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Minimizing the risks of latex allergy: the effectiveness of written information.

BACKGROUND: Latex allergy has been identified as an occupational risk for the dental profession. This study assessed whether identified latex-allergic dental personnel changed their practices after receiving verbal and written information about the management of latex allergy. METHODS: A survey conducted at the 1998 Australian Dental Association Congress identified 157 dental personnel with clinical latex allergy, or at high risk from latex exposure. The workplace implications were then explained to them by a consultant allergist. Four weeks later, follow up written information on latex allergy was mailed out. The information sheet outlined possible symptoms and cross-reactions, implications for the workplace, hand care advice and management strategies to reduce latex exposure in the workplace. After six weeks, a questionnaire, designed to assess whether appropriate steps to reduce latex exposure had been taken, was mailed out. RESULTS: Seventy per cent of the questionnaires were returned. All respondents felt the information was easy to understand and informative. While 50 per cent of respondents indicated that they had changed to powder-free or non-latex gloves, only five respondents were fully compliant with all instructions. CONCLUSION: Compliance with instructions regarding minimizing exposure to latex in a group of latex-allergic dental personnel was poor.

Adult↗

Understanding and cooperation among alter and host personalities.

There is little occupational therapy literature that addresses the profession's efficacy in the treatment of persons with multiple personality disorder, yet the characteristics and complexity of this disorder render it one that can gain much from occupational therapy intervention. This paper examines the ways in which the occupational therapist can help in the treatment of patients with multiple personality disorder by introducing the alter personalities to each other, encouraging rapport among the personalities, and providing tasks that allow the alter personalities and the host to work together for mutual benefit.

Dissociative Identity Disorder↗

Muriel Driver Memorial Lecture. Making our mark in the marketplace.

This paper explores the impact of a changing health care environment on the organization, management, and delivery of occupational therapy services in Canada. Political, economic, and other societal forces are having a profound effect on the demand for and the practice of occupational therapy. The influence of such forces on occupational therapy is discussed within the context of the profession's internal organization, external image, educational continuum, and practice directions. The paper reviews the profession's past response to such forces and develops approaches that occupational therapists individually and collectively can pursue to be more strategically positioned within the changing health care scene.

Canada↗

Psychosocial assessment of lathyrism patients in rural Estie district of South Gondar, northern Ethiopia.

Three hundred and thirty three patients in the lathyrism endemic rural Estie district of Northern Ethiopia were interviewed and examined to assess the psychosocial impacts of neurolathyrism. The majority of the affected were in the age group of 11-20 years (43%) followed by 21-30 years (29%). Males were more affected than females (4.8:1). Peak occurrences of neurolathyrism was observed at time of mobilization of the population in villagization and land diversification schemes. Females were affected to lesser extent and at an earlier age than males. Neurolathyrism affected matrimony among the rural farming population where marriage is considered as the most significant social achievement of any young member of the society. Divorce rate due to paralysis was 28%. It also influenced the choice of occupation among the afflicted rural people. Many males went into ecclesiastical professions. A significant number of males also took up occupations which traditionally were considered to be exclusively for women like basketry and embroidery. More females, not withstanding their age, were engaged in cattle-keeping. During the study, the rural communities were made aware of the association of neurolathyrism and consumptions of grass pea seed. It is believed that this step will enable communities to use home-based detoxifying methods and resort to alternate crops during times of food shortage.

Adolescent↗

[Tertiary prevention of occupational skin diseases].

BACKGROUND: Inpatient tertiary prevention of occupational skin diseases is indicated when the employee is threatened with loosing their job. Earlier studies have shown that with intensive tertiary preventive measures, 2/3 of such individuals can continue their jobs long-term. Data on the effectiveness of tertiary prevention for various occupational groups has not been previously available. PATIENTS AND METHODS: The outcome of all participants treated in the year 2002 was analyzed according to occupational groups with respect to diagnosis, medical intervention prior and during the inpatient period. RESULTS: In 91% of 296 cases contact dermatitis of the hands was diagnosed (75% primary irritant contact dermatitis (37% chronic irritant contact dermatitis, 38% irritated atopic hand eczema, 16% allergic contact dermatitis). Clinically relevant Type IV-delayed hypersensitivity (allergic contact dermatitis) reactions were identified in 42% of cases; in most cases, the delayed hypersensitivity followed irritant contact dermatitis. In more than 83% of cases, a complete or nearly complete remission was achieved. Clinical relevant Type IV sensitization was most frequent in hairdressers (66%). Cleaning and housekeeping personnel most frequently used corticosteroids on a regular basis (60%) and most often experienced corticosteroid withdrawal (53%) and atrophy of the skin of the hands (23%). CONCLUSION: The data from studies on the tertiary prevention of occupational skin diseases reveal strategies for the optimization of outpatient care indicate specific occupational risk factors. The variance between professions may reflect differing approaches to secondary prevention.

Adult↗

Occupational therapy and rehabilitation: an awkward alliance.

This article argues that although occupational therapy and rehabilitation are often considered synonymous, the latter is but one aspect of the former. Early influences on occupational therapy are briefly reviewed, and some philosophical ideas about activity are described. The rationale for the use of occupations as treatment in the early part of this century, both in Canada and in the United States, is examined and contrasted with the development of physical medicine and rehabilitation after World War II. This discussion demonstrates that the origins of occupational therapy and rehabilitation in North America had little in common. As occupational therapy became incorporated into rehabilitation, the profession's core values eroded, and although current definitions of rehabilitation offer a more appropriate fit for occupational therapy, rehabilitation continues to see engagement in occupations as a separate and subsequent step. The article concludes by considering future directions and the tasks that lie ahead.

Canada↗

[Skin protection and skin disease prevention courses for secondary prevention in health care workers: first results after two years of implementation].

BACKGROUND: Healthcare workers have an increased risk of occupational dermatoses. In January 2002, the Department of Social Medicine, Occupational and Environmental Dermatology of the University of Heidelberg started organizing special prevention courses for this group of employees in cooperation with the Accident Prevention & Insurance Association for Health Care Workers (BGW). The major aims are to improve individual skin protection and skin care habits, as well as to optimize diagnostic procedures and therapy. PATIENTS AND METHODS: The two-day course has up to 14 participants. Teaching units mainly focus on skin structure and function, general aspects of occupational skin diseases, general information concerning skin protection and practical exercises emphasizing the correct use of skin cleansing and skin protection products. Additionally, every participant undergoes a dermatological examination including a detailed history and skin inspection. Individual skin protection strategies are developed, and the participants are provided with the opportunity to ask the dermatologist questions in confidence. RESULTS: Most of the 355 participants have been female (87.3%) with a mean age of 36.9 years. 95% had hand eczema, predominantly dyshidrotic morphology. In many cases, there was a mixture of atopic, irritant and allergic contact dermatitis but irritant contact dermatitis was most common (43%). Atopy was present in 68% of the patients. The participants rated the course as good to excellent. Other benefits are the exchange of experience between patients working in the same or similar occupations and transfer of the new knowledge to colleagues, family and friends. CONCLUSIONS: Examinations and advisory services in occupational dermatology are still fragmentary. Skin barrier creams and moisturizers are not sufficiently utilized in daily practice. In the future, similar courses should be offered for employees in other professions with an increased risk of occupational skin diseases.

Adult↗

[Leadership in the health services].

The concept of leadership is not centered on strength of conviction or the ability to inspire support from others. Authority requires obedience, which is unlikely to bring about substantive changes. There are three classical types of leadership: bureaucratic (which depends on the size of one's share of power within an institution), prestige (which depends on one's technical expertise and standing in one's profession), and political (which depends on the extent of one's power in society at large). Prestige leadership pertains to an occupation and applies particularly to the health professions, especially the medical profession. Change is conditioned by factors internal to the health field (such as technological innovations and dissatisfaction with remunerations and social standing in some occupations) and by elements in the social context. These elements include historical situations favorable to change (crises) and forces for preservation of the status quo.

Health Planning↗

Psychosocial impact of the teacher's voice throughout the career.

It is generally accepted that vocal performance decreases with age. This decrease can be expected to be more pronounced in voice loading professions, which may lead to occupational dysphonia. The aim of this study was to investigate the course of voice complaints, experienced handicap, and absenteeism of work due to voice problems throughout the teaching years. Questionnaires were distributed among teachers of primary and secondary education, and 1875 were analyzed. The questionnaire was designed in such a way that personal aspects and questions about periods with symptoms and absence from work were included. The Voice Handicap Index (VHI) developed by Jacobson et al was sent along with the questionnaire. Surprisingly, a significant decrease of voice complaints during the career of the teachers was observed. The expectation that the percentage of teachers with a history of voice problems should experience more psychosocial impact, measured with the VHI, along their professional career could not be confirmed by this study. These results indicate that serious attention has to be paid to teachers with voice complaints. The fact that teachers in the beginning of their career complain more than in the end of their career emphasizes the importance of adequate aimed prevention programs for future teachers and for starting teachers with regard to their voice.

Adult↗

Quality assurance and dental hygiene.

Dental hygiene in Canada has experienced significant growth. It has shifted from an emerging occupation to a regulated health profession in several jurisdictions. Many achievements may be attributed to this growth, including self-regulation and a national code of ethics. However, the majority of Canadian dental hygienists are relying on traditional, outdated and ineffective quality assurance mechanisms, such as mandatory continuing education requirements. In the interests of public protection, dental hygiene needs to ensure that the quality assurance activities required from its members are effective, valid and reliable. Quality assurance in health care continues to undergo modifications that better reflect the public's need for competent, ethical, safe and appropriate health care. Dental hygienists and dental hygiene regulatory bodies are challenged to find valid, reliable and effective methods of quality assurance. This paper discusses some of the developments in quality assurance in health care as well as some of the key and significant achievements of dental hygiene in Canada. The use of quality assurance mechanisms currently used in dental hygiene in Canada is also discussed. The paper concludes with a discussion on the potential barriers and issues that the profession may face when attempting to incorporate suitable quality assurance activities into daily dental hygiene practice.

Canada↗

Stress and coping among hospice nurses: test of an analytic model.

Nursing is a profession with high levels of occupational stress, especially for those employed in hospice settings. This study considered the stressors, mediators, and adaptations evident among 100 hospice nurses from 20 facilities. The research tested an analytic model of stress that included social and predisposing conditioning factors, stress appraisals, coping strategies, social resources, and adaptive status. Entered as sets in a hierarchical regression analysis, stress appraisals and coping strategies proved to be the best predictors of adaptive status. Social resources exerted a more indirect influence.

Adaptation, Psychological↗

[Professional responsibility: multiple loyalty].

Among the many existing occupations, the so-called 'professions' occupy a special position. They are characterized, among other things, by a special intellectual component, special traditions and the fact that they serve the community in a particular fashion. With a profession goes a code including agreements concerning behaviour towards colleagues, clients and patients as well as the community. In the present paper, a number of critical questions are raised regarding the 'Code of Conduct for Veterinarians: Whose interests are served by this code and are given priority respectively? To what extent attention is paid to the rights of clients and patients? How are conflicts of loyalty settled or do they pass unnoticed? To what extent does monopolizing occur of a subject which others would also like to consider and have their say on, namely, the starting-points of a conscientious practice of veterinary medicine?

Ethics, Professional↗

[The artist in the 2d half of his professional life].

The authors apply the basic conceptions of gero-hygiene to the care of artists. As to the dispensaire care of artists, the particular correlations between professional activity, health, and age are referred to. The highly specialized professional training and qualification for these professions, as well as all occupationally induced injuries occurring, above all, occupational diseases of performing artists of orchestra musicians, and further artistic groups of activities, require a specific preparation for age.

Adult↗

A review and meta-analysis of formaldehyde exposure and pancreatic cancer.

BACKGROUND: Most reviews on the carcinogenicity of formaldehyde have focused on cancers of the respiratory tract. Two recent studies have suggested that exposure to formaldehyde may increase the risk for pancreatic cancer. METHODS: We examine 14 epidemiology studies of workers exposed to formaldehyde where pancreatic cancer rates were reported and use meta-analytic techniques to summarize the findings. We also rank formaldehyde exposures for the industries in these studies. RESULTS: We found a small increase of pancreatic cancer risk in the studies overall (meta Relative Risk [mRR] 1.1, 95%CI 1.0-1.3); however, this increased risk was limited to embalmers (mRR 1.3, 95%CI 1.0-1.6) and pathologists and anatomists (mRR 1.3, 95%CI 1.0-1.7). There was no increased risk among industrial workers (mRR 0.9, 95%CI 0.8-1.1) who on average had the highest formaldehyde exposures. CONCLUSIONS: A small increased risk of pancreatic cancer from formaldehyde exposure cannot be ruled out from the studies examined. However, the null findings among industrial workers and the lack of biological plausibility would argue against formaldehyde as a cause. The increased risk of pancreatic cancer among embalmers, pathologists, and anatomists may be due to a diagnostic bias or to occupational exposures other than formaldehyde in these professions.

Formaldehyde↗

Uniting practice and theory in an occupational framework. 1998 Eleanor Clarke Slagle Lecture.

The term occupation conveys the powerful essence of our profession--enabling people to seize, take possession of, or occupy the spaces, time, and roles of their lives. Occupation is activity that is both purposeful and meaningful to the person who engages in it. Our uniqueness lies in our use of occupation as a therapeutic agent, but our unique focus on occupation is not always apparent in practice. Four global groups of activities that occupational therapy practitioners use in practice are described--exercise, contrived occupation, therapeutic occupation, and adaptive occupation. Therapeutic occupation and adaptive occupation are proposed as the legitimate activities of occupational therapy. The Occupational Therapy Intervention Process Model is then presented. This model stresses a top-down approach to evaluation and provides a framework for implementing adaptive occupation for purposes of compensation as well as therapeutic occupation for purposes of remediation.

Colorado↗

Contact dermatitis in hairdressers, 10 years later: patch-test results in 300 hairdressers (1994 to 2003) and comparison with previous study.

BACKGROUND: In the last 20 years, the hairdressing profession has undergone important modifications, mainly because of a change in the substances and techniques used and improved occupational education. OBJECTIVE: To evaluate the modifications in the hairdressing profession and its actual risk of occupational allergic contact dermatitis (OACD). METHODS: We studied all 300 hairdressers seen in our department from 1994 to 2003 and compared the results with those of a previous study of 379 hairdressers who attended our department from 1980 to 1993. All were patch-tested with the European Standard series and specific hairdressing products. As previously, most of the workers were women (93%), with a mean age (23.7 years) slightly higher than that of the workers in our previous study. RESULTS: We found a significant increase in the frequency of positive patch-test responses (78.3% vs 58.8%) and OACD (58% vs 48.8%) with respect to our previous study. We also observed a significant increase in sensitization to most allergens, including p-phenylenediamine base (54% vs 45.9%), 4-aminobenzene (40.7% vs 31.9%), ammonium thioglycolate (2.7% to 12.3%), ammonium persulfate (7.9% to 14.3%), p-toluenediamine sulfate (6.8% to 15.3%), p-aminodiphenylamine (2.9% to 7.7%), o-nitro-4-phenylenediamine (2.1% to 7.3%), and aminophenols (0% to 9%), whereas a decrease was found in sensitization to Disperse Orange (17% vs 32.7%) and thioglycolic acid (15.3% to 3%). CONCLUSION: The high frequency and increase of sensitizations among hairdressers require urgent measures to improve protective measures and their application.

Adolescent↗

Women workers in the health service industry.

The health service industry is unusual in that most of the skilled as well as unskilled workers are women, although the industry is largely controlled by men. Women are hired because they constitute an inexpensive, available, and seemingly powerless work force. Women enter health service because they have few alternatives to the low-paying, dead-end jobs found there. Health service occupations are organized like craft unions, with rigid hierarchical separations and control by the top occupation. Conflicts between men and women-between management and workers-are often played out as conflicts between occupations. Challenges to physicians come from various nursing specialties as well as from technical professions. Physicians in turn create lower-level occupations which challenge the nurses' status. Increasing industrialization alters the pattern of conflict, creating opportunities for individual bureaucratic mobility as well as favorable conditions for unionization drives. Unionism is often held back by sex, race, and professional conflicts, which must be overcome if the status of women is to be changed in the industry.

Career Mobility↗

Boundaries obscured and boundaries reinforced: incorporation as a strategy of occupational enhancement for intensive care.

Medical dominance is a recurring theme in sociological analyses of healthcare work. One example of a theoretical framework by which the medical profession is said to dominate other healthcare occupations is Turner's (1995: 138) enumeration of the modes of subordination, limitation and exclusion. As Elston (1991) has noted, however, such frameworks tend to be rather speculative and there is not a great deal of evidence on how these strategies are exercised, for example, at a micro-level. There is also a tendency to portray healthcare occupations as monolithic entities, without acknowledging differences within healthcare occupations, and the relationships between them, which can arise in different clinical locales. Through a micro-level analysis of the practice of intensive care, using ethnographic data collected on three intensive care units (ICUs) in England, this paper proposes a hitherto unidentified strategy -incorporation- for medical dominance at a micro-level. Paradoxically, an enhanced position for both intensive care medicine and intensive care nursing arises, relative to proximal healthcare groups. The argument of this paper is that within the ICU an occupational boundary (doctor-nurse) is obscured, while an organisational boundary which differentiates the ICU from the wider hospital is reinforced. Overall, the power relationship between medicine and nursing in intensive care is not 'zero-sum': the influence of both groups in the wider hospital is increased by this strategy of incorporation.

Anthropology, Cultural↗