Awareness, Use, and Opinions of Individual Fit Testing of Hearing Protection Devices Among Practicing Michigan Occupational and Environmental Medicine Association Health Care Providers.

OBJECTIVE: The aim of this study is to examine the awareness, opinions, and use of individual fit testing of hearing protection devices (HPDs) among occupational medicine practitioners. METHODS: Members of the Michigan Occupational and Environmental Medicine Association completed a 21-question survey on individual fit testing of HPDs. RESULTS: The survey response rate was 67%, 53% reported having heard of individual fit testing of HPDs, and 24% reported that their clinic/site performed the testing. Major barriers to its use were perceived time to perform (63%), cost (51%), lack of an Occupational Safety and Health Administration requirement (51%), and lack of long-term studies of its effectiveness (20%). CONCLUSIONS: Further work to educate practitioners about the availability, implementation, and potential benefits of fit testing of HPDs is needed if use of this technology is to become more widespread.

Creatine phosphate kinase elevations signaling muscle damage following exposures to anticholinesterases: 2 sentinel patients.

In this study, the authors describe 2 patients who experienced confirmed exposures to anticholinesterases that commenced in the 1970s. Subsequently, elevations in creatine phosphate kinase (CPK) were initially detected more than a decade following the first acute exposure. Beginning in the early 1980s, the patients suffered from progressive generalized muscle weakness, chronic fatigue, myopathy, neuropathy, and severe neurobehavioral impairments. Previous occupational exposures included pyridostigmine, as well as isopropyl methylphosphonofluoridate (percutaneous lethal dose [LD50] < 28 mg/kg body weight), and 1 patient had exposure to agricultural organophosphates. The authors hypothesize that the workers' CPK elevations, first detected more than a decade following acute exposures to anticholinesterases, were sentinel events for impending muscle damage and necrosis. Many Gulf War veterans with Gulf War disease who reported exposures to anticholinesterases 1 decade earlier currently suffer from vague neuromuscular and cognitive impairments. Therefore, medical programs for Gulf War veterans with Gulf War Syndrome should include surveillance for elevated CPK, abnormalities of neuromuscular conduction, and genetic susceptibility, and they should promote therapeutic trials for palliation.

Reactive nitrogen and human health: acute and long-term implications.

Reactive-nitrogen (Nr) has a wide variety of beneficial and detrimental effects on human health. The most important of the beneficial effects are increasing global and regional food supplies and increased nutritional quality of available foods. However, lack of adequate dietary intake of amino acids and proteins is a serious cause of malnutrition when food supplies are inadequate because of poverty, drought, floods, wars, and displacements of people as refugees. There is sufficient, though limited, quantitative data indicating that increased circulation of Nr in the environment is responsible for significant human health effects via other exposure pathways. Nr can lead to harmful health effects from airborne occupational exposures and population-wide indoor and outdoor air pollution exposures to nitrogen dioxide and ozone. Nr can also affect health via water pollution problems, including methemoglobinemia from contaminated ground water, eutrophication causing fish kills and algal blooms that can be toxic to humans, and via global warming. The environmental pollutants stemming from reactive nitrogen are ubiquitous, making it difficult to identify the extent to which Nr exerts a specific health effect. As all populations are susceptible, continued interdisciplinary investigations are needed to determine the extent and nature of the beneficial and harmful effects on human health of nitrogen-related pollutants and their derivatives.