Workplace risk assessment criteria for pregnant workers exposed to physical exertion and biological and chemical hazards

In Finland, 91% of employer-arranged occupational health services (OHS) include primary care for employees. Occupational health (OH) physicians and OH nurses carry the main responsibility for primary care in OHS. This study analyses work- and health-related factors associated with primary care visits to OH physicians and OH nurses. This population-based cross-sectional survey encompassed 1636 randomly selected working employees aged 25-64 covered by OHS which included primary care. The associations between factors and visits during the previous 6 months were tested by Poisson regression analysis. The proportion of employees who visited OH physicians or OH nurses was 57%. Men visited OH nurses more often than women, but the number of visits to OH physicians was similar. Long-standing illnesses impairing work ability, work-related symptoms, and type of OHS provision were associated with visits to both OH physicians and nurses. Moderate psychological stress was associated with visits to OH physicians. Among men, the requirement of obtaining a sick-leave certificate on the first day of absence was associated with visits. Less possibilities to influence one's work was associated with visits to OH nurses, and among women also to OH physicians. Poor support from supervisors and co-workers had non-significant or inverse associations. The wide use of OHS and both the type and similarities between factors associated with visits may signify that both OH physicians and OH nurses are likely to encounter work-related health problems through primary care in OHS.

Pregnant workers have more health risks for health problems than other workers. There are different potential hazards in different workplaces. Occupational Health and Safety Programs need to be implemented for pregnant workers in order to avoid work related diseases in various workplaces. This study aims to determine the the implementation of occupational health and safety for pregnant workers in various workplaces. This study uses a qualitative method by conducting FGD (Focus Group Discussion) with pregnant women workers from various workplaces and in-depth interviews with occupational health and safety experts. Occupational health and safety programs have been implemented for pregnant workers such as the right to maternity leave, working hours arrangements, health insurance, and special protection for pregnant workers. However, there are some workplaces that still do not provide special protection for pregnant workers. Every workplace should pay more attention to the health and safety of pregnant workers as an effort to prevent occupational accidents and work related diseases

Primary care is frequently integrated in Finnish occupational health services (OHS). This study examines the frequency of work-related health problems in occupational health (OH) physicians' consultations for primary care and associations between health problems and interventions carried out by OH physicians. OH physicians assessed the health problems of 651 consecutive visits in a private OHS unit. The health problem was regarded as work-related if it was caused or aggravated by work, or involved impaired work ability. Interventions carried out by OH physicians were analysed by logistic regression analysis. The main health problem was caused either partially or mainly by work or symptoms were worsened by work (27%), or symptoms impaired work ability (52%). Musculoskeletal and mental disorders were the main work-related reasons for visits. In two-thirds of the cases of mental health problems, work caused or worsened symptoms, and the majority of long sickness absences were issued due to these problems. OH physicians carried out interventions concerning work or workplace in 21% of visits. Mental disorders were associated most strongly (OR 7.23, 95% CI 3.93-13.32) with interventions. The strongest association (OR 16.09, 95% CI 9.29-27.87) with work-related visits was, when the health problem was both work-induced and impaired work ability. Work-related health problems comprise a considerable part of Finnish OH physicians' work. OH physicians play an important role in early treatment, in the prevention of disability, and in interventions aimed at workplaces based on the knowledge they get through primary care in OHS.

Recent global economic difficulties have widened social inequalities, but their impact on pregnant workers is not known. To investigate the association between deprivation, exposure to occupational hazards and adverse perinatal outcomes in pregnant workers. A cross-sectional study performed in 2014 in French occupational health services. Eligible workers were women who had worked during their pregnancy and had a medical visit by occupational health physicians (OHPs) after delivery and at the time of returning to work. Deprivation was measured using the EPICES scale (Evaluation of Precariousness and Inequalities in Health Examination Centres). Information on birth outcomes was self-reported. Occupational risks for pregnancy were assessed by OHPs. Jobs were coded by the occupational health team using standardized French nomenclature. The groups (deprivation/no deprivation) were compared using univariate (chi-squared test) and multivariate Poisson regression analyses. Of 1402 pregnant workers, 293 (21%) were classed as deprived. This group more frequently encountered occupational hazards, particularly for physical exposures (P < 0.001), and had a higher risk of cumulated occupational hazards of three or more for pregnancy [adjusted relative risk (RRa) = 4.2; 95% confidence interval (CI) 2.2-7.9]. Our findings suggest that deprivation and exposure to three or more occupational hazards during pregnancy cumulatively increased the risk of pre-term birth (RRa = 3.9; 95% CI 1.2-12.4). Our data suggest that deprived pregnant workers are an occupationally vulnerable group.

In Japan, an employer of a workplace with 50 or more employees is legally required to assign an occupational health physician. The assignment rate in 2010 was reported as 87.0%. This policy started with the provision of "factory physician"in the Factory Law in 1938, then the Labour Standard Law stipulated "physician hygienist" in 1947, and finally the Industrial Safety and Health Law defined "occupational health physician" in 1972. In 1996, a revision of the law then required those physicians to complete training courses in occupational medicine, as designated by an ordinance. Historically, an on-site physician was expected to cure injuries and to prevent communicable diseases of factory workers. The means of occupational hygienic management by working environment measurements, etc., and of health management by health examinations, etc., were developed. Localized exhaust ventilation and personal protection equipment became widely utilized. Qualification systems for non-medical experts in occupational hygiene were structured, and relationships between employers and occupational health physicians were stipulated in the legislative documents. Currently, the Japan Medical Association and the University of Occupational and Environmental Health, Japan educate and train occupational health physicians, and the Japan Society for Occupational Health maintains a specialized board certification system for these physicians. In the future, additional efforts should be made to strengthen the expertise of occupational health physicians, to define and recognize the roles of non-medical experts in occupational hygiene, to incorporate occupational health services in small enterprises, to promote occupational health risk assessment in the workplace, and to reorganize the current legislation, amended repeatedly over the decades.

Prevalence of infectious risk factors during pregnancy: An infectiological snapshot of 180 pregnant women in a rural setting of Western Ghana A cross-sectional pilot study in a rural area of Western Ghana was carried out to develop an infectiological risk profile of pregnant women. For this, 180 expectant mothers were screened for the presence of pathogens, known to compromise the health of mother and child. Vaginal swabs were examined by microbiological or virological testings to detect group B streptococci (GBS), Listeria monocytogenes, Neisseria gonorrhoeae, Chlamydia trachomatis and herpes simplex virus (HSV-1/- 2). Furthermore, blood and serum samples were investigated to detect non-vaginal pathogens like Plasmodium sp., Toxoplasma gondii, hepatitis viruses (HBV, HCV, HEV), cytomegalovirus (CMV), human immunodficiency virus (HIV), rubella virus, varicella-zoster virus (VZV) and parvovirus B 19 (PB19). Finally, bacterial pathogens like Treponema pallidum and Brucella spp. were subjects of our examinations. The microbiological methods based either on direct detection of the pathogens by culture, MALDI-TOF MS and PCR, or indirect identification by serological markers. Additionally, all study participants were interviewed for the presence of potential risk factors, outcome of previous pregnancies, socio-economic aspects and antenatal medical care services. Our results showed a prevalence of acute or past infections with a broad spectrum of parasitic, viral and bacterial pathogens. Maternal malaria was shown to be frequent (10.6%), despite increasing acceptance of the intermittent preventive treatment (IPTp) and primary prevention. We showed a high prevalence of infections caused by the hepatotropic viruses HBV (16.7% HBs Ag positive) and HEV (20.7% HEV-IgM) but not for HCV (1.1% anti-HCV). With 0.6%, the prevalence of HIV was very low and might be judged as an encouraging step in the fight against AIDS. We determined a significant IgG -seroprevalence for other pregnancy-related viral pathogens, such as CMV, HSV, VZV, rubella virus, and PB19 virus. However, absence of antibodies against rubella virus in 15.7% and against VZV in 43.2% makes a significant proportion of woman susceptible for acquiring primary infection during pregnancy. Seroprevalence of Toxoplasma gondii-specific antibodies was 73.2% with three possible acute infections acquired during pregnancy. GBS, the major risk factor for neonatal sepsis, were isolated from the birth canal of 10.6% of all pregnant women. Our pilot study proofs the existence of pregnancy-related infections in a rural population of Ghana at different prevalence rates, thereby offers guidance for health officials to discuss possible future intervention schemes.

Rubella Virus Is Associated With Fuchs Heterochromic Iridocyclitis

The digitization of technological processes in enterprises is rapidly changing the world of work and requires new and up-to-date solutions in occupational health and safety (OSH). The European Agency for Safety and Health at Work (EU-OSHA) provide information to policymakers, researchers and workers about the possible effects of digitization on OSH, so that they can take timely and effective measures to ensure the safety and protection of workers. Occupational health and safety are often poorly managed in micro and small enterprises, and employees are exposed to a greater risk of workplace injuries and occupational diseases. The paper deals with online monitoring of risk assessment in the injection moulding workplace and is key to creating healthy workplaces. However, conducting a risk assessment can be quite challenging, especially for micro and small businesses that may lack the resources or expertise to do it effectively.

Work-Related Interventions during Office Visits to Occupational Health Physicians

Worker beliefs and expectations influence their health and rehabilitation. However, little is known about worker expectations of occupational health (OH) consultations and if these are associated with their perceptions of health and work. To examine worker expectations of OH consultations, and whether the variability of worker expectations is associated with their perception of health and work and personal characteristics. A questionnaire on OH physicians' professional standards was developed from national guidance and validated by a survey of OH physicians. We explored 81 workers' expectations of professional standards along with their perception of health and work. Worker expectations were compared with the OH physician validation score. Associations of worker characteristics, their health and work perceptions and their expectations of professional standards were analysed by linear regression. Worker expectations of professional standards were lower when compared with the OH physician validation score (E = 3.9 versus 4.3, ΔE = 0.48, 95% confidence interval [CI] 0.30-0.66). Perceived manager support and work apprehension were associated with worker expectations (ΔE = 0.58, 95% CI: 0.29-0.86 for least versus most support; ΔE = 0.89, 95% CI: 0.41-1.36 for least versus highest apprehension). Job title, previous OH consultations and recovery expectations were not associated with worker expectations. Worker expectations of OH physicians' professional standards were lower than the standards set by national guidance as validated by the sampled OH physicians. Workers who felt more supported by their manager, and workers who were more apprehensive about the health impact of work had higher expectations of OH physicians' standards.

This paper reviews the circumstances, current situation, and issues for Japanese occupational health physicians and discusses future developments. The Industrial Safety and Health Act requires workplaces that regularly employ 50 or more workers to appoint one occupational health physician. Their duties have been expanded by amendments to the Act, and they now have increased authority. Under these conditions, the occupational health physicians not only comply with laws and regulations but also follow a professional code of ethics. After the Act was amended in 1996, occupational health physicians had to complete additional training requirements. Basic training courses are provided by the Japan Medical Association (JMA) and the University of Occupational and Environmental Health, Japan. Most of the occupational health physicians certified by the JMA do not spend enough time on occupational health. Many Japanese occupational health work issues can be separated into issues of exposure, labor, and the occupational health system. Occupational health is characterized by changing needs because of new industrial structures and technological innovations. Given occupational health physicians’ expanding duties and professional development, they need to collaborate with one other and other occupational health staff to meet society’s expectations.

There is a strong link between Epstein-Barr virus (EBV) and multiple sclerosis (MS), but the underlying mechanisms are unclear. Patients with MS typically have a polyspecific intrathecal production of immunoglobulin G (IgG), part of which is directed against various microbial antigens. In this study, we comprehensively analyzed seroprevalences and frequencies of an intrathecal IgG production to EBV compared with 10 other common microbes in patients with MS. Antibodies to EBV and to Borrelia burgdorferi, cytomegalovirus, herpes simplex virus type 1/2, measles virus, mumps virus, rubella virus, parvovirus B19, tick-borne encephalitis virus, Toxoplasma gondii, and varicella zoster virus (VZV) were determined in stored paired CSF and serum samples of 50 patients with MS. Intrathecal antimicrobial antibody production was assessed by calculating antibody indices (AIs) according to standard formula. While 50 (100%) of 50 patients with MS were EBV seropositive, seroprevalences of all other 10 microbes were lower, ranging from 94% (VZV) to 6% (Borrelia burgdorferi). An intrathecal production of antimicrobial antibodies was detected in 102 (28%) of 370 AI determinations of patients who were seropositive to the respective antimicrobial antibodies but was practically absent in seronegative patients (2/187 [1%], p < 0.0001). The frequency of intrathecally produced antimicrobial antibodies among patients who were seropositive for the respective antibodies was roughly 40% for measles, rubella, mumps, and VZV and 70% for parvovirus B19. By contrast, the frequency of intrathecally produced EBV antibodies was low (10%) and, when related to their respective seroprevalences, lower than those of all other investigated microbes. Despite the universal EBV seroprevalence, the frequency of intrathecally produced EBV antibodies in patients with MS is lower than that of other microbes, whose seroprevalences are lower than those of EBV. This seemingly paradoxical finding underscores the unique role of EBV in MS and could be explained by the hypothesis that B lineage cells responsible for intrathecal antibody production are primed during and through acute EBV infection to enter the CNS of patients with MS, that is, at a time point when EBV antibody-producing cells have not yet been generated and, therefore, are not yet available for entering the CNS.

This study aimed to investigate the long-term changes in awareness of and knowledge about mother-to-child infections across 6 years in Japan. A questionnaire survey was conducted at our facility from October 2012 to January 2018, and the study periods were divided into 4 phases comprising 16 months each. A multiple-choice questionnaire assessed participants’ awareness of the following 13 pathogens of mother-to-child infections: cytomegalovirus (CMV), Toxoplasma gondii (T. gondii), hepatitis B virus, rubella virus, herpes simplex virus, parvovirus B19, hepatitis C virus, human immunodeficiency virus, human T cell leukemia virus type-1, measles virus, varicella-zoster virus, Chlamydia trachomatis, and Treponema pallidum. For the selected four pathogens (i.e., CMV, rubella virus, T. gondii, and parvovirus B19), the questionnaire also evaluated participants’ knowledge of transmission routes, the most susceptible time of infection that could yield severe fetal disease during pregnancy, the maximum frequency of fetal infection in cases of maternal infection, and methods to prevent maternal infection. In total, 1433 pregnant Japanese women were included in this study. There was no secular change in awareness of the pathogens concerning mother-to-child infections over time, and we also clarified that the detailed knowledge of the four pathogens of typical mother-to-child infections did not improve. Since knowledge about methods to prevent maternal infection is still insufficient for all pathogens, further advocacy is required to prevent mother-to-child infections.

In Japan, the primary administrative authority of occupational health is the Ministry of Labour, and its legislative basis is the Industrial Safety and Health Law (ISH law). Occupational health is mandated by this law and its enforcement involves the appointment of an occupational health physician (OP) for workplaces with 50 or more workers, and a full-time OP for workplaces with 1000 or more workers. The actual percentage of appointments filled for the former group is 83.4 per cent, compared with 58.4 per cent for the latter. The estimated number of OPs is 34000, of which 2000 work full time. Worker health examination is mandatory for all workplaces and many OPs allocate considerable time to its implementation. Occupational health organizations provide occupational health services such as worker health examinations to meet the demand. Basic training courses for OPs are provided by the Japan Medical Association and advanced courses are provided by the University of Occupational and Environmental Health, Japan. The Ministry of Labour recently launched a plan to establish occupational health centres to assist OPs at prefectural and regional levels. A network of such centres is planned to span the country within the next seven years.

To reduce the incidence of infants with congenital infections, women should be aware of and know prevention measures against maternal infection with mother-to-child infections during pregnancy. Our objective was to assess the awareness of and knowledge about mother-to-child infections in Japanese pregnant women. A survey of 343 Japanese pregnant women was completed. Awareness of 13 pathogens capable of mother-to-child transmission was surveyed. Knowledge about the transmission route, the most susceptible time of infection that may cause severe fetal disease during pregnancy, and methods to prevent maternal infection were investigated for four major pathogens (cytomegalovirus, rubella virus, Toxoplasma gondii, and parvovirus B19) and results were compared between these pathogens. The proportion of women aware of pathogens concerning TORCH syndrome was the following: rubella virus 76%, Treponema pallidum 69%, Toxoplasma gondii 58%, parvovirus B19 28%, herpes simplex virus 27%, and cytomegalovirus 18%. Only 8% knew how cytomegalovirus is transmitted, and only 12% knew how parvovirus B19 is transmitted; both were significantly lower than those who knew transmission routes for rubella virus or Toxoplasma gondii. The proportion of women who knew the most susceptible time for severe fetal infection by maternal acquisition of cytomegalovirus, Toxoplasma gondii, or parvovirus B19 was significantly lower than that for rubella virus. The vast majority of surveyed women were not aware of methods to prevent maternal infection with cytomegalovirus or parvovirus B19. In conclusion, current awareness of and knowledge about cytomegalovirus and parvovirus B19 infection are low in Japanese pregnant women.