Managers' perceptions of the value and impact of HAZWOPER worker health and safety training.

BACKGROUND: Worker training is a core component of the OSHA Hazardous Waste Operations and Emergency Response (HAZWOPER) standard, but few studies have considered what motivates managers to provide HAZWOPER training to employees or what they value in that training. METHODS: In 2012, four university-based programs conducted an exploratory survey of managers who sent employees to HAZWOPER courses. Results from 109 respondents were analyzed. RESULTS: Forty-two percent of respondents cited regulations as the most important reason to provide HAZWOPER training; many indicated they would provide less training if there were no standard in place. Three-quarters (74%) reported training had improved workplace conditions. Fewer than half said they were likely to involve trained employees in aspects of the organization's H&S program. DISCUSSION: Compliance with regulatory requirements is an important factor shaping managers' training delivery decisions. Managers recognize positive impacts of training. These impacts could be enhanced by further leveraging employee H&S knowledge and skills.

[Unusual course of a Guillain-Barré syndrome in connection with an RS-Virus infection in a 10 months old infant]. / Ungewöhnlicher Verlauf eines Guillain-Barré-Syndroms im Zusammenhang mit einer RS-Virusinfektion bei einem 10 Monate alten Säugling.

Guillain Barré syndrome (GBS; Synonyma: Polyneuritis, Polyradikulitis) is an acute, inflammatory, demyelinating disease of the peripheral nerve system. Clinical hallmarks are symmetric muscle paralysis, areflexia and pronounced autonomic disturbances. Respiratory failure and cardiovascular instability are the main reasons for intensive care support in patients with GBS. We present the process of illness of an 10 month old baby with GBS. The report discusses RSV as possible triggers. For children with ARDS, a nitric oxide ventilation could represent a lifesaving option.

Benign familial neonatal convulsions: always benign?

BACKGROUND: Benign familial neonatal convulsions (BFNC) is a rare autosomal dominant seizure disorder usually described to be characterized by a benign course, spontaneous remission and normal psychomotor development. The latter statement had come under consideration when a few case reports of families with less than favorable outcomes were published. METHODS: Since 1998 a total of 112 families suspected to have BFNC have been referred to our lab for genetic testing. Within this sample we identified private KCNQ2 mutations in 17 BFNC families. For 10 of those 17 families follow up information about the psychomotor development and the outcome were available. RESULTS: In 4 (40%) of the 10 families at least 1 affected individual showed delayed psychomotor development or mental retardation. Three of the four mutations were familial, while the fourth mutation was de novo. Mutations associated with an unfavorable outcome tended to be located within the functionally critical S5/S6 regions of the KCNQ2 gene. CONCLUSIONS: Our data raise the question if BFNC can indeed be described as a benign disorder, and which are the genetic and/or environmental factors that influence the outcome.

The influence of trainee characteristics on the effectiveness of health and safety training for hazardous waste site operations work.

A 10-year retrospective analysis was done using training records for 869 trainees who had attended a 40-hour course for hazardous waste site work. The course is intended for professional site workers, but had been attended by a demographically diverse audience. Analysis of test, demographic, and course data revealed some spurious effects but also indicated that trainees were not disadvantaged in their learning gains based on their own background or that of the class overall. Moreover, a large class appears to present some advantages, and a diverse class appears to present advantages in training material applied across work duties (hands-on skills, decontamination, etc.). Logistics encountered in the study raise doubts that a definition of professional/nonprofessional can be achieved or applied. Overall, the routine practice of providing separate training to professionals and nonprofessionals requires revisiting.

Testing as a measure of worker health and safety training: perspectives from a hazardous materials program.

BACKGROUND: Health and safety training for hazardous materials workers is among OSHA's major policies. A large and growing workforce in this area, and the resulting risks for these workers and the public, make quality training critical. Measuring trainees' individual knowledge following training is a common but controversial practice. METHODS: Technical issues and benefits in testing, strategies for mitigating the limitations of testing, and the relevance of testing at a broader policy level were examined from the perspective of a large and diverse program. RESULTS: Knowledge data from individuals greatly aided in evaluating program effectiveness at the time of training and in assessing workplace impact later. Use of sound testing principles and creative examination methods and materials, and collaboration across programs, all helped to address concerns for individual programs and the field generally. CONCLUSIONS: Programs would benefit from fully considering the benefits and options related to knowledge assessment in training. Those who choose to assess individual knowledge could move the process forward through added rigor, collaboration, and documentation of efforts.

The role of antibodies in acute vascular rejection of pig-to-baboon cardiac transplants.

Long-term success in xenotransplantation is currently hampered by acute vascular rejection. The inciting cause of acute vascular rejection is not yet known; however, a variety of observations suggest that the humoral immune response of the recipient against the donor may be involved in the pathogenesis of this process. Using a pig-to-baboon heterotopic cardiac transplant model, we examined the role of antibodies in the development of acute vascular rejection. After transplantation into baboons, hearts from transgenic pigs expressing human decay-accelerating factor and CD59 underwent acute vascular rejection leading to graft failure within 5 d; the histology was characterized by endothelial injury and fibrin thrombi. Hearts from the transgenic pigs transplanted into baboons whose circulating antibodies were depleted using antiimmunoglobulin columns (Therasorb, Unterschleisshein, Germany) did not undergo acute vascular rejection in five of six cases. Biopsies from the xenotransplants in Ig-depleted baboons revealed little or no IgM or IgG, and no histologic evidence of acute vascular rejection in the five cases. Complement activity in the baboons was within the normal range during the period of xenograft survival. In one case, acute vascular rejection of a xenotransplant occurred in a baboon in which the level of antidonor antibody rose after Ig depletion was discontinued. This study provides evidence that antibodies play a significant role in the pathogenesis of acute vascular rejection, and suggests that acute vascular rejection might be prevented or treated by therapies aimed at the humoral immune response to porcine antigens.

Worker health and safety training: assessing impact among responders.

A mail survey was conducted among emergency responders who received training at the New Jersey/New York Hazardous Materials Worker Training Center. Responses indicate that technical topics are extremely important (i.e., decontamination, personal protection); that the vast preponderance of trainees felt confident in their ability to recall specific critical concepts in a crisis; and that 42% of respondents (75) had experienced an incident that would have resulted in injury or death without training. Phone surveys for details of specific incidents reported by 43 of the 75 mail survey respondents revealed that anecdotal data provide powerful evidence of the value of training; that extensive and uniform training is needed across jurisdictions; that training should emphasize the technical aspects of health and safety, and should include demonstration and hands-on techniques; and that integrated organizational support for implementation of health and safety practices is critical.

Humoral responses to pig-to-baboon cardiac transplantation: implications for the pathogenesis and treatment of acute vascular rejection and for accommodation.

Organs transplanted between phylogenetically-disparate species, such as from the pig into the primate, are subject to hyperacute and acute vascular rejection. Hyperacute rejection of a porcine organ by a primate is thought to be initiated by the binding of xenoreactive natural antibodies to Galalpha1-3Gal expressed on the endothelial lining of blood vessels in the xenograft. The factor(s) which initiates acute vascular rejection is uncertain; however, there is some evidence implicating xenoreactive antibodies. The nature of the humoral response which might contribute to acute vascular rejection of a porcine organ was investigated in baboons which received a porcine cardiac xenograft plus immunosuppression with methylprednisolone, azathioprine, and cyclosporine. Following rejection and surgical removal of the xenografts, the serum concentration of xenoreactive antibodies increased in untreated animals but in immunosuppressed animals was similar to the concentration in preimmune serum. The antibodies in the sensitized recipients were specific for Galalpha1-3Gal (70-95%) and other determinants (5-30%). However, cross-blocking studies showed that, following xenotransplantation, the immunosuppressed baboons had no detectable IgM or IgG directed against "new" endothelial antigens. These results indicate that antibodies made by immunosuppressed individuals in response to xenotransplantation are much like xenoreactive natural antibodies and suggest that acute vascular rejection might in some cases be addressed by therapeutic strategies aimed at those antibodies.

Medical surveillance practices of blue collar and white collar hazardous waste workers.

Given the occupational risks of hazardous waste workers, this study was conducted to explore possible differences in medical surveillance practices among blue and white collar workers. Demographic and medical surveillance data were collected from 636 white collar and 206 blue collar trainees, enrolled in health and safety training courses. Overall, 4.5% of the trainees reported being ill or injured because of hazardous substances. Significant differences (P < .0001) were noted between groups; blue collar trainees were more likely to have been ill or injured. Differences also existed for medical surveillance enrollment; 32% of the white collar trainees report enrollment compared to 19% of the blue collar trainees (P = .004). This study indicates that blue collar trainees are more likely to be injured and less likely to be enrolled in medical surveillance programs. Issues of illness and injury, as well as medical surveillance enrollment, must be addressed; ensuring that all workers receive medical surveillance needed to prevent occupational illness in the hazardous waste field.

Strategies for evaluating the effectiveness of training programs.

This chapter has provided examples of practical and theoretical considerations that should be made when developing evaluation activities concomitant to training. Evaluation choices have been described based on considerations and experiences from others in the training field, sound rationale for program and policy research, and realistic constraints and demands of training. The discussion has presented some of the basic technical issues associated with the collection and analysis of trainee, program, and test data. It also has presented some basic considerations in optimizing procedures and in interfacing within and beyond programs for data collection. Finally, it has presented options available for data analysis from other models and methods in the training field. Whenever possible, select standard variables should be used to facilitate the advancement of training and reporting. Many variables and procedures will differ between programs based on training objectives; others should be part of basic activities. The authors conclude that use of demographic, program, and tests and nontest effectiveness measures are all important in assessing the quality of training efforts and the instruments themselves. When possible, such efforts should expand to include behavior assessment at the worksite, as occurs with behavior-based training developed and provided at the work-site. Most issues relating to evaluation in general are amenable to modification. Indeed, by responding to the issues cited, both in support of and in opposition to various methods, it is possible to address valid technical concerns and maximize data strength. The value of program evaluation will ultimately be based on the selection of critical variables and the use of data collection and analysis activities that maximize their potential. The value of program evaluation to policy development will largely be dependent upon the quality of program evaluation and the extent to which similar programs collaborate and report their outcomes.

The relationship of siblings to the size of rural Nigerian preschoolers.

PIP: Staff from a health education project in Eket village in Cross River State, Nigeria collected 1985-1986 height and weight data from at least 286 preschool children. Results from the 1 way analysis of variance tests revealed that age significantly affected mean weights for age and for height (p.01). For example, between 1 and 2 years of age the weights for age and for height fell substantially due to a decrease in breast feeding and introduction of solid foods. Similarly, birth rank significantly accounted for mean height for age (p=.01) and mean weight for age (p.01). For instance, the mean height for age and mean weight for age fell for 2nd born children. After the 2nd child, they climbed to the point where at the 6th child and greater the means were greater than for the 1st born. Number of children in the household only significantly affected mean weight for age (p=.01). A single child ranked significantly better in weight for age and weight for height than households with 2-6 children. After the 3rd child, however, a steady increase in mean percentile rank occurred with each additional child. In fact, mean percentile weight for age values of all the children in households of 7 or more children were higher than for any other household size. Observations of field staff supported the hypothesis that, in large families, the older children care and nurture the younger siblings and do not have high demands to work in the fields and maintain the households thereby accounting for the superior nutritional status for children in families of 7 or more children. Nevertheless overall nutritional status of 28% of the children were severely malnourished. Further, current nutritional status of 14% were severely malnourished. Moreover 36% ranked as chronically malnourished.^ieng

Infectious diseases and field water supply and sanitation among migrant farm workers.

An audit for fecal-related symptoms was performed on clinic patient charts of 936 migrant farm workers without access to water and sanitation facilities in the work fields and on an urban poor population of 8,968 patients. Migrants displayed a clinic utilization rate for diarrhea 20 times higher than that of the urban poor; similar findings for other enteric disease symptoms were documented. The data suggest that a water and sanitation standard mandating facilities in the work field for farm workers would reduce the incidence of fecal-related disease.

A need for community education in development: the Mit Abu El Kom case.

A quasi-experimental study was performed in Mit Abu El Kom Village, Egypt, where one-quarter of the 500 village households had been provided with new housing and indoor water and sanitation facilities and where, prior to this provision, water and sanitation facilities were inadequate or nonexistent among all households. No community health education had taken place among relocatees (subjects) or nonrelocatees (controls) in conjunction with the provision of water and sanitation facilities. This study investigated if subjects' access and exposure to facilities had alone been sufficient to significantly alter their relevant knowledge, attitudes and practices as compared to controls. This was accomplished primarily through structured household interview. Given that women are traditionally most affected by facilities and most effective in matters related to household health, one adult female from each sampled household was the respondent, totalling 123 for subjects and 111 for controls. Between-group comparisons of responses revealed overall nonsignificant differences in knowledge and attitudes and that respondent age and sex had no significant overall impact on responses. Age and sex were also discounted as affecting variables in within-group response analyses. Some significant changes in practices had occurred among subjects. However, these mainly resulted out of convenience and their potential benefits were often denigrated by changes which had not occurred or had not continued. The data indicate a need for community health education if health-related benefits of water and sanitation facilities are to be realized, and specifically indicate the need to address the educational needs of all village women.