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Biomedical subjects

J E Myers

Publications and source records attributed to J E Myers.

At least 19 recordsLinked to original sources
PubMed1995

Sick building symptoms in office workers: a follow-up study before and one year after changing buildings.

Influences of physical and psychosocial work environments and personal factors on sick building syndrome symptoms were investigated in 167 clerical workers before and one year after moving from a naturally ventilated building to an artificially ventilated building. Female gender and work on visual display units were independently associated with most symptoms in the baseline survey and with the incident (new) symptoms in the follow-up survey. After changing buildings, the prevalences of eye, skin and fatigue symptoms increased significantly. Cold and discomfort due to stuffiness were independently associated with incident eye and respiratory symptoms. Reported domestic workloads were greater for women, but did not account for any gender differences in symptom prevalence.

Air Pollution, Indoor↗
PubMed1995

Repeatability and validity of a field kit for estimation of cholinesterase in whole blood.

OBJECTIVES: To evaluate a spectrophotometric field kit (Test-Mate-OP) for repeatability and validity in comparison with reference laboratory methods and to model its anticipated sensitivity and specificity based on these findings. METHODS: 76 farm workers between the age of 20 and 55, of whom 30 were pesticide applicators exposed to a range of organophosphates in the preceding 10 days, had blood taken for plasma cholinesterase (PCE) and erythrocyte cholinesterase (ECE) measurement by field kit or laboratory methods. Paired blinded duplicate samples were taken from subgroups in the sample to assess repeatability of laboratory and field kit methods. Field kits were also used to test venous blood in one subgroup. The variance obtained for the field kit tests was then applied to two hypothetical scenarios that used published action guidelines to model the kit's sensitivity and specificity. RESULTS: Repeatability for PCE was much poorer and for ECE slightly poorer than that of laboratory measures. A substantial upward bias for field kit ECE relative to laboratory measurements was found. Sensitivity of the kit to a 40% drop in PCE was 67%, whereas that for ECE was 89%. Specificity of the kit with no change in mean of the population was 100% for ECE and 91% for PCE. CONCLUSION: Field kit ECE estimation seems to be sufficiently repeatable for surveillance activities, whereas PCE does not. Repeatability of both tests seems to be too low for use in epidemiological dose-response investigations. Further research is indicated to characterise the upward bias in ECE estimation on the kit.

Adult↗
PubMed1995

Conceptualising health services in terms of level and location of care--a view from the academic health complex.

The origin and characteristics of academic health complexes (AHCs) are briefly outlined, along with pressures for restructuring of health services towards primary levels of care within the primary health care (PHC) approach. Weaknesses and strengths of the AHCs together with imbalances in the overall health system of which they are part are discussed. The Cape Town AHC is used to exemplify a suggested framework for analysis and development of other AHCs in South Africa and their transformation in accordance with the PHC approach. A method of service mapping is employed to aid an appreciation of the complexity of AHC services. Planning for potential transformation may be facilitated by conceptualising services in two dimensions, viz. level and location of care. Two important additional dimensions of service component linkage are integration across levels of care along a vertical axis, and integration across different services at primary level along a horizontal axis (comprehensiveness). AHCs, however skewly developed in terms of level and location of care, are complex combinations of services. They encompass all levels of care provided both within and beyond the walls of multiple health care facilities which are located both centrally and peripherally. AHC services are managed by health professionals in specific academic disciplines. They include PHC functions at the interface between primary and specialist care provision, and community health functions which are principally located outside the health care facilities in the community.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1994

Application of two secondary documentary sources to identify the underreporting of fatal occupational injuries in Cape Town, South Africa.

We reviewed 8,502 deaths registered at the Salt River state mortuary, Cape Town (medical examiner records) for an 18-month period (1/1/90-6/30/91). When fatal occupational injuries located from this data source were matched with the records of the occupational safety inspectorate of the Department of Manpower, it was found that 28% had not been reported in terms of statutory regulations. Unreported deaths accounted for 25% of all fatal occupational injuries in the construction industry. None of the fatal occupational injuries in agriculture and fishing had been reported. Falls constituted 45% of the unreported fatalities. High levels of unreported fatal occupational injury indicate deficiencies in current occupational safety surveillance and enforcement in South Africa.

Accidents, Occupational↗
PubMed1994

Development of observational methods for estimation of exposure to workplace postural stress.

Several recent studies have illustrated the need for a simple observational instrument for the estimation of exposure to postural stress in epidemiological studies of musculoskeletal disorders. Such an instrument is particularly necessary in developing countries. This paper describes the development of an observational instrument across a spectrum of industrial occupations in South Africa. The instrument was derived from adaptations to previously published observational methods and was specifically adapted to the measurement and application constraints identified during empirical development work in various industries. The final instrument fulfilled its aims of being applicable across a broad spectrum of jobs, including a broad spectrum of exposure variables and being reasonably cost- and time-effective. Some construct validity is indicated by the fact that two out of the three main exposure variables of interest showed significant associations with neck and shoulder pain in an epidemiological analysis. These variables were the score of summed estimates of the duration of time in sustained postures in a working day and the score of estimated overall repetitiveness based on cycle-time criteria. Further investigations are needed for pain at other anatomical sites. The measurement and scoring problems identified are discussed with reference to some aspects of these results.

Biomechanical Phenomena↗
PubMed1993

Fenfluramine challenge test as a predictor of outcome in major depression.

It has been reported that low pretreatment cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) levels may correlate with better clinical response to selective serotonin reuptake inhibitors (SSRI) compared to non-serotonergic antidepressant drugs. We examined the hypothesis that serotonergic system status, as measured by the prolactin (PRL) response to fenfluramine (FEN), may predict outcome in a heterogenous sample treated with various types of antidepressant treatment. Higher PRL response predicted a favorable outcome for males and females treated with either pharmacotherapy, psychotherapy [milieu therapy with or without cognitive behavior therapy (CBT)], or electroconvulsive therapy (ECT). All patients in the high PRL response group responded to antidepressant therapies. Patients receiving ECT had the highest proportion of treatment responders, the highest degree of treatment response, and, unlike drug or psychotherapy treatment, improved significantly whether in the high or low PRL response group. PRL response to a single dose fenfluramine challenge may be a useful predictor of response to pharmacological or psychotherapeutic treatments in major depression. By contrast, ECT is an effective short-term treatment independent of pretreatment serotonergic responsivity.

Adolescent↗
PubMed1992

Occupational and environmental epidemiology--similarities and contrasts.

There has been considerable growth in the disciplines of occupational and environmental epidemiology in recent years, with both fields having to deal with increasingly complex exposure profiles and adverse health outcomes. Environmental and occupational epidemiology as distinct from general epidemiology are compared and contrasted. Similarities and differences between the two fields are systematically discussed in terms of epidemiological peculiarities, study design characteristics, sampling procedures, exposure assessment, typical biases, problems in determining causation, ethical constraints, and implementation possibilities for research findings. There is a need in South Africa to provide adequate training to health professionals working in these fields, so that high-quality research, which has the potential to contribute significantly to improvements in the health of workers and the general public, can be undertaken.

Environmental Exposure↗
PubMed1992

Relationship between central and peripheral serotonin indexes in depressed and suicidal psychiatric inpatients.

Serious suicidal behavior, affective disorders, and a variety of other psychopathologic behaviors and syndromes have been found to correlate with measures of the serotonin system. Clinical studies have employed a range of serotonin indexes, including the cerebrospinal fluid level of 5-hydroxyindoleacetic acid, the prolactin response to serotonin agonists, such as fenfluramine hydrochloride, and platelet serotonin-related proteins or serotonin content. Many of these indexes are correlated with suicidal behavior, but the interrelationship of these biologic measures has been uncertain. We studied the relationship of a series of serotonin indexes in patients in whom these measures were correlated with suicidal behavior. A positive correlation was found between cerebrospinal fluid 5-hydroxyindoleacetic acid and the maximal prolactin response to fenfluramine but not with platelet serotonin2 receptor indexes. The fenfluramine-stimulated maximal prolactin response correlated with platelet serotonin2 receptor number, particularly in older patients. We conclude that cerebrospinal fluid 5-hydroxyindoleacetic acid measurements cannot be replaced but can be complemented by less invasive procedures, such as a fenfluramine challenge test or platelet serotonin2 measures, in the study of the relationship of the serotonin system to psychiatric disorders.

Adult↗
PubMed1992

Acrylamide monomer and peripheral neuropathy in chemical workers.

The relationship between exposure to acrylamide monomer and neurological outcomes was investigated in 82 chemical industry workers. Vibrotactile thresholds were determined quantitatively with a Vibratron II device, using forced choice and method of limits procedures. Symptoms of numbness, limb pain, peeling skin, and sweating hands had significantly higher prevalences in the exposed than in the unexposed group. Signs of peeling skin and sweating hands were significantly more common in the exposed group. Vibration thresholds were not associated with exposure.

Acrylamides↗
PubMed1991

Policy and strategy for occupational health services in South Africa.

Recent events in South Africa have spurred policy thinking in many areas, including occupational health. Strategic thinking needs to take account of current and likely future economic and political conditions in the new South Africa. The present occupational health system, considered as a network of health services, educational and research facilities along with a mechanism of legal regulation of workplace conditions, and compensation for occupationally-related disability, is reviewed and found to be inadequate in several respects. A possible structure for an integrated occupational health system is outlined at national, regional and local levels. Both service provision and financing arrangements are addressed. The interrelation between occupational health services and general health services for workers and their dependants is approached from the point of view of the desirability of comprehensive primary health care services catering to all health needs of all workers and their dependants. Appropriate linkages between levels of care (primary, secondary and tertiary), and between relevant institutions required for an efficient occupational health system are outlined.

Health Policy↗
PubMed1991

Urbanisation and women's health in Khayelitsha. Part I. Demographic and socio-economic profile.

Demographic and socio-economic data and information on migration patterns and urban/rural links was collected from 722 households in the formal housing area and the serviced and the unserviced site areas of Khayelitsha; 659 women and 61 men were interviewed. Thirty-eight per cent of the population were aged under 15 years and 77% under 35 years. There was a predominance of females in the 5-35-year age group. There was a mean of 4.9 persons per household, and 93.5% of sites contained 1 dwelling. Of the 659 female respondents, 7% had received no formal education, 39% had primary school education, and 54% had secondary school education. Unemployment among women was 45%. Domestic service accounted for 66.2% of formal employment. Of all women 86% were unskilled, 71.9% had been born in a 'homeland', and 69.7% had migrated to an urban area before 1985. Ties to the rural areas were strong, particularly in the 'shack' areas. 'New arrivals' to an urban area were young, mostly unemployed, and lived in the worst environmental conditions. In the unserviced 'shack' areas, 47.5% of women had migrated to an urban area in the last 5 years. There are important target areas for a study of the health effects of urbanisation and for possible interventions. This study tends to confirm the 'quadruple' oppression of women in Khayelitsha, on the basis of race, social class and gender and as new arrivals in an urban environment.

Adolescent↗
PubMed1991

Urbanisation and women's health in Khayelitsha. Part II. Health status and use of health services.

A study was conducted among women in Khayelitsha to determine the relationship between urbanisation, health status and use of health services; 722 households were visited, and 659 female respondents provided information on acute and chronic illness for the 3,229 individuals who were members of their households. In addition, they provided information concerning their reproductive health, AIDS awareness, knowledge of cervical smears and use and knowledge of health services. Acute illness was reported for 4.3% of the study population, the commonest complaints being diarrhoea, abdominal pain and upper respiratory infections; 4.4% reported chronic illness, the commonest complaints being hypertension and tuberculosis; 16.2% of women reported gynaecological illness; 86% had of heard of AIDS (although their knowledge of transmission and prevention was poor); and 45% had heard of cervical smears. Patterns of illness and knowledge and use of health services vary in the different areas of residence of Khayelitsha. This appears to be related to urbanisation, age, and environmental and socio-economic factors.

Black or African American↗
PubMed1991

Acrylamide neuropathy in a South African factory: an epidemiologic investigation.

Acrylamide monomer concentrations and peripheral neurotoxicity were investigated in workers at a factory producing polymer. Monomer levels ranged from 0.07 to 2.5 times the recommended exposure limit of the U.S. National Institute for Occupational Safety and Health (1988). Those workers with exposure exceeding the limit had increased prevalences of acrylamide-related abnormalities. Logistic regression showed dose-response relationships with exposure for symptoms, abnormal sensation, decreased motor strength, abnormal gait or rombergism, and skin abnormalities. The overall prevalence of acrylamide-related abnormality was 32% in the total work force and 67% among those exceeding the limit compared with 14% in those exposed below the limit. Environmental exposure determinations and conventional clinical approaches are relatively insensitive measures. Associations might have been stronger if a biological exposure measure had existed and if quantitative neurometric techniques had been applied. Electrophysiological methods are not readily available in many settings; the use of the Vibration II for quantitative field testing holds promise.

Acrylamides↗
PubMed1991

Grain dust and respiratory health in South African milling workers.

Respiratory health was investigated in 224 grain milling workers. The likelihood of respiratory symptoms and chronic airflow limitation was raised for workers exposed to dust independent of the effects of smoking. Smokers were more likely than non-smokers to respond to a bronchodilator at the end of the working week. Dust was more strongly associated with most abnormal outcomes than was smoking. Subjective categories of exposure to dust were more strongly associated with most abnormal outcomes than were objective categories. The prevalence of all symptoms at the time of a survey conducted at the mill six years before was higher in workers who subsequently left the mill than in those who remained employed although the differences were not significant.

Adult↗