Assessing the efficacy of a German-inspired intervention on occupational contact dermatitis in Denmark: A randomised controlled trial with 3-month follow-up.

BACKGROUND: Occupational contact dermatitis (OCD) is a prevalent, often chronic disease that poses a risk for job loss and decreased quality of life. In Germany, a multi-step prevention programme emphasising early detection and highly specialised multidisciplinary treatment has been implemented with great success. OBJECTIVES: To examine the effectiveness of a Danish-adapted version of the German prevention effort on OCD severity, quality of life and occupational consequences at 3-month follow-up. METHODS: Randomised, controlled trial. Participants were recruited after the first referral from General Practitioner to Dermatologist with suspected OCD. The intervention group (IG) received a Danish-adapted, multidisciplinary intervention, while the control group (CG) navigated the Danish healthcare system without interference from the study. OCD severity, occupational consequences and quality of life were assessed at 3-month follow-up using self-reported questionnaires. RESULTS: A statistically significant decrease in the severity of eczema was found at 3-month follow-up in the IG compared to the CG. The IG were statistically significantly more likely to have seen a dermatologist at 3-month follow-up. Higher treatment level in the IG was indicated by the results but was not statistically significant. No significant difference was found in quality of life or occupational consequences. CONCLUSIONS: These initial findings suggest that early and specialised treatment of OCD improves OCD prognosis.

Impact of atopic dermatitis on occupational contact dermatitis among young people: A retrospective cohort study.

BACKGROUND: Occupational contact dermatitis (OCD) is a common occupational disease. Atopic dermatitis (AD) is a known risk factor for OCD. OBJECTIVES: To determine the prevalence of previously diagnosed AD among young workers with recognized OCD and assess its impact on OCD prognosis. METHODS: A retrospective cohort study. A questionnaire was sent to 6251 workers with recognized OCD who were under 35 years at notification (response rate: 47%). Of the respondents, 2392 answered a question about previous doctor-diagnosed AD and were included in the study. Eczema severity, occupational consequences and quality of life were examined using statistical analyses comparing workers with and without previously diagnosed AD. RESULTS: The prevalence of previously diagnosed AD was 41.8% (95% CI: 39.8-43.8). Women had a higher AD prevalence, and workers with AD reported OCD at a younger age. Workers with AD reported more frequent and severe eczema symptoms and had a higher risk of OCD negatively affecting job and occupation choices. Health-related quality of life was more adversely affected in workers with AD. CONCLUSIONS: AD significantly impacts severity and has long-term consequences for young people with OCD. Targeted prevention strategies need to be developed.

Occupational contact dermatitis among young people in Denmark - A survey of causes and long-term consequences.

BACKGROUND: Studies on the causes and consequences of occupational contact dermatitis (OCD) among young workers are non-existent. OBJECTIVES: Determine causes and consequences of OCD among workers younger than 35 years of age. METHODS: A questionnaire was sent to 6251 workers younger than 35 years at notification with recognized OCD (response rate 47%). RESULTS: The most prevalent occupations were health care workers, kitchen workers, nursery teachers, and hairdressers and beauticians. Seventy-six percent still had eczema, and 77% of these had eczema half to all the time over the last 3 months, with 61% evaluating their eczema as moderate to very severe. Fifty-three percent had changed their occupation since notification, and 42.5% had lost their job because of OCD. Allergic OCD increased the odds ratio (OR) for facial or foot eczema, job loss, change in work tasks, difficulties finding work, decrease in income, and sick leave. Age at notification of 25 years of age or younger increased the risk of job loss and feeling restricted in choice of job. Workers in the food industry had a higher OR for job loss, whereas hairdressers and beauticians had a higher risk of job loss and a decrease in income. CONCLUSIONS: The severe, long-term consequences of OCD notification signify the need for further preventive strategies among young workers.

Incidence rates of occupational contact dermatitis in Denmark between 2007 and 2018: A population-based study.

BACKGROUND: Recent population-based studies on the incidence rates (IRs) of occupational contact dermatitis (OCD) are sparse. OBJECTIVES: To determine the IRs of OCD and development thereof between 2007 and 2018 in known risk occupations. METHODS: Data on all recognized cases of OCD were used to calculate IRs as the number of recognized OCD cases per 10 000 workers per year. Asymptotic chi-square test was used to compare the IRs between 2007-2012 and 2013-2018. RESULTS: The median age at notification of OCD was below 30 years for several of the examined occupations. Hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills had the highest overall IRs of OCD. We found a statistically significant increase in the IRs of OCD for child/nursery care workers. CONCLUSIONS: The median age at notification of OCD was low for several of the occupations, signifying the need for further preventive strategies among young people. Based on the IRs of OCD, future preventive efforts should be directed at hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills. Furthermore, the statistically significant increase in IRs of OCD among child/nursery care workers highlights the need for further preventive strategies in this field.

Degree of employment, sick leave, and costs following notification of occupational contact dermatitis-A register-based study.

BACKGROUND: Occupational contact dermatitis (OCD) is the most commonly recognized occupational disease in Denmark. OBJECTIVES: To examine the impact of recognized OCD on degree of employment, sick leave, unemployment, and job change. METHODS: Data on all recognized individuals with OCD notified in Denmark between 2010 and 2015 (n = 8940) were linked to information on social transfer payments in the years before and after notification. The number of weeks on unemployment benefits or sick leave and the degree of employment during the 2 years prior to notification was compared with the 2 years following notification. RESULTS: The degree of employment decreased on average 8.9 work-hours/month, corresponding to an average annual loss of income per worker of approximately €1570. The average number of weeks that workers were receiving unemployment benefits and paid long-term sick leave rose by 2.5 and 3.4 weeks, respectively, corresponding to an average additional annual cost per worker of approximately €420 and €770, respectively. Longer case-processing time was significantly associated with lower degree of employment and higher levels of unemployment and sick leave. CONCLUSIONS: OCD has a significant negative impact on employment and economics, thus highlighting the need for a national, strategic action plan for effective prevention of OCD.

Occupational chronic obstructive pulmonary disease: a systematic literature review.

OBJECTIVE: Occupational-attributable chronic obstructive pulmonary disease (COPD) presents a substantial health challenge. Focusing on spirometric criteria for airflow obstruction, this review of occupational COPD includes both population-wide and industry-specific exposures. METHODS: We used PubMed and Embase to identify relevant original epidemiological peer-reviewed articles, supplemented with citations identified from references in key review articles. This yielded 4528 citations. Articles were excluded for lack of lung function measurement, insufficient occupational exposure classification, lack of either external or internal referents, non-accounting of age or smoking effect, or major analytic inadequacies preventing interpretation of findings. A structured data extraction sheet was used for the remaining 147 articles. Final inclusion was based on a positive qualitative Scottish Intercollegiate Guidelines Network (SIGN) score (≥2+) for study quality, yielding 25 population-wide and 34 industry/occupation-specific studies, 15 on inorganic and 19 on organic dust exposure, respectively. RESULTS: There was a consistent and predominantly significant association between occupational exposures and COPD in 22 of 25 population-based studies, 12 of 15 studies with an inorganic/mineral dust exposure, and 17 of 19 studies on organic exposure, even though the studies varied in design, populations, and the use of measures of exposure and outcome. A nearly uniform pattern of a dose-response relationship between various exposures and COPD was found, adding to the evidence that occupational exposures from vapors, gas, dust, and fumes are risk factors for COPD. CONCLUSION: There is strong and consistent evidence to support a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.

[Occupational exposure for dust and gases is an important risk factor for developing COPD]. / Erhvervseksposition for støv og dampe er en betydende risikofaktor for KOL.

Some patients with chronic obstructive pulmonary disease (COPD) are never-smokers, which suggests that there must be other important risk factors. This paper describes the evidence for an association between occupational exposure and COPD. In several studies a consistent and predominantly significant association between occupational exposures and COPD is found, even though the studies vary in design, enrolled populations and in measures of exposure and outcome. Strong evidence supports a causal association between multiple categories of occupational exposure and COPD, both within and across industry groups.

[Does shift work cause spontaneous abortion, preterm birth or low birth weight?]. / Medfører skiftarbejde øget forekomst af spontan abort, praeterm fødsel eller lav fødselsvaegt?

In Denmark 30% of females in the reproductive age regularly have shift work. 22 epidemiological papers were studied looking at associations between shift work and abortion, stillbirth, preterm birth, and birth weight. No convincing associations were observed between rotating shift work or fixed nightshift and negative pregnancy outcome. Some epidemiological support was found for a relation between fixed nightshift and late abortions/stillbirth. If fixed night work for all pregnant women is avoided, seven late abortion/stillbirths a year can be prevented. Fixed night work for pregnant women should be avoided.

Trinitrotoluene (TNT)-induced cataract in Danish arms factory workers.

PURPOSE: To compare the prevalence of cataract in workers exposed to trinitrotoluene (TNT) to the prevalence in a group of unexposed workers, matched on age and sex, using Tiukina's description and grading of TNT-induced cataract. METHODS: A total of 23 TNT-exposed and 44 unexposed workers underwent an eye examination performed by an ophthalmologist who did not know the exposure status of the subjects. All lens opacities matching Tiukina's description were classified as TNT cataract and graded on Tiukina's scale of stages 1-4. RESULTS: Four cases of TNT-induced cataract were identified among the 23 TNT-exposed workers and none in the unexposed group (p < 0.01). CONCLUSION: Exposure to TNT may cause a unique type of cataract, which a general ophthalmologist, using Tiukina's description and grading scale, will be able to distinguish from other cataracts.

Respiratory symptoms and ex vivo cytokine release are associated in workers processing herring.

OBJECTIVE: To determine the prevalence of respiratory symptoms among workers processing herring and assess ex vivo cytokine release in response to agents at their workplace. METHODS: We applied a questionnaire, and performed skin prick testing and pulmonary investigations in 36 workers at two herring factories, using 31 municipal workers as controls. In a whole blood assay (WBA), venous blood from the subjects was incubated with lipopolysaccharide (LPS), beta(1,3)-glucan or sterile-filtered, fish constituents such as skin and rinsing water. We determined the IL-1beta and IL-8 release in the plasma by chemiluminescence ELISA. RESULTS: Among smoking fish-factory workers the forced vital capacity (FVC) was higher (per cent predicted 92.0 vs 85.0; P=0.028) than among municipal workers. Fish rinsing water induced WBA IL-8 release to higher levels than LPS and glucan. Among non-smokers the induced IL-1beta release for rinsing water ( P=0.007) and the IL-8 release for skin ( P=0.001) and meat ( P=0.003) were higher in fish-factory workers than in municipal workers. The IL-1beta release for rinsing water ( P=0.028) and skin ( P=0.041) was higher among non-smokers than among smokers, and so was the IL-8 release for rinsing water ( P=0.008). CONCLUSIONS: Assessing the cytokine release by use of the WBA we identified substances in the occupational environment with a pro-inflammatory potential comparable to that of LPS. The cytokine release for fish constituents was highest among non-smoking fish-factory workers. The results suggest a priming effect of the work exposure.