It was shown that ketamine in subanesthetic doses induces psychotigenic effects in healthy volunt... more It was shown that ketamine in subanesthetic doses induces psychotigenic effects in healthy volunteers . The purpose of this study was to assess the ability of dihydropyfidine calcium channel blocker, nimodipine, to attenuate the psychotigenic effects of NMDA calcium channel antagonist, ketamine.
Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with psychotogenic and dissociativ... more Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with psychotogenic and dissociative e¤ects in healthy humans. These cognitive and perceptual e¤ects in humans are reportedly reduced by benzodiazepine premedication. This study assessed the interactive e¤ects of a ketamine (IV bolus of 0.26 mg / kg followed by an infusion of 0.65 mg / kg per hour) and lorazepam 2 mg., PO, in humans. Twentythree healthy subjects completed 4 test days involving the oral administration of lorazepam or matched placebo 2 h prior to the IV infusion of ketamine or placebo. Ketamine : 1) produced behaviors similar to the positive and negative symptoms of schizophrenia as assessed by the Brief Psychiatric Rating Scale (BPRS); 2) evoked perceptual alterations as measured by the Clinician-Administered Dissociative States Scale (CADSS); 3) impaired performance on the Wisconsin Card Sorting Test (WCST) and other tests sensitive to frontal cortical impairment; and 4) had amnestic e¤ects. Lorazepam produced attention impairments, concrete proverb interpretations, and recall impairments. Lorazepam reduced ketamine-associated emotional distress and there was a non-signiÞcant trend for it to decrease perceptual alterations produced by ketamine. However, it failed to reduce many cognitive and behavioral e¤ects of ketamine, including psychosis. Further, lorazepam exacerbated the sedative, attentionimpairing, and amnestic e¤ects of ketamine. There was no evidence of pharmacokinetic interaction between these medications. These data suggest that subhypnotic lorazepam and ketamine show a spectrum of interactive e¤ects, ranging from antagonism to potentiation.
The Journal of Nervous and Mental Disease, Oct 1, 1999
Relatives frequently accommodate patients' obsessive-compulsive symptoms and clinicians h... more Relatives frequently accommodate patients' obsessive-compulsive symptoms and clinicians hypothesize that such accommodations adversely affect patient outcome. This study's purpose was to develop a valid and reliable measure, the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS), and to investigate the family accommodation construct. We administered the FAS and additional family and patient measures to 36 adult obsessive-compulsive patients and their primary caregivers. The FAS demonstrated excellent interrater reliability and good internal consistency and performed well on assessment of its convergent and discriminant validity. Family accommodation was significantly associated with patient symptom severity and functioning, and with relatives' own obsessive-compulsive symptoms. Although most relatives accommodated patient symptoms, many did not believe that such accommodations improved the patient's clinical status. The FAS will provide researchers and clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing more adaptive coping strategies.
A chart review was conducted to compare the social, occupational, and daily functioning of 17 inp... more A chart review was conducted to compare the social, occupational, and daily functioning of 17 inpatients with obsessive-compulsive disorder, 17 with major depression, and 17 with schizophrenia. Current Global Assessment of Functioning (GAF) scores of patients with schizophrenia were significantly lower than those of patients with depression and with obsessive-compulsive disorder. However, on work performance, daily living skills, and past-year GAF scores, patients with obsessive-compulsive disorder and those with schizophrenia did not differ significantly, and both groups were significantly more impaired than patients with depression. Results show that inpatients with obsessive-compulsive disorder may exhibit severe and chronic functional impairments requiring extensive supportive and rehabilitative services.
Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering, Jan 16, 2015
Natural gas extraction activities, including the use of horizontal drilling and hydraulic fractur... more Natural gas extraction activities, including the use of horizontal drilling and hydraulic fracturing, may pose potential health risks to both human and animal populations in close proximity to sites of extraction activity. Because animals may have increased exposure to contaminated water and air as well as increased susceptibility to contaminant exposures compared to nearby humans, animal disease events in communities living near natural gas extraction may provide "sentinel" information useful for human health risk assessment. Community health evaluations as well as health impact assessments (HIAs) of natural gas exploration should therefore consider the inclusion of animal health metrics in their assessment process. We report on a community environmental health survey conducted in an area of active natural gas drilling, which included the collection of health data on 2452 companion and backyard animals residing in 157 randomly-selected households of Washington County, Pen...
Background: The majority of emerging infectious diseases are zoonotic (transmissible between anim... more Background: The majority of emerging infectious diseases are zoonotic (transmissible between animals and humans) in origin, and therefore integrated surveillance of disease events in humans and animals has been recommended to support effective global response to disease emergence. While in the past decade there has been extensive global surveillance for highly pathogenic avian influenza (HPAI) infection in both animals and humans, there have been few attempts to compare these data streams and evaluate the utility of such integration.
Patients with obsessive-compulsive disorder may experience severely disabling symptoms and requir... more Patients with obsessive-compulsive disorder may experience severely disabling symptoms and require hospitalization. Based on treatment of 77 such patients admitted to a long-term general psychiatric research unit over a seven-year period, the authors present pharmacologic, psychosocial, and behavioral management strategies for treating these patients on general psychiatric units. The treatment guidelines require only modest modifications of standard practice and can be adapted for use on general units without specialized staff training. Some patients with obsessive-compulsive disorder exhibit strong control and dependency needs and disrupt the milieu in characteristic ways. These patients may generate conflict among staff about whether the patients can control obsessive-compulsive behaviors; they may anger other patients because of the large amount of staff attention they demand. Educating staff about obsessive-compulsive patients' control and dependency needs and enlisting the support of fellow patients can improve the milieu.
A chart review was conducted to compare the social, occupational, and daily functioning of 17 inp... more A chart review was conducted to compare the social, occupational, and daily functioning of 17 inpatients with obsessive-compulsive disorder, 17 with major depression, and 17 with schizophrenia. Current Global Assessment of Functioning (GAF) scores of patients with schizophrenia were significantly lower than those of patients with depression and with obsessive-compulsive disorder. However, on work performance, daily living skills, and past-year GAF scores, patients with obsessive-compulsive disorder and those with schizophrenia did not differ significantly, and both groups were significantly more impaired than patients with depression. Results show that inpatients with obsessive-compulsive disorder may exhibit severe and chronic functional impairments requiring extensive supportive and rehabilitative services.
ABSTRACT A convenience survey of swine workers on large and small commercial farms in the Northea... more ABSTRACT A convenience survey of swine workers on large and small commercial farms in the Northeast and Midwest United States regarding zoonotic influenza awareness and precautions was conducted. Workers reported low levels of concern regarding the risk of contracting influenza from swine, and were generally not aware of national guidelines for influenza prevention. Use of personal protective equipment (PPE) varied by task, N95 respirator use was rare, and no workers were enrolled in respirator programs. Reported influenza vaccination coverage was greater than the national average in 2009-2010, but declined in 2010-2011. Workers on large farms were more likely to use PPE in some tasks and to report using more precautions when pigs appeared ill. Although reporting low levels of concern regarding zoonotic influenza and low adherence to national influenza guidelines, swine workers reported making task-based and risk-based decisions about use of PPE, suggesting opportunities for enhanced prevention of zoonotic disease transmission.
Relatives frequently accommodate patients' obsessive-compulsive symptoms and clinicians h... more Relatives frequently accommodate patients' obsessive-compulsive symptoms and clinicians hypothesize that such accommodations adversely affect patient outcome. This study's purpose was to develop a valid and reliable measure, the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS), and to investigate the family accommodation construct. We administered the FAS and additional family and patient measures to 36 adult obsessive-compulsive patients and their primary caregivers. The FAS demonstrated excellent interrater reliability and good internal consistency and performed well on assessment of its convergent and discriminant validity. Family accommodation was significantly associated with patient symptom severity and functioning, and with relatives' own obsessive-compulsive symptoms. Although most relatives accommodated patient symptoms, many did not believe that such accommodations improved the patient's clinical status. The FAS will provide researchers and clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing more adaptive coping strategies.
Swine workers may play a key role in transmission of zoonotic influenza viruses. At the same time... more Swine workers may play a key role in transmission of zoonotic influenza viruses. At the same time, little is known about the extent and effectiveness of influenza prevention programs for these at-risk workers. To characterize practices and attitudes regarding zoonotic influenza transmission among swine workers in Romania. We conducted a convenience survey of swine workers in Romania. The confidential survey included questions about awareness of zoonotic influenza risk, work tasks performed, flu vaccination status, and reported influenza-like illness. A total of 103 workers at seven farms completed the survey. The percentage of workers reporting concern about either contracting influenza from pigs or giving influenza to pigs was 78% and 70%, respectively. Although 60% of workers reported having a sick-leave policy at work, only 7% of workers reported receiving seasonal influenza vaccination during the past flu season. Only 5% of the workers reported flu-like illness during the past year while 3% of workers reported that pigs appeared sick with influenza over the same time period. The majority of workers reported using protective overalls and rubber boots during swine work, with lower rates of use of gloves. Reported use of respiratory protection was rare, and use of any personal protective equipment did not differ when pigs appeared ill. Despite awareness and concern regarding zoonotic influenza, Romanian swine workers report low rates of influenza vaccine or respiratory protection. As part of global pandemic influenza preparedness, enhanced prevention programs for swine workers should address such gaps.
Background: The Beta-Carotene and Retinol Efficacy Trial (CARET) was terminated 21 months ahead o... more Background: The Beta-Carotene and Retinol Efficacy Trial (CARET) was terminated 21 months ahead of schedule due to an excess of lung cancers. Deaths from cardiovascular disease also increased (relative risk ¼ 1.26 (95% confidence interval (CI) 0.99-1.61)) in the group assigned to a combination of 30 mg beta-carotene and 25 000 IU retinyl palmitate (vitamin A) daily. The basis for increased cardiovascular mortality is unexplained. Design: We analyzed data on serum lipids, available for 1474 CARET Vanguard participants who were enrolled in the two CARET pilot studies and transitioned to the Vanguard study. Total cholesterol and triglycerides were measured 2 months prior to, 4 and 12 months following randomization, and annually thereafter for up to 7 y. Intervention: In the asbestos-exposed pilot (N ¼ 816), participants were assigned to beta-carotene and retinol or to placebo; in the smokers pilot (N ¼ 1029), participants were assigned to beta-carotene, retinol, a combination, or placebo. Results: Serum cholesterol showed a decline over time in both arms; serum triglycerides had a continuous decline over time in the placebo arm, but an initial increase that persisted in the active arm. Both serum cholesterol concentrations (Po0.0003) and serum triglycerides (Po0.0001) were significantly higher in the participants receiving vitamin A and/or a combination of vitamin A and beta-carotene (n ¼ 863) as compared to the placebo group (n ¼ 611). Those in this active intervention group had an average cholesterol concentration 5.3 mg/dl (0.137 mmol/l) higher than those in the placebo arm. Conclusion: The differences in cholesterol and triglyceride concentrations between the groups following randomization may account in part for the unexpected excess in cardiovascular deaths seen in the active intervention arm of CARET.
The majority of emerging infectious diseases are zoonotic in origin, including recently emerging ... more The majority of emerging infectious diseases are zoonotic in origin, including recently emerging influenza viruses such as the 2009 swine-origin H1N1 influenza A epidemic. The epidemic that year affected both human and animal populations as it spread globally. In fact, before the end of 2009, 14 different countries reported H1N1 infected swine. In order to better understand the zoonotic nature of the epidemic and the relationship between human and animal disease surveillance data streams, we compared 2009 reports of H1N1 infection to define the temporal relationship between reported cases in animals and humans. Generally, human cases preceded animal cases at a country-level, supporting the potential of H1N1 infection to be a ''reverse zoonosis'', and the value of integrating human and animal disease report data.
Background: Influenza A H5N1 has killed millions of birds and raises serious public health concer... more Background: Influenza A H5N1 has killed millions of birds and raises serious public health concern because of its potential to spread to humans and cause a global pandemic. While the early focus was in Asia, recent evidence suggests that Egypt is a new epicenter for the disease. This includes characterization of a variant clade 2.2.1.1, which has been found almost exclusively in Egypt. We analyzed 226 HA and 92 NA sequences with an emphasis on the H5N1 2.2.1.1 strains in Egypt using a Bayesian discrete phylogeography approach. This allowed modeling of virus dispersion between Egyptian governorates including the most likely origin. Results: Phylogeography models of hemagglutinin (HA) and neuraminidase (NA) suggest Ash Sharqiyah as the origin of virus spread, however the support is weak based on Kullback-Leibler values of 0.09 for HA and 0.01 for NA. Association Index (AI) values and Parsimony Scores (PS) were significant (p-value < 0.05), indicating that dispersion of H5N1 in Egypt was geographically structured. In addition, the Ash Sharqiyah to Al Gharbiyah and Al Fayyum to Al Qalyubiyah routes had the strongest statistical support. Conclusion: We found that the majority of routes with strong statistical support were in the heavily populated Delta region. In particular, the Al Qalyubiyah governorate appears to represent a popular location for virus transition as it represented a large portion of branches in both trees. However, there remains uncertainty about virus dispersion to and from this location and thus more research needs to be conducted in order to examine this. Phylogeography can highlight the drivers of H5N1 emergence and spread. This knowledge can be used to target public health efforts to reduce morbidity and mortality. For Egypt, future work should focus on using data about vaccination and live bird markets in phylogeography models to study their impact on H5N1 diffusion within the country.
This study was designed to determine whether injury risk among manufacturing workers was related ... more This study was designed to determine whether injury risk among manufacturing workers was related to hours worked during the previous week. A case-crossover design was utilized to contrast hours worked prior to an injury shift with those worked prior to a non-injury shift for hourly workers. Paired t-tests were used to determine significance of the difference. Conditional logistic regression was used to assess dose-response. Hours worked prior to injury significantly exceeded hours during the control week. Workers who worked more than 64 hr in the week before the shift had an 88% excess risk compared to those who worked 40 hr or fewer, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. The study provides evidence that injury risk is related to time worked during the previous week. Control of overtime in manufacturing may reduce risk of worker injury.
The objective of the study was to determine if female workers in a heavy manufacturing environmen... more The objective of the study was to determine if female workers in a heavy manufacturing environment have a higher risk of injury compared with males when performing the same job and to evaluate sex differences in type or severity of injury. By use of human resources and incident surveillance data for the hourly population at 6 US aluminum smelters, injuries that occurred from January 1, 1996, through December 21, 2005, were analyzed. Multivariate logistic regression, adjusted for job, tenure, and age category, was used to calculate odds ratios and 95% confidence intervals for female versus male injury risk for all injuries, recordable injuries, and lost work time injuries. The analysis was repeated for acute injuries and musculoskeletal disorder-related injuries separately. Female workers in this industry have a greater risk for sustaining all forms of injury after adjustment for age, tenure, and standardized job category (odds ratio ¼ 1.365, 95% confidence interval: 1.290, 1.445). This excess risk for female workers persisted when injuries were dichotomized into acute injuries (odds ratio ¼ 1.2) and musculoskeletal disorderrelated injuries (odds ratio ¼ 1.1). This study provides evidence of a sex disparity in occupational injury with female workers at higher risk compared with their male counterparts in a heavy manufacturing environment. sex; women; wounds and injuries Abbreviation: MSD, musculoskeletal disorder.
Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with prominent psychoactive effect... more Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with prominent psychoactive effects in humans. This study evaluated whether the oral administration of haloperidol 5 mg would block the effects of an intravenous ketamine infusion (bolus of 0.26 mg/kg followed by 0.65 mg/kg per hour). Twenty healthy subjects completed 4 test days involving the oral administration of haloperidol or matched placebo 2 h prior to the intravenous infusion of ketamine or saline. Ketamine produced cognitive, behavioral, neuroendocrine, and physiologic effects in the healthy subjects that were similar to previous reports. Haloperidol pretreatment reduced impairments in executive cognitive functions produced by ketamine as measured by proverb interpretations and the Wisconsin Card Sorting Test. However, it failed to block the capacity of ketamine to produce psychosis, perceptual changes, negative symptoms, or euphoria in healthy subjects. These data outline an important, but functionally delineaeted modulation of ketamine effects by dopamine2 receptors and other sites of haloperidol action.
Seasonality of mood disorders might involve alterations in the rhythmicity of serotonin [5-HT] fu... more Seasonality of mood disorders might involve alterations in the rhythmicity of serotonin [5-HT] function. We examined seasonal effects on the neuroendocrine and mood responses to L-tryptophan (L-TRP) in depressed patients and healthy subjects. In this study, 126 drug-free patients with DSM-III-R major depression and 58 healthy subjects received in i.v. infusion of L-TRP. Serum prolactin (PRL) and plasma tryptophan levels were measured. Mood was assessed with visual analogue scales. Cosinor analysis revealed seasonal variation in peak change (delta) PRL and baseline tryptophan levels in the combined depressed and in unipolar, nonmelancholic, and nonpsychotic patients. Peak delta PRL and tryptophan levels were inversely correlated in combined depressed and unipolar patients. Seasonality was more evident in female than in male patients. These data support previous evidence that 5-HT function is abnormal in depression and further suggest a seasonal variability of such abnormalities that is absent in healthy subjects.
It was shown that ketamine in subanesthetic doses induces psychotigenic effects in healthy volunt... more It was shown that ketamine in subanesthetic doses induces psychotigenic effects in healthy volunteers . The purpose of this study was to assess the ability of dihydropyfidine calcium channel blocker, nimodipine, to attenuate the psychotigenic effects of NMDA calcium channel antagonist, ketamine.
Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with psychotogenic and dissociativ... more Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with psychotogenic and dissociative e¤ects in healthy humans. These cognitive and perceptual e¤ects in humans are reportedly reduced by benzodiazepine premedication. This study assessed the interactive e¤ects of a ketamine (IV bolus of 0.26 mg / kg followed by an infusion of 0.65 mg / kg per hour) and lorazepam 2 mg., PO, in humans. Twentythree healthy subjects completed 4 test days involving the oral administration of lorazepam or matched placebo 2 h prior to the IV infusion of ketamine or placebo. Ketamine : 1) produced behaviors similar to the positive and negative symptoms of schizophrenia as assessed by the Brief Psychiatric Rating Scale (BPRS); 2) evoked perceptual alterations as measured by the Clinician-Administered Dissociative States Scale (CADSS); 3) impaired performance on the Wisconsin Card Sorting Test (WCST) and other tests sensitive to frontal cortical impairment; and 4) had amnestic e¤ects. Lorazepam produced attention impairments, concrete proverb interpretations, and recall impairments. Lorazepam reduced ketamine-associated emotional distress and there was a non-signiÞcant trend for it to decrease perceptual alterations produced by ketamine. However, it failed to reduce many cognitive and behavioral e¤ects of ketamine, including psychosis. Further, lorazepam exacerbated the sedative, attentionimpairing, and amnestic e¤ects of ketamine. There was no evidence of pharmacokinetic interaction between these medications. These data suggest that subhypnotic lorazepam and ketamine show a spectrum of interactive e¤ects, ranging from antagonism to potentiation.
The Journal of Nervous and Mental Disease, Oct 1, 1999
Relatives frequently accommodate patients&#39; obsessive-compulsive symptoms and clinicians h... more Relatives frequently accommodate patients&#39; obsessive-compulsive symptoms and clinicians hypothesize that such accommodations adversely affect patient outcome. This study&#39;s purpose was to develop a valid and reliable measure, the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS), and to investigate the family accommodation construct. We administered the FAS and additional family and patient measures to 36 adult obsessive-compulsive patients and their primary caregivers. The FAS demonstrated excellent interrater reliability and good internal consistency and performed well on assessment of its convergent and discriminant validity. Family accommodation was significantly associated with patient symptom severity and functioning, and with relatives&#39; own obsessive-compulsive symptoms. Although most relatives accommodated patient symptoms, many did not believe that such accommodations improved the patient&#39;s clinical status. The FAS will provide researchers and clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing more adaptive coping strategies.
A chart review was conducted to compare the social, occupational, and daily functioning of 17 inp... more A chart review was conducted to compare the social, occupational, and daily functioning of 17 inpatients with obsessive-compulsive disorder, 17 with major depression, and 17 with schizophrenia. Current Global Assessment of Functioning (GAF) scores of patients with schizophrenia were significantly lower than those of patients with depression and with obsessive-compulsive disorder. However, on work performance, daily living skills, and past-year GAF scores, patients with obsessive-compulsive disorder and those with schizophrenia did not differ significantly, and both groups were significantly more impaired than patients with depression. Results show that inpatients with obsessive-compulsive disorder may exhibit severe and chronic functional impairments requiring extensive supportive and rehabilitative services.
Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering, Jan 16, 2015
Natural gas extraction activities, including the use of horizontal drilling and hydraulic fractur... more Natural gas extraction activities, including the use of horizontal drilling and hydraulic fracturing, may pose potential health risks to both human and animal populations in close proximity to sites of extraction activity. Because animals may have increased exposure to contaminated water and air as well as increased susceptibility to contaminant exposures compared to nearby humans, animal disease events in communities living near natural gas extraction may provide "sentinel" information useful for human health risk assessment. Community health evaluations as well as health impact assessments (HIAs) of natural gas exploration should therefore consider the inclusion of animal health metrics in their assessment process. We report on a community environmental health survey conducted in an area of active natural gas drilling, which included the collection of health data on 2452 companion and backyard animals residing in 157 randomly-selected households of Washington County, Pen...
Background: The majority of emerging infectious diseases are zoonotic (transmissible between anim... more Background: The majority of emerging infectious diseases are zoonotic (transmissible between animals and humans) in origin, and therefore integrated surveillance of disease events in humans and animals has been recommended to support effective global response to disease emergence. While in the past decade there has been extensive global surveillance for highly pathogenic avian influenza (HPAI) infection in both animals and humans, there have been few attempts to compare these data streams and evaluate the utility of such integration.
Patients with obsessive-compulsive disorder may experience severely disabling symptoms and requir... more Patients with obsessive-compulsive disorder may experience severely disabling symptoms and require hospitalization. Based on treatment of 77 such patients admitted to a long-term general psychiatric research unit over a seven-year period, the authors present pharmacologic, psychosocial, and behavioral management strategies for treating these patients on general psychiatric units. The treatment guidelines require only modest modifications of standard practice and can be adapted for use on general units without specialized staff training. Some patients with obsessive-compulsive disorder exhibit strong control and dependency needs and disrupt the milieu in characteristic ways. These patients may generate conflict among staff about whether the patients can control obsessive-compulsive behaviors; they may anger other patients because of the large amount of staff attention they demand. Educating staff about obsessive-compulsive patients&#39; control and dependency needs and enlisting the support of fellow patients can improve the milieu.
A chart review was conducted to compare the social, occupational, and daily functioning of 17 inp... more A chart review was conducted to compare the social, occupational, and daily functioning of 17 inpatients with obsessive-compulsive disorder, 17 with major depression, and 17 with schizophrenia. Current Global Assessment of Functioning (GAF) scores of patients with schizophrenia were significantly lower than those of patients with depression and with obsessive-compulsive disorder. However, on work performance, daily living skills, and past-year GAF scores, patients with obsessive-compulsive disorder and those with schizophrenia did not differ significantly, and both groups were significantly more impaired than patients with depression. Results show that inpatients with obsessive-compulsive disorder may exhibit severe and chronic functional impairments requiring extensive supportive and rehabilitative services.
ABSTRACT A convenience survey of swine workers on large and small commercial farms in the Northea... more ABSTRACT A convenience survey of swine workers on large and small commercial farms in the Northeast and Midwest United States regarding zoonotic influenza awareness and precautions was conducted. Workers reported low levels of concern regarding the risk of contracting influenza from swine, and were generally not aware of national guidelines for influenza prevention. Use of personal protective equipment (PPE) varied by task, N95 respirator use was rare, and no workers were enrolled in respirator programs. Reported influenza vaccination coverage was greater than the national average in 2009-2010, but declined in 2010-2011. Workers on large farms were more likely to use PPE in some tasks and to report using more precautions when pigs appeared ill. Although reporting low levels of concern regarding zoonotic influenza and low adherence to national influenza guidelines, swine workers reported making task-based and risk-based decisions about use of PPE, suggesting opportunities for enhanced prevention of zoonotic disease transmission.
Relatives frequently accommodate patients&#39; obsessive-compulsive symptoms and clinicians h... more Relatives frequently accommodate patients&#39; obsessive-compulsive symptoms and clinicians hypothesize that such accommodations adversely affect patient outcome. This study&#39;s purpose was to develop a valid and reliable measure, the Family Accommodation Scale for Obsessive-Compulsive Disorder (FAS), and to investigate the family accommodation construct. We administered the FAS and additional family and patient measures to 36 adult obsessive-compulsive patients and their primary caregivers. The FAS demonstrated excellent interrater reliability and good internal consistency and performed well on assessment of its convergent and discriminant validity. Family accommodation was significantly associated with patient symptom severity and functioning, and with relatives&#39; own obsessive-compulsive symptoms. Although most relatives accommodated patient symptoms, many did not believe that such accommodations improved the patient&#39;s clinical status. The FAS will provide researchers and clinicians with a useful tool for assessing family accommodation and for identifying families who may benefit from interventions aimed at developing more adaptive coping strategies.
Swine workers may play a key role in transmission of zoonotic influenza viruses. At the same time... more Swine workers may play a key role in transmission of zoonotic influenza viruses. At the same time, little is known about the extent and effectiveness of influenza prevention programs for these at-risk workers. To characterize practices and attitudes regarding zoonotic influenza transmission among swine workers in Romania. We conducted a convenience survey of swine workers in Romania. The confidential survey included questions about awareness of zoonotic influenza risk, work tasks performed, flu vaccination status, and reported influenza-like illness. A total of 103 workers at seven farms completed the survey. The percentage of workers reporting concern about either contracting influenza from pigs or giving influenza to pigs was 78% and 70%, respectively. Although 60% of workers reported having a sick-leave policy at work, only 7% of workers reported receiving seasonal influenza vaccination during the past flu season. Only 5% of the workers reported flu-like illness during the past year while 3% of workers reported that pigs appeared sick with influenza over the same time period. The majority of workers reported using protective overalls and rubber boots during swine work, with lower rates of use of gloves. Reported use of respiratory protection was rare, and use of any personal protective equipment did not differ when pigs appeared ill. Despite awareness and concern regarding zoonotic influenza, Romanian swine workers report low rates of influenza vaccine or respiratory protection. As part of global pandemic influenza preparedness, enhanced prevention programs for swine workers should address such gaps.
Background: The Beta-Carotene and Retinol Efficacy Trial (CARET) was terminated 21 months ahead o... more Background: The Beta-Carotene and Retinol Efficacy Trial (CARET) was terminated 21 months ahead of schedule due to an excess of lung cancers. Deaths from cardiovascular disease also increased (relative risk ¼ 1.26 (95% confidence interval (CI) 0.99-1.61)) in the group assigned to a combination of 30 mg beta-carotene and 25 000 IU retinyl palmitate (vitamin A) daily. The basis for increased cardiovascular mortality is unexplained. Design: We analyzed data on serum lipids, available for 1474 CARET Vanguard participants who were enrolled in the two CARET pilot studies and transitioned to the Vanguard study. Total cholesterol and triglycerides were measured 2 months prior to, 4 and 12 months following randomization, and annually thereafter for up to 7 y. Intervention: In the asbestos-exposed pilot (N ¼ 816), participants were assigned to beta-carotene and retinol or to placebo; in the smokers pilot (N ¼ 1029), participants were assigned to beta-carotene, retinol, a combination, or placebo. Results: Serum cholesterol showed a decline over time in both arms; serum triglycerides had a continuous decline over time in the placebo arm, but an initial increase that persisted in the active arm. Both serum cholesterol concentrations (Po0.0003) and serum triglycerides (Po0.0001) were significantly higher in the participants receiving vitamin A and/or a combination of vitamin A and beta-carotene (n ¼ 863) as compared to the placebo group (n ¼ 611). Those in this active intervention group had an average cholesterol concentration 5.3 mg/dl (0.137 mmol/l) higher than those in the placebo arm. Conclusion: The differences in cholesterol and triglyceride concentrations between the groups following randomization may account in part for the unexpected excess in cardiovascular deaths seen in the active intervention arm of CARET.
The majority of emerging infectious diseases are zoonotic in origin, including recently emerging ... more The majority of emerging infectious diseases are zoonotic in origin, including recently emerging influenza viruses such as the 2009 swine-origin H1N1 influenza A epidemic. The epidemic that year affected both human and animal populations as it spread globally. In fact, before the end of 2009, 14 different countries reported H1N1 infected swine. In order to better understand the zoonotic nature of the epidemic and the relationship between human and animal disease surveillance data streams, we compared 2009 reports of H1N1 infection to define the temporal relationship between reported cases in animals and humans. Generally, human cases preceded animal cases at a country-level, supporting the potential of H1N1 infection to be a ''reverse zoonosis'', and the value of integrating human and animal disease report data.
Background: Influenza A H5N1 has killed millions of birds and raises serious public health concer... more Background: Influenza A H5N1 has killed millions of birds and raises serious public health concern because of its potential to spread to humans and cause a global pandemic. While the early focus was in Asia, recent evidence suggests that Egypt is a new epicenter for the disease. This includes characterization of a variant clade 2.2.1.1, which has been found almost exclusively in Egypt. We analyzed 226 HA and 92 NA sequences with an emphasis on the H5N1 2.2.1.1 strains in Egypt using a Bayesian discrete phylogeography approach. This allowed modeling of virus dispersion between Egyptian governorates including the most likely origin. Results: Phylogeography models of hemagglutinin (HA) and neuraminidase (NA) suggest Ash Sharqiyah as the origin of virus spread, however the support is weak based on Kullback-Leibler values of 0.09 for HA and 0.01 for NA. Association Index (AI) values and Parsimony Scores (PS) were significant (p-value < 0.05), indicating that dispersion of H5N1 in Egypt was geographically structured. In addition, the Ash Sharqiyah to Al Gharbiyah and Al Fayyum to Al Qalyubiyah routes had the strongest statistical support. Conclusion: We found that the majority of routes with strong statistical support were in the heavily populated Delta region. In particular, the Al Qalyubiyah governorate appears to represent a popular location for virus transition as it represented a large portion of branches in both trees. However, there remains uncertainty about virus dispersion to and from this location and thus more research needs to be conducted in order to examine this. Phylogeography can highlight the drivers of H5N1 emergence and spread. This knowledge can be used to target public health efforts to reduce morbidity and mortality. For Egypt, future work should focus on using data about vaccination and live bird markets in phylogeography models to study their impact on H5N1 diffusion within the country.
This study was designed to determine whether injury risk among manufacturing workers was related ... more This study was designed to determine whether injury risk among manufacturing workers was related to hours worked during the previous week. A case-crossover design was utilized to contrast hours worked prior to an injury shift with those worked prior to a non-injury shift for hourly workers. Paired t-tests were used to determine significance of the difference. Conditional logistic regression was used to assess dose-response. Hours worked prior to injury significantly exceeded hours during the control week. Workers who worked more than 64 hr in the week before the shift had an 88% excess risk compared to those who worked 40 hr or fewer, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. The study provides evidence that injury risk is related to time worked during the previous week. Control of overtime in manufacturing may reduce risk of worker injury.
The objective of the study was to determine if female workers in a heavy manufacturing environmen... more The objective of the study was to determine if female workers in a heavy manufacturing environment have a higher risk of injury compared with males when performing the same job and to evaluate sex differences in type or severity of injury. By use of human resources and incident surveillance data for the hourly population at 6 US aluminum smelters, injuries that occurred from January 1, 1996, through December 21, 2005, were analyzed. Multivariate logistic regression, adjusted for job, tenure, and age category, was used to calculate odds ratios and 95% confidence intervals for female versus male injury risk for all injuries, recordable injuries, and lost work time injuries. The analysis was repeated for acute injuries and musculoskeletal disorder-related injuries separately. Female workers in this industry have a greater risk for sustaining all forms of injury after adjustment for age, tenure, and standardized job category (odds ratio ¼ 1.365, 95% confidence interval: 1.290, 1.445). This excess risk for female workers persisted when injuries were dichotomized into acute injuries (odds ratio ¼ 1.2) and musculoskeletal disorderrelated injuries (odds ratio ¼ 1.1). This study provides evidence of a sex disparity in occupational injury with female workers at higher risk compared with their male counterparts in a heavy manufacturing environment. sex; women; wounds and injuries Abbreviation: MSD, musculoskeletal disorder.
Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with prominent psychoactive effect... more Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist with prominent psychoactive effects in humans. This study evaluated whether the oral administration of haloperidol 5 mg would block the effects of an intravenous ketamine infusion (bolus of 0.26 mg/kg followed by 0.65 mg/kg per hour). Twenty healthy subjects completed 4 test days involving the oral administration of haloperidol or matched placebo 2 h prior to the intravenous infusion of ketamine or saline. Ketamine produced cognitive, behavioral, neuroendocrine, and physiologic effects in the healthy subjects that were similar to previous reports. Haloperidol pretreatment reduced impairments in executive cognitive functions produced by ketamine as measured by proverb interpretations and the Wisconsin Card Sorting Test. However, it failed to block the capacity of ketamine to produce psychosis, perceptual changes, negative symptoms, or euphoria in healthy subjects. These data outline an important, but functionally delineaeted modulation of ketamine effects by dopamine2 receptors and other sites of haloperidol action.
Seasonality of mood disorders might involve alterations in the rhythmicity of serotonin [5-HT] fu... more Seasonality of mood disorders might involve alterations in the rhythmicity of serotonin [5-HT] function. We examined seasonal effects on the neuroendocrine and mood responses to L-tryptophan (L-TRP) in depressed patients and healthy subjects. In this study, 126 drug-free patients with DSM-III-R major depression and 58 healthy subjects received in i.v. infusion of L-TRP. Serum prolactin (PRL) and plasma tryptophan levels were measured. Mood was assessed with visual analogue scales. Cosinor analysis revealed seasonal variation in peak change (delta) PRL and baseline tryptophan levels in the combined depressed and in unipolar, nonmelancholic, and nonpsychotic patients. Peak delta PRL and tryptophan levels were inversely correlated in combined depressed and unipolar patients. Seasonality was more evident in female than in male patients. These data support previous evidence that 5-HT function is abnormal in depression and further suggest a seasonal variability of such abnormalities that is absent in healthy subjects.
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