A survey of eye trauma and diseases at a teaching hospital: implications for training in occupational ophthalmology in Nigeria

This study explores the amount of occupational ophthalmology that it is possible to encounter within an existing teaching hospital system, as this offers the primary training facilities for resident doctors who expect to specialize in occupational medicine. The study was based on an analysis of ophthalmology patient records available at the University College Hospital, Ibadan, which is Nigeria's largest teaching hospital. One thousand, three hundred and thirty-four patients with eye disease were seen during the 1-year study. Of these, 1052 (78.9%) did not have their occupations recorded. Accidents were the only occupational diagnoses recorded, and this occurred in 75 (5.6%) of cases. The findings indicate that doctors who train in this specialty should gain experience in industries that have sizeable occupational health services, in addition to their formal ophthalmology training, in order to acquire experience in primary and occupational eye care. It is suggested that greater emphasis be placed on occupational ophthalmology in teaching hospitals and that there is a general improvement in completing patients' records: in particular, a patient's occupation should be recorded.     

Health and employment after a diagnosis of occupational asthma: a descriptive study

The objectives of this study were to describe changes in asthmaand employment after diagnoses of occupational asthma reportedto the SWORD project. Questionnaires were sent to 312 physiciansfor all 1,940 cases of occupational asthma reported from 1989–92;1,769 (91%) were returned but information was available foronly 1,317 (68%). Of patients reported by occupational physicians,45% had recovered from asthma compared to only 14% of thosereported by chest physicians (excluding medicolegal cases),presumably because of differences in severity. Proportions withthe same employer were 49% and 48% respectively. Patients exposedfor a year or more after diagnosis recovered from asthma lessfrequently but were more often employed than those exposed forless than a year. Among those whose asthma was attributed tohigh molecular weight agents, smokers had developed asthma earlierafter exposure began than others but had the best prognosis.Asthma developed following a single high exposure in 18 cases(2%), of which 13 were to irritants and five to known sensitizers.     

Quality Improvement by Means of 'Differential' Occupational Health Care: An Experiment in a Regional Occupational Health Centre

From a general policy of quality improvement, the regional OccupationalHealth Centre Eastern Gelderland has developed a method of companyhealth care based on the particular demands and needs of companies.A procedure of care ‘made to measure’ based on companyand work characteristics was designed. For one year, an experimentwas carried out in seven companies, to investigate if this ‘differentialcare’ is feasible, and if its quality is better than thetraditional ‘standard’ form. After the experiment,the companies' satisfaction proved to have increased. The influenceof the Occupational Health Centre on working conditions wasestimated more important than before. The increased satisfactionis considered to be an indication of better quality of care,compared with the traditional ‘standard’ care. Thedifferential approach appeared to be feasible. The method requiresskills of professionals in the field of planning, cooperation,estimating costs and negotiating.     

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.     

How I address quality and teamwork issues in the occupational health department

To be successful in today's climate an occupational health providerneeds well-trained and motivated staff who are both professionaland focused on delivering quality services that meet the needsof their customers. Achieving this goal is facilitated by havinga clear sense of mission with systems in place within the organizationof the department that support this and encourage continuousimprovement. Good communication, performance measures and teamworkare identified as key elements in realizing the goal of a qualitydepartment. This article, in sharing the experiences of addressingquality and teamwork, discusses important issues relevant tomany occupational health departments.     

Report of a system for diagnosis, categorizing and recording occupational mental ill-health

BACKGROUND: UK statutory systems for occupational disease recording do not include mental illness resulting from occupational stress. The issue is included within physician reporting systems, but there is no agreed set of criteria for diagnosis of occupational causation and no agreed system of categorization in terms of type of causation by workplace factors. METHOD: A multidisciplinary group of occupational health professionals, in conjunction with human resources staff, developed a system for the diagnosis, categorization and recording of occupational mental ill-health. RESULTS: The developed system was applied as a pilot and the outcome from its first year of use is presented. CONCLUSIONS: The system is considered to have operated well in pilot, and has now been adopted as a standard operating procedure by the occupational health provider who developed it. The system is proposed as a tool in the development of standardized NHS or UK national systems for the recording of occupational mental ill-health.     

广州市职业健康监护和职业病发病状况分析

目的分析广州市职业健康监护工作和职业病发病的特点。方法对1993至2002年全市劳动卫生工作情况汇总资料进行职业健康监护和职业病发病状况的回顾性研究。职业健康监护体检资料按时间顺序每5年分一组，共分两组，即1993至1997年为第1组，1998至2002年为第2组。结果10年职业健康监护体检年平均受检率均在75％以上。第2组噪声听力损伤、观察对象、物理因素重点监护人员和粉尘、化学因素禁忌证人员明显高于第1组，差异有统计学意义（P〈0．01）。第1组新发慢性职业病共91例，第2组181例，两组发病率的差异有统计学意义（P〈0．05），其中化学中毒和噪声听力损伤的发病率上升明显，两组尘肺的发病率差异无统计学意义（P〉0．05）。10年共发生各类职业病581例，其中急性中毒309例，占53．18％，慢性职业病272例，占46．82％；慢性职业病中尘肺占16．70％，铅和苯化学中毒占16．87％。随着时间的推移，尘肺、化学因素中毒和总职业病患者发病工龄趋于年轻化，发病工龄也明显缩短，差异均有统计学意义（均P〈0．01）。结论广州市初步建立了一个较规范的职业健康监护体系。体检中检出的噪声职业性重点监护和粉尘、化学因素禁忌证人员明显上升；职业病发病明显上升，以急性职业中毒和尘肺、铅和苯中毒为主；慢性职业病患者发病年龄趋于年轻化，发病工龄缩短。     

SWORD '97: surveillance of work-related and occupational respiratory disease in the UK

SWORD is one of seven clinically based reporting schemes which together now provide almost comprehensive coverage of occupational diseases across the UK. Although SWORD is now in its tenth year, participation rates remain high. Of an estimated 3,903 new cases seen this year, 1,031 (26%) were of occupational asthma, 978 (25%) of mesothelioma, 794 (20%) of non-malignant pleural disease, 336 (9%) of pneumoconiosis and 233 (6%) of inhalation accidents. Incidence rates of occupational asthma were generally highest among workers in the manufacture of wood products, textiles and food (particularly grain products and crustaceans) and additionally, in the production of precious and non-ferrous metals, rubber goods, detergents and perfumes, and in mining. Health care workers were noted to have a surprisingly high incidence of inhalation accidents. Occupational asthma attributed to latex has increased dramatically; the highest rates are among laboratory technicians, shoe workers and health care workers.     

The scale of perceived occupational stress

This article reviews previous research on the scale of occupational stress and describes in detail the Bristol Stress and Health at Work study. This study had three main aims: firstly, to determine the scale and severity of occupational stress in a random population sample; secondly, to distinguish the effects of stress at work from those of stress in general life; and finally, to determine whether objective indicators of health status and performance efficiency were related to perceived occupational stress. These aims were investigated by conducting an epidemiological survey of 17,000 randomly selected people from the Bristol electoral register, a follow-up survey 12 months later, and detailed investigation of a cohort from the original sample. The results revealed that approximately 20% of the sample reported that they had very high or extremely high levels of stress at work. This effect was reliable over time, related to potentially stressful working conditions and associated with impaired physical and mental health. The effects of occupational stress could not be attributed to life stress or negative affectivity. The cohort study also suggested that high levels of occupational stress may influence physiology and mental performance. The prevalence rate obtained in this study suggests that 5 million workers in the UK have very high levels of occupational stress.     

The perceptions of occupational health in primary care

AIM: A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care. METHODS: Qualitative data were collected using focus groups with three groups of primary care sector professionals. Quantitative data were collected nationally from 295 GPs using a postal questionnaire. RESULTS: GPs and PNs had minimal OH training, and 60% of GPs reported constraints in addressing OH matters with patients. The lack of referral routes (63 and 67%, respectively) was also seen as a barrier. OH was regarded as a speciality, and primary care professionals preferred to refer patients with OH problems to specialist centres because they perceived barriers to their dealing with the issues. A total of 74% of GPs surveyed thought that speedier access to secondary care would help them to address OH problems. CONCLUSIONS: This study has identified some of the problems associated with delivering OH through primary care. It also demonstrated a need for greater emphasis on OH education in medical and nurse training, and a need for better advice for GPs, PNs and PMs regarding support services for OH.     

Occupational lung diseases and global occupational health on the Net

Occupational lung disease is a major area of concern in occupationalhealth, exhibiting a diverse panorama across countries. Whilepneumoconiosis is deemed to be the most common occupationaldisease in many developing countries, emphasis is shifting towardsasbestos-related lung diseases and occupational asthma in industrializedcountries. Following the Occupational Health for All strategiesset forth by the World Health Organization, we propose thata model system based upon the Global Health Network can serveas an effective vehicle towards the prevention of occupationallung diseases on a global scale. It has the potential to: (1)enhance transmission of data and collaboration with the primaryhealth care system in disease surveillance; (2) strengthen researchand information transfer and (3) promote education and trainingat all levels of prevention, with a possible application tothe interpretation of chest radiograms.     

2017年河北省重点职业病分布调查

目的分析河北省重点职业病的发病特点、变化趋势和规律,为预防控制职业病提供科学依据。方法收集2017年河北省企业职业危害、劳动者职业健康检查及职业病诊断与鉴定情况,并对数据进行统计分析。结果 2017年河北省共报告重点职业病950例,主要为矽肺和煤工尘肺,行业主要集中在采矿业和制造业,以中、小型国有和私有经济企业为主;2017年河北省共申请重点职业病鉴定27例,其中有24例鉴定结果与诊断结论相符;共收集在岗期间职业健康检查个案222 780人(262 204人次),收集率为95.91%(262 204/273 393);2017年河北省进行职业病危害申报的企业共23 539家,其中存在重点职业病危害的企业14 499家,接触重点职业病危害因素328 547人次,应检281 045人次,实检273 393人次,检查率为97.28%。结论 2017年河北省需重点防控的职业病危害因素为矽尘、煤尘和噪声,需重点防控的职业病为尘肺病,需重点防控的行业为采矿业和制造业,噪声对劳动者听力的损害不容忽视。     

Surveillance of occupational and work-related diseases between 1993 and 1996 in an engineering company

There are established reporting schemes for some occupational and work-related illnesses but these schemes may underestimate the true incidence of such diseases. Not all cases may be referred to a participating physician and access to adequate diagnostic facilities are not always available. Collecting data directly from occupational health departments may overcome some problems related to under-reporting as they have good access to the entire working population within their company. The aim of this paper is to report the results from such a reporting scheme operated by a large multi-national engineering company during the period 1993-96. All UK sites of Lucas Industries (later LucasVarity) participated. A report form was completed by the occupational health department of each participating site each month. The report form gave abbreviated details of each case of occupational and work-related disease occurring at that site during the previous month. Forms were posted to a central office where the data was collated and analyzed. The incidence of respiratory diseases was broadly similar or slightly higher to that reported from other schemes. Musculoskeletal diseases were by far the most common category of disease reported. During a four year period of reporting the incidence of occupational and work-related diseases decreased overall by approximately 75%. As the reported incidence of respiratory disease was comparable with or slightly higher than that from other schemes, it appears that reporting schemes such as this can provide useful and accurate data. Musculoskeletal diseases are the most common type of disease attributed to work and should probably receive greater attention. The decrease in incidence seen in LucasVarity over time may reflect increased emphasis given to health and safety issues within the company during the reporting period.     

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

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

Surveillance of work-related diseases by occupational physicians in the UK: OPRA 1996-1999

The Occupational Physicians' Reporting Activity (OPRA) surveillance scheme for occupational physicians has now been in place for 4 years. During this period, an estimated 43,764 new cases of work-related disease have been reported. Musculoskeletal conditions make up nearly half (49%) of all cases; mental ill-health and skin disease account for 20% each, with respiratory conditions (8%) and hearing loss (5%) seen in lower proportions. Overall, eight of 42 diagnoses made up four-fifths of the new cases reported by occupational physicians. These were hand and arm disorders (8052 estimated cases), contact dermatitis (7104), disorders of the lumbar spine (6000), anxiety and depression (4788), work-related stress (3336), hearing loss (2100), elbow disorders (2040), and asthma (1680). Dermatitis and hearing loss were most frequent in manufacturing industries, lower back complaints in health care, and upper limb disorders in automotive manufacture. Psychiatric illnesses presented a different pattern, mainly affecting those in health, education and social service.     

How the occupational physician works with the unions

A few attitudinal and behavioural principles will bring abouta productive liaison between the occupational physician andtrade unions. An effective working relationship with these organizationsand employee associations can be developed, provided the occupationalhealth care professionals are impartial in their practice, theloyalty to medicine replacing any bias toward the favouringof a managerial view. Respect must be given union officials,for in their organization they have status and can advance ordefeat various health programs. Union representation on an occupationalhealth committee will gain union support and minimize the filingof health-based grievances. The presentation of occupationalhealth information at union meetings will communicate the goalsof in-plant programs and familiarize workers, through theiraccustomed channels, with the objectives of health care policiesand procedures.     

An audit of occupational health care for employees with low-back pain

Guidelines for occupational rehabilitation of workers with low-backpain were developed as part of a larger study. We have formulatedcriteria for good practice of occupational rehabilitation onthe basis of these guidelines. To assess the quality of occupationalrehabilitation in the Netherlands, these criteria were subsequentlyused in an audit of medical records. The number of patientswho received care consistent with the guidelines was comparedto the number of patients eligible to receive that kind of care(performance rate). Six performance rates were calculated fromthe medical files of 40 workers with 48 new episodes of low-backpain. Two performance rates proved to be below 25% and two almost50%. The highest performance rate, that for curative policy,was 90%. These results are discussed in the light of the reliabilityof the original data. We recommend construction of guidelinesas well as reliable registration of the occupational rehabilitationprocess to increase the possibilities of auditing and to raisethe quality of occupational health care.     

Surveillance of Australian workplace Based Respiratory Events (SABRE): notifications for the first 3.5 years and validation of occupational asthma cases

AIMS: In Australia, the SABRE programme, a notification scheme, has been established to collect incidence data on occupational lung disease. This paper reports the first 3.5 years of this scheme and the results of an occupational asthma validation study. METHODS: A notification form is mailed regularly to thoracic physicians and occupational physicians in the Australian states of Victoria and Tasmania, who use this to report new cases of occupational lung disease. The validation study was performed by a blinded panel of two doctors, who reviewed information extracted from the medical files of a sample of reported cases of occupational asthma. RESULTS: A total of 520 diagnoses were reported. The mean (+/- SD) age of the 448 patients notified was 55.7 +/- 16.2 years. There were 394 (88%) males and 54 females. The most common single condition was asthma for which the most common causative agent was wood dust. However, the most commonly reported agent overall was asbestos. The validation study of occupational asthma found only fair agreement (kappa = 0.4) between the panel and notifying doctors. However, agreement was better (kappa = 0.5) when the analysis was restricted to those cases where the reporting doctor considered the likelihood of the diagnosis was high. CONCLUSIONS: Occupational asthma is the most common occupational respiratory condition reported, which suggests increasing importance for this disease over more traditional forms of occupational lung disease. The validation study suggests that such schemes should restrict notifications only to those cases where the likelihood of the diagnosis is considered high.     

Meta-analysis in occupational epidemiology: a review of practice

OBJECTIVES: To describe past practice in meta-analyses found in occupational epidemiology, identifying the major issues that should be considered by researchers planning a meta-analysis in this setting. METHODS: An electronic search of relevant online databases was undertaken. Papers were included in the review if they contained a statistical synthesis of risks in an occupational health setting. RESULTS: Sixty reports of meta-analyses were identified, mostly in cancer. The number of meta-analyses has increased consistently over the last 20 years. A majority of studies focused on a mean overall effect, although more than half of them also investigated heterogeneity of results. Both fixed effect and random effects meta-analysis models were employed, the former more often, and in eight studies used despite a statistically significant test for heterogeneity. A large proportion of the meta-analyses included different effect measures in the statistical synthesis, for example, including standardized mortality ratios (SMRs) and standardized incidence ratios. Most meta-analyses limited to a single type of effect measure focused on SMRs. The vast majority of meta-analyses combined all studies regardless of variation in the extent of information on exposures. CONCLUSIONS: Meta-analyses in occupational epidemiology should properly explore and incorporate heterogeneity among studies. The meta-SMR is an important construct in this field, evidenced by a large proportion of cohort studies in the meta-analyses we identified. Controversy remains over the definition and validity of the meta-SMR. In addition, several other issues, notably dealing with heterogeneity in exposure, warrant further consideration.