Ten years incidence of natural rubber latex sensitization and symptoms in a prospective cohort of health care workers using non-powdered latex gloves 2000–2009

Objectives

To assess the incidence of sensitization and gloves-related symptoms in 10-year follow-up in a group of health care workers (9,660 person-years) using non-powdered latex gloves from 2000 to 2009 and to examine related factors.

Materials and methods

We studied 2,053 health care workers in Trieste Hospitals by means of skin prick test for latex extract, patch tests and medical examinations. We report the incidence of latex sensitization among workers using non-powdered latex gloves.

Results

The incidence of latex sensitization, rhinitis, asthma, urticaria, irritant and allergic contact dermatitis were 1.0; 0.12; 0.21; 0.72; 2.39 and 2.50 cases per 1,000 person-years, respectively. Respiratory symptoms and urticaria were positively related with latex sensitization (OR = 8.0; 95 % CL 1.27–48.6), with common allergic respiratory symptoms (OR = 4.19; 95 % CL 1.04–16.8) and with familial atopy (OR = 4.47; 95 % CL 1.1–17.9).

Conclusion

The incidence of latex sensitization and latex-related symptoms were very low but subjects with allergic symptoms related to common allergens are at higher risk. The use of non-latex gloves is suggested for them.     

Dermal exposure to cyclophosphamide in hospitals during preparation, nursing and cleaning activities

Objectives: To determine levels of potential and actual dermal exposure to cyclophosphamide (CP) during performance of oncology-related tasks in hospitals and to investigate the relationship with potential sources and surface contamination levels of CP. Methods: Dermal exposure to CP was determined for tasks with potential exposure to CP: preparation of CP, decanting of patients urine, washing of the patient, removal of bed sheets of treated patients and cleaning of patients toilets on oncology wards. Exposure was assessed by the collection of nitrile and latex protective medical gloves (potential exposure), washing of hands (actual exposure), from cotton pads attached to (un)covered forearms (potential or actual exposure) and a wipe sample of the forehead (actual exposure). Bulk samples (i.e. application fluids and patients excreta) and possible contact surfaces were monitored to assess the amount of CP available for dermal exposure. Results: Pharmacy technicians, oncology nurses and cleaning personnel showed actual and potential dermal exposure to CP during performance of their daily duties. Exposure occurred predominantly on the hands and sporadically on the forehead and forearms. Although all nurses used gloves during handling of patients urine and sometimes during the other nursing tasks, skin underneath gloves was repeatedly contaminated. Results of tests on bulk and surface contamination samples confirmed that patients intravenously treated with CP excrete the unmetabolised drug, which could subsequently lead to dermal exposure of hospital personnel. A clear relationship was found between dermal exposure levels and direct sources of exposure for all tasks, except for handling patients urine. Conclusions: We demonstrated for the first time that actual dermal exposure to CP is common among oncology nurses working with patients treated with this anti-neoplastic drug. Pharmacy technicians and cleaning personnel, on the other hand, are potentially exposed to CP, and protection provided by gloves seemed to be sufficient.     

Latex symptoms and sensitisation in health care workers

Background: Natural rubber latex has become an important occupational health concern, particularly among health care workers, who for protection are required to wear latex gloves when at work. This study evaluated the prevalence of latex-related symptoms and sensitisation among a large group of health care workers in Trieste hospitals. Methods: We evaluated the prevalence of latex-related symptoms in 1,165 health care workers, by means of a questionnaire, a medical examination, skin prick tests and IgE-specific evaluation. We determined atopy and latex sensitivity by skin prick tests using a battery of common inhalant allergens, a commercial latex extract (Lofarma Allergeni, Milan) and individual skin puncture tests for each of the vegetables immunologically related to latex (potato, tomato, chestnut, banana, kiwi fruit). Associations between potential risk factors for latex allergy were assessed. Results: Glove-related symptoms were noticed on 17.2% of the nurses (200) the majority of symptoms being mild dermatitis with itching and erythema (120 subjects, 11.1%). Symptoms suggestive of IgE-mediated latex allergy were found in 51 subjects: 35 (3%) complained of contact urticaria and 16 (2.2%) complained of asthma and/or rhinitis. The resulting symptoms were significantly related to skin prick tests that were positive to latex (odds ratio (OR)=11.89; 6.40–22.2), to personal atopy (OR=2.15; 1.47–3.12), to familiar atopy (OR=2.12; 1.48–3.03), to skin prick test positivity to related fruit (OR=2.01; 1.16–3.46) but not to prick test positivity to common inhalant allergens (OR=1.00; 0.71–1.39). Symptoms increased as a direct function of the time-usage of latex gloves and were more prevalent in operating room staff. Conclusion: In this large cross-sectional study, glove-related symptoms and latex skin sensitisation appear to be substantial among health care workers, and are related to common signs of atopy. We stress the need of preventive measures to avoid latex exposure when health care workers are at risk of developing allergy symptoms. Received: 18 May 2000 / Accepted: 1 November 2000     

Latex allergy: a follow up study of 1040 healthcare workers

Background

Natural rubber latex allergy can cause skin and respiratory symptoms The aim of this study was to evaluate the prevalence and incidence of latex related symptoms and sensitisation among a large group of healthcare workers in Trieste hospitals, followed for three years before and after the introduction of powder‐free gloves with low latex release.

Methods

In the years 1997–99 the authors evaluated 1040 healthcare workers exposed to latex allergen for latex related symptoms and sensitisation by means of a questionnaire, a medical examination, skin prick tests, and IgE specific antibody assay. The second evaluation was carried out in the years 2000–02, subsequent to the changeover to a powder‐free environment.

Results

Glove related symptoms were seen in 21.8% of the nurses (227), mostly consisting of mild dermatitis: 38 (3.6%) complaining of contact urticaria and 24 (2.3%) of asthma and/or rhinitis. These symptoms were significantly related to skin prick tests positive to latex (OR = 9.70; 95% CI 5.5 to 17) and to personal atopy (OR = 2.29; 95% CI 1.6 to 3.2). Follow up was completed in 960 subjects (92.3%): 19 new subjects (2.4%) complained of itching erythema when using gloves, but none was prick positive to latex. Symptoms significantly improved and in most cases disappeared (p<0.0001).

Conclusions

Simple measures such as the avoidance of unnecessary glove use, the use of non‐powdered latex gloves by all workers, and use of non‐latex gloves by sensitised subjects can stop the progression of latex symptoms and can avoid new cases of sensitisation.     

Definitions of healthy eating in Spain as compared to other European Member States

Study objective: To assess what healthy eating means for the European population and whether this concept differs between Spain and other European Countries. Design: A Pan-European survey was developed between October 1995 and February 1996 by the Institute of European Food Studies (Dublin). Each subject was asked to describe in his or her own words what he/she understood by healthy eating. Comparisons were made among four groups of European countries (Northern, Central, Spain, and other Mediterranean countries). Setting: The survey included participants from the 15 member states of the European Union, selecting quota-controlled samples to make them nationally representative. Subjects: The questionnaire was completed by 14,331 persons, approximately 1000 from each country. Results: The responses were grouped into 89 broad categories of similar answers concerning nutritional value and afterwards these responses were collapsed to simplify the presentation. The definition of healthy eating such as more fiber and less fat was more prevalent in other States, members of the European Union than in Mediterranean Countries, although the definition of balanced diet was more frequently mentioned in Spain than in the rest of the European Union. Conclusions: Our results show that the concept of balance and variety is more prevalent in Spaniards than in other traditional Mediterranean countries. Differences in the definitions of healthy eating among European countries could be explained, at least partially by differences in consumption patterns and in the nutrition education.     

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.     

Have health conditions associated with latex increased since the issuance of universal precautions?

OBJECTIVES: This study explored whether the prevalence of latex-related health conditions has increased among individuals employed in medical occupations relative to those employed in nonmedical occupations since the issuance of universal precautions in 1987. METHODS: Data derived from the 1983 to 1994 versions of the National Health Interview Survey were used to obtain odds ratios comparing prevalence rates of latex-related symptoms over time. RESULTS: No statistical evidence was found that the universal precautions resulted in increased prevalence rates of latex-related health conditions among medical workers relative to those employed in nonmedical occupations. CONCLUSIONS: Increased use of latex gloves among health care personnel subsequent to the implementation of universal precautions appears to have had no effect on latex allergic reactions experienced by these workers.     

Natural rubber latex-related occupational asthma: association with interventions and glove changes over time

BACKGROUND: Exposure to natural rubber latex (NRL) has been recognized as a cause of occupational asthma (OA), especially among health care workers (HCWs) associated with use of gloves. Little or no population-based data are available which chart the changes over time in the number of cases of OA as this problem was increasingly recognized and then interventions instituted. METHODS: We obtained the numbers of allowed asthma claims with exposure to latex by year in the province of Ontario, Canada from the Ontario Workplace Safety and Insurance Board; details of the cases from the largest teaching hospital were reviewed. Interventions included: (1) in 1996, the Board recommended in its focus for accommodation of sensitized workers, the reduction of aerosols of latex proteins and that hospital facilities use powder-free, low-protein or nonlatex gloves; and (2) hospitals instituted latex policies and glove changes at various dates. For example, at the largest teaching hospital, interventions included education and voluntary medical surveillance in 1994; substitution of low protein, "powder-free" NRL gloves for non-sterile powdered gloves in 1995; and replacement of powdered sterile NRL gloves by lower protein, "powder-free" NRL gloves in 1997. RESULTS: Through 1999, there were 60 allowed claims for asthma in Ontario with exposure to latex; of these 49 (82%) were among HCWs. The number of claims among HCWs changed from 0 to 2 per year up to 1990; increased to 7 to 11 per year between 1991-1994; and declined to 3 per year in 1995-1996 and 1 to 2 per year in 1997-1999. Of the ten institutions having two or more OA latex claims, all claims occurred in 1996 or earlier at 8 (80%). At the largest hospital, there were five accepted claims with year of diagnosis in 1993 (1 case), 1994 (3 cases), and 1995 (1 case). CONCLUSIONS: These findings suggest that, despite the effect of increasing recognition, the introduction of gloves with reduced powder and/or protein, as well as other interventions have been associated temporally with declines in the number of cases of latex OA.     

Natural rubber latex allergy workers' compensation claims: Washington State healthcare workers, 1991-1999

Occupational reaction to natural rubber latex experienced by healthcare employees was examined using data of all workers' compensation claims filed by state-insured healthcare employees in Washington State for the period 1991-1999 (n = 65,703). As latex reaction is not a condition for which there are specific identification codes, these claims were estimated by coupling source and nature of injury records that were consistent with reactions to latex. It was found that the claim rate was on average 2.66 per 10,000 state-insured healthcare workers annually. The most common condition experienced was dermal (84.3%), and most common body part affected was the hand (70.0%). Because few claims cited respiratory or conjunctivitis as reaction experienced, little evidence was discovered to support that glove powder acted as a widespread latex allergen transmitter in healthcare environments. Most cases did not require indemnity payment for lost work time (81.2%), suggesting most reactions were minor. The average cost per natural rubber latex claim was $2,759.10, compared to $3,178.18 for the average healthcare worker claim for all causes. Overall, the average cost per state-insured healthcare worker employed during this time was under $0.74 per year. Nursing aides/orderlies were the most frequent healthcare occupation filing a claim (33.2%). The majority of claimants were female (87.9%), and unmarried workers (52.0%) filed slightly more claims than married workers (48.0%). In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.34 percent of the total was potentially related to natural rubber latex, with other common healthcare workplace items cited more frequently as source of occupational injury.     

Quality of life claims in trials of anti-hypertensive therapy

The increasing use of so-called quality of life assessments in clinical trials can be seen as a laudable attempt to gather information about the impact of treatment on patients which goes beyond the purely clinical. However, there is a growing tendency for pharmaceutical companies to use quality of life claims in marketing strategies. The varying protocols and study populations, together with multicentre and multicountry trials and the variety of implied definitions of quality of life raise serious issues concerning the scientific credibility of conclusions about quality of life as an endpoint. This paper reviews reports of randomized controlled trials of anti-hypertensive therapy which used quality of life, assessed by patient-completed questionnaires, as one of the outcome variables. Criteria referring to definitions of quality of life, the validity and reliability of the measures used, administration procedures, treatment of data, adequacy of discussion of alternative explanations of the findings and the legitimacy of the findings are spelled out. It is concluded that none of the studies reviewed were justified in the claims made concerning differential effects of therapies on quality of life.     

Characterisation of strains of enteroaggregative Escherichia coli isolated during the infectious intestinal disease study in England

Strains of Escherichia coli, hybridising with a DNA probe for enteroaggregative E. coli (EAggEC), were isolated from patients with infectious intestinal disease (IID) or gastro-enteritis, and healthy controls during the study of IID in England. Of 3506 cases presenting with an IID, 160 (4.6%) had faecal EAgg-EC as compared with 46 (1.7%) of 2772 healthy controls, 53% of EAggEC isolated from each of the case and the control groups adhered in a stacked-brick formation. Strains from cases and controls belonged to over 39 and 14 different serogroups respectively, and approximately half of the strains isolated did not react with antisera in the current somatic antigen serotyping scheme. Forty-nine cases with EAggEC (31%) had a known history of foreign travel. Over 50% of strains isolated from cases and controls were resistant to one or more of eight antimicrobials, and antimicrobial resistance was not statistically significantly more common among cases with a known history of foreign travel (p = 0.57). These data form part of the largest investigation carried out on these organisms in the UK to date and provide the most comprehensive analysis of strains of EAggEC isolated from the general population of England.     

Stability of time trade-off utilities for health states associated with the treatment of prostate cancer

Background: Patients diagnosed with localized prostate cancer face several treatment options. Patient preferences for treatment side effects often dominate the decision making process. We proposed to learn more about the nature of patient preferences, or utilities, for these side effects. Methods: Two hundred and fifteen men were consecutively enrolled from three institutions for assessment after prostate needle biopsy. Baseline and 6 month follow-up assessments were done using the University of California, Los Angeles Prostate Cancer Index (UCLA PCI), and a laptop utility assessment application, U-Titer II. Patient utility was assessed for current pelvic functions as well as hypothetical pelvic dysfunctions. We calculated stability of utility scores and correlations between utility scores and UCLA PCI scores. Results: Utility scores for current pelvic functions exhibited a significant ceiling effect. Utility scores for current pelvic functions and hypothetical impaired states were stable after 6 months in patients with negative biopsies. In patients who underwent treatment, utility for current sexual function decreased by 0.13 units (p < 0.00) and utility for current urinary function decreased by 0.09 units (p < 0.01). Utility for hypothetical stress urinary incontinence rose in men with a >25-point drop in UCLA PCI score. Conclusion: Utilities for some current pelvic functions decreased in tandem with UCLA PCI scores in men who experienced >25-point changes in these scores. Utilities for some hypothetical pelvic dysfunctions rose as men began to actually experience functional changes in those areas.     

How Connectedness Contributes to Experimental Smoking Among Rural Youth: Developmental and Ecological Analyses

The influences of peer, sibling, and parents smoking on adolescents initiation of tobacco use have been explained as a function of peer pressure, genetics, and social learning processes, but rarely in combination or with assessments of the quality of these relationships. This study examined the additional contributions of connectedness to friends, siblings, parents, and teachers beyond the effects of friend, sibling, and parental smoking using logistic regression analyses with a cross-sectional middle and high school sample of 303 rural adolescents. Friends and siblings smoking, and connectedness to friends, were the strongest predictors of experimental smoking. Parental smoking and connectedness to parents and to teachers were significant predictors of experimental smoking when considered independently, but not after accounting for friend and sibling factors. Connectedness to parents and teachers decreased the odds of experimental smoking, while connectedness to friends increased the odds.Editors Strategic Implications: This strategy of assessing connectedness to–and smoking behaviors of—friends, siblings, teachers, and parents shows promise in predicting teens cigarette smoking choices. The finding that the negative effects of unconventional connectedness and smoking by friends and siblings outweigh positive effects of connectedness to adults awaits replication with different samples and measures.     

The German experience 10 years after the latex allergy epidemic: need for further preventive measures in healthcare employees with latex allergy

Objectives

Powdered latex gloves or latex gloves with high allergen content are forbidden in Germany since 1998. It was the aim of this study to test the hypothesis that nationwide preventive measures enable health care workers with latex allergy to work without health risks about 10 years afterwards.

Methods

Ninety-one health care workers who had been reported to the accident insurance between 1996 and 2004 for occupational latex allergy were examined in 2007. The survey included a questionnaire, a physical examination, spirometry, methacholine testing, skin prick testing and serum IgE measurements to latex and environmental allergens.

Results

Recent work-related possibly allergic symptoms were reported by 32 subjects (35%), among them 18 subjects (20%) with symptoms of the eyes, nose or airways. Current sensitization to latex was detected in 61 subjects (67%), and 60 subjects (66%) were atopic. Eleven subjects (12%) showed mild airway obstruction, and 27 subjects (30%) were considered hyperresponsive to methacholine. Whereas overall recent symptoms of the eyes, nose or airways were associated with current latex sensitization (OR 4.5; 95% CI 1.3–16.2), this was not the case for objective outcome parameters (spirometry, bronchial hyperresponsiveness).

Conclusions

Although most subjects had only mild disease, ongoing work-related symptoms of the eyes, nose or airways in a substantial number of subjects with latex allergy suggest the need for further secondary preventive measures in German healthcare.     

Consensus Document. Update on latex exposure and use of gloves in Italian health care settings

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.     

Health behaviours and socio-economic status in Ontario, Canada

Data from the 1990 Ontario Health Survey were used to investigate the association of socio-economic status with the likelihood of meeting current recommendations for four health behaviours (smoking, fat intake, alcohol consumption, and physical activity level) in adults living in Ontario (Canada). Health behaviours were categorised as unhealthy if they did not meet current recommendations in Ontario (smoking, fat intake < 30% of dietary energy, alcohol intake < 14 units per week, low level of leisure-time physical activity). Two summary variables based on the number ofÔ unhealthyÕ behaviours were also examined: the crude number of unhealthy behaviours reported and the likelihood of reporting 3 or 4 unhealthy behaviours. Four measures of socio-economic status were used: educational achievement, household income status, source of household income, and occupational prestige. Multiple logistic and linear regression analyses were performed to explore the association of each unhealthy behaviour and of the summary variables with socio-economic status indicators (taken independently or simultaneously), controlling for demographic characteristics. Except for the positive relationship between income status and high alcohol intake, measures of unhealthy behaviours were inversely associated with the socio-economic indices, suggesting that individuals in lower socio-economic groups are at an increased risk for health problems.     

Differences between Eastern European immigrants of German origin and the rest of the German population in health status, health care use and health behaviour: a comparative study using data from the KORA-Survey 2000

Summary. Differences between Eastern European immigrants of German origin and the rest of the German population in health status, health care use and health behaviour: a comparative study using data from the KORA-Survey 2000Objectives: To identify differences in health status, health care use and health behaviour between Eastern European immigrants of German origin and the rest of the German population in order to develop new concepts for preventive programs.Methods: Using data from the KORA-Survey 2000 (Cooperative Health Research in the Region of Augsburg), immigrants of German origin were compared to the rest of the German population with multiple regression models controlling for sex, age, living with partner, years of education and occupation. Tests of trend were performed for the groups classified according to the year of immigration.Results: Compared to other Germans, immigrants of German origin consider their health status more often as poor. They were more likely to be obese (OR = 1.95) and have hyperlipidemia (total-cholesterol/HDL-C > 4: OR = 1.71). They were less likely to use cancer screening (OR = 0.41) or to perform sport activities (OR = 0.47). All these differences decrease with the length of residence in Germany.Conclusions: Concerning their health status, Eastern European immigrants of German origin were identified as a high risk group. They should be considered for specific preventive programs and health care interventions, especially during the first years of immigration.

---

Unterschiede zwischen Aussiedlern und der übrigen deutschen Bevölkerung bezüglich Gesundheit, Gesundheitsversorgung und Gesundheitsverhalten: eine vergleichende Analyse anhand des KORA-Surveys 2000

Zusammenfassung. Fragestellung: Bis zum Jahre 2000 sind ca. 4 Mio. Aussiedler nach Deutschland eingereist. Trotzdem ist diese Bevölkerungsgruppe in der Public-Health-Forschung bisher wenig beachtet worden. Ziel dieser Studie ist es, Unterschiede bezüglich Gesundheit, Gesundheitsversorgung und Gesundheitsverhalten zwischen Aussiedlern und Nicht-Aussiedlern zu ermitteln, um auf dieser Basis Konzeptionen für Präventionsmassnahmen in der Gesundheitsversorgung entwickeln zu können.Methodik: Anhand des KORA-Surveys 2000 (Kooperative Gesundheitsforschung in der Region Augsburg) wurde eine vergleichende Analyse von Aussiedlern und den übrigen Studienteilnehmern durchgeführt. Die Zielgrössen sind den drei Bereichen Gesundheit, Gesundheitsversorgung und Gesundheitsverhalten zugeordnet. Es wurden unter Berücksichtigung von Geschlecht, Alter, Zusammenleben mit Partner, Ausbildungsdauer und Beschäftigung multiple Regressionsmodelle berechnet. Mittels Trendtest wurden Unterschiede nach der Aufenthaltsdauer untersucht.Ergebnisse: Im Vergleich zum Rest der Studienpopulation schätzen Aussiedler ihre eigene Gesundheit als schlechter ein (OR = 0,68). Sie sind eher übergewichtig (OR = 1,95) und haben häufiger ein ungünstiges Lipidverhältnis (OR = 1,71) (Gesamtcholesterin/ HDL-C>4). Ausserdem nehmen sie weniger an Krebsvorsorgeuntersuchungen teil (OR = 0,41) und sind weniger sportlich aktiv (OR = 0,47). Die beobachteten Unterschiede sind am deutlichsten bei den Aussiedlern, die vor höchstens fünf Jahren nach Deutschland übergesiedelt sind.Schlussfolgerung: Aussiedler sind eine Risikogruppe, die bei Präventions- und Versorgungsmassnahmen berücksichtigt werden sollten. Dies gilt insbesondere für Aussiedler, die sich erst seit kurzem in Deutschland aufhalten.

---

Résumé. Différences entre les immigrants de lEurope de lEst dorigine allemande et le reste de la population allemande: état de santé, utilisation des services de santé, et comportement en matière de santé. Une analyse comparative basée sur les données du KORA-Survey 2000Objectifs: Jusquen 2000, environ 4 millions de personnes ont immigré en Allemagne. Ce groupe a fait lobjet de très peu de recherches en santé publique. Lobjectif de cet article est de mettre en évidence les différences sur le plan de létat de santé, de lutilisation des services de santé et du comportement en matière de santé entre les immigrants dEurope de lEst dorigine allemande et le reste de la population allemande, afin de pouvoir développer de nouvelles pratiques de prévention.Méthodes: Sur la base de lenquête KORA 2000 (Kooperative Gesundheitsforschung in der Region Augsburg), une analyse comparative a été menée entre les immigrants et les autres participants de létude,à laide de modèles de régressions multiples tenant compte du sexe, de lâge, du fait que la personne vit seule ou en couple, du nombre dannées de formation et de lactivité professionnelle. Les différences selon les dates dimmigration ont été examinées au moyen de tests de tendance.Résultats: Les immigrants de lEurope de lEst dorigine allemande estiment leur santé plus mauvaise. Ils tendent à être plus en surpoids (OR = 1,95) et à avoir un rapport lipidique défavorable (cholestérol total/cholestérol HDL > 4) (OR = 1,71). Ils utilisent moins les services de dépistage du cancer (OR = 0,41) et ils font moins de sport (OR = 0,47). Ces différences sont particulièrement nettes chez les personnes arrivées en Allemagne depuis moins de cing ans.Conclusions: Les immigrants de lEurope de lEst dorigine allemande représentent un groupe à haut risque. Il faut leur prêter une attention particulière lors de la mise en place de services de soins et de programmes de prévention, particulièrement lorsque ces personnes résident depuis peu de temps en Allemagne.

     

Measurement of quality of life in women with breast cancer. Development of a Life Satisfaction Questionnaire (LSQ-32) and a comparison with the EORTC QLQ-C30

The purpose was to develop and validate a new instrument suitable for measuring perceived quality of life in women with breast cancer. The instrument is to be used within conventional cancer therapy as well as in complementary care, and is called the LSQ-32 (Life Satisfaction Questionnaire). The subjects were 362 women with breast cancer in all cancer stages. Cronbach's reliability coefficient of the LSQ was 0.89. The construct validity was estimated by a principal component analysis. Six orthogonal factors were identified: (1) Quality of family relation, (2) Physical symptoms, (3) Socioeconomic situation, (4) Quality of daily activities, (5) Sickness impact and (6) Quality of close friend relation. The criterion-related validity was estimated by comparing the LSQ-32 and the EORTC QLQ-C30. The scales/items of the EORTC QLQ-C30 were represented in the LSQ-32, but the factors Quality of family relation and Quality of close friend relation were not found in the EORTC QLQ-C30. It was concluded that the LSQ-32 as well as the EORTC QLQ-C30 are valuable tools in the measurement of quality of life in women with breast cancer. The LSQ-32, however, also contains an existential factor.The study was approved on 1992 04 08 by the Research Ethical Committee, Faculty of Health Sciences, University of Linköping.     

An outbreak in Italy of botulism associated with a dessert made with mascarpone cream cheese

In the late 1996, an outbreak of botulism affected eight young people (age of patients ranged from 6 to 23 years) in Italy. The onset of the illness was the same for all of these patients: gastrointestinal symptoms (nausea and vomiting) followed by neurologic symptoms. The most common neurologic symptoms were dysphagia, respiratory failure (100%), diplopia (87%), dysarthria, ptosis (75%) and mydriasis (50%). All patients required mechanical ventilation. Botulinum toxin was detected from two of respectively five sera and six stool samples analysed, while spores of Clostridium botulinum type A were recovered from all patient' faeces. The epidemiological investigation led to suspect a commercial cream cheese (mascarpone) as a source of botulinum toxin: indeed, it had been eaten by all the patients before onset of the symptoms, either alone or as the (uncooked) ingredient of a dessert, tiramisù. Botulinum toxin type A was found in the tiramisù leftover consumed by two patients and in some mascarpone cheese samples collected from the same retail stores where the other patients had previously bought their cheeses. A break in the cold-chain at the retail has likely caused germination of C. botulinum spores contaminating the products, with subsequent production of the toxin. One of the patients died, while the others recovered very slowly. Prompt international alerting and recall of the mascarpone cheese prevented the spread of the outbreak due to the wide range of distribution, demonstrating the importance of a rapid surveillance system. None of the people complaining of symptoms after the public alert resulted positive for botulinum spores and toxin.     

Individual Factors and GP Approach as Predictors for the Outcome of Rehabilitation Among Long-Term Sick Listed Cases

There appears to be a lack of evidence concerning the effect of rehabilitation programmes for the long-term sick. More focus in this area would supplement an approach that has been directed toward process evaluation of rehabilitation programmes. It was the purpose of this study to shed light on individual factors and health care and social welfare-related factors, which play a role for the outcome of rehabilitation programmes. In connection with a participatory, action-oriented outpatient rehabilitation program, a questionnaire survey was performed among the programmes participants (clients). Questionnaires were completed before the rehabilitation programmes start, at the end of the 8-week programme, and at the 9-months follow-up. Among 389 clients, 271 (69.7%) participated in the study at baseline as well at the 9-months follow-up. The majority of 212 participants were on sick leave—66.6% for more than 1 year. The remainder had been transferred to receiving social benefits after having exceeded the time limit for being sick-listed. A plan of action for active rehabilitation, which was made at the end of the 8-week rehabilitation programme, was only poorly fulfilled after 9months, 48% were still on sick leave or social benefits at this time. Individual background variables, as well as psychological well-being, mental health, pain level, and pain coping, seemed to have little effect on the outcome of rehabilitation, whilst clients own evaluations of competence and ability of the involved health care professionals were found important for a positive outcome of the programme. Especially stable relations to a single General Practitioner (GP), who took good care of the patient in the form of giving good information about health and social possibilities, and an empathic attitude toward these hard-pressed clients, were important factors. The odds ratio for a nonbeneficial outcome of the rehabilitation programme, among those who had changed GP and reported poor case treatment by the GP, was 3.9 (95% CI;1.3–11.9). Additional findings were an association between a desire to go on early retirement pension, higher age, and self-estimated poorer health at baseline, and actual status as pensioner 9 months after the programme. Predictors of a beneficial outcome from the 8-week rehabilitation programme included good and comprehensive care-taking in particular by the clients GP. The presence of a high level of symptoms and complaints of pain and stress had no effect on the outcome of rehabilitation in this cohort.