Myocardial infarction and death findings from a 22-year follow-up of a cohort of 980 employed Swedish men.

OBJECTIVES: In this article, we present death and myocardial infarction (MI) incidences over 22 years in relation to possible risk factors and their explanatory value. STUDY DESIGN: In 1993, 980 middle-aged Swedish men in an automotive industry were surveyed at a health checkup as part of the Renault-Volvo Coeur project. The Swedish cohort was revisited in 2015. METHODS: In 2015, incident MIs were identified using postal questionnaires, hospital records, and the Swedish national MI and death registers. The statistical results were given as odds ratios (ORs) and pseudo-R2 (PR2), showing the proportion of variation in risk explained by logistic models. RESULTS: One hundred and four deaths (4.6 per 1000 person-years) and 89 first MIs (4.2 per 1000 person-years) were identified. The Framingham risk index showed the strongest association with MI (OR = 23; 95% confidence interval [CI] = 5.42, 96.9), comparing the fifth quintile with the first. The all-cause death showed an OR of 3.2 (95% CI = 1.65, 6.08), with a suggested U-shape over quintiles. The percentages of PR2 for MI and death were 8.8% and 6.6%, respectively. All risk factors together explained 22% of the variation in risk of MI. Comparing mortality in men living alone with those married yielded an OR of 3.78, which was found to be statistically significant. The corresponding OR for MI was not significant. CONCLUSIONS: Traditional risk factors were confirmed but explained a modest proportion of the risk variation.

On the TRAIL to successful cancer therapy? Predicting and counteracting resistance against TRAIL-based therapeutics.

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and agonistic antibodies against TRAIL death receptors (DR) kill tumor cells while causing virtually no damage to normal cells. Several novel drugs targeting TRAIL receptors are currently in clinical trials. However, TRAIL resistance is a common obstacle in TRAIL-based therapy and limits the efficiency of these drugs. In this review article we discuss different mechanisms of TRAIL resistance, and how they can be predicted and therapeutically circumvented. In addition, we provide a brief overview of all TRAIL-based clinical trials conducted so far. It is apparent that although the effects of TRAIL therapy are disappointingly modest overall, a small subset of patients responds very well to TRAIL. We argue that the true potential of targeting TRAIL DRs in cancer can only be reached when we find efficient ways to select for those patients that are most likely to benefit from the treatment. To achieve this, it is crucial to identify biomarkers that can help us predict TRAIL sensitivity.

Mental health insurance claims among spouses of frequent business travellers.

OBJECTIVES: Following up on two earlier publications showing increased psychological stress and psychosocial effects of travel on the business travellers this study investigated the health of spouses of business travellers. METHODS: Medical claims of spouses of Washington DC World Bank staff participating in the medical insurance programme in 1997-8 were reviewed. Only the first of each diagnosis with the ninth revision of the international classification of diseases (ICD-9) recorded for each person was included in this analysis. The claims were grouped into 28 diagnostic categories and subcategories. RESULTS: There were almost twice as many women as men among the 4630 identified spouses. Overall, male and female spouses of travellers filed claims for medical treatment at about a 16% higher rate than spouses of non-travellers. As hypothesised, a higher rate for psychological treatment was found in the spouses of international business travellers compared with non-travellers (men standardised rate ratios (RR)=1.55; women RR=1.37). For stress related psychological disorders the rates tripled for both female and male spouses of frequent travellers (>or= four missions/year) compared with those of non-travelling employees. An increased rate of claims among spouses of travellers versus non-travellers was also found for treatment for certain other diagnostic groups. Of these, diseases of the skin (men RR=2.93; women RR=1.41) and intestinal diseases (men RR=1.31; women RR=1.47) may have some association with the spouses' travel, whereas others, such as malignant neoplasms (men RR=1.97; women RR=0.79) are less likely to have such a relation. CONCLUSION: The previously identified pattern of increased psychological disorders among business travellers is mirrored among their spouses. This finding underscores the permeable boundary between family relations and working life which earlier studies suggested, and it emphasises the need for concern within institutions and strategies for prevention.

Difference in carotid artery wall structure between Swedish and French men at low and high coronary risk.

BACKGROUND AND PURPOSE: We attempted to detect a group-specific north-south difference in carotid artery intima-media thickness (IMT), a marker of subsequent cardiovascular complication, by means of a case (high risk)-control (low risk) study in French and Swedish men. METHODS: The selection of high-risk and low-risk subjects was performed within the lower and upper percentiles of the Framingham risk distribution of 2 samples of 1000 white, male auto workers (45 to 50 years of age) in France (Renault) and Sweden (Volvo). In total, 299 men at low risk (79 French, 76 Swedish) and high risk (61 French, 83 Swedish), free from sustained hypertension, definite hypercholesterolemia, and cardiovascular disease, were included. Both common carotid arteries, by ultrasonography and central off-line computerized analysis, provided measurements of far wall media thickness, lumen diameter, and cross-sectional area IMT (CSA-IMT). RESULTS: As compared with low-risk status, high-risk status was associated with higher IMT (P<0.001), diameter (P<0.01), and CSA-IMT (P<0.001) in French men and higher CSA-IMT (P<0.05) in Swedish men. IMT, diameter, and CSA-IMT were higher in Swedish than in French men in the low-risk group (P<0.001) and in the high-risk group (P<0.01, P<0.001, P<0.001). The multivariate analysis of the whole population showed that IMT, diameter, and CSA-IMT were associated with risk status (P<0.01, P<0.01, P<0.001) and geographic status (P<0.001). CONCLUSIONS: These findings show that the geographic status influences carotid artery structure independent of traditional cardiovascular risk factors and that this may affect the mortality and morbidity gradient between Northern and Southern Europe.

Deep venous thrombosis associated with corporate air travel.

BACKGROUND: Deep venous thrombosis (DVT) is commonly seen among bedridden and postoperative patients. Its association with travel may also make DVT an occupational health risk to otherwise healthy business travelers. We estimated the incidence of and risk factors for DVT among 8,189 World Bank employees and a subset of 4,951 international business travelers. METHODS: Occurrence of DVT between 1995 and 1998 was determined using 1) medical insurance claims; 2) Workers' Compensation claims; and 3) intra-office E-mail solicitation followed by interview. For each insurance claim case, 10 controls were randomly selected from among World Bank employees insured during the same month and year as the case's claim was filed, and case-control analyses were performed to identify potential predictors or risk factors for DVT. RESULTS: Thirty individuals filed claims for DVT of the legs (annual incidence rate: 0.9 per 1,000 employees); three of these claims were filed within 30 days after a travel mission. Two employees reported DVT as a Workers' Compensation injury, and five staff with verified DVT participated in interviews. After controlling for age and gender, no association with any travel-related covariate was seen. Results of analyses considering all thrombophlebitis and thromboembolism followed the same pattern. The average annual incidence of DVT occurring within 30 days of mission among traveling staff ranged from 0.10 per 1,000 to 0.25 per 1,000 travelers, depending on the case-finding method. CONCLUSION: No association between DVT and travel was observed after adjustment for gender and age. These results, however, are preliminary, and due to the rarity of DVT, based on small numbers.

Corn and sesame oils increase serum gamma-tocopherol concentrations in healthy Swedish women.

We studied the effects of dietary intervention with three vegetable oils (Linola, corn or sesame oil, all good sources of gamma-tocopherol) on absolute and relative concentrations of alpha- and gamma-tocopherol in human serum. The oils contained only small amounts of linolenic acid but varying amounts of oleic and linoleic acids, and they had different concentrations of alpha-tocopherol. Forty healthy female students (mean age 26 y) were randomly assigned to one of three groups and consumed a diet that contained one of the three oils for 4 wk. Refined oils were distributed as ingredients in specially prepared buns, in margarine or as dressing. Serum tocopherols, serum lipoproteins and plasma malondialdehyde concentrations were measured. The gamma-tocopherol concentrations normalized to serum lipids increased significantly in the corn and sesame oil groups (P < 0.01), and the alpha-/gamma-tocopherol ratios decreased significantly from baseline concentrations in all groups (P < 0.05). The alpha-tocopherol concentrations did not change during the diet period in any of the three groups. Serum cholesterol, serum apolipoprotein B and plasma malondialdehyde concentrations decreased significantly only in the Linola oil group (P < 0.05). These data show that a moderately modified natural diet that contains both alpha- and gamma-tocopherol increases the serum gamma-tocopherol concentration in healthy women without affecting the serum alpha-tocopherol concentration.

Identification of a sucrose diester of a substituted beta-truxinic acid in oats.

A novel compound, 4,4'-dihydroxy-3,3'-dimethoxy-beta-truxinic acid esterified to sucrose through the fructosyl 3-and 6-carbons (1), was isolated from oat grains (Avena sativa L.). Its structure was determined by a combination of mass spectrometry and 1-D and 2-D NMR. The amounts of 1 in groats of six different oat cultivars ranged from 101 to 150 microg g(-1) (dry wt). None was detected in the hulls. The free diacid, 4,4'-dihydroxy-3,3'-dimethoxy-beta-truxinic acid (2), could not be detected in groats nor in hulls.

Marital status and cardiovascular risk in French and Swedish automotive industry workers--cross sectional results from the Renault-Volvo Coeur study.

OBJECTIVES: To compare the coronary risk profiles in a sample of the French and Swedish automotive industry employees who were married/cohabitant, divorced or single (never married). DESIGN: A cross-sectional study comparison from biological and questionnaire data between the French and Swedish samples. SETTING: Occupational health departments at Renault (employees from the north-west of France) and Volvo (employees from the south-west of Sweden). SUBJECTS: Two random samples of males aged between 45 and 50 years were examined in 1993, from Renault 1000, and from Volvo 1000. MAIN OUTCOME MEASURES: Biological data including cholesterol, blood pressure as well as the Framingham risk index. Self reported information regarding marital status, smoking, exercise, alcohol habits, and work stress assessed by the Karasek method, private social support indices, and type A behaviour according to the Bortner scale. RESULTS: More employees were married/cohabitant and fewer divorced or single at Renault. Apart from waist/hip ratio being marginally lower in Swedish single men, compared with married and divorced, no significant difference in biological cardiac risk factors (total cholesterol, blood pressure or Framingham risk index) was seen between the subgroups from any of the two countries. Compared with married/cohabitant men, it was shown that in men living alone smoking was more prevalent at Renault and Volvo. These men also showed less type A behaviour, a lower work control and a lower work support and fewer close friends. Alcohol consumption was reported in smaller amounts for Volvo employees living alone compared with married or divorced employees. Married/cohabitant and divorced staff showed similar values regarding all measured variables when compared within each country. CONCLUSIONS: Employees living alone in both France (Renault) and Sweden (Volvo) automotive companies seem to have increased nontraditional cardiac risk factors pertaining to life style and social network compared with married or divorced men. These results, in combination with the finding that more Volvo than Renault employees were living alone, suggest a higher risk for coronary heart disease amongst Volvo employees. This hypothesis will be evaluated in the 5 and 10 years follow up study.

Life events, mood, mental strain and cardiovascular risk factors in Swedish middle-aged men. Data from the Swedish part of the Renault/Volvo Coeur Study.

The associations between life events, mood, mental strain and cardiovascular risk factors were investigated in the Renault/Volvo Coeur Study. About 1,000 men, blue-collar and white-collar workers, were asked by means of interview-administered questionnaires about life events experienced during the year preceding the screening, about mood and mental strain and about smoking, alcohol consumption and exercise habits. Blood pressure, concentration of serum lipids and blood glucose, and anthropometric measures were determined in a screening procedure. Negative life events, especially work-related, were associated with depressed mood and mental strain but not with elevation of biological risk factors such as elevated blood pressure and serum lipids. Depressed mood and mental strain were related to increased tobacco consumption in blue-collar workers and increased alcohol consumption in white-collar workers.

Comparison of cardiovascular risk profile between male employees of two automotives companies in France and Sweden. The Coeur Project Group.

To determine whether or not the lower rate of coronary disease in France, in comparison with Sweden, might be explained by different cardiovascular risk profiles, a cross-sectional analysis (first step of a longitudinal study) of comparable samples of automotive workers was carried out in corporate occupational health clinics of Renault and Volvo. Traditional cardiovascular risk factors were evaluated and the Framingham coronary risk was estimated for 1000 randomly selected 45-50 years old Caucasian males from each company. Compared with the Frenchmen, the Swedish men consisted of more white collar workers and were slightly older. After adjustment for age and blue/white collar status, the Swedish men showed lower body mass indexes, waist to hip rations and heart rates, lower frequency of treatment of hypercholesterolemia and diabetes than the Frenchmen. The Swedish males also exhibited higher averages of blood cholesterol, low density lipoprotein (LDL) cholesterol and glucose, but lower frequencies of hypercholestrolemia and diabetes, and a higher frequency of family histories of cardiovascular disease. Blood pressure, hypertension prevalence, triglycerides level, and high density lipoprotein (HDL) did not differ between the groups. The average number of traditional risk factors was 1.1/person for the Frenchmen and 0.8/person for the Swedes. However, the coronary risk as estimated using the Framingham index was not different between the groups. This, together with the more frequent family history of cardiovascular disease in Swedish men, suggests a lower susceptibility to risk factors as a possible explanation for the lower cardiovascular disease prevalence reported in France, and/or the possibility that factors not measured were involved.

A study of some current methods for assessment of nasal histamine reactivity.

The aim of this study was to investigate the reactivity of the nasal mucosa of patients with pollen allergy compared to healthy controls, when challenged with histamine outside the pollen season. Assessments were made with symptom score, acoustic rhinometry, nasal peak expiratory and inspiratory flow (NPEF and NPIF) and rhinomanometry in order to find the most sensitive method for the purpose. Twenty-one patients with seasonal allergic rhinitis and 20 healthy controls were challenged with histamine dihydrochloride in increasing concentrations (0.01, 0.1, 1.0 mg/ml) locally in the nose. Our results show no difference in mucosal reactivity between the patients and controls regardless of the method used. When comparing the methods we find that NPIF and NPEF are more sensitive to mucosal changes than the other methods we have studied.

White finger symptoms: a cross-sectional study.

In a cross-sectional questionnaire study of 2,933 employees of a Swedish aircraft company, the prevalence of white finger (wf) was asked for and then correlated with information on personal and anthropometrical data and on job-related and leisure related activities. The questionnaire return rate was 96%. There were 210 (7%) who reported white finger symptoms. A positive association with age and with work with vibrating hand-tools (polishing and deburring instruments and marking pens) and a negative association with body weight was found. The higher proportion of wf among female workers did not retain statistical significance after consideration of their lesser weight in the multivariate testing. The highest proportion of wf was found among polishers/grinders (23%), sheet-metal workers (19%) and cleaners (15%). We conclude that work with vibrating hand-tools of the type used in this industry probably increases the prevalence of wf and that ways to better insulate tools need to be evaluated.

Cessation and relapse in a year-long workplace quit-smoking contest.

In an attempt to increase the impact of smoking cessation activities, some recent studies have examined the use of contests and competitions. The study reported here evaluates a year-long multiple-lottery quit-smoking contest at Volvo Flygmotor, the Volvo aircraft engine manufacturing company in Trollhattan, Sweden. Lotteries were held at 1, 6, and 12 months after the contest began. By quitting for at least 1 month, enrollees were eligible to win cash prizes. Maintaining nonsmoking status from a previous lottery automatically qualified enrollees for the next one. Smoking status was established by self-report, expired carbon monoxide, and saliva cotinine. Seventy-three employees, representing approximately 10% of the company's smokers, entered the contest during the initial 2-week enrollment period. Point prevalence 1-month and 6-month cessation rates were 64.4 and 49.3%, respectively. Continuous abstinence 6-month and 1-year rates were 45.2 and 32.8% respectively. Psychological, home, work and smoking history variables generally were not related to cessation or relapse.

The correlation between work environment and the occurrence of cervicobrachial symptoms.

The correlation between symptoms from the neck and upper extremities and some individual and work-related factors was analyzed in 2814 industrial workers. Physical stress by type of job was the factor most strongly correlated with ongoing cervicobrachial symptoms. Symptoms from the neck and upper extremities were twice as common in workers who used vibrating hand tools. Mental stress at the onset of the symptoms was associated with an increased prevalence of trapezius myalgia and with lateral humeral epicondylitis and "radial tunnel syndrome" in the dominant arm. Women had about double the rate of cervicobrachial symptoms as did men. Short stature increased the rate of symptoms from the neck, shoulders, and hands as did overweight. Playing of racquet sports decreased the risk of symptoms from the neck and hands.

Sickness absenteeism in an engineering industry--an analysis with special reference to absence for neck and upper extremity symptoms.

Neck and upper extremity symptoms (NES) are reported to increase among industrial workers. In order to quantify sickness absenteeism and relate it to some factors a questionnaire study was performed among 2,814 workers occupied at a Swedish engineering industry. Questions pertaining to age, sex, worker category, work with vibrating handtools, type of job and smoking habits were analyzed and correlated to sickness absenteeism for the previous year (1983). We found that the average days lost for personal illness was 17.2 days; 16.2 for men and 23.5 days for women. Ninety-four persons, 77 men and 17 women comprising 3.0% of all employees were sicklisted for NES corresponding to 3.3% of total sickness time lost. Blue-collar workers were sicklisted for NES five times more often than white collar workers and women in type 3 jobs (high NE stress), twice that of men occupied in the same type of job. Smokers had significantly higher absenteeism than non-smokers for any reason studied including NES. The study indicated a high prevalence of present NES problems (23%) but also that NES as a cause of leave of absence was relatively rare (3%).