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Genetic testing in the workplace is a technology both full of promise and fraught with ethical peril. Though not yet common, it is likely to become increasingly so. We survey the key arguments in favour of such testing, along with the most significant ethical worries. We further propose a set of pragmatic criteria, which, if met, would make it permissible for employers to offer (but not require) workplace genetic testing.
The aim was to assess whether self-reported reduced productivity occurred in computer users due to musculoskeletal symptoms and the association to workplace, symptom, and individual factors. The study group consisted of 1283 computer users from different occupations, of whom 498 were men and 785 were women. Reduced productivity was self-assessed by two questions addressing if and how much productivity was reduced the previous month due to musculoskeletal symptoms. There were 63 women (8.0%) and 42 men (8.4%) of the total study group who reported reduced productivity due to musculoskeletal symptoms. The mean magnitude of the reduction was 15% for women and 13% for men. This outcome was weakly associated with computer mouse position and task and symptom persistence for both men and women. For women, work demands, computer problems, and being divorced/separated were also associated with reduced productivity. Although limited by problems of subjectivity of self-report and the possibility of significant underreporting, these results suggest that a variety of interventions may serve to decrease the impact of musculoskeletal disorders in the workplace.
OBJECTIVES: In a population-based case-control study, we examined the association of testicular cancer and electromagnetic fields (EMF) in the workplace. METHODS: Incident cases (n = 269) were recruited between 1995 and 1997. A total of 797 controls matched on age and region were randomly selected from mandatory registries of residents. EMF exposure was assessed for five categories in standardized face-to-face interviews using closed questions. For each exposure category, odds ratios (OR) were calculated, stratified by age and region, and in a more complex model weighted by duration and distance using conditional logistic regression. Subgroup analyses were conducted for seminoma and non-seminoma and for blue- and white-collar workers. Additionally, potential radar exposure was individually assessed by experts based on all available information including free text. RESULTS: There was no excess risk for cases who reported to have ever worked near the following: radar units (OR = 1.0; 95% CI = 0.60-1.75); radiofrequency emitters (OR = 0.9; 95% CI = 0.60-1.24); electrical machines (OR = 1.0; 95% CI = 0.72-1.33): high-voltage lines or high-voltage electrical transmission installations (OR = 0.7; 95% CI = 0.38-1.18); or visual display units or complex electrical environments (OR = 0.9; 95% CI = 0.67-1.21). The results for the weighted exposure and subgroup analyses did not differ substantially. For radar exposure as assessed by the experts, the OR was 0.4 (95% CI = 0.13-1.16). CONCLUSIONS: EMF exposure in the workplace does not seem to be a relevant risk factor for testicular cancer in our study.
After workplace injuries, supervisors can play an important role in aiding workers, accessing health care services, and providing reasonable accommodation. However, few studies have identified those aspects of supervisor involvement most valued by employees for postinjury recovery and return to work. As part of needs assessment for a supervisory training program, 30 employees from four companies were interviewed about the role of supervisors to prevent workplace disability after injuries. From interview notes, 305 employee statements were extracted for analysis. An affinity mapping process with an expert panel produced 11 common themes: accommodation, communicating with workers, responsiveness, concern for welfare, empathy/support, validation, fairness/respect, follow-up, shared decision-making, coordinating with medical providers, and obtaining coworker support of accommodation. Interpersonal aspects of supervision may be as important as physical work accommodation to facilitate return to work after injury.
Modified duty and other accommodations by employers have been shown to be helpful in managing workplace disability associated with injuries and illnesses. Benefits of accommodation have been attributed to both reduced physical and psychosocial exposures. Although many employers have adopted proactive return to work policies that emphasize temporary work modifications, standardized methods for specifying appropriate accommodations have been elusive. On the basis of the experiences and results of a randomized controlled study of case management services for work-related upper extremity disorders, we describe issues pertaining to the application of self-report measures of function and exposure assessment for generating accommodations. Challenges of this approach are 1) including specific work tasks on measures of physical function; 2) improving concordance between ergonomic exposure categories and methods of accommodation; and 3) providing a structured process for negotiating employee and employer preferences. To improve the effectiveness and efficiency of accommodation efforts, new tools for assessing function and ergonomic exposures in the workplace should be developed to specify accommodations more directly.
This investigation examined the day-to-day relationship between alcohol use and workplace absenteeism among a sample of participants (N = 280) employed in 1 of 3 large companies located in the northeastern U.S. With a semistructured interview, information was collected from employees about specific days of drinking during a 1-month period and marked on a calendar. Data about employees' absences during the same target time period were collected from the companies' human resource departments and were also marked on a calendar. A significant relationship was found between alcohol use and workplace absences; workers were roughly 2 times more likely to be absent from work the day after alcohol was consumed.
Workplace AIDS training is a recent addition to many corporations' occupational health agenda. However, little is known about the objectives, content, and practices of AIDS training programs. A survey of 126 workplace AIDS trainers was conducted to determine the impact of the trainer's organizational affiliation (in-house, consultant, union, etc.) and personal motives on training program objectives, content, and practices. Results indicate that the organizational affiliation of trainers is significantly related to training objectives, topics, and practices, whereas strong personal motives for becoming an AIDS trainer is significantly associated with an emphasis on more controversial content areas and training practices. Findings are discussed in terms of applicability to other values-oriented training topics, applications to practice, and future research needs.
The Therapeutic Workplace is an effective drug abuse treatment that integrates abstinence reinforcement into a work setting by using a salary that drug abusers earn for work. Drug abuse patients are trained and hired to become data entry operators in a Therapeutic Workplace business. Despite the opportunity to earn a high wage, participants frequently arrive at work late and fail to work complete shifts. In the present study, a contingency management intervention to promote consistent and reliable attendance was evaluated in 4 participants. Participants were not allowed to work on days that they arrived late, and their pay was temporarily reduced each time they arrived late at work or failed to complete a work shift. A within-subject reversal design showed that the intervention increased the frequency with which participants arrived at work on time and completed work shifts.
Between 1983 and 1985, 595 employees who were entering retirement in East Germany were given a medical examination and asked to assess their workplace conditions. Ten years later, we examined whether occupational predictors were associated with death and functional dependence among the study participants and assessed how the surviving pensioners coped with activities and instrumental activities of daily living. We assigned the occupational factors reported between 1983 and 1985 to two scales: demands and resources. Multiple logistic regression analyses were carried out to examine the association of occupational and medical predictors with the outcome variables death and functional dependence. Workplace resources but not demands were significantly associated with a reduced chance of death in women, independent of medical diagnoses. For men neither of these associations were verified. Concerning functional dependence individual items such as 'control over work content' (for both sexes) significantly reduced the risk of developing ADL-dependence. The associations remained stable after medical diagnoses were additionally taken into consideration. The results of our study highlight the influence of occupational factors beyond working life and support the importance of starting geriatric health promotion before retirement age.
Thirty one laboratories of various EU Member States have participated in two interlaboratory comparisons in order to assess errors of personal sampling methods associated with both the sampling and the analytical steps. In contrast to conventional quality control schemes, this project particularly focuses attention on the sampling and identification step; it is executed by means of sampling exercises and has included discussions on potential sources of error. In a sampling exercise, participants come to a central facility and perform measurements on synthetic workplace air in a laboratory installation. Concentration levels of formaldehyde, acrolein, glutaraldehyde and acetaldehyde between 0.1 and 2 times the limit value for workplace air were prepared at various humidity levels and with acetone, occasionally, as interferent. Sampling times varied from 1-4 h. The related analytical work is performed at the analyst's own laboratory. The intention is for each participant to determine the observed value of the delivered standard atmosphere using the sampling method of his own choice. Trueness (bias), precision and relative overall uncertainty of each method-laboratory combination is calculated and verified towards compliance with EN 482, which outlines minimum performance criteria. The first challenge involved the precise gas phase generation of the selected analytes in high air flows (up to 300 1 min-1) and calculating the true value only by direct reference to primary standards. This was accomplished by modifying the capillary dosage injection technique so that reactive compounds, like low molecular mass aldehydes, could be dosed with the same accuracy and precision as unreactive solvents. A permeation tube with high emission rate was developed for formaldehyde. Up to ten different sampling techniques were evaluated. The measurement methods used by the majority of the participants were based on pumped sampling on silica cartridges (or tubes) and glass fiber filters, coated with 2,4-dinitrophenylhydrazine. It was observed that for formaldehyde, and in some cases for acetaldehyde and glutaraldehyde, the majority of the method-laboratory combinations complied with an overall uncertainty of 30%. The results for acrolein, however, indicated a systematic negative bias, often larger than minus 50% of the true value, caused by the decomposition of the acrolein DNPH derivative in the presence of excess acid and excess DNPH.
Current literature on the sociology of health views medical dominance as a structural feature of the health division of labour, and a body of literature has developed exploring the structural components contributing to the subordination of the allied health professions. In this paper, nursing literature describing the nature and source of nurses' perceptions, complaints and dissatisfactions with their profession, and sociological analyses of the position of nurses within the structure of the health care delivery system, were employed to provide a framework for assessing the degree to which structural medical dominance of the nursing profession impinges on nurses' perceptions of dominance and how these perceptions affect nurses' workplace satisfaction. A 69-item questionnaire covering aspects of doctor-nurse, doctor-patient, nurse-patient and nurse-hospital administration relationships was developed. One-hundred and thirty-three Australian nurses and 108 British nurses completed the questionnaire, in which they ranked their own level of professional satisfaction and the level of satisfaction they perceived doctors to experience. Results indicated that Australian and British nurses were not only dissatisfied with many aspects of their work environment, such as their pay and working conditions, but also experienced dissatisfaction with their professional status while perceiving the medical profession to be highly satisfied. British nurses were significantly more dissatisfied with their own profession and perceived the medical profession to be more authoritarian than did Australian nurses. No difference between Australian and British nurses' perceptions of degree of medical autonomy was found. The implications of nurses' perceived discrepancy in workplace satisfaction between nurses and doctors in the delivery of health care are discussed in terms of the structural barriers created by medical dominance. Recommendations for the training of nurses and the implications of the findings for nurse practitioners are made, together with suggestions for further research.
The General Medical Council procedures to assess the performance of doctors who may be seriously deficient include peer review of the doctor's practice at the workplace and tests of competence and skills. Peer reviews are conducted by three trained assessors, two from the same speciality as the doctor being assessed, with one lay assessor. The doctor completes a portfolio to describe his/her training, experience, the circumstances of practice and self rate his/her competence and familiarity in dealing with the common problems of his/her own discipline. The assessment includes a review of the doctor's medical records; discussion of cases selected from these records; observation of consultations for clinicians, or of relevant activities in non-clinicians; a tour of the doctor's workplace; interviews with at least 12 third parties (five nominated by the doctor); and structured interviews with the doctor. The content and structure of the peer review are designed to assess the doctor against the standards defined in Good Medical Practice, as applied to the doctor's speciality. The assessment methods are based on validated instruments and gather 700-1000 judgements on each doctor. Early experience of the peer review visits has confirmed their feasibility and effectiveness.
BACKGROUND: Socialisation into a community involves learning sanctioned ways of talking. This study investigates the case presentation genre as a site of socialisation into the clinical community of practice. METHODS: Sixteen oral case presentations and the teaching exchanges surrounding them (involving 11 students and 10 faculty members) were observed by paired researchers during inpatient paediatric medicine rounds. A total of 21 in-depth interviews were conducted with 11 students and 10 faculty. Both data sets were audio-recorded, transcribed and analysed for emergent themes and rhetorical strategies. RESULTS: Students emphasised case presentation as a school genre and described the ideal presentation as free of interruptions. As a consequence, students' presentation strategies were directed towards getting through the presentation without questions. In contrast, faculty responses suggested an understanding of the genre as a way of constructing shared professional knowledge. Faculty feedback was often explicit about critical issues in constructing shared knowledge, such as handling uncertainty. However, student presentations rarely reflected this feedback. CONCLUSIONS: The school genre described and enacted by students conflicts in key ways with the workplace genre evident in faculty feedback, suggesting that school and workplace iterations of case presentation may be at cross-purposes. Such cross-purposes have implications, because when students and teachers perceive a genre differently, a 'gap' is created in their interactions. Even rich and contextually situated feedback may get lost or distorted as it crosses this gap. Explicit acknowledgement of the multiple and flexible iterations of case presentation will improve the learning that novices experience through acquiring this central form of professional 'talk'.
There is increasing interest in distinguishing the effects of physical and psychosocial workplace stressors on the aetiology of work-related musculoskeletal disorders (MSD). Modest associations have been found between psychosocial stressors and MSD, such as intensive load, monotonous work and low job control. Interpretation of these results has been limited by likely covariation between physical and psychosocial stressors. This investigation examined exposure covariation among blue- and white-collar workers employed in a mass production manufacturing environment (N = 410). Physical stressors were assessed from questionnaire and accelerometry. Psychosocial stressors were assessed from questionnaire. Pearson and Spearman correlation coefficients were computed. An exploratory factor analysis procedure identified possible common factors linking specific physical and psychosocial stressors. Moderate to high correlations between some physical and psychosocial stressors showed evidence of covariation both across and within groups. Covariation was strongest among blue-collar production and low-status office workers. Factor analysis results showed considerable shared variance between some physical and psychosocial stressors, such as repetition and job control, suggesting that these disparate stressors manifest from common work organization factors that govern the structure of work. While recognizing the conceptual differences between physical and psychosocial stressors, these results call attention to the strong empirical relationships that can exist between some stressors in the workplace setting. To guard against ambiguous study findings that can occur when exposures are mixed, it is critical that future epidemiologic studies include information about the degree of association between task-level stressors. Future research on work organization determinants of task-level stressors, and their coincident occurrence in jobs with greater specialization, may provide promising new insights into the nature of risk for MSD and effective prevention strategies.
Nurses, together with other groups in the caring professions, show a high incidence of musculoskeletal injuries as a consequence of the handling of equipment and patients. This is an internationally recognized consequence of the work in these professions, and studies worldwide have investigated these problems. The UK Health and Safety Executive, as well as the European Community (EC) Directives, require workplaces to be assessed for their hazardousness. Ergonomics is the recognized discipline in relation to assessing whether the work, equipment, or environment match the capacities of the people concerned. An assessment procedure is presented, together with proposals for its use, which can form the basis for the ergonomic assessment of workplaces in health care, and give guidance for their improvement.
In Switzerland, as in many other industrialized countries, the nature and extent of prevention at the workplace is determined, at least partially, by known cases of compensated occupational injuries and diseases. At both the national and international levels (ILO conventions), injuries and diseases that fit appropriate lists and definitions are eligible for compensation. It has been found, based upon an investigation of a representative sample (965 subjects) of the working population in the French-speaking region of Switzerland, that this restrictive view does not take into account the fact that a large proportion of injuries and diseases are claimed by the victims to be caused by their job. These injuries and diseases, responsible for at least one month's absence from work, are not considered to be eligible for compensation but must be covered by the patient's own insurance. Moreover, the survey showed that workers considered the ill effects on health and safety to be a consequence less of the physical working environment than of the work organization, and that this category of risks was not recognized. Thus, in addition to the reduction of hazards by the application of industrial hygiene, an informed improvement of the workplace and the work organization was required. Consequently, laws and regulations on occupational injuries and diseases should be changed in order to emphasize the role of more appropriate preventive tools, which includes ergonomics.
A realistic program for managing drug abuse in the workplace requires a clear understanding of the nature and effects of both licit and illicit drugs, as well as a knowledge of reliable methods for identifying and responding to both industry and individual needs. This article reviews the nature and effects of psychoactive drugs and discusses the medical steps to be taken when they are being abused. In addition, an overview of the means for identifying workplace drug abusers is presented. Testing methods and procedures are described, and such problems as false-positive and false-negative test results are clarified. The formation of corporate drug abuse policies is discussed and a continuum of industry interaction with health and drug abuse treatment professionals is presented. The roles of industry medical review officers, employee assistance programs, and other pertinent groups and individuals are also discussed.
BACKGROUND: The health-related quality of life and economic impact of psoriasis has been documented. However, the negative impact of psoriasis on the workplace is poorly understood. AIM/METHODS: Through anonymous surveys from 30 subjects of each of three psoriasis severity groups we aim to quantify the workplace impact experienced by psoriasis patients and factors that may contribute to this impact. Data were collected using several previously validated measures including the Work Productivity Assessment Index (WPAI), SF-8, Hospital Anxiety and Depression (HADS) and past medical/psoriasis history. RESULTS: Psoriasis patients experienced negative impact at work as measured by the WPAI; this impact is directly associated with disease severity. The other instruments confirmed the negative impact of psoriasis though the degree of impact did not always correlate with disease severity or work impact. Owing to the relatively small numbers, the significance of these findings is not certain. CONCLUSIONS: This preliminary study finds that psoriasis is associated with a reduction in work productivity and social functioning; this may explain the relatively high cost of this disease on both a macro- and microeconomic level. As there was a lack of significant trends in this study, formal inferences are limited and further investigation is warranted.