Our results do not suggest that H pylori infection is a probable cause of part of gastrointestinal symptoms among Flemish municipal sewage workers of WWTPs.

BackgroundThe diagnostic accuracy of colonoscopy requires a perfect visualisation of the colonic mucosa, making bowel preparation a fundamental requisite of the procedure. Failure to adequately cleanse the bowel for colonoscopy results in an increase in costs and risks for patients, such as failed detection of neoplastic lesions, prolonged procedure duration and repetition of the examination. Due to recurrent failures observed in our hospital settings, a problem-solving approach was undertaken.PurposeThe aim of this study was to evaluate the quality of the pre-colonoscopy process of in- and outpatients (IOP) and identify potential dysfunctions.Material and methodsIn a 411-bed general hospital performing on average 90 colonoscopies per month, the colonoscopy reports of IOP from 1 January to 31 March 2017 were analysed. The rating of bowel preparation quality was determined according to the Boston Bowel Preparation Scale (BBPS). The laxative treatments used and the therapeutic indications were also recorded. A multidisciplinary team (MT) composed of a gastroenterologist, pharmacist, anaesthetist, nurse, senior nurse, endoscopist, dietetician and nurse-assistant met regularly for 6 months to assess the process, identify failure factors, create value-added flow and propose solutions to improve it. To compare the two groups, Student’s t or X 2 tests were used for continuous or dichotomous variables, respectively.ResultsTwo hundred and ninety-seven colonoscopy reports corresponding to 284 patients were analysed (13 patients repeated the examination). Eighty patients (28%) experienced an inadequate bowel preparation (BBPS ≤6 or annotation on report). The most widely used laxative was polyethylene glycol. The number of failures was significantly higher among inpatients compared to outpatients (p<0.005) using PEG. The main dysfunctions identifed were: steps of the process not known by the healthcare professionnals, inadequate use of laxatives, uninformed patients, inappropriate prescription or diet regimen. The proposed solutions made by the MT were process re-engineering, use of alternative laxatives to improve patient acceptability and elaboration of an information leaflet to empower patients in the colonoscopy preparation.ConclusionThe multidisciplinary healthcare approach led to the identification of the dysfunctions of the pre-colonoscopy process and to the implementation of new practices that improved patient engagement. A new evaluation will be performed in 2018 and the target is to reduce failures by 30%.No conflict of interest

Introduction Worldwide, illicit drug use and substance dependency will remain important public health problems during the next decades. Clinical evidence suggests that sex workers (SW) are a high risk group with increased prevalence. The study describes the state of affairs regarding monitoring illegal drug use among female sex workers in Europe and the existing gaps in our knowledge about the prevalence of use and dependency. Methods Literature review: literature published between 2000 and 2009 was searched with PubMed. Moreover, the National Reports (N¼222) provided yearly by the National Focal Points to the European Monitoring Centre on Drugs and Drug Addiction, were reviewed. Results Prevalence estimates of illicit drug use in SW were found regarding 16 countries. Levels of illicit drug use and substance dependency were found to be high compared to the general population and differed by geographical area, age and working environment. Available data suggest a trend towards increasing illicit drug use among SW in Europe. Conclusion There is substantial evidence that prevalence of illicit drug use and substance dependency are considerable higher in SW. However, because most European countries lack surveys and surveillance systems that provide solid estimates of drug use in this vulnerable population, additional research is needed. Feasibility of monitoring drug use by population-specific health services should be studied as this approach would facilitate timely interventions.

Objectives Helicobacter pylori was discovered in 1984, but up to now the way it is transmitted is not clear. Direct person-toperson transmission is thought to be most likely and could be relevant to occupational transmission, particularly in healthcare workers (HCWs). Methods Using serology, we studied the occupational risk for H pylori in HCWs in two cross-sectional studies and one cohort study (follow-up 10 years). Results In a cross-sectional study, 587 HCWs working in institutions for children with mental disabilities with a documented high prevalence of H pylori infection were compared to non-exposed controls. Using multiple logistic regression to adjust for confounding variables, an OR of 2 (95% CI 1.4 to 2.7) was found in workers having contact with faeces of inhabitants. In another cross-sectional study in 198 nursing home workers, an OR of 0.9 (95% CI 0.5 to 1.9) was found in multiple logistic regression compared to non-exposed controls after adjusting for other risk factors. In the cohort of HCWs and non-exposed controls, workers seronegative for H pylori at baseline were followed up for at least 10 years, resulting in 2254 person-years (py) in the HCW group and 1284 in nonexposed controls. In HCWs an incidence rate for H pylori infection of 0.53/100 py (95% CI 0.28 to 0.93) was found, compared to 0.39/100 py (95% CI 0.13 to 0.91) in non-exposed controls, resulting in a rate ratio of 1.36 (95% CI 0.43 to 4.21). Conclusions These results show the diffi culty in interpreting cross-sectional studies. Results of a cohort study show a slightly increased incidence of H pylori infection in HCWs compared to non-exposed controls.