***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Workers in wet work occupations have a risk for developing h and eczema . Prevention strategies exist , but compliance to the proposed recommendations is poor . Therefore , a multifaceted implementation strategy ( MIS ) is developed to implement these recommendations to reduce h and eczema among health care workers performing wet work . Methods / Design This study is a r and omised controlled trial in three university hospitals in the Netherl and s. R and omisation to the control or intervention group is performed at department level . The control group receives a leaflet containing the recommendations only . The intervention group receives the MIS which consists of five parts : 1 ) within a department , a participatory working group is formed to identify problems with the implementation of the recommendations , to find solutions for it and implement these solutions ; 2 ) role models will help their colleagues in performing the desired behaviour ; 3 ) education to all workers will enhance knowledge about ( the prevention of ) h and eczema ; 4 ) reminders will be placed at the department reminding workers to use the recommendations ; 5 ) workers receive the same leaflet as the control group containing the recommendations . Data are collected by question naires at baseline and after 3 , 6 , 9 and 12 months . The primary outcome measure is self-reported h and eczema . The most important secondary outcome measures are symptoms of h and eczema ; actual use of the recommendations ; sick leave ; work productivity ; and health care costs . Analyses will be performed according to the intention to treat principle . Cost-effectiveness of the MIS will be evaluated from both the societal and the employer 's perspective . Discussion The prevention of h and eczema is important for the hospital environment . If the MIS has proven to be effective , a major improvement in the health of health care workers can be obtained . Results are expected in 2014.Trial registration The object of this study was to compare the protective action of a new barrier cream ( Excipial Protect ® , Spirig Pharma AG , Egerkingen , Switzerl and ) to its vehicle in the context of h and irritation of apprentice hairdressers caused by repeated shampooing and exposure to hair‐care products . This was a double‐blind cross‐over comparing Excipial Protect ® ( containing aluminium chlorohydrate 5 % as active ingredient ) against its vehicle alone . The efficacy of the creams was evaluated taking into account : ( 1 ) clinical scores by research ers , ( 2 ) biometric measurements , ( 3 ) subjective opinions of the subjects . An analysis of variance was performed considering order of application , degree of atopy , and reported number of shampoos . We observed very little difference in efficacy between the protective cream and its vehicle . The presence , however , of aluminium chlorhydrate in the protective cream was shown to have a positive effect against work‐related irritation . The cosmetic qualities of the creams seemed , to the participants , to be as important as their real protective and hydrating properties , an important factor in compliance issues The purpose of this study was to develop a new model for the induction of chronic irritant contact dermatitis , which would reflect well the conditions of daily practice . Various weak irritant agents were tested for irritating potency on the skin and the sensitivity of transepidermal water loss ( TEWL ) measurements in the detection of early skin changes was also studied . 10 widely used surfactants and 1 solubilizer were applied to the skin of the forearms of healthy volunteers in aqueous solutions of 12.5 millimoles/1 for 45 min twice daily for 3 weeks . The effect on the skin was evaluated daily by means of TEWL measurements and by a visual scoring system . Each solution caused an increase in TEWL value over time due to the cumulative irritating action on the epidermal barrier . This increase in TEWL was different for the various solutions , result ing in different mean TEWL values on the last day of the experiment . Thus , it was possible to rank the agents according to irritating potency . This ranking order was the same in almost every individual and remained constant during the 3 weeks . In comparison with the visual scoring system , the TEWL measurements were more sensitive in the detection of early changes in the skin A cohort of initially 111 office apprentices was prospect ively followed for the duration of their training ( 2 and 3 years , respectively ) . The point prevalence of ( slight ) irritant or atopic h and eczema was 18.9 % in the initial and 25.0 % in the final examinations . Altogether , 37 cases of ( slight ) h and eczema were noted within the study period ; of these , 10 qualified for a more conservative definition of " h and eczema " . Expressed in a person-time-model , the incidence rates were 18.4 and 4.1 cases per 100 persons per year , respectively . The only significant risk factor for the development of ( slight ) irritant or atopic h and eczema within the study period was previous h and eczema -- partly as a child , partly during a preceding occupation ( e.g. hairdressing ) . Compared to one retrospective study in a cohort of older office employees and to a study sampling the general population , incidence rates were slightly higher in this study . Such differences may partly be due to different definitions of what has to be considered " a case of h and eczema " . The necessity to ( i ) communicate on the method of case definition and ( ii ) develop guidelines for case definition in epidemiological studies is emphasised An in vivo method was developed to measure the effectiveness of skin protective creams against 2 dye indicator solutions : methylene blue in water and oil red O in ethanol , representative of model hydrophilic and lipophilic compounds , 3 representative barrier creams commercialized as effective against lipophilic , hydrophilic , or lipophilic and hydrophilic substances were assayed by measurements of the dye in cyanoacrylate strips of protected skin sample s after various application limes . The flexural surfaces of the forearms of 6 normal volunteers ( 3 female and 3 male , mean age 26.8±4.1 years ) were treated . The method was as follows : solutions of 5 % methylene blue in water and 5 % oil red O in ethanol were prepared , and applied to untreated skin and protective‐cream‐pretreated skin with the aid of aluminum occlusive chambers , for 0 h and 4 h , respectively . At the end of the application time , the creams were removed . Consecutive skin surface biopsies ( SSB ) from 1 to 4 strips were taken . The amount of stain in each strip was determined by colorimetry , and the cumulative amount of stain from 1 to 4 strips in each measurement was calculated . The cumulative amount represents the amount of permeation of each solution at each time point , and the efficacy of skin barrier cream . The results showed one formulation at both 0 h and 4 h reduced the amount of permeation of melhylene blue ( p<0.0l ) and oil red O ( p<0.01 ) compared with the control group . Another formulation was protective against the permeation of oil red O ( p < 0.0l ) . but not against methylene blue at 0 h and 4 h ; it was not significantly different at 0 h versus 4 h. The 3rd formulation produced increased cumulative amounts to oil red O at both 0 h and 4 h ( p<0.05 ) ; it also increased permeation amounts to methylene blue ( p<0.05 ) after 4 h. This model appears a facile , rapid and objective early screen to evaluate the efficacy of skin barrier creams in vivo , as well as their individual ingredients Objective . The objective of this controlled intervention study was to quantify the efficacy of skin protection ( SP ) measures and ultraviolet B ( UVB ) hardening in the prevention of h and dermatitis in bakers ' apprentices . Method . SP measures were compared against UVB hardening in a controlled clinical trial of 94 apprentices . The apprentices were assigned to the intervention arms class-wise . Bakers ' apprentices involved in a previous follow-up study served as additional controls representing no intervention . The apprentices were interviewed and examined in a st and ardised way at the beginning of the training and at 4 monthly follow-ups . Transepidermal water loss ( TEWL ) was measured at the back of the h and s. Results . Demographic profile and atopy criteria were equally distributed in the two intervention arms and the control group . Point prevalence of h and dermatitis after 6 months was highest in the controls ( 29.1 % ) followed by the UVB ( 19.4 % ) and the SP group ( 13.3 % ) .  UVB hardening  and SP  measures reduced h and dermatitis prevalence by 9.7 % ( 95%CI : –8.5 to 28.1 ) and 15.7 % ( 95%CI : –2.4 to 33.9 ) , respectively . Application of SP measures reduced the odds ratios ( ORs ) for h and dermatitis 0.8-fold ( 95%CI : 0.17–3.70 ) and 0.33-fold ( 95%CI : 0.09–1.23 ) compared with the UVB group and the controls , respectively . These clinical trends were confirmed by statistically significant differences in TEWL values . TEWL values were consistently higher in the UVB group than in the SP group ( P=0.002 ) . Conclusions . This study provided evidence , based on significant differences in TEWL levels , that general SP measures may be more effective than UV light hardening of the skin , which in turn was more effective than no intervention . This trend was supported by the frequency of development of clinical h and dermatitis , although differences did not reach statistical significance . A multi-centre trial is recommended to confirm the efficacy of SP measures in a larger r and omised study An improved human model for the quantification of skin barrier creams ( BCs ) is described . In contrast to the previously published procedure , the back , instead of the forearm , and a total of 4 irritants are used . Due to the larger area , 3 BC formulations can be simultaneously compared to the control field , which receives the irritant only , without BC‐pretreatment . On 10 human volunteers , the irritants 10 % sodium lauryl sulfate ( SLS ) , 1 % sodium hydroxide ( NaOH ) , 30 % lactic acid ( LA ) and undiluted toluene ( TOL ) were applied via large Finn Chambers for 30 min , 5 × during the 1st week and 4 × during the 2nd week . Taktosan Salbe ( water‐in‐oil emulsion ) and RAWI Speerschutzcreme ( oil‐in‐water emulsion ) were applied 30 min before contact with the irritants . In order to asses reproducibility and interindividual variation , the BC RAWI was tested in duplicate . Irritant cutaneous reactions were quantified by 4 parameters : erythema score , transepidermal water loss , blood flow volume and stratum corneum hydration by measuring capacitance . The results showed marked differences in efficacy . Taktosan  significantly suppressed irritation by SLS , NaOH and LA , which was apparent in nearly all parameters . RAWI caused significant inhibition of SLS irritation , and a positive trend against NaOH and LA was observed . Both BCs failed against TOL . The results of duplicate testing with RAWI showed good reproducibility . The dogma that oil‐in‐water emulsions are primarily effective against lipophilic irritants , and water‐in‐oil emulsions against hydrophilic irritants , needs to be re‐evaluated on the basis of our findings . This model seems to have potential for further studies on BCs and might eluci date the complex interaction of BCs with irritants Skin  harrier function was studied after use of  occlusive gloves on normal and compromised skin . 2 studies were performed ( Study A and B ) , and the effects were evaluated by non‐invasive methods . Participants in the studies were instructed to wear an occlusive glove on one h and , while the other h and served as control . The gloves used were hypoallergenic , non‐latex . Study A : 20 volunteers  wore a glove on normal skin 6 h/day for 3 days . Study B : 20 volunteers wore a glove on sodium fauryl sulfa lei S LSI‐compromised skin 6 h/day for 3 days . Skin harrier function was evaluated by measurement of transepidermal water loss ( TEWL ) ( Evaporimeter ) , skin hydration by electrical capacitance ( Corneometer ) and inflammation was evaluated by erythema index ( DermaSpetrometer ) . Results : Study A. Glove occlusion on normal skin 6 h/day for 3 days caused no significant influence on the water barrier function . Study B : Glove occlusion on SLS‐compromised skin for the same period of time had a significantly negative effect on the water barrier function . It is concluded that occlusion may be an additional factor in the pathogenesis of cumulative irritant contact dermatitis Moisturizers are used daily by many people to alleviate symptoms of clinical ly and subjectively dry skin . Recent studies suggest that certain ingredients in creams may accelerate the recovery of a disrupted barrier and decrease the skin susceptibility to irritant stimuli . In the present single‐blind study , a moisturizing cream was tested for its influence both on barrier recovery in surfuctant‐damaged skin and on the susceptibility of normal skin to exposure to the irritant sodium lauryl sulphate ( SLS ) . Parameters measured were transepidermal water loss ( TEWL ) and skin corneometer values , indicating degree of hydration . Treatment of surfactant‐damaged skin with the test cream for 14 days promoted barrier recovery , as observed as a decrease in TEWL . Skin corneometer values also normalized more rapidly during the treatment . In normal skin , use or the test cream significantly reduced TFWL after 14 days of treatment , and irritant reactions to SLS were , significantly decreased . Skin corneometer values increased after only 1 application and remained elevated after 14 days . In conclusion , the accelerated rate of recovery of surfactant‐damaged skin and the lower degree of SLS‐induced irritation in normal skin treated with the test cream 
    Output:
    
We conclude that at present there is insufficient evidence for the effectiveness of most of the interventions used in the primary prevention of OIHD .