Global Estimates on Biological Risks at Work.

Introduction: Biological risks are a major global problem in the workplace. The recent COVID-19 pandemic has highlighted the need for a more comprehensive understanding of the biological risks at work. This study presents data on both communicable infectious biological agents and noncommunicable factors leading to death and disability for the year 2021. Methods: We followed the methodology established by the International Labour Organization (ILO) in their past global estimates on occupational accidents and work-related diseases. We used relevant ILO estimates for hazardous substances and related population attributable fractions derived from literature, which were then applied to World Health Organization mortality data. The communicable diseases included in the estimates were tuberculosis, pneumococcal diseases, malaria, diarrheal diseases, other infectious diseases, neglected tropical diseases, influenza associated respiratory diseases and COVID-19. Noncommunicable diseases and injuries considered were Chronic Obstructive Diseases (COPD) due to organic dusts, asthma, allergic reactions and risks related to animal contact. We estimated death attributable to biological risk at work and disability in terms of disability adjusted life years (DALYs). Results: We estimated that in 2022, 550,819 deaths were caused by biological risk factors, with 476,000 deaths attributed to communicable infectious diseases and 74,000 deaths caused by noncommunicable factors. Among these, there were 223,650 deaths attributed to COVID-19 at work. We calculated the rate of 584 DALYs per 100,000 workers, representing an 11% increase from the previous estimate of the global burden of work-related disabilities measured by DALYs. Conclusion: This is a first update since previous 2007 ILO estimates, which has now increased by 74% and covers most biological risks factors. However, it is important to note that there may be other diseases and deaths are missing from the data, which need to be included when new information becomes available. It is also worth mentioning that while deaths caused by major communicable diseases including COVID-19 are relatively rare within the working population, absences from work due to these diseases are likely to be very common within the active workforce.

Induced hypoglycemia for 48 hours indicates differential glucose and insulin effects on liver metabolism in dairy cows.

Hypoglycemia is a characteristic condition of early lactation dairy cows and is subsequently dependent on, and may affect, metabolism in the liver. The objective of the present study was to investigate the effects of induced hypoglycemia, maintained for 48 h, on metabolic parameters in plasma and liver of mid-lactation dairy cows. The experiment involved 3 treatments, including a hyperinsulinemic hypoglycemic clamp (HypoG, n=6) to obtain a glucose concentration of 2.5 mmol/L, a hyperinsulinemic euglycemic clamp (EuG, n=6) in which the effect of insulin was studied, and a control treatment with a 0.9% saline solution (NaCl, n=6). Blood samples for measurements of insulin, metabolites, and enzymes were taken at least once per hour. Milk yield was recorded and milk samples were collected before and after treatment. Liver biopsies were obtained before and after treatment to measure mRNA abundance by real-time, quantitative reverse transcription-PCR of 12 candidate genes involved in the main metabolic pathways. Milk yield decreased in HypoG and NaCl cows, whereas it remained unaffected in EuG cows. Energy-corrected milk yield (kg/d) was only decreased in HypoG cows. In plasma, concentration of ß-hydroxybutyrate decreased in response to treatment in EuG cows and was lower (0.41±0.04 mmol/L) on d 2 of the treatment compared with that in HypoG and NaCl cows (on average 0.61±0.03 mmol/L, respectively). Nonesterified fatty acids remained unaffected in all treatments. In the liver, differences between treatments for their effects were only observed in case of mitochondrial phosphoenolpyruvate carboxykinase (PEPCKm) and glucose-6-phosphatase (G6PC). In HypoG, mRNA abundance of PEPCKm was upregulated, whereas in EuG and NaCl cows, it was downregulated. The EuG treatment downregulated mRNA expression of G6PC, a marked effect compared with the unchanged transcript expression in NaCl. The mRNA abundance of the insulin receptor remained unaffected in all treatments, and no significant treatment differences were observed for genes related to lipid metabolism. In conclusion, low glucose concentrations in dairy cows affect liver metabolism at a molecular level through upregulation of PEPCKm mRNA abundance. Metabolic regulatory events in the liver are directed, apart from hormones, by the level of metabolites, either in excess (e.g., free fatty acids) or in shortage (e.g., glucose).

Consentimiento informado: percepción de médicos, enfermeras y padres sobre el proceso comunicativo / Informed consent: physicians, nurses and parent perception of the communication process

Current Medical Ethics are based on a model that emphasizes doctor-patient shared decision-making process. Its utmost expression is through the doctrine of informed consent (IC). In this environment there is little empirical data regarding the use of IC among adult patients, and even less in Pediatrics. Objectives: 1) Explore parents' perceptions of their rights, duties, and exercise of autonomy through an evaluation of their expectations of the communication process of IC; 2) Describe common practices and experiences of physicians and nurses as they request IC to parents of hospitalized children. Method and Sampling: Descriptive, exploratory study in three subject groups: a) patient guardians; b) pediatricians; c) physicians and nurses. A common questionnaire was adapted for each group, utilizing open and closed questions, exploring subjects' perceptions of experiences and expectations. Open questions were evaluated for common themes by 2 independent judges. Results: 100 percent of professionals agreed that guardians should be informed of the medical situation of the patient. However, less than half of guardians felt they had received information continuously, showing a gap in desired information and communication difficulties. No guardian mentioned the possibility of participating in medical decision-making. Conclusions: Results allow a data-based discussion regarding professional practices and patient preferences. New challenges arise for health care teams to improve the process of IC incorporating the needs of patients and professionals.

Las actuales declaraciones éticas se basan en un nuevo modelo de relación clínica que enfatiza la deliberación y participación de médico y paciente en la toma de decisiones. Estos elementos poseen su mejor expresión en la doctrina del consentimiento informado. En nuestro medio disponemos de escasos datos empíricos que exploren la puesta en marcha del consentimiento informado en pacientes adultos y menos aún en pediatría. Objetivos: 1) Explorar la percepción de los padres respecto a sus deberes, derechos y ejercicio de su autonomía por medio del análisis de sus expectativas respecto al proceso comunicativo de consentimiento informado; 2) Describir las vivencias y prácticas habituales de médicos y enfermeras en el proceso de ofrecer información y solicitar el consentimiento a los padres de niños hospitalizados. Método y Muestra: Estudio descriptivo, exploratorio, realizado en tres grupos de sujetos: tutores de pacientes, pediatras, médicos y enfermeras. Se aplicó un cuestionario adaptado para cada grupo en estudio, que consta de una sección de preguntas abiertas y una de preguntas cerradas que exploran la percepción de los sujetos en relación a las experiencias vividas y sus expectativas sobre la información a entregar o recibir. Los datos abiertos fueron examinados estableciendo categorías temáticas por 2 jueces independientes. Resultados: El 100 por ciento de los profesionales se mostró de acuerdo en que los tutores deben ser informados de la situación médica del paciente, sin embargo, menos de la mitad de los tutores refiere haber recibido información permanentemente existiendo diferencias entre éstos y profesionales respecto a la información deseada y dificultades en la comunicación. Ninguno de los tutores mencionó la posibilidad de participar en las decisiones médicas. Conclusiones: Los resultados permiten abrir una reflexión empíricamente fundada sobre las prácticas profesionales y preferencias de los pacientes explicitando...

Surfactant protein-D and exposure to bioaerosols in wastewater and garbage workers.

PURPOSE: Bioaerosols and their constituents, such as endotoxins, are capable of causing an inflammatory reaction at the level of the lung-blood barrier, which becomes more permeable. Thus, it was hypothesized that occupational exposure to bioaerosols can increase leakage of surfactant protein-D (SP-D), a lung-specific protein, into the bloodstream. METHODS: SP-D was determined by ELISA in 316 wastewater workers, 67 garbage collectors, and 395 control subjects. Exposure was assessed with four interview-based indicators and by preliminary endotoxin measurements using the Limulus amoebocyte lysate assay. Influence of exposure on serum SP-D was assessed by multiple linear regression considering smoking, glomerular function, lung diseases, obesity, and other confounders. RESULTS: Overall, mean exposure levels to endotoxins were below 100 EU/m(3). However, special tasks of wastewater workers caused higher endotoxin exposure. SP-D concentration was slightly increased in this occupational group and associated with the occurrence of splashes and contact to raw sewage. No effect was found in garbage collectors. Smoking increased serum SP-D. No clinically relevant correlation between spirometry results and SP-D concentrations appeared. CONCLUSIONS: These results support the hypothesis that inhalation of bioaerosols, even at low concentrations, has a subclinical effect on the lung-blood barrier, the permeability of which increases without associated spirometric changes.

Effects of bioaerosol exposure on work-related symptoms among Swiss sawmill workers.

OBJECTIVE: Exposure to bioaerosols in the occupational environment of sawmills could be associated with a wide range of health effects, in particular respiratory impairment, allergy and organic dust toxic syndrome. The objective of the study was to assess the frequency of medical respiratory and general symptoms and their relation to bioaerosol exposure. METHOD: Twelve sawmills in the French part of Switzerland were investigated and the relationship between levels of bioaerosols (wood dust, airborne bacteria, airborne fungi and endotoxins), medical symptoms and impaired lung function was explored. A health questionnaire was distributed to 111 sawmill workers. RESULTS: The concentration of airborne fungi exceeded the limit recommended by the Swiss National Insurance (SUVA) in the twelve sawmills. This elevated fungi level significantly influenced the occurrence of bronchial syndrome (defined by cough and expectorations). No other health effects (irritations or respiratory effects) could be associated to the measured exposures. We observed that junior workers showed significantly more irritation syndrome (defined by itching/running nose, snoring and itching/red eyes) than senior workers. Lung function tests were not influenced by bioaerosol levels nor dust exposure levels. CONCLUSION: Results suggest that occupational exposure to wood dust in a Swiss sawmill does not promote a clinically relevant decline in lung function. However, the occurrence of bronchial syndrome is strongly influenced by airborne fungi levels.

[A descriptive epidemiological study on canine babesiosis in the Lake Geneva region]. / Etude épidémiologique descriptive de la Babésiose canine dans la Région Lémanique.

A descriptive study was carried out in the district of the Lake Geneva between March 1, 2005 and August 31,2006 to assess the incidence and prevalence of canine babesiosis, to genotype the Babesia species occurring, to assess the most frequently clinical signs found and to address the potential of autochthonous transmission. This included a data assessment on the different tick-populations occurring in the area and on the prevalence of Babesia-DNA in these ticks. A total of 56 veterinary practices participated in the study. By blood smear and PCR, Babesia canis canis was found in 12 out of 21 cases with suspected babesiosis. In an additional 13th case, the parasite could only be detected by PCR. All autochthonous cases originated from the Western part of the Lake Geneva region. Clinical signs in affected dogs included inappetence, apathy, anemia, fever, hemoglobinuria and thrombocytopenia. There were no risk factors with regard to age, sex and breed. Most cases were diagnosed during the spring periods of 2005 and 2006 (11 cases) and two cases in autumn 2005, coinciding with the main activity period of Dermacentor reticulatus, the main vector of B. canis canis. A total of 495 ticks were collected on patients by the veterinarians, 473 were identified as Ixodes sp., 7 as Rhipicephalus sanguineus and 15 as Dermacentor reticulatus. While Ixodes sp. was found in the whole study area, D. reticulatus and R. sanguineus occurred only in the Western part till Lausanne. PCR and sequencing yielded B. canis canis positivity in 3 D. reticulatus specimen, these three ticks were collected from two different dogs both suffering from babesiosis. All R. sanguineus were negative by Babesia-PCR. Global warming, ecological changes in the potential habitat of ticks, increasing host- and vector-populations and increasing mobility of dog owners may be responsible for an emergence situation of infection risk for Babesia spp. by time. E.g., Dermacentor reticulatus has become autochtonously prevalent already till Lausanne in the Lake Geneva region, and further surveillance is suggested to tackle this problem.

Clara cell protein and surfactant protein B in garbage collectors and in wastewater workers exposed to bioaerosols.

OBJECTIVES: Inhalation of bioaerosols has been hypothesised to cause "toxic pneumonitis" that should increase lung epithelial permeability at the bronchioloalveolar level. Serum Clara cell protein (CC16) and serum surfactant protein B (SPB) have been proposed as sensitive markers of lung epithelial injury. This study was aimed at looking for increased lung epithelial permeability by determining CC16 and SPB in workers exposed to bioaerosols from wastewater or garbage. METHODS: Subjects (778 wastewater, garbage and control workers; participation 61%) underwent a medical examination, lung function tests [American Thoracic Society (ATS) criteria], and determination of CC16 and SPB. Symptoms of endotoxin exposure and several potential confounders (age, gender, smoking, kidney function, obesity) were looked for. Results were examined with multiple linear or logistic regression. RESULTS: Exposure to bioaerosols increased CC16 concentration in the wastewater workers. No effect of exposure on SPB was found. No clue to work-related respiratory diseases was found. CONCLUSIONS: The increase in CC16 in serum supports the hypothesis that bioaerosols cause subclinical "toxic pneumonitis", even at low exposure.

Cost effectiveness of a latrine revision programme in Kabul, Afghanistan.

INTRODUCTION: We assessed a household latrine revision intervention implemented in Kabul, Afghanistan for evidence of a reduction in diarrhoeal disease. METHODS: A case-control design involving 1238 cases and 625 controls was used. Logistic regression modelling was performed both for children < 5 years and < or = 11 years, and the parameter estimates were later used with results from a stratified cluster sample survey. This survey used a verbal autopsy methodology to enable an estimation of the number of deaths averted over a 1-year period. A cost-effectiveness analysis using direct and indirect costs for the intervention was then conducted and the results compared with primary health care interventions identified from a Medline search. FINDINGS: Conditional logistic regression showed that patients were less likely than controls to live in households with revised latrines (odds ratio (OR) 0.57, 95% confidence interval (CI) = 0.42-0.77 for children < 5 years, and OR 0.53, 95% = CI 0.41-0.67 for children < or = 11 years). The results from the survey of cause-specific mortality by verbal autopsy enabled estimation of the number of deaths averted over a 1-year period due to the intervention; these estimations were 235 (95% CI = 109-360) for children < 5 years and 285 (95% CI = 180-397) for children < or = 11 years. Estimates of cost effectiveness ranged from approximately US dollars 1800 to US dollars 4100 per death averted depending on age and payer perspective. CONCLUSION: These estimates are conservative because only 1 year of effectiveness is considered, yet they compare favourably with a review of other paediatric interventions. These results are important because funding for sanitation interventions is often limited by the belief that the interventions are not cost-effective.

Sperm length influences fertilization success during sperm competition in the snail Viviparus ater.

Sperm form and size is tremendously variable within and across species. However, a general explanation for this variation is lacking. It has been suggested that sperm size may influence sperm competition, and there is evidence for this in some taxa but not others. In addition to normal fertilizing sperm, a number of molluscs and insects produce nonfertile sperm that are also extremely morphologically variable, and distinct from fertilizing forms. There is evidence that nonfertile sperm play an indirect role in sperm competition by decreasing female remating propensity in Lepidopterans, but in most taxa the function of parasperm is unknown. We investigated the role of nonfertile (oligopyrene) sperm during sperm competition in the fresh water snail Viviparus ater. Previous studies found that the proportion of oligopyrene sperm increased with the risk of sperm competition, and hence it seems likely that these sperm influence fertilization success during competitive matings. In mating experiments in which females were sequentially housed with males, we examined a range of male characteristics which potentially influence fertilization success. We found that the size of oligopyrene sperm was the best predictor of fertilization success, with males having the longer sperm siring the highest proportion of offspring. Furthermore, we found a positive shell size and sperm concentration effect on paternity, and females with multiply sired families produced more offspring than females mating with only one male. This result suggests polyandry is beneficial for female snails.

Paternal investment affects prevalence of malaria.

Both reproduction and parasite defense can be costly, and an animal may face a trade-off between investing in offspring or in parasite defense. In contrast to the findings from nonexperimental studies that the poorly reproducing individuals are often the ones with high parasite loads, this life-history view predicts that individuals with high reproductive investment will show high parasite prevalence. Here we provide an experimental confirmation of a positive association between parental investment levels of male great tits Parus major and the prevalence of Plasmodium spp, a hematozoa causing malaria in various bird species. We manipulated brood size, measured feeding effort of both males and females, and assessed the prevalence of the hemoparasite from blood smears. In enlarged broods the males, but not the females, showed significantly higher rates of food provisioning to the chicks, and the rate of malarial infection was found to be more than double in male, but not female, parents of enlarged broods. The findings show that there may be a trade-off between reproductive effort and parasite defense of the host and also suggest a mechanism for the well documented trade-off between current reproductive effort and parental survival.

[Evaluation of two ELISA techniques for the diagnosis of bovine paratuberculosis]. / Evaluation de deux techniques d'ELISA pour le diagnostic de la paratuberculose bovine.

A sensitivity of 50% and a specificity of 98% were obtained in the evaluation of a serological method (commercial absorbed ELISA, Commonwealth Serum Laboratories, Parkville, Australia) for the diagnosis of paratuberculosis. The population used in the study consisted of 20 infected, suspect and non-infected herds from the region of the Plateau de Diesse. Another evaluated non-absorbed ELISA test had a sensitivity of 30% and a specificity of 91%.

[Newcastle disease: an enzyme-linked immunosorbent assay for the control of antibodies in chicks]. / Maladie de Newcastle: un enzyme-linked immunosorbent assay pour le contrôle des anticorps chez les poussins.

An enzyme-linked immunosorbent assay using a vaccine strain of Newcastle disease as antigen has been developed. It allows the control of the drop in the maternal antibody level of 1 and 28 days old chicks. Thus it can be used as alternative to the inhibition of hemagglutination method. A comparative study has shown a good correlation between the enzyme-linked-immunosorbent-assay and the inhibition of hemagglutination.