RESUMEN
To identify risk factors for persistent morbidity, we conducted a prospective study of individuals involved in hazardous materials incidents reported to the Washington Poison Center. Between December 1997 and October 1999, 202 subjects in 87 incidents were surveyed by telephone. Medical symptoms persisting for a minimum of 8 days after the incident were reported in 51 (25%) subjects, and 18 (9%) left work or school for more than 2 days because of the exposure. Medical intervention was reported in 46 (58%) of 79 subjects for whom medical records were available, and objective abnormalities were found in 57 (72%). Multiple logistic regression analysis indicated that subjects with dermal exposures, three or more alcoholic drinks per week, and previous use of psychiatric medications were more likely to report persistent symptoms. Divorced, widowed, or separated subjects, asthmatic subjects, and those having initial dermal symptoms were more likely to miss work or school for more than 2 days. Of patients evaluated at a health care facility, subjects with preexisting hypertension were more likely to receive medical treatment or have objective medical findings, whereas those with inhalation exposures and those decontaminated at the scene were less likely to be treated or have abnormalities. In our study, both incident and individual factors were predictive of adverse health effects, and these findings should be considered in planning the care of patients involved in hazardous materials incidents.
Asunto(s)
Desastres , Sustancias Peligrosas , Indicadores de Salud , Humanos , Modelos Logísticos , Estudios Prospectivos , Factores de RiesgoRESUMEN
The study objective was to analyze hazardous materials event and victim factors associated with transportation of victims to a health care facility, and evacuation or shelter-in-place of nearby populations. A retrospective review was conducted on hazardous materials events in Washington State from 1993 to 1997. Bivariate and multiple logistic regression were used to identify risk factors for transportation, evacuation, and shelter-in-place. Over five years, 2,654 victims from 457 events were reported, with 1,859 (70%) transported to a health care facility. Evacuation occurred in 279 (61%) events and shelter-in-place in 14 (3%) events. After excluding 14 deaths, regression analysis indicated that victims with trauma (OR 5.87, 95% CI 1.41-24.5), thermal burns (6.90, 1.15-41.3), dizziness/other CNS symptoms (1.59, 1.00-2.54), and headache (1.54, 1.01-2.35) were most likely to be transported. Chemical releases inside buildings (2.09, 1.06-4.10, compared with transportation events), and involving 3-5 victims (2.86, 1.54-5.31, compared to 1 victim) or > or =6 victims (8.74, 4.01-19.0), were most likely to involve evacuation or shelter-in-place. Events involving sulfuric acid (0.15, 0.05-0.49) and sodium hydroxide (0.19, 0.04-0.94) were least likely to involve evacuation or shelter-in-place. Prehospital decisions to transport victims to a health care facility and evacuate or shelter-in-place nearby populations are associated with event and victim factors. Further research is needed to determine if these factors also predict need for medical care or removal from exposure, and to develop evidence-based prehospital care protocols for hazardous materials exposure victims.
Asunto(s)
Planificación en Desastres , Servicio de Urgencia en Hospital/organización & administración , Sustancias Peligrosas , Trabajo de Rescate/organización & administración , Transporte de Pacientes , Adolescente , Adulto , Anciano , Niño , Preescolar , Toma de Decisiones , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Washingtón/epidemiología , Heridas y Lesiones/epidemiologíaRESUMEN
New patient charts were reviewed before and after the introduction of a self-administered questionnaire, designed to elicit occupational and environmental (OE) information from patients. The Occupational Health Risk Assessment questionnaire (OHRA) was expected to prompt primary care physicians to make further inquiries into OE health issues. Chart reviews determined the amount and type of information detailed in the primary care physicians' notes. Twenty-three percent of completed OHRAs indicated a job-related health problem. Despite a high prevalence of self-reported work-related symptoms and exposures, the mean number of notations regarding OE exposures was less than one item per patient chart. A comparison of mean OE notations per chart before versus after introduction of the OHRA indicated a decline in notations after introduction of the OHRA (1.03 vs 0.72, P = 0.02). We detail the type of OE issues that patients presented to a primary care practice and the resulting information contained in primary care providers' notes. Suggestions are made to improve a self-administered patient questionnaire to better diagnose, prioritize, and formulate treatment plans related to OE issues.
Asunto(s)
Exposición a Riesgos Ambientales , Anamnesis , Exposición Profesional , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Atención Primaria de Salud , Medición de Riesgo , Autoevaluación (Psicología) , Encuestas y Cuestionarios/normasRESUMEN
Identifying industries at high risk for hazardous materials releases can facilitate prevention and preparation for such events. A retrospective review by Standard Industrial Classification (SIC) codes was conducted on non-petroleum hazardous materials emergency events from 1993 to 1995 and collected by the Washington State Department of Health in a program supported by the Agency for Toxic Substances and Disease Registry. Annual US Census data were used to determine the number of facilities and employees by SIC code in the state of Washington. SIC codes with the most total events and events per 10,000 employees were ranked and characterized by type of releases. In 3 years, 1269 events were recorded, with 294 involving human victims. Industries with the highest average annual number of events per 10,000 employees were agricultural chemical manufacturing (142); petroleum refining (122); industrial and miscellaneous chemical manufacturing (56); electric light and power (54); and pulp, paper, and paperboard mills (39). Industries with high rates of hazardous materials emergency events should continue to develop methods of preventing these releases.
Asunto(s)
Contaminación Ambiental/estadística & datos numéricos , Sustancias Peligrosas/envenenamiento , Industrias , Urgencias Médicas , Humanos , WashingtónRESUMEN
OBJECTIVES: This study examined the effect of managed care on medical outcomes and patient satisfaction as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot. METHODS: One hundred twenty firms (7,041 employees) agreed to have their injured workers treated in managed-care plans. Managed care introduced two changes from the fee-for-service (FFS) delivery system currently used by injured workers in Washington State: (1) experience-rated capitation, and (2) a primary occupational-medicine delivery model. The FFS control group included injured workers employed at 392 firms (12,000 employees). A total of 1,313 workers who experienced occupationally related injuries or illnesses between April 1995 and June 1996 were interviewed by telephone at 6 weeks after injury regarding their medical outcomes and satisfaction with care. Workers whose injuries resulted in four or more lost workdays (n = 372) were also interviewed at 6 months after injury on the same topics. The areas surveyed included functional outcomes and satisfaction with care, providers, and access to providers. RESULTS: The measures of functional outcome reflected no consistent differences between the managed care and the FFS conditions. The workers who attended the managed-care system reported lower levels of satisfaction with care, particularly with access to providers. For example, 58% of managed-care patients reported satisfaction with their attending physician as compared with 69% of FFS patients (P<0.01). CONCLUSIONS: Workers treated through managed-care arrangements were less satisfied with their care, but their medical outcomes were similar to those of workers who received traditional FFS care. The current workers' compensation system in Washington State affords injured workers great latitude in choosing providers. If provider choice is substantially restricted by managed care, worker satisfaction is likely to diminish.
Asunto(s)
Programas Controlados de Atención en Salud/estadística & datos numéricos , Medicina del Trabajo/tendencias , Satisfacción del Paciente , Indemnización para Trabajadores/estadística & datos numéricos , Adulto , Análisis de Varianza , Planes de Aranceles por Servicios , Femenino , Reforma de la Atención de Salud , Investigación sobre Servicios de Salud , Humanos , Renta , Puntaje de Gravedad del Traumatismo , Masculino , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Resultado del Tratamiento , WashingtónRESUMEN
OBJECTIVES: This study examined the effect of managed care on medical and disability costs as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot (MCP). METHODS: One hundred twenty firms (7,041 employees) agreed to have their injured workers treated in managed care plans. Managed care introduced two changes from the fee-for-service (FFS) delivery system currently used by injured workers in Washington State: experience- rated capitation and a primary occupational medicine delivery network. The FFS control group included injured workers employed at 392 firms (12,000 employees). Medical and disability costs were compared for 1,058 injuries in the managed care group and 1,159 injuries in the FFS group occurring between April 1995 and June 1996. Univariate and multivariate statistical methods were used to analyze the effects of managed care on medical and disability costs. RESULTS: The mean unadjusted medical cost per injury ($587) for the managed care group was 21.5% lower (P = 0.06) than for the FFS group ($748). Adjustment for differences in worker and firm-level characteristics through multivariate analysis had little effect on the unadjusted results, except that the difference in costs between managed care and FFS groups became statistically significant (P<0.01). The major cost differences were for outpatient surgery (cost per surgery) and ancillary services (pharmacy, x-ray, physical therapy, and all other costs). In addition, disability costs, particularly percent on time loss and time-loss cost per injury, were significantly lower (P<0.01) in the managed care group. CONCLUSIONS: The results from the MCP suggest that substantial savings in workers' compensation medical and disability costs may be realized using the type of managed care intervention designed for this study. Delivering occupational health services through managed care arrangements whose design is based on an integrated, occupational health-centered delivery model may offer a viable approach for improving delivery systems, reducing costs and encouraging greater attention to disability prevention.
Asunto(s)
Programas Controlados de Atención en Salud/economía , Indemnización para Trabajadores/economía , Heridas y Lesiones/clasificación , Adulto , Costos y Análisis de Costo , Planes de Aranceles por Servicios/economía , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Medicina del Trabajo/economía , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Washingtón , Heridas y Lesiones/economíaRESUMEN
Actual or perceived exposure to hazardous materials may result in physiologic and psychological effects. However, hyperventilation following such exposures has not previously been reported. After a large-scale industrial release of oxides of nitrogen, five (29%) of 17 patients evaluated at a major trauma center were hyperventilating, as defined by arterial PCO2 <33 mm Hg, and nine patients (53%) had arterial PCO2 <37 mm Hg. First responders (rescue team members and paramedics) had a higher rate of hyperventilation than other occupational groups. Age, gender, marital status, decontamination, and mode of arrival were not significantly associated with hyperventilation, although marital status approached significance. This study suggests that hyperventilation may be a common reaction after hazardous-materials incidents, and that certain populations may be at increased risk for this condition.
Asunto(s)
Contaminantes Ocupacionales del Aire/efectos adversos , Sustancias Peligrosas/efectos adversos , Hiperventilación/inducido químicamente , Exposición por Inhalación/efectos adversos , Óxidos de Nitrógeno/efectos adversos , Exposición Profesional/efectos adversos , Adolescente , Adulto , Análisis de los Gases de la Sangre , Dióxido de Carbono/sangre , Estudios de Casos y Controles , Descontaminación , Femenino , Humanos , Hiperventilación/sangre , Hiperventilación/terapia , Masculino , Estado Civil , Persona de Mediana Edad , Oxígeno/sangre , Factores de RiesgoRESUMEN
Several existing measures of medical outcomes and some newly constructed measures of patient satisfaction were tested for reliability and validity on a sample of 100 subjects who had suffered work-related injuries and illnesses in Washington State. Included in the measures of medical outcome were the SF-36 and the upper body mobility subscale of the Health Assessment Questionnaire. The newly constructed measures of patient satisfaction assessed areas such as satisfaction with the attending physician and with access to referrals. Also administered were assessments of job satisfaction, both prior to and since the injury, and a measure of chance health locus of control. The patient satisfaction and medical outcomes measures demonstrated good reliability and validity for use with this population. However, neither the measures of job satisfaction nor chance health locus of control were related to either patient satisfaction with medical care nor to medical outcomes.
Asunto(s)
Atención a la Salud/estadística & datos numéricos , Sistemas Prepagos de Salud , Enfermedades Profesionales/terapia , Satisfacción del Paciente/estadística & datos numéricos , Heridas y Lesiones/terapia , Accidentes de Trabajo , Adolescente , Adulto , Recolección de Datos , Atención a la Salud/normas , Femenino , Sistemas Prepagos de Salud/normas , Sistemas Prepagos de Salud/tendencias , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Washingtón/epidemiología , Indemnización para Trabajadores/estadística & datos numéricos , Heridas y Lesiones/etiologíaRESUMEN
PIP: Social learning theory predicts that reading non-erotic stories involving condom use will be as effective as reading erotic stories with condom use in producing positive attitudes toward condoms. Werner's orthogenetic principle, however, predicts that reading erotic condom stories will be most effective because of the link created between sexual arousal and cognitive information about condoms. 168 male and 149 female undergraduates enrolled in Introductory Psychology at a small, private, southern university participated in a study to test the validity of these two theories. The students read one of the following types of stories: erotic with condom placement described, erotic without condom use, or non-erotic with a model for discussing condoms. The men and women who read the non-erotic stories were most positive about condoms and reported the strongest intentions to use condoms in the future. These findings suggest that erotica is not necessary to produce positive attitudes toward condoms.^ieng
Asunto(s)
Adolescente , Publicidad , Actitud , Condones , Conductas Relacionadas con la Salud , Conducta Sexual , Estudiantes , Universidades , Factores de Edad , Américas , Conducta , Anticoncepción , Demografía , Países Desarrollados , Economía , Educación , Servicios de Planificación Familiar , Comercialización de los Servicios de Salud , América del Norte , Población , Características de la Población , Psicología , Instituciones Académicas , Estados UnidosAsunto(s)
Dolor de la Región Lumbar/economía , Mecanismo de Reembolso , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/economía , Tecnología de Alto Costo , Enfermedad Crónica , Control de Costos , Humanos , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/tendencias , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiología , Imagen por Resonancia Magnética/economía , Guías de Práctica Clínica como Asunto , Tomografía Computarizada por Rayos X/economía , Estados UnidosAsunto(s)
Cruzamiento/métodos , Modelos Animales de Enfermedad , Primates/fisiología , Síndrome de Inmunodeficiencia Adquirida del Simio , Animales , Femenino , Indonesia , Macaca fascicularis/fisiología , Macaca fascicularis/psicología , Masculino , Dinámica Poblacional , Primates/psicología , Síndrome de Inmunodeficiencia Adquirida del Simio/transmisión , Organismos Libres de Patógenos EspecíficosRESUMEN
Indonesian and U.S. college students were compared to assess whether an interaction of sex of subject by sex of target on attitudes toward homosexuals would be replicated cross-culturally. The Indonesian sample was expected to hold more traditional attitudes toward women's gender-role behavior which was expected to override the interaction of sex of subject by sex of target. Knowledge of AIDS was expected to be correlated with attitudes toward homosexuals. Analysis showed that the interaction of sex of subject by sex of homosexual target was present in both samples. Knowledge of AIDS was correlated with attitudes toward homosexuals for the U.S. sample but not for the Indonesian sample. Attitudes toward women's gender-roles were correlated with attitudes toward homosexuals in both samples.
Asunto(s)
Actitud , Comparación Transcultural , Países en Desarrollo , Homosexualidad/psicología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Indonesia , Masculino , Conducta Sexual , Estados UnidosRESUMEN
PIP: The effect of reading an erotic script that described condom placement on attitudes toward condom use was investigated in 102 male and 108 female US university students. It was hypothesized that, when integrated into an erotic script, condom use would become viewed as a pleasurable activity rather than just a means of avoiding pregnancy or disease. Controls received identical scripts except that the use of condoms was omitted or received no stories. Subjects who read the erotic accounts exhibited a positive change from pretest to posttest in attitudes toward condom use, but there was no difference in this outcome between condom story and no-condom erotic story conditions. In women, but not men, a high level of arousal induced by the script was associated with negative attitudes toward condoms, suggesting that males and females may require different reading materials. Given the finding, at least in women, of an inverse relationship between explicit eroticism/sexual arousal and condom attitude scores, a 2nd experiment involving less explicit stories written by college students was conducted. Here, 100 men and 100 women students received erotic stories that either featured or did not include condom use. Again, males who read stories incorporating condom placement held more positive attitudes toward condom use than same-sex controls, but women were not affected by the manipulation. For women, a positive attitude toward condom use was associated only with history of sexual activity. Helpful would be the preparation of erotic scripts that appeal to both sexes given the demonstrated effectiveness of this social learning technique with the male subjects in both experiments.^ieng