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M M Finkelstein

Publications and source records attributed to M M Finkelstein.

At least 19 recordsLinked to original sources
PubMed2004

A cohort study of mortality among Ontario pipe trades workers.

AIMS: To study mortality in a cohort of members of the United Association of Journeymen and Apprentices of the Plumbing and Pipe Fitting Industry of the United States and Canada and to compare results with two previous proportional mortality studies. METHODS: A cohort of 25,285 workers who entered the trade after 1949 was assembled from records of the international head office. Mortality was ascertained by linkage to the Canadian Mortality Registry at Statistics Canada. Standardised mortality ratios were computed using Ontario general population mortality rates as the reference. RESULTS: There were significant increases in lung cancer mortality rates (SMR 1.27; 95% CI 1.13 to 1.42). Increased lung cancer risk was observed among plumbers, pipefitters, and sprinkler fitters. Increased risk was observed among workers joining the Union as late as the 1970s. A random effects meta-analysis of this study and the two PMR studies found significant increases in oesophageal (RR 1.24; 95% CI 1.00 to 1.53), lung (RR 1.31; 95% CI 1.19 to 1.44), and haematological/lymphatic (RR 1.21; 95% CI 1.08 to 1.35) malignancies. CONCLUSIONS: The mortality pattern is consistent with the effects of occupational exposure to asbestos. Increased risk due to other respiratory carcinogens such as welding fume cannot be excluded. There are substantial amounts of asbestos in place in industrial and commercial environments. The education and training of workers to protect themselves against inhalation hazards will be necessary well into the future.

Aged↗
PubMed2001

Do factors other than need determine utilization of physicians' services in Ontario?

BACKGROUND: Universal health care systems seek to ensure access to care on the basis of need, rather than income, but there are concerns about preferential access to cardiovascular and specialist care for high income patients. In this study, I used population-based, individual-level health, income and utilization data to determine whether whether there is evidence for differential access to physician care in relation to household income. METHODS: I studied data for 2170 Ontario respondents to the 1995 National Population Health Survey (aged 40 to 79 years) who had approved linkage of their survey responses to the administrative databases of the Ontario Health Insurance Plan and for whom income data were available. I used linear and generalized linear regression to model the mean per capita expenditures on physician care and the probability of referral to a specialist in relation to income and self-reported health status. RESULTS: Residents of higher income households incurred lower per capita expenditures for physicians' services than those in lower income households; for example, the mean per capita expenditure in the upper middle income group was $220 less (95% confidence interval -$87 to -$334) than the mean per capita expenditure in the lowest income group. Expenditures were significantly related to self-reported health status; for example, the mean per capita expenditure among those reporting fair health status was $590 higher (95% confidence interval $465 to $737) than among those reporting excellent health. After adjustment for health status, there was no association between income and the expenditures on all physician services, out-of-hospital services or specialist care. INTERPRETATION: Utilization of physicians' services in Ontario is based on need, rather than income.

Adult↗
PubMed2000

Mesothelioma and lung tumors attributable to asbestos among petroleum workers.

BACKGROUND: Asbestos exposure has been definitively found to be associated with both mesothelioma and lung cancer. Nevertheless, in the overall population of oil refinery workers potentially exposed to asbestos, many studies clearly show a definitely increased risk of mesothelioma, but no proven excess of lung cancer after comparison to the general population. Through the presentation of new data and the re-appraisal of two recent and independent epidemiological studies conducted in Liguria, Italy, and Ontario, Canada, we attempt to shed light on this apparently paradoxical finding. METHODS: Lung cancer mortality was studied among maintenance workers exposed to asbestos, and among two other subgroups of refinery employees: blue collar and white collar workers. The comparison with blue collar workers was performed in order to take into account the role of healthy worker effect, smoking habit, and the socioeconomic level. The comparison with white collar workers was performed to control for other occupational lung carcinogens. RESULTS AND CONCLUSIONS: Results reveal a consistency between the two studies and show that 96-100% of the mesotheliomas and 42-49% of the lung tumors arising among maintenance workers were attributable to asbestos exposure. Our new analysis, estimating two cases of asbestos-related lung cancer for each case of mesothelioma, confirms published findings on the magnitude of asbestos-related tumors in oil refineries.

Asbestos↗
PubMed2000

Leukemia after exposure to benzene: temporal trends and implications for standards.

BACKGROUND: Benzene is a human leukemogen. Risk assessment, and the setting of occupational and environmental standards, has assumed that risk is constant in time after a unit of exposure. Leukemia risk is known to vary with time after exposure to ionizing radiation. METHODS: A matched case-control study of leukemia risk in relation to the temporal pattern of benzene exposures was performed using data from the National Institute of Occupational Safety and Health. RESULTS: Leukemia risk following exposure to benzene varied with time in a manner similar to that following exposure to ionizing radiation. More recent exposures were more strongly associated with risk than were more distant ones. There was no significant relation between leukemia death and benzene exposures incurred more than 20 years previously. CONCLUSIONS: Recent analyses of specific occupational and environmental carcinogens, including benzene and radon, have indicated that cancer risk tends to decline as the time from exposure increases. This suggests that standards for the control of occupational or public risk must be selected to control exposures over a narrower time frame than the usual lifetime one. In the case of benzene, it would appear that risk is attributable primarily to exposures incurred during the previous 10 to 20 years, with exposures in the most recent 10 years being the most potent. To limit risk, exposures must be controlled during that interval. It is important that epidemiologists explore the temporal pattern of risk in their studies to facilitate the risk assessment of other carcinogens.

Adult↗
PubMed2000

Silica, silicosis, and lung cancer: a risk assessment.

BACKGROUND: To investigate exposure-response relationships for silica, silicosis, and lung cancer. METHODS: Quantitative review of the literature identified in a computerized literature search. RESULTS: The risk of silicosis (ILO category 1/1 or more) following a lifetime of exposure at the current OSHA standard of 0.1 mg/m(3) is likely to be at least 5-10% and lung cancer risk is likely to be increased by 30% or more. The exposure-response relation for silicosis is nonlinear and reduction of dust exposures would have a greater than linear benefit in terms of risk reduction. Available data suggests that 30 years exposure at 0.1 mg/m(3) might lead to a lifetime silicosis risk of about 25%, whereas reduction of the exposure to 0.05 mg/m(3) might reduce the risk to under 5%. CONCLUSIONS: The lifetime risk of silicosis and lung cancer at an exposure level of 0.1 mg/m(3) is high. Lowering exposures to the NIOSH recommended limit if 0.05 mg/m(3) may have substantial benefit.

Adult↗
PubMed2000

Body mass index and quality of life in a survey of primary care patients.

BACKGROUND: The prevalence of overweight and obesity is increasing and contributes to the burden of ill health in the community. The impact of obesity on health-related quality of life has been less well studied than how it affects physical morbidity and mortality. METHODS: A survey of health-related quality of life using the 12-item Short Form (SF-12) of the Medical Outcomes Study Short Form-36 was mailed to patients attending a family medicine clinic. Multiple regression analyses were used to investigate the relationships between scores on the mental and physical components of the SF-12 and body mass index (BMI) while controlling for age, sex, and family income. RESULTS: Responses were received from 565 subjects (53%). The relationships among BMI and quality of life in the mental and physical domains were nonlinear. Quality of life scores were optimal when BMI was in the range of 20 to 25 kg per m2. CONCLUSIONS: The National Heart, Lung, and Blood Institute has published evidence-based clinical guidelines for the identification, evaluation, and treatment of overweight and obesity in adults. Subjects with BMI in the range 18.5 to 24.9 kg per m2 are classified as having normal weight. These observations suggest that achieving a weight in this range will maximize the patient's subjective sense of well-being.

Aged↗
PubMed1999

Inferences on the kinetics of asbestos deposition and clearance among chrysotile miners and millers.

BACKGROUND: The health effects of asbestos are intimately related to the fate of inhaled fibers in the lungs. The kinetics of asbestos fibers have been studied primarily in rodents. The objective of this study was to explore the application of these kinetic models to human autopsy data. METHODS: We analyzed the asbestos fiber content of the lungs of 72 Quebec chrysotile miners and millers and 49 control subjects using analytical transmission electron microscopy. Statistical methods included standard multivariate linear regression and locally weighted regression methods. RESULTS: The lung burdens of asbestos bodies and chrysotile and tremolite fibers were correlated, as were the concentrations of short, medium, and long fibers of each asbestos variety. There were significant associations between the duration of occupational exposure and the burdens of chrysotile and tremolite. The concentration of chrysotile decreased with the time since last exposure but the concentration of tremolite did not. The clearance rate varied inversely with the length of chrysotile fibers. For fibers greater than 10 mu in length the clearance half-time was estimated to be 8 years. CONCLUSIONS: The patterns in our data are compatible with both of the hypotheses suggested from rodent experiments; the existence of a long-term sequestration compartment and overload of clearance mechanisms in this compartment.

Aged↗
PubMed1999

Record linkage as a research tool for office-based medical care.

OBJECTIVE: To explore the feasibility of linking records to study health services and health outcomes for primary care patients. DESIGN: A cohort of patients from the Family Medicine Centre at Mount Sinai Hospital was assembled from the clinic's billing records. Their health numbers were linked to the Ontario Hospital Discharge Database. The pattern of hospital admission rates was investigated using International Classification of Diseases (ICD) codes for primary discharge diagnosis. A pilot case-control study of risk factor management for stroke was nested in the cohort. SETTING: Family medicine clinic based in a teaching hospital. PARTICIPANTS: A cohort of 19,654 Family Medicine Centre patients seen at least once since 1991. MAIN OUTCOME MEASURES: Admission rates by age, sex, and diagnosis. Numbers of admissions for individual patients, time to readmission, and length of stay. Odds ratios for admission for cerebrovascular disease. RESULTS: The 19,654 patients in the cohort had 14,299 discharges from Ontario hospitals in the 4 years from 1992 to 1995, including 3832 discharges following childbirth. Some patients had many discharges: 4816 people accounted for the 10,467 admissions excluding childbirth. Excluding transfers between institutions, there were 4975 readmissions to hospital during the 4 years, 1392 (28%) of them within 28 days of previous discharge. Admissions for mental disorders accounted for the greatest number of days in hospital. The pilot study of risk factor management suggested that acetylsalicylic acid therapy might not be effective for elderly primary care patients with atrial fibrillation and that calcium channel blocker therapy might be less effective than other therapies for preventing cerebrovascular disease in hypertensive primary care patients. CONCLUSIONS: Record linkage combined with data collection by chart review or interview is a useful method for studying the effectiveness of medical care in Canada and might suggest interesting hypotheses for further investigation.

Adolescent↗