Evaluation of a postgraduate educational programme for occupational physicians on work rehabilitation guidelines for patients with low back pain

OBJECTIVES—The postgraduate educational programme for occupational physicians on guidelines for work rehabilitation of patients with low back pain was evaluated as to what extent did knowledge of the guidelines increase, and did the workers improve their performance at work.
METHODS—An experimental group (n=25) attended an educational programme and a reference group did so (n=20) 6 months later. Knowledge and performance were assessed for both groups, before and after education of the experimental group. Knowledge was assessed for the reference group after education.
RESULTS—Knowledge increased significantly more in the experimental group. The reference group's score increased further after education. The experimental group's adjusted gain score for performance indicators was significantly positive. Analysis of covariance also showed a significant effect for the experimental group for increased performance score.
CONCLUSIONS—The educational programme improved the quality of care because knowledge and performance of occupational physicians improved and complied better with practice guidelines.


Keywords: evaluation; postgraduate education; occupational physicians; low back pain; guidelines     

Farmers' occupational health program in Finland, 1979-1988: from research to practice

The Kuopio Regional Institute of Occupational Health, in collaboration with the Social Insurance Institution and the National Board of Health, conducted and evaluated a national model for the farmers' occupational health services. In January 1985 the National Board of Health instructed the Finnish municipal health centers to start the provision of farmers' occupational health services based on the recommendation given by the research group. The service was evaluated by experiments carried out during 1982, 1985, and 1986. The main problem in function of the services was that the health hazards (exposures) were difficult to observe and evaluate. The system of how the occupational health nurse evaluates the working conditions should be further developed. The efficiency of the services was studied by postal inquiries in 1982 and 1986. Farmers' knowledge about the appropriate means of reducing hazardous exposures had increased significantly due to the occupational health services. At the local level, the main problem in providing services for occupational farmers is that health centers do not have the resources to offer services for all farmers at the same time. Altogether by the end of 1986, about 30% of all active farmers in Finland (45,000 farmers) were willing to have occupational health services, which is voluntary for self-employed farmers.     

Etiologic and prevention effectiveness intervention studies in occupational health

In this article a basic distinction is made between etiologic and prevention effectiveness intervention studies. Etiologic intervention studies focus on elucidating causes of disease, while the purpose of prevention effectiveness intervention studies is to study methods of prevention. The design requirements for each of these studies are very different: etiologic intervention studies usually need large study populations, large exposure contrasts, ascertainment of exposure, as well as health outcome. Ideally, randomization and blinding should also be applied. Effective preventive strategies may, on the other hand, be identified in small study populations with exposure as the only outcome measure, and randomization and blinding may be superfluous. At present, intervention studies are in great demand, and often there is a wish that etiologic questions as well as prevention effectiveness be addressed in the same study. We argue that this should not be done without careful consideration of possible conflicting design aspects. © 1996 Wiley-Liss, Inc.     

Occupational health and safety in cannabis production: an Australian perspective

The legal Australian cannabis industry has been rapidly expanding due to increased awareness of the plant’s therapeutic potential, as well its diverse range of applications including biofuel, textiles, building materials, food, nutritional supplement, and animal feed. The objective of this paper is to describe the current landscape of the commercial Australian cannabis industry, summarise occupational health and safety (OHS) hazards in cannabis-related working environments, and provide suggestions for safeguarding worker health and well-being in this emerging industry.

A comprehensive search of peer-reviewed and grey literature published between 1900 and 2017 was undertaken to identify case studies and original epidemiological research on OHS hazards associated with the cannabis cultivation and the manufacture of cannabis-based products. The review found that the majority of OHS studies were undertaken in the hemp textile industry during the late twentieth century, with a small number of articles published from a variety of occupational environments including forensic laboratories and recreational marijuana farms. Cannabis harvesting and initial processing is labour intensive, and presents a physical hazard Depending on the operation, workers may also be exposed to a variety of biological, chemical, and physical hazards including: organic dusts, bioaerosols, pollen/allergens, volatile organic compounds, psychoactive substances (tetrahydrocannabinol [THC])), noise, and ultraviolet radiation.

Little research has been undertaken on the exposure to inhalable organic dust and other bioaerosols during the commercial cultivation and manufacture of cannabis-based products. Furthermore, there is an absence of Australian-based research and OHS guidance materials to help professionals develop risk management strategies in this evolving industry.

It is recommended that:

• Investigation into the toxicological properties of cannabis dusts, specifically in relation to potential occupational exposures during cultivation and manufacture, should be a priority.

• The interim adoption of the respirable cotton dust exposure standard of 0.2 mg/m³ for workplace exposure in hemp facilities until a cannabis workplace exposure standard is developed, and that exposure to medicinal cannabis containing THC are kept as low as reasonably practicable.

• An industry partnership be established for the development of an Australian health and safety guideline for the production of medicinal cannabis and hemp.

• A classification to meet the requirements of the Global Harmonization Scheme should be undertaken to ensure consistency in the use of safety and risk phrases in cannabis-related industries.

     

Oculotoxins: effects, implications, and importance in occupational health

A large number of chemicals are being used in industries. The potential of many of these chemicals to cause ocular damage has been well documented. It is therefore important that proper attention be given to the prevention of visual handicap among the population exposed to industrial chemicals. The aim of the present article is to create awareness and provoke discussion among concerned health personnel and administrators.     

Infant health effects of a nurse–community health worker home visitation programme: a randomized controlled trial

Background Home visiting is supported as a way to improve child health and development. Home visiting has been usually provided by nurses or community health workers (CHWs). Few studies compared the child health advantages of a nurse–CHW team approach over nurse prenatal and postnatal home visiting. Methods A randomized trial was conducted with Medicaid‐insured pregnant women in Kent County, Michigan. Pregnant women were assigned to a team intervention including nurse–CHW home visitation, or standard community care (CC) including nurse home visitation. Morbidity was assessed in 530 infants over their first 12 months of life from medical claims and reported by the mother. Results There were no differences in overall child health between the nurse–CHW intervention and the CC arm over the first year of life. There were fewer mother‐reported asthma/wheezing/croup diagnostics in the team intervention group among infants whose mothers have low psychosocial resources (13% vs. 27%, P = 0.01; adjusted OR = 0.4, P = 0.01). There were no differences in diagnosed asthma/wheezing/croup documented by medical claims. There were no differences in immunizations, hospitalizations and ear infections. Conclusions There was no strong evidence that infant health was improved by the addition of CHWs to a programme of CC that included nurse home visitation. Targeting such interventions at common health problems of infancy and childhood or at diagnosed chronic conditions may prove more successful.     

Occupational health in the Negev: a model for regional planning

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

火车司机职业健康知识需求情况调查

目的通过了解云南省昆明市铁路机务段所有火车司机的基本健康状况及对职业健康知识需求的情况,为职业卫生服务更好的开展提供依据。方法分别采用职业健康知识需求问卷和工作压力量表,对昆明市分管的几个铁路机务段的在岗火车司机进行问卷调查,获得该调查人群对职业健康知识需求及工作压力的状况,同时按照国家职业健康检查标准对其进行健康检查。结果①在对健康和安全知识的需求方面,80.5%的受调查者想要获得缓解工作压力的知识,71.1%的人想要获得职业病危害因素的种类及其对人体的危害知识;②工作压力调查显示,有81.5%的受试者存在不同程度的工作压力;③健康检查显示,血压异常率为4.1%,心电图检查异常率为3.8%,血尿常规异常率为9.0%。结论被调查人群均有不同程度的工作压力,同时他们也希望获得有关的职业健康及安全知识,有关部门可采取相应措施及对策来减轻职业压力,对火车司机进行相应的健康教育,提高火车司机的生活质量。     

钒的职业危害效应研究

目的调查钒职业危害效应性质及其表征,探讨发生、发展规律与特点。方法以暴露明确、时间长而稳定、规模较大的某钒制品企业职业人群为研究对象,从人群医保重慢病病史和职业健康监护两个层面进行调查与分析。结果暴露人群医保重慢病发病强度低于总体人群(即暴露人群所在公司参加医保的全体职员),以高血压病、糖尿病、甲状腺疾病和恶性肿瘤较为明显;职业环境中90%以上暴露者出现眼鼻咽刺激反应;长期职业暴露会降低接触人员的积极情绪、运动协调能力、运动速度和稳定性,损害短期视觉记忆力,增加消极情绪;并可提高血清HDL-C和PLT水平,降低TCHO、ALT、TBIL、BUN水平;引起肺通气功能下降,血压升高和心电图阳性指标增加,以及胆结石和脂肪肝的检出率较高。结论钒职业危害主要是对眼和上呼吸道刺激作用,同时也作用和影响脂肪代谢过程、神经行为功能和心血管、肺、肝、肾等器官功能。     

某制鞋企业化学有害因素的职业健康风险分析

目的 了解东莞市某制鞋企业化学有害因素产生的职业健康风险,为制鞋行业职业病危害防控提供科学依据。
方法 于2019年对东莞市某制鞋企业进行职业卫生调查、职业病危害因素检测,根据《工作场所化学有害因素职业健康风险评估技术导则》（GBZ/T 298-2017）采用半定量模型进行职业健康风险评估。
结果 该制鞋企业现有生产人员445人,实行每周工作6 d、每天11 h。该企业存在的17种化学有害因素中,丁酮、三氯乙烯、乙酸甲酯和乙酸乙酯存在超标情况。刷胶、擦拭、水印和补色4个岗位丁酮、二氯甲烷、环己酮、三氯甲烷、三氯乙烯、乙酸甲酯、乙酸乙酯、正庚烷的健康损害风险等级为低风险;补色、刷胶、水印3个岗位丙酮的健康损害风险等级为低风险;擦拭岗位乙酸丁酯、甲醇的健康损害风险等级为低风险。其余物质对各岗位工作人员健康损害的风险等级为可忽略风险。酯类、卤代烃联合接触引起的健康风险等级高于苯系物。刷胶岗位酯类、卤代烃联合接触有中等健康风险,高于其他岗位。
结论 东莞市制鞋企业中化学有害因素可诱发潜在的职业健康风险,企业及职业卫生部门应采取有效的防控措施。
     

Worksite intervention effects on physical health: a randomized controlled trial

Overweight and physical inactivity are risk factors for increased disease burden and health care expenditure. Well-designed studies are still needed to determine the treatment efficacy of worksite interventions targeting such risk factors. This randomized controlled trial was conducted at one of Australia's casinos in 2002-2003, to investigate the effects of a comprehensive exercise and lifestyle intervention on physical fitness. Only 6.4% of the workforce expressed interest in being study participants. Seventy-three employees (aged 32 +/- 8 years, 51% overweight/obese, 73% shift workers and 52% women) were recruited and randomized to treatment or wait-list control groups for 24 weeks, 44 of whom completed the intervention. Components of the intervention include supervised moderate-to-high intensity exercise including combined aerobic (at least 20 min duration 3 days/week) and weight-training (for an estimated 30 min completed 2-3 days/week), and dietary/health education (delivered via group seminars, one-on-one counselling and literature through the provision of a worksite manual). ANCOVA, by intention-to-treat and of study completers, found significant between-group differences in the mean waist circumference and predicted maximal oxygen uptake (VO2max), favouring the intervention, but effects were concentrated in one subject. For study completers, between-group differences in the mean waist circumference (82.3 +/- 9.2 versus 90.5 +/- 17.8 cm, p = 0.01) and predicted VO2max (47 versus 41 ml/kg/min, p < 0.001) remained significant without the outlier, favouring the intervention. Higher intervention compliance predicted greater improvements in physical fitness. No significant effects on body mass or body mass index were found. This worksite intervention significantly improved waist circumference and aerobic fitness in healthy but sedentary employees, most of whom were shift workers. Worksite interventions have the potential to counter the increasing burden of overweight and obesity, particularly visceral adiposity, as well as physical inactivity; however, substantial barriers to adoption/adherence need to be overcome for greater feasibility and impact on employee physical health.     

Seafood processing in South Africa: a study of working practices, occupational health services and allergic health problems in the industry

The work practices, occupational health services and allergic health problems among workplaces which process seafood in Western Cape province of South Africa were examined. A cross-sectional study was conducted among 68 workplaces that were sent a self-administered postal survey questionnaire. Workplaces reporting a high prevalence of work-related symptoms associated with seafood exposure were also inspected. Forty-one (60%) workplaces responded to the questionnaire. The workforce consisted mainly of women (62%) and 31% were seasonal workers. Common seafoods processed were bony fish (76%) and rock lobster (34%). Major work processes involved freezing (71%), cutting (63%) and degutting (58%). Only 45% of workplaces provided an on-site occupational health service and 58% of workplaces conducted medical surveillance. Positive trends were observed between workplace size and activities such as occupational health service provision (P = 0.002), medical surveillance programmes (P = 0.055) and reporting work-related symptoms (P = 0.016). None of the workplaces had industrial hygiene surveillance programmes to evaluate the effects of exposure to seafood. Common work-related symptoms included skin rashes (78%), asthma (7%) and other non-specific allergies (15%). The annual prevalence of work-related skin symptoms reported per workplace was substantially higher for skin (0-100%) than for asthmatic (0-5%) symptoms. The relatively low prevalence of employer-reported asthmatic symptoms, when compared to epidemiological studies using direct investigator assessment of individual health status, suggests likely under-detection. This can be attributed to under-provision and under-development of occupational health surveillance programmes in workplaces with less than 200 workers. This is compounded further by the lack of specific statutory guidelines for the evaluation and control of bio-aerosols in South African workplaces.     

Waiting for the doctor: gender differences in the timing of an intervention by the occupational physician

This study aims to answer the question whether the relatively high inflow risk into disability for women, compared to that for men, is related to a lower chance of being called by the occupational physician during sickness absence. This chance is influenced by sociodemographic, health-related, and work-related factors, as well as by the duration of sickness absence. Using a proportional hazards model, the risk of being called by the physician within a certain time period (the so-called hazard rate) is estimated. Kaplan–Meier curves show a gender difference in the hazard rate. Women appear to have a higher chance of being called by the occupational physician (i.e., a shorter waiting time). The influence of the covariates on the hazard rate is estimated using a Weibull model. The Weibull estimations show a negative duration dependence for women, while for men there is no duration dependence. It is concluded that the higher chance for women to be called by the occupational physician is not associated with a gender difference in treatment. Rather, it is the result of a difference in underlying characteristics. Underlying characteristics that significantly predict the waiting time for the occupational physician are in particular related to the labor market position of the employee: educational qualifications, firm size, industry, occupational workload, and job tenure. Other significant predictors are duration and diagnosis.     

职业病防治体系构建之管见——以公共产品理论为视角

文章运用公共产品理论对职业病防治体系加以分析,认为职业卫生技术服务是准公共产品,应由企业和国家共同分担其出资;职业病患者保障是私人产品,但其责任主体和支付主体是企业;职业病防治监督是纯公共产品,应由国家承担.要将获取职业卫生技术服务的"谁出资,谁受益"原则变为"共同出资,共同受益"原则,并通过制度设计,鼓励企业主动开展或购买职业卫生技术服务,并应当调整对职业卫生技术服务机构的补偿办法.     

广州市职业卫生技术服务工作回顾与展望

广州市1990～2000年职业卫生技术服务工作,主要是经常性监督、检测和定期职业性体检,在此基础上,还建立了职业健康监护系统。如为2686家企业建立职业卫生档案,为424843名工人及365597名机动车驾驶员建立了职业健康档案,建立了部分数据库,开展了一些追踪研究。通过对965家乡镇企业和768家“三资”企业的劳动卫生抽样调查,基本上掌握了7万多家乡镇企业和3000多家“三资”企业职业卫生状况,实施了劳动卫生许可证制度;对10234个职业危害作业点进行了分级评价、挂警示牌,并推行告示周知卡制度,使劳动者享有知情权。职业病发病率由80年代初的16／10000下降至6／10000。其主要缺陷是：监督与技术服务混为一体、建设项目职业病危害评价未得到有效实施、政府尚未真正把职业卫生纳入公共卫生范畴。因此,未来10年应根据《职业病防治法》,从源头上控制和消除职业病危害,目标是使广州市职业病发病率控制在5／10000以下、突发性职业中毒事故下降50％以上,并在2010年杜绝矽肺病新发病例。     

Social disparities in the burden of occupational exposures: results of a cross-sectional study

BACKGROUND: Most occupational studies evaluate a single exposure in relation to a particular disease. However, workers typically experience multiple exposures simultaneously. There is also increasing evidence of disparities in health by sociodemographic characteristics, mostly related to social position such as gender, race/ethnicity, immigration status, income, and education. Little information exists on the worker experience of multiple occupational exposures as they vary among social groups. The objectives of this article were to: assess the burden of exposures reported within 1 year by a socially diverse population working in a range of industries; and evaluate whether sociodemographic characteristics affected the patterns of these exposures. METHODS: Study participants were from 14 unionized worksites in meat processing, electrical lighting manufacturing, retail grocery stores, and school bus driving. A cross-sectional study design used a self-administered, computer-assisted questionnaire (English and Spanish) to assess sociodemographic characteristics and nine workplace exposures, within the past year. An interviewer-administered job history also was collected. RESULTS: Twelve hundred eighty-two workers (72%) completed the survey: 36% women, 23% Latino, 39% black, 24% white, and 48% born outside the US. The prevalence of high exposures ranged from 21% (chemicals) to 39% (neck strain). Forty-six percent reported three or more high exposures. Exposure reporting varied among sociodemographic groups. Some of the disparities were explained by the jobs held by different groups, but after statistically controlling for job, many disparities remained. CONCLUSIONS: Sociodemographic characteristics should be considered when conducting exposure assessments using questionnaires. More research is needed to understand how social characteristics may influence exposures.     

The farm family perception of occupational health: a multistate survey of knowledge, attitudes, behaviors, and ideas

It is vitally important to integrate the views and concerns of the farm family into the process of policy development. If the input is not there, policy planners could implement programs that are philosophically separated from the farm families' concerns and attitudes. This would destroy credibility and future farmer support of any new program development. From May of 1988 to April of 1989, a phone and mail survey of approximately 1,500 farmers and spouses was conducted to assess knowledge, attitudes, and behaviors regarding agricultural safety and health. The survey was conducted in Iowa, New York, South Carolina, and Washington state. Preliminary results from Iowa and New York indicated that: 1) farmers value highly, and are concerned with, occupational health and safety issues; 2) farmers report that their major concerns include stress, trauma and respiratory problems; 3) farmers would like access to an occupational health and safety service; and 4) any new farm health and safety programs must include farmer input to ensure practicality, applicability, and acceptance.