Photoaging and actinic keratosis in Danish outdoor and indoor workers.

BACKGROUND: The risk of photoaging and actinic keratosis caused by work related solar ultraviolet radiation exposure has not previously been investigated in Nordic countries. The objectives of this study were to describe the occurrence of photoaging, actinic keratosis, and keratinocyte cancer in a population of Danish outdoor and indoor workers, and investigate the association between these clinical findings and semi-objective measures of work related solar ultraviolet radiation exposure in the same population. METHODS: A clinical cross-sectional study of the occurrence of facial wrinkles, actinic keratosis, keratinocyte cancer, and melanocytic nevi in a population of Danish outdoor and indoor workers and associations with semi-objective measures of work related solar ultraviolet radiation exposure based on a combination of dosimetry and self-report. RESULTS: Work related solar ultraviolet radiation exposure was significantly positively associated with occurrence of facial wrinkles (α = 0.05). Actinic keratosis was associated to status as outdoor worker (OR = 4.272, CI [1.045-17.471]) and age (P < 0.001, CI [1.077-1.262]) and twice as common in outdoor workers (10.3% CI [0.05, 0.15]) compared to indoor workers (5.1% CI [0.00, 0.10]). Only two cases of keratinocyte cancer were diagnosed (<1%). Older age was negatively associated with occurrence of melanocytic nevi. CONCLUSION: Outdoor work in Denmark is associated with increased occurrence of facial wrinkles and actinic keratosis from solar ultraviolet radiation exposure, thus justifying sun safety at Danish workplaces from a clinical perspective.

Vascular morphology in normal skin studied with dynamic optical coherence tomography.

Dynamic optical coherence tomography (D-OCT) is a non-invasive imaging technique, suitable for the study of structural and dynamic features of cutaneous microvasculature. Studies with D-OCT have primarily focused on non-melanoma skin cancer (NMSC), and a reference description of healthy skin is lacking. The aim of the study was to describe the prevalence of standard microvascular features in normal skin. A total of 280 participants without skin disease were D-OCT-scanned on four body locations: three sun-exposed areas and one unexposed: forehead, back of the neck, back of the hand and medial side of the upper arm. Frequencies of standard vascular features were reported, and relations to anatomical location and demographic data were investigated. "Dots," "lines" and "curves" were the most frequent shapes at 150 µm, 300 µm and 500 µm. "Mottle" was the predominant pattern at 150 µm and 300 µm. "Mesh" was found from 300 µm and primarily found at 500 µm. Regional differences in vascular characteristics were primarily found comparing the medial side of the arm with the other body locations. In normal skin, the most frequent shapes were "dots," "lines" and "curves," and "mottle" was present more superficially than "mesh." In conclusion, regional anatomical differences should be taken into account when evaluating D-OCT images.

Correction to: Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers.

Following publication of the original article [1], it was highlighted that Table 3 contained an error.

Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers.

BACKGROUND: To prevent occupational skin cancer, it is essential that the sun-protective behavior of outdoor workers is adequate. The aim is to study the sun-protective behavior of Danish outdoor workers at work, at leisure, and on sun holiday and compare it to that of indoor workers. METHODS: This is a cross-sectional study, based on a 53-item survey completed by Danish outdoor (n = 380) and indoor workers (n = 119) in 2016-2017. Status as outdoor or indoor worker was decided based on self-report and behavioral differences were tested using (paired) t tests and multiple regression adjusted for age, sex, educational level, history of smoking, and skin type. RESULTS: Danish outdoor workers at work use sun protection less than they do at leisure and on sun holiday (α < .05) where their sun protection behavior is similar to that of indoor workers. The proportion of Danish outdoor workers that always/often use sun protection at work is for shade seeking around noon 4.2%, sunscreen 34.5%, wide-brimmed hat 25.3%, and long trousers and shirt with sleeves 42.4%. Of Danish outdoor workers, 49.5% do not think about the risk of occupational skin cancer and 11.8% think the risk is insignificant, 32.4% think that the use of sun protection is of low or no importance, 84.2% consider sunburn important as skin cancer risk factor still 88.9% have a history of sunburn at work, > 80.0% agree that risk of skin cancer is reduced by the use of sun protection, and only 4.0% dismiss the possibility of sun protection use at work. CONCLUSIONS: Skin cancer risk and use of sun protection at work are largely neglected in Danish outdoor workers, more so than at leisure and on sun holiday where their risk behavior resembles that of indoor workers. This indicates an untapped workplace preventive potential.

Solar UV exposure among outdoor workers in Denmark measured with personal UV-B dosimeters: technical and practical feasibility.

BACKGROUND: Exposure to solar ultraviolet radiation is a well-known cause of skin cancer. This is problematic for outdoor workers. In Denmark alone, occupational skin cancer poses a significant health and safety risk for around 400,000 outdoor workers. Objective measures of solar ultraviolet radiation exposure are needed to help resolve this problem. This can be done using personal ultraviolet radiation dosimeters. METHODS: We consider technical and practical feasibility of measuring individual solar ultraviolet exposure at work and leisure in professions with different á priori temporal high-level outdoor worktime, using aluminium gallium nitride (AlGaN) photodiode detector based personal UV-B dosimeters. Essential technical specifications including the spectral and angular responsivity of the dosimeters are described and pre-campaign dosimeter calibration applicability is verified. The scale and conduct of dosimeter deployment and campaign in-field measurements including failures and shortcomings affecting overall data collection are presented. RESULTS: Nationwide measurements for more than three hundred and fifty workers from several different professions were collected in the summer of 2016. On average, each worker's exposure was measured for a 2-week period, which included both work and leisure. Data samples of exposure at work during a Midsummer day show differences across professions. A construction worker received high-level occupational UV exposure most of the working day, except during lunch hour, accumulating to 5.1 SED. A postal service worker was exposed intermittently around noon and in the afternoon, preceded by no exposure forenoon when packing mail, accumulating to 1.6 SED. A crane fitter was exposed only during lunch hour, accumulating to 0.7 SED. These findings are in line with our specialist knowledge as occupational physicians. CONCLUSIONS: Large-scale use of personal UV-B dosimeters for measurement of solar ultraviolet radiation exposure at work and leisure in Denmark is indeed feasible from a technical and practical viewpoint. Samples of exposure data shown support the presumption that the Danish campaign UV-B dosimeter measurement dataset can be used to sum and compare exposure between groups of professions with reliable results to be used in future analysis with clinical as well as epidemiological/questionnaire data. This was despite some dosimeter failures and shortcomings.

Sun Protection Behavior in Danish Outdoor Workers Following a Multicomponent Intervention.

Background: Outdoor workers can be exposed to relatively high levels of ultraviolet radiation and are at risk of developing occupational skin cancer. Implementing the use of sun protection in outdoor workers at work is therefore important. The objective of this follow-up study was to evaluate the effect of a multicomponent intervention to improve the use of sun protection in Danish outdoor workers. Method: A total of 237 Danish outdoor workers were asked to complete surveys in 2016/17 and in 2020. Multicomponent interventions, between surveys, included information on skin cancer risk and use of sun protection, personal dosimetry and skin examination for signs of photodamage and skin cancer. Survey items on awareness of occupational skin cancer risk and perceived importance of sun protection as well as availability and use of sun protection at work were compared and analyzed in relation to the multicomponent intervention. Results: Overall, the use of sun protection at work increased significantly (composite score [95% CI] 4.0 [3.7, 4.3] in 2016/17 and 4.6 [4.3, 4.9] in 2020, p < 0.001). Sunscreen was by far the biggest contributor, and the only type of sun protection used at work, which changed significantly (often/always use 37% in 2016/17 and 52% in 2020, p < 0.001). The biggest influence on the increased use of sun protection at work seemed to be a significant increase in the awareness of occupational skin cancer risk (moderate/high 43% in 2016/17 and 63% in 2020, p < 0.001) and perceived importance of sun protection at work (moderate/high 69% in 2016/17 and 83% in 2020, p < 0.001). Conclusion: The results of this study indicate that awareness of occupational skin cancer risk as well as the perceived importance and use of sun protection at work in Danish outdoor workers may be improved by means of multicomponent intervention.

Optical coherence tomography quantifying photo aging: skin microvasculature depth, epidermal thickness and UV exposure.

INTRODUCTION: Photo aging predominantly occurs in the face, neck and hands due to UVA and UVB irradiation. It is associated with skin cancer and histological studies indicate thinning of the epidermis and elastosis occurs. Dynamic Optical coherence tomography (D-OCT) is a non-invasive imaging tool able to visualize the epidermis and upper dermis and its blood vessels as well as to evaluate epidermal thickness (ET) and blood flow. OBJECTIVE: To investigate ET and blood vessel depth using D-OCT in human subjects correlated to UV exposure. METHODS: We evaluated data from 249 healthy adults, that had D-OCT-scans conducted at four different regions (forehead, neck, arm and hand) and correlated ET and blood vessel depth with occupational UV exposure (total standard erythema dose, Total SED), season and demographic data. RESULTS: Regional differences in ET and blood vessel depth were found (p values < 0.001). Multiple linear regressions showed a seasonal effect on both ET (- 0.113 to - 0.288 µm/day, p values < 0.001) and blood vessel depth (0.168-0.347 µm/day, p values < 0.001-0.007) during August-December. Significant age-related decrease of ET was seen in forehead, arm and hand (0.207-0.328 µm/year, p values = 0.002-0.18) and blood vessel depth in forehead (0.064-0.553 µm/year, p values = 0.01-0.61). Males had thicker epidermis (3.92-10.93 µm, p values = 0.002-0.15). CONCLUSION: Changing seasons are a major predictor of both ET and blood vessel depth, showing strongest effect in non-exposed areas, suggesting a systemic effect, possibly due to seasonal vitamin D fluctuation. Sex, age and occupational UV exposure affect ET. This study demonstrated the feasibility of D-OCT to evaluate epidermal thickness and blood vessel depth.

Sex as a Risk Factor for Solar Ultraviolet Radiation Exposure?-Dosimetry in Danish Outdoor Workers.

Solar ultraviolet radiation (UVR) exposure is a known risk factor for the development of skin cancer. Heterogeneity in solar UVR exposure may explain the diversity in skin cancer incidence between men and women. This, however, has not previously been investigated in Danish outdoor workers using UVR dosimetry. The aim of this study was to evaluate sex differences in solar UVR dosimetry in Danish outdoor workers on working and leisure days. A cross-sectional design was used to collect dosimetry data during the Danish summer season (May to September). Analysis was based on an electronic questionnaire and dosimetry data from 450 outdoor workers (88 women, 362 men). Dosimetry data were reported as standard erythema dose (SED). The daily median SED (Interquartile range) on working days was 1.6 (2.5) in men and 1.5 (2.1) in women while on leisure days it was 0.5 (1.4) in men and 0.6 (1.3) in women. Analysis by multiple linear regression did not show any association between daily median SED and sex on either working or leisure days. In conclusion, solar UVR exposure in Danish outdoor workers did not vary according to sex.

Measurements of Solar Ultraviolet Radiation Exposure at Work and at Leisure in Danish Workers.

Exposure to solar ultraviolet radiation is the main cause of skin cancer and may well present an occupational health and safety problem. In Denmark, skin cancer is a common disease in the general population, but detailed data on solar ultraviolet radiation exposure among outdoor workers are lacking. The aim of this study was to provide objective measurements of solar ultraviolet radiation exposure on working days and at leisure and compare levels of exposure between groups of mainly outdoor, equal-parts-outdoor-and-indoor and indoor workers. To this end, UV-B dosimeters with an aluminum gallium nitride (AlGaN) photodiode detector were used to measure the solar ultraviolet radiation exposure of 457 workers in the Danish summer season. Presented as semi-annual standard erythemal dose (SED) on working days, respectively, at leisure, the results are for mainly outdoor workers 214.2 SED and 64.8 SED, equal-parts-outdoor-and-indoor workers 131.4 SED and 64.8 SED, indoor workers 55.8 SED and 57.6 SED. The daily SED by month is significantly different (α = 0.05) between mainly outdoor, equal-parts-outdoor-and-indoor and indoor workers and across professional groups; some of which are exposed at very high levels that is roofers 361.8 SED. These findings substantiate that exposure to solar ultraviolet radiation is indeed an occupational health and safety problem in Denmark.

[Lead poisoning occurs among Danish workers].

Lead poisoning still occurs among Danish workers. The Danish Working Environment Authority guideline regulates working with lead, and in Denmark there is an occupational threshold blood lead concentration of 1.0 micromol/l. In this case daily window frame lead paint removal work and guideline neglect caused significant lead exposure. Three months work resulted in a peak blood lead concentration of 3.28 micromol/l and prolonged symptoms of mild to moderate lead poisoning. General practitioners must be aware of the continuous risk of lead poisoning and refer to an occupational and environmental department.

Individual and environmental risk factors for high blood lead concentrations in Danish indoor shooters.

INTRODUCTION: International studies have shown blood lead at levels causing health concern in recreational indoor shooters. We hypothesized that Danish recreational indoor shooters would also have a high level of blood lead, and that this could be explained by shooting characteristics and the physical environment at the shooting range. MATERIAL AND METHODS: This was an environmental case study of 58 male and female shooters from two indoor shooting ranges with assumed different ventilation and cleaning conditions. Information was obtained on general conditions including age, gender, tobacco and alcohol use, and shooting conditions: weapon type, number of shots fired, frequency of stays at the shooting range and hygiene habits. A venous blood sample was drawn to determine blood lead concentrations; 14 non-shooters were included as controls. RESULTS: Almost 60% of the shooters, hereof five out of 14 women, had a blood lead concentration above 0.48 micromol/l, a level causing long-term health concern. All controls had blood lead values below 0.17 micromol/l. Independent significant associations with blood lead concentrations above 0.48 micromol/l were found for shooting at a poorly ventilated range, use of heavy calibre weapons, number of shots and frequency of stays at the shooting range. CONCLUSION: A large proportion of Danish recreational indoor shooters had potentially harmful blood lead concentrations. Ventilation, amounts of shooting, use of heavy calibre weapons and stays at the shooting ranges were independently associated with increased blood lead. FUNDING: The technical check at the two ranges was performed by the Danish Technological Institute and costs were defrayed by the Danish Rifle Association. To pay for the analyses of blood lead, the study was supported by the The Else & Mogens Wedell-Wedellsborg Foundation. TRIAL REGISTRATION: The Danish Regional Capital Scientific Ethics Committee approved the study, protocol number H-4-2010-130.