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Biomedical subjects

Susan M Tarlo

Publications and source records attributed to Susan M Tarlo.

24 records · Page 2Linked to original sources
PubMed2002

Changes in rates of natural rubber latex sensitivity among dental school students and staff members after changes in latex gloves.

BACKGROUND: A high rate of sensitization and clinical allergy to natural rubber latex (NRL) gloves has been reported in dental students and staff members. OBJECTIVE: The purpose of this study was to determine whether a change in glove use from high-protein/powdered to low-protein/powder-free latex gloves at a previously surveyed dental school reduced the prevalence of NRL sensitivity among students and staff members. METHODS: A cross-sectional study was performed through use of a questionnaire and skin prick testing to low ammoniated NRL extract; the method was similar to that used in a study conducted in 1995. Analyses were performed on the entire groups as well as on a subset of senior students. RESULTS: A total of 97 subjects (61 students and 36 staff members) completed the questionnaire and underwent skin prick testing; this compared with 131 subjects in 1995. Percentages of subjects reporting asthma symptoms, rhinitis or conjunctivitis, urticaria, or pruritus within minutes of NRL exposure were 4%, 7%, 6%, and 8%, respectively; the corresponding percentages in the 1995 survey were 7% (P = not significant), 13% (P = not significant), 20% (P =.004), and 22% (P =.005). Results were similar for the subset of senior students, but in addition there were also significantly fewer complaints of rhinoconjunctivitis in 2000 than in 1995 (0% and 12%, respectively; P =.007). Of 97 subjects who underwent skin prick testing, 3 (3%) had positive skin prick test responses of 2+ or greater to NRL; this compared with 13 (10%) of 131 subjects in 1995 (P =.03). There were 3 positive skin test responses among staff members in 2000; there were none among students. CONCLUSIONS: Our results suggest a preventive effect on NRL allergy in dental students from the change to low-protein/powder-free NRL gloves in the dental school.

Adult↗
PubMed2002

Diisocyanate-induced asthma: diagnosis, prognosis, and effects of medical surveillance measures.

Diisocyanates have been the most commonly identified cause for occupational asthma (OA) in industrialized areas. Asthma among diisocyanate workers may be true occupational asthma, caused by a high level of irritant exposure at work or by sensitization to diisocyanates. Alternatively, asthma may be coincidental to or may be aggravated by work exposures. A clear diagnosis usually requires a combination of investigations (serial peak expiratory flow recordings, methacholine challenges, and/or diisocyanate challenges), but it is important to provide the best management by identifying whether workplace changes are needed for the worker. Preventive measures to reduce the risk of occupational asthma from diisocyanates have not been prospectively evaluated. The introduction of a medical surveillance program (in Ontario, Canada) in 1983 was followed by retrospective assessments to determine benefits. Between 1980 and 1993, the proportion of all accepted compensation claims for OA that were attributed to diisocyanates, classified by year of symptom onset in the province with the program, rose to 64 percent by 1988, then fell significantly down to 29 percent in 1992 and 35 percent in 1993. Besides the medical surveillance program for diisocyanates, possible factors contributing to this reduction may include reduced diisocyanates exposures and better awareness of diisocyanate-induced asthma, both by workers and physicians. Compared with OA caused by other agents, those with OA due to diisocyanates had a significantly earlier onset of asthma after the start of the exposure (mean 5 yr vs. 7 yr), were younger and less likely to be atopic and to have smoked. The mean duration of asthma before the main medical assessment for compensation was significantly shorter among those with diisocyanate-induced asthma (mean 2 yr vs. 3 yr), and the severity was milder as assessed by medication use and pulmonary function. Those with diisocyanate-induced asthma were significantly less likely to be hospitalized for asthma. Among the subset whose outcome was determined at a mean of 2.1 years after the main medical assessment, the outcome severity was less for those with diisocyanate-induced OA. Among those with diisocyanate-induced OA, an earlier diagnosis and a trend to better outcome was found in workers from companies that were identified to be in compliance with surveillance measures.

Air Pollutants, Occupational↗
PubMed2002

Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder.

Idiopathic environmental intolerance (IEI), also known as multiple chemical sensitivity, is a clinical description for a cluster of symptoms of unknown etiology that have been attributed by patients to multiple environmental exposures when other medical explanations have been excluded. Because allergy has not been clearly demonstrated and current toxicological paradigms for exposure-symptom relationships do not readily accommodate IEI, psychogenic theories have been the focus of a number of investigations. A significantly higher lifetime prevalence of major depression, mood disorders, anxiety disorders, and somatization disorder has been reported among patients with environmental illness compared with that in controls. Symptoms often include anxiety, lightheadedness, impaired mentation, poor coordination, breathlessness (without wheezing), tremor, and abdominal discomfort. Responses to intravenous sodium lactate challenge or single-breath inhalation of 35% carbon dioxide versus a similar breath inhalation of clean air have shown a greater frequency of panic responses in subjects with IEI than in control subjects, although such responses did not occur in all subjects. Preliminary genetic findings suggest an increased frequency of a common genotype with panic disorder patients. The panic responses in a significant proportion of IEI patients opens a therapeutic window of opportunity. Patients in whom panic responses may at least be a contributing factor to their symptoms might be responsive to intervention with psychotherapy to enable their desensitization or deconditioning of responses to odors and other triggers, and/or may be helped by anxiolytic medications, relaxation training, and counseling for stress management.

Administration, Inhalation↗
PubMedDate not supplied

Barriers to diagnosis of occupational asthma in Ontario.

BACKGROUND: Occupational asthma (OA) refers to asthma caused by workplace-specific substances. A longer duration of symptoms while continuing to be exposed has been associated with a worse prognosis. Evidence suggests a significant period of time exists between symptom onset and diagnosis of OA, the reasons for which have not been investigated. The purpose of this study was to examine whether primary health care and/or socio-economic factors account for delays in Ontario. METHOD: Two hundred and forty-seven (247) chart reviews were undertaken of patients referred to the University Health Network Asthma Centre for evaluation of OA, with clinic visits from 1997-2002. Forty-two (42) patients fulfilling objective OA criteria were administered a structured telephone interview to examine the chronology and nature of health care consultation and reasons for possible delay in diagnosis. RESULTS: The mean time to diagnosis was 4.9 years (3.4 years excluding 4 outliers). On average, patients waited 7.4 months before discussing the work-relation of symptoms with a physician. Main self-reported reasons for delay were lack of enquiry about work relatedness by the primary care physician (41%) and fear of losing work time (37%). Reported increases in time during secondary care were related to difficulties associated with completion of investigations (35%). Lower education level (p = 0.04) and household income (p = 0.03) were significantly associated with an increased time to diagnosis. INTERPRETATION: Physicians who assess working adults with asthma need to ask pertinent work-related questions when taking a history in order to initiate timely investigations and referral. Socio-economic factors are also associated barriers to early diagnosis of occupational asthma.

Asthma↗