Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits

INTRODUCTION

Foreign workers (FWs) on work permit face unique health challenges and potential barriers to healthcare. We aimed to examine the epidemiology, attendance patterns, disposition, and adherence to follow-up, by FWs on work permit to two emergency departments (EDs) in Singapore.

METHODS

In this retrospective observational study, we included consecutive FWs on work permit who registered at the EDs of two public restructured hospitals from 1 May 2016 to 31 October 2016. Data obtained from electronic medical records included patient demographics, triage acuity, disposition, ED diagnoses and bill information.

RESULTS

There were 6,429 individual FWs on work permit who contributed to 7,157 ED visits over the 6-month study period, with male predominance (72.7%, 4672/6429), and median age of 31 (interquartile range 26 to 38) years. A high proportion of these FWs were triaged to low-acuity status compared to the general ED population (66.9% versus 45.9%, P<0.001). Trauma-related injuries contributed to 34.4% of their visits, and were more likely to result in admission compared to non-trauma-related conditions (18.7% vs 15.2%, P<0.001). FWs engaged in shipyard, construction and process industries were more likely to be discharged "against medical advice" (14.8% vs 3.2%, P<0.001), and default their specialist outpatient follow-up (50.1% vs 34.2%, P<0.001) for non-trauma-related conditions compared to trauma-related injuries.

CONCLUSION

In Singapore, the EDs of public restructured hospitals provide healthcare safety nets to FWs on work permit. These workers made more low-acuity visits compared to the general population during the study period and may face potential barriers to admission and follow-up.

Epidemiology, economic and humanistic burdens of Ocular Surface Chemical Injury: A narrative review

Ocular surface chemical injury (OSCI) is a common type of ocular emergency that can potentially cause significant and permanent visual impairment. However, the global prevalence, demographic factors, socioeconomic burden, and psychological impact of OSCI have not been well investigated or reported. This review aims to provide a comprehensive overview of these aspects, highlight gaps in the literature, and advocate key strategies in reducing the incidence of OSCI. OSCI was responsible for 0.1-15% of all ocular emergency presentations, with an estimated incidence of 5.1-50 per 100,000 population-year. Young working adult men were the most at-risk group, though high rates of OSCI were also observed in young children in developed countries, especially from detergent pods. Low- and middle-income countries were noted to have higher proportions of assault-related and pediatric OSCI cases, often with more severe presentations. Direct and indirect costs for some hospitalized patients led to loss of all personal and household income after the injury. Emergency department costs in the United States were estimated at $106.7 million over four years and costs of treating long term complications such as glaucoma were estimated to be as high as $93,003 over five years. Significant negative impacts on visual and health-related quality of life and psychological well-being have been reported after injury, with higher rates of anxiety, depression, and psychological distress compared to the general population.

Types and clinical outcomes of chemical ingestion in emergency departments in South Korea (2011-2016)

Objective

This study aims to provide basic data on the types and frequency of chemical ingestions and the clinical outcomes of chemical ingestion injury.

Methods

This study retrospectively analyzed the data obtained from the Emergency Department-Based Injury In-depth Surveillance of the Korea Centers for Disease Control and Prevention (South Korea) from 2011 to 2016. Patients ingesting chemicals aged ≥ 18 years were included, but those ingesting unknown chemical substances or with unknown clinical outcomes were excluded.

Results

This study included 2,712 (47.2% were men and 52.8% were women, mean age, 47.05 years) patients ingesting chemicals. Unintentional and intentional ingestions were reported in 1,673 (61.7%) and 1,039 (38.3%), respectively. The most commonly ingested chemical substances were hypochlorites, detergents, ethanol, and acetic acid. In the unintentional ingestion group, the most common chemicals upon admission were hypochlorites (74), glacial acetic acid (60), and detergent (33). The admission rates were 60% for glacial acetic acid, 58.3% ethylene glycol, and 30.4% other alkali agents. In the intentional ingestion group, the most common chemicals upon admission were hypochlorites (242), glacial acetic acid (79), ethylene glycol (42), and detergent (41). The admission rates were 91.9% for glacial acetic acid, 87.5% ethylene glycol, 85.7% potassium cyanide, and 81.4% hydrochloric acid. In total, 79 deaths (10 unintentional ingestions, 69 intentional ingestion) were reported, and glacial acetic acid had an odds ratio of 9.299 for mortality.

Conclusion

We compared the intentional and unintentional ingestion groups, and analyzed the factors affecting hospital admission and mortality in each group. The types and clinical outcomes of chemical ingestion varied depending on the purpose of chemical ingestion. The findings are considered beneficial in establishing treatment policies for patients ingesting chemicals.

Ocular chemical burns in the workplace: Epidemiological characteristics

BACKGROUND

Epidemiological studies focusing on occupational pathologies can be an important medium through which to bring about change with respect to workplace accidents, both in terms of prevention planning and management as well as the appropriate care following an accident. Ocular chemical burns benefit from urgent attention as, if not treated early and appropriately, the tissue of the eye and its functionality can be seriously compromised. The objective of this study was to collate epidemiological data on workplace ocular chemical burns which could in turn serve to identify key action points in terms of occupational health.

METHODS

Cohort study with 604 cases of chemical burns to the eye occurring in the workplace between 2014 and 2015. Criteria inclusion were diagnosis of chemical burn, patient seen at the medical centre of the mutual society, workplace acquired ophthalmic pathology leading to the issuing of a sickness certificate. No exclusion criteria were defined.

RESULTS

Ocular chemical burns were the second most common workplace eye injury (12.68%) behind foreign bodies in the eye (43.42%). Men accounted for 68.54% of cases of ocular chemical burns. In around 75% of cases, sickness certification was for less than 7 days, although 6 patients suffered permanent disability. The occupational sector which was most affected particularly the industry service industry. The economic costs with these workplace injuries were extracted.

CONCLUSIONS

Appropriate early medical assistance is essential. The production and distribution of clinical guides for health care workers could optimise first line assistance and mitigate possible training deficiencies.

Demands for multidimensional information on the work environment: A methodological framework for regular studies

BACKGROUND

Development of methodologies for making economic decisions on designing work environment studies is a theoretical challenge for researchers in occupational health sciences. There are well-defined tools available in the relevant literature for analysis of cost-efficiency associated with the assessment of an occupational exposure of interest. However, these analytical tools are not appropriate for holistic studies of the work environment as a multidimensional reality.

OBJECTIVE

This article introduces an appropriate methodology for designing cross-sectional comprehensive studies of the work environment, in order to optimize the production of information on the psychosocial, ergonomic, and physical dimensions of the work environment in regular studies.

METHODS

The employment of a translog cost-utility function is suggested as a suitable way to provide cost-minimized designs for regular studies which are aimed at providing or developing multidimensional information systems of the work environment.

RESULTS

The translog cost-utility function is not subject to predetermined restrictions, but has a flexibility property allowing it to be transformed to any specification that is adaptable to the specific work environmental characteristics and research requirements.

CONCLUSION

The translog cost-utility function is an appropriate econometric model for optimizing the production of multidimensional information on occupational exposures in regular cross-sectional workplace studies.

Work-Related Eye Injuries: A Relevant Health Problem. Main Epidemiological Data from a Highly-Industrialized Area of Northern Italy

The province of Modena is one of the most industrialized areas of Northern Italy. The medical records of the Ophthalmological Emergency Department (OED) of Modena University Hospital were studied: there were 13,470 OED accesses in 2014 and in 754 cases that an occupational eye injury occurred. The frequency of work-related eye injuries (3‰) was lower compared to other published studies, but the absolute number is still relevant, showing the need for more adequate prevention, especially in metal work, construction work, and agriculture, where the worst prognoses were observed. Intervention programs must be implemented as early as possible in the working life, considering that the frequency in younger workers is about double that of the oldest age class (3.5‰ vs. 1.8‰), and special attention should also be given to foreigners, who have a 50% higher injury risk. Furthermore, the planning of specific interventions for eye-injured workers may be useful, considering that a previous injury does not appear to encourage the adoption of preventive interventions, and a subgroup of eye-injured workers have a potential risk for new injuries. Finally, the data presented here indicates how OED records, integrated with specific occupational information, can be applied for studies on work-related eye injuries.

Adolescent workplace exposures reported to Texas poison centers

BACKGROUND

Working adolescents, with less experience and less training than adults, may take more risks and get exposed to a wide variety of toxic substances in the workplace. They may get injured when working in inadequately ventilated areas or entering areas of exposure with improper or no protective equipment.

OBJECTIVE

The purpose of this study was to describe adolescent occupational exposures reported to poison centers.

SUBJECTS

Occupational exposures reported to Texas poison centers during 2000-2015 where patients were 13-19 years in age.

METHODS

The distribution of the cases was determined for various factors.

RESULTS

There were 2430 adolescent occupational exposures. The most frequently reported major substance categories were chemicals (18%), household cleaning substances (18%), hydrocarbons (10%), and industrial cleaners (9%). Forty-five percent occurred during May-August. Males accounted for 66% of the patients; 27% were 18 years and 37% were 19 years. The most common exposure routes were inhalation (28%), dermal (27%), ingestion (26%), and ocular (24%). The patients were managed on site in 51% of the exposures. Twenty-three percent of the exposures had serious outcomes.

CONCLUSION

Adolescents involved in occupational exposures tended to be male and older. Adolescent occupational exposures were likely to involve chemicals and household cleaning substances, occur by ingestion and ocular route, and likely to be managed on site. Most were not likely to have serious outcomes.

Epidemiological Characteristics of Work-Related Ocular Trauma in Southwest Region of China

Purpose: To determine the epidemiological characteristics of work-related eye injury in representative southwest region of China. Methods: Patients with eye injuries treated at the Ninth People’s Hospital of Chongqing from 1 January 2014 to 31 December 2014 were included in the current study. All patients completed a comprehensive examination and interview. Demographic characteristics and injury details were recorded. The International Classification of Diseases (ICD-10) and Birmingham Eye Trauma Terminology (BETT) were used. Results: The average age of eye injury patients was 37.52 years and the majority were male. Among the 1055 total patients, approximately 42.9% of the injuries were work-related. The highest proportion of occupational eye trauma was observed in the group between 36 and 45 years of age. Occupational ocular trauma occurred more frequently in summer, with most from 16:00 to 18:00. Metal was the most common injury cause. Foreign body on external eye was the most common diagnosis. Workers in the manufacturing industry without pre-work safety training or eye protection were far more likely to suffer from occupational ocular trauma than those with training and protection. Conclusions: This study provides insight into the epidemiological characteristics of occupational ocular trauma in southwest region of China. The current findings might be considered as a baseline for future research on regional work-related eye injuries. Our findings will provide valuable information for further development of preventive strategies.