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1.  Leukaemia in benzene workers: a retrospective cohort study. 
A retrospective cohort study was conducted in 233 benzene factories and 83 control factories in 12 cities in China. The benzene cohort and the control cohort consisted of 28,460 benzene exposed workers (178,556 person-years in 1972-81) and 28,257 control workers (199,201 person-years). Thirty cases of leukaemia (25 dead and 5 alive) were detected in the former and four cases (all dead) in the latter. The leukaemia mortality rate was 14/100,000 person-years in the benzene cohort and 2/100,000 person-years in the control cohort; the standardized mortality ratio was 5.74 (p less than 0.01 by U test). The average latency of benzene leukaemia was 11.4 years. Most (76.6%) cases of benzene leukaemia were of the acute type. The mortality due to benzene leukaemia was high in organic synthesis plants followed by painting and rubber synthesis industries. The concentration of benzene to which patients with a leukaemia were exposed ranged from 10 to 1000 mg/m3 (mostly from 50 to 500 mg/m3). Of the 25 cases of leukaemia, seven had a history of chronic benzene poisoning before the leukaemia developed.
PMCID: PMC1007793  PMID: 3814544
2.  Lung cancer in Japanese chromate workers. 
Thorax  1978;33(3):372-374.
We have treated ten patients with lung cancer among workers in a chromate factory between 1972 and 1976. Four further cases were also found through death certificates and medical records. Most were smokers and all were men. The average duration of exposure to chromate was 24 years (range 10 to 36). The cell type in our ten patients was squamous in seven and small anaplastic type in three. The primary sites were all in large bronchi. The incidence (person per year) calculated from the number of employees, duration of factory activity, number of cancer patients, and shortest duration of labour period among the patients was 657.9 per 100,000 compared to 13.3 per 100,000 in Japan as a whole.
PMCID: PMC470898  PMID: 684674
3.  Lung cancer epidemiology in North Sardinia, Italy 
The aim of this study was to analyze and describe the epidemiological characteristics and trends of lung cancer in North Sardinia, Italy, in the period 1992–2010.
Data were obtained from the tumor registry of Sassari province which is a part of a wider registry web, coordinated today by the Italian Association for Tumor Registries.
The overall number of lung cancer cases registered was 4,325. The male-to-female ratio was 4.6:1 and the mean age 68.1 years for males and 67 years for females. The standardized incidence rates were 73.1/100,000 and 13.5/100,000 and the standardized mortality rates 55.7/100,000 and 9.9/100,000 for males and females, respectively. An increasing trend in incidence of lung cancer in women was evidenced. Conversely, incidence was found to decrease in males. Relative survival at 5 years from diagnosis was low (8.8% for males and 14.9% for females). Furthermore, an increase in mortality rates was observed in both sexes in the period under investigation.
Our data show an increasing trend of lung cancer incidence in women in North Sardinia in the last decades. Conversely, a reduction of incidence rates was observed in males. Furthermore, a slightly increasing trend in mortality rates was observed in both sexes, suggesting the need to enhance smoking control strategies, consider adoption of effective surveillance policies, and improve diagnosis and treatment methods.
PMCID: PMC3718671  PMID: 23849787
Adenocarcinoma; Italy; Lung cancer; Sardinia; Screening; Small cell; Squamous
4.  Cancer Incidence and Mortality in China, 2007 
Cancer incidence and mortality data collected from population-based cancer registries were analyzed to present the overall cancer statistics in Chinese registration areas by age, sex and geographic area in 2007.
In 2010, 48 cancer registries reported cancer incidence and mortality data of 2007 to National Central Cancer Registry of China. Of them, 38 registries’ data met the national criteria. Incidence and mortality were calculated by cancer sites, age, gender, and area. Age-standardized rates were described by China and World population.
The crude incidence rate for all cancers was 276.16/100,000 (305.22/100,000 for male and 246.46/100,000 for female; 284.71/100,000 in urban and 251.07/100,000 in rural). Age-standardized incidence rates by China and World population were 145.39/100,000 and 189.46/100,000 respectively. The crude mortality rate for all cancers was 177.09/100,000 (219.15/100,000 for male and 134.10/100,000 for female; 173.55/100,000 in urban and 187.49/100,000 in rural). Age-standardized mortality rates by China and World population were 86.06/100,000 and 116.46/100,000, respectively. The top 10 most frequently common cancer sites were the lung, stomach, colon and rectum, liver, breast, esophagus, pancreas, bladder, brain and lymphoma, accounting for 76.12% of the total cancer cases. The top 10 causes of cancer death were cancers of the lung, liver, stomach, esophagus, colon and rectum, pancreas, breast, leukemia, brain and lymphoma, accounting for 84.37% of the total cancer deaths.
Cancer remains a major disease threatening people’s health in China. Prevention and control should be enhanced, especially for the main cancers.
PMCID: PMC3555260  PMID: 23359628
Cancer registry; Incidence; Mortality; China
5.  Concurrent Docetaxel-Based Chemoradiotherapy in Squamous Cell Esophageal Cancer 
The incidence of esophageal cancer has risen worldwide in recent decades. In Romania, the incidence is 5.3/100,000 population in males and 0.7/100,000 in females, with mortality rates of 4.8/100,000 and 0.5/100,000 in males and females, respectively. Esophageal cancer is a treatable but rarely curable cancer, as many patients have advanced-stage disease at diagnosis. We evaluated a multimodality approach of preoperative radiochemotherapy for patients with squamous cell esophageal carcinoma in terms of safety, tumor response, and resectability rate.
From January 2004 to May 2007, 87 patients were included in the study. Inclusion criteria were histologically confirmed squamous esophageal cancer not amenable to curative surgery, no distant metastases, ECOG performance status ≤ 2, and no previous anticancer therapy. The preoperative treatment schedule was conformal radiotherapy (40 Gy) with concomitant weekly docetaxel (25 mg/m2) and carboplatin (AUC=2). Patients were evaluated at baseline, after having received 40 Gy radiotherapy, and 3 months after treatment ended. Endoscopy, barium swallow X-ray, and CT scan of the chest and upper abdomen were used to evaluate patients. Patients whose tumors were resectable underwent surgery; those with unresectable tumors continued radiotherapy to a total dose of 60 Gy and received four cycles of docetaxel (75 mg/m2) and carboplatin (AUC=6) (q3wk regimen). The resected patients received adjuvant chemotherapy with four cycles of the same docetaxel/carboplatin q3wk regimen.
The median patient age was 53.6 years (range, 32–70 years); 78 of the patients were males and 9 were females. Median follow-up time was 35 months. Survival rate at 1 year was 57.5% and at 2 years, 44.8%. After patients had received 40 Gy radiotherapy, 39 were determined to have resectable disease and 30 underwent surgery (6 patients refused surgery and 3 had contraindications for surgery); 48 patients had tumor regression with clinical benefit but were not operable. No patient progressed. Six of the 30 patients undergoing surgery had complete remissions. The treatment schedule was well tolerated, with no treatment-related deaths or additional hospitalizations. All except 5 of the patients were able to receive the intended chemoradiotherapy regimen. These 5 patients stopped chemoradiotherapy because of hematologic toxicity; radiotherapy was continued (after an approximate 1-week delay) following hematologic recovery. The operated patients had no additional perioperative complications. Radiation therapy was delivered as intended with no toxicity-related interruptions, except in the 5 patients mentioned above. Chemotherapy was delayed in 15 additional cases due to grade 3–4 hematologic effects; a 25% dose reduction was necessary in 9 cases.
Multimodality treatment of locally advanced esophageal cancer (concurrent radiochemotherapy ± surgery) can be considered superior to each method as single-agent therapy. Radiotherapy and chemotherapy may convert some tumors considered initially unresectable to resectable status. The weekly docetaxel/carboplatin regimen was well tolerated when administered concurrently with radiation therapy. This regimen resulted in a 44.8% resectability rate in patients considered initially unresectable, and 15.4% of patients undergoing surgery had complete remissions. Further investigation of this regimen is warranted.
PMCID: PMC3056309
6.  Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990-1994. 
Neuro-Oncology  1999;1(1):14-25.
The Central Brain Tumor Registry of the United States (CBTRUS) obtained 5 years of incidence data (1990-1994)--including reports on all primary brain and CNS tumors--from 11 collaborating state cancer registries. Data were available for 20,765 tumors located in the brain, meninges, and other CNS sites, including the pituitary and pineal glands. The average annual incidence was estimated at 11.5 cases per 100,000 person-years. The higher incidence of tumors in male patients (12.1 per 100,000 person-years) than in female patients (11.0 per 100,000 person-years) was statistically significant (P < 0.05); the higher incidence in whites (11.6 per 100,000 person-years) compared with blacks (7.8 per 100,000 person-years) was statistically significant (P < 0.05). The most frequently reported histologies were meningiomas (24.0%) and glioblastomas (22.6%). Higher rates for glioblastomas, anaplastic astrocytomas, oligodendrogliomas, anaplastic oligodendrogliomas, ependymomas, mixed gliomas, astrocytomas not otherwise specified, medulloblastomas, lymphomas, and germ cell tumors in male than in female patients were statistically significant (P < 0.05), with relative risks (RR) ranging from 1.3 to 3.4. Meningiomas were the only tumors with a significant excess in females (RR = 0.5). We noted higher occurrence rates in whites than in blacks for the following histologies: diffuse astrocytomas, anaplastic astrocytomas, glioblastomas, oligodendrogliomas, ependymomas, mixed gliomas, astrocytomas NOS, medulloblastomas, nerve sheath tumors, hemangioblastomas, and germ cell tumors, with RRs ranging from 1.5 to 3.4. Racial differences in occurrence rates were not observed for predominately benign meningiomas or pituitary tumors. This study represents the largest compilation of data on primary brain and CNS tumors in the United States. Standard reporting definitions and practices must be universally adopted to improve the quality and use of cancer registry data.
PMCID: PMC1919458  PMID: 11554386
7.  Nasopharyngeal carcinoma incidence and mortality in China in 2009 
Chinese Journal of Cancer  2013;32(8):453-460.
Nasopharyngeal carcinoma (NPC) is rare globally but common in China and exhibits a distinct ethnic and geographic distribution. In 2009, the National Central Cancer Registry in China provided real-time surveillance information on NPC. Individual NPC cases were retrieved from the national database based on the ICD-10 topography code C11. The crude incidence and mortality of NPC were calculated by sex and location (urban/rural). China's population in 1982 and Segi's world population structures were used to determine age-standardized rates. In regions covered by the cancer registries in 2009, the crude incidence of NPC was 3.61/100,000 (5.08/100,000 in males and 2.10/100,000 in females; 4.19/100,000 in urban areas and 2.42/100,000 in rural areas). Age-standardized incidences by Chinese population (ASIC) and Segi's world population (ASIW) were 2.05/100,000 and 2.54/100,000, respectively. The crude mortality of NPC was 1.99/100,000 (2.82/100,000 in males and 1.14/100,000 in females; 2.30/100,000 in urban areas and 1.37/100,000 in rural areas). The age-standardized mortalities by Chinese population (ASMC) and world population (ASMW) were 1.04/100,000 and 1.35/100,000, respectively. The incidence and mortality of NPC were higher in males than in females and higher in urban areas than in rural areas. Both age-specific incidence and mortality were relatively low in persons younger than 30 years old, but these rates dramatically increased. Incidence peaked in the 60-64 age group and mortality peaked in the over 85 age group. Primary and secondary prevention, such as lifestyle changes and early detection, should be carried out in males and females older than 30 years of age.
PMCID: PMC3845582  PMID: 23863562
Nasopharyngeal carcinoma; cancer registry; incidence; mortality; China
8.  Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey 
Tuberculosis (TB) is an established occupational disease affecting health care workers (HCWs). Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teaching hospital in Istanbul, Turkey. This study is retrospective study of health records of HCWs in our hospital from 1991 to 2000.
The mean workforce of the hospital was 3359 + 33.2 between 1991 and 2000. There were 31 cases (15 male) meeting the diagnostic criteria for TB, comprising eight doctors, one nurse and 22 other health professionals. Mean incidence of TB was 96 per 100,000 for all HCWs (relative risk: 2.71), 79 per 100,000 for doctors (relative risk: 2.2), 14 per 100,000 for nurses and 121 per 100,000 (relative risk: 3.4) for other professionals. The mean incidence of TB in Turkey between 1991 and 2000 was 35.4 per 100,000. Incidence of TB was similar in the Departments of Chest Diseases and Clinical Medicine but there were no TB cases in the Basic Science and Managerial Departments.
HCWs in Turkey who work in clinics have an increased risk for TB. Post-graduate education and prevention programs reduce the risk of TB. Control programs to prevent nosocomial transmission of TB should be established in hospitals to reduce risk for HCWs.
PMCID: PMC122064  PMID: 12144709
9.  The incidence of type 1 diabetes mellitus among 15-34 years aged Lithuanian population: 18-year incidence study based on prospective databases 
BMC Public Health  2011;11:813.
The aim of this prospective study was to determine the incidence of type 1 diabetes mellitus in 15-34-year-aged Lithuanian males and females during 1991 - 2008
A contact system with general practitioners covering 100% of the 15-34-year-aged Lithuanian population was the primary data source. Reports from regional endocrinologists and statistical note-marks of State patient insurance fund served as secondary sources for case ascertainment.
The average age-standardized incidence rate was 8.30 per 100,000 persons per year (95% Poisson distribution confidence interval [CI] 7.90-8.71) during 1991 - 2008 and was statistically significantly higher among males (10.44 per 100,000 persons per year, 95% CI 9.82-11.10) in comparison with females (6.10 per 100,000, 95% CI 5.62-6.62). Male/female rate ratio was 1.71 (95% CI 1.63-1.80). Results of the linear 1991 - 2008 regression model showed that the incidence of Type 1 diabetes in 15-34-year-aged males and females decreased slightly over the time (r = -0.215, p > 0.05).
Our data demonstrated the male predominance in primary incidence of type 1 diabetes mellitus in 15-34-year-aged population in Lithuania. The incidence of type 1 diabetes mellitus in 15-34-year-aged males and females decreased slightly during 1991-2008.
PMCID: PMC3210107  PMID: 22011463
10.  MULTIPLE SCLEROSIS—Its Frequency and Distribution, with Special Reference to San Francisco 
California Medicine  1953;79(5):381-385.
Epidemiologic surveys of multiple sclerosis were conducted in 1949 in San Francisco, Winnipeg, Boston, New Orleans, and Denver. Reports of cases for 1939 through 1948 were obtained from record offices, hospitals and clinics, and private physicians. The basis for the observations was the group of “probable” cases among residents.
In San Francisco these probable cases in residents numbered 415; however, in only 146 of these was the onset between 1939 and 1948. Of the 143 patients who were white, 51 were male and 92 female. The average annual incidence based on these figures was 2.1 per 100,000—1.5 for males and 2.6 for females.
Prevalence, based on probable cases in residents on January 1, 1949, was 29.7 cases per 100,000 population—21.2 for males and 38.1 for females.
Mortality was 0.7 per 100,000 population—0.9 for females and 0.6 for males.
In comparison of the findings for San Francisco with those of other cities, both the incidence and the severity of the disease appear to decrease from north to south.
PMCID: PMC1521900  PMID: 13106716
11.  Ruptured abdominal aortic aneurysm in the Huntingdon district: a 10-year experience. 
A study was undertaken to establish the true incidence of ruptured abdominal aortic aneurysms (RAAA) in the Huntingdon districts. RAAAs in the Huntingdon district between 1986 and 1995 were studied retrospectively. Data were collected from hospital records and hospital and community autopsies. There was a total of 139 cases of RAAA; 119 were males and 20 females, giving a M:F ratio of 6:1. The incidence of RAAAs was 17.8/100,000 person years (py) in males and 3.0/100,000 py in females. Mean age at rupture was 75.5 years in men (95% confidence intervals (CI) 74-78 years) and 80.2 in women (95% CI 78.8-83 years). There was an age-specific increase in incidence after the age of 65 years in men and after 80 years in women, although 12.6% of all RAAAs occurred in men under 65 years. In all, 100 patients were confirmed to have died of RAAA during the 10-year period. This represents 79% of all ruptures discovered. Almost three-quarters of patients did not reach the operating theatre. Of the 61 patients operated on, 29 survived (48%). The size of the aneurysm at rupture was recorded in 68 cases (49%). The mean size was 8.14 cm (SD 2.0 cm). In five cases (7.4%), rupture occurred in AAAs smaller than 6 cm. The overall mortality from RAAA in Huntingdon health district is approximately 80% and three-quarters of all deaths occurred without an operation.
PMCID: PMC2503249  PMID: 10325681
12.  Factors affecting 30-month survival in lung cancer patients 
Background & objectives:
Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India.
Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records.
A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival.
Interpretation & conclusions:
Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients.
PMCID: PMC3516029  PMID: 23168702
Duration of symptoms; histopathological type; lung cancer; never smokers; small cell lung cancer; survival
13.  Epidemiology and Course of Gastrointestinal Haemorrhage in North-east Scotland 
British Medical Journal  1973;3(5882):655-660.
A prospective study was made of 817 consecutive episodes of major gastrointestinal haemorrhage in patients admitted to hospital during 1967-8 from the defined population of North-East Scotland. The yearly admission rate was 116 per 100,000 population. Comparison of the data for city and country residents showed no appreciable differences. In the duodenal ulcer group there was an undue incidence of bleeding among foremen and skilled workers and among those who were unmarried or widowed.
Both the clinical history and the results of any previous barium meal examinations were unreliable guides to the source of the current haemorrhage. Prognosis was worse for patients who did not have a dyspeptic history and was better for those who had bled on a previous occasion. The simultaneous ingestion of alcohol and aspirin had an adverse effect on the occurrence of bleeding. Forty-seven per cent. of the patients had another major coincidental disease.
Mortality was 13·7% in the whole series and 8·6% in those with peptic ulcer (duodenal ulcer 7·1%, gastric ulcer 16·9%). In 28% of the patients further haemorrhage occurred after admission to hospital and caused a 28·8% mortality. Seventy-four patients were already in hospital when they first bled and 44% of them died.
PMCID: PMC1587031  PMID: 4542662
14.  Suicide in the 12 months after discharge from psychiatric inpatient care, Scotland 1968-92. 
STUDY OBJECTIVE: To investigate the rate of suicide in the 12 months after discharge from psychiatric hospital and to determine its relationship to age, diagnosis, and period. DESIGN: Cohort study of patients discharged from psychiatric hospital. SETTING: Scotland. PARTICIPANTS: Altogether 159,742 men and 178,271 women, aged 15-84, who were discharged from Scottish psychiatric hospitals during 1968-92. MAIN RESULTS: During the 25 year period, 1212 male patients committed suicide in 198,059 person years at risk (612 per 100,000; 95% confidence interval (CI) 578,647) and 1099 female patients committed suicide in 228,993 person years at risk (480 per 100,000; 95% CI 452, 509). The overall standardised mortality ratio (general population rate = 1) was 27 (95% CI 26, 29) in men and 40 (95% CI 38, 43) in women. There were variations in the suicide rates in relation to age, diagnosis, and period. The ratio of the 1-28 day rate to the rate between days 29 and 365 over the whole study period was 1.7 (95% CI 1.4, 1.9) in men and 1.6 (95% CI 1.3, 1.8) in women. CONCLUSIONS: The variations in the post discharge suicide rate by age, sex, diagnosis, geographical location, and period suggest that there are several risk factors which vary in their distribution. Further study of these may lead to the development of effective interventions.
PMCID: PMC1060514  PMID: 9328552
15.  Genetic determinants of exceptional human longevity: insights from the Okinawa Centenarian Study 
Age  2006;28(4):313-332.
Centenarians represent a rare phenotype appearing in roughly 10–20 per 100,000 persons in most industrialized countries but as high as 40–50 per 100,000 persons in Okinawa, Japan. Siblings of centenarians in Okinawa have been found to have cumulative survival advantages such that female centenarian siblings have a 2.58-fold likelihood and male siblings a 5.43-fold likelihood (versus their birth cohorts) of reaching the age of 90 years. This is indicative of a strong familial component to longevity. Centenarians may live such extraordinarily long lives in large part due to genetic variations that either affect the rate of aging and/or have genes that result in decreased susceptibility to age-associated diseases. Some of the most promising candidate genes appear to be those involved in regulatory pathways such as insulin signaling, immunoinflammatory response, stress resistance or cardiovascular function. Although gene variants with large beneficial effects have been suggested to exist, only APOE, an important regulator of lipoproteins has been consistently associated with a longer human lifespan across numerous populations. As longevity is a very complex trait, several issues challenge our ability to identify its genetic influences, such as control for environmental confounders across time, the lack of precise phenotypes of aging and longevity, statistical power, study design and availability of appropriate study populations. Genetic studies on the Okinawan population suggest that Okinawans are a genetically distinct group that has several characteristics of a founder population, including less genetic diversity, and clustering of specific gene variants, some of which may be related to longevity. Further work on this population and other genetic isolates would be of significant interest to the genetics of human longevity.
PMCID: PMC3259160  PMID: 22253498
longevity; genetics; centenarians; Okinawa; longevity genes
16.  Cancer risks in a historical UK cohort of benzene exposed workers 
Aims: To examine mortality from different causes and cancer incidence among a cohort of benzene workers in England and Wales.
Methods: A cohort of 5514 workers who had been occupationally exposed to benzene in 1966/67 or earlier was assembled by the former Factory Inspectorate and the Medical Research Council from details provided by 233 employers in England and Wales. The cohort was followed up for mortality (1968–2002) and cancer registrations (1971–2001). National mortality rates and cancer registration (incidence) rates were used to calculate standardised mortality ratios and standardised registration ratios.
Results: Mortality was close to expectation for all causes and significantly increased for cancer of the lip, cancer of the lung and bronchus, secondary and unspecified cancers, acute non-lymphocytic leukaemia (ANLL), and all neoplasms. Significant deficits were shown for three non-malignant categories (mental disorders, diseases of the digestive system, accidents). SMRs for other leukaemia, lymphomas, and multiple myeloma were close to or below expectation. There was some evidence of under-ascertainment of cancer registrations, although significantly increased SRRs were shown for lung cancer and cancer of the pleura (mesothelioma).
Conclusions: Many study subjects would have been exposed to carcinogens other than benzene (for example, asbestos, rubber industry fumes, foundry fumes, polycyclic aromatic hydrocarbons), and the excesses of lung cancer and mesothelioma are likely to reflect exposures to these other carcinogens. The carcinogenic effects of benzene exposure on the lymphohaematopoietic system were limited to ANLL.
PMCID: PMC1740992  PMID: 15778255
17.  Excretion of 1,2,4-benzenetriol in the urine of workers exposed to benzene. 
Urine samples were collected from 152 workers (64 men, 88 women) who had been exposed to benzene, 53 workers (men only) exposed to a mixture of benzene and toluene, and 213 non-exposed controls (113 men, 100 women). The samples were analysed for 1,2,4-benzentriol (a minor metabolite of benzene) by high performance liquid chromatography. The time weighted average solvent exposure of each worker was monitored by diffusive sampling technique. The urinary concentration of 1,2,4-benzentriol related linearly to the intensity of exposure to benzene both in men and women among workers exposed to benzene, and was suppressed by toluene co-exposure among male workers exposed to a mixture of benzene and toluene. A cross sectional balance study in men at the end of the shift of a workday showed that only 0.47% of benzene absorbed will be excreted into urine as 1,2,4-benzenetriol, in close agreement with previous results in rabbits fed benzene. The concentration of 1,2,4-benzenetriol in urine was more closely related to the concentration of quinol than that of catechol. The fact that phenol and quinol, but not catechol, are precursors of 1,2,4-benzentriol in urine was further confirmed by the intraperitoneal injection of the three phenolic compounds to rats followed by urine analysis for 1,2,4-benzenetriol.
PMCID: PMC1009826  PMID: 2775675
18.  Characteristics of drowning deaths in North Carolina. 
Public Health Reports  1988;103(4):406-411.
A retrospective study of 1,052 unintentional drowning deaths in North Carolina during the period from 1980 through 1984 was carried out, with emphasis on the victims' activity and alcohol consumption, and the settings of the accidents. The data suggest that many drownings are preventable, and reinforce the etiologic importance of ethanol consumption in such deaths. The overall drowning rate for North Carolina residents during the period covered by the study was 3.2 per 100,000 persons. Nonwhite males had the highest rate, 8.8 per 100,000 population. The next highest rate was for white males, 4.7 per 100,000. Swimming and wading, involved in 41 percent of the drowning deaths, was the most frequently associated activity. Fishing was involved in 15 percent of the deaths, and motor vehicle accidents with 8 percent. Most occurred in freshwater settings, notably lakes and ponds, 39 percent, and rivers and creeks, 29 percent. Of the 752 victims 15 years and older tested for blood ethanol, 53 percent had positive tests and 38 percent had blood alcohol concentrations of 100 milligrams per deciliter or greater. Significant percentages of victims 15 years and older with blood alcohol concentrations greater than 100 milligrams per deciliter were found in all settings and activity groups.
PMCID: PMC1478086  PMID: 3136500
19.  Chronic ulcerative colitis: incidence and prevalence in a community. 
Gut  1987;28(4):402-409.
Utilising the population based data resources of the Rochester Epidemiology Project, we determined the incidence and prevalence of chronic ulcerative colitis among Rochester, Minnesota, residents over the 20 year period, 1960-79. One hundred and thirty eight cases met diagnostic and residency criteria, for an overall age, and sex adjusted chronic ulcerative colitis incidence rate of 15.0 per 100,000 person years. The male:female ratio of age adjusted rates was 1.5:1. Age specific incidence was roughly bimodal in appearance but was not consistent in different patient subgroups. On 1-1-80, there were 120 Rochester residents with a history of chronic ulcerative colitis, corresponding to a prevalence rate of 225.2 per 100,000 population. Fifty three per cent of chronic ulcerative colitis incidence cases were 'definite' and 47% were 'probable', the former requiring consistent observations for at least six months. The definite group had proportionately more men and disease of greater extent and severity. Pancolitis comprised about one-third of all cases (4.6 per 100,000 person years). Proctitis and distal disease (7.1 and 2.0 per 100,000 person years) made up most of the rest. One-fourth of all patients had 'severe' or 'moderate' disease (3.8 per 100,000 person years), while the remainder had either 'mild' or 'transient' chronic ulcerative colitis (11.2 per 100,000 person years). In residents of Rochester, Minnesota, chronic ulcerative colitis is most often a mild disease. The over-representation of severe or complicated examples that results from selected referral to major centres probably distorts the natural clinical spectrum of the disease.
PMCID: PMC1432837  PMID: 3583067
20.  Incidence of Greenlandic stroke-survivors in Greenland: A 2-year cross-sectional study 
International Journal of Circumpolar Health  2013;72:10.3402/ijch.v72i0.22626.
To estimate age- and gender-specific incidence rates among Greenlandic stroke-survivors.
Study design
The study was performed as a cross-sectional observational study.
All Greenlandic patients admitted to Queen Ingrid's Hospital (QIH) with stroke in 2011 and 2012 were included in the study. Data were obtained from patient files and the Central Civil Registration System. Age- and gender-specific incidence rates were estimated as cases/100,000 adults/year. Direct age-standardized incidence rate was calculated using the WHO 2000–2005 population as the standard.
In 2011 and 2012, 156 cases of stroke were registered, 72 (46.2%) males and 84 (53.8%) females. The overall incidence rate of stroke was 155/100,000 person-years (95% CI 121–190), with ischemic stroke accounting for 89.1% of these. No significant differences were seen between men and women. Direct age-standardized incidence rate was 149/year/100,000 (95% CI 192–264). Median age at time of diagnosis was 60 years (interquartile range 53–69).
This study reports an age-standardized all-stroke incidence rate of Greenlandic stroke-survivors in Greenland within the wide range as incidences in Western Europe. A noticeable difference when compared to Denmark was that male and female incidence were approximately the same, and that incidence rates were high in the younger age groups. The majority of strokes were of ischemic origin.
PMCID: PMC3838970  PMID: 24282783
stroke; Greenlanders; incidence
21.  Recurrent Gram-Negative Bloodstream Infection: A 10-Year Population-Based Cohort Study 
The Journal of infection  2010;61(1):28-33.
Recurrent gram-negative bloodstream infection (BSI) has not been evaluated in a population-based setting; therefore, we performed a population-based retrospective cohort study to examine the incidence, recurrence, and mortality rates of gram-negative BSI.
We identified 944 episodes of gram-negative BSI, including 98 recurrent episodes, among Olmsted County, Minnesota, residents from 1/1/1998 to 12/31/2007. Kaplan-Meier method was used to estimate the cumulative incidence rate of recurrence and 28-day all-cause mortality rate of gram-negative BSI. Cox proportional hazard regression was used to determine risk factors for recurrence.
The overall age- and gender-adjusted incidence rate of gram-negative BSI per 100,000 person-years was 84.5 (95% confidence interval [CI]: 79.1–90.0), including 75.7 (95% CI: 70.6–80.8) for first episodes and 8.8 (95% CI: 7.1–10.6) for recurrent episodes. Among 846 patients with first episodes of gram-negative BSI, the cumulative incidence rates of recurrence after 1, 5, and 10 years of the initial episode were 5.6%, 9.2%, and 14.6%, respectively, with death treated as a competing risk. Patients with Klebsiella species were more likely than those with Escherichia coli BSI to develop recurrent gram-negative BSI (hazard ratio: 2.33 [95% CI: 1.34–3.92], p=0.003). The 28-day all-cause mortality rates following the initial and second episodes of gram-negative BSI were 10.0% (95% CI: 8.0–12.0) and 11.3% (95% CI: 4.4–18.2), respectively.
Even though recurrent gram-negative BSI was relatively uncommon in the general population, up to 15% of patients with gram-negative BSI developed a recurrent episode within 10 years of the initial episode.
PMCID: PMC2900528  PMID: 20378069
gram-negative; recurrent; bacteremia; epidemiology; mortality; incidence; risk factors; Rochester Epidemiology Project
22.  The Incidence of Central Retinal Artery Occlusion in Olmsted County, Minnesota 
American Journal of Ophthalmology  2011;152(5):820-3.e2.
To determine the incidence of central retinal artery occlusion in Olmsted County, Minnesota.
Retrospective chart review.
Medical records of all patients living in Olmsted County, MN between 1976 and 2005 diagnosed with central retinal artery occlusion cases were identified using the Rochester Epidemiology Project medical records linkage system.
Forty-three cases were identified for an unadjusted annual incidence in females of 1.02 per 100,000 and in males 1.67 per 100,000 with a combined incidence of 1.33. Incidence rates were also age- and/or sex-adjusted to the 2000 census figures for the U.S. white population using direct standardization. Age adjusted annual incidence per 100,000 for females was 1.15 (95% confidence interval [CI], 0.60 – 1.71), for males was 2.78 (95% CI, 1.69 – 3.86), and combined was 1.87 (95% CI, 1.31 – 2.43). When adjusted for age and sex, the incidence was 1.90 per 100,000 (95% CI, 1.33 – 2.47).
Central retinal artery occlusion is a rare event. The incidence is 1.3 per 100,000 in Olmsted County, Minnesota, or 1.90 per 100,000 when age- and sex-adjusted for the United States white population.
PMCID: PMC3326414  PMID: 21794842
23.  Incidence of first primary central nervous system tumors in California, 2001–2005 
Journal of Neuro-Oncology  2009;94(2):249-261.
We examined the incidence of first primary central nervous system tumors (PCNST) in California from 2001–2005. This study period represents the first five years of data collection of benign PCNST by the California Cancer Registry. California’s age-adjusted incidence rates (AAIR) for malignant and benign PCNST (5.5 and 8.5 per 100,000, respectively). Malignant PCNST were highest among non-Hispanic white males (7.8 per 100,000). Benign PCNST were highest among African American females (10.5 per 100,000). Hispanics, those with the lowest socioeconomic status, and those who lived in rural California were found to be significantly younger at diagnosis. Glioblastoma was the most frequent malignant histology, while meningioma had the highest incidence among benign histologies (2.6 and 4.5 per 100,000, respectively). This study is the first in the US to compare malignant to benign PCNST using a population-based data source. It illustrates the importance of PCNST surveillance in California and in diverse communities.
PMCID: PMC2724635  PMID: 19340398
Brain and other central nervous system neoplasms; Epidemiology; Cancer incidence; Ethnic groups; Health disparities
24.  Cancer Mortality and Incidence of Mesothelioma in a Cohort of Wives of Asbestos Workers in Casale Monferrato, Italy 
Environmental Health Perspectives  2007;115(10):1401-1405.
Family members of asbestos workers are at increased risk of malignant mesothelioma (MM). Although the hazard is established, the magnitude of the risk is uncertain, and it is unclear whether risk is also increased for other cancers. Few cohort studies have been reported.
The “Eternit” factory of Casale Monferrato (Italy), active from 1907 to 1986, was among the most important Italian plants producing asbestos-cement (AC) goods. In this article we present updated results on mortality and MM incidence in the wives of workers at the factory.
We studied a cohort of 1,780 women, each married to an AC worker during his employment at the factory but not personally occupationally exposed to asbestos. Cohort membership was defined starting from the marital status of each worker, which was ascertained in 1988 from the Registrar’s Office in the town where workers lived. At the end of follow-up (April 2003), 67% of women were alive, 32.3% dead, and 0.7% lost to follow-up. Duration of exposure was computed from the husband’s period of employment. Latency was the interval from first exposure to the end of follow-up.
The standardized mortality ratio (SMR) for pleural cancer [21 observed vs. 1.2 expected; SMR = 18.00; 95% confidence interval (CI), 11.14–27.52] was significantly increased. Mortality for lung cancer was not increased (12 observed vs. 10.3 expected; SMR = 1.17; 95% CI, 0.60–2.04). Eleven incident cases of pleural MM were observed (standardized incidence ratio = 25.19; 95% CI, 12.57–45.07).
Household exposure, as experienced by these AC workers’ wives, increases risk for pleural MM but not for lung cancer.
PMCID: PMC2022648  PMID: 17938727
asbestos; domestic exposure; epidemiology; mesothelioma
25.  Mortality and cancer incidence in the perfumery and flavour industry of Geneva. 
An analysis has been made of the mortality and cancer incidence of 1168 workers who entered the three factories of the perfumery industry of the Canton of Geneva from their establishment at the turn of the century to the end of 1964. The workers were followed up from their entry until 31 December 1980, at which date 344 were dead and 28 lost to follow up. Among the whole study population only mortality from tuberculosis was significantly raised; there was no significant increase in the incidence of or mortality from any cancer. Analysis by four exposure categories showed a significant excess of deaths from heart disease among the compounders. In addition, two deaths from aplastic anaemia were recorded in chemical process workers exposed to benzene. Further analysis by cohort of entry and by birth cohort indicated that, among the subgroup of men first employed in 1900-29 and born in 1880-99, the mortality from a wide range of causes was significantly increased below the age of 70. This increase is unlikely to be due to an occupational factor as indicated by the absence of an upward trend of mortality with longer exposure.
PMCID: PMC1007463  PMID: 3978043

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