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Biomedical subjects

S M Levin

Publications and source records attributed to S M Levin.

At least 19 recordsLinked to original sources
PubMed2000

Clinical evaluation and management of lead-exposed construction workers.

An estimated one million construction workers are currently occupationally exposed to lead. Until 1993, construction workers were not offered the protections of OSHA's 1978 standard for lead exposure in industrial activities. Preventing exposure to lead in the construction setting presents many challenges, given the rapidly and frequently changing work environment. This article reviews the adverse effects of lead on human health and presents an approach to the diagnosis, management, and prevention of lead-related illness. The medical aspects of the 1993 OSHA standard for lead in construction are described.

Absorption↗
PubMed2000

The diagnosis and management of solvent-related disorders.

Millions of workers in the United States are recurrently exposed to solvents throughout their working lives. Members of this class of compounds share the ability to dissolve waxes, fats, and oils as their common characteristic. This review offers the health practitioner a practical approach to the diagnosis, management, and prevention of solvent-related disorders that result from exposures to these compounds in the workplace. A description of commonly used solvents is provided, along with a brief review of the literature that documents their acute and chronic effects on health.

Acute Disease↗
PubMed2000

Medical examination for asbestos-related disease.

There are millions of workers whose exposure to asbestos dust prior to the implementation of asbestos regulation and improved control measures places them at risk of asbestos-related disease today. In addition, workers are still being exposed to significant amounts of asbestos, when asbestos materials in place are disturbed during renovation, repair, or demolition. Given the continued presence of asbestos-containing materials in industrial, commercial, and residential settings throughout the U.S., a sizeable population remains at risk of asbestos-related disease. This article reviews the health effects associated with exposure to asbestos and delineates the steps necessary for the comprehensive screening and clinical assessment for asbestos-related disease, in order to assist physicians in identifying and preventing illness associated with exposure to asbestos among their patients.

Asbestos↗
PubMed2000

An assessment of lead controls for torch cutting and rivet removal on steel structures.

The use of engineering and work practice controls to protect workers from lead-containing dusts and fumes generated during rehabilitation of steel structures is mandated by the Occupational Safety and Health Administration (OSHA) Lead in Construction Standard (1993). Because the implementation and assessment of controls can be problematic in the rugged and dynamic construction environment, industrial hygienists should understand the effectiveness and limitations of controls adopted. The present investigation assesses the efficacy of two controls to reduce lead exposure: paint removal prior to oxy-acetylene torch cutting of steel, and encapsulation of rivets prior to their removal. A task-based exposure assessment approach was used to evaluate these tasks at three sites. Exposures at one site without controls were compared to exposures at sites with controls. Comparison of the results via an analysis of variance (0.05 significance level) indicates that, for torch cutting, exposures at the control site were not significantly different from those at an uncontrolled site (p = 0.14). The results for rivet busting show no significant differences in exposures at the control site compared to the uncontrolled site (p = 0.08). Results are also presented from two control sites where work was done in enclosed spaces. Two main difficulties in applying the controls are explored: technical and managerial. Technical problems during torch cutting included the penetration of paint into the steel profile and the configuration of the structures. For rivet busting, working within an enclosure was an important factor. Management problems arose both from a lack of coordination among different contractors, and from a failure to provide day-to-day guidance and assessment of the control. Important components of a program to implement controls are preplanning and coordination of control implementation, frequent testing of control efficacy, and a method for timely intervention to correct deficiencies.

Dust↗
PubMed2000

Piriformis syndrome.

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1997

The effect of the OSHA lead exposure in construction standard on blood lead levels among iron workers employed in bridge rehabilitation.

Over 50,000 workers are at risk of occupational exposure to lead in the course of renovating the nation's deteriorating infrastructure. In mid-1993, to control exposure to lead in the construction setting OSHA promulgated a Lead in Construction Standard. In this study, we assessed the effect of the mandated changes in exposure conditions which followed the introduction of this new standard. We analyzed changes in baseline and maximum blood lead concentrations and in maximum increments in blood lead levels before and after introduction of the standard among iron workers employed in the renovation of a large, lead-painted, steel bridge in New York City. Results indicated that baseline and maximum blood lead levels fell significantly after the implementation of the provisions of the standard, as did maximum increments in blood lead concentrations. Seventy-six percent of the workers maintained blood lead concentrations below 20 micrograms/dl after the OSHA standard, as compared with 66% prior to its implementation. Increments of 20 micrograms/dl or more occurred considerably more frequently before introduction of the standard (13% before vs. 4% after; p = 0.01). Evidence of decreased exposure to lead was observed among iron workers who were present both before and after the introduction of the OSHA standard, as well as among iron workers newly hired after the OSHA provisions were put in place. These findings document the effectiveness of the OSHA construction lead standard in controlling exposure to lead in this complex and variable environment. The data indicate the utility of blood lead determinations in assessing the outcome of industrial hygiene interventions to reduce exposures to lead in the construction setting.

Adult↗
PubMed1997

A task-based approach to assessing lead exposure among iron workers engaged in bridge rehabilitation.

The assessment of worker exposures to airborne contaminants in the dynamic environment present at most construction sites poses considerable challenges to the industrial hygienist. In this study, we applied a task-based approach to the assessment of lead exposure among structural steel iron workers engaged in a large, complex bridge rehabilitation project. We evaluated the usefulness of task-based exposure data for the development of worker protection programs. Task-specific and multitask samples were collected, and operation-specific and 8-hr time-weighted averages were calculated. The task-specific data showed significant differences in exposure levels among different tasks. Arithmetic mean exposures varied from 1,357 micrograms/m3 lead for torch cutting and 989 micrograms/m3 for scaling to 31 micrograms/m3 for reaming and 4 micrograms/m3 for drilling. Our task-specific data were compared with the task-based exposure levels presented by OSHA in its Lead Exposure in Construction-Interim Final Rule (29 CFR 1926). There was good general agreement between our results and OSHA's reported data. Task-based data were very useful in exposure assessment and much more precise than full-shift and operation-based measurements in guiding strategies for worker protection. These findings suggest that task-based data should routinely be collected in evaluating exposure to lead and perhaps other toxic substances in construction work.

Air Pollutants, Occupational↗
PubMed1997

Putting the shoulder to the wheel: a new biomechanical model for the shoulder girdle.

The least successfully modeled joint complex has been the shoulder. In multi-segmented mathematical shoulder models rigid beams (the bones) act as a series of columns or levers to transmit forces or loads to the axial skeleton. Forces passing through the almost frictionless joints must, somehow, always be directed perfectly perpendicular to the joints as only loads directed at right angles to the surfaces could transfer across frictionless joints. Loads transmitted to the axial skeleton would have to pass through the moving ribs or the weak jointed clavicle and then through the ribs. A new model of the shoulder girdle, based on the tension icosahedron described by Buckminster Fuller, is proposed that permits the compression loads passing through the arm and shoulder to be transferred to the axial skeleton through its soft tissues. In this model the scapula 'floats' in the tension network of shoulder girdle muscles just as the hub of the wire wheel is suspended in its tension network of spokes. With this construct inefficient beams and levers are eliminated. A more energy efficient, load distributing, integrated, hierarchical system is created.

Biomechanical Phenomena↗
PubMed1996

Unraveling the chronic toxicity of lead: an essential priority for environmental health.

Although population exposure to lead has declined, chronic lead toxicity remains a major public health problem in the United States affecting millions of children and adults. Important gaps exist in knowledge of the pathophysiology of chronic lead intoxication. These gaps have impeded development of control strategies. To close current gaps in knowledge of chronic lead toxicity, we propose an integrated, multidisciplinary, marker-based research program. This program combines a) direct measurement of individual lead burden by 109Cd X-ray fluorescence analysis of lead in bone, b) determination of ALA-D phenotype, an index of individual susceptibility to lead, and c) assessments of subclinical injury produced by lead in the kidneys, nervous system and, reproductive organs. Data from this research will provide answers to questions of great public health importance: a) Are current environmental and occupational standards adequate to prevent chronic lead intoxication? b) is lead mobilized from the skeleton during pregnancy or lactation to cause fetal toxicity? c) Is lead mobilized from bone during menopause to cause neurotoxicity? d) What is the significance of genetic variation in determining susceptibility to lead? e) What is the contribution of lead to hypertension, renal disease, chronic neurodegenerative disease or declining sperm counts? f) Is chelation therapy effective in reducing body lead burden in persons with chronic overexposure to lead?

Acetylglucosaminidase↗
PubMed1993

Financing and payment reform for primary health care and substance abuse treatment.

One of the most controversial areas for health care reform concerns the treatment of alcohol and other drug problems, which account for some of the most rapidly rising costs in the health care sector. There is arguably no other set of conditions that show such variation in accessibility to treatment on the basis of insurance status, present the same degree of difficulty in providing comprehensive care, or challenge as many public and professional assumptions about behavioral, social and economic determinants. The purpose of this article is to discuss some of the financing and coverage barriers to comprehensive treatment for alcohol and other drug abuse; to discuss some innovative mechanisms for providing and financing comprehensive services; and to suggest some directions for public policy to support the development of new practice models that emphasize cost-effectiveness and efficiency of care.

Alcoholism↗