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PubMed2004

Work-related roadway crashes--United States, 1992-2002.

The risk for roadway crashes associated with driving or riding in a motor vehicle at work affects millions of persons in the United States. In 2001, approximately 4.2 million U.S. workers were classified as motor-vehicle operators (Bureau of Labor Statistics [BLS], unpublished data, 2001). Workers who use motor vehicles to perform their jobs include those who operate vehicles owned or leased by their employers and those who drive personal vehicles for work purposes. To characterize fatal occupational roadway crashes and identify workers at highest risk for fatality, CDC analyzed data for 1992-2002 from the Fatality Analysis Reporting System (FARS) of the National Highway Traffic Safety Administration and the Census of Fatal Occupational Injuries (CFOI) of BLS. This report summarizes the results of that analysis, which indicated that roadway crashes were the leading cause of occupational fatalities and that workers in transportation-related occupations were at highest risk. Effective strategies to prevent motor-vehicle-related crashes in the general public also can reduce work-related crashes. Employers should promote safe driving through vehicle selection and company policy.

Accidents, Occupational↗
PubMed2004

Tracking health care costs: trends turn downward in 2003.

This Data Bulletin is based on data from the Milliman USA Health Cost Index ($0 deductible), which is designed to reflect claims trends faced by private insurers; the U.S. Bureau of Labor Statistics' (BLS) Producer Price Index for general medical and surgical hospitals and for physicians' offices to track hospital and physician prices; the BLS's Consumer Price Index for prescription drugs and medical supplies to track prescription drug prices; and the Towers Perrin 2004 Health Care Cost Survey and the Ninth Annual National Business Group on Health/Watson Wyatt Employer Survey Report 2004 for premium trends. It is adapted from "Tracking Health Care Costs: Trends Turn Downward in 2003" by Bradley C. Strunk and Paul B. Ginsburg, Health Affairs, Web-exclusive publication, June 9, 2004, www.healthaffairs.org

Forecasting↗
PubMed2004

[Development of a new evaluation system for visual function].

Visual deterioration is caused principally by media opacity, by retinal damage, or by disorders of the higher visual system posterior to the optic nerve. In this article, we focused on media and retinal disorders and clinically evaluated a newly developed system for visual function. The decrease in visual function in cataract is subjectively well evaluated by contrast sensitivity, but is difficult to evaluate objectively. Recently, a wavefront sensor has been developed and ocular higher-order aberration (HOA) can now be measured objectively. We studied the relationship between age and HOA by wavefront sensor and found that HOA, especially spherical aberration in the lens, increased abruptly at the presbyopic age. We also found that the against-the-rule astigmatism in the lens increased at this age. Next, we investigated monocular diplopia which was presumably caused by HOA. Nine eyes with monocular triplopia and with mild nuclear cataract showed significant increase of trefoil aberration and negative spherical aberration (p<0.001). The simulated retinal Landolt's image from these two aberrations showed a triple configuration. Thus we confirmed that triplopia is caused by the combination of trefoil aberration and negative spherical aberration in early nuclear cataract. Next, we investigated whether Area under Log Contrast Sensitivity Function (AULCSF) can be predicted by HOA and light scattering. Backward light scattering (BLS) was evaluated by Schei mpflug image and the forward light scattering (FLS) by a spot size of the Hartmann image compensated for the effect of HOA. HOA was evaluated by root mean square (RMS) value from Hartmann image in a 4 mm pupil. Multiple linear regression revealed that AULCSF could be predicted from BLS, FLS, and HOA, in which each parameter contributed to the prediction significantly (p<0.01). By using this predicted value of AULCSF, the improvement of vision after cataract surgery can be predicted in cataract complicated by retinal disease. It has been reported that by fundus camera equipped with adaptive optics (AO), which is an application of wavefront analysis, photoreceptors could be visualized 2-dimensionally. We developed a compact AO fundus camera and demonstrated that cones were separately analyzed at retinal loci 1 degree temporal to the fovea centralis when the ocular aberration was reduced to less than 0.1 microm RMS in a 6 mm pupil. We are going to use this apparatus for eyes with retinal disease. The functional evaluation of residual retinal ganglion cells (RGCs) in the retina with damage to the photoreceptors is critically important for selecting candidates for artificial retina or regenerative therapy. Transcorneal electrical stimulation (TES) of the retina via contact lens electrodes evokes phosphene and indirect pupillary reflex. The threshold current for evoking phosphene in severely degenerated retinas with visual acuity worse than counting fingers showed a wide distribution, which suggested that TES was useful to evaluate residual RGCs functionally. TES also showed a neuroprotective effect. We suggest that the activation of glial cells by TES up-regulates the production of IGF-1, which eventually protects RGCs. The peripheral retina is important for walking even though the spatial resolution is not high. We developed an apparatus to measure stereopsis in the peripheral retina using a wide screen, and evaluated the peripheral stereopsis of 12 patients after macular translocation surgery and squint surgery. All three patients who showed peripheral stereopsis had only a small amount of squint angle. This method may be useful to evaluate stereopsis in patients with a central scotoma.

Cataract↗
PubMed2004

Survey of oral and maxillofacial surgeons' offices in Virginia: anesthesia team characteristics.

This survey assesses whether oral and maxillofacial surgeons in the state of Virginia are prepared for inspection of their offices. A survey asking pertinent questions on the availability of specific equipment and the educational qualifications of the anesthesia care team was developed and sent to 155 offices. Seven questions were asked regarding the availability of nurses, types of life support training, (formal or informal), the surgeons and anesthesia care personnel, and the presence of a defibrillator. Questionnaires were short and simple to encourage compliance with the study guidelines. A total of 128 (82.6%) questionnaires were returned. Only 42 of 128 (32.8%) offices employed nurses, and 6 of the 42 nurses were not considered as part of the anesthesia care team. Only 36 of 128 (28.1%) of the offices had assistants with formal anesthesia assistant course training from the American Association of Oral and Maxillofacial Surgeons (AAOMS) or the American Dental Society of Anesthesiology (ADSA). However, 93% of the assistants who participated in the anesthesia had current basic life support training (BLS) training, and 74% of the surgeons had current advanced cardiac life support (ACLS) training. The AAOMS Office Emergency Manual was present in 118 of 128 offices (92.2%), and 124 of 128 offices (96.9%) had defibrillators. The survey suggests that the surgeons are well prepared from the standpoint of having a defibrillator present and the AAOMS Office Emergency Manual available as a template for the team to use in order to answer questions that the inspection team may ask of the primary anesthesia care provider and surgeon. The majority of the surgeons had current ACLS certification, and the office anesthesia assistants had current BLS training. Most of the assistants did not have formal course training, which indicates that on-the-job training is probably the norm. Less than one third of the offices had nurses.

Anesthesia, Dental↗
PubMed2005

[Environmental effects of mercury around a large scale MSW incineration plant].

Samples of soil, vegetables, crops and air collected from Yuqiao Incineration Paint, Pudong Shanghai, were analyzed with an AMA-254 liquid/solid mercury analyzer. It is shown that background levels(BLs,2001) of mercury in surface soil is a little higher, mercury content in soils one year after operation(2002) and two year(2003) were both higher than BLs. The levels of mercury in vegetables is higher than Standard levels (GB 2762-94), the content of mercury in Soya and broomcorn sampled in 2003 was 2.3 and 2.7 times than that in 2002. Atmospheric mercury levels were 10.1, 5.0 and 10.6 ng/m3 in up-site,site and down-site.

China↗
PubMed2005

[Telecardiology in the management of acute myocardial infarction: the experience of the provincial network of Mantova].

BACKGROUND: Since June 2001 we activated a program for the treatment of acute myocardial infarction, based on the early assessment of the patient's risk profile, on telematic connection among care centers and optimization of critical pathways for access to care. The aim of this work was to assess the effectiveness of telemedicine in the reduction of time to treatment. METHODS: Mantova, a province of eastern Lombardy (northern Italy) is provided with one single sanitary district with one (tertiary hospital) referring hospital equipped with a cath lab on call 24/24 hours for primary coronary angioplasty (PTCA) and cardiac surgery and 6 community hospitals: 2 with coronary care units, 2 with a cardiology section, and 2 rehabilitation hospitals. The emergency medical system transport, activated 24/24 hours, consists of 6 advanced life support (ALS) ambulances and 11 basic life support (BLS) ambulances (2 with trained nurse staff). Each ALS ambulance is equipped with a semiautomatic defibrillator LIFEPACK 12 coupled with cellular telephone GSM transmission of the 12-lead ECG. RESULTS: In the first 3-year activity of the project 340 patients with acute myocardial infarction underwent primary PTCA: 248 (73%) referred to first aid of the nearest hospital reached either by BLS ambulance or by their own means of transport and were hence transferred to the referring hospital for primary PTCA (group A), while 92 patients (27%) were aided at their own house by ALS ambulances and, after transmission of the 12-lead ECG to the referring coronary care unit, were directly transferred to the cath lab (group B). Decisional delay was 144 +/- 65 min in group A while 74 +/- 37 min in group B. Mean door-to-balloon time was 76 +/- 26 min in group A and 47 +/- 21 min in group B. High incidence of post-procedural TIMI 3 flow was achieved in both groups. In-hospital mortality was 6.8% in group A e 5.4% in group B. CONCLUSIONS: Our data show that patients referring directly to ALS ambulances had a lower decisional delay. Transmission of the patient's ECG and clinical parameters allows an early and accurate diagnosis and assessment of the individual risk profile with a consistent reduction in time to treatment and positive effects on the mortality rate.

Aged↗
PubMedDate not supplied

Occupational disease in Connecticut: 2002.

Data on chronic work-related conditions were compiled for Connecticut for 2002 from physician reports to the Occupational Disease Surveillance System (ODSS), the Workers' Compensation (WC) Commission, and the Bureau of Labor Statistics (BLS)/ ConnOSHA survey. Physicians reported 2,082 cases of occupational disease in Connecticut in 2002, approximately half of the estimate of 4,388 cases using the BLS/ ConnOSHA methodology. Cases in the ODSS included 921 (44%) reports of musculoskeletal disorders (MSD), 476 adult lead poisonings (based on lab reporting), 338 skin disorders, and 283 respiratory and lung conditions. There were increased reports in both the ODSS and WC systems over 2001 figures. Emerging conditions included vibration-related MSD, a mold-related respiratory outbreak, and Lyme Disease/tick bites among outdoor workers. Only 86 physicians from 29 clinics reported cases indicating widespread under-reporting of occupational disorders among community physicians despite Connecticut statutes mandating reporting of work-related disease.

Connecticut↗
PubMed2006

[Assessment of physicians employed in emergency medical services about their level of knowledge on basic life support, advanced cardiac life support and medicolegal responsibilities].

BACKGROUND: We aimed to determine the level of knowledge of Emergency Medical Services (EMS) physicians on Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and medicolegal responsibilities in conjunction with related factors. METHODS: Fifty-three physicians (43 male, 10 females; mean age 39 years; range 28 to 50 years) employed in EMS were required to respond a questionnaire consisting of demographic data and educational background. They also answered 25 multiple-choice questions about BLS, ACLS and medicolegal responsibilities of physicians in a face-to-face manner. The data were analyzed using Mann-Whitney U-test and Kruskal-Wallis Analysis of Variance test. RESULTS: Mean level of knowledge was 45.4 on a hundred-point scale. Attendance to courses covering emergency aid and working as an ambulance physician for more than one year were associated with higher levels of knowledge (p=0.012; p=0.015). CONCLUSION: In-service training should be undertaken to raise the level of knowledge of the physicians employed in rural EMS and to improve the quality of field care.

Adult↗
PubMed2006

[PROVA E TRASPORTA Project: results of tele-transmission of the electrocardiogram from community hospitals and emergency service ambulances in the management of ST-elevation acute coronary syndromes].

BACKGROUND: Availability of a telematic system of electrocardiogram (ECG) transmission may improve the management of ST-elevation myocardial infarction (STEMI), by reducing time to treatment. The aim of this study was to show the effectiveness of telephone transmission of ECG in improving quality of care for patients with acute STEMI. METHODS: Since January 1, 2003, we activated a management program of STEMI in healthcare district of Varese, located in the North-West of Lombardy (Italy), comprising one fourth-level hospital, equipped with a cath lab on call 24/24 h for primary angioplasty since 1993 and cardiac surgery, and 2 community hospitals, placed in a mountain area approximately 30 km far from Varese. The emergency medical system (EMS) transport was activated 24/24 h and has 15 basic life support (BLS) ambulances with trained nurse staff and 2 mobile units with medical staff, all of them equipped with semiautomatic defibrillator Lifepack 12, enabling a GSM telephone transmission of a 12-lead ECG, coupled with 3-lead continuous rhythm recording and clinical data, if necessary. The ECGs were transmitted to a core unit placed in the coronary care unit (CCU) of the Hospital di Circolo of Varese, directly connected with the EMS core unit. RESULTS: From January 2003 to August 2005, a total of 2063 ECGs were transmitted, 538 of them (26%) recorded by EMS ambulances. Of 144 ECGs (7%) showing a persistent ST-elevation suggesting an acute STEMI (group A), 112 subjects underwent reperfusion: 73 were treated with angioplasty and 39 by lysis alone. By comparing data of group A with a group of 256 patients (180 reperfused) with acute STEMI, admitted to our hospital in the same period without ECG teletransmission (group B), we observed no statistical difference in mortality and reperfusion rates but a significative reduction in the pre-hospital and in-hospital times in group A patients treated by primary angioplasty and thrombolysis. CONCLUSIONS: Our study confirms previous results in that an early availability of a 12-lead ECG, transmitted from peripheral community hospitals and BLS ambulances, is able to reduce time to management of patients with an acute STEMI, thus improving quality of decision-making and treatment.

Aged↗
PubMed2006

Tracking health care costs: spending growth remains stable at high rate in 2005.

This Data Bulletin is based on data from the Milliman Health Cost Index 2005 Series ($0 deductible), which is designed to reflect claims trends faced by private insurers; the U.S. Bureau of Labor Statistics' (BLS) Producer Price Index for general medical and surgical for general medical and surgical hospitals and for physicians' offices to track hospital and physician prices; the BLS's Consumer Price Index for prescription drugs and medical supplies to track prescription drug prices; and the Kaiser Family Foundation/Health Research and Educational Trust 2006 Survey of Employer Health Benefits. It is adapted from "Tracking Health Care Costs: Continued Stability But At High Rates In 2005," by Paul B. Ginsburg, Bradley C. Strunk and Michelle I. Banker of HSC; and John P. Cookson of Milliman, Health Affairs, Web-exclusive publication, Oct. 3, 2006, www.healthaffairs.org.

Forecasting↗
PubMed1991

Cardiopulmonary resuscitation.

Cardiac arrest has a very poor prognosis, but if effective bystander BLS and prompt early defibrillation can be delivered to the patient the prognosis will improve. When to terminate a resuscitation is always a vexed question. No simple answer is available. The patient's history, the length of time to effective bystander BLS, the length of time to defibrillation and the presenting rhythm should all be taken into account. Successfully resuscitated patients, hopefully, should leave hospital as neurologically intact as possible.

Cardiopulmonary Resuscitation↗
PubMed1989

Antiimmunoglobulin inhibition of Burkitt's lymphoma cell proliferation and concurrent reduction of c-myc and mu heavy chain gene expression.

We have demonstrated that polyvalent antiimmunoglobulin antibodies directed at appropriate cell surface light (L) or heavy (H) immunoglobulin (Ig) chains will inhibit proliferation and the expression of c-myc and mu-Ig chain mRNA in Burkitt's lymphoma (BL) cell lines bearing 8;14 chromosomal translocations. This effect was not observed in BL cell lines bearing 8;22 translocations or in BL cell lines which did not express surface Ig or in karyotypically normal Epstein-Barr virus-transformed lymphoblastoid cell lines. The antiproliferative effect was reproducible and resulted in cell death in the most sensitive cell lines. The decrease in gene expression preceded the antiproliferative effect. The effect of anti-Ig on gene expression was relatively specific since the level of total (shown by Northern blots) and cytoplasmic (dot blots) mRNA of several other genes (beta-actin, G6PD, kappa-L chain) and the first exon of c-myc (in cell lines in which this exon is expressed separately from the second and third exons) was not changed in these same BL cell lines. Expression of both c-myc and mu was maximally inhibited between 3 and 6 h after the addition of anti-Ig. In the most sensitive BL cell line, concurrent reduction in c-myc and mu mRNA was noted as early as 1 h after anti-Ig and the nadir of expression of these genes occurred at 3 h. These results indicate that the deregulated high constitutive expression of c-myc in some BLs can be down-regulated by anti-Ig resulting in inhibition of proliferation and cell death. In addition these data are consistent with the possibility that in at least some 8;14 bearing BLs the malignant transformation occurs in an immature B-cell undergoing antigen-independent differentiation.

Antibodies↗
PubMed1989

[A case of the bare lymphocyte syndrome with clinical manifestations of diffuse panbronchiolitis].

Touraine et al reported some cases lacking HLA-class I antigens on the cell surface of their lymphocytes as "Bare lymphocyte syndrome" (BLS). Recently we experienced a case of BLS the clinical features of which are very similar to those of diffuse panbronchiolitis (DPB). Namely, she had chronic pansinusitis, diffuse nodular shadows on her chest X-ray film, obstructive impairment of pulmonary function tests and continuous increase of cold hemagglutinin titer. The pathogenesis of DPB is not confirmed. However, this case and other cases with sino-bronchial syndrome suggest that patients with DPB may have some immunodeficiencies. In addition the immunosuppressive action of erythromycin and its effectiveness on DPB were interesting. From these points of view, we discussed the relationship between this case and DPB, and the pathogenesis of DPB.

Adult↗
PubMedDate not supplied

An egg drop associated with splenomegaly in broiler breeders.

A new disease in broiler breeders known in Australia as Big Liver and Spleen Disease (BLS) is described from field observations, retrospective record analysis, and detailed study of a selected flock. BLS has a predilection for adult birds. It is characterized clinically by a sudden drop in egg production, splenomegaly, hepatomegaly, and increased mortality and histologically by a period of lymphoproliferation followed by a period of lymphoid destruction that coincides with the clinical signs. Epidemiology suggests an infectious cause, though initial attempts at isolation of a causative agent have been unsuccessful, and it is serologically distinct from the common avian viral and mycoplasma diseases.

Animals↗
PubMed1986

Cardiopulmonary resuscitation and hypothermia.

Current basic life support (BLS) protocols do not address the physiologic effects of accidental hypothermia in prehospital care. The extreme levels of bradycardia, bradypnea, and peripheral vasoconstriction that often accompany profound hypothermia may complicate the accurate diagnosis of cardiopulmonary arrest in the unmonitored patient. Although CPR is indicated in the truly pulseless, apneic victim of hypothermia, chest compressions may convert nonpalpable but adequately perfusing sinus bradycardia to ventricular fibrillation. This dilemma had led to disagreement among clinicians and researchers in hypothermia about prehospital care protocols for the severely hypothermic patient. This article reviews the controversy and recommends the application of a normal BLS protocol to hypothermic patients presenting in apparent cardiopulmonary arrest.

Humans↗
PubMed1987

Effects of training in cardiopulmonary resuscitation on competence and patient outcome.

Between 1981 and 1985 we carried out a study in two medium-sized nonteaching community hospitals to determine the rate of deterioration of knowledge and skills in cardiopulmonary resuscitation (CPR) among physicians and nurses, the accuracy of their perceptions of their knowledge and skills, the effects of practice on retention and the effect of CPR training on mortality. The participants' knowledge and skills were measured before training and immediately after, 6 months after and 12 months after training. Information on all attempts at CPR involving hospital staff was collected from medical records and from interviews with the participants. A total of 31 physicians and 54 nurses were followed during the study. Six months after training there was no difference in CPR knowledge or skills between the physicians and the nurses. In both groups CPR skills had deteriorated to near pretraining levels. By 6 months the physicians' knowledge had deteriorated to a level not significantly different from that before training. The nurses maintained a significant improvement in knowledge test scores at 12 months over those before training (p = 0.037). The physicians had an accurate perception of their knowledge but not their skills 6 months and 12 months after training, whereas the nurses did not accurately perceive either their knowledge or their skills after training. Experience with CPR did not contribute to post-training knowledge or skills in either group. There was no evidence that death rates were lower when basic life support (BLS) was begun by trained staff than when it was begun by untrained staff. The probability of survival was greater when BLS was begun within 4 minutes of arrest than when it was begun after 4 minutes, regardless of whether advanced cardiac life support was begun within 10 minutes.

Canada↗
PubMed1986

Alternative methods of ventilation during respiratory and cardiac arrest.

Artificial ventilation is a cornerstone of basic life support-cardiopulmonary resuscitation (BLS-CPR). Recent data corroborate clinical studies performed in the 1950s and 1960s, suggesting a need to change the present American Heart Association standards for artificial ventilation. These studies show that gastric insufflation followed by regurgitation and pulmonary aspiration are a major hazard of artificial ventilation with an unprotected airway. Present BLS-CPR standards require that ventilation be performed rapidly between external chest compressions or with incremental breaths. These methods of ventilation predispose the victim to gastric insufflation. Alternative methods of ventilation with longer inspiratory time and thus lower flow rate and peak inspiratory pressure are suggested. Additionally, rescue personnel, particularly EMTs and paramedics, should be taught how to apply cricoid pressure to prevent gastric insufflation in victims with an unprotected airway.

Heart Arrest↗
PubMed1996

Pediatric prehospital care: epidemiology of use in a predominantly rural state.

The objective of this study was to analyze, by retrospective review, the pediatric population utilizing emergency medical services (EMS) throughout Kentucky, with particular emphasis on differences between urban and rural areas. The source of the data used was from all prehospital runs in children less than 17 years of age reported in Kentucky in a computerized database to the state EMS branch. There were no interventions. We found that pediatric calls were more frequent in adolescents than younger children. Trauma was more frequent in older children and in rural settings and accounted for nearly 50% of all calls. Motor vehicle accidents were the most frequent cause of traumatic injuries. Run times were prolonged in the rural setting, but this was a reflection of transport rather than scene times. The use of basic life support (BLS) and advanced life support (ALS) procedures was dependent on the patient's age and the level of care of the provider. ALS procedures were infrequently performed, especially in younger patients, although the performance of these procedures did not prolong scene times. We conclude that educational initiatives for pediatric care in the prehospital setting should include assessment and stabilization of children, including appropriate procedures, both for ALS and BLS providers. Prehospital data should be linked with police reports and emergency department data to provide means of assessing the impact of prehospital services on outcome in pediatric patients.

Adolescent↗