Occupational Health Doctors Research Articles

Patterns in medical surveillance of workers exposed to lung carcinogens

Abstract One of the most common causes of lung cancer is exposure to occupational carcinogens. Free silica, diesel exhaust fumes, dyes, radon and with asbestos at the top of the list, differ by percentage according to the predominant professional activities in each country. The occupational health doctor is directly involved in the surveillance of the exposed worker, during work or post exposure, in the diagnosis and reporting of occupational cancers. Efficient screening followed by reporting and monitoring cases of occupational lung cancer and, last but not least, reintegration into professional activity are important steps in the medical surveillance of the worker exposed to occupational lung carcinogens. Standardised information collected at the level of occupational exposure monitoring systems, separated by carcinogen category and profession, may form the basis of control and prevention plans. Harmonising medical surveillance at European and global level can lead to a decrease in the incidence and mortality of work-related lung cancer.

Direitos Laborais da Mulher Grávida- um Guia prático para Profissionais de Saúde

Introduction The labor rights of pregnant women are of great relevance for the doctors that follow the pregnancy, as well as for the Occupational Health doctors. For them to be able to ensure work safety for this vulnerable group, they need to have a good understanding of the work laws. The multidisciplinarity between the two medical specialties can constitute an important alliance in the identification of specific labor risks, and the orientation of the worker. Methodology This is an review of the portuguese legislation conducted in november of 2022, regarding the Portuguese Work Code, complemented by the Practical Guide of the Subsidy of Specific Risks, from the Social Security Institute. Contents Pregnant workers must be considered a susceptible group for specific risks and there must be taken measures regarding their health and security, from various points of view. This cannot result in disadvantage in the work market and it cannot affect the equality of treatment between men and women. It’s the pregnant women right that the work conditions are evaluated, and, if needed, adapted by the employer, so the safety of the mother and the fetus is guaranteed. Discussion and Conclusions It’s important for health professionals to be informed about the work rights of pregnant women. The collaboration with Occupational Health professionals is essential in the right identification of specific work risks, so that the pregnancy can proceed without exposured to such risks and, in the case of such exposure, they can be rightly adjusted. Keywords: Labor rights; Pregnancy; General and Familiar Medicine; Occupational Medicine; Occupational Health.

Italian doctors’ understandings of work-related health and safety risks among women migrant home care workers

This article presents an exploratory study of how the social construction of risk, including stereotypes of migrant home care workers, as well as the character of official workplace health and safety regulation, may influence the ways in which occupational health risks are identified and managed by doctors. We focus our analysis upon migrant home care workers (HCWs) in Italy, who are exposed to multiple risks of developing physical and mental health problems. We begin by considering the reasons for the relative invisibility of HCWs’ health and safety risks, including wider constructions of women’s work as well as the ways these workers are treated by mainstream health and safety regulation. While Italian law requires employers to deploy occupational health doctors to monitor workers’ health and safety, work in domestic premises is excluded, so a HCW seeking certification of a workplace injury or illness would most likely approach her general practitioner (GP). However, little is known about GPs’ and other doctors’ awareness of the occupational origins of their patients’ illnesses and injuries. Our analysis starts to answer these questions through qualitative interviews with 16 doctors (mainly GPs) in Veneto regarding their understandings of migrant women’s health risks conducted between 2019 and 2020.

Процедура розслідування захворювання на COVID-19 медичних працівників у контексті реалізації державної політики щодо безпеки праці

Розглянуто основні положення норм чинного законодавства щодо розслідування випадків захворювання на COVID-19 медичних працівників у контексті реалізації державної політики щодо безпеки праці, проаналізовано сучасний стан вітчизняного державного регулювання у цій сфері, досліджено його організаційно-правові механізми, а також запропоновано пріоритетні напрями удосконалення процедури розслідування гострих професійних захворювань.

Diabetes Mellitus Among Workers Exposed to Perfluorooctanoic acid

Background: One of the health problems that can be caused by Perfluorooctanoic acid (PFOA) is Diabetes mellitus (DM). However, the causal relationship between Perfluorooctanoic acid and DM is still unclear, so it is necessary to look for some evidence regarding this relationship. The search for evidence is also equipped with a seven-step assessment of occupational diseases therefore it can assist occupational health doctors who find patients with DM and have a history of exposure to glutaraldehyde. Methods: Literature search using Pubmed, Cochrane and JSTOR databases. The keywords used are “PFOA” OR “perfluoroalkyl substances” OR “perfluorooctanoic acid” AND “diabetes mellitus”. Article selection was performed using the defined inclusion and exclusion criteria. Selected articles will be critically reviewed based on etiological studies from the Oxford Center of Evidence-Based Medicine. Result: It was in 5 selected articles that met the inclusion and exclusion criteria. The main finding after a critical review was that PFOA may increase the risk of DM. Conclusion: There is a relationship between PFOA and the incidence of DM in health workers. To establish the diagnosis of occupational diseases in health workers who are exposed to PFOA, seven steps of diagnosis of occupational diseases are used.

Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa

BackgroundHealth workers, in short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. This study aimed to assess how South Africa, prepared to protect its health workers from SARS-CoV-2 infection.MethodsThis was a cross-sectional study design applying participatory action research in four provinces of South Africa. A semi-structured questionnaire and a qualitative observational HealthWISE walkthrough risk assessment was carried out to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures.ResultsWe found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Provincial Departments of Health (PDoH) varied in how they were organized to respond: Provinces A and D had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health; Province A had an occupational health doctor and nurse; while Province B had an occupational health nurse; Province A and D PDoHs had functional OSH committees; and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment was adequate, it was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher personal protective equipment and ventilation scores. In addition, our analysis showed that hospitals with higher compliancescores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98).ConclusionsDespite some initial preparedness, greater effort to protect health workers is still warranted. Low-and-middle-income countries may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers’ health.

Challenges of Implementing Occupational Health Services (OHS) in Malaysia -Perspective of Occupational Health Doctors

Mortality estimation due to work-related illness has reached up to 2.4 million each year. The current coverage of occupational health services (OHS) in Malaysia is still low. Occupational health doctors (OHDs) are one of the essential personnel to ensure proper execution of OHS. This study was conducted to explore the experiences and views of OHDs on the challenges in implementing OHS in Malaysia. Four focus group discussions were conducted with OHDs (N = 23) from four different states in Malaysia in 2016. Another five OHDs participated in in-depth interviews to implement the identified codes or themes. The discussions were recorded and transcribed verbatim. NVivo version 11.0 was used to facilitate data analysis. The data were analysed following the thematic analysis guidelines. Three themes were identified from the discussions: difficulties in diagnosing occupational diseases and poisoning; poor practices, attitudes, and commitment by both workers and employers; and non-compliance with laws and regulations related to the industries. The common challenges discussed by the participants were the lack of knowledge and skills among OHDs, and the shortage of standard procedures, leading to difficulties to screen occupational diseases. The poor cooperation and behaviour from the industries also hindered OHDs when performing their services. This study suggests better training and provision of standard tools or guideline to assist OHDs in making occupational disease diagnoses, increasing OHS awareness among the industries, and enacting OHS as part of the laws and regulations with adequate enforcement.

DETERMINATION OF FACTORS ASSOCIATED WITH LOW BACK PAIN IN A POPULATION OF CLEANING WORKERS

Objective: The aim of this research was conducted determination of factors associated with low back pain in a population of cleaning workers. Methods: The research was carried out in the cleaning workers of İzmir Konak Municipality, without reaching any sampling method, and was applied to 318 workers who agreed to work. The data were collected between February and March 2014. Introductory information form, Oswestry functional disability form and Visual analog scale (VAS) were applied to each worker. Results: In this study, according to the result of Spearman Correlation analysis, it is seen that there is a significant and positive relationship between the oswestry functional disability form and VAS. As a result of Mann Whitney U and Kruskal Wallis analysis; economic status, rolling weight lifting and carrying, leaning weight lifting and alcohol consumption were found to be risk factors for low back pain. Conclusion: Low back pain has become a global public health problem for cleaners. For workers, their health deterioration has become an economic loss. For this reason, the occupational health doctor and the occupational health nurse should make screenings to protect and improve the waist health of the employees; It should carry out studies consisting of health education, educational programs and information in a multidisciplinary approach.

Occupational health management of work-related stress: guidelines versus practice.

BackgroundWork-related stress, anxiety and depression (WRSAD) are common, overlapping mental health problems burdened with major medical, occupational, institutional and societal implications. Current occupational health (OH) management of WRSAD is based on clinical and managerial guidelines and individual risk assessment.AimsThe study sought to identify patterns of OH advice in WRSAD and the relationships between the OH advice, available evidence, experience and expertise of the OH doctors (OHDs).MethodsA retrospective cross-sectional analysis of 101 first-time OH consultations for WRSAD by nine OHDs.ResultsThe three most common OH interventions included follow-up OH consultations, adjusted duties and referrals for counselling. All OHDs preferred a light-touch approach but the less experienced and qualified OHDs were more proactive and prescriptive.ConclusionsIn the absence of a specific occupational medical guideline for the management of WRSAD, the OH interventions may be guided by clinical guidelines, individual risk assessment, the client’s circumstances or the experience, expertise and preferences of the OHDs. In the study group, OH interventions were under-utilized and not consistently applied. Our findings support the argument for OH guideline for WRSAD to improve the consistency and effectiveness of OH interventions. This is important given the scale of the problem and the recent increase in WRSAD during the COVID-19 pandemic.

L'infirmier de santé au travail : prévention et sécurité en équipe pluridisciplinaire

The presence of nurses within occupational health care teams is now mandatory. Their role, centred on prevention, health protection and employees' safety, is practised under the authority and in close collaboration with the occupational health doctor, within a multidisciplinary team. Over recent years, their scope of practice has been expanded to include the individual monitoring of employees' health. It could be further expanded in future.

Control médico en migraña y variables relacionadas. Resultados de la encuesta europea Trabajo y Migraña

ObjectiveThis purpose of this work is to determine the care preferences and the required use of medical care by migraine patients in the different countries of Europe, and the observed differences depending on their social and demographic conditions. Material and methodsCross-sectional observational study by anonymous web survey of 3,342 patients from Spain, Italy, France, Portugal, Ireland, United Kingdom, Germany, and a mixed group of countries not included in the initial design. Variables: age, gender, country, type of location, level of studies and rural or urban area. The demand for care is collected by neurologist, primary care doctors/family/general practitioners, by occupational health doctors, nurses, by other doctors/other specialists, non-medical control/self-control. ResultsThe patients more seen by a neurologist were about 21-60years old and with a high cultural level. Primary care/family doctor care is higher in urban areas. Occupational medicine, nursing, and other specialties predominate in large cities. Self-control is greater in patients aged 21-40years and in women. Spain and Germany are the countries with the greatest demand for care in Neurology and Primary Care. ConclusionsThe medical demand for migraine care in Europe shows irregular results according to countries, with it being a priority in neurology and with less participation of Primary Care physicians, work doctors, nurses, or other specialties. Differences are observed by age, gender, and cultural level both in the demand for care and in the choice of specialist. It is important to take into account the percentage of patients who have no medical control.

Experiences of occupational health doctors and nurses about the role of physiotherapists in occupational health rehabilitation: A qualitative study.

Background:Occupational health physiotherapy has been practiced in the UK over several decades. In the past decade, the role of occupational health physiotherapy has gained recognition as a profession that can be embedded within occupational health departments; however, limited information is known about the role of physiotherapists from professional groups outside the allied health domain in this context.Objective:The aim of this study is to explore the experiences of occupational health doctors and nurses about the role of physiotherapy in occupational health rehabilitation.Methods:This study is a qualitative investigation underpinned by an interpretative construct. Thirteen semi-structured interviews were conducted. Two occupational health doctors and 12 nurses were purposively recruited from two National Health Service (NHS) hospitals. Data were analyzed using thematic content analysis, coded manually and verified by member checking.Results:The benefits of occupational health physiotherapists were rapid access intervention, advanced knowledge and clinical reasoning, evidence-based practice, and providing an additional perspective. The emerging themes of the challenges that occupational health physiotherapists may face include dealing with occupational health challenges, managing role conflicts, personal qualities and attributes, and role substitution.Conclusion:Participants described numerous roles of occupational health physiotherapists ranging from clinical to organizational components. On-going research is needed to support the role development of physiotherapists providing occupational health rehabilitation and to further advocate for its relevance in this setting.

STAKEHOLDERS READINESS TO IMPLEMENT NEW LEGISLATION ON OCCUPATIONAL EXPOSURE TO THE ELECTROMAGNETIC FIELDS

– European companies are expected to check their compliance with a new legislation about occupational exposure to the electromagnetic fields . Corresponding EU directive was issued in 2013 and was to be implemented into the national legislation of member states by 2016. The current study was launched with the aim to determine the readiness of the companies and other stakeholders affected by this new legislation. The target groups investigated by this study include workers, working environment specialists, occupational health doctors and labour inspectors. A questionnaire was developed to determine the level of knowledge and other issues introduced by the new legislation. Altogether 67 responses was received from Estonia. Significant shortcomings were reported in regard to the training of workers at high EMF workplaces/companies - score 0,15 out of 1. EMF safety arrangements, as described in the new directive, were reported to be sufficiently fulfilled only in 11 per cent of the high EMF companies. Also the workers' knowledge about the EMFs propagation and health effects was low, averaging at only 0,15 out of 1. The results indicate that at present little attention is paid on training the workers that may be affected by high levels of EMFs. Shortcomings are characteristic to all sizes of companies but are less evident in large companies. Considering the requirements of the new EMF legislation, immediate planning of appropriate schooling programs is necessary for all parties involved.

Recidiva tardia de melanoma cutâneo: relato de caso

Introduction: Ten-year survival for patients with cutaneous malignant melanoma (CMM) is considered to be synonymous with cure. However, there are reports of late recurrence after this period. This report stresses the importance of awareness of late recurrences and reflects on the role of the family physician (FP) in timely diagnosis. Case description: A 50-year-old man, who was a smoker with history of arterial hypertension and the excision of a CMM at 28 years of age, came to see his FP complaining of a dry cough for two days. An upper respiratory tract infection was diagnosed and treated symptomatically. One month later he returned due to the persistence of the cough. There were no other abnormal signs or symptoms. The cough was presumed to be a side effect of Zofenopril prescribed for control of arterial hypertension. This was stopped and replaced with Irbesartan. He returned two months later with the same complaint. There were no complaints of fever, sweating, chest pain, haemoptysis, or weight loss. Physical examination was normal. The erythrocyte sedimentation rate, ordered by his occupational health doctor, was 87mm/h. The diagnoses of pulmonary tuberculosis or lung cancer were considered. He was referred to the local emergency room, where a thoracic computerized tomography scan was performed. It revealed a proliferative nodular lesion on the left lung apex, compatible with lung cancer. The patient was referred for a pulmonary consultation, and was then admitted to hospital for partial resection of the mass. The histological results showed a metastasis of CMM, 22 years after the initial diagnosis. Comment: There are a growing number of reports of late recurrences of CMM. Early detection should be a concern for physicians. The FP can play an important role on monitoring these cases given the longitudinal continuity of care they provide.

Low measles vaccination coverage among medical residents in Marseille, France: reasons for non-vaccination, March 2013.

During 2008-12, France and Europe experienced large measles outbreaks, involving also healthcare workers (HCW). We aimed to estimate the vaccination coverage (VC) of measles among medical residents of the University of Aix/Marseille, in South-Eastern France. In March 2013, we conducted a cross-sectional study among all medical residents of the Medical Faculty of Aix/Marseille. We used a self-administered questionnaire to collect information on self-reported VC and reasons for vaccination and non-vaccination. We compared proportions, using the chi-squared test and prevalence ratios (PRs) with 95% confidence intervals (95% CIs). Of 1152 eligible residents, 703 (61%) participated in the study and 95 (14%; 95% CI: 12-17%) reported having had measles in the past. Of all participants, 613 (93%; 95% CI: 91-95%) reported having been vaccinated against measles and 389 (76%; 95% CI: 73-80%) received two doses. Only 268 (38%) reported having visited an occupational health physician. Vaccinated individuals were more likely to report easy access to vaccination as the main motivation for measles vaccination, compared with unvaccinated residents (435; 71% and 21; 45%; P < 0.001, respectively). VC among the medical residents of the University of Aix/Marseille was well below the recommended 95% coverage for two doses of measles vaccination. The majority of the study participants had not visited an occupational health doctor. Lack of easy access seems to represent major barriers to measles vaccination. We recommend that the student union, occupational health services and hospitals co-operate and address these problems in order to improve VC in this group.

Perceived Barriers and Facilitators for Return to Work Among Colorectal Cancer Survivors: Malaysian Healthcare Professionals Experience- A Qualitative Inquiry.

Return to work (RTW) can be a challenging occupational health (OH) issue among previously-employed colorectal cancer survivors. This study aimed to explore the various perceived barriers and facilitators encountered during the RTW process in cancer survivorship, from the perception of healthcare professionals (HCP). Face to face, semistructured interviews were carried out on twelve HCP (government and private sectors) from various disciplines. Data collected were transcribed verbatim and data management was aided by NVivo software 8.0. A new theory from contextual data was generated using open coding, axial coding and selective coding. The HCP shared numerous barriers and facilitators associated with RTW, under four categories. The key barriers were disturbing side effects, psychological barriers (personal factor), compensation (financial factor), poor ability to multitask (work-related factor), long paid medical leaves policy, employer's lackadaisical attitude, lack of knowledge and awareness of RTW (environmental factor). Key facilitators identified were desire to resume working life and to contribute to society (personal factor), financial pressure, maintain organizational health insurance (financial factor), less physically demanding job (work-related factor), supportive workplace and strict organizational policy on medical leaves (environmental factor). While not all HCP were trained in RTW, they all agreed that RTW is important for survivors and workplace. Occupational health doctors have a direct role in helping survivors RTW. Early Intervention on RTW during survivorship should involve occupational health doctors and employers, targeting the modifiable factors (environmental and work-related) to improve RTW after cancer.

Evaluation of Occupational Health Hazards among Oil Industry Workers: A Case Study of Refinery Workers

Occupational Health Hazard which is different from Occupational Safety Hazard is prevalently on the rise as industrialization increases in the global world. And identifying them in order to prevent and control them is very imperative to the health and well-being of the workers. The health and well-being of the workforce of a Company which is their most valuable asset should not be toyed with by the Management. Health Hazards which could result in the development of diseases and sicknesses is categorized into Physical Health Hazard, Chemical Health Hazard, Biological Health Hazard, Mechanical/Ergonomic Health Hazard and Psychosocial Health Hazard. These Health Hazards, usually, could be associated with most industrialized Organization and the Oil and Gas Refinery is not left out. Furthermore, in the course of this study, data was collected through open-ended Questionnaires to the workers and the Occupational Health Doctor. Also, Environmental Monitoring/Surveillance was carried out in seven main units of the Refinery. The questionnaire was administered to the workers randomly and was used to identify the Health Hazards, determine the awareness of the workers of the Health Hazards and evaluate the Occupational Health Practice that exists in the Refinery. Environmental Monitoring/Surveillance which includes the use of specialized equipments and good housekeeping were used to identify the different Health Hazards, and also, to assess the risk associated with the Health Hazards identified. Hazard Risk Assessment Matrix was used to identify the Health Hazards and the risks associated with them. A total of 85 respondents participated in the study. Most of the respondents were in the age range of 31- 40 years and approximately 31% run Shift Duty. Majority of respondents (82.4%) were males, married (64.7%) and had completed tertiary education (81.2%) respectively. Majority of respondents were able to identify the Health Hazards: Physical Health Hazard (74.2%); Chemical Health Hazard (70.9%); Mechanical/Ergonomics Health Hazard (78.8%) but the level of awareness of Psychosocial Health Hazard (48.3%) and Biological Health Hazards (9.6%) were low especially that of the latter. For the evaluation of Occupational Health Practice most of the respondent (78.1%) agreed that management is committed to the health and well-being of their workers. With the Environmental Monitoring, it was deduced that the above named first three Health Hazards and the Biological Health Hazard are prevalent in the Refinery. With the Hazards Risk Assessment Matrix, the level of risk these identified Health Hazards pose on the workers was 3D, 5E, 3C and 0A respectively However, workers' susceptibility to work related-diseases depends on a lot of factors, and it usually takes some time before the manifestation of the illnesses and diseases on the worker could be diagnosed. Consequently, Health Effect Management Process which is an element in Occupational Health and Safety Management System (OHS-MS) amongst others is recommended management protocol that would assist the management of an Oil and Gas Refinery protect, promote and rehabilitate the health and well-being of their workers.

Self-employment in joinery: an occupational risk facor?

Only a few studies have analyzed the health of self-employed workers. This cross-sectional study is the first to compare health status among craftsmen joiners and paid joiners. Clinical and paraclinical data for self-employed craftsmen and employees were collected by occupational health doctors according to a standardized protocol and compared. Health data and professional status relationships were analyzed by logistic regression. A total of 171 craftsmen and 196 paid workers were included. Craftsmen had more dermatologic pathologies (odds ratio (OR) = 2.67, p < 0.05), ear/nose/throat symptoms (OR = 3.38, p < 0.001), pulmonary symptoms (OR = 2.46, p < 0.05), musculoskeletal symptoms (OR = 3.09, p < 0.001), and abnormal audiogram (OR = 3.50, p < 0.001). The FEV1 was significantly lower among craftsmen (p < 0.01), independently of tobacco smoke exposure. This survey high-lights a high morbidity rate among self-employed craftsmen, suggesting that among woodworkers, professional status can be a risk factor for health. The preventive medical system for craftsmen has to be rethought to guarantee better safety for this population.

Donald Gwynvor Craig

Donald Gwynvor Craig was in practice first in Solihull, West Midlands, and subsequently became senior partner at Thamesmead, London, where he was senior lecturer at Guy’s Hospital Medical School. He...

La couverture vaccinale des adultes : enquêtes dans quatre populations d'Isère (France), 2002-2003

In order to assess their vaccination policy, the public health authorities in Isère (France) conducted several surveys to determine the vaccination coverage rate among adults. In France, the current state of knowledge in this area is limited. Four separate surveys were conducted in 2002-2003: (1) a telephone survey of 976 adults, 18% of whom had vaccination certificates; (2) a survey of 44 general practitioners (805 patients); (3) a survey of occupational health centers (82 practitioners and 1,119 employees); and (4) a survey of 1,214 patients vaccinated at the international vaccination center in Grenoble (France). The same data were recorded in all four surveys (last vaccination date, either declared by the patient or proven by a vaccination certificate). Based on certified evidence, vaccination coverage for tetanus, diphtheria, and poliomyelitis ranged from 31.6% to 83.9%, from 24.1% to 44.0%, and from 25.9% to 71.9%, respectively. Compared to general practitioners, vaccination coverage was higher among staff working at the occupational health center and lower in the general population. The four surveys covered only part of the adult population and provided only an estimate of vaccination coverage. The study found that tetanus vaccination coverage was the highest, but was still below expected levels. For the other vaccines, vaccination coverage among adults appears to be inadequate. The findings suggest that all health professionals involved in adult vaccination (occupational health doctors, general practitioners, hospital doctors, etc.) should be invited to participate in working groups on vaccination.