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.

Ethics and Occupational Health in the Contemporary World of Work.

The last two decades have seen increasing attention to professional ethics in the field of occupational health in industrialized and developing countries, partly reflecting the changing world of work, demographic shifts and new technologies. These changes have led to the revisiting of traditional ethical principles and the emergence of ethical issues related to occupational health. This article looks at the problems raised by these ethical concerns and proposes some solutions. We revised the existing literature on the ethical conflict in occupational health in order to identifying drivers and barriers for correct professional ethics. The ethical choices are not only based on balanced risk and benefit assessment for various stakeholders, but there are a number of deontological aspects as well that go beyond the mere benefit domains. There is still no systematic approach for analysing the true extent of these issues and their solutions.

Del consentimiento como prueba / Informed consent as evidence

No disponible

Sanciones por infracciones contra la salud y seguridad en el trabajo en empresas de Peru, 2011-2013 / Penalties for infringements against health and safety at work in companies of Peru, 2011-2013

Objetivo: Determinar las características de sanciones realizadas por la Superintendencia Nacional de Fiscalización (SUNAFIL) del Ministerio de Trabajo (MINTRA) peruano. Metodología: Estudio descriptivo de análisis usando la base de datos del MINTRA acerca de sanciones realizadas entre el 2011-2013. Se describieron datos de la región de la empresa, año, cantidad de trabajadores afectados y tipo de sanción. Resultados: Las empresas del Departamento de Lima tuvieron 3.583.473,45 nuevos soles (1.013.712,43 Euros) en multas en los 3 años. La sanción más común fue por el incumplimiento de implementar un sistema de gestión o no tener un reglamento de seguridad y salud en el trabajo. La norma 27.15 fue la que generó mayor cantidad de multas, por no cumplir las obligaciones relativas al seguro complementario de trabajo de riesgo. Conclusión: Este estudio puede servir de guía a las empresas, para que sepan los puntos que son más sancionados por la entidad peruana que fiscaliza el cumplimiento de la norma, para que la salud y seguridad de los trabajadores sean de calidad (AU)

Aim: To determine the characteristics of sanctions conducted by the National Superintendency of Control (SUNAFIL) from the Peruvian Ministry of Labour (MINTRA). Methodology: Descriptive analysis using MINTRA database about sanctions made between 2011-2013. Data from the region of the company, year, amount, number of workers affected and type of sanction were described. Results: The companies of Lima had S / 2,701,413.75 in fines in 3 years. The most common penalty was for failure to implement a management system or have a health and safety regulations at work. The rule 27.15 was that generated the largest amount of fines for failure to comply with the obligations relating to supplementary insurance for hazardous work. Conclusion: This study may provide guidance to businesses, so they know the points that are sanctioned by the Peruvian organization that monitors compliance with the standard, so that workers have quality health and security (AU)

Bases científicas y bioéticas del análisis de validez en medicina evaluadora / Bioethical and scientific basis of validity analysis in disability assessment medicine

El contexto médico legal en el que se desarrolla la Medicina Evaluadora, permitiendo el acceso a prestaciones económicas, obliga a considerar la validez -firmeza, consistencia y valor legal- en las consultas de valoración médica de incapacidad. Por otra parte, en el ámbito médico asistencial son habituales los casos biomédicamente inexplicables que, además, se acompañan de elevados niveles subjetivos de sufrimiento, para los que se ha propuesto el término MUPS. Lógicamente, para proteger el principio deontológico de Justicia, en un contexto de recursos limitados, resulta necesario considerar una posible distorsión clínica -discrepancias marcadas entre la afectación o las limitaciones funcionales mostradas y los elementos clínicos objetivos- y sus principales causas; desde trastornos conversivos o somatomorfos en el extremo de lo involuntario, hasta el fraude de la simulación pura. Adicionalmente, dado que la enfermedad y la discapacidad son conductas sujetas al aprendizaje y condicionamiento operante, el mismo análisis de validez nos permitirá actuar conforme a los principios de Beneficiencia y No Maleficencia, evitando reforzar las conductas injustificadas de enfermedad que pueden cristalizar en un Síndrome de Invalidez Aprendida

The forensic context in which dissability assessment medicine is practised, allowing access to workers' compensation benefits, requires consideration of the validity -firmness, consistency and legal acceptability- of medical disability assessment interviews. On the other hand, in assistential medicine biomedically unexplained cases -for which the term MUPS is proposed- are common, often accompanied by high levels of subjective suffering. Logically, to protect the ethic principle of Justice in a context of limited resources, to consider any clinical distortion -marked discrepancy between the person's claimed stress or disability and the objective clinical findings- and their root causes, from somatoform or conversion disorders at the end of the involuntary, to pure malingering is mandatory. Additionally, since disease and disability are subject to learning and operant conditioning behaviors, the same validity analysis will allow us to act according to the principles of Beneficence and Non-maleficence, avoiding reinforce abnormal illness behaviors that can crystallize in the Learned Disability Syndrome

Ethical considerations of worksite health promotion: an exploration of stakeholders' views.

BACKGROUND: Developing, implementing and evaluating worksite health promotion requires dealing with all stakeholders involved, such as employers, employees, occupational physicians, insurance companies, providers, labour unions and research and knowledge institutes. Although worksite health promotion is becoming more common, empirical research on ethical considerations of worksite health promotion is scarce. METHODS: We explored the views of stakeholders involved in worksite health promotion in focus group discussions and we described the ethical considerations that result from differences between these views. The focus group discussions were organised per stakeholder group. Data were analysed according to the constant comparison method. RESULTS: Our analyses show that although the definition of occupational health is the same for all stakeholders, namely 'being able to perform your job', there seem to be important differences in the views on what constitutes a risk factor to occupational health. According to the employees, risk factors to occupational health are prevailingly job-related. Labour unions agree with them, but other stakeholders, including the employer, particularly see employee-related issues such as lifestyle behaviour as risk factors to occupational health. The difference in definition of occupational health risk factors translates into the same categorisation of worksite health promotion; employee-related activities and work-related activities. The difference in conceptualisation of occupational health risk factors and worksite health promotion resonates in the way stakeholders understand 'responsibility' for lifestyle behaviour. Even though all stakeholders agree on whose responsibility lifestyle behaviour is, namely that of the employee, the meaning of 'responsibility' differs between employees, and employers. For employees, responsibility means autonomy, while for employers and other stakeholders, responsibility equals duty. This difference may in turn contribute to ambivalent relationships between stakeholders. CONCLUSION: All stakeholders, including employees, should be given a voice in developing, implementing and evaluating worksite health promotion. Moreover, since stakeholders agree on lifestyle being the responsibility of the employee, but disagree on what this responsibility means (duty versus autonomy), it is of utmost importance to examine the discourse of stakeholders. This way, ambivalence in relationships between stakeholders could be prevented.

Stakeholder involvement: how to do it right: article 9 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

INTRODUCTION: Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that healthcare recommendations are informed by the best available research evidence with input from appropriate stakeholders. This is the ninth of a series of 14 articles that were prepared by an international panel to advise guideline developers in respiratory and other diseases on approaches for guideline development. We updated a review of the literature on stakeholder involvement, focusing on six key questions. METHODS: In this review we addressed the following questions. (1) What are "stakeholders"? (2) Why involve stakeholders in guidelines? (3) At what stage should stakeholders contribute to guidelines? (4) What are the potential barriers to integrating stakeholder involvement? (5) How can stakeholders be involved effectively? (6) Should anyone be excluded from the process? We searched PubMed and other databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct our own systematic reviews. Our conclusions are based on available evidence, the experience of guideline developers, and workshop discussions. RESULTS AND DISCUSSION: Stakeholders are all those who have a legitimate interest in a guideline. They include healthcare professionals, patients and caregivers, public and private funding bodies, managers, employers, and manufacturers. Their engagement is justified for several reasons, including limitations of evidence, principles of transparency and democracy, ownership, and potential policy implications. They have a role to play at different points of guideline development, but their involvement can be complex. To be successful, stakeholder engagement needs to be inclusive, equitable, and adequately resourced.

Moral issues in workplace health promotion.

PURPOSE: There is debate to what extent employers are entitled to interfere with the lifestyle and health of their workers. In this context, little information is available on the opinion of employees. Within the framework of a workplace health promotion (WHP) program, moral considerations among workers were investigated. METHODS: Employees from five companies were invited to participate in a WHP program. Both participants (n = 513) and non-participants (n = 205) in the program filled in a questionnaire on individual characteristics, lifestyle, health, and opinions regarding WHP. RESULTS: Nineteen percent of the non-participants did not participate in the WHP program because they prefer to arrange it themselves, and 13% (also) preferred to keep private life and work separate. More participants (87%) than non-participants (77%) agreed with the statement that it is good that employers try to improve employees' health (χ(2) = 12.78, p = 0.002), and 26% of the non-participants and 21% of the participants think employer interference with their health is a violation of their privacy. Employees aged 50 year and older were more likely to agree with the latter statement than younger workers (OR = 1.56, 95% CI 1.02-2.39). CONCLUSION: This study showed that most employees support the importance of WHP, but in a modest group of employees, moral considerations may play a role in their decision whether or not to participate in WHP. Older workers were more likely to resist employer interference with their health. Therefore, special attention on such moral considerations may be needed in the communication, design, and implementation of workplace health promotion programs.

[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.

Challenges of a worksite health promotion project.

It is estimated that American employers spend more than $900 billion annually on health care and that obesity-attributable health care expenditures total $75 billion. The authors discuss a yearlong health promotion research project aimed at obesity and involving eight small manufacturing companies. Three hundred forty-one employees randomly selected at the intervention and control worksites were followed at baseline and at 3, 6, and 12 months for anthropometric measures, lifestyle behaviors, absences, and work performance. The authors conclude that although the worksite offers unique opportunities to develop health promotion programs, these efforts are not without challenges due to the tensions regarding the need to protect and promote health for the population, the increasing concerns over health care costs and access, and the priority to maintain individuals' rights and privacy.

[Ethical aspects of workplace health management]. / Ethische Aspekte des betrieblichen Gesundheitsmanagements.

Ethical issues have always been part of the debate around work and its relation to people. In the context of workplace health management, however, ethical considerations have received little attention to date. This paper discusses some examples of the ethical questions arising in the pursuit of workplace health management, such as issues around the organization of work procedures, double loyalties, the significance of occupational screening examinations or how people in precarious working conditions are being dealt with. Subsequently, two ethical codes commonly used in the field of work and health in German-speaking countries are introduced. They originate from the field of occupational medicine, but have meanwhile been opened to other professions in the field of work and health. Finally, some perspectives for further discussion are put forward.

[Efficiency of the patient's signature in examinations performed by the occupational medicine doctor]. / Skutecznosc podpisu pacjenta w badaniach wykonywanych przez lekarzy medycyny pracy.

BACKGROUND: A special relationship occurring between the doctor and the patient, besides many stipulations of the ethical nature, is controlled by numerous legal regulations. In the Polish legislative system, there are no clear and unequivocal regulations that would precisely define the diagnostic-therapeutic process. Communication, namely the exchange of information between the doctor and the patient plays a particular role in this process in which the doctor bears much greater responsibility than the patient, and thus is obliged to provide the patient with the comprehensible information presented in such a way that he or she would be able to interpret it properly. MATERIAL AND METHODS: The analysis comprised the binding legislation concerning prophylactic examination as well as drivers examination. The problem was discussed taking into account the current court judgments. RESULTS: The doctor should pay particular attention to adjusting the quality, quantity and way of conveying the information to the patient's ability to acquire and interpret it properly. This ability is associated with the patient's personal traits. There are no algorithms for the doctor-patient communication. The occupational medicine doctors are in a better situation as legislative regulations pertaining to specificity of their health services may indicate proper communication between the doctor and the patient. CONCLUSIONS: The importance of this communication has been notified in the legislative doctrine, where the idea of informative mistake has been formed. Such a mistake may have significant consequences especially for the occupational medicine doctors due to the specificity of performed functions. The article discusses legislative aspects concerning the exchange of information at the doctor-patient level, and presents some examples of judgments of Polish courts as well as numerous indications useful in everyday practice.

Privacy and dual loyalties in occupational health practice.

This survey set out to explore occupational health professionals' courses of action with respect to privacy in a situation of dual loyalty between employees and employers. A postal questionnaire was sent to randomly selected potential respondents. The overall response rate was 64%: 140 nurses and 94 physicians returned the questionnaire. Eight imaginary cases involving an ethical dilemma of privacy were presented to the respondents. Six different courses of action were constructed within the set alternatives proposed. The study indicated that privacy as an absolute value is not in the interest of either employees or employers. It also showed that, where dual loyalty is concerned, the most valid course of action in dealing with sensitive subjects such as drug and work community problems, sexual harassment and sick leave is to rely on tripartite co-operation. If they maintain their professional independence and impartiality, health professionals are well placed to succeed in this challenging task; if not, there are bound to be severe violations of privacy.

Sensitivity towards patient needs in the occupational health consultation.

BACKGROUND: Many employers in Finland provide not only preventive health care but also primary care for their employees. This puts occupational health professionals (OHPs) in a dual role, which in turn raises questions about patient privacy. AIM: To investigate occupational health nurses' (n = 140) and physicians' (n = 94) perceptions of privacy in caring relationships. METHODS: A self-administered questionnaire was sent to 183 occupational health (OH) physicians and 183 OH nurses. Descriptive statistics and frequency tables were used to characterize the variables. The differences between nurses and physicians were determined with Pearson's chi-square tests and Fisher's exact tests. RESULTS: Both nurses and physicians felt that physical, social, psychological and informational privacy was important in the OH setting. The duration of work experience did affect perceptions of privacy. One-third of respondents considered it good practice to take a full medical history from prospective employees as part of the pre-employment assessment. Over half of the OHPs found the currently valid requirements concerning patients' information privacy too strict in that they may in certain cases complicate the provision of care and treatment. CONCLUSIONS: Tact and sensitivity are paramount when dealing with patient privacy. The aim of privacy, however, should not be to conceal information, but rather to prevent any harmful disclosure.