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T L Guidotti

Publications and source records attributed to T L Guidotti.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

The cancer non-epidemic of county 20: case study of an epidemiological mistake.

Two suburban communities in western Canada, with a combined population of 52,000, were affected by a false allegation of increased cancer risk. In 1986, a cancer research agency responded to community concern by conducting a study of cancer incidence (1979 to 1983) and reported elevation on the order of 125% of expected for most sites. Reanalysis of these data several months later revealed an error in the population figure used to calculate the rates. Correction brought the rates into line with Alberta as a whole and comparable to other communities surrounding Edmonton. National media reported the cancer excess but did not report the correction. A Joint Advisory Committee convened at the time by the Minister responsible was a valuable resource for public education. This case study may be useful in the instruction of students and as an example of clerical errors that can indirectly affect an otherwise useful study. Residents of two nearby communities in northern Alberta became concerned about an apparently elevated rate of cancer among adults in their area. Many speculated on an association with the concentration of refineries in eastern Edmonton and petrochemical facilities outside the city in one of the communities. In 1986, the responsible provincial agency conducted a preliminary study of cancer incidence in the area compared to Alberta as a whole. The findings were summarized in a draft document which became widely circulated, although it was never intended to be the definitive report. It was "leaked" from a high government office and became the basis for numerous news stories. A reanalysis of these data revealed that the population figure used to calculate the combined cancer rates for the two communities was valid only for one of them and not the two combined. Correction of this mistake brought the calculated rates into line with those for Alberta as a whole. The original error was shown to be one of interpreting a confusing set of tables that lacked specific instructions and is not likely to be repeated. The original study is now invalidated. Reference to its findings should be made only as it has affected recent local history and public concern. There is certainly no evidence for a serious chemical threat to the health of residents of the area today in the present study and no suggestion of an occupational or environmental factor at work in the past.

Air Pollutants↗
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Implications for human health of global ecological changes.

Comparatively little attention has been given to the health implications of global ecological changes on human health, with the exception of concern over ozone depletion leading to an increased frequency of ultraviolet irradiation-induced skin cancer and cataracts. The implications for human health of five large-scale ecological disruptions were explored: climate change (greenhouse effect), ozone depletion, acid precipitation, transregional pollution, and demographic changes. Limitations of presently available data and the uncertainty of current interpretations of apparent trend is emphasized. Rigorous assessment of the effects of these changes and the response required from public health professionals is needed. This overview provides a point of departure.

Acid Rain↗
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Phenoxyacetic acid herbicides and chlorophenols and the etiology of lymphoma and soft-tissue neoplasms.

The phenoxyacetic acid herbicides and the chlorophenols are compounds of economic importance. The herbicide 2,4-D is widely used in agriculture, industry, and the home. Recently, concern has arisen over their safety as a result of studies linking these compounds with soft-tissue sarcomas and non-Hodgkin's lymphomas. We reviewed the available literature in order to advise a provincial government regulatory body and investigated methodologic issues by examining the pattern of reported cases in Alberta. We conclude that, taking into account the serious limitations on methodology in the available data, the evidence for a causal association is strongest for non-Hodgkin's lymphomas and probably reflects either a weak effect or, possibly, a confounding exposure associated with the use of 2,4-D. Given the worst-case assumptions, however, the potency of 2,4-D as a carcinogen is probably weak. Its intrinsic toxicity is less than that of alternative herbicides and the hazard posed by its use is probably much less than either the use of chemical alternatives or manual cleaning of vegetation, which carry a high risk of occupational injuries.

Chlorophenols↗
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Health promotion in perspective.

Our emphasis in the past has been on disease prevention rather than health promotion. This emphasis served us reasonably well when morbidity was high throughout society and when interventions at the community level were able to achieve massive reductions. It is not faring as well now that the major shared environmental determinants of disease have been controlled. The present situation calls for changes in individual health-related behaviour and individual clinical interventions to achieve comparable progress. As difficult to win as collective commitments to community-level interventions have been, compliance in a free society by often unmotivated persons in numerous individual instances of decision making in daily life is even more difficult. Health promotion offers the promise of a quantum leap in improving the health status of the community by participating in behaviour perceived as not only responsible but appropriate and desirable, providing positive reinforcement rather than anxiety-provoking caution. Favourable social trends, such as physical conditioning and dietary changes may be encouraged through media interventions. There are biological limitations to this approach, however. Many healthful practices confer little benefit on large groups of people and a few may be harmful to selected groups. Vigorous promotion of weight reduction and obesity control, for example, may lead to profound dissatisfaction with body image and to severely self-destructive behaviour among those prone to eating disorders such as anorexia, bulimia, and obsessive eating. Health promotion activities may fit well with social trends but their adverse potential can be aggravated because failure to comply can be penalized by peer disapproval in a way that disease prevention strategies usually are not.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Behavior↗
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Cooperation in health affairs between adjacent international communities: a successful model.

The border between the United States and Mexico presents a number of problems related to health that are simultaneously local and international. Large-scale government-to-government interactions have generally failed to achieve lasting cooperation on important health issues, with a few important exceptions. One reason for this may be that the issues have been complicated by much larger and more complex social, cultural, economic, and political differences. Another is that large organizations must each function according to their own mandates, goals, and procedures and may not mesh well with others, even with nominal counterparts. In 1981 we conceptualized a model for encouraging binational cooperation on small-scale local projects. The model incorporates three elements: a significant and difficult but soluble technical problem affecting both sides of the border (the "technocratic factor"), a mutually respected individual or team whose function is to facilitate communication and prevent misunderstandings (the "human factor"), and the actions of governments or institutions larger than the working groups (the "institutional factor"). Subsequently, we applied the model to water quality and to the distribution of sources of toxic substances in the border area, which met the criteria for the technocratic factor. Two highly respected figures in environmental health, one American and one Mexican, mediated between colleagues on either side of the border and facilitated the development of projects. Finally, after the projects had been under way long enough to have demonstrated their viability and personal interactions among the principals had become trusting and collegial, the institutional factor was admitted and major financial and administrative support obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Environmental Health↗
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Managing incidents involving hazardous substances.

Major life-threatening incidents involving hazardous substances are fortunately uncommon, but less devastating local events of this type are frequently encountered. Often the exposures involved are unknown and the health effects to be anticipated are uncertain. Physicians involved in the management of such incidents, or in the evaluation of patients who believe they may have sustained a significant exposure, must proceed methodically and with a knowledge of the most likely health outcomes. The first step is to evaluate the problem, documenting evidence and obtaining accurate information on the nature and magnitude of the hazard. The second step is to contain the problem, coordinating efforts with responsible public and private agencies. The third step is to evaluate health effects, focusing on specific outcomes when the exposure is known and on the primary organ systems of concern (dermal, respiratory, hepatic, neurologic, and renal) and carcinogenic and fetotoxic effects when the exposure is not known. Advance preparation can minimize the effect of an incident on an affected community.

Accidents, Occupational↗
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Interaction between a medical group and a school of public health: a case study of a productive affiliation.

As schools of the health sciences come under increasing financial pressures and providers must cope with the increasing complexity of the health care system, mutually supportive arrangements may become more common and more important to both parties. Underlying such arrangements is the expectation that the schools of the health sciences may gain sources of support for professional education and access to training opportunities and that the providers may gain in operational capacity and access to specialized expertise. We have developed a collaborative relationship between a school of public health and a multispecialty group medical practice. Although in some respects an improbable combination, the relationship has yielded benefits and may be of interest to other institutions.

California↗
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Preventive medicine: notes toward an agenda for change.

Preventive medicine is an exciting specialty that is often blocked in its progress by internal conflicts and external obstacles. We can all change this state of affairs. I present and compare definitions of important terms to clarify the discussion. Structural problems of the specialty include, among others, fragmentary representation, unfocused academic departments, lack of control over professionalization, and specialty identification, particularly with respect to occupational medicine. A set of suggested solutions to these problems include these actions: (1) federate the leading organizations into a coalition for organizational strength, without sacrificing their individual identities; (2) define the core content of the specialty once and for all by the mechanism of consensus-driven competency-based learning objectives; (3) build stronger bridges to clinical specialties other than family medicine, particularly to internal medicine; (4) restructure academic departments to form a preventive medicine unit as such, encouraging health care research and community medicine to connect principally with family medicine departments; (5) rethink specialty certification, including a model defining a knowledge and skills set in defined modules, which would be combined in various ways to support flexible specialty certification; and (6) integrate occupational medicine with preventive medicine generally by exploring issues of common interest and building closer institutional ties when the opportunity arises. These and other ideas might be discussed by the leadership of the principal public health and prevention organizations at a "summit" meeting, but some group must take the initiative to champion the cause. Medical Subject Headings (MeSH): preventive medicine, future, definitions, specialty certification, community medicine, population medicine.

Certification↗
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Ambient air quality and asthma: a northern perspective.

An important part of the new thinking about asthma is control of preventable risk factors, air pollution among them. The epidemiological evidence that ground-level ozone, in particular, is an important risk factor for provoking asthmatic attacks is strong. however, the evidence that it increases the prevalence of asthma overall, or mortality from asthma at levels frequently encountered in the developed world is lacking. The mechanism of airway response to ozone may be complex, involving modification of the atopic response to an antigen, rather than simple inflammation. Likewise, there may be many complexities in assessing the mechanism of association between exposure to air pollution and airways exposure, including susceptibility states, comorbidity from respiratory disorders, tolerance, and the attack rate for common viral infections. Some jurisdictions have proposed to use the frequency of asthmatic episodes as a means to set air pollution standards. The current state of the art, for many of these same reasons, does not support this. Progress will require mechanistic as well as population based research and broader thinking in the analysis of available data. Two hypotheses that especially require critical testing are age-dependent sensitization as a risk factor for asthma, and gradient-threshold response to irritant exposures.

Aging↗
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Evaluating asthma.

Explore the source record for details and available documents.

Air Pollution↗
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Evidence-based medical dispute resolution in workers' compensation.

There is a trend toward insisting on empirical evidence, rather than relying on expert judgement, in both health care and law. Medical knowledge is applied in law to provide solid logic for the physician's opinion and to place the opinion in a context that assists the adjudicator. Dr. Guidotti examines workers' compensation disputes in the light of hypothesis development and application of scientific theory.

Evidence-Based Medicine↗
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Applying epidemiology to adjudication.

Dr. Guidotti describes an epidemiologic study of firefighters, conducted by the University of Alberta, to underscore the difficulties of obtaining data and the years that can pass before analysis can even begin. He then delineates problems encountered when interpreting data in any epidemiologic study.

Epidemiologic Methods↗