Health care workers' exposure to blood-borne pathogens in Lebanon

Background Accidental exposure to blood-borne pathogens (BBPs)is a risk for health care workers (HCWs). Aim To study the pattern of occupational exposure to blood andbody fluids (BBFs) at a tertiary care hospital. Methods This study reports a 17-year experience (1985–2001)of ongoing surveillance of HCW exposure to BBFs at a 420-bedacademic tertiary care hospital. Results A total of 1590 BBF exposure-related accidents werereported to the Infection Control Office. The trend showed adecrease in these exposures over the years with an average ±standard error of 96 ± 8.6 incidents per year. In thelast 6 years, the average rate of BBF exposures was 0.57 per100 admissions per year (average of needlestick injuries alonewas 0.46 per 100 admissions). For 2001, the rates of exposurewere found to be 13% for house officers, 9% for medical student,8% for attending physicians, 5% for nurses, 4% for housekeeping,4% for technicians and 2% for auxiliary services employees.The reason for the incident, when stated, was attributed toa procedural intervention (29%), improper disposal of sharps(18%), to recapping (11%) and to other causes (5%). Conclusions The current study in Lebanon showed that exposureof HCWs to BBPs remains a problem. This can be projected toother hospitals in the country and raises the need to implementinfection control standards more efficiently. Similar studiesshould be done prospectively on a yearly basis to study ratesand identify high-risk groups.     

Exposures to blood and body fluids in Brazilian primary health care

Background Primary health care workers (HCWs) represent a growingoccupational group worldwide. They are at risk of infectionwith blood-borne pathogens because of occupational exposuresto blood and body fluids (BBF). Aim To investigate BBF exposure and its associated factors amongprimary HCWs. Methods Cross-sectional study among workers from municipal primaryhealth care centres in Florianópolis, Southern Brazil.Workers who belonged to occupational categories that involvedBBF exposures during the preceding 12 months were interviewedand included in the data analysis. Results A total of 1077 workers participated. The mean incidencerate of occupational BBF exposures was 11.9 per 100 full-timeequivalent worker-years (95% confidence interval: 8.4–15.3).The cumulative prevalence was 7% during the 12 months precedingthe interview. University-level education, employment as a nurseassistant, dental assistant or dentist, higher workload score,inadequate working conditions, having sustained a previous occupationalaccident and current smoking were associated with BBF exposures(P 0.05). Conclusions Primary Health Care Centres are working environmentsin which workers are at risk of BBF exposures. Exposure surveillancesystems should be created to monitor their occurrence and toguide the implementation of preventive strategies.     

Burnout and patient care in junior doctors in Mexico City

Background Burnout is known to occur in public service workersleading to a reduction in effectiveness at work. Aim To estimate the prevalence of burnout in junior doctorsand its impact on patient care. Methods A cross-sectional study of junior doctors at three hospitalsin Mexico City was conducted. Measures used included the MaslachBurnout Inventory (MBI), measuring depersonalization (DP), emotionalexhaustion (EE) and personal achievement (PA), a questionnaireabout patient care practices and attitudes and one on sociodemographiccharacteristics. Logistic regression analysis was used to assessthe association between burnout and suspected risk factors. Results A total of 312 junior doctors participated (responserate 65%). In total, 57% were male and the average age was 28.Average scores in MBI subscales were EE: 18.2, DP: 6.9 and PA:37.6. Burnout prevalence was 40% (126). Junior doctors withburnout were more likely to report suboptimal patient care practicesoccurring monthly (OR 5.5; 95% CI 2.7–11.2) and weekly(OR 5.2; 95% CI 1.6–16.3). The logistic regression modelfor burnout included shifts lasting >12 h, current depression,former major depression, first- or second-year junior doctors,male gender and single status. Conclusions Burnout was most strongly associated with shifts>12 h and with both current and previous depression. Reportedsuboptimal patient care was also associated with working shiftsof 12 h. Burnout may be adversely affecting junior doctors’health and their patients’ care.     

Doctors, their mental health and capacity for work

Background Information about doctors’ mental ill-healthis limited. This study looks at doctors’ careers followingmental illness and the strategies that helped them return towork. Aim To examine the effect of mental ill-health on doctors’careers. Methods Questionnaire survey of members of the Doctors SupportNetwork (DSN). The DSN is a peer support group for doctors whohave experienced, or are experiencing, mental ill-health. Results One hundred and sixteen doctors (35% response rate)returned completed questionnaires (n = 116, 63% female, 37%male). Prior to their ill-health, 80% worked full time, 15%part-time, 2% were not working and 3% were medical students.Following illness, 33% worked full time (P < 0.05), 36% part-time(P < 0.05) and 29% were not working (P < 0.01). Flexibleworking practices were the most helpful reported strategy forenabling a doctor to return to work. Conclusions Following mental ill-health, a doctor’s capacityto work full time is reduced. Most doctors return to full-timeor part-time work. With improved support, more doctors may beable to return to work.     

Which agents cause reactive airways dysfunction syndrome (RADS)? A systematic review

Aim To identify those agents reported as being associated withreactive airways dysfunction syndrome (RADS). Methods A systematic review was undertaken. Abstracts were screenedand those selected reviewed against pre-determined diagnosticcriteria for RADS. Results Significant information gaps were identified for allmeasures of interest. In some articles, even the causative agentwas not reported. The most commonly reported agents were chlorine(nine subjects), toluene di-isocyanate (TDI) (n = 6) and oxidesof nitrogen (n = 5). Most exposures occurred in the workplace(n = 51) and affected men (60%). Dyspnoea (71%) and cough (65%)were the commonest symptoms. Median symptom duration was 13months (interquartile range = 6.5–43.5) for RADS. Conclusions Although the most commonly reported agent associatedwith RADS was chlorine, the main finding of a general lack ofadequate information on exposure, investigation and outcomesuggests that to better explore RADS a more structured approachto gathering information is required. A minimum data set forreporting RADS cases is proposed.     

Attitudes to job turnover among Finnish anaesthetists

Background Structural changes have led to higher workload andmore frequent conflicts among hospital staff, which in turnhas been shown to be associated with increased employee turnover. Aims To study the willingness of anaesthetists to change theiremployment and factors associated with it. Work-related, individualand family-related factors were investigated as potential influenceson such willingness. Method A postal questionnaire was sent to all working Finnishanaesthetists (N = 550). Results The response rate was 60%; 175 (53% of responders) weremen. Of the respondents, 31% were willing to consider changingto another physician's job and 43% to a profession other thanmedicine. The most important correlates for these views wereconflicts with superiors (odds ratio 6.1; 95% confidence interval2.1–17.7) and co-workers (4.2; 1.4–12.2), low jobcontrol (2.6; 1.4–4.9), a sense of organizational injustice(2.4; 1.3–4.6), stress (6.5; 2.6–16.3) and job dissatisfaction(4.6; 2.4–8.8). Conclusions The establishment of respect, trust and genuinedialogue between co-workers and superiors is needed to minimizethe risk of loss of members of this occupational group.     

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.     

Occupational asthma in New South Wales (NSW): a population-based study

BACKGROUND: The proportion of asthma in adults that is due to occupational exposures is not known. AIM: To examine the contribution of workplace exposures to the development of asthma in adults in New South Wales (NSW) in a cross sectional, population-based study. METHODS: A randomly selected population of 5,331 18- to 49-year olds completed and returned a mailed questionnaire (response rate 37%). In adult-onset asthmatics we examined the association of asthma with reported exposure, within 1 year of asthma onset, to a list of occupations and exposures known to be at risk for occupational asthma (high-risk jobs and exposures). RESULTS: Among 910 subjects (18%) with asthma, 383 (7%) subjects reported adult-onset disease. After adjusting for sex, age and smoking, working in any high-risk job or exposure at the time of asthma onset was significantly associated with adult-onset asthma (OR 1.51, 95% CI 1.19-1.92). The population attributable risk (PAR) of adult-onset asthma for either a high-risk job or an exposure was 9.5%. Sudden onset, irritant or reactive airways dysfunction syndrome type exposures were associated with adult-onset asthma (OR 4.65, 95% CI 1.64-13.2). The PAR of adult-onset asthma for these exposures was 0.2%. CONCLUSION: Reported adult onset of asthma is common and occupational exposures may be associated with 9.5% of prevalent cases of adult-onset asthma in NSW.     

Fifteen-year trends in occupational asthma: data from the Shield surveillance scheme

Background Trends of occupational asthma (OA) differ betweenregions depending on local industries, provisions for healthand safety at the workplace and the availability of a reportingscheme to help in data collection and interpretation. Aim To assess trends in OA in an industrialized part of theUK over a 15-year period. Methods Occupational and chest physicians in the West Midlandswere invited to submit details of newly diagnosed cases withOA. Data were then transferred to the regional centre for occupationallung diseases for analysis. Results A total of 1461 cases were reported to the scheme. Sixty-eightper cent were males with mean (standard deviation) age of 44(12) years. The annual incidence of OA was 42 per million ofworking population (95% CI = 37–45). OA was most frequentlyreported in welders (9%) and health care-related professions(9%) while <1% of cases were reported in farmers. Isocyanateswere the commonest offending agents responsible for 21% of reportsfollowed by metal working fluids (MWFs) (11%), adhesives (7%),chrome (7%), latex (6%) and glutaraldehyde (6%). Flour was suspectedin 5% of cases while laboratory animals only in 1%. Conclusions Our data confirm a high annual incidence of OA inthis part of the UK. MWFs are an emerging problem, while isocyanatesremain the commonest cause. Incidence remained at a fairly stablebackground level with many small and a few large epidemics superimposed.Schemes like Midland Thoracic Society's Rare Respiratory DiseaseRegistry Surveillance Scheme of Occupational Asthma could helpin identifying outbreaks by linking cases at the workplace.     

Silica exposure, smoking, silicosis and lung cancer--complex interactions

Background Establishing a clear relationship between workplaceexposures and cancer is often difficult. The latent period forcancer development can make it difficult to establish a definitecause–effect relationship. The picture is further complicatedby variable job histories, concomitant exposure to other carcinogensand other factors such as genetic susceptibility and poor nutrition.The lack of accurate and detailed record keeping may potentiallymask informative differences among group of workers. Removingor reducing exposures to probable and known carcinogens, however,can prevent workplace cancer. Aim This paper gives an overview of the literature reportinginvestigations of the relationship between exposure to silicaand development of lung cancer with a focus on the controversyconcerning the roles of silicosis and smoking in the developmentof cancer. Method A literature search was conducted to identify epidemiologicpapers on silica, silicosis and lung cancer using electronicdatabases (MEDLINE, PubMed, Web of Science) from 1996 onwardsand paper bibliographies. Results If silicosis were the necessary step leading to lungcancer, enforcing the current silica standards would protectworkers against lung cancer risk as well. Alternatively, a directsilica–lung cancer association that has been suggestedimplies that regulatory standards should be revised accordingly. Conclusion Further research is needed in order to understandthe complex pattern of interactions leading to lung cancer amongsilica-exposed workers (and cancers and workplace exposuresin general) and to understand whether and to what extent otherworkplace lung carcinogens, total respirable dust and totalsurface size and age of silica particles affect the carcinogenicpotential of silica. In addition, the apparent paradox of alower lung cancer risk in some workplaces with high-level silicaexposure needs further investigation.     

The sensitivity and specificity of thermometry and plethysmography in the assessment of hand-arm vibration syndrome

Background Finger plethysmography and thermometry are objectivemeasures used to assess the vascular aspect of hand–armvibration syndrome (HAVS). Research to date shows poor correlationbetween these tests and Stockholm Workshop Scale (SWS) vascularstage. Clinicians, researchers and compensation boards requireobjective means to diagnose and quantify HAVS. Aims To define the specificity and sensitivity of thermometryand plethysmography using the SWS as the reference criterion.A secondary goal was to consider cut points for the tests optimizingsensitivity and specificity. Methods A cross-sectional analysis was conducted on HAVS patientsseen at an occupational medicine specialty clinic. Plethysmographyand thermometry were analyzed using SWS vascular stage as theoutcome variable. Logistic regression controlled for age, smokingand time since last vibration exposure and use of vasoactivemedications. The sensitivity and specificity of the combinedtests were calculated using varying cut points. Results A total of 139 patients consented to participate inthe study. Plethysmography stage 1 or greater showed the highestsensitivity (sensitivity 94% and specificity 15%). Specificitywas optimized combining plethysmography stage 3 and thermometrystage 3 (specificity 98% and sensitivity 23%). Maximal diagnosticaccuracy was achieved by plethysmography alone setting the criteriafor a positive test as being stage 1 or greater (70%). Conclusions Neither plethysmography nor thermometry either aloneor in combination demonstrated sufficient sensitivity and specificityto serve as an objective correlate for SWS vascular stage. Allcombinations of plethysmography and thermometry showed a lowerspecificity than sensitivity indicating that the SWS may beless sensitive in detecting vascular pathology than the objectivetests.     

Feasibility of a screening programme for lung cancer in former asbestos workers

Background Low-dose computed tomography (CT) has been foundto detect more Stage IA lung cancer than chest x-ray. Aims To investigate whether lung cancer screening with CT waseffective and acceptable in former asbestos workers. Methods CT scanning was carried out following the protocol previouslydescribed in the literature. A questionnaire was used to assesscumulative asbestos exposure. An economic analysis was alsoperformed. Informed consent was obtained from all patients. Results A total of 1119 male asbestos workers (58% of invited)were examined, of whom 65% were smokers or ex-smokers. Meanage was 57.1 years with mean cumulative exposure to asbestosof 123 fibres/ml x years. Pleural plaques were found in 375workers (32%), while 338 workers (29%) were included in theradiological follow-up, which led to 25 biopsies (13 of lung,9 of pleura, 3 of both) and five screen-detected lung cancers(0.4%), one in Stage I. Incidence rate was 149 per 10⁵, equalto that in the male general population of similar age. The expensesfor diagnosis were 1014 and 244962 Euro per screened subjectand screen-detected lung cancer case, respectively. Conclusions Screening adherence and frequency of detection werelow, while costs and radiation dose were high. In spite of ahigh cumulative asbestos exposure, lung cancer risk was notincreased relative to the general population. The screeningprogramme was not felt to be cost-effective from the perspectiveof the government as a third-party funding agency.     

Salivary acetylcholinesterase as a biomarker for organophosphate exposure

Background Workers exposed to organophosphate (OP) pesticidesare required to undergo periodic statutory medical surveillancein several countries. Aim To study the relationship between serum, erythrocyte andsaliva acetylcholinesterase (AChE) levels and to explore theuse of salivary AChE as potential biomarker for OP exposure. Methods A cross-sectional study was conducted on 19 healthyadult male lead-exposed workers who were undergoing six monthlystatutory medical examination. Passive drool saliva sampleswere collected from each worker. Each blood sample was testedfor serum and erythrocyte AChE, and each saliva sample was testedfor AChE. Results Among the 19 subjects, the mean (±standard deviation)of salivary, erythrocyte and serum AChE/cholinesterase were22.7 (±17.4), 17171 (±1467), 8861 (±1876)U/l, respectively. There was a moderate correlation betweensalivary and erythrocyte AChE (r = 0.42, P = 0.071), but notsalivary and serum AChE (r = –0.17, P = 0.48). The levelof AChE in saliva was 1820 times lower than AChE in erythrocytes. Conclusion It is probably not feasible to use saliva as a replacementfor blood for the measurement of AChE levels. This is becauseof the much lower levels of AChE in saliva relative to erythrocytes,the weak correlation between the two measurements and the previouslyreported high intra-individual variation of salivary AChE.     

Evaluation of a workshop on evidence-based medicine for social insurance physicians

Background Evidence-based medicine (EBM), a comprehensive methodto support clinical decision making by using evidence, has beeninstrumental in clinical specialties but not yet in insurancemedicine. Aims We developed and evaluated a workshop on EBM for Dutchsocial insurance physicians who perform disability evaluations. Methods Sixty-six social insurance physicians followed a 1-dayintroductory workshop that focused on teaching two EBM coreskills: to ask answerable questions and to search for the bestevidence. All outcomes were measured before, immediately afterand 3 months after the workshop by means of self-assessment.The primary outcomes were knowledge, skills, attitude and intentionto apply EBM in practice. The secondary outcomes were socialinfluence, self-efficacy and behaviour. Results Immediately after the workshop, a marked and significantimprovement was seen in self-assessed skills (mean difference4.2, 95% CI 3.7–4.6) and in self-efficacy to apply EBM(mean difference 0.7, 95% CI 0.6–0.8). For attitude, knowledgeand intention, the improvements were small. Three months afterthe workshop, the improvements in skills (mean difference 2.3,95% CI 1.8–2.9) and self-efficacy (mean difference 0.5,95% CI 0.3–0.6) remained significant. Conclusions The workshop improved self-assessed EBM skills andself-efficacy both in the short and long term. The workshopalso resulted in limited short-term improvements in self-assessedknowledge and in the intention to apply EBM in practice. TheEBM approach can be successfully taught to social insurancephysicians working in the field of disability evaluation.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Effect of work with visual display units on musculo-skeletal disorders in the office environment

Background The increase in computer and mouse use has been associatedwith an increased prevalence of disorders in the neck and upperextremities. Furthermore, poor workstation design has been associatedwith an increased risk of developing these symptoms. Aim The aims of this study were (i) to estimate the prevalenceof musculo-skeletal disorders among full-time visual displayunit (VDU) users; (ii) to examine how the prevalence variesby work environment; and (iii) to explore the association withwork factors. Method A survey was carried out on the effect of work with VDUson musculo-skeletal disorders in workers in the office environmentof 56 workplaces. Office workers (n = 298), customer serviceworkers (n = 238) and designers (n = 247) were studied. Results For all the occupations combined, the 12 month prevalencesof musculo-skeletal symptoms in the neck, shoulders, elbows,lower arms and wrists, and fingers were 63, 24, 18, 35 and 16%,respectively. The study indicated that musculo-skeletal painis common among computer workers in offices. There was no strongassociation between the duration of computer work and pain orbetween the duration of mouse use and pain, but workers' perceptionof their workstation as being poor ergonomically was stronglyassociated with an increased prevalence of pain. Conclusions Musculo-skeletal symptoms are common, but the durationof daily keyboard and mouse use had no connection with musculo-skeletalsymptoms. Instead, more consideration should be paid to theergonomics of workstations, the placing of the mouse, the posturesof the upper extremities and the handling of the mouse.     

Carpal tunnel syndrome in the Turkish steel industry

Aim Certain occupations are reported to be associated with ahigh risk for carpal tunnel syndrome (CTS). In this study, weinvestigated the development of CTS in iron–steel industryworkers. Methods Subjects were recruited from a factory of 650 workersand assessed by means of history, physical examination and electrophysiologicaltesting. Results Seventy-nine subjects from the factory and 53 healthycontrols with occupations unrelated to heavy physical work wereassessed. None of the worker group had electrophysiologicalevidence of CTS. One subject in the control group has electrophysiologicalevidence of CTS. In the worker group, all sensory nerve conductionvelocities and ulnar nerve action potential amplitudes in bothhands and distal motor latencies were statistically different. Conclusions In our study, among a group of heavy labourers,no cases of CTS were detected. However, all electrophysiologicparameters of workers were different from controls. Our resultspoint to a diffuse, but subclinical injury of peripheral nervesunder heavy physical work conditions, instead of a local effectsuch as CTS.