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R J McCunney

Publications and source records attributed to R J McCunney.

36 records · Page 2Linked to original sources
PubMed1992

Environmental health in the journals.

The environmental health aspects of general medical practice have attracted the attention of many professional organizations in the past few years, including the American College of Physicians, the Institute of Medicine, and the American College of Occupational Medicine. To assess the degree of emphasis placed on environmental health issues in professional journals, a survey of representative specialty and general medical journals was conducted through a Medline literature search. Over the past 15-year period (1976-1990) specialty journals demonstrated a dramatic and consistent increase in published articles that were indexed under the headings environmental pollution, environmental pollutants, and environmental cancer. General medical journals also demonstrated continued increases in the rate of published articles addressing these environmental health topics. Within the environmental categories, air pollution, especially that due to dusts, was the most heavily indexed topic, followed by water pollution, especially that due to chemical contamination. This study supports the notion that environmental health issues are assuming more importance in general medical practice, especially within the specialty of occupational medicine.

Environmental Health↗
PubMed1992

The influence of occupational medicine on general medicine: a look at the journals.

To assess how the occupational medicine literature may affect general medical practice, representative journals were reviewed to address (1) how frequently the specialties cite each others' literature and (2) which topics are published most commonly by the respective journals. Five general medical journals were selected to contrast with six occupational medical journals. Methods included Journal Citation Reports, which enable the tabulation of impact factor, self-citation rate, and the number of source items published by the journal. MEDLINE was used to cross reference the 11 journals with designated topics in occupational medicine. The findings indicated that occupational medical journals are nearly 50 times more likely to cite the general medical literature than the converse. The journals most likely to cite the core occupational medical literature, aside from the specialty journals themselves, were the American Review of Respiratory Diseases and the American Journal of Epidemiology. In comparing the 1976 through 1980 period with the 1986 through 1990 period, occupational medical journals published 2.5 times as many source items (letters, technical reports, and papers) compared with a decade earlier. The MEDLINE search indicated that both types of journals address the same types of occupational medicine topics with the exception of gas poisoning and toxic hepatitis, which were published much more frequently in general medical journals. Pneumoconiosis was the most frequently addressed topic by occupational medical journals. Other major categories included reproductive hazards, lead poisoning, and noise-induced hearing loss. This study indicates that occupational medicine, as reflected by its journals, is a much more active scientific discipline than it was a decade earlier.

Bibliometrics↗
PubMed1990

Providing high quality occupational medical services.

As people become more aware that their work and the environment can adversely affect their health, greater attention will focus on the role of occupational health in preventing and evaluating certain medical concerns. This wider awareness will further the demand for quality occupational medical services. Clearly, an opportunity exists for the business and health care communities to work in concert to prevent occupational and environmental health problems. Marketing efforts that can support occupational medical services range from seminars and newsletters to unique approaches of health care delivery. Examples of the latter include "fast-track" treatment of work related injuries that bypass customary delays in most emergency departments. In this manner, client organizations benefit from the special treatment, which encourages the use of the occupational health program. Conferences geared to the business community, where topics such as back injuries, drug testing or medical surveillance are presented, can enhance the credibility of the services. Moreover, since the role of occupational medicine, especially with respect to small businesses, is poorly understood, these meetings can help establish the capabilities of the program. Efforts that promote the institution itself can also be beneficial, especially regarding highly specialized equipment and services, including magnetic resonance imaging, physical therapy equipment and research efforts of its staff. As the issues evolve, occupational health professionals will need to adapt and keep abreast of the changes. Both health care providers and business should be aware of the specialized area of knowledge associated with occupational health professionals, especially the specialty of occupational medicine. Similarly, the business community is advised to take a critical review of any provision of health services to its employees. Attention to the type of staff at a medical facility as well as their training and protocols will help insure that appropriate and quality services are being provided.

Humans↗
PubMed1990

The effect of federal health policy on occupational medicine.

All three branches of the federal government affect occupational medicine. Notable examples include: 1) the Department of Transportation ruling (1988) requiring drug testing in diverse areas of the transportation industry (executive branch); 2) the Workplace Drug Act (1988) calling for organizations to have a policy towards drug and alcohol abuse (legislative branch); and 3) the Supreme Court ruling on the constitutionality of drug testing in the transportation industry (1989) and that infectious diseases are a handicap in accordance with the 1973 Federal Rehabilitation Act (1987). The executive branch plays a major role in occupational medicine primarily through the Occupational Safety and Health Administration (OSHA), which issues standards based on a rule making process; the executive branch can also affect occupational medicine indirectly, as evidenced by President Reagan's Executive Order 12291 calling for Office of Management and Budget oversight of regulatory initiatives. The legislative branch enacts laws, conducts hearings, and requests reports on the operations of federal agencies. The judicial branch addresses occupational health issues when people affected by an executive ruling want to challenge the ruling; or in the case of the Supreme Court, when deliberating an issue over which two circuit courts of appeal have come to divergent opinions. The Occupational Medicine profession can participate in the political process through awareness of proposed legislation and by responding accordingly with letters, resolutions, or testimony. Similar options exist within the executive branch by participating in the rule-making process. A representative of the Governmental Affairs Committee, through periodic visits with key Washington representatives, can keep members of the American College of Occupational Medicine informed about federal legislative and regulatory activities. In appropriate cases, the organization can then take a formal position on governmental activities that affect the speciality.

Health Policy↗
PubMed1989

Drug testing: technical complications of a complex social issue.

To control the adverse effects of substance abuse, urinary drug testing has become common practice in some occupational settings. Although it is virtually impossible to assess accurately the impact of drug abuse at work, increased accidents and absenteeism as well as impaired productivity have been attributed to drug abuse. The major analytical techniques used to screen for illegal drug use are thin-layer chromatography and enzyme- and radioimmunoassays. Gas chromatography-mass spectrometry is uniformly recommended to confirm any positive screening test. The major technical problem in interpreting screening tests is that the presence of a substance in the urine indicates merely exposure to the drug, not necessarily intoxication, habituation, or addiction. Since no certifying criteria are available to insure quality control among laboratories performing urinary drug testing, results may vary widely. In fact, a study conducted by the Centers for Disease Control suggests that poor performance of some laboratories may adversely affect the treatment of drug abuse. The Federal Rehabilitation Act (1973, section 504) prohibits discrimination against the handicapped, which includes both drug abuse and alcoholism. Legal challenges to urinary drug testing have focused on issues related to the right to privacy and freedom from unreasonable searches. Because of the wide-ranging legal, ethical, and medical ramifications of drug-screening programs, careful review of these issues is recommended before an organization establishes such a program.

Alcoholism↗
PubMed1989

Pulmonary alveolar proteinosis and cement dust: a case report.

Pulmonary alveolar proteinosis developed in a 29-year-old white man within 2 years of working as a cement truck driver. Pulmonary alveolar proteinosis (PAP), an uncommon respiratory disorder characterized by the accumulation of phospholipid material within the alveoli, has been described in association with exposure to silica, aluminum oxide, and a variety of dusts and fumes. Although a link between exposure to Portland cement and PAP has not been previously noted, this type of cement contains nearly 20% silica. Lung biopsy material, originally used to diagnose PAP, was reviewed under electron dispersive spectroscopy. Analysis indicated the presence of silica particles within the alveolar fluid and macrophages. A number of items support a causal relationship between exposure to cement dust and PAP: (1) the temporal sequence between assuming job duties and the development of the illness, (2) improvement following removal from further exposure, (3) dusty, unprotected working conditions, (4) the presence of silica within the cement, and (5) the alveolar fluid from periodic acid-Schiff-positive lung tissue.

Adult↗
PubMed1988

Diverse manifestations of trichloroethylene.

Trichloroethylene, a solvent used in a variety of industrial settings for more than 60 years, has caused adverse health effects on the central and peripheral nervous system, the skin, liver, kidney, and heart. Three men have shown relatively unusual manifestations secondary to exposure to trichloroethylene in degreasing operations in the jewelry industry. Toxic encephalopathy, hepatitis, and carpal spasm occurred among young, healthy workers. Clinical and laboratory data, including measurement of urinary trichloroacetic acid concentrations, are presented.

Adult↗
PubMed1987

Occupational illness in the arts.

Artists and craftspeople are exposed to the same hazardous materials as workers in industry. Art materials, including solvents, stones, clay, metals and dyes, are all potential health hazards. Patients whose symptoms cannot be easily categorized or who do not respond to initial treatment should be questioned about personal activities in the arts and crafts. A questionnaire devised by the Occupational and Environmental Health Committee of the American Lung Association may be useful.

Art↗
PubMed1986

Health effects of work at waste water treatment plants: a review of the literature with guidelines for medical surveillance.

Potential health hazards associated with work at waste water treatment plants include bacteria, viruses and protozoa in domestic waste and heavy metals and other hazardous substances in industrial wastes. The primary exposure route for hazardous material is through inhalation of aerosols generated in the secondary phase of water treatment that contain pathogenic organisms. Although few epidemiological studies have investigated the health of waste water treatment facility workers, hazards noted have been limited to acute, self-limited gastrointestinal illnesses. Due to the potential for long term or subtle adverse health effects, a medical surveillance program is proposed that includes attention to infectious diseases, such as hepatitis and to illness/absenteeism records.

Chlorine↗
PubMed1986

The patient with asbestos exposure.

Attention to the hazards of asbestos has aroused concern among many healthy persons who have been exposed at some time to one of the world's most versatile materials. Present standards for exposure to asbestos, however, may not fully protect workers from asbestos-induced pulmonary malignancy. To evaluate the patient who has had some asbestos exposure, the physician should focus on the pulmonary system, take a thorough occupational history, conduct a physical examination and pulmonary function studies, and obtain chest films. In managing the patient with asbestosis, removal from further occupational exposure is advisable. For workers with only pleural changes, it is unclear whether removal from the work place is of any value.

Asbestos↗
PubMed1984

A hospital-based occupational health service.

Responding to the local business community, Sturdy Memorial Hospital developed an occupational health service. Situated about 35 miles south of Boston, Attleboro has a population of 130,000, with jewelry, chemicals, and light manufacturing as its predominant industries. Featuring plant visits by a medical director with specialty training in occupational and internal medicine, the program provides clinical, ancillary, consultative, educational, and a variety of special services. Clinical services include preplacement examinations and treatment of work-related injuries. Ancillary services are audiometric testing, pulmonary function testing, and screening for heavy-metal exposures. Among the consultative services are evaluations as to whether a disease is work related; counseling on the reproductive hazards in the workplace; and disability evaluations. Work-site visits are conducted by an occupational health nurse who participates in medical surveillance and health promotion programs. Within two years the service has become affiliated with more than 60 firms on a noncontractual , fee-for-service basis. Economic self-sufficiency was established within 18 months of the institution of clinical services.

Accidents, Occupational↗