Delayed occupational asthma from epoxy exposure.

BACKGROUND: A delayed asthma reaction occurring several hours after exposure is difficult to diagnose. AIMS: To confirm a delayed asthma reaction in five workers following epoxy exposure. CASE REPORT: Working conditions with exposure to epoxy encountered at the workplace were reproduced in a challenge chamber. Specific inhalation challenge (SIC) with epoxy was compared to a control challenge. All five cases had delayed a asthma response 6-15 h after epoxy exposure. CONCLUSIONS: Our study confirms that SIC is a useful tool in diagnosing delayed asthma response.

Occupational rhinoconjunctivitis caused by the common indoor plant, Hoya compacta.

BACKGROUND: Allergic reactions to the common house plant Hoya compacta (HC) have not previously been described. AIMS: To confirm HC as the cause of rhinoconjunctivitis in three horticultural workers. METHODS: Greenhouse working conditions were reproduced in our challenge chamber. RESULTS: All three cases developed rhinoconjunctivitis when working with HC plants. A control challenge was performed in two cases with iceberg lettuce causing no symptoms. Nasal volume measured by acoustic rhinometry (AR) fell after all three active challenges, but also after one of the control challenges. CONCLUSIONS: Our study confirms that HC may cause occupational rhinoconjunctivitis and asthma through a Type I hypersensitivity reaction. Specific inhalation challenges, nasal nitric oxide measurement and AR may be useful additional tools in supporting such diagnoses for occupational physicians to consider.

Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA2 LEN) survey.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prevalent drugs inducing hypersensitivity reactions. The aim of this analysis was to estimate the prevalence of NSAID-induced respiratory symptoms in population across Europe and to assess its association with upper and lower respiratory tract disorders. METHODS: The GA2 LEN survey was conducted in 22 centers in 15 European countries. Each of 19 centers selected random samples of 5000 adults aged 15-74 from their general population, and in three centers (Athens, Munich, Oslo), a younger population was sampled. Questionnaires including questions about age, gender, presence of symptoms of asthma, allergic rhinitis, chronic rhinosinusitis, smoking status, and history of NSAID-induced hypersensitivity reactions were sent to participants by mail. Totally, 62 737 participants completed the questionnaires. RESULTS: The mean prevalence of NSAID-induced dyspnea was 1.9% and was highest in the three Polish centers [Katowice (4.9%), Krakow (4.8%), and Lodz (4.4%)] and lowest in Skopje, (0.9%), Amsterdam (1.1%), and Umea (1.2%). In multivariate analysis, the prevalence of respiratory reactions to NSAIDs was higher in participants with chronic rhinosinusitis symptoms (Odds Ratio 2.12; 95%CI 1.78-2.74), asthma symptoms in last 12 months (2.7; 2.18-3.35), hospitalization due to asthma (1.53; 1.22-1.99), and adults vs children (1.53; 1.24-1.89), but was not associated with allergic rhinitis. CONCLUSION: Our study documented significant variation between European countries in the prevalence of NSAID-induced respiratory hypersensitivity reactions, and association with chronic airway diseases, but also with environmental factors.

The Sinonasal Outcome Test 22 score in persons without chronic rhinosinusitis.

OBJECTIVES: To determine the Sinonasal Outcome Test 22 (SNOT 22) score in persons without chronic rhinosinusitis. DESIGN AND SETTING: As part of a trans-European study selected, respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis according to EPOS. PARTICIPANTS: A total of 366 persons participated at the clinical visit and of these 268 did not have chronic rhinosinusitis. All participants completed the SNOT 22. MAIN OUTCOME MEASURES: The SNOT 22. RESULTS: The SNOT 22 score ranged from 0 to 67 with a mean score of 10.5 (CI: 9.1-11.9) and the median score was 7. Persons with allergic rhinitis and blue-collar workers had a significant higher score. CONCLUSION: The median value of 7 is taken as the normal SNOT 22 score in persons without CRS and can be used as a reference in clinical settings and research. Allergic rhinitis and occupation affect SNOT 22 in persons without CRS.

The relation of airway obstruction to asthma, chronic rhinosinusitis and age: results from a population survey of adults.

RATIONALE: There is conflicting evidence on whether patients with asthma experience an accelerated decline in lung function with age. We examined the association between postbronchodilator lung function, asthma, chronic rhinosinusitis (CRS), and atopy with age using a large European sample. METHODS: In 17 centers in 11 European countries, case-control studies were nested within representative cross-sectional surveys of adults aged less than 75 years. Representative samples of participants with asthma, CRS or both and controls were assessed for postbronchodilator ventilatory function, smoking history, atopy, and treatment. Multiple regression was used to assess the interactive effects of age and diagnostic group on decline in postbronchodilator ventilatory function. RESULTS: A total of 3337 participants provided adequate data (778 with asthma, 399 with CRS, 244 with both asthma and CRS and 1916 controls who had neither asthma nor CRS). Participants with asthma had lower FEV1 /FVC (-4.09% (95% CI: -5.02, -3.15, P < 0.001) and a steeper slope of FEV1 /FVC against age (-0.14%/annum [95%CI: -0.19, -0.08]) equivalent to smoking 1-2 packs of cigarettes per day. Those with atopy had a slope equivalent to controls. CONCLUSIONS: People with asthma have a steeper decline in postbronchodilator lung function with age, but neither CRS nor atopy alone were associated with such decline.

Geographical variation in the prevalence of sensitization to common aeroallergens in adults: the GA(2) LEN survey.

BACKGROUND: Geographical variation in the prevalence of sensitization to aeroallergens may reflect differences in exposure to risk factors such as having older siblings, being raised on a farm or other unidentified exposures. OBJECTIVE: We wanted to measure geographical variation in skin prick test positivity and assess whether it was explained by differences in family size and/or farm exposure. We also compared prevalence in younger and older subjects. METHODS: Within the Global Allergy and Asthma European Network (GA(2) LEN) survey, we measured the prevalence of skin prick positivity to a panel of allergens, and geometric mean serum total immunoglobulin E (IgE), in 3451 participants aged 18-75 years in 13 areas of Europe. Estimated prevalence was standardized to account for study design. We compared prevalence estimates in younger and older subjects and further adjusted for age, gender, smoking history, farm exposure, number of older siblings and body mass index (BMI). RESULTS: Skin prick test positivity to any one of the measured allergens varied within Europe from 31.4% to 52.9%. Prevalence of sensitization to single allergens also varied. Variation in serum total IgE was less marked. Younger participants had higher skin prick sensitivity prevalence, but not total IgE, than older participants. Geographical variation remained even after adjustment for confounders. CONCLUSION: Geographical variation in the prevalence of skin prick test positivity in Europe is unlikely to be explained by geographical variation in gender, age, smoking history, farm exposure, family size and BMI. Higher prevalence in younger, compared to older, adults may reflect cohort-associated increases in sensitization or the influence of ageing on immune or tissue responses.

Acoustic rhinometry in persons recruited from the general population and diagnosed with chronic rhinosinusitis according to EPOS.

Chronic rhinosinusitis (CRS) is a disease related to the nose and the paranasal sinus as defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) criteria. The criteria include subjective symptoms, such as nasal obstruction, and objective findings by endoscopy. Acoustic rhinometry (AR) is an objective method to determine nasal cavity geometry. The technique is based on a sound pulse reflection analysis in the nasal cavity and determines cross-sectional areas as a function of distance as well as volume. AR measurements in persons recruited from the general population, with and without CRS based on the clinical EPOS criteria, were investigated. As part of a trans-European study, 362 persons, comprising 91 persons with CRS and 271 persons without CRS, were examined by an otolaryngologist including rhinoscopy. Minimum cross-sectional area, distance to minimum cross-sectional area, and volume in the nasal cavity were measured by acoustic rhinometry and all participants underwent Peak Nasal Inspiratory Flow (PNIF) and allergy test. A difference in AR was found before and after decongestion, but no difference was seen between CRS patients and controls. Positive correlation between AR and PNIF was found and AR was capable of identifying mucosal oedema and septum deviation visualised by rhinoscopy. In conclusion, AR, as a single instrument, was not capable of discriminating persons with CRS from persons without CRS in the general population. However, AR correlates well with PNIF and was capable of identifying septum deviation and mucosal oedema.

Quality of life and associated factors in persons with chronic rhinosinusitis in the general population: a prospective questionnaire and clinical cross-sectional study.

OBJECTIVES: The European Position Paper on Rhinosinusitis and Nasal Polyps describes methods to perform population-based and clinical studies on chronic rhinosinusitis in a standardised way, and it also describes how to clinical investigate CRS. The aim of this cross-sectional study was to evaluate quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population. DESIGN: As part of a trans-European study, selected respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis, and persons with and without chronic rhinosinusitis were compared. SETTING: This research took place in the department of Otolaryngology, Odense University Hospital. PARTICIPANTS: A total of 366 persons participated at the clinical visit, and of these, 91 were diagnosed with chronic rhinosinusitis, 271 without chronic rhinosinusitis and four persons were excluded. MAIN OUTCOME MEASURES: Severity of symptoms and disease-specific quality of life were measured using the Sino-Nasal Outcome Test 22, and generic quality of life was measured using European quality of life - 5 dimensions including an index score and a visual analogue scale. RESULTS: The prevalence of chronic rhinosinusitis was 9%, and the prevalence of polyps was 4%. Persons with chronic rhinosinusitis had significantly reduced disease-specific quality of life (P = 0.00) and generic quality of life (P = 0.04 and 0.01) compared with persons without chronic rhinosinusitis. Having chronic rhinosinusitis was correlated to age, allergic rhinitis and smell. CONCLUSION: This study gives insight into health-related quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population.

Diagnosing chronic rhinosinusitis: comparing questionnaire-based and clinical-based diagnosis.

BACKGROUND: The European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) incorporates symptomatic and endo- scopic criteria in the clinical diagnosis of chronic rhinosinusitis (CRS), while in epidemiological studies the definition is based on symptoms only. The aim of this study was to evaluate the correlation between questionnaire-based and clinical-based CRS. METHODS: Based on the GA2LEN postal survey data a total of 366 persons participated at the follow-up at the Danish centre and provided information on questionnaire-based CRS. At the same occasion the 366 participants underwent clinical inter- view and examination by an otorhinolaryngologist to provide information for a clinical-based CRS diagnosis. The association between questionnaire-based and clinical-based CRS diagnosis was determined using logistic regression models and kappa statistics. RESULTS: Mean age of respondents to the postal questionnaire was 45.3 years and 52.9% were female. Persons with asthma were 8.4 % and 26.2 % were actual smokers. There was moderate agreement between questionnaire-based and clinical-based CRS. Sensitivity was [corrected] low comparing questionnaire-based CRS with clinical-based CRS. Incorporation of self reported CRS and medical history in diagnosing CRS by questionnaire increased increased [corrected] the agreement and sensitivity while specificity stayed at a high level. [corrected] CONCLUSION: Evaluating the correlation between questionnaire-based and clinical-based CRS showed only moderate agree- ment and questions whether they evaluate the same disease. It brings into consideration that adjustments are needed to justify correlation between questionnaire-based and clinical-based diagnosis of CRS.

Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe.

BACKGROUND: The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population-based epidemiological surveys. METHODS: The Global Allergy and Asthma Network of Excellence (GA(2) LEN) conducted a postal questionnaire in representative samples of adults living in Europe to assess the presence of asthma and CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps. The prevalence of self-reported current asthma by age group was determined. The association of asthma with CRS in each participating centre was assessed using logistic regression analyses, controlling for age, sex and smoking, and the effect estimates were combined using standard methods of meta-analysis. RESULTS: Over 52,000 adults aged 18-75 years and living in 19 centres in 12 countries took part. In most centres, and overall, the reported prevalence of asthma was lower in older adults (adjusted OR for 65-74 years compared with 15-24 years: 0.72; 95% CI: 0.63-0.81). In all centres, there was a strong association of asthma with CRS (adjusted OR: 3.47; 95% CI: 3.20-3.76) at all ages. The association with asthma was stronger in those reporting both CRS and allergic rhinitis (adjusted OR: 11.85; 95% CI: 10.57-13.17). CRS in the absence of nasal allergies was positively associated with late-onset asthma. CONCLUSION: Geographical variation in the prevalence of self-reported asthma was observed across Europe, but overall, self-reported asthma was more common in young adults, women and smokers. In all age groups, men and women, and irrespective of smoking behaviour, asthma was also associated with CRS.

Influence of temperature and predation on survival of Salmonella enterica serovar Typhimurium and expression of invA in soil and manure-amended soil.

The effects of three temperatures (5, 15, and 25 degrees C) on the survival of Salmonella enterica serovar Typhimurium in topsoil were investigated in small microcosms by three different techniques: plate counting, invA gene quantification, and invA mRNA quantification. Differences in survival were related to the effect of protozoan predation. Tetracycline-resistant Salmonella serovar Typhimurium was inoculated into soil and manure-amended soil at 1.5 x 10(8) cells g soil(-1). Population densities were determined by plate counting and by molecular methods and monitored for 42 days. Simultaneous extraction of RNA and DNA, followed by quantitative PCR, was used to investigate invA gene levels and expression. Analysis by these three techniques showed that Salmonella serovar Typhimurium survived better at 5 degrees C. Comparing DNA and CFU levels, significantly higher values were determined by DNA-based techniques. invA mRNA levels showed a fast decrease in activity, with no detectable mRNA after an incubation period of less than 4 days in any of the soil scenarios. A negative correlation was found between Salmonella serovar Typhimurium CFU levels and protozoan most probable numbers, and we propose the role of the predator-prey interaction as a factor to explain the die-off of the introduced strain by both culture- and DNA quantification-based methods. The results indicate that temperature, manure, and protozoan predation are important factors influencing the survival of Salmonella serovar Typhimurium in soil.

Understanding work related musculoskeletal pain: does repetitive work cause stress symptoms?

BACKGROUND: Pain in the neck and upper extremity is reported with high frequency in repetitive work. Mechanical overload of soft tissues seems a plausible mechanism, but psychological factors have received considerable attention during the past decade. If psychological factors are important for development of regional pain in repetitive work, stress symptoms would likely be on the causal path. AIMS: To examine whether objective measures of repetitive monotonous work are related to occurrence and development of stress symptoms. METHODS: In 1994-95, 2033 unskilled workers with continuous repetitive work and 813 workers with varied work were enrolled. Measures of repetitiveness and force requirements were quantified using video observations to obtain individual exposure estimates. Stress symptoms were recorded at baseline and after approximately one, two, and three years by the Setterlind Stress Profile Inventory. RESULTS: Repetitive work, task cycle time, and quantified measures of repetitive upper extremity movements including force requirements were not related to occurrence of stress symptoms at baseline or development of stress symptoms during three years of follow up. CONCLUSIONS: The findings do not indicate that repetitive work is associated with stress symptoms, but small effects cannot be ruled out. Thus the results question the importance of mental stress mechanisms in the causation of regional pain related to repetitive work. However, the findings should be interpreted with caution because the stress inventory has not been validated against a gold standard.

Prognosis of shoulder tendonitis in repetitive work: a follow up study in a cohort of Danish industrial and service workers.

BACKGROUND: The physical and psychosocial work environment is expected to modify recovery from shoulder disorders, but knowledge is limited. METHODS: In a follow up study of musculoskeletal disorders in industrial and service workers, 113 employees were identified with a history of shoulder pain combined with clinical signs of shoulder tendonitis. The workers had yearly re-examinations up to three times. Quantitative estimates of duration, repetitiveness, and forcefulness of current tasks were obtained from video recordings. Perception of job demands, decision latitude, and social support was recorded by a job content questionnaire. Recovery of shoulder tendonitis was analysed by Kaplan-Meier survival technique and by logistic regression on exposure variables and individual characteristics in models, allowing for time varying exposures. RESULTS: Some 50% of workers recovered within 10 months (95% CI 6 to 14 months). Higher age was strongly related to slow recovery, while physical job exposures were not. Perception of demands, control, and social support at the time when the shoulder disorder was diagnosed, were associated with delayed recovery, but these psychosocial factors did not predict slow recovery in incident cases identified during follow up. CONCLUSION: The median duration of shoulder tendonitis in a cross sectional sample of industrial and service workers was in the order of 10 months. This estimate is most likely biased towards too high a value. Recovery was strongly reduced in higher age. Physical workplace exposures and perceived psychosocial job characteristics during the period preceding diagnosis seem not to be important prognostic factors.

Acute symptoms during non-inhalation exposure to combinations of toluene, trichloroethylene, and n-hexane.

OBJECTIVES: To study the acute effect of exposure to a mixture of three commonly used solvents in humans using a route of exposure not involving the nose and lungs, in this case a gastrointestinal application. METHODS: In a 2(3)-factorial experiment eight healthy male volunteers were exposed to the eight combinations of toluene (1. 5 and 4 mg. min(-1)) trichloroethylene (1.5 and 4 mg. min(-1)), and n-hexane (0.3 and 1.0 mg. min(-1)) for 60 min given into the stomach via a feeding tube. The body burden was measured by the exhaled solvent concentrations and the urinary excretion of metabolites during and after exposure. The subjective ratings of tiredness, sleepiness, headache, nausea, feeling of intoxication, and dizziness were estimated by continuous linear analogue rating scales before and 30, 90, and 240 min after the start of exposure. RESULTS: Concentrations of the three solvents in the end exhaled air varied between 0 and 46 mg. min(-3). The ratings of symptoms were generally low and there was no difference between the high and low doses. Neither was there any correlation between the concentration of solvents in the exhaled air and the ratings. CONCLUSIONS: The study show no effects at levels in end exhaled air of mixtures of solvents which in inhalation studies have given signs of a possible neurotoxic effect. The lack of symptoms using this alternative route supports the hypothesis that "neurotoxic" symptoms in relation to exposure to very low air concentrations of solvents are mainly indirect, mediated by irritation or smell.

Metabolic interaction between toluene, trichloroethylene and n-hexane in humans.

OBJECTIVES: This human experimental study describes the mutual metabolic interaction between toluene, trichloroethylene, and n-hexane. METHODS: Eight healthy male volunteers were exposed to combinations of toluene (1.5 or 4 mg/min), trichloroethylene (1.5 or 4 mg/min), and n-hexane (0.3 or 1.0 mg/min) for 60 min. End exhaled air concentrations were measured before and up to 240 min after the start of exposure. The urinary excretion of hippuric acid, o-cresol, trichloroethanol, trichloroacetic acid, and 2,5-hexanedione was measured before and up to 270 min after the start of the exposures. RESULTS: When the low dose rates were combined, the end exhaled concentrations were at or below the detection limit, while an increase in the dose rate of toluene increased the area under the end exhaled air concentration curve (AUC) of toluene, trichloroethylene, and n-hexane by factors of 44 (16-117) [geometric mean and 95% confidence interval], 12.8 (4.1-40.0), and 2.2 (1.2-4.1), respectively. Trichloroethylene, in turn, increased the AUC 5.0 (1.9-13.4), 25.8 (8.2-80.8) and 2.9 (1.6-5.4), respectively, whereas the corresponding values for n-hexane were 1.9 (0.7-5.1), 1.5 (0.5-4.6), and 3.2 (1.8-5.9). An 18 (range 2-34)% decrease in hippuric acid was the only interaction measured in the metabolite excretion. No correlation occurred between the individual measures of the end exhaled concentrations or the excretion of metabolites. CONCLUSIONS: The study shows that the threshold for the flow-limited metabolism of the 3 solvents in humans is exceeded at liver dose rates corresponding to inhalation exposure at occupational exposure limits. At these levels there are metabolic interactions between the 3 solvents.

Temporal epileptic seizures and occupational exposure to solvents.

Long term exposure to organic solvents is usually not considered as a possible cause of chronic epileptic seizures. A case that shows a remarkable coincidence between exposure to organic solvents and occurrence of epileptic seizures is reported. The man was a 58 year old sign writer with lifelong exposure to a mixture of organic solvents (mainly cyclohexanone, white spirit, and isopropanol). Epileptic seizures of temporal type were occurring in relation to solvent exposure. The seizures disappeared shortly after stopping exposure but returned just after a short term re-exposure to cyclohexanone. The case history suggests that exposure to organic solvents may elicit or maintain epileptic seizures despite medical treatment.

Hepatic metabolism of toluene after gastrointestinal uptake in humans.

The metabolism of toluene and the influence of small doses of ethanol were measured in eight male volunteers after gastrointestinal uptake, the toluene concentration in alveolar air and the urinary excretion of hippuric acid and ortho-cresol being used as the measures of metabolism. During toluene exposure to 2 mg.min-1 for 3 h the alveolar toluene concentration was 0.07 (range 0-0.11) mg.m-3; exposure to 6 mg.min-1 for 30 min increased the alveolar concentration to 0.9 (range 0.03-2.6) mg.m-3. Ingestion of 0.08, 0.16, and 0.32 g of ethanol per kilogram of body weight during toluene exposure of 2 mg.min-1 increased the alveolar concentration within 10 min, and maximal alveolar concentrations of 5 (SD 3), 24 (SD 11), and 39 (SD 28) mg.m-3 were reached after 30, 60, and 90 min for the three doses, respectively. Hippuric acid excretion was only decreased by an ethanol dose of 0.32 g.kg-1. Very low doses of ethanol inhibit toluene metabolism, and the procedure is sensitive enough to measure metabolic interactions between solvents and other xenobiotics in humans.

[AIDS--knowledge, behavior and attitude at the University of Aarhus in 1990. A questionnaire study]. / AIDS--viden, adfaerd og holdning på Aarhus Universitet i 1990. En spørgeskemaundersøgelse.

To describe knowledge, attitude and behaviour regarding AIDS among students and employees at the University of Aarhus an anonymous self-administered questionnaire survey was conducted in April 1990. Of the 2169 and 850 questionnaires to students and employees, respectively, 1548 (71.4%) and 568 (67%) were returned. The study group had an excellent knowledge about AIDS and the transmission of HIV-virus. However, when defining "risk behaviour" in relation to transmission of HIV-virus among heterosexuals as "> or = 2 sexual partners within the past year without using condoms" 27% of the male and 20% of the female students showed risk behaviour. Among employees the rate was highest (23%) among the male scientific staff than among the remainder (17%). It is concluded that risk behaviour was not related to age and occurred in spite of the fact that 42% of the students and 31% of the employees, who showed risk behaviour were also aware of a personal risk of being infected. There is still a need for information about AIDS, and future campaigns should be directed towards all age groups as risk behaviour is not only a phenomenon among young people.

[Are health and disease equally distributed among children?]. / Er børns sundhed og sygdom ligeligt fordelt?

Living conditions for children and young people are of great interest. In previous investigations, differences in sickness among social groups have been found. WHO plans to reduce differences in health conditions among groups within the countries by at least 25%. In this article, attention is drawn to inequalities in health among children in Denmark. Parameters such as the risk of stillbirth, congenital malformations and death during the first year of life do not differ between social groups. Where the less harsh data are concerned, inequalities still exist between social groups, also among Danish children. In relation to the goals set by WHO, it is important to be aware that the existing ways of measurement may not be sufficient.