Comparison of clinic models for patients with work-related asthma.

BACKGROUND: Work-related asthma (WRA) is a prevalent occupational lung disease that is associated with undesirable effects on psychological status, quality of life (QoL), workplace activity and socioeconomic status. Previous studies have also indicated that clinic structure may impact outcomes among patients with asthma. AIMS: To identify the impact of clinic structure on psychological status, QoL, workplace limitations and socioeconomic status of patients with WRA among two different tertiary clinic models. METHODS: We performed a cross-sectional analysis between two tertiary clinics: clinic 1 had a traditional referral base and clinical staffing while clinic 2 entirely comprised Worker's Compensation System referrals and included an occupational hygienist and a return-to-work coordinator. Beck Anxiety and Depression II Inventories (BAI and BDI-II), Marks' Asthma Quality of Life Questionnaire (M-AQLQ) and Work Limitation Questionnaire (WLQ) were used to assess outcomes for patients with WRA. RESULTS: Clinic 2 participants had a better psychological status across the four instruments compared with clinic 1 (for Beck 'Anxiety': P < 0.001 and 'Depression': P < 0.01, 'Mood' domain of M-AQLQ: NS and 'Mental Demands' domain of WLQ: P < 0.01). Clinic 2 had a greater proportion of participants with reduced income. CONCLUSIONS: Our study indicates that clinic structure may play a role in outcomes. Future research should examine this in larger sample sizes.

Comparison of Psychological, Quality of Life, Work-Limitation, and Socioeconomic Status Between Patients With Occupational Asthma and Work-Exacerbated Asthma.

OBJECTIVE: The aim of this study was to compare psychological status, quality of life (QoL), work limitation, and socioeconomic status between patients with occupational asthma (OA) and work-exacerbated asthma (WEA). METHODS: The following questionnaires were administered to participants: Beck anxiety and depression (II) inventories, Marks' Asthma Quality of Life Questionnaire, and Work Limitations Questionnaire. Cross-sectional analyses between OA and WEA subgroups were completed. RESULTS: There were 77 participants. WEA subjects had a trend to higher anxiety scores (OA = 9.2 ±â€Š8.0, WEA = 12.8 ±â€Š8.3, P = 0.07, Cohen d = 0.4). Depression scores trended higher for those with WEA (OA = 9.6 ±â€Š10.3, WEA = 13.4 ±â€Š13.5, P = 0.2, Cohen d = 0.3). QoL was comparable between groups. WEA subjects had fewer work limitations (N = 50, OA = 25.1 ±â€Š27.3, WEA = 20.6 ±â€Š24.4, P = 0.56, Cohen d = 0.3) and OA subjects were more likely to have reduced income. CONCLUSION: In a tertiary clinic, there were some modest differences for specific variables between OA and WEA subjects that may help inform management.

Prospective Impact of Psychiatric Disorders on Employment Status and Health Care Use in Patients Investigated for Occupational Asthma.

OBJECTIVE: We previously reported high rates (34%) of psychiatric disorders (PSY) in patients evaluated for occupational asthma (OA). We determined the impact of PSY on employment status and health care use 12 to 18 months later. METHODS: One hundred ninety-six patients underwent clinical and psychiatric interviews on the day of their OA evaluation. Patients were re-contacted 12to 18 months later to assess employment status and health care use. RESULTS: Results indicated that patients with a PSY at baseline were less likely to be employed (adjusted odds ratio = 2.88; 95% confidence interval = 1.29 to 6.44) irrespective of final medical diagnosis (including OA), and had higher rates of emergency visits (35% vs 19%, P = 0.04). CONCLUSION: Psychiatric morbidity is common in this population and associated with lower employment rates and greater use of emergency services. Greater efforts should be made to assess and treat PSY in this population.

Assessing work-asthma interaction with Amazon Mechanical Turk.

OBJECTIVES: To illustrate the utility of crowdsourcing for occupational health surveillance. METHODS: Amazon Mechanical Turk was used to recruit and obtain information from employed persons with asthma, who answered questions about work-asthma interactions. RESULTS: Data collection from 60 subjects required only a few hours. Participants spent on average 7 minutes responding to seven questions (one optional) and used an average of 708 words. Work exacerbation, interference of asthma with work, and suggested workplace accommodation are frequent (83% reported at least one interaction). CONCLUSIONS: The full spectrum of work-asthma interactions should be considered. Modern crowdsourcing methods have considerable potential as occupational health surveillance tools because of their effectiveness; efficiency and financial viability are additional important advantages.

Asthma related to workplace dampness and impaired work ability.

PURPOSE: To examine the long-term effects on work ability among patients previously diagnosed with occupational asthma (OA) or work-exacerbated asthma (WEA) or symptoms in relation to workplace dampness. METHODS: A questionnaire follow-up was used to study 1,098 patients (of whom 87 % were female) examined because of a suspected occupational respiratory disease caused by building dampness and mold. Self-rated work ability and early withdrawal from work were the two outcomes of the study. As determinants, we investigated the influence of the asthma diagnosis given in the initial examinations (OA or WEA), the number of persistent indoor air symptoms, and the psychosocial factors at work. RESULTS: With a mean follow-up of 7.8 years, 40 % of the OA patients, under 65 years of age, were outside worklife versus 23 % of the WEA patients and 15 % of the patients with only upper respiratory symptoms at baseline. The diagnosis of OA was associated with a nearly sixfold risk for early withdrawal from work in a comparison with a reference group with upper respiratory symptoms. A perceived poor social climate at work and poor experiences with supervisory co-operation were associated with impaired work ability outcomes. Those with multiple, long-term indoor air symptoms considerably more often perceived their work ability to be poor when compared with those with less significant symptoms. CONCLUSIONS: Adverse work ability outcomes are associated with asthma in relation to workplace dampness. The study raises the need for effective preventive measures in order to help workers with indoor air symptoms sustain their work ability.

Long-term socioprofessional and psychological status in workers investigated for occupational asthma in quebec.

OBJECTIVE: To compare the long-term status of workers with occupational asthma (OA) with those of subjects with work-exacerbated asthma (WEA) and nonasthmatic (NA) workers. METHODS: We contacted 179 subjects investigated for suspected OA at Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada, from 1997 to 2007. Participants completed questionnaires on psychological and functional status, followed by a telephone interview about socioprofessional outcomes and health care utilization. RESULTS: The OA workers are more likely to have been removed from the workplace than the WEA workers. The health-related quality of life of all workers was still impaired. A high prevalence of psychiatric disorders was found among OA and WEA workers. Compared with WEA and OA workers, the NA group showed a higher rate of physician consultations for all causes. CONCLUSIONS: Regardless of the diagnosis they received, these workers need to benefit from psychosocial support in the period after investigation for suspicion of OA.

Prevalence of psychiatric disorders among patients investigated for occupational asthma: an overlooked differential diagnosis?

RATIONALE: Up to one-third of patients assessed for occupational asthma (OA) do not receive a diagnosis of OA or any other medical disorder. Although several differential diagnoses are considered (e.g., rhinitis, chronic obstructive pulmonary disease), psychiatric disorders (many with somatic complaints that mimic asthma) are rarely considered or assessed. OBJECTIVES: To assess the prevalence of psychiatric disorders (mood and anxiety disorders and hypochondriasis) in patients suspected of having OA, and whether psychiatric morbidity increases the risk of not receiving any medical diagnosis. METHODS: A total of 219 consecutive patients (57% male; mean age, 41.8 ± 11.1 yr) underwent sociodemographic and medical history interviews on the control or specific inhalation testing day of their OA evaluation. The Primary Care Evaluation of Mental Disorders was used to assess mood and anxiety disorders, and the Whiteley Hypochondriasis Index was used to assess hypochondriasis. MEASUREMENTS AND MAIN RESULTS: A total of 26% (n = 50) of patients had OA; 25% (n = 48) had asthma or work-exacerbated asthma; 14% (n = 28) had another inflammatory disorder; 13% (n = 26) had a noninflammatory disorder; and 22% (n = 44) did not receive any medical diagnosis. A total of 34% (n = 67) of patients had a psychiatric disorder: mood and anxiety disorders affected 29% (n = 57) and 24% (n = 46) of the sample, respectively, and 7% (n = 12) had scores on the Whiteley Hypochondriasis Index indicating hypochondriasis. Hypochondriasis, but not mood or anxiety disorders, was associated with an increased risk of not receiving any medical diagnosis (adjusted odds ratio, 3.92; 95% confidence interval, 1.18-13.05; P = 0.026). CONCLUSIONS: Psychiatric morbidity is common in this population, and hypochondriasis may account for a significant proportion of the "undiagnosable" cases of patients who present for evaluation of OA.

Health-related quality of life among adults with work-related asthma in the United States.

PURPOSE: The objective of this study was to examine health-related quality of life among adults with work-related asthma. METHODS: We analyzed 2006-2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance. RESULTS: Of ever-employed adults with current asthma, an estimated 9.0% had work-related asthma, 26.9 % had poor self-rated health, 20.6% had impaired physical health, 18.2% had impaired mental health, and 10.2% had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95% confidence interval (CI), 1.31-1.60], impaired physical health (PR, 1.60; 95% CI, 1.42-1.80), impaired mental health (PR, 1.55; 95% CI, 1.34-1.80), and activity limitation (PR, 2.16; 95% CI, 1.81-2.56). CONCLUSIONS: Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.

Pilot study of personality traits assessed by the Karolinska Scales of Personality (KSP) in asthma, atopy, and rhinitis.

Asthma and atopy are common diseases. To study associations between personality and asthma, atopy, rhinitis, and personality traits were measured on the Karolinska Scales of Personality for 193 persons working in 19 buildings with suspected indoor air problems. In addition, information on history of atopy, asthma, and rhinitis was collected by postal questionnaire. In analyses, asthma was associated with higher impulsiveness scores, and atopy in non-asthmatics was associated with higher social desirability scores and lower irritability, guilt, and impulsiveness scores. Non-atopic rhinitis was associated with scores on several anxiety-related scales, while atopic rhinitis was not associated with scores on the Karolinska Scales of Personality. This exploration implies that asthma, atopy, and rhinitis may be associated with various but different personality trait scores. The finding of such personality trait associations in persons with non-asthmatic atopy raises the question of a potential role of an emotional conflict in atopy and the role of personality in asthma, atopy, and rhinitis.