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Bayram M, Burgazoglu H. The Relationships Between Control Measures and Absenteeism in the Context of Internal Control. Saf Health Work 2020; 11:443-449. [PMID: 33329910 PMCID: PMC7728821 DOI: 10.1016/j.shaw.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background The study tries to show the effect of Occupational Health and Safety (OHS) legislation implemented via plan-do-check-act methodology on accident and sickness absenteeism. Methods The data for the study gathered via a questionnaire from a large-sized organization operates in production and maintenance of passenger coaches in February–March 2019 in Turkey. The data analyzed via structural equation model analysis. Results The results showed that there are statistically meaningful relationships between OHS protective measures, training and informing of employees, and employee participation and accident and sickness absenteeism. In addition, a meaningful relationship between internal control and accident and sickness absenteeism was determined. Statistically meaningful relationships between emergency measures, and health surveillance and internal control, and accident and sickness absenteeism could not be determined. Conclusion It is concluded that the actions implemented by organizations to reduce absenteeism should be as per OHS legislation.
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Affiliation(s)
- Metin Bayram
- Business School, Sakarya University, Sakarya, Turkey
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2
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Ehteshami-Afshar S, Zafari Z, Hamidi N, FitzGerald JM, Lynd L, Sadatsafavi M. A Systematic Review of Decision-Analytic Models for Evaluating Cost-Effectiveness of Asthma Interventions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1070-1082. [PMID: 31511184 DOI: 10.1016/j.jval.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To demonstrate the landscape of model-based economic studies in asthma and highlight where there is room for improvement in the design and reporting of studies. DESIGN A systematic review of the methodologies of model-based, cost-effectiveness analyses of asthma-related interventions was conducted. Models were evaluated for adherence to best-practice modeling and reporting guidelines and assumptions about the natural history of asthma. METHODS A systematic search of English articles was performed in MEDLINE, EMBASE, and citations within reviewed articles. Studies were summarized and evaluated based on their adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). We also studied the underlying assumptions about disease progression, heterogeneity in disease course, comorbidity, and treatment effects. RESULTS Forty-five models of asthma were included (33 Markov models, 10 decision trees, 2 closed-form equations). Novel biological treatments were evaluated in 12 studies. Some of the CHEERS' reporting recommendations were not satisfied, especially for models published in clinical journals. This was particularly the case for the choice of the modeling framework and reporting on heterogeneity. Only 13 studies considered any subgroups, and 2 explicitly considered the impact of comorbidities. Adherence to CHEERS requirements and the quality of models generally improved over time. CONCLUSION It would be difficult to replicate the findings of contemporary model-based evaluations of asthma-related interventions given that only a minority of studies reported the essential parameters of their studies. Current asthma models generally lack consideration of disease heterogeneity and do not seem to be ready for evaluation of precision medicine technologies.
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Affiliation(s)
- Solmaz Ehteshami-Afshar
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Zafar Zafari
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Nima Hamidi
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, The University of British Columbia, Vancouver, Canada
| | - Larry Lynd
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada; Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, The University of British Columbia, Vancouver, Canada.
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Tarlo SM, Arif AA, Delclos GL, Henneberger P, Patel J. Opportunities and obstacles in translating evidence to policy in occupational asthma. Ann Epidemiol 2018; 28:392-400. [PMID: 28434545 PMCID: PMC5953844 DOI: 10.1016/j.annepidem.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. METHODS In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. RESULTS AND CONCLUSIONS Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices.
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Affiliation(s)
- Susan M. Tarlo
- Department of Medicine, University Health Network, University of Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Ontario, Canada,Department of Public Health Sciences, University of Toronto, Ontario, Canada,Corresponding author. Toronto Western Hospital, EW7-449, 399 Bathurst Street, Toronto, Ontario, M5T 2S8. Tel.: 416 603 5177; fax 416 603 6763. (S.M. Tarlo)
| | - Ahmed A. Arif
- UNC Charlotte, Department of Public Health Sciences, Charlotte, NC
| | - George L. Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
| | | | - Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
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Identification of novel reaction products of methylene-bis-phenylisocyanate ("MDI") with oxidized glutathione in aqueous solution and also during incubation of MDI with a murine hepatic S9 fraction. Toxicol In Vitro 2016; 36:97-104. [PMID: 27453132 DOI: 10.1016/j.tiv.2016.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 12/14/2022]
Abstract
Methylene diphenyl diisocyanate (MDI) is an important industrial chemical and asthmagenic respiratory sensitizer, however its metabolism remains unclear. In this study we used LC-MS and LC-MS/MS to identify novel reaction products of MDI with oxidized glutathione (GSSG), including an 837m/z [M+H](+) ion corresponding to GSSG bound (via one of its N-termini) to partially hydrolyzed MDI, and an 863m/z [M+H](+) ion corresponding to GSSG cross-linked by MDI (via its two γ-glutamate N-termini) [corrected]. Further studies with heavy isotope labeled and native reduced glutathione (GSH) identified an [M+H](+) ion corresponding to previously described mono(GSH)-MDI, and evidence for "oligomeric" GSH-MDI conjugates. This study also investigated transformational changes in MDI after incubation with an S9 fraction prepared from murine liver. LC-MS analyses of the S9 reaction products revealed the formation of [M+H](+) ions with m/z's and retention times identical to the newly described GSSG-MDI (837 and 863) conjugates and the previously described mono(GSH)-MDI conjugate. Together the data identify novel biological transformations of MDI, which could have implications for exposure-related health effects, and may help target future in vivo studies of metabolism.
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Herida M, Dervaux B, Desenclos JC. Economic Evaluations of Public Health Surveillance Systems: a Systematic Review. Eur J Public Health 2016; 26:674-80. [PMID: 26850905 PMCID: PMC7108512 DOI: 10.1093/eurpub/ckv250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Magid Herida
- 1 Institut de veille sanitaire, 12 rue du val d'Osne 94415 Saint-Maurice Cedex, France
| | - Benoit Dervaux
- 2 Université Lille, CHU Lille, EA2694- Santé Publique : épidémiologie et qualité des soins. F59000 Lille, France
| | - Jean-Claude Desenclos
- 1 Institut de veille sanitaire, 12 rue du val d'Osne 94415 Saint-Maurice Cedex, France
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Lefkowitz D, Pechter E, Fitzsimmons K, Lumia M, Stephens AC, Davis L, Flattery J, Weinberg J, Harrison RJ, Reilly MJ, Filios MS, White GE, Rosenman KD. Isocyanates and work-related asthma: Findings from California, Massachusetts, Michigan, and New Jersey, 1993-2008. Am J Ind Med 2015; 58:1138-49. [PMID: 26351141 DOI: 10.1002/ajim.22527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Isocyanates remain a leading cause of work-related asthma (WRA). METHODS Two independent data systems were analyzed for the period 1993-2008: (1) State-based WRA case surveillance data on persons with isocyanate-induced WRA from four states, and (2) Occupational Safety and Health Administration (OSHA) Integrated Management Information System (IMIS) isocyanate air sampling results. RESULTS We identified 368 cases of isocyanate-induced WRA from 32 industries and 678 OSHA isocyanate air samples with detectable levels from 31 industries. Seventeen industries were unique to one or the other dataset. CONCLUSION Isocyanate-induced WRA continues to occur in a wide variety of industries. Two data systems uncovered industries with isocyanate exposures and/or illness. Improved control measures and standards, including medical surveillance, are needed. More emphasis is needed on task-specific guidance, spill clean-up procedures, skin and respiratory protection, and targeted medical monitoring to mitigate the hazards of isocyanate use.
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Affiliation(s)
- Daniel Lefkowitz
- Environmental & Occupational Health Surveillance Program; New Jersey Department of Health; Trenton New Jersey
| | - Elise Pechter
- Occupational Health Surveillance Program; Massachusetts Department of Public Health; Boston Massachusetts
| | - Kathleen Fitzsimmons
- Occupational Health Surveillance Program; Massachusetts Department of Public Health; Boston Massachusetts
| | - Margaret Lumia
- Environmental & Occupational Health Surveillance Program; New Jersey Department of Health; Trenton New Jersey
| | - Alicia C. Stephens
- Environmental & Occupational Health Surveillance Program; New Jersey Department of Health; Trenton New Jersey
| | - Letitia Davis
- Occupational Health Surveillance Program; Massachusetts Department of Public Health; Boston Massachusetts
| | - Jennifer Flattery
- Occupational Health Branch; California Department of Public Health; Richmond California
| | - Justine Weinberg
- Public Health Institute; Contractor to California Department of Public Health; Richmond California
| | - Robert J. Harrison
- Occupational Health Branch; California Department of Public Health; Richmond California
| | - Mary Jo Reilly
- Division of Occupational and Environmental Medicine; Michigan State University; East Lansing Michigan
| | - Margaret S. Filios
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health; Centers for Disease Control and Prevention; Morgantown West Virginia
| | - Gretchen E. White
- Division of Respiratory Disease Studies; National Institute for Occupational Safety and Health; Centers for Disease Control and Prevention; Morgantown West Virginia
- University of Pittsburgh Graduate School of Public Health; Department of Epidemiology; Pittsburgh Pennsylvania
| | - Kenneth D. Rosenman
- Division of Occupational and Environmental Medicine; Michigan State University; East Lansing Michigan
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Riaño-Casallas MI, Palencia-Sánchez F. Los costos de la enfermedad laboral: revisión de literatura. REVISTA FACULTAD NACIONAL DE SALUD PÚBLICA 2015. [DOI: 10.17533/udea.rfnsp.v33n2a09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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An official American Thoracic Society proceedings: work-related asthma and airway diseases. Presentations and discussion from the Fourth Jack Pepys Workshop on Asthma in the Workplace. Ann Am Thorac Soc 2014; 10:S17-24. [PMID: 23952871 DOI: 10.1513/annalsats.201305-119st] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Work-related asthma is a common occupational lung disease. The scope of the Fourth Jack Pepys Workshop that was held in May 2010 went beyond asthma to include discussion of other occupational airway diseases, in particular occupationally related chronic obstructive pulmonary disease (COPD) and bronchiolitis. Aspects explored included public health considerations, environmental aspects, outcome after diagnosis, prevention and surveillance, and other work-related obstructive airway diseases. Consistent methods are needed to accurately estimate the comparative burden of occupation-related airway diseases among different countries. Challenges to accomplishing this include variability in health care delivery, compensation systems, cultural contexts, and social structures. These factors can affect disease estimates, while heterogeneity in occupations and workplace exposures can affect the underlying true prevalence of morbidity. Consideration of the working environment included discussion of practical methods of limiting exposure to respiratory sensitizers, methods to predict new sensitizers before introduction into workplaces, the role of legislated exposure limits, and models to estimate relative validity of various ameliorative measures when complete avoidance of the sensitizer is not feasible. Other strategies discussed included medical surveillance measures and education, especially for young individuals with asthma and new workers about to enter the workforce. Medical outcomes after development of sensitizer-induced occupational asthma are best following earlier diagnosis and removal from further exposure, but a subset may be able to continue working safely provided that exposure is reduced under close follow-up monitoring. It was recognized that occupationally related COPD is common but underappreciated, deserving further study and prevention efforts.
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Abstract
BACKGROUND Occupational lung diseases remain common, and health surveillance is one approach used to assist identification of early cases. AIMS To identify areas of good practice within respiratory health surveillance and to formulate recommendations for practice. METHODS Published literature was searched since 1990 using a semi-systematic methodology. RESULTS A total of 561 documents were identified on Medline and Embase combined. Other search engines did not identify relevant documents that had not already been identified by these two main searches. Seventy-nine of these were assessed further and 36 documents were included for the full analysis. CONCLUSIONS Respiratory health surveillance remains a disparate process, even within disease type. A standard validated questionnaire and associated guidance should be developed. Lung function testing was common and generally supported by the evidence. Cross-sectional interpretation of lung function in younger workers needs careful assessment in order to best identify early cases of disease. More informed interpretation of the forced expiratory volume in 1 s/forced vital capacity ratio, for example by using a lower limit of normal for each worker, and of longitudinal lung function information is advised. Immunological tests appear useful in small groups of workers exposed to common occupational allergens. Education, training and improved occupational health policies are likely to improve uptake of health surveillance, to ensure that those who fail health surveillance at any point are handled appropriately.
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Affiliation(s)
- L Lewis
- Centre for Workplace Health, Health and Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
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10
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Abstract
PURPOSE OF REVIEW Because there is sufficient knowledge of its environmental determinants, occupational asthma is a disease that ought to be largely preventable; yet its incidence in many settings remains unacceptably high. Here we review one approach to prevention: the routine use of health surveillance in exposed workforces. RECENT FINDINGS Health surveillance is widely practised but there is little evidence that it is used strategically to reduce disease incidence. There are several barriers to the effective use of its various components, chiefly symptoms questionnaires and spirometry. Cost-benefit analyses may help to increase the uptake of industry-wide workplace interventions. SUMMARY The effective use of health surveillance for occupational asthma continues to be challenging and there remains relatively little published evidence that will encourage those involved to use it more efficiently. Useful advances could be made by greater collaboration between employers, employee organizations, legislators and researchers.
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A Review and Analysis of the Clinical and Cost-effectiveness Studies of Comprehensive Health Promotion and Disease Management Programs at the Worksite. J Occup Environ Med 2011; 53:1310-31. [DOI: 10.1097/jom.0b013e3182337748] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Economic value of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity a community guide systematic review. Am J Prev Med 2011; 41:S33-47. [PMID: 21767734 DOI: 10.1016/j.amepre.2011.05.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 11/22/2022]
Abstract
CONTEXT A recent systematic review of home-based, multi-trigger, multicomponent interventions with an environmental focus showed their effectiveness in reducing asthma morbidity among children and adolescents. These interventions included home visits by trained personnel to assess the level of and reduce adverse effects of indoor environmental pollutants, and educate households with an asthma client to reduce exposure to asthma triggers. The purpose of the present review is to identify economic values of these interventions and present ranges for the main economic outcomes (e.g., program costs, benefit-cost ratios, and incremental cost-effectiveness ratios). EVIDENCE ACQUISITION Using methods previously developed for Guide to Community Preventive Services economic reviews, a systematic review was conducted to evaluate the economic efficiency of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. A total of 1551 studies were identified in the search period (1950 to June 2008), and 13 studies were included in this review. Program costs are reported for all included studies; cost-benefit results for three; and cost-effectiveness results for another three. Information on program cost was provided with varying degrees of completeness: six of the studies did not provide a list of components included in their program cost description (limited cost information), three studies provided a list of program cost components but not a cost per component (partial cost information), and four studies provided both a list of program cost components and costs per component (satisfactory cost information). EVIDENCE SYNTHESIS Program costs per participant per year ranged from $231-$14,858 (in 2007 U.S.$). The major factors affecting program cost, in addition to completeness, were the level of intensity of environmental remediation (minor, moderate, or major), type of educational component (environmental education or self-management), the professional status of the home visitor, and the frequency of visits by the home visitor. Benefit-cost ratios ranged from 5.3-14.0, implying that for every dollar spent on the intervention, the monetary value of the resulting benefits, such as averted medical costs or averted productivity losses, was $5.30-$14.00 (in 2007 U.S.$). The range in incremental cost-effectiveness ratios was $12-$57 (in 2007 U.S.$) per asthma symptom-free day, which means that these interventions achieved each additional symptom-free day for net costs varying from $12-$57. CONCLUSIONS The benefits from home-based, multi-trigger, multicomponent interventions with an environmental focus can match or even exceed their program costs. Based on cost-benefit and cost-effectiveness studies, the results of this review show that these programs provide a good value for dollars spent on the interventions.
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13
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Crocker DD, Kinyota S, Dumitru GG, Ligon CB, Herman EJ, Ferdinands JM, Hopkins DP, Lawrence BM, Sipe TA. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a community guide systematic review. Am J Prev Med 2011; 41:S5-32. [PMID: 21767736 DOI: 10.1016/j.amepre.2011.05.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/25/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
CONTEXT Asthma exacerbations are commonly triggered by exposure to allergens and irritants within the home. The purpose of this review was to evaluate evidence that interventions that target reducing these triggers through home visits may be beneficial in improving asthma outcomes. The interventions involve home visits by trained personnel to conduct two or more components that address asthma triggers in the home. Intervention components focus on reducing exposures to a range of asthma triggers (allergens and irritants) through environmental assessment, education, and remediation. EVIDENCE ACQUISITION Using methods previously developed for the Guide to Community Preventive Services, a systematic review was conducted to evaluate the evidence on effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. The literature search identified over 10,800 citations. Of these, 23 studies met intervention and quality criteria for inclusion in the final analysis. EVIDENCE SYNTHESIS In the 20 studies targeting children and adolescents, the number of days with asthma symptoms (symptom-days) was reduced by 0.8 days per 2 weeks, which is equivalent to 21.0 symptom-days per year (range of values: reduction of 0.6 to 2.3 days per year); school days missed were reduced by 12.3 days per year (range of values: reduction of 3.4 to 31.2 days per year); and the number of asthma acute care visits were reduced by 0.57 visits per year (interquartile interval: reduction of 0.33 to 1.71 visits per year). Only three studies reported outcomes among adults with asthma, finding inconsistent results. CONCLUSIONS Home-based, multi-trigger, multicomponent interventions with an environmental focus are effective in improving overall quality of life and productivity in children and adolescents with asthma. The effectiveness of these interventions in adults is inconclusive due to the small number of studies and inconsistent results. Additional studies are needed to (1) evaluate the effectiveness of these interventions in adults and (2) determine the individual contributions of the various intervention components.
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Affiliation(s)
- Deidre D Crocker
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia 30333, USA
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Abstract
Prevention of occupational asthma related to a work-sensitizing agent ideally would be achieved by avoidance of exposures that cause immunologic sensitization and subsequent asthma. There are a few examples in which a sensitizing agent has been removed from a work process and others in which exposure has been significantly changed or reduced with associated reduced rates of sensitization and disease. Additional measures include containment, use of robots, ventilation measures, exposure monitoring, and use of respiratory protective devices. Secondary prevention includes medical surveillance, which may involve periodic respiratory questionnaires, spirometry, and immunologic tests aiming to detect sensitization or disease early to allow intervention and improve outcomes. Education measures for workers to understand the meaning of work-related respiratory symptoms and appropriate workplace safety measures have not been formally evaluated but may also be expected to enhance protective measures and lead to earlier diagnosis. Tertiary prevention includes medical management and workers' compensation.
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Quirce S, Sastre J. Recent advances in the management of occupational asthma. Expert Rev Clin Immunol 2010; 4:757-65. [PMID: 20477125 DOI: 10.1586/1744666x.4.6.757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Occupational asthma (OA) is the most common occupational lung disease in industrialized countries. This respiratory disorder remains poorly diagnosed and managed, and inadequately compensated for worldwide. The most appropriate treatment for OA remains early removal from exposure to ensure that the worker has no further exposure to the causal agent with preservation of income. However, various studies demonstrate that many workers with OA continue to remain exposed to the causative agent or suffer prolonged work disruption and discrimination, and may face unemployment. Despite removal from exposure, OA frequently turns into a chronic condition and requires intensive medical management, including appropriate pharmacotherapy and patient education and counseling. There are very few studies on allergen immunotherapy in OA. Subcutaneous immunotherapy with latex extract in healthcare workers and with wheat-flour extract in subjects with baker's asthma, at adequate doses, appears to be a useful treatment in reducing cutaneous and respiratory symptoms, but should be considered as a high-risk treatment due to the appearance of systemic reactions.
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Affiliation(s)
- Santiago Quirce
- Hospital La Paz, Allergy Department, Paseo Castellana 261, 28046 Madrid, Spain.
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A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008. J Occup Environ Med 2009; 51:822-37. [PMID: 19542898 DOI: 10.1097/jom.0b013e3181a7de5a] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To conduct the seventh periodic review and analysis of the clinical and cost-effectiveness research conducted in worksite/corporate environments between 2004 and 2008. METHODS A literature search of US-based research was conducted using a multistage process including MEDLINE, ADI, EDGAR, CARL, Inform, Lexis-Nexis, as well as direct inquiries to key researchers in this area of expertise. RESULTS From 2004 to 2008, there were 16 new studies that met the Inclusion/Exclusion criteria. These studies are critiqued and entered into a data table consisting of 13 variables and citations of the 16 new studies. CONCLUSIONS Clinical and cost-effectiveness research in the worksite/corporate environment continues to evolve although there was only one randomized clinical trial conducted during the most recent interval. There are innovations in pilot studies, quasi-experimental methodologies, and econometric modeling as indicative of future trends.
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17
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Harber P, Levine J, Bansal S. How Frequently Should Workplace Spirometry Screening Be Performed? Chest 2009; 136:1086-1094. [DOI: 10.1378/chest.09-0237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Harber P, Bansal S, Balmes J. Progression from beryllium exposure to chronic beryllium disease: an analytic model. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:970-974. [PMID: 19590692 PMCID: PMC2702415 DOI: 10.1289/ehp.0800440] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 02/27/2009] [Indexed: 05/27/2023]
Abstract
BACKGROUND Understanding the progression from beryllium exposure (BeE) to chronic beryllium disease (CBD) is essential for optimizing screening and early intervention to prevent CBD. METHODS We developed an analytic markov model of progression to cbd that assigns annual probabilities for progression through three states: from BeE to beryllium sensitization and then to CBD. We used calculations of the number in each state over time to assess which of several alternative progression models are most consistent with the limited available empirical data on prevalence and incidence. We estimated cost-effectiveness of screening considering both incremental (cost/case) and cumulative program costs. RESULTS No combination of parameters for a simple model in which risk of progression remains constant over time can meet the empirical constraints of relatively frequent early cases and continuing development of new cases with long latencies. Modeling shows that the risk of progression is initially high and then declines over time. Also, it is likely that there are at least two populations that differ significantly in risk. The cost-effectiveness of repetitive screening declines over time, although new cases will still be found with long latencies. However, screening will be particularly cost-effective when applied to persons with long latencies who have not been previously screened. CONCLUSIONS To optimize use of resources, the intensity of screening should decrease over time. Estimation of lifetime cumulative CBD risk should consider the declining risk of progression over time.
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Affiliation(s)
- Philip Harber
- Division of Occupational and Environmental Medicine, Department of Family Medicine, University of California at Los Angeles, Los Angeles, California 90024, USA.
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19
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Abstract
Use of disease simulation models has led to scrutiny of model methods and demand for evidence that models credibly simulate health outcomes. We sought to describe recent obstructive lung disease simulation models and their validation. Medline and EMBASE were used to identify obstructive lung disease simulation models published from January 2000 to June 2006. Publications were reviewed to assess model attributes and four types of validation: first-order (verification/debugging), second-order (comparison with studies used in model development), third-order (comparison with studies not used in model development), and predictive validity. Six asthma and seven chronic obstructive pulmonary disease models were identified. Seven (54%) models included second-order validation, typically by comparing observed outcomes to simulations of source study cohorts. Seven (54%) models included third-order validation, in which modeled outcomes were usually compared qualitatively for agreement with studies independent of the model. Validation endpoints included disease prevalence, exacerbation, and all-cause mortality. Validation was typically described as acceptable, despite near-universal absence of criteria for judging adequacy of validation. Although over half of recent obstructive lung disease simulation models report validation, inconsistencies in validation methods and lack of detailed reporting make assessing adequacy of validation difficult. For simulation modeling to be accepted as a tool for evaluating clinical and public health programs, models must be validated to credibly simulate health outcomes of interest. Defining the required level of validation and providing guidance for quantitative assessment and reporting of validation are important future steps in promoting simulation models as practical decision tools.
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Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Campbell JD, Spackman DE, Sullivan SD. Health economics of asthma: assessing the value of asthma interventions. Allergy 2008; 63:1581-92. [PMID: 19032230 DOI: 10.1111/j.1398-9995.2008.01888.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (65%) achieved quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival.
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Affiliation(s)
- J D Campbell
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA 98195, USA
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Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, Blanc PD, Brooks SM, Cowl CT, Daroowalla F, Harber P, Lemiere C, Liss GM, Pacheco KA, Redlich CA, Rowe B, Heitzer J. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest 2008; 134:1S-41S. [PMID: 18779187 DOI: 10.1378/chest.08-0201] [Citation(s) in RCA: 306] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA). METHODS A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007. RESULTS The Consensus Document defined WRA to include occupational asthma (ie, asthma induced by sensitizer or irritant work exposures) and WEA (ie, preexisting or concurrent asthma worsened by work factors). The Consensus Document focuses on the diagnosis and management of WRA (including diagnostic tests, and work and compensation issues), as well as preventive measures. WRA should be considered in all individuals with new-onset or worsening asthma, and a careful occupational history should be obtained. Diagnostic tests such as serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests (if available), can increase diagnostic certainty. Since the prognosis is better with early diagnosis and appropriate intervention, effective preventive measures for other workers with exposure should be addressed. CONCLUSIONS The substantial prevalence of WRA supports consideration of the diagnosis in all who present with new-onset or worsening asthma, followed by appropriate investigations and intervention including consideration of other exposed workers.
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Affiliation(s)
| | - John Balmes
- University of California San Francisco, San Francisco, CA
| | | | | | - William Beckett
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Paul D Blanc
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Philip Harber
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | - Brian Rowe
- University of Alberta, Calgary, AB, Canada
| | - Julia Heitzer
- American College of Chest Physicians, Northbrook, IL
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