Michael Hodgson

Mood and behavioral symptoms in individuals with chronic solvent exposure

Psychiatric symptoms have been reported for individuals who experience chronic exposure to low levels of organic solvents. However, it is not known what proportion of such individuals experience psychiatric disorder; which specific disorders may be characteristic of this population; or whether bioaccumulation of lead contributes to the relationship between solvent exposure and psychiatric symptoms. Twenty-nine male journeymen painters and 32 male non-painter control subjects were administered semi-structured diagnostic interviews for DSM-III-R Axis I and Axis II disorders. Career solvent exposure and blood lead levels were also measured. Painters and control subjects did not differ significantly with respect to age, intelligence, or demographic characteristics. Results showed that the probability of being diagnosed with a mood disorder differed significantly in painters (41%) and control subjects (16%). Painters (66%) and control subjects (50%) did not differ for substance use diagnoses. Groups also did not differ for personality disorders involving an onset before 25 years of age. In contrast, painters exhibited a sub-clinical pattern of personality dysfunction involving symptomatology that was measured allowing for late onset (after age 25). Finally, a significant dose-response relationship was observed between career solvent exposure, blood lead level, and personality symptoms. In summary, these data showed an increased rate of psychological disturbance in a significant and substantial number of painters. However, not all painters were so characterized. This overall pattern raises a question regarding a potential role for differential vulnerability, which requires empirical validation.

Reinforcement of occupational history taking: a success story.

Background: This article describes the results of a retrospective study of 3 classes of medical students who participated in a targeted occupational and environmental health curriculum at the University of Connecticut School of Medicine. Purpose: We wanted to determine if targeted focused curricular interventions which integrated occupational and environmental health principles into routine history taking would result in increased scores on the number of questions posed during the Clinical Skills Assessment Program in the 4th year. Methods: We analyzed Clinical Skills Assessment Program questions for 3 graduating medical school classes from 1997 to 1999. Results: It appears that intense, focused training may increase the occupational and environmental questions which students ask. By revisiting the components of the history during the 3rd year, the final assessment of 4th-year students substantially and significantly increased. Conclusions: Those who wish to stem the decline in history-taking skills as students enter their clinical years should consider reinforcing these skills using structured programs and practice in areas of the history that are traditionally neglected but recognized as essential in gathering comprehensive data on patients.

First-receiver hospital decontamination: an 8-step approach to a progressive and practical program.

The effectiveness of hospital decontamination programs begins with planning, preparation, and practice. A well-thought-out hospital decontamination program encompasses complexities that are not always apparent. In disaster situations, the victim, hospital, patients, and staff are placed at serious risk if untrained, unprepared employees perform emergency decontamination procedures at the hospital-receiving site. The authors describe 8 steps to developing an emergency preparedness program and team with decontamination capabilities to facilitate emergency response in the first-receiver hospital.

40 – Indoor Air Quality

This chapter summarizes indoor environmental health. Diseases related to indoor environments do not differ from those same diseases related to other factors. Therefore, documentation of disease, per se, is no different. Such diseases do differ from non occupational and environmental forms in that their etiology is related to an exposure that is remediable. Identification of the cause, based on a specific linkage strategy, is, therefore, of paramount importance. Such linkages are far more persuasive to both the professional and regulatory community and more clearly define economic implications than the complex of symptoms commonly labeled sick building syndrome. Eye irritation is a common complaint among office workers and is widely thought by some to be the primary driver for the widespread interest in indoor environmental health effects. A wide range of frequencies of work-related mucosal irritation has been reported, ranging from 8% to well over 30% in randomly selected buildings. In buildings with known problems, this frequency is even higher. Additional individuals have persistent eye irritation without relief on weekends. These symptoms may be due to factors other than external exposures, or these individuals may have similar exposure problems at home. Epidemiologic data have long suggested that atopic individuals describe more mucosal irritation than nonatopic individuals.