Vital Signs: Exercise: Treating Sleep Apnea With a Golf Club

Vital Signs: Exercise: Treating Sleep Apnea With a Golf Club: "Will treatment outcomes for sleep apnea improve if men with the condition thought treatment might improve their golf game?

Many middle-aged men who have sleep apnea either do not seek treatment or are inconsistent about using the airway pressure masks prescribed to them. But what if they thought treatment might improve their golf game?

Dr. Marc L. Benton, a New Jersey pulmonologist who was convinced that patients would improve their golf game if they slept better, tested his hypothesis by recruiting a dozen avid golfers with untreated sleep apnea for a small, preliminary study. Dr. Benton assessed their daytime sleepiness at the beginning of the study and recorded their golf handicap index.

The patients were then fitted with nasal positive airway pressure masks and told to wear them every night.

Three to five months later, after they had completed 20 new rounds of golf, the players reported using the masks up to 95 percent of the time. Compliance was also tracked electronically.

The participants were less sleepy during the daytime, and their handicap index improved to 11 from an average of 12.4 before treatment, said Dr. Benton, who presented his findings last week at an international conference of the American College of Chest Physicians in San Diego.

The study has not been reviewed for publication. It was limited because it was not a randomized controlled trial, and neither the patients nor the researchers were blinded about the treatment and the expected outcomes."

A Prospective Blinded Evaluation of Urinary Porphyrins Verses the Clinical Severity of Autism Spectrum Disorders

A Prospective Blinded Evaluation of Urinary Porphyrins Verses the Clinical Severity of Autism Spectrum Disorders

A prospective, blinded study evaluated the relationship between autism spectrum disorder (ASD) severity measured by Childhood Autism Rating Scale (CARS) scores and urinary porphyrins among a cohort of participants (n = 26). LabCorp (CLIA-approved) tested for uroporphyrins, heptacarboxylporphyrins, hexacarboxylporphyrins, pentacarboxylporphyrins, coproporphyrin (cP) I, and cP III levels. Participants with severe ASD had significantly increased cP I, cP III, and total cP levels in comparison to participants with mild ASD. A significant correlation was observed between increasing cP levels and CARS scores. Significant correlations were also noted for comparative urinary porphyrin testing between LabCorp and the Laboratoire Philippe Auguste (ISO-approved) for total cP. Finally, total cP measured at LabCorp was found to significantly correlate with precoproporphryin (a specific porphyrin marker for mercury toxicity) measured at the Laboratoire Philippe Auguste. Since urinary porphyrin testing is clinically available, relatively inexpensive, and noninvasive, it may be used to help suggest whether heavy metal toxicity is associated with ASD.

Repeated Measures of Validated and Novel Biomarkers of Exposure to Polycyclic Aromatic Hydrocarbons in Individuals Living Near an Aluminum Plant in Qu

Repeated Measures of Validated and Novel Biomarkers of Exposure to Polycyclic Aromatic Hydrocarbons in Individuals Living Near an Aluminum Plant in Quebec, Canada

A longitudinal biomonitoring study was conducted to assess exposure to polycyclic aromatic hydrocarbons (PAH) in non-occupationally exposed nonsmoking adults living in the vicinity of an aluminum plant. Metabolites of several PAH (pyrene, naphthalene, chrysene, fluoranthene, benz[a]anthracene) were measured in the urine of the participants, including 1-hydroxypyrene (1-OHP) as a validated biomarker and pyrene diones as novel biomarkers. In total, 73 individuals living about 1 km away from the plant (taken as the exposed group) were compared repeatedly with 71 individuals living at least 11 km from the smelter (used as the control group). Complete first morning voids were collected twice, at a 2-wk interval, in the fall of 2005 and twice weekly for 2 consecutive weeks in the spring of 2006. Urinary biomarker concentrations were then measured by an ultra-performance liquid chromatography (UPLC) method with time-of-flight mass spectrometry detection (MS-TOF) (UPLC-MS-TOF). For most sampling days, individuals living near the plant showed significantly higher excretion values of both 1-OHP and pyrene diones (mean ratio up to 2- and 2.4-fold, respectively) than individuals living further from the plant. In the group living near the plant, geometric mean concentrations of 1-OHP varied from 0.047 to 0.058 μmol/mol creatinine, depending on the sampling day, as compared to 0.025 to 0.04 μmol/mol creatinine in the reference group. Corresponding mean values for pyrene diones were 0.017-0.056 μmol/mol creatinine and 0.014-0.039 μmol/mol creatinine, respectively. Urinary 1- and 2-naphthols were also measured as a reference and showed no significant differences between the two groups for most sampling days; metabolite concentrations of the other monitored PAH (chrysene, fluoranthene, benz[a]anthracene) were mostly below the analytical limit of detection of 0.005 to 0.01 μg/L, depending on the metabolite, with a detection rate varying from 0 to at most 21%. Individuals living near the aluminum plant thus appeared to be repeatedly exposed to higher pyrene levels than the control group, on the basis of both 1-OHP and pyrene dione excretions. However, 1-OHP concentrations observed in this first group were similar to those of other reference populations of nonsmokers studied in the past. Uptake of the other PAH associated with plant emissions was too small to significantly increase the excretion of their metabolites.

An Evaluation of Surrogate Chemical Exposure Measures and Autism Prevalence in Texas

An Evaluation of Surrogate Chemical Exposure Measures and Autism Prevalence in Texas

There is currently considerable discussion in the scientific community as well as within the general public concerning the role mercury (Hg) exposures may play in the apparent increased incidence of neurodevelopmental disorders (particularly autism) in children. Although the primary focus of this debate has focused on ethylmercury from vaccinations, linkage to other sources of Hg has been proposed. An ecologic association between 2001 Toxic Release Inventory (TRI; www.epa.gov/tri) data for Hg and 2000-2001 school district autism prevalence was previously reported in Texas. Evaluations using industrial release data as surrogate exposure measures may be problematic, particularly for chemicals like Hg that have complex environmental fates. To explore the robustness of TRI-based analyses of the Hg-autism hypothesis in Texas, a detailed analysis was undertaken examining the extent of the ecological relationship during multiple years and examining whether surrogate exposure measures would yield similar conclusions. Using multilevel Poisson regression analysis and data obtained from a number of publicly available databases, it was found that air Hg release data were significantly associated with autism prevalence in Texas school districts when considering data for 2001 and 2002 (2001: RR = 4.45, 95% CI = 1.60-12.36, 2002: RR = 2.70, 95% CI = 1.17-6.15). Significant associations were not found using data from 2003 to 2005. A significant association was not observed when considering air Hg data for 2000 or 2001 and school district autism prevalence data for 2005-2006 or 2006-2007, an analysis allowing for a 5-yr time period between presumed exposure and entry into the public school system (2000: RR = 1.03, 95% CI = 0.59-1.83, 2001: RR = 0.94, 95% CI = 0.59-1.47). Significant associations were not observed for any year nor for the time lagged analyses when censored autism counts were replaced by threes instead of zeros. An evaluation of TRI air emissions data for several other pollutants did not find significant associations except for nickel (RR = 1.71, 1.12-2.60), which has no history of being associated with neurodevelopmental disorders. An evaluation using downwind location from coal-fired power plants as the exposure surrogate variable also did not yield statistically significant results. The analysis suggests Hg emissions are not consistently associated with autism prevalence in Texas school districts. The lack of consistency across time may be the result of the influence of a more significant factor which remains unidentified. Alternatively, it may be that the significant association observed in 2001 and 2002 does not represent a true causal association.

Urinary Porphyrin Excretion in Children with Mercury Amalgam Treatment: Findings from the Casa Pia Children's Dental Amalgam Trial

Urinary Porphyrin Excretion in Children with Mercury Amalgam Treatment: Findings from the Casa Pia Children's Dental Amalgam Trial

Increases in the urinary concentrations of pentacarboxyl- and coproporphyrins and the appearance of the atypical precoproporphyrin have been defined in relation to mercury (Hg) body burden in animal studies, and this change in the porphyrin excretion pattern has been described as a biomarker of occupational Hg exposure and toxicity in adult human subjects. In the present studies, urinary porphyrins were determined in relation to Hg exposure in children and adolescents, 8-18 yr of age, over the 7-yr course of a clinical trial designed to evaluate the neurobehavioral and renal effects of dental amalgam in children. Subjects were randomized to either dental amalgam or composite resin treatments. Urinary porphyrins and creatinine concentrations were measured at baseline and annually in all subjects. Results were evaluated using linear regression analysis. No significant differences between treatment groups (amalgam versus composite) were found when comparing all subjects for any of the porphyrins of interest. However, incipent amalgam treatment-specific increases were observed in the mean concentrations of penta-, precopro- and coproporphyrins especially when the analyses were restricted to younger subjects (8 to 9 yr old at baseline), and these increases were most apparent during yr 2 through 3 of follow-up, the period of highest mercury exposure from amalgam treatment. Based on the mean number of amalgam fillings received by children in this group (17.8), the renal Hg concentration associated with incipient increases in urinary porphyrins was estimated to be approximately 2.7 μg/g renal cortex. This value corresponds to an observed mean urinary Hg concentration of 3.2 μg/g creatinine, which is approximately fivefold less than that at which renal damage from Hg exposure is estimated to occur in children. These findings are consistent with growing evidence supporting the sensitivity of urinary porphyrins as a biological indicator of subclinical Hg exposure in children.

Neurocognitive Screening of Lead-Exposed Andean Adolescents and Young Adults

Neurocognitive Screening of Lead-Exposed Andean Adolescents and Young Adults

This study was designed to assess the utility of two psychometric tests with putative minimal cultural bias for use in field screening of lead (Pb)-exposed Ecuadorian Andean workers. Specifically, the study evaluated the effectiveness in Pb-exposed adolescents and young adults of a nonverbal reasoning test standardized for younger children, and compared the findings with performance on a test of auditory memory. The Raven Coloured Progressive Matrices (RCPM) was used as a test of nonverbal intelligence, and the Digit Span subtest of the Wechsler IV intelligence scale was used to assess auditory memory/attention. The participants were 35 chronically Pb-exposed Pb-glazing workers, aged 12-21 yr. Blood lead (PbB) levels for the study group ranged from 3 to 86 μg/dl, with 65.7% of the group at and above 10 μg/dl. Zinc protoporphyrin heme ratios (ZPP/heme) ranged from 38 to 380 μmol/mol, with 57.1% of the participants showing abnormal ZPP/heme (>69 μmol/mol). ZPP/heme was significantly correlated with PbB levels, suggesting chronic Pb exposure. Performance on the RCPM was less than average on the U.S., British, and Puerto Rican norms, but average on the Peruvian norms. Significant inverse associations between PbB/ZPP concentrations and RCPM standard scores using the U.S., Puerto Rican, and Peruvian norms were observed, indicating decreasing RCPM test performance with increasing PbB and ZPP levels. RCPM scores were significantly correlated with performance on the Digit Span test for auditory memory. Mean Digit Span scale score was less than average, suggesting auditory memory/attention deficits. In conclusion, both the RCPM and Digit Span tests were found to be effective instruments for field screening of visual-spatial reasoning and auditory memory abilities, respectively, in Pb-exposed Andean adolescents and young adults.

Age-Related Impairments of Mobility Associated with Cobalt and Other Heavy Metals: Data from NHANES 1999-2004

Age-Related Impairments of Mobility Associated with Cobalt and Other Heavy Metals: Data from NHANES 1999-2004

Exposure to heavy metals promotes oxidative stress and damage to cellular components, and may accelerate age-related disease and disability. Physical mobility is a validated biomarker of age-related disability and is predictive of hospitalization and mortality. Our study examined associations between selected heavy metals and impaired lower limb mobility in a representative older human population. Data for 1615 adults aged ≥60 yr from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 were used to identify associations between urinary concentrations of 10 metals with self-reported and measured significant walking impairments. Models were adjusted for confounding factors, including smoking. In models adjusted for age, gender, and ethnicity, elevated levels of cadmium, cobalt, and uranium were associated with impairment of the ability to walk a quarter mile. In fully adjusted models, cobalt was the only metal that remained associated: the odds ratio (OR) for reporting walking problems with a 1-unit increase in logged cobalt concentration (μg/L) was 1.43 (95% CI 1.12 to 1.84). Cobalt was also the only metal associated with a significant increased measured time to walk a 20-ft course. In analyses of disease categories to explain the mobility finding, cobalt was associated with physician diagnosed arthritis (1-unit increase OR = 1.22 (95% CI 1.00 to 1.49). Low-level cobalt exposure, assessed through urinary concentrations of this essential heavy metal, may be a risk factor for age-related physical impairments. Independent replication is needed to confirm this association.

Surveillance Results of Depleted Uranium-Exposed Gulf War I Veterans: Sixteen Years of Follow-Up

Surveillance Results of Depleted Uranium-Exposed Gulf War I Veterans: Sixteen Years of Follow-Up

Abstract As part of a longitudinal surveillance program, 35 members of a larger cohort of 77 Gulf War I veterans who were victims of depleted uranium (DU) “friendly fire” during combat underwent a 3-day clinical assessment at the Baltimore Veterans Administration Medical Center (VAMC). The assessment included a detailed medical history, exposure history, physical examination, and laboratory studies. Spot and 24-h urine collections were obtained for renal function parameters and for urine uranium (U) measures. Blood U measures were also performed. Urine U excretion was significantly associated with DU retained shrapnel burden (8.821 μg U/g creatinine [creat.] vs. 0.005 μg U/g creat., p = .04). Blood as a U sampling matrix revealed satisfactory results for measures of total U with a high correlation with urine U results (r = .84) when urine U concentrations were ≥0.1 μg/g creatinine. However, isotopic results in blood detected DU in only half of the subcohort who had isotopic signatures for DU detectable in urine. After stratifying the cohort based on urine U concentration, the high-U group showed a trend toward higher concentrations of urine β2 microglobulin compared to the low-U group (81.7 v. 69.0 μg/g creat.; p = .11 respectively) and retinol binding protein (48.1 vs. 31.0 μg/g creat.; p = .07 respectively). Bone metabolism parameters showed only subtle differences between groups. Sixteen years after first exposure, this cohort continues to excrete elevated concentrations of urine U as a function of DU shrapnel burden. Although subtle trends emerge in renal proximal tubular function and bone formation, the cohort exhibits few clinically significant U-related health effects.

Laser relief for neck pain

Laser relief for neck pain:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61522-1/abstract

"Low-level laser therapy that uses non-thermal laser irradiation applied to the site of pain, reduces pain immediately after treatment in acute neck pain and up to 22 weeks after treatment in patients with chronic neck pain."

[Review] Physician wellness: a missing quality indicator

[Review] Physician wellness: a missing quality indicator: "When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation."

Major Lipids, Apolipoproteins, and Risk of Vascular Disease [Original Contribution]

Major Lipids, Apolipoproteins, and Risk of Vascular Disease [Original Contribution]: "

Context Associations of major lipids and apolipoproteins with the risk of vascular disease have not been reliably quantified.

Objective To assess major lipids and apolipoproteins in vascular risk.

Design, Setting, and Participants Individual records were supplied on 302 430 people without initial vascular disease from 68 long-term prospective studies, mostly in Europe and North America. During 2.79 million person-years of follow-up, there were 8857 nonfatal myocardial infarctions, 3928 coronary heart disease [CHD] deaths, 2534 ischemic strokes, 513 hemorrhagic strokes, and 2536 unclassified strokes.

Main Outcome Measures Hazard ratios (HRs), adjusted for several conventional factors, were calculated for 1-SD higher values: 0.52 log_e triglyceride, 15 mg/dL high-density lipoprotein cholesterol (HDL-C), 43 mg/dL non–HDL-C, 29 mg/dL apolipoprotein AI, 29 mg/dL apolipoprotein B, and 33 mg/dL directly measured low-density lipoprotein cholesterol (LDL-C). Within-study regression analyses were adjusted for within-person variation and combined using meta-analysis.

Results The rates of CHD per 1000 person-years in the bottom and top thirds of baseline lipid distributions, respectively, were 2.6 and 6.2 with triglyceride, 6.4 and 2.4 with HDL-C, and 2.3 and 6.7 with non–HDL-C. Adjusted HRs for CHD were 0.99 (95% CI, 0.94-1.05) with triglyceride, 0.78 (95% CI, 0.74-0.82) with HDL-C, and 1.50 (95% CI, 1.39-1.61) with non–HDL-C. Hazard ratios were at least as strong in participants who did not fast as in those who did. The HR for CHD was 0.35 (95% CI, 0.30-0.42) with a combination of 80 mg/dL lower non–HDL-C and 15 mg/dL higher HDL-C. For the subset with apolipoproteins or directly measured LDL-C, HRs were 1.50 (95% CI, 1.38-1.62) with the ratio non–HDL-C/HDL-C, 1.49 (95% CI, 1.39-1.60) with the ratio apo B/apo AI, 1.42 (95% CI, 1.06-1.91) with non–HDL-C, and 1.38 (95% CI, 1.09-1.73) with directly measured LDL-C. Hazard ratios for ischemic stroke were 1.02 (95% CI, 0.94-1.11) with triglyceride, 0.93 (95% CI, 0.84-1.02) with HDL-C, and 1.12 (95% CI, 1.04-1.20) with non–HDL-C.

Conclusion Lipid assessment in vascular disease can be simplified by measurement of either total and HDL cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride.

"

Employers told to tackle work related stress to reduce sickness bill

Employers told to tackle work related stress to reduce sickness bill Oona Mashta

The guidance, Promoting Mental Wellbeing through Productive and Healthy Working Conditions: Guidance for Employers, can be seen at www.nice.org.uk/PH22

Published 9 November 2009, doi:10.1136/bmj.b4607

Cite this as: BMJ 2009;339:b4607

The NHS in England, along with other employers, needs to promote mental wellbeing among its staff in a bid to cut the multimillion pound cost of days off resulting from work related stress, says new guidance from the National Institute for Health and Clinical Excellence (NICE).

The cost of work related stress, depression, and anxiety among NHS staff in the United Kingdom results in an estimated loss of about 4.1 million working days a year at a cost of £700m (780m; $1.2bn), estimates NICE.

But the problem was not just about staff taking time off, it said. "Presenteeism" (where staff feel obliged to go to work but are not in a fit state to be there, resulting in reduced productivity) was also a problem. NICE estimates that about 6.2 million working days are lost in the NHS in the UK throughpresenteeism at a cost of £1bn.

The guidelines on promoting wellbeing at work, which are mandatory for the NHS, the largest single employer in the UK with 1.5 million staff, call for improved line management to boost mental health among staff.

The guidance proposes simple steps, such as positive feedback to staff, including praise as well as criticism, making them feel valued, and rewarding them with small perks such as the odd afternoon off and time to attend seminars. Launching the guidance, a panel of NHS advisers said it was important that staff could see that things were done in a just and fair way.....................

What are some of the essential elements physicians should consider when in the role of expert witness?

What are some of the essential elements physicians should consider when in the role of expert witness?: "The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Inquiries and contributions to the Forum should be forwarded to Joseph J. Schwerha, MD, MPH by e-mail at schwer@pitt.edu.
(C)2009The American College of Occupational and Environmental Medicine"

1,3-Butadiene, Styrene and Lung Cancer Among Synthetic Rubber Industry Workers

1,3-Butadiene, Styrene and Lung Cancer Among Synthetic Rubber Industry Workers: "Objective: To evaluate the association between cumulative exposure to 1,3-butadiene (BD) or styrene (STY) and lung cancer among synthetic rubber industry workers.
Methods: Internal Cox regression analyses were performed both with and without natural logarithm transformation of exposure variables and both with and without the inclusion of those unexposed to monomers.
Results: Among women, analyses using untransformed BD exposure showed no trend. Analyses using natural logarithm-transformed BD exposure indicated a positive trend when the unexposed were included (P < 0.05) and an inverse trend when the unexposed were excluded (P < 0.05). No exposure-response trends were seen for BD among men or for STY among women or men.
Conclusions: These results suggest that the association between BD and lung cancer, seen in some analyses of female employees, is not causal. STY did not appear to be associated with lung cancer.
(C)2009The American College of Occupational and Environmental Medicine"

Reproductive History and Adverse Pregnancy Outcomes in Commercial Flight Crew and Air Traffic Control Officers in the United Kingdom

Reproductive History and Adverse Pregnancy Outcomes in Commercial Flight Crew and Air Traffic Control Officers in the United Kingdom: "Objective: To examine reproductive outcomes among flight crew.
Methods: Ten thousand two hundred five flight crew members and a control group of 2118 air traffic control officers completed a questionnaire in 2001 to 2004, United Kingdom.
Results: Similar proportions of flight crew and air traffic control officers reported having ever had difficulties in conceiving a baby. Risks of miscarriages and congenital malformations among pregnancies fathered by men who did not differ by occupation, but stillbirth risk was higher among flight crew (odds ratio = 2.85; 95% CI = 1.30-6.23). Among pregnancies reported by women, risks of miscarriage and stillbirth did not differ by occupation but risk of congenital malformations was higher among flight crew (odds ratio = 2.37; 95% CI = 0.43-13.06).
Conclusions: Flight crew-related exposures were not associated with adverse reproductive outcomes except for possible links, based on small numbers, between paternal exposure and stillbirths and maternal exposure and congenital malformations.
(C)2009The American College of Occupational and Environmental Medicine"

Long-Term Exposure and Health-Related Quality of Life Among Patients With Occupational Rhinitis

Long-Term Exposure and Health-Related Quality of Life Among Patients With Occupational Rhinitis: "Objective: This article evaluates health-related quality of life (HRQoL) among patients with occupational rhinitis (OR), with an average of 10 years after diagnosis.
Methods: A cross-sectional questionnaire with general (RAND-36) and disease-specific (Rhinasthma) HRQoL questions was completed by 119 OR patients and 173 controls of the same age and locality. In addition, the patients compared their estimation of current occupational exposure level with that at the time of OR diagnosis.
Results: HRQoL was impaired among patients with continuing occupational allergen exposure in all Rhinasthma and several RAND-36 scores. The HRQoL among patients no longer exposed was mainly similar to that of the healthy controls.
Conclusions: Among OR patients, continuous occupational exposure decreases QoL years after the diagnosis. To restore the well being of patients with OR, medication only is not sufficient; reduction or cessation of exposure is necessary.
(C)2009The American College of Occupational and Environmental Medicine"

Epidemiologic Studies of Styrene and Cancer: A Review of the Literature

Epidemiologic Studies of Styrene and Cancer: A Review of the Literature: "Objective: To review the epidemiologic literature on styrene and cancer.
Methods: We reviewed studies of workers exposed to styrene in manufacturing and polymerization, in the reinforced plastics industry, and in styrene-butadiene rubber production. We also reviewed studies of workers monitored for styrene exposure, studies of environmental exposure, community-based case-control studies of lymphoma and leukemia, and studies of DNA adducts. Studies of workers in the reinforced plastics industry were considered more informative because of higher worker exposure and less confounding by other carcinogens.
Results: We found no consistent increased risk of any cancer among workers exposed to styrene. A study of reinforced plastic workers reported an association between average estimated styrene exposure and non-Hodgkin lymphoma (NHL, P = 0.05) but no trend with increasing duration of exposure. Other studies of styrene exposure and NHL found no increased risk. In two US studies of reinforced plastic workers, esophageal cancer mortality was increased, but these findings were generated in a background of multiple comparisons. Results for other cancers were unremarkable.
Conclusions: The available epidemiologic evidence does not support a causal relationship between styrene exposure and any type of human cancer.
(C)2009The American College of Occupational and Environmental Medicine"

Exposure Risk Assessment in an Aluminium Salvage Plant

Exposure Risk Assessment in an Aluminium Salvage Plant: "Introduction: A cross-sectional study was conducted to evaluate possible nervous or respiratory system effects from occupational aluminium exposure.
Methodology: Exposed workers in Al salvage plant were compared with controls. The investigation involved a standardized occupational and medical history and assessments of Al levels in ambiance, serum, and urine. This was combined with an evaluation of respiratory complaints, lung, and cognitive functions.
Results: Thirty workers exposed to Al were matched to 60 individuals without exposure to Al. Significantly higher internal doses of Al in urine were found in exposed workers (11.59 [mu]g/L), when compared with the controls (4.37 [mu]g/L). Few high Al atmospheric levels were obtained (0.12-10.86 mg/m3). No significant differences concerning respiratory or neurological symptoms prevalence between the two groups were reported.
Discussion: Chronic exposure to Al dust, at the levels documented in this study over the German limit values, does not induce measurable cognitive decline.
(C)2009The American College of Occupational and Environmental Medicine"

Monday sickness may say more about your job than your health

Monday sickness may say more about your job than your health: "More than a third of sick leave is taken on Mondays, and January is the most common month for absenteeism, research suggests."

The Association Between Beliefs About Low Back Pain and Work Presenteeism

The Association Between Beliefs About Low Back Pain and Work Presenteeism: "Objective: To examine the influence of beliefs about low back pain (LBP) on reduced productivity at work ('presenteeism') caused by LBP.
Methods: Two thousand five hundred seven individuals completed the Back Beliefs Questionnaire, the Fear Avoidance Beliefs questionnaire (FABQ), and questions about LBP-related work-absence, reduced work-productivity, pain, comorbidity, and demographics.
Results: Six hundred seventy (25%) individuals were of working age, employed and reported current LBP. Univariate models showed beliefs were more 'negative' in individuals with work-absence and reduced productivity (P = 0.0001). In multivariable analysis, controlling for confounders, 'FABQwork' was a unique predictor of both absenteeism and presenteeism (each, P = 0.0001), though with small effect sizes.
Conclusions: Negative beliefs about LBP are associated with both work absence and reduced work-productivity. Further investigations should examine their potential as a target for educational interventions when considering initiatives to reduce the socioeconomic costs of LBP.
(C)2009The American College of Occupational and Environmental Medicine"

A New Health Promotion Model for Lone Workers: Results of the Safety & Health Involvement For Truckers (SHIFT) Pilot Study

A New Health Promotion Model for Lone Workers: Results of the Safety & Health Involvement For Truckers (SHIFT) Pilot Study: "Objective: This study was designed to evaluate the effectiveness of a new health promotion model for lone workers.
Methods: A single group pre- or posttest design was used to evaluate intervention effectiveness for reducing body weight and increasing healthful and safe behaviors. Truck drivers (n = 29) from four companies participated in a 6-month intervention involving a weight loss and safe driving competition, computer-based training, and motivational interviewing.
Results: Objectively measured body weight reduced by 7.8 lbs ([DELTA]SD = 11.5, [DELTA]d = 0.68, P = 0.005), and survey measures showed significant reductions in dietary fat and sugar consumption. An objective measure of safe driving also showed significant improvement, and increases in exercise motivational stage and walking fitness approached significance.
Conclusions: Results suggest that the new intervention model is substantially more engaging and effective with truck drivers than previous education-based tactics.
(C)2009The American College of Occupational and Environmental Medicine

Of Interest due to the techniques used, specifically -

Weight Loss Competitions.
Team weight loss competitions reliably produce two or three times the amount of weight loss observed in the Holmes et al 22 study of truck drivers (as mentioned above), produce very low levels of attrition and are especially effective with male workers. Although the Holmes et al nutrition education intervention produced a mean weight loss of about 4 lbs, team weight loss competitions commonly produce average weight loss ranging from 10 to 18 lbs (see Refs. 24–26). The social and financial incentives in team competitions also produce low study attrition, which is a powerful consideration given high voluntary turnover in trucking and excessive attrition (58%) observed in a previous study of truck drivers.23 For example, attrition averaged only 2.6% (range, 0%–13%) across 10 different weight loss competitions reported Stunkard et al (study 2).26 Team competitions are also especially effective with male workers (see Ref. 25), and 95% of truck drivers are men.27 This enhanced effectiveness may be due in part to increased competitive and aggressive tendencies in men28 and/or to higher historical male participation rates in competitive team sports.29
Behavioral Computer-Based Training.
Behavioral computer-based training is twice as effective as passive training in booklets.30,31 Passive training formats in a previous intervention for truck drivers produced no significant improvements in health knowledge.23 A recent meta-analysis supports replacing passive educational booklets with more engaging training tactics. Burke et al 32reviewed the effectiveness of training tactics that were, by their classification, more or less engaging. Passive methods such as lectures, booklets, and videos were classified as less engaging; computer-based training or programmed instruction were classified as moderately engaging; and behavioral modeling and role playing were considered most engaging. In the studies reviewed, engaging methods were nearly three times more effective than less engaging methods. Although truck drivers cannot easily participate in the most engaging face-to-face training formats, moderately engaging computer-based training is a next-best alternative.
Behavioral Self-Monitoring (BSM).
BSM techniques, where individuals repeatedly observe, evaluate, and record aspects of their own behavior, are widely applied by physicians and psychologists to enhance motivation for change.33–35 BSM is increasingly applied in workplace interventions to enhance worker productivity and safety.33 Evidence suggests that BSM is particularly effective in combination with common intervention tactics such as goal setting, training, and feedback. For example, Olson and Winchester 33 reviewed 24 studies of workplace interventions that included self-monitoring and found that the standardized effect size for 66 intervention phases was large by Cohen's 36 standards (mean weighted d = 2.2; 95% CI = 1.7, 2.7; Cohen's standards are small d = 0.20, medium d = 0.50, and large d = .80), as was the mean effect size for interventions targeting driving and other safety behaviors (d = 1.8). Self-monitoring techniques can be easily administered at the individual level and are therefore well suited for involving isolated workers like truck drivers in health promotion programs.
MI.
MI has emerged as an alternative and more effective approach to health coaching than traditional office-based counseling, which lacks proven effectiveness for promoting exercise and healthy eating.37–39 Originally developed to reduce problem drinking and self-harming behaviors,40,41 MI is described as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence.”42 MI techniques have been operationally defined,43 and examples of techniques include reflective listening, asking open-ended questions, and encouraging change talk. The guiding principles are to express empathy, develop discrepancy, avoid argumentation, roll with resistance, and support self-efficacy.41,42 Burke et al 44 conducted a meta-analysis of 31 controlled clinical trials of MI treatments. Standardized differences between treatment and control group means ranged from d = 0.25 to d = 0.56, with effects on exercise and diet averaging d = 0.53 (95% CI = 0.32, 0.74). MI is a good fit for truck drivers because it can be delivered anywhere a worker can receive cell phone service.

"

Spinal fusion surgery over-servicing

Spinal fusion surgery over-servicing: "http://www3.interscience.wiley.com/journal/122678682/abstract?CRETRY=1&SRETRY=0

A disproportionate increase in spinal fusion surgery in private practice in recent years may reflect overservicing by surgeons, Australian researchers say"

N-95 Respirators and Surgical Masks

N-95 Respirators and Surgical Masks: "http://www.cdc.gov/niosh/blog/nsb101409_respirator.html October 10, 2009, by Lisa Brosseau, Ph.D., and Roland Berry Ann. The emergence of H1N1 has created considerable interest about the use of surgical masks and respirators as infection control measures. Given the recent issuance of revised CDC infection control guidance for healthcare personnel that include recommendations for use of N-95 respirators, NIOSH has posted a new blog that examines the scientific principles behind the design and performance of these devices. Read more and comment on the NIOSH Science Blog."

Safety and Health for Tattooists and Piercers

Safety and Health for Tattooists and Piercers: "http://www.cdc.gov/niosh/topics/bbp/bodyart/"

Novel H1N1 Influenza and Respiratory Protection for Health Care Workers

Novel H1N1 Influenza and Respiratory Protection for Health Care Workers: "

Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have ...

Also:

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm"

Mandatory Vaccination of Health Care Workers

http://content.nejm.org/cgi/content/short/NEJMp0910151v1?rss=1&query=current

Lesions missed without whole body exams

Lesions missed without whole body exams: "The importance of performing a whole body skin examination on patients presenting with skin lesion has been underlined by a new study showing that most patients have additional asymptomatic lesions that would otherwise be missed."

Spinal X-ray curbs

Spinal X-ray curbs: "Health minister Nicola Roxon says health budget savings will be made by creating three new 'therapeutic groups' under the PBS and by encouraging doctors to request region-specific spinal X-rays for particular clinical indications."

Tackle work stress, bosses told

Tackle work stress, bosses told: "Employers need to pay more attention to the levels of stress and anxiety in the workplace, key NHS advisers say."

Obese 'struggle to earn living'

Obese 'struggle to earn living': "Obese people in the UK are struggling to earn above the national average income, according to a survey.

Just under half (46%) earn more than £20,000 a year, which is the national average, while the majority earn between £10,000 and £15,000.

The survey conducted by YouGov also indicates that only 5% of people feel their weight has held them back..............."