The risk of vaccine non-preventable infections in daycare workers: a systematic review and meta-analysis

Background: Although infectious diseases are less common in high-income countries compared to low-income countries, they should still be seriously considered as a relevant public health issue. Some professions, such as healthcare workers, laboratory workers, and care providers may be at a particularly high risk of acquiring infections. In Germany, work-related infectious diseases are after skin diseases, the most common cause of occupational diseases reported to the Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW). An occupational disease, as defined by the WHO, is “any disease contracted primarily as a result of an exposure to risk factors arising from work activity”, although this definition varies between countries. In order for infections to be recognized as an occupational disease, either the identification of an index case is needed or it must be shown that the likelihood in which a particular case of illness was attributable to the occupation: the probability of causation must be greater than 50% (the “more-likely-than-not” rule). A general “rule-of-thumb” is to equate the probability of causation of 50% with a relative risk of disease equal to two (the “doubling of the risk”). This principle is used by many countries for the recognition of an occupational disease. Few studies have concentrated on the risk of infectious disease in daycare workers, who may be at higher risk than the general population due to their frequent and close contact to young children. Research questions: The primary aim of this review was to summarize the evidence on the relationship between being a daycare worker working with children and the possible increased risk for infections not preventable by vaccines. Furthermore, research gaps were to be identified. Finally, the implications for practice and health policy based on the evidence were to be described. Methods: For the systematic reviews with meta-analysis, the Medline and Embase databases were searched using search strings defined according to the Population, Exposure, Comparison, and Outcomes (PECO) applicable to the research questions in order to find studies on vaccine non-preventable infections in daycare workers published since 2000. The search hits were evaluated using predefined inclusion and exclusion criteria by two independent reviewers. A separate manual search was performed by reviewing the reference lists of key articles and systematic reviews. The “citation tracking factor” by Google scholar was used to find additional relevant studies. The resulting studies were extracted and were assessed in eight risk of bias domains for the judgement of study quality. With a meta-analysis, the pooled risk of infections for daycare workers compared to the general or a reference population was calculated. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: After evaluating the 6879 records, ten methodologically adequate studies were identified regarding parvovirus B19 infection (four studies) and cytomegalovirus (CMV) infection (six studies). No adequate studies on other infections were found. For parvovirus B19 infection, three cross-sectional studies and one retrospective cohort study were identified. The pooled parvovirus B19 seroprevalence in daycare workers was 70.3% (95% CI 59.5-80.4). Of three studies investigating the relative risk (RR) of parvovirus B19 infection on daycare workers, only one study evaluated seroconversion rates. There was an indication for an increased risk of parvovirus B19 infection for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98–1.27) using prevalence estimators. Furthermore, daycare workers had a higher parvovirus B19 seroconversion rate compared to the unexposed population (RR = 2.63, 95% CI 1.27–5.45) in the low risk of bias study. For CMV infection, five cross-sectional studies and one cohort study were included. The pooled CMV seroprevalence of daycare workers was 59.3% (95% CI 47.6-70.9). The four studies investigating risk of infection indicated an increased seroprevalence for daycare workers compared to a reference population (prevalence ratio, RR=1.54, 95% CI 1.33-1.77). No study evaluated CMV seroconversions for daycare workers. Conclusions: The findings suggest higher parvovirus B19 and cytomegalovirus seroprevalence for daycare workers compared to the general population. There is a need for longitudinal and higher-quality studies regarding infections not preventable by vaccines in daycare workers, as well as a need to study other infections for which daycare workers may be at higher risk. Nonetheless, when the actual occupational seroconversion risk is considered by taking into account the pre-occupational seroprevalences, the pooled relative risks for both parvovirus B19 and CMV infection are compatible with a doubled seroconversion risk corresponding to a probability of causation due to the occupation of at least 50%. Preventative efforts in the workplace are needed based on the legally required risk assessment at the workplace. Moreover, it is important to raise awareness of the potential risk of infection in women trying to conceive or during pregnancy. Recommendations to prevent infections in the day care center include using gloves and frequent handwashing after exposure to young children’s bodily fluids, cleaning surfaces, and avoiding intimate contact with young children if pregnant, although these measures alone may not completely protect the daycare worker from infection. Currently, in Germany, an employment ban for pregnant daycare workers depends on the federal state. To avoid occupational risks for pregnant daycare workers, scientific-based guidelines should be developed and applied consistently

Dresdner Lebenslagen 60+: Bericht zur Lebenssituation von Dresdnerinnen und Dresdnern ab 60 Jahren (LAB60+ Studie): Ein Kooperationsprojekt zwischen der Landeshauptstadt Dresden und der Technischen Universität Dresden

Die Stadtverwaltung hat es sich zur Aufgabe gemacht, auf die Bedürfnisse und Bedarfe unserer Seniorinnen und Senioren noch besser einzugehen. Deswegen wurde diese Studie in Auftrag gegeben. Sie stellt eine hervorragende wissenschaftliche Überprüfung und Ergänzung unseres bisherigen praktischen Tuns rund um das Thema Altern in Dresden dar und setzt sich unter anderem mit Elementen des bereits bestehenden Fachplans Seniorenarbeit und Altenhilfe inklusive des Aktionsplans für gesundes und aktives Altern, dem Dresdner Kompetenzzentrum für den Übergang in den Ruhestand und dem Pflegenetzwerk auseinander. Weg vom defizitorientierten, hin zum ressourcenorientierten Ansatz lautet ein Prinzip der Dresdner Seniorenpolitik. Es liegt auch der LAB60+ Studie zugrunde. Sie wirft einen umfassenden Blick auf die Potenziale und Chancen in der vielgliedrigen nachberuflichen Lebensphase. Beleuchtet werden notwendige Rahmenbedingungen für eine hohe Lebenszufriedenheit, für Selbsthilfe und für möglichst eigenständiges Wohnen je nach Lebensentwurf. Knapp 2.400 über 60-Jährige nahmen an der Befragung teil und haben sich dem Fragebogen mit über 90 Fragen gestellt. Die hohe Rücklaufquote von 40 Prozent verdeutlicht das hohe Interesse der Zielgruppe und die Wichtigkeit des Themas. Die Kooperation mit der Technischen Universität Dresden habe ich als äußerst nützlich und gewinnbringend für beide Seiten erlebt. Die Ergebnisse und Ableitungen der LAB60+ Studie liefern einen konstruktiven Beitrag für die fachliche und kommunalpolitische Auseinandersetzung in unserer Stadt. Bei der Entwicklung konkreter Maßnahmen ist mir eine Beteiligung der Dresdnerinnen und Dresdner sehr wichtig. Dafür ist eine Seniorinnen- und Seniorenkonferenz geplant. Künftig wollen wir die Lebenssituation der älteren und alten Menschen und das Miteinander der Generationen regelmäßig untersuchen und damit eine wissenschaftlich basierte Grundlage für weitere Diskussion und Entscheidung entwickeln. Redaktionsschluss: Januar 202

The risk of vaccine non-preventable infections in daycare workers: a systematic review and meta-analysis

Background: Although infectious diseases are less common in high-income countries compared to low-income countries, they should still be seriously considered as a relevant public health issue. Some professions, such as healthcare workers, laboratory workers, and care providers may be at a particularly high risk of acquiring infections. In Germany, work-related infectious diseases are after skin diseases, the most common cause of occupational diseases reported to the Institution for Statutory Social Accident Insurance and Prevention in the Health Care and Welfare Services (BGW). An occupational disease, as defined by the WHO, is “any disease contracted primarily as a result of an exposure to risk factors arising from work activity”, although this definition varies between countries. In order for infections to be recognized as an occupational disease, either the identification of an index case is needed or it must be shown that the likelihood in which a particular case of illness was attributable to the occupation: the probability of causation must be greater than 50% (the “more-likely-than-not” rule). A general “rule-of-thumb” is to equate the probability of causation of 50% with a relative risk of disease equal to two (the “doubling of the risk”). This principle is used by many countries for the recognition of an occupational disease. Few studies have concentrated on the risk of infectious disease in daycare workers, who may be at higher risk than the general population due to their frequent and close contact to young children. Research questions: The primary aim of this review was to summarize the evidence on the relationship between being a daycare worker working with children and the possible increased risk for infections not preventable by vaccines. Furthermore, research gaps were to be identified. Finally, the implications for practice and health policy based on the evidence were to be described. Methods: For the systematic reviews with meta-analysis, the Medline and Embase databases were searched using search strings defined according to the Population, Exposure, Comparison, and Outcomes (PECO) applicable to the research questions in order to find studies on vaccine non-preventable infections in daycare workers published since 2000. The search hits were evaluated using predefined inclusion and exclusion criteria by two independent reviewers. A separate manual search was performed by reviewing the reference lists of key articles and systematic reviews. The “citation tracking factor” by Google scholar was used to find additional relevant studies. The resulting studies were extracted and were assessed in eight risk of bias domains for the judgement of study quality. With a meta-analysis, the pooled risk of infections for daycare workers compared to the general or a reference population was calculated. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: After evaluating the 6879 records, ten methodologically adequate studies were identified regarding parvovirus B19 infection (four studies) and cytomegalovirus (CMV) infection (six studies). No adequate studies on other infections were found. For parvovirus B19 infection, three cross-sectional studies and one retrospective cohort study were identified. The pooled parvovirus B19 seroprevalence in daycare workers was 70.3% (95% CI 59.5-80.4). Of three studies investigating the relative risk (RR) of parvovirus B19 infection on daycare workers, only one study evaluated seroconversion rates. There was an indication for an increased risk of parvovirus B19 infection for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98–1.27) using prevalence estimators. Furthermore, daycare workers had a higher parvovirus B19 seroconversion rate compared to the unexposed population (RR = 2.63, 95% CI 1.27–5.45) in the low risk of bias study. For CMV infection, five cross-sectional studies and one cohort study were included. The pooled CMV seroprevalence of daycare workers was 59.3% (95% CI 47.6-70.9). The four studies investigating risk of infection indicated an increased seroprevalence for daycare workers compared to a reference population (prevalence ratio, RR=1.54, 95% CI 1.33-1.77). No study evaluated CMV seroconversions for daycare workers. Conclusions: The findings suggest higher parvovirus B19 and cytomegalovirus seroprevalence for daycare workers compared to the general population. There is a need for longitudinal and higher-quality studies regarding infections not preventable by vaccines in daycare workers, as well as a need to study other infections for which daycare workers may be at higher risk. Nonetheless, when the actual occupational seroconversion risk is considered by taking into account the pre-occupational seroprevalences, the pooled relative risks for both parvovirus B19 and CMV infection are compatible with a doubled seroconversion risk corresponding to a probability of causation due to the occupation of at least 50%. Preventative efforts in the workplace are needed based on the legally required risk assessment at the workplace. Moreover, it is important to raise awareness of the potential risk of infection in women trying to conceive or during pregnancy. Recommendations to prevent infections in the day care center include using gloves and frequent handwashing after exposure to young children’s bodily fluids, cleaning surfaces, and avoiding intimate contact with young children if pregnant, although these measures alone may not completely protect the daycare worker from infection. Currently, in Germany, an employment ban for pregnant daycare workers depends on the federal state. To avoid occupational risks for pregnant daycare workers, scientific-based guidelines should be developed and applied consistently

A Rapid Review on the Influence of COVID-19 Lockdown and Quarantine Measures on Modifiable Cardiovascular Risk Factors in the General Population

Preceding coronavirus outbreaks resulted in social isolation, which in turn is associated with cardiovascular consequences. Whether the current COVID-19 pandemic negatively impacts cardiovascular health is unclear. The aim of the rapid review was to investigate, whether COVID-19 lockdown influences modifiable cardiovascular risk factors (i.e., physical inactivity, sedentary behaviour, smoking, alcohol use, unhealthy diet, obesity, bad blood lipids, and hypertension) in the general population. Medline and EMBASE were searched until March 2021. Title, abstracts, and full texts were screened by one reviewer and 20% by a second reviewer. Only studies using probability sampling were included in order to ensure the representativeness of the target population. Data extraction and critical appraisal were done by one reviewer and double-checked by another reviewer. We identified 32 studies that fulfilled our inclusion criteria. Findings show that physical activity decreased, and sedentary behaviour increased among all age groups during the COVID-19 lockdown. Among adults, alcohol consumption increased, dietary quality worsened, and the amount of food intake increased. Some adults reported weight gain. Studies on children and adolescents were sparse. This rapid review found a high number of epidemiological studies on the impact of COVID-19 lockdown measures on modifiable cardiovascular risk factors, but only a few used probability sampling methods

Occupational risk factors for meniscal lesions: a systematic review and meta-analysis

Background!#!Meniscal lesions are common and are associated with the development of knee osteoarthritis. Knee-straining activities at work such as kneeling or squatting cause high biomechanical stresses on the knee joints that can lead to acute or chronic injuries. The objective of this systematic review is to update the evidence on the potential relationship between occupational risk factors and meniscal lesions.!##!Methods!#!We searched the Medline, Embase and Web of Science databases until August 2021 to identify epidemiological observational studies on the association between occupational risk factors and meniscal lesions. Study selection, data extraction and risk of bias assessment were performed independently by two reviewers. Effect measures were extracted from individual studies and pooled with random effects meta-analysis. Heterogeneity analyses were conducted. We used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the overall quality of evidence.!##!Results!#!The database search resulted in 11,006 references, and 46 additional studies were identified through hand search. Twenty-two studies (represented in 25 publications) met the predefined eligibility criteria and nine records were included in the meta-analysis. There was only one study with an overall low risk of bias. Significant associations between occupational risk factors and the development of meniscal lesions were found for kneeling (effect size (ES) 2.15, 95% CI 1.67-2.76), squatting (ES 2.01, 95% CI 1.34-3.03), climbing stairs (ES 2.28, 95% CI 1.58-3.30), lifting and carrying weights ≥ 10 kg (ES 1.63, 95% CI 1.35-1.96), lifting and carrying weights ≥ 25 kg (ES 1.56, 95% CI 1.08-2.24), playing football on a professional level (ES 5.22, 95% CI 3.24-8.41), working as a hard coal miner (ES 5.23, 95% CI 2.16-12.69) and floor layers (ES 1.99, 95% CI 1.43-2.78). The overall quality of evidence according GRADE was moderate to low.!##!Conclusion!#!We found consistent evidence of an increased risk of meniscal lesions by occupational knee-straining exposures. Our findings are important for the development of preventive strategies to reduce work-related knee disorders and work absence.!##!Trial registration!#!PROSPERO (registration no. CRD42020196279 )

Dose–Response Relationship between Physical Workload and Specific Shoulder Diseases—A Systematic Review with Meta-Analysis

Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease

The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression

Increased age appears to be a strong risk factor for COVID-19 severe outcomes. However, studies do not sufficiently consider the age-dependency of other important factors influencing the course of disease. The aim of this review was to quantify the isolated effect of age on severe COVID-19 outcomes. We searched Pubmed to find relevant studies published in 2020. Two independent reviewers evaluated them using predefined inclusion and exclusion criteria. We extracted the results and assessed seven domains of bias for each study. After adjusting for important age-related risk factors, the isolated effect of age was estimated using meta-regression. Twelve studies met our inclusion criteria: four studies for COVID-19 disease severity, seven for mortality, and one for admission to ICU. The crude effect of age (5.2% and 13.4% higher risk of disease severity and death per age year, respectively) substantially decreased when adjusting for important age-dependent risk factors (diabetes, hypertension, coronary heart disease/cerebrovascular disease, compromised immunity, previous respiratory disease, renal disease). Adjusting for all six comorbidities indicates a 2.7% risk increase for disease severity (two studies), and no additional risk of death per year of age (five studies). The indication of a rather weak influence of age on COVID-19 disease severity after adjustment for important age-dependent risk factors should be taken in consideration when implementing age-related preventative measures (e.g., age-dependent work restrictions)

The Effect of Ambient Environmental Conditions on COVID-19 Mortality: A Systematic Review

Weather conditions may have an impact on SARS-CoV-2 virus transmission, as has been shown for seasonal influenza. Virus transmission most likely favors low temperature and low humidity conditions. This systematic review aimed to collect evidence on the impact of temperature and humidity on COVID-19 mortality. This review was registered with PROSPERO (registration no. CRD42020196055). We searched the Pubmed, Embase, and Cochrane COVID-19 databases for observational epidemiological studies. Two independent reviewers screened the title/abstracts and full texts of the studies. Two reviewers also performed data extraction and quality assessment. From 5051 identified studies, 11 were included in the review. Although the results were inconsistent, most studies imply that a decrease in temperature and humidity contributes to an increase in mortality. To establish the association with greater certainty, future studies should consider accurate exposure measurements and important covariates, such as government lockdowns and population density, sufficient lag times, and non-linear associations

Psychosocial work stress and parent-child bonding during the COVID-19 pandemic: clarifying the role of parental symptoms of depression and aggressiveness

Abstract Background Parental work stress and impaired mental health seem to have intensified during the current COVID-19 pandemic. Both can have a negative impact on parent-child bonding: psychosocial work stress in the course of a spillover effect from work to family and symptoms of impaired mental health as part of a crossover effect from parent to child. This potentially affects the child’s development in the long term. Method This cross-sectional study examined the relationship between psychosocial work stress and parent-child bonding during the early COVID-19 pandemic (May–June 2020). Symptoms of depression and aggressiveness were considered as mediators of this relationship. The sample consisted of employees in Eastern Germany (n = 380; 42.9% mothers, 57.1% fathers), aged 24–55 years, with children aged 0–36 months. Results In the total sample, an association was only found after adjusting for potential confounders, indicating that higher psychosocial work stress is associated with weaker bonding between the parent and child (β = 0.148, p = .017, 95% CI [0.566, 5.614]). The separate analyses for mothers and fathers did not reveal a statistically significant relationship between psychosocial work stress and parent-child bonding. In the total sample, the higher the psychosocial work stress was, the higher were the parental symptoms of depression (β = 0.372, p < .001, 95% CI [3.417, 5.696]) and aggressiveness β = 0.254, p < .001, 95% CI [1.008, 3.208]). The mental health symptoms in turn were related to weaker parent-child bonding (symptoms of depression β = 0.320, p < .001, 95% CI [0.345, 0.749]; symptoms of aggressiveness β = 0.394, p < .001, 95% CI [0.697, 1.287]). The results furthermore suggested that parental mental health symptoms mediate the association between psychosocial work stress and parent-child bonding (symptoms of depression, ab = 2.491, 95% CI [1.472, 3.577] and of aggressiveness, ab = 2.091, 95% CI [1.147, 3.279]). The mediation effect was also found in the separate analyses for the mothers and fathers. Discussion The results of this study during the early COVID-19 pandemic in Germany highlight the importance of prevention as well as intervention measures in relation to psychosocial work stress that may play a debilitating role in the context of family relationships. In addition, the results suggest that both employers and employees should be made aware of the importance of psychosocial work stress, as it can have a negative impact on mental health, which in turn may have a major influence on family relationships