SUMMARYBackgroundSkin diseases constitute up to 30% of all occupational diseases for which compensation is payable and the work-related skin diseases are responsible for an estimated 25% of all lost work days.Occupational skin diseases affect workers of all ages in a wide variety of work setting such as; hairdressing, medical, dental, veterinary, agricultural, cleaning, printing, painting, construction, food preparation and catering.The most common work related dermatosis is contact dermatitis. As occupational skin diseases are disabling and mostly affect young people, they are expensive for society. Recently, occupational skin diseases are reported to be an important predictor for long term unemployment, and so prevention is necessary.Objectives:■ To determine the most prevalent occupational skin problems among service workers at Zagazig University Hospitals.■ To elucidate the personal and occupational risk factors associated with the detected skin problems among service workers at Zagazig University Hospitals.■ To propose, implement and compare the effect of a skin care intervention program.Subjects and Methods:The present study was conducted among the service workers at Zagazig University Hospitals during the period from October 2004 through May 2005.A sample of two hundred and fourty workers from service workers at Zagazig University Hospitals were included in this study. They were classified into 2 groups:1) The intervention group (120 workers) from hospital service workers who were assigned as full time, permenant workers affiliated to the selected workplace and worked for duration not less than one year.2) The control group (120 workers) was selected from non hospital workplaces ( The academic building of Faculty of Medicine, Zagazig University).Every worker was subjected to:1) Nordic Occupational Skin Questionnaire (NOSQ).2) Skin examinations with special reference to the exposed skin (upper and lower limbs).3) An intervention program was applied to the hospital service workers which includes:A- Health education sessions and pamphlets.B- Supplying them with protective gloves.4) Three months later, questionnaire post test was done for the intervention group for evaluation of their knowledge after application of the educational program.Results:The study revealed that work hours per week, daily wet work hours, history of atopy and self reported skin symptoms such as fissures and itching have statistically significant difference among the hospital service workers than control group, while history of eczema and contact allergy have no significant difference between them.Study of the frequency of occupational dermatoses showed that the highest frequency was among the hospital service workers (50.0%) compared with (19.2%) among the control group.Occupational contact dermatitis was the most common type of occupational skin diseases among the hospital service workers (27.5%) followed by tinea pedis (10.8%) paronychia and onychomycosis (3.3%).The hands were the commonest site of affection among the study groups; 23.3% among the hospital service workers and 11.6% among the control group.It was evident that occupational dermatoses were significantly higher among service workers who work in patient service like Internal Medicine, Surgery, Pediatric...etc (56.6%) rather than those who work away from patient service i.e laundery, kitchen ..etc (30%).Although this study revealed that skin diseases were more higher among hospital service workers who work at wet work for more than 2 hours daily (67.5%) than those who work less than ½ hours/day (13.3%), there was no statistically significant association between them. In addition, history of skin atopy and contact allergy have no significant effect on occupational dermatoses.The study revealed also frequent exposures of hospital workers to detergents and dust only. The hospital service workers with detergents exposure were at four times increased risk of skin diseases (O.R=4.21) than those without detergents exposure.Finally, after logistic regression analysis of factors affecting frequency of occupational dermatoses among the hospital service workers, the work hours per week are the only significant factor predicting occupational dermatoses among the hospital service workers.The present study revealed that correct knowledge about eczema was lacking before intervention. There was a change in the knowledge and attitude. Our study shows significant improvement of the correct knowledge about eczema among the hospital service workers after intervention. There was also significant improvement of the attitude which appeared in the frequency of use of protective gloves which increased from 61.9% to 85.7%.Conclusion:From these results, we can conclude the following:- Occupational dermatoses constitute a major health problem among the hospital service workers especially contact dermatitis.- Although the wet work hours were significant among the hospital service workers than control group, there was no significant association with the occupational dermatoses.- The hands are the commonest site of skin diseases among the hospital service workers and control group.- The work hours per week are the only significant factor predicting occupational dermatoses among the hospital service workers* Vascular dementia and dementia of Alzheimer type “the two most common types of dementia” are both associated with elevation of blood homocysteine level and reduction of its biological determinant folate and vitamin B12 levels.* Hyperhomocysteinaemia in these dementing disorders (VaD & DAT) is correlated with the severity of both cognitive impairment as well as radiological brain atrophic changes.* Brain MRI with its better regional anatomical resolution than CT scan, is of value not only in the diagnosis of dementia but also in the differential diagnosis of its types, however, CT scan is easier, cheaper, more widely available and most importantly, is much less distressing to dementia patients.* Vascular dementia is commonly associated with bilateral lesions, multiple and larger lesions as well as extensive white matter lesions, however, the usefulness of “heterogenous” VaD as a diagnostic category is questionable.* The radiological findings of leukoaraiosis is not only assiociated with VaD but also with DAT, however, it is more severe in VaD than DAT patients.* The demonstration of vascular risk factors, hyperhomocysteinaemia, radiological global brain atrophic changes and leukoaraiosis in both VaD and DAT patients, points to a substantial overlap between these dementing disorders which suggest that “vascular pathology”, the traditional cornerstone of the differential diagnosis, may not represent a clear line of demarcation as originally thought.RECOMMENDATIONS:* Homocysteine is an intriguing amino-acid that will continue to excite neuropsychological researches.* Homocysteine as a functional marker of B vitamin status in the tissues, represents growing area of interest in the neurochemical evaluation of VaD and DAT patients with its possible application in the early diagnosis of dementia even at a preclinical stage. Furthermore, future determination of the correlation between blood homocysteine level with oxidative stress and immune activation markers during different stages of progression of these dementing disorders, could provide further insight to the role of homocysteine in their pathogenesis.* Large scale double blind and placebo controlled clinical trials in high risk population are needed to determine whether lowering blood homocysteine level would reduce the risk of VaD and DAT.* Modified criteria are required to specify the etiology of heterogenous “VaD” as a part of the diagnostic formulation.* Future longitudinal large scale studies are needed to compare the evolution of VaD and DAT during different stages of disease progression.* With the hope to minimize the burden of dementia, one challenge is to develop major public health strategies affecting large populations for the modification of the vascular and demographic risk factors in the early and midlife. Another challenge, is the need to move toward identifying the cognitive impairment at an earlier stage before the development of dementia.* The convergence of VaD and DAT (neurochemically, epidemiologically, clinically and radiologically) provides a potential framework for an improved understanding of the pathogenesis of such dementing disorders and offers some promise toward the search for preventive and therapeutic strategies.