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PubMed2002

A pilot study of community mental health care for depression in a supermarket setting.

OBJECTIVE: Women with depression whose diagnosis is made in community mental health clinics attend relatively few treatment sessions. A pilot project was undertaken to test the feasibility of providing psychotherapy for depressed women in a supermarket, a novel setting that may minimize barriers to care such as stigma associated with visiting a mental health clinic. METHODS: Twelve women who met DSM-IV criteria for a depressive disorder were recruited from a rural mental health clinic and offered 16 weekly sessions of supportive psychotherapy with cognitive-behavioral elements in an administrative conference room of a local supermarket. Outcomes measured were treatment attendance, depressive symptoms, and satisfaction with treatment. RESULTS: Six of the women completed the study. For the entire group, the mean number of sessions attended was 5.2. Those who completed the study attended an average of 8.7 sessions and showed significant improvement on measures of depression and anxiety. They rated their treatment experience as "very satisfactory." For the two therapists, conducting therapy in the supermarket presented some logistical problems, such as limited access to telephones and the absence of a check-in desk. The therapists also reported that providing therapy in this setting was challenging to their professional identities. CONCLUSIONS: The women in the study found treatment in the supermarket to be an appealing alternative to the mental health clinic because of greater accessibility, a perceived reduction in stigma, and convenient "one-stop shopping" for both groceries and mental health treatment.

Community Health Services↗
PubMedDate not supplied

Effect of povidone-iodine on Streptococcus mutans in children with extensive dental caries.

PURPOSE: The purpose of this pilot project was to determine the effect of a 10% povidone-iodine solution on plaque Streptococcus mutans and on incidence of new caries in young children following dental rehabilitation under general anesthesia. METHODS: Twenty-five children ages 2 to 7 years, scheduled for dental treatment under general anesthesia, were enrolled. Children in the experimental group (N = 13) had povidone-iodine applied 3 times at 2-month intervals. Control children (N = 12) had no treatment. Plaque samples were taken from all children at baseline, 6 months and cultured for total bacteria and S mutans. Dental examinations were conducted at baseline, 6 months, and 1 year. RESULTS: Experimental and control children had similar dietary habits, caries experience, and S mutans levels at baseline. All children's S mutans counts decreased significantly at 6 months (P = .003). The difference between the 2 groups was not significant (P = .58). At 1 year, 5 of 8 children in the control group had new caries compared to 2 of 11 children in the experimental group (P = .06). Povidone-iodine was well accepted by participating families. CONCLUSIONS: Extensive one-time restorative dental treatment resulted in a significant suppression S mutans levels at 6 months. Further exploration of the role of povidone-iodine in caries management is indicated.

Anti-Infective Agents, Local↗
PubMed1998

Management and environmental risk factors for Salmonella enteritidis contamination of eggs.

OBJECTIVE: To analyze data for 60 poultry flocks voluntarily enrolled in the Pennsylvania Salmonella enteritidis Pilot Project and determine management and environmental risk factors associated with production of S enteritidis-contaminated eggs. SAMPLE POPULATION: 60 flocks for which at least 1 environmental sample (manure or egg-handling equipment) was positive for S enteritidis. PROCEDURE: Samples of manure, egg-handling equipment, and mice were submitted for bacterial culture of S enteritidis. When S enteritidis was isolated from environmental samples, 1,000 eggs were collected from the flock every 2 weeks for 8 weeks and submitted for bacterial culture. RESULTS: 18 flocks were found to have produced contaminated eggs. Estimated overall prevalence of contaminated eggs was 2.64/10,000 eggs produced, but flock-specific prevalence ranged from 0 to 62.5/10,000 eggs. Flocks with high levels of manure contamination were 10 times as likely to produce contaminated eggs as were flocks with low levels. However, 5 flocks with low levels of manure contamination produced contaminated eggs. CONCLUSIONS: Evaluation of the level of manure contamination could be used to help identify flocks at risk of producing S enteritidis-contaminated eggs. CLINICAL RELEVANCE: Flocks with high levels of S enteritidis-contaminated manure appeared to pose the greatest public health threat, and on-farm programs to reduce the prevalence of egg contamination should be developed for farms with high levels of manure contamination. Efforts to reduce the overall number of on-farm pathogens should decrease the incidence of foodborne disease in humans.

Animal Husbandry↗
PubMed1997

Tn916 transposition in Haemophilus influenzae Rd: preferential insertion into noncoding DNA.

The availability of completely sequenced genomes has created an opportunity for high throughput mutational studies. Using the conjugative transposon Tn916, a pilot project was initiated to determine the efficiency of gene disruption in the first completely sequenced bacterium, Haemophilus influenzae Rd strain KW20. DNA was isolated from Tn916-mutagenized cells, and the point of transposon insertion was determined by inverse PCR, DNA sequencing, and mapping to the wild-type genome sequence. Analysis of the insertion sites at the nucleotide level demonstrated a biased pattern of insertion into regions rich in stretches of A's and T's. Although Tn916 integrated at multiple dispersed positions throughout the chromosome, 9 of 10 insertion events occurred in noncoding, intergenic DNA. It was determined that the intergenic DNA was over 5% more A + T-rich than that of protein coding sequences. This suggests that A + T-rich sequences similar to the Tn916 insertion site would be more likely to reside in the intergenic DNA. In an effort to identify other likely sites for transposon integration, a hidden Markov model of the consensus target insertion site was derived from the Tn916-H. influenzae junction fragments and searched against the entire genome. Eighty percent of the 30 highest-scoring predicted Tn916 target sites were from intergenic, nonprotein-coding regions of the genome. These data support the hypothesis that Tn916 has a marked preference for insertion into noncoding DNA for H. influenzae, suggesting that this mobile element has evolved to minimize disruption of host cell function on integration.

Base Sequence↗
PubMed1996

Work activities before and after implementation of an automated dispensing system.

The impact of an automated dispensing system (ADS) on medication-related work activities by nurses and pharmacists was studied. A point-of-care ADS (Baxter Sure-Med) was installed on two nursing units (the surgical intensive care unit [SICU] and a medicine unit [4NMU]) of a 400-bed university hospital as part of a pilot project. A self-reported work-sampling study was used to collect observations of medication-related work activities by nurses, health unit coordinators (nursing support staff), and pharmacists for a seven-day period before ADS implementation and a seven-day period after implementation. There were 7797 observations of nurse work activities, 1408 observations of health unit coordinator work activities, and 4236 observations of pharmacist work activities. The percentage of nurse work activities that were medication related decreased from 20.7% before ADS implementation to 18.4% afterward on 4NMU and increased slightly from 10.8% to 11.0% on the SICU. Medication-related health unit coordinator work activities increased from 17.5% to 25.3% of total activities on 4NMU and decreased from 16.6% to 10.7% on the SICU. None of these changes was significant. For decentralized pharmacists supporting 4NMU, the percentage of work activities classified as clinical increased significantly from 36.5% to 49.1%. For decentralized pharmacists supporting the SICU, clinical activities increased from 27.9% to 35.1%. There were no significant changes on either unit in pharmacist activities classified as technical. An overall measure of the efficiency with which pharmacists used their time for patient care-related activities increased. A point-of-care ADS did not affect the proportion of time spent by nurses on medication-related activities and seemed to give pharmacists more time for clinical work.

Automation↗
PubMed2006

Inter-disciplinary focus groups on telephone medicine: a quality improvement initiative.

OBJECTIVE: To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups. DESIGN: Descriptive pilot project. SETTING: Extended Care and Rehabilitation Center (ECRC), Durham VA Medical Center, Durham, North Carolina. PARTICIPANTS: Eight of 20 registered or licensed practical nurses and 4 of 6 geriatric medicine fellows voluntarily participated in this quality improvement project. MEASUREMENTS: In two 45-minute focus groups, participants were asked to discuss 3 open-ended questions related to telephone medicine. Comments were recorded during the discussions; topical themes were identified by the authors. RESULTS: Participant comments could be categorized into 4 domains describing the characteristics of nurses and physicians who practice the best telephone medicine: (1) provides the appropriate medical component of patient care; (2) appreciates contextual issues; (3) respects the other party's time and resources; and (4) possesses a collaborative attitude. The focus groups identified 5 quality improvement goals: (1) better nursing assessment and provision of patient information; (2) minimization of non-urgent calls after hours; (3) more decisive physician action (or explanation of inaction); (4) better physician familiarity with facility policies/logistics; and (5) better communication/paging system. The discussion format allowed nurses and physicians to identify and respond to potential barriers to improving quality in each area. CONCLUSION: Nurses and physicians appreciate unique aspects of long-term care telephone medicine and identify distinct barriers to improving practice. Interdisciplinary focus groups were a productive step toward understanding the telephone medicine experience in our facility and developing quality improvement interventions for both nurses and physicians.

After-Hours Care↗
PubMed2005

Progress in glaucoma treatment research: a nonrandomized prospective study of 102 patients with advanced refractory glaucoma treated by Leksell gamma knife irradiation.

OBJECT: The authors performed a study to characterize the effects of ciliary body gamma knife surgery (GKS) for advanced glaucoma. METHODS: In addition to a pilot project involving 14 patients, 88 other patients were treated. Four 8-mm isocenters were used. Blind eyes received 20 Gy to the 50% isodose. If there was preserved vision the dose was 15 Gy. The median follow up was 20 months (range 2-54 months). Severe pain was present in 93% of patients with secondary glaucoma; after GKS it was substantially improved in 89% of cases. In primary open angle glaucoma, the pain was less frequent and severe. In more than half the patients it disappeared during a median latency of 6 weeks. The median intraocular pressure value was lowered in patients with secondary glaucoma (from 51.3-27 mm Hg). The same values for primary glaucoma were 25.3 and 16.1 mm Hg, respectively, after a median latency of 12 weeks. Twenty-seven of 40 patients with neovascular glaucoma showed a marked reduction of neovascularization after a median latency of 18 weeks. Treatment complications were slight. There was postoperative lacrimation in 61%. Two patients underwent postirradiation cataract extraction. Noninfectious keratitis was observed in two patients. Pharmacotherapy could be reduced in all patients and ceased in approximately one third. There has been no recurrence of the initial symptoms and no worsening of visual acuity. CONCLUSIONS: Gamma knife surgery ameliorates the main symptoms in advanced glaucomas and precludes the need for eventual ocular enucleation.

Adolescent↗
PubMed2005

Remote presence proctoring by using a wireless remote-control videoconferencing system.

Remote presence in an operating room to allow an experienced surgeon to proctor a surgeon has been promised through robotics and telesurgery solutions. Although several such systems have been developed and commercialized, little progress has been made using telesurgery for anything more than live demonstrations of surgery. This pilot project explored the use of a new videoconferencing capability to determine if it offers advantages over existing systems. The video conferencing system used is a PC-based system with a flat screen monitor and an attached camera that is then mounted on a remotely controlled platform. This device is controlled from a remotely placed PC-based videoconferencing system computer outfitted with a joystick. Using the public Internet and a wireless router at the client site, a surgeon at the control station can manipulate the videoconferencing system. Controls include navigating the unit around the room and moving the flat screen/camera portion like a head looking up/down and right/left. This system (InTouch Medical, Santa Barbara, CA) was used to proctor medical students during an anatomy class cadaver dissection. The ability of the remote surgeon to effectively monitor the students' dissections and direct their activities was assessed subjectively by students and surgeon. This device was very effective at providing a controllable and interactive presence in the anatomy lab. Students felt they were interacting with a person rather than a video screen and quickly forgot that the surgeon was not in the room. The ability to move the device within the environment rather than just observe the environment from multiple fixed camera angles gave the surgeon a similar feel of true presence. A remote-controlled videoconferencing system provides a more real experience for both student and proctor. Future development of such a device could greatly facilitate progress in implementation of remote presence proctoring.

Computer-Assisted Instruction↗
PubMed1996

Carboxypeptidase G2 rescue after high-dose methotrexate.

PURPOSE: This study was a pilot project to assess the safety and efficacy of carboxypeptidase G2 (CPG2) rescue from high-dose (HD) methotrexate (MTX) in patients with recurrent cerebral lymphoma. PATIENTS AND METHODS: Four patients with recurrent primary CNS lymphoma (PCNSL) were studied. Patients received 3.0 g/m2 MTX infused over 2 hours. Twelve hours after the start of MTX, 50 U/kg CPG2 was infused; a second dose of CPG2 was given 6 hours after the first. Blood and CSF were collected and assayed for levels of MTX, CPG2, and 2,4-diamino-N10-methylpteroic acid (DAMPA), a cleavage product of MTX after CPG2. Serum was collected for at least 2 weeks after administration of MTX-CPG2 to assess anti-CPG2 activity antibodies. RESULTS: All patients had at least a 2-log decline in plasma MTX levels to the subtherapeutic range within 5 minutes of CPG2 administration. The second dose of CPG2 did not further diminish the already low plasma MTX level. DAMPA appeared and was detected as the plasma MTX concentration decreased. CSF MTX concentration remained elevated for 4 hours after CPG2, and its decline followed first-order kinetics. Anti-CPG2 activity antibodies were not detected in any patient. No MTX or CPG2 toxicity was observed. CONCLUSION: CPG2 rescue is a safe, effective alternative to leucovorin rescue after HD MTX and may prove particularly useful for the treatment of MTX-sensitive CNS tumors, as it does not affect CSF MTX levels.

Antimetabolites, Antineoplastic↗
PubMed1997

Results of a community-based campaign to reduce fat intake.

In 1992, a community-based 'Fat Watch' campaign was held in the city of Alkmaar in the Netherlands. The campaign was implemented within the framework of the nationwide mass-mediated 'Fat Watch' campaign (1991-1994), which aimed at a 10% reduction in fat intake among the general Dutch population. The intervention was carried out as a pilot project to study the effectiveness of strategies and activities, and to apply them subsequently in more cities. The campaign aimed primarily at the active involvement of intermediaries. Effects of the campaign were studied by telephone questionnaires among about 500 respondents, before and after the campaign in both the experimental and a control community. The questionnaire was based on the 'attitude, social influence, self-efficacy' (ASE) model. The results showed that 56% of the respondents were aware of a campaign in their community and that the campaign was positively evaluated by those familiar with it. After the campaign, self-rated fat consumption was significantly higher. No differences between the experimental and control community were found regarding attitude, social influence or self-efficacy expectations towards a reduction in fat consumption or intention to buy low-fat food products. However, as opposed to the control community, there was a significant decrease in actual fat consumption between pre- and post-test in Alkmaar. Furthermore, after the campaign, significantly more respondents in the experimental community intended to eat lower-fat food products and reported a behavioral change in the last six months. It was concluded that the campaign was quite successful as far as campaign awareness was concerned, but that it did not result in substantial change of behavior. The limited decrease in fat consumption observed should be interpreted with care.

Analysis of Variance↗
PubMed1983

[Rehabilitation and return to work of patients after aortocoronary bypass].

A pilot project with medical, physical and psychosocial evaluation and a physical and psychosocial rehabilitation program included 59 men, under age 60, inactive for less than one year and who underwent aortocoronary bypass surgery between november 1978 and march 1980. A control group of 60 comparable patients was studied by questionnaire one year after the operation. The percentage of return-to-work was not significatively different: respectively 92 p. 100 and 89 p. 100. A previous study on a similar population determined 9 predictive sociodemographic and medical factors: age, angina class, duration of symptoms, associated vascular disease, non cardiovascular illness, education, physical workload, length of preoperative unemployment, annual income. The evaluations of this study showed the importance of the psychosocial factors and alcoholism. In comparison with our previous studies, the increased percentage of return-to-work (from 69 p. 100 to 89 p. 100) is mostly due to a shorter preoperative period of inactivity; the percentage of patients operated on within three months of inactivity increased from 44 p. 100 to 74 p. 100 in the last ten years. In the group of patients with a good or excellent preoperative prognosis, 94 p. 100 were working after one year. We conclude that a strategy for improving return-to-work after surgery is to decrease the period of preoperative inactivity. By using nine objective predictive factors and a psychosocial evaluation, it is possible to screen patients with a poor return-to-work prognosis and to submit them to an individualized rehabilitation program.

Adult↗
PubMedDate not supplied

A pilot study of recovery room bypass ("fast-track protocol") in a community hospital.

PURPOSE: To evaluate the effectiveness of short-acting anesthetic drugs and techniques to achieve recovery room bypass criteria after minor surgery in a community hospital environment. METHODS: After agreement by a multidisciplinary committee, a pilot project was undertaken to assess the usefulness of ultra- short acting anesthetic drugs and pre-emptive analgesia to facilitate rapid recovery from general anesthesia. A cohort of 100 ASA I-II patients aged 18-65 yr undergoing simple knee arthroscopy or minor peripheral orthopedic procedures was compared to a similar cohort treated in the three months prior to the study period. Outcomes of interest included patient morbidity, success in achieving post-anesthesia care unit (PACU) bypass criteria, impact upon nursing resources, duration of operating room (OR) and hospital stay, and pharmaceutical costs before and after implementation. RESULTS: No patient morbidity was demonstrated prior to discharge home, and successful PACU bypass occurred in 83% of cases. Achievement of PACU discharge criteria while in the OR did not prolong the OR time, and discharge from hospital occurred earlier in the patients who did not require PACU care (P=0.0006 all "fast-track cases" vs all "controls"). Nursing complaints were more numerous when the day surgery personnel did not normally participate in PACU care. The cost of anesthetic care was significantly more using ultra-short acting drugs (CDN $14.17 vs CDN $20.57), but closer adherence to protocol could reduce this differential (CDN $18.84). CONCLUSION: Not all patients who receive a general anesthetic require admission to a phase I recovery facility. However, the justification for use of more expensive pharmaceuticals to achieve PACU bypass requires extensive changes in operating systems and voluntary professional behaviours.

Adolescent↗
PubMed1994

Continuously improving primary care.

BACKGROUND: This article describes efforts to understand and improve the daily work processes of primary care within the Henry Ford Health System, where continuous quality improvement (CQI) has been a key business strategy since 1988. We began a pilot project in 1990 that attempted to accelerate the implementation of continuous improvement in primary care. The clinical site was the general internal medicine (GIM) ambulatory clinic, which has 50,000 patient visits annually. STRATEGIES FOR IMPROVEMENT: For four key elements--physicians as leaders, prevention and primary care, patient access, and innovation and team work--we planned and implemented continuous improvement based on three questions: What were we trying to accomplish? What can we change that would lead to an improvement? How would we know a change is an improvement? EXAMPLE: Prevention and Primary Care. In our primary care setting, an appropriate clinical process to improve would include preventive medicine, specifically Pap-smear performance. In our partnership with the department of obstetrics/gynecology, GIM physicians wanted to improve the rate of adequate Pap smears. To reduce variation in the rates with which physicians collected specimens that were adequate for cytologic examination, the team recommended use of a specific tool, a cervi-brush, which should be more effective in producing adequate specimens. As cervi-brush use increased, rates of inadequate Pap smears dropped from 20%-25% in 1989 to less than 10% for the first six months of 1991. CONCLUSIONS: By focusing attention and resources on a limited number of improvement teams, our initial success built enthusiasm and commitment within GIM and accelerated changes that were incorporated into strategic planning for the Henry Ford Health System as a whole.

Female↗
PubMed2006

Pilot study of a self-administered stress management and exercise intervention during chemotherapy for cancer.

GOALS OF WORK: This pilot project explored the feasibility, safety, and effectiveness of a self-administered exercise and stress management intervention for cancer patients receiving chemotherapy. PATIENTS AND METHODS: Thirty-nine of 56 eligible patients (acceptance =69%) with a variety of solid tumors volunteered for the study. Participants were advised to exercise 20-40 min at 50-75% estimated heart rate reserve 3-5 times per week. In addition, patients were provided with instruction and written materials regarding stress management techniques. Follow-up data were collected during regularly scheduled outpatient visits at the start of the second, third, and fourth chemotherapy cycles using diary entries and the same questionnaires previously administered at baseline. MAIN RESULTS: Twenty-four of 39 patients (62%) completed all study requirements. These participants completed 438 of the 678 exercise sessions assigned (adherence =62%). Of the stress management techniques, positive thinking most practiced most frequently (48%), followed by deep breathing (38%) and active relaxation (37%). Paired t tests, comparing baseline values with final recorded values, indicated a significant improvement over time in bodily pain (p<0.03) and mental health (p<0.04) subscale scores. Participants' evaluations of the combined intervention were favorable: 90% felt it was helpful to them and 100% would recommend it to another patient. CONCLUSIONS: A self-administered intervention combining aerobic exercise and stress management was acceptable and safe for cancer patients receiving chemotherapy. Preliminary data demonstrating intervention efficacy should be confirmed in subsequent randomized clinical trials.

Adult↗
PubMed2005

Primary and secondary prevention of drink driving by the use of alcolock device and program: Swedish experiences.

To prevent drinking and driving, alcolock (or alcohol-interlock) devices and programs were introduced in Sweden in 1999. Two types of prevention programs were begun. A primary prevention strategy was initiated to prevent alcohol impaired driving by individuals not pre-selected for having prior DWI offences. This approach was first applied as a pilot project in three commercial transport companies (buses, trucks, taxis). Also a secondary prevention trial was begun as a voluntary 2-year program for DWI offenders involving strict medical requirements, including counseling and regular checkups by a medical doctor. The program did not require a prior period of hard suspension and focused on changing alcohol use habits. Alcolocks in commercial vehicles have been well accepted by professional drivers, their employers, and their passengers, and the number of vehicles with alcolocks as a primary prevention measure is rapidly growing in Sweden. Three of 1000 starts in the primary prevention program were blocked by the alcolock after measuring a BAC higher than the legal limit and lock point of 0.02% (20mg/dl). Only 11% of eligible DWI offenders took part in the voluntary, secondary prevention program. Of these, 60% had diagnoses of alcohol dependence or abuse. During the program, alcohol consumption generally decreased significantly as measured through five biological alcohol markers, and the rate of DWI recidivism fell sharply from a yearly rate of approximately 5% to almost 0. These effects on DWI recidivism are paralleled by reduced rates of police-reported traffic accidents involving injuries and hospital admissions due to road accidents. Successful completion of the program appears to have lasting effects (even 2.5 years later) in terms of far lower rates of DWI recidivism and maybe also lower crash rates. On the other hand those being dismissed from the program appear to rapidly return to previous behaviour. Hard suspension seems almost to have an adverse effect on DWI recidivism, but crashes resulting in injuries may be reduced during revocation.

Accidents, Traffic↗
PubMed1997

Norplant implants in Ethiopia.

This is a cross-sectional study involving 364 clients who have had Norplant implants insertion for contraception at the Gandhi Memorial Hospital (GMH) during the second half of 1994. It was part of the pilot project designed to introduce Norplant in Ethiopia after evaluating the safety, efficacy, tolerance, acceptability and reversibility of the method. The vast majority of the clients were found to be married, housewives, multiparae, relatively educated, urban dwellers, Christian by faith and in their reproductive age group with a mean age of 27.9 +/- 5.7 years. A significant number of them used one or more types of contraceptive methods prior to their switch to Norplant (P < 0.05). A third of the patients were lactating at the time of the Norplant insertion. The time taken to insert the implants was 12.5 +/- 4.3 minutes. The mean duration since the insertion is computed to be 25.3 +/- 4.2 months. Their main source of information was from the medical personnel. The acceptability and continuation rate of the method was 93.9% and 95.1%, respectively. The fertility-reversibility among those who desired to have childbirth was achieved in 72.3% and 84.1% at one and two years, respectively. Adverse effects of Norplant were registered in a quarter of the study population and included abnormal menstruation, headache, weight changes and pain at the site of implantation. These were not influenced by age, body weight, parity, duration of usage of the method, blood pressure patterns and previous use of contraception (P > 0.05). We have not encountered any method failure in the last 30 months. The study concludes that Norplant is safe, effective, acceptable, and reversible long-term birth control method which can be used in our setting in parallel with other available options.

Adolescent↗
PubMed1999

An evaluation of worker lead exposures and cleaning effectiveness during removal of deteriorated lead-based paint.

We evaluated worker lead exposures and cleaning effectiveness during initial cleanup of 19th-century buildings with highly deteriorated lead-based paint. Eighteen rooms of similar size and condition in two university-owned buildings were selected for a pilot project to compare three methods for removing loose paint, paint chips, and dust. The methods used were: dry scraping followed by dry sweeping (no engineering or work practice controls); wet scraping and high-efficiency particulate air (HEPA) vacuuming; and the latter method with the addition of a portable HEPA-filtered exhaust fan in the room providing about 40 air changes per hour. The final step for all methods was wet-mopping once with tri-sodium phosphate solution. During a single day 18 rooms were cleaned; each of three two-person work crews cleaned six rooms, two with each method. Air and surface samples were collected before, during, and after cleaning. All of the methods were potentially hazardous to workers: 44 percent of the method-based exposures (range: 5.0-360 micrograms/m3) and one of five full-shift exposures exceeded the OSHA PEL (range 9.4-110 micrograms/m3). Lowest worker exposures were during the wet scraping and vacuuming method (mean: 24 micrograms/m3). Providing general ventilation in rooms did not reduce worker exposures and appeared to increase them (mean: 73 micrograms/m3). Overall, the mean floor surface lead levels were reduced 50 percent after cleaning (from 2,600 to 1,300 micrograms/ft2), but the effectiveness of the three methods in reducing floor lead levels did not differ significantly. Overall, the method, mean paint lead concentration, pre-cleaning surface lead concentration, and work crew were significantly associated with the mean worker exposures during cleaning (p = 0.023), but not with the post-cleaning surface lead concentrations (p = 0.13).

Air Pollutants↗
PubMed2003

An evaluation of the Swedish ignition interlock program.

The Swedish alcohol ignition interlock program for driving while intoxicated (DWI) offenders, both first-time as well as multiple offenders, was launched as a pilot project in 1999. It is a volunteer program and differs in some respects from other programs: It covers a period of 2 years, it includes very strict medical regulations entailing regular checkups by a physician, it does not require a prior period of hard suspension, and it focuses strongly on changes in alcohol habits. Records from the 5 years prior to the offence showed that DWI offenders are generally in a high-risk category long before their offense, with a four to five times higher accident rate (road accidents reported by the police) and a three to four times higher rate of hospitalization due to a road accident. Only 12% of the eligible DWI offenders took part in the program and, of these, 60% could be diagnosed as alcohol dependent or alcohol abusers. During the program, alcohol consumption is monitored through self-esteem questionnaires (AUDIT) and five different biological markers. Our data show a noticeable reduction in alcohol consumption among the interlock users. This, combined with the high rate of compliance with the regulations, probably accounts for the fact that there was no case of recidivism during the program. Preliminary findings also suggest a reduction in the annual accident rate for interlock users while in the program. It still is too early to draw any conclusions concerning the rate of recidivism after completion of the program due to an insufficient amount of data for analysis. Nevertheless, the preliminary results are so promising that the program will now be expanded to cover all of Sweden as well as to include all driver's license categories.

Accidents, Traffic↗