BABYSCAN: a whole body counter for small children in Fukushima.

BABYSCAN, a whole body counter for small children with a detection limit for (137)Cs of better than 50 Bq/body, was developed, and the first unit has been installed at a hospital in Fukushima, to help families with small children who are very much concerned about internal exposures. The design principles, implementation details and the initial operating experience are described.

Self-reported depressive symptoms in women hospitalized for acute coronary syndrome.

The purpose of this cross-sectional observational study was to explore depressive symptoms, among 377 women, during hospitalization for acute coronary syndrome (ACS). Women were screened for depressive symptoms using the Beck Depression Inventory-II (BDI-II). Pearson chi-squared tests for independence were used for comparisons between categorical variables and t-tests for independent samples were used for comparisons between continuous variables. Tukey's honestly significant difference test along with one-way anova test was used to conduct multiple comparisons between the three defined age groups ranging from 29-49, 50-64 to ≥65 years. A total of 118 women screened positive for depression (BDI-II score ≥ 14). The percentage of women that met the criteria for a positive depression screening was significantly different between the three age groups. The proportion of depressed women who reported feelings of sadness, past failures, punishment, self-dislike, agitation, worthlessness, sleep disturbances and irritability varied significantly by age group. Study findings indicate that symptom experience and severity may differ across a lifetime. These results support the need to understand the complexity of depressive symptoms experienced by women. The ability to understand and recognize depressive symptoms in women, with ACS, may assist healthcare professionals with the management of a modifiable cardiovascular risk factor.

Decontamination of the skin with absorbing materials.

Stimulation of the penetration of topically applied substances into the skin is a topic of intensive dermatological and pharmacological research. Next to intercellular penetration, i.e. a penetration inside the lipid layers around the corneocytes, follicular penetration also represents an efficient penetration pathway. The hair follicles act as a long-term reservoir for topically applied substances. They are surrounded by or contain several important target structures, such as blood capillaries, stem cells and dendritic cells. Therefore, the hair follicles have to be well protected from hazardous substances coming into contact with the skin. The traditional method of decontamination of the skin involves an intensive washing procedure. However, this process represents a massage, which pushes the hazardous substances even deeper into the hair follicles. In the present study, the application of absorbing materials for decontamination of the skin was investigated after the application of a model substance utilizing the tape-stripping procedure. It was found that absorbing materials are better suited than the washing process for decontamination of the skin.

Neutron investigations of rotational motions in monolayer and multilayer films at the interface of MgO and graphite surfaces.

Recent experimental investigations of the rotational motion of methane and molecular hydrogen using inelastic neutron scattering (INS) measurements in combination with thermodynamic techniques have provided a unique view of the evolution of the interaction of these two molecules with the MgO (100) surface and graphite basal plane. Despite significant differences in the chemical and physical properties and surface symmetry of these two adsorbents, the dynamical behavior of the adsorbed films is remarkably similar. The interaction of a CH4 monolayer solid with MgO and graphite, as monitored by the behavior of the J = 0 --> J = 1 free rotor transition, is so strong that there is no evidence for unhindered rotation of the molecule below 20 K. Using this same transition as a probe, H2 monolayer solids exhibit nearly free or significantly hindered motion on graphite and MgO (100) surfaces, respectively. Investigations of CH4 and H2 multilayer films on MgO find that once the film thickness exceeds approximately 3 layers, the molecule-molecule interactions predominantly determine the dynamical properties of the molecular film furthest from the surface. INS signals indicate that the dynamical motion in thicker films is closely related to that observed in the bulk system. The results of these studies serve as a valuable pathway for developing a qualitatively accurate description of the potential energy surfaces that govern the microscopic properties of these systems.

Direct observation of H2 binding to a metal oxide surface.

Inelastic neutron scattering is used to probe the dynamical response of H2 films adsorbed on MgO(100) as a function of film thickness. Concomitant diffraction measurements and a reduced-dimensionality quantum dynamical model provide insight into the molecule-surface interaction potential. At monolayer thickness, the rotational motion is strongly influenced by the surface, so that the molecules behave like quasiplanar rotors. These findings have a direct impact on understanding how molecular hydrogen binds to the surface of materials used in catalytic and storage applications.

Ensuring the success of local public health workforce assessments: using a participatory-based research approach with a rural population.

OBJECTIVES: To investigate a process for comprehensive rural public health workforce data collection, and apply this process to a competency and training needs assessment of local health department (LHD) workers in the state of Kansas, USA. STUDY DESIGN: Participatory research methods were used to determine an appropriate process for data collection. Survey instruments included the Council on Linkages public health core competencies and Columbia University public health emergency preparedness competencies. METHODS: LHD workers collaborated with the state health department to develop and pre-test training for LHD directors about the nature and purpose of the survey, as well as instructions for distributing it to their staff members. The final survey instrument included demographics, a workforce competency assessment, and an assessment of training interests, motivators and barriers. Surveys were stratified by occupational type, with employees in professional roles asked to report on additional competencies. RESULTS: All 1501 Kansas LHD employees received the needs assessment survey, and 1141 (76%) were returned. Respondents reported greater mean 'importance to job' than ability across competency domains, indicating potential training needs. Across occupational types, primary training motivators were increased competency and personal satisfaction. Barriers included lack of time, cost and family commitments. CONCLUSIONS: Using participatory research methods, the state of Kansas was able to achieve a high response rate from LHD workers. This process can serve as a model for other rural communities and organizations with limited resources. In addition, the survey results provide information about competency-oriented knowledge and training gaps of sectors of the local public health workforce, which can be used to develop training in a targeted fashion.

The National Violent Death Reporting System: an exciting new tool for public health surveillance.

The US does not have a unified system for surveillance of violent deaths. This report describes the National Violent Death Reporting System (NVDRS), a system for collecting data on all violent deaths (homicides, suicides, accidental firearms deaths, deaths of undetermined intent, and deaths from legal intervention, excluding legal executions) in participating states. The NVDRS centralizes data from many sources, providing a more comprehensive picture of violent deaths than would otherwise be available. The NVDRS collects data on victims, suspects, and circumstances related to the violent deaths. Currently, 17 US states participate in the NVDRS; the intention is for the NVDRS to become a truly national system, representing all 50 states, the District of Columbia, and the US territories. This report describes the history of the NVDRS, provides an overview of how the NVDRS functions, and describes future directions.

Homicide of children aged 0-4 years, 2003-04: results from the National Violent Death Reporting System.

INTRODUCTION: To better understand, and ultimately prevent, infant/child homicide, it is imperative to more thoroughly elucidate the circumstances and conditions related to such instances. Data were obtained from the US National Violent Death Reporting System (NVDRS) to illuminate circumstances related to homicide among children aged 4 years or less, and to identify demographic groups which may be at increased risk. METHODS: The NVDRS is an active surveillance system that provides comprehensive information on all violent deaths that occur within participating states within the US. Standard statistical tests were conducted to determine homicide rates among children ages 0-4 across states that provided data for both 2003 and 2004 (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia). These data were further used to investigate infant/child homicides by race, gender, and other relevant circumstances (for example, victim-suspect relationship, weapon type, and location of homicide). A Poisson regression model was fitted to the sample data to investigate the multivariate relationship between the infant/child homicide rate and available demographic information. RESULTS: The 2003 homicide rate for children ages 0-4 was 3.0 per 100,000 population. The 2004 homicide rate was 2.5 per 100,000 population. African Americans were 4.2 times as likely as whites to be victims of homicide. Suspects were commonly parents/caregivers. The vast majority of infant/child homicides occurred in houses or apartments, using weapons that include household objects. CONCLUSION: Homicides of infants and young children are most often committed in the home, by parents/caregivers, using "weapons of opportunity". This suggests that the risk of infant/child homicide is greatest within the primary care giving environment. Moreover, the use of "weapons of opportunity" may be indicative of maladaptive stress responses. Prevention and intervention strategies to reduce infant/child homicide should target the home environment and attend to maladaptive stress responses.

CDC's National Violent Death Reporting System: background and methodology.

OBJECTIVES: This paper describes a new surveillance system called the National Violent Death Reporting System (NVDRS), initiated by the United States Centers for Disease Control and Prevention. NVDRS's mission is the collection of detailed, timely information on all violent deaths. DESIGN: NVDRS is a population based, active surveillance system designed to obtain a complete census of all resident and occurrent violent deaths. Each state collects information on its own deaths from death certificates, medical examiner/coroner files, law enforcement records, and crime laboratories. Deaths occurring in the same incident are linked. Over 270 data elements can be collected on each incident. SETTING: The 13 state health departments of Alaska, Colorado, Georgia, Maryland, Massachusetts, New Jersey, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Virginia, and Wisconsin. SUBJECTS: Cases consist of violent deaths from suicide, homicide, undetermined intent, legal intervention, and unintentional firearm injury. Information is collected on suspects as well as victims. INTERVENTIONS: None. OUTCOME MEASURES: The quality of surveillance will be measured in terms of its acceptability, accuracy, sensitivity, timeliness, utility, and cost. RESULTS: The system has just been started. There are no results as yet. CONCLUSIONS: NVDRS has achieved enough support to begin data collection efforts in selected states. This system will need to overcome the significant barriers to such a large data collection effort. Its success depends on the use of its data to inform and assess violence prevention efforts. If successful, it will open a new chapter in the use of empirical information to guide public policy around violence in the United States.

Multilocus effects of the renin-angiotensin-aldosterone system genes on blood pressure response to a thiazide diuretic.

BACKGROUND: The renin-angiotensin-aldosterone (RAA) system regulates blood pressure (BP) levels and influences responses to antihypertensive medications. Variation in RAA system genes has been reported to influence interindividual differences in BP levels and the occurrence of hypertension (HTN). METHODS: We evaluated the relationship between variation in genes of the RAA system and interindividual differences in BP response to a thiazide diuretic. Analyses were carried out in a race- and gender-specific manner in 255 unrelated hypertensive African-Americans (125 men and 130 women) and 246 unrelated hypertensive non-Hispanic Whites (133 men and 113 women). RESULTS: The angiotensin II receptor (AT(1)R) A1166C and angiotensinogen G-6A polymorphisms had a significant effect on systolic BP response to the diuretic in African-American women. Multilocus analyses indicated that the effects of these genes combined additively to influence response. Results of a permutation test to adjust for multiple comparisons and the possible nonindependence among genotypes remained significant at the P=0.003 level. CONCLUSIONS: Among African-American women, particular gene variations in the RAA system have additive effects on BP response to a thiazide diuretic.

The feasibility of evaluating a tobacco control intervention for working youth.

OBJECTIVES: To describe the feasibility of implementing evaluation methods for a worksite tobacco control intervention for teens. Indicators of feasibility included employment stability, response rates to multiple surveys, and self reported 30 day smoking. DESIGN: Grocery stores that were part of a single chain were randomised to four intervention stores and five control stores as part of the SMART project, a phase II methods development study designed to reduce smoking among working adolescents. SUBJECTS: Data on smoking in the last 30 days and employment patterns were collected from working teens aged 15-18 years at seven data points over the 12 month intervention period using cross sectional surveys. RESULTS: Data on employment stability indicate that employee turnover rates averaged 21% over the seven administrations. Response rates for the seven surveys ranged from 43-77% and were slightly greater in the control stores than the interventions stores (71% v 59%, p = 0.06). Mean current smoking at the individual store level ranged from 9-32% and there was a negative correlation between smoking prevalence and response rate by survey and by store (-0.029, p = 0.03). Among smokers who completed at least two surveys, there were no significant differences between intervention and control store on changes in the frequency of smoking. CONCLUSIONS: Evaluating a tobacco control intervention in the grocery store setting requires multiple survey assessments to monitor changes in smoking among adolescents. Strategies are needed to maintain high response rates and increase the number of multiple responses from eligible teens.

Feasibility of implementing intervention methods in an adolescent worksite tobacco control study.

OBJECTIVE: To present feasibility data on SMART, the first teen worksite behavioural tobacco control intervention. DESIGN: This phase II study was designed to estimate the efficacy and feasibility of a small scale, randomised, controlled intervention. SETTING AND SUBJECTS: This study, addressing youths aged 15-18 years, was implemented in four intervention and five control grocery stores that had an average of 44 eligible teens. INTERVENTIONS: The tobacco use cessation and prevention interventions were based on social influences and peer leader models. Employee break rooms served as centres both for interactive activities including open houses, teen advisory boards, peer leader interviews, games and contests; and non-interactive interventions including bulletin boards and table tents with health messages and home mailings. MAIN PROCESS MEASURES: Project staff collected process data on the extent of implementation of intervention activities, participation rates in activities, and contacts with peer leaders. On the final survey, teens reported on awareness of, participation in, and motivation for participating in project activities. RESULTS: Indicators of feasibility were identified and discussed, including the number of activities implemented, teen participation, management support, cost, and barriers to and facilitators of implementation. During the 12 month intervention, a mean of 24.1 interactive activities and 55.3 non-interactive activities were implemented, and a mean 14.2% participation rate per activity per site was achieved. Eighty four per cent of teens reported being aware of SMART, and 39% reported participating in interactive and 67% in non-interactive activities. CONCLUSIONS: Teen smoking cessation rates in worksite programmes might be improved if they are conducted in companies where there is job stability and if teen programmes are part of worksite-wide tobacco control programmes that include both teens and adults.

Violent attacks on Middle Easterners in the United States during the month following the September 11, 2001 terrorist attacks.

OBJECTIVES: To document and describe hate related violent attacks on Middle Easterners or those perceived to be Middle Easterners during the month following the September 11, 2001 terrorist attacks in New York City and Washington, DC. METHODS: The LexisNexis database of newspaper reports were used to identify incidents of hate related violent acts against Middle Easterners or those perceived to be Middle Easterners in the US between September 1 and October 11, 2001. A total of 100 incidents of hate related violence were identified in the 2659 news articles that were reviewed. RESULTS: Of the 100 incidents of violent victimization that took place during the period September 1 to October 11, only one incident occurred before September 11. The 99 incidents that occurred after September 11 involved at least 128 victims and 171 perpetrators. Most violent victimizations occurred within 10 days of the attacks, involved male perpetrators and male victims, and occurred in convenience stores, on the streets, at gas stations, at schools/colleges, and at places of worship. DISCUSSION: Most violent victimizations occurred in the 10 days immediately following the terrorist attacks indicating that interventions that promote tolerance and understanding of diversity need to be implemented quickly in order to be effective. In addition, patrolling by police and Neighborhood Watch programs around convenience stores and gas stations may also be effective strategies for reducing hate related violent crimes.

Social influences, social norms, social support, and smoking behavior among adolescent workers.

PURPOSE: To examine the relationships between worksite interpersonal influences and smoking and quitting behavior among adolescent workers. DESIGN: The cross-sectional survey assessed factors influencing tobacco use behavior. SETTING: During the fall of 1998, data were collected from 10 grocery stores in Massachusetts that were owned and managed by the same company. SUBJECTS: Eligible participants included 474 working adolescents ages 15 to 18. Eighty-three percent of workers (n = 379) completed the survey. MEASURES: The self-report questionnaire assessed social influences, social norms, social support, friendship networks, stage of smoking and quitting behavior, employment patterns, and demographic factors. RESULTS: Thirty-five percent of respondents were never smokers, 21% experimental, 5% occasional, 18% regular, and 23% former smokers. Using analysis of variance (ANOVA), results indicate that regular smokers were 30% more likely than experimental or occasional smokers to report coworker encouragement to quit (p = .0002). Compared with regular smokers, never smokers were 15% more likely to report greater nonacceptability of smoking (p = .01). chi 2 tests of association revealed no differences in friendship networks by stage of smoking. CONCLUSIONS: These data provide evidence for the need to further explore social factors inside and outside the work environment that influence smoking and quitting behavior among working teens. Interpretations of the data are limited because of cross-sectional and self-report data collection methods used in one segment of the retail sector.

Medically recommended cessation of employment among pregnant women in Georgia.

OBJECTIVE: To ascertain the proportion of employed pregnant women who receive medical advice to stop working during pregnancy and to describe their characteristics. METHODS: Data were analyzed from the Georgia Pregnancy Risk Assessment Monitoring System, a surveillance system that surveys new mothers about pregnancy risk factors, health behaviors, and birth-related outcomes. Employment during pregnancy was defined as work for pay for 10 hours or more per week. RESULTS: We studied 1635 women who were employed during pregnancy. A physician or nurse had advised 27.7% (95% CI 24.5%, 30.9%) of them to stop working during pregnancy. Independent predictors of receiving this advice were hospitalization (RR 2.3, 95% CI 1.7, 2.8) and history of previous preterm birth (RR 1.6, 95% CI 1.1, 2.2). Low birth weight (under 2500 g) occurred in 5.8% of women not advised to stop work, in 6.9% of women advised to stop work because of swelling, fatigue, stress, or another reason, and in 13.4% of women advised to stop work because of labor, high blood pressure, or vaginal bleeding (P <.001). Among women advised to stop working in the first through seventh months of pregnancy, 91.7% (95% CI 88.8, 94.5) delivered at 36 or more weeks' gestation. CONCLUSION: Work cessation during pregnancy was commonly recommended in this population and was associated with clinical risk factors and adverse birth outcomes. For some women it resulted in a long period of work absence before delivery.

Health information in material safety data sheets for a chemical which causes asthma.

OBJECTIVE: To assess the quality of health information on material safety data sheets (MSDS) for a workplace chemical that is well known to cause or exacerbate asthma (toluene diisocyanate, TDI). DESIGN: We reviewed a random sample of 61 MSDSs for TDI products produced by 30 manufacturers. MEASUREMENTS AND MAIN RESULTS: Two physicians independently abstracted data from each MSDS onto a standardized audit form. One manufacturer provided no language about any respiratory effects of TDI exposure. Asthma was listed as a potential health effect by only 15 of the 30 manufacturers (50%). Listing asthma in the MSDS was associated with higher toluene diisocyanate concentrations in the product (P <.042). Allergic or sensitizing respiratory reactions were listed by 21 manufacturers (70%). CONCLUSIONS: Many MSDSs for toluene diisocyanate do not communicate clearly that exposure can cause or exacerbate asthma. This suggests that physicians should not rely on the MSDS for information about health effects of this chemical.

Barriers to smoking cessation initiatives for Medicaid clients in managed care.

In this paper, key barriers to providing smoking cessation services for low income individuals are illustrated using epidemiologic data from a population which was enrolled in a Medicaid managed care plan in Kansas during 1998. The Plan served 623 pregnant women who could potentially benefit from assistance in avoiding tobacco exposure. The prevalence of smoking among adult clients was 44.8%. twice the national average. Only 52.3% of adult smokers were advised by a provider to quit in the previous year. Most individuals in the client population (81.7% of the 10,733 members) were children, suggesting the importance of targeting environmental tobacco smoke exposure in order to reduce morbidity from asthma. The adult household member who needed smoking cessation services, however, was unlikely to qualify for health care benefits through Medicaid. The median length of enrollment was only 1.9 months, providing very little client contact time for tobacco control initiatives. The literature suggests that some providers may lack skills in treating tobacco as an addiction. It would be a major task for the managed care organization to train the 2,000 physicians in 68 of the 105 counties of Kansas who cared for this population. Potential solutions include improving reimbursement for smoking prevention and treatment, and developing cheaper smoking cessation services which are effective and acceptable among low-income individuals. The managed care organization could provide patient education materials and staff training for physicians and other members of the office staff.

Variability in physician management of employment during pregnancy.

BACKGROUND AND OBJECTIVES: Successful employment outcomes for pregnant women result from a complex interplay between the woman, her employer, her prenatal care provider, laws and other influences. METHODS: A mail survey about management of employment during pregnancy was sent to directors of US residency programs that train prenatal care providers. Each physician was randomly assigned one of 4 vignette patients whose job involved prolonged standing, rotating shifts and lifting 40 lbs. Half the vignette patients had risk factors for preterm birth and half would have financial difficulty if placed on an unpaid antenatal leave. RESULTS: The 301 respondents estimated that they provide a written job restriction for 20% of their employed pregnant patients, although in 6 clinics the job restriction rate was 100%. For vignettes with preterm birth risk factors, 62.5% of physicians would always recommend a job restriction, 35.6% would do so sometimes, and 2.2% would rarely do so. When the vignette did not have risk factors for preterm birth, 21.5% of the physicians would always recommend a job restriction, 51.3% would do so sometimes, 25.9% would do so rarely and 1.3% would never do so. Economic factors were not associated with prescribing job restrictions. One in 5 of the residency programs provides no teaching on occupational health issues in pregnancy, and 65.1% provide 2 hours or less. CONCLUSIONS: Variability in employment recommendations suggests that some women may not obtain the job modifications that they need, whereas others may be restricted unnecessarily. The limited curriculum time devoted to this topic may make it difficult to train physicians about complex employment issues during pregnancy.

The pronoun bias effect strikes again: a reply to Pynte and Colonna.

The gender of an initial adjectival phase (AP) influences the analysis of a phrase which is a potential main clause subject in French. Pynte and Colonna (this issue) establish this generalization but analyze it without considering critical aspects of sentence structure, specifically, the fact that the AP has a null pronominal subject. If grammars contain a violable constraint requiring coreference between the pronominal subject of an initial subordinate phrase and the subject of the main clause, then in Pynte and Colonna's study perceivers must choose on-line between an analysis which satisfies the same subject constraint and one which doesn't. From this perspective, it is expected that the subject analysis of the ambiguous phrase predominates. Further, on this view, the preference fits with independent generalizations about language such as the existence of switch-reference languages which obligatorily mark the coreference relation between the initial subordinate subject and the main clause subject. It also fits with already established facts about language processing, such as Cowart and Cairns' (1987) Pronoun Bias Effect.