Multicentre cohort study 'Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assurance of Inpatient Management (ROQ)': results from a 3-year follow-up.

BACKGROUND: A tertiary individual prevention programme (TIP) is offered to patients with severe occupational skin disease (OSD) in Germany. Previously, it was shown that the burden of OSDs is considerably reduced in patients up to 1 year after the TIP. OBJECTIVES: To evaluate the long-term effects of the TIP. PATIENTS AND METHODS: In a prospective multicentre cohort study, the clinical and patient-reported outcome data 3 years after the TIP were evaluated. RESULTS: Of the 1788 patients initially included in the study, 1410 were available for the 3-year follow-up analysis. The severity of OSD, the use of topical corticosteroids and days of absence from work were significantly reduced 3 years after the TIP, and the quality of life and skin protective behaviour were significantly improved. Of the patients, 96.9% were able to resume work. One thousand one hundred and sixty-six patients (82.7%) were still working 3 years after the TIP, 874 of them (75.0%) in the same occupational field. Hairdressers had the lowest rate of remaining in their original profession (41.3%). CONCLUSIONS: The follow-up during 3 years of this unique cohort of patients with OSDs shows that the TIP is associated with sustained improvements in terms of disease severity, ability to work, quality of life, and prognosis.

Predictors of benefit from an atopic dermatitis education programme.

BACKGROUND: Multidisciplinary, age-related, structured, group educational programmes for children with atopic dermatitis (AD) and their parents have shown positive long-term outcomes with respect to quality of life and coping behaviour of the participants. We aimed to identify predictors of favourable long-term outcome of an education measure for parents of children with AD aged 3 months to 7 years in the framework of The German Atopic Dermatitis Intervention Study (GADIS). METHODS: In an exploratory approach, the data of 274 child-parent pairs were analysed with respect to the influence of various somatic and psychological variables as possible predictors of treatment success. Changes in parents' QoL, SCORAD (Scoring Atopic Dermatitis), topical corticosteroid use and parents' knowledge about AD between baseline and 12-months' follow-up were chosen as measures of long-term treatment success (outcome). RESULTS: Psychological rather than somatic parameters were identified as predictors of treatment success. Parents who had negative treatment experiences in the past and possessed only poor coping abilities with regard to scratch control benefitted the most from the training programme. The outcome of the education measure was independent of parents' schooling, vocational level and income. CONCLUSIONS: Parents of children with AD who lack adequate coping abilities should be particularly encouraged to take part in such an education programme.

Cost of illness from occupational hand eczema in Germany.

BACKGROUND: There is little knowledge about the costs of occupational hand eczema. OBJECTIVES: To estimate the societal costs of patients with occupational hand eczema in Germany. METHODS: Resource use during the past year, disease severity and quality of life [Dermatology Life Quality Index (DLQI)] were gathered for patients with occupational hand eczema before they entered a special rehabilitation programme. Costs were calculated from the societal perspective. The analysis focused on all patients and the severity groups no signs/mild (group A) and moderate to severe (group B). RESULTS: One hundred and fifty-one patients were analysed, with a mean age of 44.9~years and a mean DLQI score of 10.9; 64.9% were male. Sickness absence was recorded for 62.9% of all patients (76.4~days on average in the last 12~months). Annual societal costs were €8799 per patient. Indirect costs represented 70% of total costs. Quality of life (DLQI) was statistically different across both severity groups (group A, 7.9; group B, 12.9), but direct treatment costs were not (€2705 versus €2610, respectively). There was a trend towards higher indirect costs in patients in severity group B (group A, €5120; group B, €6796). CONCLUSION: The annual societal costs of patients with occupational hand eczema in this study are high, and similar to those for severe psoriasis and atopic dermatitis.

Multicentre study 'rehabilitation of occupational skin diseases -optimization and quality assurance of inpatient management (ROQ)'-results from 12-month follow-up.

BACKGROUND: Occupational skin disease (OSD) is common, and imposes a considerable personal and public burden. To tackle OSD, the German stepwise procedure of handling OSD was set up. It contains an interdisciplinary, integrated inpatient rehabilitation measure [tertiary individual prevention (TIP)] [dermatological treatment and diagnostic procedures, and patient education (health and psychological)]. The primary aims of the TIP are reduction of the severity of OSD, reduction in the use of corticosteroids, facilitation of return to work, decreased absence from work, and enhanced quality of life (QoL). It was positively evaluated for a period of 4 weeks after return to work. OBJECTIVES: To investigate whether the observed short-term effects remain significant and meaningful over a period of 12 months after discharge from the TIP. METHODS: A prospective design was used to compare clinical and patient-reported outcome data between admission to a 3-week inpatient TIP and 12 months after discharge (12-month follow-up). RESULTS: Of 1788 individuals admitted to the TIP, data from 1617 individuals were available for analysis. We observed a significant reduction in the severity of OSD, the use of topical corticosteroids, and days of absence from work because of OSD. QoL was significantly improved, and 87.4% were able to return to work and remain in the workforce. CONCLUSIONS: A randomized controlled trial would have been desirable, but was not possible, for legal and other reasons. However, the long-term 12-month follow-up shows that the TIP is associated with sustained improvements in terms of ability to work, QoL, and prognosis, and reductions in days of absence from work because of skin conditions and topical corticosteroid application. These results indicate that the TIP provided a reduction in the personal and public burden of OSD.

First results from the multicentre study rehabilitation of occupational skin diseases--optimization and quality assurance of inpatient management (ROQ).

UNLABELLED: BACKGROUND AND OBJECTIVES. The German stepwise procedure of handling occupational skin diseases (OSDs) offers interdisciplinary integrated (inpatient/outpatient) rehabilitation measures [tertiary individual prevention (TIP)] for severe OSD. In 2005, a prospective cohort multicentre study was started in order to evaluate TIP. METHODS: One thousand seven hundred and eighty-eight patients with severe OSD were treated and educated in five clinics with follow-up before and 4 weeks after return to work. RESULTS: During the inpatient phase, there was a significant improvement in the severity of OSD (Osnabrueck Hand Eczema Severity Index, p < 0.001) and in the quality of life (Dermatology Life Quality Index, p < 0.001). These effects were largely sustained during the outpatient follow-up phase and in the 4 weeks after return to work. Among all patients, 89.4% used topical steroids before TIP, including 52.5% using high-grade topical steroids; 93.2% of the patients were able to refrain from using topical steroids before returning to work. As a result of TIP, return to work was possible for 1587 patients (88.8%). CONCLUSIONS: The primary objectives of TIP (return to work, improvement of OSD, enhancement of quality of life, and reduction in the use of topical steroids) were successfully met. The long-term follow-up (1 and 3 years after TIP) will examine whether these favourable outcomes can be sustained.

Structured education program improves the coping with atopic dermatitis in children and their parents-a multicenter, randomized controlled trial.

OBJECTIVE: The objective of this study was to prove training-specific effects in children with atopic dermatitis (AD) and their parents concerning coping with the disease after their participation in a training program. In the 1-year follow-up, the changes in the training group were compared to the changes in a waiting control group while controlling the effects of the changes in severity scores. METHODS: One hundred eighty-five children aged 8-12 years and their parents participated in the study. Complete data sets at the 1-year follow-up were available for 185 parent-child pairs (102 training group; 83 waiting control group). In addition to the severity of the AD [measured with the Scoring Atopic Dermatitis (SCORAD)], data on children's itching-scratching cognitions and coping behavior and on parents handling their affected children were used in the analysis. To study whether the intervention group experienced an additional psychological benefit, which is not due to the SCORAD values, analyses of covariance with repeated measures with standardized residual change scores of the SCORAD as covariate were calculated. RESULTS: The intervention group showed greater improvement in children's coping behavior and in parents' handling their affected children. Additional effects of the training program not due to somatic improvement could be seen in the scales of itching-scratching cognitions and in three of four scales on parents dealing with their affected children. CONCLUSION: The training program, which was tested in the German Atopic Dermatitis Intervention Study, had effects on almost all explored psychological variables. Therefore, additional psychological benefit in the training group does not only depend on the greater improvement of SCORAD values in this group.

Multicenter study "Medical-Occupational Rehabilitation Procedure Skin--optimizing and quality assurance of inpatient-management (ROQ)".

Scientifically based prevention and patient management concepts in occupational dermatology have substantially improved during recent years. Currently the public statutory employers' liability insurance bodies fund a multi-step intervention approach designed to provide quick preventive help for all levels of severity of occupational dermatoses. An administrative guideline (hierarchical multi-step intervention procedure for occupational skin diseases--"Stufenverfahren Haut") insures professional support and optimal patient orientation by the statutory insurers' representatives. For secondary prevention, the so-called dermatologist's procedure ("Hautarztverfahren") was recently updated in order to provide more rapid dermatologic consultations which are covered for by the public statutory employers' liability insurance bodies. Additionally, combined outpatient dermatologic and health-educational intervention seminars ("secondary individual prevention"[SIP]) are offered to affected employees in a nationwide scheme. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed ("tertiary individual prevention"[TIP]). TIP requires 3 weeks inpatient treatment including intensive health care instruction and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study ("Medical-Occupational Rehabilitation Procedure Skin--optimizing and quality assurance of inpatient-management"-"Medizinisch-Berufliches Rehabilitationsverfahren Haut--Optimierung und Qualitätssicherung des Heilverfahrens"[ROQ]) started which will further standardize TIP and evaluate scientific sustainability in depth (3-year dermatological follow-up of 1,000 patients). The study is being funded by the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]).

Itch intensity evaluated in the German Atopic Dermatitis Intervention Study (GADIS): correlations with quality of life, coping behaviour and SCORAD severity in 823 children.

The German Atopic Dermatitis Intervention Study (GADIS), which includes 823 children and adolescents, showed that age-related educational programmes are effective in the long-term management of atopic dermatitis. We investigated whether the itch severity obtained in the scoring of atopic dermatitis (SCORAD) correlates with quality of life and coping behaviour in children and parents. There were significant but low correlations between the severity of atopic dermatitis and the itch intensity. Itch and sleeplessness were significantly correlated. Significant correlations of itch with the coping behaviour and quality of life in parents of children with atopic dermatitis were measured. The coping and itching behaviour of children (8-12 years) and adolescents (13-18 years) had higher significant correlations with the itch compared with the parents' answers. Quality of life in children (8-12 years) and adolescents (13-18 years) showed a significant negative correlation with itch intensity. Quality of life, itch intensity and coping strategies should be considered when treating patients with atopic dermatitis.

Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial.

OBJECTIVE: To determine the effects of age related, structured educational programmes on the management of moderate to severe atopic dermatitis in childhood and adolescence. DESIGN: Multicentre, randomised controlled trial. SETTING: Seven hospitals in Germany. PARTICIPANTS: Parents of children with atopic dermatitis aged 3 months to 7 years (n = 274) and 8-12 years (n = 102), adolescents with atopic dermatitis aged 13-18 years (n = 70), and controls (n = 244, n = 83, and n = 50, respectively). INTERVENTIONS: Group sessions of standardised intervention programmes for atopic dermatitis once weekly for six weeks or no education (control group). MAIN OUTCOME MEASURES: Severity of eczema (scoring of atopic dermatitis scale), subjective severity (standardised questionnaires), and quality of life for parents of affected children aged less than 13 years, over 12 months. RESULTS: Significant improvements in severity of eczema and subjective severity were seen in all intervention groups compared with control groups (total score for severity: age 3 months to 7 years - 17.5, 95% confidence intervals - 19.6 to - 15.3 v - 12.2, - 14.3 to - 10.1; age 8-12 years - 16.0, - 20.0 to - 12.0 v - 7.8, - 11.4; - 4.3; and age 13-18 years - 19.7, - 23.7 to - 15.7 v - 5.2, - 10.5 to 0.1). Parents of affected children aged less than 7 years experienced significantly better improvement in all five quality of life subscales, whereas parents of affected children aged 8-12 years experienced significantly better improvement in three of five quality of life subscales. CONCLUSION: Age related educational programmes for the control of atopic dermatitis in children and adolescents are effective in the long term management of the disease.

Epidemiology of tick bites and borreliosis in children attending kindergarten or so-called "forest kindergarten" in southwest Germany.

The so-called "forest kindergartens" have been increasingly popular in Germany since the beginning of the 1990s. These are nurseries located in forested areas where children spend all-season full-time outdoors. Fifty-three kindergartens in the state of Baden-Württemberg, Germany participated in this study. In a prospective clinical cohort study, the child's personal data, history, protective parental habits concerning tick bites, number of tick bites, and cases of borreliosis were recorded monthly (March-October 2004) using a questionnaire. Altogether, 1,707 children of 25 "forest kindergartens" (506 children) and 28 conventional kindergartens (1,201 children) were included. The response rate was 75% in "forest kindergartens" and 65% in conventional kindergartens. In the "forest kindergartens", 1,503 tick bites especially on the trunk and on the head were found, whereas 502 tick bites were registered in conventional kindergartens. Sixteen cases of borreliosis were diagnosed (10 in "forest kindergartens", six in conventional kindergarten), most frequently manifesting as erythema migrans. Children attending a "forest kindergarten" have a 2.8 times increased risk of experiencing tick bites and a 4.6 times increased risk of suffering from borreliosis compared to conventional kindergarten in Germany, although protective parental behavior in "forest kindergarten" children was significantly better than that in conventional kindergarten.

Cardiovascular risk factors and motivation for a healthy life-style in a German community--results of the GP-based Oestringen study.

This paper explores the motivation of patients towards a healthy life-style in a small community with a special general practice and community-based health education program in order to identify reasons for different motivations and barriers and to improve preventive measures and outcome. The last of six standardised health surveys carried out over 9 years in the five general practices was therefore combined with a questionnaire to explore the attitudes of a sample of patients from these practices (N = 1044) and all attendees of 11 health education courses (N = 153). In addition to the cardiovascular risk factors, data were collected on sociodemographic factors and motivations for health promotion. The results show that, over time, the risk factors of hypertension (P < 0.001) and smoking (P < 0.005) had decreased. Health-promoting activities were not associated with cardiovascular risk factors; the motivations "duty" and "staying young" correlated with gender (P < 0.05). Patients with good health and white collar professions were more active. About 20% specified specific barriers to health-related activities. As expected, the participants of an educational program were more highly motivated by "fun", "fitness" and "meaningfulness". This group was mainly female. Future preventive measures should take into account that motivation for health promotion depends more on psychosocial factors than on risk factors; frequent obstacles should be noticed in the community.

Patient willingness to pay for preventive measures in primary care: a study of five GPs in a German community.

OBJECTIVE: To explore the willingness of patients in a usual primary care setting to pay out-of-pocket fees for their own health promotion, in correlation with risk factors and net income, and compared to patients of an educational programme. METHODS: A standardised health survey carried out in five general practices (GPs) of a small community with a special GP-based health education programme was combined with a questionnaire to explore the special attitudes of patients from a practice sample (n = 973) and from educational courses (n = 202): covering, in addition to cardiovascular risk factors, the sociodemographic factors, net income, and out-of-pocket fees that could be spent for own health promotion. RESULTS: After attending an educational programme, the patient's willingness to spend 15-40 euros/month for their own health promotion was high but there was no correlation with the income (p < 0.56), in contradiction to the patients of the practice sample who would pay more money the more they earn (p < 0.001). High levels of cardiovascular risk were associated with low education (p < 0.001), but net income and willingness to pay for preventive measures did not significantly correlate with cardiovascular risk factors. CONCLUSION: Participants of educational courses are willing to pay a rational out-of-pocket fee for preventive measures without correlation with their incomes, thus reducing the social gradient; future preventive measures should take into account that reasonable cost sharing is well accepted by well-informed patients.