1
|
Keefe AR, Demers PA, Neis B, Arrandale VH, Davies HW, Gao Z, Hedges K, Holness DL, Koehoorn M, Stock SR, Bornstein S. A scoping review to identify strategies that work to prevent four important occupational diseases. Am J Ind Med 2020; 63:490-516. [PMID: 32227359 DOI: 10.1002/ajim.23107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts. METHODS To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants. RESULTS We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity. CONCLUSIONS This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.
Collapse
Affiliation(s)
- Anya R. Keefe
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario Toronto Ontario Canada
| | - Barbara Neis
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | | | - Hugh W. Davies
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Zhiwei Gao
- Department of Clinical Epidemiology, Faculty of MedicineMemorial University St. John's Newfoundland Canada
| | - Kevin Hedges
- Occupational Health Clinics for Ontario Workers Ottawa Ontario Canada
| | - D. Linn Holness
- Department of Medicine and Public Health SciencesSt. Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Mieke Koehoorn
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Susan R. Stock
- Division of Biological Risks and Occupational HealthInstitut national de santé publique du Québec (Quebec Institute of Public Health) Montreal Quebec Canada
- Department of Social and Preventive MedicineSchool of Public Health, Université de Montreal Montreal Quebec Canada
| | - Stephen Bornstein
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| |
Collapse
|
2
|
|
3
|
Hald M, Thyssen JP, Zachariae C, Røpke MA, Carstensen JM, Schultz N, Johansen JD. Multispectral imaging of hand eczema. Contact Dermatitis 2019; 81:438-445. [PMID: 31389010 DOI: 10.1111/cod.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand eczema is a disease with large variation in clinical presentation and severity. Scoring systems for quantitative severity assessment exist. However, they are observer-dependent. An objective quantitative tool for scoring of hand eczema would improve categorization of hand eczema. OBJECTIVE To investigate the usefulness of multispectral imaging in assessing severity of hand eczema with respect to extent and the different morphological features. METHODS Patients with hand eczema (n = 60) and healthy controls (n = 28) were included. The severity of hand eczema was assessed by a dermatologist using the Hand Eczema Severity Index (HECSI) and a global assessment (Physician Global Assessment [PGA]). Multispectral imaging of the hand was performed on all patients and controls using the VideometerLab Instrument. RESULTS Areas of the morphological elements identified by multispectral imaging were statistically significantly correlated with the PGA scores. Analyzed by Cohen's kappa, a moderate agreement between imaging-based severity assessment and PGA was found. The imaging-based severity assessment was also correlated with HECSI (Spearman rho 0.683, P < .001). Still, the imaging-based algorithm was not capable of differentiating hand eczema patients from controls. CONCLUSIONS Multispectral imaging allows quantitative measurements of different skin parameters to be performed. In its present form, multispectral imaging cannot replace the clinical assessment of a dermatologist. However, after refinement, this or similar technologies could prove useful.
Collapse
Affiliation(s)
- Marianne Hald
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Mads A Røpke
- Department of Clinical Pharmacology, LEO Pharma A/S, Ballerup, Denmark
| | | | | | - Jeanne D Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| |
Collapse
|
4
|
Weistenhöfer W, Uter W, Bernet F, Drexler H. The tissue viability imaging system-Suitable method for discovering minimal skin changes in occupational screenings? Results of a cross-sectional field study. Skin Res Technol 2019; 25:553-563. [PMID: 30770590 DOI: 10.1111/srt.12686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/12/2019] [Accepted: 01/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND For early detection of initial skin changes in occupational screenings, only few objective assessment systems are available. OBJECTIVES With the aim of assessing an objective measurement method for hand eczema, we trialed the application of the tissue viability imaging (TiVi) system, quantifying erythema non-invasively by polarized light spectroscopy. MATERIALS AND METHODS In a field study with 625 employees of a semiconductor production company, 411 were exposed to prolonged wearing of occlusive gloves in the clean room. TiVi system and Hand Eczema Score for Occupational Screenings (HEROS), a quantitative skin score for the hands, were used, supplemented by a standardized personal interview. RESULTS TiVi values of 65 up to 246 for each hand (palm or back), for each participant summed to overall 289 up to 848 (median 389), were measured. Higher TiVi values were noted for men, smokers, and with increasing age. Correlation between TiVi and HEROS was only weak. Several factors like skin pigmentation, thickness of the skin, or tattoos seem to influence TiVi results. CONCLUSIONS The practical relevance of one-time measurements with the TiVi system in occupational screenings seems to be limited. Specifically, the TiVi system cannot replace dermatological examinations at the workplace. Notwithstanding, the application for other scientific purposes might be useful.
Collapse
Affiliation(s)
- Wobbeke Weistenhöfer
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Franziska Bernet
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Hausarztpraxis Tegernheim, Tegernheim, Germany
| | - Hans Drexler
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
5
|
Parsons V, Williams HC, English J, Llewellyn J, Ntani G, Madan I. The development of a protocol for diagnosing hand dermatitis from photographic images. Contact Dermatitis 2018; 79:270-275. [DOI: 10.1111/cod.13053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/25/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Vaughan Parsons
- Clinical Trials Unit; King's College London & Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - Hywel C. Williams
- Centre of Evidenced Based Dermatology; University of Nottingham; Nottingham UK
| | - John English
- Department of Dermatology; Nottingham University Hospitals NHS Foundation Trust; Nottingham UK
| | - Joanne Llewellyn
- Centre of Evidenced Based Dermatology; University of Nottingham; Nottingham UK
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Unit; University of Southampton; Southampton UK
| | - Ira Madan
- School of Medicine; Occupational Health Service, Guy's and St Thomas’ NHS Foundation Trust & King's College London; UK
| |
Collapse
|
6
|
Minami T, Fukutomi Y, Sekiya K, Akasawa A, Taniguchi M. Hand eczema as a risk factor for food allergy among occupational kitchen workers. Allergol Int 2018; 67:217-224. [PMID: 28874315 DOI: 10.1016/j.alit.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND An increasing number of studies in children is highlighting the importance of transdermal routes of exposure to food allergens through damaged skin in the pathogenesis of food allergies. However, data on this in adults are limited. A few case-series studies has documented development of food allergy among kitchen workers with hand eczema after direct contact exposure to foods. METHODS To explore the significance of hand eczema as a risk factor for food allergies in adults at the epidemiological level, we performed a cross-sectional web-based questionnaire survey on kitchen workers whose exposures were classed as occupational (cooks and food handlers, n = 1592) or non-occupational (housewives, n = 1915). Logistic regression was used to explore the association between the presence/severity of hand eczema and the risk of food allergy after adjustment for potential confounders. RESULTS Current hand eczema and current diagnosed food allergy were more common among occupational kitchen workers (OKW) than among non-occupational kitchen workers (NOKW) (32.3%-vs-29.9% and 9.9%-vs-3.8%, respectively). Current hand eczema was significantly associated with increased risk of current diagnosed food allergy in OKW (adjusted odds ratio 2.4, 95% CI 1.6-3.7). Those with more severe hand eczema were more likely to suffer from allergic symptoms for foods, and diagnosed food allergy. CONCLUSIONS This study illustrates a significant public health problem in the adult population, documenting a major impact of hand eczema on the ongoing adult food allergy epidemic.
Collapse
|
7
|
Weistenhöfer W, Uter W, Drexler H. Protection during production: Problems due to prevention? Nail and skin condition after prolonged wearing of occlusive gloves. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:396-404. [PMID: 28696905 DOI: 10.1080/10937404.2017.1304741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Wearing of occlusive gloves during the whole working shift is considered a risk factor for developing hand eczema, similar to wet work. Moreover, the increased hydration due to glove occlusion may lead to brittle nails. Two hundred and seventy clean room workers, wearing occlusive gloves for prolonged periods, and 135 administrative employees not using gloves were investigated. This included a dermatological examination of the nails and the hands, using the Hand Eczema ScoRe for Occupational Screening (HEROS), measurement of transepidermal water loss (TEWL), and a standardized interview. Of the clean room workers, 39%, mainly women, reported nail problems, mostly brittle nails with onychoschisis. Skin score values showed no significant differences between HEROS values of both groups. TEWL values of exposed subjects were similar to TEWL values of controls 40 min after taking off the occlusive gloves. In a multiple linear regression analysis, male gender and duration of employment in the clean room were associated with a significant increase in TEWL values. The effect of occlusion on TEWL seems to be predominantly transient and not be indicative of a damaged skin barrier. This study confirmed the results of a previous investigation showing no serious adverse effect of wearing of occlusive gloves on skin condition without exposure to additional hazardous substances. However, occlusion leads to softened nails prone to mechanical injury. Therefore, specific prevention instructions are required to pay attention to this side effect of occlusion.
Collapse
Affiliation(s)
- Wobbeke Weistenhöfer
- a Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine , Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Wolfgang Uter
- b Department of Medical Informatics , Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Hans Drexler
- a Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine , Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| |
Collapse
|
8
|
Occupational dermal exposure to nanoparticles and nano-enabled products: Part I—Factors affecting skin absorption. Int J Hyg Environ Health 2016; 219:536-44. [DOI: 10.1016/j.ijheh.2016.05.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 11/23/2022]
|
9
|
Weistenhöfer W, Uter W, Drexler H. Has dry/cold weather an impact on the skin condition of cleanroom workers? JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2016; 79:1118-1124. [PMID: 27924708 DOI: 10.1080/15287394.2016.1219602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In previous epidemiological studies irritant skin changes were reported significantly more frequently under dry/cold ambient air conditions. The aim of this study was to assess whether a similar effect might be observed in cleanroom workers, occupationally exposed to strictly controlled ambient conditions. This investigation examined 690 employees of a semiconductor production company in Germany, one half in winter (n = 358) and the other half in spring (n = 332). In both waves, both cleanroom workers, who used occlusive gloves predominantly during the entire shift, and employees in the administration, serving as the control group, were included. Ambient outdoor temperature and relative humidity (RH) were measured and absolute humidity (AH) was calculated. Hands were dermatologically examined with quantitative clinical skin score HEROS, supplemented by transepidermal water loss (TEWL) and stratum corneum hydration measurements. Temperature ranged from -5.41 to 6.51°C in winter (RH 71.04-92.38%; AH 2.85-6.7 g/m3) and from 6.35 to 10.26°C in spring (RH 76.17-82.79%; AH 5.66-7.92 g/m3). Regarding HEROS, TEWL, and corneometry, no marked consistent pattern regarding an enhanced or decreased risk of irritant skin changes was found. Work in a strictly controlled environment with prolonged wearing of occlusive gloves, with clean hands and without exposure to additional hazardous substances, did not seem to negatively affect the skin. In this particular setting, meteorological conditions also did not appear to adversely affect the skin. It is conceivable that wearing of gloves and air conditioning in the plant protect skin of the hands from adverse effects due to dry and cold air encountered when not working.
Collapse
Affiliation(s)
- Wobbeke Weistenhöfer
- a Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Wolfgang Uter
- b Department of Medical Informatics, Biometry and Epidemiology , Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| | - Hans Drexler
- a Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander University Erlangen-Nürnberg (FAU) , Erlangen , Germany
| |
Collapse
|
10
|
Apfelbacher C. No difference in skin condition between workers exposed and not exposed to glove occlusion in a semiconductor company. Br J Dermatol 2015; 172:855-6. [DOI: 10.1111/bjd.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C.J. Apfelbacher
- Medical Sociology; Institute of Epidemiology and Preventive Medicine; University of Regensburg; Dr Gessler-Str. 17 93051 Regensburg Germany
| |
Collapse
|
11
|
Weistenhöfer W, Wacker M, Bernet F, Uter W, Drexler H. Occlusive gloves and skin conditions: is there a problem? Results of a cross-sectional study in a semiconductor company. Br J Dermatol 2015; 172:1058-65. [PMID: 25319754 DOI: 10.1111/bjd.13481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although there is poor scientific evidence that working with occlusive gloves is as damaging as wet work, prolonged glove occlusion is considered to be a risk factor for developing hand eczema similar to wet work. OBJECTIVES To assess the effects of wearing occlusive gloves during the whole working day, without exposure to any additional hazardous substances, on skin condition and skin barrier function. METHODS We investigated 323 employees of a semiconductor production company in Germany: 177 clean-room workers wearing occlusive gloves during the whole shift (exposed group) and 146 employees working in administration (control group). A standardized interview was performed, the skin condition of both hands was studied using the quantitative skin score HEROS, and transepidermal water loss (TEWL) and stratum corneum hydration were measured. RESULTS There was no significant difference in skin condition between the two subgroups. Values for TEWL and corneometry were significantly higher in exposed participants (P < 0·05). However, the TEWL values were similar to control values if participants took off the occlusive gloves at least 30 min before the measurement. Hence, the effect of occlusion on skin barrier function seems to be transient. CONCLUSIONS Prolonged wearing of occlusive gloves with clean hands and without exposure to additional hazardous substances does not seem to affect the skin negatively.
Collapse
Affiliation(s)
- W Weistenhöfer
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, D-91054, Erlangen, Germany
| | | | | | | | | |
Collapse
|
12
|
Lindberg M, Bingefors K, Meding B, Berg M. Hand eczema and health-related quality of life; a comparison of EQ-5D and the Dermatology Life Quality Index (DLQI) in relation to the hand eczema extent score (HEES). Contact Dermatitis 2013; 69:138-43. [DOI: 10.1111/cod.12067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Kerstin Bingefors
- Department of Pharmacy; Uppsala University; SE-751 05; Uppsala; Sweden
| | | | | |
Collapse
|
13
|
Baumeister T, Uter W, Weistenhöfer W, Drexler H, Kütting B. On the lookout for precursor lesions: where does dry skin end and slight hand eczema begin? Contact Dermatitis 2011; 66:63-71. [DOI: 10.1111/j.1600-0536.2011.01969.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
14
|
Kütting B, Uter W, Weistenhöfer W, Baumeister T, Drexler H. Does Smoking Have a Significant Impact on Early Irritant Hand Dermatitis in Metal Workers? Dermatology 2011; 222:375-80. [DOI: 10.1159/000329433] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/24/2011] [Indexed: 11/19/2022] Open
|