Pre-employment Health Research Articles

Pre-Employment Screening Among Health Care Workers—Ethical Issues

Occupational health practitioners deal with the questions of confidentiality, relation between the right to work and the right to health, between individual freedom and the risks other can run. An audit of pre-employment health assessment of health care workers, in the United Kingdom and in France, discussed the efficiency of pre-employment screening. Screening tests and medical examinations should not be used as a pretext to avoid implementing effective preventive measures. The pre-employment examination has mostly to be used for education of the future employees and for collection of baseline data. Appropriate procedures such as developing preventive policies, health promotion, and control of hazards in the work environment are efficient for the promotion of equal employment rights for women, older workers, or people with disabilities.

The Reliability of Personal Alcohol Consumption Estimates in a Working Population

Health and safety problems related to alcohol consumption represent a major concern in many businesses and consequently pre-employment questionnaires and workplace health promotion packages frequently contain questions seeking basic estimates of alcohol consumption. Although individuals with very heavy drinking patterns often attract much attention, on a population basis most morbidity is likely to arise from drinkers consuming above the recommended limits but not sufficient to result in gross occupational or social effects. This study reviews the research on the reliability of questionnaire techniques used to quantify alcohol consumption and compares the most valid retrospective interview based estimate of consumption, the time line follow-back (TLFB), with a prospective daily diary (DD) method in a working population. The DD method was acceptable and produced significantly higher estimates of consumption and for 'normal' subjects gave consistent estimates of +/- 10 units/week over several weeks. Appropriate questionnaire design is discussed and the use of a DD method in health promotion activities recommended.

Preventive effectiveness of pre-employment medical assessments.

OBJECTIVE AND METHODS: Health gain, prevention of health loss, and avoidance of financial risk all seem to be driving forces for the use of pre-employment medical assessment. An attempt is...

Identifying environmental risk to male reproductive function by occupational sperm studies: logistics and design options.

Malfunction of the male reproductive system might be a sensitive marker of environmental hazards, the effects of which may extend beyond reproductive function. The testis is more vulnerable to heat and ionising radiation than any other organ of the body and several xenobiotics are known to disrupt spermatogenesis after low level exposure. Studies of environmental impact on human health are often most informative and accurate when carried out in the workplace where exposures can be high and easy to document. Semen analysis provides readily obtainable information on testicular function. The main advantages in comparison with functional measures such as fertility rates and time taken to conceive are the possibilities to examine men independently of marriage and pregnancy, to find changes of fecundity with different exposures within the same person and to detect adverse effects when no alteration of fertility is yet taking place. In the implementation of an occupational sperm study considerable attention must be paid to logistic issues. A mobile laboratory unit for initial semen preparation and processing may in some situations increase worker compliance and the quality of sperm cell motility. The cross sectional design which has been used in almost all male reproductive studies so far has several severe limitations including selection bias because of differential participation, difficulties in defining a suitable reference group, and lack of information about the time dimension of the cause-effect relation. The longitudinal design deals adequately with most of these constraints. Semen samples are collected before, during, and possibly after exposure to the risk factor of interest and causal inferences are based upon change of semen variables within a man over time rather than upon differences between men. The logistics of the longitudinal study may benefit from pre-employment health examinations to enrol newly hired workers and require fewer participants to obtain comparable statistical power. In conclusion, andrological methods and epidemiological designs are available for the implementation of valid studies concerned with environmental impact on human testicular function. Occupational sperm studies should probably not be the first choice when the objective is initial screening of environmental impact on fertility but should be implemented when their is a need to corroborate or refuse earlier evidence that specific exposures have impact on testicular function.

A Study on the Status of Preemployment Health Examination

A Study on the Status of Preemployment Health Examination

Implications of the Allitt inquiry.

The case of Beverly Allitt (Glasper and Whiting, 1993) highlights the issue of preemployment health screening and its relationship to psychiatric illness. The main purpose of pre-employment health screening is to assess a particular job applicant's health. Theoretically, such screening should identify psychiatric illness if there is a known history. However, if an illness has not been diagnosed, routine screening procedures may not be effective for ascertaining psychiatric disorders, such as Munchausen syndrome.

Audit of pre-employment health assessment in the National Health Service.

Seventeen (77 per cent) of the 22 NHS occupational health departments in the West Midlands Region replied to a postal questionnaire about pre-employment health assessment. In only 5 departments (29 per cent) was the decision whether to interview and examine a prospective employee dependent on the results of a self-administered questionnaire. All departments were asked how many prospective employees had been screened and how many rejected/restricted over a 2 week period. Departments which interviewed/examined all prospective employees tended to have higher rejection/restriction rates than departments operating a selective policy: 6 (2.6 per cent) out of 232 versus 16 (1.4 per cent) out of 1140, relative risk 1.6, 95 per cent confidence interval 0.8 to 3.4, P = 0.31. In departments which did not automatically interview/examine prospective employees, the median proportion seen by nurses was 56 per cent, and by doctors was only 12 per cent. Within one NHS Region we have documented wide variation in what constitutes a pre-employment health assessment. A selective approach would release a significant amount of occupational health staff time.

Outbreak of the Reactive Airways Dysfunction Syndrome after a Spill of Glacial Acetic Acid

The reactive airways dysfunction syndrome (RADS) defines a chronic asthmalike illness with airway hyperresponsiveness that develops within 24 h of a single, brief, highly irritating inhalation exposure. Support for the syndrome has been limited to case reports. A chemical spill, exposing hospital employees to 100% acetic acid, offered an opportunity to more convincingly establish the existence of RADS. All 56 exposed subjects were asked both to complete a questionnaire focusing on their preexposure health status, potential for exposure, and symptom development after the accident, 8 months after the spill, and to undergo methacholine challenge testing to detect airway hyperresponsiveness. An industrial hygienist, blinded to clinical data, estimated each subject's exposure. Preemployment health history forms were reviewed to assess recall bias. The study questionnaire was returned by 51 (91%) subjects; 24 (47%) consented to methacholine challenge, including 7 of the 8 with RADS-consistent symptoms. Diagnostic criteria for RADS were satisfied by none of 7 (0%) subjects with low exposure, 1 of 30 (3.3%) with medium exposure, and 3 of 14 (21.4%) with high exposure (test of trend p value = 0.021). The odds ratio estimate of the relative risk of RADS in subjects with high exposure was 9.8 (95% Cl, 0.902 to 264.6). Neither stratified analysis nor review of the preemployment health history forms revealed evidence of confounding or recall bias, respectively. The reactive airways dysfunction syndrome appears to be a valid clinical entity. Further study of RADS is especially appropriate given increasing evidence that airway inflammation may be etiologically important in all asthma.

Clinical Report: Pre-Employment Screening and Health Management for Safety Forces—Methods and Techniques

The purpose of this clinical report is to describe the process by which safety forces (police and fire) are tested prior to employment (pre-employment screening) and the periodic evaluations used to maintain such standards. The process began by testing 350 male police volunteers and developing a series of age stratified norms. These norms are used to compare incoming recruits such that candidates of a given age are compared to norms developed from police officers of the same age. The purposes of this report are to describe the clinical tests used in the pre-employment screening, to report the normative data and to describe the methods of comparing data obtained from applicants to the established norms. The proper management of high risk employees through pre-employment screening and intervention programs has been viewed as being necessary both for the individual employee in reducing injury and disease and for the municipality for cost saving purposes. J Orthop Sports Phys Ther 1990;11(9):398-401.

An Employee Health Service in Saudi Arabia

Health services for employees of this 500-bed tertiary care hospital include programs normally available to employees at hospitals in the United States. These programs include primary care, health promotion, health surveillance, and pre-employment health screening. The most pervasive influence on the health care provided is Islam. Saudi Arabia is a conservative Muslim country and all health care activities must be accomplished within the religious and cultural norms of the country. Communicable diseases endemic to this part of the world are of special concern in employee health. Special programs are in place for the prevention and control of tuberculosis, hepatitis B, brucellosis, ophthalmic chlamydia, malaria, and meningococcal disease.

Pre-Employment Screening and Cardiovascular Intervention Program

Pre-employment screening and health maintenance on the job has been an area of concern for both hospitals and industry. Can various disease processes be ' prevented and can money be saved in the process are some basic questions. A program in Akron, OH involving police officers has been set up to examine these and other questions. This program is being presented as a model for use in a variety of settings since the components have a broad range of application. The components include; pre-employment screening, mandatory health standards, and comprehensive intervention program. This program has been very successful in Akron and it is suggested that the model can have a significant impact in business and industrial settings. J Orthop Sports Phys Ther 1986;8(1):42-47.

Inadequate sensitivity of tuberculin tine test for screening employee populations.

Tuberculin Tine and Mantoux skin tests were simultaneously applied to opposite arms of 1,065 medical center employees during their usual preemployment and annual health examinations for the purpose of evaluating the Tine test sensitivity. Of 829 skin tests read, 39 (5%) were positive by the Mantoux method. Tine tests were positive in 27 of the 39: a sensitivity of 69% and a false-negative rate of 31%. In view of these results, the tuberculin tine test is not sensitive enough and is not indicated for employee screening programs when finding tuberculosis infection, and not disease, is the primary goal.

Absence of the booster phenomenon in serial tuberculin skin testing.

The Center for Disease has recently recommended that tuberculin skin testing of new hospital employees be done in two steps because of the so-called "booster phenomenon." To assess the feasibility of the two-step method in our hospital, we performed a pilot study using this method on all our new hospital employees during a 6-month period. From July 1, 1980, to December 31, 1980, all newly hired employees of the Strong Memorial Hospital were given a two-step tuberculin skin test as part of their preemployment health evaluation. During this time, 571 new employees were tested, 416 (73%) of whom completed both steps. The mean age of the 416 employees was 26 yr. Fourteen of 448 employees (3.1%) had positive reactions on the first test. None of the 416 employees had positive reactions on the second test. Additional visits for skin test administration, costs of informational materials, administrative expenses, and supplies added approximately $2,600 to the costs of our tuberculin skin testing program during the study period. The absence of the booster phenomenon in our employee population may be due to (1) the relatively young age of our hospital employee population who may be less likely to have remote infection with Mycobacterium tuberculosis and/or (2) the relatively uncommon occurrence of nontuberculous mycobacterial infection in our area of the country. Depending on the age of employees of an institution and its geographic location, the two-step method may not detect any additional reactors. We recommend that hospitals contemplating adoption of this method first perform a similar pilot study in order to assess the frequency of the booster phenomenon in their employee populations.

Work-related medical surveillance in small workplaces.

This paper discusses job-related health examinations only; general screening for health is the responsibility of the community and therefore beyond the scope of occupational health services. Accordingly, in this context health examinations were considered sensible for two reasons only: first, to insure that an employee`s mental and physical attributes match the requirements of his or her job and, second, to detect possible adverse health effects caused by work. The first category refers to preemployment examinations and the second to periodic examinations. A routine preemployment physical examination program for workers considered for any job seems needless from a labor protection point of view. One-third of the work force under study was considered to be in need of either preemployment or periodic health examinations or both. Young workers (under the age of 18) to be examined prior to assignment to a new job constituted only 2 Ofo of the population. Most preemployment and periodic examinations were required for workers exposed to noise. They numbered 480 (20%). Eighty-five of them should be given an audiometry examination annually and the rest, 395 persons, every third year. Exposure to chemical substances created a need for health examinations for less than 10 % of the workers, allergens, solvents, mineral dusts, and metals being the most common such substances. In eight establishments 25 persons were exposed to lead. Their blood tests indicated, however, that routine health monitoring was unnecessary. In addition, truck driver examinations and color vision tests for electricians could fit within occupational health care, along with the preemployment examinations of food handlers required by the National Health Law. In contrast to engineering controls, the training of proprietors of small businesses and their employees, labor inspection, and other preventive measures, health examinations seem to play a secondary role in the labor protection of small workplaces.

Survey of safety and health care in British medical laboratories.

A retrospective postal survey of 24 000 medical laboratory workers in England, Wales, and Scotland showed highly variable standards of safety and health care. Pre-employment health screening was offered to two-thirds of employees, the physicians being the least likely to be examined (15%). Scottish laboratories provided better safety control than English and Welsh laboratories, while Public Health Service Laboratories had a better record than National Health Service establishments. Mouth pipetting is still practised in 65% of English and Welsh laboratories, and the use of protective clothing is rarely compulsory. The servicing of safety cabinets is often inadequate. Known and suspected carcinogens are still apparently used in a few laboratories (2-10%). In view of the wide variation in standards among laboratories, urgent consideration should be given to establishing regulations for codes of safe practice rather than relying merely on recommendations as at present.