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Ahmed F, Fathi H, Bedos C. The experiences of people living with environmental sensitivities concerning oral health and access to dental services. Disabil Rehabil 2024; 46:2600-2609. [PMID: 37403705 DOI: 10.1080/09638288.2023.2227972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Because people living with environmental sensitivities are poorly acknowledged in our society, we still know very little about their experiences navigating in the health care system, especially with respect to dental services. Our objective, therefore, was to describe their dental care pathway and better understand their experiences accessing oral health services. MATERIALS AND METHODS A qualitative descriptive study was conducted in partnership with organizations supporting people with environmental sensitivities. Through a criterion sampling technique, 12 people living with environmental sensitivities in Quebec (Canada) were invited to participate in individual semi-structured interviews. These interviews lasted around 90 min and were transcribed to be thematically analysed. RESULTS Participants faced major barriers accessing dental services and thus lived for long periods of time with unmet dental needs. Their dental care pathways were often delayed or even interrupted for several reasons. First because they were exposed to pollutants upon leaving their house, which rendered their trip to the dentist perilous. Second because dentists lacked knowledge about environmental sensitivities and seemed reluctant to accommodate them. CONCLUSIONS We invite governments, dental professionals, and researchers to develop policies and clinical approaches for improving people living with environmental sensitivities' quality of life and access to dental services.
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Affiliation(s)
- Farah Ahmed
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Homa Fathi
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Christophe Bedos
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
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Hempel S, Danz M, Robinson KA, Bolshakova M, Rodriguez J, Mears A, Pham C, Yagyu S, Motala A, Tolentino D, Akbari O, Johnston J. Multiple chemical sensitivity scoping review protocol: overview of research and MCS construct. BMJ Open 2023; 13:e072098. [PMID: 37739463 PMCID: PMC10533706 DOI: 10.1136/bmjopen-2023-072098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Multiple chemical sensitivity (MCS) has been characterised by reported adverse responses to environmental exposures of common chemical agents (eg, perfumes, paint, cleaning products and other inhaled or ingested agents) in low doses considered non-toxic for the general population. There is currently no consensus on whether MCS can be established as a distinct disorder. METHODS AND ANALYSIS The scoping review of the literature will be guided by five questions: How is MCS defined and which diagnostic criteria have been proposed? What methods are used to report prevalence and incidence estimates of MCS? What are the characteristics of the body of scientific evidence that addresses whether MCS is a distinct disorder or syndrome? What underlying mechanisms for MCS have been proposed in the scientific literature? Which treatment and management approaches for MCS have been evaluated in empirical research studies? We will conduct a comprehensive search in 14 research databases. Citation screening will be supported by machine learning algorithms. Two independent reviewers will assess eligibility of full-text publications against prespecified criteria. Data abstraction will support concise evidence tables. A formal consultation exercise will elicit input regarding the review results and presentation. The existing research evidence will be documented in a user-friendly visualisation in the format of an evidence map. ETHICS AND DISSEMINATION Determined to be exempt from review (UP-22-00516). Results will be disseminated through a journal manuscript and data will be publicly accessible through an online data repository. REGISTRATION DETAILS The protocol is registered in Open Science Framework (osf.io/4a3wu).
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Margie Danz
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Karen A Robinson
- Division of Health Science Informatics, John Hopkins Medicine, Baltimore, Maryland, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jesus Rodriguez
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Alanna Mears
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Cindy Pham
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Danica Tolentino
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Omid Akbari
- Molecular Microbiology and Immunology, University of Southern California, Los Angeles, California, USA
| | - Jill Johnston
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Damiani G, Alessandrini M, Caccamo D, Cormano A, Guzzi G, Mazzatenta A, Micarelli A, Migliore A, Piroli A, Bianca M, Tapparo O, Pigatto PDM. Italian Expert Consensus on Clinical and Therapeutic Management of Multiple Chemical Sensitivity (MCS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111294. [PMID: 34769816 PMCID: PMC8582949 DOI: 10.3390/ijerph182111294] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/29/2022]
Abstract
Multiple chemical sensitivity (MCS) is a multisystem, recurrent, environmental disorder that flares in response to different exposures (i.e., pesticides, solvents, toxic metals and molds) under the threshold limit value (TLV) calculated for age and gender in the general population. MCS is a syndrome characterized by cutaneous, allergic, gastrointestinal, rheumatological, endocrinological, cardiological and neurological signs and symptoms. We performed a systematic review of the literature to summarize the current clinical and therapeutic evidence and then oriented an eDelphi consensus. Four main research domains were identified (diagnosis, treatment, hospitalization and emergency) and discussed by 10 experts and an MCS patient. Thus, the first Italian MCS consensus had the double aim: (a) to improve MCS knowledge among healthcare workers and patients by standardizing the clinical and therapeutic management to MCS patients; and (b) to improve and shed light on MCS misconceptions not supported by evidence-based medicine (EBM).
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Affiliation(s)
- Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, 35131 Padua, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Daniela Caccamo
- Department of Biomedical Sciences, Dental Sciences, & Morpho-Functional Imaging, Polyclinic Hospital University, 98124 Messina, Italy;
| | - Andrea Cormano
- International Society of Doctors for Environment, 82100 Benevento, Italy;
| | - Gianpaolo Guzzi
- Italian Association for Metals and Biocompatibility Research—A.I.R.M.E.B., 20122 Milan, Italy;
| | - Andrea Mazzatenta
- Department of Neuroscience, Imaging and Clinical Science, ‘G. d’Annunzio’ University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, 39100 Bolzano, Italy;
- ITER Center for Balance and Rehabilitation Research (ICBRR), 02032 Rome, Italy
| | - Alberto Migliore
- Department of Internal Medicine, Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy;
| | - Alba Piroli
- Department of MeSVA, University of L’Aquila, 67100 L’Aquila, Italy;
| | | | | | - Paolo Daniele Maria Pigatto
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
- Correspondence: ; Tel.: +39-02-5031-9971
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Durbhakula S, Cohen SP. Gadolinium use for interventional pain procedures: where we are and where we are heading. Reg Anesth Pain Med 2018; 44:4-6. [DOI: 10.1136/rapm-2018-100163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 11/03/2022]
Abstract
In recent years as the use of interventional pain procedures has soared, so too has outside and internal scrutiny. This scrutiny includes agreater emphasis on weighing the risks and benefits of procedures, increased surveillance for adverse events, and cost containment strategies. In 2016, the first reports of gadolinium deposition in the central nervous system began to surface, though retention in other organ systems has been appreciated for over a decade. In this issue of Regional Anesthesia & Pain Medicine, Benzon et al. report a series of patients with document edhypersensitivity reactions to iodinated contrast medium who were inadvertently administered iodine-based contrast without adverse consequences. In this article, we discuss the epidemiology of contrast-mediated adverse effects, the mechanistic basis for hypersensitivity reactions, the risks and benefits of various approaches in the patient with a documented contrast hypersensitivity reaction, and risk mitigation strategies.
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Monro JA, Puri BK. A Molecular Neurobiological Approach to Understanding the Aetiology of Chronic Fatigue Syndrome (Myalgic Encephalomyelitis or Systemic Exertion Intolerance Disease) with Treatment Implications. Mol Neurobiol 2018; 55:7377-7388. [PMID: 29411266 PMCID: PMC6096969 DOI: 10.1007/s12035-018-0928-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/24/2018] [Indexed: 12/11/2022]
Abstract
Currently, a psychologically based model is widely held to be the basis for the aetiology and treatment of chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME)/systemic exertion intolerance disease (SEID). However, an alternative, molecular neurobiological approach is possible and in this paper evidence demonstrating a biological aetiology for CFS/ME/SEID is adduced from a study of the history of the disease and a consideration of the role of the following in this disease: nitric oxide and peroxynitrite, oxidative and nitrosative stress, the blood–brain barrier and intestinal permeability, cytokines and infections, metabolism, structural and chemical brain changes, neurophysiological changes and calcium ion mobilisation. Evidence is also detailed for biologically based potential therapeutic options, including: nutritional supplementation, for example in order to downregulate the nitric oxide-peroxynitrite cycle to prevent its perpetuation; antiviral therapy; and monoclonal antibody treatment. It is concluded that there is strong evidence of a molecular neurobiological aetiology, and so it is suggested that biologically based therapeutic interventions should constitute a focus for future research into CFS/ME/SEID.
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Affiliation(s)
- Jean A Monro
- Breakspear Medical Group, Hemel Hempstead, England, UK
| | - Basant K Puri
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
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Gibson PR. Introduction to the Special Issue on Environmental Sensitivities: Living on the Margins with Access Denied. ECOPSYCHOLOGY 2017. [DOI: 10.1089/eco.2017.0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Pamela Reed Gibson
- Department of Psychology, James Madison University, Harrisonburg, Virginia
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Harsh J, Hodgson J, White MB, Lamson AL, Irons TG. Medical Residents' Experiences With Medically Unexplained Illness and Medically Unexplained Symptoms. QUALITATIVE HEALTH RESEARCH 2016; 26:1091-1101. [PMID: 25800718 DOI: 10.1177/1049732315578400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patients who present with medically unexplained illnesses or medically unexplained symptoms (MUI/S) tend to be higher utilizers of health care services and have significantly greater health care costs than other patients, which add stress and strain for both the patient and provider. Although MUI/S are commonly seen in primary care, there is not sufficient information available regarding how providers can increase their level of confidence and decrease their level of frustration when working with patients who present with MUI/S. The goal of this article is to present findings from a qualitative phenomenology study, which highlights medical residents' experiences of caring for patients with MUI/S and the personal and professional factors that contributed to their clinical approaches. Results from these studies indicate that residents often experience a lack of confidence in their ability to effectively treat patients with MUI/S, as well as frustration surrounding their encounters with this group of patients.
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Affiliation(s)
- Jennifer Harsh
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Mark B White
- Northcentral University, Prescott Valley, Arizona, USA
| | | | - Thomas G Irons
- East Carolina University, Greenville, North Carolina, USA
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Jeong I, Kim I, Park HJ, Roh J, Park JW, Lee JH. Allergic diseases and multiple chemical sensitivity in korean adults. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:409-14. [PMID: 25228997 PMCID: PMC4161681 DOI: 10.4168/aair.2014.6.5.409] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/13/2013] [Accepted: 10/22/2013] [Indexed: 11/20/2022]
Abstract
Purpose Multiple chemical sensitivity (MCS) is a clinical syndrome representing multi-organ and psychological symptoms caused by chronic exposure to various chemicals in low concentrations. We evaluated the prevalence and related factors of MCS targeting Korean adults using the Quick Environmental Exposure and Sensitivity Inventory (QEESI©). Methods A total of 446 participants were recruited from Severance Hospital. Participants underwent a questionnaire interview including questions on sociodemographic factors, occupational and environmental factors, allergic diseases, and the QEESI©. Among them, 379 participants completed the questionnaire and the QEESI©. According to the QEESI© interpretation results, participants were divided into very suggestive (VS) group and less suggestive (LS) group. Results The estimated prevalence of MCS was higher in allergic patients than non-allergic participants (19.7% and 11.3%, respectively, P=0.04). In the multivariate logistic regression analysis, ages of 30-39 (OR, 2.94; 95% CI, 1.25-6.95) and those of 40-49 (OR, 2.51; 95% CI, 1.02-6.21) were significantly related to MCS compared to those aged less than 30 years. Female sex (OR, 2.16; 95% CI, 1.11-4.18), experience of dwelling in a new house (OR, 2.05; 95% CI, 1.04-4.03), and atopic dermatitis (OR, 1.95; 95% CI, 1.04-3.69) were also significantly related to MCS. However, only age of 30-39 in the allergic group was significant in the stratified analysis. Conclusions The estimated prevalence of MCS was higher among allergic patients than non-allergic participants. People with experience of dwelling in a new house and atopic dermatitis were more at risk of being intolerant to chemicals. Further studies to provide the nationally representative prevalence data and clarify risk factors and mechanisms of MCS are required.
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Affiliation(s)
- Inchul Jeong
- Graduate School of Public Health, Yonsei University, Seoul, Korea. ; Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
| | - Inah Kim
- Graduate School of Public Health, Yonsei University, Seoul, Korea. ; Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jung Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jaehoon Roh
- Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea. ; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
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