Industrialization and food safety for the Tsleil-Waututh Nation: An analysis of chemical levels in shellfish in Burrard Inlet.

While Indigenous food systems remain critical for community well-being, traditionally harvested foods are a potential source of toxic exposures. The Tsleil-Waututh Nation (TWN) is seeking to restore shellfish harvesting in Burrard Inlet (British Columbia [BC], Canada), where the cumulative effects of industrial activity have nearly eliminated safe harvesting. The Trans Mountain Expansion project would triple the capacity to transport oil through the inlet, threatening TWN's progress to restore shellfish harvesting. To inform ongoing efforts we assessed contamination by heavy metals (arsenic, cadmium, lead, and mercury) and 48 polycyclic aromatic hydrocarbons (PAHs) congeners in different shellfish species (Softshell clams, Varnish clams, and Dungeness crab) in three areas. We compared our results against local screening values (SVs) established by the TWN and BC Ministry of Environment and Climate Change Strategy, as well as provincial and national benchmarks. In total, we analyzed 18 composite samples of Softshell clams and Varnish clams (5 individuals per sample), as well as 17 individual crabs. We found chemical contamination in all species at all sites. PAHs were most frequently detected in Softshell clams, highest in the site closest to the pipeline terminus. Clams presented higher levels of contamination than crabs for PAHs, but not for heavy metals. For Softshell and Varnish clams, all heavy metals across study sites exceeded at least one of the population-specific SVs. Of the 14 PAHs detected, benzo(a)pyrene presented a median concentration in Softshell clams of 3.25 µ/kg, exceeding local SV for subsistence fisher. Our results call for further assessment of human health impacts related to food harvesting within Burrard Inlet and establishing a long-term coordinated program co-led by the TWN to monitor contamination and inform future harvesting programs. The study draws attention to the need to consider locally-relevant toxicity benchmarks, and include potential health impacts of food contamination in appraising development project proposals.

Reforming the workers' compensation process for occupational lung disease among miners in South Africa: an efficiency study of claims assessment.

PURPOSE: The large burden of silicosis and tuberculosis (TB) in the South African mining industry, coupled with an under-resourcing of the compensation agencies responsible for certifying occupational lung disease, have resulted in serious backlogs. This work aimed to measure the efficiency gains from triaging occupational lung disease claims using claim type, years of mining exposure and computer aided detection (CAD) to save on scarce medical adjudicators. METHODS: During 2020, the compensation authority started to triage claims for TB and those of miners with < 10 years of service to two-person panels instead of the four-person panel plus radiologist used previously. Efficiency gain was calculated in medical person-units saved and reduction in delays. Different service thresholds predictive of silicosis were simulated, as well as the impact of pre-classification of chest X-rays with CAD using different combinations of sensitivity and specificity. RESULTS: The new triage system saved 20.3% in person-time units and reduced delays by 10-20 days. Without CAD the greatest efficiency gain (28%) was projected from dispensing with a mining service threshold and routing all non-TB claims to the small panels at the outset. Simulation of four different CAD sensitivity/specificity combinations yielded efficiency gains of 18.2-36.1%, with 31.1% judged the most realistic. Use of sensitivity of close to 100% would not be feasible because of the very low resulting specificity. CONCLUSION: Pre-adjudication triage of claims at the compensation agency is capable of saving a substantial proportion of adjudicator time and reducing certification delays. Additional efficiency gains are achievable by referring all claims to small panels to begin with and improvement of CAD performance for this ex-miner population.

Emotional abuse interacts with borderline personality in adolescent inpatients with binge-purging eating disorders.

PURPOSE: Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still uncertain, particularly in adolescents. This study investigates the correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female adolescent inpatients with eating disorders (EDs). METHODS: One hundred and twenty-eight inpatients (ages 14-18) were assessed, 54 were diagnosed with restricting-type anorexia nervosa (AN-R) and 33 with a binge-purging ED [BP-ED; comprising patients with binge-purging type anorexia nervosa (AN-BP), n = 15, and bulimia nervosa (BN), n = 18]. Fifty healthy participants made up the control group (CG). CEN and CEA were assessed with the Childhood Trauma Questionnaire, while the Personality Style and Disorder Inventory was implemented to determine personality styles. RESULTS: A MANOVA revealed a significant main effect of CEA on spontaneous-borderline personality style [F(8,119) = 17.1, p < 0.001, η2 = 0.126], as well as a main effect of ED group on spontaneous-borderline [F(2,119) = 3.1, p = 0.048, η2 = 0.050]. A significant interaction between ED group, CEA, and spontaneous-borderline was found [F(2,119) = 3.5, p = 0.034, η2 = 0.055] with BP-ED showing significantly higher scores in CEA (9.3 ± 4.0) and in spontaneous-borderline (14.2 ± 6.2). CONCLUSIONS: Considering CEA and borderline personality style in adolescent inpatients with BN or AN-BP may help improve the understanding of the etiology and maintenance of BP-ED and provide more effective treatment targets. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Modulation of the La/Lb Mixing in an Indole Derivative: A Position-Dependent Study Using 4-, 5-, and 6-Fluoroindole.

The lowest two electronically excited singlet states of indole and its derivatives are labeled as La or Lb, based on the orientation of the transition dipole moment (TDM) and the magnitude of the permanent electric dipole moment. Rotationally resolved electronic Stark spectroscopy in combination with high level ab initio calculations offers the possibility to determine these characteristics and thus the electronic nature of the excited states. In the present contribution this approach was pursued for the systems 4- and 6-fluoroindole and the results compared to the previously investigated system 5-fluoroindole. Changing the position of the fluorine atom from 5 to 4 or 6 is accompanied by an increasing amount of La character in the S1 state. This dramatically influences the orientation of the TDM and erases its ability to be a reasonable identifier of the nature of the excited states for both molecules. However, for 4-fluoroindole, where the influence of the La is weak, the nature of the S1 state can still be assigned to be mainly Lb based on the excited state dipole moment. For 6-fluoroindole, this is not the case anymore, and the La/Lb nomenclature completely breaks down due to heavily mixed excited states.

Nicotinic α4ß2 acetylcholine receptors and cognitive function in Parkinson's disease.

BACKGROUND: Idiopathic Parkinson's disease (IPD) is characterized by the clinical motor symptoms of hypokinesia, rigidity, and tremor. Apart from these motor symptoms, cognitive deficits often occur in IPD. The positive effect of cholinesterase inhibitors on cognitive deficits in IPD and findings of earlier molecular imaging studies suggest that the cholinergic system plays an important role in the origin of cognitive decline in IPD. METHODS: Twenty-five non-demented patients with IPD underwent a 5-[123I]iodo-3-[2(S)-2-azetidinylmethoxy]pyridine (5-I-A-85380) SPECT to visualize α4ß2 nicotinic acetylcholine receptors (nAchR) and cognitive testing with the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) battery to identify domains of cognitive dysfunction. RESULTS: In the CERAD, the IPD patients exhibited deficits in non-verbal memory, attention, psychomotor velocity, visuoconstructive ability, and executive functions. After Bonferroni correction for multiple comparisons, we found significant correlations between performance of the CERAD subtests Boston Naming Test (a specific test for visual perception and for detection of word-finding difficulties) and Word List Intrusions (a specific test for learning capacity and memory for language information) vs binding of α4ß2 nAchR in cortical (the right superior parietal lobule) and subcortical areas (the left thalamus, the left posterior subcortical region, and the right posterior subcortical region). CONCLUSIONS: These significant correlations between the results of the CERAD subtests and the cerebral α4ß2 nAchR density, as assessed by 5-I-A-85380 SPECT, indicate that cerebral cholinergic pathways are relevant to cognitive processing in IPD.

[First occurrence of an organic manic schizophreniform syndrome followed by catatonia induced by anti-NMDA-receptor encephalitis]. / Erstmanifestation eines organischen manisch-schizophreniformen Syndroms mit nachfolgender Katatonie bei NMDA-Rezeptor-Antikörper-positiver Encephalitis.

We report on a 39-year-old female patient who developed catatonia after there had been schizomanic symptoms in the six months before. At admission the patient exhibited catatonia, a tetraspastic syndrome and focal epileptic seizures. The cranial MRI revealed bilateral subcortical hyperintense lesions which took up contrast agent. Examination of the cerebrospinal fluid disclosed a lymphocytic pleocytosis and autochthone oligoclonal bands. In the serum autoantibodies against the NMDA-NR-1 receptor were reproducibly detected. A detailed search for a tumour was negative. In detail, we could exclude a neoplasm of the ovaries which is often present in the paraneoplastic type of anti-NMDA-receptor encephalitis. Therefore we assume an autoimmune, not paraneoplastic, encephalitis in our patient. The symptoms improved significantly after an immunosuppressive therapy - initially with glucocorticoids followed by rituximab - had been initiated. This case illustrates that an autoimmune encephalitis should be looked for when first psychotic symptoms occur.

Polarization-based non-staining cell detection.

Polarization is an important characteristic of electromagnetic waves, which can not be detected by either the human visual system or traditional image sensors. Motivated by various animal species with polarization vision as well as by the prospect of improving the image quality of the imaging systems, we are exploring the potential of polarization for microscope imaging. The most powerful techniques for molecule monitoring requires complex preprocessing for labeling the sample with different dyes. In this paper, we propose a cell detection method using polarization imaging without any need for staining target cell samples with any chemical dye. The motivation for this work is to develop an optical imaging technique that is simple and that can be used on live cells. The polarization sensitivity of cell samples is studied in this paper. A definition for the quantity called "polarization deviation" is proposed in order to identify clearer the difference between target cells and the background. Based on the polarization deviation detection method, a three-parameter polarization imaging method is employed to further simplify the image capture procedure for the proposed label-free cell detection. A color imaging methodology based on the well-known color space is utilized in order to represent the captured polarization information using computer graphics.

[Meningoencephalitis and ventricular arrhythmia caused by yersiniosis]. / Meningoenzephalitis und ventrikuläre Rhythmusstörungen bei Yersiniose.

We report on a 19-year-old patient without any immunodeficiency and without a history of significant diseases in whom two seizure attacks as symptoms of meningoencephalitis occurred after he had suffered from abdominal symptoms for a week. Later, we could observe frequent polymorphic ventricular extrasystoles. A massive production of anti-Yersinia IgM, IgG and IgA as a sign of an acute infection could be found, although we were not able to detect the microbe itself with culturing methods. After targetted antibiotic treatment, the patient fully recovered within two weeks and could be discharged from hospital without clinical abnormalities and an almost normalised cell count in the cerebrospinal fluid. Possible ways of infection are mice which the patient kept as pets and his work in the sewer system. The present case reminds us to think of uncommon infectious agents even in young patients without a predisposition but unusual symptoms and/or potentially relevant anamnestic data.

[Clinical and imaging diagnostics of Parkinson's disease and multiple system atrophy]. / Klinische und bildgebende Diagnostik bei Morbus Parkinson und Multisystematrophie.

The diagnosis of Parkinson's disease (PD) and multiple system atrophy (MSA) is primarily made by clinical symptoms, but might still remain challenging even for experienced neurologists. Neuroradiologic imaging may be a useful tool in the diagnostic work-up, particularly for excluding other diseases, such as normal pressure hydrocephalus, multi-infarct dementia and cerebellar lesions. Nuclear medicine methods can additionally support the diagnosis and differential diagnosis of PD and MSA.

Endostitch-assisted endoscopic Zenker's diverticulostomy: a tried approach for difficult cases.

The aim was to describe a tried approach to endoscopic Zenker's diverticulostomy, especially in those patients with unfavorable anatomy or smaller pouches who may otherwise be relegated to open repair. The study design was a retrospective case series The setting was an urban, tertiary care university medical center There were seven patients, both inpatient and outpatient, with chief complaints of dysphagia. All had a documented Zenker's diverticulum (ZD) on barium swallow. All of the patients were deemed by the primary surgeon to have some anatomic factor that limited exposure of the diverticulum. The patients underwent Endostitch-assisted endoscopic Zenker's diverticulostomy. Records were retrospectively reviewed, including preoperative and postoperative swallowing status, radiographic findings, operative findings, and follow-up results. Seven patients were reviewed, each of whom had successful endoscopic treatment of ZD. Notably, in each case, an anatomical factor precluded the seating of the gastrointestinal anastomosis (GIA) stapler on the cricopharyngeal bar without the use of endoscopic retention sutures. The majority of the patients were discharged on postoperative day one. All but one patient noted a marked improvement in swallowing function immediately following the procedure and at their outpatient follow-up visit. Endoscopic Zenker's diverticulostomy has been well-described and established as a reliable technique in a majority of cases. We report on our experience using a previously described technique specifically for difficult, unfavorable, or contraindicated cases and suggest the employment of this technique as an alternative method to facilitate endoscopic repair and possibly limit the need for an open approach.

[Multiple aneurysms of intracranial arteries in neurofibromatosis Recklinghausen type 1]. / Multiple Aneurysmen intrakranieller Arterien bei Neurofibromatose von Recklinghausen Typ 1.

We report on a 58 year old female patient with neurofibromatosis Recklinghausen type 1 (NF-1) in whom multiple intracranial aneurysms could be proven. Vascular changes in patients with NF-1 are frequent and concern primarily the aorta, the kidney arteries, the coronary and gastrointestinal arteries. Our case shows that in patients with NF-1 intracranial artery changes like aneurysms, maybe in need of treatment, are possible.

An analogue of the erythroid membrane skeletal protein 4.1 in nonerythroid cells.

Protein 4.1 is a crucial component of the erythrocyte membrane skeleton. Responsible for the amplification of the spectrin-actin interaction, its presence is required for the maintenance of erythrocyte integrity. We have demonstrated a 4.1-like protein in nonerythroid cells. An antibody was raised to erythrocyte protein 4.1 purified by KCl extraction (Tyler, J. M., W. R. Hargreaves, and D. Branton, 1979, Proc. Natl. Acad. Sci. USA, 76:5192-5196), and used to identify a serologically cross-reactive protein in polymorphonuclear leukocytes, platelets, and lymphoid cells. The cross-reactive protein(s) were localized to various regions of the cells by immunofluorescence microscopy. Quantitative adsorption studies indicated that at least 30-60% of the anti-4.1 antibodies reacted with this protein, demonstrating significant homology between the erythroid and nonerythroid species. A homologous peptide doublet was observed on immunopeptide maps, although there was not complete identity between the two proteins. When compared with erythrocyte protein 4.1, the nonerythroid protein(s) displayed a lower molecular weight--68,000 as compared with 78,000-and did not bind spectrin or the nonerythroid actin-binding protein filamin. There was no detectable cross-reactivity between human acumentin or human tropomyosin-binding protein, which are similarly sized actin-associated proteins, and erythrocyte protein 4.1. The possible origin and significance of 4.1-related protein(s) in nonerythroid cells are discussed.

A randomized prospective study comparing two flexible epidural catheters for labour analgesia.

BACKGROUND: Previous studies evaluating stiff epidural catheters found that the three-holed design provided superior labour analgesia compared with an end-holed design. This was believed due to improved medication distribution. Recently, flexible epidural catheters with both designs have been shown to be superior to the stiff epidural catheters. We investigated the success of labour analgesia comparing the flexible three-holed with the flexible end-holed epidural catheter. METHODS: This was a prospective, single-blinded randomized study. We enrolled 500 parturients in active labour. The primary outcome was complete relief of labour pain assessed at 30 min. We also assessed the occurrence of paresthesias, intravascular and intrathecal placement, catheter replacement, and treatment of breakthrough pain during labour. Comparisons were made using Pearson's chi(2), with significance determined at the 0.05 level. RESULTS: Four hundred and ninety-three subjects completed the study. Initial analgesia was similar (complete labour analgesia: end-holed=85% vs 80% 95% CI of difference: 13% to -3%; P=NS). The incidence of paresthesia was similar (end-holed=3.6% vs 5.3%; P=NS). There was one intrathecal and three intravascular catheters in the three-holed group and two intravascular catheters in the end-holed group. The number of supplemental boluses and catheter replacements required during labour was similar between the groups. CONCLUSIONS: There were no differences in the initial analgesia success rate, complications, or labour analgesia between end-hole vs multi-hole flexible epidural catheters.

[Perioperative management of patients with Parkinson's disease]. / Perioperative Betreuung bei Morbus Parkinson.

Ageing patients reveal an increasing coincidence of orthopaedic disorders and Parkinson's disease (PD). In addition, parkinsonian motor symptoms predispose individuals for orthopaedic diseases. PD patients have a higher risk of perioperative complications than patients without PD; this higher risk is based on motor and autonomous deficits in PD as well as on interactions between antiparkinsonian and anaesthesia medications. The elevated perioperative risk in PD can be reduced by appropriate perioperative management and no longer represents a contraindication to surgery in PD patients.

[Bilateral spontaneous carotid artery dissection in osteogenesis imperfecta (type I)]. / Bilaterale spontane Karotisdissektion bei Osteogenesis imperfecta (Typ I).

We report on a 36-year-old patient with an acute cerebral infarction due to a spontaneous dissection of both internal carotid arteries in conjunction with type I osteogenesis imperfecta. Spontaneous dissections of cerebral arteries (DCA) represent a common cause of cerebral infarctions in younger patients. Our case shows that a hereditary connective tissue disorder should be considered in all patients with "spontaneous" DCA. The identification of an - initially unknown - hereditary connective tissue disorder may con-tribute to primary and secondary prophylaxis of cerebral ischemia.

Social transformation, collective health and community-based arts: 'Buen Vivir' and Ecuador's social circus programme.

Worldwide, interest is increasing in community-based arts to promote social transformation. This study analyzes one such case. Ecuador's government, elected in 2006 after decades of neoliberalism, introduced Buen Vivir ('good living' derived from the Kichwan sumak kawsay), to guide development. Plans included launching a countrywide programme using circus arts as a sociocultural intervention for street-involved youth and other marginalised groups. To examine the complex ways by which such interventions intercede in 'ways of being' at the individual and collective level, we integrated qualitative and quantitative methods to document relationships between programme policies over a 5-year period and transformations in personal growth, social inclusion, social engagement and health-related lifestyles of social circus participants. We also conducted comparisons across programmes and with youth in other community arts. While programmes emphasising social, collective and inclusive pedagogy generated significantly better wellbeing outcomes, economic pressures led to prioritising productive skill-building and performing. Critiques of the government's operationalisation of Buen Vivir, including its ambitious technical goals and pragmatic economic compromising, were mirrored in social circus programmes. However, the programme seeded a grassroots social circus movement. Our study suggests that creative programmes introduced to promote social transformation can indeed contribute significantly to nurturing a culture of collective wellbeing.

Promoting health in response to global tourism expansion in Cuba.

The ability of communities to respond to the pressures of globalization is an important determinant of community health. Tourism is a rapidly growing industry and there is an increasing concern about its health impact on local communities. Nonetheless, little research has been conducted to identify potential mitigating measures. We therefore took advantage of the 'natural experiment' provided by the expansion of tourism in Cuba, and conducted four focus groups and key informants interviews in each of two coastal communities. Participants expressed concerns about psycho-social impacts as well as occupational and environmental concerns, and both infectious and chronic diseases. A wide array of programs that had been developed to mitigate potential negative were described. Some of the programs were national in scope and others were locally developed. The programs particularly targeted youth as the most vulnerable population at risk of addictions and sexually transmitted infections. Occupational health concerns for workers in the tourism sector were also addressed, with many of the measures implemented protecting tourists as well. The health promotion and various other participatory action initiatives implemented showed a strong commitment to address the impacts of tourism and also contributed to building capacity in the two communities. Although longitudinal studies are needed to assess the sustainability of these programs and to evaluate their long-term impact in protecting health, other communities can learn from the initiatives taken.

Facial emotion recognition in Parkinson's disease: Association with age and olfaction.

OBJECTIVE: The ability to recognize facial emotion expressions has been reported to be impaired in Parkinson's disease (PD), yet previous studies showed inconsistent findings. The aim of this study was to further investigate facial emotion recognition (FER) in PD patients and its association with demographic and clinical parameters (including motor and nonmotor symptoms). METHOD: Thirty-four nondemented PD patients and 24 age- and sex-matched healthy controls (HC) underwent clinical neurological and neuropsychological assessment, standardized olfactory testing with Sniffin' Sticks, and the Ekman 60 Faces Emotion Recognition Test. RESULTS: PD patients had a significantly lower score on the total FER task than HC (p = .006), even after controlling for the potential confounding factors depression and apathy. The PD group had a specific impairment in the recognition of surprise (p = .007). The recognition of anger approached statistical significance (p = .07). Increasing chronological age and age at disease onset were associated with worse performance on the FER task in PD patients. Olfactory function along with PD diagnosis predicted worse FER performance within all study participants. CONCLUSION: Facial emotion recognition and especially the recognition of surprise are significantly impaired in PD patients compared with age- and sex-matched HC. The association of FER with age and olfactory function is endorsed by common structures that undergo neurodegeneration in PD. The relevance of FER in social interaction stresses the clinical relevance and the need for further investigation in this field. Future studies should also determine whether impaired FER is already present in premotor stages of PD.

Platelet membrane glycoprotein IIIa contains target antigens that bind anti-platelet antibodies in immune thrombocytopenias.

The precise pathogenic mechanism of platelet destruction in immune thrombocytopenias is not known, although many investigators have found that platelet-associated IgG is increased in these diseases. We report here the differentiation between specific binding of anti-platelet antibody, associated with platelet destruction, and the ubiquitous presence of nonspecific, platelet-associated IgG. Using an electrophoretic separation and antibody overlay technique, we have identified a specific membrane protein that bears target platelet antigens in immune thrombocytopenias. When posttransfusion purpura serum was studied, antibody binding to the PlA1 antigen on glycoprotein IIIa was readily distinguished from the nonspecific binding of immunoglobulin to a protein of 200,000 mol wt. After reduction of disulfide bonds, the PlA1 antigenicity was not observed, and IgG bound nonspecifically to a protein band with an apparent molecular weight of 45,000. We have also identified anti-platelet antibodies in patients with idiopathic thrombocytopenic purpura and determined their antigenic specificity. Antibodies which bind to a 100,000-mol wt protein were found in nine of thirteen patients with chronic disease. The antigens in three of these cases were studied in detail by using both reduced and nonreduced control and Glanzmann's thrombasthenic platelets. Target antigens were localized to glycoprotein IIIa, but are different from PlA1. The immune thrombocytopenic purpura antigenic system is clearly distinguished from nonspecific platelet-associated IgG. Sera from eight children with acute idiopathic thrombocytopenic purpura were also studied. In all cases, the nonspecific IgG binding to the 200,000-mol wt protein was observed. However, we were unable to demonstrate antibody binding to glycoprotein IIIa, which suggested that the acute childhood form of this disease may have a different pathogenic mechanism than that of the autoimmune chronic cases.

Occupational tuberculosis in South Africa: are health care workers adequately protected?

Setting: A provincial tertiary hospital in Gauteng province, South Africa, with a high burden of tuberculosis (TB) patients and high risk of TB exposure among health care workers (HCWs). Objective: To determine HCWs' adherence to recommended TB infection prevention and control practices, TB training and access to health services and HCW TB rates. Design: Interviews with 285 HCWs using a structured questionnaire as part of a large, international mixed-methods study. Results: Despite 10 HCWs (including seven support HCWs) acquiring clinical TB during their period of employment, 62.8% of interviewees were unaware of the hospital's TB management protocol. Receipt of training was low (34.5% of all HCWs and <5% of support HCWs trained on TB transmission; 27.5% of nurses trained on respirator use), as was use of respiratory protection (44.5% of HCWs trained on managing TB patients). Support HCWs were over 36 times more likely to use respiratory protection if trained; nurses who were trained were approximately 40 times more likely to use respirators if they were readily available. Conclusion: Improved coordination and uptake of TB infection prevention training is urgently needed, especially for non-clinical HCWs in settings of regular exposure to TB patients. Adequate supplies of appropriate respiratory protection must be made available.

Contexte : Un hôpital provincial de niveau tertiaire dans la province de Gauteng, Afrique du Sud avec de très nombreux patients avec tuberculose (TB) et un risque élevé d'exposition à la TB parmi les travailleurs de santé (HCW).Objectif : Déterminer l'observance des HCW vis-à-vis des pratiques recommandées de prévention de l'infection et de lutte contre la TB, la formation en matière de TB et l'accès aux services de santé, et le taux de TB chez les HCW.Schéma : Entretiens avec 285 HCW, basés sur un questionnaire structuré, dans le cadre d'une vaste étude internationale à multiples méthodes.Résultats : Bien que 10 HCW (dont sept personnels de soutien) aient eu une TB pendant leur période de travail, 62,8% des répondants n'étaient pas au courant du protocole de prise en charge de la TB dans l'hôpital. La couverture de la formation a été faible (34,5% de tous les HCW et moins de 5% des HCW de soutien sur la transmission de la TB ; 27,5% des infirmiers sur l'utilisation d'un masque respiratoire), tout comme l'utilisation d'une protection respiratoire (44,5% des HCW prenant en charge des patients TB). Les HCW de soutien ont été 36 fois plus susceptibles d'utiliser une protection respiratoire s'ils avaient été formés ; les infirmiers qui avaient été formés ont été environ 40 fois plus susceptibles d'utiliser des masques respiratoires s'ils étaient facilement disponibles.Conclusion : Une amélioration de la coordination et de la couverture de la formation à la prévention de l'infection TB est requise d'urgence, surtout pour les HCW de soutien dans les contextes d'exposition régulière aux patients TB. Des stocks suffisants de protection respiratoire doivent être disponibles.

Marco de referencia: Un hospital provincial de atención terciaria en la provincia de Gauteng de Suráfrica, donde se observa una alta carga de morbilidad por tuberculosis (TB) y un alto riesgo de exposición de los profesionales de salud (HCW) a la enfermedad.Objetivo: Evaluar la observancia de las prácticas de prevención y control de la infección tuberculosa, la capacitación en materia de TB y el acceso de los HCW a los servicios de atención y calcular la tasa de TB en este tipo personal.Método: Se entrevistaron 285 HCW mediante un cuestionario estructurado, en el marco de un extenso estudio internacional por métodos mixtos.Resultados: Pese a que 10 HCW (incluidos siete miembros del personal auxiliar) habían adquirido la enfermedad tuberculosa durante el período de su empleo, el 62,8% de los entrevistados no conocía el protocolo de manejo de la TB del hospital. La tasa de capacitación era baja (34,5% de todos los HCW y menos de 5% del personal auxiliar sobre la transmisión de la TB y 27,5% del HCW sobre la utilización de mascarillas respiratorias) y asimismo la utilización de la protección respiratoria (el 44,5% de los HCW que se ocupaban de pacientes con TB). La probabilidad de que personal auxiliar utilizara la protección respiratoria era 36 veces mayor al haber recibido capacitación; el personal de enfermería tenía una probabilidad 40 veces mayor de utilizar las mascarillas respiratorias cuando había sido formado y el material estaba al alcance.Conclusión: Se precisa con urgencia una mejor coordinación y una utilización más amplia de la formación sobre la prevención de la infección tuberculosa, sobre todo dirigida a los HCW auxiliares, en los entornos donde es corriente la exposición a pacientes tuberculosos. Es necesario contar con los suministros adecuados de protección respiratoria al alcance del personal.