How much do workers’ health examinations add to health and safety at the workplace? Occupational preventive usefulness of routine health examinations

ObjectiveDespite no evidence in favour, routine workers’ health examinations, mostly pre-employment and periodic, are extensively performed worldwide with important allocation of resources. In Spain they are performed within a theoretical job-specific health surveillance system. Our objective was to ascertain their occupational preventive usefulness from the perspective of occupational health professionals.MethodsCross sectional study. Online survey addressed to all physicians and nurses members of the Catalan Society of Safety and Occupational Medicine (n = 539) in 2011. Univariate and bivariate analyses of prevalence and prevalence differences of answers.ResultsResponse rate 53% (n = 285). According to more than 70% of respondents the health surveillance system isn’t cost-effective, doesn’t meet the goal of early detection of health damage related to work, and doesn’t contribute to improve the occupational risk prevention system. Further deficiencies were identified regarding specificity and scientific basis for health examinations, quality of collective health surveillance and referral of suspected cases to mutual insurance companies for diagnosis and treatment. Bivariate analysis showed a significantly more negative opinion for several items amongst physicians (versus nurses) and amongst professionals working in external prevention services (versus internal services).ConclusionsThis study raises serious concerns about how health examinations are performed within our workers’ health surveillance system, which should be reviewed to ensure the fulfilment of its occupational preventive objective. Our results might encourage other countries with similar practices to assess them in order to assure their fitness for purpose.     

A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service

BACKGROUND: This study aimed to establish how important an occupational health unit (OHU) is to its clients, and to identify the perceived needs and priorities for such a service. METHODS: A cross-sectional postal survey of a stratified, randomly selected group of employees (n = 760) and all human resources (HR) managers (n = 34) was conducted in the Irish Civil Service. Each participant was requested to rate the overall importance of the OHU and to prioritize eight proposed functions for the unit: medical surveillance, general health education, pre-employment/promotion medical assessments, ill-health retirement assessments, return-to-work (after sick leave) assessments, occupational health education, research, and general medical screening. The results were analysed according to age group, gender, grade and occupation. RESULTS: There was a response rate of 69% from employees and 74% from personnel managers. Significantly more HR managers than employees (92 versus 81%) thought an occupational health service was either important or very important. There were also differences in prioritization of functions by employees and HR managers. HR managers prioritized those functions concerned with assessing individuals' fitness for work, notably pre-employment/promotional health assessments, whereas employees consider group-directed 'preventative' functions to be more important, i.e. general medical screening, health education and medical surveillance. Both sets of opinions are not mutually exclusive, and considerable overlap exists, notably in the areas of occupational and general health education.     

Evaluation of the effectiveness of pre-employment screening

Aim As pre-employment screening and selection is a main function in the protection of susceptible applicants from developing an occupational disease, we need insight into the effectiveness of this intervention under different exposure conditions. The aim of our study was to demonstrate the feasibility and usefulness of three indicators to evaluate the effectiveness of pre-employment examinations.Method We used a pre-employment medical evaluation table to gather the data needed for the indicators for effectiveness. The first indicator chosen is the predictive value of a positive test result (PPV) corresponding to the percentage of applicants who will develop an occupational disease after a positive test result. The second indicator is the number of pre-employment medical examinations needed to reduce the number of new cases of an occupational disease by one (number needed to test, NNT). The third is the number of rejections for the job, as the consequence of a positive test result, needed to reduce the number of new cases of an occupational disease by one (number needed to reject, NNR). To illustrate feasibility and usefulness, we used the example of potroom asthma in the primary-aluminium industry. We used data on personal risk factors and on the incidence of potroom asthma from a nested case–control study in the Netherlands.Results The three indicators for effectiveness could be applied. For high incidence rates, defined as 0.04 (40 cases/1,000 employees per year), the PPV values for personal risk indicators varied from 5% to 27%. The NNT varied from 116 to 667. Finally, the NNR varied from 4 to 20. For low incidence rates, defined as 0.005 (5 cases/1,000 employees per year), the PPV values were low (0.6% to 5%). The NNT were high (1,111 to 5,000). The NNR varied from 23 to 155.Conclusion The three indicators for effectiveness are applicable under the condition of the availability of relevant empirical data. The indicators provided useful information for the evaluation of the effectiveness of specific tests, which might be added as selection criteria. The personal risk factors studied were far from effective as selection instruments, especially in situations where a low incidence of potroom asthma exists. Personal risk factors at the pre-employment stage should not be added to the standard procedure to select susceptible applicants. Under conditions, they may be taken into account in a workers health surveillance programme. As a contribution to evidence-based occupational medicine, we recommend the use of the pre-employment medical evaluation table and the three chosen indicators for effectiveness as a standard tool to evaluate the effectiveness of pre-employment medical examinations.     

Occupational health services for municipal employees

Most municipalities have departments responsible for fire, policing, public works, parks, sanitation, health, water, administration, and communications. A comprehensive occupational medicine program must address the potential and actual health hazards associated with each of these fields, as well as pre-employment/placement medical evaluations, medical surveillance, wellness programs, work-related injury, case management, return-to-work accommodations, and drug and alcohol testing. While no standard for municipal occupational heath services exists, a comprehensive approach to the variety of work settings that are inherent even in small municipalities is important for the service provider.     

Some trends in worker access to health care in the United States (1974-1983)

As a result of national surveys of occupational health and safety conditions in the American workplace, the National Institute for Occupational Safety and Health (NIOSH) has collected data on the provision of health care to workers as a consequence of their employment. Two of these surveys, initiated in 1972 and 1981, permit a preliminary examination of the trends in worker access to such care. This paper presents data on the provision of some aspects of medical care to workers in manufacturing and nonmanufacturing facilities as a result of employment. Among the principal findings are increases in general health care provided to workers, increased use of off-site physicians, and increased use of screening examinations or tests. Other analyses indicate a decreased use of on-site physicians and pre-employment examinations and decreased industrial retention of health information on new employees.     

Evidence base for pre-employment medical screening

This paper examines the evidence base for the use of pre-employment/pre-placement medical examinations. The use of pre‑employment examinations is often driven more by cultural practices than evidence. There is a lack of evidence on their effectiveness in preventing health-related occupational risks. Hypertension screening is highlighted as a common pre-employment practice for which there is no standardized criteria to use to determine fitness for work. There are inherent problems in screening for psychiatric disorders and substance abuse as well as potential for racial bias and other unintended negative effects. This paper questions the economic case for this practice and also expresses concerns about paternalism related to identified risk factors. Health assessments should only be included when appropriate to the task environment and the general use of pre-employment exams and drug screening should be eliminated. Generally, a health assessment by questionnaire should suffice. Occupational health providers should advise against the application of physical or mental standards that are not relevant to fulfilment of the essential job functions. Consensus development regarding best practice, as well as consideration for acquiring outcome data related to pre-employment practice, is recommended.     

Occupational health in the Negev: a model for regional planning

In the Negev region of Israel, I tested a model approach to occupational health planning. This model included components assessing exposures, measuring adverse health outcomes, and evaluating health services. I analyzed employment survey data, compiled an exposure data base, and carried out site visits covering 10,707 employees (over 50% of the regional industrial work force). Site visits identified exposure hazards of inorganic and organic dusts, heavy metals, chemicals, pesticides, and noise. I identified elevated relative regional injury rates by Standard Morbidity Ratios (SMRs) in a variety of industries, including sixfold increases for mining and non-metallic minerals manufacture (SMR 6.8, 99% CI 6.1-7.7). Review of biological monitoring data suggested deficiencies in pesticide and heavy metals surveillance. A survey of primary care clinics estimated 13,707 cases of occupational injury and illness untreated by existing occupational medical services. Based on these findings, I formulated regional occupational health planning goals, including targeting high-risk industries for increased preventive activities. This regional approach, combining multiple measures of occupational health status, can serve as a model for assessing local public health planning needs.     

Clinical activities in an academic hospital-based occupational medicine program

OBJECTIVES: The objectives of this article are to characterize the clinical activities encountered by a large academic hospital-based occupational medicine program and to discuss their implications for occupational medicine residency training and the training of practicing physicians. METHODS: Clinical activities from July 1, 1996, to December 31, 2004, were retrieved from computerized databases and categorized. All morbidity coding was performed using the same classification scheme and resource. RESULTS: The largest volume of clinical activities included patients seen for physical examinations, work-related injury and illness care, and substance abuse testing. The most frequently encountered workers' compensation cases were musculoskeletal. CONCLUSIONS: Although medical surveillance examinations, toxic exposure assessments, and other specialty services were available, the demand for such services was relatively low.     

工业企业职业卫生现况调查

目的调查职业病危害企业的职业卫生状况,提出相应的职业卫生管理对策。方法分层随机抽样杭州及衢州135家企业,就职业病防治管理制度、职业病危害项目申报、职业病危害防护措施、职业健康检查及作业场所职业病危害因素监测等项目进行调查分析。结果 135家调查企业中,进行职业病危害申报的企业占60.00%;开展职业病危害因素监测的企业占80.00%,不同地区、不同经济类型、不同规模企业之间,差异有统计学意义(P0.01或P0.05);对全部工人提供上岗前、在岗期间及离岗时健康体检的企业分别占51.85%、54.07%和20.74%;不同地区、不同经济类型、不同规模企业之间职业健康体检的比例差异也有统计学意义(P0.01或P0.05)。结论浙江省工业企业职业病防治工作存在地区差异,小型企业、私有企业是今后职业卫生工作的重点关注对象。     

Skin disorders and job fitness assessment

BACKGROUND: Assessment of fitness for employment represents the final phase of the risk evaluation and health surveillance carried out during pre-employment and periodical medical examination. Dermatoses are frequent diseases both in the general population and workers, therefore job fitness assessment for workers with skin problems will frequently fall within the occupational health area. The physician must verify whether or not the dermatosis is an occupational disease and must adopt preventive measures to avoid any worsening or relapse of the clinical situation due to occupational factors. OBJECTIVES: This article gives suggestions for correct management of occupational and non-occupational skin diseases in the workplace, with practical examples of job fitness assessment. METHODS: We first examined the role of the occupational physician in the evaluation of occupational risk factors that can induce work-related dermatoses or aggravate other dermatoses. We then discussed the factors that must be considered during assessment of fitness for employment when dermatoses are present. Finally, we examined practical examples of occupational or non-occupational dermatoses that can cause functional limitations, factors that can influence job fitness evaluation, and the possible role of allergological tests. RESULTS AND CONCLUSIONS: Several dermatoses can be aggravated or caused by occupational factors (e.g. atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, keratinization disorders, lichen planus, physical urticaria). Close cooperation between the dermatologist and the occupational physician is very important in order to make an etiological diagnosis that is necessary for the job fitness assessment. It is difficult to define definitive criteria for the assessment of fitness for employment; in this article only some suggestions are made and they can vary according to the different situations.     

2008—2012年河池市有色金属企业工人上岗前职业健康检查结果分析

目的通过对上岗前职业健康检查资料的分析,了解河池市有色金属企业劳动者就业前的身体健康状况,为制定职业病防治策略及岗前择业提供参考依据。方法对该市近5年来6家有色金属企业10 972人上岗前的职业健康检查资料进行统计分析,并对各年度的检查情况、职业禁忌证、疑似职业病和其他疾病或异常结果的检出情况进行比较。结果上岗前职业健康检查人数呈逐年上升的趋势,5年职业禁忌证检出986人,检出率为8.98%;铅作业职业禁忌证检出率较高,为3.65%;疑似职业病共检出18人,检出率0.16%;其他疾病和单项（多项）指标异常检出3 083人,检出率28.10%;所检项目未见异常人数6 885人,占总检人数的62.75%。结论该市有色金属企业工人就业前的身体健康状况不容乐观,相关部门应加强对厂矿企业的监督管理和职业卫生知识及相关法律、法规的培训宣传工作,督促用人单位主动安排即将从事接触职业病危害因素作业的劳动者进行上岗前的健康检查。     

From clinical activities to didactics and research in occupational medicine

BACKGROUND: The daily practice of Occupational Physicians in the mot industrialized countries suggests that the frequency of traditional occupational diseases is progressively lowering, their gravity is decreasing, and the etiological factors are changing. This trend should be quantitatively and qualitatively verified with ad hoc studies. The information is particularly relevant for Academic Institutions where medical students and residents in occupational medicine are trained. OBJECTIVES: To analyse the trends of clinical diagnoses and health surveillance activities conducted in the last 15 years by an Italian Institute of Occupational Health, and to gain information on the most relevant topics to be taught in academic program and to be addressed with future research. METHODS: Data sources were represented by the computerised registration of a) diagnostic activities and b) health surveillance programs, conducted by the Institute of Occupational Medicine of the University of Brescia, a highly industrialized area in Northern Italy. The observation period was from 1990 to 2005. The health surveillance programs regarded workers pulled from an iron foundry, a veterinary institute, a health departments for the assistance of elderly subjects, a nursery schools and a municipal department for road maintenance. RESULTS: Diagnostic activities were conducted on 9080 subjects, who had been referred for suspected occupational disease. The diagnosis of occupational disease was confirmed for 3759 cases. Multiple diseases were diagnosed in 1554 subjects, yielding the total number of 5721 occupational diseases. The most frequent diagnoses accounted for allergic skin disease (23.4%), followed by pneumoconiosis (20.4%), chronic obstructive pulmonary disease (15.9%), noise hearing loss (7.1%), musculoskeletal disorders (6.9%), respiratory allergies (6.9%), cancer (5.9%), miscellaneous (6.4%). When limited to the last quinquennium, the analysis showed a definite increase of muskuloskeltal disorders, cancer, and, although at a lesser extent, diseases due to psychosocial factors. The analysis of the health surveillance programs regarded 1207 workers, and showed that various non occupational diseases caused limitation to individual work fitness. The most frequent conditions were musculoskeletal disorders (65%) and skin diseases (14%). CONCLUSIONS: The results from these two investigations are important not only for the didactic program run by the Institute, but also because they indicate the most relevant topics to be addressed with future research, at least at a local level.     

Activities of an Occupational Health Organization in Japan, in Special Reference to Services for Small- and Medium-Scale Enterprises

This paper reports the activities of occupational health organizationsin Japan, taking Nishinihon Occupational Health Service Center,one of the largest scale occupational health service providers,as an example. The organizations, at the request of enterprises,provide occupational health services on a profit basis especiallyfor small- and medium-scale enterprises which lack the humanresources and/or facilities to meet legal requirements on occupationalhealth. The main services include: (1) providing various typesof medical examinations for workers, (2) measuring work environment,(3) occupational physicians and occupational health nurses providinga comprehensive service. Among these services, legally requiredhealth examinations and work environment measurements are wellserved even for small-scale enterprises. Less effective arethe health promotion and occupational health service by theoccupational health staffs. In the future, these services willbe better provided by a newly developed network system to supportoccupational heath activities in small-scale enterprises. Received       13 December 1994 Accepted       11 April 1995     

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.     

Identificazione dei lavoratori ex-esposti ad amianto in Toscana da inserire nel programma di sorveglianza sanitaria

«Identification of workers with past asbestos exposure in Tuscany eligible to health surveillance programme».Background:In 2016 the Administration of the Tuscany Region, Italy, established a health surveillance programme for workers with past asbestos exposure. The programme includes two levels of activities, a local basic health evaluation, and a centralized in-depth evaluation of specific cases.Objectives:To estimate the number and identify the workers with past exposure to asbestos in Tuscan industrial settings entitled to participate in the health surveillance programme.Methods:The number of formerly-exposed workers was estimated from the records of the working population of 15,441 workers of thirteen Tuscan asbestos industrial plants and from the existing data bases of the Local Health Administrations (USLs) and the Institute for Study, Prevention and Cancer Network (ISPRO), and from national data bases such as Social Security Administration (INPS) and National Institute for Insurance against Accidents at Work (INAIL). The expected number of medical examinations per year was estimated from the adhesion rates seen in previous comparable programmes.Results:The estimated number of workers with past asbestos exposure eligible to the programme was 5,446. The estimated number of health examinations in the first and second phases of the surveillance programme during 2016-24 was 7,275 and 7,155, respectively, follow-up examinations included. The number of workers identified from local data bases was 4,713: They had been operating in 129 plants that had been using asbestos in the past. Further 1,395 workers were identified from previous health surveillance activities.Conclusions:The use of several sources of information and the cooperation between occupational health services made it possible to identify a high proportion of former asbestos workers and plants., It is, nevertheless, still necessary to complete the list of eligible workers, and to facilitate their participation by making the programme more widely known.Key words: Past occupational exposure, health surveillance, asbestos     

Occupational medicine in Morocco: analysis of practices and proposition of action

With the aim of a better knowledge of their activities of training and information of workers, a survey has been conducted through questionnaires sent to 582 occupational health physicians in Morocco. Among the 48% of physicians who accepted to answer the questionnaire, over half was effectively working in companies. This study revealed many problems in prevention of professional hazards. Workers information about professional risks and measures of prevention was systematically given by 56% of physicians during pre-employment examination and 51% during systematic visit. During "third time", 49% of physicians were informing workers of professional risks and 54% of measures of prevention. With regards to meetings of information, only 26% of physicians were organising such meetings and teaching workers first aid. Consequently, we propose the implementation of protocols "Safety in companies". Informing and teaching the workers about safety, are the mandatory first steps to reduce and prevent professional diseases and accidents; occupational medicine, despite various obstacles should promote it.     

Comparison of three methods of pre-employment medical evaluations

BACKGROUND: Increasing efforts are being made to prevent sickness absence and to increase worker efficiency, including the use of costly pre-employment medical assessment of white-collar workers and labourers, excluding occupations for which medical supervision is required by law. AIM: To investigate whether filling out an occupational health questionnaire (OHQ) as pre-employment assessment was more efficient than previously used protocols which included a physical examination and laboratory tests performed for each applicant. METHODS: Retrospective study comparing three groups of job applicants: Group A--applicants examined by an occupational physician (OP); Group B--applicants examined by a general practitioner (GP) whose medical records were subsequently evaluated by an OP and Group C--the applicant filled out an OHQ which was evaluated by an OP. RESULTS: The study included 1940 pre-employment assessments divided into groups A (618), B (256) and C (1066). The restriction rate was 2.1, 1.2 and 2.3%, respectively. The lowest restriction rate (1.4%) was among applicants 29 years old and younger and the highest one (3.6%) among 50 years and older. The most frequent diagnoses among restricted applicants were musculoskeletal and circulatory diseases (15 and 12%, respectively). CONCLUSIONS: The restriction rate achieved by medical examinations either done by an OP (Group A) or by a GP (Group B) was the same as in OHQ (Group C). The use of a self-administered questionnaire evaluated by an OP is the preferred method of pre-employment evaluation for non-hazardous occupations.     

"Fitness for public service" - results of standardised acceptance examinations

From Nov. 1 1990 to Dec. 31 2001 4928 applicants (61 % female, 39 % male) were examined, totalling 6580 pre-employment examinations, to decide whether they fulfilled the health requirement criteria for civil servants. Standardised aptitude criteria were used, career-specific requirements taken into account. To exclude with a high probability were any risks of premature disability for service or frequent disorders. In 394 cases (= 5.99 %) the results were negative. This assessment was final in 298 cases (= 4.53 % of all examinations) or was confirmed negative in repeated examinations even after special conditions had been imposed. Main reasons for disqualification were second- and third-degree adipositas with additional risk factors or a metabolic syndrome, chronic cardio-vascular and metabolic diseases requiring permanent treatment, malignant neoplasms or non-fulfilment of the criteria for special careers. The comparatively high rate of disqualification is mainly due to the high average age of the applicants examined (40 % of all applicants were over 40, 13 % were older than 50). Purpose, sensitivity and specifics of such examinations are discussed. Taking into consideration the high rate of civil servants prematurely unfit for work, such pre-employment examinations are regarded as highly justified. Moreover, it is necessary to have clear guidelines, aptitude criteria and examination procedures for individual careers. It is also important to adhere strictly to local responsibility for pre-employment examinations.     

某外企1505名劳动者上岗前职业健康检查结果分析

目的了解劳动者就业前的健康状况,及早发现职业禁忌证,同时建立劳动者职业健康监护档案,为企业科学、合理地安排劳动者从事有职业病危害的作业提供客观依据。方法采用现况调查研究的方法,对2008年4月—2009年5月某外企1505名准备从事噪声及苯系化合物作业的劳动者进行上岗前职业健康检查,对结果进行分析。结果常见病及单项指标异常者593人,检出率39.4%。职业健康检查目标疾病异常结果：纯音听阈测试异常者29人,13人为职业禁忌证;心电图异常者85人,11人为职业禁忌证;血压明显升高者5人,血常规异常者73人,均为职业禁忌证。共检出102人为职业禁忌证,检出率6.8%。结论上岗前进行职业健康检查对保障劳动者与企业的合法利益具有重要意义。