Health Vigilance Research Articles

Geographic dimensions of a health network dedicated to occupational and work related diseases.

BackgroundAlthough introduced nearly 40 years ago, Geographic Information Systems (GISs) have never been used to study Occupational Health information regarding the different types, scale or sources of data. The geographic distribution of occupational diseases and underlying work activities were always analyzed independently. Our aim was to consider the French Network of Occupational Disease (OD) clinics, namely the “French National OD Surveillance and Prevention Network” (rnv3p) as a spatial object in order to describe its catchment.MethodsWe mapped rnv3p observations at the workplace level. We initially analyzed rnv3p capture with reference to its own data, then to the underlying workforce (INSEE “Employment Areas”), and finally compared its capture of one emblematic occupational disease (mesothelioma) to an external dataset provided by a surveillance system thought to be exhaustive (PNSM).ResultsWhile the whole country is covered by the network, the density of observations decreases with increase in the distance from the 31 OD clinics (located within the main French cities). Taking into account the underlying workforce, we show that the probability to capture and investigation of OD (assessed by rates of OD per 10,000 workers) also presents large discrepancies between OD clinics. This capture rate might also show differences according to the disease, as exemplified by mesothelioma.ConclusionThe geographic approach to this network, enhanced by the possibilities provided by the GIS tool, allow a better understanding of the coverage of this network at a national level, as well as the visualization of capture rates for all OD clinics. Highlighting geographic and thematic shading zones bring new perspectives to the analysis of occupational health data, and should improve occupational health vigilance and surveillance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12942-016-0063-7) contains supplementary material, which is available to authorized users.

Phycotoxins by Harmful Algal Blooms (HABS) and Human Poisoning: An Overview

Phycotoxins are potent natural toxins synthesized by certain marine algae and cyanobacteria species during quot Harmful Algal Blooms quot HABs often seen as water discoloration known as quot Red Tides quot quot Green Tide quot They are grouped by chemical structure mechanisms of action target tissues biological and health effects A constant threat to public health and economy environmental contaminants in aquatic ecosystems seafood drinking water requiring multidisciplinary action at the local and international level to manage their potentially harmful effects The bloom of toxigenic Pseudo nitzschia along the west coast of North America resulted in domoic acid contamination of crab and clams numerous harvesting closures and Consumer Warning issued by local public health authorities Whereas the massive cyanobacteria blooms reported in Florida in June lead to banning drinking water in some locations Public health vigilance monitoring and research need to be maintained and enhanced Despite scientific advancements phycotoxin research relating to human exposure and health consequences are sparse while blooms of toxigenic species have become more prevalent worldwide At present phycotoxins poisonings diagnosis and management largely based on the ability of health care provider to interpret presenting clinical symptoms collect exposure history identify and establish the exposure event Several phycotoxins are neurotoxic potentially lethal and or associated with chronic adverse health effects Human intoxications are often misdiagnosed under diagnosed and under reported to public health authorities hampering proper management and epidemiology data A regulatory standard alertness by public health organizations and primary health care providers in regions with a history of HABs helps to minimize and manage human health risks Nonetheless there are populations at higher risk of exposure due to cultural practices recreational shellfish pickers anglers aboriginals in coastal regions Human exposure and poisoning can occur worldwide after consuming contaminated seafood while traveling or products imported from world location with limited analytical facilities and regulatory implementation

Vigilancia epidemiológica de la sífilis en la ciudad de Valencia. Impacto y evolución del período 2003-2014

In Spain syphilis shows an increasing trend from last decade and multiple papers reported an increasing of exposed population.Our aim was to describe the evolution of the incident of the syphilis in the geographical frame of the city of Valencia, to identify the characteristics and practices of risk of the affected ones.A classic design of vigilance of public health was applied, longitudinal retrospective study. Geographical area: the city of Valencia. Period: January 2003-December 2014. Variables: age and sex, national origin, dates of access to the sanitary system, date of diagnosis, clinical forms of presentation, conducts of risk, and practices of risk.The annual impact of the disease evolved from 2.4 × 105 in 2004 up to 14.5 × 105 in 2014. Males (82.96%) masculinity rate: 4.8. Major specific incidence took places on age-groups 35-39 years with 16.49 × 105 and 40-44 years with 16.98 × 105. The difference between women stands out according to origin: middle ages in autochthonous (39.72 years) opposite to foreigners (32.91 years); P = .004. The primary forms were 5 times more probable in males. The major factor of risk was to have multiple couples (54.89%), man-to-man homo or bisexuals reaches 90.0% of it. The HIV (human immunodeficiency virus) infection was 29.07% in males and 4.35% in women. Precedent of multiple couple relations would not be a minor of 42 times more likely among the homosexual population with syphilis.Major determinant of risk were the relations with multiple pairs and the prevention will have to be focused to the group of men who practice sex with men.

Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination.

Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.

GIS applied to agriclimatological zoning and agrotoxin residue monitoring in tomatoes: A case study in Espírito Santo state, Brazil

Searches related to global warming have provided important insights into the response of terrestrial ecosystems, but few have examined the impacts on agricultural crops, particularly those associated with the monitoring of agrotoxin residues. In this context, the agriclimatological zoning is an important tool in the planning and consolidation of crops and should be considered in any initiative that involves such planning. This tool is particularly important in the analysis of agrotoxin residues and may be applied by the Program Analysis of Agrotoxin Residues in Food (PARA) created by the National Health Vigilance Agency of Brazil (ANVISA), which enables greater food security and contributes to the improvement of human health. The aim of this study was to elaborate the current and future agriclimatological zoning for the tomato crop, relating it with the monitoring of samples collected by PARA in Espírito Santo State, Brazil. The results indicate that a temperature increase of 5 °C creates a decrease in apt areas from 37.3% to 4.3%, for a total reduction of 33 percentage points (−88.5%). It is noted that of the 41 producing municipalities, only 26 have apt areas greater than 50%, highlighting the municipalities with apt areas greater than 90%, represented by Mantenópolis (100%), Guaçuí (98.5%), São José do Calçado (97.8%), Irupi (94.4%), Santa Teresa (92.3%), and Marechal Floriano (91.4%). The veracity of agriclimatological zoning is proved by a Kendall rank correlation coefficient of 0.876, indicating that the distribution of the variables of apt areas and productivity are similar at the significance level of 0.05 with a confidence interval 95%. After validation of the agriclimatological zoning for the tomato crop, it is recommended that the PARA should monitor 36 municipalities rather than the current 18, representing an increase of 100%. The methodology can be adjusted to agricultural crops of other countries.

Ebola Virus Disease--Sierra Leone and Guinea, August 2015.

The Ebola virus disease (Ebola) outbreak in West Africa began in late 2013 in Guinea (1) and spread unchecked during early 2014. By mid-2014, it had become the first Ebola epidemic ever documented. Transmission was occurring in multiple districts of Guinea, Liberia, and Sierra Leone, and for the first time, in capital cities (2). On August 8, 2014, the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern (3). Ministries of Health, with assistance from multinational collaborators, have reduced Ebola transmission, and the number of cases is now declining. While Liberia has not reported a case since July 12, 2015, transmission has continued in Guinea and Sierra Leone, although the numbers of cases reported are at the lowest point in a year. In August 2015, Guinea and Sierra Leone reported 10 and four confirmed cases, respectively, compared with a peak of 526 (Guinea) and 1,997 (Sierra Leone) in November 2014. This report details the current situation in Guinea and Sierra Leone, outlines strategies to interrupt transmission, and highlights the need to maintain public health response capacity and vigilance for new cases at this critical time to end the outbreak.

Health problems of nursing workers in a public educational institution

To identify the issues occurred with nursing workers through a Health Monitoring System for Nursing Workers (SIMOSTE) and to describe the consequences of those problems. This is a quantitative, exploratory and descriptive study realized in a teaching hospital in the west region of the city of São Paulo. From the SIMOSTE, 1.847 occurrences were registered in a six month period. Within the main occurrences, medical licenses, work related accidents with and without removals; psychiatric consultations and psychotherapy were highlighted. The data points out to the need for the development of new health vigilance actions to notify accidents and illness related to work, besides the prevention of issues.

Novel coronavirus infection in the Eastern Mediterranean Region: time to act

The Eastern Mediterranean Region of World Health Organization has been an emerging focus for global health after the discovery of a novel coronavirus infection in some countries in the Region. The Region has already witnessed a number of emerging zoonoses with epidemic potential. In view of this new virus, there is now an urgent need for strong public health vigilance and monitoring of the evolution of the virus in the Region. The situation will challenge and test the national health authorities' resilience and ability to respond in a timely manner. This review summarizes the evidence related to the emergence in the Region of new epidemic diseases of predominantly zoonotic origin and the challenges posed by the discovery of the novel coronavirus infection, and outlines recommendations for the countries for early detection, prevention threats from this novel coronavirus infection. and control of public health

Tracing New Occupational Diseases, an Introduction

Continuous changes in work and in working conditions give rise to new occupational health risks and possibly to new occupational diseases. Social partners and governments have a need for timely and specific knowledge about new risks. Where there is insufficient knowledge of these risks, opportunities for intervention and prevention are missed. Although a great deal of effort goes into risk assessment, in order to manage the risks brought on by new technologies, signalling new and undesirable side-effects of work on health is a complementary approach. The approach of occupational health and safety vigilance is comparable with analyzing and learning from occupational accidents and identification of the adverse effects of drugs: although drugs have undergone extensive testing for safety in the research phase, they may produce unexpected and sometimes serious adverse health effects after introduction into the market. In society, the need to identify new health risks more quickly and more effectively has grown rapidly over the past decade. The continuous need to identify new risks is a process that involves uncertainty, and on in which a balance must be found between a dynamic approach and a careful approach. The challenge is to prevent any occupational damage to health without creating unnecessary concern. There is a growing impact of chronic work-related health problems, such as musculoskeletal disorders, psycho-social risks, and stress at work. There are fears that nanotechnology risks a repeat of the asbestos tragedy. Reproductive capacity can be endangered by the health problems that can arise when parents-to-be or their unborn children are exposed to risk factors that present in the work environment. Various methods exist to identify the occurrence of occupational diseases. At times this leads to detection of new occupational health risks. The power and limitation of these methods form the core of this Congress in which organ-system oriented issues and specific new occupational diseases are contested, discussed, and represented in the papers herein. This Congress was meant to help to create an international network for knowledge exchange in this field. A European consortium is already established; Monitoring trends in Occupational Diseases and New and Emerging Risks Net work (MODERNET). This will make the best possible use of nationally of existing expert groups, as well as promoting the cooperation between institutes of various countries that are charged with the detection and evaluation of new health risks. A source of inspiration for this Congress was the International Symposium on New Epidemics in Occupational Diseases in Helsinki in 1994 [1] the close collaboration with Finnish Institute of Occupational Health (FIOH) in the organization of this Congress was very much appreciated. The Congress was held in the Academic Medical Center in Amsterdam, the Netherlands. It was organized by the Scientific Committee on Occupational Medicine from the International Commission on Occupational Health (ICOH) and the Netherlands Center of Occupational Diseases from the Coronel Institute. The Congress was supported by international bodies: International Labour Organization, World Health Organization and European Agency for Safety and Health at Work (EU-OSHA) and the Netherlands Ministry of Employment and Social Affairs.

Book Review: Global Public Health Vigilance: Creating a World on Alert

Book Review: Global Public Health Vigilance: Creating a World on Alert

Psychiatry disorders and dengue: Is there a relationship?

The aim of this study was to examine the relationship of compulsive hoarding with dengue. Fifty two adults notified by health vigilance authorities because of inappropriate trash accumulation in vacant lots in Goiânia, Central Brazil, completed a questionnaire regarding the presence and severity of hoarding behavior (Hoarding Rating Scale-Interview HRS-I). Five dimensions of hoarding are evaluated with this instrument: difficulty using spaces due to clutter, difficulty discarding possessions, excessive acquisition of objects, emotional distress and functional impairment due to hoarding behaviors. The sample was primarily male, with an average age of 49 years. Eighty six percent of the sample scored 14 or greater on the HRS-I, indicating pathological hoarding. The medias of the five HRS-I domains were high, indicating severeness of all dimentions of pathological hoarding. These results highlight the relationship between psychiatric disorder and actions upon environmental conditions that favors dengue, as well as its associated public health burden.

A ORGANIZAÇÃO DA ESTRATÉGIA SAÚDE DA FAMÍLIA E ASPECTOS RELACIONADOS AO ATRASO DO DIAGNÓSTICO DA TUBERCULOSE

Objetivou-se analisar a relação entre a organização dos serviços de saúde e os fatores que influenciam no retardo do diagnóstico da tuberculose em Distritos Sanitários do Município de João Pessoa-Paraíba. Pesquisa qualitativa que envolveu seis trabalhadores da gestão de saúde – apoiadores matriciais. As informações foram coletadas mediante entrevista semiestruturada e tratadas pela técnica de Análise de Discurso. Os resultados mostram que nas equipes da Estratégia Saúde da Família não há planejamento das ações de controle da tuberculose e que prevalece a busca passiva dos sintomáticos respiratórios, demonstrando que os serviços não estão organizados para o efetivo controle da doença. Os discursos dos sujeitos também indicam que, como gestores, desconhecem a estratégia oficial de enfretamento da tuberculose e não estão sintonizados com os conceitos de promoção e vigilância da saúde. Conclui-se que o modo como está organizado o controle da tuberculose concorre para o retardo ao diagnóstico.

Enfermagem e atenção à saúde do trabalhador: a experiência da ação de imunização na Fiocruz/Manguinhos

The worker, while doing his activities in contact with pathogenic agents, is exposed to the risk of getting diseases that could result in death. The immunization appears as one of the ways to preserve and protect against this contamination. This article presents an experience of workers immunization during the period of 2005 to 2008, by the implantation of the project Nursing Integral Actions of Worker's Health Vigilance at Fundação Oswaldo Cruz (Fiocruz), Manguinhos campus, Rio de Janeiro. This is a descriptive, explorative and quantitative study, using primary data from the construction of the project. During the project 12.904 doses of different vaccines were applied in a population with a variety of job activities and ages. Civil construction, security, gardening, maintenance and clearing service teams were the most mobilized and receptive to the activities. With this experience it was possible the installation of the vaccination room at CST/DIREH/Fiocruz, the implantation of campaigns at the unities, specific immunization actions to the workers and operative groups and lectures focused in health education.

Antimicrobial Resistance among Invasive Nontyphoidal Salmonella enterica Isolates in the United States: National Antimicrobial Resistance Monitoring System, 1996 to 2007

Nontyphoidal salmonellae (NTS) are important causes of community-acquired bloodstream infection. We describe patterns of antimicrobial resistance among invasive NTS in the United States. We compared bloodstream NTS isolates with those from stool submitted to the National Antimicrobial Resistance Monitoring System (NARMS) from 1996 to 2007. We describe antimicrobial resistance among invasive strains by serogroup and serotype. Of the 19,302 NTS isolates, 17,804 (92.2%) were from stool or blood. Of these, 1,050 (5.9%) were bloodstream isolates. The median ages (ranges) of patients with and without bacteremia were 36 (<1 to 97) years and 20 (<1 to 105) years, respectively (P < 0.001). Males (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06 to 1.38) and those ≥65 years of age were at greater risk for invasive disease. Salmonella enterica serotypes Enteritidis, Typhimurium, and Heidelberg were the most common serotypes isolated from blood; S. enterica serotypes Dublin, Sandiego, and Schwarzengrund were associated with the greatest risk for bloodstream isolation. Of invasive isolates, 208 (19.8%) were resistant to ampicillin, 117 (11.1%) to chloramphenicol, and 26 (2.5%) to trimethoprim-sulfamethoxazole; 28 (2.7%) isolates were resistant to nalidixic acid and 26 (2.5%) to ceftriaxone. Antimicrobial resistance to traditional agents is common. However, the occurrence of nalidixic acid and ceftriaxone resistance among invasive NTS is cause for clinical and public health vigilance.

Os impasses da pobreza absoluta: a experiência da Ouvidoria Coletiva na região da Leopoldina, Rio de Janeiro (RJ, Brasil)

The experience of Collective Ombudsman developed in the Leopoldina region, city of Rio de Janeiro, enlarges the traditional vision of health vigilance and consists in organizing a system of qualitative evaluation of the sanitary vigilance able to identify the health problems of the population and the methods utilized in the attempt to overcome these problems. Health professionals, religious and community leaders congregated in monthly forums to present and discuss living conditions perceived in the communities in which they carry on their activities. From the point of view of the social dimensions involved in the health-illness processes, this work aims to discuss the way that poverty compromises the popular classes' health, especially for the mental health and the "diffuse suffering". The methodology allowed us to organize, in a systematic way, the listening and favored the recognition of local knowledge, constructed from the life experiences of the people who deal with the suffering, the illness and their determinants on the life conditions of the poor population. The precarious living conditions for a significant part of the population were perceived as generating impasses in the resolution of their health problems. The results point towards the importance of understanding the health problems of the population, the resources utilized to face them and proposals for possible solutions in the field of health.

Gestion des alertes sanitaires et risque émergent

Following health crisis that have occurred in the nineties (contaminated blood, mad cow, asbestos, etc.) and more recently those generated by the heat wave in 2003 or by emerging infectious pathogens (SARS, West Nile, Chikungunya, H5N1, H1N1…), a real health vigilance system has been progressively developed in France. After a brief historical overview of the health alert system, this article will give the guiding principles of its current organization in France and will present two examples of recent health alerts (Chikungunya in the Reunion Island in 2005–2006 and hepatitis A outbreak in the Côtes-d’Armor in August 2007), that have needed the implementation of preventive measures regarding the blood donor selection. These two examples have shown that the position of the alert in the French health vigilance system needs to be very close to the event. In that case, health alert is a very useful tool for decision making especially when measures have to be taken to prevent transfusion-transmitted pathogens.

QUALIDADE DE FARELOS DE ARROZ CRU, EXTRUSADO E PARBOILIZADO

Rice is the second most consumed cereal in the world, having reached a global production of 661.3 millions of tons, in 2008. Rice bran, resulted from grain milling to obtain white rice or polished parboiled rice, has significant amounts of carbohydrates, proteins, lipids, soluble fiber, vitamins, and minerals. This study had the objective of evaluating some physicochemical and microbiological characteristics of raw rice bran (RRB), extruded rice bran (ERB), and parboiled rice bran (PRB). All the analyses were done according to standardized methods recommended by the Brazilian National Health Vigilance and International Association of Official Analytical Chemists. The PRB presented the highest contents of protein (17.17 g 100 g-1), lipids (36.03 g 100 g-1), dietary fiber (34.06 g 100 g-1), calcium (99.45 mg 100 g-1), zinc (15.58 mg 100 g-1), cupper (1.45 g 100 g-1), and manganese (17.81 g 100 g-1), and the lowest levels of carbohydrate (5.73 g 100 g-1), ash (7.01 g 100 g-1), potassium (507.55 mg 100 g-1), and iron (6.83 mg 100 g-1). All the rice bran samples showed Aspergillus sp. contamination, but ERB had the lowest colonies counting. All samples showed acceptable microbiological patterns for coliforms at 45&ordm;C and Bacillus cereus, and Salmonella sp. absence, according to the Brazilian legislation. The RRB, ERB, and PRB have high nutritive value, being considered good sources of proteins, lipids, dietary fiber, and minerals. KEY-WORDS: Oryza sativa L.; macronutrients; minerals; fungi.

Qualidade de farelos de arroz cru, extrusado e parboilizado

O arroz é o segundo cereal de maior consumo no mundo, sendo a produção mundial estimada em 661,3 milhões de toneladas, em 2008. O farelo, resultante do beneficiamento do grão, para obtenção do arroz polido ou parboilizado polido, possui quantidades significativas de carboidratos, proteínas, lipídios, fibras insolúveis, vitaminas e minerais. Este trabalho teve por objetivo avaliar algumas características físico-químicas e microbiológicas do farelo de arroz cru (FAC), do farelo cru submetido à extrusão (FAE) e do obtido após o processo de parboilização do arroz (FAP). Todas as análises foram realizadas conforme métodos recomendados pela Agência Nacional de Vigilância Sanitária Brasileira e International Association of Official Analytical Chemists. O FAP apresentou maior teor de proteínas (17,17 g 100 g-1), lipídios (36,03 g 100 g-1), fibra alimentar (34,06 g 100 g-1), cálcio (99,45 mg 100 g-1), zinco (15,58 mg 100 g-1), cobre (1,45 g 100 g-1) e manganês (17,81 g 100 g-1) e menor teor de carboidratos (5,73 g 100 g-1), cinzas (7,01 g 100 g-1), potássio (507,55 mg 100 g-1) e ferro (6,83 mg 100 g-1). Em todos os farelos, foi detectada presença de Aspergillus sp., sendo que o FAE apresentou o menor número de colônias. Todos os farelos apresentaram padrões microbiológicos aceitáveis, para coliformes a 45ºC e Bacillus cereus, e ausência de Salmonela sp., conforme legislação brasileira. FAC, FAE e FAP possuem alto valor nutritivo, sendo fontes de proteínas, lipídios, fibra alimentar e minerais.

As agências reguladoras independentes brasileiras: o caso da Agência Nacional de Vigilância Sanitária

In the 90's, came into place several organs and entities provided with independence towards the state's central structure, with technical speciality and autonomy, including normative, able to direct the new social activities in the trail of public interests juridically defined. In this context, the main objective of this paper is to analyze more carefully the Brazilian Health Surveillance Agency - ANVISA, created by federal law 9.782, of January 26 th. 1999, with the purpose of putting into action public policies of health and sanitary vigilance drawn by the Ministry of Health. Thus, it is also aim of this work to examine the aspects of independence and autonomy of this agency, based on its attributions designed by the law 9.782 and taking into account the brazilian regulatory environment.

Distribuição espaço-temporal da mortalidade por malformações congênitas e causas mal definidas, em estados da região centro-sul do Brasil

A investigação da distribuição espacial da mortalidade por malformações congênitas pode ser útil em programas de vigilância ambiental em saúde. Foram analisados os padrões espaço-temporais da mortalidade por malformações congênitas e causas mal definidas em Estados brasileiros (MS, MT, GO, MG, SP, PR, SC e RS) e no Distrito Federal, no período de 2000 a 2004. Os valores observados foram obtidos do Sistema de Informações de Mortalidade (SIM) do Ministério da Saúde. Foi utilizado um modelo bayesiano que rende interação espaço-temporal. Muitas microrregiões com baixas taxas para malformações congênitas tiveram valores elevados para causas mal definidas, sendo que os óbitos por causas mal definidas prejudicam a identificação de microrregiões com taxas de mortalidade por malformações congênitas acima do esperado, indicativas da existência de fatores ambientais de risco para estas doenças.