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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

An analysis of the work content of the physician-specialist at Apia General Hospital, Western Samoa, over a 12-month period in 1973-74 is described. Respiratory infections, rheumatic heart disease, hypertension, diabetes, peptic ulcer, and various forms of liver disease were encountered most commonly.
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PMID:The physician-specialist in Western Samoa. 105 46

Macroscopic and light microscopic features of regional ischemic infarcts of retina in autopsy eyes are described. Lesions were found throughout life span, most patients having significant primary or secondary vascular disease (younger had systemic hypertension, rheumatic heart disease, vasculitis or sickle hemoglobinopathy; most older patients had arteriosclerosis). Diabetes mellitus and infarction of other organs (including brain) also were common. Topographically almost all lesions were found in posterior fundus; most were temporal and involved anatomical macula. Microscopically there was destruction of inner retinal layers with preservation of outermost cells of inner nuclear layer; occasionally ganglion cell layer was relatively spared.
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PMID:Regional ischemic infarcts of the retina. 108 10

This study was made to determine whether zinc deficiency is one of the factors involved in growth retardation of infants of high-risk pregnancies. The high risk factors were hypertension of pregnancy, diabetes mellitus, congenital heart disease, chronic nephritis, rheumatic heart disease and hyperthyroidism. 102 neonatal infants were divided into 3 groups: breast fed group, 37 cases; test group, 32 cases formula-fed with supplementary zinc 1.14-2.28 mg/kg/d; and control group, 33 cases formula-fed and supplemented with Vitamin B complex as placebo. The groups were divided by double-blind and randomized method. There were no differences in the 3 groups in sex ratio, growth status and serum zinc concentration at the beginning of the study. Anthropometric data were obtained at 0, 3 and 6 months.
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PMID:Growth promoting effect of zinc supplementation in infants of high-risk pregnancies. 129 Dec 3

The study was undertaken to clinically assess the consequences of alcohol consumption in 'communal' drinking patients whose levels of alcohol consumption could not be determined accurately in grams of alcohol. The level of alcohol consumed by 100 adult 'communal' drinking medical patients per drinking session was scored on a scale 0-10. The score was based on a qualitative impression of how much alcohol was drunk, level of consciousness, behaviour and gait. The frequency of drinking days in a week was scored on a 0-7 scale. The duration of drinking in years prior to registration at the clinic was also recorded. The pattern of diseases among the drinkers was compared to that of 70 adult non-drinkers. The individual diseases were ranked to association with alcohol consumption by the Kruskal-Wallis Test. The drinkers attained a mean level score of 5.75 +/- 2.16, a frequency of 4.75 +/- 2.4 days but the duration of prior drinking varied greatly. Gout, dilated cardiomyopathy, epilepsy and hypertension ranked highest in that order to alcohol usage. Rheumatic heart disease and Diabetes mellitus ranked low. The probability significance were, for level score p = 0.005, frequency p = 0.016 and duration p = 0.001. This method was able to identify the morbid chronic medical diseases associated with alcohol usage in 'communal' drinkers. There is a need to evaluate it against a known screening instrument like the Alcohol Use Disorders Identification Test (AUDIT).
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PMID:A clinical assessment of the consequences of alcohol consumption in 'communal' drinkers in the Zimbabwean Midlands. 129 68

Congestive heart failure (CHF) is a major cause of mortality and morbidity, and has a prognosis similar to that of several malignancies. There are increasing trends in both prevalence and incidence rates of CHF which points towards CHF becoming a major community health problem. Early detection of CHF is dependent upon criteria to define the initial stages of a condition which progresses slowly over many years. In western countries the dominant causes of CHF are hypertension and coronary heart disease, which account for more than 75% of the cases. Other precursors are diabetes and rheumatic heart disease. Independent risk factors for CHF are hypertension, smoking, obesity, and psychological stress. Early detection of CHF through identification of early symptoms such as dyspnea on exertion, treatment of known heart diseases, and treatment of risk factors may prevent its progress. Epidemiological data indicate that primary preventive efforts should be directed against hypertension, smoking and obesity. A multiple risk factor interventional approach seems to yield the best result since these risk factors act synergistically.
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PMID:Epidemiology and prognosis of heart failure. 179 25

A case of polyarteritis nodosa is reported. The patient, a 56-year-old white woman, had cutaneous nodules, ulcers and livedo reticularis over the limbs. Abdominal angiography revealed the presence of microaneurysms. Hypertension, rheumatic heart disease (under anticoagulation therapy) and diabetes mellitus, were also detected. The controversial attempt in distinguishing between systemic and cutaneous polyarteritis is emphasized, and the influence of warfarin on skin lesions morphology is discussed.
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PMID:[Polyarteritis nodosa. Considerations on a clinical case]. 198

The files of 222 patients (112 men) admitted to a Medical Department (Medicina 1) of the Hospital de Santa Maria (Lisbon) between 1/1/87 and 21/6/88 with the diagnosis of congestive heart failure (CHF) were studied retrospectively. The next parameters were considered: sex, age, cause of cardiac disease, duration of CHF, presence of diabetes, predispondent factors of CHF episodes, cardiac rhythm and blood pressure on admission, presence of rales, ascitis and edema, echocardiographic findings and evolution. Ischemic heart disease (IHD) (50%) and hypertensive heart disease (HHD) (31%) were the most frequent causes of CHF in this study. The mean age was 70 years, being higher in women (74 versus 66 years). Men were predominant in the younger groups. The rheumatic heart disease (RHD) group had the lowest mean age (54) while the cardiac diseases of unknown origin had the highest mean age (79). Patients with RHD were those with longer CHF (16 years) while patients with IHD, idiopathic cardiomyopathy and cor pulmonale had a shorter duration of CHF (less than 5 years). The respiratory infection was the most frequent predisponent factor (40%). In a high number of cases (31%) it was not possible to find the presumable cause of the CHF episode. Atrial fibrillation was the predominant disarrhythmia (44%) on admission, specially in patients with RHD. Patients with HHD isolated or associated to other causes were those with higher initial blood pressure. Echocardiographic studies were suggestive that HHD can be associated with CHF without a significant increase in left atrium and ventricle dimensions nor impairment of left ventricle systolic function. Echocardiographic analysis of larger numbers of patients and the study of left ventricular diastolic function and Doppler flow patterns will eventually contribute to a better understanding of CHF physiopathology.
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PMID:[Heart failure at an internal medicine department: a retrospective study]. 204 21

The epidemiology and etiology, pathophysiology, diagnosis, and treatment of congestive heart failure (CHF) are reviewed. CHF affects as many as 4 million Americans and is one of the most prevalent causes of death in hospitalized patients. Major risk factors for developing CHF include advanced age, male sex, hypertension, coronary artery disease, smoking, hypercholesterolemia, diabetes mellitus, and rheumatic heart disease. Heart failure results from decreased intrinsic myocardial contractility caused by one or more of three changes: (1) altered adrenergic nervous system function, (2) impaired delivery of calcium to contractile elements in the heart, and (3) reduced myosin-ATPase activity in the myocardium. The disease is progressive, and no intervention has yet been found to stop it effectively. CHF is diagnosed based on subjective signs and symptoms and objective assessment using auscultation, ECG, chest roentgenogram, laboratory tests, and noninvasive and invasive tests. Treatment of CHF begins with restriction of physical activity and sodium intake. Pharmacologic interventions start with either digitalis glycosides or thiazide diuretics; both may be used concomitantly as the disease progresses. Current studies are focusing on the use of angiotensin-converting enzyme inhibitors as first-line agents for CHF. When CHF worsens, loop diuretics are substituted for or added to the thiazide diuretics, and vasodilators are added to reduce the workload on the heart. Other inotropic agents, including the new bipyridine derivatives, may also be used. In patients not responding to these and other aggressive therapeutic interventions, cardiac transplantation is the only option. Despite advances in management of CHF, little improvement in overall survival has been demonstrated, and no intervention has stopped or reversed the progression of CHF.
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PMID:Current concepts in clinical therapeutics: congestive heart failure. 287 92

34 cases of Listeria monocytogenes endocarditis reported in the literature from 1950-1986 were reviewed. The male to female ratio was 2: 1. The average age was 49 years, and 35% of patients were 60 years of age or older. A single case of polymicrobial endocarditis was identified. There were 8 cases of prosthetic valve endocarditis. Left-sided cardiac involvement predominated, with only a single case of right-sided endocarditis reported. Aortic and mitral valvular involvement accounted for 32 and 29% of cases respectively. Underlying cardiac disease was present in over half of the cases, with rheumatic heart disease being the most common underlying cardiac condition. Noncardiac underlying conditions were found in 38% of cases. These included chronic hemodialysis, alcoholism, pregnancy, malignancies, diabetes mellitus, steroid therapy and malnutrition. Onset of the disease was varied as was initial presentation. There was a high incidence of vascular phenomena (59%), with large vessel emboli seen late in the course of many cases. Many cases were diagnosed late. Overall mortality was 50%. Treatment of listeria endocarditis varied from case to case. A review of in vitro and in vivo studies as well as case reports suggests that ampicillin or penicillin plus an aminoglycoside may be the treatment of choice.
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PMID:Listeria monocytogenes endocarditis: a review of the literature 1950-1986. 305 15


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