Janice Hegewald

A multifactorial analysis of concurrent patch-test reactions to nickel, cobalt, and chromate.

Background:  Previous research indicates that positive patch tests to nickel (II) sulphate, cobalt (II) chloride and potassium dichromate commonly occur together.

The role of psychosocial working conditions on burnout and its core component emotional exhaustion – a systematic review

AimsTo analyze the association between psychosocial working conditions and burnout and its core component emotional exhaustion, a systematic literature review was undertaken including cohort studies, case–control studies, and randomized controlled trials.MethodsThe literature search in Medline and PsycInfo was based on a defined search string and strict exclusion and inclusion criteria. Evaluation of the 5,599 initially identified search hits by two independent reviewers and a detailed quality assessment resulted in six methodologically adequate cohort studies considering the relationship between psychosocial working conditions and burnout (one study) as well as the burnout core component emotional exhaustion (five studies).ResultsThe results of our systematic review point to a relationship between psychosocial working conditions and the development of emotional exhaustion/burnout. Particularly high job demands seem to play a role in the development of emotional exhaustion. However, strong intercorrelations between workplace factors, as a matter of principle, make the identification of a single psychosocial workplace factor (being associated with an especially high or low risk of burnout) difficult.ConclusionsMultidimensional approaches including reduction of work demands, enhancement of decision latitude and improving the social climate might be promising for preventing burnout and emotional exhaustion. However, methodologically adequate intervention studies are urgently needed to prove the effectiveness of workplace interventions.

A multilingual European patch test software concept: WinAlldat/ESSCA

drugs but also occupational allergens) (3–5). To our knowledge, there has never been described an erythema multiforme with contact dermatitis from rubber vulcanization agents. The lesions were the consequence of indirect occupational contact with rubber piping via the intermediary of a detachment gel able to absorb and concentrate rubber allergens. The clinical course of the disease was biphasic: initially, an acute eczema with poor response to topical corticosteroids and then erythema multiforme requiring systemic corticosteroids. The pathophysiological mechanism could be a systemic response due to the strength of the allergen or cytotoxicity as in erythema multiforme with herpetic infection (4, 5). We were amazed by the rapidity of this sensitization to rubber vulcanization agents. An occupational survey found other workers presentingwith a similar eruption at the same factory.

The impact of meteorological conditions on patch test results with 12 standard series allergens (fragrances, biocides, topical ingredients).

Background  Fluctuating irritability of the skin induced by low ambient temperature and humidity may compromise the reproducibility of patch testing.

Aircraft, road and railway traffic noise as risk factors for heart failure and hypertensive heart disease-A case-control study based on secondary data.

BACKGROUND Several studies point to an elevated risk for cardiovascular diseases induced by traffic noise. AIMS We examined the association between aircraft, road traffic and railway noise and heart failure or hypertensive heart disease (HHD) in a large case-control study. METHODS The study population consisted of individuals that were insured by three large statutory health insurance funds in the Rhine-Main area of Germany. Based on insurance claims and prescription data, 104,145 cases of heart failure or HHD diagnosed 2006-10 were identified and compared with 654,172 control subjects. Address-specific exposure to aircraft, road and railway traffic noise in 2005 was estimated. Odds Ratios were calculated using logistic regression analysis, adjusted for age, sex, local proportion of persons receiving unemployment benefits, and individual socioeconomic status (available for 39% of the individuals). RESULTS A statistically significant linear exposure-risk relationship with heart failure or hypertensive heart disease was found for aircraft traffic noise (1.6% risk increase per 10dB increase in the 24-h continuous noise level; 95% CI 0.3-3.0%), road traffic noise (2.4% per 10dB; 95% CI 1.6-3.2%), and railway noise (3.1% per 10dB; 95% CI 2.2-4.1%). For individuals with 24-h continuous aircraft noise levels <40dB and nightly maximum aircraft noise levels exceeding 50dB six or more times, a significantly increased risk was observed. In general, risks of HHD were considerably higher than the risks of heart failure. CONCLUSIONS Regarding the high prevalence of traffic noise from various sources, even low risk increases for frequent diseases are relevant for the population as a whole.

The Gutenberg Health Study: measuring psychosocial factors at work and predicting health and work-related outcomes with the ERI and the COPSOQ questionnaire

BackgroundSeveral instruments have been developed to assess psychosocial workload. We compared two of these instruments, the Effort-Reward Imbalance (ERI) model and the Copenhagen Psychosocial Questionnaire (COPSOQ) with regard to congruent validity and internal validity.MethodsThis analysis is based on a population-based sample of the baseline examination of 2,783 employees from the Gutenberg Health Study (GHS). About half of the participants completed the ERI questionnaire (n = 1,342), the other half completed the COPSOQ (n = 1,441). First, the two samples were compared and descriptive analyses were carried out calculating mean values for both instruments in general, then separately for age, gender and main occupational groups. Second, we analyzed the relationship between ERI and COPSOQ scales on the workplace situation and on the workplace outcomes: job satisfaction, general health, burnout, satisfaction with life, by applying stepwise logistic regression analysis.Results and discussionFor the majority of occupations, high effort as reflected by the ERI corresponded with high demands as reflected by the COPSOQ. Comparably, high reward (according to ERI) yielded a good agreement with high “influence and development” (according to COPSOQ). However, we could also find differences between ERI and COPSOQ concerning the intensity of psychosocial workload in some occupations (e.g., physicians/pharmacists or warehouse managers/warehousemen/transport workers). These differences point to differing theoretical concepts of ERI and COPSOQ. When the ability of ERI and COPSOQ was examined to determine the associations with health and work outcomes, burnout could be better predicted by the COPSOQ; this might be due to the fact that COPSOQ comprises the constructs “work-privacy conflict” and “emotional demand”, which are closely related to burnout. However, methodological differences between these instruments limit their direct comparability.ConclusionsThe ERI and COPSOQ instrument yielded similar results for most occupational groups. The slightly stronger association between psychosocial workload as assessed by COPSOQ and burnout might be explained by its broader approach. The ability of the ERI and COPSOQ instrument to reflect relevant risk factors for clinically manifest disorders (e.g., coronary heart disease) will be derived from subsequent prospective analyses of the GHS with the follow-up data.

The association between ambient air conditions (temperature and absolute humidity), irritant sodium lauryl sulfate patch test reactions and patch test reactivity to standard allergens.

To support the decision as to whether erythematous patch test reactions to allergens are irritant or allergic, sodium lauryl sulfate (SLS, 0·5% in water) has been added to the standard patch tests since July 1996 in the Dortmund Department of Dermatology. Data on 1600 patients patch tested up until June 2001, as well as standardized data on ambient temperature and humidity obtained by the German Meteorological Service, were included in a logistic regression analysis taking age, sex and atopy as potential confounders into account. The pattern of association was heterogeneous: while doubtful reactions to nickel sulfate were significantly associated with dry/cold weather conditions, but not with SLS reactivity, the opposite was observed for lanolin alcohol, benzocaine and Myroxylon pereirae resin (balsam of Peru). Doubtful reactions to other allergens, namely formaldehyde, fragrance mix or p‐phenylenediamine, were associated with both factors. For several other allergens of the standard series, no distinct, significant pattern could be discerned. In conclusion, meteorological conditions and SLS reactivity independently contribute information on individual irritability at the time of patch testing, and both should be considered.

Occupational polycyclic aromatic hydrocarbon exposure and risk of larynx cancer: a systematic review and meta-analysis

Polycyclic aromatic hydrocarbons (PAH) are genotoxic substances formed during combustion. Occupational PAH exposure has been shown to increase the risk of lung cancer and may be associated with other respiratory cancers. We conducted a systematic review and meta-analysis to clarify the relationship between occupational PAH exposures and larynx malignancies. We searched EMBASE and MEDLINE (until July 2014) using a series of search strings developed to seek case–control studies or longitudinal studies of workers (Population) exposed to PAHs (Exposure) and their risk for larynx cancer incidence and/or mortality (Outcome). Two independent reviewers screened the titles and abstracts for eligible articles and a third reviewer negotiated consensus. Further assessments of eligibility and sources of bias were conducted in a similar manner. The study results were pooled with random effects meta-analysis. The search resulted in 3377 records. The data of 92 full-text articles representing 63 studies were included and extracted. The majority of studies (n=47) was judged likely to be biased; only 16 studies were judged as methodologically adequate. The pooled effect size was 1.45 (95% CI 1.30 to 1.62; I2=30.7%; =0.03) for larynx cancer incidence and 1.34 (95% CI 1.18 to 1.53; I2=23.8%; =0.03) for larynx cancer mortality. While few studies allowed an investigation of dose–response, these indicate a positive dose–response effect. Although most studies may underestimate the true effect due to inexact approximations of PAH exposure, the meta-analysis suggests a robust positive association between PAH and larynx cancer.

Myocardial Infarction Risk Due to Aircraft, Road, and Rail Traffic Noise: Results of a Case–Control Study Based on Secondary Data

BACKGROUND Traffic noise can induce stress reactions that have effects on the cardiovascular system. The exposure-risk relationship between aircraft, road, and rail traffic noise and myocardial infarction is currently unknown. METHODS 19 632 patients from the Rhine-Main region of Germany who were diagnosed with myocardial infarction in the years 2006-2010 were compared with 834 734 control subjects. The assignment of persons to groups was performed on the basis of billing and prescription data from three statutory health insurance carriers. The exposure of all insurees to aircraft, road, and rail traffic noise in 2005 was determined from their residence addresses. As estimators of risk, odds ratios (OR) were calculated by logistic regression analysis, with adjustment for age, sex, regional social status variables, and individual social status (if available). The evaluation was performed on the basis of the continuous 24-hour noise level and the categorized noise level (in 5 decibel classes). RESULTS The linear model revealed a statistically significant risk increase due to road noise (2.8% per 10 dB rise, 95% confidence interval [1.2; 4.5]) and railroad noise (2.3% per 10 dB rise [0.5; 4.2]), but not airplane noise. Airplane noise levels of 60 dB and above were associated with a higher risk of myocardial infarction (OR 1.42 [0.62; 3.25]). This higher risk is statistically significant if the analysis is restricted to patients who had died of myocardial infarction by 2014/2015 (OR 2.70 [1.08; 6.74]. In this subgroup, the risk estimators for all three types of traffic noise were of comparable magnitude (3.2% to 3.9% per 10 dB rise in noise level). CONCLUSION In this study, a substantial proportion of the population was exposed to traffic noise levels that were associated with an albeit small increase in the risk of myocardial infarction. These findings underscore the importance of effective traffic noise prevention.

Association between aircraft, road and railway traffic noise and depression in a large case-control study based on secondary data

Background Few studies have examined the relationship between traffic noise and depression providing inconclusive results. This large case‐control study is the first to assess and directly compare depression risks by aircraft, road traffic and railway noise. Methods The study population included individuals aged ≥40 years that were insured by three large statutory health insurance funds and were living in the region of Frankfurt international airport. Address‐specific exposure to aircraft, road and railway traffic noise in 2005 was estimated. Based on insurance claims and prescription data, 77,295 cases with a new clinical depression diagnosis between 2006 and 2010 were compared with 578,246 control subjects. Results For road traffic noise, a linear exposure‐risk relationship was found with an odds ratio (OR) of 1.17 (95% CI=1.10–1.25) for 24‐h continuous sound levels ≥70 dB. For aircraft noise, the risk estimates reached a maximum OR of 1.23 (95% CI=1.19–1.28) at 50–55 dB and decreased at higher exposure categories. For railway noise, risk estimates peaked at 60–65 dB (OR=1.15, 95% CI=1.08–1.22). The highest OR of 1.42 (95% CI=1.33–1.52) was found for a combined exposure to noise above 50 dB from all three sources. Conclusions This study indicates that traffic noise exposure might lead to depression. As a potential explanation for the decreasing risks at high traffic noise levels, vulnerable people might actively cope with noise (e.g. insulate or move away).