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PubMed2005

Cancer incidence among male military and civil pilots and flight attendants: an analysis on published data.

Flight personnel are exposed to cosmic ionizing radiation, chemicals (fuel, jet engine exhausts, cabin air pollutants), electromagnetic fields from cockpit instruments, and disrupted sleep patterns. Only recently has cancer risk among these workers been investigated. With the aim of increasing the precision of risk estimates of cancer incidence, follow-up studies reporting a standardized incidence ratio for cancer among male flight attendants, civil and military pilots were obtained from online databases and analysed. A meta-analysis was performed by applying a random effect model, obtaining a meta-standardized incidence ratio (SIR), and 95% confidence interval (CI). In male cabin attendants, and civil and military pilots, meta-SIRs were 3.42 (CI = 1.94-6.06), 2.18 (1.69-2.80), 1.43 (1.09-1.87) for melanoma; and 7.46 (3.52-15.89), 1.88 (1.23-2.88), 1.80 (1.25-2.58) for other skin cancer, respectively. These tumors share as risk factors, ionizing radiation, recreational sun exposure and socioeconomic status. The meta-SIRs are not adjusted for confounding; the magnitude of risk for melanoma decreased when we corrected for socioeconomic status. In civil pilots, meta-SIR was 1.47 (1.06-2.05) for prostate cancer. Age (civil pilots are older than military pilots and cabin attendants) and disrupted sleep pattern (entailing hyposecretion of melatonin, which has been reported to suppress proliferative effects of androgen on prostate cancer cells) might be involved. In male cabin attendants, meta-SIR was 21.5 (2.25-205.8) for Kaposi's sarcoma and 2.49 (1.03-6.03) for non-Hodgkin's lymphoma. AIDS, which was the most frequent single cause of death in this occupational category, likely explains the excess of the latter two tumors.

Aircraft↗

PubMed2004

Sexually violent predators and civil commitment laws.

This article analyzes the civil commitment models for treating sexually violent predators (SVPs) and analyzes recent civil commitment laws. SVPs are commonly defined as sex offenders who are particularly predatory and repetitive in their sexually violent behavior. Data from policy literature, a survey to all states, and a review of law review Websites identify 16 states that have civil commitment statutes to address the problem and treatment of SVPs, four states that are in the process of passing such laws, six states that failed to enact proposed statutes, six states that lack SVP legislation, and 18 states that do not have relevant data available. The majority of such laws have created a false sense of safety because they address only convicted sex offenders. New approaches to the civil commitment of sexually violent predators have created multifaceted demands, controversy, ethical dilemmas, and learning opportunities. It is advised that research should be focused on the parameters of sexually violent behaviors, program flexibility, and treatment effectiveness.

Adult↗

PubMed1993

Notable minimum value of relative risk recognized by Japanese epidemiologists and rule of proof in civil trial: questionnaire survey.

Members of The Japanese Society of Cancer Epidemiology were questioned about relative risk in cancer epidemiology. The notable minimum value of relative risk recognized by the epidemiologists distributed from 1.1 to 5.0, and the mean and the standard deviation of the notable minimum value were 1.92 and 0.760. In civil litigation of United States a plaintiff must prove one's case by a "preponderance of evidence," which means that a causal relationship between risk factors and a health disturbance to a plaintiff is proved when relative risk is 2.0 or more. The mean value 1.92 of the notable minimum value of relative risk nearly corresponded to the relative risk 2.0, which indicates that opinion of Japanese epidemiologists did not disagree with the rule of the proof in civil litigation of United States. It is mentioned that the standard of the proof should be "high probability" based on "a high level of conviction in the judge's own mind" in Japanese civil trials, and that the "high probability" means that relative risk is 5.0 or more if we dare to quantify the vagueness. This value corresponded to the maximum value of the notable minimum relative risk in the questionnaire to the Japanese epidemiologists. In civil litigation of Japan, the standard of the proof based on epidemiological results may be more conservative than the opinion of Japanese epidemiologists.

Causality↗

PubMedDate not supplied

Best practice management strategies for mental health nurses during the clinical application of civil commitment: an overview.

AIM: The aim of this article is to outline best practice management strategies for nurses during the clinical application of civil commitment of mentally ill persons. METHOD: A thorough literature search on 'coercion' and 'civil commitment' was undertaken using MEDLINE, CINAHL and PSYCHINFO. Published and unpublished research undertaken by the authors in New Zealand on this topic was drawn upon. This research considered the use of civil commitment during admission to acute mental health services, acute forensic mental health services and community mental health services. RESULTS: The experience of coercion by service users coincides with the degree of restriction associated with the service they are involved in. Socio-demographic factors, clinical factors and the experience of coercive events have little bearing on the amount of coercion experienced. Rather it is the pattern of communication and the use of 'procedural justice' that has the potential to ameliorate the amount of perceived coercion. CONCLUSIONS: 'Procedural justice' aligns with the emphasis placed on the therapeutic relationship in mental health nursing and is an important consideration for nurses during the clinical application of civil commitment.

Coercion↗

PubMed1998

[Nursing in the movies: its image during the Spanish Civil War].

INTRODUCTION: The cinema had carried out a determining role in the development of stereotypes and in a wide gamut of models related to real life situations. The objective of this analysis is to determine the influence cinema had on the image of nurses during the Spanish Civil War from 1936-1939. These are the initial hypotheses: the role of Spanish nurses during the civil war was reflected by both sides in their respective movie productions; and the image of nurses shown in these films, on both sides, presents a conflicting role concept for women in society. METHODS AND MATERIALS: Following strategies developed by specialists in film analysis (Bondwell 1995, Uneso 1995, Carmona 1991) a total of 453 movie productions, 360 on the republican side and 93 on the national side, were reviewed. These films were listed in the Spanish National Films Library records. RESULTS: After analyzing the Spanish cinema productions during the Spanish Civil War, data relating to 453 films were identified. The genre included documents, news programs and fiction movies. 77 were produced in 1936, 235 in 1937, 102 in 1938 and 39 in 1939. A tremendous difference exists between the republican productions, 79% of the total, and the national productions. By genres, the types produced on the republican side were: in 1936, 53 documentals, 4 news programs and 9 fiction films; in 1937, 186 documentals, 5 news programs and 19 fiction films; in 1938, 72 documentals, 1 news programs and 2 fiction films; in 1939, 2 documentals and 2 fiction films. On the national side, their productions were: in 1936, 10 documentals and 1 fiction film; in 1937, 22 documentals, 2 news programs and 1 fiction film; in 1938, 19 documentals and 3 news programs; in 1939, 29 documentals and 6 fiction films. CONCLUSIONS: During the Spanish Civil War, movies produced by both sides made an effort to reflect their ideal woman as a stereotypical ideal nurse. This ideal nurse showed the values, ideas, aesthetics and prejudices each side held in the war.

Attitude to Health↗

PubMed2001

[Estimating cardiovascular age of civil flying personnel by means of heart rate and blood pressure variability analysis].

Objective. To estimate the cardiovascular age of civil flying personnel by means of heart rate and blood pressure variability analysis and to evaluate its significance in aviation medicine. Method. First, heart rate variability (HRV), blood pressure variability (BPV) and spontaneous baroreflex sensitivity (BRS) were analyzed among 89 healthy civil flying personnel by using conventional AR spectral analysis and sequence method respectively. Then, principal component analysis was conducted over original and derived variables of HRV and BPV spectral and BRS data. Finally, by the use of multiple regression in which the chronological age acted as the dependent variable and the components significantly related to age were used as the regressors, the equation for estimating the cardiovascular age was established. Result. Only seven principal components can exactly reflect the same information of autonomic regulatory function which was embodied in the 17 variables of HRV and BPV spectral and BRS parameters. Among the seven principal components, the PC2orig, PC4orig and PC2deri were negatively correlated with chronological age (P<0.05), whereas the PC3orig was positively correlated with the chronological age (P<0.01). The cardiovascular age derived from the equation was significantly correlated with the chronological age of the civil flying personnel (r= 0.73, P<0.01). Conclusion. The cardiovascular age estimated by means of a multi-variate analysis of HRV, BPV and BRS can be treated as a comprehensive indicator reflecting the age dependency of autonomic regulatory function of cardiovascular system in healthy civil flying personnel, and its interpretation and significance in application are surely worthy of further and fully dedicated efforts.

Adult↗

PubMed2003

Selective serotonin reuptake inhibitors in pilot fatalities of civil aviation accidents, 1990-2001.

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are popularly prescribed for treating depression. With a few exceptions, these psychotropic medications are not approved by aeromedical regulatory authorities for use by aviators. Since SSRIs have the potential for impairing performance and causing drug-drug interactions, the prevalence of SSRIs in pilot fatalities of civil aviation accidents was evaluated. METHODS: Postmortem samples from pilots involved in fatal civil aircraft accidents are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological evaluation. Findings from such evaluations are maintained in the CAMI Toxicology Database. This database was examined for the presence of SSRIs in pilot fatalities of the accidents that occurred during 1990-2001. RESULTS: Out of 4,184 fatal civil aviation accidents from which CAMI received samples, there were 61 accidents in which pilot fatalities had SSRIs. Of these accidents, 56 were of the general aviation category, 2 were of the air taxi and commuter category, 2 were of the agricultural category, and 1 was of the ultralight category. Blood concentrations of SSRIs in the fatalities were 11-1121 ng x ml(-1) for fluoxetine; 47-13102 ng x ml(-1) for sertraline; 68-1441 ng x ml(-1) for paroxetine; and 314-462 ng x ml(-1) for citalopram. In 39 of the 61 pilots, other drugs--for example, analgesics, antihistaminics, benzodiazepines, narcotic analgesics, and/or sympathomimetics--and/or ethanol were also present. As determined by the National Transportation Safety Board, the use of an SSRI [with or without other drug(s) and/or ethanol] has been a contributory factor in at least 9 of the 61 accidents. CONCLUSIONS: Numbers of SSRI-involved accidents were low, and blood SSRI concentrations in the associated pilot fatalities ranged from subtherapeutic to toxic levels. However, the interactive effects of other drug(s), ethanol, and/or even altitude hypoxia in producing adverse effects in the pilots cannot be ruled out. Findings from this study should be useful in investigating SSRI and other substance-involved accidents and in making decisions concerning the use of SSRIs in aviation.

Accidents, Aviation↗

PubMed2004

Association between civil procedure and medical malpractice litigation in Japan.

The effect of shortcomings in the system of civil procedure in Japan, such as excessive delay and possible mistaken judgment on the existence of negligence, on medical malpractice litigation and legal outcomes has not been examined. Using data on judgments and the decisions in medical malpractice litigation by the Tokyo and Osaka District Courts, we examined the association between civil procedure and medical malpractice litigation, and predictors of the decisions of medical malpractice litigation. The basis of the civil procedure to secure quick decisions was related to the amount of medical malpractice litigation, but not to the decisions in medical malpractice litigation. Negligence and a factor other than negligence were related to the rate of decisions in favor of the plaintiff. Although the study implies that shortcomings in civil procedure negatively influence medical malpractice litigation, it was not determined whether decisions were made based on mistaken judgment concerning the existence of negligence. Since there are methodological limitations to this study, further studies are necessary to verify these findings.

Compensation and Redress↗

PubMed2004

[Developments in civil and disciplinary law. A view of the revision of the Netherlands Society for Dentistry (NMT) administration of justice].

According to some people, the renewed Dutch civil disciplinary law is not fulfilling the expectations. Some procedures seem to be reductant for accused dentists. Besides the civil disciplinary law, also the professional disciplinary law of Dutch Dental Association is questionable. The Association is planning to change the current professional disciplinary law. However, the proposed amendments may have the consequence that a Dutch dentist more frequently will be faced with a civil disciplinary law procedure or normal civil law procedure.

Dentistry↗

PubMed2005

Human factors analysis and classification system applied to civil aircraft accidents in India.

INTRODUCTION: The Human Factors Analysis and Classification System (HFACS) has gained wide acceptance as a tool to classify human factors in aircraft accidents and incidents. This study on application of HFACS to civil aircraft accident reports at Directorate General Civil of Aviation (DGCA), India, was conducted to ascertain the practicability of applying HFACS to existing investigation reports and to analyze the trends of human factor causes of civil aircraft accidents. METHOD: Accident investigation reports held at DGCA, New Delhi, for the period 1990--99 were scrutinized. In all, 83 accidents occurred during this period, of which 48 accident reports were evaluated in this study. RESULTS: One or more human factors contributed to 37 of the 48 (77.1%) accidents. The commonest unsafe act was 'skill based errors' followed by 'decision errors.' Violations of laid down rules were contributory in 16 cases (33.3%). 'Preconditions for unsafe acts' were seen in 23 of the 48 cases (47.9%). A fairly large number (52.1%) had 'organizational influences' contributing to the accident. DISCUSSION: These results are in consonance with larger studies of accidents in the U.S. Navy and general aviation. Such a high percentage of 'organizational influences' has not been reported in other studies. This is a healthy sign for Indian civil aviation, provided effective remedial action for the same is undertaken.

Accidents, Aviation↗

PubMedDate not supplied

[Expert's opinion in civil proceedings for damages in cases relating to hospital infections, especially to hepatitis B and C infections].

Many papers considering the role of the forensic medicine expert in legal proceedings and a probative value of medico-legal opinions have been published. Prof. Jaegermann's consideration and essays about the theory of opinionating are particularly worth mentioning. Medicolegal opinions in civil proceedings for damages in cases relating to hospital infections, including hepatitis B and C virus infections seem to be of great importance. Legal composition of records in the civil code, especially those relating to the demandant who in agreement with art. 6 of the PC is obliged to present the facts (prerequisites of civil liability) from which the claim included in the damage suit results, and also the obligatory principles for the civil procedure which highlight the role of the forensic medicine expert and the significance of the medico-legal opinion as important evidence during proceedings. It is known that in cases of this type of expert's opinion is of decisive significance and legal decision is very often based on the conclusions drawn. The author presents consultative problems and difficulties relating to the analysis of facts and evidence material in the epidemiologic aspect which a forensic medicine expert comes across while giving his/her opinion. Questions posed by the court and expectations of the judge appointing an expert who should provide reliable information from his/her field and comprehensively explain all the doubts in the investigated question are suggested to be discussed independently. The complicated character of infections with hepatitis B and C viruses, especially their various courses and clinical pictures as well as the efficiency of all the diagnostic methods used make the provision of a medico-legal opinion more difficult.

Cross Infection↗

PubMed1981

Federal civil service adult survivor annuitants and Social Security, December 1975.

This article reviews the recent experience of adult survivor annuitants under the Federal civil service retirement program. Data are presented for such persons in terms of their status in December 1975 as primary beneficiaries, secondary beneficiaries, or nonbeneficiaries under the Old-Age, Survivors, and Disability Insurance (OASDI) program. Analysis reveals that 63 percent of the survivor annuitants were dual beneficiaries-that is, they received an OASDI benefit as well as an annuity payment. About half the remaining annuitants were permanently insured under the OASDI program, so it can be anticipated that at least four-fifth of the Federal civil service survivor annuitants ultimately will also receive an OASDI benefit. The survivor annuity replaced 27 percent of a decreased spouse's Federal civil service salary at the median. The median replacement rate of annuity plus OASDI benefit was 48 percent of civil service salary.

Aged↗

PubMed1995

Vision impairment and corrective considerations of civil airmen.

BACKGROUND: Civil aviation is a major commercial and technological industry in the United States. The Federal Aviation Administration (FAA) is responsible for the regulation and promotion of aviation safety in the National Airspace System. To guide FAA policy changes and educational programs for aviation personnel about vision impairment and the use of corrective ophthalmic devices, the demographics of the civil airman population were reviewed. METHODS: Demographic data from 1971-1991 were extracted from FAA publications and databases. RESULTS: Approximately 48 percent of the civil airman population is equal to or older than 40 years of age (average age = 39.8 years). Many of these aviators are becoming presbyopic and will need corrective devices for near and intermediate vision. In fact, there has been approximately a 12 percent increase in the number of aviators with near vision restrictions during the past decade. Ophthalmic considerations for prescribing and dispensing eyewear for civil aviators are discussed. CONCLUSIONS: The correction of near and intermediate vision conditions for older pilots will be a major challenge for eye care practitioners in the next decade. Knowledge of the unique vision and environmental requirements of the civilian airman can assist clinicians in suggesting alternative vision corrective devices better suited for a particular aviation activity.

Adult↗

PubMed1993

[ The 'new cow' slaughtered, an introduction to the new Civil Code regulations concerning hidden flaws in in animals].

The obligation to guarantee the absence of hidden flaws has been omitted from the New Civil Code, which became law in 1992. It has been incorporated in the obligation to fulfil all aspects of the sales agreement. Conformity is the central theme of the new Civil Code: the delivered goods must fulfil the expectations of the purchaser. If this is not the case, then one can speak of default. The purchaser no longer has to take out a summons against the vendor within six weeks; instead, under the terms of the new Civil Code, the purchaser should inform the vendor at short notice on which of his/her entitled rights he/she will base an appeal. In the new civil Code, the possibility of demanding extra compensation ans other aspects of the sale, such as the transfer of risk, have been changed. The special emphasis on consumer purchase is new. However, all things considered, the veterinarian will find that the new regulations will not lead to substantial changes in practice. The closing sentence of the customary declaration will have to be changed to satisfy the new regulations.

Animals↗

PubMed1996

Changing trends in mental health legislation: anatomy of reforming a civil commitment law.

In this article, we discuss changing trends of mental health legislation in the United States using a case study of the process of reforming the civil commitment law in New Jersey. That state's new commitment law, commonly called the "screening law," was enacted after a thirteen-year legislative process. Changes in the orientation of the proposed legislation and the dynamics of the process of reforming the commitment law in the state exemplify changing national trends in civil commitment legislation. We consider how the proposed legislation shifted in emphasis from a strong civil libertarian orientation to a social service approach. We assess the role of various interest groups, their negotiations, and the compromises that emerged. Our analysis of the process shows that changes in the social and political environment were the decisive factors that stimulated the process of reforming the civil commitment laws. Many of these changes occurred outside the mental health system and could be neither anticipated nor controlled by the various parties. Our examination of the process and the final outcome of this legislation reveals how organizations and interest groups, in their efforts to adapt to changing conditions, shaped the legislative outcome according to their interests.

Commitment of Persons with Psychiatric Disorders↗

PubMed1998

[Quality assurance based on civil and penal law].

The term "quality assurance" primarily concerns the provisions of professional regulations and law relating to health service physicians. It would be too sweeping to regard liability or criminal law as normative parameters for guaranteeing quality assurance in the narrower sense. Nevertheless, along with expert opinions sought within the context of relevant lawsuits, court rulings under civil law and criminal law in effect constitute an indirect form of "quality control". As a consequence, many court decisions act as a standard for the future. Civil law is concerned with determining whether the patient has received the quality of medical service to which he is entitled; for all intents and purposes, the same applies to the judgement of medical treatment under criminal law, whereby all cases, whether civil or criminal, concern diagnostic and therapeutic practice in specific treatment situations, the organisation of treatment and the provision of information. With regard to these areas, a contribution can therefore be made to quality assurance by observing pertinent civil and criminal judicature.

Germany↗

PubMed1985

Health care, public policy and the courts: black health status as a civil rights issue.

In the U.S.A. serious differences in the health status between black and white citizens continue to exist. Black Americans are less healthy and receive less health care than while Americans. The discrimination is examined as a civil rights issue with focus on both the policy and judicial perspectives of the application of Title VI of the Civil Rights Act of 1964 and the implementative effects of the Hill-Burton Act of 1946. The application, and compliance and enforcement, of civil rights to health care is complicated by a captivity process involving Federal agencies, by corporate medical rights emphasizing a business approach to health care, and by a liberal pluralistic political arena in which certain influential groups prevail over others. In order for black health status and care to improve in the U.S.A., blacks must continue to utilize the judicial system to seek redress of health care inequities. Second, they must utilize their demonstrated political power to demand better treatment from the medical establishment.

Black or African American↗

PubMed2006

Civilization as a biosystem examined by the comparative analysis of biosystems.

Darwinian evolutionary theory has played a central role in the life sciences. However, this principle is rarely applied to exceptional life-like systems such as human societies and the life-like chemical systems associated with the origin of life. For a description of the nature of these exceptional life-like biosystems, the development of alternative approaches is necessary. The existence of analogies among biosystems at different hierarchical levels has frequently been discussed. The present paper, however, focuses on the analogies of the structures and functions of different biosystems, based on the following perspectives. The roles of an individual biosystem and its building blocks in relation to the environment are evaluated from the standpoint of the hierarchies of organisms, whereby the principle of which hierarchy is regarded as an "individual" biosystem is proposed. In addition, the definition and characteristics of civilization are discussed on the basis of this principle. The analogies between cell-type systems, civilizations, ecosystems, and other biosystems are qualitatively evaluated. It is reasonable to regard all biosystems as possessing clear or ambiguous boundaries. Biosystems at higher levels than prokaryotes comprise both living and non-living building blocks, while prokaryotes comprise only non-living building blocks. The similarities concerning the interactions among the building blocks in relation to their environment are also discussed. Furthermore, the analogy between different biosystems concerning metabolism, self-reproduction, mutation, the relationship between genotype and phenotype (information and function), individuality, and stability are evaluated. The proposed analytical approach not only provides an insight into the characteristics of civilizations as biosystems, but also the characteristics of biosystems at different hierarchical levels.

Biological Evolution↗