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This study evaluated the concordance of Architect™ chemiluminescent microparticle immunoassays with Captia™ ELISA for cytomegalovirus (CMV) IgM and IgG, with Enzygnost™ and Captia™ ELISA for rubella IgM and IgG and with Trep-Sure™ ELISA for syphilis treponemal antibodies in a mixed pediatric and obstetrical population. Total agreement between assays and Kappa statistic value were 82.5% (95% CI: 75.6-87.7) and 0.65 (95% CI: 0.54-0.77) for CMV IgM, 82.8% (95% CI: 76.7-87.6) and 0.65 (95% CI: 0.55-0.75) for CMV IgG, 89.2% (95% CI: 82.9-93.4) and 0.56 (95% CI: 0.36-0.75) for rubella IgM, 88.6% (95% CI: 82.9-92.6) and 0.74 (95% CI: 0.63-0.84) for rubella IgG, and 97.9% (95% CI: 94.5-99.4) and 0.89 (95% CI: 0.79-1.00) for syphilis treponemal antibodies. This study demonstrates that the Architect™ chemiluminescent microparticle immunoassays correlate well with other FDA-approved ELISA assays in this specific population.

Background The detection of antibodies against Epstein-Barr viral capsid (VCA) and nuclear (EBNA) antigens is routinely performed with different commercially available immunoassays. Objectives In this study, we evaluated the concordance and performance of the Architect™ chemiluminescent microparticle immunoassays (CMIAs) using Captia™ enzyme linked immunosorbent assays (ELISA) for VCA IgM, and standard immunofluorescence (IF) assays for VCA IgG and EBNA IgG as comparative techniques. Study design Sera were selected from a heterogeneous population including pediatric and adult patients. Results Concordance between CMIAs and comparative assays was high with total agreement percentages of 84,1% (95% CI: 77.8–88.9) for VCA IgM, 90,6% (95% CI: 84.2–94.7) for EBNA IgG and 98,0% (95% CI: 93.9–99.6) for VCA IgG. Moreover, kappa statistic values showed good to excellent correlation with values of 0.68 (95% CI: 0.57–0.79) for VCA IgM, 0.73 (95% CI: 0.58–0.87) for EBNA IgG and 0.95 (95% CI: 0.89–1.00) for VCA IgG. A correlation was observed between positivity levels on CMIAs and semi-quantitative fluorescence intensity on IF for VCA IgG and EBNA IgG assays. With regard to an accepted gold standard IF assays, CMIA was 98,1% (95% CI: 93.3–99.8) sensitive and 97,4% (95% CI: 86.5–99.9) specific for the detection of VCA IgG. For the detection of EBNA IgG, it was 92,2% (95% CI: 85.1–96.6) sensitive and 84,6% (95% CI: 65.1–95.6) specific. Conclusion In summary, we demonstrated that the CMIA EBV antibody detection panel has high performance and high concordance with other commercially available immunoassays.

In response to the lack of sensitivity and reproducibility of previously marketed rapid antigen detection tests, a novel fluorescent immunoassay was recently developed. This new assay offers rapidity and automated reading. More characterization of this assay is needed. The aim of this study was to assess diagnostic performance of Sofia influenza A+B and respiratory syncytial virus (RSV) while compared to traditional viral cell culture. A total of 416 respiratory samples were analyzed prospectively with both methods in a tertiary pediatric center. Sensitivity and specificity of the Sofia™ test were 90.0% and 98.0% for influenza A, 90.9% and 98.9% for influenza B, and 87.7% and 94.7% for RSV compared to traditional cell culture. Overall, Sofia influenza A+B and RSV assays performed well in comparison to culture in a pediatric population.

Background The diagnosis of occupational asthma (OA) can be challenging and needs a stepwise approach. However, the predictive value of the methacholine challenge has never been addressed specifically in this context. Objective We sought to evaluate the sensitivity, specificity, and positive and negative predictive values of the methacholine challenge in OA. Methods A Canadian database was used to review 1012 cases of workers referred for a suspicion of OA between 1983 and 2011 and having had a specific inhalation challenge. We calculated the sensitivity, specificity, and positive and negative predictive values of methacholine challenges at baseline of the specific inhalation challenge, at the workplace, and outside work. Results At baseline, the methacholine challenge showed an overall sensitivity of 80.2% and a specificity of 47.1%, with positive and negative predictive values of 36.5% and 86.3%, respectively. Among the 430 subjects who were still working, the baseline measures displayed a sensitivity of 95.4%, a specificity of 40.1%, and positive and negative predictive values of 41.1% and 95.2%, respectively. Among the 582 subjects tested outside work, the baseline measures demonstrated a sensitivity and specificity of 66.7% and 52%, respectively, and positive and negative predictive values of 31.9% and 82.2%, respectively. When considering all subjects tested by a methacholine challenge at least once while at work (479), the sensitivity, specificity, and positive and negative predictive values were 98.1%, 39.1%, and 44.0% and 97.7%, respectively. Conclusion A negative methacholine challenge in a patient still exposed to the causative agent at work makes the diagnosis of OA very unlikely.

Background To examine pediatric oncologists' grief reactions to patient death, and the impact patient death has on their personal and professional lives. Procedure The grounded theory method was used. Data was collected between March 2012 and July 2012 at two academic centres in Canada. Twenty-one out of 34 eligible pediatric oncologists at different stages of their career were recruited and interviewed about their experiences with patient death. Inclusion criteria were: being able to speak English and having had a patient die in their care. The participants formed three groups of oncologists at different stages of career including: fellows, junior oncologists, and senior oncologists who varied in sub-specialties, gender, and ethnicities. Results Pediatric oncologists reported a range of reactions to patient death including sadness, crying, sleep loss, exhaustion, feeling physically ill, and a sense of personal loss. They also reported self-questioning, guilt, feelings of failure and helplessness. The impact of these deaths had personal consequences that ranged from irritability at home, feeling disconnected from family members and friends, and becoming more desensitized towards death, to gaining a greater and more appreciative perspective on life. Professional impacts included concern about turnover or burnout at work and improving holistic care as a result of patient deaths. Conclusions Grief over patient death and the emotional labour involved in these losses are a robust part of the pediatric oncology workplace and have major impacts on pediatric oncologist's personal and professional lives. Interventions that focus on how to help pediatric oncologists deal with these reactions are needed. Pediatr Blood Cancer 2015;62:134–142. © 2014 Wiley Periodicals, Inc.

Objective Because of its high prevalence, early screening for occupational asthma (OA) is crucial. We aimed to evaluate the screening performance of the Occupational Asthma Screening Questionnaire-11 items (OASQ-11) in a clinical setting. Methods Between January 2009 and December 2011, 169 workers referred for potential OA to our hospital completed the OASQ-11 and underwent workups to determine the final diagnosis. The discriminative abilities of the OASQ-11 as a whole and in relation to demographic and exposure parameters were determined by the area under the receiving operator characteristic curve (AUC). Results Model 1, consisting of the OASQ's items, showed fair discrimination (AUC, 0.69; 95% confidence interval, 0.58 to 0.80). Addition of age and exposure duration to model 1 improved discrimination (AUC, 0.80; confidence interval, 0.72 to 0.88). Conclusion A simple model consisting of the OASQ-11's items, age, and exposure duration could well discriminate subjects with OA in a clinical setting.

This article summarizes the main new categories of occupational agents responsible for causing occupational asthma, with and without a latency period reported in the last 10 years. It also reports examples of occupational agents for which the fabrication processing or use have influenced the outcome of occupational asthma.

Background and objective: Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a 1-year integrated care (IC) programme comprising two components (patient-centred education + case management) would be effective in preventing COPD-related hospitalizations. Methods: This was a retrospective longitudinal cohort study. Data were retrieved both from an administrative database in the province of Quebec (Canada), and from the medical records at two hospitals in Montreal. One hundred and eighty-nine COPD patients were randomly selected from registers at these centres, from 2004 to 2006. Patients in the intervention group underwent a programme comprising two components: patient -centred education—involving three group sessions of self-management education that included one motivational interview and instruction in the use of a written action plan; and case management—involving scheduled follow-up visits with access to a call centre. The intervention group was compared with a group receiving usual care (UC). The main outcome was COPD-related re-hospitalizations, with length of hospital stay and emergency department (ED) visits being secondary outcomes. Results: Logistic regression analysis with adjustment for covariates showed that there was a lower probability of re-hospitalization over the follow-up year in the IC group compared with the UC group (odds ratio 0.44; 95% confidence interval 0.23–0.85). Subgroup analyses revealed that the IC programme prevented more COPD-related hospitalizations in women compared with men. There were no significant between-group differences in length of hospital stay or number of ED visits. Conclusions: An IC programme combining self-management education and case-management can decrease rates of COPD-related hospitalizations, particularly among women.

Most previous research evaluating the effect of interventions on HRQoL in COPD patients has focused on measuring HRQoL using aggregated questionnaire scores, increasing the risk of false-negative results. There is also evidence to suggest that self-evaluations of functional status are less likely to be modified over time relative to self-evaluation of emotional status. This study was a secondary analysis of a prospective study that compared the efficacy of a self-management education program (SM) on emotional and functional dimensions of HRQoL. One hundred and ten patients were recruited from the Sacré-Coeur Hospital of Montreal (Canada). Patients were included in either the SM group (n = 60) or the usual-care group (UC, n = 50). The SM group underwent a 4-week intervention based on content featured in "Living Well with COPD" program. Patients were assessed pre and 12-months post-intervention; the primary outcome was net change in the emotional and functional subscales scores of the St-George's Respiratory Questionnaire (SGRQ) and Short-Form health survey questionnaire (SF-36). Only the emotional dimension scores of both the SGRQ (impact) and the SF-36 (mental component summary) were statistically and clinically improved in the SM group compared to UC. Also, the 12-month adjusted between-group difference in the SGRQ-impact scores was 3-fold higher than the minimum clinically important difference in SM vs. UC patients. HRQoL needs to be regarded as a combination of distinct self-evaluations with unique dynamics over time. This distinction should be taken into account in program development and evaluation, to choose intervention components likely to impact on both types of self-evaluations related to HRQoL.

OBJECTIVE: To assess the effects of a self-management program on health-related quality of life (HRQoL) and morbidity commonly associated with chronic obstructive pulmonary disease (COPD).METHODS: A total of 57 outpatients with stable COPD received four weeks of self-management education, while 45 patients received usual care. Patients were evaluated at baseline, at three months and one year following the educational intervention. The primary outcome variable was HRQoL measured by the St George’s Respiratory Questionnaire (SGRQ). The secondary outcome variables were number of emergency room visits and hospitalizations for exacerbation.RESULTS: The intervention group’s HRQoL improved significantly at three months (total score A=−5.0 [P=0.006]) and 12 months (total score A=−6.7 [PCONCLUSIONS: A planned education program improved HRQoL while decreasing the number of emergency room visits and hospitalizations in patients with stable COPD; this improvement persisted at 12 months.

Objectives Surveillance programmes for occupational asthma should reduce the severity of asthma both at the time of diagnosis and after removal from exposure as well as costs related to functional impairment. The aim of this study was to compare the severity and cost of diisocyanate-induced occupational asthma in workers participating in a surveillance programme and in twice the number of workers diagnosed after being referred by their physician. Methods Answers to a self-administered questionnaire led to possible referral for further assessment that included methacholine testing and specific inhalation challenges as the gold standard for confirming occupational asthma. Results Of the 2897 workers who participated, 182 (6.3%) had a positive questionnaire. 79/182 (43%) were referred for further medical assessment and 20 had confirmed occupational asthma by specific inhalation testing. At the time of diagnosis, the 20 screened subjects had a mean PC 20 of 3.35 mg/ml as compared to 1.50 mg/ml (p=0.05) in the 66 controls. Two years after diagnosis and removal from exposure, the 20 subjects screened had a mean PC 20 of 4.81 mg/ml compared to 1.67 mg/ml (p=0.03) in controls. Clinical remission occurred in 34% of the screened group compared to 16% of the control group (p=0.02). The median costs for functional impairment were $C11 900 in screened subjects and $C19 600 in controls (p=0.04). Conclusions Subjects with occupational asthma screened by a medical surveillance programme have a better outcome both at the time of diagnosis and 2 years after removal from exposure, with lower compensation costs compared to controls.

Objective To assess prospectively the impact of psychiatric disorders on risk for exacerbations. The course of chronic obstructive pulmonary disease (COPD) is punctuated by acute exacerbations. Although anxiety and mood disorders are common in patients with COPD, no studies have assessed prospectively the association between these disorders and exacerbations. Methods Psychiatric disorders were evaluated by a structured psychiatric interview in 110 patients (51% women, age (mean +/- standard deviation) = 66 +/- 8 years) with stable COPD and previous admission for exacerbations recruited from two outpatient clinics. Patients were followed for a mean of 2 years and both inpatient-treated (i.e., treated in the emergency department or hospital) and outpatient-treated (i.e., treated with medication in the patient's own environment) exacerbations were recorded. Results Independent of covariates, patients with psychiatric disorders exhibited a significantly higher weighted annual rate of exacerbations treated in an outpatient setting after adjustment for covariates (3 versus 2, p = .003) than patients without psychiatric disorders, but no difference in exacerbations treated in the inpatient setting. They were also at a higher risk for any (relative risk (RR) = 1.56, 95% Confidence Interval (CI) = 1.02-2.37) and outpatient (RR = 1.68, 95% CI = 1.08-2.59) exacerbations, but not inpatient exacerbations (RR = 1.36, 95% CI = 0.82-2.25). Conclusions Patients with psychiatric disorders are at greater risk of exacerbations treated in an outpatient setting but not those treated in an inpatient setting. These outpatient-managed exacerbations account for a significant proportion of the healthcare burden for COPD, so interventions should target patients with psychiatric disorders to improve management of COPD.

Background: Drug-related problems (DRPs) are common following hospital discharge. Active communication of a written pharmacy discharge plan may increase the number of community pharmacists' interventions. Objective: To assess the impact of the active communication of a written pharmacy discharge plan. Methods: This was a pilot study comparing 2 groups of pharmacists over a period of 6 weeks. Participating community pharmacists were assigned to either the control group (those who provided usual patient care during hospital stay and transmission of a standard written pharmacy discharge plan) or the active communication group (those who, in addition to the usual care provided in the control group and the written pharmacy discharge plan, included a list of up to 3 DRPs with proposed interventions to resolve them and a telephone call from the hospital pharmacist to the community pharmacist to facilitate the transfer of information). The patients enrolled were adults admitted to the respiratory unit of our hospital who were returning home following their discharge. Patients were assigned to the control or the active communication group based on the community pharmacy where they usually filled their prescriptions. Results: Overall, 36 community pharmacists were included in the study and assigned to either the active communication (n = 17) or control group (n = 19). A total of 22 patients were assigned to either the control group (n = 8) or the active communication group (n = 14). The mean number of community pharmacist interventions per patient was 4.2 in the active communication group and 0.9 in the control group (p = 0.0004). The mean number of DRPs per patient for which there was at least one intervention made by the community pharmacist was 2.8 in the active communication group and 0.6 in the control group (p = 0.0001). Conclusions: Results of this pilot study demonstrate that the active communication of a written discharge plan may increase the number of interventions by community pharmacists.

The objectives of this study were to evaluate the effect of a continuing education activity on the clinical evaluation and advice provided by nurses working for a telephone triage service with an asthmatic client base, and to measure the number of referrals to Asthma Education Centers (AECs). The results suggest a positive impact on the quality of the telephone intervention in the short term, but this was not sustained over time. Few patients were referred to an AEC.

Objective: The objective of this project was to assess both the outcome for patients diagnosed with proven isocyanate-induced occupational asthma (IIOA) by specific inhalation challenge (SIC) and the functional impairment, 2 years after cessation of exposure to isocyanates, using the compensation insurance scale proposed in the province of Quebec. Methods: We used a retrospective cohort of 233 patients diagnosed in the province of Quebec between 1985 and 2002 and randomly chose 105 of those patients. We kept 89 subjects with complete data at T0 (the time of diagnosis) and 79 were reevaluated at T2, approximately 2 years after their removal from exposure, for final impairment–disability assessment. At each evaluation (T0 and T2), a clinical examination and lung function tests, including spirometry and methacholine challenge, were performed. Results: At T2, 79 of 89 patients were reassessed (89%). The remaining patients were lost to follow up (8) or too unstable to be reassessed for final impairment–disability settlement (2). No statistical difference was observed for spirometry data and antiasthmatic medication use between T0 and T2 (P 0.11). At T2, 73% of patients were still using short-acting 2 agonists and 39% inhaled glucocorticoids. A forced expiratory volume in 1 second variation of 10% from T0 to T2 occurred in 31 subjects (40%). Forced expiratory volume in 1 second worsened in 14 (18%), remained significantly unchanged in 51 (64%), and improved in 14 (18%). Nonspecific bronchial hyperresponsiveness (BHR) improved in significantly in 19 (24%); the others remained unchanged. Both were not associated with smoking status (P 0.05). Nonspecific BHR was normalized in nine of 79 (11%) patients. Clinical remission occurred in only four (5%) subjects. The mean impairment– disability score was 21% 13% at 2 years according to the scale used by the Workers’ Compensation Board. Conclusions: These results show the generally poor medical outcome of IIOA and suggest the importance of early detection and withdrawal of the workers from exposure to isocyanates. They also emphasize the need for medical surveillance program and adequate treatment of patients with IIOA. (J Occup Environ Med. 2006;48:1093–1098)

Background The high burden of asthma appears to be related to poor asthma control. Although previous studies have reported associations between depressive disorders (DDs) and anxiety disorders (ADs) and worse asthma control and quality of life, the relative impact of these disorders on asthma control and quality of life has not been explored. This study evaluated the relative impact of having a DD and/or AD on asthma control and quality of life. Method Five hundred four consecutive adults with confirmed, physician-diagnosed asthma underwent a brief, structured psychiatric interview using the Primary Care Evaluation of Mental Disorders. Asthma control and asthma-related quality of life were assessed using the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ). All patients underwent standard spirometry. Results Thirty-one percent of patients (n = 157) met the diagnostic criteria for one or more psychiatric disorders (8% had DD only, 12% had AD only, and 11% had both). Analyses revealed independent effects for DDs on total ACQ scores (p Conclusions Results suggest that DDs and ADs are associated with worse asthma-related quality of life, but only DDs are associated with worse asthma control. Interestingly, having both a DD and an AD did not confer additional risk for worse asthma control or quality of life. Physicians may want to consider the differential impact of negative mood states when assessing levels of asthma control and quality of life.

Summary Asthma and obesity tend to co-occur, but relatively few studies have linked obesity, measured using body mass index (BMI), to clinically relevant measures of asthma morbidity. This study assessed BMI in a Canadian sample of asthma outpatients, and evaluated associations between BMI and levels of asthma severity, asthma control, and asthma-related quality of life. A total of 382 adult asthma patients underwent demographic and medical history interviews on the day of their clinic visit. Patients' self-reported height and weight were used to calculate BMI (kg/m 2 ). Asthma severity was classified according the GINA (2002) guidelines. Patients completed the Asthma Control (ACQ) and Asthma Quality of Life (AQLQ) Questionnaires and underwent standard pulmonary testing (spirometry). A total of 139 (36%) patients had a normal BMI; 149 (39%) patients were overweight; and 94 (25%) patients were obese. There was no relationship between BMI and asthma severity when controlling for age and sex. Patients with higher BMI scores had higher ACQ and lower AQLQ scores, independent of age, sex and asthma severity. Results identify higher BMI and obesity as potential behavioral factors related to worse asthma control and quality of life, but not asthma severity, and suggest important avenues for asthma management and control initiatives.

The second Jack Pepys Workshop on Occupational Asthma was held in Toronto, Canada, in May 2004. The present report summarises key questions and research needs as identified by the international participants. The audiotapes from the workshop discussions were summarised by the organising chairs of the Symposium and the resulting document was circulated for input from all invited workshop participants. In total, 100 key questions and research needs were identified. Identified needs included: provision of different definitions depending on the use of data; explanations for differences in frequency studies; and better characterisation of genetic and environmental determinants of occupational asthma. The role of irritants and the pathogenesis of various forms of work-related asthma need further research, and there are also questions and research needs for diagnosis, prevention and understanding of persistence and airway remodelling. In conclusion, although advances have been made in the understanding of occupational asthma and other work-related asthma, further key issues remain that need addressing.

BACKGROUND: Action plans are recommended for most patients with persistent asthma to reduce the morbidity associated with this chronic disease. Unfortunately, despite these recommendations, this tool remains underused.METHODS: The authors conducted a descriptive study at the asthma clinic of a tertiary care centre to determine the number of asthmatic patients presenting to a respiratory physician (new reference or follow-up visit) who possessed an individualized, written action plan, and to evaluate the patients’ level of confidence and perceived efficacy toward their plans. In addition, for all patients in the study, the level of confidence in and the perceived efficacy of three different action plans (two traditional tools versus a simplified tool) were compared.RESULTS: A total of 92 asthmatic patients were included in the study. Overall, 46% of the patients possessed an action plan. The patients’ average level of confidence and perceived efficacy toward their action plans were high (4.1 out of five and 3.3 out of four, respectively). When the three different action plans were compared, the level of confidence in and perceived efficacy of the traditional tools were similar, both being superior to the simplified tool.CONCLUSION: The number of asthmatic patients who presented to the asthma clinic and who possessed an action plan was higher than the reported Canadian mean of 10%; however, most of the patients were treated by specialized respiratory physicians, which may explain this improvement. Considering that most patients with persistent asthma should have an individualized, written action plan, the present study confirms that this tool is still not used for all asthmatic patients.

Monitoring airway inflammation by means of induced sputum cell counts seems to improve the management of asthma. We sought to assess whether such monitoring at the end of periods at and away from work combined with the monitoring of PEF could improve the diagnosis of occupational asthma. We enrolled subjects suspected of having occupational asthma. Serial monitoring of PEF was performed during 2 weeks at and away from work. At the end of each period, induced sputum was collected. Specific inhalation challenge was subsequently performed. PEF graphs were interpreted visually by five independent observers. Forty-nine subjects, including 23 with positive specific inhalation challenge, completed the study. The addition of sputum cell counts to the monitoring of PEF increased the specificity of this test, respectively, by 18 (range [r] 13.7-25.5) or 26.8% (r 24.8-30.4) depending if an increase of sputum eosinophils greater than 1 or 2% when at work was considered as significant. The sensitivity increased by 8.2% (r 4.1-13.4) or decreased by 12.3% (r 3.1-24.1) depending on the cutoff value in sputum eosinophils chosen (greater than 1 or 2%, respectively). The addition of sputum cell counts to PEF monitoring is useful to improve the diagnosis of occupational asthma.

Inhalation challenges with occupational agents are used to confirm the aetiology of occupational asthma. It has been proposed that using closed-circuit equipment rather than the realistic challenge method would improve the methodology of these tests. Changes in forced expiratory volume in one second (FEV 1 ) were examined in 496 subjects with “positive specific inhalation challenges”, i.e. changes in FEV 1 of ≥20% after exposure to an occupational agent, including 357 subjects exposed by the realistic method, 108 using the closed-circuit method and 31 by both methods. For immediate reactions, 18 of 95 (19%) showed changes in FEV 1 of ≥30% with the closed-circuit method, whereas a significantly larger proportion, i.e. 77 of 200 (38.5%), showed such changes using the realistic method. As regards nonimmediate reactions, changes in FEV 1 of ≥30% occurred in 16 of 43 (37%) cases with the closed-circuit method as compared to a larger proportion, i.e. 87 of 180 (48%) cases, using the realistic method. This favourable effect was significantly more pronounced in workers with higher levels of bronchial hyperresponsiveness to methacholine. It is concluded that, for agents that can be generated using the closed-circuit method, use of such apparatus results in a smaller proportion of exaggerated bronchoconstriction than does the realistic method, this being particularly true for low-molecular weight agents.

The scientific literature on occupational asthma is steadily increasing and no longer only describes case reports with prevalence figures and limited physiopathologic and immunologic data. Prospective cohort studies are currently carried out with relevant incidence figures and risk factors. Genetic susceptibility is explored. New diagnostic means are described. Surveillance programs are conducted and preventive measures are proposed.A relevant account was published on the respiratory consequences (irritant-induced asthma, a type of occupational asthma) of exposure of firefighters at the World Trade Center site. Glutathione-S-transferase appears to be an interesting susceptibility gene for occupational asthma as a result of isocyanates. Inflammation caused by neutrophils and not only by eosinophils is more often associated with occupational asthma. Examination of induced sputum and assessment of exhaled nitric oxide are becoming useful diagnostic tools. Cleaners are at increased risk of developing occupational asthma, although the causal agents are unknown. Surveillance programs currently combine strategies that aim to reduce exposure and identify cases early.New scientific information provides better, accurate figures on the frequency of occupational asthma and on risk factors, proposes relevant diagnostic tools more directly related to the physiopathology of the disease, and suggests effective surveillance programs in high-risk workplaces.

Patients with coexisting work-related rhinitis and asthma would benefit from an adequate and simultaneous recognition of both diseases. The present case illustrates the advantages and importance of using an integrated approach to confirm a diagnosis of occupational rhinitis (OR) and occupational asthma (OA).A 38-year-old woman, who worked as an animal laboratory technician since 2004, first noticed the appearance of rhinitis and conjunctivitis symptoms in 2007 when she was exposed to rats. A skin-prick test with rat extract was strongly positive. A specific inhalation challenge with parallel assessment of nasal and bronchial responses was conducted. After 10 min of exposure, she developed rhinitis and conjunctivitis symptoms, her forced expiratory volume in 1 s dropped by 27.5% and her nasal volume, measured by acoustic rhinometry, decreased by 80% from baseline values. After allergen exposure, induced sputum and nasal lavage examination demonstrated an increase in eosinophils (11% and 20%, respectively). A diagnosis of associated allergic OA and OR was confirmed and she was advised to stop working with rats.A systematic and parallel diagnostic approach enables confirmation of a diagnosis of OA and OR in patients complaining of work-related rhinitis and asthma symptoms.

Breast cancer patients' utilisation of supportive care has been understudied. In this paper, results from a population-based survey are used to assess the role of physicians and nurses in providing supportive care to women. Participants for this study were women with histologically confirmed invasive breast cancer diagnosed 23-36 months prior to contact about the study, who were randomly selected from the Ontario Cancer Registry. Patients for whom a physician approved contact were sent a survey questionnaire. There were two follow-up mailings. The survey included items related to patients' perceptions of supportive care involvement of oncologists, surgeons, family physicians and nurses. Among 1,119 eligible patients, 65% returned completed questionnaires. A total of 72% of these women reported having talked with an oncologist about one or more supportive care issues; 78% with a surgeon; 73% with a family physician; and 45% with a nurse. Factors linked to seeking supportive care from physicians and/or nurses included: younger age, working status, higher education, additional health insurance beyond that provided by government, higher household income, and receiving chemotherapy. Results indicate that physicians and nurses were providing important supportive care to most women with breast cancer. In a health care context where specialised supportive care services (e.g. help from dietitians, psychologists, social workers) are often unavailable or difficult to access, supportive care remains largely a responsibility of medical and nursing professionals. Even brief interventions may make an important difference to how patients deal with their illness over time.

In this study, the authors examine the under-investigated topic of patient-provided support for spouse caregivers. Thirty-four men with prostate cancer and their female partners were interviewed separately three times: before the man’s radical prostatectomy, 8 to 10 weeks postsurgery, and 1 year postsurgery. The core category of active consideration encompassed 4 dimensions: easing spousal burden, keeping us up, maintaining connection, and considering spouse. Patient-provided support entails two overlapping tasks: minimizing the practical and emotional impact of the illness and tending to the caregiver’s social-emotional needs. A theory expounding on the double bind of being both a patient and an agent in light of masculine socialization practices is articulated and brought to bear on the phenomenon of patient-provided support.

This paper draws on the results of a longitudinal, qualitative study of men with prostate cancer and their spouses. Thirtyfour men with prostate cancer and their spouses were interviewed (simultaneously and separately) at three points in time: prior to surgery; eight to 10 weeks post-surgery; and 11 to 13 months post-surgery. The primary focus for this paper is on the final set of interviews with the men, (although women’s responses are also reported upon). Whereas sexuality had not been a primary concern for men in earlier interviews, it surfaced in a major way in the interviews conducted a year after their treatment. Most of the men (71%) were totally impotent, and all of the rest were dealing with some loss of capacity. Six components of sexuality-related experience emerged from interviews, including 1) moving sex to the foreground; 2) navigating biotechnology (or not); 3) working things out as a couple; 4) coming to terms with the new me; 5) keeping things private; and 6) revisiting the treatment decision. While men tend to publicly downplay the impact of their illness experience, including erectile dysfunction, in reality they face major challenges in sorting through biotechnological remedies to impotence and in negotiating new sexual terrain with their partners.

Kim L Lavoie,1–3 Gregory Moullec,1,2,4 Catherine Lemiere,2 Lucie Blais,2 Manon Labrecque,2 Marie-France Beauchesne,2 Veronique Pepin,2,4 André Cartier,2 Simon L Bacon1,2,41Montreal Behavioural Medicine Centre, 2Research Centre, Hôpital du Sacré-Cœur de Montréal – A University of Montreal Affiliated Hospital, Montréal, 3Department of Psychology, University of Quebec at Montreal (UQAM), Succursale Center-Ville, Montreal, 4Department of Exercise Science, Concordia University, Montreal, Quebec, CanadaPurpose: Daily adherence to inhaled corticosteroid (ICS) regimens is one of the most important factors linked to achieving optimal asthma control. Motivational interviewing (MI) is a client-centered communication style that focuses on enhancing intrinsic motivation to engage in appropriate self-management behaviors. MI has been shown to improve a variety of health behaviors including medication adherence in other disorders, but its efficacy for the improvement of ICS adherence in asthmatics has yet to be examined. This pilot “proof of concept” trial assessed the feasibility of MI to improve daily ICS adherence and asthma control levels in adult asthmatics.Methods: Fifty-four poorly controlled (Asthma Control Questionnaire [ACQ] score≥1.5), highly nonadherent (filled

To examine pediatric oncologists' grief reactions to patient death, and the impact patient death has on their personal and professional lives.The grounded theory method was used. Data was collected between March 2012 and July 2012 at two academic centres in Canada. Twenty-one out of 34 eligible pediatric oncologists at different stages of their career were recruited and interviewed about their experiences with patient death. Inclusion criteria were: being able to speak English and having had a patient die in their care. The participants formed three groups of oncologists at different stages of career including: fellows, junior oncologists, and senior oncologists who varied in sub-specialties, gender, and ethnicities.Pediatric oncologists reported a range of reactions to patient death including sadness, crying, sleep loss, exhaustion, feeling physically ill, and a sense of personal loss. They also reported self-questioning, guilt, feelings of failure and helplessness. The impact of these deaths had personal consequences that ranged from irritability at home, feeling disconnected from family members and friends, and becoming more desensitized towards death, to gaining a greater and more appreciative perspective on life. Professional impacts included concern about turnover or burnout at work and improving holistic care as a result of patient deaths.Grief over patient death and the emotional labour involved in these losses are a robust part of the pediatric oncology workplace and have major impacts on pediatric oncologist's personal and professional lives. Interventions that focus on how to help pediatric oncologists deal with these reactions are needed.

Work-related asthma can be divided in two major entities: work-exacerbated asthma and occupational asthma. Occupational asthma is further split into two subtypes: sensitizer-induced occupational asthma and irritant-induced asthma, which includes reactive airway dysfunction syndrome. The patient’s medical history (type of symptoms and timing) is not sufficient to diagnose occupational asthma. The diagnosis requires an objective confirmation of asthma and of work-related functional changes. Psychological distress, health-related quality-of-life impairment, and comorbid psychiatric disorder are frequent in patients with work-related asthma or work-related asthma symptoms and have to be considered in the evaluation and treatment. Many areas of research are still needed to understand the complexity of work-related asthma.

Purpose: The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery. Description of study: As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery. Results: Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption. Clinical implications: Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.

This qualitative study explored issues of support and coping for couples where the man had been diagnosed with prostate cancer. Thirty-four men with prostate cancer and their spouses were interviewed separately at three points in time: prior to surgery; 8 to 10 weeks post-surgery; and 11 to 13 months post-surgery. The core category for the couples’ experience with diagnosis and treatment for prostate cancer was Managing the Impact of Illness. Five major domains emerged, including: dealing with the practicalities; stopping illness from interfering with everyday life; keeping relationships working; managing feelings; and making sense of it all. While it was clearly important for couples to manage illness and to reduce its potential intrusion into everyday life, this strategy had psychological costs as well as benefits. Men struggled to stay in control of their emotions and their lives, typically vacillating between the pulls of fierce self-reliance and fearful neediness. Women were constrained from employing their usual strategies of coping and were distressed by the complicated requirements of being supportive while also honoring their partners’ need for self-reliance.

This paper draws on the results of a longitudinal, qualitative study of men with prostate cancer (treated with prostatectomy) and their spouses. Interviews were conducted separately and simultaneously with men and their spouses, at three points in time (pre-surgery, 8-10 weeks post-surgery and 11-13 months post-surgery). The primary focus in the paper is on men's responses to questions about their decisions to share information (or not) with others about their diagnosis and ongoing medical situation. Most men with prostate cancer avoided disclosure about their illness where possible, and placed great importance on sustaining a normal life. Factors related to limiting disclosure included men's low perceived need for support, fear of stigmatization, the need to minimize the threat of illness to aid coping, practical necessities in the workplace, and the desire to avoid burdening others. This study contributes to an understanding of disclosure issues related to prostate cancer, and raises issues about how best to be helpful to men, given their tendency to minimize the impact of illness, and the need for support.

Unconventional therapies have become increasingly popular with health care consumers in recent years. As patients seek information and attempt to make decisions about unconventional therapies, they often turn to nurses, asking their opinion about certain therapies. The nurse's attitudes and beliefs about unconventional therapies very likely will influence the response to the patient's inquiries. This work represents the findings of interviews with 48 nurses regarding their perspectives on unconventional therapies. Without exception, all nurses interviewed emphasized the need for information regarding unconventional therapies to be readily available for patients and health care professionals. The other themes identified in the interviews included the following: various people use unconventional therapies; people seek unconventional therapies for a variety of reasons; communication about unconventional therapies needs to be open; and conventional and unconventional practitioners ought to work collaboratively. The participants interviewed saw a clearly defined role for nurses regarding unconventional therapies.

Background Panic disorder (PD) is a common anxiety disorder among asthmatic patients with overlapping symptoms (e.g., hyperventilation). However, the longitudinal impact of PD on asthma control remains poorly understood. This study assessed the impact of PD and panic-anxiety on asthma control over a 4.3-year follow-up in 643 adult asthmatic patients. Methods Consecutive patients presenting to a tertiary asthma clinic underwent a sociodemographic, medical history, and psychiatric (Primary Care Evaluation of Mental Disorders) interview and completed questionnaires including the Anxiety Sensitivity Index (ASI) to assess panic-anxiety. At follow-up, patients completed the Asthma Control (ACQ) and Asthma Quality of Life (AQLQ) questionnaires and reported emergency department visits and hospitalizations during the follow-up. Results Baseline frequency of PD was 10% (n = 65). In fully adjusted models, analyses revealed that PD and ASI scores predicted worse follow-up ACQ total scores (β = 0.292, p = .037; β = 0.012, p = .003) but not AQLQ total scores. ASI scores also predicted greater nocturnal and waking symptoms, activity limitations, and bronchodilator use on the ACQ (β = 0.012-0.018, p < .05) as well as lower symptom (β = -0.012, p = .006) and emotional distress (β = -0.014, p = .002) subscale scores on the AQLQ. Neither PD nor ASI scores were associated with hospitalizations, although ASI scores (but not PD) were associated with an increased risk of emergency department visits (relative risk = 1.023, 95% confidence interval = 1.001-1.044). Conclusions PD and anxiety sensitivity are prospectively associated with poorer asthma control and may be important targets for treatment.

Thirty-two survivors of cancer who demonstrated an interest in unconventional therapies were interviewed. The results showed that Ihey had a variety of motivations for their interest. They consistently portrayed the mainstream cancer care system as tolerating the use of unconventional approaches while essentially remaining disengaged from the subject. Many of the survivors argued that health care professionals should be more interested in, more informed about, and more willing to discuss unconventional therapies. They also believed that personal experience was an important source of evidence for considering treatment options and that health care professionals often ignored this evidence, paying attention only to randomized clinical trials. In general, the survivors made a case for a better response from the health care system regarding consumers' needs concerning unconventional treatment options. Whether and how these needs are addressed represents a major and important challenge for the mainstre...

Interferon-gamma release assays (IGRAs) are newly approved for diagnosing latent tuberculosis infection (LTBI). An internal audit was conducted to review the use of a newly implemented IGRA at the Hôpital du Sacré-Coeur de Montréal (Montréal, Québec) to evaluate its concordance with Canadian recommendations and its implication on diagnosis.From April 2007 to January 2009, all Quantiferon TB Gold In-Tube (QFT, Cellestis inc, USA) tests performed in at the Hôpital du Sacré-Coeur de Montréal were retrieved. Strategies used to investigate LTBI and clinical interpretation of test results were compared with the local algorithm, which is derived from the current national guidelines.A total of 200 patients tested with QFT were included in the analysis. LTBI investigation and QFT testing were considered to be appropriate in 87.5% and 66.5% of patients, respectively. Overall, 67 QFT tests were performed inappropriately; 25 were performed when a LTBI investigation was not indicated and 42 were performed whe LTBI interpretation was possible with the result of the tuberculin skin test alone. Among the 175 patients investigated appropriately for LTBI, 49 QFT tests (28%) were interpreted incorrectly; 32 patients (at high risk of developing active tuberculosis) had a positive tuberculin skin test and a negative QFT result wrongly interpreted as being negative for LTBI and 13 patients should have undergone further LTBI investigations.Globally, the present study revealed that there are discrepancies on how the IGRA was employed and interpreted in a Montreal hospital and that strict compliance to the guidelines could significantly reduce errors in interpretation.Les tests de libération d’interféron gamma (TLIG) ont récemment été approuvés pour diagnostiquer une infection tuberculeuse latente (ITBL). Une vérification interne a été organisée pour examiner l’utilisation d’un nouveau TLIG à l’Hôpital du Sacré-Cœur de Montréal (Montréal, Québec) ainsi que pour en évaluer la concordance avec les recommandations canadiennes et les conséquences sur le diagnostic.D’avril 2007 à janvier 2009, les chercheurs ont extrait tous les tests Quantiferon TB Gold In-Tube (QFT) effectués à leur centre. Ils ont comparé les stratégies utilisées pour évaluer l’ITBL et l’interprétation clinique des résultats des tests avec leur algorithme local, dérivé des lignes directrices nationales à jour.Au total, 200 patients ayant subi le test QFT ont participé à l’analyse. L’examen de l’ITBL et le test QFT ont été considérés comme convenables chez 87,5 % et 66,5 % des patients, respectivement. Dans l’ensemble, 67 tests QFT avaient été mal exécutés, soit 25 lorsque l’examen de l’ITBL n’était pas indiqué et 42 lorsqu’il était possible d’interpréter l’ITBL grâce aux seuls résultats du test cutané à la tuberculine. Chez les 175 patients ayant subi des examens convenables de l’ITBL, 49 tests QFT (28 %) avaient été mal interprétés. En effet, 32 patients (très vulnérables à une tuberculose active) présentaient un test cutané à la tuberculine positif et un résultat négatif du test QFT interprété à tort comme négatif à l’ITBL, tandis que 13 patients auraient dû subir des examens plus approfondis de l’ITBL.Globalement, la présente étude a révélé des divergences dans l’utilisation du TLIG au centre et établi qu’un respect rigoureux des lignes directrices pourrait réduire considérablement les erreurs d’interprétation.

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 Hopital du Sacre-Coeur de Montreal, 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.

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.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.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.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).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.

This article summarizes the main new categories of occupational agents responsible for causing occupational asthma, with and without a latency period reported in the last 10 years. It also reports examples of occupational agents for which the fabrication processing or use have influenced the outcome of occupational asthma.

whole was determined by the area under the Receiving Operator Characteristic curve (AUC). The calibration was assessed with the Hosmer-Lemeshow (H-L) goodness-of-fit test. Results: Of 150 workers who answered the OASQ-11, 18 (12%) had OA and 132 (88%) other conditions (including 64 (43%) with personal asthma). Workers with OA were younger, a higher proportion were atopic and had bronchial hyper responsiveness. The sensitivity of the 11 items varied between 72 and 100% and the specificity between 13 and 41%. The OASQ-11 showed a good discrimination (AUC .894; 95% CI .821 to .968) and calibration (H-L test p-value .862). Conclusion: OASQ-11 as a whole showed a good diagnostic performance in clinical setting. Further studies will be necessary to see if it could serve as a simple and useful tool to detect OA in a workforce population.