Self-reported skin exposure--validation of questions by observation

The aim of this study was to validate questions regarding skin exposure using observation. The study group consisted of 40 individuals in 5 different occupations: nurse in an intensive care unit, car mechanic, hairdresser, kitchen worker, and office worker. The participants completed a questionnaire before the start of a working day. The questionnaire covered total skin exposure times to water, foodstuffs, chemicals, and occlusive gloves and also covered the frequency of hand-washing during a working day. Observers subsequently used a hand-held computer to register the time and the frequency of each exposure. A strong correlation between self-reports and observations was found for questions regarding exposure times to water, foodstuffs, and occlusive gloves and also a moderate correlation for questions regarding frequency of hand-washing. The present observation method was insufficient for estimating total exposure times to chemicals as the true exposure time is influenced by, e.g. the use of contaminated protective gloves and the efficacy with which the chemicals were removed. The inter-observer reliability showed a very strong correlation. We consider the questions regarding skin exposure to water, foodstuffs, protective gloves, and hand-washing to be useful for future studies. The observation method seems to be reliable, useful, and easy to apply.     

Oral prednisone suppresses allergic but not irritant patch test reactions in individuals hypersensitive to nickel

A multicentre, randomized, double-blind, crossover study was designed to investigate the effects of prednisone on allergic and irritant patch test reactions. 24 subjects with known allergy to nickel were recruited and patch tested with a nickel sulfate dilution series in aqueous solution, 5% nickel sulfate in petrolatum and 2 dilution series of the irritants nonanoic acid and sodium lauryl sulfate. The subjects were tested x2, both during treatment with prednisone 20 mg oral daily and during placebo treatment. The total number of positive nickel patch test reactions decreased significantly in patients during prednisone treatment. The threshold concentration to elicit a patch test reaction increased and the overall degree of reactivity to nickel sulfate shifted towards weaker reactions. The effect of prednisone treatment on the response to irritants was divergent with both increased and decreased numbers of reactions, although there were no statistically significant differences compared with placebo. It is concluded that oral treatment with prednisone suppresses patch test reactivity to nickel, but not to the irritants tested.     

Rapid and sensitive loop-mediated isothermal amplification test for Clostridium difficile detection challenges cytotoxin B cell test and culture as gold standard

Compared to the composite gold standard cytotoxin B assay and toxigenic culture, the loop-mediated isothermal amplification (LAMP) test for Clostridium difficile had a sensitivity and specificity of 98%, positive predictive value of 92%, and negative predictive value of >99%. A one-hour turnaround time for the LAMP test provides rapid diagnosis and cost savings.     

Family history of cardiovascular disease and influence on statin therapy persistence

Purpose

Persistence to statins is low, presumably due to lack of perception of risk. Having a close relative suffering from cardiovascular disease (CVD) might increase persistence to statins. We investigated whether family history of CVD influences the discontinuation of statin treatment.

Methods

A population-based cohort study was performed. Swedish registers on dispensed drugs, hospitalization and cause of death were linked to the Multi-generation Register. Incident statin users 20–72 years of age were identified between 2006 and 2007 and followed until 30 June 2009. Family history of CVD was defined as the presence of relatives with a previous cardiovascular event. Cox regression was used to study discontinuation and estimate the effect of the family history of CVD, adjusting for gender, age, education, income, healthcare provider, prevention’s type, birth’s country and residence’s county. Stratified analysis by type and severity of cardiovascular event was performed.

Results

A total of 86,002 patients were enrolled; 61.5 % had a family history of CVD. Discontinuation of statin therapy was not associated with family history of CVD (HR: 0.98; 95 % CI:0.96–1.01), except for patients with a family history of death from myocardial infarction (MI) (HR: 0.95 95 % CI:0.92–0.98). Young age, foreign background, low income, and statin for primary prevention and for secondary prevention when prescribed by a general practitioner were associated with higher risk of statin discontinuation.

Conclusions

Having relatives suffering from CVD did not consistently influence the persistence to statin treatment. A family history of death from MI had a slight significant positive effect on statin persistence, though not clinically relevant.     

Effects of an outpatient pulmonary rehabilitation program on quality of life and physical performance in patients with chronic obstructive pulmonary disease (COPD)

Seventeen patients with severe chronic obstructive pulmonary disease (COPD) participated in an outpatient rehabilitation program twice a week for 8 or 12 weeks (Group I and Group II, respectively). Health Related Quality of life (HQL) and mood were assessed by the Chronic Respiratory Disease Questionnaire (CRDQ) and the Mood Adjective Check List (MACL) before, one month, and six months after the program. Exercise tolerance was tested before and after the program by a maximal cycle test, a six-minute walking test (6MW) and a submaximal cycle test (only Group II). During the submaximal cycle test, heart rate, lactate level, breathlessness and leg fatigue were measured. HQL significantly improved immediately after the pulmonary rehabilitation program and six months after the completion of the program. There was a significant improvement in mood one month after the program. The maximal workload and the six-minute walking test were significantly greater after the program. Heart rate and lactate level at peak exercise and breathlessness and leg fatigue were significantly after the program. Correlation analysis found a significant relationship between the 6MW and emotional function in the CRDQ (r = 0.54). An outpatient rehabilitation program improved quality of life, mood, exercise tolerance, lactate level, and symptoms of patients with COPD.     

Self-reported skin exposure -- a population-based study

The aim was to study self-reported skin exposure in individuals from the general population with or without hand eczema. In a population-based study in 1996 using postal questionnaires to 3000 individuals, 215 of 2218 (9.7%) reported hand eczema during the past 12 months. 182 (85%) of those with hand eczema and 182 without hand eczema, matched for age and sex, participated in telephone interviews in 1997 regarding exposure to skin irritants at work and in leisure time. No differences were shown in occupational exposure to water, hand washing or chemicals in individuals with or without hand eczema. Women reported more wet exposure than men at work and in leisure time. A correlation was found between occupational wet exposure and wet work at home. Persons in high-risk occupations reported more frequent exposure to skin irritants. However, 53% in high-risk occupations reported exposure to water and detergents for less than half-hour a day and 11% in low-risk occupations for more than half-hour a day. In conclusion, individuals with or without hand eczema seem to have similar exposure to skin irritants. Using job titles as a proxy for exposure gives misclassification, which may result in underestimation of the hand eczema risk.     

Skin exposure in geriatric care - a comparison between observation and self-assessment of exposure

The aim of this study was to compare observation and self-assessment of skin exposure to irritants during a working day in nursing in geriatric care. The study group consisted of 40 volunteers, 13 nurses, and 27 assistant nurses. Before the start of a working day, the participants completed a questionnaire regarding skin exposure to water, gloves, hand disinfection, and moisturizers. Observers subsequently used a hand-held computer to register the time and frequency of each exposure. The total mean skin exposure time was 96 min per working day, including glove use. The mean exposure time to water was 9 min per working day. A tendency to overestimate was found for all exposures. A strong correlation between self-reports and observations was found for hand disinfection and moisturizers, while a moderate correlation was found for gloves and number of water exposures and a weak correlation for total time of water exposure. Despite the differences between self-assessment and observation of the exposure, we consider the questionnaire to be useful for surveying skin exposure in nursing. Furthermore, the observations in this study suggest that nursing work in geriatric care may comprise limited exposure to water.     

An evaluation of a short questionnaire for parents about their school-aged children's global maturity level

The aim was to evaluate a questionnaire for parents concerning their school-aged children's global maturity level. Immature children (n = 29) as reported by their parents were compared to a control group (n = 68). Immaturity was linked to a reduced general knowledge, a childish body appearance, problems with the fine motor function and problems with peers. The index group also had on average a lower test result in total score of the Wechsler Intelligence Scale for Children and more commission errors in the Continuous Performance Test, both test results indicating a lower mental age.