New-onset COPD and Decline in Lung Function Among Wood Dust-Exposed Workers: Re-analysis of a 6-year Follow-up Study

Abstract

Objectives

There is a lack of longitudinal studies exploring the association between organic wood dust exposure and new-onset chronic obstructive pulmonary disease (COPD) and change in lung function. We have re-investigated these associations in a 6-year follow-up cohort of furniture workers exposed to wood dust using improved outcome measures and methods.

Methods

A large follow-up study of 1112 woodworkers (63%) from the Danish furniture industry and 235 controls (57%) was conducted between 1998 and 2004. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and the ratio (FEV1/FVC) standardized for age, height, and sex using the Global Lung Function Initiative 2012 equations were assessed at baseline and follow-up. Questionnaires on respiratory symptoms, wood dust exposure, and smoking habits were collected. Exposure was assessed as exposure level at baseline and as cumulative exposure in the follow-up period from quantitative task specific job exposure matrix available at both baseline and follow-up based on personal dust sampling using passive dust monitors. The association between exposure to wood dust and new-onset COPD was assessed with logistic regression, whereas the association between wood dust and the longitudinal change in z-score for lung function was assessed with linear regression.

Results

Similar associations were seen for different exposure metrics. An exposure–response relation was seen for new-onset COPD for female smokers with an odds ratio (OR) (95% confidence interval [CI]) of 8.47 (0.9–82.4) in the highest exposed group compared to controls, and a significant test for trend P = 0.049. No such association was seen among males for whom only smoking was strongly associated to new-onset COPD. For change in lung function, a significant exposure–response was seen for females, confirming previous findings, with increasing levels of wood dust exposure showing larger decline in lung function (β [95% CI]: −0.32 ΔzFEV1 (−0.56 to −0.08, P = 0.009) for third quartile exposure compared to controls, test for trend, P = 0.005, equivalent to an excess loss of 125 ml in the 6 years of follow-up). An opposite association was seen for men.

Conclusion

In conclusion, we found that female woodworkers have a dose-dependent increased OR of new-onset COPD and an excess decline in lung function suggesting that female woodworkers may be more susceptible to wood dust exposure than male woodworkers. Among male woodworkers, only smoking and asthma were significant predictors for new-onset COPD and excess decline in lung function. These results emphasize that reduction in both smoking and wood dust exposure should continuously be an effort to prevent adverse pulmonary health effects.

Early‐onset neutropenia after rituximab therapy for bullous pemphigoid

Clinical and Experimental Dermatology, EarlyView.

Scarring alopecia with follicular papules in a father and his daughter

Clinical and Experimental Dermatology, EarlyView.

Concentrations and health risks of heavy metals in soils and crops around the Pingle manganese (Mn) mine area in Guangxi Province, China

Abstract

Heavy metal concentrations in agricultural fields and their ecological risks are a source of extensive concern worldwide. A field survey was conducted to investigate the present situation and health risks of heavy metals (Mn, Pb, Zn, Cu, and Cd) and crops (corn, green soybean, sweet potato, persimmon, cassava, and Chinese chestnut) around the Pingle manganese (Mn) mine site in Guangxi Province, China, which was abandoned 20 years ago. The results showed that the ranges of Mn, Pb, Zn, Cu, and Cd were 2706.54–6760.16, 229.37–275.84, 160.39–215.48, 58.11–75.30, and 5.78–6.98 mg kg⁻¹, respectively, which were approximately 15.38–38.41, 11.76–14.15, 2.12–2.85, 2.09–2.71, and 21.64–28.75 times greater than their respective background values. Most of these concentrations exceeded the national standard for soil quality (grade 2) developed by the Ministry of Environmental Protection of China (1995). Contamination assessments based on the single contamination index (P_i), Nemerow multi-factor index (P_com), and potential ecological risk index (RI) showed that the sampled soils were severely polluted with these heavy metals, especially Pb and Cd. Similarly, the crops were enriched with Pb and Cd, with concentrations of 10.22–41.78 and 2.33–5.37 mg kg⁻¹, respectively, which were much higher than the threshold values of the national food standards. Contamination assessments with P_i and P_com also showed that the crops were severely polluted with Pb and Cd. The bioaccumulation factor values for Cd were highest among the heavy metals, with an average mean of 0.66 in these six crops, demonstrating that Cd readily accumulates in these crops. An assessment showed that the health risk for adults living in the mining-impacted areas was significant. Our study strongly recommends that heavy metal contamination in agricultural soils and crops grown around the Pingle Mn mining-affected areas should be treated to mitigate the health risks.

“My clothes, pillowcases, and bedsheets have turned green-colored!”

Introduction: Chromhidrosis is a rare disorder in which there is pigmentation of sweat in a variety of colors. The condition can be categorized into apocrine, pseudoeccrine, and true eccrine chromhidrosis. Although it does not cause serious health problem, it may be associated with psychologic stress and social embarrassment. We report a rare case of idiopathic chromhidrosis in a healthy middle-aged female with no significant medical history. A 56-year-old woman with no significant medical history and no personal history of skin cancer presented with a chief complaint "my clothes, pillows, and bedsheets have turned green-colored from my sweats." The patient has noticed light green-colored stains on her pillow cases, bedsheets, and her underwear, shirts, and bras for the past 6 months without any identifiable precipitants or triggers.

Clinical assessment of the local tolerance and cosmetic efficacy of a topical skin care formulation used after 70% glycolic acid facial skin rejuvenation procedures in healthy female subjects: A randomized, controlled, evaluator-blind study

Background: Facial chemical peels are among the most widespread nonsurgical cosmetic procedures. Post-peeling guidelines recommend only the general use of topical emollients and the need for high factor broad spectrum sunscreens. However, clinical evidence on the use of specific emollients in this indication is limited.

Clinical complications of lepra reactions: An in-patient experience from Pakistan

Introduction: The World Health Organization stated the global prevalence of leprosy as 176,176 cases at the end of 2015. Leprosy is an incapacitating infectious disease primarily affecting the skin and peripheral nerves. Immunologic complications of leprosy occur as immune-mediated lepra reactions type 1 and 2. These reactions remain a diagnostic dilemma for many physicians, dermatologists and neurologists. Despite the success of multidrug therapy these reactions cause considerable morbidity and physical disabilities by nerve damage.

Clinical evaluation of 11 investigational allergens in TRUE Test panel 3.2 in children and adolescents

Background: Epicutaneous patch testing is the criterion standard method to confirm contact sensitization, the first step in making the diagnosis of allergic contact dermatitis (ACD) in both adult and pediatric populations. Eleven new investigational allergens of the Thin-Layer Rapid Use Epicutaneous (TRUE) Test panels had been Food and Drug Administration (FDA) approved for adults for diagnosis of ACD, but not in children at the time of this study.

Clinical evaluation of a comprehensive topical antioxidant system in mildly to moderately photodamaged skin

Background: Topical antioxidants are fundamental to skin health. A product containing water-soluble, enzymatic, and lipid-soluble antioxidants provides protection at all cellular levels of the skin against the visible effects of ultraviolet (UV) and environmental damaging free-radicals.

Sensitive skin compatibility of cleansing wipes

Background: Individuals with sensitive skin should use skin cleansing products that are efficacious, nonirritating, and help maintain a healthy skin barrier. Facial cleansing wipes are a popular format used for general cleansing and make-up removal. A facial wipe was developed with nonionic surfactants, which were selected to provide nonirritating and efficacious cleansing, due to the surfactants' low protein-binding affinity. The unique blend of spun-lace nonwoven fibers in this facial wipe offers gentle and effective cleansing.

The rates of herpes zoster, hepatitis c, and tuberculosis among patients with psoriasis treated with apremilast, biologics, conventional systemics, and corticosteroids in the U.S. MarketScan database

Background: Patients (pts) with psoriasis are at increased risk for infection. We compared rates of treated herpes zoster, hepatitis C (HepC), and tuberculosis (TB) by treatment in pts with psoriasis.

Point-of-care decision support for appropriate acne management

Background: Referral from primary care providers for acne is a costly process associated with high no-show rates and delayed treatment. We previously demonstrated that models of algorithm-based acne care may lead to reductions in the rate of dermatology referrals, missed appointments, and delayed treatment. In this retrospective chart analysis, we evaluate the impact of an electronic decision support tool on the management of patients referred for acne.

Superior even skin tone and antiaging benefit of combination of 4-hexyl resorcinol and niacinamide

Unevenness of skin tone is a pervasive problem that develops with aging and sun exposure. Skin color results from the action of multiple biologic pathways that primarily control melanin synthesis and distribution. In the present studies we explored the possibility of using a synergistic approach to enhance the efficacy of cosmetic products. We evaluated the in vitro and clinical efficacy of a combination of 4-hexyl resorcinol, a known tyrosinase inhibitor and niacinamide, a melanosome transfer inhibitor, both of which regulate two different process involved in the development of skin color.

Reasons for discontinuation of secukinumab between weeks 12 and 52 in psoriasis patients responsive to treatment at week 12

Background: Patients enrolled in RCTs are subject to strict study guidelines to ensure validity, thus limiting a patients' ability to manage their own treatment plan. As such, rates and reasons for treatment discontinuation reported in secukinumab RCTs may not correlate to outcomes seen in the real world. Therefore, we aimed to investigate reasons for discontinuation of secukinumab between weeks 12 and 52 in patients who achieved efficacious outcomes at week 12.

Noxious nocebos in dermatology

Importance: Negative expectations on the part of the patient or the dermatologist can negatively influence treatment responses resulting in the nocebo effect.

The burden of nail psoriasis: A real-world analysis from the Corrona Psoriasis Registry

Objective: Nail psoriasis (Pso) is often correlated with more severe psoriatic disease and is difficult to treat; only a few studies have shown its association with significant functional and psychosocial impairment. The objective of this study was to describe the impact of nail Pso on clinical and patient-reported outcomes (PROs) among patients enrolled in the Corrona Psoriasis Registry.

Sonidegib preplanned subgroup analyses of objective response rates: 30-month results from the BOLT study

Background: Sonidegib 200 mg once daily (qd) was approved in the United States for patients with locally advanced basal cell carcinoma (laBCC) not amenable to curative surgery or radiotherapy based on results of the phase 2 BOLT study (NCT01327053). The 30-month overall efficacy and safety data from the BOLT study have been presented; here we report the 30-month results from a preplanned subgroup analysis for the primary end point, the objective response rate (ORR), in patients with laBCC receiving 200 mg, data which have not been presented.

Staphylococcus aureus biofilm in atopic dermatitis (AD): In vitro model and in vivo early AD study

Introduction and objectives: Biofilm is one of the most important virulence factors in infectious diseases; biofilm-associated bacteria show an innate resistance to antibiotics and host innate immune defenses. The presence of S. aureus biofilms in AD lesions has been described recently. In AD, biofilm seems to play a role in pruritus, inflammation and in resistance to antimicrobial peptides (PAMs). We used in vitro models to study the role of S. aureus and its biofilm in AD and to evaluate a lipid-replenishing balm specifically formulated for baby and child with atopic skin.

Patient profile of nonresponders to ustekinumab in moderate-to-severe psoriasis patients enrolled in the Corrona Psoriasis Registry

Objective: Describe the baseline characteristics of moderate to severe psoriasis (Pso) patients enrolled in the Corrona Psoriasis Registry who respond/did not respond to ustekinumab.

The impact of dermatology lectures on internal medicine residents

Background: Most medical students receive an average of 10 hours of dermatology teaching before starting residency, and only 25% take dermatology elective in medical school. Internal medicine (IM) residents regularly encounter dermatologic complaints and diseases, yet 63% of primary care residents state that they are inadequately prepared to diagnose common skin disorders. A recent study showed that an isolated didactic curriculum is a sufficient teaching method for IM residents, as measured by a multiple-choice test.