A case-control study of multiple myeloma and occupation

Lifetime job histories from a population-based, case-control study were analyzed to investigate the relationship between multiple myeloma and employment in various occupations and industries. Interviews were obtained from 89% (692) of eligible incident cases and 83% (1683) of eligible controls. An elevated risk was observed among persons ever employed as painters [odds ratio (OR) + 2.1, 95% confidence interval (CI) + 1.2–3.6], particularly for those employed for 10 or more years (OR + 4.1, 95% CI + 1.8–10.4). A small excess risk was observed among agricultural workers employed for 10 or more years (OR + 1.3, 95% CI + 1.0–2.2), with a higher relative risk observed among farm laborers (OR + 1.8, 95% CI + 1.0–4.0). Among agricultural workers who reported having been highly exposed to pesticides, the OR was 5.2 (95% CI + 1.6–21.1). Some evidence, based on smaller numbers, was also found to support an association with firefighting and employment in the petroleum- and coal-products manufacturing industries. Little evidence was found to support the previously noted association with wood exposure, and no evidence for an association with employment in the rubber or petroleum refining industries was found. This study lends further support to previously reported associations between multiple myeloma and employment among painters and agricultural workers. © 1993 Wiley-Liss, Inc.     

Balneoclimatic prevention and treatment of vascular disorders due to vibration at the forestry workers

Summary A total of 824 chain-saw operators who were employed in felling trees in the forestry industry were exposed to local vibration, which produced peripheral blood-flow disorders and lesions in the joints and hand bones. In the last 10 years, they have undergone 24-day balneoclimatic treatment at the Kolobrzeg Health Resort. It was found that a stay in the spa and certain balneological treatments exert a favorable effect on the peripheral blood-flow disorders produced by the local vibration of chain saws. The symptoms (chills and numbing of the fingers, etc.) disappeared in nearly 40% of these workers. An improvement in the objective indices of the peripheral circulation (thermographic and plethysmographic tests) was observed in about 90% of patients treated with brine baths combined with underwater vibratory massage (rotatory) or brine baths alone. The brine bath and vibratory massage have a direct beneficial influence on the peripheral blood flow of pectoral limbs.     

分级诊疗背景下多病共存患者就医机构选择行为及其影响因素研究

背景 近年来,国内针对多病共存患者在分级诊疗背景下就医机构选择行为的研究较少,研究多病共存患者的就医机构选择行为有重要的现实意义。目的 以分级诊疗为视角,分析多病共存患者就医机构选择行为及其影响因素,为进一步落实分级诊疗制度和合理配置医疗资源提供研究参考。方法 采用随机抽样法,选取2019-06-01至2020-01-01在上海市杨浦区中心医院医疗联合体（上海市杨浦区中心医院和上海市杨浦区定海、延吉、长白社区卫生服务中心）就诊的多病共存患者为研究对象。采用自设问卷对其进行调查,收集多病共存患者的一般资料,了解其对分级诊疗政策的认知情况及实际遵守情况、在不同疾病控制状况下至社区卫生服务中心首诊的意愿,以及其选择就诊医疗机构时考虑的因素等。采用二分类Logistic回归分析多病共存患者此次因病就医是否选择至社区卫生服务中心首诊的影响因素。结果 共发放1 100份问卷,回收有效问卷1 072份,有效问卷回收率为97.45%。1 072例多病共存患者中,老年（≥60岁）多病共存患者占85.07%(912/1 072)。624例（58.21%）患者表示知晓分级诊疗制度;940例（87.69%）患...     

Factors related to the development of sensitization to green coffee and castor bean allergens among coffee workers

Background Occupational allergic respiratory symptoms in coffee workers have been frequently reported, but the ultimate cause of sensilization is still debated, castor bean being considered besides green coffee beans. Atopy and cigarette smoking have been suggested as promoting factors of sensitizalion for several occupational allergens. Objective This study was carried out to assess the prevalence of allergic respiratory symptoms and of sensitization to both green coffee beans and castor bean in the whole workforce of a coffee manufacturing plant. Furthermore we wanted to ascertain both the presence of castor bean antigens in the settled dust of the green coffee beans warehouse and the possible crossreactivity between the two beans. Meanwhile, the effect of smoking and atopy was considered. Method: Two-hundred and eleven workers were examined. A questionnaire on oculorhinitis and asthma was administered and skin-prick tests for green coffee beans, castor bean and 15 common inhalant allergens were carried out. Isoelectric focusing, isoelectric focusing immunoblot and radioallergosorbent assay (RAST) inhibition were performed on samples of settled environmental dust from the green coffee area, as well as on castor bean and green coffee beans. Results Ten per cent of the workers complained of oculorhinitis alone and 16% of asthma (nearly always associated with oculorhinitis). The overall prevalence of skin-sensitization was: 15% for green coffee beans, 22% for castor bean, 22% for common allergens. Evidence of sensitization to occupational allergens was more common in smokers, with a more than twofold increase in relative risk. The strong association between skin positivity to common and occupational allergens suggests that atopy acts as an enhancing host factor towards occupational sensitization. The analysis of the dust confirmed the presence of castor bean antigens. Conclusion Our findings indicate that castor bean is the major cause of occupational sensitization among coffee workers, whereas smoking and atopy act as enhancing factors.     

Enhancing Behavior Change Skills in Health Extension Workers in Ethiopia: Evaluation of an Intervention to Improve Maternal and Infant Nutrition

Maternal and infant nutrition are problematic in areas of Ethiopia. Health extension workers (HEWs) work in Ethiopia’s primary health care system, increasing potential health service coverage, particularly for women and children, providing an opportunity for health improvement. Their roles include improving maternal and infant nutrition, disease prevention, and health education. Supporting HEWs’ practice with ‘non-clinical’ skills in behavior change and health communication can improve effectiveness. This intervention study adapted and delivered a UK-developed training intervention for Health Extension Workers (HEWs) working with the United Nations World Food Programme in Ethiopia. The intervention included communication and behavioral training adapted with local contextual information. Mixed methods evaluation focused on participants’ reaction to training, knowledge, behavior change, and skills use. Overall, 98 HEWs were trained. The intervention was positively received by HEWs. Pre-post evaluations of communication and behavior change skills found a positive impact on HEW skills, knowledge, and motivation to use skills (all p < 0.001) to change women’s nutritional behavior, also demonstrated in role-play scenarios. The study offered substantial learning about intervention delivery. Appropriate cultural adaptation and careful consideration of assessment of psychological constructs are crucial for future delivery.     

Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination

ObjectivesQuantify how observable characteristics contribute to influenza vaccination disparities among White, Black, and Hispanic nursing home (NH) residents.DesignRetrospective cohort.Setting and ParticipantsShort- and long-stay U.S. NH residents aged ≥65 years.MethodsWe linked Minimum Data Set (MDS) and Medicare data to LTCFocUS and other facility data. We included residents with 6-month continuous enrollment in Medicare and an MDS assessment between October 1, 2013, and March 31, 2014. Residents were classified as short-stay (<100 days in NH) or long-stay (≥100 days in NH). We fit multivariable logistic regression models to assess the relationships between 27 resident and NH-level characteristics and receipt of influenza vaccination. Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparity in influenza vaccination between White versus Black and White versus Hispanic NH residents. Analyses were repeated separately for short- and long-stay residents.ResultsOur study included 630,373 short-stay and 1,029,593 long-stay residents. Proportions vaccinated against influenza included 67.2% of White, 55.1% of Black, and 54.5% of Hispanic individuals among short-stay residents and 84.2%, 76.7%, and 80.8%, respectively among long-stay residents. Across 4 comparisons, the crude disparity in influenza vaccination ranged from 3.4 to 12.7 percentage points. By equalizing 27 prespecified characteristics, these disparities could be reduced 37.7% to 59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors across all analyses. Characteristics unmeasured in our data (eg, NH staff attitudes and beliefs) may have also contributed significantly to the disparity.Conclusions and ImplicationsThe racial/ethnic disparity in influenza vaccination was most dramatic among short-stay residents. Intervening on factors associated with NH quality would likely reduce these disparities; however, future qualitative research is essential to explore potential contributors that were unmeasured in our data and to understand the degree to which these factors contribute to the overall disparity in influenza vaccination.     

广西农村暗娼安全套坚持使用情况及影响因素分析

目的 了解广西农村地区暗娼人群商业性行为时安全套使用情况及影响因素, 为制定暗娼艾滋病综合干预措施提供参考依据。 方法 采用多级抽样的方法,2019年4—6月在国家和省级暗娼哨点招募农村暗娼进行横断面问卷调查,调查内容包括场所位置、一般人口学信息、艾滋病知识、性行为特征及安全套使用等。用多因素非条件logistic 回归方法分析最近一个月坚持使用安全套的相关因素。 结果 2019年共调查农村暗娼1 350人,平均年龄(42.71±8.62)岁,艾滋病知识知晓率为95.63%(1 291/1 530),最近一次商业性性行为使用安全套比例为94.72%(1 274/1 345),最近一个月商业性性行为每次均使用安全套的比例为87.85%(1 186/1 350)。多因素非条件logistic 回归显示,知晓艾滋病知识(OR=14.857,95%CI:8.196～26.932)是安全套坚持使用的促进因素;交易场所为村屯(OR=0.180,95%CI:0.106～0.304)、30岁及以上年龄(30～岁组,OR=0.275,95%CI:0.090～0.841;50～岁组,OR=0.131,95%CI:0.042～0.407)是安全套坚持使用的障碍因素。 结论 应进一步加强对农村地区、大年龄暗娼人群安全套推广使用等综合干预力度。     

Risk for SARS-CoV-2 Infection in Healthcare Workers,Turin, Italy

We measured severe acute respiratory syndrome coronavirus 2 spike protein subunits S1/S2 antibodies by using capillary electrophoresis and a chemiluminescence immunoassay for 5,444 active healthcare workers in Italy. Seroprevalence was 6.9% and higher among participants having contact with patients. Seroconversion was not observed in 37/213 previously infected participants.