Mercury exposure aboard an ore boat

Two maritime academy interns (X and Y) were exposed to mercury vapor after spilling a bottle of mercury on the floor in an enclosed storeroom while doing inventory aboard an ore boat. During a 3-day period, intern Y suffered transient clinical intoxication that resolved after he was removed from the environment and he showered and discarded all clothing. His initial serum mercury level dropped from 4 ng/mL to < 0.05 ng/mL. Intern X had an initial level of 11 ng/mL, which continued to rise to a maximum of 188.8 ng/mL. He complained of tremulousness, insomnia, and mild agitation and was hospitalized. He had showered and discarded all clothing except his footwear earlier than intern Y. Intern X's continued exposure due to mercury in the contaminated boots during the 2 weeks before hospitalization was presumed to be the cause. Removing his footwear led to resolution of his toxic symptoms and correlated with subsequent lowered serum mercury levels. Chelation was initiated as recommended, despite its uncertain benefit for neurologic intoxication. Mercury is used in the merchant marine industry in ballast monitors called king gauges. New engineering is recommended for ballast monitoring to eliminate this hazard.     

Health effects of exposure to natural arsenic in groundwater and coal in China: an overview of occurrence

Between 2001 and 2005, 21,155 of 445,638 wells in 20,517 villages in 292 counties in 16 provinces from China, or 5% of wells, were found to contain > 50 microg/L arsenic (As) by field testing with the Merck As kit. We achieved quality assurance of analysis of at least 10% of the wells containing > 50 microg/L As using hydride generation atomic fluorescence spectrometry and silver dithiodicarbomate spectrometry. Our best estimate of the population exposed to > 50 microg/L As in drinking water was 582,769. This is probably an underestimate for China because of the limited area surveyed. In a survey of 135,492 individuals in eight provinces, we used the National Diagnosis Standard for Endemic Arsenicosis and identified 10,096 cases of arsenicosis with various degrees of skin lesions. The arsenicosis occurrence rate of 7.5% is likely an overestimate, because the survey focused more on known and suspected endemic areas of arsenicosis. The occurrence of arsenicosis correlates positively with the percentage of wells containing > 50 microg/L As, or at a ratio of 1 to 5%. Based on both the amount of As in well water and the rate of occurrence of arsenicosis, Shanxi province, Inner Mongolia autonomous region, and Jilin province are the top three areas in China as of 2005 for exposure to endemic As from drinking water. Our survey also identified exposure to high levels of As from wells in several provinces and from the indoor burning of coal containing high levels of As in Shaanxi province. These areas, however, have not had any reports of previous arsenicosis endemics. In the endemic areas, the average rate of occurrence of arsenicosis at advanced stages was 1.2%, possibly because of a long exposure time of > 20 years; the rate of occurrence increased to 2.7% when we included a high dose of As exposure from the indoor burning of coal. Mitigation to reduce As exposure remains a challenge in rural China.     

Residential radon exposure and lung cancer: an overview of ongoing studies.

This review paper summarizes the ongoing case/control studies of residential radon exposure and lung cancer. Discussion is offered in the areas of lung cancer risk factors, sample size requirements, radon exposure assessment, and meta-analysis. This is an important topic that deserves a "best effort" study design.     

Cumulative risk assessment: an overview of methodological approaches for evaluating combined health effects from exposure to multiple environmental stressors

Systematic evaluation of cumulative health risks from the combined effects of multiple environmental stressors is becoming a vital component of risk-based decisions aimed at protecting human populations and communities. This article briefly examines the historical development of cumulative risk assessment as an analytical tool, and discusses current approaches for evaluating cumulative health effects from exposure to both chemical mixtures and combinations of chemical and nonchemical stressors. A comparison of stressor-based and effects-based assessment methods is presented, and the potential value of focusing on viable risk management options to limit the scope of cumulative evaluations is discussed. The ultimate goal of cumulative risk assessment is to provide answers to decision-relevant questions based on organized scientific analysis; even if the answers, at least for the time being, are inexact and uncertain.     

Mercury exposure in chloralkali plants

The employees of two chloralkali plants were studied to correlate the signs and symptoms of mercury toxicity with levels of exposure. For purposes of comparison, the workers were divided into three groups. These groups were selected on the basis of hours worked in the mercury cell room or in other areas of mercury exposure. The population of the first plant was studied from 1957-1978, and preliminary findings were published in 1964. The second plant's population was studied for 3.5 years beginning in 1976. Time-weighted average exposure levels to mercury vapor in the high exposure group generally ranged between 0.05 to 0.10 mg/m3. No significant differences in the frequency of objective or subjective findings were noted among the three groups except for a lower post exposure systolic and post exposure diastolic blood pressure in the high exposure group in the second plant's population. There was no correlation of mercury vapor exposure with subjective or objective weight loss.     

The epidemiology of exposure to electromagnetic fields: an overview of the recent literature

Epidemiologic studies of exposure to electromagnetic fields (EMF) have been reviewed. Possible links to incidences of cancer and abnormal fetal development have been suggested by some investigators. In general, the results have been inconsistent. There are many deficiencies in the studies, and many questions have been raised about the validity of some of the conclusions proposed. There is currently no definitive evidence of an association between exposure to EMF and the alleged risks. Due to problems and limitations inherent in future studies (misconceptions about exposure levels, uncertainty about field variability, criticisms of surrogate measures), this question is unlikely to ever be answered with certainty. Unfortunately, many highly-publicized accounts of speculative and unsubstantiated claims have caused undue concern among the general public.     

Telemedicine: an overview

Telemedicine involves the transfer of medical data for use in diagnosis, treatment and education. The interaction may involve two-way live audio and video visits between patients and medical professionals, sending patient monitoring data from the home to a clinic or transmitting patient images and medical file from a primary care provider to a specialist. Telemedicine is already widely used in radiology, cardiac monitoring and other forms of remote patient monitoring and in targeted population groups such as correctional care populations, the military and veterans' health care.     

Dioxins: an overview

This review article summarizes what is known about human health following exposure to dioxins. It is meant primarily for health professionals but was also written with the general public in mind. The need for such an article became apparent to the authors following media inquiries at the time the then Ukraine presidential candidate Victor Yushchenko was deliberately poisoned with the most toxic dioxin, tetrachlorodibenzodioxin or TCDD.     

Stents: an overview

Over the last 10 years the development of stent technology has had a major effect on the treatment of patients with cardiac vascular and non-vascular disease. However, no two abnormalities are ever alike and stents differ hugely in their properties.     

Palivizumab: an overview

Respiratory syncytial virus (RSV) affects almost all children in their first 2 years of life and can cause severe or even life-threatening disease in some at-risk infants. Treatment is limited and there is currently no safe or effective vaccine. However, a new monoclonal antibody, palivizumab, reduces RSV hospitalization by 55% in at-risk groups if given prophylactically throughout the RSV season.     

Telemedicine: an overview

Telemedicine--the use of telecommunications and computer technology to provide medical information and services at a distance--is growing in popularity. Because of the rapid advances being made in the technology, more and more clinical applications can now be performed via telemedicine. However, the decision to adopt telemedicine should be made only if a clinical need for this technology can be demonstrated. And successful implementation and operation depend on specifically designing the technical infrastructure--that is, the computer hardware and software and the telecommunications system--to meet this clinical need. But even more important is making sure that everyone involved in such a program, including clinicians, telecommunications suppliers, and patients, understands the objectives, benefits, and particular requirements of telemedicine. In this Guidance Article, we provide an overview of the issues surrounding telemedicine. We present examples of successful telemedicine programs, along with guidance for facilities considering programs of their own. We also outline the barriers to successful implementation. And we discuss how, once a telemedicine program is in place, facilities can evaluate the effect of the program on their delivery of healthcare. In supplementary articles, we discuss the technology used for telemedicine and provide a list of telemedicine resources for readers who wish to learn more about the subject.     

Age and ageing: an overview

Europe is ageing, as exemplified by the UK population where, in the foreseeable future, more people will be over than under age 50: industry appears slow to recognise and appreciate all that older workers still have to offer: bundling them off into early retirement wastes precious talents. Memory difficulty is not an inevitable part of ageing.