Occupational screening

Medical screening of workers is one of the tools often used to assess suitability for work and to attempt to reduce worker ill-health. This article outlines the objectives of the screening process and the basic criteria to be followed in developing a quality programme. It describes the different types of medical examination used in this setting. Screening programmes should be related to hazards specific to the work place as well as to the physical and mental requirements of the job. The guiding principle in the prevention of occupational disease should always be the control of hazardous exposure to prevent harmful effects occurring rather than early detection of harmful effects after they have occurred. The importance of being aware of and abiding by these principles is particularly applicable in the local context.peer-reviewe

Managers’ attitudes to illicit drug testing in the workplace

The aim of this study was to collect data regarding managers’ views on the need to introduce drug testing at work and on the employment prospects of illicit drug users by means of a self administered questionnaire. A slight majority of managers (258, 56.5%) favoured the introduction of pre-employment drug testing with a smaller proportion (219, 47.9%) in favour of testing during employment. Practically none of the respondents (1.1%) was willing to employ a current illicit drug user and less than half (41.6%) were willing to employ a person with a past history of drug use. An increased willingness was noted among managers of younger age groups and in larger companies to employ past drug users. These results indicate that there is the possibility that work place drug testing may be used as a tool to discriminate against workers suffering from drug abuse rather than to offer opportunities for rehabilitation of the individual. The findings highlight the urgent need for the establishment of guidelines to be followed during drug testing in Malta by the appropriate statutory authority, since suitable legislation is absent.peer-reviewe

Environmental monitoring at St George’s Bay (Malta) in connection with beach replenishment works

This study was financed by the Malta Tourism Authority (MTA) through contract dated 14th April 2004 and tender MTA/104/2004 dated 26th November 2004, both awarded to Ecoserv.Adverse impacts of coastal beach replenishment projects on the marine environment are well documented. As a result, coastal managers have been seeking ways and techniques with which to implement beach replenishment projects without causing adverse changes to marine ecosystems. In May 2004, the Malta Tourism Authority undertook beach replenishment at St George’s Bay (St Julians, Malta) in which coarse sediment of terrestrial origin, having a mean grain size of 2 mm, was deposited at the head of the bay to create an artificial beach. An extensive 2-year (January 2004 to December 2005) environmental monitoring programme was commissioned by the MTA to monitor the potential impacts of the replenishment works on the marine environment. The programme included surveys of physico-chemical attributes (beach and seabed profile surveys, granulometric analysis and microscopic examination of sublittoral sediments, and water quality studies), and use of seagrass as a bioindicator of environmental quality. For most of the attributes surveyed, data was collected from stations located within the putatively ‘impacted’ inlet, and from control stations before initiation of the works and following the beach replenishment works. Data for mean sediment grain size, water quality attributes (salinity, dissolved oxygen, total suspended solids and nutrients) and seagrass morphometric parameters (shoot density, length and biomass of adult leaves, and shoot epiphyte biomass) were analysed using analysis of variance (ANOVA). Overall, the results of the various monitoring components indicated that (i) no major transport of sediment from the beach to the sublittoral had occurred, and (ii) the beach replenishment works did not result in any adverse impacts on the marine environment. Good project planning and management, the relatively sheltered location of the replenished beach, together with appropriate choice of grain size of the sand used for replenishment appear to have contributed to the success of the project.peer-reviewe

Causes and outcomes of hyponatraemia at Mater Dei Hospital, Malta

CONTEXT: Hyponatraemia is the most common electrolyte balance disorder in clinical practice, amounting to 15–20% of casualty visits. While there is general agreement that associated mortality rates are high, most studies are uncontrolled.OBJECTIVE: To determine the characteristics, causes and outcome of severe hyponatraemia (<125 mmol/l) in hospitalised patients and to indentify mortality predictors.DESIGN: This is a retrospective case-controlled study of all medical admissions in the months of February, June and November, who at any point during the index admission developed a serum sodium <125 mmol/l. For each case, an age- and gender-matched control was identified.RESULTS: A total of 5195 medical admissions were reviewed. Of these, 193 patients had a sodium level <125 mmol/. 26 patients were excluded from the case group leaving a total of 167 cases and 193 controls. Length of hospital stay was more prolonged in the case group (12 vs 8 days, P<0.001). There was a highly significant excess mortality, both during the index admission (25% in cases vs 7% in controls (P < 0.001)) as well as till the end of the follow-up period (52% in cases vs 22% in controls (P<0.001)). Mortality was unrelated to severity of hyponatraemia. Patients who developed the lowest serum sodium later on during their admission (ie sodium levels continued falling during the admission or fell de novo), had a higher rate of mortality than patients whose lowest serum sodium was on the day of admission (64.3% vs 45%, P 0.019). A cox regression analysis showed that hyponatraemia (P<0.001), male gender (P 0.033), age (P 0.021), and serum creatinine level (P 0.008) were independent risk factors for mortality. There was no statistically significant difference between the rates of ITU admission at different levels of hyponatraemia <125 mmol/l (P=0.497). Thus, serum sodium levels of <125 mmol/l should be used to identify patients who need more intensive monitoring and therapy irrespective of the degree of hyponatraemia. Only 41% of cases developed neurological symptoms, of these, confusion and altered level of consciousness were the more prevalent at 12% each, followed by falls (9%), unsteady gait (4%) and seizures (4%). The cause for hyponatraemia was frequently poorly evaluated and in 23% of cases no definite diagnosis was made.CONCLUSION: Data on assessment, investigation and management of hyponatraemia illustrates variability and shortcomings in clinical practice. The question remains whether the relationship between hyponatraemia and increased mortality is causal or associative.peer-reviewe

Final report on project SP1210: Lowland peatland systems in England and Wales – evaluating greenhouse gas fluxes and carbon balances

Lowland peatlands represent one of the most carbon-rich ecosystems in the UK. As a result of widespread habitat modification and drainage to support agriculture and peat extraction, they have been converted from natural carbon sinks into major carbon sources, and are now amongst the largest sources of greenhouse gas (GHG) emissions from the UK land-use sector. Despite this, they have previously received relatively little policy attention, and measures to reduce GHG emissions either through re-wetting and restoration or improved management of agricultural land remain at a relatively early stage. In part, this has stemmed from a lack of reliable measurements on the carbon and GHG balance of UK lowland peatlands. This project aimed to address this evidence gap via an unprecedented programme of consistent, multi year field measurements at a total of 15 lowland peatland sites in England and Wales, ranging from conservation managed ‘near-natural’ ecosystems to intensively managed agricultural and extraction sites. The use of standardised measurement and data analysis protocols allowed the magnitude of GHG emissions and removals by peatlands to be quantified across this heterogeneous data set, and for controlling factors to be identified. The network of seven flux towers established during the project is believed to be unique on peatlands globally, and has provided new insights into the processes the control GHG fluxes in lowland peatlands. The work undertaken is intended to support the future development and implementation of agricultural management and restoration measures aimed at reducing the contribution of these important ecosystems to UK GHG emissions

Contrasting vulnerability of drained tropical and high-latitude peatlands to fluvial loss of stored carbon

Carbon sequestration and storage in peatlands rely on consistently highwater tables. Anthropogenic pressures including drainage, burning, land conversion for agriculture, timber, and biofuel production, cause loss of peat-forming vegetation and exposure of previously anaerobic peat to aerobic decomposition. This can shift peatlands from net CO2 sinks to large CO2 sources, releasing carbon held for millennia. Peatlands also export significant quantities of carbon via fluvial pathways, mainly as dissolved organic carbon (DOC). We analyzed radiocarbon (14C) levels of DOC in drainage water from multiple peatlands in Europe and Southeast Asia, to infer differences in the age of carbon lost from intact and drained systems. In most cases, drainage led to increased release of older carbon from the peat profile but withmarked differences related to peat type. Very low DOC-14C levels in runoff from drained tropical peatlands indicate loss of very old (centuries to millennia) stored peat carbon. High-latitude peatlands appear more resilient to drainage; 14C measurements from UK blanket bogs suggest that exported DOC remains young (500 year) carbon in high-latitude systems. Rewetting at least partially offsets drainage effects on DOC age

Overriding water table control on managed peatland greenhouse gas emissions

Global peatlands store more carbon than is naturally present in the atmosphere1,2. However, many peatlands are under pressure from drainage-based agriculture, plantation development and fire, with the equivalent of around 3% of all anthropogenic greenhouse gases emitted from drained peatland3–5. Efforts to curb such emissions are intensifying through the conservation of undrained peatlands and rewetting of drained systems6. Here we report CO2 eddy covariance data from 16 locations and CH4 data from 41 locations in the British Isles, and combine them with published data from sites across all major peatland biomes. We find that the mean annual effective water-table depth (WTDe; that is, the average depth of the aerated peat layer) overrides all other ecosystem- and management-related controls on greenhouse gas fluxes. We estimate that every 10 cm of reduction in WTDe could reduce the net warming impact of CO2 and CH4 emissions (100-year Global Warming Potentials) by at least 3 t CO2e ha-1 yr-1, until WTDe is < 30 cm. Raising water levels further would continue to have a net cooling effect until WTDe is < 10 cm. Our results suggest that greenhouse gas emissions from peatlands drained for agriculture could be greatly reduced without necessarily halting their productive use. Halving WTDe in all drained agricultural peatlands, for example, could reduce emissions by the equivalent of over 1% of global anthropogenic emissions

Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences

Non peer reviewe

Children’s and adolescents’ rising animal-source food intakes in 1990–2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15–19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.publishedVersio

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.publishedVersio