Self-reported hand symptoms: a role in monitoring health care workers for latex sensitization?

BACKGROUND: The use of powdered natural rubber latex (NRL) gloves increased greatly in the 1980s because of concerns about transmission of blood-borne infections and the subsequent implementation of universal precautions. The most common clinical reactions to glove use are irritant and T-cell-mediated contact dermatitis. However, IgE-mediated immediate reactions to latex have become a serious concern for health care workers (HCWs). The diagnosis of latex allergy requires a comprehensive medical history and diagnostic tests. The skin prick test is the preferred diagnostic method, although it can be time-consuming. OBJECTIVE: To determine the role of hand symptoms reported on questionnaires in monitoring HCWs for latex sensitization. METHODS: Questionnaires were completed by 804 HCWs at 2 hospitals. Using a positive skin prick test (SPT) result as a criterion standard of latex sensitization, the diagnostic performance of hand symptoms was evaluated. RESULTS: Increasing latex glove use was strongly related to increasing reports of hand symptoms. Hand symptoms were highly associated with glove-related respiratory and systemic symptoms. A positive SPT result was seen in 5% of HCWs and increased with the number of hand symptoms: 0 (1.6%), 1 to 2 (3.4%), and 3 to 7 (19.0%). Participants reporting more than 2 hand symptoms were 11 times more likely to have positive SPT results compared with those with 2 or fewer hand symptoms. CONCLUSION: Hand symptoms are closely associated with latex sensitization. Questionnaires should be useful in health monitoring for HCWs who use latex gloves.

The effects of national and international HIV/AIDS funding and governance mechanisms on the development of civil-society responses to HIV/AIDS in East and Southern Africa.

The study takes stock of the exponential growth in the number of new civil-society organisations (CSOs) working in the HIV/AIDS field in East and Southern Africa during the period 1996-2004. We researched this development through a survey of 439 CSOs in six countries and case studies focused on the evolution of community responses to HIV/AIDS in specific communities in eight countries. We describe the types of CSOs that emerged, their relationships with governments and donors, and their activities, organisational characteristics and funding requirements. The data presented show that the vision of social mobilisation of HIV/AIDS responses through community-level organisations has faced strong external challenges. Evidence from survey data, national HIV/AIDS spending assessments and case studies shows that in some respects the changing international aid environment undermines the prospects for development of the civil-society sector's contributions in HIV/AIDS responses. Of particular interest is to understand how the "Three Ones" and the Paris Declaration on Aid Effectiveness have reshaped international funding for HIV/AIDS responses. There has been relatively little attention paid to the impact of the new management and funding modalities--including national performance frameworks, general budget support, joint funding arrangements and basket funds--on civil-society agencies at the forefront of community HIV/AIDS responses. Evidence is presented to show that in important respects the new modalities limit the unique contribution that CSOs can make to national HIV/AIDS responses. It is also shown that the drive to rapidly intensify the scale of HIV/AIDS responses has involved using community organisations as service providers for externally formulated programmes. We discuss this as a strong threat to the development of sustainable civil-society economies as well as to CSOs' diversity and responsiveness. The ways in which CSOs are responding to these challenges are discussed, pointing to possibilities for a new phase of development of the civil-society sector.

National Asthma Education and Prevention Program severity classification as a measure of disease burden in children with acute asthma.

OBJECTIVE: To examine the association between the National Asthma Education and Prevention Program (NAEPP) severity classification and other measures of burden of disease in children with acute asthma. METHODS: We performed a cross-sectional study of 750 children <18 years of age with a physician diagnosis of asthma and treated in an emergency department (ED) for acute asthma exacerbation. Subjects were assigned to 1 of 4 levels of severity (mild intermittent, mild persistent, moderate persistent, or severe persistent). Assignments followed 3 methods: the report of symptom frequency alone (standard method); symptom frequency and reported controller-medication use (modified method); or the additive modified method in which the symptom frequency and reported controller-medication use were assigned numeric values and a score was calculated. An asthma-specific quality-of-life score was calculated by using the Integrated Therapeutics Group Child Asthma Short Form (ITG-CASF). The number of ED visits and hospital admissions for asthma over the previous 12 months was collected also. Differences between severity groups were compared with analysis of variance, and the proportion of variance explained (r2) was calculated. RESULTS: Using the standard classification method, 55% of subjects had mild intermittent asthma, 21% had mild persistent asthma, 14% had moderate persistent asthma, and 10% had severe persistent asthma. Among those classified as having mild intermittent asthma by symptoms alone, 22% were reclassified as having persistent asthma when controller medications were accounted for. With all 3 scoring methods, mean ITG-CASF scores decreased significantly with each increasing level of severity. However, the magnitude of this association was modest. There was a significant but limited association between severity level and mean number of ED visits and hospitalizations. CONCLUSION: NAEPP severity classification alone provides an incomplete picture of the burden of disease in children with asthma.

Pediatric asthma case management: a review of evidence and an experimental study design.

Asthma is a complex disease that involves physiological, environmental, and psychosocial factors. This paper reviews childhood asthma case management by social service professionals, lay health workers, and nurses, and it presents a new randomized controlled study using nurse case management in a local community coalition. Evidence suggests the common factor for success involves case managers spending time contacting and patiently and persistently working with the family, thus building a trusting relationship. Although case management time is an expense for a health care payer, provider, and the child and family, the positive outcomes achieved can demonstrate the benefit of these interventions to all parties involved. The described experimental study assesses the cost and effectiveness of home-based nurse case management by a community coalition for children visiting an emergency department for asthma care.