Extended Working Hours and Health

Statistical analyses of the relation between the amount of working hours and impairments to health, based on data from a European survey on working conditions in 2000, clearly reveal that there is a substantial correlation between the number of working hours per week and the frequencies of health complaints. This applies to both musculo‐skeletal disorders as well as to psycho‐vegetative complaints. The relationship of the duration of the exposure to working conditions to health impairments is moderated by a great number of individual (e.g., age) and situational (e.g., shift‐work) variables, showing additive or interactive effects for which selected examples have been presented. In general, however, there is a consistent functional relationship between the number or working hours and their effects on the workers that holds over a great variety of conditions. It is argued that requests for extending working hours should thus be handled with care.     

Introduction: Aging and the Multifaceted Influences on Adaptation to Working Time

This special issue of Chronobiology International presents a selection of papers originally delivered at the 18th International Symposium on Shift Work and Working Time, held at Yeppoon, Australia, in August 2007. The key theme of the symposium was “Aging and Working Time: Creating Safe Environments.” Older workers are widely believed to experience greater difficulty than younger workers adapting to shift work and irregular work schedules. However, while the three reviews of age effects published here (Costa & Di Milia, ; Folkard, ; Gander & Signal, ) identify evidence that older workers do indeed adapt less well, they also demonstrate that much more research is urgently required. The remaining papers address various aspects of the impact of work schedules on health, safety, sleep, and performance. They can be divided into three broad categories: circadian and other periodic factors; sleep, sleepiness, and fatigue; and other aspects of health and adjustment. This collection of papers showcases the best of contemporary research on the safety and health effects of working hours, continuing the tradition established by the two previous issues of the journal devoted to earlier symposia on shift work and working time.     

The Ethics of Engaged Presence: A Framework for Health Professionals in Humanitarian Assistance and Development Work

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships.     

Development and testing of an Index of Stream Condition for waterway management in Australia

1. An Index of Stream Condition (ISC) has been developed to assist broad scale management of waterways by providing an integrated measure of their environmental condition. 2. The ISC provides scores for five components of stream condition: (i) hydrology (based on change in volume and seasonality of flow from natural conditions); (ii) physical form (based on bank stability, bed erosion or aggradation, influence of artificial barriers, and abundance and origin of coarse woody debris); (iii) streamside zone (based on types of plants; spatial extent, width, and intactness of riparian vegetation; regeneration of overstorey species, and condition of wetlands and billabongs); (iv) water quality (based on an assessment of phosphorus, turbidity, electrical conductivity and pH); and (v) aquatic life (based on number of families of macroinvertebrates). 3. The ISC is intended for use by managers at state and regional levels and can be used to report on stream condition, assist with priority setting, judge the long-term effectiveness of rehabilitation programs and assist with adaptive management. The best available scientific information was used by a multidisciplinary group of scientists and managers to create a stream assessment procedure that can be used routinely by people with limited scientific training. 4. ISC development included trials in four catchments in Victoria, Australia. Over 80 stream reaches were assessed and the results were used to refine the ISC to improve the ease of measurement and ensure that outcomes met the expectations of users. The ISC is now available to be used more widely for reporting on stream condition.     

Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa

Background

High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions.

Methods and Findings

Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries.

Conclusions

As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive, and validated index may enable ongoing and efficient observation-based assessment of care quality during labor and delivery in sub-Saharan Africa, facilitating targeted quality improvement.     

Understanding the Development and Perception of Global Health for More Effective Student Education

The concept of “global health” that led to the establishment of the World Health Organization in the 1940s is still promoting a global health movement 70 years later. Today’s global health acts first as a guiding principle for our effort to improve people’s health across the globe. Furthermore, global health has become a branch of science, “global health science,” supporting institutionalized education. Lastly, as a discipline, global health should focus on medical and health issues that: 1) are determined primarily by factors with a cross-cultural, cross-national, cross-regional, or global scope; 2) are local but have global significance if not appropriately managed; and 3) can only be efficiently managed through international or global efforts. Therefore, effective global health education must train students 1) to understand global health status; 2) to investigate both global and local health issues with a global perspective; and 3) to devise interventions to deal with these issues.     

Health Development Meets the End of State Socialism: Visions of Democratization, Women's Health, and Social Well-Being for Contemporary Russia

As development organizations undertake thetask of improving the public health in formersocialist states, their interventions are shaped by aparticular cultural logic and predetermined frame ofpossible action. In the context of local encounters,however, they often confront competing interpretationsof a society's prevailing needs. How they managesuch differences may not only explain the outcomes ofa given project, but may also reveal the capacitiesand limitations of development agencies to engineerpost-socialist change. This article examines a recentWHO project in St. Petersburg, Russia, which definedwomen's ``social well-being' as a local health concern.While the project employed a discourse of ``democracy'to promote women's empowerment in the clinic, itsparameters of intervention neither incorporated localknowledge nor addressed the structural relationsunderlying clinic-level conflicts. Two kinds ofresults ensued: the ideology of democracy wasrejected, while WHO's recommendations were partiallyappropriated as profit-making strategies.     

Development of a Tool to Facilitate Participation of Maori in the Management of Stream and River Health

A cultural health index (CHI) for streams was developed in a program of collaborative research involving members of Ngai Tahu (an iwi [tribe] within the South Island of New Zealand) and ecologists at Otago University. The aim was to provide a tool for effective participation of Maori in resource management decisions. Five cultural values are of central importance to the nature of the CHI: mauri (spiritual life force), mahinga kai (traditional resource harvesting), kaitiakitanga (guardianship obligation), ki uta ki tai (mountains-to-the-sea holistic philosophy), and wai taonga waters that are treasured). The CHI has three components. Forty-six stream sites in two culturally important river catchments were first classified according to whether there is a traditional association with Maori. The second component assessed the historical and contemporary mahinga kai status of the site, including questions of legal and physical access. The third component was a Cultural Stream Health Measure (CSHM) that encapsulates indicators of catchment, riparian, and instream condition in a manner that is consistent with Maori values. The CSHM was found to be significantly correlated with western measures of stream health commonly used in New Zealand (Macroinvertebrate Community Index, Stream Health Monitoring and Assessment Kit), and performed at least as well in encapsulating the relationship between land development and stream health. We describe a multistep process by which other indigenous people can develop a cultural ecosystem health measure, and then use the tool to ensure a substantial role in decision making with the agency in charge.     

Concentrations of Heavy Metals and Arsenic in Market Rice Grain and Their Potential Health Risks to the Population of Fuzhou,China

Heavy metals and As in rice are of increasing concern in China. In this study, concentrations of Pb, Cd, Cu, Cr, Sb, Ni, and As in rice collected from markets in Fuzhou, China, were investigated by ICP-MS and AFS, and their potential health risk to inhabitants were estimated by target hazard quotient (THQ), hazard index (HI), and target cancer risk (TR). The results showed that the concentrations of the seven studied elements in rice grain were all below the permissible limits of China's national standards for foodstuffs (NY/T 419–2007 and GB 2726–2012). For non-carcinogenic risk, the THQ values of individual elements were within the safe interval. However, without considering the bio-accessibility and speciation of toxic elements, the HI values suggest inhabitants in Fuzhou may experience potential health effects due to rice consumption. Cadmium is the major contributor to HI, followed by As. The TR values of As for adults and children were both higher than the acceptable range. The results of this study suggest that more attention should be paid toward monitoring toxic substances (especially Cd and As) in rice in order to assure the food safety for consumers in Fuzhou, China.     

Development and validation of a Biotic Index for evaluation of environmental quality in the central region of Argentina

The Suquía River (Córdoba, Argentina) has become an important issue because it flows into Mar Chiquita Lake, one of the largest saline lakes in the world. This water body, together with the expansive swamps of the Dulce River on the northern shore and the mouth of Suquía and Xanaes River, is considered one of the most important wetlands in Argentina in terms of biodiversity in a range of freshwater to very saline environments. Nevertheless, the presence of densely populated urban settlements and the increasing environmental impact due to anthropogenic activities characterize the central and lower sections of Suquía River Basin. Fishes are particularly affected and change their distribution and abundance as a consequence of the environmental deterioration. We collected information on fish fauna to develop and validate a Biotic Index to assess degradation of the Suquía River Basin. We classified fish species according to their sensitiveness or tolerance to environmental degradation, based on their distribution and abundance variations along a water quality gradient in order to design a Biotic Index for Suquía River Basin. The set of metrics used in the Biotic Index calculation was conformed by: the abundance of Astyanax eigenmanniorum, Rineloricaria catamarcensis, Gambusia affinis and Cnesterodon decemmacultus, the proportion of sensitive species richness, and the proportion of tolerant species richness. They clearly distinguished between the impaired and referenced sites. We demonstrated that it is possible to use fish as indicators of water quality in Córdoba Province (central part of Argentina) in order to carry out rapid and relatively inexpensive monitoring and conservation programs. The application of this Biotic Index showed that fish assemblages reflect the watershed conditions and are sensitive to changes in water quality across the environmental gradient.     

An Approach to Integrating Occupational Safety and Health into Life Cycle Assessment: Development and Application of Work Environment Characterization Factors

Integrating occupational safety and health (OSH) into life cycle assessment (LCA) may provide decision makers with insights and opportunities to prevent burden shifting of human health impacts between the nonwork environment and the work environment. We propose an integration approach that uses industry‐level work environment characterization factors (WE‐CFs) to convert industry activity into damage to human health attributable to the work environment, assessed as disability‐adjusted life years (DALYs). WE‐CFs are ratios of work‐related fatal and nonfatal injuries and illnesses occurring in the U.S. worker population to the amount of physical output from U.S. industries; they represent workplace hazards and exposures and are compatible with the life cycle inventory (LCI) structure common to process‐based LCA. A proof of concept demonstrates application of the WE‐CFs in an LCA of municipal solid waste landfill and incineration systems. Results from the proof of concept indicate that estimates of DALYs attributable to the work environment are comparable in magnitude to DALYs attributable to environmental emissions. Construction and infrastructure‐related work processes contributed the most to the work environment DALYs. A sensitivity analysis revealed that uncertainty in the physical output from industries had the most effect on the WE‐CFs. The results encourage implementation of WE‐CFs in future LCA studies, additional refinement of LCI processes to accurately capture industry outputs, and inclusion of infrastructure‐related processes in LCAs that evaluate OSH impacts.     

A tribute to Claude Shannon (1916–2001) and a plea for more rigorous use of species richness, species diversity and the 'Shannon–Wiener' Index

In the literature, the terms species richness and species diversity are sometimes used interchangeably. We suggest that at the very least, authors should define what they mean by either term. Of the many species diversity indices used in the literature, the Shannon Index is perhaps most commonly used. On some occasions it is called the Shannon–Wiener Index and on other occasions it is called the Shannon–Weaver Index. We suggest an explanation for this dual use of terms and in so doing we offer a tribute to the late Claude Shannon (who passed away on 24 February 2001).     

Exposure to Metals through the Consumption of Fish and Seafood by the Population Living Near the Ebro River in Catalonia,Spain: Health Risks

The health risks due to metal exposure from consuming various fish and seafood species were assessed for the Catalan population living near the Ebro River (Spain). The concentrations of arsenic, cadmium, chromium, copper, mercury, manganese, nickel, and lead were determined in samples of mussel, clam, hake, sole, cuttlefish, sardine, and anchovy randomly acquired in various localities of the zone under evaluation. In general terms, metal concentrations were similar or lower than the levels recently reported in the literature. The current dietary intake of metals is analogous to that recently estimated for the non-exposed population of Catalonia. Metal exposure through fish and seafood consumption would only mean a slight increase of noncarcinogenic and carcinogenic risk for arsenic, whereas the remaining elements showed risk values below the corresponding threshold levels.     

Inupiat Health and Proposed Alaskan Oil Development: Results of the First Integrated Health Impact Assessment/Environmental Impact Statement for Proposed Oil Development on Alaska’s North Slope

We report on the first Health Impact Assessment (HIA) for proposed oil and gas development in Alaska’s North Slope region. Public health is not generally analyzed in the Environmental Impact Statement (EIS) process in the U.S. We conducted an HIA for proposed oil development within the National Petroleum Reserve - Alaska in response to growing concerns among North Slope Inupiat communities regarding the potential impacts of regional industrial expansion on their health and culture. We employed a qualitative HIA methodology, involving a combination of stakeholder input, literature review, and qualitative analysis, through which we identified potential health effects. The possible health outcomes identified include increases in diabetes and related metabolic conditions as a result of dietary change; rising rates of substance abuse, domestic violence, and suicide; increased injury rates; more frequent asthma exacerbations; and increased exposure to organic pollutant, including carcinogens and endocrine disruptors. There are also potential benefits, including funding for infrastructure and health care; increased employment and income; and continued funding of existing infrastructure. Based on these findings, we recommend a series of public health mitigation measures. This project represents the first formal effort to include a systematic assessment of public health within the U.S. EIS process. The inclusion of public health concerns within an EIS may offer an important and underutilized avenue through which to argue for environmental management strategies that focus on public health, and may offer communities a stronger voice in the EIS process. An erratum to this article can be found at     

A Competence-based Approach to the Design of a Teaching Sequence about Oral and Dental Health and Hygiene: A Case Study

We present a case study to illustrate the design and implementation of a teaching sequence about oral and dental health and hygiene. This teaching sequence was aimed at year 10 students (age 15–16) and sought to develop their scientific competences. In line with the PISA assessment framework for science and the tenets of a context-based approach to science education, the design of the teaching sequence was based on real-life situations. After setting out these premises the paper describes and illustrates the stages and tasks involved in the teaching sequence, and discusses certain aspects of its implementation. We conclude by considering a number of issues related to the teaching sequence, including its transfer to teachers.     

Development and clinical application of an enzyme immunoassay for the determination of midregional proadrenomedullin

Adrenomedullin (ADM) is a 52‐amino acid peptide with a variety of physiologic functions such as immunomodulating activity, direct bactericidal activity, maintenance of renal homeostasis, and vasodilatory activity. Midregional proADM (MR‐proADM) is derived from a larger 185‐amino acid precursor peptide, prepro‐adrenomedulin (preproADM), by posttranslational processing. It is suggested to be co‐synthesized with ADM in equimolar amounts and has the advantages over ADM in having a longer half‐life, no bioactivity, and no binding to protein. Therefore, MR‐proADM serves as a surrogate for ADM secretion. In this study, we attempted to develop an enzyme immunoassay (EIA) for quantifying MR‐proADM‐like immunoreactive substance (IS), which is applicable for monitoring plasma MR‐proADM levels. By using β‐d ‐galactosidase‐labeled preproADM(83‐94) as a marker antigen, anti‐rabbit IgG‐coated immunoplate as a bound/free separator, and 4‐methylumbelliferyl‐β‐d ‐galactopyranoside as a fluorogenic substrate, a sensitive and specific EIA was developed for the quantification of MR‐proADM‐IS in human plasma. The lower limit of quantification was 0.032 pmol/well, and the steep competitive inhibition EIA calibration curve obtained was linear between 0.16 and 10 nmol/L. By using human plasma samples containing 0.2 and 2.0 nmol/L of MR‐proADM, the interassay coefficients of variation (reproducibility) were 10.78% and 8.83%, respectively, and intraassay coefficients were 3.91% and 7.81%. Plasma MR‐proADM‐IS level was significantly higher in patients with chronic renal failure (1.39 ± 0.50 nmol/L) compared with healthy subjects (0.19 ± 0.07 nmol/L). These results suggest that our EIA may be useful to evaluate plasma MR‐proADM levels as a biomarker in various clinical settings. Copyright © 2012 European Peptide Society and John Wiley & Sons, Ltd.