Prevalence and utilization of company integration management in Germany: Results of the 2018 BiBB/BAuA survey of employed persons

OBJECTIVES

This secondary analysis aims to investigate the implementation of the legally required company integration management ("BEM") in case of an incapacity for work of at least six weeks and to identify predictors.

METHODS

Database is the representative randomized 2018 BIBB/BAuA Employment Survey of 20 012 employed persons in Germany.

RESULTS

Of the 1367 employees entitled to company integration management, 40% received an offer from their employer and 27% accepted it. In the public sector, half of those who were entitled reported an offer. Among those entitled to company integration management, employees under the age of 30, at risk of dismissal, or with fixed-term employment contract received an offer particularly rarely. Entitled employees with disabilities or in companies with works/staff councils received disproportionately often an offer of company integration management. Logistic regression analyses reveal strong associations between company integration management offer and the duration of incapacity to work. The probability of receiving an offer is almost halved for those entitled in medium-sized compared to small companies. The higher the level of educational qualification, the higher are odds ratios for an offer. In companies in which employees were less or not satisfied with their work overall, the chance of a company integration management offer is significantly reduced almost by half. The chance of an offer is more than three times higher in companies with workplace health promotion compared to those without.

CONCLUSIONS

Only a minority of eligible employees received an offer that is closely associated with health-promoting corporate culture and job satisfaction.

Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990-2011

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.

Privacy in occupational health practice: Promoting and impeding factors

Aim: This article describes the views of occupational health professionals, employees, and employers on factors that are thought to promote and impede privacy in occupational health practice. Methods: The data were collected through theme interviews with 44 subjects and were analysed by content analysis. Results: Both promoting and impeding factors organized around two content areas: ``caregiving'' (patient—caregiver relationship) and ``tripartite cooperation'' (cooperation between occupational health professionals, employees, and employer). The content areas illustrated the two different roles Finnish occupational health professionals have toward their two groups of clients: employees and employers. ``Adequate behaviour'' (respect, good communication, presence) and ``Adequate knowledge base'' (instinct, work experience, ethical thinking, knowledge of legislation) promoted privacy in caring relationship, whereas ``Inadequate behaviour'' (untrustworthy, busy, distant, ``friend'') impeded its realization. In tripartite cooperation, the promoting factors had to do with ``Common good'' (impartiality, regular contacts, community spirit, fair play) and ``Individual good'' (informed consent, advocacy). The main category, ``Confusions in loyalties'', emerged from three subcategories (confusions in confidentiality, confusions in duties, and confusions in roles) illustrating the impeding factors in tripartite cooperation. Conclusions: Questions of privacy are crystallized in occupational health professionals' diverse duties and roles towards employees and employers. In occupational health practice, privacy cannot be seen only as a privilege of employees, but must also be viewed as an instrumental value serving the interests of employers and whole work community. Confusions in loyalties need more discussion and research before privacy can be optimally realized. Lapses in confidentiality should never happen.

[History of mandatory (set by decree) preliminary and periodic medical examinations of workers in hazardous work conditions]

The article deals with over a hunderd years history of foundation and pregress in organization and process of mandatory preliminary and periodic medical examinations of workers exposed to hazardous work conditions.

Emerging from the tragedies in Bangladesh: a challenge to voluntarism in the global economy

Under the regime of private company or multi-stakeholder voluntary codes of conduct and industry social auditing, workers have absorbed low wages and unsafe and abusive conditions; labor leaders and union members have become the targets of both government and factory harassment and violence; and trade union power has waned. Nowhere have these private systems of codes and audits so clearly failed to protect workers as in Bangladesh's apparel industry. However, international labor groups and Bangladeshi unions have succeeded in mounting a challenge to voluntarism in the global economy, persuading more than 180 companies to make a binding and enforceable commitment to workers' safety in an agreement with 12 unions. The extent to which this Bangladesh Accord will be able to influence the entrenched global regime of voluntary codes and weak trade unions remains an open question. But if the Accord can make progress in Bangladesh, it can help to inspire similar efforts in other countries and in other industries.

[Problems of practical implementation of legislation basis in organizing and conducting preliminary and periodic medical examinations of workers]

The article deals with problems of implementation of legislation documents in federal medicine, education, purchases for governmental and municipal needs. The authors analyzed and summarized main problems in organizing and conducting preliminary and periodic medical examinations of workers (exemplified by decreed communities in government-financed establishments).

[Contemporary reforms and optimization of medical examination committees in Russian Railways JSC]

The authors considered problems of restructurization and organization of medical examination committees in Russian Railways JSC, and their interlevel interactions. Detailed specification included documents circulation, order and terms of medical examination. Principles of conclusion on occupational fitness examination are specified. The article covers tasks of further development of occupational medical examination work in trade occupational medicine.

[Occupational lung diseases caused by exposure to chrysotile asbestos dust and the preventive measures]

To reveal major principles in system of occupational lung diseases prevention among workers engaged into extraction and usage of chrysotile asbestos, the authors specified main criteria for diagnosis of asbestos-related pulmonary diseases and signs of exposure to chrysotile dust, with identification of risk groups for occupational diseases development. The authors formulated main principles of prevention and rehabilitation for workers with asbestos-related pulmonary diseases. Special attention was paid to harmonization of all medical and technical measures aimed at prevention and liquidation of occupational asbestos-related diseases.

[Occupational health services as the insurance product and insurance economic instruments]

BACKGROUND

One of the most controversial issues in restructuring the Polish health insurance system is the implementation of private voluntary insurance and creation within it a new insurance product known as occupational health services (OHS). In this article some opportunities and dilemmas likely to be faced by providers and employers/employees, when contracting with insurance institutions, are considered as a contribution to the discussion on private insurance in Poland. The basic question is how private insurance institutions could influence the promotion of different preventive activities at the company level by motivating both OHS providers and employers.

MATERIAL AND METHODS

The descriptive qualitative method has been applied in the analysis of legal acts, scientific publications selected according to keywords (Pubmed), documents and expert evaluations and research project results.

RESULTS

Taking into account the experiences of European countries, described in publications, international experts' opinions and results of research projects the solution proposed in Poland could be possible under the following several prerequisites: inclusion of a full scope of occupational health services into the insurance product, constant supervision of occupational medicine professionals, monitoring of the health care quality and the relations between private insurers and OHS provider and implementation of the economic incentives scheme to ensure an adequate position of OHS providers on the market.

CONCLUSIONS

The proposed reconstruction of the health insurance system, comprising undoubtedly positive elements, may entail some threats in the area of health, organization and economy. Private voluntary health insurance implementation requires precisely defined solutions concerning the scope of insurance product, motivation scheme and information system.

[The occupational physician in France]

The French Labor law defines the role and its allocation criteria of the occupational physician (OP) the same as in Japan. In France, occupational medicine is one of the medical specialties. The OP resident must follow the 4 years clinical training before certification. After having finished their residency, they are entitled to work for the occupational health service office of a company or company association (in the case of small and medium sized companies). The most important characteristics of the French system is that they cover all workers regardless of company size. The main role of the OP is prevention of work related diseases and accidents. They are not allowed to do clinical services except for emergency cases. Their main activities are health examinations, health education, patrol and advice for better working condition. Formerly, it was rather difficult to attract the medical students for OP resident course because of its prevention oriented characteristics. A growing concern about the importance of health management at the work site, however, has changed the situation. Now, the number of candidates for OP resident course is increasing. Their task has expanded to cover mental health and other life style related diseases. The 2011 modification of law redefines the role of the OP as a director of an occupational health service office who has a total responsibility of multidisciplinary services. The French and Japanese occupational health systems have many of similarities. A comparative study by researchers of UOEH is expected to yield useful information.

Market competition, ownership, payment systems and the performance of health care providers - a panel study among Finnish occupational health services providers

Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provider and prices are market determined. The price regulation of public providers was abolished in 1995. We had data on providers from 1992, 1995, 1997, 2000 and 2004. The unbalanced panel consisted of 1145 providers and 4059 observations. Our results show that in more competitive markets providers in general offered a higher share of medical care compared to preventive services. The association between unit prices and revenues and market environment varied according to the provider type. For-profit providers had lower prices and revenues in markets with numerous providers. The public providers in more competitive regions were more sensitive to react to the abolishment of their price regulation by raising their prices. Employer governed providers had weaker association between unit prices or revenues and competition. The market share of for-profit providers was negatively associated with productivity, which was the only sign of market spillovers we found in our study.

[Reformation of occupational health in France: state of the problem and new law]

The state of the problem and new law of France No 2011-867 on occupational health organization and two decrees are described. These introduce services of health at work mainly with prophylactic tasks and whose functions are performed by interdisciplinary teams including doctors, assistants and specialists on occupational risk prevention. The documents are based on ILO Convention No 161 "Occupational health services".

[Comparative analysis of occupational health services practice of international companies of oil and gas industry and ILO Convention "Occupational Health Services"]

A comparative analysis of current work practices of occupational health services of international companies of Russian oil & gas industry and provisions of ILO Convention 161 and Recommendation 171 "Occupational Health Services" has been carried out. Proposals for improvement and harmonization of labor legislation related to this problem have been formulated.

[Development of social hygienic research in industrial medicine]

The article covers history of establishment and development of social hygienic research in Industrial Medicine Research Institute with RAMSc over last 90 years. The materials deal with founders and leaders of Social Hygienic research laboratory in various periods, with history of occupational morbidity studies, with development and results of social hygienic studies, organization of occupational therapy service in Russia, studies concerning remote effects of occupational hazards through analytic epidemiology methods, with considerably restricted possibilities in studies of relationships (especially remote) between work conditions and workers' health nowadays due to implemented law on personal data and new approaches to evaluation of industrial hazards effects on health.

[Occupational health and early detection of depression]

The Ministry of Health, Labor and Welfare is planning to conduct a stress check for employees, using the opportunity of the periodical health check. In this paper, the author summarizes some problems with the plan, and refers to the meaning of detecting mental disorders in the workplace. Just like psychiatric treatment and other mental health activities, occupational mental health should be discussed from the historical point of view, excluding shortsighted judgment and improvised measures.

[Migrant vaccinations in Poland]

After the European Union accession in 2004, Poland has been perceived by foreigners as an attractive destination of their migration, and also as a popular transit country for people going further to the Western Europe countries. The Nofer Institute of Occupational Medicine is involved in the implementation of the international project PROMOVAX (Promote Vaccinations among Migrant Populations in Europe). The objective of the project is to promote immunizations among migrant populations in Europe. This article presents the up-to-date legal regulations that are effective in Poland, taking into account their relevance to the issue of vaccinations in migrant population. The analysis of the Polish legislation concerning this problem shows that there are no specific regulations addressed to migrant population staying in our country. This issue seems to be popular in the European Union, where immunization of migrants is given high priority. From the point of view of health care professionals it is important to be aware of the fact that EU open borders favor the increased flow of people between countries. The scale of migration from outside the EU to its member states also contributes to the increase in potential contacts between health care workers and migrants working in Poland.

[State of supply services for industrial hygiene and safety in Colombia]

INTRODUCTION

Institutions that supply occupational health services must offer services that are reliable and of high quality across the spectrum of industrial hygiene and safety needs.

OBJECTIVE

Services for occupational health were identified at several institutions, and the technical quality and reliability of these services were compared in different regions of Colombia.

MATERIALS AND METHODS

This descriptive study identified the services available for industrial hygiene and safety in 15 cities of Colombia. A survey was conducted in 192 institutions offering such services and a statistical analysis of these results was undertaken. This sample was taken from a nationwide list of institutions purportedly licensed for this activity.

RESULTS

Thirty-two percent (61) of the evaluated institutions provided hygiene services, and 48% (93) provided safety services. The range of health services was provided on a subcontract basis both for professional personnel and the equipment. Six institutions in the area of industrial hygiene and 1 in the area of industrial security were supplying services with pending or suspended institutional licenses.

CONCLUSION

Deficiencies in the quality, infrastructure and levels of automation were identified at institutions that supply services of hygiene and industrial security. The resulting recommendatios are that the Ministry of the Social Protection fortifies mechanisms for (1) the evaluation and control of the supplied services, and (2) verify that the institutional activity is in accordance with current and valid licensing.

[Regulation and methodic background for safe controlled usage of chrysotile asbestos in Russia]

The article covers main results of regulation and methodic background for safe controlled usage of chrysotile asbestos in Russia. The authors consider that now Russian Federation has contemporary regulation and methodic background aimed to safe, controlled and responsible usage of chrysotile asbestos. The background covers all stages of complete industrial cycle of chrysotile from its extraction to utilization.

Management system of occupational diseases in Korea: statistics, report and monitoring system

The management system of occupational diseases in Korea can be assessed from the perspective of a surveillance system. Workers' compensation insurance reports are used to produce official statistics on occupational diseases in Korea. National working conditions surveys are used to monitor the magnitude of work-related symptoms and signs in the labor force. A health examination program was introduced to detect occupational diseases through both selective and mass screening programs. The Working Environment Measurement Institution assesses workers' exposure to hazards in the workplace. Government regulates that the employer should do health examinations and working conditions measurement through contracted private agencies and following the Occupational Safety and Health Act. It is hoped that these institutions may be able to effectively detect and monitor occupational diseases and hazards in the workplace. In view of this, the occupational management system in Korea is well designed, except for the national survey system. In the future, national surveys for detection of hazards and ill-health outcomes in workers should be developed. The existing surveillance system for occupational disease can be improved by providing more refined information through statistical analysis of surveillance data.

Worksafe Australia: to the McKay report and beyond

The health and safety of workers was not the only raison d'être for Worksafe Australia. To the Hawke Government, to the ACTU hierarchy and to the employers, a federal initiative in occupational health was a vital item in the ALP-ACTU Accord which would lock the unions into wage restraint. To the already powerful Commonwealth Department of Employment and Industrial Relations the initiative was a golden opportunity to establish a new federal structure under its influence. Thus a bureaucracy, top-heavy with administrators, came into being whilst established national occupational health activities ground to a halt. Plagued by dissent from within and criticism from without, the organisation was saved from extinction only by its importance to the Accord. In 1987 the Government appointed Mr. B. V. McKay to review Worksafe Australia, following which the activities of the organisation were streamlined, with due acknowledgement now given to the key role of the States in giving effect to nationally-agreed policies and standards. However problems remain, and the future of Worksafe Australia is still uncertain.

[The analysis of legal basis of telediagnosis and teleconsultation in clinical practice. are we allowed to consult our patients via phone? Part I]

BACKGROUND

Telemedicine means the delivery of medical service without personal contact between the patient and physician. Although Polish legal regulations do not prohibit so called "distant medical treatment", they do not specify clear and ambiguous terms of such a service. The practitioner faces numerous doubts concerning the telediagnosis and teleconsultation. The authors discuss the problems of acceptability of telediagnosis and teleconsultation in Poland.

MATERIAL AND METHODS

The material comprised a whole set of legal acts of the Polish and European origin that could have any impact on the legal basis of telemedicine in Poland. The method applied was of interpretative nature, and the texts of above-mentioned acts were thoroughly analyzed, providing the first comprehensive study on this subject.

RESULTS

The results applied to practitioners of numerous medical specializations, but it should be stated that the examples studied and analyzed focused on teleconsultations in occupational medicine. The analysis revealed that current legal regulations do not specify the exact form the medical consultations should acquire. Nevertheless, it should be admitted that "distant consultation"; via the Internet, phone or other means of IT is not prohibited. The authors emphasize, however, that the distant consultations should be treated as an exception to the rule, which says that the patient should be personally consulted by the physician.

CONCLUSIONS

The achievements of information technology greatly contributes to the quality of diagnostic and therapeutic processes. The existence of many unclear and ambiguous rules and opinions makes it necessary to establish legal regulations specifying the principles of distant exchange of medical data.

[The analysis of legal basis of telediagnosis and teleconsultation in clinical practice. Are we allowed to consult our patients via phone? Part II]

BACKGROUND

This paper is composed of two parts, the first one addresses the issue of legal grounds for teleconsultation and telemedicine in Poland, the other tries to answer the questions whether the provision of health services with use of telemedical tools does not breach medical professional secrecy or personal data protection.

MATERIAL AND METHODS

The material comprised a whole set of Polish and European legal acts that could have any impact on the legal basis of telemedicine in Poland. The method applied was of interpretative nature, and the texts of above-mentioned acts were thoroughly analyzed, providing the first comprehensive study on this subject.

RESULTS

The medical professional secrecy is not violated if the range of transmitted data is limited to those, which are absolutely necessary in the diagnostic and therapeutic process. This rule involves the transmission of indispensable personal and medical data, however, sharing the patient's appearance should be preceded by his/her informed consent.

CONCLUSIONS

The achievements of information technology greatly contribute to the quality of diagnostic and therapeutic processes. Due to the rapid development of modern means of telemedicine we face the need to establish legal regulations, specifying the principles of distant exchange of medical data.

[Legal problems associated with occupational medicine that psychiatrists need to know about]

In 1988 the Japanese government revived the Labor Safety Hygiene law to include a new section called Workers' Total Health Promotion Plan. Before that time worker's mental health issues weren't legally the responsibility of the Company. Guidelines and standards to maintain and assess the mental health of the workers were established in August 2000. In March 2009 the Ministry of Health, Labour and Welfare Labor Standard Bureau (No. 0326002) started to promote new methods for maintaining the mental health of Japans' work force. From May of this year based on the suggestions of a government committee for Mental Health in the Workplace the government is looking at requiring the yearly physical examinations of employees to include mental health check ups as well. This committee presented its report in July of 2010. I reported that mental health is as critical to employees' over all health and well being as their physical health. Mental health issues should be covered by all occupational health safety and hygiene laws.

[Age management in enteprises as a part of occupational safety and health in elderly workers]

An aging society is one of the most important demographic, social and economic challenges facing the contemporary world. Human capacity to perform work changes with age, which is mostly caused by the decrease in physical capacity, physical fitness and in some elements of psychophysical fitness (e.g., perceptibility, reaction time, efficiency of sense organs). Moreover, the incidence of disorders of the circulatory, respiratory, and musculoskeletal systems as well as of hormonal and metabolism disorders is higher in older persons. On the other hand, the requirements posed by professional work, as long as no change of post takes place, most often remain the same irrespective of age. As a result, the actual workload may increase with age. Although work ability decreases with age, the demographic and economic contexts point to the necessity to prolong occupational activity. It is justifiable to encourage an increasing number of elderly workers to remain in employment but only if the measures are being taken to maintain their work ability during the entire occupational activity period and to advance their qualifications. These measures must be accompanied by activities targeted at the modification of tasks, work stands, time and rhythm of work, so as to adapt them to the changing worker's capacities. Numerous activities are being systematically implemented in enterprises and the process is called "age management". The article describes the main assumptions of this new approach and the role of occupational physicians in the whole process.

[Legislation and inspection for the health and safety of workers. Efficacy and limits]

OBJECTIVES

To provide information regarding Occupational Health and Safety (OHS) Inspections in Europe.

METHODS AND RESULTS

The dynamics that are transforming regulatory subsystems and complementary inspection services are described. Simplification initiatives, the limits and difficulties of applying the different models of Health and Safety Management Systems are discussed. Examples are given on how to evaluate legislation and technical standards during planning and enforcement. Different approaches for studying characteristics, methodologies and efficacy in practice of OHS Inspection are provided.

CONCLUSIONS

Targeted inspections need to respond to the needs of enterprises and workers. Impartiality must be guaranteed and workers' participation should be facilitated.

Getting healthy: issues to consider before implementing a wellness program

Healthcare costs continue to rise. Employers struggle to provide health insurance for their employees. Wellness programs continue to gain popularity as a method of cost-control, but implicate a variety of federal and state laws, including privacy laws, discrimination prohibitions, laws governing health plans, tax laws, and more. Additionally, employers must consider the practical concerns of promoting employee participation and benefits to workers in wellness programs. Wellness programs are not difficult to form, but do require consideration of all of these issues. This article identifies and explains the legal and practical issues of which the employer considering implementing a new wellness program must be aware, and makes some suggestions on how to address those issues when forming a program.

[Occupational health in the Polish Supreme Court interventions]

It is the employer's duty to guarantee each worker the protection of his or her health and life, whereas the worker's duty is to undergo medical examinations and to comply with workplace safety and health regulations. Problems connected with the occupational health are the subject of courts' interventions. The author, using the jurisprudence of the Supreme Court, presents occupational health issues, which are the subject of the most frequent interventions and reviews the justification in individual cases.

[Attitudes of Polish enterprises towards tobacco smoking in the context of state policy]

BACKGROUND

The aim of the paper is to give a picture of anti-tobacco activities in enterprises, their conditions and changes that have taken place since 2000.

MATERIAL AND METHODS

The data come from questionnaire-based interviews carried out in 2006 on an all-Poland representative sample of 611 companies employing at least 50 people. They were compared with outcomes of two mail surveys conducted on randomly selected samples of similar enterprises in 2000 (N = 755) and 2001 (N = 215).

RESULTS

Tobacco smoking is rarely considered by enterprises as their own problem (17% of them were aware of the range of this phenomena among employees, whereas 5% were interested in its consequences for a company). In every ten workplace there is a total ban on smoking, whereas the same proportion of workplaces have not incorporated any tobacco smoking regulations. Only one third of the companies have smoking rooms meeting the criteria set by the Minister of Labor. The same number accepts smoking in prohibited areas. In 40% of companies, which had set any kind of their own anti-tobacco bylaws, their employees did not always obey them. Only in a half of workplaces, the management consequently and successfully enforce anti-smoking regulations. Other activities aimed at solving tobacco smoking problems are very rare. Among them, penalties and education on harmfulness of tobacco smoking are most common. In comparison with the beginning of the decade, legal anti-tobacco regulations are now more commonly obeyed. However, an apparent decline in the frequency of educational activities is observed. Moreover, the management is seldom aware of the negative impact of tobacco smoking on the functioning of their companies on the market.

CONCLUSIONS

The introduction of more restrictive legislation and education on harmfulness of tobacco smoking cannot be regarded as sufficient methods of reducing smoking in enterprises.

[Alcohol and working life]

Alcohol-related harm constitutes a significant factor decreasing work productivity. Of heavy alcohol users, most participate in working life. According to labour contract law, a person attending the workplace inebriated can be fired. If the employer applies a deferral to treatment practice, the drug- or alcohol-addicted person can be provided with the choice of therapy and rehabilitation instead of terminating the employment. According to the recent recommendation by the trade unions, organizations should have a program for preventing substance abuse. The employer should take care of the worker's intoxicant education and train the foremen to intervene in the situations on time.

[Physicians' duty to inform about the presence of health contraindications to driving motor vehicles]

BACKGROUND

The issue concerning the duty of physicians to inform about health problems, which could be a contraindication to driving a motor vehicle, give in practice rise to many questions. Existing regulations do not apply to this issue directly, and the available literature lacks a definite stand on this matter. Information collected by the competent authorities about health problems, which may be a contraindication to driving a motor vehicle could contribute enormously to reducing or eliminating health risks among drivers and other potential road users.

MATERIAL AND METHODS

Current legislation that could in any way refer to the discussed problem were subjected to a thorough analysis and interpretation. with reference to the existing case law.

RESULTS

Despite the lack of clear regulations, physicians are obliged to provide the authorized agencies with the information about health problems, which could be a contraindication to driving a motor vehicle. The transfer of this kind of information is a legitimate exemption from doctor-patient confidentiality, therefore, physicians who transfer it do not expose themselves to bearing the responsibility. In the absence of clear standards governing the scope of information that physicians should make available for relevant authorities, the information does not need, but may include a specific medical diagnosis.

CONCLUSIONS

This article presents first comprehensive approach to the exchange of information between physicians and the body entitled to obtain information on medical unfit to drive motor vehicle, which is a helpful guide in daily practice.

[Is it acceptable to carry out preventive screening in any given place?]

BACKGROUND

Employers are, among their numerous responsibilities, obliged to refer their employees or the person applying for the job to prophylactic examinations. Initial, seasonal and check-up examinations should be carried out in the primary occupational health care institution the employer is obliged to sign the contract for this kind of services, according to the binding regulations. However, due to the fact that these regulations do not contain an imperative that prophylactic examinations must be performed in the institution with which the employer is under contract, it is theoretically possible that the examinations are carried out in an outpatient department chosen by an individual who is to be examined.

MATERIAL AND METHODS

The critical analysis of existing rules, judgments and writs was performed.

RESULTS

In practice, such a possibility exists only in case of those who apply for the job. This results from the fact that job candidates unlike employees, are not obliged to follow the employer's official order concerning initial examinations. Employees and those employed on the basis of the civil-law contract have to obey the employer's official orders concerning the type and place of performing prophylactic examinations. The employee's disobedience in this matter may have serious consequences arising from the contravention of order and work organization rules.

CONCLUSIONS

Employees employed on the basis of the civil-law contract are obliged to undergo prophylactic examinations. However, the time and the type of institution in which the examination is performed depends on the legal basis of employment. Persons applying for the job do not have to obey the employer's official orders and thus cannot be forced to perform the examination in a given time or institution. If the conditional contract is signed, the employee can start his or her work without presenting the certificate of working ability at a given post.

[Efficiency of the patient's signature in examinations performed by the occupational medicine doctor]

BACKGROUND

A special relationship occurring between the doctor and the patient, besides many stipulations of the ethical nature, is controlled by numerous legal regulations. In the Polish legislative system, there are no clear and unequivocal regulations that would precisely define the diagnostic-therapeutic process. Communication, namely the exchange of information between the doctor and the patient plays a particular role in this process in which the doctor bears much greater responsibility than the patient, and thus is obliged to provide the patient with the comprehensible information presented in such a way that he or she would be able to interpret it properly.

MATERIAL AND METHODS

The analysis comprised the binding legislation concerning prophylactic examination as well as drivers examination. The problem was discussed taking into account the current court judgments.

RESULTS

The doctor should pay particular attention to adjusting the quality, quantity and way of conveying the information to the patient's ability to acquire and interpret it properly. This ability is associated with the patient's personal traits. There are no algorithms for the doctor-patient communication. The occupational medicine doctors are in a better situation as legislative regulations pertaining to specificity of their health services may indicate proper communication between the doctor and the patient.

CONCLUSIONS

The importance of this communication has been notified in the legislative doctrine, where the idea of informative mistake has been formed. Such a mistake may have significant consequences especially for the occupational medicine doctors due to the specificity of performed functions. The article discusses legislative aspects concerning the exchange of information at the doctor-patient level, and presents some examples of judgments of Polish courts as well as numerous indications useful in everyday practice.

[Medicine and the sexual distribution of work: an analysis of the scientific discourse on the role of the "human factor" in improving performance at work (Spain, 1922-1936)]

During the first third of the twentieth century, and especially after the 1920s, a discourse on occupational hygiene and safety began to develop in Spain. This discourse, without rejecting the value of the work carried out in the factory environment, particularly stressed the need to take into account what was called the "human factor." Promoted mainly by the budding occupational doctors and psychologists, this discourse became part of both the lines of biological thinking of constitutional pathology as well as the economic ideas of the so-called OCT, and it expounded the need to take the somatic and psychic characteristics of people into account in order to carry out "rational" distribution of the same in the workplace. The article aims to highlight the way in which this discourse contained elements that would help to attribute specific roles within the workplace based on the biological and psychological characteristics of men and women, so facilitating the legitimisation of a sexual distribution of work which helped to reinforce the social organization of gender at that time.

Characteristics of effective job health and safety committees

Although Health and Safety Committees (HSCs) are widely used, there is very little empirical information on what specific characteristics of HSCs (structure, activities, and resources) are associated with effectiveness in lowering injury and illness rates. An exploratory study was conducted in Connecticut, a state which requires HSCs in all workplaces with at least 25 employees. The study included analysis of administrative data (including HSC meeting minutes) of 29 committees. Lower injury rate companies were found to have a higher ratio of hourly workers to managers on the HSC, a larger committee compared to size of the employer, and reviewed a larger average number of worker complaints and suggestions.

Regulatory and tax issues for worksite wellness programs

Worksite wellness programs continue to grow and find expression in employer organizations of all types. As these programs mature and are offered to larger and larger numbers of employees in more worksites increased opportunity exists for regulatory problems. Applicable legislation and major federal regulatory issues affecting worksite wellness programs are explored and categorized. Final rules regarding Title I non-discrimination provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are described and implications for employers are identified. Due to the increasing importance of incentive rewards in programming, the tax implications of various types of program expenditures are also described. Finally, suggestions for legislative amendments and regulatory changes that would enhance wellness program effects are described.