Epidemiological case-control study on contact sensitisation in female foot care specialists with occupational contact dermatitis: Patch test data of the Information Network of Departments of Dermatology (IVDK), 2008 to 2022.

BACKGROUND: Mainly women work as foot care specialists (FCS). They are at risk to develop occupational dermatitis (OD). OBJECTIVES: The objective of this study is to describe the contact sensitisation pattern of female FCS with OD. METHODS: In a retrospective study, patch test and clinical data collected by the Network of Departments of Dermatology (IVDK) from 2008 to 2022 were analysed. Data of 116 female FCS with OD were compared with data of 13 930 female patients with OD working in other professions and 78 612 female patients without OD. RESULTS: Hand dermatitis (93.1%) was significantly more common and face dermatitis (0.9%) significantly less common in female FCS with OD compared to other female patients with or without OD. Frequent suspected allergen sources were disinfectants, gloves, leave-on and nail cosmetics. Occlusion and wetness were important co-factors. The most common diagnoses were irritant contact dermatitis (26.7%) and allergic contact dermatitis (21.6%). No sensitisation to any of the baseline series allergens was significantly more frequent in female FCS with OD than in the two control groups. However, sensitisations to allergens which FCS are abundantly exposed to, including fragrances, preservatives, rubber ingredients and disinfectants, were most common. CONCLUSIONS: FCS should be aware of the OD risk and prevention should be promoted.

Effects of cardiovascular drugs on mortality in severe chronic obstructive pulmonary disease.

RATIONALE: Cardiovascular drugs may improve survival in chronic obstructive pulmonary disease (COPD). However, previous studies did not account for major sources of bias, and drug effects have not been evaluated in severe COPD. OBJECTIVES: To estimate the time-dependent effects of cardiovascular drugs on survival in oxygen-dependent COPD, accounting for immortal and immeasurable time bias. METHODS: Prospective national study of patients starting long-term oxygen therapy for COPD in Sweden between 1 October 2005 and 30 June 2009. Effects on mortality were estimated using extended Cox regression adjusted for age, sex, PaO2, PaCO2, World Health Organization performance status, body mass index, comorbidity, and concomitant medications. Immortal and immeasurable time bias was addressed by analyzing all medications as time-dependent variables and accounting for hospitalized time, respectively. MEASUREMENTS AND MAIN RESULTS: Time-dependent effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, antiplatelet drugs, ß-blockers, and statins on all-cause mortality were measured. Of the 2,249 included patients, 1,129 (50%) died under observation. No patient was lost to follow-up. The adjusted time-dependent model was compatible with reduced mortality for antiplatelet drugs (hazard ratio [HR], 0.86; 95% CI, 0.75-0.99; P = 0.030) and trends for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR, 0.90; 95% CI, 0.79-1.04; P = 0.166) and statins (HR, 0.86; 95% CI, 0.72-1.03; P = 0.105), whereas ß-blockers increased mortality (HR, 1.19; 95% CI, 1.04-1.37; P = 0.010). CONCLUSIONS: This study supports that antiplatelet drugs improve survival and ß-blockers decrease survival in oxygen-dependent COPD.

Trends in cause-specific mortality in oxygen-dependent chronic obstructive pulmonary disease.

RATIONALE: Since the introduction of long-term oxygen treatment (LTOT) in chronic obstructive pulmonary disease (COPD) with chronic hypoxia, the proportion of women and the age of patients starting LTOT have increased markedly. We hypothesize that this might have led to shifts in the causes of death over time. OBJECTIVES: To test for time trends in cause-specific mortality in COPD with LTOT. METHODS: Patients starting LTOT for COPD in Sweden between January 1, 1987 and December 31, 2004 were included in a national prospective study and monitored until withdrawal of LTOT, death, or December 31, 2004. The primary end point was cause of death obtained from the Swedish Causes of Death Register. MEASUREMENTS AND MAIN RESULTS: A total of 7,628 patients (53% women) were monitored for a median of 1.7 years (range, 0-18.0 yr). No patient was lost to follow-up and 5,457 patients died during the study. The crude overall mortality increased by 1.6%/year (95% confidence interval [CI], 0.9-2.2%/yr; P < 0.001). The absolute risk of death increased for circulatory disease by 2.8%/year (95% CI, 1.3-4.3%/yr; P < 0.001) and for digestive organ disease by 7.8%/year (95% CI, 1.9-14.0%/yr; P = 0.009). The absolute risk of death decreased for respiratory disease by 2.7%/year (95% CI, 2.0- 3.3%/yr; P < 0.001) and for lung cancer by 3.4%/year (95% CI, 1.1-5.7%/yr; P = 0.004). CONCLUSIONS: In oxygen-dependent COPD, mortality has increased over time both overall and of nonrespiratory causes, including cardiovascular disease. This highlights the importance of optimized diagnostics and treatment of comorbidities to decrease morbidity and mortality.

Increased survival with mechanical ventilation in posttuberculosis patients with the combination of respiratory failure and chest wall deformity.

BACKGROUND: Patients who have had tuberculosis are at risk for respiratory failure with hypercapnea from chest wall deformity and hypoxia from pulmonary sequelae. The combination of hypercapnea and hypoxia justifies both mechanical ventilation and oxygen therapy as treatment options. We aimed to study which treatment mode is associated with the best survival in patients with the combination of respiratory failure and chest wall deformity from tuberculosis. METHODS: Swedish patients starting oxygen therapy or mechanical ventilation between 1996 and 2004 due to the combination of respiratory failure and chest wall deformity from tuberculosis were eligible for conclusion. They were followed up prospectively until October 2006, with death as the primary outcome. RESULTS: A cohort of 188 patients was included. Eighty-five patients received mechanical ventilation, and 103 received oxygen therapy alone. No patients were excluded, and no patients were unavailable for follow-up. Mechanical ventilation was associated with a significantly better survival than oxygen therapy alone, even after adjustments for age, gender, concomitant respiratory disease, blood gas tensions, and vital capacity, with an adjusted hazard risk of death of 0.35 (95% confidence interval, 0.17 to 0.70). CONCLUSION: Patients with the combination of respiratory failure and chest wall deformity from tuberculosis had a significantly better survival when treated with home mechanical ventilation than with long-term oxygen therapy alone. We recommend home mechanical ventilation with or without supplementary oxygen as the first choice of treatment for these patients.

Survival and future need of long-term oxygen therapy for chronic obstructive pulmonary disease--gender differences.

We aimed to study trends in gender-related differences in incidence, and prevalence for long-term oxygen therapy due to chronic obstructive pulmonary disease. Another aim was to study survival after onset of oxygen therapy. Prospectively followed were 5689 Swedish patients, who were prescribed oxygen therapy because of chronic obstructive pulmonary disease from 1987 to 2000. The annual incidence of women starting oxygen therapy increased more rapidly than that in men. In 2000, 7.6 per 100,000 women started treatment compared with 7.1 in men. The frequency of ever smoking in Sweden in the age group receiving oxygen, i.e. age 65-84 years, was 36.4% in women and 65.0% in men, indicating that women ran a higher risk of developing an oxygen-requiring chronic hypoxaemia. An increase in women requiring oxygen therapy is predicted due to the increase in smoking frequency in young and middle-aged women and it is estimated that about 70% of Swedish patients on oxygen in 2026 will be women, with an estimated prevalence of 61 per 100,000. In conclusion, the incidence and prevalence for long-term oxygen therapy increases more rapidly among women than in men. This is probably due to the increased frequency of smoking in women compared with men and a higher susceptibility to develop severe hypoxaemia in women. The survival is better in women with long-term oxygen therapy than in men.

Occupational exposure and severe pulmonary fibrosis.

BACKGROUND: External agents, especially metal and wood dust, are believed to be risk factors for development of idiopathic pulmonary fibrosis (IPF). The aim of this case-control study was to investigate which occupational exposure types are associated with development of severe pulmonary fibrosis (PF), and especially IPF. METHODS: An extensive postal questionnaire including 30 specific items regarding occupational exposure was completed by 181 patients with severe PF and respiratory failure reported to the Swedish Oxygen Register, among whom 140 were judged as having IPF. The questionnaire was also completed by 757 control subjects. We stratified data for age, sex and smoking and calculated odds ratios (ORs). RESULTS: We found increased risk for IPF in men with exposure to birch dust (OR 2.7, 95% confidence interval (95% CI) 1.30-5.65) and hardwood dust (OR 2.7, 95% CI 1.14-6.52). Men also had slightly increased ORs associated with birds. We did not find any increased risk in association with metal dust exposure. CONCLUSION: Exposure for birch and hardwood dust may contribute to the risk for IPF in men.

A nationwide structure for valid long-term oxygen therapy: 29-year prospective data in Sweden.

BACKGROUND: Long-term oxygen therapy (LTOT) improves prognosis in COPD with severe hypoxemia. However, adherence to criteria for eligibility and quality of LTOT is often insufficient and varies between countries. The aim of this study was to evaluate a national structure for prescription and management of LTOT over three decades in Sweden. METHODS: The study was a prospective, population-based study of 23,909 patients on LTOT from 1987 to 2015 in the Swedish National Register of Respiratory Failure (Swedevox). We assessed the prevalence, incidence, and structure of LTOT; completeness of registration in Swedevox; and validity of prescription and management of LTOT in Sweden according to seven published quality indicators. RESULTS: LTOT was prescribed by 48 respiratory or medicine units and managed mainly by specialized oxygen nurses. Swedevox had a stable completeness of 85% of patients starting LTOT since 1987. The national incidence of LTOT increased from 3.9 to 14.7/100,000 inhabitants over the time period. In 2015, 2,596 patients had ongoing therapeutic LTOT in the registry, a national prevalence of 31.6/100,000. Adherence to prescription recommendations and fulfillment of quality criteria was stable or improved over time. Of patients starting LTOT in 2015, 88% had severe hypoxemia (partial pressure of arterial oxygen [PaO2] <7.4 kPa) and 97% had any degree of hypoxemia (PaO2 <8.0 kPa); 98% were prescribed oxygen ≥15 hours/day or more; 76% had both stationary and mobile oxygen equipment; 75% had a mean PaO2 >8.0 kPa breathing oxygen; and 98% were non-smokers. CONCLUSION: We present a structure for prescription, management, and follow-up of LTOT. The national registry effectively monitored adherence to prescription recommendations and most likely contributed to improved quality of care.

Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home.

BACKGROUND: Home mechanical ventilation (HMV) and long-term oxygen therapy (LTOT) are the two treatment alternatives when treating respiratory insufficiency in patients with kyphoscoliosis. We aimed to study the effect on survival with regard to HMV or LTOT alone in patients with respiratory insufficiency due to kyphoscoliosis. METHODS: Swedish patients with nonparalytic kyphoscoliosis (ie, scoliosis not related to neuromuscular disorders) who started LTOT or HMV between 1996 and 2004 were followed up prospectively until February 14, 2006, with death as the primary outcome. Treatment modality, arterial blood gas levels, the presence of concomitant respiratory diseases, and age were recorded at the onset of treatment. No patient was lost to follow-up. RESULTS: One hundred patients received HMV, and 144 patients received oxygen therapy alone. Patients treated with HMV experienced better survival, even when adjusting for age, gender, concomitant respiratory diseases, and blood gas levels, with a hazard ratio of 0.30 (95% confidence interval, 0.18 to 0.51). CONCLUSION: The survival of patients with kyphoscoliosis receiving HMV was better than that of patients treated with LTOT alone. We suggest HMV and not oxygen therapy alone as the primary therapy for patients with respiratory failure due to kyphoscoliosis, regardless of gender, age, and the occurrence of concomitant respiratory diseases.

Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes: a randomized controlled clinical trial.

STUDY OBJECTIVES: In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements. DESIGN: After an initial 6-week physical training program, researchers' patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year. SETTING: All seven thoracic surgery centers in Sweden. PATIENTS: All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS. INTERVENTIONS: Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively. MEASUREMENTS AND RESULTS: Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV(1), residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months. CONCLUSIONS: In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.

Comorbidity and sex-related differences in mortality in oxygen-dependent chronic obstructive pulmonary disease.

BACKGROUND: It is not known why survival differs between men and women in oxygen-dependent chronic obstructive pulmonary disease (COPD). The present study evaluates differences in comorbidity between men and women, and tests the hypothesis that comorbidity contributes to sex-related differences in mortality in oxygen-dependent COPD. METHODS: National prospective study of patients aged 50 years or older, starting long-term oxygen therapy (LTOT) for COPD in Sweden between 1992 and 2008. Comorbidities were obtained from the Swedish Hospital Discharge Register. Sex-related differences in comorbidity were estimated using logistic regression, adjusting for age, smoking status and year of inclusion. The effect of comorbidity on overall mortality and the interaction between comorbidity and sex were evaluated using Cox regression, adjusting for age, sex, Pa(O2) breathing air, FEV(1), smoking history and year of inclusion. RESULTS: In total, 8,712 patients (55% women) were included and 6,729 patients died during the study period. No patient was lost to follow-up. Compared with women, men had significantly more arrhythmia, cancer, ischemic heart disease and renal failure, and less hypertension, mental disorders, osteoporosis and rheumatoid arthritis (P<0.05 for all odds ratios). Comorbidity was an independent predictor of mortality, and the effect was similar for the sexes. Women had lower mortality, which remained unchanged even after adjusting for comorbidity; hazard ratio 0.73 (95% confidence interval, 0.68-0.77; P<0.001). CONCLUSIONS: Comorbidity is different in men and women, but does not explain the sex-related difference in mortality in oxygen-dependent COPD.

Increased relative mortality in women with severe oxygen-dependent COPD.

BACKGROUND: Although the incidence of COPD is rapidly increasing in women, knowledge is lacking concerning differences in relative mortality and causes of death in women compared with men. We aimed to analyze differences in relative mortality and cause-specific mortality between men and women on long-term oxygen therapy (LTOT) for COPD. METHODS: Patients starting LTOT for COPD in Sweden between January 1, 1987, and December 31, 2004, were prospectively followed until termination of LTOT or through December 31, 2004. Causes of death according to the Swedish National Causes of Death Register were compared between the study group and the general Swedish population matched for age and sex, with the relative mortality expressed as standardized mortality rates (SMRs). RESULTS: A total of 7,646 patients, 4,033 women and 3,613 men, were followed for a median of 1.7 years (range 0-18.0). No patient was lost to follow-up. A total of 5,448 patients, 2,745 women and 2,703 men, died. Women had a higher SMR than men: overall mortality, SMR 12.0 (95%, 11.6-12.5) vs 7.4 (95% CI, 7.1-7.6); for respiratory disease, SMR 127.9 (95% CI, 122.4-133.6) vs 66.0 (95% CI, 63.1-69.0); cancer, SMR 3.5 (95% CI, 3.0-3.9) vs 2.2 (95% CI, 1.9-2.5); and cardiovascular disease, SMR 3.7 (95% CI, 3.3-4.1) vs 2.5 (95% CI, 2.3-2.7), respectively. CONCLUSIONS: In severe COPD treated with long-term oxygen, women have higher relative mortality than men both overall and for respiratory disease, as well as for cardiovascular disease and cancer.

A model of quality assessment in patients on long-term oxygen therapy.

BACKGROUND: The difficulty of implementing guidelines for long-term oxygen therapy (LTOT) has been recognized. We performed this analysis to evaluate the impact of a national quality assurance register on the quality of LTOT and to suggest indicators with levels for excellent quality LTOT. METHODS: Based on national register data on Swedish LTOT patients in 1987-2005, we measured nine quality indicators and the achievement levels of the participating counties in fulfilling these treatment criteria. RESULTS: There were improvements in the following eight quality indicators: access to LTOT, PaO(2) < or = 7.3 kPa without oxygen, no current smoking, low number of thoracic deformity patients without concomitant home mechanical ventilation, >16 h of oxygen/day, mobile oxygen equipment, reassessment of hypoxemia when LTOT was not started in a stable state of chronic obstructive pulmonary disease (COPD) and avoidance of continuous oral glucocorticosteroids in COPD. There was decline in the quality indicator PaO(2) > 8 kPa on oxygen. After improvements, three criteria were fulfilled by > or = 80% of the counties in 2004-2005. CONCLUSIONS: We found improvements in eight of nine quality indicators. We suggest these indicators with levels for excellent quality for use in quality assurance of LTOT based on our results.