Inequities in occupational diseases recognition in France.

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.

[Ethical problems of mutagenesis and genetic testing at the workplace].

Selected ethical problems arising in the studies of mutagenic effects and genetic testing at the workplace (genetic monitoring and genetic screening) are discussed.

Public health measures to control tuberculosis in low-income countries: ethics and human rights considerations.

In low-income countries, tuberculosis (TB) control measures should be guided by ethical concerns and human rights obligations. Control programs should consider the principles of necessity, reasonableness and effectiveness of means, proportionality, distributive justice, and transparency. Certain measures-detention, infection control, and treatment to prevent transmission-raise particular concerns. While isolation is appropriate under certain circumstances, quarantine is never an acceptable control measure for TB, and any detention must be limited by necessity and conducted humanely. States have a duty to implement hospital infection control to the extent of their available resources and to provide treatment to health care workers (HCWs) infected on the job. HCWs, in turn, have an obligation to provide care unless conditions are unreasonably and unforeseeably unsafe. Finally, states have an obligation to provide adequate access to treatment, as a means of preventing transmission, as broadly as possible and in a non-discriminatory fashion. Along with treatment, states should provide support to increase treatment adherence and retention with respect for patient privacy and autonomy. Compulsory treatment is almost never acceptable. Governments should take care to respect human rights and ethical obligations as they execute TB control programs.

Saúde do trabalhador: a relação entre ergonomia, atividade física e qualidade de vida / Health of the worker: the relation between ergonomics, physical activity and quality of life

Acreditamos que, com o acelerado desenvolvimento de tecnologias, mais envolvidas e necessitadas estão as empresas de alta produtividade. Entretanto, a atenção à saúde do seu funcionário tem se mostrado cada vez mais desapercebida. Existem, ainda, instituições que não têm se preocupado, como deveriam, com o estudo do homem, no que diz respeito às suas limitações, dificuldades e necessidades em sua atividade profissional. O presente estudo propõe uma reflexão a respeito da saúde do trabalhador, sendo que o principal propósito é analisar os programas que buscam promover e melhorar a qualidade de vida desta categoria. Procurou-se, também, com base na literatura, definições e conceitos sobre as bases ergonômicas e posturais que devem ser consideradas em qualquer estudo referente à saúde ocupacional

Ethical issues in occupational disease outbreak investigations.

Occupational disease outbreak investigations usually involve rapid, small-scale analysis of reports of diseases with a suspected occupational etiology, usually in a single workplace or among workers of a single employer. Ethical issues are similar to those encountered in epidemiologic studies in the workplace, with the added constraints of the need to respond rapidly, limited numbers of subjects, low statistical power, and the mandate to issue results even when the ability to generalize them is limited. Informed consent, voluntary participation, fairness, and confidentiality are major ethical issues in workplace outbreak investigations. The obligation to publicly report a workplace hazard when a non-disclosure statement has been signed can also present an ethical dilemma for outbreak investigators.