Asbestos-related hazards in developing countries.
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Biomedical subjects
Publications and source records attributed to B S Levy.
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As the nations of Eastern Europe undergo political and economic transitions, they face considerable occupational and environmental health challenges. Although occupational health services are relatively well developed, environmental health services and policies are not. There are major needs in the areas of education and training, supplies and equipment, and policy development. In addition, privatization poses a variety of new challenges and dangers to occupational and environmental health. This commentary discusses the challenges that face Eastern European nations, and describes opportunities for collaboration among scientists, policymakers, labor, management, and community groups in the United States and Eastern Europe.
We report on a second phase of a physician-based project on occupational disease surveillance based on both sentinel health events and sentinel physicians. We included participating physicians in seven specialties and incorporated a component to assess the feasibility of using physician reporting to target work site evaluations. We identified 36 patients whose illnesses were probably or possibly work-related. We found that both patients and physicians were reluctant to request workplace evaluations.
Many bipolar sterilization failures have occurred because of incomplete desiccation of the endosalpinx. This study compared the effect upon human fallopian tubes of different waveforms of electrical energy at advancing power settings. When the Valleylab SSE2-L generator was attached to the Kleppinger bipolar forceps, complete desiccation was confirmed with the power set at 25 W in a cutting waveform. Other waveforms (coagulation and blend) failed to complete the task at the same power setting. An inline current meter assures the operator that all the available energy is delivered. This information should help to reduce bipolar sterilization failures.
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Because of the inadequacies of surveillance data for occupational disease in the United States, this study was undertaken to determine the feasibility of using physicians' and hospital records for occupational disease surveillance. The study was based on Rutstein's sentinel health event (occupational) classification and the use of sentinel physicians. Data were gathered on nonmalignant dermatologic and respiratory diagnoses prospectively at five sites and retrospectively at four of these sites. The combined approaches identified 49 patients whose illnesses were probably work-related. Because the prospective approach took less than 10% of the time for each case identified compared with the time required for the retrospective approach, and prospective data are more timely and easier to access, the prospective approach appears to be better.
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Recent reports of bipolar sterilization failures have questioned the compatibility of bipolar forceps used with different electrogenerators. Four different bipolar forceps were matched and mismatched with five generators and the electrocoagulation effect was studied by two physicians trained in the histologic evaluation of electrical injury. All bipolar systems, matched or mismatched, failed to coagulate the fallopian tube as completely as unipolar control--except for the matched Kleppinger system. Conversely, when mismatched with other generators the coagulation effect of the Kleppinger forceps fell far below that of other bipolar forceps--matched or mismatched. Each bipolar system should be compatible and its electrocoagulation effect studied before it is used for female sterilization.
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Glioblastomas developed within two years of each other in an otherwise unrelated married couple in their fifties. There was a daughter who died of Hodgkin's disease but no other unusual incidence of cancer in either siblings, parents or other children. No clear etiology of risk factors for brain tumor were identified. The development of such conjugal tumors, although apparently rare, raises important etiologic questions.
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A survey of 111 of the 127 United States medical schools revealed that 73 (66 per cent) specifically taught occupational health during the 1982-83 academic year, compared to 50 per cent in 1977-78. Occupational health was a required part of the curriculum in 54 per cent of the schools compared to 30 per cent in 1977-78. However, the median required curriculum time for occupational health was four hours during both academic years. Increased attention needs to be given to occupational health in medical school curricula.
Bowel injuries during laparoscopy can result from either electrical damage or direct trauma. When electrocoagulation is used with laparoscopy, it is frequently assumed that any bowel injury is from that source. That assumption might not be accurate. In animal studies we evaluated the histologic characteristics of both electrical and traumatic bowel injuries. A consistent difference in injury pattern, both gross and microscopic, was noted. With a high degree of accuracy, those histologic and gross characteristics can be used to distinguish traumatic from electrical injuries following operative laparoscopy.
Concern about upper respiratory tract irritation and other symptoms among workers at a glass bottle manufacturing plant led to an epidemiologic and an industrial hygiene survey. Questionnaire responses from 35 hot end and 53 cold end workers indicated that the incidence of wheezing, chest pain, dyspnea on exertion, and cough was significantly elevated among hot end workers. Among both smokers and nonsmokers, hot end workers reported higher, but not significantly higher, rates of wheezing and chest pain. Among smokers, hot end workers reported significantly higher rates of dyspnea on exertion and cough than did cold end workers. Data suggest that reported exposure to stannic chloride solution likely caused these symptoms. The industrial hygiene survey, conducted when stannic chloride use had been reduced, cleaning had been done, and ventilation improved, focused on measuring air contaminants that might possibly cause symptoms. Levels of hydrogen chloride, which apparently was formed by the combination of stannic chloride and water in the presence of heat, were elevated. The finding of increased prevalence of respiratory symptoms among hot end workers was consistent with this exposure. Recommendations were made to reduce hazardous exposures at this plant. Individuals responsible for occupational health should be aware that relatively benign substances, such as stannic chloride and water, can combine spontaneously to form hazardous substances.
Severe respiratory tract irritation occurred in at least 74 of 100 boilermakers who were exposed to high levels of vanadium pentoxide fume during oil-to-coal conversion of a utility company power plant in a rural area of western Massachusetts. Many were welders working in confined areas with inadequate ventilation. Most frequent symptoms were productive cough, sore throat, dyspnea on exertion, and chest pain or discomfort. The illness was severe enough to cause 70 workers to consult physicians and most of them to lose time from work (median, five days). Wheezing (in 39%) was the most frequent finding on physical examination. Mild hypoxemia was noted in several workers; most (72%) had normal chest x-ray films. Expiratory flow rate over the middle 50% of the forced vital capacity was the pulmonary function test most remarkably affected (median, 57% of predicted for 24 workers tested). The Occupational Safety and Health Administration documented levels of vanadium pentoxide fume at or above the permissible exposure limit in all eight air samples taken from inside the boiler; it cited the company for inadequate mechanical ventilation and an inadequate respiratory protection program for workers. The report of this outbreak may help prevent future problems by drawing attention of physicians, workers, and managers to the potential pulmonary hazards in power plant conversion.
In attempting to make the diagnosis of myocardial infarction, the family physician has available an increasing array of enzyme and nuclear imaging techniques to add to the clinical and electrocardiographic findings. In this review several of the new diagnostic tests are described, and their role is discussed both in supplementing and replacing older diagnostic tests. A general strategy for employing both old and new tests is proposed, with a goal of achieving both increased diagnostic accuracy and reduced charges for laboratory tests.
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