Denise M. Gaughan

Acute Upper and Lower Respiratory Effects in Wildland Firefighters

Objectives: To assess acute respiratory effects experienced by wildland firefighters. Methods: We studied two Interagency Hotshot Crews with questionnaires, spirometry, and measurement of albumin, eosinophilic cationic protein (ECP), and myeloperoxidase (MPO) as indicators of inflammation in sputum and nasal lavage fluid. Assessments were made preseason, postfire, and postseason. Results: Fifty-eight members of the two crews had at least two assessments. Mean upper and lower respiratory symptom scores were higher postfire compared to preseason (P < 0.001). The mean forced expiratory volume in 1 second was lower postfire compared to preseason (P < 0.001) and then recovered by postseason. Individual increases in sputum and nasal ECP and MPO from preseason to postfire were all significantly associated with postfire respiratory symptom scores. Conclusions: Wildland firefighting was associated with upper and lower respiratory symptoms and reduced forced expiratory volume in 1 second. Within individuals, symptoms were associated with increased ECP and MPO in sputum and nasal lavage fluid. The long-term respiratory health impact of wildland firefighting, especially over multiple fire seasons, remains an important concern.

HIV as a chronic disease: Implications for long-term care at an AIDS-dedicated skilled nursing facility

ObjectiveTo describe the characteristics and outcomes of the first 3 years of admissions to a dedicated skilled nursing facility for people with acquired immunodeficiency syndrome (AIDS).MethodsSystematic chart review of consecutive admissions to a 30-bed, AIDS-designated long-term care facility in New Haven, Connecticut, from October 1995 through December 1998.ResultsThe facility has remained filled to 90% or more of its bed capacity since opening. Of 180 patients (representing 222 admissions), 69% were male; mean age was 41 years; 57% were injection drug users; 71% were admitted directly from a hospital. Leading reasons for admission were (1) the need for 24-hour nursing/medical supervision, (2) completion of acute medical treatment, and (3) terminal care. On admission, the median Karnofsky score was 40, and median CD4+ cell count was 24/mm3; 48% were diagnosed with serious neurologic disease, 44% with psychiatric illness; patients were receiving a median of 11 medications on admission. Of 202 completed admissions, 44% of patients died, 48% were discharged to the community, 8% were discharged to a hospital. Median length of stay was 59 days (range 1 to 1,353). Early (≤6 months) mortality was predicted by lower admission CD4+ count, impairments in activities of daily living, and the absence of a psychiatric history; long-term stay (>6 months) was predicted by total number of admission medications, neurologic disease, and dementia. Comparison of admissions from 1995 to 1996 to those in 1997 to 1998 indicated significantly decreased mortality rates and increased prevalence of psychiatric illness between the two periods (P<.01).ConclusionsA dedicated skilled nursing facility for people with AIDS can fill an important service need for patients with advanced disease, acute convalescence, long-term care, and terminal care. The need for long-term care may continue to grow for patients who do not respond fully to current antiretroviral therapies and/or have significant neuropsychiatric comorbidities. This level of care may be increasingly important not only in reducing lengths of stay in the hospital, but also as a bridge to community-based residential options in the emerging chronic disease phase of the AIDS epidemic.

Occupational sensitization to soy allergens in workers at a processing facility

Background Exposure to soy antigens has been associated with asthma in community outbreaks and in some workplaces. Recently, 135 soy flake processing workers (SPWs) in a Tennessee facility were evaluated for immune reactivity to soy. Allergic sensitization to soy was common and was five times more prevalent than in health care worker controls (HCWs) with no known soy exposure.

Adverse respiratory outcomes associated with occupational exposures at a soy processing plant

This study aimed to characterise the relationship between adverse health outcomes and occupational risk factors among workers at a soy processing plant. A questionnaire, spirometry, methacholine challenge, immune testing and air sampling for dust and soy were offered. Prevalence ratios (PRs) of respiratory problems from comparisons with the US adult population were calculated. Soy-specific immunoglobulin (Ig)G and IgE among participants and healthcare worker controls were compared. Associations between health outcomes and potential explanatory variables were examined using logistic regression. 147 (52%) out of 281 employees, including 66 (70%) out of 94 production workers, participated. PRs were significantly elevated for wheeze, sinusitis, ever-asthma and current asthma. Participants had significantly higher mean concentrations of soy-specific IgG (97.9 mg·L−1 versus 1.5 mg·L−1) and prevalence of soy-specific IgE (21% versus 4%) than controls. Participants with soy-specific IgE had three-fold greater odds of current asthma or asthma-like symptoms, and six-fold greater odds of work-related asthma-like symptoms; the latter additionally was associated with production work and higher peak dust exposures. Airways obstruction was associated with higher peak dust. Work-related sinusitis, nasal allergies and rash were associated with reported workplace mould exposure. Asthma and symptoms of asthma, but not other respiratory problems, were associated with immune reactivity to soy.

Psychiatric comorbidity and the long-term care of people with aids

ObjectivesTo examine the association of comorbid psychiatric disorders with admission and discharge characteristics for patients residing at a long-term care facility designated for acquired immunodeficiency syndrome (AIDS).MethodsDemographic and clinical characteristics were obtained by systematic chart review for all patients (N=180) admitted to the facility from its opening in October 1995 through December 1999. Lifetime history of severe and persistent psychiatric disorders (major depression, bipolar and psychotic disorders) was determined by current diagnosis on baseline clinical evaluation or a documented past history.ResultsForty-five patients (25%) had comorbid psychiatric disorders. At admission, patients with comorbidity were more likely to be ambulatory (80% vs. 62%,P=.03) and had fewer deficits in activities of daily living (27% vs. 43%,P=.05). After controlling for human immunodeficiency virus (HIV) disease severity, patients with comorbidity had significantly lower discharge rates (relative risk=0.43,95% confidence interval 0.23–0.78,P=.0001) and death rates (relative risk=0.53,95% confidence interval 0.42–0.68,P=.009).ConclusionsPatients with AIDS and comorbid psychiatric disorders at this facility had more favorable admission characteristics and were less likely to be discharged or to die. They may have been admitted earlier in their disease course for reasons not exclusively due to HIV infection. Once admitted, community-based residential alternatives may be unavailable as a discharge option. These findings are unlikely to be an anomaly and may become more pronounced with prolonged survival due to further therapeutic improvements in HIV care. Health services planners must anticipate rising demands on the costs of care for an increasing number of patients who may require long-term care and expanded discharge options for the comanagement of HIV disease and chronic psychiatric disorders.

High hsCRP Is Associated With Reduced Lung Function in Structural Firefighters

BACKGROUND To assess the association between markers of systemic inflammation and pulmonary function in a population of structural firefighters. METHODS We studied male career members of a large Midwestern fire department with questionnaires, spirometry, and high-sensitivity C-reactive protein (hsCRP) as a biomarker of systemic inflammation. We examined percent predicted forced expiratory volume in 1 s (FEV1 %-predicted) and forced vital capacity (FVC%-predicted). RESULTS Complete data were available for 401 firefighters. Higher hsCRP levels were associated with lower lung function values, after adjusting for confounding variables. Specifically, for every twofold increase in log10-hsCRP, FEV1 %-predicted decreased by a mean 1.5% (95% CI: 0.4, 2.6%) and FVC%-predicted decreased by a mean 1.4% (95% CI: 0.4, 2.3%). CONCLUSION hsCRP as a biomarker of systemic inflammation may indicate reduced lung function in structural firefighters.

Flu-like illness among workers at a soy processing plant

Harris-Roberts et al. [2012] described associations between chest symptoms and soy sensitization among workers at South African soy processing plants. These findings were similar to our recently reported observations in workers at a US soy processing plant [Cummings et al., 2010]. Harris-Roberts et al. also described associations between work and flu-like illness, prompting us to examine our unpublished data on flu-like illness in US soy processing workers. These data were collected in a NIOSH IRB-approved research study from participants who provided informed consent. We asked 147 study participants, all current soy plant employees, whether they had flu-like illness with aches, pains, fever, chills, and night sweats during the past 12 months and whether their symptoms were different away from work. Our determination of soy sensitization, work classification, and exposure categories has been described previously [Cummings et al., 2010]. We calculated frequencies and used logistic regression to examine associations. We considered two-sided P � 0.05 to be statistically significant. Analyses were conducted with SAS version 9.2 (SAS Institute, Cary, NC). A total of 55 (37%) participants reported flu-like illness and 20 (14%) reported flu-like illness that was better away from work (‘‘work-related flu-like illness’’). Work-related flu-like illness was not associated with soyspecific IgE (odds ratio [OR] ¼ 1.6, 95% confidence interval [CI] ¼ 0.5‐4.9). Production workers had a higher odds of work-related flu-like illness than non-production workers (OR ¼ 4.4, 95% CI ¼ 0.9‐21.0). Work-related flu-like illness was not associated with exposure categories for inhalable dust (P ¼ 0.33), inhalable soy antigen (P ¼ 0.33), or peak dust (P ¼ 0.41). When examined linearly, soy-specific IgG was not associated with workrelated flu-like illness (P ¼ 0.44). Workers in the second distributional tertile of soy-specific IgG had a higher odds of work-related flu-like illness than other workers, including those in the third distributional tertile (OR ¼ 4.6; 95% CI ¼ 0.9‐23.4). This finding may reflect immune tolerance or a healthy worker effect. The prevalence of work-related flu-like illness was lower in our study (14%) than in the study by Harris