A systematic review of working conditions and occupational health among immigrants in Europe and Canada.

BACKGROUND: A systematic attempt to summarize the literature that examines working conditions and occupational health among immigrant in Europe and Canada. METHODS: We established inclusion criteria, searched systematically for articles included in the Medline, Embase and Social Sciences Citation Index databases in the period 2000-2016 and checked the reference lists of all included papers. RESULTS: Eighty-two studies were included in this review; 90% were cross-sectional and 80% were based on self-report. Work injuries were consistently found to be more prevalent among immigrants in studies from different countries and in studies with different designs. The prevalence of perceived discrimination or bullying was found to be consistently higher among immigrant workers than among natives. In general, however, we found that the evidence that immigrant workers are more likely to be exposed to physical or chemical hazards and poor psychosocial working conditions is very limited. A few Scandinavian studies support the idea that occupational factors may partly contribute to the higher risk of sick leave or disability pension observed among immigrants. However, the evidence for working conditions as a potential mediator of the associations between immigrant status and poor general health and mental distress was very limited. CONCLUSION: Some indicators suggest that immigrant workers in Europe and Canada experience poorer working conditions and occupational health than do native workers. However, the ability to draw conclusions is limited by the large gaps in the available data, heterogeneity of immigrant working populations, and the lack of prospectively designed cohort studies.

[Occupational dermatoses. Cross-cultural adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) from English to Spanish and Catalan]. / Dermatosis profesionales. Adaptación transcultural del cuestionario Nordic Occupational Skin Questionnaire (NOSQ-2002) del inglés al castellano y al catalán.

BACKGROUND: Eczema of the hands and urticaria are very common occupational dermatoses. The Nordic Occupational Skin Questionnaire (NOSQ-2002), developed in English, is an essential tool for the study of occupational skin diseases. The short version of the questionnaire is useful for screening and the long version is used to study risk factors. OBJECTIVE. The aim of this study was to culturally adapt the long version of the NOSQ to Spanish and Catalan and to ensure comprehension, semantic validity, and equivalence with the original. METHODS: The principles of the International Society for Pharmacoeconomics and Outcomes Research for good research practices were applied. A 4-phase method was used, with direct, revised translation, back translation, and cognitive interviews. RESULTS: After direct translation, a first version was issued by the Spanish Working Group. This version was evaluated in cognitive interviews. Modifications were made to 39 questions (68 %) in the Spanish version and 27 questions (47 %) in the Catalan version. Changes included addition of examples to improve understanding, reformulation of instructions, change to use of a direct question format, and addition of certain definitions. The back translation was evaluated by the original authors, leading to a further 7 changes in the Spanish version and 2 in the Catalan version. The third consensus version underwent a second round of cognitive interviews, after which the definitive version in each language was issued. CONCLUSION. Spanish and Catalan versions of the NOSQ-2002 questionnaire are available at www.ami.dk/NOSQ and www.arbejdsmiljoforskning.dk.

Experiences with implementation of evidence-based prevention programs to prevent occupational skin diseases in different occupations.

Occupational skin diseases are among the most frequently recognized occupational diseases in many industrialized countries. This paper describes and review experiences with implementation of interventions to prevent occupational skin diseases in different occupational settings representing the food processing industry and a hospital. The study populations were gut cleaners with all participants being exposed to wet work, cheese dairies and a hospital where all employees were included. The effect of implementation of evidence-based prevention programs were tested by questionnaire surveys on baseline and follow-up. A significant reduction in eczema at hands or forearms was observed among gut cleaners. At cheese dairies the eczema frequencies were low except for a comparison dairy where significant changes were seen. At the hospital a non significant reduction in hand eczema was observed. Changes related to use of protective measures and knowledge on prevention of occupational skin diseases were observed. A process evaluation carried out at the gut cleaning departments showed association between the eczema frequency at follow-up, activities related to prevention and implementation of an occupational health management system. In addition to documenting the scientific background for evidence-based prevention programs to prevent occupational skin diseases in different occupations, both the study population and the study design should be considered carefully when testing the implementation of workplace interventions. These aspects may influence the outcome in different directions and either facilitate or hamper the possibilities to provide scientific documentation of the effect of the intervention tested.

A randomised controlled intervention study on prevention of work related skin problems among gut cleaners in swine slaughterhouses.

AIMS: To evaluate the effect of an intervention to reduce work related skin problems in gut cleaning departments in Danish swine slaughterhouses. The intervention consisted of an evidence based prevention programme and a documented method for implementation. METHODS: Randomised controlled intervention study with a one year follow up. The intervention included educational activities and evidence based recommendations. The effect of the intervention was evaluated by telephone interviews using a standardised questionnaire based on the Nordic Occupational Skin Questionnaire (NOSQ-2002) with modified and additional questions on exposure, preventive measures, information, and discussions on prevention of skin problems, etc. RESULTS: A total of 644 (87.5%) responded at the baseline interview and 622 (71.6%) at the one year follow up interview. A total of 495 participated in both interviews (67.3%). In the intervention departments the frequency of eczema on hands or forearms within the past three months at follow up was reduced significantly from 56.2% at baseline to 41.0% at follow up, while a slight non-significant increase was observed in the comparison departments (from 45.9% to 50.2%). The intervention activities resulted in more frequent use of protective gloves in general and the use of cotton gloves worn underneath rubber and plastic gloves. At follow up three times as many in the intervention departments used the recommended high fat skin care products introduced as part of the intervention activities. At follow up, discussion of skin problems was increased in the intervention group while no changes were observed in the comparison group. CONCLUSIONS: A significant 27% relative reduction of occupational eczema in a high risk group was feasible through implementation of an evidence based prevention programme.

Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure.

Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.

Classification criteria for skin-sensitizing chemicals: a commentary.

A formalized, standardized and effective mechanism for the identification of substances which possess significant skin sensitization potential is a necessary first step in the process of limiting the incidence of allergic contact dermatitis. Strategies to achieve such hazard identification are unified throughout the European Union and also have been publicised by the World Health Organization. Global harmonization of these and other approaches (e.g., in the USA) is being driven by the Organization for Economic Cooperation and Development. In this paper, the benefits and limitations of these classification systems are reviewed. A common element of all the systems is that they seek to distinguish important contact allergens from chemicals which are infrequent sensitizers. The European criteria are legal requirements in the EU member states and formal classification as a skin sensitizer leads to mandatory labelling. The most notable omission from current and proposed classification criteria relates to the relative potency of a classified skin sensitizer and the exposure dose. Such information is necessary for proper risk assessment and management measures to be implemented.

Formaldehyde allergy: A follow-up study.

BACKGROUND: Formaldehyde is a commonly used preservative in cosmetic products, cleaning agents and industrial products, and sensitization to formaldehyde frequently occurs. OBJECTIVE: The aim of the study was to evaluate the effect of extensive information and exposure assessment of formaldehyde on the prognosis of eczema. METHODS: The present study was designed as a clinical follow-up study of formaldehyde-sensitive patients. 105 patients diagnosed as formaldehyde allergic in the period January 1 1990 to December 31 1994 were thoroughly informed about their allergy, and exposure assessment was performed as a formaldehyde analysis on the patients' products. RESULTS: At follow-up 1 to 5 years later, 57 patients accepted the invitation to attend the outpatient clinic for an interview and a skin examination by a dermatologist, and were also at this time asked to bring products to which they were currently exposed for formaldehyde analysis. Evaluated by reported number of eczema eruptions and from objective skin examination patients had generally improved from their first visit to the department. At follow-up, 38 of 49 patients bringing products for analysis were still exposed to formaldehyde, as assessed by formaldehyde analysis on their products. There was a trend that severe eczema was found more often in patients still exposed to formaldehyde, but this finding was not statistically significant. Thirty-seven patients reported that they "paid attention to their allergy" when buying and using cosmetics or consumer products. CONCLUSION: Patients who paid attention to their allergy had statistically significantly fewer eruptions than those who did not.

Threshold for occluded formaldehyde patch test in formaldehyde-sensitive patients. Relationship to repeated open application test with a product containing formaldehyde releaser.

Our purpose was to investigate the eliciting threshold concentration of formaldehyde in formaldehyde-sensitive individuals in the occluded and non-occluded patch test, and to evaluate the relationship to repeated open application test (ROAT) with a product containing a formaldehyde releaser. 20 formaldehyde-sensitive patients and a control group of 20 healthy volunteers were included in the study. Occluded and non-occluded patch tests with formaldehyde solutions from 25 to 10,000 ppm, and ROAT for 1 week with a leave-on cosmetic product containing on average 300 ppm formaldehyde, were carried out simultaneously on each subject. In the occluded patch test, 1/2 of the 20 patients only reacted to 10,000 ppm formaldehyde, 9 reacted to 5,000 ppm, 3 reacted to 1,000 ppm, 2 reacted to 500 ppm and 1 reacted to 250 ppm. No definite positive reactions were observed in the non-occluded patch test or in the ROAT. No positive reactions were observed in the control group to any of the test procedures. We concluded that the threshold concentration for occluded patch test to formaldehyde in formaldehyde-sensitive patients was 250 ppm. The threshold in occluded patch test corresponded to the degree of sensitivity. Definite positive reactions in the ROAT were not seen, either indicating that they are unlikely to happen with the type of product used or that the exposure time was too short.

[Use of chemicals in Danish workplaces]. / Kemikaliebrug i danske virksomheder.

The use and distribution of hazardous products in Danish industry were investigated. An exposure estimation model was developed. Based on data collected in the investigation and on the composition of about 9400 products national numbers of chemical exposure events and national volumes of chemicals were estimated. Data are presented for 36 chemical substances with chronic toxic effects and high estimated national numbers of exposure events. Seven of the 36 substances are carcinogens, 17 reprotoxicants, 12 allergens, and 18 neurotoxicants. This cross-sectional survey on chemical exposure may serve as comparison for future surveys.

Comparison of 2 tests for clinical assessment of formaldehyde exposure.

The objective of the study was to obtain further experience on the applicability of 2 tests for clinical assessment of formaldehyde exposure. About 1300 products brought in by consecutive formaldehyde-sensitive eczema patients during a 2-year period were tested with both the chromotropic acid test and the acetylacetone test. The chromotropic acid test was modified by including a 2nd reading after 2 days. The outcome was identical for about 90% of the products, and 74% of the products that were positive on day 2 were also positive on day 1. More than 1/2 of the tests that scored as traces or caused problems on day 1 became positive on day 2. For products analyzed with both the chromotropic acid test (day 2 readings) and the acetylacetone test, about 80% gave identical results. Positive reactions were frequently found for hair shampoo, creams and lotions, soap and skin cleansers, make-up and dishwashing liquids. The samples causing discolouration or problems in the tests were mostly concentrated in specific product categories. Very few products caused problems in both test methods. Thus, the most convenient test can be used as the 1st choice and, for product categories causing discolouration or problems with a specific test, the other test method can be used.

National survey on the use of chemicals in the working environment: estimated exposure events.

OBJECTIVES: To obtain knowledge about the use and distribution of hazardous chemicals in Danish industry. This knowledge is used to regulate the occupational environment and prevent hazardous exposure. METHODS: A national survey on the use of chemicals was carried out in 1989 in a stratified sample of 1448 Danish businesses. 13,000 different chemical products were reported. Information on components in the chemical products was obtained from the Danish product register data base (PROBAS) and by inquiries to suppliers and manufacturers. At the end of the study the composition of about 9400 of the products was known. A model was developed to estimate national numbers of chemical exposure events as a supplement to data on weights of chemicals used. RESULTS: Data are presented for 36 chemical substances with chronic toxic effects and high estimated national numbers of exposure events for the industry groups included in the survey. Seven of the 36 substances are carcinogens, 17 are reproductive toxicants, 12 are allergens, and 18 are neurotoxicants according to listings of chronic toxicants used by the Danish authorities. The largest national number of exposure events was estimated for the industry groups manufacture of fabricated metal products, and personal services, cleaning, and hair dressing. These should have special attention in further preventive work. CONCLUSIONS: This survey on the use of chemicals is the first nationwide investigation in Denmark to delineate the use of all chemicals. The data have been used in a project to review occupational hazards in general in Danish industry. In the future, the data may be used as a basis for measuring chemical substitution, developing chemical safety, and as reference for more specific investigations and for follow up studies. Also job exposure matrices based on actual use of chemical products can be constructed.

Identification of formaldehyde releasers and occurrence of formaldehyde and formaldehyde releasers in registered chemical products.

Substances referred to as formaldehyde releasers were identified on review of the literature. Information on product categories and typical concentrations for chemical products containing formaldehyde and formaldehyde releasers was obtained from the Danish Product Register Data Base (PROBAS). As of February 1992, 62,000 products were registered in PROBAS, 30,900 of these with information on composition and product category. Among the components of these products, 19 of the 22 identified formaldehyde releasers were found. The number of products registered with each formaldehyde releaser varied from 4 to 171, with cleaning agents, soaps, shampoos, paint/lacquers, and cutting fluids as the most frequent product categories. The most frequently registered formaldehyde releasers were bromonitropropanediol, bromonitrodioxane, and chloroallylhexaminium chloride. Formaldehyde itself was registered in 1,781 products, and was found in all product categories included in the study. It is concluded that products for industrial use as well as household and personal care products should be considered as sources of formaldehyde exposure. The use of unsystematic chemical names in literature is discussed.

Contact allergens in registered cleaning agents for industrial and household use.

Cleaning work is a common cause of both irritant and allergic contact dermatitis. Cleaning agents for industrial and household use are registered in the Danish Product Register Data Base (PROBAS) according to a special notification rule issued by the Danish Environmental Protection Agency. About 2350 registered washing and cleaning agents containing about 1250 different chemical substances were marketed in Denmark in February 1992. The occurrence of 49 contact allergens in 16 different product types within washing and cleaning agents were listed. Preservatives and surface active agents made up the main part of contact allergens. Isothiazolinones and formaldehyde releasers were the most commonly registered preservatives, and coconut diethanolamide the most commonly registered surface active agent. The major product types registered as containing contact allergens were general cleaners, skin cleaners, hair shampoos, and floor polishes.

Allergic contact dermatitis from formaldehyde. A case study focussing on sources of formaldehyde exposure.

Formaldehyde is a common contact allergen. The prognosis of formaldehyde-sensitive patients is generally considered to be bad because of widespread exposure to formaldehyde. 11 patients with eczema and a positive patch test to formaldehyde were interviewed by a dermatologist and a toxicologist/chemist and instructed to fill in a questionnaire on exposure to chemical products. The content of formaldehyde and formaldehyde releasers in such products was examined using the database of the Danish Product Register (PROBAS) and by supplemental inquiries of manufacturers or importers. All the patients used one or more products containing formaldehyde or formaldehyde releasers. Sources of exposure were cosmetics and personal care products, dishwashing liquids, water-based paints, photographic products, etc. Patients were advised to use alternatives to those products containing formaldehyde or formaldehyde releasers. The status of 10 out of the 11 patients' eczema at follow-up was about 1/3 healed, 1/3 improved and in 1/3 no change. When the relevance of positive patch test reactions to formaldehyde was based on information obtained on exposure, a very high rate of current relevance was found. Computerized data on product composition allows the screening of products for contact allergens and also generates lists of contact allergens indicated for patch testing, based on the patients' own products.

Contact allergens in registered chemical products.

A national database on chemical products (the Danish Product Register (PROBAS] was searched for products containing selected contact allergens. As of June 1990, a total of 47,400 products were registered in PROBAS. About 27,800 of these were fully computerized. A list of 43 allergens was established, based on the European standard patch test series, substances classified "May cause sensitization by skin contact", text books on contact dermatitis, and clinical experience. The number of products in which each of these allergens was registered varied from 30 to more than 1300. Formaldehyde was registered in all product categories included in the study. Benzyl alcohol, stearic acid, epoxy compounds, diethylenetriamine and butylated hydroxytoluene were registered in more than half of the product categories. Paints/lacquers and hardeners for two-component products (paints, glues, fillers, etc.), cleaning agents, binders, adhesives/glues and toiletries made up the most frequently registered product categories for the allergens listed. The possibilities and limitations of database information on chemical products are discussed.

Sensitizing risk of butylated hydroxytoluene based on exposure and effect data.

A national database on chemical products (the Danish Product Register (PROBAS) was searched for products containing butylated hydroxytoluene (BHT). As of March 1990, 440 products containing BHT were registered. The content of BHT was below 50 ppm in 66% of these products. Paints/lacquers (1- and 2-component) and hardeners for 2-component paints, glues, fillers, etc. make up the main categories. No positive reactions were seen in 1336 consecutive eczema patients patch tested with BHT. From the widespread use of BHT, it was considered that BHT could be regarded as a safe antioxidant in the normally used concentrations. The possibilities, limitations, and demands of product registration as exposure estimates are discussed.

Nickel content of food and estimation of dietary intake.

Nickel contents of foods are reviewed. A thorough knowledge of nickel in food is of new relevance. Among dermatologists it is a general opinion that flare of hand eczema can occur after per oral nickel exposure. The prevalence of nickel allergy in the Danish population is 10% for women and 2% for men. Nickel intake from the Danish diet is estimated as 150 microgram/person/day on average. Roots and vegetables, meal, grain and bread relatively supply the average diet with much nickel. Certain food items, e.g. cocoa and chocolate, soya beans, oatmeal, nuts and almonds, fresh and dried legumes, have very high nickel contents. Consumption of these items in larger amounts may increase the nickel intake to 900 micrograms/person/day or more. Within the range of 600-5,600 micrograms of nickel may provoke hand eczema, when given in single doses as nickel sulphate. An obvious question is thus whether nickel in the diet can cause flare of hand eczema. This should and can only be established by provocation studies with low-level nickel diets combined with a single food having a high nickel content.

Nickel in tap water.

Nickel analyses of tap water from several sources in Copenhagen gave up to 490 X 10(-6) g X 1(-1) in the first 250 ml portions. Hot water gave higher values than cold water. After flushing for 5 min, low values were found. Considerable variation from time to time and from tap to tap was found. Drinking of only the first portion in the morning might have an influence on nickel hand eczema.