ABSTRACT
Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been described as a risk factor for postsurgical infection. The purpose of this study is to determine the prevalence of MRSA in pediatric orthopaedic patients and whether being a MRSA carrier is a predictor of postoperative infection. Six hundred and ninety-nine consecutive pediatric patients who underwent MRSA nasal screening prior to surgery were studied. Postoperative cultures, total surgical site infections (SSIs), and epidemiological and surgical prophylaxis data were reviewed. Forty-four of 699 patients (6.29%) screened positive for MRSA. Nine of the 44 patients (20.5%) that screened positive for MRSA had a subsequent SSI compared to 10 of the 655 patients (1.52%) that screened negative (p < 0.05). All 9 patients with a SSI had myelomeningocele. The prevalence of MRSA was 6.30% and was predictive of postoperative infection. Children with myelomeningocele were at the highest risk for having a positive MRSA screening and developing SSI.
ABSTRACT
In this study, we hypothesized that the granulomatous disorder sarcoidosis is not caused by a single pathogen, but rather results from abnormal responses of Toll-like receptors (TLRs) to conserved bacterial elements. Unsorted bronchoalveolar lavage (BAL) cells from patients with suspected pulmonary sarcoidosis and healthy non-smoking control subjects were stimulated with representative ligands of TLR-2 (in both TLR-2/1 and TLR-2/6 heterodimers) and TLR-4. Responses were determined by assessing resulting production of tumour necrosis factor (TNF)-α and interleukin (IL)-6. BAL cells from patients in whom sarcoidosis was confirmed displayed increased cytokine responses to the TLR-2/1 ligand 19-kDa lipoprotein of Mycobacterium tuberculosis (LpqH) and decreased responses to the TLR-2/6 agonist fibroblast stimulating ligand-1 (FSL)-1. Subsequently, we evaluated the impact of TLR-2 gene deletion in a recently described murine model of T helper type 1 (Th1)-associated lung disease induced by heat-killed Propionibacterium acnes. As quantified by blinded scoring of lung pathology, P. acnes-induced granulomatous pulmonary inflammation was markedly attenuated in TLR-2(-/-) mice compared to wild-type C57BL/6 animals. The findings support a potential role for disordered TLR-2 responses in the pathogenesis of pulmonary sarcoidosis.
Subject(s)
Sarcoidosis, Pulmonary/metabolism , Toll-Like Receptor 2/metabolism , Adolescent , Adult , Aged , Animals , Bronchoalveolar Lavage Fluid/cytology , Bronchoalveolar Lavage Fluid/immunology , Case-Control Studies , Cytokines/biosynthesis , Disease Models, Animal , Female , Gene Expression , Humans , Ligands , Male , Mice , Mice, Knockout , Middle Aged , Pneumonia/genetics , Pneumonia/immunology , Propionibacterium acnes/immunology , Protein Multimerization , Sarcoidosis, Pulmonary/genetics , Sarcoidosis, Pulmonary/immunology , Toll-Like Receptor 2/antagonists & inhibitors , Toll-Like Receptor 2/genetics , Toll-Like Receptor 4/agonists , Toll-Like Receptor 4/metabolism , Toll-Like Receptors/chemistry , Toll-Like Receptors/genetics , Toll-Like Receptors/metabolism , Young AdultABSTRACT
The usual specimens submitted by a medical examiner for toxicological analysis include blood, urine, bile, vitreous humor, stomach contents, and solid-organ tissue. The detection of drugs in these specimens typically involves a combination of techniques including colorimetry, immunoassay, and gas chromatography. Although many laboratories rely principally on urine for the detection of drugs of abuse by immunoassay, these assays may be applied to other specimen types. An evaluation of Microgenics Corporation's cloned enzyme donor immunoassay (CEDIA) was conducted in order to evaluate its use in the detection of cocaine/cocaine metabolites in vitreous humor specimens. During a 14-month period, 392 vitreous humor specimens were analyzed by the CEDIA DAU Cocaine assay. Instrument parameters were set according to published manufacturer's guidelines. All presumptive positive immunoassay results prompted confirmatory testing and quantitation by gas chromatography-mass spectrometry (GC-MS) of other specimens including blood. Vitreous humor specimens were not tested by GC-MS. Using a approximately 100-ng/mL cutoff, the CEDIA assay produced 23 presumptive positive results, 22 of which were confirmed by GC-MS. The only specimen which could not be confirmed, elicited an immunoassay screen value near the cutoff limit. Routine analysis of blood, urine, bile, and/or bladder wash specimens by gas chromatography-nitrogen phosphorus detection revealed the presence of cocaine/cocaine metabolites in only 7 (31.8%) of the 22 confirmed cases. The concentration ranges of cocaine and benzoylecgonine in the blood specimens were none detected to 337 ng/mL and 17 to 8598 ng/mL, respectively. Cocaethylene was not detected in these cases. Analysis of vitreous humor specimens by CEDIA improved the detection rate of cocaine/cocaine metabolites by 0.7% in the cases submitted to our laboratory during the 14-month period.
Subject(s)
Cocaine-Related Disorders/diagnosis , Cocaine/analogs & derivatives , Cocaine/analysis , Immunoenzyme Techniques/methods , Autopsy , Forensic Medicine/methods , Gas Chromatography-Mass Spectrometry , Humans , Sensitivity and Specificity , Vitreous Body/chemistryABSTRACT
A pilot program in the cardiac surgical service resulted in a $ 1.3 million reduction in patient charges while quality patient outcomes were sustained. Pivotal to the success of the program was the implementation of the case manager role.
Subject(s)
Cardiac Surgical Procedures/organization & administration , Case Management/organization & administration , Total Quality Management/organization & administration , Cardiac Surgical Procedures/mortality , Humans , Job Description , Outcome Assessment, Health Care , Pilot ProjectsABSTRACT
A transition to ambulatory preoperative antibiotic bowel preparation was carried out. The protocol included a liquid diet for 40 hours preceding surgery and coordination of purging with buffered oral saline laxative, 45 mL containing 8 g sodium phosphate and 22 g sodium biphosphate (Fleet Phospho-Soda, C.B. Fleet Co, Lynchburg, Va) and bisacodyl preparation with an oral erythromycin base-neomycin routine. Enemas were omitted. Personnel in the preoperative evaluation center had the responsibility of instructing patients, distributing directions and drugs, and reviewing for compliance and possible problems during the preoperative period. All patients scheduled for any of a variety of gastrointestinal procedures, as well as some other complex operations, were included in this study. Follow-up data were obtained. Surgeons' comments regarding efficacy were highly favorable. In only five cases was there comment regarding liquid stool, and this was no impediment to surgery. This incidence was comparable with that of the inpatient experience, as was the spectrum of postoperative complications. Transfer of responsibility to the department proceeded with ease. Results were entirely comparable with those of the former inpatient experience.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Gastrointestinal Diseases/surgery , Premedication/methods , Adult , Aged , Aged, 80 and over , Ambulatory Care/methods , Anti-Bacterial Agents/adverse effects , Female , Follow-Up Studies , Gastrointestinal Diseases/complications , Humans , Male , Middle Aged , Premedication/adverse effects , Preoperative CareABSTRACT
In response to concerns about the occurrence of epididymitis among employees at a Du Pont textile fibers plant, information was obtained from 1342 (94.8%) active male employees on history of epididymitis and/or orchitis (6.8%), prostatitis (11.5%), other genitourinary conditions, and vasectomy. Vasectomy was associated with an odds ratio of 3.26 (90% confidence interval (CI) = 1.96, 5.43) for subsequent development of epididymitis. History of prostatitis was also a risk factor for epididymitis (odds ratio = 5.02, 90% CI = 2.94, 8.58).
Subject(s)
Epididymitis/epidemiology , Occupational Diseases/epidemiology , Textile Industry , Delaware/epidemiology , Epididymitis/etiology , Humans , Male , Occupational Diseases/etiology , Orchitis/complications , Orchitis/epidemiology , Prevalence , Prostatitis/complications , Risk Factors , Surveys and Questionnaires , Vasectomy/adverse effectsABSTRACT
This case-control study was undertaken to determine whether the risk of developing cancers of the buccal cavity and pharynx (N = 39), liver (N = 6), prostate (N = 43), testis (N = 11), or malignant melanoma of the skin (N = 39) is related to exposure to dimethylformamide (DMF). Case and control subjects were obtained from four Du Pont plants. DMF is produced at one plant and used at the other three. Cancer cases identified from the company Cancer Registry comprise those reported among active male employees at the study plants during 1956 to 1985. For each case, two control subjects were selected, matched on sex, payroll class (wage or salary), birth year, and plant. To determine whether an employee could have been exposed to DMF during his career at the plant, all jobs with potential for exposure to DMF were identified. Each job was assigned an exposure ranking based on DMF industrial hygiene air monitoring, DMF metabolite (measured as N-methylformamide in urine) monitoring, and knowledge of the evolution of manufacturing processes and workplace exposure controls. Each employee's DMF exposure pattern was then characterized as (a) ever v never having been exposed to DMF and (b) highest DMF exposure experienced. Summary analyses for all plants combined showed no statistically significant association between ever having been exposed to DMF and subsequent development of cancers of the buccal cavity and pharynx, liver, malignant melanoma, prostate, and testis. Examined by plant site, prostate cancer at one plant was significantly elevated, based on three case subjects exposed out of four.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Chemical Industry , Dimethylformamide/adverse effects , Neoplasms/chemically induced , Occupational Diseases/chemically induced , Adult , Aged , Cohort Studies , Dimethylformamide/urine , Evaluation Studies as Topic , Facial Neoplasms/chemically induced , Facial Neoplasms/urine , Humans , Liver Neoplasms/chemically induced , Liver Neoplasms/urine , Male , Melanoma/chemically induced , Melanoma/urine , Middle Aged , Neoplasms/urine , Occupational Diseases/urine , Pharyngeal Neoplasms/chemically induced , Pharyngeal Neoplasms/urine , Prostatic Neoplasms/chemically induced , Prostatic Neoplasms/urine , Regression Analysis , Risk Factors , Sampling Studies , Skin Neoplasms/chemically induced , Skin Neoplasms/urine , Testicular Neoplasms/chemically induced , Testicular Neoplasms/urine , Time FactorsABSTRACT
This study introduced trained paraprofessionals, community health workers (CHWs), into the emergency department (ED) to supplement providers' routine efforts in high blood pressure (HBP) detection, treatment, and follow-up among high-risk black men. In a demonstration project over a 2-year period, CHWs provided (1) BP and pulse measurements, and educational counseling regarding HBP and cardiovascular risk factors; (2) telephone preappointment reminders to improve ED follow-up visit rates; and (3) recontact of patients failing to show for their ED follow-up visits to improve return rates even after missed BP appointments. Results of preappointment reminders by CHWs showed a 19% improvement in appointment keeping (P less than .001). With a sample of patients who had failed to return for a follow-up visit, CHW contact was also effective, showing an overall improvement rate of 7% (P less than .001). The results reported support the idea that individuals from the community, trained as paraprofessionals, can improve appointment keeping as well as be useful in assisting in screening and counseling for chronic conditions within the ED. These CHWs are seen as having the additional advantage of enhancing the integration of the ED, the community, and continuing care sites. The approaches used in this study should be applicable and may serve as a model for the approach to other chronic conditions experienced in urban high-risk communities.
Subject(s)
Community Health Workers , Emergency Service, Hospital/organization & administration , Hypertension/diagnosis , Adult , Appointments and Schedules , Baltimore , Evaluation Studies as Topic , Female , Humans , Male , Medical Indigency , Patient Education as Topic , Referral and Consultation , Urban PopulationABSTRACT
Formaldehyde vapor induces cancer of the nasal passages in laboratory animals. In this case-control epidemiologic study, occupational information was obtained for 198 persons with sinonasal cancer (SNC), for 173 with nasopharyngeal cancer (NPC) identified as incident cases by the Connecticut Tumor Registry over 41 years among Connecticut males dying of any cause, and for 605 controls sampled from Connecticut death certificates. City directories and death certificates provided information on job, industry, employer, and year of employment for exposure classification. Without knowledge as to case-control status, an industrial hygienist particularly experienced in epidemiologic studies of formaldehyde classified each study subject with respect to probability and degree of formaldehyde exposure. For those with probable exposure to the high level 20+ years prior to death the odds ratio for NPC was 2.3 [95% confidence limits (CL): 0.9, 6.0], and for those with this same risk factor among men dying at age 68+ (the median study age at death or older) the odds ratio was 4.0 [95% CL: 1.3, 12.0--with two-sided P = .015, unadjusted for multiple significance tests, and with two-sided P = .129 in testing for interaction between this risk factor (never any exposure vs. probable exposure to high level 20+ years prior to death) and age (age less than 68 yr vs. age 68+ yr)]. Odds ratios were close to unity for 9 of 13 industries. Formaldehyde-related occupations in printing appeared to be associated with any type of nasal cancer (either SNC or NPC).
Subject(s)
Formaldehyde/toxicity , Nasopharyngeal Neoplasms/etiology , Nose Neoplasms/etiology , Occupational Diseases/etiology , Paranasal Sinus Neoplasms/etiology , Humans , Male , Nasopharyngeal Neoplasms/epidemiology , Nose Neoplasms/epidemiology , Paranasal Sinus Neoplasms/epidemiology , Registries , Risk FactorsABSTRACT
In a previous publication, Pell et al described the cancer epidemiologic surveillance program that was begun in the Du Pont Company in 1956 and presented standardized cancer incidence and mortality data through 1974 for Du Pont employees compared with such data for the US general population. This report provides the analysis of an additional 10 years of cancer incidence and mortality data, and examines time trends for specific cancer sites. Conoco, Inc, acquired in 1981, is not included in the analysis.
Subject(s)
Chemical Industry , Neoplasms/epidemiology , Adult , Age Factors , Delaware , Female , Humans , Male , Middle Aged , Neoplasms/mortality , Occupational Diseases/epidemiology , Occupational Diseases/mortality , Retirement , Risk , Sex FactorsABSTRACT
Studies in England and Italy have demonstrated a striking association between employment in the shoemaking industry and cancer of the nasal cavities and sinuses. However, three recent, large-scale proportionate mortality studies of U.S. shoeworkers do not show any deaths from these tumors. This paper reviews the methodology of those studies, emphasizing the underlying data and statistical power. In addition, epidemiologic and other considerations important in assessing and interpreting the apparent absence of a nasal cancer risk in the U.S. shoe industry are discussed.
Subject(s)
Nose Neoplasms/mortality , Occupational Diseases/mortality , Shoes , Cross-Sectional Studies , Ear Neoplasms/mortality , Humans , Male , Paranasal Sinus Neoplasms/mortality , Risk Factors , United Kingdom , United StatesSubject(s)
Air Pollutants, Occupational/adverse effects , Formaldehyde/adverse effects , Nasopharyngeal Neoplasms/chemically induced , Occupational Diseases/chemically induced , Oropharyngeal Neoplasms/chemically induced , Pharyngeal Neoplasms/chemically induced , Chemical Industry , Humans , Missouri , Nasopharyngeal Neoplasms/epidemiology , Occupational Diseases/epidemiology , Oropharyngeal Neoplasms/epidemiologyABSTRACT
A cohort of 1,083 male employees who had potential for exposure to acrylonitrile between 1944 and 1970 at a Du Pont textile fibers plant were followed through 1981 for mortality and through 1983 for cancer incidence. In total, the 21 cancer deaths were fewer than expected based on either Du Pont or U.S. rates. No significant excesses were seen by primary site. In all, 37 cancer cases occurred as compared with 36.5 expected based on company rates. Five lung cancer cases were observed and 6.9 expected. There were 5 prostate cancer cases as compared with 1.9 expected. Of these, 4 occurred among wage employees during the 1975-1983 period, compared to 0.9 expected. This excess was statistically significant.
Subject(s)
Acrylonitrile/adverse effects , Neoplasms/mortality , Nitriles/adverse effects , Occupational Diseases/mortality , Delaware , Humans , Male , Neoplasms/chemically induced , Neoplasms/epidemiology , Occupational Diseases/chemically induced , Occupational Diseases/epidemiology , Prostatic Neoplasms/mortality , TextilesABSTRACT
Several epidemiologic studies have suggested that leather workers have an elevated risk of bladder cancer, nasal cancer, and leukemia. A case-control analysis of patient files at a large cancer treatment facility in New York State indicated that several bladder cancer patients had worked at a large shoe manufacturing company in upstate New York. A mortality study was initiated to determine whether there was an unusual cancer risk associated with employment in this facility. Because company records were not available, local newspaper obituaries were used to identify former company employees who died between 1960 and 1979. Proportionate mortality (PMR) analyses were conducted by using 4,734 death certificates and the general U.S. population for comparison. There were no excess deaths from nasal cancer or bladder cancer, and mortality from leukemia was slightly lower than expected. Increased relative frequencies of digestive cancers were seen among men and women. There were significant excesses of deaths from multiple myeloma among both men (PMR = 193) and women (PMR = 346).
Subject(s)
Cause of Death , Occupational Diseases/mortality , Shoes , Adolescent , Adult , Aged , Aged, 80 and over , Digestive System Neoplasms/mortality , Female , Humans , Leukemia/mortality , Male , Middle Aged , Multiple Myeloma/mortality , Risk Factors , Tanning , Urinary Bladder Neoplasms/mortalityABSTRACT
A historical cohort study evaluated the mortality experience of 26,561 workers employed in 10 formaldehyde-producing or -using facilities. Approximately 600,000 person-years of follow-up accrued as workers were followed to January 1, 1980. Estimates of historical exposure to formaldehyde by job were developed by project industrial hygienists using monitoring data available from participating plants, comments from long-term workers, and comprehensive monitoring data specifically collected for this study. Mortality from all causes combined was about as expected [standardized mortality ratio (SMR) = 96] based on mortality rates of the general U.S. population. Significantly fewer deaths occurred from infective and parasitic diseases (SMR = 51) and from accidents (SMR = 72) than expected. Cancer overall was not related to formaldehyde exposure. Workers exposed to formaldehyde had slight excesses for Hodgkin's disease and cancers of the lung and prostate gland, but these excesses were not consistently related to duration of or average, cumulative, or peak formaldehyde exposure levels. Recent animal studies found nasal cancer among rats exposed to formaldehyde, but no excess of this tumor occurred in this study. Mortality from brain cancer and leukemia among these industrial workers was not excessive in contrast to reported excesses among professional groups (e.g., anatomists, embalmers, and pathologists) with exposure to formaldehyde. Although there was a deficit for cancer of the buccal cavity and pharynx, mortality from certain subsites, i.e., the nasopharynx and oropharynx, was elevated. These subsites did not, however, show a consistently rising risk with level of exposure. These data provide little evidence that mortality from cancer is associated with formaldehyde exposure at levels experienced by workers in this study.
Subject(s)
Industry , Neoplasms/mortality , Adult , Environmental Exposure , Female , Formaldehyde , Hodgkin Disease/chemically induced , Humans , Leukemia/chemically induced , Lung Neoplasms/chemically induced , Male , Middle Aged , Mouth Neoplasms/chemically induced , Nose Neoplasms/chemically induced , Occupational Diseases/mortality , Pharyngeal Neoplasms/chemically induced , Prostatic Neoplasms/chemically induced , Regression Analysis , Time FactorsABSTRACT
The mortality experience of a nation-wide cohort of 293,958 veterans was analyzed by occupation and industry to generate hypotheses in occupational cancer. Results are presented on 107,563 deaths occurring between 1954 and 1970. Information on usual employment (occupation and industry) and smoking habits was available from questionnaires completed in 1954 and 1957. Complete enumeration of these results by occupation and industry is available as special National Cancer Institute monographs from the author (A. B.). This report presents the mortality experience for selected occupations. Excesses of lung cancer among shipyard workers, truck drivers, and plumbers are consistent with previous reports. Elevated risks for stomach cancer among carpenters and machinists may reflect exposure to dusts, abrasives, and cutting oils.
Subject(s)
Neoplasms/mortality , Occupations , Veterans , Adult , Aged , Epidemiologic Methods , Gastrointestinal Neoplasms/mortality , Humans , Leukemia/mortality , Lung Neoplasms/mortality , Lymphoma/mortality , Male , Middle Aged , Mortality , Occupational Diseases/mortality , Smoking , Surveys and Questionnaires , United States , Urogenital Neoplasms/mortalityABSTRACT
To systematically evaluate bias in estimating relative risks associated with occupational exposures obtained in the absence of smoking data, the authors compared crude and smoking-adjusted standardized mortality ratios for selected occupations using data from a study of U.S. veterans. Crude and smoking-adjusted SMRs were highly correlated: lung cancer (r = .88), bladder cancer (r = .98), and intestinal cancer (r = .97). Greater differences occurred for lung cancer, which is more strongly related to smoking than bladder or intestinal cancer.
Subject(s)
Occupational Diseases/mortality , Smoking , Humans , Intestinal Neoplasms/mortality , Lung Neoplasms/mortality , Male , United States , Urinary Bladder Neoplasms/mortalityABSTRACT
A previous report presented the cancer morbidity and mortality experience through 1976 of a cohort of 1,345 male employees with potential for exposure to acrylonitrile at a fibers-producing plant. This study has now been updated through 1983 for cancer incidence and through 1981 for mortality. Overall, 43 cancer cases have occurred, with 37.1 expected based on company rates. A previously reported excess number of cases of lung cancer remains, but is not as marked (10 observed, 7.2 expected). Prostate cancer cases were significantly in excess, with six cases observed and 1.8 expected. Mortality analyses revealed 36 cancer deaths, with 31.6 expected. Of these, 14 were from lung cancer, with 11.6 expected based on company rates. Only one death from prostate cancer occurred, with 1.0 expected. To our knowledge, prostate cancer excesses have not been reported in any other acrylonitrile studies, and hence their significance is currently difficult to assess.
Subject(s)
Acrylonitrile/adverse effects , Neoplasms/chemically induced , Nitriles/adverse effects , Occupational Diseases/chemically induced , Chemical Industry , Follow-Up Studies , Humans , Lung Neoplasms/chemically induced , Lung Neoplasms/mortality , Male , Neoplasms/mortality , Occupational Diseases/mortality , Prostatic Neoplasms/chemically induced , Prostatic Neoplasms/mortality , Registries , United StatesABSTRACT
A retrospective cohort mortality study was conducted on 807 fur dyers, fur dressers (tanners), and fur service workers who were pensioned between 1952 and 1977 by the Fur, Leather and Machine Workers Union of New York City. Workplace exposures of fur workers varied with job category. Dyers were exposed to oxidative dyes used in commercial hair dyes; dressers and service workers were exposed to tanning chemicals. In a comparison with the New York City population, no significant increases in mortality were observed among the fur dyers. Among fur dressers, mortality from all malignant neoplasms [standardized mortality ratio (SMR) 151] and lung cancer (SMR 232) was significantly elevated, as was mortality from cardiovascular disease (SMR 126) among fur service workers. When examined by ethnic origin, the elevated SMR values and directly age-adjusted rate ratios suggested that foreign-born fur dressers and eastern European-born fur workers experienced the highest risks for lung and colorectal cancers, respectively. These data support previous findings of increased mortality from colorectal cancer in the foreign-born population of the United States and suggest a possible occupational etiology for the observed lung cancer excess.
Subject(s)
Coloring Agents/adverse effects , Occupational Diseases/mortality , Tanning , Textile Industry , Adult , Aged , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/mortality , Hair Dyes/adverse effects , Humans , Male , Middle Aged , Neoplasms/chemically induced , Neoplasms/mortality , New York City , Occupational Diseases/chemically induced , Respiratory Tract Diseases/chemically induced , Respiratory Tract Diseases/mortality , Retrospective StudiesABSTRACT
A mortality odds ratio analysis of cause of death among 347 White female members of the American Chemical Society (ACS) revealed a five-fold excess of suicide, notably by cyanide poisoning. Risk was also elevated for all cancers combined and for cancers of the breast, ovary, stomach, pancreas, and lymphatic and hematopoietic system. The excess breast and ovary cancer deaths were limited to unmarried women.