Secondary level interventions

Interventions for occupational stress can be divided up into three types, known as primary, secondary and tertiary level interventions (Cox and Cox... 

Secondary level cognitive and behavioural interventions for normative levels of occupational stress... 

This book is presented in three parts. Part 1 (Chapters 1 and 2) provides an introduction to and overview of stress in the occupational context, and its causes and consequences. A cognitive behavioural model of occupational stress based on Aaron T. Beck s seminal work on the subject (Beck 1984) is developed. Part 2 (Chapters 3-8) introduces the standard cognitive behavioural therapy (CBT) approach to assessment, formulation and the primary, secondary and tertiary interventions for treating occupational stress. While the main focus of this section is on individual CBT interventions, a chapter on organizational interventions has also been included, as an acknowledgement of the importance of primary level interventions. Case illustrations of the standard CBT approach are presented in Chapters 9, 10 and 11. It should be noted that the names and some of the details presented in all the case illustrations have of course been altered to protect the identity of those individuals involved. 

Human toxicity data are limited to secondary citations. Because these citations provided no experimental details, they cannot be considered reliable. Deaths have occurred from aniline ingestion and skin absorption, but doses were unknown. Reviews of the older literature indicate that a concentration of 5 ppm was considered safe for daily exposures, concentrations of 7 to 53 ppm produced slight symptoms after several hours, a concentration of 40 to 53 ppm was tolerated for 6 h without distinct symptoms, a concentration of 130 ppm may be tolerated for 0.5 to 1 h without immediate or late sequalae, and 100 to 160 ppm was the maximum concentration that could be inhaled for 1 h without serious disturbance. In studies of accidents with unknown exposure concentrations, methemoglobin levels of up to 72% were measured. Recoveries occurred with a minimum of medical intervention following cessation of exposure. 

A policy of a three level safety design was also adopted. This includes the use of utilities and safety devices. An orthogonal design was used such that interruption of any part of these services would not affect the remaining sections. Manual bypasses were also provided in order to permit operator intervention at any point in the process. Finally, any releases of material from any of the relief devices were directed into secondary holding vessels in order to prevent releases into the atmosphere. 

In severe ocular bums with complete loss of the limbal vascularization, other than the predictable impossibility of secondary re-epithelialization, there is an immediate risk of necrosis for the anterior segment. In order to restore the limbal circulation and to block the evolution towards a necrosis or an aseptic ulceration, a Tenon s plastics may be realized. It consists in the making of a Tenon s advancement flap located at the level of the limbus [4-8]. The intervention must be realized as soon as the necrotic tissues have been removed. The dissection starts in the equatorial region and continues at the back of the conjunctival sacs. The flaps must be 1-2 mm thick. Their elastic consistency helps their advancement. The flap is sutured to the... 

Until relatively recent times, the fetus has been a black box for the physician, and any attempt at intervention was likely to result in a rapid demise. With the introduction, however, by Liley of amniotic fluid evaluation of elevated AOD levels as a marker for hyperbilirubinemia secondary to Rh disease, and the initiation of intrauterine transfusion for severe hemolytic disease, the era of fetal evaluation and intervention began (38). In the succeeding years, the fetus has been the subject of increasing evaluation not only for the potential of disease but also for interventions as dramatic as exteriorization of the fetus outside the uterus for fetal surgery for a variety of clinical conditions (39). 

There have been three primary and eight secondary prevention trials in which dietary change was the only variable. Dietary modification included reduction in total fat, substitution of saturated fat by polyunsaturated oils and reduction in cholesterol intake. These changes resulted in a reduction of saturated fat intake by 27 55% and reductions in plasma cholesterol of up to 18%. However, with the exception of one study, the Lyon Diet Heart Study (de Lorgeril et al., 1994), neither total or CHD mortality was lowered significantly by the dietary interventions (Ravnskov, 1998 Parodi, 2004). In the successful Lyon Diet Heart Study, a Mediterranean-type diet was compared with the usual post-infarct prudent diet. Throughout this trial, plasma cholesterol levels were similar in both the treatment and control groups. 

Rubins, H.B. Robins, S.J. Collins, D. Eye, C.L. Anderson, J.W. Elam, M.B., et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial study group. N. Engl. J. Med. 1999, 341, 410-418. 

Secondary intervention studies are few. A study in Japan [240(Ib)] identified infants at high risk of house dust mite allergy and asthma postnatally, on the basis of early manifestations of atopy (i.e. eczema and food allergy). Children were enrolled during the 1st year of life and randomised to house dust mite prevention which resulted in a substantial reduction in house dust mite allergen levels. At the 1-year follow-up, children in the active treatment group had lower levels of IgE antibody, prevalence of positive skin prick test responses to house dust mite, and lower incidence of wheezing episodes. Follow-up is awaited. 

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