Wastewater-based estimation of diabetes mellitus prevalence in 237 cities: A cross-China study

Diabetes mellitus, a metabolic disease characterized by hyperglycemia, has been witnessed as a rapidly escalating worldwide health crisis. China currently had 140.9 million diabetic population in 2021, which was the largest globally. DM has witnessed a significant surge in the past few decades, leading to an alarming rise in the overall burden caused by this disease. To monitor the near real-time DM prevalence and the consumption of first-line anti-diabetic drugs, a wastewater-based epidemiology (WBE) approach based on the back-calculation of metformin concentration was implemented in 237 cities in China. The quantitative analysis of metformin in wastewater was conducted by LC-MS/MS with satisfactory results of method validation. The average concentration of metformin in wastewater was 14.07 ± 13.16 μg/L, and the per capita consumption was 5.16 ± 2.08 mg/day/inh, ranging from 0.90 to 10.36 ± 4.63 mg/day/inh. The calculated metformin prevalence was found to be 0.52 % ± 0.28 %, and the final estimated DM prevalence was 11.33 % ± 4.99 %, which was nearly consistent with the result of the International Diabetes Federation survey of 9.98 %. The results suggested that metformin might be one of the suitable WBE biomarkers in DM monitoring and WBE strategy could potentially enable the estimation of DM prevalence in most of Chinese cities after reasonable correction of associated parameters.

Mass gathering in Qatar 2022 World Cup. What should be especially monitored?

OBJECTIVES

At the end of 2022, the football world championship will be held in Qatar. These types of meetings require a risk analysis. It proposes an approach to determine which health risks should be prioritized.

METHOD

We use a mixed methodology (Hierarchical Process Analysis, World Health Organization STAR and European Commission INFORM) to determine the risk level of a total of 12 health entities.

RESULTS

Our analysis identifies 6 health entities with a moderate risk. There are 4 whose valuation is as low risk and 2 as very low.

CONCLUSIONS

In our work we focus the analysis from a point of view of the route of transmission or presentation of health events, which facilitates a visualization of the preventive measures to be implemented, both organizationally and individually by the attendees.

Agricultural activities and risk of Alzheimer's disease: the TRACTOR project, a nationwide retrospective cohort study

Data regarding Alzheimer's disease (AD) occurrence in farming populations is lacking. This study aimed to investigate whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with AD than others, using nationwide data from the TRACTOR (Tracking and monitoring occupational risks in agriculture) project. Administrative health insurance data (digital electronic health/medical records and insurance claims) for the entire French agricultural workforce, over the period 2002-2016, on the entire mainland France were used to estimate the risk of AD for 26 agricultural activities with Cox proportional hazards model. For each analysis (one for each activity), the exposed group included all FMs that performed the activity of interest (e.g. crop farming), while the reference group included all FMs who did not carry out the activity of interest (e.g. FMs that never farmed crops between 2002 and 2016). There were 5067 cases among 1,036,069 FMs who worked at least one year between 2002 and 2016. Analyses showed higher risks of AD for crop farming (hazard ratio (HR) = 3.72 [3.47-3.98]), viticulture (HR = 1.29 [1.18-1.42]), and fruit arboriculture (HR = 1.36 [1.15-1.62]). By contrast, lower risks of AD were found for several animal farming types, in particular for poultry and rabbit farming (HR = 0.29 [0.20-0.44]), ovine and caprine farming (HR = 0.50 [0.41-0.61]), mixed dairy and cow farming (HR = 0.46 [0.37-0.57]), dairy farming (HR = 0.67 [0.61-0.73]), and pig farming (HR = 0.30 [0.18-0.52]). This study shed some light on the association between a wide range of agricultural activities and AD in the entire French FMs population.

Farming activity and risk of treated thyroid disorders: Insights from the TRACTOR project, a nationwide cohort study

BACKGROUND

Epidemiological data regarding thyroid diseases are lacking, in particular for occupationally exposed populations.

OBJECTIVES

To compare the risk of hypothyroidism and hyperthyroidism between farming activities within the complete population of French farm managers (FMs).

METHODS

Digital health data from retrospective administrative databases, including insurance claims and electronic health/medical records, was employed. This cohort data spanned the entirety of French farm managers (FMs) who had undertaken work at least once from 2002 to 2016. Survival analysis with the time to initial medication reimbursement as timescale was used to examine the association (hazard ratio, HR) between 26 specific farming activities and both treated hypothyroidism and hyperthyroidism. A distinct model was developed for each farming activity, comparing FMs who had never engaged in the specific farming activity between 2002 and 2016 with those who had. All analyses were adjusted for potential confounders (e.g., age), and sensitivity analyses were conducted.

RESULTS

Among 1088561 FMs (mean age 46.6 [SD 14.1]; 31% females), there were 31834 hypothyroidism cases (75% females) and 620 hyperthyroidism cases (67% females), respectively. The highest risks were observed for cattle activities for both hyperthyroidism (HR ranging from 1.75 to 2.42) and hypothyroidism (HR ranging from 1.41 to 1.44). For hypothyroidism, higher risks were also observed for several animal farming activities (pig, poultry, and rabbit), as well as fruit arboriculture (HR = 1.22 [1.14-1.31]). The lowest risks were observed for activities involving horses. Sex differences in the risk of hypothyroidism were observed for eight activities, with the risk being higher for males (HR = 1.09 [1.01-1.20]) than females in viticulture (HR = 0.97 [0.93-1.00]). The risk of hyperthyroidism was two times higher for male dairy farmers than females.

DISCUSSION

Our findings offer a comprehensive overview of thyroid disease risks within the FM community. Thyroid ailments might not stem from a single cause but likely arise from the combined effects of various causal agents and triggering factors (agricultural exposome). Further investigation into distinct farming activities-especially those involving cattle-is essential to pinpoint potential risk factors that could enhance thyroid disease monitoring in agriculture.

Exercise and associated features with low-level exercise among doctors

BACKGROUND

Physical activity had been reported among doctors-in-training, with very few focusing on attending doctors. This study aimed to evaluate the physical activity, particularly exercise, of Thai doctors and features associated with low-level exercise.

MATERIALS AND METHODS

Thai doctors who participated in the hospital's CSR service, which was conducted between Feb 14, 2022, to Oct 31, 2022, were verbally informed along with an information sheet about this parallel study. The doctors who consented to participate provided their personal data on diets, work hours, illnesses, health surveillance, stress, state of well-being, and exercise. To investigate the association with clinical features, the exercise level was categorized as low-level (≤ 2 days/week) or high-level (≥ 3 days/week).

RESULTS

The median age of 1187 doctors was 45.0 years. Slightly over half were female (55.4%) or worked ≤ 40 hours/week (55.3%). The presence of illnesses was found in 55.9%, irregular health surveillance in 29.0%, no/low fiber diet in 19.2%, overweight/obesity in 28.0%, and moderate/severe stress in 25.9%. Among the doctors who provided exercise data, 29.8% had a high-level of exercise and 49.0% had a low-level. Independent features associated with low-level exercise were no/low fiber diet (aOR = 3.01), irregular health surveillance (aOR = 2.41), age ≤ 60 years (aOR = 1.82), female gender (aOR = 1.79), and work > 40 hours/week (aOR =  1.76).

CONCLUSIONS

Only 30% of Thai doctors had a high level of exercise. The significant independent factors for low-level exercise were younger age, female, working load, irregular health surveillance, and no/ low fiber diet.

A retrospective review of the utility of chest X-rays in diving and submarine medical examinations

Introduction

Performance of routine Chest X-rays (CXRs) in asymptomatic individuals to assess hyperbaric exposure risk is controversial. The radiation risk may overshadow the low yield in many settings. However, the yield may be higher in certain settings, such as tuberculosis-endemic countries. We evaluated the utility of routine CXR in diving and submarine medical examinations in South Africa.

Methods

Records of 2,777 CXRs during 3,568 fitness examinations of 894 divers and submariners spanning 31 years were reviewed to determine the incidence of CXR abnormality. Associated factors were evaluated using odds ratios and a binomial logistic regression model, with a Kaplan-Meier plot to describe the duration of service until first abnormal CXR.

Results

An abnormal CXR was reported in 1.1% per person year of service, yielding a cumulative incidence of 6.5% (58/894) of the study participants. Only four individuals had a clinical indication for the CXR in their medical history. A range of potential pathologies were seen, of which 15.5% were declared disqualifying and the rest (84.5%) were treated, or further investigation showed that the person could be declared fit.

Conclusions

In South Africa, a routine CXR has a role to play in detecting abnormalities that are incompatible with pressure exposures. The highest number of abnormalities were found during the initial examinations and in individuals with long service records. Only four individuals had a clinical indication for their CXR during the 31-year span of our study. Similar studies should be performed to make recommendations in other countries and settings.

Agricultural activities and risk of treatment for depressive disorders among the entire French agricultural workforce: the TRACTOR project, a nationwide retrospective cohort study

Background

Although depression is a major issue among farming population, to date, there have been few studies on specific agricultural activities. We aimed to investigate whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with depression than others.

Methods

This nationwide retrospective cohort study used data from an administrative health database available to the TRACTOR project. This database pertains to the entire French agricultural workforce (overseas workers not included). Data were analyzed from January 2021 to December 2022. All FMs that worked at least once over the period 2002-2016 were included. The outcome measure was the association between 26 agricultural activities and the risk of depression measured as hazard ratios (HRs) after adjusting for age, sex, and pre-existing medical comorbidities. The time to first depression insurance declaration, or first antidepressant prescription claim was used as the underlying timescale. For each activity, the reference/control group included all FMs that never performed the considered activity between 2002 and 2016, while the exposed group included FMs that performed the considered activity at least once from 2002 to 2016. Four sensitivity analyses were conducted to test hypotheses, and to address potential sources of bias.

Findings

There were 84,507 (7.76%; 28.2 cases per 1000 person-years) depression cases among 1,088,561 FMs (mean age 46.6 [SD 14.1]). Compared to other activities, dairy farming (HR = 1.37, 95% confidence interval: 1.32-1.42), cow farming (HR = 1.53 [1.47-1.59]), poultry and rabbit farming (HR = 1.37 [1.27-1.50]), and mixed farming (HR = 1.30 [1.24-1.36]) were more strongly associated with depression. Sex differences were observed, with most of the time, risks higher for females than for males.

Interpretation

Agricultural activities at risk of depression among the entire French agricultural workforce were identified. These findings do represent a crucial first step on the road to implement effective preventive measures against depression to determine where additional resources should be allocated to screen for depression, along with intervention.

Funding

MIAI@Grenoble Alpes, and Mutualité Sociale Agricole.

How fit are military hyperbaric personnel after an asymptomatic or mild symptomatic COVID-19 infection? A retrospective study

INTRODUCTION

In the diving community there is a special need to know if asymptomatic or mild COVID-19 disease impacts the cardiopulmonary functioning of individuals with occupational exposure to extreme environments. To date, no controlled studies have been conducted comparing COVID-19-infected hyperbaric employees and non-COVID-19-infected peers in a military setting.

METHODS

Between June 2020 and June 2021, healthy, hyperbaric, military personnel aged between 18 and 54 years old, who had recovered from asymptomatic or subclinical COVID-19 disease at least one month earlier, were analysed. Non-COVID-infected peers with medical assessments during the same period were used as the control group. Somatometry, spirometry, VO₂ max, and DLCO were measured for each group.

RESULTS

No clinically relevant differences in somatometry, lung function tests, and exercise testing were found between the COVID-19 group and the controls. However, the percentage of individuals with a decrease in estimated VO2-max of 10% or more was significantly greater in the COVID group than in the control group (24 vs. 7.8%, P = 0.004).

CONCLUSIONS

After asymptomatic or mild symptomatic COVID-19 infections, military hyperbaric employees are as fit as those who had not encountered COVID-19. As this research was based on a military population, it cannot be extrapolated to a nonmilitary population. Further studies in nonmilitary populations are necessary to determine the medical relevance of the present findings.

Notification of malaria cases in the Brazilian Amazon Basin from 2010 to 2020: an analysis of the reporting times

BACKGROUND

As controlling malaria transmission remains a public-health challenge in the Brazilian Amazon basin, the National Surveillance System for Malaria (SIVEP-MALARIA) has registered malaria notifications for over fifteen years helping in the decision-making on control and elimination. As a surveillance database, the system is prone to reporting delays, and knowledge about reporting patterns is essential in decisions.

METHODS

This study contains an analysis of temporal and state trends of reporting times in a total of 1,580,617 individual malaria reports from January 2010 to December 2020, applying procedures for statistical distribution fitting. A nowcasting technique was applied to show an estimation of number of cases using a statistical model of reporting delays.

RESULTS

Reporting delays increased over time for the states of Amazonas, Rondônia, Roraima, and Pará. Amapá has maintained a similar reporting delay pattern, while Acre decreased reporting delay between 2010 and 2020. Predictions were more accurate in states with lower reporting delays. The temporal evolution of reporting delays only showed a decrease in malaria reports in Acre from 2010 to 2020.

CONCLUSION

Malaria notifications may take days or weeks to enter the national surveillance database. The reporting times are likely to impact incidence estimation over periods when data is incomplete, whilst the impact of delays becomes smaller for retrospective analysis. Short-term assessments for the estimation of malaria incidence from the malaria control programme must deal with reporting delays.

Microbiota and environmental health monitoring of mouse colonies by metagenomic shotgun sequencing

Metagenomic next-generation sequencing (mNGS) allows the monitoring of microbiota composition of murine colonies employed for scientific purposes in a single test by assessing the composition of gut microbiome and the detection of pathogens from fecal pellets. In this study, we tested the potential use of mNGS for monitoring both microbiota composition and the presence of pathogens through Environmental Health Monitoring, by using exhaust dust collection filters derived from individually ventilated cages (IVC) systems.mNGS analysis was performed on nucleic acids isolated from filters collecting air from the exhaust of: (1) cages with mice housed in a non-pathogen free facility; (2) animal-free cages with clean chow and bedding from the same facility; (3) cages housing mice from a specific-pathogen free (SPF) facility. mNGS results revealed correspondence between microbiome composition from fecal pellets and filter, including pathogenic bacteria (Helicobacter hepaticus, Helicobacter typhlonius, Chlamydia muridarum, Rodentibacter pneumotropicus, Citrobacter rodentium), intestinal protozoa (Tritrichomonas muris, Spironucleus muris) nematoda (Aspiculuris tetraptera) and eukaryotic parasites (Myocoptes musculinus), present in the colony. Entamoeba muris and Syphacia obvelata were detected in fecal pellets but not in filter. The animal free exhaust dust filter, exposed to clean cages (no mice) placed in the IVC after removal of all mice, exhibited the presence of the same pathogens due to contaminated connecting pipes, confirming the sensitivity of the approach. Conversely, the filter from SPF colony revealed the absence of pathogens.The current use of exhaust dust collection filters in health surveillance requires multiple molecular tests to identify specific pathogens and does not provide information on the colony microbiome. This work provides the proof-of-principle that assaying exhaust dust collection filters by mNGS for microbiota monitoring of laboratory mice is feasible. In its daily application, results suggest the usefulness of the test in SPF facilities, where pathogenic micro-organisms are expected to be absent. mNGS analysis of exhaust dust collection filters allows the analysis of multiple cages, reducing the number of tests required for pathogen detection and corresponding costs, and avoiding the use of sentinel mice.

The effects of COVID-19 on poisonings in the paediatric emergency department

Objectives

The purpose of this study is to describe the impact of the pandemic on poisoning in children under 18 years presenting to a tertiary care paediatric emergency department (ED) in Canada.

Methods

We utilized the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) surveillance data to identify children presenting to the Hospital for Sick Children for poisonings during two time periods: pre-pandemic (March 11 to December 31, 2018 and 2019) and pandemic (March 11 to December 31, 2020). Primary outcomes investigated the change in proportion for total poisonings, unintentional poisonings, recreational drug use, and intentional self-harm exposures over total ED visits. Secondarily, we examined the change in proportion of poisonings between age, sex, substance type, and admission requirement pre-pandemic versus during pandemic.

Results

The proportions significantly increased for total poisonings (122.5%), unintentional poisonings (127.8%), recreational drug use (160%), and intentional self-harm poisonings (104.2%) over total ED visits. The proportions over all poisoning cases also significantly increased for cannabis (44.3%), vaping (134.6%), other recreational drugs (54.5%), multi-substance use (29.3%), and admissions due to poisonings (44.3%) during the pandemic.

Conclusion

Despite an overall decrease in ED visits, there was a significant increase in poisoning presentations to our ED during the pandemic compared with pre-pandemic years. Our results will provide better insight into care delivery and public health interventions for paediatric poisonings.

Comparison of mortality hazard ratios associated with health behaviours in Canada and the United States: a population-based linked health survey study

BACKGROUND

Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications.

METHODS

The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history.

RESULTS

A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a 'healthy profile' was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada.

CONCLUSION

Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development.

Workplace health surveillance and COVID-19: algorithmic health discrimination and cancer survivors

PURPOSE

This article examines ways COVID-19 health surveillance and algorithmic decision-making ("ADM") are creating and exacerbating workplace inequalities that impact post-treatment cancer survivors. Cancer survivors' ability to exercise their right to work often is limited by prejudice and health concerns. While cancer survivors can ostensibly elect not to disclose to their employers when they are receiving treatments or if they have a history of treatment, the use of ADM increases the chances that employers will learn of their situation regardless of their preferences. Moreover, absent significant change, inequalities may persist or even expand.

METHODS

We analyze how COVID-19 health surveillance is creating an unprecedented amount of health data on all people. These data are increasingly collected and used by employers as part of COVID-19 regulatory interventions.

RESULTS

The increase in data, combined with the health and economic crisis, means algorithm-driven health inequalities will be experienced by a larger percentage of the population. Post-treatment cancer survivors, as for people with disabilities generally, are at greater risk of experiencing negative outcomes from algorithmic health discrimination.

CONCLUSIONS

Updated and revised workplace policy and practice requirements, as well as collaboration across impacted groups, are critical in helping to control the inequalities that flow from the interaction between COVID-19, ADM, and the experience of cancer survivorship in the workplace.

IMPLICATIONS FOR CANCER SURVIVORS

The interaction among COVID-19, health surveillance, and ADM increases exposure to algorithmic health discrimination in the workplace.

Google Trends Data: A Potential New Tool for Monitoring the Opioid Crisis

INTRODUCTION

There is a need to strengthen the standard surveillance of the opioid overdose crisis in the USA. The role of Google Trends (GT) was explored in this context.

METHODS

In this study, a systemic GT search was done for a period from January 2004 to December 2018. "Naloxone" and "drug overdose" were chosen as search inputs. By using locally weighted scatterplot smoothing, we locally regressed and smoothed the relative search data generated by the GT search. We conducted a changepoint analysis (CPA) to detect significant statistical changes in the "naloxone" trend from 2004 to 2018. Cross-correlation function analyses were done to examine the correlation between 2 time series: year-wise relative search volume (RSV) for "naloxone" and "drug overdose" with the age-adjusted drug overdose mortality rate. Pearson's correlation was performed for the state-wise age-adjusted mortality rate due to drug overdose and RSV for "naloxone" and "drug overdose."

RESULTS

Smoothed and regressed GT of "naloxone" were similar to the "opioid overdose" trend published by the National Center for Health Statistics. The CPA showed 2 statistically significant points in 2011 and 2015. CPA of year-wise RSV for "naloxone" and "drug overdose" showed significantly positive correlation with the age-adjusted drug overdose mortality at lag zero. State-wise RSV for "naloxone" and "drug overdose" too showed a strong and significant positive correlation with the state-wise mortality data.

DISCUSSION/CONCLUSION

Inexpensive, publicly accessible, real-time GT data could supplement and strengthen the monitoring of opioid overdose epidemic if used in conjunction with the existing official data sources.

The lower limit for FEV1/FVC in dive medical assessments: a retrospective study

INTRODUCTION

Interpreting pulmonary function test (PFT) results requires a valid reference set and a cut-off differentiating pathological from physiological pulmonary function; the lower limit of normal (LLN). However, in diving medicine it is unclear whether an LLN of 2.5% (LLN-2.5) or 5% (LLN-5) in healthy subjects constitutes an appropriate cut-off.

METHODS

All PFTs performed at the Royal Netherlands Navy Diving Medical Centre between 1 January 2015 and 1 January 2021 resulting in a forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and/or FEV₁/FVC with a Z-score between -1.64 (LLN-5) and -1.96 (LLN-2.5) were included. Records were screened for additional tests, referral to a pulmonary specialist, results of radiological imaging, and fitness to dive.

RESULTS

Analysis of 2,108 assessments in 814 subjects showed that 83 subjects, 74 men and nine women, mean age 32.4 (SD 8.2) years and height 182 (7.0) cm, had an FVC, FEV₁ and/or FEV₁/FVC with Z-scores between -1.64 and -1.96. Of these 83 subjects, 35 (42%) underwent additional tests, 77 (93%) were referred to a pulmonary specialist and 31 (37%) underwent high-resolution CT-imaging. Ten subjects (12%) were declared 'unfit to dive' for various reasons. Information from their medical history could have identified these individuals.

CONCLUSIONS

Use of LLN-2.5 rather than LLN-5 for FEV₁/FVC in asymptomatic individuals reduces additional investigations and referrals to a pulmonary specialist without missing important diagnoses, provided a thorough medical history is taken. Adoption of LLN-2.5 could save resources spent on diving medical assessments and protect subjects from harmful side effects associated with additional investigations, while maintaining an equal level of safety.

Evolutionary clustering and community detection algorithms for social media health surveillance

The prominent rise of social networks within the past decade have become a gold mine for data mining operations seeking to model the real world through these virtual worlds. One of the most important applications that has been proposed is utilizing information generated from social networks as a supplemental health surveillance system to monitor disease epidemics. At the time this research was conducted in 2020, the COVID-19 virus had evolved into a global pandemic, forcing many countries to implement preventative measures to halt its expanse. Health surveillance has been a powerful tool in placing further preventative measures, however it is not a perfect system, and slowly collected, misidentified information can prove detrimental to these efforts. This research proposes a new potential surveillance avenue through unsupervised machine learning using dynamic, evolutionary variants of clustering algorithms DBSCAN and the Louvain method to allow for community detection in temporal networks. This technique is paired with geographical data collected directly from the social media Twitter, to create an effective and accurate health surveillance system that grows as time passes. The experimental results show that the proposed system is promising and has the potential to be an advancement on current machine learning health surveillance techniques.

[The tracking of COVID-19 at work. The experience in the Basque country.]

On 31 December 2019 China reported around 27 cases of pneumonia of unknown origin. Some days later a new type of virus which was named New Coronavirus 2019-nCoV was identified as the cause. On 11 March 2020 the World Health Organisation (WHO) declared a COVID-19 pandemic and urged authorities to locate, isolate, test and treat each case and trace every contact. The monitoring of workers' health is subject to specific protocols, which in this case take the form of the Procedure for Action for Occupational Health and Safety against Exposure to SARS-CoV-19. From the outset, the drawing up of this protocol in the Basque Country entailed integrated action by Health and Surveillance services in the monitoring network for COVID-19 cases and contacts in the region. The figures show that since November 2020 a total of 19,471 cases of COVID-19 have been addressed at 17,260 firms, with 22,696 close contacts at work since September, 294 outbreaks and 7,178 temporary invalidity certificates due to close contact since December 2020. The effects of vaccination can be observed in health and socio-sanitary personnel since March 2021 and in other groups since June. Health and safety services need to be thorough in collective health monitoring. This service must be factored into public health activities, which need to be led by the public authorities as has been done during the current pandemic.

[Contribution of the occupational health to the COVID-19 pandemic control.]

When the World Health Organization declared Covid-19 as a public health emergency of international concern, the Spanish Ministry of Health called the health, labor, social security authorities, Labor and Social Security Inspection, National Institute of Security and Occupational Health, employers, unions, occupational risk prevention services, mutual societies and scientific societies of occupational medicine and nursing, to collaborate in the control of the transmission of SARS-CoV-2 in companies. The Occupational Health Group of the Public Health Commission of the Interterritorial Council of the National Health System, developed the Procedure for the prevention of occupational risks in the face of exposure to SARS-CoV-2, which has been updated 15 times until the date. It contains the prevention measures to be implemented in the workplaces: organizational and collective protection, personal protection, especially vulnerable worker and risk level, study and management of cases and contacts that occurred in the company, collaboration in the management of temporary disability and, more recently, reincorporation and management of vaccinated workers. As a result of these cooperation and collaboration frameworks, a series of activities were deployed in the workplace, which are described in this article.

Occupational exposure to electromagnetic fields in magnetic resonance environment: an update on regulation, exposure assessment techniques, health risk evaluation, and surveillance

Magnetic resonance imaging (MRI) is one of the most-used diagnostic imaging methods worldwide. There are ∼50,000 MRI scanners worldwide each of which involves a minimum of five workers from different disciplines who spend their working days around MRI scanners. This review analyzes the state of the art of literature about the several aspects of the occupational exposure to electromagnetic fields (EMF) in MRI: regulations, literature studies on biological effects, and health surveillance are addressed here in detail, along with a summary of the main approaches for exposure assessment. The original research papers published from 2013 to 2021 in international peer-reviewed journals, in the English language, are analyzed, together with documents published by legislative bodies. The key points for each topic are identified and described together with useful tips for precise safeguarding of MRI operators, in terms of exposure assessment, studies on biological effects, and health surveillance.

De-escalation strategies for non-pharmaceutical interventions following infectious disease outbreaks: a rapid review and a proposed dynamic de-escalation framework

BACKGROUND

The severity of COVID-19, as well as the speed and scale of its spread, has posed a global challenge. Countries around the world have implemented stringent non-pharmaceutical interventions (NPI) to control transmission and prevent health systems from being overwhelmed. These NPI have had profound negative social and economic impacts. With the timeline to worldwide vaccine roll-out being uncertain, governments need to consider to what extent they need to implement and how to de-escalate these NPI. This rapid review collates de-escalation criteria reported in the literature to provide a guide to criteria that could be used as part of de-escalation strategies globally.

METHODS

We reviewed literature published since 2000 relating to pandemics and infectious disease outbreaks. The searches included Embase.com (includes Embase and Medline), LitCovid, grey literature searching, reference harvesting and citation tracking. Over 1,700 documents were reviewed, with 39 documents reporting de-escalation criteria included in the final analysis. Concepts retrieved through a thematic analysis of the included documents were interlinked to build a conceptual dynamic de-escalation framework.

RESULTS

We identified 52 de-escalation criteria, the most common of which were clustered under surveillance (cited by 43 documents, 10 criteria e.g. ability to actively monitor confirmed cases and contact tracing), health system capacity (cited by 30 documents, 11 criteria, e.g. ability to treat all patients within normal capacity) and epidemiology (cited by 28 documents, 7 criteria, e.g. number or changes in case numbers). De-escalation is a gradual and bi-directional process, and resurgence of infections or emergence of variants of concerns can lead to partial or full re-escalation(s) of response and control measures in place. Hence, it is crucial to rely on a robust public health surveillance system.

CONCLUSIONS

This rapid review focusing on de-escalation within the context of COVID-19 provides a conceptual framework and a guide to criteria that countries can use to formulate de-escalation plans.

The U.S. national biomonitoring network - Enhancing capability and capacity to assess human chemical exposures

BACKGROUND

With the increased use of biomonitoring in public health, biomonitoring networks are forming worldwide. The National Biomonitoring Network (NBN), created in 2018, is an interconnected system of U.S. government laboratories in collaboration with public health partners, to advance human biomonitoring science and practice. The NBN aims to harmonize biomonitoring data for use in routine public health practice.

METHODS

The NBN has taken a systems approach to provide high-quality biomonitoring data by establishing quality standards, mentoring nascent programs, and enhancing analytical capability and capacity through technical assistance. Guided by a multi-disciplinary Network Steering Committee (NSC), the NBN has developed an organizational framework, membership criteria, and guidance practices related to study design, quality management and analytical measurements. To facilitate the production of these resources, the NSC established interdisciplinary workgroups of subject matter experts.

RESULTS

To date, 20 state public health laboratories have joined the NBN. Differences in land-use practices, state and local laws and availability of resources resulted in considerable variability in the design and approach of NBN member biomonitoring programs. By contributing technical guidance, technical training, examples and templates for analytical and epidemiological practices and opportunities for collaboration and interaction, the NBN addressed some of these challenges. Important challenges remaining are to define minimum data variables for laboratory measurements, demographic and exposure information, and to identify an appropriate national repository for biomonitoring data.

CONCLUSION

The current NBN membership has greatly benefited from the resources, collaboration and engagement with other state and federal scientists. The NBN hopes to expand membership and increase interaction with biomonitoring networks internationally. While the objectives of biomonitoring networks around the world may differ, understanding their structures, advantages and limitations inform the NBN and provide opportunity for cross-network collaboration.

An ethical dimension to accident management and health surveillance

Many radiation protection actions carry a multitude of direct and indirect consequences that can impact on the welfare of affected populations. Health surveillance raises ethical challenges linked to privacy and data protection, as well as questions about the net benefit of screening. The SHAMISEN project recognized these issues and developed specific recommendations to highlight ethical challenges. Following a brief overview of ethical issues related to accident management, this paper presents the SHAMISEN recommendations: R1 The fundamental ethical principle of doing more good than harm should be central to accident management; and R4 Ensure that health surveillance respects the autonomy and dignity of affected populations, and is sensitive to any inequity in the distribution of risks and impacts. While a holistic approach to accident management means that decisions will be complicated by different values, perceptions and uncertainties about outcomes, addressing ethical issues could help ensure that the assumptions and potential conflicts behind eventual decisions are as transparent as possible.

A comprehensive approach for microbiota and health monitoring in mouse colonies using metagenomic shotgun sequencing

Background

Health surveillance of murine colonies employed for scientific purposes aim at detecting unwanted infection that can affect the well-being of animals and personnel, and potentially undermine scientific results. In this study, we investigated the use of a next-generation sequencing (NGS) metagenomic approach for monitoring the microbiota composition and uncovering the possible presence of pathogens in mice housed in specific pathogen-free (SPF) or conventional (non-SPF) facilities.

Results

Analysis of metagenomic NGS assay through public and free algorithms and databases allowed to precisely assess the composition of mouse gut microbiome and quantify the contribution of the different microorganisms at the species level. Sequence analysis allowed the uncovering of pathogens or the presence of imbalances in the microbiota composition. In several cases, fecal pellets taken from conventional facilities were found to carry gene sequences from bacterial pathogens (Helicobacter hepaticus, Helicobacter typhlonius, Chlamydia muridarum, Streptococcus pyogenes, Rodentibacter pneumotropicus, Citrobacter rodentium, Staphylococcus aureus), intestinal protozoa (Entamoeba muris, Tritrichomonas muris, Spironucleus muris) nematoda (Aspiculuris tetraptera, Syphacia obvelata), eukaryotic parasites (Myocoptes musculinus) and RNA virus (Norwalk virus). Thus, the use of NGS metagenomics can reduce the number of tests required for the detection of pathogens and avoid the use of sentinel mice.

Conclusions

In summary, in comparison with standard approaches, which require multiple types of test, NGS assay can detect bacteria, fungi, DNA and RNA viruses, and eukaryotic parasites from fecal pellets in a single test. Considering the need to protect animal well-being and to improve the success and reproducibility of preclinical studies, this work provides the proof-of-concept that the use of NGS metagenomics for health monitoring of laboratory mice is a feasible and dependable approach, that is able to broaden the current concept of health monitoring of laboratory mice from “pathogen surveillance” to a more inclusive “microbiota surveillance”.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42523-021-00113-4.

Prospective health surveillance for COVID-19 among health care workers at a university medical center in Taiwan, January to June 2020

Background

Healthcare personnel (HCP) at the front line of care are exposed to occupational hazards that place them at risk for infection, which then endanger patient safety and compromise the capability of the healthcare workforce. As of March 8, 2021 more than 420,170 HCP in US had been infected with SARS CoV-2 with 1388 deaths. In two Taiwan hospitals COVID-19 outbreaks involved HCP and resulted in shutdown of service. This report describes our prospective health surveillance of the HCP and COVID-19 containment measures in a teaching hospital in Taiwan during Jan. 1 through June 30, 2020.

Methods

We prospectively monitored incidents, defined as an HCP with the predefined symptoms, reported by HCP through the web-based system. HCP were managed based on an algorithm that included SARS CoV-2 RNA PCR testing. Infection prevention and control policy/practice were reviewed.

Results

This hospital took care of 17 confirmed COVID-19 cases during the study period and the first Case was admitted on January 23, 2020. Among the 14,210 HCP, there were 367 incident events. Of 283 HCP tested for SARS CoV-2, 179 had predefined symptoms. These included 10 HCP who met the national case definition for COVID-19 infection and 169 based on Extended COVID-19 Community Screening program. The other 104 asymptomatic HCP were tested based on hospital policy. All of them had tested negative.

Conclusion

We attribute our success in preventing COVID-19 infections among HCP to rapid, proactive, decisive, integrated national and institutional response in the early stages of the epidemic

Estimating COVID-19 recovery time in a cohort of Italian healthcare workers who underwent surveillance swab testing

OBJECTIVES

The COVID-19 pandemic is putting a huge strain on the provision and continuity of care. The length of sickness absence of the healthcare workers as a result of SARS-CoV-2 infection plays a pivotal role in hospital staff management. Therefore, the aim of this study was to explore the timing of COVID-19 recovery and viral clearance, and its predictive factors, in a large sample of healthcare workers.

STUDY DESIGN

This is a retrospective cohort study.

METHODS

The analysis was conducted on data collected during the hospital health surveillance programme for healthcare staff at the University Hospital of Verona; healthcare workers were tested for SARS-CoV-2 through RT-PCR with oronasopharyngeal swab samples. The health surveillance programme targeted healthcare workers who either had close contact with SARS-CoV-2-infected patients or were tested as part of the screening-based strategy implemented according to national and regional requirements. Recovery time was estimated from the first positive swab to two consecutive negative swabs, collected 24 h apart, using survival analysis for both right-censored and interval-censored data. Cox proportional hazard was used for multivariate analysis.

RESULTS

During the health surveillance programme, 6455 healthcare workers were tested for SARS-CoV-2 and 248 (3.8%, 95% confidence interval [CI]: 3.4-4.3) reported positive results; among those who tested positive, 49% were asymptomatic, with a median age of 39.8 years, which is significantly younger than symptomatic healthcare workers (48.2 years, P < 0.001). Screening tests as part of the health surveillance programme identified 31 (12.5%) of the positive cases. Median recovery time was 24 days (95% CI: 23-26) and 21.5 days (95% CI: 15.5-30.5) in right- and interval-censoring analysis, respectively, with no association with age, sex or presence of symptoms. Overall, 63% of participants required >20 days to test negative on two consecutive swabs. Hospitalised healthcare workers (4.8%) were older and had a significantly longer recovery time compared with non-hospitalised healthcare workers in both analyses (33.5 vs 24 days, P = 0.005).

CONCLUSIONS

Recovery from COVID-19 and viral clearance may take a long time, especially in individuals who are hospitalised. To detect asymptomatic cases, screening programmes for healthcare workers is recommended.

[Control of SARS-CoV-2 in prisons]

OBJECTIVE

Review of control and management of SARS-CoV-2 infection in penitentiary institutions in Spain and other countries.

MATERIAL AND METHODS

A systematic review a comprehensive literature search in Global Health, SCOPUS, Medline and EMBASE was performed using relevant keywords and medical descriptors (MeSH) related to the coronavirus disease (COVID-19) and prisons. National and international recommendations and guides were examined as well as documents published by some countries.

RESULTS

The key points of the guides are discussed. The vast majority of recommendations coincide with respect to the measures and procedures that should be used, except for some discrepancy regarding the population screening. Until now, most industrialized countries (except the US and some specific scenarios) have controlled successfully the epidemic in prisons. Less data is found as regards to socioeconomically more disadvantaged countries.

CONCLUSIONS

Prisons are prone to a high risk of SARS-CoV-2 transmission due to their space limitations and sometimes poor environmental and hygienic conditions. The recommendations of the control and management of SARS-CoV-2 infection must be the same as those outside the prison, but must be adapted to the peculiarities of the prison. The recommendations must be issued by the health administration in coordination with the prison administration. Finally, must be abide by the Mandela Rules or by the Standard Minimum Rules for the treatment of United Nations prisoners.

The SHAMISEN Project: Challenging historical recommendations for preparedness, response and surveillance of health and well-being in case of nuclear accidents: Lessons learnt from Chernobyl and Fukushima

Experience suggests that current nuclear accident response planning in European countries mostly has a technical focus, with less attention paid to social, psychological and ethical issues. Information provided tends to be directed towards decisions made by experts, rather than for the support of affected populations. The SHAMISEN (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) consortium, composed of close to 50 experts from 10 countries, performed a critical review of current recommendations and experiences regarding dose assessment and reconstruction, evacuation decisions, long-term health surveillance programmes and epidemiological studies. The review included case studies and lessons drawn from the living conditions and health status of populations affected by the Chernobyl and Fukushima accidents, taking an integrative approach to health and well-being. Based on this work, SHAMISEN developed a series of comprehensive recommendations aimed at improving the preparedness, response, long-term surveillance and living conditions of populations affected by past or future radiation accidents, in a manner responding to their needs, while minimising unnecessary anxiety.

Evaluation of the diagnostic accuracy of a new point-of-care rapid test for SARS-CoV-2 virus detection

BACKGROUND

The easy access to a quick diagnosis of coronavirus disease 2019 (COVID-19) is a key point to improve the management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to contain its spread. Up to now, laboratory real-time PCR is the standard of care, but requires a fully equipped laboratory and significant infrastructure. Consequently, new diagnostic tools are required.

METHODS

In the present work, the diagnostic accuracy of the point-of-care rapid test "bKIT Virus Finder COVID-19" (Hyris Ltd) is evaluated by a retrospective and a prospective analysis on SARS CoV-2 samples previously assessed with an FDA "authorized for the emergency use-EUA" reference method. Descriptive statistics were used for the present study.

RESULTS

Results obtained with the Hyris Kit are the same as that of standard laboratory-based real time PCR methods for all the analyzed samples. In addition, the Hyris Kit provides the test results in less than 2 h, a significantly shorter time compared to the reference methods, without the need of a fully equipped laboratory.

CONCLUSIONS

To conclude, the Hyris kit represents a promising tool to improve the health surveillance and to increase the capacity of SARS-CoV-2 testing.

Common mental health conditions among navy divers: A brief report

INTRODUCTION

A recent article reported on common mental health conditions among recreational scuba divers, and observed that the prevalence mirrored national population figures. This raised the question of the extent to which this might also be the case among professional divers. No data on commercial divers could be located; this paper presents the situation among navy divers.

METHODS

Mental health survey data from 132 South African Navy divers were reviewed to describe the 12-month prevalence of common mood, anxiety, and alcohol misuse disorders.

RESULTS

Prevalence of common mood and anxiety conditions appeared to reflect local general population estimates, and the occurrence of alcohol misuse was higher than local population figures, although the usefulness of the population data could be challenged.

CONCLUSIONS

It appeared that common mental health conditions in both sport and navy divers may generally conform to their respective local general population estimates. If this were to be the case in the broader professional diving environment as well, the inclusion of some form of formal mental health screening during commercial diving medical examinations may be beneficial.

The Relationships Between Control Measures and Absenteeism in the Context of Internal Control

Background

The study tries to show the effect of Occupational Health and Safety (OHS) legislation implemented via plan-do-check-act methodology on accident and sickness absenteeism.

Methods

The data for the study gathered via a questionnaire from a large-sized organization operates in production and maintenance of passenger coaches in February–March 2019 in Turkey. The data analyzed via structural equation model analysis.

Results

The results showed that there are statistically meaningful relationships between OHS protective measures, training and informing of employees, and employee participation and accident and sickness absenteeism. In addition, a meaningful relationship between internal control and accident and sickness absenteeism was determined. Statistically meaningful relationships between emergency measures, and health surveillance and internal control, and accident and sickness absenteeism could not be determined.

Conclusion

It is concluded that the actions implemented by organizations to reduce absenteeism should be as per OHS legislation.

Community dashboards to support data-informed decision-making in the HEALing communities study

BACKGROUND

With opioid misuse, opioid use disorder (OUD), and opioid overdose deaths persisting at epidemic levels in the U.S., the largest implementation study in addiction research-the HEALing Communities Study (HCS)-is evaluating the impact of the Communities That Heal (CTH) intervention on reducing opioid overdose deaths in 67 disproportionately affected communities from four states (i.e., "sites"). Community-tailored dashboards are central to the CTH intervention's mandate to implement a community-engaged and data-driven process. These dashboards support a participating community's decision-making for selection and monitoring of evidence-based practices to reduce opioid overdose deaths.

METHODS/DESIGN

A community-tailored dashboard is a web-based set of interactive data visualizations of community-specific metrics. Metrics include opioid overdose deaths and other OUD-related measures, as well as drivers of change of these outcomes in a community. Each community-tailored dashboard is a product of a co-creation process between HCS researchers and stakeholders from each community. The four research sites used a varied set of technical approaches and solutions to support the scientific design and CTH intervention implementation. Ongoing evaluation of the dashboards involves quantitative and qualitative data on key aspects posited to shape dashboard use combined with website analytics.

DISCUSSION

The HCS presents an opportunity to advance how community-tailored dashboards can foster community-driven solutions to address the opioid epidemic. Lessons learned can be applied to inform interventions for public health concerns and issues that have disproportionate impact across communities and populations (e.g., racial/ethnic and sexual/gender minorities and other marginalized individuals).

TRIAL REGISTRATION

ClinicalTrials.gov (NCT04111939).

Comparing methods of performing geographically targeted rural health surveillance

Background

Worsening socioeconomic conditions in rural America have been fueling increases in chronic disease and poor health. The goal of this study was to identify cost-effective methods of deploying geographically targeted health surveys in rural areas, which often have limited resources. These health surveys were administered in New York’s rural Sullivan County, which has some of the poorest health outcomes in the entire state.

Methods

Comparisons were made for response rates, estimated costs, respondent demographics, and prevalence estimates of a brief health survey delivered by mail and phone using address-based sampling, and in-person using convenience sampling at a sub-county level in New York’s rural Sullivan County during 2017.

Results

Overall response rates were 27.0% by mail, 8.2% by phone, and 71.4% for convenience in-person surveys. Costs to perform phone surveys were substantially higher than mailed or convenience in-person surveys. All modalities had lower proportions of Hispanic respondents compared to Census estimates. Unadjusted and age-adjusted prevalence estimates were similar between mailed and in-person surveys, but not for phone surveys.

Conclusions

These findings are consistent with declining response rates of phone surveys, which obtained an inadequate sample of rural residents. Though in-person surveys had higher response rates, convenience sampling failed to obtain a geographically distributed sample of rural residents. Of modalities tested, mailed surveys provided the best opportunity to perform geographically targeted rural health surveillance.

Epidemiology of skydiving-related deaths and injuries: A 10-years prospective study of 6.2 million jumps between 2010 and 2019 in France

OBJECTIVES

To analyse the data on skydiving deaths and injuries collected prospectively by the French Parachuting Federation (FFP) between 2010 and 2019.

DESIGN

Prospective cohort study.

METHODS

Data on number of skydiving deaths and injuries were collected prospectively between January 2010 and December 2019, among all skydivers licensed to the FFP, via a standardised report form that included the skydiver's sex and level of experience (classified as tandem, student, or experienced), deaths, injuries, and injury location. The number of licensees, jumps, skydiving deaths and injuries were analysed descriptively and expressed as rates per 100,000 jumps and per 1000 skydivers with 95% confidence intervals (95%CI).

RESULTS

Among the almost 6.2 million jumps performed by 519,620 skydivers over 10 years between 2010 and 2019, 35 deaths and 3015 injuries were reported, corresponding to 0.57 deaths (95%CI 0.38 to 0.75) and 49 injuries (95%CI 47.0 to 50.1) per 100,000 jumps. Male skydivers had a five times higher deaths rate than women (RR=4.8, 95%CI 1.5 to 15.6). There was no death in tandem skydivers. Student skydivers had a six times higher risk of injuries than experienced skydivers (RR=6.1, 95%CI 5.7 to 6.6) and tandem skydivers had a significant lower risk of injuries than experienced skydivers (RR=0.07, 95%CI 0.06 to 0.08). 83.3% of the injuries occurred during the landing phase and 64.3% concerned the lower limb.

CONCLUSIONS

This large survey shows that the highest risk of death concerned experienced and male skydivers, and the highest risk of injuries concerned student skydivers. It also shows the safety of tandem skydiving. These results can be of help to develop skydiving-related deaths and injuries risk reduction strategies, and thus improve the global skydiving safety and the skydivers' health.

South Pacific Underwater Medicine Society guidelines for cardiovascular risk assessment of divers

The South Pacific Underwater Medicine Society (SPUMS) diving medical for recreational scuba divers was last reviewed in 2011. From 2011 to 2019, considerable advancements have occurred in cardiovascular risk assessment relevant to divers. The SPUMS 48th (2019) Annual Scientific Meeting theme was cardiovascular risk assessment in diving. The meeting had multiple presentations updating scientific information about assessing cardiovascular risk. These were distilled into a new set of guidelines at the final conference workshop. SPUMS guidelines for medical risk assessment in recreational diving have subsequently been updated and modified including a new Appendix C: Suggested evaluation of the cardiovascular system for divers. The revised evaluation of the cardiovascular system for divers covers the following topics: 1. Background information on the relevance of cardiovascular risk and diving; 2. Defining which divers with cardiovascular problems should not dive, or whom require treatment interventions before further review; 3. Recommended screening procedures (flowchart) for divers aged 45 and over; 4. Assessment of divers with known or symptomatic cardiovascular disease, including guidance on assessing divers with specific diagnoses such as hypertension, atrial fibrillation, cardiac pacemaker, immersion pulmonary oedema, takotsubo cardiomyopathy, hypertrophic cardiomyopathy and persistent (patent) foramen ovale; 5. Additional cardiovascular health questions included in the SPUMS guidelines for medical risk assessment in recreational diving; 6. Updated general cardiovascular medical risk assessment advice; 7. Referencing of relevant literature. The essential elements of this guideline are presented in this paper.

Estimating the prevalence of hepatitis B by wastewater-based epidemiology in 19 cities in China

China has the world's largest burden of Hepatitis B virus (HBV) infection, with 86 million HBV carriers, including 32 million chronic Hepatitis B patients. To monitor the HBV prevalence in near real-time, a wastewater-based epidemiology (WBE) method by using lamivudine as a biomarker was conducted in 19 cities in the Southern part of China. LC-MS/MS was utilized to quantify lamivudine in sewage, and satisfactory method validation results were achieved. The average concentration of lamivudine in sewage was 156.4 ± 107.1 ng/L, and the daily consumption was 30.1 ± 19.8 mg/day/1000inh in average ranging from 0.4 to 105.5 mg/day/1000inh. The prevalence of chronic Hepatitis B was estimated to be 2.5% ± 1.7% based on the prevalence of lamivudine usage, which was 0.035% ± 0.023%. Besides, the estimated HBV prevalence in population aged over 15 years in 19 cities was 6.8% ± 4.5% and was consistent with the previous statistical data of 7% in 2018. This research demonstrated that the estimation of HBV prevalence by WBE with lamivudine as a biomarker is feasible in big cities in Southern China.

Diving after SARS-CoV-2 (COVID-19) infection: Fitness to dive assessment and medical guidance

Scuba diving is a critical activity for commercial industry, military activities, research, and public safety, as well as a passion for many recreational divers. Physicians are expected to provide return-to-diving recommendations after SARS-CoV-2 (COVID-19) infection based upon the best available evidence, often drawn from experience with other, similar diseases. Scuba diving presents unique physiologic challenges to the body secondary to immersion, increased pressure and increased work of breathing. The long-term sequelae of COVID-19 are still unknown, but if they are proven to be similar to other coronaviruses (such as Middle East respiratory syndrome or SARS-CoV-1) they may result in long-term pulmonary and cardiac sequelae that impact divers' ability to safely return to scuba diving. This review considers available literature and the pathophysiology of COVID-19 as it relates to diving fitness, including current recommendations for similar illnesses, and proposes guidelines for evaluation of divers after COVID-19. The guidelines are based upon best available evidence about COVID-19, as well as past experience with determination of diving fitness. It is likely that all divers who have contracted COVID-19 will require a medical evaluation prior to return to diving with emphasis upon pulmonary and cardiac function as well as exercise capacity.

Recommendation for the establishment of a poison control center at the Korea Disease Control and Prevention Agency

There is currently no governmental body in South Korea resembling the type of poison center (PC) recommended by the World Health Organization (WHO). All Organization for Economic Cooperation and Development (OECD) member countries except for South Korea maintain such a PC tasked with both preventing poisoning accidents and supporting the prompt treatment of poisoned patients. Such a PC could very possibly have allowed the country to more promptly recognize the widespread wave of humidifier disinfectant (HD) associated health effects, including fatal lung injury and death, that lasted started roughly in 2000 and continued through 2011. Despite this chemical poisoning tragedy, South Korea still lacks a surveillance system to monitor health effects caused by the use and consumption of materials that include products containing chemicals, foodborne pathogens, drugs, pesticides, etc. There have been no legal procedures for examining the potential risk of products or materials manufactured by industry. The reporting of national poisoning data or causes of poisoning, which is near ubiquitous in advanced countries with a PC, has not taken place We recommend that a PC should be established within the Korea Disease Control and Prevention Agency (KDCA). In addition, in order to perform surveillance of poisoning cases across the country, a certain number of regional PCs, including at large hospitals, will also be necessary.

Muscle-strengthening Exercise Epidemiology: a New Frontier in Chronic Disease Prevention

This current opinion provides an overview of the emerging discipline of muscle-strengthening exercise epidemiology. First, we define muscle-strengthening exercise, and discuss its recent addition into the global physical activity guidelines, which were historically mainly focused on aerobic physical activity (walking, running, cycling etc.). Second, we provide an overview of the current clinical and epidemiological evidence on the associations between muscle-strengthening exercise and health, showing a reduced mortality risk, and beneficial cardiometabolic, musculoskeletal, functional and mental health-related outcomes. Third, we describe the latest epidemiological research on the assessment, prevalence, trends and correlates of muscle-strengthening exercise. An overview of recent population estimates suggests that the proportion of adults meeting the current muscle-strengthening exercise guideline (10-30%; ≥ 2 sessions/week) is far lower than adults reporting meeting the aerobic exercise guideline (~ 50%; ≥ 150 min/week). Fourth, we discuss the complexity of muscle-strengthening exercise promotion, highlighting the need for concurrent, coordinated, and multiple-level strategies to increase population-level uptake/adherence of this exercise modality. Last, we explore key research gaps and strategies that will advance the field of muscle-strengthening exercise epidemiology. Our objective is to provide a case for increased emphasis on the role of muscle-strengthening exercise for chronic disease prevention, and most importantly, stimulate more research in this currently understudied area of physical activity epidemiology.

Absence of IgG antibodies among high-risk contacts of two confirmed cases of Crimean-Congo haemorrhagic fever in the autonomous region of Madrid (Spain)

Crimean-Congo haemorrhagic fever (CCHF) is a widely distributed tick-borne disease. In Spain, the disease has emerged as outbreak associated with high-risk exposures. Our goal was to evaluate the prevalence of antibodies against the CCHF virus (CCHFV) in high-risk contacts. A cross-sectional study was conducted. Three hundred eighty-six high-risk contacts were identified comprising family contacts and hospital workers who had attended the cases. Fifty-seven cases with closer exposure were selected. However, forty-nine cases participated in the study. IgG antibodies were detected by immunoenzymatic techniques. All determinations tested negative for anti-CCHFV IgG antibodies. Most of the responders were women (73.5%), and belong to the intensive care department (53.1%). In relation to other possible sources of exposures, 18.4% travelled to countries with CCHF transmission risk. No CCHF positivity was recorded among selected high-risk contacts. This highlights the importance of standard precautions which might have protected healthcare workers and care providers from CCHF infection.

Street Food, Food Safety, and Regulation: What is the Panorama in Colombia?

ABSTRACT

Public management of street food is a challenge in many countries. In Colombia, despite the extent of the economic, social, and food contributions of the segment and the concern from the public health perspective, the amount of research on the subject still remains insufficient. Thus, this study aimed to establish a panorama of the street food trade in Colombia, considering its mode of operation, food security, and regulatory context, based on the scientific literature published between 2000 and 2018. A literature review was carried out in the Medline, SciELO, LILACS, Scopus, Redalyc, and Google Scholar databases, as well as in the University of Colombia's institutional repositories and scientific books. A set of 19 publications were selected and evaluated for three dimensions-work and culture, food safety, and regulation-according to the objectives and methodologies applied. In category 1, relative to work and culture, five studies were retrieved (26.3%), highlighting the economic and social contribution of the sector and the protection of food cultural heritage. Category 2, referring to hygiene and microbiological safety in the activity, covers 11 publications (57.9%) and comprised the largest research field of interest in the country. Among the food pathogens surveyed, Salmonella spp. were the most investigated, registering nonconformity in the samples (6.55%). Category 3, with three articles (15.8%), covered public policies and regulation of the segment, highlighting the challenges to regulating the sector and the need for intersectional articulation in administrative policies. The results confirm both the relevance of the segment to food security and the concern with microbiological hazards, demanding strategies to improve its regulation and functioning in the country, with the aim of protecting the health of consumers.

HIGHLIGHTS

#HIV: Alignment of HIV-Related Visual Content on Instagram with Public Health Priorities in the US

Instagram, with more than 1 billion monthly users, is the go-to social media platform to chronicle one's life via images, but how are people using the platform to present visual content about HIV? We analyzed public Instagram posts containing the hashtag "#HIV" (because they are self-tagged as related to HIV) between January 2017 and July 2018. We described the prevalence of co-occurring hashtags and explored thematic concepts in the images using automated image recognition and topic modeling. Twenty-eight percent of all #HIV posts included hashtags focused on awareness, followed by LGBTQ (24.5%) and living with HIV (17.9%). However, specific strategies were rarely cited, including testing (10.8%), treatment (10.3%), PrEP (6.2%) and condoms (4.1%). Image analyses revealed 44.5% of posts included infographics followed by people (21.3%) thereby humanizing HIV and stigmatized populations and promoting community mobilization. Novel content such as the handwriting image-theme (3.8%) where posters shared their HIV test results appeared. We discuss how this visual content aligns with public health priorities to reduce HIV in the US and the novel, organic messages that public health could help amplify.

Professional diver routine health surveillance and certification: an internet-based satisfaction survey of New Zealand divers

INTRODUCTION

Professional divers, like many other specialised occupational groups, are subject to regulatory constraints that include mandatory initial medical certification and routine recertification. The New Zealand system of diver certification and health surveillance has undergone modifications in recent years, but its acceptance among end-users has never been formally assessed. Because of the wide variety of tasks, circumstances and personalities encountered in the diving industry, unanimous satisfaction is an unrealistic expectation, but establishing the current mood of divers in this regard and canvassing opinions on possible improvements is an important step towards optimising the certification process.

METHOD

A multi-choice satisfaction questionnaire was added, as a quality assurance measure, to the on-line health questionnaire completed annually by all New Zealand professional divers. A complete 12-month dataset was analysed to determine levels of satisfaction, areas of dissatisfaction and suggestions for improvement. Comparison of the opinions of various diver groups was achieved by stratification into employment-type sub-groups and those working locally, overseas or both.

RESULTS

The responses of 914 divers who completed the survey established an 85% satisfaction rate with the existing diver certification system. Dissatisfaction was independent of diving locality. Compliance cost was the most common area of dissatisfaction, particularly among recreational diving instructors.

CONCLUSIONS

Most New Zealand professional divers consider the current certification system satisfactory. Effective communication between the regulating authority and divers was identified as an important area for further development.

Views of health care professionals and policy-makers on the use of surveillance data to combat antimicrobial resistance

BACKGROUND

Providing healthcare professionals with health surveillance data aims to support professional and organisational behaviour change. The UK Five Year Antimicrobial Resistance (AMR) Strategy 2013 to 2018 identified better access to and use of surveillance data as a key component. Our aim was to determine the extent to which data on antimicrobial use and resistance met the perceived needs of health care professionals and policy-makers at national, regional and local levels, and how provision could be improved.

METHODS

We conducted 41 semi-structured interviews with national policy makers in the four Devolved Administrations and 71 interviews with health care professionals in six locations across the United Kingdom selected to achieve maximum variation in terms of population and health system characteristics. Transcripts were analysed thematically using a mix of a priori reasoning guided by the main topics in the interview guide together with themes emerging inductively from the data. Views were considered at three levels - primary care, secondary care and national - and in terms of availability of data, current uses, benefits, gaps and potential improvements.

RESULTS

Respondents described a range of uses for prescribing and resistance data. The principal gaps identified were prescribing in private practice, internet prescribing and secondary care (where some hospitals did not have electronic prescribing systems). Some respondents under-estimated the range of data available. There was a perception that the responsibility for collecting and analysing data often rests with a few individuals who may lack sufficient time and appropriate skills.

CONCLUSIONS

There is a need to raise awareness of data availability and the potential value of these data, and to ensure that data systems are more accessible. Any skills gap at local level in how to process and use data needs to be addressed. This requires an identification of the best methods to improve support and education relating to AMR data systems.

State of knowledge on the occupational exposure to carbon nanotubes

Carbon nanotubes (CNT) trigger fascination as well as anxiety, given their unique physical and chemical properties, and continuing concerns around their possible health effects. CNT exposure assessment is an integral component of occupational and environmental epidemiology, risk assessment, and management. We conducted a systematic review to analyze the quality of CNT occupational exposure assessments in field studies and to assess the relevance of available quantitative data from occupational hygiene and epidemiological perspectives. PubMed and Scopus databases were searched for the period 2000-2018. To grade the quality of each study, we used a standardized grid of seven criteria. The first criterion addressed 12 items deemed most relevant CNT physical-chemical properties with respect to their in vitro and in vivo toxicity. We included 27 studies from 11 countries in the review and graded them high (n = 2), moderate (n = 15) and low quality (n = 10). Half of the studies measured elemental carbon mass concentration (EC) using different methods and aerosol fractions. In 85% of studies, the observed values exceed the US National Institute for Occupational Safety and Health Recommended Exposure Limit. The quantification of CNT agglomerates and/or CNT contained fibers becomes increasingly common although lacking methodological standardization. Work activities with the greatest mean CNT mass concentrations were non-enclosed and included sieving, harvesting, packaging, reactor cleaning, extrusion and pelletizing. Some of the large studies defined standardized job titles according to exposure estimates at corresponding workstations and classified them by decreasing CNT exposure level: technicians > engineers > chemists. The already initiated harmonization of CNT exposure assessment and result reporting need to continue to favor not only studies in the field, but also to identify companies and workers using CNTs to characterize their exposures as well as monitor their health. This will enable an objective and realistic evaluation of risks associated with CNT applications and an appropriate risk management.

Longitudinal screening of hearing threshold in navy divers: is diving really a hazard?

INTRODUCTION

Hearing loss (HL) is common in the adult working population. It is widely assumed that diving is a risk factor for HL. However, studies with sufficient follow-up comparing HL in divers to non-divers are limited. This study aimed to assess the hearing threshold (HT) of Royal Netherlands Navy divers who had been diving for more than 15 years and to compare it to the ISO standard 7029:2017 reference table.

METHODS

In this 25-year retrospective cohort study the Royal Netherlands Navy Diving Medical Centre audited the medical records of 1,117 Navy divers. Yearly dive medical assessments were performed according to professional standards, including audiometry. HTs were compared to the ISO 7029:2017 reference table, including Z-distribution, using paired t-tests.

RESULTS

Thirty-five divers were included who had been diving for 15 years or longer. The HT increased significantly in nine of the 16 measured frequencies, while the Z-score decreased significantly in nine of the 16 tested frequencies (eight in both ears). In the 25-year follow-up the pattern was more obvious, with one significantly increased HT, and 10 significantly decreased Z-scores.

DISCUSSION

The absolute HT increases after 15 years of military diving, but less than would be expected from normal age-related deterioration. Moreover, when comparing Z-scores, this sample of divers actually hear better than non-divers. We conclude that military diving is not an increased risk for HL compared to regular occupational hazards and suggest withdrawing the requirement for routine yearly audiometric evaluation as part of a dive medical examination.

Bundles for the central sterile supply department

BACKGROUND

Traditional resources, such as bundles, can help experts define essential steps of health product processing to prevent infections. The present study developed bundle content construction and validation criteria for central sterile supply departments (CSSDs).

METHODS

The present study employed a Delphi technique modified for content evaluation. Eleven professionals with at least 4 years of experience in sterilization were enlisted. Participants discussed main stages of the process virtually and compiled a list of items based on scientific references justified by law and/or logical reasoning. Agreement, disagreement, and/or suggestions on each step resulted in bundles for a CSSD. Items were then reassessed by experts using a Likert scale with a 90% approval criterion.

RESULTS

Six bundles were developed: cleaning, inspection, preparation and packaging, sterilization, and storage resulting from 384 responses and 373 agreements (Interassessor coefficient = 97%).

DISCUSSIONS

Items obtained from the criteria assessment received majority agreement from the first document.

CONCLUSIONS

Agreement among varying professionals was achieved, and bundles were successfully developed to evaluate the processing of goods in CSSDs.

The Danish health and morbidity surveys: study design and participant characteristics

BACKGROUND

Reliable data from health surveys are essential to describe the status and trends in health indicators by means of information not available from official registers. In Denmark, nationally representative health surveys (the Danish Health and Morbidity Surveys) have been carried out among adults during the past three decades by the Danish National Institute of Public Health, University of Southern Denmark. The aim of the present study is to describe the study design of the three most recent surveys in 2010, 2013, and 2017, including the survey mode and response rates.

METHODS

In 2010, 2013, and 2017, the samples (n = 25,000 each) were based on random sampling of individuals aged 16 years or older with a permanent residence in Denmark. A subsample of previously invited respondents was also re-invited in subsequent survey waves. Data were collected through self-administered questionnaires, yet with a concurrent mixed-mode approach, allowing for the invited individuals to complete either a web questionnaire or an identical paper questionnaire. In 2010 and 2013, survey invitations were sent by regular postal mail, whereas a secure electronical mail service, Digital Post, was used to invite the majority (90.1%) of the sample in 2017.

RESULTS

The overall response rate decreased from 60.7% in 2010 to 57.1% in 2013 and 56.1% in 2017. Between 2010 and 2017 the response mode distribution for the web questionnaire increased markedly from 31.7 to 73.8%. The largest increase in the proportion which completed the web questionnaire was found in the oldest age group.

CONCLUSIONS

Data from the Danish Health and Morbidity Surveys reveal an increasing proportion of the respondents to complete web questionnaires instead of paper questionnaires. Even though the response rate remained relatively stable in 2017, declining response rates is a major concern in health surveys. As the generalizability to the Danish population may be compromised by a low response rate, efforts to increase the response rate or keep it stable are crucial in future surveys. Thus, efforts should be made to ensure convenience and feasibility in relation to access to and the completion of survey (web) questionnaires.

Surveillance of work environment and heat stress assessment using meteorological data

Health surveillance and workplace surveillance are two related but different aspects of occupational health services. The assessment of heat stress using heat indices and thermal models in connection with meteorological data is an important part of surveillance of workplace heat. The assessment of heat exposure provides the basis for occupational health services. Workers should have health surveillance if the high heat stress cannot be reduced.