Promotion of a healthy work life at small enterprises in Thailand by participatory methods

The major problems of small enterprises include unfavourable working conditions and environment that affect safety and health of workers. The WISE (Work Improvement in Small Enterprises) methodology developed by the ILO has been widely applied to improve occupational safety and health in small enterprises in Thailand. The participatory methods building on local good practices and focusing on practicable improvements have proven effective in controlling the occupational hazards in these enterprises at their sources. As a result of applying the methods in small-scale industries, the frequency of occupational accidents was reduced and the working environment actually improved in the cases studied. The results prove that the participatory approach taken by the WISE activities is a useful and effective tool to make owner/managers and workers in small enterprises voluntarily improve their own working conditions and environment. In promoting a healthy work life at small enterprises in Thailand, it is important to further develop and spread the approach.     

Occupational health nurses' activity after general health examination for workers

In this study, the present condition of occupational health nurse's role after performing general health examination was surveyed. Questionnaires were mailed to 41 companies, and returned questionnaires from 24 of them were analyzed. Although general health examination results were reported to all workers individually in 100% of companies, physician's opinion regarding the examination results were obtained in 86% of companies with part-time physicians comparing with 100% of those with full-time physicians. Health care support related to the examination results were performed by 90% of occupational health nurses and 70% of physicians in companies which employed full-time physicians, but by 100% of occupational health nurses and 50% of physicians in those which employed part-time physicians. In companies with part-time physicians, 64% of occupational health nurses played roles in submitting reports to Labor Standard Inspection Office, but only 30% of occupational health nurses did it in those with full-time physicians. These results show that occupational health nurses working in companies with part-time occupational health physicians were more active in providing health care for workers after general health examination than occupational health nurses working in those with full-time occupational health physicians.     

HBV- and HCV- infected workers in the Japanese workplace

Around three million Japanese are persistently infected with HBV or HCV. Though most of them work in various industries, little is known about the actual conditions in their workplaces. To clarify the workplace conditions of workers with hepatitis, three kinds of questionnaire surveys, answered by occupational health physicians and workers with hepatitis, were carried out. The rates of workers recognized as workers with hepatitis B or C by occupational health physicians were 0.82% and 0.48% of 130,092 workers, respectively. About 30% of workers with hepatitis were engaged in "hazardous work". The percentage of workers engaged in various types of hazardous work among workers with hepatitis was nearly the same as that among all Japanese workers. About 30% of occupational health physicians witnessed exacerbation of hepatitis in the workers at their workplaces, and 22% of workers with hepatitis experienced exacerbation of hepatitis. The rate of workers with hepatitis who had experienced exacerbation was not significantly different between workers with and without hazardous work. Workers with hepatitis have strong concerns about the relationship between work and exacerbation. As causes of exacerbation, occupational health physicians cited "unknown", "drinking" and "quit treatment" while workers with hepatitis answered "work-related causes", besides "unknown" and "drinking."     

广州市工人对职业危害因素致癌性认识的调查分析

随机抽取广州石化总厂、广州汽车制造厂等7家工厂,并按10％的比例抽取1007名工人作为本次的调查对象。用美国洛杉矶加利福尼亚大学健康教育系提供的调查表,对调查对象进行职业危害因素致癌性认知的调查。结果72.3％的工人认为在工作环境中有危害健康的物质,67％以上的工人能正确认识香烟、煤尘、放射线、铅毒和石棉等的致癌性。大部分工人正确的意识到“经常与医生保持联系是保证健康的最佳途径”和“工人本人应该对自己的健康负主要责任”。平常工人主要通过阅读报纸、杂志获得职业危害方面的知识,并且认为从医生那里获得的知识最为可信。年长者、文化程度高者、干部和技术人员对职业危害因素知识的了解优于年轻人、文化水平低者和一般工人。     

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.     

Manual for primary health care on Basic Occupational Health Services. Encouraging publication from India,focused on informal occupations

Objective

To discuss a new book from India intended to inform and educate primary health care professionals on workers’ health problems, with the aim to encourage new initiatives.

Study design

The book is considered against the background of international developments and evaluated on the usefulness for practice and policy development.

Results

The publication focuses on the 90% of the workers in India working informal, without a contract or social security, and often exposed to poor working conditions. It is the final aim of the book to prioritize care for those at the highest risk. For informal workers specialized occupational health services are absent. Therefore, primary health care might take care of basic facilities on workers’ health, when educated and adequately supported by online information, occupational health experts and clinical referral services. Such new developments started as well in other countries such as China, Thailand, Iran and Indonesia, encouraged by WHO, WONCA (family physicians), ILO and ICOH (occupational health experts). In the book working conditions are described in 22 branches of economic activities in India with many informal workers like agriculture, leather and tanning industry, oil mills and street vendors. Next, associated health complaints and occupational diseases are explained. This information is relevant for family physicians to be able to recognize work-relatedness of health complaints and diseases. Numerous diseases can be work related such as asthma, depressive disorders, dermatitis, a variety of musculoskeletal disorders, hearing impairment, cancer of many organs, various infectious and neurological diseases. Diagnosis, treatment and prevention can be improved in primary health care, as well as advising in return to work activities. More detailed information on specific occupational or work-related diseases is given in clinical chapters. Comments are given to improve the usefulness in supporting new practices and policies.

Conclusion

This book from India fits well in worldwide developments promoting the integration of forms of workers’ health care in primary health care.

     

Contribution of occupational factors to social inequalities in self-reported health among French employees

Objectives

Social inequalities in health have been widely demonstrated. However, the mechanisms underlying these inequalities are not completely understood. The objective of the study was to examine the contribution of various types of occupational exposures to social inequalities in self-reported health (SRH).

Methods

The study population was based on a random sample of 3,463 men and 2,593 women of the population of employees in west central France (response rate: 85–90 %). Data were collected through a voluntary network of 110 occupational physicians in 2006–2007. Occupational factors included biomechanical, physical, chemical and psychosocial exposures. All occupational factors were collected by occupational physicians, except psychosocial work factors, which were measured using a self-administered questionnaire. Social position was measured using occupational groups.

Results

Strong social gradients were observed for a large number of occupational factors. Marked social gradients were also observed for SRH, manual workers and clerks/service workers being more likely to report poor health. After adjustment for occupational factors, social inequalities in SRH were substantially reduced by 76–134 % according to gender and occupational groups. The strongest impacts in reducing these inequalities were observed for biomechanical exposures and decision latitude. Differences in the contributing occupational factors were observed according to gender and occupational groups.

Conclusion

This study showed that poor working conditions contributed to explain social inequalities in SRH. It also provided elements for developing specific preventive actions for manual workers and clerks/service workers. Prevention towards reducing all occupational exposures may be useful to improve occupational health and also to reduce social inequalities in health.     

Exposure limits and medical surveillance in occupational health

The standards for pollutants in workplace air constitute a social consensus or agreement about acceptable levels of occupational hygiene. This agreement to exposures up to these limits inevitably includes a finite risk to the health of the workers. The numeric values of standards are needed to assess the requirements for ventilation and other occupational hygiene conditions. Planning and everyday practice in industry also need hygienic stan- dards so that practical hygienic and safety measures can be maintained. These standards are not, however, levels below which there is no risk to health. While the hygienic stan- dard itself carries acceptance of a certain risk, doctors cannot ethically accept any health risk to workers whatever the source of exposure. Thus personnel working in occupa- tional health have to think about the risks of ill health even when the hygienic standards are met. The physician in occupational health has to be especially concerned to discover and estimate the risks to anyone particularly susceptible to exposures within the hygien- ically acceptable conditions. To do this, the occupational health physician uses medical examinations and specific investigations. In the follow-up of workers, health occupa- tional health personnel use medical examinations in order to detect possible risks or to assess the general health status of individual workers. Health examinations are also used to detect specific injuries caused by the agents to which workers are known to be exposed in their work.     

Occupational physicians' education and training across European Union countries

The framework directive on improvements in the safety and health of workers is being implemented into the national legislation of European Union countries, and occupational physicians are requested to play a key role in undertaking preventive measures. Since there is no common specific requirement for the training and education of these health professionals, this report aims to provide a comparative picture of the educational process across European Union training bodies. Each curriculum provides theoretical knowledge and practical experience, but deep differences exist among different countries. Core knowledge is mainly based on the traditional disciplines (such as occupational hygiene, occupational toxicology, ergonomics, epidemiology and biostatistics, relevant legislation, and preventive medicine). General learning objectives should include assessment of the workplace environment, communication and education, legislation, occupational diseases, and relationships between health and work. Core experience, often based on task-based learning, emphasizes the need for assessment of a range of working environments; for surveillance, including the biological monitoring, of workers at risk; for assessment of disability, impairment, and fitness for work; for the clinical ability to recognize occupational diseases; for the formulation of differential diagnosis; and for management of workers developing disease in the course of their employment. New curricular elements (such as management, economics, quality assurance, and marketing) are being introduced in some institutions with the aim of stressing the renewed role of the occupational physician in meeting society and employers' needs. The need to educate and train a professional figure whose competence should allow the delivery of high-quality occupational health services across European Union countries compels the harmonization of the formative process of occupational physicians. Received: 3 January 1999 / Accepted: 14 January 1999     

Women workers confront one-eyed science: building alliances to improve women's occupational health

Women suffer many health problems related to their work, but attempts to improve their situation face obstacles at two levels: recognition of their problems and ability to organize to prevent them. Recognition by occupational health specialists has been delayed due in part to: A perception that women's issues have been included in research focussed on male workers; pressure to deal with more visible issues of mortality and well-established illness; ignorance of women's working conditions; methodological biases and inadequacies. Recognition by unions is slowed when women and their concerns are absent from union membership and/or governing structures. Feminist health advocates have not often participated in these struggles, due to social class differences and difficulties in linking with some male-dominated unions. Also, due to the wide variety of hazardous working conditions, they do not emerge from population-based analyses of health determinants in the same way as do domestic violence, tobacco or poverty. The authors describe three alliances necessary for successful research, policy and practice in women's occupational health: between feminist and working-class organizations; between feminists and occupational health scientists; between researchers and women workers.     

The purpose of occupational medicine.

The purposes of occupational medicine are described in terms of its clinical medical, environmental medical, research, and administrative content. Each of these components is essential in different proportions in comprehensive occupational health services for different industries, and can only be satisfactorily provided by occupational physicians and occupational health nurses who are an integral part of their organizations. Two-thirds of the working population in the United Kingdom are without the benefits of occupational medicine. The reorganization of the National Health Service and of local government presents the opportunity to extend occupational health services to many more workers who need them. It is suggested that area health authorities should provide occupational health services for all National Health Service staff and, on an agency basis, for local government and associated services, eventually extending to local industry. Such area health authority based services, merged with the Employment Medical Advisory Service, could conveniently then be part of the National Health Service, as recommended by the British Medical Association, the Society of Occupational Medicine, and the Medical Services Review Committee.     

Development and evaluation of a quality assessment instrument for occupational physicians

OBJECTIVES: To develop and apply a method for assessing the quality of the process of occupational health care for individual patients. METHODS: The scientific literature was studied to develop a method to assess the quality of the process of occupational rehabilitation for workers with low back pain. The method was applied to health care and university workers with low back pain who were rehabilitated by their occupational physicians. RESULTS: Assessment of quality of care is regarded as a four step approach. Firstly, guidelines should be developed and implemented. Secondly, indicators for quality and criteria to demarcate good and deviant quality were derived from the guidelines. Thirdly, a method for data collection was chosen. Finally, quality was scored. For occupational rehabilitation, there was some deviance from the guidelines for most cases, especially in continuity of care with a deviant rate of 47%. Other indicators deviated from 1.4%- 17.4%. Occupational physicians agreed on the relevance of the indicators and criteria, but for three indicators they evaluated the criteria as too rigid. They did not agree with their own performance scores in 66% of the deviant cases. CONCLUSION: Assessing the quality of the process of occupational health care with this method is an asset to present methods, but more specific criteria are needed for a more sensitive assessment.

 

     

Working Relationship,Participation and Outcome in a Psychiatric Day Care Unit Based on Occupational Therapy

A process-outcome study was conducted in a psychiatric day care unit based on occupational therapy for long-term patients with severe mental illness. The development of the working relationship was explored. Most of the patients and staff rated the quality of the working relationship as good. The study also investigated whether working relationship and participation factors were related to outcome concerning psychiatric symptoms, global mental health, and occupational functioning. A group of patients with a positive development in working relationships from their own perspective showed greater improvement in global mental health and the habituation aspects of occupational functioning than another group with a less positive development. Patients' assessment of a better working relationship vis-à-vis the main therapist compared to the other occupational therapists was reflected in a greater improvement in global mental health and occupational functioning. There were no clear-cut linear relationships between specific levels of the working relationship and outcome. Patient participation, especially in a psychological sense, was positively related to occupational functioning. It was concluded that further investigations are needed before any general statements can be made regarding which treatment processes play a role in and have an influence on the outcome of occupational therapy.     

Occupational health in Brazil

Brazil is a recently industrialised country with marked contrasts in social and economic development. The availability of public/private services in its different regions also varies. Health indicators follow these trends. Occupational health is a vast new field, as in other developing countries. Occupational medicine is a required subject in graduation courses for physicians. Specialisation courses for university graduated professionals have more than 700 hours of lectures and train occupational health physicians, safety engineers and nursing staff. At the technical level, there are courses with up to 1300 hours for the training of safety inspectors. Until 1986 about 19 000 occupational health physicians, 18 000 safety engineers and 51 000 safety inspectors had been officially registered. Although in its infancy, postgraduation has attracted professionals at university level, through residence programmes as well as masters and doctors degrees, whereby at least a hundred good-quality research studies have been produced so far. Occupational health activities are controlled by law. Undertakings with higher risks and larger number of employees are required to hire specialised technical staff. In 1995 the Ministry of Labour demanded programmes of medical control of occupational health (PCMSO) for every worker as well as a programme of prevention of environmental hazards (PPRA). This was considered as a positive measure for the improvement of working conditions and health at work. Physicians specialising in occupational medicine are the professionals more often hired by the enterprises. Reference centres (CRSTs) for workers' health are connected to the State or City Health Secretariat primary health care units. They exist in more populated areas and are accepted by workers as the best way to accomplish the diagnosis of occupational diseases. There is important participation by the trade unions in the management of these reference centres. For 30 years now employers organisations have also kept specialised services for safety and occupational health. Although they are better equipped they are less well used by the workers than the CRSTs. At the federal level, activities concerned with occupational health are connected to three ministries: Labour, Health and Social Security. The Ministry of Labour enacts legislation on hygiene, safety and occupational medicine, performs inspections through its regional units and runs a number of research projects. The Ministry of Health provides medical care for workers injured or affected by occupational diseases and also has surveillance programmes for certain occupational diseases. The Ministry of Social Security provides rehabilitation and compensation for registered workers. In spite of a decrease in the number of accidents at work during the past 25 years, working conditions have not improved. Changes in the laws of social security in the 1970s discouraged registration and reporting of occupational injuries and diseases. In consequence death rates due to accidents increased. With the implementation of the CRSTs, the recorded incidence of occupational diseases has risen, not only because of improved diagnosis, but also because of stronger pressure from the unions and better organisation of public services and enterprises. Received: 24 February 1997 / Accepted: 14 March 1997     

Work-related accidents, with biological materials, in health care workers in public hospitals in Brasilia, Brazil, 2002/2003

This study evaluates the knowledge and acceptance of biosafety measures by health care professionals in light of the potential risk of occupational transmission of HIV. The survey assessed 570 health care workers from 6 hospitals, randomly selected from all hospitals in the Federal District (Brasilia), Brazil. The sample corresponds to 15.0% of the all health professionals in the selected hospitals. These professionals answered a semi-structured questionnaire on knowledge of biosafety and universal precautions, risk of occupational HIV transmission, work-related accidents, use of personal protective equipment (PPE), and acceptance of chemoprophylaxis and HIV testing. The overall accident coefficient was 39.1. Dentists, physicians, and laboratory technicians were those who most frequently suffered such accidents. The accident coefficient was inversely proportional to the hospital capacity. The professionals' knowledge of biosafety concepts and the fact that written norms were displayed in their workstations did not positively affect the work accident coefficient.     

Occupational physicians' new attributions and responsibilities

BACKGROUND: With the introduction in Italy of the Law regarding alcohol abuse and addiction (Law No.125/01), new tasks and responsibilities were assigned to occupational physicians. This law establishes that in working activities with a high risk of industrial accidents, or which may cause a risk for the safety and health of others, workers are forbidden to consume alcoholic beverages during working hours. In addition, occupational physicians are asked to play a key role in testing workers for alcohol levels. In March 2006 a specific list of job titles was issued which makes the law effective. DISCUSSION AND CONCLUSIONS: The application of this law gives rise to various consequences and ambiguities, in particular for occupational physicians, mainly concerning the identification of workers with alcohol problems, the subsequent control of such workers, including proposals for valid rehabilitation programmes, and assessment of residual work fitness. All these aspects can, to some extent, produce conflicts between privacy rights and the need to ensure the health and safety of workers and third parties. A specific screening package is proposed for the identification of alcohol abuse as well as methods to overcome some of the constraints. Specific and effective guidelines need to be issued by scientific societies and health authorities.     

重庆市925名机械制造业女工职业压力现状及影响因素分析

目的 分析重庆市机械制造业女工职业压力现状及影响因素,促进女性职工身心健康。方法 采用随机整群抽样方法,选取重庆市两家机械制造业的925名女工为研究对象,使用中国疾病预防控制中心编制的《女工职业健康专项调查问卷》调查其职业压力状况,采用多元线性回归方法来分析其职业压力的主要影响因素。结果 被调查的925名女工中有843人（占91.1%）存在一定程度的职业压力,其中有轻度职业压力641人（占69.3%）,中度职业压力196人（占21.2%）,重度职业压力6人（占0.7%）。多元线性回归分析结果显示：分别相比初中及以下文化程度、年收入<3万元、工龄<10年、长时间站立的女工,文化程度为高中或中专、个人年收入大于10万、工龄在10～20年和可随意调整工作体位的女工职业压力得分较低（β=-0.690～-5.583,P <0.01）;相比白班作业,工作形式为夜班的女工职业压力得分相对较高（β=0.752,P <0.05）。结论 机械制造业女工普遍存在一定程度的职业压力,相关部门应当做好企业监管,创造良好的工作环境和社会支持环境,提高职业待遇,有效缓解机械制造业女工的职业压...     

Development of occupational health in Japan

This paper was presented as a Lucas Lecture 1990 before the Faculty of Occupational Medicine, Royal College of Physicians, United Kingdom. It describes the development of occupational health in Japan including primitive industrialization (mining, smelting and others) back as far as the 8th century. The modern industrialization of Japan began slightly over one hundred years ago, i.e. from the beginning to the middle of the Meiji era. Before World War II, Japanese workers in industry suffered terrible working conditions, represented by a booklet published in 1925 entitled "The Tragic History of Female Workers" by Wakizo Hosoi. At that time a pioneer named Dr. Gito Teruoka was hard at work. He literally became the "Father of Occupational Health" in Japan. He established the Kurashiki Institute of Science of Labour in 1921 in Kurashiki City located in western Honshu, which is the main island of Japan. At the beginning of the Showa era, from 1930 to 1950, various types of occupational diseases were reported and the situation was overviewed by Dr. Juko Kubota. The rapid industrialization immediately after World War II during which workers were exposed to chromium, benzidine, beta 2-naphthylamine, arsenic, vinyl chloride monomer, asbestos, bischloromethyl ether and other chemicals gave rise to occupational cancer. The Ministry of Labour (MOL) was established in 1947 and the Labour Standard Law enacted. As a result, the incidence of tuberculosis decreased rapidly and occupational health emphasized the early detection of tuberculosis. After tuberculosis was nearly eradicated, more complicated working conditions developed in various industries. MOL enacted the Industrial Safety and Health Law in 1972 and occupational health practices improved greatly. Furthermore, in 1988 MOL amended the Law and announced guidelines on maintenance and promotion of health for the work population. However, there is a great disparity in occupational health services between large establishments and small factories. The University of Occupational and Environmental Health, Japan, (UOEH) was established in 1978 to promote occupational health sciences as well as to train and foster occupational health personnel to meet the short supply of occupational health physicians. However, there is no authority that establishes standards for occupational health physicians and nurses. The urgent necessity of establishing an authorized institution for the qualification of occupational health personnel is emphasized.     

Worker participation in occupational health research: theory and practice

In the area of occupational health, progressive scientists in many countries are attempting to carry out scientific inquiry into the effects of working conditions on the health of workers in a participatory relationship with workers. The author proposes an action research model to describe the underlying research process, taking into account the interests of both workers and academics. For worker/scientist cooperation to be effective, means must be found for the two groups to work on an equal footing. Workers' participation in occupational health research projects takes two forms: informational input-workers' knowledge of working conditions and health problems systematized and used to better understand the work situation and its effects on health and well-being; and partnership--workers' participation in the design and realization of all stages of the research project. Institutional context and worker participation are analyzed in the present article in the light of the experiences of our research group, Group de Recherche-action en Biologie de Travail (Action Research on Work Biology), at the Université du Québec à Montréal. The group has been involved in action research with unions for the past ten years under the terms of a signed agreement between the University and the two major Québec unions, the Féderation des travailleurs (travailleuses) du Québec and the Conféderation des syndicats nationaux.