Effectiveness of Glutamine Oral Care in Reducing Oral Mucositis and Improving Oral Health After Neurosurgery: A Randomized Controlled Trial with Microbiome Analysis.

BACKGROUND Hospital-acquired infections negatively impact the health of inpatients and are highly costly to treat. Oral care reduces the microorganism number in the mouth and lungs and is essential in preventing postoperative oral inflammation, lung infection, and other complications. This study was designed to determine the effects of oral care with glutamine on oral health, oral flora, and incidence of pneumonia in patients after neurosurgery. MATERIAL AND METHODS This was a parallel, double-blind, randomized trial. Patients admitted to the Neurosurgery Department of the hospital from July to October 2021 were selected. Three hundred patients who met the inclusion criteria were randomized into 3 groups. The control group (n=100) received oral care with routine oral nursing methods with saline, whereas the experimental group (n=100) received oral care with 5% glutamine. A compound chlorhexidine group (n=100) was set as a positive control. All patients, care providers, and investigators were blinded to the group assignment. The incidence of local debris, oral mucositis, halitosis, dryness, oral mucositis disorders, and oral flora types were collected and analyzed in all groups. RESULTS The incidence of local debris, oral mucositis, halitosis, dryness, and other oral mucositis disorders in the glutamine oral care group was significantly decreased, compared with that of the control group. Oral flora types in the glutamine and chlorhexidine groups were significantly reduced. CONCLUSIONS Oral care with 5% glutamine after neurosurgery is associated with a lower incidence of oral disorders and pneumonia, and a significant reduction in oral flora.

Anti-Inflammatory Effects of Two-Week Sacral Nerve Stimulation Therapy in Patients With Ulcerative Colitis.

BACKGROUND AND AIMS: Sacral nerve stimulation (SNS) showed anti-inflammatory properties in animal models of inflammatory bowel disease. We aimed to evaluate the effectiveness and safety of SNS in patients with ulcerative colitis (UC). MATERIALS AND METHODS: Twenty-six patients with mild and moderate disease were randomized into two groups: SNS (delivered at S3 and S4 sacral foramina) and sham-SNS (delivered 8-10 mm away from sacral foramina), with the therapy applied once daily for one hour, for two weeks. We evaluated the Mayo score and several exploratory biomarkers, including C-reactive protein in the plasma, pro-inflammatory cytokines and norepinephrine in the serum, assessment of autonomic activity, and diversity and abundance of fecal microbiota species. RESULTS: After two weeks, 73% of the subjects in the SNS group achieved clinical response, compared with 27% in the sham-SNS group. Levels of C-reactive protein, pro-inflammatory cytokines in the serum, and autonomic activity were significantly improved toward a healthy profile in the SNS group but not in the sham-SNS group. Absolute abundance of fecal microbiota species and one of the metabolic pathways were changed in the SNS group but not in the sham-SNS group. Significant correlations were observed between pro-inflammatory cytokines and norepinephrine in the serum on the one side and fecal microbiota phyla on the other side. CONCLUSIONS: Patients with mild and moderate UC were responsive to a two-week SNS therapy. After performing further studies to evaluate its efficacy and safety, temporary SNS delivered through acupuncture needles may become a useful screening tool for identifying SNS therapy responders before considering long-term implantation of the implantable pulse generator and SNS leads for performing long-term SNS therapy.

EEG and ECG-Based Multi-Sensor Fusion Computing for Real-Time Fatigue Driving Recognition Based on Feedback Mechanism.

A variety of technologies that could enhance driving safety are being actively explored, with the aim of reducing traffic accidents by accurately recognizing the driver's state. In this field, three mainstream detection methods have been widely applied, namely visual monitoring, physiological indicator monitoring and vehicle behavior analysis. In order to achieve more accurate driver state recognition, we adopted a multi-sensor fusion approach. We monitored driver physiological signals, electroencephalogram (EEG) signals and electrocardiogram (ECG) signals to determine fatigue state, while an in-vehicle camera observed driver behavior and provided more information for driver state assessment. In addition, an outside camera was used to monitor vehicle position to determine whether there were any driving deviations due to distraction or fatigue. After a series of experimental validations, our research results showed that our multi-sensor approach exhibited good performance for driver state recognition. This study could provide a solid foundation and development direction for future in-depth driver state recognition research, which is expected to further improve road safety.

The Effect of Education Intervention on Osteoporotic Fracture and Bone Mineral Density in Elderly Women With Osteoporosis: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to assess whether a 5-year follow-up education intervention changed the risk for fragility fractures and increased bone mineral density (BMD) in elderly women with osteoporosis. METHODS: This randomized controlled trial included 104 women who were hospitalized or visited a specialist for osteoporosis care at Sichuan Translational Medicine Research Hospital in China from October 2013 to June 2014. The patients were randomly assigned to either an education intervention group (n = 52) or a control group (n = 52). The intervention was conducted by an endocrinologist who provided the intervention group with personized recommendations. All participants were followed for 5 years. RESULTS: Compared with the control group, the patients in the intervention group had a lower risk for fragility fracture, lower pain score, higher BMD at the greater trochanter of the femur, total hip and the first lumbar vertebra, together with higher compliance with anti-osteoporosis drug regimens and higher intake of vitamin D supplements (all P <.05). After adjustment for history of fracture, calcium consumption, age and body mass index (BMI), the association of change in BMD and pain score and the medication possession ratio (MPR) of anti-osteoporosis drugs were both significantly different (P < .05, P < .001, respectively). In subgroup analysis by past fractures, patients who experienced post-fractures were more likely to experience refracture (P < .05). CONCLUSIONS: The personalized education intervention by endocrinologists can significantly increase the BMD of the greater trochanter of the femur and reduce pain scores in elderly women with osteoporosis, suggesting that this education intervention may serve as an important addition to standard anti-osteoporosis treatment.

Tracking the Impact of COVID-19 and Lockdown Policies on Public Mental Health Using Social Media: Infoveillance Study.

BACKGROUND: The COVID-19 pandemic and its corresponding preventive and control measures have increased the mental burden on the public. Understanding and tracking changes in public mental status can facilitate optimizing public mental health intervention and control strategies. OBJECTIVE: This study aimed to build a social media-based pipeline that tracks public mental changes and use it to understand public mental health status regarding the pandemic. METHODS: This study used COVID-19-related tweets posted from February 2020 to April 2022. The tweets were downloaded using unique identifiers through the Twitter application programming interface. We created a lexicon of 4 mental health problems (depression, anxiety, insomnia, and addiction) to identify mental health-related tweets and developed a dictionary for identifying health care workers. We analyzed temporal and geographic distributions of public mental health status during the pandemic and further compared distributions among health care workers versus the general public, supplemented by topic modeling on their underlying foci. Finally, we used interrupted time series analysis to examine the statewide impact of a lockdown policy on public mental health in 12 states. RESULTS: We extracted 4,213,005 tweets related to mental health and COVID-19 from 2,316,817 users. Of these tweets, 2,161,357 (51.3%) were related to "depression," whereas 1,923,635 (45.66%), 225,205 (5.35%), and 150,006 (3.56%) were related to "anxiety," "insomnia," and "addiction," respectively. Compared to the general public, health care workers had higher risks of all 4 types of problems (all P<.001), and they were more concerned about clinical topics than everyday issues (eg, "students' pressure," "panic buying," and "fuel problems") than the general public. Finally, the lockdown policy had significant associations with public mental health in 4 out of the 12 states we studied, among which Pennsylvania showed a positive association, whereas Michigan, North Carolina, and Ohio showed the opposite (all P<.05). CONCLUSIONS: The impact of COVID-19 and the corresponding control measures on the public's mental status is dynamic and shows variability among different cohorts regarding disease types, occupations, and regional groups. Health agencies and policy makers should primarily focus on depression (reported by 51.3% of the tweets) and insomnia (which has had an ever-increasing trend since the beginning of the pandemic), especially among health care workers. Our pipeline timely tracks and analyzes public mental health changes, especially when primary studies and large-scale surveys are difficult to conduct.

The effects of video based nursing education on perioperative anxiety and depression in patients with gastric cancer.

The purpose of this study was to determine the effect of video-based nursing education on perioperative anxiety and depression. A total of 128 patients scheduled for minimally invasive gastrectomy were randomly divided into intervention (n = 64) and control (n = 64) group. The. The anxiety and depression scores, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were assessed before the intervention, 1 h before surgery and 24 h after surgery. And the cortisol levels were measured before the intervention and 1 h before surgery. No significant difference was observed in baseline anxiety score, depression score, vital signs and cortisol level (P > 0.05). The anxiety level, depression level, SBP, DBP and HR of patients in intervention group was significantly lower than that in control group at 1 h before surgery and 24 hs after surgery (P < 0.05). The serum cortisol in the intervention group was also significantly lower than that in the control group 1 h before surgery (p < 0.001). Video-based nursing education was effective in decreasing the perioperative anxiety and depression of patients undergoing minimally invasive gastrectomy. It could also keep vital signs and serum cortisol levels in normal limits.

Limited potential of harvest index improvement to reduce methane emissions from rice paddies.

Rice is a staple food for nearly half of the world's population, but rice paddies constitute a major source of anthropogenic CH4 emissions. Root exudates from growing rice plants are an important substrate for methane-producing microorganisms. Therefore, breeding efforts optimizing rice plant photosynthate allocation to grains, i.e., increasing harvest index (HI), are widely expected to reduce CH4 emissions with higher yield. Here we show, by combining a series of experiments, meta-analyses and an expert survey, that the potential of CH4 mitigation from rice paddies through HI improvement is in fact small. Whereas HI improvement reduced CH4 emissions under continuously flooded (CF) irrigation, it did not affect CH4 emissions in systems with intermittent irrigation (II). We estimate that future plant breeding efforts aimed at HI improvement to the theoretical maximum value will reduce CH4 emissions in CF systems by 4.4%. However, CF systems currently make up only a small fraction of the total rice growing area (i.e., 27% of the Chinese rice paddy area). Thus, to achieve substantial CH4 mitigation from rice agriculture, alternative plant breeding strategies may be needed, along with alternative management.

Long-Term Changes in Drug Craving and Nutritional Status of Opioid Addicts with Nucleus Accumbens Ablative Stereotactic Neurosurgery at Five Years Postoperatively.

BACKGROUND: The nucleus accumbens (NAcc) has been proven to be associated with drug and food craving. NAcc ablative neurosurgery has been suggested to modulate the balance of the brain reward system and thus alleviate drug dependence in patients. It has been hypothesized that it would also alleviate food craving in patients as well as altering their nutritional status. AIMS: This study aimed to estimate the effect of NAcc neurosurgery on drug craving and nutritional status in patients with drug dependence at 5 years postoperatively. METHODS: The study included 100 patients with NAcc surgery and 92 patients without surgery. Body mass index (BMI) and body fat percentage (BF%) were examined to assess nutritional status, and questionnaires were administered to assess drug craving. RESULTS: Compared with the nonsurgery group and the relapse patients from the surgery group, the nonrelapse patients from the surgery group had higher BMI and BF% but lower drug craving. There were no significant differences between the nonsurgery group and the relapse patients in BMI, but the relapse patients had higher drug craving than the nonsurgery group. CONCLUSIONS: Long-term follow-up suggested that NAcc ablative neurosurgery would alleviate drug craving and yield a better nutritional status if individuals sustained abstinence. It would increase drug craving but would not ruin the nutritional status of patients even when individuals relapsed postoperatively.

Metal hypersensitivity in patient with posterior lumbar spine fusion: a case report and its literature review.

BACKGROUND: Metal hypersensitivity, mostly documented in prosthesis implantation, is a rare complication after arthroplasty. Such cases become rarer and more difficult to diagnose when it comes to lumbar surgery. CASE PRESENTATION: We present the case of a 52-year-old female patient with reoccured low back pain and sciatica after posterior lumbar decompression and fusion (PLDF) for her lumbar disc herniation. The initial clinical and radiological examinations showed no pathologies. Further imaging and histopathological studies in later period revealed an aseptic loosening of the hardware and an aseptic inflammatory response which was diagnosed to be metal hypersensitivity. To our knowledge, few allergic cases in the matter of spinal fusion were reported so far. CONCLUSIONS: Metal hypersensitivity after spinal fusion should be considered in patients with representation of postoperative back pain. And elaborate history taking would conduce a lot to it's diagnose.

Characteristics identification and evolution patterns analyses of road chain conflicts.

Chain conflicts would cause chain-reaction crashes, which might result in elevated fatality rates. Chain conflicts describe a phenomenon wherein evasive actions taken by a following vehicle's driver after a conflict impact nearby vehicles, which occur frequently but are reported less often. To effectively reduce conflict risk, comprehending the evolution patterns of chain conflicts under varied traffic conditions and road segments is crucial, in order to make chain conflicts management strategies. Initially, rear-end or sideswipe conflicts between two vehicles are identified based on vehicle trajectory data captured by an unmanned aerial vehicle group. Subsequently, a chain conflict identification algorithm is proposed, considering the randomness of occurrence time and fluctuation of impact duration, to link individual conflicts. Chain conflict rates exhibit significant variations across different road segments under diverse traffic conditions. Multiple risk and propagation indicators are extracted to unveil latent characteristics of chain conflicts from a high-level perspective. Based on prominent characteristic disparities, three evolution patterns are identified, i.e., Longitudinal Risk Decrease Pattern, Longitudinal Risk Increase Pattern, and Comprehensive High-risk Persistent Pattern. Spatial-temporal high-risk areas associated with each pattern are determined, and transition probabilities between patterns are calculated. The results indicate that these patterns tend to remain stable, with transitions mainly occurring from low-risk to high-risk patterns. Moreover, strategies to reduce conflict risk are proposed based on the characteristics of different patterns. This study holds great significance in understanding chain conflict evolution patterns and preventing chain-reaction crashes.

Patient and public involvement in systematic reviews: frequency, determinants, stages, barriers, and dissemination.

OBJECTIVES: To investigate the frequency, determinants, stages, and barriers of patient and public involvement (PPI) in systematic reviews and to explore its association with the dissemination of reviews. STUDY DESIGN AND SETTING: We examined systematic reviews that required the inclusion of a PPI declaration, published in The BMJ between January 1, 2015, and December 31, 2022. Multivariable analysis was used to assess the association between PPI and key variables. We investigated the association between PPI and the dissemination of reviews using Altmetric scores, citations, and full-text views. RESULTS: A total of 217 systematic reviews were included, of which 56 (25.8%, 95% CI 20.0%-31.6%) included PPI, with a steady increase from 5.9% (1/17) in 2015 to 44.4% (4/35) in 2022. Of the 217 systematic reviews, 160 (73.7%) involved methodologists as co-authors. Factors significantly associated with a higher proportion of PPI included the publication year after 2019 (adjusted odds ratio [aOR] 2.46, 95% CI 1.26-4.83), the involvement of methodologist (aOR 3.08; 95% CI 1.27-7.47), and being led by researchers from high-income countries (aOR 5.47; 95% CI 1.23-24.30). Reviews that included PPI had higher Altmetric scores per month (6.6 vs 3.4, P = .002) and more monthly full-text (1048.6 vs 636.5, P < .001) and PDF (217.7 vs 129.0, P < .001) views than reviews without PPI. However, there was no difference in the monthly citations (2.2 vs 2.0, P = .365) between reviews with and without PPI. CONCLUSION: The proportion of systematic reviews reporting PPI in The BMJ has increased over time, possibly due to journal policies, but it still remains at a low level. Reviews led by researchers from high-income countries or involving methodologists are associated with a higher frequency of PPI within The BMJ. Furthermore, reviews incorporating PPI within The BMJ have a higher potential for broad dissemination.

Patient satisfaction with nursing care in infertility patients: A questionnaire survey.

Infertility remains a persistent global reproductive health challenge, with causative factors encompassing abnormalities in both the male and female reproductive systems. Typically, female partners seek initial consultations for infertility concerns, often within the context of routine annual well-woman check-ups. Nurses providing preventive care play a crucial role, conducting initial diagnostic assessments, and addressing certain causes of infertility. Patient satisfaction serves as a vital indicator of care quality. Identifying factors contributing to patient satisfaction with nursing services is crucial, yet research in this area has been limited. This study aimed to compare infertility patients' assessments of nurse quality and satisfaction with hospital services. The findings could offer valuable insights for healthcare providers, hospitals, and policymakers, guiding improvements in nursing care delivery and enhancing patient satisfaction in China's infertility treatment sector. By understanding patients' perspectives and experiences, healthcare providers can make necessary adjustments to improve care quality and patient outcomes. The sample included 1200 patients, and data collection utilized a self-assessment questionnaire, with percentages employed for analysis. Nurses are integral to caring for infertility patients during visits and conducting research to advance fertility care practices.

The association of gluten-free diet with thyroid autoimmunity in patients with celiac disease: a meta-analysis.

Background: Thyroid autoimmunity is an immune response to thyroid antigens that causes varying degrees of thyroid dysfunction. The sole effective treatment for Celiac Disease (CD) is a gluten-free diet (GFD). However, the association between GFD and thyroid autoimmunity in patients with CD has not been confirmed. Methods: A comprehensive search of several databases, involving PubMed, Embase, Web of Science, Medline, and Cochrane databases, was conducted to identify studies that primarily addressed the effects of GFD on thyroid autoimmunity in CD subjects. The meta-analysis involved studies that compared the risk of ATPO and ATG antibody positivity in CD patients with GFD, the risk of developing AITD, and the risk of developing thyroid dysfunction. Fixed-effects models or random-effects models were used to calculate the odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results: A total of 10 observational studies met the inclusion criteria and included 6423 subjects. The results indicated that GFD is positively associated with thyroid autoimmunity in the children subgroup of CD patients (OR = 1.61, 95%CI 1.06-2.43, P = 0.02). However, there was no significant difference in thyroid autoimmunity between the group adhering to GFD and the control group in the total CD population. Conclusion: The results seem to indicate that subjects with a more pronounced autoimmunity (such as to have an early onset of CD) appear to have a greater risk of thyroid autoimmunity.

[Anti-depressive effect of acupuncture on selective serotonin reuptake inhibitors].

OBJECTIVE: To evaluate anti-depressive effects of acupuncture on selective serotonin reuptake inhibitors (SSRIs). METHODS: Totally 60 patients with depression were randomly assigned to the control group (30 cases) and the treatment group (30 cases). All patients took one kind of SSRIs. Those in the treatment group were additionally treated by acupuncture. All were treated for 6 weeks. Patients' efficacies were evaluated with Hamilton Depression Scale (HAMD), Self-rating Depression Scale (SDS), and Eisenberg antidepressant side effects scale (Asberg). RESULTS: Compared with the control group after 6 weeks of treatment, the cured-markedly effective rate was improved by 33.4% in the treatment group (P < 0.05). The HAMD was lower in the treatment group. The tendency of interaction of sleep disorder factor and anxiety/somatization factor was different between at the end of 1-week treatment and at the end of 6-week treatment in the treatment group (P < 0.05). The SDS score decreased at the end of 6-week treatment in the treatment group. The reduction rate was elevated by 19.23% (P < 0.05). By the end of 6-week treatment, the average score of Asberg decreased by 3.77 score in average in the treatment group, while it decreased by 0.07 score in average in the control group (P < 0.05). CONCLUSION: Acupuncture could effectively improve anti-depressive effects of SSRIs and reduce their adverse reactions.

Post-discharge health education for patients with enterostomy: A nationwide interventional study.

Background: After discharge, patients with enterostomy face problems with poor self-nursing ability and low levels of psychological and social adjustment, which, without timely intervention, seriously affect their quality of life. We delivered health education to discharged enterostomy patients based on a WeChat health management program and evaluated its impact on their ostomy self-care ability and psychosocial adaptation level. Methods: Based on the WeChat health management program, we conducted continuous health education in the first, third, seventh, 11th, and 23rd weeks after discharge of enterostomy patients/before temporary enterostomy restoration to observe its impact on their self-care ability and psychosocial adaptation levels, as evaluated by an ostomy self-care ability questionnaire and ostomy adjustment inventory-20 checklist. Results: We included 4201 patients with enterostomy. Our findings showed that the self-care score of patients with enterostomy at discharge (baseline) (mean = 15.23, standard deviation (SD) = 5.22) was lower than that after intervention (mean = 17.71, SD = 1.28) (P < 0.05). The enterostomy psychosocial adaptation score of the enterostomy patients at discharge (baseline) (mean = 44.59, SD = 9.82) was lower than that after intervention (mean = 50.25, SD = 12.97) (P < 0.05). Conclusions: Health education for enterostomy patients after discharge can improve their self-care ability and psychological adaptation. Future studies could further explore the views and attitudes of this population toward health education based on the WeChat health management program.

Awareness, Use, and Opinions of Individual Fit Testing of Hearing Protection Devices Among Practicing Michigan Occupational and Environmental Medicine Association Health Care Providers.

OBJECTIVE: The aim of this study is to examine the awareness, opinions, and use of individual fit testing of hearing protection devices (HPDs) among occupational medicine practitioners. METHODS: Members of the Michigan Occupational and Environmental Medicine Association completed a 21-question survey on individual fit testing of HPDs. RESULTS: The survey response rate was 67%, 53% reported having heard of individual fit testing of HPDs, and 24% reported that their clinic/site performed the testing. Major barriers to its use were perceived time to perform (63%), cost (51%), lack of an Occupational Safety and Health Administration requirement (51%), and lack of long-term studies of its effectiveness (20%). CONCLUSIONS: Further work to educate practitioners about the availability, implementation, and potential benefits of fit testing of HPDs is needed if use of this technology is to become more widespread.

Assessing the effects of China's Three-North Shelter Forest Program over 40 years.

Forests provide vital ecosystem services such as soil and water conservation, climate regulation, and carbon storage. Large-scale afforestation programs are being attempted in many countries to improve environmental conditions in deteriorated or unfavorable locations. China's Three Northern Protected Forest Program (TNSFP), accounting for 42.40 % of China's total land area, is the world's largest afforestation program to date. The TNSFP has continued providing critical ecosystem services to humans over 73 years (1978-2050) with a total investment of CNY 93.3 billion. To facilitate understanding of the TNSFP's contribution, the effects of the TNSFP for last 43 years were comprehensively evaluated by using integrated review of structured literature, bibliometric analysis, and thematic analysis. We incorporated and expanded the direct ecosystem services evidence of the TNSFP from wind and sand control, soil erosion control and carbon sequestration to indirect economic benefits, e.g. increasing crop yield and promoting economic development. We found that over the past 40 years of TNSFP construction, wind and sand hazards and soil erosion in China's Three-North areas have been effectively controlled, and forest carbon sequestration, grain production and economic output have steadily increased. The ecosystem services provided by the TNSFP are highly consistent with the thrust of the UN Sustainable Development Goals, and the TNSFP has contributed to the realization of SDG2, SDG8, SDG13, and SDG15. Although achieving tremendous ecological, economic, and social benefits, the TNSFP still has knowledge gaps in its scientific basis. And the limited local engagement and insufficient investment highly hinder the TNSFP from playing its multiple functions. We suggest several urgent actions and directions to address these limitations. This review could help researchers gain insight into key areas of ecological restoration in the TNSFP, providing a reference for future research in the TNSFP construction in China and other regions of the world embarking on similar journeys.

Status of and perspectives on COVID-19 vaccination after lifting of the dynamic zero-COVID policy in China.

On December 7, 2022, China's National Health Commission issued the Ten New Covid Rules lifting the dynamic zero-COVID policy. In the interim, vaccination campaigns continue to be promoted. We assessed the potential impacts on the status, perceptions, and attitudes toward COVID-19 vaccines via an online self-administered questionnaire. Among 1,170 participants, 1,142 (97.6%) participants were vaccinated against COVID-19, and 51.8% (591/1,142) have already received the booster. More than half of the participants who were vaccinated were ages 31 to 50 (51.8%). Participants believed the following strategies could improve the vaccination rate: timely feedback of the vaccination data (such as safety, efficacy, and other issues of public concern) from authoritative media (95.6%), increasing the number of vaccination sites and availability of vaccines and using more convenient methods of making appointment (95.2%), recommendations from friends and relatives (94.8%), and presenting the qualifications of the staff performing vaccination (89.1%). More measures, including targeted measures for different age groups and timely feedback on the vaccination data including safety and efficacy from authoritative media, are likely to help improve vaccination rates.

Association of working hours and cumulative fatigue among Chinese primary health care professionals.

Introduction: The association between long working hours and cumulative fatigue is widely acknowledged in the literature. However, there are few studies on the mediating effect of working hours on cumulative fatigue using occupational stress as a mediating variable. The present study aimed at investigating the mediating role of occupational stress in the relationship between working hours and cumulative fatigue in a sample of 1,327 primary health care professionals. Methods: The Core Occupational Stress Scale and the Workers' Fatigue Accumulation Self-Diagnosis Scale were utilized in this study. The mediating effect of occupational stress was examined using hierarchical regression analysis and the Bootstrap test. Results: Working hours were positively associated with cumulative fatigue via occupational stress (p < 0.01). Occupational stress was found to partially mediate the relationship between working hours and cumulative fatigue, with a mediating effect of 0.078 (95% CI: 0.043-0.115, p < 0.01), and the percentage of occupational stress mediating effect was 28.3%. Discussion: Working hours can be associated with cumulative fatigue either directly or indirectly via occupational stress. As a result, by reducing occupational stress, primary health care professionals may reduce the cumulative fatigue symptoms caused by long hours of work.

A County-Level Program for the Evaluation of the Potential for Take-Home Lead Exposures Among Children in Michigan.

OBJECTIVE: Take-home lead exposure involves lead dust inadvertently carried from the worksite by employees that becomes deposited in their homes and vehicles. We piloted a program in 2 counties in Michigan to investigate the countywide potential for take-home lead exposures across industries. METHODS: During 2018-2020, we identified establishments through internet searches and industry-specific registries. We visited establishments with a physical storefront in-person; we attempted to contact the remaining establishments via telephone. We administered questionnaires at the establishment level to assess the presence of lead and the current use of practices meant to mitigate the potential for take-home lead exposures. We recruited workers for wipe sampling of lead dust from their vehicle floors to test for lead levels. RESULTS: We identified 320 establishments with potential lead use or exposures. Questionnaire responses revealed widespread worker exposures to lead and a lack of education and implementation of best practices to prevent lead from leaving the worksite. Dust samples (n = 60) collected from employee vehicles showed a ubiquitous tracking of lead out of the workplace, with a range of 5.7 to 84 000 µg/ft2 and a geometric mean of 234 µg/ft2. Of the sample results, 95.0% were above the lead dust clearance levels for homes established by the US Environmental Protection Agency. CONCLUSIONS: This work suggests that take-home lead exposures are widespread and may be important sources of lead exposure among children. It also demonstrates the feasibility of a program for the identification of establishments whose employees may be susceptible to taking lead dust home with them and whose children may subsequently be targeted for blood lead monitoring.