Disability rates for cardiovascular and psychological disorders among autoworkers by job category, facility type, and facility overtime hours.

BACKGROUND: We examined the association between long work hours, assembly line work and stress-related diseases utilizing objective health and employment data from an employer's administrative databases. METHODS: A North American automobile manufacturing company provided data for claims for sickness, accident and disability insurance (work absence of at least 4 days) for cardiovascular disease (CVD), hypertension and psychological disorders, employee demographics, and facility hours worked per year for 1996-2001. Age-adjusted claim rates and age-adjusted rate ratios were calculated using Poisson regression, except for comparisons between production and skilled trades workers owing to lack of age denominator data by job category. Associations between overtime hours and claim rates by facility were examined by Poisson regression and multi-level Poisson regression. RESULTS: Claims for hypertension, coronary heart disease, CVD, and psychological disorders were associated with facility overtime hours. We estimate that a facility with 10 more overtime hours per week than another facility would have 4.36 more claims for psychological disorders, 2.33 more claims for CVD, and 3.29 more claims for hypertension per 1,000 employees per year. Assembly plants had the highest rates of claims for most conditions. Production workers tended to have higher rates of claims than skilled trades workers. CONCLUSIONS: Data from an auto manufacturer's administrative databases suggest that autoworkers working long hours, and assembly-line workers relative to skilled trades workers or workers in non-assembly facilities, have a higher risk of hypertension, CVD, and psychological disorders. Occupational disease surveillance and disease prevention programs need to fully utilize such administrative data.

Effects of early mobilization on unhealed dysvascular transtibial amputation stumps: a clinical trial.

OBJECTIVE: To observe the effects of early mobilization on unhealed transtibial (TT) amputation stump wounds of dysvascular etiology. An "unhealed" stump was defined as having a wound greater than 1cm x 1cm at least 3 weeks after surgery. DESIGN: An observational cohort study. SETTING: This center receives about 250 new lower-limb amputees a year from over 50 surgeons working in 16 hospitals. Over 35% are unhealed. PARTICIPANTS: Sixty-six consecutive new TT amputees (age 62.8+/-10.8y) of dysvascular etiology (diabetes 50%) with unhealed stumps were recruited. Sixty-one percent were current or past smokers. The mean +/- SD stump wound size was 7.7+/-2.7cm x 3.2+/-2.0cm. INTERVENTIONS: The wound size was measured, and stump transcutaneous oxygen (TcpO(2)) and transcutaneous carbon dioxide (TcpCO(2)) were measured. Wounds were debrided and dressed by using a standard protocol. Mobilization using a Pneumatic Post-Amputation Mobility (PPAM) Aid for approximately 3 weeks was followed by provision of a TT prosthesis. A standard physiotherapy walking training program was performed. MAIN OUTCOME MEASURES: Stump wound healing, time to achieve healing, and resting transcutaneous oxygen pressure pre- and posttherapy. RESULTS: Of the 66 amputees, 4 did not start. Sixty-two started; 6 withdrew, and 56 completed the trial. Complete wound healing was achieved in 74% (46/62) over a mean of 141 (87-270) days. The mean +/- SD stump TcpO(2) at baseline was 41.3+/-19.8mmHg and increased significantly to 50.6+/-21.9mmHg (P<.02) after 97 (34-185) days of mobilization. Nine of 46 required revision plastic surgery. Five subjects, whose wounds were healing, became unwell, dropped out, and later deceased. Five subjects, all current smokers, did not heal and underwent higher amputation. CONCLUSIONS: Patients with large unhealed TT stump wounds can simultaneously undergo walking training by using a prosthesis and can achieve wound healing. Seventy-four percent of subjects achieved full wound healing. The small minority of patients who did not heal were current smokers whose TcpO(2) levels did not improve throughout the trial. Rising levels of stump TcpO(2)were associated with wound healing.

Highwire restrains synaptic growth by attenuating a MAP kinase signal.

Highwire is an extremely large, evolutionarily conserved E3 ubiquitin ligase that negatively regulates synaptic growth at the Drosophila NMJ. Highwire has been proposed to restrain synaptic growth by downregulating a synaptogenic signal. Here we identify such a downstream signaling pathway. A screen for suppressors of the highwire synaptic overgrowth phenotype yielded mutations in wallenda, a MAP kinase kinase kinase (MAPKKK) homologous to vertebrate DLK and LZK. wallenda is both necessary for highwire synaptic overgrowth and sufficient to promote synaptic overgrowth, and synaptic levels of Wallenda protein are controlled by Highwire and ubiquitin hydrolases. highwire synaptic overgrowth requires the MAP kinase JNK and the transcription factor Fos. These results suggest that Highwire controls structural plasticity of the synapse by regulating gene expression through a MAP kinase signaling pathway. In addition to controlling synaptic growth, Highwire promotes synaptic function through a separate pathway that does not require wallenda.

Cytoplasmic inositol hexakisphosphate production is sufficient for mediating the Gle1-mRNA export pathway.

Production of inositol hexakisphosphate (IP6) by Ipk1, the inositol-1,3,4,5,6-pentakisphosphate 2-kinase, is required for Gle1-mediated mRNA export in Saccharomyces cerevisiae cells. To examine the network of interactions that require IP6 production, an analysis of fitness defects was conducted in mutants harboring both an ipk1 null allele and a mutant allele in genes encoding nucleoporins or transport factors. Enhanced lethality was observed with a specific subset of mutants, including nup42, nup116, nup159, dbp5, and gle2, all of which had been previously connected to Gle1 function. Complementation of the nup116Deltaipk1Delta and nup42Deltaipk1Delta double mutants did not require the Phe-Gly repeat domains in the respective nucleoporins, suggesting that IP6 was acting subsequent to heterogeneous nuclear ribonucleoprotein targeting to the nuclear pore complex. With Nup42 and Nup159 localized exclusively to the nuclear pore complex cytoplasmic side, we speculated that IP6 may regulate a cytoplasmic step in mRNA export. To test this prediction, the spatial requirements for the production of IP6 were investigated. Restriction of Ipk1 to the cytoplasm did not block IP6 production. Moreover, coincident sequestering of both Ipk1 and Mss4 (an enzyme required for phosphatidylinositol 4,5-bisphosphate production) to the cytoplasm also did not block IP6 production. Given that the kinase required for inositol 1,3,4,5,6-pentakisphosphate production (Ipk2) is localized in the nucleus, these results indicated that soluble inositides were diffusing between the nucleus and the cytoplasm. Additionally, the cytoplasmic production of IP6 by plasma membrane-anchored Ipk1 rescued a gle1-2 ipk1-4 synthetic lethal mutant. Thus, cytoplasmic IP6 production is sufficient for mediating the Gle1-mRNA export pathway.

Evaluation of the clinical usefulness of isolation of fetal DNA from the maternal circulation.

OBJECTIVE: To assess the reliability of isolating free fetal DNA from maternal usefulness. DESIGN: Fetal DNA was isolated from plasma or serum that was either collected prospectively or from archived samples collected for the purposes of second trimester screening. METHODS: Prospective samples were collected from patients undergoing prenatal diagnostic procedures (n = 24). A second group of samples from Rhesus negative women (n = 28) were assayed in which blood had originally been collected for maternal triple serum screening. DNA was extracted from all samples and assayed for the presence of the beta-globin gene, sex-determing region Y (SRY) gene and Rh gene. All DNA sample handling and extraction was carried out by a single operator, and polymerase chain reaction (PCR) was carried out using previously published PCR primers and appropriate controls. The accuracy of results was assessed relative to the karyotype in the case of the SRY gene or cord blood phenotype in the case of the Rh gene. RESULTS: The SRY PCR results were compared to fetal cell karyotypes obtained from invasive diagnostic testing, 21 out of the 24 samples were correctly 'sexed'. The RhD PCR results were compared to fetal cord blood samples at the time of delivery, and showed both false positive and false negative results. Two RhD negative babies were genotyped as RhD positive, despite repeat analysis. CONCLUSION: It is possible to isolate fetal DNA from maternal serum. It is a potentially clinically useful technique in our laboratory and can be used to detect male fetuses, and Rh negative fetuses. To be useful in clinical practice, it is necessary to safeguard against contamination at the time of sample handling, and to use the optimal range of primers available to cover the polymorphisms present within the RhD gene. Although not robust enough yet to be used with diagnostic certainty in our hands, immense improvements in technique, probes and real-time PCR equipment make this type of diagnosis a reality in the near future.

A patient-held record for cancer patients from diagnosis onwards.

This article presents the findings of a qualitative study looking at the content and use of a personally held record for cancer patients. The study was conducted in the York area of the UK over a 1-year period and the record was introduced to patients as near to diagnosis as possible. The record had three main sections: general information, communication sheets and a health diary. Users were invited to complete questionnaires and volunteer patients took part in independently facilitated focus group discussions. Patients liked the record and placed importance on access to information early in their treatment process. They valued the health diary as a means of therapy and personal reflection and shared information in the records with family and friends. The steering group coordinating the study believed there was sufficient positive feedback to warrant further work. However, the findings of regional and national working groups must be assessed before progressing to the next stage of development.

Results of salmonella isolation from poultry products, poultry, poultry environment, and other characteristics.

Five hundred sixty-nine Salmonella were isolated out of 4745 samples from poultry products, poultry, and poultry environment in 1999 and 2000 from the Pacific northwest. These Salmonella were identified to their exact source, and some were serogrouped, serotyped, phage typed, and tested for antibiotic sensitivity. Food product samples tested included rinse water of spent hens and broilers and chicken ground meat. Poultry environment samples were hatchery fluff from the hatcheries where eggs of grandparent broiler breeders or parent broiler breeder eggs were hatched and drag swabs from poultry houses. Diagnostic samples were of liver or yolk sac contents collected at necropsy from the young chicks received in the laboratory. Of these samples tested, 569 were Salmonella positive (11.99%). Ninety-two Salmonella were serogrouped with polyvalent somatic antisera A-I and the polymerase chain reaction. Somatic serogroups B and C comprised 95.25% of all the Salmonella. Out of a total of 569 positive samples, 97 isolates of Salmonella were serotyped. A total of 16 serotypes and an unnamed Salmonella belonging to serogroup C1 were identified. The Salmonella serotypes were heidelberg (25.77%); kentucky (21.64%); montevideo (11.34%); hadar and enteritidis (5.15% each); infantis, typhimurium, ohio, and thompson (4.12% each); mbandaka and cerro (3.09% each); senftenberg (2.06%); berta, istanbul, indiana, and saintpaul (1.03% each); and an unnamed monomorphic Salmonella (2.06%). Ninety-two Salmonella were tested for drug sensitivity with nine different antimicrobials. All of the 92 Salmonella were resistant to erythromycin, lincomycin, and penicillin except one sample (S. berta), which was moderately sensitive to penicillin. All of the tested Salmonella were susceptible to sarafloxacin and ceftiofur. The percentages of Salmonella susceptible to sulfamethoxazole-trimethoprim, gentamicin, triple sulfa, and tetracycline were 97.83%, 92.39%, 86.96%, and 82.61%, respectively.