Josef Vobecky

A case-control study of risk factors for large bowel carcinoma

Two hundred and seven large bowel cancer patients (93% of all cases diagnosed in a defined community between 1965 and 1976) were matched at random with non‐cancer subjects of same age, sex, and place of residence. Men with cancer, aged 75 years and younger than, had a more frequent history of work in a local factory handling synthetic fiber than controls (22 versus 10; P < 0.025). In this factory 45% of cancers occurred before age 60, while this was true in only 24% of cancer cases outside the factory (P < 0.05). There was a greater tendency for cancers in factory workers to occur in the colon than in the rectum. Heredity was not found to be a risk factor for large bowel cancer. The rate of prior appendectomy was higher in men with colon cancer (P < 0.05) and the rate of prior cholecystectomy was lower in females with colonic cancer (P < 0.05). A previous hemorroidectomy was also found more often in males with colonic cancer (P < 0.05). Long‐standing severe constipation was present more often in patients with cancer (P < 0.01). There was some evidence for a compounding influence of different risk factors, as studied by relative risk ratio. This study confirms the existence of a high risk of large bowel cancer in a group of workers in a synthetic fiber factory and suggests other factors antecedent to large bowel cancer.

Population Health Care Practices: An Epidemiologic Study of the Immediate Effects of a Universal Health Insurance Plan

In an analysis of self-perceived utilization of health services by a population, no major change in the use of such services has been noted in the period immediately following a universal health insurance plan as compared to the period immediately preceding its introduction. Among the variables analyzed are medical consultations, hospitalizations, and drug consumption. Plausible explanations lie in the consistency of health care habits, in population perceptions of the real availability of such services, in underreporting of events that depend upon memory, in a time overlap inherent in the study design, and also in the unwillingness or incapacity of a satiated or saturated health care system to respond to demands placed upon it. Data collected later in the history of the development of the health insurance plan might reveal greater differences than have here been reported under conditions where major financial barriers to health care access are absent.

Rheumatoid arthritis and ankylosing spondylitis in an ethnically homogenous population: Familial distribution of complaints☆

Abstract Sex and age distributions of rheumatoid arthritis as well as of ankylosing spondylitis on probands reported here do not differ from that generally known for these diseases. About 30 per cent of patients of working age had to change their occupation for reasons of health. Twice as many parents of probands with ankylosing spondylitis were afflicted with the illness than in the rheumatoid arthritis group. In parents of spouses, the differences were lower. The overall frequency of rheumatic complaints was higher in siblings of ankylosing spondylitis probands than in siblings of rheumatic arthritis probands and the difference between these two groups were significantly higher in male siblings of A.S. probands for joint pains, back and hip pains and joint swelling. In siblings of R.A. probands women reported significantly greater frequence of joint swelling than men. Back and hip pains were more frequently reported by men than women in siblings of A.S. probands. Reduction of working capacity and mobility limitations are higher in male siblings of probands with ankylosing spondylitis.