Showing papers in "Journal of Occupational and Environmental Medicine in 1995"
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TL;DR: This paper reported that a substantial number of patients suffer treatment-caused injuries while in the hospital and that inappropriate use of drugs was the leading cause of these injuries. But, they also found that 64% of the injuries were preventable.
Abstract: FOR YEARS, medical and nursing students have been taught Florence Nightingale's dictum—first, do no harm. 1 Yet evidence from a number of sources, reported over several decades, indicates that a substantial number of patients suffer treatment-caused injuries while in the hospital. 2-6 In 1964 Schimmel 2 reported that 20% of patients admitted to a university hospital medical service suffered iatrogenic injury and that 20% of those injuries were serious or fatal. Steel et al 3 found that 36% of patients admitted to a university medical service in a teaching hospital suffered an iatrogenic event, of which 25% were serious or life threatening. More than half of the injuries were related to use of medication. 3 In 1991 Bedell et al 4 reported the results of an analysis of cardiac arrests at a teaching hospital. They found that 64% were preventable. Again, inappropriate use of drugs was the leading cause of
486 citations
TL;DR: Support is provided to the hypothesis that trichloroethylene and other halogenated hydrocarbons are carcinogenic for the liver and lymphohematopoietic tissues, especially for non-Hodgkin lymphoma.
Abstract: Epidemiologic studies and long-term carcinogenicity studies in experimental animals suggest that some halogenated hydrocarbons are carcinogenic. To investigate whether exposure to trichloroethylene, tetrachloroethylene, or 1,1,1-trichloroethane increases carcinogenic risk, a cohort of 2050 male and 1924 female workers monitored for occupational exposure to these agents was followed up for cancer incidence in 1967 to 1992. The overall cancer incidence within the cohort was similar to that of the Finnish population. There was an excess of cancers of the cervix uteri and lymphohematopoietic tissues, however. Excess of pancreatic cancer and non-Hodgkin lymphoma was seen after 10 years from the first personal measurement. Among those exposed to trichloroethylene, the overall cancer incidence was increased for a follow-up period of more than 20 years. There was an excess of cancers of the stomach, liver, prostate, and lymphohematopoietic tissues combined. Workers exposed to 1,1,1-trichloroethane had increased risk of multiple myeloma and cancer of the nervous system. The study provides support to the hypothesis that trichloroethylene and other halogenated hydrocarbons are carcinogenic for the liver and lymphohematopoietic tissues, especially for non-Hodgkin lymphoma. The study also documents excess of cancers of the stomach, pancreas, cervix uteri, prostate, and the nervous system among workers exposed to solvents.
190 citations
TL;DR: In this paper, a case-control approach was used, with separate analyses for blacks and whites after excluding homemakers, 33,509 cases and 117,794 controls remained, and a job exposure matrix was used to estimate the probability and level of 31 workplace exposures.
Abstract: Mortality records from 24 states, gathered from 1984 to 1989 and coded for occupation and industry, were used to develop leads to workplace exposures as possible breast cancer risk factors A case-control approach was used, with separate analyses for blacks and whites After excluding homemakers, 33,509 cases and 117,794 controls remained A job exposure matrix was used to estimate the probability and level of 31 workplace exposures After adjusting for socioeconomic status, suggestive associations for probability and level of exposure were found for styrene, several organic solvents (methylene chloride, carbon tetrachloride, formaldehyde), and several metals/metal oxides and acid mists Because of the methodologic limitations of this study, its primary value is in suggesting hypotheses for further evaluation The findings for styrene, selected solvents, and metals and metal-related exposures deserve additional study
153 citations
TL;DR: The weight of current evidence supports the conclusion that both male and female physicians have elevated rates of suicide, with females at particularly high risk.
Abstract: Suicide is the eighth leading cause of death in the United States. Suicide rates have been reported to be particularly high in professional, managerial, and executive groups. We reviewed English language epidemiological studies on suicide and occupation published since 1982. Some studies suggest that workers in a number of occupations, including chemistry, farming, and law enforcement, may have elevated suicide rates. The weight of current evidence supports the conclusion that both male and female physicians have elevated rates of suicide, with females at particularly high risk. Elevated rates of suicide in a particular occupational group may result from a complex interaction between job factors such as work stress and access to means and other risk factors such as age and presence of a mental disorder.
142 citations
TL;DR: A meta-analysis of the association between central nervous system cancer and occupational exposure to electric and magnetic fields found considerable heterogeneity among the results.
Abstract: We conducted a meta-analysis to acquire an understanding of the association between central nervous system cancer and occupational exposure to electric and magnetic fields. To explore sources of heterogeneity, study characteristics were scored and examined using regression analysis. An inverse-variance weighted pooling leads to a small overall increase in relative risk (10 to 20%) for the broad group of electrical occupations. One of the largest differences was lower relative risk for Scandinavian studies. Lower relative risks were also reported in cohort- and incidence-based studies. Findings were not sensitive to assumptions, including unpublished data, influence of individual studies, weighting schemes, and modeling. Whereas most studies present a small elevation in risk, there is considerable heterogeneity among the results.
135 citations
TL;DR: The findings are consistent with those from earlier assessments, indicating that occupational exposure to coke oven emissions is associated with significant excess mortality from cancer of the respiratory system and of the prostate.
Abstract: This study concerns the update of cause-specific mortality among coke oven workers. Updated information provides 3 decades of work history and vital status follow-up on 15,818 workers. Mortality patterns are summarized by race, cumulative exposure, and period of follow-up. The findings are consistent with those from earlier assessments, indicating that occupational exposure to coke oven emissions is associated with significant excess mortality from cancer of the respiratory system and of the prostate. Depending on the segment of the population considered, the respiratory cancer risk for coke oven workers ranged as high as 4.45 times that for non-oven workers. Relative risk values for cancer of the prostate ranged as high as 1.93. Rates of respiratory cancer across period of follow-up are declining, suggesting that the implementation of emissions control and occupational exposure limits has been beneficial.
121 citations
TL;DR: For most cancers, incidence rates are rising, while mortality rates are generally stable or declining, while death rates for the majority of the cancers were steady or declining.
Abstract: Background Cancer incidence rates have been reported to be increasing in the United States, although trends vary according to form of cancer. Purpose We identify the cancers accounting for the rising incidence, quantify the changes that have occurred from the mid-1970s to the early 1990s, and contrast incidence and mortality trends to provide clues to the determinants of the temporal patterns. Methods Sex-, race-, and age-specific and age-adjusted incidence rates for the 5-year periods 1987-1991 versus 1975-1979 were calculated for 28 cancers among men and 30 cancers among women using data from the Surveillance, Epidemiology, and End Results (SEER) Program of cancer registration covering about 10% of the U.S. population. Similar rates were computed using national mortality data. Cancers were ranked according to the change in incidence rates over the two periods. Results Age-adjusted incidence rates for all cancers combined increased by 18.6% among males and 12.4% among females from 1975-1979 to 1987-1991, due largely to rising rates for prostate cancer among men and for breast and lung cancers among women. National mortality rates for all cancers combined rose less steeply, 3% and 6% among men and women, respectively, driven mostly by continuing increases in lung cancer mortality, while death rates for the majority of the cancers were steady or declining. Total cancer incidence rose at all ages, but with different tumors responsible for the increases at different ages: leukemia and brain/nervous system cancer among children; testicular cancer, nonmelanoma skin cancer (largely Kaposi's sarcoma), non-Hodgkin's lymphoma, and melanoma among young and middle-aged adults; and prostate, breast, and lung cancers among older individuals. In contrast, mortality rates for all cancers combined declined among both males and females under age 55 years, increasing only among older persons. Conclusions Trends in cancer incidence and mortality differ. For most cancers, incidence rates are rising, while mortality rates are generally stable or declining. Implications Much of the recent increase in cancer incidence can be explained by known factors. Improved detection appears to account for most of the increases in breast cancer among women and prostate cancer among men. On the other hand, cigarette smoking is the major determinant of the rise in lung cancer among women, acquired immunodeficiency syndrome has led to increases in non-Hodgkin's lymphoma and Kaposi's sarcoma among young and middle-aged men, and sunlight exposure patterns have affected the trends in melanoma. Some trends remain unexplained, however, and may reflect changing exposures to carcinogens yet to be identified and clarified.
115 citations
TL;DR: There is evidence that maternal agricultural occupation and pesticide exposure may be associated with elevated risk of spontaneous abortion and stillbirth, but the epidemiologic evidence is inconclusive as regards the risk of adverse pregnancy outcome.
Abstract: Exposure to pesticides is inherent in many agricultural jobs. Most of the interest in connection with pesticides and pregnancy outcome has been directed to birth defects. Some indications of an elevated risk of limb anomalies have been associated with ecologic exposure, maternal environmental exposure to pesticides determined by the mother's place of residence, and parental occupation involving potential pesticide exposure. Orofacial clefts have been related to maternal environmental exposure to pesticides and exposure in agricultural work. Moreover, there is evidence that maternal agricultural occupation and pesticide exposure may be associated with elevated risk of spontaneous abortion and stillbirth. However, some studies have found no indication of reproductive hazards but, altogether, the epidemiologic evidence is inconclusive as regards the risk of adverse pregnancy outcome.
114 citations
TL;DR: It is concluded that, at the present stage, none of the polymorphic sites determined in the CYP genes can yet be used as markers for increased lung cancer risk.
Abstract: Because of important roles of cytochromes P450 in the metabolic activation of many precarcinogens, extensive research in the past has focused on the relationship between the distribution of polymorphic variants of different isozymes of P450 and cancer susceptibility. In this respect three isozymes in particular have been studied, CYP1A1, CYP2D6, and CYP2E1. Both CYP1A1 and CYP2E1 participate in the metabolism of many suspected as well as established carcinogens, whereas essentially only one carcinogenic substrate has been identified for CYP2D6. Polymorphic sites for the three CYP genes have been identified both in the open reading frame as well as in introns and the regulatory 5' region. In the present contribution we summarize the molecular epidemiological research relating CYP polymorphism to cancer susceptibility and in some cases to toxicity. An interesting polymorphism has been described on the phenotypic level for the inducibility of CYP1A1, a polymorphism that in some studies has been related to a mutation in the 3' flanking region of the CYP1A1 gene. However, the genetic basis for this polymorphism might be inherited in the genes coding for proteins responsible for the induction of CYP1A1, ie, the Ah receptor or the ARNT protein. Data on lung cancer and CYP1A1 gene polymorphism indicate that carriers of genotypes associated with CYP1A1 inducibility are at higher risk for cancer, but that, at least for Caucasians, the recognized mutations probably identify only a fraction of the inducible individuals. The amount of DNA adducts correlates well in some studies to the individual activity registered for CYP1A1. CYP2D6 phenotype and genotype have mainly been related to the incidence of lung cancer, but results from 13 different studies now show an absence of any significant correlation between these parameters. In the case of CYP2E1, some studies indicate a relationship between lung cancer and the occurrence of a rare allele, although future research is needed in order to establish a significant relationship. It is concluded that, at the present stage, none of the polymorphic sites determined in the CYP genes can yet be used as markers for increased lung cancer risk. Future research in this field might be focused on the establishment of new polymorphic sites in the CYP genes, affecting inducibility or function, and on the molecular basis for the interesting differences in CYP1A1 inducibility.
113 citations
TL;DR: The findings substantiate a local epidemic of latex allergy among medical center employees and skin testing is warranted to investigate health care workers suspected of being latex-sensitive.
Abstract: IgE-mediated sensitivity to natural rubber latex is being recognized more frequently among health care workers. Between January 1990 and June 1993, we evaluated 342 consecutive Mayo Medical Center employees who reported symptoms suggestive of latex allergy. All were interviewed and underwent puncture skin testing with extracts of rubber gloves. In some cases, latex-specific IgE antibodies were measured by immunoassay. One hundred four of the 342 employees evaluated (30%) were latex-allergic. Risk factors for sensitization included frequent use of disposable gloves, presence of prior atopic disease, and prior or current hand dermatitis. The peak onset of symptoms occurred in late 1989 and early 1990 and did not correlate with a peak in glove usage at our medical center, which continued to rise. Most sensitized employees (78%) reported contact urticaria from rubber gloves, and over two thirds also experienced allergic rhinitis, conjunctivitis, or asthma when working in areas where large numbers of gloves were being used. Sixteen episodes of rubber-induced anaphylaxis were documented in 12 employees; six episodes occurred after latex skin testing and were easily reversed with appropriate therapy. Our findings substantiate a local epidemic of latex allergy among medical center employees. Epidemiologic studies are needed to assess the effects of various interventions to reduce occupational exposure to latex allergens. Although prick skin testing with concentrated latex glove extracts presents some risk of systemic reaction, pending availability of commercial diagnostic extracts, such testing is generally safe when performed by skilled laboratory personnel. Skin testing is warranted to investigate health care workers suspected of being latex-sensitive.
113 citations
TL;DR: Since substantial ethnic differences exist in the distribution of altered and normal alleles, and findings in one ethnic group are not necessarily applicable to others, these biomarkers are still in the validation stage, but as more information emerges on the specific features that lead to enhanced susceptibility they can undoubtedly be used to determine risks of environmental exposures to susceptible individuals and populations.
Abstract: Individual susceptibility to lung cancer due to occupational and environmental exposures to carcinogenic agents has been shown to be modulated by host-specific factors. The underlying principle of these factors is the differences that confer sensitivity or resistance to the disease. Since the majority of chemical carcinogens are not capable of causing hazardous effects per se, the metabolism of these compounds is a crucial part of the initial host response to the environmental exposure. Disturbances in the balance between activation and detoxification may thus explain the individual variations in responses to exposures to carcinogens. Many of the metabolic enzymes have recently been shown to express genetic polymorphisms in the population, and an association has been found between cigarette smoke-induced lung cancer and CYP1A1, CYP2D6, and GSTM1 genes. In addition, GSTM1 and NAT2 polymorphisms have been associated with susceptibility to bladder cancer. Since substantial ethnic differences exist in the distribution of altered and normal alleles, and findings in one ethnic group are not necessarily applicable to others, these biomarkers are still in the validation stage. However, as more information emerges on the specific features that lead to enhanced susceptibility they can undoubtedly be used to determine risks of environmental exposures to susceptible individuals and populations.
TL;DR: Evaluated characteristics of patients with WRUEDs suggest that, in addition to medical management, more aggressive approaches to pain control, prevention of unnecessary surgery, directed efforts to improve patients' abilities to manage residual pain and distress, and attention to employeremployee conflicts may be important in preventing the development of prolonged work disability in this population.
Abstract: Work-related upper-extremity disorders (WRUEDs) are an increasingly common cause of work-related symptoms and disability. Although most upper-extremity disorders are acute and self-limited, a small percentage of workers with symptoms go on to permanent disability and account for the majority of costs associated with these conditions. Little is known, however, about this progression from symptoms to disability and how it might be prevented. In this study, we evaluate the demographic, vocational, medical, and psychosocial characteristics of patients with WRUEDs and examine several hypotheses regarding the differences between working and work-disabled patients. One hundred twenty-four consecutive patients were evaluated in a clinic specializing in occupational upper-extremity disorders. Patients currently working (n = 55) and work-disabled patients (n = 59) were similar with regard to age, gender, and reported job demands. The work-disabled group reported less time on the job, more surgeries, a higher frequency of acute antecedent trauma, and more commonly had "indeterminate" musculoskeletal diagnoses. They also reported higher pain levels, more anger with their employer, and a greater psychological response or reactivity to pain. These findings, though cross-sectional in nature, suggest that, in addition to medical management, more aggressive approaches to pain control, prevention of unnecessary surgery, directed efforts to improve patients' abilities to manage residual pain and distress, and attention to employer-employee conflicts may be important in preventing the development of prolonged work disability in this population.
TL;DR: Positive findings encourage further studies with an improved study design and methods, particularly with improved assessment of exposure, to link paternal exposure to spontaneous abortion, congenital malformation, and low birth weight or preterm birth.
Abstract: The findings and methodological issues of epidemiologic studies on adverse developmental effects of parental occupational exposure to organic solvents are reviewed. The studies on maternal effects suggest that high exposure to solvents may increase the risk of spontaneous abortion, but the findings on congenital malformations are inconsistent. Suggestive associations of spontaneous abortions have also been observed with some particular solvents. The evidence appears to be most adequate for toluene. Evidence on the effects of paternal exposure to solvents on pregnancy outcome is limited and inconsistent. Suggestive results link paternal exposure to spontaneous abortion, congenital malformation, and low birth weight or preterm birth. A common methodological weakness in these studies is the inaccurate data on exposure. Positive findings encourage further studies with an improved study design and methods, particularly with improved assessment of exposure.
TL;DR: The results suggest that the presence of control and social support at work protects physicians from developing job dissatisfaction and psychiatric distress.
Abstract: This study examines the relationship between the psychosocial work environment and cross-sectional job dissatisfaction and prospective psychiatric distress in a cohort of Hopkins Medical School graduates in midcareer. An instrument was constructed consisting of five scales: psychological job demands, patient demands, work control, physician resources, and coworker support. The results of scale reliability and factor analysis are presented. Higher job demands were found to be associated with increases in job dissatisfaction and psychiatric distress and greater resources were associated with decreased levels of dissatisfaction and distress. In multiple-regression analysis, only work control and social support were found to be independently associated with dissatisfaction and distress. These results suggest that the presence of control and social support at work protects physicians from developing job dissatisfaction and psychiatric distress.
TL;DR: In this article, a double-blind, placebo-controlled nicotine patch studies of 4 weeks or longer with random assignment of subjects, biochemical confirmation of abstinence, and subjects not selected on the basis of specific diseases (eg, coronary artery disease).
Abstract: Objective —To estimate the overall efficacy and optimal use of the nicotine patch for treating tobacco dependence. Data Sources. —Nicotine patch efficacy studies published through September 1993, identified through MEDLINE, Psychological Abstracts, and Food and Drug Administration new drug applications. Study Selection. —Double-blind, placebo-controlled nicotine patch studies of 4 weeks or longer with random assignment of subjects, biochemical confirmation of abstinence, and subjects not selected on the basis of specific diseases (eg, coronary artery disease). Data Extraction. — Pooled abstinence rates and combined odds ratios (ORs) at end of treatment and 6-month follow-up were examined overall and in terms of patch type (16-hour vs 24-hour), patch treatment duration, dosage reduction (weaning), counseling format (individual vs group), and intensity of adjuvant behavioral counseling. Data Synthesis. —Across 17 studies (n=5098 patients) meeting inclusion criteria, overall abstinence rates for the active patch were 27% (vs 13% for placebo) at the end of treatment and 22% (vs 9% for placebo) at 6 months. The combined ORs for efficacy of active patch vs placebo patch were 2.6 at the end of treatment and 3.0 at 6 months. The active patch was superior to the placebo patch regardless of patch type (16-hour vs 24-hour), patch treatment duration, weaning, counseling format, or counseling intensity. The 16-hour and 24-hour patches appeared equally efficacious, and extending treatment beyond 8 weeks did not appear to increase efficacy. The pooled abstinence data showed that intensive behavioral counseling had a reliable but modest positive impact on quit rates. Conclusions. —The nicotine patch is an effective aid to quitting smoking across different patch-use strategies. Active patch subjects were more than twice as likely to quit smoking as individuals wearing a placebo patch, and this effect was present at both high and low intensities of counseling. The nicotine patch is an effective smoking cessation aid and has the potential to improve public health significantly. ( JAMA . 1994;271:1940-1947)
TL;DR: There is reason to suggest that human semen parameters can serve as valuable indicators of toxic and, in future, even genotoxic effects of occupational and environmental factors.
Abstract: Many kinds of exposures and chemicals have been shown to affect human sperm quantity and quality. This review focuses first on the best known occupational testicular toxin, dibromochloropropane. Prolonged heat is clearly detrimental to spermatogenesis. Studies on occupational heat, radiation, and chemical exposures and their effects on sperm are reviewed. The evaluation of human sperm studies is hampered by inconsistencies in biological analytical methods, in control for confounders, and in weaknesses of study design. Still, there is reason to suggest that human semen parameters can serve as valuable indicators of toxic and, in future, even genotoxic effects of occupational and environmental factors.
TL;DR: A 17-year revaluation of testicular function and reproductive performance of 15 production workers with dibromochloropropane (DBCP)-induced testicular dysfunction found restoration of fertility was followed by a gradual increase of this value to 41.4%.
Abstract: The current study summarizes a 17-year reevaluation of testicular function and reproductive performance of 15 production workers with dibromochloropropane (DBCP)-induced testicular dysfunction Sperm count recovery was evident within 36 to 45 months in three of the nine azoospermic and in three of the six oligozoospermic men with no improvement thereafter A significant increase in plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and a nonsignificant decrease in testosterone level were detected in the severely affected individuals There was no increase in the rate of spontaneous abortions and congenital malformations among pregnancies conceived during or after exposure A low prevalence of male infants conceived during paternal exposure was found as compared with the preexposure period (166% versus 529% ; P <025) Restoration of fertility was followed by a gradual increase of this value to 414%
TL;DR: This work reviewed the current literature on disease risk among fire fighters to compare findings and to infer magnitude of risk, and suggested the following conclusions with respect to general presumption of risk.
Abstract: Because of their occupational exposure to a variety of toxic agents, fire fighters may be at risk for a number of exposure-related diseases. We reviewed the current literature on disease risk among fire fighters to compare findings and to infer magnitude of risk. A standard mortality ratio (SMR) of 200 is equal to an attributable risk of 100% of expected, sufficient to justify presumption in most workers' compensation systems that accept this. We therefore concentrated on risks that approach or exceed an SMR of 200 or an equivalent risk estimate, bearing in mind that confidence intervals around these estimates are wide. Based on the criteria for presumption of occupational risk, we suggest the following conclusions with respect to general presumption of risk: (1) Lung cancer: There is evidence for an association but not of sufficient magnitude for a general presumption of risk. (2) Cardiovascular. There is no evidence for an increased risk of death overall from heart disease. Sudden death, myocardial infarction, or fatal arrhythmia occurring on or soon after near-maximal stress on the job are likely to be heart related, but such "heart attacks" occurring away from work cannot be presumed to be work related. (3) Aortic aneurysm: The evidence is incomplete for an association, but if an association does exist, it would probably be of a magnitude compatible with a general presumption of risk. (4) Cancers of the genitourinary tract, including kidney, ureter, and bladder: The evidence is strong for both an association and for a general presumption of risk. (5) Cancer of brain: Incomplete evidence strongly suggests a possible association at a magnitude consistent with a general presumption of risk. (6) Cancer of lymphatic and hematopoietic tissue: By group, there is some evidence for both an association and a general presumption or risk. However, the aggregation is medically meaningless. We therefore recommend a case-by-case approach. (7) Cancer of the colon and rectum: There is sufficient evidence to conclude that there is an association but not that there is a general presumption of risk. (8) Acute lung disease: Unusual exposures, such as exposure to the fumes of burning plastics, can cause severe lung toxicity and even permanent disability. This does not appear to result in an increased lifetime risk of dying from chronic lung disease. Language: en
TL;DR: Molecular modeling and NMR measurements indicated that the conformations of DNA adducts depend upon the hydrocarbon involved and the cis or trans opening of the epoxide ring during adduct formation.
Abstract: Polycyclic aromatic hydrocarbon carcinogens are usually activated for DNA binding by the metabolic formation of bay region dihydrodiol epoxides with R,S,S,R stereochemistry. Such metabolites from planar hydrocarbons reacted preferentially with the amino groups of deoxyguanosine residues, whereas those from nonplanar hydrocarbons were more efficiently trapped by DNA and reacted preferentially with the amino groups of deoxyadenosine residues, in some cases. Molecular modeling and NMR measurements indicated that the conformations of DNA adducts depend upon the hydrocarbon involved and the cis or trans opening of the epoxide ring during adduct formation. The structural characterization of carcinogen-DNA adducts and investigations of relationships between specific adducts and biological effects represent an important background that can be valuable in molecular epidemiological approaches.
TL;DR: The Pressure-Specified Sensory DeviceTM (PSSD) was used to measure the pressure threshold in 72 clinical nerve entrapment syndromes, each of which also had EDT, and has a high sensitivity, but a low specificity, when compared with EDT for diagnosis of peripheral nerveEntrapment.
Abstract: Quantitative sensory testing of pressure threshold has been recommended for diagnosis and monitoring of peripheral nerve problems, yet there has been no validation of the results of such testing with electrodiagnostic testing (EDT), the “gold standard.” The Pressure-Specified Sensory DeviceTM (PSSD) was used to measure the pressure threshold in 72 clinical nerve entrapment syndromes (23 carpal, 23 cubital, and 16 tarsal tunnel syndromes, and 10 common peroneal nerve entrapment at the fibular head), each of which also had EDT. There was diagnostic agreement between both EDT and PSSD in 54 of the 72 nerve entrapments (75%). The sensitivity of the PSSD was 100% for each of the four nerve entrapments. In those patients in whom there was a disagreement, the PSSD was abnormal when the EDT was normal. In conclusion, quantitative sensory testing with the PSSD has a high sensitivity, but a low specificity, when compared with EDT for diagnosis of peripheral nerve entrapment.
TL;DR: It is prudent to consider exposure to high-level noise and shift work as risks to reproduction, and some results have related noise exposure andshift work to menstrual disturbances and infertility.
Abstract: In addition to having possible direct effects on the fetus, noise induces a stress reaction in the mother, possibly causing reproductive disturbances. In shift work, many physiological functions and systems that are circadian in nature can be disturbed. Study results indicate that occupational noise at the level of approximately 85 dB L Aeq(8 h) or higher and shift work, especially rotating schedules, may have independent negative effects on birth weight and length of gestation. Some forms of shift work have also been associated with early fetal loss. Moreover, some results have related noise exposure and shift work to menstrual disturbances and infertility. Although the evidence is not ample, it is prudent to consider exposure to high-level noise and shift work as risks to reproduction.
TL;DR: Cigarette smoking and silica exposure were found to be significantly associated with deaths attributed to lung cancer and disease of the respiratory system and, because of concerns about the healthy worker effect, with an occupational referent population.
Abstract: In the final phase of the mortality study of workers at an automotive iron foundry, a subset (N = 3929) of the original cohort of 8147 men, consisting of those exposed to formaldehyde during the period from January 1960 through May 1987, was analyzed. In addition to the external US population, an internal population (N = 2032), consisting of men who had worked in the same foundry during the same time period but not in formaldehyde-exposed jobs, was also used as a referent. Follow-up continued through December 31, 1989. Smoking status was ascertained for 65.4% of the exposed and for 55.1% of the unexposed cohorts. Detailed work histories and evaluation of occupational exposures by an industrial hygienist enabled us to categorize cumulative formaldehyde and silica exposures. Standardized mortality ratios were used to compare the mortality experience of the exposed cohort with the US population and, because of concerns about the healthy worker effect, with an occupational referent population. Relative risks for race, formaldehyde exposure status, smoking status, and silica exposure level were estimated by fitting a Poisson regression model to four causes of death: cancers of the buccal cavity and pharynx, lung cancer, diseases of the respiratory system, and emphysema. No association between formaldehyde exposure and deaths from malignant or nonmalignant diseases of the respiratory system was found. Cigarette smoking and silica exposure were found to be significantly associated with deaths attributed to lung cancer and disease of the respiratory system.
TL;DR: Symptom-triggered therapy individualizes treatment, decreases both treatment duration and the amount of benzodiazepine used, and is as efficacious as standard fixed-schedule therapy for alcohol withdrawal.
Abstract: Objective. —To assess the effect of an individualized treatment regimen on the intensity and duration of medication treatment for alcohol withdrawal. Design. —A randomized double-blind, controlled trial. Setting. —An inpatient detoxification unit in a Veterans Affairs medical center. Patients. —One hundred one patients admitted for the treatment of alcohol withdrawal who could give informed consent and had no history of seizures or medication use that might alter the clinical course of withdrawal. Intervention. —Patients were randomized to either a standard course of chlordiazepoxide four times daily with additional medication as needed (fixed-schedule therapy) or to a treatment regimen that provided chlordiazepoxide only in response to the development of the signs and symptoms of alcohol withdrawal (symptomtriggered therapy). The need for administration of "as-needed" medication was determined using a validated measure of the severity of alcohol withdrawal. Main Outcome Measures. —Duration of medication treatment and total chlordiazepoxide administered. Results. —The median duration of treatment in the symptom-triggered group was 9 hours compared with 68 hours in the fixed-schedule group ( P P Conclusions. —Symptom-triggered therapy individualizes treatment, decreases both treatment duration and the amount of benzodiazepine used, and is as efficacious as standard fixed-schedule therapy for alcohol withdrawal. ( JAMA . 1994;272:519-523)
TL;DR: In conclusion, automobile assembly- line workers appear to be a high-risk group for work-related symptoms from the forearm-hand and exposure to physical load should be conscientiously analyzed, since women may perform different tasks than men.
Abstract: The aim was to study the prevalence of physical exposures and symptoms of the forearm-hand in a population with highly repetitive jobs. Automobile assembly-line workers (ALWs) (n = 521) and a control group (CG) from the general population answered a questionnaire. Consistent differences were found between the groups. ALWs reported more symptoms from the forearm-hand and higher exposure to repetitive movements, precision movements, and manual handling (< or = 15 kg) than the CG. Female ALWs reported more symptoms and higher exposure to known risk factors for work-related forearm-hand disorders than their male colleagues. In conclusion, automobile assembly-line workers appear to be a high-risk group for work-related symptoms from the forearm-hand. Also, exposure to physical load should be conscientiously analyzed, since women may perform different tasks than men.
TL;DR: In this paper, long-term deficits in visuospatial function and memory and disturbances in mood have been clinically identified and followed in four patients occupationally exposed to perchloroethylene (PCE).
Abstract: Long-term deficits in visuospatial function and memory and disturbances in mood have been clinically identified and followed in four patients occupationally exposed to perchloroethylene (PCE). A frontal/limbic hypothesis is offered as the site of pathology. A separate study among 65 dry cleaners was conducted to provide similar evidence of impairment, suggesting a continuum between clinical and preclinical effects. Three exposure zones were identified for the counter clerks, pressers, and operators corresponding to air levels of 11.2, 23.2, and 40.8 ppm. Decrements were found for visual reproductions (14.4%), the number correct (6.7%) and the latency (10%) for pattern memory, and the number correct (3.9%) for pattern recognition. Chronic, life-long deficits appear below 50 ppm and require at least 3 years of exposure. A reexamination of the OSHA standard is recommended and shows that behavioral testing can be used as an early indicator of more serious clinical effects.
TL;DR: The results indicate that any occupational leukemogenic exposures at the plant have been reduced to a point at which they are insufficient to cause leukemia.
Abstract: This study evaluated mortality among 9796 white male workers at a petroleum-manufacturing plant. The main purpose was to examine recent patterns in leukemia mortality, for which an increase had been reported in an earlier investigation. Compared to U.S. white men, the cohort had an excess of leukemia in 1940-1979 (38 observed/23 expected; standardized mortality ratio = 168; 95% confidence interval = 119-230). In the 1980s, there was a deficit of leukemia (8 observed/14 expected; standardized mortality ratio = 55; 95% confidence interval = 24-108). However, this was balanced by an excess of myelofibrosis and myelodysplasia (4 observed, < 1 expected). These results indicate that any occupational leukemogenic exposures at the plant have been reduced to a point at which they are insufficient to cause leukemia. Hourly workers also had an excess of deaths from mesothelioma in the 1980s (8 observed, about 2.5 expected), possibly because of exposure to asbestos in the past.
TL;DR: Hb adduct measurement is used for hygienic surveillance of occupational exposures and is a tool for identification of reactive metabolites, not only in individuals with known exposure, but also for characterization of adducts to Hb from compounds acting as mutagens in the background carcinogenesis.
Abstract: For the estimation of cancer risks from environmental chemicals, knowledge of the target dose is essential, dose being defined as the time integral of concentration in target tissues. In vivo doses from chronic or intermittent exposures are best determined from established steady-state levels of macromolecule adducts of reactive compounds or intermediates. For dose monitoring, hemoglobin (Hb) is preferred to DNA for several reasons: accessibility in large amounts, availability of methods for chemical identification, and well-determined life span due to absence of repair. For these reasons, and because of the proportionality of rates of DNA and Hb adduct formation, Hb adduct levels give better information on cumulative DNA adduct levels than do direct measurement of DNA adducts. The scientific background of Hb adduct measurement, target dose determination, and risk estimation based on the relative genotoxic potency, with gamma-radiation as reference standard, is reviewed and exemplified. The sensitivity of the method for Hb adduct measurement permits determination of exposures where the associated annual cancer risk is less than 1 per million. Besides application for studies of metabolism by determination of in vivo doses in exposed animals and humans, as a basis for risk estimation, Hb adduct measurement is used for hygienic surveillance of occupational exposures. Determination of Hb adducts by mass-spectrometric techniques gives a tool for identification of reactive metabolites, not only in individuals with known exposure, but also for characterization of adducts to Hb from compounds acting as mutagens (initiators) in the background carcinogenesis. This is the large fraction of the total number of cancer cases that occur among individuals without known exposure.
TL;DR: Repetitive strain injuries in Ontario were examined with respect to gender for the period 1986 to 1991, using data from Ontario Workers' Compensation Board systems and revealed that the risk of RSIs for women is greater than that for men.
Abstract: Repetitive strain injuries (RSIs) in Ontario were examined with respect to gender for the period 1986 to 1991, using data from Ontario Workers' Compensation Board systems. Technical issues surrounding analysis of workplace injuries and theoretical suggestions raised by the data are discussed. Analyses revealed that the risk of RSIs for women is greater than that for men. Furthermore, women receive compensation benefits because of RSIs for a longer period than do their male counterparts, which may indicate a longer-term effect of RSIs on women.
TL;DR: Compared to community-wide reference incidence and mortality rates, significant excess breast cancer risks were identified for housewives, registered nurses, clinical laboratory technicians, schoolteachers, social workers, secretaries and typists, and meat wrappers and cutters.
Abstract: Breast cancer incidence and mortality measured for the population of a major metropolitan center included 7368 cases and 2357 deaths over 15 years, ascertained according to National Cancer Institute Surveillance, Epidemiology, and End Results program procedures. Occupational risks were estimated with a census-based occupation coding system for cases and deaths, mean annual age-standardized rates, and age-truncated occupation allocation. Data limitations include absence of population frequencies of personal risk factors for breast cancer, occupation designation errors, lack of knowledge about chemical exposures in apparently high-risk occupations, and the possibility that the number of comparisons could produce significant differences by chance. Compared to community-wide reference incidence and mortality rates, significant excess breast cancer risks were identified for housewives, registered nurses, clinical laboratory technicians, schoolteachers, social workers, secretaries and typists, and meat wrappers and cutters. High incidence rates with unremarkable mortality rates were identified for dental hygienists, religious workers, electronic engineering technicians, authors and journalists, restaurant and bar managers, realty and insurance saleswomen, bank tellers and cashiers, telephone operators, canning and bottling workers, chemical and gas handlers, and papermill workers. These findings agree in part with similar reports and will contribute to the generation of hypotheses to be tested by more specific, in-depth studies.
TL;DR: Hepatitis A vaccine, or immune globulin where HAV vaccine is not available, is recommended for all nonimmune travelers visiting developing countries and is usually not necessary in persons born after 1945.
Abstract: Objective. —To assess the risk of hepatitis A in international travelers and to recommend preventive measures. Data Sources. — Index Medicus , 1974 through 1983; MEDLINE, 1984 through 1993; and unpublished data of the Centers for Disease Control and Prevention. Study Selection. —Review of all retrospective and cohort studies on hepatitis A and other vaccine-preventable diseases in travelers, of seroepidemiologic surveys of hepatitis A virus (HAV) antibodies in travelers, of data on the various hepatitis A vaccines, of economic analyses, and of recommendations of recognized organizations. Data Extraction. —Independent analysis by multiple observers. Data Synthesis. —The incidence rate for unprotected travelers, including those staying in luxury hotels, is estimated to be three per 1000 travelers per month of stay in a developing country. Persons eating and drinking under poor hygienic conditions have a rate of 20/1000 per month. This makes hepatitis A the most frequent infection in travelers that may be prevented by immunization. In many industrialized countries persons born after 1945 have an HAV antibody seroprevalence (immunity) of less than 20%. New inactivated HAV vaccines induce protective antibodies in more than 95% of recipients and offer protection estimated to last for 10 years or more, whereas protection by immune globulin lasts only 3 to 5 months. Conclusions. —Hepatitis A vaccine, or immune globulin where HAV vaccine is not available, is recommended for all nonimmune travelers visiting developing countries. Prescreening for antibodies to HAV in travelers living in countries with low prevalence is usually not necessary in persons born after 1945. ( JAMA . 1994;272:885-889)