Programme for prevention of foot dermatoses in patients with work-related skin diseases: Follow-up data of a prospective cohort study (OCCUPES).

BACKGROUND: A programme based on health education has been developed to prevent foot dermatoses (FD) in patients with work-related skin diseases (WRSD). OBJECTIVE: To evaluate the effectiveness of the programme in a prospective cohort study (OCCUPES). METHODS: Six and 12 months after completing the programme, follow-up questionnaires were sent to 231 patients with WRSD and FD. Assessments included occupational footwear and foot care, self-reported disease course, and health-related quality of life. RESULTS: Response to follow-ups was >70%. Wearing functional socks and changing footwear and socks during one work shift increased (all p < 0.001). Complaints about occupational footwear decreased, including sweating and exposure to moisture/wetness. More than 60% reported improved FD while quality of life significantly increased. After 12 months, all foot symptoms were less frequent, including itch (p = 0.009), pain when walking (p = 0.005), pain in rest (p = 0.015) and smell (p = 0.001). The programme received very good ratings by the participants. CONCLUSIONS: The intervention was effective in improving occupational footwear, foot care and preventive behaviour. It resulted in a reduced burden of FD and should be implemented in the general care of patients with WRSD.

Programme for prevention of foot dermatoses in patients with work-related skin diseases: Baseline data and first results of a prospective cohort study (OCCUPES).

BACKGROUND: Programmes for prevention of hand dermatoses in patients with work-related skin diseases (WRSD) are well established. Similar interventions for foot dermatoses (FD) are widely missing. OBJECTIVE: To evaluate the effectiveness of a programme for prevention of FD based on health education in patients with WRSD while investigating the impact and possible causative factors of FD. METHODS: In a prospective cohort study (OCCUPES), 231 patients with WRSD and FD participating in the programme were recruited. The skin was examined and questionnaires were completed, including assessment of footwear, FD severity, symptoms and health-related quality of life. RESULTS: The baseline and some early results are presented. A work-related causation of FD was likely in 60 patients (26.0%) with irritant contact dermatitis being the most frequent diagnosis. Work-related FD were associated with male sex (p = 0.012), sweating in footwear (p = 0.004) and wearing of safety footwear (p = 0.013). FD were often long-lasting with a high degree of work-absenteeism, quality of life impairment, itch and pain, particularly in work-related FD. CONCLUSIONS: Interventions are needed to reduce the burden of FD in patients with WRSD. The programme addresses current shortcomings in prevention of FD. A long-term evaluation of its effectiveness follows.

Skin Protection Seminars to Prevent Occupational Skin Diseases: Results of a Prospective Longitudinal Study in Apprentices of High-risk Professions.

BACKGROUND: Occupational skin diseases (OSDs) are frequent in professions with exposure to skin hazards. Thus, a health educational intervention for apprentices of high-risk professions was conducted. It was the aim of this study to gain insight into possible effects of this intervention. METHODS: A one-time skin protection seminar was conducted in 140 apprentices of health-related and non-health-related professions [trained cohort (TC)]. In addition, 134 apprentices of the same occupations were monitored [untrained cohort (UTC)]. The OSD-specific knowledge and the skin condition of the hands were assessed at baseline (T0), after the seminar (T1), and after 6 (T2) and 12 months (T3). RESULTS: The OSD-specific knowledge increased in all cohorts from T0 to T3, but we found a significantly higher knowledge in the TC at T2 (p < 0.001, t = 3.6, df = 196, 95% confidence interval = 0.9, 3.3) and T3 (p < 0.001, t = 3.8, df = 196, 95% confidence interval = 1.0, 3.2) compared to the UTC. Our results indicated a better skin condition of the hands in the TC of the health-related professions but not in the non-health-related professions. CONCLUSION: The study indicates that an educational intervention may positively influence the disease-specific knowledge and the prevalence of OSD in apprentices. However, definite conclusions cannot be drawn because of the heterogeneous study cohorts and the study design. Future research should aim at tailoring primary prevention to specific target groups, e.g., in view of the duration and frequency of skin protection education, different professions, and gender-specific prevention approaches.

Interdisciplinary and multiprofessional outpatient secondary individual prevention of work-related skin diseases in the metalworking industry: 1-year follow-up of a patient cohort.

BACKGROUND: In Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance. METHODS: The multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity. RESULTS: Data from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program. CONCLUSIONS: The results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a "high-risk" profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining.

Survey zu sensibilisierenden Inhaltsstoffen von oxidativen Haarfarben (Konsumenten- und Kabinettware) in Deutschland.

HINTERGRUND: Bestandteile oxidativer Haarfarben, wie z. B. p-Toluylendiamin, sind zum einen teils hochpotente Kontaktallergene, zum anderen sind zahlreiche Verbraucher, Friseurkunden bzw. Friseure exponiert. METHODIK: Survey zur Exposition gegenüber aktiven Komponenten oxidativer Haarfarben in Deutschland, basierend auf der Erfassung der qualitativen Produktrezeptur nach INCI, gesondert für Konsumenten- und die in den Salons verwendete "Kabinett"-Ware, bei der auch das gemeinsame Vorkommen der Bestandteile dargestellt wird. ERGEBNISSE: Die 20 am häufigsten verwendeten Stoffe sind nahezu ausnahmslos starke oder sehr starke Sensibilisatoren; Spitzenreiter ist p-Toluylendiaminsulfat, das in 88 % aller Produkte enthalten ist. Zwischen Produkten im Einzelhandel und professionellen Produkten im Friseurfachhandel bestehen nur geringe Häufigkeitsunterschiede. Häufige Kombinationen bestehen zwischen p-Toluylendiamin, Resorcin sowie m-Aminophenol, wobei die Einsatzkonzentrationen, die in dieser Studie nicht untersucht werden konnten, je nach Nuance sehr unterschiedlich sind. SCHLUSSFOLGERUNGEN: Die univariate Betrachtung zeigt, dass die aktuelle "Friseurstoff-Reihe" der Deutschen Kontaktallergie-Gruppe das Expositions-Spektrum von Allergenen nicht gut abdeckt; überdies legen auch Ergebnisse anderer Studien nahe, dass eine Reihe weiterer Allergene getestet werden sollte. Darüber hinaus bedarf der Effekt einer kombinierten Exposition gegenüber mehreren Allergenen gleichzeitig, mit der besonderen dynamischen Allergokinetik oxidativer Haarfarben, hinsichtlich des Sensibilisierungsrisikos weiterer Forschung.

Survey of sensitizing components of oxidative hair dyes (retail and professional products) in Germany.

BACKGROUND: Components of oxidative hair dyes, such as p-toluylenediamine, are very potent contact sensitizers to which many consumers as well as hairdressers and their clients are commonly exposed. METHODS: Based on the qualitative composition of both retail and professional haircare products as determined by package labeling (according to INCI), we conducted a survey on the exposure to active components of oxidative hair dyes in Germany. The joint occurrence of components is also discussed. RESULTS: Nearly all of the 20 most commonly used substances are potent or very potent contact sensitizers. Contained in 88 % of all products, p-toluylenediamine is the most common component. There are only minor differences between retail and professional products. A frequent combination of substances includes p-toluylenediamine (sulfate), resorcinol as well as m-aminophenol. However, their actual concentrations (which were not investigated in this study) may vastly differ depending on the shade of the individual hair dye. CONCLUSIONS: Descriptive univariate analysis reveals that the currently used patch test series "Hairdressing Chemicals", as recommended by the German Contact Allergy Research Group (DKG), does not adequately cover the spectrum of allergens consumers and professionals are exposed to. Other studies have also suggested that a number of other allergens should be tested as well. Taking into account the dynamic kinetics of oxidative hair dyes with respect to allergy development, the effects of combined simultaneous exposure to multiple allergens on the risk of sensitization requires further research.

Prevalence of foot eczema and associated occupational and non-occupational factors in patients with hand eczema.

BACKGROUND: Foot eczema often occurs in combination with hand eczema. However, in contrast to the situation with hand eczema, knowledge about foot eczema is scarce, especially in occupational settings. OBJECTIVE: To evaluate the prevalence of foot eczema and associated factors in patients with hand eczema taking part in a tertiary individual prevention programme for occupational skin diseases. PATIENTS/MATERIALS/METHODS: In a retrospective cohort study, the medical records of 843 patients taking part in the tertiary individual prevention programme were evaluated. RESULTS: Seven hundred and twenty-three patients (85.8%) suffered from hand eczema. Among these, 201 patients (27.8%) had concomitant foot eczema, mainly atopic foot eczema (60.4%). An occupational irritant component was possible in 38 patients with foot eczema (18.9%). In the majority of patients, the same morphological features were found on the hands and feet (71.1%). The presence of foot eczema was significantly associated with male sex [odds ratio (OR) 1.78, 95% confidence interval (CI) 1.29-2.49], atopic hand eczema (OR 1.60, 95%CI: 1.15-2.22), hyperhidrosis (OR 1.73, 95%CI: 1.33-2.43), and the wearing of safety shoes/boots at work (OR 2.04, 95%CI: 1.46-2.87). Tobacco smoking was associated with foot eczema (OR 1.79, 95%CI: 1.25-2.57), in particular with the vesicular subtype. CONCLUSIONS: Foot eczema is common in patients with hand eczema, and is related to both occupational and non-occupational factors.

Mapping nanomechanical properties of freshly grown, native, interlamellar organic sheets on flat pearl nacre.

We imaged surfaces of freshly grown flat pearl nacre (Haliotis tuberculata) in different stages of growth in seawater using an atomic force microscope (AFM). Characteristic mineral phases of nacre, such as aragonitic stacks of coins, as well as the associated organic sheets, could be detected. Apart from imaging, the acquisition of force volumes on freshly grown organic surface areas on flat pearl nacre was conducted with the AFM. The evaluation of the force volumes with the Hertz-Sneddon model resulted in Young's moduli in the MPa range. The presented values are considerably smaller than values previously determined from macroscopic tensile tests. This might reflect the anisotropy of the organic nacre layers.

Olanzapine overdose in children and adolescents: two case reports and a review of the literature.

Although the atypical antipsychotic olanzapine is increasingly being used in child and adolescent psychiatry, reports of olanzapine overdose in this young population are scarce. We report on two cases of adolescents who attempted suicide with an overdose of olanzapine: (1) A 14-year-old female ingested 275 mg olanzapine, which produced the highest reported nonlethal serum level (1503 ng/mL) and caused somnolence, agitation (acutely), and extrapyramidal symptoms (EPS; after 54 hours) but no major clinical complications. The serum olanzapine level dropped to 129 ng/mL within 48 hours; and (2) a 17-year-old male ingested 400 mg olanzapine, the highest reported nonlethal dose of olanzapine in adolescents, which produced respiratory suppression requiring intubation and mechanical ventilation; he recovered after 3 days. Based on clinical monitoring and postmortem data, the 2 patients survived the ingestion of high doses of olanzapine. We also provide a review of the literature, encompassing all reported cases of olanzapine overdose in children and adolescents and discuss symptoms, diagnosis, and treatment options, based on pharmacokinetic and pharmacodynamic considerations.