Antony Stewart

Occupational health risks of pathologists - results from a nationwide online questionnaire in Switzerland

BackgroundPathologists are highly trained medical professionals who play an essential part in the diagnosis and therapy planning of malignancies and inflammatory diseases. Their work is associated with potential health hazards including injuries involving infectious human tissue, chemicals which are assumed to be carcinogenic or long periods of microscope and computer work. This study aimed to provide the first comprehensive assessment of the health situation of pathologists in Switzerland.MethodsPathologists in Switzerland were contacted via the Swiss Society of Pathologists and asked to answer an ethically approved, online anonymous questionnaire comprising 48 questions on occupational health problems, workplace characteristics and health behaviour.Results163 pathologists participated in the study. Forty percent of pathologists reported musculoskeletal problems in the previous month. The overall prevalence was 76%. Almost 90% of pathologists had visual refraction errors, mainly myopia. 83% of pathologists had experienced occupational injuries, mostly cutting injuries, in their professional career; more than one fifth of participants reported cutting injuries in the last year. However, long lasting injuries and infectious diseases were rare. Depression and burnout affected every eighth pathologist. The prevalence of smoking was substantially below that of the general Swiss population.ConclusionsThe results of this study suggest that more care should be taken in technical and personal protective measures, ergonomic workplace optimisation and reduction of work overload and work inefficiencies. Despite the described health risks, Swiss pathologists were optimistic about their future and their working situation. The high rate of ametropia and psychological problems warrants further study.

Interventions to increase influenza vaccination rates in children with high-risk conditions--a systematic review.

BACKGROUND Influenza is a common cause of morbidity and mortality, especially among the elderly and those with certain chronic diseases. Annual influenza vaccination is recommended for individuals in at-risk groups, but rates of vaccination are particularly low in children with high-risk conditions (HRCs). OBJECTIVE To conduct a systematic review of studies that have examined interventions aimed at improving influenza vaccination in children with HRCs. METHODS Two databases - PubMed and SCOPUS - were searched (with no time or language restrictions) using a combination of keywords - Influenza AND vaccination OR immunization OR children AND asthma OR malignancy OR high-risk AND reminder. Duplicates were removed, and abstracts of relevant articles were screened using specific inclusion/exclusion criteria. Thirteen articles were selected, and five additional studies were identified following a review of the reference lists of the initial thirteen articles, bringing the total number to eighteen. RESULTS Most studies were conducted in the United States. Among the 18 studies, there was one systematic review of a specific intervention in asthmatic children, seven randomized controlled trials (RCTs), six before-and-after studies, one non-randomized controlled trial, one retrospective cohort study, one quasi-experimental post-test study, and one letter to editors. Interventions reported include multi-component strategies, letter reminders, telephone recall, letters plus telephone calls, an asthma education tool and year-round scheduling for influenza vaccination, amongst others. CONCLUSION There is good evidence that reminder letters will improve influenza vaccination uptake in children with HRCs, but the evidence that telephone recall or a combination of letter reminder and telephone recall will improve uptake is weak. It is not known if multiple reminder letters are more effective than single letters or if multi-component strategies are more effective than single or dual component strategies. There is a need for further research of these interventions, possibly outside the United States.

Do Asians with diabetes in Sandwell receive inferior primary care? A retrospective cohort study.

Although diabetes is more prevalent among Asian people, Asians with diabetes are anecdotally believed to receive a lesser standard of care, compared with non-Asians. The aim of this study was to evaluate whether Asian patients with diabetes in Sandwell receive an inferior standard of care in primary care compared with non-Asians. Standards were based on tests carried out, in compliance with Sandwells Diabetes Local Clinical Guideline. Data were collected from records of 774 patients with diabetes in 14 Sandwell practices. Proportions were recorded of Asian patients receiving specified tests, compared with non-Asians. No significant differences were observed between Asians and non- Asians for checks on feet, eyes, body mass index (BMI), smoking or blood pressure. Significantly fewer Asians received an HbA1c check. The mean HbA1c value was higher in Asians. More Asian patients received a urine test than non-Asians. Asian patients generally had lower BMI values. When stratified by practice however, no significant differences between Asians and non-Asians were observed for any single check. No significant differences were found between the over all proportions of checks carried out between Asians and non-Asians. A wide variation was observed in the proportion of patients who had individual checks done, between practices. There were no systematic differences in the standard of care given to Asian and non-Asian patients. Practices varied a great deal in the extent to which they carry out, and record, checks on patients with diabetes. A possible explanation for the reason that no summary result showed a significant difference was due to the confounding effect of the practice: that general practices tended to treat all their patients - Asian and non-Asian - similarly. Nevertheless, general prac titioners should therefore take steps to ensure that all patients with dia betes have these checks at recommended intervals.

Public health action and mass chemoprophylaxis in response to a small meningococcal infection outbreak at a nursery in the West Midlands, England

Background: Meningococcal infection is fatal in 10% of cases, and age-specific attack rates are highest in infancy. A nursery outbreak was declared just before a bank holiday weekend in August 2010, when two children attending the same nursery were confirmed to have meningococcal infection. Although such outbreaks are rare, they generate considerable public alarm and are challenging to manage and control. This report describes the investigation and public health response to the outbreak. Results: Both cases had relatively mild disease and were confirmed as having serogroup B infection. Chemoprophylaxis and advice were given to most of the 146 children and 30 staff at the nursery. Within 28 hours of declaring the outbreak, over 95% of parents received information, advice and prescriptions for their children. GPs were also given information and the after-hours service provided continuity over the weekend. No further cases were identified and the outbreak was closed four weeks after being declared. Conclusions: Considerable logistical challenges were involved in providing timely advice and chemoprophylaxis to the entire nursery and staff one day before a bank holiday weekend. The speed of the public health response and implementation of preventive measures was crucial in providing assurance to parents and staff, and reducing their anxiety. The decision to provide on-site prescribing at the nursery (coupled with information sessions and individual counselling) proved to be a key implementation-success factor. Effective coordination and management by the outbreak control team was able to rapidly provide leadership, delegate tasks, identify gaps, allocate resources and ensure a proactive media response. A number of useful lessons were learnt and recommendations were made for future local practice.

Mobile telecommunications and health: report of an investigation into an alleged cancer cluster in Sandwell, West Midlands

Aims: Residents of one street expressed concern about the number of incident cancers, following the installation of a nearby mobile phone base station. The investigation explored whether the base station could be responsible for the cancers. Methods: Data were collected from residents’ medical records. GPs and oncologists provided further information. Results: Ward-level cancer incidence and mortality data were also obtained, over four three-year time periods. A total of 19 residents had developed cancer. The collection of cancers did not fulfil the criteria for a cancer cluster. Standardized mortality ratios (SMRs) for all malignant neoplasms (excluding non-melanoma skin cancers) in females (1.38 (95% CI, 1.08–1.74)) and all persons (1.27 (CI, 1.06–1.51)) were significantly higher than in the West Midlands during 2001–3. There were no significant differences for colorectal, female breast and prostate cancers, for any time period. Standardized incidence ratios (SIRs) for non-melanoma skin cancers in males and all persons was significantly lower than in the West Midlands during 1999–2001, and significantly lower in males, females and all persons during 2002–4. Conclusions: We cannot conclude that the base station was responsible for the cancers. It is unlikely that information around a single base station can either demonstrate or exclude causality.

Can Matrix Reimprinting Be Effective in the Treatment of Emotional Conditions in a Public Health Setting? Results of a U.K. Pilot Study

Objectives: This pilot study was carried out to establish the feasibility and effectiveness of Matrix Reimprinting (MR). A dedicated MR/ Emotional Freedom Techniques service was delivered in a community setting within the National Health Service in the metropolitan borough of Sandwell, United Kingdom. Method: Over a 15-month period, the study followed clients accessing the service for a range of emotional conditions. At the start and end of their treatment, clients were asked to complete the CORE-10 (psychological distress; main outcome variable), Warwick-Edinburgh Mental WellBeing Scale (WEMWBS; mental well-being), Rosenberg Self Esteem and Hospital Anxiety and Depression Scale (HADS; anxiety and depression) measurement scales. Results: 24 clients were included in the MR pilot study, and the mean number of sessions attended was 8.33 (Mdn = 6.5). There were both statistically and clinically significant improvements for CORE-10 (52% change, p < .001), Rosenberg Self-Esteem (46% change, p < .001), HADS Anxiety (35% change, p = .007), and HADS total score (34% change, p = .011) and a statistically significant improvement for WEMWBS (30% change, p < .001). All MR clients showed clinical improvements. Conclusions: Despite the limited sample size and other limitations, significant improvements were shown. The results support the potential of MR as a cost-effective treatment to reduce the burden of a range of physical and psychological disorders. Further larger studies are called for, with protocols to minimize dropouts.

Book Reviews: Epidemiology: A Very Short Introduction: By Rodolfo Saracci. Published by Oxford University Press, 2010. Paperback 144pp. Price £7.99. ISBN 978-0-19-954333-5

Calcium and magnesium are essential for human health. The main source of both is food but drinkingwater may provide an important extra source. The concentration of both elements varies widely between supplies and can be further modified by water treatment processes. Does this matter and is there a case for making recommendations on ‘ideal’ levels in potable water? The world Health organization assembled an international expert group to consider whether consumption of drinking-water containing a relatively small amount of calcium and/or magnesium provides positive health benefits. The consensus of the expert group is presented in the first chapter of this book and provides a good thumbnail sketch of recognized problems associated with calcium and magnesium deficiencies, the intake contributions of various types of potable water and suggestions for further studies. This is followed by 11 short chapters providing a background to the conclusions reached by the experts. There is a good coverage of the literature, which highlights how there are important gaps in our knowledge on not only the intake of calcium and magnesium from food and water but also the health significance of a deficient intake. The approach is wide reaching and successfully brings together the clinical aspects of deficiencies with consideration of the dietary sources of calcium and magnesium and with particular reference to the importance of drinking-water. information from clinical trials as well as epidemiological evidence is presented. The importance of calcium and magnesium for human health cannot be over-emphasized and perhaps one of the most useful contributions is the section of perceived gaps in our knowledge and the recommendations for further research. This book provides an authoritative précis of the topic and will be of use to all those interested in the public health aspects of drinking-water.

Lifting the fog--bringing clarity to public health.

Antony Stewart, Professor in Public Health at Staffordshire University gives his view on public health today — and argues that, rightly or wrongly, evidence of clinical efficacy is not enough to guarantee implementation