Novel metrics for relating personal heat exposure to social risk factors and outdoor ambient temperature.

A more precise understanding of individual-level heat exposure may be helpful to advance knowledge about heat-health impacts and effective intervention strategies, especially in light of projected increases in the severity and frequency of extreme heat events. We developed and interrogated different metrics for quantifying personal heat exposure and explored their association with social risk factors. To do so, we collected simultaneous personal heat exposure data from 64 residents of metropolitan Phoenix, Arizona. From these data, we derived five exposure metrics: Mean Individually Experienced Temperature (IET), Maximum IET, Longest Exposure Period (LEP), Percentage Minutes Above Threshold (PMAT), and Degree Minutes Above Threshold (DMAT), and calculated each for Day Hours, Night Hours, and All Hours of the study period. We then calculated effect sizes for the associations between those metrics and four social risk factors: neighborhood vulnerability, income, home cooling type, and time spent outside. We also investigated exposure misclassification by constructing linear regression models of observations from a regional weather station and hourly IET for each participant. Our analysis revealed that metric choice and timeframe added depth and nuance to our understanding of differences in exposure within and between populations. We found that time spent outside and income were the two risk factors most strongly associated with personal heat exposure. We also found evidence that Mean IET is a good, but perhaps not optimal, measure for assessing group differences in exposure. Most participants' IETs were poorly correlated with regional weather station observations and the slope and correlation coefficient for linear regression models between regional weather station data and IETs varied widely among participants. We recommend continued efforts to investigate personal heat exposure, especially in combination with physiological indicators, to improve our understanding of links between ambient temperatures, social risk factors, and health outcomes.

Dermatitis ocupacional en la industria alimentaria: revision sistematica de la literatura / Occupational dermatitis in the food industry: systematic review of literature

Introducción: la dermatitis ocupacional es una patología frecuente con graves consecuencias en la actividad laboral. Material y Métodos: se realizó una revisión sistemática de la literatura acerca de dermatitis ocupacional en el sector de la industria de alimentos y se determinaron factores asociados a etiología y manifestaciones clínicas. Resultados: se incluyeron 22 artículos. La prevalencia de dermatitis ocupacional fue de 27%, los factores asociados con el desarrollo de Dermatitis Ocupacional fueron: manipulación de alimentos, lavarse las manos más de 20 veces/día y ser mujeres panaderas. Se identificaron alérgenos comunes como: ajo, harina, thiuramix, carbamix, níquel y contacto con calamar. Los irritantes fueron jabones, detergentes y desinfectantes. Conclusiones: la dermatitis ocupacional tiene una prevalencia muy alta (27%) en la industria de la alimentación. Sabiendo que la dermatitis ocupacional es prevenible y con alta prevalencia se evidencia que hay falta de conocimiento en los factores asociados en la génesis de la patología

Introduction: occupational dermatitis is a frequent pathology as a result of work activity. Material and Methods: a systematic review of the literature on occupational dermatitis was carried out in the food industry sector and factors associated with etiology and clinical manifestations were determined. Results: twenty-two articles were included. The prevalence of occupational dermatitis was 27%, the factors associated with the development of Occupational Dermatitis were: food handling, washing hands more than 20 times/day; be women bakers. Common allergens were identified as: garlic, flour, thiuramix, carbamix, nickel and contact with squid. The irritants were soaps, detergents and disinfectants. Conclusions: occupational dermatitis has a very high prevalence (27%) in the food industry. Knowing that occupational dermatitis is preventable and with high prevalence, it is evident that there is lack of knowledge in the factors associated in the genesis of the pathology

Legionnaires' disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study.

BACKGROUND: During a Legionnaires' disease (LD) outbreak, combined epidemiological and environmental investigations were conducted to identify prevention recommendations for facilities where elderly residents live independently but have an increased risk of legionellosis. METHODS: Survey responses (n = 143) were used to calculate attack rates and describe transmission routes by estimating relative risk (RR) and 95% confidence intervals (95% CI). Potable water collected from five apartments of LD patients and three randomly-selected apartments of residents without LD (n = 103 samples) was cultured for Legionella. RESULTS: Eight confirmed LD cases occurred among 171 residents (attack rate = 4.7%); two visitors also developed LD. One case was fatal. The average age of patients was 70 years (range: 62-77). LD risk was lower among residents who reported tub bathing instead of showering (RR = 0.13, 95% CI: 0.02-1.09, P = 0.03). Two respiratory cultures were characterized as L. pneumophila serogroup 1, monoclonal antibody type Knoxville (1,2,3), sequence type 222. An indistinguishable strain was detected in 31 (74%) of 42 potable water samples. CONCLUSIONS: Managers of elderly-housing facilities and local public health officials should consider developing a Legionella prevention plan. When Legionella colonization of potable water is detected in these facilities, remediation is indicated to protect residents at higher risk. If LD occurs among residents, exposure reduction, heightened awareness, and clinical surveillance activities should be coordinated among stakeholders. For prompt diagnosis and effective treatment, clinicians should recognize the increased risk and atypical presentation of LD in older adults.

Identifying Challenges to the Integration of Computer-Based Surveillance Information Systems in a Large City Health Department: A Case Study.

OBJECTIVE: Integrated infectious disease surveillance information systems have the potential to provide important new surveillance capacities and business efficiencies for local health departments. We conducted a case study at a large city health department of the primary computer-based infectious disease surveillance information systems during a 10-year period to identify the major challenges for information integration across the systems. METHODS: The assessment included key informant interviews and evaluations of the computer-based surveillance information systems used for acute communicable diseases, human immunodeficiency virus/acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis. Assessments were conducted in 1998 with a follow-up in 2008. Assessments specifically identified and described the primary computer-based surveillance information system, any duplicative information systems, and selected variables collected. RESULTS: Persistent challenges to information integration across the information systems included the existence of duplicative data systems, differences in the variables used to collect similar information, and differences in basic architecture. CONCLUSIONS: The assessments identified a number of challenges for information integration across the infectious disease surveillance information systems at this city health department. The results suggest that local disease control programs use computer-based surveillance information systems that were not designed for data integration. To the extent that integration provides important new surveillance capacities and business efficiencies, we recommend that patient-centric information systems be designed that provide all the epidemiologic, clinical, and research needs in one system. In addition, the systems should include a standard system of elements and fields across similar surveillance systems.

Expression of beta-galactosidase by recombinant respiratory syncytial viruses for microneutralization assay.

The beta-galactosidase gene (lacZ) was inserted into a recombinant respiratory syncytial virus (RSV) A2 strain of subgroup A RSV (designated as A-lacZ) and a chimeric RSV that had the G and F surface glycoproteins of A2 replaced by those of the subgroup B RSV 9320 strain (designated as B-lacZ). Both recombinant RSVs, A-lacZ and B-lacZ, grew well in tissue culture and expressed high levels of beta-galactosidase. Using these two beta-galactosidase-expressing recombinant RSVs, a novel microneutralization assay was developed to measure serum anti-RSV neutralizing antibody from subgroup A or subgroup B RSV infection. The assay was carried out in 96-well plates and the unneutralized virus was quantitated by spectrophotometric measurement of the beta-galactosidase enzymatic reaction following incubation of the infected cell lysate with the enzyme substrate, chlorophenol red beta-D-galactopyranoside (CPRG). Adult human sera positive for anti-RSV antibody as shown by Western blot analysis and subgroup A or subgroup B RSV infected monkey sera were examined for the levels of anti-RSV neutralizing antibodies by the microneutralization assay in comparison with the plaque reduction neutralization assay. A higher antibody titer was detected when the neutralization assay was performed with the homologous RSV than the heterologous RSV, indicating that neutralization assay could distinguish antigenic differences between the two RSV subgroups. The microneutralization assay is comparable to the plaque reduction neutralization assay in sensitivity, but it is rapid, less laborious and suitable for screening a large number of samples.