D. Linn Holness

A review of 79 cases of eyelid dermatitis

Seventy-nine patients with eyelid dermatitis and 1012 patients with dermatitis at other sites were assessed with patch tests. Eighty-nine percent of the eyelid cases involved women. Only the eyelids were involved in 78.5% of cases. Of the patients with eyelid dermatitis 46% had allergic contact dermatitis, 15% had irritant contact dermatitis, and 23% had atopic dermatitis. Only 13% were work related. Positive reactions to patch tests for cinnamic alcohol, diazolidinyl urea, and neomycin sulfate occurred more frequently, whereas those for cobalt and nickel occurred less frequently, in patients who had eyelid dermatitis when compared to the reactions of patients who did not have eyelid dermatitis.

Disease outcome in workers with occupational skin disease

BACKGROUND Occupational contact dermatitis (OCD) contributes significantly to the burden of occupational disease, but there is little known about prognostic factors. OBJECTIVE The study was designed to determine the health status of workers with OCD at least 2 years after diagnosis and to identify risk factors related to prognosis. METHODS A questionnaire study was conducted of workers with a diagnosis of work-related skin disease. RESULTS Of the 201 workers with OCD, 76% noted improvement and 40% reported that they were currently free of any eruption. Approximately one third noted that their skin disease interfered with household, work, or recreational activities. The key prognostic factor appeared to be sex because women reported a better outcome. Diagnosis and atopic status tended to be related to some outcomes, whereas age was not. CONCLUSION Examination of other possible factors, some of which may be associated with sex, that might affect outcome should be undertaken to gain a better understanding of possible management strategies. A retrospective study has methodologic limitations and a prospective intervention trial should yield more information.

Health Status of Funeral Service Workers Exposed to Formaldehyde

A study of 84 funeral service workers and 38 control subjects in Toronto, Canada, revealed that the embalmers reported chronic bronchitis, dyspnea, and nasal, eye, and skin irritation more frequently than controls. Apprentices reported symptoms and exhibited signs of irritation more frequently than experienced embalmers, but both of these groups were more affected than the inactive embalmers or the controls. Airborne formaldehyde levels were 0.36 +/- 0.19 ppm (mean +/- standard deviation) during 22 embalming procedures. General ventilation was shown to significantly lower the levels. No significant change in forced vital capacity, forced expiratory volume in 1 sec, FEF50 or FEF75 was demonstrated with formaldehyde exposure nor were the baseline lung function results significantly different from those 38 unexposed controls. Based on patch testing, 4% and 10% were sensitive to formaldehyde and glutaraldehyde, respectively, whereas none of the controls exhibited positive reactions.

Results of a quality of life questionnaire in a patch test clinic population

There has been increasing interest in quality of life outcomes, but there has been little reported on this topic for individuals with contact dermatitis. The objectives of this study were (i) to pilot a dermatology‐specific quality of life instrument to assess its acceptability in a patch test clinic population, (ii) to see the effects of contact dermatitis on the patients’ lives and (iii) to determine what factors may influence quality of life outcomes in this population. A dermatology‐specific quality of life instrument was modified and used for 339 patients undergoing patch testing in a contact dermatitis clinic. The most common effect was pain or itching in 61%. Approximately 1/3 noted embarrassment, interference with work, or sleep disturbance. Other concerns were reported by less than 25% of the population. On multivariate analysis, the key factor influencing most outcomes was hand involvement. The instrument was well accepted by the clinic population and is now being used in a prospective study of outcomes. In the population assessed, it demonstrated the effects of disease. Analysis suggests that a key factor influencing these quality of life outcomes is hand involvement.

Factors affecting attainment of paid employment after lung transplantation

BACKGROUND Limited data exist regarding return to or attainment of paid employment after lung transplantation. Accordingly, the purpose of our study was to identify the issues relating to paid employment after this procedure. METHODS We conducted a mailed survey using Dillmans protocol. We mailed questionnaires to surviving Toronto General Hospital lung transplant recipients (n = 190). We used descriptive statistics, t-tests, and chi-square tests to analyze the data. RESULTS A total of 117 lung transplant recipients completed the questionnaires (70% response rate). The mean age of respondents was 51 +/- 13 years. Fifty-one percent of the sample were women and 72% were married. Cystic fibrosis and chronic obstructive pulmonary disease were the most frequent pre-transplant diagnoses. Fifty-six percent of participants had paid employment at some point before transplant. After transplant, 37% of respondents obtained employment. Individuals who obtained paid employment were more likely to be younger (p = 0.002), to have university degrees (p = 0.02), to report higher health ratings (p = 0.001), and to feel physically able to work (p = 0.01). They also were more likely to express a desire to enter the paid workforce (p < 0.0001); to describe receiving physician encouragement to work (p < 0.0001); to identify the possibility of obtaining paid employment as a primary motivator for the transplantation (p = 0.01); and to report that their previous jobs were available after transplantation (p = 0.01). All individuals who did not obtain paid employment cited personal or transplant-related factors. CONCLUSIONS Medical and social factors influence attainment of paid employment after lung transplantation. Important components of the pre-transplant assessment are discussion of expectations about attaining employment and openly exploring the recipients motivation for employment.

Occupational dermatitis in food handlers and bakers

Of 1346 patients with suspected contact dermatitis examined in Toronto, 10 bakers and 10 food handlers were found to have occupational contact dermatitis. Although not dissimilar in age, years in the trade, or length of illness, men were significantly overrepresented in the population of bakers (100% vs 40%, p less than 0.05). One baker had occupational asthma related to rye flour. Compared with the bakers, significantly more of the food handlers had allergic contact dermatitis (70% vs 20%, p less than 0.05). In addition to food components, cinnamates and rubber were found to be causes of allergic response. One food handler had contact urticaria caused by shellfish. The standard screening tests, combined with the use of contactants specific to occupational history, yielded a definitive determination of the existence of a contact allergy in our subjects.

Contact Allergens in Persons With Leg Ulcers: A Canadian Study in Contact Sensitization:

Individuals with chronic leg ulcers often develop contact allergic reactions to topical preparations used to treat their wounds and the surrounding skin. The objective of this study was to determine the frequency of positive patch test responses to common allergens in patients with leg ulcers or venous disease. A case series of 100 consecutive, consenting patients with chronic venous disease and other causes of leg ulcers that were available for patch testing were enrolled. The patients were tested with 38 common allergens, including those most relevant to leg ulcers. A total of 46% of the patients had at least 1 positive patch test response. Multiple reactions in the same patient were common. The most frequent groups of sensitizers were fragrances, lanolin, antibacterial agents, and rubber-related allergens. Though the prevalence of positive patch test reactions is high in this population, it is lower than commonly reported. This may be the result of clinical practice that considered the avoidance of common sensitizers in the management of patients with leg ulcers.

Acute and Chronic Respiratory Effects of Occupational Exposure to Ammonia

In a soda ash plant, 58 workers exposed to mean airborne ammonia levels of 9.2 +/- 1.4 ppm were compared with 31 control workers with a mean exposure of 0.3 +/- 0.1 ppm. There were no differences between the groups in the reporting of respiratory or cutaneous symptoms, sense of smell, baseline lung function, or change in lung function over a work shift at the beginning and end of a workweek. No relationships between level or length of ammonia exposure and lung function results were demonstrated.

Behind the mask: Determinants of nurse's adherence to facial protective equipment

Background As the predominant occupation in the health sector and as the health worker with the most patient interaction, nurses are at high risk for occupational transmission of communicable respiratory illness. The use of facial protective equipment (FPE) is an important strategy to prevent occupational transmission. Methods A 2-phased study was conducted to examine nurses adherence to recommended use of FPE. Phase 1 was a cross-sectional survey of nurses in selected units of 6 acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses. Results Of the 1,074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of FPE. Multivariable analysis revealed 6 predictors of adherence: unit type, frequency of equipment use, equipment availability, training, organizational support, and communication. Following the survey, 100 observations in 14 intensive care units were conducted that revealed a 44% competence rate with proper use of N95 respirators and knowledge as a significant predictor of competence. Conclusion Whereas increasing knowledge should enhance competence, strategies to improve adherence to recommended use of FPE in a busy and complex health care setting should focus on ready availability of equipment, training and fit testing, organizational support for worker health and safety, and good communication practices.

Cutaneous and respiratory symptoms among professional cleaners

BACKGROUND Occupational dermatitis is very common and has a large economic impact. Cleaners are at an increased risk for both work-related cutaneous and respiratory symptoms. AIMS To compare the prevalence of occupational cutaneous symptoms among professional indoor cleaners to other building workers (OBW) and to determine associations with exposures and with respiratory symptoms among cleaners. METHODS A questionnaire completed by indoor professional cleaners and OBW to compare rash and respiratory symptoms between these groups examined workplace factors such as training, protective equipment and work tasks. RESULTS In total, 549 of the 1396 professional cleaners (39%) and 593 of the 1271 OBW (47%) completed questionnaires. The prevalence of rash was significantly higher in the cleaners compared to the OBW. For male cleaners, 21% (86/413) had a rash in the past 12 months compared to only 11% (13/115) of OBW (P < 0.05). The rashes experienced by the cleaners were more likely to be on their hands and worse at work. Cleaners washed their hands significantly more often than OBW. Cleaners with a rash were less likely to have received workplace training regarding their skin and were more likely to find the safety training hard to understand. Cleaners with a rash within the past year were significantly more likely to have work-related asthma symptoms than cleaners without a rash (P < 0.001). CONCLUSIONS This study demonstrates a strong link between work-related symptoms of asthma and dermatitis among cleaners. Effective preventive measures, such as the use of protective skin and respiratory equipment, should be emphasized.