The implementation of knowledge dissemination in the prevention of occupational skin diseases.

BACKGROUND: Occupational skin diseases (OSD) have a high medical, social, economic and political impact. Knowledge dissemination from research activities to key stakeholders involved in health care is a prerequisite to make prevention effective. OBJECTIVES: To study and prioritize different activity fields and stakeholders that are involved in the prevention of OSD, to reflect on their inter-relationships, to develop a strategic approach for knowledge dissemination and to develop a hands-on tool for OSD prevention projects METHODS: Seven different activity fields that are relevant in the prevention of OSD have been stepwise identified. This was followed by an impact analysis. Fifty-five international OSD experts rated the impact and the influence of the activity fields for the prevention of OSD with a standardized questionnaire. RESULTS: Activity fields identified to have a high impact in OSD prevention are the political system, mass media and industry. The political system has a strong but more indirect effect on the general population via the educational system, local public health services or the industry. The educational system, mass media, industry and local public health services have a strong direct impact on the OSD 'at risk' worker. Finally, a hands-on tool for future OSD prevention projects has been developed that addresses knowledge dissemination and different stakeholder needs. CONCLUSION: Systematic knowledge dissemination is important to make OSD prevention more effective and to close the gap between research and practice. This study provides guidance to identify stakeholders, strategies and dissemination channels for systematic knowledge dissemination which need to be adapted to country-specific structures, for example the social security system and healthcare systems. A key for successful knowledge dissemination is building linkages among different stakeholders, building strategic partnerships and gaining their support right from the inception phase of a project.

Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe - position paper of the COST Action StanDerm (TD 1206).

BACKGROUND: Skin diseases constitute up to 40% of all notified occupational diseases in most European countries, predominantly comprising contact dermatitis, contact urticaria, and skin cancer. While insufficient prevention of work-related skin diseases (WRSD) is a top-priority problem in Europe, common standards for prevention of these conditions are lacking. OBJECTIVE: To develop common European standards on prevention and management of WRSD and occupational skin diseases (OSD). METHOD: Consensus amongst experts within occupational dermatology was achieved with regard to the definition of minimum evidence-based standards on prevention and management of WRSD/OSD. RESULTS: By definition, WRSDs/OSDs are (partially or fully) caused by occupational exposure. The definition of OSD sensu stricto additionally includes diverging national legal requirements, with an impact on registration, prevention, management, and compensation. With the implementation of the classification of WRSD/OSD in the International Classification of Diseases (ICD) 11th Revision in future, a valid surveillance and comparability across countries will be possible. Currently, WRDS and OSD are still under-reported. Depending on legislation and regulations, huge differences exist in notification procedures in Europe, although notification is crucial to prevent chronic and relapsing disease. Facilities for early diagnosis, essential for individual patient management, should be based on existing guidelines and include a multidisciplinary approach. Patch testing is essential if contact dermatitis persists or relapses. Workplace exposure assessment of WRSD/OSD requires full labelling of product ingredients on material safety data sheets helping to identify allergens, irritants and skin carcinogens. Comparable standards in primary, secondary and tertiary prevention must be established in Europe to reduce the burden of WRSD/OSD in Europe. CONCLUSION: The adoption of common European standards on prevention of WRSD/OSD will contribute to reduce the incidence of OSD and their socio-economic burden.

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.

Assessment of the Non-Cystic Fibrosis Bronchiectasis Severity: The FACED Score vs the Bronchiectasis Severity Index.

INTRODUCTION: Non-cystic fibrosis bronchiectasis (NCFB) is a multidimensional disease, and no single isolated parameter is proved to have sufficient power for any overall determination of its severity and prognosis. OBJECTIVE: To compare the results of the assessment of the NCFB severity with respect to its prognosis in the same patients by two different validated scores, i.e. the FACED score and the Bronchiectasis Severity Index (BSI). METHODS: An observational study including 37 patients with NCFB (16 males and 21 female aged 46 to 76 years) was performed. All patients underwent evaluation of the variables incorporated in the FACED score (FEV1 % predicted, age, chronic colonization by Pseudomaonas aeruginosa, radiological extent of the disease, and dyspnea) and in the BSI (age, body mass index, FEV1 % predicted, hospitalization and exacerbations in previous year, dyspnea, chronic colonization by Pseudomaonas aeruginosa and other microrganisms, and radiological extent of the disease). RESULTS: According to the value of the derived overall FACED score we found 17 patients (45.9%) with mild bronchiectasis, 14 patients (37.8%) with moderate bronchiectasis and 6 patients (16.2%) with severe bronchiectasis. The mean derived FACED score was 3.4 ± 1.3. In addition, according to the value of the derived overall BSI score, the frequency of patients with low, intermediate and high BSI score was 16 patients (43,2%), 14 patients (37.8%) and 7 patients (18.9%), respectively. The mean derived BSI score was 6.4 ± 2.5. CONCLUSION: We found similar results by the assessment of the NCFB severity in regard to its prognosis by both the FACED score and the BSI. Further studies determining how these scores may impact clinical practice are needed.

National survey on identifying vulnerable workers and availability of occupational health services in the Republic of Macedonia.

OBJECTIVE: In order to identify vulnerable groups and high risk sectors which are at greater need of basic occupational health services, we performed a questionnaire-based study including, as key informants, different stakeholders and key players in the process of improving health and safety at work. METHODS: The Institute of Occupational Health of Macedonia developed an specially designed questionnaire in collaboration with the WHO Regional Office for Europe. Vulnerable groups/sectors include: unemployed, female workers, workers aged under 18 years, workers aged over 55 years and workers in the informal sector, construction industry, textile industry, agriculture, and the health care workers. The Likert scale method was used to evaluate most of the questions in the questionnaire, and the study subjects were instructed to give their professional opinion in completing the questionnaire. RESULTS: All examined groups/sectors were judged to have high risk for occupationally related health problems by over 70% of the responders. Aging workers and workers in agriculture and in the construction industry were judged to have the highest risk for such problems, as well as low health status. All examined groups/sectors were judged to have good availability of primary health care services, while agriculture, unemployed, the informal sector and young workers were judged as having poor availability of occupational health services. CONCLUSION: The provision of Basic Occupational Health Services (BOHS) incorporated in the framework of primary health care via the public health approach was judged as a good conceptfor Macedonia.

Respiratory and nasal symptoms, immunological changes and lung function among petroleum refinery workers.

OBJECTIVE: To assess adverse respiratory effects and immunological changes among petroleum refinery workers. METHODS: We performed a cross-sectional study including 80 subjects employed in the coking unit of a petroleum refinery (54 males and 26 females, aged 28-56 years, duration of exposure 7-28 years) and an equal number of office workers, matched by sex, age and smoking habits. Asthma and allergic rhinitis diagnosed by a physician, as well as respiratory and nasal symptoms in the last 12 months, were recorded by questionnaire. Evaluation of the subjects under study also included skin prick tests for common inhalable allergens and lung function tests. RESULTS: We found a similar prevalence of asthma and allergic rhinitis in both examined groups. Prevalence of overall respiratory symptoms was higher among petroleum refinery workers (33.7% vs. 22.5%) with a statistically significant difference for cough (30.0% vs. 13. 7%, p = 0.018) and wheezing (21.1% vs. 8.6%, p = 0.029). Prevalence of overall nasal symptoms was higher among petrol refinery workers (36.2% vs. 23.7%) with a statistically significant difference for runny nose (28.7% vs. 12.5%, p = 0.014). We found a similar prevalence of allergic sensitization to common inhalable allergens in both examined groups. The results of lung function tests showed significantly lower value of MEF50 (61.9% vs. 67.4%, p = 0.019) and MEF75 (56.1% vs. 62.9%, p = 0.000) among petroleum refinery workers. Respiratory impairment was observed in both smoking and non-smoking petroleum refinery workers. CONCLUSION: Our data suggest that workplace exposure among petroleum refinery workers may lead to respiratory and nasal symptoms and lung function impairment.