Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study.

BACKGROUND: A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates. OBJECTIVES: To evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure. METHODS: Six hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age2, sex, phototype and non-occupational UV exposure were calculated. RESULTS: Participants with high versus no (OR 2.08; 95% CI 1.24-3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15-3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses. CONCLUSION: The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.

Is ultraviolet exposure acquired at work the most important risk factor for cutaneous squamous cell carcinoma? Results of the population-based case-control study FB-181.

BACKGROUND: Squamous cell carcinoma (SCC) is one of the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting ultraviolet (UV) exposure during leisure time. However, the relative impact of occupational and nonoccupational UV exposure for SCC occurrence is unclear. OBJECTIVES: To investigate the association between occupational and nonoccupational UV exposure for SCC in a multicentre population-based case-control study hypothesizing that high occupational UV exposure increases the risk of SCC. METHODS: Consecutive patients with incident SCC (n = 632) were recruited from a German national dermatology network. Population-based controls (n = 996) without history of skin cancer were recruited from corresponding residents' registration offices and propensity score matched to cases. Lifetime UV exposure, sociodemographic and clinical characteristics were assessed by trained physicians. Occupational and nonoccupational UV exposure doses were estimated by masked investigators using established reference values. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were assessed using conditional logistic regression adjusting for relevant confounders. RESULTS: Total solar UV exposure was significantly associated with increased SCC. The OR for high (> 90th percentile) vs. low (< 40th percentile) and high vs, moderate (40-59th percentile) occupational UV exposure was 1·95 (95% CI 1·19-3·18) and 2·44 (95% CI 1·47-4·06) for SCC. Adjusting for occupational UV exposure, nonoccupational UV exposure was not significantly related to SCC incidence. Dose-response relationships were observed for occupational but not for nonoccupational solar UV exposure. CONCLUSIONS: Solar occupational UV exposure is a major determinant of incident SCC. Our findings indicate that prevention strategies should be further expanded to the occupational setting.

Associations of fatigue to work-related stress, mental and physical health in an employed community sample.

BACKGROUND: While work-related fatigue has become an issue of concern among European employees, the relationship between fatigue, depression and work-related stressors is far from clear. The purposes of this study were (1) to determine the associations of fatigue with work-related stressors, severe medical disease, health behavior and depression in the working population and (2) to determine the unique impact of work-related stressors on fatigue. METHODS: We used cross-sectional data of N = 7,930 working participants enrolled in the Gutenberg Health Study (GHS) from 2007 to 2012 filled out the Personal Burnout Scale (PBS) of the Copenhagen Psychosocial Questionnaire (COPSOQ), the PHQ-9, and a list of work-related stressors. RESULTS: A total of 27.5% reported increased fatigue, esp. women, younger persons with a lower social status and income, smokers, severely medically ill, previously and currently depressed participants. Fatigue was consistently associated with severe medical disease, health behavior and depression, which need to be taken into account as potential confounders when analyzing its relationship to work-related strains. Depression was consistently associated with work-related stressors. However, after statistically partialling out depression, fatigue was still significantly associated with work-related stress. CONCLUSIONS: Fatigue as an indicator of allostatic load is consistently associated with work-related stressors such as work overload after controlling for depression. The brief Personal Burn-out Scale is suitable for assessing work-related fatigue in the general population.

Current and cumulative night shift work and subclinical atherosclerosis: results of the Gutenberg Health Study.

PURPOSE: The study examines the association between exposure to current and cumulative night shift work and subclinical parameters of atherosclerosis. METHODS: Participants of a population-based cohort study (the Gutenberg Health Study, N = 15,010) aged 35-64 years were examined at baseline (2007-2012). Investigations included measurements of arterial stiffness, vascular function [reactive hyperaemia (RH) index], and intima media thickness (IMT). Also, a complete job history (including up to 15 periods), occupational exposures, a variety of lifestyle, and dispositional variables were enquired. RESULTS: Night shift work was performed by 1071 out of 8065 currently employed individuals. The strongest association after adjustment for age, sex, job complexity level, being a manager, overtime work, and noise appeared for more than 660 night shifts within the last 10 years and a significantly increased arterial stiffness of 0.33 m/s. This reflects a 4 % flow velocity increase for individuals with more than 660 night shifts compared to non-night workers. Regarding the entire professional life, night shift workers showed a significantly decreased vascular function by -0.054 RH index points by using the same adjustment. IMT values did not differ statistically from non-night workers. Lifestyle and dispositional factors showed an influence on all used subclinical atherosclerosis parameters. CONCLUSIONS: The cross-sectional results demonstrate an association between night work and detrimental changes in the atherosclerotic process. The association is more pronounced with more years in night shift and is partly explained by lifestyle and dispositional factors. Longitudinal analyses are necessary to confirm the results.

Coping patterns in special school staff: demographic and organizational factors.

BACKGROUND: Teachers' mental health is commonly discussed in organizational health studies, but studies in special schools are rare. Work-related coping and experience patterns (WCEPs) have been shown to be associated with mental health and intentions to leave. The influence of organizational factors on coping patterns has not been examined. AIMS: To assess the distribution of WCEPs in special school staff and to identify potential influencing factors. METHODS: We surveyed a sample of teachers and educational staff in 13 German special schools using the WCEP questionnaire and COPSOQ (Copenhagen Psychosocial Questionnaire). RESULTS: Of 245 teachers and 417 educational staff contacted, 114 teachers (47%) and 252 educational staff (60%) responded, an overall response rate of 55% (366/662). Coping patterns of special school staff were classified as unambitious (30%), excessively ambitious (7%), resigned (17%), healthy-ambitious (12%) or unclassifiable (34%). Furthermore we found several significant relations with demographic and organizational factors. For example, the resigned pattern is associated with age [Exp(B) 1.12; 95% CI 1.05-1.19], emotional demands [Exp(B) 1.07; 95% CI 1.01-1.12], work-family conflict [Exp(B) 1.07; 95% CI 1.03-1.10] and bullying [Exp(B) 1.04; 95% CI 1.00-1.08]. CONCLUSIONS: Since emotional and social factors are associated with risky (excessively ambitious or resigned) and unambitious coping patterns in special school teachers and educational staff, interventions should focus on them. Further research could explore causal relations and observe the development of coping styles over time.

No acute effects of an exposure to 50 ppm methyl methacrylate on the upper airways.

PURPOSE: The German MAK value of methyl methacrylate has been fixed at 50 ppm. The aim of this study was to evaluate possible acute effects of an exposure to 50 ppm methyl methacrylate on the upper airways of human subjects. METHODS: Twenty healthy subjects were exposed to 50 ppm methyl methacrylate and to air (sham) in an exposure chamber for 4 h according to a crossover design. Symptoms were assessed by the SPES questionnaire. Olfactory thresholds for n-butanol and mucociliary transport time were measured before and after exposure. Concentrations of interleukin 1ß and interleukin 8 were determined in nasal secretions taken after exposure. mRNA levels of interleukins 1ß, 6 and 8, tumor necrosis factor α, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein 1, and cyclooxygenases 1 and 2 were measured in nasal epithelial cells, obtained after exposure. Possible effects were investigated by semiparametric and parametric crossover analyses. RESULTS: The score of the item "irritation to the nose" was slightly elevated following exposure to methyl methacrylate (p ≤ 0.01). Olfactory functioning was not impaired. Mucociliary transport time did not change. Neither concentrations of interleukins in nasal secretions nor mRNA levels were elevated. CONCLUSION: Only minor irritating effects on the nose were observed. The acute exposure to 50 ppm methyl methacrylate did not cause any adverse effects. However, the results cannot be extrapolated to chronic exposure.

[Dying in Rhineland-Palatinate (Germany): preferred and actual place of death]. / Sterben in Rheinland-Pfalz: Gewünschter und tatsächlicher Sterbeort.

BACKGROUND: Until now, no official statistics about the place of death in Germany exist. OBJECTIVES: The aim of our study was to determine where people died in Rhineland-Palatinate (Germany) in 2008, and which place of death was preferred. We further aimed to identify influencing factors on dying at home vs. dying in an -institution. METHODS: Our cross-sectional survey was based on a random sample of 5000 inhabitants of Rhineland-Palatinate (Germany) that had died between May and August 2008. Relatives of these deceased persons received a questionnaire containing socio-demographic and health-specific questions. RESULTS: After removing duplicates, 4967 questionnaires were sent out. 3832 questionnaires were delivered and 1378 completed, leading to a response rate of 36.0%. 38.2% of the deceased died at home, 39.3% in a hospital, 13.4% in a nursing home, 7.5% in a palliative care facility and 1.6% elsewhere. 93.8% of the deceased who expressed a preference wanted to die at home. Altogether, 58.3% had their wish fulfilled. Suffering from cancer (aOR:1.30; 95% CI:1.01-1.68), social support (aOR being married:1.33; 95% CI:1.04-1.70; aOR having a non-/part-time working relative:1.71; 95% CI: 1.28-2.29), a high care level (aOR care level II:2.79; 95% CI: 2.06-3.79; aOR care level III: 4.96; 95% CI:3.40-7.24), and living in a rural municipality (aOR: 1.36; 95% CI:1.01-1.84) were factors favouring=BE; AE=favoring home death compared with institutional death. CONCLUSION: Altogether, 4 of 10 patients who wanted to die at home could not die in their preferred place. Future studies should focus on the question as to what extent the strengthening of outpatient care structures, e. g., by introducing specialised=BE spezialized=AE outpatient palliative care, can allow more people to die at home.

Acute effects of an exposure to 100 ppm 1-methoxypropanol-2 on the upper airways of human subjects.

The German MAK value of 1-methoxypropanol-2 has been fixed at 100 ppm. The aim of this study was to evaluate possible acute effects of an exposure to 100 ppm 1-methoxypropanol-2 on the upper airways of human subjects. Twenty subjects were exposed in a crossover design to 100 ppm 1-methoxypropanol-2 and to air in an exposure chamber for 4h. Subjective symptoms were assessed by questionnaire. Olfactory thresholds for n-butanol and mucociliary transport time were measured before and after exposure. Concentrations of interleukin 1ß and interleukin 8 were determined in nasal secretions taken after exposure. mRNA levels of interleukins 1ß, 6 and 8, tumor necrosis factor α, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein 1, and cyclooxygenases 1 and 2 were measured in nasal epithelial cells, obtained after exposure. Possible effects were investigated by semiparametric and parametric cross-over analyses. Subjects did not have any subjective irritating symptoms. The olfactory threshold was slightly elevated following exposure to 1-methoxypropanol-2. Mucociliary transport time did not change. Neither concentrations of interleukins in nasal secretions nor mRNA levels except for interleukin 1ß were higher after exposure to 1-methoxypropanol-2. In conclusion, the acute exposure to 100 ppm 1-methoxypropanol-2 did not cause clear-cut adverse effects in test subjects.

[Raynaud's phenomenon in occupational vibration exposure]. / Raynaud-Phänomen bei einer beruflichen Vibrationsbelastung.

HISTORY AND ADMISSION FINDINGS: A 34-year-old female stonemason was referred for expert opinion. The question at issue was, whether she suffered from vibration-induced white finger disease. She was exposed to high-frequency hand-arm vibrations for many years. She reported white finger attacks at the long fingers, which were associated with cold weather. Until this point, physical findings were normal. INVESTIGATIONS: The cold water provocation test showed a slight delay of the rewarming for the long fingers of the right hand. The nailfold capillary microscopy was normal. DIAGNOSIS AND COURSE: The slight Raynaud's phenomenon was recognized as an occupational disease with a diagnosis of vibration-induced white finger disease. About three years later, the symptoms of the Raynaud's phenomenon had deteriorated, although the patient had finished working with vibrating tools. The cold water provocation test confirmed the deterioration. At this time, the patient had inflamed swellings of some joints caused by rheumatoid arthritis. CONCLUSION: The differential diagnosis of a Raynaud's phenomenon should include occupational causes. Occupational history is diagnostically indicative. If an occupational disease is assumed, a report must be filed. With respect to German social law, the deterioration of the Raynaud's phenomenon was caused by the rheumatoid arthritis, which is regarded as independent from the job.

Systematic review: Progression of beryllium sensitization to chronic beryllium disease.

BACKGROUND: The relevance of beryllium sensitization testing for occupational health practice and prevention is unclear. AIMS: To analyse the natural course of beryllium sensitization and clarify the prognosis following cessation of exposure among sensitized workers. METHODS: An electronic literature search was conducted in PubMed, Embase, Toxline and Cochrane databases supplemented by a manual search. Data abstraction and study quality assessment with adapted guideline checklists were performed independently by three reviewers. Seven studies met the eligibility criteria and were included in the systematic review; however, six of the seven studies were of low methodological quality. RESULTS: A substantial (although not specifically quantifiable) proportion of beryllium-sensitized employees will develop chronic beryllium disease (CBD). To date, it is unknown if cessation of exposure in sensitized workers reduces the progression rate to CBD. CONCLUSIONS: To determine the utility of regular assessments for beryllium sensitization among exposed workers, there is a need for prospective studies. This should include detailed and continuous exposure monitoring, regular tests for beryllium sensitization and a thorough diagnostic evaluation of sensitized workers to confirm or exclude CBD.

Intoxication with a tropenol ester.

BACKGROUND: While the effects of medicinal products are investigated in depth before approval, often very little is known about the intermediates occurring during synthesis. The pharmacological properties of these intermediates can differ substantially from those of the end product. AIMS: To describe a work accident involving intoxication with such an intermediate, tropenol ester. CASE REPORT: A healthy 40-year-old chemical-technical operative erroneously used a scrubbing brush that had just been used to clear up tropenol ester, contaminating his work clothes. Presumably, contact was made with his skin when removing his work clothes later. Shortly thereafter, he developed signs of anticholinergic intoxication with mydriasis, dry mouth, abnormal coordination and later sleepiness and seizures. The patient received intensive medical treatment. Two weeks later, the anticholinergic symptoms had subsided. Qualitative analysis of a urine sample showed traces of tropenol ester. The substance is a muscarinic acetylcholine receptor antagonist. CONCLUSIONS: The clinical symptoms and biomonitoring suggest that intoxication with tropenol ester had occurred, which, as a tertiary amine, readily passes through the blood-brain barrier. The protracted course suggests high affinity for the receptor. Appropriate safety precautions must be taken when handling research substances and intermediates of unknown toxicity.

Comparison of subjective olfaction ratings in patients with and without olfactory disorders.

OBJECTIVE: Olfactory dysfunction is common. The reliability of self-assessment tools for smell testing is still controversial. This study aimed to provide new data about the accuracy of olfactory self-assessment compared with a standardised smell test. DESIGN: Prospective, controlled, cohort study of patients with olfactory disorders and healthy controls. SUBJECTS: Ninety-six patients with a smell deficit and 71 controls were asked to rate their sense of smell on a visual analogue scale. Their olfactory abilities were also evaluated with the Sniffin' Sticks tests. RESULTS: The whole cohort showed a significant correlation between visual analogue scale smell scores and Sniffin' Sticks total scores. This correlation was also significant in the patient group, but not in the control group. These results were independent of olfactory deficit aetiology and subject age. CONCLUSION: Self-assessment of olfaction is only a reliable indicator in smell-impaired patients, not in healthy controls. For an accurate assessment of olfaction, reliable, standardised tests are needed.

[Are deaf patients in Germany informed about their legal rights for a sign language interpreter?]. / Sind gehörlose Patienten in Deutschland über ihren gesetzlichen Dolmetscheranspruch informiert?

Deaf citizens are confronted with barriers in a health-care system shaped by hearing people. Therefore the German legislature provides a supply with sign language interpreters at the expense of the health insurances. The present study initially examines in how far the deaf are informed about this and use said interpreters. Traditional surveys are based on spoken and written language and therefore are unsuitable for the target audience. Because of this, a cross-sectional online study was performed using sign language videos and visually oriented answers to allow a barrier-free participation. With a multivariate analysis, factors increasing deaf people's risks not to be informed of the supply with interpreters were identified: Of 841 deaf participants, 31.4% were not informed of their rights. 41.3% have experience with an interpreter at the doctor's and report a mainly trouble-free reimbursement of costs. Young and modestly educated deaf have a higher risk of not being informed of the interpreter supply. Further information is necessary to provide equality of opportunities to deaf patients utilising medical benefits.

[Working conditions and health of general practitioners in Rhineland-Palatinate, Germany: first results of a state-wide survey]. / Arbeitssituation und Gesundheit von Hausärzten in Rheinland-Pfalz: Erste Ergebnisse einer landesweiten Befragung.

AIM: The present study was designed to assess work stress and strain of German general practitioners as well as their health situation by means of standardised and validated instruments. A further objective was to investigate potential means to systematically prevent stress in the target population. METHODS: The Institute of Occupational, Social and Environmental Medicine of the University Medical Centre of Mainz carried out a state-wide anonymous survey between June and July 2009. Altogether, 2 092 practice-based GPs in the federal German state of Rhineland-Palatinate were asked to take part in the cross-sectional study via postal mail. RESULTS: 808 GPs participated (response rate 38.6%), n=790 of these were eligible for the analysis. We found high levels of work strain and perceived stress. The estimated weekly workload was 54.4 h, about one quarter of which (13.4 h) was dedicated to administrative work. 86.8% of the GPs exceeded the cut-off >1 of the ERI-Q (short version) indicating a high stress level. In the preceding year, participants had kept up their work on an average of 8 days on which they actually felt too sick to work. Measures to prevent stress, as suggested by the general practitioners themselves aim at a reduction of administrative work, an improvement of the financial situation - especially in terms of a higher financial security - and a decrease of the workload. Users of professional supervision and systematic relaxation techniques rated these as helpful regarding stress reduction. CONCLUSION: The present study is an important first step to systematically assess the working situation and health of GPs in Germany. The results reported here indicate an urgent need for actions to prevent stress.

[Over-indebtedness and additional payments to the German health-care system - discrimination upon destitution in expenditure]. / Uberschuldung und Zuzahlungen im deutschen Gesundheitssystem - Benachteiligung bei Ausgabenarmut.

AIM OF THE STUDY: In the past few years, the number of over-indebted private households in Germany has steadily increased and is currently estimated to have reached 3.13 million. Financial difficulties culminating in private insolvencies of the persons concerned may lead to a restrained usage of health-care services that require additional payment. For the first time ever this study has examined whether over-indebted individuals refrain from seeking medical treatment or from buying prescribed medicine because of their financial situation. METHODS: The cross-sectional study covered over-indebted persons in Rhineland-Palatinate and was conducted between July 2006 and March 2007. In cooperation with 53 debt counselling agencies in Rhineland-Palatinate and in cooperation with the specialized debtor counselling centre of the Johannes Gutenberg-University of Mainz a singular, anonymous questionnaire-based survey in written form was conducted. RESULTS: Altogether 666 persons (51% female) between 18 and 79 years old (mean value: 41,0 years, standard deviation: 11,2 years; median: 41 years) participated in this evaluation, which amounts to a participation rate of 35.5%. The majority of participants stated to refrain from buying prescribed medication (65.2%) as well as from seeking medical advice and paying euro 10.00 own contribution (60.8%) because of their financial situation. The multivariate, binary logistic end-model showed age, family situation, insolvency proceedings, medical conditions and the self-reported attitude towards health alertness to be relevant factors of influence for both target variables. CONCLUSION: The enacted own financial contribution when seeking health care or when receiving medication in Germany might cause a discrimination of indebted persons or households with regard to health care and medical treatment. Because of the obligation of additional payment, health services are not independent of an individual's financial resources, meaning that especially destitution in expenditure affects equal opportunities in the health care system.