Fire fighters are exposed to substances which are recognized or suspected causal agents in cancer or heart disease. The purpose of this study was to determine whether or not fire fighters experience increased risk for any specific cause of death. A retrospective cohort study was conducted, with 5,995 subjects recruited from all six fire departments within Metropolitan Toronto. The mortality experience of the cohort was ascertained through computerized record linkage and compared to that of the male Ontario population specific to cause, age, and calendar period from 1950 through 1989. Average duration of follow-up was 21 years, and there were 777 deaths among the 5,414 males included in the analysis, giving an all-cause standardized mortality ratio of 95 (95% confidence interval: 88-102). Three specific causes of death exhibit statistically significant excesses (brain tumors, "other" malignant neoplasms, and aortic aneurysms). There are also slight increases in risk for some other sites of cancer, and for various diseases of the respiratory, circulatory, and digestive systems. This study is consistent with others in demonstrating that fire fighters experience increased risk of death from cancer of the brain, and in suggesting increased risk for various other causes of death.
South Riverdale in Toronto, Canada, underwent a lead-abatement program. In 1988, lead-contaminated soil was replaced at 970 properties, and in 1989, professional housecleaning for lead removal was conducted in 717 households. The effect of "abatement" on blood lead levels in young children was investigated. Data were analyzed from 12 cross-sectional blood-screening surveys that were conducted during an 8-y period in South Riverdale and in two comparison areas. Responses regarding behavioral, household, lifestyle, neighborhood, and environmental factors, all of which were gleaned from associated questionnaires, were also analyzed. Response rates varied between 32% and 75%. During the years between 1984 and 1992, blood lead decreased in all study areas. There appeared to be a minimal blood lead level of 2-3 micrograms/dl for urban Ontario children who were less than 6 y of age. The significant difference between South Riverdale and the control areas disappeared by 1992. Although abatement activity in South Riverdale was associated with an accelerated decline in blood lead levels, it was difficult to distinguish this from effects of decreased Toronto air lead levels or decreased smelter emissions. Within South Riverdale, abatement appeared to be associated with a slower decline in blood lead levels over time, likely the result of selection bias, soil mixing, or recontamination from the smelter. No difference was observed between the separate effects of housecleaning or soil replacement. The findings could neither strongly support nor refute beneficial effects of abatement.
Clinical information was collected on 118 adolescents who developed ESRF at age 143 months or older and were treated between 1966 and 1986 at the Toronto Hospital for Sick Children. The cumulative survival rate in transplanted patients (N = 109) was 80.1% after 15 years. Survival rates after four years were 93.9% in transplanted and 46.9% in nontransplanted patients (P less than 0.001). No patient receiving dialysis alone (N = 9) was followed longer than four years. Nine patients received three transplants and had an 89% survival rate. Six of these had a functioning graft at end of the follow-up. The cumulative survival of the entire group was 76.4% at eighteen years. Forty-two (35.6%) patients had a height below the third percentile. Functional status obtained by a structure telephone interview with a member of the present treating nephrology service was good (G) or excellent (E) for 66.7% of all patients (73.5% of transplant patients (N = 68) and 45% of dialysis patients (N = 20). Hemodialysis patients functioned less well [25% G/E (N = 12)] than peritoneal dialysis patients [75% G/E (N = 8)]. Most patients achieved an appropriate level of formal education although more slowly than normal adolescents. Only 11 patients were neither enrolled in an educational institution nor employed. We conclude that aggressive treatment for adolescents with ESRF is an appropriate application of health care resources.
During a nine-month period, July 1980 through March 1981, the mortality rate for patients on the cardiology ward of a children's hospital was 43.1 deaths per 10,000 patient-days, as compared with 11.0 deaths per 10,000 patient-days during the preceding 54 months. Twenty-five (76 per cent) of 33 infant deaths during this nine-month period occurred between midnight and 6:00 a.m., as compared with 1 of 10 infant deaths during a separate 27-month period (P less than 0.001). Although nearly all deaths occurred in patients with serious congenital heart disease, epidemic-period deaths were more likely to have an unexpected timing and a clinical pattern consistent with digoxin toxicity. In four patients, forensic and clinical digoxin measurements suggested that an intravenous overdose of digoxin had been administered shortly before death. Although a review of nursing schedules revealed a strong association (relative risk, 64.6) between infant deaths and the duty times of a particular nurse, the cause of the epidemic remains unclear. The study led to suggestions that the hospital strengthen central control over procedures for dispensing medicines and implement a system for monitoring the occurrence of deaths by time and place within the hospital.
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