Asbestos exposure in lung cancer

Indonesia has limited data on asbestos-related diseases despite abundant using. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR=2.04, 95% CI=1.21-3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI= 1.01-9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI=1.71-44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards

Asbestos-Related Lung Cancer: A Hospital-Based Case-Control Study in Indonesia

Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21–3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01–9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71–44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards

Pleural plaques and pleural changes among lung cancer patients exposed to asbestos

Background Indonesia is one of the world's largest asbestos importing countries. While asbestos is the main contributor to work-related lung cancer, studies or reports regarding the CT findings of asbestos-related lung cancer have been limited in the country. The objective of this study was to compare CT findings of the size of the tumor and pleural and lung parenchymal changes between lung cancer patients exposed to asbestosis and those not exposed. Methods This cross-sectional study involved 96 lung cancer patients consisting of 48 subjects who had been exposed to asbestos and 48 who had not been exposed. They underwent thoracic CT scans at the Radiology Department of Persahabatan Hospital. Asbestos exposure was determined using interviews that followed a protocol similar to that of a previous study about asbestos-related lung cancer. Senior radiologists investigated the existence of pleural and parenchymal changes. An independent T- test and chi-square test to compare CT scan features between the two groups. Results The mean age was 57.75 ± 8.56 years in the asbestos-exposed group and 58.56 ± 7.99 years in the unexposed group. The proportion of tumor sizes of more than five cm, pleural plaques, and subpleural dot-like or branching opacities were significantly higher among asbestos-exposed subjects compared to the non-exposed group (p = 0.044;p=0.37;p=0.041, respectively). Conclusions Asbestos exposure is significantly related to the size of the tumor and the existence of pleural plaques and asbestosis. These findings may help further management of lung cancer patients and the policy of asbestos use in Indonesia

Effect of Carica Papaya L Leaf Infusion on Transporting Glucose across Small Intestine Cell Membrane of Wistar Rats Model

Background: Carica papaya L leaf is one of the common types of plant that has been used as treatment for diabetes mellitus (DM). The leaf possibly contain quercetin, which may inhibit glucose transport through cell membrane of small intestine. This study was conducted to determine the effect of Carica papaya L leaf infusion on glucose transport in Wistar rat model.Methods: A one-group pretest-posttest explorative study was designed using perfusion method. Nine male rats were fasted for 18-24 hours before dissected. A 25 mL glucose solution was given as early control, before Carica papaya L leaf infusion treatment A 25 mL glucose solution was later given again after Carica papaya L leaf infusion as late control. Artificial perfusion equipment had been used to maintain the back and forth flow of glucose in the small intestine. Sample was taken every 15 minutes for one hour for each treatment.Results: Carica papaya L leaf infusion did not decrease the concentration of glucose absorption significantly compared to early control. The mean absorption of glucose in early control was 85.39+4.42 mg/dl and during treatment was 84.51+4.20 mg/dL.Conclusions: Carica papaya L leaf infusion does not have significant inhibiting effect on glucose transport across small intestine cell membrane. Further explorative study is required

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Interleukin-6 Level and Neutrophil-Lymphocytes Ratio and Severity of Coronavirus Disease 19

Interleukin-6 (IL-6) is a proinflammatory cytokine that plays an important role in hyperinflammation and cytokine storm in Coronavirus Disease 19 (COVID-19) patients. The neutrophil-lymphocyte ratio (NRL) describes the innate and adaptive immune responses. Elevated IL-6 and NLR levels usually indicate a severe clinical condition in COVID-19 patients. Aim of this study was to determine the correlation of IL-6 and NLR with the severity of illness in COVID-19 hospitalized patients. This was a descriptive correlative observational study with a cross-sectional design using secondary data from COVID-19 patients treated in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from November 2020 to October 2021. There were 225 subjects who were classified by the severity and analyzed for IL-6 levels and NLR. Median levels of IL-6 at moderate, severe, and critical levels were 4.1 pg/mL, 20.4 pg/mL, and 38.8 pg/mL, respectively. The median NLR at moderate, severe, and critical grades were respectively 4.41, 9.65, and 17.79. The correlation between IL-6, NLR, and severity was 0.441 (p<0.001) and 0.408 (p<0.001). Meanwhile, the correlation between IL-6 levels and NLR in COVID-19 was 0.230 (p<0.001). Thus, IL-6 and NRL levels have a moderate positive correlation with the severity of COVID-19, while IL-6 and NRL have a weak correlation because IL-6 is not the only factor that affects the NRL

Vulnerable Workers and COVID-19: Insights from a Survey of Members of the International Commission for Occupational Health

The COVID-19 pandemic has negatively impacted on the health and wellbeing of populations directly through infection, as well as through serious societal and economic consequences such as unemployment and underemployment. The consequences could be even more severe for those more vulnerable to the disease, such as the elderly and those with underlying health conditions. Indeed, there is evidence that such vulnerable populations are disproportionately affected in terms of both, their health and the socioeconomic impact. The aim of our study was to determine whether occupational health (OH) professionals thought that the COVID-19 pandemic might further disadvantage any particular group(s) of vulnerable workers globally, and if so, which group(s). A cross-sectional study was carried out with a sample of OH professionals by means of an online questionnaire which was shared via email within the ICOH (International Commission for Occupational Health) community. Data was collected over a period of two weeks in May 2020 and 165 responses from 52 countries were received. In this paper, the responses relating to questions about vulnerable workers are reported and discussed. Globally, our responders felt that those in less secure jobs (precarious employment (79%) and informal work (69%)), or unemployed (63%), were the most at risk of further disadvantage from this pandemic. The majority felt that their governments could act to mitigate these effects. There were suggestions of short-term alleviation such as financial and social support, as well as calls for fundamental reviews of the underlying inequalities that leave populations so vulnerable to a crisis such as COVID-19

Online health information-seeking experiences during the COVID-19 lockdown among social media users in four countries

Most countries imposed lockdown restrictions on high-risk cities due to the coronavirus (COVID-19) disease. Although individuals adopted social media use during the lockdown, it is unclear how online information-seeking experiences affected their health and quality of life. We conducted an online survey among people living in cities in Ghana, India, Indonesia, and Pakistan that were affected by lockdown restrictions. Using Colaizzi’s method, we thematically analyzed 166 participants’ (males = 93, females = 73) online text responses. We observed that uncertainties about COVID-19 and the feeling of boredom predisposed participants to become victims of misinformation. Once they were misinformed, they felt anxious about COVID-19. Consequently, some overused social media to obtain additional information while others decreased or avoided its usage entirely. Our study provides insight into a recent global phenomenon. There is a need for adequate psychological support services through social media to lessen the use of unhealthy coping mechanisms