Sources of occupational stress in NSW and ACT dentists.

BACKGROUND: This study aimed to identify and understand the chronic sources of work stress in the NSW and ACT dentistry context. Further, the study examines whether Australian dentists are exposed to similar sources of work stress as dentists internationally. METHODS: A purposive sample of registered members of the NSW Branch of the Australian Dental Association (ADA) were interviewed. Participants were selected because they represented the key characteristics of the broader ADA population. Interviews were recorded and fully transcribed. Themes were identified, developed, refined and clarified using established and rigorous methods of interview investigation and analysis. RESULTS: A total of 18 dentists participated in the study. Inductive content analysis was used to develop six main categories of chronic sources of stress. These groupings were time and scheduling pressures, professional concerns, patient/public perceptions of dentists, staffing problems, pressures associated with treating patients and business process stressors. CONCLUSIONS: Like their international counterparts, Australian dentists are subject to a variety of job-specific stressors. However, the most notable difference between Australian and international dentists relates to the business side of dentistry. It would appear that the Australian statutory, regulatory and industrial relations environment place unique and profound pressures on Australian dentists.

Unified fitness report for the workplace.

Fitness statements often are required of physicians by patients, employers, governmental agencies, and insurance providers to determine if the patient is fit for duty. Physicians making these ability statements are legally obligated to carefully justify them when placing or excluding individuals from the workplace. The Americans with Disabilities Act (ADA) mandates that medical providers use justifiable criteria and rational thought when determining the capability and risk of an individual. This chapter reviews the legal requirements of the ADA for employers and physicians and presents a uniform methodology that both can use to determine the performance capability of an individual with a temporary or permanent impairment or disability.

Functional ability assessment: guidelines for the workplace.

Short- and long-term disability certification is required in all Western countries for extended time away from work. The Americans With Disabilities Act mandates that medical providers use rational thought and justifiable criteria when evaluating an employee's "fitness for duty". In order to facilitate employment/disability decisions, physicians must now serve as an advisor to the employer. Both the employer and the physician are legally obligated to carefully justify any recommendations for placement or exclusion from the workplace. We propose a uniform methodology that both physicians and employers could use together to determine the performance capability of an individual with a temporary or permanent impairment or disability in terms of essential job functions as defined under the Americans With Disabilities Act.

Fitness for duty considerations in disabling occupational low-back pain.

Individuals who develop a work or non-work-related medical condition in the course of employment generally recover and return to full-duty status. There are, however, a small number who develop chronic diseases, delayed recovery syndromes or other similar disabling conditions. These difficult situations raise the question of whether the individual continues to be a qualified employee for the job he/she was hired to perform. Workers who develop stationary medical conditions with residual impairment, functional limitations, chronic pain syndromes or permanent medical restrictions represent significant medical, legal and ethical challenges for the treating or evaluating physician as well as the employer. Occupational low-back pain (OLBP) is not only one of the most commonly encountered of these type of conditions in the industrial setting, but also represents a significant disability challenge when material handling activities are considered essential functions of the job. This paper presents an appropriate medical, legal and ethical approach to identifying workers with OLBP risk and assisting the employer in either matching them to essential functions of jobs they may be qualified to hold or moving them into an appropriate disability pathway.

Chronic, recurrent low back pain. A methodology for analyzing fitness for duty and managing risk under the Americans with Disabilities Act.

Chronic, recurrent low back pain, although one of the most commonly encountered medical conditions in the workplace, is one of the most difficult to manage. With the passage of the Americans with Disabilities Act, the proper management of the worker with recurrent low back pain poses an even greater challenge. We propose an interdisciplinary methodology to evaluate the worker at high medical risk of recurrent low back pain and determine the potential ergonomic risks of essential function tasks in material-handling work. The proposal considers the ethical and legal liabilities of risk assessment and fitness for duty evaluation that physicians, ergonomists, attorneys, and ultimately business managers and supervisors experience in balancing the societal interests represented by the Americans with Disabilities Act.

Medication reporting in the workplace.

Impairment from medication use in hazardous work environments has not been well studied. We analyzed incident events in an explosive manufacturing facility using a retrospective case control study to determine whether medication use was related to safety incidents. Medication use between the incident group and the controls was not significantly different. However, 23% of the incident group had been employed by the facility for less than 1 year compared with 2% of controls. Only 19% of restricted medication use was self-reported. In this study, being employed less than 1 year was a greater predictor of safety incidents than was medication use, and self-reporting did not reflect actual medication use. We conclude that medication use is not directly related to safety events and that a self-reporting program is difficult to justify in the corporate setting.

Arsenic levels in fingernails as a biological indicator of exposure to arsenic.

The analysis of urine, blood, and hair has been used previously to monitor occupational exposure to arsenic (As). Although arsenic is normally present in human fingernails (usually as a result of dietary factors), this study evaluated the potential use of levels of arsenic in fingernails as a biological indicator of occupational exposure to this element. Air samples and fingernail clippings were obtained from individuals with no exposure and high, medium, and low exposure. A washing technique, previously developed to remove exogenous arsenic from hair, was modified to wash the fingernail samples collected in this study. It was demonstrated that 98% of exogenous arsenic was removed from these nails. A high correlation coefficient (r = 0.89) was observed in a comparison of the mean air arsenic concentrations of each exposure group with corresponding arsenic levels in fingernails. From the data collected, an equation was derived to estimate the air arsenic exposure level for a worker from the arsenic content of fingernails: air arsenic concentration (micrograms As/m3) = 1.79 x fingernail arsenic level (micrograms As/g nail)-5.9.

Quantitative muscle strength testing: a comparison of job strength requirements and actual worker strength among military technicians.

In this study the authors investigate the percentage of mismatch between job demands and worker physical capacity in Utah National Guard mechanics. This population had demonstrated a higher incidence of low back trouble than other job descriptions reviewed. The authors utilized onsite still and videotape photography and a computerized biomechanical strength prediction model to assess loads on the lumbosacral spine due to various job tasks. Job demands were then compared to the actual physical capacity of the individual workers based on static strength testing in job-related positions. A load cell on the testing apparatus entered the force generated into a computer which averaged the force of the last three seconds of a five-second lift. It was determined that as much as a 38% mismatch existed within this population for some job tasks which these workers were exposed to. Suggestions for preventing job-related low back cumulative trauma disorders are presented, including: engineering redesign, worker selection programs, work hardening, and others.

Respiratory effects of mesquite broiling.

Mesquite wood charcoal has been widely promoted for the unique taste it imparts to broiled food. We recently examined a 21-year-old mesquite broiler cook with evidence suggestive of respiratory allergy or irritation following exposure to mesquite broiler smoke in a Salt Lake City restaurant. We subsequently surveyed 13 mesquite and 17 gas-flame ("charcoal") broiler cooks to determine the prevalence of respiratory symptoms among workers exposed to broiler smoke. The survey demonstrated statistically significant (P less than or equal to .05) respiratory irritation in the mesquite broiler group compared with the gas-flame broiler group in one of four symptom categories. Two other symptom categories strongly suggested the presence of (P less than .10) respiratory irritation in the mesquite broiler group. Personal air sampling was conducted or two mesquite broiler cooks and two gas-flame broiler cooks and compared. Unidentified saturated and unsaturated aliphatic hydrocarbons (C8 through C12) with high molecular weights from 108 to 182 were present in air samples from the mesquite broiler cooks and not in the air samples from the gas-flame broiler cooks.

Pneumoconiosis and exposures of dental laboratory technicians.

One hundred and seventy-eight dental laboratory technicians and 69 non-exposed controls participated in an epidemiological respiratory study. Eight technicians who had a mean of 28 years' grinding nonprecious metal alloys were diagnosed as having a simple pneumoconiosis by chest radiograph. Mean values for per cent predicted FVC and FEV1 were reduced among male nonsmoker technicians compared to male nonsmoker controls; after controlling for age, there was also a reduction in spirometry with increasing work-years. An industrial hygiene survey was conducted in 13 laboratories randomly selected from 42 laboratories stratified by size and type of operation in the Salt Lake City, Utah metropolitan area. Personal exposures to beryllium and cobalt exceeded the Threshold Limit Values (TLVs) in one laboratory. Occupational exposures in dental laboratories need to be controlled to prevent beryllium-related lung disorders as well as simple pneumoconiosis.

Reversible beryllium sensitization in a prospective study of beryllium workers.

Chronic beryllium disease is a granulomatous and fibrotic pulmonary disorder with increased numbers and percentage of lymphocytes in bronchoalveolar lavage fluid similar to that found in hypersensitivity pneumonitis. Blastogenic lymphocyte transformation (LT) to beryllium salts has been described in lavage and blood lymphocytes in patients with chronic beryllium disease. We conducted a 3-yr prospective study to evaluate the relationship between LT and beryllium exposure and pulmonary changes consistent with chronic beryllium disease. There were 15.9% (13/82) positive LTs in 1979 and 8.2% (5/61) in 1982. Of 11 positive LTs in 1979, 8 were negative in 1982, concomitant with a significant reduction in exposure. A positive LT was not associated with reduced pulmonary function, and no radiographic changes consistent with beryllium disease were identified. We propose that LT in beryllium workers is related to exposure and is reversible when exposure levels are reduced through diligent industrial hygiene measures.