Perceived barriers and solutions by generalist physicians to work towards timely young-onset dementia diagnosis

Objectives: Timely diagnosis of young-onset dementia (YOD) is an important prerequisite to initiate appropriate support. However, YOD diagnosis is often late. We aimed to explore the perspectives of referring general practitioners and occupational physicians, to better understand their barriers to YOD diagnosis and reveal potential solutions to facilitate timely diagnosis.Methods: We conducted 16 semi-structured qualitative interviews with general practitioners and occupational physicians in the Netherlands. Inductive thematic analysis was applied to the transcripts with a team including researchers from various (clinical) backgrounds.Results: Thematic analysis revealed three themes related to: (1) disease characteristics that hinder YOD recognition, being the low incidence and the fact that they mimic other prevalent conditions like burn-out and depression; (2) physicians' attitudes that delay YOD diagnosis, as fear of mis-diagnosis and therapeutic nihilism; and (3) proposed solutions to navigate the challenging YOD diagnostic trajectory including monitoring people with depression and burn-out to consider YOD when recovery stagnates, and more effective interprofessional collaboration.Conclusion: In this study, referring physicians confirmed barriers known to YOD diagnosis and suggested potential solutions to improve YOD diagnosis. Future prospective studies in people with a primary diagnosis of depression or burn-out may show whether these interventions are potentially effective.

Mandate or Not Mandate: Knowledge, Attitudes, and Practices of Italian Occupational Physicians towards SARS-CoV-2 Immunization at the Beginning of Vaccination Campaign

Vaccinations used to prevent coronavirus disease (COVID-19)-the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-are critical in order to contain the ongoing pandemic. However, SARS-CoV-2/COVID-19 vaccination rates have only slowly increased since the beginning of the vaccination campaign, even with at-risk workers (e.g., HCWs), presumptively because of vaccine hesitancy. Vaccination mandates are considered instrumental in order to rapidly improve immunization rates (but they minimize the impact of vaccination campaigns). In this study, we investigated the acceptance (i.e., knowledge, attitudes, and practices) from occupational physicians (OPs)) in regard to SARS-CoV-2/COVID-19 vaccination mandates. A total of 166 OPs participated in an internet-based survey by completing structured questionnaires. Adequate, general knowledge of SARS-CoV-2/COVID-19 was found in the majority of OPs. High perception of SARS-CoV-2 risk was found in around 80% of participants (79.5% regarding its occurrence, 81.9% regarding its potential severity). SARS-CoV-2/COVID-19 vaccination was endorsed by 90.4% of respondents, acceptance for SARS-CoV-2 vaccine was quite larger for mRNA formulates (89.8%) over adenoviral ones (59.8%). Endorsement of vaccination mandates was reported by 60.2% of respondents, and was more likely endorsed by OPs who exhibited higher concern for SARS-CoV-2 infection occurrence (odds ratio 3.462, 95% confidence intervals 1.060-11.310), who were likely to accept some sort of payment/copayment for SARS-CoV-2/COVID-19 vaccination (3.896; 1.607; 9.449), or who were more likely to believe HCWs not vaccinates against SARS-CoV-2 as unfit for work (4.562; 1.935; 10.753). In conclusion, OPs exhibited wide acceptance of SARS-CoV-2/COVID-19 vaccinations, and the majority endorsed vaccination mandates for HCWs, which may help improve vaccination rates in occupational settings.

Supporting Occupational Physicians in the Implementation of Workers' Health Surveillance: Development of an Intervention Using the Behavior Change Wheel Framework

Workers’ health surveillance (WHS) is an important preventive activity aimed at prevention of work-related diseases. However, WHS is not regularly implemented in some EU-countries. As occupational physicians (OPs) have to play an important role in implementation of WHS, this study aimed to develop an intervention to support OPs in implementation of WHS. The behavior change wheel framework (BCW) was used to develop the intervention. First, the problem was defined, and target behavior was selected by using results from a survey study among OPs. Subsequently, change objectives in target behavior were specified. Finally, appropriate intervention functions, behavior change techniques, and modes of delivery were identified to develop the intervention. Target behaviors were (1) OPs initiate WHS, and (2) OPs conduct preventive consultations with workers. OPs’ capabilities, and experienced opportunities were identified as change objectives. Intervention functions (education, training, enablement) and behavior change techniques (information about consequences, demonstration, instructions, behavioral practice, feedback on behavior, goal setting, action planning, reviewing goals) were selected to develop the intervention, delivered by face-to-face group training and e-learning. The proposed intervention consists of training and e-learning to support OPs in implementing WHS. Feasibility and effect of the intervention will be evaluated in future studies.

Behaviour of occupational health services during the COVID-19 pandemic

BACKGROUND

Disasters, crises and pandemics are emergencies which impact on businesses severely. The COVID-19 pandemic reached its peak in mid-April 2020 in the UK. During this period, NHS Occupational Health Services (OHS) were stretched to their limit along with other health services. OHS may have had to change their pattern of operation, operating times, services offered, etc. to cope with the pandemic. Data about business model modifications, services offered by the OHS businesses during the pandemic could help in better utilization of OHS resources in the future.

AIMS

To understand the behaviour of OHS in different parts of the country during the COVID-19 pandemic.

METHODS

An online survey link was sent to both accredited and unaccredited UK Occupational Health Physicians (OHPs).

RESULTS

Sixty-two OHPs responded to the survey. In the current pandemic, 51% of the OHS (95% CI 0.38-0.62) offered weekend or out-of-hours (OOH) services, 21% had to employ extra staff (95% CI 0.13-0.33) and 54% had to change their working hours (95% CI 0.41-0.65). Ninety per cent of the OHS (95% CI 0.78-0.94) continued to offer routine services; however, there was a decline in offering vaccination services. Fifty-six per cent of the OHS (95% CI 0.42-0.67) offered a dedicated telephone line and 46% of the OHS (95% CI 0.32-0.56) started a dedicated COVID-19 queries inbox.

CONCLUSIONS

There was a change in the behaviour of the OHS to cope with the pandemic. Having a dedicated helpline to manage the crisis situation seemed a logical step whilst offering routine services.

Knowledge, Attitudes, Practices (KAP) of Italian Occupational Physicians towards Tick Borne Encephalitis

Tick-Borne Encephalitis (TBE) is an occupational health threat with increasing incidence in the geographic area of Italy. Despite this, TBE vaccination rates have ranged from 10% to 40% in Italy, even in at-risk workers. The reasons for this low rate are investigated in this present study of the knowledge, attitudes, and practices of occupational physicians (OP) regarding TBE disease and vaccination in at-risk workers. A total of 229 OP participated in an internet-based survey by completing a structured questionnaire. Adequate general knowledge of TBE disease was found in 58% of OP. Accurate perception of TBE risk in occupational settings was found in 20%. TBE vaccination for at-risk workers was recommended by 19%. Willingness to recommend TBE vaccination was more likely by OP practicing in endemic areas (Odds Ratio 3.10, 95% confidence intervals 1.47–6.55), who knew the existence of the term “arboviruses” (3.10, 1.29–7.44), or exhibited a better understanding of TBE (2.38, 1.11–5.12)—and were positive predictors for promoting TBE vaccine, while acknowledging that TBE as a severe disease was a negative one. Tick-borne disorders in Italy are a still rare (but increasing) occupational health threat, and vaccination gaps for TBE virus may find an explanation in OP incomplete knowledge of evidence-based recommendations.

Physicians' opinions about the causes of underreporting of occupational diseases

Occupational diseases cause an important burden on health and economy; however, they are substantially underestimated. We aimed to investigate the opinions of physicians about causes of underreporting of occupational diseases. We collected data with a questionnaire, listing 30 possible causes for underreporting of occupational diseases. 478 physicians participated in the study. The first 3 most frequent causes perceived as "very important" are; employers' perception of occupational safety and health services as a loss of revenue (64.9%), prevalent employment without a legal contract (64.6%), and prevalent employment as subcontracted (59.4%). 52.1% of the physicians worked or currently working as an occupational physician. With the increase of working year as an occupational physician, there was a statistically significant decrease in the strength of importance for 17 of the 30 statements. This finding may be one of the important causes of underreporting of occupational diseases.

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.

The Role of Work-Related Factors in the Development of Psychological Distress and Associated Mental Disorders: Differential Views of Human Resource Managers, Occupational Physicians, Primary Care Physicians and Psychotherapists in Germany

Objectives: This study analyses the perceived relevance of stress-dimensions in work-settings from the differential views of Human Resource Managers (HRM), Occupational Physicians (OP), Primary Care Physicians (PCP) and Psychotherapists (PT) in Germany. Methods: Cross-sectional study design, using a self-report questionnaire. Descriptive measures and explorative bivariate methods were applied for group-comparisons. Results are presented as rankings of perceived importance and as polarity profiles of contrasting views. Results: N = 627 participants completed the questionnaires (HRM: n = 172; OP: n = 133; PCP: n = 136; PT: n = 186). The stress dimensions with the highest mean ratings across all four professions were: ‘social relationships in the work place’ (M = 3.55, SD = 0.62) and ‘superiors´ leadership style’ (M = 3.54, SD = 0.64). Mean ratings of perceived relevance of stress dimensions differed most between HRM and the three medical professions. Conclusions: The perceived importance of work-related stress-dimensions seems to be higher in the medical disciplines (OP, PCP, PT) than in the group from the management sector (HRM). However, no fundamental disagreement on the role of work-related stress-dimensions seems to hinder e.g., intensified efforts of cooperation across sectors in tackling the “stress-pandemic” and improving the (mental) health of employees.

Checklist for psychosocial risk evaluation: a prospective evaluation study

BACKGROUND

Although psychosocial risk evaluation (PRE) is legally required, implementation is often suboptimal. Occupational health specialists face various challenges in implementing a systematic PRE process.

AIMS

To evaluate if a checklist strengthens the competencies of occupational physicians in PRE design and implementation.

METHODS

A prospective pilot survey with a baseline and follow-up assessment at 12 months was conducted with occupational physicians who applied the checklist. Three outcome criteria were assessed: (i) physicians' general competence in PRE, (ii) physicians' self-reported skills in PRE and (iii) feasibility of the checklist.

RESULTS

Twenty-four occupational physicians participated. Checklist users reported increased competence in PRE at follow-up, increasing in competence twice as much as physicians who did not use the checklist during the study period although this was not statistically significant. With regard to specific skills over time, checklist users reported increased knowledge of the PRE procedure (P < 0.05), as well as increased strategic planning for PRE (P < 0.01). All feasibility criteria were rated positively.

CONCLUSIONS

Our checklist may help occupational health clinicians to overcome the barriers that are responsible for the gap between official recommendations and occupational health and safety practice in PRE. However, our results are based on a preliminary study with a limited sample size.

A review of guidelines for collaboration in substance misuse management

BACKGROUND

Substance misuse among the working population results in increasing economic costs. General practitioners (GPs) and occupational physicians (OPs) can play a central role in detecting and managing substance misuse in the working population. Their collaboration could be critical in coordinating care, in facilitating rehabilitation and in reducing sickness absence.

AIMS

To search guidelines for evidence on collaboration between GPs and OPs in substance misuse detection and management in the working population.

METHODS

International guidelines regarding collaborative care for alcohol, illicit drug, hypnotic and tranquillizer misuse were identified by a systematic search in the Guidelines International Network and US National Guidelines Clearinghouse databases.

RESULTS

In total, 20 guidelines were considered of sufficient methodological quality, based on the criteria of the Appraisal of Guidelines for Research and Education II instrument. Only two guidelines reported on the OP's role in screening and intervention for alcohol misuse.

CONCLUSIONS

There is a lack of guidance on the OP's role and on collaboration between GPs and OPs in this field. Further study is required on their respective roles in substance misuse management, the effectiveness of workplace interventions and the benefits of collaboration.

Relationship between job stress and self-rated health among Japanese full-time occupational physicians

OBJECTIVE

We investigated relationship between job stress and self-rated health among Japanese nese full-time occupational physicians (OPs).

METHODS

In 2000, we mailed self-administrated questionnaires to 716 OPs. Of these OPs, 349 (49%) returned sufficiently completed questionnaires for analyses. oblique-rotated principal factor analysis of the job stress questionnaire extracted three components; low understanding of occupational health services in companies (low understanding), conflicts between occupational physicians and their coworkers (conflicts), and discrepancies between occupational physicians' routine work and occupational health services (discrepancies).

RESULTS

The model, in which low understanding contributed to self-rated health through job satisfaction and self-rated health was influenced by job satisfaction and discrepancies, provided a good fit to the data.

CONCLUSIONS

We found that a potential relationship between job stress and self-rated health among Japanese full-time OPs. The present results implied that among full-time OPs, low understanding contributed negatively to self-rated health through job satisfaction, and that self-rated health was influenced positively by job satisfaction and negatively by discrepancies.