Some jobs may be more likely to cause illness

An autoimmune disease is a condition in which our immune system betrays our body and begins to attack our own tissues. Millions of Americans are afflicted with autoimmune diseases such as type 1 diabetes, rheumatoid arthritis, lupus, and scleroderma. Since previous studies have suggested that autoimmune disease might arise from exposure to viruses, environmental hazards, and industrial chemicals - all of which might be encountered on the job - Anneclaire De Roos and colleagues at the University of Washington systematically examined the relationship between people who died from autoimmune disease and their occupation. After surveying death certificates of people who died from autoimmune disease from more than 26 states, researchers found that farmers who worked with crops and people with certain industrial jobs had approximately 1 1/2 times increased chance of death from autoimmune disease. A farmer might, for example, be more likely to be exposed to pesticide and dust, which may provoke an immune response in his body that eventually leads to disease. "This is one of the largest studies that links occupational exposure and autoimmune disease," says De Roos, "and it has generated a lot of interesting hypotheses," so that researches now know which occupations they should carefully study to determine exactly what exposure - be it dust, virus, or crop - might lead to disease. BOTTOM LINE: This expansive study concretely links several occupations, such as farming and the textile industry, to increased risk of death from autoimmune disease. CAUTIONS: The information was gathered from death certificates - "so we can't really know if the person was employed in the occupation before or after the disease was diagnosed," says De Roos - suggesting it's unclear whether the job exposure actually caused the disease.

WHAT'S NEXT: The research group may examine specific occupations to help determine which exposures might be leading to disease.

WHERE TO FIND IT: Arthritis & Rheumatism, October

SUSHRUT JANGI

Traditionally, doctors consult with patients in their offices and visit the hospital once or twice a day to see admitted patients. Lately, however, hospitals have started hiring doctors who are present all the time, and studies have shown that patients under the care of a hospital-based physician are likely to be discharged sooner. Recently, Dr. William N. Southern and colleagues of the Montefiore Medical Center in New York looked at how patients under the care of teaching hospital-based doctors fared. They looked at 2,913 patients who were cared for by teaching hospital-based doctors and 6,124 by traditional physicians between 2002 and 2004. The researchers found that patients cared for by hospital-based doctors were discharged in five days while the other group tended to stay in the hospital for almost six days. The study also found that patients with serious illnesses like strokes, congestive heart failure, and pneumonia recovered the fastest by being cared for by hospital-based doctors. However, the readmission and death rates for both groups post-discharge was the same, which was reassuring. BOTTOM LINE: "We believe hospital-based physicians offer the highest quality of care" said Southern, who is also the paper's lead author. "Our data suggest that they are more efficient than traditional doctors."

CAUTIONS: The study did not look at patient satisfaction and it is likely that patients may worry when they are admitted to a hospital and put under the care of a hospital-based doctor whom they meet for the first time.

WHAT'S NEXT: Southern is comparing the outcome of patients - discharge times, readmission and death rates - under the care of doctors with many years of experience versus newly-practicing physicians.

WHERE TO FIND IT: Archives of Internal Medicine, Sept. 24

SENA DESAI GOPAL