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REASON FOR PERFORMING STUDY: It is the impression of some surgeons that geriatric horses have a lower survival rate compared to mature nongeriatric horses following colic surgery. One possible reason for this is that geriatric horses may be more critically ill at admission and have more severe disease than mature nongeriatric horses. OBJECTIVE: To compare admission historical, physical examination and laboratory data for geriatric and mature nongeriatric horses referred for signs of colic. METHODS: Medical records of horses admitted with a presenting complaint of colic between 2000 and 2006 were reviewed. Geriatric horses ≥16 years (n = 300) and mature nongeriatric horses 4-15 years (n = 300). Information obtained included duration of colic prior to admission, admission level of pain, heart rate, intestinal borborygmi, packed cell volume (PCV), plasma creatinine and blood lactate concentrations and peritoneal fluid total protein. Data were analysed using a Chi-squared test or an analysis of variance. Level of significance was P<0.05. RESULTS: There was no difference between geriatric and mature horses in the duration of colic prior to admission or in admission heart rate, PCV, or plasma creatinine or blood lactate concentrations. However, geriatric horses were more likely to be moderately painful and less likely to be bright and alert than mature horses; and less likely to have normal intestinal borborygmi than mature horses. Peritoneal fluid total protein concentration was higher in geriatric than mature horses. CONCLUSIONS AND POTENTIAL RELEVANCE: Geriatric horses presenting with signs of colic had a similar admission cardiovascular status based on heart rate, PCV, and plasma creatinine and blood lactate concentration to mature horses. Geriatric horses, however, may have different causes of colic, which may be more serious than mature horses based on pain, lack of intestinal borborygmi and peritoneal fluid total protein concentration.

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REASON FOR PERFORMING STUDY: Owners and veterinarians are often concerned about mortality of geriatric horses following colic surgery. OBJECTIVE: To compare treatment, diagnosis and short-term survival for geriatric compared to mature nongeriatric horses with colic. METHODS: Medical records of horses admitted with a presenting complaint of colic between 2000 and 2006 were reviewed. Geriatric horses were aged ≥16 years (n = 300) and subcategorised as age ≥20 years (n = 134). Mature nongeriatric horses were age 4-15 years (n = 300). Information obtained included medical (included horses subjected to euthanasia without surgery) vs. surgical management, lesion location, type and classification, surgical procedures performed and short-term survival. Data were analysed using a Chi-squared test or an analysis of variance. Level of significance was P<0.05. RESULTS: The overall short-term survival of geriatric horses was lower than that for mature horses (59 vs. 76%, respectively). The survival of medically managed geriatric horses was lower than that for mature horses (58 vs. 80%, respectively). The survival of surgically managed geriatric horses was not different to that for mature horses (59 vs. 70%, respectively) except for geriatric horses age ≥20 years (53%). There was no difference in survival between geriatric and mature horses with small (86 and 83%, respectively) or large (78 vs. 70%, respectively) intestinal strangulating lesions or those undergoing jejunojejunostomy (75 vs. 70%, respectively). Geriatric horses with a large colon simple obstruction had a lower survival compared to mature horses (80 vs. 97%, respectively). CONCLUSIONS AND POTENTIAL RELEVANCE: The survival of geriatric horses with a strangulating lesion or requiring jejunojejunostomy was not different to that for mature horses. Geriatric horses presenting with colic were more likely than mature horses to be subjected to euthanasia without surgery (i.e. lower survival with medical treatment). Geriatric horses undergoing surgery for a large colon simple obstruction had a lower survival than mature horses.

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BACKGROUND AND METHODS: From a statewide medical examination program, we identified firefighters who were deemed unfit for duty by attending physicians (ATTENDING FAIL, n=9) and those who would have been disqualified by the application of selected numerical criteria from the 1997 National Fire Protection Association (NFPA) guidelines (NFPA FAIL, n=27) and criteria from a Medical Workshop (WORK FAIL, n=16). The subjects who were unfit for duty or failed numerical criteria were compared with those who were fit for duty and passed all objective criteria (FIT group, n=302). All subjects were given an overall morbidity rating by a board certified internist. Comparisons on two surrogate measures of fitness, VO(2) max predicted and predicted coronary heart disease (CHD) risk, were also performed. RESULTS: We found a significant tendency towards worse results (e.g. higher blood pressure or lower spirometric function) among the three FAIL groups compared with the FIT group. The FAIL groups shared only a small overlap, however, with the firefighters with the highest morbidity ratings, lowest predicted VO(2) max, and highest CHD risks. Increasing morbidity was associated with higher age, lower spirometric function, lower predicted VO(2) max, increasing cholesterol, greater BMI, and higher predicted 10 year CHD risk. CONCLUSIONS: Although the presence of a single serious or poorly controlled condition may render an individual unfit for safe performance as a firefighter, examination of our cohort suggests that multiple risk factor models or overall clinical assessments are superior means of identifying firefighters with poor health status and increased CHD risk.

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We analyzed results from the medical examinations of 340 hazardous materials firefighters and applied various objective standards in simulated fitness for duty determinations. Ten percent had elevated blood pressures, 13% had far visual acuity worse than 20/30 in one or both eyes, and 38% had abnormal audiometry. The strictest standards for resting blood pressure and corrected visual acuity would have failed 2% and 1% of the cohort, respectively. For audiometry, 0%-5% of the cohort would have failed, depending on the hearing requirements set. The strictest hearing standard did not allow for corrective devices so that few failures would be reversible. Visual and audiometric testing and measurement of resting blood pressure all have significant clinical yields. Studies of simulated firefighting are needed to establish minimum hearing requirements and determine whether corrective devices can be worn safely during duty.

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Occupational asthma is common, yet little is known about long-term outcomes in the United States. A case series of 55 (of 72) occupational asthma patients were interviewed in follow-up 31 (+/- 15) months after removal from the cause to evaluate asthma severity and employment outcomes. Standard criteria were used to rate severity. At follow-up, 54 subjects (98%) had active asthma, of which 26 cases (47%) were "severe." Multivariate analysis showed increased risk of "severe" asthma for women (odds ratio [OR] = 13.8; 95% confidence interval [95% CI] = 1.3 to 151.7) and industrial sector workers (OR = 11.9; 95% CI = 1.3 to 109.8). Thirty-eight subjects (69%) were unemployed, risk being greater for those with "severe" asthma (OR = 20.9; 95% CI = 1.9 to 229.8) and for those without a college degree (OR = 7.3; 95% CI = 1.2 to 43.4). These results indicate that occupational asthma is disabling and probably irreversible for most patients referred to a specialty clinic, despite prolonged removal from causative agents. Women, industrial workers, and those with severe asthma or lack of a college degree appear to be at risk for worse outcomes. Greater efforts at primary and secondary prevention should lessen the burden of long-term illness and unemployment due to occupational asthma.

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