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Biomedical subjects

J Ratcliffe

Publications and source records attributed to J Ratcliffe.

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

Medical screening in the workplace: proposed principles.

Medical screening and biological monitoring are two techniques in a continuum of practices used to prevent occupational disease. Medical screening is the examination of workers for pathological conditions. Biological monitoring is the examination of the worker for the presence of an intoxicant or its metabolite. These techniques are common in industry, and are frequently components of health standards recommended by the National Institute for Occupational Safety and Health (NIOSH) to the Occupational Safety and Health Administration. However, an underlying set of principles for medical screening and biological monitoring in the workplace has not been delineated. In this paper, a modification of the principles for screening in the community is proposed that will be more appropriate to the workplace. This modified set of principles is not a statement of the policy of NIOSH on this important subject, but rather a presentation of the authors' views as a starting point for dialogue on these issues.

Humans↗
PubMed1985

The influence of funding agencies on international health policy, research and programs.

Funding agencies, through the exercise of "strategic funding," are able to exert controlling influence in various fields of endeavor, and international health provides no exception to this general rule. A common way such control is exerted is to define the problem to be solved in a way that serves the vested interest of the funder. This is possible because the way a problem is defined determines the solution(s) to the problem. Currently, international health professionals are confronted with two contending definitions of health. The World Health Organization has defined health theoretically (to guide discussion) as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." This definition reflects a health-oriented conceptualization of health as primarily a social product, and hence leads to social-oriented solutions to problems of ill health in society. On the other hand, funding agencies have defined health operationally (to guide activity) as "the absence of disease or illness." This definition reflects a disease-oriented conceptualization of health, which therefore leads to biotechnical, individual-oriented solutions to disease and illness in society. To choose between these two definitions is to choose between two quite different problems to be solved, two very different sets of solution strategies and two very different sets of value structures. This choice represents a particularly difficult dilemma to international health professionals who are dependent on external funding agencies for their support.

Financing, Organized↗
PubMed1985

Opiate receptor blockade and diurnal pituitary and adrenal hormone levels.

Peripheral pituitary hormone levels exhibit circadian variations though the mechanism of these changes is unknown. In order to investigate the possible role of endogenous opiates in such changes we have studied the influence of opiate receptor blockade with naloxone (6.8 mg) on pituitary hormones in the morning and again in the evening in six normal male volunteers. Basal ACTH, cortisol, aldosterone and prolactin were higher in the morning than in the evening. Following naloxone at 0700h both ACTH and cortisol rose indicating a tonic inhibition of ACTH by endogenous opiates at that time. At 2230h cortisol rose following naloxone but ACTH did not, suggesting that endogenous opiates do not play an important role in the diurnal rhythm of this hormone and consistent with the suggestion that endogenous opiates can effect cortisol levels independently of their action on ACTH. Neither aldosterone nor prolactin were influenced by naloxone. In contrast TSH was unaffected by naloxone in the morning but fell in the evening (mean + SE decrement over 120 min -0.6 +/- 0.3 mU/l as compared with the control +0.6 +/- 0.4 mU/l; p less than 0.01). Thus, endogenous opiates probably tonically stimulates TSH levels in the evening when TSH may increase and possibly play a role in the circadian rhythm of TSH.

Adrenal Cortex Hormones↗
PubMed1985

Sperm as an indicator of reproductive risk among petroleum refinery workers.

A questionnaire study of men in a wastewater treatment plant of a petroleum refinery showed twice the rate of fetal loss in the period during employment in the plant compared with the periods before and after. Questions regarding the interpretation of that study and continuing concern about reproductive risk prompted us to perform a cross sectional evaluation of sperm concentration and morphology. After adjustment for an abstinence period, the mean sperm concentration of the 74 unexposed men did not differ significantly from that of the 34 exposed men (79.9 million/cm3 v 68.2 million/cm3, p(1) = 0.16). The two groups also had a similar proportion of sperm with abnormal morphology (49.1% v 44.5%, p(1) = 0.94). This lack of association remained when degree of exposure, age, use of alcohol and marijuana, past illness or fever, use of baths or sauna, and history of urological problems were considered. These results are most consistent with the absence of sperm mediated reproductive problems.

Abortion, Spontaneous↗
PubMed1985

Cytogenetic studies in humans after short-term exposure to ethylene dibromide.

Ethylene dibromide (EDB) has been shown to increase sister chromatid exchange in animal cells in vitro, but its cytogenetic effects in humans have not been previously studied. A solution containing EDB is used in the summer months in Colorado to spray felled pine trees to kill pine beetles. We have assessed the frequencies of sister chromatid exchanges and chromosomal aberrations in the peripheral blood lymphocytes of 14 sprayers both before and after exposure. Six nonexposed individuals also were tested. Full-shift personal breathing-zone air samples indicated that the sprayers were exposed to an average of 60 ppb of EDB, as an eight-hour time weighted average. The range of exposure was from 5 to 281 ppb. Workers sprayed EDB for only five to 26 days during the summer, with an average of 14 days. After adjusting for smoking and the use of prescription medicine, there was no statistically significant difference between the frequencies of either sister chromatid exchange or chromosomal aberrations before and after spraying.

Adult↗
PubMed1984

Difficulty in diagnosing hemobilia from a hepatic artery aneurysm: value of endoscopic retrograde cholangiography.

A case of hemobilia due to a hepatic artery aneurysm is described. Despite 2 arteriograms and 2 laparotomies, the cause of the bleeding remained undetected until a further selective cannulation of the celiac axis artery was performed. Endoscopic retrograde cholangiography demonstrated that postoperative jaundice was not due to obstruction and outlined the aneurysm within a hepatic duct.

Adult↗
PubMed1978

Social justice and the demographic transition: lessons from India's Kerala State.

Kerala is a small, densely crowded state in South India. It is a poor state, even by Indian standards. Its per capita income of US$80 lies well below the all-India average of US$120, and it suffers from the lowest per capita caloric intake in India. Nevertheless, Kerala has managed to achieve the demographic transition from high (premodern) to low (modern) birth and death rates-something no other Indian state has been able to attain. Indeed, the magnitude of Kerala's fertility decline-the birth rate fell from 39 in 1961 to 26.5 in 1974-has never before been observed in a nation with comparable levels of income and undernutrition. Other indices of Kerala's soical development are equally surprising: levels of literacy, life expectancy, female education, and age at marriage are the highest in India, while mortality rates, including infant and child mortality, are the lowest among Indian states. But Kerala's anomalous and unexpected demographic trends and levels are not the result of the direct interventions designed to influence health and fertility levels elsewhere in India-conventional strategies of population control and health services delivery that thus far are notable for their failure to generate such positive results. Instead, Kerala's demographic levels evidently reflect a broad social response to structural reforms in its political economy.

Birth Rate↗
PubMedDate not supplied

The 1990 GP contract: modelling variation in minor surgery provision.

Logistic regression was used to determine the extent to which general medical practices undertake the maximum amount of minor surgery activity allowed for in the GP contract. Data on activity for 89 practices in the Grampian region of Scotland was available for two consecutive financial years: 1992-93 and 1993-94. Comparison of the regression models developed in each year showed that rural location and practice size were consistently associated with the maximization of minor surgery activity under the terms of 1990 GP Contract. In 1993-94 practices with a greater proportion of deprived patients were also more likely to be 'maximizers'. Quantitative modelling allows the performance of GPs to be assessed and also helps to identify factors which are a barrier to service development. It seems likely that, in Grampian, GPs who were able to exploit fully the provisions of their contract were those whose patients had the greatest capacity to benefit from minor surgery. Currently the GP contract is nationally negotiated, but in the future local negotiated remuneration is likely to become widespread. Modelling will have an important role in the design and monitoring of incentive structures, and help to ensure that service provision equates to local needs.

Contract Services↗