Occupational Physicians Research Articles

Health Promotion Interventions in Occupational Settings: Fact-finding Survey among Italian Occupational Physicians.

Occupational Physicians (OPs) are essential for health promotion (HP) at the workplace, although their HP knowledge and perception are still under-searched. Between September and December 2022, the Italian Society of Occupational Medicine (SIML) - HP working group performed a cross-sectional survey on SIML-OPs aimed to address their approach, experience, strategies, and needs concerning HP plans. A total of 336 OPs completed the questionnaire. Regarding HP's OP perception, this was reported as a social investment (34.45%) and shared responsibility for all the company's preventive figures (30.18%). Over half of the enrolled OPs declared to have been involved as HP plans' organizers (57.30%) or collaborators (54.80%) in the previous 5 years. The greatest percentage of organizers were in the younger age groups (40-59 years; 50%). Additionally, following a more limited number of companies, prevalently of medium-high dimensions, and more than 500 workers were positively associated with greater OP participation in HP initiatives. Promoting healthy lifestyles was the main target of the HP plans (88.64%). Interdisciplinary collaboration, OP training on HP procedures and information on the targeted population have been reported as effective issues to support an active engagement of OPs in HP. A general interest of the Italian OPs with respect to HP was demonstrated, however, information on the potential benefits of HP in workplace aligned with OP perceptions and needs seem necessary to successfully implement HP interventions.

Vasovagal Syncope at Work: A Narrative Review for an Occupational Management Proposal.

Syncope is a complex clinical manifestation that presents considerable diagnostic difficulties and, consequently, numerous critical issues regarding fitness for work, especially for high-risk tasks. To date, it is impossible to quantify the exact impact of syncope on work and public safety since it is highly improbable to identify loss of consciousness as the fundamental cause of work or driving-related accidents, especially fatal injuries. Working at high-risk jobs such as public transport operators, in high elevations, or with exposure to moving parts, construction equipment, fireworks, or explosives demand attention and total awareness. Currently, no validated criteria or indicators are available for occupational risk stratification of a patient with reflex syncope to return to work. By drawing inspiration from the updated literature, this narrative review intends to summarise the leading knowledge required regarding the return to work for subjects affected by syncope. According to the available data, the authors highlighted some key findings, summarised in macro-items, such as defined risk stratification for vasovagal accidents, return to work after a critical event, and a focus on pacemaker (PM) implementation. Lastly, the authors proposed a flowchart for occupational physicians to help them manage the cases of workers affected by syncope and exposed to levels of risk that could represent a danger to the workers' health.

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.

Improving trends estimates for specific work-related ill-health conditions when excess zeros are present in a voluntary health reporting scheme

BackgroundTrends in occupational disease incidence are estimated in voluntary reporting schemes such as The Health and Occupational Reporting (THOR) Network in the UK. Voluntary reporting schemes request responses even if...

The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis.

For many years, occupational physicians have debated whether there is a link between working the night shift and depression and other co-occurring mental health issues, with an emphasis on work-related, biological, individual, and environmental factors. We performed this systematic review and meta-analysis to estimate the overall association between sleep deprivation and depression among nurses working night shifts. A systematic search was carried out across the electronic databases PubMed, Scopus, and Web of Science from inception to 30 September 2022, for studies that reported a relationship between estimated night shift work and depression in nurses. The outcomes were measured using the odds ratio (OR) and matching 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation technique was used to evaluate the quality of the evidence, and the Newcastle-Ottawa Scale was utilized to assess the methodological quality of each of the included studies. We determined the overall relationship between working nights and the onset of depression. A total of 20 studies were included in the systematic review. Furthermore, 8 studies were included in the meta-analysis due to their common use of the OR as an effect measure. The 8 studies gave an overall estimate indicating a statistically significant association between night shift work and depression among nurses (OR = 1.49 95% CI: 1.26, 1.76). The prediction interval for the overall estimate was (0.995, 2.231). This implies that the true OR in a future study would most likely fall within this range, with a 95% certainty. The outcome of this systematic review and meta-analysis showed a significant association between night shift work, the circadian and sleep disruption it causes, and the risk of depression in nurses. This demonstrates that nurses who work night shifts are at risk of developing depression.

Pocket Consultant Occupational Health

The five authors of this edition are all authorities in occupational hygiene and occupational health and are affiliated with universities in South Africa, Canada, the USA and the UK. Two of them are emeritus. According to previous editions this book is intended for use by occupational health professionals, including occupational physicians, anywhere in the world. From its long-standing history (first edition published in 1983), I infer that this book was first meant to be kept in your pocket to have it at hand when you encounter a problem in practice. With the current edition with almost 500 pages this is not possible anymore. The book counts 20 chapters covering occupational health topics that vary from sampling strategies for exposure measurement to ethical aspects of occupational health. It deals both with topics of occupational medicine such as the diagnosis of occupational disease and of occupational hygiene such as risk assessment. The range of topics makes the book valuable for all occupational health professionals.

SARS-CoV-2 Emergency Management in the ASL 1 Abruzzo Companies, Italy: An Autumn 2022 Cross-Sectional Investigation

The SARS-CoV-2 pandemic still represents a public health emergency that affects workplaces and forces employers to develop technical, organizational and procedural measures safeguarding workers' health, particularly 'fragile' ones. This research aimed to assess employers' adherence to the emergency measures planned by the Italian government to hinder COVID-19 during Autumn 2022. A cross-sectional study was conducted in Autumn 2022, with an 18-item questionnaire derived from the Italian State's governmental indications, sent by email to 51 companies of Marsica and Peligna Valley, L'Aquila, Southern Italy. A total of 20 recruited companies (65% were micro-enterprises, belonging to the food and financial sector) responded to the questionnaire within a mean time of 18 days (±11.64), which was lower for medium- and large-sized companies as well as for banking sector ones (p < 0.05). As regards intervention strategies, sanitization (92.7% of positive answers) and specific training (83.3%) showed almost full compliance in contrast to working organization (47.5%) and social distancing (61.7%). The companies that reported managing fragility (50%) belong almost exclusively to the banking sector, with predominantly office-based tasks. The study provided insight into critical issues relating to compliance with national legislative directives and the crucial role of occupational physicians as global advisors for all workplaces.

Occupational Fall Risk Assessment Tool for older workers.

No easy-to-use fall risk assessment tools have been devised to assess occupational fall risk in older workers. To develop an Occupational Fall Risk Assessment Tool (OFRAT) and report its predictive validity and reliability in older workers. The baseline fall risk assessment was completed by 1113 participants aged ≥60 years who worked ≥4 days/month in Saitama, Japan. Participants were followed up for falls during occupational activities for 1 year, and 30 participants were assessed twice for test-retest reliability. The following assessment measures were summed to form the OFRAT risk score: older age, male sex, history of falls, physical work participation, diabetes, use of medications increasing fall risk, reduced vision, poor hearing, executive dysfunction and slow stepping. The scores were then classified into four grades (0-2 points: very low, 3 points: low, 4 points: moderate and ≥5 points: high). During follow-up, 112 participants fell 214 times during work. The negative binomial regression model showed that participants with higher grades had a higher incidence rate ratio [95% confidence interval] for falls than those with very low grades (low: 1.64 [1.08-2.47], moderate: 4.23 [2.82-6.34] and high: 6.12 [3.83-9.76]). The intraclass correlation coefficient for risk score was 0.86 [0.72-0.93], and the weighted kappa coefficient for grade assessment was 0.74 [0.52-0.95]. The OFRAT is a valid and reliable tool for estimating the occupational fall risk in older workers. It may assist occupational physicians implement strategies to prevent falls in this group.

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.

Acquired Brain Injury and Work Participation - A Dutch Interdisciplinary Guideline for Occupational and Insurance Physicians

Acquired Brain Injury and Work Participation - A Dutch Interdisciplinary Guideline for Occupational and Insurance Physicians Abstract. This article discusses the Dutch interdisciplinary guideline 'Acquired brain injury and work participation'. Its development follows the methodology of evidence-based medicine and supports all professionals involved in the vocational re-integration of workers with traumatic (e.g., traffic accident) and non-traumatic (e.g., stroke) acquired brain injury.

Fitness to work decision for bipolar disorder patients : about 4 cases

IntroductionBipolar disorder or manic-depressive psychosis is a severe recurrent psychiatric disorder that, if left untreated, can lead to severe social harm, disability and neurotrophic changes in the brain. However, social and psychological factors play a key role in the onset and progression of the disorder. Therefore, a bio-psycho-social therapeutic approach in the form of an integrated model of “Collaborative Care” is recommended.ObjectivesDetermining the main factors interfering with the decision of fitness to work in bipolar disorders according to work requirements.MethodsClinical cases including health professionals (HP) was carried out. Cases were examinated at a specialized occupational health Clinics including HP between 2018 and 2022. Data was collected from medical records and by questioning patients directly in case of missing data.Results Four HP were included in the study. All suffering from bipolar disorder. The average age was 37 years [28,49]. All were women. Two were divorced and one single. Two anesthesia technicians, a nurse and a cleaner. Two were smokers. Two were transferred to another department because non psycho-education of colleagues at work, dealing with patients, verbal and physical agressivness and cognitive disorders. The two anesthesia technicians were judged unfit for work because of their work responsability and the need for the integrity of all cognitive faculties in the workplace.ConclusionsIn order to decide the fitness to work, occupational physician must consider both bipolar disorder impact and workplace exigency. The adequacy between disease stability and others security is iteratively revised.Disclosure of InterestNone Declared

Psychological impact of telework during the COVID-19 pandemic in Tunisia

IntroductionTelework is a work organization in which a task that could have been performed on the employer’s worksite is performed by an employee outside of these offices, using information and communication technologies. COVID-19 pandemic has strengthened digitalization as the result of social distancing and lockdown. However, teleworking can lead to different risks for employees mental health.ObjectivesEvaluation of the psychosocial impact of telework during the first wave of the COVID-19 pandemic in TunisiaMethodsDescriptive cross-sectional study carried out from17 to 22 May 2021. It included workers who teleworked during the first lockdown. The data collection was performed with a self-administered online questionnaire specifying the socio-medical, occupational and psychosocial characteristics.Results A total of 612 teleworkers were included. The mean age was 33±6.9 years. Sex ratio (M/F) was 0.32. The main sectors of activity were telecommunications and information technology (31.6%), legal and financial services (19%) and administration and organizations (16.5%). The teleworkers were operating in the private sector in 91.6% of the cases. Teleworking had been practiced before the health confinement by 55.6% of the cases and 86.3% had never received teleworking training. Psychosocial repercussions were noticed among 92.2%. During confinement, teleworkers reported a mood sadness in 36.4%, persistent anxiety in 27.8% and constant exhaustion in 43.3%. Sleep disorders were reported by 65.5%. They were difficulty in getting to sleep in 42.5% and a difficult morning awakening in 51.8%. The absence of work organization was significantly correlated with mood sadness (p&lt;0.001), chronic anxiety (p=0.01), sleep disorders (p=0.03), and constant exhaustion (p=0.001). Spending breaks in front of the television and on social networks was significantly correlated with sadness of mood (p=0.04), anxiety (p=0.009), and sleep disorders (p=0.04).ConclusionsPsychological impact of teleworking during health confinement at the COVID-19 pandemic was significant. Therefore, the role of the occupational physician is important in the detection and the prevention of health consequences.Disclosure of InterestNone Declared

A workers' health surveillance online training programme for occupational physicians.

To support occupational physicians (OPs) in the implementation of workers' health surveillance (WHS), a training programme was developed. (i) To evaluate the effects of a WHS training programme for OPs on knowledge, self-efficacy and skills to implement WHS. (ii) To evaluate to what extent a WHS training programme is acceptable and feasible for implementation in practice. A single-blinded randomized controlled trial with waiting-list control group was used. The WHS training programme consisted of an e-learning and a 4.5-h online training session. OPs completed a knowledge test (0-8), self-efficacy questionnaires on knowledge and skills (6-60), and vignette assignments (0-16) to measure skills. OPs completed the questionnaires, either before and after the WHS training programme (intervention group), or before the training programme (control group) while receiving the training programme after the waiting period. All OPs completed questionnaires about the training's acceptability, and feasibility for implementation in practice. ANCOVA and Poisson regression analyses were conducted. The self-efficacy score (M = 44.1 versus M = 37.2) (P < 0.001) and skills score (M = 9.6 versus M = 8.3) (P < 0.05) of OPs in the training group (N = 16) were higher than the control group (N = 23). No effect was found on knowledge. Evaluation of acceptability and feasibility showed that 21 (58%) OPs were very satisfied with the training part on initiating WHS, and 29 (85%) would recommend the WHS training programme to colleagues. This WHS training programme has a positive effect on self-efficacy and skills of OPs to implement WHS, and may be acceptable and feasible to implement in practice.

Creating opportunities for telehealth education, assessment, and care through Hotspotting (CO-TEACH): An interprofessional telehealth delivery curriculum and guide

Telehealth offers a healthcare solution when functional, social, or geographic barriers arise; however, many clinical education curricula are ill-equipped to prepare learners for effective, multidisciplinary telehealth consultations. The COVID-19 pandemic drastically expanded reliance on telehealth in clinical practice and highlighted the urgent need to educate students across health professions in telehealth delivery. To address this educational gap, student and faculty collaborators from Duke University and the University of North Carolina at Chapel Hill utilized a developmental evaluation approach to rapidly design and pilot a compact, five-session, virtual curriculum to train students from a broad range of health professions in telehealth delivery. Through focused readings, large group didactics, and small group discussion, the curriculum provided a general overview of telehealth, addressed specific issues in health equity and access in virtual care both locally and nationally, introduced skills for conducting telehealth visits, and employed a patient simulation for students to practice their newly learned skills. The curriculum was delivered virtually over eight weeks to 36 students from ten health professions programs (occupational therapy, social work, pharmacy, audiology, speech-language pathology, dentistry, medicine, nursing, physical therapy, and physician assistants) across two universities. End-of-course feedback surveys identified that students most valued the opportunity to work with learners from different professions, practical instruction for telehealth, and a standardized patient experience. On post-course surveys students reported high self-efficacy in their telehealth competencies and indicated very positive attitudes toward interprofessional education. Overall, the compact nature of this curriculum facilitates adaptability to other student-led groups.

Guideline for the Diagnosis of Occupational Asthma – the Role of the Occupational Physician

Guideline for the Diagnosis of Occupational Asthma – the Role of the Occupational Physician

Workplace Health Promotion Embedded in Medical Surveillance: The Italian Way to Total Worker Health Program.

In 2011, NIOSH launched the Total Worker Health (TWH) strategy based on integrating prevention and health promotion in the workplace. For several years now, in Italy, this integration has led to the creation of workplace health promotion embedded in medical surveillance (WHPEMS). WHPEMS projects, which are also implemented in small companies, focus each year on a new topic that emerges from the needs of workers. During their regular medical check-up in the workplace, workers are invited to fill in a questionnaire regarding the project topic, its outcome, and some related factors. Workers receive advice on how to improve their lifestyles and are referred to the National Health Service for any necessary tests or treatments. Results collected over the past 12 years from more than 20,000 participants demonstrate that WHPEMS projects are economical, sustainable, and effective. The creation of a network of occupational physicians who are involved in WHPEMS projects could help to improve the work culture, health, and safety of workers.

Psychosocial Risks and Telework – A Reflection about the Pandemic from the Point of View of an Occupational Physician

Psychosocial Risks and Telework – A Reflection about the Pandemic from the Point of View of an Occupational Physician

Bioetics Issues of Artificial Placenta and Artificial Womb Technology.

The worldwide infertility crisis and the increase in mortality and morbidity among infants, due to preterm births and associated complications, have stimulated research into artificial placenta (AP) and artificial womb (AW) technology as novel solutions. These technologies mimic the natural environment provided in the mother's womb, using chambers that ensure the supply of nutrients to the fetus and disposal of waste substances through an appropriate mechanism. This review aims to highlight the background of AP and AW technologies, revisit their historical development and proposed applications, and discuss challenges and bioethical and moral issues. Further research is required to investigate any negative effects of these new technologies, and ethical concerns pertaining to the structure and operation of this newly developed technology must be addressed and resolved prior to its introduction to the public sphere.

Occupational exposure to work-related stress, a proposal of a pilot study to detect psychological distress in collar-workers.

Work-related psychosocial risks have been identified as significant occupational health and safety risks; the occupational physicians must assess and monitor the health status of workers in order to verify that work is not a source of harm to exposed operators. The aim of the study was to investigate the outcomes related to anxiety and depression traits in workers exposed to stress-related work. A questionnaire was administered to a large population of Italian public administration workers; the Centre for Epidemiologic Studies - Depression Scale questionnaire was used to measure depression, the Self rating Anxiety Scale was used to measure anxiety, the UK Management Standards Indicator tool questionnaire was used to assess work adjustment. A descriptive analysis, a multivariate analysis, as well as logistic regression models were used to assess the health outcomes related to stress. A total of 292 workers participated in the study; 100% of participants had a Centre for Epidemiologic Studies - Depression Scale score over the cut-off; 41.78% had a Self rating Anxiety Scale score over the cut-off; the results support a correlation between the Centre for Epidemiologic Studies - Depression Scale results and the UK Management Standards Indicator tool results; and a correlation between Self-rating Anxiety Scale results and the UK Management Standards Indicator tool results. The Demand, Management, Support and Relationship results were associated with mental health outcomes, and it could be a useful tool in occupational medicine, to identify workers at risk for negative mental health outcomes, becoming an essential tool in workers' health assessment and for prevention of mental health disorders.

Video display terminal use and limitations according to italian legislative decree: occupational and forensic perspective.

In this paper, the authors conduct a review inherent in the use of video display units considering the laws currently in force in Italy, with emphasis on critical legislative and operational issues. Video Display Terminal (VDTs) are today an essential element in almost all work environments, from offices where they represent the fundamental work tool to production environments where they are indispensable for carrying out control functions (command stations, quantity management and flows, etc.) or for design work. The risk due to VDTs is one of the factors considered by the Italian Legislative Decree 81/08, so its assessment is part of the employer's obligations and at the same time requires health surveillance by the occupational physician. The new workstations have certainly not reduced visual postural demands, but they have changed them, opening the door to new disor-ders and imposing greater flexibility on the activity of the occupational physician, who often cannot limit himself to an annual inspection of the workplace. The aim of this work is to examine the current critical issues and future prospects of ergophthalmology.