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PubMedDate not supplied

Never audit alone--the case for audit teams.

UNLABELLED: On-site audits, conducted by technical and quality assurance (QA) experts at the data-gathering location, are the core of an effective QA program. However, inadequate resources for such audits are the bane of a QA program and, frequently, the proposed solution is to send only one auditor to the study site. There are several reasons why audits should be performed by more than one person: 1. SAFETY: Audits of EPA projects frequently involve hazardous chemicals or other environmental hazards. They also often involve working after normal work hours in remote locations with dangerous equipment. It is unsafe to work alone under such conditions. 2. Skills: Many of EPA's projects are multidisciplinary, involving multiple measurements systems, several environmental media, and complex automated data collection and analysis systems. It is unlikely that one auditor would have the requisite skills to assess all of these operations. 3. Separateness: Two auditors can provide two (sometimes differing) perspectives on problems encountered during an audit. Two auditors can provide complementary expertise and work experience. Two auditors can provide twice the surveillance power. 4. Support: The operations that need to be assessed are sometimes in different parts of a site, requiring two auditing devices or considerable commuting time. Also, auditors are occasionally diverted by managers wishing to show their best efforts rather than the whole operation; if two auditors are on-site, one can interview managers while the other talks with technical staff. If there is a dispute, one auditor can support the other in verifying observations. 5. Savings: Although sending one auditor is perceived to be a cost-saving measure, it may be more economical to send two auditors. Time on site (lodging, food) is decreased, more of the project is assessed in one visit, less pre-audit training is required, and report preparation is accelerated. In summary, sending more than one auditor on a field audit is smarter, safer and more effective, and can be less expensive in the long run.

Environmental Health↗

PubMedDate not supplied

Differences in HPRT mutant frequency among middle-aged Flemish women in association with area of residence and blood lead levels.

Biomarkers were measured in residents of Wilrijk and Hoboken, industrial suburbs of the city of Antwerp, and of Peer, a rural municipality in Flanders, Belgium. Persons with known occupational exposures to toxic compounds or commuting over long distances were excluded. Here, we report the hypoxanthine phosphoribosyltransferase gene (HPRT) variant frequencies for 99 non-smoking women aged 50-65 years. HPRT values above the detection limit (V(fpos) values) were observed for 43 subjects (21 from Peer, 22 from Antwerp). The median (10th to 90th percentiles) HPRT variant frequency (V(fpos)) in peripheral lymphocytes was 9.59 (3.44-56.99) for Peer and 3.57 (1.57-13.96) for Antwerp. The V(fpos) value was significantly higher in Peer than in Antwerp, both in terms of crude data (p=0.011) and after correction for age, level of education, smoking status, serum level of selenium and body mass index through analysis of covariance (p=0.011). For the total study population, serum lead concentration showed a non-significant positive correlation with lnV(fpos). In addition, subjects with a blood lead concentration above the median tended to have higher V(fpos) values (9.45x10(-6) for 'high' group versus 5.21x10(-6) for 'low' group; p=0.077 after correction for confounding). Subjects with a serum selenium level above the median tended to have lower V(fpos) values (4.99x10(-6) for 'high' group versus 9.83x10(-6) for 'low' group; p=0.051 after correction for confounding). These data are consistent with an indirect genotoxic effect of lead and with an antimutagenic effect of selenium.

Aged↗

PubMed2006

Assessing attitude: the case of health-enhancing physical activity.

OBJECTIVES: The basic phases of constructing compact questionnaire scales for health-promotion interventions are demonstrated in the case of attitudes towards two modes of physical activity, outdoor aerobic exercise (OAE) and everyday commuting activity (ECA). The scales were to show good psychometric properties and to provide adequate indicators of attitude. METHODS: Behaviours and criteria were specified for both OAE and ECA. The items describing the emotional (affect) and cognitive (outcome-expectations) aspects of attitude towards OAE and ECA behaviours were selected on the basis of a pilot study. The scales under development were used in a Finnish population survey on health, personal resources and physical activity (n = 1,516). Item analyses were completed for purposes of refining the scale; principal component analyses and factor analyses were used to establish the dimensional structure of the scales. Evidence of discriminatory validity was provided by comparing the scale scores of the different groups of respondents with regular, with sub-criterion, and without any OAE and ECA behaviours, respectively. RESULTS: The purported psychometric properties were met in the case of the affective and, less obviously, the positive outcome-expectation scales. The negative expectation scales need to be reconstructed with additional items. CONCLUSIONS: The psychometric properties of the affective scales and the positive expectation scales allow conclusions to be drawn regarding group differences in attitudes towards OAE or ECA behaviours. These scales are ready to be cross-validated in a new sample. Test-retest reliability should also be established.

Adult↗

PubMed2005

Noise exposure levels from personal stereo use.

Hearing healthcare professionals often express concern about the possible increased risk of noise injury, and potential for subsequent hearing loss that may result from the rise in the use of personal stereo players (PSP) in the community. Measurements were made of a sample of 55 individuals who were using a PSP as part of their daily activity, for example commuting to work, in what could be considered noisy backgrounds. Thus measurements could be considered to exemplify the worst-case conditions. The average, A-weighted, eight-hour equivalent, continuous noise exposure level was determined to be 79.8 dB, with a statistically significant difference between males and females, of 80.6 dB and 75.3 dB respectively. There was no correlation between self-reported hearing loss and/or the incidence of tinnitus. The noise exposure results obtained did not indicate that there was a significant increase in the risk to potential noise injury from PSP use alone.

Adolescent↗

PubMed2006

Dust in the underground railway tunnels of an Italian town.

This article assesses hazards associated with exposure to dust in tunnels and platforms of the A and B lines of Rome's underground railway and provides an informed opinion on the risks to workers and the travelling public of exposure to tunnel dust. The study focused on the analysis and measurement of dust granulometric classes PM10, respirable fraction, respirable combustible dust, and the organic, metallic, siliceous, and fibrous components. Comparing the measurement values from the tunnels and platforms with those found at the entrances to the underground railway stations, it emerges that dust concentration in the tunnels and platforms is three times higher, with a maximum PM10 value of 479 microg/m3. Averaged over 24 hours, in relation to the above ground levels, drivers and station staff are exposed to an additional value of 11 microg/m3 and 10 microg/m3, respectively. If commuters were to remain in the trains or on the station platforms, the 24-hour average exposure would increase by 3 microg/m3. Iron and silica were the major components found in the dust. The use of silica sand in the emergency braking system of the carriages is capable of causing a dispersion of quartz in the air in percentages varying from 5% to 14%. Methods are suggested in this article for the reduction of dust dispersion.

Air Pollutants↗

PubMed1997

Rural migration: what attracts new residents to non-metropolitan areas.

"This study uses the experience of three non-metropolitan counties in Pennsylvania to explore which community characteristics have the greatest influence on people's decisions to move to rural areas. Personal characteristics affected how in-migrants evaluated prospective rural residential locations. Higher income in-migrants placed a high priority on job opportunities, housing quality, a short commute to work, quality of schools, and low local taxes. Lower income in-migrants were more likely to value a location near family and friends. Ability to own a home, housing costs, and local taxes were also important."

Americas↗

PubMedDate not supplied

Japanese migration in contemporary Japan: economic segmentation and interprefectural migration.

This paper examines the economic segmentation model in explaining 1985-86 Japanese interregional migration. The analysis takes advantage of statistical graphic techniques to illustrate the following substantive issues of interregional migration: (1) to examine whether economic segmentation significantly influences Japanese regional migration and (2) to explain socioeconomic characteristics of prefectures for both in- and out-migration. Analytic techniques include a latent structural equation (LISREL) methodology and statistical residual mapping. The residual dispersion patterns, for instance, suggest the extent to which socioeconomic and geopolitical variables explain migration differences by showing unique clusters of unexplained residuals. The analysis further points out that extraneous factors such as high residential land values, significant commuting populations, and regional-specific cultures and traditions need to be incorporated in the economic segmentation model in order to assess the extent of the model's reliability in explaining the pattern of interprefectural migration.

Adolescent↗

PubMed1994

An analytical approach to quantitative reconstruction of non-uniform attenuated brain SPECT.

An analytical approach to quantitative brain SPECT (single-photon-emission computed tomography) with non-uniform attenuation is developed. The approach formulates accurately the projection-transform equation as a summation of primary- and scatter-photon contributions. The scatter contribution can be estimated using the multiple-energy-window samples and removed from the primary-energy-window data by subtraction. The approach models the primary contribution as a convolution of the attenuated source and the detector-response kernel at a constant depth from the detector with the central-ray approximation. The attenuated Radon transform of the source can be efficiently deconvolved using the depth-frequency relation. The approach inverts exactly the attenuated Radon transform by Fourier transforms and series expansions. The performance of the analytical approach was studied for both uniform- and non-uniform-attenuation cases, and compared to the conventional FBP (filtered-backprojection) method by computer simulations. A patient brain X-ray image was acquired by a CT (computed-tomography) scanner and converted to the object-specific attenuation map for 140 keV energy. The mathematical Hoffman brain phantom was used to simulate the emission source and was resized such that it was completely surrounded by the skull of the CT attenuation map. The detector-response kernel was obtained from measurements of a point source at several depths in air from a parallel-hole collimator of a SPECT camera. The projection data were simulated from the object-specific attenuating source including the depth-dependent detector response. Quantitative improvement (>5%) in reconstructing the data was demonstrated with the nonuniform attenuation compensation, as compared to the uniform attenuation correction and the conventional FBP reconstruction. The commuting time was less than 5 min on an HP/730 desktop computer for an image array of 1282*32 from 128 projections of 128*32 size.

Brain↗

PubMed2003

Evaluation of the care of women living with HIV/AIDS in São Paulo, Brazil.

To evaluate care provided to women living with HIV in São Paulo, Brazil, based on their own experiences, patients from HIV/AIDS reference clinics answered a questionnaire on circumstances of HIV testing, health personnel's attitudes at diagnosis, adherence to follow-up, services provided by care centers and access to laboratory monitoring. From September 1999 to February 2000, 1,068 women were interviewed. Most had over 8 years of education and reported having regular sexual partners, being mothers and family caregivers. They were diagnosed as HIV-infected for 4.36 +/- 3.15 years. The majority had been referred to testing without counseling. Post-test counseling was provided depending on the testing center. Neither pre-test nor post-test counseling were associated to time since diagnosis. Some patients reported having felt indifference, discrimination or criticism at diagnosis, depending on where testing occurred. Compliance to medical follow-up was associated to adherence to antiretrovirals and to shorter time since diagnosis, but not with having a primary caregiver or with commuting time to the care center. Psychological support, nutrition care and oral health were women's less addressed needs. Access to gynecological care was associated with counseling on mother-to-child transmission and on safe sex. Access to CD4+ cell counts and HIV viral loads was concordant with guidelines, but the understanding of their meaning was incomplete. We conclude that women living with HIV/AIDS in São Paulo, Brazil have limited HIV risk perception and unmet care needs. Better training of professionals in charge of diagnosis and integrating women's health and family-planning actions to AIDS programs may enhance care.

Adolescent↗

PubMed2003

Effects of intermittent exposure to high altitude on pulmonary hemodynamics: a prospective study.

Chronic alveolar hypoxia due to disease or low atmospheric pressure at high altitude results in the development of hypoxic pulmonary hypertension. The effects of intermittent hypoxia on pulmonary hemodynamics in healthy men have not been studied. We aimed to investigate, prospectively, pulmonary hemodynamics in workers commuting between an elevation of 3700 and 4200 m (4-week working shift) and lowland, below 500 m (4 weeks of holiday). Pulmonary hemodynamics has been investigated by Doppler echocardiography in 26 healthy Caucasian males, mean age 42 +/- 9 yr. First at lowland (760 m) and next during the fourth week of work at high altitude. Investigations were repeated in 21 subjects 1 year later at the end of the high-altitude exposure. The third series of investigations was performed 2 yr after the initial ones in 10 subjects who earlier had shown the strongest hypoxic vasoconstriction. At lowland, subjects presented with normal pulmonary hemodynamics. At high altitude, mean pulmonary artery pressure (PAPm) rose from 14.7 +/- 2.7 mmHg to 25.8 +/- 8.3 mmHg. One year later the PAPm remained unchanged in hypoxic conditions (25.0 +/- 7.3 mmHg). At the end of a 2-year follow-up of 10 "hyperreactors," PAPm measured at the end of the hypoxic exposure was the same as at the initial investigation, averaging 28 +/- 4.0, 28 +/- 3.5, and 29 +/- 2.5 mmHg at the beginning and at 1 and after 2 yr of intermittent exposure to high altitude. We concluded that intermittent exposure to 4000 m lasting 3 yr does not lead to development of permanent pulmonary hypertension.

Acclimatization↗

PubMed2003

Improving oxygenation at high altitude: acclimatization and O2 enrichment.

When lowlanders go to high altitude, the resulting oxygen deprivation impairs mental and physical performance, quality of sleep, and general well-being. This paper compares the effects of ventilatory acclimatization and oxygen enrichment of room air on the improvement of oxygenation as judged by the increase in the alveolar P(O2) and the reduction in equivalent altitude. The results show that, on the average, complete ventilatory acclimatization at an altitude of 5000 m increases the alveolar P(O2) by nearly 8 torr, which corresponds to a reduction in equivalent altitude of about 1000 m, although there is considerable individual variability. By comparison, oxygen enrichment to 27% at 5000 m can easily reduce the equivalent altitude to 3200 m, which is generally well tolerated. Because full ventilatory acclimatization at altitudes up to about 3600 m reduces the equivalent altitude to about 3000 m, oxygen enrichment is not justified for well-acclimatized persons. At an altitude of 4200 m, where several telescopes are located on the summit of Mauna Kea, full acclimatization reduces the equivalent altitude to about 3400 m, but the pattern of commuting probably would not allow this. Therefore, at this altitude, oxygen enrichment would be beneficial but is not essential. At higher altitudes such as 5050 m, where other telescopes are located or planned, the gain in oxygenation from acclimatization is insufficient to produce an adequate mental or physical performance for most work, and oxygen enrichment is highly desirable. Full ventilatory acclimatization requires at least a week of continuous exposure, although much of the improvement is seen in the first 2 days.

Acclimatization↗

PubMed2003

Age, flight experience, and risk of crash involvement in a cohort of professional pilots.

Federal aviation regulations prohibit airline pilots from flying beyond the age of 60 years. However, the relation between pilot age and flight safety has not been rigorously assessed using empirical data. From 1987 to 1997, the authors followed a cohort of 3,306 commuter air carrier and air taxi pilots who were aged 45-54 years in 1987. During the follow-up period, the pilots accumulated a total of 12.9 million flight hours and 66 aviation crashes, yielding a rate of 5.1 crashes per million pilot flight hours. Crash risk remained fairly stable as the pilots aged from their late forties to their late fifties. Flight experience, as measured by total flight time at baseline, showed a significant protective effect against the risk of crash involvement. With adjustment for age, pilots who had 5,000-9,999 hours of total flight time at baseline had a 57% lower risk of a crash than their less experienced counterparts (relative risk = 0.43, 95% confidence interval: 0.21, 0.87). The protective effect of flight experience leveled off after total flight time reached 10,000 hours. The lack of an association between pilot age and crash risk may reflect a strong "healthy worker effect" stemming from the rigorous medical standards and periodic physical examinations required for professional pilots.

Accident Proneness↗

PubMed2000

Stages of change in two modes of health-enhancing physical activity: methodological aspects and promotional implications.

Measurement scales for stages of change were developed and the stages were assessed in two specific modes of Health-Enhancing Physical Activity (HEPA) in a cross-sectional survey (N = 1516); representative samples were selected from three age groups, i.e. from three phases of adult life. Outdoor Aerobic Exercise (OAE) was used as an example of fitness activity; Everyday Commuting Activity (ECA) was selected to represent lifestyle physical activity. Scales used by the Prochaska team were modified for this study, and the stages of Precontemplation and Preparation were each divided into two new stages. Consistency of the stage measurement was moderate for OAE and good for ECA. As regards content validity, consistent associations were found between stage scores and contextual variables for both behaviors. The results show that, at a given time, a person can be in different stages in different modes of HEPA. Therefore, the behavior of interest must be specified before accurate information on the stages of change in a population can be obtained. The results also indicate the importance of contextual factors in HEPA promotion.

Adult↗

PubMed2002

Project Liberty: a public health response to New Yorkers' mental health needs arising from the World Trade Center terrorist attacks.

The September 11th terrorist attacks had a dramatic impact on the mental health of millions of Americans. The impact was particularly severe in New York City and surrounding areas within commuting distance of the World Trade Center. With support from the federal government, state and local mental health authorities rapidly mounted a large-scale public health intervention aimed at ameliorating the traumatic stress experienced by residents of the disaster area. The resulting program, named Project Liberty, has provided free public educational and crisis counseling services to tens of thousands of New Yorkers in its initial months of operation. Individuals served vary widely in the severity of experienced trauma and associated traumatic reactions. Data from logs kept by Project Liberty workers suggest that individuals with the most severe reactions are being referred to longer-term mental health treatment services.

Crisis Intervention↗

PubMed1993

The role of alcohol in work-related fatal accidents in Australia 1982-1984.

This paper describes the role of detectable blood alcohol in fatal work injuries. An attempt was made to identify all work-related fatalities that occurred throughout Australia in the period 1982-1984. A research team examined coroners' records and classified 1737 fatal injury cases as being work-related according to study definitions. The following were also extracted from data in coroners' records: (i) whether or not the description of the fatal event indicated that inebriation was likely to have been a factor; (ii) whether or not there was documentation of blood alcohol concentration (BAC), and if so, what it was. The likelihood of inebriation was assessed without knowledge of the victim's BAC. In 1030 (59 per cent) of the 1737 fatal work injury cases, a BAC determination was documented. Zero levels were detected in 867 fatalities (84 per cent), and 163 cases (16 per cent) had non-zero BAC. In the latter group the median BAC was 104 mg%. Sixty-five per cent of measurable BAC cases had BAC greater than 50 mg%. Fatality risk in the non-zero BAC group relative to that of the zero BAC group was elevated for the following factors: marital status--single (risk ratio (RR) = 1.7, 95 per cent confidence interval (CI) 1.1-2.8) or separated/divorced (RR = 2.4, CI 1.5-3.8); occupation as manager, executive or administrator (RR = 2.5, CI 1.5-5.8); and commuting (RR = 1.6, CI 1.2-2.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗

PubMed1998

The construction flagperson: a target for injury.

A road construction 'flagger' is a construction crew member whose responsibility it is to safely co-ordinate vehicle traffic through road worksites. Flaggers are suffering injuries and fatalities at the worksite as a result of being struck by moving vehicles, both construction and commuter. These incidents are largely preventable with a more defensive flagger training programme. A cross-Canada provincial survey of occupational health and safety organizations revealed no national co-ordination and standardization in flagperson training. Statistics concerning flagger injury and fatality are disjointed and incomplete, and as such are not useful for evaluating and validating training and job performance. We recommend a revisiting of flagperson training standards and that greater effort is taken in gathering data specifically on flagger injuries and fatalities.

Accident Prevention↗

PubMed2004

Underreporting of fatal occupational injuries in Catalonia (Spain).

BACKGROUND: Thoroughness in a given health information system is one of its most important quality indicators. In Spain, in approximately 30% of serious occupational injuries, there is no information on the final outcome. AIM: To assess underreporting of fatal occupational injuries in Catalonia. METHODS: All serious occupational injuries (excluding commuting injuries) reported in Catalonia (Spain) between 1994 and 1998 (n = 7330) were linked with data from the Catalonian Mortality Register, 117 deaths being identified during the year following the injury date. In order to assess whether death could or could not have been related to the prior occupational injury, two experts examined these cases independently. RESULTS: The experts concluded (kappa = 0.98) that 69 (59%) of these deaths were probably related to occupational injuries; the vast majority (n = 65) occurred within 3 months of the injury. This represents an accumulated risk of dying of approximately 1% for the total of serious injuries, not varying with economic activity or job category. However, this risk varied depending on the form of accident, and the site and nature of the injury. CONCLUSIONS: Occupational injury cases, especially serious ones, should be followed up over at least 3 months. These results suggest the importance of carrying out active case-finding and of incorporating the death certificate as one of the documents to be systematically reviewed in order to complete the statistics.

Accidents, Occupational↗

PubMed1996

Characteristics of leisure time physical activity associated with decreased risk of premature all-cause and cardiovascular disease mortality in middle-aged men.

The association between leisure time physical activity and the risk of all-cause and cardiovascular disease mortality was analyzed in a Finnish cohort of 1,072 men age 35-63 years who were followed up for 10 years and 10 months. During the period, 168 deaths were recorded, 93 of which were the result of cardiovascular diseases. Leisure time physical activity was assessed by several measures: 1) a single question combining an estimate of the frequency and intensity of the total amount of leisure time physical activity, 2) a compiled measure of leisure time physical activity derived from three separate questions concerning the intensity and frequency of activity, 3) a physical energy expenditure index computed as an estimate of weekly energy expenditure for leisure time activity and commuting to work, 4) 16 separate specified activities of daily living and domestic chores included in the leisure time physical activity index. The association between baseline leisure time physical activity and the risk of death was assessed using the Cox proportional hazards model. After adjustment for potential confounders, the leisure time physical activity energy expenditure index and participation in several specific activities of daily living and domestic chores showed that the mortality risk for all causes and cardiovascular diseases was highest in the most sedentary men. With respect to the leisure time physical activity energy expenditure index, sedentary men ( those with an estimated weekly energy expenditure in leisure time physical activity of < 800 kcal) had an increased risk of 2.74 (95% confidence interval 1.46-5.14) for all-cause mortality and a risk of 3.58 (95% confidence interval 1.45-8.85) for cardiovascular disease mortality compared with the most active persons (those with an estimated weekly energy expenditure in leisure time physical activity of at least 2,100 kcal) when age, initial health status, marital status, employment status, and smoking were controlled.

Adult↗