Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study

Objectives: Sick building syndrome (SBS) is described as a group of symptoms attributed to the physical environment of specific buildings. Isolating particular environmental features responsible for the symptoms has proved difficult. This study explores the role and significance of the physical and psychosocial work environment in explaining SBS. Methods: Cross sectional data on the physical environment of a selection of buildings were added to individual data from the Whitehall II study—an ongoing health survey of office based civil servants. A self-report questionnaire was used to capture 10 symptoms of the SBS and psychosocial work stress. In total, 4052 participants aged 42–62 years working in 44 buildings were included in this study. Results: No significant relation was found between most aspects of the physical work environment and symptom prevalence, adjusted for age, sex, and employment grade. Positive (non-significant) relations were found only with airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. Greater effects were found with features of the psychosocial work environment including high job demands and low support. Only psychosocial work characteristics and control over the physical environment were independently associated with symptoms in the multivariate analysis. Conclusions: The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms

Barriers to the up-take of telemedicine in Australia - A view from providers

Introduction: The continued poorer health status of rural and remote Australians when compared with their urban counterparts is cause for concern. The use of advanced technology to improve access to health care has the potential to assist in addressing this problem. Telemedicine is one example of such technology which has advanced rapidly in its capacity to increase access to healthcare services or provide previously unavailable services. The important anticipated benefits of greater access to healthcare services are improved health outcomes and more cost-effective delivery

Federal government relief programs for grain farmers: rewards for the late adjusters?

Non-Peer ReviewedThe Canadian Federal Government has introduced several major ad hoc relief programs for prairie farmers in the last fifty years, in response to various agricultural crises. Each of these programs has rewarded late adjusters – farmers who contributed to the crises by not responding appropriately to market or environmental conditions. Early adjusters who quickly and innovatively responded have been treated indifferently or penalized by the programs. The 1941 Wheat Acreage Reduction (WAR) program and 1970 Lower Inventory for Tomorrow (LIFT) favoured farmers who grew large acreages of wheat in the preceding years despite high levels of Canadian and world wheat stocks. Farmers who had cut production or diversified received less program money than the late adjusters. The Special Canadian Grains Program (SCGP) of 1986, introduced to offset low world prices in traditional crops, made no payments to special crop producers in its first year. Producers who cultivated below average quality land in a township or who planted traditional rotations regardless of, sometimes in spite of, climatic conditions in 1988 received much of the benefit of the Canadian Crop Drought Assistance Program (CCDAP). The 1989 Permanent Cover Program of the Canada-Saskatchewan Agreement on Soil Conservation will reward, at least in part, late adjusters who brought marginal land under cultivation, some as recently as July 1987, without regard for environmental consequences. Throughout the last fifty years, the delivery quota system, based on the number of acres farmed, has encouraged extensive farming techniques and the cultivation of marginal land. Farmers who practiced annual cultivation of export crops may have maximized short run economic returns given the combined economic and policy signals which were received. Farmers who have tried to farm according to the best long-term agronomic practices have not been rewarded through policy initiatives. Ad hoc programs which have tried to move producers away from traditional prairie crops and cultivation methods, especially wheat production, often have been poorly designed, underfunded and limited in scope. Fundamental federal government policies for Prairie agriculture, including the Homestead Act, the Land Survey, and the Crow Rate/Western Grain Transportation Act (WGTA) have consistently pushed Prairie land use in a single direction, encouraging annual cultivation and the production of grain, especially wheat, for export at the expense of most other types of agricultural production. A precarious cyclical economy has been one result, especially in Saskatchewan. Deterioration of a significant portion of the land base has been another. The provincial land assessment and property taxation system may have institutionalized this land degradation. The "Wheat is King" tradition is still alive and well on the prairies and in the minds of policy planners. Wheat will remain a major crop. However, governments which are serious about diversification in Prairie agriculture must begin to reward early adjusters – those who innovate and respond appropriately to markets and the physical environment. Federal Government legislation for the prairie region should be enabling, not disabling legislation

Polymorphisms in the circadian expressed genes PER3 and ARNTL2 are associated with diurnal preference and GNβ3 with sleep measures

Sleep and circadian rhythms are intrinsically linked, with several sleep traits, including sleep timing and duration, influenced by both sleep homeostasis and the circadian phase. Genetic variation in several circadian genes has been associated with diurnal preference (preference in timing of sleep), although there has been limited research on whether they are associated with other sleep measurements. We investigated whether these genetic variations were associated with diurnal preference (Morningness-Eveningness Questionnaire) and various sleep measures, including: the global Pittsburgh Sleep Quality index score; sleep duration; and sleep latency and sleep quality. We genotyped 10 polymorphisms in genes with circadian expression in participants from the G1219 sample (n = 966), a British longitudinal population sample of young adults. We conducted linear regressions using dominant, additive and recessive models of inheritance to test for associations between these polymorphisms and the sleep measures. We found a significant association between diurnal preference and a polymorphism in period homologue 3 (PER3) (P < 0.005, recessive model) and a novel nominally significant association between diurnal preference and a polymorphism in aryl hydrocarbon receptor nuclear translocator-like 2 (ARNTL2) (P < 0.05, additive model). We found that a polymorphism in guanine nucleotide binding protein beta 3 (GNβ3) was associated significantly with global sleep quality (P < 0.005, recessive model), and that a rare polymorphism in period homologue 2 (PER2) was associated significantly with both sleep duration and quality (P < 0.0005, recessive model). These findings suggest that genes with circadian expression may play a role in regulating both the circadian clock and sleep homeostasis, and highlight the importance of further studies aimed at dissecting the specific roles that circadian genes play in these two interrelated but unique behaviours

BCG Vaccination in HIV-Infected Children

Despite the use of Bacillus Calmette-Guérin (BCG) vaccination for many years, infants and young children exposed to adults with infectious forms of tuberculosis (TB) are at high risk of developing complicated TB disease. This risk is much higher among HIV-infected children, and data on BCG protective efficacy in HIV-infected children is lacking. Recent research on BCG safety in HIV-infected infants has resulted in policy shifts, but implementation is challenging. New approaches to preventing TB among infants and children, particularly HIV-infected infants, are needed. This paper briefly reviews BCG safety and efficacy considerations in HIV-infected infants and discusses other approaches to preventing TB, including new TB vaccines and vaccination strategies

Availability of difficult airway equipment to rural anaesthetists in Queensland, Australia

Introduction: Since 1990 several airway devices have become available to assist in difficult intubation. Multiple surveys have assessed difficult airway equipment availability in international anaesthetic departments and emergency departments. The practice of GP anaesthetists is unique in both its multidisciplinary nature and geographical isolation. Objectives: General practitioners performing general anaesthesia in rural and remote Queensland, Australia were surveyed to assess their access to difficult airway equipment and whether this was related to the remoteness of their location or attendance at continuing professional development activities. Methods: Design: survey. Setting: proceduralists performing general anaesthesia in hospitals categorised as Rural, Remote and Metropolitan Area (RRMA) classification 4 to 7 inclusive were surveyed. Outcome measure: data collected included demographic information, availability of airway management equipment, and attendance at continuing professional development activities. The received data was entered into a Microsoft Excel spreadsheet and analysed in Statistical Package for Social Sciences (SPSS Inc; Chicago, IL, USA) using the frequencies and crosstabs functions. The Fisher’s exact test was used. A p-value of less than 0.10 was considered noteworthy and a p-value of less than 0.05 was considered to be significant. A statistical comparison was made between the known demographics of the target population and the survey responders. The known demographics were derived from the Health Workforce Queensland database and included age, gender, practice location and practitioner type. Results: Seventy-nine surveys were distributed and 35 returned (response rate 44%). This represented 21 hospitals. There was no statistical difference between the target population and the survey responders in terms of age and gender. There was no statistical difference in terms of practice location, although the small percentage responding from RRMA 6 was notable. There was a statistically significant difference between the groups in terms of practitioner type. Hospital-based practitioners were relatively under-represented in the responder group. Eighty-two per cent of practitioners felt they had access to appropriate equipment and this was not significantly related the remoteness of their location. There was wide variation in available equipment. Simple adjuncts such as the bougie and stylet were not universally available but cricothyroidotomy sets were more common. Practitioners in the more remote locations were less likely to have attended an educational activity such as conference, workshop or skills laboratory (p=0.05). Conclusions: We suggest standardisation of difficult airway equipment for rural practitioners. This could be supported by increased availability of airway management workshops in remote areas. Such an intervention would be in line with other initiatives to standardise medical equipment in rural and remote Queensland hospitals. Familiarity with infrequently used equipment may assist practitioners and their locums. Standardisation of equipment and practice is a recognised method of improving patient safety

Clinical communication skills learning outcomes among first year medical students are consistent irrespective of participation in an interview for admission to medical school

Background: Although contentious most medical schools interview potential students to assess personal abilities such as communication. Aims: To investigate any differences in clinical communication skills (CCS) between first year students admitted to UQ medical school with or without an admissions interview. Methods: A retrospective analysis of 1495 student assessment scores obtained after structured communication skills training (CCS) between 2007 and 2010. Results: The average assessment score was 3.76 ([95% CI, 3.73-3.78]) and adjusting for student characteristics, showed no main effect for interview (p=0.89). The strongest predictor of scores was gender with females achieving significantly higher scores (3.91 [95% CI, 3.54-4.28] vs. 3.76 [95% CI, 3.39-4.13]; p≤0.001). Conclusions: Data show no differences in post-training assessment measures between students who were interviewed during selection or not. Further research about the quality and retention of communications skills after training is warranted

Short-term outcomes of down-referral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A retrospective cohort study

Background. The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children’s Hospital (RCWMCH), Cape Town, South Africa. Few published data exist on the outcomes of these children.Objectives. To assess outcomes of children receiving ART in the first 12 months after down-referral to primary healthcare (PHC) clinics and identify determinants of successful down-referral.Methods. A retrospective cohort study of children &lt;15 years of age who initiated ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012 was completed. Baseline characteristics of patients and caregivers as well as CD4+ counts, viral loads (VLs) and weights were collected 6 and 12 months after down-referral. Outcomes included retention in care and viral suppression.Results. Of 116 children down-referred to the two study PHC clinics, 81.9% arrived at the designated PHC clinic and a further 8.6% continued care at other clinics, the remaining 9.5% being lost to follow-up. Of those successfully down-referred, 11.4% took &gt;8 weeks to present, possibly experiencing treatment interruption. At 12 months after down-referral, only 81.0% remained in care. No factors were associated with retention in care in multivariable analysis. For children who remained in care at the designated PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow-up, and 54.7% of this cohort had documented viral suppression at 12 months. However, if only children with VL results are considered, 75.9% (41/54) were virally suppressed 12 months after down-referral.Conclusions. Down-referral of children on ART is complex, with risk of loss to follow-up and treatment interruption

Structural role of the tyrosine residues of cytochrome c

The tertiary structures of horse, tuna, Neurospora crassa, horse [Hse65,Leu67]- and horse [Hse65,Leu74]-cytochromes c were studied with high-resolution 1H n.m.r. spectroscopy. The amino acid sequences of these proteins differ at position 46, which is occupied by phenylalanine in the horse proteins but by tyrosine in the remaining two, and at positions 67, 74 and 97, which are all occupied by tyrosine residues in horse and tuna cytochrome c but in the other proteins are substituted by phenylalanine or leucine, though there is only one such substitution per protein. The various aromatic-amino-acid substitutions do not seriously affect the protein structure