Assessment of occupational exposure to leptospirosis in a sheep-only abattoir

2010 ◽  
Vol 139 (5) ◽  
pp. 797-806 ◽  
Author(s):  
S. DORJEE ◽  
C. HEUER ◽  
R. JACKSON ◽  
D. M. WEST ◽  
J. M. COLLINS-EMERSON ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
High Risk ◽  
Occupational Exposure ◽  
Low Risk ◽  
Risk Modelling ◽  
Spreadsheet Model ◽  
Risk Period ◽  
Daily Risk ◽  
Risk Of Exposure ◽  
Stochastic Risk

SUMMARYThis study estimated the frequency of exposure of meat workers to carcasses infected with Leptospira serovars Hardjobovis or Pomona in a sheep-only abattoir in New Zealand. A stochastic spreadsheet model was developed to assess the daily risk of exposure of eviscerators, meat inspectors and offal handlers to live leptospires in sheep carcasses from May to November 2004 (high-risk period), and from December 2004 to June 2005 (low-risk period). The average sheep processed per day were 225 for an eviscerator, 374 for a meat inspector, and 1123 for an offal handler. The median daily exposures during high- and low-risk periods were 11 [95% distribution interval (DI) 5–19] and three (95% DI 1–8) infected carcasses/day for eviscerators, 18 (95% DI 9–29) and six (95% DI 2–12) for meat inspectors, and 54 (95% DI 32–83) and 18 (95% DI 8–31) for offal handlers, respectively. Stochastic risk modelling provided evidence that processing of sheep carcasses exposed meat workers regularly to live leptospires with substantial seasonal variation.

scholarly journals SARS-CoV-2 Infection in Healthcare Personnel With High-risk Occupational Exposure: Evaluation of 7-Day Exclusion From Work Policy

2020 ◽  
Author(s):  
Helena C Maltezou ◽  
Xanthi Dedoukou ◽  
Maria Tseroni ◽  
Paraskevi Tsonou ◽  
Vasilios Raftopoulos ◽  
...  
Keyword(s):  
High Risk ◽  
Occupational Exposure ◽  
Underlying Disease ◽  
Low Risk ◽  
Risk Exposure ◽  
Healthcare Personnel ◽  
Risk Category ◽  
Public Health Organization ◽  
Increased Risk ◽  
History Of

Abstract Background As of late February 2020, Greece has been experiencing the coronavirus disease 2019 (COVID-19) epidemic. Healthcare personnel (HCP) were disproportionately affected, accounting for ~10% of notified cases. Exclusion from work for 7 days was recommended for HCP with high-risk occupational exposure. Our aim was to evaluate the 7-day exclusion from work policy for HCP with high-risk exposure. Methods HCP with a history of occupational exposure to COVID-19 were notified to the Hellenic National Public Health Organization, regardless of their exposure risk category. Exposed HCP were followed for 14 days after last exposure. Results We prospectively studied 3398 occupationally exposed HCP; nursing personnel accounted for most exposures (n = 1705; 50.2%). Of the 3398 exposed HCP, 1599 (47.1%) were classified as low-risk, 765 (22.5%) as moderate-risk, and 1031 (30.4%) as high-risk exposures. Sixty-six (1.9%) HCP developed COVID-19 at a mean of 3.65 (range: 0–17) days postexposure. Of the 66 HCP with COVID-19, 46, 7, and 13 had a history of high-, moderate- or low-risk exposure (4.5%, 0.9%, and 0.8% of all high-, moderate-, and low-risk exposures, respectively). Hospitalization and absenteeism were more prevalent among HCP with high-risk exposure. A logistic regression analysis showed that the following variables were significantly associated with an increased risk for the onset of COVID-19: male, administrative personnel, underlying disease, and high-risk exposure. Conclusions HCP with high-risk occupational exposure to COVID-19 had increased probability of serious morbidity, healthcare seeking, hospitalization, and absenteeism. Our findings justify the 7-day exclusion from work policy for HCP with high-risk exposure.

scholarly journals Impact of COVID-19 Pandemic on Open Fractures: a Retrospective Multi-centre Cohort Study in the Different Risk Periods of China

2021 ◽  
Author(s):  
Jialei Chen ◽  
Rong Luo ◽  
Gang Zhong ◽  
Ming Liu
Keyword(s):  
High Risk ◽  
Prevention And Control ◽  
Low Risk ◽  
Control Measures ◽  
Direct Closure ◽  
Number Of Patients ◽  
Risk Period ◽  
Level I ◽  
Prevention And Control Measures ◽  
And Control

Abstract BackgroundThe COVID-19 pandemic has had a significant impact on orthopaedic trauma worldwide, but the extent of this impact regarding the low-risk period is still unclear. This study aims to evaluate the epidemiology of open limbs fractures during the different risk periods and the effect of routine prevention and control measures.MethodsA retrospective multi-centre cohort study was conducted in three different level trauma centres. Three 60-day periods were analyzed: the high-risk period - 2020/1/24-2020/3/24, the low-risk period - 2021/1/24-2021/3/25, and the no-risk period as a control group for comparison - 2019/1/24-2019/3/25. Demographic data, medical history, and surgery and antibiotic therapy data at presentation were collected and evaluated.ResultsA total of 123 patients met the inclusion criteria. We observed a significant "J" shaped change in the total number of patients, with fewer patients in 2020 (n=34, -17%) and more in 2021 (n=48, +17%) compared to 2019 (n=41). However, fewer patients visited the level I centre in the low-risk period (82.9% 2019 vs. 70.6% 2020 vs. 56.3% 2021, P=0.024). Meanwhile, longer antibiotics therapy period (＞48 hours) were more prevalent in low-risk period (39% 2019 vs. 58.8% 2020 vs. 68.8% 2021, P=0.018). Regarding definitive closure type, increase in direct closure was observed in high-risk period (51% 2019 vs. 78.9% 2020 vs. 63.5% 2021, P=0.024). ConclusionDuring the high-risk period, the total number of patients was expected to decline, whereas in the low-risk period, the number may increase. They preferred the lower level II and III centre for patients during the pandemic rather than the higher level I centre. For surgeons, they were prone to direct closure and a more extended antibiotic therapy period. Routine prevention and control measures seem not adversely affect the treatment outcomes and process of open fractures.Trial registrationChiCTR, ChiCTR 2100046151. Registered 5 May 2021, http://www.chictr.org.cn/edit.aspx?pid=123490&htm=4.

scholarly journals Comparison of Tuberculosis Infection Control Programs in Canadian Hospitals Categorized by Size and Risk of Exposure to Tuberculosis Patients, 1989 to 1993 – Part 2

1997 ◽  
Vol 8 (4) ◽  
pp. 195-201
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
Helen Gibson ◽  
Geoffrey Taylor ◽  
Carol Whyman ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Low Risk ◽  
Respiratory Protection ◽  
Hospital Size ◽  
Screening Programs ◽  
Environmental Controls ◽  
Hospital Infection Control ◽  
Mdr Tb ◽  
Risk Of Exposure

OBJECTIVE: To analyze tuberculosis (TB) programs in acute care hospitals (hospitals) categorized by size and risk of exposure to TB patients from 1989 to 1993.DESIGN: Retrospective survey.PARTICIPANTS: Members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who worked in Canadian hospitals received questionnaires. One questionnaire per hospital was completed.OUTCOME: Hospitals reported the number of respiratory TB and human immunodeficiency virus (HIV) cases admitted, the engineering and environmental controls available, and the type of occupational TB screening programs available. Data were stratified by hospital size and risk of exposure to TB patients.RESULTS: Thirty-four (10.9%) hospitals with at least 500 beds admitted more than 50% of the TB cases, more than 40% of the multidrug-resistant TB (MDR-TB) cases and more than 65% of the HIV cases. Thirty-six (11.6%) facilities classified as high risk hospitals reported more than 70% of the TB cases, more than 58% of the MDR-TB cases and more than 75% of the HIV cases. A significantly higher pooled average tuberculin test conversion rate was found in individuals working in high risk (4.4%) than in low risk hospitals (1.5%). Significantly more high risk than low risk hospitals had an isolation room with air exhausted outside, negative air pressure and at least six air changes per hour. Only 13 high risk hospitals had all three engineering characteristics. Surgical masks were used for respiratory protection in 18 (50%) high risk and 186 (77.8%) low risk hospitals.CONCLUSIONS: Nosocomial transmission ofMycobacterium tuberculosismay have occurred because TB programs available in many Canadian hospitals were inadequate.

Papillary Thyroid Carcinoma: How Radical Lymphadenectomy Should be Performed?

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 63-68
Author(s):  
Schweizer ◽  
Seifert ◽  
Gemsenjäger
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Sentinel Nodes ◽  
Fand Sich ◽  
Radical Lymphadenectomy ◽  
N Status

Fragestellung: Die Bedeutung von Lymphknotenbefall bei papillärem Schilddrüsenkarzinom und die optimale Lymphknotenchirurgie werden kontrovers beurteilt. Methodik: Retrospektive Langzeitstudie eines Operateurs (n = 159), prospektive Dokumentation, Nachkontrolle 1-27 (x = 8) Jahre, Untersuchung mit Bezug auf Lymphknotenbefall. Resultate: Staging. Bei 42 Patienten wurde wegen makroskopischem Lymphknotenbefall (cN1) eine therapeutische Lymphadenektomie durchgeführt, mit pN1 Status bei 41 (98%) Patienten. Unter 117 Patienten ohne Anhalt für Lymphknotenbefall (cN0) fand sich okkulter Befall bei 5/29 (17%) Patienten mit elektiver (prophylaktischer) Lymphadenektomie, und bei 2/88 (2.3%) Patienten ohne Lymphadenektomie (metachroner Befall) (p < 0.005). Lymphknotenrezidive traten (1-5 Jahre nach kurativer Primärtherapie) bei 5/42 (12%) pN1 und bei 3/114 (2.6%) cN0, pN0 Tumoren auf (p = 0009). Das 20-Jahres-Überleben war bei TNM I + II (low risk) Patienten 100%, d.h. unabhängig vom N Status; pN1 vs. pN0, cN0 beeinflusste das Überleben ungünstig bei high risk (>= 45-jährige) Patienten (50% vs. 86%; p = 0.03). Diskussion: Der makroskopische intraoperative Lymphknotenbefund (cN) hat Bedeutung: - Befall ist meistens richtig positiv (pN1) und erfordert eine ausreichend radikale, d.h. systematische, kompartiment-orientierte Lymphadenektomie (Mikrodissektion) zur Verhütung von - kurablem oder gefährlichem - Rezidiv. - Okkulter Befall bei unauffälligen Lymphknoten führt selten zum klinischen Rezidiv und beeinflusst das Überleben nicht. Wir empfehlen eine weniger radikale (sampling), nur zentrale prophylaktische Lymphadenektomie, ohne Risiko von chirurgischer Morbidität. Ein empfindlicherer Nachweis von okkultem Befund (Immunhistochemie, Schnellschnitt von sampling Gewebe oder sentinel nodes) erscheint nicht rational. Bei pN0, cN0 Befund kommen Verzicht auf 131I Prophylaxe und eine weniger intensive Nachsorge in Frage.

Individuals at high risk for suicide are categorically distinct from those at low risk.

2017 ◽  
Vol 29 (4) ◽  
pp. 382-393 ◽  
Author(s):  
Tracy K. Witte ◽  
Jill M. Holm-Denoma ◽  
Kelly L. Zuromski ◽  
Jami M. Gauthier ◽  
John Ruscio
Keyword(s):  
High Risk ◽  
Low Risk

A review study of nasal endoscopy protocol during the COVID-19 pandemic

2020 ◽  
Vol 2 (CSI) ◽  
pp. 38-41
Author(s):  
Rafid Jabbar
Keyword(s):  
High Risk ◽  
Health Services ◽  
Paranasal Sinus ◽  
Medical Staff ◽  
Nasal Endoscopy ◽  
Paranasal Sinus Diseases ◽  
The World ◽  
Major Procedure ◽  
Risk Of Exposure ◽  
Review Study

During ENT practice, we have to examine the nose and perform several nasal procedures in our clinics. Otolaryngologists are at a high risk of exposure to the COVID-19 virus. Nasal endoscopy is a major procedure for the diagnosis of the nasal and paranasal sinus diseases and introducing proper health services for our patients. In addition, the world is living the era of the COVID-19 pandemic, for which we have to protect ourselves, educate our medical staff, and work together against the spread of this severely contagious disease within our communities. The main purpose of this study is to review the protocol of nasal endoscopy in the ENT clinic and enhance the safest way to deal with patients during this pandemic.(1)

A Critical Overview of Systematic Reviews of Chemotherapy for Advanced and Locally Advanced Pancreatic Cancer using both AMSTAR2 and ROBIS as Quality Assessment Tools

2020 ◽  
Vol 15 ◽  
Author(s):  
Amit Dang ◽  
Surendar Chidirala ◽  
Prashanth Veeranki ◽  
BN Vallish
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Systematic Reviews ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Risk Of Bias ◽  
Low Risk ◽  
Locally Advanced Pancreatic Cancer ◽  
Grade 3 ◽  
Critical Overview

Background: We performed a critical overview of published systematic reviews (SRs) of chemotherapy for advanced and locally advanced pancreatic cancer, and evaluated their quality using AMSTAR2 and ROBIS tools. Materials and Methods: PubMed and Cochrane Central Library were searched for SRs on 13th June 2020. SRs with metaanalysis which included only randomized controlled trials and that had assessed chemotherapy as one of the treatment arms were included. The outcome measures, which were looked into, were progression-free survival (PFS), overall survival (OS), and adverse events (AEs) of grade 3 or above. Two reviewers independently assessed all the SRs with both ROBIS and AMSTAR2. Results: Out of the 1,879 identified records, 26 SRs were included for the overview. Most SRs had concluded that gemcitabine-based combination regimes, prolonged OS and PFS, but increased the incidence of grade 3-4 toxicities, when compared to gemcitabine monotherapy, but survival benefits were not consistent when gemcitabine was combined with molecular targeted agents. As per ROBIS, 24/26 SRs had high risk of bias, with only 1/26 SR having low risk of bias. As per AMSTAR2, 25/26 SRs had critically low, and 1/26 SR had low, confidence in the results. The study which scored ‘low’ risk of bias in ROBIS scored ‘low confidence in results’ in AMSTAR2. The inter-rater reliability for scoring the overall confidence in the SRs with AMSTAR2 and the overall domain in ROBIS was substantial; ROBIS: kappa=0.785, SEM=0.207, p<0.001; AMSTAR2: kappa=0.649, SEM=0.323, p<0.001. Conclusion: Gemcitabine-based combination regimens can prolong OS and PFS but also worsen AEs when compared to gemcitabine monotherapy. The included SRs have an overall low methodological quality and high risk of bias as per AMSTAR2 and ROBIS respectively.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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