Experiences of Diagnosis, Symptoms, and Use of Reliever Inhalers in Patients With Asthma and Concurrent Inducible Laryngeal Obstruction or Breathing Pattern Disorder: Qualitative Analysis of a UK Asthma Online Community.

BACKGROUND: Breathing pattern disorders (BPDs) and inducible laryngeal obstruction (ILO) cause similar symptoms to asthma, including dyspnea and chest tightness, with an estimated prevalence of up to one-fifth of patients with asthma. Both conditions can be comorbid with asthma, and there is evidence that they are misdiagnosed and mistreated as asthma. OBJECTIVE: This study aims to explore whether the symptoms of ILO and BPD were topics of discussion in a UK asthma online health community and patient experiences of diagnosis and treatment, in particular their use of reliever inhalers. METHODS: A qualitative thematic analysis was performed with posts from an asthma community between 2018 and 2022. A list of key ILO or BPD symptoms was created from the literature. Posts were identified using the search terms "blue inhaler" and "breath" and included if describing key symptoms. Discussion threads of included posts were also analyzed. RESULTS: The search retrieved a total of 1127 relevant posts: 1069 written by 302 users and 58 posted anonymously. All participants were adults, except 2 who were parents writing about their children. Sex and age were only available for 1.66% (5/302; 3 females and 2 males) and 9.93% (30/302) of participants (27 to 73 years old), respectively. The average number of posts written by each participant was 3.54 (range 1-63). Seven participants wrote >20 posts each. Participants experiencing undiagnosed ILO or BPD symptoms, whether or not comorbid with asthma, expressed frustration with the "one-size-fits-all" approach to diagnosis, as many felt that their asthma diagnosis did not fully explain symptoms. Some suspected or were formally diagnosed with BPD or ILO, the latter reporting relief on receiving a diagnosis and appropriate management. Participants showed awareness of their inappropriate salbutamol use or overuse due to lack of effect on symptoms. BPD and ILO symptoms were frequently comorbid with asthma. The asthma online community was a valuable resource: engagement with peers not only brought comfort but also prompted action with some going back to their clinicians and reaching a diagnosis and appropriate management. CONCLUSIONS: Undiagnosed ILO and BPD symptoms and lack of effects of asthma treatment were topics of discussion in an asthma online community, caused distress and frustration in participants, and affected their relationship with health care professionals, showing that patients experiencing BPD and ILO have unmet needs. Clinicians' education on BPD and ILO diagnosis and management, as well as increased access to appropriate management options, such as respiratory physiotherapy and speech and language therapy, are warranted particularly in primary care. Qualitative evidence that engagement with the online community resulted in patients taking action going back to their clinicians and reaching a diagnosis of ILO and BPD prompts future research on online peer support from an established online health community as a self-management resource for patients.

Applying behaviour change theory to speech and language therapy intervention for inducible laryngeal obstruction.

BACKGROUND: Speech and language therapists (SLTs) provide interventions for inducible laryngeal obstruction (ILO) despite a current lack of evidence to inform intervention delivery. This study is the first step to develop an evidence-based intervention for ILO, using behaviour change theory and the Behaviour Change Technique Taxonomy version 1 (BCTTv1). Outcomes will inform the early development stage of a complex speech and language therapy intervention for ILO, enabling more precise reporting of ILO intervention studies, as per CONSORT guidelines. AIMS: (1) To identify whether the BCTTv1 is a useful tool for characterising speech and language therapy interventions for ILO, based on existing literature, current practice and patient interviews. (2) To identify key behaviour change techniques (BCT) used within existing complex speech and language therapy interventions for ILO METHODS AND PROCEDURES: A five-phase study was conducted: (1) a systematic literature search of six electronic databases (Medline, EMBASE, CINAHL (EBSCO), Scopus, Trip, Web of Science) and grey literature between 2008 and 2020; (2) observations of six speech and language therapy intervention sessions; (3) a semi-structured interview with an SLT to validate the observed BCTTs; (4) consensus from four national expert SLTs regarding application of synthesised BCTT data to their own experiences of ILO interventions; and (5) patient engagement to review and comment on findings. OUTCOMES AND RESULTS: Forty-seven BCTs in total were coded across all three sources. Thirty-two BCTs were identified in clinical observations; 31 in interviews with SLTs and 18 in the literature. Only six BCT were identified in all three sources. Expert SLTs confirmed clinical application and relevance. Patients reported finding the concept of BCT challenging but highlighted the value of psychoeducation to support their understanding of symptoms and in turn to understand the rationale behind speech and language therapy intervention recommendations. CONCLUSION: This study indicates that the BCTTv1 is a suitable framework to identify and describe intervention components used within speech and language therapy interventions for ILO. A practice-research gap exists, reinforcing that existing literature does not capture the complexity of speech and language therapy intervention for ILO. Further research is needed to develop our understanding of the BCTs that support optimal behaviour change for this patient group. WHAT THIS PAPER ADDS: What is already known on the subject There is growing recognition for the value of speech and language therapists (SLTs) in delivering complex interventions for patients with inducible laryngeal obstruction (ILO), including evidence to suggest that their intervention can improve quality of life for patients and reduce excessive healthcare use. There are, however, no randomised controlled trials in this field; thus it is unclear what constitutes the most effective intervention. What this study adds This study demonstrates the complexity of speech and language therapy interventions for ILO and highlights the practice-research gap. It identifies a range of behaviour change techniques that are used in existing practice and captures patient views relating to the components identified within this study. What are the clinical implications of this work? Findings highlight the value of providing education about factors that might be driving ILO symptoms and in turn the importance of sharing with patients the rationale for treatment recommendations that necessitate a change in their behaviours. Identified behaviour change techniques can be used when developing and implementing SLT interventions for ILO.

Pitfalls of using the ILO classification for silicosis compensation claims.

BACKGROUND: The International Labour Organization (ILO) Classification of Radiographs of Pneumoconioses is used as the primary tool to determine compensation for pneumoconiosis in Turkey. AIMS: We aimed to evaluate how the ILO classification applied, but obtaining chest radiographs in the workplace for screening until the completion of compensation claim files by the referral centres, based on the ILO reading. METHODS: The study included 320 digital chest radiographs previously taken for screening from eight different ceramic factories and having finalised claim files by referral centres. We used an expert reference panel consisting of five ILO readers to re-evaluate all the radiographs independently using ILO standard films and reached a conclusion based on the agreement among at least three readers. The evaluation primarily included technical quality and silicosis diagnosis with an ILO 1/0 or above small profusion. The results were compared with previous findings. RESULTS: Sixty-three (20%) chest radiographs were unacceptable for classification purposes according to the ILO technical quality grades. Among the remaining 257 chest radiographs, we diagnosed 103 with silicosis (40%), while the referral centres diagnosed 182 (71%). A discrepancy was found between our results and previous evaluations. We diagnosed silicosis in 50% and 17% of the previous silicosis and normal evaluations, respectively. CONCLUSIONS: Our findings suggest that the use of the ILO classification for compensation claims may be problematic due to the way of its implementation in Turkey in addition to its subjectivity.

Lessons from 12 years of marine fauna stranding data in the south of Peru.

In Peru, while several mass mortality events have been reported in the last two decades, there has been minimal systematic stranding monitoring. In this study, we report on repeated stranding monitoring that took place between October 2003 and October 2015, at Ite beach, Tacna (17° 54' 47" S 70° 58' 21" W). The objectives of the study were to assess the proportion of strandings by taxon and whether there were seasonal effects on abundance of stranded marine fauna. The study location was assessed opportunistically by trained observers who recorded and identified every stranded marine animal to the highest taxonomic degree possible. Stranded specimens of seabirds and marine mammals were grouped into overarching taxa of coastal and oceanic seabirds, and cetaceans and carnivorans. A principal component analysis (PCA) to visualize the association among stranded taxa registered along the study period and sea surface temperature anomalies using the Oceanic El Niño Index (ONI 3.4) and El Niño Coastal Index (ICEN) indexes and a Kruskal-Wallis test were conducted to evaluate abundance differences among taxonomic groups, taxa strandings and seasons. A total of 17,827 carcasses were encountered, 92.4% was seabirds and 7.6% marine mammals. Differences in abundances were significant among coastal and oceanic seabirds and marine mammals. Significant differences among seasons for cormorants and boobies were also identified. Coastal seabirds and pinnipeds dominated the stranding counts. A massive mortality of cormorants and boobies was registered between June and July 2014 possibly due to a moderate El Niño event. These strandings provide valuable information that could help lay the groundwork for implementation of a stranding network and science-based management projects in southern Peru.

Now is the time to press the reset button: Helping India's companies to become more resilient and effective in overcoming the impacts of COVID-19, climate changes and other crises.

COVID-19 is the pandemic caused by one of the coronaviruses. This virus was not known before the outbreak in Wuhan, China, in December 2019. By January of 2020 it was declared to be a global human health crisis. The deaths and illnesses caused by the virus caused extensive fear and anxiety among people in all societies. The pandemic slowed economic activities nearly to a halt. The challenges of how companies should respond to the disruptions in their supply chains and how they can build more resilient systems, must be systematically addressed. The authors of this paper highlighted essential factors which can help companies to overcome this crisis and other types of crises, by learning from the approaches taken in India, which has a unique and diverse economic system. The Analytical Hierarchy Process (AHP) technique was used to identify the essential factors which can help companies to improve their resilience so they can recover during and after the COVID-19 pandemic era and potentially in other similar complex crises. The results of the AHP evaluation were prioritized by performing a sensitivity analysis to prioritise the essential factors. The "Role of governance" was found to be the most important factor that can be used to help in rebuilding industries and societies and in helping them to become more resilient to future severe shocks. The results of this research were used to develop recommendations for company managers, practitioners and policy-makers. The authors hope that this advice will help India to become a stronger nation with more resilient companies, which are better prepared to anticipate and to respond to future crises. We hope people in other nations will also benefit from the finding presented in this paper.

Radiological progression and lung function decrements among silica-exposed ceramic workers: a longitudinal study.

Objectives: This follow-up study set out to evaluate the natural course and radiographic progression of silicosis among ceramic workers and describe the risk factors related with disease progression. Materials and methods: We retrospectively analyzed the data of ceramic workers with silicosis who were referred to our hospital between February 2010 and March 2018. A total of 165 ceramic workers followed at least 24 months and with at least two chest radiographs were included in the study. Results: The duration of silica exposure ranged from 5.5 to 27 (median 13.6) years. The numbers of patients according to follow-up time were as follows: 38 (2-2.9) years, 77 (3-3.9) years, 26 (4-4.9) years, 17 (5-5.9) years, and 7 (≥6) years. Overall 62 of 165 (37.5%) cases showed radiologic evidences of progression ranging from 2 to 8.9 years (mean 3.7 years). Pulmonary function loss rate among silicosis patients was 36.9% (61/165). Multiple logistic regression analysis showed a significant relation between radiographic progression and age (OR, 1.079: 95% CI, 1.011-1.152), follow-up time (OR, 1.557: 95% CI, 1.144-2.118), and the ILO category (category 2 or 3) at first visit (OR, 3.507: 95% CI, 1.505-8.170). Conclusions: Our findings suggest that one-third of Turkish ceramic workers with silicosis who were followed up to 8.9 years showed progression that was related to increasing age greater ILO category at time of initial visit and follow-up duration.

Occupational health: a world of false promises.

The response of the World Health Organization (WHO) to the Ebola outbreak in West Africa in 2015 demonstrated that the global health system is unprepared to address what should be its primary mission, control of disease epidemics while protecting health workers. Critics blamed WHO politics and its rigid culture for the poor response to the epidemic. We find that United Nations agencies, WHO and the International Labor Organization (ILO), are faced with the global problem of inadequate worker protections and a growing crisis in occupational health. The WHO and ILO are given monumental tasks but only trivial budgets, and funding trends show UN agency dependence on private donations which are far larger than funds contributed by member states. The WHO and ILO have limited capacity to make the necessary changes occupational health and safety demand. The UN could strengthen the national and global civil society voice in WHO and ILO structures, and by keeping conflict of interest out of policy decisions, ensure greater freedom to operate without interference.

Comparison between two assessment methods for exercise-induced laryngeal obstructions.

Exercise-induced laryngeal obstructions (E-ILOs) are important differential diagnoses to exercise-induced asthma and are diagnosed by the continuous laryngoscopy exercise (CLE) test. There are two different methods for evaluating the severity of E-ILOs using recordings from the CLE test; the CLE score and EILOMEA. The aim of this study was to investigate the consistency between these methods. Using their respective method, the developers of each method evaluated 60 laryngoscopic recordings from patients with different subtypes and various levels of severity of E-ILOs. The CLE score evaluates glottic and supraglottic obstructions on a 4-grade scale. EILOMEA uses software to calculate the obstruction severity on continuous scales from a still frame of the larynx during maximal obstruction giving three parameters reflecting glottic and supraglottic obstruction. The means of the EILOMEA measures differed significantly for CLE score 1 vs. 2 and 2 vs. 3, but not for 0 vs. 1 for glottic as well as supraglottic obstructions. The EILOMEA method does not distinguish between CLE score 0 and 1, but otherwise the methods correlate. Since previous studies have suggested that only CLE scores of 2 and 3 reflect a severity of E-ILOs of clinical importance, this lack of the EILOMEA method is not crucial for a correct medical evaluation.

[Guidelines for the use of the International Classification of Radiographs of Pneumoconioses of the International Labour Office (ILO): Substantial changes in the currrent edition]. / Wytyczne stosowania Miedzynarodowej Klasyfikacji Radiogramów Pylic Pluc Miedzynarodowego Biura Pracy (ILO) ­ istotne zmiany w obecnie obowiazujacej edycji.

The International Classification of Radiographs of Pneumoconioses is the scheme worked out by the International Labour Office in Geneva (ILO), to register radiographic chest abnormalities in a well-ordered, reproducible and comparable way. It is used for diagnosing abnormalities caused by dust exposure. Guidelines for the use of the ILO International Classification of Radiographs of Pneumoconioses contain detailed information and recommendations on how to use the classification, as well as how the chest X-ray examination should be performed and recorded. To facilitate the diagnosis of observed abnormalities the classification is completed by the set of standard radiograms illustrating typical irregularities referring to lungs and pleura, included in the classification. The article presents the key information on classification and the most important amendments adopted in the 2000 and 2011 ILO guidelines revisions. These changes refer to radiographs quality assessment, the way of presenting abnormalities registered in standard radiographs (QUAD set, digital images) and registration of failures not related to dust exposure. Particularly important complements result from the development of radiological imaging techniques. They are concerned about the classification of radiographic images of the chest recorded digitally. Med Pr 2016;67(6):833-837.

The pathologist's view of silicosis in 1930 and in 2015. The Johannesburg Conference legacy.

The 1930 International Labour Office Conference on silicosis in Johannesburg was a turning point in the history of silicosis and in the recognition of the associated pathologic patterns. Since 1930, pneumoconioses such as silicosis have become much rarer in developed countries and can now be diagnosed at an early stage based on clinical and radiologic criteria. However, in spite of these advances, pathologists must remember to look for silica in tissues, particularly when clinical and radiologic findings are more uncertain. Furthermore, nowadays pathologists essentially observe silicotic lesions as incidental findings adjacent to lung cancers. In addition to identifying the characteristic lesions, pathologists must also try to identify their causative agent, in the case of crystalline silica firstly by using polarized light examination, followed as appropriate by more sophisticated devices. Finally, pathologists and clinicians must always keep in mind the various implications of exposure to silica compounds in a wide range of diseases.

Baldia Factory Fire Tragedy: A Black Spot for Workplace Safety Standards in Pakistan.

BACKGROUND: The Baldia Factory (BF) fire incident in Pakistan was among the most tragic workplace fires in the world claiming the lives of more than 259 people. METHODS: A case study was conducted to evaluate the state of the safety measures, firefighting systems, building regulations, employees' documentation, and compensation structures. RESULTS: The case study found many deficiencies in the fire safety program and lack of adherence to and enforcement of existing fire regulations. CONCLUSION: Findings are discussed in the context of fire safety regulations and enforcement in low- and middle-income countries such as Pakistan.

Asian Intensive Reader of Pneumoconiosis program: examination for certification during 2008-2020.

This study examined physicians' participation and performance in the examinations administered by the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) program from 2008 to 2020 and compared radiograph readings of physicians who passed with those who failed the examinations. Demography of the participants, participation trends, pass/fail rates, and proficiency scores were summarized; differences in reading the radiographs for pneumoconiosis of physicians who passed the examinations and those who failed were evaluated. By December 2020, 555 physicians from 20 countries had taken certification examinations; the number of participants increased in recent years. Reported background specialty training and work experience varied widely. Passing rate and mean proficiency score for participants who passed were 83.4% and 77.6 ± 9.4 in certification, and 76.8% and 88.1 ± 4.5 in recertification examinations. Compared with physicians who passed the examinations, physicians who failed tended to classify test radiographs as positive for pneumoconiosis and read a higher profusion; they likely missed large opacities and pleural plaques and had a lower accuracy in recognizing the shape of small opacities. Findings suggest that physicians who failed the examination tend to over-diagnose radiographs as positive for pneumoconiosis with higher profusion and have difficulty in correctly identifying small opacity shape.

Can COVID-19 infection be considered an occupational disease or injury? Analysis to fill up regulatory gaps.

BACKGROUND: Although the pandemic is nearing its end, the question of whether COVID-19 infection will be considered a work-related or occupational disease remains a legal issue. Therefore, this study aims to provide clarification on this matter. OBJECTIVES: Since the International Labour Organization (ILO) serves as the primary authority on work-related matters, this study is focused on analyzing the ILO's policies regarding the acknowledgment of COVID-19 infections as occupational diseases. It also investigates how States can recognize COVID-19 as such a disease while delving into the connection between the disease or injury and the occupation itself. METHODOLOGY: This study utilizes a doctrinal methodology, focusing on legal research. This approach employs an applied (expository) research method and discusses the topic from a professional constituency perspective, as proposed by Arthurs in 1983. RESULT: The findings indicate that the ILO does not explicitly mention the pandemic or COVID-19 infection as an occupational disease in its list. However, it does include "infectious-related diseases" or "work that carries a particular risk of contamination" as occupational or work-related diseases, which can logically be interpreted as encompassing COVID-19 infection as an occupational or work-related disease. RECOMMENDATION: As the ILO sets guiding principles for its member States, this study recommends that the ILO should establish clear and comprehensive guidelines for member States to recognize COVID-19 infections or any future pandemics as occupational diseases. CONCLUSION: This study will serve as a valuable resource for policymakers who intend to enact or amend national legislation to align with the ILO. Furthermore, it will assist relevant stakeholders in taking necessary actions based on the study's findings.

Computed tomography-based imaging biomarker identifies coal workers' pneumoconiosis.

Rationale: The increase in the incidence and the diagnostic limitations of pneumoconiosis have emerged as a public health concern. This study aimed to conduct a computed tomography (CT)- based quantitative analysis to understand differences in imaging results of pneumoconiosis according to disease severity. Methods: According to the International Labor Organization (ILO) guidelines, coal workers' pneumoconiosis (CWP) are classified into five categories. CT images were obtained only at full inspiration and were quantitatively evaluated for airway structural variables such as bifurcation angle (θ), hydraulic diameter (Dh), wall thickness (WT), and circularity (Cr). Parenchymal functional variables include abnormal regions (emphysema, ground-glass opacities, consolidation, semi consolidation, and fibrosis) and blood vessel volume. Through the propensity score matching method, the confounding effects were decreased. Results: Category 4 demonstrated a reduced θ in TriLUL, a thicker airway wall in both the Trachea and Bronint compared to Category 0, and a decreased Cr in Bronint. Category 4 presented with higher abnormal regions except for ground-glass opacity and a narrower pulmonary blood vessel volume. A negative correlation was found between abnormal areas with lower Hounsfield units (HU) than the normal lung and the ratio of forced expiratory volume in 1 s/forced vital capacity, with narrowed pulmonary blood vessel volume which is positively correlated with abnormal areas with upper HU than the normal lung. Conclusion: This study provided valuable insight into pneumoconiosis progression through a comparison of quantitative CT images based on severity. Furthermore, as there has been paucity of studies on the pulmonary blood vessel volume of the CWP, in this study, a correlation between reduced pulmonary blood vessel volume and regions with low HU values holds significant importance.

Dissensus and Deadlock in the Evolution of Labour Governance: Global Supply Chains and the International Labour Organization (ILO).

Global supply chains (GSCs) present the International Labour Organization (ILO) with a challenge that goes to the heart of its founding mandate and structure, one built on the prominence of nation states and national representatives of employers and workers. In February 2020, discussions in the ILO on the rise of GSCs reached deadlock. To fully understand why the ILO has been unable to address decent work deficits in GSCs greater attention needs to be paid to contestation, power and legitimacy in the deliberation of labour governance. Drawing on the concept of agonistic pluralism we examine the evolution of the ILO's attempt to establish a new labour standard on GSCs under three empirical phases between 2002 and 2020. We argue that shifting power asymmetries between the tripartite constituents of governments, employers and workers, increased counter-hegemonic contestation, and intensified questioning of the deliberative legitimacy of the adversaries, explain the dissensual relations at the ILO. This article contributes to the literature on labour standards in GSCs in demonstrating how and why contestation underpins the evolution of labour governance over time.

Part-time work: the co-production of a contested employment model for women in Austria and internationally, 1950s to 1980s.

In 2022, every second employed woman in Austria worked part-time, while only 12.6 percent of men did so. In more affluent countries, part-time work has evolved from a special form of employment to a gendered norm in the past six decades, whereas in state-socialist and post-state-socialist Europe, this model of women's employment played a much less pronounced role historically. Albeit contested, part-time work has been a concern of women trade unionists since the 1950s. This article examines the emergence and evolution of an important trend in the history of women's work from a multi-level perspective. It explores how women activists in the ICFTU, the ILO and in Austria dealt with part-time work as a method of harmonizing women's unpaid and paid work. Collaboration with the ILO played an important role in Austrian developments, and Austrian activists aimed to impact on international decision-making. Furthermore, the article shows the rather hidden role women civil servants played in generating knowledge on the topic. This analysis of the evolution of the gendered norm of part-time work and its contestation contributes to recent research on shifts in reproductive arrangements and gender relations in the second half of the twentieth century.

Enterprise-Based Participatory Action Research in the Development of a Basic Occupational Health Service Model in Thailand.

Various basic occupational health services (BOHS) are provided, particularly in-plant BOHS; however, it might be necessary to start expanding BOHS. The current study focuses on BOHS model development using participatory action research (PAR) at a large-sized enterprise in northeastern Thailand. The PAR began with a situation analysis using ILO Convention C161, problem and cause analysis, the development of an action plan, observation and action, evaluation, and replanning. The research tools included interviews, focus group discussions (FGDs), and participant observations. The participants included managers, human resource staff, safety officers, and workers. Both inductive and deductive thematic analyses were undertaken. The results showed that (1) education and learning experience led to the workers detecting work-related diseases early by themselves and the implementation of medical surveillance programs; (2) the workers' occupational health needs led to return-to-work assessments and first aid room system development; (3) the employer's experience led to appropriate fit-for-work examinations and emergency preparedness; and (4) the feedback from BOHS providers led to a hospital-to-in-plant return-to-work conversion. The study concluded that the enterprise could develop fit-for-work and return-to-work assessments as per the ILO Convention C161 under the policy; however, medical surveillance and the first aid room system need to be developed through counseling at the hospital's occupational medicine clinic.