Factors associated with severity of injury resulting from acute releases of hazardous substances in the manufacturing industry

Data from the Hazardous Substances Emergency Events Surveillance system was used to identify factors associated with the severity of injuries of victims (an ordinal outcome variable) harmed in acute chemical release events in the manufacturing industry. We used proportional odds models to account for the order of severity in the outcome, with the general estimation equation. There were 659 events involving 2826 victims. More severe injuries were associated with explosion (adjusted OR aOR = 6.45), multiple chemicals (aOR = 1.75), multiple chemical categories (aOR = 1.70), the chemical group acids (aOR = 1.6), multiple injuries to an individual (aOR = 1.38-1.56) (ranges represent several models), confinement within a structure in a fixed facility (aOR = 1.76-1.90), and being located in the midwest region (aOR = 1.76-1.90). The summer was less likely than all other seasons to be associated with more severe outcome. The results provide information beneficial for preventive activities.     

Twofold trauma exposure – the dual function of attachment avoidance

Spouses of traumatized war veterans might suffer from distress following indirect exposure to combat and direct exposure to domestic abuse. Yet the effect of this twofold trauma exposure is far from being fully understood. Theory views attachment security as a personal resource mitigating adversity, whereas attachment insecurities intensify distress. Nevertheless, there are mixed results concerning the effects of attachment in the aftermath of trauma. Furthermore, the role of trauma exposure levels regarding the effects of attachment remains largely uninvestigated. Filling these gaps, this study assessed female military spouses 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Direct (domestic abuse) and indirect (veteran partners’ posttraumatic stress symptoms) trauma exposure, attachment, depression, and anxiety were assessed. Findings indicated an interaction between the trauma types in predicting spouses’ anxiety. Domestic abuse moderated the relations between attachment and distress. Although attachment anxiety had nonsignificant effects on anxiety among low-level domestic abuse sufferers, it predicted elevated anxiety among high-level domestic abuse sufferers. Furthermore, while attachment avoidance predicted elevated distress among low-level domestic abuse sufferers, its effects dissolved or became positive in nature among high-level domestic abuse sufferers. Discussion focuses on evolutionary explanations of the functions of attachment under different conditions of threat.     

Secondary traumatization and attachment among wives of former POWs: a longitudinal study

The aim of the present study was to examine the directionality of the association between post-traumatic stress symptoms (PTSS) and attachment insecurities across time among indirect trauma survivors. Wives of former prisoners of war (ex-POWs), with and without post-traumatic stress disorder (PTSD), and comparable controls were assessed 30 (T1) and 38 (T2) years after the Yom Kippur War. As expected, wives of ex-POWs endorsed higher PTSS compared to wives of controls. Wives of ex-POWs with PTSD endorsed higher PTSS and higher attachment avoidance compared to wives of ex-POWs without PTSD and controls. There were significant associations between PTSS and attachment insecurities. Contrary to the hypothesis, the relationship between PTSS and attachment insecurities among wives of ex-POWs was unidirectional, with attachment anxiety at T1 predicting PTSS at T2, and not vice versa. Results indicate that attachment anxiety might act as a risk factor for secondary traumatic reactions.     

A regulatory role for CD72 expression on B cells in systemic lupus erythematosus

Background

B regulatory cells and their regulatory products/markers, such us semaphorin 3A (sema3A) and its receptor NP-1, FcγIIB, IL-10, and others, act at the very base of self-tolerance, maintenance, and prevention of autoimmune disease development.

Objectives

The aim of the present study was to assess the involvement of CD72, a regulatory receptor on B cells, in systemic lupus erythematosus (SLE). In addition, the potential of soluble sema3A in enhancing the expression of CD72 on B cells of SLE patients was investigated.

Results

CD72 expression on activated B cells of SLE patients was significantly lower than that of normal controls. This lower expression of CD72 in SLE patients correlated inversely with SLE disease activity and was associated with lupus nephritis, the presence of anti-dsDNA antibodies, and low levels of complement. Co-culture of purified B cells from healthy controls with condition-media containing recombinant sema3A resulted in significant enhancement of CD72. Similar enhancement of CD72 on activated B cells from SLE patients, though significant, was still lower than in normal individuals.

Conclusions

The lower expression of CD72 on activated B cells from SLE patients correlates with SLE disease activity, lupus nephritis, the presence of anti-dsDNA antibodies, and low levels of complement. The improvement of CD72 expression following the addition of soluble semaphorin 3A suggests that CD72 may be useful as a biomarker to be followed during the treatment of SLE.     

Stress reactions of school-age children to the bombardment by scud missiles: A 1-year follow-up

Follow-up long-term stress effects to bombardment by scud missiles were restudied 1 year following the Persian Gulf war in a group of 326 6th, 8th, and 11th grade children from areas hit and not hit by the missiles. Postwar stress reactions were assessed by a continuous global symptom score (Frederick and Pynoos, 1988) and by a dichotomous PTSD index. Overall, a large drop in stress reactions was obtained with lapse of time. Residual long-term stress reactions were found to be associated with higher immediate (4-week) stress reactions, a greater degree of exposure, and younger age. Results were discussed in relation to residual and evaporation of stress reaction effects as well as in terms of childhood resilience.     

Intradialytic parenteral nutrition in malnourished children treated with hemodialysis.

OBJECTIVE: To examine the feasibility and effectiveness of intradialytic parenteral nutrition (IDPN) in children on hemodialysis. DESIGN: Prospective experimental study with a single intervention group. SETTING: A pediatric hemodialysis unit. SUBJECTS: Four malnourished children on hemodialysis (3 girls and 1 boy) 4 to 18 years of age were studied during a period of 1 year. INTERVENTION: IDPN, which is composed of amino acids (8.5% solution), glucose (as 10% to 15% dextrose), and 20% fat emulsion, was administered at every dialysis session (3 times a week, during 4 hours each time) for 7 to 12 weeks. MAIN OUTCOME MEASURE: Oral caloric intake (evaluated by using a 3-day diet history), dry weight (weight after dialysis), body mass index, percent ideal body weight, total lymphocyte count, and serum levels of albumin before, immediately after cessation of IDPN, and 3 months after cessation of IDPN. RESULTS: Oral caloric intake increased markedly after IDPN administration, from 5 to 63 kcal/kg/d (mean, 33 kcal/kg/d) before IDPN administration to 35 to 177 kcal/kg/d (mean, 86 kcal/kg/d) at the time of cessation. Weight did not change during the treatment period but it did increase from 9.5 to 36.4 kg (mean, 25 kg) to 11 to 39 kg (mean, 26.7 kg) 3 months later. Percent ideal body weight increased from 73% to 88% (mean, 78.5%) to 79% to 90% (mean, 85.1%), and body mass index increased from 12.2 to 15 kg/m(2) (mean, 13.5 kg/m(2)) to 13.4 to 15.5 kg/m(2) (mean, 14.6 kg/m(2)). Total lymphocyte count increased from 538 to 2,041 cells/mm(3) (mean, 1,403 cells/mm(3)) to 724 to 2,884 cells/mm(3) (mean, 2,066 cells/mm(3)). Plasma levels of albumin increased in 1 patient but remained unchanged in others. CONCLUSION: Short-term IDPN treatment may serve as a safe and effective nutritional intervention in malnourished children on hemodialysis.     

Assessing the validity of the Plutchik suicide risk scale

One of the newer scales of suicide risk devised by Plutchik and colleagues was tested to see if it could discriminate between levels of suicide ideation and suicide attempts. A sample of 80 subjects were placed into various categories of suicide risk on the basis of a psychiatric examination. Results showed that the full scale did not adequately discriminate among groups. An explanation of the results has been proposed and a design to test this suggestion described.     

Effect of erythromycin on image quality and transit time of capsule endoscopy： A two-center study

AIM： To compare the effect of oral erythromycin vs no preparation with prokinetics on the transit time and the image quality of capsule endoscopy （CE） in evaluating small bowel （SB） pathology. METHODS： We conducted a retrospective, blinded （to the type of preparation） review of 100 CE studies, 50 with no preparation with prokinetics from one medical center （Group A） and 50 from another center with administration of a single dose of 200 mg oral erythromycin 1 h prior to CE （Group B）. Gastric, SB and total transit times were calculated, the presence of bile in the duodenum was scored, as was cleanliness within the proximal, middle and distal intestine. RESULTS： The erythromycin group had a slightly shorter gastric transit time （21 min vs 28 min, with no statistical significance）. SB transit time was similar for both groups （all P 〉 0.05）. Total transit time was almost identical in both groups. The rate of incomplete examination was 16% for Group A and 10% for Group B （P = 0.37）. Bile and cleanliness scores in different parts of the intestine were similar for the two groups （P 〉 0.05）. CONCLUSION： Preparation for capsule endoscopy with erythromycin does not affect SB or total transit time. It tends to reduce gastric transit time, but it does not increase the cecum-reaching rate. Erythromycin does not adversely affect image quality. We consider the routine use of oral erythromycin preparation as being unjustified, although it might be considered in patients with known prolonged gastric emptying time.     

Hazardous substances releases causing fatalities and/or people transported to hospitals: rural/agricultural vs. other areas

INTRODUCTION: Mass-casualty and hospital preparedness has been analyzed widely. However, information regarding the types of areas where these events occur is limited. Therefore, the characteristics of acute hazardous substances releases resulting in death/multiple-victim events occuring in rural/agricultural areas and in all other areas were studied and compared. METHODS: Data reported to the Hazardous Substances Emergency Events Surveillance (HSEES) system from 16 state health departments during 1993-2000 were used to examine factors associated with events with death/multiple victims involving acute release of hazardous substances. A death/multiple-victim event is defined as any event resulting in a death and/or at least five people being transported to a hospital. RESULTS: Of a total of 43,133 events, 6661 occurred in rural/agricultural areas. Of these, 107 were death/multiple-victim events with 632 victims, of whom 91 died and 77 were hospitalized. All other areas had 472 death/multiple-victim events with 7981 victims, of whom 116 died and 413 were hospitalized. Death/multiple-victim events in rural/agricultural areas were more likely to be associated with transportation (Proportional Ratio (PR) = 4.1, 95% CI = 3.1-5.4) and fires and/or explosions (PR = 1.4, 95% CI = 0.95-2.0) than were death/multiple-victim events in all other areas. Among transportation-related events in rural/agricultural areas, 19 were associated with air transport--mainly crop dusters--and resulted in 18 deaths. Responders were three times more likely to be injured in rural/agricultural areas. Of responders, volunteer firefighters constituted 52% compared with 6.7% in all other areas. The most frequently released chemicals in rural/agricultural areas were ammonia, chlorine, and pesticides. In all other areas, ammonia, chlorine, hydrochloric acid, carbon monoxide, and 0-chlorobenzylidene malononitrile, a tearing agent often associated with an illegal or unauthorized act, were released most frequently. CONCLUSIONS: Findings from this analysis suggest that remedial actions should address safety measures in both transportation and fixed facilities containing acute hazardous substances. These include regular maintenance of equipment, education of workers about the substances used in their facility, rigorous training and licensing of drivers and crop duster operators, and education and training of employees and first responders in the use of protective equipment. These activities may reduce the number of events, casualties, and costs associated with hazardous substance events.