Air-conditioned environments do not prevent deterioration of human semen quality during the summer.

OBJECTIVE: To determine if air conditioning might mitigate summer reductions in semen quality. DESIGN: Prospective study of semen quality in summer and winter. SETTING: Normal human volunteers were studied in the setting of a fertility laboratory. PATIENTS, PARTICIPANTS: Two groups of volunteers were selected from the vicinity of New Orleans: 64 men who worked indoors during the summer in air-conditioned environments and 76 others who worked outdoors. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Parameters of manual semen analysis were examined for seasonal and group differences. RESULTS: Remarkably similar reductions in semen quality during summer as compared with winter were observed in both indoor and outdoor workers, respectively, with regard to the following parameters of semen quality: 19% and 19% in sperm concentration, 25% and 27% in total sperm per ejaculate, 17% and 20% in motile sperm concentration, 13% and 15% in percent sperm with normal morphology, and 23% and 23% in concentration of morphologically normal motile sperm. CONCLUSIONS: These findings do not support the hypothesis that the heat of the summer is detrimental to male reproductive capacity. The available evidence suggests instead a possible role of photoperiod in causing the seasonal changes in semen quality.

Developing occupational and environmental medicine curricula for primary care residents: project EPOCH-Envi. Educating Physicians in OCupational Health and the Environment.

To help primary care residency programs develop or improve residency curricula in occupational and environmental medicine, the National Institute for Occupational Safety and Health launched a train-the-trainer initiative. This project was called EPOCH-Envi (Educating Physicians in OCcupational Health and the Environment). From 1990 to 1996, 46 2-day curriculum development workshops were held. These featured (1) guidelines on how to plan, implement, and evaluate a curriculum, (2) continuing education on occupational illnesses and injuries, (3) a worksite or environmental site visit, and (4) information resources. A total of 435 faculty from 305 residency programs participated, representing 42.5% of the family practice residencies and 24.9% of the internal medicine residencies in the United States. A survey conducted among attendees (60.4% response rate) 17 months after their workshop revealed that 65.6% of respondents had added lectures on occupational and environmental topics to the residency curriculum. Other curriculum improvements were also made. Primary care physicians manage most patients with occupational and environmental health problems or concerns. Providing technical assistance specifically designed to support occupational and environmental health education in primary care residencies can have a positive impact on curriculum content.

Teaching occupational and environmental medicine in primary care residency training programs: experience using three approaches during 1984-1991.

There is a critical shortage of physicians trained to recognize and treat occupational and environmental health problems. We implemented several required teaching programs for internal medicine and family medicine residents that focus on providing primary care for these problems. Clinical experiences were developed using the university and medical center as an example of a workplace with chemical and physical hazards. On-site experiences were also provided at local industries, but when resident stipend support for this aspect was discontinued, that part of the program was suspended. Didactic programs were associated with a statistically significant improvement in house staff knowledge scores. These occupational and environmental health issues can be introduced during residency, resulting in increased expertise in this discipline.

Occupational risks in the rubber industry.

Important epidemiologic findings have resulted in safer work conditions over the past decades. Maintaining this improvement in worker risk requires continued epidemiological surveillance for unrecognized dangers and intense enforcement of industrial hygiene principles. It also demands an enhanced clinical suspicion and a low threshold for clinical diagnosis of potentially attributable health problems in workers whose workplace chemical environment is in continual evolution. Clinicians should be familiar with the known associations of work and disease, and remain alert to the possibility of chemically mediated disease in workers exposed to this highly complex mixture of chemical agents.

Recurrent sulindac-induced aseptic meningitis in a patient tolerant to other nonsteroidal anti-inflammatory drugs.

The association of nonsteroidal anti-inflammatory drugs (NSAIDs) and recurrent aseptic meningitis has been only rarely noted in patients without underlying connective tissue disease. I have described a patient who had four episodes of unexplained meningitis for which no auto-inflammatory or infectious cause could be found. Three of the episodes were found to have been immediately preceded by sulindac doses. The patient has tolerated aspirin, indomethacin, naproxyn, fenoprofen, diflunisal, and ibuprofen before and since this association was noted, implying an immunologic hypersensitivity to sulindac and not a pharmacologic effect of the entire class of such drugs.

Exposure assessment and gender differences.

Exposure assessments for occupational epidemiological studies are typically conducted to (1) establish risk gradients with exposure, evaluating a potential causal relationship, or (2) estimate exposure-response dosimetry for quantitative risk calculations. Unavailable quantitative exposure data require use of surrogate or qualitative measures. Differences in women's employment patterns may make surrogate measures less reliable, resulting in systematic errors. Exposures associated with traditionally female careers have not been fully evaluated. Occupational cohorts are often defined to include workers with a minimum employment duration or employment for some minimum time in exposure-related jobs, thereby excluding many women workers. Even when included among studied and exposed worker cohorts, women's domestic exposures may confound risk evaluation. Male/female differences in xenobiotic uptake, distribution, kinetics, and metabolism may affect the relationship between external exposure and resulting biologically effective dose. Clinical factors alter the recognition of disease among women workers, confounding risk determination. Recognizing these problems during design and analysis of occupational cancer epidemiology research is essential to develop valid preventive strategies.

Urinary creatinine excretion is not stable: a new method for assessing urinary toxic substance concentrations.

Urinary concentrations of toxic substances require correction to adjust for the misleading effects of varying states of hydration. The most common method in current use involves calculation of substance-to-creatinine concentration ratios. For accuracy, this method assumes creatinine excretion rates to be stable despite varying rates of urinary flow. However, this underlying assumption has been challenged in recent studies. Our evaluation of separate data regarding individual voids confirmed that creatinine excretion rate depends significantly (p less than .0001) on urinary flow. We calculated a logarithmic regression model identical to one reported previously. The partial correlation coefficient for log flow was .21 after adjusting for inter-individual differences in creatinine excretion rates. We propose a simple method to correct creatinine concentrations in "spot" urine samples for the effects of varying hydration. The new method retains many benefits of the classical correction by substance-creatinine ratios.