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PubMed2003

The concordance of pollution prevention and occupational health and safety: a perspective on U.S. policy.

BACKGROUND: Occupational health and pollution prevention, although conceptually linked by the common goals of preventing exposure to toxic materials and lowering risk functions, have been largely confined to separate patterns of practice and professional development. Some analysts see this as a missed opportunity for synergy and raising the level of protection afforded to both the worker and the ambient environment. By using current specific examples we show how strategies that integrate pollution prevention and occupational health practices can be effective at reducing chemical exposures and environmental releases beyond the levels normally achieved using traditional methods alone. METHODS: Similarities in approaches to addressing chemical hazards at the source, are analyzed in the context of U.S. policy and recent state and federal initiatives. Results obtained from the analysis of multi-pathway risks found within the automotive refinishing sector serve as examples of how best to select engineering and control strategies. RESULTS: Industry survey, metal speciation, and methylene chloride usage data from studies conducted in Rhode Island, coupled with case reports from other settings, demonstrate that opportunities exist to concurrently mitigate multiple environmental and occupational health hazards. CONCLUSIONS: The collaborative initiatives undertaken in the automotive refinishing industry sector demonstrate that an integrated environmental and occupational health approach can more effectively address multiple chemical releases and workplace exposures. Such synergy should be advanced in the future by similar integrative and collaborative strategies.

Air Pollution↗
PubMed2004

Loss of heterozygosity on the X chromosome is an independent prognostic factor in ovarian carcinoma: from the Danish "MALOVA" Ovarian Carcinoma Study.

BACKGROUND: Ovarian carcinoma (OC) is the fifth most frequent female cancer type and the fourth most frequent cause of death from cancer among women in Denmark. At the time they are diagnosed with OC, approximately 70% of patients have advanced disease. It is believed that loss of tumor suppressor gene activity plays an important role in the origin and progression of OC and other malignancies. Loss of heterozygosity (LOH) may be detected in individuals heterozygous for an allele and is associated with loss of function of tumor suppressor genes. METHODS: The polymorphic marker regions (TP53, CACNLB1, D18S58, DXS538, and DXS454) were amplified by polymerase chain reaction followed by separation using gel electrophoresis before LOH was identified. In total, 160 women with primary epithelial OC were included in the study. RESULTS: Univariate analyses showed significant differences in survival between patients who had advanced OC with LOH or with retention using the microsatellite markers DXS454 (P = 0.04) and DXS538 (P = 0.01). Multivariate Cox regression analysis that included all patients showed that DXS454 (relative hazard [RH] = 3.5; P = 0.002; 95% confidence interval [95% CI], 1.6-7.8), radicality of primary surgery (RH = 5.5; P < 0.0001; 95% CI, 2.7-11.1), and serum tetranectin level (RH = 0.8; P = 0.009; 95% CI, 0.7-0.9) were independent prognostic factors for survival. Multivariate Cox regression analysis restricted to patients with International Federation of Obstetrics and Gynecology Stage III-IV disease showed that DXS454 (RH = 3.4; P = 0.007; 95% CI, 1.4-8.1), radicality of primary surgery (RH = 5.4; P < 0.0001; 95% CI, 2.2-12.9), and serum tetranectin level (RH = 0.8; P = 0.042; 95% CI, 0.7-1.0) were independent prognostic factors. CONCLUSIONS: LOH at DXS454 (Xq21-q23) appeared to be correlated with reduced survival in patients with OC.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Back-projection of German AIDS data using information on dates of tests.

The paper presents an application of back-projection methods to the reported AIDS data which are collected by the AIDS Center in the Federal Office of Health, Berlin. The analysis is based on all data reported up to 31 December 1992. The data are broken down by major risk groups. Correction for reporting delays takes into account temporal changes in their distribution. The paper applies the EMS algorithm for the estimation of HIV incidence. The incubation period is modelled according to a convolution of several exponential distributions which describe time dependent phenomena like change of case definition and therapy effects. For each case it is reported whether an antibody test has been performed before diagnosis, and if yes, at what time this test was performed. The modelling of the incubation distribution takes into account the transition from a state 'not yet tested' into a state 'tested'. Only tested individuals in three pre-AIDS states are eligible for treatment. The model allows us to estimate not only the current total HIV prevalence but also a breakdown into those that are not yet tested, those that are tested but not yet treated and those that are under treatment. The results depend on the assumptions about the effect of treatment and on the degree of smoothing applied in the EMS algorithm.

Acquired Immunodeficiency Syndrome↗
PubMed1981

Community mental health centers: movement away from the model?

What happens to community mental health centers when federal funding declines and then ends? Analysis of service utilization patterns over a five year period for a cohort of "graduate" community mental health centers indicates two distinct patterns. One group appeared to assure their fiscal viability by maximizing the traditional inpatient, outpatient, and emergency services while cutting back less lucrative services, such as consultation and education, home visits, and partial hospitalization. The other group maintained a balanced mix of all the services, but apparently did so at some risk to their financial status. Implications for the future of community based mental health care are discussed.

Community Mental Health Centers↗
PubMed1980

[Analysis of the therapeutic results in 1127 patients with fractures of the femur in the Federal Republic of Germany and in Switzerland (author's transl)].

Under the aspect of quality control of the surgical treatment the results of femur-fractures of 1127 patients were scrutinized. These patients were treated in 16 German and in 21 Swiss AO-hospitals. Different complications are discussed. The study shows that not so much the chosen method of osteosynthesis is of paramount importance, but the way it is performed, especially if the surgical technic is done according to standardized principles and biomechanical rules. As the injuries are in many cases very severe and as in many patients the fracture of the femur is only part of the polytrauma, the results are satisfying.

Adult↗
PubMed2006

[Effects of tobacco tax increase on cigarette consumption and the impact on health policy].

The purpose of this study is to analyse the recent development of tobacco taxes and demand for cigarettes in Germany and to describe consequences for health policy. A descriptive analysis of aggregated data of the Federal Statistical Office is used to show the development of tax income and consumer behaviour with regard to the degree of substitution between differently taxed tobacco products. From 1993 to 2002 the demand for cigarettes increased nearly continuously. In 2003 the demand for industrial cigarettes went down by 8.6% and in 2004 by 15.8%. The difference between taxes and prices of industrial cigarettes and substitutes increased over the time period and still continues to increase. Tax and price differences between tobacco products led to partial compensation of the decreasing demand for industrial cigarettes. Therefore a tax increase on substitute products like fine cut tobacco is recommended. There is still a lack of longitudinal epidemiological data on smoking behaviour in Germany that could affirm effects of tobacco taxation.

Germany↗
PubMed1998

Environmental Values and Popular Conflict over Environmental Management: A Comparative Analysis of Public Comments on the Clinton Forest Plan

/ Public participation in environmental management decisions has frequently led to conflict. This paper examines the role of environmental values in fueling these conflicts, based on a data base and sample content analysis of written public comments solicited in 1994 regarding the highly contentious Clinton Forest Plan (also known as Option 9) proposed for management of federal forests in the US Pacific Northwest. The analysis considered whether those respondents favoring more versus less environmental protection than was offered in Option 9 held entirely different values, identifying which antagonistic values appeared to be most fundamental and where (if at all) values consensus occurred. It also compared values emanating from respondents within and outside the affected region, although few major differences were detected in this regard. Results suggest that strong values differences did exist among those preferring greater versus less environmental protection, in particular as concerned the extent, form, and spatial and temporal scope of justification of their positions, their ideas of forests, and the appropriate role of people in forest management. Disagreement concerned far more than purely environmental values: a major point of difference involved human benefits and harms of the proposed forest plan. Indeed, both sides' positions were overridingly anthropocentric and consequentialist-a values orientation that almost inevitably spells conflict in light of the commonly differentiated social impacts of environmental management decisions. Although public involvement in environmental management thus cannot be expected to lead to a clear and consensual social directive, the Pacific Northwest case suggests that viable environmental management solutions that take this range of values into account can still be crafted.KEY WORDS: Environmental values; Public participation; Clinton Forest Plan; Pacific Northwest

Journal Article↗
PubMed2006

An analysis of respondent driven sampling with Injection Drug Users (IDU) in Albania and the Russian Federation.

Injection drug users in Tirana, Albania and St. Petersburg, Russia were recruited into a study assessing HIV-related behaviors and HIV serostatus using Respondent Driven Sampling (RDS), a peer-driven recruitment sampling strategy that results in a probability sample. (Salganik M, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Method. 2004;34:193-239). This paper presents a comparison of RDS implementation, findings on network and recruitment characteristics, and lessons learned. Initiated with 13 to 15 seeds, approximately 200 IDUs were recruited within 8 weeks. Information resulting from RDS indicates that social network patterns from the two studies differ greatly. Female IDUs in Tirana had smaller network sizes than male IDUs, unlike in St. Petersburg where female IDUs had larger network sizes than male IDUs. Recruitment patterns in each country also differed by demographic categories. Recruitment analyses indicate that IDUs form socially distinct groups by sex in Tirana, whereas there was a greater degree of gender mixing patterns in St. Petersburg. RDS proved to be an effective means of surveying these hard-to-reach populations.

Adolescent↗
PubMed1990

The U.S. Federal Highway Administrations receiving water impact methodology.

This paper presents the final results of the application of a probabilistic approach for evaluating the water quality impact of highway stormwater runoff to receiving waters. A brief review of the development of the probabilistic characterization of runoff water quality data is presented along with a description of the probabilistic stream impact method. In this paper we present the interactive Decision Support program that takes the procedure user through the Federal Highway Administration's highway runoff analysis procedure. The procedure requires the input of fixed site data, rainfall and streamflow statistics, highway runoff water quality, and target concentrations. The methodology user is provided guidance in entering the required data. Output of the procedure is a return frequency of the exceedances of the target concentration. This methodology is intended for planning level analyses.

Environmental Monitoring↗
PubMed1998

Chefs' attitudes toward healthful food preparation are more positive than their food science knowledge and practices.

OBJECTIVE: To determine if chefs' and student chefs' attitudes, knowledge, and practices regarding healthful food preparation are consistent with the Dietary Guidelines for Americans. DESIGN: An analytical survey questionnaire was distributed to 4 chef groups. Sections 1 and 2 of the survey measured chefs' food science knowledge (13 questions) and likelihood of using food preparation practices (15 questions) necessary to meet the 1990 Dietary Guidelines for Americans. Section 3 (22 questions) measured chefs' attitudes toward nutrition in general, toward the importance of healthful food preparation practices, and toward the US Dietary Guidelines. SAMPLE: Of 512 surveys distributed by mail, at culinary meetings, and in classes at 2 culinary schools, 447 (86%) were returned (158 from practicing chefs and 289 from student chefs). Practicing chefs included chef educators, foodservice chefs from a national corporation, and independent chef members of the American Culinary Federation of New York City. STATISTICAL ANALYSIS: Descriptive statistics included frequencies, means, and standard deviations of survey items and of individual survey sections. Reliability and validity were determined using alpha coefficients and principal components analysis. Analysis of variance was used to examine differences in practice, attitudes, and knowledge among chef groups. RESULTS: Both practicing chefs and student chefs answered more than 70% of the food science questions correctly; independent chefs scored significantly lower than educator and corporate chefs. More than two thirds of the chefs and student chefs correctly responded to questions about the nutrient composition of food and how cooking affects the nutrient content of food. All chef groups were confused about fat and cholesterol in food and in the body. Few healthful food preparation practices were likely to be used by any chef group more than two thirds of the time, although the subscale of the attitude toward the importance of these practices was very positive. The majority of practicing chefs thought that customers do not care about the US Dietary Guidelines and nutrition; student chefs thought that customers do care. Both groups strongly agreed that, as chefs, they are responsible for the nutritional content of the food they prepared. APPLICATION: Both chefs and student chefs are willing to learn about food science and recipe modification principles as they apply to healthful cooking practices. The opportunities are clear: Dietitians have the expertise to teach chefs healthful food preparation techniques, recipe modification, and food composition information.

Adolescent↗
PubMed1987

N-nitrosamines and nitrosatable amines, potential precursors of N-nitramines, in children's pacifiers and baby-bottle nipples.

Sixteen types of children's pacifiers and baby-bottle nipples, bought in shops in Israel but produced both there and elsewhere in the world, were analyzed for their contents of N-nitrosamines, which have been shown to be potent carcinogens in animals, and of nitrosatable amines. Two methods were used: one, originating in the United States, involved dichloromethane extraction of total volatile N-nitrosamines from the nipples and pacifiers, and the other, from the Federal Republic of Germany, consisted of analysis of N-nitrosamines and their amine precursors that migrated into artificial saliva. N-Nitrosodibutylamine (NDBA). N-nitrosodiethylamine (NDEA), N-nitrosodimethylamine (NDMA). N-nitrosopiperidine (NPIP), and N-nitrosopyrrolidine (NPYR) were detected by the first method, at individual levels as high as 369 ppb. Using the second method, NDBA, NDEA, NDMA, and N-nitrosomorpholine (NMOR) were detected at concentrations up to 41 ppb, in addition to the three nitrosatable amines dibutylamine, diethylamine, and dimethylamine. Upon nitrosation in the artificial saliva, these amines produced not only the related N-nitrosamines but also relatively high levels of the corresponding N-nitramines (N-nitrodibutylamine, N-nitrodiethylamine, and N-nitrodimethylamine), probably formed by oxidation of the N-nitrosamines by peroxides used for vulcanization of elastomers. Thus, if N-nitramines are not measured in addition to N-nitrosamines after nitrosation, the second method may underestimate the quantities of nitrosatable amines present in artificial saliva extracts. Whether N-nitramines, some of which have been shown to be both mutagenic and carcinogenic, also occur in the saliva of babies exposed to these products remains to be confirmed. Of the samples tested, 50% failed to meet both the U.S. and the FRG regulations. A larger percentage, 60%, would not conform to the new standard suggested in the United States, and more than 80% failed to comply with the even stricter Dutch standard.

Amines↗
PubMed2001

Clinical profile of arrhythmogenic right ventricular cardiomyopathy in Chinese patients.

OBJECTIVE: To study the clinical profile of Chinese patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). PATIENTS: Chinese patients who fulfilled the diagnostic criteria of ARVC proposed by the Task Force of the European Society of Cardiology and of the scientific council on cardiomyopathy of the International Society and Federation of Cardiology were recruited for analysis. METHODS: Clinical data of patients with ARVC including age, sex, family history, presenting symptoms, electrocardiograph (ECG), echocardiography, cardiac catheterization, magnetic resonance imaging (MRI), electrophysiology study (EPS) and therapeutic intervention were analyzed. RESULTS: Eleven patients (seven males) were diagnosed with ARVC. Mean age at clinical presentation was 42.6+/-14.8 years. Two patients (18.1%) had positive family history of ARVC or premature sudden cardiac death. The commonest presenting symptoms were palpitation (73%) and dizziness (46%). Spontaneous ventricular tachycardia (VT) was the presenting arrhythmia in 54% and 1 (9%) with ventricular fibrillation and cardiac arrest. Seven patients (64%) had the ECG abnormality as defined by the Task Force. Echocardiography showed right ventricular (RV) dilatation in five patients (46%) and all patients had normal left ventricular function. Nine patients (90%) had RV wall thinning or fibrofatty replacement on MRI examination. Inducible monomorphic VT was detected in four out of nine patients at EPS. All eight patients had normal coronary arteries and left ventriculogram but RV dilatation and global hypokinesia was seen in three patients. Implantable cardioverter defibrillators were implanted in five patients and two of them had shocks delivered during the follow-up period. CONCLUSION: In this study, familial incidence of premature sudden death in patients with ARVC appears to be low and left ventricular involvement in affected individuals is uncommon. MRI is still the best investigation for ARVC.

Adult↗
PubMed1990

Ethical issues in geriatric nephrology: overview.

Developments in medical care over the past five to six decades have provided remarkable life-sustaining technologies (LST) that have contributed to prolongation of the life span of patients, as well as to a general increase in health and well-being. End-stage renal disease (ESRD) treatment is a prototype of these LST treatments and of the issues surrounding provision of chronic/catastrophic care. This remarkable progress has been accompanied by ethical dilemmas that include allocation of scarce resources, and initiation and termination of care with LST. Consideration of these ethical dilemmas are especially poignant for the elderly, because they raise "hard choices" and there are no easy answers to these ethical dilemmas.

Aged↗
PubMed2002

Tumor progression, histologic grading and DNA-ploidy as predictive factors of lymphogenous metastasis in primary carcinoma of the Fallopian tube.

UNLABELLED: The bad prognosis of primary carcinoma of the Fallopian tube (FTC), with 5-year overall survival rates of only 35%, is particularly ascribed to lymphogenous metastasis. Yet, we know very little on the pathophysiologic factors on which this lymphogenous metastasis is based. The present study, therefore, aims at evaluating the influence of intra-abdominal tumor progression and tumor-cell anaplasia on lymphogenous metastasis in FTC. We studied 41 cases of FTC, who had been subjected to radical lymphadenectomy during primary operation in a retrospective analysis. Staging was done by International Federation of Gynecology and Obstetrics-classification. Histologic grading and nuclear DNA-content (DNA-index) were used for evaluating tumor-cell anaplasia. Histologic grading discriminated between highly differentiated (G1), moderately dedifferentiated (G2), and dedifferentiated (G3) tumors. According to their DNA-indices, tumors were separated into three groups: DNA-index < or =1.1 (euploid cases), DNA-indices between 1.1 and 2.0 (cases of intermediate ploidy), and DNA-index >2.0 (aneuploid cases). The overall incidence of lymph node metastases was 43.9%. There was no correlation between histologic grading and DNA-index (P=0.98). Lymphogenous metastasis set in after the tumor had transgressed the tube (intra-abdominal stage II). Further intra-abdominal tumor progression (including omentum, liver, or peritoneum) significantly increases the incidence of lymph node metastases (P=0.02). There was only a single G1-tumor that had already disseminated into the lymph, all other cases of lymph node metastases were found in G2- or G3-tumors. DNA-index and the extent of lymphogenous metastases were not found to be correlated (P=0.74). CONCLUSIONS: The extent of lymphogenous metastases in FTC depends above all on intra-abdominal tumor progression. This fact has clinical consequences as the indication for lymphadenectomy can be obtained directly during operation. The results of histologic grading are of no impact on the surgical proceedings; the determination of DNA-ploidy is negligible.

Adult↗
PubMed2005

[Exposure to tobacco smoke (passive smoking) in the home and inpatient treatment of children under the age of 5 years in Germany].

BACKGROUND AND OBJECTIVE: Exposure to environmental tobacco smoke (ETS) poses an impact on the health of the newborns and infants. In Germany research about the tobacco-attributable morbidity and mortality has been conducted to a very small extent. This analysis examines all data from 16 federal states in regard to number and duration of hospitalization of children exposed to ETS up to 5 years of age. MATERIAL AND METHODS: Integration of two different data sets: (a) national data (number of households with children younger than 5 years exposed to a current smoker) with (b) hospital statistics (number and duration of hospitalisations by diagnoses) for all 16 federal states. Relative risks for tobacco-attributable diseases were taken from current research. RESULTS: In Germany the rate for tobacco-attributable hospitalisations of children between 0 and < 5 years range from 1.6 % to 3.8 % between states. Between 22.0 % and 27.1 % of all hospitalisations with the diagnosis of otitis media or respiratory diseases are attributable to passive smoking. CONCLUSION: Tobacco-attributable hospitalisations pose a serious but preventable problem for the health care system.

Asthma↗
PubMed2004

Medicolegal analysis of injury during endoscopic sinus surgery.

OBJECTIVES: To survey the causes, characteristics, and outcomes of malpractice litigation resulting from injuries sustained during endoscopic sinus surgery (ESS). STUDY DESIGN: A retrospective analysis of United States state and federal civil litigation involving injuries resulting from ESS. METHODS: Sources were state and federal court decisions and jury verdict reports accessed through a computerized legal database. The 41 cases were decided or settled between 1990 and 2003. The cases and reports were analyzed for pertinent data regarding plaintiffs, defendants, allegations of wrongdoing, resulting injury, expert witnesses, and resulting verdict or settlement. Correlation between severity of injury and case outcome was analyzed. RESULTS: All suits reviewed involved ESS. Many cases included multiple causes of action, or types of malpractice, including negligent technique, 31 (76%); lack of informed consent, 15 (37%); and wrongful death, 2 (5%). The defendant-physician specialty was overwhelmingly otolaryngology, 40 (98%). The most common presenting complaint, or indication for surgery, was chronic sinusitis, 30 (73%). The injuries caused by surgery were frequently multiple, including cerebrospinal fluid (CSF) leak, 10 (24%); brain damage, 6 (15%); diplopia, 7 (17%); and death, 2 (5%). The majority of cases reviewed (83%) resulted in a verdict rather than settlement. The result of the verdict or settlement was 17 (41%) in favor of the plaintiff, 23 (56%) in favor of the defendant, and 1 (2%) unknown. The average award was 751,275 dollars, with a median of 410,239 dollars and a range of 61,000 dollars to 2,870,000 dollars. CONCLUSIONS: This is the first study to review malpractice litigation resulting from injuries sustained during ESS and shows a hitherto unexpected pattern between severity of injury and case outcome.

Endoscopy↗