Personal Protective Equipment in COVID-19: Impacts on Health Performance, Work-Related Injuries, and Measures for Prevention.

OBJECTIVE: To assess impact of personal protective equipment (PPE) on healthcare providers (HCPs) in caring for COVID-19 patients. METHODS: A cross-sectional survey was conducted over 50 hospitals in China. Descriptive analyses and Chi-square tests were performed on the collected data. RESULTS: All 104 frontline HCPs report negative impacts of PPE on their clinical performance, 97% of them experienced discomfort and injuries caused by wearing PPE for long hours. Frontline HCPs provided suggestions to alleviate the negative impacts and to enhance communication between healthcare staff and patients. Two hundred eighty two non-frontline HCPs also revealed similar problems; however, we recorded a few discrepancies between answers given by frontline and non-frontline HCPs. CONCLUSIONS: Wearing PPE for long hours degrades health performance. Measures were suggested to improve the design of PPE for protecting HCPs and enhancing their services to COVID patients.

[Elaboration and psychometric properties of a well-being scale at work. The Serenat study among employees in occupational medicine unit]. / Élaboration et qualités psychométriques d'une échelle de bien-être au travail. Étude SERENAT auprès de salariés vus en médecine du travail.

BACKGROUND: Well-being at work is nowadays a major public health challenge. It includes, among others, absence of psychological (anxio-depressive) symptoms, perceived positive work conditions (environment and organization), happiness and good quality of life at work. Many studies have shown that social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for anxiety and depression. There is currently no global indicator to measure both the state of mental health and social working conditions. The main objective of this work is to construct and explore the psychometric properties of scale of well-being at work called "Serenat" in order to validate it. METHODS: The Serenat Scale is a self-report questionnaire composed of 20 items. All items are scored on a four-point Likert scale ranging from 0 (strongly disagree) to 3 (strongly agree) resulting in a range of 0 to 60. It was constructed from data collected from the literature and from consultations in an Occupational Health Unit. From January 2014 to May 2017 193 subjects who have consulted an occupational doctor are included in this cross sectional survey. Validation included item quality and data structure diagnosis, internal consistency, intraobserver reliability evaluation and external consistency. RESULTS: The Serenat scale showed very good item quality, with a maximal non-response rate of 0.01 % per item, and no floor effect. Factor analysis concluded that the scale can be considered unidimensional. Cronbach's alpha of internal consistency was 0.89. The intraclass correlation coefficient for intraobserver reliability was 0.89. Serenat scale was correlated with HADS (r=-0.54; P<0.001), STAI-Y (r=-0.78; P<0.001) and BDI-13 (r=-0.57; P<0.001). CONCLUSION: Serenat's well-being at work scale shows good psychometric properties for final validation. It could be useful to occupational physicians for individual and collective screening. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02905071.

A call for Applied Knowledge and Lived Interdisciplinarity in the medical care of depressed employees: a cross-sectional survey with German occupational physicians and psychotherapists.

OBJECTIVES: To identify approaches for an effective patient-centred care of depressed employees, we investigated occupational physicians' (OPs) and psychotherapists' (PTs) knowledge about job stressors on the development of depression, application of this knowledge, interdisciplinary cooperation and perceived barriers. STUDY DESIGN: A cross-sectional online survey. PARTICIPANTS: OPs (163; 48.5% male) and PTs (69; 43.5% male) providing complete data on the survey out of 257 OPs and 112 PTs who started the survey. There have been 458 (OPs) and 821 (PTs) initial clicks. METHODS: Main outcome measures were the importance ratings of specific job stressors, the frequency of asking patients about those stressors, the need for interdisciplinary cooperation, as well as perceived barriers for cooperation. We performed multivariate analysis of variance, intraclass correlation coefficients (ICCs) and Spearman's rank-order correlations. RESULTS: The achieved response rate for OPs was 56.1% and for PTs 13.6%. Both disciplines agreed on the importance of job stressors regarding depression (ICC=0.90; 95% CI: 0.54 to 0.98), but both ranked these factors differently from the current state of research. As to knowledge application, OPs showed positive associations between the importance of job stressors and the frequency of asking employees about them (eg, job insecurity (rs=0.20, p=0.005)) and PTs for social stressors (eg, interpersonal conflicts (rs=0.38, p=0.001)). OPs (mean=3.41) reported a higher necessity of interdisciplinary cooperation than PTs (mean=3.17; F(1,230)=7.02, p=0.009). Furthermore, cooperation was reported as difficult to implement. PTs perceived barriers (eg, time restriction) as more hindering (mean=3.2) than OPs (mean=2.8; F(1,171)=8.16, p=0.005). CONCLUSIONS: Both disciplines are aware of the relevance of job stressors as risk factors for depression, but should be encouraged to ask employees more frequently about them. The need for interdisciplinary cooperation and possible barriers are discussed. It is crucial to emphasise the meaning of sufficient cooperation, since closing this gap for improving patient-centred care especially for employees suffering from depression is necessary.

Practices and Attitudes of Michigan-Based Occupational Physicians Regarding Adult Immunization.

OBJECTIVE: To assess practices and barriers regarding adult immunizations, among occupational and environmental physicians in Michigan. METHODS: A 10-item multiple choice web based questionnaire was designed after reviewing the Centers for Disease Control and Prevention recommendations and the current literature on adult immunization standards. RESULTS: Assessing immunization status is common practice for 62% of respondents. 92% of respondents recommend the annual influenza vaccination, unless contraindicated. The most commonly reported barriers included the cost of providing immunizations and the prioritization of acute over preventative care. Use of standing order vaccinations and reminder-recall systems were popular strategies used to improve vaccination rates. CONCLUSIONS: Occupational physicians frequently recommend influenza, tetanus, and hepatitis B vaccines when indicated, but are less likely to order other vaccines for patients. Promotion of a more comprehensive assessment of immunity needs in the workplace may improve national vaccine coverage.

Occupational safety and health in maritime sector in Morocco 60 years after independence: current state, constraints and prospects.

BACKGROUND: The aim of this study was to evaluate the situation 60 years after independence, to assess the current state, to highlight the constraints and to propose recommendations for improving occupational health in the maritime sector. MATERIALS AND METHODS: This study was based on collecting data of: 1) Legislative texts on occupational health and safety; 2) Statistics from administrations (Ministry of Health and Ministry of Marine Fisheries), general medical council of Morocco, scientific societies and associations of occupational health and maritime medicine; 3) Analysis of a self-questionnaire sent to 22 physicians working in fishermen's health services and listed in the yearbook 2017 of the Moroccan Society of Maritime Medicine. It included five sections: socio-demographic and professional characteristics, training, assessment of activities, constraints in their exercise and ten priority recommendations to improve the situation. RESULTS: Health and safety in maritime sector are progressing since the Labour Code of 2004 and the Convention of December 27, 1996 between the Ministry of Health and the Ministry of Marine Fisheries. It concerns the organisation of a fishermen's health prevention with the establishment of the fishermen's health office at central level and fishermen's health services at the main ports. However, medical coverage is still insufficient. Maritime medicine remains an unattractive specialty because the physicians are a poorly paid and have some difficult working conditions. CONCLUSIONS: The absence of up-to-date synthetic data on safety and health in maritime sectors led us to carry out this study, which showed some dysfunctions and deficiencies that hinder the promotion of workers' health in this sector. The recommendations proposed by the physicians should be the backbone of any improvement related to occupational health and safety. It is the practitioners themselves who, faced with their practice, are the best able to disseminate a reflection qualified as ethical, which cannot be dissociated from their everyday activities.

Practice patterns of occupational medicine physicians in Canada.

The objectives of this survey were to identify the practice patterns of Canadian physicians working in the field of occupational medicine and to determine whether the type of certification influences the nature of the work they perform in the field. An Internet-based survey was conducted in September 2015 of members of the Occupational and Environmental Medicine Association of Canada. Eighty-six Canadian-based occupational medicine physicians completed the survey (response rate 36%). These physicians performed a wide variety of tasks (12 ± 6), with few spending most of their time doing a single task. The most frequently performed tasks were fitness-to-work (78%) and return-to-work evaluations (78%). Specialty-trained physicians were more likely to be involved in teaching and research and less likely to be involved in a variety of ability-to-work evaluations.

Factors associated with adherence to recommendations to visit a physician after annual health checkups among Japanese employees: a cross-sectional observational study.

Periodic health checkups constitute an important public health strategy to prevent the onset of diseases and promote healthy behaviors. However, adherence to recommendations to undergo further medical examination after annual health checkups is not necessarily high. This study examined the factors related to adherence to recommendations among Japanese employees. We conducted a cross-sectional study of 219 employees who had ignored recommendations to visit a physician for the previous 3 yr; we assessed their work- and life-related factors, health status, and health literacy. We analyzed the data of 103 employees who met the inclusion criteria. Participants who lived alone and had a primary doctor, lower job demand, and lower self-rated health were significantly more likely to adhere to recommendations, suggesting that work- and life-related factors-rather than individual health literacy-may be more important. Further study is needed toward effective utilization of annual health checkups in the workplace.

The role of occupational medicine in assessing work limitation: A cross-sectional study on construction workers over a five-year period in Croatia.

BACKGROUND: Maintaining adequate working ability of construction workers is of considerable importance for society, as the construction sector is burdened with high prevalence of work-related diseases and health-issues. OBJECTIVE: To determine the number and age of construction workers in Croatia with temporary or permanent work limitation status, as well as to identify the most common health causes of such work limitation. METHODS: A retrospective cross-sectional study was performed using the data from 2534 construction workers, aged between 18 and 65 years, who underwent standardized routine occupational health examinations between 2011 and 2015. Thorough medical history and medical record reviews, blood and urine analyses, vision parameters and hearing range evaluation, as well as mental health assessment were conducted on every study participant. RESULTS: A total of 210 construction workers (8.29%) received occupational/work limitation status (either temporary or permanent). Four main categories of work limitation were high blood pressure, disorders of the liver and digestive system, hearing loss and amblyopia, comprising 61.69% of all diagnoses. A total of 37.62% of workers with work limitation status had two or more different diagnoses (i.e. co-morbid conditions). Those with work limitation (either temporary or long-term) were significantly older than those fit enough to work (p-value <0.00001). CONCLUSIONS: This type of organized screening represents a significant preventative effort in the construction industry, as workers may become more cognizant of the conditions that may affect their work ability.

Occupational medicine specialist referral triggers: Mixed-methods analysis of teleconsult cases.

Background: Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM). Aims: To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider's training. Methods: Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed. Results: 108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68-3.14) or neurological (OR: 1.69, 1.28-2.24) conditions. Medication usage (OR: 2.2, 1.49-2.26) was more likely to be a source of clinical concern among referring providers. Conclusions: The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners.

Do workers' health surveillance examinations fulfill their occupational preventive objective? Analysis of the medical practice of occupational physicians in Catalonia, Spain.

OBJECTIVES: Although routine workers' health examinations are extensively performed worldwide with important resource allocation, few studies have analyzed their quality. The objective of this study has been to analyze the medical practice of workers' health examinations in Catalonia (Spain) in terms of its occupational preventive aim. MATERIAL AND METHODS: A cross-sectional study was carried out by means of an online survey addressed to occupational physicians who were members of the Catalan Society of Safety and Occupational Medicine. The questionnaire included factual questions on how they performed health examinations in their usual practice. The bivariate analysis of the answers was performed by type of occupational health service (external/internal). RESULTS: The response rate was 57.9% (N = 168), representing 40.3% of the reference population. A high percentage of occupational physicians had important limitations in their current medical practice, including availability of clinical and exposure information, job-specificity of tests, and early detection and appropriate management of suspected occupational diseases. The situation in external occupational health services - that covered the great majority of Catalan employees - was worse remarkably in regard to knowledge of occupational and nonoccupational sickness absence data, participation in the investigation of occupational injuries and diseases, and accessibility for workers to the occupational health service. CONCLUSIONS: This study raises serious concerns about the occupational preventive usefulness of these health examinations, and subsequently about our health surveillance system, based primarily on them. Professionals alongside health and safety institutions and stakeholders should promote the rationalization of this system, following the technical criteria of need, relevance, scientific validity and effectiveness, whilst ensuring that its ultimate goal of improving the health and safety of workers in relation to work is fulfilled. Other countries with similar surveillance systems might be encouraged by our results to assess how their practices fit the intended purpose. Int J Occup Med Environ Health 2017;30(6):823-848.

Knowledge, attitudes, beliefs and practices of occupational physicians towards vaccinations of health care workers: A cross sectional pilot study in North-Eastern Italy.

OBJECTIVES: This study aims to characterize personal attitudes and knowledge of a sample of Italian occupational physicians (OPhs) towards immunization practice in the case of healthcare workers (HCWs). MATERIAL AND METHODS: A total of 90 OPhs (42.2% of males, 57.8% of females, mean age of 50.1±8.3 years old) compiled a structured questionnaire through a telephonic interview. They were asked about the official Italian recommendations for HCWs, their general knowledge of vaccine practice, their propensity towards vaccines (both in general and about specific immunizations), their risk perception about the vaccine-preventable infectious diseases. Eventually, a regression analysis was performed in order to identify factors predictive for vaccine propensity. RESULTS: Only 12 out of 90 subjects correctly identified all the 7 recommended immunizations. The hepatitis B virus (HBV) vaccine was correctly identified by 95.6% of the sample, and was also associated with the more positive attitude and the more accurate risk perception. Influenza vaccine had the lowest acceptance (75.9%). Eventually, pertussis, measles, parotitis and varicella vaccines were insufficiently recognized as recommended ones (all cases < 50% of the sample). General knowledge of vaccine and knowledge of official recommendations were significantly correlated with the attitude towards immunization practice (r = 0.259, p = 0.014 and r = 0.438, p < 0.0001). In the regression analysis general knowledge (unstandardized coefficient (B) = 0.300, 95% confidence interval (CI): 0.090-0.510, p = 0.006) and risk perception (B = 0.579, 95% CI: 0.155-1.003, p = 0.008) were significant predictors of the propensity to vaccinate. CONCLUSIONS: Vaccinations gaps in HCWs may found their roots in OPhs incomplete knowledge of evidence-based recommendations. Specific training programs and formations courses should then be planned. Int J Occup Med Environ Health 2017;30(5):775-790.

[The INAIL contribution to gender medicine through analysis of the accidents at work and occupational diseases data.] / Il contributo dell'INAIL alla medicina di genere attraverso l'analisi dei dati relativi all'andamento infortunistico e tecnopatico.

OBJECTIVES: The gender mainstreaming is important from the different repercussions that diseases can cause in women rather than in men. METHODS: For several years, Inail has been involved in the collection of accidents at work and occupational diseases data, having regard to the gender difference. In this contest statistical data on accidents at work and occupational diseases reported to Inail in the last five years in the Inail Statistical Database have been analyze.

Awareness of Medical Fitness to Drive Guidelines among Occupational Physicians and Psychiatrists.

Irrespective of national guidelines for medical fitness to drive, this study investigated the cumulative expert wisdom of clinicians regarding minimum periods of driving cessation required for patients suffering from conditions that can impair driver capability. Occupational Physicians (196) and Psychiatrists (103) completed an online questionnaire. For private motorists, the modal response for anxiety and depression favoured clinical discretion, followed by three month cessations for hypomania, acute psychosis, schizophrenia and alcohol dependence and six weeks for alcohol misuse/dependence. For professional drivers the modal value for anxiety and depression was three months, rising to six months for hypomania, psychosis and schizophrenia and 12 months for both alcohol misuse/dependence. Chi-square test results indicated statistically significant differences in clinical opinion between Occupational Physicians and Psychiatrists regarding driving cessation times for drivers suffering from psychiatric and alcohol misuse conditions except for alcohol dependence. Further studies are warranted to investigate these issues in more depth.

Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance.

BACKGROUND: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. METHODS: Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM's official archives in Rome. RESULTS AND CONCLUSIONS: The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers.

Prevalence of cannabis and cocaine consumption in French fishermen in South Atlantic region in 2012-2013 and its policy consequences.

BACKGROUND: The aim of the study was to evaluate the use of cannabis and cocaine among fishermen followed in occupational medicine in the ports of Aquitaine and Charente-Maritime (Direction interrégionale de la mer Sud-Atlantique [DIRM-SA]). MATERIALS AND METHODS: Thousand fishermen could be recruited during medical regulatory examination by the occupational physicians and nurses of Occupational Health Department for Seamen. RESULTS: About 20% of fishermen were former smokers. A third of the fishermen are at risk for excessive drinking according to the AUDIT-C. The prevalence of cannabis experimentation was estimated at 58%. The prevalence of positive urine test for cannabis was 28%. The prevalence of experimentation with cocaine was about 16%. The prevalence of positive urine test for cocaine was 4.5%. CONCLUSIONS: In accordance with its objectives, this study allows objectifying cannabis and cocaine consumption among fishermen. The national rules for fitness at sea have to be modified by introducing the use of urinary tests by occupational physician.

Current Status and Prospects of Occupational Medicine in the Russian Federation.

An in-depth analysis conducted on the historical background and current status of occupational medicine in Russia is presented. Scientific and practical bases of occupational medicine in the Russian Federation were based on 2 of the most important principles of health service: free medical care and its preventive orientation. Our analysis of the current situation in occupational medicine in modern Russia shows a transition from the vision of zero occupation-related harm to the strategy of recognizing, assessing, and managing occupational exposures. The system of workplace monitoring is developing successfully, with the creation of a federal database for the state of working conditions and the implementation of mechanisms for occupational risk assessment and management. However, at the same time, the system of medical surveillance for workers needs substantial reform. Over the past few years, the professional community of specialists in occupational medicine has taken several steps to improve the quality of its work. Understanding of the need for reforming the system of occupational medicine has continued to grow, which will improve the quality of medical monitoring for workers and extend professional longevity. Current challenges and prospects of occupational medicine in the Russian Federation are discussed.

A Dimensionally Reduced Clustering Methodology for Heterogeneous Occupational Medicine Data Mining.

Clustering is a set of techniques of the statistical learning aimed at finding structures of heterogeneous partitions grouping homogenous data called clusters. There are several fields in which clustering was successfully applied, such as medicine, biology, finance, economics, etc. In this paper, we introduce the notion of clustering in multifactorial data analysis problems. A case study is conducted for an occupational medicine problem with the purpose of analyzing patterns in a population of 813 individuals. To reduce the data set dimensionality, we base our approach on the Principal Component Analysis (PCA), which is the statistical tool most commonly used in factorial analysis. However, the problems in nature, especially in medicine, are often based on heterogeneous-type qualitative-quantitative measurements, whereas PCA only processes quantitative ones. Besides, qualitative data are originally unobservable quantitative responses that are usually binary-coded. Hence, we propose a new set of strategies allowing to simultaneously handle quantitative and qualitative data. The principle of this approach is to perform a projection of the qualitative variables on the subspaces spanned by quantitative ones. Subsequently, an optimal model is allocated to the resulting PCA-regressed subspaces.

Scientific publications in public, environmental and occupational health journals by authors from China, Japan and Korea in East Asia: A 10-year literature survey from 2003 to 2012.

OBJECTIVES: To compare the number and quality of public, environmental and occupational health articles published in international journals from the 3 major non-English speaking countries of East Asia: China, Japan and Korea. MATERIAL AND METHODS: Public, environmental and occupational health articles from China, Japan and Korea that were published in 161 journals from 2003 to 2012 were retrieved from the Science Citation Index Expanded (SCIE) database. We recorded the numbers of total articles, impact factors (IF), citations, number of articles in top 10 journals, references as well as the article distribution from various regions in China. RESULTS: From 2003 to 2012, China, Japan and Korea published 5713, 3802 and 1967 papers respectively, with accumulated impact factor of 14 934.55, 8758.36 and 6189.25, the average impact factor of 2.61, 2.30 and 3.15 and the average citation numbers per document of 5.08, 6.49 and 5.25. In the top 10 high-impact public, environmental and occupational health journals, China, Japan and Korea accounted for 50.19%, 20.34% and 29.47% of all the papers published in those journals, respectively. Total impact factors of the most popular 10 papers for China, Japan and Korea were: 26.23, 27.08 and 26.91. Distribution of scientific papers among regions was unbalanced in China, for Hong Kong and Taiwan it accounted for 47.31% of the papers from China. CONCLUSIONS: From 2003 to 2012, both the quality and number of papers from China published in public, environmental and occupational health journals have greatly improved. China exceeded Japan and Korea in the number, accumulated impact factor, total citation times and the average number of references, while Korea had the highest average impact factor. Japan had the highest journal impact factor among the most popular journals, and the highest average citation number per document.