Work-related assault injuries among nurses.

Work-related violence is a major public health problem; however, there is a serious deficiency in the knowledge of risk factors for this problem. The purpose of this case-control study was to identify risk factors for work-related assault injuries among nurses. We used unconditional logistic regression to model the dependence of work-related assault injuries on each exposure of interest and the respective confounders. We found a decreased rate for the presence of security personnel (RR = 0.40; 95% CI = 0.19-0.82). We found increased rates for the following factors: the perception that administrators considered assault to be part of the job (RR = 8.14; 95% CI = 3.76-17.60); having received assault prevention training in the current workplace (RR = 4.64; 95% CI = 2.33-9.23); a high (>5) vs. low (<2) patient/personnel ratio (RR = 2.54; 95% CI = 1.13-5.70); working predominantly with patients with mental illness (RR = 3.5; 95% CI = 1.41-8.85); and working with patients who had more than 1- to 4-week and more than 4-week lengths of stay in the institution vs. <1 day (RR = 8.85; 95% CI = 1.58-49.52 and 4.25; 95% CI = 1.17-15.39, respectively).     

Adult glioma in relation to residential power frequency electromagnetic field exposures in the San Francisco Bay area.

In a population-based study, we examined residential power frequency electromagnetic field exposures for 492 adults newly diagnosed with histologically confirmed glioma between August 1, 1991 and April 30, 1994, in the San Francisco Bay area and 462 controls, obtained through random-digit dialing frequency, matched to cases for age, gender, and race. Residential exposure assessment consisted of spot measures with EMDEX (Enertech Consultants, Campbell, CA) meters and wire codes based on characterization and location of nearby power lines. We considered the index residence at the time of the case's diagnosis or the control's interview and all other California residences of each subject for 7 years before study entry. We obtained wire codes for eligible residences of 76% and for index residences of 99% of subjects. Using the Kaune-Savitz wire code classification, the relative risk for longest held residences coded as "high" compared with "low" was 0.9 [95% confidence interval (CI) = 0.7-1.3], while relative risk and 95% CIs for front door spot measures of 1.01-2 milligauss, 2.01-3 milligauss, and higher than 3 milligauss compared with < or =1 milligauss were 1.0 (0.7-1.4), 0.6 (0.3-1.1), and 1.7 (0.8-3.6). Adjustment for age, gender, race, and whether the subject owned the residence did not meaningfully alter these findings, nor did comparisons using index or highest coded residence. Because of potential exposure misclassification and the unknown pertinent exposure period, these data cannot provide strong support against, but clearly do not support an association between, adult glioma and residential power frequency electromagnetic field exposures.     

Measuring treatment outcomes and client satisfaction in a partial hospitalization program

Mental health practitioners are increasingly being called on to evaluate the effectiveness of the treatment they provide. The partial hospitalization component of the mental health industry also has felt this call for outcome research. This article presents the results of one program's attempts to answer that call through an assessment of treatment outcome and client satisfaction at a partial hospitalization program. Participants (N=287) were evaluated at admission, discharge, and 3-month follow-up. The article outlines the procedures used for assessment and uses the results as an example of the type of data that can be obtained through outcomes measurement. The article is intended to provide an example of program evaluation that is easy and inexpensive to administer.     

Epidemiology of rotavirus diarrhea in Egyptian children and implications for disease control.

Reliable epidemiologic data are essential for formulating effective policy to control rotavirus disease through immunization. The objective of this study was to describe the epidemiology of rotavirus diarrhea in a population-based cohort of children under 3 years of age residing in Abu Homos, Egypt, in 1995-1996. Rotavirus diarrhea incidence rates (episodes per person-year) were 0.13 for infants aged <6 months, 0.61 for those aged 6-11 months, 0.17 for those aged 12-23 months, and 0.15 for those aged 24-35 months. Fifty-six percent of children with rotavirus diarrhea had clinical dehydration; 90% of rotavirus diarrheal episodes occurred between July and November. In infants under 1 year of age, receipt of breast milk was associated with a lower incidence of rotavirus diarrhea. No other sociodemographic or environmental factor was found to be significantly associated with rotavirus diarrhea. Of 46 rotavirus isolates with strains identified, 41 (89%) were G serotypes 1 and 2. Rotavirus diarrhea was a major cause of morbidity in this cohort. Promotion of breastfeeding may exert a protective effect in young infants in this setting, but improvements in water and sanitation are unlikely to be effective preventive measures. The use of effective immunization against rotavirus in early infancy should be considered a public health priority.     

Excess mortality from hepatocellular carcinoma in an HCV-endemic township of an HBV-endemic country (Taiwan)

Taiwan is an endemic area of hepatitis B virus (HBV). All previous studies have concluded that HBV is the major cause of hepatocellular carcinoma (HCC) in Taiwan. An HBV- and hepatitis C virus (HCV)-endemic township, Tzukuan, in southern Taiwan has been identified with the prevalence of 24% for HB surface antigen (HBsAg) and 37% for anti-HCV antibodies. To elucidate the aetiology of HCC and impact of HCV in this township, we conducted a case-control study and compared HBV-related liver cancer mortality in Tzukuan and Taiwan as a whole. Based on cancer registration datasets of 2 medical centres from 1991 to 1995, we recruited 18 male and 9 female HCC cases from the study township. Their mean age (+/- standard deviation) was 60.3 (+/- 7.3) years. Randomly sampled from a community-based survey, 4 age- (+/- 2 years) and sex-matched residents were selected as community controls for each HCC case. The HBsAg carrier rate was 40.7% in cases and 25.0% in controls (P = 0.1). Anti-HCV positive rate was 88.9% in cases and 53.7% in controls (P = 0.008). Age-adjusted liver cancer mortality in Tzukuan (36.5 per 10(5)) was significantly higher than that of Taiwan as a whole (20 per 10(5)). Based on the HBsAg-positive rate among HCC patients (40.7% in Tzukuan and 77.4-86.6% in Taiwan), the estimated HBV-related liver cancer mortality was similar in Tzukuan (14.9 per 10(5)) and Taiwan (15.8-17.3 per 10(5)). We concluded that HCV was the major risk factor for excess liver cancer mortality in this HCV-endemic township of the HBV-endemic country.     

A delicate balance: homeostatic control of copper uptake and distribution.

The cellular uptake and intracellular distribution of the essential but highly toxic nutrient, copper, is a precisely orchestrated process. Copper homeostasis is coordinated by several proteins to ensure that it is delivered to specific subcellular compartments and copper-requiring proteins without releasing free copper ions that will cause damage to cellular components. Genetic studies in prokaryotic organisms and yeast have identified membrane-associated proteins that mediate the uptake or export of copper from cells. Within cells, small cytosolic proteins, called copper chaperones, have been identified that bind copper ions and deliver them to specific compartments and copper-requiring proteins. The identification of mammalian homologues of these proteins reveal a remarkable structural and functional conservation of copper metabolism between bacteria, yeast and humans. Furthermore, studies on the function and localization of the products of the Menkes and Wilson's disease genes, which are defective in patients afflicted with these diseases, have provided valuable insight into the mechanisms of copper balance and their role in maintaining appropriate copper distribution in mammals.     

Plutonium fecal and urinary excretion functions: derivation from a systemic whole-body retention function.

Liver-bile secretion directly influences the content of plutonium in feces. To assess the reliability of plutonium metabolic models and to improve the accuracy of interpreting plutonium fecal data, we developed a compartmental model that simulates the metabolism of plutonium in humans. With this model, we can describe the transport of plutonium contaminants in the systemic organs and tissues of the body, including fecal and urine excretions, without using elaborate kinetic information. The parameter values of the models, which describe the translocation rates and recycling of plutonium in the body, can be derived from a multi-term exponential systemic function for whole-body retention. The analytical derivations and algorithms for solving translocation parameter values are established for the model and illustrated by applying them to the biokinetics and bioassay of plutonium. This study describes how to (1) design a physiological model for incorporating liver biliary secretion and for obtaining a fecal-excretion function, (2) develop an analytical solution for identifying the translocation-parameter values incorporating the recycling of plutonium in the body, and (3) derive a set of urinary and fecal excretion-functions from a published systemic whole-body retention function, generally acknowledged to be accurate, as a real and practical example.     

Lumbar vertebral angles and back muscle loading with belts.

The study examined belt effects on the change of lumbosacral angle (LSA) and back muscle activity in postures of standing, erect sitting, and slump sitting. We thought that the resulting changes of LSA and back muscle activity when wearing belts with different mechanical characteristics should be different. Eighteen healthy male subjects participated in this study. Though we failed to identify a significant belt effect on the back muscle EMG, the radiographic data revealed an interactive effect of postures and belts on the change of LSA. In standing, the belts increased LSA by increasing almost every lumbar vertebral angle. In erect sitting, the lumbar belt had no effect but the pelvic belt decreased LSA through a decrease in the L1/L3. While sitting slump with a trunk flexion of 15 degrees, both belts increased LSA by restricting the movement of the pelvis. Belt effect on LSA was accompanied with a change of pelvic angle. Significant correlation was found between the backward rotation angles of the pelvis and the angles of LSA (r = 0.692, p < 0.0001), also between the decrease of pelvic angles and the increase of back muscle EMG (r = -0.4, p = 0.017). A change in LSA and pelvic angle after wearing a belt along with posture change seems lead to an increase of the myoelectric activities on the back.     

Review of animal models in carotenoid research

Foods containing provitamin A carotenoids are the primary source of vitamin A in many countries, despite the poor bioavailability of carotenoids. In addition, epidemiologic studies suggest that dietary intake of carotenoids influences the risk for certain types of cancer, cardiovascular disease and other chronic diseases. Although it would be ideal to use humans directly to answer critical questions regarding carotenoid absorption, metabolism and effects on disease progression, appropriate animal models offer many advantages. This paper will review recent progress in the development of animal models with which to study this class of nutrients. Each potential model has strengths and weaknesses. Like humans, gerbils, ferrets and preruminant calves all absorb beta-carotene (betaC) intact, but only gerbils and calves convert betaC to vitamin A with efficiency similar to that of humans. Mice and rats efficiently convert betaC to vitamin A but absorb carotenoids intact only when they are provided in the diet at supraphysiologic levels. Mice, rats and ferrets can be used to study cancer, whereas primates and gerbils are probably more appropriate for studies on biomarkers of heart disease. No one animal model completely mimics human absorption and metabolism of carotenoids; thus the best model must be chosen with consideration of the specific application being studied, characteristics of the model, and the available funding and facilities.     

Evaluation of Developmentally Appropriate Programs for Adolescent Tobacco Cessation

Despite introduction of numerous smoking prevention programs in schools, tobacco use has not declined among adolescents. Schools face the dilemma of what to do with students who smoke and are not ready to quit. This study evaluated two programs based on the stages of change model. The educational program, the Tobacco Education Group (TEG), was designed for adolescents not yet thinking about quitting. The cessation program, the Tobacco Awareness Program (TAP), was intended for adolescents who want to quit. Evaluation was completed on 351 students at six public high schools. Compared to a control group of adolescent smokers not assigned to programs, both intervention groups significantly decreased tobacco use. Self-reported use was validated biochemically. Self-efficacy for quitting increased in both programs. Posttest use was predicted by posttest self-efficacy, peer support, and parental support, after controlling for initial use and initial self-efficacy.