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Biomedical subjects

J R Goldsmith

Publications and source records attributed to J R Goldsmith.

At least 73 records · Page 4Linked to original sources
PubMed1986

Pulmonary function screening and monitoring in occupational health.

Lung function testing among occupationally exposed workers has demonstrated its usefulness in risk evaluation and, once risks are identified, in medical surveillance. Its usefulness for screening and biological monitoring for effects of exposure is not yet established; in part, this is due to some failure to understand the requirements for screening and for monitoring, and in part, it is due to some unresolved questions as to procedures and their interpretation. The use of screening in occupational groups in general and those exposed to inhalational risks is evaluated. The current recommendation is that priority for screening be given to risk factor reduction, including smoking cessation. Problems associated with screening relate to procedures, equipment, and interpretation of data. An agenda is proposed for an international effort to determine principles for epidemiological use of lung function tests for prevention of occupational pulmonary disease risks.

Adult↗
PubMed1984

Epidemiological monitoring in environmental health: introduction and overview.

Epidemiological monitoring as used here is the repeated standardized evaluation of the health status of a population for the purpose of protecting this population from environmental health hazards. It is contrasted with epidemiological studies and environmental monitoring. Non-specificity of environmental monitoring is an important justification for epidemiological monitoring. In considering why epidemiological monitoring has not been more extensively used, historical, conceptual, and technical reasons are suggested. A modest increase in resources in this field is likely to be relatively cost-effective.

Environmental Health↗
PubMed1984

Epidemiological monitoring in the vicinity of a coal-fired power plant.

An epidemiological monitoring program has been designed and put into operation in response to a health monitoring requirement of a permit to build a coal-fired power plant. It will consist of four 350 megawatt units and is being built on the Mediterranean coast about halfway between Tel-Aviv and Haifa; the first unit became operational in 1981. The resident population within a 10 km. radius consists of about 69,000 persons. The permit to build this power plant required the installation of a comprehensive monitoring network including environmental, health and agricultural monitoring. Four types of studies are included in the epidemiological monitoring program: mortality analyses, monitoring of requests for health services, studies of pulmonary symptoms and lung function in school children, and panel studies of children and adults with chronic pulmonary conditions. Areas of maximal expected exposure risk and two other comparable areas of lesser risk were chosen, based on expected emissions, meterological and topographical considerations; baseline data were gathered for a year prior to the operation of the first unit of the power plant. Subsequent data are planned to be collected for another 10 years. The program permits detection of short-term effects based on increases in health service requests, medium-term effects by repeat examination of panelists, and long-term effects based on pulmonary conditions among school children. The initial survey, before plant operations showed, among other things, lower flow rates for children in the area expected to have medium levels of exposure.

Adult↗
PubMed1984

Feasibility of epidemiological monitoring for a proposed coal-fired power plant, Ivanpah, California.

The authors were asked to determine the feasibility of conducting epidemiologic monitoring for adverse health impact of emissions from the proposed Ivanpah Coal-Fired Power Plant. The study was required by the licensing agency, and specifically concerned health effects on the surrounding community. No potential occupational effects were considered. The area of concern was limited by the licensing agency to a circle of 50 mile radius around the Ivanpah site. The proposed power plant will be capable of generating 1500 megawatts of electricity utilizing low sulfur western coal. It is designed with stack heights of 500 feet for good dispersion and is planned to be outfitted with the best available stack emission control equipment. To establish whether an epidemiologic study is feasible, one must determine: (1) the size of the population which potentially would be exposed; (2) the pollutants to which that population might be exposed and the expected level of exposure and (3) the known or expected health effects of these pollutants and the frequency of such health outcomes. In addition, as in any epidemiologic study, the choice of a proper comparison group, the acceptability of a study to the population to be monitored and costs of the study in relation to available resources must also be taken into account. The population residing within 20 miles of the site consists of approximately 1,500 people at the present time. This population is not expected to increase significantly, although there is the possibility of growth of a "company town" surrounding the plant. Such an event would clearly alter the feasibility of conducting an epidemiologic study. Air quality modeling was used to predict the exposures to the population from various emissions from the proposed generating station. It was based on worst-case assumptions of wind speed, direction, atmospheric stability and percent sulfur-content coal. While a great many pollutants may result from coal burning, the levels of all pollutants, with the possible exception of ozone, are expected to be much lower than existing standards allow and therefore of little practical concern in the communities near Ivanpah. Since ozone is not a primary pollutant but is of secondary origin, its concentration, given the appropriate conditions, could increase with distance from the plant. None of the expected health outcomes occurs with sufficient frequency to allow the detection, with a reasonable degree of statistical certainty, of any reasonably expected increase in frequency in an epidemiologic study of a population as small as that which is associated with the Ivanpah site.(ABSTRACT TRUNCATED AT 400 WORDS)

Air Pollutants↗
PubMed1984

Monitoring of hospital emergency room visits as a method for detecting health effects of environmental exposures.

We excepted from the logs of the adult and children's emergency room at Soroka Hospital Medical Center the number and types of services requested by day for the year 1980. Both total visits and visits for respiratory conditions were examined in order to test whether rain, heat, or pollutants led to increased requests for emergency room care. The total visits for adults were 72,375, of which 1,727 (2.4%) were for selected respiratory conditions. The total visits for children were 19,232, and respiratory conditions were 3,980 (20.7%). There is marked seasonal excess for respiratory visits for children in winter, and a lesser excess for adult respiratory conditions. Non-respiratory conditions and overall visits are higher in summer months. Fewer visits occur on Saturday and on Friday, with the maximum on Sunday. Otitis and bronchitis among children show little day-of-week trends. "High event" days for admissions are determined by fitting a Poisson distribution to the numbers of admissions by day for various respiratory complaints, and we then examine the concordance between these high event days and days with rain, high pollution or temperature. Adult respiratory conditions were more likely to occur on days with high total particulates (TSP) and "respirable" particulates (RSP). When the mean values of RSP and TSP for high asthma and shortness of breath days were compared with a random day for the same month, significant differences were found for RSP for adults, but not for TSP. Natural dust is the more likely cause of this association. Emergency room monitoring should be useful in locations with high levels of man-made pollutants.

Adult↗
PubMed1984

Monitoring of unfavorable reproductive outcome (URO) among occupationally exposed groups.

In the Negev Region of Israel, population 300,000, with a centralized health care and health data system, we propose to monitor associations of occupational exposure with the following URO (approximate rates in parenthesis): infertility (10%), spontaneous abortion (10%), stillbirth (1%), pregnancy complications (5%), specific birth defects (1%), all birth defects (5%), low birth weight (5%), neonatal morbidity (5%); all URO (25%). Critical covariates include smoking, age, contraceptive use, coexisting disease, parity, spouse exposures, and past reproductivity history. Currently exposed women are estimated to include 150 in hospital operating rooms, 200 laboratory workers, 75 chemical production workers and 20 in mercury thermometer factory; men include 5000 in chemical production, 1000 in agricultural chemical use, 100 in chemical laboratories and 200 in university and hospital laboratories. Adjusting for expected turnover rates, we estimate that overall exposures which have risks of increased URO will include about 5000 men and 1000 women. Since priority in research resources goes to most feasible detection and prevention combinations, we define and examine "minimal detectable risk ratios" based on expected populations sizes and incidences for a two year cohort study with estimated one "exposed pregnancy" per five person years in this young population. We tabulate these risk ratios using a cutoff for false positive at p=0.05 and false negative at p=0.1. Sex ratio changes represent outcomes relatively easily detected. Proposed application of these criteria to Negev populations and an example of such applications to published work place exposures to dioxins are shown.

Chemical Industry↗
PubMed1984

Asbestos-exposed populations: prevention, care, and compensation.

In Israel, the prevention and care of asbestos-associated diseases with latency periods of one to four decades (asbestosis, mesothelioma, increased frequency of cancer of the lung and other sites) are not satisfactory, and new national policies are required. Such policies have three major goals: (a) elimination or reduction of exposure to asbestos dust; (b) measures to promote cessation or drastic reduction of cigarette smoking among those currently or formerly exposed; and (c) equitable compensation for the consequences of past exposures. The practical elements of a program to achieve these three goals include (a) exposure standards and control technology; (b) identification of sources, routes, and levels of exposure and groups at risk; (c) compensation and job security; (d) medical monitoring and follow-up; (e) smoking cessation; (f) selective substitution of other substances for asbestos; and (g) establishment of a panel for policy supervision and the overseeing of compensation programs. Delay in implementation risks higher death rates for asbestosis and cancer among previously exposed workers, greater exposure among current workers, loss of experienced workers from the work force, and unnecessary hardship for families not adequately compensated.

Adult↗
PubMed1984

Increase in relevant data after introduction of a problem-oriented record system in primary pediatric care.

We determined the effect of the problem list and standard data base components of the problem-oriented record (POR) on kibbutz clinic care. We compared quantity and type of data collected and number of problems identified before and after POR implementation at an experimental clinic with the same variables measured at a similar clinic. Family history, prenatal, natal, nutritional, immunization, environment, review of systems, psychosocial and total data collected, as well as number of chronic problems identified, increased significantly after POR implementation.

Child↗
PubMed1984

Strategies for pooling data in occupational epidemiological studies.

In occupational epidemiology, most of the populations at risk are of limited size, and therefore pooling of the experience of different groups with similar exposure is desirable. We present and compare five different strategies for pooling of such data, including the "default" strategy of present reporting practices, which have the disadvantage that the experience of many small units is not recorded because of the low statistical power of small populations. A simple summation strategy including cases and controls from diverse groups, while attractively simple, may be fallacious when cases and controls have different proportions which are confounded with the risk ratios. Separate summation of observed and expected numbers of cases avoids the risk of fallacy, but may be unduly influenced by the results in one large plant. A "Clinical Trial" type of strategy in which all of the data are collected by a common protocol and therefore considered as a single data set is administratively complex and does not seem well suited for occupational epidemiology. Probability pooling seems to have attractive features, avoiding most of the disadvantages of the other strategies, and having the added feature that weighting for exposure and duration of follow-up can be included. Probability pooling requires exact probability statements for each study. Examples are given for pooling of data from exposures of operating room personnel to anaesthetic agents, cohorts of workers exposed to asbestos, and cohorts of workers exposed to man-made mineral fibres. A working group is proposed to recommend procedures and to assist in interpreting pooling activities.

Abnormalities, Drug-Induced↗
PubMed1983

Emergency room admissions, meteorologic variables, and air pollutants: a path analysis.

Daily hospital emergency room admissions at hospitals located within 8 km of Los Angeles Basin monitoring stations at Long Beach, Lennox, Azusa, and Riverside, California, were examined for correlations with pollutant and meteorologic variables for 1974-1975. By conventional correlation and regression with lagged and temporospatial analysis, the authors could not distinguish effects of pollution by particulate sulfate from those due to meteorologic variables and oxidant. The authors use a variety of structural models and path analysis to estimate "direct" effects on emergency room admissions of maximum temperature, humidity, wind velocity, barometric pressure, carbon monoxide, sulfur dioxide, nitric oxide, high-volume suspended particulates, coefficient of haze, nitrogen dioxide, oxidant, and sulfate. Criteria for choice of models included plausibility of pairwise dependence relationships, magnitude of the correlations with emergency room admissions, and examination of the partial correlation matrix. Their results show that a variety of models gave similarly large path coefficients for a given location for the following variables: maximum temperature at each site; sulfate at Long Beach and Lennox but not at Riverside which nevertheless had the highest sulfate means; oxidant at Azusa which had the highest oxidant levels. At other locations, despite substantial and significantly elevated correlation coefficients, oxidant had a small or negative path coefficient. After considering other possible factors, the authors conclude that sulfate pollution at Lennox and Long Beach had an important and possibly causal association with demand for emergency room admissions. This demonstrates the usefulness of using a variety of structural models in the analysis of ecologic data.

Air Pollution↗
PubMed1983

Air pollution and family health.

Air pollution is classified according to chemical characteristics of the pollutants and sources: reducing air pollution, photochemical air pollution, point-source emission and indoor air pollution. The primary pollutants are particulates, oxides of sulfur and nitrogen, ozone, hydrocarbons, carbon monoxide and lead. A knowledge of the effects of these on healthy people and impaired patients can provide the physician with specific measures to apply in individual cases.

Air Pollutants↗
PubMed1982

Asbestos as a systemic carcinogen: the evidence from eleven cohorts.

Most known occupational carcinogens are site-specific, which implies that they are "complete" carcinogens with both "initiating" and "promoting" properties (Berenblum's terminology). Excess cancer at gastrointestinal sites among cohorts occupationally exposed to asbestos has been interpreted as reflecting additional site-specific effects, although excess at other sites has also been observed in some studies. The hypothesis that excess cancer at gastrointestinal sites cannot be distinguished from excess cancer at all nonpulmonary sites is tested by data from New York-New Jersey insulation workers working in 1943; similar workers employed after 1943; U.S.-Canadian insulation workers; London factory workers, male and female; Quebec miners and millers; retired U.S. factory workers; U.S. shipyard insulators; Italian shipyard workers in Genoa; Amosite factory workers; and U.S. factory workers. Excluding lung cancer and mesothelioma, observed-expected ratios for nonpulmonary cancer mortality range from 0.97 to 2.78, and do not differ significantly from gastrointestinal ratios. A dose-response gradient is observed for both ratios, when dose is estimated from lung cancer ratios, or in some studies, measured exposures. Site-specificity is unlikely for nonpulmonary cancer associated with asbestos exposure more than 20 years previously. Systemic carcinogenesis may be an example of promotion or impairment by asbestos of some cancer defense mechanism; immunological mechanisms have been suggested by Turner-Warwick and Parkes. Prospective studies are indicated.

Adult↗
PubMed1982

Prevention of occupational cancer: a different approach.

The dominant strategy for preventing occupational cancer in the United States is agent-based. An alternative set of preventive strategies based on a more healthful workplace can replace this approach, and not only provides practical guidance on what to do, but also criteria for the prevention of cancer from known or suspected agents and from suspected occupations, not now covered by agent-oriented strategies. The strategy is based on preventing the occurrence of any unfavorable health effect from known or possible carcinogenic exposures. All known occupational carcinogens have other effects detectable earlier than cancer and usually at a lower dose. The proposed strategy is built on the assumption that yet-to-be identified carcinogens will also have this property. Strategies for prevention once exposure to known carcinogens has occurred are also proposed. The benefits include the prevention of other diseases. One large industrial complex has already embarked on such an approach.

Carcinogens↗