Sickness absence and flight type exposure in flight crew members.

BACKGROUND: Shift work research has shown that the relationship between exposure to irregular working times and sickness absence may differ between working populations. Not much is known about the prevalence of sickness absence in flight crews or about the relationship between exposure to different flight schedules and sickness absence in this population. AIMS: To examine the association between cumulative exposure to different flight types and sickness absence in flight crew members. METHODS: The study population consisted of flight crew members from a 5 year historic cohort. Flight schedule and sickness absence data were obtained from company records. The association between the cumulative exposure to different flight types and sickness absence episodes of >7 days was determined using univariate and multivariate logistic regression analyses. Adjusted models were obtained by adding potential confounders. Previous sickness absence was added to compose the fully adjusted models. RESULTS: The records of 8228 employees were analysed. The fully adjusted univariate analyses showed that the numbers of medium-haul flights and flights with time zone crossings were associated with an increase in the odds for sickness absence. The fully adjusted multivariate analyses showed no significant associations between flight types and sickness absence. CONCLUSIONS: Cumulative exposure to flight types was not independently associated with sickness absence in flight crew members when previous sickness absence was taken into account. Because sickness absence in the past can predict future absence, preventive strategies targeted at flight crew members with a history of high sickness absence may be effective.

Evaluating frequency, diagnostic quality, and cost of Lyme borreliosis testing in Germany: a retrospective model analysis.

BACKGROUND: Data on the economic impact of Lyme borreliosis (LB) on European health care systems is scarce. This project focused on the epidemiology and costs for laboratory testing in LB patients in Germany. MATERIALS AND METHODS: We performed a sentinel analysis of epidemiological and medicoeconomic data for 2007 and 2008. Data was provided by a German statutory health insurance (DAK) company covering approx. 6.04 million members. In addition, the quality of diagnostic testing for LB in Germany was studied. RESULTS: In 2007 and 2008, the incident diagnosis LB was coded on average for 15,742 out of 6.04 million insured members (0.26%). 20,986 EIAs and 12,558 immunoblots were ordered annually for these patients. For all insured members in the outpatient sector, a total of 174,820 EIAs and 52,280 immunoblots were reimbursed annually to health care providers (cost: 2,600,850€). For Germany, the overall expected cost is estimated at 51,215,105€. However, proficiency testing data questioned test quality and standardization of diagnostic assays used. CONCLUSION: Findings from this study suggest ongoing issues related to care for LB and may help to improve future LB disease management.

Occupational health guidelines for the management of low back pain: an international comparison.

BACKGROUND: The enormous socioeconomic burden of low back pain emphasises the need for effective management of this problem, especially in an occupational context. To address this, occupational guidelines have been issued in various countries. AIMS: To compare available international guidelines dealing with the management of low back pain in an occupational health care setting. METHODS: The guidelines were compared regarding generally accepted quality criteria using the AGREE instrument, and also summarised regarding the guideline committee, the presentation, the target group, and assessment and management recommendations (that is, advice, return to work strategy, and treatment). RESULTS: and CONCLUSIONS: The results show that the quality criteria were variously met by the guidelines. Common flaws concerned the absence of proper external reviewing in the development process, lack of attention to organisational barriers and cost implications, and lack of information on the extent to which editors and developers were independent. There was general agreement on numerous issues fundamental to occupational health management of back pain. The assessment recommendations consisted of diagnostic triage, screening for "red flags" and neurological problems, and the identification of potential psychosocial and workplace barriers for recovery. The guidelines also agreed on advice that low back pain is a self limiting condition and, importantly, that remaining at work or an early (gradual) return to work, if necessary with modified duties, should be encouraged and supported.

Toxoplasma gondii antibodies in pregnant women and their newborns in Dar es Salaam, Tanzania.

The sera of 849 Tanzanian pregnant women were tested at delivery for Toxoplasma gondii antibodies with the Sabin-Feldman dye test (DT) and an immunosorbent agglutination assay. A total of 296 (35%) of these women had DT titers greater than 1:4. The percentage of women with dye test titers greater than 1:4 was 34-37% regardless of the individual ages. The rate of positivity for human immunodeficiency virus 1/2 (HIV-1/2) using Western blotting was 11.5%. There was no relationship between prevalence of a positive DT result and HIV infection nor between the intensity of the DT result and HIV infection. Sixty-four parturients had a DT titer of 1:1,000 or more. From 57 newborns of these mothers, cord sera were available and were screened by the DT and the immunosorbent agglutination assay. Seven of these were found to be positive for IgM and/or IgA antibodies. It was concluded that the rate of serologic evidence for prenatal Toxoplasma infection in cord blood samples in the present study of Tanzanian pregnant women was approximately 0.8%.

Prevention of running injuries by warm-up, cool-down, and stretching exercises.

The purpose of this study was to evaluate the effect of a health education intervention on running injuries. The intervention consisted of information on, and the subsequent performance of, standardized warm-up, cool-down, and stretching exercises. Four hundred twenty-one male recreational runners were matched for age, weekly running distance, and general knowledge of preventing sports injuries. They were randomly split into an intervention and a control group: 167 control and 159 intervention subjects participated throughout the study. During the 16-week study, both groups kept a daily diary on their running distance and time, and reported all injuries. In addition, the intervention group was asked to note compliance with the standardized program. At the end of the study period, knowledge and attitude were again measured. There were 23 injuries in the control group and 26 in the intervention group. Injury incidence for control and intervention subjects was 4.9 and 5.5 running injuries per 1000 hours, respectively. The intervention was not effective in reducing the number of running injuries; it proved significantly effective (P < 0.05) in improving specific knowledge of warm-up and cool-down techniques in the intervention group. This positive change can perhaps be regarded as a first step on the way to a change of behavior, which may eventually lead to a reduction of running injuries.

Is range of motion of the hip and ankle joint related to running injuries? A case control study.

This study concerns a case-control study on the relation between range of motion (ROM) of the hip and ankle joints and running injuries. Sixteen male runners who had sustained a medically treated running injury during the year prior to the ROM measurements were matched for weekly running distance and age with sixteen male runners who had not sustained such an injury. All subjects were fit at the time of measurement. ROM was measured by standardized goniometry after a warm-up on a cycle-ergometer. Within non-injured subjects all goniometric measurements showed no significant (p > 0.05) differences between the left and right side of the body. Within injured subjects all goniometric measurements showed no significant (p > 0.05) differences between the injured and non-injured side of the body. Runners who had sustained a running injury showed a significant (p > 0.001) more restricted ROM of the hip joints (average ROM value 59.4 degrees +/- 8.0 degrees) in comparison to runners who had no been injured during the same period (average value ROM 68.1 degrees +/- 5.2 degrees). No such differences (p > 0.05) were found with regard to ankle ROM (average ROM value injured 12.8 degrees +/- 3.4 degrees and average ROM value non injured 14.0 degrees +/- 2.7 degrees). These findings suggest that ROM can be characterized as a more or less stable anthropometric trait.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence, severity, aetiology and prevention of sports injuries. A review of concepts.

Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the 'sequence of prevention'. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step. In this review some aspects of the first and second step of the sequence of prevention are discussed. The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of 'sports injury' and 'sports participation'. The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample. Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the 'sequence of prevention' the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model.(ABSTRACT TRUNCATED AT 400 WORDS)

[Suspected syphilis during pregnancy due to cross reactions in Borrelia infection]. / Luesverdacht in der Schwangerschaft durch Kreuzreaktionen bei Borrelien-Infektion.

A weakly positive titre (1:20) in the Treponema pallidum haemagglutination test and a highly positive titre (1:1280) in the fluorescence Treponema antibody absorption test, but negative result for IgM antibodies, were found in the serum of a 23-year-old pregnant woman. The cardiolipin microflocculation test was at first borderline positive, but negative on repeat. In the absence of a history of syphilis tests for Borrelia antibodies were performed. Those for antibodies against B. burgdorferi were highly positive in the ELISA test (550 units), in the indirect Borrelia immunofluorescence test 1:1280 for IgG antibodies and 1:160 for IgM antibodies. In the Borrelia-specific indirect haemagglutination test, which measures both IgG and IgM antibodies, the titres were 1:640 to 1:1280. These results confirmed the presence of an infection with B. burgdorferi and not with Treponema pallidum.

Validation of two running tests as estimates of maximal aerobic power in children.

In order to validate the "Maximal Multistage 20 Meter Shuttle Run Test" by Leger and Lambert (1982) (20-MST) as an estimate of maximal aerobic power (VO2max) and to compare the results of this test with the results of a 6 min endurance run, 82 subjects (41 boys and 41 girls) aged 12-14 performed the 20-MST and the 6 min endurance run, and had their VO2max directly measured during maximal treadmill running. The 20-MST is a maximal running test starting at a running speed of 8.0 km X h-1, which is increased every minute and in which the pace is set by an audio signal. Performing the test, one runs a 20-meter course back and forth. The test result is expressed as "palier" (one palier is approximately one minute). The mean results of the 20-MST were, for boys, 8.0 palier (+/- 1.7) and for girls, 6.4 palier (+/- 1.5). The mean results of the 6 min endurance run were for boys, 1264.4 meters (+/- 160.8), and for girls, 1103.9 meters (+/- 144.7). The mean VO2max for boys was 53.2 ml X kg-1 X min-1 (+/- 5.4) and for girls, 44.1 (+/- 4.8) ml X kg-1 X min-1. The correlation coefficient between VO2max and the 20-MST was found to be 0.68 (+/- 3.9) for boys, 0.69 (+/- 3.4) for girls and 0.76 (+/- 4.4) for both sexes, and that of VO2max with the 6 min endurance run was 0.51 (+/- 4.6) for boys, 0.45 (+/- 4.3) for girls and 0.63 (+/- 5.3) for both sexes. The conclusion is that the 20-MST is a suitable tool for the evaluation of maximal aerobic power. Although the differences in validity between the 20-MST and the 6 minutes endurance run were statistically not significant (p greater than 0.05), for reasons of practicability the 20-MST should be preferred to the 6 minutes endurance run when used in physical education classes.

[Blood and tissue levels of mitomycin C after intravesical instillation]. / Serum- und Gewebe-Mitomycin-C-Spiegel nach intravesikaler Instillation.

Local mitomycin C (MMC) bladder instillation immediately after transurethral resection of superficial transitional cell carcinoma of the bladder caused an MMC serum concentration up to 24.5 ng/ml of an average. Neither bladder perforation by TUR nor vesicorenal reflux are contraindications for local instillations MMC. Systemic side effects are not to be expected. The highest MMC concentrations were found in the cancer tissue. There were measurable concentrations of MMC down to the adventitia. The indication for immediate postoperative local MMC-chemotherapy is discussed.

[Local chemotherapy of bladder carcinoma with mitomycin (author's transl)]. / Lokale Chemotherapie des Harnblasenkarzinoms mit Mitomycin.

40 patients with transitional cell carcinoma of the bladder, stage Tis, Ta und Tl, were treated by a topical cytostatica-therapy with Mitomycin C (MMC) after transurethral resection of the bladder in order to investigate: 1. The curative influence on the carcinoma in situ, 2. the prevention of tumor cell implantations. After an average observation time of up to the 23.4 months this concept of therapy seems to be promising because of clearly reduced recurrence rate and the lack of systemic toxicity. MMC absorption studies with 19 patients, partly with reflux and TUR-caused perforation of the bladder, showed that MMC instillation therapy (20 mg MMC in 40 ml NaCl) immediately after resection does not result inn systemically toxic serum concentration.