Occupational Hand Research Articles

The Effectiveness and Safety of Niacinamide 4% and Virgin Coconut Oil 30% for Secondary Prevention of Occupational Hand Dermatitis

The Effectiveness and Safety of Niacinamide 4% and Virgin Coconut Oil 30% for Secondary Prevention of Occupational Hand Dermatitis

Contact dermatitis: etiologies of the allergic and irritant type

The term contact dermatitis describes an inflammatory process of the skin that occurs in response to contact with exogenous substances and involves pruritic and erythematous patches. Approximately 80% of all contact dermatitis is primary irritant contact dermatitis (ICD), whereas allergic contact dermatitis (ACD) makes up only 20% of contact dermatitis cases, the estimated prevalence of contact dermatitis in the United States being 1.4%. Among patch-tested patients, nickel has been identified as the most common allergen. Cobalt is the second most common metal allergen and is found in various dental alloys, paints, and coloring components of porcelain and glass. The average prevalence of dermatitis due to p-phenylenediamine (PPD) was found to be 4.3% in Asia, 4.0% in Europe, and 6.2% in North America. Rubber gloves are a major cause of occupational ACD in healthcare workers. Occupations involving frequent handwashing, between 20 and 40 times per day, have shown an increased incidence in cumulative ICD. The prevalence of occupational hand dermatitis was 69.7% in workers that reported a handwashing frequency exceeding 35 times per shift. The use of alcohol-based sanitizers is much more prevalent among today's healthcare workers than frequent handwashing. Both allergic and ICD are worldwide problems.

An overlooked risk for healthcare workers amid COVID-19: Occupational hand eczema.

OBJECTIVE:Hand hygiene, one of the most critical preventive methods against Coronavirus Disease-2019 (COVID-19) cross-transmission, has increased during the COVID-19 outbreak. The present study aims to investigate the prevalence and risk factors of hand eczema (HE) and associated symptoms in healthcare workers (HCWs) during the COVID-19 outbreak.METHODS:We distributed a self-administered online survey to physicians and nurses in Kahramanmaras, Turkey. The survey included questions about HE-associated symptoms and risk factors before and during the pandemic.RESULTS:Five hundred sixty-four individuals (349 physicians and 215 nurses) answered the survey. Post-COVID-19, the prevalence of HE increased from 6.6% to 11.7% and the prevalence of HE-associated symptoms increased from 39.5% to 79.3%. Female gender (odds ratio [OR]: 3.92; 95% confidence interval [CI]: 2.12–7.25), a history of atopic diseases (OR: 1.7; 95% CI: 1.03–2.8), more frequent handwashing (OR: 1.03; 95% CI: 1.01–1.05), and more frequent use of moisturizers (OR: 1.12; 95% CI: 1.01–1.24) were independently associated with the risk of HE-associated symptoms.CONCLUSION:Because of increased handwashing during the COVID-19 outbreak, there is a significant increase in HE-associated symptoms in HCWs. Proper education and preventive strategies for HE are urgently needed for HCWs fighting on the front lines of COVID-19.

The methylisothiazolinone epidemic goes along with changing patients' characteristics - After cosmetics, industrial applications are the focus.

Sensitization to methylisothiazolinone (MI) has seen an exceptional epidemic, mainly attributed to its use in cosmetics. To trace the epidemic of MI allergy (2009-2018), and to analyze a possible change of patients' characteristics. Informationsverbund Dermatologischer Kliniken-data of patients patch tested between 2009 and 2018 with MI (0.05% aq.) were analyzed concerning anamnestic items and sensitization frequencies. Overall, 4.9% reacted positive to MI. Comparing sensitization to MI in three periods (2009, 2013/14, and 2017/18), there was an increase to 7% in 2013 and a decrease to 3.4% in 2018. The MOAHLFA Index (M=Men, O=Occupational Dermatitis, A=Atopic Dermatitis, L=Leg Dermatitis, F=Face Dermatitis, A= Age > 40) for the period 2013/14 is characterized by a lower proportion of occupational dermatitis and a higher proportion of face dermatitis. The period 2017/18 is characterized by increases of occupational dermatitis and hand dermatitis, and a decrease of face dermatitis. Painters, personal care workers, and hairdressers were particularly affected. Sensitization in hairdressers and personal care workers (mostly cosmeticians) decreased after the peak in 2013/14, whereas sensitization to MI in painters continued to increase. After an unprecedented epidemic of MI allergy, mainly caused by its use in cosmetics, the continuous use of MI in industrial applications, for example, paints, and subsequent sensitization remain a matter of concern.

Management of High-Pressure Injection Hand Injuries: A Multicentric, Retrospective, Observational Study.

Hand injuries after high-pressure injection are a medical emergency. These events occur frequently in workers during industrial cleaning, painting, and lubrication, and may have devastating consequences, leading to eventual amputation and poor functional outcomes. The authors have investigated the evolution, management, and outcome. Medical records of occupational medicine units and hand surgery units were collected in order to spot the high-pressure gear accident cases. Records were analyzed by dividing the subjects into two groups: those treated within 6 h and after 6 h of the trauma. A follow-up was carried out at least 1 year after treatment; the post-treatment outcomes were assessed. Of the 71 (100%) subjects, 26 (37%) were treated ≤6 h and 45 (63%) >6 h. A total of 28% (n = 20) underwent amputation. In 61% of cases, accidents had occurred in the iron and steel sector. High viscosity materials with a delayed treatment beyond 6 h seemed to determine compartmental syndrome and following amputation. A significantly better outcome was reported among subjects treated ≤6 h compared to those treated >6 h, 20% (n = 7) versus 26% (n = 9), respectively. Early management of this type of injury is crucial. The results of this study may contribute to providing guidelines to occupational physicians in order to best manage this type of emergency.

Prevention of hand eczema

Apart from endogenous factors, hand eczema is often caused by irritant or allergic contact dermatitis related to occupational or non-occupational exposure to skin hazards. This enables several complementary approaches on the level of primary, secondary and tertiary prevention. Ahigh priority is set on identification and subsequent reduction or elimination of causative exposures. Important preventive approaches include legal regulations, technical and organizational measures as well as correct use of adequate personal protective equipment (e.g. protective gloves). Interventions based on health education are conducted to improve individual protective behaviour. Even though evidence-based proof of effectiveness is limited, preventive measures are considered of particular importance for avoidance of occupational hand eczema and its adverse sequelae. Therefore, acomplex, step-wise approach to occupational skin diseases has been established in Germany. In recent years, the positive impact of secondary and tertiary preventive measures of this approach has been demonstrated.

Development of a haptic system for occupational hand therapy

This paper presents a therapeutic haptic system. The platform consists of a hand exoskeleton - actuated by gearmotors - and a virtual interface that operates in conjunction with the Myo armband to collect electromyographic data from this eight-channel device. The system aims at serving as an auxiliary tool in occupational therapy routines to rehabilitate people with motor disabilities in their hands. The exoskeleton has a simple mechanical structure that requires five actuators for its operation and allows the hand to move throughout its nominal range of motion, as well as reproduce the movements essential to perform occupational therapy exercises. The virtual interface simulates a ball, with software-configurable size and stiffness and records data about the movements performed by the patient, the electromyographic activity, and the reaction forces applied by the exoskeleton. Similarly, the interface includes a pre-established routine of occupational therapy. We validated the correct operation of our haptic system through a protocol conducted by ten healthy test subjects. During that protocol, we recorded and plotted the information collected by the system. We obtained informed consent from all the research participants.

Factors influencing prognosis for occupational hand eczema: new trends

Variables traditionally reported to influence the prognosis of occupational hand eczema (OHE) are atopic dermatitis (AD) and contact sensitization. However, recent studies indicate that lifestyle factors may be of major importance. To identify factors influencing the prognosis in a cohort of patients with recognized OHE. In this register-based cohort study, individuals with hand eczema recognized as occupational disease in the period January 2010-December 2011 were identified using files from Labor Market Insurance Denmark and included in the study. At baseline, information on sex, age, occupation, wet work, AD and contact sensitization was collected. In 2015 participants received a questionnaire with questions about lifestyle factors, current occupation and healing of OHE. In total, 2703 patients received the questionnaire; 1491 responded to the question about healing of OHE and were included in the study. Altogether, 19·3% of patients reported complete healing at follow-up. Current tobacco smoking and a high level of stress were factors inversely associated with healing of hand eczema (P < 0·001 and P = 0·030, respectively), while a high level of exercise was significantly related to healing of eczema (P = 0·011). Change of profession was a favourable prognostic factor, while age, sex, AD, contact sensitization and education did not significantly influence prognosis. Traditionally important risk factors such as AD and contact sensitization had no marked influence on prognosis, while lifestyle factors were of major importance. Our findings indicate that risk factors may vary over time, allowing for new perspectives on prevention. What's already known about this topic? Occupational hand eczema has a relapsing course and a poor overall prognosis. Atopic dermatitis and contact sensitization have previously been reported as risk factors for a poor prognosis. What does this study add? The results indicate that lifestyle factors are of importance for the prognosis of occupational hand eczema. Traditionally reported risk factors such as atopic dermatitis and contact sensitization do not currently influence prognosis.

Workmen’s compensation for occupational hand injuries

The Compensation for Occupational Injuries and Diseases Act No. 130 of 1993, as amended in 1997 (COIDA), provides payment to healthcare providers for treatment of occupational injuries in South Africa (SA). Patients and employers are often unaware of procedures for claiming, and patients then carry the burden of costs themselves. Additionally, under-billing results in a loss of income for treating hospitals. Hand injuries are common occupational injuries and form the focus of this study. To investigate whether occupational hand injuries treated at the Martin Singer Hand Unit at Groote Schuur Hospital, Cape Town, were accurately captured and allocated correct professional fee coding and billing. Accurate capturing and billing would allow for access to the Compensation Fund and allocation of finances to improve service delivery, as well as avoid unnecessary costs to otherwise uninsured patients. All new hand injuries presenting to the hand unit at the hospital in August 2017 were sampled in a retrospective folder review. Injuries on duty (IODs) were identified and analysed further. Coding and billing were compared with independent private quotes. Sixty new hand injuries presented during the month. Fifteen were IODs, but only 6 were recognised by administration. The other 9 were billed at minimum income rates and 5 of these patients also had operations, which were not billed for. A total of ZAR88871.99 was under-billed in terms of professional fees only. The 9 incorrectly classified patients had to bear costs themselves at a median of ZAR130.00 each. There were large discrepancies in billing for occupational hand injuries. This resulted in costs to the patients and loss of income for the facility. Access to the Compensation Fund is vital in financing resources in the overburdened public sector. Suggestions for improvement include accessing COIDA funds in order to improve administration at the unit, so improving identification, coding and billing of occupational hand injuries.

Healthy Hands: a pilot study for the prevention of chronic hand eczema in healthcare workers of an Italian University Hospital.

Healthcare workers are at risk for occupational chronic hand eczema (CHE) because of frequent handwashing and prolonged use of occlusive gloves. Prevention programs based on skin care education have been shown to be beneficial. We developed and assessed the efficacy of a skin care educational intervention for healthcare workers of our hospital. The intervention consisted of two sessions, one week apart, each divided in a theoretical and a practical part, focusing on the skin barrier, types of eczema, risk factors for CHE, hand hygiene measures respectful of the skin, proper use of protective gloves and emollient creams. Its efficacy was assessed by a questionnaire, administered before and after the intervention, investigating the participants' knowledge of risk factors for CHE and risk behaviors. Twenty-three subjects, mostly (65.2%) nurses, took part in the intervention; 60.9% had a self-reported atopic background and 65.2% participants reported a history of CHE. The intervention improved significantly the participants' knowledge on CHE risk factors, i.e. frequent handwashing (P=0.023), surgical scrubbing (P=0.016) and prolonged glove wearing (P=0.022). The frequency of hand washing was significantly reduced (P=0.022). The participants gave a positive unanimous feedback. Our intervention was effective, by significantly improving the participants' knowledge and by inducing significant behavioral changes. Improving the formulation of alcoholic hand rubs may be a key factor to encourage their use. Coexisting nonoccupational risk behaviors are just as important in the prevention of CHE.

A job-exposure matrix addressing hand exposure to wet work.

The aim of this study was to create a job-exposure matrix (JEM) for wet work. A JEM is a tool used to assess exposure to potential health hazards in occupational epidemiological studies. It can be used when counselling concerning job change/job choice, as a medico-legal tool when recognizing diseases as occupational and when planning interventions regarding prevention of, in this case, occupational hand eczema. The study population was based on results from national surveys on working environment performed by the National Research Centre for the Working Environment in Denmark in 2000, 2005, and 2010 (National Research Centre for the Working Environment). We assessed responses on questions regarding wet hands, glove wear and total wet work. For the JEM a cutoff of 2h total wet work/day was chosen as the exposure measurement. The proportion of responses of 2h total wet work/day in each profession is illustrated as a number between 0 and 1 equal to 0-100% of the responses. Total wet work was most frequent among cleaners (domestic, office, and hotel cleaning), butchers and fishmongers, cooks, beauticians (hairdressers, barbers, related work) and health care workers (home-based personal workers, dentists, dental assistants). Regarding differences between sexes we found that indifferent of age and profession, women had 78% higher odds of having wet work. We found that wet work as an exposure varies among professions depending on whether wet hands or glove wear is assessed. A JEM is a useful tool to assess the extent of the exposure, wet work, independent of prior perceptions of classical wet work professions.

Factors determining the effectiveness of conservative treatment in patients with carpal tunnel syndrome.

The study aims to assess selected factors contributing to the long-term effects of the conservative treatment of carpal tunnel syndrome (CTS). Forty-nine individuals diagnosed with CTS were enrolled in the study. The symptoms resulted from occupational hand overuse in 37 patients. The assessment involved 78 hands before the therapy (study 1) and 1 year after the end of the therapy (study 2). The clinical symptoms assessed included: pain, numbness, tingling, morning stiffness, vegetative disorders and difficulties in activities of daily living (ADL). The range of motion (ROM) in the hand joints and the pressure generated during the cylindrical grip were measured. Phalen's tests, an electrodiagnostic test and a 2-point discrimination study were performed. A significant reduction of symptoms and improvement in tested parameters were found in study 2. The largest ROM in the hand, the lowest level of pain and the largest reduction in the frequency of daytime tingling were found in the oldest patients in study 2. In subjects with better initial electrodiagnostic test results, a significant reduction in daytime numbness and daytime tingling was obtained. In individuals previously subjected to conservative therapy, a significant improvement in the ROM of the hand and a better quality of sensation were noted in study 2. A higher level of pain, a lower reduction in the frequency of daytime tingling, and a smaller improvement in ADL capacity were noted in individuals who overused their hands at work after the therapy. The effects of conservative CTS treatment after 1 year, expressed as the reduction of subjective symptoms, were independent of the patient's age. A worse initial electrodiagnostic test result is a predictor of less favorable therapy results. Hand overuse during occupational activity may negatively affect the effects of conservative treatment in individuals with CTS. A change in the nature of occupational activity positively influenced the long-term maintenance of the effects of conservative treatment. Int J Occup Med Environ Health. 2019;32(2):197-215.

Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial

ObjectiveThe objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke. Methods50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training. ResultsThe AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001). ConclusionsThese data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group. SignificanceThese results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.

Health-care providers' perspectives on factors influencing return-to-work after surgery for nontraumatic conditions of the upper extremity

Study DesignThis study is a descriptive survey. IntroductionHealth care providers (HCPs) are key stakeholders who facilitate workers’ return to work (RTW) following upper extremity surgery. Hand therapists play a major role in this process, yet we do not know if and/or how their perspectives differ from other HCPs. Purpose of the StudyThis study examined HCPs’ opinion on factors that influence RTW after surgery for nontraumatic upper extremity conditions and whether HCPs from different disciplines differed in their opinion. MethodsHCPs (occupational therapists, physiotherapists, hand therapists, exercise physiologists, psychologists, surgeons, and general practitioners) completed a survey rating 50 factors on a worker’s ability to RTW. Each factor was scored using a 5-point Likert scale from “not” to “extremely” influential, which was later dichotomised. Agreement was indicated at 75%. The level of disagreement between disciplines was examined. ResultsRespondents (n = 787) identified 20 factors being influential on RTW. They are (in order from highest to lowest) poor pain coping (the highest, >85% of respondents), postoperative psychological state, RTW self-efficacy, employer/supervisor’s support, employer’s unwillingness for job modification, recovery expectations, job satisfaction, suitable duties availability, whether the job can be modified, and mood disorder diagnosis. There was agreement that two factors do not influence RTW, gender, and preemployment medical assessment. There was disagreement (P < .05) between HCP disciplines on six factors (obesity, comorbidities, doctors’ RTW recommendation, diagnosis, fitness, income). There were no consistent patterns with respect to which professions disagreed across all six factors. Hand therapists differed from the other disciplines for three of the factors including diagnosis, comorbidities, and doctor’s recommendation for RTW. DiscussionThe factors that stakeholders agreed as having the greatest influence were mainly related to the worker (pain and psychological factors) and the workplace and are amenable to RTW interventions. ConclusionInterventions facilitating RTW and future research should consider the factors identified by HCPs in this study.

Abstract No. 500 Patterns of clinical history and angiography in hypothenar hammer syndrome: a case series

Hypothenar Hammer Syndrome (HHS) is a rare syndrome that may be defined as damage to the palmar ulnar artery typically due to chronic, repetitive trauma. Clinical and imaging manifestations may include: aneurysm, pseudoaneurysm, thrombosis, microemboli, vasospasm, “corkscrew” vessels, stenosis, ectasia, pulsatile mass, and digital ischemia. While HHS is thought to be due to chronic, repetitive palmar trauma related to occupations such as mechanic, machinist, carpenter, and other workers who use vibrating tools, case reports of HHS stemming from acute isolated incidents have been described. This case series presents five patients who were diagnosed with HHS in order to examine trends in risk factors and clinical history leading to similar presentations. A chart review of all upper extremity angiograms from October 2003 to April 2018 was performed (n = 400). Angiography reports were reviewed if present in the electronic medical record to determine indications and findings of the studies. In cases where HHS could not be ruled out from the reports, follow-up clinic visits were reviewed to provide corroborative information. In total, 5 patients were found to have HHS. All five patients were middle-aged males with a history of repetitive occupational hand trauma, often from machinery-type jobs. Clinical presentations were similar among patients, involving some combination of digital numbness, pain, and discoloration. Two patients presented with an acute-on-chronic history, two patients had a distant acute trauma in addition to chronic occupational history, and one patient had only chronic, repetitive trauma with no acute inciting event. HHS can occur in the setting of isolated chronic trauma alone. However, this series shows the most common presentation of HHS to be associated with an acute event in the setting of chronic repetitive trauma.

Hand as hammer: A comprehensive review of biomechanical studies related to occupational hand strikes

AbstractA growing number of workers in modern automotive assembly plants are confronted with occupational tasks involving repeated high‐impact hand strikes. Such repetitive physical workloads account for diseases of soft tissues or musculoskeletal disorders in the hand, wrist, or entire upper body. The purpose of this review was to identify and discuss the most pertinent occupational and physiological investigations concerning such hand strikes with particular emphasis on the biomechanical parameters examined. Articles were drawn from four databases to identify publications about occupational hand strikes. First, studies were selected that evaluated hand impact loads measured with the help of force measurement devices. For a deeper understanding of biomechanical factors regarding hand impacts, the scope of the search was extended to include ancillary studies about impacts on wrists or elbows. Overall, 945 abstracts were screened, and five full‐text articles were included in the final review. In addition, 34 ancillary articles about impact stress on the hand–arm complex were discussed because of positive relations between high forces, repetition rates or acceleration, and progressing stress in the hand–arm complex identified in studies about critical biomechanical load limits, in the field of fall arrests and sports, i.e. tennis. Furthermore, studies about effective arm movements and body postures during hand strikes as used in martial arts were reviewed. Although certain biomechanical parameters are both known and well documented, studies available at present cannot sufficiently account for specific disorders in the wrist or arm that are triggered by occupational hand strikes.

PREVALENCE OF OCCUPATIONAL HAND CONTACT DERMATITIS AND ITS ASSOCIATED FACTORS AMONG STAFF NURSES OF A PUBLIC HOSPITAL IN SELANGOR

https://doi.org/10.32827/ijphcs.6.1.118Background: Introduction Occupational contact dermatitis is the commonest occupational skin disease and hands are affected the most. Among healthcare workers, nurses have the highest prevalence of occupational hand contact dermatitis (OHCD). Prevalence of OHCD varies between countries and it shows an increasing trend. OHCD can cause economically burden to a country, reduce the quality of life of a nurse and increase the risk of cross infection. The aim of this study was to identify the prevalence factors associates with OHCD.Materials and Methods: A cross-sectional study was conducted among 206 staff nurses of Hospital Selayang who full filled inclusion and exclusion criteria Data was collected 7 May 2018 till 1 June 2018 using validated data questionnaire. Pre-test of the self- administered questionnaire was conducted among 50 staff nurses. Data was analysed using IBM Statistical Package for Social Science (SPSS) version 23.0 involving descriptive and inferential statistics.Result: The response rate was 100%. A 12-month prevalence of OHCD among staff nurses of Hospital Selayang was 26.2%. Hours of wearing glove, skin symptoms with gloves, skin symptom with hand washing liquid or soap, eczema history and allergy history to any substances were found associated with OHCD.Conclusion: OHCD showed to be a problem among staff nurses at the study location with a prevalence of 26.2%. Further intervention should be taken to prevent OHCD among staff nurses.Keywords: Occupational skin disease, hand contact dermatitis, nurse

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 3: nomenclature and outcome assessment.

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE). It presents the key findings from 11 systematic reviews published in 2016 that focus on AE outcome assessment, disease impact and nomenclature. Systematic reviews on the treatment and prevention of AE are summarized in Part 1 of this update, and systematic reviews on the epidemiology of and risk factors for AE are summarized in Part 2. Six reviews summarized what outcome measurement instruments have been used in published AE trials, or summarized validation studies for the available instruments. These reviews were used to inform consensus decisions by the Harmonising Outcome Measures for Eczema initiative. Although validated instruments exist for clinical signs and patient-reported symptoms, there are currently no validated instruments for capturing quality of life or long-term control. Four reviews examined the impact of AE on children and their families, but few studies were included. One birth cohort study found no association between AE and educational attainment at 11years. AE has a moderate impact on health-related quality of life and a substantial impact on family life. AE is a major risk factor for occupational hand dermatitis, and it is advised that young atopic individuals are informed about high-risk occupations. Further efforts are required to standardize the nomenclature for AE, which is also commonly known as 'atopic dermatitis' or 'eczema', and preferred terms vary around the world.

Personal and occupational factors contributing to biomechanical risk of the distal upper limb among dairy workers in the Lombardy region of Italy

Biomechanical overload in the wrist flexor and extensor muscles, together with awkward hand positions during work activities, can result in occupational wrist and hand disorders. Dairy workers, specifically those that work in the milking parlor, are exposed to highly repetitive and forceful exertions of the upper limb throughout their work shift. There are very few studies that have investigated the determinants that contribute to the risk of distal upper limb musculoskeletal disorders among dairy workers. The purpose of the present study was to identify the variables affecting the biomechanical overload of the distal upper limb among milking parlor workers, define risk profiles, and propose possible interventions to reduce the high physical loads to the distal upper limb during milking activities. Forty male workers from the three most common milking parlor systems in Lombardy Italy were recruited to participate in this study. Multiple correspondence analysis of personal characteristics and occupational risk factors, followed by cluster analysis, led to the identification of three distinct groups of workers. Low, medium and high risk profiles were assigned to each group based on the risk assessments performed using the Strain Index and electromyography of the distal upper limb. The main risk determinants were workstation characteristics, work organization and milking routine. A well-organized milking routine, milking cluster weight below 2.4 kg or the use of supporting arms for the milking cluster may reduce the risk of biomechanical overload.

Occupational hand dermatitis in car repair workers.

IntroductionExposure to used gasoline engine oils during oil change and other automobile repair services is common for many mechanics, electrical technicians, and other car service workers. We aimed to determine the prevalence of hand dermatitis in car repair workers with different specialty and actual dermal exposure hazards in the workplace.MethodsWe examined the dermal problems in 153 male car repair workers and compared it to 140 office workers. Exposed and control groups were administered a Nordic Occupational Skin Questionnaire. Dermal exposure score also was calculated.ResultsThe prevalence of hand dermatitis in car repair workers (19.0%) was significantly higher than office worker (7.9%) [OR: 2.74, (95% CI = 1.31, 5.73)] and also higher than general population. Prevalence of atopic dermatitis was significantly higher in exposed group that had hand dermatitis compared with those who had no hand dermatitis (P < 0.001). The highest hand dermatitis as well as actual dermal exposure was observed in the mechanics and transmission technician respectively.ConclusionCar repair workers have an elevated prevalence of hand dermatitis in comparison with office workers. The most important risk factors for hand dermatitis among car repair workers are atopic dermatitis and the next the level of skin exposure to potential skin hazards.