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Biomedical subjects

P Froom

Publications and source records attributed to P Froom.

At least 19 recordsLinked to original sources
PubMed1998

Calcitropic hormones and occupational lead exposure.

The authors sought to clarify in a cross-sectional study the possible associations between homeostatic regulators of calcium and occupational exposure to lead. Subjects were 146 industrial male employees, 56 with and 90 without occupational lead exposure. The main outcome measures were serum concentration of parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (calcitriol). The median values of blood lead were 40.5 microg/dl in the exposed group and 4.0 microg/dl in the controls. There were no differences between groups in dietary history and serum calcium levels. PTH and calcitriol levels were significantly higher in the exposed than in the nonexposed subjects (42.0+/-24.2 vs. 33.6+/-14.9 pg/ml, p <0.05; and 83.8+/-27.0 vs. 67.9+/-17.6 pmol/liter, p <0.001, respectively). Multivariate analyses showed that after controlling for possible confounders, occupational lead exposure (no/yes) was independently associated with PTH level (pg/ml) (beta = 7.81, 95% confidence interval (CI) 3.7-11.5) and with calcitriol (pmol/liter) (beta = 12.3, 95% CI 3.84-20.8). It is concluded that subjects occupationally exposed to lead show a substantial compensatory increase in PTH and calcitriol activities which keep serum calcium levels within normal range. This may be of clinical significance since a sustained increase in calcitropic hormones in susceptible subjects may eventually increase the risk of bone disorders.

Adult↗
PubMed1998

Prevention of needle-stick injury by the scooping-resheathing method.

BACKGROUND: The objective of this study was to determine the effects of teaching the scooping-resheathing method on the incidence of needle-stick injuries in medical students. METHODS: Before starting their first clerkship, 81 medical students were given a 15-min lecture on the high incidence and dangers of needle-stick injuries and a demonstration of the scooping-resheathing method. The number of needle-stick injuries that occurred during the 3-month clerkship was compared with the number reported by 86 medical students who had completed their first clerkship 1 year previously and had not been given such instruction. RESULTS: Compared with controls, the study group had a 3.8-fold lower risk of needle-stick injury (95% confidence interval, 2.0-7.4, P < 0.0001) and a 8.3-fold lower risk of multiple needle-stick injuries (95% confidence interval, 2.0-35.0, P < 0.001). Those in the study group, who consistently used the scooping method had a much lower risk of injury than those who did not (1 of 36 [2.8%] vs. 8 of 45 [17.4%], P = 0.039). CONCLUSIONS: We conclude that a lecture recommending the scooping-resheathing method is effective in reducing the risk of needle-stick injuries in medical students during their first rotation. Because this is the first time that an intervention not requiring change in equipment has been successful, further studies are warranted to substantiate our findings and for extrapolation to other medical personnel in other cultural settings.

Accidents, Occupational↗
PubMed1998

Effect of dietary calcium on blood lead concentrations in occupationally exposed and nonexposed workers.

Workers exposed to lead may benefit from a calcium-rich diet, since calcium competes with lead for intestinal absorption. We studied the effect of dietary calcium on blood lead levels. We assessed blood lead levels, dietary intake of calcium, smoking and alcohol consumption, and anthropometric and demographic data in 56 workers exposed to lead and 90 workers without such exposure. Mean intake of dietary calcium was 775 +/- 370 mg/day in the nonexposed workers and 858 +/- 423 mg/day in the exposed workers. Occupational lead exposure explained nearly 90% of the variance in blood lead levels of the entire cohort. Smoking and alcohol intake also showed significant associations with blood lead levels, but their combined effect was less than 2%. When the exposed and nonexposed workers were considered separately, no association was found between blood lead levels and calcium intake. The amount of calcium in the diet does not influence blood lead levels. Further studies are warranted to determine whether dietary calcium influences blood lead levels in exposed and nonexposed workers in other settings and in subjects with lower intakes of calcium.

Adult↗
PubMed1998

Accelerated phase of chronic myeloid leukemia presenting with hypercalcemia and a mediastinal mass.

A patient with chronic myeloid leukemia developed hypercalcemia as a presenting sign of the accelerated phase of the disease. Ultrasound of the neck showed a large hypodense mass connected to the thyroid gland, which was thought to be a parathyroid tumor and the cause of the hypercalcemia. Histology of the surgically removed mass revealed a chloroma. The patient's course was complicated by respiratory failure and metastatic calcinosis of the lung, an unusual finding in hypercalcemia of short duration.

Calcinosis↗
PubMed1998

Variation in the ambulatory blood pressure response to daily work load--the moderating role of job control.

OBJECTIVES: This quasi-experimental study tested the ambulatory blood pressure responsivity to daily variation in the work load of the same workers and examined whether this responsivity is moderated by perceived job control. METHODS: The subjects were 79 nonshift, normotensive men who reported nearly almost equal occurrences of low and high work load in a typical workday. Job control was assessed by questionnaire. The workers recorded their situational work load and other parameters at each recording of ambulatory blood pressure. RESULTS: An analysis of covariance showed the main effects of both situational work load and job control on systolic ambulatory blood pressure, as well as a significant work load by job control interaction, even after control for clinic blood pressure, age, and body mass index. A blood pressure response to increased work load was observed only for workers with low job control. These workers also had a higher average systolic ambulatory blood pressure than workers reporting high control. The difference was 6.2 mm Hg (0.82 kPa) during the low workload periods and 10.2 mm Hg (1.36 kPa) during the high workload periods. A further multiple regression analysis confirmed the interaction and the main effect of job control but not that of work load, after control for work-related activities, body position, and hour of examination. CONCLUSIONS: This study showed that ambulatory blood pressure at work can fluctuate with variations in work load but only for workers with low job control. Low job control is independently associated with higher systolic ambulatory blood pressure.

Adult↗
PubMed1998

Predictive value of determinations of zinc protoporphyrin for increased blood lead concentrations.

Blood lead (PbB) and red cell zinc protoporphyrin (ZPP) concentrations are widely used biomarkers for lead toxicity. It is uncertain, however, whether either or both are needed for monitoring lead exposure and how discordant PbB and ZPP values should be interpreted. We reviewed the results of PbB and ZPP determinations in 94 workers in a lead-battery plant over a 13-year period and retrieved all 807 sets of tests in which both PbB and ZPP were available, with a follow-up PbB value 6 months later. PbB exceeded 1.93 micromol/L (40 microg/dL) in 414 (51%), and 2.90 micromol/L (60 microg/dL) in 105 (14%) of the blood samples. We derived the test properties of various ZPP concentrations for concurrent "toxic" PbB concentrations, defined as > or = 1.93 and 2.90 micromol/L (40 and 60 microg/dL). The results indicated that, given a population of lead-exposed workers with a 10% prevalence of PbB of > or = 2.90 micromol/L (60 microg/dL), a policy of testing PbB only in those with ZPP > 0.71 micromol/L (40 microg/dL) would obviate 42% of the PbB tests, but would miss about three cases with toxic PbB concentrations in every 200 workers at risk. A finding of increased ZPP concentrations with a concurrent "nontoxic" PbB was associated with an increased risk of a toxic PbB concentration 6 months later. We conclude that (a) screening by testing only ZPP does not safeguard exposed persons against lead toxicity, and (b) the frequency of PbB monitoring should be guided by estimates of the risk of future lead toxicity in individual workers.

Biomarkers↗
PubMed1998

Smoking cessation and weight gain.

Cigarette smokers have a lower average body weight than nonsmokers, and the cessation of smoking is associated with weight gain. Although this weight gain does not offset the health benefits of smoking cessation, it is frequently a source of concern for smokers planning to quit. The objective of our review was to estimate the risk and duration of weight gain after cessation of smoking to help physicians in counseling concerned smokers. We reviewed the literature by doing a MEDLINE search using key words for articles on the changes in body weight after smoking cessation. The retrieved data indicated that (1) the risk of weight gain is highest during the 2 years immediately following smoking cessation, and declines thereafter; (2) on average, sustained quitters gain about 5 to 6 kg in weight; (3) physical exercise, older age, higher baseline body mass index, and lower rates of smoking attenuate the degree of weight gained after smoking cessation; and (4) the evidence regarding the permanence of the expected weight gain is conflicting.

Body Weight↗
PubMed1997

Asymptomatic microscopic hematuria--is investigation necessary?

Microscopic hematuria is common in asymptomatic adults, but the benefit of screening the general population for blood in the urine has not been established. On the other hand, most studies of referred patients with putatively asymptomatic microscopic hematuria have reported a 2-11% prevalence of urothelial malignancies, leading to the recommendation that all patients with microscopic hematuria be thoroughly investigated. Urinalysis is inexpensive and highly acceptable to the general population, but is neither a sensitive, nor specific test, and has poor predictive value for urothelial malignancies, and nephrological diseases. Furthermore the benefits of early detection of such diseases has not been established. We conclude that screening urinalysis cannot be recommended. Studies are needed to determine which constellation of findings primary physicians use to select patients for referral to centers with urological and nephrological expertise.

Adult↗
PubMed1997

Hypertension and sickness absence: the role of perceived symptoms.

The association between perceived symptoms and absenteeism was examined in five groups of employed adults: normotensives, unaware hypertensives, aware and untreated hypertensives, aware and treated hypertensives, and falsely aware normotensives. Aware hypertensives (untreated and treated) and falsely aware normotensives had a higher average of perceived symptoms than normotensives, whereas unaware hypertensives had lower. The absenteeism rate across the groups showed a similar pattern. A significant interaction of perceived symptoms by study group on absenteeism was uncovered. Hypertensives and falsely aware normotensives who reported a low level of symptoms were not absent more than their normotensive counterparts. However, aware hypertensives and falsely aware normotensives who perceived a high symptoms level showed higher absenteeism than unaware hypertensives and normotensives with a similar level. This suggests that aware hypertensives have a greater tendency than both normotensives and unaware hypertensives to equate their symptoms with ill health and to act accordingly. Special attention should be directed to aware hypertensives who perceive a threat to their health.

Adult↗
PubMed1997

Pressure response to successive clinic readings predicts an elevated blood pressure at 2.6 years' follow-up: the Israeli CORDIS Study. Cardiovascular Occupational Risk Factor Determination in Israeli Industries.

BACKGROUND: Many persons exhibit an elevation in blood pressure (BP) when examined in a medical setting. We examined whether individuals exhibiting an exaggerated pressure response (high responders) to BP determination would have an elevated baseline BP on follow-up, independent of the initial BP level. METHODS AND RESULTS: A total of 1217 employed men not on hypertensive medication, aged 20-64 years were examined over 2-4 years (mean 2.6 years) following the baseline measurements at entry. Pressure response was assessed at entry and defined as the difference between the first and fourth values in successive readings. Such a response was apparent for systolic BP (SBP) but was negligible for diastolic BP (DBP) and the former was negatively related to the baseline BP value. High responders were defined as persons showing a pressure response greater than the average for the respective subgroup with an initially similar baseline BP value. Logistic regression results indicated that those with high SBP responsivity had a 2.7 times greater chance of having an elevated SBP (> or = 140 mm Hg) on follow-up (95% CI 1.8-4.1, P < 0.001), independently of initial SBP, age, or body mass index. Other significant predictors were the initial baseline SBP value and age. In those with an initial SBP of 130-139 mm Hg, the baseline SBP was not predictive of future readings whereas high responders had a four times higher risk of having an elevated SBP on follow-up (OR = 4.0, 95% CI 2.0-8.0, P < 0.001). CONCLUSIONS: These findings suggest that SBP hyperresponsivity, to BP determination at the clinic independently predicts elevated SBP 2.6 years later. Further studies are warranted to determine the predictive value over a longer follow-up period.

Adult↗
PubMed1997

Association of calcitriol and blood pressure in normotensive men.

The purpose of this study was to clarify the possible associations between the serum 1,25-dihydroxyvitamin D (calcitriol) level and blood pressure. Cross-sectional analysis of data was performed. Data collected included levels of serum calcitriol, parathyroid hormone, serum calcium, and blood lead; blood pressure; dietary history; and demographic and anthropometric variables. One hundred normotensive male industrial employees made up the study population. Systolic blood pressure and diastolic blood pressure were main outcome measures. After possible confounders were controlled for, multivariate analyses yielded an inverse, independent, and statistically significant association between calcitriol level and systolic blood pressure (standardized beta= -0.2704, P=.0051). A similar trend of borderline significance was found for the association between calcitriol and diastolic blood pressure (standardized beta= -0.1814, P=.0611). Parathyroid hormone, serum calcium, and blood lead levels were not associated with blood pressure. When subjects were divided into four groups by calcitriol level, those in the lowest quartile showed significantly higher systolic and diastolic blood pressures than those in the upper quartile (difference=11 mmHg, P=.007, and difference=4 mmHg, P=.071, respectively). There is an inverse association between serum calcitriol level and blood pressure. This suggests that in addition to its role in calcium homeostasis, the active metabolite of vitamin D may play a role in determining blood pressure. The differences in both systolic and diastolic blood pressures between the upper and lower quartiles of serum calcitriol were substantial and may be of clinical significance.

Adult↗
PubMed1997

Seasonal differences in blood cell parameters and the association with cigarette smoking.

Seasonal changes in red cell parameters need to be defined in order to properly interpret laboratory results. In this study blood counts were obtained prospectively in 104 healthy men (84 non-smokers and 20 smokers) aged 28-63 years during the summer and winter months. Seasonal changes in plasma volume were also calculated. In healthy non-smokers, their haemoglobin concentration and haematocrit ratio were lower in summer than in winter with a concomitant 5.5% increase in plasma volume. In smokers, there was no change in plasma volume, but haematocrit levels increased in summer. We conclude that both smoking status and seasonal variation should be taken into account in the evaluation of blood count results. Further studies are warranted to determine if our results can be extrapolated to subjects of both sexes and of various ages exposed to different climatic conditions.

Adult↗
PubMed1996

Fatigue among Israeli industrial employees.

We examined the prevalence of fatigue and its association with occupational conditions and health-related habits in 3785 industrial employees of six industrial sectors to define modifiable factors. The factors examined included complaints of fatigue during and after work, an ergonomic evaluation of employees' workstations, demographic characteristics, and health-related habits. Eighteen percent of the subjects complained of severe fatigue frequently or very frequently. We were able to identify two major modifiable variables that were independently associated with the presence of fatigue. Logistic regression showed that those workers who did not participate in physical activity at least once a week had a 1.7-fold increase in prevalence of severe fatigue (95% confidence interval = 1.3 to 2.3, P < 0.001). The other major modifiable factor was temperature control, with those workers who worked at non-temperature-controlled workstations having a 50% increase in the prevalence of fatigue (odds ratio = 1.5, 95% CI = 1.1 to 2.1; P = 0.01). Accidents were significantly more frequent in those workers with fatigue. Further studies should focus on intervention programs to modify the factors identified by this study.

Adult↗
PubMed1996

Industrial accidents are related to relative body weight: the Israeli CORDIS study.

OBJECTIVES: The accident rate might be influenced by intrinsic characteristics of the workers, by risks inherent in the work environment, or a combination of these factors. As increased weight may be associated with sleep disturbances and fatigue, a high body mass index (BMI) might be an independent risk factor for accidents in industrial workers. METHODS: 3801 men were examined and followed up for two years for the occurrence of accidents. The objective environmental conditions were recorded and translated into a single score of ergonomic stress levels. Height and weight were recorded, as were possible confounding factors including measures of fatigue, type A personality, total night time sleep, job satisfaction, somatic complaints, smoking, and education levels. RESULTS: Both BMI and ergonomic stress levels independently predicted involvement in accidents (two or more) with those in the highest BMI quartile who worked in an environment with high ergonomic stress levels having a 4-6 times increased risk of accidents compared with those in the lowest BMI quartile who worked in an environment with low ergonomic stress levels (95% confidence interval (95% CI) 2.4-9.0, P < 0.001). Although increasing somatic complaints and a low educational level also were predictors of accidents, they did not mediate the effect of the BMI on the accident rate. Increasing age, less smoking, and decreased sleep hours were significantly associated with an increased BMI, but the association of BMI and involvement in accidents also could not be explained by those factors or the other confounders. CONCLUSIONS: BMI independently influences the accident rate. Further studies warranted to confirm these findings and to explore mechanisms supporting biological plausibility.

Accidents, Occupational↗
PubMed1996

Age, seasonality and health.

Seasonal effects on mood and other components of functional status have been demonstrated in large segments of the general population but have received little attention in primary care patients. In the present study on adult members of a communal settlement (kibbutz) in Israel, seasonality and functional status were measured in both the winter and summer seasons in the same patients. Patients under age 65 had better overall health ratings than those 65 and over in both winter and summer. Overall health ratings were better in summer for those under 65 but were unchanged in the older group. Summer and winter seasonality scores were more constant in the younger group than in the older patients. We conclude that both age and seasonality need to be considered when measuring functional status in primary care patients.

Aged↗
PubMed1996

Disease evaluated on return-to-work examinations: aviation ground personnel compared to other workers.

Aviation ground personnel are subjected to a wide range of chemical and physical exposures that may lead the occupational physician to see a different spectrum of morbidity in the airport compared to other settings. It is essential to determine the most common medical problems in airport ground personnel in order to identify possible work-related conditions and in order to set the priorities for establishing health promotion programs and training occupational physicians. We compiled the diagnoses in 1000 consecutive visits of ground workers to the airport clinic for return-to-work examinations, and compared them to 7000 workers seen in general occupational clinics. The frequencies of the various categories of disease were similar in both type of clinics, except that low back pain was significantly more common in the ground personnel [251 (20.6%) vs. 1176 (15.2%), p < 0.003]. Over 80% of the diseases occurred in 10 diagnostic categories: cancer, fractures, hypertension, ischemic heart disease, knee pain, low back pain, neck pain, operations for various medical conditions, phonal trauma, and pregnancy. We conclude that, except for low back pain, the spectrum of disease seen in the airport clinic is not significantly different from that seen in general occupational medicine clinics. Focusing on the interaction of a limited number of diseases with the work environment will provide the occupational physician with a comprehensive training program, and the emphasis needed for establishing health promotion programs.

Aviation↗
PubMed1995

Needlesticks in medical students in university hospitals.

The incidence of needlesticks and the effect of experience and other personal characteristics on the risk of needlesticks in medical students are unknown. Eighty-nine medical students were given a self-administered questionnaire. The questionnaire was completed by 86 students, and there were 91 sticks in 43 students. The incidence of needlesticks was 5.8/1000 procedures on the first rotation and 0.1/1000 during the second 4-month period (relative risk, 6.5, with 95% confidence interval (CI) of 3.4-125; P < 0.001). Personal characteristics were not associated with needlesticks except for tension felt while drawing blood and accident proneness. Those who were stuck during the first rotation were more likely to be stuck subsequently (odds ratio, 9.0, with 95% CI of 1-422; P < 0.05). We conclude that experience decreases the risk for needlesticks and therefore effective instructional intervention may have the biggest impact during the first medical student ward experience. Emphasis may have to be placed on those students who are accident prone or have been stuck in the past. Further studies are warranted to substantiate our findings and to test the effectiveness of various interventional approaches.

Adult↗