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PubMed2001

Methods of appointment and qualifications of club doctors and physiotherapists in English professional football: some problems and issues.

OBJECTIVE: To examine the methods of appointment, experience, and qualifications of club doctors and physiotherapists in professional football. METHODS: Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. RESULTS: In almost all clubs, methods of appointment of doctors are informal and reflect poor employment practice: posts are rarely advertised and many doctors are appointed on the basis of personal contacts and without interview. Few club doctors had prior experience or qualifications in sports medicine and very few have a written job description. The club doctor is often not consulted about the appointment of the physiotherapist; physiotherapists are usually appointed informally, often without interview, and often by the manager without involving anyone who is qualified in medicine or physiotherapy. Half of all clubs do not have a qualified (chartered) physiotherapist; such unqualified physiotherapists are in a weak position to resist threats to their clinical autonomy, particularly those arising from managers' attempts to influence clinical decisions. CONCLUSIONS: Almost all aspects of the appointment of club doctors and physiotherapists need careful re-examination.

Clinical Competence↗
PubMed1993

How many microbiology consultants are needed?

It is difficult to measure medical staff workload and medical staff requirements in microbiology departments. A review of 14 job descriptions for consultant microbiologists showed that the number of hospital beds and the number of specimens are more reliable workload indices than the population figure. Ratios between beds or specimens and medical staff numbers may help to identify understaffed or overstaffed microbiology departments.

England↗
PubMed2006

Prevalence and risk factors for work related asthma in young adults.

OBJECTIVES: To investigate the prevalence and predictors of work related asthma in young adults from the general population. METHODS: A total of 1922 subjects randomly selected from a birth cohort 1978/79 in Brazil, aged 23-25 years, completed a respiratory symptoms questionnaire based on the European Community Respiratory Health Survey, and underwent spirometry, bronchial challenge test with methacholine, and skin prick test. For subjects presenting with bronchial hyperresponsiveness, workplace exposure and its relationship with symptoms were assessed by a specific questionnaire and individualised job description to define cases of work related asthma. RESULTS: The prevalence of work related asthma was 4.2% (81 cases): 1.5% (29 cases) were classified as aggravated asthma and 2.7% (52 cases) as occupational asthma. Work related asthma was associated with atopy and education. Lower educational level (1-8 years of schooling) was associated with work related asthma (odds ratio 7.06, 95% CI 3.25 to 15.33). There was no association between work related asthma and smoking, gender, or symptoms of rhinitis. CONCLUSION: The prevalence of work related asthma was high (4.2%), and was associated with low schooling, probably because of low socioeconomic level. The disease may therefore be a consequence of poverty.

Adult↗
PubMed1994

Occupational hand dermatoses of hairdressers in Tainan City.

OBJECTIVES: To determine the prevalence, clinical features, and patterns of hand dermatosis in hairdressers in Tainan, Taiwan, and to examine the associations between patterns of dermatosis and risk factors such as job description, work exposure, and sensitisation to common allergens. METHODS: Interviews, examinations, and patch tests of the hairdressers from nine hairdressing stores randomly selected from Tainan City. Patch test agents included 41 substances with common allergens, shampoo preservatives, hair dyes, permanent waving and bleaching agents. RESULTS: 98 hairdressers finished the examination, 83% of them had occupational dermatosis and 32% had scissor induced scars or wounds. Most of the dermatoses belonged to either dry metacarpophalangeal dermatitis or eczema of the fingers. 44% of the hairdressers showed positive skin reaction to one or more patch test agents. The patch test results were different from previous reports in that the most common allergens were nickel, thimerosal, Captan, Kathon CG, and fragrance mix, and that the sensitivity to hair dye and permanent wave ingredients were low. The dry metacarpophalangeal dermatitis was associated with exposure to shampoo, and the eczema of the fingers with skin sensitivity to patch test agents. CONCLUSION: Hairdressers in Tainan City had a high prevalence of dermatoses including traumatic wounds, and allergic and irritant contact dermatitis. The rates of sensitivity to some of the common sensitising agents were different from previous reports.

Adolescent↗
PubMed1995

Evaluation of biomarkers in plasma, blood, and urine samples from coke oven workers: significance of exposure to polycyclic aromatic hydrocarbons.

OBJECTIVE: The aim was to assess the significance of two biomarkers; antibody to benzo(a)pyrene DNA adducts and concentration of hydroxyethylvaline haemoglobin adducts in samples from a well studied group of coke oven workers. As a measure of exposure we have used 1-hydroxypyrene in urine. METHODS: Urine and blood samples were collected from coke oven workers and a control group. Samples from coke oven plant workers were collected in January and June. 1-Hydroxypyrene was measured in urine by high performance liquid chromatography (HPLC), antibodies to benzo(a)pyrene DNA adducts were measured by ELISA and hydroxyethylvaline haemoglobin adducts were measured by gas chromatography-mass spectrometry (GC-MS). RESULTS: Mean urinary 1-hydroxypyrene in samples from coke oven workers varied from 1.11 to 5.53 umol/mol creatinine and 0.14 umol/mol creatinine in the control group. Workers at the top side had the highest values of urinary 1-hydroxypyrene. Antibody to benzo(a)pyrene DNA adducts did not correlate with either 1-hydroxypyrene nor length of work at the coke oven plant. But antibody concentration in samples collected in January was predictive of the concentration in samples collected in June. A small non-significant increase in hydroxyethylvaline haemoglobin adducts was found in samples from coke oven workers relative to the control group when comparing smokers and nonsmokers separately. CONCLUSION: 1-Hydroxypyrene correlates well with exposure groups based on job description. Antibodies to benzo(a)-pyrene DNA adducts was related to people and not exposure. Work at a coke oven plant might lead to increased hydroxyethylvaline haemoglobin adducts.

Adult↗
PubMed1996

Occupational risk factors for female breast cancer: a review.

OBJECTIVES: Although progress has been made in identifying personal risk factors and in improving treatment for female breast cancer, incidence rates continue to increase. With women now occupying a sizable fraction of the workforce, it is worth inquiring whether there are occupational risk factors for breast cancer. This is a review of occupational studies on female breast cancer. METHODS: Suitable reports and published articles with associations of female breast cancer and occupation were identified from technical reports, by searching the MEDLINE bibliographic data base, and by reviewing each paper on cancer that was published in 20 major journals during the period from about 1971-94. RESULTS: A total of 115 studies were identified; 19 studies relied exclusively on data collected for administrative purposes, and there were four incident case-control studies and 92 cohort studies. Although data for individual industries, occupations, and exposures were sparse, there was limited evidence of an association with employment in the pharmaceutical industry and among cosmetologists and beauticians. Associations were also found for chemists and occupations with possible exposure to extremely low frequency electromagnetic fields, but potential methodological weaknesses preclude drawing any definite conclusions. There was little support for increased risks among textiles workers, dry cleaning workers, and nuclear industry workers. CONCLUSIONS: Few high quality occupational studies directed specifically toward women have been carried out to allow the unambiguous identification of occupational risk factors for breast cancer. It is suggested that investigations that account for non-occupational risk factors and that assess exposure in a more detailed way be carried out. One strategy already suggested is to conduct population based, case-control studies in which subjects are interviewed about their occupational histories and exposure to chemical and physical agents which are then attributed from the job descriptions by a team of experts. These studies can then be supplemented when necessary with cohort studies of specific populations.

Breast Neoplasms↗
PubMed1999

Exposure to toluene in the printing industry is associated with subfecundity in women but not in men.

OBJECTIVE: To examine the possible influence of exposure to toluene on human fertility. METHODS: In a cross sectional study, a sample of 150 male and 90 female printing industry workers were interviewed retrospectively on reproductive experience with a modified version of the European study of infertility and subfecundity questionnaire. Exposure categories comprised job descriptions and information on exposure measurements obtained by industrial hygienists. The fecundability ratio (FR) was estimated on the basis of time to pregnancy (TTP) or periods of unprotected intercourse not leading to pregnancy (PUNP) by means of survival analysis with proportional hazard models. Confounders such as age, ethnicity, smoking, parity, pelvic inflammatory diseases, and frequency of sexual intercourse were controlled for in the analyses. RESULTS: 256 Periods of TTP or PUNP were reported by men and 174 by women. After exclusion of induced abortions, birth control failures, and periods without employment for female workers we were able to analyse 169 periods in men and 100 periods in women. Male workers who had been exposed to different concentrations of toluene and their partners did not show a reduction in fecundity. In women (39 periods occurred during exposure) fecundity was reduced (FR 0.47, 95% confidence interval (95% CI) 0.29 to 0.77). Neither, restriction to only the first period nor exclusion of PUNPs changed the results (FR 0.48, 95% CI 0.24 to 0.97). CONCLUSION: After considering possible biases, low daily exposure to toluene in women seems to be associated with reduced fecundity. This result is in accordance with other findings for organic solvents and supports both the hypotheses that (a) organic solvents could affect hormonal regulation, and that (b) organic solvents increase early fetal losses which in turn contributes to longer times of unprotected intercourse.

Adolescent↗
PubMed2003

Protein-lipid interplay in fusion and fission of biological membranes.

Disparate biological processes involve fusion of two membranes into one and fission of one membrane into two. To formulate the possible job description for the proteins that mediate remodeling of biological membranes, we analyze the energy price of disruption and bending of membrane lipid bilayers at the different stages of bilayer fusion. The phenomenology and the pathways of the well-characterized reactions of biological remodeling, such as fusion mediated by influenza hemagglutinin, are compared with those studied for protein-free bilayers. We briefly consider some proteins involved in fusion and fission, and the dependence of remodeling on the lipid composition of the membranes. The specific hypothetical mechanisms by which the proteins can lower the energy price of the bilayer rearrangement are discussed in light of the experimental data and the requirements imposed by the elastic properties of the bilayer.

Animals↗
PubMed1982

The psychiatric chief resident: does gender make a difference?

The authors surveyed women and men psychiatric chief residents who were near the end of their residency training. The findings documented the active participation of women in leadership roles as psychiatric residents in education, administration, and clinical care. Men and women reported remarkably similar job descriptions, opportunities, and difficulties. Women were less likely than men to participate in research activities during the chief residency or to accept full-time faculty positions after training.

Adult↗
PubMed2000

The role of the community psychiatrist as medical director: a delineation of job types.

To examine the variety of roles filled by psychiatrists functioning as medical directors in community settings, a survey of all members of the American Association of Community Psychiatrists was undertaken. A total of 168 respondents classified themselves as agency medical directors or program medical directors. Medical directors also classified their breadth of supervisory responsibility as including medical staff only, medical and other clinical staff, or all staff (including administrative staff). A classification scheme of six types of medical director positions based on level of operation and breadth of supervisory responsibility was created. This classification helps clarify the medical director's role, providing guidance to psychiatrists and agencies negotiating job descriptions for this position.

Analysis of Variance↗
PubMed1975

Administrative considerations in developing a volunteer program.

A volunteer program can become a solid, smooth-functioning part of a community mental health center or other agency if it is built around the needs of both the agency and the volunteers. The author discusses the need to develop realistic job descriptions, to screen the applicants carefully, and to provide continued training and supervision both individually and in groups. She emphasizes that staff resistance to a volunteer program can be overcome by involving staff members in the program and by making them aware of the high quality of work the volunteers do.

Administrative Personnel↗
PubMed1997

The changing role of the psychiatrist in board-and-care homes.

The role of the psychiatrist in board-and-care homes has been changing dramatically since a job description was published in 1989. The role has become more complex as a result of advances in psychopharmacology, the trend toward polypharmacy regimens, the necessity to evaluate the interaction potentials of drug combinations, and the emergence of more sophisticated treatment algorithms. Broad social trends have added to the complexity of board-and-care treatment, such as the tendency to release more severely disturbed patients from long-term-care facilities because of the increasing costs associated with institutionalization. However, treatment of these patients will continue to be expensive because of the higher costs of new drugs and of using medication combinations. Continued high-cost treatment will increase pressure to control costs by managed care companies, third-party payers, and government agencies. Although this paper describes the effects of these trends on board-and-care psychiatrists, they are also relevant to psychiatrists in general and to other practitioners.

Cost Control↗
PubMed1997

Estimating psychiatric manpower requirements based on patients' needs.

OBJECTIVE: To provide a better understanding of the complexities of estimating psychiatric manpower requirements, the authors describe several approaches to estimation and present a method based on patients' needs. METHODS: A five-step method for psychiatric manpower estimation is used, with estimates of data pertinent to each step, to calculate the total psychiatric manpower requirements for the United States. The method is also used to estimate the hours of psychiatric service per patient per year that might be available under current psychiatric practice and under a managed care scenario. RESULTS: Depending on assumptions about data at each step in the method, the total psychiatric manpower requirements for the U.S. population range from 2,989 to 358,696 full-time-equivalent psychiatrists. The number of available hours of psychiatric service per patient per year is 14.1 hours under current psychiatric practice and 2.8 hours under the managed care scenario. CONCLUSIONS: The key to psychiatric manpower estimation lies in clarifying the assumptions that underlie the specific method used. Even small differences in assumptions mean large differences in estimates. Any credible manpower estimation process must include discussions and negotiations between psychiatrists, other clinicians, administrators, and patients and families to clarify the treatment needs of patients and the roles, responsibilities, and job description of psychiatrists.

Adult↗
PubMed1997

The impact of organizational factors on mental health professionals' involvement with families.

OBJECTIVE: Drawing on an organizational behavior framework, this study explored the impact of attitudinal, occupational, and organizational factors on mental health professionals' involvement with clients' families. METHODS: Data came from a survey conducted with psychiatric staff at the largest public hospital and the largest private hospital in Indianapolis between 1991 and 1993 as part of the Indianapolis network mental health study. Responses of 184 clinicians who provided direct care were analyzed using multiple regression to assess the impact of their attitudes toward families, job characteristics, and organizational work environment on the amount of contact they had with clients' families. RESULTS: Providers' attitudes toward families had no significant effect on the frequency of their contact with families. Job and organizational factors were the strongest predictors. Specifically, being a social worker or therapist and working on day and evening shifts were associated with increased involvement with families. Staff members' perceptions of how well their unit functioned were also positively correlated with frequency of contact with families. CONCLUSIONS: The organizational environment in mental health agencies has a significant influence on the extent to which professionals become involved with clients' families. Administrators and policy makers should give careful consideration to how the work environment encourages or limits mental health professionals' abilities and willingness to get more involved with clients' families.

Adult↗