The Utility of Spot vs 24-Hour Urine Samples for Metal Determination in Veterans With Retained Fragments

OBJECTIVES

The objective of this investigation is to explore the utility of using a spot urine sample in lieu of a 24-hour collection in assessing fragment-related metal exposure in war-injured veterans.

METHODS

Twenty-four veterans collected each urine void over a 24-hour period in separate containers. Concentrations of 13 metals were measured in each void and in a pooled 24-hour sample using inductively coupled plasma mass spectrometry. To assess the reliability of spot sample measures over time, intraclass correlations (ICCs) were calculated across all spot samples. Lin's concordance correlation coefficient was used to assess agreement between a randomly selected spot urine sample and each corresponding 24-hour sample.

RESULTS

In total, 149 spot urine samples were collected. Ten of the 13 metals measured had ICCs more than 0.4, suggesting "fair to good" reliability. Concordance coefficients were more than 0.4 for all metals, suggesting "moderate" agreement between spot and 24-hour concentrations, and more than 0.6 for seven of the 13 metals, suggesting "good" agreement.

CONCLUSIONS

Our fair to good reliability findings, for most metals investigated, and moderate to good agreement findings for all metals, across the range of concentrations observed here, suggest the utility of spot urine samples to obtain valid estimates of exposure in the longitudinal surveillance of metal-exposed populations.

Evaluating a framework for tuberculosis screening among healthcare workers in clinical settings, Inner Mongolia, China

BACKGROUND

Health care workers are at high risk for tuberculosis (TB). China, a high burden TB country, has no policy on medical surveillance for TB among healthcare workers. In this paper, we evaluate whether China's national TB diagnostic guidelines could be used as a framework to screen healthcare workers for pulmonary TB disease in a clinical setting in China.

METHODS

Between April-August 2010, healthcare workers from 28 facilities in Inner Mongolia Autonomous Region, China were eligible for TB screening, comprised of symptom check, chest X-ray and tuberculin skin testing. Healthcare workers were categorized as having presumptive, confirmed, or clinically-diagnosed pulmonary TB, using Chinese national guidelines.

RESULTS

All healthcare workers (N=4347) were eligible for TB screening, of which 4285 (99%) participated in at least one TB screening test. Of the healthcare workers screened, 2% had cough for ≥ 14 days, 3% had a chest X-ray consistent with TB, and 10% had a tuberculin skin test induration ≥ 20 mm. Of these, 124 healthcare workers were identified with presumptive TB (i.e., cough for ≥ 14 days in the past 4 weeks or x-ray consistent with TB). Twelve healthcare workers met the case definition for clinically-diagnosed pulmonary TB, but none were diagnosed with TB during the study period.

CONCLUSION

A substantial proportion of healthcare workers in Inner Mongolia had signs, symptoms, or test results suggestive of TB disease that could have been identified using national TB diagnostic guidelines as a screening framework. However, achieving medical surveillance in China will require a framework that increases the ease, accuracy, and acceptance of TB screening in the medical community. Routine screening with improved diagnostics should be considered to detect tuberculosis disease among healthcare workers and reduce transmission in health care settings in China.

Biological hazards and healthcare-associated infections in Italian healthcare facilities: some considerations on inspections and accountability

Healthcare-associated infections are a major clinical and public health problem that involve, in a variety of ways, healthcare professionals, hospital administrators and, above all, patients. In Italy, the incidence of infectious complications generally varies from 5-10% (hospitalized patients) to 1% (home care patients); 5-10% of such infections manifest epidemically, and infections caused by antibiotic-resistant microorganisms are becoming more and more common, with a mortality rate of 20-30%. Moreover, any "preventable deaths or serious injuries" attributable to a (concrete) causality resulting from a breach of rules, laws and regulations, as well as imprudence, incompetence or negligence by the operators will determine a possibility of a penal prosecution for manslaughter or grievous bodily harm, and also generate expenses for civil procedures and insurance compensation. The adoption of company policies covering appropriate risk assessment, epidemiological monitoring, implementation of guidelines, procedures and protocols, activity of the Hospital Infections Committee and proper communication between managers and facilities, training of healthcare personnel and medical surveillance of employees can help reduce the adverse phenomena of healthcare-associated infections.

The ordinary work environment increases symptoms from eyes and airways in mild steel welders

Purpose

We aimed to follow diary-registered symptoms from eyes and airways in mild steel welders and relate them to different exposure measures. Furthermore, we would clarify the influence of possible effect modifiers.

Methods

Non-smoking welders with (N = 74) and without (N = 32) work-related symptoms the last month were enroled. Symptoms and work tasks each day for three two-week periods during 1 year were obtained. Respirable dust (RD) was measured 1 day each period for each worker. The personal daily exposure was assessed as: (1) days at work, (2) welding time and (3) estimates of RD from welding and grinding, calculated from diary entries and measurements.

Results

Only 9.2 % of the particle measurements exceed the Swedish occupational exposure limit (OEL; 5 mg/m³). Days at work increased the risk of symptoms studied: eyes: 1.79 (1.46–2.19), nasal: 2.16 (1.81–2.58), dry cough: 1.50 (1.23–1.82) and wheezing and/or dyspnoea: 1.27 (1.03–1.56; odds ratio, 95 % confidence interval). No clear dose–response relationships were found for the other exposure estimates. Eye symptoms increased by number of years welding. Nasal symptoms and dry cough increased having forced expiratory volume in first second below median at baseline. Wheezing and/or dyspnoea increased in winter, by number of years welding, having a negative standard skin-prick test and having a vital capacity above median at baseline.

Conclusion

The current Swedish OEL may not protect welders against eye and airway symptoms. The results add to the evidence that welders should be offered regular medical surveillance from early in the career.

Managing genetic tests, surveillance, and preventive medicine under a public health insurance system

There is a prospect in the medium to long term future of substantial advancements in the understanding of the relationship between disease and genetics. We consider the implications of increased information from genetic tests about predisposition to diseases from the perspective of managing health care provision under a public health insurance scheme. In particular, we consider how such information may potentially improve the targeting of medical surveillance (or prevention) activities to improve the chances of early detection of disease onset. We show that the moral hazard implications inherent in surveillance and prevention decisions that are chosen to be privately rather than socially optimal may be exacerbated by increased information about person-specific predisposition to disease.