The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
Abstract Background As a global health crisis, the COVID-19 pandemic offered a unique opportunity to identify sickness absence (SA) patterns consisting of long and short episodes and total number of SA days in a cohort of Finnish public sector employees while comparing to pre-pandemic timepoint. Methods Survey data from 39,791 employees in four Finnish cities in 2020 were linked to SA records between Jan-1 and Dec-31, 2021. We used K-means modelling on short (1–9 days) and long (10–365 days) episodes and total numbers of SA days. For comparison, we analysed 2019 (pre-pandemic) SA records. Employee and work characteristics associated with SA patterns were analysed using multinomial regression. Results Four distinct SA patterns during COVID-19 were identified: Low SA (n = 31,320, 79%), repeated short episodes (n = 5149, 13%), repeated long episodes (n = 2964, 7%), and very high SA (n = 358, 1%). Compared to others, employees with low SA were less likely to have had a first-wave COVID-19 infection, more frequently worked from home, were more often men in higher occupational positions, had lower body mass index, lower smoking and higher alcohol abstinence rates. Repeated short episodes were associated with younger age and team reorganization, whereas repeated long episodes and very high SA were linked to older age. Except for fewer overall SA days, the pre-pandemic SA pattern structure was similar. Conclusions We identified four distinct SA patterns with different employee correlates during the COVID-19 pandemic. These patterns appeared stable over time, as similar profiles – albeit with lower overall SA rates – were evident before the pandemic.
Persistent physical symptoms (PPS) can significantly impair work ability and daily functioning, exacerbated by comorbid illness worry (IW). This randomized controlled trial (RCT) examined the effectiveness of guided internet-based treatment on work ability and daily functioning of working-aged individuals with PPS associated with indoor environment (IE) and/or chronic fatigue (CF) with disability. The intervention was based on acceptance and commitment therapy (ACT) combined with individual case formulation, compared to treatment as usual (TAU). IW’s role in moderating effects was explored. In this RCT (Clinicaltrials.gov NCT04532827), 103 individuals with PPS linked to IE, CF or both were assigned to a video-based case conceptualization and 10-week internet-based ACT with TAU (iACT + TAU; n = 50) or TAU alone (n = 53). Self-reported work ability and daily functioning were assessed from pre-intervention to 9-month follow-up, examining the potential moderating effect of baseline IW. Analyses used linear mixed models and Type III ANOVA. Of the 103 participants, 62
BACKGROUND:Adult obesity has been linked to specific infections, but evidence across the full spectrum of infectious diseases remains scarce. In this multicohort study with impact modelling, we examined the association between this preventable risk factor and the incidence, hospitalisations, and mortality of 925 bacterial, viral, parasitic, and fungal infectious diseases, and estimated their global and regional attributable impact. METHODS:We used pooled data from two Finnish cohort studies and repeated analyses in an independent population from the UK Biobank. BMI was assessed at baseline (1998-2002 in the Finnish studies; 2006-10 in UK Biobank), and participants were categorised as having healthy weight (18·5-24·9 kg/m2), overweight (25·0-29·9 kg/m2) or obesity, classified as class I (30·0-34·9 kg/m2), class II (35·0-39·9 kg/m2), or class III (≥40·0 kg/m2). Participants were followed up through national hospitalisation and mortality registries for hospital admissions and deaths due to infectious diseases. Using hazard ratios derived from the Finnish cohorts and UK Biobank, along with obesity prevalence estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study database, we estimated the proportion of fatal infections attributable to obesity globally, regionally, and by country for the years 2018 (before), 2021 (during), and 2023 (after the COVID-19 pandemic). FINDINGS:The analysis included 67 766 adults (mean age 42·1 [SD 10·8] years; 49 516 [73·1%] females, 18 250 [26·9%] males) from the Finnish cohorts and 479 498 adults (mean age 57·0 [SD 8·1] years; 261 084 [54·4%] females, 218 414 [45·6%] males) from UK Biobank. Participants had no recent history of infection-related hospitalisations at baseline. During follow-up, there were 8230 incident infection cases in the Finnish cohorts and 81 945 in UK Biobank. Compared with individuals of healthy weight, those with class III obesity had a three-times higher risk of infection-related hospital admissions (Finnish cohorts 2·75 [95% CI 2·24-3·37], UK Biobank 3·07 [2·95-3·19]), death (Finnish cohorts 3·06 [1·25-7·49], UK Biobank 3·54 [3·15-3·98]), or either outcome (Finnish cohorts 2·69 [2·19-3·30], UK Biobank 3·07 [2·95-3·19]). The corresponding pooled hazard ratio for either fatal or non-fatal severe infection among individuals with any obesity (classes I-III) was 1·7 (1·7-1·8). This association was consistent across different indicators of obesity (BMI, waist circumference, and waist-to-height ratio), demographic and clinical subgroups, and a wide range of infections (non-fatal and fatal, acute and chronic, bacterial and viral [including subtypes], and parasitic and fungal). Applying these risk estimates to global burden of disease data, the population attributable fractions of infection-related deaths due to obesity were estimated at 8·6% (6·6-11·1) in 2018, 15·0% (12·8-17·4) in 2021, and 10·8% (8·6-13·6) in 2023. INTERPRETATION:Adult obesity is a risk factor for infection-related hospitalisations and mortality across diverse pathogen types, populations, and baseline clinical profiles, with evidence suggesting that approximately one in ten infection-related deaths worldwide might be attributable to obesity. FUNDING:Wellcome Trust, Medical Research Council, and Research Council of Finland.
Work engagement refers to an enduring, positive, affective-motivational state of employee well-being. Specifically, work engagement is a state of mind that is characterized by vigor, dedication, and absorption. In this review, after a brief introduction to other conceptualizations of engagement at work, we discuss the temporal and social aspects of work engagement and the main theoretical perspectives from which it is investigated. We also summarize the abundant information on the key antecedents and consequences of work engagement that over 20 years of research has produced and review work engagement in different contexts: in various groups, during organizational changes, and in remote work. After discussing different types of interventions that aim to boost work engagement, we end by presenting practical implications and future research options.
