivity, may vary by age and thus influence research results. OBJECTIVE: The purpose of this study was to investigate whether young patients had an increased risk of lymph node-positive colon and rectal cancers in the Department of Defense Military Health System, which provides universal health care to its beneficiaries. DESIGN: This was a retrospective, cross-sectional study. SETTINGS: Patients were identified from the US Department of Defense Automated Central Tumor Registry. PATIENTS: Included patients were diagnosed with histologically confirmed primary stage I to III colon and rectal adenocarcinomas between 1989 and 2013, had surgery and ≥1 lymph node examined, and did not receive preoperative radiotherapy. Logistic regression was used to examine the relationships between age at diagnosis (18-49, 50-59, 60-69, and ≥70 y) and lymph node positivity overall and stratified by tumor T stage and number of lymph nodes examined. MAIN OUTCOME MEASURES: Lymph node positivity of colon and rectal cancers was measured. RESULTS: The youngest patients (aged 18-49 y) were more likely to have lymph node-positive colon and rectal cancers compared with those who were aged ≥70 years after adjustment for potential confounders (OR = 2.04 and 95% CI, 1.63-2.56 for colon cancer; OR = 1.73 and 95% CI, 1.11-2.70 for rectal cancer). A similar tendency was shown in most colon and rectal cancer subgroups stratified by tumor T stage and number of lymph nodes examined. LIMITATIONS: This study was limited by its small sample size for certain subgroup analyses. No information on comorbidities, BMI, or other indicators of health status was available. CONCLUSIONS: In a universal healthcare system, young age was associated with increased lymph node positivity of colon and rectal cancers, suggesting that factors other than access to care may play a role in this association. See Video Abstract at http://links.lww.com/DCR/B90. EDAD Y POSITIVIDAD DE GANGLIOS LINFÁTICOS EN PACIENTES CON CÁNCER DEL COLON Y EL RECTO EN EL SISTEMA DE SALUD MILITAR DE EE UU: La edad temprana puede estar asociada con un mayor riesgo de compromiso de los ganglios linfáticos en el momento del diagnóstico de cáncer colorrectal. La accesibilidad a la atención medica, que está relacionada con la detección del cáncer, el estadio del tumor y, por lo tanto, la positividad de los ganglios linfáticos, puede variar según la edad y, por lo tanto, influir en los resultados de la investigación.Investigar si los pacientes jóvenes tenían un mayor riesgo de cáncer del colon y el recto con ganglios linfáticos positivos en el Sistema de Salud Militar del Departamento de Defensa, que brinda atención médica universal a sus beneficiarios.Estudio transversal retrospectivo.Se identificaron pacientes del Registro Automático Central de Tumores del Departamento de Defensa de los Estados Unidos.Fueron diagnosticados con adenocarcinomas del colon y el recto en estadio I-III confirmados histológicamente entre 1989-2013, se les realizó una cirugía y se examinaron ≥ 1 ganglio linfático, y no recibieron radioterapia preoperatoria. La regresión logística se utilizó para examinar las relaciones entre la edad al momento del diagnóstico (18-49, 50-59, 60-69 y ≥70 años) y la positividad de los ganglios linfáticos en general y fue estratificada por el estadio T tumoral y el número de ganglios linfáticos examinados.Positividad de ganglios linfáticos de cáncer del colon y el recto.Los pacientes más jóvenes (18-49 años) tenían más probabilidades de tener cáncer del colon y el recto con ganglios linfáticos positivos en comparación con aquellos que tenían 70 años o más después del ajuste por posibles factores de confusión (odds ratio: 2.04, intervalo de confianza del 95%: 1.63 -2.56 para el cáncer de colon; odds ratio: 1.73, intervalo de confianza del 95%: 1.11-2.70 para el cáncer de recto). Se mostró una tendencia similar en la mayoría de los subgrupos de cáncer del colon y el recto estratificados por el estadio T tumoral y el número de ganglios linfáticos examinados.Tamaño de muestra pequeño para ciertos análisis de subgrupos. No hay información sobre comorbilidades, índice de masa corporal u otros indicadores del estado de salud.En un sistema de salud universal, la edad joven se asoció con un aumento de la positividad de los ganglios linfáticos del cáncer del colon y el recto, lo que sugiere que otros factores además del acceso a la atención medica pueden desempeñar un papel en esta asociación. Consulte Video Resumen en http://links.lww.com/DCR/B90.

Mortality of 196,826 Men and Women Working in U.S.-Based Petrochemical and Refinery Operations: Update 1979 to 2010.

OBJECTIVE: To describe mortality trends of men and women working in various petrochemical and refinery operations of a U.S.-based company. METHODS: The cohort consists of full-time employees with at least 1 day of service during 1979 through 2010. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated for 111 possible causes of death studied. RESULTS: SMRs for malignant mesothelioma and asbestosis were highest for the 1940s decade of hire. Increased SMRs were observed for malignant melanoma and motor neuron disease with no obvious work patterns. Decreasing mortality patterns were observed for aplastic anemia and acute nonlymphocytic leukemia. CONCLUSIONS: Mortality surveillance of this large established cohort aids in assessing the chronic health status of the workforce. Identifying methods for incorporating job-exposure matrices and nonoccupational risk factors could further enhance interpretations for some findings such as motor neuron disease.

An interdisciplinary framework for derivation of occupational exposure limits.

Protecting the health and safety of workers in industrial operations is a top priority. One of the resources used in industry to ensure worker safety is the occupational exposure limit (OEL). OELs are derived from the assessment and interpretation of empirical data from animal and/or human studies. There are various guidelines for the derivation and implementation of OELs globally, with a range of stakeholders (including regulatory bodies, governmental agencies, expert groups and others). The purpose of this manuscript is to supplement existing guidance with learnings from a multidisciplinary team approach within an industry setting. The framework we present is similar in construct to other risk assessment frameworks and includes: (1) problem formulation, (2) literature review, (3) weight of evidence considerations, (4) point of departure selection/derivation, (5) application of assessment factors, and the final step, (6) derivation of the OEL. Within each step are descriptions and examples to consider when incorporating data from various disciplines such as toxicology, epidemiology, and exposure science. This manuscript describes a technical framework by which available data relevant for occupational exposures is compiled, analyzed, and utilized to inform safety threshold derivation applicable to OELs.

Assessing the potential influence of asthma on student attendance/absence in public elementary schools.

OBJECTIVES: Student health, well-being, and productivity are determined in part by attending school daily. Increased annual average daily attendance (ADA) increases public funding for school district-based enrichment programs. Asthma is reported as the number 1 cause of American school absenteeism due to chronic illness; however, only limited, estimated national data exist. Accurate, precise ways to assess potential disparities in disease-driven absence do not yet exist. The authors summarize part of their community-based participatory research (CBPR), namely planning then testing a set of matching field sheet (data collection) and computer-based spreadsheets (database) based on previous school-based research to track attendance and reasons for absence. METHODS: The CBPR process occurred mid-2005 to mid-2008, with final activities in DeKalb County, Georgia, August-December 2007 (fall semester) for this portion. The authors tracked absence, with an ability to examine data overall and at classroom, grade, and school levels by gender, race/ethnicity, and doctor-diagnosed asthma as reported to schools on student emergency cards. RESULTS: The authors characterized their study sample, consisting of 914 4th-5th grade children (overall, 9.2% of children with asthma) from seven randomly selected, consenting participating schools (n = 21 classrooms per grade, 2 to 4 classrooms per grade per school). Six schools used paper versions of tools while one school used electronic versions. The authors presented attendance results in various aggregated manners. Absence was higher (ADA lower) among 4th grade asthmatic students compared to the entire classroom. CONCLUSIONS: This study can inform future interdisciplinary school-based research combining health and student academic productivity, adult work performance outcomes, and other measures.

Knowledge and awareness of heat-related morbidity among adult recreational endurance athletes.

Adults have been increasingly motivated to compete in recreational endurance sports events. Amateurs may lack a complete understanding of recommended strategies for handling heat and humidity, making heat-related illnesses increasingly possible. This is compounded by global climate change and increasing average surface and air temperatures, especially in urban areas of industrialized nations in Europe and North America that have hosted most events to date. We conducted an on-line, secure survey at the 2nd Annual ING Georgia Marathon and Half-Marathon in Atlanta, Georgia, in 2008. We included previously validated questions on participant socio-demographics, training locations, and knowledge and awareness of heat-related illnesses. Participants were aware of heat illnesses, and of heat stroke as a serious form of heat stress. However, the majority, across age and gender, did not understand the potential severity of heat stroke. Furthermore, 1-in-5 participants did not understand the concept of heat stress as a form of heat-related illness, and how heat stress may result from buildup of muscle-generated heat in the body. Adult recreational endurance athletes are another susceptible, vulnerable population sub-group for applied research and public health educational interventions, especially in urban areas of industrialized nations in Europe and North America.

Community environmental quality knowledge and awareness among nurses: developing and piloting an assessment survey in schools.

About one in five Americans spends a considerable number of hours in school each week, and thus, is exposed to a variety of environmental agents. Community health nursing professionals require resources and specific training to acquire the environmental knowledge needed to raise personal and community awareness as an enhancement of their practice. Given limited resources for schools and local public health education initiatives, identifying and prioritizing environmental concerns comes before actions to prevent or reduce exposures. With the rise in prevalence of childhood asthma, of special concern are those agents within the school environment that may serve as asthma triggers. This pilot project, within a larger study in a large school district in metropolitan Atlanta, Georgia, developed and piloted an environmental health priorities survey with school nurses and other school staff about indoor and outdoor microenvironments relevant to school-aged children. Findings indicate that participants (N = 34) could prioritize environmental issues to inform future intervention activities (such as continuing education training), and distinguish predominantly indoor from typical outdoor exposure agents and their major sources.