Comparative effects of tobacco smoking and nasal nicotine

OBJECTIVE: Compare the electroencephalographic (EEG) and cardiovascular effects of tobacco smoking and nasal nicotine in the same subjects. METHODS: Eleven volunteer smokers were studied after >10 h of overnight tobacco deprivation. Quantitative EEG was used to measure brain electrical changes produced by four different treatments. Each subject smoked a low (0.08 mg) and average nicotine (1 mg) yield cigarette on one test day and received placebo and nicotine nasal spray (0.5 mg/spray) on a second day in a counterbalanced design. EEG activity was measured from 16 scalp electrodes and analyzed as delta, theta, alpha (1), alpha (2), beta (1), and beta (2) frequency bands. Heart rate (HR), blood pressure (BP), and plasma venous nicotine concentrations (VNC) were monitored during both sessions. EEG data from all 16 channels at each of six frequencies were compared over 10 min using repeated measures ANOVA analysis. Changes in HR, BP, and VNC from baseline were compared using ANOVA followed by post hoc Scheffe's test. RESULTS: Smoking an average nicotine delivery cigarette resulted in highly significant decreases in alpha (1) activity, significant increases in alpha (2) activity, and significant increases in both HR and VNC compared to all other conditions. CONCLUSION: When smokers are allowed to pace themselves, cigarette smoking is far more effective than nasal nicotine in activating the EEG and increasing HR and VNC. This lack of equivalent physiological effects may explain the low success rate when nicotine nasal spray is used by those trying to quit smoking.     

Investigation on the antibacterial properties of garlic (Allium sativum) on pneumonia causing bacteria

The antibacterial activity of the crude aqueous extract of garlic was investigated against some pneumonia causing bacteria by an agar dilution technique. The results revealed that Streptococcus pneumoniae standard test organism was completely inhibited by 7.8 mg/ml of media and the clinical isolate of Klebsiella pneumoniae was completely inhibited by 24.38 mg/ml of media, indicating that Streptococcus pneumoniae is the most sensitive and Klebsiella pneumoniae the least. Garlic could be used as an effective antibacterial agent for these pathogenic microorganisms.     

The importance of monitoring fluid intake during treatment of overactive bladder

This article presents the most recent data on the role of fluid intake in the management of overactive bladder. Studies of the effect of volume and type of fluid intake on symptoms of overactive bladder are critically reviewed. This information is discussed in the context of the impact of fluid intake on overall health. Methods for measuring and monitoring fluid intake during the treatment of overactive bladder are also discussed. Overall recommendations are made on the indications, method, and effectiveness of fluid monitoring in overactive bladder.     

CT healthcare failure mode effect analysis (HFMEA): the misadministration of IV contrast in outpatients

This article aims to inform and educate healthcare organizations about one of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) patient safety goals. The goal allows healthcare institutions to be proactive in identifying risks to patient safety and reduce medical errors at the same time. In this article, you will learn what a Healthcare Failure Mode and Effect Analysis (HFMEA) is, how to pick an appropriate topic, and the steps to follow to be able to implement your own HFMEA. The goal of the HFMEA performed at Massachusetts General Hospital (MGH) was to prevent the misadministration of IV contrast in outpatients in the CT department.     

Assessment of the implementation of HIV-rapid test kits at different levels of health institutions in Ethiopia

OBJECTIVE: Evaluation and monitoring of Human Immunodeficiency Virus (HIV) testing reagents at the point of service is helpful to prevent the occurrence of problems related to testing and interpretation. To evaluate the implementation of HIV rapid test kits at the point of services in voluntarily counseling and testing (VCT) and diagnostic centers in Ethiopia. METHODS: The assessment was the third phase of evaluation of HIV rapid test kits in Ethiopia followed from phase-I and phase-II. Known proficiency testing panels, well-structured questionnaire (addressing type of tests, human resource and problems related to tests), onsite supervision and retesting of samples collected from sites were used to evaluate the performances of reagents and laboratories. RESULTS: Forty-four health institutions were included. Thirty-six (90.0%) health institutions had trained human resource on HIV testing. In 27 (61.4%) three types of HIV rapid test kits (Determine, Capillus and Unigold) were available. Serial-algorithm was used in all the laboratories. In 31 (70.4%) of them external quality control specimens were not used. Twenty two (50.0%) of the laboratories reported frequent shortage of reagents. All (100%) were able to identify negative specimens distributed. Positive proficiency panel samples were identified in 37 (94.8%) of the 39 laboratories. There was 98.3% agreement at a screening level between the sites and the central laboratory. Rate of discrepancy between screening and confirmatory assays was found to be 3.0% and 2.1% at the sites and at central laboratory, respectively. CONCLUSION: The test kits showed a good performance at the point of services in the field sites. However, continuous assessment of HIV test kits at the point of service and training of professionals on newly arrived techniques are recommended to have effective testing performance with acceptable sensitive and specific testing algorithm. Effective quality assurance program should be in place to support programs such as VCT, prevention of mother-to-child-transmission and antiretroviral therapy.     

Evidence of bladder oversensitivity in the absence of an infection in premenopausal women with a history of recurrent urinary tract infections

Study Type – Prevalence (case control) Level of Evidence 4 What's known on the subject? and What does the study add? Urinary tract infections (UTIs) have been implicated in the aetiology of interstitial cystitis/painful bladder syndrome (IC/PBS). Prior studies have described symptoms and laboratory tests suggestive of UTI at the onset of IC/PBS as well as a significant history of childhood recurrent UTIs. However, the mechanism by which recurrent UTIs contribute to the development of IC/PBS is not clear. Our study shows that women with recurrent UTI suffer from bladder oversensitivity. Our findings have useful clinical implications. Women with bladder oversensitivity complain of urinary frequency which is often misdiagnosed as an infection and treated with unnecessary antibiotics. Additionally, there are no effective therapies for bladder oversensitivity. Therefore, women with recurrent UTI should undergo prompt evaluation and treatment of episodes of infection to prevent the development of bladder oversensitivity. Our findings also provide a possible mechanism for the development of IC/PBS. Whether women with recurrent UTI are at increased risk for developing IC/PBS in the future will need to be confirmed in future studies.

OBJECTIVE

• ? To compare the mean voided volume and bladder sensation during filling cystometry in women with a history of recurrent urinary tract infection (UTI) and controls.

PATIENTS AND METHODS

• ? This was a case–control study including adult women seen in the urogynaecology clinic.
• ? The cases were 49 women with at least three documented positive urine cultures >105 colonies/mL in the previous 12 months and no active infection at the time of data collection.
• ? Controls were 53 women with stress urinary incontinence and no history of recurrent UTI or coexistent urge urinary incontinence.
• ? We compared bladder diary variables and filling cystometry data in the absence of an active infection.

RESULTS

• ? There was no significant difference in the median age, parity and body mass index of women with a history of recurrent UTI and controls.
• ? The median number of voids per day and median number of voids per litre of fluid intake was significantly greater in women with recurrent UTI than controls (12 vs 7 voids/day and 6 vs 4 voids/L, P= 0.005 and P= 0.004 respectively).
• ? The median average voided volume was significantly lower in women with recurrent UTI than controls (155 vs 195 mL, P= 0.008).
• ? On filling cystometry, median volumes of strong desire to void and maximum cystometric capacity were significantly lower in women with recurrent UTI than controls (all P < 0.05).

CONCLUSION

• ? In the absence of an infection, premenopausal women with a history of recurrent UTI have significantly greater urinary frequency, lower average voided volume and a lower threshold of bladder sensitivity than controls.

     

Paid Sick Leave and Nonfatal Occupational Injuries

Objectives. We examined the association between US workers’ access to paid sick leave and the incidence of nonfatal occupational injuries from the employer’s perspective. We also examined this association in different industries and occupations.Methods. We developed a theoretical framework to examine the business value of offering paid sick leave. Data from the National Health Interview Survey were used to test the hypothesis that offering paid sick leave is associated with a reduced incidence of occupational injuries. We used data on approximately 38 000 working adults to estimate a multivariate model.Results. With all other variables held constant, workers with access to paid sick leave were 28% (95% confidence interval = 0.52, 0.99) less likely than workers without access to paid sick leave to be injured. The association between the availability of paid sick leave and the incidence of occupational injuries varied across sectors and occupations, with the greatest differences occurring in high-risk sectors and occupations.Conclusions. Our findings suggest that, similar to other investments in worker safety and health, introducing or expanding paid sick leave programs might help businesses reduce the incidence of nonfatal occupational injuries, particularly in high-risk sectors and occupations.Paid sick leave is one of the nonwage benefits that US employers can offer to their workers. Although the 1993 Family and Medical Leave Act requires public agencies and private-sector establishments to provide up to 12 weeks of leave to eligible workers,1 this leave can be paid or unpaid.2,3 At the state level, only California and New Jersey have implemented paid family leave systems that provide workers with partial wage replacement.4 For workers, paid sick leave is associated with shorter recovery times3 and reduced complications from minor health problems.5–10 Paid sick leave also enables workers to care for loved ones when they most need it,11 can help prevent the spread of contagious diseases in day-care facilities and schools,12–15 and would enable compliance with pandemic influenza mitigation recommendations.16Employers can realize gains from offering paid sick leave through the reduction of productivity losses associated with sick workers who continue to work but are not fully productive (i.e., “presenteeism”).3,7,17–19 Paid sick leave also can help prevent the spread of contagious diseases to coworkers, which reduces the cost of unscheduled leave (absenteeism).20 The costs associated with sick workers who continue to work can be substantial. For example, Goetzel et al.21 estimated presenteeism costs to be the largest component of the overall costs of absenteeism, productivity losses, and short-term disability.Working while sick also can increase workers’ probability of suffering an injury.22 Sick or stressed workers who continue to work are likely to take medications, experience sleep problems, or be fatigued.23–25 These factors can impair their ability to concentrate or make sound decisions, which can in turn increase their probability of suffering an additional illness or sustaining a workplace injury. A recent study comparing workers with severe occupational injuries and those with nonsevere injuries demonstrated that a family member’s hospitalization, which is likely to be a major stressor for the entire family, increased by 9% the probability that a worker would suffer a severe occupational injury.26Despite the advantages of paid sick leave for both workers and employers, the number of private-sector workers who have access to it remains low. For example, between 1996 and 1998 nearly 90% of workers in state and local governments had access to paid sick leave, compared with only 45% of workers in the private sector.3 A more recent study concluded that in 2010, after consideration of the average job tenure requirement of 78 days that is imposed by employers before workers have access to paid sick leave, only 40 million workers in the private sector had access to this job benefit, a figure well below the 44 million workers who were estimated to be eligible for such leave by the Bureau of Labor Statistics (BLS).27Additional empirical evidence on the advantages and costs of paid sick leave would help inform employers’ decisions about offering or expanding paid sick leave benefits to workers. We examined the hypothesis that offering paid sick leave to workers would be associated with a lower incidence of nonfatal occupational injuries. We also assessed whether this association varied by occupation and industry sector, with the expectation that greater differences would be observed in occupations and sectors in which workers are at higher risk of suffering nonfatal occupational injuries. To our knowledge, this is the first US study to empirically examine these issues.