The acrolentiginous melanoma: how to recognise and when to refer?

In Caucasians, the acrolentiginous melanoma is a rare type of melanoma and may appear on hands, feet and subungually. It has the worst prognosis of all melanomas, due to the high rate of misdiagnosis. In 30% of the patients, it presents amelanotic and may resemble for example a common wart, paronychia, ulceration or mycosis. We present 4 patients, aged 48 years and older, in whom an acrolentiginous melanoma was contemplated. One of the lesions was highly suspected of a subungual acrolentiginous melanoma, because of the presence of Hutchinson's sign. Another lesion presented amelanotic and mimicked a foot ulcer. Acrolentiginous melanoma should be considered in case of uncertain diagnosis, delay in healing, enlargement of the lesion and when a pigmented lesion is larger than 7 mm. In these situations, early histopathological examination should be performed.     

Smoke and malaria: are interventions to reduce exposure to indoor air pollution likely to increase exposure to mosquitoes?

Indoor air pollution from the domestic use of biomass fuels by poor households in developing countries is known to be harmful to health, and efforts are being made to address this problem by changes in fuel type, stove technology, house design and fuel-use practices. However, anecdotal evidence suggests that smoke may play an important role by providing protection from biting insects and that efforts to reduce smoke may increase exposure, particularly to mosquitoes and malaria. This paper reviews the literature relating to the repellent effect of smoke on mosquitoes and finds that there is currently no evidence that smoke from domestic fuel use provides effective protection from mosquitoes and malaria. Given the limited number and quality of studies, this finding cannot be interpreted as conclusive. The literature relating to house ventilation and mosquito entry was also reviewed, and an association between eaves spaces and increased indoor mosquito density was noted. Additionally, literature on the effect of soot on the efficacy of insecticide-treated bed nets was considered, but no direct impact was shown. Efforts to reduce indoor air pollution remain desirable even in areas of malaria transmission.     

Occupational hygiene: where from and to?

Occupational Hygiene was born in the forties in the USA, from the need to focus on the causes of the occupational diseases from a scientific and technical point of view. In other words this is to understand how to detect, how to evaluate and how to control the chronic risks at the workplace. The discipline developed very well from that time up to the nineties thank to a strong commitment of dedicated people and professional societies supported by international organizations such as the ILO and the WHO. Nowadays the situation of Occupational Hygiene differs considerably between countries which can arbitrarily be categorized according to the "culture and tradition" they have in this field. The development of this science has decreased in the countries where it has been very well established. This is probably due to the fact that the field of Occupational Health has been enlarged very much in the last decade so that Occupational Hygiene has to struggle more than before to defend its ecological niche (specificity) in this vast domain. In some countries the discipline is mixed with safety or environmental protection or even with the quality management and there is no curricula for Occupational Hygiene only. In many countries it simply does not exist. What will be the future of Occupational Hygiene? It is not possible to answer this question but there are clear opportunities to show the importance of Occupational Hygiene such as the REACH regulation in Europe which full comply with the core competencies of this profession. Other opportunities such as the elaboration of simple tools to assess and control the occupational hazards (toolkits) may also lead to a decrease in the need of well educated professionals since these tools will not require a long training to be used. In conclusion, the future will depend on the way the actual occupational hygienists will work to become more visible and to be considered as essential partners to reach the main goal of Occupational Health which is to build up healthy workplaces, for healthy companies in a healthy economy. The Occupational Hygiene Societies at the national level and the IOHA (International Occupational Hygiene Association) at the international level, will have a key role to play in this future evolution.     

Heart failure clients’ encounters with professionals and self-rated ability to return to work

Background People with heart failure are sick listed for long periods and disability pension is common. Healthcare professionals need knowledge about factors that can enhance their return to work processes. Aims This study focus on people on sick leave due to heart failure and their encounters with healthcare professionals/social insurance officers. Specifically, it aimed to investigate associations between: (1) encounters and socio-demographic factors and, (2) encounters and self-rated ability to return to work. Material and methods A cross-sectional study based on registry data and a postal questionnaire to people on sick leave due to heart failure (n?=?590). Bivariate correlation analyses and logistic regression analyses were used. Results Gender, income, and age were strongly associated with encounters with both social insurance officers and healthcare professionals. Self-rated ability to return to work was associated with the encounters ‘Made reasonable demands’, ‘Gave clear and adequate information/advice’ and ‘Did not keep our agreements’. Conclusion and significance To enhance clients’ abilities to return to work demands should be reasonable, information and advice need to be clear, and agreements should be kept. These results can be used by healthcare professionals as occupational therapists involved in vocational rehabilitation for people on sick leave due to heart failure.     

Differential access to health care and support? A qualitative analysis of how Australian smokers conceptualise and respond to stigma

Scholarship on stigma, originally theorised as a ‘mark’ of social disgrace or difference, has since moved away from individual-level analyses to consider the socio-cultural context in the ‘marking’ of groups of people. In response to this theoretical shift, scholars have demonstrated how extensive tobacco denormalisation policies have contributed to the stigmatisation of smokers, documenting smokers’ experiences of stigma across a number of developed countries. We extend this analysis to the Australian context, examining smokers’ constructions of stigma and their reactions to policies that would give smokers differential access to healthcare. Based on 29 interviews with Australian smokers, we focus on what constitutes evidence of stigma and how participants use social comparisons to respond to stigma. We then explore an assumption underpinning participants’ accounts of stigma: that only smokers committed to cessation are ‘deserving’ of treatment. We close by discussing theoretical perspectives and opportunities in stigma research and the need to extend a stigma lens to study emerging public health issues, such as electronic cigarettes.     

Urgent endoscopic retrograde cholangio-pancreatography: to whom, when and how to perform?

Although the effectivity of an urgent endoscopic retrograde cholangio-pancreatography was documented, some aspects relating to this method are still debated. Timing of this procedure has not been established yet. Indications for urgent endoscopic retrograde cholangio-pancreatography with stone extraction from the common bile duct in patients with biliary pancreatitis remains controversial. Biliary decompression and drainage is the cornerstone of acute cholangitis treatment. The timing of endoscopic retrograde cholangio-pancreatography should be based on the grade of the severity of the disease. Using endoscopic retrograde cholangio-pancreatography, the accurate diagnosis and treatment of bile leaks in a timely manner is imperative to limit associated morbidity and mortality. Difficulty in cannulating the common bile duct is one of the main risk factors for pancreatitis occurring after the procedure. Alternative techniques to facilitate difficult cannulation are discussed. Organized training and introduction of objective measures of the investigator's competence are emphasized to improve the performance of the procedure in Hungary.     

Health care workers’ ability and willingness to report to duty during catastrophic disasters

Catastrophic disasters create surge capacity needs for health care systems. This is especially true in the urban setting because the high population density and reliance on complex urban infrastructures (e.g., mass transit systems and high rise buildings) could adversely affect the ability to meet surge capacity needs. To better understand responsiveness in this setting, we conducted a survey of health care workers (HCWs) (N=6,428) from 47 health care facilities in New York City and the surrounding metropolitan region to determine their ability and willingness to report to work during various catastrophic events. A range of facility types and sizes were represented in the sample. Results indicate that HCWs were most able to report to work for a mass casualty incident (MCI) (83%), environmental disaster (81%), and chemical event (71%) and least able to report during a smallpox epidemic (69%), radiological event (64%), sudden acute respiratory distress syndrome (SARS) outbreak (64%), or severe snow storm (49%). In terms of willingness, HCWs were most willing to report during a snow storm (80%), MCI (86%), and environmental disaster (84%) and least willing during a SARS outbreak (48%), radiological event (57%), smallpox epidemic (61%), and chemical event (68%). Barriers to ability included transportation problems, child care, eldercare, and pet care obligations. Barriers to willingness included fear and concern for family and self and personal health problems. The findings were consistent for all types of facilities. Importantly, many of the barriers identified are amenable to interventions.     

Tolerance to shift work—how does it relate to sleep and wakefulness?

Objectives There is limited knowledge as to why some individuals tolerate shift work and others do not. As a consequence of their intolerance, many individuals develop dissatisfaction with their shift schedule. To evaluate if dissatisfaction with ones shift system was related to alterations of the daily pattern of sleep and sleepiness, we followed two groups of shift workers that were either highly satisfied or dissatisfied with their shift schedule, during an entire shift cycle.Methods Thirty-six male and 20 female shift workers were selected according to their satisfaction with their shift schedule. The shift cycle included seven work periods (triads of shifts; night shift—afternoon shift—morning shift), with only 8–9 hours off (quick returns) between shifts, but followed by a day off.Results Sleep length was reduced after night shifts (4.8 h) and afternoon shifts (5.4 h). Sleepiness was increased during all shifts, particularly night shifts. Sleepiness did not accumulate across the shift cycle even though sleepiness was slightly increased directly after the last triad of shifts. There were few significant gender differences. Dissatisfied shift workers reached much higher levels of sleepiness and reported less sufficient sleep, but not objectively poorer or shorter sleep. Amongst dissatisfied workers, this resulted in an increase of sleepiness problems across shifts within the triad of shifts. Dissatisfied workers also had more performance lapses at the end of the night shift.Conclusions Satisfaction with the shift schedule seems to reflect how well the shift workers were coping with the schedule. It is suggested that the increase of sleep/wake problems within the work period for the dissatisfied shift workers is related to increased sensitivity to curtailed and displaced sleep.     

The emergence and evolution of swine viral diseases: to what extent have husbandry systems and global trade contributed to their distribution and diversity?

Over the last 20 years, pig production has been characterised by a rapid increase in the volume of pig meat produced, greater intensification of the pig-rearing process and much greater international movement of products. There have also been many novel viral diseases that challenge the industry. Are these two developments linked and, if so, how? To understand how changes in the industry may influence the evolution of viruses, it is important to understand something of evolutionary theory. For RNA viruses, the concept of 'quasispecies' has moved solidly from theory to fact. Such viruses do not exist as a single entity, but as a 'cloud' of viruses, whose degree of diversity is influenced by a number of factors. Chief among these are the size and rate of the replicating population, along with the availability and diversity of susceptible hosts. A feature of RNA viruses is a high level of mutation, due to lack of capability to correct errors on the part of the host cell. Both in vivo and in vitro, RNA viruses have been shown to accumulate and fix these mutations, leading to bottleneck events and fitness loss, the phenomenon known as'Muller's ratchet'. Likewise, the opposite effect, fitness gain, can be achieved in an environment providing for high levels of replication and the generation of large populations of virus. This has been shown to be possible in vitro by high-volume passage. It is possible that the regular introduction of diverse viruses within large-scale pig production provides an in vivo equivalent that could drive quasispecies populations to increased fitness, and may explain why emergent viruses, either new to science or with new synergies and presentation, seem to be appearing more commonly.     

Insecticide Residues in Soil,Water, and Eggplant Fruits and Farmers’ Health Effects Due to Exposure to Pesticides

Objectives

Eggplant (Solanum melongena L.) is an important vegetable crop that is widely cultivated in the tropical and subtropical areas in Asia. Globally, the top three eggplant producers are China, India, and Egypt. The Philippines has been one of the top 10 eggplant-producing countries based on area planted and crop productivity. This study aims to describe the insecticide residues found in soil, water, and eggplant fruits in eggplant farms in Sta. Maria, Pangasinan.

Methods

The study design is a cross sectional of randomly selected eggplant farms in Sta. Maria, Pangasinan. Soil, water, and eggplant fruits were collected and subjected to gas chromatography (Shimadzu) analysis for multi-pesticide residues.

Results

Farmers from Sta. Maria, Pangasinan were found to be applying a broad spectrum of insecticides on their eggplant crop. Soil samples from 11 (about 42 %) out of the 26 farms tested positive for insecticide residues, six of which from four farms exceeded the acceptable maximum residue limit. These residues were profenofos, triazophos, chlorpyrifos, cypermethrin, and malathion. No insecticide residues were detected from water samples taken from the 26 farms. Cypermethrin and chlorpyrifos were the insecticide residues detected in eggplant fruit samples. A maximum of 20 % of the eggplant samples tested positive for insecticide residues. In the eggplant fruit study, all farmers have been using Prevathon^® for 24 years at a rate of 10 ml/application, and Malathion^® for 25 years at about 16.5 ml/application, respectively equivalent to 0.24 liter-years and 0.413 liter-years of exposure. Similarly, to the findings in the soil and water study, although Brodan^® and Magnum^® were not prevalently applied, the farmers’ liter-years of exposure to these insecticides, and their active ingredients, were highest at about 18.92 and 10.0, respectively. The farmers and farm workers in the soil and water study reported experiencing itchiness of the skin (63.8 %), redness of the eyes (29.3 %), muscle pains (27.6 %), and headaches (27.6 %), as being related to their pesticide exposure.

Conclusion

In summary, a maximum of 20 % of the eggplant samples tested positive for insecticide residues at any one stage of sampling done. The farmers and farm workers also reported of pesticide-related illnesses but none of them sought any medical attention. Intervention to reduce the farmers’ pesticide exposure can focus on the risk factors identified, primarily the toxicity of pesticides used, the unsafe application practices, and the adverse health effects of pesticide exposure.

Electronic supplementary material

The online version of this article (doi:10.1007/s12199-014-0425-3) contains supplementary material, which is available to authorized users.     

Silence and cancer: why do families and patients fail to communicate?

This study examined the phenomenon of avoidance of family communication about cancer. Thirty-seven Stage III or IV lung cancer patients and 40 caregivers, including 24 primary and 16 secondary caregivers, were interviewed; a total of 26 families were studied. The interviews were audiotaped and transcribed. Analysis of the interviews indicated that two thirds of the families (65%) experienced communication problems. The avoidance of family communication was associated with several underlying thought processes: avoidance of psychological distress; desire for "mutual protection;" and belief in positive thinking. Family communication was further hindered by the increasing difficulty of issues inherent to late-stage cancer. The adverse impact of communication avoidance and the implications of our findings are discussed.