Analysis on occupational health risk assessment methods / 中国职业医学

Occupational health risk assessment is a legal requirement. In legal terms, "occupational health risk assessment" is a means which focuses on occupational disease monitoring and special investigations, analyzing relevant information collected, and ultimately identifying high-risk industries and regions, and proposing reasonable, feasible, and scientific risk management and control recommendations to reduce occupational health risks in key industries and regions. The collection and selection of information are the foundation and core of occupational health risk assessment work. Causation determination is an important basis for information classification in occupational health risk assessment. The establishment and application of mathematical models are the prospects and directions for high-quality development of occupational health risk assessment work. However, the current research does not pay adequate attention on mathematical models for occupational health risk assessment methods, resulting in no substantial progression or improvement in occupational health risk assessment work. The key to future occupational health risk assessment work is to accurately grasp the definition of occupational health risk assessment in a legal term, to streamline and improve the indicator system of occupational health risk assessment, to actively explore and apply mathematical models for occupational health risk assessment, and to enhance the efficiency and accuracy of occupational health risk assessment work.

A preliminary study on the probability of causation of male breast cancer for occupational radiation workers / 中华放射医学与防护杂志

Objective:To explore the probability of causation method ology of male breast cancer and to provide theoretical basis for the diagnosis of occupational radiogenic male breast cancer in China.Methods:Using the male excess relative risk model (EAR) fitted from the Japanese atomic bomb survivors and the female excess absolute risk model (ERR) provided by the Biological Effect of Ionizing Radiation Committee VII (BEIRVII), the breast dose and the probability of causation of the previous case of male breast cancer were calculated.Results:The average probability of causation ( PC) calculated by male ERR model was 94.6%, and the upper limit of 95% PC was 98.3%. Using female EAR model and female breast cancer incidence, the average PC was 70.3%, and the upper limit of 95% PC was 153.3%. when male breast cancer incidence was used, the average PC was 99.2%.By both methods, the male breast cancer patient could be determined to be caused by occupational radiation exposure. Conclusions:The upper limit of 95% PC calculated by female EAR model and female breast cancer incidence was higher than that by male ERR model.The uncertainty of probability of causation for female EAR model still need further research. Occupational radiogenic male breast was proposed to listed in occupational radiogenic neoplasms, which will make the list more perfect and scientific and reasonable to meet potential claims.

Rudolf Virchow,poverty and global health:from "politics as medicine on a grand scale" to "health in all policies" / 《全球健康杂志（英文）》

The German pathologist and politician Rudolf Virehow proposed the concept of sociomedical causation,em-phasising the role of social and environmental factors in the aetiology and prevention of diseases.Virchow's achievements are threefold:he was a founder of scientific biomedicine,he characterised medicine as a social science as much as a biological science and he promoted and improved public health.In his landmark report of a typhus epidemic in mid-19th century Germany,Virchow drew a connection between the epidemic and poverty and living conditions.He proposed radical social reform and stated that,"medicine is social science and politics nothing but medicine on a grand scale".The task of medicine was therefore not merely to treat disease but also to contribute to the health of the entire population.Virchow realised that,in order to improve the health of the public,medicine must attend to both its biological and social underpinnings.His work has had far-reaching con-sequences for the development of public health and medical sociology.As in Virchow's times,poverty,deprived living conditions,malnutrition,crowding and economic insecurity determine to a high degree the prevalence of disease and life expectancy in low-and middle-income countries today.Sociomedical causation is not limited to infectious diseases but also extends to the contemporary pandemics of non-communicable diseases.Obesity and other non-communicable diseases cannot be addressed effectively without considering and acting on the social determinants of health.The concept of "health in all policies" has emerged with the goal of promoting political action addressing the social determinants of health.This concept concerns prevention of disease,promotion of a healthy lifestyle and improvement of factors potentially harmful to the health of entire populations.The current"health-in-all-policies" reforms in China may advance the global evidence base for the prevention of chronic disease in low-,middle-and high-income countries.

Genetic relatedness and its causal role in the evolution of insect societies

It has been proposed that age reprogramming enables old cells to be rejuvenated without passage through an embryonicstage (Singh and Zacouto in J. Biosci. 35 315–319, 2010). As such, age reprogramming stands apart from the inducedpluripotent stem (iPS) and nuclear transfer-embryonic stem (NT-ES) cell therapies where histo-compatible cells are produced only after passage through an embryonic stage. It avoids many of the disadvantages associated with iPS and NT-EScell therapies. Experimental evidence in support of age reprogramming is burgeoning. Here, we discuss possible newapproaches to enhance age reprogramming, which will have considerable benefits for regenerative therapies.

Time-varying effects of body mass index on mortality among hemodialysis patients: Results from a nationwide Korean registry

BACKGROUND: Unlike patterns observed in the general population, obesity is associated with better survival among hemodialysis patients, which could be explained by reverse causation or illness-related weight loss. However, the time-varying effect of body mass index (BMI) on hemodialysis survival has not been investigated. Therefore, this study investigated the time-varying effect of BMI on mortality after starting hemodialysis. METHODS: In the present study, we examined Korean Society of Nephrology data from 16,069 adult patients who started hemodialysis during or after the year 2000. Complete survival data were obtained from Statistics Korea. Survival analysis was performed using Cox regression and a non-proportional hazard fractional polynomial model. RESULTS: During the median follow-up of 8.6 years, 9,272 patients (57.7%) died. Compared to individuals with normal BMI (18.5–24.9 kg/m²), the underweight group (< 18.5 kg/m²) had a higer mortality hazard ratio (HR, 1.292; 95% confidence interval [CI], 1.203–1.387; P < 0.001) and the overweight group (25.0–29.9 kg/m²) had a lower mortality HR (0.904; 95% CI, 0.829–0.985; P = 0.022). The underweight group had increasing HRs during the first 3 to 7 years after starting hemodialysis, which varied according to age group. The young obese group (< 40 years old) had a U-shaped temporal trend in their mortality HRs, which reflected increased mortality after 7 years. CONCLUSION: The obese hemodialysis group had better survival during the early post-dialysis period, although the beneficial effect of obesity disappeared 7 years after starting hemodialysis. The young obese group also had an increased mortality HR after 7 years.

Pharmaceutical Analysis of Judicial Precedents Involving Off-label Drug Use / 中国药学杂志

OBJECTIVE: To analyze 13 judicial precedents involving off-label drug use and explore the legal interpretation on off-label drug use in China in order to provide experience for establishment of off-label drug use and clinical application. METHODS: Based on the law databases (China Judgements Online, Chinalawinfo, Jufaanli, Itslaw), 13 cases were searched and screened involving legal off-label drug use. The relationship was investigated and discussed between different results and characteristics of the 13 cases. RESULTS: In 13 cases, there are 2 cases probably reasonable for off-label use, 2 cases unreasonable but not correlated with patients′ outcomes, 9 unreasonable and with a causal relationship with patients′ outcomes. In the 9 unreasonable cases, there are 4 cases without sufficient evidence, 3 cases without informed consent, 1 case lack of monitoring after off-label use, 1 case with idiosyncratic reaction, and 1 case not consistent with the label of the drug used. CONCLUSION: Major deficiencies of off-label drug use in China are without sufficient evidence, lack of informed consent and with uncompleted system on off-label drug use. Establishing more completed and detailed system, investigating enough clinical evidence, better informed consent and monitoring after off-label use are important measurements to ensure safety on off-label drug use.

Probability of causation for occupational cancer after exposure to ionizing radiation

BACKGROUND: Probability of causation (PC) is a reasonable way to estimate causal relationships in radiation-related cancer. This study reviewed the international trend, usage, and critiques of the PC method. Because it has been used in Korea, it is important to check the present status and estimation of PC in radiation-related cancers in Korea. METHODS: Research articles and official reports regarding PC of radiation-related cancer and published from the 1980s onwards were reviewed, including studies used for the revision of the Korean PC program. PC has been calculated for compensation-related cases in Korea since 2005. RESULTS: The United States National Institutes of Health first estimated the PC in 1985. Among the 106 occupational diseases listed in the International Labor Organization Recommendation 194 (International Labor Office (ILO), ILO List of Occupational Diseases, 2010), PC is available only for occupational cancer after ionizing radiation exposure. The United States and United Kingdom use PC as specific criteria for decisions on the compensability of workers’ radiation-related health effects. In Korea, PC was developed firstly as Korean Radiation Risk and Assigned Share (KORRAS) in 1999. In 2015, the Occupational Safety and Health Research Institute and Radiation Health Research Institute jointly developed a more revised PC program, Occupational Safety and Health-PC (OSH-PC). Between 2005 and 2015, PC was applied in 16 claims of workers’ compensation for radiation-related cancers. In most of the cases, compensation was given when the PC was more than 50%. However, in one case, lower than 50% PC was accepted considering the possibility of underestimation of the cumulative exposure dose. CONCLUSIONS: PC is one of the most advanced tools for estimating the causation of occupational cancer. PC has been adjusted for baseline cancer incidence in Korean workers, and for uncertainties using a statistical method. Because the fundamental reason for under- or over-estimation is probably inaccurate dose reconstruction, a proper guideline is necessary.

Ectopia renal cruzada en un adolescente / Crossed renal ectopia in an adolescent

Se presenta el caso clínico de un adolescente de 14 años de edad, blanco, quien acudió al Centro de Salud Urbano Satelital de la amazonía ecuatoriana de Tena por presentar dolor mantenido de moderada intensidad en flanco derecho con irradiación al muslo del mismo lado. Se le realizó ecografía abdominal, que indicó la existencia de un riñón en herradura y posible agenesia de este órgano en el lado derecho, por lo cual se decidió efectuar un urograma excretor, cuyos resultados mostraron una ectopia renal cruzada izquierda. El paciente inició tratamiento profiláctico con seguimiento trimestral y tuvo una evolución favorable.

The case report of a 14 years white adolescent, who went to the Satelital Urban Health Center of Tena Ecuadorian amazonía is presented due to a sustained pain of moderate intensity in the right flank with irradiation to the thigh of the same side. An abdominal ultrasound was carried out that indicated the existence of a horseshoe kidney and possible agenesis of this organ in the right side, reason why it was decided to make an excretor urogram whose resulting in a left crossed renal ectopia. The patient began prophylactic treatment with follow up every three months and he had a favorable clinical course.

Proving Causation With Epidemiological Evidence in Tobacco Lawsuits / 예방의학회지

Recently, a series of lawsuits were filed in Korea claiming tort liability against tobacco companies. The Supreme Court has already issued decisions in some cases, while others are still pending. The primary issue in these cases is whether the epidemiological evidence submitted by the plaintiffs clearly proves the causal relationship between smoking and disease as required by civil law. Proving causation is difficult in tobacco lawsuits because factors other than smoking are involved in the development of a disease, and also because of the lapse of time between smoking and the manifestation of the disease. The Supreme Court (Supreme Court Decision, 2011Da22092, April 10, 2014) has imposed some limitations on using epidemiological evidence to prove causation in tobacco lawsuits filed by smokers and their family members, but these limitations should be reconsidered. First, the Court stated that a disease can be categorized as specific or non-specific, and for each disease type, causation can be proven by different types of evidence. However, the concept of specific diseases is not compatible with multifactor theory, which is generally accepted in the field of public health. Second, when the epidemiological association between the disease and the risk factor is proven to be significant, imposing additional burdens of proof on the plaintiff may considerably limit the plaintiff's right to recovery, but the Court required the plaintiffs to provide additional information such as health condition and lifestyle. Third, the Supreme Court is not giving greater weight to the evidential value of epidemiological study results because the Court focuses on the fact that these studies were group-level, not individual-level. However, group-level studies could still offer valuable information about individual members of the group, e.g., probability of causation.

Causalidad y responsabilidad médica / Causality and medical liability

Desde el inicio de la vida misma siempre han surgido interrogantes sobre el por qué suceden las cosas, el hombre en su afán desea buscar causas y los efectos de las mismas en diferentes ámbitos de la vida. En el peritaje médico es fundamental determinar las causas y los efectos o consecuencias que estas produjeron en determinadas situaciones sobre la integridad de las personas demandantes mediante una relación de causalidad o nexo causal que permita unirlas, para relacionarlas con un posible autor y establecer la presencia o no del daño causado, y de esta manera determinar la responsabilidad del autor de un hecho ilícito. En este artículo en particular, basado en términos de la responsabilidad médica y así, asesorar a la Autoridad Judicial a la hora de impartir justicia.

From the beginning of live there always questions about why things happen, men have the wish to look for the cause and effect of them in different field of the live. The forensic expert evaluation is fundamental to determine the causes and the effects or consequenses that this produce in different situation on the integrity of the person who demand through the causation relation or the causal nexus, that permit to unit them with a possible author and establish the presence or not of the injury caused, and in this way determine the responsibility of the author of and ilicit act. In this article in particular, based on terms of medical responsibility, therefore asesorate the Judicial Autority to concede justice.

Epidemiological evidence in law: a comment on Supreme Court Decision 2011Da22092, South Korea / 한국역학회지

This paper offers a commentary on three aspects of the Supreme Court's recent decision (2011Da22092). First, contrary to the Court's finding, this paper argues that epidemiological evidence can be used to estimate the probability that a given risk factor caused a disease in an individual plaintiff. Second, the distinction between specific and non-specific diseases, upon which the Court relies, is shown to be without scientific basis. Third, this commentary points out that the Court's finding concerning defect of expression effectively enables tobacco companies to profit from the efforts of epidemiologists and others involved in public health to raise awareness of the dangers of smoking.

Dr. B.R. Ambedkar as a Historian

Ambedkar was well versed in various disciples. Hence he was able to contribute with authority to various disciplines. Ambedkar‟s contribution to history is discussed in the present paper. He examines the various popular theories and their limitation in the understanding and unfolding of events related to history. The paper explores the problem of objectivity, imagination and interpretation as understood by Ambedkar.

A case of chronic myeloid leukemia in a diagnostic radiographer

BACKGROUND: Occupational radiation exposure causes certain types of cancer, specifically hematopoietic diseases like leukemia. In Korea, radiation exposure is monitored and recorded by law, and guidelines for compensation of radiation-related diseases were implemented in 2001. However, thus far, no occupation-related disease was approved for compensation under these guidelines. Here, we report the first case of radiation-related disease approved by the compensation committee of the Korea Workers' Compensation and Welfare Service, based on the probability of causation. CASE PRESENTATION: A 45-year-old man complained of chronic fatigue and myalgia for several days. He was diagnosed with chronic myeloid leukemia. The patient was a diagnostic radiographer at a diagnostic radiation department and was exposed to ionizing radiation for 21 years before chronic myeloid leukemia was diagnosed. His job involved taking simple radiographs, computed tomography scans, and measuring bone marrow density. CONCLUSION: To our knowledge, this is the first approved case report using quantitative assessment of radiation. More approved cases are expected based on objective radiation exposure data and the probability of causation. We need to find a resolution to the ongoing demands for appropriate compensation and improvements to the environment at radiation workplaces.

Is selectivity an aphrodisiac? / ¿Es la selectivividad un afrodisiaco?

In a recent article, Eastwick, Finkel, Mochon, and Ariely (2007) reported data to indicate that selectivity might be an important factor in determining romantic desire. Using a speed-dating paradigm, they found that individuals who, on average, rated potential dates as highly desirable were likely to receive lower average ratings from their dates, as evidenced by what they termed as negative generalized correlations. However, the dyadic correlations were positive, suggesting that, across pairs, desire was somewhat reciprocated. Eastwick et al. go as far as to claim that "... daters somehow broadcast their unselec-tivity... " (page 318), which we find to be a deeply dissatisfying explanation. We present an alternative and more principled approach in order to account for the disassociation between the generalized and dyadic correlations. We implemented a multi-agent model that allows an assessment of the relative contributions of selectivity and matching on ratings of attractiveness. The model suggests that the match between potential daters' attractiveness is the most important predictor of romantic desire. We believe that Eastwick et al's (2007) article is just another example of a dangerous pattern in social psychology research: spectacular claims are made on the flimsiest of evidence.

En un artículo reciente, Eastwick, Finkel, Mochon y Ariely (2007) reportaron datos que indicaban que la selectividad podría ser un factor importante para determinar el deseo romántico. Usando un paradigma de citas rápidas, se encontró que los individuos que en promedio calificaron posibles citas como altamente deseables eran los que recibían más bajas calificaciones en promedio de sus citas, como lo que demuestra lo que ellos denominan como correlaciones negativas generalizadas. Sin embargo, las correlaciones diádicas fueron positivas, lo que sugiere que, a través de pares el deseo era algo recíproco. Eastwick et al. (2007) van más lejos al afirmar que " ... personas que se citan de alguna manera difunden su no selectividad... " (p 318), donde encontramos una explicación profundamente desalentadora. Presentamos una aproximación alternativa y un enfoque basado en la disociación entre las correlaciones generalizadas y diádicas. Hemos implementado un modelo multi-agente que permite una evaluación de las contribuciones relativas de la selectividad y la congruencia en las calificaciones de la atracción. El modelo sugiere que la igualación entre el atractivo potencial de personas que se citan es el predictor más importante del deseo romántico. Creemos que el artículo de Eastwick et al (2007) es sólo otro ejemplo de un patrón peligroso en la investigación en el campo de la psicología social: las afirmaciones espectaculares son realizadas con la evidencia más débil.

Changes in values of probability of causation for lung cancer due to radiation in Chinese uranium miners / 中华放射医学与防护杂志

Objective To evaluate the difference of PC values based on GBZ 97-2002 and on GBZ 97-2009 for lung cancer cases in Chinese uranium miners.Methods Using 19 lung cancer data ascertained in the past epidemiological study,PC values were calculated according to GBZ 97-2002 and GBZ 97-2009.Results In the 19 lung cancer cases,those cases that could not be judged as radiogenic cancers based on GBZ 97-2002,but may be judged as radiogenic cancers with GBZ 97-2009.The probability was enlarged by 1.1 times at least.The major reason was that the used value was the upper limit of 95％ in GBZ 2009 but the median in 2002.Conclusions Compared to GBZ 97-2002,the criteria value of PC in GBZ 97-2009 drops obviously.

Enfoques modernos del sesgo y la causalidad en la investigación epidemiológica / Modern approaches to bias and causation in epidemiological research

Los conceptos de causalidad y sesgo están en la base de la investigación biomédica moderna, desde el análisis de cientos de factores de exposición, hasta los megaestudios para evaluar intervenciones. Los consumidores de estos productos de la investigación, vemos con desconcierto, que una conclusión que se formula hoy, se pone en duda mañana, y se desecha poco tiempo después, para eventualmente ser retomada en el futuro bajo otras ópticas u otros presupuestos. Aunque no es el único responsable, el sesgo metodológico juega un papel importante como determinante de esta realidad. Este artículo tiene el propósito de destacar el concepto de sesgo, relevante, entre otras posibles acepciones, para la investigación biomédica contemporánea, y su asociación con la definición técnica de confusión, exponer la visión moderna sobre el significado práctico de una causa y examinar críticamente dos modernos recursos analíticos para afrontar el problema del sesgo y la causalidad: los puntajes de susceptibilidad y las variables instrumentales

The concepts of causation and bias are crucial to modern biomedical research, ranging from the analysis of hundreds of exposure factors to megatrials, in order to assess the impact of interventions. As consumers of these research products, we are amazed that a statement made today is put into question tomorrow, discarded afterwards, and eventually retaken in the future from different perspectives or under different assumptions. Although the methodological bias is not the only culprit, it plays an important role as determinant of this reality. This paper intended to clarify the concept of bias, which is relevant, among other possible meanings, to contemporary biomedical research, and its association with the technical meaning of confounding. Other objectives were to present the current vision on the practical meaning of cause in epidemiological causal inference, and to critically review two modern analytical tools to deal with bias and causation such as propensity scores and instrumental variables

Causes of Behavioral Processes: An Interview with Mario A. Bunge / Causas de los Procesos Comportamentales: Un diálogo con Mario Bunge

Mario A. Bunge is one of the most prominent philosophers and humanists of our time. His vast record of publications has covered, among others, episte-mology, ontology, ethics, philosophy of natural and social sciences, philosophy of technology, and philosophy of mind. A topic that intersects many of these areas and is recurrent in Bunge's work is causality. His analyses of the causal principle, and the redefinition of determinism into near-determinism have been applied to different philosophical issues that range from the causal role of neuronal functioning to the laws of social phenomena. Bunge has criticized functionalism, cognitivism, computationalism, behaviourism, and idealism in their attempt to explain human and non-human behaviour. This article results from an extensive interview held with Dr. Bunge in which we discussed a variety of conceptual issues related to the notions of causality and explanation in psychology.

Research advances in probability of causation calculation of radiogenic neoplasms / 军事医学科学院院刊

Probability of causation (PC) was used to facilitate the adjudication of compensation claims for cancers diagnosed following exposure to ionizing radiation. In this article, the excess cancer risk assessment models used for PC calculation are reviewed. Cancer risk transfer models between different populations, dependence of cancer risk on dose and dose rate, modification by epidemiological risk factors and application of PC are also discussed in brief.

Associations, causation and model in psychiatry / Associações, causas e modelos em psiquiatria

This paper discusses models, associations and causation in psychiatry. The different types of association (linear, positive, negative, exponential, partial, U shaped relationship, hidden and spurious) between variables involved in mental disorders are presented as well as the use of multiple regression analysis to disentangle interrelatedness amongst multiple variables. A useful model should have internal consistency, external validity and predictive power; be dynamic in order to accommodate new sound knowledge; and should fit facts rather than they other way around. It is argued that whilst models are theoretical constructs they also convey a style of reasoning and can change clinical practice. Cause and effect are complex phenomena in that the same cause can yield different effects. Conversely, the same effect can have a different range of causes. In mental disorders and human behaviour there is always a chain of events initiated by the indirect and remote cause; followed by intermediate causes; and finally the direct and more immediate cause. Causes of mental disorders are grouped as those: (i) which are necessary and sufficient; (ii) which are necessary but not sufficient; and (iii) which are neither necessary nor sufficient, but when present increase the risk for mental disorders.

Este artigo discute modelos, associações e fatores causais em psiquiatria. Os diferentes tipos de associação (linear, positiva, negativa, exponencial, parcial, em forma de U, escondida e fortuita) entre as variáveis envolvidas na ocorrência de transtornos mentais são apresentados, bem como o uso da análise de regressão múltipla para analisar covariâncias entre múltiplas variáveis. Um modelo, para ser útil, deve ter consistência interna, validade externa e poder preditivo, ser dinâmico para incorporar novas descobertas e adequar-se aos fatos, e não o contrário. Os modelos, embora sejam construtos teóricos, implicam em uma dada forma de pensar e têm implicações para a prática clínica. Causa e efeito constituem um fenômeno complexo, podendo a mesma causa ter diferentes efeitos e, inversamente, o mesmo efeito, uma gama diferente de causas. Nos transtornos mentais e no comportamento humano há sempre uma cadeia de eventos iniciada por uma causa indireta e remota; seguida por causas intermediárias; e por último, uma causa direta e imediata. As causas dos transtornos mentais podem ser agrupadas em: (i) necessárias e suficientes; (ii) necessárias, mas não suficientes; e (iii) nem necessárias nem suficientes, mas se presentes, aumentam o risco para a ocorrência de transtornos mentais.

Subsídios da obra Comportamento Verbal de B. F. Skinner para a terapia analítico-comportamental / Subsidies of B. F. Skinners book Verbal Behavior for behavior analytic therapy

Os conceitos de causalidade múltipla, de autoclíticos e de edição podem auxiliar o terapeuta analítico-comportamental a conduzir avaliações funcionais e a intervir. Ao avaliar, ele leva em consideração que o conteúdo das falas de clientes tem múltipla determinação e presta atenção a sutilezas de autoclíticos e de edições. Usa autoclíticos para promover bom relacionamento e adesão à terapia e para ensinar o cliente a descrever seu comportamento e controles. Respaldado na noção de causalidade múltipla, pode trabalhar com metáforas, fantasias e alegorias, e pode fornecer estimulação suplementar para fortalecer respostas do cliente já existentes, porém fracas. Discute-se que a lógica do trabalho clínico é diferente do da análise experimental do comportamento e que diferentes análises de comportamento podem ser apropriadas para se alcançar objetivos terapêuticos.

Concepts of multiple causation, autoclitics and edition help behavior analytic therapists to conduct functional evaluations and to intervene. In evaluating the therapist takes into account that verbalization of clients have multiple determination and pays attention to subtleties of autoclitics and editions. He uses autoclitics to promote a good therapeutic relationship, adherence to treatment and to teach the client to describe his behavior and its controlling variables. Metaphors, fantasies and allegories are possible interventions based on multiple causation notion. Therapists can provide supplementary stimulation to strengthen existing but weak responses. The logic of clinical work being different from experimental analysis of behavior and that different contingencies analysis may be appropriate are discussed.