Does an occupational physician have a duty to carry out general clinical assessments?

An occupational physician is employed to be responsible for the overall assessment of workers' health risks and all work-related pathological situations which creates an unusual doctor-patient relationship. The duties of the occupational physician are also very limited as is their professional responsibility. However, the boundaries of the occupational physician's duties and responsibilities are not always clear. The purpose of this article is to answer the following question: Does the occupational doctor have a duty to carry out general clinical evaluations (not work-related) of the patient?

[Diagnostic difficulties and legal analysis of potential claims to occupational medicine specialists based on a case of unrecognizable cardiac angiosarcoma]. / Trudnosci diagnostyczne i analiza prawna potencjalnych roszczen wobec lekarza medycyny pracy na przykladzie nierozpoznanego naczyniakomiesaka serca.

The article presents a case of sudden death of a 56-year-old woman at the workplace, caused by a very rare primary cardiac tumor. The patient's family reported a crime to the prosecutor's office suggesting participation of third parties in causing the death or malpractice in physical examinations before the death. A review of clinical data concerning cardiac angiosarcoma, available in electronic databases (e.g., Web of Science, PubMed), was presented, which could be useful in the practice of occupational medicine specialists. A legal analysis of potential claims to occupational medicine specialist in the case of failure to recognize primary cardiac tumors was also included in the article. Med Pr. 2020;71(6):757-64.

Peer review audit of non-specialist occupational physician reports.

BACKGROUND: With declining specialist occupational physician (OP) numbers, there is increasing recognition of the importance of non-specialist physicians in occupational health (OH) service delivery, yet to date, this physician group remains understudied and their competency requirements poorly understood. AIMS: To evaluate the quality of a sample of non-specialist OH reports and compare these with specialist reports. METHODS: A retrospective peer review audit of a convenience sample of 200 consecutive non-specialist and specialist OH reports from an Irish OH service using an assessment form based on the modified Sheffield Assessment Instrument for Letters SAIL(OH)1. RESULTS: Of the 200 peer reviewed OH reports, 159 (80%) were from non-specialists. For all questions, 87% and above of non-specialist reports were 'satisfactory' or 'above expected'. On the overall assessment, out of 10, the mean non-specialist report score was 6.8 (standard deviation (SD) 3-10) and the specialist score was 7.3 (SD 3-10). Comparatively, non-specialist reports highlighted legal/ethical issues marginally more and adhered slightly better to contractual/ethical/legal boundaries, while specialist reports fared better in addressing manager's questions, in their structure and clarity and in covering all significant aspects of the case, particularly if the case was complex. CONCLUSIONS: Our findings demonstrate a high standard of OH report quality in this sample of non-specialist OPs that is consistent across all key OH report components. Potential development areas are also identified that can inform education/training tailored to this physician group and assist in competency standard-setting.

[Recommendations for performing specific inhalation challenge tests: Polish experience in relation to the European Respiratory Society guideliness]. / Wytyczne do przeprowadzania swoistych wziewnych testów prowokacyjnych: stanowisko Europejskiego Towarzystwa Chorób Ukladu Oddechowego (ERS) w kontekscie polskich doswiadczen.

A diagnosis of occupational diseases implicates some medical and legal consequences; therefore, the most specific and objective methods are needed in the diagnostic process. Specific inhalation challenge (SIC) tests currently play an irreplaceable role in diagnosing allergic airway diseases (e.g., allergic rhinitis, asthma) as well as allergic conjunctivitis and systemic reactions, also the occupational ones. In 2014, a team of the European Respiratory Society experts published a statement that provides practical recommendations for performing SIC tests in diagnosing occupational asthma. In the current publication, the authors discuss the European guidelines in the context of Polish experience of the reference center - the Department of Occupational Diseases and Environmental Health, the Nofer Institute of Occupational Medicine in Lódz. The article describes the procedures and diagnostic criteria employed during SIC tests in diagnosing occupational asthma. Med Pr. 2020;71(3):381-97.

Should systemic sclerosis be recognised as an occupational disease in Switzerland?

Systemic sclerosis is a rare autoimmune disease characterised by a multifactorial aetiology involving a gene–environment interaction. Despite the growing epidemiological arguments for odds ratio (OR) data showing an association with occupational exposure, systemic sclerosis is not currently included in the list of recognised occupational diseases in Switzerland, unlike other northern European countries. Future recognition will be conditional on the demonstration of a strong association between the disease and occupational exposure in the scientific literature. The present article’s main goal is to present five cases of systemic sclerosis investigated for possible occupational aetiologies during occupational pathology consultations at the Institute for Work and Health, in Lausanne. The occupational aetiologies of these cases are discussed against the background of a literature review of publications from the past 20 years in order to determine whether recognition as an occupational disease is possible within Switzerland’s legal framework. Epidemiological studies of systemic sclerosis have identified strong associations with occupational factors such as exposure to silica and solvents, with ORs >2, and weaker associations with epoxy resins and welding fumes. Other occupational exposures are also known to induce systemic sclerosis-like diseases, such as vinyl chloride disease and toxic oil syndrome. All five patients had been exposed to either silica, solvents, or both. Given their exposure and the data in the literature, four patients had their cases declared to their accident insurance companies and two of them were recognised as suffering from an occupational disease by the Swiss National Accident Insurance Fund. Our literature review enabled us to design a short questionnaire to help general practitioners and rheumatologists to identify those patients with systemic sclerosis who are likely to have their illness recognised as an occupational disease.

Guía para el diagnóstico, el tratamiento y la prevención del eccema de manos / Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema

El eccema de manos es una patología frecuente con un fuerte impacto en la calidad de vida de los pacientes y un alto coste social y laboral. Su manejo por los médicos de atención primaria y de medicina del trabajo es complejo debido a la variedad de etiologías, la evolución difícilmente predecible de la enfermedad y la respuesta al tratamiento. El diagnóstico precoz y las medidas protectoras adecuadas son esenciales para evitar la cronificación, que es mucho más difícil de tratar. Una correcta derivación a un especialista y la valoración de una baja laboral en el momento adecuado resultan cruciales para un buen manejo de estos pacientes. En esta guía sobre el eccema crónico de manos analizamos el proceso diagnóstico, las medidas preventivas y los tratamientos, con especial énfasis en el papel del médico de atención primaria y de medicina del trabajo en los estados iniciales de su manejo

Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease

[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.

A survey of current audit practice in occupational health.

BACKGROUND: In the 1990s, challenges were identified in relation to the quality of practice in occupational medicine, including a limited evidence-base and the need to translate good evidence into high-quality practice. Audit has been identified as having an important role to play in addressing the determinants of variations and quality in practice. AIMS: To explore current practice of occupational health (OH) audit and outcome measures. METHODS: A survey of 30 OH conference participants who were affiliated with an OH service or a professional body, from ~2000 attendees at the Triennial Congress of the International Commission on Occupational Health (ICOH) in Dublin, Ireland, over 2 days in May 2018. RESULTS: Of the 30 participants, 1 was lost at follow-up and 29 participants gave verbal consent to answer questions in relation to carrying out audit and outcomes. Overall, 25 participants undertook regular audit, 19 on an annual basis, 4 on a monthly basis and 2 every 2 years. Twelve participants confirmed multiple audit outcomes and 13 used audits for internal training purposes only. Four participants did not undertake any audit. Less than 50% confirmed multiple audit outcomes that included internal feedback for training purposes and external publication such as conference poster presentations and peer-reviewed publications. CONCLUSIONS: This limited observational study underscores conclusions of previous research that development of clinical audit guidance and measurement of outcomes in occupational medicine is mostly unpublished.

Arsenic Exposure, Assessment, Toxicity, Diagnosis, and Management: Guidance for Occupational and Environmental Physicians.

: Arsenic is ubiquitous in the environment and human exposure can occur from multiple possible routes including diet. Occupational medicine physicians asked to evaluate workers with elevated urine arsenic levels may be unaware that many sources of arsenic exposure are not work related. In this paper, we address arsenic exposure sources and pathways, adverse health effects of arsenic exposure and those subpopulations at increased risk, and the evaluation and treatment of those exposed to elevated arsenic levels.

Dermatopatías Laborales: Registro de Mutual de Seguridad CChC durante 2012 / Occupational Skin Diseases: Register of Mutual Security CChC during 2012

INTRODUCCIÓN: En Chile existen escasos estudios epidemiológicos sobre las dermatosis ocupacionales; sin embargo, éstas corresponden a uno de los grupos de enfermedades profesionales más frecuentes, por lo cual se hace necesario generar más información local. Material y MÉTODOS: Se realizó un análisis retrospectivo y descriptivo de las consultas médicas dermatológicas en Mutual de Seguridad CChC (Cámara Chilena de la Construcción) durante el año 2012. Se utilizaron buscadores automáticos en la ficha electrónica para seleccionar los casos por diagnósticos. Se seleccionaron aquellas calificadas como Enfermedades Profesionales que fueron derivadas para evaluación por Dermatología. Los datos fueron analizados según sexo, edad, ocupación y días de reposo. RESULTADOS: 398 casos fueron identificados como dermatosis profesionales en estudio; y de ellos 58 ingresados fueron tratados en consultas de dermatología. De las enfermedades profesionales, los diagnósticos más frecuentes fueron dermatitis de contacto irritativa (DCI) con un 61% y alérgica con un 13% de los afectados (DCA). Del total de pacientes, 59% fueron hombres y 41% mujeres. Los rubros más afectados fueron, en primer lugar la salud (27,5%), seguida de la manipulación de alimentos (21%) y el aseo (16%). El total de días de reposo (días de trabajo perdidos) de todos los pacientes por dermatosis laboral fueron 1.077 días. DISCUSIÓN: Las descripciones más frecuentes coinciden con el desempeño bajo condiciones húmedas y uso de sanitizantes, jabones, detergentes y productos de aseo en general, lo cual favorece una mayor indicencia de dermatitis de contacto. Las dermatitis de contacto fueron el diagnóstico más frecuente. La proporción entre hombres y mujeres afectados es similar a lo descrito en la literatura

INTRODUCTION: There are few epidemiological studies on occupational dermatosis in Chile. However, these belong to one of the biggest occupational disease groups. It is for this reason necessary to generate more local information. MATERIALS AND METHODS: A retrospective and descriptive analysis of dermatological medical consultations was carried out in Hospital Clinic Mutual de Seguridad CChC (Chilean Chamber of Construction) during 2012. Automatic search engines were used in the electronic file to select diagnostic cases. Those qualified as Professional Diseases were referred to the department of Dermatology for evaluation. The data were analyzed according to sex, age, occupation and rest days. RESULTS: 398 cases were identified as professional dermatosis under study; and 58 of them entered treatment for Dermatology. Of the occupational diseases, the most frequent diagnoses were irritant contact dermatitis -ICD-(61%) and allergic contact dermatitis -ACD- (13%). Of the patients overall, 59% were men and 41% women. The most affected areas were healthcare (27,5%), followed by food handling (21%) and cleanliness (16%). The total number of rest days (days off work) of all patients due to occupational dermatosis was 1,077 days. DISCUSSION: The most affected items coincide with the performance under humid conditions and the use of sanitizers, soaps, detergents and cleaning products in general, which favors a higher incidence of contact dermatitis. Contact dermatitis was the most frequent diagnosis. The proportion between affected men and women is similar to that described in the literature

The Role of the Professional Supervisor in the Audiometric Testing Component of Hearing Conservation Programs.

: ACOEM believes that the functions of a professional supervisor in hearing conservation programs are part of the "core practice" of occupational medicine. This guidance emphasizes the role occupational medicine clinicians play in the supervision of audiometric surveillance conducted under the auspices of hearing conservation programs and reviews the regulatory and scientific basis and pertinent practices involved in this supervisory role.

Occupational Noise-Induced Hearing Loss.

: Occupational hearing loss is preventable through a hierarchy of controls, which prioritize the use of engineering controls over administrative controls and personal protective equipment. The occupational and environmental medicine (OEM) physician plays a critical role in the prevention of occupational noise-induced hearing loss (NIHL). This position statement clarifies current best practices in the diagnosis of occupational NIHL.

Quality of observational studies in prestigious journals of occupational medicine and health based on Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: a cross-sectional study.

OBJECTIVE: The present study applied the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement to observational studies published in prestigious occupational medicine and health journals. RESULTS: A total of 60 articles was evaluated. All sub-items were reported in 63.74% (95% confidence interval [CI], 56.24-71.24%), not reported in 29.70% (95% CI, 20.2-39.2%), and not applicable in 6.56% (95% CI, 4.86-8.26%) of the studies. Of the 45 sub-items investigated in this survey, eight were reported 100% of the time, 13 were addressed in more than 90% of the articles, 22 were included in more than 75% of the studies, and 27 sub-items were applied in more than 50% of the articles published in the journals included in this study.

Protocolo de Vigilancia de la Salud de trabajadoras durante Lactancia Materna / Protocol for Health Surveillance of Workers during Breastfeeding

Introducción: la lactancia natural, se debe priorizar en niños pequeños según OMS, exige un plan de protección, promoción y apoyo a la misma, promoviendo la conciliación de la vida familiar y laboral. No obstante, se debe velar tanto por la vigilancia de la salud como por la equidad socio-laboral y económica entre los trabajadores. Esto requiere implantar un protocolo que detecte el correcto cumplimiento de estas medidas. Objetivos: detectar a trabajadoras lactantes especialmente sensibles, evaluando las medidas preventivas, y su implantación eficaz y equitativa. Discusión: se establecen pautas para el examen de salud, su periodicidad del mismo y herramientas (se planteó el uso de un marcador biológico), con el fin de lograr los objetivos planteados. Conclusión: no hay claridad en los protocolos de actuación ante una trabajadora en lactancia materna; este protocolo puede garantizar equidad entre los trabajadores, permitiendo únicamente aquellas mujeres en las que esté comprometida la seguridad durante éste proceso

Introduction: breastfeeding, an important form of nutrition for infants, demands an action plan for protection, promotion and support to it, promoting the reconciliation of family life and work. However, both the health surveillance and the socio-labor and economic equity among workers must be ensured. Therefore, it is necessary to implement a protocol that detects the correct fulfillment of these measures. Objectives: to detect especially sensitive workers as breastfeeding mothers, evaluating preventive measures, and workers with adapted posts that are not a breastfeeding. Discussion: guidelines are established for the health surveillance, as well as the periodicity of it and the tools, including the use of a biological marker, in order to achieve the objectives raised. Conclusion: there is no clarity in the protocols of action before a worker in the breastfeeding period; this protocol can guarantee fairness among workers, allowing only those women in whom security is compromised during this process

Fitness-for-Duty Assessments of Industrial Firefighters: Guidance for Occupational Medicine Physicians.

: Industrial firefighters share many characteristics with municipal firefighters; however, employers frequently have not addressed or characterized the unique job duties, hazards, and specific physical/mental demands associated with industrial firefighting. In addition, gaps exist in the medical literature with regard to industrial firefighter demographics, behavioral risk factors, and chronic diseases. Finally, the proper methodologies for fitness-for-duty assessment of employees acting in this capacity are lacking. To address these gaps, the American College of Occupational and Environmental Medicine (ACOEM) convened a Task Force in 2014, to develop fitness-for-duty guidance for industrial firefighters. This document highlights these gaps and suggests research opportunities to enhance the health and safety of this population. While an extensive literature review found a lack of studies for this population-thus excluding the development of an evidence-based document-sufficient materials were available from which to draw preliminary conclusions, considerations for best practices, and recommendations for future studies.