Considerations Concerning the Epidemiology of Occupational Dermatoses

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/ 3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Our erudite colleague, in his Letter to the Editor, has made a valiant effort to demonstrate that any piece of medical knowledge can be expanded upon, and made comments on our article [1], some erroneous and some others possibly reminiscent of cases of cognitive ignorance or mispresentation. We clearly mentioned in our article that the firms included in our study received services by four qualified physiciansdone senior , experienced specialist in occupational medicine " assisted " by three enterprise physicians specializing in occupational medicine. Assistance, also entailed training, supervision, and ensuring that there was consistency and uniformity in diagnosing and recording cases of occupational dermatoses. Additional supervision provided by another three senior, experienced, specialist physicians participating in this study ensured scientific quality assurance, which also included ascertaining that the same procedures and methods for diagnosis and for collection of data on possible causal factors were used by all four enterprise physicians throughout the study period. Intra-and interobserver variability was not considered, for two reasons: Firstly, because of the afore-mentioned strengthened supervision. Secondly, it is apparent that in our study we used clinical diagnoses rather than laboratory or paraclinical test results. There are drawbacks related to using clinical diagnosis in an epidemiologic study [2]. These were eliminated , as all four enterprise physicians had access to the same laboratory tests and dermatologists. As we stated in our article, in all borderline or obscure skin diseases, diagnosis was always confirmed by the same dermatologists of the same university dermatology department, where specialist laboratory and other investigations were also carried out, whenever indicated. This means that observations were complete and accurate and the reasoning sound. Diagnoses were made by similarly trained enterprise physicians. They used the same specific criteria for making the same diagnosis, adhering to these criteria throughout the study. They also used the same terms to refer to the same clinical condition. Thus, the single term used for each of the occupational dermatoses studied had the same meaning to all these physicians. Our colleague ignores and mispresents the statement already made by us that " our study has no external validity, but it certainly does have internal validity, as regards the population studied. " …