Metabolic risk factors for cardiovascular disease in a working population: a retrospective cohort study.

Risk factors for cardiovascular disease (CVD) appear to cluster in individuals, possibly because of a single, underlying metabolic disorder. We describe the prevalence of metabolic risk factors for CVD in a young working population and the tendency for individuals with some risk factors to acquire additional factors. This was a retrospective three-year follow-up study of baseline CVD risk factors assessing (1) incidence of risk factors and (2) fatal CVD. The study group consisted of 9,747 Eastman Kodak employees, who participated in a worksite-based cardiovascular screening program in Rochester, New York, which included a medical history, physical examination, and laboratory evaluation. Abnormal metabolic risk factors were defined as (1) an abnormal glucose value (fasting blood sugar greater than 115 mg/dl); (2) abnormal lipids (high-density lipoprotein cholesterol under 35 mg/dl in men or under 45 mg/dl in women; or low-density lipoproteins of 160 or greater; or triglycerides greater than 250 mg/dl), and (3) hypertension (blood pressure systolic above 160 mmHg; or diastolic above 90 mmHg). Subjects were classified as having none, one, two, or all three risk factors. Prevalence of single risk factors were: hypertension 9.8%, abnormal lipids 22.6%, and abnormal glucose 1.5%. Combinations of two risk factors were greater than expected by chance (p < 0.01). Individuals who started with one or more abnormal values tended to have an increased risk of developing others. The highest relative risk (RR) was for those with hypertension and a later diagnosis of abnormal glucose (RR 2.0; 95% CI = 0.87, 4.58). Seven employees of 4,263 with at least one risk factor died of CVD, compared with one of 5,484 employees with no factors (RR 9.0, 95% CI = 1.1, 73.2). In conclusion, this study suggests that young working individuals with CVD risk factors may continue to acquire additional factors. This clustering could be an indication of an underlying metabolic disorder and identify individuals at risk for negative CVD sequelae.

The Seychelles study of fetal methylmercury exposure and child development: introduction.

Studies of outbreaks of methylmercury poisoning in Japan and Iraq from consumption of methylmercury (MeHg)-contaminated fish or bread proved that brain was the target organ, the toxic effects were dose-related, and the fetal brain was especially susceptible. Previous population studies suggested that a 5% risk of minimal fetal effect may be associated with a maternal hair mercury concentration during pregnancy of 10-20 ppm (mu g/g), a level that can be readily achieved by frequent consumers of fish. However, these studies had limitations, and as a result no definite conclusion concerning the lowest effect level could be reached and the question of a possible hazard to public health remained unanswered. There was a clear need for a more definitive study that would be prospective, involve a large enough cohort for risk analysis and adhere to accepted epidemiological principles. An appropriate site for such a study is the Republic of Seychelles, a location that afforded successful collaboration between the Seychelles Ministry of Health and faculty of the University of Rochester. A pilot study of 804 infant-mother pairs was followed by a main study of 779 mother-infant pairs. In the pilot study children were examined once between 5 and 109 weeks of age; in the main study they are being evaluated longitudinally starting at 6 1/2 months of age. This paper introduces both the pilot and main studies, describes their design, and summarizes the findings through 6 1/2 months of age. When the Seychelles study is completed, the analyses will provide a database for those nations that choose to regulate their citizens' fish consumption and/or provide dietary education.

Current needs for comprehensive occupational health services support for employers.

The most valuable resource for most employers is their personnel. Maintaining the health and effective work performance of employee groups is enhanced by a strong and well-delivered occupational health program. Employers' needs in this area include access to urgent care services for on-plant medical problems that occur, regulatory compliance assistance, and medical specialty consultation to identify the contribution of workplace exposures to employee health. This article identifies aspects of each wherein community ambulatory care facilities may assist employers to optimize the health of their work force, provide important and cost-effective medical services, and ensure compliance with legal and regulatory health obligations. The enhancing functions of both high-quality medical care for individuals and the use of population-directed medical programming and diagnosis using epidemiology are illustrated.

Foot blister risk factors in an ROTC summer camp population.

Data that establish risk factors for foot blister morbidity among ROTC cadets at summer camp are presented. The subjective blister attack rate was 42.1 per 100 cadets. Women had a relative risk of 1.6 that of men (p < 0.001). Cadets with a history of blisters in the 2 years before camp had an increased relative risk of blister formation. Cadets who reported wearing their boots less than 20 hours per week during the 2 weeks immediately before camp had elevated risk. Other factors are examined. These data suggest that the foot must become conditioned to its footwear to prevent blister formation.

Early ankle mobilization, Part I: The immediate effect on acute, lateral ankle sprains (a randomized clinical trial).

A random clinical trial was performed to determine the immediate effects of early ankle mobilization on active duty military members with moderate and severe lateral ankle sprains. Sixty-four subjects were randomly allocated to one of three treatments: a plaster cast, an air-stirrup (Aircast Inc., Summit, New Jersey), or an elastic wrap. Each intervention lasted 2 weeks followed by 3 weeks of rehabilitation. Subjects who were allowed early mobilization returned to work and running significantly sooner than those placed in plaster casts (p = 0.029). Swelling (p = 0.009) and pain (p < 0.001) decreased while range of motion increased (p = 0.027) in the early mobilization groups. Between the mobilization groups, those in the elastic wrap performed as well as those in the air-stirrup.

Podiatric utilization referral patterns at an Army medical center.

Presented is the first descriptive data on a large military Podiatry Clinic supporting largely combat troops. Data consist of initial podiatric problems of soldiers and other beneficiaries of podiatric care. Demographic, physician referral patterns, and other pertinent summarized survey information of outpatient utilization at the Podiatry Clinic, Madigan Army Medical Center, Fort Lewis, Washington, are examined. Findings are based on new and initial consult referrals from the month of November 1988. The results indicated that some clinics needed inservices and further education concerning podiatric care. This study has led to the implementation of changes which have resulted in better and more timely patient care.

The short-term impact of Army smoking policies.

A cross-sectional study was performed among soldiers of an infantry battalion to determine smoking prevalence and to assess the short-term impact of Army smoking policies instituted within the preceding 6 months. Data were collected using a structured pretested questionnaire. The response was 91.5%. Smoking prevalence was 45%. This study yielded conflicting data on the effectiveness of the new policies. The importance of educating the smoker on health risks was corroborated. Army health care providers had questioned the majority of the soldiers regarding their smoking status, but failed to suggest they quit or provide suggestions on how to quit.

Building-associated risk of febrile acute respiratory diseases in Army trainees.

Airborne transmission of infectious agents and associations of indoor air pollutants with respiratory illnesses are well documented. We hypothesized that energy conservation measures that tighten buildings also increase risks of respiratory infection among building occupants. At four Army training centers during a 47-month period, incidence rates of febrile acute respiratory disease were compared between basic trainees in modern (energy-efficient design and construction) and old barracks. Rates of febrile acute respiratory disease were significantly higher among trainees in modern barracks (adjusted relative risk estimate, 1.51; 95% confidence interval, 1.46 to 1.56), and relative risks were consistent at the four centers. These results support the hypothesis that tight buildings with closed ventilation systems significantly increase risks of respiratory-transmitted infection among congregated, immunologically susceptible occupants.

Occupational and geographic risk factors for hepatitis B among US Army enlisted personnel during 1980.

Hepatitis B hospitalization rates for US Army enlisted personnel were determined by occupation and geographic area for 1980. The only group in the US Army currently recommended to receive hepatitis B vaccine is medical personnel regularly exposed to blood. Other groups of Army personnel, specifically those working in areas of high hepatitis B endemicity, have been thought to be at higher risk. Therefore, this work was undertaken to document hospitalization rates for all personnel using occupational blood exposure criteria as well as geographic area of assignment as risk factors for hepatitis B. The hospitalization rates underestimate true rates of hepatitis B incidence by a wide margin, and therefore were not used to calculate specific costs and specific benefits for a new vaccination strategy. In spite of this limitation, these data were useful for calculating relative risk, attributable risk, and amount of vaccine preventable disease. The risk of hospitalization for blood-exposed employees was consistently higher than that for non-blood-exposed personnel. The magnitude of the relative risk for blood exposure may be as high as 3.8 times or as low as 1.2 times, depending on which occupational comparison group is used. The relative risk of hospitalization in South Korea vs. the United States was 3.1 (p less than 0.0001), that for Europe vs. the United States, 2.1 (p less than 0.0001). Of all occupational and geographic risk comparisons, assignment to South Korea carried the highest attributable risk: 225 per 100,000. The amount of vaccine preventable disease in personnel assigned to South Korea was similar to that in occupationally blood-exposed employees (5.5 vs. 5.2 hospitalized cases per 1,000 vaccinees) after prorating exposure to risk based on average number of days of exposure to risk over three years. These data support the argument that geographic factors are as important as occupational blood exposure in defining risk of hepatitis B hospitalization among the US Army enlisted personnel.

Frequency of illness associated with epidemic hepatitis A virus infections in adults.

Hepatitis A virus infection is often described as mild or asymptomatic, particularly in children. The failure of most adults who are found to be immune to remember symptoms of an illness suggestive of hepatitis A virus supports this belief. In 1982, two large outbreaks occurred in well documented populations of military personnel. These outbreaks were each extensively studied epidemiologically and serologically. It was found that 28/29 (96.6%) hepatitis A infections recognized prior to immune serum globulin in Outbreak A and 35/46 (76.1%) infections in Outbreak A were symptomatic. Symptomatic cases failed to occur beyond eight days of immune serum globulin administration to these predominantly susceptible groups. Between 40 and 70% of patients were icteric. Apparent contrasts in symptoms associated with hepatitis A infection in adults and children suggest a basic age-dependent difference in immune response to such infection.

Etiology of viral hepatitis in American soldiers.

To define better which types of hepatitis are prevalent among American soldiers, the authors studied 413 separate episodes of acute viral hepatitis among 412 soldiers admitted to US Army hospitals during 1978-1979. Most soldiers (68.8%) had acute hepatitis B (estimated annual hospitalization rate: 5.41/1000 soldiers in West Germany, 2.51/1000 in South Korea, less than 1/1000 in the United States). Subtype ayw was predominant in Germany, whereas adr was predominant in South Korea. Hepatitis B was more often associated with contact history or parenteral use of drugs in West Germany than in South Korea (p less than 0.001). Non-A, non-B hepatitis accounted for 27% of cases in West Germany (2.16/1000), but only 3% in South Korea (0.11/1000); hepatitis A only 15% in South Korea (0.48/1000) and 1% in West Germany (0.08/1000). These findings indicate that hepatitis B is the most prevalent form of viral hepatitis among US soldiers worldwide but also suggest substantial differences in the epidemiology of this infection in South Korea and West Germany. Such data will be useful in developing hepatitis B immunization policy within the military.