Rethinking the Paradigm and Practice of Occupational Health in a World Without Decent Work: A Perspective From East and Southern Africa.

The global political economy is generating new forms and growing shares of informal, insecure, and precarious labor, adding to histories of insecure work and an externalization of social costs. The COVID-19 pandemic has highlighted the consequences of ignoring such signals in terms of the increased risk and vulnerability of insecure labor. This paper explores how such trends are generating intersecting adverse health outcomes for workers, communities, and environments and the implications for breaking siloes and building links between the paradigms, science, practice, and tools for occupational health, public health, and eco-health. Applying the principle of controlling hazards at the source is argued in this context to call for an understanding of the upstream production and socio-political factors that are jointly affecting the nature of work and employment and their impact on the health of workers, the public, and the planet.

Exploring Occupational Health Professionals Understanding and Needs in Regard to Total Worker Health (TWH).

BACKGROUND: Occupational health professionals (OHPs) are in a unique position to impact the health and well-being of employees at work and outside of work. One way of achieving this holistic health goal is to integrate the concept of Total Worker Health® (TWH) into the organization's culture. It is critical for OHPs to develop the ability to incorporate TWH into their practices, yet there are gaps in our understanding of OHP's attitudes toward change and toward TWH, their level of TWH knowledge, and the number of OHPs who have adopted TWH. METHODS: An electronic survey was administered to a national sample of 4,777. This cross-sectional study used Qualtrics to record survey responses measuring knowledge of TWH, attitude toward change, resistance to change, transformational leadership ability, perception of organizational readiness, and leadership commitment. FINDINGS: The total sample size was 253 (5.3%). Most respondents were bachelors prepared nurses (75.1%) with greater than 10 years' experience (71.5%) and employed in manufacturing (42.6%). Approximately 74% (n = 125) of respondents knew about TWH, but did not have a program in place or were unsure of the existence of one. A high percentage (74.0%) were open to implementing TWH, had favorable attitudes toward change (M = 3.9 on a 5-point Likert-type scale), but needed education on how to move forward (56.0%). CONCLUSIONS/APPLICATION TO PRACTICE: Findings suggest that most OHPs know about TWH, but generally have not adopted the TWH concept at their worksites. However, they are open to implementing TWH programs and have favorable attitudes toward change.

The challenge of maintaining necessary vascular and endovascular services at a referral center in Northern Italy during the COVID-19 outbreak.

OBJECTIVES: The Padova Hospital Vascular Surgery Division is located in Veneto, one of the area of the Northern Italy most hit by the Coronavirus disease 2019 outbreak. The aim of this paper is to describe the protocols adopted and to evaluate their impact during the acute phase of Coronavirus spread, focusing on the management of elective and urgent/emergent surgery, outpatients activity, and also health staff preservation from intra-hospital Coronavirus disease 2019 infection. METHODS: Several measures were progressively adopted in the Padova University Hospital to front the Coronavirus disease 2019 outbreak, with a clear strong asset established by 9 March 2020, after the Northern Italy lockdown. Since this date, the Vascular Surgery Unit started a "scaled-down" activity, both for elective surgical procedures and for the outpatient Clinical activities; different protocols were developed for health preservation of staff and patients. We compared a two months period, 30 days before and 30 days after this time point. In particular, emergent vascular surgery was regularly guaranteed as well as urgent surgery (to be performed within 24 h). Elective cases were scheduled for "non-deferrable" pathology. A swab test protocol for COVID-19 was applied to health-care professionals and hospitalized patients. RESULTS: The number of urgent or emergent aortic cases remained stable during the two months period, while the number of Hospital admissions via Emergency Room related to critical limb ischemia decreased after national lockdown by about 20%. Elective vascular surgery was scaled down by 50% starting from 9 March; 35% of scheduled elective cases refused hospitalization during the lockdown period and 20% of those contacted for hospitalization where postponed due to fever, respiratory symptoms, or close contacts with Coronavirus disease 2019 suspected cases. Elective surgery reduction did not negatively influence overall carotid or aortic outcomes, while we reported a higher major limb amputation rate for critical limb ischemia (about 10%, compared to 4% for the standard practice period). We found that 4 out of 98 (4%) health-care providers on the floor had an asymptomatic positive swab test. Among 22 vascular doctors, 3 had a confirmed Coronavirus disease 2019 infection (asymptomatic); a total of 72 swab were performed (mean = 3.4 swab/person/month) during this period; no cases of severe Coronavirus disease 2019 (deaths or requiring intensive care treatment) infection were reported within this period for the staff or hospitalized patients. CONCLUSIONS: Elective vascular surgery needs to be guaranteed as possible during Coronavirus disease 2019 outbreak. The number of truly emergent cases did not reduce, on the other side, Emergency Room accesses for non-emergent cases decreased. Our preliminary results seem to describe a scenario where, if the curve of the outbreak in the regional population is flattened, in association with appropriate hospitals containment rules, it may be possible to continue the activity of the Vascular Surgery Units and guarantee the minimal standard of care.

The Rise of Shop Floor Ergonomics: A Personal Perspective.

OCCUPATIONAL APPLICATIONS Based on a 45-year career as a practitioner in industrial ergonomics, I offer in this paper a personal memoir on how ergonomics came to the shop floor in North America, involving ordinary workers in an early effort to prevent what was at the time an unknown problem - work-related Musculoskeletal Disorders. The actions included the beginning of a low-tech, practical improvement process that is still effective today. In total, the experience can provide encouragement to everybody to be confident in their ability when trying new endeavors and to remember that small initial steps can eventually lead to major change.

Nuevos paradigmas en seguridad y salud en el trabajo / New paradigms in occupational safety and health

Los paradigmas en seguridad y salud en el trabajo (SST) nacieron bajo la influencia de las compañías aseguradoras que alimentaron con su data a Heinrich (1931) quien publicó una obra que durante décadas ha sido la guía del personal de seguridad e higiene ocupacional (SHO), en que hace ver que los daños a la salud y la vida de los trabajadores son responsabilidad de los afectados y no de las condiciones y ambiente de trabajo, de la organización del trabajo, ni mucho menos del objetivo de la reproducción del capital, que ha llevado a que se desarrollan acciones de previsión del efecto, como la dotación de implementos de protección personal y colectiva, así como programas basados en el comportamiento del personal y no la prevención del peligro originado en los materiales, en la máquina, la herramienta, el procedimiento, por lo cual continúan sucediéndose incidentes fatales y graves. Para superar esos paradigmas, luego de analizar como impactan, se plantean algunas propuestas como: desarrollo de la perspectiva holística, uso adecuado del léxico en SHO, incorporación de la práctica de la confiabilidad de equipos y procesos al trabajo y el desarrollo de un modelo de gestión que tome en cuenta: al proceso social de trabajo, al objeto a transformar en un bien o un servicio, el estado de los activos y la caracterización tanto del objeto como de los activos, en una dinámica integradora, impulsada por un proceso de mejora continua(AU)

Paradigms in occupational safety and health (OSH) were born under the influence of the insurance companies that provided Heinrich (1931) with his data, who published a work that for decades has been the guide of OSH professionals. His findings, suggested that damages to the health and life of the workers are the responsibility of those affected and not the conditions and work environment, the organization of work, or much less the objective of the growth of capital. This approach led to the development of actions to mitigate or limit the effects of a hazard, such as the provision of personal and collective protective equipment, as well as employee-based behavioral programs and not the primary prevention of hazards related to the materials, machinery, tools, or tasks; hence fatal, serious incidents continue to occur. To overcome these paradigms, after analyzing their impact, we propose other approaches. Among these, the development of a more holistic perspective, adequate use of the OSH lexicon in OSH, incorporation of equipment reliability of equipment, work processes and management models that consider the social work process, the object to be transformed into a good or a service, the state of the assets and the characterization of both the object and the assets, in an integrative dynamic, driven by a process of continuous improvement(AU)

Toward an Expanded Focus for Occupational Safety and Health: A Commentary.

Powerful and ongoing changes in how people work, the workforce, and the workplace require a more holistic view of each of these. We argue that an expanded focus for occupational safety and health (OSH) is necessary to prepare for and respond rapidly to future changes in the world of work that will certainly challenge traditional OSH systems. The WHO Model for Action, various European efforts at well-being, and the Total Worker Health concept provide a foundation for addressing changes in the world of work. However, a paradigm expansion to include the recognition of worker and workforce well-being as an important outcome of OSH will be needed. It will also be vital to stimulate transdisciplinary efforts and find innovative ways to attract and train students into OSH professions as the paradigm expands. This will require active marketing of the OSH field as vibrant career choice, as a profession filled with meaningful, engaging responsibilities, and as a well-placed investment for industry and society. An expanded paradigm will result in the need for new disciplines and specialties in OSH, which may be useful in new market efforts to attract new professionals. Ultimately, to achieve worker and workforce well-being we must consider how to implement this expanded focus.

Health-promoting leadership: An integrative review and future research agenda.

AIM: To provide a synthesis of the evidence of health-promoting leadership related to nursing by exploring definitions, core attributes and critical conditions. BACKGROUND: Increasing pressure in healthcare settings due to efficiency requirements, population ageing with complex illnesses and projected global shortage of nurses, is a potential threat to nurses' health and job satisfaction, and patient quality of care and safety. New ways of thinking about nursing leadership and evidence-based human resource management are required to improve nursing environments. DESIGN: Integrative literature review. DATA SOURCES: Eight databases were searched: Academic Search Premier, CINAHL, Emerald, ERIC, Web of Science, MEDLINE, Psychinfo and Science Direct. Included papers were published between 2000-2016. REVIEW METHODS: Of 339 papers, 13 were eligible for inclusion: eight qualitative and five quantitative. Studies were assessed for quality using standardized checklists. Framework-based synthesis was used, allowing for themes identified a priori to be specified as coding categories. This method also allows new themes to emerge de novo. RESULTS: Four themes were identified. There are multiple definitions of health-promoting leadership, along with description of the non-health-promoting leader. The health-promoting nurse leader engages in employees' health promotion, and takes responsibility for actions and maintains open communication, accommodating nurses' participation in change processes. Through competence development, the health-promoting organization builds capacity. CONCLUSION: Health-promoting leadership may be a promising path to optimizing nursing outcomes through holistic thinking, which emphasizes the importance of context. Accumulated research is required to build a stronger line of international research, with attention to underlying mechanisms, limiting conditions and behaviours known to health-promoting leadership.

A Framework for Integrating Environmental and Occupational Health and Primary Care in a Postdisaster Context.

CONTEXT: Integration of environmental and occupational health (EOH) into primary care settings is a critical step to addressing the EOH concerns of a community, particularly in a postdisaster context. Several barriers to EOH integration exist at the physician, patient, and health care system levels. PROGRAM: This article presents a framework for improving the health system's capacity to address EOH after the Deepwater Horizon oil spill and illustrates its application in the Environmental and Occupational Health Education and Referral (EOHER) program. This program worked with 11 Federally Qualified Health Center systems in the Gulf Coast region to try to address the EOH concerns of community members and to assist primary care providers to better understand the impact of EOH factors on their patients' health. IMPLEMENTATION: The framework uses a 3-pronged approach to (1) foster coordination between primary care and EOH facilities through a referral network and peer consultations, (2) increase physician capacity in EOH issues through continuing education and training, and (3) conduct outreach to community members about EOH issues. EVALUATION: The EOHER program highlighted the importance of building strong partnerships with community members and other relevant organizations, as well as high organizational capacity and effective leadership to enable EOH integration into primary care settings. Physicians in the EOHER program were constrained in their ability to engage with EOH issues due to competing patient needs and time constraints, indicating the need to improve physicians' ability to assess which patients are at high risk for EOH exposures and to efficiently take environmental and occupational histories. DISCUSSION: This article highlights the importance of addressing EOH barriers at multiple levels and provides a model that can be applied to promote community health, particularly in the context of future natural or technological disasters.

Effects of mindfulness meditation on occupational functioning and health care utilization in individuals with anxiety.

OBJECTIVES: To examine the effect of mindfulness meditation on occupational functioning in individuals with Generalized anxiety disorder (GAD). METHODS: Fifty-seven individuals with GAD (mean (SD) age=39 (13); 56% women) participated in an 8-week clinical trial in which they were randomized to mindfulness-based stress reduction (MBSR) or an attention control class. In this secondary analysis, absenteeism, entire workdays missed, partial workdays missed, and healthcare utilization patterns were assessed before and after treatment. RESULTS: Compared to the attention control class, participation in MBSR was associated with a significantly greater decrease in partial work days missed for adults with GAD (t=2.734, df=51, p=0.009). Interestingly, a dose effect was observed during the 24-week post-treatment follow-up period: among MBSR participants, greater home mindfulness meditation practice was associated with less work loss and with fewer mental health professional visits. CONCLUSION: Mindfulness meditation training may improve occupational functioning and decrease healthcare utilization in adults with GAD.

Adicción al trabajo: características, detección y prevención desde una perspectiva integral / Workaholics: characteristics, identification and prevention from a holistic perspective

Introducción: El trabajo otorga a la persona el sentido de su identidad, influye en su autoestima y le da legitimación ante la familia y sociedad. No obstante, hay una fracción de trabajadores que lo llevan a cabo de forma muy intensa y compulsiva, lo cual tiene consecuencias negativas. Esto configura un trastorno que se conoce como adicción al trabajo. Objetivo: Describir las características de la adicción al trabajo y factores que predisponen a la misma, así como las acciones preventivas de la adicción al trabajo a nivel organizacional e individual. Material y Método: Revisión de publicaciones y lectura crítica-reflexiva sobre la adicción al trabajo en bases de datos Medline, Cuiden, Cochrane, Pubmed y Google Académico mediante las palabras claves: enfermería, adicción al trabajo y sintomatología clínica durante el año 2013. Resultados: La aparición de síntomas físicos son generalmente indicadores para la detección de la adicción al trabajo, sin embargo, estos síntomas físicos por sí solos no permiten señalar una posible adicción, siendo preciso evaluar también aspectos psicológicos y relaciones sociales. Conclusiones: Resulta difícil diferenciar entre dedicación al trabajo y adicción al trabajo por cuatro motivos fundamentales: 1) la no aceptación del problema por parte del laborodependiente 2) las personas muy trabajadoras son alabadas dentro de la sociedad, la excesiva dedicación es considerada como una cualidad; 3) la falta de información hacia la población para la concienciación de la adicción al trabajo como enfermedad; 4) la no contemplación de la adicción al trabajo dentro de los manuales de criterios diagnósticos (CIE-10) (AU)

Introduction The work gives the person a sense of identity, affects its self-esteem and gives legitimacy to the family and society. However, there is a fraction of workers who carry it out in a very intense and compulsive way, which has negative implications. This sets a condition known as work addiction. Objective To describe the characteristics of workaholism and factors that predispose to it, as well as preventive actions to avoid workaholism at organizational and individual level. Methods: Literature review and critical and reflexive reading. workaholism within the following database: Medline, Cuiden, Cochrane, Pubmed and Google Scholar using as keywords: nursing, workaholism and clinical symptomatology during 2013. Results: The appearance of physical symptoms are usually indicators for detecting workaholism, however, these physical symptoms alone do not allow to point out a possible addiction, being also necessary to evaluate psychological and social aspects. Conclusions: It is difficult to differentiate between hard work and workaholism for four main reasons: 1) the rejection of the problem by the person affected 2) hardworking people are praised in society, excessive devotion is regarded as a quality 3) the lack of information to the population for awareness raising of work addiction as a disease, 4) non-existence of workaholism within the criteria of diagnostic manuals (ICD-10) (AU)

[Paradigm shift in health: forecasting and causation as a basis for risk management].

The problem of occupational risk management (ORM) is discussed using the evidence-based medicine approach and bio- and IT-technologies. The prognosis and causation of work-related health disorders are analyzed as components of ORM system. The Web-based handbook "Occupational risk assessment" with software and information materials as practical tool is presented.

Alveolitis alérgica extrínseca: forma de presentación inicial como fiebre de origen desconocido / Extrinsic allergic alveolitis: an initial form of presentation as a fever of unknown origin

La alveolitis alérgica extrínseca se caracteriza por un proceso inflamatorio inmunológico con afectación pulmonar producida por inhalación de polvo orgánico. Se considera una enfermedad laboral y es una causa muy importante de incapacidad transitoria y permanente que se puede evitar. Ocasionalmente el diagnóstico no es sencillo, pero es importante realizarlo en los primeros estadios, cuando todavía es reversible la enfermedad (AU)

Extrinsic allergic alveolitis is characterised by an inflammatory immune process with pulmonary impairment caused by inhalation of organic dust. It is considered an occupational disease and is a very significant cause of temporary and permanent disability that can be prevented. The diagnosis is not often easy, but it is important to make it in the early stages, when the disease is still reversible (AU)

Economic burden of depression in South Korea.

BACKGROUND: A recent national survey in South Korea indicated that the 12-month prevalence rate of major depressive disorder was 2.5%. Depressive disorders may lead to disability, premature death, and severe suffering of patients and their families. This study estimates the economic burden of depression in Korea from a societal perspective. METHODS: Annual direct healthcare costs associated with depression were calculated based on the National Health Insurance database. Annual direct non-healthcare costs were estimated for transport. Annual indirect costs were estimated for the following components of productivity loss due to illness such as morbidity (absenteeism and presenteeism) and premature mortality. Indirect costs were estimated using the large national psychiatric epidemiological surveys in Korea. The human capital approach was used to estimate indirect costs. RESULT: The total cost of depression was estimated to be $4,049 million, of which $152.6 million represents a direct healthcare cost. Total direct non-healthcare costs were estimated to be $15.9 million. Indirect costs were estimated at $3,880.5 million. The morbidity cost was $2,958.9 million and the mortality cost was $921.6 million. The morbidity cost was identified as the largest component of overall cost. CONCLUSION: Depression is a considerable burden on both society and the individual, especially in terms of incapacity to work. The Korean society should increase the public health effort to prevent and detect depression in order to ensure that appropriate treatment is provided. Such actions will lead to a significant reduction in the total burden resulting from depression.

[Comparative analysis of ecologic safety in major oil processing enterprise, using criteria of public health risks].

Comparative analysis covered ecologic safety of production branches in major oil processing enterprise. According to health risk criteria, maximal jeopardy levels appear to be connected with respiratory diseases caused by fuel components, deep oil refining complex and biologic treatment facilities.

EB120/28 Rev.1: Salud de los trabajadores: proyecto de plan de acción mundial. Informe de la Secretaría / EB120/28 Rev.1: Workers' Health: draft global plan of action. Report of the Secretariat

En virtud de la resolución WHA49.12, la 49ª Asamblea Mundial de la Salud hizo suya la estrategia mundial de la OMS de salud ocupacional para todos e instó a los Estados Miembros a que elaboraran programas nacionales de salud ocupacional para todos los trabajadores y, en particular, para los de los sectores de alto riesgo, los grupos vulnerables y las poblaciones subatendidas. Posteriormente, en diversas reuniones de alto nivel, como la Cumbre Mundial sobre el Desarrollo Sostenible (Johannesburgo, Sudáfrica, 2002), y conferencias ministeriales regionales sobre la salud, el trabajo y el medio ambiente, se ha instado a la OMS a reforzar aún más su labor en el ámbito de la salud ocupacional y a vincular ésta con la promoción de la salud. Así pues, la Secretaría ha preparado un proyecto de plan de acción mundial sobre la salud de los trabajadores 2008-2017 para establecer un marco normativo que permita la adopción de medidas concertadas para proteger, promover y mejorar la salud de todos los trabajadores. El plan se ha elaborado sobre la base de las propuestas relativas a la adopción de medidas nacionales e internacionales presentadas por 104 países en una encuesta llevada a cabo en 2005 y teniendo en cuenta las orientaciones consignadas en el Undécimo Programa General de Trabajo y el Plan Estratégico a Plazo Medio 2008-2013. Para ultimar el documento, se consultó a los Estados Miembros, a organizaciones internacionales de empleadores y sindicatos y a los centros colaboradores de la OMS para la salud de los trabajadores. Se prevé que el plan estimulará el desarrollo de políticas, infraestructura, tecnologías y alianzas, lo cual contribuirá a alcanzar el nivel básico de protección sanitaria en todos los lugares de trabajo. (AU)