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Hazardous chemicals: psychological dimensions of the health sequelae of a community exposure in Texas. 总被引:2,自引:1,他引:1
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H H Dayal T Baranowski Y H Li R Morris 《Journal of epidemiology and community health》1994,48(6):560-568
STUDY OBJECTIVE--A chemical spill from an oil refinery exposed the local community to more than 40,000 lb of highly toxic and corrosive hydrofluoric acid. A community based symptom prevalence study found an association between exposure and physical symptoms: the psychological impact of the disaster and its potential effect on the reporting of physical symptoms is examined here. DESIGN--The study used a population based survey design consisting of two phases: phase I, the exposure phase, and, phase II, the symptom prevalence phase. SUBJECTS--In phase I, information indicative of exposure was collected on 10,811 individuals in a door to door survey of a geographically defined area. In phase II, symptom prevalence information was gathered through in-person interviews with 2509 subjects selected from the phase I census in a sampling scheme that balanced across the exposure categories with regard to age, gender, and predisposition. The refusal rate in both phases was < 5%. MEASUREMENT AND MAIN RESULTS--Stepwise logistic regression analyses were used to assess the relative predictive importance of psychological variables and hydrofluoric acid exposure in explaining the reported physical symptoms two years after the disaster. The findings show a linear relationship between the level of hydrofluoric acid exposure and the degree of psychological stress two years after the accident. High exposure had a long term (more than two years) impact on physical health for some self reported symptoms, even after controlling for the psychological impact. Some physical symptom reports, however, were better explained by psychological status than by exposure to hydrofluoric acid. The physical symptoms for which exposure was the major predictor were those for which the biological plausibility of a relationship with hydrofluoric acid exposure was direct. CONCLUSIONS--Measures of psychological status should be included in symptom studies of health sequelae to man-made disasters so that the physical effects of exposure can be more accurately assessed. 相似文献
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H H Dayal M Brodwick R Morris T Baranowski N Trieff J A Harrison J R Lisse G A Ansari 《Annals of epidemiology》1992,2(3):213-230
An accident at an oil refinery in Texas City, Texas, released around 40,000 lb of hydrogen fluoride, exposing the community to the highly toxic and corrosive substance. A population-based epidemiologic study was conducted to evaluate the impact of the accident on the health of the community. Exposure assessment was done using a multipronged approach through a door-to-door survey of 10,811 individuals. A symptom survey resulting in 1994 completed interviews was conducted with a stratified random sample selected from the exposure study database. The sampling was balanced with respect to age, gender, and predisposition across the three ordinal exposure categories. The results show a strong dose relationship (P < 10(-4)) between the exposure and symptoms reported following the accident and 2 years later, most notably breathing and eye symptoms. However, substantial improvement in health was reported over the 2-year period regardless of the level of exposure. Problems of recall bias and behavioral sensitization are considered and it is recognized that the study may have overestimated the effect. It is also recognized that the study may not have completely unraveled the relative importance of exposure and host response in health outcome, since the two were probably conflated in the exposure measure. Nevertheless, the independence of predisposition and reported level of exposure, the magnitude of effect and its consistency, the unmistakable dose response, the large sample size, and the mutual corroboration of various findings make it difficult to dismiss the interpretation that the hydrofluoric acid exposure indeed caused health problems in the community that continued for at least 2 years after the accident. 相似文献
4.
Ghrelin expression in hyperplastic and neoplastic proliferations of the enterochromaffin-like (ECL) cells 总被引:1,自引:0,他引:1
Ghrelin, a recently discovered peptide isolated from the gastric corpus mucosa, is believed to be important in the regulation
of growth hormone secretion and has been shown to increase appetite and food intake as well. It may also have other gastrointestinal
and cardiac functions. Because a cell of origin for ghrelin has not been convincingly identified in the gastric mucosa thus
far, we studied the immunohistochemical expression of ghrelin in proliferative lesions of the enterochromaffin-like (ECL)
cells—a cell that is not only exclusively confined to the gastric corpus mucosa but is its dominant endocrine cell type as
well.
Formalin-fixed, paraffin embedded tissues from three cases of gastric ECL cell hyperplasia and five ECL carcinoids (three
with coexisting foci of diffuse, linear, and micronodular hyperplasia) were immunohistochemically stained for ghrelin, using
a commercially available antibody. The Sevier-Munger stain for ECL cells and immunohistochemical stains for chromogranin,
gastrin, serotonin, somatostatin, and vesicular monoamine transporter-2 (VMAT-2) were performed on parallel sections for correlation
with the ghrelin staining results.
All ECL cell carcinoids and hyperplastic lesions were positive for both the Sevier-Munger and the immunohistochemical stains
for chromogranin and VMAT-2. Immunoreactivity for ghrelin was seen in 4/5 ECL carcinoids, all cases of ECL cell hyperplasia,
as well as in all areas with linear and micronodular hyperplasia adjacent to the ECL cell carcinoids. In each instance, such
staining was confined to the Sevier-Munger, and VMAT-2 positive cells only.
Our findings indicate that the ECL cells are either the ghrelin-producing cells of the gastric mucosa or acquire the capability
to synthesize ghrelin during proliferative states encompassing the entire hyperplasia to neoplasia spectrum. In view of the
orexigenic and other known actions of ghrelin, the functional and/or biologic significance of ghrelin production in such ECL
cell proliferations needs to be investigated further. 相似文献
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Patient‐level Factors and the Quality of Care Delivered in Pediatric Emergency Departments
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James P. Marcin MD MPH Patrick S. Romano MD MPH Parul Dayal MS Madan Dharmar MBBS PhD James M. Chamberlain MD Nanette Dudley MD Charles G. Macias MD MPH Lise E. Nigrovic MD MPH Elizabeth C. Powell MD MPH Alexander J. Rogers MD Meridith Sonnett MD Leah Tzimenatos MD Elizabeth R. Alpern MD MSCE Rebecca Andrews‐Dickert MD Dominic A. Borgialli DO MPH Erika Sidney MD T. Charles Casper PhD J. Michael Dean MD Nathan Kuppermann MD MPH for the Pediatric Emergency Care Applied Research Network 《Academic emergency medicine》2018,25(3):301-309
Objective
Quality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient‐level factors.Methods
This was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hierarchical multivariable linear regression model with hospital site as a random effect.Results
In the multivariable model, among the 620 ED encounters reviewed, we did not find any association between patient age, sex, race/ethnicity, and payment source and the quality of care delivered. However, we did find that some chief complaint categories were significantly associated with lower than average quality of care, including fever (–0.65 points in quality, 95% confidence interval [CI] = –1.24 to –0.06) and upper respiratory symptoms (–0.68 points in quality, 95% CI = –1.30 to –0.07).Conclusion
We found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.10.
Ashish Kumar Jha Gaurav Kumar Vishwa Mohan Dayal Abhay Ranjan Arya Suchismita 《World journal of gastroenterology : WJG》2021,27(18):2090-2104
Hepatitis E virus (HEV) is an important cause of repeated waterborne outbreaks of acute hepatitis. Recently, several extrahepatic manifestations (EHMs) have been described in patients with HEV infection. Of these, neurological disorders are the most common EHM associated with HEV. The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation. Patients can present with normal liver function tests, which can often be misleading for physicians. There is a paucity of data on HEV-related neurological manifestations; and these data are mostly described as case reports and case series. In this review, we analyzed data of 163 reported cases of HEV-related neurological disorders. The mechanisms of pathogenesis, clinico-demographic profile, and outcomes of the HEV-related neurological disorders are described in this article. Nerve root and plexus disorder were found to be the most commonly reported disease, followed by meningoencephalitis. 相似文献