Assessment of Stature in Spinal Cord Injury Garshick, Eric; Ashba, Jacqueline; Tun, G. Carlos ...
The journal of spinal cord medicine,
19/1/1/, Volume:
20, Issue:
1
Journal Article
Peer reviewed
Assessment of stature has been a neglected part of the medical assessment of individuals with spinal cord injury (SCI). In past studies of pulmonary function in SCI, it has not been stated how ...stature was assessed in order to calculate predicted pulmonary function. As part of a study of respiratory function in SCI, we examined the accuracy of self-report of stature and whether upper extremity measurements could be used to predict stature in 88 individuals with SCI. Although armspan and four other upper extremity measurements were significant predictors of length, recalled height was the best predictor. On average, for any value of armspan, an individual with complete SCI was 2.3 cm shorter than an individual with incomplete SCI. Individuals with complete SCI also had greater differences between recalled height and measured length compared with individuals with incomplete SCI, and this difference was not due to age or years since injury. It is likely that differences in bone demineralization account for the differences in length comparing individuals with complete and incomplete SCI. The 95 percent confidence intervals for predicted values of length based on armspan or recalled height were too wide for accurate calculation of predicted pulmonary function. In order to classify accurately the extent of pulmonary function abnormality, we suggest that measurements of supine length be made part of the medical assessment of individuals with SCI. (J Spinal Cord Med 1997; 20:36-42)
As a part of a series of epidemiological studies of railroad workers, measurements were made to characterize workers' exposures to diesel exhaust. Since diesel exhaust is not a single compound, an ...exposure marker was sought. The personal exposures to respirable particulate matter (RPM) of over 530 workers in 39 common jobs were measured in four U.S. railroads over a three-year period. Significant amounts of cigarette smoke (20-90%) were found in many of these samples. Therefore, the respirable particulate concentration, adjusted to remove the fraction of cigarette smoke (ARP), was chosen as a marker of diesel exhaust exposures. The geometric mean exposures to ARP ranged from 17 micrograms/m3 for clerks to 134 micrograms/m3 for locomotive shop workers. Significant interrailroad variations were observed in some job groups indicating that the different facilities, equipment, and work practices found among the railroads can affect a worker's exposure to diesel exhaust. Climate was also found to have a significant effect on exposure in some job groups.
The diesel exhaust exposures of railroad workers in thirteen job groups from four railroads in the United States were used to estimate U.S. national average exposures with a linear statistical model ...which accounts for the significant variability in exposure caused by climate, the differences among railroads and the uneven distribution of railroad workers across climatic regions. Personal measurements of respirable particulate matter, adjusted to remove the contribution of cigarette smoke particles, were used as a marker for diesel exhaust. The estimated national means of adjusted respirable particulate matter (ARP) averaged 10 micrograms/m3 lower than the simple means for each job group, reflecting the climatic differences between the northern railroads studied and the distribution of railroad workers nationally. Limited historical records, including some industrial hygiene data, were used to evaluate past diesel exhaust exposures, which were estimated to be approximately constant from the 1950's to 1983.
A large study has been undertaken to assess the exposure to diesel exhaust within diesel trucking terminals. A critical component of this assessment is an analysis of the variation in carbonaceous ...particulate matter (PM) across trucking terminal locations; consistency in the primary sources can be effectively tracked by analyzing trends in elemental carbon (EC) and organic molecular marker concentrations. Ambient samples were collected at yard, dock and repair shop work stations in 7 terminals in the USA and 1 in Mexico. Concentrations of EC ranged from 0.2 to 12 microg m(-3) among the terminals, which corresponds to the range seen in the concentration of summed hopanes (0.5 to 20.5 ng m(-3)). However, when chemical mass balance (CMB) source apportionment results were presented as percent contribution to organic carbon (OC) concentrations, the contribution of mobile sources to OC are similar among the terminals in different cities. The average mobile source percent contribution to OC was 75.3 +/- 17.1% for truck repair shops, 65.4 +/- 20.4% for the docks and 38.4 +/- 9.5% for the terminal yard samples. A relatively consistent mobile source impact was present at all the terminals only when considering percentage of total OC concentrations, not in terms of absolute concentrations.
Before the transition from steam- to diesel-powered locomotives during the 1950s certain railroad workers had the opportunity for significant occupational exposure to asbestos. Past studies have ...demonstrated that older workers with jobs associated with the repair of steam locomotives had the most exposure. To determine the prevalence of currently employed railroad workers with past asbestos exposure we surveyed 514 white male employees of an active US railroad by mail questionnaire. Twenty-one percent (50/242) of the workers 50 years old or greater had likely asbestos exposure compared to 3% (9/275) of the workers 49 years old or less (p less than .001). Fifteen (30%) of the 50 older workers with likely asbestos exposure had current job titles no longer suggestive of past exposure. The duration of exposure of these older active workers was short, (median = 3 years; range, 6 months to 15 years). A history of past asbestos exposure may still be obtained among active railroad workers with past railroad shop employment.
The American Thoracic Society (ATS) has formulated guidelines for spirometry. We hypothesized that individuals with SCI (SCI), as a result of weak respiratory muscles, would exhibit poor test ...acceptability and reproducibility. Seventy-eight SCI subjects (39 with complete SCI) answered a respiratory questionnaire and performed spirometry. Of those with complete SCI, the proportion of subjects which met ATS criteria decreased with higher levels of injury. Poor test performance was not associated with age, respiratory symptoms or muscle fatigue. The most common reason for failing to meet ATS criteria for acceptability was excessive back extrapolated volumes (EBEV). Individuals with efforts that were acceptable except for EBEV and/or for exhalation of less than six seconds had values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) that were reproducible. If ATS criteria for acceptable spirometry were used in studying subjects with SCI, individuals producing otherwise reproducible values for FVC and FEV1 would be excluded. We found reproducibility similar to what has been reported in other cohorts and conclude that longitudinal study of respiratory function in SCI is feasible.
The risk of lung cancer as a result of exposure to diesel exhaust from railroad locomotives was assessed in a cohort of 55,407 white male railroad workers 40 to 64 yr of age in 1959 who had started ...railroad service 10 to 20 years earlier. The cohort was traced until the end of 1980, and death certificates were obtained for 88% of 19,396 deaths; 1,694 lung cancer cases were identified. Yearly railroad job from 1959 to death or retirement was available from the Railroad Retirement Board, and served as an index of diesel exhaust exposure. Directly standardized rates and a proportional hazards model were used to calculate the relative risk of lung cancer based on work in a job with diesel exhaust exposure beginning in 1959. A relative risk of 1.45 (95% CI = 1.11, 1.89) for lung cancer was obtained in the group of workers 40 to 44 yr of age in 1959, the group with the longest possible duration of diesel exposure. The cohort was selected to minimize the effect of past railroad asbestos exposure, and analysis with workers with possible asbestos exposure excluded resulted in a similarly elevated risk. Workers with 20 yr or more elapsed since 1959, the effective start of diesel exposure for the cohort, had the highest relative risk. These results taken in conjunction with other reported results support the hypothesis that occupational exposure to diesel exhaust results in a small but significantly elevated risk for lung cancer.
The effect of exposure to ozone (O3) in ambient air on respiratory function was studied in 30 healthy adult nonsmokers engaged in a regular daily program of outdoor exercise in Tuxedo, NY during the ...summer of 1985. Each subject did the same exercise each day, but exercise intensity and duration varied widely between subjects, with minute ventilation ranging from 20 to 153 L and duration ranging from 15 to 55 min. Spirometry was performed immediately before and after each exercise period. O3 concentrations during exercise ranged from 21 to 124 parts per billion (ppb). All measured functional indexes showed significant (p less than 0.01) O3-associated mean decrements with FVC at -2.1 ml/ppb, FEV1 at -1.4 ml/ppb, PEFR at -9.2 ml/s/ppb, FEF25-75 at -6.0 ml/s/ppb, and FEV1/FVC at -0.038%/ppb. Mean decrements were smaller for 10 subjects with minute ventilations greater than 100 L than for 10 other subjects with minute ventilations between 60 and 100 L or for the 10 subjects with minute ventilations below 60 L. Overall, the functional decrements were similar in magnitude to those we have seen in children engaged in supervised recreational programs in summer camps. For 10 subjects with minute ventilations comparable to those used in controlled 1- and 2-h exposures to O3 in purified air in chambers (50 to 80 L), the effects were about twice as large as those reported for the chamber studies.
This study examined the relationship between lifetime alcohol consumption and respiratory symptoms in 195 subjects (including 111 alcoholics) and FEV1 level in 165 subjects (including 91 alcoholics). ...After adjustment for age and cigarette smoking status, using multiple logistic regression, lifetime alcohol consumption was a significant predictor of chronic cough and chronic phlegm, but not of any wheeze or persistent wheeze. Multiple linear regression analysis indicated that lifetime alcohol consumption was also a predictor of lower levels of FEV1 in a model that included age, pack-years of cigarette smoking, and an interaction between alcohol consumption and pack-years. The interaction between smoking and alcohol consumption was in a direction opposite to the independent effects of alcohol and smoking, suggesting a protective effect of alcohol with heavier amounts of smoking. Additional study is needed to further assess the relationship between respiratory symptoms and alcohol consumption, and between pulmonary function and alcohol consumption.
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