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Biomedical subjects

F Gerr

Publications and source records attributed to F Gerr.

At least 37 records · Page 2Linked to original sources
PubMed1997

Medical information on the Internet: a study of an electronic bulletin board.

OBJECTIVE: To assess medical information provided in a medically oriented Internet discussion group, in terms of the professional status of the individuals providing information, the consistency of the information with standard medical practice, and the nature of the evidence cited in support of specific claims or recommendations. DESIGN: Standardized review of 1,658 consecutive messages on a particular online discussion group during a 5-month period. SETTING: An online discussion group for sufferers of painful hand and arm conditions. SUBJECTS: All participants in this discussion group during the study period. MEASUREMENTS AND MAIN RESULTS: Professional training of those offering medical information, consistency of the advice and recommendations offered with conventional medical practice, and nature of evidence cited in support of medical claims were determined. Of all messages, 55.9% (927) addressed a medical topic. Of these, 79% (732) provided medical information, of which 89.3% (654) were authored by persons without professional medical training, and 5.1% (37) were authored by trained health professionals. Approximately one third of the medical information provided was classified as unconventional. Personal experience was the basis of information provided in 61% of the nonprofessionals' messages and 13.5% of the professionals' messages, while no source was given as the basis of information provided in 29.8% of the nonprofessionals' messages and 67.6% of the professionals' messages. A published source was cited in 9.2% of the nonprofessionals' and 18.9% of the professionals' messages. CONCLUSIONS: These findings suggest that medical information available on Internet discussion groups may come from nonprofessionals and may be unconventional, based on limited evidence, and/or inappropriate.

Arm↗
PubMed1996

Upper extremity musculoskeletal symptoms among female office workers: associations with video display terminal use and occupational psychosocial stressors.

The relationships between musculoskeletal symptoms and both video display terminal (VDT) use and occupational psychosocial stress were assessed among women office workers by self-administered questionnaires. Significantly increased odds ratios for neck or shoulder symptoms were observed for subjects who had ever used a VDT, had less job security, and had more stressful work during the 2 weeks prior to completion of the questionnaire. Significantly increased odds ratios for arm and hand symptoms were observed for subjects who had used a VDT for more than 6 years, reported a very crowded workplace, or reported very stressful work during the 2 weeks prior to completion of the questionnaire. Among current non-users, those who previously used VDTs were more likely to report upper extremity musculoskeletal symptoms than those who had never used VDTs. This suggests that individuals with symptoms may be more likely to reduce their VDT usage, distorting results of cross-sectional studies.

Adult↗
PubMed1996

Methodological limitations in the study of video display terminal use and upper extremity musculoskeletal disorders.

Upper extremity musculoskeletal disorders may occur as a result of work with keyboard-equipped video display terminals. Many studies of the associations between keyboard use and upper extremity disorders have appeared in both the human factors and occupational epidemiologic literature. Methodological limitations and inconsistent results have limited conclusions that can be made from these studies, however. Although exposure conditions can be carefully controlled, human factors studies are limited by relatively small sample sizes, short exposure durations, and reliance on outcome measures with unknown relevance to chronic adverse health effects. Epidemiologic studies have been limited by poor ascertainment of both exposure and health outcome. Many have failed to control for any potential confounding. An almost exclusive reliance on cross-sectional study designs has resulted in possible bias from selective survival, exposure-effect reversal, and poor estimates of exposures occurring prior to development of the disorder. Given the inconsistency in the literature and the growing controversy surrounding this issue, prospective study of this question using objective methods for assessment of exposure and health outcome is recommended. This design allows identification of incident cases and minimizes bias from selective survival. In addition, ergonomic and psychosocial variables prior to onset of symptoms can be ascertained periodically. Given estimates for up to 100 million video display terminals to be in use in the United States by the year 2000, clarification of the health effects of their use is critical.

Arm Injuries↗
PubMed1995

Sensitivity and specificity of vibrometry for detection of carpal tunnel syndrome.

A cross-sectional study was performed to assess the utility of vibrotactile thresholds (VTs) obtained before and after a 10-minute period of wrist flexion as a method for detection of carpal tunnel syndrome (CTS) among adult subjects. Subjects with hand discomfort were recruited from patients referred to a university-based electromyography laboratory. Asymptomatic subjects were recruited from among office and technical staff at a professional school. In addition to electrophysiologic evaluation (EP), all subjects were offered VT measurement of the index and small fingers, bilaterally, before and after a 10-minute period of wrist flexion. A total of 144 subjects were recruited, and three hand-condition groups were established: 57 hands had symptoms and EP results compatible with CTS (Group 1), 58 hands had symptoms compatible with CTS and normal EP results (Group 2), and 123 hands had no symptoms and normal EP results (Group 3). Group 1 was considered the "disease-positive" group, and Groups 2 and 3 were both considered "disease-negative" groups. Analyses were performed separately for dominant and nondominant hands, and results were pooled when appropriate. Outcomes of interest were the VTs obtained from the index and small fingers before and after 10 minutes of maximal voluntary wrist flexion as well as variables calculated from them. Significant differences in mean VT were observed between the three hand-condition groups for most of the outcomes evaluated. At any given level of specificity, the sensitivity of vibrometry performed after 10 minutes of wrist flexion was approximately two times that obtained before wrist flexion for detection of electrophysiologically confirmed CTS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

The treatment of lead poisoning from gunshot wounds with succimer (DMSA)

Lead poisoning is an unusual complication of gunshot wounds that occurs when retained lead bullet fragments are in contact with body fluids capable of solubilizing lead. The epidemic of violence by gunfire may result in increasing numbers of lead poisoning cases from this exposure. The use of oral chelation for toxicity resulting from this mode of exposure has not been previously discussed. Cases of lead poisoning arising from bullet lead in the synovial cavity of the hip, synovial cavity of the chest, and pleural space are reported. A combination of surgical debridement and chelation therapy with oral succimer produced a satisfactory outcome in all three cases. Oral succimer may be a safe and effective chelation agent for treating lead toxicity in adults with high lead levels secondary to gun shot wounds.

Adult↗
PubMed1994

Hemolytic anemia following succimer administration in a glucose-6-phosphate dehydrogenase deficient patient.

Because of its favorable side effects profile, the oral chelating agent dimercaptosuccinic acid is often used for treatment of lead intoxication. We report a case of a 45-year-old black male with glucose-6-phosphate dehydrogenase deficiency and a 17 year history of occupational lead exposure who developed hemolysis during treatment with dimercaptosuccinic acid for symptomatic lead intoxication.

Anemia, Hemolytic↗
PubMed1994

Heterogeneity of effects of ethanol ingestion on postural stability as measured by two devices.

Measurement of postural stability has been used to assess effects of exposure to selected neurotoxicants. Its widespread application has been limited by several factors, including the use of cumbersome, expensive measurement systems and limited demonstration of sensitivity for detecting neurotoxicity. Recently, a less expensive, portable device for assessing postural stability via measurement of head position has been developed and used in some field studies. Although this head position monitor (HPM) is commercially available, no validation information for it has been published. To evaluate the HPM's utility, it was compared to a force platform (FP) system in an ethanol experiment. Ten adult male subjects were given 0.5 ml/kg ethanol and placebo using a counterbalanced, cross-over design. Stability measurements were made immediately prior to administration of alcohol or placebo and at fifteen minute intervals for two hours following administration. At each time interval, stability was monitored during two eyes-open trials alternated with two eyes-closed trials, each of 60-second duration. On a group basis, marginally significant effects of alcohol consumption consistent with results of other published studies were observed with both devices. The maximum increase in speed of sway occurred at 15 minutes post-ethanol ingestion for the eyes-closed condition. Specifically, sway speed increased from 1.11 cm/sec pre-ingestion to 1.50 cm/sec 15 minutes post-ingestion for the HPM, and from 1.81 m/sec to 2.13 cm/sec for the FP. No significant increase in sway speed was observed for the eyes-open condition. These groups differences obscured substantial heterogeneity of response to ethanol among the ten subjects, i.e., only two of the 10 subjects showed an observable increase in sway speed following ethanol ingestion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Dimercaptosuccinic acid in the treatment of depression following lead exposure.

Long-term exposure to lead is known to cause a variety of neurotoxic manifestations, including symptoms of depression. Dimercaptosuccinic acid (DMSA), a recently approved oral chelating agent, can diminish the body burden of lead, but few cases of documented clinical improvement following treatment have been reported. We report a case of moderate to severe depression in a long-term lead worker that appeared to respond dramatically to DMSA. This response suggests a possible therapeutic role for DMSA in the treatment of depression in lead-exposed patients.

Adult↗
PubMed1993

Vibrotactile threshold testing in occupational health: a review of current issues and limitations.

Quantitative cutaneous vibrotactile threshold measurement has been proposed as a useful method for assessing peripheral nervous system function in occupational and environmental neuroepidemiology. It allows rapid, quantitative, and nonaversive assessment of peripheral nervous system function. Acceptance of this method is currently limited, however, because of poor standardization of methods, the lack of data regarding the effects of age, gender, and other covariates, and minimal demonstration of association between vibrotactile threshold and conventional measures of peripheral nerve function. Data from a series of validation studies intended to address some of these problems are presented and relevant literature is discussed. Specifically, results of studies in which reliability and time efficiency of testing protocols were measured, the effects of covariates on measurement of vibrotactile threshold were estimated, and vibrotactile thresholds were compared to physical examination and electrophysiologic evaluation are discussed. Recommendations are made regarding choice and standardization of testing protocol, covariates, and issues for future research.

Humans↗
PubMed1992

A cross sectional epidemiological survey of shipyard workers exposed to hand-arm vibration.

The hand-arm vibration syndrome, widely known as vibration white finger, is a disorder of nerves and blood vessels that occurs in workers exposed to segmental vibration. A cross sectional symptom survey was performed on a sample of workers employed by a large shipyard in the north eastern United States. Random samples were drawn from departments composed of full time dedicated pneumatic grinders, workers with part time exposure to vibration, and other workers not exposed to vibratory tools. Of the 375 workers sampled, 79% responded. The prevalence of white finger symptoms was 71%, 33%, and 6% among the three exposure groups respectively. Similarly, the prevalence of numbness and tingling in the hands and fingers in the three exposure groups was 84%, 50%, and 17%. Workers were classified according to the Stockholm Workshop staging systems for vascular and sensorineural symptom severity. Exposure-response analyses of both vascular and sensorineural stage showed monotonically increasing prevalence of higher disease stages with increasing duration of exposure. Logistic regression analysis, performed to control for potential confounding factors including age and current smoking state, produced highly significant (p less than 0.001) associations between cumulative duration of exposure and prevalence of symptoms. In these analyses smoking state was significantly related to vascular and sensorineural symptoms and age was not. Average latency to onset of symptoms was less than five years of full time equivalent work with vibratory tools. Logistic regression analyses were performed to assess the effect of use of particular work practices on reported symptoms. Further study of this workforce with objective, quantitative measures of peripheral neurological and vascular function is required to characterise the clinical and subclinical effects of vibration exposure.

Cross-Sectional Studies↗
PubMed1991

Comparison of vibrotactile thresholds with physical examination and electrophysiological assessment.

Measurement of cutaneous vibrotactile thresholds may be useful for assessment of the functional integrity of the somatosensory system. To validate a rapid method of determining vibrotactile thresholds that uses a commercially available electromechanical device, vibrotactile thresholds were compared with standardized physical examination findings of sensory function and electrophysiological parameters in 79 patients referred to the Mount Sinai Hospital Neurophysiology Laboratory for clinical electrophysiological evaluation. A statistically significant monotonic association between graded physical examination of vibration perception and vibrotactile threshold was observed for all digits tested in the upper and lower extremities. Statistically significant associations were also observed between vibrotactile thresholds and a variety of electrophysiological measures of the median, ulnar, tibial, peroneal, and sural nerves. The strongest associations were observed between great toe vibrotactile thresholds and late response latencies measured in nerves in the lower extremities. Determination of vibrotactile thresholds may be useful in settings where quantitative measures of large fiber nerve function are desirable and electrophysiological study is not feasible.

Action Potentials↗
PubMed1991

Upper-extremity musculoskeletal disorders of occupational origin.

Sufficient evidence is available at this time to conclude that several well-defined soft-tissue disorders of the upper extremities are etiologically related to occupational factors. These disorders include tendinitis of the hand and wrist, CTS, and hand-arm vibration syndrome. Force, repetition, and vibration have been established as risk factors in the etiology of these disorders. Evidence exists that other, poorly understood factors also may contribute to etiology. At this time no firm guidelines can be established regarding maximum no-effect exposure levels. We agree, however, with Armstrong (3): "Although there are no standards for excessively repetitive or forceful work, common sense dictates that these tasks be minimized to the extent possible." Tool and job redesign may be required in many situations to accomplish these goals. In addition to appropriate reductions in risk factors, medical surveillance is required and will allow greater appreciation of the extent of this growing problem, as well as ongoing assessment of the efficacy of preventive intervention.

Arm↗
PubMed1990

Detailed clinical assessment of neurological function in symptomatic shipyard workers.

Forty eight patients with extensive occupational exposure to pneumatic grinding tools were evaluated at a university sponsored occupational health clinic. All patients were interviewed and examined by a physician and assessed neurologically with standard clinical, functional motor, quantitative vibrotactile, and electrodiagnostic tests. Sensorineural symptoms were nearly universal; 47 patients (98%) reported numbness and tingling of the hands and fingers. Among clinical tests, two point discrimination and 30 Hz vibration perception were most frequently abnormal. In order to evaluate associations between quantitative test results and sensorineural symptoms, patients were stratified into two groups of symptom severity according to a consensus sensorineural staging system. The tests that discriminated best between the groups of more and less symptomatic patients were hand strength dynamometry, and vibrotactile thresholds. Age standardised 120 Hz vibrotactile thresholds were significantly raised in digit II in 41% of hand measurements. Nerve conduction studies were neither significantly different between more and less symptomatic groups nor correlated with clinical and quantitative sensory tests. Twenty five per cent of the patients had slowing of sensory conduction velocities in the median nerve at the wrist (less than 48 m/s). Of this subset of patients only two showed abnormal slowing of the median nerve distal to the wrist, but half also showed ulnar nerve slowing (less than 47 m/s). This observation highlights the difficulty of differentiating median nerve entrapment from diffuse distal neuropathy in workers exposed to vibration and points to the need for concomitant quantitative sensory and functional motor assessment.

Adult↗
PubMedDate not supplied

Covariates of human peripheral nerve function: I. Nerve conduction velocity and amplitude.

A systematic investigation of covariates of nerve conduction measures was performed on data collected by the U.S. Centers for Disease Control. Nerve conduction velocity and amplitude were obtained for the median motor, median sensory, ulnar sensory, peroneal motor, and sural sensory nerves on 4,462 subjects. The magnitude of effect of skin temperature, height, body mass index, age, race, place of military service, smoking status, alcohol consumption, income, and EMG examiner was estimated for all 10 conduction outcomes. The major covariates were skin temperature, height, and examiner. Covariates with smaller but not unimportant effects on conduction outcomes were age, race, smoking status, and income. Alcohol consumption was associated with only small effects on conduction measures. These results provide an empirical basis for selection of variables to control in studies employing nerve conduction measures.

Adult↗
PubMedDate not supplied

Covariates of human peripheral nerve function: II. Vibrotactile and thermal thresholds.

A systematic investigation of covariates of quantitative sensory thresholds was performed on data collected by the U.S. Centers for Disease Control. Vibrotactile and thermal sensory thresholds were obtained from the index finger and great toe of 4,462 male Vietnam-era veterans. The magnitude of effect of skin temperature, height, body mass index, age, race, place of military service, smoking status, alcohol consumption, income, and examiner was estimated for the four outcomes. The major covariates of finger and toe vibrotactile threshold were age, height, body mass index, and examiner. The major covariates of toe thermal threshold were height, income, and examiner, and of finger thermal threshold were age, income, examiner, race, and smoking status. Alcohol consumption had only small effects on vibrotactile thresholds and essentially no effect on thermal thresholds. These results provide an empirical basis for selecting variables to control in studies employing vibrotactile and thermal threshold measures.

Adult↗
PubMedDate not supplied

Covariates of human peripheral nerve function: III. Effects of reported drinking.

A cross-sectional epidemiologic study of the relationship between alcohol consumption and peripheral nerve function was performed using data from a cohort of 4462 male Vietnam-era Army veterans selected independently of either alcohol consumption history or clinical disorders associated with excessive alcohol use. Self-reported alcohol consumption, expressed as current drinking intensity (drinks per month), was the primary measure of alcohol use. The dependent variables were: (a) conduction velocity and amplitude of the median motor, median sensory, ulnar sensory, peroneal motor, and sural sensory nerves; (b) vibrotactile and thermal thresholds of the index finger and great toe. Drinkers who reported consuming < 180 drinks per month had, in general, slightly faster mean nerve conduction velocities, slightly greater evoked response amplitudes, and slightly lower vibrotactile thresholds than did both never drinkers and drinkers reporting consuming more than 179 drinks per month. The heaviest drinking category (> 179 drinks/month) had slightly slower mean conduction velocities and slightly smaller mean amplitudes than all other drinking categories. No consistent associations were observed between thermal thresholds and alcohol consumption. These results suggest that consuming up to 6 drinks per day alone does not cause slowed nerve conduction velocity, diminished amplitude of the evoked response, or elevated sensory thresholds in 35- to 45-year-old men.

Adult↗