A global survey on occupational health services in selected international commission on occupational health (ICOH) member countries

Ethical challenges from a problem-solving intervention with workplace involvement: a qualitative study among employees with common mental disorders, first-line managers, and rehabilitation coordinators

PURPOSE

This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders.

METHODS

A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes.

RESULTS

A main theme was identified "the workplace and healthcare hold different organizational value logics" and four sub-themes: "the PSI-WPI challenged the organizational goals and values of the workplace and healthcare", "the PSI-WPI challenged organizational values on fairness", "the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators" and "the PSI-WPI introduced a need for the employee to juggle the employee and patient roles".

CONCLUSION

Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders' roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.

Effects of interventions implemented by occupational health professionals to prevent work-related stress complaints: a systematic review

Work-related stress complaints are a growing societal problem. Occupational health professionals often play a key role in its prevention. However, studies providing an overview of preventive interventions and their effectiveness are lacking. Therefore, the aim of this systematic review was to summarise the evidence on the effectiveness of interventions delivered by occupational health professionals to prevent work-related stress complaints.A systematic search in PubMed, Embase, PsycInfo and Medline was performed in May 2023 based on PICO (population, intervention, control and outcomes) elements. Inclusion criteria were: peer-reviewed papers with a randomised controlled trial design, quasi-experimental design and pre-post evaluations with a control group; working populations not on sick leave; interventions delivered by occupational health professionals; and stress outcomes. Data were extracted using a predefined extraction form, risk of bias was assessed using the Cochrane risk of bias tool for randomised trials (RoB-2) and Risk of Bias in non-randomised Studies-of Interventions tool, and a narrative analysis was performed to summarise data.Nine studies were included in this review and encompassed a diverse range of populations, interventions and professionals involved, outcome measures, and effects observed. Five studies found either mixed effects on stress outcomes, short-term positive effects, or positive effects in a subgroup of participants demonstrating high adherence to the intervention.As the results show mixed findings, a high risk of bias, and a limited number of studies was available, more research is needed to the effectiveness of the interventions and the factors underlying this.

Systematizing Information Use to Address Determinants of Health Worker Health in South Africa: A Cross-sectional Mixed Method Study

Background

Recognizing that access to safe and healthy working conditions is a human right, the World Health Organization (WHO) calls for specific occupational safety and health (OSH) programs for health workers (HWs). The WHO health systems' building blocks, and the International Labour Organization (ILO), highlight the importance of information as part of effective systems. This study examined how OSH stakeholders access, use, and value an occupational health information system (OHIS).

Methods

A cross-sectional survey of OSH stakeholders was conducted as part of a larger quasi experimental study in four teaching hospitals. The study hospitals and participants were purposefully selected and data collected using a modified questionnaire with both closed and open-ended questions. Quantitative analysis was conducted and themes identified for qualitative analysis. Ethics approval was provided by the University of Pretoria and University of British Columbia.

Results

There were 71 participants comprised of hospital managers, health and safety representatives, trade unions representatives and OSH professionals. At least 42% reported poor accessibility and poor timeliness of OHIS for decision-making. Only 50% had access to computers and 27% reported poor computer skills. When existing, OHIS was poorly organized and needed upgrades, with 85% reporting the need for significant reforms. Only 45% reported use of OHIS for decision-making in their OSH role.

Conclusion

Given the gap in access and utilization of information needed to protect worker's rights to a safe and healthy workplace, more attention is warranted to OHIS development and use as well as education and training in South Africa and beyond.

Enterprise-Based Participatory Action Research in the Development of a Basic Occupational Health Service Model in Thailand

Various basic occupational health services (BOHS) are provided, particularly in-plant BOHS; however, it might be necessary to start expanding BOHS. The current study focuses on BOHS model development using participatory action research (PAR) at a large-sized enterprise in northeastern Thailand. The PAR began with a situation analysis using ILO Convention C161, problem and cause analysis, the development of an action plan, observation and action, evaluation, and replanning. The research tools included interviews, focus group discussions (FGDs), and participant observations. The participants included managers, human resource staff, safety officers, and workers. Both inductive and deductive thematic analyses were undertaken. The results showed that (1) education and learning experience led to the workers detecting work-related diseases early by themselves and the implementation of medical surveillance programs; (2) the workers' occupational health needs led to return-to-work assessments and first aid room system development; (3) the employer's experience led to appropriate fit-for-work examinations and emergency preparedness; and (4) the feedback from BOHS providers led to a hospital-to-in-plant return-to-work conversion. The study concluded that the enterprise could develop fit-for-work and return-to-work assessments as per the ILO Convention C161 under the policy; however, medical surveillance and the first aid room system need to be developed through counseling at the hospital's occupational medicine clinic.

A Repository for Publications on Basic Occupational Health Services and Similar Health Care Innovations

Background

Occupational health services are not available for more than 80% of the global workforce. This pertains especially to informal workers, workers in agriculture and in small enterprises, and self-employed. Many are working in hazardous conditions. The World Health Organization, the International Labor Organization, the International Commission on Occupational Health, and the World Organization of Family Doctors promote as part of a solution, basic occupational health services (BOHS) integrated in primary or community health care. Quality information on this topic is difficult to find. The objective of this study is to develop an open access bibliography, a repository, referring to publications on BOHS and similar innovations, to support progress and research.

Methods

The database design and sustaining literature searches (PubMed, Google Scholar, SciELO) are described. For each publication selected, basic bibliographic data, a brief content description considering copyright restrictions, and a hyperlink are included.

Results

Searches resulted in a database containing 189 references to publications on BOHS such as articles in scientific journals, reports, policy documents, and abstracts of lectures. A global perspective is applied in 43 publications, a national or regional perspective is applied in 146 publications. Operational and evaluative research material is still scarce. Examples of references to publications are shown.

Conclusion

The repository can inspire pioneers by showing practices in different countries and can be used for reviews and in-depth analyses. Missing publications such as from China, Russia, Japan, Republic of Korea, and Spanish/Portuguese speaking countries, can be added in the future, and translated. Search functions can be developed. International collaboration for the promotion of occupational health coverage for all workers must be intensified.

Work-related head injury and industry sectors in Finland: causes and circumstances

OBJECTIVE

Despite the continuous development of occupational safety, the prevalence of work-related head injuries is excessive. To promote prevention, we conducted a study evaluating the risks and pathways that precede head injuries in different economic activity sectors.

METHODS

In Finland, more than 90% of employees are covered by inclusive statutory workers' compensation. We obtained data on occupational head injuries in 2010-2017 from an insurance company database. The European Statistics on Accidents at Work (ESAW) variables represented the characteristics of the accidents and the injury. We analysed the risk factors, contributing events and injury mechanisms in 20 industry sectors, based on the Statistical Classification of Economic Activities in the European Community (NACE).

RESULTS

In the 32,898 cases, the most commonly affected area was the eyes (49.6%). The highest incidence of head injuries was in construction (15.7 per 1000 insurance years). Construction, manufacturing, and human health and social work activities stood out due to their distinctive ESAW category counts. 'Working with hand-held tools' [risk ratio (RR) 2.23, 95% confidence interval (CI) 2.14-2.32] in construction and 'operating machines' (RR 3.32, 95% CI 3.01-3.66) and 'working with hand-held tools' (1.99, 1.91-2.07) in manufacturing predicted head injury. The risk related to parameters of violence and threats in health and social work activities was nearly ninefold the risk of other sectors.

CONCLUSION

The risks and pathways preceding head injuries varied considerably. The highest head injury rates were in construction and manufacturing. Violence emerged as a major risk factor in human health and social work activities.

Working with alcohol prevention in occupational health services: "knowing how" is more important than "knowing that" - the WIRUS OHS study

BACKGROUND

Alcohol consumption is a major public health challenge; the majority of employees consume alcohol regularly and a considerable proportion of employees can be characterized as risky drinkers in need of interventions. Occupational health services (OHS) are uniquely positioned for implementing alcohol prevention interventions targeting employees, but rarely do so. Studies have shown that lack of knowledge among OHS personnel is a barrier to alcohol prevention activity. This study aimed to explore OHS personnels' levels of theoretical and practical alcohol knowledge, and whether these two ways of knowing were differentially associated with alcohol prevention activity.

METHODS

In this cross-sectional study, survey data were collected from 322 OHS personnel in Norway in 2018 (response rate = 53.6%). The survey included variables of two ways of knowing (theoretical and practical) and three types of doing (intervention frequency, conducting individual interventions, and conducting group interventions). Data were analyzed with descriptive statistics, paired sample t-tests, bivariate correlations, and adjusted linear and logistic regression analyses.

RESULTS

OHS personnel rated their theoretical alcohol knowledge higher than their practical knowledge (η² = 0.33, p < 0.001). Higher reported levels of practical knowledge were associated with higher intervention frequency (b = 0.39, β = 0.60, p < 0.001) and greater likelihood of conducting individual interventions (OR = 1.60, p < .001) as well as group interventions (OR = 1.84, p < 0.001). Theoretical knowledge was not associated with conducting interventions, and there was no evidence of an interaction between the two ways of knowing in their association with doing. Sensitivity analyses did not indicate clustering effects of OHS personnel being employed within different units.

CONCLUSIONS

Different ways of knowing about alcohol among OHS personnel were dissimilarly associated with conducting alcohol prevention interventions in occupational health settings. For doing, knowing how seems to be more important than knowing that. Training programs for OHS personnel should emphasize knowledge about how to deal with alcohol-related issues and how to conduct prevention interventions, rather than focus on detrimental effects of alcohol.

A Context Analysis with Stakeholders' Views for Future Implementation of Interventions to Prevent Health Problems Among Employees with a Lower Socioeconomic Position

Purpose Health problems among employees with a lower socioeconomic position (SEP) often result from an interplay of problems on multiple life domains. Contextual factors greatly affect implementation of interventions that aim to solve these type of problems. The aim of this study was to gain insight into the organizational and socio-political context for implementation of preventive interventions that consider multiple life domains among employees with a lower SEP. Methods In total 16 semi-structured interviews were conducted with stakeholders at organizational level, occupational health service (OHS) level, and at socio-political macro level. Thematic analysis was performed to identify themes that describe the perceptions of stakeholders about the impact of contextual factors on implementation. Results The following themes were identified: (1) the importance of addressing problems on multiple life domains among employees with a lower SEP, (2) unclarity of responsibilities for solving problems on multiple life domains, (3) necessity of better collaboration between occupational and curative healthcare, (4) insufficient investments in prevention by employers, (5) difficulties in early identification of employees at risk for health problems, and (6) risk of conflicting role for supervisors in addressing problems on multiple life domains. Conclusions Implementation of preventive interventions considering multiple life domains among lower SEP employees is challenging, due to various contextual factors. To improve the feasibility, many different stakeholders both in- and outside occupational health practice need to be involved, collaborate, and need to be convinced of the added value to prevent problems on multiple life domains among employees with a lower SEP.

Global policy responses to the COVID-19 pandemic: results of the ICOH survey

Background

On the basis of its role for the development of occupational health research, information, good practices, the International Commission on Occupational Health (ICOH) launched the present survey to collect information on public health and prevention policies put in place by the governments of the countries in the world to contain the pandemic.

Methods

A cross-sectional study was conducted through an online questionnaire focused on COVID-19 data, public health policies, prevention measures, support measures for economy, work, and education, personal protective equipment, intensive care units, contact tracing, return to work, and the role of ICOH against COVID-19. The questionnaire was administered to 113 ICOH National Secretaries and senior OSH experts. Collected data refer to the period ranging from the beginning of the pandemic in each country to June 30, 2020.

Results

A total of 73 questionnaires from 73 countries around the world were considered valid, with a 64.6% response rate. Most of the respondents (71.2%) reported that the state of emergency was declared in their country, and 86.1% reported lockdown measures. Most of the respondents (66.7%) affirmed that the use of face masks was compulsory in their country. As for containment measures, 97.2% indicated that mass gatherings (meetings) were limited. Regarding workplace closing, the most affected sector was entertainment (90.1%).

Conclusion

The results of this survey are useful to gain a global view on COVID-19 policy responses at country level.

The Occupational Medicine Pipeline: Report on the Results of a Survey of International Occupational Medicine Society Collaborative (IOMSC) Member Countries

OBJECTIVE

To learn how occupational and environmental medicine (OEM) expertise is developed and maintained around the world and to inform strategies for further international development of OEM.

METHODS

An anonymous survey was conducted of leaders of the 48 member societies (from 43 countries) of the International Occupational Medicine Society Collaborative (IOMSC) to evaluate OEM training, certification, maintenance, and recertification requirements.

RESULTS

OEM physician leaders representing 46 of the 48 IOMSC member societies (95.8%) completed the survey between December 2019 and February 2020. Academic post-graduate and on-the-job training were the most frequent methods for developing OEM expertise, with little use of online coursework and minimal OEM content in medical school in most countries. Occupational medicine board certification usually required graduate specialty training and passing a certification examination, while occupational medicine recertification requirements were uncommon.

CONCLUSION

The IOMSC is positioned to support the international development of OEM expertise by sharing information on competencies, best practices in medical education curriculum content and examples of OEM specialty certification pathways from different countries.

OUP accepted manuscript

Background

The occupational well-being (OW) of educators can be defined as a balance between resources and workload factors as seen from four aspects of working life: (i) individual, (ii) working conditions, (iii) professional competence and (iv) work community. The research in this study examined the individual aspect as particular importance to the physical and mental workability of educators.

Aims

To study the individual aspect of the OW of educators as well as the associating factors.

Methods

A cross-sectional survey design was conducted among educators working in health and social care education in Finland. The data were collected with an electronic survey using the ‘Occupational well-being of social and health care teachers—index questionnaire’. The data were analysed with an SPSS version 27 using descriptive statistics, explorative factor analysis and linear regression analysis.

Results

The educators (n = 552, response rate 31%) assessed their resources for managing their mental workload as quite poor (2.41, standard deviation [SD] 0.98). In addition, workplace support promoting OW was assessed as being quite poor (2.37, SD 0.88), and as especially requiring more measures during working hours. Associations with the individual aspect of OW were found between the personal and work-related background variables as well as overall OW.

Conclusions

The perceptions of the educators indicated that resources to cope with workload factors should be promoted. Investing in educators’ resources at work, enabling well-being actions during working hours and avoiding backlog situations would all help promote the educators’ OW.

Integration of basic occupational health services into primary health care in Thailand: Current situation and progress

BACKGROUND

Informal workers are high-risk groups for getting occupational diseases. They also have difficulties in accessing occupational health services (OHSs). The Basic OHS (BOHS) program integrates BOHS activities into existing primary health care. The study aims to describe how the BOHS program has been developed and to update the situation of BOHS in Thailand.

METHODS

Four steps for the development of the program include (1) preparation, (2) model development, (3) implementation and expansion, and (4) quality assurance (QA). The program started with the study of the situation of OHS in primary care units (PCUs) and identification of the gap for OH practice among PCUs' staff. The pilot study was conducted in 19 PCUs. After that, expansion of the model and quality assurance of the services have been implemented until now.

RESULTS

In 2019, 84% of PCUs (8242) provided BOHS, but the number decreased to 22% (2123 PCUs) in 2020. The target groups were mainly farmers. The OHS activities include an arrangement of farmers' clinics and conducting outreach activities in the field. The latest health surveillance program for farmers reported that 40.5% of 862,585 farmers had high pesticide exposure by field-kit testing. Regarding the QA audit, 75% of PCUs were certified for basic or higher levels of BOHS standards.

CONCLUSIONS

Integration of OHS into the PCUs is feasible, successful and replicable. Its sustainability requires policy support, continued empowerment of staff, and resource allocation.

Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa

BACKGROUND

Health workers, in short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. This study aimed to assess how South Africa, prepared to protect its health workers from SARS-CoV-2 infection.

METHODS

This was a cross-sectional study design applying participatory action research in four provinces of South Africa. A semi-structured questionnaire and a qualitative observational HealthWISE walkthrough risk assessment was carried out to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures.

RESULTS

We found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Provincial Departments of Health (PDoH) varied in how they were organized to respond: Provinces A and D had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health; Province A had an occupational health doctor and nurse; while Province B had an occupational health nurse; Province A and D PDoHs had functional OSH committees; and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment was adequate, it was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher personal protective equipment and ventilation scores. In addition, our analysis showed that hospitals with higher compliance scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98).

CONCLUSIONS

Despite some initial preparedness, greater effort to protect health workers is still warranted. Low-and-middle-income countries may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers' health.

Prevalence of Work-Related Injury and Its Determinants among Construction Workers in Ethiopia: A Systematic Review and Meta-Analysis

Background

Construction is one of the highest risky jobs for accident-related fatalities and injuries globally. This systematic review and meta-analysis aimed to estimate the pooled prevalence of work-related injury and its associated factors among construction workers in Ethiopia.

Methods

A systematic literature search was performed by using PubMed, Science Direct, and Google Scholar. A random-effects model was used to estimate the pooled prevalence of work-related injury and its associated factors. The heterogeneity of the studies was assessed by using the I² test, and the presence of publication bias was evaluated by using funnel plot and Egger's test.

Results

After reviewing 292 articles, we included 10 studies that fulfilled the inclusion criteria in the meta-analysis. The findings from the 10 studies showed that the pooled prevalence of work-related injury in Ethiopia was 46.78% (95% CI: 32.17, 61.38). The subgroup analysis of this study showed that the highest prevalence was reported in Addis Ababa with the prevalence of 55.9% (25.42, 86.4), followed by a study conducted in Oromia Region with a prevalence of 43.3% (33.3, 53.3). Lack of occupational safety training (OR: 2.43, 95% CI: 1.76, 3.35), not using of personal protective equipment (OR: 2.32, 95% CI: 1.80, 2.99), and male workers (OR: 2.44, 95% CI: 1.15, 5.17) were the major factors significantly associated with the occurrence of work-related injury among construction workers.

Conclusions

This study confirmed that construction is still a high-risk job with a high prevalence of work-related injury in Ethiopia. The modifiable risk factors such as the use of personal protective equipment (PPE), lack of safety training, and gender were the major associated factors with injury. Therefore, a continuous safety training and awareness creation program on risk-taking behavior should be given to construction workers.

Contribution of ICOH to Address the Different OSH Needs among Countries: Results of a Survey

The aim of this study is to map the coverage of occupational safety and health (OSH) rules and provisions and their enforcement at a country level worldwide. Members' participation in the International Commission on Occupational Health (ICOH) activities was also investigated. We used a questionnaire-based survey to collect data. An online questionnaire was administered from February 14 to March 18, 2018 to all ICOH members for the triennium 2015 to 2017 (n = 1929). We received 384 completed questionnaires from 79 countries, with a 20% response rate. To synthesize information about the coverage of OSH rules and provisions and their level of enforcement, a synthetic coverage index was calculated and combined with country, gross domestic product (GDP) per capita and the human development index (HDI). We used multiple correspondence analysis (MCA) to analyze the members' participation in ICOH activities. More than 90.0% of the sample declared that in their own country there is a set of rules and provisions regulating OSH in the workplace, and training procedures and tools to improve workers' awareness. However, these rules and training procedures are mainly "partially" enforced and utilized (39.0% and 45.4%). There was no statistically significant association between country and GDP per capita and the synthetic coverage index, whilst controlling for HDI. The level of engagement in ICOH activities is higher in senior members (aged 65 years or older), coming from high-income countries, having held a position within ICOH, with a higher level of education and a researcher position. An integrated and multidisciplinary approach, which includes research, education and training, is needed to address OSH issues and their impact both at global and country level.

The Role of Occupational Health Services in Psychosocial Risk Management and the Promotion of Mental Health and Well-Being at Work

The development and enhancement of occupational health services (OHS) at the national level is central to ensuring the sustainable health, well-being and work engagement of the working population. However, due to differences in national health, social security and occupational safety and health systems, the content, capacity, coverage and provisions of OHS vary considerably across national contexts. Obtaining a better understanding in terms of such similarities and variations internationally is essential as such comparative information can help inform evidenced-based decision-making on OHS at both policy and practice levels. This paper therefore reviews and analyses the key policies, standards and approaches in OH systems and services, using both academic and grey literature, across 12 industrialised countries (Australia, Canada, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, United Kingdom and the United States of America). It provides a detailed overview and categorization of OHS in these selected countries in terms of the legal and policy context, organisation and financing and coverage and staffing while specifically discussing variations aimed at psychosocial risk management and the promotion of mental health and well-being at work. It draws conclusions on key development needs of OHS internationally to ensure psychosocial risk management and mental health promotion are prioritised effectively in a preventive manner.

Development of an Intervention to Create a Supportive Work Environment for Employees with Chronic Conditions: An Intervention Mapping Approach

Purpose This study describes the development of an evidence-based intervention to create a supportive work environment for employees with chronic conditions. Occupational physicians (OPs) play an important role in guiding organizations in this process of organizational change. Supportive work environments can aid in preventing work-related problems and facilitate sustainable employment. Current workplace interventions for employees with chronic conditions are mainly focused on return to work or a reduction in sick leave at the individual worker's level. This study contributes to the literature an organizational-level intervention which utilizes a preventive approach. Methods Intervention mapping (IM) is a six-step, structured protocol that was used to develop this intervention. In step 1, a needs assessment was conducted to define the problem and explore the perspectives of all stakeholders involved. The program outcomes and the performance objectives of employees with chronic conditions and occupational physicians were specified in step 2. In step 3, appropriate methods and practical applications were chosen. Step 4 describes the actual development of the intervention, consisting of (1) a training for occupational physicians to teach them how to guide organizations in creating a supportive work environment; (2) a practical assignment; and (3) a follow-up meeting. The intervention will be implemented in a pilot study in which occupational physicians will put their acquired knowledge and skills into practice within one of their organizations, which is delineated in step 5. Conclusions IM proved to be a valuable and practical tool for the development of this intervention, aiming to facilitate sustainable employment for employees with chronic conditions.

The Implementation of Workers' Health Surveillance by Occupational Physicians: A Survey Study

OBJECTIVE

Workers' health surveillance (WHS) is an important preventive activity to prevent work-related diseases. This study aimed to get insight in the implementation of WHS by occupational physicians (OPs).

METHODS

A survey was conducted among 128 OPs, in which the actual implementation of WHS, OP's needs, knowledge, skills and motivation of, and opportunities for the implementation of WHS were assessed.

RESULTS

In total, 96 OPs had implemented WHS in the past 5 years. Almost all OPs were motivated, and indicated the need for further development of knowledge and skills. The OPs experienced insufficient opportunities to implement WHS, and mentioned employers are not positive towards WHS.

CONCLUSION

Even though OPs are motivated to implement WHS, development of knowledge and skills, and support to implement WHS at employers is needed to increase implementation of WHS.

Preventing sickness absence among employees with common mental disorders or stress-related symptoms at work: a cluster randomised controlled trial of a problem-solving-based intervention conducted by the Occupational Health Services

OBJECTIVES

Common mental disorders (CMDs) are among the main causes of sickness absence and can lead to suffering and high costs for individuals, employers and the society. The occupational health service (OHS) can offer work-directed interventions to support employers and employees. The aim of this study was to evaluate the effect on sickness absence and health of a work-directed intervention given by the OHS to employees with CMDs or stress-related symptoms.

METHODS

Randomisation was conducted at the OHS consultant level and each consultant was allocated into either giving a brief problem-solving intervention (PSI) or care as usual (CAU). The study group consisted of 100 employees with stress symptoms or CMDs. PSI was highly structured and used a participatory approach, involving both the employee and the employee's manager. CAU was also work-directed but not based on the same theoretical concepts as PSI. Outcomes were assessed at baseline, at 6 and at 12 months. Primary outcome was registered sickness absence during the 1-year follow-up period. Among the secondary outcomes were self-registered sickness absence, return to work (RTW) and mental health.

RESULTS

A statistical interaction for group × time was found on the primary outcome (p=0.033) and PSI had almost 15 days less sickness absence during follow-up compared with CAU. Concerning the secondary outcomes, PSI showed an earlier partial RTW and the mental health improved in both groups without significant group differences.

CONCLUSION

PSI was effective in reducing sickness absence which was the primary outcome in this study.

Decent Work, ILO's Response to the Globalization of Working Life: Basic Concepts and Global Implementation with Special Reference to Occupational Health

Twenty years ago, the International Labour Organization (ILO) launched a new strategy, the Decent Work Agenda, to ensure human-oriented development in the globalization of working life and to provide an effective response to the challenges of globalization. We searched for and analysed the origin of the Decent Work concept and identified the key principles in ILO policy documents, survey reports, and relevant United Nations’ (UN) documents. We also analysed the implementation of the Decent Work Country Programmes (DWCPs) and examined the available external evaluation reports. Finally, we examined the objectives of the ILO Decent Work Agenda and the Decent Work targets in the UN 2030 Agenda for Sustainable Development in view of occupational health. In two thirds of the ILO’s Member States, the Decent Work Agenda has been successfully introduced and so far fully or partly implemented in their DWCPs. The sustainability of the Decent Work approach was ensured through the UN 2030 Agenda, the ILO Global Commission Report on the Future of Work, and the ILO Centenary Declaration. However, objectives in line with the ILO Convention No. 161 on Occupational Health Services were not found in the DWCPs. Although successful in numerous aspects in terms of the achievement of the Decent Work objectives and the UN Sustainable Development Goals (SDGs), the Decent Work Agenda and the Decent Work Country Programmes need further development and inclusion of the necessary strategies, objectives, and actions for occupational health services, particularly in view of the high burden of work-related diseases and, for example, the present global pandemic. In many countries, national capabilities for participation and implementation of Decent Work Country Programmes need strengthening.

A screening questionnaire for occupational and hobby exposures during pregnancy

BACKGROUND

Occupational and environmental exposures during the prenatal period may be associated with adverse pregnancy outcomes and lifelong health effects. Yet, identification and evaluation of these potential hazards is lacking in routine obstetric care.

AIMS

To assess the feasibility of incorporating a self-administered occupational and environmental exposure questionnaire into obstetric clinics.

METHODS

A cross-sectional survey assessed prenatal clinic patients at a public hospital who were currently employed and <20 weeks gestation. Questionnaires evaluated job characteristics, workplace and hobby exposures, protective equipment use and symptoms during pregnancy.

RESULTS

Of 69 participants (96% response rate), 46% were predominantly Spanish-speaking. Primary occupations were caregiver (16%), cleaner (14%) and administrative assistant (14%). Overall, 93% were exposed to a workplace hazard, with most participants reporting physical stressors (82%) or organic solvent exposure (78%). Most women (74%) used some personal protective equipment. Nearly half (54%) reported at least one non-pregnancy symptom, and 52% were referred for follow-up with an occupational medicine practitioner. Household and hobby-related chemical exposures were common in our sample (91%). We observed moderate consistency between job task and chemical use responses: 67-99% of intentionally redundant questions were fully or partially matched. Closed- compared to open-ended activity questions identified a higher proportion of physical stressors (82% versus 12%) and cleaning product (76% versus 30%) exposures.

CONCLUSIONS

A self-administered questionnaire is an effective screening tool for identifying women with occupational and hobby-related exposures during pregnancy. Consistent incorporation of exposure assessment into prenatal care can improve clinical communications and early interventions for at-risk pregnant women.

A World of False Promises: International Labour Organization, World Health Organization, and the Plea of Workers Under Neoliberalism

Occupational health and safety is poorly served by United Nations agencies designated to protect workers: the World Health Organization (WHO) and the International Labor Organization (ILO). The neoliberal programs initially adopted by the United Nations supported institutions of social protection and regulation and expanded worker protections and union growth. Neoliberalism later became synonymous with globalism and shared in its international success. The fundamental change under neoliberalism was the exchange and accumulation of capital. The major beneficiaries of neoliberalism, at the expense of workers, were large transnational corporations and wealthy investors. During this period, WHO and ILO activities in support of workers declined. As neoliberalism ultimately became neoconservatism, occupational health and safety was purposely ignored, and labor was treated with hostility. Neoliberalism had evolved into a harsh economic system detrimental to labor and labor rights. The United Nations is now in decline, taking with it the trivial WHO and ILO programs. Replacements for the WHO and ILO programs must be developed. It is not enough to call for renewed funding, given the United Nations’ failure to direct the global effort to protect workers. A new direction must be found.

Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis

Introduction

Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health.

Objective

To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis.

Data sources

The literature search was performed in four electronic databases in two searches, in 2014 and in 2017.

Eligibility criteria (using PICO)

Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included.

Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof.

Results

Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect.

Limitations

Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common.

Conclusions and implication of key findings

Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.

Does occupational noise matter amongst manufacturing (small and medium enterprises) workers? Empirical evidence from Magaba, Mbare, Zimbabwe

BACKGROUND

The significance of how occupational noise can influence attitudes towards occupational noise exposure, susceptibility to hearing loss and job performance has generally been neglected in the past studies.

OBJECTIVES

The aim of this study was to determine the impact of occupational noise on attitudes towards occupational noise exposure, susceptibility to hearing loss and job performance of manufacturing small and medium enterprises (SMEs) workers in Zimbabwe.

METHOD

A survey was conducted involving 250 respondents, including manufacturing SME workers, and the hypotheses were analysed by applying structural equation modelling.

RESULTS

Occupational noise had a positive and significant effect on attitudes towards occupational noise exposure and perceived susceptibility to hearing loss amongst manufacturing SME workers. In addition, attitudes towards exposure to occupational noise and the perceived susceptibility of hearing loss have had a positive and significant impact on manufacturing SME workers' job performance.

CONCLUSION

The novelty of the research is its analysis of occupational noise as an indicator of attitudes towards occupational noise exposure and susceptibility to hearing loss as well as job performance. This study provides practitioners with beneficial implications. Collective knowledge on occupational noise could help manufacturing SME managers in recognising the perceptions of employees on occupational noise and how it ultimately affects job performance. Moreover, this study is intended to add new knowledge to the current body of African occupational noise literature - a context that has not received much research attention in developing countries.

Facilitators, barriers and support needs for staying at work with a chronic condition: a focus group study

BACKGROUND

Working with a chronic condition can be challenging. Providing support to workers with a chronic condition can help them to stay at work and prevent work-related problems. Workers with a chronic condition who successfully stay at work can provide valuable input for the development of effective supportive interventions to prevent exit from work and facilitate sustainable employment. The aim of this study is to explore the lived experiences of workers with a chronic condition and identify existing barriers, facilitators and possible support needs for staying at work.

METHODS

Four focus groups were conducted between August and December 2017 with workers with one or more chronic conditions (n = 30). Participants included employees and (partially) self-employed workers. All focus group data were transcribed verbatim and thematically analyzed.

RESULTS

Disclosure and expressing one's needs were considered important personal facilitators for staying at work. Environmental facilitators included receiving practical information on working with a chronic condition and social and employer support. Environmental barriers were identified in the work environment, the health care system and service provision, e.g., manager and co-worker's lack of knowledge about working with a chronic condition, a lack of focus on work in the course of treatment for a chronic condition, dissatisfaction with occupational physician support, and the absence of support for self-employed workers. Provided support should be available to all workers, and be proactive and tailored to the workers' specific support needs.

CONCLUSIONS

A variety of facilitators, barriers and support needs were identified in various domains. By addressing environmental barriers (e.g., by integrating work in the course of treatment and creating supportive work environments), sustainable employment by workers with a chronic condition can be promoted.

Current practices and perceived implementation barriers for working with alcohol prevention in occupational health services: the WIRUS OHS study

BACKGROUND

Alcohol is associated with detrimental health and work performance outcomes, and one to three out of ten employees may benefit from interventions. The role of occupational health services (OHS) in alcohol prevention has received little attention in research. The primary aims of this study were to explore current practices of alcohol prevention targeting employees in occupational health settings, and examine whether and which perceived implementation barriers were associated with alcohol prevention activity. The secondary aim was to explore whether barriers were differentially associated with primary, secondary and tertiary prevention activities.

METHODS

In this cross-sectional study, survey data were collected from 295 OHS professionals in Norway in 2018. Data were analysed by means of descriptive statistics, one-way analysis of variance, paired samples t-tests, and multivariate linear regression analyses.

RESULTS

Overall, seven out of ten OHS professionals worked with alcohol-related cases less than monthly, while only one out of ten did so on a weekly basis. Their activities were more focused on tertiary prevention than on primary and secondary prevention. Physicians, psychologists and nurses reported to handle alcohol-related issues more often than occupational therapists and physical therapists. Higher levels of implementation barriers internal to the OHS' organisation (competence, time and resources) were associated with lower alcohol prevention activity. Barriers external to the OHS' organisation (barriers concerning employers and employees) were not. This pattern was evident for primary, secondary and tertiary prevention activities. A majority of OHS professionals agreed that employees' alcohol consumption constitute a public health challenge, and that OHS' should focus more on alcohol prevention targeting employees.

CONCLUSIONS

Occupational health settings at workplaces may be particularly serviceable for alcohol prevention programmes since the majority of the population is employed and the majority of employees consume alcohol. An increase in overall prevention activity, and a shift from mainly focusing on tertiary prevention to an increased emphasis on primary and secondary prevention, may both hinge on increased training of OHS professionals, emphasising knowledge on the importance of working with alcohol prevention, and training in administering alcohol prevention programmes. Making alcohol prevention a priority may also require increased allocation of time and resources.

Occupational noise exposure and hearing loss: A study of knowledge, attitude and practice among Tanzanian iron and steel workers

We assessed Knowledge Attitude and Practice (KAP) regarding occupational noise exposure, Noise-induced hearing loss, audiometry and use of hearing protection devices among iron and steel factory workers exposed to high noise level. A modified, validated, structured questionnaire was used to collect information from 253 male workers randomly selected from the four factories. The sum scores for each domain of KAP were computed. Scores above 75% were defined as good knowledge and positive attitude. For practice, scores of >50% were defined as good. Independent samples t-test and Chi-squared test were used to analyze association between KAP and continuous/categorical variables respectively. Majority of workers displayed poor knowledge and poor practice (94%), but 76% displayed a positive attitude. Most of the workers (86%) had never been provided with hearing protection devices. The mean scores for attitude and practice differed significantly between the four factories (one-way ANOVA, p < 0.001). Implementation of hearing conservation program with provision of hearing protection devices are suggested.

Healthy worker, healthy citizen: the place of occupational health within public health research in Switzerland

OBJECTIVES

To assess the state of Swiss occupational health (OH) research over the period 2008-2017.

METHODS

Two types of indicators were constructed, focused, respectively, on resources available for OH research and its output. Data for their assessment were gathered from specialized research institutions, professional associations, and the Swiss Federal Statistical Office.

RESULTS

Thirty-two of 317 Ph.D./M.D.-Ph.D. theses delivered were in the field of OH. The number of OH physicians progressed substantially, but the density of OH professionals per number of active workers showed important variations between OH disciplines and geographical regions. The number of yearly peer-reviewed publications increased substantially but represented 6% of publications in public health in 2017. Psychological and respiratory health conditions were the most studied topics, while papers on cancers accounted for only 10%.

CONCLUSIONS

This study suggests a limited place of OH research in the Swiss public health landscape and the need for a national research effort in OH. This requires an improved collaboration between regional and federal authorities and communication/coordination between public health authorities and OH executive institutions belonging to the economic sector.

Standing working posture and musculoskeletal pain among Citrus sinensis workers in a low-income country

Background. Work-related musculoskeletal pain (WRMP) among Citrus sinensis farm workers has barely been studied. Yet most work tasks in such farms are manually performed using awkward standing postures that can contribute to WRMP. Aim. This study assessed the standing working posture in relation to WRMP among C. sinensis workers. Methods. Ninety-two workers engaged in manual tasks participated in this cross-sectional study. Postures at the upper limbs were analysed using the rapid upper limb assessment (RULA) method. Data were analysed using SPSS version 20. Results. Analyses generally showed statistically significant associations (p < 0.05) between a body part RULA score and WRMP at the concerned body part. The upper arm score was >1 in 77.2% of the workers and caused upper arm pain in 66.3%; the association between the upper score and upper pain was statistically significant (χ ²= 20.57; p < 0.05). Similarly, significant associations were found between: (a) wrist score and wrist pain; (b) neck score and neck pain; (c) trunk score and back pain. Conclusions. C. sinensis workers use unsafe postures which contribute to WRMP at the upper arm, trunk, neck and wrists. Ergonomics measures are required to improve their working posture.

Disparities in Unintentional Occupational Injury Mortality between High-Income Countries and Low- and Middle-Income Countries: 1990⁻2016

Objective: Using estimates from the Global Burden of Disease (GBD) study, we examined differences in unintentional occupational injury mortality rates from 1990 to 2016 between high-income countries (HICs) and low- and middle-income countries (LMICs). Methods: Unintentional occupational injury mortality rates were obtained through the GBD online visualization tool. We quantified mortality changes over time for common external causes of injury for ages 15–49 years and 50–69 years separately in HICs and LMICs using negative binomial regression models. Results: In 2016, there were 24,396 and 303,999 unintentional occupational injury deaths among individuals aged 15 to 69 years in HICs and LMICs, respectively, corresponding to 3.1 and 7.0 per 100,000 people. Between 1990 and 2016, unintentional occupational injury mortality for people aged 15–69 years dropped 46% (from 5.7 to 3.1 per 100,000 people) in HICs and 42% in LMICs (from 13.2 to 7.0 per 100,000 people). Sustained and large disparities existed between HICs and LMICs for both sexes and both age groups during 1990–2016 (mortality rate ratio: 2.2–2.4). All unintentional occupational injury causes of death displayed significant reduction with one exception (ages 15–49 years in HICs). Country-specific analysis revealed large variations in unintentional occupational injury mortality and changes in occupational injury mortality between 1990 and 2016. Conclusions: Despite substantial decreases in mortality between 1990 and 2016 for both HICs and LMICs, a large disparity continues to exist between HICs and LMICs. Multifaceted efforts are needed to reduce the disparity.

Using e-Delphi to formulate and appraise the guidelines for women's health concerns at a coal mine: A case study

Background

E-Delphi is an online method widely used in health and social research to strengthen decision-making processes and reach consensus on developing guidelines for health services.

Objectives

The e-Delphi technique was designed to formulate and appraise a set of criterion-referenced guidelines for women’s health concerns of mineworkers at a selected coal mine in Mpumalanga, South Africa.

Method

The University Learning Management System’s discussion forum was customised to suit the characteristics of e-Delphi as the second phase of a primary study on the formulation of guidelines for women’s health concerns. Six purposively sampled experts with extensive experience in Occupational Health and in Women’s Health participated. Online engagements on the formulation and appraisal of the guidelines for women’s health concerns took 7 weeks, divided into four phases as preparatory, exploratory, consensus and refinement. From the experts’ inputs, guidelines were drafted. Experts were invited to evaluate the guidelines by using a 7-point Likert scale with AGREE II criteria. Consensus was reached in two e-rounds.

Results

Eight guidelines were formulated, appraised and adopted as: change management, control of hazardous environments, suitable psychosocial working environment, provision of health care service, uphold human dignity and adherence to human rights, effective measures for safety participation compliance, accessible, available and relevant on-site health care services and hope and resilience. Each guideline has rationale, operational strategies and anticipated outcomes.

Conclusion

E-Delphi platform used various tools to deliberate on the process of guidelines formulation and appraisal. The platform was convenient for the experts’ participation in the discussion at any time and anywhere.

Which work-related characteristics are most strongly associated with common mental disorders? A cross-sectional study

OBJECTIVES

Studies exploring work-related risk factors of common mental disorders (CMDs), such as major depressive disorder (MDD), generalised anxiety disorder (GAD) or alcohol abuse, have generally focused on a limited set of work characteristics. For the first time in a primary care setting, we examine simultaneously multiple work-related risk factors in relation to CMDs.

METHOD

We use data from a study of working individuals recruited among 2027 patients of 121 general practitioners (GPs) representative of the Nord-Pas-de-Calais region in the North of France (April-August 2014). CMDs (MDD; GAD; alcohol abuse) were assessed using the Mini-International Neuropsychiatric Interview. Six worked-related factors were examined (work intensity, emotional demands, autonomy, social relations at work, conflict in values and job insecurity). Several covariates were considered (patient, GP and contextual characteristics). To study the association between workplace risk factors and CMDs, we used multilevel Poisson regression models adjusted for covariates.

RESULTS

Among study participants, 389 (19.1%) met criteria for MDD, 522 (25.8%) for GAD and 196 (9.7%) for alcohol abuse. In multivariable analyses adjusted for covariates, MDD/GAD was significantly associated with work intensity (RR 1.16, 95% CI 1.06 to 1.27) (absolute risk=52.8%), emotional demands (RR 1.24, 95% CI 1.13 to 1.35) (absolute risk=54.9%) and social relations at work (RR 0.78, 95% CI 0.70 to 0.87) (absolute risk=15.0%); alcohol abuse was associated with social relations at work (RR 1.25, 95% CI 1.01 to 1.53) (absolute risk=7.6%) and autonomy (OR 0.82, 95% CI 0.67 to 0.99) (absolute risk=8.9%).

CONCLUSIONS

Several workplace factors are associated with CMDs among working individuals seen by a GP. These findings confirm the role of organisational characteristics of work as a correlate of psychological difficulties above and beyond other sources of risk.