Towards automated detection of psychosocial risk factors with text mining.

BACKGROUND: Psychosocial risk factors influence early retirement and absence from work. Health checks by occupational health nurses (OHNs) may prevent deterioration of work ability. Health checks are documented electronically mostly as free text, and therefore the effect of psychological risk factors on working capacity is difficult to detect. AIMS: To evaluate the potential of text mining for automated early detection of psychosocial risk factors by examining health check free-text documentation, which may indicate medical statements recommending early retirement, prolonged sick leave or rehabilitation. Psychosocial risk factors were extracted from OHN documentation in a nationwide occupational health care registry. METHODS: Analysis of health check documentation and medical statements regarding pension, sick leave and rehabilitation. Annotations of 13 psychosocial factors based on the Prima-EF standard (PAS 1010) were used with a combination of unsupervised machine learning, a document search engine and manual filtering. RESULTS: Health check documentation was analysed for 7078 employees. In 83% of their health checks, psychosocial risk factors were mentioned. All of these occurred more frequently in the group that received medical statements for pension, rehabilitation or sick leave than the group that did not receive medical statement. Documentation of career development and work control indicated future loss of work ability. CONCLUSIONS: This study showed that it was possible to detect risk factors for sick leave, rehabilitation and pension from free-text documentation of health checks. It is suggested to develop a text mining tool to automate the detection of psychosocial risk factors at an early stage.

Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study.

Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.

Health check documentation of psychosocial factors using the WAI.

BACKGROUND: Health checks in occupational health (OH) care should prevent deterioration of work ability and promote well-being at work. Documentation of health checks should reflect and support continuity of prevention and practice. AIMS: To analyse how OH nurses (OHNs) undertaking health checks document psychosocial factors at work and use the Work Ability Index (WAI). METHODS: Analysis of two consecutive OHN health check records and WAI scores with statistical analyses and annotations of 13 psychosocial factors based on a publicly available standard on psychosocial risk management: British Standards Institution specification PAS 1010, part of European Council Directive 89/391/EEC, with a special focus on work-related stress and workplace violence. RESULTS: We analysed health check records for 196 employees. The most frequently documented psychosocial risk factors were home-work interface, work environment and equipment, job content, workload and work pace and work schedule. The correlations between the number of documented risk and non-risk factors and WAI scores were significant: OHNs documented more risk factors in employees with lower WAI scores. However, documented psychosocial risk factors were not followed up, and the OHNs' most common response to detected psychosocial risks was an appointment with a physician. CONCLUSIONS: The number of psychosocial risk factors documented by OHNs correlated with subjects' WAI scores. However, the documentation was not systematic and the interventions were not always relevant. OHNs need a structure to document psychosocial factors and more guidance in how to use the documentation as a tool in their decision making in health checks.

Manual material handling advice and assistive devices for preventing and treating back pain in workers.

BACKGROUND: Training and assistive devices are considered major interventions to prevent back pain among workers exposed to manual material handling (MMH). OBJECTIVES: To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain. SEARCH STRATEGY: We searched MEDLINE to November 2005, EMBASE to August 2005, and CENTRAL, the Back Group's Trials Register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to September 2005. SELECTION CRITERIA: We included randomized controlled trials (RCT) and cohort studies with a concurrent control group, aimed at changing human behaviour in MMH and measuring back pain, back pain-related disability or sickness absence. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data and assessed the methodological quality using the criteria recommended by the Back Review Group for RCTs and MINORS for the cohort studies. One author of an original study supplied additional data for the review. The results and conclusions are based on the primary analysis of RCTs. We conducted a secondary analysis with cohort studies. We compared and contrasted the conclusions from the primary and secondary analyses. MAIN RESULTS: We included six RCTs (17,720 employees) and five cohort studies (772 employees). All studies focused on prevention of back pain. Two RCTs and all cohort studies met the majority of the quality criteria and were labeled high quality. We summarized the strength of the evidence with a qualitative analysis since the lack of data precluded a statistical analysis. There is moderate evidence that MMH advice and training are no more effective at preventing back pain or back pain-related disability than no intervention (four studies) or minor advice (one study). There is limited evidence that MMH advice and training are no more effective than physical exercise or back belt use in preventing back pain (three studies), and that MMH advice plus assistive devices are not more effective than MMH advice alone (one study) or no intervention (one study) in preventing back pain or related disability. The results of the cohort studies were similar to the randomised studies. AUTHORS' CONCLUSIONS: There is limited to moderate evidence that MMH advice and training with or without assistive devices do not prevent back pain, back pain-related disability or reduce sick leave when compared to no intervention or alternative interventions. There is no evidence available for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain.

Audit matrix for evaluating Finnish occupational health units.

OBJECTIVES: The aim of this article is to describe how an audit matrix for occupational health units was formulated, what the preliminary results tell about its applicability, and how the matrix can help to implement the principles of "good practice in occupational health services". METHODS: Twelve areas eligible for auditing were selected for the matrix. According to the recently issued principles of good practice, the principles of total quality management and continuous quality improvement, each area was divided into descriptions of 4 quality levels, the lowest being given 0 points and the highest 5-6 points. The maximum total score was 72 points. RESULTS: Of the 30 external audits, no unit had less than 18 points. Nine units had 19-36 points, 17 units had 37-54 points, and 4 units had over 54 points. "Maintenance of work ability" received the highest mean of the given points (4.1), followed by "curative care"(4.0) and "multidisciplinarity"(3.9). The lowest means were for "planning of activities" (3.1), "customer orientation"(3.2), and "quality improvement"(3.2). CONCLUSIONS: The audit matrix proved to be a practical method for auditing occupational health units, revealing both the most common flaws and strengths in the quality of Finnish occupational health services. Because the matrix has been accepted well by occupational health professionals and it manages to classify the units, it is probably a useful instrument for evaluating the performance of occupational health units and promoting good practice.

Ethical issues among Finnish occupational physicians and nurses.

A postal survey was conducted among 200 Finnish occupational physicians and nurses on their ethical values and problems. Both groups considered 'expertise' and 'confidentiality' as the most important core values of occupational health services (OHS) corresponding with newly published national ethical guidelines for occupational physicians and nurses in Finland. Nearly all respondents had encountered ethically problematic situations in their work, but ethical problems with gene testing in the near future were not considered likely to occur. Only 41% of the nurses and 36% of the physicians had received some training in the ethics of OHS, and 76% of all respondents never used available ethical guidelines. According to the results, even if ethics play a vital role in OHS, the ability to critically evaluate one's own performance seems quite limited. This creates a need for further training and more practicable national guidelines.

Occupational IgE-mediated rhinitis caused by ninhydrin.

Ninhydrin is a laboratory chemical used as a reagent in the detection of free amino and carboxyl groups in proteins and peptides. We present the case of a laboratory technician who developed symptoms of rhinitis when handling papers immersed in a solution containing ninhydrin. Prick tests for ninhydrin and ninhydrin RAST were positive. The inhalation provocation test in an exposure chamber gave an immediate nasal response. A positive prick test to ninhydrin, an elevated level of specific IgE antibodies to ninhydrin, and the RAST inhibition test confirmed an IgE-mediated type I allergic reaction. We are not aware of any other report of ninhydrin as a cause of IgE-mediated allergy.

Combined ulcerogenic effect of ethanol and acetylsalicylic acid on the gastric mucosa of the rat.

The effect on rat gastric mucosa of ethanol and acetylsalicylic acid given at two doses singly or in combination were studied by administering the drugs into the stomach. 40% ethanol alone caused many ulcerations after 5 h, and the effect was even more marked with simultaneous administration of acetylsalicylic acid (ASA). 10% ethanol and 50 mg ASA/kg b. wt. were tolerated well. The mucosal lesions consisted of coagulation necrosis and hemorrhages, with a disappearance of histamine and serotonin from the mucosal mast cells in and around the lesion.