Cancer Survivors and Returning to Work Perspectives from Occupational Health Physicians in Korea

BACKGROUND: This study was conducted from an occupational health perspective to document cancer survivors' ability to return to work, the role of clinical care, and the current status of effective return-to-work. METHODS: This cross-sectional study was conducted to evaluate the experiences and opinions of occupational health physicians (OHPs) regarding cancer survivors' return-to-work. A self-reported survey was conducted from December 30, 2015, to January 30, 2016, targeting 337 OHPs. Questions included: 1) treatment experiences of survivors in the words of OHPs, 2) current status of the assessments of fitness for work of cancer survivors, 3) experiences associated with workplace and treatment, and 4) problems of returning to work and overcoming system. RESULTS: Only 25% of the respondents said that they had experience treating cancer survivors, and the average number of patients was 12.6 per annum, which indicated that few cancer survivors were treated. Eleven cases included conducting assessment of fitness for work. There were 17 respondents who did not treat cancer survivors. Both those who had and did not have experience in treating survivors showed higher musculoskeletal system disorders (53.8 vs. 63.5) than cancer (15.5 vs. 11.2) in terms of frequency of the diseases in the assessment of fitness for work. Most respondents said that OHPs evaluate the current role appropriately and preferred OHPs in the future. They responded that OHPs found it difficult to treat cancer survivors, and it was psychologically tough to communicate with them (61.4%). Regarding the association of patient rehabilitation with workplaces, 48.9% said that workplaces provide inadequate support. CONCLUSION: As a preliminary study, we found that OHPs were found to have little experience in treating cancer survivors and undergo difficulties owing to poor collaboration with workplaces and communication with patients. This study will provide basic data for future studies to promote cancer survivors' return to workplaces.

Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV / Adverse effects of antiretroviral prophylaxis after occupational exposure to HIV

A exposição ocupacional a material biológico com risco de transmissão do vírus da imunodeficiência humana (HIV) constitui uma emergência médica. A profilaxia pós-exposição (PEP) deve ser iniciada precocemente e mantida por 28 dias. Desde julho de 2015, o Ministério da Saúde passou a recomendar o uso combinado de três drogas antirretrovirais para a PEP, menos tóxicas e melhor toleradas do que as usadas anteriormente. Apesar disso, quase metade dos expostos em uso da PEP apresenta efeitos adversos. Geralmente, eles são leves e autolimitados. Os mais comuns são alterações gastrointestinais, astenia, cefaleia e tontura. Entretanto, eventos mais graves já foram observados e a taxa de interrupção da profilaxia permanece elevada. Em 2017, o Ministério da Saúde modificou o esquema de primeira linha da PEP, substituindo o terceiro antirretroviral. Esse artigo relata um caso de toxicidade associada ao uso da PEP após exposição ocupacional a material biológico contaminado pelo HIV, traz a revisão dos potenciais efeitos adversos das drogas antirretrovirais que compõem o esquema profilático preconizado pelo Ministério da Saúde e discute a conduta do médico do trabalho diante dessas complicações.

Occupational exposure to biological materials involving risk of human immunodeficiency virus (HIV) transmission is a medical emergency. Post-exposure prophylaxis (PEP) should be started early and administered for 28 days. Since July 2015, the Brazilian Ministry of Health recommends the combined use of three antiretroviral drugs for PEP, which are less toxic and better tolerated than the ones previously used. Nevertheless, almost half of the exposed individuals under PEP exhibit adverse effects, which are usually mild and self-limited. The most frequent adverse events are gastrointestinal disorders, asthenia, headache and dizziness. However, more severe events have been reported, and the rate of non-completion of prophylaxis remains high. In 2017, the Brazilian Ministry of Health modified the first-line PEP regimen involving replacement of the third antiretroviral drug. The present article reports a case of toxicity associated with PEP following an occupational accident involving exposure to HIV infected biological material. In addition, we review the potential adverse effects of antiretroviral drugs included in the prophylactic regimens recommended by the Brazilian Ministry of Health and discuss measures occupational physicians should adopt vis-à-vis these complications

Exposure to occupational hazards for pregnancy and sick leave in pregnant workers: a cross-sectional study

BACKGROUND: This study aimed to investigate the association between exposure to occupational hazards for pregnancy and sick leave (SL) in pregnant workers. METHODS: A cross-sectional study was performed in French occupational health services in 2014. Occupational hazards for pregnancy were assessed by occupational health physicians (OHPs). After delivery and at the time of returning to work, 1,495 eligible workers were interviewed by OHPs. Information on SL was self-reported. Risk ratios (RRs) were calculated from multivariable analyses based on a generalized linear model with a Bernoulli distribution and a log link adjusted for selected confounders for binary outcomes or zero-inflated negative binomial regression for count outcomes. RESULTS: Among recruited workers, 74.9% presented “at least one SL” during pregnancy. After adjustment, the cumulative index of occupational hazards (0, 1–2, 3–4, ≥ 5 risks) for pregnancy was significantly associated with “at least one SL” during pregnancy in a dose–response relationship. This gradient was also observed with “early SL” (<15 week gestation): from 1 to 2 risks, RR = 1.48 (95% confidence intervals (CIs): 0.92-2.38); from 3 to 4 risks, RR = 2.03 (95% CI: 1.25-3.30); equal to or higher than five risks, RR = 2.90 (95% CI: 1.89-4.44); with “duration of absence” (adjusted mean): from 1 to 2 risks, m = 38.6 days; from 3 to 4 risks, m = 46.8 days; equal to or higher than five risks, m = 53.8 days. We also found that deprivation, pregnancy at risk, assisted reproductive therapy, work-family conflicts, home-work commuting felt as difficult and young age are associated with a higher risk of SL. CONCLUSIONS: Our results support the assertion that pregnant workers exposed to occupational hazards for pregnancy without medical complications are also at risk of taking SL during pregnancy. More prevention in the workplace for pregnant workers exposed to occupational hazards could reduce SL.

Álcool e drogas no trabalho: conhecimento do candidato ao título de especialista em medicina do trabalho em relação ao tema / Alcohol and drug use at work: required knowledge for the title of specialist in occupational medicine

Contexto: O conhecimento teórico do médico do trabalho em relação ao gerenciamento dos casos de uso, abuso e dependência de álcool e drogas no local de trabalho é um fator preocupante, tendo em vista o grande crescimento desta prática no Brasil. Objetivos: O presente artigo visa avaliar o conhecimento dos médicos do trabalho sobre o tema, objetivando ações de melhoria nesta área de atuação. Tais ações podem ser realizadas pelos cursos de formação e por instituições ligadas à área. Métodos: Foi realizada uma questão aberta em relação ao tema na Prova de Título de Especialista em Medicina do Trabalho de 2012, cujos resultados foram estudados e discutidos através de metodologia de correção desenvolvida pelos autores. Resultados: A média de conhecimento sobre o tema ficou em 4,26, em uma escala de 0 a 10. Conclusões: O estudo sugere que o conhecimento pericial sobre o tema é precário, exigindo urgentemente ações das instituições formadoras e demais órgãos em relação a este grande problema que ocorre na prática diária.

Context: Theoretical knowledge of the occupational physician on the management of cases of use, abuse and dependence on alcohol and drugs in the workplace is a concern, given the strong growth of this practice in Brazil. Objectives: This article aims to assess physicians' knowledge on the subject, seeking improvement actions in this field. Such actions can be achieved by training courses and institutions related to the field. Methods: An open question on the topic was included in the Test for Certification in Occupational Medicine, 2012, the results of which have been studied and discussed using a correction methodology developed by the authors. Results: The average knowledge on the subject was 4.26 on a scale from 0-10. Conclusions: The study suggests that the expert knowledge on the subject is precarious, requiring urgent educational actions from institutions and other bodies in relation to this major problem that occurs in daily practice.

Implantação do Núcleo de Atenção à Saúde e à segurança do Trabalhador (NASST) / Implementation of the Center for Attention to Health and Safety of Workers (NASST)

Apresenta diretrizes para a Implantação do Núcleo de Atenção à Saúde e à segurança do Trabalhador (NASST) no Estado do Tocantins. Apresenta ainda fluxo para retirada de EPIS, atribuições dos Médicos e Enfermeiro do Trabalho conforme a Instrução Técnica, recebimento de Atestados Médicos e outros.

It presents guidelines for the implementation of the Center for Attention to Health and Safety of Workers (NASST) in the State of Tocantins. It also has a flow for withdrawing EPIS, duties of doctors and occupational nurses according to the Technical Instruction, receipt of medical certificates and others.

Presenta lineamientos para la implementación del Centro de Atención a la Salud y Seguridad de los Trabajadores (NASST) en el Estado de Tocantins. También cuenta con un flujo de retiro de EPIS, deberes de médicos y enfermeras ocupacionales de acuerdo con la Instrucción Técnica, recepción de certificados médicos y otros.

Il présente des lignes directrices pour la mise en œuvre du Centre d'attention à la santé et à la sécurité des travailleurs (NASST) dans l'État de Tocantins. Il dispose également d'un flux pour retirer l'EPIS, les devoirs des médecins et infirmiers du travail selon l'instruction technique, la réception des certificats médicaux et autres.

El papel de la adaptación como generadora de satisfacción laboral en médicos de salud ocupacional / The role of adaptation as generator of job satisfaction in occupational health doctors

OBJETIVO: analizar la construcción teórica del concepto de satisfacción laboral a través de la percepción de la adaptación al puesto de trabajo en médicos de salud ocupacional. MÉTODO: se aplicó la teoría fundamentada, utilizando el muestreo teórico propositivo hasta la saturación teórica. La muestra se integró con diez médicos dedicados a la salud ocupacional en la ciudad de México, durante el 2014. Se aplicaron entrevistas a profundidad y los datos obtenidos fueron analizados con el software Atlas-ti, dando como resultado códigos que se integraron en categorías, con las cuales se generó la teoría. RESULTADOS: Mis motivos de elección, Cambié de vida, y Oportunidades y proyectos fueron las categorías emergentes con las cuales se integró la dimensión de Adaptación al puesto de trabajo como elemento básico de la construcción teórica de la satisfacción laboral de los médicos de salud ocupacional. CONCLUSIONES: La satisfacción laboral en los médicos de salud ocupacional se presenta conforme se da su adaptación al puesto de trabajo, pues no existe desde el inicio de su vida laboral en el área, sino que se va generando conforme van aprendiendo y cambiando de actitud con respecto al trabajo.

OBJECTIVE: to analyze the theoretical construction of job satisfaction's concept through the adaptation to the job's perception in occupational health physicians. METHOD: it was applied the grounded theory, using proactive until theoretical saturation theoretical sampling. The sample was composed of ten physicians dedicated to occupational health in Mexico city, during the 2014. In-depth interviews were applied and the data obtained were analyzed with the software Atlas-ti, giving as a result: codes, which were integrated into categories, with which the theory was generated. RESULTS: My reasons for choice, I changed my life, and Opportunities and projects were the emerging categories with which joined the dimension of Adaptation to the post, as a basic element of the theoretical construction of the job satisfaction of occupational health physicians. CONCLUSIONS: Job satisfaction in occupational health physicians is presented as its adaptation to the job. It did not exist since the beginning of their working lives in the area, but it was generated as they learned and changed the attitude towards the work.

Propuesta para valorar aptitud en las evaluaciones médicas ocupacionales / Proposal to assess occupational medical evaluations

Los médicos ocupacionales determinan la aptitud laboral de los trabajadores a partir de la realización o revisión de los exámenes médicos ocupacionales para las empresas. Actualmente, el resultado en términos de aptitud está basado más en el sentido común que en el razonamiento científico. Ello debido a la falta de difusión adecuada de los derechos de las personas, a la incipiente aplicación de la Medicina basada en evidencia en la Medicina Ocupacional y del Medio Ambiente, a la falta de una valoración de las capacidades funcionales del trabajador según lo riesgos del trabajo (profesiogramas) y a la diversidad de criterios empresariales, entre otras. Por lo tanto, es necesario una secuencia de criterios asociados a la legislación, a los clínicos ocupacionales, la evaluación del puesto de trabajo y las decisiones empresariales para asegurar la construcción del sustento para una decisión que puede afectar el futuro laboral de las personas. Si bien es cierto, los próximos protocolos o documentos técnicos asociados a la vigilancia de la salud de los trabajadores ayudarán a mitigar la actual situación, la decisión de brindar aptitud laboral siempre será consecuencia del análisis integral de los criterios propuestos...

Occupational physicians determine the fitness for work through occupational medical evaluations. Currently, the results are based more on common sense than decisions by scientific methodology. It is due inadequate diffusion of Human Rights, the emerging evidence-based medicine applied to the Occupational Medicine and Environment, the acknowledgment of assessment of the functional capacity of workers and workplace hazards and the business decisions, among others. Therefore, we propose a sequence associated with the legislation, the occupational based in clinical evidence, the assessment of risk at the workplace and the business decisions to support the medical decision that can affect the future employment of people...

Doctors' views on the quality of claims provided by pharmaceutical representatives: a comparative study in Malaysia and Australia

Objectives: Doctors perceive the interactions with pharmaceutical representatives as professionally appropriate. However, studies have shown that the interaction is associated with less rational prescribing of medications. No previous study has assessed doctors' opinions of the presentation of pharmaceutical representatives and the quality of claims provided to the doctors in Australia and Malaysia. The aim of this study was to compare the opinions of Australian and Malaysian doctors of sales explanations and quality of claims provided by the pharmaceutical representatives

Methods: We recruited samples of primary care doctors in Australia and Malaysia to evaluate pharmaceutical sales visits. After a visit, doctors were asked to fill out a questionnaire on the main product and claims discussed during the visit. Descriptive statistics were employed, and Chi-square analysis and clustered linear regression were used to assess differences between doctors from both countries

Results: The majority of doctors reported that the presentations were convincing as well as likely to change their prescribing habits and improved their knowledge. The majority of marketing claims recorded by doctors in Australia and Malaysia were classified as vague claims. Approximately one-third of the claims were unambiguous [Australia 31% and Malaysia 33%]. In a majority of the presentations [Australia, 65%, Malaysia, 84%], doctors indicated that the primary claims by the pharmaceutical representatives were entirely or nearly accurate

Conclusions: Doctors in Australia and Malaysia held generally positive views of the presentations of pharmaceutical representatives, although the information being presented varied

A Call for Action to Improve Occupational Health and Safety in Ghana and a Critical Look at the Existing Legal Requirement and Legislation

Occupational health and safety (OHS) is a broad field of professional practice, which involves specialists from different disciplines including but not limited to engineers, occupational health physicians, physical and biological scientists, economists, and statisticians. The preventive systems required to ensure workers are protected from injuries and illnesses dwell heavily on engineers; however, the extent to which the engineer can go regarding planning and implementing preventive measures is dependent on specific legal requirements, leadership commitment from the company, organization, and nation. The objective of this paper is to identify the areas of opportunities for improvements in OHS management in Ghana with regard to the nation's legal requirements, commitment of the Ghana government, and Ghanaian leadership as well as appropriate structuring of Ghanaian institutions responsible for monitoring and managing OHS in Ghana. This paper identified Ghana's fragmented legal requirements concerning OHS, which are under different jurisdictions with unclear responsibilities and accountabilities. The paper also highlights the training needs of Ghanaian academic institutions regarding OHS. Among other recommendations made including structuring of Ghanaian institutions to manage OHS in line with the ILO-OSH 2001, this paper aligns the recommendations with the articles and elements of International Labour Organization convention number 155 and OHSAS 18001 elements.

Emerging Zoonoses: the "One Health Approach"

Zoonoses represent a public health risk recently pointed out by the spreading of previously unknown human infectious diseases emerging from animal reservoirs such as severe acute respiratory syndrome and avian influenza caused by H5N1-virus. These outbreaks have shown that animal breeding activities can pose a significant public health risk. Until now, the risk of zoonoses has probably been underestimated, particularly in occupational settings. The emergence or re-emergence of bacterial (Mycobacterium bovis and Brucella spp) or viral (hepatitis E virus) infections shows that zoonoses should be considered as emerging risks in agricultural and animal breeding and should be addressed by specific preventive interventions. Close cooperation and interaction between veterinarians, occupational health physicians and public health operators is necessary, for a worldwide strategy to expand interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. This is what the One Health Approach was intended to be.

Será posible la formación ética y profesional de médicos y especialistas en el sistema de salud actual?: [editoriales] / Would the ethical and professional training of physicians and specialist be possible under the current health care system?: [editorial]

La profesión médica enfrenta hoy un enorme reto ante los cambios en los sistemas de salud en diversos países, y Colombia no es la excepción. El bienestar del paciente, que debería ser la prioridad, se ve amenazado por las exigencias del sistema, que impone restricciones de tiempo y fracciona el cuidado del enfermo entre diferentes actores...

Comparison of ergonomic risk assessment outputs from rapid entire body assessment and quick exposure check in an engine oil company

During the last decades, to assess the risk factors of work-related musculoskeletal disorders [WMSDs], enormous observational methods have been developed. Rapid Entire Body Assessment [REBA] and Quick Exposure Check [QEC] are two general methods in this field. This study aimed to compare ergonomic risk assessment outputs from QEC and REBA in terms of agreement in distribution of postural loading scores based on analysis of working postures. This cross-sectional study was conducted in an engine oil company in which 40 jobs were studied. All jobs were observed by a trained occupational health practitioner. Job information was collected to ensure the completion of ergonomic risk assessment tools, including QEC, and REBA. The result revealed that there was a significant correlation between final scores [r=0.731] and the action levels [r =0.893] of two applied methods. Comparison between the action levels and final scores of two methods showed that there was no significant difference among working departments. Most of studied postures acquired low and moderate risk level in QEC assessment [low risk=20%, moderate risk=50% and High risk=30%] and in REBA assessment [low risk=15%, moderate risk=60% and high risk=25%]. There is a significant correlation between two methods. They have a strong correlation in identifying risky jobs, and determining the potential risk for incidence of WMSDs. Therefore, there is possibility for researchers to apply interchangeably both methods, for postural risk assessment in appropriate working environments

Development of Quality Assessment Domain and its Priority in Korea's Occupational Health Services: A Special Health Examination / 대한산업의학회지

OBJECTIVE: The purpose of this study was to develop a quality assessment domain and to determine its priority in Korea's Occupational Health Services. METHODS: We designed the study in a 3 phase approach. The first phase of the process encompasses making a list of measures for quality assessments by a thorough review of the literature. The second phase emcompassed the development of inclusion and priority criteria. The third phase of survey development was conducted during August 2008 and a questionnaire was administered to occupational health physicians covering 58 subjects. RESULTS: Finally we investigated 40 quality assessment measures, including 2 for structural domain, 17 for process domain, 21 for result domain in occupational health service. The 40 quality assessment measures divided into 2 parts. The early quality assessment part was 14 measures that including 8 measures for process domains and 5 measures for result domains. CONCLUSION: We investigate a quality assessment domain and determined the priorities of the occupational health service in Korea.

A eletricidade e o médico do trabalho / The electricity and the occupational medical

A eletricidade é a mais versátil forma de energia conhecida. Seu uso transformou a civilização atual. A palavra eetricidade vem do grego elektron, que significa âmbar. Thales, na antiga Grécia, ao friccionar um pedaço de âmbar, verificou que este passou a atrair pedaços de pena e tecidso. O inglês William Gilbert (1544-1603) percebeu que outros cristais e pedras preciosas, quando friccionados passavam a se comportar como âmbar, atraindo pequenos pedaços de tecidos, penas e lascas de madeira, e deu a essas substâncias o nome de substâncias elétricas. Vários cientistas passaram a pesquisar a eletricidade, e a primeira aplicação prática para a humanidade foi a invenção do pára-raios por Franklin (1706-1790). Com a invenção da pilha eleétrica por Volta (1745-1827), pela primeira vez a eletricidade era produzida de modo contínuo. Faraday (1791-1867) e Henry (1797 - 1878), estudando o eletromagnetismo, demonstraram a possibilidade de transformar a energia mecânica em eletricidade com o dìnamo. Da mesma forma, a eletricidade também podia ser transformada em energia mecânica através do motor elétrico. Estavam lançados os pilares que modificaram intensamente o setor produtivo. Com o aumento vertiginoso do uso da eletricidade, foram construídas numerosas usinas hidrelétricas. Num mundo voraz por energia, novas maneiras de produzir eletricidade foram implementadas, como: utilização da biomassa, energia solar, eólica, nuclear e células de combustível. Com o uso maciço da eletricidade, a legislação teve que ser modificada para proteger usuários e trabalhadores. A nova redação da NR 10 dá ênfase à segurança e qualificação do trabalhador no que toca ao conhecimento das normas técnicas e noções de primeiros socorros às vítimas de acidentes com a eletricidade.

Proposta de mudança no ensino de toxicologia do médico do trabalho no Brasil, a partir da análise de erros cometidos por profissionais na condução de casos atendidos / Proposal of change in the teaching of toxicology of the occupational physician in Brazil, based on the analysis of errors made by professionals in the management of cases attended

Em um universo de centenas de casos envolvendo problemas de toxicologia ocupacional atendidos ao longo de 17 anos (1984 a 2001) por uma instituição governamental especializada em Saúde e Trabalho, foi constado que a grande maioria deles tinha sido anteriormente conduzido de forma equivocada pelos médicos do trabalho. Isto mostrou uma falha no ensino deste conhecimento a estes profissionais, e a partir deste fato, o ensino de toxicologia para os médicos, e especialmente para os médicos do trabalho, foi estudado, assim como os conceitos fundamentais das boas práticas da toxicologia ocupacional. A fim de se propor maneiras objetivas de melhoria dos cursos, foram analisados em profundidade dez casos extraídos do universo existente através do método qualitativo de estudos de casos, muito utilizado na área de educação, e a partir da compreensão das causas que levaram aos conceitos equivocados, e que tiveram suas conseqüências nos erros cometidos, foram elaboradas propostas de mudança da forma de se ministrar o conhecimento de toxicologia aos médicos do trabalho no Brasil

In a universe of hundreds of cases related to occupational toxicology, assisted over 17 years (from 1984 to 2001) in a governmental institution specialized in Occupational Health, it was observed that the great majority of them had been inadequately managed by the occupational physicians previously. This fact showed a flaw in the knowledge to these professionals. Based on this finding, a study was designed to evaluate the teaching of toxicology for physicians, particularly occupational physicians, as well as to assess the essential concepts of the good practices of occupational toxicology. In order to suggest objective measures to improve the courses, ten cases were deeply analyzed using a case study, a qualitative research methodology frequently used in the Education area. Based on the understanding of the causes responsible by the equivocal concepts, a set of proposals for changing the teaching of toxicology to occupational physicians in Brazil has been created.

A visão do médico do trabalho: leucopenias ocupacionais: incapacidade versus agravamento / The vision of workplace physician: occupational leucopenias: incapacity versus aggravation

Neste relato, apresento a visão do médico do trabalho em relação as leucopenias ocupacionais, da necessidade do hematologista na avaliação dos casos e participantes da equipe multiprofissional de vigilâncias das condições ambientais de trabalho.