From 51% to 100%: mandatory seasonal influenza vaccination.

We believe we are the first union hospital to succeed in mandating the seasonal influenza vaccine for employees and physicians. We relate the process that we used to achieve this success. Our main purpose is to share our success with other colleagues in the health care industry who are facing similar opposition to mandatory vaccination.

Medical monitoring: a beneficial remedy for residents living near an environmental hazard site.

OBJECTIVE: People living close to an environmental hazard site may suffer health harms from real or perceived contaminant exposures. In class-action litigation, medical monitoring is a potential remedy that has been allowed in some jurisdictions but not others. From 1952 to 1989, a US Department of Energy uranium metal plant near Fernald, Ohio, released ionizing radiation and uranium particulates into the surrounding community. METHODS: Settlement of litigation between nearby residents and the Department of Energy resulted in an 18-year medical monitoring program (N = 9775), which focused on general health promotion rather than effects of uranium. RESULTS: Participation was higher than projected; decreases in common risk factors (cholesterol and blood pressure) and deaths from cancer have been observed. CONCLUSIONS: These data support the appropriateness of comprehensive medical monitoring as a remedy for people affected by defined sources of environmental contaminants.

Health effects in community residents near a uranium plant at Fernald, Ohio, USA.

OBJECTIVES: Health outcomes in persons who lived in the area surrounding a U.S. Department of Energy (DOE) uranium processing plant near Fernald, Ohio were evaluated using data of Fernald Medical Monitoring Program (FMMP) participants. METHODS: Residential history information was used to identify participants who lived in close proximity to the plant (less than 2 miles), in the direction of groundwater runoff (south of the plant), or used a well or cistern as a drinking water source. Standardized prevalence ratios (SPRs) for certain disease endpoints were calculated using the U.S. National Health Interview Survey(NHIS) and the National Health and Nutrition Examination Survey (NHANES) data files for comparison rates. RESULTS: Findings suggest that prior living within the Fernald exposure domain is related to increased prevalence of urinary system disease. Statistically significant elevations of bladder disease (standardized prevalence ratio or SPR = 1.32) and kidney disease (SPR = 2.15), including sub-categories, kidney stones (SPR = 3.98) and chronic nephritis (SPR = 2.03) were noted, as well as increased rates for hematuria and urethral stricture. In regression analyses with adjustment forage and sex, serum creatinine levels were increased in those who had lived close to the plant. Increased white blood cell count and hemoglobin levels, and decreased mean corpuscular volume were also found in those living less than 2 miles from the plant. Those who used a well or cistern for drinking water were found to have increased urinary microalbumin, red blood cell count and hematocrit. CONCLUSIONS: These preliminary findings will provide the basis for future hypothesis testing incorporating important determinants of exposure not included in this study, such as duration and calendar year of exposure, location relevant to prevailing wind direction, and age at exposure.