Development of asthma and allergic inflammation involves innate immunity but the environmental contributions remain incompletely defined. Analysis of dust collected from the homes of asthmatic individuals revealed that the polysaccharide chitin is environmentally widespread, and associated with β-glucans, possibly from ubiquitous fungi. Cell wall preparations of Aspergillus isolated from house dust induced robust recruitment of eosinophils into mouse lung, an effect that was attenuated by enzymatic degradation of cell wall chitinand β-glucans. Mice expressing constitutively active acidic mammalian chitinase (AMCase) in the lungs demonstrated a significant reduction in eosinophil infiltration after fungal challenge. Conversely, chitinase inhibition prolonged the duration of tissue eosinophilia. Thus, fungal chitin derived from home environments associated with asthma induces eosinophilic allergic inflammation in the lung, and mammalian chitinases, including AMCase, limit this process.

Objective Several case reports have linked solvent exposure to Parkinson’s disease (PD), but few studies have assessed associations with specific agents using an analytic epidemiologic design. We tested the hypothesis that exposure to specific solvents is associated with PD risk using a discordant twin pair design. Methods 99 twin pairs discordant for PD ascertained from the National Academy of Science/National Research Council (NAS/NRC) World War II Veteran Twins Cohort were interviewed regarding lifetime occupations and hobbies using detailed job-task-specific questionnaires. Exposures to 6 specific solvents selected a priori were estimated by expert raters unaware of case status. Results Ever exposure to trichloroethylene (TCE) was associated with significantly increased risk of PD (OR 6.1, 95%CI 1.2 – 33; p = 0.034), and exposure to perchloroethylene (PERC) and carbon tetrachloride (CCl4) tended toward significance (respectively: OR 10.5, 95%CI 0.97-113, p = 0.053; OR 2.3, 95%CI 0.9-6.1, p = 0.088). Results were similar for estimates of exposure duration and cumulative lifetime exposure. Interpretation Exposure to specific solvents may increase risk of PD. TCE is the most common organic contaminant in groundwater, and PERC and CCl4 are also ubiquitous in the environment. Our findings require replication in other populations with well-characterized exposures, but the potential public health implications are substantial.

BackgroundOccupation has been suggested to play a role in amyotrophic lateral sclerosis (ALS) etiology, but detailed information on the importance of specific workplace exposures is lacking.ObjectivesOur aim was to assess the relationship between workplace exposures and the risk of ALS and to evaluate potential interactions between these exposures and smoking.MethodsWe conducted a case–control study in New England between 1993 and 1996, comprising 109 cases and 253 controls who completed a structured interview covering occupations and workplace exposures. Unconditional logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for ALS. Analyses were conducted among the entire study population and after stratification by smoking.ResultsWe observed a higher risk of ALS for construction workers excluding supervisors (OR = 2.9; 95% CI, 1.2–7.2) and precision metal workers (OR = 3.5; 95% CI, 1.2–10.5). Self-reported exposures to paint strippers; cutting, cooling, or lubricating oils; antifreeze or coolants; mineral or white spirits; and dry cleaning agents each appeared to be associated with a 60–90% higher risk. Specific chemicals related to a > 50% increase in risk of ALS included aliphatic chlorinated hydrocarbons, glycols, glycol ethers, and hexane. Relative risks associated with these workplace exposures and chemicals were greater among nonsmokers and persisted in mutually adjusted models.ConclusionsOur data suggest that certain occupations and workplace exposures may be associated with increased risk of ALS. These results need to be confirmed in independent populations.

High 2-dose MMR coverage protected many students from developing mumps but was not sufficient to prevent the mumps outbreak. Vaccine-induced protection may wane. Similar US settings where large numbers of young adults from wild-type naive cohorts live closely together may be at particular risk for mumps outbreaks.

In this study, the risk of WRMSDs was more strongly influenced by specific psychosocial and physical job-related exposures than by broad socioeconomic factors such as education and income.

The home environment is strongly linked to lung function, health status, and disease severity in adult asthma and rhinitis.

Standardized terminologies, such as the Nursing Interventions Classification (NIC) taxonomy, may be used in multiple ways to represent nursing constructs. This study is the first known to explore the NIC as a framework for the development of a nursing workload measure. While the NIC may not represent the complexity of nurses' work, the classification system may represent uniformly the work of nurses in health information systems to yield reliable data for a nursing workload measure. Keywords Delphi methods; nurse workload; nursing interventions classificationThe association between nurse staffing and patient outcomes has been explored extensively in the nursing literature. A meta-analysis of 96 studies found that an increase of 1 registered nurse (RN) full-time equivalent per patient day was associated with a 9% reduction in the odds of a death in intensive care unit patients, a 16% reduction in the odds of a death in surgical patients, and a 6% reduction in the odds of a death in medical patients. 1 Other researchers have demonstrated the economic value of improved quality of care achieved through higher staffing levels.2 , 3 Adequate nurse staffing is important in terms of both quality of patient care and fiscal responsibility.Determining adequate nurse staffing may depend ultimately on workload. Generally, workload is a function of the time, complexity, and volume of the interventions that must be performed in a given period. 4 Carayon and Alvarado 5 propose several dimensions of nursing workload including physical, cognitive, time pressure, emotional, quantitative, qualitative, and variability. Physical workload is defined as the manual direct tasks (ie, moving and lifting patients and bathing patients) and physical organization (ie, gathering intravenous pumps and vital signs monitoring equipment) associated with patient care.5 Cognitive workload is the intellectual processing of patient information that drives performance and decision making.6 Time pressure is the demand exerted by the number of tasks performed under temporal constraints (ie, necessary assessments, measurements, documentation, and therapies performed on a regular and/or frequent basis).5 Quantitative and qualitative workload are defined as the amount and difficulty of work, respectively.7 Finally, workload variability is the degree to Copyright © 2010 which workload fluctuates during a period of time.7 These dimensions operate in tandem and yield the overall nursing workload for a given set of patients and their nursing requirements.A challenge that nurse managers face is the ability to collect data on the various dimensions of nurse workload to make informed staffing decisions. With the increased use of health information technology in the hospital setting, measuring nursing workload by using these technologies would be ideal. A fundamental building block of most healthcare information technologies is standardized terminologies.Standardized terminologies provide a foundation by which domain-specific information and data are tran...

Background: Patients with poor health literacy often lack the knowledge needed to manage their treatment. Objective: The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis. Method: The study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence. Results: Participants (N=125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence. Conclusion: Study findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.