Predominance of Clostridium difficile ribotypes 012, 027 and 046 in a university hospital in Chile, 2012.

In a 1-year survey at a university hospital we found that 20·6% (81/392) of patients with antibiotic associated diarrohea where positive for C. difficile. The most common PCR ribotypes were 012 (14·8%), 027 (12·3%), 046 (12·3%) and 014/020 (9·9). The incidence rate was 2·6 cases of C. difficile infection for every 1000 outpatients.

Back to the future: sweatshop conditions on the Mexico-U.S. border. II. Occupational health impact of maquiladora industrial activity.

Present working conditions in one of the most active areas of the maquiladora system along the Mexico-U.S. border are reminiscent of nineteenth-century U.S. sweatshops. The organization of production is Tayloristic and authoritarian, with detailed division of labor, repetitive simple tasks, and piecework wages. Modern participative management styles are not apparent in the maquiladora setting. This study consists of two separate but interrelated surveys conducted in 1992, one of community leaders and this one of workers in maquiladora enterprises in the towns of Matamoros and Reynosa, Mexico. The community survey evaluated the economic and psychosocial impact of the maquiladora enterprise and was conducted simultaneously to the workers' survey and in the same Mexican towns where the workers lived and worked. The community leaders acknowledged the employment opportunities that maquiladora factories had brought to the region but believed them to have high environmental and psychosocial costs. For the occupational component, a community-based survey of 267 maquiladora workers was conducted. participants were chosen with more than a year seniority in the industry and living in the two Mexican cities surveyed. They responded to an extensive questionnaire given by trained canvassers. The workers' survey found evidence that maquiladora workers (81% female) report symptoms from musculoskeletal disorders related to working conditions. Acute health effects compatible with chemical exposures were also identified. Prevalence of symptoms was correlated with increasing duration of exposure to ergonomic risk factors and qualitative chemical exposure indexes. Other chronic disease was not apparent. The survey demonstrated inequalities in salary, working hours, and safety training between the two communities. Matamoros workers are substantially better paid and work fewer hours per week than Reynosa workers. Most hazards reported in the worker's survey have been well studied in the general occupational health literature with respect to adverse health effects. Therefore, it is recommended that hazard surveillance studies would be more useful towards the goal of prevention than further etiologic studies. Specific recommendations on policy and remediation interventions are also made.

Back to the future: sweatshop conditions on the Mexico-U.S. border. I. Community health impact of maquiladora industrial activity.

Present working conditions in one of the most active areas of the maquiladora system along the Mexico-U.S. border are reminiscent of nineteenth-century U.S. sweatshops. This conclusion was reached after evaluating two separate but interrelated surveys among Mexican nationals living near the Mexico-U.S. border, one of community leaders (Paper I), and one of workers in maquiladora enterprises in the towns of Matamoros and Reynosa, Mexico (Paper II). Paper I evaluates the results of the community leaders' survey. Criteria for selection of the leaders were: level of responsibility in the community; knowledge of the industry in the region, and length of residence in the area (more than 3 years). Representatives from government, maquiladora industry management, labor union leadership, labor union activists, and community improvement activists were interviewed. Structured questionnaires with opportunities for open-ended answers were used by trained Spanish speaking interviewers. The questions covered community demographics, health care structures, governance of the region, knowledge of working conditions, and knowledge of environmental impact on the region and the community. Community leaders were ambivalent on the purported benefits of the development of these types of industries in their communities. A substantial majority (21 of 25) thought that the maquiladoras brought few positive developments, other than creating jobs. Serious concerns about overextending weak social infrastructures and about environmental deterioration were voiced. Immediate (preventive) measures appear necessary to develop community infrastructures and to protect environmental health.

Birth weight from pregnancies dated by ultrasonography in a multicultural British population.

OBJECTIVE: To produce standard curves of birth weight according to gestational age validated by ultrasonography in the British population, with particular reference to the effects of ethnic origin. DESIGN: Retrospective analysis of computerised obstetric database. SETTING: Three large maternity units associated with Nottingham University with over 16,000 deliveries a year. PATIENTS: 41,718 women with ultrasound dated singleton pregnancies and delivery between 168 and 300 days' gestation. MAIN OUTCOME MEASURES: Length of gestation, ethnic origin, parity, maternal height and weight at booking, smoking during pregnancy; the effect of these variables on birth weight. RESULTS: Birth weights from ultrasound dated pregnancies have a higher population mean and show less flattening of the birthweight curve at term than those of pregnancies dated from menstrual history. Significant differences were observed in mean birth weights of babies of mothers of European origin (3357 g), of Afro-Caribbean origin (3173 g), and from the Indian subcontinent (3096 g). There were also significant interethnic differences in length of gestation, parity, maternal height, booking weight, and smoking habit which affected birth weight. The ethnic differences in birth weight were even greater when the effect of smoking was excluded. CONCLUSIONS: Birthweight standards require precise dating of pregnancy and should describe the population from which they were derived. In a heterogeneous maternity population the accurate assessment of an individual baby's weight needs to take the factors which affect birthweight standards into consideration.

PIP: A new set of standard curves of birth weight for singleton pregnancies with gestational age dated by ultrasonography was generated for the British population. The source of data was a computerized obstetric database of 41,718 pregnancies delivered between 168 and 300 days' gestation, taken from 3 large maternity units in East Midlands, the Nottingham University and City Hospitals, and Derby City Hospital. There were significant differences between the birthweights of 37,336 babies of mothers of English-European origin (3357 gm), 1008 babies of Afro-Caribbean origin (3173 gm), and 1547 babies of Indian subcontinent origin (3096 gm). There were also significant differences between ethnic groups for gestational length, parity, maternal height, weight, and smoking. These differences were greater than smoking was controlled. The effect of smoking was dose-related: at 40 weeks' gestation mean birthweights were 3580 gm for nonsmokers, 3416 gm for 1-9 cigarettes daily, 3374 gm for 10-19 cigarettes daily, and 3377 gm, for over 20 cigarettes daily. About 30% of the European and Afro-Caribbean women smoker, but almost none of the east Indians did. As had been seen elsewhere, ultrasound dating showed a lower gestational age than did menstrual dating (276 vs. 279 days), a discrepancy that is most likely to be clinically relevant in postdate gestations. While ultrasound dating is much more accurate, ethnic origin must be taken into account when assessing individuals.

Airborne endotoxin concentrations in various work areas within a cotton mill in Central America.

Gram-negative bacteria and their endotoxins have been shown to cause profound changes in the structure and function of mammalian lungs. Airborne exposures in humans have resulted in bronchoconstriction and symptoms of chest tightness and dyspnea. Cotton dust is often heavily contaminated and endotoxin has been postulated to be the agent in cotton dust which is responsible for the byssinosis syndrome. Previous studies of cotton dust have revealed variable amounts of contamination by bacterial endotoxin, with the variability determined in large part by botanical and climatic characteristics. We report here the results of an environmental study conducted in a cotton mill located in the tropics of Central America using locally grown cotton. Results indicate that airborne endotoxin was present in all yarn preparation and weaving areas and ranged from a low of 18 EU/m3 in weaving to a high of 3138 EU/m3 in opening areas. Airborne levels and the amount of endotoxin per nanogram of dust were not higher than values obtained in temperate climates.

Respiratory disease in a textile factory in Nicaragua.

This is the first epidemiologic study conducted in a textile mill in Nicaragua using techniques and diagnostic criteria similar to those used in the United States and England. The prevalence of byssinosis and nonspecific respiratory symptoms were studied in 194 workers in a cotton mill in Managua. Limited environmental sampling, performed using a vertical elutriator in yarn preparation and weaving areas, indicated that exposures were similar to those reported in other parts of the developing world. A modified translated version of the Medical Research Council respiratory questionnaire was administered. Pulmonary function tests were performed before and after the Monday workshift to measure across-shift change in ventilatory function. The prevalence of byssinosis was 5.9% and all the cases occurred among exposed women. Nonspecific respiratory symptoms were also more prevalent among exposed workers. After adjusting for age, gender, smoking habit, and work tenure, the exposure odds ratios for usual cough and usual phlegm were 3.3 and 2.2, respectively. The association between exposure and across-shift decrement in FEV1 was not significant. Byssinotic workers, however, had greater decrements in FEV1% than those without byssinosis: 5.5% versus 1.8%. A consistent gender effect was observed in which both exposed and unexposed women were found to have greater across-shift decrements in FEV1 than men. The gender difference existed among long-term workers as well as workers who had been employed less than 2 years. Results are related to cotton dust exposure, as has been documented elsewhere. The poorer health status of the women in this study population deserves follow-up.