Biomedical subjects
M M Zack
Publications and source records attributed to M M Zack.
Association of blood pressure and polychlorinated biphenyl levels.
The geometric mean serum level of polychlorinated biphenyls (PCBs) of 458 persons in a communitywide study was 17.2 microgram/L, with 80% to 90% having levels within the range found in other community groups. As a dependent variable, PCB levels were found to be positively related to age, even when controlled for all other variables associated with PCB level: sex, local fish consumption, obesity, serum cholesterol level, and alcohol consumption. No major point source of PCB contamination was found, and fish taken in the drainage of a major population center had mean PCB levels below the current enforceable Food and Drug Administration tolerance of 5 mg/kg. As an independent variable, serum PCB levels were positively associated with gamma-glutamyl transpeptidase level, serum cholesterol level, and measured blood pressure. The PCB-blood pressure association, which was independent of age, sex, body mass index, and social class, must be confirmed in other exposed populations.
Cross-sectional study of a community with exceptional exposure to DDT.
The geometric mean level of total DDT in serum samples (76.2 ng/mL) from 499 persons living downstream from a defunct DDT-manufacturing plant was several times the national geometric mean (15.0 ng/mL). DDE isomers, metabolites of DDT, accounted for an average of 86.7% of total DDT. Total DDT levels increased with age, even when controlled for other independent variables also significantly associated with DDT: race, sex, fish consumption, years of residence, socioeconomic status, alcohol consumption, and serum triglyceride levels. Fish consumption, the second strongest determinant of DDT level, had one third the predictive power of age. Total DDT levels were not associated with specific illness or ill health. However, total DDT levels were positively associated with levels of serum cholesterol, triglyceride, and gamma-glutamyl transpeptidase. The finding that serum DDE levels increase with age suggests that no equilibrium in body burden has been reached or that pharmacokinetics or serum/adipose partition may vary with age.
Alcohol consumption and high-density-lipoprotein cholesterol.
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Risk factors for myocardial infarction associated with the Chicago snowstorm of jan 13- 15, 1979.
Sixty male survivors of acute myocardial infarction in the week after the Chicago blizzard of Jan 15, 1979, were matched by hospital and sex with 60 myocardial infarction survivors from a week without snowfall to determine whether a history of previous heart disease or of cardiac risk factors increased the risk of a postblizzard myocardial infarction. Cases did not differ significantly from control subjects with respect to age, percentage working full time, or percentage with a history of heart disease, hypertension, smoking, diabetes mellitus, obesity, or gout. Hypercholesterolemia was four times as common among cases as among controls.
Increased incidence and prevalence of multiple sclerosis in Los Alamos County, New Mexico.
The incidence and prevalence of multiple sclerosis (MS) in Los Alamos County, New Mexico, were investigated because the number of reported cases appeared to have increased. The point prevalence on November 1, 1979, was 75.7 per 100,000, and average annual incidence rates for the period 1960-1969 and 1970-1979 were 3.4 and 3.7 per 100,000, respectively. The rates of MS in Los Alamos County were greater than expected from previous epidemiologic surveys of North America. The unusual ethnic composition and high socioeconomic level of the population probably contributed to the increases.
Lead exposure in stained glass workers.
To evaluate lead exposure in stained glass workers, we measured blood lead levels in 12 professional glass workers, in 5 hobbyists, and in 4 workers' family members. Professional workers lead levels (mean 20.7 micrograms/dl) were higher than hobbyists' (11.6 micrograms/dl) (P = 0.02) or family members' (11.3 micrograms/dl). Levels increased with years worked, hours worked per week, and percentage of work involving lead. The mean lead concentration in settled dust samples from a stained glass workshop was 11,000 parts per million. Stained glass workers are at increased risk of lead exposure.
Metabolic consequences of exposure to polychlorinated biphenyls (PCB) in sewage sludge.
Polychlorinated biphenyls (PCB) were discovered in sewage sludge used for fertilizer in Bloomington, Indiana. The PCB had been discharged into the municipal sewage system by an electrical capacitor manufacturing plant. To study the epidemiology and metabolic consequences of PCB exposure an epidemiologic and clinical survey was conducted. Mean serum PCB levels were 17.4 ppb in 89 sludge users, 75.1 ppb in 18 workers with occupational exposure to PCB, 33.6 ppb in 19 members of those workers' families, and 24.4 ppb in 22 community residents without unusual exposure to PCB. In sludge users PCB levels were associated positively with per cent performance of garden care (p = 0.035) and negatively with wearing gloves while gardening (p = 0.021), but were not significantly associated with the amount of sludge used or the duration of exposure. In no groups were chloracne or systemic symptoms of PCB toxicity noted, nor were significant correlations found between PCB levels and tests of hematologic, hepatic, or renal function. Plasma triglyceride levels increased significantly with serum PCB concentrations in both alcohol drinkers and nondrinkers (r = 0.541, n = 36, p < 0.001 for nondrinkers). These data indicate that PCB may alter lipid metabolism at levels of exposure and bioaccumulation insufficient to produce overt symptoms.
Epidemiology and the 1980 census.
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Increase in deaths from ischaemic heart-disease after blizzards.
Death certificates in eastern Massachusetts after six blizzards in 1974--78, including the record blizzard of Feb. 6, 1978, were examined to identify the effect on mortality of these storms. The total number of deaths was significantly higher (8%) in a "blizzard week" than in the preceding and subsequent (control) weeks (114.1 vs. 105.3 deaths per day). Deaths from ischaemic heart-disease (I.H.D.), which rose significantly by 22% in the blizzard week from 36.7 to 44.6 deaths per day, accounted for 90% of the excess total deaths. The increase was greater in males than in females (30% vs. 12%), and in both sexes there was no difference in the distribution of deaths by age between the blizzard and control weeks. I.H.D. deaths were increased for 8 days after a snowstorm, suggesting that the effect was related to activities such as snow shovelling rather than the storm itself. The identification of those at increased risk of I.H.D. death after major snowstorms and of the circumstances surrounding such deaths could lead to public-health measures to reduce these weather-related premature deaths.
Motor neuron disease in Lehigh county, Pennsylvania: an epidemiologic study.
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High school contact among persons with leukemia and lymphoma.
We studied frequency of contact among Connecticut high school students and teachers with leukemia and lymphoma diagnosed during or after high school from 1960 through 1971. Risk of having attended the same grade at the same school during the same year was greater among students with Hodgkin's disease (HD) than among simulated controls drawn in proportion to school enrollment (relative risk = 1.44; approximate 95% lower confidence limit = 1.05). Risk of developing HD was also greater among students enrolled simultaneously at the same school as students already diagnosed with HD than among students not so enrolled (relative risk = 2.05; 95% lower confidence limit = 1.39). However, fewer HD cases (16) were diagnosed from 1965 through 1970 at schools that formerly had patients enrolled (1959-64) than at matched schools without such patients (24). We found no evidence of increased contact among persons with non-HD lymphomas or leukemias, except between HD and non-HD lymphomas (relative risk = 1.41; approximate 95% lower confidence limit = 1.11).
Tetrachlorodibenzodioxin: an accidental poisoning episode in horse arenas.
Tetrachlorodibenzodioxin was identified as the apparent cause of an outbreak of poisoning in humans, horses, and other animals. Exposure was related to the spraying of contaminated waste oil on riding arenas for dust control. The contamination resulted from improper disposal of a toxic industrial waste. The pathologic effects and chemical identification of tetrachlorodibenzodioxin are described.
Letter: Sibship size and Hodgkin's disease.
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Neurologic evaluation of a population exposed to arsenic in Alaskan well water.
One hundred forty-seven persons exposed to arsenic from well water were evaluated by neurologic examination and nerve conduction studies. Total arsenic concentrations in well water ranged from 1 to 4781 micrograms/L and from 6 to 4964 micrograms/L in urine; a calculated index of arsenic ingestion ranged from 1 to 4521 micrograms/day. No dose-response relationship existed between arsenic ingestion and symptoms or physical findings compatible with peripheral neuropathy. Five of six persons with symptoms or physical findings suggestive of sensory neuropathy had normal nerve conduction velocities. Thirteen persons with elevated arsenic ingestion but no signs or symptoms of neuropathy had one or more abnormal nerve conduction velocities. No dose-response relationship, however, existed between arsenic ingestion and nerve conduction velocities. The authors concluded that arsenic ingestion from well water at the concentrations found in this Alaskan community did not result in clinical or subclinical neuropathy.
Measuring health-related quality of life for public health surveillance.
In public health research and practice, quality of life is increasingly acknowledged as a valid and appropriate indicator of service need and intervention outcomes. Health-related quality of life measures, including objective and subjective assessments of health, are particularly useful for evaluating efforts in the prevention of disabling chronic diseases. Such data can inform health policy, planning, and practice. Mechanisms for routinely monitoring quality of life of populations at the State and local levels are currently lacking, however. This article discusses the rationale for and concepts measured by four quality of life questions developed for the 1993 Behavioral Risk Factor Surveillance System, a State-based telephone surveillance system. To encourage quality of life surveillance by States, the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion held two related workshops, one in December 1991 and the other in June 1992. The workshops convened experts in quality of life and functional status measurement and resulted in the formulation of items for the Behavioral Risk Factor Surveillance System on self-perceived health, recent physical and mental health, and recent limitation in usual activities. The criteria, including feasibility and generalizability, considered by the Centers for Disease Control and Prevention and the workshop participants in the selection and development of these items are discussed. A model that conceptualizes the relationship of quality of life domains measured by the four survey items is presented and validated with preliminary data from the 1993 Behavioral Risk Factor Surveillance System. Finally, how States can use these measures to track progress towards the Year 2000 goal of improving quality of life is discussed.