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PubMedDate not supplied

[Experimental validation of the Evidence-Based Occupational Health paradigm and of the PICO model in the decision making process applied by occupational health physicians].

BACKGROUND: Health care organizations are increasingly aware of the need to apply quality assurance principles to serve their mission and there is an increasing pressure on health professionals to ensure that the practice is based on evidence of appropriateness. Medical specialists of different disciplines, including occupational health, are presently required to shift from habitual practices to evidence-based practices, and have began to use an approach based on the paradigm of Evidence-Based Medicine and of Evidence-Based Occupational Health (EBOH). OBJECTIVE AND METHODS: The study was carried out to analyse how the paradigm of the EBOH could be implemented in the search, analysis and synthesis of the best available evidence to apply in the decision-making process in occupational health practice. Out of 464 medical examinations consecutively performed by 4 occupational health physicians, 6 cases were selected on the basis of their complexity and the need for further investigation. Each case was submitted to each of the 4 physicians, who were asked to make a decision according to the EBOH paradigm: i.e., (i) identification of the problem according to the PICO model, (ii) solution of the problem according to his/her internal evidence or experience (iii) search for scientific external evidence, (iv) critical appraisal of such evidence, (v) application of the evidence in the decision-making process, (vi) comparison between internal evidence and external evidence. Outcome measurements, including satisfaction of the physicians, were collected. RESULTS: No differences were found between the decisions based on external evidence or on internal evidence in about 50% of the cases (13/24). In about 1/3 of the cases (7/24) no agreement was observed between the decisions taken on the basis of internal and external evidence. In some cases (5/24) no useful information was added for the purposes of decision-making. In about 50% of the cases the professionals were satisfied with the information found in databases, due to its usefulness both in increasing their knowledge and in improving their practice. CONCLUSIONS: Due to their involvement in a corporate system, the participants were aware of the need to practice according to quality assurance principles and to relinquish ineffective and obsolete practices. They agreed with the need to search for the best available evidence with the aim of guaranteeing efficacious interventions. In spite of a number of obstacles to the application of the EBOH paradigm to occupational health practice, the study demonstrated that such approach can be successfully applied in this field and that it can be proposed for the search of appropriate solutions to the problems usually encountered in professional practice.

Decision Support Systems, Clinical↗

PubMed2005

[Role of obligatory medical insurance in insuring victims of occupational accidents and patients with occupational diseases].

The author described current system insuring victims of occupational accidents and patients with occupational diseases, with participation of all off-budget funds and health service budget, with consideration of work conditions and occupational morbidity in Rostov region. Analysis covered experience and efficiency of Obligatory Medical Insurance System (unique in this country, which participated in insuring occupational victims) in insuring victims of occupational accidents in the region.

Accidents, Occupational↗

PubMed1991

Differential treatment of occupational disease v occupational injury by workers' compensation in Washington State.

Washington State's workers' compensation claims filed in 1984 and followed through 1988 contained 11,356 claims for occupational disease and 178,927 claims for occupational injury. There was a higher rate of rejection (18% v 4%) and resource utilization (14% v 5%) for occupational disease when compared to occupational injury. The factors most predictive of rejection included the specific disease category and the provider frequency of filing. Development of diagnostic guidelines would aid health providers in identifying and properly characterizing occupational diseases.

Accidents, Occupational↗

PubMed1984

The mortality odds ratio (MOR) in occupational mortality studies--selection of reference occupation(s) and reference cause(s) of death.

In occupational mortality studies, the information on the population at risk is frequently not available. In these circumstances, the rate ratio of interest can be assessed through the mortality odds ratio (MOR), given appropriate selections of reference occupation(s) and reference disease(s). The reference occupation should be chosen with a view to three aspects of validity: (1) comparability of effects, i.e., identity of mortality effects between the index and the reference occupation apart from the effect of the exposure under study; (2) comparability of contrasted populations, i.e., same job entry and exit factors and similar health promotion programmes when related to the mortality under study; and (3) comparability of mortality information, i.e., same diagnostic and certification practices for the cause of death of interest between the contrasted populations. The reference causes of death must also satisfy these requirements with the additions that the exposure under study have no effect on the risk of reference causes of death, and that the accuracy of information about the compared occupations be the same as in the context of the index cause of death. Throughout the discussion, an example of exploring cancer risks among lens manufacturing workers is used.

Epidemiologic Methods↗

PubMed1998

Proposal for the assessment of quantitative dermal exposure limits in occupational environments: Part 1. Development of a concept to derive a quantitative dermal occupational exposure limit.

Dermal uptake of chemicals at the workplace may contribute considerably to the total internal exposure and so needs to be regulated. At present only qualitative warning signs--the "skin notations"--are available as instruments. An attempt was made to develop a quantitative dermal occupational exposure limit (DOEL) complementary to respiratory occupational exposure limits (OELs). The DOEL refers to the total dose deposited on the skin during a working shift. Based on available data and experience a theoretical procedure for the assessment of a DOEL was developed. A DOEL was derived for cyclophosphamide and 4,4-methylene dianiline (MDA) according to this procedure. The DOEL for MDA was tested for applicability in an actual occupational exposure scenario. An integrated approach is recommended for situations in which both dermal and respiratory exposures contribute considerably to the internal exposure of the worker. The starting point should be an internal health based occupational exposure limit--that is, the maximum dose to be absorbed without leading to adverse systemic effects. The proposed assessment of an external DOEL is then either based on absorption rate or absorption percentage. The estimation of skin penetration seems to be of crucial importance in this concept. If for a specific substance a maximal absorption rate can be estimated a maximal skin surface area to be exposed can be assessed which may then serve the purpose of a DOEL. As long as the actual skin surface exposed is smaller than this maximal skin surface area the internal OEL will not be exceeded, and therefore, no systemic health problems would be expected, independent of the dermal dose/unit area. If not, the DOEL may be interpreted as the product of dermal dose/unit area (mg/cm2) and exposed skin surface area (cm2). The proposed concept for a DOEL is relevant and can be made applicable for health surveillance in the occupational situation where dermal exposure contributes notably to the systemic exposure. Further research should show whether this concept is more generally applicable.

Humans↗

PubMed1996

Occupational factors in multiple sclerosis: an analysis of occupational mortality statistics for men and married women in Great Britain.

This paper presents an exploratory study based on occupational mortality statistics for Great Britain. It examines disease concordance between marital partners for multiple sclerosis (MS). Previous studies have revealed that a married woman's life expectancy and her specific cause of death is reliably associated with the occupational mortality of her husband. This relationship exists across a wide range of occupations but is particularly marked in the case of MS. The present study examines the mortality rates for MS for a large number of occupations (taking into account possible sources of statistical bias) and considers the relationship of these findings with existing hypotheses about the aetiology of MS. It is suggested that there should be more consideration of occupational and psychological factors in multicausal explanations of the disease.

Adult↗

PubMed1990

The Canadian occupational performance measure: an outcome measure for occupational therapy.

The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as well as information about its use for therapists.

Canada↗

PubMed1982

Occupational role history: a screening tool for psychiatric occupational therapy.

Psychiatric hospitalization has become telescoped, thus focusing on short-term acute care. Since discharge plans are needed on admission, occupational therapists must evaluate the patient quickly and succinctly. A screening tool was developed as a preliminary device to identify critical information in two major areas: patterns of skills and achievement or patterns of dysfunction in past and current occupational role; and the degree of balance or imbalance between leisure activities and those activities associated with occupational role. The screening tool, the Occupational Role History, was used in a pilot study on 20 adult inpatients at the UCLA Neuropsychiatric Institute. The results of the pilot study suggest that this tool is useful in establishing treatment priorities from an occupational therapy perspective.

Adolescent↗

PubMed1986

Roles and functions of occupational therapy in adult day-care (position paper). American Occupational Therapy Association.

Occupational therapy's long-standing involvement in adult day-care attests to the importance of the profession's role in this setting. The functional approach used by occupational therapy helps the older person overcome multiple disablements associated with aging. Intervention promotes independence, adaptation, and the maintenance of occupational performance in self-care, work, and leisure. Working collaboratively with the day-care staff, participant, and family or care giver, occupational therapy personnel use their expertise to analyze activities and facilitate problem solving. Occupational therapy personnel may also work as administrators, activity coordinators, and consultants within the adult day-care setting.

Adult↗

PubMedDate not supplied

Occupational mental health promotion: a prevention agenda based on education and treatment. The American Psychological Association/National Institute for Occupational Safety and Health, Health Promotion Panel, 1990 Work and Well-Being Conference.

PURPOSE OF THE REVIEW. Psychological disorders are one of the 10 leading work-related diseases and injuries in the United States according to the National Institute for Occupational Safety and Health. This article addresses occupational metal health and preventive stress management in the workplace. The individual and organizational costs are briefly considered with concern for reducing the burden of suffering associated with these problems. SEARCH METHOD. As an American Psychological Association interdisciplinary panel, we searched the psychological, medical, public health, and organizational literature. We selected articles relevant to the problem of psychological disorders in the workplace and to enhancing occupational mental health and preventive stress management. IMPORTANT FINDINGS. The panel proposed a national agenda of education and treatment, combined with a program of evaluation research, for addressing these issues. Target populations are identified, and the need for collaboration among a variety of national constituencies is considered. Advancing occupational mental health and promoting skills in preventive stress management is considered in the context of comprehensive health promotion. MAJOR CONCLUSIONS. The panel concluded that there is a pressing need to: 1) set a 'gold' standard concerning the current state of knowledge in the domains of occupational mental health and stress management; 2) identify Diagnostically Related Groups (DRGs) which are stress-related; 3) establish assessment standards for stress and mental health; 4) set guidelines for reasonable interventions; and 5) establish acceptable post-outcome criteria.

Health Education↗

PubMedDate not supplied

[Respiratory occupational allergies: the experience of the Hospital Operative Unit of Occupational Medicine in Lombardy from 1990 to 1998].

A retrospective study on occupational rhinitis and asthma diagnosed in 7 occupational health institutes in Lombardia (North-West Italy) was performed using a standardized card. 141 cases of rhinitis and 281 cases of asthma due to sensitization to occupational agents were analyzed and their clinical characteristics, aetiology, diagnostic methods and associated allergic diseases were determined. In this population the most frequent agents of occupational rhinitis were wheat flour and latex, whereas those of occupational asthma were latex and isocyanate. More than half of the subjects had more than one clinical manifestation of allergy. In 92 out of the 281 asthmatic patients rhinitis was the first clinical manifestation, particularly in subjects sensitized to high molecular weight substances, and preceded, asthma by 12 months as a mean. Specific bronchial provocation tests were useful for the diagnosis of asthma in 153 of the asthmatic patients and 45 of them had an isolated late bronchial reaction following the specific stimulus. At diagnosis 61 subjects (21.7%) had FEV1 < 80% of predicted; factors associated to ventilatory impairment were sensitization to high molecular weight substances, duration of exposure to the sensitizing agent, persistence of exposure after onset of symptoms.

Adolescent↗

PubMed2001

WORKSAFE IOWA Occupational Medicine Associates Network: a university--community partnership in occupational safety and health.

The WORKSAFE IOWA Occupational Medicine Associates Network is a unique health care model for dispensing regional occupational medicine services in the state of Iowa, USA. WORKSAFE IOWA is an educational, informational, and consultation service of the College of Public Health at The University of Iowa. WORKSAFE IOWA includes a fee-for-service industrial hygiene program, the Occupational Medicine Associates Network, and educational and informational services. The Associates Network provides education, information, and consultation in exchange for an annual fee paid by each Associate to the university-based network. The Associates clinics provide comprehensive occupational medicine services to up to 1,500 clients through 66,000 annual clinic visits in their respective communities. The Associates Network has been financially self-sustaining over a period of 10 years, and has proven to provide valuable services to the community-based Associates, and to provide excellent training opportunities for the University students in several occupational safety and health disciplines.

Community Networks↗

PubMed2005

An evaluation of the variation in the rates of occupational accidents in Turkey with trend analysis methodology. Are occupational accidents really diminishing?

OBJECTIVE: To show whether the rate of occupational accidents is decreasing in Turkey. METHODS: Data on incidence and deaths due to occupational accidents in Turkey during the period 1970-2000 were obtained and evaluated at the Department of Public Health, Hacettepe University, Ankara, Turkey. The data were collected in January 2003. The occupational accident rates were analyzed by morbidity, mortality and case fatality rates. The change in each variable over years was tested by trend analysis methodology. A regression analysis was performed on data on 3-point moving averages. RESULTS: The morbidity decreases significantly over the last 30 years (p<0.01) with a slope of -0.003. The correlation of the morbidity tendency due to years was 0.995 (p<0.01) and the total variance descriptive rate was 0.991. In respect to mortality, the variation due to years was declining (0.00001, p<0.01). The correlation of the model was 0.950 (p<0.01) and brings out the total variance to 0.903. The trend analysis model can be explained meaningfully in respect of constant and slope (p<0.01). In respect of fatality the variance over the years was 0.00029 (p<0.01). The correlation of the model was 0.934 (p<0.01) and brings out the total variance of 0.872. CONCLUSION: The main reason of the decrease of occupational accidents was probably due to unreported accidents, which do not cause injury. Reasons for underreporting of minor accidents should be investigated and this point should be taken into consideration when planning an occupational accident prevention programs.

Accidents, Occupational↗

PubMed1989

[Occupational physicians in Norway--the number and work hours. An indicator of the development of occupational health services?].

We do not know the present size of the occupational health service in Norway, and we have no certain knowledge about occupational health physicians. Many of them are not registered in our health personnel registry. In 1971 there were 663 occupational health physicians. They did about 2% of the total work of Norwegian doctors. When the data in the health personnel registry are adjusted, they indicate that Norway should have somewhat more than 1,100 occupational health physicians in 1986, doing roughly 5% of the work of all doctors. However, in addition to the above, there is extensive "contact with doctors through the place of work". In a national survey conducted in 1983, one million employees said that this possibility was open to them. In 1988 the Directorate of Labour Inspection recorded only 550,000 employees offered an occupational health service. It is unknown what kind of service the other 450,000 employees receive, who delivers it, and how many hours of work this takes.

Norway↗

PubMed1979

Human development through occupation: theoretical frameworks in contemporary occupational therapy practice, part 1.

In 1968, the report of a conference sponsored by the American Occupational Therapy Association called for the development of an integrated theory of occupational therapy. A review of the practical problems faced by therapists today, contrasted with major developments in the art and science of the field during the past decade, suggests that this goal has not been attained. However, three major theoretical frameworks for therapy have evolved through the work of Fidler and Mosey, Wilbarger, and Llorens, who participated in the conference on theory. Reilly and associates developed a fourth framework of significance. Through analysis of theoretical constructs, generic concepts that characterize occupational therapy can be identified. Theoretical constructs and research validation of the four approaches to occupational therapy are discussed in this article. A second article to appear in a subsequent issue of AJOT illustrates the use of the four theoretical frameworks to derive a philosophical basis for practice and a model of the practice process called "human development through occupation."

Human Development↗

PubMed1984

[Vascular diseases and occupation. Incidence and significance of circulatory diseases in occupational medicine].

The high incidence and socio-medical significance of vascular diseases--which often manifest during the working lifetime of the patient--mean that doctors in occupational medical practice have more and more frequently to deal with these lesions, irrespective of whether they are causally linked to the patient's occupation or not. For diseases of the circulatory system usually have a direct effect on the patient's efficiency and fitness for work. Depending on the localisation of the lesion, certain precautionary measures may be needed at work, or it may no longer be possible for the affected person to carry out certain jobs--or at least not without risk. This applies not merely to arterial, but also to venous and lymphatic diseases. Further, there are a number of recognised occupational diseases that manifest, or may manifest, as circulatory disorders. A range of occupation-related effects or exposures of a physical, chemical or possibly immunological-allergic nature can lead to vascular lesions including premature attrition of the vascular system. The early detection and prevention of circulatory disorders may become a major task of occupational medicine in the future.

Adult↗

PubMed1998

Recognizing occupational disease--taking an effective occupational history.

Occupational exposures contribute to the morbidity and mortality of many diseases. However, occupational diseases continue to be underrecognized even though they are responsible for an estimated 860,000 illnesses and 60,300 deaths each year. Family physicians can play an important role in improving the recognition of occupational disease, preventing progressive illness and disability in their own patients, and contributing to the protection of other workers similarly exposed. This role can be maximized if physicians raise their level of suspicion for workplace disease, develop skills in taking occupational histories and establish routine access to occupational health resources.

Adult↗

PubMed1991

Occupational asbestos exposure and mesothelioma risk in Los Angeles County: application of an occupational hazard survey job-exposure matrix.

We evaluated the newly available National Institute for Occupational Safety and Health (NIOSH) National Occupational Hazard Survey (NOHS) job exposure matrix (JEM) by considering mesothelioma risk from asbestos exposure. We applied this system (NOHS-JEM) to the Los Angeles County Cancer Surveillance Program (CSP) to see how many cancer cases could be assigned asbestos exposure and how asbestos exposure affected mesothelioma risk. Using the same CSP data, our "experts" classified asbestos exposure simply by occupation and industry. Both exposure classifications were divided into low and high; the NOHS-JEM by the number of exposed people per couplet, and ours by judgements of intensity. Odds ratios (OR) for mesothelioma risk for low and high asbestos exposure for the NOHS-JEM were 2.0 (95% C.I. 1.2-3.4) and 2.5 (95% C.I. 1.2-4.8). For ours, corresponding risks were 1.6 (95% C.I. 1.1-2.4) and 6.3 (95% C.I. 2.5-15.1). Our system was able to assign more cases to couplets then the NOHS-JEM (35,895 to 22,369). Three limitations of the NOHS-JEM were that many occupation-industry couplets were not classified at all, many couplets associated with past asbestos exposure (before the 1972-1974 NOHS survey) were not classified as asbestos exposure, and no assessment of intensity was made. These limitations may apply to other exposures and should be carefully considered before the NOHS-JEM is applied to other case-control studies.

Adolescent↗