Mark Cullen | Stanford University (original) (raw)

Papers by Mark Cullen

Occupational and environmental medicine, Jan 10, 2015

To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expe... more To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expert ratings of job-level psychosocial demand and job control, adjusting for job-level physical demand. Among a cohort of 9260 aluminium manufacturing workers in jobs for which expert ratings of job-level physical and psychological demand and control were obtained during the 2 years following rating obtainment, multivariate mixed effects models were used to estimate relative risk (RR) of minor injury and minor MSD, serious injury and MSD, minor MSD only and serious MSD only by tertile of demand and control, adjusting for physical demand as well as other recognised risk factors. Compared with workers in jobs rated as having low psychological demand, workers in jobs with high psychological demand had 49% greater risk of serious injury and serious MSD requiring medical treatment, work restrictions or lost work time (RR=1.49; 95% CI 1.10 to 2.01). Workers in jobs rated as having low control di...

Comprehensive and updated throughout, this new edition makes it easy to detect, diagnose, and tre... more Comprehensive and updated throughout, this new edition makes it easy to detect, diagnose, and treat the full spectrum of problems caused by occupational or environmental factors, including physical, chemical, and biologic agents. An international cast of experts offers in-depth, authoritative guidance on clinical problems as well as the legal and regulatory issues impacting the practice of occupational and environmental medicine today. Section 1 is on principles and practice. Section 2 on work sectors and special populations includes a chapter on mining. Section 3 on occupational diseases and injuries includes several chapters of relevance to the coal mining industry, including diseases of the lung and pleura covering silicosis, respiratory diseases of coal miners, and malignancies of the respiratory tract and pleura. Section 4 on hazards in the workplace and the environment includes a chapter on mineral dusts. Section 5 covers policy, regulation and control.

American Journal of Psychiatry

Psychiatrists treating patients with depression or nonspecific somatic complaints seldom think of... more Psychiatrists treating patients with depression or nonspecific somatic complaints seldom think of lead intoxication as a possible cause. Because occupational exposure to lead is so common, these disturbances may often be associated with lead intoxication. To facilitate earlier clinical recognition and proper treatment among the many individuals at risk, the authors describe four cases of organic affective disturbance associated with lead intoxication, review the neuropsychiatric disturbances that have been reported with chronic exposure to lead, and report the results of their experience evaluating the psychiatric aspects of lead intoxication among individuals exposed in their work.

Journal of occupational medicine.: official publication of the Industrial Medical Association

Because many occupationally exposed workers are disabled by medically unexplained symptoms, the a... more Because many occupationally exposed workers are disabled by medically unexplained symptoms, the authors set out to develop etiologically, prognostically, and therapeutically distinct diagnostic categories for these patients. Rigorous diagnostic criteria were applied to a sample of 21 patients with disproportionate disability: three patients had typical posttraumatic stress disorders (PTSD), seven had atypical PTSD, and the remainder suffered somatoform disorders. Recognition of PTSD is important because, unlike somatoform disorders, PTSD often responds to appropriate treatment. Some of the factors that may lead to PTSD are discussed, based on the case series. Using case examples, the authors discuss the diagnostic criteria for typical and atypical PTSD; differentiate these from somatoform disorders; and discuss the implications of the study for prevention of PTSD and for case management.

Medicine

Among 31 newly diagnosed cases presented here and in the recent clinical reports reviewed, classi... more Among 31 newly diagnosed cases presented here and in the recent clinical reports reviewed, classic lead intoxication, with colic and anemia, is relatively uncommon. More commonly, manifestations are insidious and range from subtle, often asymptomatic neuropsychiatric and endocrine disturbances to the more classically described neuropathy and arthropathy. Juxtaposing clinical observations and experimental advances, three syndromes of adult inorganic lead intoxication can be discerned. 'Acute' poisoning, usually occurring after brief and intense lead exposure, is often dominated by lead colic, hemolysis and hepatocellular injury are frequently associated. Renal tubular dysfunction and acute encephalopathy may be seen with overwhelming exposure while milder cases may be limited to arthralgia, headache or the like. 'Chronic' intoxication, commonly seen among individuals with ongoing, steady lead exposure, is characterized by nervous system and endocrine impairment, often...

Clinics in Chest Medicine

... Subject, 01 COAL, LIGNITE, AND PEAT; 60 APPLIED LIFE SCIENCES; OCCUPATIONAL DISEASES; HEALTH ... more ... Subject, 01 COAL, LIGNITE, AND PEAT; 60 APPLIED LIFE SCIENCES; OCCUPATIONAL DISEASES; HEALTH HAZARDS; RESPIRATORY SYSTEM DISEASES; EPIDEMIOLOGY;OCCUPATIONAL EXPOSURE; DUSTS; COAL MINERS; COAL MINING; NEOPLASMS; ASTHMA ...

American Journal of Psychiatry

The authors describe a variant of posttraumatic stress disorder that presents as a somatoform dis... more The authors describe a variant of posttraumatic stress disorder that presents as a somatoform disorder. Applying clearly specified diagnostic criteria, they found that seven of 21 patients who were severely disabled by medically unexplained symptoms following occupational exposure to toxic substances had atypical posttraumatic stress disorder, while three patients had typical posttraumatic stress disorder and the remainder suffered from somatoform disorders. Analysis of these cases revealed specific exposure factors and personality characteristics that favor the development of atypical posttraumatic stress disorder. The authors discuss the theoretical, clinical, and therapeutic advantages of this diagnosis.

The American journal of tropical medicine and hygiene

Weekly oral chloroquine prophylaxis for malaria has been associated with impaired antibody respon... more Weekly oral chloroquine prophylaxis for malaria has been associated with impaired antibody response to intradermal rabies vaccination. Experimental data indicate that chloroquine may inhibit yellow fever virus in vitro, yet there has been no clinical evidence to suggest that antibody response to yellow fever vaccine is impaired by concomitant oral administration of chloroquine. A prospective trial was undertaken to evaluate the antibody response to yellow fever 17D vaccine (Connaught Laboratories) of volunteers who were randomized to taking either chloroquine or no drug. Of fifty subjects, 28 were randomized to taking chloroquine, 22 were randomized to taking no drug. Yellow fever 17D vaccine was administered on day 0 and blood sampled on days 0, 14, 35 and 210. Chloroquine was administered weekly for four weeks. There was no significant difference in peak antibody titer by plaque reduction neutralization testing (PRNT) between the group that took chloroquine (mean log peak of recip...

Gastroenterology

The clinical characteristics, laboratory results, and liver biopsy findings of seven workers with... more The clinical characteristics, laboratory results, and liver biopsy findings of seven workers with toxic liver injury associated with exposure to several solvents, including substantial levels of the widely used solvent dimethylformamide, are presented. Three patients had short exposure (less than 3 months), four long exposure (greater than 1 year). Among those with brief exposure, symptoms included anorexia, abdominal pain, and disulfiram-type reaction. Aminotransferases were markedly elevated with the ratio of alanine aminotransferase to aspartate aminotransferase always greater than 1. Liver biopsy showed focal hepatocellular necrosis and microvesicular steatosis with prominence of smooth endoplasmic reticulum, complex lysosomes, and pleomorphic mitochondria with crystalline inclusions. Among workers with long exposure, symptoms were minimal and enzyme elevations modest. Biopsies showed macrovesicular steatosis, pleomorphic mitochondria without crystalloids, and prominent smooth e...

Toxicology and Industrial Health

Proceedings / the ... Annual Symposium on Computer Application [sic] in Medical Care. Symposium on Computer Applications in Medical Care

This paper describes a prototype information sources map (ISM), an on-line information source fin... more This paper describes a prototype information sources map (ISM), an on-line information source finder, for Occupational and Environmental Medicine (OEM). The OEM ISM was built as part of the Unified Medical Language System (UMLS) project of the National Library of Medicine. It allows a user to identify sources of on-line information appropriate to a specific OEM question, and connect to the sources. In the OEM ISM we explore a domain-specific method of indexing information source contents, and also a domain-specific user interface. The indexing represents a domain expert's opinion of the specificity of an information source in helping to answer specific types of domain questions. For each information source, an index field represents whether a source might provide useful information in an occupational, industrial, or environmental category. Additional fields represent the degree of specificity of a source in individual question types in each category. The paper discusses the deve...

Journal of occupational medicine.: official publication of the Industrial Medical Association

Dr. Cullen: The experience with the new research models, starting with the prototypic experience ... more Dr. Cullen: The experience with the new research models, starting with the prototypic experience of the rubber industry studies of the 1970s and expanding to diverse sectors of American industry in the 1980s, has yielded some important lessons for the future. In closing this symposium I shall try to summarize these briefly. Certain strengths of the evolving process seem common to each of the models. Alone and collectively, the new research arrangements have quite apparently served to increase substantially the pool of funds available to the academic sector for the study of occupational health and safety problems. As a consequence, a larger pool of investigators has participated in the research process, greatly strengthening the future academic capability and experience of our fragilely supported teaching centers. Combined with the involvement of the academic centers in the review process, there has been an undeniable broadening and deepening of the nation's research output and l...

Pediatrics

To assess the false positive rate of blood lead (BPb) determinations on samples obtained by finge... more To assess the false positive rate of blood lead (BPb) determinations on samples obtained by fingerstick from children screened in an urban clinic. From a single fingerstick (N = 1573), blood was collected in a capillary tube for determining lead concentration (CPb) by graphite furnace and an additional sample was absorbed onto a filter paper for determining lead concentration (FPb) by atomic absorption spectrophotometry with Delves cup. Zinc protoporphyrin (ZPP) was measured immediately and a confirmatory venous lead (VPb) specimen was obtained at the same visit if the ZPP was > or = 35 micrograms/dL (0.6 mumol/L); children with either a CPb or FPb > or = 15 micrograms/dL (0.7 mumol/L) were later recalled for determining VPb. For the 172 children who had a VPb on the same day as the screening tests, the false positive rates (95% confidence intervals) at a lead threshold of 15 micrograms/dL (0.7 mumol/L) were: CPb, 13.5% (6.7-20.3); FPb, 19.1% (11.8-26.4). Analyses using all 67...

American Journal of Industrial Medicine

This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut... more This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut Division of Vital Statistics death data to determine whether machining fluid exposure is associated with laryngeal cancer risk. Laryngeal cancer cases were compared with oral cancer controls and general population controls. Level of exposure to machining fluids was imputed from the usual occupation and industry on the death certificate. Because exposure was infrequent among females, analysis was limited to males. When cases were compared to oral cancer controls, high exposure to machining fluids was associated with laryngeal cancer (odds ratio = 1.48; 95% confidence interval = 1.01-2.16), with a p-value for trend of 0.08. When cases were compared to population controls, no association between machining fluid exposure and laryngeal cancer was observed. A possible reason for the contrasting results, other than chance, is that exposure data quality for the cases and oral cancer controls ma...

Annals of internal medicine

American Journal of Clinical Nutrition

The purpose of this investigation was to examine the association between dietary intake of vitami... more The purpose of this investigation was to examine the association between dietary intake of vitamin A in the form of retinol and provitamin A carotenoids and the prevalence of bronchial squamous metaplasia in a sample of asbestos workers from an industrial clinic. Bronchial biopsies were obtained from 49 asbestos workers. Pulmonary function testing was done and in-person interviews were conducted to estimate dietary intake of retinol and provitamin A carotenoids, tobacco exposure, and asbestos exposure. Results indicated that workers with metaplasia reported consuming a significantly lower intake of total vitamin A [2000 retinol equivalents (RE)/d] than did subjects without metaplasia (2710 RE/d, P = 0.02). Logistic regression analyses showed that higher intakes of retinol [odds ratio (OR): 0.31; 95% CI: 0.04, 2.44], provitamin A carotenoids (OR: 0.31; 95% CI: 0.03, 2.84), and total vitamin A (OR: 0.29; 95% CI: 0.03, 2.49) were associated with a nonsignificant reduction in the OR for...

Occupational and environmental medicine, Jan 10, 2015

To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expe... more To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expert ratings of job-level psychosocial demand and job control, adjusting for job-level physical demand. Among a cohort of 9260 aluminium manufacturing workers in jobs for which expert ratings of job-level physical and psychological demand and control were obtained during the 2 years following rating obtainment, multivariate mixed effects models were used to estimate relative risk (RR) of minor injury and minor MSD, serious injury and MSD, minor MSD only and serious MSD only by tertile of demand and control, adjusting for physical demand as well as other recognised risk factors. Compared with workers in jobs rated as having low psychological demand, workers in jobs with high psychological demand had 49% greater risk of serious injury and serious MSD requiring medical treatment, work restrictions or lost work time (RR=1.49; 95% CI 1.10 to 2.01). Workers in jobs rated as having low control di...

Comprehensive and updated throughout, this new edition makes it easy to detect, diagnose, and tre... more Comprehensive and updated throughout, this new edition makes it easy to detect, diagnose, and treat the full spectrum of problems caused by occupational or environmental factors, including physical, chemical, and biologic agents. An international cast of experts offers in-depth, authoritative guidance on clinical problems as well as the legal and regulatory issues impacting the practice of occupational and environmental medicine today. Section 1 is on principles and practice. Section 2 on work sectors and special populations includes a chapter on mining. Section 3 on occupational diseases and injuries includes several chapters of relevance to the coal mining industry, including diseases of the lung and pleura covering silicosis, respiratory diseases of coal miners, and malignancies of the respiratory tract and pleura. Section 4 on hazards in the workplace and the environment includes a chapter on mineral dusts. Section 5 covers policy, regulation and control.

American Journal of Psychiatry

Psychiatrists treating patients with depression or nonspecific somatic complaints seldom think of... more Psychiatrists treating patients with depression or nonspecific somatic complaints seldom think of lead intoxication as a possible cause. Because occupational exposure to lead is so common, these disturbances may often be associated with lead intoxication. To facilitate earlier clinical recognition and proper treatment among the many individuals at risk, the authors describe four cases of organic affective disturbance associated with lead intoxication, review the neuropsychiatric disturbances that have been reported with chronic exposure to lead, and report the results of their experience evaluating the psychiatric aspects of lead intoxication among individuals exposed in their work.

Journal of occupational medicine.: official publication of the Industrial Medical Association

Because many occupationally exposed workers are disabled by medically unexplained symptoms, the a... more Because many occupationally exposed workers are disabled by medically unexplained symptoms, the authors set out to develop etiologically, prognostically, and therapeutically distinct diagnostic categories for these patients. Rigorous diagnostic criteria were applied to a sample of 21 patients with disproportionate disability: three patients had typical posttraumatic stress disorders (PTSD), seven had atypical PTSD, and the remainder suffered somatoform disorders. Recognition of PTSD is important because, unlike somatoform disorders, PTSD often responds to appropriate treatment. Some of the factors that may lead to PTSD are discussed, based on the case series. Using case examples, the authors discuss the diagnostic criteria for typical and atypical PTSD; differentiate these from somatoform disorders; and discuss the implications of the study for prevention of PTSD and for case management.

Medicine

Among 31 newly diagnosed cases presented here and in the recent clinical reports reviewed, classi... more Among 31 newly diagnosed cases presented here and in the recent clinical reports reviewed, classic lead intoxication, with colic and anemia, is relatively uncommon. More commonly, manifestations are insidious and range from subtle, often asymptomatic neuropsychiatric and endocrine disturbances to the more classically described neuropathy and arthropathy. Juxtaposing clinical observations and experimental advances, three syndromes of adult inorganic lead intoxication can be discerned. 'Acute' poisoning, usually occurring after brief and intense lead exposure, is often dominated by lead colic, hemolysis and hepatocellular injury are frequently associated. Renal tubular dysfunction and acute encephalopathy may be seen with overwhelming exposure while milder cases may be limited to arthralgia, headache or the like. 'Chronic' intoxication, commonly seen among individuals with ongoing, steady lead exposure, is characterized by nervous system and endocrine impairment, often...

Clinics in Chest Medicine

... Subject, 01 COAL, LIGNITE, AND PEAT; 60 APPLIED LIFE SCIENCES; OCCUPATIONAL DISEASES; HEALTH ... more ... Subject, 01 COAL, LIGNITE, AND PEAT; 60 APPLIED LIFE SCIENCES; OCCUPATIONAL DISEASES; HEALTH HAZARDS; RESPIRATORY SYSTEM DISEASES; EPIDEMIOLOGY;OCCUPATIONAL EXPOSURE; DUSTS; COAL MINERS; COAL MINING; NEOPLASMS; ASTHMA ...

American Journal of Psychiatry

The authors describe a variant of posttraumatic stress disorder that presents as a somatoform dis... more The authors describe a variant of posttraumatic stress disorder that presents as a somatoform disorder. Applying clearly specified diagnostic criteria, they found that seven of 21 patients who were severely disabled by medically unexplained symptoms following occupational exposure to toxic substances had atypical posttraumatic stress disorder, while three patients had typical posttraumatic stress disorder and the remainder suffered from somatoform disorders. Analysis of these cases revealed specific exposure factors and personality characteristics that favor the development of atypical posttraumatic stress disorder. The authors discuss the theoretical, clinical, and therapeutic advantages of this diagnosis.

The American journal of tropical medicine and hygiene

Weekly oral chloroquine prophylaxis for malaria has been associated with impaired antibody respon... more Weekly oral chloroquine prophylaxis for malaria has been associated with impaired antibody response to intradermal rabies vaccination. Experimental data indicate that chloroquine may inhibit yellow fever virus in vitro, yet there has been no clinical evidence to suggest that antibody response to yellow fever vaccine is impaired by concomitant oral administration of chloroquine. A prospective trial was undertaken to evaluate the antibody response to yellow fever 17D vaccine (Connaught Laboratories) of volunteers who were randomized to taking either chloroquine or no drug. Of fifty subjects, 28 were randomized to taking chloroquine, 22 were randomized to taking no drug. Yellow fever 17D vaccine was administered on day 0 and blood sampled on days 0, 14, 35 and 210. Chloroquine was administered weekly for four weeks. There was no significant difference in peak antibody titer by plaque reduction neutralization testing (PRNT) between the group that took chloroquine (mean log peak of recip...

Gastroenterology

The clinical characteristics, laboratory results, and liver biopsy findings of seven workers with... more The clinical characteristics, laboratory results, and liver biopsy findings of seven workers with toxic liver injury associated with exposure to several solvents, including substantial levels of the widely used solvent dimethylformamide, are presented. Three patients had short exposure (less than 3 months), four long exposure (greater than 1 year). Among those with brief exposure, symptoms included anorexia, abdominal pain, and disulfiram-type reaction. Aminotransferases were markedly elevated with the ratio of alanine aminotransferase to aspartate aminotransferase always greater than 1. Liver biopsy showed focal hepatocellular necrosis and microvesicular steatosis with prominence of smooth endoplasmic reticulum, complex lysosomes, and pleomorphic mitochondria with crystalline inclusions. Among workers with long exposure, symptoms were minimal and enzyme elevations modest. Biopsies showed macrovesicular steatosis, pleomorphic mitochondria without crystalloids, and prominent smooth e...

Toxicology and Industrial Health

Proceedings / the ... Annual Symposium on Computer Application [sic] in Medical Care. Symposium on Computer Applications in Medical Care

This paper describes a prototype information sources map (ISM), an on-line information source fin... more This paper describes a prototype information sources map (ISM), an on-line information source finder, for Occupational and Environmental Medicine (OEM). The OEM ISM was built as part of the Unified Medical Language System (UMLS) project of the National Library of Medicine. It allows a user to identify sources of on-line information appropriate to a specific OEM question, and connect to the sources. In the OEM ISM we explore a domain-specific method of indexing information source contents, and also a domain-specific user interface. The indexing represents a domain expert's opinion of the specificity of an information source in helping to answer specific types of domain questions. For each information source, an index field represents whether a source might provide useful information in an occupational, industrial, or environmental category. Additional fields represent the degree of specificity of a source in individual question types in each category. The paper discusses the deve...

Journal of occupational medicine.: official publication of the Industrial Medical Association

Dr. Cullen: The experience with the new research models, starting with the prototypic experience ... more Dr. Cullen: The experience with the new research models, starting with the prototypic experience of the rubber industry studies of the 1970s and expanding to diverse sectors of American industry in the 1980s, has yielded some important lessons for the future. In closing this symposium I shall try to summarize these briefly. Certain strengths of the evolving process seem common to each of the models. Alone and collectively, the new research arrangements have quite apparently served to increase substantially the pool of funds available to the academic sector for the study of occupational health and safety problems. As a consequence, a larger pool of investigators has participated in the research process, greatly strengthening the future academic capability and experience of our fragilely supported teaching centers. Combined with the involvement of the academic centers in the review process, there has been an undeniable broadening and deepening of the nation's research output and l...

Pediatrics

To assess the false positive rate of blood lead (BPb) determinations on samples obtained by finge... more To assess the false positive rate of blood lead (BPb) determinations on samples obtained by fingerstick from children screened in an urban clinic. From a single fingerstick (N = 1573), blood was collected in a capillary tube for determining lead concentration (CPb) by graphite furnace and an additional sample was absorbed onto a filter paper for determining lead concentration (FPb) by atomic absorption spectrophotometry with Delves cup. Zinc protoporphyrin (ZPP) was measured immediately and a confirmatory venous lead (VPb) specimen was obtained at the same visit if the ZPP was > or = 35 micrograms/dL (0.6 mumol/L); children with either a CPb or FPb > or = 15 micrograms/dL (0.7 mumol/L) were later recalled for determining VPb. For the 172 children who had a VPb on the same day as the screening tests, the false positive rates (95% confidence intervals) at a lead threshold of 15 micrograms/dL (0.7 mumol/L) were: CPb, 13.5% (6.7-20.3); FPb, 19.1% (11.8-26.4). Analyses using all 67...

American Journal of Industrial Medicine

This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut... more This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut Division of Vital Statistics death data to determine whether machining fluid exposure is associated with laryngeal cancer risk. Laryngeal cancer cases were compared with oral cancer controls and general population controls. Level of exposure to machining fluids was imputed from the usual occupation and industry on the death certificate. Because exposure was infrequent among females, analysis was limited to males. When cases were compared to oral cancer controls, high exposure to machining fluids was associated with laryngeal cancer (odds ratio = 1.48; 95% confidence interval = 1.01-2.16), with a p-value for trend of 0.08. When cases were compared to population controls, no association between machining fluid exposure and laryngeal cancer was observed. A possible reason for the contrasting results, other than chance, is that exposure data quality for the cases and oral cancer controls ma...

Annals of internal medicine

American Journal of Clinical Nutrition

The purpose of this investigation was to examine the association between dietary intake of vitami... more The purpose of this investigation was to examine the association between dietary intake of vitamin A in the form of retinol and provitamin A carotenoids and the prevalence of bronchial squamous metaplasia in a sample of asbestos workers from an industrial clinic. Bronchial biopsies were obtained from 49 asbestos workers. Pulmonary function testing was done and in-person interviews were conducted to estimate dietary intake of retinol and provitamin A carotenoids, tobacco exposure, and asbestos exposure. Results indicated that workers with metaplasia reported consuming a significantly lower intake of total vitamin A [2000 retinol equivalents (RE)/d] than did subjects without metaplasia (2710 RE/d, P = 0.02). Logistic regression analyses showed that higher intakes of retinol [odds ratio (OR): 0.31; 95% CI: 0.04, 2.44], provitamin A carotenoids (OR: 0.31; 95% CI: 0.03, 2.84), and total vitamin A (OR: 0.29; 95% CI: 0.03, 2.49) were associated with a nonsignificant reduction in the OR for...