Assessment of reproductive disorders and birth defects in communities near hazardous chemical sites: introduction.
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Adult↗
Biomedical subjects
R W Amler
Publications and source records attributed to R W Amler.
Assessment of reproductive disorders and birth defects in communities near hazardous chemical sites. I. Birth defects and developmental disorders.
Members of the workgroup on birth defects and developmental disorders discussed methods to assess structural anomalies, genetic changes and mutations, fetal and infant mortality, functional deficits, and impaired fetal and neonatal growth. Tier 1 assessments for all five adverse reproductive outcomes consist of questionnaires and reviews of medical records rather than laboratory testing of biologic specimens. The work-group members noted a role for neurodevelopmental testing and for limited genetic studies, such as karyotyping in Tier 2 assessments. Emerging methodologies to identify chromosomal aberrations, DNA adducts, and repair inhibition were reserved for Tier 3.
Adult↗
Assessment of reproductive disorders and birth defects in communities near hazardous chemical sites. II. Female reproductive disorders.
Members of the workgroup on female reproductive disorders discussed methods to evaluate five principal functions: menstrual dysfunction, infertility, pregnancy loss, lactation disorders, and pregnancy complications. To test each function, a nested strategy was considered, based on progressive levels of effort available to conduct field investigations. This strategy was analogous to the three-tier classification of biomarkers used by other workshops. The lowest level of effort, corresponding to Tier 1, consists only of questionnaires, diaries, and reviews of maternal and infant medical records. The medium level of effort (Tier 2) collects data from questionnaires and diaries, and some biologic specimens. Suggested laboratory analyses included measurement of progesterone in saliva and several glycoprotein hormones in urine that evaluate menstrual dysfunction, infertility, and pregnancy loss. The highest level of effort (Tier 3) involves prospective collection of diary information and simultaneous collection of biological specimens.
Abortion, Spontaneous↗
Impact of measles in the United States.
Measles has had a severe impact on children in the United States since colonial times. In the early decades of the 20th century, thousands of fatal measles infections were reported each year. During the 1950s an annual average of greater than 500,000 cases of measles and nearly 500 deaths due to measles were reported in the United States. Surveys indicated that 95% of the population had been infected with measles by the age of 15 years. The introduction of measles vaccine and its widespread use, which began in 1963, has had a major impact on the occurrence of measles in the United States. Reported numbers of cases, deaths due to measles, and complications of measles (e.g., encephalitis) have declined dramatically. Accompanying the decline in reported incidence of measles and following it by approximately seven years, has been a decline in the reported incidence of subacute sclerosing panencephalitis (SSPE). In recent years, the incidence of measles has dropped to levels that are less than 1% of those seen in the prevaccine era. In 1981, provisional figures indicated that only 10% of counties in the United States reported any cases of measles. The reported incidence in 1981 was 1.3 cases per 100,000 population, compared with an average incidence of 336.3 cases per 100,000 population in the decade 1950-1959. Thus, the impact of measles in the United States has been markedly reduced, and it is anticipated that indigenous transmission will be eliminated entirely from the country within the year.
Adolescent↗
Aerosolized measles vaccine--will it open the window?
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Aerosols↗
Biomedical testing of the kidney for persons exposed to hazardous substances in the environment.
To identify kidney injury and dysfunction among persons exposed to hazardous substances in the environment, a battery of biomarker tests has been identified for systematic public health use. The standardized use of tests for conducting field epidemiology studies was reviewed in a 1995 joint American-European workshop, and recommended tests were selected by the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC). These tests would be useful in conducting public health activities but are not recommended in a manner that would suggest changes in routine clinical practice. The tests selected include serum creatinine, urine analysis, urinary albumin, retinol-binding protein, N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and osmolality. Urinary creatinine was also included to adjust for urine concentration. The tests were chosen for use not only in epidemiologic field studies but also clinically oriented population screening and case studies of persons exposed to hazardous substances at waste sites. Studies using the battery may address the relationship between kidney damage and dysfunction and exposures to hazardous substances, especially in susceptible populations including children. Also, longitudinal studies should be conducted to evaluate the long-term health implications of abnormal tests and to measure the tests' predictive value for renal injury. These studies could evaluate the continuum of renal dysfunction as expressed by persistent decrements in glomerular filtration to the development of end-stage renal disease.
Biomarkers↗
The Indian burden of illness and future health interventions.
This article describes the burden of illness of Indians eligible for services from the Indian Health Service (IHS) and discusses strategies for reducing morbidity and mortality related to those conditions. To improve health to an extent that parallels the IHS's past achievements, the illnesses that now are prevelant among Indians require changes in personal and community behavior rather than intensified medical services. Analysis of these conditions leads to the conclusion that much of the existing burden of illness can be reduced or eliminated. IHS is responding to this challenge by continuing to ensure Indians' access to comprehensive health care services, by increasing educational efforts aimed at prevention, and by enlisting the support of other government and private organizations in activities that have as their purpose treating diseases if intervention will lessen morbidity and mortality (such as diabetes and hypertension) and encouraging of dietary changes, cessation of smoking, exercise, reduction in alcohol consumption, and other healthy behavior.
Adolescent↗
Persistence of influenza A/New Jersey/76 (Hsw1N1) antibody one year after vaccination.
Serum HI and neuraminidase-inhibiting (NI) antibody measurements were made at 3, 32 and 50 weeks after inactivated influenza Hsw1N1 vaccination of 438 adults in 1976. Although the highest postvaccination geometric mean HI titers were observed in persons greater than or equal to 52 years of age, the rate of antibody decline was similar in adults of all ages. In 14 children who had a seroconversion following two doses of whole virus or split virus vaccine, the geometric mean HI antibody titer was lower after the second vaccine dose than the peak titer observed in adults, and the decrease in titer was also more rapid by 4 to 7 months. One year after influenza Hsw1N1 vaccination of adults, the prevalence of homologous HI antibody greater than or equal to 40 was 71% to 97%, whereas only two of the 14 children maintained similar titers at 5 to 7 months. Neuraminidase-inhibiting antibody titer formation occurred more frequently in those without prevaccination NI antibody, but the rate of decline was also greatest in this initially seronegative group. The rate of antibody decline at one year in the population with preexisting antibody was similar to that observed for HI antibody decline in a primed population. Heterologous influenza A/Victoria/3/75 (H3N2) HI antibody formation occurred in 22% of adults aged 25 to 51 after Hsw1N1 vaccination and in 12% of those over the age of 51, but the rate of heterologous antibody decline was more rapid than that observed for homologous antibody.
Adult↗