High-risk Professions Research Articles

Critical incidents and chronic stressors at work: their impact on forensic doctors.

Workers in medium- or high-risk professions are often confronted with critical incidents at the workplace. The impact of these acute stressors may be serious and enduring. Many workers also experience chronic job stressors, such as work overload or role conflicts. This study examined the frequently neglected relationship of acute and chronic stressors with self-reported health symptoms, such as posttraumatic responses, fatigue, and burnout This association was investigated in a sample of forensic doctors in the Netherlands (N = 84). It was found that the more traumatic events the respondents experienced, the more problems they reported in coping with the traumatic events. Chronic job stressors were associated with posttraumatic responses (intrusions and avoidances) and with burnout and fatigue.

Short Term Modafinil Use During Sleep Disorder Evaluations: Focus on High Risk Professions and Behaviors

Patients can present with undiagnosed sleep disorders. Modest fatigue can impair their neurological, functional and psychological capacities. Four patients demonstrated improved functioning on modafinil, during the months required for a complete sleep evaluation, specialist consults and successful treatment. Sleep disorders increase morbidity or mortality until definitive diagnosis and full treatment. In four patients, modafinil was immediately useful as a bridging medication over 3-7 months until final successful diagnosis and treatment. Even one month of significant fatigue is unacceptable. For example, driving a motor vehicle is dangerous with some sleep disorders. Falling asleep driving or involuntary “minisleep” at the wheel is a common cause of motor vehicle accidents.1 In the United States, sleep causes at least 56, 000 motor vehicle crashes each year, resulting in 1, 550 deaths.2 Over a year, 10% of men and 4% of women admitted to falling asleep while driving.3 Insight into drowsiness can be flawed, lagging behind electroencephalographic and other evidence that the process of falling asleep has actually started.4 In clinical care, the patient may be sleepy or fatigued, but not a clear risk to drive or work. Further, many occupations do not allow for fatigue, sleepiness and errors, e.g., truck drivers, heavy construction operators, nurses dispensing medications, pilots, boat captains, military and police personnel using dangerous equipment, and childcare workers with children. Modafinil was used because it may be more selective than traditional stimulants, has a low abuse potential, is already used in many specific sleep disorders, and has a reasonable safety record. Modafinil's mechanism as a waking agent appears to be a more selective than amphetamine or methylphenidate in cats, 5 possibly causing less emotional side effects in humans, e.g., agitation and rebound depression. Perhaps due to this proposed selectivity, modafinil receives low ratings for abuse desirability, 6 and with a low solubility in water and instability at high temperatures, I.V. injections and smoking were less likely. 7 These are some reasons that modafinil might be considered in light of the non-specificity and addiction potential of traditional stimulants. Modafinil has cognitive benefits in aviation alertness and functioning. 8, 9 It decreases fatigue in narcolepsy, obstructive sleep apnea, Parkinson's disease, multiple sclerosis, stroke and fibromyalgia.10,11,12,13,14,15 Also, medically fragile patients seemed to tolerate modafinil. Our patients were much healthier than those treated with Parkinson's disease, stroke and multiple sclerosis. These private patients were all waiting for a sleep specialist appointment. They read handouts on the common use of modafinil, e.g., narcolepsy. However, they understood they were trying it for the off-label purpose of daytime sleepiness. Rare questions were answered to their satisfaction.

Study of the impact of blood lead level on humoral immunity in humans.

The objective was to study the impact of blood lead level (BLL) on serum immunoglobulin levels (SIL; IgG, IgM, IgA) in people with high-risk professions. It has been characterized that BLL > or = 25 microg/dL can cause dysfunctions in different organ systems of the body, such as the immune system. A cross-sectional study was carried out in relation to this, by using a pretested questionnaire to collect data on demographic factors and socioeconomic status, which was completed by subjects studied, such as car battery shop workers, car painters and welders of car radiators and exhausts, printing office workers (typesetters and nontypesetters) who were aged between 15 and 70 years. Venous blood was sampled to measure the BLL (by atomic absorption spectroscopy) and SIL (by SRID). The results, when analysed, suggested a reduction in SIL with emphasis on IgG in comparison with standard levels.

The use of the general health questionnaire in the Australian defence force: A flawed but irreplaceable measure?

This article discusses the use of the General Health Questionnaire (GHQ-12) in the Australian Defence Force (ADF), but comment pertaining to stress measurement and considerations for management are equally applicable to the paramilitary and other high-risk professions. It is concluded that (a) prior to the widespread administration of a questionnaire designed to determine stress levels amongst ADF personnel, the defence research community should attempt to define stress in a conceptual, strategic, and operational fashion; (b) only after an optimal conceptual definition of stress has been operationalised can the defence research community attempt to accurately determine whether (and how) current stress levels are affecting the performance of personnel and begin to impart effective stress-management techniques to those in need; and (c) no one measure can replace the GHQ, which in itself has been inappropriately applied to the ADF population in an attempt to measure the extent to which personnel experience the debilitating effects of physiological and psychological distress.

What every health care professional should know about AIDS.

As more and more clients with acquired immunodeficiency syndrome (AIDS) are encountered in health care agencies, it is important that the health care professional be well informed with current facts and information on treatment. Supportive care by the health professional is essential to assist the client in maintaining maximum quality of life and a sense of self-esteem and self-efficacy. It is important for the professional to be aware not only of the supportive care needed by clients but also of the safeguards necessary in such a high-risk profession.

Exposure to Tick-borne Encephalitis (TBE) Virus and Borrelia burgdorferi s.l. in Agricultural Workers in Southwestern Germany

Tick-borne pathogens represent an emerging risk for infection in many rural areas throughout the world. In Europe, the most important infectious diseases transmitted by ticks are Lyme disease and tick-borne encephalitis (TBE). Due to the ecology of the vector, some professions, e.g., rural or forestry workers, are repeatedly exposed to ticks. However, few studies have compared seropositivity in high-risk professions with that seen in the non-exposed, general population. In southwestern Germany, a seroepidemiological study was conducted to assess the seroprevalence of antibodies against these two agents in agricultural workers and to quantify the specific occupational risk by comparison with prevalence data obtained from a previous seroepidemiological survey in forestry workers and the general population. The data from standardized questionnaires and a serum sample were obtained from 316 farmers and agricultural workers. Testing for TBE antibodies was carried out with a commercial enzyme-linked immunosorbent assay (ELISA), for Borrelia burgdorferi (B. burgdorferi) antibodies by immunofluorescence test (IFT). Statistical analysis revealed that vaccinated agricultural workers and farmers came from farms with significantly more forestry work (p < 0.01) and more pastures (p < 0.05) than unvaccinated individuals. Unvaccinated individuals worked on larger vineyards than vaccinated ones (p < 0.05). Tick-bites were reported more often by vaccinated than by unvaccinated agricultural workers (p < 0.001) indicating, that the population group with the highest risk for tick exposure had been protected against TBE by vaccination. Compared to the general population, agricultural workers had a significantly increased relative risk (RR = 4.5; p < 0.05) for infection with Borrelia burgdorferi s.l., forestry workers were even more likely to get infected with this pathogen (RR = 7.6; p < 0.001) or TBEV (RR = 4.4; p < 0.05).

Prevalence and risk factors of upper extremity cumulative trauma disorder in dental hygienists

Cumulative trauma disorder (CTD) refers to a number of conditions arising from overuse of joints or soft tissues. The common risk factors that contribute to the development of these disorders are related to personal and occupational variables. Job analysis of the tasks performed by the dental hygienist have shown that this occupation is particularly at risk. The objectives of this study were to determine the prevalence of CTD symptoms amongst dental hygienists in Israel and to identify which are the factors that are related to CTD. A questionnaire including items concerning demographic data, employment history, professional occupational information, use of instrumentation, and CTD symptomatology was mailed to all 530 registered dental hygienists. Two hundred forty-six hygienists (46%) returned the questionnaire; 63% of the respondents were classified as CTD 'sufferers', Age, year of graduation, hours worked per week, and frequency of changing instruments were found to be significantly related to CTD symptoms. Hygienists at high risk included those aged 50 years or more (Odds ratio, OR = 6), those who graduated before 1986 (OR = 3), those who work more than 34 h per week (OR = 2.5) and those who change two or fewer instruments per patient (OR = 2). The major recommendation resulting from this study is to make dental hygienists aware that they work in a high-risk profession. It is hoped that increased awareness of the risk will spur the hygienist to make appropriate work practice, administrative, and engineering modifications and to seek treatment at the first indication of CTD symptoms.

Revisión teórica acerca del “burnout” en entrenadores: aportaciones del síndrome en la profesión de entrenador

In this article, we present a critical revision of the most relevant research about burnout in coaches. We analyse the aspects that have supported the establishment ofresearchthemes allowing a better understanding ofthe syndrome in this context. The coaching profession is a high risk profession, because of the intense interactions that must be established with other persons in the sports context and the strong pressures beared. We put forward a theoretical model that could help explain the origin and development of burnout in coaches.

Are Universal Precautions Realistic?

In concluding whether universal precautions are necessary, it certainly appears that we need something to reduce the significant problem of HIV transmission to health-care providers. As occupational risk goes, it exceeds the occupational risk of a number of other high-risk professions. Unfortunately, we do not know if universal precautions are effective. We also do not know the true compliance rate in use of universal precautions, nor whether they have an impact on transmission even if effectively used. What are the alternatives? They are not great, but some have not been adequately explored or implemented. Re-engineering around needle use in the hospital is clearly the most likely area to produce concrete results, because needlesticks are overwhelmingly the greatest source of infection, but this has not been encouraged to the degree it could be, even with systems already developed. Universal testing does not appear to be a viable alternative, for numerous reasons already discussed. Finally, are universal precautions more important for other pathogens than HIV? I would say yes. Hepatitis B, hepatitis C, and nosocomial infections are more important both as public health issues and as health-care provider prevention issues. If universal precautions are effective in reducing any of these, they are worthwhile.

Historical Perspectives on Law, Medical Malpractice, and the Concept of Negligence

Since the dawn of human history, the inherent morbidity and mortality of human beings has made the diagnosis and treatment of human disease a high-risk profession. The ancient risk of physical retribution against the physician has been replaced by the modern risk of economic indemnity or compensation. Monetary settlements and awards are at times so huge that they may result in personal bankruptcy and professional disgrace. This article should not discourage health care providers from continuing their pursuits, but encourage them to enhance their knowledge about how and why medical malpractice has developed. It has been intended to facilitate the "prudent practitioner" with a more thorough understanding of some of the elements of negligence that have caused concerns in the past and will certainly create new concerns as science continues to drag the law in its wake.

Occupational Risks in Dentistry: Comforts and Concerns

Dentistry has been portrayed as a high-risk profession in recent reports. A look at several areas of concern, however, shows that the field is no more hazardous than any other profession--and less than most.

Should Radiofrequency Current Ablation be Performed in Asymptomatic Patients with the Wolff‐Parkinson‐White Syndrome?

The exiting new method of ablation of accessory pathways using radiofrequency current applied by catheters will dramatically change our therapeutic decisions in these patients in the near future. This brief survey reviews the existing literature about the risk of the disease as well as of the procedure of catheter ablation. From these data, the risk of sudden death appears to be extremely low in asymptomatic Wolff-Parkinson-White (WPW) individuals. Side effects of catheter ablation may result from the invasive procedure as well as from radiation exposure (the latter to the patient as well as to operating physicians). While the complication rate in experienced centers is extremely low, a multicenter registry of the success and complication rate is urgently needed in view of the many centers starting with catheter ablation. Based on a subjective benefit-to-risk analysis, asymptomatic WPW individuals should be offered catheter ablation only under special circumstances (high risk profession, athletes, family history of sudden death). On the other hand, catheter ablation need not be and should not be considered generally in asymptomatic individuals with WPW pattern. Finally, this author cannot imagine that the energy, time, and money spent for mass screening and eventual catheter ablation of asymptomatic WPW individuals with its attending risks can be outweighed by the potential benefits for these asymptomatic individuals.

Safety in fishing — learning from experience

This article critically examines the level of safety in some sections of the UK fishing industry not only by looking at the available statistics but also by examining actual recent case histories. In 1989 the UK Department of Transport established the Marine Accident Investigation Branch (MAIB). Case histories published by MAIB have been taken as the basis for the article in order to illustrate and draw lessons from incidents that occur in fishing. Fishing will always be a high risk profession but there are ways in which risks can be diminished. Many of the problems are due to vessels being built below the 12 m threshold at which the 1975 Safety Rules currently apply. Some of the vessels lack adequate reserve stability to withstand capsize in the dynamic situation and there are deficiences in design and safety equipment. The training programmes introduced by Seafish for Survival, Fire Fighting and First Aid are now mandatory for all new entrants and these have almost certainly resulted in the saving of lives. However, there needs to be a much greater awareness of accident prevention and the article makes a plea for this to be given more attention. Each case study is probably unique or there are some specific circumstances as to why the accident happened. Nevertheless, there are always underlying lessons to be learnt from every incident of this type, even if there is no loss of life or serious injury.

Rabies and brucellosis immunization status and adverse reactions to rabies vaccines in veterinary students

Rabies pre-immunization has been recommended for high risk professions, including veterinarians. Cell-cultured rabies vaccines have considerably reduced the risk of post-vaccination neurological reactions found in earlier vaccines. However, some adverse reactions have been reported with Human Diploid Cell Vaccines. 329 French veterinary students were surveyed about their rabies and brucellosis vaccination status, the occurrence of adverse reactions to rabies vaccine, and their antibody titer monitoring practices. Questions also were asked to determine if mandatory rabies pre-exposure immunization upon entry to veterinary school motivated students to maintain their rabies pre-exposure vaccination. The overall vaccination rate was 98.5% for rabies and 17% for brucellosis. 19% of the rabies vaccinated students reported some form of adverse reaction, whatever the vaccine brand used, but none experienced systemic allergic reaction. Adverse reactions were twice more frequent in female than male students and were more frequent after primary series than revaccination series (Relative Risk = 1.76). Despite the mild reactions encountered, rabies pre-exposure vaccination has been well-accepted by French veterinary students. In contrast, vaccination against brucellosis was not as well-accepted for prophylaxis.

AIDS in Uganda as a gender issue.

This qualitative evaluation is based on data gathered during field trips to Uganda between 1981 and 1988. The first part of the paper describes the official view on prevalence (in 1988 Uganda, with 5455 reported cases, had the third highest prevalence of AIDS in Africa with the disease transmitted largely through heterosexual relations), the official view on the disease origin (the index case of AIDS occurred in 1983 in Kasensero village in the Rakai district), and the official control efforts (acknowledgement and publication of the magnitude of the epidemic and a 5-year prevention and control program with educational, medical, and epidemiological measures). The second part of the paper discusses public perceptions towards AIDS and its victims and highlights beliefs that assign a supernatural etiology to AIDS, social discrimination of AIDS victims, the consequences of the disease on the family and on sexuality and nuptiality. The next section looks at the impact of AIDS on health seeking behavior and the delivery of health care and notes that the private health delivery system has probably contributed to the spread of AIDS because of the use of unsterilized instruments, that unscrupulous practitioners are claiming cures, and that some people avoid health facilities for fear of infection. The fourth topic considered is the risk of HIV transmission because of sexual harassment perpetrated against women. This is followed by an assessment of 1) the affect of AIDS on women's reproductive rights and the controversy about transmission of the virus in breast milk, 2) the situation faced by women in high-risk professions, and 3) the acceptability of the condom. The paper ends by summarizing the policy and research implications revealed by this qualitative study.

Presidential Address: Psychiatry, a high-risk profession. Response to the Presidential Address.

Presidential Address: Psychiatry, a high-risk profession. Response to the Presidential Address.

Presidential Address: Psychiatry - A High-Risk Profession

Presidential Address: Psychiatry - A High-Risk Profession

Presidential Address: Psychiatry, a high-risk profession.

Presidential Address: Psychiatry, a high-risk profession.

The use of dental characteristics in the identification of human remains: A preliminary study

Dental characteristics often provide valuable information in establishing postmortem individual identification of unknown human remains, especially when conventional soft-tissue criteria cannot be used. This report proposes that routine antemortem dental records can be used for information storage and retrieval so as to assist in establishing individual postmortem identity. Such a system would be of particular use for personnel in the high-risk professions. In a limited pilot study conducted on 100 adults, information obtained on panoramic radiographs was successfully used to establish probable individual identity from simulated postmortem fragments.