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PubMed1988

Act No. 18.620, 27 May 1987.

This Act approves the Labor Code, which contains the following major provisions: 1) discrimination on the basis of sex is prohibited in contracts of employment; 2) at least 85% of an employer's workers must be of Chilean nationality, including foreigners who have a Chilean spouse or children or who have been resident in Chile for more than five years; 3) women are guaranteed maternity leave with full pay and benefits for six weeks before delivery and 12 weeks afterwards, which can be increased as necessary if the woman becomes ill during pregnancy or after delivery, as demonstrated by a medical certificate; 4) a woman cannot renounce this leave, her position must be kept open during her absence, and her contract cannot be terminated for a year after maternity leave has ended without a judge's approval; 5) a mother is entitled to leave with full pay and benefits to care for a seriously ill child less than one year old, as demonstrated by a medical certificate; 6) during pregnancy, women who are occupied in work considered harmful to their health are to be transferred to other work without a reduction of salary; and 7) establishments that employ 20 or more workers are to provide child-care facilities where mothers can feed their children and the children can remain while the mothers work; the costs of these facilities are to be paid for by the employer.

Americas↗
PubMed2006

[Pathophysiological basis of mechanical ventilation].

Mechanical ventilation is required if ventilatory insufficiency is present. This is typically indicated by hypercapnea. Hypoxemia occurs secondary to hypoventilation. Usually overload of the respiratory muscles (ventilatory pump) will be the underlying mechanism, for the most part caused by acute or chronic disease. In case of sole hypoxemia mechanical ventilation will only be indicated if the oxygen-content (equals oxygen saturation x haemoglobin x 1.39) drops below a critical threshold or if ventilatory pump failure is imminent on account of the underlying disease (eg. pneumonia). The background of our recommendations is to avoid potential damage caused by mechanical ventilation. Especially high inspiratory pressures and oxygen concentrations can be harmful to the lung. Therefore every case has to evaluated for individual target parameters of ventilation. The use of the oxygen-content instead of the arterial oxygen pressure as the target parameter will usually lead to a more careful ventilation. Cardiogenic pulmonary oedema is an exception to this rule since inspiratory positive pressure and PEEP will result in improved diffusion as well as reduction of preload and work of breathing. In recent years progress has been made on the field of ventilation access especially in severe and acute cases. Non-invasive ventilation is superior to invasive ventilation in patients with exacerbated COPD since it improves outcome effectively. This is being caused by a decline in ventilator associated pneumonias, most likely because non-invasive ventilation allows patients to clear their secretions by coughing, resulting in improved lung clearance. Controlled ventilation allows optimal unloading of the respiratory muscles which have been overloaded by the underlying disease. Application of a controlled ventilation mode in acute disease will usually require some kind of sedation. Assisted ventilation will result in improved gas exchange but only incomplete unloading of respiratory muscles and therefore delayed restitution. Permanent controlled ventilation under sedation for a prolonged period (days) requires intermittent periods of assisted- or spontaneous breathing in order to avoid atrophy of the respiratory muscles. This review summarizes background information on the nature of the derangement, the relation between oxygen supply and consumption under special consideration of respiratory muscle insufficiency and impact of different ventilation modes.

Acute Disease↗
PubMed1997

Effects of low-wage employment on family well-being.

Assumptions about the processes that link a mother's employment to the development of her child must underlie expectations about how children may fare when their mothers move from welfare dependence into employment. This article explores the idea, mentioned in the research overview by Zaslow and Emig in this journal issue, that the working conditions such as wages, work hours, and task complexity that mothers experience on the job can influence their behavior as parents and shape the home environments they provide for their children. This article discusses the significance of home environments for children's intellectual and emotional development and considers how home surroundings change when mothers begin jobs that are more rewarding or less rewarding. The authors conclude that, while maternal employment is not necessarily harmful, if welfare recipients find only low-wage, stressful jobs, working may prove costly for both family and child well-being. The authors recommend that welfare-to-work programs devote attention to (1) assisting mothers to obtain more complex work at good wages, (2) helping mothers understand the role home environments play in shaping children's development, and (3) encouraging parents to make their children's home surroundings as positive as possible.

Adult↗
PubMedDate not supplied

Renal transplantation and the living donor. Decision and consequences.

Renal transplantation in end-stage renal disease is now an accepted medical procedure but the source and origin of the grafted organ (living donor vs. cadaveric kidney) remain controversial and it appears that each transplant team has to work out its own guidelines. We present the results of questionnaires and interviews of a large number of donors, many of them looking back on their experience with the knowledge that unfortunately, and in the long run, their sacrifice proved to be in vain. All our subjects evaluated their participation as donors in the transplant program in a very positive way. There was general agreement that none of them was significantly harmed by his action and that, in the realms of self-knowledge and feelings of self-worth and self-respect, the act of donorship turned out to be a very positive and very highly valued experience. These donors' opinions and attitudes, their relatively unconflicted conduct, are in sharp contrast with the agonizing appraisal of many a transplant team. It remains the task of the team doctors to weigh and balance risks and advantages of such an intervention and to be the advocate of both the donor and the recipient. It is to them that we offer our findings in the hope that it may help them in that difficult decision-making process.

Decision Making↗
PubMed2005

A room for reflection: self-observation and transformation in participatory HIV prevention work.

This article looks at HIV prevention projects in which established stigmatized and stigmatizing roles were actively reversed and manipulated in pursuit of HIV harm reduction. In two Norwegian projects, sex workers and drug users carried out harm-reduction activities with other drug users and sex workers. Although HIV-related harm reduction was the aim of the projects, termination or reduction of drug use or sex work was not. Such changes nevertheless occurred among the sex workers and drug users who took active part in the project. The article considers these changes in order to reflect on the meanings and roles of participation in HIV prevention work. In particular, the discussion theorizes on possible ways in which alteration of roles and subject positions may produce self-reflective effects with transformative potentials.

Data Collection↗
PubMed1993

The influence of ethnicity on the health of older women.

There is increasing evidence that ethnicity is an important factor as one ages that serves as an integrating force to help an older woman filter her personal experience with aging and to pass through significant life changes, such as being a cultural and health resource for family and community, becoming a grandmother, retiring, or moving in with family when frailty occurs. Ethnicity also can act as a buffer to the visccitudes of old age. When the surrounding environment, especially the health care environment, encourages expression and the reaffirmation of ethnicity, we find examples of successful aging in many ethnic communities; however, aging is often less successful when poverty, lack of informal and or formal support, or dislocation through immigration or separation from ethnic community and family disrupt the process of coming to terms with old age. The process of counseling an older patient is a complex one, particularly when ethnicity is a strong factor in the patient's identity. Ethnicity acts as a filter to the aging process, influencing health, health beliefs and behavior, as well as interaction with health professionals. Many ethnic groups, while identifying and incorporating certain elements of scientifically based understanding of disease and illness into their lives, nevertheless also adhere to more traditional paradigms of health and illness, or associated health beliefs and behaviors sometimes called folk beliefs that diverge from mainstream Western scientific medical concepts. Older women, who are often more steeply versed in traditional health beliefs than men and often act as the first line of medical advice within the family, may adopt a combination of orthodox (scientific) and folk traditions to attempt to address illness or malaise. This multiple approach is not necessarily harmful; rather, many folk treatments (which include specific ritual behaviors, and use of teas and other folk remedies) may, from a strictly medical standpoint, play a neutral role in terms of biochemical activities but a highly positive role in terms of psychological well-being. Folk treatments allow an individual to address the social imbalances that are considered significant in causing a particular condition within the ethnic tradition. Health professionals who work with particular ethnic groups would benefit from a deeper understanding of cultural beliefs and practice, and an acknowledgement of respect for these practices. Among the variety of writings on ethnicity and health or ethnicity and aging that have appeared are practical texts on communication strategies with various ethnic groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1954

Frozen raw foods as skin-testing materials; further studies of use in cases of allergic disorders.

In further studies on the use of frozen raw food as skin-testing material in patients with allergic disorders, the results of previous work were confirmed in a greater number of subjects using a larger number of foods:Tests with frozen raw foods by the scratch method induce true positive reactions of a larger size and in greater frequency than the corresponding commercial extracts by either the scratch or the intracutaneous method. Storage in the frozen state for several years does not affect the antigenic potency of the materials. The frozen preparations have caused no harmful effects in the subjects, are free from irritant properties, and are not urticariogenic.

Female↗
PubMed2006

Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs.

OBJECTIVES: Currently there are few practical methods to identify and measure harm to hospitalized children. Patients in NICUs are at high risk and warrant a detailed assessment of harm to guide patient safety efforts. The purpose of this work was to develop a NICU-focused tool for adverse event detection and to describe the incidence of adverse events in NICUs identified by this tool. METHODS: A NICU-focused trigger tool for adverse event detection was developed and tested. Fifty patients from each site with a minimum 2-day NICU stay were randomly selected. All adverse events identified using the trigger tool were evaluated for severity, preventability, ability to mitigate, ability to identify the event earlier, and presence of associated occurrence report. Each trigger, and the entire tool, was evaluated for positive predictive value. Study chart reviewers, in aggregate, identified 88.0% of all potential triggers and 92.4% of all potential adverse events. RESULTS: Review of 749 randomly selected charts from 15 NICUs revealed 2218 triggers or 2.96 per patient, and 554 unique adverse events or 0.74 per patient. The positive predictive value of the trigger tool was 0.38. Adverse event rates were higher for patients <28 weeks' gestation and <1500 g birth weight. Fifty-six percent of all adverse events were deemed preventable; 16% could have been identified earlier, and 6% could have been mitigated more effectively. Only 8% of adverse events were identified in existing hospital-based occurrence reports. The most common adverse events identified were nosocomial infections, catheter infiltrates, and abnormal cranial imaging. CONCLUSIONS: Adverse event rates in the NICU setting are substantially higher than previously described. Many adverse events resulted in permanent harm and the majority were classified as preventable. Only 8% were identified using traditional voluntary reporting methods. Our NICU-focused trigger tool appears efficient and effective at identifying adverse events.

Catheterization↗
PubMedDate not supplied

[The use of antiadhesins--a new prospective trend in preventing and treating infectious diseases (a foundation for the technologies for creating drugs in the 21st century)].

The state and prospects of research on creation of antiadhesins--new generation drugs for preventing and treatment of infectious diseases, are analyzed in the paper. The elaboration of such drugs is based on the profound knowledge about the nature of viral, bacterial, fungal and other infectious agents of diseases, molecular mechanisms of their interactions with the affected organs and tissues which are based on the processes of carbohydrate-protein recognizing. Rapid development of such fields of science as glycobiology and lectinology has created the preconditions for artificial synthesis of oligosaccharides which mimicked the receptors and can interact with adhesive structures of the disease agents more intensively than their natural analogs and block them. This makes the interaction of the latter with the affected organs impossible. The intensive work on elaboration of natural drugs: antiadhesins, is carried out in most countries. Adhesins are not harmful for people and cannot provoke the development of resistance to them in the disease agents. Till recently Ukraine belonged to the number of countries where the fields of science mentioned above were intensively developed but, in connection with the present stagnation of science and even the artificial hindering of its development, the country gradually losses the position of a leader. Hence, one can conclude that when 10-15 years later the market of pharmaceutical products will be filled with antiadhesins, our country will not be on the list of their producers, if the authorities will spend funds to buy foreign drugs as before instead of stimulating the development and production of the home ones.

Adhesins, Bacterial↗
PubMed2003

Calcium scoring: criteria for evaluating its effectiveness.

Engineering advances in CT have produced multi-slice instruments that can scan large areas of the body in short periods of time, and such instruments now permit high resolution examination of entire anatomic regions (eg, the chest) in a single breath hold. Alternatively, these instruments can quickly scan small areas (such as the heart) with very high resolution in a very short period of time (eg, diastole). Using such CT scanners, there is no question that coronary artery calcium can be detected in small quantities and scored accurately. However, coronary calcium screening, like all screening procedures, poses a significant dilemma: early detection in a few is almost always accompanied by negative consequences for others (eg, false positives causing anxiety and unnecessary work-up, and false negatives causing delayed treatment and false reassurance). How do we balance the benefits to a few against the negative effects to others? That is the subject of this paper. A starting point for resolving the screening dilemma is to count the number of patients needed to be screened to benefit one patient (the NNS), and conversely, to determine the number of patients screened before harming one patient (NSH). Another approach is to apply published criteria suggested for the evaluation of a screening program targeted at early disease detection. In this review article, we propose 10 criteria for evaluating the effectiveness of a screening test designed to detect a risk factor for disease (ie, calcium scoring as a risk factor for coronary artery disease). We discuss how these criteria can be used to estimate NNS and NSH. Although this work focuses on coronary calcification screening, reference is made as well to other areas, such as lung and colon cancer screening.

Calcinosis↗
PubMedDate not supplied

When "privacy" threatens public health.

A European directive on privacy may make illegal much life-saving research on cancer in Britain, and the "fundamental principle" (no use of named records without permission of the individuals) could limit statistical work in Canadian cancer registries. Although the intent is to protect individuals from improper administrative use, this hardly applies to statistical aggregates that cannot identify anybody. Abstract position statements have done little to clarify the reasoning. To counter this, the present paper points to actual statistical uses of Canada's mortality database for individual follow-up on an unprecedented scale under conditions of strict confidentiality. The statistics serve to connect earlier causes with later harm. However, confusion still surrounds the question of whether privacy can be fundamentally violated by statistics drawn from personal records. Without wider understanding, real harm to health will compete poorly with imagined harm to privacy.

Canada↗
PubMed2006

Medical comorbidity in bipolar disorder: implications for functional outcomes and health service utilization.

OBJECTIVE: This is the first cross-national population-based investigation exploring the prevalence and functional implications of comorbid general medical disorders in bipolar disorder. METHODS: Data were extracted from the Canadian Community Health Survey (N = 36,984). Analyses were conducted to ascertain the prevalence and prognostic implications of predetermined comorbid general medical disorders among persons who screened positive for a lifetime manic episode (indicative of a diagnosis of bipolar disorder). Within the subpopulation of people who screened positive for a manic episode, the effect of medical comorbidity on employment, functional role, psychiatric care, and medication use was examined. RESULTS: When the data were weighted to be representative of the household population of the ten provinces in 2002, an estimated 2.4 percent of respondents screened positive for a lifetime manic episode. Rates of chronic fatigue syndrome, migraine, asthma, chronic bronchitis, multiple chemical sensitivities, hypertension, and gastric ulcer were significantly higher in the bipolar disorder group (all p < .05). Chronic medical disorders were associated with a more severe course of bipolar disorder, increased household and work maladjustment, receipt of disability payments, reduced employment, and more frequent medical service utilization. CONCLUSIONS: Comorbid medical disorders in bipolar disorder are associated with several indices of harmful dysfunction, decrements in functional outcomes, and increased utilization of medical services.

Adolescent↗
PubMedDate not supplied

Cardiorespiratory fitness and training in quadriplegics and paraplegics.

With the growing interest in exercise and sport and the significance of cardiovascular disease in the spinal cord injured population, the role of endurance training in improving cardiovascular health is of particular interest. Ordinary daily activities of those with spinal cord injury are usually not adequate to maintain cardiovascular fitness, and lack of participation in a regular activity programme may result in a debilitative cycle. As this occurs, there is a reduction in functional work capacity which may limit independence, and the reduction in cardiovascular fitness may increase the risk for cardiovascular disease. Work capacity in those with spinal cord injury is limited by loss of functional muscle mass and sympathetic control. Sympathetic nervous system impairment limits control of regional blood flow and cardiac output, and maximum heart rate following cervical lesions may be reduced to 110 to 130 beats/min. However, endurance training in quadriplegics and paraplegics can elicit improvements in exercise performance similar to those observed in able-bodied individuals. Review of 13 cardiorespiratory training studies involving spinal cord injured subjects revealed average improvements of 20% in VO2max and 40% in physical work capacity after 4 to 20 weeks of training. Based upon the positive results of these studies, the general endurance training guidelines for the normal population appear to also be appropriate for the spinal cord injured population. These guidelines can be followed during participation in a number of different activities and sports including wheelchair pushing, arm crank ergometry, aerobic swimming, ambulation training, canoeing and wheelchair basketball. There is no evidence that intense training and competition is harmful, but special areas of risk as a result of impairments in sensation, cardiovascular function, autonomic function and temperature regulation must be considered. The long term benefits of endurance training in those with spinal cord injury has not been adequately studied, but there is suggestion that similar physiological and psychological changes may occur as in able-bodied individuals.

Cardiovascular System↗
PubMed2006

Beliefs about medicines among Swedish pharmacy employees.

OBJECTIVE: The aim of this study was to describe the beliefs about medicines among pharmacy employees. A further aim was to analyse whether these beliefs were associated with any background characteristics, such as age, professional category or medication use. METHOD: The study subjects were pharmacy employees at 24 community pharmacies in Göteborg, Sweden. The participating pharmacies had a total of 372 employees (pharmacists, dispensing pharmacists, and pharmacy technicians). Data was collected at the weekly pharmacy information meetings with a questionnaire comprising background questions and the Beliefs about Medicines Questionnaire (BMQ). The general part of the BMQ was used. For each statement in the BMQ, respondents marked their degree of agreement on a five-point Likert scale (1=strongly disagree, 2=disagree, 3=uncertain, 4=agree and 5=strongly agree). MAIN OUTCOME MEASURE: The three subscales of BMQ General: General Harm, General Overuse and General Benefit. RESULTS: The majority of the 292 respondents were dispensing pharmacists. More than half of the respondents were aged 45 years or older and had worked in a pharmacy for 20 years or more. Compared to the other professional categories, a higher proportion of dispensing pharmacists stated that they currently used traditional medicines. The pharmacy employees had a mean score for General Benefit of 4.31 and a mean score for General Harm of 1.81. Pharmacists and dispensing pharmacists in general regarded medicines as somewhat more beneficial, whereas pharmacy technicians viewed medicines as slightly more harmful. Those who had worked in a pharmacy for 30-34 years regarded medicines as less harmful compared to those who had worked 0-4 years. Compared to non-users, current users of prescription drugs regarded medicines as more beneficial. When controlling for background characteristics, no confounders were detected for any of the three subscales (ANCOVA analyses). CONCLUSION: Results of the study of 292 Swedish pharmacy employees show that they regard medicines as beneficial rather than harmful and that there are differences in beliefs between the professional categories. However, the reasons for these differences remain unclear. Nevertheless, the positive beliefs among pharmacy employees may have an impact on the communication with clients and, eventually, clients' adherence to medicines.

Adolescent↗
PubMed1999

Problems of Prophylaxis of Secondary Immunodeficiency States.

An attempt is made in this paper to draw up some results of long-term studies conducted by the "Immunoprophylaxis" Center of RANS on such studies. The results of mass and individual studies among 250 thousand blue- and white-collar workers in Russian industrial enterprises are processed in the data bank of the Center, including an analysis of the immunological reactions of 30 thousand individuals studied. An analysis of the results shows that secondary immunodeficiency is encountered in 30% of the people occupied in industrial positions, in 40% of professional athletes and in more than 60% of the children studied. It should be emphasized that in enterprises where there is substantial excessive environmental harm, the frequency of development of immunodeficiency also exceeded the 60% mark. There are many reasons for the development of immunological deficiency and they depend on a large number of factors. Among them, in the first place, is the anthropogenic effect on the environment, which results in contamination of working zones, the earth, water and, as a consequence, food products, the use of which inevitably results in immunodepression. A special place in this problem is occupied by stress, which accompanies almost any professional activity. There is no doubt concerning the opinion that normal functioning of the immune system provides a sufficiently effective "interdiction" against the development of many diseases. Immune deficiency "opens the door" to illness. In other words, immunodeficiency is a detonator for the growth of a pathology.

Journal Article↗
PubMedDate not supplied

[Effects of various sport activities on peripheral venous diseases].

The study of the influence of different sporting activities on peripheral venous pathology should be based on venous physiology and precise understanding of the technology of each sport (study of the movements, positions, and muscles brought into play, the rhythm, the material employed, the risks run). At the conclusion of a long study on sportsmen of both average and highly competitive ability, and on yogis, the author was able, by means of a simple methodology applicable to all physical activity, to classify the principal sports into two categories: those which improve and those which work against the peripheral venous circulation. However he does not recommend a complete ban on the harmful sports in highly motivated patients, but rather that they should counter the disadvantages by performing antagonistic movements.

Humans↗
PubMed1995

Interprofessional education for medical and nursing students: evaluation of a programme.

This paper reports and evaluates a programme of interprofessional education for final-year medical students and fourth-year undergraduate BSc nursing students. The programme was designed in the light of social psychological studies of intergroup behaviour (the contact hypothesis). Key features included opportunities to work as equals in pairs and small groups on shared tasks in a cooperative atmosphere. Topics included communication between nurses, doctors and patients, deliberate self-harm by patients, and ethical issues in clinical care. A comprehensive evaluation of the effects of the programme on one cohort of 39 participants revealed that overall attitudes towards the other profession had improved. Participants reported increased understanding of the knowledge and skills, roles and duties of the other profession. The programme was positively evaluated by both groups of participants.

Adult↗
PubMed2000

Workers' dermal exposure to UV-curable acrylates in the furniture and Parquet industry.

The use of ultraviolet radiation-curable coatings (UV-coatings) has increased rapidly in the parquet and furniture industry. Work with UV-coatings involves risk from skin exposure to chemically reactive, concentrated acrylates that are known skin contact irritants and sensitizers. Yet, the methods and tools for measuring and quantifying dermal exposure from hazardous chemicals directly on the skin are limited and methods to measure skin exposure to UV-coatings in occupational or environmental settings have been lacking. Skin exposure to UV-coatings was measured employing a quantitative tape stripping method that we have developed for this purpose. A pilot study was performed at three workplaces. In the main study, workers' skin exposure to uncured UV-coatings was measured at seven workplaces and on two separate workdays (rounds 1 and 2) within a six-month period to determine exposure variation. Skin exposure was measured at four standardized sites on the hand, 3-4 times per work shift. The forehead was sampled once. A questionnaire was carried out with the workers in both rounds to find out factors that can affect skin exposure to UV-coatings. The pilot study indicated that both skin and surface contamination to TPGDA-containing UV-coatings were common and varied up to 2110 microgram on the sampling area of 10cm(2). In the main study skin contamination due to TPGDA was found on 16 of 23 workers, at 6 out of the 7 workplaces, and from 36 (5. 4%) of the 664 samples. In round one 8.6% (n=383) of the samples contained TPGDA and in round two 1.1 % (n=281). The average TPGDA mass on all the positive samples (n=36) was 30.4+/-77.0 microgram for the first and second rounds alone this mass was 30.6+/-80 (n=33) and 28.3+/-16.5 microgram (n=3), respectively. Despite the limited sampling area and sampling sites, we could find residues of TPGDA at all sampling times, even at the beginning of the work shift. This may be due to transfer of UV-coatings through contaminated equipment, shoes and surfaces. Our study indicates that there is a risk of harmful skin exposure to UV-coatings in the furniture and parquet industry.

Acrylates↗