Gender differences in survival after lung transplant: implications for cancer etiology.

Predictors of survival after lung transplant were analyzed in a large cohort of 990 lung transplanted patients from a single center. The overall survival was 41.6%, (41.5% in males, and 41.8% in females), the average length of the follow up was 45.84+/-51.98 months (range 0-282.47 months). Females tend to live longer than males: 50.75+/-55.41 months versus 40.64+/-47.60 months, respectively. Males had a risk of dying during the follow up that was 1.18 (95% CI 1.01-1.40) relative to females, after adjusting for ethnicity, age, smoking status, diagnosis and donor characteristics. Females who had at least one full term pregnancy during their life had better survival rates than females who had no full term pregnancies. Our results of a better survival after lung transplant in females, and among them in those who had at least a full term pregnancy support the hypothesis of a hormonal contribution to survival and of the development of immunotolerance after pregnancy. This model could be useful for understanding the role of immunity in cancer development.

How do you interpret these lab results based on the following case presentation?

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Inquiries and contributions to the Forum should be forwarded to Joseph J. Schwerha, MD, MPH by e-mail at schwer@pitt.edu.

The impact of body mass index on short-term disability in the workplace.

OBJECTIVE: The objective of this study was to assess the association between body mass index and short-term disability in a working "white collar" population. METHODS: The authors collected cross-sectional data from 19,061 health risk appraisals completed by employees of a large financial services corporation from 2000-2002. The self-reported information for demographics and job satisfaction was combined with personnel and detailed information from short-term disability events (STD) taken during the same time period. RESULTS: After adjusting for multiple covariates, body mass index is an independent predictor for STD events. Body mass index categories of overweight and obese have odds ratios of 1.26 and 1.76 compared with normal weight (P < 0.0001). CONCLUSIONS: The improvement of employee health and wellness should be pursued by the employer in an effort to promote healthier weight among their workers. This in turn should reduce STD events that result in the loss of worker productivity and a major cost to companies.

A retrospective investigation of PM10 in ambient air and cardiopulmonary hospital admissions in Allegheny County, Pennsylvania: 1995-2000.

OBJECTIVE: Air quality in Allegheny County, Pennsylvania, has improved over the last decade, and we investigated whether the lower concentrations of fine particulate matter (PM10) are still associated with adverse health outcomes. METHODS: Daily cardiopulmonary hospital admissions in elderly residents of Allegheny County and countywide average PM10 measures were available from 1995 through 2000. Using generalized additive models (GAM), a Poisson regression model was fit to the number of daily admissions using predictor variables: lags of PM10, daily temperature and humidity, day of the week, and time. RESULTS: Our findings suggest that there is a positive association of PM10 with hospital admissions, and the effect is related to current-day PM10 levels. CONCLUSIONS: Even at the lower levels of ambient air pollution as measured by PM10, there is still a suggestion of an adverse health effect in the elderly.

Occupational medicine forum.

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

Blunt trauma to large vessels: a mathematical study.

BACKGROUND: Blunt trauma causes short-term compression of some or all parts of the chest, abdomen or pelvis and changes hemodynamics of the blood. Short-term compression caused by trauma also results in a short-term decrease in the diameter of blood vessels. It has been shown that with a sudden change in the diameter of a tube or in the direction of the flow, the slower-moving fluid near the wall stops or reverses direction, which is known as boundary layer separation (BLS). We hypothesized that a sudden change in the diameter of elastic vessel that results from compression may lead not only to BLS but also to other hemodynamic changes that can damage endothelium. METHODS: We applied Navier-Stokes, multiphase and boundary layer equations to examine such stress. The method of approximation to solve the BL equations was used. Experiments were conducted in an aerodynamic tube, where incident flow velocity and weight of carriage with particles before and after blowing were measured. RESULTS: We found that sudden compression resulting from trauma leads to (1) BLS on the curved surface of the vessel wall; (2) transfer of laminar boundary layer into turbulent boundary layer. Damage to the endothelium can occur if compression is at least 25% and velocity is greater than 2.4 m/s or if compression is at least 10% and velocity is greater than 2.9 m/s. CONCLUSION: Our research may point up new ways of reducing the damage from blunt trauma to large vessels. It has the potential for improvement of safety features of motor vehicles. This work will better our understanding of the precise mechanics and critical variables involved in diagnosis and prevention of blunt trauma to large vessels.

Occupational medical history taking: how are today's physicians doing? A cross-sectional investigation of the frequency of occupational history taking by physicians in a major US teaching center.

Occupational illness plays a prominent role in the health of society, yet physicians frequently neglect occupational history-taking both in clinical practice and in medical education. This study sought to examine the trends as well as related factors that influence the taking of occupationally related histories. A total of 2050 charts were reviewed for occupational information as well as several patient demographics. Physicians obtained gender and age histories in approximately 99% of their patients; however; they only completed an occupational history in 27.8%. Characteristics such as smoking, male gender, family cancer history, middle age, and medical (vs. surgical) admission were all correlated with obtaining an occupational history. Physicians continue to do a poor job of occupational history-taking and medical education must correct the situation.

Risk of cancer as a result of community exposure to gasoline vapors.

The Tranguch Gasoline Spill leaked 50,000-900,000 gallons of gasoline from underground storage tanks, potentially exposing an area of Hazle Township and Hazleton, Pennsylvania, to chronic low levels of benzene since at least 1990. A retrospective cohort study of 663 individuals representing 275 households assessed whether affected residents were at increased risk for cancer from 1990-2000 compared with the Pennsylvania populace. Age-adjusted standard incidence ratios (SIRs) were calculated using Pennsylvania rates to determine expected numbers. The age-adjusted SIR for the gasoline-affected area was 4.40 (95% confidence interval: 1.09-10.24) for leukemia. These results suggest an association between living within the area affected by the Tranguch Gasoline Spill and increased risk for leukemia.