Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

Inflammation in induced sputum after aluminium oxide exposure: an experimental chamber study.

INTRODUCTION: Workers in aluminium production are exposed to a complex mixture of particles and gases potentially harmful to the airways, among them aluminium oxide (Al2O3). With the use of an exposure chamber, we aimed to examine the effects of short-term controlled exposure to Al2O3 on lung function and inflammatory markers in healthy volunteers. METHODS: 15 men (age 19-31) were exposed in random order to clean air or Al2O3 particles (3.8-4.0 mg/m(3)) for 2 h including 30 min exercise (stationary bike, 75 W). The permissible exposure level (PEL) for Al2O3 by Occupational Safety and Health Administration, USA, is 5 mg/m(3) time weighted average (TWA). Sham and particle exposures were separated by at least 2 weeks. Spirometry was carried out, and induced sputum and blood samples were collected 48 h before and 4 and 24 h after exposure. RESULTS: Levels of sputum neutrophils (mean (±SEM)) was increased 24 h post-Al2O3 vs pre-Al2O3 exposure (43% (4) vs 31% (4), p=0.01) and the protein level of interleukin (IL)-8 had a 4.8 (0.9)-fold change increase 24 h after exposure (p<0.01). Following Al2O3 exposure, gene signatures in sputum were significantly increased related to several pathways. CONCLUSIONS: The present study suggests that controlled exposure to Al2O3 particles at levels below PEL (TWA) induces airway inflammation in healthy humans marked by elevated neutrophils and elevated IL-8. In addition, increased expression of genes associated with several biological processes was observed in sputum. Interestingly, inhaled Al2O3-induced effects were localised to the airways and not systemic.

Incidence of cancer among welders and other shipyard workers with information on previous work history.

The incidence of cancer among 4480 shipyard workers, including 861 welders, was investigated for a potential relationship between exposure to welding fumes and lung cancer. A subcohort of 3150 workers with information on previous work history was studied separately. This investigation is a historical prospective cohort study. Environmental air samples were collected in 1973, 1977, and 1989. Information on smoking habits was surveyed in 1976 and 1984. The employment work histories were collected from the personnel register. There were 411 observed cancers of all sites versus 387.5 expected, and 45 cases of lung cancer versus 51.3 expected. Nine cases of lung cancer were found among the welders versus 7.1 expected. Among 310 former seamen with welding experience, there was 1 case of lung cancer versus 2.1 expected. These shipyard workers showed no excess risk of lung cancer. Tobacco smoking and asbestos exposure are potential confounders in the study. There was no clear relationship between exposure to welding fumes and lung cancer, but welders with the longest experience had a relative risk of 1.9 for lung cancer. The differences in lung cancer incidence among the different shipyard workers could not be attributed to differences in recruitment patterns or previous work history.

Incidence of lung cancer among shipyard welders investigated for siderosis.

The incidence of lung cancer among 428 shipyard welders exposed for more than ten years to welding fumes was investigated. The welders were examined for siderosis by the Directorate of Labor Inspection in 1975. The present study was a follow-up based on historical information from the Norwegian registry of dust-exposed workers. Twenty-three welders with siderosis, and 156 welders working at the same shipyards as the siderosis cases were studied as sub-cohorts. There was no loss on follow-up. The observation period was 1976 through 1992. There were 32 cases of cancer from all causes vs 41.3 expected. A nonsignificant excess of lung cancer was observed; 10 cases vs 6.5 expected. The incidence of lung cancer was highest for the welders with more than 30 years since first exposure (7 cases vs 4.1 expected). The sub-cohort of welders with siderosis had no case of lung cancer vs 0.5 expected. These welders were assumed to have experienced high exposure levels for welding fumes. The morbidity of cancer from all causes was low for this small group of blue-collar workers, but the incidence of lung cancer was slightly increased. The increase was not attributable to welders with siderosis. Smoking and asbestos exposure are potential confounders.

Incidence of cancer among Norwegian boiler welders.

OBJECTIVES: The cancer incidence among 2957 boiler welders was investigated. The subjects were registered electrical welders from 1942 to 1981. A subcohort of 606 stainless steel welders was studied separately. METHODS: The investigation was a historical prospective cohort study based on a national registry. The loss of follow up was 4.9%. RESULTS: There were 625 deaths (659 expected). There were 269 cancer cases (264 expected). An excess of lung cancer was found; 50 cases v 37.5 expected. There were three cases of pleural mesotheliomas v 1.1 expected. The subcohort of stainless steel welders had six cases of lung cancer v 5.8 expected, and one case of pleural mesothelioma v 0.2 expected. CONCLUSIONS: The welders in the study were assumed to represent a qualified work force. These welders had a small excess risk of lung cancer. The excess risk did not seem to be associated with stainless steel welding. Smoking and asbestos exposure were potential confounders.

Incidence of cancer among welders of mild steel and other shipyard workers.

The incidence of cancer among 4571 shipyard workers with first employment between 1940 and 1979, including 623 welders of mild steel, was investigated in a historical cohort study. The loss to follow up was 1.1%. The total number of deaths was 1078 (974.5 expected) and there were 408 cases of cancer v 361.3 expected. Sixty five cases of lung cancer were found v 46.3 expected based on the national rates for males. Four pleural mesotheliomas had occurred (1.2 expected), none among the welders. An excess of lung cancers was found among the welders (nine cases v 3.6 expected). There were six cases of lung cancer v 1.6 expected in a high exposure group of 255 welders. A survey of the smoking habits as of 1984 indicated 10%-20% more daily smokers among the shipyard production workers than among Norwegian males. Exposure to smoking and asbestos were confounding variables in this study.