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Biomedical subjects

R Y Demers

Publications and source records attributed to R Y Demers.

At least 19 recordsLinked to original sources
PubMed1996

Neurobehavioral and health-related deficits in solvent-exposed painters.

The health status of 133 solvent-exposed painters was evaluated using the Neurobehavioral Evaluation System (NES) and blood test results from a physical exam. The comparison group consisted of 51 sheetmetal workers, minimally exposed to solvents. Degree of solvent exposure was calculated using three different indices derived from questionnaire responses. Multivariate analyses, adjusted for age, alcohol consumption, and smoking, indicated that painters performed less well on the symbol digit learning and vocabulary tasks. Evidence was also found for a dose-effect relationship, particularly when several features of the work environment were considered in estimating exposure. Degree of solvent exposure predicted levels of serum lead, BUN, and SGOT. These findings indicate that questionnaire-based measures of solvent exposure can be useful predictors of neurobehavioral and health-related deficits. Verbal ability, often used by researchers as a measure of premorbid functioning, may be adversely affected by solvent exposure.

Adult↗
PubMed1996

Increasing incidence of adenocarcinomas and carcinoid tumors of the small intestine in adults.

Malignant neoplasms of the small intestine are relatively rare and have received little study. We report on trends in the age-adjusted, sex-, and race-specific incidence rates of adenocarcinomas and carcinoid tumors of the small intestine in the United States from 1973 through 1991. Data were derived from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. There were statistically significant increases in the incidence rates of both adenocarcinomas and carcinoid tumors during the time frame of the study. Rates increased most dramatically in black males, with 2- and 4-fold increases in adenocarcinomas and carcinoid tumors, respectively. The only rates that remained relatively unchanged were those of adenocarcinoma among white females. It remains to be determined if changing environmental factors are important causes of these observed trends. If environmental factors are involved in the etiology of small intestine cancers, analytic studies conducted while the disease is increasing in incidence may provide useful insights.

Adenocarcinoma↗
PubMed1995

Prostate-specific antigen in a community screening program.

BACKGROUND: This study was designed to determine who participates in community-based prostate-specific antigen (PSA) screening programs and what serum PSA levels can be expected. METHODS: A descriptive analysis of men who participated in an annual community health screening program was used to compare men who chose PSA screening with those who did not. The relationship of demographic variables to PSA level was evaluated by multivariate regression analysis. Data were available on 5548 men, 6% of whom were black. RESULTS: The population of PSA screening participants included proportionately more middle-aged white men with higher median income, as compared with men who did not participate. Those who did not participate in the screening were more likely to be either very old or very young. PSA levels increased with age, and the percentage of men with elevated PSA levels increased with age. One tenth (9.6%) of all participants had PSAs between 4 ng/mL and 10 ng/mL, and 1.9% had levels greater than 10 ng/mL. Within 1 year of the screening, 1.7% of the screened participants had a diagnosis of prostate cancer. The mean PSA in this group was 15.9 ng/mL. CONCLUSIONS: These data confirm the need for age-specific PSA reference ranges. It is likely that the same reference range can be used for all racial ethnic populations.

Black or African American↗
PubMed1994

Increasing incidence of cancer of the prostate. The experience of black and white men in the Detroit metropolitan area.

BACKGROUND: Prostate cancer mortality and incidence rates have been gradually increasing for decades in the United States, with an accelerated increase in incidence noted in the past several years. This study explores in detail the occurrence of prostate cancer in southeast Michigan from 1973 through 1991. METHODS: Data from the National Cancer Institute Surveillance, Epidemiology, and End Results program are analyzed with emphasis on time trends by race, age, stage, and treatment. RESULTS: Population-based rates for prostate cancer increased by 70% between 1988 and 1991. Increases are most pronounced for early stage disease and among whites compared with blacks. Corresponding increases in treatment with radical prostatectomy are also observed. CONCLUSION: Increased incidence of prostate cancer is likely a result of widespread use of prostate-specific antigen.

Black or African American↗
PubMed1994

Colorectal cancer incidence in pattern and model makers: evidence from a screening program.

This study is designed to evaluate the efficacy of colorectal cancer screening in a high risk population of pattern and model makers. The cohort of 1,641 white male automotive pattern and model makers was identified in 1981, and offered colorectal cancer screening. The program involved periodic 60 cm flexible sigmoid examination, stool occult blood testing, and digital rectal examination. Screening was offered in 1981, 1982, 1985, 1988, and 1991. Approximately 60% of those eligible participated in at least one screening examination. Nonparticipants showed a relative risk for incident colorectal cancer of over 10, compared to those who participated at least once in the screening. Cohort tracking has accumulated 10 years; results suggest a benefit to colorectal cancer screening in this population.

Adult↗
PubMed1994

Lymphocytopenia and occupational exposures among pattern and model makers.

OBJECTIVES: The study was performed to examine the relationship between a high prevalence of lymphocytopenia observed during a cancer screening program for pattern and model makers, who produce industrial prototypes and patterns, and 15 occupational exposures. METHODS: The cases (N = 83) were workers with lymphocyte counts of less than 1000, while the referents (N = 529) had counts of 1500 or higher. Exposures at the current workplace, and at up to 19 previous pattern and model shops, were assessed with the use of a questionnaire. RESULTS: Elevated risks were associated with exposure to epoxy resins [odds ratio (OR) 1.94, 95% confidence interval (95% CI) 1.02-3.70) and plastic dusts (OR 2.60, 95% CI 1.19-5.68) after adjustment for age and smoking status. No clear associations were found with duration of exposure or percentage of time potentially exposed. Although the results were based upon small numbers, epoxy resins and wood dust displayed the most consistent relationships in an analysis of changes in lymphocyte count and exposure status over time. CONCLUSION: While firm conclusions cannot be drawn, the strongest associations observed in this study were for exposure to epoxy resins.

Adult↗
PubMed1994

Construction occupations, asbestos exposure, and cancer of the colon and rectum.

Colorectal cancer affects more than 157,000 Americans annually. Occupational risk from exposure to asbestos dust has been implicated, leading us to explore further the possible association between colorectal cancer and asbestos. Two hundred sixty-one cases of colon and rectal cancer and 183 control cases were identified within a large, population-based case-control study conducted in southeast Michigan. Employment in occupations historically known to involve heavy exposure to asbestos was used as a surrogate for asbestos exposure. Cancers of the colon showed reduced odds ratios. Our findings differ substantially from those of the previous studies showing elevated risk. Further study is needed to address the same question, with specified asbestos exposure assessment and control for potentially significant confounders such as physical activity and diet.

Adult↗
PubMed1994

Significance of the inability to reproduce pulmonary function test results.

In 1985, 864 patternmakers participated in a voluntary union-sponsored health screening program that included an evaluation of respiratory symtomatology and dysfunction. Pulmonary function test (PFT) measurements included a minimum of three readings of forced expiratory volume at 1 second (FEV1). A "reliable" test was one where the two best volumes were within 5%. Medical history and respiratory symptoms were assessed on a standardized questionnaire. Fifty-nine of the 864 tested were unable to reproduce their best FEV1 result. Although these 59 case subjects had significantly lower PFT results than the other 805 tested (P < .01), the mean values for FEV1 and forced vital capacity for the case subjects were greater than 90% of predicted values. The case subjects were more likely to experience wheezing and dyspnea and have a history of emphysema than the rest of the group screened (n = 805). They also had a higher mean age and more years in the trade. Twenty-one of the 59 case subjects were among the 602 who participated in a similar health screening program offered 3 years later. To minimize the effects of age and smoking status on PFT performance, these 21 case subjects were each matched on age and smoking with two comparison subjects who had reliable tests. At follow-up, the 21 case subjects and 41 comparison subjects both had a decline in ventilatory capacity that was significantly greater than would be expected by advancing age alone. A number of methodological issues that impact the interpretation of these data are discussed.

Adult↗
PubMed1993

Family practice in Cuba: evolution into the 1990s.

A group of practising physicians, family practice academicians and medical students visited Cuba in 1991. The purpose of this visit was to assess the current status of the discipline of family medicine in the country. Numerous interviews were conducted with practising family physicians, Cuban medical physicians in other medical specialties, the medical school faculty, patients and officials from the Ministry of Public Health. A summary of the content of these interviews constitutes the following paper. The authors conclude that the Cubans have developed a medical care system that has its basis in family practice, and provides a model which could be emulated not only in less developed, but also in more developed countries.

Cause of Death↗
PubMed1992

The home visit in resident education: program description and evaluation.

A home visit rotation was developed to provide family practice residents with a more comprehensive understanding of the effect of patient life-style on health status. The rotation emphasizes geriatric, community, and rehabilitative medicine. In addition, the curriculum addresses issues related to patient compliance, assessment of activities of daily living, patient psychosocial needs, community services, and exposure to medical equipment of potential use to homebound individuals. Over a three-year period, 209 home visits were made. Program evaluation data suggest that at the end of the three-month rotation, residents were less concerned with personal safety and more likely to agree that home visits were an important part of residency training. A comparison of pre- and post-test knowledge scores indicated significant increases in geriatric medicine, patient compliance issues, patient functional status, and community services. A follow-up telephone interview with patients found that some patients experienced anxiety when the home visit was scheduled, but the majority were positive about the experience.

Aged↗
PubMed1991

Peripheral vibratory sense deficits in solvent-exposed painters.

Peripheral neuropathy, as exhibited by the decrease in vibratory sense, is believed to be one of the manifestations of the peripheral nervous effects of solvent exposure. A solvent-exposed group of commercial painters (n = 28) was compared with a nonexposed group of boilermakers (n = 20) for differences in vibrotactile sensitivity. Differences in vibrotactile measurements of upper and lower extremities were compared between the two groups. Painters had lower vibration perception in all four extremities with statistically significant differences noted in four of seven analytical categories. Findings from this study suggest there are significant vibration perception differences between the studied painters and boilermakers and these differences are likely to be associated with occupational exposure to organic solvents.

Humans↗
PubMed1991

Lymphocytopenia, T-lymphocyte subsets, and colorectal polyps in automotive pattern and model makers.

Several studies have found pattern and model makers to be at increased risk for colorectal polyps and colorectal cancers. One study found an increased prevalence of lymphocytopenia. The association of total lymphocyte, CD4 (T-helper cell), CD8 (T-suppressor cell), CD2 (total T-cell), and CD16 (natural killer cell) counts with biopsy-proved colorectal polyp status was investigated in 70 patternmakers participating in one or more of four sequential screenings. In logistic regression analyses after adjusting for age or trade years, pack-years smoked, and material worked with most, a history of any type of polyp was significantly associated with total lymphocyte count (odds ratio of 2.01 for a 500 cell/cc decrease, P = 0.03), and somewhat associated with decreased CD4 and CD2 counts (P values of 0.06 and 0.07, respectively). In linear regression models adjusted for age, pattern and model makers had (regardless of polyp status) significantly lower CD4, CD8, CD2, and CD16 counts than did laboratory reference controls (P value less than 0.01 for each comparison). These findings appear consistent with a sequence of carcinogenesis initiated by pattern and model makers' work-place exposures that depress immune surveillance thus promoting the development of colorectal polyps as a precursor of carcinoma.

Adenocarcinoma↗
PubMed1990

Respiratory morbidity of pattern and model makers exposed to wood, plastic, and metal products.

Pattern and model makers are skilled tradespersons who may be exposed to hardwoods, softwoods, phenol-formaldehyde resin-impregnated woods, epoxy and polyester/styrene resin systems, and welding and metal-casting fumes. The relationship of respiratory symptoms (wheezing, chronic bronchitis, dyspnea) and pulmonary function (FVC% predicted, FEV1% predicted, FEV1/FVC% predicted) with interview-derived cumulative exposure estimates to specific workplace agents and to all work with wood, plastic, or metal products was investigated in 751 pattern and model makers in southeast Michigan. In stratified analyses and age- and smoking-adjusted linear and logistic regression models, measures of cumulative wood exposures were associated with decrements in pulmonary function and dyspnea, but not with other symptoms. In similar analyses, measures of cumulative plastic exposures were associated with wheezing, chronic bronchitis, and dyspnea, but not with decrements in pulmonary function. Prior studies of exposure levels among pattern and model makers and of respiratory health effects of specific agents among other occupational groups support the plausibility of wood-related effects more strongly than that of plastic-related effects.

Adult↗
PubMed1990

Asbestos-related pulmonary disease in boilermakers.

Boilermakers are skilled building tradesmen who construct, repair, and dismantle boilers. The present study reports on the evaluation of members of a Michigan boilermaker's union for the presence of signs and symptoms of chronic pulmonary disease. Study variables included standardized evaluations of chest x-ray findings, pulmonary function testing, physical examination, and respiratory symptoms. An overall participation rate of 69% was achieved. A non-participant survey identified no significant differences between participants and non-participants in dyspnea, cough, age, or smoking history. Among participants with greater than 20 years experience in the trade, the mean FVC was 91% of predicted; the FEV1 was 86% of predicted; 25% showed at least a 1/0 profusion of interstitial markings on chest x-ray; 30% had bilateral pleural abnormalities; and 52% had audible inspiratory rales on physical examination. Forced vital capacity and forced expiratory volume at one second both decreased with years in the trade. Chest x-ray findings of interstitial fibrosis and pleural plaques were related to ten or more years in the trade, as were respiratory symptoms of pulmonary rales, wheeze, and dyspnea.

Age Factors↗
PubMed1990

Incongruence between self-reported symptoms and objective evidence of respiratory disease among construction workers.

In clinical settings, self-reported symptoms and objective evidence of disease may be poorly correlated. In the present study, symptoms and objective evidence of pulmonary disease were compared in a community sample of construction workers with occupational exposure to asbestos. Symptoms of dyspnea and cough were assessed by a standardized questionnaire. The clinical examination included a chest X-ray, pulmonary function testing (PFT), and a physical examination. Both symptoms and objective clinical findings were strongly related to years in these trades. However, less than 1% of workers reported symptoms in the absence of any clinical evidence of disease. A similar low percentage of workers denied any symptoms yet produced clear evidence of pulmonary disease on clinical examination. Results were interpreted in terms of the variety of factors which have been associated with patients' readiness, and conversely, reluctance to report symptoms. The comparatively low frequency of incongruence between symptoms and objective clinical findings in this study suggests over emphasis of malingering by other authors. Health care might be improved if more attention is given by clinicians and researchers to patients who fail to report symptoms in the presence of disease.

Adult↗
PubMed1990

The impact of physicians' brief smoking cessation counseling: a MIRNET study.

Although many family physicians may discuss smoking cessation with their patients, few do so consistently. A common belief among many physicians is that such efforts will not deter their patients from smoking. Others believe the time commitment required for a successful intervention is excessive. The present study addressed the above issues by examining the effect of a 3- to 5-minute unstructured physician discussion encouraging smoking cessation with family practice patients. Cigarette-smoking patients of two busy family practices in southeast Michigan were randomly assigned to either a control group receiving routine care or an intervention group receiving, in addition to routine care, smoking cessation counseling from their physician. A third comparison group was drawn from smokers in practices not involved in delivering the intervention. Two hundred thirty-eight patients from the intervention group, 178 from the control group, and 47 from the comparison group were followed up with a telephone interview at 6 months. Intervention group patients made significantly more quit attempts than did those in the control group (P less than .001), which was similar to the comparison group. At the 6-month follow-up, 8% of intervention group members, and 4% of both the comparison and control groups reportedly were abstinent from smoking. Among those contacted at the 1-year follow-up, the respective percentages abstinent were 8%, 3%, and 4%. Although these differences in quit rates were not statistically significant, the findings suggest that physicians can positively affect patient smoking cessation. This intervention was feasible in busy family practices, highlighting its generalizability and applicability to other family practice settings in the United States.

Adult↗