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PubMed2006

Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury.

PROBLEM: One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. METHODS: In this cross-sectional study 187 Ontario workers completed a telephone survey 17-43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items "your HCP told you the date you could RTW," "your HCP advised you on how to prevent re-injury or recurrence," "your HCP made contact with your workplace" on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. RESULTS: The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62-6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24-5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09-4.09; adjusted OR=1.72, 95% CI=0.83-3.58). INTERPRETATION: Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.

Adolescent↗

PubMed2006

Workplace injury management: using new technology to deliver and evaluate physician continuing medical education.

OBJECTIVE: Physicians typically receive little continuing medical education (CME) about their role in workplace injury management as well as on workplace injuries and disease. Although new technologies may help educate physicians in these areas, careful evaluation is required, given the understudied nature of these interventions. The objective of this study is to evaluate two promising new technologies to deliver CME (online learning and videoconferencing) and to compare the effectiveness of these delivery methods to traditional CME interventions (large urban traditional conference lectures and small group local face-to-face outreach) in their impact on physician knowledge related to workplace injury management. METHODS: This study utilized a prospective, controlled evaluation of two educational programs for BC physicians: 1) The Diagnosis and Management of Lateral Epicondylitis; and 2) Is Return-to-Work Good Medicine? Each educational module was delivered in each of four ways (Outreach Visit, Videoconference Session, Conference Lecture, Online) and physicians self-selected their participation--both in terms of topic and delivery method. Questionnaires related to knowledge as well as learner attitude and satisfaction were administered prior (pre-test) and following (post-test) all educational sessions. RESULTS: 581 physician encounters occurred as a result of the educational interventions and a significant percentage of the physicians participated in the research per se (i.e. there were 358 completed sets of pre-test and post-test 'Knowledge' questionnaires). Overall the results showed that the developed training programs increased physicians' knowledge of both Lateral Epicondylitis and the physician's role in Return-To-Work planning as reflected in improved post-test performance when compared to pre-test scores. Furthermore, videoconferencing and online training were at least as effective as conference lectures and instructor-led small group outreach sessions in their impact on physician knowledge. CONCLUSIONS: Use of effective videoconferencing and online learning activities will increase physician access to quality CME related to workplace injury management and will overcome access barriers intrinsic to types of CME interventions based on instructor-student face-to-face interactions.

Analysis of Variance↗

PubMed1984

Assessing recent developments and opportunities in the promotion of health in the American workplace.

The purpose of this paper is to offer, as a basis for discussion, a review of the two main interpretations of what constitutes the meaning and scope of health promotion in the workplace. The two interpretations analyzed are: (a) the individual-based lifestyle approach and (b) the environmental-social approach. This paper discusses the limitations of the individual-based lifestyle approach which postulates an individualistic and fragmentated vision of the process of health in the workplace. In contrast, the environmental-social approach provides a more comprehensive framework of reference in which the socioeconomic, environmental and political components are integrated in the primary prevention strategies of health promotion in the workplace. Under this health alternative it is crucial that workers or their representatives be included as full participants in the overall process of planning, organization and implementation of promotion of health in the workplace.

Health Education↗

PubMedDate not supplied

[Impact of a smoke-free workplace policy in a company].

OBJECTIVE: To assess the impact of a smoke-free workplace policy in a company. METHOD: The impact of the implementation of a smoke-free workplace policy was assessed between October 2001 and February 2003 in a company with 184 employees. Two surveys of the entire staff were performed, one before the implementation of the new policy and the other 14 months after. RESULTS: Both passive exposure to tobacco smoke and tobacco consumption among smokers decreased. The proportion of workers free of tobacco smoke exposure at their workplace increased from 32% to 84% (p < 0.001) and, among smokers, the mean daily consumption of cigarettes was reduced by 7.3 cigarettes (p = 0.049). CONCLUSIONS: Demarkation of areas where smoking is allowed not only reduces passive exposure to tobacco smoke at the workplace but also seems to encourage smokers to quit smoking or to reduce tobacco consumption.

Adult↗

PubMed2006

Exhaled carbon monoxide level as an indicator of cigarette consumption in a workplace cessation program in Taiwan.

BACKGROUND: Smoking cessation programs are critical to the safety and health of workers. Exhaled carbon monoxide (CO) is an effective indicator of smoking in clinics and hospitals. Its application in the community and workplace, however, remains limited. This study assessed whether exhaled CO concentration can be used as an objective indicator of the amount of daily cigarette consumption among smokers in the workplace in Taiwan. METHODS: A total of 150 workers from a chemical manufacturer in Taiwan were included; there were 27 nonsmokers and 123 current smokers. The number of cigarettes smoked daily by each subject was reported, and exhaled CO concentration was measured in each subject using the Micro CO meter (Micro Medical Ltd, Chatham, Kent, UK). RESULTS: Exhaled CO levels were associated with the number of cigarettes consumed daily, with a correlation coefficient of 0.73 (p < 0.01) and an adjusted R-square (simple linear regression model) of 0.44. The mean exhaled CO level of nonsmokers was 4.2 ppm (95% confidence interval, 3.3-5.1). A reading of > 6 ppm had a sensitivity of 84% and specificity of 85% in detecting workplace smoking. CONCLUSION: Exhaled CO level can be used as an objective, noninvasive indicator to determine the smoking status of an individual in the workplace.

Adult↗

PubMed1996

Investigation into the impact of introducing workplace aerosol standards based on the inhalable fraction.

Since the late 1970s, there has been considerable discussion about describing human aerosol exposure in terms of a scientific criterion based on the efficiency with which particles are inhaled through the nose and/or mouth during breathing. As international agreement on the quantitative form of this criterion has emerged, progress is quickening towards workplace and environment aerosol standards in which the current 'total aerosol' approach will be replaced by one based on 'inhalability'. Wind tunnel investigations of a range of personal samplers currently used in workplaces for sampling 'total' aerosol have shown that many of these are not adequate for collecting the inhalable fraction. Such experimental evidence is supported by considerations of the physical sampling characteristics of the various samplers. Studies have been conducted to investigate workers' exposures to 'total' and inhalable aerosol in the workplaces of several industries in several countries, using side-by-side sampling in which participating workers wear two samplers, one for 'total' aerosol and the other for inhalable aerosol. The results from the several hundred sample pairs taken so far show that the level of exposure based on inhalable aerosol consistently exceeds that for 'total' aerosol. The observed ratios between the inhalable and 'total' aerosol exposures range from 1.2 to > 3, tending to be greater for workplaces where the aerosol is expected to be coarser. Such results may be used to assess the impact on industry of new limit values based on inhalable aerosol. It is clear that measured levels of exposure will tend to rise, so that there will be generally increased proportions of exposure measurements where levels will come close to, or exceed, current exposure limits. Those proportions may be greater still if new, lower limit values for 'total' aerosol currently under consideration for some substances are implemented. This paper examines these issues by reference to examples of exposure data taken from a range of industries and proposes options for how such information might influence the setting of future occupational exposure limits.

Administration, Inhalation↗

PubMedDate not supplied

Long-term follow-up of workplace and well water manganese effects on iron status indexes in manganese miners.

The authors assessed the effect of water reconstitution in the workplace by evaluating the iron status of manganese mine workers during a long-term study. Subsequent analyses and biological monitoring were performed in a group of 150 manganese miners before, and 2.8 yr after, reconstitution of drinking water in the miners' workplace. The authors found significantly high concentrations of manganese in the workplace well water, as well as in the miners' blood, urine, and hair. There was a considerable prevalence of epithelial lesions, which resulted from iron deficiency, in the miners, compared with controls. The authors assessed the prevalence of iron deficiency grades (i.e., I > II > III > IV) before and after water reconstitution. Reconstitution of drinking water for the ultimate attainment of healthy levels of manganese and other minerals resulted in a significant improvement in the miners' iron status and a decreased prevalence of epithelial lesions. The authors concluded that alterations in iron status may result from the cumulative effect of high levels of manganese in consumed water, as well as in airborne dust, in the workplace. Such elevated levels should be considered as an occupational hazard because they have an ability to interfere with iron absorption.

Adult↗

PubMed1999

Under-reporting of work-related disorders in the workplace: a case study and review of the literature.

Accurate reporting of work-related conditions is necessary to monitor workplace health and safety, and to identify the interventions that are most needed. Reporting systems may be designed primarily for external agencies (OSHA or workers' compensation) or for the employer's own use. Under-reporting of workplace injuries and illnesses is common due to a variety of causes and influences. Based on previous reports, the authors were especially interested in the role of safety incentive programmes on under-reporting. Safety incentive programmes typically reward supervisors and employees for reducing workplace injury rates, and thus may unintentionally inhibit proper reporting. The authors describe a case study of several industrial facilities in order to illustrate the extent of under-reporting and the reasons for its occurrence. A questionnaire and interview survey was administered to 110 workers performing similar tasks and several managers, health, and safety personnel at each of three industrial facilities. Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries, including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job. Interviews with management representatives revealed administrative and other barriers to reporting, stemming from their desire to attain a goal of no reported injuries, and misconceptions about requirements for recordability. The corporate and facility safety incentives appeared to have an indirect, but significant negative influence on the proper reporting of workplace injuries by workers. A variety of influences may contribute to under-reporting; because of under-reporting, worker surveys and symptom reports may provide more valuable and timely information on risks than recordable injury logs. Safety incentive programmes should be carefully designed to ensure that they provide a stimulus for safety-related changes, and to discourage under-reporting. A case-control study of similar establishments, or data before and after instituting safety incentives, would be required to more clearly establish the role of these programmes in under-reporting.

Accidents, Occupational↗

PubMed1999

Do workplace interventions prevent low-back disorders? If so, why?: a methodologic commentary.

The demand for workplace interventions to prevent low-back disorders has increased in recent years. At the same time, a crisis in the literature has become apparent: there are conflicting reports on whether or not these interventions work. With the aim of understanding the reason for the dissension in the literature, six studies were selected for close examination. These were studies of interventions based on differing principles, i.e. a change in organizational ethos to promote back safety, back belt use, the introduction of ergonomic devices, and back-strengthening exercises. If the studies are taken at face value, any of the interventions, regardless of type, has a tremendous effect. Methodological problems inherent in these studies may provide a clue to why essentially different interventions were found to be consistently successful. Study design quality has long been noted to exert a particular influence on the evaluation of outcomes: the quality of the study design is often inversely related to reported outcomes. Of the six studies selected for examination, four did not include a contemporaneous control group, five did not randomly assign subjects to test and control groups, and none included a placebo group. Given these research designs, variables other than those tested by the studies may have produced the reported results. These variables include 'beliefs of the intervention providers' and 'coalescence of the work group', both of which are discussed. Two approaches, the pragmatic and the explanatory, may be used to study workplace interventions to prevent low-back disorders. Most of the examined studies are pragmatically oriented. Having dealt with study design problems expeditiously, these studies may be characterized as more immediately responsive to the demand to evaluate workplace interventions than explanatory studies. On the other hand, explanatory studies, most notably associated with randomized clinical trials in medicine, are more rigorous. Enough pragmatically oriented studies have been conducted to suggest that workplace interventions may have an effect on low-back disorders. More conclusive explanatory studies may now be conducted.

Accidents, Occupational↗

PubMed1992

Drug testing in the Australian workplace: overview of the issues.

This paper is an overview of the issues surrounding employee drug testing programs as they apply to the Australian workplace. Drug testing may be seen within a historical context of control over workers. Its practice is most prevalent in the USA, but it is also occurring in Australia, Canada and England. It is undeniable that alcohol and other drug use causes significant problems in many workplaces, though the apparently substantial costs to industry and the prevalence of drug use among workers are difficult to estimate with any degree of precision. Drug testing programs in the workplace appear to have majority public support in the USA and are even supported by some unions in Australia and the USA; there are, however, critics of the programs. The evaluation evidence to date is sparse, but is promising in that it suggests that drug testing programs can be responsible for reducing the prevalence of drug use among workers as well as dramatically reducing company costs for absenteeism, accidents and medical insurance claims. However, due to methodological shortcomings one cannot state conclusively that drug testing programs are as effective as they appear to be. Research using more rigorous designs and generating data that can be compared across studies is needed. Distasteful though drug testing is, we may see benefits in its use, similar in concept to random breath testing on our roads. Many of the procedural and legal problems in early US programs have been eliminated, refinements which should assist Australians. The legal issues, however, are quite different in Australia. A drug testing program should not be the sole remedy for reducing alcohol and other drug problems in the workplace and such a program must also be accompanied by rehabilitation and educational components. Ethical issues are briefly discussed.

Journal Article↗

PubMed1999

Do the UK workplace Radon Action Levels reflect the radiation dose received by the occupants?

In the UK, Action Levels for radon have been established at 400 Bq m(-3) for the workplace and 200 Bq m(-3) for the home. We have estimated the dose received by occupants of rooms with radon levels near or above the Action Level, using hourly radon readings, and a questionnaire to record occupancy. In the workplace, results for 73 staff suggest that doses are lower than expected, partly due to part-time working and partly due to the mobility of staff. The 75% quantile for the series, corrected to a 37 hour week, is 5.2 mSv at 400 Bq m(-3). Compared to the current annual limit for radiation workers, the Action Level could be increased, but the current Action Level is compatible with the recent EEC Directive requiring a lower dose limit. However, when raised radon levels in the workplace were reduced by remediation in the series we studied, the dose reduction to staff was consistently around half of the radon level reduction. Although it would be appropriate to study more locations, this suggests an Action Level for remediated workplaces of 200 Bq m(-3). Finally, in a limited series of dose assessments in domestic properties, we found that doses could considerably exceed 5 mSv at the 200 Bq m(-3) Action Level, primarily because the sample included an example of high occupancy, in our case several Asian wives in purdah, whose occupancy was almost total.

Air Pollutants, Radioactive↗

PubMed2006

The performance of laboratories analysing heavy metals in the Workplace Analysis Scheme for Proficiency (WASP).

This paper discusses the proficiency of laboratories analysing identical test samples representative of metals in air in the Workplace Analysis Scheme for Proficiency (WASP) and the variability of results from laboratories used to assess personal exposure in the workplace. Over 11 years, the performance of laboratories has significantly improved for lead, cadmium and chromium. Laboratories show better agreement when using inductively coupled plasma-atomic emission spectroscopy (ICP-AES) than flame atomic absorption spectroscopy (FAAS) when analysing chromium, but not when analysing lead and cadmium. Data from the proficiency testing scheme show that for a customer to have confidence that a measurement value does not exceed the workplace exposure limit the analytical result would have to be <134 microg m(-3) for lead and 23 microg m(-3) for cadmium for an 8 h sample and 129 microg m(-3) for lead, 21 microg m(-3) for cadmium and 429 microg m(-3) for chromium for a 4 h sample (for samples with relatively soluble matrices), before considering the further uncertainties due to sampling. The performance criterion for satisfactory performance (+/-8.3%) was found to be appropriate as long as laboratories participated consecutively in all rounds. Estimates of the overall uncertainty of results from ICP-AES and FAAS analysis were shown to meet the criteria in EN482. Samples from some types of workplace environments are more difficult than the WASP test material to dissolve into solution, so it is expected that estimates of uncertainty are larger for less soluble analytes and matrices. WASP has now initiated a programme to help laboratories assess their performance with more complex matrices.

Air Pollutants, Occupational↗

PubMed1992

Health promotion in the British workplace: a suitable case for treatment?

Over the years, the British workplace has provided a fertile bed for the growth of health-related surveillance, research and intervention. A brief review of the literature on this topic, highlights the plethora of different groups involved, and their differing agenda in relation to the health of the workforce. Key participants, including the workforce, have different perceptions of, and commitment to, the promotion of health. Health promotion should be concerned with reducing inequalities in health experience and opportunity but, because the large majority of British workplaces have no access to appropriate occupational health services, most health promotion activity is concentrated in large profit-making concerns with suitable existing facilities. In this article, the background to health-related initiatives in the British workplace is given, and the various contributions to workplace health promoting activities are noted. Their potential for mis-use is discussed and the need for a more comprehensive and integrated approach to primary care, including health promotion, is suggested. In the present economic climate in Britain there is a need to create a comprehensive database of all health promotion activities so that, with collaboration, integration and coordination of all initiatives, regardless of venue, we can put our present meagre resources to best use.

Female↗

PubMed1999

A systematic review of the effectiveness of health promotion interventions in the workplace.

The aim of this study was to identify and critically review evaluations of the effectiveness of health promotion programmes in the workplace. In line with guidelines for 'good practice' within the literature on workplace health promotion, this study aimed to assess the extent to which evaluated interventions considered employees' expressed needs or involved employee-employer partnerships. Overall, 110 outcome evaluations were located. Only a quarter of these reported that interventions were implemented in response to the explicit needs and/or views of the employees and very few involved partnerships. Most of the programmes targeted individual behaviour and supportive organizational change was limited. The majority of the outcome evaluations were not sufficiently rigorous to make a strong case for the effectiveness of workplace health promotion. However, some pointers to success were identified. It was concluded that there seems to be a wide disparity between what counts as 'good practice' within workplace health promotion and what is reported in the evaluation of effectiveness literature. This is not to say that 'good practice' does not exist, but that either such programmes are not rigorously evaluated for their effectiveness and/or that many of the evaluation findings remain outside the public domain.

Health Promotion↗

PubMed2004

Individual neutron monitoring in workplaces with mixed neutron/photon radiation.

EVIDOS ('evaluation of individual dosimetry in mixed neutron and photon radiation fields') is an European Commission (EC)-sponsored project that aims at a significant improvement of radiation protection dosimetry in mixed neutron/photon fields via spectrometric and dosimetric investigations in representative workplaces of the nuclear industry. In particular, new spectrometry methods are developed that provide the energy and direction distribution of the neutron fluence from which the reference dosimetric quantities are derived and compared to the readings of dosemeters. The final results of the project will be a comprehensive set of spectrometric and dosimetric data for the workplaces and an analysis of the performance of dosemeters, including novel electronic dosemeters. This paper gives an overview of the project and focuses on the results from measurements performed in calibration fields with broad energy distributions (simulated workplace fields) and on the first results from workplaces in the nuclear industry, inside a boiling water reactor and around a spent fuel transport cask.

Artifacts↗

PubMed1993

The role of dynamic three-dimensional trunk motion in occupationally-related low back disorders. The effects of workplace factors, trunk position, and trunk motion characteristics on risk of injury.

Current ergonomic techniques for controlling the risk of occupationally-related low back disorder consist of static assessments of spinal loading during lifting activities. This may be problematic because several biomechanical models and epidemiologic studies suggest that the dynamic characteristics of a lift increase spine loading and the risk of occupational low back disorder. It has been difficult to include this motion information in workplace assessments because the speed at which trunk motion becomes dangerous has not been determined. An in vivo study was performed to assess the contribution of three-dimensional dynamic trunk motions to the risk of low back disorder during occupational lifting in industry. More than 400 repetitive industrial lifting jobs were studied in 48 varied industries. Existing medical and injury records in these industries were examined so that specific jobs historically categorized as either high-risk or low-risk for reported occupationally-related low back disorder could be identified. A triaxial electrogoniometer was worn by workers and documented the three-dimensional angular position, velocity, and acceleration characteristics of the lumbar spine while workers lifted in these high-risk or low-risk jobs. Workplace and individual characteristics were also documented for each of the repetitive lifting tasks. A multiple logistic regression model was developed, based on biomechanical plausibility, and indicated that a combination of five trunk motion and workplace factors distinguished between high and low risk of occupationally-related low back disorder risk well (odds ratio: 10.7). These factors included 1) lifting frequency, 2) load moment, 3) trunk lateral velocity, 4) trunk twisting velocity, and 5) the trunk sagittal angle. This analysis implies that by suitably varying these five factors observed during the lift collectively, the odds of high-risk group membership may decrease by almost 11 times. The predictive power of this model was found to be more than three times greater than that of current lifting guidelines. This study, though not proving causality, indicates an association between the biomechanical factors and low back disorder risk. This model could be used as a quantitative, objective measure to design the workplace so that the risk of occupationally-related low back disorder is minimized.

Biomechanical Phenomena↗

PubMed2004

Patch testing with metalworking fluids from the patient's workplace.

In view of the wide variety of components currently used in metalworking fluids (MWF), relevant contact sensitizations may be overlooked, because commercially available MWF test series cannot cover the full spectrum. Hence, patch testing with MWF from the patient's workplace is an important additional diagnostic tool. However, recommendations on how to perform such patch tests vary. We retrospectively analyzed patch test data of the Department of Dermatology in Dortmund, 1992-2003. In 141 metalworkers tested because of suspected occupational contact dermatitis due to MWF, 829 patch tests with 306 samples of MWF were performed. Water-based MWF (wb MWF) were mainly tested in 2 dilution series, i.e. pure (workplace concentration), 10% aq. and 1% aq., and pure, 50% aq. and 10% aq. Positive reactions to wb MWF occurred in 27 patients. Patch testing with wb MWF at workplace concentration resulted in 16.1% (39/242) positive reactions, with a positivity ratio of 69% and a reaction index of 0. From the analysis of reaction patterns and concomitant reactions, we conclude that most of these positive reactions indicated true contact allergy. With lower concentrations, relevant allergic reactions may be missed. Neat oils were tested as is or diluted from 1 to 50% in olive oil, but no reactions at all were observed. For optimum benefit of patch testing with MWF from the patient's workplace, breakdown testing is recommended. To overcome the time-consuming difficulties associated with this procedure, we propose a centre for information and documentation of contact allergies due to occupational exposure. Furthermore, full declaration of MWF ingredients is desirable.

Adult↗

PubMed1993

Predicting the receipt of employer-sponsored health insurance: the role of residence and other personal and workplace characteristics.

Americans without health insurance constitute a significant public policy concern. Previous research has demonstrated that rural Americans are more likely to be without coverage. Beyond documenting this comparative disadvantage, however, current research has two specific deficiencies: studies have not examined whether the factors that predict the receipt of employer-sponsored health insurance are equivalent across residence categories, and few studies have used a multivariate framework to examine the predictors of the receipt of health insurance. Using data from the 1987 National Medical Expenditure Survey, the influence of residence is examined along with other variables known to be associated with an increased likelihood of receiving health insurance from an employer (specifically, seven employee and six workplace characteristics). At a bivariate level, an individual's place of residence did affect the probability of receiving health insurance from an employer, with nonmetropolitan workers least likely to receive such benefits. The influence of the employee and workplace characteristics on receipt of insurance, however, did not vary significantly by place of residence. In a multivariate model, six employee and six workplace characteristics were identified as significant predictors. These findings do not refute the existence of important residential differences in health insurance coverage, rather, they suggest that the differences are due to identifiable population and workplace characteristics that vary in their distribution by residence.

Employment↗