M. van Sprundel

Voiding Habits and Wetting in a Population of 4332 Belgian Schoolchildren Aged Between 10 and 14 Years

Objective: To determine the prevalence of daytime- with/without night-time wetting, in Belgium, in a group of 10 to 14 year old schoolchildren, and to study the voiding habits. Subjects and methods: A questionnaire of 41 questions was developed and completed by 4332 parents at home. Results: Wetting or soiling episodes were reported by a total of 528 (12%) of the children: monosymptomatic nocturnal enuresis by 62 (1%), daytime wetting with/without night-time wetting by 343 (8%), and faecal soiling by 123 (3%). We found significantly more girls in the wetting group, and the capacity to regularly postpone the voiding was significantly lower in this group. Significantly more children had nocturia in the group with wetting. Conclusions: Children with daytime wetting with/without night-time wetting have very often bladder-sphincter dysfunctions, which is in turn correlated with recurrent urinary tract infections. Eight percent of the 10 to 12 year old schoolchildren report daytime wetting with/without night-time wetting with some frequency. Surprisingly few parents, especially in the daytime wetting group, searched for medical help. Physicians and paediatricians should be encouraged to be more attentive to wetting in children and initiate discussion about urinary en faecal problems with parents and children.

The selenium status of Belgian population groups : I. Healthy adults.

A moderate level of selenium (Se) was demonstrated in the blood (123 ng/mL), erythrocytes (RBC) (161 ng/mL), and plasma (97 ng/mL) of 110 male and 54 healthy female Belgian adults by using hydride-generation atomic absorption spectrometry. These values agree well with those found in neighboring countries. The study is the first one to report on normal values for these parameters in Belgians.Glutathione peroxidase (GSH-Px) activity has also been assayed. The group in considered nondeficient. Neither the concentration of Se in blood, plasma, or RBC, nor the activity of GSH-Px in the latter, were related to age, sex, blood pressure, or smoking habits. Oral contraception was associated with elevated plasma Se levels as compared to controls (P<0.01).A statistically significant positive relationship existed between the Se concentrations in whole blood or in red blood cells and red blood cell GSH-Px activity (r=0.31,p<0.005).

Occupational risk factors of lung cancer: a hospital based case-control study.

OBJECTIVES: To investigate the relation between lung cancer and exposure to occupational carcinogens in a highly industrialised region in western Europe. METHODS: In a case-control study 478 cases and 536 controls, recruited from 10 hospitals in the Antwerp region, were interviewed. Cases were male patients with histologically confirmed lung cancer; controls were male patients without cancer or primary lung diseases. Data were collected by questionnaires to obtain information on occupations, exposures, and smoking history. Job titles were coded with the Office of Populations, Censuses and Surveys industrial classification. Exposure was assessed by self report and by job-task exposure matrix. Exposure odds ratios were calculated with logistic regression analysis adjusted for age, smoking history, and marital and socio-economic status. RESULTS: A job history in the categories manufacturing of transport equipment other than automobiles (for example, shipyard workers), transport support services (for example, dockers), and manufacturing of metal goods (for example, welders) was significantly associated with lung cancer (odds ratios (ORs) 2.3, 1.6, and 1.6 respectively). These associations were independent of smoking, education, civil, and economic status. Self reported exposure to potential carcinogens did not show significant associations with lung cancer, probably due to nondifferential misclassification. When assessed by job-task exposure matrix, exposure to molybdenum, mineral oils, and chromium were significantly associated with lung cancer. A strong association existed between smoking and lung cancer: OR of ex-smokers 4.2, OR of current smokers 14.5 v non-smokers. However, smoking did not confound the relation between occupational exposure and lung cancer. CONCLUSIONS: The study has shown a significant excess risk of lung cancer among workers in manufacturing of metal goods, manufacturing of transport equipment (other than automobiles), and transport support services. Assessment of exposure to specific carcinogens resulted in significant associations of chromium, mineral oils, and molybdenum with lung cancer. This study is, to our knowledge, the first study reporting a significant association between occupational exposure to molybdenum and lung cancer.

Co-exposure to lead increases the renal response to low levels of cadmium in metallurgy workers.

PURPOSE Research on the effect of co-exposure to Cd and Pb on the kidney is scarce. The objective of the present study was to assess the effect of co-exposure to these metals on biomarkers of early renal effect. METHODS Cd in blood (Cd-B), Cd in urine (Cd-U), Pb in blood (Pb-B) and urinary renal biomarkers, i.e., microalbumin (μ-Alb), beta-2-microglobulin (β₂-MG), retinol binding protein (RBP), N-acetyl-β-d-glucosaminidase (NAG), intestinal alkaline phosphatase (IAP) were measured in 122 metallurgic refinery workers examined in a cross-sectional survey. RESULTS AND CONCLUSIONS The median Cd-B, Cd-U, Pb-B were: 0.8 μg/l (IQR = 0.5, 1.2), 0.5 μg/g creatinine (IQR = 0.3, 0.8) and 158.5 μg/l (IQR = 111.0, 219.3), respectively. The impact of Cd-B on the urinary excretion of NAG and IAP was only evident among workers with Pb-B concentrations ≥ 75th percentile. The association between Cd-U and the renal markers NAG and RBP was also evidenced when Pb-B ≥ 75th percentile. No statistically significant interaction terms were observed for the associations between Cd-B or Cd-U and the other renal markers under study (i.e., μ-Alb and β2-MG). Our findings indicate that Pb increases the impact of Cd exposure on early renal biomarkers.

Results of a questionnaire evaluating the effects of different methods of toilet training on achieving bladder control

Objective To analyse if family situation, personal habits and toilet training methods can influence the achievement of bladder control.

Selenium in environmental and drinking waters of Belgium

The tetravalent and hexavalent selenium content of water samples can be determined by conventional energy-dispersive X-ray fluorescence after different preconcentration steps. Selenium values of nearly three-hundred different environmental and drinking water samples in Belgium are reported. The results are quite low, ranging from the detection limits up to 1 microgram 1-1. The concentration levels are compared to literature data and the speciation is discussed. The contribution of drinking water to the daily intake of selenium in Belgium ranges from less than 0.2 to 5%.

Hepatitis E virus infection: an emerging occupational risk?

BACKGROUND Hepatitis E virus (HEV) infection is endemic in many developing countries, causing substantial morbidity. Transmission is primarily faeco-oral and is associated with both sporadic infections and epidemics in areas where poor sanitation and weak public health infrastructures exist. Recently, it has become clear that HEV is also an endemic disease in industrialized countries. Moreover, a porcine reservoir and growing evidence of zoonotic transmission have been reported in these countries, suggesting the possibility of occupational transmission to man. AIMS To summarize the current knowledge on the epidemiology and prevention of transmission of HEV infection in occupational settings. METHODS The following key words were used to explore PubMed: hepatitis E, disease, epidemiology, profession(al), occupation(al). RESULTS After screening of the results, 107 publications were retained. In non-endemic regions, seroprevalence varied from a few per cent (2-7.8%) in Europe, Japan and South America to 18.2-20.6% in the USA, Russia, UK, southern France and Asia. A meta-analysis of 12 cross-sectional studies evaluating HEV immunoglobulin G (IgG) seroprevalence in individuals occupationally exposed to swine showed greater odds of seropositivity in the exposed group but also a high degree of heterogeneity. A funnel plot suggested publication bias. CONCLUSIONS There was a significant association between occupational exposure to swine and HEV IgG seroprevalence, but the level of prevalence detected depended also on the type of HEV IgG kits used. Further research, including on mechanisms and risk factors for infection, as well as the development of better serological tests for identification of infection, is required.

The occupational risk of Helicobacter pylori infection among workers in institutions for people with intellectual disability

Objectives: A cross-sectional study to evaluate the occupational risk for Helicobacter pylori infection, on top of other risk factors, in staff members of institutions for people with intellectual disability. In these institutions, the residents had a documented high prevalence of H pylori infection (86% presenting antibodies). As a control group, the study used administrative workers from other companies. Methods: All participants completed a questionnaire concerning sociodemographic characteristics, medical history and employment data and they underwent a serology test. Results: 671 staff members of the institutions and 439 subjects in the control group participated in the study. Prevalence of H pylori antibodies was significantly higher in the study group than in the control group (40.6% vs 29.2%; p<0.001). Crude odds ratio for occupational risk was 1.68; adjusting for the confounding effect of age, gender, body mass index, smoking, tropical journeys and number of household members during childhood resulted in an even higher (adjusted) OR of 1.98 (95% CI 1.42 to 2.69). In multiple logistic regression analysis adjusting for variables shown to be confounders, faecal contact continued to be significantly associated with H pylori infection. Attributable risk was 49.5%. Conclusions: H pylori infection is an occupational risk in healthcare workers working in institutions for people with intellectual disability. We identified faecal contact as an independent occupational risk factor for H pylori infection.

Need for a comprehensive, consistently applied national hepatitis B vaccination policy for healthcare workers in higher educational institutions: a case study from South Africa.

BACKGROUND Hepatitis B virus (HBV) is transmitted by infected blood and other body fluids, placing healthcare workers (HCWs) and student HCWs at increased risk of HBV infection through occupational exposure. AIM To establish the existence, content and implementation of hepatitis B (HB) vaccination policies for student HCWs being trained at higher educational institutions (HEIs) in South Africa. METHODS Self-administered structured questionnaires were sent to 23 nursing colleges and 11 universities in South Africa that train doctors, nurses or dentists. FINDINGS Twelve (35%) questionnaires were returned. Ten HEIs had a policy consisting mainly of recommendations given to students at registration. Nine HEIs made HB vaccinations available, with four HEIs covering the cost through student fees. Seven HEIs did not require a record of previous vaccination. Six HEIs did not accept non-responders (NRs), three HEIs would only accept an NR after receiving a second three-dose vaccination series and counselling, six HEIs regarded an HBV carrier as infectious, and 10 HEIs would accept HBV carriers as students. The low response rate makes it difficult to generalize the results, but may suggest a lack of an HB vaccination policy for student HCWs at non-responding HEIs. CONCLUSIONS Policies of responding HEIs regarding HB vaccination, HBV carriage and response to HB vaccination were variable, sometimes inappropriate and not sufficiently comprehensive to protect student HCWs against occupationally acquired HBV. This emphasizes the need for a comprehensive, consistently applied, nationally coordinated vaccination policy to ensure that student HCWs receive proper protection against HBV infection.

Comparative immunogenicity of two vaccination schedules of a combined hepatitis A and B vaccine in healthy volunteers.

Summary.  In 1996, a combined vaccine against both hepatitis A and B was licensed and commercialized and has been recommended for healthcare personnel in Belgium. This study compares the immunogenicity against hepatitis B virus (HBV) and safety of two vaccination schedules (0–1–12 months and 0–1–6 months) with this vaccine. This is a randomized, stratified and controlled study in healthy adult workers, who are not occupationally exposed to HBV. Seroconversion (≥1 IU/L) and seroprotection (≥10 IU/L) rates were compared using Fisher’s exact test; geometric mean concentrations (GMCs) of anti‐HBs were compared using one‐way ANOVA. All statistical analyses were carried out with SPSS 11 on Apple Macintosh. A total of 399 subjects were enrolled in the study, and 356 were analysed according to the protocol. The rate of ≥10 IU/L at 6 months was 70.6% in the group 0–1–12 and 79.9% in the group 0–1–6; this rate decreased to 55.9% at 12 months in the first group. Seroconversion and seroprotective rates against HBV measured at month 13 in group 0–1–12 (98.9% and 95.6%) and measured at month 7 in group 0–1–6 (99.4% and 97.1%) were not statistically significantly different. GMC of anti‐HBs after the 0–1–12 schedule was more than two fold higher than after 0–1–6 schedule (P < 0.001). Reported side effects were comparable in both groups with a slight tendency to fewer side effects in the 0–1–12 group after the third dose. The results from our study show that the completed schedule 0–1–12 offers at least equal protective immunogenicity against HBV as the completed 0–1–6 schedule. People not receiving their third dose at 6 months can be given this dose up to 12 months after the first dose. The drawback of this flexibility, however, is the longer time period before the protection becomes effective.