Occupational eye injury and risk reduction: Kentucky workers' compensation claim analysis 1994-2003.

BACKGROUND: Occupational eye injuries are a significant source of injury in the workplace. Little population-based research in the area has been conducted, and is necessary for developing and prioritizing effective interventions. METHODS: Workers' compensation data from the state of Kentucky for the years 1994-2003 were analysed by demographics, injury nature and cause, cost, and occupational and industrial characteristics. The US Bureau of Labor Statistics' Current Population Survey was utilised to compute injury rates for demographic and occupational groups. RESULTS: There were 10,545 claims of ocular injury, representing 6.29 claims per 10,000 workers on average annually. A substantial drop in the claim rate was found after the state passed monetary penalties for injuries caused by employer negligence or OSHA violations. Claims by men were over three times more likely than those by women to have associated claim costs (OR 0.52; 95% CI 0.32 to 0.85; p = 0.009). The highest eye injury rates per 10,000 of 13.46 (95% CI 12.86 to 14.07) were found for the helpers/labourers occupation, and of 19.95 (95% CI 18.73 to 21.17) for the construction industry. The total cost of claim payments over the period was over $3,480,000, and average cost per claim approximated $331. CONCLUSIONS: Eye injuries remain a significant risk to worker health, especially among men in jobs requiring intensive manual labour. Evidence showed that increased legislative regulation led to a decline in eye injuries, which was consistent with other recent findings in the area. Additionally, targeting groups most at risk, increasing worker training, providing effective eye protection equipment, and developing workplace safety cultures may together reduce occupational eye injuries.

Multiple-site optical recording of membrane potential from a salivary gland. Interaction of synaptic and electrotonic excitation.

The interaction between synaptic and electronic excitation of cells from the salivary gland of the snail Helisoma trivolvis was studied using a voltage-sensitive merocyanine dye. Linear and square photodiode matrix arrays were used to record simultaneously the response to neuronal stimulation of 15-25 separate regions of the gland. Laterally opposed acini exhibited highly synchronous electrical activity, which suggested a correspondingly high degree of electrical coupling. In the longitudinal direction, coupling appeared weaker. The onset of depolarization after neuronal stimulation was progressively delayed along the longitudinal gland axis, in agreement with the measured conduction velocity of the presynaptic nerve spike. In most instances, neuronal stimulation directly activated a regenerative gland response (action potential) at the junction between the anterior and central duct. Excitation of distal gland regions was usually mediated by electronic spread from active, more proximal gland regions. Occasionally, "collisions" between excitatory waves traveling in opposite directions were observed.

A comparison of clomipramine and doxepin in neurotic depression.

Results of a double-blind 4-week trial in depressed outpatients given clomipramine (N = 30) or doxepin (N = 36) are reported. Both groups showed significant improvement in physician-rated measures after 1 week of treatment; comparison of the groups favored clomipramine over doxepin for four of six measures. The response to treatment was less clear-cut with the patient-rated measures. The overall incidence and severity of adverse experiences were similar for both treatment groups. Clomipramine was effective, safe, and well tolerated as compared to doxepin in the treatment of outpatients with neurotic depression.

The introduction of routine Haemophilus influenzae type b conjugate vaccine in Chile: a framework for evaluating new vaccines in newly industrializing countries.

OBJECTIVE: To determine the burden of Haemophilus influenzae type b (Hib) disease, the safety and immunogenicity of Hib conjugate vaccine, the practicality of combining Hib conjugate and diphtheria-tetanus-pertussis vaccines and the effectiveness of routine vaccination. STUDY DESIGNS: A series of studies were carried out involving infants and children in Santiago, Chile. The study designs included retrospective surveillance, cost-benefit analysis, randomized placebo-controlled trials of safety and immunogenicity and a Phase IV postlicensure evaluation of vaccine effectiveness. RESULTS: The studies included in this stepwise process showed that Hib invasive disease was a significant public health problem with a substantial economic burden; that combining Hib conjugate and diphtheria-tetanus-pertussis vaccines was practical, safe and elicited a strong immunologic response; and that the combined formulation afforded a high level of protection against invasive Hib disease (90% effectiveness). CONCLUSIONS: In July, 1996, Chile became only the third newly industrializing country to introduce routine Hib conjugate vaccination. New vaccines, such as Hib conjugates, will be more expensive than existing ones. The stepwise process used in Chile may serve as an example for the evaluation of new vaccines in nonindustrialized countries.

Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine does not depress serologic responses to diphtheria, tetanus or pertussis antigens when coadministered in the same syringe with diphtheria-tetanus-pertussis vaccine at two, four and six months of age.

The safety and immunogenicity of a vaccine against Haemophilus influenzae type b consisting of purified polyribosylribitol phosphate conjugated to tetanus toxoid (PRP-T) were evaluated in 277 Chilean infants who were randomly assigned to one of three treatment groups: Group A, PRP-T mixed with diphtheria-tetanus-pertussis (DTP) vaccine in a single syringe and given as a single inoculation in one arm and placebo in the other arm; Group B, PRP-T given in one arm and DTP in the other arm; Group C, DTP given in one arm and placebo in the other. Infants were immunized at 2, 4 and 6 months of age and examined daily for 4 days after each immunization. Serum PRP antibodies; tetanus, diphtheria and pertussis antitoxin; pertussis agglutinins; and antibodies to Bordetella pertussis filamentous hemagglutinin were measured at baseline and 2 months after each dose. PRP-T was well-tolerated. After three doses of PRP-T vaccine 100% of infants attained PRP antibody concentrations > or = 0.15 micrograms/ml and 96 to 99% achieved high anti-PRP concentrations (> or = 1.0 micrograms/ml). The post-third dose anti-PRP geometric mean titer was high (6.94 micrograms/ml) in infants who were given PRP-T combined with DTP, although it was somewhat lower than the geometric mean titer of the group who received PRP-T in a separate arm (9.93 micrograms/ml) (P not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical and immunologic response of Chilean infants to Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine coadministered in the same syringe with diphtheria-tetanus toxoids-pertussis vaccine at two, four and six months of age.

The safety and immunogenicity of a vaccine against Haemophilus influenzae type b consisting of purified polyribosylribitolphosphate conjugated to tetanus toxoid (PRP-T) was evaluated in 278 Chilean infants who were randomly assigned to one of three treatment groups: Group A, PRP-T mixed with diphtheria-tetanus toxoids-pertussis (DTP) vaccine in a single syringe and given as a single inoculation in one arm and placebo in the other arm; Group B, PRP-T given in one arm and DTP in the other arm; Group C, DTP given in one arm and placebo in the other. Infants were immunized at 2, 4 and 6 months of age and examined daily for 4 days after each immunization; serum PRP antibodies were measured at baseline and 2 months after each dose. The only adverse systemic reaction attributable to PRP-T beyond that caused by DTP alone was a 7 to 20% increase in febrile responses in the first 24 hours after the first and second doses of vaccine; the fevers were largely low grade and not accompanied by increased irritability, diminished activity or loss of appetite, compared with the group who received DTP without PRP-T. After the first dose 72% of infants who received PRP-T combined with DTP and 67% who received it in a separate arm attained antibody concentrations greater than or equal to 0.15 micrograms/ml. After two doses of PRP-T, 93 and 95%, respectively, had concentrations greater than or equal to 0.15 microgram/ml and after three doses 100% of infants who received PRP-T had such titers.(ABSTRACT TRUNCATED AT 250 WORDS)

Large scale, postlicensure, selective vaccination of Chilean infants with PRP-T conjugate vaccine: practicality and effectiveness in preventing invasive Haemophilus influenzae type b infections.

BACKGROUND: Haemophilus influenzae type b (Hib) conjugate vaccines have demonstrated an impressive impact in diminishing Hib disease in industrialized countries. However, their high cost prompts nonindustrialized countries to corroborate their effectiveness under local conditions before considering their programmatic implementation. Such a postlicensure evaluation of vaccine effectiveness was undertaken in Chile. METHODS: After its licensure in Chile polyribosylribitol phosphate-tetanus toxoid protein conjugate vaccine (PRP-T), combined with diphtheria-tetanus-pertussis vaccine, was introduced into the Expanded Program on Immunization schedules in 36 health centers throughout metropolitan Santiago for 12 months, whereas 35 similar health centers administered only diphtheria-tetanus toxoid-pertussis vaccine. Bacteriologic surveillance data for invasive Hib cases collected over the ensuing 30 months were analyzed. RESULTS: In an intent-to-vaccinate (effectiveness) analysis, PRP-T provided 90.2% protection (95% confidence interval, 74.5 to 100%) against invasive Hib disease (40 vs. 4 cases, P < 0.001). Vaccine effectiveness was 91.3% against meningitis (22 vs. 2 cases) and 80% against pneumonia and empyema (10 vs. 2 cases, P = 0.039). Vaccine efficacy among infants who received all three doses of PRP-T was 91.7% (95% confidence interval, 64.8 to 100%). CONCLUSIONS: Programmatic use of Hib conjugate vaccine administered in combination with diphtheria-tetanus-pertussis vaccine constitutes a highly effective and practical intervention in Chile, a newly industrializing country.

Effects of baroreceptor activation on spontaneous activity in the sweat glands and nictitating membrane of the cat.

(1) In chloralose-anesthetized cats, elevation of carotid sinus pressure caused blood pressure, sweat gland potentials and nictitating membrane tension to decrease. (2) The onset and recovery of the sweat gland and nictitating membrane responses usually preceded the respective phases of the blood pressure (depressor) response; the latencies of the sweat gland and nictitating membrane responses agreed with the latencies predicted for neural reflex pathways. (3) The sweat gland and nictitating membrane responses were evoked less consistently than the depressor response. (4) In experiments where only the sweat gland potentials and blood pressure were studied: (a) the sinus pressure threshold for inhibition of sweat gland activity was similar to the threshold for the depressor response; (b) cutting the sinus nerves, or blocking the efferent neural activity to the sweat glands, eliminated the effects of sinus pressure elevation on the sweat gland potentials; (c) with carotid sinus pressure held constant, decreases in blood pressure, produced by stimulating the peripheral end of the vagus nerve, did not affect the sweat gland potentials. (5) These results indicate that baroreceptors can reflexly modulate activity in sympathetic neurons whose target organs are not fundamentally involved in blood pressure regulation.

Workers' compensation claims from latex glove use: a longitudinal analysis of Minnesota data from 1988 to 1997.

Allergic reaction experienced by health care workers from latex glove use has increasingly become the focus of researchers evaluating occupational sources of injury in health care settings. Many studies have attempted to estimate the prevalence of latex sensitization among health care workers by using various methods, but the findings have been inconsistent and do not predict reactivity. This study used workers' compensation data from Minnesota from 1988 to 1997 to assess allergic reactivity rates, injury severity, and costs associated with latex allergic reactions. The average reactivity rate was 7.1 claims per 100,000 health care workers, and total cost associated with the claims averaged $0.295 per health care employee. Using empirical cost data from another study, it was found that it is not cost-beneficial for health care institutions to globally adopt latex glove-free policies solely on the basis of workers' compensation costs.

Assessing latex allergy among health care employees using workers' compensation data.

Latex allergies among health care workers have garnered considerable attention from medical researchers and practitioners. However, the majority of research on natural rubber latex allergy has focused on clinical methodologies and emphasized the quantification of employee sensitization rates as opposed to actual incidents of reactivity. Workers' compensation data provide information on the number and impact of reactions to latex use. This article presents an analysis of health care workers' compensation data from North Dakota to estimate the prevalence, costs, and nature of claims associated with latex allergic reaction. The results show an annual average claim rate of 1.52 per 10,000 health care workers employed in the state, and annual costs averaging about $.08 per health care worker. Skin disorders were the most commonly reported condition. These findings are compared with previous studies of Minnesota and Rhode Island and demonstrate similar results.

Waitlist mortality decreases with increased use of extended criteria donor liver grafts at adult liver transplant centers.

Extended criteria donor (ECD) liver allografts are often allocated to less severely ill liver transplant (LT) candidates who are at a relatively lower risk of pretransplant mortality, but it is not clear that the use of ECD allografts will decrease center waitlist mortality (WLM). Individual patient data from the UNOS OPTN database (2002-2005) were aggregated to obtain center-specific data. Deceased donor allografts with any of the following characteristics were defined as ECDs: from a donor with any of the criteria described by the New York State Department of Health Workgroup; or 12+ h of cold ischemia. Multivariate regression was used to examine the relationship between WLM and ECD, non-ECD and LDLT use after adjusting for candidate severity of illness. A total of 3555 ECD transplants, 11,660 standard criteria donor (SCD) transplants, and 717 LDLTs were performed at 100 centers during this period. The model demonstrated that SCD and ECD LTs were inversely correlated with a center's WLM (beta=-0.242 and -0.221, respectively; p

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data.

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.

GABA inactivation at the crayfish neuromuscular junction.

Changes in the effective membrane resistance of the abductor muscle of the dactylopodite of the caryfish were used to indicate changes in the GABA concentration in the synaptic cleft. Following bath application of GABA (10(-5) to 5 X 10(-5) M), the muscle membrane resistance decreased and then increased slowly over the next few minutes. Renewing the solution or stirring the bath restored the GABA effect. Higher GABA concentrations produced a large stable decrease in membrane resistance. An active uptake system for GABA in the junctional region is suggested by the observation that the slow increase in membrane resistance following GABA application was decreased by cooling to 2 degrees C or by the addition of known GABA uptake blockers such as L-DABA, beta-guanidinopropionic acid, or nipecotic acid. The transport inhibitors, PCMBS and chlorpromazine, produced irreversible decreases in muscle membrane resistance, which precluded examining their effects on GABA inactivation. The decrease in GABA effect was not dependent on the external sodium concentration or on the degree of receptor activation. Nipecotic acid, which blocked GABA inactivation, did not affect the decay of the neurally evoked inhibitory junctional potential.

MSORTV imaging of electrotonic conduction in a syncitium: optical recording of polarization spread in a simple salivary gland.

The spread of hyperpolarizing current injected into the salivary gland of the snail Helisoma trivolvis was studied with the technique of multiple site optical recording of transmembrane voltage (MSORTV). Using MSORTV it was possible to monitor simultaneously the spread of current passed by an intracellular microelectrode in up to 124 separate gland regions. Our results demonstrate the feasibility of combining conventional intracellular injection techniques with MSORTV to visualize 2-dimensional current spread in an electrical syncitium.

[Treatment of typhoid fever with chloramphenicol or ampicillin combined with oxyphenbutazone]. / Tratamiento de las fiebres tíficas con cloranfenicol o ampicilina asociados a oxifenbutazona.

Ninety-four patients with typhoid fever were treated, at random, with three therapeutic regimens: chloramphenicol alone, chloramphenicol plus oxyphenbutazone, and ampicillin plus oxyphenbutazone. The results are evaluated analyzing the body temperature graph and by serial blood had bone marrow cultures taken at intervals until they became negative. Bacteriologic diagnosis was confirmed by blood culture (39.3%) and/or bone marrow culture (77%). The mean duration of fever was 3.3 days for the group treated with chloramphenicol-oxyphenbutazone, 4.3 for those with chloramphenicol alone and 5 days for the group ampicillin-oxyphenbutazone; at the same time, blood cultures became negative at 4.4, 5.5 and 4.4 days respectively. Negativization of bone marrow cultures was not influenced by the addition of oxyphenbutazone. It is concluded that the influence of oxyphenbutazone in shortening the febrile period or in the negativization of blood cultures is not significant. It is considered that oxyphenbutazone is not an important therapeutic tool in this group of diseases.

Luminal and basolateral surface membranes of secretory acinar cells: electrophysiological comparison of cationic sensitivities.

Cation sensitivities (K+, Na+, and Ca2+) of luminal and basolateral membrane surfaces of secretory acinar cells were compared using a luminally perfused and externally superfused salivary gland from the aquatic snail, Helisoma trivolvis. Tight junctions delimiting the two membrane surfaces were observed near the acinar lumen suggesting that the total membrane area exposed to the superfusion solution exceeded that in contact with the luminal perfusion solution. The resting membrane potential of acinar cells was found to be dependent upon the K+ concentration in both the external superfusion and the luminal perfusion solutions. Unilateral K+ elevation at either membrane surface produced a rapid and sustained depolarization of the acinar cell. For a given K+ concentration, the level of depolarization produced by K+ elevation at the basolateral surface was significantly higher than at the luminal surface. The highest level of membrane depolarization was observed following simultaneous K+ elevation at both membrane surfaces. The ability of acinar cells to generate overshooting action potentials in response to electrical field stimulation was dependent upon both Na+ and Ca2+. Complete blockade invariably occurred following bilateral removal of either cation. The effects of unilateral removal of either Na+ or Ca2+ proved to be somewhat variable. In general, unilateral removal of Na+ was more effective in reducing the regenerative response than Ca2+ while removal of either cation from the basolateral surface was more effective in reducing the regenerative response than its removal from the luminal surface. Electrically evoked action potentials in acinar cells could also be blocked with unilateral application of the Ca2+ antagonist, cadmium (Cd2+), at either membrane surface. However, higher Cd2+ concentrations were required to achieve complete blockade when applied to the luminal than to the basolateral gland surface. This result fails to support a hypothesis of voltage-sensitive Ca2+ channels being spatially restricted to the luminal cell surface in this preparation.

[Widal reaction and phenotypes in children with typhoid fever (preliminary study)]. / Reacción de Widal y fenotipos en niños con fiebre tifoidea (estudio preliminar).

Recognition of genetic heterogeneity in typhoid fever patients might allow studies on the behaviour of definite cohorts regarding this infection, which would be important for clinical and epidemiological purposes. Under the hypothesis that agglutinins response (Widal test) is a suitable phenotype for this objective, associations between results of this response at admission (positive and negative) and clinical and hematological variables were explored in 91 children with bacteriologically confirmed typhoid fever, admitted to a metropolitan hospital at Santiago, Chile, during 1981-82 period. Association between gender and negative Widal test was found in males when this test was performed during the third week of disease (OR = 10, p = 0.52) as well as a tendency of females to express figures below the mean for total WBC count in patients older than 10 years (OR = 2.43, p = 0.019) and for neutrophils (%) in younger than this age when the Widal test was negative in the latter (OR = 10, p = 0.016). These preliminary findings suggest that Widal test and gender might interact for determining the presumptive heterogeneity in this children group.

Impact of Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine on responses to concurrently administered diphtheria-tetanus-pertussis vaccine.

OBJECTIVE: To assess whether serum antibody responses to diphtheria-tetanus-pertussis (DTP) vaccine were affected by coadministration of Haemophilus influenzae type b capsular polyribosylribitol phosphate polysaccharide-tetanus protein (PRP-T) conjugate vaccine when given to patients at 2, 4, and 6 months of age. DESIGN: Randomized, double-blind clinical trial. SETTING: Urban Santiago, Chile. PATIENTS: Healthy infants assembled from health centers. Two hundred seventy-eight (74%) of 375 eligible infants participated; 222, who complied with the complete protocol, constituted the primary group under analysis. INTERVENTIONS: One of three vaccine regimens was given to study participants at 2, 4, and 6 months of age, either DTP mixed in the same syringe as PRP-T (group 1); DTP and PRP-T given at separate injection sites (group 2); or DTP without PRP-T (group 3). PRIMARY OUTCOME MEASURES: Titers of serum antidiphtheria toxoid, antitetanus toxoid, and pertussis agglutinin antibodies were measured in blood samples taken from patients 2 months after each dose. RESULTS: Serum antidiphtheria toxoid and antitetanus toxoid responses showed no important depressions in the patients receiving PRP-T. In contrast, geometric mean titers (GMTs) of pertussis agglutinins, expressed as reciprocal serum dilutions, after both the second and third doses (GMT2, GMT3) were lowest in group 1 (GMT2 = 89; GMT3 = 1230), intermediate in group 2 (GMT2 = 123; GMT3 = 1995), and highest in group 3 (GMT2 = 210; GMT3 = 3090; P less than .05 for trend group 1 less than group 2 less than group 3 after each dose). Antipertussis toxin and antipertussis filamentous hemagglutinin antibody titers also were depressed in patients who received PRP-T. Follow-up of a subset at 18 months revealed an expected decline of pertussis agglutinin titers to near baseline levels in each group. CONCLUSIONS: Concurrent administration of PRP-T vaccine with DTP vaccine, either in the same syringe or at different sites, interfered with antipertussis responses to a primary series of immunizations. Although the clinical significance of this antagonism is uncertain, these data underscore the caution required in decisions to add new vaccines to existing immunization regimens.