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Biomedical subjects

H M Kipen

Publications and source records attributed to H M Kipen.

14 recordsLinked to original sources
PubMed1992

Sentinel pathophysiologic conditions: an adjunct to teaching occupational and environmental disease recognition and history taking.

Primary care physicians have an increasingly important role in identifying occupational and environmental (O/E) disease. However, the basic skills in O/E history taking, diagnosis, and management have not been adequately incorporated into traditional American medical education or practice. Reasons for these educational barriers are discussed. A new approach to O/E history taking, based on a modified list of occupational sentinel health events, is described. This list will give medical students and residents a practical, directed approach to recognizing O/E conditions and evaluating exposures in formulating a differential diagnosis. Through improved detection and assessment on the part of primary care physicians, appropriate referrals to occupational health specialists can be made for further investigation and public health surveillance.

Diagnosis, Differential↗
PubMed1991

Are non-whites at greater risk for occupational cancer?

All occupational cancer epidemiology articles that reported data on non-whites from four major journals were identified for the years 1984-1987. In addition to these 14 papers, four more papers were identified from computer searches, and another 13 were found by following up references from the original 14. Within these 31 papers, there were 36 analyzable cohorts (subgroups by job and sex). Five cohorts had elevated all-cancer mortality ratios in non-whites without an increase in whites. Sixteen cohorts showed elevated ratios in both racial groups, with 11 of the 16 having a higher non-white cancer mortality ratio than white cancer mortality ratio. For the 25 studies in which at least one racial group's cancer ratio was elevated, the non-white ratio exceeded the white ratio in 17 (68%). The overall paucity of articles on non-white cancer mortality, as well as the apparent trend toward increased occupational cancer mortality in non-whites, is discussed.

Bias↗
PubMed1991

Acute occupational respiratory diseases in hospital discharge data.

We investigated the feasibility of using hospital discharge diagnoses of ICD codes 506, 507, and 508, respiratory diseases from external sources, to identify occupational sentinel health events [SHE(O)]. Two hundred sixty-nine records were reviewed and 66 (25%) were incidents where the work-relatedness of the respiratory diseases was documented in the medical records. Twenty-six percent of the 269 records contained no exposure information. Sixty-four of the 66 occupational cases were from ICD codes 506.0-506.9, with the largest number classified as ICD codes 506.0 (bronchitis and pneumonitis due to fumes and vapors) and 506.3 (other acute and subacute respiratory conditions due to fumes and vapors). We conclude that surveillance of ICD codes in the 506 series, where 39% of the cases were secondary to occupational exposures, is a valuable component of a surveillance system for preventable occupational lung disease.

Adult↗
PubMed1991

The use of portable peak flowmeters in the surveillance of occupational asthma.

The purpose of this study was to identify the strengths and limitations of using portable peak flowmeters to document suspected cases of occupational asthma that were reported to a statewide surveillance project. The New Jersey Department of Health conducts surveillance for occupational asthma as part of the federally sponsored Sentinel Event Notification System for Occupational Risks (SENSOR). Between May 1988 and January 1990, 70 cases were reported voluntarily by physicians. Subjects who were still employed in suspected work sites were requested to test themselves for at least 15 days, using portable peak flowmeters to generate serial measurements of their peak expiratory flow rate (PEFR). For each of the 14 subjects who were successfully tested, the PEFR data provided valuable information about their asthma-work association. However, a large number of subjects whose cases were reported (56) either could not be tested or were not successfully tested. The proportion of subjects completing the test would probably improve if it were conducted when their conditions were first diagnosed. Accordingly, the collection of serial peak flow measurements to document occupational asthma would best be initiated by the treating physician when the patient first sought care, rather than waiting until after the case was reported to the state health department.

Adult↗
PubMed1990

Limitations of hospital discharge diagnoses for surveillance of extrinsic allergic alveolitis.

Hospital discharge diagnoses were used to identify all inpatient cases of extrinsic allergic alveolitis (EAA) from 1979 to 1982 in New Jersey. Of 170 reported cases, the hospital records of 48 were available for review. Based on published criteria for the diagnosis of EAA, only three cases (6%) could be classified as probable EAA, while 10 (21%) were possible cases, and 34 (73%) were not EAA. Limitations were apparent in the accuracy of discharge coding and also in the accuracy of the physician's diagnosis. These findings should promote caution among investigators using unvalidated reports based on ICD-9 hospital coding of EAA. Implications for reporting of other occupational lung diseases are discussed.

Alveolitis, Extrinsic Allergic↗
PubMed1990

Material safety data sheets. Caveat emptor.

Numerous hazardous chemicals are present in workplaces and the environment. Physicians are likely to be increasingly challenged with the evaluation of individuals exposed to these chemicals. Recent legislation mandates the creation of material safety data sheets that describe the composition and toxicity of hazardous compounds. This legislation has also greatly increased the availability of material safety data sheets to workers and physicians. While these can be of great assistance in the evaluation of exposed individuals, they often contain deficiencies that preclude the prudent physician from relying exclusively on them. A few typical material safety data sheets are reviewed to illustrate what one can expect to find.

Carbon Disulfide↗
PubMed1989

Use of longitudinal analysis of peripheral blood counts to validate historical reconstructions of benzene exposure.

We studied over 17,000 peripheral blood counts, accumulated during hematologic surveillance from 1940 through 1975, from a cohort of 459 benzene-exposed workers. Linear regressions demonstrated significant decreases in white and red cell counts, as well as hemoglobin, for workers exposed during the 1940s, without persistent trends over the ensuing 25 years. Strongly positive correlations were observed between these blood count fluctuations and fluctuations in retrospective estimates of benzene exposures for these workers in the earlier period of surveillance (mean estimated exposure 1940 to 1948, 75 ppm), but not for later years, (mean estimated exposure 1948 to 1975, 15 to 20 ppm). These data suggest substantial limitations of hematologic examination of populations to detect abnormalities in populations currently exposed to benzene. The analysis also demonstrates a novel approach to the biological validation of exposure estimates based upon limited industrial hygiene and historical record data. The application of biologic monitoring data may be useful for assisting decisions in reconstruction of a previous exposure.

Air Pollutants, Occupational↗
PubMed1988

Hematologic effects of benzene: a thirty-five year longitudinal study of rubber workers.

We studied over 17,000 peripheral blood counts, accumulated during surveillance from 1940 through 1975, from a cohort of 459 benzene-exposed workers. Linear regressions demonstrated significant decreases in white and red cell counts, as well as hemoglobin, for workers exposed during the 1940's, without persistent trends over the ensuing 25 years. Strongly positive correlations were observed between these blood count fluctuations and fluctuations in retrospective estimates of benzene exposures for this plant for the earlier periods of surveillance (mean estimated exposure 1940 to 1948, 75 ppm), but not for later years (mean estimated exposure 1948 to 1975, 15 to 20 ppm). These data suggest substantial limitations of hematologic examination of populations to detect abnormalities in populations currently exposed to benzene. The data also demonstrate a novel approach to the biological validation of exposure estimates based upon limited industrial hygiene and historical record data.

Benzene↗
PubMed1987

Pulmonary fibrosis in asbestos insulation workers with lung cancer: a radiological and histopathological evaluation.

This study was undertaken to determine the relation between radiographic and histological manifestations of pulmonary asbestosis (interstitial fibrosis) in insulation workers who had died of lung cancer. Of 450 confirmed deaths from lung cancer a chest radiograph suitable for determining evidence of pneumoconiosis was obtained in 219. Of these cases, 138 also had a tissue specimen submitted that was suitable for histological study to determine the extent of histological fibrosis. There was a significant albeit limited correlation between the radiographic and histological findings (r = 0.27, p less than 0.0013). All 138 cases had histological evidence of parenchymal fibrosis; in 25 (18%), however, there was no radiographic evidence of parenchymal fibrosis. In 10 cases (7%) both parenchymal and pleural disease were undetectable on the radiograph. Thus a negative chest radiograph does not exclude the presence of interstitial fibrosis (asbestosis) in a substantial proportion of insulation workers previously exposed to asbestos who develop lung cancer.

Asbestos↗
PubMed1986

Respiratory abnormalities among photographic developers: a report of three cases.

Photographic developing processes employ hazardous chemical substances, many with known adverse effects on the respiratory system. Three cases documenting respiratory symptoms and suggesting small airway abnormalities among photographic developers are reported. Work-related factors which might contribute to these findings, as well as public health implications, are discussed.

Adult↗