[Surveillance of a patient subjected to treatment for arrhythmia. Assistance to heart patients].
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Arrhythmias, Cardiac↗
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Canada↗
Prevalence of hepatitis C infection in health care workers affiliated with a liver transplant center.
The risk of hepatitis C to liver transplantation health care workers has not been identified. We compared the occupational risk of hepatitis C in health care workers associated with liver transplantation with risk of health care workers affiliated with the same institutions but not involved in transplantations. Health care workers were recruited from 2 transplant centers. Participation was voluntary; results were confidential. An occupational and health history questionnaire was completed and blood was donated for testing. Health care workers were categorized into 3 groups according to risk for hepatitis C infection: very high, high, and low risk. A total of 241 health care workers were recruited from 2 transplant centers. Fifty-nine percent (142/241) were female; mean age was 38.7 years. Health care workers included: 48.5% (117/241) nurses, 24.9% (60/241) physicians, and 17% (42/241) laboratory personnel. The mean number of years in their occupation was 13.5 years (range < 1 year to 38 years). Twenty-four percent (57/241) were categorized in a very high risk occupation for hepatitis C, 66% (158/241) in a high risk occupation, and 10.8% (26/241) in a low risk occupation. A total of 2.1% (5/241) of health care workers were reactive to hepatitis C by enzyme immunosorbent assay; three of these were positive by polymerase chain reaction testing. Of the 3, none had a history of hepatitis or transfusion. However, 5.3% (3/57) of health care workers involved with liver transplantation were infected, as compared with 0% (0/184) who were not (P = 0.013). We conclude that health care workers associated with liver transplantation may be at a higher risk for hepatitis C when compared with health care workers not associated with transplantation.
Adult↗
HIV infection, syphilis, and tuberculosis screening among migrant farm workers--Florida, 1992.
An estimated 2.7-4.0 million persons in the United States are classified as migrant and seasonal farm workers (1). Despite a high prevalence of tuberculosis (TB) and other conditions among migrant workers (2-4), approximately 13% have access to or receive care at federally funded migrant health clinics (5). During February-March 1992, to assess the prevalence of selected health conditions among migrant farm workers, the Florida Department of Health and Rehabilitative Services (FDHRS) conducted a voluntary screening for human immunodeficiency virus (HIV)-1 infection, syphilis, and TB among workers living in 14 migrant camps in Immokalee, Florida. This report summarizes the results of the screening and describes disease-prevention efforts developed by FDHRS for migrant workers.
Adolescent↗
Euthanasia and assisted suicide: a survey of registered social workers in British Columbia.
This anonymous postal survey explores the attitudes and experiences concerning voluntary euthanasia (VE) and assisted suicide (AS) held by professionally registered members of the British Columbia Association of Social Workers. Social workers determine only a minor moral distinction between VE and AS and a large majority believe both acts should be legal, in certain circumstances (VE 75.9 per cent; AS 78.2 per cent). Approximately 80.0 per cent feel that social workers should be involved in social policy development concerning VE and AS, and, if such acts were to be legal, 70.0 per cent believe social workers should be involved in the decision making process with clients. Over 21.0 per cent of all social workers and nearly 40.0 per cent of social workers with medical employers have been consulted by a patient about VE or AS. Six respondents (1.1 per cent) reported assisting the death of a patient by VE. None had involvement in AS. Further research and education is required to better inform social work practice in this ethical area. Given the unique position of social workers in health care, they should, for the benefit of patients, families, and physicians, actively participate in the discussion concerning end of life decisions.
Attitude of Health Personnel↗
Organization of health care in small plants in the USA.
In the USA, the concept of an occupational health programme has grown steadily, and now embraces the total health of the worker. Elements of basic in-plant health programmes have been identified and patterns developed for successful operation.Today, health services in small plants still fall far short of optimal requirements. No more than 5% of workers in small plants enjoy the benefit of occupational health services. The main reason for the arrested development of these programmes is the lack of organizational and administrative techniques for providing health services in small plants. Recently, however, several projects have demonstrated that these difficulties can be overcome, and the future development of such programmes in small plants thus looks hopeful.Other recent developments hold promise of strengthening the health services available to workers. Union health centres, now being established in increasing numbers, offer the workers varying services, ranging from diagnostic and preventive procedures to complete medical care. Further benefits to both the worker and his family are being provided under collective bargaining agreements by voluntary health-insurance schemes.In addition to making services available to large numbers of workers previously not covered, the development of both union health centres and the prepaid health-insurance schemes offer future possibilities for integration of these programmes into the preventive and diagnostic services offered in the plant.Finally, governmental occupational health agencies, in addition to their industrial hygiene activities, are taking an increasing interest in the establishment and development of in-plant health programmes.
Health Promotion↗
Cash benefits for short-term sickness, 1948--76.
National income-maintenance programs provide cash benefits when workers become unemployed, retire, are injured on the job, have a long-term disability, or die. For short-term sickness, however, only five States, one other jurisdiction, and a single industry require wage-replacement protection. Voluntary plans cover a substantial number of additional workers, including many whose protection was established through labor-management negotiations. In this annual update of estimates on the extent of protection provided, many of the historical statistics have been revised back to 1967 as a result of new information on the amount of sick-leave benefits paid to employees of the Federal Government. The effects of the new data on the benefit series are examined, as are trends in the provision of sickness benefits for maternity--an issue subject to considerable recent controversy.
Female↗
One step forward, two steps back: worker representation and health and safety in the United Kingdom.
There is now quite strong evidence for a set of preconditions that help determine the effectiveness of worker representation and consultation in improving health and safety outcomes. One of these preconditions is a regulatory framework that defines workers' rights to representation and employers' obligations to respond. Using the United Kingdom as its focus, this article explores developments at the national policy level. It shows how long-awaited legislative reforms to improve provisions for worker representation in health and safety have so far failed to materialize and, instead, government strategy has concentrated on promoting voluntary approaches. The author reviews the evidence of what makes worker representation in health and safety effective and suggests that, far from abandoning approaches to legislative reform, the U.K. agencies should be seeking to make improvements to the British provisions if they are to provide the necessary stimulus and support for worker representation in health and safety at work. Such improvements need to address long-standing weaknesses in existing provisions and their relevance to the changing world of work. The arguments presented here apply to the essential role of regulatory support for worker participation in all advanced market economies if it is to improve health and safety outcomes.
Accidents, Occupational↗
MIDAS (Migraine Disability Assessment): a valuable tool for work-site identification of migraine in workers in Brazil.
CONTEXT: MIDAS was developed as a fast and efficient method for identification of migraine in need of medical evaluation and treatment. It was necessary to translate MIDAS, originally written in English, so as to apply it in Brazil and make it usable by individuals from a variety of social-economic-cultural backgrounds. OBJECTIVE: To translate and to apply MIDAS in Brazil. SETTING: Assessment of a sample of workers regularly employed by an oil refinery. SETTING: Refinaria Presidente Bernardes, Cubatão, São Paulo, Brazil. PARTICIPANTS: 404 workers of the company who correctly answered a questionnaire for the identification and evaluation of headache. When the individual considered it to be pertinent to his own needs, there was the option to answer MIDAS as well. METHODS: MIDAS, originally written in English, was translated into Brazilian Portuguese by a neurologist and by a translator specializing in medical texts. The final version of the translation was obtained when, for ten patients to whom it was applied, the text seemed clear and the results were consistent over three sessions. MAIN MEASUREMENTS: Prevalence and types of primary headaches, evaluation of MIDAS as a tool for identification of more severe cases. RESULTS: From the total of 419 questionnaires given to the employees, 404 were returned correctly completed. From these, 160 persons were identified as presenting headaches, 44 of whom considered it worthwhile answering MIDAS. Nine of these individuals who answered MIDAS were identified as severe cases of migraine due to disability caused by the condition. An interview on a later date confirmed these results. Three were cases of chronic daily headache (transformed migraine) and six were cases of migraine. CONCLUSIONS: MIDAS translated to Brazilian Portuguese was a useful tool for identifying severe cases of migraine and of transformed migraine in a working environment. The workers did not consider MIDAS to be difficult to answer. Their high level of voluntary participation demonstrates that this medical condition was of real interest among the workers, whether they were sufferers or not.
Adult↗
Coping strategies and burnout among veteran child protection workers.
OBJECTIVES: First, to learn how veteran (2 years or more) child protective service (CPS) investigations workers cope with job stress; and secondly, to examine the relationship between coping strategies and levels of emotional exhaustion, depersonalization, and sense of reduced personal accomplishment (burnout syndrome). METHOD: Cross-sectional, self-report methodology was used to measure coping strategies and the burnout syndrome. The voluntary subjects were 151 front-line CPS workers with at least 2 years experience in a southeastern Department of Social Services. They attended one of nine stress management workshops provided in various locations around the state. Quantitative analyses were run on the data. RESULTS: These workers perceived themselves to use Engaged (active) coping strategies more than Disengaged (avoidant) strategies. Sixty-two percent of participants scored in the high range on Emotional Exhaustion, the aspect some researchers consider to be the heart of Burnout. Those who used Engaged coping were less likely to feel depersonalized and more likely to feel a sense of personal accomplishment. Those who used Disengaged coping were more likely to feel emotionally exhausted, depersonalized, and to have a sense of reduced personal accomplishment. CONCLUSION: Neither the use of active nor avoidant coping strategies saved these workers from Emotional Exhaustion. The problem-focused strategies they are taught and use most do not help deal with the emotional content and context of their work, suggesting the use of emotion-focused coping to prevent and remediate burnout.
Adaptation, Psychological↗
Emergency medicine tools to manage smallpox (vaccinia) vaccination complications: clinical practice guideline and policies and procedures.
In December 2002, the federal government began a program to immunize approximately 500000 civilian public health and health care workers with smallpox (vaccinia) vaccine as a part of our pre-event defense against bioterrorism. First responders will likely follow, and the general US population might be offered vaccination in the next 1 to 2 years. Recent reports that suggest the possible association of the vaccine to adverse cardiac events (including deaths), liability concerns for hospitals, and the availability of compensation for workers with vaccine complications have significantly reduced voluntary participation. Vaccinees might experience robust primary takes or serious adverse events, including viral or even bacterial cellulitides, encephalitis, progressive skin destruction, and other life-threatening complications. With the increasing prevalence of immune suppression from both diseases and immunosuppressive medications, complications might be seen in higher frequency than previously reported. Emergency medicine providers and staff must become familiar with clinical presentations and management of vaccine complications. In addition, policies and procedures must be developed to prevent unimmunized providers from inadvertently contacting the active vaccination sites of their patients and, if the providers themselves have active vaccination sites, to protect their patients and their own families.
Antiviral Agents↗
Themes from the frontlines: hospital social work with people with AIDS.
There is little in the literature that specifically explores challenges and perceived rewards faced by direct care social work practitioners who work with an inpatient AIDS population, although there are hints (Egan, 1993, Oktay, 1992, and Gilmann, 1991). This article, based on a study of 20 designated inpatient AIDS social workers at four large inner-city voluntary hospitals, will focus on challenges and rewards as perceived by social work practitioners working with the HIV infected population. The study will report commonly identified themes which include unique stressors, rewards and challenges experienced by social work practitioners working with those living with AIDS.
Acquired Immunodeficiency Syndrome↗
The role of biological monitoring in the health management of lead-exposed workers.
In 1967, the problem of occupational lead exposure came to public attention in Korea. Since then, regular progress has been made in lowering workplace lead exposures, instituting new workplace controls, and implementing health examinations of exposed workers. Serious lead poisoning episodes led to the introduction of biological monitoring programs on a voluntary basis in high lead exposure facilities in Korea. Occupational health services for lead workers in Korea during the last 10 years could be categorized into three phases. During the first phase (1988-1993), effort was directed at increasing awareness among workers concerning the hazards of lead exposure, biological monitoring was commenced with zinc protoporphyrin (ZPP), and a respiratory protection program was introduced. During the second phase (1994-1996), a computerized health management system of lead workers was developed, blood lead measurement was added for biological monitoring, and engineering controls were introduced in the workplace to lower air lead levels to comply with air lead regulations. Finally, during the third phase (1997-present), bone lead measurement by X-ray fluorescence was introduced to evaluate total body lead burden. During the period 1988-1998, air lead levels have remained generally steady and above the permissible exposure level (PEL), but ZPP and blood lead levels have shown a steady decline. It was discovered that in a developing country like Korea, which cannot introduce engineering controls quickly to protect lead workers, biological monitoring was very useful in identifying and lowering excess lead absorption. In the future, as average exposure duration continues to rise, bone lead measurement may be recommended to adequately protect the long-term health of lead workers.
Air Pollutants, Occupational↗
Coping with loss: the development and evaluation of a children's bereavement project.
The 'Kingfisher Project' is a community-based programme of support groups for bereaved children. It has been developed by a multi-disciplinary group of workers from health, education, social services and the voluntary sector. Thirty-six children and young people have have been through the first five groups of the programme. Children accessing the service are predominantly those at high risk of developing longer-term problems as a result of bereavement. Evaluation indicates that the children and young people benefit in terms of increased social, behavioural, emotional and physical well-being. Two sub-groups appear to have benefited less: these are children and young people with learning difficulties, and teenage girls. Project evaluation has enabled workers to develop insights into the programme's strengths and weaknesses and has raised questions which merit further exploration.
Adaptation, Psychological↗
Lung function and surface electromyography of intercostal muscles in cement mill workers.
Impairment of pulmonary function in cement mill workers has been previously reported without considering a variety of parameters that can help evaluate more thoroughly the effect of cement dust on the respiratory system. In addition, an integrated approach has not been considered to assert the involvement of respiratory muscles. Therefore, in the present study spirometry and surface electromyography (SEMG) of intercostal muscles were used for indicating pulmonary impairment. In this study, a group of 50, apparently healthy volunteers, male cement mill workers aged 20-60 years with exposure of 13 years on average, were randomly selected. They were matched with another group of 50 control healthy male subjects in terms of age, height, weight and socioeconomic status. Both groups met the standard exclusion criteria. Spirometry was performed on an electronic spirometer, while SEMG of intercostal muscles was performed by using a chart recorder. The results demonstrated statistically significant reduction in lung function parameters i.e., force vital capacity (FVC) (p < 0.0005); force expiratory volume in first second (FEV1) (p < 0.0005); peak expiratory flow (PEF) (p < 0.005); and maximum voluntary ventilation (MVV) (p < 0.0005) in cement mill workers, when compared with controls. However, the FEV1/FVC ratio was significantly higher (p < 0.025) in cement mill workers. Similarly, the parameters obtained from SEMG of intercostal muscles, i.e. number of peaks (NOP) (p < 0.0005); maximum peak amplitude (MPA) (p < 0.0005); peak to peak amplitude (PPA) (p < 0.0005); duration of response (DOR) (p < 0.0005) and maximum peak duration (MPD) (p < 0.0005), were significantly lower in cement mill workers than in controls. It is concluded that exposure to cement dust not only impairs lung function but also affects costal muscle performance, thus possibly indicating the decreased lung and thoracic compliance.
Adult↗
["The Use and Control of Stress". A program applied to workers of the IMSS. Instituto Mexicano del Seguro Social].
Stress, is considered to be a bodily response to both internal and environmental stimuli, is a live and unavoidable energy. It is important and necessary to learn to use it beneficially. In order to determine the utility of the educational program. "The use use and control of stress", a quasi-experimental study was conducted in 1993, in which 39 voluntary Zone I General Hospital (IMSS Tlaxcala State Delegation) workers were selected, based on stress levels over 3 points as found in an institutional validated to measure the stress level. Five groups were set up, and eight weekly educative interventions, composed of cognitive contents including stress, relaxation techniques, and techniques for living of 90 minutes each were attended by the members of these groups, utilizing groups dynamics. The results were analyzed in simple absolute and relative frequencies, as well as by Student's t tests. They show a reduction stress levels in 94.8% of the participants, which represents a 69.1% general gain, with p = < 0.005. The conclusion is that learning related with the use and control of stress is an alternative to improve the mental health of the individual and as concerns the work environment, to modify attitude of the IMSS worker.
Adult↗
Policies and practices for improving influenza immunization rates among healthcare workers.
OBJECTIVE: To determine the attitudes, policies, and barriers for requiring annual versus voluntary influenza vaccinations for the staff of healthcare institutions in North Carolina. METHODS: Five different types of institutions serving at-risk elderly populations throughout North Carolina were chosen for study, including hospitals, home health agencies, nursing homes, dialysis centers, and assisted living facilities. Infection control managers completed a 45-question telephone survey on policies for annual influenza vaccinations for employees, incentives to encourage immunizations, support for mandatory influenza vaccinations for workers, barriers to employee vaccinations, and support for a state law to mandate influenza immunizations for employees with patient care contact. RESULTS: Of 312 institutions, 268 (86%) participated in the study. Only 38% of institutions reported having formal written employee influenza vaccination policies, and only 2% actually mandated annual employee vaccinations. Reported barriers to increasing healthcare worker annual influenza vaccinations included "fear of side effects" and "perceived ineffectiveness of the flu vaccine." Almost half of the respondents would support mandating influenza vaccinations for all healthcare workers with direct patient contact. CONCLUSION: A state-wide survey of the receptivity, policies, and implications of mandated employee influenza vaccinations among healthcare institutions serving the elderly in North Carolina found written policies uncommon and most of the mechanisms used to increase vaccinations voluntary. Efforts should be tailored to individuals, institutions, and healthcare systems to dramatically increase employee immunization rates.
Attitude of Health Personnel↗
Life years lost at hazardous waste sites: remediation worker fatalities vs. cancer deaths to nearby residents.
We present a hypothetical case study using the Years of Potential Life Lost (YPLL) metric to compare cancer risks incurred by residents living near a Superfund site to occupational fatality risks incurred by workers employed in that site's remediation. Since cancer occurs late in life, and because we assume its mortality rate is 60%, each case results in 8.8 YPLL. Each occupational fatality, which typically occurs earlier in life, results in 38.1 YPLL. In our case study, the residential population of 5000 incurred 1.3 YPLL, compared to 5.7 YPLL incurred by the 500 workers. Several uncertain assumptions may influence our calculations; moreover, occupational risks may be viewed as more "voluntary" than risks incurred by residents. However, because the magnitude of the YPLL incurred by workers and residents may be comparable, risk managers should consider occupational risks when evaluating remedial alternatives.
Accidents, Occupational↗