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Biomedical subjects

D L Holness

Publications and source records attributed to D L Holness.

At least 19 recordsLinked to original sources
PubMed2001

Dermatitis in a particleboard manufacturing facility.

Exposure to wood dust and other chemicals used in particleboard manufacture may cause contact dermatitis. To assess the prevalence and nature of skin complaints in the refining and drying department of a particleboard manufacturing facility following introduction of a new process, workers were assessed by a physician, using a standardized questionnaire concerning symptoms, past and family history, workplace exposures, and use of protective equipment. Cutaneous examination and patch testing were then performed. Questionnaire results showed that workers complained of rash, nasal and eye irritation, as well as cough and bothersome odours. Cutaneous examination identified a heterogeneity of skin problems, with dermatitis being mainly irritant rather than allergic. Quaternium-15 (Dowicil 200) was the only allergen to which more than 1 individual reacted. Aside from the odours, exposure to wood dust could account for the other reported symptoms. Allergic reactions on patch testing were few and did not explain the dermatitis; most skin reactions were irritant. Recommendations to the company included improved dust control, through ventilation and personal hygiene measures, as well as protective clothing. The investigation highlights how the introduction of a new process may focus attention on health complaints that have been present for some time before.

Adult↗
PubMed2001

Results of a quality of life questionnaire in a patch test clinic population.

There has been increasing interest in quality of life outcomes, but there has been little reported on this topic for individuals with contact dermatitis. The objectives of this study were (i) to pilot a dermatology-specific quality of life instrument to assess its acceptability in a patch test clinic population, (ii) to see the effects of contact dermatitis on the patients' lives and (iii) to determine what factors may influence quality of life outcomes in this population. A dermatology-specific quality of life instrument was modified and used for 339 patients undergoing patch testing in a contact dermatitis clinic. The most common effect was pain or itching in 61%. Approximately 1/3 noted embarrassment, interference with work, or sleep disturbance. Other concerns were reported by less than 25% of the population. On multivariate analysis, the key factor influencing most outcomes was hand involvement. The instrument was well accepted by the clinic population and is now being used in a prospective study of outcomes. In the population assessed, it demonstrated the effects of disease. Analysis suggests that a key factor influencing these quality of life outcomes is hand involvement.

Activities of Daily Living↗
PubMed2001

Results of evaluating health care workers with prick and patch testing.

BACKGROUND: Health care workers are exposed to many agents that can cause irritant or allergic contact dermatitis. Recently, much attention has been focused on latex sensitivity, which commonly causes contact urticaria. Most studies have examined the conditions of irritant or allergic contact dermatitis and contact urticaria independently. Therefore, we have little information about the possible occurrence of these conditions in the context of combined assessment including both prick and patch testing. OBJECTIVE: To determine the prevalence of irritant and allergic contact dermatitis and contact urticaria in a group of health care workers presenting with skin problems. METHODS: Retrospective review of health care workers assessed by both prick and patch testing in an occupational health clinic. RESULTS: The diagnoses included 61% with irritant contact dermatitis, 31% with allergic contact dermatitis, and 27% with contact urticaria to latex. Eleven percent had both allergic contact dermatitis related to thiuram and contact urticaria to latex. Ninety five percent were deemed to be work-related. CONCLUSION: Health care workers presenting with skin complaints should be assessed with both prick and patch testing.

Adult↗
PubMed2000

Expanding the epidemiologic profile: risk factors for active tuberculosis in people immigrating to Ontario.

BACKGROUND: Many people immigrating to Canada come from countries with a high burden of tuberculosis. The aim of this study was to develop a detailed epidemiologic profile of foreign-born people with tuberculosis living in Ontario. METHODS: In this population-based case-control study, cases of tuberculosis diagnosed in 1994-1995 were identified from the database of the Ontario Reportable Disease Information Service and were considered eligible for analysis if a record of landing (receipt of permission to establish residence in Canada) from the period 1986-1995 was found in the Citizenship and Immigration Canada (CIC) database, if the person was at least 11 years of age at the time their visa was issued, and if the person had not been diagnosed with tuberculosis before becoming legally landed in Canada. Control subjects, who met the same criteria as the case subjects but who did not have tuberculosis in 1994-1995, were identified from a CIC database for landed immigrants. RESULTS: A total of 1341 cases of tuberculosis in foreign-born people were reported in Ontario in 1994-1995. A record of landing was found in CIC databases for 1099 of these people, 224 of whom were not legally landed at the time of diagnosis. In total, 602 cases met the inclusion criteria. The 2 strongest determinants of risk among those who had become landed within the preceding 10 years were referral for medical surveillance by immigration officials (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.6-6.0) and world region of origin (Somalia [OR 67.7, 95% CI 31.3-154.9], Vietnam [OR 25.0, 95% CI 12.5-50.0], the Philippines [OR 11.9, 95% CI 6.0-23.3], other sub-Saharan African countries [OR 11.6, 95% CI 5.7-23.2], India [OR 9.7, 95% CI 4.9-18.9], China [OR 6.1, 95% CI 3.1-12.1], other Asian countries [OR 4.7, 95% CI 2.4-9.1], the Middle East [OR 4.1, 95% CI 2.0-8.3], Latin America [OR 1.9, 95% CI 0.9-3.8), and the former socialist countries of Europe [OR 1.8, 95% CI 0.8-3.8]; the reference category was countries with established market economies). Low socioeconomic status was an independent risk factor. INTERPRETATION: The risk of tuberculosis in groups of people migrating to Ontario is highly variable and is influenced by several factors. Successful population-based tuberculosis prevention strategies will need to accommodate this variability.

Adolescent↗
PubMed2000

Results of a pilot study reviewing dermatitis claims submitted to the Ontario Workplace Safety and Insurance Board.

BACKGROUND: Workers who develop occupational skin disease are often eligible for workers' compensation benefits; however, there is little known about the decision-making process for adjudicating claims submitted for work-related skin problems. OBJECTIVE: The objective of this pilot study was to test a file abstraction instrument and determine the nature of information that was available for decision-making. METHODS: Files submitted to the Ontario Workplace Safety and Insurance Board (WSIB) in 1995 for dermatitis were identified. The last 51 files were abstracted to collect information concerning demographics, physicians seen, information available in the claim file for decision making, as well as type of claim and outcome of the claim. RESULTS: Approximately 70% of the claims were "no-lost-time" and one-third of total claims were accepted for compensation. Although there was reasonable information related to the clinical status, most claims had no information that related to workplace issues such as exposures or association with work. Claims that were for lost time or were accepted had more information available. CONCLUSIONS: The pilot study has demonstrated that there is a lack of information related to workplace issues that would be important in decision-making. The study will be extended to examine the entire year's claims in order to develop a strategy to enhance the understanding of the WSIB and providers regarding the information necessary for decision-making and to determine methods to facilitate its collection.

Adult↗
PubMed2000

Asthmatic subjects symptomatically worse at work: prevalence and characterization among a general asthma clinic population.

STUDY OBJECTIVES: To assess the prevalence of a historical occupational component to asthma in an adult asthma clinic and to compare characteristics of asthmatic subjects with and without work-attributed symptoms. DESIGN: A retrospective review of data obtained from a physician-administered questionnaire, answers to which were obtained at the initial patient visit of asthmatic subjects, and which included specific questions regarding the relationship of work to symptoms. Chart review data were used to supplement information on workplace exposures and investigations. SETTING: A university-based secondary- and tertiary-referral asthma clinic. PATIENTS: Seven hundred thirty-one adult asthmatic subjects who were referred for assessment and management of asthma. INTERVENTIONS: Statistical analyses of asthmatic subjects with and without work-attributed symptoms and a determination, from chart review, of the likelihood of causes for symptomatic worsening of asthma at work. MEASUREMENTS AND RESULTS: Sixty percent of the patients (435) had adult onset of asthma, among whom 310 patients (71%) were employed at the time of their visit. Fifty-one patients reported their asthma to be worse at work (ie, 16% of adult-onset working asthmatic subjects). Sixteen of these patients (31%) had likely or possible sensitizer-induced occupational asthma (OA), and 49% likely had aggravation of underlying asthma. The other 20% of patients had possible OA or aggravation of underlying asthma at work. CONCLUSIONS: Adult-onset asthmatic subjects commonly report a worsening of asthma at work, more commonly on the basis of likely aggravation of underlying asthma than on the basis of likely or possible OA.

Adolescent↗
PubMed1999

Occupational health and safety management systems in the Canadian pulp and paper industry: methods of auditing.

The Canadian Pulp and Paper Association has developed eight "Guiding Principles for Management of Occupational Health and Safety" (OH&S) for its member companies. As part of a study to assess member companies' OH&S activities, an on-site audit was performed for 11 sites. The audit assessed five key components of a management system for a number of OH&S activities. Management-system components more likely to be in place included system ownership and goals and procedures, whereas measures of performance, a review of measures, and corrective action were less likely to be present. Environmental surveillance and injury reduction were most actively monitored, as indicated by the number of measures of performance relating to these activities. The auditing process demonstrated leadership and communicated the OH&S priorities of the Canadian Pulp and Paper Association to the sites.

Canada↗
PubMed1998

Incidence of latex sensitization among latex glove users.

BACKGROUND: Although there are several reports of the prevalence of latex sensitization among health care workers, the incidence of sensitization is unknown. OBJECTIVE: The objective of this study was to estimate the incidence of sensitization among latex glove users at a hospital in Hamilton, Ontario, Canada. METHODS: Workers with negative results to the skin test at baseline were followed prospectively over 1 year, some wearing powdered gloves and others using powder-free gloves. They were reevaluated in 1995 with a questionnaire and skin prick test (SPT) sensitivity to latex reagents, three common inhalants, and six foods. A conversion was defined as a (new) latex SPT with wheal diameter at least 4 mm greater than saline control. Glove extracts were assayed for antigenic protein, and air samples were obtained to estimate exposure to airborne latex protein. RESULTS: During powdered glove use, personal exposures ranged from 5 to 616 ng/m3, whereas during powder-free glove use, all but two results for air samples were below the limit of detection (about 0.1 ng/m3). During the study period, the protein concentration in the powdered gloves, initially mean 557 microg/gm of sample, declined at a rate of 295 microg/gm per year (p < 0.0001). Of the 1075 SPT-negative participants at baseline, 479 were working in eligible wards, and of these, 435 (91%) participated in follow-up, 227 using powder-free gloves and 208 using powdered gloves. We identified four conversions, two (1.0%) in the powdered glove group and two (0.9%) in the powder-free group. The two participants using powdered gloves were the only converters who were symptomatic. The significance of skin test conversions identified in the powder-free group, both asymptomatic patients, is unclear. The limitations of the study are discussed, including the limited power, the declines in latex protein concentrations, and the possibility of information (observer) bias. CONCLUSION: To our knowledge, this represents the first reported estimate (about 1%) of incidence of sensitization in hospital personnel using latex gloves.

Cross-Sectional Studies↗
PubMed1998

Prevalence of upper extremity symptoms and possible risk factors in workers handling paper currency.

The prevalence of upper extremity symptoms in the workforce is high, particularly in industries characterized by forceful, repetitive or awkward movements. A study was undertaken to assess the prevalence of upper extremity symptoms in bank workers in a paper currency processing operation and to examine the role of possible risk factors for these complaints. Thirty-nine workers of a total workforce of 47 were assessed with a questionnaire and physical examination. The questionnaire collected information about demographics, health status, symptom reporting, psychosocial work stressors and other work exposure characteristics. Overall, 59% of the workers reported having significant work-related upper extremity musculoskeletal symptoms in the preceding year, including 49% with neck and shoulder symptoms and 49% with arm and wrist symptoms. In this study the key predictive factor for upper extremity musculoskeletal symptoms was psychological job demands. The workers had similar ergonomic stressors (with little gradient of exposure) and therefore our results do not contradict the importance of ergonomic factors in the development of upper extremity symptoms. However, the results do suggest that within a group exposed to similar ergonomic stressors, psychological job demands may be an important factor associated with musculoskeletal symptoms.

Adult↗
PubMed1997

Investigation of factors affecting mass psychogenic illness in employees in a fish-packing plant.

This study of the factors affecting the development of mass psychogenic illness (MPI) was carried out in a large fish-packing plant in New Brunswick, Canada. A total of 269 out of 270 plant employees (99.6%) participated in the study and of these, 208 cases were affected with symptoms of MPI and 61 controls were unaffected over a period of 2 1/2 months. A questionnaire was administered to participating employees to collect information about symptoms, demographic factors, work history, pre-existing medical problems, potential workplace triggering exposure factors, and various psychosocial factors. Multiple logistic regression indicated that the main factors associated with MPI, in decreasing order of importance, were skill creation in the job, odor perception, and female sex. Management of this incident required reassurance of employees that there was no hazardous exposure in the plant as well as recognition of the need to reduce underlying sources of stress in the work environment.

Adult↗
PubMed1997

Latex sensitivity in dental students and staff: a cross-sectional study.

BACKGROUND: Dental practitioners, like other health care providers who regularly use latex gloves, are at increased risk for latex sensitivity. They are also at risk for irritant or allergic contact dermatitis. OBJECTIVE: This study was carried out to determine the prevalence of latex sensitivity and possible risk factors in staff and students of a Faculty of Dentistry. METHODS: A cross-sectional study was performed by using a questionnaire and allergy skin prick testing. RESULTS: Two hundred three students and staff members completed the questionnaire. Five percent reported asthma symptoms on exposure to rubber products, 13% reported symptoms of rhinitis or conjunctivitis, and 17% reported pruritus or urticaria within minutes of exposure to rubber. Overall, 10% of 131 subjects who underwent skin prick tests had a positive response to natural rubber latex. Among the students tested, there were increasing percentages of positive skin test responses to latex with increasing years of study (0% of Year 1 and 2 students tested; 6% of Year 3; and 10% of Year 4). Positive responses were seen as early as Year 3 in students (in their second year of clinical activity and glove use). Positive skin prick test responses to latex were related to a personal history of atopy (p = 0.005), positive prick test responses to common allergens (p < 0.005), latex-attributed immediate pruritus or urticaria (p < 0.05), rhinoconjunctivitis (p < 0.001), and asthma symptoms (p < 0.001). CONCLUSION: Dental school students and faculty are at high risk for latex sensitization. This occurs as early as the second year of glove use. Overall prevalence of skin sensitization was 10% of those tested. Preventive strategies in this group merit further investigation.

Adult↗
PubMed1997

Characteristics of occupational medicine practitioners and practice in Canada.

To obtain baseline information with respect to occupational medicine practice in Canada, a questionnaire survey of members of the Occupational and Environmental Medical Association of Canada was carried out by mail in 1993. One hundred eighty-six responses were received (56% of the membership). The average age of the respondents was 49.5, 12% were female, and 55% worked full-time in occupational medicine. Practice types included corporate settings (58%), clinics (23%), government agencies (14%), worker's compensation boards (7%) and academic settings (5%). Sixty percent had some formal training in occupational medicine, and 46% had occupational medicine certification by either the Royal College of Physicians and Surgeons of Canada, the Canadian Board of Occupational Medicine, or the American Board of Preventive Medicine. Younger physicians were more likely to be female and have gone directly into occupational medicine. Women were more likely to be working full-time in occupational medicine but worked fewer hours per week. Those physicians with specialty qualifications were older and more likely to be working full-time in occupational medicine and be active in professional activities. The Association intends to continue surveying its members on a triennial basis, identifying trends in the practice profiles and continuing education needs.

Adult↗
PubMed1997

Results of patch testing with a special series of rubber allergens.

The purpose of this study was to examine the results of patch testing with the rubber components on a standard screening tray and compare them with the results of testing with a special series of 27 rubber components (rubber tray). 1670 patients were patch tested with the screening tray and 317 of these were also tested with the rubber tray. 16% of those tested with the rubber tray had a positive response to at least 1 of the rubber allergens on the screening tray and 22% had a positive response to at least 1 of the allergens on the rubber tray. The most common positive response to the rubber tray allergens was to tetramethylthiuram monosulfide. There were no responses to 3 of the components on the rubber tray and there was only 1 positive response to a further 4 components. The diagnostic test characteristics of the rubber components on the screening tray were examined using the rubber tray as the gold standard. The sensitivity of the screening tray was 94%, specificity 51%, positive predictive value 87% and negative predictive value 71%. Of the 317 tested, 11% were found to have a positive to a substance on the rubber tray that was not evident from the results of the screening tray.

Adult↗
PubMed1997

Latex allergy: epidemiological study of 1351 hospital workers.

OBJECTIVE: To determine the prevalence of latex sensitisation among a large group of healthcare workers, study the occupational and non-occupational factors associated with latex allergy, and characterise latex exposure in air and by gloves. METHODS: All 2062 employees of a general hospital in Hamilton, Ontario, Canada who regularly used latex gloves were invited to participate in a cross sectional survey, representing the baseline phase of a prospective cohort morbidity study. Attempts were made to recruit employees who were diagnosed with latex allergy before the survey. Glove extracts were assayed for antigenic protein, and area and personal air samples were obtained on two occasions (summer and winter) to estimate exposure to airborne latex protein. A questionnaire on medical and occupational information was administered by an interviewer. Skin prick tests were performed with latex reagents, three common inhalants, and six foods. RESULTS: The mean (SD) latex protein concentrations were 324 (227) micrograms/g in powdered surgical gloves and 198 (104) micrograms/g in powdered examination gloves. Personal latex aeroallergen concentrations ranged from 5 to 616 ng/m3. There was a total of 1351 (66%) participants. The prevalence of positive latex skin tests was 12.1% (95% confidence interval (95% CI) 10.3% to 13.9%). This prevalence did not vary by sex, age, hospital, or smoking status but subjects who were latex positive were significantly more likely to be atopic (P < 0.01). Participants who were latex positive were also significantly more likely to have positive skin tests to one or more foods (Mantel-Haenszel odds ratio (OR) adjusted for atopy 12.1, 95% CI 7.6 to 19.6, P < 10(-9)). Work related symptoms were more often reported among latex positive people, and included hives (OR 6.3, 95% CI 3.2 to 12.5), eye symptoms (OR 1.9, 95% CI 1.2 to 2.8), and wheezy or whistling chest (OR 4.7, 95% CI 2.8 to 7.9). The prevalence of latex sensitivity was highest among laboratory workers (16.9%), and nurses and physicians (13.3%). When the glove consumption per healthcare worker for each department was grouped into tertiles, the prevalence of latex skin test positivity was greater in the higher tertiles of glove use for sterile (surgical) gloves (P < 0.005) but not for examination gloves. CONCLUSIONS: In this large, cross sectional study of healthcare workers, the prevalence of latex sensitisation was 12.1% (9.5% among all those eligible), and there were significant associations with atopy, positive skin tests to certain foods, work related symptoms, and departmental use of gloves per healthcare worker. This cohort is being followed up prospectively and will be retested to determine the incidence of development of latex sensitivity.

Adult↗
PubMed1997

Results of patch testing with a specialized collection of plastic and glue allergens.

Patch testing was performed on 235 patients with a specialized collection of plastic and glue components. Thirteen percent had a positive response to at least one of the allergens. Seventy-four percent of the responses were relevant to either the present or a past problem, and 64% were occupationally related. The substances that yielded the greater percentage of positive responses were ethylenediamine, triethylenetetramine, diethylenetriamine, diaminodiphenylmethane, melamine formaldehyde resin, phenol formaldehyde resin, cresylglycidylether, phenylglycidylether, and N, N-dimethyl-p-toluidine. Of the 47 agents used, 26 did not elicit any positive responses. There were few distinguishing characteristics between those who exhibited a positive response to these agents and those who did not. In 12 cases (5% of those tested), the diagnosis of allergic contact dermatitis would have been missed if the plastics and glues components were not used.

Adhesives↗
PubMed1996

Medications as risk factors for farm injury.

A case-control study was used to determine whether cases of farm injury were more likely than controls to have been regularly exposed to certain types of medication including those that cause side effects which may predispose to injury. Persons reporting an injury (n = 176) were identified in a population-based mail survey of people on 1364 Ontario farms, and compared to people without injuries using a 4:1 control: case ratio. Bivariate, stratified, and multivariable analyses were used to quantify the strength of associations between exposures to certain medications and the occurrence of farm injury. Those who regularly used certain types of medication were separated into two groups: people who used the medications in isolation, and those who used the medications in combination with other medications. Response to the survey was 77.3% among cases and 82.6% among controls. Strong and statistically significant increases in risk for injury were observed in association with the regular use of stomach remedies or laxatives by males (OR 2.8; 95% CI: 1.0,7.7), and regular use of heart of circulatory medications by men over the age of 45 (OR 4.2; 95% CI: 1.2,14.7). The identified associations remained after adjustment for age, co-morbidity, tillable farm acreage, education, income, alcohol consumption and tobacco use. Several possible explanations for the occurrence of the identified associations, other than the etiological hypothesis originally advanced, are discussed.

Accidents, Occupational↗