Luca Cegolon

Jellyfish Stings and Their Management: A Review

Jellyfish (cnidarians) have a worldwide distribution. Despite most being harmless, some species may cause local and also systemic reactions. Treatment of jellyfish envenomation is directed at: alleviating the local effects of venom, preventing further nematocyst discharges and controlling systemic reactions, including shock. In severe cases, the most important step is stabilizing and maintaining vital functions. With some differences between species, there seems to be evidence and consensus on oral/topical analgesics, hot water and ice packs as effective painkillers and on 30 s application of domestic vinegar (4%–6% acetic acid) to prevent further discharge of unfired nematocysts remaining on the skin. Conversely, alcohol, methylated spirits and fresh water should be carefully avoided, since they could massively discharge nematocysts; pressure immobilization bandaging should also be avoided, as laboratory studies show that it stimulates additional venom discharge from nematocysts. Most treatment approaches are presently founded on relatively weak evidence; therefore, further research (especially randomized clinical trials) is strongly recommended. Dissemination of appropriate treatment modalities should be deployed to better inform and educate those at risk. Adequate signage should be placed at beaches to notify tourists of the jellyfish risk. Swimmers in risky areas should wear protective equipment.

Body piercing and tattoo: awareness of health related risks among 4,277 Italian secondary school adolescents

BackgroundThe awareness of health risks associated with body art among secondary school pupils has never previously been studied in depth. A large sample of secondary school adolescents from the Veneto Region (North East Italy) were investigated in order to inform health education programs.Methods6 public secondary schools from each of the 7 Provinces of the Veneto Region were selected. All students attending the 1st, 3rd, and 5th school years were surveyed by an anonymous self administered questionnaire on their perception of health risks related to body art and other explanatory variables. Logistic regression analysis was employed, reporting adjusted Odds Ratios (OR) with 95% Confidence Interval (CI).ResultsAmong 4,277 available students (aged 14-22 years), boys were consistently: less knowledgeable of infectious diseases related to body art (OR = 0.78; CI: 0.66, 0.94), less likely to be aware of the hygienic norms to be observed in a body art parlour (OR = 0.54; 0.44, 0.65), less likely to refer to a certified body art parlour (OR = 0.56; 0.48, 0.66), less likely to refer to a professional health care provider for complications related to body art (OR = 0.71; 0.59, 0.86). Students attending the first school year (baseline) had a lesser knowledge of body art related infectious diseases, were less likely to refer to a certified body art parlour, and to know the mandatory hygienic rules to be observed when performing body modifications. Interviewees from the provinces of Rovigo and Vicenza were less likely to be conscious of the health risks associated with body modifications, and those with tattoos were less knowledgeable about the infection risk (OR = 0.60; 0.42, 0.86) and less likely to refer to a professional health care provider in case of medical complication (OR = 0.68;0.48, 0.95). Students with piercings were less likely to refer to a certified practitioner for receiving body art (OR = 0.62; 0.50, 0.77) or therapy for medical complications (OR = 0.37; 0.29, 0.46).ConclusionsHealth education programs should focus on males, pupils attending lower school years, living in specific Provinces of the Region, and with a positive attitude towards piercing or tattoo.

The Primary Care Practitioner and the diagnosis of occupational diseases

BackgroundRather than a clinical diagnosis, in occupational medicine the critical point is the etiological diagnosis. The first is useful for the therapy, the latter for preventive, epidemiological, regulatory, and insurance measures.DiscussionAs with causality criteria which are employed in population studies, the answering of four easy questions allows a Primary Care Practitioner to establish a causal link between the work activities and a potential disease that a specific patient may present.After determining the clinical diagnosis and the actual pathology of an occupational disease, the identity, duration, and intensity of the exposure have to be detected for establishing a close-causal effect. The judgment on the occupational origin of the disease requires an integrated approach using multiple sources of information, and goes beyond the clinical diagnosis. This may require consultation with a specialist in occupational medicine.SummaryIt is important that the Primary Care Practitioner takes an accurate medical history since this may be the only chance a patient has to have their occupational disease recognised and properly detected/identified. Proper identification of the causative nature of such diseases is important for establishing preventive measures in eliminating and controlling future cases against exposure, epidemiological reporting and studies (particularly in identifying the rates of disease), regulatory reporting requirements and insurance compensation.

Asbestos abatement workers versus asbestos workers: exposure and health-effects differ.

Szeszenia-Dąbrowska et al. [1] provided an interesting view on the current state of asbestos-related diseases in Poland. Observation reported in this study can be extended to other developed nations. As mentioned by the authors, asbestos exposure levels have dramatically changed since the 1950/1960’s (e.g., 8 to 0.001 f/cc). The type of activity associated with asbestos has also changed. Historically, asbestos workers (AW) were involved with mining, manufacturing and installing asbestos-containing materials (ACM), while today abatement workers conduct its removal and disposal. These two groups are different and distinct populations, experience dissimilar exposure and differing health consequences from asbestos. Most studies today include anyone historically or presently involved with ACM in the same category; however, these two groups should be distinguished. Exposure of asbestos abatement workers (AAW) is very low (0.001 to 0.080 f/cc) as noted in SzeszeniaDąbrowska paper and other reports [2]. This level of exposure will result in negligible rates of asbestos-related diseases as has been seen for AW [3]. Presently, only one study [4] evaluated health-effects of AAW. Most studies/reports use AW in discussing potential health hazards of AAW, which is erroneous and misleading. Health-related effects for AAW from asbestos have shown little hazard from this mineral with the major consequences coming from personal habits, especially smoking [3,5]. As a result of the high rate of smoking (50 to 70%), cancer risks, particularly lung cancer, will remain high for AAW [5,6]. Smoking rates for AAW not appear to have changed over the past 25 years, in the United States, despite required education of this occupational population [5,6]. It is becoming important to distinguish these two groups; although, historically, they have been included as one population. Current protective practices related to AAW are not oriented toward present risks [5]. Education and training for AAW should focus on smoking cessation and other personal habits/risk reduction (e.g., drug use, driving hazards), which represents actual risks [3]. Preventive practices related to these personal activities will provide the highest benefits in reducing short and long-term health-effects for this occupational population [5]. Thus, legislation needs to focus on present hazards and less on asbestos directly.

Epidemiological pattern of leprosy in an endemic area of North-East Brazil, 1996-2005: the supporting role of a Nongovernmental Organization

In an endemic area of North-East Brazil (the town of Picos, State of Piauí), a nongovernmental organization (NGO) supported the activity against leprosy in connection with governmental health organizations and local agents. The indicators of leprosy elimination were compared over time (within Picos) and across space (Picos versus Piauí). The case detection rate, above 8 per 10,000 people in the last two years of observation, increased over time in Picos (p=0.010). This finding could be due to active detection activities rather than expanding endemicity, as suggested by the reduction in leprosy in children (p=0.053) and the decrease in the proportion of new cases with grade 2 disability (p<0.001). These indicators showed a more favorable time trend in the city than in the State, suggesting that NGO activity was supportive in the battle towards leprosy control.

Infectious disease risk in asbestos abatement workers

BackgroundThe current literature reports increased infectious disease occurrence in various construction occupations, as an important contributor to morbidity and mortality arising from employment.These observations should be expanded to asbestos abatement workers, as the abatement can create an environment favorable for bacterial, viral and fungal infections.DiscussionAsbestos abatement work employs activities resulting in cuts, blisters and abrasions to the skin, work in a dirty environment and exposure to dust, mists and fumes.Furthermore, this population exhibits a high smoking rate which increases the risk of chronic obstructive pulmonary disease and respiratory infections.In addition, these workers also commonly employ respirators, which can accumulate dirt and debris magnifying exposure to microbes. Use of respirators and related types of personal protective equipment, especially if shared and in the close environment experienced by workers, may enhance communicability of these agents, including viruses.SummaryAbatement workers need to be provided with information on hazards and targeted by appropriate health education to reduce the infection risk. Epidemiological studies to investigate this risk in asbestos removers are recommended.

Osteopontin, asbestos exposure and pleural plaques: a cross-sectional study

BackgroundOsteopontin (OPN) is a plasma protein/cytokine produced in excess in several malignancies. In a recent study OPN was reported as being related to the duration of asbestos exposure and presence of benign asbestos-related diseases; however, it was unclear whether this protein was an indicator of exposure or effect.MethodsIn 193 workers, 50 with pleural plaques (PP), in whom different indicators of past asbestos exposure were estimated, OPN plasma levels were assessed using commercial quantitative sandwich enzyme immunoassays according to the manufacturers instructions.ResultsOsteopontin increased with increasing age and several aspects of asbestos exposure, without differences related to the presence of pleural plaques. At multivariable regression analysis, the explanatory variables with a significant independent influence on OPN were length of exposure (positive correlation) and time elapsed since last exposure (positive correlation).ConclusionsSince asbestos in lung tissue tends to wane over time, OPN should decrease (rather than increase) with time since last exposure. Therefore, OPN cannot be a reliable biomarker of exposure nor effect (presence of pleural plaques).

Work related injuries: estimating the incidence among illegally employed immigrants

BackgroundStatistics on occupational accidents are based on data from registered employees. With the increasing number of immigrants employed illegally and/or without regular working visas in many developed countries, it is of interest to estimate the injury rate among such unregistered workers.FindingsThe current study was conducted in an area of North-Eastern Italy. The sources of information employed in the present study were the Accidents and Emergencies records of a hospital; the population data on foreign-born residents in the hospital catchment area (Health Care District 4, Primary Care Trust 20, Province of Verona, Veneto Region, North-Eastern Italy); and the estimated proportion of illegally employed workers in representative samples from the Province of Verona and the Veneto Region. Of the 419 A&E records collected between January and December 2004 among non European Union (non-EU) immigrants, 146 aroused suspicion by reporting the home, rather than the workplace, as the site of the accident. These cases were the numerator of the rate. The number of illegally employed non-EU workers, denominator of the rate, was estimated according to different assumptions and ranged from between 537 to 1,338 individuals. The corresponding rates varied from 109.1 to 271.8 per 1,000 non-EU illegal employees, against 65 per 1,000 reported in Italy in 2004.ConclusionsThe results of this study suggest that there is an unrecorded burden of illegally employed immigrants suffering from work related injuries. Additional efforts for prevention of injuries in the workplace are required to decrease this number. It can be concluded that the Italian National Institute for the Insurance of Work Related Injuries (INAIL) probably underestimates the incidence of these accidents in Italy.

A worksite intervention to reduce the cardiovascular risk: proposal of a study design easy to integrate within Italian organization of occupational health surveillance

BackgroundDespite the substantial amount of knowledge on effectiveness of worksite health promotion (WHP) in reducing cardiovascular disease (CVD) risk, WHP programs are not systematically applied in Italy. The aim was to design an intervention easy to integrate within the Italian organization of workplace health surveillance.MethodsWe used the “pretest-posttest design”. Workers were employed in multiple occupations and resident in Veneto region, Italy. Occupational physicians (OPs) performed all examinations, including laboratory evaluation (capillary blood sampling and measure of glycaemia and cholesterolemia with portable devices), during the normal health surveillance at worksite. CVD risk was computed based on sex, age, smoking habit, diabetes, systolic pressure and cholesterol level. After excluding those with <40 years of age, missing consent, CVD diagnosis or current therapy for CVD, missing information, CVD risk <5%, out of 5,536 workers 451 underwent the intervention and 323 male workers were re-examined at 1 year. CVD risk was the most compelling argument for changing lifestyle. The counseling was based on the individual risk factors. Individuals examined at posttest were a small fraction of the whole (6% = 323/5,536). In these workers we computed the ratio pretest/posttest of proportions (such as percent of subjects with cardiovascular risk >5%) as well as the exact McNemar significance probability or the exact test of table symmetry.ResultsCVD risk decreased by 24% (McNemar p = 0.0000) after the intervention; in a sensitivity analysis assuming that all subjects lost to follow-up kept their pretest cardiovascular risk value, the effect (−18%) was still significant (symmetry p < 0.0000). Each prevented CVD case was expected to cost about 5,700 euro.ConclusionsThe present worksite intervention promoted favorable changes of CVD risk that were reasonably priced and consistent across multiple occupations.