Search

Moisturizers are used for the treatment of dry and irritated skin. The benefit of moisturizers when used on normal skin has recently been challenged, since an earlier study indicated that the increased hydration that follows long-term use of moisturizers on normal skin may facilitate penetration of irritants. The aim of the present study was to evaluate short-term use of 2 different moisturizers used on normal skin: cream A (high lipid content) and B (moderate/low lipid content). Nineteen healthy volunteers applied the moisturizers on the upper arm/forearm 3 times daily for 5 days, while the other upper arm/forearm served as symmetrical control. The day after moisturizer treatment was stopped the skin was challenged with a patch test of sodium lauryl sulphate. Skin reactions were evaluated by bioengineering measuring methods and clinical scoring. Skin response to sodiumlauryl sulphate was increased on moisturizer treated arms compared to controls for one of the moisturizer (cream A), while this was not statistically significant for the other moisturizer (cream B). Data confirm previous indications that some moisturizers when used on normal skin may increase skin susceptibility to irritants. [ABSTRACT FROM AUTHOR]

These symptoms worsen quality of life and can contribute to early treatment discontinuation, such that supplemental estrogens are sometimes considered to mitigate these endocrine therapy toxicities. The authors used the nationwide Danish registry of 8461 women diagnosed with early stage, estrogen receptor-positive breast cancer to identify and follow patients who received or did not receive oral menopausal hormone therapy (MHT; n = 133 patients) or vaginal estrogen therapy (VET; n = 1957 patients) postdiagnosis. Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy. Patients who are taking aromatase inhibitors should try alternative strategies for management of genitourinary symptoms because VET will likely increase their risk for breast cancer recurrence. [Extracted from the article]

Background: Correct daily skin care is important regarding hand eczema (HE). However, only a few studies have evaluated the level of knowledge among hospital cleaners. Objective: To examine the level of knowledge regarding skin protective behaviour and risk factors with respect to HE in hospital cleaners. Methods: All cleaners working in four hospitals in Denmark were invited to participate in the study, which was based on a questionnaire consisting of 22 questions. Results: 142 of 236 cleaners (response rate = 60.1%) were included. The mean of total correct answers were approximately five out of nine questions. 85.6% of participants evaluated themselves to have a low degree of knowledge of skin care and protection. Based on the number of correct answers, 90% were defined as having low knowledge. Being born or raised outside of Denmark was statistically significantly associated with lower level of knowledge. Risk factors for HE such as, work with wet hands, and use of household cleaning products were only recognized as risk factors by less than 50%. Conclusion: Our study indicates that Danish hospital cleaners have a low degree of knowledge regarding skin care and protection. Cleaning workers born or raised outside of Denmark are in need of special attention. [ABSTRACT FROM AUTHOR]

Background: Health care workers (HCWs) report frequent adverse skin reactions (ASRs) due to face personal protective equipment (F‐PPE) use during the coronavirus disease 2019 (COVID‐19) pandemic. Objectives: To describe self‐reported ASRs among HCWs using F‐PPE; investigate background factors, such as chronic skin diseases and skin types (dry, oily, combination, sensitive), and determine whether HCWs took preventive methods against ASRs. Methods: An online questionnaire was distributed to 22 993 HCWs at hospitals. Results: The prevalence of ASRs was 61.9% based on 10 287 responders. Different types of F‐PPE caused different reactions. The most common ASRs from surgical masks were spots and pimples (37.2%) and from FFP3 masks was red and irritated skin (27.3%). A significantly higher proportion of HCWs with chronic skin diseases had ASRs (71.6%) than those without chronic skin diseases (59.7%) (P <.001). Some skin types were more prone to ASRs (sensitive skin [78.8%] vs dry skin [54.3%]; P =.001). HCWs using F‐PPE for >6 hours versus <3 hours per day had a four times higher ASR risk (P = <.001). Nearly all HCWs used preventive and/or counteractive methods (94.2%). Conclusions: It is important to consider background factors, such as chronic skin diseases and skin types, to prevent and counteract ASRs due to F‐PPE use. [ABSTRACT FROM AUTHOR]

Background: During the first wave of the COVID‐19 pandemic of Spring 2020, Denmark was one of the first countries to introduce lockdown measures, including closing of all daycare centers. Following the reopening of daycare centers, Danish Health Authorities implemented a mandatory intensive hand hygiene regimen. Objectives: To examine the occurrence and point prevalence of hand eczema as a consequence of more intensive hand hygiene among Danish children attending daycare. Methods: The heads of 1667 daycare centers in Denmark were contacted and asked to forward a link to a questionnaire to parents of the children attending the daycare center. Results: Among 6858 children, 12.1% had hand eczema before reopening of daycare centers, whereas 38.3% reported hand eczema after the children returned to daycare. Of the children who never had hand eczema, 28.6% developed hand eczema after returning to daycare. The risk of hand eczema was significantly associated with atopic dermatitis, female gender, higher age, and frequency of handwashing. Conclusion: Following the implemented hygiene regimen, a high proportion of young children rapidly developed hand eczema. Well‐established prophylactic skin care might have spared a proportion of the children from developing hand eczema. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a prevalent relapsing inflammatory skin disease. There is currently little knowledge about healthcare utilization and medication use along with parental corticosteroid phobia in relation to severity of pediatric AD. Objectives: To study the association between parental‐reported healthcare utilization, medication use, and topical corticosteroid phobia and pediatric AD severity. Methods: The study population included all children in Denmark with a diagnostic code of AD (ICD‐10 code, group L20) given at a hospital department of dermatology between 2014 and 2018. A questionnaire containing 158 response items was sent to the legal parents. We surveyed disease severity, AD treatment, corticosteroid phobia, and healthcare use along with other variables. Disease severity was assessed using the Patient‐Oriented Eczema Measure tool, and corticosteroid phobia was assessed using the Topical Corticosteroid Phobia (TOPICOP) score. Results: In total, 1343 (39%) parents completed the questionnaire and 95.3% were completed by the biological mother. Children's mean age was 8.9 ± 4.5 years, and 52.8% were boys. Severe AD was associated with a higher number of healthcare visits to GPs, private dermatologists, and hospital departments. Mean global TOPICOP score was 38.27 ± 19.9%. There was a significant inverse linear trend between global TOPICOP score and parental educational level (Ptrend <.0005). Conclusions: The significant association between high global TOPICOP score and low parental educational level, resulting in delayed treatment of AD flares, indicates that improved family education ultimately may reduce healthcare expenses and burden of disease. [ABSTRACT FROM AUTHOR]

Background and purpose — It is well recognized that some knee arthroplasty (KA) patients present with prolonged postoperative inflammation and some develop persistent pain. It can reasonably be speculated that some of these problems develop because of low-grade infections with low virulence bacteria caused by intraoperative contamination. This prospective study was performed to investigate whether intraoperative contamination results in lower patient-reported outcomes (PRO) for patients who were clinically uninfected in the first year after surgery. Patients and methods — We combined data from 2 major prospective studies on patients undergoing primary KA at 2 Danish hospitals between September 2016 and January 2018. Pre- and postoperative (1.5, 3, 6, and 12 months) PROs and intraoperative microbiological cultures were obtained on a total of 714 patients who were included in the study. Based on the microbiological cultures, the patients were divided into 2 groups, contaminated and non-contaminated, and differences in PROs between the 2 groups were analyzed. Results — 84 of 714 (12%) patients were intraoperatively contaminated; none of the 714 patients developed clinical infection. The preoperative Oxford Knee Score was 24 and 23 for contaminated and non-contaminated patients, respectively, improving to 40 and 39 at 1 year (p = 0.8). 1-year AUC for Oxford Knee Score and absolute improvement at each postoperative time point for Forgotten Joint Score and EQ-5D-5L also were similar between contaminated and non-contaminated patients. Interpretation — Patient-reported outcomes from 714 patients do not indicate that intraoperative contamination affects the knee-specific or general health-related quality of life in primary KA patients who are clinically uninfected 1 year after surgery. [ABSTRACT FROM AUTHOR]

Background. Atopic dermatitis (AD) is a chronic skin condition where nonadherence often results in lack of disease control. Objective. We wanted to determine whether the combination of an electronic memory button and a supportive application (app) would affect the Quality of Life and subjective and objective severity measures among AD patients over one month following the patient's normal schedules of treatment. Methods. A randomized, investigator-blinded, prospective observational feasibility study for one month where patients diagnosed with AD were randomized based on POEM severity score and divided into 3 groups. The 3 groups were (1) the control group with two consultations, (2) in addition to group 1, patients also received electronic memory buttons to click every time they used their topical products, and (3) in addition to group 2, patients also received an app to track their treatment schedules. At both consultations, patients were evaluated using SCORAD, EASI, POEM, and DLQI. Results. 96 patients were enrolled and randomized, of which 83 patients completed the study. EASI and SCORAD scores were lower in all groups at 2nd consultation (p < 0.05); however, these were highly significant for group 3 (p < 0.005), and for EASI between groups 2 and 3 (p < 0.05). The POEM score decreased significantly in group 3 (p = 0.024), and no difference was found in DLQI between visits. Conclusion. A reduction in severity following objective assessments of the AD was observed for all groups and was highly significant for patients offered a memory button and the corresponding app. Furthermore, patients reported a significant subjective beneficial effect if they used the memory button and app. This indicates that digital solutions may have a benefit in clinical practice and may reduce nonadherence and increase the wellbeing of the patients. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Because of changes in sedation strategies, more patients in the intensive care unit (ICU) are conscious. Therefore, new and challenging tasks in nursing practice have emerged, which require a focus on the problems that patients experience. Thirst is one such major problem, arising because the mechanical ventilator prevents the patients from drinking when they have the urge to do so. To gain a deeper understanding of the patients' experiences and to contribute new knowledge in nursing care, this study focuses on the patients' experiences of thirst during mechanical ventilation (MV) while being conscious. Aims: To explore patients' experience of thirst while being conscious and mechanically ventilated. Design: This hermeneutic study used qualitative interviews of 12 patients. Method: Data were analyzed based on content analysis. Interviews were conducted between September and October 2014 in two large ICUs in Denmark. Result: Four themes relating to the patients' experiences of thirst during MV were identified: a paramount thirst, a different sense in the mouth, deprivation of the opportunity to quench thirst and difficulties associated with thirst. Conclusion: Patients associate feelings of desperation, anxiety and powerlessness with the experience of thirst. These feelings have a negative impact on their psychological well‐being. A strategy in the ICU that includes no sedation for critically ill patients in need of MV introduces new demands on the nurses who must care for patients who are struggling with thirst. Relevance to clinical practice: This study shows that despite several practical attempts to relieve thirst, it remains a paramount problem for the patients. ICU nurses need to increase their focus on issues of thirst and dry mouth, which are two closely related issues for the patients. Communication may be a way to involve the patients, recognize and draw attention to their problem. [ABSTRACT FROM AUTHOR]

Psoriasis is a long-term condition with a possibly cumulative life course impairment. Young people struggle to minimize its effects on appearance and functioning. To date, the self-management needs of adolescents suffering from psoriasis have been underinvestigated. Using focus groups and individual interviews, we present an interpretive description of young people’s experiences of living with psoriasis, the challenges they face, and the support they need to relieve suffering and come to terms with their condition. This process is characterized by loneliness, the self-imposition of limitations, and the lack of personalized knowledge and communication skills to manage the impact of disease and society’s reactions. Our study provides insight into needs of early interventions tailored to address condition, role, and emotional management, involving parent education, peer support, storytelling, and roles for professionals. We argue that further research should involve young people, their parents, and professionals in the development and evaluation of interventions. [ABSTRACT FROM AUTHOR]

Background: Hand eczema (HE) is common in health care workers (HCWs). During the last decade, new recommendations have supported increased use of alcohol-based hand rub (ABHR) to partially replace hand washings to lower the prevalence of HE. However, newer data on this recommendation is lacking., Objectives: To assess current 1-year prevalence of HE in HCWs, to investigate exposure, and the extent of subjective discomfort to hand washings and ABHR., Methods: A digital questionnaire was sent to 4876 HCWs from April to May 2020., Results: Of 2125 respondents (1779 women, 346 men), 14.7% reported HE within the last year. In total, 9.1% reported >20 hand washings per shift and 76.0% reported ABHR use >20 times per shift. HE was significantly associated with hand washings (adjusted odds ratio [OR] 1.73 [95% confidence interval [CI] 1.26-2.36]) and glove use on wet skin (adjusted OR 1.99 [95% CI 1.27-3.12]). Subjective discomfort to ABHR was reported significantly more often than to hand washings (P < .001) and significantly more often in HCWs with HE than in those without HE (P < .001)., Conclusions: The current 1-year HE prevalence in HCWs of 14.7% was lower than in previously reported Scandinavian data. HE was related to frequent hand washings, as previously reported, and to glove use on wet skin, which is a possible risk factor for HE that should be further explored., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background Tattoo removal by Q-switched yttrium aluminium garnet (YAG) lasers is golden standard; however, clients' satisfaction with treatment is little known. Objective To determine clients' satisfaction with tattoo removal. Methods One hundred and fifty-four tattoo removal clients who had attended the private clinic 'Centre for Laser Surgery', Hellerup, Denmark, from 2001 to 2013 completed a questionnaire concerning outcome expectations, level of pain experiences and satisfaction with tattoo removal. The laser surgeon and his team were blinded from data handling. The study design included a minimum 2-year postlaser treatment observation period from 2013 to 2015. Results Overall, clients were satisfied with their laser treatment; 85% assessed their treatment and results to be acceptable to superb, while 15% assessed their treatment and results to be inferior to unacceptable. Effectiveness relative to colour of tattoo on a scale from 0 (no effect) to 10 (complete removal) scored a mean of blue 9.5, black 9.4, yellow 8.9, red 8.8 and green 6.5. Clients were dissatisfied with green pigment remnants, which could mimic bruising. One hundred and twenty-nine clients (84%) experienced moderate to extreme pain during treatment. Twenty-eight (20%) developed minor scarring. There were many reasons for tattoo removal; e.g. stigmatisation (33%), conspicuousness (29%) and poor artistic quality (22%). One hundred and two clients had expected complete removal of tattoos without a blemish, expectations that were only partly fulfilled. During the treatment period, clients adjusted expectations and adapted more realistic views of outcomes. Conclusion The majority of clients were satisfied with Q-switched YAG laser removal of tattoos despite high pretreatment expectations which were only partly met. The study supports YAG lasers for tattoo removal as acceptable therapy of today, with room for new approaches. [ABSTRACT FROM AUTHOR]

Background Atopic dermatitis ( AD) is a chronic inflammatory skin condition with a multifactorial etiopathogenesis. Studies have suggested that several perinatal factors may influence the risk of AD in early childhood. We investigated possible neonatal risk factors such as jaundice, blue light phototherapy, birthweight, gestational age at birth, and season of birth on the risk of developing AD in the first 5 years of life. Materials & Methods Data were collected through Danish nationwide administrative registers. All newborn children between 1997 and 2007 (n = 673,614) were included in the cohort. Incidence rate ratios ( IRRs) were estimated with 95% confidence intervals (95% CIs) by multivariate Poisson regression analyses. Results We identified a total of 85,743 children with AD in the first 5 years of life. The risk of AD was slightly increased in children with neonatal jaundice ( IRR 1.13 [95% CI 1.06-1.21]). Preterm birth was inversely associated with the risk of AD ( IRR 0.74, [95% CI 0.68-0.81]) as well as low birthweight ( IRR 0.68, [95% CI 0.61-0.75]). Children born in fall and winter seasons had an increased risk of AD compared to spring and summer. No association between neonatal blue light therapy and the risk of AD was found. Conclusions Low birthweight and preterm birth were inversely associated with AD, while neonatal jaundice and cold seasons of birth were associated with an increased risk of AD. [ABSTRACT FROM AUTHOR]

Background The incidence of occupational hand eczema is approximately 0.32 per 1,000 person years. The burden of the disease is high, as almost 60% has eczema-related sick leave during the first year after notification, and 15% are excluded from the workforce 12 years after disease onset. New treatments and prevention strategies are needed. Methods/design Trial design: The PREVEX trial is a randomised, parallel-group, superiority trial. Participants: All individuals from the Capital Region of Denmark and Region Zealand with a suspected occupational skin disorder notified to the National Board of Industrial Injuries between June 2012 and December 2013 are invited to participate in the trial. Inclusion criteria are: self-reported hand eczema and informed consent. Exclusion criteria are: age <18 years or >65 years; permanent exclusion from the workforce; inability to understand the Danish language; any serious medical condition; and lack of written informed consent. We plan to randomise 742 participants. Interventions: The experimental intervention is an educational course in skin-protective behaviour and written information about skin care related to their specific occupation. Also, a telephone hotline is available and a subgroup will be offered a work-place visit. The experimental and the control group have access to usual care and treatment. All participants are contacted every eighth week with questions regarding number of days with sick leave or other absence from work. 12 months after randomisation follow-up is completed. Objective: To assesses the effect of an educational course versus treatment as usual in participants with newly notified occupational hand eczema. Randomisation: Participants are centrally randomised according to a computer-generated allocation sequence with a varying block size concealed to investigators. Blinding: It is not possible to blind the participants and investigators, however, data obtained from registers, data entry, statistical analyses, and drawing of conclusions will be blinded. Outcomes: The three co-primary outcomes, assessed at 12 months, are: total number of selfreported days with sick leave; health-related quality of life; and subjective assessment of hand eczema severity. Explorative outcomes are: self-reported eczema-related sick leave, absence from work registered by the DREAM-register and by self-report, risk behaviour, knowledge of skin protection and performance management (self-efficacy; and self-evaluated ability to self-care). Discussion The PREVEX trial will be the first individually randomised trial to investigate the benefits and harms of group-based education in patients with newly notified occupational hand eczema. [ABSTRACT FROM AUTHOR]

Background Iodopropynyl butylcarbamate ( IPBC) is a preservative that may cause contact allergy. The first cases were reported in 1997, and IPBC is currently included in our extended European baseline series in Denmark. Objectives To assess trends during the period 2000-2011 concerning IPBC allergy in Denmark, and to address the question of the significance of concomitant reactions to the thiuram mix. Patients/materials/methods Nine thousand seven hundred and fifty-five (6449 female; 3306 male) patients were patch tested with IPBC and the European baseline series at Gentofte Hospital during 2000-2011. The results were registered in an anonymized database, and analyzed with spss™. Results Fifty-four cases of IPBC contact allergy were detected. A significant rising trend during 2000-2011 was observed, with no significant changes during 2006-2011. MOAHLFA index analysis showed that IPBC contact allergy was, in our cohort, significantly more prevalent among male patients, occupational, related to hand eczema, and more frequent among patients over 40 years old. A significant relationship between IPBC and thiuram mix allergy was found. Conclusions IPBC continues to be among the less frequent allergens. A 0.2% concentration in patch testing has contributed to the diagnosis of more sensitizations to this substance. Further studies are needed to clarify the reason for the over-representation of thiuram allergy in patients sensitized to IPBC. [ABSTRACT FROM AUTHOR]

Background. Occupational hand eczema is common in hairdressers, owing to excessive exposure to wet work and hairdressing chemicals. Objectives. To quantify occupational skin exposure and the use of protective gloves among hairdressers in Denmark. Methods. A register-based study was conducted comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self-administered postal questionnaire in May 2009, including questions on hairdressing tasks performed in the past week at work and the extent of glove use. A response rate of 67.9% (n = 5324) was obtained. Results. Of the respondents, 55.7% still worked as hairdressers, and they formed the basis of this study. Daily wet work was excessive; 86.6% had wet hands for ≥2 hr, and 54% for ≥ 4 hr. Glove use was fairly frequent for full head hair colouring and bleaching procedures (93-97.7%), but less frequent for highlighting/lowlighting procedures (49.7-60.5%) and permanent waving (28.3%). Gloves were rarely worn during hair washing (10%), although this was more frequently the case after hair colouring procedures (48.9%). Conclusions. Occupational skin exposure was excessive among hairdressers; the extent of wet work and chemical treatments was high, and glove use was inconsistent, especially for certain hair colouring procedures and wet work tasks. [ABSTRACT FROM AUTHOR]

Background: Renal transplant recipients (RTRs) are at high-risk of developing aggressive and potentially lethal non-melanoma skin cancer, which emphasizes the need for consistent sun protective behaviour. Objective: To identify factors that exert an influence on the sun protective behaviour of RTRs. Methods: A total of 10 RTRs were individually interviewed using a semi-structured interview guide (five women, five men). The interviews were conducted in Copenhagen in June 2008. Transcriptions of the interviews were subsequently analyzed using predefined concepts from the Health Belief Model. Results: The major result was the finding that patients did not perceive the threat of skin cancer as an important health problem and, therefore, did not give a high priority to sun protection, even though patients were aware of their increased risk of developing skin cancer. Moreover, negative individual attitudes towards the use of sunscreens and wearing hats were barriers against efficient sun protective behaviour. Conclusions: This study shows that the Health Belief Model can be used to identify and describe factors that influence decisions and behaviour among RTRs regarding sun protective behaviour. We recommend that RTRs are informed about the potential severity of skin cancer, and about the importance of consistent sun protective behaviour. [ABSTRACT FROM AUTHOR]

Several studies describe intersectoral collaboration in Western healthcare as hampered by lack of coordination of care and treatment and incoherent patient pathways. We performed an ethnographic study following elderly patients from admission to an emergency unit (EMU) to discharge and further treatment and care at other facilities in the healthcare system. The aim was to explore how health professionals work together across sectors in the Danish healthcare system and how they create patient pathways for elderly patients (+65) with multiple chronic illnesses. Intersectoral collaboration was identified as distant relations between large numbers of health professionals, where communication was conveyed by electronic health record (EHR) formats which promoted information delivery that focused on patients' immediate symptoms. Other significant 'mediators' of communication were the telephone that seemed to resemble face‐to‐face communication and the patient who delivered information from one professional to another. We suggest that the communication among professionals at various facilities interacts with the format and functionalities of the EHRs, which typically fall short in delivery of information across sectors, because the often complex needs of patients with multimorbidity do not fit in with the available functionalities of the EHR. [ABSTRACT FROM AUTHOR]

Background: Tissue dielectric constant (TDC) measurement may become an important tool in the clinical evaluation of chronic lower extremity swelling in women; however, several factors are known to influence TDC measurements, and comparative data on healthy lower extremities are few., Methods: Thirty-four healthy women volunteered. Age, BMI, moisturizer use and hair removal were registered. Three blinded investigators performed TDC measurements in a randomized sequence on clearly marked locations on the foot, the ankle and the lower leg. The effective measuring depth was 2.5 mm., Results: The mean TDC was 37.8 ± 5.5 (mean ± SD) on the foot, 29.0 ± 3.1 on the ankle and 30.5 ± 3.9 on the lower leg. TDC was highly dependent on measuring site (P<0.001) but did not vary significantly between investigators (P=0.127). Neither age, BMI, hair removal nor moisturizer use had any significant effect on the lower leg TDC. Intraclass correlation coefficients were 0.77 for the foot, 0.94 for the ankle and 0.94 for the lower leg., Conclusion: The TDC on the foot was significantly higher compared with ankle and lower leg values. Foot measurements should be interpreted cautiously because of questionable interobserver agreement. The interobserver agreement was high on lower leg and ankle measurements. Neither age, BMI, hair removal nor moisturizer use had any significant on effect on the lower leg TDC. TDC values of 35.2 for the ankle and 38.3 for the lower leg are suggested as upper normal reference limits in women., (© 2012 The Authors Clinical Physiology and Functional Imaging © 2012 Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

The study presented is a randomized, controlled intervention study with the purpose of implementing an evidence-based skin disease prevention programme. The hypothesis explored in this article is whether a high-fat petrolatum-based moisturizer can be an alternative to protective gloves in wet-work occupations. The study population was all gut cleaners in Danish swine slaughterhouses, and data were collected by telephone interviews using a standardized questionnaire - The Nordic Occupational Skin Questionnaire (NOSQ-2002). At baseline, 644 (88%) gut cleaners responded and at 1-year follow-up 622 (72%). 135 gut cleaners in the intervention and 277 in the comparison group responded at both telephone interviews. In the intervention group, the eczema frequency was reduced significantly. Detailed analyses revealed that protective gloves are the overall most effective protective means and did not indicate that a high-fat moisturizer could be an alternative. Furthermore, the most extensive improvements could not be explained by combinations of protective behaviour but was found among those who had received information on, and was having discussions on prevention of skin problems. This only applied to the intervention group. A continuous focus on prevention of skin problems with information and discussions on the shop floor therefore seemed to be most important for reducing skin problems.