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Carcinogens in the Workplace

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81. Nicotine Addiction (Diagnosis)

cervical cancer. Anal cancer in both heterosexual men and women also was due largely to cigarette smoking. Interactions between viral factors and tobacco exposure increase cancer risk. Nonsmokers exposed to environmental tobacco smoke have a significantly higher risk of developing cancers and pulmonary diseases. Concentrations of toxins and carcinogens are higher in sidestream smoke. Children exposed to secondhand smoke develop a variety of respiratory disorders and morbidity. Postcessation depression (...) Rev . 2007 Jan 24. CD004493. . Thomas R, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev . 2006 Jul 19. 3:CD001293. . Sowden AJ, Arblaster L. Mass media interventions for preventing smoking in young people. Cochrane Database Syst Rev . 2000. CD001006. . Cahill K, Moher M, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev . 2008 Oct 8. CD003440. . Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane

2014 eMedicine.com

82. Mesothelioma (Diagnosis)

W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD Share Email Print Feedback Close Sections Sections Mesothelioma Overview Practice Essentials Malignancies involving mesothelial cells that normally line the body cavities, including the pleura (see the image below), peritoneum, pericardium, and testis, are known as malignant mesothelioma. Asbestos, particularly the types of amphibole asbestos known as crocidolite and amosite asbestos, is the principal carcinogen implicated (...) cava. Previous Next: Etiology Asbestos , particularly the types of amphibole asbestos known as crocidolite and amosite asbestos, is the principal carcinogen implicated in the pathogenesis of malignant pleural mesothelioma. Exposure to chrysotile asbestos is also associated malignant mesothelioma, but at a lower incidence than occurs with the other types. (The rod-shaped amphiboles are more carcinogenic than the chrysotile.) [ ] Approximately 8 million people in the United States have been exposed

2014 eMedicine.com

83. Mesothelioma (Overview)

Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD Share Email Print Feedback Close Sections Sections Mesothelioma Overview Practice Essentials Malignancies involving mesothelial cells that normally line the body cavities, including the pleura (see the image below), peritoneum, pericardium, and testis, are known as malignant mesothelioma. Asbestos, particularly the types of amphibole asbestos known as crocidolite and amosite asbestos, is the principal carcinogen implicated in the pathogenesis (...) : Etiology Asbestos , particularly the types of amphibole asbestos known as crocidolite and amosite asbestos, is the principal carcinogen implicated in the pathogenesis of malignant pleural mesothelioma. Exposure to chrysotile asbestos is also associated malignant mesothelioma, but at a lower incidence than occurs with the other types. (The rod-shaped amphiboles are more carcinogenic than the chrysotile.) [ ] Approximately 8 million people in the United States have been exposed to asbestos

2014 eMedicine.com

84. Cancer and Rehabilitation (Overview)

by uncontrolled growth and spread of abnormal cells, which can result in death. Cancer is caused by both external factors (eg, chemicals, radiation, viruses) and internal factors (eg, hormones, immune conditions, inherited mutations). Causal factors may act together or in sequence to initiate or promote carcinogenesis. Ten or more years may pass between carcinogenic exposure or inheritance of a mutation and detectable cancer. Today, cancer is treated with surgery, radiation, chemotherapy, hormones

2014 eMedicine.com

85. Cancer and Rehabilitation (Treatment)

by uncontrolled growth and spread of abnormal cells, which can result in death. Cancer is caused by both external factors (eg, chemicals, radiation, viruses) and internal factors (eg, hormones, immune conditions, inherited mutations). Causal factors may act together or in sequence to initiate or promote carcinogenesis. Ten or more years may pass between carcinogenic exposure or inheritance of a mutation and detectable cancer. Today, cancer is treated with surgery, radiation, chemotherapy, hormones

2014 eMedicine.com

86. Organic Solvents (Treatment)

is the appropriate goal. Reducing inhalation, ingestion, or dermatologic exposures may be accomplished by not eating or smoking in the workplace and by improving use of PPE, including masks and breathing apparatuses. Other protective measures are wearing gloves made of latex, Vicryl, or other impermeable material to limit skin absorption and by showering and changing clothes on completion of job tasks. Changing the duration of exposure is also important. This may be accomplished by changing shifts and rotating (...) of the work week 4 mg/L TCE Vinyl chloride None None None Xylene Methylhippuric acid 1.5 g/g at the end of the shift Xylene Xylene * TTCA - 2-thiothiazolidine 4-carboxylic acid. Table 3. Recommended Exposure Limits, Organic Solvents Compound ppm, mg/m, 3 OSHA PEL as TWAs NIOSH REL as TWAs, IDLH ACGIH TLV, STEL Acetone 1000 (2400) 250 (590), 2500 750 (1780) ceiling, 1000 (2380) Acrylamide 0.3 (0.03), 60 level for carcinogenicity None Benzene 10, 25 ceiling, 50 for 10 min 0.1, STEL 1, 500 10 (32) Carbon

2014 eMedicine.com

87. Nicotine Addiction (Overview)

cervical cancer. Anal cancer in both heterosexual men and women also was due largely to cigarette smoking. Interactions between viral factors and tobacco exposure increase cancer risk. Nonsmokers exposed to environmental tobacco smoke have a significantly higher risk of developing cancers and pulmonary diseases. Concentrations of toxins and carcinogens are higher in sidestream smoke. Children exposed to secondhand smoke develop a variety of respiratory disorders and morbidity. Postcessation depression (...) Rev . 2007 Jan 24. CD004493. . Thomas R, Perera R. School-based programmes for preventing smoking. Cochrane Database Syst Rev . 2006 Jul 19. 3:CD001293. . Sowden AJ, Arblaster L. Mass media interventions for preventing smoking in young people. Cochrane Database Syst Rev . 2000. CD001006. . Cahill K, Moher M, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev . 2008 Oct 8. CD003440. . Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane

2014 eMedicine.com

88. Toxic Neuropathy (Treatment)

. . Miller JM, Chaffin DB, Smith RG. Subclinical psychomotor and neuromuscular changes in workers exposed to inorganic mercury. Am Ind Hyg Assoc J . 1975 Oct. 36(10):725-33. . National Institute for Occupational Safety and Health (NIOSH). Tetrachloroethylene. Current Intelligence Bulletin; January 1978. number 20. Occupational Medicine Physician's Guide to Neuropathy in the Workplace Part 3: Case Presentation. J Occup Environ Med . 2009 Jul. 51(7):861-2. . Pleasure DE, Schotland DL. Peripheral (...) neuropathies. Rowland LP, ed. Merritt's Textbook of Neurology . 8th ed. Philadelphia: Lea & Febiger; 1989. 601-26. Rowland LP, ed. Merritt's Textbook of Neurology . 8th ed. Philadelphia: Lea & Febiger; 1989. Rutchik J. Occupational medicine physician's guide to neuropathy in the workplace, part 2: electromyography and cryptogenic and toxic neuropathy. J Occup Environ Med . 2009 May. 51(5):622-5. . Rutchik JS. Occupational medicine physician's guide to neuropathy in the workplace, Part 1. J Occup Environ

2014 eMedicine.com

89. Toxic Neuropathy (Overview)

, 2017 Author: Jonathan S Rutchik, MD, MPH, FACOEM; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Share Email Print Feedback Close Sections Sections Toxic Neuropathy Overview Practice Essentials Toxic neuropathy refers to neuropathy caused by drug ingestion, drug or chemical abuse, or industrial chemical exposure from the workplace or the environment. Distal axonopathy, causing dying-back axonal degeneration, is the most common form. Signs (...) : OSHA - Occupational Safety and Health Association; NIOSH - National Institute of Occupational Safety and Health; ACGIH - American Congress of Governmental Industrial Hygienists; TWA - time-weighted average; TLV - threshold limit value; PEL - permissible exposure limit; REL - recommended exposure limit; ppm - parts per million; STEL - short-term exposure limit; Ca - level for carcinogenicity; C - ceiling, should never be exceeded; ND - not determined Utilizing neurophysiologic testing

2014 eMedicine.com

90. Toxicity, Phosgene (Treatment)

such as superimposed infection. No data suggest carcinogenicity or reproductive/developmental hazards in association with phosgene exposure. Many patients report ongoing exertional dyspnea for months or even years after phosgene exposure despite normalized chest radiographs. Some patients may develop reactive airway dysfunction syndrome (RADS), which is an irritant-induced reactive airway process. These patients may benefit from follow-up pulmonary function testing 2-3 months after phosgene exposure, possibly (...) to include a methacholine challenge test. Chronic low level exposure to phosgene (< 0.1 ppm) in a cohort of almost 800 workers at a uranium enrichment facility during World War II resulted in no documented increase in all-cause mortality or respiratory causes of mortality in 35 years of follow-up when matched with unexposed control workers at the same facility. Mortality/Morbidity The Occupational Safety and Health Administration permissible exposure limit (OSHA PEL) for the workplace is 0.1 ppm (0.4 mg

2014 eMedicine Emergency Medicine

91. Toxic Neuropathy (Follow-up)

to work and reduction of exposure. This clinician may be able to work with the company supervisors or management to improve the work environment. This may occur if the company chooses to substitute the neuropathy-causing agent with a less-toxic agent in the workplace, to change the schedules of workers so that their exposure is less during a period of time, or to promote safer personal protective equipment. Communication between health care provider and management is essential for this individual's (...) with similar metabolism may lead to increased toxicity. Workers, by law, need to be informed of chemicals in the workplace and their potential health hazards. Material safety data sheets (MSDS), per order of Occupational Safety and Health Administration (OSHA), are available to all workers in the workplace. The Emergency Planning and Community Right to Know Act (EPCRA) requires that facilities using, storing, or manufacturing hazardous chemicals make public inventory and report every release to public

2014 eMedicine.com

92. Cancer and Rehabilitation (Follow-up)

by uncontrolled growth and spread of abnormal cells, which can result in death. Cancer is caused by both external factors (eg, chemicals, radiation, viruses) and internal factors (eg, hormones, immune conditions, inherited mutations). Causal factors may act together or in sequence to initiate or promote carcinogenesis. Ten or more years may pass between carcinogenic exposure or inheritance of a mutation and detectable cancer. Today, cancer is treated with surgery, radiation, chemotherapy, hormones

2014 eMedicine.com

93. Toxicity, Phosgene (Overview)

such as superimposed infection. No data suggest carcinogenicity or reproductive/developmental hazards in association with phosgene exposure. Many patients report ongoing exertional dyspnea for months or even years after phosgene exposure despite normalized chest radiographs. Some patients may develop reactive airway dysfunction syndrome (RADS), which is an irritant-induced reactive airway process. These patients may benefit from follow-up pulmonary function testing 2-3 months after phosgene exposure, possibly (...) to include a methacholine challenge test. Chronic low level exposure to phosgene (< 0.1 ppm) in a cohort of almost 800 workers at a uranium enrichment facility during World War II resulted in no documented increase in all-cause mortality or respiratory causes of mortality in 35 years of follow-up when matched with unexposed control workers at the same facility. Mortality/Morbidity The Occupational Safety and Health Administration permissible exposure limit (OSHA PEL) for the workplace is 0.1 ppm (0.4 mg

2014 eMedicine Emergency Medicine

94. Hazmat (Treatment)

in decontamination. Other standards (ie, 29 CFR 1910.132 [d], 1988) delineates that employers must assess the workplace for potential hazards and have employees use (PPE) appropriate for that hazard. Under OSHA standards, an emergency response team is defined as an individual or group who responds to a release of a hazardous material, no matter where it occurs. This regulation initially was intended for hazardous waste operators and emergency response personnel at hazardous waste facilities; however, in the case

2014 eMedicine Emergency Medicine

95. Hazmat (Follow-up)

in decontamination. Other standards (ie, 29 CFR 1910.132 [d], 1988) delineates that employers must assess the workplace for potential hazards and have employees use (PPE) appropriate for that hazard. Under OSHA standards, an emergency response team is defined as an individual or group who responds to a release of a hazardous material, no matter where it occurs. This regulation initially was intended for hazardous waste operators and emergency response personnel at hazardous waste facilities; however, in the case

2014 eMedicine Emergency Medicine

96. Cancer and Rehabilitation (Diagnosis)

by uncontrolled growth and spread of abnormal cells, which can result in death. Cancer is caused by both external factors (eg, chemicals, radiation, viruses) and internal factors (eg, hormones, immune conditions, inherited mutations). Causal factors may act together or in sequence to initiate or promote carcinogenesis. Ten or more years may pass between carcinogenic exposure or inheritance of a mutation and detectable cancer. Today, cancer is treated with surgery, radiation, chemotherapy, hormones

2014 eMedicine.com

97. Late Effects of Childhood Cancer and Treatment (Follow-up)

, and spelling. In addition, school absence continues to be a problem even after children finish therapy. [ ] With the exception of children with brain tumors, childhood cancer survivors’ rates of high school graduation and college attendance are similar to those of controls. Occupational attainment and workplace problems Rates of employment and salaries are similar between survivors and controls, with the exception that cancer survivors have a higher likelihood of being denied entry into the military (...) services. In the past, cancer survivors often experienced problems in the workplace with respect to job discrimination, though more recent studies suggest that such problems are occurring less often. Insurance issues Barriers to obtaining health insurance include refusal of new applications, policy cancellations or reductions, higher premiums, waived or excluded preexisting conditions, and extended waiting periods. A study from North Carolina found that childhood cancer survivors were more likely

2014 eMedicine Pediatrics

98. Passive Smoking and Lung Disease (Treatment)

, Division of Cancer Prevention . 1987. US DHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. US DHHS Public Health Service, Office of the Surgeon General, Office on Smoking . 1990. Fathallah N, Maurel-Donnarel E, Baumstarck-Barrau K, Lehucher-Michel MP. Three-year follow-up of attitudes and smoking behaviour among hospital nurses following enactment of France's national smoke-free workplace law. Int J Nurs Stud . 2012 Feb 18. . Fujishiro K, Stukovsky KD, Roux AD (...) , Landsbergis P, Burchfiel C. Occupational gradients in smoking behavior and exposure to workplace environmental tobacco smoke: the multi-ethnic study of atherosclerosis. J Occup Environ Med . 2012 Feb. 54(2):136-45. . . Priest N, Roseby R, Waters E, et al. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. [update of Cochrane Database Syst Rev. 2003; (3): CD001746; PMID: 12917911]. Cochrane Database of Systematic Reviews . 2008. 4:CD001746. . Gruer

2014 eMedicine Pediatrics

99. Late Effects of Childhood Cancer and Treatment (Overview)

, and spelling. In addition, school absence continues to be a problem even after children finish therapy. [ ] With the exception of children with brain tumors, childhood cancer survivors’ rates of high school graduation and college attendance are similar to those of controls. Occupational attainment and workplace problems Rates of employment and salaries are similar between survivors and controls, with the exception that cancer survivors have a higher likelihood of being denied entry into the military (...) services. In the past, cancer survivors often experienced problems in the workplace with respect to job discrimination, though more recent studies suggest that such problems are occurring less often. Insurance issues Barriers to obtaining health insurance include refusal of new applications, policy cancellations or reductions, higher premiums, waived or excluded preexisting conditions, and extended waiting periods. A study from North Carolina found that childhood cancer survivors were more likely

2014 eMedicine Pediatrics

100. Late Effects of Childhood Cancer and Treatment (Treatment)

, and spelling. In addition, school absence continues to be a problem even after children finish therapy. [ ] With the exception of children with brain tumors, childhood cancer survivors’ rates of high school graduation and college attendance are similar to those of controls. Occupational attainment and workplace problems Rates of employment and salaries are similar between survivors and controls, with the exception that cancer survivors have a higher likelihood of being denied entry into the military (...) services. In the past, cancer survivors often experienced problems in the workplace with respect to job discrimination, though more recent studies suggest that such problems are occurring less often. Insurance issues Barriers to obtaining health insurance include refusal of new applications, policy cancellations or reductions, higher premiums, waived or excluded preexisting conditions, and extended waiting periods. A study from North Carolina found that childhood cancer survivors were more likely

2014 eMedicine Pediatrics

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