Managing risks to drivers in road transport

This report presents a number of case studies in managing risks to road transport drivers. The cases feature a variety of initiatives and interventions to protect drivers.In the road transport sector, as with any other, it is important to pay attention to working conditions in order to ensure a skilled and motivated workforce. Certain characteristics of the sector make it more difficult to practice risk management than in other sectors. But by taking account of how the sector operates in practice, and the characteristics of drivers themselves and the way they work, risks can be successfully manage

Percutaneous Catheter Dilatation of Benign Ureteroenteric Anastomotic Strictures Followed or not by Retrograde Transconduit Placement of a Catheter: Long Term Results

BACKGROUND: We report our experience on multiple balloon dilatations for benign ureteroenteric anastomotic strictures after total cystectomy and urinal deviation by ileal conduit, followed or not by retrograde placement of a permanent catheter through the stoma of the ileal conduit. PATIENTS AND METHODS: Patients were classified in two groups: Group A included patients treated only by multiple balloon dilatations and Group B patients in whom multiple dilatations were followed by retrograde insertion of a permanent catheter through the stoma of the ileal conduit, which then had to be replaced regularly. Records of survival and patency rates were recorded. RESULTS: Twenty patients with 24 benign ureteroenteric anastomotic strictures referred to radiology department. Long-term results were available in only 15 patients, who finally included in the study. In Group A long term follow-up was achieved in five patients. Mean primary patency time of stenoses (interval between initial dilatation and recurrence) was 33.2 months. This time-period proved to be the same as the survival time of Group A patients, since all five patients eventually succumbed to the underlying disease or other reasons. In Group B, 6 patients are still alive and 4 patients eventually succumbed to the underlying disease or other reasons. Mean primary patency time of stenoses was 38.1 months. CONCLUSIONS: Balloon dilatations of benign ureteroenteric anastomotic strictures, due to radical cystectomy and urinal deviation by ileal conduit, were technically successful in all cases. Patency rate was comparable in the two study groups. However, regular catheter replacement through the ileal conduit is well tolerated and gives a sense of security to both patient and physician

New risks and trends in the safety and health of women at work

In 2009 and 2010, the Agency commissioned an update to its previous research on gender issues at work (EU-OSHA, 2003), which found that inequality both within and outside the workplace can have an effect on the health and safety of women at work. This report provides that update and the first figures on the effects of the recent economic downturn on women at work. It aims to fulfil the task outlined by the European strategy on health and safety at work (EC, 2002) for EU-OSHA’s European Risk Observatory: ‘examining the specific challenges in terms of health and safety posed by the more extensive integration of women in the labour market’. Gender inequalities in the workplace and work–life balance issues have become increasingly important as the employment rates of women have continued to grow in all Member States. Although in 2012 58.6 % of working age women (in the EU-27) were in employment and women filled 59 % of all newly created jobs in 2009(1 ), the extent to which women contribute economically still seems to be underestimated. At its start, women were affected less than men by the recent economic crisis, as the first jobs to be lost were mostly in the male-dominated construction and manufacturing industries. However, between 2008 and 2012, European gender differences in employment fell by an average of 7.6 to 6.3 percentage points, mainly because male employment rates fell more than those of women, which have returned to the 2007 level. A modern organisation of work, a knowledge economy, competitiveness and more and better jobs are central to the post-2010 Lisbon Strategy and the EU’s 2020 Strategy. Women are essential to the workforce in terms of providing an active and sustainable source of labour, and in June 2010 the European Council set a new, ambitious target aiming to raise the employment rate for women and men aged 20–64 to 75 % by 2020, partly through the greater participation of young people, older workers and low-skilled workers and the better integration of legal migrants. However, although employment rates for women are rising, much remains to be done, especially for older and younger women, to reach this goal and at the same time ensure decent work for all. The issue of occupational safety and health (OSH) for women who work in the European Union (EU) is central to an understanding of the working environment. Previous research has shown that women’s OSH has to be improved. Research from the European Commission illustrates that, even by 1995, women accounted for close to or above half of all cases of work-associated ill health, including allergies (45 %), infectious illnesses (61 %), neurological complaints (55 %) and hepatic and dermatological complaints (48 %). The situation has not improved. Further, for ‘women’s jobs’, such as those in the health and social services, retail and hospitality sectors, there is a stagnation in accident rates in some countries; women are more likely to be bullied and harassed, subjected to sexual harassment and have to use poorly fitting personal protective equipment that is not usually sized for a smaller frame. The aims of this review are to: Provide a statistical overview of the trends in employment and integration of women in the labour market, and explore how they impact on their occupational safety and health. Identify and highlight the main issues and trends in employment characteristics, working conditions, hazard exposure and work-related accidents and health problems for women at work and explore more in-depth selected issues not addressed thoroughly before, such as combined exposures, informal work and the rehabilitation of women into work. Identify emerging issues for OSH research and the prevention of occupational diseases and accidents affecting women at work. This focus on OSH benefits not only women but also men who work, and thus reinforces the considerable potential to be gained by improved workplaces. A summary of the findings and trends and a more detailed list of suggestions is included in every chapter of this report and in the conclusions

A CD8+ T cell transcription signature predicts prognosis in autoimmune disease.

Autoimmune diseases are common and debilitating, but their severe manifestations could be reduced if biomarkers were available to allow individual tailoring of potentially toxic immunosuppressive therapy. Gene expression-based biomarkers facilitating such tailoring of chemotherapy in cancer, but not autoimmunity, have been identified and translated into clinical practice. We show that transcriptional profiling of purified CD8(+) T cells, which avoids the confounding influences of unseparated cells, identifies two distinct subject subgroups predicting long-term prognosis in two autoimmune diseases, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), a chronic, severe disease characterized by inflammation of medium-sized and small blood vessels, and systemic lupus erythematosus (SLE), characterized by autoantibodies, immune complex deposition and diverse clinical manifestations ranging from glomerulonephritis to neurological dysfunction. We show that the subset of genes defining the poor prognostic group is enriched for genes involved in the interleukin-7 receptor (IL-7R) pathway and T cell receptor (TCR) signaling and those expressed by memory T cells. Furthermore, the poor prognostic group is associated with an expanded CD8(+) T cell memory population. These subgroups, which are also found in the normal population and can be identified by measuring expression of only three genes, raise the prospect of individualized therapy and suggest new potential therapeutic targets in autoimmunity

The potential utility of B cell-directed biologic therapy in autoimmune diseases

Increasing awareness of the importance of aberrant B cell regulation in autoimmunity has driven the clinical development of novel B cell-directed biologic therapies with the potential to treat a range of autoimmune disorders. The first of these drugs—rituximab, a chimeric monoclonal antibody against the B cell-specific surface marker CD20—was recently approved for treating rheumatoid arthritis in patients with an inadequate response to other biologic therapies. The aim of this review is to discuss the potential use of rituximab in the management of other autoimmune disorders. Results from early phase clinical trials indicate that rituximab may provide clinical benefit in systemic lupus erythematosus, Sjögren’s syndrome, vasculitis, and thrombocytopenic purpura. Numerous case reports and several small pilot studies have also been published reporting the use of rituximab in conditions such as myositis, antiphospholipid syndrome, Still’s disease, and multiple sclerosis. In general, the results from these preliminary studies encourage further testing of rituximab therapy in formalized clinical trials. Based on results published to date, it is concluded that rituximab, together with other B cell-directed therapies currently under clinical development, is likely to provide an important new treatment option for a number of these difficult-to-treat autoimmune disorders

Changes in health-related quality of life in Greek adult patients two years after successful renal transplantation

Introduction. This study was undertaken to compare and evaluate the heath-related quality of life (HRQOL) in Greek adult transplant recipients before and 2 years after successful renal transplantation (RT). The SF-36 survey score was used. Methods. Eighty-five Greek hemodialysis patients underwent RT at the Transplant Unit of Evangelismos General Hospital of Athens, including 44 men and 41 women (mean age 43.8 years; range 21-59 years). The scale scores of a Greek version of the SF-36 survey were compared between the transplant and the hemodialysis patients. We also examined the relationships of the scale scores with the patients' age and the type of donor. Results. According to the SF-36 health survey, transplant recipients had better results for general health perception (p≤0.001), role-physical functioning (p≤0.01), role-emotional functioning (p≤0.01), and vitality (p≤ 0.01). In addition, the scale score of physical functioning, general health and vitality of the patients who were younger than 30 years at the time of transplantation were significantly higher than those of the patients who were older than 30 years, while the scores of bodily pain, general health, and physical functioning were significantly lower in cadaveric graft recipients compared with living-related recipients. Conclusions. The SF-36 health survey is a validated and comprehensive instrument for evaluating renal transplant patients' HRQOL. Our data demonstrated an improvement in HRQOL in renal transplant patients 2 years after successful renal transplantation. The data also confirmed that the recipients' age at transplantation and the type of donor were important factors affecting the HRQOL