Fluoride doped γ-Fe2O3nanoparticles with increased MRI relaxivity

Fluoride doping in γ-Fe₂O₃nanoparticles induces large increases in magnetic anisotropy and relaxivities,r₁andr₂.

Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation

AIMS

To assess parent satisfaction with a nurse led clinic for children with intractable, functional constipation compared with a paediatric gastroenterology outpatient clinic.

METHODS

A validated questionnaire covering six separate domains in 48 statements (provision of information, empathy with the patient, technical quality and competence, attitude towards the patient, access to and continuity with the caregiver, and overall satisfaction) was employed. For all outcomes, the data were analysed on an intention-to-treat basis.

RESULTS

90/107 (84%) questionnaires were returned: 40/51 (78%) from the paediatric gastroenterology clinic and 50/56 (89%) from the nurse led clinic. Results indicated a high "total" satisfaction with the clinical care, but these were statistically significantly higher in the nurse led clinic compared with the paediatric gastroenterology clinic (median score 8.7 and 7.3 respectively, out of a maximum score of 10). This difference was consistent across all domains when the scores from those attending the nurse led clinic were compared with those attending the paediatric gastroenterology clinic (information median score 8.7 v 7.5; empathy 9.0 v 7.3; competence 9.1 v 8.0; attitude 8.7 v 7.3; access 8.2 v 6.7). All comparisons were highly statistically significant.

CONCLUSION

These results provide firm evidence that parents of children with intractable constipation are satisfied with the care they receive in both the paediatric and nursing clinic setting. Parent satisfaction, however, was significantly higher in those attending the nurse led clinic. This study adds further support to the development of a nurse led service to manage intractable, functional constipation in children.

Nurse management of intractable functional constipation: a randomised controlled trial

AIMS

To evaluate the effectiveness of a nurse led clinic (NLC) compared with a consultant led paediatric gastroenterology clinic (PGC) in the management of chronic constipation.

METHODS

Children (age 1-15 years) with functional constipation were randomised following a detailed medical assessment to follow up in either the NLC or PGC. An escalating algorithm of treatment was used as the basis of management in both the NLC and PGC. Main outcome measures were: time to cure at last visit or later confirmed by telephone; time to cure at last visit; and time to prematurely leaving the study.

RESULTS

A total of 102 children were recruited, of whom 52 were randomly assigned to NLC and 50 to PGC. Outcome assessment showed that 34 children in the NLC and 25 children in the PGC were confirmed cured at their last visit or later confirmed by telephone. The median time to cure was 18.0 months in the NLC and 23.2 months in the PGC. The probability of being cured was estimated as 33% higher in the NLC compared to PGC (hazard ratio 1.33). Attending the NLC hastened time to cure by an estimated 18.4%.

CONCLUSION

Children who attend an NLC are equally as, if not more likely to be cured of intractable constipation, than those attending a PGC and on average their cure will occur sooner. Results suggest that an NLC can significantly improve follow up for children with intractable constipation and highlight the important role for clinic nurse specialists in management of children with gastrointestinal disease.

Presentation, diagnosis and initial management of patients referred to a hospital tooth wear clinic

Information on presenting complaints, diagnosis and initial management strategy was recorded on a proforma for 114 consecutive patients referred to a hospital tooth wear clinic over a two-year period. Over twice as many male patients were referred as females. Twenty percent of patients had no presenting complaint and the others shared the common complaints concerning appearance, sensitivity and their deteriorating dentitions. The assessment of aetiology identified attrition as the most common cause of tooth wear in the subject group studied. About half the group were prescribed preventative treatment only and the other half were deemed to require restorative dental treatment.

Migraine and masticatory muscle volume, bite force, and craniofacial morphology

The purpose of this investigation was to compare the masticatory muscle volume, bite force, and craniofacial morphology of migrainous subjects with age- and sex-matched controls. Ten adult dentate migraineurs were matched with 10 dentate age- and sex-matched controls. The groups consisted of nine women and one man (mean age, 43 years; range, 29 to 51 years). Volumetric analysis of the masseter and medial pterygoid muscles was performed using magnetic resonance imaging. Craniofacial morphology was analyzed from standard cephalometric radiographs using 30 angular and linear variables. Recordings of bite force were made using a strain gauge transducer. There was a significant difference in the volume of both masseter and medial pterygoid muscles between the two subject groups (P<.0001), with the muscles of the migraineurs nearly 70% larger. The migraineurs recorded significantly higher maximal bite forces (P<.0001) than did the controls. No significant differences for any craniofacial morphological measurement were demonstrated between the two groups. It was concluded that the migraineurs had larger masseter and medial pterygoid muscle volumes, and greater bite forces than the controls, which could not be explained by any change in craniofacial morphology.

Masseter and temporalis muscle EMG levels and bite force in migraineurs

The purpose of this study was to compare absolute and proportional electromyography (EMG) levels in the masseter and temporalis muscles during performance of a variety of oral functions for migraineurs and age- and sex-matched controls. Both groups consisted of nine women and one man, with a mean age of 43 years (range, 29 to 51 years). Absolute resting EMG levels and those levels during swallowing and speech were not significantly different between the groups, but the levels of the group with migraine were significantly higher during maximum voluntary effort contractions on the anterior teeth and on the posterior teeth for both muscles. When expressed as a percentage of those levels obtained at maximal posterior contraction (ie, proportional levels), no difference in functional activity was demonstrated between groups. It was concluded that the two groups studied had similar levels of EMG activity in the masseter and temporalis muscles during the normal oral functions investigated, but that the group with migraine had higher levels of absolute EMG activity during anterior and posterior maximum voluntary contractions. Furthermore, the group with migraine demonstrated higher levels of anterior and posterior bite force, although not correlated with EMG levels.

Mortality rates and causes among U.S. physicians

CONTENT/OBJECTIVES: No recent national studies have been published on age at death and causes of death for U.S. physicians, and previous studies have had sampling limitations. Physician morbidity and mortality are of interest for several reasons, including the fact that physicians' personal health habits may affect their patient counseling practices.

METHODS

Data in this report are from the National Occupational Mortality Surveillance database and are derived from deaths occurring in 28 states between 1984 and 1995. Occupation is coded according to the U.S. Bureau of the Census classification system, and cause of death is coded according to the ninth revision of the International Classification of Diseases.

RESULTS

Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6). The top ten causes of death for white male physicians were essentially the same as those of the general population, although they were more likely to die from cerebrovascular disease, accidents, and suicide, and less likely to die from chronic obstructive pulmonary disease, pneumonia/influenza, or liver disease than were other professional white men.

CONCLUSIONS

These findings should help to erase the myth of the unhealthy doctor. At least for men, mortality outcomes suggest that physicians make healthy personal choices.

Clinical rest and closest speech positions in the determination of occlusal vertical dimension

Two subject groups had their mandibular positions determined, using an electrognathograph, at the clinical rest position (CRP) and at the closest speaking position (CSP). They were classified into a toothwear (largely of attritional origin) group (n=30) and a non-toothwear, or normal, group (n=60). The mean CRP deduced for the groups was similar in all three dimensions and found to be just less than 2 mm open from and 0.6 mm posterior to intercuspal position (IP) and approximately in the midline. The CSP, in two dimensions, of the toothwear group was significantly closer to IP than that of the normal group. The vertical component of CRP and CSP was similar for the normal group but CSP was significantly reduced in comparison to CRP for the toothwear group. The most forward component of CSP was significantly more anteriorly placed than was that of CRP. Although there was a pronounced inter-individual variation the results suggest toothwear, of long acting aetiology, has less affect on CRP than on CSP.

Hernia: is it a work-related condition?

BACKGROUND

Development of hernias among active workers is a major occupational problem, however, the work-relatedness of hernias has not been well investigated. It is a difficult question for occupational and primary care physicians who must often address whether a worker with an inguinal hernia should be restricted from work requiring lifting of heavy objects.

METHODS

To evaluate the possible work-relatedness of inguinal hernias, a cross-sectional study was performed. The goal of the study was to determine hernia incidence according to occupation with the Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics in 1994. Hernia incidence rates (per 10,000 workers) for industry and occupation categories were calculated with the estimates of the number of hernias in males and the employed male workers from the Current Population Survey. Rate ratios (RR) of hernia incidence rates were calculated.

RESULTS

In 1994, an estimated 30, 791 work-related hernias in males were reported by US private establishments. The occupation groups with the highest RR were laborers and handlers (RR, 2.47; 95% confidence interval (CI), 2.14-2.80), machine operators (RR, 2.13; 95% CI, 1.81-2.44), and mechanics and repairers (RR, 1.72; 95% CI, 1.43-2.00).

CONCLUSIONS

Rate ratios for hernias vary considerably within industries and occupations, with the highest ratios found in industries and occupations involving manual labor. This provides support for the hypothesis that the hernias are work-related, especially in work involving strenuous, heavy manual labor. Am. J. Ind. Med. 36:638-644, 1999. Published 1999 Wiley-Liss, Inc.

The mandibular speech envelope in subjects with and without incisal tooth wear

PURPOSE

The purpose of this study was to describe a mandibular envelope of motion during speech for 2 subject groups. One subject group had experienced no tooth wear and the other had incisal tooth wear. The speech envelope was to be described with regard to its maximal dimensions in the vertical, anteroposterior, and lateral directions, and its most superior and anterior positions in relation to intercuspal position.

MATERIALS AND METHODS

An electromagnetic method of jaw tracking was employed to record mandibular speech movements for 60 subjects whose teeth exhibited no tooth wear and 30 subjects with incisal dental attrition. The test speech exercise contained all of the word sounds that occur in the English language. The test was recorded 3 times, and mean values for parameters were reported.

RESULTS

The speech envelope of the tooth wear group was significantly smaller (Student's t test, P < 0.01) in all 3 dimensions than that of the normal group. The tooth wear group speech envelope was also located closer to the intercuspal position in the vertical dimension (P < 0.01) and was not as anteriorly placed (P < 0.01). In the normal group, correlations were found between the vertical incisor overlap and the most superior speech position (r = 0.48, P < 0.0001), and between the horizontal incisor overlap and the most anterior mandibular speaking position (r = 0.63, P < 0.0001).

CONCLUSION

The envelope of mandibular movement during speech differed in dimension and position between the 2 groups investigated.

Ischemic heart disease mortality and occupation among 16- to 60-year-old males

Cardiovascular disease is the leading cause of death, and the role of occupation continues to generate interest. Using the National Occupational Mortality Surveillance system, proportionate mortality ratio (PMR) analyses were used to examine the association between occupation and ischemic heart disease among 16- to 60-year-old males. We used data from 1982-1992 from 27 states. Separate analyses were conducted for blue-collar and white-collar occupations. Among the blue-collar occupations with the highest PMRs for ischemic heart disease mortality were sheriffs, correctional institution officers, policemen, firefighters, and machine operators. Physicians (blacks only) and clergy (both races) were among the white-collar occupations with the highest PMRs for ischemic heart disease. Although more study is needed, consideration should be made for targeting high-PMR occupations, with improvement in work organization to reduce occupational stress and promotion of healthy lifestyles through cardiovascular disease prevention programs.

Burning mouth in Parkinson's disease sufferers

OBJECTIVE

The purpose of the study was to determine the prevalence of burning mouth (BM) in a population of Parkinson's Disease (PD) sufferers and also to assess the use of pain profiles in identifying the type of burning sensation experienced.

DESIGN

Subjects were surveyed by means of a one shot postal questionnaire for which ethical approval had previously been granted. Anonymity was guaranteed and therefore no attempt was made to follow up non-respondents.

MAIN OUTCOME

BM was reported by 24% of respondents. The pain profiles were completed by 17 BM sufferers.

CONCLUSION

Burning mouth is reported to occur in 24% of PD sufferers which is 5 times greater than that of the general population. The reason for this is uncertain but the result has implications for the future care of PD patients and indicates the need for increased dental input at PD outpatient clinics.

Mandibular incisor position for English consonant sounds

PURPOSE

The purpose of this study was to describe the mandibular incisor positions for the 24 consonant sounds of the English language. Further aims were to determine if the incisor format for each sound is affected by its position in a word, or by combination with an open or closed vowel.

MATERIALS AND METHODS

A total of 30 young adult subjects had their incisal positions determined using an electrognathographic technique during performance of a number of speech tests.

RESULTS

The mean values of the 24 consonants, in the vertical direction, showed a range from the intercuspal position of 2.5 mm for a sibilant sound to 11.7 mm for the /H/ sound, and an anteroposterior range of 1.4 mm anterior for a sibilant sound to 1.8 mm posterior for the /M/ sound. The range in the mean lateral dimension was always less than 1 mm on either side of the midline. The placement of a sound in the initial or final position in a word had no effect on the incisal position. The degree of vertical opening was significantly greater for 8 of the consonant sounds when in combination with an open vowel sound. The anteroposterior and lateral positions were unaffected by vowel association.

CONCLUSION

The incisor position for consonant sounds is unaffected by initial or final word placement. Some consonant sound positions are affected by combination with an open or closed vowel sound. Sibilant sounds produced a clinically acceptable measure of the most superior and anterior speaking positions in all subjects.

Occupational dermatitis causing days away from work in U.S. private industry, 1993

BACKGROUND

Occupational skin disease is an important cause of disability in the workplace. The aim of this report is to estimate the incidence of occupational dermatitis cases that causes days away from work and to characterize the cases.

METHODS

The Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics collects employer reports on work-related dermatitis. Descriptive data are collected on a sample of the cases that result in days away from work. Estimates of the number of cases and days away from work were calculated by industry, occupation, and exposure source.

RESULTS

In 1993, there were an estimated 8,835 cases of occupational dermatitis, a rate of 1.12/10,000 workers. The largest number of cases was in health services, while the highest rate was in agricultural crops. The occupation with the largest number of cases was non-construction laborers. Cleaning/polishing agents caused the largest number of cases. Calcium hydroxide and oxides caused a median of nine days away from work.

DISCUSSION/CONCLUSIONS

The survey data show that the effect of occupational dermatitis is substantial in the lives of workers. These descriptive data should be used to target interventions.

Cancer mortality among laundry and dry cleaning workers

A cancer mortality study of 8,163 deaths occurring among persons formerly employed as laundering and dry cleaning workers in 28 states is described. Age-adjusted sex-race cause-specific proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed for 1979 through 1990, using the corresponding 28-state mortality as the comparison. For those aged 15-64 years, there were excesses in black men for total cancer mortality (PMR = 130, 95% confidence interval (CI) = 105-159) and cancer of the esophagus 1 (PMR = 215, 95% CI = 111-376), and in white men for cancer of the larynx (PMR = 318, 95% CI = 117-693). For those aged 65 years and over, there were statistically nonsignificant excesses for cancer of the trachea, bronchus, and lung in black women (PMR = 128, CI = 94-170) and for cancer of other and unspecified female genital organs in white women (PMR = 225, CI = 97-443). The results of this and other studies point to the need for the effective implementation of available control measures to protect laundry and dry cleaning workers.

Tuberculosis Mortality and Silica Exposure: A Case-Control Study Based on a National Mortality Database for the Years 1983-1992

A case-control study (8,740 cases; 83,338 controls) was done to evaluate the association between potential occupational exposure to silica and risk of tuberculosis (TB) mortality, using the National Occupational Mortality Surveillance database for 1983-1992. Potential silica exposure was based on the decedent's usual industry and occupation. Assignment of potential exposure to silica was based on the entire range of industries and occupations. Odds ratios (ORs) for mortality from respiratory TB associated with potential high and intermediate exposures to silica were 1.30 (95% CI 1.14-1.48) and 1.07 (95% CI 0.77-1.47), respectively, adjusting for silicosis, other pneumoconioses, age, gender, race, socioeconomic status, and potential exposure to active TB. The elevated OR was seen in all subgroups: male, female, white, and black. The average age at death among respiratory TB cases with potential silica exposure was significantly younger by four years than that among cases without potential silica exposure. The findings suggest that potential occupational exposure to silica alone, in the absence of silicosis, is associated with respiratory TB mortality, with a dose-response relationship.

Gastrointestinal cancer mortality of workers in occupations with high asbestos exposures

Asbestos, which is a well-known risk factor for lung cancer and malignant mesothelioma, has also been suggested as a gastrointestinal (GI) carcinogen. This study was conducted to assess the relationship between high asbestos exposure occupations and the occurrence of G1 cancer. Death certificate data were analyzed from 4,943,566 decedents with information on occupation and industry from 28 states from 1979 through 1990. Elevated proportionate mortality ratios (PMRs) for mesothelioma were used to identify occupations potentially having many workers exposed to asbestos. All PMRs were age-adjusted and sex- and race-specific. The PMRs for GI cancers in white males were then calculated for these occupations after excluding mesothelioma, lung cancer, and non-malignant respiratory disease from all deaths. We identified 15,524 cases of GI cancer in the 12 occupations with elevated PMRs for mesothelioma. When these occupations were combined, the PMRs for esophageal, gastric, and colorectal cancer were significantly elevated at 108 (95% confidence interval = 107-110), 110 (106-113), and 109 (107-110), respectively. Esophageal cancer was elevated in sheet metal workers and mechanical workers. Gastric cancer was elevated in supervisors in production and managers. Colorectal cancer was elevated in mechanical and electrical and electronic engineers. However, high exposure occupations like insulation, construction painter supervisors, plumbers, furnace operators, and construction electricians showed no elevations of GI cancers. In conclusion, this death certificate study supports an association between asbestos exposure and some GI cancer, however the magnitude of this effect is very small.

Industries and cancer

Epidemiologic evidence on the relationship between selected industries and cancer is reviewed. This article will focus on several industries which have not been covered elsewhere in this volume, briefly describe current research on cancer in the agricultural and construction industries, and discuss surveillance data on cancer mortality in relation to industry listed on US death certificates. Employment in the rubber industry has been associated with bladder cancer, leukemia, stomach, and lung cancer and is considered by the International Agency for Research on Cancer (IARC) to have 'sufficient evidence of carcinogenicity in humans.' Studies of workers exposed to polychlorinated biphenyls (PCBs) have reported excess mortality from gastrointestinal neoplasms, hematologic neoplasms, and skin cancer (specifically malignant melanoma); IARC considers that the evidence for carcinogenicity in humans is 'limited.' Employment in the boot and shoe industry has been associated with nasal adenocarcinomas in England and Italy ('sufficient'). Hairdressers and barbers have been found to have excess bladder cancer and less consistent evidence for several other sites ('limited'). Workers exposed to wood dust have excess mortality from cancer of the nasal sinuses and paranasal cavities; there is less consistent evidence for excess laryngeal cancer ('sufficient'). Workers employed in the petroleum industry have limited evidence for excess leukemia and other lymphatic and hematopoietic neoplasms, and skin cancer (particularly malignant melanoma) ('limited').

Neurodegenerative diseases: occupational occurrence and potential risk factors, 1982 through 1991

OBJECTIVES

To identify potential occupational risk factors, this study examined the occupational occurrence of various neurodegenerative diseases.

METHODS

Death certificates from 27 states in the National Occupational Mortality Surveillance System were evaluated for 1982 to 1991. Proportionate mortality ratios were calculated by occupation for presenile dementia, Alzheimer's disease, Parkinson's disease, and motor neuron disease.

RESULTS

Excess mortality was observed for all four categories in the following occupational categories: teachers; medical personnel; machinists and machine operators; scientists; writers/designers/entertainers; and support and clerical workers. Clusters of three neurodegenerative diseases were also found in occupations involving pesticides, solvents, and electromagnetic fields and in legal, library, social, and religious work. Early death from motor neuron disease was found for firefighters, janitors, military personnel, teachers, excavation machine operators, and veterinarians, among others.

CONCLUSIONS

Neurodegenerative disease occurs more frequently in some occupations than in others, and this distribution, which may indicate occupational risk factors, should be further investigated.

Sprue design in removable partial denture casting

OBJECTIVES

Correct sprue design is a major factor in the reduction of defects in castings of cobalt-chromium alloy. The purpose of this study was to investigate the sprue arrangements decided by a group of dental technicians, for a series of proposed removable partial denture castings, in order to determine if there was any consistency between them which would suggest the application of criteria in their design.

METHODS

Information was gathered by postal inquiry with recipients asked to indicate their sprue designs on diagrams of patterns for proposed cobalt-chromium partial denture castings.

RESULTS

Replies were received for 260 proposed castings from dental schools, technical colleges and commercial laboratories which gave an overall response rate of 52%. Results displayed a wide range of responses in relation to sprue number and dimension, attachment site and the intended direction of metal flow.

CONCLUSION

It was concluded that the group of technicians studied arbitrarily chose sprue arrangements for the castings proposed rather than following definite design criteria that seek to minimize potential problems during casting procedures.

Effects of alpha-cyano-4-hydroxycinnamic acid on fatigue and recovery of isolated mouse muscle

Fatigue and recovery of mouse soleus and extensor digitorum longus muscles were investigated in standard saline and in saline containing the lactate + hydrogen ion transport blocker, alpha-cyano-4-hydroxycinnamic acid (cinnamate). The fatigue protocol was a series of brief isometric tetani which reduced isometric force by about 25%. Recovery was monitored by test tetani during recovery. Both muscles recovered completely in standard saline. Soleus muscle also recovered completely in the presence of cinnamate, whereas extensor digitorum longus hardly recovered at all. Force during fatigue and recovery can be described in a mathematical simulation in which force depends on intracellular inorganic phosphate and pH, and the only effect of cinnamate is to block lactate + hydrogen ion transport. The results of the simulation suggest that during the fatiguing series of tetani pH changes are small and have a negligible effect on force, but pH is a major determinant of the timecourse of recovery in extensor digitorum longus.

Breast Cancer Screening among Employed American Women

From the 1990 National Health Interview Survey Health Promotion and Disease Prevention supplement, the authors estimated the 1990 baseline prevalence of breast cancer screening among employed U.S. women aged 50-70 years. Proportions of women screened for breast cancer were calculated by occupational category and demographic characteristics, and were compared with the Healthy People 2000 objective that 60% of women aged 50 and older have had mammography and a clinical breast examination within the preceding two years. The objective was exceeded for white-collar workers (61.8%) and workers with some college (64.1%), but was not met by any blue-collar/service workers (40.8%); or any workers with only a high school diploma (54.7%) or less than a high school diploma (38.5%). Identification of occupational categories and demographic subgroups among working women will be helpful to those planning breast cancer screening programs, in both the public and the private sectors.

The practice of Consultants in Restorative Dentistry (UK) in routine infection control for impressions and laboratory work

This investigation aimed to examine the practice of the members of The Consultants in Restorative Dentistry Group (UK) in relation to routine cross-infection control when handling impressions and items of prosthetic laboratory work. A questionnaire was sent to one hundred and twenty six members of the Group. A response rate of 63% was recorded. Seventy percent of respondents routinely rinsed and disinfected dental impressions. Twenty four percent routinely rinsed items of laboratory work and 44% routinely disinfected items of laboratory work. The results of this study demonstrate a lack of uniformity in the practice of members of the group in routine infection control for impressions and laboratory work.

Mortality patterns among construction workers in the United States

Thirteen authors from the National Institute for Occupational Safety and Health contribute to this summary of recent and ongoing national occupational mortality surveillance studies of construction workers, including studies conducted under NIOSH's Fatality Assessment and Control Evaluation project, Sentinel Health Events project, National Occupational Mortality Surveillance System, and other projects.

Mortality patterns of US female construction workers by race, 1979-1990

In 1990, the US construction industry employed 7.6 million workers, of whom 8% were women. Only one epidemiologic study for women employed in the construction industry was previously published. We analyzed usual occupation and industry codes on death certificates from 28 states between 1979 and 1990 to evaluate mortality patterns among both black and white female construction industry workers. Proportionate mortality for cancer and several other chronic diseases was significantly elevated among 2,273 white female and 197 black female construction workers. White women younger than age 65 at death had significantly elevated proportionate mortality ratios (PMRs) for all cancer, lung cancer, and traumatic fatalities. Black women younger than age 65 at death had a significantly elevated PMR for traumatic fatalities. Elevated mortality for specific cancer sites and other diseases was observed for white and black women employed in construction trades. These results suggest that more detailed investigations that include women and other minorities should be undertaken.

Occupation and lung cancer mortality among women: using occupation to target smoking cessation programs for women

Lung cancer mortality rates are increasing for women, despite the fact that 90% of these deaths could be prevented by smoking cessation. Targeted workplace smoking cessation programs may increase the effectiveness of lung cancer prevention for women. This study uses proportionate mortality ratio analysis of occupationally coded death certificates, from 28 states between 1979 and 1990, to identify occupations in which women are at high risk of lung cancer mortality. The study found gender and racial variation in the results for broad occupational groups. Blue-collar occupations associated with potentially carcinogenic workplace exposures also had elevated proportionate mortality ratios, probably reflecting both occupational and tobacco exposure. For women, specific occupations such as managers and financial officers revealed significant elevations in lung cancer mortality. Cessation programs targeting women in these occupational groups may increase the effectiveness of lung cancer prevention.

Reproducibility of the speech envelope and interocclusal dimensions in dentate subjects

This paper describes and compares the mandibular speech envelope and interocclusal dimensions, at the closest speaking and postural positions, for a group of 30 dentate subjects measured at separate data-collecting sessions. Mandibular movement was recorded by electrognathograph during recitation of a general phonetic articulation test containing all speech sounds. Comparison of the speech envelope and interocclusal dimensions between each recording session revealed no significant differences among them. An overall mean value calculated for the closest speaking space and postural interocclusal space from all recordings was significantly different (P > .05), with the closest speaking space the larger; however, considerable individual variation was noted.

Using occupational mortality data for surveillance of work-related diseases of women

A recently developed source of occupational mortality data from 28 states for the years 1979 through 1990 can be used to meet goals for the surveillance of women's work-related diseases. A proportionate cancer mortality ratio analysis is used to illustrate use of the data to address the goals of identifying previously unrecognized work-related disease and targeting consultation or health promotion programs to appropriate occupations. Strengths of the data include broad geographical coverage and coverage of all causes of death and numerous industries and occupations. The data set is current and very large, with annual additions. The data have certain limitations. Death certificate information collected regarding occupation and cause of death may not be accurate; furthermore, death certificates have little information on potential confounding factors, such as smoking.

A comparison of analyses of occupational bladder cancer: death certificate vs. population-based case-control interview data

The authors examined the utility of death certificate data for occupational health surveillance by comparing the ability of the data to identify high-risk occupations for bladder cancer with that of a population-based case-control study. Death certificate data for white males from 23 states for 1979-1987 were analyzed using proportionate mortality ratios. The case-control study used cancer registry cases for 1977-1978. Results were compared for 21 a priori suspect occupations. A broad definition of agreement resulted in agreement for 62% of the occupations; the death certificate study identified eight of 15 occupations identified by the case-control study and neither study identified five of the categories. While death certificate data have many limitations, our results indicate that death certificate data can provide clues to some potential occupational health problems. With the advantages of inexpensive data, large sample size, and industrial coverage, more refined analyses of the data should prove useful for occupational mortality surveillance and hypothesis generation.

Effect of verbal and written education on denture wearing and cleansing habits

This investigation aimed to examine the effect of verbal and written education on the denture wearing and cleansing regimens of a group of patients scheduled to have replacement complete dentures. Current denture habits were elicited by questionnaire prior to treatment. Each patient received verbal and written instruction on a standardised denture wearing and cleaning regimen. Six months after completion of treatment each patient was posted a repeat questionnaire. The response rate was 68%. There was no notable alteration in the denture care regimens of the patients after treatment. It was concluded that verbal and written education did not change the denture habits of the subject group.

Occupation as a risk identifier for breast cancer

OBJECTIVES

Breast cancer mortality may be reduced if the disease is detected early through targeted screening programs. Current screening guidelines are based solely on a woman's age. Because working populations are accessible for intervention, occupational identification may be a way of helping to define and locate risk groups and target prevention.

METHODS

We used a database consisting of 2.9 million occupationally coded death certificates collected from 23 states between 1979 and 1987 to calculate age-adjusted, race-specific proportionate mortality ratios for breast cancer according to occupation. We performed case-control analyses on occupational groups and on stratifications within the teaching profession.

RESULTS

We found a number of significant associations between occupation and frequency of breast cancer. For example, white female professional, managerial, and clerical workers all had high proportions of breast cancer death. High rates of breast cancer in teachers were found in both proportionate mortality ratio and case-control analyses.

CONCLUSIONS

These findings may serve as in an aid in the effective targeting of work-site health promotion programs. They suggest that occupationally coded mortality data can be a useful adjunct in the difficult task of identifying groups at risk of preventable disease.

Closest speaking space during the production of sibilant sounds and its value in establishing the vertical dimension of occlusion

The purpose of this investigation was to determine whether the production of sibilant sounds involved adopting a jaw position that corresponded to the closest vertical speaking space (CSS), by analysis of the smallest vertical excursion of the mandible during the performance of different phonetic exercises. A further objective was to establish the variability in the CSS produced by individual sibilant phonemes. Thirty young adult subjects had their CSS determined during three separate phonetic tests, using a kinesiograph (Sirognathograph, Siemens A.G., Benshiem, Germany) and a Bio-Pak (BioResearch Associates Inc., Milwaukee, WI) jaw-tracking software program. The first test was a general phonetic articulation test containing all the sounds of the English language and specifically including all six sibilant word sounds. The second phonetic test contained the six sibilant sound making up a short sentence. The third test included six single words, each expressing a different sibilant sound. No statistically significant difference among the mean CSS determined in each of three exercises was demonstrable. A phonetic test containing all sibilant sounds produced a CSS equivalent to that of a test containing all speech sounds. The vertical component of the CSS was also independent of the form or duration of the phonetic tests containing the sibilant word sounds used in this investigation. The CSS determined for 5 of the individual sibilant phonemes in the third exercise differed (p < 0.05) from that calculated for the three complete exercises. It was concluded that voicing sibilant phonemes, or word sounds, does cause the subject to adopt the CSS.(ABSTRACT TRUNCATED AT 250 WORDS)

A preliminary investigation into the effect of increased occlusal vertical dimension on mandibular movement during speech

Current methods of determining whether a patient will accommodate to an increased occlusal vertical dimension rely on a largely subjective assessment of the mandibular rest position and capacity to adapt whilst wearing a temporary appliance. The purpose of this preliminary study was to establish if mandibular movement during speech may provide an objective criterion in the assessment of adaptation to increases in occlusal vertical dimension. The closest speaking space, measured as the vertical distance between an incisor point and centric occlusion, as determined during pronunciation of sibilant speech sounds was chosen to depict mandibular movement. The closest speaking space was determined using a Sirognathograph for six young adult subjects and varied from a mean of 1.0 to 3.3 mm. An acrylic splint covering the entire occlusal surface of the lower arch, designed to increase the occlusal vertical dimension by 4 mm in the incisor region, was then cemented on each subject's mandibular arch. The closest speaking space was again determined after 5 days continuous wear of the splint and the mean values found to have decreased to a range of 0.0-1.0 mm. The differences between the mean values for the closest speaking space for each subject before and after splint wear were statistically significant. It was postulated that this method may lead towards an objective basis for deciding if patients will adapt to an increase in occlusal vertical dimension.

Agreement of latest and longest occupation and industry as reported in the 1980 National Health Interview Survey

The effectiveness of using the latest occupation instead of usual in studies of chronic disease was assessed by comparing latest and usual occupation for agreement. The 1980 National Health Interview Survey Occupational Supplement collected information on both latest and longest job and the lengths of the jobs. We compared the latest occupation and industry with the longest (usual) occupation and industry for agreement. For men, the industry agreement was 68.1% and the occupation agreement was 69.9%. Women had slightly higher agreement: 70.3% for industry and 70.5% for occupation. The percent of agreement varied by industry or occupation and age, sex, race, respondent, and length of latest job. We conclude that the percentage of agreement of latest occupation and industry with usual is sufficient for analyses of National Health Interview Survey chronic disease data using latest occupation or industry.

Ischemic heart disease and acute myocardial infarction mortality among police officers

The relationship between the occupation of police officer and ischemic heart disease (IHD) mortality was examined through case-control studies using 1968/78 death certificate records from Rhode Island and Utah. IHD was divided into two subcategories--acute myocardial infarction (AMI) and other IHD. In both states, the odds ratio (OR) for AMI was significantly elevated (Rhode Island, OR = 1.3; Utah, OR = 1.8), and was higher than the OR for other IHD (Rhode Island, OR = 1.1; Utah, OR = 1.4). The odds ratio for AMI was higher in the less than 65 yr age group (Rhode Island, OR = 2.1; Utah, OR = 2.1) than in the greater than or equal to 65 yr age group (Rhode Island, OR = 0.9; Utah, OR = 1.6). These results suggest that the elevated risk for IHD among police officers observed in this and other studies is primarily due to an elevated risk for AMI. The pattern of diminishing risk with age suggests a risk factor, possibly stress, the effect of which diminishes when exposure ceases at retirement.

Death certificate-based occupational mortality surveillance in the United States

Surveillance of cause-specific mortality patterns by occupation and industry through the use of death certificate records is a simple and relatively inexpensive approach to the generation of leads as to potential occupational disease problems. Researchers from the National Institute for Occupational Safety and Health (NIOSH) have been working with the National Center for Health Statistics, other federal agencies, and state health departments on a number of programs to foster the development of standardized, routine coding of occupation and industry entries on death certificates by state health departments. Thirty-one states and the District of Columbia are now doing such coding. These data are being analyzed currently by investigators at NIOSH and at individual state health departments for the purpose of hypothesis generation on occupation-disease relationships. The proportionate mortality ratio method is the predominant method being used, as appropriate denominator data are not generally available. This type of surveillance is particularly useful for the study of occupation and industry groups for which it is difficult to assemble cohorts, such as groups that are predominantly non-union and in small workplaces. Limitations of this surveillance include its inappropriateness for monitoring those occupational diseases which are not often fatal, and the limited scope and accuracy of death certificate information.