thesis
The older dockworker : evaluation and follow-up of a screening program
- Publication date
- 3 December 1975
- Publisher
- In 1974 Blackburn wrote: "The present state of progress in cardiovascular
epidemiology includes the overriding demonstration that there are vast
differences in the frequency of coronary heart disease (CHD) among
populations and that the risk of the diseases varies enormously according to the
burden of individual or population risk characteristics .... The thrust will
surely continue towards quantitative rather than qualitative assessment of
CHD risk and a preventive approach to its management. The practitioner will
no longer regard the multiple mild and moderate risk factors and bad habits as
trivialities, but as powerful combined elements of risk requiring effective
action ... Prevention is still the word; it should now be given its balanced
share of effort which, I hope we can now agree, involves more than just lip
service". These and other statements can be found in a detailed literature
review given in chapter II.
In order to provide more than just "lip service" in 1971 at the Occupational
Health Service for the Port of Rotterdam a standardized screening effort was
undertaken to investigate the prevalence of CVD among dockworkers between
the ages of 55 and 65. The results of the first screening have been published by
Baart in 1973. A second screening in the same group of dockworkers was
carried out between October 1972 and November 1973. In addition the
possibilities of intervention in individuals with abnormal findings were to be
explored. These investigations provide the basis for this thesis.
A total of 503 persons studied at screening I were invited to participate in
screening II. Four hundred and fortyseven of them appeared. The screening
consisted of various items of the medical history obtained by means of a
standardized questionnaire, the determination of height, weight, blood
pressure, a resting· and an exercise-electrocardiogram, a chest roentgenogram
and the determination of serum cholesterol, total lipids, blood sedimentation
rate as well as data on ventilatory functions. The methodology and patient
material is described in chapter III and in various annexes. The follow-up study
provided not only data on the prevalence of risk indicators at two different
times but it also gave the opportunity to evaluate the consistency of the testing
procedures employed during th