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.

Cancer Survivors and Returning to Work Perspectives from Occupational Health Physicians in Korea.

BACKGROUND: This study was conducted from an occupational health perspective to document cancer survivors' ability to return to work, the role of clinical care, and the current status of effective return-to-work. METHODS: This cross-sectional study was conducted to evaluate the experiences and opinions of occupational health physicians (OHPs) regarding cancer survivors' return-to-work. A self-reported survey was conducted from December 30, 2015, to January 30, 2016, targeting 337 OHPs. Questions included: 1) treatment experiences of survivors in the words of OHPs, 2) current status of the assessments of fitness for work of cancer survivors, 3) experiences associated with workplace and treatment, and 4) problems of returning to work and overcoming system. RESULTS: Only 25% of the respondents said that they had experience treating cancer survivors, and the average number of patients was 12.6 per annum, which indicated that few cancer survivors were treated. Eleven cases included conducting assessment of fitness for work. There were 17 respondents who did not treat cancer survivors. Both those who had and did not have experience in treating survivors showed higher musculoskeletal system disorders (53.8 vs. 63.5) than cancer (15.5 vs. 11.2) in terms of frequency of the diseases in the assessment of fitness for work. Most respondents said that OHPs evaluate the current role appropriately and preferred OHPs in the future. They responded that OHPs found it difficult to treat cancer survivors, and it was psychologically tough to communicate with them (61.4%). Regarding the association of patient rehabilitation with workplaces, 48.9% said that workplaces provide inadequate support. CONCLUSION: As a preliminary study, we found that OHPs were found to have little experience in treating cancer survivors and undergo difficulties owing to poor collaboration with workplaces and communication with patients. This study will provide basic data for future studies to promote cancer survivors' return to workplaces.

Work ability meetings-a survey of Finnish occupational physicians.

BACKGROUND: Work ability meetings (WAMs) are planned discussions between an employee, a manager and an occupational physician (OP) to support work ability and return to work (RTW). During the last decade, WAMs become a popular intervention in Finnish occupational healthcare, although research on their content is lacking. AIMS: To describe the practice of WAMs in Finland. METHODS: We sent an internet survey by e-mail to members of the Finnish Society of Occupational Health Physicians in August 2014. We asked them to describe the last WAM they had attended, the employee the meeting concerned, the reason why it was convened, the content of the meeting and the action plan developed. RESULTS: A total of 303 of 1304 OPs responded (24%) to the survey. The meetings were most often arranged for employees in manual or clerical work (71%). There were several overlapping reasons for convening a WAM, including a worker's reduced work ability (57%), functional ability (42%) or long-term sickness absence (38%). The meetings consisted of RTW planning, clarification of the situation and a dialogue between the three parties. In half of the cases, the action plans dealt with modifications of work tasks. A third of cases were forwarded to vocational rehabilitation, while permanent disability pension was considered in 6% of cases. CONCLUSIONS: The focus of WAMs was on workplace adjustments to support workers to remain at work. The WAMs dealt mostly with early interventions for RTW: work modifications, adjustments and vocational rehabilitation.

Needs survey on the priority given to periodical medical examination items among occupational physicians in Japan.

OBJECTIVES: To clarify the priority given to periodical medical examination items among occupational physicians in Japan. METHODS: Sixty-two occupational physicians who participated in this study selected statutory and non-statutory items within two types of budget plans: one lower (8,500 yen) than the total fee of statutory medical examinations (9,250 and 11,290 yen), and the other higher (12,000 yen) than the total fee. Medical fee points were used to set the cost of each medical examination item. A three round Delphi method was used from May to July 2016 to clarify the consensus opinion of occupational physicians. RESULTS: The statutory items (selection rate: between 66 and 100%), except for waist circumference (15%) and sputum examination (0%), and serum creatinine (58%, non-statutory item) were included in the smaller budget plan (8,500 yen). In the larger budget plan (12,000 yen), the statutory items (selection rate: between 92 and 100%), except for waist circumference (39%) and sputum examination (0%), and some non-statutory items, namely serum creatinine (95%), leukocytes (92%), uric acid (89%), and fecal occult blood reaction (81%), had a selection rate over 80%. In addition, statutory items with higher accuracy were preferred, which included the following: air conduction pure-tone audiometry (92%), imaging diagnosis of thoracic X-ray examinations by a specialist (97%), glycated hemoglobin levels (98%), and electrocardiogram assessment by a specialist (100%). CONCLUSION: The statutory items, except for waist circumference and sputum examination, and some of the non-statutory items (e.g., serum creatinine) were given higher priority among occupational physicians in Japan.

Management of occupational noise induced hearing loss in the mining sector in South Africa: Where are the audiologists?

OBJECTIVE: This study was conducted to explore the scope of practice for occupational audiologists in the mining industry and the audiologists' involvement in hearing conservation programmes in South African mines. Additionally, this study investigated the mining industry's role in the audiologists' involvement, and assessed the audiologists' levels of preparedness for working in occupational audiology. METHODS: In-depth, qualitative telephone and face-to face interviews were conducted with seven occupational audiologists involved in the management of occupational, noise-induced hearing loss (ONIHL) in the South African mining sector. Snowball sampling was utilized to recruit possible participants for this study. Data were analysed using inductive thematic analysis. RESULTS: The following themes were identified: scope-context misalignment, juniorization of the experts, audiologists are important... but for what?, and limited training in occupational audiology. CONCLUSIONS: Our evidence highlights important gaps in HCPs in South Africa. The fact that the audiologists responsible for the management of ONIHL are only minimally and peripherally involved may play a significant role in the lack of progress reported in the management of ONIHL in the South African mining sector.

Differences in opinions of occupational physicians on the required competencies by field of practice: results of an international Delphi study.

BACKGROUND: The activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey. METHODS: An international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work. RESULTS: There was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups. CONCLUSION: This study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles.

Self-determining medical leadership needs of occupational health physicians.

Purpose The purpose of this study was to explore which factors motivate doctors to engage in leadership roles and to frame an inquiry of self-assessment within Self-Determination Theory (SDT) to identify the extent to which a group of occupational health physicians (OHPs) was able to self-determine their leadership needs, using a National Health Service (NHS) England competency approach promoted by the NHS England Leadership Academy as a self-assessment leadership diagnostic. Medical leadership is seen as crucial to the transformation of health-care services, yet leadership programmes are often designed with a top-down and centrally commissioned "one-size-fits-all" approach. In the UK, the Smith Review (2015) concluded that more decentralised and locally designed leadership development programmes were needed to meet the health-care challenges of the future. However, there is an absence of empirical research to inform the design of effective strategies that will engage and motivate doctors to take up leadership roles, while at the same time, health-care organisations continue to develop formal leadership roles as a way to secure medical leadership engagement. The problem is further compounded by a lack of validated leadership qualities assessment instruments which support researching this problem. Design/Methodology/approach The analysis draws on a sample of about 25 per cent of the total population size of the Faculty of Occupational Medicine ( n = 1,000). The questionnaire used was the Leadership Qualities Framework tool as a form of online self-assessment ( NHS Leadership Academy, 2012 ). The data were analysed using descriptive statistics and simple inferential methods. Findings OHPs are open about reporting their leadership strengths and leadership development needs and recognise leadership learning as an ongoing development need regardless of their level of personal competence. This study found that the single most important factor to affect a doctor's confidence in leadership is their experience in a management role. In multivariate regression, management experience accounted for the usefulness of leadership training, suggesting that doctors learn best through applied "leadership learning" as opposed to theory-driven programmes. Drawing on SDT ( Deci and Ryan, 1985 ; 2000 ; Ryan and Deci, 2000 ), this article provides a theoretical framework that helps to understand those doctors who are likely to engage in leadership and management activities in the organisation. More choice and self-determination of medical leadership programmes are likely to result in more relevant leadership learning that builds on doctors' previous experience in this area. Research limitations/implications While this study benefitted from a large sample size, it was limited to the use of purely quantitative methods. Future studies would benefit from the application of a mixed methodology to combine quantitative data with one-to-one interviews or a focus group. Practical implications This study suggests that doctors are able to determine their own learning needs reliably and that they are more likely to increase their confidence in leadership and management if they are exposed to leadership and management experience. Originality/value This is the first large-scale study of this kind with a large sample within a single medical specialty. The study is considered as insider research, as the first author is an OHP with knowledge of how to engage OHPs in this work.

[Physicians' assessments of work capacity in patients with SHC: comparison between five European countries]. / Beoordeling van arbeidsongeschiktheid bij SOLK.

OBJECTIVE: Comparing assessments of incapacity to work in patients with subjective health complaints (SHC) by physicians from 5 different European countries. DESIGN: Cross-sectional study. METHOD: General practitioners from Norway (n=56), Sweden (n=29), Denmark (n=41), France (n=46) and occupational and insurance physicians from the Netherlands (n=93) watched and assessed incapacity to work in nine video vignettes of patients with SHC. We subsequently analysed differences between assessments (whether or not there was incapacity to work) by country, with Norway as a reference, as well as differences between general practitioners from the four countries and occupational and insurance physicians using a generalised linear mixed model. RESULTS: Assessments of incapacity to work by physicians from the 5 countries were generally very similar. However, compared to Norwegian general practitioners, Swedish general practitioners (odds ratio (OR) of 0.43 with 95% confidence interval (CI) of 0.23-0.79) and Dutch occupational and insurance physicians (OR of 0.55 with 95% CI of 0.36-0.86) concluded less often that the patients in the videos were unable to work. There were no differences between general practitioners from the other 2 European countries and those from Norway. The Dutch occupational and insurance physicians also concluded less often that there was an incapacity to work compared to all general practitioners from the other 4 European countries (OR of 0.67 with 95% CI of 0.49-0.93). CONCLUSION: There are significant differences between assessments of incapacity to work in patients with SHC between countries and professional groups, but these differences are generally small. Potential explanations for these differences could be found in occupational and insurance medicine specialist training and in the existence of professional guidelines.

Cooperation between general practitioners, occupational health physicians, and rehabilitation physicians in Germany: what are problems and barriers to cooperation? A qualitative study.

PURPOSE: General practitioners (GPs), occupational health physicians (OPs), and rehabilitation physicians (RPs) fulfill different functions in the rehabilitation process, which need to be interlinked effectively to achieve a successful medical and occupational rehabilitation. In Germany, this cooperation at the interfaces is often suboptimal. The aim of this study was to identify and discuss perceived barriers to cooperation between GPs, OPs, and RPs. METHODS: We used a qualitative study design with eight focus group discussions (FGD) with GPs, OPs, RPs, and rehabilitants. Two FGDs per expert group with 4-10 participants were conducted. The transcripts were analyzed using qualitative content analysis. RESULTS: A number of obstacles to cooperation were reported by the participants, including (1) organizational (e.g., missing contact details, low reachability, schedule restrictions), (2) interpersonal (e.g., rehabilitants level of trust in OPs, low perceived need to cooperate with OPs, low motivation to cooperate), and (3) structural barriers (e.g., data privacy regulations, regulations concerning rehabilitation reports). CONCLUSION: The present data agree with study results from other countries, which addressed interfaces in the rehabilitation process. While some barriers could be overcome by the participants themselves, a multi-level stakeholder approach might be necessary. Future quantitative research is required to assess the relative weight of the findings.

La aptitud laboral y la aptitud psicofísica en las profesiones de riesgo / No disponible

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Patient and physician views of accompanied consultations in occupational health.

BACKGROUND: Accompanied (triadic) consultations, or consultations where a third person is present, are poorly researched and little research has been carried out in an occupational health (OH) setting. AIMS: To elicit the views of patients and OH physicians about accompanied consultations. METHODS: OH receptionists gave a self-administered questionnaire to patients after they attended OH consultations with a companion. We interviewed participating OH physicians to ascertain their views on accompanied consultations. RESULTS: Twenty-six patient questionnaires were completed (response rate 52%). Seventy-three per cent (19) of responders were accompanied by a spouse and 12% (3) by non-family members. Patients reported their companion was helpful with recall of information (100%), supportive (100%), provided extra information to the physician (81%) and enabled them to discuss the outcome afterwards (92%). In two consultations, the companion attended to provide support on procedural matters. Patients were not concerned that the consultation might involve sensitive discussion or physical examination. OH physicians reported concerns that the companion would make the consultation more difficult or influence its outcome. They felt that written information, guidelines and training in how to manage accompanied consultations would be useful. CONCLUSIONS: Patients who attended OH consultations with a companion felt the companion was beneficial to the consultation and did not have concerns about personal issues. OH physicians felt that further guidance and training on accompanied consultations would be useful. Written information could usefully be provided to patients attending an OH consultation with a companion.

Searching for consensus among physicians involved in the management of sick-listed workers in the Belgian health care sector: a qualitative study among practitioners and stakeholders.

BACKGROUND: In Belgium, the management of sick leave involves general practitioners (GPs), occupational health physicians (OPs) and social insurance physicians (SIPs). A dysfunctional relationship among these physicians can impede a patient's ability to return to work. The objective of this study was to identify ways to improve these physicians' mutual collaboration. METHODS: Two consensus techniques were successively performed among the three professional groups. Eight nominal groups (NGs) gathered 74 field practitioners, and a two-round Delphi process involved 32 stakeholders. RESULTS: From the results, it appears that two areas (reciprocal knowledge and evolution of the legal and regulatory framework) are objects of consensus among the three medical group that were surveyed. Information transfer, particularly electronic transfer, was stressed as an important way to improve. The consensual proposals regarding interdisciplinary collaboration indicate specific and practical changes to be implemented when professionals are managing workers who are on sick leave. The collaboration process appeared to be currently more problematic, but the participants correctly identified the need for common training. CONCLUSIONS: The three physician groups all agree regarding several inter-physician collaboration proposals. The study also revealed a latent conflict situation among the analysed professionals that can arise from a lack of mutual recognition. Practical changes or improvements must be included in an extended framework that involves the different determinants of interdisciplinary collaboration that are shown by theoretical models. Collaboration is a product of the actions and behaviours of various partners, which requires reciprocal knowledge and trust; collaboration also implies political and economic structures that are led by public health authorities.

General practitioners' and occupational health physicians' views on their cooperation: a cross-sectional postal survey.

PURPOSE: Prevention, rehabilitation and reintegration into the workplace are examples of overlapping work fields of general practitioners (GPs) and occupational health physicians (OPs). In Germany, however, cooperation between GPs and OPs is often lacking or suboptimal. In this article, we present GPs' and OPs' views on a variety of aspects of their cooperation and differences between them. METHODS: Survey questionnaire was developed on the basis of literature research and results of focus group interviews. Cross-sectional postal survey among GPs (n = 1000) and OPs (n = 383) was performed in the federal state of Baden-Württemberg, Germany. Explorative descriptive and logistic regression analyses were carried out (controlling for potential confounders). RESULTS: Response rates were 31 and 48 %, respectively. Mutual telephone calls were the most frequent contact medium (49 and 91 %, respectively). Both groups considered themselves to have clearly separate areas of responsibility (median = 4, rating scale from 1 "agree not at all" to 5 "agree definitely"). Necessity to cooperate and need to improve cooperation were both rated as 4 (by GPs) and 5 (by OPs), respectively (p < 0.001, Wilcoxon test). Several variables were found to be different by logistic regression analysis of answers from the two groups (e.g. in regard to importance of rehabilitation, primary prevention services, caring for chronically ill workers or changing of workplace conditions). Sensitive topics (e.g. concerning mutual rivalry, remuneration or adherence to medical confidentiality) were also found to be rated differently. CONCLUSION: The data show potential interest of both physicians groups to develop cooperation. As the ratings often differed significantly, particularly in regard to statements presented, answers influenced by social desirability are generally unlikely.

El papel de la adaptación como generadora de satisfacción laboral en médicos de salud ocupacional / The role of adaptation as generator of job satisfaction in occupational health doctors

OBJETIVO: analizar la construcción teórica del concepto de satisfacción laboral a través de la percepción de la adaptación al puesto de trabajo en médicos de salud ocupacional. MÉTODO: se aplicó la teoría fundamentada, utilizando el muestreo teórico propositivo hasta la saturación teórica. La muestra se integró con diez médicos dedicados a la salud ocupacional en la ciudad de México, durante el 2014. Se aplicaron entrevistas a profundidad y los datos obtenidos fueron analizados con el software Atlas-ti, dando como resultado códigos que se integraron en categorías, con las cuales se generó la teoría. RESULTADOS: Mis motivos de elección, Cambié de vida, y Oportunidades y proyectos fueron las categorías emergentes con las cuales se integró la dimensión de Adaptación al puesto de trabajo como elemento básico de la construcción teórica de la satisfacción laboral de los médicos de salud ocupacional. CONCLUSIONES: La satisfacción laboral en los médicos de salud ocupacional se presenta conforme se da su adaptación al puesto de trabajo, pues no existe desde el inicio de su vida laboral en el área, sino que se va generando conforme van aprendiendo y cambiando de actitud con respecto al trabajo.

OBJECTIVE: to analyze the theoretical construction of job satisfaction's concept through the adaptation to the job's perception in occupational health physicians. METHOD: it was applied the grounded theory, using proactive until theoretical saturation theoretical sampling. The sample was composed of ten physicians dedicated to occupational health in Mexico city, during the 2014. In-depth interviews were applied and the data obtained were analyzed with the software Atlas-ti, giving as a result: codes, which were integrated into categories, with which the theory was generated. RESULTS: My reasons for choice, I changed my life, and Opportunities and projects were the emerging categories with which joined the dimension of Adaptation to the post, as a basic element of the theoretical construction of the job satisfaction of occupational health physicians. CONCLUSIONS: Job satisfaction in occupational health physicians is presented as its adaptation to the job. It did not exist since the beginning of their working lives in the area, but it was generated as they learned and changed the attitude towards the work.

La formación en Medicina del Trabajo, cambiar para mejorar / Occupational Medicine training, the change to improving

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Verbal interaction patterns in the clinical context: A model of how people change in therapy / Patrones de interacción verbal en el contexto clínico: un modelo de cómo la gente cambia en terapia

BACKGROUND: The paper 'Why do people change in therapy? A preliminary study' (2006), published in this journal, led to the beginning of a line of research based on observational methodology and aimed at the clarification of the therapeutic process. Throughout these years, significant progress has been made towards an explanation of clinical change. In this paper, a synthesis of this line of research is presented, along with a series of conclusions that can, to some extent, provide an answer to the questions we posed in the aforementioned first paper. METHOD: Verbal behavior both of therapist and client was coded for 92 clinical sessions using the Verbal Behavior Interaction Category System (SISC-INTER-CVT). Descriptive and sequential analyses of the observations were then performed. RESULTS: The data show the existence of certain patterns of verbal interaction that are related to the clinically relevant activities undertaken by the therapist, from which a model for verbal interaction in the clinical context was developed. CONCLUSIONS: The functional analysis of the therapist-client verbal interaction is essential for the comprehension of the processes that explain clinical change as well as for the improvement of the quality of psychological therapy

ANTECEDENTES: el artículo publicado en esta revista '¿Por qué la gente cambia en terapia? Un estudio preliminar' (2006) supuso el inicio de una línea de investigación basada en metodología observacional, dirigida a clarificar el proceso terapéutico. A lo largo de estos años han sido grandes los avances en la explicación del cambio clínico. En este artículo se presenta una síntesis de esta línea de investigación, aportando una serie de conclusiones que, en cierta medida, dan respuesta a muchos de los interrogantes que presentábamos en ese primer trabajo al que hacíamos referencia. MÉTODO: se registró la conducta verbal de terapeutas y clientes en 92 sesiones clínicas, mediante el sistema de categorización de la interacción de la conducta verbal en terapia (SISC- INTER- CVT). A continuación, se realizó un análisis descriptivo y secuencial de las observaciones. RESULTADOS: los datos mostraron la existencia de ciertos patrones de interacción verbal, relacionados con las actividades clínicamente relevantes desempeñadas por el terapeuta, a partir de los cuales se desarrolló un modelo de interacción verbal en el contexto clínico. CONCLUSIONES: el análisis funcional de la interacción verbal terapeuta-cliente resulta imprescindible para comprender los procesos que explican el cambio clínico y aumentar la calidad de la terapia psicológica

Occupational health physicians have better work conditions for handling sickness certification compared with general practitioners: results from a nationwide survey in Sweden.

AIMS: To study whether occupational health physicians (OPs) have a better work situation regarding handling of sickness certification compared with other physicians, in particular general practitioners (GPs), and to analyze associations between OPs' experiences of assessing and providing a long-term prognosis of patients' work capacity and some potentially interrelated factors. METHODS: Answers to a nationwide survey from physicians who had sickness certification consultations at least once monthly were analyzed. Differences among OPs (n=481), GPs (n=4257) and physicians working in other clinical settings (n=9452) were estimated by chi square tests. Associations between OPs' experiences as above and potentially interrelated factors were estimated using logistic regression analyses. RESULTS: Among OPs, a lower proportion experienced clinical work situations related to sickness certifications as 'very problematic', compared with the other physicians, and especially so compared with GPs. A higher proportion of OPs also had organizational support for handling sickness certifications. For OPs, experience of sickness certification consultations as problematic once a month or less often, not experiencing sickness certification tasks as a work environment problem, and having a well-established workplace policy regarding sickness certification matters were significantly positively associated with finding assessing and providing a long-term prognosis of work capacity as 'not at all/somewhat problematic'. CONCLUSIONS: OPs' work situation regarding sickness certifications was favorable compared with that of other physicians, and especially compared with that of GPS. Our results underline the importance of organizational support for ensuring physicians' experience of having professional competence in handling assessments of patients' work capacity.

Collaboration between general practitioners and occupational physicians: a comparison of the results of two national surveys in France.

OBJECTIVE: To study the perceptions that general practitioners (GPs) and occupational physicians (OPs) have of GPs' role in occupational health and their willingness to work together to prevent the exclusion of patients with disabilities from the workplace. METHODS: Cross-sectional telephone survey of two randomly selected national samples of GPs and OPs was conducted. RESULTS: The majority of GPs and OPs are in favor of cooperation, especially to prevent exclusion from the workplace. However, some GPs lack trust in OPs' independence, an attitude associated negatively with the practice of GP referral to OPs to anticipate disability-related problems likely to occur when returning to work after a prolonged sick leave. CONCLUSIONS: There are some barriers to cooperation, on the part of both OPs and GPs. Initiatives are needed to encourage cooperation between these two types of physicians.

Prospective evaluation of mental health training for occupational health practitioners.

BACKGROUND: Occupational health (OH) practitioners need to be confident in identifying and managing mental health problems in the workforce. AIMS: To evaluate the effectiveness of a one-day workshop in improving the knowledge, attitude and confidence of OH practitioners in detecting and managing depression, anxiety, suicide risk, alcohol misuse and drug abuse. METHODS: Interactive mental health workshops for 164 OH practitioners held in five regions in England were evaluated by self-administered questionnaire. Data were collected immediately prior to the workshop (T1), immediately after the workshop (T2) and 4 months following the workshop (T3). RESULTS: At T1, the response rate was 97% (159/164), 90% at T2 and 63% at T3. The mean improvement in participants' knowledge was 8% (95% CI 6-10) at T2 compared with T1. The biggest improvement was in participants with no previous training in the management of common mental health problems in the workplace, mean improvement 9% (95% CI 6-12). Participants' confidence improved in all areas assessed at T2, and the improvement in confidence compared with that at baseline was sustained at 4 months (T3). Participants reported using the knowledge gained in clinical practice in all topic areas covered. Use of knowledge gained at the workshop was significantly higher in those who had had previous training in managing common mental health disorders. CONCLUSIONS: This one-day interactive workshop was a feasible and effective method of improving OH professionals' confidence, knowledge and application of skills in practice in key areas of mental health.