Jose Hernán Alfonso – Work-related Skin Disease in Norway
Norway , and its contribution to the risk of cutaneous squamous cell carcinoma in the Nordic countries . Alfonso has gathered approaches from dermatology , occupational medicine , and epidemiology . His material is based on data from 3 different registries as well as from the Norwegian Survey on Living Conditions and a Nordic Occupational Cancer Study .
The first paper is a register-based case-series of notified work-related skin diseases for the period 2000 – 2013 ( 1 ). A substantial decline in the number of notifications is observed during this period . The distribution of occupations and causative exposures notified are similar to what has been reported from other countries with more complete notifications systems . A consider able underreporting may explain the remarkable decline in the number of annual notifications , which leads to negative consequences on prevention and research of these conditions .
The second paper is a population-based study with a 3-year follow-up focusing on the risk for skin problems from self-reported occupational exposures ( 2 ). Indoor-dry air was a baseline predictor of skin problems at follow-up , and exposure to cleaning products , water , and indoor dry air was a predictor of skin problems at both baseline and follow-up . The population-attributable risk to these factors of 16 %, suggests a potential for prevention via reduction of known risk factors .
In the third paper , Alfonso aims to quantify the contribution of occupational skin exposure to the risk of physician-certified long-term sick leave in the general working population of Norway ( 3 ). This study shows evidence of an association between self-reported occupational skin exposure to cleaning products and waste in men , and skin exposure to water in women . The large sample drawn from the general Norwegian working-age population and the focus on individual exposure factors are the study ’ s strengths . The estimated population attributable risk of 14.5 % emphasizes the contribution of occupational skin exposure as an important risk factor for long-term sick leave .
The fourth paper focuses on the variation of risk for cutaneous squamous cell carcinoma among occupational categories of four Nordic countries ( 4 ). The study was based on approximately 12.9 million persons from Finland , Iceland , Sweden , and Norway , with a follow-up up to 45 years . Occupations with high socioeconomic status , some with outdoor work , and some with potential exposure to chemical substances , showed high risk for cutaneous squamous cell carcinoma . The occupational variation in the risk of cutaneous squamous cell carcinoma might be associated with socioeconomic factors , and to some extent to occupational exposures .
In conclusion , this thesis adds to the evidence that occupational skin exposure contributes to the burden of skin problems and long-term sick leave in the general working population of Norway , and identifies targets for prevention of cutaneous squamous cell carcinoma .
List of original publications
I . Alfonso JH , Løvseth EK , Samant Y , Holm JØ . Work-related skin diseases in Norway may be underreported : data from 2000 to 2013 . Contact Dermatitis 2015 ; 72 : 409 – 412 .
II . Alfonso JH , Thyssen JP , Tynes T , Mehlum IS , Johannessen HA . Self-reported occupational exposure to chemical and physical factors and risk of skin problems : a 3-year follow up study of the general working population of Norway . Acta Derm Venereol 2015 ; 95 : 959 – 962 .
III . Alfonso JH , Tynes T , Thyssen JP , Holm JØ , Johannessen HA . Self-reported occupational skin exposure and risk of physician-certified long-term sick leave : a prospective study of the general working population of Norway . Acta Derm Venereol 2016 ; 96 : 336 – 340 .
IV . Alfonso JH , Martinsen JI , Pukkala E , Weiderpass E , Tryggvadottir L , Nordby KC , Kjærheim K . Occupation and relative risk of cutaneous quamous cell carcinoma : a 45-year follow-up study in four Nordic countries . J Am Acad Dermatol 2016 ; 75 : 548 – 555 .
96 Dissertations
Forum for Nord Derm Ven 2016 , Vol . 21 , No . 4