Workplace health improvement: perspectives of environmental health officers

BACKGROUND

Environmental health practice in the field of occupational health and safety is traditionally concerned with protecting health relating to the workplace. However, little is currently known about environmental health officers' (EHOs) perceptions of their role in workplace health improvement, a pertinent topic in light of the recent government agenda for improving the health of the workforce in the UK.

AIMS

To explore how EHOs perceive workplace health improvement and its relevance to their professional role.

METHODS

A qualitative methodology was employed, using a case-study design with thematic analysis of 15 transcripts of in-depth telephone interviews with EHOs working in London, UK.

RESULTS

EHOs view themselves primarily as enforcement officers, with legislation guiding their understandings of workplace health. Many interpret work-related ill health in terms of safety and physical injury and do not feel competent in assessing broader psychosocial elements of ill health. However, a few EHOs welcomed the opportunity to promote health in the workplace, recognizing the importance of prevention.

CONCLUSIONS

This study indicates a gap between the contemporary EHO role framed by professional bodies as holistic and contributing to public health goals and the role perceived by EHOs 'on the ground'. A more traditional, protective and enforcement-based approach persists among EHOs in this sample, and few feel they have skills to address determinants beyond physical hazards to health. Yet, a minority of EHOs adopted a more health-promoting approach, suggesting that the potential contribution of EHOs to the workplace health improvement agenda should be explored further.

Is Metabolic Syndrome and Central Obesity Relevent to Biology and Progression of Postmenopausal Breast Cancer?

Introduction: Obesity isassociated with both an increased risk of postmenopausal breast cancer and increased mortality rates. The mechanism is unclear, and central (visceral) obesity, insulin resistance, altered sex steroids, and altered adipokines, are mooted as possible factors. These features may cluster in the so-called Metabolic Syndrome (MetS), and the focus of this study was to systematically relate MetS to standard clinicopathological indices of breast cancer.Methods: Postmenopausal women with newly diagnosed breast cancer (n=105) were prospectively recruited. A detailed clinical and dietary history was performed, as well as body composition analysis, metabolic screen, and plasma measurement of adipokines and inflammatory markers. MetS was defined according to the International Diabetes Federation definition.Results: One hundred and five patients were recruited, the median age was 68 years (40-94) and the mean BMI was 28.3 ± 5.2 kg/m2, with 87% of patients centrally obese. MetS was diagnosed in 39% of patients, and was significantly (p<0.005) associated with 13cm greater waist circumference, higher total and trunk fat mass and increased inflammation with CRP levels almost double for MetS patietns compared to non MetS (10.3 ± 2.7 V's 5.8 ± 1.0 mg/L; p=0.084).Patients with later pathological stage (II- IV) were significantly more likely to be obese (BMI) (45% Vs 16%; p=0.007), centrally obese (waist circumference) (94% Vs 72%; p=0.009), hyperglycaemic (31% Vs 12%; p=0.047), hyperinsulinaemia (19% Vs 0; p=0.026) and 51% had MetS compared to 12% for early stage disease (Path stage 0-I). Patients with node positive disease were significantly more likely to be hyperinsulaemic (22% V's 5%; p=0.030) and have MetS (50% V's 30%; p=0.028) than node negative disease.MetS was not associated with hormone receptor status or serum levels of oestradiol, progesterone, testosterone, or SHBG levels. However, SHBG levels decreased with obesity (p=0.002) and as the number of features of MetS increased (0 features: 87 ± 15.8 compared to 5 features: 32 ±2.7; p=0.003). Insulin levels increased with obesity (p=0.006), and with increasing number of features of MetS.Discussion: MetS and central obesity are common in Irish postmenopausal breast cancer patients. MetS appears to be associated with aggressive tumour biology, and this may have significance in preventive and novel treatment approaches.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1051.

Prognostic features for response and survival in elderly patients withde novoacute myeloid leukemia treated with mitoxantrone and intermediate dose cytarabine

Forty-three fit elderly patients with de novo acute myeloid leukemia (AML) received chemotherapy with mitoxantrone and intermediate dose cytarabine (MIDAC) in a phase II clinical trial conducted by the Australasian Leukaemia and Lymphoma Group. The main aim of the study was to evaluate the tolerability and efficacy of MIDAC in inducing durable remissions. While the chemotherapy was generally well tolerated, less than half the patients achieved complete remission (CR) after induction and many of those in CR could not receive planned consolidation cycles. The median overall survival for all patients was 6.5 months and the median disease-free survival for those achieving CR was 8.3 months. Only 2 patients survived beyond 4 years. Factors significantly associated with shorter survival were adverse cytogenetics, marrow dysplasia and increasing age. These results suggest that only selected elderly patients with AML are likely to benefit from aggressive chemotherapy and that novel therapies are required to improve the poor prognosis of this group.

Retinal nerve fiber thickness in inflammatory demyelinating diseases of childhood onset

PURPOSE

To evaluate retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography (OCT) in children with acquired demyelinating diseases.

METHODS

This is a cross-sectional study of patients seen between 2006-2008 at the Pediatric MS Center of the Jacobs Neurological Institute. Consensus definitions for pediatric demyelinating disease were followed. All children received OCT testing and assessment of visual acuity (VA) using Snellen and low contrast letter acuity (LCLA) charts.

RESULTS

Thirty-eight children diagnosed with acquired demyelinating disease, 15 healthy controls, and five children with other neurological disorders (OND) were included. Average RNFLT in healthy controls was 107 +/- 12 microm(n = 30) versus 108 +/- 5 microm (n = 10) in OND controls. In children with multiple sclerosis, average RNFLT +/- SD was 99 +/- 14 microm in unaffected (n = 24) versus 83 +/- 12 micromin eyes affected by optic neuritis ("affected eyes") (n = 10). Average RNFLT in children with acute disseminated encephalomyelitis and transverse myelitis was 102 +/- 15 microm in unaffected (n = 18) versus 67 +/- 17 microm in affected eyes (n = 6). In children with optic neuritis (ON), average RNFLT +/- SD was 97 +/- 13 microm in unaffected (n = 5) versus 89 +/- 12 microm in affected eyes (n = 9). Differences between children with demyelinating disease and controls and between ON and nonON eyes were statistically significant (P < 0.001). Bivariate correlations of RNFLT with LCLA (P = 0.002) and VA (P < 0.001) were significant.

CONCLUSIONS

OCT may be a valuable tool for the assessment and monitoring of anterior optic pathway dysfunction in children with demyelinating diseases.

Has the ThinPrep method of cervical screening maintained its improvement over conventional smears in terms of specimen adequacy?

Liquid-based cytology (LBC) has replaced conventional smear assessment in many centers over recent years. In our laboratory this transfer took place in 1999. At that time we performed a split sample study comparing the conventional method of cervical smear evaluation with the ThinPrep system. This split sample study identified a dramatic improvement in specimen adequacy with LBC. While 11% of conventional preparations were reported as unsatisfactory and almost 9% were reported as suboptimal, evaluation of the same cases using LBC saw this combined figure reduced to 2.3%.

AIM

To evaluate whether this dramatic fall in unsatisfactory smears has been maintained with the use of LBC. The database for all smears reported for 2005 (100% LBC) was interrogated. The number of unsatisfactory reports was calculated. The reason for an unsatisfactory report was recorded for each case. The overall unsatisfactory rate was compared with that reported in the 1999 split sample study. A total of 41,312 smear tests were reported in 2005. 1,342 (3.25%) were reported as unsatisfactory. Our findings support the ongoing value of LBC in a routine cervical screening laboratory in terms of continuing to maintain a low rate of unsatisfactory smears.

Identification of a nephritogenic immunodominant B and T cell epitope in experimental autoimmune glomerulonephritis

Experimental autoimmune glomerulonephritis (EAG) can be induced in Wistar Kyoto (WKY) rats by immunization with the non-collagenous domain (NC1) of the alpha 3 chain of type IV collagen, alpha3(IV)NC1. In patients with Goodpasture's disease, the major B cell epitope is located at the N-terminus of alpha3(IV)NC1. In order to investigate whether B and T cell responses in EAG are directed towards immunodominant peptides within the same region of rat alpha3(IV)NC1, we immunized WKY rats with recombinant rat alpha3(IV)NC1 (positive control) and five 15-mer overlapping synthetic peptides from the N-terminus of rat alpha3(IV)NC1: pCol(17-31), pCol(24-38), pCol(31-45), pCol(38-52) and pCol(45-59). Positive control animals immunized with alpha3(IV)NC1 produced an antibody response directed towards alpha3(IV)NC1 and pCol(24-38). Splenic T cells from these animals proliferated in response to alpha3(IV)NC1 and pCol(24-38). No significant antibody or T cell responses were observed to the other peptides examined. Animals immunized with pCol(24-38) developed linear deposits of immunoglobulin G on the glomerular basement membrane, albuminuria and focal necrotizing glomerulonephritis with crescent formation by week 6 after immunization. Circulating antibodies from these animals recognized pCol(24-38) and alpha3(IV)NC1, and their T cells proliferated in response to pCol(24-38) and alpha3(IV)NC1. Animals immunized with the other peptides developed no significant immune response to alpha3(IV)NC1 and no disease. In conclusion, these results demonstrate that a 15-mer peptide from the N-terminus of alpha3(IV)NC1 [pCol(24-38)] is recognized by B and T cells from rats immunized with recombinant alpha3(IV)NC1, and that the same peptide is capable of inducing crescentic glomerulonephritis. Identification of this immunodominant peptide will be of value in designing new therapeutic strategies for inducing mucosal tolerance in EAG, which may be applicable to patients with glomerulonephritis.

Determining the need for ethical review: a three-stage Delphi study

AIMS

The aims of the study were to explore expert opinion on the distinction between "research" and "audit", and to determine the need for review by a National Health Service (NHS) Research Ethics Committee (REC).

BACKGROUND

Under current guidelines only "research" projects within the NHS require REC approval. Concerns have been expressed over difficulties in distinguishing between research and other types of project, and no existing guidelines appear to have been validated. The implications of this confusion include unnecessary REC applications, and crucially, the potential for ethically unsound projects to escape review.

METHODS

A three-stage Delphi method was chosen to explore expert opinion and develop consensus. Stage 1 comprised ten semi-structured interviews gathering opinion on distinguishing between types of project and how to determine need for ethical review. Stages 2 and 3 were questionnaires, asking 24 "experts" to rate levels of ethical concern and types of project for a series of questions. Anonymised responses from stage 2 were fed back in stage 3. The final responses were analysed for consensus.

RESULTS

Of 46 questions, consensus was achieved for 14 (30.4%) for level of ethical concern and for 15 (32.6%) for type of project.

CONCLUSIONS

Several ideas proved discriminatory for classifying the type of project and assessing level of ethical concern, and they can be used to develop an algorithm to determine need for ethical review. There was little relationship between assessment of the level of ethical concern and classification of the project. There was inconsistency in defining and classifying studies as something other than "research" or "audit".