Kathleen McPhaul

Elevated urine uranium excretion by soldiers with retained uranium shrapnel.

The use of depleted uranium in munitions has given rise to a new exposure route for this chemically and radioactively hazardous metal. A cohort of U.S. soldiers wounded while on or in vehicles struck by depleted uranium penetrators during the Persian Gulf War was identified. Thirty-three members of this cohort were clinically evaluated, with particular attention to renal abnormalities, approximately 3 y after their injury. The presence of retained shrapnel was identified by x ray, and urine uranium concentrations were measured on two occasions. The absorption of uranium from embedded shrapnel was strongly suggested by measurements of urine uranium excretion at two time intervals: one in 1993/1994 and one in 1995. Mean urine uranium excretion was significantly higher in soldiers with retained shrapnel compared to those without shrapnel at both time points (4.47 vs. 0.03 microg g(-1) creatinine in 1993/1994 and 6.40 vs. 0.01 microg g(-1) creatinine in 1995, respectively). Urine uranium concentrations measured in 1995 were consistent with those measured in 1994/1993, with a correlation coefficient of 0.9. Spot urine measurements of uranium excretion were also well correlated with 24-h urine collections (r = 0.95), indicating that spot urine samples can be reliably used to monitor depleted uranium excretion in the surveillance program for this cohort of soldiers. The presence of uranium in the urine can be used to determine the rate at which embedded depleted uranium fragments are releasing biologically active uranium ions. No evidence of a relationship between urine uranium excretion and renal function could be demonstrated. Evaluation of this cohort continues.

The utility of spot collection for urinary uranium determinations in depleted uranium exposed Gulf War veterans.

The utility of spot urine collections for uranium bioassay determinations was examined in a small cohort of depleted uranium exposed Gulf War veterans. Some members of the group are excreting elevated concentrations of urinary uranium resulting from the metabolism of retained metal fragments, the residua of several friendly fire incidents. Uranium determinations were performed on both 24-h timed collections and spot urine samples using kinetic phosphorescence analyzer (KPA) methodology. Results ranged from non-detectable to 30.7 mcg g(-1) creatinine in a 24-h collection. A creatinine-standardized spot sample and a 24-h uncorrected sample both correlated highly (R2=0.99) with a creatinine corrected 24-h collection, presumed to be the best estimate of the urinary uranium measure. This relationship was upheld when the population was stratified by uranium concentration into a high uranium group (> or = 0.05 mcg U/g creatinine) but for the lower uranium group (< 0.05 mcg U/g creatinine) more variability and a lower correlation was seen. The uncorrected spot sample, unadjusted for volume, concentration or creatinine had the lowest correlation with the 24-h creatinine adjusted result, especially at lower urinary uranium concentrations. This raises questions regarding the representativeness of such a sample in bioassay programs.

Assessing risk for violence on home health visits.

The objective of this study was to develop and test measures for assessing risk of violence toward staff during home visits. Home visiting health workers from public and private home visiting programs in a Mid-Atlantic state (n = 130) were surveyed to assess exposure to risky home visits, verbal and physical violence, and workplace violence safety climate. Two measures demonstrated evidence of reliability and validity moving the safety research closer to developing tools and processes for protecting home care clinicians.

The Worksite Heart Health Improvement Project (WHHIP): feasibility and efficacy.

OBJECTIVE Test the feasibility and efficacy of the Worksite Heart Health Improvement Project (WHHIP). DESIGN The WHHIP was a quasi-experimental 6-month pilot performed in 2 long-term care facilities. SAMPLE Thirty-nine female minority nursing assistants participated in this study with a mean age of 42.39 (SD = 12.79) years. MEASUREMENTS Measures were collected at baseline, 3, and 6 months and included blood pressure, lipid panel, body mass index, physical activity levels, diet behaviors, depressive symptoms, and self-efficacy outcomes. INTERVENTION The 3-month WHHIP intervention included 3 components: environmental and policy assessment; education; and on-going motivation. The control site received education only. RESULTS Subject participation averaged 47% and 58% in exercise and diet related activities, respectively. Generalized estimating equations showed the treatment group showed significant improvements in depressive symptoms (p = .012), systolic blood pressure (p = .028), total cholesterol (p = .002) and triglycerides (p = .011) over time. The treatment group also showed trends for improvement in diet behaviors (p = .069) and diastolic blood pressure (p = .073). CONCLUSIONS This study provided feasibility evidence for the WHHIP and preliminary evidence that the WHHIP can improve heart healthy behaviors and subsequent outcomes among nursing assistants in long-term care settings.

Personal Care Assistants and Blood Exposure in the Home Environment: Focus Group Findings

Abstract Background: Exposure to blood and bodily fluids continues to be an important and life-threatening risk facing health care workers employed in traditional health care workplaces. Little is known about how blood exposure risk impacts personal care assistants (PCAs) who provide care in homes. Objectives: A National Institute for Occupational Safety and Health (NIOSH)-funded community based participatory research project between Service Employees International Union (SEIU), PCAs, and university-based researchers was conducted to increase the understanding of the risk of exposure to blood among PCAs. Methods: Six focus groups were conducted to assess the relationship between the context of work, blood exposure, and Results: Findings indicate that PCAs are exposed to blood even though they do not provide health care or treatment. Training and barrier protection may be available, but the quality of each was highly variable if available. Conclusions: Focus group findings will be used to implement a union-based participatory primary prevention intervention for the reduction of blood exposure among PCAs.

Occupational risk factors for blood and body fluid exposure among home care aides.

This cross-sectional study of home care aides examines self-reported occupational exposure to blood and body fluids to determine if factors that place these workers at risk can be identified. Home care aides working for two agencies in the Chicagoland area were surveyed. A total of 62 (6.3%) of the home care aides reported instances of blood and body fluid exposure either via sharps or mucous membrane contact. Although few aides reported performing health care-related tasks such as colostomy care, caring for a urinary catheter, or bowel stimulation (which were outside their scope of duties), those who did were significantly more likely to experience blood and body fluid exposure (p ≤ .01). Level of assistance needed by clients in tasks such as feeding, laundry, and transportation was also found to be significantly associated with blood and body fluid exposure (p ≤ .01). These data highlight the importance of, and need for, home care aid training in the use of universal precautions.

Evaluation of Home Health Care Nurses' Practice and Their Employers' Policies Related to Bloodborne Pathogens

BACKGROUND Food service workers incur the greatest proportion of burn injurie s. The Colorado Health Departments Occupational Hospitalized Bum Surveillance database contains information on burns requiring inpatient care from 1989 to 1993 (CDC, 1993). Thirty-three percent of these bums were identified as occupational, and more than one third of those occurred in restaurants (CDC). A Washington State study compared

Drug testing: a preventive approach

M s. M c Ne el y is an Assi stant Professor a nd Coordinator, Occupational Health Program, Simmons College Gradua te Nurs ing Program , Boston , Ma ssachusetts. tivity, higher absenteeism, increased accident rates, and/or observed drug abuse or drug dealings at the worksite may influence an employer to consider a variety of alternatives (Bompey, 1986; Dogoloff, 1985; MacDonald, 1986). Given President Reagans endorsement of urine drug testing for federal employees and his encouragement of such testing in the private sector, urine drug testing has become a workable option for concerned employers. Are employers legitimately concerned that illegal or unauthorized substance abuse results in enormous costs to industry or are employers seizing upon a new mechanism to terminate employees? Statistics suggest that the problem of drug abuse is growing and expanding in the workplace. Sixty-five percent of all persons entering the workforce between the ages of 18-25 have tried illegal drugs. Of this age group, 41% have tried marijuana, 20% have experimented with cocaine, and 84% have used alcohol. Fifty-six percent of the 65.8 billion dollar price tag for drug abuse in 1980 was borne by