Mortality and cancer rates among workers in the Swedish PVC processing industry.

Personnel lists from four PVC-processing industries were collected on production of employees with at least three months of employment at the beginning of 1945 and the last day of employment December 31, 1974. Of 2073 persons, 103 could not be followed up, because they had moved abroad. The remaining persons comprise the cohort of 1970 individuals who were analyzed and compared with the national population with respect to mortality from various diseases and cancer morbidity. The death risk from myocardial infarction is elevated in the cohort. This elevation is most clearly apparent in the subcohort which had at least two years of exposure time and where the analysis was directed at circumstances chronologically close to the time of exposure. The myocardial infarction risk related to vinyl chloride exposure is discussed in relation to earlier studies on the vascular effects of vinyl chloride. An indication of an elevated risk of morbidity and mortality from tumors in the digestive organs is also present. However, this is not statistically confirmed. A few future follow-ups of the present study are necessary in order to clarify any possible elevated risk of tumors in the PVC-processing industry.

Self-rated health. Comparisons between three different measures. Results from a population study.

BACKGROUND: Self-rating of health is among the most frequently assessed health perceptions in epidemiological research. The aim of this study was to compare different measures of global self-rated health (SRH) with respect to differences in age and sex groups and relations to hypothesized determinants. METHOD: Three single-question measures of SRH were included in a health questionnaire administered to 8200 randomly chosen men and women. Two SRH measures were non-comparative, one with seven (SRH-7) and one with five response options (SRH-5), while the third measure included a comparison with others of the same age (SRH-age). SRH-7 had specified response options only at the ends of the scale, while the other two measures gave specified statements for each option. Comparisons between the SRH assessments were studied with respect to response frequencies, frequency distributions, age and gender differences and differences in associations with hypothesized determinants. RESULTS: The differences between the SRH measures were in most cases marginal. Some diversities may, however, be worth considering: a high drop-out rate for the SRH-7 measure in the oldest age group; a trend that SRH-7 correlated most strongly with the independent variables; SRH-age showed improved health ratings with increasing age but a less skewed frequency distribution compared to the non-comparative measures. CONCLUSIONS: The results imply that non-comparative measures are more appropriate in longitudinal studies and that measures without specified response options might be less suitable for an older study group. The overall impression is, however, that the different measures represents parallel assessments of subjective health.

Self-report as a selection instrument in screening for cardiovascular disease risk.

INTRODUCTION: Cardiovascular disease (CVD) risk screening may rely partly on self-report information. The accuracy of self-reporting in relation to the actual risk factor status is insufficiently known. DESIGN: Self-report (yes, no, don't know) of presence of hypertension, hyperlipidemia, and overweight was compared to the corresponding risk factor data obtained by physical examination and blood analysis. The examinations carried out in a primary health care setting in Sweden were on a randomized population of 122 men and 127 women aged 20 to 60 years. RESULTS: Unawareness of hyperlipidemia was 71% in women and 56% in men, as compared to 29% or lower for the other risk factors. The sensitivity of self-report was 69% or higher for the other risk factors, with the exception of hypertension in women, where it was 29%. Specificity was generally high, except for hyperlipidemia. CONCLUSION: On a population level, self-reports of hypertension, hyperlipidemia, and overweight provide a feasible selection instrument by which a subpopulation with high risk factor frequency can be identified. However, the rate of misclassification is considerable. For hyperlipidemia, the benefit of self-reporting is presently limited, due to the high unawareness of this risk factor. Individual awareness and accurate knowledge about the presence or absence of risk factors needs to improve before self-reporting can be used as a reliable instrument in risk factor screening.

Patient charges--a hindrance to financially and psychosocially disadvantage groups seeking care.

This study examines the extent to which people forego seeking primary health care due to the cost and to investigate the associated demographic, physical, psychological and social factors. In 1995, questionnaires were sent to a random sample of the population in two healthcare regions in the Stockholm area in Sweden covering a total of about 400,000 inhabitants. Among the sample of 8200 people over the age of 17 yr, 69% replied to the questionnaire. About 22% stated that on one or more occasions during the past year they had foregone seeking care due to the cost. About 30% stated that they had foregone or hesitated seeking medical help due to the cost during the past year. This applied to women to a greater extent than men. Not seeking medical care was strongly correlated to a self-assessment of personal finances. Among those who described their financial situation as poor, more than half stated that, on at least one occasion, they had foregone seeking medical care due to the cost. As a consequence, weaker groups in society such as the unemployed, students, foreign nationals and single mothers were overrepresented in this group. Those who had foregone care perceive their health as worse and they had a greater degree of general pains and a higher occurrence of chronic disease/disability compared to those who had not foregone care. Between 1970 and 1995, patient charges for consulting a general practitioner within Stockholm County have increased more than three times faster than the consumer price index. The results suggest that the rapidly increasing patient charges particularly affect the weaker social groups and thus pose a threat to the aim of Swedish healthcare legislation--that good care should be available to everyone on equal terms.

Long-term exposure to jet fuel. II. A cross-sectional epidemiologic investigation on occupationally exposed industrial workers with special reference to the nervous system.

Thirty jet fuel exposed workers selected according to exposure criteria and thirty nonexposed controls from a jet motor factory were examined, with special reference to the nervous system, by occupational hygiene physicians, psychiatrists, psychologists, and neurophysiologists. The controls and the exposed subjects were matched with respect to age, employment duration, and education. Among the exposed subjects the mean exposure duration was 17 years, and 300 mg/m3 was calculated as a rough time-weighted average exposure level. The investigation revealed significant differences between the exposed and nonexposed groups for (a) incidence and prevalence of psychiatric symptoms, (b) psychological tests with the load on attention and sensorimotor speed and (c) electroencephalograms. When the control group was selected, it was ensured that the two groups were essentially equivalent except for exposure to jet fuel. It is concluded, therefore, that the differences found between the groups are probably related to exposure to jet fuel.

Exposure to organic solvents. A cross-sectional epidemiologic investigation on occupationally exposed care and industrial spray painters with special reference to the nervous system.

In the present epidemiologic study 80 car or industrial spray painters with long-term low level exposure to organic solvents were examined and compared with two matched reference groups of nonexposed industrial workers (80 persons in each group). The aim of the study was to investigate the possible effects of the solvent exposure on health. The investigation included psychiatric interviews, psychometric tests, neurological, neurophysiological and ophthalmologic examinations, and computed tomography of the brain. The painters' previous and present exposure was carefully assessed by interviews and on-the-job measurements both at modern places of work and in a reconstructed model of a workshop from 1955. On the basis of the psychiatric interviews the psychiatric symptoms were rated according to a specially designed scale of 46 different items, graded in seven steps of increasing severity. The psychological performance was assessed by a battery of 18 tests. The neurological and neurophysiological examinations comprised visual evoked responses (VER), electroencephalography (EEG), and computerized EEG analysis (SPA) for the central nervous system and electroneurography (ENeG), the estimation of vibration sense thresholds, and a quantified neurological examination for the peripheral nervous system. The ophthamologic examination concentrated on the condition of the lens. Statistically significant differences between the exposed individuals and referents were found for psychiatric items indicative of a slight cerebral lesion (ie, a neurasthenic syndrome). The psychometric tests revealed statistically significant differences between the groups with respect to reaction time, manual dexterity, perceptual speed, and short-term memory. No differences were found with respect to performance on verbal, spatial, and reasoning tests. Significant differences between the groups were also found for the majority of the neurophysiological parameters measuring peripheral nerve functions, the most pronounced occurring in the long, sensory fibers. Moreover EEG and VER showed some differences between the groups, as did the results of the ophthalmologic examination and the computed tomography. Finally, it should be emphasized that the exposure levels, as measured at modern places of work and in the reconstructed workshop from 1955, were found to be considerably lower than the valid threshold limit values in Sweden.

Is there a connection between car accidents, near accidents, and type A drivers?

The authors examined Type A behavior pattern, which has been investigated primarily as a risk factor for coronary heart disease, as a risk factor for car accidents and near accidents. Type A behavior pattern, which is characterized by excessive impatience, competitiveness, hostility, and time pressure, was assessed by means of the Videotaped Structured Interview. One hundred thirty-five Swedish car drivers (66 men and 69 women) were studied: 78 Type A and 58 Type B (that is, not having, Type A behavior). Time pressure was significantly associated with near accidents when age, sex, annual mileage, and urban driving were controlled in a multivariate model.

Investigation of visual strain experienced by microscope operators at an electronics plant.

This investigation was concerned with the examination of 75 microscope operators at an electronics plant, with reference to eye function and visual strain. It consisted of three separate parts: (1) standardised interviews dealing with symptoms of visual strain, (2) examinations of the refractive state as well as possible diseases of the eye, and (3) examination of binocular vision. It emerged that 80% of the microscope operators engaged in full time microscope operation experienced various symptoms of visual strain. A statistically verified relationship was found to exist between these manifestations of visual strain on the one hand and uncorrected astigmatism, fusion insufficiency (poorer eye co-ordination) and the length of time spent at the microscope during the working day on the other.

Health from the patient's point of view. How does it relate to the physician's judgement?

OBJECTIVES: The purpose of this study was to evaluate the relationship of self-rated health to a measure of physical status, based on a professional rating of the individual's health from a strictly physical point of view. METHODS: A random selection of 407 people over the age of 20 from the north-western catchment area of greater Stockholm were invited in 1995 to a physical examination, including a self-report questionnaire with questions about self-rated health, lifestyle, psychosocial factors and quality of life. A measure of physical health on a 5-point graded scale was constructed using the information from the records of the physical examination as a base. RESULTS: Self-rated health and the professional ratings of health coincided in approximately 60% of the cases. There were a relatively large number of cases where the ratings were contradictory. The correlation between the scales was 0.45. Comparison between the two ratings with respect to association with potential determinants showed that physical factors naturally explained most of the variances in physical health, whereas social and mental well-being and somatic conditions (women) were the most important explanatory variables for self-rated health. Irrespective of whether they had "favourable" or "unfavourable" health, those with "poor" self-rated health also had perceived lower social and mental well-being, less appreciation, more somatic conditions (women) and worse coping abilities (men). CONCLUSIONS: With mental, psychosocial and social problems becoming more pronounced in sickness patterns for primary care patients, self-rated health could be a helpful device, especially when time resources for consultations are short. This measure could also give a more global view of the patient's situation when effectivity and rationality can be a threat to a holistic view of the patient.

Cardiovascular effects of social support in the work place: twenty-four-hour ECG monitoring of men and women.

Psychosocial work characteristics, such as work demand, work control, and social support at work, have been shown to be related to the development of coronary heart disease in epidemiological studies. However, the mechanisms which mediate the social and psychological effects on the cardiovascular system are not known. We have studied the direct cardiovascular effects of psychosocial work environment characteristics in 148 working men and women, representing seven different occupational groups (physicians, teachers, musicians, policemen, train engineers, prison personnel, and saw mill workers). Besides standardized measures of work demand, work control, and social support, ambulatory 24-hour monitoring of electrocardiograms in the customary work and home environment was performed. Systolic and diastolic blood pressure were measured as well as other standard physiologic risk factors for coronary heart disease. Mean heart rates were found to be significantly higher in persons reporting low social support at work. This effect was maintained during working hours as well as during leisure time and rest. Of the other related physiologic risk factors, systolic, but not diastolic blood pressure was found to be higher in persons reporting low social support. Smoking, alcohol consumption and relative body mass index were not related to social support at work. Controlling for age, sex and physical strain at work, strengthened the association of low social support with elevated heart rates.

Four years experience of a cardiovascular opportunistic screening and prevention programme in the primary health care in Sollentuna, Sweden.

OBJECTIVE: To study the feasibility of a cardiovascular prevention programme. DESIGN: Opportunistic screening for cardiovascular risk factors. Advice and treatment to reduce identified cardiovascular risk factors. Individually designed follow-up. SETTING: Primary health care in Sollentuna (51,000 inhabitants), Sweden. SUBJECTS: Visitors to health care centres. MAIN OUTCOME MEASURES: Feasibility and effectiveness to reduce identified cardiovascular risk factors. RESULTS: During 4 years 5622 persons, of whom 4655 (83%) were in the age group 20-60 years, participated in the programme. The prevalences of risk factors as smoking, overweight, hypertension, hypercholesterolaemia and hypertriglyceridaemia were high. At follow-up investigations, mean S-cholesterol levels were reduced by 7% among men and 10% among women. S-triglycerides were reduced by 24% and 42%, respectively. Diastolic blood pressures were reduced in men from 95 to 90 mmHg and in women from 94 to 88 mmHg. However, no effects on weight were noted and due to a low follow-up rate meaningful analysis of smoking habits was not possible. CONCLUSION: A programme for cardiovascular screening and prevention can be integrated in the primary health care system. Prevalent cardiovascular risk factors like hypercholesterolaemia, hypertriglyceridaemia and high blood pressure were significantly reduced after intervention.

Metabolism and excretion of ropivacaine in humans.

The pharmacokinetics, biotransformation, and urinary excretion of ropivacaine (Naropin), a new local anesthetic agent, have been studied in six healthy male volunteers after a 15-min iv infusion of 152 mumol (50 mg) of [14C]ropivacaine, with a specific radioactivity of 22.5 kBq/mumol (8.8 kBq/mg). Blood, urine, and feces were collected for up to 96 hr after administration. The plasma and urine samples were analyzed for unchanged ropivacaine and for four of its metabolites, i.e. 3-OH-2',6'-pipecoloxylidide (3-OH-PPX), 4-OH-ropivacaine, 3-OH-ropivacaine, and the N-dealkylated metabolite PPX, using GC and HPLC methods. The presence of 2,6-xylidine in plasma was also analyzed. The metabolites were quantified after acidic hydrolysis. The radioactivity could be followed in plasma for up to 14 hr after administration, with ropivacaine being the predominant compound in the early samples. The concentrations of the aforementioned metabolites in plasma were below or just above the lower limit of quantification, and no 2,6-xylidine was detected. The maximum plasma concentration of ropivacaine was 5.9 +/- 2.6 microM (1.6 +/- 0.7 mg/liter), with an elimination half-life of 2.0 +/- 0.3 hr and a total plasma clearance of 397 +/- 127 ml/min. The maximum plasma concentration value for the total radioactivity was 5.5 +/- 2.4 microM (1.5 +/- 0.7 mg/liter) and the elimination half-life was 5.4 +/- 2.9 hr. [14C]Ropivacaine and its metabolites were mainly excreted in the urine, with a total recovery of 86 +/- 3% in the urine and 9 +/- 1% in the feces after 96 hr. Most of the radioactivity (about 68%) was excreted within 12 hr. Ropivacaine was extensively metabolized, and only 1 +/- 0.6% of the dose was excreted unchanged in the urine. The major metabolite identified in the urine was conjugated 3-OH-ropivacaine, which was excreted to an extent of 37 +/- 3% of the dose. The urinary excretion of 4-OH-ropivacaine was < 1%, whereas the N-dealkylated metabolites PPX and 3-OH-PPX accounted for 2 and 3% of the dose, respectively. An additional hydroxylated metabolite, 2-OH-methyl-ropivacaine, was tentatively identified in the urine of some volunteers, accounting for about 4-15% of the dose.