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Occupational health education in Poland: new needs, new requirements, new programmes.

The conditions of modern work environment in Poland generate new problems, new needs and new expectations in the area of occupational health. They are associated not only with the rapidly changing technologies and new professions but also with the psychosocial factors pertaining to extensive transformations of the political and economic systems. New needs and expectations determine a new approach: firstly, to the responsibilities of the occupational health specialists; secondly, to the organisation and management of the workers health care; and thirdly, to the general principles of the occupational health, including in particular relevant legislation. The new requirements concerning the operation of the occupational health system in all the three dimensions must be addressed in the design of the new training programmes in occupational health whether under- or postgraduate. Subjects to updating and modification should be not only the content of the training but also its forms and methodology. Competence-based learning should be accompanied by the modern methods of problem solving, distant learning, organised self-education and self-assessment. The growing interest in the quality of the training should be expressed, first of all, in the activities aiming at the development of procedures to assess the effectiveness of the training. It seems also necessary to adopt the active learning approach intensifying acquisition and verification of the knowledge and skills. This approach would also lead to deeper changes in the students' mentality and behaviour, e.g. to make them able to estimate their own and others' level of professional competence or shape the personal system of professional values under the conditions of the free-market economy in the health care which entails quality requirements for the services and the competition among its providers.

Curriculum↗

[Dutch midwives: image and occupation. Developments in midwifery in Leiden, Arnhem, 's-Hertogenbosch and Leeuwarden, 1650-1865].

My study on the social position of Dutch midwives in early modern Europe was induced by the consistently negative image in the literature at the time. Medical doctors and accoucheurs (obstetricians) expressed critical opinions on both the occupation of midwifery and the midwives themselves. They disparaged the behaviour, activities, training, income, additional jobs and social background of midwives. Later, medical doctors and historians reproduced and promulgated this negative image of midwives. At issue is the extent to which the attitudes of medical doctors and accoucheurs corresponded to those of the broader population, and how these attitudes were related to the actual place in society. The question is if midwives took a marginal position in urban society. My work focusses on four Dutch cities: Arnhem, Leeuwarden, Leiden and 's-Hertogenbosch. It deals with the period 1650-1685. The criticism of medical practitioners and of a accoucheurs on midwives are described. The occupation itself is discussed: the activities of midwives and the development of the profession (regulation, training and rivalry). At the end of the seventeenth and the beginning of the eighteenth century, the medical profession began to show an interest in childbirth. Rivalry between accoucheurs and midwives, competition between legal and illegal practitioners of midwifery, and in-fighting within the profession tell us something about the development of the profession. From the eighteenth century on, attending problematic births was claimed as a privilege of accoucheurs. Data from municipal archives were used to find out if and to what extent midwives were marginalised. Their geographical mobility, social background (occupations of parents), occupations of husbands, income and domicile are discussed. Analysis of this material indicates that midwives belonged to the common urban labouring class (consisting of artisans and workers), and were not very different from other members of this class. Certainly they were not marginalised, instead they had a relatively privileged position within the common labouring class. Five motives can be distinguished for the negative image expressed by medical doctors and accoucheurs in their publications: 1) professional rivalry, 2) division of theoretical and practical knowledge, 3) class differences, 4) gender, and 5) 'polluting' activities. Studies on ideas of pollution and 'infamous' occupations might lead one to conclude that midwives in the Dutch Republic were stigmatised. I found no evidence, however, that the opinions of medical doctors and accoucheurs were shared by the broader public. Official recognition of midwives - the regulation of their practice and education - protected tham. This has contributed to their position as independent practitioners in the Netherlands up to today.

History, Modern 1601-↗

Bakers' rhinoconjunctivitis: a case report.

Bakers' rhinoconjunctivitis is a rare occupational disease characterized by nasal and/or ocular symptoms occurring during and after exposure to flour. Occupational allergies represent a difficult problem in that avoidance therapy is not easily obtainable in those individuals not willing to change professions.

Adult↗

Rethinking the concept of professionalism: the case of journalism.

Journalists in the UK have always been ambivalent about what form of occupational control to pursue. Although resistant to the structures of the conventional profession, they have embraced the idea of 'professionalism'. As the formations traditionally associated with Anglo-American professions become relevant to fewer and fewer employees and increasingly subject to external regulation it is more relevant, we suggest, to investigate how the discourse of 'professionalism' as a set of values and identities can be mobilized by employers as a form of self-discipline. Journalism, notable for its powerful occupational mythology, provides a vivid example of how this process has eased the imposition of radical changes to the organization of work. Now, ironically, recent changes in the occupation's social composition and training may mean that journalists, who have always cherished a self-image as socially marginal, will aspire to conventional professional respectability.

Humans↗

[Employee protection and occupational medicine in Switzerland. Legal and organizational aspects].

The regulations aimed at protecting the health of workers are essentially contained in both the Labour Law (general hygiene, duration of work and rest periods, special protection of women and minors) and in the Law Governing Accident Insurance (prevention of accidents and professional illnesses). The employer is obliged to take all the necessary measures for the protection of his employees and to ensure the collaboration of the latter to this end. The National Insurance together with the federal and cantonal Labour Law enforcement agencies share the task of supervising the application of legal health protection. In particular, the National Insurance and the Confederation have a medical service at their disposal. In order to comply with requirements, large firms have their own health and safety service, some with an industrial physician. An ordinance which will oblige high risk firms or firms above a certain size to have resident industrial physicians as well as other labour safety specialists is at present being discussed. One of the aims of the proposed revision of the Labour Law is an improvement in the medical supervision of workers exercising their profession at night.

Accidents, Occupational↗

Legal liability for occupational therapists.

In recent years technological advances, increased social awareness, and changing moral values have brought to light may legal questions in the health field. There can be little doubt that members of our profession, as well as the public, are now very aware of the possibility of malpractice. There are critical questions and issues for the occupational therapist: How can the therapist decrease the likelihood of being charged with malpractice? What standard of practice does the law apply? How may she anticipate her conduct to be judged legally? What outcome can she expect? In fact, to date there have been no malpractice claims against occupational therapists in Canada but the Canadian Association of Occupational therapists has arranged for malpractice coverage. Nevertheless, the therapist is responsible for administering the reasonable skill and care that are recognized as appropriate by at least a significant minority of the profession. As in all aspects of the health field, prevention is to be preferred.

Canada↗

Interest among occupational therapy managers in measuring workload for case costing.

OBJECTIVES: Interest in costing health care delivery on an individual case basis has increased in recent years as concern with overall health care costs has heightened. Costing exercises have been largely oriented around medical classification systems. Measures to incorporate the contributions of allied health activities such as occupational therapy are relatively recent. The objective of this study was to examine the attitudes and opinions of senior occupational therapy managers toward workload measurement on the basis of case mix. METHOD: A survey was sent to all 198 senior occupational therapy managers in accredited Canadian facilities, which was completed by 182 respondents for a response rate of 92%. The questionnaire asked about workload measurement system(s) currently used, satisfaction with the system(s), and needs and expectations of workload systems in general. RESULTS: The majority of respondents were using a time recording workload measurement system and expressed relatively low levels of satisfaction with it. Current systems were unable to provide costing data, which respondents ranked as very important for themselves as managers. The majority of respondents believed that it would be useful or very useful to be able to cost occupational therapy services by a diagnostic grouping system and to establish standard protocols per diagnosis, standard times per procedure per institution, and standard times per procedure for the profession. CONCLUSION: There is support for developing or expanding current methods of measuring workload. Senior occupational therapy managers would like to be able to predict their workload prospectively, a step that will accommodate the move toward case costing and program management.

Attitude of Health Personnel↗

Media education based on the philosophy of pragmatism.

The responsibility for crafts instruction at New York University was transferred recently from the Art Department to the Department of Occupational Therapy, where a new model of media education has been developed. This change resulted from the difficulties students and faculty experienced in integrating craft activities with occupational therapy's conceptual foundations and the realities of practice. These problems are not unique to this university but are common throughout our profession. This paper will discuss these problems and an attempt at their solution by outlining a model for media education based on historical and philosophical concepts pertinent to the profession. This model demonstrates the academic justification for the development and presentation of media education courses by occupational therapy faculty.

Art↗

Evidence-based practice and the professionalization of dental hygiene.

The application of knowledge is fundamental to human problem solving. In health disciplines, knowledge utilization commonly manifests through evidence-based decision making in practice. The purpose of this paper is to explore the development of the evidence-based practice (EBP) movement in health professions in general, and dental hygiene in particular, and to examine its relationship to the professionalization agenda of dental hygiene in Canada. EBP means integrating practitioner expertise with the best available external evidence from research. Proponents of EBP believe that it holds promise for reducing a research-practice gap by encouraging clinicians to seek current research results. Both the Canadian and American Dental Hygienists Associations support practice based on current research evidence, yet recent studies show variation in practice. Professionalization refers to the developmental stages through which an organized occupation passes as it develops traits that characterize it as a profession. The status conferred by professionalization privileges a group to make and monitor its own decisions relative to practice. Dental hygiene's success in acquiring attributes of a profession suggests that transformation to a profession is occurring. This paper compares the assumptions and challenges of both movements, and argues the need for a principal focus on the development of a culture of evidence-based dental hygiene practice.

Canada↗

The professional dominance perspective, revisited.

The autonomy of the medical profession, exemplified by its ability to direct the substance of its own work, is a central tenet of Freidson's professional dominance perspective. Critics of professional dominance argue that the autonomy of the profession has eroded because of the loss of its monopoly over medical knowledge and its diminishing authority over patients (deprofessionalization), or because of its loss of control over key occupational prerogatives (proletarianization). The professional dominance of medicine may, however, be more valuable to the profession's own neglect of its avowed public promise to regulate itself than to external forces resulting from changes in the health care delivery system.

Delivery of Health Care↗

[Clinical studies and pathogenesis of hairdresser's dermatitis].

Characteristically, hairdresser's dermatitis arises shortly after occupational exposure and tends to clear quickly following a change of professions. A large number of causative agents are usually found. There is a considerably higher incidence in females. The following factors play a major role in the pathogenesis of hairdresser's dermatitis alkalinity of the substances used, carelessness in handling the chemicals, mechanical trauma and constant wetting of the skin, and constitutional factors such as hyperhidrosis and dyshidrosis.

Adolescent↗

Research values of occupational and physical therapists.

A national survey was conducted to determine occupational and physical therapists' values toward research. While members of both professions were found to have similar research-related values, therapists identified as researchers held somewhat more positive views of research than did clinicians. The primary differences between clinicians and researchers related to values regarding the relationship between research and professional status, and to the relationship between research and clinical practice.

Adult↗

Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies.

The recent increased threat of terrorism, coupled with the ever-present dangers posed by natural disasters and public health emergencies, clearly support the need to incorporate bioterrorism preparedness and emergency response material into the curricula of every health professions school in the nation. A main barrier to health care preparedness in this country is a lack of coordination across the spectrum of public health and health care communities and disciplines. Ensuring a unified and coordinated approach to preparedness requires that benchmarks and standards be consistent across health care disciplines and public health, with the most basic level being education of health professions students. Educational competencies establish the foundation that enables graduates to meet occupational competencies. However, educational needs for students differ from the needs of practitioners. In addition, there must be a clear connection between departments of public health and all other health care entities to ensure proper preparedness. The authors describe both a process and a list of core competencies for teaching emergency preparedness to students in the health care professions, developed in 2003 and 2004 by a team of experts from the four health professions schools of Columbia University in New York City. These competencies are directly applicable to medical, dental, nursing, and public health students. They can also easily be adapted to other health care disciplines, so long as differences in levels of proficiency and the need for clinical competency are taken into consideration.

Allied Health Personnel↗

[Healthy choice of occupation for juveniles in the textile and clothing industry in light of preventive examinations].

Choice of profession in line with natural liking or aptitude for a certain type of work and physical fitness is considered as a proper one. The aim of this study was to verify the effectiveness of pre-placement examinations of juvenile leaving primary schools. The study covered: (1) 210 students of textile and clothing schools; (2) 70 students from special care classes of the textile school; and (3) 312 graduates from primary schools applying for admission to textile and clothing schools. The study was carried out at the Nofer Institute of Occupational Medicine, Lodz, Poland. The reported subjective symptoms were usually limited to the headache (27%). The most prevalent abnormalities were visual organ impairments. Within the group of special care students from the textile school, scoliosis and functional disturbances of the nervous system were detected. The study revealed that both the range of pre-placement examinations of juvenile and the recognition of the criteria for certifying work capability are inadequate.

Adolescent↗

Competency-based occupational standards: influences on Australian speech pathology education.

Speech Pathology Australia developed competency-based occupational standards in response to a national government initiative across all professions and these standards have formed the basis for the accreditation process of speech pathology education programmes in Australia since 1994. This paper presents a critical appraisal of the contribution of a competency framework to curricular design, focussing on both content coverage and teaching methodologies. Also, the assessment of learning promoted through a competency-based framework is considered in relation to models of critical thinking.

Australia↗

Some objective measures indicative of perceived voice robustness in student teachers.

One of the problems confronted in the teaching profession is the maintenance of a healthy voice. This basic pedagogical tool is subjected to extensive use, and frequently suffers from overload, with some teachers having to give up their profession altogether. In some teacher training schools, it is the current practice to examine the student's voice, and to refer any perceived susceptibility to strain to voice specialists. For this study, a group of vocally healthy students were examined first at the teacher training schools, and then at the ENT clinic at the University Hospital of Nijmegen. The aim was to predict whether the subject's voice might be at risk for occupational dysphonia as a result of the vocal load of the teaching profession. We tried to find objective measures of voice quality in student teachers, used in current clinical practice, which reflect the judgements of the therapists and phoniatricians. We tried to explain such measures physiologically in terms of robustness of, and control over voicing. Objective measures used included video-laryngostroboscopy, phonetography and spectrography. Maximum phonation time, melodic range in conjunction with maximum intensity range, and the production of soft voice are suggested as possible predictive parameters for the risk of occupational voice strain.

Adolescent↗

Fatal occupational inhalation of hydrogen sulfide.

A young man aged 22 years, a sewer worker by profession, died after massive inhalation of hydrogen sulfide while at work. He was rescued by the emergency services and admitted to the critical care department, where he died due to massive myocardial necrosis less than 24 h after admission. In this case, where the causes of the accident were not clearly established, autopsy and anatomopathologic examination made it possible to confirm the causal lesions which resulted in death and to question the initial version of the circumstances of the accident. Medicolegal investigation was valuable in determining possible liabilities and repercussions on coverage as an industrial accident by the national health insurance system.

Adult↗