No abstract

Summary To evaluate occupational exposures as risk factors for hairy cell leukaemia (HCL), a population-based case-control study on 121 male HCL patients and 484 controls matched for age and sex was conducted. Elevated odds ratio (OR) was found for exposure to farm animals in general: OR 2.0, 95% confidence interval (Cl) 1.2-3.2. The ORs were elevated for exposure to cattle, horse, hog, poultry and sheep. Exposure to herbicides (OR 2.9, Cl 1.4-5.9), insecticides (OR 2.0, Cl 1.1-3.5), fungicides (OR 3.8, Cl 1.4-9.9) and impregnating agents (OR 2.4, Cl 1.3-4.6) also showed increased risk. Certain findings suggested that recall bias may have affected the results for farm animals, herbicides and insecticides. Exposure to organic solvents yielded elevated risk (OR 1.5, Cl 0.99-2.3), as did exposure to exhaust fumes (OR 2.1, Cl 1.3-3.3). In an additional multivariate model, the ORs remained elevated for all these exposures with the exception of insecticides. We found a reduced risk for smokers with OR 0.6 (Cl 0.4-1.1) because of an effect among non-farmers.

Psychological factors such as anxiety and depression are prevalent in patients with asthma. The purpose of this study was to investigate the relationship between respiratory symptoms and psychological status and to estimate the importance of psychological status in comparison with other factors that are known to be associated with respiratory symptoms. This study included 2270 subjects aged 20-44 (52% female) from Sweden, Iceland, and Norway. Each participant underwent a clinical interview including questions on respiratory symptoms. Spirometry and methacholine challenge were performed. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Eighty-two percent of the subjects reported no anxiety or depression whatsoever, 11% reported anxiety, 2.5% depression and 4% reported both anxiety and depression. All respiratory symptoms, such as wheezing, breathlessness and nightly symptoms, were more common, at a statistically significant level, in participants who had depression and anxiety, even after adjusting for confounders (ORs 1.33-1.94). The HADS score was the most important determinant for nightly symptoms and attacks of breathlessness when at rest whereas bronchial responsiveness was the most important determinant for wheezing, and breathlessness when wheezing. The probability of respiratory symptoms related to HADS score increased with increasing HADS score for all respiratory symptoms. In conclusion, there is a strong association between respiratory symptoms and psychological status. There is therefore a need for interventional studies designed to improve depression and anxiety in patients with respiratory symptoms.

The incidence of allergic alveolitis (AA) and of febrile reactions (FR) to inhaled mold dust in those who did not meet the criteria of AA was investigated in Swedish farmers, and the findings were related to farming methods and exposure type. A questionnaire was completed by 6,702 farmers. A stratified sample of 390 farmers underwent examination comprising spirometry, a skin-prick test, blood tests for precipitating antibodies and total IgE and an interview concerning symptoms, exposure and farming methods. The yearly incidence of AA was 2–3/10,000 farmers. The incidence of FR was 30–50 times higher (1/100 farmers) and the majority of these reactions was of a toxic rather than allergic type (organic dust toxic syndrome). Among farmers with recent FR or AA there was a higher frequency of positive precipitin reactions (p < 0.05). Exposures to moldy grain, straw, wood chips and hay were associated with both AA and FR. A major difference in exposure between 17 farmers with AA and 80 with FR was that AA appeared to require repeated exposure, while FR was associated with occasional heavy exposure to mold dust.

No abstract

The causes of the worldwide increase in asthma seen during the last decades remain largely unexplained, but lifestyle and diet are suggested to play important roles. In this follow up of a large-scale population sample in Sweden, we wanted to identify modifiable risk factors for the cumulative incidence over a 13-year follow-up period. In 1990, a self-administered questionnaire was completed by 12,560 individuals from three age groups (16, 30-39 and 60-69 years of age) in two counties of Sweden. In 2003, the eligible subjects (n = 11,282) were sent a new postal questionnaire. In total 8150 (response rate 73%) answered the questionnaire. The prevalence of asthma in 2003 had increased in all ages. In the young adults, the asthma prevalence rose from 11.3% in 1990 to 25.0% in 2003. Adult asthma onset was identified in 791 of the participants. Smoking [RR (95% CI) = 1.37 (1.12-1.68)], BMI [1.49 (1.25-1.77 per inter quartile range)], and nocturnal gastro-oesophageal reflux (GOR) [2.16 (1.72-2.72)] were significant independent risk factors for the cumulative incidence of asthma. The impact of risk factors differed between the age groups where BMI and GOR had a significantly higher impact in the middle aged and the elderly (p < 0.05). High consumption of fruit and fish was protective especially in the elderly [0.52 (0.35-0.77)]. No significant difference was found in the impact of risk factors between men and women. Weight loss, smoking cessation and a diet rich in fruit and fish may be of importance in preventing onset of adult asthma.

The lack of specialist nurses in operating theatres is a serious problem. The aim of this study was to describe reasons why specialist nurses in perioperative care chose to leave their workplaces and to describe the process from the thought to the decision. Twenty specialist nurses (i.e. anaesthesia, NA, and operating room nurses) from seven university- and county hospitals in Sweden participated in qualitative individual in-depth interviews. Data were analysed by systematic text condensation. We identified four themes of reasons why specialist nurses quitted their jobs: the head nurses' betrayal and dismissive attitude, and not feeling needed; inhumane working conditions leading to the negative health effects; not being free to decide about one's life and family life being more important than work; and, colleagues' diminishing behaviour. Leaving one's job was described as a process and specialist nurses had thought about it for some time. Two main reasons were described; the head nurse manager's dismissive attitude and treatment of their employees and colleagues' mistreatment and colleagues' diminishing behaviour. Increasing knowledge on the role of the head nurse managers in specialist nurses' decision making for leaving their workplace, and creating a friendly, non-violent workplace, may give the opportunity for them to take action before it is too late.

Clinical symptoms and exposure conditions were investigated in 80 farmers with organic dust toxic syndrome, defined as the occurrence of febrile reactions after exposure to organic dust in subjects with no evidence ofallergic alveolitis. The material was compiled from a field study of febrile reactions in the farming community and the diagnosis was based on interviews performed by physicians. Of the 75 men (mean age 44) and five women (mean age 39), only 13% of the men and none of the women were current smokers. One attack had been experienced by 44% and the remaining subjects had had two or more attacks, often several years apart. The duration ofsymptoms was 24 hours or less in 46% of the farmers and in 95% of the cases the symptoms lasted less than one week. The attacks were most common in the autumn and were usually provoked by handling grain (80% of the farmers with organic dust toxic syndrome). Other causes were hay, straw, wood chips, and silocapping material. The material was usually described as extremely mouldy and the episodes were usually provoked by unusual work tasks such as cleaning grain bins or removing mouldy feed. Twenty three farmers had consulted physicians: five of nine examined during symptoms had slightly abnormal chest radiographs and two of four examined had decreased arterial oxygen tension. Spirometry performed during a symptom free interval was normal.