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Although the nature of firefighting involves particular health hazards, previous mortality and morbidity studies of firemen have produced inconsistent evidence for an increased risk of mortality from cardiovascular disease, respiratory disease, cancer and accidents. Mortality experience since 1915 has been examined in 5655 Boston firefighters, comprising all male members of the city fire department with three or more years of service. The observed cause of death as stated on the death certificates of 2470 deceased firefighters has been compared with the numbers expected based on rates for the male population of Massachusetts and of the United States of America. Among all firefighters, deaths from all causes were 91% of expected. The standardised mortality ratio (SMR) was markedly reduced (less than 50) for infectious disease, diabetes, rheumatic heart disease, chronic nephritis, blood diseases and suicide. The SMR was 86 for cardiovascular deaths, 83 for neoplastic deaths, and 93 for respiratory deaths. The SMR for accidents was 135 for active firefighters. The results suggest that the survival experience of firefighters is strongly influenced by strict entry selection procedures, ethnic derivation, and sociocultural attributes of membership. While excessive morbidity has been demonstrated in firefighters, there does not appear to be a strong association between occupation and cause-specific mortality.
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PMID:Mortality among Boston firefighters, 1915--1975. 65 33

In a 22-year followup of 3686 San Francisco longshoremen, the roles of physical activity, cigarette smoking habit, and systolic blood pressure level were evaluated independently in relation to risk of death from a broad range of diseases. Smoking pattern and blood pressure status were established in 1951 and job activity was assessed annually during the followup period. Lower levels of energy expenditure predicted increased risk of fatal heart attack and perhaps of stroke. Heavy cigarette smoking predicted increased risk of death from heart attack, cancer, chronic obstructive respiratory disease, and pneumonia. Higher levels of systolic blood pressure were associated with death from all cardiovascular diseases, diabetes mellitus, and cirrhosis. Tacit to these findings: sedentary living takes its toll largely through heart disease and stroke; the toxicity of cigarette smoking is associated with a broader range of diseases, including heart attack, cancer, and respiratory disease; and higher level of blood pressure related to an even broader range of cardiovascular disease than either of the other characteristics studied.
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PMID:Energy expenditure, cigarette smoking, and blood pressure level as related to death from specific diseases. 68 71

A summary of the literature shows that there are well-marked seasonal variations in mortality for total deaths, for respiratory and cardiovascular diseases and for diabetes, the mortality rate being higher in winter than in summer. These seasonal variations in mortality are seen in infants under 1 year of age and in older people but not in youths and young adults. The amplitude of the seasonal variation in mortality increases with increasing age because of the higher incidence of cardiovascular and respiratory mortality in older people. Seasonal variations in air temperature are a more important determinant of seasonal variations in respiratory and cardiovascular deaths than are fluctuations in air pollution; there is usually a time-lag of up to a week in the change in air temperature before the mortality rate for these diseases increases; a run of 4 - 5 days of stressful temperatures (either hot or cold) has more effect on mortality than an isolated hot or cold day. Examination of the seasonal variations in all causes of death of the four population groups in South Africa shows that Whites and Asians display the typical pattern of a winter high and a summer low mortality of populations in developed countries. The seasonal variation in mortality of Coloureds and Blacks is quite different. It shows two peaks, one in winter and one in summer. This bimodal pattern in the seasonal variation is due to the fact that one-third of all Coloured and Black deaths occur in infants under 1 year of age and most of these deaths occur in summer as a result of gastro-enteritis. Comparison was made of the seasonal variations in mortality rates for all causes of death and for respiratory and ischaemic heart disease (IHD) deaths of Whites over 40 years of age in Durban and Johannesburg. This showed that the seasonal variation for all causes of death is greater in Johannesburg than in Durban, i.e. proportionately more older Whites die during winter in Johannesburg than in Durban. The reason for this difference is that the seasonal variation in respiratory disease mortality is much greater in Johannesburg than it is in Durban, but the seasonal variation in IHD mortality is the same in the two cities.
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PMID:Climate and disease. 69 79

One hundred and thirty samples of amniotic fluid from normal and diabetic pregnant women were analyzed for cortisol concentration. In normal pregnancies, cortisol was present in low concentrations until 35 weeks' gestation, followed by a sharp rise at 36 weeks and a continued upward trend to 39 weeks. The rise after 35 weeks was delayed or absent in many patients with diabetes. In the combined population, the incidence of respiratory disease with a lecithin/sphingomyelin ratio greater than or equal to 2 was 26 per cent if the amniotic fluid cortisol was less than 4.3 microgram per 100 ml. and 2.9 per cent if the cortisol concentration was greater than or equal to 4.3 microgram per 100 ml.
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PMID:Amniotic fluid cortisol in normal and diabetic pregnant women and its relation to respiratory disease in the neonate. 71 58

A postal inquiry into the current use of subarachnoid spinal analgesia obtained replies from approximately 70% of consultants in both Scotland and Sweden. Although medico-legal anxiety was still an important feature of Scottish practice, the publication of large series with a low incidence of complications had also exerted some influence, and 40% of consultants employed the technique. In contrast, 70% of Swedish replies indicated current use of spinal analgesia and the individual frequency of administration was considerably higher. The present popularity of epidural analgesia has contributed to some decline in the use of subarachnoid spinal analgesia in Sweden, particularly in the case of longer surgical procedures. Anaesthetists in both countries expressed dissatisfaction with the limited choice of available spinal agents and considered their duration of action to be inadequate. In Scotland, conditional indications, such as diabetes mellitus and respiratory disease, were of major importance, whereas Swedish users more often specified surgical procedures for which subarachnoid spinal analgesia was considered to be the anaesthetic of choice. Few anaesthetists had experience of complications and no major neurological sequelae were reported. More than 80% of replies indicated that subarachnoid spinal anaesthesia had a useful place in anaesthetic practice.
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PMID:Subarachnoid spinal analgesia. A comparative survey of current practice in Scotland and Sweden. 72 13

Hospital admission rates and death rates for cerebrovascular disease differ markedly between states. Hospital admission data were analyzed: (a) to ascertain why death rates from this disease group are lower in Michigan than in North Carolina and (b) to clarify whether hospital care in either state has inadequacies that can be corrected quickly. Among both whites and blacks of the same age, case-fatality ratios were higher in North Carolina than in Michigan. Subarachnoid and cerebral hemorrhages were diagnosed more often in the southern state. For both areas, the records showed a marked underreporting of hypertension and diabetes mellitus as secondary conditions in the hospital admissions; elevated blood pressures were about equally common in each state but were treated more vigorously in Michigan. Secondary diagnoses of respiratory disease and use of anti-infective agents were reported more frequently in North Carolina. In contrast, diabetes mellitus was more prevalent in Michigan admissions. Some reasons for these findings are advanced, particularly as they relate to diagnostic and treatment patterns. Finally, the need for more detailed research is emphasized to create guidelines for better hospital care of cerebrovascular disease.
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PMID:Comparison of hospital admissions for cerebrovascular disease in Michigan and North Carolina. 97 5

The pre-travel medical evaluation of elderly patients and patients with chronic illness requires special assessment and advice. Screening and special precautions are reviewed for traveling patients with respiratory disease, cardiac disease, sinusitis, diabetes mellitus, HIV infection, and other chronic medical conditions. Current guidelines for empiric therapy and prophylaxis of travelers' diarrhea are reviewed, with emphasis on concerns in geriatric or chronically ill travelers. Special considerations such as potential drug-drug interactions and insurance coverage are also discussed.
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PMID:The pre-travel medical evaluation: the traveler with chronic illness and the geriatric traveler. 129 Feb 73

Felodipine is a dihydropyridine calcium antagonist which may be administered once daily in an extended release (ER) formulation. As monotherapy in older patients with mild to moderate essential hypertension, felodipine ER once daily provides effective control of blood pressure (BP). The drug has also been effective, either as monotherapy or in combination with other antihypertensive medications, in comparisons with other antihypertensive agents, and does not adversely affect lipid profiles or, in patients with diabetes mellitus, glycaemic control. Results in patients with angina pectoris and congestive heart failure indicate a potential role for felodipine ER in these indications and data also suggest the drug reduces left ventricular hypertrophy. In addition, felodipine ER appears suitable for use in patients with concomitant respiratory disease, renal or hepatic dysfunction, cerebrovascular or peripheral ischaemic disease, or gout, making it particularly useful in the elderly who often have more than one significant clinical condition. Felodipine ER has generally been well tolerated by older patients in clinical trials, although further confirmation in the long term is desirable. Thus, felodipine ER effectively lowers BP in older patients with essential hypertension with the added convenience of once daily administration. It may be used as monotherapy or in combination with other antihypertensive agents and is a practical advance in the treatment of hypertension in the elderly.
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PMID:Felodipine. A review of the pharmacology and therapeutic use of the extended release formulation in older patients. 139 20

In sick preterm neonates receiving intensive care a spectacular rise in monocyte count has frequently been observed in sequential full blood examinations. The etiology of this has not previously been investigated and this study examines clinical factors that may contribute to this finding. Thirty (5.1%) of the 587 neonates who required intensive care during the study period had significant monocytosis (absolute count greater than 1700/mm3). Their mean gestation was 29 weeks (range 26-32 weeks). Monocytic response occurred at an age of 5.5 +/- 3 (mean +/- S.D.) days with 20% occurring at birth, 57% in the first week and 23% in the second week of life and lasted for 19.8 +/- 16 days (mean +/- S.D.). Most reached peak levels within two weeks and these ranged between 2,170 and 7176 per mm3. Analysis of the clinical variables against 37 controls revealed lower mean birth weight and gestational age, and higher incidence of leukocytosis, multiple transfusions, albumin infusions and theophylline therapy in the study group in comparison to the controls (P less than 0.001). No significant difference was found in maternal risk factors (pre-eclampsia, diabetes and amnionitis), birth asphyxia, respiratory disease, parenteral nutrition, proven infection and antibiotic therapy. An unexpected association with maternal steroid therapy was demonstrated. It is speculated that monocytosis represents a physiological though immature response of the marrow of small premature infants to a variety of exogenous stimuli including drugs and foreign protein infusions.
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PMID:Monocytosis in preterm infants. 159 7

In order to determine the changes in the clinico-pathological pattern of admitted patients in an internal medicine department, 240 patients/year were compared during the years 1984 and 1989. A predominant proportion of males was registered (3:2); which did not vary by the year. An increased tendency of the median age (55.78 vs 58.48 years) was also established. The medium time of admission (8.98 vs 9.5 days) and mortality rate (6.3% vs 7.1%) did not change. A high rate (greater than 50%) of cardiovascular and respiratory disease was found on analyzing the cause of admission; in 1989 infection caused by HIV was detected and admissions to optimize the treatment of patients with diabetes mellitus were observed which did not exist in 1984. A slight but surprising decrease in admissions due to acute ischemic cardiopathy and significant decrease of admissions owing to respiratory disease were also noted. The majority of the patients admitted had a baseline disease (85% in 1984 and 87.1% in 1989). The knowledge of these data and their variations in every hospital department will, undoubtedly, assist in achieving a better use of technical and human health resources.
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PMID:[Comparative morbidity study 1984-1989 in the internal medicine department of a second-level general hospital]. 188 42


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