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Biomedical subjects

G F Stein

Publications and source records attributed to G F Stein.

9 recordsLinked to original sources
PubMed1995

Impact of a medical back care program on utilization of services and primary care physician satisfaction in a large, multispecialty group practice health maintenance organization.

STUDY DESIGN: Samples of patients with new back pain were compared at two medical centers, one with and one without a medical back care program. OBJECTIVES: To measure the impact of a medical back care program on use of services and physician satisfaction in a health maintenance organization. SUMMARY OF BACKGROUND DATA: A medical back care program is staffed with specially trained primary care physicians and provides consultative and educational services to the medical center. METHODS: Program impact on services was measured by comparing the number of physician office visits, consultations, physical therapy referrals, and imaging procedures provided to a sample of patients with back pain at the two medical centers. Physician satisfaction with care provided to patients with back pain was measured by a survey sent to primary care physicians at both medical centers. RESULTS: At the medical center with a back care program, 42% fewer consultations, 59% fewer physical therapy referrals, and 33% fewer imaging procedures were ordered. Less expensive consultations with back care physicians in medicine or family practice were ordered more frequently than consultations with either neurologists or orthopedists. This change in pattern of care took place without significantly altering clinical course. The effect of the program on the rate of surgery was not measured. CONCLUSIONS: The results of this study support the benefits of an organized medical back care program.

Adolescent↗
PubMed1985

Oesophageal cancer studies in the Caspian littoral of Iran: some residual results, including opium use as a risk factor.

A study was conducted in northern Iran in areas of very high, high and moderately low incidence of oesophageal cancer. Morphine metabolites in urine as an indicator of opium use, and a variety of nutritional and biochemical measures, including salivary antipyrine half-life, were determined in households with a case of oesophageal cancer and in control households. Results on 1,590 individuals showed that the prevalence of appreciable levels (greater than or equal to 1 microgram/ml) of urinary morphine metabolites was much higher in areas of high and very high incidence of oesophageal cancer than in low-incidence areas, particularly for those under age 50 years in both sexes, where a 6-fold difference was seen. Members of households with a case of oesophageal cancer had a higher prevalence of positive urinary morphine metabolite findings than members of control households from the same village. Salivary anti-pyrine half-life (AP-T1/2), as a measure of hepatic drug metabolizing capacity, was estimated in 120 subjects. No relationship was seen with use of opium, region of residence, case-control status of household, age or sex. Experimental studies have meanwhile identified mutagenic substances with carcinogenic potential in opium pipe scrapings, used widely in the study region, opium pyrolysates and morphine pyrolysates. Our data give additional support to the hypothesis that opium use, in the form of its pyrolysates, is one of the factors involved in the aetiology of oesophageal cancer in the region.

Adolescent↗
PubMed1981

Mount St Helens eruptions, May 18 to June 12, 1980. An overview of the acute health impact.

Thirty-five known deaths were caused by the landslide and lateral blast of the May 18 eruption of Mount St Helens and at least 23 persons are missing. In 18 of 23 cases that reached autopsy, asphyxiation from ash inhalation was the cause of death. A rapidly established hospital surveillance system detected increases in the number of emergency room (ER) visits and admissions for asthma and bronchitis in communities with the heaviest ashfall after the May 18 eruption and the eruptions on May 25 and June 12. There were also increases in the number of ER visits for ash-related eye complaints in some areas. laboratory studies indicated that the May 18 ash was not acutely toxic, but the respirable portion contained 3% to 7% of crystalline free silica, a potential pneumoconiosis hazard to certain heavily exposed occupational groups. Continuing volcanic activity of Mount St Helens and future eruption of other volcanoes in the Cascade Range may pose a variety of health hazards, including blast, ashfalls, flooding, damage to public utilities, and possible psychosocial effects.

Asphyxia↗
PubMedDate not supplied

The occupational hazards of formulating oral contraceptives--a survey of plant employees.

In May 1976 an investigation of a factory in Puerto Rico which formulates oral contraceptives revealed that during the previous 12 months five of the company's twenty-five employees (20%), and twelve of the company's thirty female employees (40%) had experienced symptoms associated with hyperestrogenism. The affected males had gynecomastia and three of them also reported a history of decreased libido or impotence. The affected females each had had at least one episode of intermenstrual bleeding during the preceding 12 months. There was an estimated relative risk of 4.3 for intermenstrual bleeding in nonclerical female employees compared with matched controls who did not work at the plant. Elevated levels of plasma ethinyl estradiol were twice as frequent in the two highest-risk job categories compared with the rest of the factory population, but the difference in prevalence of elevated levels was not statistically significant (P = 0.08). Wide variations in mestranol concentration were noted in the environmental dust samples. Prompt consideration should be given to establishing health standards for persons occupationally exposed to estrogens in view of the possible long-term sequelae of such exposure.

Contraceptives, Oral↗
PubMedDate not supplied

Common-source community and industrial exposure to trichloroethylene.

In July 1979, 1,900 gallons of trichloroethylene (TCE) were released into ground and surface water from a pipe manufacturing plant in Montgomery County, Pennsylvania. To evaluate community and occupational exposure to TCE, we conducted environmental and medical surveys. In well water samples obtained in August 1979 within 1 km of the factory, TCE concentrations ranged to 183,000 parts per billion (ppb); EPA's proposed guideline for TCE in drinking water is 5 ppb. Levels of TCE declined with distance from the plant and decreased in the months following the spill. However, lower level TCE contamination was widespread and persistent, suggesting multiple releases. Within the plant, mean time-weighted occupational exposure to TCE of degreaser operators was 205 mg/m3; the recommended time-weighted exposure limit is 135 mg/m3. Mean short-term exposure was 1,084 mg/m3; the recommended short-term limit is 535 mg/m3. Seven of 9 exposed workers reported drowsiness, dizziness, or mental confusion. In exposed workers, mean urinary excretion of TCE metabolites rose from 298 micrograms/L pre-shift to 480 micrograms/L post-shift. On re-evaluation of the factory following improvements in ventilation and work practices, mean time-weighted occupational exposure to TCE had decreased to 84 mg/m3 and short-term exposure to 400 mg/m3; symptom frequency and concentrations of urinary TCE metabolites also were reduced. This episode demonstrates that community and occupational exposure to chemical toxins may share a common origin.

Environmental Exposure↗
PubMedDate not supplied

The Three Mile Island Population Registry.

Shortly after the March 28, 1979, accident at the Three Mile Island (TMI) nuclear plant outside Harrisburg, Pa., the Pennsylvania Department of Health, in conjunction with the Centers for Disease Control and the U.S. Bureau of the Census, conducted a census of the 35,930 persons residing within 5 miles of the plant. With the help of 150 enumerators, demographic and health-related information was collected on each person to provide baseline data for future short- and long-term epidemiologic studies of the effects of the accident. Individual radiation doses were estimated on the basis of residential location and the amount of time each person spent in the 5-mile area during the 10 days after the accident. Health and behavioral resurveys of the population will be conducted approximately every 5 years. Population-mobility, morbidity, and mortality will be studied yearly by matching the TMI Population Registry with postal records, cancer registry records, and death certificate data. Because the radiation dose from TMI was extremely small, any increase in morbidity or mortality attributable to the accident would be so small as not to be measurable by present methods; however, adverse health effects as a result of psychological stress may occur. Also, a temporary increase in reporting of disease could occur because of increased surveillance and attention to health.

Accidents↗