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Biomedical subjects

E D Richter

Publications and source records attributed to E D Richter.

At least 19 recordsLinked to original sources
PubMed1997

Pesticide use, exposure, and risk: A joint Israeli-Palestinian perspective.

The major predictors of health risk from pesticide exposure are quantity and toxicity of pesticides reaching end-users, field workers, and persons (including children) with casual and indirect exposures to field and food residues, drift, and contaminated groundwater. Past work in Israel and the Palestinian National Authority has documented risks for acute poisoning, daily illness, transient neurotoxic effects, and potential cancer hazards in workers, populations exposed to pesticide drift, and the general population. Risk assessment predicts that reduction in use of agents with high toxicity and pesticide substitution are desired strategies for achieving the largest reductions in risk, but successful implementation and program sustainability depend on maintaining crop yield and increasing farmer earnings. A joint pilot Israeli-Palestinian-NGO program aims to determine whether crop yields and profits can be sustained while reducing pesticide use, promoting integrated pest management, and restricting ecosystem damage. The project involves six components: (1) assessments of health risk and crop yield in relation to pesticide use and exposure; (2) training health-agricultural teams to introduce and evaluate crop growth and managements with reduced pesticide use; (3) tracing and stopping import and trade in banned or restricted pesticides; (4) restricting child labor; (5) promoting information delivery and worker and community right-to-know and right-to-act; and (6) establishing a uniform regional standard for protection of workers and the general public. Preliminary evidence (organochlorines and breast cancer, organophosphates and illness in field workers) indicates that (1) a reduction of use is the foremost determinant of a reduction in health risk; (2) cotton yield can be increased despite a reduction in pesticide use (organophosphates); and (3) a reduction in pesticide use (organophosphates and organochlorines) has to be part of a crop rotation program for food crops timed to seasonal fluctuations in supply, demand, and crop price.

Agricultural Workers' Diseases↗
PubMed1997

Emergency preparedness and response in Israel during the Gulf War.

We examined the effect of the emergency response on medical and public health problems during the 1991 Gulf War in Israel. On the first day of the conflict, the number of deaths from suffocation, asphyxiation, aspiration, myocardial infarction, cardiac arrest, and cerebrovascular accident increased abruptly, as did the number of sudden deaths associated with the use of tight-fitting masks with filters in sealed rooms. Much of the excess risk for death from cardiorespiratory complications during the first alert may have been a consequence of its duration (140 minutes). Mass evacuation and concrete buildings are believed to have kept the death toll from trauma down, and mask use may have protected against facial and upper-airway injuries. Falls and hip fractures, airway irritation from exposure to bleach, carbon monoxide intoxication from open kerosene heaters in sealed rooms, and self-injection with atropine syringes were also noted. A measles epidemic and increased death rates from automobile crashes were other preventable causes of death. Protection against biological warfare was limited to surveillance of trends for pneumonia and gastroenteritis. Emergency planners failed to anticipate the need for better mask fit, hands-on training in the use of masks, and special guidelines for older persons to prevent deaths from suffocation and other cardiovascular-respiratory problems in the first minutes of use. If masks are to be distributed as a protection against chemical warfare, a simpler model including the use of shrouds for whole-body skin protection might help avoid cardiorespiratory complications. Public health problems not adequately dealt with in the predisaster period are apt to emerge with greater severity during a crisis.

Accidents, Traffic↗
PubMed1995

Occupation and environment in internal medicine: sentinel events and trigger questions.

Patients who undergo sentinel events indicate a breakdown in the chain of prevention and protection. Because most work- or environmentally induced illnesses and disabilities produce nonspecific or late symptoms and signs, the search for exposures to physical, toxic, ergonomic, or sociopsychological events that induce these sentinel events has to be based on systematic investigative routine, and not on the physician's mere awareness. Routine use of five "trigger" questions to identify jobs, tasks, exposures, symptoms, and other persons at risk can be effective, quick, and inexpensive in the search for preventable illness related to work or environment in the sentinel patient, especially when illness persists, recurs, or progresses or occurs in others. Sometimes, others can be helped when it is too late to do anything for the sentinel individual. This holds true for the relatively simple situations of one exposure and one outcome and for settings in which there are many exposures or many diseases in one or many patients. The newer set of "clean" environments that include ergonomic and sociopsychological hazards and stress at the work-station have produced new sentinel events. Knowledge of the impact of macro-environmental hazards presupposes familiarity with their impact on individual risks. Using the sentinel event to promote prevention of hazardous exposures means opportunities for reducing unnecessary risk in individuals and small groups. Opportunities for prevention arise when sentinel events occur at the time of exposure. Where there is latency between exposure and outcome, an anticipatory approach based on awareness of future risks from preventable current exposures is needed. The search for external exposures that have already occurred and for those that are preventable should be a routine part of internal medicine.

Adult↗
PubMed1991

The IARC classification system: input, internal logic, output, and impact.

The IARC Monographs "Evaluation of Carcinogenic Risk of Chemicals to Man" elegantly condense and classify information on carcinogenic hazards. They serve as an invaluable basis for the regulation of carcinogenic exposures, yet the monographs are inadequate in several respects: 1. The monographs reflect only what is reported and published in peer-reviewed sources; they have not themselves generated support for studies on agents and processes for which information is lacking, partial, or inadequate. 2. There has been misuse of the output, which reflects varying levels of certainty as to human health hazards. Lack of absolute certainty on human carcinogenicity has been used as a basis for deferring regulations or other preventive action to restrict exposures. 3. The monographs ignore high-risk situations which may result from combined or interactive effects, because of the orientation mostly on specific agents. There is not adequate attention to frequently reported excesses of disease other than cancer in certain occupations with mixed exposures. Earlier recognition of more widespread and more reversible effects, other than cancer, needs to be emphasized to control exposures. 4. Control of carcinogenic exposures for workers has been less exacting and consistent than control of exposures for the community at large (water, air, food, and drugs). 5. The gap between knowledge of risks and action to control them is great and calls attention to the need for more aggressive professional input.

Animals↗
PubMed1991

Work injuries and exposures in children and young adults: review and recommendations for action.

Child labor, the penultimate form of cheap labor, is endemic in poor countries; it also occurs in affluent countries. Little information has been available on injuries, disease, and effects on growth and development in the tens of millions of children at risk. Preventive and control measures are eliminating the gross abuses, tracing and banning hazardous exposures to toxic agents, eliminating risks of injuries and ergonomic strain, providing health services for working children through the primary health care network, and developing international failsafe design standards for tools and work systems, if these children must work. There is a need to train public health professionals, pediatricians, and maternal and child health care personnel in carrying out simple descriptive epidemiologic studies and setting up interventive programs. Eliminating the worst conditions and controlling hazards where there is no imminent alternative to child labor are suggested as the basis for a two-pronged strategy for protecting children who are forced to work.

Accidents, Occupational↗
PubMed1986

Smoking, morbidity, and pulmonary function in a group of ex-asbestos workers: a pilot study.

Thirty-three of 184 formerly exposed asbestos textile workers were interviewed to evaluate knowledge, attitudes, and practices concerning smoking and asbestos. Twenty-three subjects in this group also underwent physical examination to determine smoking-symptom/sign-pulmonary function interrelationships. Approximately half of the exworkers smoked, and the majority who had stopped did so mostly because of illness rather than because of knowledge concerning smoking-asbestos hazards. All workers welcomed the offer of smoking cessation programs. Smokers and exsmokers, but not nonsmokers, were at risk for obstructive-type impairments, but all three groups contained subjects with impairments interpretable as restrictive. The presence of shortness of breath, cough, râles, or decreased breathing sounds alone or in any combination greatly increased the odds that either obstructive- or possible restrictive- or mixed-type impairments would be found on spirometry. Mass screening techniques required about one hour of person time per examinee to assess health status, provide educational material on smoking, and counsel workers on referral arrangements. The findings suggest that smoking alerts, smoking cessation clinics, and medical follow-up are needed, feasible, and acceptable in Israel.

Aged↗
PubMed1986

Zinc protoporphyrin levels in children in Haifa: a pilot study.

Zinc protoporphyrin (ZPP) levels of greater than or equal to 40 micrograms dl-1 were found in blood samples of 32 (12.1%) out of 264 children living in Kiryat Yam, Haifa Bay (a sea-level neighborhood with much vehicular traffic, located 4.5 km from an industrial zone in the bay area), 22 (8.8%) out of 251 children living in Neve Shaanan (located on a mountainside, 3.5 km from an industrial zone and exposed to visible smoke pollution), and 14 (6.5%) out of 214 children from Mt Carmel (Ahuza), which is furthest from industry and where visible signs of pollution are seldom seen. Zinc protoporphyrin levels, low in non-anemic infants, were slightly higher in 1st graders from all three neighborhoods; higher levels were found in both 3rd and 6th graders from Kiryat Yam, but only in 6th graders from Neve Shaanan. The ZPP levels remained unchanged in older, Mt. Carmel children. Zinc protoporphyrin concentrations of greater than or equal to 40 micrograms dl-1 varied inversely with two indices of socio-economic status (parental ethnic origin and father's educational level). Blood lead levels of greater than or equal to 20 micrograms dl of blood were found in eight (13%) out of 62 children with ZPP levels greater than or equal to 40 micrograms dl-1, but in none (0%) of 14 children with ZPP levels greater than or equal to 40 micrograms dl-1. Three (60%) out of five children with ZPP levels greater than or equal to 50 micrograms dl-1 had Pb levels of greater than or equal to 20 micrograms dl-1. In Kiryat Yam, Pb(B) was higher in 31 children with ZPP greater than or equal to 40 micrograms dl-1 compared with 13 with ZPP less than 40 micrograms dl-1. The data on age-associated increases in ZPP in children suggest the possibility of an effect on red blood cell porphyrin metabolism, in some cases from cumulative low level lead exposures, and in others from iron deficiency, especially in poorer socio-economic groups. The findings call for further studies, both in the populations studied here, and elsewhere, to determine the role of lead toxicity and iron deficiency in children of all age groups, and the need for preventive action.

Age Factors↗
PubMed1986

Sequential cholinesterase tests and symptoms for monitoring organophosphate absorption in field workers and in persons exposed to pesticide spray drift.

Pre-season, in-season and post-season cholinesterase (ChE) levels (Ellman method) were monitored in 36 field workers (sprayers, field hands, leaf inspectors) from 3 kibbutzim and 25 residents from the same kibbutzim. Small and presumably inconsequential in-season reductions in plasma and whole blood ChE activity were seen in field workers and residents exposed to spray drift, but not in non-exposed residents. Intra- and inter-individual variability in plasma and whole blood ChE activities were within 'normal' ranges (e.g., less than 30% inhibition), but the variability (intra- and inter-individual) was greater in the field workers compared with residents. Daily logs from the infirmary of one kibbutz for 1 month recorded an excess of complaints (respiratory tract, eye irritation, headache) in residents on days when organophosphates were sprayed from aircraft compared to days when other or no pesticides were sprayed. The findings provide some indications of the utility and the level of sensitivity of plasma ChE for monitoring field workers, and possibly residents exposed to drift. Selective semi-routine examinations of alkylphosphates in urine together with the assessment of health effects are recommended to determine whether or not ChE monitoring is needed on a routine basis, or should be replaced by alkylphosphate monitoring.

Adolescent↗
PubMed1984

Monitoring for neurotoxic effects from low level exposures to organophosphate pesticides.

Data from small scale studies on low level and delayed neurotoxic effects from exposure to organophosphate pesticides suggest the need for monitoring those at risk in agriculture and industry, as well as residents repeatedly exposed to aerosol drift from aerial spraying. A pilot program is put forth with the aim of determining whether such effects occur in exposed populations, and if they do, assessing their incidence, distribution and severity, as well as the efficacy of control programs.

Aryldialkylphosphatase↗
PubMed1984

Asbestos-exposed populations: prevention, care, and compensation.

In Israel, the prevention and care of asbestos-associated diseases with latency periods of one to four decades (asbestosis, mesothelioma, increased frequency of cancer of the lung and other sites) are not satisfactory, and new national policies are required. Such policies have three major goals: (a) elimination or reduction of exposure to asbestos dust; (b) measures to promote cessation or drastic reduction of cigarette smoking among those currently or formerly exposed; and (c) equitable compensation for the consequences of past exposures. The practical elements of a program to achieve these three goals include (a) exposure standards and control technology; (b) identification of sources, routes, and levels of exposure and groups at risk; (c) compensation and job security; (d) medical monitoring and follow-up; (e) smoking cessation; (f) selective substitution of other substances for asbestos; and (g) establishment of a panel for policy supervision and the overseeing of compensation programs. Delay in implementation risks higher death rates for asbestosis and cancer among previously exposed workers, greater exposure among current workers, loss of experienced workers from the work force, and unnecessary hardship for families not adequately compensated.

Adult↗