Occupational Medicine-Oxford最新文献

Background: 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.

Aims: To elucidate the working conditions of health workers and introduce a worker-centred, technology-based strategy moving beyond traditional practices and entrenched medical culture.

Methods: 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.

Results: 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.

Conclusions: 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.

Background: Preceding studies of environmental and occupational risk factors of sarcoidosis yielded inconsistent findings.

Aims: We aimed to ascertain the occupational risk factors for sarcoidosis in a case-control study.

Methods: 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.

Results: 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%, P < 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.

Conclusions: 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.

Background: 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.

Aims: 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.

Methods: 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 I² statistic.

Results: 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).

Conclusions: 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.

Background: 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.

Aims: 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.

Methods: 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.

Results: Men (n = 8682) accounted for 58% of the total sample (n = 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.

Conclusions: 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.

Background: Healthcare workers (HCWs) report higher rates of long coronavirus disease (COVID) (LC) than other occupational groups. It is still unclear whether LC is a lifelong condition. Workforce shortfalls are apparent due to sick leave, reduced hours and lower productivity.

Aims: To investigate the lived experience of LC on a range of HCWs, including impact on health-related quality-of-life (HRQL), use of health services, working and personal lives and household finances.

Methods: Longitudinal mixed methods with online surveys and qualitative interviews 6-months apart. HCWs including healthcare professionals, ancillary and administration staff who self-report LC were recruited through social media and National Health Service channels. Interviewees were purposively sampled from survey responses.

Results: The first survey was completed by 471 HCWs (S1) and 302 (64%) the follow-up (S2). A total of 50 HCWs were interviewed initially and 44 at second interview. All participants experienced various relapsing, remitting, changing and prolonged LC symptoms (mean 7.1 [SD 4.8] at S2) and a third reported day-to-day activities 'limited a lot'. Most participants were working in a reduced capacity: reduced hours, different role or location. Healthcare was limited, and often unsatisfactory. Participants feared reinfection, their future, ability to work and financial security (59% (n = 174) at S2). They experienced stigma, distress, grief for their former self and some felt unsupported, however, as awareness of LC grew some experienced improved understanding and support.

Conclusions: Most participants continued working, managing complex and dynamic symptoms effecting their everyday life and ability to work. Most did not report significant improvements over time and feared for their future and financial security.

Background: Physicians in certain specialities are routinely exposed to procedural ionizing radiation. Their risk of cancer is unknown, including by cancer sub-types.

Aims: To assess cancer risk among exposed physicians.

Methods: This population-based case-control study was completed in Ontario, Canada, where healthcare is universal, using linkage of physician billing claims to a province-wide cancer registry. Up to five cancer-free physician controls were matched to each cancer-affected physician, by sex, and both age at and year of, entry into practice. Cumulative exposure to procedural ionizing radiation was captured by physician billing claims. Conditional logistic regression generated an odds ratio (OR) of cancer per 1000 procedures performed and as a binary exposure comparing physicians above the upper 95th percentile cumulative number of procedures (≥200) to those below this cut point.

Results: Mean (standard deviation) age of the 1265 cases and 5772 non-cancer controls was 39.7 (10.7) and 37.7 (9.0) years, and 45% and 49% were female, respectively. After a median (interquartile ranges) of 13.0 (6.9-20.4) and 12.5 (6.5-20.1) years of lookback among cases and controls, the OR of cancer was 1.02 (95% confidence interval 0.99-1.05; P = NS) per 1000 additional procedures performed. Modelling the cumulative exposure to procedures nonlinearly did not change the observed association (P > 0.40 for each). Comparing physicians above versus below the upper 95th percentile cumulative number of procedures, the OR of cancer was 1.23 (95% confidence interval 0.75-2.01, P = NS).

Conclusions: Physician exposure to procedural ionizing radiation was not associated with a higher risk of cancer. Measures that minimize radiation exposure should continue.

Background: Sinonasal carcinomas (SNC) constitute about 3% of all head and neck carcinomas, squamous cell carcinoma being the most common histologic subtype. Some geographical patterns in incidence are observed, as occupational exposure to wood dust is associated with intestinal-type adenocarcinoma (ITAC).

Aims: This study aims to describe the prevalence and characteristics of sinonasal ITAC cases in a region of northern Portugal with a robust wood industry.

Methods: A retrospective study of all sinonasal malignancies diagnosed over 5 years, in a tertiary hospital, primarily focused on ITAC subtypes. Data on sociodemographic and clinical variables were collected through electronic medical records and telephonic assessments.

Results: Of all 33 cases, 85% were ITAC. ITAC predominantly affected males (96%) with a mean age of 66.2 years. Most patients diagnosed with sinonasal ITAC had occupational wood dust exposure (96%), particularly to hardwoods. Initial symptoms included unilateral nasal obstruction (75%) and epistaxis (71%). Despite a median time of 3 months from symptoms to consultation, 50% presented at an advanced stage, with a 29% mortality rate.

Conclusions: Sinonasal ITAC is an occupational hazard of woodworkers and represents the vast majority of SNC in the region. This study advocates for targeted community interventions, emphasizing occupational safety measures and healthcare awareness to reduce morbimortality associated with this occupational cancer.

Background: Academic researchers experience high levels of stress, isolation and loneliness, which compromise their well-being. There is a particular need to address these issues amongst early career and postgraduate research staff. 'Spaces for Listening' is an initiative to increase active listening and provide peer support.

Aims: To assess the feasibility, acceptability and potential impacts of Spaces for Listening in an academic setting.

Methods: Early career and postgraduate researchers from a large university in the UK were invited to attend 'Academic Spaces for Listening' (ASfL). Five ASfL sessions (including in-person and Chinese language) were held. A mixed-methods study using online survey and in-depth interviews was conducted. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed using principles of thematic analysis. The qualitative and quantitative findings were integrated at the interpretation phase.

Results: A total of 25 participants attended an ASfL session, 22 of them completed the survey and 6 participants participated in semi-structured interviews. Participants were very satisfied with the session content (68%, n = 15), organization (68%, n = 15) and delivery (68%, n = 15). Four themes were identified from qualitative analysis: (i) the 'Academic Spaces for Listening' (ASfL) experience; (2) impact of ASfL; (3) potential challenges of ASfL and (4) ASfL in the future. Interpersonal connectedness was an important outcome for participants during the session. Participants showed interest in the future of ASfL.

Conclusions: Implementing Spaces for Listening in an academic setting is feasible and was well received by participants. The initiative may fill a gap in the social interactions amongst academic researchers.

Background: Mental-health-based consultations in occupational health (OH) are increasing due to ongoing changes in working life.

Aims: We studied the self-assessed mental health competence of trainees and trainers in OH specialist physician training.

Methods: We conducted an online survey from June to August 2022. We analysed how trainees and trainers in OH assessed their own competence in mental health practice with N (%) and means (standard deviation [SD]). We analysed the underlying assumptions about competences specific to OH using an explanatory factor analysis. We applied the Kruskal-Wallis test to determine differences between trainees and trainers using the variables in the factor analysis.

Results: Respondents' perceptions of mental health competence were more positive among trainers (mean 3.97, SD 0.72) than trainees (mean 3.66, SD 1.08, P = 0.2123). Based on trainee physicians' own assessments, more experience increases competence, until after 7 years, when the perceived competence seems to decrease. The trainer physicians' self-assessed mental health competence decreased over time. With factor analyses, we identified five competence factors: general mental health, workplace risks and resources, rehabilitation, promotion and prevention, and special skills. In our results, individual-level mental health competences such as work ability evaluation and to manage return-to-work processes were evaluated better than community-based proactive processes.

Conclusions: Physicians in OH specialist physician training self-assessed their mental health competence better at the employee level than at the workplace level. Based on our results, we need to develop the curriculum of OH specialist physician training to meet the needs of working life in support of mental health.