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[Clinico-occupational history in neurology and scope of occupational neurology].

INTRODUCTION: The occupational environment generates a large amount of illness which involves several specialities, including neurology. However, there is little awareness--or little training--in this field as in most medical specialities, since in the basic tool of a doctor's work, the clinical history, importance is sometimes given to aspects such as sex, race etc. and data referring to the patient's occupation and the risks this may imply for his health are considered to matter less. DEVELOPMENT: The creation of a new working party within the Sociedad Española de Neurología, that of Neurología del Trabajo (Occupational Neurology) aims to correct these deficiencies, and to make colleagues aware of the importance of assessing the occupational hazards of patients and attempt to relate them to the clinical picture which presents. In order to do this we must first mark out our field of action, the commonest diseases and the administrative route used for claiming for these conditions. Then we will have to evaluate our relationship with other professional colleagues in the field of occupational health and finally consider the tasks of training, investigation and promotion of occupational health.

Humans↗

Demonstrating the cost effectiveness of an expert occupational and environmental health nurse: application of AAOHN's success tools. American Association of Occupational Health Nurses.

According to DiBenedetto, "Occupational health nurses enhance and maximize the health, safety, and productivity of the domestic and global work force" (1999b). This project clearly defined the multiple roles and activities provided by an occupational and environmental health nurse and assistant, supported by a part time contract occupational health nurse. A well defined estimate of the personnel costs for each of these roles is helpful both in demonstrating current value and in future strategic planning for this department. The model highlighted both successes and a business cost savings opportunity for integrated disability management. The AAOHN's Success Tools (1998) were invaluable in launching the development of this cost effectiveness model. The three methods were selected from several tools of varying complexities offered. Collecting available data to develop these metrics required internal consultation with finance, human resources, and risk management, as well as communication with external health, safety, and environmental providers in the community. Benchmarks, surveys, and performance indicators can be found readily in the literature and online. The primary motivation for occupational and environmental health nurses to develop cost effectiveness analyses is to demonstrate the value and worth of their programs and services. However, it can be equally important to identify which services are not cost effective so knowledge and skills may be used in ways that continue to provide value to employers (AAOHN, 1996). As evidence based health care challenges the occupational health community to demonstrate business rationale and financial return on investment, occupational and environmental health nurses must meet that challenge if they are to define their preferred future (DiBenedetto, 2000).

Cost-Benefit Analysis↗

Occupational medicine residency training programs. The role occupational health nurses play.

An experienced occupational health nurse with suitable academic qualifications is able to assist in providing a well-rounded education and teaching physicians to be effective members of occupational health teams. Nurses are involved in teaching occupational health to physicians in the academic and practicum phases of occupational medicine residency training programs. However, the involvement of nurses in training physicians is inconsistent among the accredited residencies. Most of the nurses involved in teaching occupational health to physicians are at least master's degree prepared. Nurses are involved in the didactic, clinical, and administrative components of the training programs. Though nurses are involved in residency training programs to an extent, the lack of consistent involvement limits the diversity of points of view and fosters an imbalance in the training of occupational medicine residents.

Curriculum↗

Setting priorities for occupational cancer research and control: synthesis of the results of occupational disease surveillance studies.

The objectives of this paper were 1) to identify occupations with potentially high cancer risk by combining the results of 12 major occupational disease surveillance studies, 2) to develop a quantitative methodology for accomplishing the first objective, and 3) to make recommendations concerning priorities for occupational cancer research and control on the basis of the results of this analysis in conjunction with other available epidemiologic, industrial hygiene, toxicologic, and employment data. It was suggested that the first priority be the investigation and control of occupational exposure to asbestos, particularly in the automobile repair and construction industries. Of the 34 occupational groups found to be at high risk for lung cancer in this analysis, 18 have potential asbestos exposure. The second priority was suggested to be research into the consistent lung-cancer excess found among motor vehicle drivers. This excess may be due to occupational exposure to diesel and gasoline engine exhaust, to cigarette smoking, or to both of these factors.

Adolescent↗

Occupations, cigarette smoking, and lung cancer in the epidemiological follow-up to the NHANES I and the California Occupational Mortality Study.

What jobs are associated with the highest and lowest levels of cigarette use and of lung cancer? Are there gender differences in these jobs? Two data sets-the Epidemiological Follow-up to the National Health and Nutrition Examination Survey (NHEFS) and the California Occupational Mortality Study (COMS) were analyzed to answer these questions. For females, the broad occupations ranking from highest to lowest cigarette use in the NHEFS was: transportation operators, managers, craft workers, service workers, operatives, laborers, technicians, administrative workers, farm owners and workers, sales workers, no occupation, and professionals. The corresponding ranking for males was: transportation operators, no occupation, laborers, craft workers, service workers, technicians, and professionals. The highest-ranking jobs in the COMS were waitresses, telephone operators, and cosmetologists for women, and water-transportation workers, roofers, foresters and loggers for men. Teachers were especially low on all four lists. This study could not determine whether employment within any occupation encouraged smoking or if smokers selected certain occupations.

Administrative Personnel↗

Occupational class, occupational mobility and cancer incidence among middle-aged men and women: a prospective study of the French GAZEL cohort*.

OBJECTIVE: To examine the association between occupational class, occupational mobility and cancer incidence in the 1990s. METHODS: Prospective study of 14,853 men and 5493 women employed by a large French company. Incident cases (any cancer, smoking and alcohol-related, breast) were ascertained through a validated company-based cancer registry (1990-2002). Hazard ratios (HRs) by occupational class and by career-long occupational mobility were calculated adjusting for age, marital status, tobacco and alcohol consumption, weight, diet, asbestos exposure, family history of cancer, and reproductive history. RESULTS: 359 male cancers (107 smoking and alcohol-related) and 208 female cases (120 breast cancers) were observed. Male clerks and manual workers were at high risk, particularly of smoking and alcohol-related cancers (compared to managers, age-adjusted HRs: 2.95 95% CI 1.37-6.38 and 2.18 95% CI 1.15-4.11). Adjusting for specific health behaviors and other cancer risk factors reduced this gradient (fully-adjusted HRs respectively 1.95 95% CI 0.89-4.27 and 1.54 95% CI 0.80-2.97). The risk was also associated with occupational mobility. We found no association between women's occupational class and cancer. CONCLUSION: The incidence of smoking and alcohol-related cancers among French men shows a strong socioeconomic gradient. Policies addressing these social disparities are needed.

Adult↗

The occupations of drink drivers: using occupational information to identify targetable characteristics of offenders.

Data collected by the Victoria Police at the time an alleged drink-driving offender undergoes an evidential breath test for the presence of alcohol were analyzed to investigate the possibility that occupational information could be used to define groups of drink-drivers with similar characteristics. Such groups could then be utilized in the development of targeted public education campaigns in the Victorian (Australia) context where there are already high levels of enforcement and mass-media publicity. It is argued that drink-drivers in this context are likely to share some characteristics which might reduce the impact of current programs. Analysis of the data relied on the application of a theory of the relationship between career choice and other behavioral characteristics (Holland, 1973, Making Vocational Choices, Prentice Hall, Englewood Cliffs, N.J.; Holland, 1975, Manual for the Vocational Preference Inventory, Consulting Psychologists Press, Palo Alto, CA). The analysis identified two potential groups which accounted for 58% of the male drink-drivers. These groups differed from other male drink drivers in a number of ways, underlining the potential for their use as targets in future campaigns. One occupational category accounted for 42% of the male drink drivers, including occupations such as carpenter, electrician, chef, mechanic, gardener, and laborer. The behavioral characteristics associated with these occupational codes in the Holland model included asocial, conforming, reserved, introspective, unpopular, orderly, careful, unimaginative, and defensive. The other occupational category accounted for 16% of the male drink drivers and included occupations such as business manager, company director, public servant, and sales representative. Behavioral characteristics associated with this combination included acquisitive, adventurous, ambitious, energetic, extroverted, friendly, and generous.

Adolescent↗

Post-exposure prophylaxis after occupational and non-occupational exposures to HIV: an overview of the policies implemented in 27 European countries.

The aim of this survey, which was part of an English-French project supported by the Commission of the European Communities, was to compare access to HIV post-exposure prophylaxis (PEP) in the occupational and non-occupational contexts in 27 European countries. A protocol was designed in May 1998 in collaboration with all country consultants. Data were collected at country level by each consultant through interviews, review of local and national recommendations and results of national or local surveys. The final comparative analysis was carried out from the individual country reports and a review of the literature. The large majority of European countries have detailed procedures regarding occupational PEP: 20/27 have produced national guidelines, three have adopted the US CDC recommendations and only four have no official recommendations. Although no standard protocol exists, the more common one is a four-week implementation of a triple combination therapy. In the context of non-occupational exposure to HIV, only five countries have guidelines with specific recommendations and one country has adopted the CDC recommendations. In the majority of cases (13 countries), PEP is never recommended but is only available in a few circumstances, sometimes with major limitations. In the last eight countries, such PEP is not currently available. Although the estimations of HIV transmission risks in occupational and non-occupational contexts are really comparables, easy access to PEP after accidental sexual or blood exposures is not guaranteed for the general population in the majority of European countries.

Anti-HIV Agents↗

Recording of data of individual measurements of occupational exposure: guideline of the Dutch Society of Occupational Hygiene (October 1999).

Following the recommendations of the European Working Group on Exposure Databases, a Working Group (on Storage of Data of Measurements of Occupational Exposure) of the Dutch Occupational Hygiene Society has developed a Guideline which was presented at the International Symposium on Occupational Exposure Databases and Their Application for the Next Millennium, November 1-3, 1999, London. To establish the present situation, a small-scale telephone survey of monitoring practices and storage of data was done within the Society. The results of the telephone survey and the draft guidance document were discussed with the occupational hygienists and other stakeholders (e.g., authorities, industry, labor unions, and occupational physicians) in a society meeting. This meeting was used to gather ideas on the need and support for a guidance document and to get input for improving the draft guidance document and for implementation of the Guideline. After this meeting, the Guideline was further developed and published by the Dutch Occupational Hygiene Society. The Guideline concentrates on the data elements required when storing exposure data. The data elements presented are the minimum and should be stored minimally to ensure proper interpretation of results at present and in the future and definitions of the items used are given. The Guideline does not prescribe how the data should be stored, or which procedures need to be used to guarantee the quality of the recorded data elements.

Data Collection↗

Health status and occupation: use of a health status index to measure the health of occupations.

A total of 4466 employed persons completed the short Auckland University Health Status Index (AUHSI) questionnaire and a health score was assigned to each individual on the basis of their responses. This health score was found to have statistically significant associations with a number of health-related measures, including socio-economic status (P < 0.001), and with occupational group: administrative, clerical/sales/service, skilled trades and unskilled labour (P < 0.001). Within the occupational groups, 3361 employees could be assigned to 42 specific occupations having 19 or more members each. After controlling for age and gender, significant differences in mean health score for specific occupation were found in the clerical/sales/service (P < 0.05), skilled trades (P = 0.002) and unskilled manual (P < 0.05) groups. It is postulated that these differences may be due to the nature of the specific occupation. Some possible reasons are listed. It is concluded that a global measure of health status such as this may be useful in the planning and evaluation of occupational health services.

Female↗

Costs of occupational asthma and of occupational chronic obstructive pulmonary disease.

PURPOSE OF REVIEW: The purpose of this review is to summarize the most recent findings on the costs of occupational asthma and chronic obstructive pulmonary disease, illustrating the different approaches for estimates, the results and the social and financial implications. RECENT FINDINGS: Many published data in the literature show that occupational asthma and chronic obstructive pulmonary disease represent a relevant proportion of the total prevalence of these diseases. Previous findings demonstrated that occupational asthma has adverse economic and employment consequences for the worker, and a significant cost related to the claims. Recent studies using a standard method have specifically estimated the cost of the proportion of cases of asthma and chronic obstructive pulmonary disease attributable to occupational exposure out of the total costs of these diseases, and demonstrated that it is significant. Some recent data indicate a beneficial outcome of occupational asthma and a reduction in the number of the claims from primary and secondary preventive intervention at the workplace. SUMMARY: In conclusion, occupational asthma and chronic obstructive pulmonary disease are likely to pay a substantial contribution to the total costs of the two disorders. These costs are expected to rise with the increasing prevalence of the diseases. Intervention strategies for effective control and prevention at the workplace should lessen the burden of long-term illness and impact on public health costs.

Asthma↗

Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group.

A voluntary scheme for the surveillance of work related and occupational respiratory disease (SWORD) was established in January 1989 with help from the British Thoracic Society and the Society of Occupational Medicine and support from the Health and Safety Executive. Three hundred and fifty four chest physicians representing 90% of the chest clinics in the United Kingdom and 361 occupational physicians submit reports regularly of newly diagnosed cases of work related respiratory illness with information on age, sex, residence, occupation, and suspected causal agent. In 1989 2101 cases were notified, of which frequent diagnoses were asthma (26%), mesothelioma (16%), pneumoconiosis (15%), benign pleural disease (11%), and allergic alveolitis (6%). Incidence rates calculated against denominators from the Labour Force Survey showed very large differences between occupational groups, especially for asthma and asbestos related diseases. Substantial regional variation in the incidence of asthma was not explained by the geographical distribution of high risk industries and was probably due to differing levels of ascertainment. The results imply that the true frequency of acute occupational respiratory disease in the United Kingdom may have been three times greater than that reported.

Acute Disease↗

Occupational performance measures: a review based on the guidelines for the client-centred practice of occupational therapy.

In 1987, Health and Welfare Canada and the Canadian Association of Occupational Therapists Task Force recommended that work go forward to develop an outcome measure for occupational therapy which reflects the Occupational Performance Model. The first step in this process was to review critically those outcome measures which assess occupational performance and that are currently available in the literature. This paper will present the review process, describe in more detail eight assessments that fulfilled many of the review criteria, discuss the limitations of these measures using the "Guidelines for the Client-centred Practice of Occupational Therapy as the framework, and make recommendations for the development of a new outcome measure for use in occupational therapy.

Activities of Daily Living↗

Sex-typing and prestige ratings of occupations as indices of occupational stereotypes.

In the present study, an ethnically diverse convenience sample (N=295; 56% female) of working adults (47%) and college students (age M=23.7, SD=6.7) rated a list of 25 occupations on a 9-point sex-typing scale, with anchors of 1: mostly associated with men and 9: mostly associated with women. They also rated the status or prestige of these occupations on an 11-point Prestige scale, with anchors of 1: low prestige/status and 11: high prestige/status. Findings were consistent with results reported by Panek, Rush, and Greenawalt in 1977 and O'Connor in 1982. Little has changed: respondents still hold sex-based opinions about occupations. Moreover, occupational titles perceived as mostly associated with men were rated higher in prestige than occupational titles perceived as mostly associated with women. This pattern was found for both high and low prestige jobs. Men and women did not differ in their evaluations of these occupations.

Adolescent↗

Roles and functions of occupational therapy in early childhood intervention (position paper). American Occupational Therapy Association.

Occupational therapy is based on the belief that purposeful activity, or occupation, may be used to generate adaptive skills of children with developmental dysfunction. Developmental activities such as feeding, movement, play, and interaction with others are the primary occupation of infants and young children. By using intrinsic motivation and purposeful activities, occupational therapy personnel encourage the child to acquire an increasing repertoire of developmental skills and coping behavior patterns. Intervention promotes sensorimotor, psychosocial, and cognitive functions and may prevent disability or decrease dysfunction in order for the child to meet personal needs and adapt to the demands of the environment. Occupational therapy facilitates the occupational performance of parents in coping effectively with the challenges of care giving and family life.

Certification↗

[A survey of public health nurses regarding their awareness of the abilities, skill and knowledge necessary to fulfill an occupational health nurse's role, and proposal of a new curriculum for occupational nurse specialists at the master level].

The areas of conduct and professional roles in occupational health nursing in Japan has not been defined as yet, even though occupational health nurses have contributed to implementing jobs related to the health examination in workplaces every year. We surveyed public health nurses regarding their awareness of the abilities, skills and knowledge necessary to fulfill an occupational health nurses' role. When answering, they became aware of deficiencies in their abilities, skills and knowledge. This was particularly true in counseling, health assessment skills and management abilities, specialized knowledge of occupational safety and health, ergonomics and environmental health. We propose a curriculum at the master level for occupational health nurse specialists with reference to the core curriculum for occupational and environmental health nursing in the USA.

Curriculum↗

[Reasons for difficulties encountered in diagnosing and certifying occupational disease reported by some regional centers of occupational medicine].

Observations about kinds of and reasons for difficulties encountered in diagnosing and certifying occupational diseases, made during the analysis of over 3,000 medical history files, were verified with the opinions of the personnel employed in the 14 selected regional centres of occupational medicine. The evaluation of the body of workers, the diagnostic basis, kinds of diagnostic and certification difficulties and their causes, the data on diagnosed occupational diseases, and appeals against certifications which negate the grounds for diagnosing occupational diseases were surveyed and the results presented. The results obtained indicate convergent causes of incorrect decisions taken by those involved in the Institute, and by directors of regional centres of occupational medicine. This provides the basis for developing measures aimed at eliminating the mistakes made in the process of diagnosing and certifying occupational diseases.

Certification↗

Guidelines for the diagnosis of occupational asthma. Subcommittee on 'Occupational Allergy' of the European Academy of Allergology and Clinical Immunology.

The 'Guidelines for the diagnosis of Occupational Asthma' have been written by the Subcommittee on Occupational Allergy of the European Academy of Allergology and Clinical Immunology to give common diagnostic criteria in the evaluation of individual patients with suspected occupational asthma. The suggested diagnostic procedure includes five steps. 1. History suggestive of occupational asthma. 2. Confirmation of bronchial asthma, with demonstration of reversibility of bronchial obstruction, of non-specific bronchial hyperreactivity and of increased diurnal variability of peak expiratory flow rates (PEFR). 3. Confirmation of work-related bronchoconstriction with serial measurements of PEFR and of non-specific bronchial reactivity. 4. Confirmation of sensitization to occupational agents with skin tests and/or in vitro tests to detect specific immunoglobulins. 5. Confirmation of causal role of occupational agent with specific bronchial challenges. Requirements, advantages and limitations are discussed for each of the suggested techniques.

Allergens↗