Occupational Health Care Research Articles

Improving person-centered occupational health care for workers with chronic health conditions: a feasibility study

BackgroundPerson-centered care is needed to effectively support workers with chronic health conditions. Person-centered care aims to provide care tailored to an individual person’s preferences, needs and values. To achieve this, a more active, supportive, and coaching role of occupational and insurance physicians is required. In previous research, two training programs and an e-learning training with accompanying tools that can be used in the context of person-centered occupational health care were developed to contribute to this changing role. The aim was to investigate the feasibility of the developed training programs and e-learning training to enhance the active, supportive, and coaching role of occupational and insurance physicians needed for person-centered occupational health care. Information about this is important to facilitate implementation of the tools and training into educational structures and occupational health practice.MethodsA qualitative study was conducted, with N = 29 semi-structured interviews with occupational physicians, insurance physicians, and representatives from occupational educational institutes. The aim was to elicit feasibility factors concerning the implementation, practicality and integration with regard to embedding the training programs and e-learning training in educational structures and the use of the tools and acquired knowledge and skills in occupational health care practice after following the trainings and e-learning training. Deductive analysis was conducted based on pre-selected focus areas for a feasibility study.ResultsFrom an educational perspective, adapting the face-to-face training programs to online versions, good coordination with educational managers and train-the-trainer approaches were mentioned as facilitating factors for successful implementation. Participants underlined the importance of aligning the occupational physicians’ and insurance physicians’ competences with the educational content and attention for the costs concerning the facilitation of the trainings and e-learning training. From the professional perspective, factors concerning the content of the training and e-learning training, the use of actual cases from practice, as well as follow-up training sessions were reported. Professionals expressed good fit of the acquired skills into their consultation hour in practice.ConclusionThe developed training programs, e-learning training and accompanying tools were perceived feasible in terms of implementation, practicality, and integration by occupational physicians, insurance physicians and educational institutes.

Revisiting COVID-19 and Occupational Mental Health.

This cross-sectional study aimed to describe the frequency of psychological sequelae of COVID-19 in healthcare workers (HCWs) conducted at The Aga University Hospital, from May to July 2020. The data collection was done online using a demographics questionnaire, concern of COVID-19 scale, Generalised Anxiety Disorder, and Impact of event scale. A total of 560 responses were received. Nearly 25% of participants had moderate to severe anxiety or psychological distress due to COVID-19. Female responders reported more anxiety compared to males. (p= 0.001. The doctors and nurses reported significant psychological distress (p=0.046). The participants with moderate to severe anxiety and psychological distress reported statistically significant high levels of concern of the following: inadequate protective measures, contracting and spreading COVID-19, medical violence, and deteriorating quality of patient interaction due to COVID-19. The COVID-19 pandemic has highlighted areas of development for occupational healthcare policy development in Pakistan. Implementation of contextualised solutions, especially psychosocial determinants is necessary to mitigate the invisible mental health burden and its impact on HCWs in Pakistan. Key Words: Occupational mental health, Pakistan, Anxiety, Depression.

Ergebnisse einer Expertenbefragung zur Umsetzung der ganzheitlichen arbeitsmedizinischen Vorsorge in der betrieblichen Praxis

Results of an expert survey on the implementation of holistic occupational preventive healthcare in company practice Objectives: The aim of the Ordinance on Preventive Occupational Medicine (ArbMedVV) is to detect and prevent work-related diseases at an early stage, to provide employees with individual advice and to support employers in matters of occupational health protection. The prevention potential of a holistic approach to occupational healthcare has been indicated for some time and is being further reinforced with a recent amendment to the ArbMedVV. The aim of this study was to obtain assessments of the implementation of holistic occupational healthcare (GAMV) based on expert interviews with occupational health and safety stakeholders. Methods: Eleven expert interviews were conducted and evaluated with fourteen representatives from the units of the Committee for Occupational Medicine (AfAMed) at the Federal Ministry of Labour and Social Affairs (BMAS). The interview guide was based on the following model: On the one hand various factors influencing the implementation of the GAMV (e.g. legal and operational framework conditions) must be taken into account. With regard to the effects of the GAMV, a distinction must be made between expectations, the actual implementation observed, and the results achieved. In addition, derived aspects are to be considered. Results: It becomes clear that there are deficits in the (successful) implementation of the GAMV. Possible reasons include, for example, the legal framework, resource issues, structural and organizational aspects of occupational healthcare, and the motivation of and information acquired by those involved. Conclusions: The results indicate that the holistic approach to occupational healthcare formulated in the ArbMedVV requires increased awareness and implementation support. According to the experts, the new Occupational Medicine Rule (AMR 3.3) for the GAMV will be helpful. Keywords: occupational health care – holistic approach – ArbMedVV – expert survey

Quantification of 26 metals in human urine samples using ICP-MSMS in a random sample collective of an occupational and environmental health care center in Aachen, Germany

Despite several studies on metal exposure in the general population, the knowledge on the background burden of distinct metals is still sparse (e.g. Cu, In, Mn, Pb, Sn, Sr, Ta, Te). While up to date reference values exist for 16 distinct metals as Biological Reference Value (BAR) or the 95th percentile for Al, As, Ba, Be, Cd, Co, Cr, Hg, Li, Mo, Ni, Pt, Sb, Se, Tl and U respectively, the background burden of the general population for the remaining elements is unknown or yet no matter of scientific counselling. We established and validated an inductively coupled plasma triple quadrupole mass spectrometry (ICP-MSMS) human biomonitoring method (HBM), that enabled us to determine 26 metals in urine. Al, As, Ba, Be, Cd, Co, Cu, Ga, Gd, Hg, In, Li, Mo, Ni, Pb, Sb, Se, Sn, Sr, Ta, Te, Tl, V and Zn were analyzed. The method was applied to 88 urine samples collected in the ambulance of the Institute for Occupational, Social and Environmental Medicine (IASU) Aachen, Germany. Patients from two major metal processing companies (steel and copper) and a more heterogenous group of occupational exposed and non-exposed persons were defined and distinguished. HBM data from about 88, in general occupationally unexposed persons against certain metals served as a collective representing the general population in first approximation. For these the 95th percentiles are reported. Significant differences of urinary metal concentrations of the employees of the two metal processing companies compared to the third group were observed among others for Cu, Cr, Ni, Mn and are discussed, thus demonstrating the usefulness of the method for both environmental and occupational purposes.

“You Have to Keep in Mind That You’re Dealing with People's Lives”: How Hospital Service Workers Enact an Ethic of Care

The COVID-19 pandemic heightened the need to examine the health and safety of all workers, especially frontline workers, like hospital service workers (HSWs). Given ongoing pandemic-related challenges like healthcare labor shortages, attention to HSWs is essential. This paper draws from 3 waves of in-depth interviews conducted with HSWs from 2017 to 2020 to understand the evolving nature and challenges of their work from their perspectives. By analyzing the interviews, we found their approach to labor consistent with a feminist ethic of care. The ethic of care framework understands care as a public responsibility necessary for a functioning society. Workers perceived the ethic of care to be consistently violated by their employer, which contributed to poor working conditions, threatening the well-being of workers and patients alike. Drawing from workers' experiences and insights, the ethic of care framework can inform organizational changes to improve both occupational health and patient care.

Economic consequences of hospital closures

Hospitals anchor much of US health care and receive a third of all medical spending, including various subsidies. Nevertheless, some become insolvent and exit the market. Research has documented subsequent access problems; however, less is understood about broader implications. We examine over 100 rural hospital closures spanning 2005–2017 to quantify the effects on the local economy. We find sharp and persistent reductions in employment, but these localize to health care occupations and are more impactful in areas experiencing complete closures. Aggregate consumer financial health and housing markets appear unaffected by the shuttering of a rural hospital.

A survival analysis approach to determine factors associated with non-retention of newly hired health workers in Iran

Background and aimOne of the main tasks of the healthcare human resource management is to maintain and retain professional staff. The high level turnover of professional staff may reduce the quality of healthcare service delivery. Therefore, this study investigated the factors associated with the turnover of the newly recruited healthcare professionals using survival analysis method in Iran.Materials and methodsThis historical cohort analysis comprised 6811 employees who began working at Mashhad University of Medical Sciences between 2005 and 2020. Employees recruited at any of the university’s units between the years 2005 to 2019 were included. We used appropriate descriptive indices and Log-rank test and the Cox proportional-hazards model to assess the staff turnover. A significance level of 0.05 was used for all tests.ResultsThe findings of the survival analysis showed that the probability of turnover in one year, two years, and five years of employment were 0.12, 0.16, and 0.27. Based on the findings of the Log-rank test, the probability of turnover in entire of the study period was not statistically different between male and female (p = 0.573), and likewise between employees with healthcare occupations and non-healthcare occupations (p = 0.351). Employees whose current workplace and birthplace were not similar had a significantly higher probability of turnover (p < 0.001). Accordingly, the Cox regression result showed, the risk of turnover for the singles was 1.22 times higher than the married. For the Ph.D degree was 3.23 times higher compared to those with a diploma or an associate degree, and for a bachelor’s or master’s degree was 2.06 times more likely to change their workplace than those with a diploma or an associate degree.ConclusionPolicies promoting the recruitment of native-born professionals, given priority to the married candidates than single ones, and/or recurring candidates to pledge to stay in the locality of recruitment site can increase the staff retention and reduce the costs of staff turnover including re-hiring, initial and on-the-job training, accommodation, and other extra living consumptions away from home and family.

Competence and professionalisation among return-to-work coordinators in Sweden: comparisons by original profession

ABSTRACT Return-to-work coordinators (RTWC) support people on sickness absence and is a new healthcare occupation in Sweden. Its practitioners represent a variety of professions, there is no common undergraduate training and vague role and competence descriptions. The aim was to explore differences in training and competence according to original professions (occupational therapists, physiotherapists, counselling, and other professions) and coordinators’ views on which professions they believe provide the best competence for the role. All RTWCs (82) in one region were invited to answer a questionnaire (89% response rate). Mixed-methods analyses were applied. The results showed that counselling professions were more likely than other professional groups to have further training, particularly in conversation methods, and a lower proportion of them stated needing more knowledge about gender equality, social problems, insurance/benefit and conversation methods. The analysis of free-text answers identified three competence areas of importance: advice and guidance, a holistic view, and personality over profession. Occupational therapists and social workers were seen as having the best competence for the coordinating role. The results outline some common values, norms and important competences for RTWCs that could help develop the RTW coordination training and pave the way for RTWCs professionalisation process.

Management and Treatment of Traumatic Amputation of Phalanges by the Surgeon

The patient's life and capacity to carry out everyday tasks may be significantly impacted by traumatic phalange amputation. Motor vehicle collisions and occupational exposure are risk factors for traumatic phalange amputation. To maximize the preservation of the severed component and reduce complications, proper care and treatment of traumatic phalange amputation are essential. The successful reimplantation of the severed component using the PA approach has been demonstrated. Traumatic phalange amputation treatment options include surgical repair and reperfusion therapy. Yet, time is of the importance for a successful course of therapy, therefore prompt medical attention is essential. For the sake of patient safety and occupational health care, traumatic phalange amputation prevention is crucial. Traumatic injuries can be prevented through the use of personal protective equipment and training in occupational safety. As traumatic phalange amputation can have a significant impact on the function and appearance of the affected limb, which can affect the patient's ability to perform daily activities and self-esteem, it is important to provide a comprehensive approach to the patient's care that includes psychological and emotional support. In general, traumatic phalange amputation may be effectively managed and treated, which can greatly enhance the patient's quality of life and lessen the effects of the injury.

Patients' Experiences, Needs, and Expectations of Cooperation Between Medical Specialists and Occupational Health Physicians: A Qualitative Study.

Cooperation between clinical and occupational health care practitioners is a key aspect of clinical work-integrating care. This study aimed to gain insight into patients' experiences, needs, and expectations regarding cooperation between medical specialists and occupational health physicians. A thematic qualitative study was conducted involving a total of 33 participants in eight online focus groups. Participants indicated practitioners are currently working in an isolated manner. However, participants desired for partnership between specialists and occupational health physicians to address work-related concerns and showed a need for explanation of the consequences of their diagnosis, so this can be translated into their ability to work. Currently, cooperation between clinical and occupational health care is lacking. Yet, some participants experienced that these disciplines could complement each other by working together to support patients in work participation.

Occupational risk of SARS-CoV-2 infection: a nationwide register-based study of the Danish workforce during the COVID-19 pandemic, 2020–2021

ObjectiveMost earlier studies on occupational risk of COVID-19 covering the entire workforce are based on relatively rare outcomes such as hospital admission and mortality. This study examines the incidence of...

A narrative review of the impact of work hours and insufficient rest on job performance.

This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. Narrative review. Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

Occupational role and COVID-19 among foreign-born healthcare workers in Sweden: a registry-based study.

Many studies report that foreign-born healthcare workers (HCWs) in high-income countries have an elevated risk of COVID-19. However, research has not yet specifically evaluated the distribution of COVID-19 among foreign-born workers in different healthcare work groups. We examined the risk of COVID-19 infection and hospitalization among foreign-born HCWs in different occupational roles in Sweden. We linked occupational data (2019) of 783 950 employed foreign-born workers (20-65 years) to COVID-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the hazard ratio (HR) with 95% confidence intervals (95% CIs) of COVID-19 infection and hospitalization in eight healthcare occupational groups vs. non-HCWs and assessed whether region of birth modified the association between healthcare occupations and COVID-19. All HCWs had a higher risk of COVID-19 outcomes than non-HCWs, but the risk differed by occupational role. Hospital-based assistant nurses had the highest risk (infection: HR 1.78; 95% CI 1.72-1.85; hospitalization: HR 1.79; 95% CI 1.52-2.11); allied HCWs had the lowest risk (infection: HR 1.22; 95% CI 1.10-1.35; hospitalization: HR 0.98; 95% CI 0.59-1.63). The relative hazard of the outcomes varied across foreign-born workers from different regions. For example, the relative risk of COVID-19 infection associated with being a physician compared to a non-HCW was 31% higher for African-born than European-born workers. The risk of COVID-19 among foreign-born HCWs differed by occupational role and immigrant background. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help reduce COVID-19 risk among foreign-born HCWs.

Health check-ups as interventions for work disability management: supervisors and occupational healthcare follow the recommendations to a great extent

ObjectivesWork disability management is a problem globally. This study was designed to find out whether the initiation, process and outcome of health check-ups (HCUs) follow the national legislation and whether...

COVID-19, jobs and skills-Exploratory analysis of the job postings in the US and UK healthcare job market.

The COVID-19 pandemic has significantly affected all spheres of life, including the healthcare workforce. While the COVID-19 pandemic has started driving organizational and societal shifts, it is vital for healthcare organizations and decision-makers to analyze patterns in the changing workforce. In this study, we aim to identify patterns in healthcare job postings during the pandemic to understand which jobs and associated skills are trending after the advent of COVID-19. Content analysis of job postings was conducted using data-driven approaches over two-time intervals in the pandemic. The proposed framework utilizes Latent Dirichlet Allocation (LDA) for topic modeling to evaluate the patterns in job postings in the US and the UK. The most demanded jobs, skills and tasks for the US job postings are presented based on job posting data from popular job posting websites. This is obtained by mapping the job postings to the jobs, skills and tasks defined in the O*NET database for the healthcare occupations in the US. The topic modeling results clearly show increased hiring for telehealth services in both the US and UK. This study also presents an increase in demand for specific occupations and skills in the USA healthcare industry. The results and methods used in the study can help monitor rapid changes in the job market due to pandemics and guide decision-makers to make organizational shifts in a timely manner.

Outlook on Common U.S. Health Care Occupations: Benefits, Costs and Future Trends

Students anticipating a career in specific popular health professions need to balance salary, availability of training, enrollment, and predicted job growth against costs of tuition, training time and levels of degree requirements. Comparative data on these variables are also an important resource for undergraduate guidance counselors, yet this information is widely scattered through different professional associations, government and private databases. The research aim of this report is to compile data from public and private databases and professional association websites, and use this data to describe median salaries, job growth, tuition, training levels and opportunities for eleven health practitioner professions from vocational to professional doctorate. Although primary care physicians hold the highest levels of compensation, nursing and physician assistants hold the greatest ratio of compensation for time in training and per tuition dollar. Training programs available in these fields are readily accessible and are accommodating increased enrollment. There is a significant positive correlation between predicted future employment needs and enrollment for health professional programs. Baccalaureate nursing, nurse practitioners, and physician assistants are growing health careers with high predicted earnings, moderate time to training and tuition. Other doctoral professions offer similar compensation but require longer training. These current data serve as a useful guide to assist students and undergraduate counselors in identifying health carriers that best align student goals and finances.

Physical Activity Patterns, Satisfaction, and Quality of Life Among Nursing and non-Nursing Staff in an Office-Based Care Coordination Program.

Sedentary work is associated with poor health outcomes. Many healthcare occupations, including office-based care coordination, are largely sedentary. Many nurses do not achieve the recommended levels of daily physical activity, however, the physical activity levels among nurses working in care coordination are not known. To assess the physical activity levels, self-reported health and well-being, overall quality of life, and work-related satisfaction of office-based care coordinators, and compare these among nursing and non-nursing staff. This study collected objective physical activity data using accelerometry along with self-reported information on work-related quality of life and satisfaction from 42 healthcare staff working in a hospital-affiliated office-based care coordination program. Results were compared among nursing and non-nursing staff. Nurses had lower moderate-to-vigorous physical activity levels compared to non-nursing staff (25 min/day vs. 45, p = .007). There were no differences in daily sedentary time, light activity, or steps between nursing and non-nursing staff. Nurses reported high quality of life scores compared to non-nursing staff (4.4 vs. 4.1, p = .02), but similar levels of work-related quality of life, happiness, self-rated health, and well-being. Nurses working in an office-based care coordination program had lower levels of physical activity but reported a higher overall quality of life than non-nurse work colleagues working in a similar environment. Given known health risks associated with sedentary occupational work and the growing number of care coordination programs, health policies and initiatives aimed at increasing the physical activity levels of care coordination workers is of prime importance.

When Patients are Assailants: Valuing Occupational Risks in Health Care

AbstractIntentional violence against healthcare workers inflicts a physical and mental toll, motivating legislative proposals to better regulate these occupational risks. This article uses this context to address two novel issues for benefit assessment raised by injuries from assailants: potential heterogeneity in valuation based on the context of the injury risk and possible reductions in self-reported valuations when the exposed population has been trained to feel responsible for the risk. This article presents experimental evidence on workers’ preferences over the form of intervention: protection (risk reduction) or insurance (cost-sharing). The experiment also elicits worker valuations of occupational health care risks, calculating the value of a statistical injury (VSI), based on local wage-risk tradeoffs, in the general range of $200,000. Workers accord a premium to risk reductions that might eliminate the risk of injuries. Both the physical harm and the process by which the injury occurs may affect benefit assessments for the regulation of workplace violence. Non-healthcare participants require a $40,000 premium per expected injury resulting from intentional harm. While health care workers do not generally require such a premium, health care workers in clinical positions require more compensation to face occupational risks. Insurance coverage for monetary losses is more highly valued than protective measures for accidental harms, though there is no significant comparable preference for insurance against intentional harms. The results have important practical implications for addressing the concerning phenomenon of violence against healthcare workers, suggesting that expanding insurance compensation would be desirable, as would assigning an intentionality premium to intentional injuries.

Characterization of Cleaning and Disinfection Product Use, Glove Use, and Skin Disorders by Healthcare Occupations in a Midwestern Healthcare Facility.

Healthcare facility staff use a wide variety of cleaning and disinfecting products during their daily operations, many of which are associated with respiratory or skin irritation or sensitization with repeated exposure. The objective of this study was to characterize the prevalence of cleaning and disinfection product use, glove use during cleaning and disinfection, and skin/allergy symptoms by occupation and identify the factors influencing glove use among the healthcare facility staff. A questionnaire was administered to the current employees at a midwestern Veterans Affairs healthcare facility that elicited information on cleaning and disinfection product use, glove use during cleaning and disinfection, skin/allergy symptoms, and other demographic characteristics, which were summarized by occupation. The central supply/environmental service workers (2% of the total survey population), nurses (26%,), nurse assistants (3%), and laboratory technicians (5%) had the highest prevalence of using cleaning or disinfecting products, specifically quaternary ammonium compounds, bleach, and alcohol. Glove use while using products was common in both patient care and non-patient care occupations. The factors associated with glove use included using bleach or quaternary ammonium compounds and using cleaning products 2-3 or 4-5 days per week. A high frequency of glove use (≥75%) was reported by workers in most occupations when using quaternary ammonium compounds or bleach. The use of alcohol, bleach, and quaternary ammonium compounds was associated with skin disorders (p < 0.05). These research findings indicate that although the workers from most occupations report a high frequency of glove use when using cleaning and disinfection products, there is room for improvement, especially among administrative, maintenance, and nursing workers. These groups may represent populations which could benefit from the implementation of workplace interventions and further training regarding the use of personal protective equipment and the potential health hazards of exposure to cleaning and disinfecting chemicals.

A numerical tool for assessing human thermal safety and thermal comfort in cold-weather activities.

This paper describes a newly developed software tool to evaluate human thermal safety and thermal comfort in cold-weather activities aimed at guiding users to arrange activity plans and select appropriate clothing ensembles. The software inputs include conditions of activity, environment, human body, and clothing ensemble. It outputs physiological temperatures, cold injury risks, thermal sensations, and thermal comforts in intuitive ways like cloud maps and curves. The software tool is characterized by (1) integration of a thermoregulatory model that predicts human thermophysiological responses under exercise conditions in cold environments, (2) the functions of clothing ensemble database and individual parameter database, (3) the human centric outputs that directly reflect human physiological and mental status, and (4) the user-friendly operation interface and output interface, as well as a wide applicability. The software is validated with human test studies covering ambient temperatures from - 30.6 to 5°C, clothing ensembles from 1.34 to 3.20 clo, and activity intensities from 2 to 9 Mets. The average prediction RMSEs of core temperature, mean skin temperature, thermal sensation, and thermal comfort are 0.16°C, 0.45°C, 0.58, and 1.41, respectively. The software is an advanced expansion to current standards and guidance of cold exposure assessment and a meaningful tool for the fields of occupational health care, cold protection, and environmental ergonomics.