Lived Experiences of Patients Suffering from Acute Old World Cutaneous Leishmaniasis: a Qualitative Content Analysis Study from Iran

Background: The aim of this study was to explore the experiences of patients who suffer from acute cutaneous leishmaniasis in Iran, focusing on quality of life.Methods: The study was conducted at two different sites in Iran in 2010–2011. Individual in-depth interviews were conducted with six men and six women parasitologically confirmed acute cutaneous leishmaniasis. Interviews were recorded, transcribed verbatim, and translated into English. Qualitative content analysis was used for data analysis.Results: The participants, aged 23 to 63yr, had mild to severe disease. Based on the analysis four main themes were developed. "Fearing an agonizing disease" reflects patients' experiences of disease development resulting in sadness and depression, "struggling to cope" and "taking on the blame" both illustrate how patients experience living with the disease, which included both felt and enacted stigma as major social concerns. "Longing for being seen and heard" refers to patients' experiences with healthcare as well as their expectations and demands from communities and healthcare to be involved in closing the knowledge and awareness gap.Conclusion: Mental and social dimensions of cutaneous leishmaniasis were complex and adversely affected patients' lives by causing psychological burden and limiting their social interactions. Health authorities have to plan programs to increase the disease awareness to prevent the existing stigma to improve patients' social condition and medical care.</p

Circuit-based interrogation of sleep control.

Sleep is a fundamental biological process observed widely in the animal kingdom, but the neural circuits generating sleep remain poorly understood. Understanding the brain mechanisms controlling sleep requires the identification of key neurons in the control circuits and mapping of their synaptic connections. Technical innovations over the past decade have greatly facilitated dissection of the sleep circuits. This has set the stage for understanding how a variety of environmental and physiological factors influence sleep. The ability to initiate and terminate sleep on command will also help us to elucidate its functions within and beyond the brain

Office illness : the worker, the work and the workplace

The work started with the clinical observations in patients working in buildings with indoor air problems. Signs of seborrhoeic dermatitis, erythematous facial skin conditions and itching conditions on the trunk were noted. Another point of departure was the attribution of facial skin symptoms to VDT work by patients. A questionnaire-based prevalence study of symptoms compatible with the Sick Building Syndrome (SBS) and facial skin symptoms in 4,943 office workers formed the basis for two case referent studies, one focusing on SBS, the other on facial skin symptoms in VDT workers. The prevalence of SBS was three times higher in women than men. The prevalence was higher in young persons and in atopies. Facial skin symptoms showed the same pattern. Psychosocial work load, paper and VDT work were also risk indicators for SBS and for skin symptoms. The symptom excess in women was analyzed with reference to differences in biological or acquired risks and different illness and reporting behaviour. In spite of inequalities in social conditions at home and at work and differences in physical working conditions, these differences could only explain a small part of the gender difference. The odds ratio for SBS in women was lowered from 3.4 in the crude analysis to 3.0 in the multivariate analysis. Effect modification was in most cases stronger in men and the clinical validation of the questionnaire refuted the hypothesis that women over-report symptoms. The results indicate that the gender difference in symptom prevalence is part of a general pattem common to psychosomatic illnesses. In the case referent study of SBS, atopy, psychosocial work load, buildings built or renovated after 1977, the presence of photocopiers and a low outdoor air flow rate were risk indicators. The association between air quality and the occurrence of SBS symptoms was demonstrated by a flow-response relation between the outdoor air flow rate and SBS symptoms. In the case referent study of skin symptoms in VDT work, psychosocial work load, electric background fields, the presence of fluorescent lights with plastic shields and low cleaning frequency were risk indicators. The clinical findings in the two case groups and their referents supported the applied relevance of the studies. Compared with the referents, the SBS cases had more work- related facial erythema, seborriioeic dermatitis and general pruritus, while skin symptom cases, had more work-related facial erythema than their referents. The results show that SBS symptoms and facial skin symptoms have a multifactorial background with constitutional, psychosocial and physical risk indicators. As the indoor air quality is a determinant of SBS symptoms, and the building itself is but one source of indoor air pollution, it is suggested that the name Sick Building Syndrome (SBS) be replaced by Indoor Air Syndrome (IAS).Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 5 uppsatser.digitalisering@um

Office illness : the worker, the work and the workplace

The work started with the clinical observations in patients working in buildings with indoor air problems. Signs of seborrhoeic dermatitis, erythematous facial skin conditions and itching conditions on the trunk were noted. Another point of departure was the attribution of facial skin symptoms to VDT work by patients. A questionnaire-based prevalence study of symptoms compatible with the Sick Building Syndrome (SBS) and facial skin symptoms in 4,943 office workers formed the basis for two case referent studies, one focusing on SBS, the other on facial skin symptoms in VDT workers. The prevalence of SBS was three times higher in women than men. The prevalence was higher in young persons and in atopies. Facial skin symptoms showed the same pattern. Psychosocial work load, paper and VDT work were also risk indicators for SBS and for skin symptoms. The symptom excess in women was analyzed with reference to differences in biological or acquired risks and different illness and reporting behaviour. In spite of inequalities in social conditions at home and at work and differences in physical working conditions, these differences could only explain a small part of the gender difference. The odds ratio for SBS in women was lowered from 3.4 in the crude analysis to 3.0 in the multivariate analysis. Effect modification was in most cases stronger in men and the clinical validation of the questionnaire refuted the hypothesis that women over-report symptoms. The results indicate that the gender difference in symptom prevalence is part of a general pattem common to psychosomatic illnesses. In the case referent study of SBS, atopy, psychosocial work load, buildings built or renovated after 1977, the presence of photocopiers and a low outdoor air flow rate were risk indicators. The association between air quality and the occurrence of SBS symptoms was demonstrated by a flow-response relation between the outdoor air flow rate and SBS symptoms. In the case referent study of skin symptoms in VDT work, psychosocial work load, electric background fields, the presence of fluorescent lights with plastic shields and low cleaning frequency were risk indicators. The clinical findings in the two case groups and their referents supported the applied relevance of the studies. Compared with the referents, the SBS cases had more work- related facial erythema, seborriioeic dermatitis and general pruritus, while skin symptom cases, had more work-related facial erythema than their referents. The results show that SBS symptoms and facial skin symptoms have a multifactorial background with constitutional, psychosocial and physical risk indicators. As the indoor air quality is a determinant of SBS symptoms, and the building itself is but one source of indoor air pollution, it is suggested that the name Sick Building Syndrome (SBS) be replaced by Indoor Air Syndrome (IAS).Diss. (sammanfattning) Umeå : Umeå universitet, 1994, härtill 5 uppsatser.digitalisering@um

Assessment of workers’ knowledge and views of occupational health hazards of gold mining in Obuasi Municipality, Ghana

Background: Small-scale mining in Ghana has been a major community and national concern due to its contribution to the destruction of farmlands and bodies of water, and to the loss of human life. Small-scale mining exposes workers to varying degrees of health hazards and problems. Objectives: The study aimed to assess the knowledge and views of workers about the occupational health hazards and problems related to small-scale gold mining in Obuasi Municipality, Ghana, to help improve workers’ safety at the mining sites. Methods: A cross-sectional study was done between May and December 2011. Simple random sampling was used to select 150 small-scale miners take part in this study. The workers were asked about their knowledge and views of occupational health hazards and problems related to gold mining. Data were entered with EpiData Entry 3.1 and analyzed using Stata 11. Results: Most workers (63.3%) had low knowledge of occupational health and safety regulations. Multivariable logistic regression analysis showed that knowledge about regulations was associated with level of education (OR = 8.5; 95% CI: 7–10.5). The common effects of mining that workers expressed awareness of were land pollution (30%), water pollution (28%), air pollution (18.7%), and noise pollution (16%). The factors influencing exposure to health hazards related to mining were low educational levels (14%), little work experience (30.7%), incorrect handling of equipment or chemicals (26%), poor law enforcement (12.7%), and negligence (16.7%). In general, occupational lung disease (16%), occupational hearing loss (14%), heat illnesses (12%), eye infections (16%), malaria (24%), and skin infections (18%) were the most common health problems study participants mentioned. Conclusion: High levels of occupational health hazards and problems related to gold mining exist among workers in private mines. Safety program should be offered as part of associated public health programs to limit the most significant risks. We further recommend education and training on regulations and the use of personal protective equipment

Is p-tert-butylphenol-formaldehyde resin (PTBP-FR) in TRUE Test (R) (Mekos test) sensitizing the tested patients?

Background. In a population study using TRUE Test (R), we noted late reactions to p-tert-butylphenol-formaldehyde resin (PTBP-FR) in 0.5% of subjects tested. Objectives. In order to explore possible test sensitization, differences in the contents of sensitizers within PTBP-FR in test preparations for TRUE Test (R) and Finn Chambers (R) were analysed. Subjects allergic to PTBP-FR and subjects with late reactions to PTBP-FR were retested in order to explore whether these groups reacted to different PTBP-FR sensitizers. Pallents/materials/methods. Four individuals with late reactions and 5 subjects with established allergy to PTBP-FR were retested with defined PTBP-FR sensitizers. PTBP-FR constituents in patches from TRUE Test (R) were analysed with high-performance liquid chromatography. Previously analysed samples of PTBP-FR constituents served as a reference. Results. The pattern of reaction to PTBP-FR sensitizers was similar in both groups. Subjects with suspected sensitization had somewhat stronger reactions than controls. The concentrations of monomers, dimers and trimers were generally higher in the TRUE Test (R) resin than in reference substances. Conclusions. Retesting did not add information regarding causes of possible sensitization. Analysis showed that the resin used in TRUE Test (R) has a lower degree of polymerization or condensation, which may enhance its sensitizing properties. A follow-up of late reactions to PTBP-FR in TRUE Test (R) should be carried out

Dermatology in public health - a model for surveillance of common skin diseases

Aims: The aim was to establish a baseline prevalence of skin conditions of public health importance in the general population and taking the validity of the questions into account. Our model is intended for future surveillance of skin conditions. Methods: The suggested questions have for the first time been used in Swedish population surveys. A random sample was taken from the general population aged 16 to 84 years of the participating areas. Results: During the past 12 months, hand eczema was reported by 9.4%, childhood eczema by 15.7% and nickel allergy by 13.7% of the population. Hand and childhood eczema questions have previously been validated. Taking the validity into account, the actual population prevalence of hand eczema (11.7%) is underestimated, and the prevalence of atopic childhood eczema (10.0%) is overestimated based on the results of the questionnaire. In addition to presenting prevalence, population survey results can be used for risk analyses. A 10-fold risk of hand eczema in individuals with childhood eczema and self-reported nickel sensitivity is shown in our study. Conclusions: Questionnaires can be used for epidemiologic surveillance so long as the questions are validated and that the validity is taken into account when estimating the occurrence of the conditions. Public health surveys such as this one lay the basis for future epidemiological surveillance of skin conditions that can be subject to interventions. We propose that these, or similar, questions should be used regularly in population surveys and supplemented by questions on skin exposure

Time trends in Swedish patch test data from 1992 to 2000. A multi-centre study based on age-adjusted and sex-adjusted results of the Swedish standard series

Allergic contact dermatitis is recognized as a public health problem and some major allergens have been subject to intervention aiming at lowering skin exposure. There is an obvious interest in evaluating the effect of such interventions. Population studies are difficult to perform and epidemiological studies based on clinical data from testing patients with contact dermatitis are common surrogates. Our objective was to gather Swedish clinical standard series test data on two occasions in order to monitor trends in sensitization rates. Consecutive patch test results from the Swedish standard series were collected from 9 centres from 1991 to 1993 and from 1999 to 2001. In total, 3680 and 3790 patients, respectively, were included. Crude, age-adjusted and age-stratified prevalence are given separately for women and men. Our top 10 allergens are much in line with newly published European test data. Significant changes among those allergens are increasing sensitization rates for Myroxylon pereirae and decreasing rates for colophony, 5-chloro-2-methyl-4-isothiazolin-3-one, Amerchol L 101 and thiuram mix. Nickel allergy is decreasing among young women. Among less common allergens, a noteworthy increase of sensitization to 4-phenylendiamine is found. In conclusion, significant trends in sensitization rates of important allergen, reflecting changes in exposure, have been found

A Higher Score on the Dermatology Life Quality Index, Being on Systemic Treatment and Having a Diagnosis of Psoriatic Arthritis is Associated with Increased Costs in Patients with Plaque Psoriasis

The aim of this study was to examine the relationship between measures of disease severity and costs from a socie-tal perspective in patients with plaque psoriasis. Dermatologists in Sweden recruited 443 consecutive patients who had had no biological treatment during the past 12 months. Following a Psoriasis Area and Severity Index (PASI) assessment, subjects completed self-assessments on health status/quality of life and a healthcare resource utilization/work status questionnaire. The costs of healthcare resources and sick-leave due to plaque psoriasis were estimated and related to the subject's health status. A patient's Dermatology Life Quality Index (DLQI) and being on systemic therapy, or having diagnosis of psoriatic arthritis, appeared to be more strongly associated with direct and indirect costs than did their PASI. The cost of biological therapy should be considered from the perspective of the already high costs of patients with high DLQI undergoing traditional systemic treatment