Guido Moens

Pain-related fear predicts disability, but not pain severity : a path analytic approach of the fear-avoidance model

Two studies are reported that tested the fear‐avoidance (FA) model using path analytic techniques. In study 1, 429 employees with back pain at baseline and back pain at 18 months follow‐up completed questionnaires assessing sociodemographic information, pain severity, negative affect, pain‐related fear, and disability. Results indicated that pain severity at baseline predicted pain‐related fear and disability at follow‐up, and that pain‐related fear is rather a consequence than an antecedent of pain severity. Results further revealed that the disposition to experience negative affect has a low impact upon pain severity and disability, and is best viewed as a precursor of pain‐related fear. Study 2 included 238 employees without back pain at baseline, but who developed back pain at 1 year follow‐up. A similar model as in study 1 was tested. Overall, results are in line with those of study 1. Results are discussed in terms of theoretical relevance and clinical implications.

Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study.

OBJECTIVES To assess the prevalence of varicella zoster virus (VZV) antibodies in Flemish (Belgian) healthcare workers, to investigate the association between seronegativity and selected variables, and to assess the reliability of recall about disease as a predictor of immunity. METHODS A seroprevalence study of VZV antibodies (IgG) was conducted among a systematic sample of 4923 employees in various professional groups, employed in 22 hospitals in Flanders and Brussels (Belgium). Information about sex, age, department, job, and years of employment, the country of origin, and history of varicella was obtained. The presence of VZV antibodies was investigated with the enzyme linked immunosorbent assay (ELISA), Enzygnost anti VZV / IgG (Dade Behring, Marburg, Germany). Statistical analysis was performed by calculating prevalences and prevalence ratios (PRs) and their 95% confidence intervals (95% CIs). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of the recalled history were determined. RESULTS The prevalence of VZV seropositivity in Flemish healthcare workers was 98.5% (95% CI 98.1 to 98.8). Seronegativity was significantly associated with age and job, increasing with both older and younger age. The prevalence of seronegative workers was significantly less in nursing staff than non-nursing staff. There was no significant difference for sex and years of employment. The PPV and NPV of recalled history were 98.9% and 3.4%. Sensitivity and specificity were 83% and 38.9%. CONCLUSION The prevalence of VZV seropositivity was very high in this sample of Flemish healthcare workers. Because of this low overall susceptibility, VZV infection seems not to be an important occupational risk among healthcare workers in Flanders. The increasing seronegativity above the age of 45 is possibly due to a loss of detectable antibodies. A positive history of varicella was a good predictor of immunity, but a negative history had no value as a predictor of susceptibility in adults.

Hepatitis B Vaccination Coverage in Belgian Health Care Workers

Abstract.Background:The hepatitis B virus (HBV) vaccination policy for health care workers (HCW) started in Belgium in 1983. An update of vaccination coverage and rates of seroconversion and seroprotection among HCW can give an insight into the actual status and encourage further development of vaccination programs.Patients and Methods:5,064 HCW were tested for anti-HBs. We considered those who had a positive anti-HBs test as seroconverted (SC) and those who had an anti-HBs titer > 10 IU/l as seroprotected (SP).Results:4,771 HCW were eligible for vaccination; 84.9% of them were effectively vaccinated. Among high-risk professions (nurses, care and laboratory workers), 94.79% were vaccinated; for other professions the vaccination coverage was 69.26%. Of the 1,015 non-vaccinated persons, 293 were anti-HBs positive. Among these 54.95% declared they had had a previous hepatitis infection that was serologically proven to be HBV (anti-HBc positive). Of the remaining 132 positives, 70.45% had previously undergone surgery and/or transfusion. Among these 1,015 non-vaccinated HCW, 59.03% were anti-HBs positive. Of these, 373 were nurses, care or laboratory workers. This contrasts with the results for HCW in other sectors, where 11.49% were anti-HBs positive.Conclusion:In our sample, high vaccination, seroconversion and seroprotection rates were achieved, at least for higher risk HCW. The same conclusion can be drawn if we consider hospital departments which carry a higher risk of bloodborne infections.

Observer variation in computed tomography of pleural lesions in subjects exposed to indoor asbestos.

To assess the reliability of computed tomography (CT) in detecting discrete pleural lesions, the interobserver and intra-observer variability in reading the conventional and high-resolution CT (HRCT) scans of 100 volunteers, who had worked for > or = 10 yrs in a building with known asbestos contamination, was evaluated. In the first session, pleural abnormalities were detected by a single radiologist (A1) in 13 subjects. In the second session, the scans were read again independently by the same radiologist (A2) and two other experienced radiologists (B, C). The final decision for the presence of pleural lesions was made in a final consensus reading. This gave a diagnosis of pleural abnormalities in 18 subjects, of whom eight (44%) had been detected by all three readers, five (28%) by two readers and four (22%) by only one reader; one scan, rated normal by all readers during the second session, was reconsidered because pleural abnormalities had been noted at the first reading (A1). The intra-observer agreement for reader A was good (kappa (kappa) 0.68) but the interobserver agreement between the readers was only fair to moderate (weighted kappa: A2-B=0.43, A2-C = 0.45, B-C = 0.26) in the second reading session. In conclusion, when looking for the prevalence of pleural lesions in indoor asbestos exposed subjects, the potential lack of consistency in reporting the presence of small pleural abnormalities must be borne in mind and strict precautions must be taken.

Prevalence of hepatitis C antibodies in a large sample of Belgian healthcare workers.

OBJECTIVE To assess the risk of hepatitis C virus (HCV) infection among Belgian (Flemish) healthcare workers. DESIGN A seroprevalence survey of HCV IgG antibodies. SETTING AND PARTICIPANTS A systematic sample of 5,064 employees from 22 general hospitals in Flanders and Brussels, Belgium, was tested at the annual occupational medical examination. Together with demographic and occupational data, information was collected on the frequency of blood contact, needlestick injuries, and medical and surgical history. The blood samples were tested using the third-generation Abbott Screen Kit test, with confirmation by Matrix, LIA, and an in-house polymerase chain reaction and the Quantiplex-HCV b-DNA test. RESULTS 21 persons were found to be positive for HCV markers. The overall prevalence was 0.41% (95% confidence interval [CI95], 0.24-0.59). A statistically significant association was found with a history of blood transfusion (odds ratio [OR], 4.14; CI95, 1.67-10.31) and with history of a clinically apparent hepatitis (OR, 3.98; CI95, 1.60-9.90). Although the ORs for the frequency of blood contact were slightly elevated (between 1.17 and 2.73), this association was not significant. Moreover, a history of needlestick injuries showed a nonsignificant OR of 1.28 (CI95, 0.53-3.09), and no statistically significant difference was found with a variety of duties and tasks. The ORs for potential occupational risk factors were adjusted according to age, gender, antecedents, and other confounders using a logistic regression analysis. Based on this procedure, the ORs decreased slightly. CONCLUSIONS Flemish healthcare workers showed a lower HCV seropositivity than is seen in the general population; a history of blood transfusion and of clinically apparent hepatitis was most strongly associated with the presence of HCV markers. We concluded that employees in Flemish regional general hospitals are not at an overall increased risk for HCV infection, although occasional transmission through percutaneous injuries is possible, and prevention therefore remains imperative.

Helicobacter pylori Infection: Further Evidence for the Role of Feco‐Oral Transmission

Background:  Helicobacter pylori infection is recognized as a major cause of chronic digestive diseases with a major public health impact, yet the knowledge of transmission pathways is limited. We studied the transmission in employees taking care of institutionalized persons with mental disabilities with a documented high prevalence of H. pylori.

Prevalence of hepatitis A antibodies in a large sample of Belgian health care workers.

SummaryHealth care workers (HCW), especially women (for example, pediatric nurses and day nursery workers), have been shown to be at risk for viral hepatitis A infections. In order to obtain a more precise estimate of the risk in Belgian HCW, a seroprevalence study was undertaken. The date from this study have been compared with the age-specific seroprevalence of anti-HAV in the general population (GP) as recently estimated. During 1996–1997, a sample of 5,068 employees in 22 general hospitals, geographically distributed over the Flemish and Brussels regions of Belgium, was tested for the presence of anti-HAV. Comparison of the anti-HAV prevalences in HCW and GP shows a significantly lower prevalence in HCW for the age groups 25–34, 35–44 and 45–54 years. Within these age-groups, employees performing catering tasks have the highest prevalence. This difference could be explained by socioeconomic parameters: overrepresentation of higher social classes in better educated HCW. The number of unprotected individuals in young and older age groups (25–54 years) is greater than in the general population. In view of the changing HAV epidemiology in western Europe, the number of unprotected persons will rise in the coming years. Considering the more severe course of the disease as age increases, vaccination may become important in the occupational health strategy for HCW.

Epidemiological and performance indicators for occupational health services: a feasibility study in Belgium

BackgroundIn many European countries, Occupational Health and Safety (OHS) providers report their activities and results annually. Ideally, this report should offer an overview of their activities and of the outcome regarding occupational health and safety. To establish a set of epidemiological and performance indicators for electronic reporting of data that can be used for OHS surveillance and prevention purposes. Consequently, the selected data can serve as indicators for exposure to and prevention of occupational risks (epidemiology), and contribute to the evaluation of the functioning (performance) of OHS providers.MethodsAn extensive literature search in combination with an investigation of existing reporting models was performed. The resulting list of potential indicators was assessed by different stakeholders and divided into indicators for epidemiology and for performance. Then in a feasibility study, the relevance and availability of the indicators were assessed in 17 external, 49 internal (in company) and 10 mixed OHS providers.ResultsFrom the literature survey, we obtained 1100 indicators. After validation, 257 were taken into account in the feasibility study. An indicator was considered relevant when more than 2/3 of the respondents answered in favour of the indicator. The same criterion was applied for availability. Respectively, 82% and 62% of the performance and epidemiological indicators were considered to be relevant for external OHS providers. All relevant performance indicators were available. Of the epidemiological data, only 53% were available. Remarkably, internal OHS providers assessed fewer indicators as relevant (29% and 27% of performance and epidemiology indicators respectively), but these were mostly all available (90%).ConclusionsThis study shows that it is possible to provide a snapshot of the state of OHS by means of the registration of data. These findings could be used to build a data warehouse to study national health and safety profiles and to develop a uniform report for all European countries.

Exposure and inhalation risk assessment in an aluminium cast-house

To date the exposure, absorption and respiratory health effects of cast-house workers have not been described since most studies performed in the aluminium industry are focused on exposure and health effects of potroom personnel. In the present study, we assessed the external exposure and the absorbed dose of metals in personnel from the aluminium cast house. This was combined with an evaluation of respiratory complaints and the lung function of the personnel. 30 workers from an aluminium casting plant participated and 17 individuals of the packaging and distribution departments were selected as controls. The exposure was assessed by the quantification of total inhalable fume with metal fraction and by the determination of urinary aluminium, chromium, beryllium, manganese and lead concentration. Carbon monoxide (CO), carbon dioxide (CO2), aldehydes and polyaromatic hydrocarbons and man-made mineral fibres concentration were assessed as well. In order to evaluate their respiratory status each participant filled out a questionnaire and their lung function was tested by forced spirometry. Total inhalable fume exposure was maximum 4.37 mg m(-3). Exposure to the combustion gases, man-made mineral fibres and metal fume was well below the exposure limits. Beryllium could not be detected in the urine. The values of aluminium, manganese and lead in the urine were all under the respective reference value. One individual had a urinary chromium excretion above the ACGIH defined biological exposure index (BEI) of 30 microg g(-1) creatinine. There was no significant difference in any of the categories of the respiratory questionnaire and in the results of the spirometry between cast house personnel and referents (Chi-square, all p > 0.05). Exposure in cast houses seem to be acceptable under these conditions. However, peak exposure to fumes cannot be excluded and the potential risk of chromium and beryllium exposure due to the recycling of aluminium requires further attention.

The prevalence of infections in psychiatric institutes in Belgium

To assess the prevalence of infections in psychiatric institutes in Belgium, a cross-sectional study was performed within a cluster sample of psychiatric patients from 29 psychiatric institutes (about 40% of all Belgian psychiatric institutes). During May 1992, 8679 patients were analysed. Of the study population 59% were men. The mean age +/- SD was 54.5 +/- 18.3 years, with a median of 55 years. The mean hospitalization period was 9.6 +/- 14.5 years with a median of 2 years. A total of 1334 infections were reported, and 13.1% of the patients had a least one infection (95% CI: 12.4-13.8%) at the time of the study. The most common infections were dermatological infections (31.6%), lower respiratory tract infections (25.8%), urinary tract infections (12.4%) and conjunctivitis (11.6%). Statistically significant associations with infection prevalence were found with age, psychiatric diagnosis, activity of daily living score, the duration of hospitalization, and the qualification of the person answering the survey form. The relevance and the limitations of this study are discussed.