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The Atlas of Health and Working Conditions by Occupation. 1. Occupational ranking lists and occupational profiles from periodical occupational health survey data.

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

Adult↗

[Cooperation between regional occupational health centers and the clinic of occupational diseases in the Nofer Institute of Occupational Medicine in the area of diagnosis and certification of occupational pathology].

Diagnosis and certification of occupational diseases is a statutory responsibility of all regional occupational health centres. An increasing number of certificates issued by these centres has been questioned over last recent years by employees concerned. The Nofer Institute of Occupational Medicine co-operates with these centres, particularly if some doubts are reported. Some shortcomings in diagnosis and certification become the subject of thorough analysis and steps are taken to identify the causes of miscertification.

Diagnostic Services↗

Putting occupation into practice: occupation as ends, occupation as means.

This article addresses a difficulty that many occupational therapists experience: maintaining occupation as the core of their therapeutic intervention. This difficulty not only results from but also contributes to occupational therapy's struggle with professional identity. Current manifestations of the problem are described as component-driven practice and the narrowing of occupation to basic activities of daily living. The concepts of occupation as ends and occupation as means are proposed as a practical solution to guide treatment planning and merge remediation and adaptation within a single occupational session. Each concept is investigated in terms of its history within the profession and its usefulness for analyzing and solving therapeutic problems. These concepts are discussed as useful guidelines to help occupational therapists not only in their clinical decision making but also in their understanding and expression of the field's unique expertise. A case example, applying occupation as ends and occupation as means to evaluation and treatment, is presented.

Activities of Daily Living↗

Summary measures of occupational history: a comparison of latest occupation and industry with usual occupation and industry.

The utility of using latest occupational information as a summary of work history is assessed by comparing it to usual occupation and industry. We analyzed 5,734 complete occupational histories obtained by telephone interview as part of an ongoing occupational cancer surveillance study. Of these, 73.6 per cent reported the same usual occupation as latest occupation and 76.6 per cent the same usual industry as latest industry. Differences in match rates by race and sex, occupation and industry titles and categories suggest that bias may result in studies using latest occupation or industry as a summary measure of occupational exposures.

Adult↗

[Health Protection in the Workplace: Special Commission of the Swiss Society for Occupational Medicine, Occupational Hygiene and Occupational Safety].

Fridolin Schuler (1832-1903), physician in Glarus, laid the foundations of the Swiss legislation for the protection of the working population. The law for illness and accident insurance followed in 1911, it was complemented with regulations concerning the protection from occupational diseases. Of great practical importance were coordinated efforts of physicians, technologists, hygienists and safety engineers, who founded in 1956 the "Studiengruppe für Gesundheitsschutz in Industrie und Gewerbe". In 1973 they joined with the "Groupement romand" in the "Swiss Society for occupational medicine, occupational hygiene and occupational safety" (AAA). In 1964 the Association of Swiss occupational physicians has been founded. In order to strengthen the promotion of occupational health in Switzerland a special commission on occupational medicine was constituted in 1980 within the AAA. Several subcommissions are presently working on a steadily increasing number of problems in the field of occupational health.

History, 19th Century↗

Occupation embedded in a real life: interweaving occupational science and occupational therapy. 1993 Eleanor Clarke Slagle Lecture.

This lecture presents an example of research in the genre of interpretive occupational science and demonstrates how occupational science can inform clinical practice. The innovative qualitative methodology used blended elements of the anthropological tradition of life history ethnography, ethnomethodology, the naturalistic methods used by Mattingly and Schön to study practice, and especially narrative analysis as described by Polkinghorne. The bulk of the paper is presented in the form of a narrative analysis that provides an account of a stroke survivor's personal struggle for recovery, a story that emerged from transcription, coding, and analysis of transcripts from approximately 20 hours of interview time. First, this narrative analysis provides an example of how the occupational science framework can evoke a particular kind of storytelling in which childhood occupation can be related to adult character. Storytelling of this kind is later shown to be therapeutic for the stroke survivor. Next, the narrative illustrates how rehabilitation can be experienced by the survivor as a rite of passage in which a person is moved to disability status and then abandoned. Finally, a picture is given of how occupational story making and occupational storytelling embedded in real life can nurture the human spirit to act and can become the core of clinical practice.

Persons with Disabilities↗

[Report of courses on "Occupational dermatology" and "Occupational skin and respiratory allergies" organized by the Nordic Institute for Advanced Training in Occupational Health (NIVA)].

The Nordic Institute of Advanced Training in Occupational Health (NIVA), has been organising courses for around 10 years, aimed to the constant up-date of Occupational Medicine. The courses "Occupational dermatology" and "Occupational skin and respiratory allergies", held in 2001 and 2002, analysed some occupational medicine aspects such as allergic contact dermatitis in metal workers, latex disease, allergies in odontoiatric workers, correct patch test performing. The courses has underlined the importance of the cooperation between occupational physician and dermatologist or other specialists, and the project of a standard questionnaire monitoring the exposure to allergic substances. This article is a summary of an extended publication available on the following URLs: http://www.unibs.it/medlav http://www.gimle.fsm.it.

Allergy and Immunology↗

[The department of occupational medicine of the State School of Occupational Medicine at the National Institute of Occupational Medicine in Warsaw in 1926-1939].

The Department of Occupational Hygiene, State School of Hygiene at the National Institute of Hygiene was established in 1926/27. Prof. Brunon Nowakowski was its founder and the first Director. Teaching and providing of highly qualified personnel for occupational medicine institutions was the main area of the Department's activity. The Department also carried out scientific research focusing on organisation of labour hygiene in Poland, and occupational diseases, lead poisoning in particular. The results of studies carried out by the Department provided the basis for the elaboration of numerous legal regulations in the area of occupational medicine.

History, 20th Century↗

[Analysis of occupational allergies reported to the Occupational Medicine and Hygiene Service of the Pavia ASL and to the Hospital Operative Unit of Occupational Medicine in 1993-98].

In this article the cases of occupational allergic diseases notified to 2 Occupational Health Units in Pavia in the period 1993-1998 are reported. A retrospective study was performed to obtain a descriptive analysis of the diseases. In the studied period 58 cases of occupational allergic diseases were notified. This datum probably underestimates the real occurrence of occupational diseases, because of the low accuracy of the notification system. Allergic skin diseases were more frequent (70.7%) than respiratory diseases.

Adult↗

National Institute for Occupational Safety and Health; occupational exposure to inorganic lead: request for comments and information; republication--NIOSH. Request for comments and information relevant to occupational exposure to inorganic lead.

NIOSH is reviewing its recommendations contained in the document Criteria for a Recommended Standard.... Occupational Exposure to Inorganic Lead, Revised Criteria--1978 [NIOSH 1978]. The evaluation of recent literature indicates that the NIOSH recommended exposure limit [REL] of 100 micrograms/m3 as an 8-hour time-weighted average [TWA] in that document does not sufficiently protect workers from the adverse effects of exposure to inorganic lead. NIOSH is requesting comments and information relevant to the evaluation of the potential health risks associated with occupational exposure to inorganic lead, as well as case reports or other data that demonstrate adverse health effects in workers exposed to inorganic lead at or below the OSHA permissible exposure limit [PEL] of 50 micrograms/m3 as an 8-hour TWA and any information pertinent to evaluating the technical feasibility of establishing a more protective REL for inorganic lead. NIOSH is also soliciting information on worker blood lead levels [BLLs] including data on methodologies used in measuring BLLs in the workplace and information that can be used for comparing airborne inorganic lead concentrations to observed BLLs. NIOSH intends to analyze the feasibility of developing preventive measures including an REL that would provide better protection for workers. In the interim, NIOSH plans to adopt the more protective current OSHA PEL as its REL.

Humans↗

[Social-occupational risk factors for fetal growth retardation and preterm birth. I. Role of occupational and non-occupational work].

Clinical and control examinations were performed in order to assess the effect of certain demographic, social and occupational factors on a relative risk for fetus hypotrophia and preterm birth. Two groups of cases were distinguished: mothers of hypotrophic children (72 women) and mothers of eutrophic premature babies (41 women). The control group was composed of women who had given birth to eutrophic babies (438 persons). An analysis of individual variables indicated the following risk factors for preterm birth: mother's age over 35 years, unmarried status of mothers, a low level of education; while unmarried status increased the risk for fetus hypotrophia. Only a half of women under study worked when pregnant, and no relationship between working during pregnancy and increased risk for the pathologies discussed, were found. An aggravated risk for preterm birth in women overloaded with housekeeping duties was noted. This observation applied, in particular, to women who had not been working occupationally during pregnancy. Bearing in mind a multifactorial etiology of fetus hypotrophia and preterm birth, in the authors' opinion it would be useful to analyse an unrelated effect of individual risk factors with concomitant control of confounding factors.

Confounding Factors, Epidemiologic↗

[Occupational health care as a basis of occupational medicine monitoring in small companies. Common occupational medicine/ergonomic approach to prevention].

Set out from various specific angles, the concept concerning a modern common industrial medicine/safety/ergonomics approach can be fitted into the present legal framework. Adapted according to specific needs, this approach can equally be applied in all areas--health promotion, prevention, cure, rehabilitation. Those involved in the current debate about industrial health policies start out from the premise that industrial medicine could contribute strongly in this respect. While the workmen's compensation scheme, together with the industrial medical profession, is to a considerable extent involved in the subject as a whole on the basis of the industrial safety Act, its competencies are however limited, being in actual fact confined to the field of health maintenance in the occupational context. The examinations they effect in this framework cannot be based on a holistic medical orientation, because our constitution has expressly excluded the private sphere of the individual (self-management domain). Hence, there are very little chances of success for any attempt of changing current health care practice solely via the workmen's compensation administrations. It currently is, rather, the health and pension insurance schemes who hold the potential for influence. The common approach of industrial medicine, safety and ergonomics outlined may be of considerable use also in view of their goals, and holds sufficient justification for their intervening favourably in the ongoing debate about quality and quantity of industrial medical service provision with the ministries in charge.

Ergonomics↗

Statement--fundamental concepts of occupational therapy: occupation, purposeful activity, and function.

Deriving from the philosophical basis of the profession, occupation is the core concept of the profession of occupational therapy. However, in the occupational therapy literature, the term occupation is used in a variety of ways. Occupation, a collection of activities that people use to fill their time and give life meaning, is organized around roles or in terms of activities of daily living, work and productive activities, or pleasure, for survival, for necessity, and for their personal meaning. It is the individualized, unique combination of activities that comprises an individual's occupations. Purposeful activities have been described in many different ways: as something all people engage in; as tools or media that therapists use to enhance or facilitate performance; and vehicles for bringing about change. Purposeful activities are seen as part of the process of occupational therapy. Purposeful activities are subset of occupations in that they are goal directed and serve as a major tool in the process of occupational therapy. The term function, viewed as the ability to perform activities required in one's occupations has become increasingly important to society in describing the performance or change in individuals. This societal shift in ideas has prompted the concept of function, viewed as a product, to become more important than the process of bringing about change. Occupational therapy practitioners typically have viewed the process as being just as important as the product. When working to improve function, occupational therapy practitioners use purposeful activities that are meaningful to the person in relation to his or her occupational history, preferences, personal goals, and needs. Occupational therapy practitioners need to keep the individual's occupations in the forefront of their thoughts when using any purposeful activity and to plan interventions toward improving the individual's ability to function within his or her occupations. In the interest of the profession, it is important to concentrate on occupation. Furthermore, it is essential that we study our interventions' relationship to occupation and function, and how purposeful activities are used toward supporting the individual's ability to engage in occupation.

Activities of Daily Living↗

Risk of injury for occupants of motor vehicle collisions from unbelted occupants.

OBJECTIVE: Unbelted occupants may increase the risk of injury for other occupants in a motor vehicle collision (MVC). This study evaluated the association between occupant restraint use and the risk of injury (including death) to other vehicle occupants. DESIGN: A population based cohort study. SETTING: United States. SUBJECTS: MVC occupants (n = 152 191 unweighted, n = 18 426 684 weighted) seated between a belted or unbelted occupant and the line of the principal direction of force in frontal, lateral, and rear MVCs were sampled from the 1991-2002 National Automotive Sampling System General Estimates System. Offset MVCs were not included in the study. MAIN OUTCOME MEASURE: Risk ratios and 95% confidence intervals for injury (including death) for occupants seated contiguous to unbelted occupants compared to occupants seated contiguous to belted occupants. Risk ratios were adjusted for at risk occupant's sex, age, seating position, vehicle type, collision type, travel speed, crash severity, and at risk occupants' own seat belt use. RESULTS: Exposure to unbelted occupants was associated with a 40% increased risk of any injury. Belted at risk occupants were at a 90% increased risk of injury but unbelted occupants were not at increased risk. Risks were similar for non-incapacitating and capacitating injuries. There was a 4.8-fold increased risk of death for exposed belted occupants but no increased risk of death for unbelted occupants. CONCLUSIONS: Belted occupants are at an increased risk of injury and death in the event of a MVC from unbelted occupants.

Accidents, Traffic↗

Car occupant death according to the restraint use of other occupants: a matched cohort study.

CONTEXT: A car occupant could be killed if struck by another occupant who was catapulted forward, backward, or sideways in a crash. OBJECTIVE: To estimate the association between death of a car occupant (the target) and restraint use by other occupants. DESIGN: Matched-pair cohort study comparing the outcomes of 2 target occupants in the same passenger car that crashed. SETTING: United States traffic crashes in 1988-2000, using data from the Fatality Analysis Reporting System. SUBJECTS: Target pairs, at least 1 of whom died: 61 834 front-seat pairs, 5278 rear-seat pairs, and 21 127 pairs on the left or right side. MAIN OUTCOME MEASURES: Adjusted risk ratio (RR) for death within 30 days of a crash. RESULTS: The risk of death was greater for a restrained front target occupant in front of an unrestrained occupant compared with a restrained front target in front of a restrained occupant (adjusted RR, 1.20; 95% confidence interval [CI], 1.10-1.31). For a restrained rear target occupant behind an unrestrained occupant compared with a restrained rear target occupant behind a restrained occupant, the adjusted RR was 1.22 (95% CI, 1.10-1.36). For a restrained side target occupant sitting next to an unrestrained occupant compared with a restrained side target occupant sitting next to a restrained occupant, the adjusted RR was 1.15 (95% CI, 1.08-1.22). Among unrestrained target occupants, the adjusted RRs were, for front targets, 1.04 (95% CI, 0.97-1.12), rear targets, 1.22 (95% CI, 1.10-1.36), and side targets, 0.85 (95% CI, 0.80-0.92). CONCLUSION: Persons who wish to reduce their risk of death in a crash should wear their own restraint and should ask others in the same car to use their restraints.

Accidents, Traffic↗