The border between the United States and Mexico presents a number of problems related to health t... more The border between the United States and Mexico presents a number of problems related to health that are simultaneously local and international. Large-scale government-to-government interactions have generally failed to achieve lasting cooperation on important health issues, with a few important exceptions. One reason for this may be that the issues have been complicated by much larger and more complex social, cultural, economic, and political differences. Another is that large organizations must each function according to their own mandates, goals, and procedures and may not mesh well with others, even with nominal counterparts. In 1981 we conceptualized a model for encouraging binational cooperation on small-scale local projects. The model incorporates three elements: a significant and difficult but soluble technical problem affecting both sides of the border (the "technocratic factor"), a mutually respected individual or team whose function is to facilitate communication and prevent misunderstandings (the "human factor"), and the actions of governments or institutions larger than the working groups (the "institutional factor"). Subsequently, we applied the model to water quality and to the distribution of sources of toxic substances in the border area, which met the criteria for the technocratic factor. Two highly respected figures in environmental health, one American and one Mexican, mediated between colleagues on either side of the border and facilitated the development of projects. Finally, after the projects had been under way long enough to have demonstrated their viability and personal interactions among the principals had become trusting and collegial, the institutional factor was admitted and major financial and administrative support obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of investigational allergology & clinical immunology
An important part of the new thinking about asthma is control of preventable risk factors, air po... more An important part of the new thinking about asthma is control of preventable risk factors, air pollution among them. The epidemiological evidence that ground-level ozone, in particular, is an important risk factor for provoking asthmatic attacks is strong. however, the evidence that it increases the prevalence of asthma overall, or mortality from asthma at levels frequently encountered in the developed world is lacking. The mechanism of airway response to ozone may be complex, involving modification of the atopic response to an antigen, rather than simple inflammation. Likewise, there may be many complexities in assessing the mechanism of association between exposure to air pollution and airways exposure, including susceptibility states, comorbidity from respiratory disorders, tolerance, and the attack rate for common viral infections. Some jurisdictions have proposed to use the frequency of asthmatic episodes as a means to set air pollution standards. The current state of the art, ...
Environmental and occupational epidemiology are in the tradition of "critical science."... more Environmental and occupational epidemiology are in the tradition of "critical science." Critical science is a mode of science in which scientific methods are used to critique the adverse consequences of technological development. Critical science should be explicitly recognized as a paradigm in interdisciplinary research. It is the "mode" in which environmental and occupational epidemiology function and the role that these and related disciplines play in society. As the feedback to society on the performance of technology, critical science has assumed a major role in modern society by providing an acceptable critique of technological development. The close association between scientific research and technology of the last three and one-half centuries has been the exception to the historical rule. Intelligent guidance of technology in modern society makes public participation and education in scientific, biomedical, and technical affairs imperative. Critical scien...
The design of monitoring and surveillance programs is advancing rapidly. Surveillance is a strate... more The design of monitoring and surveillance programs is advancing rapidly. Surveillance is a strategy to determine a group experience with a particular disease outcome, while monitoring focuses on the overall health experience of the group. Screening tests for early detection of abnormalities related to exposure are selected on the basis of sensitivity, specificity and the prevalence of the abnormality. Family physicians are increasingly involved in these programs, and must understand their rationale and legal framework.
Hospitals present a variety of infectious, chemical and physical hazards to their workers. Import... more Hospitals present a variety of infectious, chemical and physical hazards to their workers. Important pathogens include AIDS, hepatitis B and rubella viruses and Mycobacterium tuberculosis. Ethylene oxide is probably the greatest chemical hazard, but anesthetic gases, antineoplastic drugs and skin irritants or sensitizers are significant hazards as well. Hospitals also have poor safety records. A well-organized occupational health service that includes a physician, or a nurse with medical backup, and good records saves more than it costs.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1989
I llness and death due to environmental heat are important public health concerns, particularly f... more I llness and death due to environmental heat are important public health concerns, particularly for workers performing strenuous labour. Heat stroke, the most severe of the illnesses, is characterized by a substantially elevated core body temperature (40.5°C or more), hot dry skin and profound dysfunction of the central nervous system; it is often fatal despite aggressive therapy. Although heat stroke usually occurs in high ambient temperatures, cases have been reported in which the temperature was as low as 16°C, but the workers were wearing clothing that retained excess heat.' We report two cases of occupational death due to heat stroke.
Comparatively little attention has been given to the health implications of global ecological cha... more Comparatively little attention has been given to the health implications of global ecological changes on human health, with the exception of concern over ozone depletion leading to an increased frequency of ultraviolet irradiation-induced skin cancer and cataracts. The implications for human health of five large-scale ecological disruptions were explored: climate change (greenhouse effect), ozone depletion, acid precipitation, transregional pollution, and demographic changes. Limitations of presently available data and the uncertainty of current interpretations of apparent trend is emphasized. Rigorous assessment of the effects of these changes and the response required from public health professionals is needed. This overview provides a point of departure.
Our emphasis in the past has been on disease prevention rather than health promotion. This emphas... more Our emphasis in the past has been on disease prevention rather than health promotion. This emphasis served us reasonably well when morbidity was high throughout society and when interventions at the community level were able to achieve massive reductions. It is not faring as well now that the major shared environmental determinants of disease have been controlled. The present situation calls for changes in individual health-related behaviour and individual clinical interventions to achieve comparable progress. As difficult to win as collective commitments to community-level interventions have been, compliance in a free society by often unmotivated persons in numerous individual instances of decision making in daily life is even more difficult. Health promotion offers the promise of a quantum leap in improving the health status of the community by participating in behaviour perceived as not only responsible but appropriate and desirable, providing positive reinforcement rather than anxiety-provoking caution. Favourable social trends, such as physical conditioning and dietary changes may be encouraged through media interventions. There are biological limitations to this approach, however. Many healthful practices confer little benefit on large groups of people and a few may be harmful to selected groups. Vigorous promotion of weight reduction and obesity control, for example, may lead to profound dissatisfaction with body image and to severely self-destructive behaviour among those prone to eating disorders such as anorexia, bulimia, and obsessive eating. Health promotion activities may fit well with social trends but their adverse potential can be aggravated because failure to comply can be penalized by peer disapproval in a way that disease prevention strategies usually are not.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Occupational and Environmental Medicine, 1999
We evaluated the efficacy of a support group for injured workers as a low-cost intervention that ... more We evaluated the efficacy of a support group for injured workers as a low-cost intervention that might modify chronicity and improve outcome among workers' compensation claimants with chronic musculoskeletal disorders. This study examined the impact of support groups on injured workers with musculoskeletal injuries in relation to four health indicators: pain, somatization, depression, and pain-locus-of-control. We held nine support groups between October 1992 and March 1994. A total of 62 subjects completed the groups. The evaluation of the support group program employed a type of quasi-experimental design, a nonequivalent control group design. A comparison group was created for purposes of evaluation from Workers' Compensation Board of Alberta claimants who did not participate in the groups. We found that participation in the support groups did not seem to affect the well-being of injured workers by reducing their levels of pain, somatization, and depression, and/or by altering their pain-locus-of-control. The results do not necessarily rule out any beneficial effects of participating in support groups. However, these methods applied to this type of support group showed no demonstrable effect.
Human health studies emphasize the link between the human body and the immediate influences upon ... more Human health studies emphasize the link between the human body and the immediate influences upon it. Ecosystem health studies (defined by David Rapport et al., this volume) has, as its primary objective, the relationships and system characteristics of viable ecosystems. As a practical application, ecosystem health studies describe the mechanisms and assesses the potential to threaten or enhance human health.
The border between the United States and Mexico presents a number of problems related to health t... more The border between the United States and Mexico presents a number of problems related to health that are simultaneously local and international. Large-scale government-to-government interactions have generally failed to achieve lasting cooperation on important health issues, with a few important exceptions. One reason for this may be that the issues have been complicated by much larger and more complex social, cultural, economic, and political differences. Another is that large organizations must each function according to their own mandates, goals, and procedures and may not mesh well with others, even with nominal counterparts. In 1981 we conceptualized a model for encouraging binational cooperation on small-scale local projects. The model incorporates three elements: a significant and difficult but soluble technical problem affecting both sides of the border (the "technocratic factor"), a mutually respected individual or team whose function is to facilitate communication and prevent misunderstandings (the "human factor"), and the actions of governments or institutions larger than the working groups (the "institutional factor"). Subsequently, we applied the model to water quality and to the distribution of sources of toxic substances in the border area, which met the criteria for the technocratic factor. Two highly respected figures in environmental health, one American and one Mexican, mediated between colleagues on either side of the border and facilitated the development of projects. Finally, after the projects had been under way long enough to have demonstrated their viability and personal interactions among the principals had become trusting and collegial, the institutional factor was admitted and major financial and administrative support obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of investigational allergology & clinical immunology
An important part of the new thinking about asthma is control of preventable risk factors, air po... more An important part of the new thinking about asthma is control of preventable risk factors, air pollution among them. The epidemiological evidence that ground-level ozone, in particular, is an important risk factor for provoking asthmatic attacks is strong. however, the evidence that it increases the prevalence of asthma overall, or mortality from asthma at levels frequently encountered in the developed world is lacking. The mechanism of airway response to ozone may be complex, involving modification of the atopic response to an antigen, rather than simple inflammation. Likewise, there may be many complexities in assessing the mechanism of association between exposure to air pollution and airways exposure, including susceptibility states, comorbidity from respiratory disorders, tolerance, and the attack rate for common viral infections. Some jurisdictions have proposed to use the frequency of asthmatic episodes as a means to set air pollution standards. The current state of the art, ...
Environmental and occupational epidemiology are in the tradition of "critical science."... more Environmental and occupational epidemiology are in the tradition of "critical science." Critical science is a mode of science in which scientific methods are used to critique the adverse consequences of technological development. Critical science should be explicitly recognized as a paradigm in interdisciplinary research. It is the "mode" in which environmental and occupational epidemiology function and the role that these and related disciplines play in society. As the feedback to society on the performance of technology, critical science has assumed a major role in modern society by providing an acceptable critique of technological development. The close association between scientific research and technology of the last three and one-half centuries has been the exception to the historical rule. Intelligent guidance of technology in modern society makes public participation and education in scientific, biomedical, and technical affairs imperative. Critical scien...
The design of monitoring and surveillance programs is advancing rapidly. Surveillance is a strate... more The design of monitoring and surveillance programs is advancing rapidly. Surveillance is a strategy to determine a group experience with a particular disease outcome, while monitoring focuses on the overall health experience of the group. Screening tests for early detection of abnormalities related to exposure are selected on the basis of sensitivity, specificity and the prevalence of the abnormality. Family physicians are increasingly involved in these programs, and must understand their rationale and legal framework.
Hospitals present a variety of infectious, chemical and physical hazards to their workers. Import... more Hospitals present a variety of infectious, chemical and physical hazards to their workers. Important pathogens include AIDS, hepatitis B and rubella viruses and Mycobacterium tuberculosis. Ethylene oxide is probably the greatest chemical hazard, but anesthetic gases, antineoplastic drugs and skin irritants or sensitizers are significant hazards as well. Hospitals also have poor safety records. A well-organized occupational health service that includes a physician, or a nurse with medical backup, and good records saves more than it costs.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 1989
I llness and death due to environmental heat are important public health concerns, particularly f... more I llness and death due to environmental heat are important public health concerns, particularly for workers performing strenuous labour. Heat stroke, the most severe of the illnesses, is characterized by a substantially elevated core body temperature (40.5°C or more), hot dry skin and profound dysfunction of the central nervous system; it is often fatal despite aggressive therapy. Although heat stroke usually occurs in high ambient temperatures, cases have been reported in which the temperature was as low as 16°C, but the workers were wearing clothing that retained excess heat.' We report two cases of occupational death due to heat stroke.
Comparatively little attention has been given to the health implications of global ecological cha... more Comparatively little attention has been given to the health implications of global ecological changes on human health, with the exception of concern over ozone depletion leading to an increased frequency of ultraviolet irradiation-induced skin cancer and cataracts. The implications for human health of five large-scale ecological disruptions were explored: climate change (greenhouse effect), ozone depletion, acid precipitation, transregional pollution, and demographic changes. Limitations of presently available data and the uncertainty of current interpretations of apparent trend is emphasized. Rigorous assessment of the effects of these changes and the response required from public health professionals is needed. This overview provides a point of departure.
Our emphasis in the past has been on disease prevention rather than health promotion. This emphas... more Our emphasis in the past has been on disease prevention rather than health promotion. This emphasis served us reasonably well when morbidity was high throughout society and when interventions at the community level were able to achieve massive reductions. It is not faring as well now that the major shared environmental determinants of disease have been controlled. The present situation calls for changes in individual health-related behaviour and individual clinical interventions to achieve comparable progress. As difficult to win as collective commitments to community-level interventions have been, compliance in a free society by often unmotivated persons in numerous individual instances of decision making in daily life is even more difficult. Health promotion offers the promise of a quantum leap in improving the health status of the community by participating in behaviour perceived as not only responsible but appropriate and desirable, providing positive reinforcement rather than anxiety-provoking caution. Favourable social trends, such as physical conditioning and dietary changes may be encouraged through media interventions. There are biological limitations to this approach, however. Many healthful practices confer little benefit on large groups of people and a few may be harmful to selected groups. Vigorous promotion of weight reduction and obesity control, for example, may lead to profound dissatisfaction with body image and to severely self-destructive behaviour among those prone to eating disorders such as anorexia, bulimia, and obsessive eating. Health promotion activities may fit well with social trends but their adverse potential can be aggravated because failure to comply can be penalized by peer disapproval in a way that disease prevention strategies usually are not.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Occupational and Environmental Medicine, 1999
We evaluated the efficacy of a support group for injured workers as a low-cost intervention that ... more We evaluated the efficacy of a support group for injured workers as a low-cost intervention that might modify chronicity and improve outcome among workers' compensation claimants with chronic musculoskeletal disorders. This study examined the impact of support groups on injured workers with musculoskeletal injuries in relation to four health indicators: pain, somatization, depression, and pain-locus-of-control. We held nine support groups between October 1992 and March 1994. A total of 62 subjects completed the groups. The evaluation of the support group program employed a type of quasi-experimental design, a nonequivalent control group design. A comparison group was created for purposes of evaluation from Workers' Compensation Board of Alberta claimants who did not participate in the groups. We found that participation in the support groups did not seem to affect the well-being of injured workers by reducing their levels of pain, somatization, and depression, and/or by altering their pain-locus-of-control. The results do not necessarily rule out any beneficial effects of participating in support groups. However, these methods applied to this type of support group showed no demonstrable effect.
Human health studies emphasize the link between the human body and the immediate influences upon ... more Human health studies emphasize the link between the human body and the immediate influences upon it. Ecosystem health studies (defined by David Rapport et al., this volume) has, as its primary objective, the relationships and system characteristics of viable ecosystems. As a practical application, ecosystem health studies describe the mechanisms and assesses the potential to threaten or enhance human health.
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Papers by TL Guidotti