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Medical Surveillance (medical + surveillance)
Selected AbstractsProspective Surveillance of Hypertension in FirefightersJOURNAL OF CLINICAL HYPERTENSION, Issue 5 2003Elpidoforos S. Soteriades MD The authors evaluated blood pressure and antihypertensive medication use in 334 firefighters in an occupational medical surveillance program. Firefighters received written summaries of their examination results, including blood pressures, and were encouraged to see their personal physicians for any abnormal results. The mean age of the participants was 39 years, and the vast majority were men (n=330). The prevalence of hypertension was 20% at baseline (1996), 23% in 1998, and 23% in 2000. Among firefighters with high blood pressure readings, only 17%, 25%, and 22% were taking antihypertensive medications at the baseline, 1998, and 2000 examinations, respectively. Medical surveillance was effective in detecting hypertension in firefighters; however, after 4 years of follow-up, only 42% of hypertensives were receiving treatment with medications, including only 22% of firefighters with hypertensive readings. Overall, 74% of hypertensives were not adequately controlled. Possible reasons for low treatment rates may be the inadequate recognition among primary care physicians that mild hypertension is a significant risk factor for cardiovascular disease. [source] Beryllium lymphocyte proliferation test surveillance identifies clinically significant beryllium diseaseAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2009Margaret M. Mroz MSPH Abstract Background Workplace surveillance identifies chronic beryllium disease (CBD) but it remains unknown over what time frame mild CBD will progress to a more severe form. Methods We examined physiology and treatment in 229 beryllium sensitization (BeS) and 171 CBD surveillance-identified cases diagnosed from 1982 to 2002. Never smoking CBD cases (81) were compared to never smoking BeS patients (83) to assess disease progression. We compared CBD machinists to non-machinists to examine effects of exposure. Results At baseline, CBD and BeS cases did not differ significantly in exposure time or physiology. CBD patients were more likely to have machined beryllium. Of CBD cases, 19.3% went on to require oral immunosuppressive therapy. At 30 years from first exposure, measures of gas exchange were significantly worse and total lung capacity was lower for CBD subjects. Machinists had faster disease progression as measured by pulmonary function testing and gas exchange. Conclusions Medical surveillance for CBD identifies individuals at significant risk of disease progression and impairment with sufficient time since first exposure. Am. J. Ind. Med. 52:762,773, 2009. © 2009 Wiley-Liss, Inc. [source] Second Primary Cancers Following Breast Cancer in the Japanese Female PopulationCANCER SCIENCE, Issue 1 2001Hideo Tanaka To assess the risk of developing second primary cancers following breast cancer in Japanese females, we performed a retrospective cohort study of 2786 patients who were newly diagnosed with breast cancer at our hospital between 1970-1994, until the end of 1995 (average follow-up period, 8.6 years). The expected number of each second primary cancer was calculated by multiplying the number of appropriate person-years at risk by the corresponding age- and calendar period-specific cancer incidence rates for women obtained from the Osaka Cancer Registry. One hundred and seventeen patients developed a second primary cancer other than subsequent breast cancer, yielding an observed-to-expected ratio (O/E) of 1.3 [95% confidence interval (CI)=1.1-1.6]. The risk for developing a second primary cancer was significantly elevated during the first year following the diagnosis of breast cancer, and decreased with the passage of tune to unity. A significantly increased risk was noted for the development of ovarian cancer (O/E=2.4, 95% CI=1.0-4.6), thyroid cancer (O/E=3.7, 95% CI=1.5-7.6) and non-Hodgkin's lymphoma (NHL) (O/E=3.5, 95% CI=1.4-7.1) among the breast cancer patients compared with the general population. Patients who received hormonal therapy as the breast cancer treatment showed a significantly increased risk for ovarian cancer (O/E=5.5, 95% CI=1.8-12.9). Patients who received chemotherapy as the breast cancer treatment had an increased risk for NHL (O/E=5.0, 95% CI=1.6-11.6). These findings indicate that Japanese female patients with breast cancer had a 30% higher risk of developing a second primary cancer than the general population, the higher risk being manifested in the early period following the diagnosis of breast cancer. Medical surveillance of breast cancer patients for NHL, as well as for ovarian cancer and thyroid cancer, is required. [source] Do ,9 -tetrahydrocannabinol concentrations indicate recent use in chronic cannabis users?ADDICTION, Issue 12 2009Erin L. Karschner ABSTRACT Aims To quantify blood ,9 -tetrahydrocannabinol (THC) concentrations in chronic cannabis users over 7 days of continuous monitored abstinence. Participants Twenty-five frequent, long-term cannabis users resided on a secure clinical research unit at the US National Institute on Drug Abuse under continuous medical surveillance to prevent cannabis self-administration. Measurements Whole blood cannabinoid concentrations were determined by two-dimensional gas chromatography-mass spectrometry. Findings Nine chronic users (36%) had no measurable THC during 7 days of cannabis abstinence; 16 had at least one positive THC ,0.25 ng/ml, but not necessarily on the first day. On day 7, 6 full days after entering the unit, six participants still displayed detectable THC concentrations [mean ± standard deviation (SD), 0.3 ± 0.7 ng/ml] and all 25 had measurable carboxy-metabolite (6.2 ± 8.8 ng/ml). The highest observed THC concentrations on admission (day 1) and day 7 were 7.0 and 3.0 ng/ml, respectively. Interestingly, five participants, all female, had THC-positive whole blood specimens over all 7 days. Body mass index did not correlate with time until the last THC-positive specimen (n = 16; r = ,0.2; P = 0.445). Conclusions Substantial whole blood THC concentrations persist multiple days after drug discontinuation in heavy chronic cannabis users. It is currently unknown whether neurocognitive impairment occurs with low blood THC concentrations, and whether return to normal performance, as documented previously following extended cannabis abstinence, is accompanied by the removal of residual THC in brain. These findings also may impact on the implementation of per se limits in driving under the influence of drugs legislation. [source] Mefloquine prescriptions in the presence of contraindications: prevalence among US military personnel deployed to Afghanistan, 2007,,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 2 2010Remington L. Nevin MD Abstract Purpose Contraindications to mefloquine use include a history of certain prevalent neuropsychiatric disorders, which are thought to increase the risk of severe adverse events including anxiety, paranoia, depression, hallucinations, psychosis, and possibly suicide. Within the US military, the continued availability and use of mefloquine is subject to administrative policies dating to 2002 that require clinicians to exercise added caution during prescribing. This analysis was performed to quantify the effectiveness of these policies in ensuring health care provider compliance with package insert prescribing guidance. Methods A previously identified cohort consisting of 11,725 active duty US military personnel, among whom 1127 (9.6%) had contraindications to mefloquine use identified through medical surveillance and pharmaceutical databases, was examined to identify individuals receiving prescriptions for mefloquine in the 45 days prior to a combat deployment in 2007. Results Among the 11,725 cohort members, 4505 (38.4% of the cohort) received a prescription for mefloquine. Among the 1127 cohort members with contraindications, 155 (1.3% of the cohort) were prescribed mefloquine, comprising 13.8% of those with contraindications. Conclusions Despite the longstanding administrative policies meant to reduce such events, approximately one in seven individuals with neuropsychiatric contraindications received a prescription for mefloquine prior to a recent combat deployment, significantly increasing the risk of subsequent adverse events. Given the prevalence of neuropsychiatric disorders among US military personnel and the continued availability of mefloquine, additional study is recommended to describe and quantify the nature and extent of mefloquine-associated adverse events experienced among this group. Published in 2009 by John Wiley & Sons, Ltd. [source] Industry-wide medical surveillance of California flavor manufacturing workers: Cross-sectional resultsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 9 2010Thomas J. Kim MD Abstract Background Two cases of bronchiolitis obliterans in flavor manufacturing workers prompted California health and labor agencies to initiate industry-wide surveillance. Methods Companies' physicians submitted cross-sectional questionnaire and spirometry data for 467 workers in 16 workplaces. We compared prevalence ratios of respiratory symptoms, diagnoses, and abnormal spirometry to a general population sample. We calculated odds ratios for risk factors for spirometric obstructive abnormality. Results Flavoring workers were 2.7 times more likely than the general population to have severe airways obstruction. Risk factors identified for 18 cases with obstruction from six companies included younger age, Hispanic ethnicity, liquid and powder production work, greater company diacetyl usage, and having a coworker with obstruction. Severity of obstruction was related to tenure. At least 12 workers had probable occupational fixed airways obstruction. Conclusions The flavoring industry risk of severe lung disease justifies lowering flavoring exposures and medical screening for secondary prevention until worker safety is demonstrated. Am. J. Ind. Med. 53:857,865, 2010. © 2010 Wiley-Liss, Inc. [source] Metal and non-metal miners' exposure to crystalline silica, 1998,2002AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2006James L. Weeks ScD Abstract Background Crystalline silica is well known to cause silicosis and other diseases. Exposure is common in the mining industry and consequently, the US Mine Safety and Health Administration (MSHA) evaluates miners exposure to silica to determine compliance with its exposure limit. Methods MSHA exposure measurements were obtained for the 5-year period from 1998 to 2002 and average exposure was calculated classified by occupation and by mine. Evaluation criteria were whether average values exceeded MSHA's permissible exposure limit or the limit recommended by the National Institute for Occupational Safety and Health (NIOSH), whether there was a risk of exposure to freshly fractured silica, and whether there was a risk of a high rate of exposure to silica. Results Miners in certain jobs are exposed to silica above permissible and recommended exposure limits. Some miners may also be exposed at a high rate or to freshly fractured silica. Conclusions Known dust control methods should be implemented and regular medical surveillance should be provided. Am. J. Ind. Med. 49:523,534, 2006. © 2006 Wiley-Liss, Inc. [source] | ||||||||||