Medical aspects of expatriate health: health threats

The globalisation of business activity can lead to the movement of key employees and their dependants from country to country. In their host country these expatriates often face health hazards not experienced at home. This paper describes the range of health issues of relevance to expatriates.     

Occupational asthma prevention and management in industry--an example of a global programme

Isocyanates are widely used in the manufacture of polyurethane foams, plastics, coatings and adhesives, and are known to cause occupational asthma in a proportion of exposed workers. Substitution as a prevention strategy is not currently a feasible option. For this reason, health and safety professionals working together in an automotive coatings business created a proactive global programme to address the known potential effects of isocyanates on its workers. The goals of the programme are prevention, early detection and mitigation of effect of key endpoints, especially asthma and to a lesser degree dermatitis, in people who are occupationally exposed, or potentially exposed, to isocyanates and products containing isocyanates. The surveillance programme for isocyanates has several important components, which include assessment of exposure, pre-placement questionnaire and spirometry, training and education of employees, regularly administered periodic questionnaires, medical assessment for abnormal questionnaire responses, process for early reporting and investigation of symptomatic employees and incidents, group data review and management reporting. Although regional differences exist regarding availability of specialized services, we have successfully implemented this programme in parts of North America, Europe and Latin America, and are currently implementing elsewhere. These simple control measures are relatively inexpensive and can be applied in even small business settings. It is recommended that all employers who manufacture, handle or use isocyanate-containing products consider such a strategy.     

Developing programmes to achieve a healthy society: creating healthy workplaces in Northern Ireland

Healthy workplaces help to prevent occupational disease and injury as well as promoting positive healthy lifestyle behaviours. The concept of creating healthy workplaces through workplace health promotion has been identified as a legitimate area of activity for public health policy in Northern Ireland, supporting as it does, the settings approach as a means of improving the health and well-being of the population at large. Benefits accrue to businesses, organizations and individuals from the enhancement of positive healthy lifestyle messages in addition to reinforcing the principles of good occupational health practices. Developing a framework for the creation of healthy workplaces is part of a joint initiative between the Northern Ireland Health Promotion and Health and Safety Agencies. Commitment to delivering the concept is required from all the key players who include: employers, employees, trade union groups and health and safety professionals. A healthy workplace model needs to be created which is flexible and adaptable to suit all types of business and in particular the needs of small businesses which predominate in Northern Ireland. The principles underpinning the Business Excellence Model may be a useful vehicle for delivering workplace health promotion onto an organization's agenda.     

Occupational health issues affecting the pharmaceutical sales force

BACKGROUND: The sales force forms a significant sub-population in the pharmaceutical industry workforce. Role and organizational characteristics, such as isolation, peripatetic working and car travel and the psychosocial and ergonomic hazards related to work tasks, present particular occupational health risks. AIM: To review the occupational risks associated with peripatetic sales force work and evidence for the effectiveness of preventive interventions. METHODS: We carried out a review of the available literature between 1990 and 2003. RESULTS: The following hazards were identified as significant and worthy of further investigation for this occupational group: driving on company business; violence in the workplace; stress; ergonomic issues; and mobile phone use. CONCLUSION: To ensure effective prevention and management of employee health problems, specific health management strategies and interventions must be developed to meet the occupational health needs of this group.     

The management of occupational health by NHS Trusts in the north of England

This paper reports the findings of an audit of the management of occupational health arrangements in 36 NHS Trusts in the Northern and Yorkshire region of England. A questionnaire was designed based on a national NHS occupational health standard to obtain data on eight categories of occupational health activity: health and safety; pre-employment assessments; Infection Control; health surveillance; sickness absence; ill-health retirement; health promotion and record storage. The management arrangements for occupational health were varied. Assessments of workplace hazards, prevention of HIV-positive workers from performing exposure-prone invasive procedures and the assessment of pregnant workers were identified as issues for further consideration. Provision of competent and effective occupational health services will assist in the management of sickness absence and in the protection and promotion of health of staff. It will also contribute to the health and safety of patients.     

The application of Ontario human rights legislation to the practice of occupational medicine

Although human rights legislation has important implications for occupational physicians, these implications may be overlooked in the practice of occupational medicine in other countries where human rights legislation may be different. The potential for significant oversights becomes greater as organizations continue to centralize international business support functions, such as occupational health services, operating from a single site. Human rights legislation has important implications with respect to policy decisions upon which an occupational physician has influence. This includes decisions about whether to conduct drug and alcohol testing; the performance of medical examinations; evaluating issues related to health and safety concerns of pregnant employees; and the need to work accommodate those with handicaps as defined by human rights legislation. This article examines the application of the Ontario human rights legislation in these areas.     

Study to evaluate the effectiveness of stress management workshops on response to general and occupational measures of stress

This study was designed to evaluate the effectiveness of stress management training workshops within Zeneca Pharmaceuticals. The study was of cross-sectional design, comparing groups of workshop attendees and non-attendees. In addition, self-rated well-being scores of attendees were compared with results obtained pre-workshop and 2-3 months after the workshop. Employees participating in the study were drawn from the Manufacturing, Research and Development, Sales and Marketing sites of Zeneca Pharmaceuticals located in Cheshire, United Kingdom. Three hundred and ninety persons who had participated in stress management workshops since 1988 were matched for age, gender and department with an equal number of employees who had not attended stress management workshops. Outcome measures included self-rated well-being (as measured by the 30-question General Health Questionnaire), knowledge of company guidance on the management of stress in staff, and an assessment of coping strategies. Subjects who had not attended a stress management workshop were much more likely to have a poor understanding of the principles of management of stress in staff [odds ratio (OR) = 8.3; 95% confidence interval (CI) = 3.3-21.3] and more likely to have poor coping skills (OR = 2.8; CI = 1.3-6.1). However, mean scores for the two measures were similar in attendees and non-attendees. Self-rating of current well-being was strongly associated with the life-events score, but not related to workshop attendance. The study indicates that stress management training workshops reduce the prevalence of employees with a poor understanding of the principles of the management of stress in staff and with poor coping strategies. An improvement in the self-rated well-being observed shortly after the workshop was not sustained.     

The relationship between waist-to-hip ratio and occupational status and life-style factors among middle-aged male and female Japanese workers.

As a marker of body fat distribution and therefore level of obesity, the waist-to-hip ratio (W:H) is a good indicator of coronary heart disease risk status. The present study investigated the association between occupational status and life-style factors, and W:H of middle-aged Japanese male (n = 2,550) and female (n = 1,283) workers in a metal-products factory. A higher W:H was observed in the management level males as compared with the other male workers and we suggest this was promoted by the sedentary aspect of their work, as well as their higher levels of alcohol consumption and lower levels of leisure-time physical activity. In contrast, a higher W:H was recorded in female labourers, whose work was typically less sedentary as compared with female managers. Life-style factors included in the study were not related to this observation. We conclude that other unmeasured psychosocial factors may be important in promoting higher W:H in female labourers.     

Major chemical incidents: bridging the occupational--public health gap

Increasing awareness and concern about possible long-term health effects of exposure to chemicals after major chemical incidents has opened up a new area of public health activity. However, progress is hampered by a lack of low level exposures in potentially highly susceptible subgroups of the populations, and by a lack of expertise in public health. The challenge is to extend the toxicological and epidemiological experience developed in the occupational setting to the community level. To better define the problem population surveillance of acute chemical hazards, first set up in Wales, has been extended throughout the UK, and is also being piloted internationally. Further work is needed to address specific problems of the epidemiological follow-up of populations exposed, the assessment of the psychological consequences at the community level, and risk perception and communication. Organisational arrangements for the public health management of incidents and their sequelae must move beyond short-term funding and market competition and must incorporate the expertise of the occupational disciplines.     

Occupational safety risk management in Australian mining

In the past 15 years, there has been a major safety improvement in the Australian mining industry. Part of this change can be attributed to the development and application of risk assessment methods. These systematic, team-based techniques identify, assess and control unacceptable risks to people, assets, the environment and production. The outcomes have improved mine management systems. This paper discusses the risk assessment approach applied to equipment design and mining operations, as well as the specific risk assessment methodology. The paper also discusses the reactive side of risk management, incident and accident investigation. Systematic analytical methods have also been adopted by regulatory authorities and mining companies to investigate major losses.     

Occupational health management: an audit tool

BACKGROUND: Organizations must manage occupational health risks in the workplace and the UK Health & Safety Executive (HSE) has published guidance on successful health and safety management. AIMS: This paper describes a method of using the published guidance to audit the management of occupational health and safety, first at an organizational level and, secondly, to audit an occupational health service provider's role in the management of health risks. The paper outlines the legal framework in the UK for health risk management and describes the development and use of a tool for qualitative auditing of the efficiency, effectiveness and reliability of occupational health service provision within an organization. The audit tool is presented as a question set and the paper concludes with discussion of the strengths and weaknesses of using this tool, and recommendations on its use.     

Occupational exposure to HIV and the use of post-exposure prophylaxis

The use of antiretroviral therapy as post-exposure prophylaxis against human immunodeficiency virus (HIV) is now routine following high-risk exposure to the HIV virus. This article summarizes the management of health care workers and others exposed to HIV in an occupational setting, and the evidence behind it.     

Auditing health and safety management systems: a regulator's view

HSE's publication 'Successful Health and Safety Management' (HSG65) describes key elements of successful health and safety management systems. A three level model is explained and one of the elements, auditing, is explored in detail by the regulator. The term auditing in the health and safety context is defined and the use of proprietary and in-house systems compared. The process of auditing is described and the regulator concludes by encouraging organizations to use auditing schemes, without endorsing any particular one, as they can be a powerful tool for checking the adequacy of health and safety management systems.     

Long-term sickness absence in an NHS teaching hospital

This study was carried out to investigate the incidence andcauses of long-term sickness absence in an NHS teaching hospitaland to explore the role of the Occupational Health Service (OHS)in the management of long-term absence. Examination of attendancerecords of non-medical staff revealed an annual loss of 20,772days due to spells of absence lasting 30 calendar days or more,(incidence 0.0528/WTE employees/year, prevalence 5.53 days long-termabsence/WTE employee/year). A self-administered questionnairewas sent to 190 staff who had taken long-term absence duringthe previous 12 months. The response rate was 75%. Musculoskeletalproblems and back pain in particular were the main reasons forabsence, accounting for 30% of total days lost. Work-relatedillness made an important contribution with a third of thosewith musculoskeletal and a quarter of those with mental illnessattributing the reason for their absence to work. Many staffreported non-medical factors such as delays in waiting for treatmentand anxiety about return to work which prevented them from returningto work sooner. Only a minority of staff had attended OHS andreferral was often delayed. OHS may have an important role toplay in both prevention and management of long-term absenceby early assessment and intervention such as expediting treatmentor arranging rehabilitation programmes. However in order tobe effective, a clear policy to encourage early and consistentreferral is required.     

A former human resources manager's views

Over the past decade there has been a growing interest in occupational health as a result of some high profile legal cases, the growth of research into the psychological contract and the need to invest in people's health and development. In this article a personal viewpoint is expressed that if occupational health physicians or psychologists are to make an effective contribution to the long-term business success of their employers then they must adopt a strategic approach to their work. They ought to be able to do this and still maintain their clinical autonomy and protect the interests of their employee clients. The need for partnerships between bodies representing clinicians, managers and government agencies is also explored, taking into consideration the government's green paper Our Healthier Nation.     

Activity profiles of the occupational health services in a multinational company

The management of the European division of a multinational company was aware of possible differences in the occupational health services (OHS) at their different locations. The objective of this study was to carry out a baseline assessment of these OHS. Structured interviews with representatives of the OHS were conducted at 20 locations in 11 countries. The OHS Recommendation from the International Labour Organization (ILO) was used as a standard for the organization and functions of the OHS. Considerable differences in the activity profiles of the OHS were detected. The inter-enterprise, multidisciplinary OHS spent most of their time on surveillance of workers' health in relation to work and on preventive activities in the working environment. Little time was spent on curative services for individual workers. OHS made up of individual physicians and nurses generally spent much of their time on treatment of occupational and non-occupational diseases. This study has clarified the status of the OHS providers and the potential for improvements in order to meet the needs of the company's locations and to comply more closely with the ILO recommendation.     

Occupational health and safety curricula: the factors that decide -an Australian experience

Societal, economic and other changes in recent years have resulted in both an increased level and diversity of education and training in occupational health and safety in Australia. Consideration has been given to the key skills and knowledge required by those who take tertiary level courses and who practise as specialists and generalists in the field of occupational health and safety. The curricula and mode of implementation of these courses are determined by the needs of employers, increased emphasis on quality management systems, the prevailing work climate including information technology, communication and legislative requirements all in the context of a rapidly changing tertiary education system.     

Quality management of occupational health services: The necessity of a powerful medical profession

Over the past few years there has been a growing interest inquality management in occupational health services. In thisarticle the central role of the medical profession in this areais highlighted from a personal point of view. It is argued thata powerful and active profession is needed as a countervailingpower in the field of tension between employees and the company,and for balancing the interests of these two main clients. Therefore,the medical profession should develop a policy on quality andapply quality management on national and local levels to reacha high professional level. In this way the profession can maintainthe clinical autonomy that is necessary to be a countervailingpower. Elements of such quality management are national guidelines,local peer review and intercolleagual visitation. These activitiesmust be incorporated in the quality management of the occupationalhealth services unit.     

Communication between an occupational physician and other medical practitioners--an audit

Four hundred and seventy-two consecutive referral episodes relatingto 386 patients attending the Occupational Health Departmentof a general teaching hospital were analyzed to evaluate thefrequency, content and effect on management of communicationsbetween the occupational physician and other doctors. In all,250 episodes (53%) were associated with such a communication.The likelihood of a communication was strongly influenced byreason for referral, particularly in respect of long or shortterm sickness absence; univariate odds ratios (OR)=10.58, 95%Cl=8.13–27.08) and 2.65, 95% Cl=1.55–4.60) respectively;a medical diagnosis of psychiatric illness (OR=3.17, 95% Cl=1.69–5.97));and by number of consultations. Communication was also morelikely when the occupational outcome was ill health retirement,rehabilitation in work or modified work. Ninety-eight per centof specific requests for information or an opinion eliciteda reply. Information received from other doctors influencedthe occupational health physician's management in 52 referralepisodes (20%). Specific action by GPs as a result of communicationwas documented in 54 and by specialists in 37 episodes. Theimportance of communication between occupational health physicianand other doctors in the occupational health process is confirmed.