Socioeconomic status and bone health in community-dwelling older men: the CHAMP Study.

SUMMARY: The association between socioeconomic status (SES) and bone health, specifically in men, is unclear. Based upon data from the large prospective Concord Health in Ageing Men Project (CHAMP) Study of community-dwelling men aged 70 years or over, we found that specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, reflected bone health in older Australian men. INTRODUCTION: Previous studies reported conflicting results regarding the relationship between SES and bone health, specifically in men. The main objective of this study was to investigate associations of SES with bone health in community-dwelling men aged 70 years or over who participated in the baseline phase of the CHAMP Study in Sydney, Australia. METHODS: The Australian Socioeconomic Index 2006 (AUSEI06) based on the Australian and New Zealand Standard Classification of Occupations was used to determine SES in 1,705 men. Bone mineral density and bone mineral content (BMC) were determined by dual-energy X-ray absorptiometry. Bone-related biochemical and hormonal parameters, including markers of bone turnover, parathyroid hormone, and vitamin D, were measured in all men. RESULTS: General linear models adjusted for age, weight, height, and bone area revealed no significant differences across crude AUSEI06 score quintiles for BMC at any skeletal site or for any of the bone-related biochemical measures. However, multivariate regression models revealed that in Australian-born men, marital status was a predictor of higher lumbar BMC (ß = 0.07, p = 0.002), higher total body BMC (ß = 0.05, p = 0.03), and lower urinary NTX-I levels (ß=-0.08, p = 0.03), while living alone was associated with lower BMC at the lumbar spine (ß=-0.05, p = 0.04) and higher urinary NTX-I levels (ß=0.07, p = 0.04). Marital status was also a predictor of higher total body BMC (ß = 0.14, p = 0.003) in immigrants from Eastern and South Eastern Europe. However, in immigrants from Southern Europe, living alone and acculturation were predictors of higher femoral neck BMC (ß = 0.11, p = 0.03) and lumbar spine BMC (ß = 0.10, p = 0.008), respectively. CONCLUSIONS: Although crude occupation-based SES scores were not significantly associated with bone health in older Australian men, specific sub-characteristics of SES, namely, marital status, living circumstances, and acculturation, were predictors of bone health in both Australia-born men and European immigrants.

Role of inorganic nitrite in methaemoglobin formation after nitrate ester administration to the rat.

1. Methaemoglobin is rapidly formed during the incubation of rat red cells with inorganic nitrite, whereas ethylene glycol dinitrate at a higher concentration has little effect.2. The concentrations of blood inorganic nitrite in the rat after ethylene glycol dinitrate or glyceryl trinitrate injection can be reproduced by the infusion of nitrite. The methaemoglobin formed after ethylene glycol dinitrate or glyceryl trinitrate injection is equivalent to that produced from nitrite infusions simulating its formation from the nitrate esters.3. It is concluded that methaemoglobin arising from nitrate ester administration is formed principally by the action of the metabolite inorganic nitrite.

Review of recent toxicology studies on p-dichlorobenzene.

Results from recent long-term inhalation, mutagenicity, embryotoxicity and metabolism studies on p-dichlorobenzene (p-DCB) are reviewed. Groups of male and female rats and female mice were exposed for 5 hr/day on 5 days/wk to p-DCB at concentrations of 0, 75 or 500 ppm for a total period of c. 76 wk (rats) or 57 wk (female mice) followed by 36 wk (rats) or 19 wk (female mice) without p-DCB exposure. No overt signs of toxicity were apparent at any exposure level nor were there treatment-related effects on the biochemical determinations, urine analyses or haematological parameters. Slightly elevated urinary coproporphyrin excretion and increased liver and kidney weights were regarded as treatment-related effects in the 500-ppm exposure group of the rats. The non-tumour and tumour pathology did not indicate any treatment-related effect in any group of either species. An embryotoxicity and teratology study on rats exposed to 0, 75, 200 or 500 ppm p-DCB vapour in air during the period of organogenesis did not demonstrate any signs of embryo- or foetotoxicity or teratogenicity at any exposure level. In a series of mutagenicity tests including the Salmonella typhimurium, dominant lethal and cytogenetic assays, p-DCB did not produce a mutagenic response. Studies using oral or inhalation routes of exposure demonstrated rapid metabolic transformation of p-DCB and excretion of the products, even after long-term exposure.

Physical training programs for public safety personnel.

The nature of public safety jobs often reflects sudden strenuous exertion at a moment's notice. In the 1970s, police and fire departments became acutely aware of high numbers of on-the-job injuries and illnesses related to coronary heart disease. Disability payments for premature cardiovascular problems were being linked to cardiovascular risk factors accrued while on the job. This prompted public safety departments to initiate fitness programs for their employees. The fitness level of public safety personnel is not high. Job-related benefits have been linked to consistent physical training; high aerobic capacity, high muscular strength and endurance, above-average lean body weight, and minimal body fat are necessary for efficient job performance. In light of the physical benefits gained through regular exercise, pioneer departments began exercise programs for their personnel. These included the fire departments in Lawrence, Kansas, Alexandria, Virginia and Los Angeles, and the Dallas police department. Mealey documents psychologic improvements with exercise. Pioneer fitness programs such as that of the Los Angeles fire department have noted evidence of risk-factor reduction following institution of a mandatory program. The Alexandria department has instituted mandatory entrance requirements for their recruits, such as a no-smoking policy while on the job and mandatory exercise participation. Many community departments are not able to justify the institution of fitness programs. They may cite cost, lack of space, or lack of administrative support for the inability to initiate these programs. Legal and union ramifications may also deter the effort of program implementation. Considerations when implementing programs should involve cost of equipment, space, employee input, and determination of mandatory versus voluntary status. Preliminary medical screening and fitness evaluations should reliably evaluate an employee's physical ability to perform job-related tasks. The tests should be performed on a regular basis during employment. It is important, therefore, to convey the benefits of exercise to administrators. Frequent exercise testing should record progress of participants during exercise training and goals should be constantly updated. Pioneer programs should be used as models to follow when implementing a public safety physical training program. However, individual departments should evaluate the needs of their own personnel with respect to equipment, exercise schedule and type, and place of training.(ABSTRACT TRUNCATED AT 400 WORDS)

Practice wisdom.

A participatory process approach in research and scholarship is proposed in the context of the postmodern movement and a disciplinary emphasis on practice. Two sequential studies are presented to illustrate praxis in nursing in which health is expanding consciousness. A framework of personal practice was developed from the first study and reconceptualized in the second as a process of modeling practice involving partnership, dialogue, pattern recognition, and health as dialectic. This praxis illustrates the merging of theory, practice and research as practice wisdom. Health and caring can be seen as the same process.

Changes in selected pulmonary functions in patients diagnosed with myasthenia gravis.

Patients with myasthenia gravis (MG) face major pulmonary problems as a part of the disease process. In this descriptive study, changes in selected pulmonary functions (respiratory rate, negative inspiratory force, tidal volume and forced vital capacity) in 14 patients diagnosed with mild or moderate MG were measured every two hours from 8:00 a.m. to 8:00 p.m. Females comprised 64% of the sample while 36% were males. All subjects received anticholinesterase medication, and some subjects received additional treatment modalities. Most of the subjects were nonsmokers or previous smokers, but two subjects continued to smoke. Ninety-three percent of the sample had forced vital capacities less than 60% of their predicted values. Myasthenic forced vital capacities were significantly lower (p = .0000) than those predicted for normal subjects. The inspiratory force for the sample was low at 8:00 a.m. as well as in females over 55 years of age. There was a wide variation in tidal volume. The comparison of myasthenic values for respiratory rate, inspiratory force and tidal volume to normal values derived from random tables and prediction equations was not significant. The major implications from this study are the need to assess pulmonary function in the hospitalized myasthenic every two hours, and the need for a program of coughing, deep breathing and sighing after medication administration when muscles are strongest.

Agricultural work related injury and ill-health and the economic cost.

This paper contains a literature review of the occupational injuries and ill-health in agriculture world-wide and a survey of the attempts that have been made to estimate the resulting economic and social costs. Agricultural workers suffer a wide variety of disorders as a result of their occupation. These range from minor (cuts, bruises) to more severe (deep wounds, fractures), permanent (amputation, spinal cord injury) and fatal injury. Ill-health as a result of contact with animals, micro-organisms, plant material dusts or chemicals are associated with certain types of agriculture. There is an underlying but unquantified incidence of pain, stress and injury as a result of ergonomic problems due to poor working procedures and conditions. Statistics from many countries or regions show that agriculture consistently has one of the highest accident and injury rates of the industrial sectors. There are many causes for the work related injury and ill-health in agricultural workers. In developed countries, tractors and other machinery cause a significant proportion of the accidents and are a major cause of occupational deaths. In less developed countries, accidents due to hand tools such as hoes, sickles and cutting instruments are most prevalent. Animals are a significant cause of injury and ill-health in many countries. Debilitating allergic reactions in the respiratory tract or the skin are caused by exposures to organic dusts, or by contact with allergenic plants in the field respectively. Where comparative data are available, occupational pesticide poisoning in agriculture is a small proportion (< 1-4%) of the total work related disorders. Because of the wide variety of occupational risks to agricultural workers, it is emphasised that if one type of agricultural practice is replaced by another then the risks from the alternative procedure need to be considered. If, for example, agrochemical pest control practices are replaced by methods involving the increased use of machinery, draught animals or manual operations, then an assessment of the resulting risks should be taken into account. Some of the economic costs of occupational injury and ill-health in agriculture can be quantified directly, such as medical costs, the cost of rehabilitation and loss of earnings. Other costs are more difficult to estimate such as loss of opportunity and income foregone for permanent and fatal injury and for the effect on a victim's family. The estimation of the overall economic costs to farming communities and national agriculture requires further development. When one agricultural practice is replaced wholly or partly by another, for example agrochemical pest control by alternative control methods, then it is necessary to take into account the occupational health costs of the alternative procedure for realistic comparative assessment. There are a number of issues which require continued or increased attention by the relevant national and international authorities and by the agricultural industry. These include the improved collection and collation of occupational health statistics, a better understanding of the extent of ergonomic problems in agriculture, more realistic assessments of the cost of occupational injury and ill-health and the continued need to reduce occupational health disorders by appropriate training and education in agricultural practices and the use of agricultural equipment.

Field evaluation of protective equipment for pesticide operators in a tropical climate.

In order to extend the practical advice and information on personal protection when using pesticides in tropical climates, a GIFAP-FAO Working Group carried out a study on protective equipment worn by pesticide workers in hot and humid conditions in Thailand. Items assessed included protective garments worn by workers mixing and loading the organophosphorus insecticide formulation Tamaron and by spraymen applying the diluted formulation for several hours per day to a cotton crop with knapsack sprayers. The mixer-loaders also wore nitrile rubber gloves and a faceshield. The protective garments were made up of two pieces, an upper garment of a double apron design and separate trousers. Garments made up of different materials were assessed for their acceptability to the workers, their comfort and durability and their protectiveness against the insecticide. As a result of the study it is considered that cotton protective garments are appropriate for pesticide workers in these conditions if additional protection is necessary. The nitrile rubber gloves and faceshield were also found to be suitable for mixer-loaders in these circumstances. It is emphasized that the effective use of protective equipment must go hand in hand with safe handling precautions and the adoption of good personal hygiene.

Case management and nurses.

Case management, along with calls for review of the position of nurses in healthcare provision, has become increasingly familiar as a feature of the restructuring of health services. There has been considerable confusion about the meaning of case management. Nurses in New Zealand have looked to nurses' experience and research in the United States where the term originated and have undertaken our own research to construct models for our system. This paper provides a sketch of case management developments in New Zealand with reference to American nurses' endeavours. It is an edited version of the discussion paper: "Case Management and Nurses" prepared for the College of Nurses Aotearoa in 1995-1996. It is intended to provide a contemporary reference to prompt discussion of the concept and more extensive analysis and critique of nursing's contribution within the changing health sector. Case management is conceptualised as a feature of health service delivery at the interface between funds management and professional practice. While nurses have played a major part in service delivery initiatives and research, this interface has been addressed only superficially.

The scope of advanced nursing practice.

The paper, a response to the Ministerial Taskforce on Nursing, has been developed to contribute to the current discussion about nursing practice. The evolving conceptualisation of the scope of practice in New Zealand is scanned as the backdrop for critique of the current trend. An overview of some aspects of developments in the United Kingdom and United States serves to highlight some significant issues concerning the potential for nurses to contribute innovatively to health care in the new era of change. An alternative conceptualisation of practice in three nurse role categories is presented as the inter-relationship of scope and expertise to illustrate how the trend to specialisation might be incorporated in a service scheme founded in the discipline of nursing.

Developing a new model of integrated care.

A proposed model of nursing care attempts to break out of the straitjacket of providing health care within current service structures. A family nursing practitioner would play a key role in integrating health care for families across traditional health service boundaries.

Living with high blood pressure.

This study was undertaken to explore the experience of people taking long-term antihypertensive medication. The study contributes to the understanding health professionals have of people with high blood pressure and the antihypertensive treatments they receive. Consideration was given to the full life context of people taking long-term antihypertensive medication and the health/medical culture in which people find themselves. A qualitative method of inquiry generated the descriptive data. Nineteen participants (four men and 15 women) were interviewed once, of which 16 were interviewed a second time. Data analysis involved extraction of concepts which in turn were clustered into themes. An organizing framework was constructed to integrate the six themes and 18 sub-themes. The framework represents the individual's experience as a sequence, starting broadly in the social context of her/his life, and narrowing down to the particulars of personal routine and patterns referring to living with hypertension and it's medication regimens. The final theme refers to the broader context of the health culture. A vast range of experiences were described by participants taking long-term antihypertensive medication. This accentuates the necessity for health professionals to address the uniqueness of the individual, and consider the context of a person's life when prescribing and monitoring medications for people with high blood pressure.

Screening for liver disease in vinyl chloride workers.

Following the occurrence of hepatic fibrosis and angiosarcoma in polyvinyl chloride autoclave workers, a screening programme was set up for workers at risk in a large production plant. There was no significant difference in liver function tests between workers and a control group of men in the same factory, not exposed to vinyl chloride. Four exposed workers out of 422 were found to have enlarged spleens compared with none out of 202 controls. Liver biopsies from selected cases showed no significant pathological changes, although there was minimal increase in portal tract and sinusoidal fibrosis in exposed workers.

Biochemical changes during the initial stages of industrial lead exposure.

Biochemical measurements were carried out on 20 workers entering employment in a lead industry. Blood lead (Pb-B) urinary delta-aminolevulinic acid (ALA), and coproporphyrin (CP) levels were determined before entry and then at approximately weekly intervals for the first 12 weeks of employment. Levels of blood lead began to increase in all men within one week rising from an average pre-employment figure of about 1-1 mumol/l (22 mug/100 ml) to a value of about 2-9 mumol/l (60 mug/100 ml) at three weeks. Subsequently there was only a small increase in Pb-B values levelled for the rest of the period.