Work outcome in workers with occupational skin disease

We carried out a follow-up study of employment outcome for 230 workers with a diagnosis of occupational skin disease who were at least 2 years postdiagnosis. Seventy-eight percent of the workers were working, but 57% of those working had changed jobs, 67% because of their skin problem. Thirty-one percent had lost no time from work because of their skin disease, while 35% had lost at least 1 month. Forty-three percent had applied for workers' compensation benefits, and 87% of those who had applied were successful in their claims. Older workers were more likely to be unemployed and to have applied for workers' compensation benefits. Women were less likely to have lost time from work and to have applied for workers' compensation. Those who had changed their jobs tended to have a better outcome with respect to active dermatitis, though they had lost more time from work and had more often applied for workers' compensation benefits.     

Notification of occupational skin diseases by dermatologists in The Netherlands

Background A voluntary surveillance scheme of occupational skindiseases (OSDs) in The Netherlands starting in 2001 aimed toimprove insight in the incidence of OSD especially occupationalcontact dermatitis (OCD), risk professions and causal agents.This paper presents the results of this scheme during 2001–05. Methods Reports of new cases of OSD received from the participatingdermatologists on a monthly basis were analysed. Data evaluatedincluded information on diagnosis, sex, age, sickness, absenteeism,profession and causal agents. Relative differences in incidencerates between industries or branches were estimated by calculatingincidence rate ratios. Results About 80% of the notifications concerned OCD. The highestnumber of notifications was recorded in the first year of thescheme. This was probably due to reporting of a mixture of incidentand prevalent cases. During the following 5 years, the numberof yearly notifications of OSD declined. Hairdressers, nurses,metalworkers, mechanics and cleaners were the most commonlyaffected professions. Wet work and irritating substances werethe most frequently reported causal agents. Most patients withOCD were not absent from work. Conclusions A voluntary surveillance scheme with dermatologistsprovides valuable data about the distribution of OCD in riskprofessions and the causal agents. However, it has certain limitationsin assessing trends in incidence. Active medical surveillancein populations at risk should be encouraged not only to improvesecondary prevention but also to obtain more reliable informationabout the incidence of OCD.     

Contact dermatitis in Alstroemeria workers

Hand dermatitis is common in workers in the horticultural industry. This study determined the prevalence of hand dermatitis in workers of Alstroemeria cultivation, investigated how many workers had been sensitized by tulipalin A (the allergen in Alstroemeria) and took stock of a wide range of determinants of hand dermatitis. The 12-month period prevalence of major hand dermatitis amounted to 29.5% whereas 7.4% had minor dermatitis. Of these workers, 52.1% were sensitized for tulipalin A. Several personal and work-related determinants played a role in the multifactorial aetiology of hand dermatitis. Factors which showed a significant relationship with major hand dermatitis were: female sex, atopic dermatitis, chapped hands and the frequency of washing hands. It may be concluded that the Alstroemeria workers are a population at risk of developing contact dermatitis and it might be useful to carry out an educational campaign to lower the high prevalence.     

Occupational contact dermatitis in the UK: a surveillance report from EPIDERM and OPRA

Since February 1993 the EPIDERM surveillance scheme has collected data on occupational skin disease from consultant dermatologists in the UK. Reporting by occupational physicians to the scheme began in May 1994 and was superseded in January 1996 by the Occupational Physicians Reporting Activity (OPRA). The schemes currently receive reports on incident cases from 244 dermatologists and 790 occupational physicians. An estimated total of 9937 cases of contact dermatitis reported by dermatologists was calculated from surveillance data; 8129 contact dermatitis cases were estimated from reports by occupational physicians. The annual incidence of occupational contact dermatitis from dermatologist reports was 6.4 cases per 100,000 workers and 6.5 per 100,000 from reports by occupational physicians, an overall rate of 12.9 cases per 100,000 workers. Manufacturing industries account for the greatest number of cases seen by both sets of reporting physicians, with health care employment second. Reports from dermatologists also indicate high rates of dermatitis in the personal service industries (mainly hairdressers and barbers) and in agriculture. With the exception of an increase in cases seen in nurses in both schemes, the numbers and proportions of cases of contact dermatitis within occupations have remained fairly constant over the 6-year reporting period. Agents accounting for the highest number of allergic contact dermatitis cases were rubber (23.4% of allergic cases reported by dermatologists), nickel (18.2), epoxies and other resins (15.6), aromatic amines (8.6), chromium and chromates (8.1), fragrances and cosmetics (8.0), and preservatives (7.3). Soaps (22.0% of cases), wet work (19.8), petroleum products (8.7), solvents (8.0), and cutting oils and coolants (7.8) were the most frequently cited agents in cases of irritant dermatitis. The national scope of the data, together with the parallel structure by which both dermatologists and occupational physicians report incident cases, is useful in determining the extent of skin hazards in UK industry and may help in better targeting efforts to reduce the burden of skin disease at work.     

Occupational ceramic fibres dermatitis in Poland

Recently, the use of asbestos has been considerably limited in Poland, with the simultaneous increase in the manufacture, processing and application of man-made mineral fibres, which includes ceramic fibres. The aims of this study were (1) to assess the type and frequency of dermal changes caused by the irritant activity of ceramic fibres among workers at the plants that manufacture packing and insulation products; and (2) to compare the irritant activity of Polish-made L-2 and L-3 ceramic fibres with that of the Thermowool ceramic fibres made in England. Workers (n = 226) who were exposed to ceramic fibres underwent dermatological examination. Patch tests with the standard allergen set, together with samples of the fibres L-2, L-3, and Thermowool fibres, were applied to all the workers. It has been shown that the Polish-made L-2 and L-3 fibres differed from Thermowool fibres in that the L-2 and L-3 fibres contained zirconium and were coarser. The proportion of filaments with diameters above 3 microns was 11.1% in the L-3 fibre and 6.3% in the L-2 fibre samples. The Thermowool fibre did not contain filaments thicker than 3 microns. Evident dermal changes, resulting from strong irritant activity of the fibres, were detected in 109 (48.2%) of the workers examined. Irritant contact dermatitis acuta (maculae, sometimes papulae and small crusts on the upper extremities, trunk, and lower extremities), disappearing after 2-3 days, was found in 50 (22.1%) workers. Irritant contact dermatitis chronica (diffuse permanent erythema with numerous telangiectasiae on the lateral portions of the face and neck, on the trunk, behind the auricles) was detected in 40 (17.7%) workers. The remaining 19 (8.4%) workers had both types of dermal change. All examined workers complained of very strong itching. The results of the patch tests confirmed the irritant activity of the ceramic fibres. Erythema without oedema, persisting for up to 96 h, appeared at the places where the fibres had been applied to the skin in 44 (19.5%) workers. In addition, the irritant activity of the fibres has been shown to be correlated with their thickness. The Thermowool fibre was the weakest irritant, because it did not contain filaments above 3 microns in diameter; the L-2 fibre containing 6.3% filaments above 3 microns caused somewhat stronger skin irritation; while the L-3 fibre, which contained 11.1% filaments thicker than 3 microns, was the strongest irritant. A few cases of allergy to nickel, chromium and colophony (rosin) were also detected.     

Irritant dermatitis among workers cleaning up a pesticide spill: California 1991

An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacramento River in California after a spill of metam sodium. The spilled chemical decomposes to methylisothiocyanate (MITC), a known skin irritant. A retrospective cohort study was conducted among the inmates and their crew leaders. Among 42 jail group members, 27 had dermatitis involving the feet and ankles; dermatitis was associated with lower extremity water contact (RR = 3.4, 95% CI 1.0-11.8); the attack rate increased with length of time spent in the water. For comparison, other state and federal employees who worked in the river at the same time were also interviewed. None reported dermatitis. Over three-quarters (24/31) of these other clean-up workers whose feet became wet changed to dry clothing immediately; none of the jail group changed immediately. The river concentration of MITC measured 20-40 ppb at the time of exposure. We speculate that prolonged wetness, occlusive boots, friction, and heat contributed to chemical irritation at this low concentration; the experience of the other clean-up workers suggests that this outbreak could have been prevented.     

Absence attributed to incapacity and occupational disease/accidents among female and male workers in the fish-processing industry

Sick-leave between 1984 and 1989 was higher among both female(n=515) and male (n=304) fish-processing workers [observed/expected(O/E) 2.24 and 1.69, respectively] than among non-exposed groups(0.62 and 0.89). Diagnoses in the musculoskeletal system dominated(i.e., neck/upper limbs; females, exposed vs. non-exposed workers:30 vs. 12%: males: 11 vs. 5.8%). In subjects who left employment,the O/E-ratio decreased (females: 3.02 vs. 1.55; males: 2.40vs. 1.55). Among those women hired before the start of the observationperiod, exposed subjects had higher frequencies of sick-leavethan non-exposed, for both total illness and musculoskeletaldiagnoses. In the men, there were corresponding differences,though not fully statistically significant. Reported occupationaldiseases [O/E: females: 4.5; (95% confidence interval) Cl=3.2–6.1;males: 2.3; Cl=1.3–3.9] and accidents (females: 4.3; Cl=3.0–5.9;males: 1.8; Cl=1.2=2.7) were also higher in female than in malefish-processing workers, and much higher than in non-exposedworkers. In conclusion, work in the fish-processing industrywas associated with increased frequencies of sick-leave, especiallybecause of diagnoses of the musculoskeletal system, and occupationaldisorders and accidents, in particular among female workers.     

Work-related skin disease in the plastics industry

In a survey of a representative sample of workers taken at each of four different plastics manufacturers, 122 completed self-administered questionnaires were obtained. Twenty-six respondents (21.3%) met the case definition for having a work-related skin disorder during the preceding year. Sixteen (61.5%) cases indicated that their skin problems were present for 11 or more days, and 50% reported that their normal daily activities were at least somewhat affected. Risk of disease was elevated for workers who reported skin contact with formaldehyde (OR = 3.30; 95% CI = 1.02–10.69) or with polyvinylchlorides (PVCs) or their prescursors (OR = 4.08; CI = 1.19–14.06), used barrier creams (OR = 4.51; CI = 1.22–16.68), were female (OR = 5.42; CI = 0.97–30.22), were 35 or younger (OR = 4.65; CI = 1.53–14.19), and for each use of hand cleaner at work (OR = 1.22; CI = 1.05–1.41). These findings should be considered when designing programs to reduce the incidence of skin disease among workers in the plastics industry. Am. J. Ind. Med. 31:545–550, 1997. © 1997 Wiley-Liss, Inc.     

Evaluation of skin symptoms among workers at a swedish paper mill

Process and office workers at a Swedish paper mill (n + 274) and dairy workers (n + 45) were investigated with questionnaires regarding skin symptoms. In the second part of the study, subjects reporting skin symptoms and a random sample of subjects without symptoms were examined and investigated with patch testing. Pruritus and skin irritation probably related to exposure to dust were found. The results do not indicate an increased prevalence of contact allergy. In two cases, positive patch test reactions to paper size (rosin) and a slimicide, mercaptobenzothiazole (MBT), were noted. © 1993 Wiley-Liss, Inc.     

Strategies for prevention: occupational contact dermatitis

The economic consequence of occupational contact dermatitis (OCD) is considerable and impacts on an individual's quality of life. There are a range of prevention strategies, which include: elimination or substitution of harmful exposures; technical control measures; personal protection; identification of susceptible individuals; and education, training and health surveillance. Each one has been shown to have varying degrees of success in reducing OCD, but further work is required to evaluate the effectiveness of preventive measures in the workplace. OCD is not considered a high priority in most affected industries and therefore the development of health and safety policies to reduce its prevalence should be encouraged, although guidance and assistance would be required, because all employees are entitled to a safe working environment.     

Respiratory illness in agricultural workers

Respiratory diseases have long been recognized in association with work in farming. Overall, only a small proportion of the population is employed in agriculture, so respiratory disease in farmers is not a major public health issue. However, farmers are known to have high morbidity and mortality from certain respiratory diseases, as shown by routinely collected statistics. Despite this, knowledge of the frequency, nature and risk factors for some respiratory disorders in agricultural workers is incomplete. Multiple exposures are common and some exposures can give rise to more than one specific disease. Moreover, the most common respiratory symptoms reported by farm workers (wheeze, dyspnoea and cough) are relatively non-specific and can be associated with several occupational respiratory disorders. This review describes the main occupational respiratory illnesses in farming and summarizes the current literature about epidemiology and prevention. The most important diseases are rhinitis and asthma, which, although common, are not usually fatal. Some non-allergic conditions, e.g. asthma-like syndrome and organic toxic dust syndrome, are not yet fully understood, but appear to be common among farm workers. The most serious respiratory diseases are hypersensitivity pneumonitis and respiratory infections, but these are rare. Most importantly, respiratory diseases are preventable by controlling harmful exposures to organic dust, toxic gases and chemicals on farms through improvements in animal rearing techniques, ventilation of animal accommodation, careful drying and storage of animal feed-stuffs, crops and other products, and use of personal protective equipment.     

Prevalence of upper extremity symptoms and possible risk factors in workers handling paper currency

The prevalence of upper extremity symptoms in the workforceis high, particularly in industries characterized by forceful,repetitive or awkward movements. A study was undertaken to assessthe prevalence of upper extremity symptoms in bank workers ina paper currency processing operation and to examine the roleof possible risk factors for these complaints. Thirty-nine workersof a total workforce of 47 were assessed with a questionnaireand physical examination. The questionnaire collected informationabout demographics, health status, symptom reporting, psychosocialwork stressors and other work exposure characteristics. Overall,59% of the workers reported having significant work-relatedupper extremity musculoskeletal symptoms in the preceding year,including 49% with neck and shoulder symptoms and 49% with armand wrist symptoms. In this study the key predictive factorfor upper extremity musculoskeletal symptoms was psychologicaljob demands. The workers had similar ergonomic stressors (withlittle gradient of exposure) and therefore our results do notcontradict the importance of ergonomic factors in the developmentof upper extremity symptoms. However, the results do suggestthat within a group exposed to similar ergonomic stressors,psychological job demands may be an important factor associatedwith musculoskeletal symptoms.     

Work-related infectious disease reported to the Occupational Disease Intelligence Network and The Health and Occupation Reporting network in the UK (2000-2003)

BACKGROUND: Infectious diseases remain an important cause of self-reported work-related illness, with socio-economic consequences, including sickness absence. Reporting of infectious disease by occupational and specialist physicians is an important tool in the investigation of occupationally related infections and is relevant in their management. AIMS: To examine the reporting of cases of infectious disease by occupational and specialist physicians to schemes collecting data on occupational ill-health. METHODS: Cases of infectious disease reported by occupational and specialist physicians to the UK based schemes, Occupational Disease Intelligence Network (ODIN) and The Health and Occupation Reporting network (THOR), from 2000 to 2003 were analysed by reporting patterns, diagnosis, single case or outbreak reporting and industry. RESULTS: The total number of estimated cases of infectious disease reported to ODIN and THOR from 2000 to 2003 was 5606; 74.9% cases were diarrhoeal disease, and 11.1% scabies. The majority (81.4%) of cases were reported in SIDAW, where the participation rate for reporters was 55%. Reporting rates were much higher in OPRA, SWORD and EPIDERM (ranging from 86 to 96%). The most frequently reported industrial sectors were social care (39.5%) and health (29.4%); while the manufacture of chemical products contributed 4.3% overall, but 33.8% to estimated cases in OPRA. CONCLUSIONS: Despite limitations related to under reporting, the occupational and specialist physician schemes in ODIN and THOR provide data that may be used to look at patterns of case reporting for occupational ill-health, including infectious disease. The reporting schemes also provide an important means of alerting peers about potential novel causes, precipitating factors, or industrial sectors associated with occupational disease.     

Mortality from asthma, chronic obstructive pulmonary disease, respiratory system cancer, and stomach cancer among paper mill workers: a case-referent study

In an earlier case-referent study from a soft-paper mill with levels of paper dust exceeding 5 mg/m3, an increased mortality was found (OR = 3.8, p less than 0.05) from asthma and chronic obstructive pulmonary disease (COPD) among the employed. Furthermore, other studies on paper mill workers have also indicated an increased mortality from lung cancer. The main objectives of the present case-referent study were to investigate the mortality from asthma. COPD, and lung cancer in two other Swedish paper mills. In these mills, the levels of paper dust have been below 3 mg/m3. The subjects for the study were all men who died between 1961 and 1985 from asthma and COPD (n = 31), respiratory cancer (n = 27), and stomach cancer (n = 33) selected in three parishes surrounding two paper mills. As referents we randomly selected about six times as many men who had died from nonmalignant nonrespiratory diseases in these parishes (n = 550). On the basis of information found in the personnel records in the mills, the men were classified into different occupational categories or as unexposed. No increased risk of asthma or COPD was found among the workers exposed to paper dust. However, it was found that there was significantly increased mortality (OR = 5.7, p less than 0.05) for asthma and COPD among workers in a previous log sorting department. The study also showed a significantly increased risk of lung cancer (OR = 2.1, p less than 0.05) among maintenance workers. There was no increased risk of stomach cancer in the study.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increased risk of asthma among Finnish construction workers

AIM: To determine the risk of asthma among 7891 Finnish construction workers in the Pirkanmaa Region of southern Finland. METHOD: Retrospective cohort study of hospital records of the Tampere University Hospital. A population of Pirkanmaa paper mill workers (n=2686) and the Pirkanmaa working age population (n=252,500) served as reference populations. RESULTS: There were 147 new cases of asthma among the construction workers in 1991-1995. The annual rate was 37 per 10,000 workers and the odds ratio was 2.1 [95% confidence interval (CI)=1.2-3.6] for the women and 1.8 (95% CI=1.5-2.2) for the men when compared with the general working age population. In general, the risk of asthma among the paper mill workers did not differ from the risk of asthma among the general working age population. The construction workers had an increased risk for asthma, although the number of reported cases of occupational asthma was lower for the construction workers than for the paper mill workers or for the working population. CONCLUSION: Construction work, especially dusty tasks, was associated with an elevated risk of asthma. Thus the effect of exposure to irritant agents may have a role in the development of asthma among construction workers. For the most part, these cases of asthma do not meet the criteria for occupational asthma because the specified causal agent can not be defined. The aetiologic agents and mechanisms of asthma in construction work should be clarified for preventive measures.     

Cardiovascular mortality among Swedish pulp and paper mill workers

BACKGROUND: Malignant diseases but also cardiovascular and respiratory disorders and diabetes mellitus have been associated with work in pulp and paper production. The present cohort focuses on cardiovascular mortality in relation to various exposures in this industry. METHODS: The cohort, followed-up for mortality, includes 7,107 workers, 6,350 men and 757 women, from three major old mills in the middle of Sweden. RESULTS: Instead of a healthy-worker effect, a slightly increased risk for death in diseases of the circulatory system was found for male workers. Notably, work with sulfate digestion, steam and power generation and maintenance was associated with significantly increased risks. Cerebrovascular diseases showed non-significantly increased risks for maintenance and paper and paperboard production and manufacture. CONCLUSIONS: The differences in risk among various parts of the production are striking although it is hard to pinpoint any specific exposures. Dust and small particles along with sulfur compounds might be suspected.     

Microorganism-induced skin disease in workers exposed to metalworking fluids

BACKGROUND: An outbreak of skin disorders among workers potentially exposed to metalworking fluids prompted the present study. Few studies have described skin disorders associated with microbe-contaminated metalworking fluids. METHODS: Samples of materials contaminated with metalworking fluids were obtained from two manufacturing facilities in Ohio. Pathogenic bacteria and yeasts, in concentrations sufficient to cause skin disease, were cultured from 9 of 12 (75%) sampled materials. RESULTS: Allergic patch testing of five affected people produced negative results for standard allergens, augmented by fluids and items from their workplace. This ruled out allergies as the cause of the skin disease. Improper handling and disposal of cotton gloves, inappropriate use of scouring pads and ineffective hand wiping were apparently responsible for the microbiological contamination. The hands and forearms were most commonly affected. CONCLUSION: Improper handling of soluble, synthetic and semi-synthetic metalworking fluids provides an excellent environment for the growth of a range of microorganisms, including bacteria and fungi. If allowed to grow because of poor occupational hygiene, these microorganisms can cause skin disorders among workers. Soiled protective clothing (gloves, coveralls and work boots) should be cleaned or discarded on a regular basis. When washing up, workers should not use metalworking fluids and items used to clean machinery.     

Mortality in employees of a Scottish paper mill

To assess possible health risks associated with the manufacture of paper, we carried out a retrospective analysis of mortality among 4,242 men and women employed at a Scottish paper mill between 1955 and 1992. During follow-up to 1994, 959 subjects had died giving an SMR of 0.85 (95% CI 0.80–0.90) in comparison with the national population. Mortality from all cancer (SMR 0.77, 95% CI 0.68–0.88) and particularly from lung cancer (SMR 0.64, 95% CI 0.50–0.81) was lower than expected. An excess of lymphatic and hematopoietic cancer (11 deaths, SMR 2.17) was observed in the making department. These findings do not support an occupational hazard of lung cancer as suggested by several earlier studies. The excess of lymphatic and hematopoietic cancer in the making department was unexpected, and may be a chance occurrence. Am. J. Ind. Med. 32:535–539, 1997. © 1997 Wiley-Liss, Inc.     

Chronic fatigue among bank workers in Brazil

The present study examines the prevalence of chronic fatigue (CF) among bank workers in Brazil and possible associations with gender and working conditions. The study sample included all 735 workers from the department of data processing of a state bank. CF was assessed using the Chalder Fatigue Scale. Working conditions and socio-demographic, socio-economic and psychosocial factors at work were analysed. Psychiatric symptoms were measured with the SRQ-20. The overall estimate of the prevalence of CF was 8.7% [95% confidence intervals (95% CI) = 6.4-10.9%]: 7.8% (95% CI = 5.5-10.7%) among men and 11.0% (95% CI = 6.7-16.9%) among women. The male-female difference was not statistically significant, even after adjusting for minor psychiatric disorders. The overall prevalence of CF without minor psychiatric disorders was 4.5% (95% CI = 2.7-6.3%): 3.9% (95% CI = 1.9-5.9%) among men and 6.4% (95% CI = 2.0-10.1%) among women. In the final model, risk factors for CF were fast work speed [odds ratio (OR) = 3.5], dissatisfaction at work (OR = 3.1), minor psychiatric disorders (OR = 6.8), and medium (OR = 1.8) and heavy domestic workload (OR = 12.0). CF is common among these bank workers and is associated with psychosocial factors at work. Particularly among women, domestic workload, marital status and the presence of young children were associated with CF in the stratified analysis. Domestic workload may add physical and mental stress, putting employees at risk for CF from overload, or CF may cause workers to perceive domestic work as heavy.     

Occupational dermatitis and allergic respiratory diseases in Finnish metalworking machinists

AIM: To investigate the incidences and trends of occupational skin diseases (OSDs) and allergic respiratory diseases (ARDs) in machinists working in the fabrication of metal products. METHODS: Data from the Finnish Register of Occupational Diseases during 1992-2001 were analysed. Incidence rates for skin and respiratory diseases of machinists were calculated and compared to the total working population. The patients investigated at the Finnish Institute of Occupational Health in the same period were described in detail. RESULTS: A total of 279 dermatoses and 34 ARDs were reported. Skin diseases accounted for 27% of all occupational diseases. The incidences of the skin and respiratory diseases were 1.6 and 0.2 cases per 1000 person-years, respectively. This represents a 3-fold risk for getting an OSD compared to the total working population. The number of allergic contact dermatitis (ACD) increased 3-fold during the study period. The most common causes of ACD were metalworking fluids (MWFs) and their ingredients such as formaldehyde, ethanolamines and colophony. Eighty-five per cent of ARDs were asthmas. The commonest causes of asthma were metal dusts and fumes, epoxy resins and hardeners and MWFs and their components. CONCLUSIONS: Contact dermatitis is a common occupational health problem in metalworking machinists, whereas occupational respiratory disease is rare. Only a few specific chemicals in the metalworking have thus far been identified as respiratory allergens. Specific skin tests and inhalation challenge tests with MWFs and their ingredients are recommended if an OSD or a respiratory disease is suspected.