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Biomedical subjects

R Sass

Publications and source records attributed to R Sass.

At least 19 recordsLinked to original sources
PubMed1999

The unwritten story of women's role in the birth of occupational health and safety legislation.

Women's role in the formation of trade unions and development of collective bargaining, as well as in labor's historical struggle to improve day-to-day working conditions, has been conspicuously underplayed, if not ignored. Yet, when one reviews the history of the reduction of working hours, prohibition of child labor, elimination of homework in tenement slums, reform of factory legislation, and investigations into accidents precipitating early workers' compensation legislation, the literature is rich with women's investigative reports and studies on unhealthy and unsafe working conditions. This was the case from the late 19th century in North America up until the 1950s and the Cold War. The women's movement and political activities requiring factory reforms then seemed to go underground, re-emerging in full force during the 1960s. Women's involvement in the environmental movement, especially in the United States, has been significant in politicizing occupational health as well. Their efforts led to the 1970 passage of the U.S. Occupational Health and Safety Act.

Canada↗
PubMed1996

A strategic response to the occupational health establishment.

The experiences of occupational health and safety "activists" in Canada reveal the limits of achieving reform in working conditions by technical efforts in combination with rank-and-file activation. The author argues that the way union "activists" approach occupational health and safety limits workers in dealing with their actual experiences and understanding about workplace hazards and risks, then discusses the condition for the awakening of their critical consciousness as a basis of acting on hazardous working conditions. The first movement in the way the worker apprehends the work environment is a movement of negation and is the prior condition to a critical and disclosive discourse about workplace hazards. It is the positive side of "No!" and the taking seriously of workers' rights. It is this negation of the negative that holds out the greatest hope for solidarity and a liberatory community in workplaces, since legislated workers' rights as the basis of protection have become a facade. Workers can respond with the power of saying "No!" in solidarity with suffering workers, and then work through appropriate principles, ends, or strategies avoiding entrapment by a "telos" in the first instance. By laying out these "ends" or a strategic paradigm, one introduces a "conversation stopper" for workers and atrophies their activation.

Canada↗
PubMed1996

A message to the labor movement: stop and think!

Trade unions and workers in North America have been objectified and instrumentalized by all political regimes, including the social-democratic New Democratic Party in Canada. And it is means-end non-thinking that characterizes government policies. Liberal elites and policy-making have marginalized ordinary workers making them "superfluous" without any vision of an "ethical community" and demonstrating contempt for democratic initiatives. There are oppositionary voices to the dominant social structures that oppress and undermine community and solidarity. However, trade unions and occupational health and safety "activists" have yet to reassess their strategies on workplace health and safety reforms, but are on the defensive in North America. Further, they are complicit with the dominant ideology and the occupational health and safety establishment, including the various and diverse professionals, who shape how we think about work environment matters; and they accommodate government regulators in mediating worker experiences and expectations with employer interests. The author suggests the beginning of a strategy that does not succumb to present-day liberal public policy-making and the atrophy of alternative options. In part, this strategy calls for a rudimentary phenomenology of moral judgment and a reconstruction of labor "tradition".

Canada↗
PubMed1995

A conversation about the work environment.

The author looks at work environment matters from the perspective of public policy-making and the policy instruments used to deal with workplace health and safety: standard setting; joint health and safety committees; compliance, enforcement, and prosecution; workers' compensation as an economic incentive; and collective bargaining. While regarding all as necessary, the author considers them as separately and collectively, fundamentally flawed and therefore insufficient, because liberal public policy-making itself is problematic. He proposes an alternative way of thinking about this subject from the perspective of the "politics of meaning."

Canada↗
PubMed1994

Serum antibodies to Klebsiella capsular polysaccharides in ankylosing spondylitis.

OBJECTIVE: To measure antibodies to Klebsiella capsular polysaccharides in the sera of HLA-B27 positive patients with ankylosing spondylitis (AS), compared with HLA-B27 positive and HLA-B27 negative healthy control subjects. METHODS: Antibodies were detected by means of an enzyme-linked immunosorbent assay specific for each of the 77 known Klebsiella serotypes. RESULTS: Significantly elevated frequencies and titers of antibodies to capsular polysaccharides K26, K36, and K50 were detected in sera from AS patients, compared with controls. CONCLUSION: These results suggest the predominance of Klebsiella serotypes K26, K36, and K50 in patients with AS.

Adult↗
PubMed1994

Labor policy and social democracy: the case of Saskatchewan, 1971-1982.

This article analyzes labor policy, especially that of occupational health and safety, initiated by the Saskatchewan New Democratic Party (NDP) from 1971 to 1982. The NDP was perceived by Canadian provincial labor federations and the Canadian Labour Congress as the government most approximating a European labor party. The provincial labor legislation was seen as exemplary, and the occupational health and safety legislation as a "beacon" for the rest of Canada. This article suggests that the advances in occupational health and safety statute and regulations were a direct response to the government's policy to develop uranium mining. In order to pursue a vigorous renewable and nonrenewable resource policy, the government maintained that uranium could be mined "safely." This resulted in "progressive" health and safety legislation and the reinforcement of the colonial status of people of Indian ancestry. This policy of growth and development also resulted in joint venture relationships with multinational corporations and increasing investments in the north for nonrenewable resource development. Prior to the landslide defeat of the NDP in 1982 by the Conservative Party, the richest 5 percent of Saskatchewan people earned as much, in total, as the poorest 50 percent. Meanwhile, ordinary workers experienced declining real wages and increased employment insecurity.

Democracy↗
PubMed1993

The Work Environment Board and the limits of social democracy in Canada.

A Work Environment Board was established to deal with all workplace health and safety issues within the Potash Corporation of Saskatchewan from 1978 to 1982. The Board was an experiment, established because of the observed deficiencies of the mandatory joint occupational health and safety committees that were legislated by the province in 1972. The administrators of the occupational health and safety program observed the problems faced by workers on these committees. An experiment was therefore established in one of the province's crown corporations that would transform the joint committee into a Work Environment Board with wider powers to deal with work environment matters within the corporation. In addition, a Work Environment Fund was established to enable the worker members on the Board to do their own research and to get the information they wanted. The Work Environment Board was frustrated by the fact that corporate leaders were not prepared to extend worker rights on the health and safety committees within the respective mines. Rather, they viewed health and safety reforms as part of an overall strategy of quality of work life. The social democratic government was not prepared to extend worker rights and to threaten management prerogatives. Now that there are three New Democratic Party (social democratic) governments in Canada, it appears that these governments are prepared to initiate technical improvements, but not the extension of worker rights in work environment matters.

Accidents, Occupational↗
PubMed1992

[Stage-independence and individual outcome of neuro-cognitive deficits in HIV. A follow-up study of 62 HIV-positive hemophilic patients].

62 of a series of 188 HIV-positive hemophiliacs, who had been neuropsychologically evaluated already in 1988 (T1), were re-examined 1 1/2 years later (T2). The aims of the study were to confirm the cross-sectional results of the 1988 study and to compare cross-sectional and longitudinal aspects of HIV infection and associated neurocognitive deficits. Patients were staged at T1 and T2 according to CDC classification criteria and retested using parallel tests of attention, verbal/nonverbal memory performance and depression. The following results were observed: (i) Data at T2 paralleled the findings from 1988, indicating increased deficits in attention and verbal learning and memory at an advanced stage of the disease. No association with the T4/T8 ratio was found. (ii) Between T1 and T2, 65% of the patients showed no change in stage, 27% changed one stage and only 8% showed a rapid progression through two stages. (iii) Only this latter group showed a significant cognitive deterioration over time. The remaining groups exhibited inconsistent performance changes which did not correlate with depression of changes of the T4/T8 ratio. Conclusively, the longitudinal data support the assumption of stage independent and individual different courses of the neurocognitive manifestations of HIV. A small minority of patients, however, manifested a rapid progression of the disease during the T1-T2 interval.

AIDS Dementia Complex↗
PubMed1990

Medullary cancer of the breast revisited.

Common as well as unusual, heretofore unmentioned histopathologic features observed in 336 typical and 273 atypical medullary breast cancers from 6404 patients enrolled in various stage I and II protocols of the National Surgical Adjuvant Breast and Bowel Projects (NSABP) are presented. Both medullary types exhibited comparable pathologic findings, except for the infiltrative border and/or slight or absent tumor lymphoid infiltrate which by definition characterize the atypical form. Both also demonstrated a similar, high proclivity to be aneuploid, and to lack estrogen and progesterone receptors and nodal metastases. After appropriate statistical adjustments, survival (analyzed for 198 patients with typical and 149 with atypical medullary cancers) was found to be better for untreated, node-negative and node-positive patients treated with L-PAM + 5Fu who had typical medullary cancers than those with the NOS histologic type. The magnitude of this difference was 6% at 5 and 17% at 10 years post-operatively (cumulative odds = 1.81 with a 95% confidence interval of 1.08 - 3.3) for the former group, and 4% at 5 and 16% at 10 years (cumulative odds = 1.56 with a 95% confidence interval of 1.08 - 2.23) for the latter. Survival was comparable for patients with atypical medullary and NOS types in both situations. No clear difference in survival was found in untreated, positive node patients with the 3 histologic types examined, although the sample sizes in this subset were relatively small. This information as well as other pertinent considerations indicate that the prognosis of typical medullary cancer is not as 'good' as previously perceived. It is also concluded that there is insufficient evidence at present to exclude the atypical medullary variant as a histologic type of breast cancer.

Biomarkers, Tumor↗
PubMed1989

Dukes' classification revisited. Findings from the National Surgical Adjuvant Breast and Bowel Projects (Protocol R-01).

The relative prognostic value of the Dukes, Astler, and Coller and TNM staging systems was evaluated for 745 pathologically evaluable patients with rectal cancer enrolled in protocol R-01 of the National Surgical Adjuvant Breast and Bowel Projects. All three methods were found to be highly interrelated. However, the magnitude and consistency of prognostic discrimination among stages was best exhibited by the Dukes' and TNM systems. Survival was comparable among patients with Astler and Coller A and B1 and TNM T1N0M0 and T2N0M0 lesions. Since neither method improved on the predictability noted in Dukes' A cases it is suggested that the use of confusing subscripts is unnecessary. On the other hand, striking prognostic discrimination was observed when Dukes' C cases were subdivided according to depth of tumor penetration as proposed by Astler and Coller and designated as C1 and C2. Multivariate analyses revealed this feature to be independent of number of nodal metastases (1-4 versus 5+ positive), their site (near or far from the growth), or degree of tumor differentiation. The site of nodal metastases appeared to be related to numbers of nodal metastases rather than site per se. Considerations of the findings indicate that the Dukes' staging method is the simplest and most consistent algorithm related to prognosis. The only modification that would enhance its value in this regard would be the subdivision of C cases according to the criteria of Astler and Coller rather than that proposed by Dukes himself.

Aged↗
PubMed1989

Relative prognostic value of the Dukes and the Jass systems in rectal cancer. Findings from the National Surgical Adjuvant Breast and Bowel Projects (Protocol R-01)

A comparison of the prognostic values of the Dukes and Jass systems were performed with 722 patients with rectal cancer enrolled in the National Surgical Adjuvant Breast and Bowel Projects, protocol R-01. The Jass system revealed four prognostic groups when all patients or only Dukes' B and C cases were examined; however, the magnitude of differences between groups I and II and III and IV were small. Dukes' classification, as defined in this study, revealed five prognostic groups. A statistically strong association between the Jass and Dukes systems was observed. Although histologic grade permitted further prognostic discrimination of all Dukes stages except A, only the Jass system allowed for the subdivision of C cases with up to four nodes positive for metastases. Those in that group had survival rates comparable to B cases (no nodal involvement) when scores of I and II were found. The distributions of the patients in the extremes of the Jass and Dukes systems (C2 as defined) were almost similar. The findings indicate that the Jass system is a valid prognostic method for patients with rectal carcinoma. In this material, however, it basically allowed for only two major prognostic groups whereas five were noted by the Dukes method. These results, as well as the more objective nature of Dukes' classification, warrant its continued use for prognosis and therapeutic decisions for patients with rectal cancer.

Humans↗
PubMed1989

Doxorubicin-containing regimens for the treatment of stage II breast cancer: The National Surgical Adjuvant Breast and Bowel Project experience.

Despite numerous reports of findings obtained following the use of doxorubicin (Adriamycin [A]; Adria Laboratories, Columbus, OH) for the postoperative treatment of patients with primary breast cancer and positive axillary nodes, no clear consensus exists regarding its worth when used in that setting. In June 1981, the National Surgical Adjuvant Breast and Bowel Project (NSABP) implemented two randomized clinical trials aimed at evaluating the worth of doxorubicin when administered in conjunction with melphalan (L-PAM) and fluorouracil (5-FU) (PF). A prior NSABP study identified cohorts of patients who did or did not benefit from tamoxifen (TAM, T) when used with chemotherapy. That information was employed in the design of the present studies. Women considered responsive to TAM (1,106) were randomized between PFT and PAFT, and those nonresponsive to TAM (707) were randomized between PF and PAF. Findings through 6 years of follow-up (mean duration of potential time on study, 64 months and 63 months, respectively) indicate that non-TAM-responsive patients who received PAF had a significantly better disease-free survival (DFS) (P = .003) and survival (P = .05) than did those receiving PF. By contrast, there was no significant difference in DFS (P = .6) or survival (P = .7) between PFT- and PAFT-treated patients. No disparity in the amount of drug received, whether related to the median amount or to dose-intensity, is present to account for the difference in findings between the studies. Aside from alopecia and emesis, the toxicity from the doxorubicin-containing regimens was similar to those in which doxorubicin was omitted. Cardiomyopathy was not a significant finding; there were no deaths from cardiac toxicity. The incidence of arterial and venous complications in patients receiving TAM was less than reported by others.

Aged↗
PubMed1989

The implications of work organization for occupational health policy: the case of Canada.

This article examines occupational health and safety developments in Canada during the decade of the 1970s when most government jurisdictions replaced former factory Acts with new health and safety legislation recognizing the right of workers to be involved in work environment matters. During the latter part of the 1970s, health and safety "activists" and trade unionists began to perceive the need for a wider conception of occupational health and safety. Canadian reformers were influenced by Scandinavian developments, especially the research of Dr. Bertil Gardell and his associates. Unfortunately, during the late 1970s Canada experienced a recession and a political shift to conservatism. Consequently, during the 1980s there have been no meaningful workplace health and safety reforms. Further, the article suggests that there is strong resistance by management and government to extension of worker rights in occupational health and safety. All major political parties ground their work environment policies in utilitarian concepts that trade worker health and safety for economic considerations. The author, therefore, argues for the development of an "ethics of the work environment" based upon egalitarian principles, and the transformation of the primary work group into a community of workers who can shape the character of their work environment. Ideally, the relationship between the major "actors" in our industrial relations system ought to be based on obligation instead of the present language of worker protest based on rights. Nonetheless, there is a need to extend and deepen worker rights in the workplace. Finally, the author argues that the appropriate relationship in industry to reflect a democratic work environment is "partnership"--the coming together of the primary work groups as equals.

Accident Prevention↗
PubMed1989

Value of assessment of ploidy in rectal cancers.

Flow cytometry was performed on available archival material from 232 patients with rectal cancer enrolled in the National Surgical Adjuvant Breast and Bowel Project protocol R-01. Tumor ploidy was not found to be significantly related to such pathologic and clinical parameters as Dukes' stage; nodal status; nuclear or histologic grades; patient's age, sex, or overall survival rate with an average study time of 79 months. A trend was evident that patients with poor histologic grade, or those with Dukes' B and C tumors that were aneuploid fared worse than those with diploid cancers. However, measurements of survival were found to be more strongly and consistently related to such conventional prognostic parameters as tumor differentiation, Dukes' stage, and nodal status. Further, numbers of nodes with metastases (ie, 1 to 4 or 5+) more significantly discriminated Dukes' C cases than estimation of tumor ploidy. Although tumor ploidy may reflect some features of rectal cancers, their natural history and prognosis are explained better by assessment of conventional parameters used for these purposes.

Age Factors↗
PubMed1987

Pathologic findings from the national surgical adjuvant breast project. Correlations with concordant and discordant estrogen and progesterone receptors.

Pathologic materials were available for review from 1597 women with Stage II (positive regional node metastases) invasive breast cancer in whom estrogen receptor (ER) and progesterone receptor (PR) assays of the primary tumor were performed. These women were enrolled in a clinical trial comparing the effect of postmastectomy adjuvant L-phenylalanine mustard (L-PAM) and 5-fluorouracil (5-FU) with and without tamoxifen (NSABP Protocol No. 9). Significant pathologic and clinical associations with receptor status were similar for both ER and PR except that the latter, unlike ER, was not related to patient age. Regression analyses revealed that the most significant pathologic features related to a concordant positive ERPR receptor status was low (well differentiated) nuclear and histologic grades, slight or absent tumor lymphoid infiltrate, slight or absent necrosis and moderate or marked elastica in decreasing order of importance. All of the factors enumerated are directly or indirectly related to tumor differentiation. Recognition of four or five conforming pathologic features allows for the prediction of either ER or PR status in 70% to 80% of instances respectively, and the presence of three features in 69%. This latter figure is similar to that of estimation of nuclear grade alone. Thirty percent of ERPR estimates were discordant i.e., either ER-PR+ or ER+PR-. Pathologic features associated with discordant assays were not similar to those found when the ERPR estimates were concordant. Life table analyses revealed patients with discordant receptors to exhibit disease-free survival intermediate to that of those with ER+PR+ and ER-PR- values. This information suggests that a discordant receptor status is more reflective of an aberration of ER metabolism than a methodologic error. Histograms correlating frequency of nuclear grades with levels of ER and PR were comparable and revealed patterns indicating the propriety of relating values less than 10 fm/mg as being receptor negative. The frequency of well-differentiated nuclei increased with ascending levels of ER and PR.

Breast Neoplasms↗
PubMed1986

Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). II. Relation of local breast recurrence to multicentricity.

One hundred ten local breast recurrences were observed in 1108 pathologically evaluable patients enrolled in NSABP protocol 6 who were treated by lumpectomy and followed for 5 to 95 months (average, 39 months). Eighty-six percent and 95% of all local breast recurrences were noted within 4 and 5 years, respectively, following lumpectomy. Life table analysis revealed their incidence to be 24% for those not and 6% for those receiving lumpectomy and breast irradiation. One hundred four (95%) of the breast recurrences involved the mammary parenchyma and the remaining 6 (5%) involved the skin and/or nipple only. Eleven (10%) of the former were noninvasive. The most common (86%) presentation of breast recurrence appeared to be a localized mass within or close to the quadrant of the index cancer. In 14% the recurrence not only involved the same quadrant, but was more diffuse within the breast extending to remote areas as well. This type was characterized pathologically by marked intralymphatic extension as well as involvement of the overlying skin and/or nipple after the fashion of so-called inflammatory or occult inflammatory breast cancer. The recurrences noted in the skin and/or nipple only were also pathologically characterized by intralymphatic involvement at these sites in the majority of instances. These two forms of breast recurrences appear to reflect the localized growth of highly aggressive invasive breast cancers. The concordance of histologic types and grades of the index and recurrent cancers implies that such events represent growth of overlooked tumor, a deficiency attendant with lumpectomy due to the extreme multifocal nature (not multicentricity) of some breast cancers and/or inadequacies in evaluating the lines of resection of lumpectomy specimens. Sources of error in regard to this latter are identified and guidelines for the examination of such specimens, as well as the assessment of margins, are presented. The observation that local breast recurrences noted following lumpectomy occurred within or close to the same quadrant as the index cancer, despite the presence of multicentric noninvasive cancers in 10% of the patients treated by total mastectomy, minimizes the biological and clinical significance of multicentric foci of cancer present in some breast cancers. Cancer measuring greater than or equal to 2.0 cm, having high histologic and nuclear grades, or intralymphatic extension, were found to have a statistically significant association with local breast recurrence in all patients following lumpectomy. A converse relationship was noted with tubular and scar cancers of types 1 and 4.(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗
PubMed1986

Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). I. Intraductal carcinoma (DCIS).

Seventy-eight examples of intraductal carcinoma (DCIS) were identified after pathologic review of 2072 specimens obtained from National Surgical Adjuvant Breast Project protocol 6. This randomized clinical trial compares the therapeutic merit of total mastectomy (TM) with lumpectomy (L), with (LX) and without (LO) postoperative irradiation. All patients were subjected to axillary lymph node dissection. Seven (14%) of the 51 patients with DCIS treated by L exhibited breast recurrence within or close to the site of the initial lesion 4 to 53 months (average, 16 months) after L. Only 2 (7%) of these events occurred in the 29 women treated by LX, as opposed to 23% in the LO group. No pathologic features were noticed that might have been considered predictive of local breast recurrence. The three DCIS recurrences and the four invasive forms noted are considered to represent overlooked or incompletely excised foci of cancer because of the multifocality (not multicentricity) of some breast cancers. The possibility that DCIS may represent a marker of risk for the development of cancer rather than a precursor lesion per se is suggested. Despite apparent difficulties in the pathologic diagnosis of DCIS as well as uncertainty concerning its natural history, no evidence was found to indicate that it represents a more ominous disease than invasive cancer. Indeed, treatment failure occurred in only one patient treated by LX and a similar number subjected to TM (4% versus 2%). Although these observations are short term (average follow-up, 39 months), estimates of the probability of local recurrence or survival suggest that they will not be significantly altered after longer periods of surveillance. Thus, there are no compelling reasons why DCIS may not be treated in a cosmetically acceptable manner by LX. A randomized clinical trial addressing this issue is now in progress.

Basement Membrane↗