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Religious-based denial in the NICU: implications for social work.

Families of critically ill infants in the neonatal intensive care unit may be placed in the emotionally charged position of making treatment decisions about their infants, including the withholding of medical treatment. Some families, unable to deal with these issues, cope through a harmful form of religious denial; the eternal belief in a miracle. This article discusses the concept of death, religious-based denial, and health care team reactions to such family dynamics. The role of the social worker is reviewed in regard to: (1) dealing with his/her own feelings about religious-based denial (2) advocating for families, and (3) supporting and consulting with staff around this sensitive area.

Counseling↗

[Populations of harmful rodents on commercial swine-breeding farms and their effect on the technology of swine feeding].

The effect was studied of the swine-feeding technology in five industrial complexes on the population density of the harmful rodents in them. This made it necessary to estimate the population density of the rodents in each productional section of the swine-breeding complexes, and to work out their technologic characteristic on the nutrition principle. It was established that the population density of rodents correlated positively with their access to feeds. In sections where rated, mechanical, and protected feeding was prectised the number of rodents were considerably lower than in sections with unrated feeding of pigs. It is believed that the rat invasion of the buildings in the industrial swine-breeding complexes is a factor that contributes to the rise of populations of harmful rodents, while the vast access to feeds is of greater importance chiefly for their further development.

Animal Feed↗

[The antimony conflict].

Antimony, which was already well known to the ancients, in the Middle Ages was known as Lupus metallorurn--the grey wolf--a key material in alchemists' attempts at purifying gold. Over subsequent centuries antimony returned within the bounds of conventional scientific and experimental knowledge, but inspired numerous studies, works of literature and investigations in important fields of medicine. Antimony has always aroused more interest than one might expect from a simple metal. The fact that it has been used since ancient times in cosmetics and then in alchemy gave it both positive and negative connotations, reflecting its possible uses and the benefits for health but also the potential harm. For a certain period antimony was virtually the symbol for a range of uses in alchemy or empirical medicine, in the face of modern scientific knowledge, and aroused debate that went well beyond its actual physical and chemical properties. Bernardino Ramazzini's work in the 17th-18th centuries signalled the recognition that the use of antimony was linked to health risks. Today it is put to many uses in many fields of industry and medicine, so our interest in this metal is no longer exclusively a question of history, but is highly topical.

Antimony↗

Position of the American Dietetic Association: food and nutrition misinformation.

It is the position of the American Dietetic Association (ADA) that food and nutrition misinformation can have harmful effects on the health, well-being, and economic status of consumers. Nationally credentialed dietetics professionals working in health care, academia, public health, the media, government, and the food industry are uniquely qualified to advocate for and promote science-based nutrition information to the public, function as primary nutrition educators to health professionals, and actively correct food and nutrition misinformation. Enormous scientific advances have been made in the area of food and nutrition, leading to a fine-tuning of recommendations about healthful eating. Consumers have become increasingly aware of the nutrition-health link and reliant on nutrition information to base their decisions, and have assumed partial responsibility for changing their eating behaviors. Unfortunately, these same trends also create opportunities for food and nutrition misinformation to flourish. News reports rarely provide enough context for consumers to interpret or apply the advice given, and preliminary findings often attract unmerited and misleading attention. Effective nutrition communication must be consumer-friendly and contain sufficient context to allow consumers to consider the information and determine whether it applies to their unique health and nutritional needs. Consistent with ADA's organizational vision that members "are the leading source of nutrition expertise," ADA recognizes its responsibility to help consumers identify food and nutrition misinformation in the following ways: (a) ADA members should provide consumers with sound, science-based nutrition information and help them to recognize misinformation; (b) ADA members need to be the primary source of sound, science-based nutrition information for the media and to inform them when misinformation is presented; and (c) ADA members should continue to diligently work with other health care practitioners, educators, policy makers, and food and dietary supplement industry representatives to responsibly address the health and psychological, physiological, and economic effects of nutrition-related misinformation.

Communication↗

Assessment of workload and arm position during different work sequences: a study with portable devices on construction workers.

It is recognised that work related shoulder pain is overrepresented among construction workers compared to other occupations. Studies have shown that working with hands above shoulder level increases the shoulder load. Most studies have been confined to the laboratory. The present project was carried out to map the muscular engagement and postures of construction workers undertaking ceiling fitting, and to compare the results to those of the laboratory studies. Two ambulatory devices were used, one allowing recording of electromyographic (EMG) signals bilaterally from the trapezius muscle, and the other to record the position of both arms and back by means of measuring the angles between the vertical line and the back and both upper arms. These recordings were performed during 1.5-2 h work sequences. The results show that the work was mostly performed in an upright position, that both arms were used to a similar amount and that the workers for a large proportion of their working time had their upper arms at levels that are considered harmful in view of shoulder load. The EMG data showed that nearly 50% of the work was spent with trapezius activity that exceeded that of the reference contraction used (about 15% of maximal voluntary contraction) and that the time spent in muscular relaxation was 10%. It was concluded that the exposure of construction workers undertaking ceiling fitting meets the criteria formulated on the basis of laboratory experiments with respect to a high risk of acquiring chronic shoulder pain, due to rotator cuff tendinitis.

Adult↗

Intensity and character of pain and muscular activity levels elicited by maintained extreme flexion position of the lower-cervical-upper-thoracic spine.

The aim of this study was to find out whether maintained extreme flexion position of the lower-cervical-upper-thoracic spine in a sitting posture could induce pain, and thus possibly play a role in work related disorders with cervico-brachial pain. Ten healthy subjects assessed pain intensity of experimentally-induced pain on a Visual Analogue Scale (VAS). The quality and location of the pain was indicated on a drawing of the body. The load moment induced by the weight of the head-and-neck was calculated. The EMG activity levels were recorded from the splenius, thoracic erector spinae-rhomboid, and descending part of trapezius muscles. This posture, which resembles the posture in some common work, caused pain in all subjects. The pain was experienced within 15 min, increased with time, disappeared within 15 min after the end of provocation, but was again experienced by nine subjects the same evening or next morning and lasted up to four days. The primary location was in the dorsal part of the lower cervical and upper thoracic spine; three subjects also reported pain in the arms and one in the head. The recorded EMG levels were very low, but they increased somewhat during provocation. It is suggested that thorough recordings of work postures should be included in ergonomic analyses to provide a basis for the avoidance of such positions which might provoke pain.

Adult↗

[Knowledge and attitude toward epilepsy among health area students].

Several studies in different countries show a lack of knowledge about epilepsy with consequent prejudice and discrimination to epileptic patients. We aim to evaluate knowledge and attitudes of health area junior and senior students. Simple self-administered questionnaires were applied to 290 junior students and to 274 senior students. Senior students had more familiarity, better knowledge about etiology and had a more positive perception about anticonvulsant medication. Positive attitudes about work were more common among senior students. Although, significant percentage of students had a lack of knowledge about epilepsy. A third of the respondents could use improper and potentially harmful measures during a seizure. Actions directed to increment the knowledge and attitudes of health area students could improve the quality of life of patients with epilepsy.

Adult↗

Tobacco usage in school children in Bombay, India. A study of knowledge, attitude and practise.

A study of knowledge, attitude and practice with regard to tobacco usage was conducted in 1278 boys and 353 girls studying in the final year in various schools in Bombay. The proportion of boys given to one or the other form of tobacco usage (including experimenters/triers) was significantly higher in private English median schools (22.5%) compared to private Indian language schools (6.9%) or municipal Indian language schools (13.8%). There was also a significant difference between the two types of Indian schools. Girls from only Indian language schools were entered into the study and the proportion of tobacco users in them was very low (1.1%). Most (86%) boys who used tobacco were smokers. Hence the detailed analysis is restricted to smokers. Several probable factors influencing smoking behavior were studied. It was found that significantly higher proportion of boys smoked if their father or best friend smoked. Generally boys were more sensitive to best friend's or elder brother's disapproval than to parental. They were well informed about harmfulness of smoking but knowledge about specific health hazards was limited. Most of them had a positive attitude towards nonsmoking and smoking control programmes. Tobacco use has been proven to be a major health hazard. Although its use in adults in India is common, prevalence in adolescents in urban schools is not yet high. Before the situation changes we need to mount anti-tobacco educational programmes and work towards a non-tobacco generation to contain the harmful consequences of tobacco usage.

Adolescent↗

Selected health risks caused by long-term, whole-body vibration.

The problem of a "vibration disease" caused by low-frequency whole-body vibration (wbv) is critically discussed. Disorders of the nervous, circulatory, and digestive systems are interpreted not to be predominantly wbv-specific, but to be related to the totality of working conditions. Long-term wbv exposure can probably contribute to the pathogenesis of disorders of female reproductive organs (menstrual disturbances, anomalies of position) and disturbances of pregnancy (abortions, stillbirths). Animal experiments suggest harmful effects on the fetus. WBV has a minor synergistic effect on the development of noise-induced hearing loss. Degenerative changes of the spine are more prevalent among wbv-exposed workers. Model calculations demonstrate an increased spinal load in pregnant women exposed to wbv or self-induced vibration, and illustrate a possibility for the comparison of data on stress, strain, and strength. The analysis of individual exposure-effect relationships is suggested as a future approach for evaluating potential occupation-related diseases.

Animals↗

Characteristics of effective, harm-free environments for children in out-of-home care.

The history of out-of-home care is replete with documented examples of abusive and neglectful practices. Some scholars express concern that out-of-home care is de facto abusive. Certain elements, however, can foster effective and harm-free out-of-home care, such as caregiver support, a model of care, a focus on positive behavior, a consumer orientation, training, program evaluation, and an internal program audit. These elements work together to increase program effectiveness and reduce negative outcomes such as staff burnout. Furthermore, programs that use these elements can be cost efficient.

Caregivers↗

[Comparative analysis of nourishment of Lithuanian and Latvian seafarers at sea].

OBJECTIVE: To evaluate and compare the nourishment of Lithuanian and Latvian seafarers at sea. MATERIAL AND METHODS: The present pilot study was comprised of 997 Lithuanian and 993 Latvian seafarers applying for obligatory medical examination. Participants were asked to fill out a questionnaire consisting of 44 questions. The questionnaire helped to obtain information on general data (age, education, position on ship, work record, types of ship, number of crew on ship, months of work on ship per year), medical care and health, smoking habits, usage of alcohol, weight, height, physical activity on ship, harmful factors at sea, nourishment on ship. RESULTS: At sea Latvian seafarers more often than Lithuanian seafarers took boiled and roast potatoes, porridge or flakes, cheese, curd cheese, meat, chicken, sound fruits and vegetables, eggs, coffee and juice. Every fourth seafarer drank coffee without sugar, every third put one teaspoonful, and every third--two teaspoonfuls of sugar into the cup. Twice more Lithuanians than Latvians drank tea without sugar (40.6 and 23.9%, respectively). About one-third of Lithuanian (32%) and less than a half of Latvian (40%) seafarers drank tea and coffee with two teaspoonfuls of sugar; 4-5% of seafarers put three and more teaspoons of sugar into their cup of coffee or tea. Latvian seafarers at the average consumed more white (2.1 slices) and French bread (1.9 slices) per day than Lithuanians (1.6 and 1.2 slices, respectively). Consumption of brown bread was almost the same--approximately 2.3 slices. More than a half (57.2%) of Lithuanians and 11% more of Latvians (68.2%) added salt to the food served on board. Approximately 2% of Latvian and 1.5% of Lithuanian seafarers added salt prior to tasting the food. CONCLUSIONS: At sea Latvian seafarers more often than Lithuanian seafarers took boiled and roast potatoes, porridge or flakes, cheese, curd cheese, meat, chicken, sound fruits and vegetables, eggs, coffee and juice. On the average Lithuanian seafarers took less sugar than Latvian seafarers. Latvian seafarers consumed more white and French bread than Lithuanian seafarers. Latvian seafarers consumed more salt than Lithuanian seafarers.

Attitude to Health↗

Successful linkage of medical care and community services for HIV-positive offenders being released from prison.

Human immunodeficiency virus (HIV) infection is more prevalent among the incarcerated than the general population. For many offenders, incarceration is the only time that they may access primary care. Project Bridge is a federally funded demonstration project that provides intensive case management for HIV-positive ex-offenders being released from the Rhode Island state prison to the community. The program is based on collaboration between colocated medical and social work staff. The primary goal of the program is to increase continuity of medical care through social stabilization; it follows a harm reduction philosophy in addressing substance use. Program participants are provided with assistance in accessing a variety of medical and social services. The treatment plan may include the following: mental illness triage and referral, substance abuse assessment and treatment, appointments for HIV and other medical conditions, and referral for assistance to community programs that address basic survival needs. In the first 3 years of this program, 97 offenders were enrolled. Injection drug use was reported by 80% of those enrolled. There were 90% followed for 18 months, 7% moved out of state or died, and 3% were lost to follow-up. Reincarceration happened to 48% at least once. Of those expressing a need, 75% were linked with specialty medical care in the community, and 100% received HIV-related medical services. Of those expressing a need for substance abuse treatment, 67% were successful in keeping appointments for substance abuse treatment within the community. Project Bridge has demonstrated that it is possible to maintain HIV-positive ex-offenders in medical care through the provision of ongoing case management services following prison release. Ex-offenders will access HIV-related health care after release when given adequate support.

Adult↗

A quantitative analysis of valgus torque on the ACL: a human cadaveric study.

The loads needed to elicit a positive pivot shift test in a knee with an anterior cruciate ligament (ACL) rupture have not been quantified. The coupled anterior tibial translation (ATT), coupled internal tibial rotation (ITR), and the in situ force in the ACL in response to a valgus torque, an inherent component of the pivot shift test, were measured in 10 human cadaveric knee specimens. Using a robotic/universal force-moment sensor testing system, valgus torques ranging from 0.0 to 10.0 Nm were applied in nine increments on the intact and ACL-deficient knee in flexion ranging from 0 degrees to 90 degrees. At 15 degrees of knee flexion, the coupled ATT and ITR were significantly increased in the ACL-deficient knee when compared to the intact knee. Coupled ATT increased a maximum of 291% (6.7 mm, p<0.05), while coupled ITR increased a maximum of 85% (5.1 degrees, p<0.05). At 30 degrees, the increases in coupled ATT and ITR were significant at valgus loads of 3.3 Nm and greater with a maximum increase in coupled ATT of 137% (6.3 mm, p<0.05) and a maximum increase in coupled ITR of 38% (3.6 degrees, p<0.05). At 45 degrees, coupled ATT increased significantly (maximum of 69%, 4.4 mm, p<0.05), but only at torques > or =6.7 Nm. The in situ force in the ACL was less than 20 N for all flexion angles when a torque between 3.3 and 5.0 Nm was applied. Low valgus torque elicited tibial subluxation in the ACL-deficient knee with low in situ ACL forces, similar to a positive pivot shift test. Thus, application of a valgus torque may be suitable to evaluate ACL-deficient and ACL-reconstructed knees, since subluxation can be achieved with minimal harm to the ACL graft. This work is important in understanding one load component needed for the pivot shift examination; further studies quantifying other load components are essential for better comprehension of the in vivo pivot shift examination.

Adult↗

The evaluation of maternal competency.

There is limited discussion of maternal competency in the consultation-liaison psychiatry literature. As awareness and reporting of child abuse is increasing, maternal ability to care for newborns is more often called into question. Maternal risk factors for harm and neglect have been identified, and positive signs of maternal ability have also been recognized as important to appraise. Specific domains in the maternal competency exam should be assessed by the psychiatrist, nursing staff, social work staff and pediatrician. The competency exam by the psychiatrist requires a sensitive and nonjudgmental inquiry into maternal behavior and thoughts. The authors present a case study of an inpatient maternal competency consultation that illustrates some of the dilemmas encountered. Future directions should include more involvement by psychiatrists in preventive efforts and interventions that focus on pregnant women at risk in prenatal clinics and in the community.

Adult↗

[Physical exertion at work and the course and outcome of pregnancy].

The authors present the latest data on the effect of physical load on pregnancy course and outcome, and they indicate that such as load may become a risk factor for preterm birth and low birth weight. The probability of pregnancy complications induced by great physical load is related to physiological changes occurring in the female body during pregnancy. Observations made in regard to physical load related with sport or recreation activities confirm such a likelihood. In the literature on the effect of occupation-related physical load on pregnancy course and outcome, the following factors are emphasised: intensity of physical activity (work), work pace, handling heavy objects, body position during work performance, time spent in standing position, and daily or weekly distribution of working time. The study results indicate evidently negative effect of occupation-related physical load only in the case low living standards experienced by pregnant women. The results of the studies carried out in Poland showed that high occupation burden is an independent risk factor or preterm birth and hypotrophia. Therefore, according to current regulations concerning job restrictions for pregnant women only light work and standing position limited to three hours during shift are permissible, whereas forced body position and forced work pace (e.g. at production belt) are forbidden. In the discussion, the authors compare the legal regulations binding in our country with the European Union's legislation on the protection of pregnant women against harmful factors occurring in the work environment. Attention is also turned to the need for bringing our legal regulations closer to solutions adopted by the European Union, especially in the case of lack of jobs in a given enterprise which could be performed by pregnant women.

Adult↗

[Effects of passive smoking on menstrual function of perimarital women].

To study the effects of passive smoking on menstrual function of perimarital women, 3466 premarital women in Beijing were investigated by questionnaire on their general health, occupations lifestyles, smoking and passive smoking habits, nutrition, environmental exposure and menstrual functions. The data was analyzed by Logistic regression statistics and the results showed that passive smoking at home and at work was positively associated with menstrual dysfunction and dysmenorrhea (P < 0.01) and there was a dose-response relationship (P < 0.05). The results showed that passive smoking, especially at work, can cause menstrual dysfunction of the perimarital women. It is harmful to reproductive health of the childbearing age women.

Adult↗

[Patient rights alone are not enough, too many rights can also be harmful].

The nowadays running increased emphasis on patients rights can be seen positive as a way towards a "competent partner-patient". However, better health results to come out of it want mainly an important pre-condition, which we call "general renaissance of communication culture". This should work on the non-verbal, verbal and written level. We name the following examples on this way. -Schooling for communication, including the mechanism of "positivation", that we have introduced into basic psychotherapeutic schooling. -There are further levels of quality assurance, leading to quality amelioration via evaluation and motivation. The "Rasterzeugnis" (i.e. periodical doctors' certifications, which has become obligatory per legem now in Austria) is one of these instruments. -There are highly sensible territories like communication with the incurable as well as organ transplantations. -But also the seemingly so banal written doctor's report should be the subject of important ameliorations in the routine. Following a pure standpoint of the right with neglect of all said above, can be contra-productive. We give examples of the -patients' insight into medical documents as well as -simple juridical judgement of a patient's competence. Only by synopsis of right with communication, there can be reached an optimal result for the patient. This should run under the omnipresent principle of humanitas.

Austria↗

[A combined methodology for understanding the duration of breast feeding the poor neighborhoods of Managua, Nicaragua].

This study examined the relationship of several maternal variables to the duration of exclusive breast-feeding and the total duration of breast-feeding, along with attitudes, perceptions, and beliefs about breast-feeding among women living in poor neighborhoods of Managua, Nicaragua. The field work was carried out in December 1992 and January 1993 using qualitative and quantitative methods. A structured questionnaire was administered in interviews with 556 mothers of children under 12 months of age, and meetings of four directed discussion groups were held, in which a total of 20 women participated. At one week of age, almost all the children of the mothers who were surveyed had been breast-fed, but only 45% had been exclusively breast-fed. At 12 weeks old, 30% were already completely weaned. The discussion groups revealed the coexistence of positive opinions about both breast-feeding and bottle-feeding. However, exclusive breast-feeding was considered harmful for the mother, and breast milk was not thought to be sufficient nourishment for the child. Previous experience was strongly related to the duration of exclusive breast-feeding and to total breast-feeding duration. Attitudes, social support, and work situation were important factors influencing the total length of time women breast-fed a child. In general, the results obtained through the interviews and in the discussion groups were in agreement and showed that the elements needed to promote exclusive breast-feeding were social support, a favorable community environment, and policies that dealt with problems faced by working mothers. The complementary research methods were useful for obtaining information about the relative importance of different factors that determine the duration of breast-feeding and for understanding that practice in greater depth from the mother's point of view.

Adolescent↗