Short-term effectiveness of an asthma educational program: results of a randomized controlled trial.

Asthma educational programs have been shown to reduce the use of emergency room, frequency of severe asthma attacks and hospitalization. However, its effectiveness in other morbidity parameters and on quality of life has yet to be fully understood. This prospective randomized control trial evaluated the effectiveness of a patient education program in 77 asthmatics according to "Teach Your Patients About Asthma: A Clinicians Guide" (1992). Forty asthmatic patientswere randomly allocated to Group A (usual treatment) and 37 to Group B (usual treatment plus a patient education program). The effectiveness of the educational program was evaluated by comparing morbidity outcomes at baseline and 3 months after initial evaluation. At enrolment, the two groups were not different with regard to age, sex, smoking, asthma severity atopy, FEV1, symptom-free days, use of rescue salbutamol and quality of life. Three months later, subjects in Group B showed a significant improvement in the overall quality of life (p < 0.01) and in the "Symptoms"domain (p < 0.01). None of the other parameters (use of rescue salbutamol, symptom-free days, days absent from work or school, FEV1) showed any significant change. After stratification for asthma severity, only subjects with moderate-to-severe asthma showed a significant improvement inthe overall qualityof life (p < 0.05) and in the "Symptoms" (p < 0.01) and 'Activities" (< 0.05) domains. Moreover, in subjects with moderate-to-severe asthma FEV1 value at the 3rd month of follow-up was higher in Group B than in Group A (p < 0.05). In conclusion, the educational program improved the quality of life in asthratic subjects, mainly in patients with moderate-to-severe asthma.

[Smoking in the workplace. Study at a hospital in central Italy]. / L'abitudine al fumo di tabacco nei luoghi di lavoro. Studio in un'Azienda Ospedaliera dell'Italia centrale.

Smoking is the leading preventable cause of death and the source of numerous problems in the workplace. This study assessed the smoking in health care workers in a general hospital in Central Italy. As part of the health surveillance required by Law No. 626/1994, 2743 employers (40.8% males, 59.2% females; mean age 42.0 ys, SD 9.6 ys) were interviewed. The prevalence of smokers was very high: 36.0% in men and 36.7% in women. When the population was stratified according to occupation, the highest prevalence of smokers was found in ward orderlies (45.2%) and nurses (38.9%) and the lowest in doctors (26.3%). The prevalence of smoking was similar in all occupational divisions--clinical, surgery, diagnostics and administration. This study shows that smoking is more widespread in hospital workers than in an age-matched section of the general population (27.5%). As all health workers should set a positive example in combatting smoking, occupational physicians in charge of health surveillance in hospitals should actively collaborate in smoking dissuasion programmes.

[The response to a specific bronchial provocation test and the evolution of occupational asthma. A longitudinal study in subjects with toluene diisocyanate-induced asthma]. / Risposta al test di provocazione bronchiale specifica ed evoluzione dell'asma professionale. Studio longitudinale in soggetti con asma da toluendiisocianato (TDI).

The aim of this study was to investigate the progression and long-term consequences of occupational asthma and to evaluate the effect of the pattern of response to specific bronchoprovocation test (SBPT) in the prognosis of occupational asthma among 40 subjects with asthma due to toluene diisocyanate (TDI). Nine subjects had immediate asthma, 25 subjects had late asthma and 6 subjects had dual asthma. Respiratory symptoms, persistence of exposure to TDI and lung function have been investigated both at diagnosis and at follow-up examination. At follow-up examination, 70.0% of the subjects were not exposed to TDI, and only 14.3% of "non-exposed" subjects were completely asymptomatic. At follow-up examination, 71.4% of "exposed" subjects and 55.6% of "non-exposed" subjects were regularly treated with medications because of their asthma (no statistical difference). No significant differences have been found in symptoms prevalence or lung function between "exposed" and "non-exposed" subjects. After comparing the results obtained at diagnosis and at follow-up examination, a significant decrease in FVC both in "exposed" and "non-exposed" groups (p < 0.005 and p < 0.0005, respectively) and a significant decrement in FEV1 (p < 0.05) and FVC (p < 0.0005) among the subjects with late asthma, was found. We can conclude that, despite the removal from TDI exposure, occupational asthma can lead to permanent disability with important socio-economic consequences, and late response to SBPT may be a negative prognostic factor in TDI asthma.

Acute thrombocytopenia following oral cholecystography with iopanoic acid.

We report a case of severe thrombocytopenia following oral cholecystography with iopanoic acid, a widely used contrast medium. A bone marrow aspirate showed increased numbers of megakaryocytes, suggesting a thrombocytopenia due to enhanced peripheral destruction of platelets; this examination was not reported in the previously described two cases. Although hematological reactions due to iopanoic acid are very rare, it would be wise to question patients regarding any preceding drug-induced purpura before proceeding with oral cholecystography.

Recurrent nocturnal asthma due to tolylene di-isocyanate: a case report.

In a carpenter with a history of nocturnal dyspnoea, a bronchial provocation test with a tolylene di-isocyanate (TDI) activator elicited a non-immediate asthmatic reaction, followed by recurrent nocturnal asthma for five subsequent nights. Subsequently, the study of the circadian rhythm of airflow, registered during work, confirmed the presence of recurrent nocturnal asthma of occupational origin.

Toxic polyneuropathy of shoe-industry workers. A study of 122 cases.

The toxic polyneuropathy observed in a group of shoe-industry workers in Italy was clinically characterised by a symmetrical prevalently distal motor deficit, with occasional marked weakness of pelvic girdle muscles, and frequently by only subjective sensory symptoms; non-specific disturbances usually preceded neurological signs. Subclinical cases of 'minimal' chronic neuropathy, characterised by alterations of a neurogenic type in the EMG without a reduction of motor nerve conduction velocity, were also observed. Worsening of the clinical picture, with further lowering of nerve conduction velocity, was noted in some cases up to four months after removal from the toxic environment. In the most severe cases clinical recovery took up to three years. The electromyographic and electroneurographic features were consistent with a mixed axonal neuropathy, with clear prevalence of the damage in the distal part of the nerve (dying-back neuropathy). Volatile substances, such as n-hexane and other low boiling point hydrocarbons found in high percentage in solvents and glues, are suggested as the causative agent.

Shoe-makers' polyneuropathy in Italy: the aetiological problem.

Since 1957, when the first cases of the so-called shoe-makers' toxic polyneuropathy were reported, nearly 400 cases have been described in the Italian literature. The substance that was considered to be responsible for the disease was triorthocresylphosphate (TOCP) contained in glues, artificial leathers, and some types of paints. However numerous chemical analyses of glues and leathers taken from factories where cases of the disease occurred have shown that in almost all instances little or no TOCP was present. In addition the disease manifests itself more frequently during winter and spring and this is not consistent with the absorption of the causative agent through the skin and/or gastrointestinal tract. In order to clarify the aetiology of the disease 122 workers in the shoe industry affected by toxic polymeuropathy during the period 1971-74 were studied. Workplaces where cases of polyneuropathy had occurred were visited and samples of glues and solvents were taken for chemical analysis. The polyneuropathy chiefly affects workers engaged in glueing and in the cleaning process, but it also affects those who do not have direct contact with glues or solvents. The disease is more common in women (68%) than in men (32%) and, in its more severe form begins with overwhelming prevalence during winter and early spring regardless of the job performed. No direct relationship has been found between the severity of the disease and the number of years of work in the shoe industry or of specific exposure (that is the number of years of work in the activity performed at the onset of the disease). The polyneuropathy is found almost exclusively among workers of the artisam type in small shoe factories, where standards of hygiene are low. Chemical analysis of glues and cleaning fluids collected from five different factories, where 20 cases of polyneuropathy occurred, showed the presence of paraffin hydrocarbons with a low boiling point (pentane, 2-methyl-pentane, 3-methyl-pentane, n-hexane, etc.) in concentrations of more than 80% by weight.