Early Occupational Intervention for People with Low Back Pain in Physically Demanding Jobs: 1-year Follow-up Results of the Randomized Controlled GOBACK Trial.

STUDY DESIGN: Randomized controlled trial with 1-year follow up. OBJECTIVE: The aim of this study was to assess whether people with low back pain (LBP) and self-reported physically demanding jobs, benefit from an occupational medicine intervention, in addition to a single hospital consultation and a magnetic resonance imaging, at 1 year of follow-up. Secondly, to examine whether the positive health effects, found in both groups at 6 months, persist at 1-year follow-up. SUMMARY OF BACKGROUND DATA: The prevalence of LBP is high in the working population, resulting in a substantial social and economic burden. Although there are many guidelines available on the management of LBP, including multidisciplinary biopsychosocial rehabilitation, they provide limited guidance on the occupational medicine aspects. METHODS: As reported previously, 305 participants with LBP and self-reported physically demanding jobs were enrolled in the randomized controlled study and randomly allocated to clinical care with additional occupational medicine intervention or clinical care alone. Data were collected at baseline, 6 months, and 1 year. Outcomes included in the present 1-year follow-up study are changes in neuropathic pain (painDETECT questionnaire), severity of pain (0-10 numerical rating scale), disability (Roland Morris Disability Questionnaire), fear-avoidance beliefs (FABQ), physical, and mental quality of life (short-form 36). RESULTS: The study showed no effect of an occupational intervention on neuropathic pain, fear-avoidance beliefs, physical and mental quality of life nor disability measured after 1 year. The positive effects found at 6 months in both groups, remained at 1-year follow-up. CONCLUSION: The results suggest that a thorough clinical consultation, with focus on explaining the cause of pain and instructions to stay active, can promote long-lasting physical and mental health in individuals with LBP. Therefore, additional occupational interventions could focus on altering occupational obstacles on a structural level.Level of Evidence: 2.

El olvidado papel de los médicos del trabajo en España durante la pandemia Covid-19 / The lost function of Occupational Medicine in Spain during the Covid-19 pandemic

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Pandemia COVID-19 y Medicina del Trabajo / COVID-19 Pandemia and Occupational Medicina

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Medical management, prevention and mitigation of environmental risks factors in Neurology.

The human environment and exposures arising therefrom are major contributors to neurological disorders ranging from stroke to neurodegenerative diseases. Reduction of exposure to environmental risk factors, with the goal of disease prevention or control, is addressed at the individual as well as the societal level and in recognition of differential subject vulnerability. We examine some practical solutions in high-income countries that may allow a better adaptation to environmental risks and reduce their adverse impact on the nervous system. We consider the citizen's role in reducing unhealthy exposures and explore new approaches to treatment.

17º Congresso Nacional da ANAMT: valores essenciais frente às transformações do trabalho: hoje e amanhã / 17th ANAMT National Congress: essential values in the face of the transformations of work: today and tomorrow

O fio condutor do plano de trabalho foi o elenco das competências essenciais requeridas para o exercício da especialidade, na versão atualizada em 2018. Constituíram eixos orientadores a nuvem de palavras, fruto de uma pesquisa qualitativa com diversos associados, e o tema central ­ "Valores Essenciais Frente às Transformações do Trabalho, Hoje e Amanhã". Desse exercício coletivo nasceu uma programação complexa, densa e variada, que busca despertar e facilitar a discussão dos múltiplos campos de interesses e práticas ­ características da Medicina do Trabalho praticada no Brasil. Publica em seu número especial o produto científico do Congresso, com os resumos expandidos de temas que serão abordados nas sessões de Conferências e Semiplenárias. A edição também publica as contribuições dos participantes e congressistas, que submeteram suas experiências como resumos de trabalhos científicos e irão apresentar seus resultados, discussões e conclusões ao longo dos dias do evento.

La formación en Medicina del Trabajo / No disponible

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Impact of patients' access to medical records in occupational medicine.

Background: Information technologies offer new ways to engage with patients regarding their health, but no studies have been done in occupational health services (OHS). Aims: To examine the advantages and disadvantages of providing written and oral medical information to patients in OHS. Methods: In this cross-sectional study, data were retrieved from patients visiting four different OHS during 2014-15 for a fitness for work evaluation. We built a semi-quantitative satisfaction questionnaire, with responses ranging on a Likert scale of 1-5 from very dissatisfied (1) to very satisfied (5). Results: There were 287 questionnaires available for analysis. The number of patients who received detailed oral and written information, which included an explanation of their health condition and of the occupational physician's (OP's) decision, was higher in clinics 1 and 3 compared to clinics 2 and 4 (48 and 38% compared to 21 and 31% respectively, P < 0.05). When patients were provided with detailed oral and written information, they declared having a better understanding (4.3 and 4.4 compared to 3.8 respectively, P < 0.001), a higher level of confidence in their OP (4.4 and 4.3 compared to 3.7 and 4 respectively, P < 0.001), a higher level of satisfaction (4.3 and 4.4 compared to 3.8 respectively, P < 0.001) and a higher sense of control and ability to correct the record (1.8 compared to 1.4 respectively, P < 0.01), compared to patients who received partial information. Conclusions: We recommend sharing detailed oral and written medical information with patients in OHS.

Jardineros de la Salud / Health Gardeners

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Sección de Medicina del Trabajo de la Unión Europea de Médicos Especialistas (UEMS) / No disponible

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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.

La ergonomía de la persona. la medicina del trabajo en la aviación y en el trabajo médico / Work medicine and the ergonomics of the person

La Organización Internacional de Trabajo (OIT) señala que la magnitud de las lesiones, enfermedades y muertes ocasionadas por el trabajo indica la necesidad imperiosa de los Estados de proseguir la acción para reducirlas. Medicina del trabajo y ergonomía de la persona. Importancia de los exámenes médicos en la prevención de accidentes y enfermedades laborales.

The International Labour Organization (ILO) indicates that the magnitude of work-related injuries, illnesses and deaths caused by work, indicates the imperative need for States to continue to reduce them. Medicine the work and ergonomics of the person, importance of medical examinations in prevention of accidents and labor diseases.

Crisis económica, trabajo y salud / Economic crisis, work and health

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[TRENDS IN THE RATE OF OCCUPATIONAL PHYSICIANS VERSUS MANPOWER IN ISRAEL - STATUS AND SOLUTIONS].

BACKGROUND: The specialization in occupational health was recognized in Israel in 1990. The number of specialists grew gradually over the years, yet a systematic analysis of occupational health physicians (OHP)/workers' ratio was never conducted. OBJECTIVES: To determine the trends of OHP/workers' ratio in Israel and the future activities needed in order to achieve the standards of developed countries. METHODS: The socio-demographic data was obtained by personal communication, from the Israeli Association of Occupational Medicine and Maccabi Health Services. The remaining data was obtained from publications of the Ministry of Health and the National Insurance Institute. RESULTS: By March 2014, 157 OHPs were registered in Israel, 104 active specialists and 25 residents. Among the specialists, 78 worked in the Health Maintenance Organizations (HMO), 18 in the public sector (other than HMOs) and 8 in the private sector. Even though the number of workers rises every year, the number of OHP has remained stable in the last 10 years, around 90-100 physicians. The ratio of occupational health physicians/workers in the HMOs is 1:48,000. CONCLUSIONS: The ratio of OHP/workers in Israel is comparable to the ratio in developing countries and 8-10 times less in comparison to the developed countries with a Gross Domestic Product (GDP) similar to Israel. The rate has decreased since 2007. The reason for the stable numbers is the lack of payments by the employers and the fact that the subject has been ignored by the regulatory authorities. DISCUSSION: The way to improve this situation is by doubling the number of residents every year by providing the required resources to support this new arrangement. The funds have to come from the employers, the Ministry of Economy and the Ministry of Health.