Internet use for prediagnosis symptom appraisal by colorectal cancer patients

Background. This study explored the characteristics of colorectal cancer (CRC) patients who accessed Internet-based health information as part of their symptom appraisal process prior to consulting a health care provider. Method. Newly diagnosed CRC patients who experienced symptoms prior to diagnosis were interviewed. Brief COPE was used to measure patient coping. Logistic and linear regressions were used to assess Internet use and appraisal delay. Results. Twenty-five percent of the sample (61/242) consulted the Internet prior to visiting a health care provider. Internet use was associated with having private health insurance (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.20-5.43) and experiencing elimination symptoms (OR = 1.43; 95% CI = 1.14-1.80) and was marginally associated with age (OR = 0.96; 95% CI = 0.93-0.99). Internet use was not related to delayed medical care seeking. Conclusion. Internet use did not influence decisions to seek medical care. The Internet provided a preliminary information resource for individuals who experienced embarrassing CRC symptoms, had private health insurance, and were younger.     

Cancer in veterinarians

OBJECTIVES—Veterinarians come into contact with several potentially carcinogenic exposures in the course of their occupation. These exposures include radiation, anaesthetic gases, pesticides (particularly insecticides), and zoonotic organisms. This review aims to summarise what is known about the carcinogenic risks in this profession.
METHODS—The levels of exposure to potential carcinogens in the veterinary profession are examined and evidence is reviewed for carcinogenesis of these substances in humans at doses similar to those experienced by veterinarians. The few published studies of cancer in veterinarians are also summarised.
RESULTS—Veterinarians have considerable potential for exposure to several known and potential carcinogens. Risks may be posed by work in clinics with poorly maintained x ray equipment, by use of insecticides, and from contact with carcinogenic zoonotic organisms. The few studies available suggest that veterinarians have increased mortality from lymphohaematopoietic cancers, melanoma, and possibly colon cancer.
CONCLUSIONS—The exposures examined in this review are not unique to the veterinary profession, and, as a consequence, information gathered on the carcinogenic risks of these exposures has implications for many other occupations such as veterinary nurses, animal handlers, and some farmers, as well as dentists, radiographers, and anaesthetists.


Keywords: cancer; veterinarians; occupation     

The use of insecticide treated nets by age: implications for universal coverage in Africa

Background  

The scaling of malaria control to achieve universal coverage requires a better understanding of the population sub-groups that are least protected and provide barriers to interrupted transmission. Here we examine the age pattern of use of insecticide treated nets (ITNs) in Africa in relation to biological vulnerabilities and the implications for future prospects for universal coverage.     

Collaborative research, participatory solutions: research on asbestos in Kuruman, South Africa

The 1998 South African National Asbestos Summit proposed a post-apartheid asbestos policy for the country. In the areas of environmental rehabilitation, health care, and compensation, it envisioned connecting asbestos mitigation to participatory development. In 2001, the Asbestos Collaborative, an international and interdisciplinary team, conducted follow-up research on the recommendations of the 1998 Summit, researching environmental, health, and compensation issues through consultation of documents and interviews with officials in urban areas and with people in Kuruman, a former crocidolite-mining site with high rates of asbestos-related disease. In Kuruman, local opinion supported the recommendations of the Asbestos Summit, insisting that policies to mitigate the problem of asbestos must also address poverty. In the wake of the 2001 research, a new organization, the Asbestos Interest Group (AIG), has been founded to facilitate grassroots participation in asbestos issues. One success of the AIG has been the settlement of a lawsuit by former workers against the former mining company in Kuruman.     

The use of caco-2 cells to estimate fe absorption in humans--a critical appraisal

The Caco-2 cell model is widely used to assess the bioaccessibility/availability of iron from foods and diets. Analysis of iron uptake in this human epithelial cell line is usually preceded by a two-step digestion to simulate the conditions in the stomach and small intestine. Moreover, culturing the cells on inserts permits the measurement of iron transport. The cellular iron uptake is determined by direct measurements using radioisotopes, or indirectly by measurement of ferritin, the intracellular storage form of iron. There is a good correlation between Caco-2 cell uptake and human iron bioavailability for a number of dietary factors known to affect iron absorption. However, recent data suggest that in some cases there is no correlation. Possible reasons for such discrepancies, the benefits, and limitations of the Caco-2 cell model are discussed. In conclusion, in vitro experiments with Caco-2 cells are important tools for ranking foods with respect to bioavailability, for mechanistic studies of iron absorption, and for studies of dietary factors influencing absorption. The results need to be confirmed in humans.     

Injury in Australian veterinarians

BACKGROUND: There are a number of risk factors for traumatic injury in veterinary practice but there is little information on the prevalence of injuries or the factors associated with injury in this profession. AIMS: To identify the prevalence of injuries sustained by veterinarians and the groups most at risk for different types of injury. METHODS: Cross-sectional survey of Australian veterinarians. Subjects were asked whether they had ever had a significant work-related injury, a less serious acute work injury in the last 12 months, a work-related chronic musculoskeletal problem or dog or cat bites. The prevalence of injuries by gender, practice type and decade of graduation were reported and multivariate logistic regression was used to examine the risk of each type of injury. RESULTS: Of 2800 veterinarians, over half (51%) reported a significant work-related injury during their career while 26% of practitioners reported having at least one injury in the previous 12 months. Chronic work-related musculoskeletal problems were reported by 49% of respondents. Dog and cat bites were also very common. After adjusting for graduation year and university, males were more likely than females to have experienced cat or dog bites or have a chronic or significant injury, and large animal veterinarians were most likely to have chronic or significant injuries. CONCLUSIONS: A high injury prevalence was found among Australian veterinarians with large animal practitioners at highest risk. This is the largest study of Australian veterinarians to have been reported and has shown that injuries are common and serious in the profession.     

Trends in exposure of veterinarians to physical and chemical hazards and use of protection practices

Objectives To determine whether exposure to physical and chemical occupational hazards and use of protective practices has changed in recent veterinary graduates, and to describe trends in exposure to occupational hazards and use of protective practices over time. Methods This paper reports on a retrospective cohort study of veterinarians who graduated from any of the four Australian veterinary schools between 1960 and 2000 and were currently in clinical practice. A self-completed postal questionnaire was used to collect personal details, professional history since graduation, and details of occupational hazards and protective practices used. The prevalence of occupational hazards and use of protective practices was examined by decade of graduation adjusting for gender, type of practice and number of hours worked. Results After adjusting for other factors, recent graduates tended to take more X-rays than early graduates—graduates since 1990 were 2.59 times more likely to take more than seven X-rays a week compared with graduates before 1970. Recent graduates were also more likely to personally restrain animals during X-rays but were more likely to use X-ray protection. Of those who undertook surgery, recent graduates were more likely to use anaesthetic waste gas scavengers. Over time, veterinary jobs have become more likely to involve longer hours of surgery, but shorter periods of driving. The use of scavengers for waste anaesthetic gas has increased markedly over time from 3.8% of jobs commencing in the 1960s to over 70% for jobs commencing since 1997. Conclusions This survey is, to our knowledge, the first to examine trends in the occupational health and safety practices of veterinarians. We have shown that occupational health issues are still important in veterinary practice, with most veterinarians exposed to a number of physical and chemical hazards and many using inadequate protection.     

Improving the coverage of the PMTCT programme through a participatory quality improvement intervention in South Africa

Background  

Despite several years of implementation, prevention of mother-to-child transmission (PMTCT) programmes in many resource poor settings are failing to reach the majority of HIV positive women. We report on a data driven participatory quality improvement intervention implemented in a high HIV prevalence district in South Africa.     

The impact of worksite-based health risk appraisal programs on observed safety belt use

This study assessed the effectiveness of worksite-based healthrisk appraisal (HRA) programs, with and without supplementaleducational materials on safety belt use, for increasing obvservedbelt use of program participants. HRA programs were offeredby county public health departments to employees of four manufacturingplants in two states, one with mandatory safety belt use laws,the other without such laws. Two additional worksites servedas no-treatment controls. Treatment consisted of either HRAonly, in which participants completed a questionnaire and laterattended a group counseling session, or HRA + education, whichincluded the same questionnaire and counseling components plusthe presentation of educational materials on habit change, emphasizingsafety belt use, designed specifically for this study. Directobservations of safety belt use were made by trained observersin the worksite parking lots at four times: baseline, post-HRAscreening, post-counseling, and follow-up 2–3 months later.Analyses of changes in observed safety belt use showed thatall HRA treatment groups significantly increased their ratesof use, with improvements ranging from 48 to 124% over baseline.Use of the supplemental educational materials did not produceadditional improvements. There was no significant differencebetween safety belt use increases in states with and withoutmandatory use laws. The observed rates     

The use of participatory action research and ergonomics in the prevention of work-related musculoskeletal disorders in the newspaper industry

The newspaper industry is one of many in which employees are reported to be at risk for work-related musculoskeletal disorders of the upper extremities and low back. The purpose of this 18-month demonstration project was to assess the usefulness of a participatory ergonomics process as a strategy to reduce the risk factors associated with musculoskeletal disorders at a metropolitan newspaper company. The company involved had 455 employees and a daily circulation of 75,200. Employees from both office and production areas participated. The participatory action research approach utilized required investigators to work collaboratively with the study population. Using a five-step continuous improvement process, the ergonomics committee identified and evaluated jobs having ergonomic risk factors. This was followed by the development, implementation, and evaluations of interventions aimed at reducing risk factor exposure. The committee's productivity and participant feedback were used as measures of the committee's effectiveness. During the project period, interventions were implemented in 11 of 12 targeted departments. Participant ratings of effectiveness for different aspects of the ergonomics process were generally favorable. The mean and median cost for ergonomic interventions were $376 and $25, respectively. This project demonstrated that participatory action research could be used to develop and implement ergonomic solutions that reduce the risk factors associated with work-related musculoskeletal disorders.     

Understanding community perceptions of health and social needs in a rural Balinese village: results of a rapid participatory appraisal

This article reviews the process and key recommendations derived from conducting a rapid participatory asset-focused health and social needs assessment in the small traditional rural village of Tulikup, Bali. The assessment aimed to develop recommendations for a community radio station based in Tulikup to promote social change and development. The health and social needs assessment utilized an asset-focused rapid participatory assessment cycle methodological framework, incorporating Annett and Rifkin's (1995) guidelines for rapid participatory appraisals (World Health Organization, Geneva), community-based action research (Sage Publications, California; Stringer, 1996) and asset-based community development. The study explored Tulikup's pre-existing assets and highlights the value of using rapid participatory appraisal techniques as a first step in involving communities in assessing needs and planning meaningful community development strategies. Data was collected over a 3-week in-country period and included interviews with key informants, informal individual and group discussions, field observations and reviews of existing secondary data sources. Triangulation using cultural interpreters, and participatory consultation processes with community members helped ensure data reliability and validity. Recent terrorist attacks in Indonesia and, most notably, Bali, have had widespread economic and social effects throughout Bali. In particular, secondary consequences of unemployment and a reduction in income have had negative impacts on population health and child labour at the village level. The findings and recommendations of the health and social needs rapid assessment have been utilized by the radio station to promote social change and development.     

Promoting participatory research by family physicians

In the past, researchers have inadvertently caused stigmatization of various populations, first by not involving community members and then through publishing negative findings. In contrast, participatory research, which is based on a partnership between researchers and those affected by the issue being studied, promotes the voice of those being researched. This essay highlights key principles, processes, complexities, and challenges of participatory research and outlines when participatory research is not appropriate. It also reflects on the training and skills of family physicians that make them especially suited to participatory research. Family physicians have established clinical partnerships with their patients and sometimes entire communities, are trained in patient-centered care-a good basis for community centered research-and are accustomed to working with uncertainty. In addition, they are frequently pragmatic, interested in questions arising from their patients and communities, and likely to respond well to community requests. The main challenges to participatory research are lack of funding, expertise, and time, which may improve as more funding agencies and universities support this approach to research.     

Bronchodilator responsiveness in swine veterinarians

OBJECTIVE: Swine veterinarians are known to be at risk for respiratory symptoms and airflow obstruction. The present study reassessed the prevalence of respiratory complaints and pulmonary function abnormalities in swine veterinarians and sought to characterize their response to bronchodilators. METHODS: A cross-sectional study was conducted during the American Association of Swine Veterinarians annual meeting. Subjects completed a respiratory symptom and workplace exposure history questionnaire and spirometry. Subjects with airflow obstruction were assessed for a post-bronchodilator response with beta2 agonist administration. RESULTS: Participants included 58 veterinarians (mean age, 45.5 years). Work-related symptoms assessed by questionnaire included rhinitis symptoms (60.3%), cough and chest tightness (55.2%), and wheezing (35.1%). Airflow obstruction was detected in 11/58 (19%) of subjects by spirometry. Only 2/9 (22.2%) met American Thoracic Society criteria for reversibility with bronchodilator administration. CONCLUSIONS: Respiratory symptoms and airway obstruction remain common findings in swine veterinarians. Airflow obstruction was not consistently reversible with beta agonists, suggesting that swine barn exposure may be a risk factor for irreversible airflow obstruction.