APPROACHES TO THE ALCOHOL PROBLEM IN THE WORKPLACE

The main problem areas posed by either alcohol or alcoholismin the workplace are identified as alcohol-related accidents,reduced work performance and loss of working time. In additionto the heavy costs of these problems for industry, it is suggestedthat a further and generally ignored burden comes from the prematuredeath in middle life of alcoholics who will include a disproportionatelylarge number of top management and more skilled employees. Acomparison with the history of alcohol-related road trafficaccidents suggests that there is scope for large savings froman effective campaign to reduce the incidence of alcohol-relatedproblems in the workplace. An outline is given of the managerial steps involved in settingup and running a company alcohol programme and North Americanand early U.K. experience is assessed to indicate the approachesmost likely to lead to effective prevention. An analysis isattempted of the conditions needed for effectiveness and thereasons for the reported high success rate of many existingprogrammes. Background information is provided of the resourcesavailable to assist such a project, including specialist organizations,publications, videos and facilities for staff training.     

The Impact of Modern Noninvasive Cardiac Imaging on Coronary Intervention Rates

Objectives

It remains still unclear whether the use of modern noninvasive diagnostic modalities for evaluation of coronary artery disease (computed tomography coronary angiography (CTCA), nuclear myocardial perfusion imaging (MPI)) were able to change the “diagnostic yield” of invasive coronary angiography (ICA).

Methods

The total number of ICA in the years 2000–2009 was related to the number of percutaneous interventions (PCIs) and we assessed whether there was a significant trend over time using time series analyses. We compared these data with the number of patients undergoing CTCA and nuclear MPI in the same time period.

Results

During the 10‐year observational period, 23,397 ICA were performed. The proportion of purely diagnostic ICA (without PCI) remained stable over the whole study period (tau = ?0.111, P = 0.721). A CTCA program was initiated in 2005 and 1,407 examinations were performed until 2009. Similarly, the number of nuclear MPI increased from 2,284 in the years 2000–2004 to 5,260 in the years 2005–2009 (P = 0.009).

Conclusion

Despite increasing availability, noninvasive testing modalities did not significantly alter the rate of purely diagnostic ICA, and still are underused as gatekeeper to ICA. Further effort is needed to optimize the use of noninvasive imaging modalities in the work‐up process for coronary artery disease. (J Interven Cardiol 2014;27:50–57)

     

Elevated serum triiodothyronine and intellectual and motor disability with paroxysmal dyskinesia caused by a monocarboxylate transporter 8 gene mutation

Monocarboxylate transporter 8 ( MCT8 or SLC16A2) is important for the neuronal uptake of triiodothyronine (T3) in its function as a specific and active transporter of thyroid hormones across the cell membrane, thus being essential for human brain development. We report on a German male with Allan–Herndon–Dudley syndrome presenting with severe intellectual and motor disability, paroxysmal dyskinesia combined with truncal muscular hypotonia, and peripheral muscular hypertonia at his current age of 9 years. Additionally, the patient has a lesion in the left putamen region revealed by magnetic resonance imaging and elevated serum T3 levels. The male appeared to have a hemizygous mutation (R271H) in the MCT8 gene that was sequenced directly from genomic DNA and occurred de novo in the maternal germline, as both his mother and his sister were not carriers of the mutation. Ruling out a common polymorphism, 50 normal individuals of the same ethnic background did not harbour the mutation. The identified MCT8 gene mutation (R271H) is very likely to be the genetic cause for neuronal hypothyroidism despite elevated serum T3 levels.     

Binomial cokriging for estimating and mapping the risk of childhood cancer

The incidences of human diseases vary from place to place, andthis is also likely to be so for the risk of people developingmany of them. We have analysed the spatial distribution of childhoodcancer in the West Midland Health Authority Region of Englandfrom 1980 to 1984. This is a rare disease which is consideredto be noncontagious. The observed frequencies of the diseasein the electoral wards have been converted to proportions thatestimate the risk of a child's developing it. The spatial autocorrelationof the risk, expressed in the variogram, was determined in anovel way from the proportions within electoral wards by treatingthem as binomial variables dependent on the risk and the numbersof children in the wards. The observed variogram was modelledby Whittle's elementary two-dimensional correlation. Covariancesof the proportion and cross covariances between the proportionand the risk were derived, and from the latter and the proportionsthe risk was estimated in two ways by a form of cokriging: ordinaryand conditional unbiased cokriging. The variogram of the riskshows strong autocorrelation, and the kriged estimates, whenmapped, have a distribution that is far from even. There arepatches where the estimated risk is large, especially in therural south west and the suburban north east; and there areother patches, notably the more densely populated areas, whereit is small.