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The cohort consisted of 11,178 Mead Corporation employees (9,358 males and 1,820 females) who had worked for at least one year between January 1, 1975 and December 31, 1992 at seven pulp and/or paper mills in the United States. The vital status of the cohort was determined through a variety of sources over an observation period of 17 years (1976-1992). Mortality data were analyzed in terms of cause-specific standardized mortality ratios (SMRs), with expected deaths based on U.S. national mortality rates. Job categories with similar exposures were created based on an historical exposure assessment. Mortality analyses were performed separately for total female and male employees. Among female employees, overall mortality was less than expected, and no significant cause-specific mortality excesses were observed. The small number of deaths among female employees did not permit further detailed analyses. Among male employees, statistically significant deficits from overall mortality (SMR = 69.0) and from all cancers (SMR = 71.3) were reported. In addition, low mortality risks for many specific causes were also observed, including many specific cancer sites, various types of cardiovascular diseases, and different forms of nonmalignant respiratory diseases. In particular, there was no mortality excess from lung cancer (SMR = 77.5), digestive cancer (SMR = 69.4), stomach cancer (SMR = 46.7), laryngeal cancer (no observed death), rectal cancer (SMR = 82.8). Hodgkin's lymphoma (no observed death), non-Hodgkin's lymphoma (SMR = 103.6), leukemia (SMR = 72.2), diabetes mellitus (SMR = 110.4), ischemic heart disease (SMR = 80.0), and nonmalignant respiratory diseases (SMR = 36.7). Furthermore, detailed analyses by length of employment, interval since hire (latency), and job category demonstrated no occupationally related mortality increases from any of the diseases examined. Specifically, based on internal comparisons, no upward trends in cause-specific mortality risk were observed by duration of employment. In conclusion, the results of this epidemiologic investigation demonstrated a favorable mortality experience for employees at the seven pulp and/or paper mills.

Screening programs for pediatric lead (Pb) poisoning routinely collect blood by finger stick onto specially designed filter paper (FP) for subsequent laboratory testing. Here, laser ablation inductively coupled plasma time-of-flight mass spectrometry is evaluated as a novel method for the determination of Pb in blood spotted onto FP cards. The method requires no sample pretreatment and may be particularly suitable for rapidly screening a large number of samples. Signal intensity from the ICP-MS strongly correlated (r (2) = 0.996) with Pb target values for five blood cards from a laboratory proficiency testing program. Better precision was obtained by replicate ablation line scans (<15% rsd) compared to a grid of 25 individual ablation spots (>30% rsd). Because <2% of the sample is consumed in the laser ablation analysis, selected samples can also be analyzed by traditional techniques or archived. Lead isotope ratios determined during the same total-Pb analysis appear to be effective for discerning contamination extraneous to the blood sample. Determining that an elevated result was due to contamination may negate the need for retesting with invasive pediatric venipuncture. Some elements monitored along with Pb exhibited signal profiles conducive to potential quantitation (Ca, V, Fe, Cu Zn), whereas others did not (Cr, Mn, Co, Ni, Cd, Hg, Tl, U). Copper, Ca, and V were inversely correlated with Pb (r = -0.89, -0.90, and -0.92, respectively). Scanning electron microscope images revealed surface modality differences between FP spotted with fresh whole blood and reconstituted freeze-dried blood reference material.

Objective: The Slash (multiple-job holders) become increasingly prevalent in the labor force under the context of fast-developing gig economy and other emerging employment forms active on platforms. However, health outcomes of multiple-job holding have not received sufficient research treatment and is far from reaching consensus. This study provides an empirical investigation on the influence of multiple-job holding on individual health., Method: This study uses data from China Health and Retirement Longitudinal Study (CHARLS-2015 survey) which covers 28 provinces/municipalities in China and tracks work and health status of the population aged over 45 years using stratified random sampling (N = 12,659-16,526 for examinations of different types of health status (i.e., chronic conditions/body aches/depression, in study 1), and from the Survey of Household Economics and Decision-making (SHED-2019) which is conducted by the Federal Reserve Board of the United States and documents economic behavior and related risks of the population aged over 18 years (N = 6603 for baseline model and N = 10,718 for supplementary test, in study 2). To address the potential endogeneity of multiple-job holding, the instrumental variable (IV) regressions are conducted to ensure the validity of results. The implementation of Study 1 and 2 in different national context could help test the generalization of research results., Results: Compared with non-multiple jobs holding, multiple-job holding with only one additional job is associated with better health status (i.e., less chronic conditions and body aches, a lower level of depression shown in study 1, and better self-assessed general health shown in study 2), however, multiple-job holding with at least two additional jobs turns to be associated with worse health status (shown in both study 1 and 2). These results show that the optimal level of multiple-job holding could be featured with one additional job besides the primary job., Conclusion: Multiple-job holding, with different structures, has both bright and dark side for health outcomes. To maintain an optimal level of multiple-job holding could benefit individual health., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Breast cancer treatment includes increasingly complex and expensive treatments. Accordingly, the current estimates of the cost of breast cancer treatment are out of date., Methods: The SEER-Medicare Data Link provided 142,837,978 paid Medicare claims from 398,148 female beneficiaries between the ages of 22 and 110 diagnosed with breast cancer between 2007 and 2016. These claims were compared with 153,071,044 claims from 443,952 Medicare beneficiaries without a cancer diagnosis. The total, fully adjudicated, amounts for each claim were summed to determine total treatment cost for each beneficiary. These costs were then aggregated by year after diagnosis and stage at diagnosis. The actuarial survival of beneficiaries with cancer was calculated using the Kaplan-Meier method., Results: Mean costs for the control group were $8,019 per year. The 10-year cost of cancer treatment in Medicare beneficiaries was directly related to stage at diagnosis and ranged from $103,573 for stage 0 cancers to $376,573 for stage 4 cancers. The highest cost occurred during the first 2 years after diagnosis, the time of the beneficiary's initial treatment. Following the first 2 years, healthcare costs remained elevated for at least 10 years after diagnosis., Conclusions: The 10-year treatment cost of female Medicare beneficiaries with breast cancer increases with increasing stage at diagnosis. Any effective screening technology that reduces stage at diagnosis will result in significant treatment cost savings to the Medicare program., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The priority aim of this study is to investigate the effect of carbon footprint, which is an indicator of environmental degradation, on health expenditures for the USA. In the study, cointegration analysis was performed for the period 1970-2016 by using health expenditures, carbon footprint, gross domestic product per capita and life expectancy at birth variables. According to the results of standard cointegration analysis, only cointegration relationship between health expenditures and income was found. In the models with carbon footprint, no cointegration relationship was discovered between the original values of the variables. This result was approached with suspicion, and it was thought that there might be a hidden cointegration between healthcare expenditures and carbon footprint. For this purpose, the hidden cointegration analysis and crouching error correction model proposed by Granger and Yoon [18] were employed among the positive and negative components of the variables of healthcare expenditures and carbon footprint. The results of the hidden cointegration analysis revealed that there was a hidden cointegration relationship between the positive components of healthcare expenditures and the positive components of carbon footprint. Analysis results show that a 1% increase in carbon footprint will cause a 2.04% increase in healthcare expenditures in the long term in the USA. When the positive components of the variables were considered, it was concluded that there was a one-way long-term asymmetric causality relationship between carbon footprint and healthcare expenditures. As a result of the study, it was proposed that the carbon footprint should be diminished to prevent the increasing burden of the healthcare expenditures on the budget.

During the last 15 years, peer review has been widely incorporated into radiology quality improvement programs. However, current implementations are variable and carry concerns, including subjectivity of numerical scores and a sense of merely satisfying regulatory requirements. The Society for Pediatric Radiology (SPR) Quality and Safety Committee sought to evaluate the state of peer review programs in pediatric radiology practices, including implementation methods, perceived functions, strengths and weaknesses, and opportunities for improvement. We distributed an online 16-question survey to SPR members. Questions pertained to the type of peer review system, the use of numerical scores and comments, how feedback on discordances is given and received, and the use of peer learning conferences. We collected 219 responses (15% of survey invitations), 80% of which were from children's hospitals. Fifty percent of respondents said they use a picture archiving and communication system (PACS)-integrated peer review system. Comment-enhanced feedback for interpretive discordances was either very important or somewhat important to performance improvement in 86% of responses, compared to 48% with a similar perception of numerical scores. Sixty-eight percent of respondents said they either rarely or never check their numerical scores, and 82% either strongly or somewhat agreed that comments are more effective feedback than numerical scores. Ninety-three percent either strongly or somewhat agreed that peer learning conferences would be beneficial to their practice. Forty-eight percent thought that their current peer review system should be modified. Survey results demonstrate that peer review systems in pediatric radiology practices are implemented variably, and nearly half of respondents believe their systems should be modified. Most respondents prefer feedback in the form of comments and peer learning conferences, which are thought to be more beneficial for performance improvement than numerical scores.

Purpose: We sought to characterize trends in demographics, comorbidities, and postoperative complications among patients undergoing primary and revision cervical disc replacement (pCDR/rCDR) procedures., Methods: In this retrospective database study, the Premier Healthcare database was queried from 2006 to 2019. Annual proportions or medians were calculated for patient and hospital characteristics, comorbidities, and postoperative complications associated with CDR surgery. Trends were assessed using linear regression analyses with year of service as the sole predictor., Results: A total of 16,178 pCDR and 758 rCDR cases were identified, with a median (IQR) age of 46 (39; 53) and 51 (43; 60) years among patients, respectively. The annual number of both procedures increased between 2006 and 2019, from 135 to 2220 for pCDR (p < 0.001), and from 17 to 49 for rCDR procedures (p < 0.001), with radiculopathy being the main indication for surgery in both groups. Mechanical failure was identified as a major indication for rCDR procedures with an increase over time (p = 0.002). Baseline patient comorbidity burden (p = 0.045) and complication rates (p < 0.001) showed an increase. For both procedures, an increase in outpatient surgeries and procedures performed in rural hospitals was seen (pCDR: p = 0.045; p = 0.006; rCDR: p = 0.028; p = 0.034)., Conclusion: PCDR and rCDR procedures significantly increased from 2006 to 2019. At the same time, comorbidity burden and complication rates increased, while procedures were more often performed in an outpatient and rural setting. The identification of these trends can help guide future practice and lead to further areas of research., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)