RESUMEN

The Work Ability Index (WAI) is the most commonly used tool for evaluating work capacity. Self-assessments made by workers can be influenced by various occupational and emotional factors. We wanted to study the association of work-related factors, such as work annoyance, stress, overcommitment, job satisfaction, social support, and emotional factors, such as anxiety, depression, and happiness, with work ability, in a sample of 490 healthcare workers from an Italian public health company. A principal component analysis indicated the presence of two components of the WAI questionnaire; the first expresses "subjectively estimated work ability" (SEWA), and the second refers to "ill-health-related work ability" (IHRWA). Using stepwise multiple hierarchical linear regression, we identified the factors that best predicted the total score on the WAI and on the two components. The total score was negatively predicted by anxiety, depression, a lack of happiness, low job satisfaction, overcommitment, and work annoyance. Age, being female, anxiety, and occupational stress were associated with a reduction in the IHRWA component score, while overcommitment, work annoyance, a lack of social support, depression, and a lack of happiness were negatively associated with the SEWA component. These results can help interpret those of epidemiological studies and provide guidance on ways to improve work ability.

RESUMEN

The Work Ability Index (WAI) is the most widely used questionnaire for the self-assessment of working ability. Because of its different applications, shorter versions, and widespread use in healthcare activities, assessing its characteristics is worthwhile. The WAI was distributed online among the employees of a healthcare company; the results were compared with data contained in the employees' personal health records and with absence registers. A total of 340 out of 575 workers (59.1%) participated; 6.5% of them reported poor work ability. Exploratory factor analysis indicated that the one-factor version best described the characteristics of the WAI. The scores of the complete WAI, the shorter form without the list of diseases, and the minimal one-item version (WAS) had equal distribution and were significantly correlated. The WAI score was inversely related to age and significantly lower in women than in men, but it was higher in night workers than in their day shift counterparts due to the probable effect of selective factors. The WAI score was also correlated with absenteeism, but no differences were found between males and females in the average number of absences, suggesting that cultural or emotional factors influence the self-rating of the WAI. Workers tended to over-report illnesses in the online survey compared to data collected during occupational health checks. Musculoskeletal disorders were the most frequently reported illnesses (53%). Psychiatric illnesses affected 21% of workers and had the greatest impact on work ability. Multilevel ergonomic and human factor intervention seems to be needed to recover the working capacity of healthcare workers.

Asunto(s)

Asunto(s)

RESUMEN

The Recruit Assessment Program (RAP) is a cross-sectional, baseline survey of U.S. Marine recruits administered at Marine Corps Recruit Depot, San Diego. This report presents RAP study procedures and survey content that was administered to 229,015 participants between 2003 and 2021. Self-reported data were collected on recruit demographics, physical and mental health, adverse life experiences, lifestyle and risky behaviors, and substance use. In 2013, the survey was updated to remove questions with other linkable and reliable sources and those with low completion rates and low relevance to Marine health research; the removal of these items allowed for the addition of instrument measures for major depression, post-traumatic stress disorder, anger, and resilience with no significant change to overall survey length. Average completion rates are approximately 95%. Multiple studies have shown the utility of RAP data collected thus far as a robust data repository of pre-service health and behavioral measures.

Asunto(s)

RESUMEN

Uterine fibroids are the most common benign tumors of the uterus among women of reproductive age, disproportionally affecting non-Hispanic Black women compared to other races and ethnicities. This report is an update of a 2011 MSMR report that examined uterine fibroids among female active component service members in the U.S. Armed Forces from 2001 to 2010. Incident uterine fibroids were identified for this report from inpatient and outpatient medical encounter data from 2011 to 2022. Health care burden was estimated utilizing uterine fibroid-related inpatient and outpatient diagnostic and procedure codes. Crude incidence rates and incidence rate ratios were calculated to compare rate differences between subpopulations. A total of 16,046 new uterine fibroid cases were identified, with an incidence rate of 63.5 cases per 10,000 person-years (95% confidence interval: 62.5-64.5). The highest incidence rates were observed among service women 40 years and older, non-Hispanic Black women, and those who served in the Army. Health care burden analysis showed that, even with increases in medical encounters and individuals affected, the numbers of hospital bed days declined over time. The decline in uterine fibroid-related hospital bed days could be attributed to early diagnoses and minimally-invasive treatments. Continued promotion of uterine fibroid awareness can potentially help further reduce uterine fibroid-related impacts on military readiness.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

In Denmark, injunctions of "early" cancer diagnosis increasingly imply surveillance of small tissue changes, which may or may not develop into cancer. Based on fieldwork at diagnostic lung cancer clinics and with people in CT surveillance for tissue changes, I explore how detected tissue changes are ascribed meaning as signs of "nothing" or "something." Inspired by Peircean semiotics, I suggest that the semiotic indeterminacy of tissue changes points to how diagnostic socialities both expand medical semiotics and enable this expansion. The article, thereby, contributes to understandings of signs as diagnostic infrastructures.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Construction workers at U.S. Department of Energy (DOE) nuclear weapons facilities are screened to identify DOE-related occupational illnesses, including beryllium sensitization (BeS) and chronic beryllium disease (CBD). The study objectives were to estimate beryllium disease risks and the CBD claims acceptance rate in the energy workers' benefits program. METHODS: Workers diagnosed with BeS via beryllium lymphocyte proliferation test (BeLPT) included in screening examinations were interviewed about subsequent diagnosis of CBD. We estimated the proportion who developed CBD based on the ratio of CBD cases, based on self-reported compensation claim status, to all workers with BeS interviewed. We used stratified analyses to explore trends in disease frequency by age, race, sex, DOE employment duration, site, trade group, and cigarette smoking history. RESULTS: Between 1998 and 2020, 21,854 workers received a BeLPT; 262 (1.20%) had BeS (two abnormals or one abnormal plus one borderline test); 212 (0.97%) had a single abnormal BeLPT. Of 177 BeS workers interviewed, 35 (19.8%) reported an accepted CBD compensation claim. The claims acceptance rate among BeS workers increased with years of DOE employment, from 8.4% with <5 years to 33.3% for >25 or more years. Five of 68 interviewed workers with a single positive BeLPT reported CBD claim acceptance; an additional CBD case was confirmed by chart review (8.8%). CONCLUSIONS: Years of DOE work predict the risk of developing CBD among those sensitized and getting a claim for CBD accepted. Ongoing surveillance and increased awareness of the risk of beryllium exposure and CBD as an occupational disease among construction workers are needed.

Asunto(s)

RESUMEN

To improve the identification and management of viral respiratory infections, we established a clinical and virologic surveillance program for pediatric patients fulfilling pre-defined case criteria of influenza-like illness and viral respiratory infections. The program resulted in a cohort comprising 6,073 patients (56% male, median age 1.6 years, range 0-18.8 years), where every patient was assessed with a validated disease severity score at the point-of-care using the ViVI ScoreApp. We used machine learning and agnostic feature selection to identify characteristic clinical patterns. We tested all patients for human adenoviruses, 571 (9%) were positive. Adenovirus infections were particularly common and mild in children ≥1 month of age but rare and potentially severe in neonates: with lower airway involvement, disseminated disease, and a 50% mortality rate (n = 2/4). In one fatal case, we discovered a novel virus: HAdV-80. Standardized surveillance leveraging digital technology helps to identify characteristic clinical patterns, risk factors, and emerging pathogens.

RESUMEN

Headache is a very common condition that can have a significant impact on work. This study aimed to assess the prevalence of headaches and their impact on a sample of 1076 workers from 18 small companies operating in different sectors. The workers who volunteered to participate were asked to fill in the Headache Impact Test-6 (HIT-6) and answer questions designed to assess stressful and traumatic factors potentially associated with headaches. The volunteers subsequently underwent a medical examination and tests for diagnosing metabolic syndrome. Out of the 1044 workers who completed the questionnaire (participation rate = 97%), 509 (48.8%) reported suffering from headaches. In a multivariate logistic regression model, female gender, recent bereavement, intrusive leadership, and sleep problems were significantly associated with headaches. In univariate logistic regression models, headache intensity was associated with an increased risk of anxiety (OR 1.10; CI95% 1.09; 1.12) and depression (OR 1.09; CI95% 1.08; 1.11). Headache impact was also associated with the risk of metabolic syndrome (OR 1.02; CI95% 1.00, 1.04), obesity (OR 1.02, CI95% 1.01; 1.03), and reduced HDL cholesterol (OR 1.03; CI95% 1.01; 1.04). The impact of headache calls for intervention in the workplace not only to promote a prompt diagnosis of the different forms of headaches but also to improve work organization, leadership style, and the quality of sleep.

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: Numerous drugs pose harm to healthcare workers. Medical surveillance (MS) questionnaires often do not capture desired information. Social cognitive theory, plain language, and quality improvement were explored to design an MS questionnaire. The goal of this study was to pilot test an MS questionnaire assessing employees' hazardous drug (HD) exposures consistent with a 2016 public standard addressing safe handling of HDs in health care. METHODS: A cross-sectional study design was used to conduct qualitative analysis of questionnaire data collected from a convenience sample of three to five employees from each of the four departments at elevated risk of HD exposures in a large tertiary healthcare organization. Key research questions addressed employees' understanding of questionnaire items and interview completion rates. FINDINGS: Fourteen employees (oncology nurses, pharmacy technicians, housekeepers, and laundry workers) participated. None had participated in the organization's prior hazardous drug medical surveillance (HDMS) activities. For the surveillance process, employees preferred in-person interviews to emailed questionnaires. Challenges for questionnaire comprehension related to employees' basic skills of literacy and numeracy. CONCLUSION/APPLICATION TO PRACTICE: Strategies for ensuring employee comprehension of health and safety communications are critical. Questionnaires should be written in plain language employees can understand the first time it is read.

Asunto(s)

RESUMEN

OBJECTIVES: The objective of this investigation is to explore the utility of using a spot urine sample in lieu of a 24-hour collection in assessing fragment-related metal exposure in war-injured veterans. METHODS: Twenty-four veterans collected each urine void over a 24-hour period in separate containers. Concentrations of 13 metals were measured in each void and in a pooled 24-hour sample using inductively coupled plasma mass spectrometry. To assess the reliability of spot sample measures over time, intraclass correlations (ICCs) were calculated across all spot samples. Lin's concordance correlation coefficient was used to assess agreement between a randomly selected spot urine sample and each corresponding 24-hour sample. RESULTS: In total, 149 spot urine samples were collected. Ten of the 13 metals measured had ICCs more than 0.4, suggesting "fair to good" reliability. Concordance coefficients were more than 0.4 for all metals, suggesting "moderate" agreement between spot and 24-hour concentrations, and more than 0.6 for seven of the 13 metals, suggesting "good" agreement. CONCLUSIONS: Our fair to good reliability findings, for most metals investigated, and moderate to good agreement findings for all metals, across the range of concentrations observed here, suggest the utility of spot urine samples to obtain valid estimates of exposure in the longitudinal surveillance of metal-exposed populations.

Asunto(s)

RESUMEN

BACKGROUND: Despite the ban on the production of asbestos-containing materials, introduced in Poland over 20 years ago, new cases of asbestos-related diseases are still being recorded. Systematic control of respiratory function in people exposed to asbestos dust is, therefore, extremely important due to the biological properties of this mineral. MATERIAL AND METHODS: The Amiantus preventive medical examination program was undertaken in 2000 to implement the legal rights of former employees of asbestos processing plants for this type of examinations. People who have ever been employed in such factories have been authorized to use preventive medical examinations for the rest of their lives. The research is continuous, spread over time and focused, in particular, on the assessment of the respiratory system. RESULTS: Since the beginning of the program, throughout 20 years of its implementation, 8329 people have been examined, including 5199 (62.4%) men for whom a total of 34 454 medical examinations have been carried out. During the program period, the percentage of diagnosed pathologies increased from 8% in 2000 to 25% in 2019. Overall, 2078 asbestos-related diseases were diagnosed among former employees of asbestos processing plants under the Amiantus Program, which accounted for 25% of this group. Among all diseases caused by exposure to asbestos, the most common were: asbestosis (1880 cases - 90.5%), lung cancer (121 cases - 5.8%) and pleural mesothelioma (77 cases - 3.7%). Diseases of pleura in the form of plaques and diffuse pleural thickening were diagnosed in 40% of the examined patients, while radiological pulmonary shadows affected over 65% of former employees of asbestos processing plants. CONCLUSIONS: The Amiantus Program, thanks to the long observation period, enabled monitoring the health of former employees exposed to asbestos, and created a unique opportunity to carry out epidemiological analyzes. These studies allowed the authors to expand their knowledge of the natural history of asbestos-related diseases. Med Pr. 2020;71(5):595-601.

Asunto(s)

RESUMEN

SUMMARY: The thyroid gland is one of the most radiosensitive human organs. There are two major unwanted consequences from radiation to the thyroid in humans: hypothyroidism and neoplasia. In the system of dose limitation medical surveillance undoubtedly acquires obligations with regard to early tumor diagnosis (secondary prevention). On the basis of the risk coefficient of radioinduction of tumors established by international organizations, thyroidology should not be neglected. Following a wide range of doses of ionizing radiation, an increased risk of thyroid adenomas and nodules has been also observed in a variety of populations and settings, continuing for decades following exposure. Considerably less findings are available regarding functional thyroid disease including autoimmune diseases. In general, associations for these outcomes were fairly weak and significant radiation effect were most observed following high dose, particularly for hypothyroidism. Considerably less consistent findings are available regarding functional thyroid diseased including autoimmune diseases. The medical surveillance of exposed workers with thyroid pathology frequently involves delicate problems in particular concerning the differential diagnosis between benign and malignant nodules. In contrast to rare thyroid cancer, thyroid nodules are extremely common particularly among women. Thus, most thyroid nodules are benign, and it is important for a better outcome to identify those are likely to be malignant especially at an early stage. Therefore screening of all exposed workers is proposed since the beginning of their thyroid radiation exposure and an up to date diagnostic protocoI is discussed. As a consequence of this justified strategy of secondary prevention a huge amount of thyroid nodules, mostly benign, is found involving problems of management especially from the point of view of medical surveillance of radiation protection. In this paper the author: - 1) Discusses the issues and suggests an up to date approach to diagnosis and management of nodular and functional thyroid diseases - 2) Identifies conditions which representing particular problems require a more restrictive judgement of fitness - 3) Intends to demonstrate that the proposed diagnostic protocol conciliates with due economy providing the right balance between effectiveness and costs, the real requirement of medical surveillance, reducing as far as possible undesirable effects such as damage from excessive protection and patient/physician delay, which is extremely dangerous in the early diagnosis of tumors.

Asunto(s)

RESUMEN

Introduction: An infectious disease outbreak like the current COVID-19 pandemic can lead to particularly high infection rates in areas where diagnostic laboratory support is limited. The deployment of mobile laboratories can help to detect pathogens, monitor the presence in a population, and inform public health authorities to take measures aimed at reducing pathogen spread. Materials and Methods: Available layouts and operational descriptions of mobile laboratories were analyzed for their suitability for the envisioned purpose and to assure high standards of biosafety and biosecurity. Recent media coverage on creative solutions for the diagnostics of SARS-CoV-2 (drive-through test centers, self-swab, inverse gloveboxes to protect health care workers) from various countries were considered. Results: A minimalistic and optimized design to construct a multifunctional laboratory on the chassis of a regular-sized box truck is proposed and can serve as a blueprint to rapidly develop additional diagnostic capacities. Discussion: For acute health threats including the current COVID-19 outbreak, rapid diagnosis of infection is key to recommend measures aimed at preventing the spread of the pathogen. Laboratory layouts that are similar to the one proposed here are used in stationary setups, and mobile laboratories have been built on varying platforms (trailers, shipping containers, etc).

RESUMEN

RESUMEN Cuba organizó y desarrolló desde 1990 hasta 2011 un programa de atención médica integral masivo y gratuito destinado a niños de áreas afectadas por el accidente de Chernóbil. Este trabajo recoge los resultados finales de este programa, al cual estuvieron vinculados cientos de trabajadores de la salud y la ciencia en Cuba y que permitió, durante más de 21 años, que se trataran y rehabilitaran en la isla un total de 26 114 pacientes, el 84 % de los cuales eran niños, procedentes fundamentalmente de Ucrania, Rusia y Bielorrusia. Se presentan también otros aspectos de la colaboración médica desarrollada en territorio ucraniano, así como los resultados esenciales de la evaluación del impacto radiológico del accidente en los niños que recibieron asistencia médica en nuestro país.

ABSTRACT From 1990 till 2011, a free health care program for children from areas affected by the Chernobyl accident was organized and implemented by the Cuban Government.. A significant number of qualified personal in medicine and science collaborated with this program. The information gathered for more than 21 years and the conclusive results obtained in the program are presented here. During this time, 26 114 patients, 84 % children, mostly from Ukraine, Russia and Belarus were treated in the mentioned program. Other aspects of the Cuban medical assistance in Ukraine and the main results obtained in the radiological impact evaluation of the accident on the children treated in Cuba are also included.

RESUMEN

OBJECTIVES: Our objective was to monitor blood lead levels (BLLs) of miners and ore processors participating in a pilot programme to reduce lead poisoning and take-home exposures from artisanal small-scale gold mining. A medical surveillance programme was established to assess exposures as new methods aimed at reducing lead exposures from ore were introduced in a community in Nigeria where children experienced substantial lead-related morbidity and mortality. METHODS: Extensive outreach and education were offered to miners, and investments were made to adopt wet methods to reduce exposures during mining and processing. We conducted medical surveillance, including a physical exam and repeated blood lead testing, for 61 miners selected from among several hundred who participated in the safer mining pilot programme and consented to testing. Venous blood lead concentrations were analysed using the LeadCare II device at approximately 3-month intervals over a period of 19 months. RESULTS: Overall geometric mean (GM) BLLs decreased by 32% from 31.6 to 21.5 µg/dL during the 19-month project. Women had a somewhat lower reduction in GM BLLs (23%) compared with men (36%). There was a statistically significant reduction in log BLLs from baseline to the final test taken by each participant (p<0.001). CONCLUSIONS: The observed reductions in GM BLLs during the pilot intervention among this representative group of miners and ore processors demonstrated the effectiveness of the safer mining programme in this community. Such measures are feasible, cost-effective and can greatly improve health outcomes in mining communities.

Asunto(s)