A review of current literature on epidemiology of immediate glove irritation and latex allergy.

Natural rubber latex (NRL) allergy has attained world-wide importance with the diagnosis of glove hypersensitivity, contact urticaria, rhinitis, conjunctivitis, asthma and anaphylaxis. In the present report, the latest literature of the epidemiology of NRL allergy is reviewed, an account on the incidence of NRL allergy (19 new cases of contact urticaria/100,000 workers per year) among health care workers is given and the prevention of NRL allergy is discussed. Among health care workers, NRL allergy has gained prominence particularly with the spread of AIDS and an increase in the use of rubber gloves for barrier protection. For screening NRL allergy, a simple and quick test based on a self-administered questionnaire has been presented, but it needs further evaluation before routine use can commence. Further analytic studies will show if the use of low allergen gloves reduces the incidence of NRL allergy.     

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.     

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.     

Practising evidence-based occupational health in individual workers: how to deal with a latex allergy problem in a health care setting

BACKGROUND: Natural rubber latex, mainly contained in disposable medical gloves, is an important cause of occupational allergy in health care workers. Management of latex allergy includes education, reduction of cutaneous or mucosal contact with rubber products and minimization of exposure to latex allergens in the work environment. METHODS: This paper reports a case study dealing with the latex allergy health problem of an operating theatre nurse. The examination was required because of a recent onset rhino-conjunctivitis crisis and asthma during usual working activities. The case was investigated and a solution provided according to the evidence-based medicine (EBM) paradigm using the PICO model. RESULTS: The literature search was conducted using Medline and the Cochrane Library. Twenty-one papers were considered to offer appropriate solutions. Two main types of interventions were suggested: (i) changing the work setting, (ii) limiting the work activities. The evidence obtained was discussed with the nurse, who was considered unfit to continue her work in the operating theatre where her colleagues used latex gloves. The resident proposed that she could relocate to a work environment where only non-latex gloves were used and latex medical devices were not present. CONCLUSION: The case study shows that, as for other clinicians, the occupational physician can use the EBM paradigm according to the PICO model as a tool for providing appropriate solutions for the individual worker.     

The impact of Hymenoptera venom allergy on occupational activities

The objective of this study was to investigate the impact ofallergy to hymenoptera venom on the occupational activitiesof patients undergoing immunologic treatment for insect stinganaphylaxis. The design was a cross-sectional study conductedin a sample of 500 out of 1,500 patients undergoing venom inmunotherapyfor insect sting reaction in 13 allergy clinics in Israel. Aself-administered questionnaire was used to collect data aboutdemographic characteristics of patients, severity of the allergicreaction, and adverse effects on occupational activities. Ofthe 204 respondents who were part of the labour force, 48.5%reported adverse effects on routine occupational activities.The factors with a significant influence on the probabilityof adverse occupational effects were: (1) patient's type ofwork (blue collar vs. white collar: OR=;3.22, p<0.001; armyvs. white collar: OR=5.28, p=0.001); (2) severity of the allergicreaction (severe reaction vs. mild/moderate reaction: OR=2.34,p=0.007). Our findings suggest that severe insect sting allergyhas an adverse impact on patients' occupational activities.This factor requires special attention by the medical community.Social workers and occupational physicians should collaboratein the assessment and management of these patients.     

Reduced health-related quality of life in former North Sea divers is associated with decompression sickness

BACKGROUND: Diving is associated with long-term effects on several organ systems. AIM: The objective was to investigate the impact of decompression sickness (DCS) and diving exposure on health-related quality of life (HRQL) in former Norwegian North Sea divers. METHODS: HRQL was recorded by a questionnaire in the cohort of 375 Norwegian North Sea divers registered before 1990. Demographic data, relevant health data and data on diving education, history of DCS and SF-36 were recorded in 230 divers. RESULTS: All SF-36 sub-scores were significantly reduced compared with Norwegian norms. Reduced scores were seen for all scales among divers who reported previous DCS compared to those without DCS. A decreasing trend in scores was seen when comparing no DCS, skin or joint DCS and neurological DCS. There was a decreasing trend in scores related to number of days in saturation and maximal depth. Stratification on DCS showed that the impact of saturation diving was present only in divers with DCS. CONCLUSIONS: HRQL was reduced in this study sample of divers. Having had DCS during the diving career contributed significantly to the reduction in all SF-36 scales, and apparently neurological DCS has the most pronounced impact. Cumulative diving exposure including days in saturation and maximal depth contributed to a reduced HRQL.     

A survey of starch particle counts in the hospital environment in relation to the use of powdered latex gloves

As latex proteins, which cause latex hypersensitivity, can befound on starch particles and inhalation may be a route forsensitization, the presence of starch particles in hospitalair was examined. The starch particles were demonstrated byimmobilization onto cellulose acetate filters and staining withiodine. Rooms in which powdered latex gloves were used gavecounts of up to >3667 particles per cubic meter of air. Starchparticles were not found in the air in rooms where latex gloveswere not used, and were highest in rooms with a high glove usagebut no ventilation. A change to powder-free gloves significantlyreduced the count of starch particles in the unventilated Accident/EmergencyDepartment air. Use of powder-free gloves should be consideredespecially in unventilated areas in healthcare premises.     

Latex glove allergy among hospital employees: a study in the north-west of England

The frequency of use and duration of wearing latex gloves among hospital employees has increased due to concerns about AIDS and hepatitis. In many countries there is increased consciousness about latex sensitization. In the UK, the Medical Device Agency has been monitoring latex allergy for a number of years but has not found any conclusive evidence of any significant problem. We report following a detailed questionnaire study in two hospitals in the north-west of England. A total of 1,827 members of staff were questioned about latex allergy at work. One hundred and twenty-four (7%) of these hospital employees had experienced symptoms strongly suggestive of latex allergy. Of this group, 56 had a-RAST test (IgE specific to latex), which was positive in seven (12.5%). There was a history of atopy in 31%, and a family history of atopy in 17% of the individuals. As a result of the study it was found that 17% (21 of the affected individuals) had already changed their working practice by using latex-free gloves. We were able to increase awareness of latex allergy within the hospitals. Both individuals and health care organizations need to be aware of the problem and hospital organizations should encourage staff to seek guidance to address the problem and, if necessary, to take appropriate measures to improve working practices. Practical guidelines are given with regard to identifying the problem and glove use for hospital staff.     

Symptoms, ill-health and quality of life in a support group of Porton Down veterans

BACKGROUND: There has been a Human Volunteer Programme at the British chemical weapons research facility at Porton Down since the First World War, in which some of the participants were exposed to chemical warfare agents. AIM: To identify any striking specific morbidity patterns in members of the Porton Down Veterans Support Group (PDVSG). METHODS: A self-completed postal questionnaire was prepared including health immediately after the visits to Porton Down, subsequent diagnoses and hospital admissions, symptoms in, and after, the first 5 years after the visits, fatigue symptoms and current quality of life, measured using the SF-36. RESULTS: Responses were received from 289 of 436 (66%). Results reported here relate to 269 male respondents of mean age 66.8 years. Sixty-six per cent reported their first visit to Porton Down in the 1950s. The most common diagnoses or hospital admissions reported were diseases of the circulatory system. In the first 5 years after their visits the most common symptoms were headache, irritability or outbursts of anger and feeling un-refreshed after sleep. In the later period, most common symptoms were fatigue, feeling un-refreshed after sleep and sleeping difficulties. Sixty-five per cent met the definition for a case of 'fatigue'. Current quality of life dimensions were consistently lower than age-specific estimates from general population samples. CONCLUSIONS: Members of the PDVSG responding to this survey reported poorer quality of life than the general population. Despite there being no clear pattern of specific morbidities, we cannot rule out ill-health being potentially associated with past experience at Porton Down.     

Quality of life of cancer patients with different prognoses

This study examines differences and similarities in the quality of life of 253 cancer patients with good, medium and poor prognoses. Our main hypothesis was that patients with a good prognosis will experience a higher quality of life than patients with a medium or poor prognosis. A multivariate analysis of covariance of eight quality of life scales was performed with prognosis as a factor and with age, sex, and the duration of the illness as covariates. Significant main effects of prognosis were found for the general QOL-scale and for physical aspects of quality of life. There were, however, only marginal and non-significant effects of prognosis groups on social and psychological functioning. A final multivariate analysis confirms earlier findings that performance status shows a weak but significant relationship with the psychological functioning. Thus, the physical condition of the patient at the time of measurement seems to have some influence on the psychological functioning, whereas the severity of the disease as inducated by the classification into prognosis groups does not. These results question the general attitude that seriously ill cancer patients have reduced social and psychological well-being. An alternative interpretation is that the scales used to measure psychological aspects of quality of life are inadequately sensitive.This study is supported by grants no 89090/001-002 from the Norwegian Cancer Society and by the Faculty of Medicine, University of Trondheim. The study has been evaluated and approved by the Regional Ethical Committee for Medical Research.     

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.     

Quality of life of patients with Fabry disease

This paper is the first of its kind to study the impact of Fabry disease (FD) in affected males, and shows that FD is associated with a significant decline in several domains. Using the medical outcomes study (MOS) SF-36 and a FD-specific questionnaire, we compared the observations found among these patients with that obtained for the general US population and other chronic disease states, including Gaucher disease (GD) (another lysosomal storage disorder), end-stage renal disease, stoke and AIDS. Patients with FD have a score profile most similar to patients with AIDS. In comparison with patients with GD, Fabry patients score substantially lower across all domains. Using simple linear regression, potential predictors of health-related quality of life (HRQOL) for Fabry patients were also determined. As in the general population, stroke, cardiac problems and renal disease lead to substantial decrement in HRQOL. In addition, two disease specific symptoms (acroparesthesia and anhidrosis) and pain are also predictors of decreased quality of life. Currently, no specific therapy for FD exists. As enzyme therapy for FD becomes increasingly available, it will be interesting to evaluate the therapy's impact on the quality of life of patients.     

The effects of asthma on the quality of life and employment of construction workers

Relatively little is known about the consequences of asthma for patients' work ability. In particular, the relationship between asthma and construction work has not been studied previously. The aim of this study was to determine how asthma affects construction workers' work ability and quality of life, and the most important conditions that cause respiratory symptoms in construction work. A questionnaire was sent to all construction workers examined in the pulmonary clinic of Tampere University Hospital between 1991 and 1995 who were diagnosed as having 'asthma bronchiale' (n = 104). In addition, 206 non-asthmatic construction workers were recruited from the register of the local trade union. Altogether, 73% of the asthmatic construction workers and 70% of the controls completed the questionnaire. Of the asthmatics, 48% were retired, whereas only 24% of the controls were receiving a pension. The asthmatics evaluated their work ability and general health as significantly worse than did the controls. The asthmatics had more limitations in their work and everyday life than the controls. Asthmatic construction workers had often changed work tasks and also occupation because of their illness. Building renovation, cleaning and insulation with mineral fibre materials were the most common causes of respiratory symptoms in the workplace, among both the asthmatics and the controls. Cold air, physical exercise and all types of dust and smoke caused the asthmatics to experience symptoms. It was concluded that asthma limits the work and everyday life of construction workers. Exposure to dusty, non-sensitizing agents is associated with asthmatic symptoms among construction workers.     

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.     

天然胶乳橡胶避孕套质量检验和标准分析

天然胶乳橡胶避孕套是一种量大面广的医疗器械产品,是我国落实避孕节育措施和预防性病与艾滋病传播的重要产品,受到消费者的欢迎,同时也是相关政府部门重点监管的产品之一。本文就广东省医疗器械质量监督检验所多年来的国家和省级避孕套监督抽验以及日常的注册检验、委托检验情况进行分析探讨,并就进一步改进检验标准,提高产品质量,提出一些思考和建议。     

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.


     

Subjective quality of life in patients with chronic fatigue syndrome

The aim of this study was to (1) assess Subjective Quality of Life (SQOL) of patients with Chronic Fatigue Syndrome (CFS) using a generic concept and to compare the findings with those in groups with mental disorders and healthy subjects, and (2) investigate whether and, if so, to what extent socio-demographic and clinical variables predict SQOL in CFS patients. Seventy-three patients diagnosed with CFS were randomly selected and interviewed from two specialised clinics. CFS was diagnosed using the Oxford Criteria. SQOL was assessed on the Manchester Short Assessment of Quality of Life (MANSA) and Health-Related Quality of Life (HRQOL) on the Medical Outcome Study Short-Form 36 (MOS) SF-36. A battery of mood and symptom questionnaires, including the Symptom Checklist Questionnaire (SCL-90-R), was administered to assess various aspects of symptomatology as potential predictor variables. Multiple regression analyses were conducted to identify predictors of SQOL. Overall, SQOL was low in CFS patients and less favourable than in groups with mental disorders and healthy subjects. Satisfaction was particularly low with life as a whole, leisure activities and financial situation. Whilst SQOL was only moderately correlated with HRQOL, the SCL-90-R score, especially SCL-90-R Depression scale score, was the best predictor of SQOL explaining 35% of the variance. HRQOL and generic SQOL appear distinct despite some overlap. The findings underline that SQOL is significantly disrupted in CFS patients. Depressive symptoms are statistically the strongest ‘predictor’ of SQOL, although the direction of the relationship is not established. These data suggest that treatment of depression associated with CFS, regardless of causation, could help to improve SQOL in CFS patients.     

Quality of life of persons with onychomycosis

Onychomycosis is a fungal infection of the nails which, although unsightly in appearance, is often considered to be a cosmetic problem. This research reports on the development and performance of a quality-of-life instrument to measure the impact of this disease on the patients' mental and general health, social functioning, pain, and self-confidence. In telephone interviews, 680 members of a health maintenance organization (299 with onychomycosis and 381 without) were asked a battery of items regarding quality of life (mental and social functioning, self-esteem, pain) and specific problems and symptoms related with one's nails. Persons with onychomycosis had significantly poorer ratings compared with the healthy persons with respect to general health (p=0.02) and bodily pain p<0.001). Persons with onychomycosis also had significantly (p<0.05) poorer ratings for mental health, social functioning, health concern, physical appearance, and functional limitations associated with activities involving standing on one's feet or working with one's fingers. This study is the first to document the impact of onychomycosis on an individual's quality of life. Persons with onychomycosis may adapt to this condition, but they continue to experience embarrassment and discomfort that reduces their quality of life.This research was supported through a research grant from Sandoz Research Institute to Technology Assessment Group, Inc.     

中国部分地区关节炎患者生活质量调查

目的　初步评价中国部分地区关节炎患者的生活质量。方法　采用分层随机抽样方法获得关节炎患者 1344例 ,生活质量调查采用关节炎患者生活质量量表 ,填答方式为自填法。结果调查的关节炎患者中 ,各年龄组不同性别患者的生活质量得分差异均无显著性 (P >0 .0 5 ) ;但其中 6 5岁以上女性、受教育年数较少者、月均收入较低者的生活质量得分均相对较差 ;丧偶或离婚者得分也较未婚和已婚者差 (t=9.310 ,P =0 .0 0 1) ;无业者、农民的得分较其他所有职业者低 (P <0 .0 5 ) ;在生理指标方面显示生理指标得分差者 ,生活质量得分也差 ,但对于压痛指数 2、3级者之间生活质量得分差异并无显著性 (平均差数为 4 .910 ,P =0 .76 5 ) ,对于关节肿胀指数 0、1级者之间 (平均差数为16 .30 8,P =0 .0 79)以及 2、3级者之间 (平均差数为 6 .6 4 3,P =0 .5 33)差异也无显著性。结论　关节炎患者整体生活质量的提高不仅有赖于医学水平的提高 ,还有赖于有关部门予以重视 ,并采取完善社会保障制度和农村医疗保障制度 ,提高农村教育水平 ,关注老年生活等有效措施。     

Measuring quality of life in hospice patients using a newly developed Hospice Quality of Life Index

The purpose of this study was to evaluate the validity and reliability of the newly developed Hospice Quality of Life Index (HQLI). Sixty-eight patient/caregiver dyads from one hospice were asked to fill out the HQLI on admission and after 3 weeks of hospice care. Hospice experts evaluated the items on the tool to assess content validity. The content validity index (0.83) and the alpha coefficients (r=0.87 and 0.83) supported the validity and reliability of the HQLI. Item analysis revealed items with which patients were most satisfied and aspects of quality of life that were considered to be most important.