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Biomedical subjects

R Herbert

Publications and source records attributed to R Herbert.

At least 37 records · Page 2Linked to original sources
PubMed2000

Work-related death: a continuing epidemic.

Worldwide, work-related illnesses and injuries kill approximately 1.1 million people per year. In 1992, an estimated 65,000 people in the United States died of occupational injuries or illness. Most estimates indicate that occupational diseases account for far more fatalities than occupational injuries. However, an accurate enumeration of occupational disease fatalities is hampered by a paucity of data, owing to underdiagnosis of occupational diseases and inadequacy of current surveillance systems. In this commentary, the authors review the epidemiology of death due to occupational disease and injury in the United States and discuss vulnerable populations, emerging trends, and prevention strategies for this ongoing public health problem.

Accidents, Occupational↗
PubMed2000

PEDro.

Explore the source record for details and available documents.

Academies and Institutes↗
PubMed2000

The Prince Edward Island Conceptual Model for Nursing: a nursing perspective of primary health care.

The philosophy of primary health care (PHC) recognizes that health is a product of individual, social, economic, and political factors and that people have a right and a duty, individually and collectively, to participate in the course of their own health. The majority of nursing models cast the client in a dependent role and do not conceptualize health in a social, economic, and political context. The Prince Edward Island Conceptual Model for Nursing is congruent with the international move towards PHC. It guides the nurse in practising in the social and political environment in which nursing and health care take place. This model features a nurse/client partnership, the goal being to encourage clients to act on their own behalf. The conceptualization of the environment as the collective influence of the determinants of health gives both nurse and client a prominent position in the sociopolitical arena of health and health care.

Family Nursing↗
PubMed1999

Carpal tunnel syndrome and workers' compensation among an occupational clinic population in New York State.

BACKGROUND: This study evaluated the experience in the New York State workers' compensation (WC) system of 135 patients with work-related carpal tunnel syndrome diagnosed at an academic occupational medicine clinic between 1991-1994. METHODS: Worker's Compensation Board (WCB) records were reviewed to ascertain: (1) the proportion of WC claims that were not initially accepted (i.e., that were challenged) by the WC insurer, (2) the proportion of challenged claims ultimately decided in the claimant's favor, (3) the length of the period between case filing and claim adjudication, and (4) risk factors for claim challenge. RESULTS: Seventy-nine percent of the claims were not initially accepted by the WC insurer (challenged/no response). Of the 81 challenged/no response cases adjudicated (ruled on) at the time of the study, 96.3% were accepted as work-related. Mean time from claim initiation to adjudication was 429 days (range 58-1,617). Mean time from physician request for any treatment and WCB authorization was 226 days (range 0-1,296). Mean time from physician request for surgery authorization and WCB authorization was 318 days (range 7-595). Claims filed by non-whites, low-wage workers, and union members were significantly more likely than others to be challenged. CONCLUSIONS: Patients with work-related carpal tunnel syndrome face frequent claim challenge by WC insurers in NY State, with attendant prolonged delays in adjudication and treatment authorization. Likelihood of claim rejection was strongly related to ethnicity and socio-economic status.

Carpal Tunnel Syndrome↗
PubMed1999

Is immobilization associated with an abnormal lipoprotein profile? Observations from a diverse cohort.

OBJECTIVE: The potential effects of ethnicity, gender, and adiposity on the serum lipid profile in persons with spinal cord injury (SCI) were determined. SUBJECTS: Subjects with SCI were recruited during their annual physical examination from Rancho Los Amigos Medical Center, Downey, California. Sedentary able-bodied controls were Bridge and Tunnel Officers of the Triboro Bridge and Tunnel Authority of the New York City metropolitan area. METHODS: Serum lipid profiles were investigated in 320 subjects with SCI and compared to those obtained from 303 relatively sedentary able-bodied controls. Serum lipid studies were obtained in the fasting state. Data were collected between 1993 and 1996. All lipid determinations were performed by the same commercial laboratory. MAIN OUTCOME MEASURES: The dependent variables were the values from the lipid profile analysis. The independent variables consisted of study group, gender, ethnic group, age, duration of injury, and anthropometric measurements. RESULTS: The serum high-density lipoprotein cholesterol (HDL-c) level was reduced in the SCI compared with the control group (mean+/-SEM) (42+/-0.79 vs 47+/-0.67 mg/dl, P<0.0005). The serum HDL-c level was significantly lower in males with SCI than males in the control group (39+/-0.83 vs 45+/-0.70 mg/dl, P<0.0001), but not for females (51+/-1.54 vs 54 1.52 mg/dl, n.s.). Within the subgroups for whites and Latinos, HDL-c values were also lower in subjects with SCI than in controls (whites: 41+/-1.02 vs 46+/-0.86 mg/dl, P<0.0001; Latinos: 37+/-1.53 vs 42+/-1.59 mg/dl, P<0.05), but not for African Americans (49+/-1.56 vs 51+/-1.27 mg/dl, n.s.). African Americans had higher HDL-c values than whites or Latinos (SCI: 49+/-1.56 vs 41+/-1.02 or 37+/-1.53 mg/dl, P< 0.0001; controls: 51+/-1.27 vs 46+/-0.86 mg/dl, P<0.01 or 42+/-1.59 mg/dl, P<0.0005). In persons with SCI, the serum HDL-c values were inversely related to body mass index and estimated per cent body fat (r=0.27, P<0.0001). CONCLUSION: In white and Latino males, but not in females or African Americans, immobilization from SCI appears to be associated with lower HDL-c values than in controls.

Adult↗
PubMed1999

Predicting attrition in basic military training.

This cohort study investigated whether the risk of attrition during Australian Army recruit training was predicted by the fitness, age, date of enlistment, or injury status of recruits. Subjects were 1,317 male Australian Army recruits undertaking 12 weeks of intensive training. Fitness was measured using a 20-m progressive shuttle run test (20 mSRT) in which higher scores reflected higher fitness. A total of 184 subjects failed to complete training. Two hundred seventy-six disabling lower limb training injuries were recorded; 100 were stress fractures or periostitis. Scores on the 20 mSRT ranged between 3.5 and 13.5. Multivariate survival analysis revealed a strong negative association between 20 mSRT score and risk of attrition (p < 0.001) and a positive association between sustaining a lower limb injury and risk of attrition (p < 0.001). These effects were additive. Age and enlistment date were not significantly associated with risk of attrition. Fitness and training procedures may be important, modifiable risk factors for attrition.

Adolescent↗
PubMed1998

Promoter trapping identifies real genes in C. elegans.

Promoter trapping involved screening uncharacterized fragments of C. elegans genomic DNA for C. elegans promoter activity. By sequencing the ends of these DNA fragments and locating their genomic origin using the available genome sequence data, promoter trapping has now been shown to identify real promoters of real genes, exactly as anticipated. Developmental expression patterns have thereby been linked to gene sequence, allowing further inferences on gene function to be drawn. Some expression patterns generated by promoter trapping include subcellular details. Localization to the surface of particular cells or even particular aspects of the cell surface was found to be consistent with the genes, now associated with these patterns, encoding membrane-spanning proteins. Data on gene expression patterns are easier to generate and characterize than mutant phenotypes and may provide the best means of interpreting the large quantity of sequence data currently being generated in genome projects.

Animals↗
PubMed1997

The Union Health Center: a working model of clinical care linked to preventive occupational health services.

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having field a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings.

Ambulatory Care Facilities↗
PubMed1997

Screening for depression among acutely ill geriatric inpatients with a short Geriatric Depression Scale.

BACKGROUND: Depression is not uncommon among acutely ill geriatric inpatients. METHOD: The performances of shorter versions of the Geriatric Depression Scale (GDS) in screening for depression among acutely ill geriatric inpatients were examined. RESULTS: A cut-off of 2/3 gives the best sensitivity (88%) and specificity (75%) for the 10-item version (GDS10). A cut-off of 0/1 gives the best sensitivity (72%) and specificity (90%) for the 4-item version (GDS4). A positive response to item 6 ("Do you often feel helpless?") on the GDS10 gave a sensitivity of 76% and specificity of 75%. Patients found the GDS10 tolerable and acceptable. CONCLUSION: Both shorter versions of the GDS may be utilized in screening for depression among acutely ill geriatric inpatients.

Aged↗
PubMed1996

Healthy Hearts at work: Prince Edward Island Heart Health Program CSC worksite pilot project.

Prince Edward Island experiences a higher-than-average death rate from cardiovascular disease. The Prince Edward Island Heart Health Program is a health promotion/disease prevention research project of Health Canada and the Prince Edward Island Department of Health and Social Services. This paper describes and evaluates a worksite program, based on the principles of community mobilization, that was initiated with the Civil Service Commission of the Prince Edward Island government. The building of a partnership, the risk appraisal session administered in the workplace, the establishment of an Employee Wellness Committee, and subsequent programming which has occurred in the workplace were the key components in the process. Collaboration with the partner agency and participation of employees in the planning process has resulted in the delivery of programs which could not have been achieved by one of the agencies alone, without many additional resources. It is hoped that these characteristics of collaboration and employee participation will also result in sustainability of this initiative when PEI Heart Health is no longer involved.

Cardiovascular Diseases↗
PubMed1995

Identification of a series of 3-(benzyloxy)-1-azabicyclo[2.2.2]octane human NK1 antagonists.

The synthesis and in vitro and in vivo evaluation of a series of 3-(benzyloxy)-1-azabicyclo-[2.2.2]octane NK1 antagonists are described. While a number of 3,5-disubstituted benzyl ethers afford high affinity, the 3,5-bis(trifluoromethyl)benzyl was found to combine high in vitro affinity with good oral activity. Detailed structure-activity relationship studies in conjunction with data from molecular modeling and mutagenesis work have allowed the construction of a model of the pharmacophore. Specific interactions that have been identified include an interaction between His-197 and one of the rings of the benzhydryl, a lipophilic pocket containing His-265 that the benzyl ether occupies, and a possible hydrogen bond between Gln-165 and the oxygen of the benzyl ether.

Animals↗
PubMed1995

The chemical and mineralogical behaviour of Pb in shooting range soils from central Sweden.

Recently investigations have shown that the annual flux of lead from shotgun pellets to shooting range soils is significant in some countries. This paper presents the data of chemical and mineralogical analyses of soils and Pb-pellet crusts from five shooting ranges in Sweden and, based on these results, evaluates the retention of lead in these shooting range soils. In the soils, Pb-pellets and bullets are readily decomposed and transformed to crust materials composed of Pb-bearing minerals. The transformation products in the crust materials, identified by X-ray diffraction, are predominantly hydrocerussite [Pb(3)(CO(3))(2) (OH)(2)], associated with cerussite (PbCO(3)) and anglesite (PbSO(4)). In a period of 20-25 years, an average of 4.8% metallic lead in the pellets has been transformed to lead carbonate and lead sulphate, where the former is the more stable mineral in the surface environment. However, in soils relatively rich in humus an average of 15.6% metallic lead in the pellets was transformed to secondary lead compounds in the same period. The results of the chemical analyses indicate that Pb is rather immobile in the soil profile. The surficial horizon contains higher concentrations of lead (52-3400 mg kg(-1)), while lower concentrations of lead were found in the E and B horizons where the total Pb concentrations (8-37 mg kg(-1)) are within about one standard deviation of the mean reference sample concentration. An inverse relationship is revealed between the aluminium hydroxide content of the soil fraction and EDTA-extractable Pb, which suggests that these compounds have affected the retention of lead.

Journal Article↗
PubMed1993

Mortality after elective total hip arthroplasty in elderly Americans. Age, gender, and indication for surgery predict survival.

Medicare Part A claims records were used to determine the perioperative mortality and cumulative postoperative survival of elderly Americans undergoing total hip arthroplasty (THA) for reasons other than hip fracture. The indication for THA was determined by analysis of the diagnosis codes in the claims records. Perioperative mortality was 0.95% (48/5078) and increased with age, from 0.34% (three of 872) in those 66 years to 69 years of age to 3.75% (nine of 240) among those 85 years of age or older. Perioperative mortality was not related to race, gender, or the indication for which the surgery was performed. Among these elderly patients not operated on for hip fracture, cumulative survival after surgery increased with decreasing age, female gender, and when osteoarthrosis was the indication for surgery. Persons undergoing THA had better survival after surgery than the age-gender-matched general population. Perioperative mortality among elderly Americans undergoing THA in the community is low and similar to that estimated by the 1982 NIH Consensus Conference, which considered primarily data reported from referral centers.

Age Factors↗
PubMed1992

Novel 5-HT3 antagonists: indol-3-ylspiro(azabicycloalkane-3,5'(4'H)-oxazoles).

The synthesis and biochemical evaluation of a series of spirofused indole oxazoline 5-HT3 antagonists is described in which the oxazoline ring acts as a bioisosteric replacement for esters and amides. The effect of substitution about the indole ring has shown the steric limitations of the aromatic binding site. Incorporation of a variety of azabicyclic systems within the rigid spirofused framework has allowed the definition of a binding model which incorporates a number of known antagonists and agonists. In this model steric constraints limit substitution around the indole ring although there is some bulk tolerance at the 1- and 2-positions. The importance of constraining the basic nitrogen within an azabicyclic system is underlined by comparison with the monocyclic piperidine. The highest affinity was observed for those compounds in which the basic nitrogen occupies a bridgehead position, the most potent analogue in this group being the azabicyclic [3.3.1] system (pIC50 = 8.95), suggesting lipophilic interactions may play a role in increasing affinity. A suggested model for agonist binding is included in which the basic nitrogens are superimposed and the 5-hydroxyl group of 5-HT is superimposed on the H-bond-accepting atom of the heterocyclic linking group.

Animals↗
PubMed1992

Results of colectomy in elderly patients with colon cancer, based on Medicare claims data.

Currently available estimates of outcomes following colon resection in elderly patients with colon cancer are based on series collected at academic medical centers. We used Medicare Part A claims and enrollment records of a 5% nationally random sample of elderly Medicare beneficiaries from 1983 to 1985 to estimate how patient age and sex affected perioperative mortality and 1- and 2-year survival rates among elderly patients undergoing a colon resection procedure for colon cancer. Among the 5,586 individuals in our data set, the overall perioperative mortality rate was 5.0%, ranging from 3.3% in beneficiaries 66 to 69 years of age to 9.3% in those 85 years of age and older. Men had a 31% higher perioperative mortality rate than women (5.8% versus 4.4%, p less than 0.05). The overall postoperative survival rates at 1 and 2 years were 72% and 63%, respectively, decreasing with increasing age, but were similar in men and women. This analysis provides age- and sex-specific estimates of outcomes following surgery for elderly patients with colon cancer that are more precise and have more potential for generalization than those that were available previously.

Age Factors↗
PubMed1992

What are trusts allowed to do?

NHS trusts may not be a feature of the health services for ever, but current legislation will be applicable for some time to come. Legal aspects of trust status are described in two features. In the first, Anita Morrish identifies what trusts are legally empowered to do and those areas where their powers, if they exist, are less clearly defined.

Hospital Restructuring↗
PubMed1991

Accuracy of Medicare claims data for estimation of cancer incidence and resection rates among elderly Americans.

To explore the reliability of Medicare Part A claims data for clinical and health services research related to the care of patients with cancer, the authors compared estimates of the incidence of and resection rates for cancer of the breast, colon, and lung derived from analysis of Medicare Part A data versus data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Incidence rates of breast, colon, and lung cancer estimated from Medicare Part A data were within 6% of estimates derived from SEER data. Resection rates estimated from Medicare Part A data, in contrast, were 12% to 27% lower than resection rates based on SEER data. This discrepancy is not explained by variations in practice between regions participating in versus those not participating in the SEER registries but may be due to undercoding of surgical procedures in Medicare Part A data. This analysis suggests that Medicare data can provide useful insights into the care of patients with cancer, but research regarding inpatient procedures employed in management of cancer should be based on analysis of Medicare Parts A and B data combined.

Abstracting and Indexing↗