Health Promotion Interventions in Occupational Settings: Fact-finding Survey among Italian Occupational Physicians.

BACKGROUND:  Occupational Physicians (OPs) are essential for health promotion (HP) at the workplace, although their HP knowledge and perception are still under-searched. METHODS: Between September and December 2022, the Italian Society of Occupational Medicine (SIML) - HP working group performed a cross-sectional survey on SIML-OPs aimed to address their approach, experience, strategies, and needs concerning HP plans. RESULTS: A total of 336 OPs completed the questionnaire. Regarding HP's OP perception, this was reported as a social investment (34.45%) and shared responsibility for all the company's preventive figures (30.18%). Over half of the enrolled OPs declared to have been involved as HP plans' organizers (57.30%) or collaborators (54.80%) in the previous 5 years. The greatest percentage of organizers were in the younger age groups (40-59 years; 50%). Additionally, following a more limited number of companies, prevalently of medium-high dimensions, and more than 500 workers were positively associated with greater OP participation in HP initiatives. Promoting healthy lifestyles was the main target of the HP plans (88.64%). Interdisciplinary collaboration, OP training on HP procedures and information on the targeted population have been reported as effective issues to support an active engagement of OPs in HP. CONCLUSIONS: A general interest of the Italian OPs with respect to HP was demonstrated, however, information on the potential benefits of HP in workplace aligned with OP perceptions and needs seem necessary to successfully implement HP interventions.

Patients' Experiences, Needs, and Expectations of Cooperation Between Medical Specialists and Occupational Health Physicians: A Qualitative Study.

OBJECTIVE: Cooperation between clinical and occupational health care practitioners is a key aspect of clinical work-integrating care. This study aimed to gain insight into patients' experiences, needs, and expectations regarding cooperation between medical specialists and occupational health physicians. METHODS: A thematic qualitative study was conducted involving a total of 33 participants in eight online focus groups. RESULTS: Participants indicated practitioners are currently working in an isolated manner. However, participants desired for partnership between specialists and occupational health physicians to address work-related concerns and showed a need for explanation of the consequences of their diagnosis, so this can be translated into their ability to work. CONCLUSIONS: Currently, cooperation between clinical and occupational health care is lacking. Yet, some participants experienced that these disciplines could complement each other by working together to support patients in work participation.

Training for occupational health physicians to involve significant others in the return-to-work process of workers with chronic diseases: a randomized controlled trial.

PURPOSE: To determine the efficacy of the "Training for Occupational health physicians To Involve Significant others" (TOTIS) e-learning module for improving occupational health physicians' (OHPs) knowledge, attitudes, and self-efficacy regarding involving significant others in the return-to-work process. MATERIALS AND METHODS: A randomized controlled trial with 87 OHPs, involving an intervention group and a wait-listed control group. Between-group differences in knowledge, attitude, and self-efficacy outcomes, and retention of effects were assessed using ANOVA and paired t-tests. Reactions to the e-learning module were analyzed with descriptive statistics and thematic analysis. RESULTS: We found moderate to large effects on OHPs' knowledge (p < 0.001, ηp2 = 0.202), attitudes (p = 0.003, ηp2 = 0.098), and self-efficacy (p < 0.001, ηp2 = 0.237), with retention of all changes at 10-week follow-up. OHPs graded the e-learning module with a mean score of 7.9 out of 10 (SD = 1.11) and indicated that the module increased their awareness of the role of significant others and encouraged them to address this more often. CONCLUSIONS: The TOTIS e-learning module and accompanying materials are valuable resources for OHPs to learn how significant others influence work outcomes of workers with chronic diseases and to manage their involvement in the re-integration process. TRIAL REGISTRATION: This study is registered in the Netherlands Trial Register under trial number NL8744; https://www.trialregister.nl/trial/8744.Implications for rehabilitationThe TOTIS e-learning module is the first evidence-based training to improve the knowledge, attitudes, and self-efficacy of occupational health physicians with regard to involving significant others in the re-integration process of workers with chronic diseases.The e-learning module and accompanying tools can increase the awareness of occupational health physicians about the role of significant others and encourage them to address the role of significant others in the re-integration process of sick-listed workers.It could be beneficial to expand on the e-learning module with a face-to-face training program involving group interaction, peer discussion, and skills development.

[The Japanese Law Regulating Underwater and Caisson Work: Current Issues and Future Developments].

The Japan "Ordinance on Safety and Health of Work under High Pressure", which is the law regulating health conditions for workers under high pressure environments, was amended in 2014. The revised regulations have highlighted other difficulties and new problems, but they have not yet written an appropriate amendment based on the aspect of occupational and environmental health. Health management for occupational divers and caisson workers in accordance with the new regulations has not determined the best approach to reducing related disorders and will cause other legal problems. This paper presents some issues in the new regulations for hyperbaric workers, which directly or indirectly involve occupational health physicians. Health checkups and work limitations should be done in consideration of the occupational characteristics of the undersea and hyperbaric environment. Regular examinations using specific studies are useful to diagnose the early stages of chronic conditions for workers, and are also useful for determining the hiring suitability for hyperbaric workers. Work limitations should be decided by the conditions that induce serious accidents or disorders that result from exposure to hyperbaric environments, and depend on the obstacles for work due to sequelae of decompression sickness. The new regulations need to be properly revised, based on scientific evidence, to include health management for workers in undersea and hyperbaric environments.

A comprehensive diagnostic service to clarify intervention needs when work participation is at risk: study protocol of a randomized controlled trial (GIBI, DRKS00027577).

BACKGROUND: Effective care services for people whose work participation is at risk require low-threshold access, a comprehensive diagnostic clarification of intervention needs, a connection to the workplace and job demands, and interdisciplinary collaboration between key stakeholders at the interface of rehabilitation and occupational medicine. We have developed a comprehensive diagnostic service to clarify intervention needs for employees with health restrictions and limited work ability: this service is initiated by occupational health physicians. METHODS/DESIGN: Our randomized controlled trial tests the effectiveness of a comprehensive diagnostic service for clarifying intervention needs (GIBI: Comprehensive clarification of the need for intervention for people whose work participation is at risk). The comprehensive intervention comprises three elements: initial consultation, two-day diagnostics at a rehabilitation center and follow-up consultations. We will include 210 employees with health restrictions and limited work ability, who are identified by occupational health physicians. All individuals will receive an initial consultation with their occupational health physician to discuss their health, work ability and job demands. After this, half the individuals are randomly assigned to the intervention group and the other half to the waiting-list control group. Individuals in the intervention group start two-day diagnostics, carried out by a multi-professional rehabilitation team in a rehabilitation center, shortly after the initial consultation. The diagnostics will allow first recommendations for improving work participation. The implementation of these recommendations is supported by an occupational health physician in four follow-up consultations. The control group will receive the comprehensive two-day diagnostic service and subsequent follow-up consultations six months after the initial consultation. The primary outcome of the randomized controlled trial is self-rated work ability assessed using the Work Ability Score (0 to 10 points) six months after study inclusion. Secondary outcomes include a range of patient-reported outcomes regarding physical and mental health, impairment, and the physical and mental demands of jobs. DISCUSSION: This randomized controlled trial is designed to test the effects of a new complex intervention involving a comprehensive clarification of intervention needs in order to promote work participation and prevent the worsening of health and work disability. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00027577, February 01, 2022).

Uptake of Voluntary Occupational Health Care-Assessments of German Occupational Health Physicians and Employees.

Workers' health surveillance is considered essential for employees' health and protection against hazardous working conditions. It is one part of occupational health care and thus one of four pillars of holistic workplace health management. In Germany, employers are obliged to provide mandatory and voluntary occupational health care (OHC) to employees, dependent on the defined occupational hazards. However, employees are not obliged to make use of voluntary OHC. No empirical information is available about the uptake of voluntary OHC by employees and the influencing factors in Germany. Thus, we carried out an explorative multi-perspective study with qualitative and quantitative elements to get insights from the view of occupational health physicians (OHPs) and employees. We conducted a survey among OHPs based on prior statements from two focus group discussions. A multivariate logistic regression analysis was performed to detect enablers and barriers regarding employee uptake of the offered voluntary OHC. We used extended qualitative methods among employees instead of an analogous survey. In total, 460 OHPs participated in the survey (response rate 29.1%), and 25 employees took part in interviews. Most of the employees had not heard the term voluntary OHC before, and only a few remembered respective occupational health care after explanatory request. In total, 78% of the OHPs assessed that employees always/mostly take up voluntary OHC. The most important attributed reason for non-uptake was that employees see no need for occupational health care when they feel healthy. The most important enabler for the perceived high uptake of voluntary OHC in the regression analysis was a positive attitude of the OHP toward voluntary OHC. While OHPs perceived that voluntary OHC was accepted by a majority of employees, this was not confirmed by the interviews with selected employees. This could indicate that the OHP respondents overestimated the amount of uptake. Since it became clear that employees are often unfamiliar with the terminology itself, we see a need for more and better information regarding the objectives and content of occupational health care to improve this important pillar of workplace health management.

[Work-related asthma in clinical practice]. / Werkgerelateerd astma in de klinische praktijk.

Work-related asthma is an underestimated problem. More awareness is needed for early identification of work-related lung diseases to prevent permanent damage in patients with lung diseases. Work-related asthma can lead to an increase in the burden of disease, the number of exacerbations and hospital admissions. Therefore, exposure to substances with irritating and/or sensitizing properties should be regarded as an additional treatable trait in asthma treatment. The number of occupations where such exposures plays a role is large and diverse. Inquiring about the profession, activities or future career choice of the (asthma) patient during the first consultation is of great importance for the correct diagnosis and treatment. Cooperation between pulmonologist, lung nurse, ENT specialist, dermatologist, company doctor and occupational hygienist can contribute to this. A regional organization with a 'multidisciplinary consultation' for occupational lung diseases is important to guarantee optimal care and advice. The clinical case series demonstrate work-related asthma in clinical practice.

[Transition and future tasks of occupational health practice in small and mid-sized companies in the city of Sapporo].

OBJECTIVES: This study aimed to examine the present state of activities of occupational health physicians (OHPs) and companies' opinions about them. METHODS: Questionnaires, to be answered anonymously, were sent to 1,898 companies with ≥ 50 employees. We analyzed the data according to type of industry and the size of the company. RESULTS: We received 692 responses. First, we compared the data with the results of a previous study we had conducted in 2003. The percentage of companies that employed OHPs was found to have increased from 77% to 97%. The implementation rate of work place inspection conducted by OHPs had increased from 41% to 65%, and the attendance rate of health committees increased from 24% to 56%. Regarding overtime, we found that the percentage of workers who did more than 80 hours of overtime work per month had decreased from 29% to 7%, but in the transportation industry the high rate of 38% was maintained. Stress assessments were conducted by 98% of the companies with ≥ 50 employees. CONCLUSIONS: This study determined the present situation in companies, with regard to recent law revisions. Stress assessments are carried out more frequently, the number of workers doing overtime has decreased, and measures against second-hand smoke are being promoted. In addition, we found an increase in the frequency of work place inspection and attendance of health committees, but in one-third of the companies these were not carried out.

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?

Assessing HIV provider knowledge, screening practices, and training needs for HIV-associated neurocognitive disorders. A short report.

Management of HIV-associated neurocognitive disorders (HAND) is becoming increasingly important with HIV-positive people living normal life spans. We aimed to establish the level of HAND awareness among doctor and nurse occupational health practitioners, screening used to detect impairment, factors limiting screening for HAND, and training needs. One-hundred-and-five members of the nursing and physician professional societies for occupational health practitioners in South Africa and Occupational Health Departments at five South African universities responded to an email invitation to complete an online survey addressing demographics, HAND knowledge, screeners being used to screen for HAND and related training needs. While 80% had heard of HAND, few (13.3%) were aware of the Frascati criteria. Only 2% had received training addressing HAND; 11.4% screened for HAND; 45.7% did not know what screening tool to us; 80% preferred spending <15 min on screening. The largest obstacle to screening was lack of expertise (77.1%) but 77.3% thought it important to screen for HAND. 94.3% wanted screening training. Health providers are poorly informed about HAND and lack expertise and tools to screen for HAND in their treatment programs. While few had relevant training, they recognize the importance of screening for HAND in the workplace and desire training.

[Qualitative analysis of provided information and advice from occupational physicians to attending clinical physicians in supporting an employee's work-treatment balance].

OBJECTIVES: In Japan, the population is aging and there is a declining birth rate. It is an important occupational health issue to support the balance between illness treatment (including nursing care, childcare, etc.) and work. Many patients require mental and financial support to help them with their work-treatment balance. In 2016, the Ministry of Health, Labor and Welfare provided guidelines for supporting employee's work-treatment balance, and in 2018, "Consulting Fee" was approved as an insured medical treatment when clinic doctors supported their patients for continuing to work. The request for the consulting fee requires that the clinician and the occupational physician exchange information on the support necessary for the patient to continue working. Generally, occupational physicians obtain medical information from clinicians to give advice on a worker's employment considerations. However, we do not know what kind of workplace information clinicians hope to know when treating their patients. Therefore, we conducted this survey to clarify how occupational physicians could provide useful information to clinicians. METHODS: We asked approximately 1,500 occupational physicians from the Occupational Health Subcommittee of the Japan Society for Occupational Health to provide us with a letter sent to their clinician to assist workers. From the collected letters, the structural parts of the letters (titles, greetings, acknowledgments, etc.) were removed. We defined a section as a contextual unit that does not impair the meaning. The prepared sections underwent qualitative inductive analysis using the content analysis method of "Berelson, B." RESULTS: A total of 103 cases and 178 documents from 42 people were included in the analysis. Extracting descriptions that could be interpreted as providing information, including descriptions related to treatment, employment, and living environment, and opinions and suggestions from occupational physicians resulted in 596 sections. As a result of the qualitative and inductive classification, the information was classified into three large categories that consisted of information provision, opinions of occupational physicians, and information handling, five middle and eighteen small classifications. In addition, some good practices that were considered significant to clinicians were illustrated. CONCLUSIONS: We analyzed and categorized the information present in the letters sent by occupational physicians to clinicians. The letter does not need to contain all the information in the category table. However, it is important that it should have the necessary and sufficient information considering the case in question. We believe that this category table will aid occupational physicians in writing letters to clinicians.

Desempeño ocupacional de una y un superheroe / Occupational performance of one and one superhero

La aparición de las y los superhéroes ha sido a lo largo de la historia una propaganda social que mantiene viva la llama de la esperanza. La realidad se torna incierta cuando una o un superhéroe flaquea. Pero la realidad es que todas y todos los superhéroes a lo largo de su vida han sentido una falta de equilibrio ocupacional que ha roto su sensación de competencia. Esta situación no exenta de ciertas repercusiones mantiene ese punto de cercanía con la sociedad. El desempeño ocupacional de una o un superhéroe va a depender las cruzadas en las que se encuentre. En la sociedad actual más de una y uno se ha enfundado en el traje siendo esa o ese superhéroe para otros y otras

The appearance of superhero has been throughout history a social propaganda that keeps the flame of hope alive. Reality becomes uncertain when one or a superhero falters. But the reality is that each and every superhero throughout their lives has felt a lack of occupational balance that has broken their sense of competence. This situation is not without certain repercussions maintains that point of closeness with society. The occupational performance of one or a superhero will depend on the crusades in which they are. In today's society more than one and one has dressed in the suit being one or a superhero for others and others

Factors that influence occupational physicians' decision to issue an employer warning in Japan.

OBJECTIVES: To elucidate the factors that influence occupational physicians' decision to issue an employer warning. METHODS: The interview was conducted with 10 Japan Society for Occupational Health certified occupational physicians (COPs) and certified senior occupational physicians (CSOPs) to create nine fictive scenarios in which an occupational physician may need to consider issuing a warning. Sixteen CSOPs assessed the seriousness of the problem in each of nine scenarios where they may need to consider issuing an employer warning. Next, using a survey questionnaire, 597 COPs and CSOPs were asked to rate how likely they were to issue a warning in each of the nine scenarios, and answer items on their characteristics and number of previously issued warnings. A multilevel logistic regression analysis nested for various scenarios was used to assess the odds ratio (OR) of being likely to issue a warning. RESULTS: Valid questionnaires were obtained from 117 participants (19.6%). The ORs and 95% confidence intervals (CIs) were as follows: mean score of seriousness of the problem, 5.90 (4.50-7.75); years of experience as occupational physician, 1.04 (1.02-1.06); women, 1.75 (1.20-2.54); being a part-time occupational physician without in-house experience, 2.08 (1.31-3.29); and having previously issued two or more times warnings, 1.99 (1.29-3.06), compared with those who had never issued a warning. CONCLUSIONS: Occupational physicians' likelihood to issue a warning was associated with the seriousness of the problem as assessed in various scenarios, years of experience as occupational physician, gender, employment type, experience as in-house occupational physician, and number of past warnings.

Occupational health physicians as users of electronic health records.

BACKGROUND: Electronic health records (EHRs)' purpose is to facilitate the documentation of patient data and to improve the exchange of information between the professionals involved in a patient's care. AIMS: To investigate occupational health (OH) physicians' experiences of EHRs and the factors hampering work. METHODS: An electronic questionnaire was sent to physicians working in OH services in April 2017 and a total of 342 OH physicians participated in the study. The results were reported as quantities and percentages. The survey text was analysed using data-driven content analysis. RESULTS: The respondents considered their EHR stable in terms of technical features but the routine tasks with EHR were not straightforward. Also, the documentation of patient data for statistical purposes took an unreasonable amount of time and the access to patient data from other organizations was poor. Instead, a well-functioning feature of EHRs were electronic prescriptions. The factors, which hampered respondents' work, were constant or frequent time pressure, too little time to do their job properly and a stress caused by uncompleted tasks. CONCLUSIONS: This study showed that the usability problems of EHRs were the slowness, unexpected downtimes and difficulties in obtaining patient data. Also, respondents felt very often a lack of time in their work. OH physicians' work is best supported by EHRs that consider their specific role in healthcare, i.e. the assessment of work ability, the co-ordination of care and rehabilitation and support for return to work.

Support for balancing cancer treatment and work by occupational health nurses: support structures and implementation status.

This study aimed to quantitatively grasp the structure of support for balancing cancer treatment and work among occupational health nurses (OHNs) with the current implementation status. The anonymous questionnaire was designed based on the findings of our previous qualitative study and distributed to OHNs. The degrees of support implementation for workers with cancer, superiors and colleagues, and human resource managers were assessed for each item. Factor analysis of support items was conducted, and Wilcoxon signed-rank test was carried out to compare the support scores between the factors. Support for workers with cancer comprised six factors in which the factor, concerning the provision of information regarding resources inside and outside the company, showed the lowest score. Support for superiors and colleagues was divided into three factors, and that for human resource managers comprised two factors. By Mann-Whitney's U-test, it was found that OHNs, who worked without full-time occupational health physicians for smaller companies, showed significantly higher implementation for several support factors, such as support to human resource managers. This study revealed the structure as well as implementation status of OHNs' support for balancing cancer treatment and work, which will provide suggestions for developing training programs for OHNs to promote these activities.

[Work environment that support workers with diseases to maintain a work-treatment balance in Ishikawa prefecture: relationship with company scale and type of industry].

OBJECTIVES: We investigated the support environments in companies in Ishikawa prefecture that aim to maintain a balance between work and treatment of their employees' diseases. The relationships between these strategies, company size, and type of industry were examined. METHODS: In 2016, as a part of a survey, questionnaires were sent to 1,491 companies with ≥ 50 employees. Of the 688 companies who responded (response rate, 46.1%), 624 companies who provided complete main survey data were included in the final analysis. The questionnaire acquired responses on systems for arranging working hours and sick leave, the role of occupational health physicians, and the outcomes of support that was offered over the last 3 years. The targeted diseases were mental health problems, such as depression, and physical diseases. Responses were compared according to the size of the company and type of industry. RESULTS: A total of 409 companies (65.5%) reported their experiences of helping employees maintain a balance between treatment and work over the last 3 years. Employees with depression received the most support. In 36.7% of the companies, some employees had retired due to their disease over the last 3 years, with the highest proportion in medical care and welfare businesses. Further, 66% of the companies had a support system to help employees with diseases, and the proportion of companies with flexible working hours and sick leave increased with the number of employees. The proportion of companies with shorter working hours and hourly paid leave was lower in the manufacturing industry and transportation/traffic business. The proportion of companies in which an occupational health physician interviewed employees who took sick leave and returned to work was 22%. CONCLUSIONS: Almost 70% of the companies reported supporting workers during their disease treatment. There were some differences in arranging these support systems between companies of varying sizes and type of industry. The enablement of companies to support workers with diseases so that they keep working and receive treatment requires consideration of company characteristics.