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PubMed1997

Home oxygen therapy in Medicare beneficiaries, 1991 and 1992.

STUDY OBJECTIVE: Obtain descriptive data on the use of home oxygen by Medicare beneficiaries and study the impact of certain demographic factors and diagnoses on oxygen use. METHODS: A home oxygen user was defined as any Medicare beneficiary with at least one claim for home oxygen in the Health Care Financing Administration National Claims History 5% Physician Supplier Files for 1991 and 1992. Railroad board beneficiaries, health maintenance organization members, and those without continuous part B coverage were excluded. RESULTS: In 1991, there were 21,489 beneficiaries in the sample who received oxygen therapy. In 1992, there were 8,418 new users. Twenty-six percent of new users died in 1992. Factors significantly associated with death included age 76 years or older (relative risk [RR], 1.3), pneumonia (RR, 1.3), lung cancer (RR, 3.8), male gender (RR, 1.2), heart failure (RR, 1.3), and diagnoses suggestive of COPD (RR, 0.45). Seven percent of new users discontinued therapy within 1 month, 28% within 6 months. Liquid oxygen was used by 19% of current and 14% of new users. Factors significantly associated with liquid oxygen use included portable oxygen claims (odds ratio [OR], 2.4), nonmetropolitan residence (OR, 0.73), and white race (OR, 1.2). CONCLUSIONS: Descriptive information on patterns of home oxygen use, including associated medical conditions, types and duration of therapy, and survival is useful for regulatory purposes. This information supports concerns that current payment policy may discourage suppliers from providing liquid oxygen in underserved areas.

Aged↗
PubMedDate not supplied

[Frequency of intestinal helminth eggs in public restrooms in Sorocaba, SP].

Four hundred and five water closets were investigated: 11 located at public squares, 2 at the railroad station, 4 at the bus station, 55 at bars and restaurants, 146 at state schools, 116 at municipal schools, 8 at private schools, 36 at public health centers, 16 at sports centers, 8 at orphanages and 3 at shopping malls. Microscopy slides with adhesive tape were used. The material was obtained by sticking the tape onto the following elements: 4 spots on the toilet seat, internal and external door knobs, latch, faucet handle and discharge valve (push button or pulling string). Out of the 405 water closets studied, 22 (5.43%) were contaminated. Eggs of Ascaris lumbricoides, Ancylostomatidae, Enterobius vermiculares, Taenia sp and Hymenolepis nana were found. In 2 water closets eggs of 2 parasites were found simultaneously.

Animals↗
PubMedDate not supplied

Ecoepidemiological aspects of American cutaneous leishmaniasis in the state of São Paulo, Brazil.

The aim of this study is to review some of the ecoepidemiological aspects of american cutaneous leishmaniasis (ACL) in the State of São Paulo, Brazil. During the first half of this century ACL occurred in São Paulo, predominantly on the bank of the Tietê River, where there were railroad constructions and there was inevitable contact between workers and forested areas. Man's activities resulted in a drastic reduction of the forested regions of the State and molded the present landscape found in São Paulo, which brought a gradual change in the epidemiology of ACL during this century. Currently ACL can be considered as an endemic disease. Nowadays, ACL is found in different regions of São Paulo State, and is no longer limited to the bank of the Tietê River. The disease occurs in all age groups and sexes. Lack of knowledge about wild reservoir hosts of Leishmania (V.) braziliensis has simulated speculation about the possible role played by domestic animals (dogs and equines). Man's activities also favoured Lutzomyia intermedia a sandfly species which can clearly thrive in changed environments. L.(V.) braziliensis continues to be transmitted, even after decades of forest destruction in São Paulo.

Animals↗
PubMed2003

Prevalence of infection with hantavirus in rodent populations of central Argentina.

We studied hantavirus seroprevalence and virus variability in rodent populations in Diego Gaynor, northwest of Buenos Aires province, Argentina. Rodent samplings were conducted in railroads and cropfield borders in March and July 1999, September and December 2000, and March 2001. Antibody detection was performed by an enzyme link immunosorbent assay (ELISA), using the recombinant nucleoprotein of Andes (AND) virus as antigen. Tissue samples were taken from positive antibody individuals in order to confirm the presence of hantavirus genomic material and to identify virus genotypes. Akodon azarae was the most abundant species, followed by Oligoryzomys flavescens, while Calomys laucha and C. musculinus were rarely caught. We found a rate of seroprevalence of 9.3% for a total sample of 291 A. azarae and 13.5% for 37 O. flavescens. After molecular analyses of hantavirus, we confirmed the presence of hantavirus genomic material in 16 individuals with ELISA (+) results and two individuals with ELISA (-). Four amplimers for each species were sequenced and compared to the corresponding sequences of representative hantaviruses. We identified the AND Cent Lec from three O. flavescens, and the Pergamino virus from four A. azarae and from one O. flavescens. A. azarae males had higher seroprevalence than females, and heavier individuals showed higher seroprevalence than lighter ones. We did not find seroprevalence differences according to sex in O. flavescens, although this result may have been produced by the low sample size. The lowest seroprevalence was found in a period of high rodent density, when juveniles prevailed in the population. We found higher seroprevalences than those detected in previous studies for other localities of central Argentina where cases of hantavirus pulmonary syndrome (HPS) have been reported. The presence of AND Cent Lec virus in rodent populations of the study area, which is responsible of HPS cases in central Argentina, suggests that human populations are at risk of HPS disease, although there were not reported cases of this disease until today.

Animals↗
PubMed1996

[Immigration and epidemics in the State of São Paulo].

The article discusses sanitation issues as aspects of the process of foreign immigration into São Paulo state during the first decade after the Proclamation of the Republic. The text also shows the relationships between this wave of immigration and the structuring of state sanitation services and the devising of the techno assistance model adodpted by these services as of the 1890's. At a time when yellow fever was the most common and lethal of the epidemics plaguing that state--killing mainly foreigners--one of the lodestars of public health actions was the defense of this inflow of immigrants. The interests of coffee growers, expansion of the railroads, immigration, and yellow fever all came into play when the oligarchies then in power in São Paulo defined what direction sanitation measures would take. The Brazilian government's authoritarian organization left no room for individual health assistance initiatives. Long a demand of both urban and rural populations, forms of individual health assistance became widespread only in the 1930's, when Brazil developed its social health-care system.

Brazil↗
PubMed2002

DNA technology, interstate commerce, and the likely origin of formosan subterranean termite (Isoptera: Rhinotermitidae) infestation in Atlanta, Georgia.

This study was the first to use DNA sequencing data to infer the origin of a Formosan subterranean termite, Coptotermes formosanus Shiraki, infestation. Cytochrome oxidase II gene sequence was used to define eight specific maternal lineages from 14 geographic locations across the southeastern United States, Hawaii, and China. One maternal lineage, A, was unique to all the Atlanta collections and one New Orleans collection, which indicated that termites at these sites shared a common maternal ancestor. The impact of interstate commerce in terms of Formosan subterranean termite introductions is addressed as is the industry response needed to arrest the spread of these termites via commercial traffic in used railroad cross ties.

Animals↗
PubMed1982

Occupational risk for laryngeal cancer.

In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics.

Adult↗
PubMed2003

Reestablishing public health and land use planning to protect public water supplies.

OBJECTIVES: This study measured the extent to which land use, design, and engineering practices could reduce contamination of major public water supplies. METHODS: Key parcels of land were identified in New Jersey, and the potential uncontrolled loading of contaminants was estimated with the US Environmental Protection Agency's Long-Term Hydrologic Impact Assessment model for a variety of land use, design, and engineering scenarios. RESULTS: High-density per-acre development and engineering controls, along with housing and light commercial activity near main railroads, would substantially reduce runoff. CONCLUSIONS: In New Jersey, government and purveyor action is being taken as a result of, and in support of, these findings.

Benchmarking↗
PubMed1990

Cardiovascular reflexes in workers exposed to hand-arm vibration.

In the present study autonomic function was observed by measuring cardiovascular reflexes. The quiet breathing test, the deep breathing test and the Valsalva manoeuvre were used. The aim was to study the effects of long-term exposure to hand-arm vibration on the cardiovascular reflexes. The study group included 47 workers (lumberjacks and railroad workers) who were exposed to hand-arm vibration. 36% of the subjects had vibration induced white finger (VWF). Comparisons were also made with 5 primary Raynaud's cases. The changes of the R-R interval in the quiet and deep breathing tests had a significant negative correlation with the ages of the subjects. In all the results there was no evidence that hand-arm vibration could cause autonomic dysfunction in general, but there were signs that it could reduce the autonomic function among workers who are susceptibility to developing white finger reactions. Also, it is possible that the primary Raynaud's cases had reduced cardiovascular reflex responses.

Adult↗
PubMed1977

Skull injuries caused by high voltage electricity.

Four cases by high voltage electricity are reported. Particular interest is taken in describing initial conservative treatment of injuries where the entrance of the current has been through the head, followed by surgical excision and flap surgery. This procedure had an uneventful postoperative course. Other methods comprising an earlier excision and revitalizing flap coverage over the necrotic bone thereby avoiding later bone grafting are being discussed and may be preferable. A decrease in high voltage injuries has been noticed during the last ten-year period compared to earlier data (5.5% down to 1.4%). This may well be partially explained by improved precautionary measures, but children are still prominent among the injured. All the children were injured while playing around railroad areas.

Electric Injuries↗
PubMed1987

Human poisoning by zigadenus.

Zigadenus (death camas) is a dangerous plant in the United States. The literature contains several well-documented nonfatal human cases of zigadenus poisoning. Fatal cases were recorded in interviews of 19th century western American Indians. This paper contains an account from early in the 20th century of some railroad workers who died shortly after eating the bulbs. The probable fatal dose, extrapolated from animal data, ranges from less than one-tenth pound (four-five bulbs) for a young child to a pound for an adult. Other parts of the plant such as nectar and seeds are also highly toxic.

Adult↗
PubMed1999

Long-term memory for temporal structure: evidence form the identification of well-known and novel songs.

In three experiments, long-term memory for temporal structure was examined by having participants identify both well-known (e.g., "I've Been Working on the Railroad") and novel songs. The target songs were subjected to a number of rhythmic alterations, to assess the importance of four critical features of identification performance. The four critical features were meter, phrasing, rhythmic contour (ordinal scaling of note durations), and the ratio of successive durations. In contrast with previous work, the unaltered version of each song was identified significantly better than any altered version. This indicates that rhythm is stored in long-term memory. Furthermore, the results demonstrated that all four critical features play a role in the identification of songs. These results held for both well-known and novel tunes.

Adult↗
PubMed2004

Dealing with power struggles in clinical and educational settings.

When power struggles occur, the implications for early intervention are numerous. Trying to intervene with a person who has already reached the anger phase of crisis can often be like trying to stop a train by standing on the railroad tracks and holding up one's hands. As a direct result of early and purposeful intervention using simple and accessible techniques (i.e., self-awareness, awareness of others' messages, prioritization, decisiveness, consistency, communication), professionals can create an environment of safety and trust in which all individuals feel heard. In this manner, all needs can be addressed without allowing potentially negative interactions to escalate to levels at which restraints, ultimatums, and consequences are needed. In addition, the likelihood of success increases with early intervention. By recognizing that, in many cases, winning and losing power struggles is accomplished at the expense of treatment and educational goals, enlightened professionals can not only avoid future confrontations but also effect desired client or student outcomes.

Adaptation, Psychological↗
PubMed1984

Chronic strongyloidiasis in World War II Far East ex-prisoners of war.

Fifty-two of 142 (37%) American ex-prisoners of war that worked on the Burma-Thailand Railroad during World War II were found to have previously unrecognized symptomatic Strongyloides stercoralis infections. A characteristic urticarial creeping skin eruption on the abdomen, buttocks and thighs occurred in 92%. Infection was also associated with pruritus ani, abdominal pain, indigestion, heartburn, and diarrhea. Demonstration of larvae in ether-formalin stool concentrates in these chronic low density infections required 5 hours of microscopy per case to detect 90% of positive cases. Therapy with thiabendazole resulted in a clinical cure in 93% and a microscopic cure in 100%; but was associated with frequent side effects. Chronic strongyloidiasis should be considered in veterans of Far East conflicts and in others with intimate soil contact in rural Strongyloides stercoralis-endemic areas who present with recurrent creeping skin eruption, abdominal pain, and eosinophilia.

Aged↗
PubMedDate not supplied

Projecting future medical care costs using four scenarios of lifestyle risk rates.

PURPOSE: This study predicts medical care expenditures over 10 years for Union Pacific Railroad (UPRR) under alternative health risk factor scenarios for the UPRR workforce. DESIGN: This paper describes the development of an economic forecasting model to predict medical care expenditures assuming four different scenarios of population risk. The variables used to predict medical care expenditures are employee demographics and health risk profiles. SETTING: UPRR is a transportation company with more than 56,000 employees in 25 states west and south of the Mississippi River. SUBJECTS: Employees of UPRR. MEASURES: Intermediate outcomes included health risk measures related to exercise patterns, body weight, eating habits, smoking, alcohol consumption, total cholesterol, blood glucose, blood pressure, stress, and depression. Major outcome measures included projected total annual payments by UPRR for medical care services for the decade following 1998. RESULTS: The UPRR work force is projected to grow by 500 employees per year over the 10-year study period. The average age is expected to increase from 44 to 48 years. Without further health promotion intervention, 7 of the 11 risk factors assessed would likely worsen among UPRR's workforce. Medical care cost increases are projected to range from $22.2 million to $99.6 million in constant 1998 dollars over the next decade, depending on the effectiveness of risk factor modification programs. With an expected health promotion budget averaging $1.9 million annually over 10 years, health risks must decline at least 0.09% per year for the program to pay for itself. CONCLUSIONS: Estimating various risk and cost scenarios can facilitate program planning and produce an economic justification for worksite health programs.

Adult↗
PubMed1992

Cancer incidence among creosote-exposed workers.

Cancer incidence was studied among 922 creosote-exposed impregnators at 13 plants in Sweden and Norway. The subjects had been impregnating wood (eg, railroad cross-ties and telegraph poles), but no data on individual exposures were available. The study population was restricted to men employed during the period 1950-1975, and their cancer morbidity was checked through the cancer registries. The total cancer incidence was somewhat lower than expected, 129 cases versus 137 expected [standardized incidence ratio (SIR) 0.94]. Increased risks in both countries combined were observed for lip cancer (SIR 2.50, 95% confidence interval (95% CI) 0.81-5.83), skin cancer (SIR 2.37, 95% CI 1.08-4.50), and malignant lymphoma (SIR 1.9, 95% CI 0.83-3.78). Exposure to sunlight may have contributed to the risk of lip and skin cancer. The small number of cancer cases does not permit valid conclusions. The findings indicate that impregnating wood with creosote in earlier decades increased the risk of skin cancer.

Cohort Studies↗
PubMed1997

Urinary 1-naphthol excretion in the assessment of exposure to creosote in an impregnation facility.

OBJECTIVES: This study explored the possibility of using urinary 1-naphthol excretion as a marker of complex exposure among workers handling creosote. METHODS: Urine specimens of 6 workers from a creosote impregnation plant, where railroad ties were impreganted with coal tar creosote, were collected during 1 workweek, and the concentration of 1-naphthol was determined. 1-Naphthol in spot urine samples of 5 occupationally nonexposed male smokers was used as the background reference. Concurrently, naphthalene and 10 different polycyclic aromatic hydrocarbons (PAH) were determined in personal air samples. RESULTS: The mean airborne exposure of the workers was 1.5 mg/m3 for vaporous naphthalene, 5.9 micrograms/m3 for particulate PAH and 1.4 micrograms/m3 for PAH with 4-6 aromatic rings. The mean urinary concentration of 1-naphthol at the end of the workshift was 20.5 (range 3.5-62.1) mumol/l, whereas the referents' urinary concentration was below the detection limit (0.07 mumol/l). Airborne naphthalene correlated fairly well with 1-naphthol when measured at the end of the shift (r = 0.745). CONCLUSIONS: This method of analysis for 1-naphthol is sufficiently sensitive for measuring low occupational exposures to naphthalene. Low background exposures are, however, unlikely to result in detectable urinary levels of 1-naphthol. Since naphthalene is the most abundant compound in creosote vapor, urinary 1-naphthol determination serves well as a biological marker of exposure to vaporous creosote. Urinary 1-naphthol alone is not, however, a suitable marker for inhalatory or cutaneous exposure to PAH originating from creosote.

Air Pollutants, Occupational↗
PubMed1987

Exposure to creosote in the impregnation and handling of impregnated wood.

The major components of vapors and polycyclic aromatic hydrocarbons in particulate matter were identified and quantified in two creosote impregnation plants and in the handling of treated wood. The vapors were collected on XAD-2 resin (recovery in the range of 82-102%) and analyzed by gas chromatography. Particulate polycyclic aromatic hydrocarbons were collected on glass fiber filters and analyzed with high-pressure liquid chromatography with a fluorescence detector. The main components of the vapors were naphthalene, methyl naphthalenes, indene, phenol, and its methyl homologues, benzothiophene, diphenyl, acenaphthene and fluorene. The exposure of the workers to vapors varied between 0.1 and 11 mg/m3. The concentrations of particulate polycyclic aromatic hydrocarbons varied between 0.2 and 46 micrograms/m3. The benzo(a)pyrene concentration was under 0.03 micrograms/m3, except in manual metal-arc welding and in the boring of railroad ties, where it was 0.24-0.89 micrograms/m3. In the measurement of creosote vapors, naphthalene could be used as an indicator agent.

Air Pollutants, Occupational↗