Altered T-lymphocyte subsets in hospitalized intravenous drug abusers.

Baseline immunologic abnormalities were identified in 16 hospitalized intravenous drug abusers ( IDAs ) without acquired immune deficiency syndrome (AIDS). Twelve (75%) of 16 had inverted helper-suppressor ratios. In seven patients (44%), the abnormal ratio resulted from an increase in the absolute number of suppressor cells with a normal number of helper T lymphocytes. In five patients (31%), the reduced ratio resulted primarily from decreased helper cells, immunophenotypic findings similar to those seen in patients with AIDS. These findings are similar to what has been noted in other groups at risk for AIDS. Longitudinal follow-up as well as studies of "healthy" IDAs are required to understand the prognostic implications of these data.

Downsizing, role demands, and job stress.

This is a cross-sectional study consisting of self-administered survey instruments to measure psychological distress and stress-inducing work demands after 6 months of rumors about an upcoming corporate downsizing event. The workforce consisted predominantly of white males who were married, college-educated, and nonsmokers. Higher stress levels were seen among older, more educated workers, who had longer company tenure. Role boundary problems, noxious physical environments, and company tenure were retained in the final multivariable model predicting distress level. The ongoing time delay for management to implement the threatened layoff and peer rankings for a new job performance appraisal contributed to a decline in worker solidarity because of concerns about career and job security. These uncertainties reduced worker productivity and effective teamwork.

Hospitals and plastics. Dioxin prevention and medical waste incinerators.

CHLORINATED DIOXINS and related compounds are extremely potent toxic substances, producing effects in humans and animals at extremely low doses. Because these compounds are persistent in the environment and accumulate in the food chain, they are now distributed globally, and every member of the human population is exposed to them, primarily through the food supply and mothers' milk. An emerging body of information suggests that dioxin contamination has reached a level that may pose a large-scale, long-term public health risk. Of particular concern are dioxin's effects on reproduction, development, immune system function, and carcinogenesis. Medical waste incineration is a major source of dioxins. Polyvinyl chloride (PVC) plastic, as the dominant source of organically bound chlorine in the medical waste stream, is the primary cause of "iatrogenic" dioxin produced by the incineration of medical wastes. Health professionals have a responsibility to work to reduce dioxin exposure from medical sources. Health care institutions should implement policies to reduce the use of PVC plastics, thus achieving major reductions in medically related dioxin formation.

Workers' compensation in the United States and the role of the primary care physician.

The workers' compensation system was designed as a no-fault system in the early years of the last century. The system is organized on a state level. There are three differing models in current use: the single public fund, the single private fund, and an open market. States range as well in the amount of choice available to the injured workers in their selection of health care providers. In each state though, the physician plays an integral role in ensuring that the injured worker obtains adequate medical care in a prompt and efficient manner. The physician's function is either as treating physician, or as one who provides an independent medical evaluation for either the employee's lawyer, the employer, the insurer or their counsel or the state. Many obvious improvements in the system have not been made because political agreement on the state level is often lacking.

Research colloquium on occupational respiratory diseases: a conference in Cuba (1984).

At an international conference in Havana, Cuba, March 19-21, 1984, health professionals from the United States, Canada, and Cuba participated in a research colloquium on occupational lung diseases. Participants and speakers discussed the state of the art of knowledge, research, and management of key occupational lung diseases, and suggested directions for future efforts. Differences among the three countries in terms of the medical, economic, and social aspects of defining, treating, and compensating occupational diseases were also considered.

Occupational medicine: a role for the primary care physician.

Knowledge of the general categories of disease-causing exposures is essential to the practice of primary care medicine, but occupational medicine remains an area in which most physicians are markedly undereducated. A relevant occupational history may provide the clues to an otherwise elusive etiology. A directory of resources for the primary physician follows the text of the article.

Occupational health services for municipal employees.

Most municipalities have departments responsible for fire, policing, public works, parks, sanitation, health, water, administration, and communications. A comprehensive occupational medicine program must address the potential and actual health hazards associated with each of these fields, as well as pre-employment/placement medical evaluations, medical surveillance, wellness programs, work-related injury, case management, return-to-work accommodations, and drug and alcohol testing. While no standard for municipal occupational heath services exists, a comprehensive approach to the variety of work settings that are inherent even in small municipalities is important for the service provider.

A health survey of toll booth workers.

The prevalence of respiratory and other health problems in a cohort of highway toll booth workers was surveyed by mailed questionnaire. In a low proportion of respondents (43.2%), a high prevalence of central nervous system complaints (headaches, irritability, or anxiety, and unusual tiredness), mucous membrane irritation (eye irritation, nasal congestion, and dry throat), and musculoskeletal problems (joint and back pains) was found. We believe these symptoms are reflective of the acute irritant and central nervous system effects of exposure to motor vehicle exhaust. The musculoskeletal complaints are likely the result of bending, reaching, and leaning out of the toll booth. The need for in-depth evaluation of the ventilation systems and the ergonomic and job stressors of work at toll booths is suggested by these results.

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.

Neurobehavioral effects of the on-call experience in housestaff physicians.

Sixty-tree medical residents were tested on a battery of computer-based, self-administered neurobehavioral tests before and after a 36-hour in-hospital call plus postcall day to assess the central nervous system effects of the call experience and its accompanying sleep deprivation. Statistically significant decreases in performance were found postcall on tests of sustained visual attention (P less than 0.0001), speed and coding ability (P less than 0.0001) and short-term recall (P less than 0.0001). Hand-eye coordination improved (P less than 0.02).

The fall of zinc protoporphyrin levels in workers treated for chronic lead intoxication.

A temporal fall of zinc protoporphyrin (ZPP) levels in whole blood was observed in 51 patients with occupational chronic lead intoxication who were removed from exposure, treated with intravenous calcium disodium edetate (EDTA), and followed for periods up to 2,273 days. ZPP levels fell, with a mean half-life of 68 days, to a mean baseline level of 36 micrograms/dl of whole blood. The baseline ZPP level was positively associated with the length of exposure (p less than .01) and the blood lead half-life (p less than .001). The amount of EDTA received had no apparent effect on ZPP levels. These data suggest that the fall of ZPP levels is largely a function of red blood cell turnover. The baseline ZPP level appears to be a useful biologic index of the biologically active pool of lead for at least two years after removal from exposure.

Trends in asthma mortality among African Americans and whites in Chicago, 1968 through 1991.

Death certificate data were used to examine asthma mortality among African Americans and Whites aged 5 through 34 years in Chicago from 1968 through 1991. African Americans experienced consistently higher asthma mortality throughout the period. Asthma mortality remained stable among Whites from 1968 through 1991 but increased by 337% among African Americans from 1976 through 1991 (P < .001). The increase was greatest among 20- through 34-year-olds. Between 1979 and 1991, outpatient and emergency department deaths increased significantly, while the proportion of dead-on-arrival cases remained stable at 51%. This shift to non-inpatient deaths suggests that lack of access to health care may play a role in increasing asthma mortality.

Stress among package truck drivers.

In 1992, a cross-sectional questionnaire study of package truck drivers in one company was conducted at four widely scattered sites throughout the US; 317 drivers participated, representing 82% of those eligible. The package truck drivers scored significantly above the US working population comparison norm on all summary and individual scales derived from the SCL 90-R, indicating a substantial increase in psychologic distress for this group. The Global Severity Index, the best single summary measure of psychological distress in the SCL 90-R, revealed a mean T score for the drivers of 64.20, 91st percentile of the normative population. The group perceived significantly more daily stressful events than the average working adult, and their sensitivity to these events was also increased. Role overload, a component of the Occupational Stress Inventory, was the most consistent factor associated with symptoms of psychological distress on multiple regression analysis. This study suggests that job stress is a psychological health hazard for these drivers.

Activities of an employer independent Occupational Medicine Clinic, Cook County Hospital, 1979-1981.

In July 1976, Cook County Hospital, a 1,363-bed general public hospital in Chicago, Illinois, established a hospital-funded Occupational Medicine Clinic. A review was made of the clinic records of the 486 new patients evaluated at the clinic from July 1979 to June 1981. Information is presented concerning age, ethnic origin, sex, union representation, referral sources, reason for the referral, number and type of toxic exposure, diagnosis, occupational relationship of the disease, and disposition.

Elimination kinetics of blood lead in workers with chronic lead intoxication.

Blood lead elimination half-lives were determined for 65 patients with occupational chronic lead intoxication who were removed from exposure, treated with intravenous EDTA, and followed for periods of up to 2,419 days. The median overall blood lead elimination half-life was 619 days in patients with normal renal function and 1,907 days in patients with renal impairment. Slow-phase elimination half-lives in patients followed for longer than 5 years ranged from 1,658 to 7,189 days. Blood lead concentrations declined during periods of chelation with a mean half-life of 7 days and rebounded to near prechelation concentrations following termination of chelation with a mean doubling time of 27 days. The overall blood lead elimination half-life was positively associated with length of follow-up (p less than 0.001), age (p = 0.04), and duration of exposure (p = 0.02), but was not associated with the initial blood lead concentration following cessation of exposure or the total amount of EDTA received.