forskning som miljösköterska · aim - to examine the meaning and the mechanism of persulphate in...
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Forskning som miljösköterska
… vägen dit?
… väl där?
… sen’ då?
NU-dagarna Malmö 8 maj 2014
Kerstin Kronholm Diab
Regionmiljösköterska, Med Dr
Min historia
Utbildning inom hälso- och sjukvård …
• 1976 Leg sjuksköterska
• 1981 Hälso- och sjukvårdsadministration, 60 hp
• 1983 Vidareutbildning i medicin och kirurgi, 30 hp
• 1985 Arbetsmiljölära,15 hp
• 1986 Företagssköterskeutbildning
• 2002 Vårdvetenskap, 31 – 80 hp
• 2003 Kvalitativa forskningsmetoder
• 2004-12 Doktorand, halvtid (8 år)
Forts Min historia
Arbete?
1977 Kirurgi - Helsingborgs lasarett
1978 Gynekologi - Morges, Schweiz
1979 – 82 Olika sjukskötersketjänster inom primärvård,
gerontologi, MVC
1982 – 91 Företagshälsovård, Malmö
1991 Arbets- och miljömedicin, Lund
Vad hände när jag hade bestämt mig?
Ansökan – antagning 2004-12
Huvudhandledare Jørn Nielsen
Biträdande handledare Edith Andersson
Arbete, kurser, arbete …..
Mittseminarium 2011-11
Slutseminarium 2014-01
Disputation 2014-04
Forskarutbildning (240 hp)
Totalt kurskrav, 22.5 hp
Obligatoriska forskarkurser
• Introduktionskurs, 1 hp
• Forskningsetik, 1.5 hp
• Statistiska metoder inom medicins forskning, 1.5 hp
• Vetenskaplig kommunikation, 1.5 hp
• Muntlig kommunikation, 1.5 hp
Valbara forskarutbildningskurser
Portfoliosystem
Avhandlingen, minst 180 hp
Delmål
Vilka kurser valde jag utöver obligatoriska?
• EndNote - referenshantering
• SPSS - statistikprogram
• Hur man skriver och illustrerar en vetenskaplig artikel
• Introduktion till epidemiologisk metodik
• Kvalitativa metoder med fokus på forskningsintervjun
• Advanced course in Grounded Theory – Situational Analysis
• Livskvalitet som utfallsmått i vårdforskning, KI
• Yrkes- och miljömedicin - tillgodoräknande
Female hairdressers Respiratory symptoms, mechanisms and health-related
quality of life and their views on the work environment
Kerstin Kronholm Diab
Arbets- och miljömedicin, Lund
Hairdressing – dream profession?
In 2010 about
• 2 400 work sites with an average of three employees
• 15 000 one-man enterprises
• 5 700 employees
• mean age just above 30 years
• 85 – 90% female hairdressers
• 2600 hairdressers graduated
• about 40% still active 8 years after graduation
• affiliation to Occupational Health is very low, 12-13 %
In 2005 – 2009
• Hairdressers reported 292 work-related illnesses
• Female hairdressers reported more cases of hypersensitivity and skin
problems than all branches of activity
Hairdressing
Hairdressers are exposed to numerous hair chemicals in
hair dyes, bleaching products, permanent wave solutions,
hair sprays and various styling products potentially
harmful to the airways.
Bleaching products contain persulphates (ammonium,
potassium and/or sodium persulphates) in concentrations
up to 60%, and are mixed with an oxidizing agent, mostly
hydrogen peroxide. During mixture powder or granules
whirl in the air and are easily distributed to the eyes and
the airways.
Young hairdressers
In a cohort of just below 300 recently graduated
hairdressers in Southern of Sweden examined
2006 – 2010 …
… about 50 % atopics
… 25 – 32 % nasal symptoms
… 8 – 14 % ocular symptoms
… 2 – 9 % dry cough
… 2 – 8 % wheeze/dyspnea
Ur Aktuellt fredag 4 april
http://www.svt.se/nyheter/sverige/var-tredje-frisor-drabbad-
av-arbetsrelaterade-nasbesvar
Frisör med både näsbesvär och astma arbetar trots sina
besvär
Overall aim of the thesis
To gain knowledge of …
the occurrence of asthma,
the mechanism of work-related nasal symptoms,
the variations in respiratory symptoms and effects on
the health-related quality of life during a work period,
how young hairdressers reason about their work
environment
Studies
Study I (1997-98) Cohort, retrospective study
Study (2002) Nasal challenge study
Study III II (2004-05) Cohort, short term study
Study IV (2009-11) Qualitative interview study
Papers I - IV
I Albin M, Rylander L, Mikoczy Z, Lillienberg L, Dahlman Hoglund A, Brisman J, Toren
K, Meding B, Kronholm Diab K, Nielsen J. Incidence of asthma in female
Swedish hairdressers. Occup Environ Med 2002, 59;2:119-123.
II Kronholm Diab K, Truedsson L, Axmon A, Nielsen J. Persulphate challenge in female hairdressers with nasal hyperreactivity suggests immune cell, but not IgE reaction. Int Arch Occup and Environ Health 2009, 82;771-777.
III Kronholm Diab K, Jönsson BAG, Axmon A, Nielsen J. Work related airway symptoms, nasal reactivity and health related quality of life in female hairdressers - a follow-up study during exposure. Int Arch Occup Environ Health 2014, 87:61–71.
IV Kronholm Diab K, Nielsen J, Andersson E. Swedish female hairdressers’
view on their work environment – a qualitative study. Journal of Occupational Health 2014,56;2:2014; 56:100–110.
Study I
Aim
To examine the risk of asthma
To examine if hay fever during childhood, smoking and specific
hair treatments have an impact on the risk of asthma
Retrospective corhort study of 3 957 female hairdressers and
4 905 referents from the general population
Postal questionnaires
Self-reported asthma and time of onset
Hair treatments – bleaching and hair spray
Employment time
Study I
Results
Hairdressing work moderately increased the incidence
of asthma. Hay fever during childhood and smoking
did not modify the risk from hairdressing work.
The time to onset of asthma was 6 years among the
participating hairdressers
The incidence of asthma was slightly higher, but not
significant, in the most frequent users of bleaching
products and hair spray than in the others.
Study II
Aim - To examine the meaning and the mechanism of
persulphate in hairdressers with bleaching powder-associated
rhinitis
Nasal challenge with potassium persulphate
3 groups – female hairdressers with bleaching powder-
associated nasal symptoms, asymptomatic hairdressers and
atopic women
Outcomes
Nasal symptoms
Acoustic rhinometry
Inflammatory markers in nasal lavage fluid
Specific serum antibodies to potassium persulphate
Lymphocytes in blood
Study II
Results
Symptomatic hairdressers had an increase in nasal
symptoms and in albumin in the nasal lavage
Atopics reacted to a lesser intent
Symptomatic hairdressers had an increase in Th1
cells
No evidence of a Type 1 reaction to potassium
persulphate
Study III
Aim
To examine how respiratory symptoms, inflammatory
markers and nasal reactivity against persulphate
develop in hairdressers with bleaching powder-
associated rhinitis during one month of exposure after
an exposure-free period
To examine how HRQoL is influenced during this work
period and to compare the HRQoL with that of pollen
allergic women during the season
Study III
Diary of symptoms and work tasks during 4 weeks 3 groups – female hairdressers with bleaching powder-associated nasal
symptoms, asymptomatic hairdressers and pollen allergic women (during
the first month of the season)
Outcomes
• Nasal symptoms
• Work tasks
• Inflammatory markers in nasal lavage fluid
• SF-36 and RQLQ
• Nasal reactivity (symptomatic hairdressers)
Study III
Results
Symptomatic hairdressers increased steadily in nasal symptoms
parallel to a decrease in HRQoL during the exposure period
Symptomatic hairdressers used more hairspray
Albumin in nasal lavage of the symptomatic hairdressers increased
after 1 w, and further enhanced after 4 w
ECP in the nasal lavage of the symptomatic hairdressers was
significantly higher after 4 w of exposure compared to after 1 w
Nasal reactivity to potassium persulphate did not increase during the
exposure
Study IV
Aim
To examine how hairdressers after three to four years
of work reason about their physical, social and
psychological work environment with special focus on
work related risks, possibilities to influence,
implementation of knowledge, financial impact and
impact of work related symptoms
Study IV
Qualitative interview study with 14 hairdressers
Covering aspects of the physical, social and psychological
work environment
Open ended interviews using a thematic guideline
Opening question: How is your work environment?
Recorded interviews, verbatim transcription
Manifest and latent content analysis
Study IV
Main findings
An awareness of the impact of the work environment
and the possibilities of influencing it, but also an
inability to achieve preventive improvements emerged
Various symptoms did not change this
The organization, teachers and the acceptance of the
work environment were important issues
Making the work environment an active part of their
business was not common
Main theme
AWARENESS of the impact of the work environment and of possibilities to
influence it
Themes Subthemes
Seeing one’s work environment Influencing the work environment
Applying knowledge
Planning work
Seeing one’s customers Adjusting to the customer’s needs
Caring for the customer
Seeing one’s profession Developing and continuing in the
professional role
Being creative and getting variation at
work
Seeing one’s symptoms Accepting one’s symptoms
Managing one’s symptoms
Managing one’s waste
Är det värt allt arbete?
Absolut, om du …
• har ett område/frågor som väcker ditt intresse
• kan förankra det
• är nyfiken
• vill vidareutvecklas
• är analytisk
• har energi och tid
… är det jätteroligt och enormt stimulerande
och utvecklande att doktorera ….
Hur gör man?
Förslagsvis kontakta
• Professor Irene Jensen på Kompetenscentret för företagshälsovård, http://www.fhvforskning.se/, professornharordet.blogspot.se
- forskning inom företagshälsovård
• Annan institution
- kan vara arbets- och miljömedicinsk enhet, universitet/ högskola med arbetsforskning, eller någon annan institution inom din intressesfär
• Leta efter doktorandtjänst
• Mer information om forskarutbildning i Lund på http://www.med.lu.se/utbildning/utbildning_paa_forskarnivaa
More hairdresser studies-
Exposure
2012 – 2013 Chamber study of bleaching
• 12 hairdressers with nasal bleaching powder-associated symptoms performed bleachings and the concentration of particles and irritating compounds were examined
• Symptoms and imflammatory markers were measured before,
during and after the exposure
• The results are still preliminary, but it seems that mixing is
crucial for the exposure, and also the dried bleach
Sara börjar blanda
blekmedel i exponerings-
kammaren
More hairdresser studies-
Exposure
More hairdresser studies-
Prospective for three years
Follow-up study of recently graduated hairdressers
(results are being processed)
• To understand the selection out of the profession
• To see the incidence of respiratory symptoms
Follow-up study of hairdresser students for three years
• To understand the selection out of the hairdressing
schools
• To see the incidence of respiratory symptoms
Skin symptoms
Incidence of skin symptoms
Hairdressers
• Hairdressing 23,8 per 1000 py
<25 years of age 37,1 per 1000 py
Change of profession due to skin symptoms
• Hairdressers 6,2 %
• Referents 1,9 %
LIND M et al., 2007. Incidence of hand eczema in female Swedish hairdressers.
Occup Environ Med, 64, 191-5.
Praktiska slutsatser för frisörer
• Det finns ett kemikalieproblem
• Medvetandet om detta bör höjas
• Höjd skyddsnivå (ventilation, handskar)
• Ventilationskrav bör förtydligas
• För tidigt för rekommendationer om enskilda produkttyper
• Dialog med frisörer, leverantörer och
tillsynsmyndigheter
Ekologiska färger hos Friekosör, Stockholm
Rekommendationer för frisörer
• Skydda huden mot hårfärgämnen
- Byta handskar mellan varje kund
- Använda handskarna endast en gång!
- Klippa håret före färgningen
• God ventilation – allmän, dragskåp, punktutsug
• Frisörprodukter – byta ut farliga produkter
• Korrekta arbetsmetoder – och växla mellan arbetsuppgifterna
• God hygien
Diskutera frisörernas arbetsmiljö?
Mitt telnr 046-17 31 79
Min email [email protected], [email protected]
T
A
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F
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Länkar – artiklar om frisörers arbetsmiljö • Arbetsmiljöforskning - http://www.arbetsmiljoforskning.se/search/node/fris%C3%B6rer
Arbetsliv - http://www.prevent.se/sv/Arbetsliv/Sok-i-artikelarkivet/
• Naturskyddsföreningen -http://www.naturskyddsforeningen.se/nyheter/giftiga-harprodukter-pa-frisorsalongen
http://www.naturskyddsforeningen.se/sveriges-natur/2010-4/harvardsprodukter-som-skadar
• Arbetsmiljöverket – http://www.av.se/dokument/publikationer/rapporter/RAP2012_06.pdf
file:///I:/Bra%20arbetsmilj%C3%B6%20f%C3%B6r%20fris%C3%B6rer.pdf
• Forskning.se -http://www.forskning.se/nyheterfakta/nyheter/nyheterfranforskningse/kemikalierutgorhalsoriskforfrisorer.5.61fbca9812ec690a32180001030.html
• Miljösamverkan Skåne - http://projektwebbar.lansstyrelsen.se/miljosamverkanskane/Sv/projekt/pagaende-projekt/Pages/frisorer.aspx
• Hållbar Utveckling Skåne (HUT) - http://www.hutskane.nu/projekt/avslutade-projekt-3/hallbar-frisor/
• Frisörtidningen – fyra artiklar under 2012 (nr 4,6,8,10)
• Bulletin 2012:2, s 4, 6, 1012:3 s 2 - http://www.skane.se/sv/Webbplatser/Labmedicin_Skane/Verksamhetsomraden/Arbets--och-miljomedicin/Publikationer/Bulletin---Nyhetsbrev/