Intelligence gain and social cost savings attributable to environmental lead exposure reduction strategies since the year 2000 in Flanders, Belgium.

BACKGROUND: Recent lead (Pb) exposure reduction strategies enabled to lower children's blood lead levels (B-Pb) worldwide. This study reports the estimated intelligence gain and social cost savings attributable to recent exposure reduction based on reported B-Pb levels observed in adolescents sampled within the framework of the Flemish Environment and Health Studies (FLEHS, Belgium), i.e. in 2003-2004 (FLEHSI), in 2008-2009 (FLEHSII), and in 2013-2014 (FLEHSIII). METHODS: Intelligence Quotient (IQ) loss per 100,000 individuals - attributable to B-Pb above 20 µg/L - was estimated based on widely accepted dose response functions between children's B-Pb and IQ (- 1.88 IQ points for a duplication in B-Pb from 20 µg/L onwards; 95% Confidence Interval (CI): - 1.16;-2.59) and B-Pb exposure distribution parameters of FLEHS studies. The results were translated to the Flemish population of 15-year-olds. Given a 3-year time gap between subsequent sampling periods, the exposure distribution of each study was assumed 3 years prior to the study as well. Economic impact was estimated based on expected decrease in lifetime earnings (€ 19,464 per decreasing IQ point in 2018). RESULTS: The percentage of the adolescent population exceeding a B-Pb of 20 µg/L decreased from 57% (FLEHSI) to 23% (FLEHSII), and even further to 2.5% (FLEHSIII). The estimated IQ loss per 100,000 individuals was 94,280 (95% CI: 58,427-130,138) in FLEHSI, 14,993 (95% CI: 9289-20,695) in FLEHSII, and 976 (95% CI: 604-1347) in FLEHSIII. This translates into a total loss of 378,962 (95%CI: 234,840-523,091) IQ points within the Flemish population of 15-year-olds between 2000 and 2014. Assuming that current exposure levels do not reincrease, the expected IQ loss during the subsequent period of 15 years is estimated to be maximally 10,275 (95%CI: 6363-14,182) points. CONCLUSIONS: 7176 (95%CI: 4447-9905) million € of social cost savings were achieved by Pb reduction strategies in Flanders over 15 years. If current exposure levels further reduce to B-Pb below 20 µg/L for the whole population, social cost savings may increase up to 7376 (95%CI: 4571-10,181) million €. Given the relatively low lead contamination in Flanders, the global impact of ongoing reduction strategies is expected to be tremendous.

Adverse effects of low occupational cadmium exposure on renal and oxidative stress biomarkers in solderers.

OBJECTIVES: Recent studies suggest adverse health effects after low exposure to cadmium (Cd). Brazing with Cd-containing solder exposes workers to Cd. The purpose of this study was to assess: (1) indicators of Cd exposure in blood (Cd-B)/ urine (Cd-U); (2) the association between Cd-B, Cd-U and renal and oxidative stress biomarkers. METHODS: In this cross-sectional study Cd-B, Cd-U, renal (ie, N-acetyl-ß-D-glucosaminidase/urinary intestinal alkaline phosphatase (IAP)/microalbumin/beta-2-microglobulin/retinol binding protein and oxidative stress markers (ie, derivatives of reactive oxygen metabolites/glutathione peroxidase/superoxide dismutase (SOD)/ advanced oxidation protein products/8-hydroxy-2'-deoxyguanosin/8-isoprostanes) were determined in 36 solderers. RESULTS: Multiple linear regression analysis adjusting for age and pack-years of smoking show that IAP is statistically significantly associated with Cd-B (B=0.24; SE=0.11) and Cd-U (B=0.15; SE=0.07). Also SOD is statistically significantly associated with Cd-B (B=62.96; SE=29.62). The association between SOD and Cd-U is of borderline statistical significance (B=37.69; SE=19.59). CONCLUSIONS: While there is still some debate as whether the Cd-induced tubular effects are reversible or not, IAP and SOD appear as sensitive and potentially useful early biomarkers for the health surveillance of workers exposed to low levels of Cd.

Predictors of respiratory sickness absence: an international population-based study.

BACKGROUND: Respiratory tract-related occupational disability is common among adults of working age. We examined occupational vapors, gas, dust, or fume (VGDF) exposure as a predictor of disability, based on respiratory sickness absence among the actively employed, at an early point at which prevention may be most relevant. METHODS: Currently employed European Community Respiratory Health Survey II participants (n = 6,988) were classified into three mutually exclusive, condition/symptom-based categories: physician-diagnosed asthma, self-reported rhinitis, and wheeze/breathlessness (n = 4,772). Logistic regression analysis estimated the odds of respiratory sickness absence (past 12 months) by VGDF exposure. RESULTS: In the condition/symptom groups, 327 (6.9%) reported respiratory sickness absence. Exposure to VGDF was associated with increased odds of respiratory sickness absence: asthma odds ratio [OR] 2.0 (95% confidence interval [CI] 1.1-3.6), wheeze/breathlessness OR 2.2 (95% CI 1.01-4.8); rhinitis OR 1.9 (95% CI 1.02-3.4). CONCLUSION: One in 15 currently employed with asthma, breathlessness, or rhinitis reported respiratory sickness absence. VGDF exposure doubled the odds of respiratory sickness absence, suggesting a focus for disability prevention.

Air exposure assessment of TDI and biological monitoring of TDA in urine in workers in polyurethane foam industry.

OBJECTIVES: Toluene diisocyanate (TDI) is used in the manufacturing process of polyurethane (PU) foams and is a potent inducer of occupational asthma. The objective of this study was to evaluate the correlation between the exposure to total TDI (2,4- and 2,6-TDI) in air and the corresponding biomarker concentration of total TDA (2,4- and 2,6-TDA) in hydrolysed urine. The aim was also to propose an appropriate biological exposure limit for total TDA in urine. METHODS: 9 workers from two production lines in a PU foam producing plant were studied. Personal exposure to TDI during four representative production shifts was monitored by an active air sampling method (filter impregnated with 1-(2-methoxyphenyl)piperazine) and quantified by high-performance liquid chromatography and diode array detection (NIOSH n° 2535, 5521). In parallel, pre-shift and post-shift urinary samples were collected from the exposed workers, and TDA concentrations were determined by gas chromatography-mass spectrometry after alkaline hydrolysis. All samples were collected on four measuring days: two Fridays (end of workweek) and two Mondays (start of workweek) separated by a weekend without exposure. RESULTS: Strong correlations between the personal air concentrations of total TDI and the corresponding biomarker levels of total TDA in urine (r=0.816) were observed. An increase of 18.12 µg TDA/l (post-shift minus pre-shift concentration) corresponds to an exposure of 5 ppb (37 µg/m(3), the current American Conference of Governmental Industrial Hygienists threshold limit value) during the shift. CONCLUSIONS: The increase in TDA during the shift is a suitable biomarker for exposure to TDI during the same shift. Further research is needed to evaluate the use of start of week or end of week post-shift TDA in urine as biomarker since TDA was found to accumulate during the working week and thus the moment of sampling will clearly influence the result.

European survey of hepatitis B vaccination policies for healthcare workers.

BACKGROUND: The risk of transmission of hepatitis B virus (HBV) to healthcare workers (HCWs) is well known. Under current European Union (EU) legislation, all employers should perform a risk assessment to identify those exposed to HBV and offer vaccination. Immunization should happen early after the start of their career to avoid infection and development of carrier status. METHODS: Cross-sectional survey of country representatives, to find out how policies are put into practice in European countries. RESULTS: Answers were received from 17 countries, representing 89% of the population and 90% of HCWs in the EU-25. HBV vaccination was mandatory for medical, and nursing and other paramedical staff in five countries, and recommended in all other countries. It was mandatory for medical students and student nurses in five countries and recommended in nine other. Pre-vaccination serotesting was done in six countries. The vaccination schedule most often used was 0, 1, 6 months. Combined vaccine (hepatitis A virus /HBV) was used in 10 countries. Post-vaccination serotesting was done in 14 countries. Data on HBV vaccination coverage were available in 11 countries and published in five of them. Coverage was 85-93%. CONCLUSION: These results show the variation as to how EU legislation is translated into practice in European countries. More consultation between key actors at EU level could help to optimize the way this matter is dealt with. A battery of measures and interventions-including introduction of immunization programmes against HBV infection and increasing immunization coverage in HCWs-can contribute to further reducing HBV transmission to HCWs.

Workers' perception of chemical risks: a focus group study.

Workers' perceptions with respect to health and safety at work are rarely taken into account when considering the development of prevention programs. The aim of this study was to explore workers' perceptions of chemical risks at the workplace, in order to investigate the prerequisites for a workplace health program. A qualitative study was conducted involving seven focus groups of 5-10 participants (blue-collar workers) each. All groups were homogeneous in terms of sex, work status, language, and company membership. Results showed that several factors have an important influence on workers' perception of chemical risks. Workers assess risks by means of both sensory and empirical diagnosis and are concerned about the long-term health consequences. They perceive the threat of chemical risks as high. Despite this, they are resigned to accepting the risks. Existing formal sources of information are rarely consulted because they are judged to be difficult to understand and not user friendly. Instead, workers tend to obtain information from informal sources. Communication problems with and lack of trust in prevention advisers and hierarchy are frequently mentioned. Workers feel that their specific knowledge of their working conditions and their proposals for practical, cost-effective solutions to improve health and safety at the workplace are insufficiently taken into account. The use of focus groups yielded a useful insight into workers' perceptions of chemical risks. Our findings suggest that training programs for prevention advisers should include topics such as understanding of workers' perceptions, usefulness of a participatory approach, and communication and education skills.

Early exposure to solid foods and the development of eczema in children up to 4 years of age.

Early exposure to solid foods in infancy has been associated with the development of allergic diseases. However, scientific evidence for this is conflicting. The aim of this study was to examine the association between early exposure to solid foods in the infant's diet and the development of eczema up to 4 years of age. We conducted an etiologic case-control study nested in the PIPO cohort (Prospective Cohort on the Influence of Perinatal Factors on the Occurrence of Asthma and Allergies). In this cohort data on nutrition, environmental exposures and parent-reported eczema were collected prospectively starting from 5 months pregnancy by means of questionnaires administered during two home visits and semi-annual postal questionnaires. In addition, detailed information on the timing of introduction of solid foods at individual food item level was collected at 1 year of age. Adjusted odds ratios and 95% confidence intervals were computed using logistic regression analysis as a measure of association between eczema and the timing of exposure to solid foods. Early introduction (within the first 4 months) of solid foods was inversely associated with eczema up to 4 years of age (adj OR: 0.49; 95% CI: 0.32-0.74). Moreover, we found that early exposure to solid foods was associated with a reduced risk for eczema only among children with allergic parents (adj OR: 0.35; 95% CI: 0.20-0.63), whereas no significant effect was found among children with non-allergic parents (adj OR: 0.69; 95% CI: 0.37-1.29). The results of this study show that early exposure to solid foods is associated with less parent-reported eczema in children, particularly among children with allergic parents. Therefore, the current study does not support a delayed introduction of solid foods for the prevention of eczema in childhood.

Work-related Helicobacter pylori infection among sewage workers in municipal wastewater treatment plants in Belgium.

INTRODUCTION: Most studies among sewage workers of wastewater treatment plants (WWTPs) have found a higher prevalence of gastrointestinal symptoms than among non-sewage exposed workers. Waterborne transmission of Helicobacter pylori (H pylori) has been hypothesised, as the bacteria can survive into an aqueous environment and has been detected in sewage. A health and hygiene questionnaire has demonstrated a higher prevalence of peptic ulcers among Belgian WWTP operators and maintenance workers than among non-sewage exposed colleagues. OBJECTIVES: To assess the seroprevalence of H pylori infection in Belgian sewage workers at municipal WWTPs, and to determine whether sewage exposure is an important risk factor for acquisition of H pylori and the possible association with gastrointestinal symptoms. METHODS: A seroprevalence study of H pylori antibodies was conducted among 317 WWTP employees (operators, maintenance workers, laboratory personnel, other job). Information about demographic variables, possible H pylori risk factors, working history, and history of current gastrointestinal symptoms during last 3 months was obtained by a questionnaire. The presence of H pylori IgG was investigated with an ELISA. The results were compared with those of 250 employees of a pharmaceutical company (operators, maintenance workers, laboratory personnel). RESULTS: The prevalence of H pylori IgG antibodies among sewage workers was 16.7% (95% CI 12.6 to 20.8%) compared to 13.6% (95% CI 9.4 to 17.8%) among the control group. In a logistic regression model with controlling for age and educational levels, OR study/control group was 1.02 (95% CI 0.58 to 1.80 with p=0.93). No significant associations were found between the H pylori status and gastrointestinal symptoms, occupational exposures in different tasks, nor with hygienic practices. CONCLUSIONS: Our results do not suggest that H pylori infection is a probable cause of part of gastrointestinal symptoms among Flemish municipal sewage workers of WWTPs.

Do inter-hospital comparisons of in-hospital, acute myocardial infarction case-fatality rates serve the purpose of fostering quality improvement? An evaluative study.

BACKGROUND: In-hospital case-fatality rates in patients, admitted for acute myocardial infarction (AMI-CFRs), are internationally used as a quality indicator. Attempting to encourage the hospitals to assume responsibility, the Belgian Ministry of Health decided to stimulate initiatives of quality improvement by means of a limited set of indicators, among which AMI-CFR, to be routinely analyzed. In this study we aimed, by determining the existence of inter-hospital differences in AMI-CFR, (1) to evaluate to which extent Belgian discharge records allow the assessment of quality of care in the field of AMI, and (2) to identify starting points for quality improvement. METHODS: Hospital discharge records from all the Belgian short-term general hospitals in the period 2002-2005. The study population (N = 46,287) included patients aged 18 years and older, hospitalized for AMI. No unique patient identifier being present, we tried to track transferred patients. We assessed data quality through a comparison of MCD with data from two registers for acute coronary events and through transfer and sensitivity analyses. We compared AMI-CFRs across hospitals, using multivariable logistic regression models. In the main model hospitals, Charlson's co-morbidity index, age, gender and shock constituted the covariates. We carried out two types of analyses: a first one wherein transferred-out cases were excluded, to avoid double counting of patients when computing rates, and a second one with exclusion of all transferred cases, to allow the study of patients admitted into, treated in and discharged from the same hospital. RESULTS: We identified problems regarding both the CFR's numerator and denominator.Sensitivity analyses revealed differential coding and/or case management practices. In the model with exclusion of transfer-out cases, the main determinants of AMI-CFR were cardiogenic shock (OR(adj) 23.0; 95% CI [20.9;25.2]), and five-year age groups OR(adj) 1.23; 95% CI [1.11;1.36]). Sizable inter-hospital and inter-type of hospital differences {(OR(comunity vs tertiary hospitals)1.36; 95% CI [1.34;1.39]) and (OR(intermediary vs tertiary hospitals)1.36; 95% CI [1.34;1.39])}, and nonconformities to guidelines for treatment were observed. CONCLUSIONS: Despite established data quality shortcomings, the magnitude of the observed differences and the nonconformities constitute leads to quality improvement. However, to measure progress, ways to improve and routinely monitor data quality should be developed.

Domestic use of hypochlorite bleach, atopic sensitization, and respiratory symptoms in adults.

BACKGROUND: Professional use of hypochlorite (bleach) has been associated with respiratory symptoms. Bleach is capable of inactivating allergens, and there are indications that its domestic use may reduce the risk of allergies in children. OBJECTIVE: To study the associations between household use of bleach and atopic sensitization, allergic diseases, and respiratory health status in adults. METHODS: We identified 3626 participants of the European Community Respiratory Health Survey II in 10 countries who did the cleaning in their homes and for whom data on specific serum IgE to 4 environmental allergens were available. Frequency of bleach use and information on respiratory symptoms were obtained in face-to-face interviews. House dust mite and cat allergens in mattress dust were measured in a subsample. Associations between the frequency of bleach use and health outcomes were evaluated by using multivariable mixed logistic regression analyses. RESULTS: The use of bleach was associated with less atopic sensitization (odds ratio [OR], 0.75; 95% CI, 0.63-0.89). This association was apparent for specific IgE to both indoor (cat) and outdoor (grass) allergens, and was consistent in various subgroups, including those without any history of respiratory problems (OR, 0.85). Dose-response relationships (P < .05) were apparent for the frequency of bleach use and sensitization rates. Lower respiratory tract symptoms, but not allergic symptoms, were more prevalent among those using bleach 4 or more days per week (OR, 1.24-1.49). The use of bleach was not associated with indoor allergen concentrations. CONCLUSION: People who clean their homes with hypochlorite bleach are less likely to be atopic but more likely to have respiratory symptoms.

Inhalation incidents and respiratory health: results from the European Community Respiratory Health Survey.

BACKGROUND: Inhalation incidents are an important cause of acute respiratory symptoms, but little is known about how these incidents affect chronic respiratory health. METHODS: We assessed reported inhalation incidents among 3,763 European Community Respiratory Health Survey (ECRHS) participants with and without cough, phlegm, asthma, wheezing or bronchial hyperresponsiveness. We then examined whether inhalation incidents during the 9-year ECRHS follow-up period were associated with a new onset of any of these respiratory outcomes among 2,809 participants who were free of all five outcomes at the time of the baseline ECRHS survey. RESULTS: Inhalation incidents were reported by 5% of participants, with higher percentages reported among individuals with asthma-related outcomes at the time of the baseline survey. Among participants without symptoms at baseline, our analyses generated non-statistically significant elevated estimates of the risk of cough, phlegm, asthma and wheezing and a non-statistically significant inverse estimate of the risk of bronchial hyperresponsiveness among participants who reported an inhalation incident compared to those without such an event reported. DISCUSSION: Our findings provide limited evidence of an association between inhalation incidents and asthma-related symptoms. These data could be affected by differences in the reporting of inhalation incidents according to symptom status at the time of the baseline survey; they should thus be interpreted with caution.

Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II).

BACKGROUND: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. METHODS: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. FINDINGS: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. INTERPRETATION: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely.

Occupational risk factors for asthma among nurses and related healthcare professionals in an international study.

OBJECTIVE: The authors examined the relations between self-reported work tasks, use of cleaning products and latex glove use with new-onset asthma among nurses and other healthcare workers in the European Community Respiratory Health Survey (ECRHS II). METHODS: In a random population sample of adults from 22 European sites, 332 participants reported working in nursing and other related healthcare jobs during the nine-year ECRHS II follow-up period and responded to a supplemental questionnaire about their principal work settings, occupational tasks, products used at work and respiratory symptoms. Poisson regression models with robust error variances were used to compare the risk of new-onset asthma among healthcare workers with each exposure to that of respondents who reported professional or administrative occupations during the entire follow-up period (n = 2481). RESULTS: Twenty (6%) healthcare workers and 131 (5%) members of the referent population reported new-onset asthma. Compared to the referent group, the authors observed increased risks among hospital technicians (RR 4.63; 95% CI 1.87 to 11.5) and among those using ammonia and/or bleach at work (RR 2.16; 95% CI 1.03 to 4.53). CONCLUSIONS: In the ECRHS II cohort, hospital technicians and other healthcare workers experience increased risks of new-onset current asthma, possibly due to specific products used at work.

Occupational exposure among bakery workers: impact on the occurrence of work-related symptoms as compared with allergic characteristics.

OBJECTIVE: The aim of the study is to examine the relationship between exposure to occupational allergens, sensitization, and atopy and several outcome variables and the independent associations of these interrelated risk factors to work-related symptoms in particular. METHODS: Data were collected by questionnaire, skin prick tests, lung function tests, and exposure measurements among 246 workers from 74 bakeries and analyzed using logistic and linear regression analyses. RESULTS: Exposure levels were associated with respiratory symptoms, sensitization to baker's allergens, and lung function. High exposure and sensitization to common and bakers' allergens were independent risk factors for work-related symptoms. However, allergy determinants performed best in predicting work-related symptoms. CONCLUSIONS: Current exposure to occupational allergens is a risk factor for work-related symptoms, but sensitization to occupational allergens and atopy are more adequate and easier obtainable predictors of work-related symptoms.

Occupational injuries in Flemish pilots in Belgium. A questionnaire survey.

A questionnaire survey was conducted in Antwerp, Belgium in 2002-2004 on the factors influencing the occurance of work-related accidents and injuries in Flemish maritime pilots. 130 questionnaires were collected and analysed, and the response rate was 37.6%. The accidents reported in the questionnaire occured between 1980 and 2005, and most of them (70.7%) during the last 10 years. Various factors were taken into consideration: causes of accidents, their time and site, type of injury, human factors, transfer to ships, use of safety equipment, state of the sea, visibility, etc. The obtained results were summed up in 3 tables, and were compared with data from the literature. In this study, authors attempted to assess the importance of these various factors on the occurance of work-related accidents among pilots, and improve their prevention.

Hepatitis B vaccination of healthcare workers at the Princess Marina Hospital, Botswana.

BACKGROUND: Batswana (i.e., the people of Botswana) healthcare workers (HCWs) are at high risk for occupational exposure to hepatitis B virus (HBV), thus the Botswana Ministry of Health recommends that HCWs should receive three doses of hepatitis B (HB) vaccine. However, there are no data on HB vaccination uptake by Batswana HCWs. This study investigated knowledge of, and attitudes towards, HB prevention and control, and predictors of HB vaccination uptake in HCWs at the Princess Marina Hospital during 2010. METHODS: Self-administered questionnaires were distributed to doctors, nurses and laboratory workers (n=200). Knowledge was measured using 14 questions; attitude was measured using a 5-point Likert scale and 9 statements. Data on vaccination status and demographics were collected. RESULTS: Of the respondents, 17.2% (20/116) had good knowledge and 97.4% (113/116) had positive attitudes. At least one dose of HB vaccine had been received by 50.9% (59/116), while 31.0% (36/116) had received all three doses. Profession was the only predictor of HB vaccination uptake, with being a laboratory worker (OR=61.0) or a doctor (OR=51.5) predicting HB vaccination uptake with at least one dose. CONCLUSION: This is the first study on HB vaccination of Batswana HCWs, and shows that HB vaccination uptake is suboptimal.

Allergic sensitization, symptoms, and lung function among bakery workers as compared with a nonexposed work population.

Only few studies have assessed relative risks on occupational asthma and allergy among bakery workers, and none of them have included respiratory and work-related symptoms as well as sensitization to occupational allergens and pulmonary function. A random sample of 246 workers from traditional and industrial bakeries in two regions of Belgium were compared with a reference population of 251 workers from a petrochemical plant in the same region. Data on skin test positivity, symptoms, and lung function were collected by standardized procedures. Differences between the two subpopulations were analyzed using multiple logistic and linear regression analyses. On average, bakery workers did not more often have skin test positivity than reference workers (39.4% and 42.6%, respectively). However, bakery workers had a strongly increased risk of sensitization to specific bakery allergens (OR 22.0, 95% CI = 6.3-77.1.), whereas their risks of positive skin tests to common allergens, including wheat pollen and storage mite, were significantly decreased (OR 0.6, 95% CI = 0.4-0.9). Bakery workers had significantly more often respiratory and work-related symptoms. Accordingly, they had lower lung function parameters. Atopy and sensitization to bakers' allergens were independent and additional risk factors for work-related symptoms. Bakery workers are at increased risk of respiratory and allergic symptoms and skin test reactivity to specific bakers' allergens wheat flour and alpha-amylase. Wheat pollen and storage mite should not be regarded as baker's allergens. Nevertheless, pulmonary function of bakery workers can be characterized as mild airway obstruction only.

Helicobacter pylori infection: a global occupational risk for healthcare workers?

The occupational risks from Helicobacter pylori, a major cause of gastroduodenal diseases, were reviewed for selected groups of healthcare workers (HCWs). A literature search was performed using Medline/Pubmed, 1983 to June 2003. Additional manual searches were made using reference lists from the selected articles. Current knowledge implies various pathways of agent transmission, favoring person-to-person transmission. The risks are highest for gastroenterologists, some nurses, and employees caring for persons with mental disability. Results for other groups are conflicting.

High prevalence of Schistosoma mansoni in six health areas of - Kasansa health zone, Democratic Republic of the Congo: short report.

School-aged children suffer the most from schistosomiasis infection in sub Saharan Africa due to poverty and limited sanitary conditions. Mapping of disease burden is recommended and there is a need of updating prevalence data which is as old as 20 years in the Democratic Republic of Congo. An epidemiological and parasitological study was carried out in 2011 in the health zone of Kasansa. Six health areas (HA) were included in the study. In each health area, one primary school was selected. School-aged children were screened for S. mansoni infection using parallel Kato-Katz and direct microscopy techniques. A total of 335 school-aged children were screened. The average prevalence was 82.7% and ranged between 59.5-94.9%. Four of the six HAs had a prevalence level over 91%. Of all infected children, about half 112 (43.2%) had light parasite density. These results demonstrate that Schistosoma mansoni infection is a bigger problem than anticipated and there is an urgent need to implement effective control measures.

Toxoplasmosis among pregnant women: high seroprevalence and risk factors in Kinshasa, Democratic Republic of Congo.

OBJECTIVE: To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo. METHODS: Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity. RESULTS: A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95% CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%; 95% CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed. CONCLUSION: In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20% were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy.