Quality of life in patients with latex allergy

BACKGROUND: Exposure to natural rubber latex (NRL) may lead to a variety of allergic clinical manifestations that may affect the quality of life (QOL). AIM: To assess QOL of patients with different clinical effects of NRL allergy including rhino-conjunctivitis, asthma, anaphylaxis and skin manifestations. METHOD: A questionnaire to assess QOL was mailed to 56 patients who had been assessed and managed for various clinical manifestations of latex allergy at a university affiliated hospital in Toronto, Canada. RESULTS: Thirty-one questionnaires were completed and returned. Thirty of the respondents were health care workers. Forty-one percent of the respondents had changed their jobs to reduce exposure to latex and 13% had stopped working. However the respondents did not report a great effect on the QOL related to latex allergy. CONCLUSION: The results of this study indicate that the various clinical manifestations of latex allergy can be managed so that there is no significant interference with QOL.     

Dental surgeons with natural rubber latex allergy: a report of 20 cases.

Latex allergy is becoming a major occupational health issue and dental surgeons are at risk from becoming sensitized to natural rubber latex. A study was conducted to investigate risk factors and glove-related symptoms reported by dentists with natural rubber latex allergy. Twenty dentists, who had undergone serological or dermatological testing for a Type I allergy to latex, were identified from a questionnaire survey. Risk factors investigated were: gender, years in clinical practice, exposure to latex gloves, atopic history and food allergy. The majority of dentists (75%) gave an atopic history. Glove-related adverse reactions ranged from cutaneous to systemic manifestations. All twenty dentists reported itching of the hands in response to latex gloves. One respondent was unable to continue in dental practice because of her glove-related allergies; nineteen dentists were able to continue by using synthetic, non-latex gloves.     

Primary prevention of latex related sensitisation and occupational asthma: a systematic review

Methods

Eight primary prevention intervention studies on natural rubber latex (NRL) published since 1990 were identified and reviewed. This is the largest evidence base of primary prevention studies for any occupational asthmagen.

Results

Review of this small and largely observational evidence base supports the following evidence statement: Substitution of powdered latex gloves with low protein powder‐free NRL gloves or latex‐free gloves greatly reduces NRL aeroallergens, NRL sensitisation, and NRL‐asthma in healthcare workers. Evidence in support of this statement is ranked SIGN level 2+, referring to well conducted case‐control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal.

Conclusion

Substitution of powdered latex gloves with low protein powder‐free NRL gloves or latex‐free gloves promises benefits to both workers'' health and cost and human resource savings for employers. This message should be broadly disseminated beyond the hospital sector to include other healthcare settings (such as aged care facilities) as well as food service and other industries where latex gloves might be used.     

Meta-analysis in occupational epidemiology: a review of practice

OBJECTIVES: To describe past practice in meta-analyses found in occupational epidemiology, identifying the major issues that should be considered by researchers planning a meta-analysis in this setting. METHODS: An electronic search of relevant online databases was undertaken. Papers were included in the review if they contained a statistical synthesis of risks in an occupational health setting. RESULTS: Sixty reports of meta-analyses were identified, mostly in cancer. The number of meta-analyses has increased consistently over the last 20 years. A majority of studies focused on a mean overall effect, although more than half of them also investigated heterogeneity of results. Both fixed effect and random effects meta-analysis models were employed, the former more often, and in eight studies used despite a statistically significant test for heterogeneity. A large proportion of the meta-analyses included different effect measures in the statistical synthesis, for example, including standardized mortality ratios (SMRs) and standardized incidence ratios. Most meta-analyses limited to a single type of effect measure focused on SMRs. The vast majority of meta-analyses combined all studies regardless of variation in the extent of information on exposures. CONCLUSIONS: Meta-analyses in occupational epidemiology should properly explore and incorporate heterogeneity among studies. The meta-SMR is an important construct in this field, evidenced by a large proportion of cohort studies in the meta-analyses we identified. Controversy remains over the definition and validity of the meta-SMR. In addition, several other issues, notably dealing with heterogeneity in exposure, warrant further consideration.     

Low prevalence of clinical latex allergy in UK health care workers: a cross-sectional study.

The prevalence of natural rubber latex allergy amongst health care workers has been reported to vary between 1 and 40%. This is because different diagnostic criteria have been used on heterogeneous groups of subjects. We have undertaken a cross-sectional study of all 5600 employees in two National Health Service trusts served by one department of occupational health and one department of clinical immunology. The period prevalence (1999-2000) for Type I clinical latex allergy in the clinical health care workers was found to be 17/3500 (0.5%). Difficulties in diagnosis and factors which may have contributed to this low prevalence rate are discussed. No cases were forced to leave health care work as a consequence of their allergy.     

A review of the healthy worker effect in occupational epidemiology.

This review article aims to anatomize sources of the healthy worker effect (HWE) and to summarize advantages and limitations of several approaches frequently proposed to eliminate the HWE. Although the HWE is frequently addressed in the context of selection bias, our review suggests that the selection of occupational cohorts with advantageous health status would preferably be addressed as a source of confounding biases. The authors also conclude that the exclusion of unhealthy workers at employment and the study of active workers are the two main sources of HWE, and that the use of the general population as a comparison group in occupational epidemiology should be avoided if possible. The authors encourage investigators to make distinctions between the underlying factors related to the use of the general population as the comparison group in occupational epidemiology.     

Sensitisation to natural rubber latex: an epidemiological study of workers exposed during tapping and glove manufacture in Thailand

OBJECTIVES—To estimate the prevalence of sensitisation to natural rubber latex in latex tappers and latex glove factory workers, and to relate this to airborne exposure to latex.
METHODS—Five hundred workers employed in three latex glove factories, 314 tappers, and 144 college students (control group) were studied. The workers in the glove factories were classified into three exposure groups; high, moderate, and low. Personal exposures to natural rubber latex aeroallergens were measured by immunoassay. Symptom questionnaires and skin prick tests with latex allergens (Stallergènes 1:200 w/v) and other common environmental allergens were performed. The criterion for positivity was a wheal reaction at least 3 mm in diameter greater than that to a diluent control.
RESULTS—The geometric mean (GM) concentration of latex in air was 15.4 µg/m³ for those employed in glove stripping, glove inspections, and packing of powdered gloves. The moderate exposure glove manufacturing group and the tappers had GM concentrations of 2.3 and 2.4 µg/m³ respectively, compared with United Kingdom users of latex powdered gloves,who had GM concentrations of 0.5 µg/m³. The prevalence of sensitisation to latex in the tappers and latex glove factory workers was 1.3% and 1.7% respectively. No positive cases were found among the college students. Workers who showed a positive skin prick test to latex were more likely to be atopic. Work related respiratory and dermatological symptoms were found in about 20% of each population studied, but were not related to the presence of positive latex prick tests.
CONCLUSIONS—This study suggests that in the Thai latex industries, latex sensitisation is rare despite high concentrations of airborne exposure and is less prevalent than in the healthcare sector in Europe where skin exposure is greater.


     

Impact of a latex policy on an acute NHS hospital: an audit

BACKGROUND: A latex policy was introduced in 1999 in a large, acute UK hospital. AIM: To audit the impact of the policy. METHOD: Semi-structured interview of the managers of 40 wards between April 2001 and July 2002. RESULTS: A policy was available on only 26 (65%) of the wards. Compliance with the policy was limited to 20 (50%) wards. CONCLUSIONS: Compliance with the policy was low in the hospital. Staff and patients are being unnecessarily exposed to the hazard of latex.     

A review of current literature on physiological tests and soft tissue biomarkers applicable to work-related upper limb disorders

Work-related upper limb disorders (WRULD) are among the most commonly reported occupational illnesses. Epidemiological evidence of work-relatedness has been reported for a number of conditions, including carpal tunnel syndrome, hand/wrist tendinitis, shoulder tendinitis and hand-arm vibration syndrome. A range of electrodiagnostic techniques and psychophysical tests has been used to assess neurological dysfunction associated with WRULD, whereas only very few studies have examined biochemical markers of soft tissue injury. This report reviews key literature on physiological tests and biochemical markers of musculoskeletal stress/injury, which are applicable to studies of WRULD. The paper concludes by proposing new ways that testing might be implemented during occupational health surveillance to enable early warning of impending problems and to provide more insight into the underlying nature of soft tissue disorders.     

A systematic review of prevalence and risk factors associated with playing-related musculoskeletal disorders in pianists

BACKGROUND: Playing-related musculoskeletal disorders (PRMDs) are a recognized problem amongst instrumental musicians. Although pianists are prominent in data regarding prevalence of PRMDs, there is poor understanding of piano-specific risk factors associated with PRMDs. AIM: To synthesize published literature on the prevalence of and risk factors associated with PRMDs in pianists. METHODS: Thirty-eight databases were searched. Eligible studies were those investigating prevalence of or risk factors associated with PRMDs in pianists, using an appropriate methodology according to a hierarchy of evidence. Information regarding study population, operational definition of PRMD, risk factors investigated, statistical tests used and outcomes was extracted and narratively synthesized for all eligible papers above an arbitrarily chosen quality score. RESULTS: The literature search identified 482 citations. Fifty-two papers were ranked in a hierarchy of evidence; 12 were eligible for evaluation using a quality assessment tool. Common methodological limitations included sampling/measurement biases, inadequate reporting of reliability/validity of outcome measures, lack of operational definition of PRMD and no statistical significance testing. Prevalence rates for PRMDs in pianists varied widely (26-93%). Four authors demonstrated statistically significant risk factors; however, no authors combined a clear operational definition of PRMD with statistically established risk factors. There was no consensus between authors regarding risk factors. CONCLUSIONS: Current evidence does not provide sufficient information regarding prevalence of and risk factors associated with PRMDs in pianists. Future studies should provide an operational definition of PRMD, use valid, reliable measurement tools, utilize a prospective cohort study design and perform appropriate statistical tests.     

Postal questionnaire study of disability associated with latex allergy among health care workers in Finland

In this study, the association between natural rubber latex (NRL) sensitization and work ability index (WAI) among health care workers was investigated. Furthermore, the diagnostic sensitivity and specificity of a postal questionnaire as a screening device of NRL allergy was evaluated. The study population consisted of 32 female health care workers with an occupational latex allergy, and 51 control subjects who were individually matched for age and occupation. A self-administered two-part questionnaire, including seven items of a work ability index (WAI), as well as questions on glove-related symptoms, was mailed to the subjects. The median age for NRL allergic subjects was 40 years (range 23–62), and the diagnosis of occupational latex allergy had been made six years (range 2–16) before the present study. The WAI scores were on average lower among the sensitized subjects as compared with their nonsensitized controls. Even after removing the contribution of the presence of allergic eczema, diagnosed by a physician, from the original WAI score, the proportion of NRL allergic subjects and the control subjects in the good work ability category were 34% and 53%, respectively. Ten health care workers (31%) had changed occupation and one early retirement had occurred after sensitization to NRL. The sensitivity and specificity of the present self-administered questionnaire as an indicator for latex allergy was 84% and 98%, respectively. In conclusion, there is a clear association between NRL allergy and a decrease in the WAI among health care workers, which cannot be explained by age, gender, profession, or history of atopy. Am. J. Ind. Med. 32:197-204, 1997. © 1997 Wiley-Liss, Inc.     

Searching bibliographic databases for literature on chronic disease and work participation

BACKGROUND: The work participation of people with chronic diseases is a growing concern within the field of occupational medicine. Information on this topic is dispersed across a variety of data sources, making it difficult for health professionals to find relevant studies for literature reviews and guidelines. AIM: The goal of this project was to identify bibliographic databases and search terms that could be most useful for retrieving relevant studies on this topic. METHODS: Five broad questions regarding work participation and chronic disease were formulated, focusing on angina pectoris, depression, diabetes mellitus, hearing impairment and rheumatoid arthritis. A search strategy for retrieving information on these questions was developed and run in five bibliographic databases: Medline, EMBASE, PsycINFO, Cinahl and OSHROM. Relevant publications were selected from the search results. The utility of the selected databases and search terms was evaluated by analysing the number of relevant publications that were retrieved. RESULTS: The number of relevant publications retrieved from each database varied. Most (84%) of the relevant publications that were retrieved from each database were unique to that source. For each database, specific search terms for the concept of 'work' were useful for retrieving relevant publications. CONCLUSION: Medline, EMBASE and PsycINFO are useful databases for quick searches. Useful search terms for the concept of 'work' are work capacity, work disability, vocational rehabilitation, occupational health, sick leave, absenteeism, return to work, retirement, employment status and work status. For comprehensive searches, we recommend additional searches in Cinahl and OSHROM, adapting the search terms to specific databases.     

An update of a systematic review of controlled clinical trials on the primary prevention of back pain at the workplace

OBJECTIVE: To update the evidence on the effectiveness of lumbar supports, education and exercise in the primary prevention of low back pain at the workplace. METHODS: A computerized search for controlled clinical trials published between 1997 and 2002 was conducted, and the methodological quality of the studies was assessed using a criteria list. The available evidence was graded with a rating system for the level of evidence. Effect sizes of individual studies were combined if the studies were sufficiently similar. RESULTS: Five new papers were identified for the update. These trials were added to the previously available trials (n = 11). The methodological quality of most studies was low. Since three of four RCTs on lumbar supports reported no effect, there is no evidence for the effectiveness of lumbar supports. No evidence for education could be found either, since all six RCTs showed negative results. The four RCTs on exercise consistently reported a positive effect, indicating limited evidence for the effectiveness of exercise. CONCLUSION: There is no evidence for the effectiveness of lumbar supports or education in the primary prevention of low back pain at the workplace. There is limited evidence for the efficacy of exercise, and the effect that can be obtained is moderate. There is still a need for methodologically sound studies and studies on the cost-effectiveness of exercise. Also the possible effect of lumbar supports in the treatment of back pain needs further investigation.     

Occupational health guidelines for the management of low back pain at work: evidence review

There is increasing demand for evidence-based health care. Back pain is one of the most common and difficult occupational health problems, but there has been no readily available evidence base or guidance on management. There are well-established clinical guidelines for the management of low back pain, but these provide limited guidance on the occupational aspects. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000. These are the first national occupational health guidelines in the UK and, as far as we are aware, the first truly evidence-linked occupational health guidelines for back pain in the world. They were based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes. The full evidence review is on the Faculty web site (www.facoccmed.ac.uk), but an abridged version is presented here to aid its dissemination.     

Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices

AIMS: To review the literature on sharps injuries and occupational bloodborne virus transmission in health care in the UK and the worldwide evidence for injury prevention of sharps safety devices. METHODS: Literature review by online database and Internet resource search. RESULTS: Twenty-four relevant publications were identified regarding UK reported sharps injury rates. UK studies showed as much as a 10-fold difference between injuries reported through standard reporting systems (0.78-5.15 per 100 person-years) and rates estimated from retrospective questionnaires of clinical populations (30-284 per 100 person-years). National surveillance data from England, Wales and Northern Ireland gives a rate of 1.43 known hepatitis C virus or human immunodeficiency virus (HIV) transmissions to health care workers per annum. When extrapolated, this suggests an approximate rate of 0.009 such viral transmissions per 1000 hospital beds per annum. Risk of infection from sources with no risk factors is extremely small (less than one in one million for HIV transmission based on Scottish data). Thirty-one studies on the efficacy of sharps safety devices showed evidence of a reduction in injuries, with the greatest reductions achieved by blunt suture needles and safety cannulae. CONCLUSIONS: Although injuries remain common, confirmed viral transmission in the UK has been relatively rare. The degree of under-reporting of sharps injuries may be as much as 10-fold. Safety-engineered devices are likely to be effective at injury reduction.     

A review of studies on maternal occupational exposures and birth defects, and the limitations associated with these studies.

The proportion of pregnant women who work during pregnancy is increasing as more women move into previously male-dominated occupations. With this move, occupational exposure to chemical or physical factors during pregnancy could be further increased. In the last decade, there have been many reports on the causes of birth defects. Unfortunately, most reported associations between occupational exposures and adverse reproductive outcomes in epidemiological studies are equivocal and often controversial. Many reported associations are only suggestive. More information is needed before firm conclusions can be drawn. The major reasons for ambiguous findings are due to limitations of study methodology, e.g. inappropriate endpoints, multiple confounders, low study power and inadequate analysis methods. It must also be noted that maternal work, and therefore exposure, may also differ greatly from country to country.     

Attitudes and access to electronic exchange of information on occupational disease

BACKGROUND: THOR is a network of work-related disease surveillance schemes dependent on volunteer case reporting by medical specialists. Data collection and dissemination has hitherto been paper-based. AIMS: To elicit the opinion of existing reporters in THOR on electronic exchange of information and to assess the practical capabilities of the same reporters to participate in electronic communication. METHODS: A mail-based questionnaire of randomly selected THOR reporters using closed format questions. RESULTS: The response rate to the questionnaire was 66% (253/383). Almost half (47%) of the responders wanted dissemination of information solely in an electronic form, 35% favoured paper-based reports, while 16% wanted both paper and electronic reports. Two-thirds (66%) would make use of electronic archives of reports and 59% would use this facility to resolve questions by accessing accumulated data. The majority (82%) read e-mail more than once a week and 34% browsed the web as frequently. However, 5% did not have e-mail and 6% never browsed the web. Most responders judged their internet connectivity to be rapid (68%) and convenient (83%), and 91% could receive e-mail attachments. CONCLUSIONS: Most responders have the skills and infrastructure required to engage in electronic information exchange, and are favourably disposed to electronic means of communication. However it is also relevant to note that one-third of responders have a preference for the existing paper-based system.     

A follow-up study on the association of working conditions and lifestyles with the development of (perceived) mental symptoms in workers of a telecommunication enterprise

AIM: This study investigated the association of working conditions and lifestyle with mental health in Japanese workers. METHODS: A follow-up study was carried out in the Kanto district of Japan of workers in a telecommunications enterprise who received their first annual health check-up between 1992 and 1996 and were between 20 and 54 years old. Workers who reported mental symptoms, had a past history of disease, or current illness at their first check-up were excluded from the analysis. In total, the study included 23 837 workers. The association between working conditions and lifestyle and the development of mental symptoms was investigated by pooled logistic regression analyses. RESULTS: Working long hours and part-time work, as opposed to normal daytime hours of work, were factors associated with the development of mental symptoms in males, as were smoking, short sleeping hours, little physical exercise, rarely taking three meals a day, frequently eating within 1 h before sleep, much preference for salty meals and little preference for vegetables. Consumption of alcohol was negatively associated with the development of mental symptoms in males. Overall, the results suggested that the lower the Healthy Work and Lifestyle Score, the higher the risk of developing mental symptoms. CONCLUSIONS: Working conditions and lifestyle, especially food preferences, have an apparent influence on the mental health of Japanese workers. Moreover, the Healthy Work and Lifestyle Score indicates that working conditions and lifestyle appear to have a cumulative influence upon the mental health of Japanese workers.     

A study of work-related musculoskeletal case reports to The Health and Occupation Reporting network (THOR) from 2002 to 2003

BACKGROUND: Occupational musculoskeletal disorders are frequently seen by occupational physicians and rheumatologists, and there are well-established UK-based schemes set-up for reporting these conditions. An apparent fall in case reporting for work-related musculoskeletal disorders in Great Britain to The Health and Occupation Reporting network (THOR) was observed from 2002 to 2003. AIMS: To investigate changes in case reporting for musculoskeletal disorders sent by occupational physicians to Occupational Physicians Reporting Activity (OPRA) and by rheumatologists to Musculoskeletal Occupational Surveillance Scheme (MOSS) between 2002 and 2003. METHODS: Musculoskeletal cases returned by more than 800 physicians from Great Britain reporting to OPRA and MOSS in 2002-2003 were analysed. Changes in reporting are described at individual physician and group levels in: numbers of participants, levels of response, and numbers of case reports by disease category and major occupational and industrial groups. RESULTS: In 2002-2003, musculoskeletal disease was the most frequently reported major disease category in OPRA. Between 2002 and 2003, the proportion of musculoskeletal case reporting fell by 37% in OPRA, and 7% in MOSS. This fall was seen in many disease categories, across a wide range of occupations and industries. In OPRA, the greatest fall in reporting (74%) was for the category Raynaud's/Hand-Arm Vibration Syndrome/Vibration White Finger. CONCLUSIONS: The fall in occupational musculoskeletal case reporting between 2002 and 2003 cannot be explained by internal factors within the reporting system. This observation highlights the need for systematic investigation of trends in case reporting for work-related ill-health.