Professional diver routine health surveillance and certification: an internet-based satisfaction survey of New Zealand divers.

INTRODUCTION: Professional divers, like many other specialised occupational groups, are subject to regulatory constraints that include mandatory initial medical certification and routine recertification. The New Zealand system of diver certification and health surveillance has undergone modifications in recent years, but its acceptance among end-users has never been formally assessed. Because of the wide variety of tasks, circumstances and personalities encountered in the diving industry, unanimous satisfaction is an unrealistic expectation, but establishing the current mood of divers in this regard and canvassing opinions on possible improvements is an important step towards optimising the certification process. METHOD: A multi-choice satisfaction questionnaire was added, as a quality assurance measure, to the on-line health questionnaire completed annually by all New Zealand professional divers. A complete 12-month dataset was analysed to determine levels of satisfaction, areas of dissatisfaction and suggestions for improvement. Comparison of the opinions of various diver groups was achieved by stratification into employment-type sub-groups and those working locally, overseas or both. RESULTS: The responses of 914 divers who completed the survey established an 85% satisfaction rate with the existing diver certification system. Dissatisfaction was independent of diving locality. Compliance cost was the most common area of dissatisfaction, particularly among recreational diving instructors. CONCLUSIONS: Most New Zealand professional divers consider the current certification system satisfactory. Effective communication between the regulating authority and divers was identified as an important area for further development.

Outdoor workers' perceptions of the risks of excess sun-exposure.

OBJECTIVES: To describe the pattern of associations with sunscreen use of sun protection attitudes and knowledge in a large sample of New Zealand outdoor workers. We also examined the relationship between perceived skin type and perceived risk of developing skin cancer. METHODS: Outdoor workers from nine occupational groups (n=1,131) completed a questionnaire, which included measures of skin cancer related risk perceptions, knowledge and sunscreen use. RESULTS: Sunscreen use was associated with perceived prioritization of sun-protection, concern about sun-exposure, knowledge about the effects of sun-exposure and perceived supportive workplace culture. These variables accounted for 37% of the variation in sunscreen use. Maori, younger workers and forestry workers least likely to report sunscreen use and sun-exposure risk perception. CONCLUSIONS: Interventions that strengthen knowledge about risks and values of sun protection are likely to increase sun protection efforts. However, interventions for outdoor workers need to take into account potential socio-demographic, personal and workplace influences are required to prevent the risk of developing non-melanoma skin cancers within this population group.

On solutions to the shortage of doctors in Australia and New Zealand.

The World Health Organization estimates a current global shortage of 4.3 million health workers. Australia and New Zealand compare unfavourably with other Organisation for Economic Co-operation and Development (OECD) countries in respect to doctor numbers. The overall shortage of doctors in Australia and New Zealand is exaggerated by the disciplinary, cultural and demographic maldistribution of the doctors relative to need and utility. Australia and New Zealand are the most reliant of the OECD countries on foreign doctors. An increase in spending on health promotion and disease prevention is essential. However, it is unlikely that the demand for doctors will be significantly reduced by compressions of morbidity in the later years of life or that there will be a substantive increase in either the percentage of the community employed in health services or in the output from the current workforce. Doctor shortages are better addressed by alignment of elements of the education and health systems with each other and with patient care needs, and by innovative health provider training and employment.

The long-term effects of compressed gas diving on lung function in New Zealand occupational divers: a retrospective analysis.

OBJECTIVES: Long-term effects of occupational diving on lung function are uncertain. No previous study has been conducted on New Zealand occupational divers. The aim of this study was to investigate changes in divers' lung function over a five year period. METHODS: The lung function data of all occupational divers with two spirometric determinations separated by a five year interval (N = 336 out of 1,475 currently registered divers) were entered into a database and analysed for changes (5.6 years mean). The trends were correlated against gender, smoking status and years of diving experience (as more accurate diving exposure data were not available). Spirometric indices were compared with predicted reference values derived from New Zealand (WRS), Australian (Gore), and American (NHANES III and Knudson) populations. RESULTS: Small, but signifi cant, decreases were found in FEV1 (0.27% against predicted per annum, P = 0.02) and PEF (0.47% per annum, P = 0.04) using the NHANES III equations. No other changes in lung function parameters reached statistical significance (P < 0.05) using any of the four sets of prediction equations. No changes correlated significantly with reported years diving. CONCLUSION: Observed changes to occupational divers' lung function tests over 5.6 years were small and unrelated to years of diving, which might be due to a 'healthy worker effect'. Clinical relevance is unlikely, but this requires further evaluation. There was significant disparity in normative values derived from the four sets of prediction equations and there is some consequential concern about the ongoing utility of such surveillance of New Zealand professional divers.