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Workers are selected into and out of physically demanding jobs with regard to their health. The study of occupational mortality and morbidity is hampered by this selection. Furthermore, social selection and rapid turnover are involved in health selection. Because different stages of disease form only one continuum (dissatisfaction-death), the correct interpretation of the results also requires measures softer than mortality. Earlier studies have concluded that soft and hard measures of health follow one another as explanations for the termination-of-employment rate. The aim of this study was to determine which age and exposure categories are the most prone to health selection. Mortality and morbidity were studied on three different exposure levels defined primarily according to the physical demands of the work: heavy level (iron foundries); medium level (manufacture of metal products); and light level (manufacture of electrical devices). The population comprised 15,714 men hired in 1950-1976 to work in the three branches of the metal industry. Another cohort, a cross-sectional one, of 1292 workers (who had been hired earlier and were still working in 1950) in the three industrial branches was used to clarify selection due to disability and mortality. Data for the mortality and disability analyses were obtained from national death and disability registers. The period of follow-up was 1950-1978. A questionnaire on occupational history, morbidity, and the causes of turnover was sent to 400 current and 600 former workers from each industrial branch. A questionnaire concerning occupational history was also sent to the nearest relatives of a total of 450 decidents. The occupational histories of the current and former workers were compared for changes in the exposure level throughout their complete occupational histories. The occupations during the workers' life-times were also classified into three exposure levels on the basis of physical demands (heavy, medium, and light). The three exposure levels showed different patterns of change according to age throughout the workers' complete occupational histories. Selection into and out of jobs within and between different exposure levels appeared to be a continuous process, a chain of selection. This conclusion was ascertained when the complete occupational histories were analyzed according to the exposure levels (heavy, medium, light) of the occupations from which the workers came and to which they transferred. The foundry workers entered the industry from either heavy or medium-level occupations, and most of them sought lighter work in medium-level occupations. The metal product workers either began their work lives within the metal product industry or they transferred to it from work that entailed the same exposure level. After leaving a job, the metal product workers generally moved to medium (i.e., the same level) or light occupations. The electrical workers switched from medium-level work, or they began their worklives within that industrial branch. When they left a job, they chose medium or light work in the metal industry. Due to the chain of selection from one exposure level to another, the mortality and morbidity rates for a certain exposure level can be underestimated or overestimated if complete occupational histories are not available. The selection process was different for different diseases and was manifested as different stages of disease. Ache or pain in the musculoskeletal system within the last 12 months was more frequent among the foundry and metal product workers than among the electrical workers. Both the currently employed and former foundry workers had significantly more earlier-diagnosed musculoskeletal diseases than the electrical workers. The younger age classes of foundry workers (< 45 years) had a higher occurrence of musculoskeletal diseases than the metal product workers; in the older age classes the opposite was true. (ABSTRACT TRUNCATED)
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PMID:Mortality, morbidity and health selection among metal workers. 931 71

"In the year 1562, having noticed that none of the ancient or modern physicians had treated the subject of dental care, I wrote this first book on the teeth". So begins the preface to the five books of the Opuscula medica senilia by Girolamo Cardano, the first organic text on dentistry in history. It competed with the famous Libellus de dentibus by Bartolomeo Eustachio that appeared in 1563 (but was written in 1562). However, our intention is not to establish precedence but bring to reader's attention Cardano's work that complemented Eustachio's anatomy and physiology of the teeth with their pathology and therapy. This article summarises Cardano's biography and gives a brief review of literature on the De dentibus and of his first complete translation from Latin into Italian. De dentibus is the first of the five books of the Opuscula and is divided into three chapters, as described below. Chapter one, De dentibus, recalls briefly the anatomy and embryology of human teeth as bones and compares them with the teeth of some animals. Follows a description of systemic and local procedures, to preserve, protect, and cure the teeth. Preservation and protection are related to diet, sleep, physical activity, systemic and local medicaments, and amulets., whereas therapy involves remedies taken over from the Ancient Greek and Roman medicine (Hippocrates, Archigenes, Galen, Scribonius, Pliny the Younger, Ezio, Marcellus Empiricus ) and Arabic medicine (Avicenna in particular). The chapter continues with guidelines and procedures for shedding teeth that are damaged beyond repair using a special saltpetre and alum distillate of Cardano's own invention, which he finds very effective. The chapter concludes with tooth extraction tools and methods, especially the one by Scribonius Largo with red-hot iron. Chapter two, -De morbis dentium in specie, describes diseases that affect the teeth and that can cause ache, mobility, weakness, numbness, or deformity (dolor, commotio, imbecillitas, stupor, deformitas). All these conditions may interact, creating a wide range of situations. Ache has seven possible causes that include altered humour, a cavity, a nerve injury, an abscess, breath (flatus), worms, and cold, and Cardano describes the remedies at physician's disposal that even include spells. The causes of mobility are the same as for the ache plus periodontal problems such as dry root or alveolar laxity, and the author discusses local and systemic treatment options. Weakness is considered the worst of the dental pathologies, as it can easily require extraction. Stupor is caused by the corruption of the tooth or a nerve injury, and Cardano refers to it as a life-threatening condition (quoad vitam) in older people if untreated, but also easy to remedy if detected early. Cardano then identifies a whole series of deformities: tooth colour, roughness, fracture, position, number, absence, length, calculus, bad smell, and porosity, and for each of them he offers a wide variety of remedies, in part original and in part borrowed from the ancients. In the last part, Cardano stresses the need to extract as few teeth as possible: "I've never seen anyone die from the diseases of the teeth, except for a tooth extracted inappropriately" To emphasize the dichotomy between medicine and surgery, he explains that tooth care is medical, but extraction requires an experienced surgeon. Chapter three, De fluxione, frequentissima causa morborum dentium, identifies gumboil as a frequent cause of dental disease, and describes the pathogenesis and therapy of gumboil-related diseases, gout in particular.
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PMID:[The 1562 De dentibus by Girolamo Cardano]. 2531 Jun 9