The prevalence of self-reported symptoms of respiratory disease and community belief about the severity of pollution from various sources

It is postulated that health effects of air pollution may be direct and indirect through people's perception about the severity of pollution and concerns over its impact on their health. A cross sectional postal survey of some 6,559 households was conducted in the area of Ellesmere Port and Neston Borough Council. A total of 3,402 (51.9%) usable questionnaires were returned and included in the subsequent analyses. Childhood asthma was associated with central heating. Adult asthma was associated with the number of people in the house who had ever smoked and 'crowding'. General adult respiratory symptoms were associated with perception of industrial air pollution and neighbour noise in univariable but not multivariable analyses. In the multivariable model number of people in the household who had ever smoked, exposure to traffic fume pollution, crowding and living in rented accommodation. This suggests a complex relationship between actual levels of pollution (though not directly measured in this study), social deprivation, socio-behavioural factors and people's perceptions about pollution. A model of the relationship of these factors is proposed and it is argued that studies of the health impact of air pollution that concentrate only on chemical exposure will be flawed unless they are placed in the context of perception and socio-behavioural factors.

Immune biomarkers in relation to exposure to particulate matter: a cross-sectional survey in 17 cities of Central Europe

Human population data on air pollution and its effects on the immune system are scarce. A survey was conducted within the framework of the Central European Study of Air Quality and Respiratory Health (CESAR) to measure a panel of immune biomarkers in children of Bulgaria, Czech Republic, Hungary, Poland, Romania, and Slovakia. Seventeen cities were chosen to represent a wide range of exposure to outdoor air pollution. In each, ambient particulate matter of less than 10 microns diameter and less than 2.5 microns diameter (PM10 and PM2.5) were measured with a Harvard impactor. Blood was collected from 366 school children aged 9 to 11 yr between 11 April and 10 May 1996. The percentage of B, total T, CD4+, CD8+, and natural killer (NK) lymphocytes was determined by flow cytometry (Becton Dickinson); total immunoglobulins of class G, M, A and E (IgG, IgM, IgA, and IgE) were measured in serum using nephelometry (Behring). Associations between PM and each log-transformed biomarker concentration were studied by linear regression, in a two-stage model. The yearly average concentrations varied from 41 to 96 micrograms/m3 for PM10 across the 17 study areas, from 29 to 67 micrograms/m3 for PM2.5, and from 12 to 38 micrograms/m3 for PM10-2.5 (coarse). Number of B, CD4+, CD8+, and NK lymphocytes increased with increasing concentration of PM, having adjusted for age, gender, parental smoking, laboratory of analysis, and recent respiratory illness. Differences in lymphocyte number were larger and statistically significant for exposure to PM2.5. Similar results were found when we examined the association between PM and lymphocyte number separately for each laboratory. Total IgG was increased with increasing concentration of PM, significantly in the case of PM2.5. When we repeated the analyses with two other statistical approaches the results did not differ from those reported here. The effect of coarse PM on lymphocyte numbers appears small in comparison to PM2.5. One possible interpretation of our findings is that long-term exposure to airborne particulates leads to inflammation of the airways and activation of the cellular and humoral immune system.

Environmental Mycological Study and Respiratory Disease Investigation in Fur‐processing Workers

This paper presents the results of an investigation of respiratory symptoms, chest X-ray examinations, and analysis of antibodies to fungi of 138 fur-processing workers and 40 control workers. Industrial hygiene survey and environmental mycological studies were also conducted. The dust concentrations in fur processing workshops (1.8-6.7 mg/m3) were below the national health limit (10 mg/m3). Most dusts in all fur processing workshops contained less than 2.0% silica. Numbers of isolated fungi in fur processing workshops [629-3,681 cfu/m3 (colony forming unit/m3)] were significantly higher than those in control environments (63-503 cfu/m3). The prevalences of respiratory symptoms in fur processing workers were higher than those in control workers, especially among female exposed workers. The prevalences of the symptoms in female exposed workers were 37.9% with chronic cough, 28.4% with chronic phlegm, 10.5% with dyspnea, 22.1% with chest tightness, and 4.2% with fever. Seven cases showed abnormalities in chest X-ray examinations. The OD450nm values for antibodies to fungi in fur processing workers were significantly higher than those in control workers (P<0.05). The prevalences of positive anti-fungi antibodies in fur-processing workers were also significantly higher than those in control workers (p<0.01). The results suggested that fungi might be one of the main allergens in respiratory diseases in fur processing workers.

Extraintestinal nematode infections of red foxes (Vulpes vulpes) in Hungary

A survey was carried out to investigate the prevalence and worm burden of extraintestinal nematodes in 100 red foxes (Vulpes vulpes) of Hungary. The overall prevalence of nematode infections of the respiratory tract was 76%. Eucoleus aerophilus (Capillaria aerophila) was the predominant species (66%), followed by Crenosoma vulpis (24%), Eucoleus (Capillaria) böhmi (8%) and Angiostrongylus vasorum (5%). Pearsonema (Capillaria) plica was found in 52% of the urinary bladders. In 3% of the foxes, Trichinella britovi was present in muscle samples. The high prevalence of lungworms and P. plica and the fox colonisation in urban areas may enhance the prevalence of these nematode infections in domestic dogs and cats, and the flow of T. britovi from the sylvatic cycle to the domestic cycle, enhancing the risk of infections in humans.

[Sick leave among workers employed in restructured enterprise]

Ownership and restructuring transformations that are taking now place in Poland, as well as the situation on the labor market have their impact on the indicators, which illustrate the workers' health situation, including temporary work disability preceding the issue of the certification granting the disability pension. The aim of this analysis was to identify the changes in the extent and causes of sickness absence among workers after restructuring. The study was carried out in one of the largest transport industry enterprises during the years of its restructuring (1984-1994), covering 8588 workers, and after its restructuring (1997-1999), covering 2702 workers. Following the restructuring, the enterprise's staff was rejuvenated so that the number of workers aged over 50 years decreased by almost fifty percent. The analysis was based on the sickness absence rate calculated as the ratio between the number of days of work disability in a given period of time and the number of person-days in the same period. In 1997-1999, a 33% decrease in sickness absence among women and a 25% decrease among men were observed in the study enterprise as compared with the period of 1989-1994. However, the enhanced absence was also found due to the following diseases: mental disorders (a threefold increase in men); diseases of the musculoskeletal system (by 54% in men and by 43% in women); endocrine, nutritional and metabolic diseases and immunity disorders (a threefold increase in women). Following the restructuring, considerable changes in the sickness absence structure, by causes of diseases, were revealed. A substantial decrease in the share of male and female absence due to diseases of the respiratory and circulatory systems and almost threefold decrease in complications of pregnancy, childbirth and the puerperium in women were noted. In addition, over twofold increase in male and female sickness absence due to diseases of the musculoskeletal system, and lower but significant increase due to mental pathologies (from 3 to 12% in males and from 4 to 7% in women) were recorded. The changes observed in sickness absence result mainly from the changes in the magnitude and structure of employment in the restructured enterprise and related organizational modifications, which arise stressogenic situations among workers, more intensified at risk of unemployment.

[Respiratory diseases in European farmers. Part 1: Literature review]

Farming is still one of the most important economic sectors in the world. At the same time, a high prevalence of respiratory diseases in farmers is well known. Among these, allergic and non-allergic asthma, chronic bronchitis, hypersensitivity pneumonitis and organic dust toxic syndrome (ODTS) are of uppermost importance. Because of the large variety of agriculture across Europe exposure conditions and risk factors for airway diseases may vary largely. While exposure to organic dusts and irritants are most important in grain and animal production, workers in greenhouses are mainly exposed to pollen, fungi, as well as pesticides. Up to now, the knowledge about the prevalence of respiratory diseases in European farmers working in different agricultural sectors was limited. Furthermore, reliable data on farming characteristics as well as exposure patterns that might prone risk factors for respiratory diseases were missing. Therefore, the European Farmers' Project was initiated. The results of this study are given in the second part of this paper.

The medicine and epidemiology of bovine respiratory disease in feedlots

Bovine Respiratory Disease (BRD) results from a complex, multifactorial interaction of stressors, animal susceptibility, and respiratory pathogens. The infectious agents associated with BRD are ubiquitous among cattle populations. Typically, one or a combination of stressors are necessary to initiate BRD. Prevention of BRD should, therefore, address management procedures to minimise stressors. Administration of vaccines against BRD agents may help reduce the incidence of BRD but is unlikely to eliminate the condition. The effectiveness of antimicrobials in the treatment of BRD depends primarily on early recognition and treatment. The use of antioxidant vitamins, minerals or other agents in the prevention and treatment of BRD warrants further research.

Profile of patients attending pediatric emergency service at Chandigarh

Profile of children attending in a Pediatric Emergency Unit of an urban teaching hospital over a period of one year was analyzed. The total number of patients seen between September 1999 to August 2000 was 9205; there was a prepondence of boys (73%). The maximum number of patients were seen in the monsoon month of July and August. About half (52.5%) of the patients were infants. Fever (29.5%), breathing difficulty (17.4%) and diarrhea (14.5%) were the most common presenting symptoms. Respiratory and gastrointestinal illnesses were the two commonest pediatric emergencies. About 2% (n-198) patients died within 24 hours of hospitalization; 42.3% deaths were in the age group of 0-28 days. Sepsis was the most common diagnosis in patients who died. This information may help in planning and development of a Pediatric Emergency unit and prioritizing residents, training.

Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations

BACKGROUND

Influenza causes lower respiratory tract complications (LRTCs), particularly bronchitis and pneumonia, in both otherwise healthy adults and those with underlying conditions. The aim of this study was to assess the effect of oseltamivir treatment on the incidence of LRTCs leading to antibiotic treatment and hospitalizations following influenza illness.

METHODS

We analyzed prospectively collected data on LRTCs and antibiotic use from 3564 subjects (age range, 13-97 years) with influenzalike illness enrolled in 10 placebo-controlled, double-blind trials of oseltamivir treatment.

RESULTS

In adults and adolescents with a proven influenza illness, oseltamivir treatment reduced overall antibiotic use for any reason by 26.7% (14.0% vs 19.1% with placebo; P<.001) and the incidence of influenza-related LRTCs resulting in antibiotic therapy by 55% (4.6% vs 10.3% with placebo; P<.001). In those subjects considered at increased risk of complications, 74 (18.5%) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 (12.2%) of 368 oseltamivir recipients (34.0% reduction; P =.02). Hospitalization for any cause occurred in 18 (1.7%) of 1063 placebo recipients compared with 9 (0.7%) of 1350 oseltamivir-treated patients (59% reduction; P =.02). In contrast, among subjects with an influenzalike illness but without a confirmed influenza infection, the incidence of LRTCs (6.7% vs 5.3%), overall antibiotic use (19.7% vs 19.3%), or hospitalizations (1.7% vs 1.9%) was similar between placebo and oseltamivir recipients, respectively.

CONCLUSION

Oseltamivir treatment of influenza illness reduces LRTCs, antibiotic use, and hospitalization in both healthy and "at-risk" adults.

Effectiveness of influenza vaccination of children with recurrent respiratory tract infections in reducing respiratory-related morbidity within the households

To evaluate the effectiveness of influenza vaccination in reducing respiratory-related morbidity among children with recurrent respiratory tract infections (RRTIs) and their household contacts, 127 children aged 6 months-9 years (78 males; median age, 3.7 years) with a history of RRTIs (>/=6 episodes per year if aged >/=3 years; >/=8 episodes per year if aged <3 years) were randomized to receive the intranasal virosomal influenza vaccine (n=64 with 176 household contacts) or a control placebo (n=63 with 173 household contacts). During influenza season, the vaccinated children had fewer respiratory infections, febrile respiratory illnesses, prescribed antibiotics and antipyretics, and missed school days than the controls, and similar benefits and a reduction in the loss of parental work were observed among their household contacts. This study shows that the benefits of influenza vaccination extend to children with RRTIs and their family members and encourages to recommend its use in such children.

Health effects of welding

Many of the epidemiology studies performed are difficult to compare because of differences in worker populations, industrial settings, welding techniques, duration of exposure, and other occupational exposures besides welding fumes. Some studies were conducted in carefully controlled work environments, others during actual workplace conditions, and some in laboratories. Epidemiology studies have shown that a large number of welders experience some type of respiratory illness. Respiratory effects seen in full-time welders have included bronchitis, airway irritation, lung function changes, and a possible increase in the incidence of lung cancer. Pulmonary infections are increased in terms of severity, duration, and frequency among welders. Although epidemiological studies have demonstrated an increase in pulmonary illness after exposure to welding fumes, little information of the causality, dose-response, and possible underlying mechanisms regarding the inhalation of welding fumes exists. Even less information is available about the neurological, reproductive, and dermal effects after welding fume exposure. Moreover, carcinogenicity and short-term and long-term toxicology studies of welding fumes in animals are lacing or incomplete. Therefore, an understanding of possible adverse health effects of exposure to welding fumes is essential to risk assessment and the development of prevention strategies and will impact a large population of workers.

Respiratory effects of toluene diisocyanate in the workplace: a discussion of exposure-response relationships

Toluene diisocyanate (TDI) is an important industrial intermediate used in manufacturing flexible polyurethane (PUR) foams, surface coatings, cast elastomers, sealants, and adhesives. In this review long-term trends in workplace exposures to TDI are assessed in both the producing and using industries, and respiratory health effects of TDI are evaluated in relation to workplace TDI concentrations. The key respiratory health effects associated with repeated or long-term TDI exposure are bronchial asthma and an accelerated rate of decline in lung function. In the early years of the industry, annual incidence rates of occupational asthma (OA) due to TDI ranged from 1% to as high as 5 to 6%, depending on the extent of engineering and work practice controls in the various workplaces. Since the mid-1970s, annual OA incidence rates have been <1%, where 8 h TDI concentrations have been maintained below 5 ppb as determined by personal monitoring, even where short-termTDI concentrations above 20 ppb and less frequently above 40 ppb were routinely detected. In these latter settings, there is evidence that the majority of OA cases may be attributable to TDI concentrations well above 20 ppb associated with overexposure incidents. Further study is needed regarding the role of such incidents in inducing respiratory sensitization. Cross-sectional and longitudinal studies of lung function have indicated that continued exposure after development of work-related respiratory symptoms can lead to transient or accelerated fixed declines in forced expiratory volume in 1 sec (FEV1). These findings are congruent with the FEV1 declines demonstrated in general population studies of persons with persistent bronchial hyperresponsiveness or nonoccupational asthma. More recent longitudinal studies in settings with ongoing medical surveillance have provided no consistent evidence of accelerated FEV1 loss among employees exposed up to 5 ppb TDI on an 8 h time-weighted average basis.

A comparison of intrathecal opioid and intravenous analgesia for the incidence of cardiovascular, respiratory, and renal complications after abdominal aortic surgery

Major surgery evokes a stress response that can produce deleterious consequences, especially in a population at high risk for those complications. We tested the hypothesis that decreasing or eliminating one of the sources of stress by providing intense analgesia in the immediate postoperative period via application of neuraxial opioids would decrease major nonsurgical complications. Two-hundred-seventeen patients scheduled to undergo abdominal aortic surgery were randomly allocated to receive either general anesthesia alone (control) or general anesthesia combined with intrathecal opioid (1 micro g/kg sufentanil with 8 micro g/kg preservative-free morphine injected at the L4-5 interspace). Postoperative care was identical in the two groups, including patient-controlled analgesia. Each patient provided an assessment of postoperative pain using a visual analog scale. Postopera-tive complications were recorded according to criteria established a priori. The administration of intrathecal opioid provided more intense analgesia than patient-controlled analgesia during the first 24 h postoperatively (P < 0.05). There was no difference between groups for the incidence of combined major cardiovascular, respiratory, and renal complications (P > 0.05) or mortality (P > 0.05). The incidence of myocardial damage or infarction, as defined by abnormal plasma concentration of troponin I, did not differ between the two groups (P > 0.05). In patients undergoing major abdominal vascular surgery, decrease of one contributor to postoperative stress, by provision of intense analgesia for the intraoperative and initial postoperative period, via application of neuraxial opioid, does not alter the combined major cardiovascular, respiratory, and renal complication rate.

IMPLICATIONS

Provision of intense analgesia for the initial postoperative period after major abdominal vascular surgery, via the administration of neuraxial opioid, does not alter the combined incidence of major cardiovascular, respiratory, and renal complications.

Pet- and pollen-induced upper airway symptoms in farmers and in nonfarmers

The effect of farming on the risk of upper airway symptoms is not clear. In this cross-sectional, population-based study, 198 female farmers, 50 nonfarmers living on a farm, and 218 nonfarmers not living on a farm, filled in a symptom questionnaire and underwent skin-prick testing with common and agricultural allergens. In the logistic regression analysis, the latter group served as a control. Several adjustments were made, including childhood farming environment. Current farming was found to decrease the risks of pet- and pollen-induced upper airway symptoms, dose-dependently with the intensity and duration of animal husbandry. Including skin-test positivity to pets in the regression models did not affect the negative association between farming and pet-induced symptoms. In contrast, animal husbandry increased the risk of farm work-induced upper airway symptoms. Animal husbandry often induces work-related upper airway symptoms. However, the present study among female adults suggests that it may also decrease the risk of pet- and pollen-induced upper airway symptoms.

Respiratory symptoms correlating to smoking prevalence: the National Nutrition Survey and the National Life-style Survey in Japan

BACKGROUND

Although the fact that smoking habits have adverse effects on health, whether the high proportion of smokers elevates the prevalence of symptoms relating to the smoking in a community is still unknown.

METHODS

An ecologic study about whole Japan was conducted. Age-adjusted smoking prevalence was calculated using the National Nutrition Survey data from 1986 through 1995 by prefecture and sex. Age-adjusted respiratory symptom prevalence were observed using the National Life-style Survey data in 1995. Correlation among 46 and/or 43 prefectures was examined by sex.

RESULTS

There was a negative correlation between smoking prevalence and wheezing prevalence among males (r = -0.301). Among females, positive correlations were observed on the symptoms of nasal obstruction (r = 0.355), nasal discharge (r = 0.344), sore throat (r = 0.481), cough (r = 0.350), sputum (r = 0.594), wheezing (r = 0.451), palpitation (r = 0.363), dyspnea (r = 0.587), and frontal chest pain (r = 0.472).

CONCLUSIONS

Smoking prevalence was deeply related to respiratory symptoms among females in Japan.

Lung findings on high resolution CT in early ankylosing spondylitis

OBJECTIVE

Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton and pulmonary involvement is a well known feature of the disease. The aim of this study was to investigate the pulmonary high resolution computed tomography (HRCT) findings of patients with early AS. The relationship between pulmonary function tests (PFT) and HRCT findings was also determined.

SUBJECTS AND METHODS

Twenty-eight patients with AS (mean age 30.8+/-7.4 and disease duration 7.0+/-2.6) were included in the study. Patients with a disease duration of >10 years or had other pulmonary diseases were excluded. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic HRCT and PFT.

RESULTS

All chest radiographs were normal and HRCT revealed abnormalities in 18 patients. The most common abnormalities seen on HRCT were mosaic pattern (ten of 28), subpleural nodule (seven of 28) and parenchymal bands (five of 28). Seven of ten patients with mosaic pattern revealed air trapping areas on end expiratory scans. Twelve patients had abnormal PFT and all had restrictive type of involvement. Ten of these 12 patients had abnormal HRCT and the remaining two patients had normal HRCT. On the other hand, eight patients with normal PFT had abnormalities on HRCT.

CONCLUSION

Patients with early AS frequently have abnormalities on HRCT, even though they have normal PFT and chest X-ray. Small airway involvement was found as frequent as interstitial lung disease in early AS.

Classification of acute respiratory disorders of all newborns in a tertiary care center

OBJECTIVE

To assess the usefulness of current diagnostic criteria in the understanding of neonatal respiratory distress in a tertiary care hospital.

METHODS

We prospectively studied 2824 consecutive deliveries to determine the frequency of respiratory disorders of all types. We used definitions based on standard texts, with borderline cases being classified as having the disease in question.

RESULTS

Somewhat less than half of all symptomatic infants met textbook criteria for a respiratory diagnosis. Of this subset, the most common diagnosis was respiratory distress syndrome (RDS), followed by transient tachypnea of newborn (TTN), meconium aspiration syndrome (MAS), pneumonia and others. The 323 infants who fit no standard diagnosis all had self-limited conditions similar to TTN. Most (52%) were well in less than 12 hours. Those still symptomatic after 12 hours differed from the definition of TTN by having a clear chest film (38%) and/or by requiring mechanical ventilation (10%). A slight revision of the traditional diagnostic criteria allowed classification of all these cases.

CONCLUSION

More than 50% of newborns with acute respiratory symptoms do not fit textbook definitions, even broad definitions which include borderline cases. The concept of TTN should be expanded to include cases with a normal chest film. In addition, we suggest adding the category "transient respiratory insufficiency of the newbom" (TRIN) for babies ventilated briefly but not demonstrably surfactant deficient or infected. This category probably includes infants with many contributing etiologies.

[Tobacco- or alcohol-attributable inpatient treatments]

BACKGROUND AND OBJECTIVE

The aim of the study was to determine how many inpatient treatments are attributable to tobacco smoking or alcohol risk-drinking in a high tobacco smoking and alcohol per capital consumption country.

PATIENTS AND METHODS

Relative mortality risks from international studies, inpatient diagnoses in the year 1997 (n = 12,803,729), rates of tobacco smokers and alcohol risk drinkers from Germany (microcensus 1995, n = 169,403; German National Health Survey 1990/1991, n = 7450) were the data base.

RESULTS

Of all inpatient treatment cases in the year 1997, 9.9 % (n = 1,273,651) were tobacco- or alcohol-attributable. The inpatient stays took 1.5 days more than those who were not tobacco- or alcohol-attributable.

CONCLUSION

It is concluded that early detection and early intervention are needed for the decrease of the number of inpatient treatments.

Peptides of pineal gland and thymus prolong human life

OBJECTIVES AND DESIGN

Researchers of the St. Petersburg Institute of Bioregulation and Gerontology of the North-Western Branch of the Russian Academy of Medical Sciences and the Institute of Gerontology of the Ukrainian Academy of Medical Sciences (Kiev) clinically assessed the geroprotective effects of thymic (Thymalin) and pineal (Epithalamin) peptide bioregulators in 266 elderly and older persons during 6-8 years. The bioregulators were applied for the first 2-3 years of observation.

RESULTS

The obtained results convincingly showed the ability of the bioregulators to normalize the basic functions of the human organism, i.e. to improve the indices of cardiovascular, endocrine, immune and nervous systems, homeostasis and metabolism. Homeostasis restoration was accompanied by a 2.0-2.4-fold decrease in acute respiratory disease incidence, reduced incidence of the clinical manifestations of ischemic heart disease, hypertension disease, deforming osteoarthrosis and osteoporosis as compared to the control. Such a significant improvement in the health state of the peptide-treated patients correlated with decreased mortality rate during observation: 2.0-2.1-fold in the Thymalin-treated group; 1.6-1.8-fold in the Epithalamin-treated group; 2.5-fold in the patients treated with Thymalin plus Epithalamin as compared to the control. A separate group of patients was treated with Thymalin in combination with Epithalamin annually for 6 years and their mortality rate decreased 4.1 times as compared to the control.

CONCLUSIONS

The obtained data confirmed the high geroprotective efficacy of Thymalin and Epithalamin and the expediency of their application in medicine and social care for health maintenance and age-related pathology prevention in persons over 60 to prolong their active longevity.

Psychiatric distress and health-related quality of life in obesity

Health-related quality of life (HRQL) is poor in obese patients and not necessarily related to the severity of disease. In a large proportion of patients psychopathological distress is also present and its role on poor HRQL has never been quantified.

METHODS

In 207 patients entering a University-based weight-reducing programme (38 males, 169 females), a package of self-administered questionnaires was submitted to measure HRQL (Short-Form 36) and psychopathological distress [general: Symptom Check-List 90 (SCL-90); depression: Beck Depression Inventory (BDI); binge eating: Binge Eating Scale (BES)]. Several clinical and anthropometric data were also recorded.

RESULTS

HRQL, both in its physical and mental component, was significantly reduced in obesity when related to Italian population norms. SCL-90 identified psychopathological distress in 53 patients (26%), the BDI was indicative of depression in 89 cases (43%), whereas high scores of the BES were measured in 88 cases. Logistic regression analysis identified psichopathological distress as the major factor associated with poor HRQL.

CONCLUSIONS

Psychiatric disturbances significantly contribute to poorly perceived health status. Only a comprehensive treatment including a specific approach to psychiatric symptoms may be effective in improving the perceived health status of obese patients seeking treatment.

Association between exposure to workplace secondhand smoke and reported respiratory and sensory symptoms: cross-sectional study

The purpose of this work was to assess the relation between exposure to secondhand smoke (SHS) at work and reported respiratory and sensory symptoms. A cross-sectional telephone survey of 382 nonsmoking indoor workers in Victoria, Australia was used. After controlling for potential confounders, exposure to SHS at work for part of the day was significantly associated with an increased risk of wheeze (OR = 4.26), frequent cough (OR = 2.26), sore eyes (OR = 3.77), and sore throat (OR = 2.70). Among workers who had not experienced a cold in the past 4 weeks, we found strong dose-response relationships between increasing levels of exposure to SHS at work and morning cough, frequent cough, sore eyes and sore throat, and a positive relationship for wheeze. These findings provide compelling evidence that nonsmoking indoor workers are adversely affected by exposure to SHS at work and underline the importance of workplace smoke-free policies in protecting the health of workers.

Sex differences in lung vulnerability to tobacco smoking

Studies have indicated that females are more vulnerable to the deleterious effect of tobacco smoking than males. The current study aimed to investigate the associations between tobacco smoking and reported respiratory symptoms, self-rated health, and lung function by sex. In 1995-1997 65,225 subjects aged > or = 20 yrs (71% of invited) attended for screening within the Nord-Trøndelag Health Study. Among these, 10,941 subjects selected randomly or because they reported having asthma or asthma-related symptoms, participated in the Bronchial Obstruction in Nord-Trøndelag study consisting of spirometry and a personal interview. Tobacco smoking was associated with increased prevalence of respiratory symptoms, reduced lung function, and lower score on global self-rated health (SRH). Adjusted for smoking burden and lung function, females had a higher risk for reporting respiratory symptoms and lower SRH compared with males. Further, smoking burden was associated with a larger relative reduction in expiratory lung function in females than in males. Females reported more symptoms and lower self-rated health compared with males with similar smoking burden. Even if smoking in females was associated with a larger reduction in per cent predicted lung function compared with males, this does not fully explain the higher symptom prevalence in females.

[Morbidity diagnosed in the general medicine public structures in Tunisia]

The study of morbidity in general medicine is very useful in order to adapt training curricula to the reality of medical practice in the first degree. The objective of this work was to describe the morbidity charted in general medicine in Tunisia's Sousse region. It consisted of a prospective and descriptive study involving six basic health centres in Sousse and was conducted over the course of 30 randomly selected days during the year 2000. There were 4022 consultations included in the study which were described according to the SOAP plan. The coding of the charted diagnoses was carried out according to the International Classification of Primary Care (CISP). There were 98% of the consultants who were self-referred and 84% of the consultations corresponded to new cases. The consultants' sex-ratio was 0.5 in favour of females with an average age of 27 years. There were 4,597 diagnoses noted utilising 336 codes from the CISP classification system. The "Respiratory" chapter took the first place on the list (39.6%) followed by the "Circulatory" chapter. The "Top 30" list of the most often charted diagnoses totaled 72% of the consultations among which the three most frequent health problems were pharyngitis (14.4%), acute bronchitis (8.3%) and arterial hypertension (7.4%). This study demonstrates that the practice of general medicine is characterised by instinctive first solutions and versatility. The predominance of cardiovascular and respiratory illnesses illustrates the double burden of morbidity which is faced by Tunisian general medicine practitioners. The "Top 30" list should serve as basis for planning pregraduate and continuing medical training.

[Organic dust-induced allergic respiratory diseases]

Epidemiology, pathogenesis, clinical picture, diagnosis, management, and prognosis of allergic alveolitis are described in this paper.

Respiratory symptoms and occupational exposures in New Zealand plywood mill workers

OBJECTIVES

To study work exposure and respiratory symptoms in New Zealand plywood mill workers.

METHODS

Personal inhalable dust (n = 57), bacterial endotoxin (n = 20), abietic acid (n = 20), terpene (n = 20) and formaldehyde (n = 22) measurements were taken and a respiratory health questionnaire was administered to 112 plywood mill workers.

RESULTS

Twenty-six percent of the dust exposures exceeded 1 mg/m(3), however, none of the samples exceeded the legal limit of 5 mg/m(3) [geometric mean (GM) = 0.7 mg/m(3), geometric standard deviation (GSD) = 1.9]. Workers in the composer area (where broken sheets are joined together) were significantly (P < 0.01) more highly exposed. Endotoxin levels were low to moderate (GM = 23.0 EU/m(3), GSD = 2.8). Abietic acid levels ranged from 0.3 to 2.4 micro g/m(3) (GM = 0.7 micro g/m(3), GSD = 1.8) and were significantly (P < 0.05) higher for workers in the composer area of the process. Geometric mean levels of alpha-pinene, beta-pinene and Delta(3)-carene were 1.0 (GSD = 2.7), 1.5 (GSD = 2.8) and 0.1 (GSD = 1.4), respectively, and alpha-pinene and beta-pinene levels were significantly (P < 0.001) higher for workers in the 'green end' of the process, up to and including the veneer dryers. Formaldehyde levels ranged from 0.01 to 0.74 mg/m(3) [GM = 0.08 mg/m(3) (= 0.06 p.p.m.), GSD = 3.0]. Asthma symptoms were more common in plywood mill workers (20.5%, n = 112) than in the general population [12.8%, n = 415, adjusted OR (95% CI) = 1.5 (0.9-2.8)]. Asthma symptoms were associated with duration of employment and were reported to lessen or disappear during holidays. No clear association with any of the measured exposures was found, with the exception of formaldehyde, where workers with high exposure reported more asthma symptoms (36.4%) than low exposed workers [7.9%, adjusted OR (95% CI) = 4.3 (0.7-27.7)].

CONCLUSIONS

Plywood mill workers are exposed to inhalable dust, bacterial endotoxin, abietic acid, terpenes and formaldehyde, and they appear to have an increased risk of developing work-related respiratory symptoms. These symptoms may be due to formaldehyde exposure, although a potential causal role for other exposures cannot be excluded.