Working with adult clients who may have experienced childhood abuse: Recommendations for assessment and practice.

The delayed memory debate has generated many questions about therapeutic practices that are likely to be beneficial and detrimental to clients. This article proposes components of optimal practice for working with adult clients who may have been abused as children. The recommendations are organized around the following themes: (a) competence, (b) assessment and treatment planning, (c) psychotherapy process and technique, (d) memory issues, (e) and ethics. The authors emphasize the importance of a collaborative therapeutic relationship and urge clinicians to proceed cautiously when encountering treatment issues for which scientific knowledge and consensus are still evolving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational pathology: present and future

Formed 75 years ago, occupational pathology has defined structure of occupational morbidity, determined principles of occupational diseases' pathogenesis and pathomorphosis, demonstrated dependence of occupational entities on acting occupational hazards, described clinical manifestations of occupational diseases, emphasized informative diagnostic complexes. Diagnosis in occupational pathology now is established on basis of etiology. Manifold activities helped to form a system preventing health disorders caused by occupational hazards. Topical problem is to elaborate and put into practice some criteria for compensation of occupational damage with differential expert assessment of functional disorders caused either by occupational disease or by general one. Prospective trend could be to create a system organizing and managing workers' health on workplace and to put "protection by time" principle into practice with forecasting risk of occupational diseases and dose-effect dependence. Another prospect is to elaborate and put into practice a training in social and psychologic adaptation for occupational managers and industrial workers.     

Safety in the clinical laboratory

There are many hazards in the clinical laboratory that could result in injury, illness, or loss of property. Many of these hazards are common to the home and a wide variety of working environments; others are unique toi the laboratory. Since control and prevention of occupational illness and injury depends on recognizing their causes and taking timely and appropriate corrective action, this article presents a basic program for protecting the health and safety of clinical laboratorians. It consists of three parts: hazard identification, control measures, and accountability.     

Pathomorphology of lungs and heart in experimental prolonged hypoxia

The need for an effective control of cardiovascular diseases is evident. Possibilities to achieve this both in the curative and the preventive field are restricted mainly due to the insufficient knowledge of their etiopathogenesis. Although the cause is not known, the discovery to risk factors provides a sound evidence for prevention. Attempts to reverse elevated risk factor levels are all directed towards a more healthy way of life. Group oriented prevention is one of the most frequently applied approaches to test the hypothesis of preventability. While it offers many advantages, the delayed timing of the intervention and the restricted coverage limits the possibility of inference from its results. The community approach implies acting on the whole population by changing their behaviour towards a more healthy way of life. Apart from the beneficial "side effects" on other chronic diseases, their outcome in the pilot areas may be inferred to the total population. The final proof of any scientific evidence from the public health point of view is, after all, its applicability and effectiveness in real life situation.     

Health status of the Russian population and current problems in occupational medicine and industrial ecology

Major goal of occupational medicine--better health of employees--could be reached through integrated theoretical and practical approaches to the issues assigned to different scientific spheres. The article suggests some principles of new direction in prophylactic medicine. Those principles form a theoretical basis for occupational medicine and industrial ecology: being also a powerful instrument for evaluation and management of occupational and ecologic risk. The authors define group and individual risk, base a concept of residual risk and necessitate further improvement of protecting measures to restrict individual risk for every employee.     

The spectrum of respiratory disease associated with exposure to metal working fluids

Occupational respiratory diseases have been reported following exposure to metal working fluids. We report a spectrum of respiratory illnesses occurring in an outbreak in 30 workers of an automobile parts engine manufacturing plant. Workers presented with respiratory complaints and, after clinical and laboratory evaluations, were classified as those having hypersensitivity pneumonitis, occupational asthma, or industrial bronchitis, or those without occupational lung disease. Hypersensitivity pneumonitis affected seven workers, with six exhibiting serum precipitins to Acinetobacter Iwoffii. Occupational asthma and industrial bronchitis affected 12 and six workers, respectively. Oil-mist exposures were below current recommendations. Gram-negative bacteria, but no fungi, Thermophiles, or Legionella, were identified. Although specific agents responsible for each individual case could not be identified, probably both specific sensitizing agents and non-specific irritants from metal working fluids, additives, or contaminants contributed to this spectrum of occupational respiratory illness.     

Peer discussions of cancer among Hispanic migrant farm workers

Hispanic migrant agricultural workers' exposure to pesticides and other agrichemicals places them at increased risk for a variety of acute and chronic conditions, including cancer. As a socioeconomically disadvantaged group, migrant workers also face many barriers to effective cancer control. In 1992, a series of focus groups was held with 55 Hispanic migrant agricultural workers (22 women, 33 men) in central Wisconsin to gather information on their knowledge and attitudes regarding cancer etiology and treatment, their practices regarding cancer screening and early detection, and their concerns regarding occupational exposure to pesticides. Beliefs that pesticides are toxic and can cause health problems were common among participants. In addition, however, participants reported that they are reluctant to demand occupational protections to which they are entitled because they are afraid of losing their jobs. Study results also suggest that barriers to effective primary and secondary prevention of cancer in this Hispanic migrant agricultural worker population include knowledge and information barriers, cultural barriers, and socioeconomic barriers. A lack of knowledge and information regarding the causes of cancer, its prevention, and its early detection and treatment was evident among participants, which in turn was reflected in strong fatalistic attitudes toward the disease. Cultural barriers included attitudes of embarrassment and shame associated with physical examinations and women's strong discomfort with male clinicians. Socioeconomic barriers to secondary prevention included the cost of obtaining health services, time constraints associated with the need to work and long working days, and a lack of transportation. Efforts to improve cancer screening as well as other preventive health services in the Hispanic migrant agricultural worker population must acknowledge these barriers and address as many of them as possible to be successful.     

A proposed classification of veterinary epidemiosurveillance networks

With the signing of the General Agreement on Tariffs and Trade and the establishment of the World Trade Organisation, the trading environment for animal products has changed. Disease control measures can no longer be applied as trade barriers unless supported by scientific epidemiological data. In this context, it has become necessary, if not obligatory, to gain accurate and up-to-date knowledge about the epidemiological status of important infectious animal diseases. The role of veterinary epidemiosurveillance networks is therefore gaining importance. Furthermore, epidemiosurveillance contributes to the protection of animal populations from exotic or emerging diseases, as well as to the development and evaluation of disease control programmes. Despite the large diversity of surveillance networks, the authors propose a method of network classification. The criteria for classification are as follows: the type of disease being monitored (i.e., surveillance of exotic versus endemic diseases). The number of diseases concerned (i.e., focused networks versus broad-based networks). The area being covered (i.e., local, national or international networks). The population being monitored (i.e., whether the network is targeted at suspect or susceptible animals). The sampling strategy of the network (i.e., sample-based networks versus exhaustive networks). The method of collecting data (i.e., passive data collection versus active collection). The type of network management (i.e., autonomous management versus that which is integrated with other programmes). This classification is discussed and illustrated by examples published in the literature. It may aid in the future development of a grid for the evaluation of veterinary epidemiosurveillance networks.     

Word knowledge and working memory as predictors of reading skill.

Three measures of working memory capacity and three measures of word knowledge were used as predictors of three different measures of reading skill. The results demonstrated that the size of a reader's vocabulary and the speed of accessing it are independent of a "depth" measure of word knowledge and that reading comprehension, reading speed, and text inferencing ability are all independent measures of reading skill. A series of regression analyses were conducted to derive a causal model of the three reading performance measures. The results indicated that working memory efficiency during reading was related to comprehension, whereas a more passive working memory capacity measure was related to reading speed. Moreover, text inferencing ability was related only to word knowledge. We conclude that concepts such as "reading skill," "working memory," and "word knowledge" are multidimensional constructs that cannot be captured by a single variable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute adrenal insufficiency: a new presentation of Castleman''s disease

On the 19-21 September 1994 an international meeting of experts was convened at the World Health Organization office in Geneva. The result of this meeting was the formation of the PACE working group. PACE stands for "Prevention And Control Exchange". It is programme designed to stimulate the sharing of solutions and control measures in order to reduce occupational hazards. Internationally there is wide agreement on the need for sharing of knowledge and a realisation that a collaborate effort is required.     

Occupational disease profile in Taiwan, Republic of China

Lack of knowledge of the exact contents of the materials and improper handling of the toxic chemicals lead to the occurrence of occupational illnesses in the developing countries. However, the incidence of occupational diseases was usually underestimated. This article presents the profile of occupational diseases in Taiwan from two sources, i.e. occupational disease benefit payments of labor insurance and the review of relevant literature. The primarily documented occupational diseases in Taiwan were pneumoconioses. The second most common occupational disease was carbon monoxide intoxication, followed by lead poisoning and noise-induced hearing loss. Less than five percent of occupational diseases were due to the other causes, including decompression syndrome, heat stroke, toxic hepatitis, neurological disorders and hematologic disorders. The number of occupational diseases recognized in Taiwan was considered to be seriously underestimated due to the shortage of occupational medical specialists. Priority in the development of occupational medicine in Taiwan is to educate industrial hygienists and physicians to recognize health hazards in the work environment and to diagnose occupational diseases. Recognition of occupational diseases could subsequently highlight the health hazards in the workplace and prevent workers from overexposure.     

Secondary prevention of excessive alcohol use: assessing the prospects of implementation

BACKGROUND: Alcohol risk and harm reduction is a public health approach that goes beyond specialized treatments for alcoholism. The greatest potential for reducing alcohol risk and harm in a population depends on the extent to which health care practitioners use secondary prevention programmes. OBJECTIVE: We aim to assess the factors that affect the prospects of disseminating comprehensive, secondary prevention programmes into mainstream practice. METHOD: A decision balance was used to assess the prospects of practitioners implementing comprehensive programmes systematically. The stages-of-change model provides perspectives about behaviour change with regard to patients, practitioners and practice settings. RESULTS AND CONCLUSIONS: Programme implementation is extremely unlikely given the current organization of health care settings. To maintain the use of such programmes, we need to change the "unit of leverage" in the system: from the clinical encounter--that is, practitioners working with individual patients in a case-finding manner--to an organizational level--that is, the appropriate use of managerial and information systems supporting health care settings to identify at-risk patients systematically as they enter primary care and hospital settings. With appropriate infrastructure support, practitioners will be able to fulfil the potential for as well as maintain the use of comprehensive, secondary prevention programmes to reduce alcohol risk and harm in the population.     

AIDS control and the workplace: the role of occupational health services in South Africa

AIDS interventions typically fail to address the disjuncture between private behaviors and the social determinants of HIV infection. Data from a telephone survey of manufacturing companies and a postal survey of occupational health nurses in the Western Cape, South Africa, were used to explore the possible role of occupational health services in prevention and control of AIDS. The author found limited evidence of worker involvement in AIDS programs, particularly in companies with occupational health professionals. The management of sexually transmitted diseases was incomplete. Mandatory pre-employment testing of workers for HIV was not widespread. Respondents' opinions on priorities for AIDS prevention and control reflected a preoccupation with knowledge transfer. To ensure their effectiveness, workplace AIDS programs must improve worker participation and integrate AIDS prevention in general workplace health and safety programs. In addition, education programs must develop objectives within a critical theoretical understanding of the behavioral issues relevant to AIDS prevention, and must emphasize the empowerment of women in the workplace. In the context of the present restructuring of health services in South Africa, occupational health services, using the strategies outlined, can make a major contribution to national AIDS prevention and control.     

Preparing for the "silver age of dentistry"

Providing oral health care to older adults will be a challenging and rewarding part of dental practice in the years ahead. It will include understanding normal aging, appreciation of the pathophysiology of chronic diseases experienced by many elderly, and application of key principles of pharmacology in care of patients receiving medications for treatment of these diseases. It will involve an understanding of the interaction of systemic conditions with oral health status, adequate diagnosis of oral disease, and appropriate rational treatment planning with a strong emphasis on preventive dentistry. It will include care provided in nursing homes or during housecalls for the homebound. Dentist-geriatricians will be working with teams of healthcare professionals that include physicians, dentists, podiatrists, ophthalmologists, nurses, social workers, nutritionists, pharmacists, and occupational and physical therapists. Above all, the team will provide skilled compassionate care, which is always good business!     

Clients'' health needs: nurses'' concern

The mucopolysaccharidoses (MPS) are rare inborn errors of metabolism. They are caused by defects in enzymes which are necessary for the degradation of mucopolysaccharides. An effective causal treatment is not available as yet. Nevertheless, it is the duty of the doctor, both from the medical and human aspect to assist MPS patients and their families physically and psychologically over many years. This task needs much empathy, working morale and knowledge of these diseases on the part of the medical adviser involved, but also demonstrates the limitations of active medical treatment. Since 10 years the "Austrian Society for Mucopolysaccharidoses" has tried to fill the gap between the MPS families' need for help and the still discouraging current medical treatment prospectives.     

Revising sanitary norms of microclimate in industrial accommodations]

The article outlines new edition of a project "Sanitary norms of microclimate in industrial compartments". Up-to-date scientific data, results of studies concerning human heat state in experimental and industrial conditions, evaluation of the workers' health state helped to modify optimal and allowable parameters of microclimate, to rectify requirements for measurement conditions and measuring devices. When the recommended temperature could not be maintained, the duration of work in such conditions should be limited for prevention of overheating and overcooling. To examine prophylactic measures against overheating, the authors suggested an integral characteristic of heating environmental load (TNS-index) and set its safe values.     

GTP cyclohydrolase deficiency; intrafamilial variation in clinical phenotype, including levodopa responsiveness

Traditional Chinese drugs (TCDs) have played a key role for Chinese people in the treatment of diseases since ancient times. The use of TCDs has generated a great amount of information in the past thousand years about the relationship between natural products and the human body. However, up to now, our understanding on the mode of action of the TCD is still limited. Considering that the basic mechanism of all drug function involves the interaction between the drug and biological receptors at the molecular level, we propose to connect TCDs with modern medicine theory through molecular structures. We propose to explain functions of TCDs by using the knowledge developed in modern molecular biology, pharmacology, computer chemistry, and biochemistry. We are working on a computer-aided Chinese drug study that is discussed in this paper. A short introduction on the progress of our research is also given.     

When Science Isn't Enough: Wilhelm Hueper, Robert A. M. Case, and the Limits of Scientific Evidence in Preventing Occupational Bladder Cancer

A recent outbreak of occupational bladder cancer in a Buffalo, New York, factory confirmed the carcinogenicity of ortho-toluidine, an aromatic amine that had first been implicated in human bladder cancer cases decades earlier. Events leading to this outbreak replicated the history of numerous earlier bladder cancer outbreaks among workers exposed to beta-naphthylamine and benzidine, two other aromatic amines that were widely used in the dye and rubber industries and that have been responsible for bladder cancer outbreaks in the United States, Germany, Switzerland, England, France, Italy, Austria, Czechoslovakia, the former Soviet Union, Poland, and China. The historic development of scientific knowledge of occupational bladder cancer prefigured many debates that later occurred around other environmental carcinogens; two of the giants of occupational medicine, Wilhelm Hueper and Robert A. M. Case, played seminal roles in the study of these chemicals. Examination of the history of worker exposure to aromatic amines and the subsequent development of bladder cancer at Du Pont, Allied Chemical, and other U.S. manufacturers demonstrates that these carcinogens were regulated only after cancer epidemics were recognized. Production and use of aromatic amines continues in developing countries; these nations will inevitably experience similar outbreaks unless steps are taken to eliminate exposure to these deadly chemicals. This paper chronicles the history of occupational bladder cancer in the United States, highlighting the roles of Hueper and Case in occupational cancer investigation and prevention.     

Epidemiologic aspects of respiratory aging: contribution of the PAQUID survey

BACKGROUND: Respiratory ageing raises for the epidemiologists many questions still unsolved by clinical and physiological approaches: prevalence of chronic respiratory diseases, consequences on autonomy, risk factors. This paper aims to provide some responses based on a wide sample of elderly people: the PAQUID cohort. METHOD: PAQUID is a cohort of 3777 dwellers representative of the population aged 65 and over in two administrative areas of south-western France. The study is based on general variables as well as specific variables identifying dyspnea, asthma, chronic bronchitis and their risk factors. Disability was measured using specific scales. Mortality is registered during the follow-up. RESULTS: Twenty-five percent of subjects had a dyspnea for minor efforts (level 3 and over). There was a significant relationship between dyspnea and disability levels for basic and instrumental activities of daily living. Mortality rate was significantly associated to dyspnea level of the subjects at inclusion in the cohort, especially in men, even taking into account other mortality related risk factors (sex, smoking, occupation). 6.1% of the subjects reported symptoms of asthma. But only 2.5% reported symptoms in the twelve last months. The follow-up has shown new asthma cases among symptom-free subjects at the beginning of the survey. Previous occupation especially agricultural (pesticides exposition), and industrial activity, smoking and allergy may be considered as the main respiratory risk factors. CONCLUSION: These data provide more knowledge of some aspects of respiratory ageing. The results allowed to evaluate associated morbidity, to determine risk factors and to measure its impact on disability and mortality. Such information may be useful for prevention of respiratory related disability.     

Recommended distributions for exposure factors frequently used in health risk assessment

Although there has been nearly complete agreement in the scientific community that Monte Carlo techniques represent a significant improvement in the exposure assessment process, virtually all state and federal risk assessments still rely on the traditional point estimate approach. One of the rate-determining steps to a timely implementation of Monte Carlo techniques to regulatory decision making is the development of "standard" data distributions that are considered applicable to any setting. For many exposure variables, there is no need to wait any longer to adopt Monte Carlo techniques into regulatory policy since there is a wealth of data from which a robust distribution can be developed and ample evidence to indicate that the variable is not significantly influenced by site-specific conditions. In this paper, we propose several distributions that can be considered standard and customary for most settings. Age-specific distributions for soil ingestion rates, inhalation rates, body weights, skin surface area, tapwater and fish consumption, residential occupancy and occupational tenure, and soil-on-skin adherence were developed. For each distribution offered in this paper, we discuss the adequacy of the database, derivation of the distribution, and applicability of the distribution to various settings and conditions.