Comparison of SVO2, SPO2, and clinical parameters with arterial blood gases during ventilatory weaning after cardiac surgery.
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Biomedical subjects
Publications and source records attributed to J Melius.
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Concern about environmental pollutants has increased; however, it remains unclear whether chronic exposures to toxic chemicals in the environment occur at doses sufficient to produce adverse health effects in humans. To date, community studies have not adequately addressed this question. In this study, the authors linked two existing data bases of the New York State Department of Health to evaluate the relation between congenital malformations and residential proximity to hazardous waste sites in New York State. A total of 9,313 newborns with congenital malformations and 17,802 healthy controls living in proximity to 590 hazardous waste sites in 1983 and 1984 were evaluated. After the authors controlled for several possible confounding factors, results indicated that maternal proximity to hazardous waste sites may carry a small additional risk of bearing children with congenital malformations (odds ratio (OR) = 1.12, 95% confidence interval (Cl) 1.06-1.18). Higher malformation rates were associated with both a higher exposure risk (no exposure risk: OR = 1.00; low exposure risk: OR = 1.09, 95% Cl 1.04-1.15; high exposure risk: OR = 1.63, 95% Cl 1.34-1.99) and documentation of off-site chemical leaks (not exposed: OR = 1.00; exposed, but no leaks at site: OR = 1.08, 95% Cl 1.02-1.15; exposed, and leaks found at site: OR = 1.17, 95% Cl 1.08-1.27). The increased rates detected may be important in terms of their public health implications. Further research is necessary to strengthen causal inferences regarding the teratogenicity, of waste site exposure.
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This study examined the relationship between birthweight and exposure to emissions of methylene chloride (DCM) from manufacturing processes of the Eastman Kodak Company at Kodak Park in Rochester, Monroe County, New York. County census tracts were categorized as exposed to high, moderate, low or no DCM based on the Kodak Air Monitoring Program (KAMP) model, a theoretical dispersion model of DCM developed by Eastman Kodak Company. Birthweight and information on variables known to influence birthweight were obtained from 91,302 birth certificates of white singleton births to Monroe County residents from 1976 to 1987. No significant adverse effects of exposure to DCM on birthweight were found. Adjusted birthweight in high exposure census tracts was 18.7 g less than in areas with no exposure (95% confidence interval for the difference between high and no exposure - 51.6, 14.2 g). Problems inherent in the method of estimation of exposure, which may decrease power or bias the results, are discussed. Better methods to estimate exposure to emissions from multiple industrial point sources are needed.
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This summarizes current knowledge of the benefits and risks of fluoride ingestion. The preponderance of evidence indicates that fluoride can reduce the incidence of dental caries and that fluoridation of drinking water can provide such protection. Due to the ubiquitous nature of exposures to fluoride sources other than drinking water, it is currently impossible to draw firm conclusions regarding the independent effect of fluoride in drinking water on caries prevalence using an ecologic study design. Moderate dental fluorosis occurs in 1 to 2% of the population exposed to fluoride at 1 mg/l in drinking water and in about 10% of the population at 2 mg/l; moderate/severe fluorosis occurs in variable percentages ranging up to 33% of the population exposed to fluoride at 2.4 to 4.1 mg/l in drinking water. The issue of whether moderate or severe dental fluorosis represents an adverse health effect is still controversial. There is no evidence of skeletal fluorosis among the general U.S. population exposed to drinking water fluoride concentrations lower than 4 mg/l. Radiographically detected osteosclerosis after chronic exposure to fluoride in drinking water at 8 mg/l was not associated with clinical symptoms. Reports of crippling skeletal fluorosis associated with low concentrations of fluoride in drinking water in tropical countries have been attributed to other dietary factors. The available data suggest that some individuals may experience hypersensitivity to fluoride-containing agents. Further studies on hypersensitivity are required. There is no evidence of increased incidence of renal disease or renal dysfunction in humans exposed to up to 8 mg fluoride per liter in drinking water. Structural changes in kidneys of experimental animals have been detected at doses exceeding 1 to 5 mg fluoride per kilogram per day. Based on four case reports, individuals with renal insufficiency who consume large volumes of naturally fluoridated water at 2 to 8 mg/l are possibly at increased risk of developing skeletal fluorosis. Studies on the effects of fluoride in individuals with renal insufficiency are needed. There is no evidence that chronic exposure to concentrations of fluoride reported to be greater than 2 mg/l in drinking water increases human cancer mortality or incidence. A study of lifetime exposure to fluoride on cancer incidence in rats and mice has been completed, but assessment for cancer has not been completed. There is no evidence that fluoride is genotoxic except in some in vitro assays at cytotoxic concentrations. There is no in vivo evidence that fluoride affects human cellular enzyme activities.(ABSTRACT TRUNCATED AT 400 WORDS)
BDE added to dry bleach have been associated with immunologic sensitization and development of clinical allergic disease in detergent workers and occasionally in consumers. However, improved dust control and modification of the manufacturing process through encapsulation of enzyme were believed to have reduced or eliminated these problems. To determine whether or not immunologic sensitization could still develop in the detergent industry, we studied employees of a dry bleach manufacturing plant that incorporated encapsulated BDE into a consumer product. We performed air sampling for enzyme dust and total particulates, administered questionnaires, conducted physical examinations, and spirometry in 13 currently exposed, two previously exposed and nine nonexposed, employees. To assess sensitization status, RAST and ELISA were performed. Air concentrations of enzyme dust ranged from 0.002 to 1.57 micrograms/m3; all of these levels were below the TLV of 3.9 micrograms/m3. Positive BDE-specific RAST results (3.4%, 4.4%, and 8.0% binding) were obtained in three of 12 currently exposed workers. Results of personal breathing-zone air sampling indicated that these workers had high dust-exposure levels. Specificity of RAST was verified by RAST inhibition with BDE. BDE-RAST binding was not significantly elevated in the nonworkers (range: 0.6% to 1.4% binding). Positive results for specific IgG by ELISA were obtained in four of 12 currently exposed and in one of two previously exposed workers but in none of the nonexposed workers. We conclude that immunologic sensitization can develop after occupational exposure to encapsulated BDE in the dry bleach industry. We have not proved, however, that this immunologic reactivity is related to clinical sensitivity.
Ways to prevent lead poisoning and regulations intended to eliminate exposures to lead are the topics here. Lead registries and other studies are described that were designed to evaluate the extent of the problem and to address the lack of routine blood-lead monitoring in the industry.
The construction industry has one of the highest proportions of workers without health insurance. The authors review the two types of insurance systems that are generally used to cover the cost of health care for construction workers in the U.S.: health and welfare funds and workers' compensation. Recent developments in health care delivery in the U.S. are discussed, as are the more comprehensive occupational medicine services offered in France, Germany, The Netherlands, and Sweden.
In this review of engineering controls that can be used to check the spread of tuberculosis in health care settings, the authors address types of ventilation and supplements to ventilation such as HEPA filtration and ultraviolet germicidal irradiation. They also specifically cover engineering controls for use during medical procedures that pose an increased risk for transmission of TB.
Sections on research, education, and service summarize efforts that are needed to control the workplace transmission of TB and measures that can be taken while research is being carried out. Topics include ways to identify infectious patients, techniques for measuring the airborne concentration of TB, and the need for surveillance programs.