Ahmed A. Arif

Association between cleaning-related chemicals and work-related asthma and asthma symptoms among healthcare professionals

Objectives Work-related asthma (WRA) is an important public health problem affecting one quarter of adults with asthma. Although cleaning substances are routinely used in hospitals, few studies have addressed their potential adverse respiratory health effects on healthcare professionals (HCPs). This study attempts to identify relationship between work-related exposure to cleaning-related chemicals and development of WRA among HCPs. Methods Of 5600 HCPs surveyed, 3650 responded to a validated questionnaire about their occupation, asthma diagnosis, variability of asthma symptoms at and away from work, and exposure to individual cleaning substances. Workplace asthma was defined as a categorical variable with four mutually exclusive categories: work-related asthma symptoms (WRAS), work-exacerbated asthma (WEA), occupational asthma (OA) and none. Multivariable logistic regression analysis was used to evaluate the association between self-reported use of cleaning substances and asthma outcomes among HCPs. Results Prevalences of WRAS, WEA and OA were 3.3%, 1.1% and 0.8%, respectively. The prevalence estimates were generally higher among female than male HCPs. The odds of WRAS and WEA increased in a dose-dependent manner for exposure in the longest job to cleaning agents and disinfectants/sterilants, respectively. For exposure in any job, the odds of WRAS were significantly elevated for both factor 1 (bleach, cleaners/abrasives, toilet cleaners, detergents and ammonia) and factor 2 (glutaraldehyde/ortho-phtaldehyde, chloramines and ethylene oxide). Significantly elevated odds of WEA were observed for exposure to bleach, factor 2 and formalin/formaldehyde. Exposure to chloramines was significantly associated with an almost fivefold elevated odds of OA. Conclusions HCPs are at risk of developing WRA from exposure to cleaning substances.

Occupational exposures and asthma among nursing professionals

Objectives: To identify occupational exposure risk factors associated with the development of new-onset asthma in nurses. Methods: A cross-sectional survey was administered to a sample of licensed Texas nurses (response rate 70%) and compared to three other healthcare professional groups. Nursing professionals were defined based on self-reported longest held job. Outcome variables were physician-diagnosed new-onset asthma after entry into the healthcare profession and symptoms associated with bronchial hyper-responsiveness (BHR). Occupational exposures were ascertained through a job-exposure matrix, grouped into four categories: cleaning-related tasks, use of powdered latex gloves, administration of aerosolised medications, and tasks involving adhesive compounds, glues and/or solvents. Results: After adjustment for age, sex, ethnicity, atopy, smoking, body mass index and seniority, reported asthma was significantly greater among nursing professionals involved in medical instrument cleaning (OR = 1.67, 95% CI 1.06 to 2.62) and exposure to general cleaning products and disinfectants (OR = 1.72, 95% CI 1.00 to 2.94). Use of powdered latex gloves during 1992–2000 was associated with 1.6 times (95% CI 1.01 to 2.50) the odds of reported asthma. In univariate analysis, exposure to adhesives, glues and/or solvents was associated with a twofold increase in the odds of reported asthma, but not after adjustment for covariates. Similarly, the odds of BHR-related symptoms were significantly greater among nursing professionals exposed to general cleaning products and disinfectants (OR = 1.57, 95% CI 1.11 to 2.21) and adhesives, glues and/or solvents used in patient care (OR = 1.51, 95% CI 1.08 to 2.12). Conclusion: Among nursing professionals, workplace exposures to cleaning products and disinfectants increase the risk of new-onset asthma.

Occupational exposures and asthma in health-care workers: comparison of self-reports with a workplace-specific job exposure matrix.

The authors compared self-reported occupational exposures with a workplace-specific job exposure matrix (JEM) in a 2004 survey of Texas health-care professionals (n = 3,650), by asthma status. Sensitivity, specificity, chance-corrected (kappa) and chance-independent (phi) agreement, and associations of self-reported exposures with asthma were compared with those for the JEM. Among asthmatics, the median sensitivity of self-reported exposures was 74% (range, 53-90); specificity was 64% (range, 27-74). For nonasthmatics, median sensitivity was 67% (range, 40-88) and specificity was 70% (range, 33-82). Sensitivity was higher among asthmatics for exposures involving perceptible odors. Specificity was higher among nonasthmatics for instrument cleaning and exposure to adhesives/solvents. Asthmatics showed better agreement with the JEM for patient-care-related cleaning (phi = 0.51 vs. 0.40); there was little difference for other exposures. In all cases, confidence intervals overlapped. Prevalence ratios were higher with self-reported exposures than with the JEM; differences were greatest for cleaning products, adhesives/solvents, and gases/vapors. However, confidence intervals overlapped with those obtained using the JEM. In asthma studies, differential reporting bias by health status should be taken into consideration. Findings favor using externally developed methods of exposure classification, although information gleaned from examining distributions of exposure self-reports, particularly among nondiseased persons, can provide useful information for improving the reliability of exposure ascertainment.

Effectiveness of pesticide safety training and knowledge about pesticide exposure among Hispanic farmworkers.

Background:Pesticide poisoning rates remain high among farmworkers despite programs aimed at reducing pesticide exposure. Methods:A cross-sectional study was conducted among 187 Hispanic farmworkers in North Carolina. Farmworkers were interviewed to determine the association between pesticide safety training and knowledge about pesticides and use of personal protective equipment (PPE). Results:Use of PPE was higher among farmworkers who reported wearing gloves reduced the harmful effects of pesticides (adjusted odds ratio, 5.73; 95% confidence interval, 2.20–14.92) and those who received pesticide safety training at the extension office or growers association (adjusted odds ratio, 44.62; 95% confidence interval, 3.96–503.33). Conclusion:Some farmworkers are still not using PPE. Evaluation of Environmental Protection Agency Worker Protection Standards pesticide safety training and requirements for providing PPE are crucial to encourage farm workers to use PPE.

Race/ethnicity, income, chronic asthma, and mental health: a cross-sectional study using the behavioral risk factor surveillance system.

Objective: To examine the relationships among race/ethnicity, income, and asthma on mental health outcomes in individuals surveyed as part of the Centers for Disease Control and Prevention 2004 Behavioral Risk Factor Surveillance System (BRFSS). Racial and ethnic disparities in asthma prevalence exist, which may be explained in part by socioeconomic status. Individuals with asthma often have comorbid mental health conditions, the rates of which are also marked by significant racial and ethnic disparities. Methods: We obtained 2004 BRFSS demographic, asthma, and mental health data on Hispanics, non-Hispanic Whites, and non-Hispanic Blacks. Linear regression analysis was used to examine the main and interaction effects of race/ethnicity, income, and history of asthma on poor mental health (n = 282,011), as well as on depression (n = 14,907) and anxiety (n = 14,871) specifically. Results: A significant three-way interaction emerged among race/ethnicity, income, and history of chronic asthma on number of days of poor mental health. Among the most impoverished (income <

The association between symptomatic asthma and neurobehavioral comorbidities among children.

15,000/yr), Hispanics with asthma reported greater number of days of poor mental health than non-Hispanic Whites with asthma. However, among those with slightly greater economic resources, Hispanics with asthma reported fewer number of days of poor mental health than non-Hispanic Whites. Conclusions: The results of this study highlight the complex interactions among race/ethnicity, income, and asthma on mental health outcomes. BRFSS = Behavioral Risk Factor Surveillance System.

Use of Exhaled Nitric Oxide as a Biomarker in Diagnosis and Management of Chronic Obstructive Pulmonary Disease

Background. Asthma affects millions of children in the United States. The extent to which asthma and other medical conditions coexist, however, is largely unknown. Objective. This study aimed to determine associations between symptomatic asthma and neurobehavioral comorbidities among children in rural United States. Methods. This cross-sectional study used data from 406 parents/caregivers of children aged 16 or younger, who completed survey questionnaires assessing their childs health status. Symptomatic asthma was defined as parents’/caregivers’ report of physician diagnosed asthma and presence of night-time asthma symptoms in their children. The dependent variables were parents’/caregivers’ reported comorbidities in children. Results. Symptomatic asthma was present in 9% of the sample. Approximately 26% parents/caregivers reported their child had one or more mental health problems and 13% reported one or more neurological problems. In multivariable logistic regression analyses, a statistically nonsignificant 50% elevated odds of one or more mental health problems were observed for children with symptomatic asthma (adjusted odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.6–3.5). Of the individual comorbidities included in the mental health construct, more than 2-fold elevated odds of anxiety problems (adjusted OR = 2.6, 95% CI = 0.8–8.6) and attentional problems (adjusted OR = 2.4, 95% CI = 1.0–5.8) were observed for symptomatic asthma. The odds of reporting one or more neurological problems were 4-fold elevated (adjusted OR = 4.0, 95% CI = 1.6–10.0) for symptomatic asthma. Of the individual comorbidities included in the neurological construct a significantly elevated odds of hearing impairment or deafness was observed among children with symptomatic asthma (adjusted OR = 8.2, 95% CI = 1.5–45.3) as compared to the no asthma/no symptoms reference group. Conclusion. These data suggest significant associations between symptomatic asthma and neurological comorbidities.

The well-being of children in food-insecure households: results from The Eastern Caribbean Child Vulnerability Study 2005.

Background: Chronic obstructive pulmonary disease (COPD), a progressive and nonreversible disease, is a leading cause of mortality and morbidity throughout the world. Because airway inflammation is a hallmark of COPD, it has been proposed that measuring exhaled nitric oxide, a marker of inflammation, in exhaled breath condensate could prove to be an inexpensive and efficient method to detect COPD in outpatient settings. Methods: This study used secondary data on a sample of 10,214 individuals 30 years and older from the National Health and Nutrition Examination Survey 2007 to 2010. Binary and ordinal logistic regression analyses were used to test the association of exhaled nitric oxide (eNO) with COPD and COPD severity. Results: The prevalence of COPD was 7.2%, based on self-reported physician diagnoses and 11.4% based on prebronchodilator spirometry analysis. This study found no statistically significant association between eNO, COPD, and COPD severity (P > .05). Conclusions: The findings of this study do not support use of eNO as a biomarker of inflammation in diagnosis and management of COPD.

Prenatal exposure to secondhand smoke may increase the risk of postpartum depressive symptoms

OBJECTIVE To examine the relationship between food insecurity and child well-being indicators. DESIGN Cross-sectional survey conducted in 2344 households with children. The main exposure measure was food insecurity status, which was categorized as food secure or food insecure based on two or more food insecurity questions answered in the affirmative. Multiple logistic regression analysis was used to model the association between food insecurity status and selected child well-being indicators. SETTING Barbados, St. Lucia and St. Vincent and the Grenadines (hereafter St. Vincent), three Eastern Caribbean countries, 2005. SUBJECTS A random sample of households with children was identified by the governments of Barbados, St. Lucia and St. Vincent. In-home interviews were conducted by social workers. RESULTS One-third (33%) of households were categorized as food insecure. Food-insecure households were more likely to include a chronically ill parent (OR = 2.48; 95% CI 1.76, 3.49), a recently divorced parent (OR = 1.92; 95% CI 1.21, 3.05), a child requiring multiple visits to a health-care provider for a disability (OR = 3.98; 95% CI 1.20, 13.19) or injury (OR = 1.78; 95% CI 1.12, 2.83), a child with a learning disability (OR = 2.08; 95% CI 1.16, 3.74) or a child with a physical disability (OR = 2.54; 95% CI 1.22, 5.32) after adjustment for poverty and other demographic variables. CONCLUSIONS The results indicate that food-insecure households were more likely to be burdened by child disability (learning and physical), family system disruption (recent divorce and chronic illness) and child health-care needs (for disability and injury) than food-secure households. The implementation of programmes and policies to minimize food insecurity in the Eastern Caribbean may be warranted.

The association of childhood asthma with mental health and developmental comorbidities in low-income families

BACKGROUND The harmful effects of smoking during pregnancy on occurrence of postpartum depressive symptoms (PPDS) have been well studied, but there is little research on the association of secondhand smoke (SHS) exposure during pregnancy with PPDS. This study aimed to explore the relationship between prenatal exposure to SHS during pregnancy and PPDS. METHODS The authors analyzed data from 6884 women who participated in the North Carolina Pregnancy Risk Assessment and Monitoring System survey (2004-08). Data on the exposure (prenatal SHS), outcome (PPDS) and covariates were obtained from self-reported questionnaires. Univariable and multivariable logistic regression was used for data analysis. RESULTS The prevalence of PPDS was 16.5%. In the unadjusted analysis, women exposed to SHS during pregnancy had nearly twice the odds of PPDS than the unexposed (odds ratio, OR = 1.90, 95% confidence interval, CI: 1.61-2.26). After adjusting for potential confounders, the association between SHS and PPDS was weakened but remained statistically significant (OR = 1.49, 95% CI: 1.23-1.80). A dose-response relationship was not evident in the analyses. Maternal smoking during pregnancy did not appear to modify the association between SHS and PPDS. CONCLUSIONS The current study identified a positive association between SHS and PPDS.