Professional activity, information demands, training and updating needs of occupational medicine physicians in Italy: National survey

The challenges of managing patients with cancer in the workplace: Needs, opportunities and perspectives of occupational physicians

Cancer is a global major public health problem since it is a leading cause of death, accounting for nearly 10 million deaths in 2020 worldwide and the most recent epidemiological data suggested that its global impact is growing significantly. In this context, cancer survivors have to live for a long time often in a condition of disability due to the long-term consequences, both physical and psychological. These difficulties can seriously impair their working ability, limiting the employability. In this context, the occupational physician plays a key role in the implementation and enforcement of measures to support the workers affected by cancer, to address issues such as the information on health promotion, the analysis of work capacity and the management of disability at work and also promoting a timely and effective return to work and preserving their employability. Therefore, the aim of this study was to gather useful information to support the occupational physicians in the management of workers affected by cancer, through a survey on 157 Italian occupational physicians. Based on the interviewees' opinions, the most useful occupational safety and health professionals in terms of job retention and preservation of workers affected by cancer are the employers and the occupational physicians themselves, whose role is crucial in identifying and applying the most effective reasonable accommodations that should be provided to the workers affected by cancer. The provision of these accommodations take place on the occasion of mandatory health surveillance medical examination to which the worker affected by cancer is subjected when he returns to work. Results on training and information needs showed that the management of the workers affected by cancer is essentially centered on an appropriate fitness for work judgment and on the correct performance of health surveillance. However, an effective and successful management model should be based on a multidisciplinary and integrated approach that, from the earliest stages of the disease, involves the occupational physicians and employers.

Development of an interprofessional task-based learning program in the field of occupational health: a content validity study

OBJECTIVE

One of the duties of the educational system is to provide situations in which students learn the tasks corresponding to their future careers in an interprofessional team. This study was designed to develop an interprofessional task-based training program.

METHODS

This was a curriculum development study conducted by content validity methodology in two stages: 1) 'framework development' which resulted in the creation of the framework items; and 2) 'evaluation of the framework' (judgment and quantification). The first stage consisted of task identification, generation of sub-tasks, and assimilation of items into a usable format. The second stage consisted of the judgment -quantification of the content validity of items and the framework. After that, the framework of the tasks of the occupational health team was finalized in the expert panel. After explaining the tasks, a matrix for task-expected roles in the occupational health team and a matrix for task-required skills to perform each task were developed. The next step determined the appropriate teaching and assessment methods for each task. Finally, an expert panel reviewed and approved the components of the interprofessional task-based training program.

RESULTS

Integrating the interprofessional education strategy with task-based learning was considered innovative in occupational health team training. In the development stage, 48 items were extracted, and then 35 tasks were generated in the step of identification of tasks. In the second step, 174 sub-tasks were developed. The tasks and sub-tasks were categorized into seven areas. After the stage of evaluation of the framework, 33 tasks were categorized into seven main areas, including "assessment and identification of workplace hazards" (n = 10), "control of occupational hazards" (n = 4), "determining the appropriate job position for each person" (n = 3), "occupational health examinations" (n = 6), "management of occupational/work-related diseases" (n = 5), "inter-organizational and inter-disciplinary relations, and legal judgment" (n = 3) and "education and scholarship in occupational health services" (n = 2).

CONCLUSION

The results of the present study can be used in developing the use of the interprofessional strategy and task-based training as two appropriate strategies for the purposeful development of learners' abilities in the fields involved in providing occupational health services in their future careers.

Working Conditions of Occupational Physicians-A Scoping Review

Occupational physicians (OPs) offer a wide range of health support for employees and are confronted with varying job characteristics and demands. They monitor occupational health and safety and promote work(place)-related health measures and assessments. While helping employees to (re)gain a healthy status, their own job satisfaction as well as the investigation of their working conditions have earned limited research attention. Thus, this scoping review aims to summarize the current state of knowledge concerning OPs’ working conditions, i.e., work-related resources and stressors. PubMed, Web of Science and LIVIVO as well as grey literature were screened for relevant English or German articles until 10/2021. From a total of 1683 identified publications, we analyzed 24 full text articles that fulfilled all inclusion criteria. The overall study sample included 3486 male (54.6%), 2892 female (45.3%) and 5 diverse OPs, from which 1049 OPs worked in full-time (85.6%) and 177 in part-time (14.4%). The majority (72.4%) worked for the Occupational Health Service (OHS), 13% were self-employed, and 14.6% worked for a company/in-house service. The classification of stressors and resources was based on an inductively generated categorization scheme. We categorized 8 personal, relational and environmental resources and 10 stress factors. The main resources were support for personnel development and promotion, positive organizational policy, promoting work-life balance and other aspects of health. Key stressors were information deficits, organizational deficiency and uncertainty as well as socioeconomic influences and high professional obligations. The working conditions of OPs are still a topic with too little research attention. This scoping review reveals several starting points to maintain a healthy OP workforce and gives recommendations for action for the near future.

Workers’ health surveillance targeting mental health: evaluation of a training

Background

Mental health complaints occur frequently among healthcare workers. A workers’ health surveillance mental health module (WHS-MH) was found to be effective in improving work functioning of nurses, although not implemented regularly. Therefore, training for occupational physicians and nurses to facilitate the implementation of WHS-MH was developed and evaluated.

Aims

This study was aimed to evaluate the effect of training on knowledge, self-efficacy and motivation to implement WHS-MH, and to evaluate participants’ satisfaction with the training.

Methods

Three-hour training was held among 49 occupational physicians and nurses in the Netherlands. Effect on knowledge, self-efficacy and motivation was assessed using knowledge tests and questionnaires before and immediately after the training. Satisfaction with the training was measured using questionnaires after the training.

Results

A mean knowledge test score of 5.3 (SD = 1.6) was found before training, which did not significantly increase after training (M = 5.6, SD = 1.8). In total, 43% agreed or strongly agreed to have sufficient skills to implement WHS-MH, which significantly increased to 78% after the training. Furthermore, 87% agreed or strongly agreed to be motivated to initiate WHS, which significantly increased to 94% after the training. The majority of participants were satisfied with the training.

Conclusions

Training may enhance the implementation of the WHS-MH through increasing self-efficacy and motivation. However, no effect on level of knowledge to implement WHS-MH was found.

Developing a Competency Framework of Interprofessional Occupational Health Team: A First Step to Interprofessional Education in Occupational Health Field

OBJECTIVE

The present study aimed to develop a competency framework for interprofessional collaboration in an occupational health team.

METHODS

This study was carried out in three stages. In the first stage, the viewpoints of different stakeholders on the essential competencies of interprofessional team members in occupational health services (OHS) were assessed. In the second stage, extracted codes were converted into competencies in expert panels. After that, the extracted items were categorized by inductive content analysis approach into competency framework. In the third stage, the content validity of interprofessional competencies in OHS was evaluated.

RESULTS

The competency framework was finalized in six competency domains including prevention, occupational disease management, occupational health assessments, inter-disciplinary and interprofessional collaboration, education, and evidence-based practice and professionalism.

CONCLUSION

The framework could be developed in interprofessional education in OHS based on competency-based education approach.

A Cardiovascular Risk Score for Use in Occupational Medicine

Cardiovascular disease is one of the most frequent causes of long-term sickness absence from work. The study aims to develop and validate a score to assess the 10-year risk of unsuitability for work accounting for the cardiovascular risk. The score can be considered as a prevention tool that would improve the cardiovascular risk assessment during health surveillance visits under the assumption that a high cardiovascular risk might also translate into high risk of unsuitability for work. A total of 11,079 Italian workers were examined, as part of their scheduled occupational health surveillance. Cox proportional hazards regression models were employed to derive risk equations for assessing the 10-year risk of a diagnosis of unsuitability for work. Two scores were developed: the CROMA score (Cardiovascular Risk in Occupational Medicine) included age, sex, smoking status, blood pressure (systolic and diastolic), body mass index, height, diagnosis of hypertension, diabetes, ischemic heart disease, mental disorders and prescription of antidiabetic and antihypertensive medications. The CROMB score was the same as CROMA score except for the inclusion of only variables statistically significant at the 0.05 level. For both scores, the expected risk of unsuitability for work was higher for workers in the highest risk class, as compared with the lowest. Moreover results showed a positive association between most of cardiovascular risk factors and the risk of unsuitability for work. The CROMA score demonstrated better calibration than the CROMB score (11.624 (p-value: 0.235)). Moreover, the CROMA score, in comparison with existing CVD risk scores, showed the best goodness of fit and discrimination.

Comparative study on the activities of part-time occupational physicians in Japan between 2008 and 2016: effects of the stress-check program

The Ministry of Health, Labor, and Welfare of Japan recommends that an occupational physician (OP) play an important role in implementing the stress-check program since 2015. This study aimed to compare the activities and encountered difficulties of Japanese part-time OPs in 2008 and 2016, and to investigate the effects of the stress-check program. Questionnaires were sent via mail to 946 part-time OPs in Kyoto prefecture in 2016. Completed questionnaires were returned by 181 OPs who were private practitioners or physicians in hospitals, and served as OPs on a part-time basis. In 2016, OPs utilized long hours for activities related to general health examination and to stress-check. Hours for specific health examination, health and hygiene education, health promotion activity, development of a comfortable workplace, and guidance of workers on sick leave reduced from 2008 to 2016. A total of 62% OPs frequently encountered difficulties in the stress-check-related activities in 2016. Many OPs also reported difficulties in the mental health care and the prevention of health hazard due to overwork both in 2008 and 2016. Enforcement of the stress-check program in 2015 changed the activities of part-time OPs in Japan. OPs should be given opportunities to gain more information in this area.

Gender differences and occupational factors for the risk of obesity in the Italian working population

BACKGROUND

Obesity is a multifactorial condition and a major risk factor associated with several non-communicable diseases, such as cardiovascular disease, and with a higher risk of premature death and disability. Sex-specific factors have key roles and must be taken into consideration in studying occupational factors associated with the risk of obesity. The aim of this study was to investigate gender differences in body mass index (BMI) in a large cohort representative of Italian workers and, correlating this index with several demographic and occupational variables, to verify sex- and work-dependent differences in the risk of obesity.

METHODS

We utilized data from INSuLa, a cross-sectional, nationally representative survey of the Italian worker population conducted in 2013 by the Italian Workers' Compensation Authority to investigate health and safety at work. Analyses were run on a sample of 8000 Italian workers, aged from 16 to 64 years. Logistic regression models were employed to assess gender differences in the relation between occupational characteristics and BMI. We adjusted for age, education, variables related to health protection at work, and chronic conditions and diseases.

RESULTS

There were several significant differences in the BMI between males and females, linked to some occupational factors. For instance, female shift workers were 1.32 times (95% CI 1.11-1.57) more likely to be overweight or obese than normal-weight workers, and this association was maintained when controlling for confounders. The likelihood of overweight or obesity among women who worked 1-2 night shifts per week was significantly higher - 1.5-1.6 times - than those on day shifts.

CONCLUSIONS

Gender-specific differences in occupational factors associated with the risk of obesity are useful with a view to characterizing this risk and helping identify workplace-targeted intervention strategies.

The view and policy of management of occupational health services on the performance of workers' health surveillance: a qualitative exploration

Background

Although workers’ health surveillance is an important preventive activity, it is not regularly performed. In addition to the occupational physician, the management of occupational health services can also be involved in the performance of workers’ health surveillance. The present study investigated the view and policy of the managements of occupational health services on the performance of workers’ health surveillance by occupational physicians.

Method

Semi-structured face-to-face interviews about the mission, view, and policy of the occupational health services with respect to workers’ health surveillance were conducted with eighteen randomly selected board members of occupational health services in the Netherlands. The results were transcribed verbatim and were analysed using MAXQDA software to form themes and categories.

Results

The first theme found was the view of the management of occupational health services. Categories found were mission statements of occupational health services and the attitude of the management of occupational health services towards workers’ health surveillance. Three types of mission statements were mentioned by the board members: keeping workers at work, improving the health of workers, or helping the employer with sick-leave management. Both positive and negative attitudes towards workers’ health surveillance appeared from the interviews. Some board members mentioned that workers’ health surveillance can improve workers’ health, and creates awareness about workers’ health. Other board members mentioned that performing workers’ health surveillance is eliciting problems, and that employers do not have a positive attitude towards workers’ health surveillance. The second theme was the policy on performing workers’ health surveillance. Categories found were the policy on performing workers’ health surveillance towards companies, and the policy on performing workers’ health surveillance towards professionals. Some occupational health services recommend workers’ health surveillance to all companies. However, in general workers’ health surveillance was only performed at request of companies, and no instructions or training programmes for occupational physicians were provided.

Conclusion

Although some of the mentioned views on workers’ health surveillance are positive, the policy of occupational health services on workers’ health surveillance does, so far, in general, not stimulate occupational physicians or employers to perform or organize workers’ health surveillance.

Diabetes and work: The need of a close collaboration between diabetologist and occupational physician

AIM

The Italian Society of Occupational Medicine (SIML), the Italian Diabetes Society (SID) and the Association of Diabetologists (AMD) joined a working group that produced a consensus paper aimed to assess the available evidence regarding the interplay between specific working conditions, including shift- and night-time work, working activities at high risk of accidents and work at heights, working tasks requiring high-energy expenditure, working activities at extreme temperatures and diabetes.

DATA SYNTHESIS

Diabetes is a group of metabolic disorders caused by defects in insulin secretion and/or action affecting millions of people worldwide, many of whom are or wish to be active members of the workforce. Although diabetes, generally, does not prevent a person from properly performing his/her working tasks, disease complications can significantly compromise a person's ability to work. Therefore, it appears evident the need to understand the relationship between occupational risk factors and diabetes. The working group included in the document some practical recommendations useful to ensure diabetic workers the possibility to safely and effectively undertake their jobs and to adequately manage and treat their disease, also in the workplace. In this perspective concerted action of all the workplace preventive figures, occupational physicians and diabetologists should be strongly encouraged.

CONCLUSIONS

Further studies are necessary to define workplace-based interventions, which should be minimally invasive towards the work organization, allowing diabetic workers to fully realize their work skills while improving their wellbeing at work.

Consideration of psychosocial factors in workplace risk assessments: findings from a company survey in Germany

Purpose

Work-related psychosocial risks are an increasingly important issue in occupational safety and health (OSH) policy. In Germany, as in many other European countries, employers are legally required to carry out workplace risk assessments (WRAs) and to account for psychosocial factors when doing this. The aim of this study was to expand the still scarce and sketchy empirical evidence on the extent to which employers comply with these obligations, as well as on possible determinants of compliance behaviour.

Methods

Survey data from 6500 German companies were used to calculate the prevalence of workplace risk assessments that include psychosocial factors. Furthermore, multinomial logistic regressions were performed to explore which company characteristics influence the chance of psychosocial risk assessment occurrence.

Results

The prevalence of psychosocial risk assessments was 21%. Next to company size (OR = 5.7, 95% CI 3.0–11.0), availability of safety specialist assistance (OR = 3.5, 95% CI 2.6–4.6), availability of occupational health specialist assistance (OR = 3.4; 95% CI 2.6–4.4) and inspection by OSH authority (OR = 3.4, 95% CI 2.4–4.7) were the strongest predictors of psychosocial risk assessment occurrence. Smaller (but still significant) effect sizes were found for the level of knowledge about legal OSH requirements, training of managers in OSH, economic situation of the company, presence of a works council, positive view on the benefit of OSH, affiliation with the production sector and magnitude of psychosocial risks within the company.

Conclusions

The study results indicate large deficiencies in the implementation of psychosocial risk assessments, especially for small companies. Findings suggest that enhancing companies’ utilisation of professional OSH experts and strengthening the advisory and control capacities of the OSH inspection authorities in the area of psychosocial risks would be beneficial for improving the current situation.

Improving the job-retention strategies in multiple sclerosis workers: the role of occupational physicians

Several studies evaluated whether a person with multiple sclerosis is employed or not and investigated the main symptoms that hinder the job performance. However, despite occupational physicians are fundamental in managing disabled subjects, there is a serious lack of data regarding their role in improving employability of these workers. In this regard, we assessed occupational physicians' professional activity and training/updating needs in order to identify and develop management tools, operative procedures and training programs helpful to support and implement adequate job-retention strategies. Four hundred three Italian occupational physicians compiled a self-administered questionnaire to evaluate individual demographics, health surveillance system, fitness for work and training needs. Our findings confirmed the suitability to adopt environmental adjustments at workplace (particularly referring to the ergonomics of workstation, the typology of occupational risk factors and the working time) to accommodate individual's needs in order to improve working ability among multiple sclerosis workers. Moreover, training events discussing operational guidelines and standardized instruments and/or methodologies to adequately manage the disable workers should be fostered. Therefore, in this regard, occupational physicians could play a key role but they need more high-quality training especially concerning the different tools that are currently available to assess the work issues in multiple sclerosis patients.

Information exchange using a prescribed form and involvement of occupational health nurses promotes occupational physicians to collaborate with attending physicians for supporting workers with illness in Japan

The maintenance of a balance between work and disease treatment is an important issue in Japan. This study explored factors that affect collaboration between occupational physicians (OPs) and attending physicians (APs). A questionnaire was mailed to 1,102 OPs. The questionnaire assessed the demographic characteristics of OPs; their opinions and behaviors related to collaboration, including the exchange of medical information with APs; and the occupational health service system at their establishments. In total, 275 OPs completed the questionnaire (25.0% response rate). Over 80% of respondents believed OPs should collaborate with APs. After adjusting for company size, collaboration ≥10 times/yr (with regard to both returning to work following sick leave and annual health check-ups for employees) was significantly associated with environmental factors, such as the presence of occupational health nurses (odds ratio (OR): 5.56 and 5.01, respectively, p<0.05) and the use of prescribed forms for information exchange (OR: 4.21 and 3.63, respectively, p<0.05) but not with the demographic characteristics of the OPs (p>0.05). The majority of OPs believed that collaboration with APs is important for supporting workers with illnesses. Support systems including prescribed forms of information exchange and occupational health nurses, play pivotal roles in promoting this collaboration.