Alongamentos no trabalho

Physicians' Knowledge, Attitudes, and Practice of Occupational Diseases Diagnosis and Occupational History Taking.

OBJECTIVES: This cross-sectional study assessed physicians' knowledge and attitudes toward occupational diseases, their practice of occupational history taking, and the associated factors and barriers. METHODS: From January 1 to June 30, 2023, Egyptian physicians from different specialties (n = 278) completed a questionnaire including sociodemographic and occupational data, questions measuring knowledge, attitudes, practice, and barriers. RESULTS: The significant predictor of low knowledge was the nonuse of a standard history form. The lack of undergraduate education/postgraduate training in occupational diseases was the predictor of unfavorable attitudes and poor practice. Unfavorable attitudes also predicted poor practice. The main barriers were insufficient knowledge and busy schedules. CONCLUSIONS: Different specialties physicians are essential in recognizing occupational diseases. They need to be knowledgeable about occupational diseases within their specialties. Specialized undergraduate and postgraduate training in this topic can help achieve such needs.

Undergraduate occupational medicine education in European Medical Schools: better training to meet today's challenges.

BACKGROUND: Occupational medicine (OM) faces considerable challenges today, one of them related to the university training of future physicians considered suboptimal at a global level as it has been pointed out in many studies. The aim of this study is to update the state of OM medical education in European universities. METHODS: Between March and August 2022, an e-mail survey regarding OM training to undergraduate medical students was conducted among OM professors at European universities in 28 countries (n = 347). RESULTS: Of the 347 universities, 53 medical schools from 19 countries responded (response rate = 15.3%). In 89% of cases, OM was taught. The average number of hours per academic year was 24.3, with significant variation within the same country. Lectures were the most popular teaching technique (98%), with a considerable use of modern approaches such as problem-based learning (61%), and e-learning (57%). While occupational diseases and principles of prevention were covered, other subjects such as the environmental impact or collaboration with an OM physician were poorly represented in the educational program. CONCLUSION: According to data, several European medical schools may provide insufficient OM education and training to their students. The education of undergraduate occupational medicine students in European medical schools should be designed to equip them with the knowledge and skills required to meet today's challenges. It is critical that undergraduate OM education in European medical schools be enhanced, harmonized, and standardized.

Practical Applications and Observational Implications of Time-Based Coding for Workers' Compensation Clinical Encounters-A Follow-up to Best Practices in Documenting and Coding High-Value Care in Workers' Compensation Encounters-ACOEM Guidance Statement.

ABSTRACT: Clinical practices that provide workers' compensation care and other services related to managing work-related illnesses and injuries have long been challenged in receiving appropriate payment for their professional work. The American College of Occupational and Environmental Medicine (ACOEM) has provided excellent guidelines for coding and billing via its various documents that have been provided over the years. However, despite these guidelines, payors have been slow to adopt occupational specific coding guidelines to justify higher professional payment. With the move to a Centers for Medicare & Medicaid Services (CMS)-sponsored time-based coding option in 2011, the occupational and environmental medicine (OEM) clinics have been able to finally not only document but recoup the value of those services that go beyond the simple patient interface, being able to capture those activities that truly provide high value in the management of workers' medical issues.

How occupational physicians pay attention to the values of employees: a qualitative study.

PURPOSE: The Dutch Association for Occupational Medicine considers employee values to be an essential pillar in occupational medicine. The occupational physician should focus on what an employee finds valuable. However, it is unclear how occupational physicians comply with this policy and pay attention to employee values. The present study aims to fill this gap by mapping to what extent occupational physicians pay attention to employee values. METHOD: We used an exploratory qualitative research method through in-depth interviews with 10 Dutch occupational physicians. Additionally, two non-participating observations were conducted. RESULTS & CONCLUSION: The results show that values remain mostly implicit and are applied intuitively or unconsciously but not explicitly. Hence, the ethical requirements of the Dutch Association for Occupational Medicine policy remain underexposed and under-executed. Multiple facets foster or impede a conversation about values. As far values were mentioned they were mainly extrinsic, social, and prestige-oriented. Intrinsic values were hardly mentioned. However, a few occupational physicians explicitly stated that they pay attention to values and reported that heeding to employee values contributes to better collaboration and decision-making with the employee. We argue that paying attention to intrinsic values may improve the overall work quality of occupational physicians and benefit employee well-being.

[General practice and occupational medicine: a dynamic exchange?] / Médecine générale, médecine du travail : quelle dynamique d'échange ?

GENERAL PRACTICE AND OCCUPATIONAL MEDICINE: A DYNAMIC EXCHANGE? Occupational physicians and general practitioners have different roles but share the common goal of maintaining and promoting the health of the population. Their collaboration is necessary, and both practitioners and employees are generally in favor of it. This collaboration is particularly necessary in several situations: the discovery of a pathology by the occupational physician, the need for temporary incapacity, or difficulties in maintaining employment. Especially in the case of musculoskeletal disorders and mental suffering at work. The pre-reinstatement visit is an important tool for achieving this collaboration. There are also several ways of improving these exchanges, such as the introduction of joint training courses.

MÉDECINE GÉNÉRALE, MÉDECINE DU TRAVAIL : QUELLE DYNAMIQUE D'ÉCHANGE ? Le médecin du travail et le médecin généraliste ont des places et des rôles différents mais pour objectif commun de maintenir et promouvoir la santé de la population. Leur nécessaire collaboration, à laquelle les praticiens comme les salariés se disent globalement favorables, est pourtant insuffisamment constatée sur le terrain. Cette collaboration est nécessaire dans plusieurs situations : découverte d'une pathologie par le médecin du travail, nécessité d'une inaptitude temporaire ou encore difficultés de maintien en emploi. C'est particulièrement le cas pour les situations de troubles musculo-squelettiques et de souffrance psychique au travail. La visite de préreprise est un outil important pour permettre cette collaboration. Il existe également plusieurs pistes d'amélioration de ces échanges, comme la mise en place de formations communes.

[Occupational medicine in France: the current situation in 2024]. / Médecine du travail en France, état des lieux en 2024.

OCCUPATIONAL MEDICINE IN France : THE CURRENT SITUATION IN 2024. Occupational medicine has evolved since its creation in 1946. Occupational medicine services have become Occupational health services (OHS) and medical examination in nowadays only a part of their missions, which include helping the employers to perform risk assessment, patients to stay at work, and implementing health promotion in the workplaces in order to prevent disabilities. To fulfill those missions, OHS can rely on health specialists (occupational physicians and nurses) but also on a wide range of competencies, from toxicologists to ergonomists, and from psychologists to occupational hygiene specialists, all gathered in multidisciplinary teams, leaded by the occupational physician. Optimizing cooperation between general practitioners and occupational health physicians is still needed to improve the worker journey, to facilitate his ability to return to work and to ameliorate his long-term health follow-up according to his previous occupational exposures.

MÉDECINE DU TRAVAIL EN FRANCE, ÉTAT DES LIEUX EN 2024. La médecine du travail a peu à peu évolué, depuis sa création en 1946. Les services médicaux du travail sont devenus des services de prévention et de santé au travail, et le suivi de santé ne représente désormais qu'une partie de leur activité. L'aide à l'évaluation des risques, le maintien en emploi, les actions de promotion de la santé dans une perspective de prévention de la désinsertion professionnelle ont pris une place grandissante. Cela s'est accompagné d'une évolution des compétences au sein de ces services. Outre la compétence santé représentée par le binôme médecin-infirmier, des ergonomes, psychologues et toxicologues sont désormais présents ; ils interviennent en prévention des risques professionnels et constituent des équipes pluridisciplinaires, animées et coordonnées par le médecin du travail. Une meilleure collaboration entre médecin du travail et médecin traitant reste nécessaire pour améliorer le parcours du travailleur, son maintien en emploi et son suivi de santé au long cours en fonction de ses expositions professionnelles passées.

[Role of the occupational medicine in the prevention of diseases and accidents]. / Rôle de la Médecine du travail dans la prévention des maladies et des accidents.

Occupational medicine is an essential branch of preventive medicine that aims to protect the health of workers in the workplace. Any work situation exposes the worker to occupational hazards. The three levels of prevention applied in occupational medicine make it possible, together, to control risks. Primary prevention aims to prevent the occurrence of damage related to occupational risks, secondary prevention aims to early detect work-related health problems and in tertiary prevention, the objective is to limit the consequences of occupational risks or diseases already developed. It is not always possible to completely eliminate an occupational hazard. Regular medical examinations, at a frequency appropriate to the risks identified, meet this objective and therefore make it possible to detect work-related health problems or problems that could influence work. A proactive approach focused on prevention helps to reduce occupational risks, prevent work-related diseases, and to promote a healthy and safe work environment for all.

La médecine du travail est une branche essentielle de la médecine préventive qui vise à protéger la santé des travailleurs sur leur lieu de travail. Toute situation de travail expose le travailleur à des dangers professionnels. Les trois niveaux de prévention appliqués en médecine du travail permettent, ensemble, de maîtriser les risques. La prévention primaire vise à empêcher l'apparition des dommages liés aux risques professionnels, la prévention secondaire vise à détecter précocement les problèmes de santé liés au travail et en prévention tertiaire, l'objectif est de limiter les conséquences des risques professionnels ou des maladies déjà développées. Il n'est pas toujours possible de supprimer complètement un risque professionnel. Les examens médicaux réguliers, à une périodicité adaptée aux risques identifiés, répondent à cet objectif et permettent donc de détecter les éventuels problèmes de santé liés au travail ou qui pourraient influencer le travail. Une approche proactive axée sur la prévention contribue à réduire les risques professionnels, à prévenir les maladies liées au travail, et à promouvoir un environnement de travail sain et sécurisé pour tous.

Occupational Physicians' Management of Workers With Multiple Sclerosis in Italy: Results From a Survey.

BACKGROUND: This study, conducted on a sample of Italian occupational physicians (OPs), aimed to gather data regarding professional activity and their needs in managing workers with multiple sclerosis. METHODS: A convenience sample of OPs recruited by e-mail invitation to the list of Italian Society of Occupational Medicine members was considered. A total of 220 OPs participated between July and October 2022. An ad hoc questionnaire was developed based on previous survey experiences. It investigated, among others, the characteristics of OP respondents, the evaluation of fitness for work issues, and the OP training and updating needs on multiple sclerosis and work. RESULTS: Ninety-one percent of OPs had to assess the fitness for work of workers with multiple sclerosis during their activity. Sixty-four percent experienced particular difficulties in issuing a fitness for work judgment. Regarding the level of knowledge on multiple sclerosis, 54% judged it sufficient. The "Assessment of fitness for work for the specific task" and the "Role of the OPs in identifying reasonable accommodations" were the most interesting training topics regarding MS management in work contexts chosen by the respondents. CONCLUSIONS: The interest in the work inclusion and job retention of people with disability, particularly the aspects linked to the Identification and implementation of reasonable accommodations, will require integration with the occupational safety and health protection system and will undoubtedly impact the OP's activities.

Best Practices in Documenting and Coding High-Value Care in Workers' Compensation Encounters-ACOEM Guidance Statement.

ABSTRACT: Workers' compensation outpatient care requires attention to causation, functional assessment, work disability prevention, and return-to-work planning, elements not usually addressed in other types of outpatient encounters. Because these elements of care deviate from the usual pattern of ambulatory services, providers of workers' compensation care have faced challenges in billing and auditing practices resulting in underpayment when providing high-value care based on evidence-based guidelines. Recent changes in Centers for Medicare & Medicaid Services rules on documentation requirements for coding outpatient evaluation and management encounters offer an opportunity for occupational health clinicians to be paid appropriately for care that follows occupational medicine practice guidelines. There remains a need to define the elements of documentation that should be expected in delivering high-value workers' compensation care. This article provides guidance for documenting high-value workers' compensation care.

[Expectations And Motivations Of Young Occupational Medical Physicians: A Quantitative Survey Of Five German Academies]. / Erwartungen und Motive des arbeitsmedizinischen Nachwuchses: eine quantitative Befragung in fünf deutschen Akademien.

STUDY AIM: The aim of this study was to describe the characteristics of future occupational physicians and to evaluate their expectations from and motivations for undertaking postgraduate medical education courses in occupational medicine. This will provide a basis for further increasing the attractiveness of occupational medicine as a discipline in preventive medicine and counteracting the shortage of occupational medical physicians. METHODS: At five locations in Germany, physicians in postgraduate medical education courses in occupational medicine were asked about their expectations from occupational medicine, their reasons for starting postgraduate medical education courses, and their assessment of these courses. The survey took place between 2018 and 2021. The data were analysed descriptively, and a cluster analysis was applied to identify the types of motives for continuing postgraduate medical education courses in occupational medicine. RESULTS: Of the 233 respondents, the majority were female (68.5%) and the mean age was 43.1 years (SD 7.9 years). The response at the State Chamber of Physicians of Saxony was 50% and at the remaining four academies was between 18% and 23%. The analysis revealed four different types of motives: "career & interest", "work & life balance", "self-employment" and "desire for change". Two-thirds of the participants were in favour of a greater integration of occupational medicine into medical school curriculum. CONCLUSIONS: The results suggest that there are different motives that lead physicians to pursue continuing education in occupational medicine. These motives should be considered when recruiting young occupational physicians.

Regulatory and Ethical Considerations on Artificial Intelligence for Occupational Medicine.

Generative artificial intelligence and Large Language Models are reshaping labor dynamics and occupational health practices. As AI continues to evolve, there's a critical need to customize ethical considerations for its specific impacts on occupational health. Recognizing potential ethical challenges and dilemmas, stakeholders and physicians are urged to proactively adjust the practice of occupational medicine in response to shifting ethical paradigms. By advocating for a comprehensive review of the International Commission on Occupational Health ICOH code of Ethics, we can ensure responsible medical AI deployment, safeguarding the well-being of workers amidst the transformative effects of automation in healthcare.

Assessing the profile and utility of diplomates in occupational medicine.

BACKGROUND: The utility of the occupational medicine diploma in the UK is yet to be explored. The NHS 'Growing Occupational Health (OH) and Wellbeing' programme provides opportunities for diplomates to increase their OH work. AIMS: To assess what proportion of diplomates carry out OH work, the type of work being undertaken, to identify obstacles impeding OH work, to capture their interest in future work opportunities and what additional support they require. METHODS: A link to an online questionnaire was sent to diplomates via several professional bodies; we estimate that 2428 diplomates received this. The survey was open from 24 March to 31 May 2022. RESULTS: Replies were received from 310/2428 (13%) diplomates. Fifty-two per cent of respondents were males and 35% were female. Respondents were diverse in terms of age and geographical region. Main employment settings: 13% primary care, 43% secondary care, 31% private sector, 24% public sector and 20% self-employed. Seventy-two per cent of diplomates had undertaken OH clinical work since completion of their diploma, and 90% of those were undertaking OH clinical work at the time of the survey. Specific obstacles to accessing OH work highlighted included existing workload constraints, lack of employment opportunities with OH providers and lack of time. CONCLUSIONS: Many (126/310; 41%) respondents had considered increasing their OH work in the previous 12 months. Increasing mentorship from senior OH clinicians to diplomates was suggested by 4% of respondents to enhance the utility of diplomates.