Audit of a pre-employment risk identification form

A risk identification form was introduced as part of SouthmeadHealth Services NHS Trust's pre-employment procedure. Its purposewas to allow occupational health nurses to identify employeeswith specific occupational health needs. One hundred employees'risk identification forms were studied and a comparison madebetween the manager's assessment and that of an independentoccupational health nurse's assessment based on job title alone.The actual risks involved in the post were identified by theemployee after 1 month employment, together with an occupationalhealth nurse from Southmead NHS Trust. There was a greater agreementbetween the managers' assessments and the actual risks identified(range 83–100%), than between the independent nurse'sassessments and the actual risks identified (range 59–100%),in all categories other than driving. The sensitivity of themanagers' risk assessments were higher than that of the independentnurse in all categories and the positive predictive value ofthe managers' risk assessments were higher than that of theindependent nurse in all but two categories.     

A health promotion programme for oil refinery employees: changes of health promotion needs observed at three years

The main aim of this three-year follow-up study was to evaluatethe long-term effects of a workplace health promotion interventionprogramme offered by the Neste Oyj corporation's occupationalhealth service. Another aim was to study factors associatedwith changes in health promotion needs. These were assessedusing information obtained by means of questionnaires and laboratorymeasurements. The target areas assessed were physical activity,musculoskeletal problems, dietary habits, obesity, blood pressure,serum lipids, smoking, quality of sleep and mental well-being.Participants from one oil refinery were offered special healthpromotion counselling, while those from the other oil refinerystudied received only their personal results, written informationand instructions. Evaluation of the changes in needs was mainlybased on comparison of the results of two examinations performedwith an interval of three years. Effects of special health promotioncounselling were observed in the target area of physical activity.Elimination of certain health promotion needs was seen in bothgroups in all of the target areas. The most extensive changeswere seen in the target areas of musculoskeletal symptoms, dietaryhabits, blood pressure and mental well-being. Basic education,occupational status and age-group, as well as the value of tendinghealth were frequent variables explaining the reduction in theneed for health promotion activities. Worker participation inhealth promotion counselling activities provided by occupationalhealth services can be high, as in this study in which the participationrate was 90% and the drop-out rate during the three years only10%.     

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.     

Perception and provision of occupational health services in the UK

BACKGROUND: There is difficulty in defining occupational health services among stakeholders of the service. Concurrently, there are concerns about the state of occupational health provision in the UK. AIMS: To determine stakeholders' perception of the services that occupational health encompasses and the level as well as the rationale behind the provision of these services. METHODS: The research was undertaken as a postal questionnaire survey of the FTSE 350 companies and selected public sector organizations in the UK. This was followed up by telephone calls to a random selection of non-respondents to obtain non-respondent data. RESULTS: There is a difference in opinion among managers and occupational health professionals about the services provided by occupational health. Taking into account non-respondent data to partially adjust for overestimation biases, the level of provision of occupational health services among the FTSE 350 companies is 69% and in public sector organizations is 95%, giving an average provision of 72%. Sixteen per cent of respondents thought there was a trend towards outsourcing of services. The most frequently cited reason for provision of an occupational health service was that it was for the benefit of employees. CONCLUSIONS: There remains room for improvement in the level of occupational health services provision in large UK private sector organizations. By bridging the gap between the different stakeholders' perceptions of the remit and benefits of the service, a higher level of provision in the private sector similar to that of public sector organizations can be achieved.     

Life-style related health promotion needs in oil refinery employees

This report describes the screening procedure used in the assessmentof health promotion needs in a group of oil refinery employees(n=885). The aim of the study was to assess the life-style relatedhealth promotion needs before initiating an intervention programmestudy. The frequency of different health promotion needs andtheir distribution according to age, gender and employee groupwere examined, as well as the factors explaining different healthpromotion needs. The assessment was based on laboratory testsand questionnaires covering the target areas of physical activityand fitness, dietary habits, overweight, blood pressure, serumlipids, smoking, alcohol consumption, sleep, mental health,and musculoskeletal symptoms. Life-style related health promotionneeds were frequent. Self-assessed health was strongly associatedwith health promotion needs in most of the ten target areasand also with the total number per person of areas with healthpromotion needs. Health promotion needs were also associatedwith such demographic variables as age, gender, basic education,and vocational training, If health promotion activities areprovided to employees in a company, assessment of individualneeds is necessary to find the employees with the greatest needof health promotion actions. This study presents one methodof screening, although certain simplification is needed to makeit fit into the daily routines. The contents of health promotionactivities could also vary according to the differences relatedto age and gender observed in health promotion needs of thetarget population.     

Occupational health provision in UK universities

BACKGROUND: Very few studies have been done of occupational health provision across an entire employment sector and universities are particularly understudied. The British government published updated guidance on university occupational health in 2006. AIM: To describe the occupational health services to all the universities in the UK. METHODS: All 117 universities in the UK were included. Detailed surveys were carried out in 2002, 2003 and 2004 requesting self-completed information from each university occupational health service. This paper presents information on general characteristics of the service, staffing, services provided and outcome reporting. RESULTS: There was variation in the type of occupational health provision; half the universities had an in-house occupational health service, 32% used a contractor, 9% relied on the campus primary care or student health service and 9% had ad hoc or no arrangements. In all, 93 of the 117 (79%) universities responded to the detailed questionnaire, the response rate being higher from in-house services and from larger universities. There was a wide variation in staffing levels but the average service was small, staffed by one full-time nurse with one half-day of doctor time per week and a part-time clerical or administrative member of staff. A range of services was provided but, again, there was wide variation between universities. CONCLUSIONS: It is unclear if the occupational health provision to universities is proportional to their needs. The wide variation suggests that some universities may have less adequate services than others.     

Communication between an occupational physician and other medical practitioners--an audit

Four hundred and seventy-two consecutive referral episodes relatingto 386 patients attending the Occupational Health Departmentof a general teaching hospital were analyzed to evaluate thefrequency, content and effect on management of communicationsbetween the occupational physician and other doctors. In all,250 episodes (53%) were associated with such a communication.The likelihood of a communication was strongly influenced byreason for referral, particularly in respect of long or shortterm sickness absence; univariate odds ratios (OR)=10.58, 95%Cl=8.13–27.08) and 2.65, 95% Cl=1.55–4.60) respectively;a medical diagnosis of psychiatric illness (OR=3.17, 95% Cl=1.69–5.97));and by number of consultations. Communication was also morelikely when the occupational outcome was ill health retirement,rehabilitation in work or modified work. Ninety-eight per centof specific requests for information or an opinion eliciteda reply. Information received from other doctors influencedthe occupational health physician's management in 52 referralepisodes (20%). Specific action by GPs as a result of communicationwas documented in 54 and by specialists in 37 episodes. Theimportance of communication between occupational health physicianand other doctors in the occupational health process is confirmed.     

Status of health promotion programme implementation in small-scale enterprises in Japan.

This study was conducted to determine the status of the implementation of health promotion programmes (HPPs) in Japanese small-scale enterprises (SSEs). A survey was conducted in 1996 using a questionnaire mailed to all the member construction companies (n = 772) of a health insurance society, and a response rate of 84% was obtained. Health examination was most frequently conducted (90%), followed by exercise/fitness programmes (17%), smoking measures (12%), health guidance (11%) and nutrition education (6%). Mental health programmes and the government-advocated Total Health Promotion Plan (THP) were implemented at less than 2% of SSEs. The implementation rates for these programmes, except for smoking measures and the THP, were higher at large enterprises than at SSEs. The employment rate for occupational physicians (OPs) was 9% and 49% at SSEs and large enterprises, respectively. The activity most frequently conducted by OPs was health examination, followed by curative services and health education. Advising employees to undergo re-examination or more valid examination after the annual health examination was most frequently conducted by non-health professionals.     

What determines the size of occupational health services in UK universities?

BACKGROUND: There is wide, largely unexplained, variation in occupational health (OH) provision between UK employers. AIM: To explain the variation in OH provision across the UK university sector. METHODS: Analyses of data from a survey of university OH services and from the Higher Education Statistics Agency. The outcome variable was clinical (doctor + nurse) staffing of the university's OH service. The explanatory variables examined were university size, income, research activity score and presence or absence of academic disciplines categorized by an expert panel as requiring a high level of OH provision. RESULTS: All 117 UK universities were included and 93 (79%) responded; with exclusions and incomplete data, between 80 and 89 were included in analyses. There was wide variation in clinical OH staffing (range 0-8.4 full-time equivalents). Number of university staff explained 34% of the variation in OH staffing. After adjusting for other factors, neither the research activity nor the presence of high-needs disciplines appeared to be factors currently used by employers to determine their investment in OH. CONCLUSIONS: Government or other guidelines for university employers should take organizational size into account. Employers may need guidance on how to provide OH services proportionate to specific occupational hazards or other OH needs.     

Evaluation of the effectiveness of pre-employment screening

Aim As pre-employment screening and selection is a main function in the protection of susceptible applicants from developing an occupational disease, we need insight into the effectiveness of this intervention under different exposure conditions. The aim of our study was to demonstrate the feasibility and usefulness of three indicators to evaluate the effectiveness of pre-employment examinations.Method We used a pre-employment medical evaluation table to gather the data needed for the indicators for effectiveness. The first indicator chosen is the predictive value of a positive test result (PPV) corresponding to the percentage of applicants who will develop an occupational disease after a positive test result. The second indicator is the number of pre-employment medical examinations needed to reduce the number of new cases of an occupational disease by one (number needed to test, NNT). The third is the number of rejections for the job, as the consequence of a positive test result, needed to reduce the number of new cases of an occupational disease by one (number needed to reject, NNR). To illustrate feasibility and usefulness, we used the example of potroom asthma in the primary-aluminium industry. We used data on personal risk factors and on the incidence of potroom asthma from a nested case–control study in the Netherlands.Results The three indicators for effectiveness could be applied. For high incidence rates, defined as 0.04 (40 cases/1,000 employees per year), the PPV values for personal risk indicators varied from 5% to 27%. The NNT varied from 116 to 667. Finally, the NNR varied from 4 to 20. For low incidence rates, defined as 0.005 (5 cases/1,000 employees per year), the PPV values were low (0.6% to 5%). The NNT were high (1,111 to 5,000). The NNR varied from 23 to 155.Conclusion The three indicators for effectiveness are applicable under the condition of the availability of relevant empirical data. The indicators provided useful information for the evaluation of the effectiveness of specific tests, which might be added as selection criteria. The personal risk factors studied were far from effective as selection instruments, especially in situations where a low incidence of potroom asthma exists. Personal risk factors at the pre-employment stage should not be added to the standard procedure to select susceptible applicants. Under conditions, they may be taken into account in a workers health surveillance programme. As a contribution to evidence-based occupational medicine, we recommend the use of the pre-employment medical evaluation table and the three chosen indicators for effectiveness as a standard tool to evaluate the effectiveness of pre-employment medical examinations.     

Demonstrating the economic value of occupational health services

Many large companies operate some form of occupational health service (OHS). More companies now require specific evaluative information to justify the continued provision of an in-house OHS. This is in the face of increased pressure to control costs, combined with an awareness that the service itself can induce activity (supplier-induced demand) and could be substituted with health care provided or even funded outside the company. The lack of routinely collected data and the conceptual difficulty in defining and measuring the outcomes of an OHS provide challenges for economic evaluation. A purely human capital approach, where people are valued by their wage rates, is likely to be insufficient, since OHSs have multiple objectives. These objectives include fulfilling statutory obligations, contributing to the creation of a culture of partnership, reduction of potential costs to the company (sickness benefit, production loss, poor performance, litigation, insurance) and providing a suitable environment for the cost-effective reduction of the social and health service costs of illness at work. Evidence is needed to quantify some of these arguments and demonstrate to decision makers the value generated by OHSs. The aim of this paper is to consider the practicality of different economic evaluation methodologies, specifically cost models, contingent valuation (willingness-to-pay) and development of OHS-specific outcome measures. In considering different approaches, we present the results of our research in two UK companies.     

Methods to persuade higher management to invest in health promotion programmes in the workplace

This study was conducted to find effective methods to persuadehigher management to invest in workplace health promotion (WHP)programmes. The study included 639 occupational health professionalsselected from the directory of the Japan Society for OccupationalHealth. A questionnaire survey was mailed to health professionalsthroughout Japan in 1992, and all respondents were asked toidentify themselves. We received 242 replies, which constituteda response rate of 38%. Eighty-one per cent of the respondentshad attempted to persuade higher management to implement a WHPprogramme. Health professionals frequently presented their caseto higher management through a safety and health committee (SHC),and advice provided at the SHC was perceived to be the mosteffective method by occupational nurses (ONs) and safety andhealth supervisors (SHSs). This method was rated second by occupationalphysicians (OPs), who thought recommendations from OPs stipulatedby the Industrial Safety and Health Law to be most effective.Statistics on medical examinations constituted the data mostfrequently used to persuade higher management, followed by reportson worksite inspections and health care plans. Nearly 90% ofOPs and 80% of ONs and SHSs felt that the above methods werefairly successful.     

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.     

Activity profiles of the occupational health services in a multinational company

The management of the European division of a multinational company was aware of possible differences in the occupational health services (OHS) at their different locations. The objective of this study was to carry out a baseline assessment of these OHS. Structured interviews with representatives of the OHS were conducted at 20 locations in 11 countries. The OHS Recommendation from the International Labour Organization (ILO) was used as a standard for the organization and functions of the OHS. Considerable differences in the activity profiles of the OHS were detected. The inter-enterprise, multidisciplinary OHS spent most of their time on surveillance of workers' health in relation to work and on preventive activities in the working environment. Little time was spent on curative services for individual workers. OHS made up of individual physicians and nurses generally spent much of their time on treatment of occupational and non-occupational diseases. This study has clarified the status of the OHS providers and the potential for improvements in order to meet the needs of the company's locations and to comply more closely with the ILO recommendation.     

Occupational epidemiology

The epidemiological literature for assessing risk in many, if not most, modern occupations has now become sufficiently obsolete that it can no longer be depended upon to guide either prevention or adjudication of compensation. This obsolescence must be dealt with by developing new sources of information pertinent to occupational hazards and the risks associated with most occupations. Ideally, a comprehensive surveillance mechanism that would be automatically updated for the changing risk in a changing economy would be ideal and may be attainable with further developments in health information technology. The characteristics of such a system are described. However, there are many obstacles to such a system which appear insurmountable in the short term. A more eclectic plan for cooperation and data-sharing would help in the short term and would establish a pattern of collaboration that could both place adjudication on a more solid foundation and avoid allegations of collusion in business. The general outline for a practical programme of collaboration along these lines is presented.     

An assessment of occupational health care in the Netherlands (1996-2005)

BACKGROUND: The extensive Dutch occupational health care system of the past decade has not led to the desired outcomes, namely, a decrease of work absenteeism and the associated costs. AIM: To assess the differences between in-house and external occupational health care services in the process quality of occupational health care provided. METHODS: In total, 26 interviews were conducted with chief executive officers of occupational health services (OHS). The responses and other relevant policy documents were analysed and described. A key component of this process was to compare differences between in-house and external services. RESULTS: Notable differences in quality were found to exist between in-house and external occupational health care systems, with the in-house occupational health care services offering the highest process quality. CONCLUSION: Our findings suggest that the effectiveness of OHS is mainly dependent on their structure (in-house versus external) and on economic factors (profit driven versus not for profit).     

The scope of international occupational medical practice

The international physician has a tremendous scope of responsibility. Clinical care and its management, occupational and environmental medicine, travel medicine, marine and aviation medicine, public health and other disciplines must be addressed. Programmes must include expatriates, national citizens, travellers, families, extended families, and the surrounding communities. Moreover, in the international context, the occupational physician is a representative of the company in the host country. Furthermore, the knowledge required is not only vast, but changes rapidly. It requires not only clinical acumen, but also the ability to effectively design and implement many types of programmes in the context of the customs and regulations of the country and with the guidance of management.     

Pre-employment health assessments for food handlers: a survey of occupational physicians in the food industry

The format of pre-employment health screens within the food industry varies considerably. The aim of this study was to produce a consensus on the content of a screen that will enable employees to handle food with minimum risk to the product and employee. A questionnaire was sent to the 63 members of the Food Industry Medical Association, of whom 45 (71%) responded. As a minimum, a questionnaire completed by the applicant is thought to be sufficient. Applicants reporting health problems need to be assessed by a health professional.     

Emergence of occupational medical services outside the workplace

A new type of occupational medicine clinic has recently emerged in the United States. These clinics are multispecialty in staffing, are located in hospital outpatient departments, and are affiliated with academic medical centers. Their primary goal is to provide personal health and medical services including diagnosis, treatment, and follow-through of occupationally related diseases. Approximately 15 such clinics have been established in the last several years. A review of the medical, economic, and social forces that have historically shaped the content and scope of occupational medical and health services for workers explains in large part the reasons why many of these clinics have now come into being. Characteristics of eight of these clinics are reviewed in detail. These clinics provide a setting for inter-disciplinary and interspecialty education of personnel and offer the medical community a demonstration of a means for better recognition and treatment of occupationally related illnesses.