[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.

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.

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.

[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.

Interventions to increase the reporting of occupational diseases by physicians.

BACKGROUND: Under-reporting of occupational diseases is an important issue worldwide. The collection of reliable data is essential for public health officials to plan intervention programmes to prevent occupational diseases. Little is known about the effects of interventions for increasing the reporting of occupational diseases. OBJECTIVES: To evaluate the effects of interventions aimed at increasing the reporting of occupational diseases by physicians. SEARCH METHODS: We searched the Cochrane Occupational Safety and Health Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, OSH UPDATE, Database of Abstracts of Reviews of Effects (DARE), OpenSIGLE, and Health Evidence until January 2015.We also checked reference lists of relevant articles and contacted study authors to identify additional published, unpublished, and ongoing studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs (cRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) of the effects of increasing the reporting of occupational diseases by physicians. The primary outcome was the reporting of occupational diseases measured as the number of physicians reporting or as the rate of reporting occupational diseases. DATA COLLECTION AND ANALYSIS: Pairs of authors independently assessed study eligibility and risk of bias and extracted data. We expressed intervention effects as risk ratios or rate ratios. We combined the results of similar studies in a meta-analysis. We assessed the overall quality of evidence for each combination of intervention and outcome using the GRADE approach. MAIN RESULTS: We included seven RCTs and five CBA studies. Six studies evaluated the effectiveness of educational materials alone, one study evaluated educational meetings, four studies evaluated a combination of the two, and one study evaluated a multifaceted educational campaign for increasing the reporting of occupational diseases by physicians. We judged all the included studies to have a high risk of bias.We did not find any studies evaluating the effectiveness of Internet-based interventions or interventions on procedures or techniques of reporting, or the use of financial incentives. Moreover, we did not find any studies evaluating large-scale interventions like the introduction of new laws, existing or new specific disease registries, newly established occupational health services, or surveillance systems. Educational materialsWe found moderate-quality evidence that the use of educational materials did not considerably increase the number of physicians reporting occupational diseases compared to no intervention (risk ratio of 1.11, 95% confidence interval (CI) 0.74 to 1.67). We also found moderate-quality evidence showing that sending a reminder message of a legal obligation to report increased the number of physicians reporting occupational diseases (risk ratio of 1.32, 95% CI 1.05 to 1.66) when compared to a reminder message about the benefits of reporting.We found low-quality evidence that the use of educational materials did not considerably increase the rate of reporting when compared to no intervention. Educational materials plus meetingsWe found moderate-quality evidence that the use of educational materials combined with meetings did not considerably increase the number of physicians reporting when compared to no intervention (risk ratio of 1.22, 95% CI 0.83 to 1.81).We found low-quality evidence that educational materials plus meetings did not considerably increase the rate of reporting when compared to no intervention (rate ratio of 0.77, 95% CI 0.42 to 1.41). Educational meetingsWe found very low-quality evidence showing that educational meetings increased the number of physicians reporting occupational diseases (risk ratio at baseline: 0.82, 95% CI 0.47 to 1.41 and at follow-up: 1.74, 95% CI 1.11 to 2.74) when compared to no intervention.We found very low-quality evidence that educational meetings did not considerably increase the rate of reporting occupational diseases when compared to no intervention (rate ratio at baseline: 1.57, 95% CI 1.22 to 2.02 and at follow-up: 1.92, 95% CI 1.48 to 2.47). Educational campaignWe found very low-quality evidence showing that the use of an educational campaign increased the number of physicians reporting occupational diseases when compared to no intervention (risk ratio at baseline: 0.53, 95% CI 0.19 to 1.50 and at follow-up: 11.59, 95% CI 5.97 to 22.49). AUTHORS' CONCLUSIONS: We found 12 studies to include in this review. They provide evidence ranging from very low to moderate quality showing that educational materials, educational meetings, or a combination of the two do not considerably increase the reporting of occupational diseases. The use of a reminder message on the legal obligation to report might provide some positive results. We need high-quality RCTs to corroborate these findings.Future studies should investigate the effects of large-scale interventions like legislation, existing or new disease-specific registries, newly established occupational health services, or surveillance systems. When randomisation or the identification of a control group is impractical, these large-scale interventions should be evaluated using an interrupted time-series design.We also need studies assessing online reporting and interventions aimed at simplifying procedures or techniques of reporting and the use of financial incentives.

[Is the guideline for work-related medical rehabilitation successfully implemented?]. / Gelingt die Umsetzung des Anforderungsprofils zur Durchführung der medizinisch-beruflich orientierten Rehabilitation?

BACKGROUND: The guideline for work-related medical rehabilitation (WMR) in responsibility of the German Pension Insurance describes standards of work-related measures in medical rehabilitation. We investigated if contents and recommended amount of treatment were successfully implemented and which improvements were associated with the implementation. METHODS: Implementation of the WMR guideline was evaluated at 7 inpatient orthopaedic rehabilitation centres. Patients completed questionnaires at beginning of rehabilitation, at dis-charge and 3 months after discharge. Details -regarding the treatments provided were extracted from the standardised discharge report. RESULTS: The recommended amount of social counselling and work-related psychosocial therapy measures were appropriate. However, there were discrepancies regarding the recommended amount of functional capacity training. The standardised mean difference (SMD) between baseline and 3-month follow-up sick leave duration indicated an almost medium-sized effect (SMD=0.47; 95% CI: 0.28-0.66). An additional 5 h of work-related therapy was associated with a 1.2-week decrease in sick leave duration (95% CI: -2.38 to -0.03). CONCLUSION: The guideline was for the most part successfully implemented and sets important standards for the roll-out of WMR. The nationwide implementation of the WMR guideline requires a continuous quality assurance that -enables promptly feedback about the achieved implementation level.

[Methods of risk assessment and their validation]. / Metodi di valutazione del rischio e lore validazione.

The review of the literature data shows several methods for the the risks assessment of biomnechanical overload of the musculoskeletal system in activities with repetitive strain of the upper limbs and manual material handling. The application of these methods should allow the quantification ofriskfor the working population, the identification of the preventive measures to reduce the risk and their effectiveness and thle design of a specific health surveillance scheme. In this paper we analyze the factors which must be taken into account in Occupational Medicine to implement a process of validation of these methods. In conclusion we believe it will necessary in the future the availability of new methods able to analyze and reduce the risk already in the design phase of the production process.

[Acute alcohol poisonings among patients in Toxicology Unit, Nofer Institute of Occupational Medicine in the period of time 2007-2012]. / Zatrucia alkoholami wsród pacjentów Oddzialu Toksykologii Instytutu Medycyny Pracy im. J. Nofera w Lodzi, hospitalizowanych w latach 2007-2012.

UNLABELLED: The purpose of the research was to present the analysis of acute alcohol poisonings (ethanol, methanol, ethylene glycol, isopropanol) in Toxicology Unit (TU), Nofer Institute of Occupational Medicine (NIOM), Lódz, Poland. MATERIALS AND METHODS: To further analysis were chosen all cases, whose were coded according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision. RESULTS: There were 10,936 acute poisonings in the analyzed period of time 2007-2012 years, 3,088 of them referred to alcohol poisonings (28%). The largest group of patients included cases with ethanol intoxication (2,883 subjects), the second and third one-cases with methanol and ethylene glycol poisonings (99 and 98 respectively), 8 cases were poisoned with isopropanol. The largest group of patients includes cases at age less than 30 years. Patients at age above 60 years formed the lowest group among the total number of poisonings. Most of the admitted cases were men (2,417 patients) and cases hospitalized due to ethanol abuseladdiction (93%). Ethylene glycol poisonings constituted the leading cause of deaths (10 subjects). CONCLUSIONS: The study shows, that intoxications with alcohols are a big problem in NIOM and the number of alcohol poisonings markedly increased in the years 2007-2012.

[Acute novel drugs poisoning among patients of Nofer Institute of Occupational Medicine in Lodz, Toxicology Unit, hospitalized in the years 2008-2012--epidemiology, clinical state]. / Ostre zatrucia nowymi srodkami psychoaktywnymi wsród pacjentów oddzialu Toksykologii Instytutu Medycyny Pracy w Lodzi w latach 2008-2012-- rozpowszechnienie, obraz kliniczny zatrucia.

UNLABELLED: Intoxication with novel recreational drugs poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications. OBJECTIVES: Description of clinical pattern novel drug intoxication. METHODS: retrospective review of medical records patients hospitalized in the Toxicology Unit (TU) with diagnosis of intoxication with novel recreational drugs. RESULTS: During the period from 2008-2010--431 patients were admitted to TU with mentioned above diagnosis. 159 (36.9%) patients were positive for ethanol with its average concentration in blood 150 mg%. Presence of other substances like amphetamine, cannabinoids, atropine, ephedrine, carbamazepine, benzodiazepines and dextrometorphan was confirmed. The most frequent clinical symptoms observed on admission were: anxiety, agitation, complaints associated with circulatory system and vertigo Average pulse rate and both: diastolic and systolic pressure were within normal limits, however authors noted slight tendency toward tachycardia. One patients died due to multiorgan failure. Average period of hospitalization amounted 2.24 days. Co-poisoning with ethanol was associated with higher frequency of circulatory system disturbances. RESULTS: Clinical pattern of poisoning with novel drugs could partially correspond with mild sympathomime. tic syndrome.