Safe handling of cytostatic drugs: recommendations from independent science

OBJECTIVES

Due to their mechanism of action, most classical cytostatic drugs have carcinogenic, mutagenic and/or reprotoxic properties. Therefore, occupational exposure of healthcare staff to these drugs should be prevented. Our objective was to lay out European legislation on this topic and reflect on the process of revising the European CM-directive. We summarise independent European and Dutch studies, and give a concise set of basic recommendations for safe working with cytotoxic drugs in healthcare facilities.

METHODS

We were directly involved in the process of revising the CM-directive: first, through an EU commissioned workshop in the Netherlands, and after that by contributing to the pan-European stakeholder symposium. For this aim, we had to gather the relevant study data from the Netherlands and from Europe. We analysed all relevant industry-independent studies and collated a set of basic recommendations.

RESULTS

Independent studies show that the development of measures in recent years can lead to a safe work environment. Standardising the cleaning process leads to a significant improvement in environmental contamination in the majority of hospitals. In the Netherlands, exposure of workers was shown to be well beneath the limit value of 0.74 µg cyclophosphamide per week, therefore showing that the measures taken in recent years are adequate.

CONCLUSIONS

The safety of healthcare workers is of the utmost importance. Current practice in the Netherlands show that measures taken in recent years are adequate. European legislation should be based on independent scientific research and practice. The first goal should be to bring countries with less safe working levels to a higher level instead of introducing measures that only increase healthcare budgets but not healthcare safety.

[Research progress on the occupational health and personal protection of emergency responders]

To meet the requirement from the economy and society, China's emergency rescue has been developing towards specialization and professionalization. The working environment for emergency responders is special accompanying with tremendous challenges and uncertainties. To promote the research on occupational health and personal protection is an important guarantee for the workers in China to realize the goal of "decent work". This paper reviews the hazards that affect the occupational health of emergency rescue workers, the research progress of adverse outcomes caused from exposure to these hazards, and the related development issues of personal protection. In order to ensure the safety and health of emergency rescue workers, the direction of further research on occupational health of emergency rescue workers is put forward.

Descriptive study of chest x-ray examination in mandatory annual health examinations at the workplace in Japan

The utility of chest x-ray examination (CXR) in mandatory annual health examinations for occupational health is debatable in Japan. This study aimed to provide basic data to consider future policies for mandatory annual health examinations in the workplace. A nationwide descriptive survey was performed to determine the rate of detection of tuberculosis, lung cancer, and other diseases through CXR in organizations associated with National Federation of Industrial Health Association. The rate of finding on CXR conducted during annual health examinations in FY2016 was evaluated. Data regarding diagnosis based on follow-up examination findings were obtained and compared with the national statistics. In addition, CXR findings were compared with the results of low-dose lung computed tomography performed at the Hitachi Health Care Center. From 121 surveyed institutions, 88 institutions with 8,669,403 workers were included. For all ages, 1.0% of examinees required follow-up examination. Among 4,764,985 workers with diagnosis data, the tuberculosis detection rate was 1.8–5.3 per 100,000 persons. For Lung cancer, 3,688,396 workers were surveyed, and 334 positive cases were detected. The lung cancer detection rate using CXR was 9.1–24.4 per 100,000 persons. From 164 cases with information regarding the clinical stage, 72 (43.9%) had Stage I lung cancer. From 40,045 workers who underwent low-dose computed tomography multiple times, 31 lung cancer cases, all with Stage I disease, were detected (detection rate: 77.4 per 100,000 persons). Our findings suggest that CXR plays a little role in the detection of active tuberculosis. With regard to LC screening, the detection rate of LC by CXR was lower, approximately 50%, than the expected rate (41.0 per 100,000 persons) of LC morbidity based on the age–sex distribution of this study population. However, the role of CXR for LC screening cannot be mentioned based on this result, because assessment of mortality reduction is essential to evaluate the role.

Health and Mortality in Korean Healthcare Workers

BACKGROUND

To evaluate the health status of healthcare workers (doctors and nurses) compared to those in the general population based on the National Health Insurance Service database and the cause of death data from Statistics Korea.

METHODS

The subjects of this study were 104,484 doctors and 220,310 nurses working in healthcare facilities from 2002 to 2017, and who had undergone at least one general medical examination. Based on the subject definition, the subject data were extracted from the National Health Insurance healthcare facility database and qualification database. We collected medical use details included in the research database, general medical examination results, medical history included in the health examination database, and additional data on the cause of death from the National Statistics database to analyze the main cause of death and mortality.

RESULTS

In terms of the major causes of death and mortality among healthcare workers, the mortality rate associated with intentional self-harm, injury, transportation accident, heart disease, addiction, and falling was significantly higher than that in the general population. Further, the prevalence of respiratory and gastrointestinal diseases was high. When analyzing the proportional mortality ratio (PMR) by cause of death for healthcare workers, the PMR values for death related to malignant neoplasm was the highest. In terms of diseases, both doctors and nurses had higher rates of infectious diseases such as maternal sepsis, rubella, and measles.

CONCLUSION

The health status of healthcare workers differs from that of the general population. Thus, it is important to consider the occupational characteristics of healthcare personnel. This study is unique in that it was conducted based on medical use indicators rather than survey data.

Comprehensive occupational health services for healthcare workers in Zimbabwe during the SARS-CoV-2 pandemic

BACKGROUND

Healthcare workers are disproportionately affected by COVID-19. In low- and middle- income countries, they may be particularly impacted by underfunded health systems, lack of personal protective equipment, challenging working conditions and barriers in accessing personal healthcare.

METHODS

In this cross-sectional study, occupational health screening was implemented at the largest public sector medical centre in Harare, Zimbabwe, during the "first wave" of the country's COVID-19 epidemic. Clients were voluntarily screened for symptoms of COVID-19, and if present, offered a SARS-CoV-2 nucleic acid detection assay. In addition, measurement of height, weight, blood pressure and HbA1c, HIV and TB testing, and mental health screening using the Shona Symptom Questionnaire (SSQ-14) were offered. An interviewer-administered questionnaire ascertained client knowledge and experiences related to COVID-19.

RESULTS

Between 27th July and 30th October 2020, 951 healthcare workers accessed the service; 210 (22%) were tested for SARS-CoV-2, of whom 12 (5.7%) tested positive. Clients reported high levels of concern about COVID-19 which declined with time, and faced barriers including lack of resources for infection prevention and control. There was a high prevalence of largely undiagnosed non-communicable disease: 61% were overweight or obese, 34% had a blood pressure of 140/90mmHg or above, 10% had an HbA1c diagnostic of diabetes, and 7% had an SSQ-14 score consistent with a common mental disorder. Overall 8% were HIV-positive, with 97% previously diagnosed and on treatment.

CONCLUSIONS

Cases of SARS-CoV-2 in healthcare workers mirrored the national epidemic curve. Implementation of comprehensive occupational health services during a pandemic was feasible, and uptake was high. Other comorbidities were highly prevalent, which may be risk factors for severe COVID-19 but are also important independent causes of morbidity and mortality. Healthcare workers are critical to combatting COVID-19; it is essential to support their physical and psychological wellbeing during the pandemic and beyond.

Application of ISO/IEC Guide 51 to COVID-19 infection control for the occupational safety

COVID-19 is around the world. We attempt to apply three-step method in ISO/IEC Guide 51: 2014 to COVID-19 infection control in the workplace. The results show that the COVID-19 infection control measures include the eradication of the virus, the destruction of infectivity, the detoxification and weakening and the elimination of opportunities for infection as "Inherently Safe Design Measures", the avoidance of contact as "Safeguarding and Complementary Protective Measures" and the reduction of contact and the avoidance of seriousness as "Information for Use". Among these specific measures, the New Normal, especially in the manufacturing industries, would be "telecommuting" and "unmanned workplaces", which are part of the elimination of opportunities for infection, and "changes in flow lines" and "changes in airflow", which are part of the avoidance of contact. Where "telecommuting" and "unmanned workplaces" are feasible, they should be implemented as much as possible, and where they are not, attempts should be made to minimize human-to-human contact by "changes in flow lines". In addition, in the area of "changes in airflow", there are high expectations for future research on how to establish a ventilation design for COVID-19, in which but also the source would be workers themselves, not only combustible gases and toxic gases.

Strengthening a Culture to Address Bullying and Incivility in the Care Environment

The safety of our patients and our workforce is paramount to elevating the health and wellness of the global communities we serve. The health and well-being of our frontline staff directly influences the environment of care, and it is our job as healthcare leaders to address workplace bullying, incivility, and lateral and horizontal violence. From patient to provider violence, to peer-peer bullying, these acts of incivility erode at the core of the care environment and impact an organization's culture of safety, influence nursing engagement scores, negatively impact patient outcomes, and decrease overall retention. Magnet® organizations help to elevate the practice of nursing and ensure world-class interprofessional care. Therefore, the Commission on Magnet has included new language in the 2023 Magnet Application Manual in the Organizational Overview (OO7), which directly addresses the organization's structure and processes aimed at addressing workplace violence, bullying, and incivility.

Supporting the Health of Our Nurses Using the 4A Model

Despite the well-documented need for nurse-focused efforts on health and wellness, too few healthcare organizations have made a meaningful impact on this issue. Nurse health should be integrated into the strategic and operational workings of the organization. Environments of health and wellness require attention, accountability, action, and accessibility. Although individual choice is the starting point, true success will be achieved when nurse health is a nonnegotiable outcome consistent with quality, safety, finance, and patient experience.

Menopausal symptoms and work: a narrative review of women's experiences in casual, informal, or precarious jobs

Governments, employers, and trade unions are increasingly developing "menopause at work" policies for female staff. Many of the world's most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.

A Multidisciplinary Approach and Review of Safety Recommendations for Plastic Surgeons during the COVID-19 Pandemic: Are N95 Masks Enough?

SUMMARY

The novel coronavirus disease of 2019 pandemic presents a unique challenge to the field of plastic and reconstructive surgery. Although plastic surgeons may be postponing elective operations, there are still a number of emergent or urgent procedures that may need to be performed, and surgeons may be facing the reality of returning to a new normalcy of operating with coronavirus disease of 2019. These procedures, consisting of those such as head and neck reconstruction or maxillofacial trauma, largely require a multidisciplinary approach and may be considered of higher risk to health care workers because of the involvement of areas of the body identified as sources for viral transmission. Moreover, viral transmission may potentially extend beyond respiratory secretions, which has been the main focus of most safety precautions. The authors aim to present the scope of these procedures and the means of viral transmission, and to provide safety precaution recommendations for plastic surgery and its related disciplines.

Rational emotive occupational health coaching for quality of work-life among primary school administrators

BACKGROUND

This study aimed at investigating the effect of rational emotive occupational health coaching on quality of work-life among primary school administrators.

METHOD

This is a double blinded and randomized control design study. A total of 158 administrators were sampled, half of them were exposed to rational emotive occupational health treatment package that lasted for 12 sessions. Two self-report measures were utilized in assessing the participants using quality of work life scale. Data collected were analyzed using MANOVA statistical tool.

RESULT

The results showed that rational emotive occupational health coaching is effective in improving perception of quality of work-life among public administrators. A follow-up result showed that rational emotive occupational health coaching had a significant effect on primary school administrators' quality of work life.

CONCLUSION

This study concluded rational emotive occupation health coaching is useful therapeutic strategy in improving quality of work of primary school administrators, hence, future researchers and clinical practitioners should adopt cognitive-behavioral techniques and principles in helping employers as well as employees. Based on the primary findings and limitations of this study, future studies, occupational psychotherapists should qualitatively explore the clinical relevance of rational emotive occupational health practice across cultures using different populations.

The effect of contextual information on professional judgment: Reliability and biasability of expert workplace safety inspectors

INTRODUCTION

A critical aspect of occupational safety is workplace inspections by experts, in which hazards are identified. Scientific research demonstrates that expectation generated by context (i.e., prior knowledge and experience) can bias the judgments of professionals and that individuals are largely unaware when their judgments are affected by bias.

METHOD

The current research tested the reliability and biasability of expert safety inspectors' judgments. We used a two-study design (Study 1, N = 83; Study 2, N = 70) to explore the potential of contextual, task-irrelevant, information to bias professionals' judgments. We examined three main issues: (1) the effect that biasing background information (safe and unsafe company history) had on professional regulatory safety inspectors' judgments of a worksite; (2) the reliability of those judgments amongst safety inspectors and (3) inspectors' awareness of bias in their judgments and confidence in their performance.

RESULTS

Our findings establish that: (i) inspectors' judgments were biased by historical contextual information, (ii) they were not only biased, but the impact was implicit: they reported being unaware that it affected their judgments, and (iii) independent of our manipulations, inspectors were inconsistent with one another and the variations were not a product of experience.

CONCLUSION

Our results are a replication of findings from a host of other professional domains, where honest, hardworking professionals underappreciate the biasing effect of context on their decision making. The current paper situates these findings within the relevant research on safety inspection, cognitive bias and decision making, as well as provides suggestions for bias mitigation in workplace safety inspection. Practical Application: Our results have implications for occupational health and safety given that inspection is an integral aspect of an effective safety system. In addition to our findings, this study contributes to the literature by providing recommendations regarding how to mitigate the effect of bias in inspection.

Depression among physicians and other medical employees involved in the COVID-19 outbreak: A cross-sectional study

Health care employees are the front liners whom are directly involved in the management of COVID-19 at high risk of developing psychological distress and other mental health illness. We aim to assess the burden of depression during this pandemic on health care employees treating COVID-19 in Saudi Arabia. We also will shed the light on the best solutions of how to encounter depression.A cross-sectional, hospital-based survey conducted via a region-stratified, 2-stage cluster sample was conducted for 554 participants in >15 hospitals from April 29, 2020, to June 30, 2020. Depression is measured using the established PHQ9 score system. We grade PHQ9 depression scores as: normal, 0 to 4, mild, 5 to 9, significant (moderate or severe), 10 to 27. χ2/Fisher exact test was used; significant association between level of depression and survey characteristics were made. P value <0.05 was considered statistically significant.A total of 554 participants completed the survey. A total of 18.9% (n = 105) were aged <29 years, 51.2% (n = 284) were between 30 to 39 years and female represent 70% of all participants. Of all participants, 53.7% (n = 298) were nurses, and 38.6% (n = 214) were physicians; 68.5% (n = 380) worked in central area hospitals in Saudi Arabia. No significant (P = .432, 95% confidence interval [CI]) association was observed between sex and depression classifications. However, female had high proportion of significant depression 75.0% (n = 76) was observed as compared to male 24.8% (n = 25). Depression was significant in Saudis 61.4% (n = 62) (P < .001, 95% CI) and medical staff who encountered corona patients 51.5% (n = 52) (P < .002, 95% CI). Hospital preparedness associated with more freedom of depression symptoms 69.1% (n = 199/288) (P < .001, 95% CI).Frontline young health care workers especially physician in Saudi Arabia reported a high rate of depression symptoms. Countermeasures for health care workers represent a key component for the mental and physical well-being as part of public health measures during this pandemic. Attention to hospital preparedness and adequacy of personal protective equipment contributed to milder depression symptoms. Further studies need to be conducted on crisis management and depression.

Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.

Workforce perceptions of human factors as indicators of plant reliability and process safety

Human factors, as perceived by the maintenance workforce, were used as the measure for comparing work areas within a petroleum company. These factors were then compared to an objective measure of reliability (Mean Time Between Failures) in order to determine which factors would be most predictive of plant reliability and process safety. Maintenance personnel were surveyed using scales based on Problem-solving, Vigilance, Design and maintenance, Job-related feedback and Information about change. Analysis of Variance was used to assess the strength of these variables in relation to Reliability Level. Significant differences were observed between different reliability levels based on workforce perceptions of problem-solving requirements and the design and maintainability of plant. Conclusions were that perceptions of human factors in the workplace can be predictive of group-level performance, and that if issues relating to design and maintainability are not addressed at the design stage, greater problem-solving abilities will be required from maintenance personnel. Practitioner summary: Workforce perceptions of plant performance could provide a statistically valid measure of current and future reliability. A survey of perceptions of human factors was conducted with maintenance personnel in a petroleum company. Results indicated significant relationships between reliability and requirements for Problem-solving, as well as Design and Maintenance of equipment. Abbreviations: HFIT: human factors investigation tool, FPSO: floating production, storage and offtake, MTBF: mean time between failures, CPS: cognitive problem- solving, WDS: work design questionnaire, SPSS: statistical package for the social sciences, PAF: principal axis factoring, ANOVA: analysis of variance, ANCOVA: analysis of co-variance, M: mean, SD: standard deviation.

Home Care Aide Safety Concerns and Job Challenges During the COVID-19 Pandemic

Home care aides are on the frontlines providing care to vulnerable individuals in their homes during the COVID-19 pandemic yet are often excluded from policies to protect health care workers. The goal of this study was to examine experiences of agency-employed home care aides during the COVID-19 pandemic and to identify ways to mitigate concerns. We used an innovative journaling approach with thirty-seven aides as well as in-depth interviews with fifteen aides and leadership representatives from nine home health agencies in New York and Michigan. Workers described a range of concerns around workplace safety including uncertainty around whether a client had COVID-19, inadequate access to personal protective equipment and safe transportation, as well as fundamental changes to interactions with clients. Agencies also faced challenges acquiring personal protective equipment for their aides. This research points to needed resources to support home care aides and home health agencies both during a public health crisis and in the future.

Cabin crew health and fitness-to-fly: Opportunities for re-evaluation amid COVID-19

Aircrew fitness-to-fly is among the elements that make aviation the safest form of long-distance transport. The health of cabin crew is a crucial determinant in carrying out safety-related duties. 'Fitness-to-fly' is associated with defined workplace conditions, for which airlines have a legal duty to ensure fitness for employment. We explored the literature on fitness-to-fly to obtain a pragmatic assessment of the challenges for aeromedical examinations. Regulations promulgated by aviation regulatory authorities and airline-internal policies have similar status and meaning, yet there is no harmonised approach internationally, and an inability to conform periodic medical assessments to actual operational fitness. The COVID-19 pandemic has highlighted the need to better understand fitness-to-fly criteria. Fitness-to-fly measures are mainly based on self-reported data and there is a need for a 'safety' factor for self-reports. Aeromedical evaluations should evolve from meeting medical standards to include pandemics as an element of the overall risk of aircraft operations. Re-evaluating criteria for fitness-to-fly assessment will further the goal of linking research to the actual needs of public health decisionmakers. If airlines are to resume operations at pre-pandemic levels, they must demonstrate to the public and public health agencies that fitness-to-fly assessment is appropriate and effective.

The Pandemic's Toll-A Case for Clinician Support

Healthcare providers perform lifesaving work in unusually stressful work environments due to the challenges and related risks of battling the unprecedented COVID-19 pandemic. The potential personal and professional toll is substantial. This article describes how one healthcare facility benefited from existing peer support resources to address workforce well-being, ensuring that resources were available to support workforce resilience throughout the protracted COVID response.

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

Autopsies on COVID-19 have provided deep insights into a novel disease with unpredictable and potentially fatal outcome. A standardized autopsy procedure preferably with an in-situ technique and systematic tissue processing is important. Strict safety measures include personal protective equipment with a standardized protocol for dressing and undressing, usage of FFP-3 masks and minimization of aerosol production. The use of an airborne infection isolation (AIIR) room is preferred. Viral RNA analysis using swabs from throat, both lungs and other organs provides information on cross-organ viral dynamics. To correctly determine the full extent of pathological organ changes an adequate processing procedure is of the utmost importance. Systematic dissection and processing of the lungs revealed pulmonary infarction caused by thrombosis and thromboembolism and bacterial bronchopneumonia as the most frequent cause of death. Fungal pneumonia (aspergillus) was found in one case. The quality of the tissue was sufficient for histopathological and immunohistochemistry analyses in all cases. Viral RNA from throat or lung swabs was detectable post mortem in 89 % of the cases and could also be detected from paraffin-embedded tissue by real-time PCR. Complete COVID-19 autopsies including extensive histopathological studies and viral RNA analysis require approximately three times more human and technical resources and time compared to standard non-COVID autopsies. Autopsies on COVID-19 are feasible, present a manageable risk, while following a strict protocol, and provide novel insights into disease pathogenesis and the clinician with important feedback.

How Useful is COVID-19 Antibody Testing - A Current Assessment for Oncologists

The coronavirus disease 2019 (COVID-19) pandemic due to infection by a new human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has seriously disrupted the provision of oncology services and their uptake. Antibody testing, both at an individual level and of populations, has been widely viewed to be a key activity for guiding the options for treatment of high-risk individuals, as well as the implementation of safe control of infection measures. Ideally, the detection of a specific antibody should signify that all individuals tested have been infected by SARS-CoV-2 and that in the case of specific IgG that they are immune to further infection. This would enable SARS-CoV-2-infected individuals to be appropriately managed and healthcare workers shown to be immune to return to work where they would no longer pose a risk to their patients or be at risk themselves. Unfortunately, this is not the case for COVID-19, where it has been shown that immunity may not be protective, and seroconversion delayed or absent. The variability in antibody test performance, particularly that of lateral flow assays, has caused confusion for the public and healthcare professions alike. Many antibody test devices have been made available without independent evaluations and these may lack both adequate sensitivity and specificity. This review seeks to educate healthcare workers, particularly those working in oncology, of the current benefits and limitations of SARS-CoV-2 antibody testing.

Creating a Workplace Culture of Preventive Health: Process and Outcomes of the Colon Cancer-Free Zone at Virginia Cooperative Extension

Colorectal cancer is the third leading cause of cancer death in the USA, yet is highly preventable and detectable at an early stage through screening. Virginia Cooperative Extension (VCE) implemented a worksite colon cancer awareness program to increase colorectal cancer screening rates and preventive lifestyle behaviors among its employees. The Colon Cancer-Free Zone program is designed using best practice principles of worksite health programs and includes information sessions covering the topics of colorectal cancer, screening guidelines, insurance coverage, and preventive lifestyle behaviors. It is conducted in a campaign format that includes a strategic communication strategy targeting relevant screening barriers and facilitators, peer champions, and incentives. The program was implemented with VCE employees statewide utilizing a web-based system for the information sessions, and resulted in broad participation, a significant increase in screening self-efficacy (4.15 ± 0.64 vs 3.81 ± 0.76, ρ = 0.006), changes in diet and physical activity (50% and 40% of participants, respectively), and a 20.6% increase in the employee colorectal cancer screening rate. A Colon Cancer-Free Zone toolkit was developed for use by Extension Agents to implement the program at worksites in their service communities.

Current legislation on tattooing in France

Since 2004, tattooing products have been recognized as such by French law. A tattooist must declare his activity to the ARS (French regional health agency). A tattooist is legally compelled to undergo training sessions on occupational safety and hygienic requirements and to deliver his certificate to the ARS. A tattooist commits himself to preliminarily informing his customers of the risks they possibly incur and of the precautions to be taken. He also commits himself to complying with general rules and regulations and with good practices of hygiene and safety; lastly, he signs an agreement pertaining to waste disposal (DASRI). Contrary to pharmaceutical products, tattooing products are not subject to authorization prior to their commercialization. Any adverse effect after tattooing must be the subject of a declaration addressed to the ANSM (French health products safety agency) by the customer, the tattooist or a health professional.

Analysis of coal mine occupational disease hazard evaluation index based on AHP-DEMATEL

The main purpose to analysis the occupational-disease-inductive index in coal mine is to protect the life and health of the workers and reduce the losses caused by it. According to the occupational-disease-inductive factors "produce source-cause factors-function object" to analyze the whole process of occupational disease hazard control in coal mine, determined the occupational-disease-inductive factors cause of coal mine. Then, the occupational disease hazard of coal mine based on the energy release cause model was established, built the evaluation index system of coal mine occupational disease hazard. The AHP-DEMATEL evaluation model was used to analyze the indicators. Combined with the application of case study, the evaluation results were in good agreement with the actual situation of occupational hazard management in coal mines. It indicated that the indicator system has a strong generalization and adaptability.

Survey of the necessary competencies and proficiency of safety officers in Thailand

Competency is important for professionals' effective performance and career development. However, little is known about the necessary competencies and proficiency in these for Thai safety officers. Therefore, this study aimed to identify the necessary competencies for this group and to compare proficiency in each competency between senior and junior safety officers. A descriptive, cross-sectional study was conducted among 73 safety officers using a self-administered questionnaire. Twenty-five competencies were classified as necessary. Mean proficiency scores were higher for senior safety officers than for more junior safety officers for all examined competencies; however, this difference was not statistically significant for 'first aid' or for 'air sampling and analytical methods'. Regulatory compliance was assessed as the most important competency. Gaps between necessity and proficiency were observed in managing safety programs for the junior group. In both groups, proficiency was lowest in the competency of mental health. The results indicate that Thai safety officers' training needs may be particularly high for regulatory compliance, managing safety programs, and mental health. Lifelong learning is important for enabling occupational safety and health practitioners to fulfill current requirements in Thailand and elsewhere. Multiple training approaches and a specialist qualification program may encourage competency development, especially for junior practitioners.

Features of the Japanese Industrial Safety and Health Act: some key points regarding the organization of safety and health management

The Japanese Industrial Safety and Health Act was first enacted in 1972. The purpose of this Act is to secure the safety and health of workers in the workplace, as well as to facilitate the establishment of a comfortable work environment. To fulfill these purposes, the Industrial Safety and Health Act aims to clarify the responsibility system in the workplace and to promote proactive efforts by both employers and employees to maintain safety and health in the workplace. Specifically, it is expected that occupational accidents will be prevented by obligating employers to appoint safety and health personnel in accordance with the Act. In this paper, I introduce the features and key points of the Industrial Safety and Health Act, especially in relation to Chapter 3 (Articles 10-19), which provides for the organization of the safety and health management system. In addition, I describe recent amendments to the Act.

An enhanced whole-body vibration emission index for railway vehicles

Whole-body vibration (WBV) is a concept that is gaining importance in the railway sector. Occupational disorders, such as back pain and sciatica, frequently cause sick leave and have resulted in lawsuits against employers. Railway operators require a clear procedure for specification and purchase of certified rail vehicles that evaluate the vehicle from the point of view of the effect of WBV. However, a review of current standards and studies shows no clear and simple method for defining a vibration emission value, such as that defined in EN 1032 for mobile machinery. This study proposes a systematic and robust railway driver-related vibration index and describes the methodology for its determination. The proposed index, based on current WBV standards, is robust and allows comparisons between vehicles. For index validation, we used experimental results as well as results from a neural network using the cabin floor data. Practitioner summary: A new vibration emission index is proposed for the certification of railway vehicles, using whole-body vibration, based on current standards. It could be used as a criterion when purchasing a vehicle and as a design specification for manufacturers, thereby improving the ergonomics of drivers' working environment. Abbreviations: EAV: exposure action value; RMS: root mean square; VDV: vibration dose value; VEI: vibration emission index; VTV: vibration total value; WBV: whole-body vibration.

Self-Reported Compliance With Personal Preventive Measures Among Chinese Factory Workers at the Beginning of Work Resumption Following the COVID-19 Outbreak: Cross-Sectional Survey Study

BACKGROUND

Maintaining compliance with personal preventive measures is important to achieve a balance of COVID-19 pandemic control and work resumption.

OBJECTIVE

The aim of this study was to investigate self-reported compliance with four personal measures to prevent COVID-19 among a sample of factory workers in Shenzhen, China, at the beginning of work resumption in China following the COVID-19 outbreak. These preventive measures included consistent wearing of face masks in public spaces (the workplace and other public settings); sanitizing hands using soap, liquid soap, or alcohol-based hand sanitizer after returning from public spaces or touching public installations and equipment; avoiding social and meal gatherings; and avoiding crowded places.

METHODS

The participants were adult factory workers who had resumed work in Shenzhen, China. A stratified two-stage cluster sampling design was used. We randomly selected 14 factories that had resumed work. All full-time employees aged ≥18 years who had resumed work in these factories were invited to complete a web-based survey. Out of 4158 workers who had resumed work in these factories, 3035 (73.0%) completed the web-based survey from March 1 to 14, 2020. Multilevel logistic regression models were fitted.

RESULTS

Among the 3035 participants, 2938 (96.8%) and 2996 (98.7%) reported always wearing a face mask in the workplace and in other public settings, respectively, in the past month. However, frequencies of self-reported sanitizing hands (2152/3035, 70.9%), avoiding social and meal gatherings (2225/3035, 73.3%), and avoiding crowded places (1997/3035, 65.8%) were relatively low. At the individual level, knowledge about COVID-19 (adjusted odds ratios [AORs] from 1.16, CI 1.10-1.24, to 1.29, CI 1.21-1.37), perceived risk (AORs from 0.58, CI 0.50-0.68, to 0.85, CI 0.72-0.99) and severity (AOR 1.05, CI 1.01-1.09, and AOR 1.07, CI 1.03-1.11) of COVID-19, perceived effectiveness of preventive measures by the individual (AORs from 1.05, CI 1.00-1.10, to 1.09, CI 1.04-1.13), organization (AOR 1.30, CI 1.20-1.41), and government (AORs from 1.14, CI 1.04-1.25, to 1.21, CI 1.02-1.42), perceived preparedness for a potential outbreak after work resumption (AORs from 1.10, CI 1.00-1.21, to 1.50, CI 1.36-1.64), and depressive symptoms (AORs from 0.93, CI 0.91-0.94, to 0.96, CI 0.92-0.99) were associated with self-reported compliance with at least one personal preventive measure. At the interpersonal level, exposure to COVID-19-specific information through official media channels (AOR 1.08, CI 1.04-1.11) and face-to-face communication (AOR 0.90, CI 0.83-0.98) were associated with self-reported sanitizing of hands. The number of preventive measures implemented in the workplace was positively associated with self-reported compliance with all four preventive measures (AORs from 1.30, CI 1.08-1.57, to 1.63, CI 1.45-1.84).

CONCLUSIONS

Measures are needed to strengthen hand hygiene and physical distancing among factory workers to reduce transmission following work resumption. Future programs in workplaces should address these factors at multiple levels.

Proposed Modifications in the 6-Minute Walk Test for Potential Application in Patients With Mild COVID-19: A Step to Optimize Triage Guidelines

Supplemental Digital Content is available in the text.

COVID-19 in the UK and Occupational Health and Safety: Predictable not Inevitable Failures by Government, and Trade Union and Nongovernmental Organization Responses

This commentary examines the occupational health and safety issues faced by the UK workers in the COVID-19 pandemic, against the background of government cuts in health care and in occupational health and safety budgets, and a deregulatory climate. The UK government has been obsessed, blinkered, and distracted by the desire to leave the European Union (Brexit). The state of knowledge about the virus, especially from international agencies that identified pandemic threats and strategies to combat it, is outlined. UK politicians, government bodies, medical and scientific advisors, and employers periodically ignored or abused that knowledge. Regulatory and ministerial inaction and errors on the workplace virus risks emerged. In contrast, several trade unions, health professional bodies, and nongovernmental organizations identified COVID-19 threats from poor personal protection equipment, working practices, and knowledge gaps and offered solutions for health care workers, social care workers, production workers, and service workers in "essential" occupations.

Reduction of Contagion Risks by SARS-Cov-2 (COVID-19) in Air-Conditioned Work Environments

BACKGROUND

The coronavirus emergency obliged Italy's government to stop production and trade activities to limit the =risk of contagion. Italy will restart activities in a few days and some security measures will have to be taken to limit the risks of spreading the virus as much as possible.

OBJECTIVE

This work summarizes the rules that are to be adopted for the reduction of the risks of SARS-CoV-2 infection with particular regard to the air conditioning systems in working environments, the sources of risk, and possible risk reduction measures.

RESULTS

Ducted air systems are of great importance, widespread, and often overlooked in risk assessment. Scientific evidence has shown that air conditioning systems can be both an infection risk reducer and, if misused, a multiplier of infection possibility.

LIMITATIONS

A narrative review with paucity of literature.

[System and human resources for occupational health in the republic of the Philippines: Management of occupational health activities at overseas workplaces for Japanese enterprises]

OBJECTIVES

This study aimed to consider the appropriate occupational health system for Japanese enterprises in the Philippines based on information on the regulations and development of specialists.

METHODS

We collected information using an information-gathering checklist. Along with literature and internet surveys, we conducted interviews by visiting local business sites, central government agencies in charge of medical and health issues, and educational institutions with specialized occupational physician training curricula.

RESULTS

Occupational health administration in the Philippines is managed by the Department of Labor and Employment, which issues the Occupational Safety and Health Standards that specify the legal requirements for occupational health. A new law(Republic Act 11058),enacted in 2018 to strengthen the Occupational Safety and Health Standards, has newly established a penalty provision in case of violations. Professional personnel responsible for occupational health are grouped as safety officers and occupational health personnel, including occupational physicians and occupational nurses; training is conducted at the Occupational Safety and Health Center of the Department of Labor and Employment and educational institutions. The basic medical insurance system and the workers' compensation system are operated by the Philippine Health Insurance Corporation and Social Security Committee, respectively, both of which are government agencies.

CONCLUSIONS

We confirmed that occupational health activities in the Philippines are based on government regulations, namely, the Occupational Safety and Health Standards. In addition, the enactment of a new law calls for strict compliance with corporate occupational health activities. To manage proper occupational health activities at overseas workplaces, Japanese corporations should clarify corporate-wide policies and support local employers in complying with regulations and utilizing highly specialized personnel.

COVID-19 Autopsy. Electronic address: anapat.hrc@salud.madrid.org. The first COVID-19 autopsy in Spain performed during the early stages of the pandemic

We describe the implementation of a COVID-19 Autopsy Programme in our Hospital, report the main findings from the first autopsy of the programme and briefly review the reports of lung pathology of these patients.

Factors associated with physical injury or police involvement during incidents of workplace violence in hospitals: Findings from the first year of California's new standard

BACKGROUND

Workplace violence in healthcare settings is known to be a costly and often underreported problem. In California, hospitals are required to report incidents of violence towards workers to the California Occupational Safety and Health Administration (CalOSHA) using an online reporting system that went into effect in 2017.

METHODS

Reports submitted to CalOSHA from July 2017 to September 2018 pursuant to this new requirement were analyzed using descriptive methods and logistic regression.

RESULTS

Four hundred eight hospitals submitted reports using the new incident reporting system. Behavioral health units had 1.82 times the odds of the reported incident resulting in physical injury compared to inpatient medical units, and investor-owned facilities had 2.43 times the odds of the reported incident resulting in physical injury compared to city or county-owned facilities. Inpatient and behavioral health units had significantly reduced odds of a reported incident resulting in police involvement when compared to other locations within the hospital.

CONCLUSIONS

These findings indicate that protections for healthcare workers deserve ongoing attention from stakeholders and legislators and provide insight into how healthcare facilities report incidents of violence towards workers.

Fetal Diagnosis and Therapy during the COVID-19 Pandemic: Guidance on Behalf of the International Fetal Medicine and Surgery Society

The COVID-19 pandemic has stressed patients and healthcare givers alike and challenged our practice of antenatal care, including fetal diagnosis and therapy. This document aims to review relevant recent information to allow us to optimize prenatal care delivery. We discuss potential modifications to obstetric management and fetal procedures in SARS-CoV2-negative and SARS-CoV2-positive patients with fetal anomalies or disorders. Most fetal therapies are time sensitive and cannot be delayed. If personnel and resources are available, we should continue to offer procedures of proven benefit, acknowledging any fetal and maternal risks, including those to health care workers. There is, to date, minimal, unconfirmed evidence of spontaneous vertical transmission, though it may theoretically be increased with some procedures. Knowing a mother's preoperative SARS-CoV-2 status would enable us to avoid or defer certain procedures while she is contagious and to protect health care workers appropriately. Some fetal conditions may alternatively be managed neonatally. Counseling regarding fetal interventions which have a possibility of additional intra- or postoperative morbidity must be performed in the context of local resource availability. Procedures of unproven benefit should not be offered. We encourage participation in registries and trials that may help us to understand the impact of COVID-19 on pregnant women, their fetuses, and neonates.

Knowledge transfer for occupational health and safety: Cultivating health and safety learning culture in construction firms

Within the last decades the incidence of workspace injuries and fatalities in the UK construction industry has declined markedly following the developments in occupational health and safety (OHS) management systems. However, safety statistics have reached a plateau and actions for further improvement of OHS management systems are called for. OHS is a form of organizational expertise that has both tacit and explicit dimensions and is situated in the ongoing practices. There is a need for institutionalization and for the transfer of knowledge across and along construction supply chains to reduce OHS risks and facilitate cultural change. The focus of this article is the factors that facilitate OHS knowledge transfer in and between organizations involved in construction projects. An interpretative methodology is used in this research to embrace tacit aspects of knowledge transfer and application. Thematic analysis is supported by a cognitive mapping technique that allows understanding of interrelationships among the concepts expressed by the respondents. This paper demonstrates inconsistency in OHS practices in construction organizations and highlights the importance of cultivating a positive safety culture to encourage transfer of lessons learnt from good practices, incidents, near misses and failures between projects, from projects to programmes and across supply chains. Governmental health and safety regulations, norms and guidelines do not include all possible safety issues specific to different working environments and tied to work contexts. The OHS system should encourage employees to report near misses, incidents and failures in a 'no-blame' context and to take appropriate actions. This research provides foundation for construction project practitioners to adopt more socially oriented approaches towards promoting learning-rich organizational contexts to overcome variation in the OHS and move beyond the current plateau reached in safety statistics.

The Occupational Safety and Health Administration at 50: Protecting Workers in a Changing Economy

The passage of the Occupational Safety and Health Act of 1970 brought unprecedented changes in US workplaces, and the activities of the Occupational Safety and Health Administration (OSHA) have contributed to a significant reduction in work-related deaths, injuries, and illnesses. Despite this, millions of workers are injured annually, and thousands killed.To reduce the toll, OSHA needs greater resources, a new standard-setting process, increased civil and criminal penalties, full coverage for all workers, and stronger whistleblower protections. Workers should not be injured or made sick by their jobs. To eliminate work injuries and illnesses, we must remake and modernize OSHA and restructure the relationship of employers and workers with the agency and each other.This includes changing the expectation of what employers must do to protect workers and implementing a requirement that firms have a "duty of care" to protect all people who may be harmed by their activities. Only by making major changes can we ensure that every worker leaves work as healthy as they were when their work shift began.