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  1. Article: Epidemiology of neurodegeneration in American-style professional football players.

    Lehman, Everett J

    Alzheimer's research & therapy

    2013  Volume 5, Issue 4, Page(s) 34

    Abstract: The purpose of this article is to review the history of head injuries in relation to American-style football play, summarize recent research that has linked football head injuries to neurodegeneration, and provide a discussion of the next steps for ... ...

    Abstract The purpose of this article is to review the history of head injuries in relation to American-style football play, summarize recent research that has linked football head injuries to neurodegeneration, and provide a discussion of the next steps for refining the examination of neurodegeneration in football players. For most of the history of football, the focus of media reports and scientific studies on football-related head injuries was on the acute or short-term effects of serious, traumatic head injuries. Beginning about 10 years ago, a growing concern developed among neurologists and researchers about the long-term effects that playing professional football has on the neurologic health of the players. Autopsy-based studies identified a pathologically distinct neurodegenerative disorder, chronic traumatic encephalopathy, among athletes who were known to have experienced concussive and subconcussive blows to the head during their playing careers. Football players have been well represented in these autopsy findings. A mortality study of a large cohort of retired professional football players found a significantly increased risk of death from neurodegeneration. Further analysis found that non-line players were at higher risk than line players, possibly because of an increased risk of concussion. Although the results of the studies reviewed do not establish a cause effect relationship between football-related head injury and neurodegenerative disorders, a growing body of research supports the hypothesis that professional football players are at an increased risk of neurodegeneration. Significant progress has been made in the last few years on detecting and defining the pathology of neurodegenerative diseases. However, less progress has been made on other factors related to the progression of those diseases in football players. This review identifies three areas for further research: (a) quantification of exposure - a consensus is needed on the use of clinically practical measurements of blows to the head among football players; (b) genetic susceptibility factors - a more rigorous set of unbiased epidemiological and clinical studies is needed before any causal relationships can be drawn between suspected genetic factors, head injury, and neurodegeneration; and (c) earlier detection and prevention of neurodegenerative diseases.
    Language English
    Publishing date 2013-07-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2506521-X
    ISSN 1758-9193
    ISSN 1758-9193
    DOI 10.1186/alzrt188
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  2. Article ; Online: Suicide Mortality Among Retired National Football League Players Who Played 5 or More Seasons.

    Lehman, Everett J / Hein, Misty J / Gersic, Christine M

    The American journal of sports medicine

    2016  Volume 44, Issue 10, Page(s) 2486–2491

    Abstract: Background: There is current disagreement in the scientific literature about the relationship between playing football and suicide risk, particularly among professional players in the National Football League (NFL). While some research indicates players ...

    Abstract Background: There is current disagreement in the scientific literature about the relationship between playing football and suicide risk, particularly among professional players in the National Football League (NFL). While some research indicates players are at high risk of football-related concussions, which may lead to chronic traumatic encephalopathy and suicide, other research finds such a connection to be speculative and unsupported by methodologically sound research.
    Purpose: To compare the suicide mortality of a cohort of NFL players to what would be expected in the general population of the United States.
    Study design: Cohort study; Level of evidence, 3.
    Methods: A cohort of 3439 NFL players with at least 5 credited playing seasons between 1959 and 1988 was assembled for statistical analysis. The vital status for this cohort was updated through 2013. Standardized mortality ratios (SMRs), the ratio of observed deaths to expected deaths, and 95% CIs were computed for the cohort; 95% CIs that excluded unity were considered statistically significant. For internal comparison purposes, standardized rate ratios were calculated to compare mortality results between players stratified into speed and nonspeed position types.
    Results: Suicide among this cohort of professional football players was significantly less than would be expected in comparison with the United States population (SMR = 0.47; 95% CI, 0.24-0.82). There were no significant differences in suicide mortality between speed and nonspeed position players.
    Conclusion: There is no indication of elevated suicide risk in this cohort of professional football players with 5 or more credited seasons of play. Because of the unique nature of this cohort, these study results may not be applicable to professional football players who played fewer than 5 years or to college or high school players.
    MeSH term(s) Adolescent ; Adult ; Cohort Studies ; Football/statistics & numerical data ; Humans ; Male ; Middle Aged ; Retirement ; Seasons ; Suicide/statistics & numerical data ; United States/epidemiology
    Language English
    Publishing date 2016-05-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197482-8
    ISSN 1552-3365 ; 0363-5465
    ISSN (online) 1552-3365
    ISSN 0363-5465
    DOI 10.1177/0363546516645093
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  3. Article ; Online: Mortality of lead smelter workers: A follow-up study with exposure assessment.

    Bertke, Stephen J / Lehman, Everett J / Wurzelbacher, Steven J / Hein, Misty J

    American journal of industrial medicine

    2016  Volume 59, Issue 11, Page(s) 979–986

    Abstract: ... due to lead exposure. Am. J. Ind. Med. 59:979-986, 2016. Published 2016. This article is a U.S ...

    Abstract Background: Lead exposure has been linked to impaired renal function and kidney failure. High lead exposures have been associated with increased mortality from certain cancers, hypertension, cardiovascular disease, and amyotrophic lateral sclerosis (ALS).
    Methods: We extended vital status follow-up on a cohort of 1,990 lead smelter workers by 25 years and computed standardized mortality ratios and rate ratios (RR) stratified by cumulative lead exposure.
    Results: The update added 13,823 person-years at risk and 721 deaths. Increased risk of mortality was observed for the a priori outcomes of lung cancer, cardiovascular disease (including cerebrovascular disease), chronic kidney disease, and ALS. However, of these outcomes, only cardiovascular, cerebrovascular, and chronic kidney diseases were associated with a positive exposure-response in RR analyses.
    Conclusions: This study reaffirms the association of lead exposure with cardiovascular and kidney diseases; however, increased mortality observed for certain cancers is not likely to be due to lead exposure. Am. J. Ind. Med. 59:979-986, 2016. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/chemically induced ; Cardiovascular Diseases/mortality ; Cause of Death ; Female ; Follow-Up Studies ; Humans ; Kidney Diseases/chemically induced ; Kidney Diseases/mortality ; Lead ; Lead Poisoning/complications ; Lead Poisoning/mortality ; Lung Neoplasms/mortality ; Male ; Metallurgy ; Middle Aged ; Occupational Diseases/chemically induced ; Occupational Diseases/mortality ; Occupational Exposure/adverse effects ; Occupational Exposure/statistics & numerical data ; United States/epidemiology
    Chemical Substances Lead (2P299V784P)
    Language English
    Publishing date 2016-06-28
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.22618
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  4. Article ; Online: Author response.

    Lehman, Everett J / Hein, Misty J / Baron, Sherry L / Gersic, Christine M

    Neurology

    2013  Volume 80, Issue 13, Page(s) 1266–1267

    MeSH term(s) Athletic Injuries ; Cause of Death ; Football ; Humans ; Male ; Neurodegenerative Diseases ; Retirement
    Language English
    Publishing date 2013-03-26
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
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  5. Article: Tattooing regulations in U.S. States, 2011.

    Carlson, Valeria P / Lehman, Everett J / Armstrong, Myrna

    Journal of environmental health

    2012  Volume 75, Issue 3, Page(s) 30–37

    Abstract: Tattooing's popularity has led to regulatory concerns because medical complications linked to unsanitary practices can have a lasting health impact. The authors' study sought to determine whether existing state tattooing laws and regulations (rules) ... ...

    Abstract Tattooing's popularity has led to regulatory concerns because medical complications linked to unsanitary practices can have a lasting health impact. The authors' study sought to determine whether existing state tattooing laws and regulations (rules) effectively protect public health. A 10-item checklist was created for each of three types of rules (sanitation, training, and infection control) identified as having the greatest public health impact. State rules were classified as effective if the state scored > or = 7 on all three categories, moderate if > or = 4 in all three categories, minimal if < 4 in one or more categories, and ineffective if < or = 2 in all three categories. Forty-one states have at least one state statute regulating tattooing practice. On the basis of the authors' study criteria, 36 states regulate sanitation effectively; 15 states regulate training effectively; and 26 states regulate infection control effectively. Fourteen states meet the criteria for regulating all three categories effectively. Specific rules vary substantially by state. Public health agencies should encourage states to adopt and enforce effective, evidence-based tattooing rules.
    MeSH term(s) Education/legislation & jurisprudence ; Humans ; Infection Control/legislation & jurisprudence ; Public Health/legislation & jurisprudence ; Sanitation/legislation & jurisprudence ; State Government ; Tattooing/legislation & jurisprudence ; Tattooing/standards ; United States
    Language English
    Publishing date 2012-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 411432-2
    ISSN 0022-0892
    ISSN 0022-0892
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  6. Article: Mortality of workers employed in shoe manufacturing: an update.

    Lehman, Everett J / Hein, Misty J

    American journal of industrial medicine

    2006  Volume 49, Issue 7, Page(s) 535–546

    Abstract: Background: In the late 1970s, the National Institute for Occupational Safety and Health identified two shoe manufacturing facilities where workers experienced relatively "pure" exposures to toluene. A mortality study was conducted through December 31, ... ...

    Abstract Background: In the late 1970s, the National Institute for Occupational Safety and Health identified two shoe manufacturing facilities where workers experienced relatively "pure" exposures to toluene. A mortality study was conducted through December 31, 1982. An original study did not detect elevated leukemia mortality but did detect increased lung cancer mortality. The present study is an update of the mortality of the original cohort.
    Methods: The study cohort consisted of workers employed 1 month or more between 1940 and 1979 at two Ohio shoe manufacturing plants. Vital status was ascertained through December 31, 1999.
    Results: Seven thousand eight hundred twenty eight workers, contributing 300,777 person years, were available for analysis. An excess of lung cancer deaths persisted with additional years of follow-up (SMR = 1.36, 95% confidence interval (CI) = 1.19-1.54). Trend tests did not indicate a positive trend between lung cancer risk and duration of employment. Mortality from leukemia was not significantly elevated in the updated analysis.
    Conclusions: Results indicate a possible association between lung cancer mortality and exposure to chronic, low-levels of organic solvents. Although the strength of this conclusion was weakened by the lack of increasing lung cancer risk in relation to duration of employment, other studies have supported this association.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Air Pollutants, Occupational/adverse effects ; Child ; Dementia/epidemiology ; Female ; Follow-Up Studies ; Humans ; Industry ; Leukemia/mortality ; Life Tables ; Lung Neoplasms/mortality ; Male ; Middle Aged ; Mortality/trends ; Occupational Exposure ; Shoes ; Solvents/adverse effects ; Toluene/adverse effects ; United States/epidemiology
    Chemical Substances Air Pollutants, Occupational ; Solvents ; Toluene (3FPU23BG52)
    Language English
    Publishing date 2006-07
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.20322
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  7. Article ; Online: Body mass index, playing position, race, and the cardiovascular mortality of retired professional football players.

    Baron, Sherry L / Hein, Misty J / Lehman, Everett / Gersic, Christine M

    The American journal of cardiology

    2012  Volume 109, Issue 6, Page(s) 889–896

    Abstract: Concern exists about cardiovascular disease (CVD) in professional football players. We examined whether playing position and size influence CVD mortality in 3,439 National Football League players with ≥ 5 pension-credited playing seasons from 1959 to ... ...

    Abstract Concern exists about cardiovascular disease (CVD) in professional football players. We examined whether playing position and size influence CVD mortality in 3,439 National Football League players with ≥ 5 pension-credited playing seasons from 1959 to 1988. Standardized mortality ratios (SMRs) compared player mortality through 2007 to the United States population of men stratified by age, race, and calendar year. Cox proportional hazards models evaluated associations of playing-time body mass index (BMI), race, and position with CVD mortality. Overall player mortality was significantly decreased (SMR 0.53, 95% confidence interval [CI] 0.48 to 0.59) as was mortality from cancer (SMR 0.58, 95% CI 0.46 to 0.72), and CVD (SMR 0.68, 95% CI 0.56 to 0.81). CVD mortality was increased for defensive linemen (SMR 1.42, 95% CI 1.02 to 1.92) but not for offensive linemen (SMR 0.70, 95% CI 0.45 to 1.05). Defensive linemen's cardiomyopathy mortality was also increased (SMR 5.34, 95% CI 2.30 to 10.5). Internal analyses found that CVD mortality was increased for players of nonwhite race (hazard ratio 1.69, 95% CI 1.13 to 2.51). After adjusting for age, race, and calendar year, CVD mortality was increased for those with a playing-time BMI ≥ 30 kg/m2 (hazard ratio 2.02, 95% CI 1.06 to 3.85) and for defensive linemen compared to offensive linemen (hazard ratio 2.07, 95% CI 1.24 to 3.46). In conclusion, National Football League players from the 1959 through 1988 seasons had decreased overall mortality but those with a playing-time BMI ≥ 30 kg/m2 had 2 times the risk of CVD mortality compared to other players and African-American players and defensive linemen had higher CVD mortality compared to other players even after adjusting for playing-time BMI.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Cardiovascular Diseases/ethnology ; Cardiovascular Diseases/mortality ; Cardiovascular Diseases/physiopathology ; Continental Population Groups ; Humans ; Male ; Middle Aged ; Occupational Exposure/adverse effects ; Retirement ; Risk Factors ; Soccer ; Survival Rate/trends ; United States/epidemiology ; Young Adult
    Language English
    Publishing date 2012-03-15
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 80014-4
    ISSN 1879-1913 ; 0002-9149
    ISSN (online) 1879-1913
    ISSN 0002-9149
    DOI 10.1016/j.amjcard.2011.10.050
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  8. Article ; Online: Neurodegenerative causes of death among retired National Football League players.

    Lehman, Everett J / Hein, Misty J / Baron, Sherry L / Gersic, Christine M

    Neurology

    2012  Volume 79, Issue 19, Page(s) 1970–1974

    Abstract: Objective: To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players.: Methods: This was a cohort mortality study of ... ...

    Abstract Objective: To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players.
    Methods: This was a cohort mortality study of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988. Vital status was ascertained through 2007. For analysis purposes, players were placed into 2 strata based on characteristics of position played: nonspeed players (linemen) and speed players (all other positions except punter/kicker). External comparisons with the US population used standardized mortality ratios (SMRs); internal comparisons between speed and nonspeed player positions used standardized rate ratios (SRRs).
    Results: Overall player mortality compared with that of the US population was reduced (SMR 0.53, 95% confidence interval [CI] 0.48-0.59). Neurodegenerative mortality was increased using both underlying cause of death rate files (SMR 2.83, 95% CI 1.36-5.21) and multiple cause of death (MCOD) rate files (SMR 3.26, 95% CI 1.90-5.22). Of the neurodegenerative causes, results were elevated (using MCOD rates) for both ALS (SMR 4.31, 95% CI 1.73-8.87) and AD (SMR 3.86, 95% CI 1.55-7.95). In internal analysis (using MCOD rates), higher neurodegenerative mortality was observed among players in speed positions compared with players in nonspeed positions (SRR 3.29, 95% CI 0.92-11.7).
    Conclusions: The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Athletic Injuries/complications ; Athletic Injuries/epidemiology ; Athletic Injuries/mortality ; Cause of Death ; Cohort Studies ; Football ; Humans ; Male ; Middle Aged ; Neurodegenerative Diseases/epidemiology ; Neurodegenerative Diseases/etiology ; Neurodegenerative Diseases/mortality ; Reference Values ; Retirement ; Retrospective Studies
    Language English
    Publishing date 2012-09-05
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Intramural
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0b013e31826daf50
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  9. Article ; Online: Compliance with bloodborne pathogen standards at eight correctional facilities.

    Lehman, Everett J / Huy, Janice M / Viet, Susan M / Gomaa, Ahmed

    Journal of correctional health care : the official journal of the National Commission on Correctional Health Care

    2012  Volume 18, Issue 1, Page(s) 29–44

    Abstract: This study had three objectives: (a) to examine compliance with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens (BBPs) Standard at eight correctional facilities, (b) to identify potential barriers to compliance, and (c) to ... ...

    Abstract This study had three objectives: (a) to examine compliance with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens (BBPs) Standard at eight correctional facilities, (b) to identify potential barriers to compliance, and (c) to discuss steps to address these barriers. Eight facilities of different sizes and locations were visited to examine employer adherence to 15 selected BBP risk reduction activities. Facility compliance was less than 50% for four activities: updating exposure control plans, implementing use of appropriate safer medical devices, soliciting employee input on selection of safer devices, and training medical staff when such devices are implemented. Inconsistent compliance may be due to difficulties in applying the standards in the correctional health care work setting. Any BBP training and health communication activities targeted to correctional health care workers should be tailored to the correctional facility setting.
    MeSH term(s) Blood-Borne Pathogens ; Guideline Adherence/statistics & numerical data ; Guidelines as Topic ; Health Services Administration/standards ; Health Services Administration/statistics & numerical data ; Hepatitis B Vaccines/administration & dosage ; Humans ; Infection Control/organization & administration ; Infection Control/statistics & numerical data ; Inservice Training/organization & administration ; Prisons/standards ; Prisons/statistics & numerical data ; Protective Devices/utilization ; United States ; United States Occupational Safety and Health Administration/standards
    Chemical Substances Hepatitis B Vaccines
    Language English
    Publishing date 2012-01
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2233559-6
    ISSN 1940-5200 ; 1078-3458
    ISSN (online) 1940-5200
    ISSN 1078-3458
    DOI 10.1177/1078345811421466
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  10. Article ; Online: Proportionate mortality study of the United Association of Journeymen and Apprentices of the Plumbing and Pipe Fitting Industry.

    Lehman, Everett J / Hein, Misty J / Estill, Cheryl F

    American journal of industrial medicine

    2008  Volume 51, Issue 12, Page(s) 950–963

    Abstract: Background: This study examined causes of deaths among unionized plumbers, pipefitters and allied trades.: Methods: Deaths of union members from the years 1971, 1979, 1987, and 1995 were selected as a representative sample from a computer file ... ...

    Abstract Background: This study examined causes of deaths among unionized plumbers, pipefitters and allied trades.
    Methods: Deaths of union members from the years 1971, 1979, 1987, and 1995 were selected as a representative sample from a computer file provided by the union. These years provided 15,411 deaths for proportionate mortality ratio (PMR) analysis.
    Results: PMRs for lung cancer and asbestosis were significantly elevated compared to U.S. white males. PMRs for chronic disease of the endocardium and cardiomyopathy were also elevated. Elevations were not observed in other a priori causes: laryngeal cancer, lymphatic cancer, and neurological disorders. PMRs for transportation accidents for pipe/steam-fitters were elevated in 1971 and 1979, but not in 1987 or 1995.
    Conclusion: Despite the limitations of a PMR analysis, study results indicate mortality related to asbestos exposure is, and will continue to be, an area of concern for members of the union.
    MeSH term(s) Adult ; Asbestosis/mortality ; Cardiovascular Diseases/mortality ; Causality ; Cause of Death ; Databases, Factual ; Hematologic Neoplasms/mortality ; Humans ; Labor Unions ; Lung Neoplasms/mortality ; Male ; Metallurgy ; Middle Aged ; Occupational Diseases/mortality ; Occupational Exposure ; Occupational Health ; Retrospective Studies ; Survival Analysis ; United States/epidemiology ; Young Adult
    Language English
    Publishing date 2008-12
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 604538-8
    ISSN 1097-0274 ; 0271-3586
    ISSN (online) 1097-0274
    ISSN 0271-3586
    DOI 10.1002/ajim.20640
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