What practicing dentists should know about EPSDT. Early and Periodic, Screening, Diagnosis and Treatment

Dr. Al-Tannir was formerly working as a student intern in the West Virginia Bureau of Public Health Division of Dental Health. He is currently the Dental Public Health Resident for the Department of Veterans Affairs, VA Medical Center, Perry Point, Maryland and Clinical Instructor at the University of Maryland at Baltimore Dental School, Department of Oral Health Care Delivery. The purpose of this paper is to provide practicing dentists in West Virginia with an overview, understanding and appraisal of the Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT) dental program. EPSDT is one of the least understood and least publicized programs in the Department of Health and Human Resources and is the children's preventive health component of Medicaid. West Virginia can meet the oral health needs for its children by making dental services, both curative and preventive, more available through the EPSDT program. This program can be a principal means, if sufficiently utilized, of meeting the oral health care needs of West Virginia Children by minimizing financial and attitudinal barriers.     

Center for Excellence in Construction Safety

The National Institute for Occupational Safety and Health (NIOSH) has funded the establishment of a Center for Excellence in Construction Safety at West Virginia University. The overall objectives of the Center include: (1) The promotion of hazard control components in engineering curricula; (2) the promotion of hazard awareness and safety‐related knowledge and skills specific to the construction industry; and (3) the promotion of the consideration of safety issues during project design for the purpose of reducing injury during construction. Specific tasks to be accomplished by the Center include: (1) The development of course materials and instruction on construction safety for civil engineering students at the undergraduate and graduate levels; (2) the promotion of such course materials for adoption by other civil engineering academic institutions; (3) the design and conduct of projects related to the improvement of current construction practices that would develop design parameters to reduce trauma during the construction phase; and (4) the establishment of techniques for the collection and dissemination of construction safety information, educational materials, developed guidelines, and design criteria to engineers, architects, contractors, and trade unions.     

Acute otitis. Etiology, diagnosis, treatment

Glutaraldehyde is an antibacterial and antiviral agent commonly used for cleaning and disinfection of endoscopic equipment. The accepted glutaraldehyde air-concentration is 0.2 ppm. The irritant action, allergic potential and possible neurotoxicity of glutaral have been reported. Red eyes, cough, headache and running nose are most frequent symptoms of glutaral activity. The incidence of bronchial asthma and contact dermatitis has also been reported. In order to avoid occupational hazards of glutaraldehyde closed washing-disinfection systems, proper ventilation (20 cycles per hour), vapour recovery safety nozzle and neutralizing agent should be used.     

Ecosystem health as a clinical rotation for senior students in Canadian veterinary schools

A research nurse interviewed 55 practice staff in 11 general practices to ascertain their views about their needs for occupational health care. In a second parallel study, a specialist in occupational medicine undertook an in-depth audit of occupational health provision in five other general practices with respect to the organization, the health and safety process, the services and the working environment. In the first study, the majority of practice staff reported the need for various aspects of occupational health care, particularly stress at work. In the second study, general practitioners and practice managers possessed a basic awareness of occupational health matters such as Health and Safety legislation, but their limited knowledge was not translated into effective management. General practice staff did not know where to obtain occupational health advice; most practices had no policies or procedures in place to manage health and safety. Both studies illustrate the need for expert occupational health advice in primary care.     

Lymphoma, myeloma and occupation: results of a case-control study

The known risk factors for lymphoma and myeloma cannot account for the current incidence rates of these cancers, and there is increasing interest in exploring occupational causes. We present results regarding lymphoma and myeloma from a large case-control study of hundreds of occupational exposures and 19 cancer sites. We examine in more detail those exposures previously considered to be related to these cancers, as well as exposures which were strongly related in our initial analyses. Lymphoma was not associated in our data with exposure to solvents or pesticides, or employment in agriculture or wood-related occupations, although numbers of exposed cases were sometimes small. Hodgkin's lymphoma was associated with exposure to fabric dust, and non-Hodgkin's lymphoma was associated with exposure to copper dust, ammonia and a number of fabric and textile-related occupations and exposures. Employment as a sheet metal worker was associated with development of myeloma.     

Organizational injury rate underreporting: The moderating effect of organizational safety climate.

The goals of this study were (a) to assess the extent to which construction industry workplace injuries and illness are underreported, and (b) to determine whether safety climate predicts the extent of such underreporting. Data from 1,390 employees of 38 companies contracted to work at a large construction site in the northwestern United States were collected to assess the safety climate of the companies. Data from the Occupational Safety and Health Administration (OSHA) logs kept by the contractors allowed for calculation of each company's OSHA recordable injury rate (i.e., the reported injury rate), whereas medical claims data from an Owner-Controlled Insurance Program provided the actual experienced rate of injuries for those same companies. While the annual injury rate reported to OSHA was 3.11 injuries per 100 workers, the rate of eligible injuries that were not reported to OSHA was 10.90 injuries per 100 employees. Further, organizations with a poor safety climate had significantly higher rates of underreporting (81% of eligible injuries unreported) compared with organizations with a positive safety climate (47% of eligible injuries unreported). Implications for organizations and the accuracy of the Bureau of Labor Statistics's national occupational injury and illness surveillance system are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postexposure prophylaxis after nonoccupational HIV exposure: clinical, ethical, and policy considerations

In the wake of recent breakthroughs in antiviral therapies and Centers for Disease Control and Prevention (CDC) recommendations advocating occupational postexposure prophylaxis (PEP), health care workers are increasingly receiving inquiries about PEP following exposures to the human immunodeficiency virus (HIV) through sex and injection drug use. The probability of HIV transmission by certain sexual or injection drug exposures is of the same order of magnitude as percutaneous occupational exposures for which the CDC recommends PEP. In such cases, if the exposure is sporadic, it seems appropriate to extrapolate from the data on occupational PEP and recommend prophylaxis. However, for individuals with continuing or low-risk exposures, we instead recommend referrals to state-of-the-art risk reduction programs. Clinicians, using local HIV seroprevalence data and their knowledge of transmission probabilities, can help exposed patients make an informed decision regarding PEP. Because of the large number of risky encounters that will not be treated prophylactically, even after significant outreach efforts, public health interventions that emphasize PEP as part of a comprehensive HIV prevention program should be confined to cities with highest HIV prevalences.     

Characteristics of West Virginians having myocardial infarction

BACKGROUND: Prevalence of risk factors in patients having myocardial infarction (MI) have been reported in large US and international studies, but little is known about the prevalence of risk factors in West Virginians having MI. METHODS: Risk factors for MI were identified by ICD-9 codes. Logistic regression analysis was used to compute odds ratios and 95% confidence intervals. RESULTS: In this cohort (n = 727), 72% of men less than 65 years old were current smokers. Women were older and had a lower frequency of smoking and a higher frequency of diabetes mellitus and obesity than men. Women less than 65 years old had significantly more hypertension than men. CONCLUSIONS: In West Virginia, women who have MI are more likely to be nonsmoking diabetics with hypertension.     

Should infection control practitioners do follow-up of staff exposures to patient blood and body fluids?

BACKGROUND: The purpose of this study was to determine the efficiency of a joint infection control/occupational health program for the follow-up of accidental blood or bloody body fluid exposures in health care workers. METHODS: A comprehensive staff follow-up program for all blood exposures with known patient sources was initiated in 1989, consisting of patient follow-up by the Infection Control Department (risk assessment for hepatitis B virus [HBV] and [HIV] infection and obtaining of consent for HIV testing) and staff follow-up by the Occupational Health Department. In 1992 a mailed survey was conducted to examine exposure follow-up policies and responsibilities in large teaching hospitals across Canada. RESULTS: A total of 924 blood exposures with known patient sources were reported between January 1989 and December 1993. HIV and HBV screening was obtained for 67.9% and 87.6% of patients assessed as at low risk and 82.3% and 92.2% of those assessed as at high risk for infection, respectively. Two previously unknown HIV-seropositive patients were identified, one of whom had been classified as at low risk (one of 530 [0.19%] patients at low risk who underwent screening). Primary reasons for screening being missed were patient discharge (46.3%) or communication problems (18.0%). The requirement for informed written consent before HIV screening accounted for the difference in completed HIV and HBV screens. Results of the hospital survey indicated that 40.8% of Canadian hospitals follow up all patients who are involved in blood exposures; however, most hospitals still rely on the physician to obtain consent (87.6%). CONCLUSIONS: Use of ICPs to screen patients involved in staff blood exposures during regular hours may be the most efficient method of follow-up, particularly if supplemented by a backup team of health professionals on nights and weekends. Although screening all patients for HBV/HIV may detect patients with undisclosed high-risk behaviors, institutions must decide whether the practice is cost-effective in areas of low prevalence.     

Renal failure in two patients with Wolfram syndrome

BACKGROUND/OBJECTIVE: Aluminium is produced from the mineral bauxite. Occupational exposure is reported during the industrial processing of aluminium and is associated with pulmonary and neurotoxicity. However, data on exposure and toxicity of workers in the open bauxite mining industry do not exist. Therefore, a study was performed to explore aluminium exposure in employees involved in this bauxite mining process in a Surinam mine. METHODS/DESIGN: A group of workers occupationally exposed to aluminium in an open bauxite mine were compared with a group of nonexposed wood processors. Serum aluminium was analyzed using atomic absorption spectrometry Data from the clinical chemistry of the blood and a questionnaire were used to explore determinants for aluminium exposure. RESULTS: No significant difference between serum aluminium in the exposed (4.4 +/- 2.0 micrograms/L, n = 27) and control group (5.1 +/- 1.5 micrograms/L, n = 27) was detected. For the serum concentration of the clinical chemical variables (calcium, citrate, and creatinine), a statistically significant difference was computed (p < or = 0.02) between the exposed and control group. All levels were slightly higher in the exposed group; no statistically significant correlations with serum aluminium were found. CONCLUSIONS: In this study, serum aluminium values were in the normal range, no significant difference between the groups could be detected despite long-term occupational exposure.     

Relations among occupational hazards, attitudes, and safety performance.

This study examined psychological empowerment and organizational identification as outcomes of occupational context and predictors of occupational safety performance. In this study, 171 hospital employees from 17 units and 21 occupations completed surveys measuring psychological empowerment, organizational identification, and supervisor safety practices. They also completed measures of 2 dimensions of safety performance: use of personal protective equipment and safety participation. These data were merged with Occupational Information Network (O*NET) context ratings of occupational hazards and physical demands. Results indicated that occupational hazards were negatively related to individual-level psychological empowerment and organizational identification, which were in turn positively related to safety participation. Psychological empowerment and organizational identification also interacted with perceptions of supervisor safety actions in the prediction of personal protective equipment use. Results have implications for organizational safety performance and point to the role of occupational context in psychological empowerment and the extent to which employees participate in the safety of their worksite. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

浅析露天矿山开采爆破与安全

在我国科技和经济高速发展的推动下我国矿山开采行业得到了快速的发展,采矿行业与其他普通行业相比,具有危险性较大、工作强度高、作业环境恶劣等特点。露天矿山开采工艺具有一定的复杂性和繁琐性,如果没有充分做好相关的安全保护工作那么极可能造成伤亡事故的发生。为了能够有效保证露天矿山开采爆破效率和安全性,那一定要掌握露天采矿必备爆破技术,对露天采矿危险因素进行全面的研究和分析,对爆破技术进行不断的优化和完善,进而保证露天矿山开采活动高效率安全进行。     

职业健康心理学(OHP)在采矿行业中的应用探讨

通过分析采矿行业矿工的工作压力、工作倦怠和工作家庭冲突,个人、企业和社会环境之间的关系等方面的内容,提出职业健康心理学在采矿行业中应用的重要性,从职业健康心理学的角度在不同方面谈谈如何解决当前采矿行业矿工心理不健康的现象,以达到矿工拥有正确的职业健康心理,从而促进个体和企业的健康发展。     

Effectiveness and patient satisfaction with screening flexible sigmoidoscopy performed by registered nurses

CONTEXT: In December 1995, reported Salmonella enterica serotype Newport (SN) infections increased sharply in Oregon and British Columbia but not elsewhere in North America. Similar unexplained increases had been noted in 6 other states in the fall of 1995. OBJECTIVE: To determine the source of the outbreak(s). DESIGN: Case-control studies, environmental investigations, bacterial subtyping, and surveillance information review. SETTINGS: Oregon and British Columbia communities (winter 1995-1996) and Georgia, Oklahoma, Pennsylvania, Vermont, Virginia, and West Virginia (fall 1995). PARTICIPANTS: Oregon and British Columbia residents with culture-confirmed SN infections and onset from December 1, 1995, through February 29, 1996, and healthy community controls. MAIN OUTCOME MEASURES: Odds ratio (OR) of illness associated with exposures; distribution patterns and culture of alfalfa seeds and sprouts; subtyping of SN isolates. RESULTS: We identified 133 cases in Oregon and British Columbia; 124 (93%) occurred in patients older than 18 years; 87 (65%) were female. Case patients were more likely than community control subjects to report having eaten alfalfa sprouts in the 5 days preceding illness (41% [17/41] vs 4% [3/75]; OR, 17.0; 95% confidence interval, 4.3-96.0). Case isolates shared a distinctive pulsed-field gel electrophoresis (PFGE) pattern. The SN was grown from seeds and alfalfa sprouts. The distribution of 1 seed lot to multiple growers corresponded to the distribution of cases. Distribution of a second seed lot from the same European wholesaler corresponded to the location of the fall outbreak, which was characterized by a similar demographic profile. The PFGE pattern of fall outbreak isolates and confiscated sprouts and seeds was indistinguishable from the Oregon and British Columbia outbreak and differed from background isolates. CONCLUSIONS: The SN-contaminated alfalfa seeds were distributed to multiple growers across North America in 1995 and resulted in a protracted international outbreak scattered over many months. Current sprouting methods are inadequate to protect consumers from such events. Alfalfa sprouts may be an elusive but important vehicle for salmonellosis and other enteric infections.     

Occupational risk perception, safety training, and injury prevention: Testing a model in the Italian printing industry.

This study examined occupational risk perception in relation to safety training and injuries. In a printing industry, 350 workers from 6 departments completed a survey. Data analysis showed significant differences in risk perceptions among departments. Differences in risk perception reflected the type of work and the injury incidents in the departments. A structural equation analysis confirmed a model of risk perception on the basis of employees' evaluation of the prevalence and lethalness of hazards as well as the control over hazards they gain from training. The number of injuries sustained was positively related to the perception of risk exposure and negatively related to evaluations about the safety training. The results highlight the importance of training interventions in increasing workers' adoption of safety procedures and prevention of injuries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Murine strain differences in the volume effect and incidence of radiation-induced colorectal obstruction

We have previously reported high levels of the coagulation inhibitor TFPI in the blood of patients with gastrointestinal cancer. TFPI is not an acute-phase reactant, but high levels have also been reported in patients with septicaemia and disseminated intravascular coagulation (DIC). To study its relationship with other types of malignancy, TFPI activity was first determined in plasma samples from 214 patients with various malignancies. In a second cohort of 83 patients, total and free TFPI antigen, protein C, antithrombin, fibrin monomer and D-dimer were also measured. Elevated TFPI activity and antigens were found in about half of the patients with solid tumours. In contrast, elevated TFPI was rare in haematological malignancies (12%). In the 18 patients with acute nonlymphocytic leukaemia (ANLL), elevated free TFPI was found only in patients who also had DIC. No correlation was found between TFPI levels and fibrin monomer or D-dimer levels. Only four out of 20 patients with solid tumours had normal levels of fibrin monomer and D-dimer, yet three out of these four had elevated TFPI. In conclusion, elevated TFPI in ANLL is related to the coexistence of DIC. In solid tumour disease increased TFPI may reduce protective fibrin formation, but the pathogenic mechanism is as yet unknown.     

Ethylene glycol ethers and risks of spontaneous abortion and subfertility

Potential reproductive effects from occupational exposures to ethylene glycol ethers (EGE) are of concern since these organic solvents have been used widely in industry, and their reproductive toxicity has been well documented in animal studies. For determination of whether occupational exposure to EGE was associated with increased risks of spontaneous abortion and subfertility (i.e., taking more than 1 year of unprotected intercourse to conceive), a retrospective cohort study was conducted among workers at two semiconductor manufacturing plants in the eastern United States in 1980-1989 as part of a larger evaluation of reproductive health. Reproductive and occupational histories were obtained from interviews of semiconductor manufacturing workers and spouses. Assessment of potential exposure to mixtures containing EGE (none, low, medium, and high) was based on reported processes and company records. There were 1,150 pregnancies to semiconductor manufacturers, 561 to female employees and 589 to wives of male employees. Among female manufacturers, potential exposure to mixtures containing EGE was associated with increased risks of spontaneous abortion (relative risk in the high exposure group = 2.8; 95% confidence interval (CI) 1.4-5.6) and subfertility (odds ratio in the high exposure group = 4.6; 95% CI 1.6-13.3). Both of these risks exhibited a dose-response relation with potential EGE exposure (p for trend = 0.02). Among spouses of male manufacturers potentially exposed to mixtures containing EGE, there was no increased risk of spontaneous abortion, but there was a nonsignificant increased risk of subfertility (odds ratio in the high exposure group = 1.7; 95% CI 0.7-4.3).     

Occupational exposure to HIV: considerations for postexposure prophylaxis and prevention

HIV seroconversion as a result of an occupational exposure is a terrifying concern of healthcare workers who deliver care to patients in a variety of health care settings. In this article the most recent CDC guidelines for the management of HIV exposure and postexposure prophylaxis are reviewed. Prevention of bloodborne pathogen exposures, specifically through the selection of safety devices, is recognized as an important issue.     

矿山事故应急管理现状及改进措施

近些年来矿山事故频发,给矿山工作人员及矿山产业带来了巨大的损失。在这一背景下,优化和完善矿山安全管理工作,提高应急救援管理水平,减少安全事故所带来的损失,预防安全事故的滋生,是目前矿山行业及矿山企业管理人员所需要认真思考的问题。