***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: 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 BACKGROUND Limited information documents the prevention and treatment benefits of a h and care regimen using moisturizer in a controlled manner for employees in typical manufacturing situations . OBJECTIVE The objective was to assess the effectiveness of a comprehensive skin care program including skin conditioning lotion in multiple manufacturing environments where employees are at high risk for skin disease . METHODS A r and omized trial test design with multiple measures , including skin bioengineering measurement techniques , visual grading , and self- assessment question naires , was used to broadly characterize skin condition . RESULTS Comparison of the change in the skin condition of workers using the full h and care regimen with moisturizer versus a control group using a regimen without moisturizer  demonstrated significant ( p < .05 ) improvements in multiple measures after 1 to 2 weeks . Corneometer readings consistently showed significant improvement for employees using moisturizer , regardless of their work location . CONCLUSION Improved skin condition result ed from the regular use of an effective skin conditioning h and moisturizer as part of a skin care regimen in work environments in which workers were prone to experiencing occupational irritant contact dermatitis 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 A total of 942 workers of 13 dyeing and printing factories in the area of Como ( N. Italy ) were examined in order to detect skin complaints on the h and s and forearms . Of these , 868 were eligible for and consented to participate in a controlled and r and omized experiment aim ed at assessing the efficacy of using barrier creams in practical circumstances . 657 workers underwent all three control examinations arranged over about one year . In the r and omized group for treatment with barrier creams the cumulative incidence of objective skin lesions was significantly lower than in the group in which no particular recommendation of use was made ( 44.5 % versus 54.4 % positive for objective examination in at least one of the three control examinations after recruitment : 95 % confidence limits of the difference between 2%-17 % percentages ; 39.9 % versus 47.0 % in subjects who were negative at the recruitment examination , 59.0 % versus 76.8 % in subjects who were positive at the recruitment examination ) . The use of a hydrocarbon cream was significantly more effective than using a silicone cream ( 95 % confidence limits of the differences of cumulative incidences : -10.9 % + 20.7 % comparing silicone creams with non-treatment ; 2.8%-20.2 % comparing hydrocarbon creams with non-treatment ) The effect on the skin of housewives of using a washing product in the home for all cleaning purpose s under conditions of maximal exposure has been studied . Tests conducted on over 4,000 housewives showed that detergents containing proteolytic enzymes had no greater effect on the skin than conventional detergents , even when the h and skin condition was initially poor . The same was true in a further test on 130 housewives with “ dishpan ” h and s. No adverse reactions attributable specifically to the enzyme products were seen . No eruptions from contact with clothes washed in enzyme products were reported from any of the families involved in these tests 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 Aims : To evaluate the effect of implementation of an evidence based skin care programme for wet work employees as part of an occupational health and safety management system . Methods : 375 wet work employees were included in a prospect i ve r and omised controlled trial , allocated to either intervention ( n = 207 ) or control ( n = 168 ) . The intervention group was exposed to a skin care programme during the five month study period . The intervention included an educational programme for a group of frontline employees , who underwent formalised training , and subsequently introduced the information to their colleagues . As part of the intervention a skin care policy including written instructions was established at each workplace . Both groups answered a test quiz , completed question naires on behaviour and symptoms , and underwent clinical examination of their h and s before and after the five month period . Results : No difference between the intervention and the control group was found at baseline with respect to clinical symptoms or behaviour . Evaluation after the five months of intervention revealed a significantly higher information level on skin care in the intervention group compared to the control group , a significant change in behaviour in the intervention group but not in the control group , and significantly less skin symptoms as evaluated clinical ly in the intervention group but not in the control group . No significant difference was found for self reported skin problems . Conclusions : The intervention was successful with respect to information level ( knowledge ) , behaviour , and clinical symptoms . Implementation of a skin care programme as part of an occupational health and safety management system is recommended as a prophylactic measure for employees in wet occupations Objectives : The objective of the present implementation study is to document how an intervention to reduce work-related skin problems by means of implementing an evidence -based skin protection programme in six gut-cleaning departments in swine slaughterhouses was understood , accepted and carried out . The association between the degree of implementation and the reduction of work-related skin problems in each department is examined . The intervention included a top-down strategy with establishment of a management system focusing on skin risks and a bottom-up strategy with participation of a selected group of shop floor workers and the safety representative , as change agents , as well as an empowerment-based educational programme , where the middle management and representatives from the top management also participated . Methods : The study design was a r and omized controlled intervention study with a 1-year study period . The outcome of the intervention was evaluated by telephone interviews . Data on the implementation process consisted of self-administered question naires , focus interviews and compiled written material s. Four indexes referring to the management system and the change agents ’ intervention activities were constructed . Finally , the Pearson correlation coefficient was used to test the correlation between the degree of implementation and the eczema frequency at 1-year follow-up . Results : There was a statistically significant association ( p < 0.05 ) between both the index for the combined implementation method and the eczema frequency after 1 year of intervention , and between the activities of the change agents and the eczema frequency . In contrast to this there was only a weak association between the establishment of a formal management system alone and the outcome . Conclusion : The study evidence s that a combination of a top-down and a bottom-up implementation method is effective to reduce work-related skin problems  , and that the process of implementation is a significant determinant of the overall results The effect of three industrial h and cleansers on transepidermal water loss ( TWL ) was evaluated in groups of healthy volunteers . After 2 weeks , subjects using Baracaide averaged 47 % less TWL than those using Swarfega und 35 % less than with Go‐Jo . In a second study in printers , the use of Baracaide decreased TWL by 20 % after 2 weeks . Because it contains no volatile solvents , Baracaide may be less injurious to the barrier layer OBJECTIVE To examine the impact of introduction of an alcohol-based h and rub on h and hygiene knowledge and compliance and h and colonization of healthcare workers ( HCWs ) in a long-term-care facility ( LTCF ) . METHODS Two floors of an LTCF participated . Ward A used the h and rub as an adjunct to soap and water ; ward B was the control . HCWs ' h and s were cultured using the bag-broth technique for Staphylococcus aureus , gram-negative bacilli ( GNB ) , C and ida , and vancomycin-resistant enterococci ( VRE ) . HCWs completed a  question  naire at baseline and after an educational intervention and introduction of rub . RESULTS H and 
    Output:
    
However , this risk reduction may not be clinical ly important .
The investigated interventions to prevent OIHD probably cause few or no serious adverse effects .
AUTHORS ' CONCLUSIONS Moisturisers used alone or in combination with barrier creams may result in a clinical ly important protective effect , either in the long- or short-term , for the primary prevention of OIHD .
Barrier creams alone may have slight protective effect , but this does not appear to be clinical ly important .
For skin protection education , the results varied substantially across the trials , the effect was imprecise , and the pooled risk reduction was not large enough to be clinical ly important .
The very low quality of the evidence means that we are unsure as to whether skin protection education reduces the risk of developing OIHD .
The interventions probably cause few or no serious adverse effects .
We conclude that at present there is insufficient evidence to confidently assess the effectiveness of interventions used in the primary prevention of OIHD .
This does not necessarily mean that current measures are ineffective .