Occupational respiratory disease in mining

This review is based on research-based literature on occupational lung disease in the mining and related industries, focusing on conditions of public health importance arising from asbestos, coal and silica exposure. Both 'traditional' and 'new' concerns about occupational respiratory disease in miners are addressed, with the inclusion of practical evidence-based findings relevant to practitioners working in developed and developing countries. Mining is not a homogeneous industry since current miners work in formal and informal operations with numerous, and often multiple, air-borne exposures. A further occupational health challenge facing primary care practitioners are ex-miners presenting with disease only after long latency. The sequelae of silica exposure remain an occupational health priority, particularly for practitioners who serve populations with concomitant HIV and tuberculosis infection and even when exposure is apparently below the statutory occupational exposure level. Coal workers' pneumoconiosis, asbestos related diseases, lung cancer and other occupational respiratory diseases remain of considerable importance even after mining operations cease. While mining exposures contribute significantly to lung disease, smoking is a major factor in the development of lung cancer and chronic obstructive airways disease necessitating a comprehensive approach for prevention and control of mining-related occupational lung disease.     

Implementation of Department of Health guidelines for hepatitis B vaccination: a regional audit of NHS occupational health policies and procedures

The objective of this study was to assess the implementationof the UK Health Departments' guidelines on protecting healthcareworkers and patients from hepatitis B infection. The surveytook place in February 1994 in the form of a postal questionnairesurvey of occupational health departments. The study frame wasthe 18 district-based occupational health departments in thenorthern region of the NHS. The main outcome measures were compliancewith the national guidelines on vaccination and the assessmentof the hepatitis B status of employees performing exposure proneprocedures. Compliance with the guidelines was variable. Therewere marked variations in the interpretation of serologicaldata and there was a failure to establish the hepatitis B statusof surgeons, in some cases. There is a need to provide trainingfor occupational health practitioners about hepatitis B andto ensure that there is a uniform standard of practice withinthe NHS.     

Advice given to patients about return to work and driving following surgery

BACKGROUND: The post-operative advice given to patients by health care practitioners regarding return to work and return to driving may have an impact upon their absence duration. The only guidance that is readily available to assist health care practitioners give this advice is provided by the Department of Work and Pensions (DWP). AIMS: To identify what advice local consultant surgeons, occupational physicians and general practitioners give to patients about return to work and driving, following benign abdominal hysterectomy (BAH) and Birmingham hip resurfacing (BHR). To explore health care practitioners' awareness of the DWP evidence-based return to work guidelines. METHOD: A questionnaire was administered to 216 health care practitioners, asking them about the advice they would give to patients undergoing BAH or BHR, regarding return to driving and return to work. RESULTS: Fifty-eight per cent of all health care practitioners that responded were unaware of the DWP evidence-based guidance. Seventy-four per cent of occupational physicians were aware of this guidance but only 32% of general practitioners and 0% of hospital specialists. The advice given regarding expected duration of sickness absence was very variable, ranging between 2 weeks and >12 weeks for both BAH and BHR procedures. Twenty-one different operative 'patient information sheets' were examined and these included only very brief and very general advice about return to work. CONCLUSION: National guidance on post-operative return to work advice could be beneficial. The guidance should be supported by health care practitioners and provide advice about normal ranges of time to return to driving and to return to work.     

Nosocomial transmission of influenza

Influenza is a common nosocomial infection. Serious outbreaks occur typically in elderly long-term patients, but have also been reported in renal, transplant and oncology units, neonatal intensive care and paediatrics. It is likely that staff-patient cross-infection is common. Prompt diagnosis of an outbreak lies at the heart of an effective influenza control programme. This requires effective virological surveillance. There are a variety of strategies that can help to prevent spread of influenza in health care settings. Basic infection control should include isolating infected residents, restricting circulation of nursing staff between patients, and restriction of visitors. Annual influenza immunization should be offered to elderly patients, subjects with chronic disease, and those in long-term residential or nursing home care. Vaccination of health care workers has been shown to be effective in protecting elderly patients in long-term care. Use of oral amantadine or rimantadine is an additional possible strategy for prophylaxis or treatment during an outbreak.     

The general practitioners' view

General practitioners have patients on their lists who work in a variety of occupations, but the doctor is most unlikely to have had any training in occupational medicine. As a result, occupational causes for illness are rarely considered by GPs. Little contact occurs between occupational health physicians and GPs leading to a lack of understanding of the occupational physician's role. These two factors, when combined, may lead to patients receiving sub-optimal treatment. This could be remedied by better undergraduate and postgraduate training, and by greater professional contact.     

Finding ergonomic solutions--participatory approaches

This paper gives an overview of the theory of participatory ergonomics interventions and summary examples from a range of industries, including health care, military, manufacturing, production and processing, services, construction and transport. The definition of participatory approaches includes interventions at macro (organizational, systems) levels as well as micro (individual), where workers are given the opportunity and power to use their knowledge to address ergonomic problems relating to their own working activities. Examples are given where a cost-effective benefit has been measured using musculoskeletal sickness absence and compensation costs. Other examples, using different outcome measures, also showed improvements, for example, an increase in productivity, improved communication between staff and management, reduction in risk factors, the development of new processes and new designs for work environments and activities. Three cases are described from Canada and Japan where the participatory project was led by occupational health teams, suggesting that occupational health practitioners can have an important role to play in participatory ergonomics projects.     

Benchmarking self-reported practice regarding Scottish Executive guidance on hepatitis C-infected health care workers

BACKGROUND: The 2002 Scottish Executive guidance 'hepatitis C-infected health care workers' advised NHS Scotland occupational health departments regarding screening health care workers (HCW) who perform or who may perform exposure-prone procedures (EPPs) for hepatitis C virus (HCV) infection. In 2004, 2 years following the launch of the guidance, there was anecdotal evidence of challenges to implementation and clinical and ethical concerns regarding the screening process. AIM: To benchmark the implementation of the Executive guidance on hepatitis C-infected HCW in NHS Scotland. METHODS: Lead occupational health practitioners in 15 Scottish NHS Boards completed a questionnaire and provided relevant local policies. RESULTS: All 15 NHS Boards responded: 87% (n = 13) had implemented the guidance with partial implementation in the remaining boards. While 87% required identified and validated samples (IVS), no consistent method was reported for how results from an IVS were recorded. There was also no consensus as to the duration a result was considered valid or consistency in charging for tests required by other employers. Across Scotland, some employee groups were being screened over and above those recommended within the guidance. Overall, there was agreement on the value of a standardized NHS hepatitis C status certificate and the importance of explicit screening criteria and identifying EPP workers. CONCLUSION: The survey confirms the challenges in implementing the guidance on managing HCV-infected HCW within NHS Scotland. These include lack of clarity regarding who, when and how frequently a HCW should be screened and how the results of such tests should be recorded.     

Sexual health and HIV in travellers and expatriates

Travellers engaging in sexual contact with a new partner abroad may be at high risk of acquiring a sexually transmitted infection. This review examines the impact of travel on sexual health and provides prevention, management and treatment recommendations to practising occupational health physicians.     

The interaction between general practitioners and occupational health professionals in relation to rehabilitation for work: a Delphi study

BACKGROUND: Anecdotally, communication between general practitioners (GPs) and occupational health professionals is poor and acts as a barrier to successful rehabilitation for work. It is not known how widely this view is held by the many stakeholders in rehabilitation for work, or how important the observation is in its effect. METHODS: A Delphi study was conducted by initial semi-structured telephone interview, followed by a three-round collation and feedback of opinion by e-mail. The 25 participants were identified by suggestion within the study process for their position as key informants within a wide range of stakeholders. RESULTS: The process generated a consensus statement which identifies the extremely important nature of rehabilitation for work, the crucial role by GPs, the central role of occupational health professionals in case management and the barrier represented by the often very poor communication between them. CONCLUSION: The way forward is to improve communication by mutual education and understanding and a team approach to rehabilitation strategy. This may be facilitated by the GPs who work in occupational health and disability assessment and the involvement of other health professionals to great benefit for all stakeholders.     

Occupational and environmental medicine: sustainable development?

Occupational medicine is evolving to meet the needs of the 21st century. There is a need to define the remit of occupational and environmental medicine in order to facilitate the development and maintenance of requisite competencies, the establishment of educational goals for practitioners and production of a professional product for the global market place. The delivery of occupational health services will be underpinned by quality assurance systems.     

Exploring the need for an occupational health service for those working in primary care

A research nurse interviewed 55 practice staff in 11 generalpractices to ascertain their views about their needs for occupationalhealth care. In a second parallel study, a specialist in occupationalmedicine undertook an in-depth audit of occupational healthprovision in five other general practices with respect to theorganization, the health and safety process, the services andthe working environment. In the first study, the majority ofpractice staff reported the need for various aspects of occupationalhealth care, particularly stress at work. In the second study,general practitioners and practice managers possessed a basicawareness of occupational health matters such as Health andSafety legislation, but their limited knowledge was not translatedinto effective management. General practice staff did not knowwhere to obtain occupational health advice; most practices hadno policies or procedures in place to manage health and safety.Both studies illustrate the need for expert occupational healthadvice in primary care.     

Sickness absence due to influenza

In addition to its recognized health effects, influenza has socio-economic consequences, most notably sickness absence and associated work disruption. It may account for 10-12% of all sickness absence from work. Data on the impact of influenza on work are limited. Most research has assessed the impact of an intervention, usually influenza immunization. Within the available literature, there are five randomized controlled trials in the workplace that have assessed the effectiveness of influenza immunization as an intervention: two in the general working population and three in the health sector. If the benefit desired is a reduction in sickness absence as a cost-effective measure, the likely outcome is a modest gain in years when incidence of influenza is increased in the community. There are some distinctive factors in the health care industry: health care workers may exhibit different absence behaviour, they may be more exposed to infection at work and they may pose a risk as a source of nosocomial infection. From the occupational health perspective, how do we best inform employers currently? The cost-effectiveness case has not been absolutely proven. More research appears necessary, including assessment of those factors that influence uptake of influenza immunization. In the interim, a targeted approach to certain job categories may be the way forward.     

Vaccination against influenza: UK health care workers not on-message

Vaccination of health care workers against influenza is considered to be important as a means of protecting patients from nosocomial infection. Vaccine uptake rates have been reported to be no more than 40% and often between 20 and 30%. An evaluation of the performance of UK National Health Service trusts, following a governmental directive to implement vaccination during the winter of 2000-2001, has shown a poor uptake of vaccine. Reasons for accepting or declining vaccine are discussed. There is a need for global leadership on this issue to promote the value of vaccination and to change the behaviour of health care workers.     

Evaluation of an occupational health service for general practitioners and their staff in a primary care trust

BACKGROUND: An occupational health service was set up in 2002 for general practitioners (GPs) and their staff in a London primary care trust (PCT). The service was based on a needs assessment undertaken in the locality in 1998. AIMS: To evaluate awareness, usage and perceived helpfulness of the service amongst GPs and practice managers, and to ascertain current perceived priorities for what to include in the service. METHODS: Questionnaire survey sent postally and electronically to 199 named GPs and 69 practice managers in 78 practices in the PCT. RESULTS: Overall 119/268 (44%) responses were received from 54/78 practices (69%). Awareness of the existence of the service was high (76%), and although uptake had been poor, this was not related to a perception that the service was unlikely to be helpful. Almost all those who had used the service had found it helpful. Nineteen (16%) respondents asked for more information about the service. Advice on health and safety law and fitness for work assessments were the highest priorities and hepatitis B immunization lowest, as in the 1998 needs assessment. However, a discrepancy between GPs and practice managers with regard to the perceived relative importance of pre-employment health screening and counselling/stress management emerged. CONCLUSIONS: The service is valued by users but could be developed by exploring new ways to disseminate information about the service and deliver it.     

The Distance Learning Courses in Occupational Medicine--20 years and onwards

BACKGROUND: The first Distance Learning Course in Occupational Medicine was set up in 1984 at the Department of Occupational Health, University of Manchester. AIMS: This paper describes the progress of that course and developments within distance learning education in occupational health at The University of Manchester over the subsequent 20 years. It also looks at the future objectives and modes of teaching of occupational health at Manchester via distance learning. METHODS: Analysis has been undertaken of student demographics and matching between original forecasts and actual outcomes. RESULTS: Original forecasts of student uptake have been surpassed. There are indications of increases in the number of female and part-time students, and a corresponding decline in the number of general practitioners enrolling on the Advanced course. Response to developing circumstances has resulted in the Distance Learning Unit setting up additional courses. CONCLUSIONS: The farsightedness of those who predicted the need for academic training in occupational health by distance learning has been proved correct. Further evolution is essential to maintain and improve the value and success of the courses.     

Is there value in routinely obtaining a report from the general practitioner as part of pre-entry health screening of students for nursing studies?

BACKGROUND: Reports from general practitioners (GPs) are requested on applicants for nurse training, but there is no published evidence of the merit of this practice. AIMS: To assess the benefit of GP report in health assessments of student nurse applicants. METHODS: An audit was made of information obtained by health declaration form (HDF), nurse's assessment, GP report and, when performed, a physician's assessment for each applicant. Agreement between the health questionnaire and GP report was analysed by kappa statistics. RESULTS: Of 254 applicants, 246 (97%) were declared 'fit to work', four (1.6%) were deemed 'fit with restrictions' and four (1.6%) were considered 'unfit to work'. The most common problems declared were psychiatric and skin problems. The agreement between health declaration and the information provided by GPs was classed as almost perfect for diabetes and only fair to moderate for all other measures. The reports provided additional information on problems not declared by applicants, but all of these were passive problems. The four unfit candidates all had psychiatric illness, but in all cases the occupational health assessment was sufficient to make this decision or to request further information. In the 'fit with restrictions' category, three of the four GP reports (75%) helped in correctly assigning the applicants to this category. In one of these eight cases a passive problem had not been declared. CONCLUSIONS: The additional information in GP reports does not affect the conclusion regarding fitness for training in most cases and does not provide sufficient information to merit it being sought routinely.     

A South-East Asian perspective

In order to discuss the subject of occupational medicine in the next century, changes in the present demographic profile and work activity must be considered first. Only then can the challenges be identified, and appropriate strategies be formulated to respond to them. In the diverse countries of South-East Asia, improved health and work conditions, the advent of new technology, a redistribution of work activity, and an ageing workforce can be expected. Two other factors that have specific impact in the region are the recent financial crisis and the occurrence of an international environmental haze from forest fires. The various countries in South-East Asia, which are in different stages of development, and have different problems and priorities, will respond differently to the demands for occupational health. It is likely that there will be a shift in the focus of current health care activities towards specific work sectors, the recognition of new hazards at work, the identification of newly emerging work related diseases, and an increase in health promotion in the workplace. Hopefully, there will be improved training of health professionals to ensure that there are adequate numbers and that they are well prepared to face these changes. Responsive, appropriate and well enforced labour legislation to protect the health of all workers, and international cooperation in occupational and environmental health are also required. As global and regional economic conditions continue to remain unstable and the impact of the crisis further takes its course, the final effect on occupational health in South-East Asia remains to be seen.     

An economic evaluation of occupational health

There is an increasing need to evaluate the costs and benefits of an occupational health service (OHS). However, measuring benefits from an OHS is inherently difficult. Instead, an economic model can be constructed to present the minimum threshold benefits required for OHSs to be cost-effective, given what is known about costs. This model assumes that the benefits of an OHS are to maximize health and morale of employees; maximize performance and increase productivity; minimize medico-legal costs; enhance workplace safety; and reduce sickness absence. A certain distribution across these benefits can be assumed for each OHS. The overall required value of all benefits brought about by use of an OHS is in the range 158-199 Pounds per year. The plausibility of results can be assessed using known data and judgement. Despite many uncertainties it is likely that the minimum benefit thresholds will be achieved overall.     

Prevalence of hepatitis B and C virus infection in barbers in the Sivas region of Turkey

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the most devastating health problems in the world, including Turkey. The route of transmission of HBV and HCV is mainly parenteral, a small number of epidemiological studies demonstrating that perinatal, sexual, household and occupational transmission occurs. Contact of a patient's blood or bodily fluids with non-intact skin is another mode of HBV and HCV transmission. Barbers in Turkey may often be exposed accidentally to the blood and bodily fluids of their customers. The aim of this study was to determine the prevalence of HBV and HCV infection in barbers. We conducted a study to determine the prevalence of antibodies against HBV and HCV among 176 barbers and 180 control subjects in the Sivas region of Turkey. The prevalence of HBV and HCV was found to be higher in barbers (39.8 and 2.8%, respectively) than in a comparison group (28.3 and 1.1%, respectively). No significant relationship was found with the duration of occupation. Among the seropositive subjects, it was found that most had been exposed to needle pricks or scissor cuts. Our data suggest that both HBV and HCV infections may constitute occupational hazards for barbers. The sources of infection could be not only such personal risk factors as 'sharps' injuries and scissor cuts, but may also include other unknown factors.     

Physician health and wellness

BACKGROUND: Impaired physician health can have a direct impact on patient health care and safety. In the past, problems of alcoholism and substance abuse among physicians have received more attention than other conditions-usually in the form of discipline. While patient safety is paramount, the medical profession may be more successful in achieving the required standards by fostering a culture committed to health and wellness as well as supporting impaired physicians. OBJECTIVE: To develop ethical guidelines regarding physician health and wellness. METHODS: The American Medical Association's (AMA's) Council on Ethical and Judicial Affairs developed recommendations based on the AMA's Code of Medical Ethics, an analysis of relevant Medline-indexed articles, and comments from experts. The report's recommendations were adopted as policy of the Association in December 2003. RESULTS: Individually, physicians can promote their personal health and wellness through healthy living habits, including having a personal physician. The medical profession can foster health and wellness if its members are taught to identify colleagues in need of assistance and initiate appropriate methods of intervention, including referrals to physician health programs. CONCLUSIONS: Physicians whose health or wellness is compromised should seek appropriate help and engage in honest self-assessment of their ability to practice. The medical profession should provide an environment that helps to maintain and restore health and wellness. Physicians need to ensure that impaired colleagues promptly modify or cease practice until they can resume professional patient care. In addition, physicians may be required to report impaired colleagues who continue to practice despite reasonable offers of assistance.