Development of the hearing protection assessment (HPA-2) questionnaire

BACKGROUND

Noise-induced hearing loss (NIHL) remains an important occupational health issue as the second most commonly self-reported occupational injury or illness. The incorrect and inconsistent use of hearing protection devices (HPDs) compromises their effectiveness in preventing NIHL.

AIMS

To describe the development of an easily administered yet robust questionnaire to investigate factors that influence HPD use.

METHODS

A hearing protection assessment (HPA-2) questionnaire was developed using items based on themes identified in our previous research. These fell into two classes: supports and barriers to wearing HPD, which formed two scales within the questionnaire. The questionnaire, which also included demographic items, was administered to workers from 34 manufacturing companies. The internal consistency of the scales was tested, and factor analysis was conducted to investigate the underlying structure of the scales.

RESULTS

Of the 1053 questionnaires distributed, 555 completed questionnaires were received giving a response rate of 53%. The Cronbach's alpha for the barriers scale (α = 0.740) and supports scale (α = 0.771) indicated strong internal reliability of the questionnaire. The supports and barriers were further described as five key factors (risk justification, HPD constraints, hazard recognition, behaviour motivation and safety culture) that influence hearing protection behaviour. Workers who reported always using HPDs had more supports across these factors, while those who did not always wear HPDs reported more barriers.

CONCLUSIONS

The HPA-2 questionnaire may be useful in both research and interventions to understand and motivate hearing protection behaviour by identifying and targeting supports and barriers to HPD use at different levels of the ecological model.

Bioaerosol health effects and exposure assessment: progress and prospects

Exposures to bioaerosols in the occupational environment are associated with a wide range of health effects with major public health impact, including infectious diseases, acute toxic effects, allergies and cancer. Respiratory symptoms and lung function impairment are the most widely studied and probably among the most important bioaerosol-associated health effects. In addition to these adverse health effects some protective effects of microbial exposure on atopy and atopic conditions has also been suggested. New industrial activities have emerged in recent years in which exposures to bioaerosols can be abundant, e.g. the waste recycling and composting industry, biotechnology industries producing highly purified enzymes and the detergent and food industries that make use of these enzymes. Dose-response relationships have not been established for most biological agents and knowledge about threshold values is sparse. Exposure limits are available for some contaminants, e.g. wood dust, subtilisins (bacterial enzymes) and flour dust. Exposure limits for bacterial endotoxin have been proposed. Risk assessment is seriously hampered by the lack of valid quantitative exposure assessment methods. Traditional culture methods to quantify microbial exposures have proven to be of limited use. Non-culture methods and assessment methods for microbial constituents [e.g. allergens, endotoxin, beta(1-->3)-glucans, fungal extracellular polysaccharides] appear more successful; however, experience with these methods is generally limited. Therefore, more research is needed to establish better exposure assessment tools and validate newly developed methods. Other important areas that require further research include: potential protective effects of microbial exposures on atopy and atopic diseases, inter-individual susceptibility for biological exposures, interactions of bioaerosols with non-biological agents and other potential health effects such as skin and neurological conditions and birth effects.

The prevalence of eating disorders in female health care students

Previous research has suggested a raised prevalence of eating disorders amongst female medical students. This study aimed to test the belief, commonly held by occupational physicians, that there is also an increased prevalence of eating disorders amongst female applicants to nurse training. If correct, it implies the need for additional support and may predict increased failure to complete the course. Three groups of female students were compared: applicants to a university nurse training course, first-year medical students and a comparison group of first-year university students on courses not related to health care. Possible eating disorders were identified using two self-report instruments, the EAT-26 and the BITE questionnaires, and the body mass index. No significant statistical difference was found in the prevalence of eating disorders between the three groups, using the above measures. After controlling for age and ethnicity, 20% of the nurse applicants were found to have disordered eating patterns meriting further investigation, compared with 19% of medical students and 21% of arts students. The nursing students are being followed up to compare the progress of those with and without disordered eating patterns.

The effects of dietary selenomethionine on polyamines and azoxymethane-induced aberrant crypts

We evaluated the effects of dietary selenomethionine supplementation on colonic polyamine levels and the ability of L-selenomethionine supplementation to modulate the carcinogenic activity of azoxymethane (AOM) in the rat colon. Four-week-old male F344 rats were treated with 15 mg/kg body weight of AOM once a week for 2 weeks. Dietary selenomethionine at a concentration of either 1 or 2 ppm was administered in AIN-76A rodent diet to AOM-treated animals for 16 weeks. Aberrant crypt foci (ACF), precursor lesions of colon cancer, were investigated after the 16 week treatment course. Selenomethionine given in the diet at 2 ppm markedly reduced the number of aberrant crypt foci. The multiplicity of ACFs (i.e. the number of aberrant crypts/focus) and the percentage of microadenomas were also affected by selenomethionine in a dose dependent manner. However, evaluation of the colonic tissue polyamine levels between control and treated groups showed no significant difference. These results demonstrate that selenomethionine can modulate the development of AOM-induced premalignant lesions through a polyamine-independent mechanism.

Impact of FK506 and steroids on adaptation after intestinal resection or segmental transplantation

Segmental small intestinal transplantation (SIT) using living related donors (LRD) is being evaluated as a therapy, clinically. Advantages of this technique include an increase in the donor pool, optimization of the timing of transplants, and potential immunologic benefits. However, the ability of a short segment of intestine to function after transplantation has not been investigated in large animal models. This study evaluates the impact of immunosuppression on the adaptive process and the ability of a transplanted segment of intestine to adapt. A pig model of segmental SIT was used. Animals were resected, leaving 150 cm of distal ileum (n = 5), resected and treated with FK506 (n = 4), or steroids (n = 4), or with FK506 + steroids (n = 7), or transplanted using a similar segment of ileum and treated with FK506 + steroid immunosuppression (n = 9). Animals undergoing resection, or resection plus steroid treatment, did well, gaining weight post-operatively (37% and 15% of preoperative weight, respectively). However, animals undergoing resection and treated with FK506 or FK506 + steroids did poorly, losing weight (-14% and -22% of preoperative weight, respectively) and showing significant impairment of intestinal adaptation, morphologically and functionally. Furthermore, FK506-treated animals developed inflammatory changes in the intestinal mucosa, mimicking rejection. Segmental SIT animals had a high rate of rejection (66%) and showed a similar impairment in adaptation. Hence, segmental SIT is a stringent physiological test of intestinal adaptation. FK506 appears to impair gut function after resection, either directly, or by interfering with the adaptive process. In this model of segmental SIT, FK506 and steroids at the doses tested did not provide adequate immunosuppression to prevent rejection and the graft did not function adequately to allow growth. Further studies are required to evaluate the mechanisms underlying these findings, and to determine if similar effects occur in humans.

The importance of intuition in the occupational medicine clinical consultation

Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined.

Effects of exposure to grain dust in Polish farmers: work-related symptoms and immunologic response to microbial antigens associated with dust

Medical examinations were performed in a group of 76 Polish farmers heavily exposed to grain dust during harvesting and threshing, and in a group of 63 healthy urban dwellers not exposed to organic dusts (controls). The examinations included: interview concerning the occurrence of respiratory disorders and work-related symptoms, physical examination, lung function tests, and allergological tests comprising skin prick test with 4 microbial antigens associated with grain dust and agar-gel precipitation test with 12 microbial antigens. As many as 34 farmers (44.7%) reported the occurrence of work-related symptoms during harvesting and threshing. The most common was dry cough reported by 20 individuals (26.3%). Dyspnoea was reported by 15 farmers (19.7%), tiredness by 12 (15.7%), chest tightness by 8 (10.5%), plugging of nose and hoarseness by 5 each (6. 5%). No control subjects reported these work-related symptoms. The mean spirometric values in the examined group of farmers were within the normal range, but a significant post-shift decrease of these values was observed after work with grain. The farmers showed a frequency of the positive early skin reactions to environmental allergens in the range of 10.8 - 45.5%, and a frequency of positive precipitin reactions in range of 3.9 - 40.8%. The control group responded to the majority of allergens with a significantly lower frequency of positive results compared to the farmers. The obtained results showed a high response of grain farmers to inhalant microbial allergens and indicate a potential risk of occupational respiratory diseases (such as allergic alveolitis, asthma, Organic Dust Toxic Syndrome) among this population

Head and neck cancer in the South West of England: influence of socio-economic status on incidence and second primary tumours

This study examined possible links between the incidence of head and neck squamous cell carcinoma (HNSCC) and social deprivation. Data on all HNSCC registered between 1985 and 1991 in the South West of England were collected. Excluding tumours of the lip and skin there were 1570 cases, 72% in males. Of these, 1467 were identified as first primary tumours. Corrected chi-squared tests, accepting significance at the 5% level, were used to examine the association of socio-economic status (Carstairs index) with incidence at different sites. Overall, the incidence of HNSCC was higher in the socially deprived group. In males, the most deprived group had a significantly higher incidence of oral carcinoma than all other groups (P<0.05), whereas the incidence of laryngeal carcinoma showed a gradual rise with increasing deprivation. In females, where numbers were relatively low, the trend remained, but was less clear. In total, seventy-two (4.9%) cases went on to develop a second primary, of which 35% were in the lung and 13% in the bladder. Socio-economic status did not affect the development of a second primary tumour. The association of HNSCC with carcinoma of the bladder is a new finding.

Anterior knee pain: a review

OBJECTIVE

To establish whether there is consensus in the areas of definition, classification, assessment, diagnostic tests, and management of anterior knee pain.

DATA SOURCES

A Medicine search for the years 1988-1995 was performed using the terms patellofemoral joint, knee joint and pain, injury and rehabilitation, and anterior knee pain. In addition, references from selected papers were examined.

STUDY SELECTION

A total of 77 references specifically related to anterior knee pain were reviewed in the areas of definition, classification, assessment, diagnostic tests, and management. Although a small number of these papers were analytic in their study design, most of the papers reviewed were descriptive.

DATA EXTRACTION

Definitive statements on anterior knee pain in the areas noted herein were extracted and summarized. Similar statements were then grouped as indicative of general consensus. Independent and divergent statements were also summarized for each area of anterior knee pain.

DATA SYNTHESIS

Most of the literature related to anterior knee pain is subjective in nature and demonstrates limited consensus among experts. There is no generally accepted definition or classification of anterior knee pain. There was some agreement on the assessment, use of diagnostic tests, and management of anterior knee pain, but there are no definitive or objective management outcome criteria.

CONCLUSIONS

The scientific literature on anterior knee pain is sparse. This review supports a need for the development of consensus guidelines for anterior knee pain. A consensus approach to anterior knee pain could result in the more efficient use of high-yield diagnostic tests, the use of more effective and standardized protocols for assessment and treatment, increased patient satisfaction, and recommendations on fitness counseling and early prevention.

The Medical Data Index (MDI) dependency module: a shared database to assist discharge planning and audit

As part of the development of integrated, patient-based hospital information technology (IT) systems in the South-Western Region of England, a module has been developed which will hold core data pertaining to the functional status and current resources of elderly or disabled patients. Its purpose is to assist early identification of unmet needs and facilitate prompt transfer to community care. The module provides a shared database, which is completed or updated as necessary on admission and is then available to all appropriate users of the hospital system, avoiding duplication of data collection. In addition to details of home circumstances and support, it includes brief, standardized assessment scales for activities of daily living and mental state, which will identify the need for specialist referral. A summary is provided for easy communication with other care agencies.

Do psychiatric patients know what is good for them?

The paper reports the findings of a medical audit exercise which monitored 192 consecutive psychiatric admissions. Approximately two-thirds of patients, consultants and referrers provided information on admission objectives and the degree to which they were attained. One-third of the patients furnished information on social problems and satisfaction with treatment. Sanctuary was rated as an important admission objective by patients but neglected by consultants and referrers. Patient satisfaction with treatment was significantly correlated with attainment of patient as well as consultant objectives, and negatively correlated with social problems. Agreement between consultant and patient on admission objectives was inversely related to both duration of contact with psychiatric services and number of previous admissions suggesting that congruence with consultants may be lost over time. The limitations imposed by variable response rates are acknowledged. It is concluded that serious note should be taken of psychiatric patients' own treatment objectives.

Cytokinetic analysis of the impaired proliferative response of peripheral lymphocytes from aged humans to phytohemagglutinin

The effect of donor age on the rate of cell entry into the proliferating pool and subsequent cell cycle duration for peripheral lymphocytes stimulated by phytohemagglutinin (PHA) were examined by using the bromodeoxyuridine incorporation-differential staining technique. Distribution curves for the appearance of metaphase cells in successive generations as a function of culture time were obtained and analyzed both graphically and by a computer simulation model. Peripheral lymphocytes from aged individuals (approximately 75 yr) were stimulated by PHA at approximately one-half of the rate of peripheral lymphocytes from young individuals (approximately 21 yr). Subsequent cell-cycle durations were estimated to range from 10.0 to 25.0 h for aged individual lymphocyte cultures and 10.6-15.6 h for young individual lymphocyte cultures. The possible significance of these findings to aging in general is discussed.

BISACK analysis of the phytohaemagglutinin-induced proliferation of human peripheral lymphocytes

The rate of stimulation as well as subsequent cell cycle duration was examined in phytohaemagglutinin-stimulated human peripheral lymphocytes grown in vitro in the presence of non-inhibotory concentrations of bromodeoxyuridine. After incorporation of this heavy atom analogue of thymidine into replicating cellular DNA, it was possible to identify unequivocally metaphase cells which had replicated for one, two and three or more cells cycles. Utlizing this technique, distribution curves were obtained for the appearance of metaphase cells in successive generations, were analysed by a computer simulation model, and the rate of stimulation (4.5% per hr of the reminaing unstimulated population) and cell cycle duration (12.3 hr) were determined. The results were compared with those obtained by autoradiography and the possible relationship to the 'transition probability' model for cellular proliferation is discussed.