A double-blind randomised controlled trial of gloved versus ungloved merocel middle meatal spacers for endoscopic sinus surgery.

BACKGROUND: Middle meatal spacers are commonly used following endoscopic sinus surgery to prevent post-operative bleeding and lateralization of the middle turbinates. The effects of nasal packing on post-operative sinonasal mucosal healing remain unknown in humans. OBJECTIVE: This study aims to compare the histopathalogical effects of Merocel and Merocel covered with a finger glove on mucosal healing, and patients` discomfort immediately post-operatively after endoscopic sinus surgery and at removal of the nasal packing. METHODS: Thirty-seven patients with chronic rhinosinusitis undergoing bilateral endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive Merocel middle meatal spacer (MMMS) in one nostril and finger glove Merocel middle meatal spacer (FGMMS) in the contra lateral side. Patients were seen on post-operative day 6, and completed a visual analogue score reporting the post-operative discomfort from nasal packing on each side. Following the removal of nasal packing, patients indicated which side caused more discomfort on removal. Biopsies were taken from the middle turbinates and sent to a blinded pathologist who scored the level of mucosal inflammation from 0 - 4. RESULTS: There was no statistically significant difference between MMMS and FGMMS in regards to their effect on sinonasal mucosal inflammation and discomfort post-operatively. A statistically significant difference was noted with respect to discomfort at removal with the uncovered Merocel more likely to cause discomfort when compared to the Merocel covered in a glove finger. CONCLUSION: MMMS and FGMMS are equivalent in the amount of sinonasal mucosal inflammation and discomfort post endoscopic sinus surgery. However, the main advantage of the FGMMS was a significant reduction in pain on removal when compared with the MMMS.

Quantifying tasks, ergonomic exposures and injury rates among school custodial workers.

A job exposure matrix of ergonomics risk factors was constructed for school custodial workers in one large school district in the province of British Columbia using 100 h of 1-min fixed-interval observations, participatory worker consensus on task durations and existing employment and school characteristic data. Significant differences in ergonomics risk factors were found by tasks and occupations. Cleaning and moving furniture, handling garbage, cleaning washrooms and cleaning floors were associated with the most physical risks and the exposure was often higher during the summer vs. the school year. Injury rates over a 4-year period showed the custodian injury rate was four times higher than the overall injury rate across all occupations in the school district. Injury rates were significantly higher in the school year compared with summer (12.2 vs. 7.0 per 100 full-time equivalents per year, p < 0.05). Custodial workers represent a considerable proportion of the labour force and have high injury rates, yet ergonomic studies are disproportionately few. Previous studies that quantified risk factors in custodial workers tended to focus on a few tasks or specific risk factors. This study, using participatory ergonomics and observational methods, systematically quantifies the broad range of musculoskeletal risk factors across multiple tasks performed by custodial workers in schools, adding considerably to the methodological literature.

The mortality gap between urban and rural Canadians: a gendered analysis.

INTRODUCTION: The primary purpose of this article is to demonstrate the role that age, gender, and place play in rural-urban differences in mortality, in order to better develop policy to reduce these differences. METHODS: In 2006, the Canadian Institute for Health Research published a major epidemiological investigation into the morbidity and mortality experience of Canadians, using mortality data as well as the 2004 Canadian Community Health Survey. Using these data, gender differences in mortality across the rural-urban continuum were further explored. The proportion of excess deaths occurring in each of the four different types of rural places, relative to deaths in urban places, were calculated for different gender and age groups. RESULTS: Differences in mortality across the urban-rural continuum are mainly driven by people under 45 years, and are particularly due to deaths caused by injury and poisoning, motor vehicle accident (MVA) and suicide. The proportion of excess deaths relative to urban places for those under 45 years increases with decreasing age. Remote places have the highest excess in mortality for suicide, MVA, injury and poisoning, relative to urban places. CONCLUSION: The relative mortality for young girls living in rural compared with urban places is similar to the relative mortality for young rural boys. There is, therefore, a need for prevention policies targeted at both boys and girls to prevent suicide, injury/poisoning, and MVAs in rural, and especially in remote, places.

The quality of nutritional information available on popular websites: a content analysis.

The overall purpose of this study was to increase knowledge and understanding of the new informational landscape that is emerging on the Internet in relation to nutritional health content in order to provide policy makers with better communication and health promotion tools. We identified the sites most used by Canadians to access nutrition information and conducted content analyses to identify the sources of this nutritional information as well as its quality by systematic comparison with the main guidelines published in the Canada Food Guide. We found that commercial websites accounted for 80% of visits and time spent on seeking health and nutrition information. We also found uneven messaging about fruit and vegetable intake as well as consistent messaging undermining the 'eat a variety of foods' message, which is a central component of the Canada Food Guide. On the positive side, inappropriate or incongruent advice about salt, coffee and alcohol intake was virtually non-existent and advice congruent with the guide was found three times more often than incongruent advice. Finally, the site offering the best advice was a non-commercial government-based site. This site differed from the commercial sites not so much in its ability to deliver the 'right' advice but more in its ability to exclude articles with poor and misleading advice on their sites.

Youth sexual behaviour in a boomtown: implications for the control of sexually transmitted infections.

BACKGROUND: Northeastern British Columbia, Canada, is undergoing rapid in-migration of young, primarily male, workers in response to the "boom" in the oil/gas industries. Chlamydia rates in the region exceed the provincial average by 32% (294.6 cases per 100 000 persons compared with 213.3). Evidence indicates that sociocultural and structural determinants of young people's sexual health are key to consider in the design of interventions. OBJECTIVES: To investigate how sociocultural and structural features related to the oil/gas boom are perceived to affect the sexual behaviour of youth in a Northeastern "boomtown". METHODS: The study included ethnographic fieldwork (8 weeks) and in-depth interviews with 25 youth (ages 15-25 years) and 14 health/social service providers. RESULTS: Participants identified four main ways in which the sociocultural and structural conditions created by the boom affect sexual behaviours, fuelling the spread of sexually transmitted infections (STIs): mobility of oil/gas workers; binge partying; high levels of disposable income and gendered power dynamics. CONCLUSIONS: The sociocultural and structural conditions that are fostered by a resource-extraction boom appear to exacerbate sexual health inequalities among youths who live and work in these rapidly urbanising, remote locales. To meet the needs of this population, we recommend STI prevention and testing service delivery models that incorporate STI testing outreach to oil/gas workers and condom distribution. Global, national and local STI control efforts should consider the realities and needs of similar subpopulations of young people.

An evaluation of hospital discharge records as a tool for serious work related injury surveillance.

OBJECTIVES: To identify and describe work related serious injuries among sawmill workers in British Columbia, Canada using hospital discharge records, and compare the agreement and capturing patterns of the work related indicators available in the hospital discharge records. METHODS: Hospital discharge records were extracted from 1989 to 1998 for a cohort of sawmill workers. Work related injuries were identified from these records using International Classification of Disease (ICD-9) external cause of injury codes, which have a fifth digit, and sometimes a fourth digit, indicating place of occurrence, and the responsibility of payment schedule, which identifies workers' compensation as being responsible for payment. RESULTS: The most frequent causes of work related hospitalisations were falls, machinery related, overexertion, struck against, cutting or piercing, and struck by falling objects. Almost all cases of machinery related, struck by falling object, and caught in or between injuries were found to be work related. Overall, there was good agreement between the two indicators (ICD-9 code and payment schedule) for identifying work relatedness of injury hospitalisations (kappa = 0.75, p < 0.01). There was better concordance between them for injuries, such as struck against, drowning/suffocation/foreign body, fire/flame/natural/environmental, and explosions/firearms/hot substance/electric current/radiation, and poor concordance for injuries, such as machinery related, struck by falling object, overexertion, cutting or piercing, and caught in or between. CONCLUSIONS: Hospital discharge records are collected for administrative reasons, and thus are readily available. Depending on the coding reliability and validity, hospital discharge records represent an alternative and independent source of information for serious work related injuries. The study findings support the use of hospital discharge records as a potential surveillance system for such injuries.

Effect of de-industrialisation on working conditions and self reported health in a sample of manufacturing workers.

STUDY OBJECTIVE: To explore the impact of de-industrialisation over a 20 year period on working conditions and health among sawmill workers, in the province of British Columbia (BC), Canada. DESIGN AND SETTING: This investigation is based on a sample of 3000 sawmill workers employed in 1979 (a year before the beginning de-industrialisation) and interviewed in 1998. The sample was obtained by random selection from an already gathered cohort of approximately 28 000 BC sawmill workers. Change in working conditions from 1979 to 1998 are described. Self reported health status, in 1998, was used as a dependent variable in logistic regression after controlling for confounders. MAIN RESULTS: Downsizing in BC sawmills eliminated 60% of workers between 1979 and 1998. Working conditions in 1998 were better for those who left the sawmill industry and obtained re-employment elsewhere. Workers who remained employed in restructuring sawmills were approximately 50% more likely to report poor health than those re-employed elsewhere. CONCLUSIONS: Working conditions and health status were better for workers who, under pressure of de-industrialisation, left the sawmill industry and obtained re-employment outside this sector.

A collaborative evidence-based approach to making healthcare a healthier place to work.

It is increasingly well documented that a collaborative problem-solving approach is more effective in addressing workplace health concerns than an adversarial approach. Combining this with strategies based on good evidence is key to success. On this premise, a trial was conducted in British Columbia, beginning in July 1999, based on a collaborative approach in which healthcare workers and managers work together to identify and implement evidence-based initiatives to improve the health and working conditions of healthcare workers.

International trade regulation and publicly funded health care in Canada.

The World Trade Organization (WTO) creates new challenges for the Canadian health care system, arguably one of the most "socialized" systems in the world today. In particular, the WTO's enhanced trade dispute resolution powers, enforceable with sanctions, may make Canadian health care vulnerable to corporate penetration, particularly in the pharmaceutical and private health services delivery sectors. The Free Trade Agreement and its extension, the North American Free Trade Agreement, gave multinational pharmaceutical companies greater freedom in Canada at the expense of the Canadian generic drug industry. Recent challenges by the WTO have continued this process, which will limit the health care system's ability to control drug costs. And pressure is growing, through WTO's General Agreement on Trade in Services and moves by the Alberta provincial government to privatize health care delivery, to open up the Canadian system to corporate penetration. New WTO agreements will bring increasing pressure to privatize Canada's public health care system and limit government's ability to control pharmaceutical costs.

Invasion of murine respiratory epithelial cells in vivo by Burkholderia cepacia.

Pulmonary infections caused by Burkholderia cepacia are an important cause of morbidity and mortality in cystic fibrosis (CF) patients. Several features suggestive of invasion and intracellular sequestration of B. cepacia in CF are persistence of infection in the face of antibiotic therapy and a propensity to cause bacteraemic infections in patients with CF. A mouse respiratory challenge model was used to investigate the invasion phenotype of B. cepacia in vivo. After intratracheal inoculation, epidemic B. cepacia strains translocated from lung to liver and spleen; however, all bacteria were cleared from all organs within 7 days. B. cepacia strains, irrespective of cable piliation, were capable of attaching to and then invading murine respiratory tract epithelial cells. Histopathological examination of lungs showed interstitial infiltrates comprised mainly of polymorphonuclear leucocytes and were associated with widened alveolar septa. Electron microscopy demonstrated B. cepacia within epithelial cells and pulmonary macrophages. This study provides support for in-vitro observations that B. cepacia strains from patients with CF adhere to and then invade respiratory epithelial cells. The invasion phenotype in B. cepacia may be an important virulence factor in CF infections.

Measuring psychosocial job strain with the job content questionnaire using experienced job evaluators.

BACKGROUND: A union/management system of job evaluation has been in place in the British Columbia (BC) sawmill industry since the late 1960s. This system uses an instrument, very similar to the job content questionnaire (JCQ) to evaluate psychosocial work conditions for sawmill jobs. METHODS: Four experienced evaluators, one from the union and three from industry, independently estimated psychosocial work conditions for 54 current job titles in a "typical" coastal sawmill using a shortened, 18-question version of the JCQ questionnaire. RESULTS: Inter-rater reliability was acceptable for control but not for co-worker social support, physical demand, or psychological demand. Reliability was least for psychological demand. CONCLUSIONS: Experienced job evaluators in the sawmill industry were able to reliably estimate only the control dimension of the JCQ. The observed lowest reliability for psychological job demand may be due to the imprecise construct definition in the domain of the JCQ instrument.

Comparison of expert-rater methods for assessing psychosocial job strain.

OBJECTIVES: This study tested the reliability and validity of industry- and mill-level expert methods for measuring psychosocial work conditions in British Columbia sawmills using the demand-control model. METHODS: In the industry-level method 4 sawmill job evaluators estimated psychosocial work conditions at a generic sawmill. In the mill-level method panels of experienced sawmill workers estimated psychosocial work conditions at 3 sawmills. Scores for psychosocial work conditions were developed using both expert methods and applied to job titles in a sawmill worker database containing self-reported health status and heart disease. The interrater reliability and the concurrent and predictive validity of the expert rater methods were assessed. RESULTS: The interrater reliability and concurrent reliability were higher for the mill-level method than for the industry-level method. For all the psychosocial variables the reliability for the mill-level method was greater than 0.90. The predictive validity results were inconclusive. CONCLUSIONS: The greater reliability and concurrent validity of the mill-level method indicates that panels of experienced workers should be considered as potential experts in future studies measuring psychosocial work conditions.

Effects of de-industrialization on unemployment, re-employment, and work conditions in a manufacturing workforce.

BACKGROUND: The purpose of this study was to investigate the impact of a 20-year process of de-industrialization in the British Columbia (BC) sawmill industry on labour force trajectories, unemployment history, and physical and psychosocial work conditions as these are important determinants of health in workforces. METHODS: The study is based on a sample of 1,885 respondents all of whom were sawmill workers in 1979, a year prior to commencement of de-industrialization and who were followed up and interviewed approximately 20 years later. RESULTS: Forty percent of workers, 64 years and under, were employed outside the sawmill sector at time of interview. Approximately one third of workers, aged 64 and under, experienced 25 months of more of unemployment during the study period. Only, 1.5% of workers were identified as a "hard core" group of long-term unemployed. Workers re-employed outside the sawmill sector experienced improved physical and psychosocial work conditions relative to those employed in sawmills during the study period. This benefit was greatest for workers originally in unskilled and semi-skilled jobs in sawmills. CONCLUSIONS: This study shows that future health studies should pay particular attention to long-term employees in manufacturing who may have gone through de-industrialization resulting in exposures to a combination of sustained job insecurity, cyclical unemployment, and adverse physical and psychosocial work conditions.

Downsizing and industrial restructuring in related to changes in psychosocial conditions of work in British Columbia sawmills.

OBJECTIVES: This paper investigates changes in the psychosocial and physical work conditions of the sawmill industry in British Columbia, Canada, over the past 35 years. METHODS: Shifts in work conditions were examined within the context of historical changes in sawmill labor demography and job taxonomy as the industry was both downsized and restructured, largely in response to an economic recession in the early 1980s. RESULTS AND CONCLUSIONS: Downsizing eliminated approximately 60% of the work force and 1/4 of sawmill job titles. Although all the job categories in restructured sawmills showed increased levels of control, the gradient in control across job categories was steeper in 1997 than in 1965; this change may have important health implications particularly for the unskilled workers in the restructured mills.

Childhood cancer in the offspring of male sawmill workers occupationally exposed to chlorophenate fungicides.

The objective of this study was to determine whether paternal occupational exposure to chlorophenol fungicides and their dioxin contaminants is associated with childhood cancer in the offspring of sawmill workers. We used data from 23,829 British Columbian sawmill workers employed for at least 1 continuous year between 1950 and 1985 in 11 sawmills that used chlorophenates. Probabilistic linkage of the sawmill worker cohort to the provincial marriage and birth files produced an offspring cohort of 19,674 children born at least 1 year after the initiation of employment in the period 1952-1988. We then linked the offspring cohort to the British Columbia Cancer Registry. We included all malignancies in cases younger than 20 years of age that appeared on the cancer registry between 1969 and 1993. We calculated standardized incidence ratios (SIRs) using the British Columbia population as a reference. A nested case-control analysis assessed the effects of paternal cumulative exposure and windows of exposure on the risk of developing cancer in the offspring. We identified 40 cases of cancer during 259,919 person-years of follow-up. The all-cancer SIR was 1.0 [95% confidence interval (CI), 0.7-1.4]; the SIR for leukemia was 1.0 (CI, 0.5-1.8); and the SIR for brain cancer was 1.3 (CI, 0.6-2.5). The nested case-control analysis showed slightly increased risks in the highest categories of chlorophenol exposure, although none was statistically significant. Our analyses provide little evidence to support a relationship between the risk of childhood cancer and paternal occupational exposure to chlorophenate fungicides in British Columbian sawmills.

The history of injury and industrial disease rates in British Columbia from 1950 to 1996.

The purpose of this investigation is to describe changes in industrial injury and disease rates in British Columbia between 1950 and 1996. Data on injury and disease rates were abstracted manually from WCB Annual Reports for the years 1950 through 1996. A number of interesting patterns emerge. Death report rates declined by 79% during the study period. Injury report rates also declined, although less dramatically, by 29%, over the 46-year study period with much of the decrease occurring prior to 1970. Accepted claims for impact injuries declined prior to the 1970s. At the same time claims for strain injuries began to increase with the pace of increase accelerating after 1970. A similar pattern was observed for industrial disease as the incidence of strain-based disease claims also increased rapidly after 1970. This pronounced trend towards "strain-related" injuries and disease creates new challenges for adjudication and prevention. The identification of work organizational and job structural features which contribute to strain injury and disease and the elucidation of the relationship between these conditions and "physical" strain injuries should be a priority for injury epidemiologists and WCB.

Life-threatening gastrointestinal hemorrhage due to juvenile polyposis.

A 14-yr-old, previously healthy boy presented with massive lower GI hemorrhage. After the routine endoscopic and radiological evaluation, laparotomy and intraoperative colonoscopy revealed multiple polyps in the colon. A hemicolectomy was performed because of the severity of hemorrhage. A diagnosis of juvenile polyposis was made based upon histological findings and the family history. This is an extremely unusual presentation of juvenile polyposis and has been reported only once before. The clinical features, diagnosis, and therapeutic options for juvenile polyposis are discussed. Juvenile polyposis, although a rare condition in the pediatric population, should be considered in the differential diagnosis of life-threatening GI hemorrhage.

Gender, work roles and psychosocial work characteristics as determinants of health.

This paper aims to identify gender similarities and differences in psychosocial work characteristics for those in and out of paid employment, to inform research on possible health-related effects. Specifically five questions are addressed: do women report poorer work characteristics than men; are gender differences related to specific characteristics; do work characteristics differ between full- and part-time women workers and between those in paid and unpaid work; are socio-economic gradients in work characteristics similar for men and women; and, if there are gradients, do they differ between women in paid and unpaid work? Analyses are based on the 33 year follow-up of the 1958 British birth cohort. Four psychosocial work characteristics were examined: learning opportunities, monotony, pace of work, and flexibility of breaks. Women reported more negative work characteristics than men, primarily because of differences in learning opportunities (26% lacked opportunity compared with 13% of men) and monotonous work (47 and 31% respectively). Women in full-time employment reported fewer negative characteristics (27%) than part-time (39%) or home-workers (36%). Home-workers had fewer opportunities for learning (36%) and greater monotony (49%) than paid workers (21 and 22% respectively), however fewer home-workers reported inability to control the work pace (11% compared to 23%) and inflexibility of breaks (21% compared to 47%). Socio-economic gradients in work characteristics were similar among men and women, except for flexibility of break times. A socio-economic gradient in work characteristics was found for full- and part-time workers, but not among home-workers. Differences in self reported health were also examined: a social gradient was found for all employment status groups, being strongest for home-workers despite the absence of a gradient in negative work characteristics. In conclusion, these marked gender differences in psychosocial work characteristics need to be considered in future research on work and health.

Opportunities for a broader understanding of work and health: multiple uses of an occupational cohort database.

Occupational cohort studies conducted to study cancer incidence and mortality require extensive data gathering about workers' job histories, exposures, and health outcomes. Although this process is expensive, the database created can be looked upon as a resource for broad investigations of the relationship between work and health. This paper presents the example of a retrospective cohort study which began in the traditional way, examining the link between a specific pesticide exposure and mortality and cancer incidence. The cohort register has since been used to investigate whether infertility, adverse reproductive outcomes, and childhood cancers might be associated with this exposure. It is also being used as the basis for studying other sawmill exposures including noise and wood dust as well as socioeconomic factors including job strain, job mobility, unemployment, and retraining. This approach allows both the efficient use of occupational cohorts as well as providing the opportunity for investigators to develop a more comprehensive perspective on the determinants of the health status of workers and their families.