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Adei D, Acquah Mensah A, Agyemang-Duah W, Kwame KanKam K. Economic Cost of Occupational Injuries and Diseases among Informal Welders in Ghana. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2021.1876338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Dina Adei
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Acquah Mensah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Williams Agyemang-Duah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kenneth Kwame KanKam
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kef K, Güven S. The Prevalence of Allergic Rhinitis and Associated Risk Factors Among University Students in Anatolia. J Asthma Allergy 2020; 13:589-597. [PMID: 33204115 PMCID: PMC7667705 DOI: 10.2147/jaa.s279916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Allergic rhinitis is a common disease in Turkey. However, there are not enough studies on its prevalence. Survey-based studies conducted by experienced and qualified researchers to large populations provide information about the prevalence of allergic rhinitis and risk factors associated with it. AIM The aim of this study was to determine the prevalence of allergic rhinitis and related factors in university students in Anatolia. METHODS An extended and modified form of "The European Community Respiratory Health Survey" was conducted to university students in Turkey. The data were obtained through a face-to-face interview method. R version 4.0.2 was used for statistical analysis. Data were presented as frequency and percentage. Chi-squared test of independence was used to analyze the relationship between allergic rhinitis diagnosis and other variables. Statistically significant variables were further analyzed with multivariate logistic regression test. RESULTS Data was collected from a total of 2020 participants, but 1714 participants were eligible for multivariate analysis. The mean age of the participants was 20.71 ± 3.12 years; 42.88 (n= 735) were male, and 57.12% (n= 979) were female. While the rate of those who thought that they had nasal allergies was 23.862% (n = 409), the rate of those diagnosed by a doctor was 15.986% (n = 274). The most common allergic symptom in the participants was sneezing, and the most common triggering factor was house dust. CONCLUSION We found a high prevalence of 15.986% doctor diagnosed allergic rhinitis among university students in Anatolia. Genetic, environmental and economic factors were associated with high prevalence of allergic rhinitis.
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Affiliation(s)
- Kemal Kef
- Department of ENT, Private Kesan Hospital, Edirne, Turkey
| | - Selis Güven
- Department of ENT, Trakya University School of Medicine, Edirne, Turkey
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Lu YC, Yang CW, Lin YH, Hsueh JY, Chen JL, Yang SH, Chen YC, Chen HY. Identifying the Chinese Herbal Medicine Network and Core Formula for Allergic Rhinitis on a Real-World Database. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:5979708. [PMID: 33204289 PMCID: PMC7665915 DOI: 10.1155/2020/5979708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/28/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023]
Abstract
MATERIALS AND METHODS Patients with a primary diagnosis of AR (ICD-9-CM code: 477.9) in 2010 were included, and the National Health Insurance Research Database in Taiwan was used as the data source. Association rule mining and social network analysis were used to establish and explore the CHM network. Possible molecular pathways of the CHM network were summarized and compared with commonly used western medicine (WM) by conducting overrepresentation analysis in the Reactome pathway database. The potential proteins acted by CHMs were obtained from the CHM ingredient-protein databases, including STITCH, TCMSP, TCMID, and TCM@Taiwan. RESULTS There were 89,148 AR subjects found in 2010, and a total of 33,507 patients ever used CHM. On an average, 5.6 types of CHMs were utilized per prescription. Xin-Yi-Qing-Fei-Tang was used most frequently (25.5% of 222,279 prescriptions), while Xiao-Qing-Long-Tang with Xin-Yi-San was the most commonly prescribed CHM-CHM combination. Up to six distinctive clusters could be found among the CHM network, and core CHMs could be found for AR, such as Xiao-Qing-Long-Tang and Xin-Yi-Qing-Fei-Tang. A total of 140 molecular pathways were covered by the CHM network (2,432 ingredients from 31 kinds of CHMs), while 39 WMs covered 55 pathways. Among pathways responding to the immune system, WM mainly acted on cytokine signaling-related pathways, while CHM mostly acted on neutrophil/macrophage-related innate pathways and dendritic cell-related adaptive immunity pathways. CONCLUSION Our study demonstrated and analyzed the CHM network for AR. Core CHM for AR and possible molecular pathways were presented as well, and this information is crucial for researchers to select candidates for CHM-related studies.
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Affiliation(s)
- Yen-Chu Lu
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Wei Yang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Hsuan Lin
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ju-Yu Hsueh
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Jiun-Liang Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sien-Hung Yang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsing-Yu Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Xiong J, Yuan T, Huang Q, Wang X, Yang J, Jiang Y, Zhou X, Liao K, Xu L. The effectiveness of thunder fire moxibustion for treating allergic rhinitis: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e20711. [PMID: 32791666 PMCID: PMC7386999 DOI: 10.1097/md.0000000000020711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Allergic rhinitis (AR) is a chronic disease, resulting in severe syndromes such as sneezing, itching, nasal blockage, and rhinorrhea. The major medications treating AR cause side effects, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Thus, this systematic review and meta analysis aims to systematically evaluate the effectiveness and safety of TFM in the treatment of AR. METHODS Nine databases, including Medline, PubMed, Web of Science, Embase, the Cochrane Library, China National Knowledge Infrastructure Database (CNKI), WanFang Database (WF), Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBM) from inception to July 2020 will be searched. In addition, the grey literature and the references of all included literature will be retrieved manually. Reviewers will identify studies, extract data and assess the quality independently. The outcomes of interest include: total nasal symptom score, total non-nasal symptom score, rhinitis quality of life questionnaire, visual analog scale, Laboratory indicators: serum immunoglobulin E, immunoglobulin A, or immunoglobulin G level and adverse events. Randomized clinical trials will be collected, methodological quality will be evaluated using the Cochrane risk-of-bias assessment tool, and the level of evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis will be performed using RevMan5.3.0 software. RESULTS Because the review is ongoing, no results can be reported. CONCLUSIONS The findings from this review will provide reliable evidence for effectiveness and safety of TFM for AR. ETHICS AND DISSEMINATION Ethical approval requirements are not necessary for this review. This systematic review and meta analysis will be disseminated online and on paper to help guide the clinical practice better. PROSPERO REGISTRATION NUMBER CRD42019141113.
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Affiliation(s)
- Jun Xiong
- Department of Acupuncture and Moxibustion, The Affiliated Hospital with Jiangxi University of TCM
| | - Ting Yuan
- School of Acupuncture, Moxibustion and Tuina of Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Qiaotong Huang
- The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Xue Wang
- School of Acupuncture, Moxibustion and Tuina of Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Jun Yang
- School of Acupuncture, Moxibustion and Tuina of Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Yunfeng Jiang
- Department of Acupuncture and Moxibustion, The Affiliated Hospital with Jiangxi University of TCM
| | - Xiaohong Zhou
- Department of Acupuncture and Moxibustion, The Affiliated Hospital with Jiangxi University of TCM
| | - Kai Liao
- Department of Acupuncture and Moxibustion, The Affiliated Hospital with Jiangxi University of TCM
| | - Lingling Xu
- Department of Acupuncture and Moxibustion, The Affiliated Hospital with Jiangxi University of TCM
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Joubert AI, Geppert M, Johnson L, Mills-Goodlet R, Michelini S, Korotchenko E, Duschl A, Weiss R, Horejs-Höck J, Himly M. Mechanisms of Particles in Sensitization, Effector Function and Therapy of Allergic Disease. Front Immunol 2020; 11:1334. [PMID: 32714326 PMCID: PMC7344151 DOI: 10.3389/fimmu.2020.01334] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/26/2020] [Indexed: 12/15/2022] Open
Abstract
Humans have always been in contact with natural airborne particles from many sources including biologic particulate matter (PM) which can exhibit allergenic properties. With industrialization, anthropogenic and combustion-derived particles have become a major fraction. Currently, an ever-growing number of diverse and innovative materials containing engineered nanoparticles (NPs) are being developed with great expectations in technology and medicine. Nanomaterials have entered everyday products including cosmetics, textiles, electronics, sports equipment, as well as food, and food packaging. As part of natural evolution humans have adapted to the exposure to particulate matter, aiming to protect the individual's integrity and health. At the respiratory barrier, complications can arise, when allergic sensitization and pulmonary diseases occur in response to particle exposure. Particulate matter in the form of plant pollen, dust mites feces, animal dander, but also aerosols arising from industrial processes in occupational settings including diverse mixtures thereof can exert such effects. This review article gives an overview of the allergic immune response and addresses specifically the mechanisms of particulates in the context of allergic sensitization, effector function and therapy. In regard of the first theme (i), an overview on exposure to particulates and the functionalities of the relevant immune cells involved in allergic sensitization as well as their interactions in innate and adaptive responses are described. As relevant for human disease, we aim to outline (ii) the potential effector mechanisms that lead to the aggravation of an ongoing immune deviation (such as asthma, chronic obstructive pulmonary disease, etc.) by inhaled particulates, including NPs. Even though adverse effects can be exerted by (nano)particles, leading to allergic sensitization, and the exacerbation of allergic symptoms, promising potential has been shown for their use in (iii) therapeutic approaches of allergic disease, for example as adjuvants. Hence, allergen-specific immunotherapy (AIT) is introduced and the role of adjuvants such as alum as well as the current understanding of their mechanisms of action is reviewed. Finally, future prospects of nanomedicines in allergy treatment are described, which involve modern platform technologies combining immunomodulatory effects at several (immuno-)functional levels.
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Affiliation(s)
- Anna I Joubert
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Mark Geppert
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Litty Johnson
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Robert Mills-Goodlet
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Sara Michelini
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Evgeniia Korotchenko
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Albert Duschl
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Richard Weiss
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Jutta Horejs-Höck
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Martin Himly
- Division of Allergy and Immunology, Department of Biosciences, University of Salzburg, Salzburg, Austria
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Association Between Work Absence and Health Services Utilization and Costs Among Employed Individuals With Arthritis. J Occup Environ Med 2020; 62:e240-e244. [DOI: 10.1097/jom.0000000000001836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Scadding GK, Kariyawasam HH, Scadding G, Mirakian R, Buckley RJ, Dixon T, Durham SR, Farooque S, Jones N, Leech S, Nasser SM, Powell R, Roberts G, Rotiroti G, Simpson A, Smith H, Clark AT. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2019; 47:856-889. [PMID: 30239057 DOI: 10.1111/cea.12953] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
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Affiliation(s)
- G K Scadding
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - H H Kariyawasam
- The Royal National Throat Nose and Ear Hospital, London, UK.,UCLH NHS Foundation Trust, London, UK
| | - G Scadding
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - R Mirakian
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - R J Buckley
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - T Dixon
- Royal Liverpool and Broad green University Hospital NHS Trust, Liverpool, UK
| | - S R Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, London, UK
| | - S Farooque
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - N Jones
- The Park Hospital, Nottingham, UK
| | - S Leech
- Department of Child Health, King's College Hospital, London, UK
| | - S M Nasser
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - R Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham UK
| | - G Roberts
- Department of Child Health, University of Southampton Hospital, Southampton, UK
| | - G Rotiroti
- The Royal National Throat Nose and Ear Hospital, London, UK
| | - A Simpson
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, UK
| | - H Smith
- Division of Primary Care and Public Health, University of Sussex, Brighton, UK
| | - A T Clark
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Tziraki-Segal C, De Luca V, Santana S, Romano R, Tramontano G, Scattola P, Celata C, Gelmi G, Ponce Márquez S, Lopez-Samaniego L, Zavagli V, Halkoaho A, Grimes C, Tomás MT, Fernandes B, Calzà L, Speranza P, Coppola L, Jager-Wittenaar H, O'Caoimh R, Pietilä AM, Carriazo AM, Apostolo J, Iaccarino G, Liotta G, Tramontano D, Molloy W, Triassi M, Viggiani V, Illario M. Creating a Culture of Health in Planning and Implementing Innovative Strategies Addressing Non-communicable Chronic Diseases. FRONTIERS IN SOCIOLOGY 2019; 4:9. [PMID: 33869336 PMCID: PMC8022497 DOI: 10.3389/fsoc.2019.00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/01/2019] [Indexed: 06/12/2023]
Abstract
Ongoing demographic changes are challenging health systems worldwide especially in relation to increasing longevity and the resultant rise of non-communicable diseases (NCDs). To meet these challenges, a paradigm shift to a more proactive approach to health promotion, and maintenance is needed. This new paradigm focuses on creating and implementing an ecological model of Culture of Health. The conceptualization of the Culture of Health is defined as one where good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities where citizens have the opportunity to make choices and be co-producers of healthy lifestyles. Based on Antonovsky's Salutogenesis model which asserts that the experience of health moves along a continuum across the lifespan, we will identify the key drivers for achieving a Culture of Health. These include mindset/expectations, sense of community, and civic engagement. The present article discusses these drivers and identifies areas where policy and research actions are needed to advance positive change on population health and well-being. We highlight empirical evidence of drivers within the EU guided by the activities within the thematic Action Groups of the European Innovation Partnership on Active and Healthy Aging (EIP on AHA), focusing on Lifespan Health Promotion and Prevention of Age-Related Frailty and Disease (A3 Action Group). We will specifically focus on the effect of Culture on Health, highlighting cross-cutting drivers across domains such as innovations at the individual and community level, and in synergies with business, policy, and research entities. We will present examples of drivers for creating a Culture of Health, the barriers, the remaining gaps, and areas of future research to achieve an inclusive and sustainable asset-based community.
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Affiliation(s)
- Chariklia Tziraki-Segal
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV- Community Clubs for Elders, Jerusalem, Israel
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | - Rosa Romano
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Paola Scattola
- Health Protection Agency of the Metropolitan City of Milan, Milan, Italy
| | - Corrado Celata
- Health Promotion, Screening and Prevention Unit, Milan, Italy
| | - Giusi Gelmi
- Health Protection Agency of the Metropolitan City of Milan, Milan, Italy
| | - Sara Ponce Márquez
- International Research Projects Office (IRPO), Universidad de Deusto, Bilbao, Spain
| | - Luz Lopez-Samaniego
- Progress and Health Foundation, Regional Ministry of Health of Andalucía, Seville, Spain
| | | | - Arja Halkoaho
- School of Health Care and Social Services Education and R&D, Tampere University of Applied Sciences, Tampere, Finland
| | - Corrina Grimes
- Public Health Agency of Northern Ireland, Belfast, United Kingdom
| | - Maria Teresa Tomás
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Beatriz Fernandes
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Laura Calzà
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Patrizia Speranza
- General Affairs Unit, Federico II University Hospital, Naples, Italy
| | - Liliana Coppola
- Health Promotion, Screening and Prevention Unit, Milan, Italy
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Rónán O'Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Anna-Maija Pietilä
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | | | - Joao Apostolo
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Guido Iaccarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - William Molloy
- Clinical Gerontology and Rehabilitation Centre, Gerontology and Rehabilitation School of Medicine, University College of Cork, Cork, Ireland
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | | | - Maddalena Illario
- Health Innovation Division, General Directorate for Health, Naples, Italy
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On-the-Job Productivity Losses Among Employees With Health Problems: The Role of Work Accommodations. J Occup Environ Med 2018; 59:885-893. [PMID: 28742765 DOI: 10.1097/jom.0000000000001094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Debates about the productivity impact of work accommodations typically focus on employment and labor force participation outcomes. This study considers whether accommodations mediate on-the-job productivity losses among employees who report health problems. METHODS The study uses ordered logistic regression to predict employees' self-reported productivity losses as a function of health problems and experiences with needed work accommodations. RESULTS On average, the odds that an employee who did not get a needed accommodation reported higher levels of lost productivity are 5.11 times the odds for an employee who got a needed accommodation. CONCLUSIONS Although health problems make it difficult for many employees to perform well on the job, accommodations could reduce productivity losses in some cases. Nonetheless, more research on the impact of specific kinds of accommodations for different chronic conditions is warranted.
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López-Arquillos A, Rubio-Romero JC, López-Arquillos C. Workers' medication as occupational risk at construction site with formworks. Work 2018; 57:389-395. [PMID: 28800352 DOI: 10.3233/wor-172573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Accidents in the construction sector are a cause for concern. The influence of many different factors in construction accidents have been studied (age, company size, length of service, deviation, drugs or alcohol consumption, etc.) but the influence of medicinal substances in specific construction activities has not been evaluated until now. OBJECTIVE The aim of the research presented here is to identify the effect of different medicinal substances on the occupational risk levels of construction activities with formworks. METHODS An expert panel was selected in order to quantify the individual risk of each medication for each individual construction activity. RESULTS Results showed that narcotics, antipsychotics, and hypnotics had the highest risk values, and the use of cranes and cutting materials were considered the most dangerous activities for a medicated worker. CONCLUSIONS Data obtained in this research can help reduce the negative effects of the substances studied on the occupational safety of construction workers. A better knowledge of the risk levels according to the current capabilities of workers under the effects of medication is a powerful tool in planning safer construction activities.
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Sami AS, Scadding GK, Howarth P. A UK community-based survey on the prevalence of rhinosinusitis. Clin Otolaryngol 2017; 43:76-89. [PMID: 28498627 DOI: 10.1111/coa.12902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES There is limited information about the prevalence of rhinosinusitis in the UK community. This study aimed to identify its prevalence and investigate any association with demographic variables. The secondary aims were to determine the degree of impairment, impact on quality of life and any costs incurred by patients. DESIGN We used a modified version (MSNOT-20) of a quality-of-life instrument, the sinonasal outcome test-20 (SNOT-20), in a small and successful pilot project. It was then used in a community-based survey and a second phase 6 months later to test repeatability. Nasal examination and comparison of its quality-of-life section with other health-related quality-of-life tools occurred in the second phase. SETTING AND PARTICIPANTS The questionnaire was administered by post to 2000 Farnborough (UK) residents, selected through stratified randomisation. The relation of an abnormal MSNOT-20 score with hay fever, asthma, smoking, food allergy, work productivity and social limitation was also analysed. MAIN OUTCOME AND RESULTS The response rate was 79.8%; over thirty per cent of the community suffer from upper respiratory tract symptoms with impact on multiple domains of quality of life including emotional, financial costs and loss of days at work. The MSNOT-20 provided a more sensitive assessment of health-related quality of life than the Short Form 36 questionnaire. CONCLUSION Rhinosinusitis is prevalent in the Farnborough community and associated with significant morbidity and impairment on quality of life. The MSNOT-20 is a useful disease-specific quality-of-life tool in rhinosinusitis.
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Affiliation(s)
- A S Sami
- ENT and Allergy Department, University Hospital Lewisham, London, UK
| | - G K Scadding
- ENT and Allergy Department, Royal National Throat, Nose and Ear Hospital, London, UK
| | - P Howarth
- Allergy and Immunology Department, University Hospital Southampton, UK
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12
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Kappen JH, Durham SR, Veen HI', Shamji MH. Applications and mechanisms of immunotherapy in allergic rhinitis and asthma. Ther Adv Respir Dis 2016; 11:73-86. [PMID: 27678500 DOI: 10.1177/1753465816669662] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Clinical and immunologic tolerance are hallmarks of successful allergen immunotherapy (AIT). Clinical benefits such as reduced symptoms, pharmacotherapy intake and improvement of quality of life persist following cessation of treatment. Successful AIT is associated with suppression of allergic inflammatory cells such as mast cells, eosinophils and basophils in target organs. Furthermore, AIT down-regulates type 2 innate lymphoid cells and allergen-specific type 2 T-helper (Th2) cells. The immunologic tolerant state following AIT is associated with the induction of distinct phenotypes of regulatory T-cells (T-regs) including interleukin (IL)-10-, IL-35- and transforming growth factor (TGF)-β- producing T-regs and FoxP3+ T-regs. B-cell responses, including the induction of IL-10+ regulatory B-cells (B-regs) and the production of IgG4-associated blocking antibodies are also induced following successful AIT. These events are associated with the suppression of antigen-specific Th2 responses and delayed immune deviation in favour of Th1 type responses. Insight into the mechanisms of AIT has allowed identification of novel biomarkers with potential to predict the clinical response to AIT and also novel therapeutic strategies for more effective and safer AIT.
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Affiliation(s)
- Jasper H Kappen
- Department of Pulmonology, STZ centre of excellence for Asthma & COPD, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Stephen R Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK
| | - Hans In 't Veen
- Department of Pulmonology, STZ centre of excellence for Asthma & COPD, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Mohamed H Shamji
- Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London SW7 2AZ, UK
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Central nervous system effects of the second-generation antihistamines marketed in Japan--review of inter-drug differences using the proportional impairment ratio (PIR)-. PLoS One 2014; 9:e114336. [PMID: 25501360 PMCID: PMC4264760 DOI: 10.1371/journal.pone.0114336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 11/08/2014] [Indexed: 11/19/2022] Open
Abstract
Background Second-generation antihistamines (AHs) have, in general, fewer sedative effects than the first-generation. However, important inter-drug differences remain in the degree of cognitive and/or psychomotor impairment. The extent to which a particular compound causes disruption can be conveniently compared, to all other AHs, using the Proportional Impairment Ratio (PIR). Although the PIR can differentiate the relative impairment caused by individual drugs, there is no indication of the reliability of the ratios obtained. Objective To calculate the PIRs –together with 95% confidence intervals (CIs), as an index of reliability– and compare AHs currently, or soon to be, available in Japan, with respect to their intrinsic capacity to cause impairment. Methods Results from studies of cetirizine, desloratadine, ebastine, fexofenadine, levocetirizine, loratadine, mequitazine, and olopatadine were included in the PIR calculations. All data utilised came from crossover studies in healthy volunteers which were randomised and placebo and positive-internal controlled. Existing databases from studies reporting the sedative effects of AHs on objective (speed, accuracy, memory) and subjective (feeling) psychometrics were augmented, via results from suitable studies published after the previous reviews. The null value for a PIR was one. Results A total of 45 studies were finally included for this review. Of the AHs assessed, fexofenadine, ebastine, and levocetirizine showed a PIR for objective tests of 0. However, only fexofenadine (PIR = 0.49) had an upper limit of the 95% CI of less than 1. Fexofenadine, levocetirizine, desloratadine, olopatadine, loratadine, and mequitazine all had a PIR for subjective ratings of 0, but the upper limits of the 95% CIs were all in excess of 1, although fexofenadine (PIR = 2.57) was the lowest. Conclusions The results show that there are differences between second-generation AHs in the extent of sedation produced. However, subjective ratings indicate that patients may not necessarily be aware of this.
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Shamji MH. Mechanisms of Allergen-Specific Sublingual Immunotherapy and the Use of Biological Markers in Allergic Rhinitis. CURRENT TREATMENT OPTIONS IN ALLERGY 2014. [DOI: 10.1007/s40521-013-0009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Occupational allergic diseases in kitchen and health care workers: an underestimated health issue. BIOMED RESEARCH INTERNATIONAL 2013; 2013:285420. [PMID: 24319680 PMCID: PMC3844187 DOI: 10.1155/2013/285420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study evaluated the frequencies of allergic symptoms and rate of upper respiratory infections during the past year in the general population, kitchen workers (KW) and health care workers (HCW). METHODS The European Community Respiratory Health Survey (ECRHS) was used to inquire retrospectively about asthma and asthma-like symptoms and the number of treatments required for previous upper respiratory tract infections (URTI: acute pharyngitis, acute sinusitis, etc.) during the past year for health care workers, kitchen workers, and members of the general population. Adjusted odds ratios by gender, age, and smoking status were calculated. RESULTS 579 subjects (186 from the general population, 205 KW, and 188 HCW; 263 females, 316 males) participated in the study. Noninfectious (allergic) rhinitis was significantly higher in the HCW and KW groups than in the general population (P < 0.001). Cumulative asthma was significantly higher only in the HCW group (P < 0.05). In addition, the HCW and KW groups had significantly higher risks of ≥2/year URTI (OR: 1.59, 95% CI: 1.07-2.38 versus OR: 1.57, 95% CI: 1.05-2.38) than the general population. CONCLUSION Occupational allergic respiratory diseases are an important and growing health issue. Health care providers should become familiar with workplace environments and environmental causes of occupational rhinitis and asthma.
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Yalcin AD, Basaran S, Bisgin A, Polat HH, Gorczynski RM. Pollen aero allergens and the climate in Mediterranean region and allergen sensitivity in allergic rhinoconjunctivitis and allergic asthma patients. Med Sci Monit 2013; 19:102-10. [PMID: 23396359 PMCID: PMC3629014 DOI: 10.12659/msm.883762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We evaluated the profiles of allergic rhino-conjunctivitis and asthma patients annually in Antalya, a Mediterranean coastal city in Turkey. MATERIAL AND METHODS We evaluated patients' allergic clinical status, and recorded the climate and pollens in the city center air, investigating any correlation between pollination, climatic conditions and allergic disorders. The meteorological conditions and the pollen count/cm2 during every month of the year and the concordance of this with the patient's clinical status were evaluated. RESULTS SPT positivity for plantago lanceolata, aspergillus fumigatus and d. pteronyssinus was significant in patients younger than 40 years old. Pollination levels are consistent from March 2010 to February 2011. In Antalya, high levels occur mostly from April to June, thus we performed skin prick tests mostly in May/June (~30%). During these months meteorological conditions of the city were windy with low humidity, without rain, and lukewarm temperatures, all of which contribute to high-risk conditions for seasonal allergies. CONCLUSIONS The major allergen between April and June was derived from Graminea; between February and March was Cupressus spp; and between March and June was Pinus spp. These results suggest that the pollination is correlated with allergic conditions and thus SPT might be best performed according to the pollen count.
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Affiliation(s)
- Arzu Didem Yalcin
- Allergy and Clinical Immunology Unit, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey.
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Abstract
Allergic rhinitis is a global health problem that causes major illness and disability worldwide. Although nasal and nonnasal symptoms are directly attributable to inflammation in the upper respiratory tract, individuals also experience generalized symptoms that include fatigue, mood changes, depression, anxiety and impairments of work and school performance, and cognitive function. Health-related quality of life focuses on patients’ perceptions of their disease and measures impairments that have a significant impact on the patient. The burden of disease, as the patient perceives it, forms the basic motivation to seek medical aid or to undergo therapy. Adherence to therapy requires changes in health, perceived by patients as relevant and outweighing eventual disadvantages of intervention. Because so many factors are involved in health-related quality of life, there are multiple ways in which it can be measured. A variety of validated and standardized questionnaires have been developed including assessments of school performance, work performance, productivity, and other parameters that quantify the impact of allergic rhinitis and its treatment on quality of life. The aim of this review is to highlight the impact of allergic rhinitis on the quality of life and to analyze the most commonly used health-related quality of life instruments.
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Pawankar R, Mori S, Ozu C, Kimura S. Overview on the pathomechanisms of allergic rhinitis. Asia Pac Allergy 2011; 1:157-67. [PMID: 22053313 PMCID: PMC3206239 DOI: 10.5415/apallergy.2011.1.3.157] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 09/25/2011] [Indexed: 12/21/2022] Open
Abstract
Allergic rhinitis a chronic inflammatory disease of the upper airways that has a major impact on the quality of life of patients and is a socio-economic burden. Understanding the underlying immune mechanisms is central to developing better and more targeted therapies. The inflammatory response in the nasal mucosa includes an immediate IgE-mediated mast cell response as well as a latephase response characterized by recruitment of eosinophils, basophils, and T cells expressing Th2 cytokines including interleukin (IL)-4, a switch factor for IgE synthesis, and IL-5, an eosinophil growth factor and on-going allergic inflammation. Recent advances have suggested new pathways like local synthesis of IgE, the IgE-IgE receptor mast cell cascade in on-going allergic inflammation and the epithelial expression of cytokines that regulate Th2 cytokine responses (i.e., thymic stromal lymphopoietin, IL-25, and IL-33). In this review, we briefly review the conventional pathways in the pathophysiology of allergic rhinitis and then elaborate on the recent advances in the pathophysiology of allergic rhinitis. An improved understanding of the immune mechanisms of allergic rhinitis can provide a better insight on novel therapeutic targets.
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Kubo N, Senda M, Ohsumi Y, Sakamoto S, Matsumoto K, Tashiro M, Okamura N, Yanai K. Brain histamine H1 receptor occupancy of loratadine measured by positron emission topography: comparison of H1 receptor occupancy and proportional impairment ratio. Hum Psychopharmacol 2011; 26:133-9. [PMID: 21433074 DOI: 10.1002/hup.1184] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS We have evaluated the sedative properties of H1-antihistamines by using positron emission tomography (PET) and ¹¹C-doxepin. The purpose of the present study was to measure histamine H1 receptor occupancy (H1RO) of loratadine 10 mg in patients with allergic rhinitis and to compare this occupancy with that of d-chlorpheniramine 2 mg, a first-generation antihistamine. We also compared our PET findings with the proportional impairment ratio reported by McDonald et al. METHODS The H1RO of loratadine 10 mg and d-chlorpheniramine 2 mg were evaluated in human brains in a double-blind and crossover design using ¹¹C-doxepin PET. Eleven young male patients with allergic rhinitis were examined by PET following oral single administration of loratadine 10 mg and d-chlorpheniramine 2 mg. RESULTS Loratadine 10 mg occupied 11.7 ± 19.5% of histamine H1 receptors in the cortex, whereas d-chlorpheniramine 2 mg occupied 53.0 ± 33.2% in the same area, suggesting a non-sedating property of loratadine at a dose of 10 mg. The H1RO values of loratadine and d-chlorpheniramine as well as those of previous studies were found to be significantly proportional to the proportional impairment ratio (r = 0.899). CONCLUSION Measurement of H1RO is a sensitive and absolute method to characterize the non-sedating property of drugs with H1 antagonistic activity.
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Affiliation(s)
- Nobuo Kubo
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan
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Bencova A, Rozborilova E, Antosova M. Bidirectional link between upper and lower airways in patients with allergic rhinitis. Eur J Med Res 2010; 14 Suppl 4:18-20. [PMID: 20156718 PMCID: PMC3521381 DOI: 10.1186/2047-783x-14-s4-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Exhaled nitric oxide has been proposed as a noninvasive marker of eosinophilic airway inflammation in lower airways. The aim of the study was to investigate the impact of atopy, pollen exposure, and pharmacological treatment on NO production in lower airways of patients with allergic rhinitis. SUBJECTS AND METHODS Measurements of exhaled NO were performed in 79 non-asthmatic subjects with seasonal allergic rhinitis outside and in pollen season, before and after pharmacological treatment, and in 54 healthy controls. RESULTS Patients with allergic rhinitis had significantly higher levels of exhaled NO (18.3 +/-11.0 ppb) than healthy controls (13.0 +/-7.2 ppb) measured outside the pollen season (P=;0.0024). Increased exhaled NO levels were also found in patients with allergic rhinitis in the pollen season (27.0 +/-20.0 ppb) compared with the levels outside pollen season (P=0.0001), before pharmacological treatment. In rhinitic patients treated by nasal corticosteroids and antihistamines in the pollen season, the levels of exhaled NO were significantly lower (17.0 +/-16.4 ppb; P=0.045) than those before treatment. No difference was found in NO levels in rhinitic patients outside and in pollen season after pharmacological treatment. CONCLUSIONS This study has shown the presence of eosinophilic airway inflammation in the lower airways in allergic rhinitis patients. A significant increase of exhaled NO after pollen exposure in rhinitic patients underlies the impact of inflammation on the upper respiratory tract. A bidirectional link between upper and lower airways is confirmed by a decrease in exhaled NO in the pollen season, almost to the starting levels, after application of topic corticosteroids and antihistamines.
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Affiliation(s)
- A Bencova
- Clinic of Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine, Comenius University, Martin 03601, Slovakia.
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22
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Church MK, Maurer M, Simons FER, Bindslev-Jensen C, van Cauwenberge P, Bousquet J, Holgate ST, Zuberbier T. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy 2010; 65:459-66. [PMID: 20146728 DOI: 10.1111/j.1398-9995.2009.02325.x] [Citation(s) in RCA: 260] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND First-generation H(1)-antihistamines obtained without prescription are the most frequent form of self-medication for allergic diseases, coughs and colds and insomnia even though they have potentially dangerous unwanted effects which are not recognized by the general public. AIMS To increase consumer protection by bringing to the attention of regulatory authorities, physicians and the general public the potential dangers of the indiscriminate use first-generation H(1)-antihistamines purchased over-the counter in the absence of appropriate medical supervision. METHODS A GA(2)LEN (Global Allergy and Asthma European Network) task force assessed the unwanted side-effects and potential dangers of first-generation H1-antihistamines by reviewing the literature (Medline and Embase) and performing a media audit of US coverage from 1996 to 2008 of accidents and fatal adverse events in which these drugs were implicated. RESULTS First-generation H(1)-antihistamines, all of which are sedating, are generally regarded as safe by laypersons and healthcare professionals because of their long-standing use. However, they reduce rapid eye movement (REM)-sleep, impair learning and reduce work efficiency. They are implicated in civil aviation, motor vehicle and boating accidents, deaths as a result of accidental or intentional overdosing in infants and young children and suicide in teenagers and adults. Some exhibit cardiotoxicity in overdose. CONCLUSIONS This review raises the issue of better consumer protection by recommending that older first-generation H(1)-antihistamines should no longer be available over-the-counter as prescription- free drugs for self-medication of allergic and other diseases now that newer second- generation nonsedating H(1)-antihistamines with superior risk/benefit ratios are widely available at competitive prices.
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Affiliation(s)
- M K Church
- Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Germany
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Alsowaidi S, Abdulle A, Shehab A, Zuberbier T, Bernsen R. Allergic rhinitis: prevalence and possible risk factors in a Gulf Arab population. Allergy 2010; 65:208-12. [PMID: 19735489 DOI: 10.1111/j.1398-9995.2009.02123.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological studies mainly from Europe, the USA and Asia indicate a high prevalence of allergic rhinitis (AR) in modern societies. However, little is known about AR among the heterogeneous population of the United Arab Emirates (UAE). OBJECTIVES To estimate the prevalence of AR and its independent risk factors in Al-Ain City, UAE. METHODS We used a validated, self-administered questionnaire modified from the ISAAC study to collect data from a two stage randomly selected sample of 10 000 school children. Overall, 7550 subjects (aged 13 years and above, siblings, and their parents) responded. We assessed the prevalence of AR (both crude and standardized prevalence of previous 12 months) as well as the independent relationship of AR with age, gender, education, nationality and family history by means of logistic regression. RESULTS The response rate was 76%. A total of 6543 subjects (median age 30 years) were included in the final analysis. Self-reported prevalence of AR (having symptoms in the past 12 months) was 36%, while adjusted values for sex/age yielded a prevalence of 32%. Regression analysis revealed that AR was independently associated with family history, Arab origin, younger age, female gender and higher education. CONCLUSIONS The relatively high prevalence of AR found in this study may be attributable to modernization and genetic factors. Further studies on the impact of rapid environmental and cultural changes on AR in the Arab countries are needed and currently planned in conjunction with GA(2)LEN (Global Allergy and Asthma European Network).
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Affiliation(s)
- S Alsowaidi
- Department of Internal Medicine, UAE University, Al-Ain, United Arab Emirates
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Kim YH, Kim KS. Diagnosis and treatment of allergic rhinitis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2010. [DOI: 10.5124/jkma.2010.53.9.780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Su Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Emanuel IA, Parker MJ, Traub O. Undertreatment of allergy: exploring the utility of sublingual immunotherapy. Otolaryngol Head Neck Surg 2009; 140:615-21. [PMID: 19393398 DOI: 10.1016/j.otohns.2009.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 01/06/2009] [Accepted: 01/15/2009] [Indexed: 10/20/2022]
Abstract
Allergic syndromes are highly prevalent and are comprised of a wide variety of clinical problems, including rhinitis, conjunctivitis, atopic dermatitis and urticaria, asthma, and food allergies. Numerous studies have shown that allergic syndromes are both underdiagnosed and undertreated. This is related to many factors, including trivialization of allergic conditions by physicians and patients, failure to adhere to diagnostic and treatment guidelines, and dissatisfaction with conventional pharmacologic treatments. Immunotherapy involves the administration of allergen extracts in an attempt to induce immunologic tolerance and has been used for the treatment of allergic syndromes and the prevention of long-term complications. Conventional subcutaneous immunotherapy is effective but is also associated with a risk of serious adverse events, requires administration by a trained health care professional, and is contraindicated in certain populations. By contrast, sublingual immunotherapy has been used extensively in Europe and possesses most of the benefits of subcutaneous immunotherapy along with increased safety, tolerability, and convenience. This narrative review explores data from selected clinical studies and concludes that sublingual immunotherapy may be well suited to fill the gap posed by the undertreatment of allergic syndromes in the United States.
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Affiliation(s)
- Ivor A Emanuel
- Department of Otolaryngology, University of California San Francisco, San Francisco, CA, USA.
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Moscato G, Vandenplas O, Van Wijk RG, Malo JL, Perfetti L, Quirce S, Walusiak J, Castano R, Pala G, Gautrin D, De Groot H, Folletti I, Yacoub MR, Siracusa A. EAACI position paper on occupational rhinitis. Respir Res 2009; 10:16. [PMID: 19257881 PMCID: PMC2654869 DOI: 10.1186/1465-9921-10-16] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 03/03/2009] [Indexed: 01/15/2023] Open
Abstract
The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.
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Affiliation(s)
- Gianna Moscato
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Olivier Vandenplas
- Service de Pneumologie, Cliniques de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | | | - Jean-Luc Malo
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Luca Perfetti
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | | | - Jolanta Walusiak
- Department of Occupational Diseases, Institute of Occupational Medicine, Lodz, Poland
| | - Roberto Castano
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Gianni Pala
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Denyse Gautrin
- Center for Asthma in the Workplace, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche-Pneumologie, Montreal, Quebec, Canada
| | - Hans De Groot
- Department of Allergology, Erasmus MC, Rotterdam, The Netherlands
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Mona Rita Yacoub
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy
| | - Andrea Siracusa
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
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Schultz AB, Chen CY, Edington DW. The cost and impact of health conditions on presenteeism to employers: a review of the literature. PHARMACOECONOMICS 2009; 27:365-378. [PMID: 19586075 DOI: 10.2165/00019053-200927050-00002] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Employers are becoming concerned with the costs of presenteeism in addition to the healthcare and absenteeism costs that have traditionally been explored. But what is the true impact of health conditions in terms of on-the-job productivity? This article examines the literature to assess the magnitude of presenteeism costs relative to total costs of a variety of health conditions. Searches of MEDLINE, CINAHL and PubMed were conducted in July 2008, with no starting date limitation, using 'presenteeism' or 'work limitations' as keywords. Publications on a variety of health conditions were located and included if they assessed the total healthcare and productivity cost of one or more health conditions. Literature on presenteeism has investigated its link with a large number of health conditions ranging from allergies to irritable bowel syndrome. The cost of presenteeism relative to the total cost varies by condition. In some cases (such as allergies or migraine headaches), the cost of presenteeism is much larger than the direct healthcare cost, while in other cases (such as hypertension or cancer), healthcare is the larger component. Many more studies have examined the impact of pharmaceutical treatment on certain medical conditions and the resulting improvement in on-the-job productivity. Based on the research reviewed here, health conditions are associated with on-the-job productivity losses and presenteeism is a major component of the total employer cost of those conditions, although the exact dollar amount cannot be determined at this time. Interventions, including the appropriate use of pharmaceutical agents, may be helpful in improving the productivity of employees with certain conditions.
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Affiliation(s)
- Alyssa B Schultz
- University of Michigan Health Management Research Center, Ann Arbor, Michigan 48104-1689, USA
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Alavinia SM, Molenaar D, Burdorf A. Productivity loss in the workforce: associations with health, work demands, and individual characteristics. Am J Ind Med 2009; 52:49-56. [PMID: 18942667 DOI: 10.1002/ajim.20648] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Decreased productivity at work is an important consequence of the presence of health problems at work. METHODS The study population consisted of 2,252 workers in 24 different companies in The Netherlands in 2005-2006 (response 56%). Self-reported loss of productivity on the previous workday was measured on a 10-point numerical rating scale by the Quantity and Quality method. Logistic regression analysis was used to explore the associations between work demands, health problems, individual characteristics, and lifestyle factors with the occurrence of productivity loss. RESULTS About 45% of the workers reported some degree of productivity loss on the previous workday, with an average loss of 11%. Moderate and severe functional limitations due to health problems (OR = 1.28 and 1.63, respectively) and lack of control at work (OR = 1.36) were associated with productivity loss at work with population attributable fractions of 7%, 6%, and 16%, respectively. CONCLUSION Productivity losses at work frequently occur due to health problems and subsequent impairments, and lack of control over the pace and planning of work. This will substantially contribute to indirect costs of health problems among workers.
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Affiliation(s)
- Seyed Mohammad Alavinia
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Lee YM, Jung MH. [Economic impact according to health problems of workers]. ACTA ACUST UNITED AC 2008; 38:612-9. [PMID: 18753813 DOI: 10.4040/jkan.2008.38.4.612] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to examine health problems and to estimate economic impact based on health problems of workers. METHODS The subjects of this study consisted of 301 workers who received a group occupational health service. Data was collected from February 1 to March 30, 2006. The questionnaire contained questions based on general characteristics and the Stanford Presenteeism Scale. Data was analyzed with descriptive statistics, t-test using SPSS program. RESULTS The primary health conditions as reported by workers were ranked in order as stomach or bowel disorders, back or neck disorders, or liver function disorders. The reason of absenteeism per worker was ranked in order as asthma, or a breathing disorder. The reason of presenteeism was ranked in order as asthma, insomnia or a sleep disorder. The cost of the total economic impact on the workplace in this study was 8,851,838 won. The cost of absenteeism per worker was 8,390 won. The cost of presenteeism per worker was 941,732 won. CONCLUSION Presenteeism had a strong correlation to health conditions of the workers. Therefore, improving the work conditions of the workers is very important. If employers improve the health condition of workers, they will benefit from improved productivity in their business.
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Affiliation(s)
- Young-Mi Lee
- Department of Nursing, Osaka University, Osaka, Japan.
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Clinical characteristics of allergic rhinitis according to allergic rhinitis and its impact on asthma guidelines. Clin Exp Otorhinolaryngol 2008; 1:196-200. [PMID: 19434267 PMCID: PMC2671762 DOI: 10.3342/ceo.2008.1.4.196] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 09/18/2008] [Indexed: 11/15/2022] Open
Abstract
Objectives The Allergic rhinitis and its impact on asthma (ARIA) guidelines were suggested for use to classify allergic rhinitis (AR). However, few studies have been performed in Asians. The objective of this study is to identify the clinical characteristics of AR in Korean patients according to the ARIA guidelines. Methods For the study, 610 patients who had been diagnosed with allergic rhinitis at Seoul National University Bundang Hospital and 545 patients who had been diagnosed with allergic rhinitis at 3 local clinics were included. All the patients were categorized into 4 groups, such as the mild intermittent, mild persistent, moderate-severe intermittent and moderate-severe persistent groups. The patients were given a questionnaire on allergic rhinitis-related symptoms and they underwent blood tests, including the blood eosinophil count and the serum total IgE level. Results The most prevalent type was the moderate-severe persistent group (34.7%), and the moderate-severe intermittent group (17.1%) was the rarest. There were significant differences among the 4 groups for olfaction (P<0.001), self-awareness of rhinitis (P=0.013), a previous history of AR (P<0.001), self-awareness of asthma (P=0.001) and allergic conjunctivitis (P<0.001). On the allergy laboratory tests, there was a significant difference between the groups for the eosinophi count (P=0.004). The number of blood eosinophil was more in the persistent groups than in the intermittent groups. Conclusion According to the ARIA guidelines, the moderate-severe persistent group was the most prevalent for Korean patients. Blood eosinophilia and olfactory dysfunction were the most severe in the moderate-severe persistent group.
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Goetzel RZ, Ozminkowski RJ, Bowen J, Tabrizi MJ. Employer integration of health promotion and health protection programs. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2008. [DOI: 10.1108/17538350810893900] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, van Weel C, Agache I, Aït-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, Kuna P, Le LTT, Lemiere C, Li J, Lockey RF, Mavale-Manuel S, Meltzer EO, Mohammad Y, Mullol J, Naclerio R, O'Hehir RE, Ohta K, Ouedraogo S, Palkonen S, Papadopoulos N, Passalacqua G, Pawankar R, Popov TA, Rabe KF, Rosado-Pinto J, Scadding GK, Simons FER, Toskala E, Valovirta E, van Cauwenberge P, Wang DY, Wickman M, Yawn BP, Yorgancioglu A, Yusuf OM, Zar H, Annesi-Maesano I, Bateman ED, Ben Kheder A, Boakye DA, Bouchard J, Burney P, Busse WW, Chan-Yeung M, Chavannes NH, Chuchalin A, Dolen WK, Emuzyte R, Grouse L, Humbert M, Jackson C, Johnston SL, Keith PK, Kemp JP, Klossek JM, Larenas-Linnemann D, Lipworth B, Malo JL, Marshall GD, Naspitz C, Nekam K, Niggemann B, Nizankowska-Mogilnicka E, Okamoto Y, Orru MP, Potter P, Price D, Stoloff SW, Vandenplas O, Viegi G, Williams D. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8-160. [PMID: 18331513 DOI: 10.1111/j.1398-9995.2007.01620.x] [Citation(s) in RCA: 3035] [Impact Index Per Article: 189.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adolescent
- Asthma/epidemiology
- Asthma/etiology
- Asthma/therapy
- Child
- Global Health
- Humans
- Prevalence
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/therapy
- Risk Factors
- World Health Organization
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Hôpital Arnaud de Villeneuve, Montpellier, France
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Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, Ryan D, Walker SM, Clark AT, Dixon TA, Jolles SRA, Siddique N, Cullinan P, Howarth PH, Nasser SM. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy 2008; 38:19-42. [PMID: 18081563 PMCID: PMC7162111 DOI: 10.1111/j.1365-2222.2007.02888.x] [Citation(s) in RCA: 245] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co-morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.
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Affiliation(s)
- G. K. Scadding
- The Royal National Throat Nose & Ear Hospital, Gray's Inn Road, London, UK
| | - S. R. Durham
- Department of Upper Respiratory Medicine, Imperial College NHLI, Guy Scadding Building, Royal Brompton Campus, London, UK
| | - R. Mirakian
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
| | - N. S. Jones
- Department of Otorhinolaryngology‐Head & Neck Surgery, Queens Medical Centre, Nottingham, UK
| | - S. C. Leech
- Department of Child Health, Kings College Hospital, Denmark Hill, London, UK
| | - S. Farooque
- Department of Asthma, Allergy & Respiratory Medicine, Guy's Hospital, London, UK
| | - D. Ryan
- Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK
| | - S. M. Walker
- Education For Health, The Athenaeum, Warwick, UK
| | - A. T. Clark
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
| | - T. A. Dixon
- Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - S. R. A. Jolles
- Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK
| | - N. Siddique
- Department of respiratory medicine, Southampton General Hospital, Southampton, UK
| | - P. Cullinan
- Department of Occupational and Environmental Medicine, Imperial College, London, UK and
| | | | - S. M. Nasser
- Cambridge University NHS Foundation Trust, Allergy Clinic, Cambridge, UK
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Maurer M, Zuberbier T. Undertreatment of rhinitis symptoms in Europe: findings from a cross-sectional questionnaire survey. Allergy 2007; 62:1057-63. [PMID: 17581263 DOI: 10.1111/j.1398-9995.2007.01367.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allergic rhinitis is a frequent disease affecting one in five Europeans with a significant impact on patient quality of life, health-care costs, and economic productivity. Although effective treatments exist, the disease often remains undiagnosed and not correctly treated, despite clear diagnostic and therapeutic guidelines from WHO, EAACI (European Academy of Allergology and Clinical Immunology), and GA(2)LEN (Global Allergy and Asthma European Network). This study elucidates the reasons for this discrepancy from the patients' point of view. METHODS An internet and telephone survey was conducted with 2,966 randomly selected adults with allergies from the general population in the five major EU countries: UK, France, Germany, Italy, and Spain. RESULTS The main reason that the majority of respondents first visited a medical professional for their rhinitis symptoms was because these symptoms became intolerable. The respondents had not seen a medical professional in the past year for their rhinitis symptoms in 52.6% of the cases, and 30.2% of the respondents preferred nonprescription medication because it did not require visiting a doctor. 'Nontreaters' and 'homeopathic treaters' together made up 26.2% of the respondents, and 40.2% of them gave the cost of medication as a reason they do not use allergy medications. CONCLUSIONS Allergic rhinitis remains widely undertreated in Europe with avoidable socioeconomic consequences. Effective treatment exists, but patients wait too long to seek medical advice, and health providers neglect to actively screen early for allergies.
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Affiliation(s)
- M Maurer
- Allergie-Centrum-Charité Department of Dermatology and Allergy, Charité- Universitätsmedizin Berlin, Member of GA(2)LEN Berlin, Germany
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Schultz AB, Edington DW. Employee health and presenteeism: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2007; 17:547-79. [PMID: 17653835 DOI: 10.1007/s10926-007-9096-x] [Citation(s) in RCA: 287] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 06/27/2007] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Many employers focus on their large and easily measured cost of health care, yet until recently they have ignored the impact of health on productivity. Studies of some chronic conditions and some health risk factors suggest that costs of lost productivity exceed costs of medical care. This review will examine the literature to explore the link between employee health and on-the-job productivity, also known as presenteeism. METHODS Searches of Medline, CINAHL and PubMed were conducted in October 2006, with no starting date limitation with "presenteeism" or "work limitations" as keywords. A total of 113 studies were found using this method. Each study was evaluated based on the strength of the study design, statistical analyses, outcome measurement, and controlling of confounding variables. RESULTS Literature on presenteeism has investigated its link with a large number of health risks and health conditions ranging from exercise and weight to allergies and irritable bowel syndrome. As expected, the research on some topic areas is stronger than others. CONCLUSIONS Based on the research reviewed here, it can be said with confidence that health conditions such as allergies and arthritis are associated with presenteeism. Moreover, health risks traditionally measured by a health risk appraisal (HRA), especially physical activity and body weight, also show an association with presenteeism. The next step for researchers is to tease out the impact of individual health risks or combinations of risks and health conditions on this important outcome measure.
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Affiliation(s)
- Alyssa B Schultz
- Health Management Research Center, University of Michigan, 1015 E. Huron St., Ann Arbor, MI 48104-1688, USA.
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Botteman MF, Ozminkowski RJ, Wang S, Pashos CL, Schaefer K, Foley DJ. Cost effectiveness of long-term treatment with eszopiclone for primary insomnia in adults: a decision analytical model. CNS Drugs 2007; 21:319-34. [PMID: 17381185 DOI: 10.2165/00023210-200721040-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Although the clinical benefits of pharmacological treatments for insomnia have been studied, no systematic assessment of their economic value has been reported. This analysis assessed, from a broad payer and societal perspective, the cost effectiveness of long-term treatment with eszopiclone (LUNESTA, Sepracor Inc., [Marlborough, MA, USA]) for chronic primary insomnia in adults in the US. METHODS A decision analytical model was developed based on the reanalysis of a 6-month placebo-controlled trial, which demonstrated that eszopiclone 3mg significantly improved sleep and daytime function measures versus placebo in adults with primary insomnia. Patients were classified as either having remitted or not remitted from insomnia based upon a composite index of eight sleep and daytime function measures collected during the trial. These data were supplemented with quality-of-life and healthcare and lost productivity cost data from the published literature and medical and absenteeism claims databases. RESULTS Compared with non-remitted patients, patients classified as remitted had lower monthly healthcare and productivity costs (in 2006 dollars) [a reduction of $US242 and $US182, respectively] and higher quality-adjusted life-year (QALY) weight (a net gain of 0.0810 on a scale ranging from 0 to 1). During the study, eszopiclone-treated patients were about 2.5 times more likely to have remitted than placebo-treated patients. Six months of eszopiclone treatment reduced direct (healthcare) and indirect (productivity) costs by an estimated $US245.13 and $US184.19 per patient, respectively. Eszopiclone use was associated with a cost of $US497.15 per patient over 6 months (including drug cost, dispensing fee, physician visit and time loss to receive care). Thus, after considering the above savings and the costs associated with eszopiclone treatment over 6 months, cost increased by $US252.02 (excluding productivity gains) and $US67.83 (including productivity gains) per person. However, eszopiclone treatment was also associated with a net QALY gain of 0.006831 per patient over the same period. Consequently, the incremental cost per QALY gained associated with eszopiclone was approximately $US9930 (including productivity gains [i.e. $US67.83 / 0.006831]) and $US36 894 (excluding productivity gains [i.e. $US252.02 / 0.006831]). Sensitivity analyses using a variety of scenarios suggested that eszopiclone is generally cost effective. CONCLUSIONS This analysis suggested that long-term eszopiclone treatment was cost effective over the 6-month study period, particularly when the impact on productivity costs is considered. Given the increasing interest in new pharmacological interventions to manage insomnia, payers and clinicians alike should carefully consider the balance of health and economic benefits that these interventions offer. Accordingly, additional research in this area is warranted.
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Abstract
Allergic disease is an increasing problem worldwide. Allergic rhinitis, an inflammatory response to an allergen, affects an estimated 20-40 million people in the US, while chronic idiopathic urticaria is a dermatoallergic condition that affects 0.1-3% of people in the US and Europe. The primary goals of treatment for allergic rhinitis are to reduce symptoms, which include sneezing, rhinorrhoea and nasal congestion, improve quality of life and prevent the sequelae associated with this disease, while the goal for chronic idiopathic urticaria is the rapid and prolonged control of symptoms. Quantitatively, histamine is the most abundant mediator present during an allergic episode - thus, antihistamines (historically called histamine H(1) receptor antagonists, now called H(1) receptor inverse agonists) are a first-line defense against allergic rhinitis and chronic idiopathic urticaria. Although first-generation antihistamines can cause sedation and cognitive impairment, second-generation antihistamines are relatively non-sedating and free of such adverse events owing to their comparative inability to penetrate the blood-brain barrier. Desloratadine is one such second-generation antihistamine and is indicated for the treatment of allergic diseases, including allergic rhinitis and chronic idiopathic urticaria. It has proven efficacy against the symptoms associated with seasonal and perennial allergic rhinitis, including nasal congestion, and chronic idiopathic urticaria. As a result, it has been shown to improve patients' quality of life. The safety and efficacy profiles of desloratadine are well established, and published postmarketing analyses have assessed >54 000 patients. Although earlier second-generation antihistamines have been associated with cardiovascular adverse effects, desloratadine has been shown to be safe and well tolerated at nine times the recommended dose. In addition, it has been shown to not interact with concomitantly administered drugs and food. Overall, current data indicate that desloratadine is a safe and effective treatment for allergic diseases.
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MESH Headings
- Histamine H1 Antagonists, Non-Sedating/adverse effects
- Histamine H1 Antagonists, Non-Sedating/therapeutic use
- Humans
- Loratadine/adverse effects
- Loratadine/analogs & derivatives
- Loratadine/therapeutic use
- Product Surveillance, Postmarketing
- Randomized Controlled Trials as Topic
- Rhinitis, Allergic, Perennial/drug therapy
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/drug therapy
- Rhinitis, Allergic, Seasonal/immunology
- Urticaria/drug therapy
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Affiliation(s)
- William E Berger
- Department of Pediatrics, Division of Allergy and Immunology, University of California, Irvine, California, USA.
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Burton WN, Chen CY, Conti DJ, Schultz AB, Edington DW. The association between health risk change and presenteeism change. J Occup Environ Med 2006; 48:252-63. [PMID: 16531829 DOI: 10.1097/01.jom.0000201563.18108.af] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This prospective study investigates whether changes in health risks are associated with changes in presenteeism (on-the-job productivity loss). METHOD A total of 7026 employees of a national financial services company responded to a health risk appraisal (HRA), which included a modified version of the Work Limitation Questionnaire (WLQ) in both 2002 and 2004. The association between changes in health risks and changes in self-reported presenteeism was examined. RESULTS Changes in perceptual/psychologic health risks had a strong association with changes in presenteeism. Individuals who reduced their risks generally saw an improvement in productivity, whereas those who gained risks or remained high-risk status saw deterioration in productivity. Each risk factor increased or reduced was associated with a commensurate change in 1.9% productivity loss over time and estimated to be 950 dollars per year per risk changed. CONCLUSIONS Positive and negative changes in health risks are associated with same-direction changes in presenteeism.
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Affiliation(s)
- Wayne N Burton
- Department of Environmental and Occupational Sciences, University of Illinois at Chicago, USA
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Musich S, Hook D, Baaner S, Edington DW. The association of two productivity measures with health risks and medical conditions in an Australian employee population. Am J Health Promot 2006; 20:353-63. [PMID: 16706007 DOI: 10.4278/0890-1171-20.5.353] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the impact of health on job performance using two measures of productivity loss: (1) a self-reported measure of health-related presenteeism and (2) an objective measure of absenteeism. DESIGN A cross-sectional survey using a Health Risk Appraisal (HRA) to evaluate self-reported presenteeism and the prevalence of 12 health risks and eight medical conditions. SETTING AND SUBJECTS Employees (n=224) of a private insurance provider in Australia. MEASURES A Health Risk Appraisal (HRA) questionnaire was used to evaluate self-reported presenteeism on different aspects of job demands and to assess the prevalence of 12 health risks and eight medical conditions. Illness absent hours were obtained from company administrative records. RESULTS Increased presenteeism was significantly associated with high stress, life dissatisfaction, and back pain, while increased illness absenteeism was significantly associated with overweight, poor perception of health, and diabetes. Excess presenteeism associated with excess health risks (productivity loss among those with medium- or high-risk status compared to those with low-risk status) was independently calculated at 19.0% for presenteeism and 12.8% for illness absenteeism. CONCLUSIONS This study demonstrates an association between health metrics and self-reported work impairment (presenteeism) and measured absenteeism. The study provides a first indication of the potential benefits of health promotion programming to Australian employees in improving health and to the corporation in minimizing health-related productivity loss.
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Affiliation(s)
- Shirley Musich
- Health Management Research Center, University of Michigan, Ann Arbor, MI 48104-1688, USA.
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Abstract
AR is a common condition affecting individuals of all ages. Those afflicted with AR often suffer from associated inflammatory conditions of the mucosa,such as AC, rhinosinusitis, asthma, otitis media with effusion, and other atopic conditions, such as eczema and food allergies. Lack of treatment or treatment with suboptimal therapy may result in reduced quality of life and compromise productivity at work or school. Although environmental controls may prove difficult to implement, and not all controls appear adequately to mitigate symptoms of AR, they continue to represent a foundation for treatment. Many different classes of medications are now available, and they have been shown to be effective and safe in a large number of well-designed, double-blind, placebo-controlled clinical trials. Some of the over-the-counter medi-cations have been associated with increased sedation, potentially leading to accidents and fatalities at work or while operating complex machinery, such as automobiles. Only immunotherapy with increasing doses of individually targeted allergens results in sustained changes in the immune system. Although anti-IgE is probably only the first successful immunomodulator commercially available to treat AR, monoclonal antibodies will remain too costly, at least in the near future, to find their way into routine AR treatment.
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MESH Headings
- Anti-Inflammatory Agents/therapeutic use
- Cost of Illness
- Desensitization, Immunologic
- Histamine H1 Antagonists/therapeutic use
- Humans
- Immunologic Factors/therapeutic use
- Leukotriene Antagonists/therapeutic use
- Quality of Life
- Respiratory System Agents/therapeutic use
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/therapy
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Affiliation(s)
- Alexander N Greiner
- Allergy and Asthma Medical Group and Research Center, and University of California at San Diego, San Diego, CA 92123, USA.
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Burton WN, Chen CY, Conti DJ, Schultz AB, Pransky G, Edington DW. The Association of Health Risks With On-the-Job Productivity. J Occup Environ Med 2005; 47:769-77. [PMID: 16093926 DOI: 10.1097/01.jom.0000169088.03301.e4] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Decreased on-the-job productivity represents a large yet poorly characterized indirect cost to employers. We studied the impact of employee health risk factors on self-reported worker productivity (presenteeism). METHODS Using a brief version of the Work Limitation Questionnaire incorporated into a Health Risk Appraisal, 28,375 employees of a national company responded to the survey. The association between health risks and work limitation and each of the four domains was examined. Percentage of lost productivity also was estimated. RESULTS Ten of 12 health risk factors studied were significantly associated with self-reported work limitations. The strength of the associations varied between risks and the four domains of work limitation. Perception-related risk factors such as life dissatisfaction, job dissatisfaction, poor health, and stress showed the greatest association with presenteeism. As the number of self-reported health risk factors increased, so did the percentage of employees reporting work limitations. Each additional risk factor was associated with 2.4% excess productivity reduction. Medium and high-risk individuals were 6.2% and 12.2% less productive than low-risk individuals, respectively. The annual cost of lost productivity in this corporation was estimated at between 99Mdollars and 185Mdollars or between 1392dollars and 2592dollars per employee. CONCLUSIONS Health risk factors represent additional causes of lost productivity.
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Meerding WJ, IJzelenberg W, Koopmanschap MA, Severens JL, Burdorf A. Health problems lead to considerable productivity loss at work among workers with high physical load jobs. J Clin Epidemiol 2005; 58:517-23. [PMID: 15845339 DOI: 10.1016/j.jclinepi.2004.06.016] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Revised: 05/17/2004] [Accepted: 06/30/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the feasibility and validity of two instruments for the measurement of health-related productivity loss at work. STUDY DESIGN AND SETTING A cross-sectional study was conducted in two occupational populations with a high prevalence of health problems: industrial workers (n=388) and construction workers (n=182). We collected information on self-reported productivity during the previous 2 weeks and during the last work day with the Health and Labor Questionnaire (HLQ) and the Quantity and Quality instrument (QQ), with added data on job characteristics, general health, presence of musculoskeletal complaints, sick leave, and health-care consumption. For construction workers, we validated self-reported productivity with objective information on daily work output from 19 work site observations. RESULTS About half the workers with health problems on the last working day reported reduced work productivity (QQ), or 10.7% of all industrial workers and 11.8% of all construction workers, resulting in a mean loss of 2.0 hr/day per worker with reduced work productivity. The proportion of workers with reduced productivity was significantly lower on the HLQ: 5.3% of industrial workers and 6.5% of construction workers. Reduced work productivity on the HLQ and the QQ was significantly associated with musculoskeletal complaints, worse physical, mental and general health, and recent absenteeism. The QQ and HLQ questionnaires demonstrated poor agreement on the reporting of reduced productivity. Self-reported productivity on the QQ correlated significantly with objective work output (r=.48). CONCLUSION Health problems may lead to considerable sickness presenteeism. The QQ measurement instrument is better understandable, and more feasible for jobs with low opportunities for catching up on backlogs.
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Affiliation(s)
- W J Meerding
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands.
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Bousquet J, Demarteau N, Mullol J, van den Akker-van Marle ME, Van Ganse E, Bachert C. Costs associated with persistent allergic rhinitis are reduced by levocetirizine. Allergy 2005; 60:788-94. [PMID: 15876309 DOI: 10.1111/j.1398-9995.2005.00820.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Allergic rhinitis was recently classified by the ARIA guidelines as persistent or intermittent. Levocetirizine was shown to improve symptoms and health-related quality of life of patients with persistent allergic rhinitis in the XPERT study, a 6-month randomized double blind placebo-controlled trial. OBJECTIVE To assess the total costs of persistent allergic rhinitis, and the effect of long-term treatment with levocetirizine on these costs from several perspectives (societal, social security system, and employers). METHODS Direct medical cost parameters (medications, physician visits and hospitalizations) and time lost parameters (workdays and Usual Daily Activities (UDA) lost) related to persistent allergic rhinitis and its comorbidities (asthma, sinusitis, otitis and upper respiratory infection) were measured. A cost analysis was performed using 2002 French costing data. RESULTS From a societal perspective, the total cost of persistent allergic rhinitis without long-term treatment was estimated at 355.06/patient/month. From a social security perspective, levocetirizine treatment yielded an additional cost of 2.78/patient/month, compared to no-treatment. However, levocetirizine reduced the total cost of persistent allergic rhinitis and its comorbidities by 152.93/patient/month from a societal perspective and by 64.70/patient/month from an employer perspective. Most gains resulted from a decrease in the lost workdays and UDA in the levocetirizine group. CONCLUSION The cost of persistent allergic rhinitis is substantial. Treatment with levocetirizine reduces the cost of persistent allergic rhinitis and its comorbidities to the society by 152.93/patient/month while improving symptoms and health-related quality of life.
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Affiliation(s)
- J Bousquet
- Clinique des Maladies Respiratoires, University Hospital, Montpellier, France
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Kubo N. [Social requirement of the antihistamines for Japanese pollinosis]. Nihon Yakurigaku Zasshi 2005; 125:279-84. [PMID: 15997164 DOI: 10.1254/fpj.125.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Okubo K, Gotoh M, Shimada K, Ritsu M, Okuda M, Crawford B. Fexofenadine Improves the Quality of Life and Work Productivity in Japanese Patients with Seasonal Allergic Rhinitis during the Peak Cedar Pollinosis Season. Int Arch Allergy Immunol 2005; 136:148-54. [PMID: 15650312 DOI: 10.1159/000083322] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 09/22/2004] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Although currently in its infancy, quality of life (QOL) research in Japan is rapidly expanding and is expected to become a standard outcome measure in clinical trials. In Japan, QOL has not previously been assessed in patients with allergic rhinitis (AR); we report the first clinical study applying the recently validated Japanese translations of the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Work Productivity and Activity Impairment-Allergy Specific (WPAI-AS) Questionnaire to assess the effects of the oral antihistamine, fexofenadine, on QOL and work productivity due to cedar pollinosis. PATIENTS AND METHODS A randomized, double-blind, placebo-controlled, single-site study was conducted during the peak cedar pollinosis season in Japan. After a 7-day run-in period, subjects were randomized to receive fexofenadine HCl 60 mg twice daily (bid) or placebo for 2 weeks. RESULTS Overall, 206 Japanese subjects with AR were included in the intention-to- treat population (fexofenadine, n = 104, and placebo, n = 102). Fexofenadine statistically significantly improved overall QOL compared with placebo (p = 0.005) and improvements were reported in the RQLQ domains: activities (p = 0.047), practical problems (p = 0.003), nasal symptoms (p = 0.003) and eye symptoms (p </= 0.001). Clinically significant improvements in practical problems, eye symptoms and activity limitations, exceeding the 0.05 level, were observed with fexofenadine. These improvements in QOL were associated with significant symptom relief (p < 0.001 vs. placebo). Improvements in impairment at work were also reported with fexofenadine. CONCLUSION In Japan, this is the first clinical study to show that fexofenadine HCl (60 mg b.i.d.) improves overall QOL and work productivity in patients with seasonal AR using validated Japanese instruments.
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Affiliation(s)
- F Estelle R Simons
- Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, and the Canadian Institutes of Health Research National Allergy, Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
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Burton WN, Pransky G, Conti DJ, Chen CY, Edington DW. The association of medical conditions and presenteeism. J Occup Environ Med 2004; 46:S38-45. [PMID: 15194894 DOI: 10.1097/01.jom.0000126687.49652.44] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A self-reported measure of four domains of work impairment based on the Work Limitations Questionnaire was completed by 16,651 employees of a large financial services corporation. Using a multivariate model to control for coexisting conditions, age, and gender, significant relationships were observed between medical conditions and patterns of impaired work performance. Depression was highly associated with work limitations in time management (odds ratio [OR] = 2.05), interpersonal/mental functioning (OR = 2.50), and overall output (OR = 2.24). Arthritis (OR = 1.56) and low back pain (OR = 1.32) were associated with physical function limitations. These same two conditions were associated with limitations in mental/interpersonal functioning but with low back pain having the higher odds ratio (OR = 1.54 vs. 1.22). These results suggest that worksite interventions (eg, disease management programs) should be tailored to the unique effects observed with specific medical conditions. More targeted programs could have important benefits for productivity in the workplace.
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