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Occupational medical history taking: how are today's physicians doing? A cross-sectional investigation of the frequency of occupational history taking by physicians in a major US teaching center.

Occupational illness plays a prominent role in the health of society, yet physicians frequently neglect occupational history-taking both in clinical practice and in medical education. This study sought to examine the trends as well as related factors that influence the taking of occupationally related histories. A total of 2050 charts were reviewed for occupational information as well as several patient demographics. Physicians obtained gender and age histories in approximately 99% of their patients; however; they only completed an occupational history in 27.8%. Characteristics such as smoking, male gender, family cancer history, middle age, and medical (vs. surgical) admission were all correlated with obtaining an occupational history. Physicians continue to do a poor job of occupational history-taking and medical education must correct the situation.

Academic Medical Centers↗

Occupation in lifestyle redesign: the Well Elderly Study Occupational Therapy Program.

This article describes an innovative preventive occupational therapy intervention for well older adults, the Well Elderly Treatment Program. In a previously reported large-scale randomized effectiveness study, this intervention was found to be highly successful in enhancing the physical and mental health, occupational functioning, and life satisfaction of multicultural, community-dwelling elders. In this article, the philosophical background, manner of development, topical content, methods of program delivery, and mechanisms underlying the program's positive effects are discussed, along with implications for occupational therapy practice. The treatment was based on application of occupational science theory and research and emphasized the therapeutic process of lifestyle redesign in enabling the participants to actively and strategically select an individualized pattern of personally satisfying and health-promoting occupations. The wide-ranging effectiveness of the program supports the occupational therapy profession's emphasis on occupation in affecting health and positions practitioners to extend their services to the realm of preventive interventions.

Aged↗

Outcomes of an occupational therapy program for mothers of children with disabilities: impact on satisfaction with time use and occupational performance.

OBJECTIVE: This experimental research study evaluated the impact of an 8-week psychosocial occupational therapy intervention program for mothers who have children with disabilities. METHOD: Thirty-eight mothers of children with disabilities were randomly assigned to participate either in the treatment or the control group (19 in each). The occupational therapy intervention was designed to facilitate increased perceptions of satisfaction with time use and occupational performance, thereby positively affecting maternal and family well-being. The Canadian Occupational Performance Measure (COPM) was administered to measure self-perceptions of occupational performance and satisfaction over time. RESULTS: No significant differences were found between the two groups on time use perceptions. Although no significant differences were found between the two groups on the COPM Performance subscale, the treatment group demonstrated significantly greater score increases (p < .05) on the COPM Satisfaction subscale. CONCLUSION: This preliminary study suggests that attending to the time use and occupational concerns of mothers of children with disabilities can have a positive impact on their satisfaction with occupational performance.

Adult↗

[The occupational medicine graduate training system in the field of occupational medicine].

The analysis of data on the teaching of occupational medicine in particular medical schools in Poland shows great diversity in presenting the subject to the students of medicine. It relates both to the curriculum and organizational and didactic methods and opinions and postulates expressed by the lecturers . Currently, occupational medicine is a separate subject in the curricula of four medical colleges in Poland, which does not, however, mean that in other colleges the conditions of lecturing on occupational medicine are unsatisfactory. On the contrary, the variety of problems of occupational medicine presented as part of other subjects points to the fact that this particular branch of medical science has been taken seriously. Although the present form of lectures and classes devoted to occupational medicine does enable students to get certain knowledge and competence in this field of science, it does not help shaping a proper attitude toward the subject: still too few students are interested in specializing in occupational medicine and working as industrial health service staff. In such circumstances, some activity must be undertaken to improve the process of pre-graduate studies in occupational medicine.

Curriculum↗

The role of occupational and non-occupational factors in workers ill-health.

In most European countries occupational health and public health have developed separately, the reasons behind this are mainly historical and political. Although this may be understandable, even today, due to the political factors involved, it is amazing that the research on the morbidity and mortality of people of working age does not aim at comprehensive analyses of etiological factors behind these types of health outcomes. Our knowledge on the health needs of workers is limited, in most countries we even lack any information on distribution of the major illnesses amongst the various occupational categories. Some information, however, is currently being gathered, based on the need to make operational the concept of work-related diseases which has been put forward by WHO. The US NIOSH programme on work-related diseases, or the Danish TOP-11-Programme, serve as examples for these types of developments. Additional need to study the causes of ill-health, and ways to counteract them amongst the working population, results from the health promotion action that has also been developed as a part of the HFA 2000. The aim of this overview is to study the importance of occupational and non-occupational factors in the etiology of the ill-health of workers. Evidently, such analyses are premature today. However, some anecdotal examples will be mentioned. The major emphasis of the paper is, however, laid on the needs for the coordination and evaluation of occupational health and other health programmes concerning those of working age. Some assumptions will also be made on the development of occupational health and the consequences of this development for those who are occupational health practitioners.

Europe↗

[The French occupational health system. I. Organization of the French occupational health system].

In the first part the author discusses the fundamental principles of occupational health in France, organisational structure of company and inter-company occupational health services as well as the role and responsibilities of occupational physicians. Part II will deal with the evolution of the system. Occupational health in France deserves attention, at least, because of two reasons. Firstly, a great role of an occupational physician distinguishes it from occupational health in other European countries. Secondly, the French experience can be very useful in restructuring of the Polish occupational health system.

France↗

A prospective field study of the relationship of potential occupational risk factors with occupational injury/illness.

Twenty-one occupationally related risk factors were measured and prospectively evaluated for statistically significant relationships with occupational injury/illness in 442 manual material handlers, working for three different companies, at nine U.S. locations, and encompassing 15 different job descriptions. OSHA 200 logs were used to ascertain evidence of occupational injury/illness (dichotomous) within this population for 1 year after the testing and measurement were completed. The present study demonstrated evidence of a subset of critical variables significantly related to occupational injury/illness occurrence through the significantly related occupational risk factors presented in the univariate and multivariate models. Higher occurrences of injury/illness were significantly associated with nine risk factors in the univariate model, with odds ratios ranging from 1.11-2.27. The significantly (p<0.05) related risk factors in the univariate model were lifting frequency; weight lifted per day; weight lifted per hour; number of trunk flexions per hour; number of trunk twists per hour; number of trunk motions per hour; number of knee flexions per hour; number of shoulder flexions per hour; and static shoulder flexion. In the multivariate analysis two risk factors were associated with occupational injury/illness. The significantly (p<0.05) related risk factors in the multivariate model were lifting frequency (p=0.0010, odds ratio [OR]=4.47, 95% confidence interval [CI]=[2.38-8.40], and average weight of lift (p=0.0001, OR=1.71, 95% CI=[1.29-2.25]).

Accidents, Occupational↗

Occupational health surveillance, screening, and prevention activities in occupational health nursing practice.

Occupational health nursing practice is broad and encompasses surveillance, screening, and prevention activities as part of the scope of practice. While there has been some controversy about who is responsible for these activities, it is clear occupational health nurses play a pivotal role in overseeing, managing, implementing, and evaluating these programs. In fact, recent OSHA standards have included broad language that permits licensed health care professionals acting within their legal scope of practice to conduct medical and health surveillance activities. While the contributions of occupational health nurses are well documented, little is known about the degree and emphasis in practice related to surveillance, screening, and prevention programs. This study examined the scope of independent and interdependent practice by occupational health nurses related to these activities and found 71% of occupational health nurses had overall responsibility for program management, and the majority performed surveillance, screening, and prevention functions as independent practice. Physician supervision for any of these activities ranged from only 0% to 8% in reporting. The results of this study validate the independent functioning in scope of occupational health nursing practice related to surveillance, screening, and prevention activities while recognizing the contributions all providers make to a healthy work force.

Cross-Sectional Studies↗

[Knowledge of selected occupational groups about biological agents in the environment and ways of health protection against occupational exposure to biological hazards].

BACKGROUND: Occupational, biological factors of microbial, plant and animal origin may become a health hazard to the exposed workers. The aim of the study was to assess the knowledge of biological agents present in the work environment, related health risks, and health protection against biological exposure at work among workers of certain occupational categories. MATERIALS AND METHODS: A population of 150 workers, employed in the health, forestry and municipal services, was interviewed using a specially developed questionnaire. Each occupational category comprised 50 workers. RESULTS AND CONCLUSIONS: The level of workers' knowledge of occupational, biological agents, their effect on human body, symptoms and diseases induced by occupational exposure to biological hazards is rather limited in the study groups. Personal protective measures, prophylactic vaccination and compliance with principles of personal hygiene are considered to be the most effective ways of health protection against occupational exposure to biological hazards.

Adult↗

Occupational health nursing in Lebanon: exploring the world through international occupational health programs.

Lebanon is undergoing rapid developments. The majority of occupations (approximately two thirds) fall under services, industry makes up one fifth, and the remaining occupations are in agriculture. Primary health care is recently gaining renewed interest, with a focus on primary preventive services. Occupational health practice lags behind, despite the presence of legislation. Data related to occupational illnesses and injuries are fragmented. There is need for comprehensive multidisciplinary national studies to identify occupational health needs. Occupational health nursing is underdeveloped in Lebanon. Nevertheless, the establishment of a National Nurses' Order is hoped to promote the educational preparation and scope of nursing practice in the field.

Adult↗

Selected topics related to occupational exposures. Part III. Occupational dermatology

Occupational skin disorders are very common and are a surprisingly frequent cause of lost work time. Failure to suspect an occupational cause can lead to repeated treatment failure and needlessly prolong patient misery and frustration. Primary care providers play a key role in recognizing possible occupational causes and arranging appropriate education, preventive measures, and treatment. Occupational skin conditions often occur in nonindustrial settings in workers such as hairdressers, health care personnel, and food handlers. Irritant contact dermatitis is by far the most prevalent occupational skin condition and is emphasized in this article. Allergic contact dermatitis, infections, skin cancers, and acneform eruptions may also have significant occupational associations. We will present criteria that suggest on occupational exposure, list common offending agents, and review the clinical presentations and relevant pathophysiology. We provide guidance on a directed history and physical examination and suggest when diagnostic testing is most likely to have value. Finally we outline preventive measures such as contact avoidance, barrier creams, and protective gloves and address therapy and indications for referral.

Journal Article↗

Selected topics related to occupational exposures. Part IV. Occupational liver disease

Occupational and environmental substances associated with liver injury include industrial chemicals, drugs, certain bacterial and viral infections, and other physical agents. Hepatotoxic chemical agents can be classified as direct hepatotoxins, indirect hepatotoxins, or agents that cause liver injury as a result of host idiosyncrasy. More than 100 industrial chemicals have been shown to be acutely hepatotoxic. Occupations with hepatotoxin exposures are numerous and include farm workers, chemists, dry cleaners, electroplaters, garage workers, health care workers, nurses, painters, printers, rayon makers, and others. Clinical presentation of occupational liver disease may be acute/subacute or chronic but is often insidious. Some hepatotoxins are capable of causing malignancy. The key to diagnosis of occupational liver disease is exposure history. The occupational and environmental history should include a brief description of the patient's current and recent jobs to the extent necessary to assess their potential for workplace hepatotoxic exposures. Confounders such as obesity, alcohol, and viral hepatitis are common, and a careful history and examination are essential. A variety of tests are used to evaluate liver disease and may include serum markers, tests of synthetic liver function, clearance tests, and anatomic tests. A key responsibility of the primary care provider is to prevent further liver injury from preventable occupational exposures; not only the patient but also coworkers may be at risk. Efforts should be made to ensure that patients with potential hepatotoxic exposures are working or living in safe conditions. Collaboration with an occupational specialist may be especially useful in this regard.

Journal Article↗

Incidence of occupational asthma by occupation and industry in Finland.

BACKGROUND: Systematic research on occupation or industry-specific incidence of occupational asthma (OA) is sparse. We calculated the incidence of notified OA by occupation, industry and causative agent in Finland for the years 1989-95. METHODS: The numbers of cases of reported OA were retrieved from the Finnish Registry of Occupational Diseases for the population between 20 and 64 years of age. The numbers of employed workers were retrieved from Statistics Finland. Incidence rates were calculated for each occupation, industry and the total workforce. RESULTS: Altogether 2602 cases of OA were notified and the mean annual incidence rate was 17.4 cases/100,000 employed workers. The incidence rate was the highest in bakers, other painters and lacquerers, veterinary surgeons, chemical workers, farmers, animal husbandry workers, other food manufacturing workers, welders, plastic product workers, butchers and sausage makers, and floor layers. Cases caused by animal epithelia, hairs and secretions or flours, grains, and fodders accounted for 60% of the total. CONCLUSIONS: Estimation of occupation and industry-specific incidence rates forms the basis for successful prevention of OA, but necessitates collection of data over several years from well-established surveillance systems.

Adult↗

Occupational lung diseases and global occupational health on the Net.

Occupational lung disease is a major area of concern in occupational health, exhibiting a diverse panorama across countries. While pneumoconiosis is deemed to be the most common occupational disease in many developing countries, emphasis is shifting towards asbestos-related lung diseases and occupational asthma in industrialized countries. Following the Occupational Health for All strategies set forth by the World Health Organization, we propose that a model system based upon the Global Health Network can serve as an effective vehicle towards the prevention of occupational lung diseases on a global scale. It has the potential to: (1) enhance transmission of data and collaboration with the primary health care system in disease surveillance; (2) strengthen research and information transfer and (3) promote education and training at all levels of prevention, with a possible application to the interpretation of chest radiograms.

Computer Communication Networks↗

Liver cirrhosis deaths within occupations and industries in the California occupational mortality study.

Mortality rates were drawn from the California Occupational Mortality Study (COMS) to analyze liver cirrhosis deaths within occupations and industries from 1979 to 1981. Age-adjusted Standardized Mortality Rates (SMRs) were made available by the State of California for separate analyses of women, men, blacks and whites. Rankings of occupations with narrow confidence intervals were strikingly similar for blacks and whites. Within occupations, the highest female SMRs were for waitresses, telephone operators, cosmetologists, dress makers, hospital orderlies, textile workers, and laborers. The lowest female SMRs were for skilled crafts workers and teachers. High male occupations included water transportation workers, bartenders, loggers, laborers, roofers, construction workers, farm workers, iron workers, and painters. Low male occupations included teachers, physicians and dentists, managers, factory supervisors, business sales workers, heavy equipment operators, and other professionals. High female industries included eating and drinking places, laundry/dry cleaning, nursing and personal care facilities, aerospace, beauty shops, and entertainment. Low female industries included wholesale trades and education. High male industries included water transportation, military, guard services, eating and drinking places, iron and steel mills, and railroads. Low male industries included research/engineering labs, education, and computer manufacturing. This study was descriptive. It remains unknown whether certain jobs cause excessive drinking and cirrhosis, or whether people who are prone to develop cirrhosis select certain jobs.

Adolescent↗

Maternal occupational risk factors for oral clefts. Occupational Exposure and Congenital Malformation Working Group.

OBJECTIVES: This study investigated the role of maternal exposures at work during pregnancy in the occurrence of oral clefts. METHODS: The occupational exposures of 851 women (100 mothers of babies with oral clefts and 751 mothers of healthy referents) who worked during the first trimester of pregnancy were studied. All the women were part of a multicenter European case-referent study conducted using 6 congenital malformation registers between 1989 and 1992. In each center, the mother's occupational history, obtained from an interview, was reviewed by industrial hygienists who were blinded to the subject's status and who assessed the presence of chemicals and the probability of exposure. Odds ratios (OR) were estimated by a multivariate analysis including maternal occupation or occupational exposures during the first trimester of pregnancy and possible confounding factors such as center of recruitment, maternal age, urbanization, socioeconomic status, and country of origin. RESULTS: After adjustment for confounding factors, cleft palate only was significantly associated with maternal occupation in services such as hairdressing [OR 5.1, 95% confidence interval (95% CI) 1.0-26.0] and housekeeping (OR 2.8, 95% CI 1.1-7.2). The analysis suggests that the following occupational exposures are associated with orofacial clefts: aliphatic aldehydes (OR 2.1, 95% CI 0.8-5.9) and glycol ethers (OR 1.7, 95% CI 0.9-3.3) for cleft lip with or without cleft palate and lead compounds (OR 4.0, 95% CI 1.3-12.2), biocides (OR 2.5, 95% CI 1.0-6.0), antineoplastic drugs (OR 5.0, 95% CI 0.8-34.0), trichloroethylene (OR 6.7, 95% CI 0.9-49.7), and aliphatic acids (OR 6.0, 95% CI 1.5-22.8) for cleft palate only. CONCLUSIONS: Due to the limited number of subjects, these results must be interpreted with caution. However, they point out some chemicals already known or suspected as reproductive toxins.

Adult↗

[Current topics for occupational and environmental medicine and physiology in the U.S.A.--with special reference to occupational lung diseases].

Current topics for occupational and environmental medicine and physiology in the U.S.A., especially in the National Institute for Occupational Safety and Health (NIOSH), and the University of California, San Francisco, are reviewed. Reduction of the rate for occupational lung diseases is one of the national objectives for occupational safety and health in the U.S.A., and NIOSH has rated it as the top disease of ten-leading work-related diseases and injuries. Current topics for occupational lung diseases--asbestosis, byssinosis, silicosis, coal worker's pneumoconiosis, lung cancer, and occupational asthma & hyperreactivity, and for pathophysiology of airway hyperreactiveness and pulmonary edema are discussed.

Humans↗

[Occupational hazards in the Moroccan craft sector and proposal for occupational health services].

The absence of occupational health services, the numerous occupational hazards and the high number of people working in the handicraft sector have sparked this study. Descriptive, cross-sectional epidemiological studies were carried out throughout 1996 for different artisan activities: iron-work, jewellery making, rug making, tannery, "zellige", pottery, and woodworking. The study included 449 artisans and consisted of an analysis of work conditions, a medico-social questionnaire, a clinical examination and among certain artisans, a biological check-up, a respiratory check-up (thoracic x-ray and lung function testing), and a toxicological check-up. Poor work conditions and the absence of any technical protection (collective or individual) are common to all the workshops visited. Multiple risks as well as various and frequent pathologies were observed for all the artisan activities. The most common ailments are those linked to posture and musculo-skeletal problems (67.6%), oral (58.2%), ocular (46.9%), dermatological (35.7%), ear/nose/throat (35.3%), respiratory (31.1%), digestive (21.1%) and neurological (20.7%). Often the same artisan showed several simultaneous conditions linked to work. The legislative texts related to occupational health and safety are many and dispersed, and would profit by being updated and regrouped within a work code which would make them easier to consult and would allow all partners in the social sector to get to know them. In addition, this legislation which has been strengthened, is unfortunately not enforced. We should support every initiative focused on developing the prevention of occupational hazards and the spirit of safety within artisan workshops. The concern for occupational risks within the artisan milieu owes its importance to their abundance, the diversity of the professions involved, and the number of different risks to which artisans are exposed. The role of a worksite doctor is therefore considerable, and his field of intervention in this milieu is vast. The broader goal of occupational health services is to protect and improve the physical, mental, and social well-being of its workers; it is natural that these services should give more attention to general health promotion (vaccinations, health education...). Given that the artisan sector is organised around its structures of production, it seems urgent to introduce medical coverage and to improve health and safety conditions within the sector.

Humans↗