Logging injuries in Louisiana: nature,trends, and rehabilitation considerations

Logging is a dangerous occupation, as documented through reported injuries and fatalities. Accidents in the logging industry account for pain, suffering, employee turnover, and high insurance costs. Worker injuries and high insurance costs, in addition to other factors, may be minimized and reduced through safety education and improved logging practices. Furthermore, the injured logger, or logger with a disability may return to logging or other employment through development of viable medical and vocational rehabilitation planing. This article addresses the economic impact of logging, reviews logging injuries, describes a safety program designed to reduce logging injures, discusses rehabilitation considerations for specific injuries, and outlines particular reemployment prospects for loggers with disabilities.     

Severity-of-illness systems. An overview for medical directors--Part one

To a baseball fan, the weight of a player's bat is not very important, and the grace with which it is swung has only slightly more appeal. Both these factors matter far less than how often and with what results the bat meets the ball. Similarly, in today's competitive health care environment, the medical director has to focus on results. Not only external demands from constituencies such as insurers, payers, consumers, and regulators, but also internal pressures for sound management decisions require accurate information about the outcomes of care. In this two-part article, the authors examine the contributions that severity-of-illness systems can make to outcomes monitoring.     

Naturally Occurring Retirement Community-Supportive Service Program: an example of devolution

Devolution is defined as the transfer of power or authority from a central government to a local government. This article addresses federal policies on housing for the elderly and the devolution of funding for federal senior housing and describes two aspects of devolution of federal housing policy for the elderly. One, it points out the decreasing interest in senior housing by federal authorities as indicated by the decreased amount of funds allocated for this purpose. Two, it emphasizes the need for supportive, assistive services for residents of senior housing and how federal funds have not addressed this need adequately or sufficiently. As a consequence, there have emerged Naturally Occurring Retirement Communities (NORCs) in New York State, a housing arrangement that provides supportive and health services to all eligible residents. The article concludes with a discussion of policy implications and the need for additional research before replicating this model.     

Child welfare education and training: future trends and influences

Based on a review of current economic, political, social, and professional trends, the authors propose recommendations for child welfare education and training. Future partnerships between child welfare agencies and schools of social work will need to incorporate cross-system collaboration, multiculturalism, and family-centered approaches with a broader conceptualization of child well-being.     

Twelve questions to ask about your outcomes monitoring system--Part II

Commercial and customized outcomes monitoring systems designed to assess the results of care, whether clinical outcomes or resource use, are not all of equal value or equally appropriate for every use. In creating each system, its developers had to make critical decisions about such matters as definitions of outcomes for study, selection of patients, selection of data elements, methods and timing of data collection, and method of analysis and reporting. Each system represents a unique set of choices that were made. This series of two articles presents answers to 12 questions that will help users understand the basic workings of an outcomes monitoring system--to be able to distinguish good systems from the mediocre and the bad, and to make wise use of a system already in operation. In addition to the six questions presented in the April 1994 issue of Physician Executive, the following six questions are of critical importance in determining a system's value to you and your organization.     

An Examination of Accidental-Release Scenarios from Chemical-Processing Sites: The Relation of Race to Distance

Objective. This study is intended to enhance the discussion of environmental equity by offering a methodology that is based on chemical‐specific risk zones that reflect inventories of chemical facilities, risk dispersion modeling, local weather conditions, and the unique chemical processes of each site. The central question concerns whether the racial makeup of a community near a chemical‐processing site is characteristic of the city, county, or community as a whole. In essence, does the racial makeup of a community vary by distance from a chemical‐processing facility? Methods. A comparison of the racial makeup of the community was examined for 13 chemical‐processing sites submitting off‐site consequence data under the Environmental Protection Agency Risk Management Plan, by clusters of the sites, and for all sites in the community. Instead of relative ratios, we look at odds ratios. The odds ratio compares the odds of being African American to the odds of being non‐African American at two given distance classes. In this way we may make inferences about how much higher (or lower) are the odds of an African American (relative to a non‐African American) living in a closer distance class (as opposed to a further distance class). Results. The results show that as one moves further from a facility, the characteristics of the community reflect less and less the makeup near the site. The percentage of African Americans living near a chemical‐processing site tends to be much higher when compared to population characteristics further from the site. Conclusions. The study shows that distance does make a significant difference in the racial characteristics of the population from a chemical‐processing site. Using data reflecting accidental‐release scenarios, weather conditions, and the chemical process from the local community provides a more realistic basis for determining vulnerability zones.     

The effect of habitual exercise on respiratory- muscle function in older adults

Older adults' participation in habitual exercise might be affected by alterations to respiratory mechanics such as decreased respiratory-muscle strength. This reduction can cause a decrease in efficiency of the ventilatory pump, potentially compromising exercise participation. This research examined the role of habitual exercise in respiratory-muscle function and the associated implications for exercise performance. Seventy-two healthy older adults (36 men, 64.9 +/- 8.6 years, 177.2 +/- 8.4 cm, 82.5+/- 11.9 kg; 36 women, 64.9 +/- 9.5 years, 161.7+/- 6.4 cm, 61.6 +/- 9.2 kg) undertook respiratory-function and walking-performance tests. Active men and women achieved higher scores than their inactive counterparts for all tests except spirometry, where no differences were evident. The results indicate that a significant amount of the elevated fitness level might be accounted for by increased endurance capacity of the inspiratory muscles. Inactive older individuals might be at risk for inadequate respiratory-muscle strength, so interventions should be considered.