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Biomedical subjects

R A Etzel

Publications and source records attributed to R A Etzel.

At least 55 records · Page 3Linked to original sources
PubMed1992

Passive smoking and middle ear effusion among children in day care.

One hundred thirty-two children who attended a research day-care center were studied to determine whether passive tobacco smoke exposure was associated with an increased rate of otitis media with effusion or with an increased number of days with otitis media with effusion during the first 3 years of life. Based on preliminary studies, a serum cotinine concentration of greater than or equal to 2.5 ng/mL was considered indicative of exposure to tobacco smoke. Otitis media with effusion was diagnosed using pneumatic otoscopy by nurse practitioners and pediatricians who reviewed the children's health status each weekday. The 87 children with serum cotinine concentrations greater than or equal to 2.5 ng/mL had a 38% higher rate of new episodes of otitis media with effusion during the first 3 years of life than the 45 children with lower or undetectable serum cotinine concentrations (incidence density ratio = 1.38, 95% confidence interval 1.21 to 1.56). The average duration of an episode of otitis media with effusion was 28 days in the children with elevated cotinine concentrations and 19 days in the children with lower cotinine concentrations (P less than .01). It is estimated that 8% of the cases of otitis media with effusion in this population and 17.6% of the days with otitis media with effusion may be attributable to exposure to tobacco smoke.

Age Factors↗
PubMed1991

Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988.

OBJECTIVE: To describe the epidemiology of recent unintentional carbon monoxide poisoning deaths in the United States. DESIGN: Descriptive analysis of carbon monoxide-related deaths in the United States from 1979 through 1988, based on death certificate reports compiled by the National Center for Health Statistics. POPULATION STUDIED: All US deaths, 1979 through 1988. RESULTS: We reviewed data from 56,133 death certificates that contained codes implicating carbon monoxide as a contributing cause of death. Of these, 25,889 were suicides, 210 were homicides, 15,523 were associated with severe burns or house fires, and 11,547 were classified as unintentional. The number of unintentional deaths decreased steadily by about 63 deaths per year, from 1513 in 1979 to 878 in 1988. The highest death rates occurred in winter and among males, blacks, the elderly, and residents of northern states. Motor vehicle exhaust gas caused 6552 (57%) of the unintentional deaths; 5432 (83%) of these were associated with stationary automobiles. CONCLUSIONS: The rate of unintentional death from carbon monoxide poisoning is decreasing. This may be attributable to improvements in automobile pollution control systems and improved safety of cooking and heating appliances. Prevention programs should target young drivers, males, and the elderly.

Adolescent↗
PubMed1991

Indoor air mercury concentrations following application of interior latex paint.

Mercury vapors are released from paint containing mercury compounds used to prolong the shelf-life of interior latex paint. To determine whether homes recently painted with paint containing mercury had elevated indoor-air mercury concentrations, we studied 37 Ohio homes. Twenty-one homes painted with mercury-containing paint a median of 86 days earlier were compared with 16 homes not recently painted with mercury-containing paint. Paint samples from the exposed homes contained a median of 210 mg Hg/L (range 120-610 mg/L). The median air mercury concentration was higher in the exposed homes (0.3 microgram/m3; range nondetectable--1.5 microgram/m3) than in the unexposed homes (nondetectable; range nondetectable--0.3 microgram/m3, P less than 0.0001). Among the exposed homes there were seven in which paint containing less than 200 mg/L had been applied. In these homes, the median air mercury concentration was 0.2 microgram/m3 (range nondetectable--1 microgram/m3). Six (33%) exposed homes had air mercury concentrations greater than 0.5 microgram/m3, the acceptable indoor concentration recommended by the Agency for Toxic Substances and Disease Registry. Elemental mercury was the form of mercury released into the air. These data demonstrate that potentially hazardous mercury exposure may occur in homes recently painted with paint that contains mercury concentrations less than 200 mg/L.

Air Pollution↗
PubMed1991

Passive smoking alters lipid profiles in adolescents.

Although cigarette smoking is associated with elevation of plasma lipid levels and changes in lipoprotein distribution, it is not known whether passive smoking is associated with an alteration in lipid profiles. The relation between plasma cotinine, a marker of exposure to tobacco smoke, and lipid profiles was studied in healthy adolescents from a suburban New York high school district who were undergoing preparticipation sports physicals. Forty-four percent of the adolescents reported that one or both parents currently smoked. Eleven percent of the adolescents had plasma cotinine concentrations greater than or equal to 2.5 ng/mL, the level considered indicative of exposure. Adolescents with two smoking parents had significantly higher plasma cotinine concentrations after adjustment for other factors than adolescents whose parents did not smoke. Plasma cotinine concentration greater than or equal to 2.5 ng/mL was associated with an 8.9% greater ratio of total cholesterol to high-density lipoprotein cholesterol (P less than .003) and a 6.8% lower high-density lipoprotein cholesterol (P less than .03). These results suggest that passive smoking, like active smoking, leads to alterations in lipid profiles predictive of an increased risk of atherosclerosis.

Adolescent↗
PubMed1990

Mercury exposure from interior latex paint.

BACKGROUND: Many paint companies have used phenylmercuric acetate as a preservative to prolong the shelf life of interior latex paint. In August 1989, acrodynia, a form of mercury poisoning, occurred in a child exposed to paint fumes in a home recently painted with a brand containing 4.7 mmol of mercury per liter (at that time the Environmental Protection Agency's recommended limit was 1.5 mmol or less per liter). METHODS: To determine whether the recent use of that brand of paint containing phenylmercuric acetate was associated with elevated indoor-air and urinary mercury concentrations, we studied 74 "exposed" persons living in 19 homes recently painted with the brand and 28 "unexposed" persons living in 10 homes not recently painted with paint containing mercury. RESULTS: The paint samples from the homes of exposed persons contained a median of 3.8 mmol of mercury per liter, and air samples from the homes had a median mercury content of 10.0 nmol per cubic meter (range, less than 0.5 to 49.9). No mercury was detected in paint or air samples from the homes of unexposed persons. The median urinary mercury concentration was higher in the exposed persons (4.7 nmol of mercury per millimole of creatinine; range, 1.4 to 66.5) than in the unexposed persons (1.1 nmol per millimole; range, 0.02 to 3.9; P less than 0.001). Urinary mercury concentrations within the range that we found in exposed persons have been associated with symptomatic mercury poisoning. CONCLUSIONS: We found that potentially hazardous exposure to mercury had occurred among persons whose homes were painted with a brand of paint containing mercury at concentrations approximately 2 1/2 times the Environmental Protection Agency's recommended limit.

Adolescent↗
PubMed1990

A review of the use of saliva cotinine as a marker of tobacco smoke exposure.

Cotinine, the major metabolite of nicotine, is a useful marker of exposure to tobacco smoke. It can be measured in plasma, urine, or saliva. However, distinguishing between active and passive smoking on the basis of a cotinine measurement may be difficult. In order to evaluate the relationship between saliva cotinine concentration and self-reported tobacco smoke exposure in both active and passive smokers, an English-language literature search using MEDLINE was conducted (1973-1989), and the bibliographies of identified articles were reviewed. Of 43 originally identified articles, only 22 met the criteria for inclusion. Specific information regarding population studied, reported tobacco smoke exposure, method of measurement, and cotinine concentrations was assessed. Passive smokers usually have cotinine concentrations in saliva below 5 ng/ml, but heavy passive exposure can result in levels greater than or equal to 10 ng/ml. Levels between 10 and 100 ng/ml may result from infrequent active smoking or regular active smoking with low nicotine intake. Levels greater than 100 ng/ml are probably the result of regular active smoking. Four categorizations of tobacco smoke exposure are suggested on the basis of saliva cotinine concentrations.

Adolescent↗
PubMed1990

Lethal paralytic shellfish poisoning in Guatemala.

An outbreak of paralytic shellfish poisoning occurred in Champerico, on the Pacific coast of Guatemala, July-August 1987. Of 187 people affected with characteristic neurologic symptoms, 26 died. A case study implicated a species of clam, Amphichaena kindermani, harvested from local beaches as the vehicle of the neurotoxins (saxitoxins). Children less than 6 years old had a higher fatality rate (50%) than people greater than 18 years of age (7%). The minimum lethal dose for 1 child was estimated to have been 140 mouse units of toxin/kg body weight; thus children may be more sensitive to the saxitoxins than are adults. This is the first large outbreak of paralytic shellfish poisoning recognized in Guatemala.

Adolescent↗
PubMed1987

Prolonged neonatal alloimmune thrombocytopenic purpura associated with anti-Bak(a). Two cases in siblings.

Two cases of prolonged neonatal alloimmune thrombocytopenic purpura in siblings due to anti-Bak(a) are reported. The first case was complicated by an intracranial hemorrhage due to severe thrombocytopenia, but the second case had no untoward complications. Delivery by cesarean section and immediate platelet support from "compatible" (nonmaternal) donors may have contributed to the more favorable outcome in the second case. An analysis of the gene frequencies of platelet-specific antigens suggests that factors other than the potential for maternal exposure to antigen determine the incidence of affected births. Knowledge of gene frequencies may, however, permit a priori prenatal calculation of the probability of an affected birth for couples with a previously affected child even if the genotype of the father is unknown.

Acute Disease↗
PubMed1987

Fatal parathion poisoning in Sierra Leone.

In May and June 1986, 49 persons in Sierra Leone were acutely poisoned by the organothiophosphate insecticide, parathion. Fourteen people died. Illness occurred in three episodes at two different locations that were 44 km apart. A study of 21 cases and 22 household controls was undertaken to explore which factors were associated with the development of the symptoms. Cases were more likely than controls to have eaten bread in the 4 hours before becoming ill (odds ratio, 12.7; 95% confidence interval, 2.4-83.8). Scrapings of residue from the floor of the truck that had brought the wheat flour from the mill to the general store where the baker purchased it were positive for parathion, suggesting that the flour had been contaminated during transport. Pesticide poisoning is a common problem in the developing world, and public health measures such as restricting the use of parathion may help to prevent fatal poisonings.

Adolescent↗
PubMed1985

Serum cotinine as a measure of tobacco smoke exposure in children.

To document passive smoke exposure, we measured concentrations of serum cotinine, a major metabolite of nicotine, in 38 young children and compared the results with the smoking histories of home residents. Cotinine was detected in 26 children (68%), of which ten had no household exposure according to a questionnaire. The serum cotinine concentration was significantly elevated in blacks compared with whites after controlling for the number of smokers in the home. After stratifying by race, there was a significant direct correlation between the serum cotinine concentration and the number of smokers in the home, the amount smoked by the mother, and the amount smoked by others in the home. We conclude that the serum cotinine concentration is a useful indicator of the actual exposure of young children to tobacco smoke and that unexplained racial differences in cotinine levels exist.

Black or African American↗
PubMed1984

Measuring the exposure of infants to tobacco smoke. Nicotine and cotinine in urine and saliva.

The effect of parental smoking on the well-being of infants and children is an important public health concern. It is necessary, however, to validate the existence of such exposure objectively before an evaluation of the effects of parental smoking behavior on the child's health can be made. We measured the concentration of nicotine and its major metabolite, cotinine, in the saliva and urine of 32 infants with household exposure to tobacco smoke, and 19 unexposed infants. The concentrations were significantly higher in the exposed group than in the unexposed group, with the best indicator of chronic exposure being the urinary cotinine:creatinine ratio; median in the exposed group, 351 ng per milligram (225.3 nmol per millimole); median in the unexposed group, 4 ng per milligram (2.6 nmol per millimole) (P less than 0.0001). There was a direct relation between cotinine excretion by the infants and the self-reported smoking behavior of the mothers during the previous 24 hours (r = 0.67, P = 0.0001). Our results indicate that infants who were exposed to tobacco smoke absorbed its constituents and that urinary excretion of cotinine is a reliable measure of such exposure in infants.

Cotinine↗
PubMedDate not supplied

Surveillance for dust storms and respiratory diseases in Washington State, 1991.

Southeast Washington State, which has a long history of seasonal dust storms, experienced 2 d of dust storms in October 1991, during which PM10 levels exceeded 1,000 micrograms/m3 (i.e., six times greater than the Environmental Protection Agency's 24-h PM10 standard). Three community hospitals in southeast Washington were visited for the purpose of assessing the possible effects of dust storms on respiratory health. During these visits, the number of emergency room visits for respiratory disorders for each day of 1991 were abstracted. These numbers were compared with daily PM10 levels for 1991. Also determined were the observed/expected ratios for the number of emergency room visits for each respiratory disorder category during October 1991. The maximum observed/expected ratio for the respiratory disorders was 1.2. For 1991, we found a 3.5% increase in the number of daily emergency room visits for bronchitis for each 100 micrograms/m3 increase in PM10. In addition, 2 d subsequent to those days on which the PM10 levels exceeded 150 micrograms/m3, there was a 4.5% increase in the number of emergency room visits for sinusitis for each 100 micrograms/m3 increase in PM10. Our results indicate that the naturally occurring PM10 in this setting has a small effect on the respiratory health of the population in general.

Air Pollutants↗
PubMedDate not supplied

Methyl tertiary butyl ether in human blood after exposure to oxygenated fuel in Fairbanks, Alaska.

Residents of Fairbanks, Alaska reported health complaints when 15%, by volume, methyl tertiary butyl ether (MTBE) was added to gasoline during an oxygenated fuel program. We conducted an exposure survey to investigate the effect of the program on human exposure to MTBE. We studied 18 workers in December 1992 during the program and 28 workers in February 1993 after the program was suspended. All workers were heavily exposed to motor vehicle exhaust or gasoline fumes. In December, the median post-shift blood concentration of MTBE in the workers was 1.8 micrograms/l (range, 0.2-37.0 micrograms/l), and in February the median post-shift blood concentration of MTBE in the 28 workers was 0.24 micrograms/l (range, 0.05-1.44 micrograms/l; p = .0001). Blood MTBE levels were measurably higher during the oxygenated fuel program in Fairbanks than after the program was suspended.

Adult↗