Condoms and sexual health education as evidence: impact of criminalization of in-call venues and managers on migrant sex workers access to HIV/STI prevention in a Canadian setting

Background

Despite a large body of evidence globally demonstrating that the criminalization of sex workers increases HIV/STI risks, we know far less about the impact of criminalization and policing of managers and in-call establishments on HIV/STI prevention among sex workers, and even less so among migrant sex workers.

Methods

Analysis draws on ethnographic fieldwork and 46 qualitative interviews with migrant sex workers, managers and business owners of in-call sex work venues in Metro Vancouver, Canada.

Results

The criminalization of in-call venues and third parties explicitly limits sex workers’ access to HIV/STI prevention, including manager restrictions on condoms and limited onsite access to sexual health information and HIV/STI testing. With limited labour protections and socio-cultural barriers, criminalization and policing undermine the health and human rights of migrant sex workers working in –call venues.

Conclusions

This research supports growing evidence-based calls for decriminalization of sex work, including the removal of criminal sanctions targeting third parties and in-call venues, alongside programs and policies that better protect the working conditions of migrant sex workers as critical to HIV/STI prevention and human rights.

     

Peer Reviewed: Workers’ Health Risk Behaviors by State,Demographic Characteristics,and Health Insurance Status

Introduction

Employers often lack data about their workers'' health risk behaviors. We analyzed state-level prevalence data among workers for 4 common health risk behaviors: obesity, physical inactivity, smoking, and missed influenza vaccination (among workers older than 50 years).

Methods

We analyzed 2007 and 2008 Behavioral Risk Factor Surveillance System data, restricting the sample to employed respondents aged 18 to 64 years. We stratified health risk behavior prevalence by annual household income, educational attainment, health insurance status, and race/ethnicity.

Results

For all 4 health risk behaviors, we found significant differences across states and significant disparities related to social determinants of health — income, education, and race/ethnicity. Among uninsured workers, prevalence of smoking was high and influenza vaccinations were lacking.

Conclusion

In this national survey study, we found that workers'' health risk behaviors vary substantially by state and by workers'' socioeconomic status, insurance status, and race/ethnicity. Employers and workplace health promotion practitioners can use the prevalence tables presented in this article to inform their workplace health promotion programs.     

Peer Reviewed: Demographic and Geographic Differences in Exposure to Secondhand Smoke in Missouri Workplaces, 2007-2008

Introduction

African Americans, Hispanics, service and blue-collar workers, and residents of rural areas are among those facing higher rates of workplace secondhand smoke exposure in states without smokefree workplace laws. Consequently, these groups also experience more negative health effects resulting from secondhand smoke exposure. The objective of this study was to examine disparities in workplace secondhand smoke exposure in a state without a comprehensive statewide smokefree workplace law and to use this information in considering a statewide law.

Methods

We developed a logistic multilevel model by using data from a 2007-2008 county-level study to account for individual and county-level differences in workplace secondhand smoke exposure. We included sex, age, race, annual income, education level, smoking status, and rural or urban residence as predictors of workplace secondhand smoke exposure.

Results

Factors significantly associated with increased exposure to workplace secondhand smoke were male sex, lower education levels, lower income, living in a small rural or isolated area, and current smoking. For example, although the overall rate of workplace exposure in Missouri is 11.5%, our model predicts that among young white men with low incomes and limited education living in small rural areas, 40% of nonsmokers and 56% of smokers may be exposed to secondhand smoke at work.

Conclusion

Significant disparities exist in workplace secondhand smoke exposure across Missouri. A statewide smokefree workplace law would protect all citizens from workplace secondhand smoke exposure.     

FSWs Typology and Condoms Use Among HIV High Risk Groups in Sindh,Pakistan: A Developing Country Perspective

Objective

We aimed to determine the association of FSWs typology with condom use among HIV high risk groups in Sindh, Pakistan

Introduction

HIV is growing rapidly worldwide resulting in estimated 34 million population [1]. Recently, its epidemic has spread in Africa, Latin America, and the Caribbean, and most parts of Asia [2]. According to Antenatal sero surveillance study conducted in 2011 by Agriteam canada, it’s prevalence in Pakistan is <0.1 [3].Focusing narrowly, its prevalence in Sindh, (one of the provinces of Pakistan) is similar in general population, but it is in the phase of concentrated epidemic (having more than 5% of prevalence in high risk groups)in vulnerable groups like IDUs and Male sex workers and transgender [4].Sexual intercourse has been identified as major route especially in HIV high risk groups including male sex workers, female sex workers (FSWs), transgender (hijras) and IV drug users. Among them, FSWs are at high risk because of unprotected sex and illicit drug use. Their prevalence is found to be 30.7% in low and middle income countries [5]. South Asia contributed with 12.63 lakh FSW in India only [6]. On the basis of their station of work, they are categorized into facility based (kothikhana, brothel or home) and mobile (street, mobile or beggars). They use different preventive measures including condom for their protection from HIV [7]. It varies with availability and access [8] . FSWs typology have different cliental and mode of action, therefore, it important to explore the preventive methods.

Methods

Data was extracted from Second Generation Surveillance, Integrated behavioral and biological survey, Round IV for HIV infection conducted by Agriteam Canada in partnership with National AIDS Control Program, Pakistan in 2011. It was a cross sectional survey for high risk groups including FSWs from Pakistan. It was ethically approved by Review Board of the Public Health Agency of Canada and HOPE International’s Ethical Review Board, Pakistan. From Sindh province, FSWs based in Karachi, Sukkur and Larkana were recruited. Considering typology, they were categorized as mobile or facility based. After informed consent, socio-demographic and risk behavior were inquired. HIV was tested by ELISA/EIA and confirmed by Western Blot. Data was analyzed on SPSS 19. Continuous variables were expressed as mean±SD while categorical as frequency(%). Logistic regression assessed the association of FSWs typology with condoms use among HIV high risk groups.

Results

Out of 4567 high risk population, 1127 were identified as FSWs. Mean age was 26.9 years. Most of them were facility based (72.8%) and 81.3% used condoms. Typology, age, education, duration of involvement, number of client per day, number of paid oral sex per month, knowledge about STI and knowledge about drop in center were significantly associated with condom use among HIV high risk groups.

Conclusions

Majority of facility based FSWs use condoms to prevent HIV infection. Awareness and access to home based FSWs should be increased. It may help in targeting and designing preventive strategies for them at government and mass level.     

Prevalence and incidence of cervical intra-epithelial neoplasia among female sex workers in Korogocho,Kenya

Setting:

Sex Workers Outreach Programme Clinic, Korogocho, Nairobi, Kenya.

Objective:

In a cohort of sex workers, to determine 1) the prevalence of cervical intra-epithelial neoplasia (CIN) and its association with human immunodeficiency virus-1 (HIV-1) infection, and 2) the incidence rate of CIN during the 3-year follow-up from December 2009 to December 2012.

Design:

Prospective nested cohort study.

Results:

Of the 350 women enrolled, the median age was 29 years (range 18–49); 84 (24%) were HIV-1-infected. At enrollment, 54 (15%) had an abnormal cytology, 39 (11%) had low-grade intra-epithelial lesions (LSIL) and 15 (4%) high-grade intraepithelial lesions (HSIL). HIV-1-infected women were 2.7 times (95%CI 1.7–4.4) more likely to have CIN than non-HIV-1-infected women. Among HIV-1-infected women, the prevalence of LSIL and HSIL was 2.5 times (95%CI 1.2–5.1) and seven times (95%CI 2.3–23.3) greater than among non-HIV-infected women. During the follow-up period, 39 (11%) women had incident CIN (6.6/100 person years [py]), with no difference by HIV status, i.e., respectively 7.9/100 py and 6.3/100 py in HIV-1-infected and non-HIV-1-infected women.

Conclusion:

The prevalence and incidence of CIN among HIV-1-infected sex workers was high; early, regular screening and follow-up of this life-threatening condition is therefore recommended.     

Recruitment-adjusted estimates of HIV prevalence and risk among men who have sex with men: effects of weighting venue-based sampling data

Objectives

We investigated the impact of recruitment bias within the venue-based sampling (VBS) method, which is widely used to estimate disease prevalence and risk factors among groups, such as men who have sex with men (MSM), that congregate at social venues.

Methods

In a 2008 VBS study of 479 MSM in New York City, we calculated venue-specific approach rates (MSM approached/MSM counted) and response rates (MSM interviewed/MSM approached), and then compared crude estimates of HIV risk factors and seroprevalence with estimates weighted to address the lower selection probabilities of MSM who attend social venues infrequently or were recruited at high-volume venues.

Results

Our approach rates were lowest at dance clubs, gay pride events, and public sex strolls, where venue volumes were highest; response rates ranged from 39% at gay pride events to 95% at community-based organizations. Sixty-seven percent of respondents attended MSM-oriented social venues at least weekly, and 21% attended such events once a month or less often in the past year. In estimates adjusted for these variations, the prevalence of several past-year risk factors (e.g., unprotected anal intercourse with casual/exchange partners, ≥5 total partners, group sex encounters, at least weekly binge drinking, and hard-drug use) was significantly lower compared with crude estimates. Adjusted HIV prevalence was lower than unadjusted prevalence (15% vs. 18%), but not significantly.

Conclusions

Not adjusting VBS data for recruitment biases could overestimate HIV risk and prevalence when the selection probability is greater for higher-risk MSM. While further examination of recruitment-adjustment methods for VBS data is needed, presentation of both unadjusted and adjusted estimates is currently indicated.Venue-based sampling (VBS), also called time-location or time-space sampling, is a study design that is widely used to provide estimates of risk factors and disease outcomes.¹ Although it can be used to study any target population that congregates at known venues associated with the population,² it has been primarily used for behavioral research of groups at risk for human immunodeficiency virus (HIV) or sexually transmitted diseases, such as men who have sex with men (MSM) and drug users.³ Because these populations are often “hidden” from probabilistic sampling (i.e., a population sampling frame cannot be constructed),⁴ using traditional probability designs may be inefficient or infeasible.⁵Several variations of VBS exist, but all introduce elements of randomness in recruitment that improve upon convenience sampling. In the Young Men''s Survey of MSM in seven U.S. cities, for example, a universe of MSM-oriented venues was created, venues were randomly selected, and presumed MSM entering a selected venue were non-preferentially approached to participate.⁶ Sampling efficiency is a chief strength of VBS, as selected recruitment venues contain a high density of the target population. But a corresponding weakness is that the group able to be sampled (e.g., MSM who visit MSM-oriented social venues) may be different from the larger target population (e.g., all sexually active MSM). VBS-based estimates are not generalizable to that larger population when the venue-attending subpopulation exhibits differential characteristics.⁷ Nonetheless, VBS data are often useful in designing outreach-based HIV prevention programs because the venue-attending subpopulation is inherently accessible.⁸Increasing the validity of VBS-based estimates for that subpopulation, however, is a persistent goal. Statistical adjustment of VBS data may be used to correct unequal selection probabilities arising from at least two VBS recruitment biases. First, someone who attends venues frequently is more likely to be sampled than someone who attends venues infrequently. If outcome variables such as partner number or alcohol consumption are also related to attendance frequency, then unweighted data will overestimate population prevalence of these variables. Second, individual selection probability is inversely related to the volume of the target population at each recruitment venue. For example, MSM at low-volume bars have higher selection probabilities than MSM at high-volume gay pride events. Not accounting for these variations may bias estimates if outcome variables are associated with recruitment venue characteristics. Ideally, venue volume would be accounted for a priori in a study design such as probability-proportional-to-size (PPS) sampling, which adjusts second-stage (i.e., participant) selection probability by the size of a first-stage sampling unit.⁹ But PPS requires precise volume enumeration before recruitment, which is often infeasible for social venues. Post hoc statistical adjustment is an alternative approach. True selection probability will always be unknown in the VBS design because the population sampling frame is undefined, but adjustment for the two aforementioned biases may serve as an appropriate proxy in the absence of that gold standard.While several studies have compared VBS estimates with those using another study design,¹⁰ few VBS-based studies have used statistical adjustment for weighted analyses. Adjustment methods were developed for the Young Men''s Survey, but study analyses have only used unweighted data because weighting did not influence HIV prevalence estimates.¹¹ Other VBS studies have presented data weighted to account for differences in venue volume but not attendance frequency.¹² To our knowledge, no VBS studies have reported comparisons of unweighted and weighted estimates of the same data. In this study, we examined the impact of adjustment for the two previously mentioned recruitment biases and compared weighted and unweighted prevalence estimates of HIV risk factors and seroprevalence in a VBS-based sample of MSM.     

Tuberculosis treatment outcomes among hospital workers at a public teaching and national referral hospital in Kenya

Setting:

Kenyatta National Hospital (KNH), Nairobi, Ken-ya, a large referral and teaching hospital.

Objective:

1) To document tuberculosis (TB) case notification rates and trends; 2) to describe demographic, clinical and workplace characteristics and treatment outcomes; and 3) to examine associations between demographic and clinical characteristics, HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) treatment and anti-tuberculosis treatment outcomes among hospital workers with TB at KNH during the period 2006–2011.

Design:

A retrospective cohort study involving a review of medical records.

Results:

The TB case notification rate among hospital staff ranged between 413 and 901 per 100 000 staff members per year; 51% of all cases were extra-pulmonary TB; 74% of all cases were among medical, paramedical and support staff. The TB-HIV coinfection rate was 60%. Only 75% had a successful treatment outcome. Patients in the retreatment category, those with unknown HIV status and those who were support staff had a higher risk of poor treatment outcomes.

Conclusion:

The TB case rate among hospital workers was unacceptably high compared to that of the general population, and treatment outcomes were poor. Infection control in the hospital and management of staff with TB requires urgent attention.     

Peer Reviewed: Building Company Health Promotion Capacity: A Unique Collaboration Between Cargill and the Centers for Disease Control and Prevention

Background

The US Centers for Disease Control and Prevention (CDC) helps protect the health and safety of all people. The workplace can be used to reach millions of workers and their families with programs, policies, and benefits that promote health. We describe a CDC-led project to build Cargill''s workplace health promotion capacity and identify the importance of a company liaison in the public-private relationship.

Context

The project goals were to engage diverse Cargill personnel, conduct a workplace health assessment, aid in the development of a workplace health program action plan, and develop Cargill''s internal capacity using knowledge and skill-building.

Methods

CDC partnered with Cargill on a workplace health promotion project to build Cargill''s capacity. A multicomponent assessment was conducted to determine priority employee health issues, stakeholder meetings were held to engage and educate Cargill management and employees, and technical assistance was provided regularly between CDC and Cargill.

Consequences

Identifying a company liaison to work with an external assessment team is critical to building capacity for a successful workplace health project. This relationship creates an understanding of company culture and operations, facilitates access to key stakeholders and data, and provides opportunities to enhance capacity and sustainability.

Interpretation

Employers undertaking workplace health promotion projects should identify a senior-level person to serve as the company health leader or liaison and who can devote the time necessary to build trusting relationships with partners to ensure project success. This person is valuable in facilitating communications, data collection, logistical support, troubleshooting, and influencing employer workplace health practices.     

Peer Reviewed: Enforcement of State Indoor Tanning Laws in the United States

Introduction

Twenty-eight US states have passed legislation for indoor tanning facilities. To our knowledge, whether these state laws are actually enforced has not been evaluated previously in all 28 states. Therefore, we interviewed key informants in these states to assess enforcement practices.

Methods

Two trained interviewers used a structured survey instrument to interview 28 key informants who were knowledgeable about enforcement practices for laws regarding indoor tanning. Respondents provided information specific to the most populous city in their states.

Results

Licensure for indoor tanning businesses was required in 22 of the 28 cities. Slightly less than half of the cities gave citations to tanning facilities that violated state law. Approximately 32% of the cities did not inspect indoor tanning facilities for compliance with state law, and another 32% conducted inspections less than annually. Of those cities that inspected at all, most conducted unannounced inspections.

Conclusion

The relatively low rates of annual inspections and citations are of concern. We recommend that future studies assess whether legislation, enforcement practices, or a combination of the 2 affects the practices of indoor tanning facilities or of consumers.     

Occupational sunlight exposure, polymorphism of glutathione S-transferase M1, and senile cataract risk

Background

The pathogenesis of cataract is influenced by a number of factors including oxidative stress. Glutathione S‐transferase (GST) catalyses the nucleophilic addition of the thiol of GST to electrophilic acceptors. It is important for detoxification of xenobiotics in order to protect tissues from oxidative damage.

Objectives

To examine whether the interaction of polymorphism of GSTM1 gene and occupational sunlight exposure modulate the risk of cataract.

Methods

Blood samples from 95 subjects with cataract and 95 age and sex matched healthy persons were collected. The genotypes of GSTM1 were determined using PCR.

Results

The null genotype of GSTM1 was associated with an increase in cataract risk in the indoor workplace, but this association was not significant in the outdoor subjects.

Conclusion

The active genotype of GSTM1 has lost its protective role in persons who work outdoors. It is suggested that activity of the GSTμ enzyme may be inhibited in the human lens after occupational exposure to UV light.     

Workplace Secondhand Smoke Exposure in the U.S. Trucking Industry

Background

Although the smoking rate in the United States is declining because of an increase of smoke-free laws, among blue-collar workers it remains higher than that among many other occupational groups.

Objectives

We evaluated the factors influencing workplace secondhand smoke (SHS) exposures in the U.S. unionized trucking industry.

Methods

From 2003 through 2005, we measured workplace SHS exposure among 203 nonsmoking and 61 smoking workers in 25 trucking terminals. Workers in several job groups wore personal vapor-phase nicotine samplers on their lapels for two consecutive work shifts and completed a workplace SHS exposure questionnaire at the end of the personal sampling.

Results

Median nicotine level was 0.87 μg/m³ for nonsmokers and 5.96 μg/m³ for smokers. As expected, smokers experienced higher SHS exposure duration and intensity than did nonsmokers. For nonsmokers, multiple regression analyses indicated that self-reported exposure duration combined with intensity, lack of a smoking policy as reported by workers, having a nondriver job, and lower educational level were independently associated with elevated personal nicotine levels (model R² = 0.52). Nondriver job and amount of active smoking were associated with elevated personal nicotine level in smokers, but self-reported exposure, lack of a smoking policy, and lower educational level were not.

Conclusions

Despite movements toward smoke-free laws, this population of blue-collar workers was still exposed to workplace SHS as recently as 2005. The perceived (reported by the workers), rather than the official (reported by the terminal managers), smoking policy was associated with measured SHS exposure levels among the nonsmokers. Job duties and educational level might also be important predictors of workplace SHS exposure.     

Listening to food workers: Factors that impact proper health and hygiene practice in food service

Background

Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers'' improper health and hygiene practice.

Objective

To investigate food workers'' perceptions of factors that impact proper food safety practice.

Method

Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior.

Results

Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies.

Conclusion

Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers'' social and structural context, that impact food safety practice.     

Compliance with smoke-free legislation within public buildings: a cross-sectional study in Turkey

Objective

To investigate public compliance with legislation to prohibit smoking within public buildings and the extent of tobacco smoking in outdoor areas in Turkey.

Methods

Using a standardized observation protocol, we determined whether smoking occurred and whether ashtrays, cigarette butts and/or no-smoking signs were present in a random selection of 884 public venues in 12 cities in Turkey. We visited indoor and outdoor locations in bars/nightclubs, cafes, government buildings, hospitals, restaurants, schools, shopping malls, traditional coffee houses and universities. We used logistic regression models to determine the association between the presence of ashtrays or the absence of no-smoking signs and the presence of individuals smoking or cigarette butts.

Findings

Most venues had no-smoking signs (629/884). We observed at least one person smoking in 145 venues, most frequently observed in bars/nightclubs (63/79), hospital dining areas (18/79), traditional coffee houses (27/120) and government-building dining areas (5/23). For 538 venues, we observed outdoor smoking close to public buildings. The presence of ashtrays was positively associated with indoor smoking and cigarette butts, adjusted odds ratio, aOR: 315.9; 95% confidence interval, CI: 174.9–570.8 and aOR: 165.4; 95% CI: 98.0–279.1, respectively. No-smoking signs were negatively associated with the presence of cigarette butts, aOR: 0.5; 95% CI: 0.3–0.8.

Conclusion

Additional efforts are needed to improve the implementation of legislation prohibiting smoking in indoor public areas in Turkey, especially in areas in which we frequently observed people smoking. Possible interventions include removing all ashtrays from public places and increasing the number of no-smoking signs.     

Experience of taking care of children exposed to HIV: a trajectory of expectations

OBJECTIVE:

to learn about the experience of caregivers/mothers providing care to infants exposed to HIV through vertical transmission.

METHODS:

this qualitative study used Symbolic Interactionism as the theoretical framework. A total of 39 caregivers of children exposed to HIV in follow-up at a specialized service were interviewed. Data were analyzed through inductive content analysis.

RESULTS:

four categories were identified that report on the lonely experience of handling the child''s antiretroviral therapy, mainly due to a lack of information or incomplete information; being attentive to required care, such as the use of prophylaxis for pneumonia, vaccines, and other practices restricted to the mother-child interaction; the desire to omit the HIV out of fear of prejudice and fear of the disease, considering future prospects.

CONCLUSION:

the HIV and the threat this infection may affect the child cause apprehension and feelings such as fear, guilt and anxiety in the caregivers. Healthcare workers need to work together with mothers so they are able to cope with demands and distress. Only then will the treatment to avoid vertical transmission be efficient and will mother and child be supported during the process, despite apprehension with the outcome.     

HIV/AIDS knowledge among men who have sex with men: applying the item response theory

OBJECTIVE

To evaluate the level of HIV/AIDS knowledge among men who have sex with men in Brazil using the latent trait model estimated by Item Response Theory.

METHODS

Multicenter, cross-sectional study, carried out in ten Brazilian cities between 2008 and 2009. Adult men who have sex with men were recruited (n = 3,746) through Respondent Driven Sampling. HIV/AIDS knowledge was ascertained through ten statements by face-to-face interview and latent scores were obtained through two-parameter logistic modeling (difficulty and discrimination) using Item Response Theory. Differential item functioning was used to examine each item characteristic curve by age and schooling.

RESULTS

Overall, the HIV/AIDS knowledge scores using Item Response Theory did not exceed 6.0 (scale 0-10), with mean and median values of 5.0 (SD = 0.9) and 5.3, respectively, with 40.7% of the sample with knowledge levels below the average. Some beliefs still exist in this population regarding the transmission of the virus by insect bites, by using public restrooms, and by sharing utensils during meals. With regard to the difficulty and discrimination parameters, eight items were located below the mean of the scale and were considered very easy, and four items presented very low discrimination parameter (< 0.34). The absence of difficult items contributed to the inaccuracy of the measurement of knowledge among those with median level and above.

CONCLUSIONS

Item Response Theory analysis, which focuses on the individual properties of each item, allows measures to be obtained that do not vary or depend on the questionnaire, which provides better ascertainment and accuracy of knowledge scores. Valid and reliable scales are essential for monitoring HIV/AIDS knowledge among the men who have sex with men population over time and in different geographic regions, and this psychometric model brings this advantage.     

DNA damage in outdoor workers occupationally exposed to environmental air pollutants

Background

Health concerns about the exposure to genotoxic and carcinogenic agents in the air are particularly significant for outdoor workers in less developed countries.

Aims

To investigate the association between personal exposure to a group of air pollutants and severity of DNA damage in outdoor workers from two Mexican cities.

Methods

DNA damage (Comet assay) and personal exposure to volatile organic compounds, PM_2.5, and ozone were investigated in 55 outdoor and indoor workers from México City and Puebla.

Results

In México City, outdoor workers had greater DNA damage, reflected by a longer tail length, than indoor workers (median 46.8 v 30.1 μm), and a greater percentage of highly damaged cells (cells with tail length ⩾41 μm); in Puebla, outdoor and indoor workers had similar DNA damage. There were more alkali labile sites in outdoor than indoor workers. The DNA damage magnitude was positively correlated with PM_2.5 and ozone exposure. Outdoor and indoor workers with ⩾60% of highly damaged cells (highly damaged workers) had significantly higher exposures to PM_2.5, ozone, and some volatile organic compounds. The main factors associated with the highly damaged workers were ozone, PM_2.5, and 1‐ethyl‐2‐methyl benzene exposure.

Conclusions

With this approach, the effects of some air pollutants could be correlated with biological endpoints from the Comet assay. It is suggested that the use of personal exposure assessment and biological endpoints evaluation could be an important tool to generate a more precise assessment of the associated potential health risks.     

Workplace Exposures and the Risk of Amyotrophic Lateral Sclerosis

Background

Occupation has been suggested to play a role in amyotrophic lateral sclerosis (ALS) etiology, but detailed information on the importance of specific workplace exposures is lacking.

Objectives

Our aim was to assess the relationship between workplace exposures and the risk of ALS and to evaluate potential interactions between these exposures and smoking.

Methods

We conducted a case–control study in New England between 1993 and 1996, comprising 109 cases and 253 controls who completed a structured interview covering occupations and workplace exposures. Unconditional logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for ALS. Analyses were conducted among the entire study population and after stratification by smoking.

Results

We observed a higher risk of ALS for construction workers excluding supervisors (OR = 2.9; 95% CI, 1.2–7.2) and precision metal workers (OR = 3.5; 95% CI, 1.2–10.5). Self-reported exposures to paint strippers; cutting, cooling, or lubricating oils; antifreeze or coolants; mineral or white spirits; and dry cleaning agents each appeared to be associated with a 60–90% higher risk. Specific chemicals related to a > 50% increase in risk of ALS included aliphatic chlorinated hydrocarbons, glycols, glycol ethers, and hexane. Relative risks associated with these workplace exposures and chemicals were greater among nonsmokers and persisted in mutually adjusted models.

Conclusions

Our data suggest that certain occupations and workplace exposures may be associated with increased risk of ALS. These results need to be confirmed in independent populations.     

Treatment outcomes of new adult tuberculosis patients in relation to HIV status in Zimbabwe

Setting:

All public health facilities in Chitungwiza District, Zimbabwe.

Objective:

To determine, in new tuberculosis (TB) patients registered in 2009, 1) the proportion of persons human immunodeficiency virus (HIV) tested, stratified by age, sex and type of TB, and 2) treatment outcomes in relation to type of TB and HIV status.

Design:

Retrospective cohort study.

Results:

Of 1800 TB patients, 1100 (61%) were tested, of whom 877 (80%) were HIV-positive and 75 (9%) were documented as receiving antiretroviral treatment (ART). HIV testing and HIV positivity were similar between patients with different types of TB. Overall, the treatment success rate was 70%, and 17% had transferred out. Being HIV-positive on ART was associated with better treatment success and lower transfer out; age ≥55 years was associated with poor treatment success and higher death rates. Defaulting was more common in those who did not undergo smear testing or in extra-pulmonary TB patients, while deaths were higher in males.

Conclusion:

In a Zimbabwe district, less than two thirds of TB patients were tested. Better treatment success was observed in patients documented as HIV-positive and on ART. Important lessons for improved TB control include increasing HIV testing uptake for better access to ART, more comprehensive recording practices on ART and better reporting on true outcomes of transfer-out patients.     

Uptake of HIV testing and HIV positivity among presumptive tuberculosis patients at Puducherry,South India

Setting:

Puducherry, a district in South India with a low prevalence of human immunodeficiency virus (HIV) infection (<1% among antenatal women).

Objectives:

1) To estimate the proportion of patients with known HIV status who were HIV-positive, 2) to describe the demographic and clinical characteristics of patients with unknown HIV status among presumptive TB patients, and 3) to assess the additional workload at HIV testing centres.

Design:

In this cross-sectional study, consecutive presumptive TB patients attending microscopy centres for diagnosis during March–May 2013 were asked if they knew their HIV status. Patients with unknown HIV status were offered voluntary counselling and HIV testing.

Results:

Of 1886 presumptive TB patients, HIV status was ascertained for 842 (44.6%); 28 (3.3%) were HIV-positive. The uptake of HIV testing was significantly higher in younger age groups, males, residents of Puducherry and smear-positive TB patients. The median increase in the number of clients tested for HIV per day per testing centre was 1 (range 0–6).

Conclusion:

The uptake of HIV testing was low. HIV prevalence was higher among presumptive TB patients than in antenatal women, and as high as in TB patients. With minimal increase in workload at HIV testing centres, HIV testing could be implemented using existing resources.     

Occupational sensitization to epoxy resins in Northeastern Italy (1996–2010)

Background:

One of the main health concerns of epoxy resins is their role as skin sensitizer. This sensitization is not uncommon, because the prevalence ranges around 1–12% of the general population.

Objectives:

Perform a cross sectional study in a patch test population from Northeastern Italy to investigate the prevalence of epoxy resins sensitization among patients with suspected contact dermatitis. Subsequently, relate findings to patients’ occupation and evaluate time trend of prevalence.

Methods:

The final study database included 19 088 consecutive patients, tested from 1996 to 2010 in Northeastern Italy.

Results:

The overall prevalence of epoxy resins sensitization was 0·89%. Dermatitis most frequently involved hands (40·25%). In both sexes, we find a significant correlation in mechanics, woodworkers, and chemical industry workers; and in males only, among farmers and fishers, construction workers, and unemployed. We found significant increase of sensitization in construction workers in the analyzed period.

Conclusions:

The overall prevalence of sensitization to epoxy resins in Northeastern Italy is in line with other European countries, but we found an increased risk of sensitization in some professions and an increasing trend of prevalence in construction workers. Better preventive actions are strongly advised in higher risk professions, with particular attentions towards building sector.