New European Community Strategy for Health and Safety: The Elephant in the Room

Abstract

Although Lithuania has comprehensive health and safety legislation in line with EU requirements, on a range of general health and occupational health and safety (OHS) indicators, it is a poor performer. Survey data suggest that the norm for work in Lithuania is based on a regime of intensification without a participative working environment in which employees have a voice in safety management. Although European-style legislative reforms appear to be having no measurable effects on CHS performance in post-communist New Member States, the EU OHS strategy for 2007–2012 fails to take account of the deteriorated working environments in these states, suggesting that prospects for harmonization of working environment standards in the enlarged Europe may recede with eastward expansion.     

The Role Of Electro-Physiological Tests in the Diagnosis of Non-Organic Hearing Loss

Today it is possible, by the use of newly developed tests, to diagnose cases of non-organic hearing loss with reasonable certainty. Having once decided that there may be non-organic elements, it is useful to supplement routine pure-tone and speech audiometry with a neurophysiological test like an ERA by means of which the auditory threshold can be established without the patients subjective judgement. A hearing loss which is apparent by routine pure-tone audiometry, but which is not evident after ERA is almost certainly non-organic, although confirmation of this state of affairs by other reliable tests is advisable. Measurement of the acoustic reflex thresholds and delayed speech feedback tests are both useful in this respect and rarely cause any confusion, except in some cases of true hearing loss in strongly recruiting ears.     

Male labor migration,patriarchy, and the awareness-behavior gap: HIV risks and prevention among migrants’ wives in Armenia

Unlike in most of the world, HIV incidence in the former Soviet Union continues to rise. While international labor migration has been identified as a potentially important contributor to this trend, most attention has been focused on risks of male migrants themselves. This study uses recent household survey data to examine HIV-related perceptions and actions of migrants’ left-behind wives in Armenia. Multivariate logistic regression analyses show that migrants’ wives are significantly more likely to suspect their husbands of extramarital sex than are non-migrants’ wives. The analyses detect greater worries about HIV infection and a higher likelihood of spousal communication on HIV matters among migrants’ wives, compared to non-migrants’ wives, but these differences are largely explained by the suspicion of husband’s extramarital sex. Finally, no difference between the two categories of women in the probability of consistent condom use with husbands is found. These findings are interpreted within the context of patriarchal culture and unequal gender relations in Armenian society as they are further reinforced by male migration. Implications of these findings for policies to increase women’s awareness of HIV risks associated with migration and their ability to reduce those risks are discussed.     

Potential health risks to adults and children in the UK from exposure to dietary lead in gamebirds shot with lead ammunition

We estimate potential risks to human health in the UK from dietary exposure to lead from wild gamebirds killed by shooting. The main source of exposure to lead in Europe is now dietary. We used data on lead concentrations in UK gamebirds, from which gunshot had been removed following cooking to simulate human exposure to lead. We used UK food consumption and lead concentration data to evaluate the number of gamebird meals consumed weekly that would be expected, based upon published studies, to result in changes, over and above those resulting from exposure to lead in the base diet, in intelligence quotient (IQ), Systolic Blood Pressure and chronic kidney disease (CKD) considered in a recent opinion of the European Food Safety Authority (EFSA) to be significant at a population level and also in SAT test scores and in rates of spontaneous abortion. We found the consumption of <1 meal of game a week may be associated with a one point reduction in IQ in children and 1.2–6.5 gamebird meals per week may be associated with the other effects. These results should help to inform the development of appropriate responses to the risks from ingesting lead from ammunition in game in the UK and European Union (EU).     

Wound treatment and pain management: a stressful time

This review and case study report considers the evidence to indicate that the progress of wound healing is negatively affected by the presence of stressors and in circumstances where patients are in pain. It considers the relationship between perceptions of pain, stress and delayed wound healing with a specific focus on guidance for clinical practice. It is appreciated that although the literature has examined these issues in the management of acute wounds, demonstrating that psychological stress can have detrimental effects on the wound‐healing process, the evidence to support this link in relation to chronic wounds is limited. The review considers evidence indicating that punch biopsy wounds heal more slowly in subjects under stress on account of caring for family members with long‐term illnesses and also considers briefly the relationship between cortisol secretion in response to stress and the consequent influences on cytokine levels and the wound‐healing process.     

Successful Treatment of Erdheim-Chester Disease With Coronary Artery Involvement

Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis and inflammatory myeloid neoplasm with poor prognosis. Symmetric long bone osteosclerosis occurs in nearly all patients, but other organs are often involved. Coronary artery involvement is rare, but was encountered in a patient who experienced angina. Radiologic presentation and histologic findings were consistent with diagnosis of ECD. A soft-tissue mass was found surrounding the right atrium, ascending aorta, and all branches of coronary artery. Interferon-alfa treatment was successful. In conclusion, we recommend coronary artery computed tomography angiography for cardiovascular evaluation of ECD and interferon-alfa to treat ECD.     

内镜黏膜下切除早期胃癌后并发迟发性胃穿孔的临床特点

目前，内镜黏膜下切除术（endoscopic submucosal dissection，ESD）已经成为无淋巴结转移风险的早期胃癌的 标准治疗方法。ESD 虽然具有显著的优点，但它依然可以引起一些并发症。ESD 术后并发迟发性胃穿孔是其中一类较为罕 见的并发症，然而，一旦该并发症发生，患者的症状通常较重，大多需要紧急处理。当前，世界上关于该并发症的研究不多， 而且主要存在两方面问题。其一，在研究对象方面，由于该并发症较为罕见，故研究对象数目较少，而且研究对象基本都 是日本人，种族来源较窄；其二，在研究结果方面，不同的研究所得出的数据及结论之间有相互矛盾之处。为解决这两方 面的问题，应当对该并发症进行进一步的研究。为使更多的研究人员关注该并发症，推动关于该并发症的调查研究，获得 更为可靠的数据及结果，从而促进该并发症在临床的预防、治疗及恢复，以减少患者的病痛，本文总结了一些该并发症相 关的研究，对 ESD 术后并发迟发性胃穿孔的发生原因、临床表现、治疗方法、预后及预防等临床特点进行综述 。     

促甲状腺激素释放激素对结肠平滑肌钾电流的影响

目的探讨促甲状腺激素释放激素(TRH)对大鼠结肠平滑肌细胞膜瞬时外向钾电流(Ito)和延迟整流钾电流(Ik)的影响。方法酶解法急性分离单个大鼠结肠平滑肌细胞,运用膜片钳方法检测10、20、50、100μmol/L的TRH对结肠平滑肌细胞膜Ito和Ik的影响。结果 TRH浓度依赖性减少Ito(P<0.05),10、20、50、100μmol/L的TRH可使峰值Ito降低13.4%、28.0%、39.5%、53.4%,但Ik降低不明显(P>0.05)。结论 TRH阻滞大鼠结肠平滑肌细胞的瞬时外向钾电流,但不能降低延迟整流钾电流,TRH可能通过调节细胞的兴奋性对肠道动力产生影响。     

The emerging EU quality of care policy: From sharing information to enforcement

Despite the fact that Member States and many citizens of the EU like to keep healthcare a foremost national competence and the EU treaties state that Member States remain primarily responsible for the organization and delivery of health care services, the European Union (EU) has expanded its involvement in healthcare policy over the last twenty years. Based on interviews and document and literature analysis we show that the scope of EU involvement has widened from public health and access to care, to quality of care. In this paper we concentrate on the latter. Focusing on the recent EU initiatives regarding the quality systems of the Member States and the quality of services, this paper shows how the depth of EU interference has increased from sharing information to standardization and even to the first signs of enforcement. We argue that at this stage, reflection on the feasibility and desirability of the EU's involvement is clearly needed, also considering the differences in quality of care policies between and within EU Member States. Both arguments in favour and against further EU involvement are discussed in this paper.