Supermarket baker's asthma: how accurate is routine health surveillance?

Background: Regular health surveillance is commonly recommended for workers exposed to occupational antigens but little is known about how effective it is in identifying cases.

Aims: To report one large company's surveillance and compare its findings with those of a standard cross-sectional survey in the same workforce.

Methods: A supermarket company with 324 in-store bakeries producing bread from raw ingredients conducted a three-stage health surveillance programme in around 3000 bakery employees. The first stage involved the administration of a simple respiratory questionnaire. If chest symptoms were present a second questionnaire focusing on their work relationship was administered. If positive a blood sample was requested for the measurement of specific IgE to flour and fungal α-amylase. The results were compared to an independent cross-sectional survey of employees in 20 of the company's stores.

Results: Two hundred and ninety nine (92%) of the company's bakeries took part in surveillance. The overall employee response for the first stage was 77%; a quarter of those with respiratory symptoms reported that they were work related. Seventy four (61%) of those with work related chest symptoms had a measurement of specific IgE to either flour or fungal α-amylase, of whom 30 (41%) had a positive result. Surveillance estimated that 1% of bakery employees (1% bakers, 2% managers, 0.6% confectioners) had work related symptoms with specific IgE. This compared with 4% (7.5% bakers, 3.3% managers, 0% confectioners) in the cross-sectional survey (n = 166, 93% response).

Conclusion: Comparison with a standard cross-sectional survey suggests that routine surveillance can underestimate the workplace burden of disease. The reasons may include technical or resource issues and uncertainties over confidentiality or the perceived consequences of participation. More research needs to be done looking into the design and efficacy of surveillance in occupational asthma.

     

Burden of suicide in Poland in 2012: how could it be measured and how big is it?

Objectives

The aim of our study was to estimate the health-related and economic burden of suicide in Poland in 2012 and to demonstrate the effects of using different assumptions on the disease burden estimation.

Methods

Years of life lost (YLL) were calculated by multiplying the number of deaths by the remaining life expectancy. Local expected YLL (LEYLL) and standard expected YLL (SEYLL) were computed using Polish life expectancy tables and WHO standards, respectively. In the base case analysis LEYLL and SEYLL were computed with 3.5 and 0% discount rates, respectively, and no age-weighting. Premature mortality costs were calculated using a human capital approach, with discounting at 5%, and are reported in Polish zloty (PLN) (1 euro = 4.3 PLN). The impact of applying different assumptions on base-case estimates was tested in sensitivity analyses.

Results

The total LEYLLs and SEYLLs due to suicide were 109,338 and 279,425, respectively, with 88% attributable to male deaths. The cost of male premature mortality (2,808,854,532 PLN) was substantially higher than for females (177,852,804 PLN). Discounting and age-weighting have a large effect on the base case estimates of LEYLLs. The greatest impact on the estimates of suicide-related premature mortality costs was due to the value of the discount rate.

Conclusions

Our findings provide quantitative evidence on the burden of suicide. In our opinion each of the demonstrated methods brings something valuable to the evaluation of the impact of suicide on a given population, but LEYLLs and premature mortality costs estimated according to national guidelines have the potential to be useful for local public health policymakers.

     

The proposal of Saraceno's psychosocial rehabilitation: is it a model of self-organization?

We discuss the theory of Psychosocial Rehabilitation proposed by Benedetto Saraceno, using the theory of Self-Organizing Systems, developed by Michel Debrun and others as a reference framework. We observe that Saraceno's proposal satisfies several aspects of self-organizing processes. However, it is not completely fit. Based on this discussion, the difficulties found in rehabilitation practice in the Mental Health area can be better understood.     

Weight control counselling in children: is it effective?

This study evaluates the results of weight control/obesity counselling in the outpatient nutrition clinic of a children's hospital. Using a retrospective design, 96 randomly selected patients referred to the clinic were followed for up to four years using their hospital charts or through information obtained from the referring physician on current weights and heights. At initial assessment, 87 of 96 (91%) children were classified as obese or severely obese at greater than 120% of their Ideal Body Weight (IBW); eight other children would be classified as overweight and one child was within normal weight for height. Forty-nine referrals (51%) did not return for a follow-up visit after the initial assessment; weights were available on 18 (37%). On follow-up of 65 patients; 8% of patients achieved an IBW; a further 34% lost weight; 46% gained weight; and 12% maintained their weight. There was no difference in weight gain or loss by amount of participation in the program or by age or gender. We conclude that the weight control/obesity counselling program in our hospital is ineffective. A multidisciplinary program, based on a nutrition education theory and which includes an evaluation framework and addresses reasons for attrition and family needs, should be developed.     

VAP: just how good a benchmark is it really?

VAP shares symptoms with several conditions common to the ICU. Diagnosis is considered to be more reliable in the outpatient setting. New measures should reflect the totality of complications that can affect ventilated patients in addition to pneumonia.     

Aboriginal children and penicillin injections for rheumatic fever: how much of a problem is injection pain?

Objective: To explore young Aboriginal people's and clinicians’ experiences of injection pain for the 10 years of penicillin injections children are prescribed to prevent rheumatic fever recurrences. Methods: Aboriginal children on the penicillin regimen and clinicians were purposively recruited from four remote sites in Australia. Semi‐structured interviews and participant observations were conducted. Views were synthesised and thematically analysed. Results: A total of 29 Aboriginal children and 59 clinicians were interviewed. Sixteen participants appeared to become accustomed to the injection pain, eight did not find pain an issue, and five found injection pain difficult. A further five believed the injections made them unwell. Patients expressed varying abilities to negotiate with clinicians about the use of pain reduction measures. Clinicians revealed good knowledge of pain reduction measures, but offered them inconsistently. All clinicians found administering the injections distressing. Conclusion: Repeated painful procedures in children necessitate well‐planned and child‐focused care. Current practices are not in line with guidance from the Royal Australasian College of Physicians about effects of repeated painful procedures on children. Initiating the long‐term injection regimen for rheumatic fever is a special event requiring expert input. A newly reported finding of a subset of young people feeling unwell after receiving the injection requires further investigation. Implications for public health: Improvement of local and jurisdictional guidelines on use of pain reduction measures for children who have been prescribed repeated painful injections for rheumatic fever is needed.     

Attrition in geriatric research: how important is it and how should it be dealt with?

Attrition, defined as a total loss to follow-up of participants, is a potential major bias in clinical trials. Participants can be lost for many reasons (death, illness, worsened health, refusal, withdrawal, lost to follow up). Attrition may be higher in older populations, so geriatric researchers should pay particular attention to the difficulties it raises. For a proper interpretation of research findings, a detailed analysis of the type of attrition observed and its possible determinants is essential, to determine if attrition has occurred at random or if it is associated to certain patient or treatment characteristics. This paper aims to review different causes of attrition, its prevalence among studies in different elderly populations, and its consequences on research findings. In addition, strategies used to minimise attrition (tracking, bonding, incentives) are discussed, and methods proposed to take this phenomenon into account are proposed.     

Waning of vaccine-induced immunity: is it a problem in Africa?

Strebel et al. misinterpreted the authors' paper on the role of schools in measles transmission. As Strebel et al. noted, the main reason for the outbreak was low vaccine coverage among children aged 5-14 years, together with a marked reduction in the incidence of measles over the past 10 years. Because of the high measles vaccine coverage in younger age groups, many children in Niakhar have gone through their first 5 years of life without being infected with the measles virus. The waning of vaccine-induced immunity has played a role. Strebel et al. believe that there is no indication of waning immunity in the authors' paper and that there is a downward bias in vaccine efficacy due to faulty methodology. Their argument, however, misses the point. The children's ages at vaccination with standard vaccine were completely different in those age groups, with the median age being 295 days for those under age 5 years and 1017 days for those aged 10-14 years. Whether waning immunity will translate into declining vaccine efficacy with age depends upon whether misclassification of vaccination status and measles history is the same in all age groups. Other observations support the existence of waning immunity. The phenomenon of waning vaccine-induced immunity needs to be examined for measles and other vaccine-preventable diseases.     

Medical futility in pediatrics: is it time for a public policy?

For the past decade, there has been a debate raging within the medical, ethical, and legal communities focusing on the issue of medical futility. What has fueled the fires of this multi-faceted debate is the patient rights movement and the perception that the right to self-determination extends not only to the refusal of medical treatments but to demands for overtreatment. The medical specialities of Pediatrics and Neonatology further complicate this issue because despite the dramatic technological advances in these areas, diagnostic and prognostic certainty for many medical conditions remains illusive. As a result, surrogates have to decide whether children with various congenital anomalies, diseases, and genetic defects should be treated aggressively if at all. This uncertainty has led to conflicts between physicians and families about whether certain medical treatments are futile and thus not in the best interest of the child. From a legal and ethical perspective, one way to resolve these conflicts would be a specific process-based public policy approach to futility determinations on a case-by-case basis. The medical futility policy proposed as a public policy protects the patient's right to self-determination; the physician's right of professional integrity; society's concern for the just allocation of scarce medical resources; and is securely rooted in the ethical tradition of promoting and defending human dignity.     

Watching television: how does it influence the dietary quality of children?

The prevalence of obesity is increasing and continues to be a concern, particularly in children, where the condition may lead to chronic health problems typically seen only in adults. This has prompted researchers to look at the relationships between sedentary behaviours, such as television viewing, diet and obesity in children. Epidemiological studies have shown repeatedly that rates of obesity are associated with both increased media use and poor diet quality in children and adults. Such studies have also shown that hours of television watched are associated with an increased intake of nutrient‐poor, energy dense foods and greater overall energy intake. In children, intervention studies that have imposed reductions in television viewing time have shown that reducing the time spent watching television may decrease energy intake and improve overall diet quality. However, these studies are confounded by the use of self‐reported measures for television viewing time and dietary intake. Despite these limitations, the results are promising and more research could lead to a greater understanding of these relationships. Ultimately, clear and concise public health messages for children and their parents regarding the benefits of television time reduction would assist in the fight against obesity.