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Biomedical subjects

Philip Harber

Publications and source records attributed to Philip Harber.

18 recordsLinked to original sources
PubMed2007

Computer algorithm for automated work group classification from free text: the DREAM technique.

OBJECTIVE: This study developed and tested a computer method to automatically assign subjects to aggregate work groups based on their free text work descriptions. METHODS: The Double Root Extended Automated Matcher (DREAM) algorithm classifies individuals based on pairs of subjects' free text word roots in common with those of standard classification systems and several explicitly defined linkages between term roots and aggregates. RESULTS: DREAM effectively analyzed free text from 5887 participants in a multisite chronic obstructive pulmonary disease prevention study (Lung Health Study). For a test set of 533 cases, DREAMs classifications compared favorably with those of a four-human panel. The humans rated the accuracy of DREAM as good or better in 80% of the test cases. CONCLUSIONS: Automated text interpretation is a promising tool for analyzing large data sets for applications in data mining, research, and surveillance. Work descriptive information is most useful when it can link an individual to aggregate entities that have occupational health relevance. Determining the appropriate group requires considerable expertise. This article describes a new method for making such assignments using a computer algorithm to reduce dependence on the limited number of occupational health experts. In addition, computer algorithms foster consistency of assignments.

Algorithms↗
PubMed2006

Mesothelioma in patients with nonoccupational asbestos exposure. An evidence-based approach to causation assessment.

The specific parameters of nonoccupational asbestos exposures (NOAE) that can distinguish an idiopathic from an asbestos-caused malignant mesothelioma (MM) are controversial. A systematic literature review yielded 1028 cases with this putative association. Only 287 of those reports had a defined single exposure to a household, building occupant, or neighborhood/community asbestos source. The available "evidence" was used to develop semiarbitrary evidence-based causation guideline rules for the assessment of putative associations between MM and NOAE. The rules are classified into class A (tissue burden analysis shows asbestos body counts or fiber counts in lung tissues comparable to MM caused by occupational exposure to asbestos) and classes B to D based on whether certain combinations of NOAE features and MM (evidence) have been described in over 15% (class B), 5% to 15% (class C), and less than 5% (class D) of the patients reviewed. The proposed 4 classes of evidence-based causation guidelines provide a semiarbitrary framework to evaluate the causation of individual MM patients by NOAE based on decreasing levels of currently available evidence. The neoplasms in classes A to C patients are probably caused by NOAE, with decreasing weight of evidence in the 3 groups. There is minimal evidence to support the causation of MM by NOAE in class D patients. There is no evidence or only anecdotal evidence to support a causal association between MM and NOAE in individuals who cannot be classified into any of the 4 classes. Future studies are needed to provide more comprehensive data regarding the association between MM and NOAE.

Asbestos↗
PubMed2006

Training pathways for occupational medicine.

OBJECTIVE: Consider the funding, organization, and applicant pool for occupational medicine residency training positions concerns in the United States. METHODS: Postgraduate training models are compared for responsiveness to competence and workforce needs, including traditional residency, nontraditional residency, postdoctoral fellowship, extended courses, multiple certificate preparation, continuing medical education, "executive MPH," and implicit education (learning from consultants in the course of practice). RESULTS: Educational models differ in comprehensiveness, crossdisciplinary experience, socialization to core professional values, financial requirements, accessibility to physicians currently in practice, potential number of trainees, and short- and long-term impact on training outcomes. CONCLUSION: There are tradeoffs between the benefits of comprehensive program standards and the benefit of facilitated training access by reducing barriers or requirements. Recognizing and understanding assumptions about training in our discipline may inform future choices.

Education, Medical, Continuing↗
PubMed2005

Influence of residency training on occupational medicine practice patterns.

OBJECTIVES: A relatively high proportion of occupational medicine (OM) specialists have not had formal residency training in OM. Members of the Western Occupational and Environmental Medicine Association, a professional organization of OM specialists, completed a postal questionnaire (160 of 561 members). METHODS: Educational background, practice setting, practice activities, and skills considered relevant were compared between those with and without formal training. RESULTS: Both groups had considerable focus in clinical care, musculoskeletal medicine, and workers' compensation. However, those with formal training practice in a broader variety of settings were less likely to have practiced another specialty, and used additional skills (toxicology, industrial hygiene, and epidemiology) in their practices. Formal education appears to create a greater diversity of skills and opportunities, but it does not appear to create a group of physicians disinterested in "front-line" occupational medicine practice. CONCLUSIONS: The data support the need for formal residency programs but also highlight the importance of access to formal training for midcareer physicians.

Clinical Competence↗
PubMed2005

Work environment and occupational health of dental hygienists: a qualitative assessment.

OBJECTIVE: We sought to characterize the work environment and identify factors that influence the occupational health of dental hygienists. METHODS: We conducted a qualitative analysis of dental hygiene work based on five national focus groups. RESULTS: We found that musculoskeletal symptoms are common, particularly after 10 years; common ergonomic problems included instruments and chairs. Important non-physical workplace problems include role ambiguity (eg, employee vs. independent practitioner), inadequate recognition, role identity (eg, distinction from dental assistants), role conflict (eg, with dentists and spousal office managers), and social isolation. CONCLUSIONS: Work organizational factors (eg, frequent part-time work, inadequate breaks, perception as a "second team" distinct from the dentist and dental-assistant team) impede the remediation of ergonomics and other problems. Job flexibility encourages hygienists to change work hours or location rather than deal with work conditions. Occupational health interventions should address social environment and work organization.

Adult↗
PubMed2005

Work environment of dental hygienists.

OBJECTIVE: We sought to evaluate how musculoskeletal disorders and workplace psychosocial factors affect dental hygienists' work hours and productivity. METHODS: We mailed a survey to dental hygienists in Los Angeles and Orange Counties, California. RESULTS: Musculoskeletal pain caused 27% of hygienists to decrease work hours and 8.7% to change office locations. Hand/wrist pain caused the most missed workdays. Conversely, conflicts with the dentist caused 28.2% of dental hygienists to change jobs and 12.7% to decrease work hours. Conflicts with staff caused 17.1% to change office locations but only 7.0% to decrease work hours. This pattern was confirmed with multiple logistic regression analyses. CONCLUSIONS: Musculoskeletal and psychosocial factors affect dental hygienists differently: musculoskeletal discomfort is more likely to cause dental hygienists to decrease their working hours, whereas professional and social conflicts are more likely to lead to change in work location.

Absenteeism↗
PubMed2005

Working words: real-life lexicon of North American workers.

OBJECTIVE: This study describes a new computer methodology for analyzing workers' free text work descriptions. METHODS: Computerized lexical analysis was applied to work descriptions of participants in the Lung Health Study, a smoking-cessation study in persons with early chronic obstructive pulmonary disease. Text was parsed and analyzed as single term roots and pairs of roots commonly occurring together. RESULTS: The frequencies of terms reflect the work of a population; our subjects' most frequently used terms included "sale, office, service, business, engine[er], secretary, construct, driv[e], comput[e], teach, truck." Standard classification schemes (NAICS and SOC) and textbooks use terms inconsistent with those of actual workers. Many common empirical terms imply both industry and job information content, although traditional coding schemes separate industry and job title. CONCLUSIONS: Formal analyses of language may facilitate communication, identify translation priorities, and allow automated work coding.

Female↗
PubMed2004

Fatal rat bite fever in a pet shop employee.

BACKGROUND: Rat bite fever is a zoonotic disease that has been described in laboratory personnel as well as the general population. METHODS: A 24-year-old male pet shop employee contracted the disease through a minor superficial finger wound on a contaminated rat cage. The disease progressed from a flu-like illness to endocarditis involving first the aortic valve and then the mitral valve and septum. Despite aggressive therapy including two surgical procedures, the patient died from sepsis and multi-organ system failure 59 days after initial injury. RESULTS: This is the first reported case of rat-bite fever (RBF) in a pet shop work setting. CONCLUSIONS: Zoonotic infections may present a significant hazard to workers handling animals. Education on hazards of animal contact and other preventive measures are needed in small places of business like pet shops.

Adult↗
PubMed2003

Occupational issues in episodic care populations.

BACKGROUND: Much care for non-emergency problems is provided at "episodic care" settings (e.g., urgent care and emergency room). METHODS: Ninety-four subjects, without known occupational disease, who were seeking care for a chronic or sub-acute problem in an episodic care location, were interviewed to assess the frequency and types of occupational health concerns. They were asked whether work probably "caused" or "made worse" their illness and whether their illness "made work difficult." RESULTS: Categorized hierarchically, 20% reported causation, 15% worsening, and 15% interference of illness with work. (Each was categorized in one category only). Only 50% reported absence of a workplace-health interaction. One-third reported that workplace changes could improve their functional status. Nevertheless, workplace factors were discussed only 21% of the time in physician-patient encounters. CONCLUSIONS: This study suggests that occupational health issues are frequent in episodic care settings and that the definition of occupational health issues should be broadened to include "made worse" and "illness makes work difficult" as well as the traditional workplace causation definition. Further, episodic care settings present unique opportunities for prevention.

Ambulatory Care↗
PubMed2003

Effect of carbon black exposure on respiratory function and symptoms.

Carbon black is a widely used pigment and filler. Some, but not all, previous studies have suggested an effect of long-term exposure upon the lungs. Carbon black production facility employees (1755) participated in the third round of the industry-wide medical surveillance testing. They were employed in 22 North American plants. Spirometry and a systematically administered questionnaire were included in the year 2000 round of the industry-wide medical surveillance program. Industrial hygiene data from an industry-wide survey in 2000-2001, as well as all available exposure assessment data collected since 1979, were integrated with process questionnaires and exposure rating questionnaires completed by plant personnel. Analyses included multiple linear regression and categorical data analyses. Multiple regression analyses showed statistically significant, consistent relationships between cumulative exposure and small reductions in forced expiratory volume in 1 second (FEV1) but not with other spirometry parameters. The estimated slopes were -2 mL FEV1 per mg-year/m3 of cumulative 'total' dust exposure and -0.7 mL FEV1 per mg-year/m3 of cumulative exposure for the inhalable fraction. In addition, heavy cumulative exposures were associated with a small increase in chronic bronchitis in nonsmokers. Recent exposures, typically much lower than in the past, were not demonstrated to be associated with these effects. Consistent with good occupational hygiene practice for any contaminant, workplace exposures to carbon black should be controlled to lowest practical levels.

Adult↗
PubMed2003

A triangulation approach to historical exposure assessment for the carbon black industry.

The determination of cumulative exposures for individual workers is necessary for research and practice of occupational health and hygiene. Reconstruction of exposures for a study of respiratory morbidity was needed to study the effects of exposure to carbon black production. Approximately 15,800 exposure estimates were needed. There were 22 plants, a 40-year time span, six job categories, and three types of dust-exposure metrics (respirable, inhalable, and "total" dust). Three information sources were used: 1) Industrial hygiene air level measurements where available (several industry-wide surveys had been conducted). 2) A formal process survey identifying specific dates and types of process and control changes. 3) An Historical Relative Exposure Rating Scale; plant health and safety personnel used this spreadsheet-based rating scheme to quantify exposures before and between years of actual measurement relative to a reference year in which measurements were available. A job-exposure matrix was calculated by integrating these three methods. Linear scaling factors were identified to interconvert geometric to arithmetic means and to interconvert total and inhalable dust. Individual worker cumulative exposures were then calculated based upon job histories linked with the job-exposure matrix. The nine-step process for integrating all available relevant data was effective in estimating the exposures for each of the cells of the job-exposure matrix. Among the 1680 workers participating, the mean cumulative inhalable dust exposure was 48.4 mg-years/m3. Early years contribute disproportionately to the cumulative exposures of individuals since levels have declined significantly over time. The use of multiple sources of information, including a relative exposure rating instrument, significantly facilitates reconstruction of historical exposures. Inadequate adjustment for temporal trends can lead to underestimation of cumulative exposures and significantly affect estimation of dose-effect relationships. These methods are applicable to other situations requiring estimation of cumulative exposure with sparse industrial hygiene data in early years.

Carbon↗
PubMed2002

A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study.

STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. SUMMARY OF BACKGROUND DATA: Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown. METHODS: Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. RESULTS: Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32-0.86; average pain, 0.22, -0.25-0.69; and disability, 0.75, -0.29-1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20-2.32). CONCLUSIONS: After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small.

Analgesics↗
PubMed2002

Fatal asbestosis 50 years after brief high intensity exposure in a vermiculite expansion plant.

The authors report the case of a 65-year-old accountant whose only asbestos exposure was during a summer job 50 years earlier in a California vermiculite expansion plant. Vermiculite is a silicate material that is useful in building and agriculture as a filler and insulating agent. He developed extensive fibrocalcific pleural plaques and end-stage pulmonary fibrosis, with rapidly progressive respiratory failure. Careful occupational and environmental history revealed no other source of asbestos exposure, and the initial clinical diagnosis was idiopathic pulmonary fibrosis; open lung biopsy shortly before his death confirmed asbestosis. Electron microscopic lung fiber burden analysis revealed over 8,000,000 asbestos fibers per gram dry lung, 68% of which were tremolite asbestos. Additional asbestiform fibers of composition not matching any of the standard asbestos varieties were also present at over 5,000,000 fibers per gram dry lung. Comparison analysis of a sample of Libby, Montana, vermiculite showed a similar mix of asbestiform fibers including tremolite asbestos. This case analysis raises several concerns: risks of vermiculite induced disease among former workers of the more than 200 expansion plants throughout the United States; health effects of brief but very high-intensity exposures to asbestos; and possible health effects in end-users of consumer products containing vermiculite.

Aged↗
PubMed2002

Second Prize: The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study.

BACKGROUND: Although chiropractors often use physical modalities with spinal manipulation, evidence that modalities yield additional benefits over spinal manipulation alone is lacking. OBJECTIVE: The purpose of the study was to estimate the net effect of physical modalities on low back pain (LBP) outcomes among chiropractic patients in a managed-care setting. METHODS: Fifty percent of the 681 patients participating in a clinical trial of LBP treatment strategies were randomized to chiropractic care with physical modalities (n = 172) or without physical modalities (n = 169). Subjects were followed for 6 months with assessments at 2, 4, and 6 weeks and at 6 months. The primary outcome variables were average and most severe LBP intensity in the past week, assessed with numerical rating scales (0-10), and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. RESULTS: Almost 60% of the subjects had baseline LBP episodes of more than 3 months' duration. The 6-month follow-up was 96%. The adjusted mean differences between groups in improvements in average and most severe pain and disability were clinically insignificant at all follow-up assessments. Clinically relevant improvements in average pain and disability were more likely in the modalities group at 2 and 6 weeks, but this apparent advantage disappeared at 6 months. Perceived treatment effectiveness was greater in the modalities group. CONCLUSIONS: Physical modalities used by chiropractors in this managed-care organization did not appear to be effective in the treatment of patients with LBP, although a small short-term benefit for some patients cannot be ruled out.

Adult↗
PubMed2002

Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study.

OBJECTIVES: This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. METHODS: Satisfaction scores (on a 10-50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. RESULTS: The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients' satisfaction. CONCLUSIONS: Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction.

Adolescent↗
PubMed2002

A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study.

OBJECTIVES: This study compared the relative effectiveness of cervical spine manipulation and mobilization for neck pain. METHODS: Neck-pain patients were randomized to the following conditions: manipulation with or without heat, manipulation with or without electrical muscle stimulation, mobilization with or without heat, and mobilization with or without electrical muscle stimulation. RESULTS: Of 960 eligible patients, 336 enrolled in the study. Mean reductions in pain and disability were similar in the manipulation and mobilization groups through 6 months. CONCLUSIONS: Cervical spine manipulation and mobilization yield comparable clinical outcomes.

Adult↗