198 OCCUPATIONAL MEDICINE 20. Beltrami EM, Williams IT, Shapiro CN, Chamberland 25. Pham HN, Protsiv M, Larsson M, Ho HT, de Vries DH, ME. Risk and management of blood-borne infections in Thorson A. Stigma, an important source of dissatisfaction health care workers. Clin Microbiol Rev 2000;13:385–407. of health workers in HIV response in Vietnam: a qualitative 21. Gagnon M. Re-thinking HIV-related stigma in health study. BMC Health Ser v Res 2012;12:474. care settings: a qualitative study. J Assoc Nurses AIDS Care 26. Platten M, Pham HN, Nguyen HV, Nguyen NT, Le 2015;26:703–719. GM. Knowledge of HIV and factors associated with atti- 22. Chen WT, Han M, Holzemer WL. Nurses’ knowledge, atti- tudes towards HIV among final-year medical students at tudes, and practice related to HIV transmission in north- Hanoi medical university in Vietnam. BMC Public Health eastern China. AIDS Patient Care STDS 2004;18:417–422. 2014;14:265. 23. Pita-Fernández S, Rodríguez-Vazquez B, Pertega-Diaz S. 27. Smith DR, Wei N, Zhang YJ, Wang RS. Needlestick and Attitudes of nursing and auxiliary hospital staff toward sharps injuries among a cross-section of physicians in HIV infection and AIDS in Spain. J Assoc Nurses AIDS Mainland China. Am J Ind Med 2006;49:169–174. Care 2004;15:62–69. 28. Ishimaru T, Wada K, Smith DR. A consensus for occu- 24. Suominen T, Koponen N, Mockiene V et al. Nurses’ know- pational health management of healthcare workers ledge and attitudes to HIV/AIDS – an international com- infected with human immunodeficiency virus, hepa- parison between Finland, Estonia and Lithuania. Int J Nurs titis B virus, and/or hepatitis C virus. J Occup Health Pract 2010;16:138–147. 2017;59:304–308. doi:10.1093/occmed/kqx194 Fifty years ago: Pulmonary function tests in asbestos workers G. L. Leathart Henderson, Dolovich, Trop and Kaneko, 1966). Early Nuffield Department of Industrial Health, University of in the disease, the crepitations are intermittent, but Newcastle upon Tyne can sometimes be brought to light by examining the lower lung in a patient lying on one side, or by exam- In established asbestosis, examination reveals crepi- ining the back of the patient who is supine. The angle tations at the lung bases, clubbing of the fingers and between the seat and the head-rest of a hospital exami- cyanosis. The clubbing and cyanosis are late and incon- nation couch affords a gap through which the back of stant features, but basal crepitations are nearly always a supine patient can be reached. Although crepitations present. To begin with they are fine and are heard at the are usually present in asbestosis, they are not invariable end of inspiration when the lungs are fully expanded, and a few patients have been seen in whom they were but as the disease progresses, they become coarser and absent despite a positive diagnosis by lung biopsy. In are audible at lower lung volumes, eventually being figure 3, the time at which basal crepitations were first heard throughout inspiration. Characteristically they heard is indicated by a thickening of the lines, con- appear first in the axillary basal region but eventually tinuous when they were invariably present, interrupted spread throughout the lung. They are heard first at when they were intermittent. This sign was present in the lung bases because of the effect of gravity. When a five of the subjects and in all of them it was first noted patient is examined lying on one side, the crepitations before the diffusing capacity had dropped significantly. often disappear from the upper lung and are heard only Crepitations were not present, however, in two of the in the lower lung, and this phenomenon is repeated cases with a low diffusing capacity, an experience simi- when the patient turns on to the other side. They are lar to that of Williams and Hugh-Jones (1960). Other heard at the back when the patient is supine and at the measurements made in these 12 subjects showed small front when he is prone. A probable reason for the vari- and inconsistent changes over the years. Compliance ations in timing of the crepitations is that the diseased rose on average by 26%, while vital capacity fell by part of the lung is less compliant than the rest and is 7–8% during the period of observation. the last to expand on inspiration, hence delaying the crepitations until the end of inspiration. The postural From: Pulmonary function tests in asbestos work- effects are clinical expressions of the principle that the ers. Trans Soc Occup Med (1968) 18, 49–55. Available lowermost part of the lung collapses furthest on expi- at: Occup Med (Lond) 968;18:49–55. doi:10.1093/ ration and expands most on inspiration (Milic-Emili, occmed/18.1.49 Downloaded from https://academic.oup.com/occmed/article-abstract/68/3/198/4998885 by Ed 'DeepDyve' Gillespie user on 21 June 2018
Occupational Medicine – Oxford University Press
Published: May 17, 2018
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