哮喘联盟

   摘要
   前言：在英国、欧州以及加拿大，均有报道职业性哮喘患者从症状出现至明确诊断之间的间隔时间过长，劳务工作者通常不情愿因为相关症状而寻求医疗帮助或改变工作环境。缩短症状出现至明确诊断之间的时间可改善劳务工作者的生活质量，并且减少社会对职业性哮喘患者的医疗支出。本研究旨在讨论职业性哮喘患者通常诊断过晚的可能相关原因。
   方法：我们有目的地对20例已经被诊断为职业性哮喘或者疑似患有职业性哮喘的个体进行一对一的半结构化的访谈（受试者平均年龄为52岁，70%为男性，80%为白种英国人）。将访谈结果进行逐字记录，并且采用主题分析法探讨受试者的健康信念以及诊断相关障碍。
   结果：我们了解以下四方面主要内容：（1）劳务工作者对职业性哮喘症状的认识；（2）工作关系；（3）劳务工作者的行动方案；（4）劳务工作者与专业医疗工作者的协商结果。每个人对职业性哮喘相关症状的理解不尽相同，包括对症状的发生、模式及特征的认识、对自身所患疾病的误解、以及忽略了哮喘的存在是种疾病。患有职业性哮喘的劳务工作者通常不情愿与管理者或同事讨论自己的健康状况，一方面害怕丢掉工作，另一方面他们并没有相应的解决措施。劳务工作者对职业性哮喘认识的改变取决于他们是否积极地关注相关症状的出现以及是否积极地寻找解决措施。积极主动的劳务工作者通常主动地去寻求权威机构的帮助，并且与全科医生商谈不充分的医疗待遇。
   结论：了解劳务工作者的健康信念可促使政策制定者以及临床医生提供更好的工作环境干预措施，以使职业性哮喘能够及时诊断。
 

（杨冬 审校）
Respir Med. 2015 Jan 26. pii: S0954-6111(15)00006-2.doi:10.1016/j.rmed.2015.01.003. [Epub ahead of print]


 

Understanding health beliefs and behaviour in workers with suspected occupational asthma.
 

Walters GI1, Soundy A2, Robertson AS3, Burge PS3, Ayres JG4.
 

ABSTRACT
INTRODUCTION: Long delays from symptom onset to the diagnosis of occupational asthma have been reported in the UK, Europe and Canada and workers are often reluctant to seek medical help or workplace solutions for their symptoms. Reducing this delay could improve workers' quality of life, and reduce the societal cost of occupational asthma. This study aimed to explore reasons behind such delays.
METHODS: A purposive sample of 20 individuals diagnosed with, or under investigation for, occupational asthma (median age = 52; 70% male; 80% white British) undertook a single semi-structured interview. Interviews were transcribed verbatim and thematic analysis was undertaken in order to explore health beliefs and identify barriers to diagnosis.
RESULTS: Four themes were identified: (1) workers' understanding of symptoms, (2) working relationships, (3) workers' course of action and (4) workers' negotiation with healthcare professionals. Understanding of symptoms varied between individuals, from a lack of insight into the onset, pattern and nature of symptoms, through to misunderstanding of what they represented, or ignorance of the existence of asthma as a disease entity. Workers described reluctance to discuss health issues with managers and peers, through fear of job loss and a perceived lack of ability to find a solution. The evolution of workers' understanding depended upon how actively they looked to define symptoms or seek a solution. Proactive workers were motivated to seek authoritative help and negotiate inadequate healthcare encounters with GPs.
CONCLUSION: Understanding workers' health beliefs will enable policy makers and clinicians to develop better workplace interventions that may aid diagnosis and reduce delay in identifying occupational asthma.
 

Respir Med. 2015 Jan 26. pii: S0954-6111(15)00006-2.doi:10.1016/j.rmed.2015.01.003. [Epub ahead of print]