Health disorders of shift workers

The effects of shift work on physiological function through disruption of circadian rhythms are well described. However, shift work can also be associated with specific pathological disorders. This article reviews the evidence for a relationship between specific medical disorders and working at night or on shift systems. The strongest evidence exists for an association with peptic ulcer disease, coronary heart disease and compromised pregnancy outcome.     

医护人员手卫生依从行为及其影响因素

目的了解医护人员手卫生依从行为及其影响因素。方法采用调查问卷自评的方法,于2014年11月-2015年2月对某院15个临床科室医护人员手卫生执行情况进行调查,采用多因素logistic回归分析医护人员手卫生执行目的对手卫生行为的影响。结果共调查医护人员364名,其中手卫生行为执行较好者245名（占67.31%）。单因素分析结果显示,不同岗位、教育程度、手卫生目的医护人员手卫生执行情况比较,差异具有统计学意义（均P＜0.05）。将单因素分析具有统计学差异的因素引入多因素logistic回归分析结果显示,手卫生目的与手卫生行为执行情况比较,差异具有统计学意义（P=0.042）;与以“保护自己”为目的进行手卫生的医护人员相比,以“防止交叉感染”为手卫生目的的医护人员手卫生行为执行得更好(OR=2.17,95%CI: 1.29～3.65)。影响医护人员手卫生行为居前5位的客观因素分别为冬天无温水洗手（占70.73%）,工作量大、太忙没时间（占61.38%）,手消毒剂及洗手液会引起皮肤粗糙/干燥（占54.88%）,未配备干手用具（占47.56%）,一次性手套的使用（占45.12%）。结论在完善手卫生硬件设施的基础上,改变医护人员只偏重“保护自己”的手卫生意识,可能是提高医护人员手卫生行为的另一种方式。     

Health status and access to health care of migrant workers in China

OBJECTIVES: We explored living and working conditions, health status, and health-care access in Chinese rural-to-urban migrants and compared them with permanent rural and urban residents. METHODS: A questionnaire was administered to 1,958 urban workers, 1,909 rural workers, and 4,452 migrant workers in Zhejiang Province, Eastern China, in 2004. Blood samples for human immunodeficiency virus (HIV) and syphilis were taken from the migrant and urban workers. RESULTS: Migrants were young, worked very long hours, and their living conditions were very basic. Nineteen percent had some form of health insurance and 26% were entitled to limited sick pay compared with 68% and 66%, respectively, for urban workers. Migrants had the best self-rated health and reported the least acute illness, chronic disease, and disability, after controlling for age and education. There were no HIV infections detected in either the migrant or urban workers. However, 15 urban workers (0.68%, 95% confidence interval [CI] 0.35, 1.02) and 20 migrants (0.48%, 95% CI 0.26, 0.66, p=0.06) tested positive for syphilis. The high cost of health care in the city was a barrier to health-care access in the last year for 15% of the migrants and 8% of the urban workers. Forty-seven percent of the migrants were unwilling to make contributions to health insurance. CONCLUSIONS: These migrants demonstrated the "healthy migrant effect." However, poor living conditions and inattention to health may make migrants vulnerable to poor long-term health. Because health insurance schemes will remain limited for the forseeable future, attention should focus on providing affordable health care to both uninsured migrants and the urban poor.     

Occupational health in health care workers

Since the second half of the 20th century occupational health in health care workers is a well-established part of occupational medicine. Identification of environmental, biological, chemical, physical, and psychosocial hazards has lead to a number of preventive measures: Technical (e.g. use of safe instruments and double gloving as protection) and immunological (vaccinations) measures against biological hazards), and technical (lifting aides) and personal (back-schools) intervention to prevent musculoskeletal disorders are well-designed examples.     

Changes in health habits of female shift workers

This paper examines the effects of shift work on the lifestyles of female factory workers. As an indicator of healthy lifestyle habits, we used a scoring system (referred to below as the 'health score') based on Lester Breslow's health habits. The 'health score' of the women was higher than that of the men, but the shift workers' score was lower than that of the non-shift workers (p<0.01). In addition, the score of workers who had changed from non-shift work to double-shift work was remarkably low (p<0.01). These results suggest that, while the female shift workers manage to maintain relatively healthy lifestyles in comparison with the males, they have more difficulty maintaining these habits than do female workers who do not perform shift work. It can be concluded that, in addition to heightening women's consciousness of their own health, surrounding entities such as the work environment, the home, and the community in general need to pay due care to Japan's female shift workers.     

Ethnic health workers in primary health care

Abstract: Ethnic health workers were employed to increase the access of communities of non-English-speaking background to health services, but their role has remained unclear in a national health system that has been criticised for being slow to respond to the needs of these communities. Interviews and a questionnaire were used to survey a convenience sample of 40 South Australian ethnic health, welfare and community workers and 17 supervisors about the important roles of ethnic health workers, how they should perform their roles and their ability to fulfil them. Interviews with 11 staff from the New South Wales Ethnic Health Worker Program then provided a broader perspective to the South Australian findings. High-priority roles were to provide help to solve immediate health problems. Roles included providing access as well as services. There were pressures on ethnic health workers to become service providers: clients from non-English-speaking backgrounds expected assistance with a wide range of problems, and mainstream staff lacked competence in meeting these needs. Ethnic health workers' involvement in needs assessment and health agency change was limited by these pressures, by ethnic health workers' separation from the work of mainstream staff and because systematic planning of services to non-English-speaking communities was lacking. The appropriate role for an ethnic health worker is as an access provider, with a greater emphasis on needs assessment and agency change. Agencies need to develop culturally appropriate service plans and training so that ethnic health workers and mainstream staff are better able to work together.     

Health care workers: risk factors for nonlatex and latex gloves during surgery

This study examined glove failure and related factors in both nonlatex and latex surgical gloves after routine use. A federally funded research study was conducted to collect surgical gloves from those directly involved in surgical procedures. All gloves were examined in the laboratory for both visual defects and barrier integrity. A total of 11,118 usable surgical gloves were examined. The overall defect rate was 7.8%; nonlatex gloves were significantly more likely to fail (8.4%) than latex gloves (6.9%). The majority of defects in the latex gloves (90%) and nonlatex gloves (70%) were not detected by visual examination. Separate logistic regression models examined predictors of defects for the gloves. The only factor that increased the odds of a defect for a latex glove was duration of use over 6 hours. Factors increasing the odds of a defect in nonlatex gloves included gloves worn by a scrub person and gloves used in certain surgical services. Scrub persons had a higher defect rate despite wearing their gloves for a significantly shorter time than other health care workers. Latex and nonlatex gloves fail under different conditions. Latex gloves fail primarily due to length of use, whereas nonlatex gloves are more sensitive to conditions of us (e.g., type of health care worker and type of surgery). Providers can help guard against glove defects by double gloving and by changing gloves often, especially when using nonlatex gloves in higher-risk surgeries.     

Tuberculosis among health care workers

To assess the annual risk for latent tuberculosis infection (LTBI) among health care workers (HCWs), the incidence rate ratio for tuberculosis (TB) among HCWs worldwide, and the population-attributable fraction of TB to exposure of HCWs in their work settings, we reviewed the literature. Stratified pooled estimates for the LTBI rate for countries with low (<50 cases/100,000 population), intermediate (50-100/100,000 population), and high (>100/100,000 population) TB incidence were 3.8% (95% confidence interval [CI] 3.0%-4.6%), 6.9% (95% CI 3.4%-10.3%), and 8.4% (95% CI 2.7%-14.0%), respectively. For TB, estimated incident rate ratios were 2.4 (95% CI 1.2-3.6), 2.4 (95% CI 1.0-3.8), and 3.7 (95% CI 2.9-4.5), respectively. Median estimated population-attributable fraction for TB was as high as 0.4%. HCWs are at higher than average risk for TB. Sound TB infection control measures should be implemented in all health care facilities with patients suspected of having infectious TB.     

Assessment of fitness for work in health care workers: biomechanical risk factors

In current practice the assessment of fitness for work in health care workers exposed to biomechanical risk factors is often based on conventional approaches rather than on evidence-based guidelines. However, an accurate evaluation of worker's psychophysical resources compared to job demand and potential occupational risk factors is essential in order to properly assess fitness for work. The latest published guidelines on the management of patients suffering from back pain reported that the evidence-based approach can minimize the period of inactivity by encouraging return to work (and to other non-dangerous physical activities) in a relatively short period of time. As for carpal tunnel syndrome, there is no scientific evidence supporting a restriction of physical activities requiring forceful movements of the hand/wrist.     

Vaccination of health care workers

Health care personnel, including laboratory workers, are at risk of contracting vaccine-preventable diseases from patients, their blood or other body fluids. Health care workers may also transmit infection to their patients. These workers should be appropriately vaccinated against the hepatitis B virus, the influenza viruses and the measles, mumps, rubella and varicella zoster viruses. Vaccination against these agents is discussed, including issues regarding the vaccination of immunocompromised health care workers and factors that influence the uptake of vaccines amongst health care workers. [AIC Aust Infect Control 2000; 5(1):6-9.]     

Latex symptoms and sensitisation in health care workers

Background: Natural rubber latex has become an important occupational health concern, particularly among health care workers, who for protection are required to wear latex gloves when at work. This study evaluated the prevalence of latex-related symptoms and sensitisation among a large group of health care workers in Trieste hospitals. Methods: We evaluated the prevalence of latex-related symptoms in 1,165 health care workers, by means of a questionnaire, a medical examination, skin prick tests and IgE-specific evaluation. We determined atopy and latex sensitivity by skin prick tests using a battery of common inhalant allergens, a commercial latex extract (Lofarma Allergeni, Milan) and individual skin puncture tests for each of the vegetables immunologically related to latex (potato, tomato, chestnut, banana, kiwi fruit). Associations between potential risk factors for latex allergy were assessed. Results: Glove-related symptoms were noticed on 17.2% of the nurses (200) the majority of symptoms being mild dermatitis with itching and erythema (120 subjects, 11.1%). Symptoms suggestive of IgE-mediated latex allergy were found in 51 subjects: 35 (3%) complained of contact urticaria and 16 (2.2%) complained of asthma and/or rhinitis. The resulting symptoms were significantly related to skin prick tests that were positive to latex (odds ratio (OR)=11.89; 6.40–22.2), to personal atopy (OR=2.15; 1.47–3.12), to familiar atopy (OR=2.12; 1.48–3.03), to skin prick test positivity to related fruit (OR=2.01; 1.16–3.46) but not to prick test positivity to common inhalant allergens (OR=1.00; 0.71–1.39). Symptoms increased as a direct function of the time-usage of latex gloves and were more prevalent in operating room staff. Conclusion: In this large cross-sectional study, glove-related symptoms and latex skin sensitisation appear to be substantial among health care workers, and are related to common signs of atopy. We stress the need of preventive measures to avoid latex exposure when health care workers are at risk of developing allergy symptoms. Received: 18 May 2000 / Accepted: 1 November 2000     

Health and health care in Vietnam

The South East Asian state of Vietnam is currently undergoing a transition from a centralised socialism to a so-called socialist market economy strongly promoting the private sector. For the last 17 years economy experienced an impressive growth. If the assumption is true that economic growth is positively correlated with the health status of the population, the strengthened economy of Vietnam must go along with an improved health situation and health care system of this country. The following paper evaluates this assumption. It is demonstrated that there is indeed a strongly positive correlation between health and development in many aspects. However, it becomes obvious that economic growth is definitely accompanied by increasing regional and social disparity challenging the health care policy of Vietnam and her international partners.     

Health and health care of employed women and homemakers: family factors

Women's increasing participation in the labor force has resulted from availability of fertility control, changed attitudes toward family size, a strong demand for occupations traditionally filled by women, and other factors. Despite many social changes, employed women continue to be concentrated in lower-income pursuits and frequently have major responsibility for the household. This paper is drawn from a study that explored the association of occupation and home responsibilities with the health of employed women and men and compared them with female homemakers. It also examined variations in the use of physician and hospital services. The principal data source was the National Health Interview Survey tapes for 1975-77. Nurturant role responsibilities were derived from records of members of the index adult's household. This paper reports on comparisons of employed women with homemakers using multiple regression analysis, and also on direct comparisons of the three work-sex groups. Study findings suggest that better health is associated with desired, positive roles such as marriage and married parenthood. Worse health is associated with unwelcome role expansions such as single parenthood, child disability, having a sick spouse and marital dissolution. Effects vary by both sex and work status. It is suggested that it is not the number of activities that may be burdensome to women's health but inability to choose one's roles and organize one's resources to meet their demands.