Validation of Self-testing as a Method to Estimate the Prevalence of Nickel Allergy

The aim of this study was to investigate the validity of self-patch testing for nickel allergy, in order to determine a cost-effective method for surveillance of the prevalence of nickel allergy. Population-based study including patch testing is the most reliable method to study the prevalence of allergy, but it is expensive and has logistical problems. A total of 191 dermatology patients referred to patch testing were provided with a self-test package with written instructions. The self-test was applied on the arm by the patient, on the same day that the regular patch test was applied on the back. The patient evaluated the self-test before patch test reading at the clinic. Patch test at the dermatology clinic detected 46/191 (24%) nickel-positive individuals. The sensitivity of the self-test was 72% (95% confidence interval (Cl) 57-84), the specificity 91% (95% Cl 85-95), and the proportion of agreement 86% (95% CI 81-91). Thus, in the population studied, the validity of self-testing for nickel allergy was adequate

Contingent Valuation Surveys and Cost-benefit Analyses | An application for a prevention programme for hand eczema

This paper provides a discussion and an analysis of some of the critical aspects when conducting a cost-benefit analysis of a health care programme based on a contingent valuation survey. In particular, we focus on how to elicit willingness to pay into a contingent valuation survey in order to provide the necessary information for identifying all components in a cost-benefit analysis. We also look at how the components in a cost-benefit analysis should be aggregated in order to study whether or not a programme is socially desirable. These issues are illustrated and discussed by using a hand eczema prevention programme as an empirical example

Dermatology in public health - a model for surveillance of common skin diseases

Aims: The aim was to establish a baseline prevalence of skin conditions of public health importance in the general population and taking the validity of the questions into account. Our model is intended for future surveillance of skin conditions. Methods: The suggested questions have for the first time been used in Swedish population surveys. A random sample was taken from the general population aged 16 to 84 years of the participating areas. Results: During the past 12 months, hand eczema was reported by 9.4%, childhood eczema by 15.7% and nickel allergy by 13.7% of the population. Hand and childhood eczema questions have previously been validated. Taking the validity into account, the actual population prevalence of hand eczema (11.7%) is underestimated, and the prevalence of atopic childhood eczema (10.0%) is overestimated based on the results of the questionnaire. In addition to presenting prevalence, population survey results can be used for risk analyses. A 10-fold risk of hand eczema in individuals with childhood eczema and self-reported nickel sensitivity is shown in our study. Conclusions: Questionnaires can be used for epidemiologic surveillance so long as the questions are validated and that the validity is taken into account when estimating the occurrence of the conditions. Public health surveys such as this one lay the basis for future epidemiological surveillance of skin conditions that can be subject to interventions. We propose that these, or similar, questions should be used regularly in population surveys and supplemented by questions on skin exposure

Hand Eczema Extent and Morphology – Association and Influence on Long-term Prognosis

Hand eczema extent was a strong negative prognostic factor in a previously published follow-up study of 868 individuals. The present aims were to study in the same cohort the association between the extent and the morphology of the hand eczema and to examine whether registering both improves the prediction of long-term prognosis. The cohort was divided into subgroups regarding eczema extent and morphology. An association between eczema extent and morphology was found, with a Spearman's correlation coefficient of 0.36. Thus, widespread eczema clearly tended to be polymorphic, and vice versa. More than two-thirds (68%) of the subjects with visible signs of eczema at the examination ended up in corresponding “high” or “low” subgroups according to extent and morphology. Both widespread eczema and polymorphism were negative prognostic factors, but recording morphology did not significantly add any information to the long-term prognosis for the groups with high or low extent scores. In conclusion, the results show a clear association between extent and morphology of hand eczema, both predicting prognosis. Recording morphology did not add significant information when assessing long-term prognosis. Consequently, our study indicates that preference should be given to uncomplicated assessment of eczema extent in studies on hand eczema

Disability Pensions due to Skin Diseases : A Cohort Study in Swedish Construction Workers

Disability pensions due to skin diseases in Swedish male construction workers were studied by linking data from pension registers and an occupational health service. Incidence rates of disability pensions for cement workers, painters and plumbers were compared with 2 control groups. A total of 623 disability pensions were granted during 4 decades of follow-up. The main diagnoses were eczema (36%) and psoriasis (49%). Pensions were mostly granted in the age range 55-64 years. Among painters, cement workers and plumbers the incidence rates for disability pensions were 33.3, 24.5 and 20.4 cases/100,000 person-years, respectively, compared with 13.7 and 9.2 cases/100,000 person-years in control groups. Relative risks were highest for eczema, and were notable for psoriasis. Attributable fractions for eczema were 90% in cement workers and painters and 75% in plumbers compared with control groups. Attributable fractions for psoriasis in the occupational groups studied were in the range 54-67%. In conclusion, eczema and psoriasis have a high impact on loss of work ability, as reflected by disability pensions

Disability pensions due to skin diseases: A cohort study in Swedish construction workers

Disability pensions due to skin diseases in Swedish male construction workers were studied by linking data from pension registers and an occupational health service. Incidence rates of disability pensions for cement workers, painters and plumbers were compared with 2 control groups. A total of 623 disability pensions were granted during 4 decades of follow-up. The main diagnoses were eczema (36%) and psoriasis (49%). Pensions were mostly granted in the age range 55–64 years. Among painters, cement workers and plumbers the incidence rates for disability pensions were 33.3, 24.5 and 20.4 cases/100,000 person-years, respectively, compared with 13.7 and 9.2 cases/100,000 person-years in control groups. Relative risks were highest for eczema, and were notable for psoriasis. Attributable fractions for eczema were 90% in cement workers and painters and 75% in plumbers compared with control groups. Attributable fractions for psoriasis in the occupational groups studied were in the range 54–67%. In conclusion, eczema and psoriasis have a high impact on loss of work ability, as reflected by disability pensions