Implementation of statutory occupational respiratory health surveillance

Health surveillance is required by UK regulations in certain circumstances, and is usually provided through an occupational health organization. Although there are studies assessing the provision of health surveillance across the country, there are no published studies addressing the practical application of legislation, guidelines and medical research to respiratory health surveillance programmes. An audit of a multidisciplinary health surveillance programme was carried out, using review of occupational health records, occupational hygiene reports and managers' risk assessments, to compare the implementation of health surveillance in different organizations and under different contractual relationships. Sixty-six per cent of National Health Service (NHS) and 56% of industrial workplaces were able to provide risk assessments but were unable to link these with appropriate health surveillance. Twenty-seven per cent of NHS employees potentially exposed to respiratory sensitizers had baseline surveillance, compared with 87% in industry. Fifty-five per cent of Medical Research Council questionnaires were inappropriately administered by the employee themselves, rather than an interviewer as recommended. Other follow-up questionnaires in use had not been formally validated. Non-regular lung function assessment using spirometry was the predominant tool used for follow-up surveillance. There was no overall strategic approach to respiratory health surveillance in the organization studied. Health surveillance programmes should focus on disease prevention without becoming a repetitious application of unvalidated tools. Clinical governance demands quality assurance standards that will effectively implement a coordinated approach to health surveillance.     

Health surveillance in milling, baking and other food manufacturing operations--five years' experience.

The objective of this study was to describe the incidence of allergic respiratory disease and its outcome in terms of symptoms and jobs, across different flour-using industries. It uses the findings of a health surveillance programme in a large food organization over a five-year period. The population under surveillance consisted of 3,450 employees with exposure to ingredient dusts, of whom 400 were in flour milling, 1,650 in bread baking, 550 in cake baking and 850 in other flour-using operations. A total of 66 employees with either asthma or rhinitis symptoms attributable to sensitization to allergens in the workplace were identified. The majority of these (48/66) had become symptomatic prior to the commencement of the health surveillance programme in 1993. The incidence rates (per million employees per year) for those who developed symptoms between 1993 and 1997 were 550 for flour milling, 1,940 for bread baking, 0 for cake baking and 235 for other flour-using operations. The agent believed to be responsible for symptoms was most commonly grain dust in flour millers and fungal amylase in bread bakers. Wheat flour appeared to have a weaker sensitizing potential than these other two substances. In terms of outcome, at follow-up 18% of symptomatically sensitized employees had left the company. Two of the ex-employees retired through ill health due to occupational asthma. Of those still in employment, 63% described an improvement in symptoms, 32% were unchanged and 4% were worse than when first diagnosed. Over half the cases still in employment were continuing to work in the same job as at the time of diagnosis.     

Provision and perception of occupational health in small and medium-sized enterprises in Sheffield, UK

A random sample of managers of small and medium-sized enterprises (SMEs) was selected from a database of businesses in Sheffield, UK. They were invited to take part in a study to evaluate the provision and perception of occupational health in SMEs in Sheffield. The study used an interviewer-led questionnaire, which collected quantitative and qualitative data; each interview took approximately 40 min to complete. Several approaches to recruitment were adopted during the study. Twenty-eight managers were interviewed over the 6 month study period. All of the SMEs employed <250 people; 43.2% did not have or had never reviewed a written health and safety policy. Only 18% had a written occupational health policy; 14.4% employed the services of a part-time occupational health physician; 7.2% employed a health and safety advisor; and 10.8% employed a part-time occupational health nurse. Twenty-five per cent had a nominated person responsible for occupational health and 67% thought that a doctor or nurse would be the best person to provide an occupational health service. Twenty-eight per cent of the companies carried out some form of pre-employment screening and 14.2% carried out health promotion. Fifteen (53.5%) collected some form of health related absence data. Eight companies (28.6%) organized a formal induction programme for all new employees. Further work should be undertaken in an attempt to improve access to local industry and particularly to SMEs. This study has clearly shown that access is possible, but different strategies of approach were required before a workable strategy could be found. Undoubtedly, this access can be improved by better understanding of the interaction between researchers, occupational health providers and local managers of SMEs.     

Beliefs and Attitudes towards AIDS Policies and Educational Programs among Japanese Businesses

This study was undertaken to clarify the beliefs and attitudesof Japanese businesses towards AIDS. Questionnaires were mailedto 1,655 Japanese companies listed on the Tokyo Stock Exchangein June 1993, and the response rate was 38% (n = 620). About60% of the responding companies had already implemented or weredeveloping AIDS measures. Only 7% of the companies had an AIDSpolicy, and 5% of the companies were developing one. Eighty-fiveper cent of the companies perceived AIDS education as necessary,while 53 % of the companies replied that HIV testing was unnecessary.As reasons for providing AIDS education, avoiding discriminationand anxiety in the workplace were frequently cited. Ninety-fiveper cent of the companies wanted guidelines or manuals for AIDSto be developed by the Ministry of Labour, or to have trainingcourses for personnel in charge of education or counsellingprovided by the Ministry. Although AIDS measures are currentlyunsatisfactory in Japanese businesses, they are expected todevelop effective measures, considering their high recognitionof the need for AIDS education.     

Is occupational dermatitis being taken seriously by UK industries?

Occupational dermatitis is a considerable burden but little is documented concerning industry response to this. A postal questionnaire survey of 1,100 UK companies was conducted to investigate skin care provision. The response rate was 51%. The person primarily responsible for health and safety had a professional qualification in only 34% of responding companies. In all, 75% of companies responded that they were required to conduct COSHH risk assessments and, of these, 71% mentioned skin hazards. Only 27% of companies had a skin care policy but 71% had procedures requiring glove use. Seventy-seven per cent of companies did not conduct regular skin checks. Twenty-six per cent had either been aware of a skin problem in the workforce in the last 12 months or had had to modify work practices. Improvement of skin care in UK industry could be facilitated by the establishment of a minimum recommended training qualification; assistance with compliance with COSHH legislation; and guidelines to design and implement a skin policy, provide worker protection and detect skin problems.     

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.     

Pre-employment health assessments for food handlers: a survey of occupational physicians in the food industry

The format of pre-employment health screens within the food industry varies considerably. The aim of this study was to produce a consensus on the content of a screen that will enable employees to handle food with minimum risk to the product and employee. A questionnaire was sent to the 63 members of the Food Industry Medical Association, of whom 45 (71%) responded. As a minimum, a questionnaire completed by the applicant is thought to be sufficient. Applicants reporting health problems need to be assessed by a health professional.     

Charging for NHSPlus: an inferential study based on the internal provision of occupational health services within the National Health Service

BACKGROUND: 'NHSPlus' was conceived as a national agency that would provide occupational health services to organizations, for a fee, without imposing any financial burden on the taxpayer. This self-funding requirement brings into focus the resource implications for such a service and the determination of the charges to be made to external clients. AIM: The existing provision of occupational health services to >100000 National Health Service (NHS) staff by 13 NHS occupational health services of various sizes was analysed, with the objective of determining an appropriate charge-out rate to third parties. METHOD: Two focus groups were questioned on their work external to the NHS. Data collected on the allocation of doctors and nurses to occupational health services in relation to the number of NHS clients serviced were used to investigate the nature of the resourcing relationship using regression analysis. RESULTS: The relationship was found to be stable enough to provide a good estimate of staff requirements (the key resource requirement). Combining this with costing information allowed inferences to be drawn concerning the economic cost and hence the break-even rate of charge for the service. This was then compared with the employer charge rates in the NHSPlus published case studies. CONCLUSIONS: The results suggest that the per capita charges to external clients are lower than the per capita cost of internal occupational health provision within the NHS, raising questions about the viability of the service.     

Demonstrating the economic value of occupational health services

Many large companies operate some form of occupational health service (OHS). More companies now require specific evaluative information to justify the continued provision of an in-house OHS. This is in the face of increased pressure to control costs, combined with an awareness that the service itself can induce activity (supplier-induced demand) and could be substituted with health care provided or even funded outside the company. The lack of routinely collected data and the conceptual difficulty in defining and measuring the outcomes of an OHS provide challenges for economic evaluation. A purely human capital approach, where people are valued by their wage rates, is likely to be insufficient, since OHSs have multiple objectives. These objectives include fulfilling statutory obligations, contributing to the creation of a culture of partnership, reduction of potential costs to the company (sickness benefit, production loss, poor performance, litigation, insurance) and providing a suitable environment for the cost-effective reduction of the social and health service costs of illness at work. Evidence is needed to quantify some of these arguments and demonstrate to decision makers the value generated by OHSs. The aim of this paper is to consider the practicality of different economic evaluation methodologies, specifically cost models, contingent valuation (willingness-to-pay) and development of OHS-specific outcome measures. In considering different approaches, we present the results of our research in two UK companies.     

Organizational practices, work demands and the well-being of employees: a follow-up study in the metal industry and retail trade

BACKGROUND: Rapid technological change and increased international competition have changed working life and work organizations. These changes may not be considered when researching employee work ability and well-being. AIM: This study investigates the impact of organizational practices, work demands and individual factors on work ability, organizational commitment and mental well-being of employees in the metal industry and retail trade. METHOD: A follow-up study was conducted to examine these connections among 1389 employees (mean age 42 years at baseline) in 91 organizations. The first survey was conducted in 1998 and was repeated in 2000. RESULTS: Changes in organizational practices and the demands of work were strongly associated with changes in employee well-being. Work ability, organizational commitment and the mental well-being of employees were increased most if the opportunities for development and influence and the promotion of employee well-being were increased and if the supervisory support and organization of work were improved. Well-being also improved with less uncertainty at work and with decreasing mental and physical work demands. In addition physical exercise and affluence also had favourable effects. CONCLUSIONS: The results confirm that several features of organizational practices are strongly associated with employees' well-being. Organizational development is an important method of improving employees' work ability, commitment and well-being.     

Improved communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload

BACKGROUND: Professional expectations for communication skills are explicit. These skills are needed for professional integrity and personal morale. Nevertheless, occupational physicians see doctors as patients for whom communication among between doctors and with their managers are the principal cause of their presenting health problems. AIM: To describe the frameworks of professionalism in medicine and the duty to care for good communication; present issues surrounding competency in communication skills; identify health problems among doctors associated with poor communication; and consider roles of economic appraisal and preventive strategies. METHOD: A literature review identified key publications of professional expectations and requirements of doctors for their communication skills. Health problems among doctors associated with poor communication and presenting at least twice in a National Health Service (NHS) occupational health (OH) department during January-December 2002, were sought by manual retrieval of all doctor-patient records. The categories of communication difficulty were agreed in the focus group discussion of the presenting problems with occupational physicians. RESULTS: Nine categories of communication difficulties among doctors resulting in their presentation in OH departments with health problems were identified. CONCLUSIONS: Personal health problems caused by poor communication involve considerable time and potential litigation costs. Doctors need to be reminded of their responsibilities. Opportunity cost studies would help to strengthen an evidence base for the need of doctors to adhere to the professional requirements of good communication skills.     

NHS occupational health services in England and Wales--a changing picture

AIMS: To establish the extent of doctor input to occupational health (OH) service provision in the UK National Health Service (NHS) in 2001 and to compare this with inputs in 1998. METHOD: A postal questionnaire was used to obtain information from OH medical staff employed by the NHS in England and Wales. RESULTS: The NHS OH service has seen an increase between 1998 and 2001 in the amount of doctor time per employee. Doctors tend to work now for more sessions per week. The proportion of doctors holding specialist qualifications has also increased. An increased number of NHS employees now have access to consultant care for occupational medicine. OH departments increasingly tend to provide services to employees beyond the NHS and are thereby able to generate income to further the development of the service. CONCLUSIONS: Steady progress is being made in improving the provision of OH services within the NHS. However, substantial variation exists in the apparent level of access to such provision. The government policy for all NHS staff to have access to a consultant-led service is not yet met. NHS Plus will impact on this picture and deserves study in the future.     

The agenda of the organization. 2: Interventions

Many contemporary organizations, though doing well in productivity, are in chaos. Stress amongst managers and employees is still rampant and the assertion that 'people are our best assets' is confirmed more in words than in actions. What interventions are needed to best add value to the agenda of the organization and influence employee performance for the better? A philosophy of employee care includes looking at how managers take responsibility for performance management, deal with their own and others' stress and how the dynamics within organizations can be understood and harnessed for the welfare of the company. It also includes reviewing, articulating and implementing policies and systems that affect individuals in the organization and the organization as a whole.     

Occupational electrocutions in Jefferson County, Alabama

Few studies have presented the general epidemiology of electrocution deaths using local medical examiner data. Data were obtained from coroner/medical examiner's files for electrocution deaths occurring between 1981 and 1998. All 27 occupational electrocutions were among men; 92.6% were white and 7.4% were black, with a mean age of 33.1 years. The rates of high- and low-voltage electrocution were similar. Low-voltage deaths showed a seasonal pattern, with the largest numbers in July, August and October. Deaths occurred most frequently among electricians and electrical helpers. The level of detail available from medical examiner records permits more complete evaluation of injury patterns than is possible using death certificate data; however, even more detailed studies, exploring worker activity at the time of injury, education, experience and training, are needed.     

A Survey of Respiratory and Dermatological Disease in the Chrome Plating Industry in the West Midlands, UK

Between 1993–1995 a cross-sectional survey of 20 chromeplating companies in the West Midlands was undertaken to assessthe prevalence of respiratory and dermatological disease inplaters. By means of a questionnaire and clinical examination71 platers were examined of whom 23% were found to have dermatitisat the time of the visit and 45% of companies had at least onecase of dermatitis in their plating workforce. Twenty-threeper cent of platers had evidence of old chrome ulceration and13% had evidence of new and healing chrome ulcers. When thenasal passages of platers were examined 17% had inflammationand 14% had septal perforation. Those with perforations wereaged less than 35 years at the time of perforation which hadusually occurred in the first 10 years of exposure. Lower respiratorysymptoms were rare. Guidance on the prevention of disease inthis occupational group which does not always have ready recourseto experienced occupational medical advice will be discussed.     

Occupational health in the Andalusian Fisheries Sector

BACKGROUND: The conditions of work in the fisheries sector are arduous with high rates of occupational accidents. Numerous factors are known that can directly influence the health of the sailor or fisherman both in fishing and merchant fleets. AIM: To evaluate the health status, safety and working conditions in the Andalusian fishing sector. METHODS: Cross-sectional questionnaire study with proportional sampling of the health and lifestyles of fishery workers in 19 of the 23 Andalusian ports. RESULTS: A total of 247 workers employed on 202 craft fishing boats responded. In all 87% of workers reported a current medical condition. The main problems reported were musculoskeletal disorders, respiratory diseases, diseases of the digestive system, eye problems and skin problems. A total of 72% reported taking some self-prescribed medication, and 60% of fishery workers smoked. Nine per cent of fishery workers admitted taking illicit drugs and 3% reported using illicit drugs on board. Diets on board were poorly balanced. While on board, 62% of crews reported a subjective significant worsening of previous health. The lifetime prevalence of accidents was 76%. CONCLUSIONS: Fishery workers had a high prevalence of self-reported medical problems, a high prevalence of self-medication, poor diets and frequently smoked. Self-medication and some medical conditions (diabetes, angina and depression) may reflect a potential failing of health checks and pre-employment checks. National health services and insurance companies dealing with occupational health should focus more on appropriate health checks, illness prevention and health promotion activities for this population.     

Improving the quality of peak flow measurements for the diagnosis of occupational asthma

INTRODUCTION: Serial measurements of peak expiratory flow (PEF) are recommended in the evidence-based review list as the first stage in objective confirmation of occupational asthma. Different centres have reported widely different success in obtaining records of sufficient data quantity for diagnosis. We investigated different methods of instruction and determined the return rate and quality of the resulting record for the diagnosis of occupational asthma. METHODS: Consecutive new referrals were recruited from a specialized occupational lung disease clinic and requested to carry out serial PEFs for the assessment of suspected occupational asthma. Requests to carry out the records were either from written postal instructions or personal instruction from a PEF specialist. Record quality received from other clinicians was also analysed separating those using dedicated occupational forms, and those submitting on graph type forms. RESULTS: The postal return rate was 56% and the personal rate 85%. The number of records fulfilling all the data quality criteria were similar in the postal and personal groups (55 and 59%, respectively). Pre-existing records from other clinics plotted from graph charts (fulfilling all criteria) were only adequate in 23%, compared with 61% adequate for pre-existing records plotted from occupational forms. Failure of the record to contain consecutive work periods of > or =3 workdays was the most common failure. CONCLUSION: The return rate of PEFs for diagnosing occupational asthma is better when patients have been given specific instructions from a PEF specialist and the data quantity better when recorded on a dedicated form.     

Perception and provision of occupational health services in the UK

BACKGROUND: There is difficulty in defining occupational health services among stakeholders of the service. Concurrently, there are concerns about the state of occupational health provision in the UK. AIMS: To determine stakeholders' perception of the services that occupational health encompasses and the level as well as the rationale behind the provision of these services. METHODS: The research was undertaken as a postal questionnaire survey of the FTSE 350 companies and selected public sector organizations in the UK. This was followed up by telephone calls to a random selection of non-respondents to obtain non-respondent data. RESULTS: There is a difference in opinion among managers and occupational health professionals about the services provided by occupational health. Taking into account non-respondent data to partially adjust for overestimation biases, the level of provision of occupational health services among the FTSE 350 companies is 69% and in public sector organizations is 95%, giving an average provision of 72%. Sixteen per cent of respondents thought there was a trend towards outsourcing of services. The most frequently cited reason for provision of an occupational health service was that it was for the benefit of employees. CONCLUSIONS: There remains room for improvement in the level of occupational health services provision in large UK private sector organizations. By bridging the gap between the different stakeholders' perceptions of the remit and benefits of the service, a higher level of provision in the private sector similar to that of public sector organizations can be achieved.     

Effects of overtime work on blood pressure and body mass index in Japanese male workers

BACKGROUND: Effects of overtime work on health is a controversial issue. AIMS: To determine the effects of overtime work on blood pressure and body mass index (BMI) for male workers in Japan. METHODS: Participants were 323 male participants of three companies. Data were collected by occupational physicians at periodic physical examinations and additional examinations. The time courses for the development of definite hypertension and an increase in BMI were recorded. The Kaplan-Meier method was used to estimate the cumulative incidence rates of developing definite hypertension and increasing BMI, and the Cox proportional hazard model was used to determine the adjusted relative hazard of overtime work. RESULTS: The age-adjusted incidence rates of developing definite hypertension and increasing BMI were significantly lower among the participants whose mean overtime was > or =50 h than among those whose mean overtime was <50 h/month (log-rank P < 0.05). The Cox proportional hazard model indicated that those who worked a mean overtime of > or =50 h/month had lower risks of developing definite hypertension (hazard ratio, 0.36; 95% CI, 0.15-0.88; P < 0.05) and increasing their BMI (hazard ratio, 0.44; 95% CI, 0.31-0.63; P < 0.01) after adjusting for age. CONCLUSIONS: The results of this study indicate that workers whose mean overtime was > or =50 h have lower risks of developing definite hypertension and increasing their BMI.