Occupational Health Care Research Articles

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.

A comparative analysis of the work environments for registered nurses, nurse aides, and caregivers using the 5th Korean Working Conditions Survey

BackgroundSince the quality of work life of healthcare workers is affected by various factors, an improvement in their work environment can reduce the burden on them, increasing their performance. This study aimed to identify the current problems in working environments for registered nurses (RNs), nurse aides (NAs), and caregivers using the 5th Korean Working Conditions Survey (KWCS), presenting measures to improve working conditions by analyzing their predictors: 1) degree of exposure to work-related risk factors (musculoskeletal and mental), 2) working patterns, 3) work-family balance, 4) work situations, and 5) self-rated health.MethodsThe sampling frame was a list of apartment and general survey zones, excluding islands, dormitories, special social facilities, tourist hotels, and foreigner zones, among the total survey zones of the 2010 Population and Housing Census. The KWCS was given to 50,205 participants of various occupations, and responses from 494 RNs, 201 NAs, and 505 caregivers were extracted to compare their 1) degree of exposure to work-related risk factors (musculoskeletal and mental), 2) working pattern, 3) work-family balance, 4) work situations, and 5) self-rated health.ResultsThe response rate was 0.449. There were significant differences in all the variables (exposure to musculoskeletal and mental work-related risk factors, working pattern, work-family balance, work situations, self-rated health, and satisfaction with working conditions) among RNs, NAs, and caregivers (p < 0.001). The degree of work-related musculoskeletal and mental risk exposure was higher among caregivers and RNs than among NAs; irregular working patterns, challenges with work-family balance, and work environment satisfaction were higher among caregivers than among NAs. In addition, work situations were poorer among caregivers and NAs than among RNs. Self-rated health was the highest among caregivers, followed by RNs and NAs. The most potent predictor of self-rated health was occupation, followed by work environment satisfaction and work-family balance; the most potent predictor of work environment satisfaction was self-rated health, followed by degree of exposure to work-related musculoskeletal and mental risk factors, occupation, work-family balance, work situation, and working patterns.ConclusionThis study confirmed that a variety of factors influence work environment satisfaction. Thus, practical and realistic measures to improve work environments tailored to each healthcare occupation should be developed at the national and community levels. Further qualitative studies are needed to analyze the work environments of nurses and other care workers in depth.

Prepandemic Mental Health and Well-being: Differences Within the Health Care Workforce and the Need for Targeted Resources.

Occupational stress and diminished well-being among health care workers were concerning even before the coronavirus disease 2019 pandemic exacerbated existing stressors and created new challenges for this workforce. Research on the mental health of health care workers has focused on physicians and nurses, with less attention to other occupations. To assess pre-coronavirus disease mental health and well-being among workers in multiple health care occupations, we used 2017 to 2019 data from the Behavioral Risk Factor Surveillance System. Across the health care workforce, insufficient sleep (41.0%) and diagnosed depression (18.9%) were the most common conditions reported. Counselors had the highest prevalence of diagnosed depression. Health care support workers had elevated prevalences for most adverse health conditions. Ensuring a robust health care workforce necessitates identifying and implementing effective occupation-specific prevention, intervention, and mitigation strategies that address organizational and personal conditions adversely affecting mental health.

Adoption of electronic health records in Saudi Arabia hospitals: Knowledge and usage

BackgroundSaudi Arabia is paying a high attention to medically serve patients through advanced healthcare including: electronic health records (EHR). It is an electronic version of patient medical history that may incorporate essential administrative, clinical, laboratorial, radiological information. Locally, there were many researches and studies conducted to measure the awareness and implementation of e-health technologies including EHRs in Saudi Arabia. However, the aim of this research is to investigate the knowledge and usage levels of EHRs among different health care providers in Saudi Arabia. Materials and MethodsBy using a survey, this cross-sectional study is conducted to examine the knowledge and usage levels of EHRs among different health care providers at different sized hospitals from different provinces in Saudi Arabia. Statistical Analysis System software was employed in this study's analysis. ResultsThere were 521 participants from different healthcare occupations involved to examine the knowledge and usage levels of EHRs in Saudi Arabia. 84.84 % of those participants are Saudis while 15.16 % of them are non-Saudis. 54.52 % of the participants are males while 45.48 % of them are females. Most participants were in the age group 31–40 years. ConclusionsIt is showing a high rate of knowledge and usage levels among both Saudi and non-Saudi healthcare providers in Saudi Arabia. Also, the using of EHRs for patients’ services in hospitals have been increased including: laboratory reports, medication prescription, following up, and hospitalization. However, there might be a little lack of participants' skills of using EHRs because of the lack of attending training programs of EHRs.

New paths to interprofessional collaboration: collaboration between assistant practitioners and practice nurses in general and occupational health care

Background: To this date, there is little to no interprofessional collaboration between professionals in general and occupational health care in the Netherlands. Where earlier initiatives for improvement focused on general practitioners (GPs) and occupational physicians (OPs), we examine the role that professionals working under task delegation of GPs and OPs can play in addressing problems on multiple life domains as well as in interprofessional collaboration.Methods: We conducted three focus group interviews with 7assistant practitioners (APs) in general practice, 11practice nurses (PNs) in general practice and 8APs in occupational health practice.Results: All PNs and APs in our study are confronted with multi-domain problems and see arole for themselves in addressing these problems. Moreover, in case of multi-domain problems, they acknowledge the relevance of interprofessional collaboration to provide good care. At this moment, however, there is practically no collaboration at the level of PNs and APs. Challenges are found in the formal task delegation and role identity of the APs in occupational health practice, unfamiliarity and prejudices among especially general practice PNs and APs regarding occupational health care, and practical barriers as privacy laws and reachability.Conclusion: Interprofessional collaboration among PNs and APs in general and occupational health care is possible, provided that asolution is found for fundamental and practical challenges. Potential solutions are to shift the focus from sharing medical information to communicating about the needs of working patients to function healthily on multiple life domains, to address interprofessional collaboration in educations, to adapt consultation protocols to include work and to organize joint meetings between professionals in general and occupational health practice. Finally, addressing structural barriers such as privacy laws and financing requires political action.

Hepatitis A and hepatitis B infection risk among employees at schools for disabled pupils

Aim of this project was to assess occupational biological hazards with regard to the risk of hepatitis A (HAV) and hepatitis B (HBV) and the need for occupational health care in schools for pupils with special needs. Teachers and educational specialists were surveyed about activities potentially providing exposure to biological agents and their individual immune status regarding HAV and HBV by a detailed questionnaire. Descriptive analyses, group comparisons and logistic regression were performed to identify factors influencing the HAV and HBV immune status. 1398 teachers and educational specialists took part. 1381 respondents reported having physical contact with pupils at work (98%). Daily contact was reported by up to 84% of all employees. Being scratched, bitten or spat at was reported by up to 93%. Hazardous activities are performed by both teachers and educational specialists. The vaccination rate was reported to be 58% for HAV and 64% for HBV. In regression analyses, failing to receive vaccine counselling [HAV: aOR 0.36 (95% CI 0.28; 0.46; p < 0.001), HBV: aOR 0.43 (95% CI 0.33; 0.55; p < 0.001)] or non-participation in infection prevention instruction [HBV: aOR 0.54 (95% CI 0.39; 0.75; p < 0.001)] were found to be significant predictors of low vaccination rates. Employees who are at risk due to occupational exposure should be instructed about infection prevention and vaccination against HAV and HBV.

Toward a ‘green allopathy’? Naturopathic paradigm and practice in Ontario, Canada

Epistemic tensions have long been evident within naturopathy, a heterodox healthcare occupation licensed across much of North America. Naturopaths less inclined toward bioscientific explanatory and evidentiary norms have long used the trope of the ‘green allopath’ to critique the practices of their more biomedically- (i.e., ‘allopathically’) inclined colleagues. Using the ‘green allopathy’ narrative as a conceptual starting point, this work uses a qualitatively-driven, mixed methods design involving interviews (n = 17) and a census-style survey (n = 366) to characterize the paradigmatic and practice patterns of licensed naturopaths in Ontario, Canada between 2017 and 2019. At odds with many interviewees' accounts, survey results suggest that the occupation's overall epistemic character, aligned with the concept of holism, has not changed much over the last two decades. Nevertheless, findings suggest notable changes in Ontario naturopaths' clinical practice patterns over the same period, including: more frequent use of botanical medicines, nutritional supplements and acupuncture; less frequent use of physical medicine (e.g., massage, hydrotherapy); and, an overall reduction in homeopathic usage. Controlling for other factors, older naturopaths are more likely to rely often on non-biomedical diagnostic modes (p = 0.042), suggesting an emerging shift, in practice, toward a ‘green allopathy’. Naturopaths' widespread ongoing engagement with therapeutic modalities whose epistemic premises diverge strongly from conventional biomedicine (e.g., homeopathy, East Asian medicine), appears mediated by the increasing body of related bioscientific evidence, and by gender and age (p-values <0.05). Gender and age also significantly predict naturopaths' alignment with more pharmaceutically-oriented care (p values < 0.05). Though naturopathy's ‘green allopathization’ appears underway, the demographic predominance of women within the profession may temper this trend in the years ahead.

Pilotstudie zur arbeitsmedizinischen Online- Vorsorge bei Tätigkeiten an Bildschirmgeräten

Pilot study of online occupational healthcare for workers using visual display units (VDUs) Objective: Public employees at state schools in Rhineland-Palatinate use visual display units in the course of their work. For the doctors at the Institute for Teacher Health, the question arose as to whether a medical consultation leading to appropriate occupational health interventions for workers using VDUs according to “ArbMedVV” could be held online. To test this idea, the study was to apply an orienting online eye test and evaluate it with regard to practicability and benefit. Method: School staff who had applied for special visual aids for use with VDUs were offered advice via online video consultation including an orienting online eye test. A standardised questionnaire served as an interview guide for the purposes of ascertaining medical history and for documentation. The results of the questionnaire and the orienting online eye test were managed in a database and evaluated descriptively for this paper. Results: Thirty consultations (26 online video consultations, 4 telephone consultations) were held during the evaluation period (22.12.2021 to 26.07.2022). Employees of vocational colleges were the most frequent participants (27 %). All employees reported complaints when working with screens. The combination of visual and shoulder/neck complaints was the most common complaint constellation (16 people, 53 %). In the majority of cases (70 %), the employees achieved a good to very good result in the orienting online eye test. Based on the comprehensive anamnesis and observations made during the video consultation, all persons received detailed advice and an occupational medical recommendation for special visual aids for their work with VDUs. Conclusion: Online occupational healthcare for VDU workers via online video consultations including an online eye test has proven to be practicable in the group presented here. A standardised questionnaire for anamnesis and documentation has demonstrated its worth. The orienting online eye test provided important information, especially through observating the employees during the procedure. The value of the orienting online eye test should be validated in comparison with conventional eye tests according to Occupational Medical Rule (AMR) 14.1. Keywords: occupational healthcare (ArbMedVV) – online eye test – school staff – visual display units

Singleplex, multiplex and pooled sample real-time RT-PCR assays for detection of SARS-CoV-2 in an occupational medicine setting

For workplaces which cannot operate as telework or remotely, there is a critical need for routine occupational SARS-CoV-2 diagnostic testing. Although diagnostic tests including the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel (CDC Diagnostic Panel) (EUA200001) were made available early in the pandemic, resource scarcity and high demand for reagents and equipment necessitated priority of symptomatic patients. There is a clearly defined need for flexible testing methodologies and strategies with rapid turnaround of results for (1) symptomatic, (2) asymptomatic with high-risk exposures and (3) asymptomatic populations without preexisting conditions for routine screening to address the needs of an on-site work force. We developed a distinct SARS-CoV-2 diagnostic assay based on the original CDC Diagnostic Panel (EUA200001), yet, with minimum overlap for currently employed reagents to eliminate direct competition for limited resources. As the pandemic progressed with testing loads increasing, we modified the assay to include 5-sample pooling and amplicon target multiplexing. Analytical sensitivity of the pooled and multiplexed assays was rigorously tested with contrived positive samples in realistic patient backgrounds. Assay performance was determined with clinical samples previously assessed with an FDA authorized assay. Throughout the pandemic we successfully tested symptomatic, known contact and travelers within our occupational population with a ~ 24–48-h turnaround time to limit the spread of COVID-19 in the workplace. Our singleplex assay had a detection limit of 31.25 copies per reaction. The three-color multiplexed assay maintained similar sensitivity to the singleplex assay, while tripling the throughput. The pooling assay further increased the throughput to five-fold the singleplex assay, albeit with a subtle loss of sensitivity. We subsequently developed a hybrid ‘multiplex-pooled’ strategy to testing to address the need for both rapid analysis of samples from personnel at high risk of COVID infection and routine screening. Herein, our SARS-CoV-2 assays specifically address the needs of occupational healthcare for both rapid analysis of personnel at high-risk of infection and routine screening that is essential for controlling COVID-19 disease transmission. In addition to SARS-CoV-2 and COVID-19, this work demonstrates successful flexible assays developments and deployments with implications for emerging highly transmissible diseases and future pandemics.

Evaluation of an e-learning on involving significant others in occupational health care

Abstract Background Significant others (SOs) like partners, family members or friends can play an important role in how workers cope with chronic disease, thereby influencing work and health outcomes. Despite the potential benefits of involving SOs in the return-to-work (RTW) process of workers with chronic diseases, guidance and training on how to manage this is scarce. Educating work and health professionals on this topic could lead to better RTW support for workers and prevention of long-term sickness absence. Objectives This study aimed to determine the effectiveness of an e-learning for improving occupational health physicians’ (OHPs) knowledge, attitudes, and self-efficacy regarding involving SOs in the RTW process. In addition, we explored OHPs’ responses to and satisfaction with the e-learning. We conducted a randomized controlled trial with 87 OHPs, involving an intervention group and a waitlisted control group. Between-group differences in knowledge, attitude, self-efficacy outcomes, and retention of effects were assessed using ANOVA and paired t-tests. Reactions to the e-learning were analyzed with descriptive statistics and thematic analysis. Results We found moderate to large effects on OHPs’ knowledge (p &amp;lt;.001, ηp2 = .202), attitudes (ηp2 = .098), and self-efficacy (p &amp;lt; .001, ηp2 = .237), with retention of all changes at 10-week follow-up. OHPs graded the e-learning with a mean score of 7.9 out of 10 (SD = 1.11) and indicated that the e-learning increased their awareness of the role of SOs in RTW and encouraged them to address this more often. Conclusions The developed e-learning is the first evidence-based training to improve the knowledge, attitudes, and self-efficacy of OHPs with regard to involving SOs in the RTW process of workers with chronic diseases. The e-learning and accompanying materials can encourage work and health professionals to more often address the role of significant others in the work re-integration process. Key messages • The developed e-learning is effective in increasing occupational health physicians’ knowledge, attitudes and self-efficacy with regard to involving significant others in the return-to-work process. • The e-learning and accompanying materials can encourage professionals to more often address the role of significant others in the work re-integration process to prevent long-term sickness absence.

Occupational role and Covid-19 among foreign-born healthcare workers: a registry-based study

Abstract Background Studies have shown an elevated risk of Covid-19 among foreign-born healthcare workers (HCWs), but data on the distribution of the risk in different occupational roles are lacking. Such data are needed for the effective control of Covid-19 risk among HCWs. Here, we examined the risk of Covid-19 infection and hospitalization in foreign-born HCWs in different occupational roles in Sweden. Methods We prospectively linked occupational data (2018-2019) of 783950 employed foreign-born (20-65 years) workers to Covid-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the risk of Covid-19 infection and hospitalization in foreign-born HCWs in eight different occupational groups compared to non-HCWs, and to assess whether the associations varied by region of birth. The analyses were adjusted for sociodemographic and socioeconomic factors, comorbidities, and Covid-19 vaccination. Results All HCWs had a higher risk of Covid-19 outcomes than non-HCWs, but the risk differed by occupational role. Assistant nurses had the highest risk both for Covid-19 infection (HR 1.80; 95%CI 1.74-1.87) and hospitalization (HR 1.85; 95%CI 1.57-2.18); other allied HCWs had the lowest risk (infection: HR 1.23; 95%CI 1.11-1.36; hospitalization: HR 1.02; 95%CI 0.63-1.67)). In some healthcare occupations, the relative risk of Covid-19 varied by region of birth. For example, physicians and dental nurses/hygienists of African and Asian origin had a higher risk of Covid-19 infection than European-born in the same occupation. In contrast, European-born assistant nurses had a greater risk of both outcomes than non-European-born in the same occupation. Conclusions The risk of Covid-19 among foreign-born HCWs varied by occupational role and region of birth. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help to reduce Covid-19 risk among foreign-born HCWs. Key messages

The effect of vocational rehabilitation on the use of health care services in Finland

Abstract Background Because vocational rehabilitation is a separate service from other health services, there may be interruptions at their interface. We examined whether the use of health services changes before and after rehabilitation. Methods Longitudinal individual-level register-based data was utilized on all individuals aged 15-60 living in the city of Oulu, Finland and starting vocational rehabilitation in 2014-2015 (N = 792). We compared their use of outpatient health care services in 3-month periods from 1.5 years before to 1.5 after the rehabilitation period to the total population of the same age and to the propensity score matched controls. Several socio-demographic factors and sickness and employment histories were used for matching. Results According to the preliminary results, rehabilitees had on average 1.5 visits to outpatient health care services in the 6th quarter before the start of rehabilitation, twice that of the total population. In the 4th quarter before the start of rehabilitation, the number increased to 1.8. After the rehabilitation period, the quarterly number of visits were at the same level as in the beginning of the follow-up. The biggest changes took place in the use of occupational health services. Changes were modest in public health care services. In other services changes were minimal. Compared to the propensity score matched controls, vocational rehabilitation did not appear to have an effect on the use of health care services. Conclusions The use of health care services is more common before vocational rehabilitation than after it. The effect of rehabilitation on the use of health care needs further analysis. Key messages • The pattern of the use of health care services changes in the course of vocational rehabilitation. The changes are mainly due to visits in occupational health care services. • The use of health care services is most common before rehabilitation. However, vocational rehabilitation does not appear to have an effect on the use of outpatient and inpatient health care services.

Why I became an Occupational health Practitioner

In June 2013 I joined a private hospital which had just signed a contract with a local Mining organization. I was assigned to manage the contract as a site manager/company doctor. It was in the deep rural areas of Botswana. I had just finished my medical internship, I had no management background and no occupational health/medicine background. In fact, I did not even know how to take a proper occupational health history. The scope of the project was broad. It covered managing day-to-day operations of the mine clinic which included both occupational health and primary care services. The field of occupational health is broad and covers the prevention of illnesses arising out of employment, work-related injuries and disorders, and all aspects of the interactions between work and health. Occupational health professionals should be involved in the design and selection of health and safety equipment, appropriate methods and procedures and safe working practices. They should encourage workers’ participation in this as well as providing feedback from experience. I was also expected to do daily patient consultations, attend management meetings and advise the Company.

Public Perceptions of Normal and Ideal Head Shape: A Crowdsourced Survey Analysis

Background: Cephalic index (CI) is an objective measure of head shape used by craniofacial surgeons to support a diagnosis of head shape abnormality. However, the consensus on what values correspond to a normal head shape are changing following the Back to Sleep campaign. Recent work has shown an increase in mean CI from 74 to 84. Following this shift, no study has been undertaken to evaluate whether the perception of normal head shape has changed as well. Methods: About 1020 subjects, 18 or older, were recruited through Amazon Turk crowdsourcing platform. Subjects were asked to select the head shapes they considered most normal in a series of questions identifying ideal head shape in children 6 months or younger. Demographic information was recorded for study participants to identify differing ethnic perceptions of head shape. Results: The mean cephalic index preferred by a crowdsourced population was 81.84 (SD 2.48). There was a difference in mean preferred CI between people who identified as black (CI = 82.875) and people who identified as white (CI = 81.500; P = .00062). There was no difference in mean preferred CI between males and females. Education level, age healthcare occupation status, medical literacy, and work involving children did not affect preference. Conclusions: The typical head shape has changed following the Back to Sleep campaign and the current perception of head shape aligns with the newly described norm as opposed to the historic population data. Criteria for intervention and outcome goals should be adjusted accordingly.

Spatial–temporal dynamics and determinants of creative class concentration—A study on urban agglomerations in China

AbstractThe knowledge spillover effects and the uneven spatial distribution of the creative class have attracted much attention from academia and politicians. Our study provides a comparative quantitative analysis of the spatial–temporal evolution and determinants of creative class concentration in three Chinese agglomerations: Beijing–Tianjin–Hebei, the Yangtze River Delta, and the Pearl River Delta, based on the panel data of 2011, 2012, and 2016 at the city level. It is found that the concentration of the creative class in the three above‐mentioned urban agglomerations in China has clear place‐specific differences. Results from the 2SLS regressions show that social tolerance is significantly and positively correlated with the creative class, but has no effect on the distribution of human capital in the three urban agglomerations. The level of economic development and also the degree of living convenience appear to be the main factors influencing the relative density of creative class (RDCC), while industry structure, university and Hukou all have positive effects on the RDCC in the three urban agglomerations. Moreover, the relative importance of the determinants varies according to the creative occupations. For major creative occupations, they are more inclined to concentrate in cities with high social tolerance, optimal industrial structure, high Hukou availability and qualified universities. For finance and health care occupations, cities with a comfortable climate are more attractive to them; while for management groups, cities with optimal industrial structure, high Hukou availability and adequate educational services are more attractive to them.

Labor market tightness and individual wage growth: evidence from Germany

It is often stated that certain occupations in Germany, because of “Demographic Change “, are dwindling, implying a labor shortage. We investigate the 10-year wage growth of young employees entering the labor market in different occupations. Our findings suggest that regional labor market tightness in occupational fields significantly explains wage growth. Individuals who start their careers in a tighter labor market enjoy higher wage growth than workers in more relaxed labor markets. We identify some occupational fields where the effect is especially strong, such as several engineering groups, IT occupations, technicians, and some commercial occupations. Interestingly, health-care occupations reveal a reverse relation.

The Recent Challenges of Medical Education in Georgia and the Ways to Deal with - Our Approach

It is generally believed that a global education crisis occurs within the health care occupations. There are several reasons that cause this condition, such as the discrepancy between educational systems and basic needs of the health care system, the rapidly-changing, complicated and dangerous environment (e.g., The COVID-19 pandemic) the problems with the disability of applying students’ theoretical knowledge in a harmless clinical environment, especially in the condition of mentor’s scarcity. At least – out of date system of medical education, where the emphasis is on getting knowledge and not its practical application. The article concerns our viewpoint and the ways, medical education can be improved upon in Georgia.

Work resumption and retention in patients with advanced cancer: Experiences and perspectives of general and occupational health care professionals.

The objectives of this study were to explore the experiences and perspectives of general and occupational health care professionals regarding work resumption and work retention of patients with advanced cancer, and to identify barriers and facilitators these professionals may encounter. A qualitative design was applied, and individual semistructured interviews were conducted. General and occupational health care professionals were eligible to participate if they were involved in the work participation guidance of patients with advanced cancer, and were recruited through the network of the research team. Interview data were transcribed verbatim and analysed thematically via ATLAS.ti 9. Interviewees (N = 17) had various occupational backgrounds, for example, occupational physician, reintegration consultant, and general practitioner. Four main themes emerged from the data: (1) Assumptions and hesitations, (2) Patient initiates stakeholder communication, (3) Role dispersion: who is in charge of what? and (4) Experience with legislation creates opportunities. Whereas most interviewees had positive experiences with, and/or optimistic expectations of, the work resumption and work retention of patients with advanced cancer, several barriers to the work participation guidance of these patients were identified. Suggestions for improvement include creating widespread awareness of the possibility of work participation of patients with advanced cancer and developing reintegration guidelines for advanced cancer.