Personal Protective Equipment in COVID-19: Impacts on Health Performance, Work-Related Injuries, and Measures for Prevention

OBJECTIVE

To assess impact of personal protective equipment (PPE) on healthcare providers (HCPs) in caring for COVID-19 patients.

METHODS

A cross-sectional survey was conducted over 50 hospitals in China. Descriptive analyses and Chi-square tests were performed on the collected data.

RESULTS

All 104 frontline HCPs report negative impacts of PPE on their clinical performance, 97% of them experienced discomfort and injuries caused by wearing PPE for long hours. Frontline HCPs provided suggestions to alleviate the negative impacts and to enhance communication between healthcare staff and patients. Two hundred eighty two non-frontline HCPs also revealed similar problems; however, we recorded a few discrepancies between answers given by frontline and non-frontline HCPs.

CONCLUSIONS

Wearing PPE for long hours degrades health performance. Measures were suggested to improve the design of PPE for protecting HCPs and enhancing their services to COVID patients.

A call for Applied Knowledge and Lived Interdisciplinarity in the medical care of depressed employees: a cross-sectional survey with German occupational physicians and psychotherapists

OBJECTIVES

To identify approaches for an effective patient-centred care of depressed employees, we investigated occupational physicians' (OPs) and psychotherapists' (PTs) knowledge about job stressors on the development of depression, application of this knowledge, interdisciplinary cooperation and perceived barriers.

STUDY DESIGN

A cross-sectional online survey.

PARTICIPANTS

OPs (163; 48.5% male) and PTs (69; 43.5% male) providing complete data on the survey out of 257 OPs and 112 PTs who started the survey. There have been 458 (OPs) and 821 (PTs) initial clicks.

METHODS

Main outcome measures were the importance ratings of specific job stressors, the frequency of asking patients about those stressors, the need for interdisciplinary cooperation, as well as perceived barriers for cooperation. We performed multivariate analysis of variance, intraclass correlation coefficients (ICCs) and Spearman's rank-order correlations.

RESULTS

The achieved response rate for OPs was 56.1% and for PTs 13.6%. Both disciplines agreed on the importance of job stressors regarding depression (ICC=0.90; 95% CI: 0.54 to 0.98), but both ranked these factors differently from the current state of research. As to knowledge application, OPs showed positive associations between the importance of job stressors and the frequency of asking employees about them (eg, job insecurity (r_s=0.20, p=0.005)) and PTs for social stressors (eg, interpersonal conflicts (r_s=0.38, p=0.001)). OPs (mean=3.41) reported a higher necessity of interdisciplinary cooperation than PTs (mean=3.17; F(1,230)=7.02, p=0.009). Furthermore, cooperation was reported as difficult to implement. PTs perceived barriers (eg, time restriction) as more hindering (mean=3.2) than OPs (mean=2.8; F(1,171)=8.16, p=0.005).

CONCLUSIONS

Both disciplines are aware of the relevance of job stressors as risk factors for depression, but should be encouraged to ask employees more frequently about them. The need for interdisciplinary cooperation and possible barriers are discussed. It is crucial to emphasise the meaning of sufficient cooperation, since closing this gap for improving patient-centred care especially for employees suffering from depression is necessary.

Factors associated with adherence to recommendations to visit a physician after annual health checkups among Japanese employees: a cross-sectional observational study

Periodic health checkups constitute an important public health strategy to prevent the onset of diseases and promote healthy behaviors. However, adherence to recommendations to undergo further medical examination after annual health checkups is not necessarily high. This study examined the factors related to adherence to recommendations among Japanese employees. We conducted a cross-sectional study of 219 employees who had ignored recommendations to visit a physician for the previous 3 yr; we assessed their work- and life-related factors, health status, and health literacy. We analyzed the data of 103 employees who met the inclusion criteria. Participants who lived alone and had a primary doctor, lower job demand, and lower self-rated health were significantly more likely to adhere to recommendations, suggesting that work- and life-related factors-rather than individual health literacy-may be more important. Further study is needed toward effective utilization of annual health checkups in the workplace.

Practice patterns of occupational medicine physicians in Canada

The objectives of this survey were to identify the practice patterns of Canadian physicians working in the field of occupational medicine and to determine whether the type of certification influences the nature of the work they perform in the field. An Internet-based survey was conducted in September 2015 of members of the Occupational and Environmental Medicine Association of Canada. Eighty-six Canadian-based occupational medicine physicians completed the survey (response rate 36%). These physicians performed a wide variety of tasks (12 ± 6), with few spending most of their time doing a single task. The most frequently performed tasks were fitness-to-work (78%) and return-to-work evaluations (78%). Specialty-trained physicians were more likely to be involved in teaching and research and less likely to be involved in a variety of ability-to-work evaluations.

Awareness of Medical Fitness to Drive Guidelines among Occupational Physicians and Psychiatrists

Irrespective of national guidelines for medical fitness to drive, this study investigated the cumulative expert wisdom of clinicians regarding minimum periods of driving cessation required for patients suffering from conditions that can impair driver capability. Occupational Physicians (196) and Psychiatrists (103) completed an online questionnaire. For private motorists, the modal response for anxiety and depression favoured clinical discretion, followed by three month cessations for hypomania, acute psychosis, schizophrenia and alcohol dependence and six weeks for alcohol misuse/dependence. For professional drivers the modal value for anxiety and depression was three months, rising to six months for hypomania, psychosis and schizophrenia and 12 months for both alcohol misuse/dependence. Chi-square test results indicated statistically significant differences in clinical opinion between Occupational Physicians and Psychiatrists regarding driving cessation times for drivers suffering from psychiatric and alcohol misuse conditions except for alcohol dependence. Further studies are warranted to investigate these issues in more depth.

[The INAIL contribution to gender medicine through analysis of the accidents at work and occupational diseases data.]

OBJECTIVES

The gender mainstreaming is important from the different repercussions that diseases can cause in women rather than in men.

METHODS

For several years, Inail has been involved in the collection of accidents at work and occupational diseases data, having regard to the gender difference. In this contest statistical data on accidents at work and occupational diseases reported to Inail in the last five years in the Inail Statistical Database have been analyze.

A Dimensionally Reduced Clustering Methodology for Heterogeneous Occupational Medicine Data Mining

Clustering is a set of techniques of the statistical learning aimed at finding structures of heterogeneous partitions grouping homogenous data called clusters. There are several fields in which clustering was successfully applied, such as medicine, biology, finance, economics, etc. In this paper, we introduce the notion of clustering in multifactorial data analysis problems. A case study is conducted for an occupational medicine problem with the purpose of analyzing patterns in a population of 813 individuals. To reduce the data set dimensionality, we base our approach on the Principal Component Analysis (PCA), which is the statistical tool most commonly used in factorial analysis. However, the problems in nature, especially in medicine, are often based on heterogeneous-type qualitative-quantitative measurements, whereas PCA only processes quantitative ones. Besides, qualitative data are originally unobservable quantitative responses that are usually binary-coded. Hence, we propose a new set of strategies allowing to simultaneously handle quantitative and qualitative data. The principle of this approach is to perform a projection of the qualitative variables on the subspaces spanned by quantitative ones. Subsequently, an optimal model is allocated to the resulting PCA-regressed subspaces.

Interventions to increase the reporting of occupational diseases by physicians

BACKGROUND

Under-reporting of occupational diseases is an important issue worldwide. The collection of reliable data is essential for public health officials to plan intervention programmes to prevent occupational diseases. Little is known about the effects of interventions for increasing the reporting of occupational diseases.

OBJECTIVES

To evaluate the effects of interventions aimed at increasing the reporting of occupational diseases by physicians.

SEARCH METHODS

We searched the Cochrane Occupational Safety and Health Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, OSH UPDATE, Database of Abstracts of Reviews of Effects (DARE), OpenSIGLE, and Health Evidence until January 2015.We also checked reference lists of relevant articles and contacted study authors to identify additional published, unpublished, and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-RCTs (cRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) of the effects of increasing the reporting of occupational diseases by physicians. The primary outcome was the reporting of occupational diseases measured as the number of physicians reporting or as the rate of reporting occupational diseases.

DATA COLLECTION AND ANALYSIS

Pairs of authors independently assessed study eligibility and risk of bias and extracted data. We expressed intervention effects as risk ratios or rate ratios. We combined the results of similar studies in a meta-analysis. We assessed the overall quality of evidence for each combination of intervention and outcome using the GRADE approach.

MAIN RESULTS

We included seven RCTs and five CBA studies. Six studies evaluated the effectiveness of educational materials alone, one study evaluated educational meetings, four studies evaluated a combination of the two, and one study evaluated a multifaceted educational campaign for increasing the reporting of occupational diseases by physicians. We judged all the included studies to have a high risk of bias.We did not find any studies evaluating the effectiveness of Internet-based interventions or interventions on procedures or techniques of reporting, or the use of financial incentives. Moreover, we did not find any studies evaluating large-scale interventions like the introduction of new laws, existing or new specific disease registries, newly established occupational health services, or surveillance systems. Educational materialsWe found moderate-quality evidence that the use of educational materials did not considerably increase the number of physicians reporting occupational diseases compared to no intervention (risk ratio of 1.11, 95% confidence interval (CI) 0.74 to 1.67). We also found moderate-quality evidence showing that sending a reminder message of a legal obligation to report increased the number of physicians reporting occupational diseases (risk ratio of 1.32, 95% CI 1.05 to 1.66) when compared to a reminder message about the benefits of reporting.We found low-quality evidence that the use of educational materials did not considerably increase the rate of reporting when compared to no intervention. Educational materials plus meetingsWe found moderate-quality evidence that the use of educational materials combined with meetings did not considerably increase the number of physicians reporting when compared to no intervention (risk ratio of 1.22, 95% CI 0.83 to 1.81).We found low-quality evidence that educational materials plus meetings did not considerably increase the rate of reporting when compared to no intervention (rate ratio of 0.77, 95% CI 0.42 to 1.41). Educational meetingsWe found very low-quality evidence showing that educational meetings increased the number of physicians reporting occupational diseases (risk ratio at baseline: 0.82, 95% CI 0.47 to 1.41 and at follow-up: 1.74, 95% CI 1.11 to 2.74) when compared to no intervention.We found very low-quality evidence that educational meetings did not considerably increase the rate of reporting occupational diseases when compared to no intervention (rate ratio at baseline: 1.57, 95% CI 1.22 to 2.02 and at follow-up: 1.92, 95% CI 1.48 to 2.47). Educational campaignWe found very low-quality evidence showing that the use of an educational campaign increased the number of physicians reporting occupational diseases when compared to no intervention (risk ratio at baseline: 0.53, 95% CI 0.19 to 1.50 and at follow-up: 11.59, 95% CI 5.97 to 22.49).

AUTHORS' CONCLUSIONS

We found 12 studies to include in this review. They provide evidence ranging from very low to moderate quality showing that educational materials, educational meetings, or a combination of the two do not considerably increase the reporting of occupational diseases. The use of a reminder message on the legal obligation to report might provide some positive results. We need high-quality RCTs to corroborate these findings.Future studies should investigate the effects of large-scale interventions like legislation, existing or new disease-specific registries, newly established occupational health services, or surveillance systems. When randomisation or the identification of a control group is impractical, these large-scale interventions should be evaluated using an interrupted time-series design.We also need studies assessing online reporting and interventions aimed at simplifying procedures or techniques of reporting and the use of financial incentives.

[Methods of risk assessment and their validation]

The review of the literature data shows several methods for the the risks assessment of biomnechanical overload of the musculoskeletal system in activities with repetitive strain of the upper limbs and manual material handling. The application of these methods should allow the quantification ofriskfor the working population, the identification of the preventive measures to reduce the risk and their effectiveness and thle design of a specific health surveillance scheme. In this paper we analyze the factors which must be taken into account in Occupational Medicine to implement a process of validation of these methods. In conclusion we believe it will necessary in the future the availability of new methods able to analyze and reduce the risk already in the design phase of the production process.

[Acute alcohol poisonings among patients in Toxicology Unit, Nofer Institute of Occupational Medicine in the period of time 2007-2012]

The purpose of the research was to present the analysis of acute alcohol poisonings (ethanol, methanol, ethylene glycol, isopropanol) in Toxicology Unit (TU), Nofer Institute of Occupational Medicine (NIOM), Lódź, Poland.

MATERIALS AND METHODS

To further analysis were chosen all cases, whose were coded according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision.

RESULTS

There were 10,936 acute poisonings in the analyzed period of time 2007-2012 years, 3,088 of them referred to alcohol poisonings (28%). The largest group of patients included cases with ethanol intoxication (2,883 subjects), the second and third one-cases with methanol and ethylene glycol poisonings (99 and 98 respectively), 8 cases were poisoned with isopropanol. The largest group of patients includes cases at age less than 30 years. Patients at age above 60 years formed the lowest group among the total number of poisonings. Most of the admitted cases were men (2,417 patients) and cases hospitalized due to ethanol abuseladdiction (93%). Ethylene glycol poisonings constituted the leading cause of deaths (10 subjects).

CONCLUSIONS

The study shows, that intoxications with alcohols are a big problem in NIOM and the number of alcohol poisonings markedly increased in the years 2007-2012.

[Collaboration between occupational physicians and other specialists including insurance physicians]

Collaboration between various stakeholders is essential for a well-operating vocational rehabilitation process. Researchers have mentioned, among other players, insurance physicians, the curative sector and employers. In 2011 the WHO organised the congress "Connecting Health and Labour: What role for occupational health in primary care". The congress was also attended by representatives of the WONCA (World Organisations of Family Medicine). In general, everyone agreed that occupational health aspects should continue to be seen as an integral part of primary health care. However, it is not easy to find literature on this subject. For this reason we conducted a review. We searched for literature relating to collaboration with occupational physicians in Dutch, English and German between 2001 and autumn 2011. Our attention focused on cooperation with specialists and insurance physicians. Therefore, we searched PUBMED using MeSH terms and made use of the database from the "Tijdschrift voor bedrijfs- en verzekeringsgeneeskunde (TBV) [Dutch Journal for Occupational - and Insurance Medicine]". We also checked the database from the "Deutsches Arzteblatt [German Medical Journal]" and made use of the online catalogue from THIEME - eJOURNALS. Last but not least, I used the online catalogue from the German paper "Arbeits -, Sozial -, Umweltmedizin [Occupational -, Social -, Milieu Medicine]". Additionally, we made use of the "snowball - method" to find relevant literature. We found many references to this subject. The Netherlands in particular has done a lot of research in this field. However, there is little research on the cooperation between occupational physicians and specialists; in particular insurance physicians. This is interesting, because several authors have mentioned its importance. However, cooperation with other specialists seems not to be the norm. Therefore, cooperation between curative physicians (specialists but also family doctors), insurance physicians and other stakeholders is essential and should be improved. In the future researchers should develop techniques, which help to improve collabora- tion. For example, Dutch investigators advocate the development of guidelines. There is agreement that collaboration between occupational physicians and some other specialists is important. In particular, collaboration between specialists in physical medicine has been investigated. Also, curative physicians and insurance physicians have an important role in disability management. So all stakeholders should work together more intensively. However, literature is difficult to find and not often part of international literature. This must change urgently.

[Acute novel drugs poisoning among patients of Nofer Institute of Occupational Medicine in Lodz, Toxicology Unit, hospitalized in the years 2008-2012--epidemiology, clinical state]

Intoxication with novel recreational drugs poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications.

OBJECTIVES

Description of clinical pattern novel drug intoxication.

METHODS

retrospective review of medical records patients hospitalized in the Toxicology Unit (TU) with diagnosis of intoxication with novel recreational drugs.

RESULTS

During the period from 2008-2010--431 patients were admitted to TU with mentioned above diagnosis. 159 (36.9%) patients were positive for ethanol with its average concentration in blood 150 mg%. Presence of other substances like amphetamine, cannabinoids, atropine, ephedrine, carbamazepine, benzodiazepines and dextrometorphan was confirmed. The most frequent clinical symptoms observed on admission were: anxiety, agitation, complaints associated with circulatory system and vertigo Average pulse rate and both: diastolic and systolic pressure were within normal limits, however authors noted slight tendency toward tachycardia. One patients died due to multiorgan failure. Average period of hospitalization amounted 2.24 days. Co-poisoning with ethanol was associated with higher frequency of circulatory system disturbances.

RESULTS

Clinical pattern of poisoning with novel drugs could partially correspond with mild sympathomime. tic syndrome.

[Evaluation of professional training of occupational medical personnel in Latvia]

System of training for occupational health and safety experts and occupational physicians has been analyzed in comparison with one of the most reliable occupational health and safety indicators--occupational diseases level and its changes during 1981-2010. Increased number of occupational diseases has been registered since 1996, reaching maximum in 2009 with 138.6 cases of occupational diseases per 100 000 employees.

[Investigation of the allocation of equipment among the major research agencies for occupational health and medicine]

OBJECTIVE

To understand the allocation of instruments and equipment in major research institutions for occupational health and medicine in China.

METHODS

Questionnaire was designed for collecting the information of the equipment used in occupational health and medicine research. Questionnaires were distributed to 78 research agencies to investigate the situation of allocation of instrument and equipment.

RESULTS

There was a great diversity of allocation in investigated agencies. The features in three kinds of agencies are different. The occupational health agencies in universities fit out the biological equipment in laboratories. The occupational health laboratories in CDCs were equipped with the chemical analytical devices. The institutes of occupational medicine were equipped with the clinical inspection instruments.

CONCLUSION

The protocol of sharing resource and predominance complementation should be established among research institutions for occupational health and medicine in the same region or neighboring provinces.

[On health protection for workers in Permsky area]

The article covers analysis of regional parameters of occupational and industrially mediated morbidity, economic and organizational aspects of workers' health protection. The authors justified measures to industrial medicine system implementation.

[Relations between the occupational physician and the general practitioner]

The occupational physician (OP) and the general practitioner (GP) both aim at maintaining and promoting public health. The attending physician is the physician who has been freely chosen by the patient whilst the occupational physician is assigned by the company. Although synergy between both professions might seem obvious, in reality it is not always so. The focus of the occupational physician's work is on the worker in his work place. Through health monitoring action and knowledge of jobs and positions, the occupational physician aims to contribute to the improvement of well-being at work. Medical examinations result in drafting a form stating the person's ability or inability to occupy his/her assigned job. In line with the required respect for the patient's rights and, hence, with his/her authorization, the GP may transmit the medical information the said GP deems useful to the OP, e.g. back-to-work medical examinations and pre-back-to-work medical consultations are opportunities to establish a contact between both practitioners in view of considering the possibilities of adapting the workplace situation at the time of resumption of work. The GP should know that there exists an appeal opportunity with the Office in charge of Monitoring Well-being at Work (Employment Federal Public Service) against a decision that by which the worker is not allowed to stay in his assigned work task. During the medical examinations the OP may endorse the action of the GP by strengthening the worker/patient's awareness of the fact that his/her health problems must be adequately taken into account and by organizing information sessions about general interest campaigns about, for instance, cardiovascular risk prevention or a campaign about quitting smoking or reducing alcohol consumption to a more sensible and reasonable level. Knowledge of delayed effects of professional exposure should be consolidated in GPs; the possibility of drawing attention to one's suspicions about occupational illnesses to the Fund for Occupational Illnesses must also again brought to mind. In order to establish a follow-up program on the health of patients beyond their professional activity, it is necessary to draft a "liaison document", between the OP and the GP, which identifies the professional risks workers/patients have been exposed to. In sum, it is important to provide GPs with means to identify the patient's OP and consolidate their knowledge of occupational medicine by organizing on-going training modules.

[Opportunities for professional career in the opinion of occupational medicine physicians]

BACKGROUND

The aim of the present study was to analyze the opinion of physicians, specialists in the field of occupational medicine, about their opportunities for professional career understood in terms of promotion to more responsible and better paid posts, when meeting the relevant criteria and requirements.

MATERIAL AND METHODS

The study was conducted in a group of Polish occupational medicine physicians (a questionnaire was mailed to the randomized, nationwide sample of 813 subjects, response rate, 35.4%).

RESULTS

The opportunity for professional career in the field of occupational medicine was assumed by 66% of respondents, while in other sections of the health care system by only 42%. These opportunities are seen as positively influenced mainly by individual factors relevant to personal traits, e.g., knowledge and abilities, organizational and managerial skills, and negatively influenced or even prevented by macrosocial factors, such as low prestige and limited demand for this specialty, specificity of the workplace and the kind of work. In the opinion of the respondents, their opportunities for professional career are also unfavorably influenced by a possible granting physicians without occupational medicine specialty responsibilties equal to those, which should be reserved to physicians who possess this specialty.

CONCLUSION

The majority of respondents consider that limited opportunities for professional career, more frequently encountered in the field of occupational medicine than in other areas of health care, do not encourage and seem to be beneficial enough to undertake and complete the specialization in occupational medicine.

[Occupational medicine physicians on their speciality. Conceptual framework of a research project and characteristics of population under study]

BACKGROUND

The paper presents conceptual assumptions and objectives of the research project on self-assessed usefulness of competencies acquired by physicians during postgraduate specialist training in occupational medicine, research methods, characteristics of the study population and the analyzed relationships between social and demographic variables.

MATERIAL AND METHODS

In 2006, the field study was carried out in a randomly drawn group of 813 occupational/industrial medicine physicians who completed specialization training in different training centers and 15 experts (directors of voivodeship centers of occupational medicine and specialization tutors). Two research methods were employed, a questionnaire mailed to physicians and interviews held with experts.

RESULTS

The group of respondents was moderately feminized (57% of women) and characterized by relatively high mean age (55 years); 50% of respondents completed their specialization before and 50% after 1990; 48% completed it in institutes of occupational medicine in Łódź and Sosnowiec and 52% in other centers; 62% are employed in non-public health care institutions and 58% run private practice; 55% are employed in more than one place.

CONCLUSIONS

The analysis of relationships between social and demographic variables shows that the gender influences the place of specialization to some degree, the period of specialization, kind and number of workplaces to a higher degree, but does not influence holding a managerial position. The age considerably differentiates the place of specialization and the number of workplaces. There is some relationship between the number of workplaces and holding a managerial post on the one hand and place of specialization on the other.

[Occupational medicine physicians: acceptance of the professional role and motives for the choice of specialization]

BACKGROUND

The professional role of the physician embraces a relatively permanent and internally coherent system of behaviors perceived as the reaction of other people to expectations and actions related to health problems. Performing this role is the main source of income, social status and prestige. It should be stressed that the role of specialist in occupational medicine differs from that of specialists in other disciplines. Its distinctive feature is that it is not oriented towards treatment, but towards prevention.

MATERIAL AND METHODS

The study was carried out in 2006, using a questionnaire mailed to a random sample of 820 specialists in occupational medicine or industrial medicine (response rate, 35%) and conducting free interviews with 15 experts.

RESULTS

The positive response to the question whether he or she would choose again the specialization in occupational medicine was an indicator of the acceptance of the assumed professional role. The results of the survey showed that 76% of respondents were positive and only 19% would have chosen another specialization. The responses to this question were diversified by the socio-demographic factors. On the basis of this diversification two profiles were constructed, favorable and unfavorable for the acceptance of the choice made in the past. Lack of work satisfaction, poor opportunities for professional advancement, and limited financial profits were reported as the major reasons for choosing other specialization than occupational medicine. The most frequently reported motives for choosing specialization in occupational medicine were the need to meet the requirements of the occupied position, the interest in this branch of knowledge and professional skills. It was also indicated that the acceptance of the role performed by the occupational medicine physician was strongly associated with the above mentioned motives and the expected financial profits.

CONCLUSIONS

The majority of specialists in occupational medicine are satisfied with the choice of their specialization. Their choice was mostly inspired by autotelic (interests) and instrumental (financial profits and meeting the job requirements) motives.

Work activity analysis of Finnish occupational health professionals

BACKGROUND

Some Finnish studies have dealt with how occupational health nurses divide their working hours but other occupational health professionals have not been evaluated.

AIMS

This study describes how occupational health professionals allocate their working hours between main tasks.

METHODS

Questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms. The data were analysed by using frequencies, means and one-way analysis of variance test.

RESULTS

Employee-oriented tasks accounted for roughly 50% of working hours from all occupational health professionals. The remaining working hours were shared between workplace visits, co-operation with partners, other occupational health care responsibilities and tasks in other health care fields, especially in the health care centres. These working hours varied greatly between the different occupational health professional groups. All units employed full-time occupational health nurses, but the services of physicians, physiotherapists and psychologists were usually provided part-time or even restricted to a few hours each week because these services were difficult to obtain. Occupational health nurses working in the municipal health care centres spent more time on workplace visits than other nurses. Employee-oriented tasks were emphasized more in physicians', physiotherapists' and psychologists' work, especially in private medical health care units and in the jointly owned health care units.

CONCLUSIONS

The amount of time occupational health professionals are able to spend on workplace activities appears to be determined by the type of their employer.

Measures for achieving recruits' enhanced fitness--a transversal study

Because of 10.94% frequency in obese recruits in Rijeka in 2005 occupational medicine decided to study causality of that and other most frequent diagnoses: pedes plani, myopia and astigmatism, kyphosis and scoliosis, asthma, hypertension and branch block. Double monitoring of 1,311 recruits was carried out by a transversal study during 2005, 2000 and 1995 and within each year according to location: city, suburbs, islands. The differences in the three periods in the city were obesity (p < 0.05) with highest frequency in 2005, asthenia (p < 0.05) with lowest frequency 0.99% in 2005, and pedes plani (p < 0.05) with highest frequency in 1995. Suburbs showed (p < 0.05) forpedes plani, p = 0.054 for obesity, and the islands obesity (p < 0.05). Myopia and astigmatism frequency went up to 25%, kyphosis to 14.13% and asthma to 5.43%. Hypertension frequency was negligible. Occupational medicine decided to react by measures increasing recruit fitness cooperating with school medicine, teachers and parents, by check-ups, corrections, dieting and physical activities.

Zur Problematik der Implementierung des betrieblichen Eingliederungsmanagements in kleinen und mittleren Unternehmen

At company level responsibility increases for the employment of workers with health-related problems or disabilities, but realisation in small and medium-sized enterprises (SME) is lacking. Therefore a model is developed based on theory and a survey.

SITUATION

Minimum requirements for "betriebliches Eingliederungsmanagement" (integration management at company level) according to section 84 (2) SGB IX Book 9 of the German Social Code, the main products of the international movement "disability management", a description of roles for realisation and the main sources of employers' support are described. Although external supporting of SMEs is unquestioned, it is expensive and retards own initiative and own activity counting solely on this.

HYPOTHESIS

Only by developing a minimum of SME's awareness, acceptance and competence, this will open up to (currently suboptimal) external support.

SURVEY

Goal is identifying SME managers' attitudes, activities, proposals and expectations referring integration management at company level to derive concepts of SME's support. 13 interviews are analysed by qualitative content analysis identifying the following barriers: information deficit, absence of priority, limited possibilities for transitional work, cost, partially limited workers' self-responsibility, illness as a "tabes" subject. Possibilities overcoming these barriers are delineated. On that basis a model is presented: pragmatically for realisation, a company contact person with minimum competence, uniform external support, institutional partners' integration and quality assurance according to disability management.

OUTLOOK

Interlocking SME world and social insurance world means first to support SME's awareness, acceptance and competence, second to create for SME a central contact in the "rehabilitation jungle" and third to develop SME-suitable premiums according to section 84 (3) SGB IX, Book 9 of the German social code.

Does enhanced information exchange between social insurance physicians and occupational physicians improve patient work resumption? A controlled intervention study

BACKGROUND

Patient work resumption after sickness absence varies even among patients with similar pathologies and characteristics. Explanations remain uncertain. One newly investigated field is "information asymmetry", a situation in which critical information is not appropriately exchanged between stakeholders in disability management. It is hypothesised that information asymmetry between social insurance physicians and occupational physicians prolongs sickness absence.

OBJECTIVES

To assess the influence of enhanced information exchange between these physicians on patient outcome.

METHODS

Non-randomised controlled intervention study. The setting was the work inability assessment consultation of social insurance physicians in Belgium. Inclusion criteria were: employee, age 18-50, and subacute (more than one month) sickness absence. The intervention was a structured information exchange (through the use of a communication form) between the patient's social insurance physician and occupational physician. The intervention started when the patient's sickness absence reached the subacute stage, and ended when the sickness absence benefit was ceased or the duration exceeded one year. The primary outcome measure was the sickness absence benefit status of the patient assessed one year after benefit onset.

RESULTS

Of the 1883 patients asked to enroll in the study, 1564 (84%) participated; 505 (32%) of 1564 patients were assigned to the intervention group and 1059 (68%) to the control group; 1553 (99%) of 1564 patients completed the study. In the intervention group, 86% received no sickness absence benefit at the end of the study, versus 84% in the control group (95% CI 0.91-1.15). No significant differences in other outcome parameters were obtained.

CONCLUSIONS

Information exchange between physicians may not be enough to influence work resumption among patients on sickness absence. Further research on stakeholders' information asymmetry and its effect on the outcome of patients are necessary. The complexity of information asymmetry in disability management cannot be underestimated.

Barriers to occupational and environmental medicine services in the southeastern United States

OBJECTIVES

We sought to determine whether low-income and minority populations in the Southeast face barriers to access to occupational and environmental medicine (OEM) services.

METHODS

Access to OEM services was defined as the presence of an OEM physician in a county or the proximity of a clinic in the Association of Occupational and Environmental Clinics network to a county.

RESULTS

Counties with higher percentages of low-income, all non-white minority, and African-American populations in South Carolina, Georgia, Alabama, and Mississippi were more likely to be farther away from an AOEC clinic. Counties with higher percentages of low-income populations were less likely to have an OEM physician. However, the percentages of minority and African-American populations in these counties were not associated with the presence of an OEM physician.

CONCLUSION

Both low-income and minority populations in the Southeast face barriers to OEM services.

Measurement of baseline shoulder function in subjects receiving workers' compensation versus noncompensated subjects

The purpose of this study was to ascertain whether a measurable difference existed in normative scores for the American Shoulder and Elbow Surgeons (ASES) questionnaire between subjects who had an active workers' compensation claim (WC) with no known shoulder injury and subjects without a compensation claim (non-WC). Subjects with non-shoulder-related orthopaedic injuries were recruited from a suburban orthopaedic sports medicine clinic and an urban occupational medicine clinic. They were asked to complete a composite questionnaire that consisted of demographic information and the ASES questionnaire. There were no significant differences in the ASES scores between subject groups. There were significant differences between subject groups with regard to work hours (P = .0001), work demands (P = .0001), and tobacco use (P = .0001). Subject group was also significantly associated with education level (P = .0001), marital status (P = .0001), work demands (P = .0001), gender (P = .0001), and sports participation (P = .0314). The ASES score was significantly affected by marital status (P = .0476), sports participation (P = .0008), and age (P = .0129).

[Human resources and activities in the occupational medicine service of Poland in 2003]

BACKGROUND

The presented paper shows the most essential data concerning the state of human resources and activities of occupational medicine services in Poland in 2003.

MATERIALS AND METHODS

The reports (around 10 000) obtained from primary occupational medicine service units and regional occupational medicine centers (forms: MZ-35A and MZ-35) are the source of information about human resources and occupational medicine services activities.

RESULTS

A majority of regional centers, due to their restructuring, have approached the legal and organizational model described in the Occupational Medicine Service Act. The assessment of activities of primary occupational medicine centres units, performed by regional occupational medicine centers, indicates the need for constant training of physicians authorized to perform prophylactic examinations of employees.

CONCLUSIONS

The year 2003 did not witness any new significant changes in the structure of occupational medicine service. One can speak rather about the continuation of trends observed in previous years.

Physician assistants in occupational medicine: how do they compare to occupational physicians?

BACKGROUND

Physician assistants (PAs) have been present in occupational and environmental medicine (OEM) in the USA since 1971, yet remarkably little is known about their activity.

METHODS

An administrative study of PA activities was undertaken and compared with the activities of physicians in the same occupational medicine setting. Patients were not triaged to either provider and all resources of care were recorded for the visit. An episode of care approach was used for the analysis.

RESULTS

The characteristics of patients seen by each provider were similar in age, gender ratio and severity of injury. Physicians saw a mean of 2.9 patients/h and PAs 2.5, but PAs worked more hours and saw more patients per year than physicians. The average charge per patient visit and total charge for an episode of care were similar. Differences between PAs and physicians were seen in the areas of 'limited duty' duration given to patients and on average PAs prescribed 15 days and physicians 17 days. PAs referred a patient 19.7% of the time, while physicians referred 17.4%. Most of the referrals were to physical therapy. The salary of a physician, based on an hourly rate, was approximately twice as much as a PA.

CONCLUSION

The use of PAs in OEM may represent a cost-effective advantage from an administrative standpoint. Clearly, more research is necessary in determining the role and utilization of PAs in OEM and how they may improve the delivery of physician services.

Nonfatal occupational injuries from slips, trips, and falls among older workers treated in hospital emergency departments, United States 1998

BACKGROUND

Falls are a leading cause of injury among older adults. As the workforce demographics shift to an older population, the dearth of information on occupational falls among older adults must be addressed.

METHODS

A national probability sample of hospital emergency departments (EDs) (National Electronic Injury Surveillance System) was utilized to characterize falls at work.

RESULTS

Older workers were found not to be at increased risk of a fall injury, but were more likely than younger workers to be hospitalized post-injury. Same-level falls were the most common type of incident among older workers. Falls from height were more prevalent among men than women. The narrative case descriptions for same-level falls to the floor primarily implicated floor contamination and tripping hazards.

CONCLUSIONS

Fall prevention programs targeted to older workers must examine extrinsic sources of falls, particularly surface traction, contaminant control, and footwear.

Manual handling risk controls in hospitals (MARCH): a cross-sectional survey of UK hospitals

Injury and ill health among healthcare staff associated with handling patients is an important area of risk for UK National Health Service (NHS) employers. Since the introduction of a specific legal duty to control this risk in 1992, many Trusts have developed manual handling risk management strategies. Anecdotally, however, practice varies between Trusts and there is no published description of common practice among NHS employers. The latter would be useful as a benchmark for risk managers. Therefore, we undertook a cross-sectional survey of 158 UK trusts (81% of those invited) using a structured interviewer-administered questionnaire to collect information about manual handling risk controls. Most Trusts had basic systems for risk management, including defined management accountability, written policies, provision of handling equipment, training, expert advice about manual handling and access to occupational health services and physiotherapy for injured employees. However, there was wide variation in important aspects, including the extent of expert manpower and criteria for referral to occupational health. Arrangements for monitoring risk controls were generally poor, and the variation in practice was a cause for concern. These data will help NHS employers by providing a benchmark against which to measure and develop risk management systems for manual handling. Future research should aim to develop standards through consensus opinion and ultimately evidence of effectiveness of risk controls.

Tertiare Pravention von Berufsdermatosen. Tertiary prevention of occupational skin diseases

BACKGROUND

Inpatient tertiary prevention of occupational skin diseases is indicated when the employee is threatened with loosing their job. Earlier studies have shown that with intensive tertiary preventive measures, 2/3 of such individuals can continue their jobs long-term. Data on the effectiveness of tertiary prevention for various occupational groups has not been previously available.

PATIENTS AND METHODS

The outcome of all participants treated in the year 2002 was analyzed according to occupational groups with respect to diagnosis, medical intervention prior and during the inpatient period.

RESULTS

In 91% of 296 cases contact dermatitis of the hands was diagnosed (75% primary irritant contact dermatitis (37% chronic irritant contact dermatitis, 38% irritated atopic hand eczema, 16% allergic contact dermatitis). Clinically relevant Type IV-delayed hypersensitivity (allergic contact dermatitis) reactions were identified in 42% of cases; in most cases, the delayed hypersensitivity followed irritant contact dermatitis. In more than 83% of cases, a complete or nearly complete remission was achieved. Clinical relevant Type IV sensitization was most frequent in hairdressers (66%). Cleaning and housekeeping personnel most frequently used corticosteroids on a regular basis (60%) and most often experienced corticosteroid withdrawal (53%) and atrophy of the skin of the hands (23%).

CONCLUSION

The data from studies on the tertiary prevention of occupational skin diseases reveal strategies for the optimization of outpatient care indicate specific occupational risk factors. The variance between professions may reflect differing approaches to secondary prevention.

What do consultant occupational physicians do in the National Health Service? An audit

AIM

To assess the range of activities undertaken by National Health Service (NHS) consultant occupational physicians, and quantify the proportion of time spent on these so that appropriate guidance and a model job description may be developed by the Association of NHS Occupational Physicians (ANHOPS).

METHODS

A questionnaire was developed and sent to all full time consultant occupational health physicians (as recorded on the ANHOPS database).

RESULTS

Sixty-five questionnaires were sent out, of which 38 were returned (59%). Only 31(48%) of replies matched the entry criteria of being full-time NHS consultants returning fully completed questionnaires. An average of 18 h face-to-face clinical work (range = 0-36 h) over five sessions (range = 0-9 sessions) was found. Remaining time was predominantly spent on clinical administrative work although some consultants took on a variety of other managerial activities.

CONCLUSIONS

Responding full-time NHS consultant OHPs found it difficult to quantify and categorize their workloads, particularly for non-clinical work. Their responsibilities vary widely. Of use for job planning purposes is the average commitment of clinical sessions (five).

Occupational health nurses' participation in health committee surveyed in Yamaguchi prefecture, Japan

This survey was conducted to know the present conditions of occupational health nurses (OHNs) activity related to health committees (HCs) in Japan. Questionnaires that included items related to duties of the OH physician (OHP), those of the OHN, and their mutual duties within the HC, were mailed to 41 companies employing OHNs and questionnaires from 18 companies were analyzed. Comparison of the frequency of OHN attendance at Health Committee Meetings (HCMs) revealed that 33.3% of OHNs attended the HCs when their companies employed full-time OHPs and 83.3% attended when their companies employed part-time OHPs. In a question about the OHN's opportunity to deliver a speech, give a report or make a presentation at their HCMs, 16.7% of OHNs in companies with full-time OHPs and 66.7% of OHNs in companies with part-time OHPs reported they had such opportunity. In companies with part-time OHPs, 50.0% of the OHNs reported that they were asked for their opinions at the HCMs, but OHNs at companies employing full-time OHPs were not asked for their opinions. It was considered that in the future, OHNs, particularly those working with a part-time OHP, will have an important role in the HC and developing OH services for their companies.

[Individual protection devices--opinion and practice of occupational medicine physician]

Technological developments have led to changes in work conditions and the character of work itself that modify the responsibilities and tasks of occupational medicine physicians. Their major task is to protect workers' health through primary prevention, which means the employment of all available measures to prevent adverse health effects resulting from working conditions unfavorable to human health. Statistical data on the incidence of occupational diseases and accidents at work in Poland show that despite many beneficial changes, better labor organization or new technologies in production and services, social and economic consequences of exposure-related diseases induced by so called hard harmful agents in the work environments are still the major problem, hence the significance of prevention. Activities aimed at preventing hazards at workplace should be carried out by employers, safety and work hygiene services and physicians involved in prophylactics. In addition, the selection and supply of individual protectors as well as their use by workers to protect themselves against dangerous and harmful factors occurring in the work environment play an essential role. The authors discuss the significance of using individual protectors from the viewpoint of occupational medicine physicians, and the tasks of this group of physicians in the light of epidemiology of occupational diseases induced by various agents present in the work environment.

[Validity of smoking histories]

Validity of smoking histories was investigated retrospectively in 185 cases of lung cancer, which are compensated as occupational diseases. We used the files inquiry of the occupational disease declarative statement, primary physicians information, information from the post-exposure medical surveillance examinations, and the files of the former company physicians as data sources. From these, the smoking status was determined and compared with single data sources. Self-reported information during post-exposure medical surveillance examinations tallied well (deviation: 6.5%), whilst physicians' information was lacking in 34.6% in (former) smokers. We propose improved sensitisation of physicians to the problem of nicotine dependence.

Need for recovery after work and the subsequent risk of cardiovascular disease in a working population

BACKGROUND

A high need for recovery after work can be regarded as a short term adverse effect of working day stressors and the person's inability to cope and recover. Consequently, it might be an intermediate factor between job stressors and cardiovascular disease (CVD).

AIM

To investigate, in a longitudinal study, the relation between need for recovery and subsequent CVD.

METHODS

Data from the Maastricht Cohort Study of 12 140 workers were used, with 42 incident self reported CVD cases during 32 months of follow up. Cox proportional hazards analysis was used to calculate age, gender, smoking status, and educational level adjusted relative risks.

RESULTS

The adjusted relative CVD risk for the second compared to the first tertile of the need for recovery score was 1.22 (95% CI: 0.49 to 3.04), and for the third compared to the first tertile was 3.16 (95% CI: 1.34 to 7.48). When need for recovery was entered as continuous score, an adjusted relative risk per SD increase of 1.54 (95% CI: 1.15 to 2.03) was found. Additional adjustment for several work related factors as job demands, did not notably change the observed relation between need for recovery and CVD. Moreover, the increased risk for subjects reporting high job demands (1.38 per SD increase; 95% CI: 1.02 to 3.92) decreased substantially after adjustment for need for recovery.

CONCLUSION

The results show that need for recovery is a strong predictor of subsequent cardiovascular disease and might be an intermediate factor between job stressors and cardiovascular disease.

[Health promotion benefits and obstacles as perceived by occupational medicine physicians in Poland]

This article presents the views of occupational medicine (OM) physicians concerning the following: (a) whether OM physicians should be involved in workplace health promotion: (b) whether they can benefit (if so in what way) from involvement in this activity; (c) whether they find the existing conditions favorable for launching health promotion projects; (d) what are the major obstacles? This paper is based on a survey carried out in the fall of 2002 in a group of 325 OM specialists who attend large groups of patients. Over 90% of the respondents believe that OM physicians should be involved in health promotion, however, one third of them do not plan any action in this field in the following year. Among the key benefits from health promotion, health gain is indicated by 80% of OM physicians. Only a few respondents perceive their involvement in health promotion as an opportunity to be more competitive in health service market, thereby to increase their income. None of those interviewed thought that involvement in health promotion win them greater respect among peers. Almost 80% of the respondents complained about unfavorable conditions for carrying out workplace health promotion. As the most significant obstacles they reported the lack of interest in health promotion among employers (86% of respondents), unsatisfactory gratification (76%), limited skill to raise funds for health promotion (64%), limited opportunities to advance education in this field (59%), and the lack of interest in health promotion among employees (57%). In general, OM physicians express their willingness to advance their knowledge of health promotion, although 64% of respondents are convinced that they are well trained in this area. According to the respondents, a proper way to promote health is not only to become very active, but to commit employers to assure the development of health promotion at workplace and to allocate more funds for health promotion projects.

The incidence of work-related disease reported by occupational physicians, 1996-2001

In the course of six calendar years, 1996-2001, 5491 new cases of work-related disease were reported by a 1-in-12 random sample of occupational physicians throughout the UK. This represented an estimated total of almost 66 000, or 11 000 cases per annum. These cases have now been analysed by sex, occupation (nine categories) and industry (eight categories), and annual average incidence rates calculated in five main disease groups against a similarly classified denominator of 3.2 million employees served by the same physicians. The overall average annual estimated rate (342 per million) was eight times higher than that reported by clinical specialists, calculated in a similar manner against the entire employed population of the UK (28 million), but 17 times higher for musculoskeletal disease. For men employed in mines and quarries, and both men and women in metallic and automotive manufacture, rates for most types of disease were very high. Occupations with the highest rates were craftsmen and female associate professionals. In all these occupational and industrial groups with high rates, musculoskeletal complaints were the main cause, and skin, respiratory or stress diseases were next in importance. In each type of disease, there was a wide range in incidence rates, suggesting important differences in risk by occupation or industry.

The rise and fall of occupational medicine in the United States

Thirty years ago, occupational medicine was one of the smallest of all the medical specialties, ignored by most physicians and medical schools. Occupational physicians were more likely to have entered the field through career transition than by residency training. In 1970, governmental agencies sought to transform occupational medicine into a major clinical specialty. Influential groups projected a need for large numbers of physicians in the field. Residency training was expanded, as were other teaching programs. However, industry and its workers' compensation insurance partners were not widely included in these plans. For that reason, among others, many physicians entering the field met with disappointment. About half the corporate positions for occupational physicians have disappeared in the last decade. Private practice opportunities turned out to be much more limited than planners had anticipated. Attempts to bring occupational medicine into the curriculum of the medical schools failed. Many of the residency programs that had been created are now closing. The proposal that occupational medicine create a joint specialty with environmental medicine is not widely accepted by the rest of medicine. Because so few physicians obtain board certification, it appears that the specialty of occupational medicine is returning to its former obscurity.