Impact of stigma, culture and law on healthcare providers after occupational exposure to HIV and hepatitis C.

Worldwide, approximately three million needlestick or sharps injuries occur annually during healthcare procedures, with an estimated 18-35 healthcare professionals (HCPs) acquiring HIV each year as a result. This qualitative study examined the lived experience of occupational exposure to HIV or hepatitis C reported by four HCPs working in a tertiary care hospital in United Arab Emirates (UAE). Findings were based on interviews conducted as part of a larger two-year study investigating an intervention to improve the reporting and management of blood and body fluid exposures (BBFE) in the hospital. The data showed that due to cultural differences, individuals exposed to the same disease within the same legal system could have different concerns. Five themes arose from the data: (1) experiencing the unexpected, (2) inevitability and finality, (3) impact of stigma, (4) responsibility and risk and (5) legal and financial implications. The participants' most important concerns and causes of stress arising from occupational BBFE were related to the social implications (i.e., stigma; legal and financial costs) rather than the biological consequences of the disease. Social implications like these may negatively impact on reporting of occupational BBFE in UAE, but may need to be addressed at a societal rather than organisational level.

Human rights and health: opportunities to advance rural occupational health.

Human rights norms principally apply to governments, setting out state obligations and citizen entitlements to a range of social and material claims, whereas the highest ethical standards of occupational health professionals (OHPs) are outlined in ethical codes. Human rights discourse is rarely used to shape professional standards for health and safety. Yet there is much potential for synergy by applying human rights approaches to workplace health and safety and professional ethics. A review of international treaties confirms an extensive articulation of the right to workplace health and safety. A case study of pesticide exposure risks to small farmers in developing countries illustrates the links between human rights, occupational health practice, and professional ethics. OHPs have a responsibility to assist in the realization of workers' occupational health rights, particularly by promoting meaningful participation of those affected by hazardous exposures. Human rights approaches may assist the prevention of work-related morbidity.

COVID-19 and Essential Workers: A Narrative Review of Health Outcomes and Moral Injury.

The COVID-19 pandemic has introduced a number of added obstacles to safe employment for already-challenged essential workers. Essential workers not employed in the health sector generally include racially diverse, low-wage workers whose jobs require close interaction with the public and/or close proximity to their coworkers, placing them at increased risk of infection. A narrative review facilitated the analyses of health outcome data in these workers and contributing factors to illness related to limited workplace protections and a lack of organizational support. Findings suggest that this already marginalized population may also be at increased risk of "moral injury" due to specific work-related factors, such as limited personal protective equipment (PPE) and the failure of the employer, as the safety and health "duty holder," to protect workers. Evidence suggests that ethical and, in some cases, legally required safety protections benefit not only the individual worker, but an employer's enterprise and the larger community which can retain access to resilient, essential services.

Focusing ethical dilemmas of evidence-based practice in SMF-exposed MRI-workers: a qualitative analysis.

PURPOSE: To analyze ethical dilemmas for occupational health physicians and other stakeholders involved in the implementation of a surveillance program in workers exposed to static magnetic fields (SMF) used in magnetic resonance imaging. METHODS: The ethical analysis was carried out according to the model proposed by Westerholm and others, which takes into account two elements: (i) the stakeholders involved in the decision process and (ii) the ethical principles of beneficence, autonomy and justice. The analysis is based on the assessment of ethical costs (violating the consistent principle) and ethical benefits (fulfillment of the consistent principle) for workers, employers, occupational health physicians, community, workers' representatives and medical inspectors. RESULTS: According to the European Directive 2004/40/EC (Official Journal of the European Union, Luxemburg), employers must ensure that health surveillance is carried out to prevent adverse health effects in SMF-exposed workers. However, limited scientific evidence on health effects from SMF influences the decision of undertaking appropriate health surveillance. The uncertainties entail a number of ethical conflicts, such as the choice of reliable indicators, the interpretation of abnormal data, the complexity of the decision-making process resulting in a fitness judgment and the diversion of funds for more effective practices. CONCLUSIONS: The analysis shows that the decision-making process aiming at the provision of evidence-based health surveillance to SMF-exposed workers is characterized by controversial ethical costs and ethical benefits for workers and the other stakeholders.

Leishmaniasis entomological field studies: ethical issues.

Occupational health remains neglected in developing countries because of competing social, economic and political challenges. Ethical issues in the workplace related to the hazards and risks of becoming infected by Leishmania (Leishmania) mexicana, through the bite of naturally infected sand flies, is another area of concern that has been neglected as well. We report here the results of reviewing two entomological field studies carried out in our research center from 2003 to 2006. Eight students from our School of Biology were invited to catch sand flies. A total of six of the eight (75%) developed a typical clinical picture of Localized Cutaneous Leishmaniasis (LCL) caused by L. (L.) mexicana. In this article we identify the ethical issues related to these kinds of studies and propose some guidelines for conducting them.

Can "presumed consent" justify the duty to treat infectious diseases? An analysis.

BACKGROUND: AIDS, SARS, and the recent epidemics of the avian-flu have all served to remind us the debate over the limits of the moral duty to care. It is important to first consider the question of whether or not the "duty to treat" might be subject to contextual constraints. The purpose of this study was to investigate the opinions and beliefs held by both physicians and dentists regarding the occupational risks of infectious diseases, and to analyze the argument that the notion of "presumed consent" on the part of professionals may be grounds for supporting the duty to treat. METHODS: For this cross-sectional survey, the study population was selected from among physicians and dentists in Ankara. All of the 373 participants were given a self-administered questionnaire. RESULTS: In total, 79.6% of the participants said that they either had some degree of knowledge about the risks when they chose their profession or that they learned of the risks later during their education and training. Of the participants, 5.2% said that they would not have chosen this profession if they had been informed of the risks. It was found that 57% of the participants believed that there is a standard level of risk, and 52% of the participants stated that certain diseases would exceed the level of acceptable risk unless specific protective measures were implemented. CONCLUSION: If we use the presumed consent argument to establish the duty of the HCW to provide care, we are confronted with problems ranging over the difficulty of choosing a profession autonomously, the constant level of uncertainty present in the medical profession, the near-impossibility of being able to evaluate retrospectively whether every individual was informed, and the seemingly inescapable problem that this practice would legitimize, and perhaps even foster, discrimination against patients with certain diseases. Our findings suggest that another problem can be added to the list: one-fifth of the participants in this study either lacked adequate knowledge of the occupational risks when they chose the medical profession or were not sufficiently informed of these risks during their faculty education and training. Furthermore, in terms of the moral duty to provide care, it seems that most HCWs are more concerned about the availability of protective measures than about whether they had been informed of a particular risk beforehand. For all these reasons, the presumed consent argument is not persuasive enough, and cannot be used to justify the duty to provide care. It is therefore more useful to emphasize justifications other than presumed consent when defining the duty of HCWs to provide care, such as the social contract between society and the medical profession and the fact that HCWs have a greater ability to provide medical aid.

How Should Physicians Help Patients Who Are Ill Because They Work in Agriculture?

Occupational health issues are not just common for farmworkers; they are practically unavoidable. Farmworkers who seek treatment for work-related injury or illness are often unable to meaningfully reduce their exposure to risk factors without further jeopardizing their already fragile well-being and tenuous livelihoods. This case commentary addresses why and how physicians presented with patients who are ill because they work in agriculture should adjust their clinical practices to better meet the unique challenges faced by this patient population. In recognition of physicians' ethical duty to participate in activities to protect and promote the health of the public, this commentary also recommends specific actions that medical professionals can take to support systemic change that would improve farmworker health and well-being.

Work, obesity, and occupational safety and health.

There is increasing evidence that obesity and overweight may be related, in part, to adverse work conditions. In particular, the risk of obesity may increase in high-demand, low-control work environments, and for those who work long hours. In addition, obesity may modify the risk for vibration-induced injury and certain occupational musculoskeletal disorders. We hypothesized that obesity may also be a co-risk factor for the development of occupational asthma and cardiovascular disease that and it may modify the worker's response to occupational stress, immune response to chemical exposures, and risk of disease from occupational neurotoxins. We developed 5 conceptual models of the interrelationship of work, obesity, and occupational safety and health and highlighted the ethical, legal, and social issues related to fuller consideration of obesity's role in occupational health and safety.

The past suppression of industry knowledge of the toxicity of benzene to humans and potential bias in future benzene research.

Petrochemical industry representatives often withhold information and misinterpret positive evidence of toxicity of benzene, even from their own research, also discouraging or delaying disclosure of findings of adverse effects to the public. They now appear to be attempting to influence study results in industry's favor by offering predetermined conclusions about study results as part of an effort to draw financial support for the studies. The American Petroleum Institute is currently raising funds for benzene research being conducted in China for which it has already announced the intended conclusions.

Environmental justice: implications for occupational health nurses.

Through the use of innovative tools, such as clinical mnemonics, exercises in risk and asset mapping, and strategic program development, occupational health nurses can incorporate dimensions of environmental justice (EJ) into the workplace. Occupational health nurses who also take on educational roles can use case studies and network with labor and EJ groups to provide clinical experiences for occupational and environmental health nursing students, thereby integrating EJ into occupational and environmental health nursing practice. Occupational health nurses are well positioned to serve as technical experts within community-based participatory research projects. Occupational health nurses must share their knowledge and experience as members of coalitions that represent workers in their fight for worker health and safety.