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Biomedical subjects

T L Guidotti

Publications and source records attributed to T L Guidotti.

At least 55 records · Page 3Linked to original sources
PubMed1993

Mortality of urban firefighters in Alberta, 1927-1987.

The mortality experience of firefighters has been an active topic of investigation. Collateral toxicological evidence suggests that certain causes of death are likely to be associated with firefighting: lung cancer, heart disease, and obstructive pulmonary disease. To date there has not been a clear and consistent demonstration of excess risk due to occupational exposure for these outcomes, but certain other cancers, including genitourinary, colon and rectum, and leukemias, lymphomas, and myeloma, appear to be consistently elevated. A major unproven hypothesis is that risk increased following the introduction, in the 1950s of combustible plastic furnishing and building materials known to generate toxic combustion products. Mortality by cause of death was examined for two cohorts totalling 3,328 firefighters active from 1927 to 1987 in Edmonton and Calgary, the two major urban centers in the province of Alberta, Canada, examining associations with cohort (before and after the 1950s) and years of service weighted by exposure opportunity. The study attained 96% follow-up of vital status and over 64,983 person-years of observation, yielding 370 deaths. Mortality from all causes was close to the expected standardized mortality ratio (96; 95% confidence limits (CL) 87, 107) as was that for heart disease (110; 95% CL 92, 131), and neither was statistically significant at the p < 0.05 level (N.S.). Excesses were observed for all malignant neoplasms (127; 95% CL 102, 155, p < 0.05) and for cancer of lung (142; 95% CL 91, 211, N.S.), bladder (315; 95% CL 86, 808, N.S.), kidney and ureter (414; 95% CL 166, 853, p < 0.05), colon and rectum (161; 95% CL 88, 271, N.S.), pancreas (155; 95% CL 50, 362, N.S.) and leukemia, lymphoma, and myeloma (127; 95% CL 61, 233, N.S.); obstructive pulmonary diseases (157; 95% CL 79, 281, N.S.). Fire-related causes showed a marked excess (486; 95% CL 233, 895, p < 0.01), but external causes overall showed a significant deficit (66; 95% CL 49, 87, p < 0.05). The lung cancer excess was confined to Edmonton; there was no consistent association with duration of employment, exposure opportunity, or cohort of entry (before or after the 1950s) except that the highest risk was observed among Edmonton firefighters with over 35 weighted years. The excess of cancers of the urinary tract was observed mostly among firefighters entering service after 1950, appeared to increase with length of service and exposure opportunity, and was observed in both cities. An occupational association with heart disease and chronic pulmonary disease is not supported in this study on this population.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

The implications of an epidemiological mistake: a community's response to a perceived excess cancer risk.

OBJECTIVES: The response of community residents to a perceived cancer excess may include changes in attitude, health-related behavior, and property values. In 1986, a cancer agency conducted a study of cancer incidence (1979 to 1983) in two suburbs of Edmonton, Alberta, and reported elevations on the order of 25% over expected for most sites. Reanalysis of these data several months later revealed an error. Correction brought the rates into line with Alberta as a whole and with other communities surrounding Edmonton. METHODS: We used public opinion trends and property value trends (during the period of concern) to study the two communities affected by the allegation of increased cancer risk. RESULTS: A survey of residents found significant differences at the time in health-related behavior and beliefs suggesting increased perception of personal, family, and community risk and modest changes in behavior. Real estate values in one community temporarily lost an average of $4000, or about 5% of total value, compared with a similar, adjacent housing market. CONCLUSIONS: The perception of an elevated cancer risk, in the absence of a true risk, may have a substantial negative effect on the affected community, both psychologically and economically.

Adult↗
PubMed1992

Human factors in firefighting: ergonomic-, cardiopulmonary-, and psychogenic stress-related issues.

There are many issues in firefighting that involve human factors and cardiopulmonary conditioning. Population-based mortality and disability surveillance studies suggest a relatively small but significant excess of disability but not mortality from nonmalignant cardiovascular disease for firefighters. More targeted cohort and case-control studies do not support such an excess and instead suggest a strong healthy worker effect. Pulmonary function among firefighters has been extensively studied, with contradictory findings. Extreme exposures and long-term exposure in combination with cigarette smoking may be risk factors for respiratory disorders and accelerated decline in airflow. It appears likely that individual firefighters who show early signs of illness are often selectively transferred out of active firefighting positions. Despite exposure to substances such as carbon monoxide that may predispose to cardiovascular mortality and morbidity, excesses are not consistently shown in mortality studies. Clinical studies of individual firefighters do suggest an elevated risk for myocardial ischemia. The ergonomic demands of firefighting are extreme at peak activity because of high energy costs for activities such as climbing aerial ladders, the positive heat balance from endogenous and absorbed environmental heat, and encumbrance by bulky but necessary protective equipment. The psychological stresses of firefighting include long periods of relative inactivity punctuated by highly stressful alarms and extremely stressful situations such as rescues, as reflected in physiological and biochemical indicators. Firefighters are at risk for depression and post-traumatic stress disorder, although morale overall is generally much higher than in comparable occupations. Women firefighter candidates as a group perform less well on selection test simulating the demands of active firefighting, but some individual women perform very well.

Cardiovascular Diseases↗
PubMed1992

Hidden assumptions in environmental research.

A major challenge in both the design of epidemiologic studies of exposure to toxic agents and the interpretation of the findings is to recognize and to accommodate the complex biologic assumptions that underlie population-based research. Environmental health research is grounded on a scientific foundation that blends toxicology with epidemiology. Toxicology without human population studies often leads to findings uninterpretable for purposes of risk assessment. Epidemiologic studies are often less helpful than they could be because the variation in response is seldom addressed, the effects under study are often small in magnitude and easily confounded, and exposure estimates are crude. The net bias is to reduce the risk estimate, perhaps substantially. Biological variation has usually been treated as "noise" in the system but it is a more basic problem that lends itself to investigation and quantification. Improved modeling of the biological determinants of response is needed if results are to be generalizable and interpretable in mechanistic terms.

Environmental Health↗
PubMed1992

Mortality of urban transit workers: indications of an excess of deaths by suicide using gas.

Urban bus drivers are exposed to a variety of discomforts and physical hazards associated with their occupation. We obtained death certificates for 99 per cent of 219 decreased members of the Amalgamated Transit Union Local 596 of Edmonton, Alberta, and conducted a proportionate mortality study against the distribution of all deaths among men in the province of Alberta, standardized by age and year of death. We found a highly significant excess from undetermined accidents due to gas (proportionate mortality ratio (PMR) 3761, based on 3 cases; p less than 0.003), which may bear a relationship to an elevation observed for suicide due to gas, which failed to achieve statistical significance (PMR 242, based on 2 cases). Collateral evidence suggests that this excess may include misclassification of some suicides. Gas inhalation as an instrument of suicide may be suggested by familiarity with vehicle exhaust. No other excess achieved statistical significance. Several causes of death showed elevated PMRs of relatively modest magnitude; elevations in PMR for lung cancer (PMR 154) and chronic obstructive pulmonary disease (PMR 176) suggest a mutual association with smoking.

Adult↗
PubMed1992

Mercury.

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Humans↗
PubMed1992

Clove cigarettes.

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Adolescent↗
PubMed1992

Occupational repetitive strain injury.

Repetitive strain injuries include a group of disorders that most commonly develop in workers using excessive and repetitious motions of the neck and upper extremity. A careful occupational history, physical examination and specific diagnostic maneuvers can help distinguish these musculoskeletal injuries from rheumatologic diseases, psychologic disorders, acute joint or tendon inflammation from other causes and single-event traumatic sprains and strains. Repetitive strain injury may be manifested by cervical syndrome, tension neck syndrome, thoracic outlet syndrome and frozen shoulder syndrome. Common injuries involving the elbow, wrist and hand include epicondylitis, carpal tunnel syndrome and ulnar nerve entrapment. Conservative treatment consisting of rest, application of ice or heat and anti-inflammatory drugs is usually effective, but the injury may take weeks or months to resolve. Modifications in the workplace can prevent many of these injuries and may be required to prevent reinjury after the patient returns to work.

Arm↗
PubMed1990

Process chemicals in the oil and gas industry: potential occupational hazards.

Numerous chemicals are used in various processes of the oil and gas industry: drilling, cementing, completion, stimulation, and production. The number and the complexity of composition of process chemicals has increased greatly over the last three decades. The occupational hazards of exposure to these agents has received little attention. We reviewed the various processes in the industry, the type of chemicals used in each process, and some of their characteristics. We placed emphasis on those for which significant toxicity has been established or is suspected, and those for which there is incomplete information on their chemistry and health hazards. This report is intended to form a basis for a more complete survey of the process chemicals, and to draw attention to the possibilities for toxic exposure resulting from use of these agents in the oil and gas industry. The ultimate objective is to promote the safe use of these agents in the industry.

Humans↗
PubMed1989

Critique of available studies on the toxicology of kretek smoke and its constituents by routes of entry involving the respiratory tract.

Kreteks are tobacco cigarettes containing clove, imported into North America from Indonesia. Health effects, including severe pulmonary toxicity, are suspected to be associated with kretek use among adolescents and young adults. The most likely candidate for a specific toxic effect among the chemical constituents of kreteks is eugenol. Eugenol is a natural compound found in high concentrations in clove buds and is the active ingredient that distinguishes kreteks from conventional cigarettes. It is a potent and valuable topical anesthetic, as well as a pungent spice constituent. Until kretek use became a fad in North America in the early 1980s, the toxicity of eugenol by routes of exposure involving the respiratory tract had not been considered because human exposure had been predominantly oral and topical. Concern over the possible pulmonary toxicity of kretek smoke has stimulated studies on the smoke, eugenol itself, and other chemical constituents of kreteks. Two sets of studies are now available for review, one series conducted by La Voie et al. of the American Health Foundation and another conducted by Clark et al. of the Huntingdon Research Centre in the United Kingdom. Their methods and findings are very different. Common problems include low statistical power, methods of exposure that do not duplicate human exposure, and failure of the models to replicate the circumstances of the extant clinical reports, which suggest that aspiration, idiosyncratic or allergic reactions, or impaired host defense mechanisms may be involved. The available toxicologic studies must be considered preliminary.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1989

Clove cigarettes. The basis for concern regarding health effects.

The smoking of clove cigarettes has been associated with 13 cases of serious illness in the United States, including hemorrhagic pulmonary edema, pneumonia, bronchitis, and hemoptysis. We describe a patient in whom, after she smoked a clove cigarette, pneumonia complicated by lung abscess developed. Her lung disease may have been caused by aspiration pneumonia as a consequence of pharyngolaryngeal anesthesia from clove cigarette smoke. Clove cigarettes appeal to adolescents experimenting with smoking practices and may influence the development of later smoking habits.

Adolescent↗
PubMed1988

Exposure to hazard and individual risk: when occupational medicine gets personal.

Occupational medicine is grounded on a scientific foundation that blends toxicology and epidemiology. Epidemiologic studies are often less helpful than they could be, both because the variation in response is seldom addressed and because exposure estimates are crude. Biologic variation has usually been treated as "noise" in the system but it is a more basic problem that lends itself to investigation and quantification. To investigate sources of variation requires personal information on factors that may modify the response in individual workers. For research, collection of selected data on nonoccupational personal characteristics of workers has become essential. The collection of personal data is also required for many legitimate functions of an occupational health service that benefit the worker, among them employee assistance, health promotion, health surveillance, and, in many cases, fitness to work evaluation. Collecting important personal data will ultimately benefit the worker and workers in general by better services, better management of individual cases, and better understanding of exposure-related disorders.

Data Collection↗