Significance of precipitins and asymptomatic lymphocytic alveolitis: a 20-yr follow-up.

What is the significance of serum precipitins and lymphocytic alveolitis in a healthy subject exposed to antigens responsible for hypersensitivity pneumonitis (HP)? This study was done to evaluate the 20-yr outcome of asymptomatic dairy farmers with or without precipitins or lymphocytic alveolitis in their bronchoalveolar lavage (BAL). Twenty-seven of the initial 43 farmers were restudied. Of the missing 16, 11 refused the follow-up, three had died and two could not be located. The restudied farmers had a clinical evaluation, lung function tests and a high resolution computed tomography (HRCT). Only one subject, an asthmatic, had dyspnoea, none described present or past symptoms suggestive of HP. Of those who were no longer on the farm, none had quit because of respiratory problems. Lung function changes were as expected with aging. The only difference was that farmers with positive precipitins had a statistically significant greater decrease in their forced expiratory volume in one second than the sero-negative farmers. Four HRCTs showed signs of minimal parenchymal abnormalities; these were not more prevalent for subjects with or without precipitins or BAL lymphocytosis. Serum precipitins and asymptomatic lymphocytic alveolitis in an asymptomatic, exposed dairy farmer have no clinically meaningful long-term consequences.

High-resolution computed tomographic characteristics in acute farmer's lung and in its follow-up.

High resolution computed tomography (HRCT) scans are increasingly used in hypersensitivity pneumonitis (HP). This study looked at HRCT findings at different phases of farmer's lung (FL), a common form of HP. A cross sectional analysis of 95 HRCT scans of FL cases (20 acute, 75 with a history of FL, 48 still in contact (Ex +) (dairy farm), and 27 who had ceased contact (Ex-)) was made. All scans were read independently by two, and if needed by three, radiologists blinded to the category. The lungs were divided into six regions (fives lobes + lingula), and read for attenuation/mosaic, ground-glass, micronodules, fibrosis, and emphysema. A score of 0-3 was given for each region and each variable: 0 = absence, 1 =<25% of the surface, 2 = 25-50%, 3 =>50%. Mediastinal lymphadenopathy was also noted. Ground glass, predominating in the lower lobes, was the most frequent feature in the acute and Ex+ cases. Other abnormalities had no preferential distribution. Ex+ had more ground-glass than the Ex- (p=0.0025). Emphysema was more frequently seen than interstitial fibrosis (p=0.004). Mediastinal lymphadenopathy was present in 26 cases (9 acute, 10 Ex+ and 7 Ex-). In conclusion, in farmer's lung: 1) ground-glass predominates in the lower lobes while the other abnormalities have no anatomic predilection; 2) contact avoidance allows a better resolution of computed tomography abnormalities than continued exposure; 3) emphysema is a more frequent finding than interstitial fibrosis; and 4) the presence of mediastinal lymphadenopathy has no negative diagnostic value.

Farming practices and the respiratory health risks of swine confinement buildings.

This study investigated whether clean swine confinement buildings (SCB) are less harmful to the respiratory system than older and dirtier facilities. Eight healthy volunteers were exposed for 4 h, at 1 week intervals, to eight SCB representing the widest possible range of cleanliness. Each volunteer and a technician rated the SCB for cleanliness from 1-10, 1 being the cleanest possible. Airborne dust, bacteria, endotoxin levels, molds, and ammonia were measured. For each volunteer measured, before and after each exposure, forced expiratory flows (forced expiratory volume in one second (FEV1), and forced vital capacity), white cells in nasal wash and venous blood, and nasal lavage levels of interleukin (IL)-8 and serum levels of IL-6. A methacholine challenge was obtained at baseline and following each exposure. Cleanliness scores ranged 1.5-8.25. Mean airborne levels were: dust 3.54 mg x m(-3) bacteria 4.25 x 10(5) CFU x m(-3); endotoxins 404 EU x m(-3); molds 883 CFU x m(-3); ammonia 20.7 parts per million (ppm). Expiratory flows decreased after exposure (FEV1 from 4.8+/-0.7 to 4.4+/-0.7, p<0.001), neutrophils in the nasal wash and white blood cells increased (28.5+/-37 to 424+/-207 x 10(3), 5.4+/-1.0 to 7.4+/-1.7 x 10(9) cells x mL(-1) respectively), IL-8 increased from 158+/-311 to 2679+/-639 pg x mL(-1), IL-6 from 0.15+/-0.26 to 2.34+/-0.92 pg x mL(-1), (p<0.001). All SCB were similarly harmful. In conclusion, modern farming has not succeeded in making swine confinement buildings inoffensive to exposed subjects.

Case management with homeless women: a descriptive study.

This article presents the results of a three-year survey of the activities of two case managers following 25 homeless women with substance abuse problems. The case managers' activity record indicated that a great deal of the case managers' energy was devoted to providing direct, concrete services. More than half the clients received four weekly contacts, for an average total of two hours/client/week. Furthermore, direct support accounted for 42.2% of all contacts reported by the case managers, suggesting that, although case managers fill many different functions, establishing and maintaining a significant relationship with the participants constituted a major part of their work. The study confirms that a high staff-to-client ratio is required to respond to the multiple needs of this population.

[Intervention in mental health: an unexpected function of shelters for homeless women]. / L'intervention en santé mentale: le mandat inattendu des maisons d'hébergement pour femmes sans abri.

The development of services for the homeless is today the target of widespread criticism. Institutions are tending to duplicate services to ensure their survival, which brings about the risk of creating second-rate services for this area of the population. In addition, many critics fear that, because of policies established by institutions, services for the homeless tend to foster rather than fight transience. Based on an analysis of the evolution of mandates of shelters for homeless women, the author suggests that the development of services for the homeless has been influenced by factors other than the survival instinct of these organizations.

[Shelters for homeless women: more than just a roof]. / Les maisons d'hébergement pour femmes sans abri: plus qu'un toit.

Until today, research on the homeless has mainly focused on the characteristics of this transient population and on the factors that have contributed to transience. However, there is little available information on the role of shelters in the distribution of services. This article is based on a study of women who have kept in contact with a shelter for homeless women after having left. It looks at the main characteristics of these women and at the types of links they have maintained. Results tend to show that: (1) the function of shelters for the homeless is not simply limited to providing lodging; (2) these shelters are part of the social resources of this transient population; (3) it is crucial that the services offered by these shelters be better known, and that they be recognized as essential partners in the planning of services, including in the case of homeless women who suffer from mental health problems.