Serosurvey and observational study of US Army Veterinary Corps officers for Q fever antibodies from 1989 to 2008.

Since World War II, the military has experienced outbreaks of Q fever among deploying units including recent case reports of Q fever in US military personnel returning from serving in the Middle East during Operation Iraqi Freedom and Operation Enduring Freedom. Occupational exposure and prevalence of Q fever among US Army Veterinary Corps officers have not been examined. A retrospective serosurvey and observational study of 500 military veterinarians were conducted using archived serum specimens from military veterinarians who entered and served between 1989 and 2008 and were tested for exposure to Coxiella burnetii. Corresponding longitudinal health-related, demographic, medical and deployment data were examined. A total of 69 (13.8%) individuals at military entry and 85 (17%) had late career positive titres. A total of 18 (3.6%) individuals showed seroconversion. Women were more likely to be seropositive after military service [prevalence ratio (PR) 1.96; 95% confidence interval (CI) 1.15-3.35] and were also more likely to seroconvert (incidence rate ratio 3.55; 95% CI 1.19-12.7). Women who deployed to Operation Iraqi Freedom were more likely to be seropositive (PR 3.17; 95% CI 1.03-9.71). Veterinarians with field service and pathology specialties had the highest incidence rates (7.0/1000 PY; 95% CI 4-12 and 3-19, respectively). This is the first report documenting US military veterinarians' exposure to C. burnetii. Military veterinarians are at risk prior to service, with moderate number of new cases developing during service and most maintaining titres for long periods of time. Women consistently demonstrated higher seroprevalence and incidence levels. As increasing numbers of women enter the veterinary profession and subsequently the US Army, this may warrant close monitoring. This study likely underestimates exposure and risk and does not address chronic health effects, which may be valuable to explore in future health studies.

Learning disabilities within mental health services: are we adequately preparing nurses for the future?

Current government policy dictates that where possible patients who have learning disabilities should be cared for within the framework of ordinary generic national health services, with specialist provision kept to a minimum. The mental health care of this client group may be problematic and diagnostic overshadowing can occur because of complex physical, emotional and behavioural issues. If the government agenda is to be followed, this will have an impact on both the pre- and post-registration education of mental health nurses and therefore this must be addressed by the nursing regulatory bodies. There is also an argument for people who have a learning disability in addition to mental health problems to be considered a specialist group within generic mental health services as are other specific groups because of the complexity of their conditions.

Fatigue and endurance limits during intermittent overhead work.

Shoulder problems are prevalent in industrial work, particularly when tasks require the hands to be used at or above shoulder level. Although extensive research has been conducted on prolonged static exertions, and several guidelines for such efforts exist, there is insufficient information for ergonomic evaluation of tasks that are intermittent and/or dynamic. A laboratory simulation was conducted of overhead assembly work that was both intermittent and dynamic, and which varied the duty cycle (work/rest ratio), arm reach, and hand orientation of a tapping task. Results consisted of endurance times and also the times of fatigue onset as indicated by perceived discomfort and declines in muscle strength. Females exhibited longer (22%) endurance times, delayed reports of discomfort, and slower declines in strength. Significant influences of duty cycle were found on both endurance and fatigue times, yet arm reach and hand orientation did not have consistent effects. Distributions of endurance and fatigue times are presented as criteria for preliminary evaluation of overhead work. Endurance times could be predicted with only moderate accuracy from earlier indicators of fatigue onset. Existing guidelines, albeit developed for static tasks, appeared unsuitable for the simulated overhead assembly efforts examined. Furthermore, such guidelines may fail to capture the substantial interindividual variability observed in this experiment.

Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.

BACKGROUND: The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest. METHODS: We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital. RESULTS: Automated external defibrillators were used, 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients 153 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (+/-SD) of 3.5+/-2.9 minutes from collapse to attachment of the defibrillator, 4.4+/-2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8+/-4.3 minutes from collapse to The arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes. CONCLUSIONS: Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates.

Incorporating OASIS into the Visiting Nurses Association.

Beginning in 1994, the Visiting Nurses Association, Western Pennsylvania, began to investigate incorporating an outcome measurement system within its organization for the purposes of marketing quality results, benchmarking achievements, and defining quality of care for both internal and external review groups. In the fall of 1995, this agency was accepted into the Outcome Based Quality Improvement (OBQI) Demonstration Project, also known as the Medicare Quality Assurance Project, which the Health Care Financing Administration has funded for the purpose of measuring clinical and utilization outcomes in the home care arena. This article reviews the processes the agency used to develop and incorporate the entire OBQI process into its systems, including the incorporation of the Outcome Assessment Information Set (OASIS). The OASIS is a set of outcome measurement questions developed by Dr. Peter Shaughnessy at the Center for Health Policy Research in Denver. The process also includes training of staff and development of forms, point-of-care software with a vendor, and plans of action for improving outcomes that have been quantified through OBQI efforts.

Retention in methadone maintenance is associated with reductions in different HIV risk behaviors for women and men.

Using AIDS Initial Assessment questionnaire (AIA) data from 353 injection drug users (IDUs) newly admitted to methadone maintenance (MM), three dimensions of injection risk behavior ("sharing with sexual partner," "sharing with others," and "new needle use") were identified. Among IDUs who continued to inject drugs at 1 year, men retained in treatment obtained lower scores on the "sharing with others" scale than men not retained, even when controlling for initial scale scores and injection frequency. Associations between retention in MM and changes in sexual risk were examined using two AIA measures of sexual risk behavior ("number of IDU sexual partners" and "relative frequency of protected vaginal intercourse"). Controlling for injection frequency, prior sexual risk, and age, there was no difference in sexual risk for men retained in treatment versus those not retained. Among women, those who stayed in MM for 1 year reported significantly fewer IDU partners.

Reporting of HIV risk behaviors by injection drug using heterosexual couples in methadone maintenance.

This study sought to identify differences within injection drug using (IDU) couples in reporting of sexual and needle risk behavior. Subjects were thirty-nine heterosexual couples entering methadone maintenance. In 33.3% of couples, one member reported sharing needles while the other member reported no sharing. In 12.9% of couples, one member reported sharing injection equipment, while the other member reported no sharing. Agreement was 77.4% between members of monogamous couples regarding frequency of condom use, 80.7% regarding vaginal intercourse with condoms, and 25.8% regarding vaginal intercourse without condoms. Within couples, a number of differences between members of the couple in injection equipment sharing were noted, suggesting that individuals who attempt to protect themselves by not sharing injection equipment may be placed at risk by their sexual partners. Further clinical and research efforts should be directed toward reducing barriers to behavior that would protect both partners. Implications for self-report measurement of HIV risk behavior and for preventive interventions are discussed.

Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: monitoring emergency medical services system performance in sudden cardiac arrest.

STUDY OBJECTIVE: To compare emergency vehicle response intervals with collapse-to-intervention intervals to determine which of these system data better correlated with survival after prehospital sudden cardiac arrest. STUDY DESIGN: A 22-month case series, collected prospectively, of out-of-hospital cardiac arrests. Times of collapse, dispatch, scene arrival, CPR, and initial defibrillation were determined from dispatch records, recordings of arrest events, interviews with bystanders, and hospital records. SETTING: Southwestern city (population, 400,000; area, 390 km2) with a two-tiered basic life support-advanced life support emergency medical services system. Emergency medical technician-firefighters without electrical defibrillation capability comprised the first response tier; firefighter-paramedics were the second tier. PATIENTS: One hundred eighteen cases of witnessed, out-of-hospital cardiac arrest in adults with initial ventricular fibrillation. MAIN OUTCOME MEASURES: Survival was defined as a patient who was discharged alive from the hospital. RESULTS: Eighteen of 118 patients (15%) survived. Survivors did not differ significantly from nonsurvivors in age, sex, or basic life support or advanced life support response intervals. Survivors had significantly (P < .05) shorter intervals from collapse to CPR (1.7 versus 5.2 minutes) and to defibrillation (7.4 versus 9.5 minutes). CONCLUSION: Collapse-to-intervention intervals, not emergency vehicle response intervals, should be used to characterize emergency medical services system performance in the treatment of sudden cardiac death.

Effect of triacontanol on numbers and functions of cells involved in inflammatory responses.

A preparation of a triacontanol-containing compound was studied for its effect on cells involved in the inflammatory response. C57BL/6 mice were injected intraperitoneally with various concentrations of this compound and investigated for total body weight, wet weight of thymus tissue, number of thymus cells and splenocytes, interleukin 1 production of spleen monocytes, and response of splenocytes to the T cell mitogen, phytohemagglutinin. Mice treated with the triacontanol preparation exhibited decreased total body weight, 24% reduction in thymus weights, 39% decrease in the number of thymus cells, and 21% depression in total splenocytes. Splenic monocytes of these animals produced a significantly reduced amount of interleukin 1 and splenocytes had a significantly depressed response to phytohemagglutinin. It is concluded that triacontanol has an inhibitory effect on at least some of the cells responsible for inflammation.

Case and survival definitions in out-of-hospital cardiac arrest. Effect on survival rate calculation.

OBJECTIVE: To determine the effect of different case and survival definitions of out-of-hospital cardiac arrest on survival rate calculations. DESIGN: A 22-month case series of nontraumatic, out-of-hospital cardiac arrests. SETTING: Southwestern city (population, 400,000; area, 390 km2) with a two-tiered emergency response system consisting of emergency medical technicians and paramedics. PATIENTS: A consecutive sample of 372 patients found without palpable pulse of spontaneous respiration. MAIN OUTCOME MEASURES: Survival rate after cardiac arrest was calculated using three case definitions of arrest and two definitions of survival. RESULTS: Twenty percent of all patients survived to hospital admission and 6% survived to hospital discharge. Twenty-six percent of adults whose collapse was witnessed survived to hospital admission, and 10% survived to hospital discharge. Patients whose collapse was witnessed and who experienced initial ventricular fibrillation survived to hospital admission in 38% and to hospital discharge in 15% of cases. CONCLUSIONS: The survival rate after out-of-hospital cardiac arrest varies widely depending on the case and survival definitions selected. To facilitate intersystem comparison and assessment of interventions designed to improve outcome, the Utstein Consensus Conference recommended that case and survival definitions should be adopted by all prehospital emergency systems.

An extramural dental education program in a rural setting in Florida.

An extramural dental education experience which is a required component of the University of Florida College of Dentistry is described. The program, established in 1977, is conducted on a contractual basis between the college and the Lafayette-Suwannee Rural Health Corporation, Inc., the governing body of the Dental Center clinic located in the town of Mayo, Florida, which is 65 miles from the dental school. The program has brought high quality comprehensive dental care to a previously underserved population. Dental students are provided with experiences that enhance social sensitization, and that are perceived by them as a help in bridging the gap between dental school and dental practice after graduation. The program has made valued contributions to the education, research, and service components of the dental school's mission.

The use of a soft denture liner for chronic residual ridge soreness.

Chronic residual ridge soreness in patients with complete dentures can be caused by various factors. A differential diagnosis between physiologic or anatomic problems (or both) and functional deficiencies in the patient's present dentures must be made. The functional deficiencies can often be eliminated easily, whereas physiologic and anatomic problems may be more difficult to correct, especially in the geriatric patient. If the functional deficiencies in the patient's dentures have been corrected and surgical procedures are not a viable alternative, placement of a long-term resilient liner can often resolve the chronic residual ridge soreness that is present in denture patients. Properly placed and properly cared for silicone or silicone rubber resilient denture liners can provide comfort for over 70% of patients with chronic residual ridge soreness for 3 to 5 years and often longer.

Prevalence and duration of breast-feeding in Manitoba.

The rate of breast-feeding in the first 3 months post partum was studied in a group of 456 mothers. At 3 months 58% had been or still were breast-feeding their infants. The mothers who breast-fed were older, had a higher level of education, had a higher socioeconomic status, and were more likely to live on farms or in small towns, to have attended prenatal education classes and to have previously breast-feds. There were no significant differences between the method of feeding and the sex or birthweight of the infant, the maternal weight/height ratio or the participation of the father in the prenatal education classes. At 1 month 45% of the infants, at 2 months 35% and at 3 months 28% were being breast-fed. Public programs to promote breast-feeding as normal, beneficial and satisfying to both mother and infant are necessary so that more mothers will attempt to breast-feed their infants. Support for continuance of breast-feeding is needed in the hospital as well as in the home and the community.