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Biomedical subjects

H Frumkin

Publications and source records attributed to H Frumkin.

At least 19 recordsLinked to original sources
PubMed2001

Health effects of long-term mercury exposure among chloralkali plant workers.

BACKGROUND: Inorganic mercury is toxic to the nervous system, kidneys, and reproductive system. We studied the health effects of mercury exposure among former employees of a chloralkali plant that operated from 1955 to 1994 in Georgia. METHODS: Former plant workers and unexposed workers from nearby employers were studied. Exposure was assessed with a job-exposure matrix based on historical measurements and personnel records. Health outcomes were assessed with interviews, physical examinations, neurological and neurobehavioral testing, renal function testing, and urinary porphyrin measurements. Exposure-disease associations were assessed with multivariate modeling. RESULTS: Exposed workers reported more symptoms, and tended toward more physical examination abnormalities, than unexposed workers. Exposed workers performed worse than unexposed subjects on some quantitative tests of vibration sense, motor speed and coordination, and tremor, and on one test of cognitive function. Few findings remained significant when exposure was modeled as a continuous variable. Neither renal function nor porphyrin excretion was associated with mercury exposure. CONCLUSIONS: Mercury-exposed chloralkali plant workers reported more symptoms than unexposed controls, but no strong associations were demonstrated with neurological or renal function or with porphyrin excretion.

Abortion, Spontaneous↗
PubMed2001

Beyond toxicity: human health and the natural environment.

Research and teaching in environmental health have centered on the hazardous effects of various environmental exposures, such as toxic chemicals, radiation, and biological and physical agents. However, some kinds of environmental exposures may have positive health effects. According to E.O. Wilson's "biophilia" hypothesis, humans are innately attracted to other living organisms. Later authors have expanded this concept to suggest that humans have an innate bond with nature more generally. This implies that certain kinds of contact with the natural world may benefit health. Evidence supporting this hypothesis is presented from four aspects of the natural world: animals, plants, landscapes, and wilderness. Finally, the implications of this hypothesis for a broader agenda for environmental health, encompassing not only toxic outcomes but also salutary ones, are discussed. This agenda implies research on a range of potentially healthful environmental exposures, collaboration among professionals in a range of disciplines from public health to landscape architecture to city planning, and interventions based on research outcomes.

Animals↗
PubMed2001

Reconstruction of occupational mercury exposures at a chloralkali plant.

OBJECTIVE: To reconstruct historical workplace exposure to mercury (Hg) from 1956 to 1994 at a large chloralkali factory for use in a current epidemiology study of the factory. METHODS: All job activities of the employees were classified into one of 16 exposure categories, and the dates of changes in the processes were identified. Exposures to Hg for each job category, at each period of the plant's operation, were then reconstructed from several data sources. A job-time period-exposure matrix was created, and the individual exposures of former workers were calculated. Data on exposure to Hg in air were compared with modelled concentrations of Hg in air and data on urinary Hg of the employees. RESULTS: Within an exposure category, concentrations of Hg in air were fairly constant for the first 20 years of the factory's operation, but began to increase in the late 1970s. Employees working in the cell room had the greatest exposures to Hg. The exposure estimates had significant correlations (p<0.001) with the urinary data and were well within the modelled range of concentrations of Hg in air. CONCLUSIONS: The highest exposures occurred from 1987 until the plant closed in early 1994 with some exposure categories having time weighted average exposures to Hg greater than 140 microg/m(3).

Air Pollutants, Occupational↗
PubMed2001

Diagnostic chelation challenge with DMSA: a biomarker of long-term mercury exposure?

Chelation challenge testing has been used to assess the body burden of various metals. The best-known example is EDTA challenge in lead-exposed individuals. This study assessed diagnostic chelation challenge with dimercaptosuccinic acid (DMSA) as a measure of mercury body burden among mercury-exposed workers. Former employees at a chloralkali plant, for whom detailed exposure histories were available (n = 119), and unexposed controls (n = 101) completed 24-hr urine collections before and after the administration of two doses of DMSA, 10 mg/kg. The urinary response to DMSA was measured as both the absolute change and the relative change in mercury excretion. The average 24-hr mercury excretion was 4.3 microg/24 hr before chelation, and 7.8 microg/24 hr after chelation. There was no association between past occupational mercury exposure and the urinary excretion of mercury either before or after DMSA administration. There was also no association between urinary mercury excretion and the number of dental amalgam surfaces, in contrast to recent published results. We believe the most likely reason that DMSA chelation challenge failed to reflect past mercury exposure was the elapsed time (several years) since the exposure had ended. These results provide normative values for urinary mercury excretion both before and after DMSA challenge, and suggest that DMSA chelation challenge is not useful as a biomarker of past mercury exposure.

Biomarkers↗
PubMed2000

Air quality and pediatric emergency room visits for asthma in Atlanta, Georgia, USA.

Pediatric emergency room visits for asthma were studied in relation to air quality indices in a spatio-temporal investigation of approximately 130,000 visits (approximately 6,000 for asthma) to the major emergency care centers in Atlanta, Georgia, during the summers of 1993-1995. Generalized estimating equations, logistic regression, and Bayesian models were fitted to the data. In logistic regression models comparing estimated exposures of asthma cases with those of the nonasthma patients, controlling for temporal and demographic covariates and using residential zip code to link patients to spatially resolved ozone levels, the estimated relative risk per 20 parts per billion (ppb) increase in the maximum 8-hour ozone level was 1.04 (p < 0.05). The estimated relative risk for particulate matter less than or equal to 10 microm in aerodynamic diameter (PM10) was 1.04 per 15 microg/m3 (p < 0.05). Exposure-response trends (p < 0.01) were observed for ozone (>100 ppb vs. <50 ppb: odds ratio = 1.23, p = 0.003) and PM10 (>60 microg/m3 vs. <20 microg/m3: odds ratio = 1.26, p = 0.004). In models with ozone and PM10, both terms became nonsignificant because of collinearity of the variables (r= 0.75). The other analytical approaches yielded consistent findings. This study supports accumulating evidence regarding the relation of air pollution to childhood asthma exacerbation.

Adolescent↗
PubMed2000

Occupational and environmental medicine and primary care.

This article introduces occupational and environmental medicine (OEM) to physicians in other specialties, and especially to primary care physicians, by highlighting the common foundations of OEM practice and primary care practice. These common foundations include careful diagnosis and treatment, appropriate use of consultants, collaboration with non-medical professionals, attention to psychosocial issues, care of the entire family, respect for confidentiality, patient education, preventing disability and maximizing function, diligent patient follow-up, epidemiological thinking, and continuing medical education.

Adult↗
PubMed2000

Use of a job-exposure matrix to assess occupational exposures in relation to birth defects.

Accurate exposure assessment remains a challenge in occupational epidemiology. We evaluated one approach, use of a job-exposure matrix (JEM), by applying the National Institute for Occupational Safety and Health (NIOSH) JEM to a large case-control birth defects study that included parental occupation information. We investigated the JEM exposure predictions in several ways and found that for a substantial proportion of the parents in the birth defects study, the JEM yielded either no exposure data or nonsense predictions. Among exposure predictions that were plausible, most were of low probability. The high probability exposure predictions were statistically unstable, and neither low nor high probability exposure predictions were reliable. There was considerable discrepancy between the JEM predictions and expert assessments for five exposures of interest. Application of the NIOSH JEM to the birth defects study database (and probably other databases as well) does not provide a useful means of assessing occupational exposures.

Case-Control Studies↗
PubMed1998

Multiple system atrophy following chronic carbon disulfide exposure.

Carbon disulfide toxicity is well characterized. The principal target organ is the nervous system, although cardiovascular, reproductive, ophthalmologic, and other effects are also recognized. The neurotoxicity manifests in three ways: encephalopathy, peripheral and cranial nerve dysfunction, and movement abnormalities. This report describes a case of olivopontocerebellar atrophy, a form of multiple system atrophy, developing in an adult after over 30 years of occupational exposure to carbon disulfide. The patient presented with the insidious onset of balance problems, impotence, and irritability, without tremor, cogwheel rigidity, bradykinesia, or changes in facial expression. Over the next few years severe ataxia developed, and the clinical diagnosis was confirmed with computed tomography and magnetic resonance imaging scans. The patient experienced multiple medical complications and died approximately 9 years after diagnosis. This case is consistent with a large body of clinical and experimental literature, much of it 50 years old, showing that carbon disulfide can cause movement disorders. It also serves as a reminder that movement disorders, ranging from parkinsonism to dystonia, are associated with a variety of toxic exposures such as manganese, carbon monoxide, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, and medications.

Brain↗
PubMed1997

Manganese in the U.S. gasoline supply.

Methylcyclopentadienyl manganese tricarbonyl (MMT) is an organic manganese compound recently approved for use in the United States as a gasoline additive. MMT use is expected to increase. This Commentary analyzes the impact of MMT use on population exposure to manganese, the health effects associated with manganese exposure, and the possibility that MMT use will lead to toxicity in the population. Although MMT use would result in only a small increment in most people's manganese exposure, certain populations will be disproportionately exposed. Although manganese is an essential nutrient at low levels, high-level manganese exposure leads to a characteristic severe nervous system toxicity. Pulmonary toxicity also occurs at high levels of exposure, and developmental toxicity to fetuses is an important concern based on more limited data. Selected subpopulations may be especially susceptible to the toxic effects of manganese. The critical question is whether the additional population exposure to manganese that would result from widespread MMT use would lead to toxic effects. Currently available evidence does not permit firm conclusions. Common sense and prudence therefore dictate that MMT not be used until further data are available and its safety is confirmed. Several measures are recommended to address the impending use of MMT in the U.S. gasoline supply.

Animals↗
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↗
PubMed1997

Cigarette smoking and thyroid hormone levels in males.

BACKGROUND: Cigarette smoking has been linked to thyroid disease, although studies of this problem have not shown consistent affects, with some studies linking smoking to increased thyroid hormone levels, and others to decreased thyroid hormone levels. METHODS: We performed a secondary analysis of information collected from 4462 Vietnam-era male US Army veterans aged 31-49 years who participated in the Vietnam Experience Study in 1985-1986. The study group consisted of 1962 current smokers and 2406 current non-smokers who had no thyroid abnormalities on physical examination, no current use of thyroid medicine, and no history of thyroid disease. RESULTS: We found that current smokers have higher thyroxine levels and lower thyroid stimulating hormone levels than never smokers and former smokers. The higher thyroxine levels that we detected in smokers, compared to non-smokers, diminished when we controlled for thyroxine-binding globulin and testosterone. We also found that heavy smokers had a smaller increase in thyroxine levels than did light smokers, when compared to non-smokers. CONCLUSIONS: Our findings suggest at least two distinct mechanisms for the effect of tobacco smoke on thyroid function; one related to higher levels of thyroxine-binding globulin and testosterone among smokers compared to non-smokers and another related to higher levels of thyrotoxins in tobacco smoke in heavy smokers compared to light and moderate smokers.

Adult↗