Background
Methods
Aim, prevention approach and timeline
Module | Content | Method | Materials | Duration | Staff and institution |
---|---|---|---|---|---|
1 | Welcoming and introduction to staff, participants, and program in order to create a trustful, open seminar atmosphere | Moderation of oral conversation (group) | Key questions for participants (e.g., occupation, risk factors) | 15-20 min. | Health educationalist, University of Osnabrück |
2 | Legal basis concerning the statutory accident insurance, the procedure of patient care, differences and possible financial and social consequence of work-related and occupational diseases and compensation in order to increase the motivation to remain in work and to perform appropriate skin protection | Oral presentation, dialogue in case of individual questions (group) | Power point slides, script for notes | 30 min. | Social security employee specialized in accident prevention, Social Accident Insurance Institution for the woodworking and metalworking industries, Dortmund |
3 | Skin protection seminar in order to gain disease-specific knowledge concerning the function and structure of the skin, anatomy of the stratum corneum, skin barrier function, external (e.g., cutting fluids, solvents) and internal (e.g., atopic diathesis) risk factors, pathogenesis of irritant and allergic contact dermatitis, and methods for skin protection, skin care and mild skin cleansing, to improve the disease management and to increase the motivation to perform skin protection behavior | Interactive, dialogue-oriented seminar (group) | Power point slides, flipcharts, hands-on skin protection experiments, pictures, metaphors, models (e.g., brick-and-mortar-model of the stratum corneum) | 90-110 min. | Health educationalist, University of Osnabrück |
4 | Lunch break | 45 min. | Cantina of the Hospital, Dortmund | ||
5 | Different types and usage of protective gloves, pictograms, hands-on showing of examples, explaining of appropriate and wrong usage (e.g., to avoid that gloves become contaminated on the inside) | Oral hands-on presentation, dialogue in case of individual questions (group) | Examples of various protective gloves to hand round to touch, feel and compare types, models, and pictograms, flipcharts | 45 min. | Technical inspector, Social Accident Insurance Institution for the woodworking and metalworking industries, Dortmund |
6 | Circle with four stations: | ||||
6a | Dermatological examination and counseling to assess the skin condition and the disease course, to recommend further diagnostics, to identify individual therapy options, and to answer individual questions | Individual patient counseling | Medical records (e.g., patch test results) | 10-15 min. | Dermatologist, Department of Dermatology, Dortmund |
6b | Review of the currently used skin protection products, if necessary: recommendation of alternative (optimized) protective gloves, skin creams, and/or mild skin cleanser for subsequent testing under real workplace conditions | Individual patient counseling | Report of workplace visit, different examples of protective gloves, creams, and cleansers | 15 min. | Technical inspector, Social Accident Insurance Institution for the woodworking and metalworking industries, Dortmund |
6c | Health educational counseling to answer individual questions, to explain the individual medical diagnosis with “simple words” (lay terms), to improve the individual skin protection behavior and to practice how to correctly apply cream | Individual patient counseling | Medical records, educational material to practice the correct application of cream and to identify “cream gaps”, other material (as individually required) | 10 min. | Health educationalist, University of Osnabrück |
6d | Counseling regarding subsequent steps and procedures (e.g., organizational inquiries, provision of skin products and gloves, information on future support by the social accident insurance) | Individual patient counseling | Documents and forms | 10 min. | Social security employee specialized in accident prevention, Social Accident Insurance Institution for the woodworking and metalworking industries, Dortmund |
Study design and recruitment
Outcomes and instruments
Data analysis
Results
Study cohort and drop-outs
Socio-demographic and work-related characteristics
Remaining in work
Dermatological examination and atopy score
T1 | T2 | ||
---|---|---|---|
OHSI score [total, for both hands] | mean [SD, range] | 4.99 [2.64, 0–13] | 3.90 [2.46, 0–11] |
diagnosis [hands] (multiple answers possible) | irritant/cumulative subtoxic contact dermatitis [%, n] | 80.7 [67] | 89.2 [74] |
allergic contact dermatitis [%, n] | 7.2 [6] | 7.2 [6] | |
atopic hand eczema [%, n] | 12.0 [10] | 9.6 [8] | |
psoriasis palmaris [%, n] | 13.3 [11] | 10.8 [9] | |
other, not classifiable [%, n] | 2.4 [2] | 3.6 [3] | |
atopy score | mean [SD, range] | 6.9 [4.36, 0–20] | n. a. |
no atopic diathesis, 0–3 points [%, n] | 18.1 [15] | n. a. | |
atopic diathesis unlikely, 4–7 points [%, n] | 41.0 [34] | n. a. | |
atopic diathesis unclear, 8–9 points [%, n] | 19.3 [16] | n. a. | |
atopic diathesis, 10 or more points [%, n] | 21.7 [18] | n. a. |
Self-reported characteristics of the skin disease
T1 | T2 | T3 | T4 | ||
---|---|---|---|---|---|
dermatological treatment due to WRSD [at present] | no [%, n] | 3.6 [3] | n. a. | 10.8 [9] | 18.1 [15] |
yes [%, n] | 94.0 [78] | n. a. | 89.2 [74] | 81.9 [68] | |
sick leave due to WRSD in the last 12 months | no [%, n] | 60.2 [50] | n. a. | n. a. | n. a. |
yes [%, n] | 38.6 [32] | n. a. | n. a. | n. a. | |
sick leave due to WRSD since T1 | no [%, n] | n. a. | 68.7 [57] | n. a. | n. a. |
yes [%, n] | n. a. | 15.7 [13] | n. a. | n. a. | |
sick leave due to WRSD since T2 | no [%, n] | n. a. | n. a. | 91.6 [76] | 86.7 [72] |
yes [%, n] | n. a. | n. a. | 7.2 [6] | 9.6 [8] | |
skin condition of the hands [“How do you assess the skin condition of your hands at the moment on a scale from 0 (no skin disorders) to 10 (severe skin disorders)?”, eleven-step numerical rating scale from 0 to 10] | mean [SD, range] | 4.96 [2.31, 0–10] | 4.57 [2.12, 1–10] | 3.64 [2.19, 0–10] | 3.71 [2.43, 0–9] |
school grade for the skin condition of the hands [“With which school grade do you assess the skin condition of your hands at the moment?”, six-step numerical rating scale from 1 (very good) to 6 (unsatisfactory)] | mean [SD, range] | 3.80 [1.12, 1–6] | 3.55 [0.99, 1–5] | 3.25 [1.08, 1–6] | 3.28 [1.20, 1–6] |
assessment of the statement | not at all [%, n] | 2.4 [2] | 7.2 [6] | 12.0 [10] | 15.7 [13] |
“I currently have skin symptoms” [five-step Likert scale] | mild [%, n] | 33.7 [28] | 33.7 [28] | 42.2 [35] | 39.8 [33] |
moderate [%, n] | 43.4 [36] | 37.3 [31] | 31.3 [26] | 31.3 [26] | |
strong [%, n] | 15.7 [13] | 8.4 [7] | 6.0 [5] | 12.0 [10] | |
very strong [%, n] | 2.4 [2] | 2.4 [2] | 2.4 [2] | – | |
photographic guide: worst hand eczema ever experienced | almost healed [%, n] | 4.8 [4] | 4.8 [4] | 8.4 [7] | 8.4 [7] |
mild [%, n] | 14.5 [12] | 18.1 [15] | 22.9 [19] | 24.1 [20] | |
medium [%, n] | 42.2 [35] | 34.9 [29] | 44.6 [37] | 42.2 [35] | |
severe [%, n] | 30.1 [25] | 22.9 [19] | 18.1 [15] | 16.9 [14] | |
photographic guide: average hand eczema in the last 12 months | almost healed [%, n] | 6.0 [5] | 2.4 [2] | 14.5 [12] | 20.5 [17] |
mild [%, n] | 41.0 [34] | 37.3 [31] | 48.2 [40] | 45.8 [38] | |
medium [%, n] | 38.6 [32] | 36.1 [30] | 26.5 [22] | 24.1 [20] | |
severe [%, n] | 4.8 [4] | 3.6 [3] | 3.6 [3] | 1.2 [1] | |
photographic guide: hand eczema at present [“If you look at your hands right now: Which group of pictures corresponds to your hand eczema? Please choose the more affected hand.” five-step Likert scale with each four pictures for four groups (almost healed to severe)] | no hand eczema [%, n] | 3.6 [3] | 3.6 [3] | 12.0 [10] | 10.8 [9] |
almost healed [%, n] | 15.7 [13] | 21.7 [18] | 31.3 [26] | 28.9 [24] | |
mild [%, n] | 41.0 [34] | 41.0 [34] | 43.4 [36] | 36.1 [30] | |
medium [%, n] | 28.9 [24] | 14.5 [12] | 9.6 [8] | 19.3 [16] | |
severe [%, n] | 3.6 [3] | 1.2 [1] | 2.4 [2] | 2.4 [2] | |
changes of the skin disorders since T2 [“Did you skin disorder change since you have participated in the skin protection seminar?”] | no (=remained the same) [%, n] | n. a. | n. a. | 38.6 [32] | 31.3 [26] |
yes [%, n] | n. a. | n. a. | 60.2 [50] | 67.5 [56] | |
I don’t know [%, n] | n. a. | n. a. | 1.2 [1] | – | |
“If yes: How did your skin disorder change?” (T3: n = 50, T4: n = 56) | healed [%, n] | n. a. | n. a. | 4.0 [2] | 14.3 [8] |
strong improvement [%, n] | n. a. | n. a. | 40.0 [20] | 28.6 [16] | |
slight improvement [%, n] | n. a. | n. a. | 48.0 [24] | 46.4 [26] | |
slight worsening [%, n] | n. a. | n. a. | 2.0 [1] | 3.6 [2] | |
strong worsening [%, n] | n. a. | n. a. | 4.0 [2] | 5.4 [3] | |
“Do you attribute this change to participating in the skin protection seminar?” (T3: n = 50, T4: n = 56) | yes [%, n] | n. a. | n. a. | 40.0 [20] | 51.8 [29] |
in parts [%, n] | n. a. | n. a. | 54.0 [27] | 28.6 [16] | |
no [%, n] | n. a. | n. a. | 6.0 [3] | 17.9 [10] |
T1 (first consultation) | T2 (after one day program) | |
---|---|---|
OHSI vs. eleven-step numerical rating scale from 0 to 10 | r = 0.487a, p < 0.001, n = 77 | r = 0.416a, p < 0.001, n = 70 |
OHSI vs. six-step numerical rating scale from 1 to 6 (school grades) | r = 0.477a, p < 0.001, n = 76 | r = 0.533a, p < 0.001, n = 70 |
OHSI vs. five-step Likert scale (verbal) | rS = 0.536b, p < 0.001, n = 77 | rS = 0.547b, p < 0.001, n = 74 |
OHSI vs. five-step Likert scale (photographic guide) | rS = 0.415b, p < 0.001, n = 73 | rS = 0.543b, p < 0.001, n = 68 |