Search PubMed⌕ Search

Biomedical subjects

N M Hadler

Publications and source records attributed to N M Hadler.

At least 19 recordsLinked to original sources
PubMed1992

Arm pain in the workplace. A small area analysis.

In the mid-1980s, use-related arm pain was recognized as a major issue for worker health and workplace safety. National policy targeted these "cumulative trauma disorders," "overuse syndromes," and "motion illnesses" for a "special emphasis program" by the Occupational Safety and Health Administration, a federal regulatory agency. The program begins with case recognition to identify the responsible ergonomic hazards with the goal of mandating ergonomic remedies. This report is a small area analysis of the impact of this process on the US West Communications, Inc work force. US West employs some 55,000 workers in 14 states. Commencing in the mid-1980s, workers in four of these states complained of upper extremity pain and were diagnosed as suffering from conditions encompassed by the "cumulative trauma disorders" rubric. The incidence was tenfold higher in one task category, directory assistance operators. No ergonomic descriptor can account for the four endemics of arm pain in directory assistance operators. The response of the medical communities to the plight of these injured claimants varied considerably from community to community. Denver represents one extreme where the clinical judgments led to multiple surgical interventions, generated a total direct cost of some $1.5 million, and left many permanently disabled workers in their wake. This analysis raises many reservations about the validity of the "cumulative trauma disorder" hypothesis and provides an object lesson in the potential for untoward outcomes from the premature introduction of clinical hypotheses into the arena of health policy.

Adult↗
PubMed1991

Current principles of rehabilitation for patients with rheumatoid arthritis.

Rehabilitation is rooted in the comfort and palliation that sufferers of rheumatic symptoms have sought from physical modalities throughout history. In recent decades, several of these empiricisms have been tested scientifically. Furthermore, function has joined comfort as a desirable and measurable outcome. This article highlights some of the more substantive information as it relates to rheumatoid arthritis. It is clear that such information facilitates more effective and efficient programs of intervention. It is equally clear that the therapeutic perspective of rehabilitation for rheumatoid arthritis is more appropriately applied throughout the course of the disease in an ongoing program of habilitation than held in reserve as a form of salvage.

Arthritis, Rheumatoid↗
PubMed1979

Does corticosteroid therapy affect the survival of patients with systemic lupus erythematosus?

The hypothesis that corticosteroid therapy is responsible for the striking improvement in survival of patients with systemic lupus erythematosus (SLE) was investigated with two approaches: Of 250 published papers on SLE, 52 were chosen for the first analysis because they included sufficient information on diagnostic criteria and survival but were not limited to patients selected for a particular target organ. From each article percent survival by series, average duration to death, and 1 and 5 year survival curves were abstracted. Each statistic showed linear improvement in survival since the 1930s without a significant change (P greater than 0.10) in slope for the time period following the introduction of corticosteroids. The second analysis examined the effect of corticosteroid therapy on 142 patients with SLE followed at the Massachusetts General Hospital between 1922 and 1966. Although the steroid use was conservative, the patients' survival, from year of entry, was comparable to the 52 abstracted series. A prognostic index was used to stratify patients admitted in the steroid era (after 1950) for life table analysis of survival with and without steroids. Steroids had no discernible effect on overall survival in low and medium risk groups. Use of steroids was associated with improved survival among high rish patients (P less than 0.05).

Adrenal Cortex Hormones↗
PubMed1979

Lysosomal enzymes in inflammatory synovial effusions.

The concentrations of several polymorphonuclear neutrophilic lysosomal constituents were quantitated by immunochemical and enzymatic assays in 28 inflammatory and 9 noninflammatory synovial fluids. The quantities of lactoferrin, myeloperoxidase, and enzymatically determined lysozyme were covariate with the neutrophil count. Enzymatic activities measured with synthetic substrates developed for the assay of chymotryptic-like cationic protein (cathepsin G) and elastase, along with immunochemically determined lysozyme, were independent of the neutrophil count. Although the latter assays were developed and standardized with human neutrophilic lysosomal constituents, they measure different activities in inflammatory synovial effusions. No elastase was detected if elastin was used as the substrate. Regardless of the source of the enzymes, there was a negative correlation between their concentration and the degree of radiographic destruction of the joint from which the fluid was obtained. Lysosomal enzymes in solution in synovial fluid are not likely to be primarily involved in cartilage destruction.

Cathepsins↗
PubMed1978

Hand structure and function in an industrial setting.

The influence of patterns of usage on the structure and function of the hands was formally tested. Three groups of female textile workers, each employed in a distinct and defined, atraumatic, repetitive, stereotyped manual task for at least 20 years, were identified in a single rural mill. Replicate data were obtained for the following measures of structure and function: range of motion, a score for the degree of radiographic degenerative changes at each hand joint, malalignment at digital joints determined radiographically, and a quantitative measure of osteophyte formation. Significant and consistent differences in the right hand when compared to the left were detected. Furthermore, highly significant task-related differences were demonstrated. These task-related differences in the structure and function of the hands were consistent with the pattern of usage. Therefore these three patterns of usage influence hand structure and function in the population studied.

Female↗
PubMed1978

Effect of calcium on structure and function of a hyaluronic acid matrix: carbon-13 nuclear magnetic resonance analysis and the diffusional behavior of small solutes.

Natural-abundance (13)C NMR at 25.16 MHz has been used to study a 2.5% matrix of hyaluronic acid at various degrees of polymerization and at various ionic strengths. Peak assignment is facilitated by comparing proton-decoupled and off-resonance-decoupled spectra of a hyaluronidase-depolymerized matrix with spectra from relevant monosaccharides. In contrast to the spectrum following depolymerization, the spectrum for intact matrix has considerable broadening, particularly for peaks assigned to the N-acetylglucosamine moiety. This is most dramatic for the hydroxymethylene carbon. With the addition of Ca(2+) above 5 mM these broadened peaks narrow and approach the sharpness observed for the hyaluronidase digest. There is no shift in resonance peak positions. These changes are quantitatively less impressive if Na(+) is substituted for Ca(2+). The data suggest the existence of a considerable degree of order in regions of the matrix at physiological concentrations of Ca(2+). Within such a matrix the translational movement of lysine and glucose is enhanced relative to that in a matrix of agarose. Further addition of Ca(2+) abrogates not only matrix order, but the enhanced diffusivity as well.

Calcium↗
PubMed1978

Subacute fluorosis: a consequence of abuse of an organofluoride anesthetic.

A young woman presented with a novel multisystem disease: painful periostitis, osteosclerosis, hypertension, and renal dysfunction. The similarity of some of this clinical picture to fluoride intoxication led to the discovery of massively elevated fluoride levels in serum, urine, and bone. Although initially an enigma, the source of fluoride was later found to be the illicit use of an anesthetic agent, methoxyflurane. This agents is one of a class of organofluorides that, by virtue of biotransformation, is a known cause of inorganic fluoride exposure. Though the drug is potentially nephrotoxic as generally used, exposure to it is transient and has not previously led to discernible bone disease.

Acute Disease↗
PubMed1978

Legal ramifications of the medical definition of back disease.

Back pain occurring without external force is extraordinarily prevalent in all segments of society. The practicing internist is often faced with the complaint, a need to define its cause, and a request to render an opinion as to whether the patient is disabled in the context of his employment. This opinion will have some weight in determining compensability under workmen's compensation law. This essay examines the inferences, as regards back pain, upon which compensation law is based. These inferences are then tested in light of our current understanding of the pathophysiology of back pain. A number of fallacies become apparent that may provide impetus for remedial legislation and clearly mandate further clinical investigation.

Back Pain↗