Status of practice guidelines in the United States: CDC guidelines as an example

BACKGROUND: Clinical practice guidelines have proliferated in the past several decades, starting with only a handful in the 1980s to over 1000 approved through The National Guideline Clearinghouse in 2002. METHODS: The purposes of this article to review research related to guideline adoption and impact and to make recommendations for assessing the outcomes of guidelines, using the CDC guideline process as an example. RESULTS: Despite the national movement toward standardization of evidence-based practice, few studies have been conducted to assess the costs of guideline development and implementation, and some practice guidelines have been implemented without concomitant assessment on patient outcomes and costs and benefits of changes in care. CONCLUSIONS: An immediate mandate is to ensure that when guidelines are promulgated, they include an evaluation plan, developed by the implementer of the guideline, which takes advantage of existing qualitative and quantitative data and programs (e.g., patient-centered care, quality assurance, risk management) not limited to expensive and sophisticated clinical trials.     

Nasal lavage biomarkers: effects of water damage and microbial growth in an office building

Selected nasal symptoms were studied in personnel who worked in a damp office building that had microbial growth (including Stachybotrys sp.) in mineral fiber insulation and gypsum board. There were also signs of dampness in the floor. Clinical examinations included nasal lavage and peak expiratory flow measurements in 12 subjects in the damp building; an additional 8 subjects in a control building (i.e., no signs of dampness or microbial growth) were also examined. Hygienic air measurements of microorganisms and volatile organic compounds were performed in both buildings. The concentrations of eosinophil cationic protein, myeloperoxidase, and albumin, and the number of subjects with eosinophils in lavage fluid, were higher among office workers in the damp building than among controls. The damp biiilding had greater amounts of total molds and bacteria in its construction than the building materials in nondamp buildings. In addition, an increase of 2-ethyl-1-hexanol in the indoor air was detected in the damp building-a sign of dampness-related alkaline degradation of diethyl-hexyl phthalate in polyvinyl chloride floor coatings. In conclusion, the results of this study indicate that exposures in a damp office building may cause an inflammatory nasal mucosal response. The results also support conclusions of earlier studies, indicating that building dampness is related to respiratory inflammation.     

Work environment effects on labor productivity: an intervention study in a storage building

BACKGROUND: Although increased attention has been focused on the relationship between occupational health and productivity, solid scientific data on this topic are sparse. The purpose of the present case study was to assess the relationship between productivity and work environment in a storage building. MATERIALS AND METHODS: The study was implemented as an intervention consisting of the renovation of a harbor storage facility. The study design consisted of a single group of employees working in the storage hall. The physical and chemical factors, perceived environment, and labor productivity were measured before and after the renovation. RESULTS: As a result of the renovation, thermal conditions, air quality, and lighting conditions improved notably. In addition, the employees' subjective evaluations showed the significant decrease in dissatisfaction ratings. The direct measure for the labor productivity, expressed as zinc tons/work-hour (tn) increased about 9% after the renovation. DISCUSSION: We conclude that increased productivity is most likely related to the combined effect of the improved work environment, i.e., better thermal climate, reduced contaminant concentrations, and better lighting conditions.     

Influence of indoor climate on the sick building syndrome in an office environment. The Danish Indoor Climate Study Group

The influence of indoor climate factors on symptoms of the sick building syndrome was investigated in Greater Copenhagen, Denmark. Altogether, 2369 office workers in 14 buildings, where indoor climate measurements were made, filled out a questionnaire. Multivariate logistic regression analyses of the multifactorial effects on the prevalence of work-related mucosal irritation and work-related general symptoms among the office workers showed that the concentration of macromolecular organic floor dust, the floor covering, the number of workplaces in the office, the age of the building, the type of ventilation, and two easily recognizable factors, the shelf factor and the fleece factor, were associated with the prevalence of symptoms.     

Radium in the environment: exposure pathways and health effects

Radium is a naturally occurring radioactive element in the environment that can exist as several isotopes. Little information is available on the acute (short-term) non-cancer effects in humans. Radium exposure has resulted in acute leukopenia, anemia, necrosis of the jaw, and other effects. Cancer is the major effect of concern. Radium, via oral exposure, is known to cause bone, head, and nasal passage tumors in humans. The US Environmental Protection Agency has not classified radium for carcinogenicity.     

Impact of a hygiene intervention on virus spread in an office building

Viral illnesses have a significant direct and indirect impact on the workplace that burdens employers with increased healthcare costs, low productivity, and absenteeism. Workers' direct contact with each other and contaminated surfaces contributes to the spread of viruses at work. This study quantifies the impact of an office wellness intervention (OWI) to reduce viral load in the workplace. The OWI includes the use of a spray disinfectant on high-touch surfaces and providing workers with alcohol-based hand sanitizer gel and hand sanitizing wipes along with user instructions. Viral transmission was monitored by applying an MS2 phage tracer to a door handle and the hand of a single volunteer participant. At the same time, a placebo inoculum was applied to the hands of four additional volunteers. The purpose was to evaluate the concentration of viruses on workers' hands and office surfaces before and after the OWI. Results showed that the OWI significantly reduced viable phage concentrations per surface area on participants' hands, shared fomites, and personal fomites (p?=?0.0001) with an 85.4% average reduction. Reduction of virus concentrations on hands and fomites is expected to subsequently minimize the risk of infections from common enteric and respiratory pathogens. The surfaces identified as most contaminated were the refrigerator, drawer handles and sink faucets in the break room, along with pushbar on the main exit of the building, and the soap dispensers in the women's restroom. A comparison of contamination in different locations within the office showed that the break room and women's restrooms were the sites with the highest tracer counts. Results of this study can be used to inform quantitative microbial risk assessment (QMRA) models aimed at defining the relationship between surface contamination, pathogen exposure and the probability of disease that contributes to high healthcare costs, absenteeism, presenteeism, and loss of productivity in the workplace.     

Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series

Objective:

Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospitalization. New treatment approaches are needed. We aimed to evaluate the potential utility of addressing eating‐related fear in the treatment of AN using psychotherapy techniques known to be effective in the treatment of anxiety disorders and obsessive compulsive disorder, namely exposure therapy and response prevention.

Method:

We developed a brief treatment intervention for AN (AN‐EXRP) and evaluated its effects in an open series of nine individuals with AN towards the end of acute weight restoration. We focused on eating behavior as the primary outcome, as it is related both to anxiety and to longer term course.

Results:

Change in anxiety with AN‐EXRP was associated with greater caloric intake.

Discussion:

These findings support the anxiety‐centered model of AN and suggest the potential utility of further developing this treatment approach. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)     

The duration and timing of exposure: effects of socioeconomic environment on adult health

OBJECTIVES: This study investigated timing and duration effects of socioeconomic status (SES) on self-rated health at 33 years of age and established whether health risks are modified by changing SES and whether cumulative SES operates through education. METHODS: Data were from the 1958 British birth cohort. Occupational class at birth and at 16, 23, and 33 years of age was used to generate a lifetime SES score. RESULTS: At 33 years of age, 12% of men and women reported poor health. SES at birth and at 16, 23, and 33 years of age was significantly associated with poor health: all ages except 16 years in men made an additional contribution to the prediction of poor health. No large differences in effect sizes emerged, suggesting that timing was not a major factor. Odds of poor health increased by 15% (men) and 18% (women) with a 1-unit increase in the lifetime SES score. Strong effects of lifetime SES persisted after adjustment for education level. CONCLUSIONS: SES from birth to 33 years of age had a cumulative effect on poor health in early adulthood. This highlights the importance of duration of exposure to socioeconomic conditions for adult health.     

Environmental tobacco smoke in an unrestricted smoking workplace: area and personal exposure monitoring.

The objective of this investigation was to determine the extent of areal and day-to-day variability of stationary environmental tobacco smoke (ETS) concentrations in a single large facility where smoking was both prevalent and unrestricted, and to determine the degree of daily variation in the personal exposure levels of ETS constituents in the same facility. The subject facility was a relatively new four-story office building with an approximate volume of 1.3 million ft3. The exchange of outside air in the building was determined to be between 0.6 and 0.7 air changes per hour. Eighty-seven area samples (excluding background) were collected at 29 locations over the course of 6 days of sampling. Locations included offices and cubicles occupied by smokers and nonsmokers, common areas, and the computer and mail rooms. Twenty-four nonsmoking subjects wore personal sampling systems to collect breathing zone air samples on each of 3 days in succession. This generated a total of seventy-two 8-h time-weighted average (TWA) personal exposure samples. In all samples, respirable suspended particulate matter, ultraviolet light-absorbing and fluorescing particulate matter, solanesol, nicotine, and 3-ethenyl pyridine were determined. With the exception of a few locations, tobacco-specific airborne constituents were determined in all samples. Not surprisingly, areas with the highest ETS constituent concentrations were offices and cubicles of smokers. Median and 95th percentile concentrations for all area samples, excluding background, were determined to be 1.5 and 8.7 microg/m3 for nicotine, and 8.2 and 59 microg/m3 for ETS-specific particles (as solanesol-related particulate matter, Sol-PM), respectively. Personal exposure concentrations of ETS components were similar to those levels found in the area samples (median nicotine and Sol-PM concentrations were 1.24 and 7.1 microg/m3, respectively), but the range of concentrations was somewhat smaller. For example, the 95th percentile 8-h TWA nicotine and ETS-specific particle (as Sol-PM) concentrations were 3.58 and 21.9 microg/m3, respectively. Intrasubject variation of daily concentrations ranged from 20% to 60%, depending on the component. Self-reported proximity to smokers was supported by higher ETS concentrations determined from the personal monitors, but only to a modest extent. Although smoking was completely unrestricted inside the main office areas of the facility, ETS levels, either areal or from personal exposure measurements, were lower than those estimated by Occupational Safety and Health Administration to be present in such facilities.     

Microbiological indoor air quality in an office building in Gliwice,Poland: analysis of the case study

Bioaerosols play a significant role in indoor air quality (IAQ) as they can be the cause of several health problems, including acute allergies and infectious diseases. This study aimed to characterize and compare the microbial air quality of air-conditioned (AC) and naturally ventilated (NV) office rooms in the Upper Silesia region of Poland. The bacterial samples were collected during the late spring season. Culturable bacteria were deposited on the nutrient media on Petri dishes to investigate the viable-culturable count (VCC) of bacteria and bacterial community structure using a Biolog GEN III system. In total, 12 species of bacteria were identified, with the most isolated Macrococcus equipercicus, Micrococcus luteus D, Staphylococcus xylosus (indoor), and Bacillus species (outdoor). The indoor mean concentrations of bacterial aerosol ranged from 10² to 10³ CFU m^?3, below Polish proposals for threshold limit standards in office buildings. The indoor-to-outdoor (I/O) ratios indicated that studied air pollutants in the office rooms originated from the indoor air. These results, together with community composition of bacteria, indicate that most of the bacteria present in the studied office building were relatively fresh and of human origin. Multi-antibiotic resistance (MAR) tests showed that the most antibiotic-resistant features were present in Macrococcus species. The office building exposure dose (OBED) and mass median aerodynamic diameter (MMAD) of bacteria aerosol were estimated. The highest value of OBED over the study period was obtained for staff working in offices with natural ventilation (141 CFU kg^?1), in contrast to the value for staff working in offices equipped with air conditioning (about 100 CFU kg^?1). The MMAD of viable airborne bacteria was higher in AC offices (2.4 μm) than in NV offices (2.2 μm).     

Kriged and modeled ambient air levels of benzene in an urban environment: an exposure assessment study

Background  

There is increasing concern regarding the potential adverse health effects of air pollution, particularly hazardous air pollutants (HAPs). However, quantifying exposure to these pollutants is problematic.     

Suggested guidelines for studying the combined effects of occupational exposure to noise and chemicals on hearing

The present document, which describes recommended standardized procedures, aims to assist individual investigators plan a study on the effects of industrial chemicals on the auditory system, collect and analyze environmental and hearing sensitivity data that are accurate and comparable to data acquired by others. This draft document is currently being reviewed by the NoiseChem Research Group. In this peer review stage we are currently accepting critiques and suggestions to this proposal. Investigations on the aforementioned topic are necessary since there is strong evidence that occupational hearing loss may be caused not only by noise but also by exposure to certain chemicals in the work environment. Since some industrial chemicals are known to be ototoxic, it is plausible to expect that if these chemicals occurred in high enough concentrations in the workplace they could affect hearing. Laboratory studies have yielded a finding not expected, namely that when simultaneous exposure to noise and chemicals occur, the hearing loss observed was greater than the expected hearing loss from noise added to the expected hearing loss from the chemical. If this synergism is verified in humans, then changes will be required in the limits that are set for occupational hazards in order to prevent occupational hearing loss.     

Surrounding greenness and exposure to air pollution during pregnancy: an analysis of personal monitoring data

Background: Green spaces are reported to improve health status, including beneficial effects on pregnancy outcomes. Despite the suggestions of air pollution-related health benefits of green spaces, there is no available evidence on the impact of greenness on personal exposure to air pollution.Objectives: We investigated the association between surrounding greenness and personal exposure to air pollution among pregnant women and to explore the potential mechanisms, if any, behind this association.Methods: In total, 65 rounds of sampling were carried out for 54 pregnant women who resided in Barcelona during 2008-2009. Each round consisted of a 2-day measurement of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) and a 1-week measurement of nitric oxides collected simultaneously at both the personal and microenvironmental levels. The study participants were also asked to fill out a time-microenvironment-activity diary during the sampling period. We used satellite retrievals to determine the surrounding greenness as the average of Normalized Difference Vegetation Index (NDVI) in a buffer of 100 m around each maternal residential address. We estimated the impact of surrounding greenness on personal exposure levels, home-outdoor and home-indoor pollutant levels, and maternal time-activity.Results: Higher residential surrounding greenness was associated with lower personal, home-indoor, and home-outdoor PM2.5 levels, and more time spent at home-outdoor.Conclusions: We found lower levels of personal exposure to air pollution among pregnant women residing in greener areas. This finding may be partly explained by lower home-indoor pollutant levels and more time spent in less polluted home-outdoor environment by pregnant women in greener areas.     

The effects of selected social and environmental variables on the eating behavior of adults in the natural environment

The current study investigated the effects of social setting, type of restaurant environment, relative weight, and sex on the number of calories consumed by adults. Subjects were observed in 14 different restaurants by trained observers. Results indicated that both males and females consumed more calories in fast-food restaurants and that they ate more when in groups as compared to when they ate alone. Females ate less in larger as compared to smaller groups of people. Relative weight was not associated with the number of calories consumed. Implications of the results are discussed and possible treatment recommendations are outlined.     

Diffusion of ideas about personal hygiene and contamination in poor countries: evidence from Guatemala

In this paper, we explore the diffusion of beliefs pertaining to the causes of childhood diarrhea in rural Guatemala. The analysis focuses on the importance of interpersonal and impersonal contacts as conduits for information and norms related to hygiene and contamination. Estimates from multivariate models reveal that there is evidence of a diffusion process through social contacts, primarily through interpersonal ones. The analysis also identifies striking differences between (1) the diffusion process related to hygiene (e.g. dirtiness) and that related to contamination (e.g. pathogens); and (2) beliefs about the causes of diarrheal illness among children in general and those among respondents' own children.     

县区CDC急性化学中毒快速应急及控制探讨

目的探讨适合县区CDC急性化学中毒应急与控制体系。方法通过目前存在的问题分析、现所开展工作体会和下一步工作设想,探讨适合县区CDC急性化学中毒控制模式。结果探讨出一种切实、可行的应急体系。结论根据探讨的急性化学中毒应急模式,可以高效、有序、快速的处理急性化学中毒事故,为当地控制化学中毒提供技术支持。     

Prevalence of the sick building syndrome symptoms in office workers before and after being exposed to a building with an improved ventilation system.

OBJECTIVE: To find if the prevalence of symptoms associated with sick building syndrome decreased among office workers after moving to a building with improved ventilation (after controlling for potential confounders). METHODS: Workers in five buildings in 1991 all moved in 1992 into a single building with improved design, operation, and maintenance of the ventilation system. All buildings had sealed windows with mechanical ventilation, air conditioning, and humidification. Workers completed a self administered questionnaire during normal working hours in February 1991 and February 1992. The questionnaire encompassed symptoms of the eyes, nose and throat, respiratory system, skin, fatigue, headache, and difficulty concentrating, personal, psychosocial, and work related factors. During normal office hours of the same week environmental variables were measured. RESULTS: The study population comprised 1390 workers in 1991 and 1371 workers in 1992 who represented more than 80% of the eligible population. The prevalence of most symptoms decreased when workers moved to the new building: skin (54%), respiratory system (53%), nose and throat (46%), fatigue (44%), headache (37%), eyes (23%). These findings were all significant and remained generally similar after controlling for personal, psychosocial, and work related factors. Furthermore, more than 60% of workers symptomatic in 1991 were asymptomatic in 1992 for all types of symptoms. In contrast, less than 15% of workers were asymptomatic in 1991 but symptomatic in 1992 for all types of symptoms. CONCLUSION: In this study, the prevalence of most symptoms usually associated with the sick building syndrome decreased by 40% to 50% after workers were transferred to a building with an improved ventilation system. The results show that it is possible to diminish the prevalence of symptoms associated with the sick building syndrome among office workers occupying a building with mechanical ventilation, air conditioning, and sealed windows.