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PubMed1981

Thoughts on irritant contact dermatitis.

An attempt is made to formulate some kind of working hypothesis concerning the pathophysiology, clinical appearance and treatment of irritant contact dermatitis. Acute irritant dermatitis may be caused by one single overwhelming external exposure of comparatively short duration. It is usually accidental and therefore recognized early as cause and effect. Chronic irritant dermatitis may be the result of a too early repetition of one impairing factor (chronic irritant dermatitis "traumiteration' type), but is more commonly the result of the influence of a variety of stimuli, each starting to be active before recovery from the foregoing stimuli has been completed (chronic irritant dermatitis 'summation' type.) By repetition of the same stimulus, or by a combination of varying stimuli, the degree of impairment surpasses a critical level, in consequence of which a clinical disease (irritant contact dermatitis) ensues. This clinical disease, however, is only 'the tip of the iceberg'. Such stimuli may be chemical, mechanical and/or climatic. To find out which are the harmful factors requires a detailed case history about the patient's work, habits and hobbies, thus enabling him to avoid as many damaging exposures as is practical, and hence reducing the sum of causative factors. A number of causative factors are enumerated. The article is intended to be a catalyst to promote discussion on this subject.

Acute Disease↗
PubMed1987

Cosmetic intolerance.

A study of cosmetic intolerance has been undertaken in 5202 patients tested for possible contact dermatitis. Each patient has been evaluated by medical history and patch testing. Intolerance to cosmetics involved only 5.9% of the total population tested. If other possible sources of allergens (medication, occupation, hobbies etc) are associated, this figure rises to 11.7%. The origin of the cosmetic intolerance is more often an allergy than irritation. Soaps and shampoos are the most important types of cosmetics responsible for adverse reactions. The principal allergens are the fragrances, preservatives, hair dyes and the patients' own products. In this last category, the specific allergen has not always been detected.

Adult↗
PubMed1995

Analysis of patients with allergic patch test reactions to a plastics and glues series.

839 patients were patch tested with a series of 31 plastics and glues allergens at a dermatologic clinic over a period of 7 years. 52 (6%) had a positive patch test reaction to 1 or more such allergens. Clinic charts of 47 patients (out of 52) were available for the study. All but 3 patients had dermatitis on their hands: 17 had only hand dermatitis. 25 (53%) patients' test results were of present or past relevance to their skin diseases. 11 patients (68%) with occupational allergic contact dermatitis (ACD) and 14 (45%) with non-occupational dermatitis had relevant reactions. p-tertiary-butylphenol-formaldehyde resin was the most common allergen (9 cases). 7 patients reacted to diaminodiphenylmethane. 5 patients, who had colophony allergy, reacted to abietic acid and 4 to abitol. There was no reaction to 14 test substances. Special series, such as this plastics and glues series, reveal the cause of ACD less frequently than standard series. However, there is no other way to confirm allergy to these usually industrial allergens, which can also sensitize through non-occupational exposure during hobby working or through unpolymerized monomer left in the finished plastic product.

Adhesives↗
PubMed2002

Strategy to increase agricultural medicine practice: an exploratory study to predict interest among generalists.

Across the nation, farmers, farmworkers and their families experience an increased risk of death, illness and disability. A major concern is to determine how medical education and the medical profession can realize their potential to benefit the agricultural community. This exploratory study was completed to identify factors that might predict interest in practice of agricultural medicine among primary care physicians. Two hundred seventy-eight Alabama primary care physicians, almost equally distributed as urban and rural, completed a questionnaire that surveyed interest in agromedicine practice, experience regarding 13 agromedicine topics, and other physician characteristics. Through a logistic regression model, interest in agromedicine practice was predicted by a high proportion of practice experience in smaller communities, agromedicine experience through personal hobby or avocation, and through professional literature. These three significant variables correctly predicted a moderate to high level of interest in agromedicine practice in 65% of the physicians in the study. If these results hold up with confirmatory study, the authors recommend that targeted efforts to produce physicians for agricultural medicine should prepare physicians whose backgrounds are rural and whose interests include agricultural and family medicine, thus predicting location and practice relevant to the needs of the agricultural community.

Accidents, Occupational↗
PubMed1992

Identifying hazards and risk opportunity in child farm injury.

Although children are overrepresented in farm injury, little is known about the environmental hazards and risk behaviours associated with injury, or about how to identify these factors at a local level. This study addresses the measurement of these hazards and hazardous behaviours. The study was conducted in 1990 at Gloucester, New South Wales, a small dairy, beef and hobby farm community. After some formative research and local consultation, a checklist survey was constructed and sent to 120 farm families with school-age children. Families were sent the checklist forms again two weeks later to assess test-retest reliability, which was found to be acceptable among the 38 per cent who responded on both occasions. The findings on the prevalence of environmental hazards and risk behaviours from the 84 per cent of respondents were useful to refine the existing injury information available from local hospital morbidity figures, which had identified injuries related to riding (horses, bicycles and motorcycles) and to machinery and drowning as major rural injury issues. In particular the importance of bicycle riding and horse-related injury were confirmed. The survey importantly identified some previously undetected issues, most notably the danger to children's hearing. The prevalence data were used to identify targets for the development of local health promotion initiatives, leading the local farm safety action group to select horses, helmets and hearing as issues for preventive action. Findings from the method indicated the importance of local information, involving farmers in constructing the checklist, and feeding back results to the community.

Agriculture↗
PubMed1992

Vision and visual disability in the daily life of a representative population sample aged 82 years.

A representative population sample (n = 203) aged 82 years was studied to determine the prevalence of impaired vision and visual disability in a cohort previously investigated at the age of 70 years. Visual impairments and disabilities were generally most marked among the non-ambulatory subjects. In the ambulatory group (n = 160) 54% had VA greater than 0.8 and 8% VA less than 0.3. Near vision was also markedly better in this group. About 90% of the ambulatory cases could read J2 or better, read books and watch TV. Statistical analysis showed no sex difference with respect to visual ability for ambulatory subjects. Subjects with a wide range of distance VA were able to read J1 and J2, whereas only one ambulatory patient with J4 or worse had a distance VA above 0.3. To watch TV and manage most of the everyday activities a distance VA of 0.4-0.5 was required. To read newspapers and books a near vision of J2 was needed and for the telephone book J1 was needed. Improvements of near vision obtained by a change of own glasses were small. Hobby and household work proved less dependent on vision. The subjects showed a fairly realistic view of their visual capability, and distance VA was a valuable predictor of visual ability and disability.

Aged↗
PubMed1977

Description of the measurement of an individual's continuous sound exposure during a 31-day period.

A dosimeter based on the equal energy rule with range from 55 to 110 dB was used to monitor continuously the noise exposure of one subject. The subject, who is the second author of this report, works in a relatively quiet laboratory area. The daily A-weighted average sound level was measured for each 24-h period [L(eq(24))] beginning at approximately 8:00 a.m. During the day the noise exposure associated with specific activities was noted. The 31-day average sound level was 76 dB while the daily L(eq)(24)) values varied from a low of 59 dB to a high of 83 dB. The type of activity that contributed most of the subject's total sound dose was night-time parties at private homes or nightclubs. Five such parties accounted for 42% of his total sound dose. One exposure at an automobile hobby shop and three outings at a bowling alley contributed another 27% to the total sound dose. If these outside recreational activities had been avoided, the 31-day average sound level would have been reduced to 71 dB. The problems involved in monitoring a 24-h noise exposure as well as future plans for more elaborate studies are discussed.

Environmental Exposure↗
PubMed2003

Focusing on the big picture.

As a postdoc in cognitive neuroscience who's also a neurology fellow, Adam Gazzaley is a meld of basic science expertise and clinical experience: He studies brain aging in people by using functional magnetic resonance imaging at the University of California (UC), Berkeley, and he also sees patients at UC San Francisco's Memory and Aging Center. The 34-year-old native New Yorker dives with equal fervor into scientific research and nature photography, two lenses for viewing a single world of discovery. Growing up in Queens, Gazzaley knew from age 7 that he wanted to become a scientist, and as a teenager, he commuted long hours to attend the Bronx High School of Science. He earned an M.D.-Ph.D. from the Mount Sinai School of Medicine in New York City. Gazzaley's hobby as a shutterbug periodically takes him on backpacking trips to document the beauty of the great outdoors. He sells fine-art prints of his photographs to individuals, hospitals, and clinics through his company, Wanderings Inc.

Brain↗
PubMed1995

Total counts of marine bacteria include a large fraction of non-nucleoid-containing bacteria (ghosts).

Counts of heterotrophic bacteria in marine waters are usually in the order of 5 x 10(sup5) to 3 x 10(sup6) bacteria ml(sup-1). These numbers are derived from unspecific fluorescent staining techniques (J. E. Hobbie, R. J. Daley, and S. Jasper, Appl. Environ. Microbiol. 33:1225-1228, 1977; K. G. Porter and Y. S. Feig, Limnol. Oceanogr. 25:943-948, 1980) and are subsequently defined as total counts of bacteria. In samples from the Baltic Sea, the North Sea (Skagerrak), and the northeastern Mediterranean Sea, we found that only a minor fraction (2 to 32%) of total counts can be scored as bacteria with nucleoids. Lack of DNA no doubt means inactive cells; therefore, a much lower number of bacteria that grow at rates higher than those previously estimated must be responsible for the measured bacterial production in these seas. The remaining bacterium-sized and/or -shaped particles included in total counts may be cell residues of virus-lysed bacteria (ghosts) or remains of protozoan grazing.

Journal Article↗
PubMed2004

Assessing quality of life in Australian patients with Graves' ophthalmopathy.

AIMS: To determine quality of life and adequacy of education and counselling in Australian patients with Graves' ophthalmopathy during the course of their illness. METHODS: A cross sectional study was conducted at the orbital and endocrinology clinics of Royal Brisbane Hospital on 162 consecutive patients with Graves' ophthalmopathy who were managed between the 1992 and 2000. The Graves' ophthalmopathy quality of life (GO-QOL) survey modified for Australian conditions was distributed to study participants. Of the 19 questions asked, nine questions related to visual functioning, eight questions were about the psychosocial consequences of changed appearance, and two questions referred to education and counselling. Additionally, clinical data on the severity of illness were collected retrospectively from the medical notes of these patients. RESULTS: Completed questionnaires were received from 128 patients. The majority of patients reported limitations in daily activities such as hobbies, driving, watching television and reading, as well as impaired self confidence. The mean GO-QOL scores in this study were (100 representing maximum QOL): visual functioning 59.0 (SD 28.0), psychosocial consequences of changed appearance 54.5 (28.4), and education and counselling 59.1 (38.8). Only about a quarter of patients indicated that education and counselling were adequate and helpful. CONCLUSION: Graves' ophthalmopathy profoundly affects QOL and adequate education and counselling are essential for helping patients to cope with their illness. The GO-QOL survey is a simple, practical tool that can be used easily in a clinic to determine the QOL issues in subjects with Graves' ophthalmopathy.

Activities of Daily Living↗
PubMed1979

Return to work and quality of life after surgery for coronary artery disease.

Changes in work capability and quality of life were assessed retrospectively in 130 patients with ischaemic heart disease who had undergone aortocoronary bypass operations during 1976-7 because of medically uncontrollable angina. A total of 85 patients (65.4%) reported complete relief from angina six months after operation, though 12 later suffered a recurrence. Substantially fewer patients needed drugs after the operation. Before operation 9 out of 117 men fully employed at the onset of angina were working without restriction or doing lighter, fulltime work, 38 were at work but seriously incapacitated by angina, and 70 were forced to stop work. After operation 70 were working without restriction or engaged in lighter work, 15 were at work but still restricted by angina, and only 32 were forced to stop work. This result was highly significant (P less than 0.001). These differences were even more pronounced in heavy manual workers, of whom none cobld work normally before operation, whereas 16 were working without restriction afterwards. Of patients wishing to engage in hobbies or sports, social activity, and sexual intercourse but were restricted before operation, about two-thirds could resume these activities afterwards. Coronary artery surgery provided dramatic symptomatic relief in up to 90% of patients and permitted rehabilitation and return to gainful employment irrespective of type of labour. The degree of symptomatic improvement and increase in exercise tolerance after successful surgery is usually far greater than occurs with any other form of treatment and directly improves quality of life and work capability.

Activities of Daily Living↗
PubMed2002

Impact of thalamic deep brain stimulation on disability and health-related quality of life in patients with essential tremor.

OBJECTIVES: To evaluate the impact of thalamic deep brain stimulation (DBS) on disability and health-related quality of life in patients with essential tremor. METHODS: Twenty seven consecutive patients were evaluated prospectively, before surgery and at a mean of 12 months (range 6-26) after thalamic DBS. Assessment tools included the Fahn-Tolosa-Marìn tremor rating scale (TRS), activities of daily living (ADL) taxonomy, Nottingham health profile (NHP) and the visual analogue scale (VAS) for measuring impact of disease on life. Additional information on the side effects of, and expectations from surgery was obtained by interview. RESULTS: Thalamic DBS improved the ability of the patients in eating, drinking, writing, home maintenance, hobbies, and participation in society. Activities of daily life requiring bimanual skills were less improved. The emotional condition of the patients was positively affected and the negative impact of the disease on life as a whole, and on social life was decreased. Seventy per cent of the patients considered that the surgical treatment met their expectations. CONCLUSIONS: After thalamic DBS, health-related quality of life including disability in ADL and social life were improved in patients with essential tremor.

Activities of Daily Living↗
PubMed2006

Prediction of sickness absence: development of a screening instrument.

OBJECTIVES: To develop a concise screening instrument for early identification of employees at risk for sickness absence due to psychosocial health complaints. METHODS: Data from the Maastricht Cohort Study on "Fatigue at Work" were used to identify items to be associated with an increased risk of sickness absence. The analytical procedures univariate logistic regression, backward stepwise linear regression, and multiple logistic regression were successively applied. For both men and women, sum scores were calculated, and sensitivity and specificity rates of different cut-off points on the screening instrument were defined. RESULTS: In women, results suggested that feeling depressed, having a burnout, being tired, being less interested in work, experiencing obligatory change in working days, and living alone, were strong predictors of sickness absence due to psychosocial health complaints. In men, statistically significant predictors were having a history of sickness absence, compulsive thinking, being mentally fatigued, finding it hard to relax, lack of supervisor support, and having no hobbies. A potential cut-off point of 10 on the screening instrument resulted in a sensitivity score of 41.7% for women and 38.9% for men, and a specificity score of 91.3% for women and 90.6% for men. CONCLUSIONS: This study shows that it is possible to identify predictive factors for sickness absence and to develop an instrument for early identification of employees at risk for sickness absence. The results of this study increase the possibility for both employers and policymakers to implement interventions directed at the prevention of sickness absence.

Absenteeism↗
PubMed1993

A case-control study of malignant and non-malignant respiratory disease among employees of a fiberglass manufacturing facility. II. Exposure assessment.

A case-control study of malignant and non-malignant respiratory disease among employees of the Owens-Corning Fiberglas Corporation's Newark, Ohio plant was undertaken. The aim was to determine the extent to which exposures to substances in the Newark plant environment, to non-workplace factors, or to a combination may play a part in the risk of mortality from respiratory disease among workers in this plant. A historical environmental reconstruction of the plant was undertaken to characterise the exposure profile for workers in this plant from its beginnings in 1934 to the end of 1987. The exposure profile provided estimates of cumulative exposure to respirable fibres, fine fibres, asbestos, talc, formaldehyde, silica, and asphalt fumes. Employment histories from Owens-Corning Fiberglas provided information on employment characteristics (duration of employment, year of hire, age at first hire) and an interview survey obtained information on demographic characteristics (birthdate, race, education, marital state, parent's ethnic background, and place of birth), lifetime residence, occupational and smoking histories, hobbies, and personal and family medical history. Matched, unadjusted odds ratios (ORs) were used to assess the association between lung cancer or non-malignant respiratory disease and the cumulative exposure history, demographic characteristics, and employment variables. Only the smoking variables and employment characteristics (year of hire and age at first hire) were statistically significant for lung cancer. For non-malignant respiratory disease, only the smoking variables were statistically significant in the univariate analysis. Of the variables entered into a conditional logistic regression model for lung cancer, only smoking (smoked for six months or more v never smoked: OR = 26.17, 95% confidence interval (95% CI) 3.316-206.5) and age at first hire (35 and over v less than 35: OR = 0.244, 95% CI 0.083-0.717) were statistically significant. There were, however, increased ORs for year of employment (first hired before 1945 v first hire after 1945: OR = 1.944, 95% CI 0.850-4.445), talc (cumulative exposure >1000 fibres/ml days v never exposed: OR = 1.355, 95% CI 0.407-5.515), and asphalt fumes (cumulative exposure >0.01 mg/m(3) days v never exposed: OR 1.131, 95% CI 0.468-2.730). For non-malignant respiratory disease, only the smoking variable was significant in the conditional logistic regression analysis (OR = 2.637, 95% CI 1.146-6.069). There were raised ORs for the higher cumulative exposure categories for respirable fibres, asbestos, silica, and asphalt fumes. For both silica and asphalt fumes, ORs were more than double the reference groups for all exposure categories. A limited number of subjects were exposed to fine fibres. The scarcity of cases and controls limits the extent to which analyses for fine fibre may be carried out. Within those limitations, among those who had worked with fine fibre, the unadjusted, unmatched OR for lung cancer was (1.0 (95% CI 0.229-4.373) and for non-malignant respiratory disease, the OR was 1.5 (95% CI 0.336-6.702). The unadjusted OR for lung cancer for exposure to fine fibre was consistent with that for all respirable fibre and does not suggest an association. For non-malignant respiratory disease, the unadjusted OR for fine fibre was opposite in direction from that for all respirable fibres. Within the limitations of the available data on fibre, there is o suggestion that exposure to fine fibre has resulted in an increase in risk of lung cancer. The increased OR for non-malignant respiratory disease is inconclusive. The results of this population, in this place and time, neither respirable fibres nor any of the substances investigated as part of the plant environment are statistically significant factors for lung cancer risk although there are increased ORs for exposure to talc and asphalt fumes. Smoking is the most important factors in risk for lung cancer in this population. The situation is less clear for non-malignant respiratory disease. Unlike lung cancer, non-malignant respiratory represents a constellation of outcomes and not a single well defined end point. Although smoking was the only statistically significant factor for non-malignant respiratory disease in this analysis, the ORs for respirable fibres, asbestos, silica, and asphalt fumes were greater than unity for the highest exposure categories. Although the raised ORs for these substances may represent the results of a random process, they may be suggestive of an increased risk and require further investigation.

Adult↗
PubMed1995

Substantial decrease of blood lead in Swedish children, 1978-94, associated with petrol lead.

OBJECTIVES: To study the potential impact of environmental exposure to petrol lead, residential area, age, sex, and lead exposing hobby, on blood lead concentrations (BPb) in children. METHODS: In the south of Sweden, yearly from 1978-94, BPb was measured in 1230 boys and 1211 girls, aged between 3 and 19 (median 10; quartiles 9 and 12) years. RESULTS: For the samples of 1978, the geometric mean (GM) was 67 (range 30-250) micrograms/l in boys and 53 (18-161) micrograms/l in girls, whereas the corresponding GMs for 1994 were 27 (12-122) and 23 (12-97) micrograms/l. The sex difference was present only in children over eight. Moreover, residential area affected BPb; in particular, children living near a smelter area had raised BPbs. There was a clear ecological relation between BPb (adjusted GM) and annual lead quantity in petrol sold in Sweden, which was estimated to be 1637 tonnes in 1976 and 133 tonnes in 1993 (P < 0.001, ecological linear regression analysis, where a two year lag of petrol lead was applied). In the 171 boys and 165 girls who were sampled twice with an interval of one to four years, the decreases in BPb were estimated to be 6% (95% confidence interval 4%-8%) and 10% (8%-13%)/year, respectively. CONCLUSIONS: The present report points out the considerable beneficial effect of the gradual banning of petrol lead on the lead exposure affecting the population and differential sex specific BPb patterns due to a pronounced age effect in girls, which may be caused by older girls' lower food intake per kg of body weight, lower lung ventilation, cleaner life style, and loss of blood lead through menstrual bleedings.

Adolescent↗
PubMed1986

Relationships between avian exposure, humoral immune response, and pigeon breeders' disease among Scottish pigeon fanciers.

In a large scale clinical survey of Scottish pigeon fanciers, 277 people completed a detailed questionnaire and provided a venous blood sample. There were 29 (10.4%) who fulfilled the clinical criteria for pigeon breeders' disease used in the study and 84 (30.3%) who showed a significant serum IgG antibody response to pigeon gammaglobulin (4 micrograms/ml) and were considered to have been sensitised. Increasing exposure was associated with a progressive tendency towards sensitisation, but the intensity of the antibody response was related to the presence of symptoms and not the degree of exposure. Thirteen out of 15 subjects in the survey with a serum concentration of antipigeon IgG greater than 60 micrograms/ml fulfilled the clinical criteria for pigeon breeders' disease, and those affected within 10 years of starting the hobby had the highest mean antibody response. Accurate quantitation of antibody response is therefore helpful in the investigation of pigeon breeders' disease. The radioimmunoassay provides a quantitative method for determining antibody response that can be used in the routine screening of pigeon fanciers and in serial monitoring of their response.

Adult↗
PubMed1989

Longitudinal course of extrinsic allergic alveolitis in pigeon breeders.

The purpose of this study was to assess the longitudinal course of pigeon breeders' disease by evaluating 24 patients with the acute form of the disease 10 years after their original diagnosis. Twenty one patients attended for clinical assessment, pulmonary function studies, chest radiography, and antibody measurement. Eighteen had continued to keep pigeons, emphasising their commitment to the hobby. Despite continued antigen exposure pigeon related symptoms had improved in most patients and only five still had troublesome symptoms. Four patients had residual abnormalities of pulmonary function or chest radiographs and three had chronic bronchitis. Fanciers had attempted to regulate their exposure to the birds by use of masks and by spending less time in their lofts but this is an unlikely explanation for the benign course of their disease, as levels of antibody to pigeon gammaglobulin remained high, suggesting that appreciable antigen exposure was still occurring. In most cases a state of equilibrium between host and antigen appeared to have developed. This observation has implications for the clinical management and understanding of the nature of the disease.

Adult↗
PubMed1996

Quality of life in adults with cystic fibrosis.

BACKGROUND: Cystic fibrosis is an inherited condition with a high mortality and morbidity. The aims of this study were to assess quality of life in a population of adults with cystic fibrosis, to compare quality of life with published scores from a healthy population and other patient groups, and to examine the relation between quality of life and other measured clinical variables. METHODS: Patients over 16 years of age attending an adult cystic fibrosis outpatient clinic were surveyed at a time when they were clinically stable. A self-complete questionnaire was administered which comprised the Nottingham Health Profile (NHP) together with six additional questions related to cystic fibrosis. RESULTS: Completed questionnaires were obtained from 240 subjects (100 women) of median age 26 years (range 16-56). Mean (SD) forced expiratory volume in one second (FEV1) was 49 (26)% predicted, forced vital capacity (FVC) was 68 (26)% predicted, and the FEV1:FVC ratio was 59 (16)%. In this cross sectional study different patterns of perceived quality of life were seen in men and women. In part 1 of the NHP there was an age related trend compared with norms in men, with more distress/disability in the dimensions of emotion, sleep, and social isolation in the older age groups. In women there was no age related trend in the degree of distress/disability compared with norms. The mean score was different from norms in the dimensions of pain, emotion and sleep. For the patients with cystic fibrosis as a whole the scores in part 1 were comparable with published scores of patients with minor non-acute conditions. Scores in part 2 of the NHP for men were different from norms in six of the seven areas of daily living (all except home life). For women the scores were different from norms in the areas of looking after the home, social life, hobbies, and holidays. There were correlations between several of the quality of life dimensions and other measured variables such as FEV1, breathlessness score, and the time spent on home treatment. CONCLUSIONS: Men and women with cystic fibrosis have different patterns of perceived quality of life, and there is an age related trend of perceived quality of life in men in some dimensions. Quality of life scores in this group, as assessed by the NHP, are similar to those reported in subjects with minor non-acute conditions.

Activities of Daily Living↗