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WORLD HOSPITAL DIRECTORY
Occupational Medicine Medical Occupational Medicine- current issue
<span class="paragraphSection">This woodblock print <span style="font-style:italic;">Notes on Sericulture</span> (silk-farming) was designed by the Japanese artist Yoshitora (active c 1840–80). He trained at the Utagawa school that specialized in the genre of <span style="font-style:italic;">ukiyo-e</span> or ‘pictures of the floating world’ [<a href="#CIT0001" class="reflinks">1</a>]. The three main themes for <span style="font-style:italic;">ukiyo-e</span> paintings and woodblock prints were beautiful women, actors and landscapes. Printed on a sheet of paper measuring 37.15 × 25.4 cm the print is in the collection of the Los Angeles County Museum of Art. The text is written in old Kanji—Japanese script that includes symbolic Chinese characters—and refers to ‘things to remember about sericulture’ (F. Onodera, personal communication). The print is one-third of a triptych <span style="font-style:italic;">Sericulture Tips</span> that was created in 1847–52 and published by Izumiya Ichibei [<a href="#CIT0002" class="reflinks">2</a>]. Sericulture depends on moriculture (mulberry tree farming) because most commercially produced silk comes from the caterpillar of the <span style="font-style:italic;">Bombyx mori</span> moth that feeds exclusively on mulberry leaves [<a href="#CIT0003" class="reflinks">3</a>].</span>
<span class="paragraphSection">Long coronavirus disease (COVID) is an umbrella term to describe prolonged health problems and symptoms that arise following COVID infection. It is affecting a large proportion of the working population and high rates of long-term work absence, detrimental to individuals, employers and economies. Return to work (RTW) is often difficult and incomplete. The Society of Occupational Medicine has produced detailed guidelines to try and achieve a sustained RTW, aimed at managers, employers, occupational health professionals and workers.</span>
<span class="paragraphSection">We thank De Beer and Schaufeli [<a href="#CIT0001" class="reflinks">1</a>] for reacting to our review of the controversies that surround the burnout construct [<a href="#CIT0002" class="reflinks">2</a>]. We believe burnout researchers should more carefully examine the paradigms within which they operate, and we commend De Beer and Schaufeli for contributing to this effort [<a href="#CIT0001" class="reflinks">1</a>]. Burnout has had a ‘bumpy ride’, undoubtedly. The construct promises to be a rich subject of study for historians of science. We believe, however, that the problems affecting burnout become far less enigmatic when considering how the construct was created [<a href="#CIT0003" class="reflinks">3</a>].</span>
<span class="paragraphSection">Bianchi and Schonfeld present ‘food for thought’ on burnout syndrome [<a href="#CIT0001" class="reflinks">1</a>]. They highlight five focal areas for discussion. As occupational well-being researchers and burnout proponents, we shortly muse about these areas from our perspective below. We address each area in the order of their initial presentation.</span>
<span class="paragraphSection">Elgar Encyclopedia of Occupational Health Psychology Edited by CooperCary, BroughPaula and AndersonVicki L.. Published by Edward Elgar Publishing Limited, Cheltenham, UK, 1st edition, 2024. ISBN: 978 1 0353 1337 2. Price: £180; 238 pp.</span>
<span class="paragraphSection">This commentary explores the invisible occupational risks of platform work, focusing on food couriers and ride-hailing drivers. Algorithmic management, income instability, and the constant pressure of surveillance create physical and psychosocial health problems. Addressing these challenges through transparency, policy reform, and improved occupational health services can better protect workers in the platform economy.</span>
<span class="paragraphSection">Professor Mansel Aylward CB was a major polymath within the field of medicine with a long career which encompassed general practice, pharmaceutical medicine, pharmaceutical research, entrepreneurialism with the creation and development of a successful clinical trials company, disability medicine and research, occupational medicine, public health, global health, academic leadership and was a pioneer of the bio-psychosocial model of health. He never retired.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Hand-arm vibration syndrome (HAVS) is an occupational disease associated with long-term exposure to power tools leading to hand-transmitted vibration exposure. Prior research has focussed on physical manifestations with little known about the psychological impacts of HAVS.<div class="boxTitle">Aims</div>To examine if HAVS severity and/or functional impairment is associated with psychological outcomes.<div class="boxTitle">Methods</div>We conducted a cross-sectional study collecting data through a survey and retrospective chart review of workers being assessed for HAVS at an occupational medicine clinic. We collected information on demographics, work conditions, disease characteristics and physical and psychological outcomes as measured through validated instruments (SF-12, QuickDASH, GAD-2, PHQ-2). Descriptive statistics and bivariate analyses were followed by multivariable models to explore associations between mental health outcomes and predictor variables.<div class="boxTitle">Results</div>Participants (<span style="font-style:italic;">N</span> = 94; 56% response rate) were male with a mean age of 48.2 years. The majority (62%) worked in the mining sector, and 27% of participants reported feeling depressed and 35% reported showing little interest in or pleasure in doing things, while 28% reported clinically significant anxiety symptoms. In multivariable models, the QuickDASH, a measure of upper-extremity function and disability, was the only significant predictor of psychological outcomes.<div class="boxTitle">Conclusions</div>Workers with HAVS have poorer mental health and physical functioning outcomes in comparison to the general population. Employers should consider tailored policies and interventions to address the mental health of workers with HAVS.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Many studies have documented exposure to psychosocial factors in healthcare workers (HCWs) during the coronavirus disease 2019 (COVID-19) pandemic. Few have done it prospectively with open-ended questions.<div class="boxTitle">Aims</div>To describe the evolution of stress factors reported by HCWs during the pandemic.<div class="boxTitle">Methods</div>A prospective cohort of 4964 HCWs (physicians, nurses, healthcare aides and personal support workers), from four Canadian provinces, received four online questionnaires between the spring 2020 and 2022. Responses to an open-ended question on stressful events were coded into 25 stressors. Multilevel logistic regressions assessed trends in stressors, and the effect of gender, occupation and age.<div class="boxTitle">Results</div>In 2020, 91% of participants reported at least one stressor compared to 51% in spring 2022. Overall, eight stressors were reported 1000 times or more among 16 786 questionnaires. Five stressors decreased over time: fear of COVID-19, problems with personal protective equipment, changing guidelines, management of difficult cases and changes to work routine. Conversely, an increasing trend was noted for volume of work, and poor behaviour from the public or colleagues. Difficulties managing patients’ deaths remained steady. Changes in stressors over time were similar by gender, professional role and age group, although the reporting of some stressors varied within subgroups.<div class="boxTitle">Conclusions</div>Reporting of most stressors decreased over the pandemic, except for stressors arising from the changing demands on staff and patients as the pandemic progressed. Such changes in workplace psychosocial factors need to be addressed by prevention programmes to ensure an appropriate support response to the needs of HCWs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Systemic sclerosis (SSc) is the connective tissue disease with the highest individual mortality. Crystalline silica is known to be an occupational risk factor for SSc. To assess past crystalline silica exposure, we aimed to study the validity of a job exposure matrix (JEM) to assess occupational exposure to crystalline silica compared to specific occupational interviews in two populations of SSc patients.<div class="boxTitle">Aims</div>To demonstrate the reliability of JEM for the assessment of occupational exposure to hazards such as silica, in severe rare disorders like SSc.<div class="boxTitle">Methods</div>Patients from two university hospital centres underwent standardized assessment of occupational silica exposure and collected job histories through face-to-face interviews. A JEM from the French program Matgéné was used to assess silica exposure and compared to the standardized interview results. Standard metrics were computed for evaluate the accuracy of JEM.<div class="boxTitle">Results</div>67 participants from Rennes, and 119 from Tours were included, with respectively 10.5% and 18.0% of patients with silica exposure based on the results of the interview. The JEM with 50% probability cut-off had a good performance when compared with the classic assessment method. A cumulative exposure index from JEM over 250 had an area under the curve between 0.76 and 0.79 and also a very high positive likelihood ratio (17.14 and 10.29).<div class="boxTitle">Conclusions</div>Despite limitations inherent to JEMs and associated validation methods, the JEM used in this setting provided accurate results to assess occupational exposure to crystalline silica for clinical purposes such as in SSc patients, especially to detect positive cases.</span>
<span class="paragraphSection">Silica exposure and silicosis are strongly associated with pulmonary tuberculosis (TB), with ex-miners from the South African gold mines carrying a large burden of both diseases. We present a case of lymph node silicosis and recurrent TB complicated by cavitation with aspergilloma requiring right upper lobectomy, in a 38-year-old ex-goldminer with only 19 months of silica exposure. While silicosis was detected histologically in the lymph nodes, radiological findings and histopathological lung parenchyma lesions were consistent with inactive TB. A worker’s compensation claim for silicotuberculosis was unsuccessful. The findings highlight the need to take into account the contribution of subradiological silicosis and/or a low silica exposure threshold to increased TB risk, and the persistence of such TB risk following exit from exposure. The case also demonstrates the need to differentiate between the radiological and pathological features of silicosis and TB, and the possible mechanistic role of lymph node silicosis in increasing TB risk. These considerations have relevance to the surveillance of silica-exposed workers in high TB settings and the potential to reduce TB risk through silica dust control.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Occupational stress among healthcare workers negatively impacts job satisfaction and patient care quality, jeopardizing healthcare system sustainability. Traditional employer-driven approaches often fail to address these challenges comprehensively, leading to persistent gaps in work condition transparency and well-being.<div class="boxTitle">Aims</div>To elucidate the working conditions of health workers and introduce a worker-centred, technology-based strategy moving beyond traditional practices and entrenched medical culture.<div class="boxTitle">Methods</div>A nationwide survey of Belgian medical residents evaluated occupational conditions and perceptions of management practices. Additionally, the alpha version of a decentralized mobile application was tested to gather user satisfaction and feedback on its usability. The data were surveyed using Pearson’s chi-squared and Kruskal–Wallis rank sum tests to assess associations between categorical and ordinal variables, respectively. Alpha-testing results were evaluated using descriptive statistics.<div class="boxTitle">Results</div>The nationwide survey, involving 257 participants, revealed significant associations between medical specialty, work choices and compensation. Notably, 91% of participants expressed strong interest in our proposed open, decentralized solution. In the alpha testing phase, 12 testers reported high satisfaction regarding time-tracking accuracy and payroll verification, though challenges related to administrative burden were also identified.<div class="boxTitle">Conclusions</div>The findings underscore the need for innovative, worker-centred occupational management solutions. The proposed solution shows promise in improving autonomy and transparency, potentially enhancing healthcare delivery and sustainability.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Preceding studies of environmental and occupational risk factors of sarcoidosis yielded inconsistent findings.<div class="boxTitle">Aims</div>We aimed to ascertain the occupational risk factors for sarcoidosis in a case-control study.<div class="boxTitle">Methods</div>A total of 237 sarcoidosis patients with a histologically confirmed diagnosis were matched with 474 controls for sex and age (median 49, interquartile range 37; 60 years) recruited from the university hospitals and outpatient centres in Belarus, Kazakhstan and the Russian Federation. Ever and cumulative (considering years and hours per week) exposure to 24 occupational factors were analysed using logistic regression.<div class="boxTitle">Results</div>In the overall sample of 711 subjects, 50% were females and any occupational exposure was more prevalent in cases compared to controls (60% versus 40%, <span style="font-style:italic;">P</span> < 0.001). Current daily smoking as opposed to ex-smoking was associated with the lower risk of the outcome. Adjusted for smoking, age, sex and a few other exposures, ever-exposure to hay in agriculture (odds ratio (OR) 3.64 (95% confidence interval (CI) 1.26; 10.50)), engine exhausts (OR 2.94 (95% CI 1.14; 7.54)) and printing equipment (OR 1.66 (95% 1.03; 2.68)) was associated with sarcoidosis. The effect was also positive for cumulative exposure to hay in agriculture (OR 2.02 (95% CI 1.00; 4.07)), stone dust (OR 1.07 (95% CI 1.01; 1.14)) and engine exhausts (OR 1.18 (95% CI 1.03; 1.38)) and was stronger in never-smokers and subjects 40 years and older.<div class="boxTitle">Conclusions</div>Widespread occupational exposures may increase the risk of sarcoidosis, but further research is needed to elucidate the complex interplay of environmental and occupational factors in the epidemiology of sarcoidosis.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>The symptoms of Long coronavirus disease 2019 (Covid-19) are heterogeneous, creating uncertainty for employers regarding the diagnosis. The prevalence of Long Covid-19 in the workforce is also unknown. Furthermore, workers affected by Long Covid-19 encounter considerable difficulties in ensuring work safety and returning to their jobs due to this condition.<div class="boxTitle">Aims</div>This review is aimed to identify the prevalence of Long Covid-19 in the workplace and to determine the various symptoms of Long Covid-19 experienced by the workers.<div class="boxTitle">Methods</div>A meta-analysis was conducted to calculate the pooled estimates for the prevalence of Long Covid-19. Heterogeneity among the estimates was evaluated using the <span style="font-style:italic;">I</span>² statistic.<div class="boxTitle">Results</div>The pooled prevalence of Long Covid-19 among workers across the 11 studies was 38% (95% CI 23–56). A total of 43 symptoms associated with Long Covid-19 were identified in the workplace, with the top five symptoms being dyspnoea at moderate activity (51%, 95% CI 39–62), mental symptoms (38%, 95% CI 6–87), dyspnoea at mild activity (35%, 95% CI 25–47), fatigue (26%, 95% CI 3–78) and effort intolerance (24%, 95% CI 15–35).<div class="boxTitle">Conclusions</div>The review indicates a significant burden of long-lasting symptoms within the workforce. The top five reported symptoms of Long Covid-19 were dyspnoea during mild and moderate activities, mental symptoms, fatigue and effort intolerance.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Previous studies have reported the impact of a diagnosed disease or self-perceived poor overall health on job loss. However, evidence is lacking on which self-reported symptoms or activity limitations are related to job loss, especially during the coronavirus disease 2019 (COVID-19) pandemic.<div class="boxTitle">Aims</div>We investigated whether self-reported symptoms or activity limitations were correlated with the occurrence of job loss within 1 year during the COVID-19 pandemic.<div class="boxTitle">Methods</div>In this prospective cohort study, we used questionnaires administered to Japanese workers. A baseline survey conducted in December 2020 was used to determine workers’ symptoms or activity limitations. Experiencing job loss since the baseline survey was ascertained with a follow-up survey in December 2021. The odds ratios of experiencing job loss were estimated using a logistic model with adjusted covariates.<div class="boxTitle">Results</div>Men (<span style="font-style:italic;">n</span> = 8682) accounted for 58% of the total sample (<span style="font-style:italic;">n</span> = 14 910), and the respondent mean age was 48.2 years. Multivariate analysis showed that workers with pain-related problems; limited physical movement and mobility; fatigue, loss of strength or appetite, fever, dizziness and moodiness; mental health problems; sleep-related problems or eye-related matters had a greater probability of experiencing job loss owing to health reasons.<div class="boxTitle">Conclusions</div>Several self-reported symptoms or activity limitations can lead to job loss after 1 year, indicating that prevention and resolution of symptoms or activity limitations are important to reduce workers’ risk of losing their jobs.</span>
<span class="paragraphSection">This is a correction to: Bruna Roberta Muntanelli, Marcos Felipe Bom Sampaio, Stephania Morreale, Augusto João Manuel, Ivan Dieb Miziara, João Silvestre Silva-Junior, P-128 SICKNESS ABSENCE DUE TO POST-TRAUMATIC STRESS DISORDER IN BRAZIL (2008-2021), <span style="font-style:italic;">Occupational Medicine</span>, Volume 74, Issue Supplement_1, July 2024, Page i244, <a href="https://doi.org/10.1093/occmed/kqae023.0635">https://doi.org/10.1093/occmed/kqae023.0635</a></span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Carpal tunnel syndrome (CTS) is a socially relevant condition. Risk factors associated with CTS severity and work have not been explored.<div class="boxTitle">Aims</div>This case-control study aims to investigate the association between CTS severity and occupational biomechanical overload considering personal anthropometric risk factors.<div class="boxTitle">Methods</div>We consecutively enrolled one CTS case for two controls. CTS cases were grouped into three classes of progressive clinical and electrophysiological severity according to two validated scales. Job titles were coded according to the International Standard Classification of Occupations (ISCO 88) and grouped into two broad socio-occupational categories: blue-collar and white-collar workers.The associations between CTS (or CTS severity) and blue-collar status were assessed using unconditional (or multinomial) logistic regression models adjusted for age, gender, centre and two anthropometric indexes: wrist-palm ratio and waist-stature ratio. Odds ratios (OR) or relative risk ratio and 95% confidence intervals (95% CI) were calculated, as appropriate.<div class="boxTitle">Results</div>We included 183 cases and 445 controls. Blue-collar status was a risk factor for CTS (OR 2.4; 95% CI 1.5–3.8). Among job titles, vine and/or olive tree growers (OR 6.0; 95% CI 2.0–17.9) and food processing workers (OR 4.8; 95% CI 1.5–15.2) were at higher risk. At multinomial logistic regression analysis, blue-collar status and the two anthropometric indexes were associated with moderate/severe CTS, after mutual adjustment.<div class="boxTitle">Conclusions</div>Blue-collar workers showed a higher risk of CTS than white-collar workers, adjusting for anthropometric and body measures as well. Preventive interventions should be addressed to decrease the biomechanical overload of the upper limbs and limit the overweight.</span>
<span class="paragraphSection">Although the worst of the coronavirus disease 2019 pandemic appears to be over, the burden of airborne infection in workplaces remains unacceptably high, leaving society vulnerable, and harming workers and others. A better approach is needed to mitigate the risk of infection as actively as other multifactorial ubiquitous risks such as workplace stress. Sources and pathways of transmission need much improved control, with special emphasis on ensuring the protection of the vulnerable and susceptible.</span>
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