Updated and expanded study of polycythemia vera and other myeloproliferative neoplasms in the tri-county area.

INTRODUCTION: The results of a 2001-2005 polycythemia vera (PV) investigation in Eastern Pennsylvania revealed a disease cluster plus underreporting and false reporting to the Pennsylvania Cancer Registry (PCR). PURPOSE: The objectives of this study were 1) to assess PV reporting to the PCR in 2006-2009, 2) to determine whether a cancer cluster persisted, and 3) to determine whether other myeloproliferative neoplasms (MPNs), including essential thrombocytopenia (ET), were subject to similar reporting problems. METHODS: Cases were identified from: 1) PCR records from the Tri-County, 2) reviewing billing records at Tri-County hematologist/oncologist offices, and 3) self-identification. An expert panel of physicians reviewed medical records and determined "true," "false," or "indeterminate" cases reported to the PCR. The analyses were conducted to determine sensitivity and positive predictive value (PPV) of case reporting to the PCR, estimate cancer incidence rates, and evaluate the presence of cancer clusters. RESULTS: Of 290 cases identified, 90% were from the original PCR, 9% from billing records, and 1% from self-report. Fifty-five cases consented to participate, and medical records were obtained for 44. The expert panel determined that 45% were true cases, 32% were false cases, and 23% were indeterminate. PV had 100% (95% CI, 59-100) sensitivity, but only 47% PPV (95% CI, 20-70): ET had 78% (95% CI, 47-99) sensitivity and 100% PPV (95% CI, 59-100). Low participation and chart review rates led to rates with wide confidence intervals. We did not identify any PV cancer clusters, but we did identify a cluster of 9 ET cases in the Wilkes-Barre, Pennsylvania area. CONCLUSION: The current study was limited by the low response rate (22%) from MPN patients in the Tri-County area. This study identified 47% PPV for PV reporting and 100% PPV for ET.

Investigation of illness associated with exposure to hydrogen sulfide among Pennsylvania school students.

During 1998, the Pennsylvania Department of Health received complaints about hydrogen sulfide odors believed to be associated with mushroom-composting operations in southeastern Pennsylvania. Many residents were concerned about possible illness in students attending an elementary school near the composting operations. In response, the department conducted health surveys during the spring and autumn at the exposed school and at a nearby control school. The surveys assessed whether exposures to hydrogen sulfide were associated with excess adverse health effects by comparing health effects among students from the exposed school with those among students from the control school. School nurses were trained to complete health questionnaires for the students. The state environmental agency measured daily ambient hydrogen sulfide concentrations at both schools. No consistent association was found between exposure to low levels of hydrogen sulfide and any adverse health effects. It was concluded that the students attending the elementary school near the mushroom-composting operations were not exposed to any significant public health hazard.

Disasters, the environment, and public health: improving our response.

Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future.

Drake Chemical Workers' Health Registry Study: I. Notification and medical surveillance of a group of workers at high risk of developing bladder cancer.

A medical surveillance program and epidemiologic study of 408 former workers of the Drake Chemical Company (now a Superfund waste site) was established in 1986. The Drake Health Registry Study was initiated because these workers had probable past exposures to beta-naphthylamine (BNA), a potent bladder carcinogen. The registry is widely viewed as a model for notification of workers at high risk of disease due to past occupational exposures. By the 40th month, 90% of the 366 living workers had been notified of the existence of the registry; 262 had been enrolled in the annual or semi-annual screening for bladder cancer. Among these, 27 persons have had abnormal screening results indicating moderate to high risk of bladder cancer and have been made eligible for further diagnostic tests. While no invasive bladder tumors were found among 18 persons completing the extended diagnostic evaluation, two diagnoses of moderate to severe dysplasia have been made. The registry has also identified three living and three deceased cases of bladder cancer in the cohort; a mortality analysis showed a 20- to 30-fold excess of bladder cancer. An incidence projection, based on the six identified cases, reveals that between six and ten new bladder cancer cases are likely to occur among the Drake cohort over the next 20 year period.

Residential health study of families living near the Drake Chemical Superfund site in Lock Haven, Pennsylvania.

The Pennsylvania Department of Health conducted a health survey of a group of residents in the Lock Haven area who live in the immediate vicinity of the Drake Superfund site. A control group of residents were selected randomly from the remaining areas of Lock Haven. The study did not indicate the presence of any serious chronic health conditions in the exposed group of residents when compared with the control group. Significantly more individuals in the exposed group than the control group experienced skin problems and sleepiness for at least 1 month prior to the survey, indicative of a possible association between direct human exposure to toxic chemicals from the site and the manifestation of symptoms. The increased prevalence of the two symptoms may also have been caused by factors other than contaminants at the Drake site, e.g., stress, occupational exposure, or other etiologic agents, or it may be a spurious finding due to chance or biased reporting.

Mortality of radiologists and pathologists in the Radiation Registry of Physicians.

The overall and cause-specific mortality experience of male radiologists and a comparable group of medical specialists, pathologists, who were included in the Radiation Registry of Physicians, is presented. The study population consists of an early-entry cohort of physicians who were members of either the American College of Radiology or the College of American Pathologists as of Jan. 1, 1962, and a late-entry cohort of similar members who joined these societies between January 1962, and June 1972. The purpose of the study was to determine if occupational exposure to low levels of ionizing radiation resulted in excess mortality from all causes and specific causes, or decreased survival patterns for radiologists compared with pathologists over the 16-year period, 1962 to 1977. The data revealed that radiologists and pathologists were comparable regarding overall mortality experience for all entrants, the early-entry cohort, and the late-entry cohort. Further analyses revealed a gradient in mortality between the two specialties, with the largest differences in the earliest birth subcohorts for all three groups, and a significant excess in mortality among radiologists in those subcohorts of the late-entry cohort born before 1920. Such a gradient may indicate an exposure effect associated with time of first exposure or duration of exposure, but not associated with time of entry into a professional society. Nevertheless, overall age-specific and age-adjusted mortality rates among radiologists and pathologists were lower in the late-entry cohort compared with the early-entry cohort, thus indicating some effect of time of entry within each specialty.(ABSTRACT TRUNCATED AT 250 WORDS)

Investigation of potential health effects associated with well water chemical contamination in Londonderry Township, Pennsylvania, U.S.A.

A community health survey was conducted by the Pennsylvania Department of Health in Londonderry Township, Dauphin County, Pennsylvania, in response to concerns about potential health effects associated with residential exposure to chemical contaminants in well water. The data indicate that there were no observable adverse health effects in the exposed group of residents, compared with the control group, which could be ascribed to long-term, low-level exposure to trichloroethylene (TCE) and other volatile organic chemicals. Significantly more individuals in the exposed group than in the control group experienced eye irritation, diarrhea, and sleepiness during the 12-month period prior to the survey. This indicated the possibility of an association of contaminated water with the manifestation of symptoms. It is hypothesized that the increased rate of symptoms observed in the exposed group, when compared to the control group, may have been caused by one or more of the following factors: (1) effect of TCE at a threshold level higher than 28 ppb, (2) effect of a single chemical entity other than TCE, and (3) additive or synergistic effects of several chemicals. It is also possible that there are factors other than water contaminants associated with the recorded symptoms, e.g., stress, that may have had an important influence in the exposed group but not in the control group.

The effect of disaster on the health and well-being of older women.

Relatively little attention has been paid to the post-disaster health status and well-being of older persons. The data discussed in this article were gathered through use of a retrospective cohort survey five years following a major flood in the Wyoming Valley of Pennsylvania. The subsample of women sixty-five years and older used in this analysis is composed of 122 female victims and forty-five controls from the same communities. The instruments used to measure mental status included Langner's 22-Item Scale, Zung's Self-rating Depression Scale, and a modified Self-Report Symptom Inventory (SCL-90). Additional items related to self-perceptions of health status, to influence of the flood on health and well-being, and to other issues. Significant differences occurred in self-perceptions, including state of mind after the flood (p less than .001), distress during recovery (p less than .001), quality of life after the flood (p less than .001), and frequency of thinking about the flood matters (p less than .025). Use of the instruments designed to assess mental status did not indicate greater levels of anxiety or depression in elderly victims as compared to non-victims.

Cancer and birth defects near the Drake Superfund site, Pennsylvania.

The Drake Superfund site in Clinton County, Pennsylvania, has been contaminated with the carcinogens beta-naphthylamine, benzidene, and benzene. The authors reviewed county-wide, age-adjusted, sex-, race-, and site-specific cancer mortality rates for the years 1950-1959, 1960-1969, and 1970-1979, and type-specific birth defects incidence rates for 1973-1978. During the 1970s, a significantly increased number of bladder cancer deaths occurred among white males in Clinton County, and a significantly increased number of other cancer deaths occurred in the general population of Clinton and three surrounding counties. There were no statistically significant clusters of any specific birth defect or of all birth defects. County-wide data on cancer and birth defects can be used for initially screening counties with Superfund sites, but more definitive studies are needed to assess the actual health effects caused by these sites.

Occupational exposure to non-ionizing radiation and an association with heart disease: an exploratory study.

Exploratory analyses for dose-related exposure to non-ionizing radiation and adverse health effects among male physical therapists were done from a mail questionnaire survey. The cohort consisted of 3004 respondents who were stratified into subgroups according to exposure across and within the various types of non-ionizing radiation energy emitted from diathermy equipment. The radiation modalities considered were ultrasound, microwave, shortwave, and infrared. An association between heart disease and exposure to shortwave radiation was the only consistently significant finding when high and low exposure groups were compared.

A historical prospective mortality study of workers in copper and zinc refineries.

Earlier health studies of workers in electrolytic refinery operations have raised concern that workers may experience excess morbidity and premature death as a result of hazardous occupational exposures. This study was designed to determine if the refinery operation is associated with any excess mortality patterns. A cohort of 4,802 male workers exposed for at least one year during 1946-1975 was assembled from nine U.S. zinc and copper refineries. Vital status was ascertained for 4,241 (88%) of the cohort. Death certificates were obtained for 84% (355/423) of the deceased. Overall standard mortality ratios (SMRs) were calculated to be 92 for the cohort, 97 for the subgroup of copper refinery workers, and 83 for the subgroup of zinc refinery workers. Significantly high cause-specific SMRs were as follows: (1) cerebrovascular disease (CBVD) for the cohort; (2) all cancers, cancer of the digestive tract, and CBVD for the copper subgroup; (3) all cancers, cancer of the respiratory tract, and CBVD for one plant that demonstrated a significantly high overall SMR (133). The significant excess of cancer deaths among the study cohort is largely due to the plant that exhibited the significantly high overall mortality rate, but lack of smoking data qualifies this finding. The significant excess of CBVD seems to be consistent across plants and further research seems warranted to verify the finding.

A case-control study of hypertensive women in a post-disaster community: Wyoming Valley, Pennsylvania.

Among 396 female flood victims participating in a five-year post-disaster survey, 31 cases were identified who developed hypertension during that time period. A case-control study of hypertension was carried out utilizing age and ponderal index as matching criteria. The purpose of the study was to assess risk factors for hypertension associated with the early recovery period. Pairwise matching yielded 29 case-control pairs for analysis. Such factors as property loss, financial difficulties, physical work, use of alcohol, and perceived distress--all associated with the recovery period--were significantly associated with hypertension. Two mental health dimensions--somatization and anxiety--and the respondent's perceived effect of the flood on health assessed at the time of the survey also demonstrated significant positive correlations with hypertension.

Comparisons of maprotiline with imipramine in severe depression: a multicenter controlled trial.

The efficacy and safety of maprotiline (Ludiomil) was compared to imipramine in patients with manic-depressive illness, depressed type (DSM II 296.2). Three hundred forty-one patients from 16 different centers entered this four-week double-blind controlled trial, with 171 in the maprotiline and 170 in the imipramine group. Efficacy measurements included the Hamilton Depression Scale, the Self-Rating Depression Scale, and the Investigator's Overall Assessment of Effectiveness. Tolerability was monitored by collection of treatment-emergent signs and symptoms (TESS), blood pressure and pulse measurements, EKGs, and EEGs. Dosage was fixed for the first week at 50 mg t.i.d. and thereafter could be varied between 50 and 300 mg daily. Clinically and statistically significant reductions in symptomatology were noted in both drug groups for most efficacy parameters at each visit during therapy. Comparison between the drug groups revealed no difference in terms of the scales utilized. A trend toward fewer TESS in the maprotiline group was noted, especially for the side effects nausea, nervousness, and increased sweating.

Baclofen, a new antispastic drug. A controlled, multicenter trial in patients with multiple sclerosis.

A double-blind, five-week, multicenter trial was conducted to compare the effect of baclofen, a unique amino acid derivative, with that of placebo in the treatment of 106 patients with spasticity secondary to multiple sclerosis. A spasticity assessment method that included a neurological examination, physicians' clinical impressions of changes during treatment, and a patient's self-evaluation was used to determine efficacy. This method showed baclofen (70 to 80 mg daily maximum, titrated) is effective relative to placebo in relieving symptoms of spasticity, such as flexor spasms, pain and stiffness, resistance to passive joint movements, and tendon stretch reflexes. Patient self-evaluation results also showed a significant reduction in clonus. Side effects were generally mild and transient.