•Axle-load control has prevented the corridor from experiencing early deterioration.•Every € invested in axle-load control has generated more than €20 of savings.•As traffic increases, axle-load ...control should not allow tolerances and exceptions.
Road conditions in Sub-Saharan Africa are typically poor, and only a subset of the newly constructed or rehabilitated roads reach their design life. Truck overloading generally causes this rapid deterioration. In Africa, there are few success stories on the imposition of axle-load limits. This study examines the existing regulations on the Douala-N’Djamena international road, which is the main transport corridor in Central Africa and the backbone for internal transport in Cameroon. It benefits from the detailed existing weighing data recorded since 1998 in the corridor’s 10 weighing stations. This vast amount of traffic data, together with available information on road structure and deterioration over time, has been used to conduct an accurate calculation of load equivalency factors. The HDM 4 model has been applied to three scenarios between 2000 and 2015: (1) no axle-load control, (2) the real situation and (3) no overloading tolerance. Results show that axle-load regulations have been reasonably well applied in Cameroon and have contributed to maintaining the corridor in fair condition. In spite of the fact that significant traffic increases are presently counterbalancing the damage avoided by axle-load limits, benefits provided by axle-load control have been substantial: in the period of 2000–2015, every € invested or spent on axle-load control has generated more than €20 of savings in road user costs and in road maintenance and rehabilitation expenditure, which represents, in absolute terms, more than €500 million.
Determination of antibody levels against vaccine-preventable diseases is of great value to assess immunization programmes. The objective of this study was to determine the prevalence of measles, ...rubella, and mumps antibodies in representative samples of the child and adult population of Catalonia and compare the findings to those obtained in 1996. A representative sample of the child and adult (>or=15 years) population of Catalonia was studied. Enzyme-linked immunosorbent assay techniques were used to determine the presence of antibodies. Equivocal results for antibodies against measles and rubella were tested using an immunofluorescence technique. To compare proportions, the chi-square test and the Fisher's exact test were used. Statistical significance was set at 0.05. Adjusted odds ratios were calculated using multiple logistic regression analysis. Samples from 2,619 people were analyzed. The global prevalence of antibodies was 98.3% for measles, 91.1% for mumps, and 98.1% for rubella. The prevalence of rubella antibodies was higher in women than in men (98.8 vs. 97.2%, respectively). Compared with the results obtained in the 1996 seroprevalence study, only the prevalence of rubella antibodies showed a statistically significant increase in men (97.2 vs. 94.6%; p=0.002) and, in particular, in women (98.8 vs. 95.3%; p<0.001). The low prevalence of susceptible subjects has already led to the elimination of indigenous measles in Catalonia and should allow the elimination of indigenous rubella by 2005. The level of antibodies necessary to interrupt the transmission of mumps has still not been reached in all age groups.
Background
Limited knowledge regarding the relative effectiveness of workplace accident prevention approaches creates barriers to informed decision‐making by policy makers, public health ...practitioners, workplace, and worker advocates.
Objectives
The objective of this review was to assess the effectiveness of broad categories of safety interventions in preventing accidents at work. The review aims to compare effects of safety interventions to no intervention, usual activities, or alternative intervention, and if possible, to examine which constituent components of safety intervention programs contribute more strongly to preventing accidents at work in a given setting or context.
Date Sources
Studies were identified through electronic bibliographic searches, government policy databanks, and Internet search engines. The last search was carried out on July 9, 2015. Gray literature were identified by searching OSH ROM and Google. No language or date restrictions were applied. Searches done between February and July of 2015 included PubMed (1966), Embase (1980), CINAHL (1981), OSH ROM (NIOSHTIC 1977, HSELINE 1977, CIS‐DOC 1974), PsycINFO (1806), EconLit (1969), Web of Science (1969), and ProQuest (1861); dates represent initial availability of each database. Websites of pertinent institutions (NIOSH, Perosh) were also searched.
Study Eligibility Criteria, Participants, and Interventions
Included studies had to focus on accidents at work, include an evaluation of a safety intervention, and have used injuries at work, or a relevant proxy, as an outcome measure. Experimental, quasi‐experimental, and observational study designs were utilized, including randomized controlled trials (RCTs), controlled before and after (CBA) studies, and observational designs using serial measures (interrupted time series, retrospective cohort designs, and before and after studies using multiple measures). Interventions were classified by approach at the individual or group level, and broad categories based on the prevention approach including modification of:
Attitudes (through information and persuasive campaign messaging).
Behaviors (through training, incentives, goal setting, feedback/coaching).
Physiological condition (by physical training).
Climate/norms/culture (by coaching, feedback, modification of safety management/leadership).
Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial‐level norms).
When combined approaches were used, interventions were termed “multifaceted,” and when an approach(es) is applied to more than one organizational level (e.g., individual, group, and/or organization), it is termed “across levels.”
Study Appraisal and Synthesis Methods
Narrative report review captured industry (NACE), work setting, participant characteristics, theoretical basis for approach, intervention fidelity, research design, risk of bias, contextual detail, outcomes measures and results. Additional items were extracted for studies with serial measures including approaches to improve internal validity, assessments of reasonable statistical approaches (Effective Practice of Organization of Care EPOC criteria) and overall inference. Random‐effects inverse variance weighted meta‐analytic methods were used to synthesize odds ratios, rate ratios, or standardized mean differences for the outcomes for RCT and CBA studies with low or moderate levels of heterogeneity. For studies with greater heterogeneity and those using serial measures, we relied on narrative analyses to synthesize findings.
Results
In total 100 original studies were included for synthesis analysis, including 16 RCT study designs, 30 CBA study designs, and 54 studies using serial measures (ITS study designs). These studies represented 120 cases of safety interventions. The number of participants included 31,971,908 individuals in 59 safety interventions, 417,693 groups/firms in 35 safety interventions, and 15,505 injuries in 17 safety interventions. Out of the 59 safety interventions, two were evaluating national prevention measures, which alone accounted for 31,667,110 individuals. The remaining nine safety interventions used other types of measures, such as safety exposure, safety observations, gloves or claim rates. Strong evidence supports greater effects being achieved with safety interventions directed toward the group or organization level rather than individual behavior change. Engineering controls are more effective at reducing injuries than other approaches, particularly when engineered changes can be introduced without requiring “decision‐to‐use” by workplaces. Multifaceted approaches combining intervention elements on the organizational level, or across levels, provided moderate to strong effects, in particular when engineering controls were included. Interventions based on firm epidemiologic evidence of causality and a strong conceptual approach were more effective. Effects that are more modest were observed (in short follow‐up) for safety climate interventions, using techniques such as feedback or leadership training to improve safety communication. There was limited evidence for a strong effect at medium‐term with more intense counseling approaches. Evidence supports regulation/legislation as contributing to the prevention of accidents at work, but with lower effect sizes. Enforcement appears to work more consistently, but with smaller effects. In general, the results were consistent with previous systematic reviews of specific types of safety interventions, although the effectiveness of economic incentives to prevent accidents at work was not consistent with our results, and effectiveness of physiological safety intervention was only consistent to some extent.
Limitations
Acute musculoskeletal injuries and injuries from more long‐time workplace exposures were not always clearly distinguished in research reports. In some studies acute and chronic exposures were mixed, resulting in inevitable misclassification. Of note, the classification of these events also remains problematic in clinical medicine. It was not possible to conduct meta‐analyses on all types of interventions (due to variability in approach, context, and participants). The findings presented for most intervention types are from limited sources, and assessment of publication bias was not possible. These issues are not surprising, given the breadth of the field of occupational safety. To incorporate studies using serial measures, which provide the only source of information for some safety interventions such as legislation, we took a systematic, grounded approach to their review. Rather than requiring more stringent, specific criteria for inclusion of ITS studies, we chose to assess how investigators justified their approach to design and analyses, based on the context in which they were working. We sought to identify measures taken to improve external validity of studies, reasonable statistical inference, as well as an overall appropriate inferential process. We found the process useful and enlightening. Given the new approach, we may have failed to extract points others may find relevant. Similarly, to facilitate the broad nature of this review, we used a novel categorization of safety interventions, which is likely to evolve with additional use. The broad scope of this review and the time and resources available did not allow for contacting authors of original papers or seeking translation of non‐English manuscripts, resulting in a few cases where we did not have sufficient information that may have been possible to obtain from the authors.
Conclusions and Implications of Key Findings
Our synthesis of the relative effectiveness of workplace safety interventions is in accordance with the Public Health Hierarchy of Hazard Control. Specifically, more effective interventions eliminate risk at the source of the hazard through engineering solutions or the separation of workers from hazards; effects were greater when these control measures worked independently of worker “decision‐to‐use” at the worksite. Interventions based on firm epidemiological evidence of causality and clear theoretical bases for the intervention approach were more effective in preventing injuries. Less effective behavioral approaches were often directed at the prevention of all workplace injuries through a common pathway, such as introducing safety training, without explicitly addressing specific hazards. We caution that this does not mean that training does not play an essential function in worker safety, but rather that it is not effective in the absence of other efforts. Due to the potential to reach large groups of workers through regulation and enforcement, these interventions with relatively modest effects, could have large population‐based effects.
Objective
Subarachnoid hemorrhage and surgical obliteration of ruptured intracranial aneurysms are frequently associated with neurological and neuropsychological abnormalities. We reported that ...intraoperative cooling did not improve neurological outcome in good‐grade surgical subarachnoid hemorrhage patients, as assessed by the Glasgow Outcome Scale score or other neurological and functional measures (National Institutes of Health Stroke Scale, Rankin Disability Scale, Barthel Activities of Daily Living). We now report the results of neuropsychological testing in these patients.
Methods
A total of 1,001 patients who bled ≤14 days before surgery were randomly assigned to intraoperative hypothermia (t = 33°C) or normothermia (37°C). Outcome was assessed approximately 3 months after surgery. Patients underwent the Benton Visual Retention, Controlled Oral Word Association, Rey–Osterrieth Complex Figure, Grooved Pegboard, and the Trail Making tests. T‐scores for each test were calculated from normative data. T‐scores were averaged to calculate a Composite Score. A test result (or the Composite Score) was considered “impaired” if the T‐score was two or more standard deviations below the norm. A Mini‐Mental State Examination was also performed.
Results
Neurological outcome data were available in 1,000 patients. Sixty‐one patients died. Of the 939 survivors, 873 completed 3 or more tests (exclusive of the Mini‐Mental State Examination). Patients with poor neurological outcomes were less likely to complete testing; only 3.9% of Good Outcome (Glasgow Outcome Scale score = 1) patients were untested, compared with 38.6% of patients with Glasgow Outcome Scale scores of 3 and 4. There were no prerandomization demographic differences between the two treatment groups. For hypothermic patients, 16.8% were impaired from their Composite Score versus 20.0% of patients in the normothermic group (p = 0.317). For patients in the hypothermic group, 54.5% were impaired on at least one test, compared with 55.5% of patients in the normothermic group (p = 0.865). Similar results were seen in patients with baseline WFNS scores = I. Mini‐Mental State Examination scores in the hypothermic and normothermic groups were 27.4 ± 3.8 and 26.8 ± 4.5, respectively.
Interpretation
This is the largest prospective evaluation of neuropsychological function after subarachnoid hemorrhage to date. Testing was completed in a high fraction of patients, demonstrating the feasibility of such testing in a large trial. However, the frequent inability to complete testing in poor‐outcome patients suggests that testing may be best used to refine outcome assessments in good‐grade patients. Many patients showed impairment on at least one test, with global impairment present in 17 to 20% of patients (18–21% of survivors). This was true even among the patients with the best preoperative condition (WFNS = 1). There was no difference in the incidence of impairment between hypothermic and normothermic groups. Ann Neurol 2006;60:518–527
Purpose
This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee ...arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings.
Methods
A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months.
Results
With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1º. The complications observed were a patellar component loosening and an acute post-infection.
Conclusion
No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient’s subjective satisfaction.
Level of evidence
Prospective case series with no comparison group, Level IV.
Although prolactin (PRL) actions and expression in the brain have been shown, dynamic changes in its intracerebral release and gene expression have still not been demonstrated. Using push‐pull ...perfusion, the in vivo release of PRL was monitored within the paraventricular nucleus (PVN) and medial preoptic area (MPOA) of virgin female, lactating and male rats in response to various stimuli. Perfusion with a depolarizing medium (56 mm K+) increased local release of PRL within both the PVN (P < 0.05) and MPOA (P < 0.05) of urethane‐anaesthetized rats, indicating release from excitable neuronal structures. The PRL in perfusates was verified by radioimmunoassay, Nb2 cell bioassays and western blot. Systemic osmotic stimulation (3 m NaCl i.p., 8 mL/kg b.w.) raised PRL concentration in plasma (P < 0.01) but not within the PVN, suggesting independent release from the pituitary and in distinct brain regions. Immobilization for 30 min increased PRL release within the PVN (P < 0.05) and the MPOA (P < 0.01) of virgin female and male (P < 0.05 each) rats and increased hypothalamic PRL mRNA expression (P = 0.008) after 30 and 90 min as revealed by real‐time polymerase chain reaction. This indicates a stress‐induced activation of both PRL release from and synthesis in hypothalamic neurons. Additionally, PRL was significantly released within, but not outside, the PVN (P < 0.01) and the MPOA (P < 0.05) of lactating rats during suckling and this was accompanied by a significant increase of PRL mRNA (P < 0.05) in the hypothalamus 60 min after suckling. This is the first demonstration of stimulus‐induced, locally restricted release and gene upregulation of PRL within the brain, emphasizing the involvement of this ‘novel’ neuropeptide in various brain functions.
Abstract Surveillance of Middle East respiratory syndrome coronavirus (MERS-CoV) was conducted to explore the possible introduction and circulation of this novel virus in Catalonia, northeastern ...Spain. Five hundred and sixty-three samples from mild and severe respiratory infections collected between January 2012 and April 2013 were screened using real-time RT-PCR. All samples were negative, suggesting that MERS-CoV is not circulating silently in Catalonia.
West Nile virus (WNV) is an emerging arbovirus first recognized in Europe in the 1950s. Since then, outbreaks have been reported in several European countries. In 2010, the first WNV outbreak was ...recorded in Spain, affecting the southern part of the country. We conducted a seroprevalence study in the Catalonia region (northeastern Spain), an area considered at high risk of arbovirus transmission. A total of 800 serum samples from blood donors were collected and screened for antibodies against WNV by enzyme-linked immunosorbent assay (ELISA) and confirmed by a microneutralization assay. More than 50 samples tested positive by ELISA, but only one sample contained neutralizing antibodies against WNV and was obtained from a donor native of Pakistan. The low seroprevalence detected may serve as reference baseline data for monitoring WNV activity in our region in future years.
Abstract Spontaneous cerebellar hemorrhage often requires surgical suboccipital decompression and clot evacuation. Predictors of postoperative neurological deficits and outcome are not widely ...addressed in the literature. A retrospective review was conducted on 37 consecutive patients with the diagnosis of cerebellar hemorrhage requiring suboccipital decompression and clot evacuation. Clinical and radiographic variables were analyzed. Outcome measures were postoperative Glasgow Coma Scale (GCS) score, and long-term outcome measured by Rankin score and Glasgow Outcome Scale (GOS) score. A multivariate statistical analysis was conducted. The average age of patients was 71.1 years. There was significant improvement of neurological exam from a mean preoperative GCS score of 8.8 to a mean postoperative GCS score of 13.0. The mortality rate was 37.9%. According to the Rankin scale, 58.6% were functionally independent, 3.4% had a moderate disability, and none had a major disability or was in a vegetative state. Using GOS score, 62.1% had a favorable outcome. The presence of multiple comorbidities was associated with worse postoperative GCS and long-term outcome. A worse preoperative neurological exam, age older than 70 years, and the presence of intraventricular hemorrhage correlated only with a worse postoperative exam but not with the long-term outcome. Patients improve neurologically after posterior fossa decompression for cerebellar hemorrhage and a high percentage attain long-term functional outcome. Only the presence of multiple clinical comorbidities was associated with a worse outcome. Since there are no other preoperative predictors of long-term outcome, we recommend suboccipital decompression, when indicated, for patients with cerebellar hemorrhage regardless of age, hematoma size, or preoperative neurological exam.
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