Health hazard among cash register operators and the effect of improved working conditions.

The health condition of female cash register operators in relation to their working conditions was investigated. A questionnaire study revealed that cash register operators more frequently complained of general fatigue, headache, sleeplessness, and low back pain than female office machine operators or other female workers. Dullness and pain in the shoulder, arm, hand, and fingers especially on the right side were characteristic of cash register operators. Physical examinations in 1973 showed that 31.3% of 371 cash register operators suffered from muscle rigidity or tenderness; 13 were severely afficted and, 69 operators had to be either laid off, reassigned to other jobs, or given shorter working hours. Occupational cervicobrachial disorders were suggested to have been caused by repetitive upper limb motions combined with static load, an unfavorable working environment, and mental stress. Implementation of some improvements including shorter operation time, worker rotation, and adoption of electronic registers proved effective in reducing the number of sufferers of cervicobrachial disorders found during the 1975 physical examinations. But the improvements were not effective enough to alleviate fatigue of the neck, shoulder, and back due presumably to sustaining upper limbs while operating the keyboard.     

Low-back pain among electric power supply workers and their attitude toward its prevention and the treatment.

Low-back pain among electric power supply workers and their opinions about the ways to prevent and relieve the disorder were investigated. A questionnaire study revealed that 38.7% of 6,272 electric power supply workers were suffering from low-back pain, including severe pain resulting in frequent absenteeism or requiring occasional rest from work. Chronological analysis of the occurrence of the disorder revealed that the incidence of gradually developing pain has increased and that improper working posture and overwork have become more important as etiological factors. Rest from work was found to be the most effective way of relieving pain, while any medical treatment which did not include rest was useless. Low-back pain among these workers is believed to have resulted from rapid and intensified work as required by increasing demand and mechanization, greater mental stress and improper working posture. As preventive measures, it is necessary to improve working hours and to lighten the rate of work. In order to relieve pain, the employers should permit the workers to absent themselves from work quickly following an attack. Discrepancy between workers' opinions and both actual causation of low-back pain and actual effectiveness of medical treatment is discussed.     

Integration of mental health into primary care and community health working in Kenya: context, rationale, coverage and sustainability

Integration of mental health into primary care is essential to meet population needs yet faces many challenges if such projects are to achieve impact and be sustainable in low income countries alongside other competing priorities. This paper describes the rationale and progress of a collaborative project in Kenya to train primary care and community health workers about mental health and integrate mental health into their routine work, Within a health systems strengthening approach. So far 1877 health workers have been trained. The paper describes the multiple challenges faced by the project, and reviews the mechanisms deployed which have strengthened its impact and sustainability to date.     

Community Demand for Doctors in the next 10 Years

The demand for doctors has increased despite improved community health, because the prevalence of chronic disease has increased, and because affluence, better education, and the growth of specialization have all stimulated demand.Most authorities have recommended an increase in the supply of doctors to meet the increasing demand. Nevertheless, a supply which preserves the present ratio of doctors to population might be adequate if medical productivity were raised. Moreover, an increase of the supply stimulates further demand; perhaps demand would fall if the supply were reduced, and community health might not deteriorate as a result of this.Other social institutions besides medicine have a claim on the available pool of talent from which doctors are recruited. It is possible that medicine already receives its fair share.     

Economic aspects of village health

Given the poor quantity and quality of medical care in most villages in the developing countries, the economic determinants of village health are the supply of labour, the cash flow associated with that labour and the availability of land. The paper examines these in the three classical 'time periods', arguing that inability to meet labour peaks is of great significance in explaining seasonal shortage of food and chronic shortage of cash. It also explains community indifference to upkeep of social overhead capital. Substitution of capital goods for labour is socially differentiated, not least by labour availability, and leads inevitably to a regressive distribution of land and the creation or enlargement of a class of landless labourers. Under certain limited conditions this class may enjoy a rising real income with associated health-promotive expenditures. The more normal case, however, is extreme poverty, whether rural or urban, with all that that implies for the undermining of health. Land reform therefore becomes a necessary precondition of health promotion.     

From confounders to suspected risk factors: psychosocial factors and work-related upper extremity disorders.

Psychosocial variables have recently been more prominent among epidemiologic risk factors for work-related upper extremity disorders (WRUEDs), but bio-behavioral mechanisms underlying these associations have been elusive. One reason is that the psychosocial domain has included many broad and disparate variables (e.g. mood, coping skills, job control, job satisfaction, job stress, social support), and this lack of specificity in the conceptualization of psychosocial factors has produced limited hypothesis testing opportunities. Therefore, recent research efforts have focused on identifying and conceptualizing specific psychosocial factors that might more clearly delineate plausible bio-behavioral mechanisms linking psychosocial factors to WRUEDs. One such factor is workstyle, a strategy that workers may employ for completing, responding to, or coping with job demands that might affect musculoskeletal health. Preliminary studies have provided support for measurable differences in workstyle among individual workers and an association with upper extremity pain and discomfort. An initial self-report measure of workstyle has been pilot tested among office workers and shown acceptable reliability and validity. Future studies are needed to study this construct among other working populations and to determine its relationship with other clinical endpoints. Nevertheless, early findings suggest workstyle may be a potential focus of WRUED prevention efforts.     

Multiscale spike train variability in primary electrosensory afferents.

Spike train variability is of fundamental importance for understanding how information is encoded and processed in the nervous system. Most studies in this area have focused on short-term variability, as characterized by the coefficient of variation of the interspike interval distribution. Here we discuss the importance of extending the analysis of spike train variability to longer time scales that span multiple interspike intervals. Recent experimental and modeling studies of probability coding (P-type) electrosensory afferent nerve fibers in weakly electric fish have provided new insights into the functional importance of multiscale spike train variability. P-type afferent spike trains are moderately irregular on short time scales of a few milliseconds, but show significantly enhanced regularity on time scales of a few hundred milliseconds. This increased regularity is beyond what would be expected for a renewal process model in which successive intervals are uncorrelated. Modeling studies suggest that the correlation structure that underlies spike train regularization arises from relative refractory effects associated with a dynamic spike threshold. Spike train regularization in P-type afferents has been shown to significantly enhance signal detectability and information transmission on time scales that are functionally relevant for electrolocation behavior.     

Physiological and psychophysiological indices dynamics in operators with three-shift working day in different working conditions

It was shown that intense operator work in pulp and paper industry (bleachers and chlorinators) with changes in shift time (day, evening, night) causes fatigue. The fatigue in operators was indicated by increasing number of errors in sensomotor coordination test and coordination index, and among chlorinators it was accompanied by deterioration of state of health. Manifestations of 24 hours' rhythm of physiological functions were detected by changes in body temperature (among bleachers), heart rate, blood pressure and sensomotor coordination indices (all operators). Harmful chemical substances (chlorine and chlorine dioxide) in the air negatively influence psychophysiological status among clorinators.     

A study of the parameters of electric stimulation on the dorsal hippocampus for the "after discharge", carried out with the aid of a current-operated telestimulator, in the rabbit supplied with permanent electrodes

Our purpose in this work has been to carry out experiment of electric stimulation of the dorsal hippocampus, by measuring exactly the quantity of stimulating current, expressed in mA, in order to ascertain the actual quantities of electric charges, expressed in microcoulombs and conveyed to the examined structure and able to cause "an after discharge". the optimum stimulation frequency involving supply of the lowest quantity of electric charges and such frequency is more or less equal to the frequency of discharge of the paroxysmal bioelectric activity (about 20 c/sec). The optimum length of the train of stimulation is very short, but non shorter than 1 sec; consequently the length of the train of stimuli of 2, 5 sec, corresponding to a current intensity inferior to 1 mA and to a sufficiently low quantity fo charges, is to be regarded as the optimum length. The optimum length of the single stimulus is very short too, but it cannot be too short, since, also in this case, the intensity of current necessary to reach the threshold for the "after discharge" would reach such values as to cause lesions in the stimulated structure; consequently the length of the single stimulus corresponding to 0, 4 msec is to be considered as to optimum length.     

Oxidative stress and inflammation: liver responses and adaptations to acute and regular exercise

The liver is remarkably important during exercise outcomes due to its contribution to detoxification, synthesis, and release of biomolecules, and energy supply to the exercising muscles. Recently, liver has been also shown to play an important role in redox status and inflammatory modulation during exercise. However, while several studies have described the adaptations of skeletal muscles to acute and chronic exercise, hepatic changes are still scarcely investigated. Indeed, acute intense exercise challenges the liver with increased reactive oxygen species (ROS) and inflammation onset, whereas regular training induces hepatic antioxidant and anti-inflammatory improvements. Acute and regular exercise protocols in combination with antioxidant and anti-inflammatory supplementation have been also tested to verify hepatic adaptations to exercise. Although positive results have been reported in some acute models, several studies have shown an increased exercise-related stress upon liver. A similar trend has been observed during training: while synergistic effects of training and antioxidant/anti-inflammatory supplementations have been occasionally found, others reported a blunting of relevant adaptations to exercise, following the patterns described in skeletal muscles. This review discusses current data regarding liver responses and adaptation to acute and regular exercise protocols alone or combined with antioxidant and anti-inflammatory supplementation. The understanding of the mechanisms behind these modulations is of interest for both exercise-related health and performance outcomes.     

Blood‐based biomarkers for Down syndrome and Alzheimer's disease: A systematic review

Down syndrome (DS) occurs due to triplication of chromosome 21. Individuals with DS face an elevated risk for development of Alzheimer's disease (AD) due to increased amyloid beta (Aβ) resulting from the over‐expression of the amyloid precursor protein found on chromosome 21. Diagnosis of AD among individuals with DS poses particular challenges resulting in an increased focus on alternative diagnostic methods such as blood‐based biomarkers. The aim of this review was to evaluate the current state of the literature of blood‐based biomarkers found in individuals with DS and particularly among those also diagnosed with AD or in prodromal stages (mild cognitive impairment [MCI]). A systematic review was conducted utilizing a comprehensive search strategy. Twenty‐four references were identified, of those, 22 fulfilled inclusion criteria were selected for further analysis with restriction to only plasma‐based biomarkers. Studies found Aβ to be consistently higher among individuals with DS; however, the link between Aβ peptides (Aβ1‐42 and Aβ1‐40) and AD among DS was inconsistent. Inflammatory‐based proteins were more reliably found to be elevated leading to preliminary work focused on an algorithmic approach with predominantly inflammatory‐based proteins to detect AD and MCI as well as predict risk of incidence among DS. Separate work has also shown remarkable diagnostic accuracy with the use of a single protein (NfL) as compared to combined proteomic profiles. This review serves to outline the current state of the literature and highlights the potential plasma‐based biomarkers for use in detecting AD and MCI among this at‐risk population.     

The cultural ecology of dietary change accompanying changing activity patterns among the shipibo

Shipibo Indians, who formed a village to establish a school and health clinic, are gradually depleting local fish and game resources. Men, recently adopting rice as a cash crop, tend to fish and hunt less than other men working only their subsistence gardens. Sale of fish and game in the village is becoming common, and pigs, once raised exclusively for sale to non-Shipibo, are now more regularly eaten and used for attracting agricultural labor. Other research has indicated that cash cropping often competes for workers' time in subsistence and so dietary change usually accompanies changing activity patterns. This paper explores the latter possibility by examining the relationship between cash cropping, wild meat procurement, and diet among the Shipibo. Time allocation and food consumption data are analyzed statistically to test a mathematical theory and model which relates indigenous work patterns to diet.     

A Low-Cost Stove Use Monitor to Enable Conditional Cash Transfers

Conditional cash transfers (CCTs)—cash payments provided to households or specific household members who meet defined conditions or fulfill certain behaviors—have been extensively used in India to encourage antenatal care, institutional delivery, and vaccination. This paper describes the social design and technical development of a low-cost, meal-counting stove use monitor (the Pink Key) that enables a CCT based on liquefied petroleum gas (LPG) usage and presents pilot data from its testing and the initial deployment. The system consists of a sensing harness attached to a two-burner LPG stove and an easily removable datalogger. For each cooking event with LPG, households receive 2 rupees—less than the cost of fuel, but enough to partially defray LPG refill costs. The system could enable innovative “self-monitoring” at a large scale—participants initiate the CCT by bringing their Pink Key to antenatal clinic visits, where care providers download data and initiate payments, and participants return the sensor to their stove at home. The system aligns with existing Indian programs to improve health among poor, pregnant women, and contributes a new method to encourage the use of clean cooking technologies.     

Effectiveness of a cytokine restraining agent (CRA (TM)) in attenuating disuse deconditioning induced by hindlimb unloading in rats

Spaceflight alters many immune responses and among the regulatory components of an organisms response system that have been to be affected by spaceflight is the cytokine network. Spaceflight, as well as ground-based model systems of spaceflight, have been shown to affect the production and activation of various cytokines including interleukins (IL) and tumor necrosis factor (TNF). Levels of urinary IL-2 are elevated on the first day of spaceflight and again after returning from space. Most results from ground-based studies in rodents indicate either no alterations in cytokines or decreased levels. Results from this experiment indicate that HP 228, a potent cytokine restraining agent (CRA (TM)) was effective in attentuating many of the disuse deconditioning changes induced by the ground-based hindlimb suspension model that simulates weightlessness in rats. HP 228 is a novel heptapeptide with unnatural amino acids and can effectively restrain lipopolysaccharide (LPS)-induced increased levels of several key cytokines, including plasma TNF alpha, IL-1 beta and IL-6. HP 228 has also been shown to be effective in several rodent models of pain, inflammation and LPS-induced lethality, as well as in reducing inducible nitric oxide synthase.     

Effect of arginine vasopressin in the nucleus raphe magnus on antinociception in the rat

Previous work has shown that arginine vasopressin (AVP) regulates antinociception through brain nuclei rather than the spinal cord and peripheral organs. The present study investigated the nociceptive effect of AVP in the nucleus raphe magnus (NRM) of the rat. Microinjection of AVP into the NRM increased pain threshold in a dose-dependent manner, while local administration of AVP-receptor antagonist-d(CH2)5Tyr(Et)DAVP decreased the pain threshold. Pain stimulation elevated AVP concentration in the NRM perfuse liquid. NRM pretreatment with AVP-receptor antagonist completely reversed AVP's effect on pain threshold in the NRM. The data suggest that AVP in the NRM is involved in antinociception.     

Arginine vasopressin in the caudate nucleus plays an antinociceptive role in the rat

Our previous work has shown that arginine vasopressin (AVP) regulates antinociception through brain nuclei rather than the spinal cord and peripheral organs. The present study investigated the nociceptive effect of AVP in the caudate nucleus (CdN) of the rat. Microinjection of AVP into the CdN increased pain threshold in a dose-dependent manner, while local administration of AVP-receptor antagonist-d(CH(2))(5)Tyr(Et)DAVP decreased pain threshold. Pain stimulation elevated AVP concentration in CdN perfuse liquid. CdN pretreatment with AVP-receptor antagonist completely reversed AVP's effect on pain threshold in the CdN. The data suggest that AVP in the CdN is involved in antinociception.     

Benchmarking environmental performance of electric insulator supply chain in India using life cycle assessment

Purpose

This study aims at finding the environmental impacts generated by an electric disk insulator supply chain, used for the distribution of electricity by an open wire system, through a case study. This study also aims at benchmarking the environmental impacts of an electric insulator manufacturing process by taking ideal condition of zero waste as reference.

Methods

Cradle-to-grave life cycle assessment (LCA) has been carried out by following the guidelines provided in ISO 14040 series standards and using Umberto NXT software. ReCiPe endpoint and ReCiPe midpoint impact assessment methodologies have been used to calculate environmental impacts under various categories. The primary data has been collected from a medium-scale manufacturer of electric disk insulators located at Bikaner in north-west India. The secondary data has been taken from ecoinvent 3.0 database and literature. The environmental impacts using endpoint assessment (ecosystem quality, human health, and resources) and midpoint assessment (climate change, fossil depletion, human toxicity, metal depletion, ozone depletion, terrestrial acidification, and water depletion) categories have been computed. Finally, the results are compared and benchmarked against the ideal zero waste condition using three different production scenarios. The limitation of this study is that the data has been collected only from one manufacturer and its supply chain.

Results and discussion

It has been found that the use of steel, electricity, and fuel; transportation of product; and disposal of water generate high environmental impacts in the supply chain. It has also been found that in the electric disk insulator supply chain, the raw material extraction phase has the highest environmental impacts followed by manufacturing, disposal, transportation, and installation phases. This study has also found that benchmark scenario “B” (zero waste condition) is environmentally more efficient in comparison to scenario “A” (actual recycling condition) and scenario “C” (maximum waste condition).

Conclusions

This study has identified that raw materials, resources, and processes in the supply chain of an electric disk insulator manufacturing unit are responsible for the environmental damage. The various manufacturing processes and installation of the electric disk insulators are similar for all manufacturers except the machinery efficiency and the generated waste. This study provides environmental impacts associated with an electric disk insulator manufacturing process under zero waste or ideal conditions (scenario B). These results are used as a benchmark to compare environmental performance of electric disk insulator supply chain operating under actual conditions.

     

Who should be doing what in the international health: a confusion of mandates in the United Nations?

Since 1945 at least five United Nations organisations have become substantially involved in international health activities. This has led to considerable confusion among policy makers, scholars, and UN staff over distinct and appropriate mandates. Interviews with staff an a historical analysis have shown that while formal mandates have been complementary, effective mandates have led to an unclear delineation of activities. The process of translating formal into effective mandates have been influenced by the decentralised nature of the UN, lack of a master plan for its activities, the considerable growth in the policy agenda and the shift towards a multisectoral approach to health. The identification of each organisation''s comparative advantage, at both the global and country levels, is one way of understanding what each organisation does best and perhaps should be doing. There is a need for improved mechanisms to define effective mandates, taking into account comparative advantages, if the mandates of UN organisations are appropriate to meet future challenges in international health.     

Bone grafts and bone morphogenetic proteins in spine fusion

Spinal fusions are being performed for various pathologies of the spine. Stabilizing vertebral segments by eliminating motion across those segments becomes critical in dealing with pathologies of the spine that lead to instability. The use of autograft has been the gold standard for spine fusion. However, due to complications such as donor site morbidity, increased operating time, and limited supply, the use of allograft as a graft extender has become an acceptable practice especially in fusions spanning multiple segments. The discovery and isolation of novel proteins (i.e., bone morphogenetic proteins, BMPs), which initiate the molecular cascade of bone formation, have experimentally been shown in numerous animal studies to be as effective as autografts. Although the use of BMPs has exciting applications in spine surgery, long-term clinical studies must be evaluated for its efficacy in various applications in humans. The use of biomimetic materials such as hydroxyapatite (HA), or tricalcium phosphate (TCP) has also been examined in several animal models as bone graft substitutes or carriers. Although these materials have shown some promise in specific site applications, more work remains in elucidating an efficacious combination of these materials and BMPs that can be as effective as autografts. This review will present the status of bone grafts, bone morphogenetic proteins, gene therapy, and work that has been done to facilitate spinal fusion and simultaneously eliminate the need for bone graft. This revised version was published online in July 2006 with corrections to the Cover Date.