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PubMed1997

Post-traumatic stress disorder symptoms and the Clapham rail accident.

BACKGROUND: Post-traumatic stress disorder is a well recognised condition which can have long-term consequences. A rail accident to commuter trains in south London provided an opportunity, within the context of a Psychological Therapies Service, to study the prevalence and associations of the condition in a follow-up study. METHOD: Postal questionnaires were completed by 187 survivors (52% response rate) 10 to 22 months after the accident, and their symptoms were compared with a commuter control group. RESULTS: The accident group scored significantly higher on the Impact of Events scale (IES) than the control group. Severity of physical injury was significantly associated with high IES scores. Thirty per cent of those moderately or severely injured showed high levels of intrusion or avoidance symptoms (sub-scores of 20 or more). Thirty per cent of those nearest the accident focus had high sub-scores, associated variables being the accident experience of risk of death, feeling trapped and seeing death. For those less directly involved the proportions with symptoms were similar to those of controls. CONCLUSIONS: It is recommended that disaster services should provide for long-term psychological effects, particularly for those survivors who are injured, who experience risk of death, feeling trapped or who witness death.

Accidents↗
PubMed2004

Factors of the physical environment associated with walking and bicycling.

PURPOSE: The purpose of this study was to identify factors of the physical environment that may influence time spent on walking and bicycling. METHODS: Demographic factors and time spent on walking and bicycling (during leisure time and for commuting purposes) were assessed with a self-administered questionnaire. GIS databases were used to objectively measure the total square area of green space and recreational space (woods, parks, sport grounds, allotments for vegetable gardens, and grounds for day trips) in a circle around the postal code of a respondent with a radius of 300 and 500 m. Multilevel regression analysis was used to study the association between walking and bicycling on the one hand, and green and recreational space on the other hand. Analyses were adjusted for gender, age, and educational level. RESULTS: In a neighborhood defined as a circle with a 300-m radius, the square area of sport grounds was associated with bicycling in general and the square area of parks was associated with bicycling for commuting purposes. It is, however, very likely that these results reflect the association of living in the outskirts of town and time spent on bicycling. CONCLUSION: The present study showed green and recreational space, specifically sport grounds and parks, to be associated with time spent on bicycling.

Adult↗
PubMed2006

The role of built environments in physical activity, eating, and obesity in childhood.

Over the past forty years various changes in the U.S. "built environment" have promoted sedentary lifestyles and less healthful diets. James Sallis and Karen Glanz investigate whether these changes have had a direct effect on childhood obesity and whether improvements to encourage more physical activity and more healthful diets are likely to lower rates of childhood obesity. Researchers, say Sallis and Glanz, have found many links between the built environment and children's physical activity, but they have yet to find conclusive evidence that aspects of the built environment promote obesity. For example, certain development patterns, such as a lack of sidewalks, long distances to schools, and the need to cross busy streets, discourage walking and biking to school. Eliminating such barriers can increase rates of active commuting. But researchers cannot yet prove that more active commuting would reduce rates of obesity. Sallis and Glanz note that recent changes in the nutrition environment, including greater reliance on convenience foods and fast foods, a lack of access to fruits and vegetables, and expanding portion sizes, are also widely believed to contribute to the epidemic of childhood obesity. But again, conclusive evidence that changes in the nutrition environment will reduce rates of obesity does not yet exist. Research into the link between the built environment and childhood obesity is still in its infancy. Analysts do not know whether changes in the built environment have increased rates of obesity or whether improvements to the built environment will decrease them. Nevertheless, say Sallis and Glanz, the policy implications are clear. People who have access to safe places to be active, neighborhoods that are walkable, and local markets that offer healthful food are likely to be more active and to eat more healthful food-two types of behavior that can lead to good health and may help avoid obesity.

Child↗
PubMed2005

Feasibility study of the use of frozen human sera in split-sample comparison of immunoassays with candidate reference measurement procedures for total thyroxine and total triiodothyronine measurements.

BACKGROUND: Diagnostic manufacturers must ensure/document metrologically traceable assays. We report on a feasibility study of a split-sample comparison for that purpose. Processed, frozen single-donation sera, assigned target values by candidate reference measurement procedures (cRMPs), were used with immunoassays for total thyroxine (TT(4)) and triiodothyronine (TT(3)) as models. METHODS: Two serum panels were quantified for TT(4) and TT(3) with validated cRMPs and measured in parallel with at least 14 immunoassays. The results were interpreted in terms of traceability of calibration (trueness) and of the individual measurement result (accuracy) by linear regression analysis and graphical representation against specifications. The commutability of the sera was investigated by parallel analysis of TT(4) in freshly collected but nonfiltered specimens. RESULTS: The TT(4) (TT(3)) concentrations in the sera (according to the cRMPs) were 64-269 nmol/L (0.88-13.7 nmol/L). The method comparison showed that for TT(4), on average, the immunoassays produced results in agreement with the cRMPs, whereas for TT(3), results were typically higher. It also demonstrated a considerable between-assay divergence in traceability of calibration and accuracy. The evidence of noncommutability of the sera attributable to processing, however, indicates that the interpretation should be treated with caution. CONCLUSIONS: Frozen sera can be used for documenting/validating traceability of total thyroid measurements. The way in which the sera are processed may jeopardize commutability, however, and therefore requires in-depth investigation.

Cryopreservation↗
PubMed2004

Metrological traceability of calibration in the estimation and use of common medical decision-making criteria.

This manuscript explains the establishment and validation of metrological traceability of calibration for routine measurement procedures using common medical decision-making criteria. Metrological traceability is considered the basis for achieving comparability of measurement results in laboratory medicine. This concept is supported by European legislation, which demands that manufacturers provide assurance and demonstrate metrological traceability of in vitro Diagnostic Medical Devices. The guidance to comply with these legislative requirements is available in different CEN/ISO standards and is used as a basis of this manuscript. The goals and accomplishments in metrological traceability of SI- and non-SI analytes is considered. Specific problems, such as non-availability of primary reference materials and measurement procedures, lack of official endorsement, and non-commutability of certain reference materials are discussed. With respect to non-commutability, the use of split-sample measurements is advocated. Also, the expression of measurement uncertainty associated with the application of the metrological traceability chain is discussed. In addition, the need for post-market vigilance assessment of traceable performance is considered. Finally, laboratory medicine scientific and professional societies, diagnostics manufacturers, and clinicians are urged to share responsibilities for understanding the implications of metrological traceability of routine measurements.

Calibration↗
PubMed2006

Mental well-being of doctors and nurses in two hospitals in Kingston, Jamaica.

Hospital work involves some of the most stressful situations found in any workplace. Furthermore, hospital workers may be affected by non-work-related stress such as family responsibilities and financial difficulties, leading to impaired mental well-being and suboptimal performance. The aim of this study was to assess the level of general mental well-being among doctors and nurses from two hospitals in Kingston, Jamaica. A total of 212 doctors and nurses at the Kingston Public Hospital and the University Hospital of the West Indies were studied yielding a participation rate of 83.1%. A self-administered questionnaire was used to gather social and biomedical data and the General Health Questionnaire 30 (GHQ 30) used to determine general mental well-being. Probable caseness was defined as a GHQ 30 score > 5. Focus group discussions were also held with staff at both hospitals. A total of 27.4% of the study population met the GHQ-30 criteria (caseness) defining them as probable cases of mental distress. Cases and non-cases were not different in age, gender or hospital of employment. However, caseness was associated with years of professional experience, work-related and non-work-related stress, serious financial difficulties and fears of coming to work. Significant predictors of increased risk of caseness were fear of coming to work (OR 3.06; CI 1.40, 6.70); professional experience in excess of five-years and high non-work-related stress. High work-related stress was associated with reduced risk of being classified a case, suggesting that work may have been therapeutic. Focus group discussions suggested that non-work stress was related to financial difficulties, commuting and child care, especially among nurses. Intervention to improve general mental well-being should be targeted at new employees and should address child care, commuting and financial management.

Adaptation, Psychological↗
PubMed2000

Empirical evaluation of axioms fundamental to Stevens's ratio-scaling approach: I. Loudness production.

Stevens's direct scaling methods rest on the assumption that subjects are capable of reporting or producing ratios of sensation magnitudes. Only recently, however, did an axiomatization proposed by Narens (1996) specify necessary conditions for this assumption that may be put to an empirical test. In the present investigation, Narens's central axioms of commutativity and multiplicativity were evaluated by having subjects produce loudness ratios. It turned out that the adjustments were consistent with the commutativity condition; multiplicativity (the fact that consecutive doubling and tripling of loudness should be equivalent to making the starting intensity six times as loud), however, was violated in a significant number of cases. According to Narens's (1996) axiomatization, this outcome implies that although in principle a ratio scale of loudness exists, the numbers used by subjects to describe sensation ratios may not be taken at face value.

Adult↗
PubMed1995

The effect of combinations of image degradations in a discrimination task.

This paper explores the ways in which combinations of image degradations affect discrimination. Nine experiments are described that examine the discriminability of visual images that are degraded with three types of information reducing transformations: random punctate visual interference, low-pass spatial frequency filtering, and local area (i.e., block) averaging. The results of these experiments characterize a powerful visual ability to discriminate highly degraded stimuli unless that ability is severely challenged by relatively high levels of random visual interference. Discriminative commutativity of the orders in which the other two degradations are imposed is demonstrated. That is, the order in which the degradations are applied does not affect the final discriminative outcome. This result is in contrast to predictions from relevant mathematics and direct examination of the images produced by both orders of degradation. The commutativity is attributed to the particularly strong effect of the low-pass spatial frequency filtering degradation on the discrimination process. This study also demonstrates that combinations of degradations in a discrimination task always result in a reduction in performance, and never in the improvement that has been reported for recognition. This difference is attributed to the fact that form discrimination is mediated mainly by local features and high-frequency spatial components, whereas recognition is mediated mainly by global features and low-frequency spatial components.

Adult↗
PubMed2004

Impact of worktime arrangements on work-home interference among Dutch employees.

OBJECTIVES: This study examined the effects of different worktime arrangements on work-home interference while taking into account other work-related factors, private situation and health status, explored gender differences in this relation, and examined reciprocal effects between workhours and work-home interference. METHODS: Data from the Maastricht cohort study on fatigue at work were used with 8 months of follow-up (N=6947 at baseline). RESULTS: Worktime arrangements were related to work-home interference among the men and women, even after control for confounding. As compared with daywork, baseline shiftwork was associated with higher work-home interference over time. Within daywork, full-time work was prospectively related to higher work-home interference than part-time work was. For full-timers, baseline overtime work, hours of overtime work, change in number of workhours, and commuting time were related to higher work-home interference over time, whereas compensation for overtime work, familiarity with work roster, ability to take a day off, and a decrease in workhours at own request were associated with less work-home interference. For the part-timers, baseline overtime work and commuting time were related to higher work-home interference over time, whereas compensation for overtime, flexible workhours, and ability to take a day off were protective against work-home interference. Reciprocal relations between work-home interference and workhours were also found. CONCLUSIONS: Worktime arrangements are clearly related to work-home interference. Because reciprocal effects exist as well, important selection processes may exist. Nevertheless, specific characteristics of worktime arrangements could constitute useful tools for reducing work-home interference.

Adult↗
PubMed2005

Risk of accidents and occupational diseases among the Finnish Defence Forces.

OBJECTIVES: Military activities are often considered more dangerous than civilian work, especially in crisis situations, but peacetime or even peacekeeping conditions have seldom been analyzed in this respect. According to the compensation statistics of the Finnish State Treasury, in 2001, 80% of injuries among military personnel were caused by accidents at work, 15% occurred during commuting to and from work, and 5% were attributable to occupational diseases. RESULTS: The compensated accident frequencies varied between 22 and 26 cases per 1 million work hours during the 1990s. During the past few years, the incidence rate has slightly declined. When accidents among military personnel were considered, most occurred during military exercises (57%), during other work (35%), or during work commuting (9%). One person died in an accident during a military exercise in 2001. On the basis of the data of this study, the hypothesis of a substantially higher risk during peacetime for military work, compared with civilian work, is not defensible. The accident rates in the calendar year 2000 were 25% higher for Finnish civilian work (32 cases per 1 million hours) than for the Finnish Defence Forces (22 cases per 1 million hours).

Accidents↗
PubMed1996

Train crash disasters and emergency plans of suburban hospitals in the New York City and Washington, DC areas: what went right; what could have been improved.

Two major train crashes in February--one in Northern New Jersey and the other in Silver Spring, MD, near Washington, DC--posed severe challenges to the disaster plans of area hospitals. The first crash involving two commuter trains near Secaucus, NJ, tested the effectiveness of emergency plans at the Jersey City Medical Center, Jersey City, NJ, and the Meadowlands Hospital Medical Center, Secaucus. The incident occurred at approximately 8:40 a.m. and resulted in three deaths and 162 injuries. The Silver Spring crash, which took place a week after the one in New Jersey, occurred in early evening and involved an Amtrak and a commuter train. It resulted in 11 deaths and 26 injuries. Holy Cross Hospital, Silver Spring, was the primary caregiver. In this report, we'll provide details on how the incidents impacted on nearby hospitals and their security staffs; how challenges, anticipated and unanticipated, were met; and what conclusions were reached in follow-up critiques.

Accidents↗
PubMed2000

Corporate action to reduce air pollution--Atlanta, Georgia, 1998-1999.

Ground-level ozone, a colorless gas, is a major constituent of smog. Since the early 1980s, controlled studies have demonstrated that exposure to elevated levels of ozone reduces inspiratory capacity in humans. In addition, ecologic analyses have indicated that daily emergency department visits for asthma exacerbations are elevated following days of high ozone pollution. The Partnership for a Smog-Free Georgia (PSG) is a state-sponsored program to reduce the number of days that ground-level ozone exceeds the national ambient air quality standard (NAAQS) in metropolitan Atlanta by providing federal and state subsidized commuting alternatives for local business employees. This report summarizes commuter data from three PSG partners to estimate reductions in emissions and monthly vehicle miles traveled that were associated with enrollment in PSG.

Air Pollution↗
PubMed2002

Human factors in aviation crashes involving older pilots.

BACKGROUND: Pilot errors are recognized as a contributing factor in as many as 80% of aviation crashes. Experimental studies using flight simulators indicate that due to decreased working memory capacity, older pilots are outperformed by their younger counterparts in communication tasks and flight summary scores. OBJECTIVE: This study examines age-related differences in crash circumstances and pilot errors in a sample of pilots who flew commuter aircraft or air taxis and who were involved in airplane or helicopter crashes. METHODS: A historical cohort of 3306 pilots who in 1987 flew commuter aircraft or air taxis and were 45-54 yr of age was constructed using the Federal Aviation Administration's airmen information system. Crash records of the study subjects for the years 1983-1997 were obtained from the National Transportation Safety Board (NTSB) by matching name and date of birth. NTSB's investigation reports were reviewed to identify pilot errors and other contributing factors. Comparisons of crash circumstances and human factors were made between pilots aged 40-49 yr and pilots aged 50-63 yr. RESULTS: A total of 165 crash records were studied, with 52% of these crashes involving pilots aged 50-63 yr. Crash circumstances, such as time and location of crash, type and phase of flight, and weather conditions, were similar between the two age groups. Pilot error was a contributing factor in 73% of the crashes involving younger pilots and in 69% of the crashes involving older pilots (p = 0.50). Age-related differences in the pattern of pilot errors were statistically insignificant. Overall, 23% of pilot errors were attributable to inattentiveness, 20% to flawed decisions, 18% to mishandled aircraft kinetics, and 18% to mishandled wind/runway conditions. CONCLUSIONS: Neither crash circumstances nor the prevalence and patterns of pilot errors appear to change significantly as age increases from the 40s to the 50s and early 60s.

Accidents, Aviation↗
PubMedDate not supplied

[Enzyme calibrators: principle and practical use].

Results of catalytic activities of enzymes are highly dependent on the measurement procedures and on local conditions. Thus, only poorly marked improvement of interlaboratory comparability of results have been observed in clinical enzymology. To solve this problem, SFBC and IFCC have proposed to use "validated enzyme calibrators". Standardised operating procedures adapted to 37 C have been developed by IFCC for the most commonly used enzymes in clinical chemistry, and will be soon published. Reference materials which have been certified with these SOPs can be used as calibrators for a set of measurement methods which exhibit the same analytical specificity. Calibrators must be commutable, a property that must be checked experimentally. It is possible to produce stable and commutable materials for the calibration of a set of methods. Interest of this approach has been demonstrated for several enzymes. Results of two studies presented here show that the comparison of results to the upper limit of reference ranges does not improve the interlaboratory comparability of results in contrast to the calibration of different methods by a common calibrator which allowed to reach an interlaboratory CV close to 4% for ALT and gammaGT.

Calibration↗
PubMed2000

Adaptations made by rheumatoid arthritis patients to continue working: a pilot study of workplace challenges and successful adaptations.

OBJECTIVES: The goals of this pilot study were to use qualitative research techniques in a group of currently employed patients with rheumatoid arthritis (RA) to develop categories of challenges encountered in maintaining employment and categories of successful adaptations made to continue working; and to identify obstacles considered to be persistent threats to continued employment. METHODS: Patients were interviewed by telephone with a questionnaire composed of structured-response format and open-ended response format questions focusing on specific challenges and adaptations in the workplace. RESULTS: Of the 22 patients interviewed, 96% were women, mean age was 50 years, 84% were college graduates, and the majority had light physical job demands and high autonomy over their work and hours worked. Patients encountered diverse challenges, such as fatigue, pain, typing, writing, physical requirements, maintaining a pleasant disposition, working overtime, traveling for business, commuting, being on time, not being able to choose rest periods, and environmental issues. Patients also made multiple adaptations to continue working, the most helpful being changing job or altering career path (36%), altering work hours (32%), using more disease-modifying antirheumatic drugs (27%), using car service (23%), sleeping more (18%), and working at home (14%). Patients were not at all confident in their ability to continue working because of RA, and perceived the following persistent threats to continued employment: fatigue (45%), not being able to use hands (45%), not being able to choose rest periods (27%), and commuting problems (18%). In addition, patients confronted psychological stresses, such as dealing with coworkers and supervisors and balancing job and personal roles. These challenges and adaptations included unfavorable work-related occurrences, or "negative work-role events." CONCLUSIONS: Seemingly successfully employed patients with RA faced multiple challenges and made major adaptations to maintain employment and still perceived their employment to be in jeopardy because of RA. The findings of this study have important implications for screening patients at risk for negative work-role events and for possible work-related and social support interventions aimed at preserving employment.

Activities of Daily Living↗
PubMed1992

Trends in bicycle helmet use in Ottawa from 1988 to 1991.

OBJECTIVE: To determine the prevalence rates of helmet use by cyclists in Ottawa in September 1991 and to compare them with the rates in a baseline survey conducted in September 1988. DESIGN: Observational survey. SUBJECTS: A total of 3252 cyclists (commuters, recreational cyclists and students in primary, secondary and postsecondary schools) were observed. In the baseline study 1963 such cyclists had been surveyed. RESULTS: In 1991, 1056 (32.5%) of the cyclists were observed wearing helmets. After the samples were standardized for varying size across the cyclist groups the total helmet use was found to have increased from 10.7% in 1988 to 32.2% in 1991. The highest increase in the rate of helmet use was found among the commuters (from 17.9% in 1988 to 44.6% in 1991); the rate had increased from 14.3% to 31.1% among the recreational cyclists and from 1.9% to 21.0% among the students. All of the trends were statistically significant (p less than 0.0001). When the student population was subdivided the rate of helmet use was found to be 25% among the elementary school children, 17% among the secondary school students and 20.2% among the postsecondary school students. CONCLUSIONS: The use of bicycle helmets in Ottawa has increased dramatically. Our experience, as well as evidence from other centres, indicates that specific interventions such as media coverage, bulk-buying projects in schools and discount coupons can accelerate the rate of helmet adoption. Although less than half of cyclists are wearing helmets the trend has acquired considerable momentum, and major gains are expected in the next few years. Nevertheless, resistance among young adults and the cost of helmets for low-income groups may be problems. These challenges call for the refinement of future promotional strategies.

Adult↗
PubMed1992

A collaborative trial for the evaluation of blood cholesterol measurement in clinical laboratories in Italy.

A collaborative trial for the evaluation of blood cholesterol measurement in Italy was carried out, with the use of two lyophilized controls, whose target values, respectively 4.42 and 6.21 mmol/l, were established by means of "definitive" methodology (isotope dilution/mass spectrometry). Results from 480 participants showed a somewhat broad dispersion (CV 6.1% and 6.3% respectively), and a definite bias (-0.25 mmol/l and -0.61 mmol/l respectively) with respect to the target values. The different analytical systems were characterized by different combinations of inaccuracy and imprecision; however, the bias observed for the higher concentration sample was a constant finding. The behaviour of the control materials, in comparison with that exhibited by patients' sera, was assessed in a manual enzymatic procedure and in the Kodak Ektachem 700 and Technicon Chem 1 systems. The peculiar property of one control material to behave differently from patients' sera in some analytical systems, i.e. the lack of commutability, was found to be partially responsible for the observed bias in the three methods studied. The importance of testing for commutability of the control materials to be used for the control of accuracy is stressed.

Blood Chemical Analysis↗
PubMed2005

Ground crew injuries and fatalities in U.S. commercial aviation, 1983-2004.

INTRODUCTION: Ground crew services are an essential part of airport operations. Injury hazards to ground crewmembers who are in close proximity to aircraft have not been well studied. The objective of this paper was to examine airport ground crew injuries and fatalities involving aircraft of commuter air carriers and major airlines. METHODS: Investigation reports for all ground crew injuries involving commuter and major airline aircraft that occurred at United States airports between 1983 and 2004 were obtained from the National Transportation Safety Board (NTSB) and analyzed to describe the immediate cause and pattern of injury occurrence. RESULTS: During the 22-yr study period, the NTSB recorded a total of 80 ground crew accidents involving landing, taxiing, or standing commercial airline aircraft, yielding an overall rate of 0.47 ground crew related accidents per 1 million aircraft departures. These accidents resulted in injuries to 98 ground crewmembers, including 21 fatalities. Two-thirds of the accidents took place as the aircraft was departing. Vehicular collisions with an aircraft made up 43% of accidents, 34% were caused by moving aircraft equipment such as propellers or nose gear, and 11% resulted from jet blasts or fires. CONCLUSIONS: intervention programs for airport ground personnel should emphasize the safe operation of the aircraft equipment and ground vehicles. Some of the injuries to ground crewmembers might be avoided through improved design of commonly used equipment.

Accidents, Aviation↗