Unemployment and mortality--a longitudinal prospective study on selection and causation in 49321 Swedish middle-aged men.

BACKGROUND: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all-cause and cause-specific mortality, adjusting for indicators of mental disorder, behavioural risk factors and social factors over the life course. METHODS: This study was based on a cohort of 49321 Swedish males, born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990-4 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973-2004 were collected in national registers. RESULTS: An increased risk of mortality 1995-2003 was found among individuals who experienced 90 days or more of unemployment during 1992-4 compared with those still employed (all-cause mortality HR 1.91, 95% CI 1.58 to 2.31. Adjustment for risk factors measured along the life course considerably lowered the relative risk (all cause mortality HR 1.30, 95% CI 1.06 to 1.58). Statistically significant increased relative risk was found during the first 4 years of follow up (all-cause mortality, adjusted HR 1.57, 95% CI 1.13 to 2.18, but not the following 4 years (all cause mortality, adjusted HR 1.17, 95% CI 0.91 to 1.50). CONCLUSION: The results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.

Unemployment, labour market policy and health in Sweden during years of crisis in the 1990's.

OBJECTIVE: To give an overview of an economic crisis in Sweden and its health consequences for employed and unemployed groups together with some health-related data from participants in labour market programmes. OUTCOME AND CONCLUSIONS: During the first half of the 1990's, Sweden was hit by a pervasive crises characterised by steeply increasing unemployment and growing job insecurity. Long-term survey data show that somatic well-being continued to improve in the population, while psychological well-being deteriorated, and this deterioration was of a similar magnitude among unemployed and employed groups. Two non-traditional labour market programmes for unemployed individuals are briefly described. Both programmes resulted in some positive effects on subjective health, which, however, were not corroborated by psychophysiological data. It is argued that the employment-unemployment dichotomy can be replaced by a dimensional view on labour market connection, as insecure jobs may have as detrimental health effects as open unemployment. Impediments to empowerment in the labour market programmes are discussed.

A phase II study of combined 5-fluorouracil and mitomycin C in advanced breast cancer.

In a Phase II study, 50 patients with advanced breast cancer were treated with a combination of 5-fluorouracil (1000 mg/m2 on days 1 and 2) and mitomycin C (6 mg/m2 on day 2) (FuMi regimen). The courses were repeated every third to sixth week. Although 35 patients had previously received combination chemotherapy and 40 patients had received endocrine treatment, objective responses were obtained in 29 patients (six complete, 23 partial). The survival was significantly correlated to the response (P less than 0.001, log rank test) complete versus partial response, partial response versus no change, no change versus progressive disease. The regimen was well tolerated (19 of 50 experienced nausea). Thirteen patients had hematopoietic toxicity at the day of starting a new course and in six cases, the FuMi regimen had to be discontinued because of longlasting thrombocytopenia. Otherwise, no side-effect of clinical importance was observed. The FuMi regimen is now compared with Adriamycin regimens and can be recommended for both first line chemotherapy and salvage chemotherapy.

Short-term intra-arterial mitomycin C in hepatic metastases.

Short-term intra-arterial Mitomycin C treatment of hepatic metastases from various malignancies was performed in 24 evaluable patients. An objective regression was obtained in 12 patients. The median survival of responders was 11 months compared with 3 months in nonresponders. No complication of the technical procedure occurred and the treatment was well tolerated. The only side effect of clinical importance was thrombocytopenia, which occurred at a median dose of 45 mg of Mitomycin C.