Hours of work and rest in the rail industry

Currently, the National Transport Commission is considering four options to form the regulatory framework for rail safety within Australia with respect to fatigue. While the National Transport Commission currently recommends no limitations around hours of work or rest, we provide evidence which suggests regulatory frameworks should incorporate a traditional hours of service regulation over more flexible policies. Our review highlights: Shift durations >12 h are associated with a doubling of risk for accident and injury. Fatigue builds cumulatively with each successive shift where rest in between is inadequate (<12 h). A regulatory framework for fatigue management within the rail industry should prescribe limits on hours of work and rest, including maximum shift duration and successive number of shifts. Appropriately, validated biomathematical models and technologies may be used as a part of a fatigue management system, to augment the protection afforded by limits on hours of work and rest. A comprehensive sleep disorder screening and management programme should form an essential component of any regulatory framework.

Intravaginal cleansing among women attending a sexually transmitted infection clinic in Kingston, Jamaica

OBJECTIVES

Although common worldwide, intravaginal cleansing is associated with poor health outcomes. We sought to describe intravaginal cleansing among women attending a sexually transmitted infection (STI) clinic in Jamaica.

METHODS

We examined intravaginal cleansing ("washing up inside the vagina", douching, and products or materials used) among 293 participants in a randomized trial of counselling messages at an STI clinic in Kingston. We focussed on information on intravaginal cleansing performed in the 30 days and three days preceding their baseline study visit. We describe reported cleansing behaviours and used logistic regression to identify correlates of intravaginal cleansing.

RESULTS

Fifty-eight per cent of participants reported intravaginal cleansing in the previous 30 days, and 46% did so in the three days before baseline. Among those who cleansed in the previous 30 days, 88% reported doing so for hygiene unrelated to sex, and three-fourths reported generally doing so more than once per day. Soap (usually with water) and water alone were the most common products used for washing; commercial douches or detergents were reported infrequently. Intravaginal cleansing in the three days before the baseline visit was positively associated with having more than one sex partner in the previous three months (adjusted odds ratio [AOR], 1.9; 95% CI, 1.1, 3.2), and negatively associated with experiencing itching in the genital area at baseline (AOR, 0.6; 95% CI, 0.4, 1.0).

CONCLUSIONS

A large proportion of women attending STI clinics in Jamaica engage in frequent intravaginal cleansing, indicating a need for clinicians to discuss this topic with them accordingly.

Steroid diffusion into the navicular bursa occurs in horses affected by palmar foot pain

Palmar foot pain is frequently treated by steroid injections into the distal interphalangeal joint (DIPJ) in the anticipation that the steroid will diffuse to the navicular bursa and palmar foot structures. The object of this study was to determine if triamcinolone acetonide (TA) would in fact be able to locally diffuse from the DIPJ into the navicular bursa in horses affected by palmar foot pain. Both forelimb DIPJs (nine horses) were injected with 10 mg of TA. Navicular bursa fluid samples, both forelimb and one hind limb (systemic control), were analysed for TA with high-performance liquid chromatography/tandem mass spectrometry (HPLC-MS/MS) six hours later. Foot radiographs were graded (0-4) on severity of changes. Forelimb navicular bursa TA concentrations (mean±sd log(10), 3.20±0.56) were significantly higher than systemic control concentrations (mean±sd log(10), 1.89±0.3) (P<0.0001). Horses with a radiographic grade of >2 were four times as likely to have TA log(10) concentrations less than 3.2 (158.49 ng/ml). TA locally diffused from the DIPJ into the navicular bursa in horses affected by palmar foot pain; TA concentrations decreased as radiographic severity increased.