Department Of Occupational Medicine Research Articles

Evaluation of an antigen-based test for hospital point-of-care diagnosis of SARS-CoV-2 infection.

BackgroundAn accurate diagnosis is essential to identify and manage SARS-CoV-2 infected patients and implement infection control measures. Although real-time reverse transcription polymerase chain reaction (RT-PCR) is the current recommended laboratory method, several rapid antigen point-of-care tests (POCTs) were developed as frontline testing for SARS-CoV-2 infection diagnosis.ObjectivesThe aim of this study was to assess a recently CE-approved POCT, SARS-CoV-2 Ag Test on the LumiraDx™ Platform (LumiraDx GmbH, Cologne, Germany) for the identification of SARS-COV-2 infected subjects at hospital setting.MethodsLumiraDx POCT was implemented in three hospital settings: adult and pediatric emergency departments and occupational medicine department along two-month period during the second peak of Italian SARS-CoV-2 pandemic. Rapid antigen testing was performed on direct nasal swabs and results were compared with those obtained by Xpert Xpress SARS-CoV-2 assay.ResultsOverall sensitivity, specificity, NPV and PPV were 90.3%, 92.1%, 95.1%, and 84.9%, respectively, compared to reference method. Sensitivity, specificity, PPV and NPV for symptomatic group were 89.3% [95% IC 84.2-93.3], 88.2% [95% IC 72.5-96.7], 97.8% [95% IC 94.6-99.1], and 58.8% [95% IC 48.4-68.5], respectively. Sensitivity, specificity, PPV and NPV for asymptomatic group were 92.1% [95% IC 85-96.5], 92.3% [95% IC 89.9-94.4], 67.9% [95% IC 61.3-73.8], and 98.5% [95% IC 97.1-99.2], respectively. False positive and negative antigen testing results in both symptomatic and asymptomatic group were observed.ConclusionSARS-CoV-2 Ag POCT may represent an interesting tool to rapidly identify symptomatic or asymptomatic infected subjects. However, in hospital setting in which false negative or false positive results may have relevant implications, confirmatory NAAT always remains necessary for the appropriate management of patients.

Occupational Noise Exposure and Diabetes Risk.

Introduction Noise is one of the most common worldwide environmental pollutants, especially in occupational fields. As a stressor, it affects not only the ear but also the entire body. Its physiological and psychological impacts have been well established in many conditions such as cardiovascular diseases. However, there is a dearth of evidence regarding diabetes risk related to noises. Aim To evaluate the relationship between occupational exposure to noise and the risk of developing diabetes. Methods This is a cross-sectional analytical study enrolling two groups of 151 workers each. The first group (noise exposed group: EG) included the employees of a Tunisian power plant, who worked during the day shift and had a permanent position. The second group (unexposed to noise group: NEG) included workers assigned to two academic institutions, who were randomly selected in the Occupational Medicine Department of the Farhat Hached University Hospital in Sousse, during periodical fitness to work visits. Both populations (exposed and unexposed) were matched by age and gender. Data collection was based on a preestablished questionnaire, a physical examination, a biological assessment, and a sonometric study. Results The mean equivalent continuous sound level was 89 dB for the EG and 44.6 dB for the NEG. Diabetes was diagnosed in 24 workers from EG (15.9%) and 14 workers from NEG (9.3%), with no statistically significant difference (p=0.08). After multiple binary logistic regression, including variables of interest, noise did not appear to be associated with diabetes. Conclusion Our results did not reveal a higher risk of developing diabetes in workers exposed to noise. Further studies assessing both level and duration of noise exposure are needed before any definitive conclusion.

Seasonal Variation in Patch Test Results with European Baseline Series.

Aim To study the influence of season on patch tests results. Methods We conducted a retrospective epidemiological study which concerned all the patients of the Tunisian center, who consulted in the Dermato-Allergology Unit of Occupational Medicine Department of Farhat Hached University Hospital-Sousse (Tunisia) over a period of 07 years. All the patients were tested by the European Standard Battery allergens (BSE). Results The data of 1000 patch tests were analyzed during the study period. More than half of the patch tests (58.6%) was positive. In winter, 63% of patch tests showed a positive reaction versus 52% of patch tests in summer without a statistically significant association. However, results of lanolin alcohols, epoxy resin, and Sesquiterpene lactone mix varied significantly with season. Atopy was significantly associated with 18.8% of positive reactions in winter and only with 5.2% of positive reactions in summer (p = 0.015). Conclusion Seasonal variations in patch tests results were more significant with some allergens of European Standard Battery and in atopic patients.

Cognitive impairments and recovery in patients with work-related stress complaints – four years later

Patients on sick leave due to work-related stress often present with cognitive complaints. The primary aim of this prospective cohort study was to examine potential long-term consequences of previous ongoing work-related stress in terms of cognitive functioning four years after initial professional care seeking. We tested a group of patients with work-related stress complaints with a comprehensive neuropsychological test battery. Patients were examined at a department of occupational medicine and tested at baseline, one-year follow-up and four-year follow-up. At each time point, we compared the performance of patients with healthy controls matched pairwise on sex, age and length of education. This paper presents the results from the four-year follow-up. Patients improved on their neuropsychological test performance during the four years but the main improvements took place during the first year. At baseline, the main impairments in the patient group concerned executive function and mental speed. At four-year follow-up, patients displayed slightly lower scores on the neuropsychological tests relative to controls but only the difference on immediate memory was significant corresponding to a small effect size (Cohen’s d). More than half of the patients who participated in the four-year follow-up reported that they felt only slightly or partially recovered. The level of work participation among the former patients improved considerably during the four-year follow-up period. Lay Summary This study examines the long-term consequences of work-related stress in terms of cognitive functioning and recovery four years after initial professional care seeking. After four years, patients continued to display significantly lower memory scores than controls but no other significant differences between the groups were found on neuropsychological tests. Levels of work participation among patients improved considerably over time, yet, more than half of the former patients who participated in the four-year follow-up did not feel completely recovered.

Occupational allergy to methacrylates: a deadly risk in workplace

Allergic contact dermatitis (ACD) caused by (meth) acrylates (MA) is common in exposed persons. Moreover, Exposure to MA may rise the predisposition to rhinitis and asthma. However, the occurrence of both asthma and ACD due to MA in the same patient seems to be exceptional. Aim: Report a case of a complex allergy to MA in workplace and stress the difficulty of professional reclassification. A 36-year-old female worker in an electric factory presented to the department of occupational medicine for rhino conjunctivitis, asthma and ACD. Symptoms of weezing dyspnea, rhino conjunctivitis and ACD appeared a few months after recruitment and followed a professional rythmicity (improved during vacation time and aggravated when return to work). The patient’s occupational history revealed that she used a glue containing Hydroxy ethyl methacrylates. Asthma was diagnosed by spirometry, a reversibility test was positive (the FEV1 went up by 12% and 250 ml), nonspecific inhalation challenge test to methacholin was not performed because of a recent history of inadequately controlled asthma. Exhaled NO revealed bronchial inflammation and eosinophilia. The skin-prick test reactions to common environmental allergens and MA were negative. On patch testing, positive reactions were found to several MA including dimethacrylates ethyglycol (++) and mainly the 2-hydroxyethylmethacrylate (2-HEMA) (++). Diagnosis of occupational asthma, rhino conjunctivitis, and ACD to MA was retained. A professional reclassification prohibiting handling all products containing MA was indicated. While resumption of work, the patient presented two episodes of severe acute asthma with hospitalization in intensive care unit and use of endotracheal intubation. Investigation concluded that effective avoidance of use and exposure to glue was not insured imposing a long work stoppage (3 years). Yet, the patient has suffered from a non-controlled severe asthma. To the best of the authors' knowledge, nowadays, there is only one previous reported case of a dentist with both occupational skin and respiratory hypersensitivity from MAs. The case we reported revealed a serious case of occupational asthma, rhino conjunctivitis and ACD caused by MA and threatening the patient's life. Patients with allergy to MA should stop handling it but in practice, professional reclassification finds its limit in severe immediate hypersensitivity forms.

Professor Sergey V. Grebenkov - naval doctor, scientist, teacher (on the 65th anniversary)

The main autobiographical, pedagogical and scientific segments of the life of the head of the Department of naval and radiation hygiene (1996-2006) S.M. Kirov military medical Academy, doctor of medical Sciences, Professor Sergey V. Grebenkov, who turned 65 on April 30, 2020. His work fell on one of the most difficult periods in the history of modern Russia and its Armed forces, associated with the collapse of the Union of Soviet Socialist Republics, the change of socio-economic formation. In these difficult conditions, the most important task was to preserve the scientific potential of the Department and ensure the further development of naval and radiation hygiene. S.V. Grebenkovs contribution to the development of hygiene consists, first of all, in the fact that in his PhD thesis (1988) he justified the list and types of promising individual means of water treatment in the field; in his doctorate (1996) - formulated the concept of human stay in a radiation- destabilized environment, developed principles and recommendations for optimizing the life of military personnel and the population in conditions of long-term stay in radioactively contaminated territories. Under his leadership, the Department developed the conceptual foundations of military ecology. He is the author (co-author) of 367 works, including three textbooks, a two-volume guide to naval and radiation hygiene (1998, 1999), 21 monographs, and a multimedia program Ecological and hygienic bases of military health protection (2001). After graduating from the military medical Academy named after S.M. Kirov, S.V. Grebenkov served in the Northern fleet as head of the medical service of a multi-purpose nuclear submarine (Western Litsa, 1978-1985), then - at the military medical Academy named after S.M. Kirov (adjunct, 1985; teacher, senior teacher, associate Professor, 1988-1996; head of the Department). After demobilization (2006) - head of the Department of occupational medicine of the North-Western state medical University named after I.I. Mechnikov, where he continues to work successfully to this day.

Questionnaires on stigmatizing attitudes among healthcare students in Taiwan: development and validation

BackgroundPeople may be stigmatized if they have mental illness, emotional and behavioral disorders (EBD), or physical or intellectual disabilities. Being stigmatized adversely affects one’s psychological well-being and quality of life. While occupational therapists frequently work with people with EBD and disabilities, all healthcare practitioners may encounter these populations, and stigmatizing attitudes of healthcare professionals towards such clients can negatively affect the therapeutic relationship, evaluation, and treatment. Therefore, understanding attitudes of healthcare students—as future practitioners in all fields of healthcare—towards people in this regard is fundamental to the future implementation of anti-stigma programs. We aimed to develop and test questionnaires for examining stigmatizing attitudes of healthcare students towards people with mental illness or disabilities and children with EBD.MethodsA literature review was conducted to identify surveys related to attitudes towards people with mental illness, EBD, and disabilities. Items that were pertinent to the concept of stigma were selected and modified to fit into the Taiwanese context. A total of 336 students from departments of occupational therapy, physical therapy, nursing, and medicine in 7 universities across Taiwan completed the questionnaires. Item analysis and factor analysis were used to examine the reliability and validity of the questionnaires. Gender differences were also considered.ResultsFactor analyses of the three questionnaires yielded factor structures that explained 61.34 to 67.15% of the variance, with Cronbach’s α values ranging from 0.71 to 0.89. The Questionnaire on Stigmatizing Attitudes Towards Mental Illness consisted of 16 items with 4 subscales: deviant behavior, social isolation, negative stereotype, and self-stigma. The Questionnaire on Stigmatizing Attitudes Towards Children with EBD consisted of 14 items with 3 subscales: rejective attitude, negative stereotype, and deviant behavior. The Questionnaire on Stigmatizing Attitudes Towards Disabilities consisted of 10 items with 3 subscales: positive stereotype, negative stereotype, and pessimistic expectation. In addition, men had slightly higher stigmatizing attitudes than women.ConclusionsThe results showed satisfactory factor structures and internal consistency, and thus support the use of these questionnaires to understand attitudes of healthcare students towards these populations. In addition, particular attention should be paid to gender differences in stigmatizing attitudes of healthcare students.

A Century of Training in Preventive Medicine in Latvia

This year we will mark the centenary since the beginning of studies in higher education in Latvia. On February 2, 1920, the first lecture on anatomy was read. After a year, the Hygiene Institute was established at the Faculty of Medicine of the Higher School of Latvia and the Department of Hygiene was founded on August 15, which can be considered as the predecessor of the present RSU Department of Occupational and Environmental Medicine.

The bilaterality of idiopathic carpal tunnel syndrome among manual workers.

To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151-61.

Impact at two years of an intervention on empowerment among medical care teams: study protocol of a randomised controlled trial in a large French university hospital

BackgroundEmpowerment of hospital workers is known as a key factor of organizational performance and occupational health. Nevertheless, empowering workers remains a real challenge. As in many traditional organizations, hospitals follow a bureaucratic model defined by a managerial culture of control and a stratified organization, which at once weaken professionals’ mastery of their work and hinder their commitment and performance. Based on the existing literature this protocol describes a new managerial and organizational transformation program as well as the study design of its effect on worker empowerment in a large French public hospital. The project is funded by the French Ministry of Health for a total of 498,180 €.MethodsThis study is a randomized controlled trial conducted in a French university hospital complex (CHU). The CHU comprises 12 sub-centers (SC) with about 20 care units and 1000 employees each. Randomization is performed at SC level. The intervention lasts 12 months and combines accompaniment of healthcare teams, frontline managers and SC directors to empower first-line professionals in the experimental SC. Quantitative outcome measurements are collected over 2 years during mandatory check-ups in the occupational medicine department. The primary outcomes are structural and psychological empowerment, motivational processes, managerial practices, working conditions, health and performance. Mixed linear modeling is the primary data analysis strategy.DiscussionThe protocol was approved by the CHU health ethics committee. The results of the analysis of the intervention effects will be reported in a series of scientific articles. The results will contribute to reflection on prevention and management policies, and to the development of Workplace Quality-of-Life. If the intervention is a success, the system will warrant replication in other SCs and in other health facilities.Trial registrationThe study was retrospectively registered at ClinicalTrials.gov on July 4, 2019 (NCT04010773).

Allergie cutanée aux dermocorticoïdes. À propos de 13 cas

BackgroundParadoxically, topical corticosteroids, anti-inflammatory and other immunomodulating drugs used in the treatment of allergic problems can in some cases themselves cause authentic delayed hypersensitivity reactions. ObjectivesTo study the socio-demographic and professional profile of patients with a skin allergy to corticosteroids. Patients and methodsWe conducted an epidemiological study that included all cases of skin allergy to corticosteroids recorded at the Dermatology-Allergology Unit of the Occupational Medicine Department of Farhat Hached University Hospital in Sousse, Tunisia, over an 11-year period of from 2005 to 2015. ResultsDuring the study period, 13 cases of sensitization to corticosteroids were included, representing a frequency of 0.76% in relation to all patch-tests conducted over the same time. Patient age in our study ranged from 16 to 62 years, with a median age of 38 years. Slight male predominance was noted (7 men vs. 6 women). Only 8 patients were professionally active. Reading of the patch-tests was performed for all patients after 48h. Sensitization to budesonide was seen in 7 patients, while the remaining 6 patients were sensitized to tixocortol pivalate. Among the 13 patients with contact eczema to corticosteroids, 9 had co-sensitization to other allergens, with only 4 patients being sensitized to corticosteroids alone (3 cases of budesonide vs. 1 case of tixocortol pivalate). Positive patch-tests for steroids were deemed relevant in 9 patients. ConclusionBecause of their anti-inflammatory effects, corticosteroids can mask the clinical signs of allergies and even render the interpretation of patch-tests extremely difficult in cases of systemic administration. Very many physicians remain unaware of allergy to corticosteroids, including large numbers actually prescribing these drugs.

Compliance with immunization and a biological risk assessment of health care workers as part of an occupational health surveillance program: The experience of a university hospital in southern Italy

The active immunization of health care workers (HCWs) is a primary measure to prevent nosocomial infection; despite this, vaccine coverage among HCWs in most countries is low. To increase vaccine coverage in the health care setting, the hygiene and occupational medicine departments of Bari Policlinico General University-Hospital implemented a vaccination procedure. This operative procedure requires that during the occupational medical examination, all employees are evaluated for immunity/susceptibility to vaccine-preventable diseases, with vaccination offered to those determined to be susceptible. The study sample comprised HCWs who attended the biological risk assessment program from December 2017 to January 2019 (n = 449). Susceptibility was higher for hepatitis B virus (23%), followed by rubella (11%), varicella (9%), mumps (8%), and measles (7%). The seroconversion rate after the administration of booster dose(s) was >80% for all vaccines. Overall, 15% of the HCWs refused the offered vaccine(s), and the main determinants of vaccination compliance were younger age (P < .0001) and being a physician (P < .05). Despite the several recommendations and campaigns to promote vaccinations, achieving high immunization rates among HCWs is still a challenge. In this scenario, public health institutions have to choose between the enforcement of the promotion or the adoption of a mandatory policy.

Establishing an online physical exercise program for people with hemophilia.

SummaryBackgroundHemophilia is a congenital bleeding disorder with an estimated frequency of 1:10,000 births. Repeated joint bleeding is a hallmark of the disorder and leads to painful hemophilic arthropathy. Regular exercise can help improve joint stability and function, reduce the risk of injury and bleeding and improve physical fitness and quality of life. This method paper describes an online training concept aiming to offer access to appropriate exercise instructions for people with hemophilia who are not able to attend regular training at a hemophilia center.MethodsThe online exercise program is accessible through the homepage of the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University Vienna as well as through scanning a QR code printed on information material using a smart phone or tablet.ResultsThe program contains exercises to improve mobility, coordination, muscular strength and flexibility. A brief introduction is given by a hematologist, a pediatrician and a physiatrist. An introductory video informs about contraindications and essential precautions, such as medical attendance and sufficient factor therapy to consider before starting the training. Another video gives advice on the exercise composition. The demonstrated exercises are explained by a physician and are available for adults and children. To individualize training recommendations and offer further diagnostic tools and physical treatment options as necessary, the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University of Vienna will establish consultation hours for people with hemophilia.ConclusionAs hemophilia is an orphan disease, patients are mainly treated in specialized centers. For patients who live far from these centers or have limited access to a training there for other reasons, the physical medicine consultation hour and the implementation of online exercise instructions offer individually adapted exercise information for a regular home-based training to benefit from increased physical fitness and joint stability.

Obituary

Obituary

Influenza vaccination in health-care workers: an evaluation of an on-site vaccination strategy to increase vaccination uptake in HCWs of a South Italy Hospital

ABSTRACT Despite the international recommendation and specific programs, and although the vaccination of health-care workers (HCWs) is considered the main measure to prevent nosocomial influenza, vaccination coverage (VC) among HCWs remains low. One of the most important barriers to vaccination uptake is the time required to attend a vaccination clinic. Centers for Disease Control and Prevention (CDC) recommends on-site influenza vaccination as a proven and cost-effective strategy that increases productivity, reduces overall absenteeism and prevents direct health-care costs. In order to increase vaccine compliance in the HCWs, the Hygiene and the Occupational Medicine departments of Bari Policlinico General University-Hospital, in the 2017/18 influenza season, promoted an on-site vaccination program in eight Operative Units (OUs). We investigated the influenza VC among HCWs of Bari Policlinico (n = 3,397), comparing VC after implementation of the on-site strategy by the Hygiene department during the 2017/18 influenza season to VC in 2016/17 season. For 2017/18 season, we also compared VC in OUs target of on-site strategy with data from in eight “control” Units (choose by simple random sampling) not included in the on-site offer. In the 2016/17 influenza season, 295/3,397 HCWs were vaccinated (VC: 8.7%) while in the 2017/18 season 482 HCWs (VC: 14.2%) received the vaccination. In OUs target of on-site vaccination, 71 HCWs (VC: 10.0%) were vaccinated in the 2016/17 season and 126 (18.0%) in the 2017/18 season, of which 101/126 (80.2%) were vaccinated in an on-site clinic. VC in OUs target of on-site vaccination increased between 2016/17 and 2017/18 seasons of 16.8 ± 10.4% (range: 5.5–37.1), while the coverage in OUs of the control group increased of 1.6 ± 2.2% (range: −1.7–4.5), with a significant difference (p < .05). Our study suggests that the offer of on-site vaccination during the 2017/18 season led to an increase of VC in HCWs compared to the classical vaccination clinic approach. The determinants of adhesion and not-adhesion must be analyzed in dept, to experiment, in the future, new good clinical practices to increase the vaccination coverage in HCWs.

Vibration induced injuries in hands in long-term vibration exposed workers

IntroductionLong-term vibration exposure may cause neurophysiological disturbances such as numbness and tingling, reduced grip strength and difficulties in handling small objects. The dominant hand will usually have a higher vibration exposure than the non-dominant hand, which may cause more severe neurological symptoms and signs in the dominant hand.MethodsThe study is based on 47 (36 males and 11 females) vibration exposed workers, all former patients from the department of Occupational and Environmental medicine, Gothenburg university. The comparison group consisted of 18 randomly selected subjects from the general population of Gothenburg. All participants completed several questionnaires and had a standardized medical examination. Thereafter, neurophysiological tests such as the determination of vibration and thermal perception thresholds were performed, as well as muscle strength tests in hands and fingers.ResultsThe temperature perception thresholds (TPTs) and the vibration perception thresholds (VPTs) did not differ significantly between the dominant and non-dominant hand in vibration exposed workers. The referents showed a significantly better performance (p ≤ 0.02 and p ≤ 0.034, respectively) than the workers for both TPTs and VPTs, indicating a negative effect on the Aß, as well as on the Aδ and C-fibers among the exposed workers.The Purdue Pegboard test showed a significantly better performance in the dominant vs non-dominant hand in both workers (p = 0.001) and referents (p = 0.033). The referents showed a better performance than the workers in both hands (p < 0.001). The Baseline handgrip, the Pinch grip and 3-Chuck grip tests did not differ significantly between the dominant and non-dominant hand in neither workers nor referents.ConclusionsIn this study, minor differences between the dominant and non-dominant hand were noted for the Purdue Pegboard test in both workers and referents. Despite a probably higher vibration exposure in the dominant hand (mostly the right hand), however, quite similar test results were noted for VPTs, TPTs, Baseline handgrip, Pinch grip and 3-Chuck grip when comparing the dominant and non-dominant hand in the vibration exposed workers. In case of lack of time and financial obstacles, neurological tests in solely the dominant hand, will probably satisfactory reflect the conditions in the non-dominant hand.

Meet the First Authors.

Meet the First Authors.

Sensitization to Fragrance mix-1 in Patients with Contact Dermatitis in Nord-East of Italy: 1996–2016 Time Trend and Gender Effect

(1) Background: Fragrance sensitization is common in Italy and their constituents are used in many cosmetics and detergents. The objective of the study was to analyze the temporal trend of sensitivity to fragrance mix-1 in northeastern Italy and to evaluate gender differences; (2) Methods: From 1996 to 2016, 27,381 consecutive patients with suspected allergic contact dermatitis were patch tested. Individual characteristics were collected through a standardized questionnaire in six departments of dermatology or occupational medicine; (3) Results: The overall prevalence of sensitization to fragrance mix-1 was 7.3%; the prevalence was significantly higher in women (7.7%) than in men (6.3%). From 1996 to 2016, we observed an increase of this sensitization, ranging from 6.2% to 7.7% in males and from 7.2% to 9.1% in females; (4) Conclusions: Our study showed that contact allergy to fragrance mix-1 is important in both sexes and prevalence is increasing over time, despite the introduction of new fragrances with lower sensitization potential. There is the need to reduce the use of fragrances mix-1 to stop the increase of sensitization in exposed subjects.

Comparison of exhaustion symptoms in patients with stress-related and other psychiatric and somatic diagnoses

BackgroundSeveral rating scales assessing stress-related symptoms of exhaustion have emerged in recent years. However, more knowledge is needed about the performance of these rating scales in patients with stress-related disorders as well as in other patient groups. With the recently developed Karolinska Exhaustion Disorder Scale (KEDS), we compared symptoms of exhaustion in different patient groups that were sorted according to diagnosis.MethodsPatients were sampled consecutively from departments of occupational medicine (DOM) at three Danish hospitals. The total study group comprised 698 care-seeking patients (487 women). Patients with stress-related diagnoses (n = 217; the International Classification of Diseases [ICD]-10 code F43: reaction to severe stress and adjustment disorder) were compared to a diverse group of patients with a range of somatic diagnoses (n = 338) and to patients with other psychiatric diagnoses (n = 143), including subgroups with major depression disorder (n = 34; F32 and F33) and problems related to employment and unemployment (n = 99; Z56). The data were analysed using linear mixed models with the SPSS statistical program.ResultsThe mean KEDS sum score in patients with stress-related diagnoses (29.3; SD = 8.0) was significantly higher than in patients with other psychiatric diagnoses (25.9; SD = 9.5) and in patients with somatic diagnoses (17.6; SD = 10.8). The subgroup with a major depression disorder had high mean KEDS sum scores (31.4, SD = 8.1), similar to patients with stress-related diagnoses, while the mean KEDS sum score in patients with problems related to employment and unemployment (Z56) was 23.5 (SD = 9.0). Young and old patients scored similarly on KEDS, but in patients with somatic diagnoses, female patients scored significantly higher than male patients.ConclusionThe symptoms of exhaustion measured with KEDS were higher in patients with stress-related diagnoses and major depression disorder than in patients with somatic diagnoses. The intermediate level of the symptoms of exhaustion that were associated with problems related to employment and unemployment, (Z56) compared to the lower level of the symptoms with somatic diagnoses, suggests that KEDS might be useful in detecting mild, prodromal states of exhaustion. This needs further investigation.

Impact of Allergic Contact Dermatitis on the Quality of Life and Work Productivity.

Background Allergic contact dermatitis (ACD) is a common chronic skin disease that generates considerable public-health and socioeconomic costs. This disease affects the quality of life and the occupational activity of patients. Aims To assess the quality of life (QOL) of patients with ACD and study the impact of this disease on their work productivity. Methods This is a cross-sectional study carried out from January 2012 to December 2014. All patients diagnosed with ACD in the Dermato-Allergology Unit of the Occupational Medicine Department at Farhat Hached University Hospital, in Sousse, were included. The impact of skin disease on the QOL of affected persons was assessed using the Dermatology Life Quality Index (DLQI). The work productivity was measured using the Work Productivity and Activity Impairment Allergic Specific questionnaire (WPAI: AS). Results The study population consisted of 150 patients. The average score of DLQI was 6.5. Over the previous 7 days, absenteeism rate was 25.9 ± 15.3%, presenteeism rate was 50.2 ± 32%, overall work productivity loss was 29.6 ± 19.4%, and daily activity impairment was 50.4 ± 32.3%. The DLQI score was significantly associated with atopy (p = 0.03), relapses strictly greater than 10 (p = 0.02), presenteeism (p <10−3), overall work productivity loss (p = 0.01), and daily activity impairment (p = 0.03). Conclusion The impact of ACD on QOL and occupational activity seems important and requires specific attention from the occupational physician.