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Biomedical subjects

E D Richter

Publications and source records attributed to E D Richter.

At least 19 recordsLinked to original sources
PubMed1995

Occupation and environment in internal medicine: sentinel events and trigger questions.

Patients who undergo sentinel events indicate a breakdown in the chain of prevention and protection. Because most work- or environmentally induced illnesses and disabilities produce nonspecific or late symptoms and signs, the search for exposures to physical, toxic, ergonomic, or sociopsychological events that induce these sentinel events has to be based on systematic investigative routine, and not on the physician's mere awareness. Routine use of five "trigger" questions to identify jobs, tasks, exposures, symptoms, and other persons at risk can be effective, quick, and inexpensive in the search for preventable illness related to work or environment in the sentinel patient, especially when illness persists, recurs, or progresses or occurs in others. Sometimes, others can be helped when it is too late to do anything for the sentinel individual. This holds true for the relatively simple situations of one exposure and one outcome and for settings in which there are many exposures or many diseases in one or many patients. The newer set of "clean" environments that include ergonomic and sociopsychological hazards and stress at the work-station have produced new sentinel events. Knowledge of the impact of macro-environmental hazards presupposes familiarity with their impact on individual risks. Using the sentinel event to promote prevention of hazardous exposures means opportunities for reducing unnecessary risk in individuals and small groups. Opportunities for prevention arise when sentinel events occur at the time of exposure. Where there is latency between exposure and outcome, an anticipatory approach based on awareness of future risks from preventable current exposures is needed. The search for external exposures that have already occurred and for those that are preventable should be a routine part of internal medicine.

Adult↗
PubMed1991

The IARC classification system: input, internal logic, output, and impact.

The IARC Monographs "Evaluation of Carcinogenic Risk of Chemicals to Man" elegantly condense and classify information on carcinogenic hazards. They serve as an invaluable basis for the regulation of carcinogenic exposures, yet the monographs are inadequate in several respects: 1. The monographs reflect only what is reported and published in peer-reviewed sources; they have not themselves generated support for studies on agents and processes for which information is lacking, partial, or inadequate. 2. There has been misuse of the output, which reflects varying levels of certainty as to human health hazards. Lack of absolute certainty on human carcinogenicity has been used as a basis for deferring regulations or other preventive action to restrict exposures. 3. The monographs ignore high-risk situations which may result from combined or interactive effects, because of the orientation mostly on specific agents. There is not adequate attention to frequently reported excesses of disease other than cancer in certain occupations with mixed exposures. Earlier recognition of more widespread and more reversible effects, other than cancer, needs to be emphasized to control exposures. 4. Control of carcinogenic exposures for workers has been less exacting and consistent than control of exposures for the community at large (water, air, food, and drugs). 5. The gap between knowledge of risks and action to control them is great and calls attention to the need for more aggressive professional input.

Animals↗
PubMed1991

Work injuries and exposures in children and young adults: review and recommendations for action.

Child labor, the penultimate form of cheap labor, is endemic in poor countries; it also occurs in affluent countries. Little information has been available on injuries, disease, and effects on growth and development in the tens of millions of children at risk. Preventive and control measures are eliminating the gross abuses, tracing and banning hazardous exposures to toxic agents, eliminating risks of injuries and ergonomic strain, providing health services for working children through the primary health care network, and developing international failsafe design standards for tools and work systems, if these children must work. There is a need to train public health professionals, pediatricians, and maternal and child health care personnel in carrying out simple descriptive epidemiologic studies and setting up interventive programs. Eliminating the worst conditions and controlling hazards where there is no imminent alternative to child labor are suggested as the basis for a two-pronged strategy for protecting children who are forced to work.

Accidents, Occupational↗
PubMed1986

Smoking, morbidity, and pulmonary function in a group of ex-asbestos workers: a pilot study.

Thirty-three of 184 formerly exposed asbestos textile workers were interviewed to evaluate knowledge, attitudes, and practices concerning smoking and asbestos. Twenty-three subjects in this group also underwent physical examination to determine smoking-symptom/sign-pulmonary function interrelationships. Approximately half of the exworkers smoked, and the majority who had stopped did so mostly because of illness rather than because of knowledge concerning smoking-asbestos hazards. All workers welcomed the offer of smoking cessation programs. Smokers and exsmokers, but not nonsmokers, were at risk for obstructive-type impairments, but all three groups contained subjects with impairments interpretable as restrictive. The presence of shortness of breath, cough, râles, or decreased breathing sounds alone or in any combination greatly increased the odds that either obstructive- or possible restrictive- or mixed-type impairments would be found on spirometry. Mass screening techniques required about one hour of person time per examinee to assess health status, provide educational material on smoking, and counsel workers on referral arrangements. The findings suggest that smoking alerts, smoking cessation clinics, and medical follow-up are needed, feasible, and acceptable in Israel.

Aged↗
PubMed1986

Zinc protoporphyrin levels in children in Haifa: a pilot study.

Zinc protoporphyrin (ZPP) levels of greater than or equal to 40 micrograms dl-1 were found in blood samples of 32 (12.1%) out of 264 children living in Kiryat Yam, Haifa Bay (a sea-level neighborhood with much vehicular traffic, located 4.5 km from an industrial zone in the bay area), 22 (8.8%) out of 251 children living in Neve Shaanan (located on a mountainside, 3.5 km from an industrial zone and exposed to visible smoke pollution), and 14 (6.5%) out of 214 children from Mt Carmel (Ahuza), which is furthest from industry and where visible signs of pollution are seldom seen. Zinc protoporphyrin levels, low in non-anemic infants, were slightly higher in 1st graders from all three neighborhoods; higher levels were found in both 3rd and 6th graders from Kiryat Yam, but only in 6th graders from Neve Shaanan. The ZPP levels remained unchanged in older, Mt. Carmel children. Zinc protoporphyrin concentrations of greater than or equal to 40 micrograms dl-1 varied inversely with two indices of socio-economic status (parental ethnic origin and father's educational level). Blood lead levels of greater than or equal to 20 micrograms dl of blood were found in eight (13%) out of 62 children with ZPP levels greater than or equal to 40 micrograms dl-1, but in none (0%) of 14 children with ZPP levels greater than or equal to 40 micrograms dl-1. Three (60%) out of five children with ZPP levels greater than or equal to 50 micrograms dl-1 had Pb levels of greater than or equal to 20 micrograms dl-1. In Kiryat Yam, Pb(B) was higher in 31 children with ZPP greater than or equal to 40 micrograms dl-1 compared with 13 with ZPP less than 40 micrograms dl-1. The data on age-associated increases in ZPP in children suggest the possibility of an effect on red blood cell porphyrin metabolism, in some cases from cumulative low level lead exposures, and in others from iron deficiency, especially in poorer socio-economic groups. The findings call for further studies, both in the populations studied here, and elsewhere, to determine the role of lead toxicity and iron deficiency in children of all age groups, and the need for preventive action.

Age Factors↗
PubMed1986

Sequential cholinesterase tests and symptoms for monitoring organophosphate absorption in field workers and in persons exposed to pesticide spray drift.

Pre-season, in-season and post-season cholinesterase (ChE) levels (Ellman method) were monitored in 36 field workers (sprayers, field hands, leaf inspectors) from 3 kibbutzim and 25 residents from the same kibbutzim. Small and presumably inconsequential in-season reductions in plasma and whole blood ChE activity were seen in field workers and residents exposed to spray drift, but not in non-exposed residents. Intra- and inter-individual variability in plasma and whole blood ChE activities were within 'normal' ranges (e.g., less than 30% inhibition), but the variability (intra- and inter-individual) was greater in the field workers compared with residents. Daily logs from the infirmary of one kibbutz for 1 month recorded an excess of complaints (respiratory tract, eye irritation, headache) in residents on days when organophosphates were sprayed from aircraft compared to days when other or no pesticides were sprayed. The findings provide some indications of the utility and the level of sensitivity of plasma ChE for monitoring field workers, and possibly residents exposed to drift. Selective semi-routine examinations of alkylphosphates in urine together with the assessment of health effects are recommended to determine whether or not ChE monitoring is needed on a routine basis, or should be replaced by alkylphosphate monitoring.

Adolescent↗
PubMed1984

Monitoring for neurotoxic effects from low level exposures to organophosphate pesticides.

Data from small scale studies on low level and delayed neurotoxic effects from exposure to organophosphate pesticides suggest the need for monitoring those at risk in agriculture and industry, as well as residents repeatedly exposed to aerosol drift from aerial spraying. A pilot program is put forth with the aim of determining whether such effects occur in exposed populations, and if they do, assessing their incidence, distribution and severity, as well as the efficacy of control programs.

Aryldialkylphosphatase↗
PubMed1984

Asbestos-exposed populations: prevention, care, and compensation.

In Israel, the prevention and care of asbestos-associated diseases with latency periods of one to four decades (asbestosis, mesothelioma, increased frequency of cancer of the lung and other sites) are not satisfactory, and new national policies are required. Such policies have three major goals: (a) elimination or reduction of exposure to asbestos dust; (b) measures to promote cessation or drastic reduction of cigarette smoking among those currently or formerly exposed; and (c) equitable compensation for the consequences of past exposures. The practical elements of a program to achieve these three goals include (a) exposure standards and control technology; (b) identification of sources, routes, and levels of exposure and groups at risk; (c) compensation and job security; (d) medical monitoring and follow-up; (e) smoking cessation; (f) selective substitution of other substances for asbestos; and (g) establishment of a panel for policy supervision and the overseeing of compensation programs. Delay in implementation risks higher death rates for asbestosis and cancer among previously exposed workers, greater exposure among current workers, loss of experienced workers from the work force, and unnecessary hardship for families not adequately compensated.

Adult↗
PubMed1984

Asbestos exposure in Israel: findings, issues and needs.

In Israel, since the 1950s, at least several thousand workers, their wives and children, and possibly many others, have been or still may be exposed to hazardous amounts of airborne asbestos fibers. These are found both in asbestos-based industries (asbestos cement, textiles and brake linings) and trades with asbestos exposure (construction, shipyard repair, boiler maintenance, insulation work). These people are at increased risk for disability or illness, or for premature death from asbestosis, from lung cancer, from exacerbation of preexisting respiratory disease (especially if they smoke), from mesothelioma, from gastrointestinal cancer, and from other malignancies. Although there has been progress, much still has to be done in the areas of legislation, standard setting, exposure control, technology, surveillance, smoking cessation, and medical care and follow-up. Compensation is needed to care for those workers currently or previously exposed, as well as for their families and others at risk. A national policy for protecting and caring for those formerly or currently exposed is indicated by the review of the situation in Israel.

Asbestos↗
PubMed1984

Lead poisoning in a West Bank Arab Village.

Eleven patients from the West Bank village of Es-Sawiyeh were admitted with lead poisoning to two Jerusalem hospitals between November 1982 and January 1983. They all belonged to several households of a single large family. Colicky abdominal pains were present in five patients, weakness in four, behavioral changes ranging from irritability to frank psychosis in four, and paralysis in one. Anemia of various degrees was seen in all patients. Basophilic stippling and reticulocytosis were encountered in all patients with moderate to severe anemia. Therapy with edetate disodium calcium and penicillamine resulted in clinical improvement in all patients. A preliminary survey of 270 subjects in the same village disclosed 84 subjects with abnormally elevated blood lead levels, 17 of whom had grade IV lead burden according to the Centers for Disease Control risk classification. Contamination of homemade flour by lead used for stabilizing the metal parts of stone mills was the source of poisoning. As the method of milling in many West Bank villages is similar, these findings may have important implications to the well being of a large section of the rural West Bank population.

Adolescent↗