Medical Retirements and Deaths in Service of Diabetic Employees in the Post Office

The first two papers in this series described the work experiencesof diabetics in one Post Office Region (Welch, 1986) and therange of duties and problems they faced (Welch, 1987). Thispaper focuses on the national picture of medical retirementsand deaths in service of diabetic employees in the Post Office During the 10 year period (1975–1984) the median agesof retiral of diabetic employees were somewhat higher than otheremployees who retired on ill health grounds. Male diabetic employeeswho died in service had somewhat lower mean and median agesthan other employees who died in service. Requests for reprints should be addressed to: Dr R. A. Welch, Chief Medical and Safety Advisor, Post Office Occupational Health and Safety Executive, The Post Office, 33 Grovesnor Place, London SW1X 1PX, UK     

Knowledge and Attitudes of Health Care Workers about AIDS and HIV Infection before and after Distribution of an Educational Booklet

Hospital workers (509) in a health authority were surveyed,and asked if they were in contact with HIV positive or AIDSpatients; about their perception of risk; of their knowledgeabout and attitudes towards HIV and AIDS problems at work; andtheir desire for more information about AIDS and HIV. Overallscores for level of knowledge and attitudes were calculated;clinical workers scored better than non-clinical workers. Following the first survey, an information booklet was distributedto all health authority staff and after distribution, 232 staffwere surveyed again. In this group (the follow-up group), therewas a reduction in perceived risk, an improvement in the levelof knowledge and in attitudes, and a reduction in the desirefor further information. The group who initially had the leastlevel of knowledge and most unfavourable attitudes (non-clinicalworkers) were the group who improved most. Requests for reprints should he addressed to: Dr M. D. McKinnon, Department of Occupational Health, Hampstead Health Authority, 5 Rosslyn Hill, London NW3 5UL, UK     

Occupational Health and Safety in the National Health Service: The Present and The Future

In this paper we review the type and extent of occupationalhealth services provided by the National Health Service forits own and Local Authority employees. We also enquired intothe extent of occupational hygiene services and safety officersin the National Health Service both in the North Western Regionand in the rest of the country. We consider ways of improvingNational Health Service Occupational Health Units includingthe provision of specialist occupational physicians to eachDistrict. Our conclusions are that future services should be consultantled. Based on our calculations for the North Western Region,this need not cost more than the present arrangements. An occupationalhygiene service should be planned to meet the needs of NationalHealth Service employees. Requests for reprints should be addressed to: Dr Malcolm Gatley, Consultant Occupational Physician, North Manchester General Hospital, Crumpsall, Manchester M8 6RB.     

Stress management in large-scale establishments]

Due to a recent dramatic change in industrial structures in Japan, the role of large-scale enterprises is changing. Mass production used to be the major income sources of companies, but nowadays it has changed to high value-added products, including, software development. As a consequence of highly competitive inter-corporate development, there are various sources of job stress which induce health problems in employees, especially those concerned with development or management. To simply to obey the law or offer medical care are not enough to achieve management of these problems. Occupational health staff need to act according to the disease type and provide care with support from the Supervisor and Personnel Division. And for the training, development and consultation system, occupational health staff must work with the Personnel Division and Safety Division, and be approved by management supervisors.     

The Atlas of health and working conditions by occupation

In this article, we describe methods which have been applied in the compilation of the Atlas of Health and Working Conditions by Occupation. First, we discuss the need for information systems to identify problems concerning working conditions and health. Such information systems have an exploratory purpose, being deployed to identify work risks in companies, groups of occupations and sectors of industry, and can also be a starting point for the generation of hypotheses on the causes of adverse health effects. In the Netherlands, occupational health services gather questionnaire data about work and health as part of periodical occupational health surveys. In the atlas, aggregated questionnaire data for 129 occupations with male employees and 19 occupations with female employees are presented. In this article, we explain the methodology used to compare occupations with regard to each item in the questionnaire. We then discuss applications of these occupational ranking lists. The cross-sectional nature of the data collection, various forms of selection and the limited size of some occupational populations have to be taken into account when interpreting the results. Occupational ranking lists can be applied in the allocation of resources and in the design of scientific research. The overviews for each occupation, presented in the second half of the atlas, provide an occupational profile of existing problems with respect to work and health. These profiles are used as basic information to develop a practical policy on working conditions and health.     

A study of South Korean casino employees and gambling problems

Background Casino employees are exposed to disproportionatelyhigh levels of gambling, drinking and smoking compared to otheroccupations. Because of their occupation, they have the opportunityto detect and prevent pathological gambling (PG). Aims To identify differences in the mental health status andsocial attitudes towards PG among casino workers in South Koreadepending upon whether they report any gambling problems. Methods Data were collected from 388 full-time casino employees.This data provided information about the prevalence of gamblingproblems, alcohol and tobacco use and depression. Employeeswere grouped according to their scores on the Korean versionof South Oaks Gambling Screen (SOGS), and those employees whogambled without experiencing any gambling problems (Group NP:SOGS = 0) and those who reported any gambling problems (GroupP: SOGS > 0) were compared. An exploratory factor analysesidentified the domains of casino employee social attitudes towardsgambling. Results Employees who reported gambling problems (Group P) reporteda higher prevalence of smoking, alcohol problems and depression(P < 0.01) compared to employees who did not report gamblingproblems (Group NP). The primary employee social attitude towardsgambling was identified by the factor of ‘Disease concept/socialawareness’. Group NP reported more positive attitudesin this domain than Group P (P < 0.01). Conclusions Employees who reported any gambling problems reporteda less positive attitude towards developing the public healthsystem to be responsive to gambling problems. These findingsindicate a need to develop health education programmes thatfocus more specifically on casino employees with gambling problems.     

Seeking help in relation to work--visiting the occupational physician or the general practitioner

BACKGROUND: It has not yet been examined whether employees with health or work problems prefer visiting the Occupational Physician (OP) or the General Practitioner (GP). AIM: Examining whether health and work problems predict visiting the OP or GP. METHOD: Multiple regression analyses within a prospective cohort study. RESULTS: None of the predictors was exclusively associated with visiting the OP, while emotional work demands and work-family conflict were associated with visiting the GP in relation to work. CONCLUSIONS: OPs might wish to clarify their preventive role to employees.     

The Contribution of High Levels of Somatic Symptom Severity to Sickness Absence Duration,Disability and Discharge

Introduction: The primary objectives were to compare the duration of sickness absence in employees with high levels of somatic symptom severity (HLSSS) with employees with lower levels of somatic symptom severity, and to establish the long-term outcomes concerning return to work (RTW), disability and discharge. Secondary objective was to evaluate determinants of the duration of sickness absence in employees with HLSSS. Methods: 489 sick-listed employees registered with five Occupational Health Physician (OHP) group practices were included in this study. We measured their baseline scores for somatic symptoms severity, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. The OHPs filled in a questionnaire on their diagnosis. A prospective 2-year follow-up was carried out to assess the long-term outcomes concerning sickness absence, and retrospective information was gathered with regard to sickness absence during the 12 months before the employees were sick-listed. Results: The median duration of sickness absence was 78 days longer for employees with HLSSS. They more often remained disabled and were discharged more often, especially due to problems in the relationship between the employer and the employee. HLSSS, health anxiety and older age contributed to a longer duration of sickness absence of employees. Conclusion: High levels of somatic symptom severity are a determinant of prolonged sickness absence, enduring disabilities and health-related job loss. Occupational health physicians should identify employees who are at risk and adhere to guidelines for medically unexplained somatic symptoms.     

The occupational health nurse as the trusted clinician in the 21st century

Occupational health nurses as trusted clinicians use their direct care skills in both on-site and off-site roles to protect human resources and contain health care costs. On-site clinics leverage the knowledge, skills, and abilities of occupational health nurses. To maximize the health of the work force, occupational health nurses use strategies aimed at improving health, engaging employees, enhancing accountability of employees, linking provider strategies, using technology creatively, and promoting healthy work environments. Occupational health nurses maintain a proactive and effective impact on occupational health and safety as part of a broader framework of holistic primary care.     

Use of prescribed medication at work in employees with chronic illness

BACKGROUND: This study examined factors associated with the use of prescribed medication at work. METHODS: Questionnaire survey of employees with diagnosed chronic illnesses from four UK organizations. Data were collected on type of chronic illness, health status, health beliefs, work limitations, occupational health support, general practitioner (GP) and line manager support. Data were analysed using univariate logistic regression. RESULTS: A total of 1474 employees with chronic illness participated. Medication use at work (yes versus no) was predicted by age, pain, diagnosis of heart disease, medication use at home, benefit of prescribed medication to health, ease of using medication at work, practical support from families and practical and emotional support from GP and line manager. In a multivariate logistic regression model, medication use at work was predicted by medication use at home and ease of using medication at work only. CONCLUSIONS: The ease of taking medication at work was found to be a key predictor of medication use at work, suggesting occupational health may play a vital role in finding ways to support employees in their usage of medication. This may be for example by providing help and guidance in storing medication at work and encouraging employees to disclose medication use to employers and managers where necessary. Occupational health services can help create a workplace culture that places a high value on health, educating staff on the value of looking after their health and the benefits of following advice.     

Rehabilitation after Illness and Injury-A Study of Temporary Alternative Work Arrangements

A study of the allocation of temporary alternative work (TAW)duties for rehabilitating employees after illness or injuryis described. This was conducted in the occupational healthdepartment of a large industrial chemical works with severalthousand employees in a wide variety of occupations. Work relatedaccidents accounted for 32 per cent of episodes. Musculoskeletalconditions formed the largest cause of illness and injury, especiallyin young employees in engineering and craft occupations. Fifty-nineper cent of TAW duties were of less than 1 month duration with7 per cent of TAW duties lasting longer than 6 months. The workforceannual prevalence of 5-5 per cent was comparable to certifiedsickness rates. It is concluded that it is practical to rehabilitateill employees in a wide range of occupations within the contextof their normal workplace by a supervised system of TAW duties. ⁰Requests for reprints should be addressed to: Dr S.P. Deacon, British Petroleum pic, Group Occupational Health Centre, Chertsey Road, Sunbury-on-Thames, Middlesex TW16 7LN.     

大型企业艾滋病健康教育政策实施效果评估

目的 推动秦皇岛港务集团完善艾滋病健康教育政策,向其他企业提供政策借鉴.方法 采用自行设计问卷,在修订的艾滋病健康教育政策实施前后,分别随机抽取不同岗位的职工2008名和1996名进行横断面问卷调查.结果 两次调查中,职工对6项艾滋病基本知识的知晓率均明显提高了8.8%～16.6%,职工的受教育程度、工作岗位、工作年限和性别是知晓率影响因素;允许感染者/病人继续工作、愿意与他们交往的职工分别增加了11.9%和4.5%;主动寻求艾滋病健康咨询的职工比例增加了19%,被动获取信息渠道中,宣传单(折页、小册子)位居第一.结论 该艾滋病健康教育政策实施效果比较好,为保证政策的生命力,贯彻<艾滋病防治条例>对企业的责任和义务要求,仍然需要对政策进一步调整和完善.     

OSHA to inspect hospitals, medical clinics for use of safer needles. Occupational Safety and Health Administration

The Occupational Safety and Health Administration (OSHA) has notified compliance officers of its intention to start imposing sanctions against health care facilities that do not use safe-needle devices. OSHA also said that facilities need to conduct yearly audits of their bloodborne pathogen programs, and must integrate new technologies wherever possible to protect their employees from exposure. Facilities affected include hospitals, home health service organizations, employment agencies, independent health care professionals, and independent contractors. About 800,000 hospital workers are accidentally punctured by needles each year. HIV is present in about 2 percent of those cases, but only a small number of workers actually contract the virus. The directive is available on the OSHA web site, and contact information is provided.     

Use of health services by Finnish employees in regard to health-related factors: the population-based Health 2000 study

Objectives

The aims of this study were to describe the use of occupational health services and other health care of Finnish employees and to examine associations between health problems and risks, and primary care visits to occupational health nurses and physicians and other health care.

Methods

A nationally representative sample of 3,126 employees aged 30–64 participated in the Health 2000 study, which consisted of a health interview, questionnaires, a clinical health examination, and the Composite International Diagnostic Interview. The use of health services was measured by self-reported visits.

Results

During the previous 12 months, 74 % of the employees visited occupational health services or municipal health centers, 52 % visited only occupational health services. From a third to a half of employees with lifestyle risks, depressive disorders or other health problems visited occupational health professionals. Obesity, burnout, insomnia, depressive mood, chronic impairing illnesses, and poor work ability were associated with visits to occupational health nurses. Among women, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to occupational health physicians. Lower educational level, smoking, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to health center physicians.

Conclusions

This study showed the importance of occupational health services in the primary health care of Finnish employees. However, a considerable proportion of employees with lifestyle risks, depressive mood, and other health problems did not use health services. Occupational health professionals are in an advantageous position to detect health risks in primary care visits.     

Musculoskeletal Disorders in Shipyard Workers

The primary hypothesis was that musculoskeletal disorders weremuch more common in older workers than in younger ones. A questionairewas answered by 1565 shipyard workers at a health check-up.We also scrutinized diagnoses from the health centre at theshipyards. The work load of each occupation was independentlyestimated in three degrees, low, moderate and heavy. There wasno obvious relation between musculoskeletal disorders and age.However, there was as expected a strong relationship betweenwork load and symptoms or medical diagnoses. The data indicatedno strong correlation between musculoskeletal disorders fromdifferent organs. Requests for reprints should be addressed to: Bengt Järvholm, Department of Occupational Medicine, S.t Sigfridsgatan 85, S-412 66 Göteborg, Sweden     

Job accommodations for HIV/AIDS: practical tips and case law

Employers need to make accommodations for all disabled employees, including those with HIV/AIDS. Companies will face an increasing need to make these accommodations as more patients respond well to new drug treatments and are able to return to the work force. Workers with HIV and AIDS pose special challenges to employers: their confidentiality must be protected, their health status changes need to be taken into consideration, and their coworkers need to be counseled. Employers need to be flexible and creative in providing extra time off, flexible work scheduling, or a place to rest. Guidelines are included for determining whether the job accommodations are reasonable or impose an undue burden on the business.     

HIV / AIDS,STDs and the workplace

Even though the workplace is ideal for promoting HIV/STD (sexually transmitted disease) prevention to benefit workers and employers, many workplaces are not convinced that they should be involved in HIV/AIDS and STD education, prevention, and support. They do not realize that time and money spent on health programs save them money. Perhaps they do not feel obligated to protect the health of their employees. The AIDS epidemic adversely affects society and the economy at both the macro and micro level. AIDS tends to strike the productive age group, thereby seriously affecting the workplace. In many Sub-Saharan African countries, at least 20% of the urban workforce may be infected with HIV. Persons living with HIV include top management, skilled professionals, general hands, and farm laborers. HIV/AIDS costs for formal employment are assumed through reduced productivity; increased costs of occupational benefits and social security measures; loss of skilled labor, professionals, and managerial expertise as well as the experience among workers; increased costs of training and recruitment; and low morale from stigmatization, discrimination, and subsequent industrial relation problems. Needed are comprehensive HIV/AIDS and STD workplace programs that ensure the rights of persons with HIV and compassionate treatment of these persons. Trade union or other labor representatives, management, and appropriate government departments should work together and build on existing health legislation and policy to bring about effective negotiation and policy development concerning AIDS and employment. Training of peer educators, support services (counseling, STD referral and/or treatment), community action, management commitment, monitoring and evaluation, and supportive workplace conditions make for effective comprehensive workplace programs. Successful programs operate in fishing villages in Tanzania, tea plantations in India, the University of Papua New Guinea, and Ugandan army camps.     

What role does transactional sex play in the HIV/STI and reproductive health risk behaviour among high-tier entertainment centre workers in China?

China's rapid economic growth over the last three decades has led to increased population wealth and the proliferation of entertainment centres where people can conduct business, relax and meet new people. Little is known about the sexual risk behaviours of employees at high-tier entertainment centres. This paper addresses this gap in knowledge by comparing HIV risk perception and sexual and reproductive health behaviours among female and male employees at three high-tier entertainment centres in two cities in China, comparing those who report a history of transactional sex to those who do not. In both cities, participants who reported a history of transactional sex were more likely than those without a history of transactional sex to report multiple sexual partnerships, more lifetime sexual partners, a history of sexually transmitted infections (STIs), having anal sex and/or recent abortions, and were more likely to perceive themselves to be at risk for STIs/HIV. However, risk behaviour was also high among those with no history of transactional sex. These findings highlight the need for targeted sexual and reproductive health initiatives for employees in these work settings.     

Employment of Diabetics in a Post Office Region

The first paper in this series of three summarized the workexperience of diabetics in one Post Office Region (Welch, 1986).The present paper focuses on the use of a questionnaire to obtainfurther information on the range of duties performed by thisgroup of diabetic employees and gives some indication of theemployment problems they face. The evidence supports the view that diabetic employees can performwide-ranging duties, including shift work. The small number(four) of employees who sought help concerning their diabetesseems to indicate the need for increasing the level of awarenessamong staff in a position to offer such help and also amongdiabetics themselves. Requests for reprints should be addressed to: Dr R. A. Welch, Post Office, Occupational Health and Safety Executive, 33 Grosvenor Place, London SWIX IPX.     

The potential role of occupational therapy in acute care with clients with HIV/AIDS

As medical interventions aimed at prolonging the lives of people with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are implemented, HIV/AIDS is evolving into a chronic disease with associated disability. People with HIV/AIDS can experience numerous occupational performance problems and occupational therapists need to examine and develop their role in helping to meet the needs of this population. Acute-care occupational therapists work with clients with HIV/AIDS who experience multiple admissions and who present with varying levels of occupational function. This paper outlines the potential role of occupational therapy in acute care with clients with HIV/AIDS using the Model of Occupational Performance (Canadian Association of Occupational Therapists, 1991) as a conceptual framework. The results of a retrospective chart review that investigated the role of two occupational therapists working with clients with HIV/AIDS in an acute-care setting are presented and compared with the potential role. Practice and research recommendations to address the discrepancies between the potential and present role are presented. Copyright © 1998 Whurr Publishers Ltd.