RESUMO
BACKGROUND: Central and Eastern European (CEE) migrant workers in essential industries are at higher risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and transmission. We investigated the relationship of CEE migrant status and co-living situation with indicators of SARS-CoV-2 exposure and transmission risk (ETR), aiming to find entry points for policies to reduce health inequalities for migrant workers. METHODS: We included 563 SARS-CoV-2-positive workers between October 2020 and July 2021. Data on ETR indicators were obtained from source- and contact-tracing interviews via retrospective analysis of medical records. Associations of CEE migrant status and co-living situation with ETR indicators were analyzed using chi-square tests and multivariate logistic regression analyses. RESULTS: CEE migrant status was not associated with occupational ETR but was with higher occupational-domestic exposure [odds ratio (OR) 2.92; P = 0.004], lower domestic exposure (OR 0.25, P < 0.001), lower community exposure (OR 0.41, P = 0.050) and transmission (OR 0.40, P = 0.032) and higher general transmission (OR 1.76, P = 0.004) risk. Co-living was not associated with occupational and community ETR but was with higher occupational-domestic exposure (OR 2.63, P = 0.032), higher domestic transmission (OR 17.12, P < 0.001) and lower general exposure (OR 0.34, P = 0.007) risk. CONCLUSIONS: The workfloor poses an equal SARS-CoV-2 ETR for all workers. CEE migrants encounter less ETR in their community but pose a general risk by delaying testing. When co-living, CEE migrants encounter more domestic ETR. Coronavirus disease preventive policies should aim at occupational safety for essential industry workers, reduction of test delay for CEE migrants and improvement of distancing options when co-living.
Assuntos
COVID-19 , Migrantes , Humanos , SARS-CoV-2 , COVID-19/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Sex workers are men, women or transgender people who have sex in exchange for money or goods. Self-employed sex workers solicit clients independently from a third-party. Self-employed sex workers are at risk of acquiring sexually transmitted infections (STIs) through their work. We performed a cross-sectional study, using an Internet survey conducted in 2019-2020 aiming to establish sexual risk behaviour and STI testing behaviour among female and male self-employed sex workers. RESULTS: A total of 76 female self-employed sex workers (FSW) and 79 male self-employed sex workers (MSW) completed the survey. Both FSW and MSW more often had sex with partners of the opposite sex during work (65.8% FSW, 61.6% MSW) and in their private life (63.3% FSW; 64.5% MSW). During vaginal sex 35.7% of FSW and 29.6% of MSW did not always use a condom. Inconsistent condom use was observed in 35.7% of FSW and 29.6% of MSW during vaginal sex, 46.2% of FSW and 35.7% of MSW did not always use a condom during receptive anal sex. The majority of both FSW and MSW tested for STIs in the past year (67.1% FSW; 67.7% MSW) and 67.5% were aware of the possibility of low-threshold testing at an STI clinic. In the past year, 11.6% of FSW and 8.1% of MSW had an STI. CONCLUSION: The reported STI positivity rate among self-employed sex workers was not very high. However, STI prevention efforts remain important considering the low compliance with condom use during sex work. Moreover, not testing for STIs in the past year was substantial with one-third of both FSW and MSW and one-third of both FSW and MSW being unaware of the possibility of low-threshold testing at an STI clinic, warranting efforts to increase testing uptake in this population.
Assuntos
Infecções por HIV , Profissionais do Sexo , Infecções Sexualmente Transmissíveis , Preservativos , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Internet , Masculino , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
OBJECTIVES: Although ethnic minority clients (EMs) from STI endemic countries have a higher risk for STI, little is known about their STI clinic consultation rate proportionality. The aim of this study was to assess consultation and chlamydia positivity rates among different EMs visiting STI clinics in the Netherlands. METHODS: We calculated consultation rates in EM groups by dividing the number of STI consultations by the total number of inhabitants in the region belonging to an EM, then compared the EM rates to native Dutch rates. Factors associated with chlamydia positivity were analysed using multivariate regression analysis. RESULTS: A total of 23,841 clients visiting an eastern Netherlands STI clinic between 2011 and 2013 were included in the analysis, of which 7% were EMs. The consultation rate of native Dutch clients was 22.5 per 1000, compared to 8.5 per 1000 among EMs. Consultation rates in all EMs were lower than in Dutch clients, except for Antillean or Aruban EMs and Latin American EMs. The chlamydia positivity rate among all clients was 15.5%, and Antillean or Aruban ethnicity (27.1%) EMs had the highest rates. Multivariate analysis identified the following factors associated with chlamydia positivity: Eastern or Northern European EM, African EM, Antillean or Aruban EM, STI related symptoms, heterosexual preference, partner in a risk group, receiving a partner notification, and having had three or more partners in the past six months. CONCLUSION: On a population level, most EMs visit STI clinics less often than native Dutch clients, but they have a higher rate of positive chlamydia diagnoses. STI clinics should increase outreach activities for EM clients because they are insufficiently reached by current practices, but contribute substantially to chlamydia incidence rates.
Assuntos
Infecções por Chlamydia/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Grupos Minoritários , Países Baixos/epidemiologia , Fatores de Risco , Parceiros Sexuais , Adulto JovemRESUMO
BACKGROUND: Chronic illnesses can increase the risk of unemployment, but evidence on the specific impact of Q-fever fatigue syndrome (QFS) on work is lacking. AIMS: The aim of this study was to describe and quantify the impact of QFS on work. METHODS: Changes in work status from 1 year prior to 4 years after acute Q-fever infection of QFS patients were retrospectively collected with a self-report questionnaire measuring employment status and hours of paid work per week. In addition, information on work ability, job satisfaction and need for recovery after work was collected in 2016. Data were compared to participants from the general population. RESULTS: The proportion of employed QFS patients from 1 year prior to 4 years after acute infection decreased from 78 to 41%, while remaining relatively constant in the general population (82 to 78%). Working QFS patients showed a decrease in mean hours of paid work from 35 to 22 h per week, which is significantly steeper compared to the general population (31-28 h per week) (P < 0.001). QFS patients showed a significantly lower work ability (P < 0.001), lower job satisfaction (P = 0.006) and greater need for recovery (P < 0.001) compared to the general population. CONCLUSIONS: The number of QFS patients with paid work decreased over the years, while patients who continue to work experience lower work ability, job satisfaction and increased need for recovery. Occupational physicians should be aware of the occurrence and severity of the impact of QFS on work, even after many years.
Assuntos
Síndrome de Fadiga Crônica , Febre Q , Doença Crônica , Fadiga , Humanos , Masculino , Estudos RetrospectivosRESUMO
The inherent and diverse capacity of dietary fibres, nondigestible oligosaccharides (NDOs) and prebiotics to modify the gut microbiota and markedly influence health status of the host has attracted rising interest. Research and collective initiatives to determine the composition and diversity of the human gut microbiota have increased over the past decade due to great advances in high-throughput technologies, particularly the 16S ribosomal RNA (rRNA) sequencing. Here we reviewed the application of 16S rRNA-based molecular technologies, both community wide (sequencing and phylogenetic microarrays) and targeted methodologies (quantitative PCR, fluorescent in situ hybridisation) to study the effect of chicory inulin-type fructans, NDOs and specific added fibres, such as resistant starches, on the human intestinal microbiota. Overall, such technologies facilitated the monitoring of microbiota shifts due to prebiotic/fibre consumption, though there are limited community-wide sequencing studies so far. Molecular studies confirmed the selective bifidogenic effect of fructans and galactooligosaccharides (GOS) in human intervention studies. Fructans only occasionally decreased relative abundance of Bacteroidetes or stimulated other groups. The sequencing studies for various resistant starches, polydextrose and beta-glucan showed broader effects with more and different types of gut microbial species being enhanced, often including phylotypes of Ruminococcaceae. There was substantial variation in terms of magnitude of response and in individual responses to a specific fibre or NDO which may be due to numerous factors, such as initial presence and relative abundance of a microbial type, diet, genetics of the host, and intervention parameters, such as intervention duration and fibre dose. The field will clearly benefit from a more systematic approach that will support defining the impact of prebiotics and fibres on the gut microbiome, identify biomarkers that link gut microbes to health, and address the personalised response of an individual's microbiota to prebiotics and dietary fibres.
Assuntos
Dieta , Fibras na Dieta , Frutanos , Microbioma Gastrointestinal/genética , Prebióticos , Fezes/microbiologia , Humanos , Filogenia , RNA Ribossômico 16S/genéticaRESUMO
In 2012 the multidisciplinary guideline Q fever fatigue syndrome was developed for the Netherlands. The availability of new research data and developments and experiences from daily clinical practice made it necessary to revise this guideline. The multidisciplinary working group that has revised the guideline is composed of representatives from all medical professions involved in the care of patients with QFS and representatives of the patients' association. The revised guideline incorporates a number of changes, including refinement of the QFS diagnostic criteria and updates regarding advice on support and reintegration.
Assuntos
Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/terapia , Infectologia/normas , Guias de Prática Clínica como Assunto , Febre Q/diagnóstico , Febre Q/terapia , Humanos , Comunicação Interdisciplinar , Países Baixos , Participação do PacienteAssuntos
Pesquisa Biomédica/história , Ciências da Nutrição/história , Papel Profissional , Agricultura/educação , Agricultura/história , Distinções e Prêmios , Pesquisa Biomédica/educação , Países em Desenvolvimento , Europa (Continente) , Tecnologia de Alimentos/educação , Tecnologia de Alimentos/história , História do Século XX , História do Século XXI , Humanos , Liderança , Países Baixos , Distúrbios Nutricionais/dietoterapia , Distúrbios Nutricionais/história , Distúrbios Nutricionais/prevenção & controle , Distúrbios Nutricionais/terapia , Ciências da Nutrição/educação , Recursos HumanosRESUMO
Q fever patients are often reported to experience a long-term impaired health status, including fatigue, which can persist for many years. During the large Q fever epidemic in The Netherlands, many patients with a laboratory-confirmed Coxiella burnetii infection were not notified as acute Q fever because they did not fulfil the clinical criteria of the acute Q fever case definition (fever, pneumonia and/or hepatitis). Our study assessed and compared the long-term health status of notified and non-notified Q fever patients at 4 years after onset of illness, using the Nijmegen Clinical Screening Instrument (NCSI). The study included 448 notified and 193 non-notified Q fever patients. The most severely affected subdomain in both patient groups was 'Fatigue' (50·5% of the notified and 54·6% of the non-notified patients had severe fatigue). Long-term health status did not differ significantly between the notified and non-notified patient groups, and patients scored worse on all subdomains compared to a healthy reference group. Our findings suggest that the magnitude of the 2007-2009 Q fever outbreak in The Netherlands was underestimated when only notified patients according to the European Union case definition are considered.
Assuntos
Notificação de Doenças/estatística & dados numéricos , Surtos de Doenças , Fadiga/epidemiologia , Nível de Saúde , Febre Q/epidemiologia , Adulto , Idoso , Doença Crônica , Estudos Transversais , Fadiga/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Febre Q/complicações , Qualidade de Vida , Inquéritos e Questionários , Fatores de TempoRESUMO
Patients with a lower respiratory tract infection (LRTI) might be at risk for long-term impaired health status. We assessed whether LRTI patients without Q fever are equally at risk for developing long-term symptoms compared to LRTI patients with Q fever. The study was a cross-sectional cohort design. Long-term health status information of 50 Q fever-positive and 32 Q fever-negative LRTI patients was obtained. Health status was measured by the Nijmegen Clinical Screening Instrument. The most severely affected subdomains of the Q fever-positive group were 'general quality of life' (40%) and 'fatigue' (40%). The most severely affected subdomains of the Q fever-negative group were 'fatigue' (64%) and 'subjective pulmonary symptoms' (35%). Health status did not differ significantly between Q fever-positive LRTI patients and Q fever-negative LRTI patients for all subdomains, except for 'subjective pulmonary symptoms' (P = 0·048).
Assuntos
Nível de Saúde , Infecções Respiratórias/complicações , Adolescente , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Dispneia/epidemiologia , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Adulto JovemRESUMO
Despite cattle herds can harbor Coxiella burnetii, risk factors for C. burnetii presence in dairy cattle herds are largely unknown. Therefore, C. burnetii herd prevalence and risk factors for bulk tank milk (BTM) positivity were investigated. In this cross-sectional study, a questionnaire was filled out by the farmer and BTM from 301 farms was tested by ELISA for presence of C. burnetii antibodies and PCR for presence of C. burnetii DNA. Risk factors were identified by univariable and multivariable logistic regression analyses. Antibodies to C. burnetii were detected in 81.6% (CI: 77.2-85.9) and C. burnetii DNA in 18.8% (CI: 14.4-23.1) of the BTM samples. Herd size (OR=1.1 per 10 cows), cleaning the bedding of the cubicles at most every other day (OR=2.8) and purchase of cattle from at least two addresses (OR=3.1) showed a significant and positive association with ELISA positivity and use of an automatic milking system a negative association (OR=0.3). Risk factors for PCR positivity were purchase of cattle from at least two delivery addresses (OR=3.2), presence of cows with ticks (OR=2.0), use of an automatic milking system (OR=0.2) and presence of goats or sheep on the farm (OR=0.4). Biosecurity and general hygiene seem associated with introduction and spread of C. burnetii in dairy herds.
Assuntos
Doenças dos Bovinos/microbiologia , Coxiella burnetii , Indústria de Laticínios/métodos , Leite/química , Febre Q/veterinária , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Feminino , Leite/microbiologia , Países Baixos/epidemiologia , Prevalência , Febre Q/epidemiologia , Fatores de RiscoRESUMO
Coxiella burnetii seroprevalence was assessed on Dutch dairy and non-dairy sheep farms using ELISA. Risk factors for seropositivity on non-dairy sheep farms were identified at farm and sheep level by univariate and multivariate multilevel analyses. Based on 953 dairy and 5671 non-dairy serum samples, sheep seroprevalences were 18.7 per cent and 2.0 per cent, respectively, and 78.6 per cent and 30.5 per cent at farm level. Significant risk factors for non-dairy sheep farms were farm location in the south of the country, sheep kept on marginal grounds, one or several supply addresses for ewes during 2007-2009 and wearing farm boots and/or outfit by professional visitors. On sheep level, risk factors included among others farm location in the south of the country, lamb breeding as main farm purpose, goat density within 10â km farm radius, use of windbreak curtain or windshields, and presence of ≥6 stillborn lambs in 2009. Farm location in the south of the country and goat density suggests that infected goats have played a role in the transmission to non-dairy sheep. Other risk factors suggest introduction of the bacterium through sheep supply and professional visitors. Biosecurity measures should be strengthened, including avoiding infection during handling of stillborn lambs and birth products in the lambing period.
Assuntos
Coxiella burnetii/isolamento & purificação , Febre Q/veterinária , Doenças dos Ovinos/epidemiologia , Doenças dos Ovinos/microbiologia , Agricultura , Animais , Estudos Transversais , Feminino , Países Baixos/epidemiologia , Gravidez , Febre Q/epidemiologia , Febre Q/microbiologia , Fatores de Risco , Estudos Soroepidemiológicos , OvinosRESUMO
Q fever, caused by Coxiella burnetii, is a recognized occupational infection in persons who have regular contact with ruminants. We determined C. burnetii seroprevalence in residents living or working on dairy cattle farms with ≥50 adult cows and identified risk factors for seropositivity. Serum samples from farm residents, including employees, were tested for C. burnetii IgG and IgM; seroprevalence was 72.1% overall and 87.2%, 54.5%, and 44.2% among farmers, spouses, and children, respectively. Risk factors included farm location in southern region, larger herd size, farm employment, birds in stable, contact with pigs, and indirect contact with rats or mice. Protective factors included automatic milking of cows and fully compliant use of gloves during and around calving. We recommend strengthening general biosecurity measures, such as consistent use of personal protective equipment (e.g., boots, clothing, gloves) by farm staff and avoidance of birds and vermin in stables.
Assuntos
Agricultura , Coxiella burnetii/isolamento & purificação , Febre Q/epidemiologia , Adolescente , Adulto , Idoso , Animais , Bovinos , Criança , Coxiella burnetii/classificação , Feminino , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Febre Q/história , Fatores de Risco , Estudos Soroepidemiológicos , Sorotipagem , Adulto JovemRESUMO
SUMMARY: In this study, Coxiella burnetii seroprevalence was assessed for dairy and non-dairy sheep farm residents in The Netherlands for 2009-2010. Risk factors for seropositivity were identified for non-dairy sheep farm residents. Participants completed farm-based and individual questionnaires. In addition, participants were tested for IgG and IgM C. burnetii antibodies using immunofluorescent assay. Risk factors were identified by univariate, multivariate logistic regression, and multivariate multilevel analyses. In dairy and non-dairy sheep farm residents, seroprevalence was 66·7% and 51·3%, respectively. Significant risk factors were cattle contact, high goat density near the farm, sheep supplied from two provinces, high frequency of refreshing stable bedding, farm started before 1990 and presence of the Blessumer breed. Most risk factors indicate current or past goat and cattle exposure, with limited factors involving sheep. Subtyping human, cattle, goat, and sheep C. burnetii strains might elucidate their role in the infection risk of sheep farm residents.
Assuntos
Agricultura , Anticorpos Antibacterianos/sangue , Coxiella burnetii/imunologia , Febre Q/sangue , Febre Q/epidemiologia , Adolescente , Adulto , Animais , Gatos , Bovinos , Criança , Indústria de Laticínios , Cães , Feminino , Cabras , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos/epidemiologia , Fatores de Risco , Estudos Soroepidemiológicos , Ovinos , Adulto JovemRESUMO
We investigated the positive predictive value (PPV) of a solitary positive immunoglobulin M (IgM) phase II response for the serodiagnosis of acute Q fever detected with either an indirect immunofluorescence assay (IFA) or an enzyme-linked immunosorbent assay (ELISA). Initial and follow-up sera from patients suspected of acute Q fever were included if initially only IgM phase II tested positive with IFA in 2008 (n=92), or ELISA in 2009 (n=85). A seroconversion for Q fever was defined as an initial sample being IgG phase II negative but positive in the follow-up sample. The PPV of an initial isolated IgM phase II result detected by IFA or ELISA was 65% and 51%, respectively, and therefore appeared not to adequately predict acute Q fever. For this reason it cannot be used as a diagnostic criterion nor should it be included in public health notification without confirmation with other markers or a follow-up serum sample.
Assuntos
Anticorpos Antibacterianos/sangue , Coxiella burnetii/imunologia , Imunidade Ativa , Imunoglobulina M/sangue , Febre Q/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Febre Q/imunologia , Adulto JovemRESUMO
We sought to determine the effects of maternal zinc supplementation on skin infections among infants in poor urban areas of Dhaka, Bangladesh. A double-blind, placebo-controlled, randomized trial was conducted among 199 and 221 Bangladeshi infants whose mothers were administered 30 mg daily of zinc or placebo, respectively. The mothers received zinc supplementation from 12-16 weeks' gestation until delivery, and the infants were followed up until 6 months of age. Among the infants of mothers who received zinc supplementation during the antenatal period, 10.6% had at least 1 episode of impetigo compared with 19.6% of the infants of mothers in the placebo group (P = 0.01). Infants in the treatment group had a 54% reduction in incidence rate of episodes of impetigo when compared with infants in the placebo group (P = 0.01). The effect of zinc supplementation was more pronounced among male infants (64% reduction) and intrauterine growth restricted and low birth weight infants (73% reduction) and among infants of mothers with increased parity (60% reduction) or decreased socioeconomic status (71% reduction).
Assuntos
Dieta/métodos , Suplementos Nutricionais , Impetigo/epidemiologia , Impetigo/prevenção & controle , Zinco/administração & dosagem , Adulto , Bangladesh/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Placebos/administração & dosagem , GravidezRESUMO
In May 2008 the Nijmegen Municipal Health Service (MHS) was informed about an outbreak of atypical pneumonia in three in-patients of a long-term psychiatric institution. The patients had been hospitalized and had laboratory confirmation of acute Q fever infection. The MHS started active case finding among in-patients, employees of and visitors to the institution. In a small meadow on the institution premises a flock of sheep was present. One of the lambs in the flock had been abandoned by its mother and cuddled by the in-patients. Samples were taken of the flock. Forty-five clinical cases were identified in employees, in-patients and visitors; 28 were laboratory confirmed as Q fever. Laboratory screening of pregnant women and persons with valvular heart disease resulted in one confirmed Q fever case in a pregnant woman. Of 27 samples from animals, seven were positive and 15 suspect for Coxiella burnetii infection. This outbreak of Q fever in a unique psychiatric setting pointed to a small flock of sheep with newborn lambs as the most likely source of exposure. Care institutions that have vulnerable residents and keep flocks of sheep should be careful to take adequate hygienic measures during delivery of lambs and handling of birth products.
Assuntos
Surtos de Doenças , Febre Q/epidemiologia , Adolescente , Adulto , Animais , Coxiella burnetii/isolamento & purificação , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Gravidez , Febre Q/transmissão , Ovinos , Doenças dos Ovinos/epidemiologia , Doenças dos Ovinos/transmissão , Adulto Jovem , ZoonosesRESUMO
OBJECTIVE: To describe the household intakes of retinol and carotenoids and social economic factors determining their intakes. SUBJECTS: Data on a total of 1001 households (771 in rural areas and 230 in urban areas) were used in the analyses. Interviewed person was household food preparer. RESULTS: Mean (s.d.) intake of carotenoids was 4178 (3154) microg/capita/day in rural and 4208 (3408) microg/capita/day in urban areas and intake of retinol was 101 (275) microg/capita/day in rural and 201 (470) microg/capita/day in urban areas. Multivariate analyses show that the subjects in households with four or more members consume about 700 microg carotenoids less compared to households with less than three members. Households with a higher expenditure (fourth quartile) consumed about 100 microg retinol/day more than those with a lower expenditure (first quartile). CONCLUSION: Carotenoids from plant food sources is the main source of vitamin A intake of the population and its main determinants are household expenditure and size of household. Food fortification and dietary diversification with special emphasis on promotion of consumption of animal foods should be key strategies for overcoming vitamin A deficiency in Vietnam.