Postdeployment evaluation of health risk communication after exposure to a toxic industrial chemical

Increasing emphasis is being placed on the appropriate communication of deployment-related risks among military service members. This report validates risk communication on the postdeployment health assessment (PDHA), in the context of a known, low-level exposure to a toxic industrial chemical. In late 2003, 245 soldiers were exposed to hexavalent chromium at an industrial site in Iraq; of those, 227 had completed PDHAs on file for review. Despite being directed to document this exposure upon redeployment, only 55 soldiers (24.2%) specifically reported chromium exposure. Increasing age and time at the industrial site were associated with increased reporting of exposure. Although providers documented deployment exposure concerns for only 65.4% of this population, this was much more often than for other redeploying service members. The PDHA is a risk assessment and risk communication tool that has sources of misclassification, and results must be interpreted with caution when individual or population occupational and environmental risks resulting from deployment are assessed.     

Biomarkers of exposure, sensitivity and disease

PURPOSE: This review is to evaluate the use of biomarkers as an indication of past exposure to radiation or other environmental insults, individual sensitivity and risk for the development of late occurring disease. OVERVIEW: Biomarkers can be subdivided depending on their applications. Markers of exposure and dose can be used to reconstruct and predict past accidental or occupational exposures when limited or no physical measurements were available. Markers of risk or susceptibility can help identify sensitivity individuals that are at increased risk for development of spontaneous disease and may help predict the increased risk in sensitive individuals associated with environmental or therapeutic radiation exposures. Markers of disease represent the initial cellular or molecular changes that occur during disease development. Each of these types of biomarkers serves a unique purpose. OUTLINE: This paper concentrates on biomarkers of dose and exposure and provides a brief review of biomarkers of sensitivity and disease. The review of biomarkers of dose and exposure will demonstrate the usefulness of biomarkers in evaluation of physical factors associated with radiation exposure, such as LET, doserate and dose distribution. It will also evaluate the use of biomarkers to establish relationships that exist between exposure parameters such as energy deposition, environmental concentration of radioactive materials, alpha traversals and dose. In addition, the importance of biological factors on the magnitude of the biomarker response will be reviewed. Some of the factors evaluated will be the influence of species, tissue, cell types and genetic background. The review will demonstrate that markers of sensitivity and disease often have little usefulness in dose-reconstruction and, by the same token, many markers of dose or exposure may not be applicable for prediction of sensitivity or risk.     

Biomarkers of exposure,sensitivity and disease

Purpose: This review is to evaluate the use of biomarkers as an indication of past exposure to radiation or other environmental insults, individual sensitivity and risk for the development of late occurring disease. Overview: Biomarkers can be subdivided depending on their applications. Markers of exposure and dose can be used to reconstruct and predict past accidental or occupational exposures when limited or no physical measurements were available. Markers of risk or susceptibility can help identify sensitivity individuals that are at increased risk for development of spontaneous disease and may help predict the increased risk in sensitive individuals associated with environmental or therapeutic radiation exposures. Markers of disease represent the initial cellular or molecular changes that occur during disease development. Each of these types of biomarkers serves a unique purpose. Outline: This paper concentrates on biomarkers of dose and exposure and provides a brief review of biomarkers of sensitivity and disease. The review of biomarkers of dose and exposure will demonstrate the usefulness of biomarkers in evaluation of physical factors associated with radiation exposure, such as LET, doserate and dose distribution. It will also evaluate the use of biomarkers to establish relationships that exist between exposure parameters such as energy deposition, environmental concentration of radioactive materials, alpha traversals and dose. In addition, the importance of biological factors on the magnitude of the biomarker response will be reviewed. Some of the factors evaluated will be the influence of species, tissue, cell types and genetic background. The review will demonstrate that markers of sensitivity and disease often have little usefulness in dose-reconstruction and, by the same token, many markers of dose or exposure may not be applicable for prediction of sensitivity or risk.     

The occupational health and safety of flight attendants

In order to perform safety-critical roles in emergency situations, flight attendants should meet minimum health standards and not be impaired by factors such as fatigue. In addition, the unique occupational and environmental characteristics of flight attendant employment may have consequential occupational health and safety implications, including radiation exposure, cancer, mental ill-health, musculoskeletal injury, reproductive disorders, and symptoms from cabin air contamination. The respective roles of governments and employers in managing these are controversial. A structured literature review was undertaken to identify key themes for promoting a future agenda for flight attendant health and safety. Recommendations include breast cancer health promotion, implementation of Fatigue Risk Management Systems, standardization of data collection on radiation exposure and health outcomes, and more coordinated approaches to occupational health and safety risk management. Research is ongoing into cabin air contamination incidents, cancer, and fatigue as health and safety concerns. Concerns are raised that statutory medical certification for flight attendants will not benefit either flight safety or occupational health.     

Assessing chemical exposures during military deployments

Before the first Persian Gulf War, military chemical concerns were focused on life-threatening/performance-impairing effects from exposures to chemical warfare agents. Now, hazards of concern include both high and low levels of chemical warfare agents and toxic industrial chemicals in air, soil, and water. The types of health effects considered have expanded to include both immediate, acute effects (mild and severe), and delayed or chronic outcomes. Because federal exposure standards are not applicable to deployed personnel, the U.S. Army Center for Health Promotion and Preventive Medicine established military-specific exposure guidelines in Technical Guide 230, Chemical Exposure Guidelines for Deployed Military Personnel. Methods used to develop the guidelines address toxicological data limitations, uniqueness of military populations and exposure scenarios, and a risk assessment process compatible with existing military operational risk management doctrine. The Technical Guide 230 helps ensure chemical hazards are addressed in various deployment scenarios.     

The traceability of carcinogenic occupational risks: state of progress in France compared with other European countries

Occupational risks are constantly evolving. The complexification of these occupational risks, the context of the flexibility with the new forms of organization, the new conditions of use and the increase in occupational mobility are accentuating the difficulties of assessment of the deferred risks for the health of employees. In point of fact, if on the one hand the immediate risk (accidental, corrosive, caustic, explosive...) is properly taken into account, on the other hand this is far from the case for the deferred risk, in particular the carcinogenic risk. Now, the liability of employers (especially with regard to cancers due to asbestos) is incurred more and more often. It is they in fact who bear the brunt of the prevention of occupational risks in France. Since 2002, the French employer has thus a veritable safety performance obligation in terms of preserving the health of the employees. Now, one of the vital keys to the prevention of deferred occupational risks resides in the traceability of the exposures that the employees have undergone throughout their working lives, in particular carcinogenic. In this context, the follow-up of the exposure of the employees to carcinogenic risks then becomes a necessity. The awareness of the necessity of setting in place an occupational exposure follow-up tool is not recent. Traceability procedures exist moreover in a certain number of countries, but so far in France we have only seen ad hoc experiments of a very limited nature for the identification and storage of occupational exposure. These are not of an exhaustive nature or only relate to mainly medical data. There is no systematic tool for the follow-up of carcinogenic exposure. This is due, on the one hand to the technical difficulties of setting in place standardized tools for exposure data collation, and on the other hand to the fact that the traceability of the personal information collated may raise ethical issues of reconciling the right to health of the employees with their right to work and the observing of their individual liberties; lastly, because the amassing of such information may raise issues of liability, in particular for the employer exposing its employees to carcinogens. Such issues transcend frontiers and have to be taken into consideration in order for progress to be made in the area of traceability of occupational exposure. Very few studies have been devoted to this subject so crucial to the prevention of occupational diseases. We propose, initially, to define traceability and the issues involved. Next, we will consider the current regulatory obligations on employers in France that may contribute to the traceability of occupational exposure and their limits. Then we will examine the brakes--the legal, ethical and technical difficulties that explain why France is lagging behind in this field. Finally, we will study the French perspectives with regard to the European advances in the traceability area.     

The assessment of movement health in clinical practice: A multidimensional perspective

This masterclass takes a multidimensional approach to movement assessment in clinical practice. It seeks to provide innovative views on both emerging and more established methods of assessing movement within the world of movement health, injury prevention and rehabilitation. A historical perspective of the value and complexity of human movement, the role of a physical therapist in function of movement health evaluation across the entire lifespan and a critical appraisal of the current evidence-based approach to identify individual relevant movement patterns is presented. To assist a physical therapist in their role as a movement system specialist, a clinical-oriented overview of current movement-based approaches is proposed within this multidimensional perspective to facilitate the translation of science into practice and vice versa. A Movement Evaluation Model is presented and focuses on the measurable movement outcome of resultants on numerous interactions of individual, environmental and task constraints. The model blends the analysis of preferred movement strategies with a battery of cognitive movement control tests to assist clinical judgement as to how to optimize movement health across an individual lifespan.     

Assessing exposures in the United Kingdom's Armed Forces--a review of systems that collect data useful for exposure assessment.

The ability to assess the exposure of individuals or groups is a critical element in any effective health surveillance system, as it provides the opportunity to identify the causes of ill health, the levels of exposure resulting in ill health and, through controlling exposures, to protect the health of Service personnel. As part of a wider programme to enhance the health surveillance capabilities of the Defence Medical Services, a project was undertaken to assess the collection and retention of data for exposure assessment in the United Kingdom's Armed Forces. The systems investigated include those for health, safety and environment policy, personnel and pay, medical records, environmental and occupational monitoring and historical records. It was found that the use of many systems for exposure assessment would be hampered by inconsistencies in the data collected, poor accessibility and linkage, and variability in the retention of the data. This paper highlights some of the problems that limit the usefulness of the record systems for exposure assessment and summarizes the principal recommendations made for enhancing the systems to better facilitate health surveillance.     

Assessment of changes in mental health conditions among sailors and marines during postdeployment phase

Previous research regarding the mental health ramifications of military deployments focused on the U.S. Army population. As part of its deployment health surveillance mission, Navy and Marine Corps Public Health Center conducted a study of the Department of Navy population to identify reported mental health effects associated with Operation Iraqi Freedom, describe mental health care utilization by returning service members previously deployed in support of Operation Iraqi Freedom, and examine the relationships between self-identified risks and provider referral practices. Despite a considerable number of self-reported mental health concerns, referral for mental health consultations and health care utilization were rare. The psychological well-being of service members is essential to the military's optimum functionality and operational readiness; therefore, continued research in this area has significant bearing on future force health protection efforts. Additionally, this study highlights the need for further research on deployment-related mental health concerns.     

核医学工作人员内照射剂量监测研究进展

随着核医学应用的广泛开展和相关工作人员的增多,潜在的职业健康问题也应该受到足够重视。目前,大多核医学放射工作人员的个人剂量监测主要是通过热释光剂量计等提供的外照射信息,并未全面开展常规内照射的监测,这可能会低估他们的年有效剂量。全面的个人剂量监测是职业健康监护的重要内容,也是职业健康管理的重要手段。本文分析了核医学内照射的特点,介绍了核素的监测技术和剂量估算方法,列出了几种常用软件,从而全面客观了解和认识当前核医学工作人员的内照射相关内容,为卫生行政部门制定监管政策及防护要求提供参考。     

Strahlenexposition von Patienten durch diagnostische und interventionelle Röntgenanwendungen

Man-made radiation exposure to the German population predominantly results from the medical use of ionizing radiation. According to the most recent evaluation, the mean effective dose per inhabitant and year from X-ray procedures increased from 1.6 to 1.8 mSv between 1996 and 2001. This rise is mainly caused by the expanding use of CT and reflects the growing importance of this imaging modality. Besides actual data on the frequency and dose of various types of X-ray examinations, patient-specific factors will be highlighted which have to be considered in the assessment of the associated individual and collective radiation risk. Moreover, different concepts to reduce radiation exposure of patients will be discussed as well as some current trends in health service that may affect radiation hygiene -- such as diagnosis-related groups for inpatients and CT screening.     

我国放射卫生信息化建设现状与展望

自2009年国家个人剂量登记系统应用以来，我国放射卫生信息化建设已走过10个年头，建立了全国放射卫生信息平台，涵盖个人剂量、职业性放射性疾病与职业健康、医用辐射防护、食品放射性核素监测、职业性放射性疾病报告5个系统，截至2018年，采集监测数据800余万条，平台授权用户1 400余名。本文就10年来我国放射卫生信息化建设的现状进行分析与总结，探讨放射卫生信息化发展的重点和难点，提出建议等，以期推进放射卫生信息化建设工作，更好地为职业性放射性疾病的预防与控制服务，助力"健康中国"建设。     

Human immunodeficiency virus and the emergency setting: Legal considerations

The emergence of human immunodeficiency virus (HIV) has changed the atmosphere surrounding the provision of emergency medical treatment. HIV-positive patients fear denial of needed health services based on their seropositivity, whereas medical providers worry about occupational exposure. Both patients and providers have concerns regarding HIV testing and the confidentiality of test results. This article summarizes some of the many legal implications created by HIV in the emergency setting.     

The Biological Effects of Radiofrequency Radiation: A Critical Review and Recommendations

Summary

Exposure of the general public and in particular certain occupational groups to radiofrequency radiation (RFR) is ubiquitous and of growing concern. No clear and widely accepted understanding of the biological effects and health implications of such RFR exposure has emerged. This paper reviews the data available, including reports of RFR effects on single cells or cell components, on genetic composition or development, on developed organs, tissues, or cell systems, and on integrative and regulatory biological systems. Reports of RFR effects on the immunological system, with consideration of the influence of neuroendocrine responses, are critically reviewed in greater detail to illustrate important points regarding data acquisition and assessment, and understanding and application of the RFR bioeffects literature in general. Factors affecting RFR bioeffects research are reviewed, and recommendations for future studies are provided.     

Occupational exposure to hydrazines: treatment of acute central nervous system toxicity

Exposure to hydrazine and hydrazines' alkylated derivatives is an important occupational health issue, which will increase in significance as space applications increase. Despite their widespread usage as rocket fuels in manned and unmanned space and missile systems, serious exposures to hydrazines are rare. While a significant number of experimental studies were performed in the late 1950s through the mid-1960s, conflicting information exists concerning the most appropriate treatment for these exposures. A cross-sectional study evaluating the most common rocket fuels such as hydrazine; 1,1-dimethylhydrazine (UDMH); mono-methylhydrazine (MMH); and Aerozine-50 against the most commonly suggested therapies, such as pyridoxine, traditional antiseizure therapies, and arginine is needed to clarify the treatment implications for human exposure. Treatments that have been useful for hyperammonemic states, such as those for the six inherited urea cycle defects, have significant potential for the improvement of hydrazine exposure treatment.     

Skin erythema and pigmentation: a review of optical assessment techniques

BackgroundSkin erythema may present due to many causes. One of the common causes is prolonged exposure to sun rays. Other than sun exposure, skin erythema is an accompanying sign of dermatological diseases such as acne, psoriasis, melasma, post inflammatory hyperpigmentation, fever, as well as exposure to specific electromagnetic wave bands.MethodsQuantifying skin erythema in patients enables the dermatologist to assess the patient’s skin health. Therefore, quantitative assessment of skin erythema was the target of several studies. The clinical standard for erythema evaluation is visual assessment. However, the former standard has some imperfections. For instance, it is subjective, and unqualified for precise color information exchange. To overcome these shortcomings, the past three decades witnessed various methodologies that aimed to achieve erythema objective assessment, such as diffuse reflectance spectroscopy (DRS), and both optical and non-optical systems.DiscussionThis review article reports on the studies published in the past three decades where the performance, the mathematical tactics for computation, and the capabilities of erythema assessment techniques for cutaneous diseases are discussed. In particular, the achievements and limitations of the current techniques in erythema assessment are presented.ConclusionThe profits and development trends of optical and non-optical methods are displayed to provide the researcher with awareness into the present technological advances and its potential for dermatological diseases research.     

Quantitative magnetic resonance imaging for chronic liver disease

Chronic liver disease (CLD) has rapidly increased in prevalence over the past two decades, resulting in significant morbidity and mortality worldwide. Historically, the clinical gold standard for diagnosis, assessment of severity, and longitudinal monitoring of CLD has been liver biopsy with histological analysis, but this approach has limitations that may make it suboptimal for clinical and research settings. Magnetic resonance (MR)-based biomarkers can overcome the limitations by allowing accurate, precise, and quantitative assessment of key components of CLD without the risk of invasive procedures. This review briefly describes the limitations associated with liver biopsy and the need for non-invasive biomarkers. It then discusses the current state-of-the-art for MRI-based biomarkers of liver iron, fat, and fibrosis, and inflammation.     

Self-reported flight hours vs. company records for epidemiologic studies of flight attendants

INTRODUCTION: Although there is increased interest in health effects studies of aircrew members, the differences between self-reported work history and company records, including effects on exposure assessment, are poorly characterized. METHODS: We collected both self-reported work history and company records as part of a National Institute for Occupational Safety and Health biomonitoring study of reproductive hormones in 45 female flight attendants. These two sources of work history information were compared to identify differences which might impact the assessment of work exposures. RESULTS: There appeared to be consistent overreporting of self-reported block time and number of flight segments compared with company record-based estimates. Overreporting in turn inflated the assessment of two important exposures: cosmic ionizing radiation estimated dose and time zones crossed. Factors including domicile, block hours per year of work, and length of employment affected the amount and direction of overreporting. Comparison to compensated credit hours, including nonflight hours, did not fully account for the overreporting. DISCUSSION: Self-report of block time may or may not include compensated nonflight hours, resulting in differences when compared to company records. Exposure bias is likely to result if the complexities of self-report are not considered when writing questionnaires. Aircrew members should be asked for additional occupational information, and a comparison of self-report block time to a sample of company records should be considered prior to exposure assessment and epidemiologic analysis.