A Repository for Publications on Basic Occupational Health Services and Similar Health Care Innovations.

Background: Occupational health services are not available for more than 80% of the global workforce. This pertains especially to informal workers, workers in agriculture and in small enterprises, and self-employed. Many are working in hazardous conditions. The World Health Organization, the International Labor Organization, the International Commission on Occupational Health, and the World Organization of Family Doctors promote as part of a solution, basic occupational health services (BOHS) integrated in primary or community health care. Quality information on this topic is difficult to find. The objective of this study is to develop an open access bibliography, a repository, referring to publications on BOHS and similar innovations, to support progress and research. Methods: The database design and sustaining literature searches (PubMed, Google Scholar, SciELO) are described. For each publication selected, basic bibliographic data, a brief content description considering copyright restrictions, and a hyperlink are included. Results: Searches resulted in a database containing 189 references to publications on BOHS such as articles in scientific journals, reports, policy documents, and abstracts of lectures. A global perspective is applied in 43 publications, a national or regional perspective is applied in 146 publications. Operational and evaluative research material is still scarce. Examples of references to publications are shown. Conclusion: The repository can inspire pioneers by showing practices in different countries and can be used for reviews and in-depth analyses. Missing publications such as from China, Russia, Japan, Republic of Korea, and Spanish/Portuguese speaking countries, can be added in the future, and translated. Search functions can be developed. International collaboration for the promotion of occupational health coverage for all workers must be intensified.

Where to Find Evidence-Based Information on Occupational Safety and Health?

Background: Occupational Safety and Health (OSH) professionals must base their advice and interventions on evidence from science, in balance with their expertise, and with workers' and other stakeholders' values and preferences. Evidence-based professional practice is one of the remedies against misinformation creating confusion and distrust in the society. Objectives: To present, for OSH professionals, an overview and critical considerations about concepts, strategies, and tools needed for an accurate search for evidence-based information. Methods: Information sources have been collected and discussed as a base for a documented vision on knowledge questions, online information sources, search engines, databases, and tools. Results: Every search should start with a carefully phrased question. To help finding a reliable answer, potential evidence-based online sources are presented. Systematic reviews and original scientific articles are regarded as primary sources. Secondary and tertiary sources are discussed, such as practice guidelines, point-of-care summaries, advisory reports, quality websites or apps, Wikipedia, quality videos, and e-lessons. To find sources, adequate use of search engines and databases is required. Examples are discussed briefly, such as PubMed/MEDLINE, Virtual Health Library, NICE, Cochrane Library, Cochrane Work, Google (Scholar), and YouTube. Conclusions: Evidence-based practice in OSH must be stimulated, relying mainly on trusted online sources. The breadth of appropriate information sources is wider than described in most publications. Search engines facilitate the finding of quality reports, videos, e-courses, and websites. Such sources can be explored by well-trained professionals to complement the use of scientific articles, reviews, point-of-care summaries, and guidelines. Adequate use of online information sources requires awareness, motivation, and skills in professionals and educators. To date, the quality of skills in searching is low, thus a more adequate education is crucial. The quality of sources, search engines, and databases will be considered more thoroughly in another study. International collaboration is profitable and needs new drivers.

Development and Evaluation of a Training Program on Occupational Health Research and Surveillance in Turkey.

OBJECTIVES: The aim of this study was to increase knowledge and skills regarding occupational health surveillance and research in professionals. METHODS: Following the Analysis, Design, Development, Implementation, and Evaluation model, several training modules have been designed and implemented in the course of 2016. Evaluation forms were distributed to 42 participants before the start and after each training module to measure changes in knowledge, skills, and self-efficacy. RESULTS: The majority of the participants were satisfied and found the training relevant and interesting for adult learners. The level of self-efficacy increased after the trainings. Females and occupational physicians displayed higher scores than men and other disciplines. After 1 year, the self-efficacy level decreased, but the level was still substantially higher than before the training. CONCLUSIONS: Feedback on the implemented training program was favorable. Participants were able to acquire and apply competencies in the subject matter at short and long term.

Cardiorespiratory fitness and physical strain during prosthetic rehabilitation after lower limb amputation.

BACKGROUND: Sufficient cardiorespiratory fitness has been regarded a prerequisite for prosthetic walking. In order to improve cardiorespiratory fitness, adequate strain ought to be placed on the system during training. OBJECTIVES: To determine cardiorespiratory fitness at the start and end of inpatient rehabilitation after lower limb amputation and determine the physical strain experienced during conventional prosthetic rehabilitation. STUDY DESIGN: Multicenter prospective cohort study. METHODS: Cardiorespiratory fitness was assessed using a peak one-legged cycle exercise test. Physical strain was assessed during a minimum of three full rehabilitation days using heart rate recordings. Physical strain was expressed in the time per day that heart rate exceeded 40% of heart rate reserve. RESULTS: At the start of rehabilitation, peak aerobic capacity was on average 16.9 (SD, 6.5) mL/kg/min (n = 33). Overall, peak aerobic capacity did not improve over the course of rehabilitation (n = 23, p = 0.464). Fifty percent of the patients experienced a physical strain level that satisfies minimum criteria for maintaining cardiorespiratory fitness (>40% heart rate reserve for 30 min/day). CONCLUSION: Cardiorespiratory fitness was low and did not increase during conventional prosthetic rehabilitation. On average, the physical strain during rehabilitation was insufficient to elicit potential improvements in aerobic capacity. Results stress the need for dedicated physical training modules at the individual level. CLINICAL RELEVANCE: This study shows that clinicians ought to be aware of the relatively low cardiorespiratory fitness of people who have undergone lower limb amputation and that improvements during rehabilitation are not always obtained. Results stress the need for physical training modules in which intensity is imposed at the individual level.

Prevention of Occupational Diseases in Turkey: Deriving Lessons From Journey of Surveillance.

INTRODUCTION: To prevent and manage the societal and economic burden of occupational diseases (ODs), countries should develop strong prevention policies, health surveillance and registry systems. This study aims to contribute to the improvement of OD surveillance at national level as well as to identify priority actions in Turkey. METHODS: The history and current status of occupational health studies were considered from the perspective of OD surveillance. Interpretative research was done through literature review on occupational health at national, regional and international level. Analyses were focused on countries' experiences in policy development and practice, roles and responsibilities of institutions, multidisciplinary and intersectoral collaboration. OD surveillance models of Turkey, Belgium and the Netherlands were examined through exchange visits. Face-to-face interviews were conducted to explore the peculiarities of legislative and institutional structures, the best and worst practices, and approach principles. RESULTS: Some countries are more focused on exploring OD trends through effective and cost-efficient researches, with particular attention to new and emerging ODs. Other countries try to reach every single case of OD for compensation and rehabilitation. Each practice has advantages and shortcomings, but they are not mutually exclusive, and thus an effective combination is possible. CONCLUSION: Effective surveillance and registry approaches play a key role in the prevention of ODs. A well-designed system enables monitoring and assessment of OD prevalence and trends, and adoption of preventive measures while improving the effectiveness of redressing and compensation. A robust surveillance does not only provide protection of workers' health but also advances prevention of economic losses.

Chronic solvent-induced encephalopathy: course and prognostic factors of neuropsychological functioning.

PURPOSE: Working in conditions with daily exposure to organic solvents for many years can result in a disease known as chronic solvent-induced encephalopathy (CSE). The aims for this study were to describe the neuropsychological course of CSE after first diagnosis and to detect prognostic factors for neuropsychological impairment after diagnosis. METHODS: This prospective study follows a Dutch cohort of CSE patients who were first diagnosed between 2001 and 2011 and underwent a second neuropsychological assessment 1.5-2 years later. Cognitive subdomains were assessed and an overall cognitive impairment score was calculated. Paired t tests and multivariate linear regression analyses were performed to describe the neuropsychological course and to obtain prognostic factors for the neuropsychological functioning at follow-up. RESULTS: There was a significant improvement on neuropsychological subdomains at follow-up, with effect sizes between small and medium (Cohen's d 0.27-0.54) and a significant overall improvement of neuropsychological impairment with a medium effect size (Cohen's d 0.56). Prognostic variables for more neuropsychological impairment at follow-up were a higher level of neuropsychological impairment at diagnosis and having a comorbid diagnosis of a psychiatric disorder at diagnosis. CONCLUSIONS: Results are in line with previous research on the course of CSE, stating that CSE is a non-progressive disease after cessation of exposure. However, during follow-up the percentage patients with permanent work disability pension increased from 14 to 37%. Preventive action is needed in countries where exposure to organic solvents is still high to prevent new cases of CSE.

One's Workplace, Other's Home? Work and Health of Domestic Workers in Argentina.

BACKGROUND: Domestic workers around the world work and eventually live in private homes where control of working conditions is difficult. OBJECTIVE: The aim of this study was to compare working conditions and its impact on general and mental health in live-in and live-out domestic workers in Argentina. METHODS: In a cross-sectional study, the Spanish version of the European Workings Condition Survey and an ad hoc questionnaire were applied to 201 domestic workers (response 94%). Twelve months' prevalence of verbal or physical workplace violence was assessed. Poor general health was defined by general health self-assessed as poor or fair. Symptoms of common mental disorders (CMD) were considered present if Goldberg's general health score was above 4. Data were analyzed using Chi square's test and logistic regression models. FINDINGS: Live-in workers formed 66% of the participants. They were more likely to take care of the elderly, iron and cook than live-out workers. Workplace violence was reported by 17% of live-in and 24% of live-out workers (p = 0.25). Overall prevalence of poor general health was 23%; 53% reported CMD. After adjustment, violence remained a statistically significant predictor of poor general health (Odds Ratio 7.3; 95% Confidence Interval 2.8-19.1) and CMD (3.2; 1.1-9.3). CONCLUSIONS: Working conditions of live-in and live-out domestic workers are different. However, exposure to workplace violence is common in both groups and affects general and mental health.

Violence at Work and Mental Distress among Firefighters in Guatemala.

BACKGROUND: Firefighting is a highly physically and mentally demanding occupation. In many countries, firefighters are frequently exposed to critical events, violent threats and assault in their job, however, knowledge about its prevalence is limited. In addition, little is known about the impact of workplace violence against firefighters in the development of mental distress. OBJECTIVE: We aimed to determine the prevalence of mental distress in firefighters exposed to workplace violence. METHODS: In this cross-sectional study, 141 male full-time firefighters of Guatemala City and Metropolitan Area (response 80.4%) were invited to answer an interview-based questionnaire including items on sociodemographics, working conditions and mental health (general health questionnaire GHQ-12). Mental distress was defined as a GHQ-12 score above 4. The item '12-months prevalence of violence on the job' included physical violence or sexual abuse from colleagues or the public. Statistical analysis with Epiinfo 7 included descriptive, bivariate and logistic regression analyses. FINDINGS: Exposure to violence at the workplace was common (37%). Prevalence of mental distress was higher in violence-exposed firefighters (54%) than among unexposed firemen (39%; p = 0.08). After adjustment, the odds for distress was not statistically significantly increased for those exposed to violence at the workplace in comparison to the unexposed group (1.87; 0.90-3.87). Especially affected by distress were middle-aged firefighters (40-49 years; adjusted Odds Ratio 2.90; 95% Confidence interval 1.20-7.05) compared to younger firemen (<40 years). CONCLUSIONS: Exposure to violence at the workplace is common in Guatemalan firefighters. Although limited by small numbers, the association between violence and poor mental health is plausible. Therefore, training programs strengthening resilience among firefighters in areas with high crime prevalence are warranted.

Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey.

BACKGROUND: The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice. METHODS: This qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM. RESULTS: Three main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians' actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands. CONCLUSIONS: Physicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.

Evaluation Studies on Education in Occupational Safety and Health: Inspiration for Developing Economies.

BACKGROUND: Education and training of students, workers, and professionals are essential for occupational safety and health (OSH). We noticed a lack of debate on how to advance coverage and quality of OSH education given high shortages in developing economies. OBJECTIVES: International discussion on future options might be stimulated by an overview of recent studies. METHODS: We employed a search of the Cochrane Library and PubMed/MEDLINE databases for articles from the last decade on evaluation of OSH education. FINDINGS: We selected 121 relevant studies and 6 Cochrane reviews. Most studies came from the United States, Western Europe, and Asia. Studies from low-income countries were scarce. From a global perspective, the number of evaluation studies found was disappointingly low and the quality needs improvement. Most commonly workers' education was evaluated, less often education of students, supervisors, and OSH professionals. Interactive e-cases and e-learning modules, video conferences, and distance discussion boards are inspiring educational methods, but also participatory workshops and educational plays. Ways to find access to underserved populations were presented and evaluated, such as educational campaigns, farm safety days, and OSH expert-supported initiatives of industrial branch organizations, schools, and primary, community, or hospital-based health care. Newly educated groups were immigrant workers training colleagues, workers with a disease, managers, and family physicians. CONCLUSIONS: Developing economies can take advantage of a variety of online facilities improving coverage and quality of education. Blended education including face-to-face contacts and a participatory approach might be preferred. For workers, minor isolated educational efforts are less effective than enhanced education or education as part of multifaceted preventive programs. Collaboration of OSH experts with other organizations offers opportunities to reach underserved worker populations. Increasing international collaboration is a promise for the future. National legislation and government support is necessary, placing OSH education high on the national agenda, with special attention for most needed professionals and for underserved workers in high-risk jobs such as in the informal sector. International support can be boosted by a high-level international task force on education and training, funded programming, and a global online platform.

A search strategy to identify studies on the prognosis of work disability: a diagnostic test framework.

OBJECTIVE: Searching the medical literature for evidence on prognosis is an important aspect of evidence-based disability evaluation. To facilitate this, we aimed to develop and evaluate a comprehensive and efficient search strategy in PubMed, to be used by either researchers or practitioners and that will identify articles on the prognosis of work disability. METHODS: We used a diagnostic test analytic framework. First, we created a reference set of 225 articles on the prognosis of work disability by screening a total of 65,692 titles and abstracts from10 journals in the period 2000-2009. Included studies had a minimum follow-up of 6 months, participants in the age of 18-64 with a minimum sick leave of 4 weeks or longer or having serious activity limitations in 50% of the cases and outcome measures that reflect impairments, activity limitations or participation restrictions. Using text mining methods, we extracted search terms from the reference set and, according to sensitivity and relative frequency, we combined these into search strings. RESULTS: Both the research and the practice search filter outperformed existing filters in occupational health, all combined with the Yale-prognostic filter. The Work Disability Prognosis filter for Research showed a comprehensiveness of 90% (95% CI 86 to 94) and efficiency expressed more user-friendly as Number Needed to Read=20 (95% CI 17 to 34). CONCLUSIONS: The Work Disability Prognosis filter will help practitioners and researchers who want to find prognostic evidence in the area of work disability evaluation. However, further refining of this filter is possible and needed, especially for the practitioner for whom efficiency is especially important.

WHEEL-I: development of a wheelchair propulsion laboratory for rehabilitation.

OBJECTIVE: To describe the enabling factors and barriers experienced in the Wheelchair Expert Evaluation Laboratory - implementation (WHEEL-i) project, in which scientific knowledge, tools and associated systematic analyses of hand-rim wheelchair propulsion technique, user's wheelchair propulsion capacity, wheelchair-user interface, and wheelchair mechanics were implemented in 2 rehabilitation centres. DESIGN: Implementation project. PATIENTS: Spinal cord injury. METHODS: In this implementation project standardized tests were performed: wheelchair skills tests, 2 questionnaires, and a steady-state exercise test on a treadmill in which propulsion technique (forces and torques) and physical strain (oxygen uptake, heart rate and mechanical efficiency) were measured. RESULTS: Good interpretation of the test outcomes was the most important barrier. In order to discuss individual wheelchair performance results with patients and clinicians, reference data were developed, smallest detectable differences were calculated and software was developed to simultaneously show video recordings and force and torque signals. CONCLUSION: Based on pilot results, the greatest barrier to systematic monitoring of the individual wheelchair fitting and learning process in rehabilitation with, among others, instrumented measurement wheels, was interpretation of outcomes. For proper interpretation of individual outcomes, the availability of reference data, smallest detectable differences and visualization of outcomes is of utmost importance.

Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study.

BACKGROUND /OBJECTIVES: Environmental exposure and personal susceptibility both contribute to the development of hand eczema. Here, we report an investigation on wet work exposure and its influence on the risk of developing hand eczema in apprentice nurses. METHODS: A prospective cohort study was performed among 721 Dutch apprentice nurses. Participants recorded wet work exposure and symptoms of hand eczema using specially designed diary cards. RESULTS: For 533 apprentice nurses, a follow-up time of 1-3 years was completed. Diary cards were supplied by 383 students. The 1-year period prevalence of hand eczema was 23% in the first year, 25% in the second year and 31% in the third year of follow-up. Eighty-one new cases of hand eczema developed, most of which occurred during the first year of follow-up. In approximately one-third of the participants, wet work exposure exceeded the national guidelines. Frequent hand washing during traineeships [odds ratio (OR) 1.5; 90% confidence interval (CI) 1.0-2.3], frequent hand washing at home (OR 2.3; 90% CI 1.5-3.7) and having a side job involving wet work (OR 1.6; 90% CI 1.0-2.4) were independent risk factors for hand eczema. CONCLUSION: As a considerable number of apprentice nurses had already developed hand eczema during traineeships, more attention should be paid to skin protection in vocational education.

Filaggrin loss-of-function mutations and atopic dermatitis as risk factors for hand eczema in apprentice nurses: part II of a prospective cohort study.

BACKGROUND/OBJECTIVES: Environmental exposure and personal susceptibility both contribute to the development of hand eczema. In this study, we investigated the effect of loss-of-function mutations in the filaggrin gene (FLG), atopic dermatitis and wet work exposure on the development of hand eczema in apprentice nurses. METHODS: Dutch apprentice nurses were genotyped for the four most common FLG mutations; atopic dermatitis and hand eczema history were assessed by questionnaire. Exposure and hand eczema during traineeships were assessed with diary cards. RESULTS: The prevalence of hand eczema during traineeships was higher among subjects with a history of hand eczema reported at inclusion. Hand washing during traineeships and at home increased the risk of hand eczema. After adjustment for the effects of exposure and FLG mutations, an odds ratio of 2.5 (90% confidence interval 1.7-3.7) was found for a history of atopic dermatitis. In this study, an increased risk of hand eczema conferred by FLG mutations could not be shown, but subjects with concomitant FLG mutations and atopic dermatitis showed the highest risk of hand eczema during traineeships. CONCLUSION: A history of atopic dermatitis, a history of hand eczema and wet work exposure were the most important factors increasing the risk of hand eczema during traineeships.

Development and evaluation of a new occupational medicine teaching module to advance self-efficacy and knowledge among medical students.

OBJECTIVES: Self-efficacy is defined as a person's beliefs in his or her abilities to successfully complete a task, and has been shown to influence student motivation and academic achievement. The purpose of this study was to evaluate the impact of a new European teaching module in occupational medicine on undergraduate students' self-efficacy and knowledge in the subject matter. METHODS: Pre-, in-between, and posttraining tests were used to assess self-efficacy and knowledge building of 261 third-year medical students on occupational health issues. Determinants of self-efficacy and knowledge were also identified. Repeated measurement data were analyzed with multilevel statistical procedures. RESULTS: The level of self-efficacy and knowledge in occupational medicine increased after the training. Students who frequently attended the lectures scored significantly higher than sporadic attendees. There was no relation between the level of self-efficacy and the final knowledge score. CONCLUSIONS: Teaching with the new occupational medicine module was effective. Lecture attendance is an important determinant of self-efficacy and performance. Self-efficacy was not associated with knowledge score. Encouraging classroom participation may enhance student achievement.

The mental vitality @ work study: effectiveness of a mental module for workers' health surveillance for nurses and allied health care professionals on their help-seeking behavior.

OBJECTIVES: To study the effectiveness of a mental module for workers' health surveillance for health care workers. METHODS: Nurses and allied health care professionals from one organization were cluster-randomized at ward level to an intervention or control group. The intervention included screening for work functioning impairments and mental health complaints. Positively screened workers were invited to visit their occupational physician. Outcome measures, including help-seeking behavior, work functioning, and mental health, were assessed at baseline, 3-month follow-up, and 6-month follow-up. RESULTS: An effect of study-group × time interaction on help-seeking behavior was found (P = 0.02). Workers in the intervention group showed less work functioning impairments over time than the control group (P = 0.04). CONCLUSION: The module can be used to stimulate help seeking from the occupational physician and to improve functioning in workers with mild to moderate work functioning, mental health complaints, or both. TRIAL NUMBER: NTR2786.