Medical evacuations among offshore oil and gas industries in the Gulf of Thailand.

BACKGROUND: Medical evacuation in the offshore oil and gas industry is costly and risky. Previous studies have found that the main cause of medical evacuation due to illness is increasing. In Thailand, there have been no studies on the causes and costs of medical evacuation in the offshore oil and gas industry. This study aims to study on the causes and costs of medical evacuation among offshore oil and gas industry in the Gulf of Thailand. MATERIALS AND METHODS: A retrospective review of data of medical evacuation among the offshore oil and gas industry in the Gulf of Thailand from 2016 to 2019 for a period of 36 months. RESULTS: During the research period, a total of 416 cases were evacuated. The majority of the causes of Medevac (84.13%) were illness. We found that 60.1% of all Medevacs were unpreventable or difficult to prevent, and only 39.9% were preventable. The cost of Medevac ranged from 10,000 to 880,000 THB per case. The cost of Medevac occurring from preventable causes was 17,160,000 THB for this period of 36 months. CONCLUSIONS: Reducing the cost of Medevac can be done by: 1) vaccination to prevent vaccine-preventable diseases, 2) screening to prevent people at risk of getting complications from pre-existing diseases to work offshore, and 3) increasing treatment capability of offshore facilities. Offshore oil and gas industry may consider cost-benefit of these approaches compared to status quo.

Should systemic sclerosis be recognised as an occupational disease in Switzerland?

Systemic sclerosis is a rare autoimmune disease characterised by a multifactorial aetiology involving a gene–environment interaction. Despite the growing epidemiological arguments for odds ratio (OR) data showing an association with occupational exposure, systemic sclerosis is not currently included in the list of recognised occupational diseases in Switzerland, unlike other northern European countries. Future recognition will be conditional on the demonstration of a strong association between the disease and occupational exposure in the scientific literature. The present article’s main goal is to present five cases of systemic sclerosis investigated for possible occupational aetiologies during occupational pathology consultations at the Institute for Work and Health, in Lausanne. The occupational aetiologies of these cases are discussed against the background of a literature review of publications from the past 20 years in order to determine whether recognition as an occupational disease is possible within Switzerland’s legal framework. Epidemiological studies of systemic sclerosis have identified strong associations with occupational factors such as exposure to silica and solvents, with ORs >2, and weaker associations with epoxy resins and welding fumes. Other occupational exposures are also known to induce systemic sclerosis-like diseases, such as vinyl chloride disease and toxic oil syndrome. All five patients had been exposed to either silica, solvents, or both. Given their exposure and the data in the literature, four patients had their cases declared to their accident insurance companies and two of them were recognised as suffering from an occupational disease by the Swiss National Accident Insurance Fund. Our literature review enabled us to design a short questionnaire to help general practitioners and rheumatologists to identify those patients with systemic sclerosis who are likely to have their illness recognised as an occupational disease.

OCT and IOP findings in a healthy worker cohort: results from a teleophthalmic study in occupational medicine.

PURPOSE: To avoid significant loss of vision in employees, the working population could be examined with ophthalmic methods as OCT and IOP measurement for detection of serious eye diseases. The value of "virtual eye clinics" in occupational preventive medicine has been previously shown. We used a telemedical approach to gather epidemiological information about prevalence of eye diseases such as glaucoma, ocular hypertension, hypertensive retinopathy, diabetic retinopathy, epiretinal membrane, AMD, adult vitelliform maculopathy, cystoid maculopathy, choroidal nevi, and macular drusen. METHODS: The study included 931 people ranging from age 39 to 65 years. Using a telemedical approach, all medical examinations and the ophthalmic examination were performed by a technician using an optical coherence tomography (SD-OCT) and a pulse air tonometer. The data were saved in the web-based patient chart MedStage® of the Talkingeyes® Collaboration Network. RESULTS: We found a high prevalence of eye diseases in a group representative for the working-age population by telemedical examination. 13.47% of the workers examined showed ocular findings necessitating treatment or control by an ophthalmologist, including ocular hypertension (5.7%), hypertensive retinopathy with loss of temporal retinal nerve fiber thickness (2.3%), epiretinal membrane (1.07%), glaucoma (0.97%), age-related macular degeneration and adult vitelliform maculopathy (0.53%), and diabetic retinopathy (0.2%). Two of the examined persons presented ocular findings requiring urgent treatment to prevent serious vision loss. CONCLUSION: Using a telemedical approach, we collected epidemiological information about prevalence of eye diseases in the working-age population. Virtual eye clinics in occupational preventive medicine are a useful method to improve sight and reduce vision loss of workers by reducing travel time and inconvenience associated with an in-person appointment with an ophthalmologist.

[The protection of the worker affected by neoplastic pathologies and the role of the occupational physician for his reintegration into work]. / Le tutele del lavoratore con patologie oncologiche e il ruolo del medico competente per il suo reinserimento lavorativo.

OBJECTIVES: The protection of the worker affected by neoplastic pathologies and his reintegration into work represent subjects of undoubted relevance for the occupational physician. Many are the workers affected by neoplastic diseases and more are those who are able to regain good living conditions and sufficient work capacity to be reintegrated into profitable work. Several rights are related to the assessment of a certain percentage of disability, the recognition of "Handicap in a serious situation", and others according to the requirements of the Italian law for the right to work of disabled people -L. 68/99 s.m.i.-. METHODS: The Occupational Physician manages the oncology patient through the targeted placement ex L. 68/99 s.m.i. or, more often, during the activity of health surveillance has to assess whether the job, considering the risks connected to it, is compatible with the conditions of biological validity of the worker, identifying, possibly, prescriptions or limitations. RESULTS: In our experience, customized working plan is an operational methodology that has proved to be very useful. In practice, the Occupational Physician uses a method to help the back to work of the worker with disability, formalizing before the limits to the performance of the work activity. The assessment of fitness for work is related to a work plan presented by the employer, based on the indications of the occupational physician, based on disability (health conditions / worker's susceptibility) that modulates or avoids job tasks that could prove harmful or aggravating the health condition of the employee. Teleworking and smart working can also be considered among the possible protection measures. CONCLUSIONS: Finally, it is useful to recall the role of INAIL for workers with a recognized neoplastic pathology related to work. With the Italian law 190/2014 art. 1, paragraph 166 are assigned to the INAIL the skills relating to the reintegration and work integration of people with disabilities from work with expenses for the INAIL. There are therefore a number of reference measures by the INAIL and the types of interventions for reintegration are identified..

The Relationship between Workplace Environment and Metabolic Syndrome.

BACKGROUND: Metabolic syndrome, a major risk factor for cardiovascular disease and diabetes, is recognized as an important health problem. OBJECTIVE: To investigated whether the workplace environment was associated with metabolic syndrome. METHODS: This study was a cross-sectional study using medical records and workplace environment reports of 1297 blue-collar Korean male workers who exposed to work hazards in one workplace. The metabolic syndrome was confirmed using the NCEP ATP III. The workplace environment was classified into organic compounds, metals, acids and bases, metalworking fluid, dust, noise and shift worker. RESULTS: Among the total subjects, 257 (19.8%) had metabolic syndrome. Age, BMI, current smoking status, and at risk alcohol drinking were found to be significant predictors of metabolic syndrome. In seven workplace environment categories, the odds ratio (OR) of metabolic syndrome increased 1.785 (95% CI 1.058 to 3.013) times in the metalworking fluid environment. CONCLUSION: The workplace environment, especially metalworking fluid is associated with metabolic syndrome.

Availability of a New Job-Exposure Matrix (CANJEM) for Epidemiologic and Occupational Medicine Purposes.

OBJECTIVE: The aim of this study was to introduce the Canadian job-exposure matrix (CANJEM). METHODS: Four large case-control studies of cancer were conducted in Montreal, focused on assessing occupational exposures by means of detailed interviews followed by expert assessment of possible occupational exposures. Thirty-one thousand six hundred seventy-three jobs were assessed using a checklist of 258 agents (listed with prevalences at http://expostats.ca/chems). This large exposure database was configured as a JEM. RESULTS: CANJEM is available in four occupational classification systems. It provides estimates of probability of exposure among workers with a given occupation, and for those exposed, various metrics of exposure. CANJEM can be accessed online (www.canjem.ca) or in a batch version. CONCLUSION: CANJEM is a large source of retrospective exposure information, covering most occupations and many agents. CANJEM can be used to support exposure assessment efforts in epidemiology and occupational health.

Pupillometer Use: Validation for Use in Military and Occupational Medical Surveillance and Response to Organophosphate and Chemical Warfare Agent Exposure.

INTRODUCTION: To analyze the effectiveness and suitability of pupillometer use in military and occupational medicine, specifically when pupil size is measured as part of medical surveillance. Pupil size is the most sensitive physical exam finding in vapor exposure to substances that inhibit acetylcholinesterase, such as nerve agent (chemical warfare) and organophosphates (used in agriculture). Pupillometer use permits real-time, accurate pupil measurements, which are of significant value in occupational setting where exposure to organophosphates is suspected and in dynamic military settings where it may be unclear if service members were exposed to nerve agent or not. MATERIALS AND METHODS: In a worker population enrolled in medical surveillance including pupil size measurement, pupils were measured using a Colvard pupillometer, whereas their pupil size had previously been measured by manual measurement. Pupil size was compared pre- and post-pupillometer implementation. RESULTS: Pupil size range was broader post-pupillometer implementation, reflecting accepted ranges of physiologically normal pupil sizes. The correlation between pupil sizes pre- and post-pupillometer was low, and the overall mean pupil diameters were statistically different between the two modalities (p < 0.0001), strongly suggesting that pupillometer use helped correct inaccurate pupil size estimates. In two real-world situations, pupillometer use proved helpful in evaluating workers who may have been exposed to an organophosphate, providing information that was immediately available and clinically relevant as part of the initial medical evaluation/physical exam. CONCLUSIONS: Pupillometer use is feasible and robustly increases the precision and accuracy of pupil size measurement in military and occupational medicine settings caring for workers potentially exposed to organophosphates. It provides near-real-time quantitative data that are immediately pertinent to determining if a service member or employee has been exposed to these agents.

Development of a tailored work-related support intervention for gastrointestinal cancer patients.

Aim is the development of a work-related support intervention, tailored to the severity of work-related problems of patients diagnosed with gastrointestinal (GI) cancer treated with curative intent. Two methods were used: (1) Work-related problems were identified from the literature and submitted to an expert panel during a modified Delphi study. Experts allocated work-related problems into degrees of severity: mild, severe or complex. In addition, experts indicated which health care professional should provide the tailored support: (2) These outcomes were combined with existing interventions to design the tailored intervention. Semi-structured interviews with experts were conducted to assess whether the intervention was comprehensive, and feasible for daily practice. A decision diagram measuring severity of work-related problems was developed based on the modified Delphi study with 44 experts, encompassing social, disease and occupational problems. Based on the degree of severity, support was provided by: an oncological nurse (mild), oncological occupational physician (severe) or multidisciplinary team (complex). The intervention encompassed three individual meetings in the clinical setting and was considered comprehensive and feasible by 12 experts. The intervention is innovative in combining oncological and occupational care in the clinic and being tailored to the needs of GI cancer patients with specific work-related problems.

[Blood pressure and sleep apnoea hypopnoea syndrome in workers. STOP-Bang test versus Epworth test]. / Presión arterial y síndrome de apnea-hipopnea del sueño en trabajadores. Test STOP-Bang frente a la escala de Epworth.

INTRODUCTION: OSAHS is associated with an increased risk of cardiovascular disease and stroke. Arterial hypertension is a key risk factor to consider due to its impact on health. METHOD: Cross-sectional study carried out on Spanish public service workers. The nocturnal apnoea risk using the Epworth and STOP-Bang questionnaires and their influence on the mean values of blood pressure are assessed. RESULTS: The detection of OSAHS using the Epworth test and, particularly with the STOP-Bang shows a significant relationship with the mean values of blood pressure, with differences between both questionnaires. CONCLUSION: The Epworth and STOP-Bang questionnaires are useful for the initial detection of OSAHS and a higher prevalence of high blood pressure. Both can be used in screening procedures in occupational health.

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.

Sleep Apnea Screening Practices During Department of Transportation Medical Examinations.

OBJECTIVE: The aim of this study was to examine the practices of Michigan Occupational and Environmental Medicine Association (MOEMA) members regarding screening for sleep apnea during required driver medical examinations. METHODS: A 13-question survey on sleep apnea screening practices was emailed to the MOEMA member. Nonresponders received additional E-mails and calls. RESULTS: The survey response rate was 66%. Fifty-five percent of respondents performed driver examinations and 94% screened for sleep apnea. Variations in practice included differences in how many risk factors were used to determine the need for polysomnography, 13% never ordered polysomnography and 42% never denied medical certification because of sleep apnea. CONCLUSION: Although there was significant consensus that sleep apnea screening was important, there was a large variation in the indication for and frequency in which sleep studies were ordered and drivers were denied approval because of concern about sleep apnea.

Pathway from PTSD to respiratory health: Longitudinal evidence from a psychosocial intervention.

OBJECTIVE: Respiratory illness and posttraumatic stress disorder (PTSD) are common debilitating conditions that frequently co-occur. Observational studies indicate that PTSD, independently of smoking, is a major risk and maintenance factor for lower respiratory symptoms (LRS). The current study experimentally tested this etiologic pathway by investigating whether LRS can be reduced by treating PTSD symptoms. METHOD: Ninety daily smokers exposed to the World Trade Center (WTC) disaster (mean age 50 years, 28% female; 68% White) completed 8-session group-based weekly comprehensive trauma management and smoking cessation treatment that focused on skills to alleviate PTSD symptoms. LRS, PTSD symptoms, and smoking were assessed weekly. Data was analyzed using multilevel models of within-person associations between LRS, PTSD symptoms, smoking, and treatment dose across 8 weekly sessions with concurrent and lagged outcomes. RESULTS: LRS improved significantly with treatment (reduction of .50 standard deviations). Reduction in PTSD symptoms uniquely predicted improvement in LRS at consecutive sessions 1 week apart and fully accounted for the treatment effect on LRS. The effect of PTSD symptoms was stronger than that of smoking, and the only effect to remain significant when both entered the model. Notably, reduction in LRS did not predict future improvement in PTSD symptoms. CONCLUSIONS: The results are in line with the etiologic pathway suggesting that PTSD symptoms are a risk and maintenance factor for chronic LRS and that treatment of PTSD can help to alleviate LRS in trauma-exposed populations. PTSD is emerging as a novel and important treatment target for chronic respiratory problems. (PsycINFO Database Record

A workplace modified duty program for employees in an oncology center.

BACKGROUND: Workplace modified duty programs may provide reasonable accommodations to employees who have partial temporary job disability and could work on duty accommodations until they fully recover. However, little is known about the implementation barriers and effectiveness of such programs. OBJECTIVE: This study is aimed at evaluating the implementation of a modified duty program for employees in an oncology center. METHODS: A modified duty program for employees working at the Bank of Cyprus Oncology Center, a non profit organization with 200 employees located in the Republic of Cyprus was evaluated based on the health records of the occupational medicine department. RESULTS: Employees' participation in the program was 3%. A total of 12 employees participated (6 each year). The participants were all women and the mean participation period was 21.6 days (range 10 - 65 days). The two most frequent reasons for a modified duty assignment were pregnancy and back pain. Employees were assigned either on limited duties or on a combination of limited duties and reduced work hours. Employees reported being very satisfied with their participation based on a follow-up narrative oral assessment. CONCLUSION: The small participation rate does not allow for advanced statistical analyses. Further studies from larger organizations are urgently needed to evaluate the effectiveness of modified duty programs. The development of a legal framework for such modified duty programs in Cyprus as well as internationally may promote their implementation in order to facilitate the effective management of temporary partial job disability for the benefit of both employees and businesses.

[Evaluation of life quality connected with health in patients with occupational diseases].

The article deals with methodology for integral evaluation of life quality connected with health in industrial medicine. Object of evaluation is life quality connected with health in workers exposed to occupational hazards. Empirical basis is long-standing study of life quality connected with health in patients with occupational diseases and in industrial workers. The article covers result of methologic instruments suggested by the authors for integral evaluation of life quality connected with health in workers and individuals exposed to occupational hazards, principles of group formation for such studies. The authors consider evaluation of life quality connected with health as a major goals of industrial medicine, as it completes quantitatively and qualitatively other studies of health changes in workers due to changing vital activity.

Reducing the underreporting of lung cancer attributable to occupation: outcomes from a hospital-based systematic search in Northern Italy.

PURPOSE: Occupational exposure to lung carcinogens is and was common in workplaces. 5-25 % of lung cancers (LCs) could be causally attributable to occupation; however, LC underreporting and undercompensation are widespread, with remarkable tolls paid by individuals and society. This work aims to: describe an ongoing hospital-based systematic search (SS) of occupational LC; improve aetiological diagnosis; increase number and quality of LC notifications. METHODS: Through a short form, physicians at a public hospital referred incident LC to the Occupational Health Unit (OHU). Only patients selected through the form were interviewed; a personal, occupational and clinical history was collected; reports were sent to the ward and Local Health Authority, with aetiological diagnosis criteria and probability of causation. RESULTS: From 1998 to 2013, 3274 cases of LC were notified to the OHU; prior to the system, just couple of dozens were assessed. A total of 1522 patients were fully interviewed; in 395 cases, causation was attributed to occupation (26 % of interviewed patients); all were notified to authorities, as compared to the handful reported before the system was adopted. Main aetiological agents were silica, asbestos, polycyclic aromatic hydrocarbons, truck driving, painting, multiple exposures. Compensation rate was remarkable (39 %). CONCLUSIONS: Through SS, many occupational LCs were found that otherwise would have been lost. Aetiological diagnosis proved to be rich of scientific advantages and practical implications, with attention to equity and social aspects. SS was easy, accountable and fostered multidisciplinary collaboration among medical specialties, significantly reducing underreporting and undercompensation of occupational LC.

Validity of mesothelin in occupational medicine practice.

OBJECTIVES: Malignant mesothelioma (MM) is the most serious asbestos-related disease. Its increasing incidence is alarming, suggesting the need for as early diagnosis as possible. This 4.5-year prospective longitudinal study aimed at assessing the benefit of measuring serum mesothelin as a marker for diagnosing malignant mesothelioma in individuals with previous occupational exposure to asbestos, as a part of their clinical follow-up care. MATERIAL AND METHODS: The study comprised 309 participants (235 males, 74 females) with a mean age of 58.9 years (standard deviation (SD) = 9.8) and a mean duration of exposure to asbestos dust of 13.4 years (SD = 9.3). From 2009 to June 2013, all subjects were followed at a department of occupational medicine in Olomouc. Apart from the standard parts of medical examination (history, physical examination, simple chest radiographs and spirometry), the patients' serum mesothelin levels were determined by the Mesomark immunoenzymatic diagnostic assay. Statistical analysis of the validity of serum mesothelin level measurement was carried out with respect to the diagnosis of MM. RESULTS: Among the participants, 16 (5.2%) individuals (14 males and 2 females) were diagnosed with malignant mesothelioma. Based on the detected mesothelin levels, their validity for prediction of malignant mesothelioma was calculated as follows: sensitivity - 0.75, specificity - 0.962, positive predictive value - 0.706, negative predictive value - 0.969, positive and negative likelihood ratios - 19.95 and 0.26, respectively, and diagnostic odds ratio - 76.8, at a 95% confidence interval. CONCLUSIONS: The high specificity was identified indicating the low false positivity as well. In the case of detecting elevated soluble mesothelin-related peptides (SMRP) levels in formerly asbestos-exposed individuals, the possibility of the presence of MM should be included into the clinical consideration. The high negative predictive value denotes a lower probability of the presence of MM in patients with normal SMRP levels but due to the limiting lower sensitivity this possibility cannot be entirely excluded.

[Medical treatment in occupational diseases as a prospective type of care for coal industry workers (review of literature)].

The review covers prospects of pharmaceutic care implementation for coal industry workers and problems of interactions between pharmaceutical workers and medical establishment officers in optimization of medical and pharmaceutic care for miners. The authors present value of pharmaceutic care in treatment of specific diseases, where pharmaceutic care is defined as system providing pharmacotherapy for better results and improving life quality of patients.

Diagnosis and Treatment of Work-Related Ulnar Neuropathy at the Elbow.

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome and occurs most commonly at the elbow due to mechanical forces that produce traction or ischemia to the nerve. The primary symptom associated with UNE is diminished sensation or dysesthesias in the fourth or fifth digits, often coupled with pain in the proximal medial aspect of the elbow. Treatment may be conservative or surgical, but optimal management remains controversial. Surgery should include exploration of the ulnar nerve throughout its course around the elbow and release of all compressive structures.

Work-Related Neurogenic Thoracic Outlet Syndrome: Diagnosis and Treatment.

Outcomes of surgery for neurogenic thoracic outlet syndrome (NTOS) in workers' compensation are poor in a majority of patients, partly due to nonspecificity of diagnosis. Most cases have no objective evidence of the presence of brachial plexus dysfunction. Up to 20% of patients experience a new adverse event. Objective neurologic signs and electrodiagnostic evidence of brachial plexus dysfunction must be present before proceeding with invasive procedures. This guideline includes objective criteria that must be met before thoracic outlet syndrome surgery can be approved in Washington State. Evidence does not support the use of scalene blocks, botulinum toxin therapy, or vascular studies to diagnose NTOS.