摘要:

This study weighs the risks to workers of cleaning up Superfund sites against the risks to residents if the sites were not cleaned up. Risks are measured by the number of deaths and disabilities due to injuries and diseases, as well as by the costs of these deaths and disabilities. We posit three methods to clean up the sites: one that is labor-intensive and two that are not. We posit 24 hypothetical sites, with varying numbers of residents and levels of cancer death and cancer disability rates. Depending on the cleanup method, the number of residents, and the rates, we find that the risks to workers frequently outweigh the risks to residents. We conclude that risks to workers should be accounted for in Environmental Protection Agency judgments regarding which and how Superfund sites should be cleaned up.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Tap water in a city like Boston, which has old houses containing lead plumbing, is known to be a significant source of potential lead exposure. Bone lead levels integrate exposure over many years, and in vivo bone lead measurements have recently become possible with the advent of K x-ray fluorescence instruments. Thus we examined the relationship between first morning tap-water lead levels measured in homes in the 1970s and levels of lead in bone measured in the 1990s among middle-aged to elderly men who lived in those homes. We studied 129 participants in the Normative Aging Study who had lead measured in their homes' tap water in 1976 and 1977 by graphite furnace-atomic absorption spectrophotometry. From 1991 to 1995, the same subjects had blood lead levels measured by graphite furnace-atomic absorption spectroscopy and tibia and patella bone lead levels measured by K x-ray fluorescence. We ran multivariate linear regression models predicting bone lead levels that adjusted for factors which had previously been linked with this outcome in the Normative Aging Study (age, pack-years of smoking, and educational level). Among subjects who lived in houses with ≥ 50 µg lead/liter of first morning tap water representing water that had been standing overnight in the plumbing in 1976 and 1977, those who reported medium or high levels of tap-water ingestion (≥ 1 glass/day) had progressively higher patella lead levels than did those with low levels of ingestion (< 1 glass/day). No such relationship was found among subjects who lived in houses with < 50 µg lead/liter of first morning tap water in 1976 and 1977. We conclude that ingestion of lead-contaminated tap water is an important predictor of elevated bone lead levels later in life.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Respirators are widely used for protection against inhaled toxins. The emphasis of research and implementation effort has evolved through several stages: the respirator device itself, use situation, respirator program factors under employer control, individual worker factors not under employer control, and occupational health systems. For this study, a computer-simulation decision assistance model was developed to assess the impact of various factors on the number of workers receiving adequate protection. Factors include the respirator protection factor, identification of sites needing respirator protection, selection of proper device, availability when needed, frequency of ever use, regularity of use among users, and variability in personal susceptibility or other factors. This analysis demonstrates that for both moderate-risk and high-risk (ie, IDLH, immediately dangerous to life and health) exposures under current circumstances, the actual protection afforded depends upon the optimization of program factors and detection of atypical outlier persons and worksites. Therefore, programs and research must focus on these areas. Occupational medicine specialists should help optimize these areas and, in addition, use each case of respiratory protection failure as an index case to improve the overall programs.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Thus far, no neuropsychological study has examined the cognitive profile of multiple chemical sensitivity (MCS) within the framework of Bell's Olfactory-Limbic Model. It predicts that cognitive weaknesses will be associated more with limbic (ie, frontal and/or temporal lobe) than with non-limbic (ie, posterior cortex) brain regions. Matched MCS, asthma, and healthy control groups (n = 63) were tested on cognitive measures with localizing value. Between-group comparisons found that the MCS group performed as well as controls on all cognitive tasks. Within-group comparisons found that both the MCS and asthma groups performed significantly more poorly on tasks that were sensitive to frontal and temporal regions than to posterior regions. Additional research is needed before concluding that the Olfactory-Limbic Model adequately describes the cognitive strengths and weaknesses of MCS. Confounding factors such as medication use and chronic illness need to be considered.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Production of hexamethylene diisocyanate (HDI) biuret and trimer from HDI monomer was started in 1988 at the plant under study. Pulmonary function tests were included as part of the annual evaluation of the workers in that unit. HDI is expected to have toxic properties similar to those of toluene diisocyanate. The latter has caused accelerated declines in pulmonary function in exposed workers. In 1991, an initial longitudinal evaluation of those pulmonary function tests was performed, comparing annual declines in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). The purpose of the study was to evaluate whether or not exposures to HDI at the unit had caused any accelerated decline in FVC or FEV1. No significant differences were seen in that evaluation, but it was decided that the study be continued in a prospective fashion. The study has been continued through 1997. The slope of the annual change in FVC and FEV1were calculated for a group of workers and a matched control group. The average annual decline in FVC for the exposed group (cases) was 0.026 L, compared with 0.025 L for the control group. For the decline in FEV1, the results were 0.044 L, compared with 0.041 L (P = 0.79). These results are virtually identical and support a conclusion that exposures within this unit to HDI have not caused an accelerated decline in FVC or FEV1. Exposures to HDI were measured during this period. The time-weighted average exposure to HDI during work not requiring respiratory protection in the unit (approximately 2 hours per day) was 0.5 parts per billion. The average daily high peak exposure was 2.9 parts per billion. Exposure to these levels appear to pose no risk of accelerated decline in pulmonary function.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The Comprehensive Clinical Evaluation Program is a US military program that provides a voluntary, clinically oriented evaluation for Gulf War health concerns. This article presents administrative data on psychological conditions (as coded using the International Classification of Diseases, 9th Revision) from the first year of the program. The most commonly diagnosed psychological conditions were medically unexplained physical-symptom syndromes; depression and anxiety, including post-traumatic stress disorder; and alcohol abuse or dependence. Psychological conditions were significantly related to a higher number of workdays lost, and the 19% of veterans with a primary diagnosis of a psychological condition reported 28% of the lost workdays among veteran who participated. Stressful Gulf War experiences were weakly but significantly related to psychological conditions. We conclude that among Gulf War veterans seeking evaluation for Gulf War-related health concerns, psychological conditions are common and are associated with important occupational morbidity.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The increased rate of tuberculosis (TB) infection and transmission from patients to health care workers (HCWs) has brought awareness of the need for better surveillance programs. The two-step purified protein derivative (PPD) skin test decreases the misinterpretation of a "boosted reaction" as a recent infection with Mycobacterium tuberculosis in HCWs. We reviewed the medical records of 4082 HCWs at an inner-city medical center who had PPD skin-testing performed as a component of the TB medical surveillance program during the years 1994 and 1995. Of those HCWs tested, 3896 (95.4%) returned for the PPD skin-test evaluation. Of those 3896 HCWs, 3659 (93.9%) had a negative baseline PPD skin test, and 237 (6.1%) had a positive skin test. Of those HCWs with a negative baseline skin test, 252 (6.9%) were eligible for the second PPD skin test. Of the 241 who returned for their second PPD skin-test reading, six (2.5%) had positive results. All six cases were foreign-born physician residents with a previous history of Bacille bilié de Calmette-Guérin (BCG) vaccination. We conclude that the two-step PPD skin test method is not indicated for HCWs at this urban medical facility.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Recent consensus guidelines delineate what appears to be the most successful and cost-effective management of low back pain (LBP), and some recent studies have suggested that better outcomes occur with the least aggressive forms of medical intervention. The purpose of this study was to describe how practitioners manage new-onset, uncomplicated low back workers' compensation (WC) disability cases. A sample of cases was randomly selected from a large insurance carrier's national data source. An effort was made to select only uncomplicated cases, which would be expected to have relatively minimal need for medical intervention. There was an apparent overuse of diagnostic and treatment modalities. Diagnostic imaging was overutilized, not only in terms of the number of studies done (65% had plain films, 22% had magnetic resonance imaging scans) but also in the time frame in which they were performed (38% had plain films on the first clinic visit). Ninety percent received at least one medication, and 38% received more than one prescription for opioid analgesics. Expensive non-steroidal anti-inflammatory drugs were prescribed more often than acetaminophen (61% versus 6%, respectively). Sixty-two percent received physical therapy that often included modalities with as yet unproven efficacy. Overutilization of either diagnostic or treatment procedures increases the likelihood of iatrogenic complications, is not cost-effective, and may adversely impact clinical and occupational outcomes.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Health effects from chronic, low-level exposure to organophosphate pesticides have not been studied extensively and are not well-established. This report follows up a study in New York State in which a cohort of 90 male pesticide applicators were found to have increased vibration sensitivity thresholds, compared with a matched sample drawn from the general population. This investigation examined the nature and extent of peripheral nerve abnormalities in a small subgroup of the original cohort. Of the nine subjects studied, four had clinical evidence of peripheral neuropathic dysfunction, and one who was normal physiologically showed electrophysiological abnormalities. The remaining four showed no clinical, electrophysiologic, or quantitative signs or other abnormalities. This study adds to the growing evidence that organophosphates are toxic to the peripheral nervous system at levels of exposure that do not induce acute or subacute symptomatology.

ISSN:1076-2752    

出版商:OVID    

年代:1999

数据来源: OVID