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Occupational diseases are diseases directly induced by work and working conditions. In the Republic of Croatia, according to the procedure set out by law, occupational diseases are reported and recognized by the Croatian Health Insurance Fund and registered and monitored in the Registry of Occupational Diseases kept by the Croatian Institute for Public Health – Department of Occupational Health. Diagnoses are under responsibility of occupational medicine specialists and are carried out according to modern occupational health criteria, which include determining the clinical picture of the disease and the damage caused by the work process. The recognition of COVID-19 as an occupational disease is extremely important for the worker considering the financial and pension benefits according to the applicable laws and regulations. Most workers who have had COVID-19 as a professional disease do not get the disease recognized as an occupational disease while they are sick. The length of the acute disease is shorter than the process of application and evaluation of occupational disease. However, the recognition of COVID-19 as an occupational disease may be important for the future. Should any of the complications (e.g. post COVID-19 syndrome) arise in the future, the worker holds their rights under health insurance. The scientific and healthcare community is still in the process of evaluating and recognizing complications of COVID-19 disease and their long-term impact on health and work ability. Key words: occupational disease, legislation, public health, occupational medicine

Introduction: The aim of the study was to assess the effect of lead concentration and shift work on the occurrence of insomnia in the employees of the Zinc Steelworks in Miasteczko Śląskie in Poland. Materials and Methods : The study group consisted of 240 employees of the zinc smelter, reporting periodic and control examinations to the Occupational Medicine Clinic. Respondents were asked to complete a questionnaire consisting of the Athens Insomnia Scale and questions about the place and nature of work. Results: Analyzing the results of lead and zinc proporphiryn( ZPP) levels in the shift and non-shift subgroups of the study group, a slightly higher mean level of lead and ZPP was found in the shift subgroup. Using logistic regression, the probability of insomnia was determined depending on the concentration of lead and ZPP in the organism. As the level of lead and ZPP increases in the study group, the probability of insomnia increases. It is the largest among the examined group working in shifts. Conclusions: As the blood lead level increases, the likelihood of insomnia in steel plant workers increases.

Lead is an environmental hazard that should be addressed worldwide. Over time, human lead exposure in the western world has decreased drastically to levels comparable to those among humans living in the preindustrial era, who were mainly exposed to natural sources of lead. To re-evaluate the potential health risks associated with present-day lead exposure, a two-pronged approach was applied. First, recently published population metrics describing the adverse health effects associated with lead exposure at the population level were critically assessed. Next, the key results of the Study for Promotion of Health in Recycling Lead (SPHERL; NCT02243904) were summarized and put in perspective with those of the published population metrics. To our knowledge, SPHERL is the first prospective study that accounted for interindividual variability between people with respect to their vulnerability to the toxic effects of lead exposure by assessing the participants' health status before and after occupational lead exposure. The overall conclusion of this comprehensive review is that mainstream ideas about the public and occupational health risks related to lead exposure urgently need to be updated because a large portion of the available literature became obsolete given the sharp decrease in exposure levels over the past 40 years. ispartof: HYPERTENSION RESEARCH vol:46 issue:2 pages:395-407 ispartof: location:England status: published

The posturography test allows assessment of the entire function of balance system and quantitative, device-based verification of the clinical Romberg test. Therefore, the aim of this study is assessment of usefulness of posturography as primary test for balance disorders in occupational medicine.The study is cross-sectional, analyzing anonymous results of 1030 patients reporting dizziness and balance disorders. Based on symptoms, clinical examination and videonystagmography patients were classified into subgroups: benign paroxysmal positional vertigo (BPPV [N = 130]), non compensated (NS [N = 82]) and compensated (S [N = 174]) peripheral vestibular, bilateral vestibular (BV [N = 63]), Ménière's disease (MD [N = 53]), central dizziness (central [N = 293]), migraine (migr. [N = 132]), psychogenic dizziness (psychog. [N = 232]), Persistent postural-perceptual dizziness (PPPD [N = 150]). Besides, 129 healthy people were included in the study.Ninety nine percent of abnormal static posturography (SP) and 94% of abnormal dynamic posturography (PD) results were found in diseased patients. Normal results were found both in healthy group (59% PS, 67% PD) and in diseased group (24% PS, 31% PD). Static posturography's abnormal results were more frequent in NS, BV and PPPD patients. In PD the differences were visible in the central, psychog. and PPPD subgroups. In NS subgroup the high negative predictive values of static and dynamic tests (82-87%) were calculated in relation to caloric test.Static tests are the basic test used in examinations of employees for occupational medicine purposes. Posturography is a quantitative record of sways in relation to normative values. Abnormal posturography results most likely indicate the presence of pathologies of the balance system, including psychofunctional disorders. Normal posturography results do not indicate the lack of pathology of balance system what should be included in the work ability assessment. Med Pr. 2022;73(2):143-50.Badanie posturografii umożliwia ocenę czynności układu równowagi jako całości i ilościową, aparaturową weryfikację klinicznej próby Romberga. Dlatego celem pracy była ocena przydatności posturografii jako głównego testu oceny zaburzeń równowagi dla potrzeb medycyny pracy.Praca ma charakter przekrojowy. Analizie poddano anonimizowane wyniki 1030 pacjentów zgłaszających się z powodu zawrotów głowy i zaburzeń równowagi. Na podstawie wywiadu, badania przedmiotowego i wyników wideonystagmografii pacjentów zakwalifikowano do podgrup osób z łagodnymi położeniowymi zawrotami głowy [ŁPZG (N = 130)], nieskompensowanymi [NS (N = 82)] i skompensowanymi [S (N = 174)] uszkodzeniami obwodowej części układu przedsionkowego, obustronnym osłabieniem pobudliwości przedsionkowej [bilateral vestibular – BV (N = 63)], chorobą Ménière’a (N = 53), zaburzeniami części ośrodkowej [ośr. (N = 293)], migrenami (N = 132), zaburzeniami psychopochodnymi [psych. (N = 232)] i persistent postural-perceptual dizziness [PPPD (N = 150)]. Do badań włączono również 129 osób zdrowych.Spośród wszystkich nieprawidłowych wyników posturografii statycznej (PS) i dynamicznej (PD), odpowiednio, 99% i 94% stwierdzono w grupie osób chorych. Prawidłowe wyniki stwierdzono zarówno u 59% (PS) i 67% (PD) osób zdrowych, jak i u 24% (PS) oraz 31% (PD) osób chorych. Wykazano częstsze występowanie nieprawidłowych wyników PS w podgrupach NS, BV i PPPD oraz PD w podgrupach ośr., psych. i PPPD. W podgrupie NS dla obu posturografii wykazano wysoką ujemną wartość predykcyjną (82–87%) w stosunku do próby kalorycznej.Testy statyczne są podstawowym badaniem wymaganym w badaniach profilaktycznych pracowników. Posturografia stanowi ilościowy zapis wychwiań w odniesieniu do wartości normatywnych. Nieprawidłowe wyniki posturografii, szczególnie statycznej, z bardzo dużym prawdopodobieństwem wskazują na występowanie patologii układu równowagi, w tym zaburzeń psychofunkcjonalnych. Prawidłowe wyniki badań posturografii nie świadczą o braku patologii układu równowagi, co powinno być uwzględnione w ocenie zdolności do pracy. Med. Pr. 2022;73(2):143–150.

Silicosis not a disease of the past. It is an irreversible, fibrotic lung disease specifically caused by exposure to respirable crystalline silica (RCS) dust. Over 20,000 incident cases of silicosis were identified in 2017 and millions of workers continue to be exposed to RCS. Identified case numbers are however a substantial underestimation due to deficiencies in reporting systems and occupational respiratory health surveillance programmes in many countries. Insecure workers, immigrants and workers in small businesses are at particular risk of more intense RCS exposure. Much of the focus of research and prevention activities has been on the mining sector. Hazardous RCS exposure however occurs in a wide range of occupational setting which receive less attention, in particular the construction industry. Recent outbreaks of silicosis associated with the fabrication of domestic kitchen benchtops from high-silica content artificial stone have been particularly notable because of the young age of affected workers, short duration of RCS exposure and often rapid disease progression. Developments in nanotechnology and hydraulic fracking provide further examples of how rapid changes in technology and industrial processes require governments to maintain constant vigilance to identify and control potential sources of RCS exposure. Despite countries around the world dealing with similar issues related to RCS exposure, there is an absence of sustained global public health response including lack of consensus of an occupational exposure limit that would provide protection to workers. Although there are complex challenges, global elimination of silicosis must remain the goal.

A tribute to Dr. Irving J. Selikoff MD, the founder of this journal, is indeed welcome now more than two decades after his passing. He was known during his lifetime as the US Father of Environmental Medicine which at the time encompassed occupational medicine and much more as industry also polluted the general environment. The 1970s were a busy time as OSHA and the EPA were newly formed and high exposures to workers were no exception. Dr. Selikoff was a brave pioneer examining workers throughout the country and Canada, publicizing their exposures, and writing and presenting the scientific results. Industry was not always receptive and controlled an astounding amount of narrative, with the creation of the American Journal of Industrial Medicine filling a void of scientific need. We four authors write about the ethics of occupational health, the plight of nuclear energy workers, the climate crisis and opportunity for unions to engage workers, and the global march toward educating medical students on workers' health and safety. All four of us interacted with Dr. Selikoff during his tenure at Mount Sinai, and over the years joined each other in promoting his legacy. Toward that end we have written articles honoring his memory.

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.

Work-related stress is an emerging risk for psychiatric occupational disorders including Adjustment Disorders (AD). The aim of this study was to investigate in workers exposed to occupational stress suffering from AD about putative indices of stress and mental health resilience such as serum cortisol (seC) levels, Heart Rate Variability (HRV) and affective temperaments. We consecutively recruited 15 male and 15 female AD patients between workers evaluated for occupational stress at an Italian Occupational Medicine Unit. SeC levels were measured by specific immunoassay. HRV indices were recorded using Task Force® Monitor system (CNSystems, Graz, Austria). Specific questionnaires were used to measure perceived and occupational stress, psychopathological symptoms and temperament. Women presented higher levels of occupational stress, higher High-Frequency HRV (HF-HRV) and lower Low-Frequency HRV (LF-HRV) than men. SeC levels were positively correlated with LF-HRV values and negatively with HF-HRV values. The LF/HF ratio resulted to be inversely correlated with the score of Harm Avoidance temperament dimension and directly with the score of Reward Dependence temperament dimension. In conclusion, in AD patients exposed to occupational stress high seC levels and reward dependence appear to be associated with a pattern of HRV reflecting less mental health resilience.

Objectives Epidemiological data on cancer diseases are alarming. The workplace has become an increasingly important site for disseminating health information and implementing health promotion activities. Occupational medicine physicians (OMPs) have the opportunity to carry out primary and secondary preventive activities focused on civilization diseases, especially cancer. The aim of this study was to evaluate the potential of OMPs in cancer prevention, including the analysis of factors determining the implementation of preventive measures, as part of standard healthcare for employees. Material and Methods The study was conducted among 362 OMPs. The interviews were carried out by the computer assisted telephone interview (CATI) method. Results Over 60% of the surveyed OMPs are ready to implement cancer preventive activities among employees. The doctors with the longest seniority in occupational health services are more likely to declare unwillingness to implement cancer preventive activities. Patient’s consent, informing women about the program and adjusting the time of the medical visit are the most important conditions for introducing cancer prevention programs by OMPs. Neither seniority nor the number of examinations performed by a physician influenced the currently implemented cancer preventive activities as part of occupational health services (including the evaluation of cancer risk factors occurrence among employees). Conclusions In Poland, OMPs are willing to implement cancer preventive activities among employees, but their current activity in this area is limited and needs development. The most specific actions should be addressed to doctors with the longest seniority in occupational health services, who are frequently unwilling to implement cancer preventive activities. Strengthening the preventive potential of Polish occupational health services requires a systemic approach to the scope and way of action of healthcare professionals. Int J Occup Med Environ Health. 2021;34(6):723–36

Background Providing frontline support places first responders at a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Aims This study was aimed to determine the anti-SARS-CoV-2 seroprevalence in a cohort of first responders (i.e. firefighters/paramedics), to detect the underascertainment rate and to assess risk factors associated with seropositivity. Methods We conducted a serological survey among 745 first responders in Germany during 27 November and 4 December 2020 to determine the anti-SARS-CoV-2 seroprevalence using Elecsys® Anti-SARS-CoV-2 immunoassay (Roche Diagnostics, Mannheim, Germany). As part of the examination, participants were asked to provide information on coronavirus disease 2019 (COVID-19)-like-symptoms, information on sociodemographic characteristics and workplace risk factors for a SARS-CoV-2 infection and any prior COVID-19 infection. Descriptive statistics and logistic regression analysis were performed and seroprevalence estimates were adjusted for test sensitivity and specificity. Results The test-adjusted seroprevalence was 4% (95% CI 3.1–6.2) and the underascertainment rate was 2.3. Of those tested SARS-CoV-2 antibody positive, 41% were aware that they had been infected in the past. Seropositivity was elevated among paramedics who worked in the emergency rescue team providing first level of pre-hospital emergency care (6% [95% CI 3.4–8.6]) and those directly exposed to a COVID-19 case (5% [95% CI 3.5–8.1]). Overall, the seroprevalence and the underascertainment rate were higher among first responders than among the general population. Conclusions The high seroprevalence and underascertainment rate highlight the need to mitigate potential transmission within and between first responders and patients. Workplace control measures such as increased and regular COVID-19-testing and the prompt vaccination of all personnel are necessary.

Alcohol abuse is one of the main lifestyle factors affecting the health of the Russian population and determining the level and dynamics of morbidity and mortality from chronic non-communicable diseases. Alcohol addiction is one of the most difficult and dangerous diseases for humanity due to the enormous medical, social, moral, ethical, economic and spiritual losses. Alcohol damage is associated with medical expenses, reduced labor productivity, premature death. In the Concept of the implementation of the state policy to reduce alcohol abuse and prevent alcoholism among the population of the Russian Federation for the period up to 2020, it was stated that "alcohol abuse causes a particularly high mortality rate among men 40-60 years old, who at this age have the most valuable professional skills; their premature death damages the workforce with professional experience, reduces the amount of investment in human capital". Conducting an anti-alcohol program within the framework of occupational medicine seems to be an effective method of solving the problems of both the drinker himself and society as a whole. Alcohol risk management of Russian enterprises is a very promising and in-demand area of scientific and practical activity, which is of great interest to physicians, managers, economists and representatives of many other fields and professions.

Work-related asthma (WRA) accounts for 10-25% of all adult asthma. It therefore seems important to raise questions regarding an asthmatic's approach to occupational or job training activities. WRA takes on two forms: work-exacerbated asthma (WEA) and occupational asthma (OA), which encompasses different subtypes of heterogeneous mechanisms. It currently represents a major challenge for occupational medicine in terms of detailed diagnosis, social care, the economic repercussions for workers and employers and, last but not least, social insurance. This review aims to sensitize health care practitioners to the peculiarities of WRA management in routine practice. More specifically, prognosis depends on early diagnosis, medical care and work adjustment measures. WEA and OA are explained in detail in view of identifying causative agents and at-risk occupations and defining adapted medical strategy. Relevant lines of questioning and complementary exams are presented. In addition, the key role of the occupational physician, especially as regards recognition and identification of occupational disease, is underlined, the objective being to facilitate optimal professional and social management. In future studies, the key role of counseling and orientation mechanisms should be highlighted as means of preventing WRA occurrence.

High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.

Currently, work in any medical organization carries a risk of coronavirus infection, and, first of all, this applies to medical organizations dealing with the treatment of patients infected with coronavirus. Medical workers are a group at increased risk of infection with the SARS-CoV-2 virus in the provision of medical care in modern conditions, which determines their incidence of COVID-19 [1–3]. The aim of the study is to explore the prevalence of cases of COVID-19 infection in medical workers providing medical care on an outpatient basis. The analysis of the incidence of COVID-19 medical workers in one of the large medical organizations of the Samara region during the period of the pandemic was carried out. The medical staff of the medical organization includes 207 doctors. There are 11 subdivisions in the structure of the medical and prophylactic institution. Research methods: content analysis of the modern regulatory framework (2020-2021), statistical, expert. For the period from May 2020 to March 2021 71 cases of infection of medical workers on an outpatient basis with SARS-CoV-2 were identified, of which 32 doctors (45%) and 39 people (55%) nurses. Based on the results of the expert assessment, the insurance nature of the infection case was established in 50 people (70%). Among the medical and nursing categories of medical workers, the largest number of cases was made by doctors and nurses of primary contact — specialists of the district service: general practitioners (40%), pediatricians (32%), doctors — obstetricians-gynecologists (12%), nurses adults (76%) and children (20%) polyclinic departments. A third of health workers received inpatient treatment for severe COVID-19, an average of 60 days. Medical workers are a risk group of COVID-19 who need support measures, since the possibility of occupational infection has been sufficiently proven, and the risk probably depends on the work performed and the conditions of direct contact of medical personnel, which requires further study in the current persisting epidemic conditions. © 2021, Izmerov Research Institute of Occupational Medicine. All rights reserved.

The results of the use of electrostatic massage in the miners with vibration disease and with shoulder joint diseases are presented. In the all patients the rehabilitation program included electrostatic massage on the ELGOS device using a lead-out electrode according to the local-segmental method. Patients of the comparison group underwent manual massage of similar areas. Before and after the treatment, the clinical manifestations of vibration disease were evaluated by vibration sensitivity test using a Rydel–Seiffer vibrotone C 64 Hz / C 128 Hz. The dynamics of functional activity indices in the patients with shoulder joint diseases was assessed using a visual analog scale questionnaire. The work showed that the electrostatic massage contributes to a faster restoration of vibration sensitivity, the volume of movements in large joints and a reduction in the clinical manifestations of vibration disease (pain in the fingers, paresthesia, numbness, etc.), which has an advantage in the conditions of the COVID-19 pandemic, since the direct impact of the masseur’s hands on the patient’s body is excluded. Ethics. When conducting the study, the authors were guided by the ethical principles of conducting medical research with the participation of a person as a subject, set out in the Helsinki Declaration of the World Medical Association of the latest revision. All patients gave informed consent to participate in the study. © 2021, Izmerov Research Institute of Occupational Medicine. All rights reserved.

Objectives: Occupational and environmental medicine (OEM) departments in healthcare institutions can be quickly overwhelmed when COVID-19 infection rates rapidly and simultaneously increase in the workforce and the patients served. Our goal is to present a detailed toolkit of practical approaches for use by front-line OEM specialists to address workforce management tasks during pandemic surges. Methods: Specific focus is on tasks related to employee symptom triage, exposure risk assessment, workplace contact tracing, and work restrictions. Results: Tools include strategies used by customer call centers, two decision support algorithms (exposure due to cohabitation or non-cohabitation), a color-coded employee case tracking tool, a contact tracing protocol, and documentation templates that serve as memory aids for encounters. Conclusions: These tools are created with commonly used software. Implementation is feasible in most front-line OEM settings, including those with limited resources.

The article highlights the life and professional path of the doctor Ivan Terentiiovych Klochkov. Much attention has been paid to the history of the creation of occupational medicine, providing medical assistance to the workers of the Alexander South-Russian factory of the Bryansk joint-stock company by factory doctors.

This paper provides a picture of the observations made over three hundred years ago by Bernardino Ramazzini (1633-1714) in light of current topical issues ranging from health problems related to work and lifestyle habits to the current burdensome COVID-19 pandemic. The main aspects of his work consist of descriptions of disorders linked to environmental risks, suggestions for measures for risk protection, and recommendations for healthy living. This paper focuses on Ramazzini's most relevant achievements by (1) analyzing the episodes that stimulated the composition of his main work and highlighting some observations on which current epidemiological and toxicological studies are based; (2) reviewing his work showing not only the systematic descriptions of work-related illnesses caused by occupational factors but also his sound etiological and physiopathological contributions to the field of occupational lung diseases, breast cancer, and environmental disorders; and (3) remarking on his main observations in the fields of risk prevention and health promotion, also in the light of some highly topical issues related to unhealthy lifestyle habits and the COVID-19 pandemic.

The coronavirus disease 19 (COVID-19) pandemic has had a tremendous impact on every facet of private life and work organisation in virtually all social and economic sectors worldwide. People who stand on the first line of defence are healthcare workers (HCWs) risking exposure to infected patients. However, even though they are often affected by COVID-19 and associated somatic and mental health problems, COVID-19 as a new illness was not immediately acknowledged as occupational disease. This is why several groups of HCWs contacted their occupational medicine physicians in 2020 with a request to register the infection with SARS-CoV-2 as occupational disease. In an attempt to support their appeals and show that hospital workers have a high occupational risk of COVID-19, this study presents COVID-19 incidence and symptoms in 100 employees working at 11 clinics of the Clinical Hospital Centre (CHC) Rijeka, Croatia from 1 June to end December 2020. All of them were infected with SARS-CoV-2 and took sick leave, which lasted 13.6±2.6 days in average. This study also looks into the role of occupational medicine physicians in prospective monitoring of acute and long-acting consequences of COVID-19 that might occur in HCWs.Bolest uzrokovana koronavirusom (COVID-19) pandemija je koja ugrožava živote mnogih pojedinaca i organizacija u gotovo svim društvenim i gospodarskim sektorima diljem svijeta. Pri tome, međutim, najviše stradavaju ljudi medicinske struke, koji su na prvoj crti obrane izloženi bolesnicima i zaraznom materijalu. Kao česte žrtve virusa, oni su izloženi brojnim somatskim i psihosocijalnim problemima, no kako početkom 2020. godine infekcija SARS-CoV-2 nije još bila uvrštena među profesionalne bolesti, brojni zdravstveni radnici zatražili su od medicine rada priznavanje COVIDA-19 kao profesionalne bolesti. Kako bismo poduprli njihove opravdane zahtjeve, napravili smo kratak osvrt na zdravstveno stanje 100 zdravstvenih radnika zaraženih SARS-CoV-2, koji su od lipnja do kraja prosinca 2020. radili u pojedinim odjelima Kliničkoga bolničkog centra (KBC) u Rijeci. Opisali smo incidenciju i simptome COVID-19 u 11 kliničkih odjela KBC-a i naglasili važnu ulogu medicine rada u procjenjivanju akutnih i mogućih dugotrajnih posljedica COVIDA-19, koje se učestalo pojavljuju u zdravstvenih radnika.

Technical Specifications for Occupational Health Surveillance (GBZ 188-2014) is an important basis for judging suspected occupational diseases and occupational contraindications. There are crossing over or overlap between occupational contraindications and diagnostic criteria of poisoning damage. Occupational contraindications have different meanings with the degree and range of common diseases or symptoms and the frequency of physical examination during employment conflicts with the current standard. Based on the practice of occupational health examination in a large population, the present study analyzed relevant articles and put forward some suggestions for revision, in combination with clinical medicine, occupational health standards, and diagnostic standards of occupational diseases. The modification could provide a reference for the revision of Technical Specifications for Occupational Health Surveillance and the practice of occupational health examination.GBZ 188-2014《职业健康监护技术规范》是判定疑似职业病、职业禁忌证的重要依据。职业禁忌证与中毒损害分级存在交叉或重叠，与常见疾病或症状的程度、范围存在歧义，在岗期间体检周期的规定与现行标准冲突。本文基于大人群职业健康检查实践，结合临床医学、职业卫生标准、职业病诊断标准等，对部分条款进行研究分析，提出修改建议，为《职业健康监护技术规范》修订、职业健康检查实践提供参考。.

The COVID-19 pandemic has highlighted the importance of Public Health interventions for global social and economic development. Still, the community's well-being depends on each individual's health. In addition to pandemics, health conditions can be altered by chronic degenerative diseases, aging, disabilities, and work. Personal behaviors such as poor nutrition, lack of physical activity, tobacco use, excessive alcohol consumption, and drug use can also affect health and safety at work. In the last twenty years, we have witnessed rapid changes in the nature of work, workplace and workforce. In parallel, there is increasing attention to fatigue, psychosocial risks and the achievement of decent, sustainable and healthy work as societal goals. Consequently, in 2011, NIOSH developed Total Worker Health®, a holistic approach to worker well-being to help improve worker health and safety. More recently, in Italy, the Ministry of Health has provided for the preparation of projects according to the "Total Worker Health (TWH)" approach in the National Prevention Plan for the five years 2020-2025. As indicated by the Ministry, the strategic role of the occupational physician is fundamental, being the only figure of occupational safety and health professionals able to integrate the health and safety of workers with their well-being to reach the Total Worker Health.

Background: Alcohol use is an ever-growing phenomenon in the population, consumption data indicate that 5–20% of the European working population have serious problems related to alcohol. The use of alcohol constitutes a risk to the health and safety of workers as well as to the safety of the general population. The present work aims to address the problem of alcohol intake in occupational settings by comparatively analyzing alcohol consumption behavior within the 27 countries of the European Union. Methods: The purpose of this research is to analyze the differences between the 27 countries of the European Union in the application of measures to assess and manage the risk of alcohol intake in occupational settings. Results: An examination of the legislation and guidelines of the different countries reveals profound differences in the management of the problem of alcohol in the workplace. The discrepancy is very wide that it ranges from the complete absence of legislative restrictions on a national level in some countries to highly restrictive measures with severe sanctions in others. Conclusions: It would be appropriate—also for the purpose of ease of movement of workers within the European Community—to find shared management models useful for protecting the health and safety of workers and the general population.

For workplaces which cannot operate as telework or remotely, there is a critical need for routine occupational SARS-CoV-2 diagnostic testing. Although diagnostic tests including the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel (CDC Diagnostic Panel) (EUA200001) were made available early in the pandemic, resource scarcity and high demand for reagents and equipment necessitated priority of symptomatic patients. There is a clearly defined need for flexible testing methodologies and strategies with rapid turnaround of results for (1) symptomatic, (2) asymptomatic with high-risk exposures and (3) asymptomatic populations without preexisting conditions for routine screening to address the needs of an on-site work force. We developed a distinct SARS-CoV-2 diagnostic assay based on the original CDC Diagnostic Panel (EUA200001), yet, with minimum overlap for currently employed reagents to eliminate direct competition for limited resources. As the pandemic progressed with testing loads increasing, we modified the assay to include 5-sample pooling and amplicon target multiplexing. Analytical sensitivity of the pooled and multiplexed assays was rigorously tested with contrived positive samples in realistic patient backgrounds. Assay performance was determined with clinical samples previously assessed with an FDA authorized assay. Throughout the pandemic we successfully tested symptomatic, known contact and travelers within our occupational population with a ~ 24–48-h turnaround time to limit the spread of COVID-19 in the workplace. Our singleplex assay had a detection limit of 31.25 copies per reaction. The three-color multiplexed assay maintained similar sensitivity to the singleplex assay, while tripling the throughput. The pooling assay further increased the throughput to five-fold the singleplex assay, albeit with a subtle loss of sensitivity. We subsequently developed a hybrid ‘multiplex-pooled’ strategy to testing to address the need for both rapid analysis of samples from personnel at high risk of COVID infection and routine screening. Herein, our SARS-CoV-2 assays specifically address the needs of occupational healthcare for both rapid analysis of personnel at high-risk of infection and routine screening that is essential for controlling COVID-19 disease transmission. In addition to SARS-CoV-2 and COVID-19, this work demonstrates successful flexible assays developments and deployments with implications for emerging highly transmissible diseases and future pandemics.

To reduce vaccine-preventable diseases in workers, workplace vaccination campaigns can be implemented on-site. The aim of this systematic review was to evaluate adherence to workplace vaccination campaigns. Three databases, PubMed, ISI Web of Science, and Scopus, were screened systematically for articles in English or Italian addressing participation in an on-site vaccination program by employees. The following data was extracted: authors, year, country, type of vaccine, type of workplace, sample size, vaccination rate. Data on the prevalence of flu vaccination were calculated and pooled using a random-effects model. Thirteen articles were included in the review, ten in the meta-analysis. Most studies were conducted in the USA (30.7%) and most vaccination campaigns were against influenza (69.2%), with a pooled estimate of 42% (95% CI: 0.25–0.60%); participation rate was highly variable, ranging from 88.9% for an influenza vaccination campaign to 5.7% for a Lyme disease vaccination campaign. Offering free on-site vaccination can be a successful tool to ensure adherence to vaccination campaigns and administration of all required doses according to the vaccine administration scheme. The occupational physician can play a key role in implementing workplace campaigns for employee mandatory vaccinations.

Background Effective care services for people whose work participation is at risk require low-threshold access, a comprehensive diagnostic clarification of intervention needs, a connection to the workplace and job demands, and interdisciplinary collaboration between key stakeholders at the interface of rehabilitation and occupational medicine. We have developed a comprehensive diagnostic service to clarify intervention needs for employees with health restrictions and limited work ability: this service is initiated by occupational health physicians. Methods/design Our randomized controlled trial tests the effectiveness of a comprehensive diagnostic service for clarifying intervention needs (GIBI: Comprehensive clarification of the need for intervention for people whose work participation is at risk). The comprehensive intervention comprises three elements: initial consultation, two-day diagnostics at a rehabilitation center and follow-up consultations. We will include 210 employees with health restrictions and limited work ability, who are identified by occupational health physicians. All individuals will receive an initial consultation with their occupational health physician to discuss their health, work ability and job demands. After this, half the individuals are randomly assigned to the intervention group and the other half to the waiting-list control group. Individuals in the intervention group start two-day diagnostics, carried out by a multi-professional rehabilitation team in a rehabilitation center, shortly after the initial consultation. The diagnostics will allow first recommendations for improving work participation. The implementation of these recommendations is supported by an occupational health physician in four follow-up consultations. The control group will receive the comprehensive two-day diagnostic service and subsequent follow-up consultations six months after the initial consultation. The primary outcome of the randomized controlled trial is self-rated work ability assessed using the Work Ability Score (0 to 10 points) six months after study inclusion. Secondary outcomes include a range of patient-reported outcomes regarding physical and mental health, impairment, and the physical and mental demands of jobs. Discussion This randomized controlled trial is designed to test the effects of a new complex intervention involving a comprehensive clarification of intervention needs in order to promote work participation and prevent the worsening of health and work disability. Trial registration German Clinical Trials Register (DRKS00027577, February 01, 2022).

Background Healthcare professionals of different occupations report pain, in particular back pain. It is known that the handling of patients and standing for long periods of time – like physiotherapists do, as well as working in bent posture – are causes of back pain. A high prevalence of low back pain (LBP) in German physiotherapists is to be expected. Objective To determine pain point prevalence, severity of pain, type of pain (acute, chronic, recurrent), most affected body locations and extent of analgesics intake in German physiotherapists. Method This was a nationwide online survey with German physiotherapists. Univariable and multivariable methods were applied to identify associations between sociodemographic variables and pain, type of pain and pain location as well as analgesic intake by type of pain. In addition, severity of pain by type was examined using the Kruska-Wallis Test. Results A total of 550 physiotherapists were included in the analysis. Prevalence of pain was 63.09 % (acute: 4.18 %, chronic: 15.27 %, recurrent: 43.64 %). Most frequently mentioned pain locations were lumbar spine (49.27 %), cervical spine (48.39 %) and head (40.47 %). Participants with chronic pain reported a higher pain severity than physiotherapists with recurrent pain. Analgesics were used by 35.29 % of study participants with pain. Participants with chronic pain indicated a significantly higher probability of using analgesics compared to physiotherapists with recurrent pain. Conclusion This study indicates a high prevalence of pain and analgesics intake in participating physiotherapists. Therefore, measures are needed to reduce pain in German physiotherapists.

Objectives: To provide perspectives from the HEAT-SHIELD project (www.heat-shield.eu): a multinational, inter-sectoral, and cross-disciplinary initiative, incorporating twenty European research institutions, as well as occupational health and industrial partners, on solutions to combat negative health and productivity effects caused by working on a warmer world. Methods: In this invited review, we focus on the theoretical and methodological advancements developed to combat occupational heat stress during the last five years of operation. Results: We outline how we created climate forecast models to incorporate humidity, wind and solar radiation to the traditional temperature-based climate projections, providing the basis for timely, policy-relevant, industry-specific and individualized information. Further, we summarise the industry-specific guidelines we developed regarding technical and biophysical cooling solutions considering effectiveness, cost, sustainability, and the practical implementation potential in outdoor and indoor settings, in addition to field-testing of selected solutions with time-motion analyses and biophysical evaluations. All recommendations were adjusted following feedback from workshops with employers, employees, safety officers, and adjacent stakeholders such as local or national health policy makers. The cross-scientific approach was also used for providing policy-relevant information based on socioeconomic analyses and identification of vulnerable regions considered to be more relevant for political actions than average continental recommendations and interventions. Discussion: From the HEAT-SHIELD experiences developed within European settings, we discuss how this inter-sectoral approach may be adopted or translated into actionable knowledge across continents where workers and societies are affected by escalating environmental temperatures. The study has received funding from the European Union’s Horizon 2020 research and innovation program under the grant agreement No 668786

Anxiety and depression can be comorbid diseases, or they can also be psychogenic complications for information about your condition. Therefore, it is essential to know how the patient's personality reacts to the awareness of his illness. The study aims to conduct a comparative analysis of indicators of anxiety and depression in patients of the occupational health clinic with various diseases, including COVID-19. Based on the screening results, we studied the need to change the tactics of organizing psychological and psychiatric care for the treatment of anxiety and depression in the Occupational Diseases Clinic after its conversion to treat patients with COVID-19. © 2021, Izmerov Research Institute of Occupational Medicine. All rights reserved.

Introduction. To date, issues related to the protection of medical workers from COVID-19 infection, including immunological protection, are of particular interest. The aim of the study was to explore seroprevalence of the IgG to SARS-CoV-2 N-protein in various groups of medical workers with the following assessment of the risk of COVID-19, depending on the seropositivity and occupational group. Materials and methods. The study of the strength of immunity to COVID-19 was carried out within the framework of the large-scale Rospotrebnadzor program to assess population immunity to the SARS-CoV-2 virus in the population of the Russian Federation, considering the protocol recommended by WHO, on the basis of the laboratories of the Center for Hygiene and Epidemiology in the Republic of Tatarstan. From the sample of the study conducted in the Republic of Tatarstan, medical workers (301) were selected without a history of a new coronavirus infection and with no clinical symptoms of this disease at the time of biomaterial sampling ( June 2020);the absence of the transferred new coronavirus infection was verified by the Unified State Information System "Electronic Health of the Republic of Tatarstan". The comparison group included 52 employees belonging to the engineering and technical personnel and not employed in medical institutions who met the above inclusion criteria. In the aggregate, the observation group (medical workers and the comparison group) included 12.1% of the participants in the population study. Results. The rate of seropositivity was 36.5% in the control groups, 23.7% — in doctors, and 38.9% — in nurses. Compared to doctors, seroprevalence was higher in nurses. The employment of medical workers in temporary infectious diseases hospitals did not affect the production of the IgG to SARS-CoV-2 N-protein. A relatively low prevalence of seropositivity among doctors of temporary infectious diseases hospitals was revealed. The probability of seroconversion decreased with age and did not depend on gender or history of recent contacts with COVID-19 patients. The survival analysis showed that the probability of remaining healthy by the end of the follow-up was the lowest among doctors from medical and preventive institutions that did not serve as temporary infectious diseases hospitals. The risk of COVID-19 in seronegative individuals was higher, but without statistical significance. Conclusion. According to the data of immunological studies for the presence of IgG antibodies to the nucleocapsid protein of the SARS-CoV-2 virus, it was found that the prevalence of seroprevalence in nurses is significantly higher than that of doctors, nurses of medical and prophylactic organizations of young age have higher seroprevalence to the nucleocapsid protein of the SARS-CoV-2. According to prospective observation, it was revealed that doctors of medical and prophylactic organizations that are not classified as temporary infectious diseases hospitals have a higher risk of developing a symptomatic form of COVID-19, which may be due to both the insufficient effectiveness of anti-epidemic measures and the peculiarities of the immune response and approaches, used to evaluate it. In the current epidemic situation, the detection of IgG antibodies to the SARS-CoV-2 virus can be used to decide on the distribution of responsibilities among medical personnel. © 2021, Izmerov Research Institute of Occupational Medicine. All rights reserved.

Competency is defined as possession of sufficient physical, intellectual, and behavioral qualifications to perform a task or serve in a role which adequately accomplishes a desired outcome. Recognizing the need for defining competencies essential to occupational and environmental medicine (OEM) physicians, the American College of Occupational and Environmental Medicine developed its first set of OEM Competencies in 1998. Later updated in 2008, and again in 2014, the increasing globalization and modernization of the workplace, along with published research on OEM practice, required an update to ensure OEM physicians stay current with the field and practice of OEM. Delineation of core competencies for the profession provides employers, government agencies, health care organizations, and other health practitioners a solid context of the role and expertise of OEM physicians.

A relationship between inhalational exposure to materials in the environment and development of interstitial lung disease (ILD) is long recognized. Hypersensitivity pneumonitis is an environmentally -induced diffuse parenchymal lung disease. In addition to hypersensitivity pneumonitis, domestic and occupational exposures have been shown to influence onset and progression of other ILDs, including idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis. A key component of the clinical evaluation of patients presenting with ILD includes elucidation of a complete exposure history, which may influence diagnostic classification of the ILD as well as its management. Currently, there is no standardized approach to environmental evaluation or remediation of potentially harmful exposures in home or workplace environments for patients with ILD. This review discusses evidence for environmental contributions to ILD pathogenesis and draws on asthma and occupational medicine literature to frame the potential utility of a professional evaluation for environmental factors contributing to the development and progression of ILD. Although several reports suggest benefits of environmental assessment for those with asthma or certain occupational exposures, lack of information about benefits in broader populations may limit application. Determining the feasibility, long-term outcomes, and cost-effectiveness of environmental evaluation and remediation in acute and chronic ILDs should be a focus of future research.

Objective: The specialty of occupational medicine is newly developing in Turkey and the number of specialists and the specialty clinics are very few. The aim of this study is to present the first two-year data of an occupational medicine outpatient clinic. This clinic is unique as it is the first outpatient clinic in a secondary health care center in Turkey (except dedicated occupational disease hospitals), and the first residency-trained occupational medicine specialist in Turkey was running this clinic. The data will be compared with national numbers in order to show if these clinics make a difference in diagnosis and notification of occupational diseases. Materials and Methods: The data is collected from the hospital database between 2017 August to 2019 August who applied to Occupational Diseases Clinic in the hospital. Only the patients who were referred by a physician or applied themselves with suspicion of an occupational disease are included to the study. The patients who applied for periodic examinations, fitness for work evaluations are not included. Results: A total of 491 patients were included to the study. 444 of them did not have a prior diagnosis of occupational disease. Of these patients, 162 (36.4%) were diagnosed with an occupational disease. 42.6 % of these diagnoses were pneumoconiosis. Conclusion: Occupational diseases are underdiagnosed and/or underreported in Turkey. A single center dedicated to occupational diseases made a substantial increase in the number of occupational diseases in two years. In conclusion, these clinics would help improving recognition of occupational diseases.

INTRODUCTION Many people have CVD risk factors without realising it and it is important to recognise the risk factors as soon as possible. Periodic examinations are a mandatory form of control for all employes in Poland. They provide an excellent opportunity to screen for the most common civilization diseases in the population. OBJECTIVE The aim of this study is to evaluate the prevalence of dyslipidaemia, hyperglycaemia and hypertension among academics in a Polish university, and to compare the results between postdoctoral fellows and other academics. MATERIAL AND METHODS The study group were postdoctoral fellows (HAB; N=135, 53 females) and other academics (NHAB; N=286, 179 females) over the age of 40 who reported for a periodic occupational medical check-up. Fasting blood samples were drawn, serum glucose, lipids and blood pressure (BP) were measured. RESULTS The mean age was 56.7 (SD 9.8) in HAB and 49.8 (SD 8.1) in NHAB. Mean systolic BP and glycaemia were significantly higher in male HAB group than male NHAB (135.8 vs 130.9 mmHg and 6.0 vs 5.6 mmol/l, respectively). The relationship in females was non-significant. The age-adjusted odds ratios (OR [95% CI]) of having elevated low density lipoprotein cholesterol, total cholesterol, glucose and blood pressure in male HAB vs male NHAB were 0.61 [0.32. 1.16], 0.64 [0.33, 1.23], 1.52 [0.80, 2.88] and 2.11 [0.88, 5.23], and in female HAB vs female NHAB - 0.59 [0.31, 1.12], 0.64 [0.32, 1.26], 0.87 [0.40, 1.79] and 1.86 [0.70, 4.68], respectively. CONCLUSIONS Adequately planned occupational medicine examinations provide an opportunity to diagnose dyslipidaemia, hyperglycaemia, or high BP in all groups of employees, including highly educated academics.

Purpose The increase in demand for health services requires companies in the segment to seek management tools and techniques that focus on reducing waste such as waiting, unnecessary displacement and low people productivity. The purpose of this paper is to present the value stream mapping (VSM) of patients at an occupational medicine clinic, proposing a new scenario with the aid of the simulation of discrete events to reduce the total waiting time during the patient's journey. Design/methodology/approach The methodology consisted of a case study developed in an occupational health clinic, involving the analysis of the patients' arrival times, time of attendance, number of employees and their functions. Data collection considered 100 random samples from the patients' arrival interval and 40 random samples for each of the operational processes performed by the clinic in a work shift. The collected data served as input for the simulation of scenarios and prioritization of the times for the proposal of the future VSM. Findings With the study it was possible to propose the reduction of time wasted in the patient's journey, mainly the waiting times (37.92%) and the lead time (29.86%), making it possible for the patient to go through the entire process without waiting for queues. In addition, the increase in employee productivity and efficiency in patient care during the work shift is considered. Research limitations/implications Despite the considerable gains obtained with the realization of this study in relation to the processing times, total waiting time and lead time, the analysis was not considered, the mode of execution of the processes performed by the professionals and the influence of the layout to improve the flow of patients, being some of the challenges for future studies to consolidate lean culture in the health segment. Practical implications The simulation of discrete events indicated that it is possible to attend a larger number of patients with the same professional structure, in case the delay in the arrival time of doctors and speech therapists is resolved. There was a reduction in the average total waiting time of 37.92%, a reduction in lead time to 29.86% and identification of the steps that most contributed to the increase in queues for patients in a 05:30 min work shift. Originality/value The work proposed the constitution of a VSM based on a discrete simulation with data from the entire health unit system, considering everything from the reception for patient registration, collection of laboratory and image exams to medical assistance. The work differs from the others in that it considers the patient's entire journey in the occupational medicine clinic, instead of prioritizing only one service department. The analysis of the results considered the scenario that presented the maximum efficiency of the available resources, respecting the patient's individualized care times, which is one of the complaints of the therapeutic teams to the use of standardization by the VSM.

BACKGROUND: The COVID-19 pandemic is still ongoing, with rapidly increasing cases all over the world, and the emerging issue of post COVID-19 (or Long COVID-19) condition is impacting the occupational world. OBJECTIVE: The aim of this systematic review was to evaluate the impact of lasting COVID-19 symptoms or disability on the working population upon their return to employment. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statements we performed a systematic review in December 2021, screening three databases (PubMed, ISI Web of Knowledge, Scopus), for articles investigating return to work in patients that were previously hospitalized due to COVID-19. A hand-searched was then performed through the references of the included systematic review. A quality assessment was performed on the included studies. RESULTS: Out of the 263 articles found through the initial search, 11 studies were included in this systematic review. The selected studies were divided based on follow-up time, in two months follow-up, follow-up between two and six months, and six months follow-up. All the studies highlighted an important impact of post COVID-19 condition in returning to work after being hospitalized, with differences based on follow-up time, home Country and mean/median age of the sample considered. CONCLUSIONS: This review highlighted post COVID-19 condition as a rising problem in occupational medicine, with consequences on workers’ quality of life and productivity. The role of occupational physicians could be essential in applying limitations to work duties or hours and facilitating the return to employment in workers with a post COVID-19 condition.

Non-specific building-related symptoms (NBRSs) describe various symptoms in those affected. Questionnaires are the first step in investigating suspected NBRSs in office environments and have been used for over two decades. However, changes in reporting of symptoms among office workers over time are currently unknown. The overall aim was thus to investigate if reported symptoms and perceived causality to the office environment have changed during 25 years of using the MM 040 NA Office questionnaire. A cross-sectional study of 26,477 questionnaires from 1995–2020 was conducted, where 12 symptoms and perceived causality to office environment were examined using logistic regression analyses of 5-year groups adjusted for sex and atopy. Reporting trends in the year groups varied slightly among symptoms, but eight symptoms were statistically significant in the 2015–2020 group compared to the 1995–1999 group. Seven symptoms had increased: fatigue, heavy-feeling head, headache, difficulties concentrating, itchy/irritated eyes, congested/runny nose, and dry/red hands. One symptom decreased: hoarseness/dry throat. Perceived causality of symptoms to the office environment decreased to a statistically significant degree in 2015–2020 for 11 symptoms, and there was an overall trend of decreasing perceived causality throughout the year groups for most symptoms. The observed time trends suggest a need for up-to-date reference data, to keep up with changes in symptom reporting in office environments over time.

STUDY AIMS: Switzerland’s Labour Law and its Ordonnance on Maternity Protection aim to protect the health of pregnant employees and their unborn children while enabling them to continue to pursue their professional activities. Some companies encounter difficulties implementing the law’s provisions. The Department of Occupational and Environmental Health, part of the Center for Primary Care and Public Health (Unisanté), has provided specialist occupational medicine consultations for pregnant employees since 2015. This study aimed to evaluate how well Swiss’ maternity protection legislation is implemented by examining a list of relevant indicators measured during the occupational health consultation. The study also sought to investigate the consultation support provided to the relevant stakeholders and the adjustments made to pregnant employees’ working conditions. METHODS: Descriptive variables and indicators relative to the application of the Swiss maternity protection legislation for 83 pregnant employees were collected during the consultation’s pilot phase (between 2015 and 2016). Descriptive statistics and cross-analyses of these indicators were made. RESULTS: Most pregnant employees faced multiple exposures to occupational risks. Preventive risk analyses were rare. Few adjustments to workstations were proposed. We found a tendency for employees to leave their workstations early on in their pregnancies due to sick leave certificate prescriptions. Specialist consultation and collaboration with occupational health physicians to recommend interventions for pregnant employees can provide significant benefits and help some pregnant women to continue at their workstations with appropriate adjustments. DISCUSSION: A specialised occupational health consultation is a useful instrument for identifying occupational hazards for both the pregnant woman and her unborn child. It is also an opportunity to explain employers’ legal responsibilities and obligations to safeguard the health of their pregnant employees and to give specific advice for their company’s situation. This consultation also enables employers to maintain their employees’ valuable professional competencies in the workplace for as long as possible. Finally, occupational health consultation helps and supports healthcare providers who must, according to the law, make decisions about whether pregnant employees can continue working safely or not.

BackgroundMany workers seek care for work-related medical conditions in primary care settings. Additionally, occupational medicine training is not consistently addressed in primary care professional training. These patterns raise concerns about the health outcomes of low-wage Latina/o immigrant workers who make use of primary care settings to obtain care for work-related injuries and illnesses. The objective of this qualitative study was to investigate how primary care clinicians assessed and addressed the role of occupational exposures on the health and well-being of Latina/o immigrant workers.MethodsWe conducted semistructured in-depth interviews with 17 primary care clinicians (physicians, resident physicians, and nurse practitioners) employed in an urban federally qualified health center (FQHC) with two sites located in Orange County, CA.ResultsUsing a constructivist grounded theory approach, we determined that primary care clinicians had a general understanding that employment influenced the health and well-being of their Latina/o immigrant patients. Clinicians delivered care to Latina/o immigrant workers who feared reporting their injury to their employer and to Latina/o immigrants whose workers' compensation claim was terminated before making a full recovery. Clinicians were responsive to patients' work-related concerns and leveraged the resources available within the FQHC. Although some clinicians offered suggestions to improve occupational health in the FQHC, a few clinicians raised concerns about the feasibility of additional health screenings and clinic-based interventions, and pointed to the importance of interventions outside of the healthcare system.ConclusionThis study underscores the complexities of addressing occupational health concerns in urban FQHCs.

Background Healthcare workers (HCWs) accounted for a significant proportion of COVID-19 infections worldwide. Retrospective seroprevalence surveys are often used to screen for unidentified previous infection with SARS-CoV-2. However, the rate of humoral response in HCWs affected by COVID-19 is not well-defined. Aims To assess the specific IgG humoral response in symptomatic and asymptomatic SARS-CoV-2-infected HCWs and identify potential factors associated with humoral response. Methods We prospectively recruited 204 HCWs with RT-PCR-confirmed COVID-19 infection to evaluate SARS-CoV-2 humoral response. Serum-IgG antibodies against SARS-CoV-2 were analysed using two commercially available serological assays. A logistic regression was performed to identify independent factors associated with positive IgG serology test. Results Overall, the SARS-CoV-2 IgG seropositivity rate was 77%. This seropositivity rate was higher in symptomatic than in asymptomatic COVID-19 infection (83% versus 57%; P < 0.001) and in older HCWs.. The seropositivity rate did not diminish with time. In logistic regression, only a history of COVID-19 symptoms and age were identified as independent factors associated with the detection of anti-SARS-CoV-2 IgG antibodies. Conclusions SARS-CoV-2 IgG antibodies are found significantly more frequently in symptomatic and in older HCWs. The fact that not all COVID-19 HCWs develop detectable IgG is vital for the interpretation of COVID-19 seroprevalence surveys.

CONTEXT Diversity in the US physician workforce is important. Physicians Underrepresented in Medicine (UIM) are more likely to serve poor, uninsured, and vulnerable populations. OBJECTIVE To increase the number of UIM physicians in Occupational Medicine. PROGRAM An Inclusion and Diversity Committee, consisting of the program director, trainees, and graduates, was created with the goal of recruiting and developing UIM residents and increasing Occupational and Environmental Medicine awareness. Outreach to UIM residents and medical students at local, regional, and national meetings, creation and distribution of descriptive brochures, and supervised 1-day observerships were some of the interventions. RESULTS Only 4 Underrepresented Minorities physicians out of 65 (6%) graduated during the first decade of the program 1997-2007; this increased to (16/70) 23% during the following decade subsequent to establishing the Inclusion and Diversity Committee. CONCLUSION A multifaceted strategic approach can help increase UIM physician participation in graduate training programs, helping address health equity.

CONTEXT There is a long-standing shortage of formally trained Occupational & Environmental Medicine (OEM) physicians despite OEM practitioners experiencing high satisfaction and low burnout. OBJECTIVE To explore the root causes of this shortage and suggest potential remedies. METHODS Cross-sectional surveys were administered to medical students queried regarding OEM training, practicing OEM physicians queried regarding timing of specialty choice, and OEM Train-in-Place (TIP) program graduates queried regarding satisfaction with training. RESULTS Of 247 medical student respondents, 70% had heard of OEM, 60% through one lecture. Of the 160 OEM physicians, 17% first became aware of OEM as medical students, and most would have chosen a different path had they heard sooner. Most TIP program trainees reported that they would not have undertaken specialty training without a TIP program (89%). CONCLUSIONS Strategies to introduce OEM earlier in medical education and TIP programs for mid-career physicians may help overcome persistent shortages of OEM specialists.

Employment, along with education, is central to the promotion of social mobility and the reduction of health inequalities. For the most part, however, physicians have limited exposure to occupational medicine during their training and rarely receive much in the way of formal training about occupational issues except those that fall commonly within their area of specialisation. Here, we illustrate why work and good employment can be so important for health and, therefore, why it should matter to all physicians. Given that under half of the UK population have access to occupational health services through their employer, physicians should be able to recognise any harm to health caused by work, so we describe the principles of eliciting a good occupational history. There is an important relationship between unemployment and poor health which will be discussed, illustrating the importance of being able to support people with long-term conditions and disabilities to remain in work for as long as they wish to do so. Patients expect to be able to seek advice from their physician about taking time off work because of ill health, planning a return to work after sickness absence and whether or not they need to change their work status because of their health condition. Therefore, we describe the fitnote: what it is for, how to complete one well and what core principles are needed in order to give patients good advice about working.

The aims of the present study were to investigate the effects of fenofibrate and bezafibrate on the risk of development of diabetic retinopathy (DR) in patients with type 2 diabetes and dyslipidemia. Japanese working age patients with type 2 diabetes and dyslipidemia were extracted from the Nihon University School of Medicine Clinical Data Warehouse. These patients were divided into three groups: control group (n=2549), fenofibrate group (n=40), and bezafibrate group (n=135). Multivariate logistic regression analysis was performed to assess the association between fibrates and the development of DR. After adjustment for covariates, fenofibrate showed no association with the risk of DR [adjusted odds ratio (OR), 0.160; 95% CI, 0.021-1.209; p=0.0758]. Bezafibrate also showed no association with the risk of DR (adjusted OR, 0.731; 95% CI, 0.411-1.299; p=0.2855). However, poor control of hemoglobin A1c (HbA1c ≥8.0%; adjusted OR, 3.623; 95% CI, 2.649-4.956; p

The process by which occupational risks in industry and manufacturing emerge has been established as a subject of research in sociology. This often-contentious process draws on toxicological findings that may or may not be accepted as established, and on epidemiological observations of pathologies. Logically enough, there has been little interest in the toxicological risks of innovative industrial technologies, due to a lack of specific cases. With the development of new technologies such as nanomaterials, the question of risks has been formally raised but has not been addressed in terms of clear toxicological results or epidemiological observations. My goal in this article is to introduce the notion of “innovative risk” to refer to a process of making risks a subject of research and discussion before evidence of health problems has been established. By examining how French labor administrations and occupational medicine organizations monitor such risks in companies and research laboratories, I will demonstrate a tension between, on the one hand, the acknowledged specificity of these risks, and, on the other hand, the standardization of actual oversight. This tension calls into question the ability of research on industrial occupational risks to approach and analyze innovative risks.

Background: Hexavalent chromium compounds are sensitizers of the skin and lung. Chronic exposure to hexavalent chromium compounds is associated with respiratory effects and ulceration and perforation of the nasal septum. Such compounds are also considered carcinogens of the lung and nasal and paranasal sinus. Objectives: To demonstrate the importance of studying occupational and non-occupational exposure when assessing the concentration of substances in the urine. Case study: A study was conducted of environmental chromium concentrations in the workplace. In addition, an occupational medical examination was performed, recording activities inside and outside the workplace, eating habits, blood lead and urine chromium at the beginning and end of the workday. Results: One worker exposed to lead chromate presented high chromium concentrations in urine (up to 62 µg/l before the working day and 52 µg/l at the end of the working day). Environmental chromium concentrations in the workplace were below 0.25 µg/m3. In view of the results, a full study was conducted of the patient’s habits outside work. He reported having bought a kilo of a medicinal herb infusion at a street market three weeks previously. The concentration of total chromium in the prepared infusion was 12000 µg/l. The patient stopped consuming the medicinal herb. Subsequently, the urine chromium analysis was below 0.5 µg/l. Discussion and Conclusions: This case is interesting because it demonstrates that the consumption of medicinal herbs can interfere with biological monitoring of workers exposed to hexavalent chromium compounds. This may give rise to confusion and can also create legal problems for companies and workers. It is important to provide advice to workers and to investigate their habits outside work, especially when there is a discrepancy between environmental and biological values. In this case, the increase in urinary chromium is due to the consumption of medicinal herbs.

Objective. To study the causes of death from common diseases at the workplace and to develop the scientifically grounded programs aimed at their prevention and decrease. A sudden death of a person at workplace is a global issue of occupational medicine in all the countries. About 85 % of sudden deaths occur due to health status of workers, first of all, circulatory system diseases and only 15 % are caused by occupational accidents. Materials and methods. To reach the aim, there were investigated the materials of investigation of the cases of death form common diseases at the workplace for 5 years (20142018) presented by the State Labor Inspection in the Republic of Bashkortostan. Results. According to the analyzed data of medicolegal report of accidents with lethal outcome resulting from common diseases it was established that men aged 5660 years, workers, mostly of manufacturing industry, died more often (92.5 %). Program of preventive measures was worked out on the basis of the obtained results. Conclusions. High death rate from circulatory system diseases at workplace needs a complex of treatment and preventive measures to be developed, which will decrease the risk of a sudden cardiac death among workers of industrial enterprises.

Background: Working in swine and poultry farms is described as a harmful job to the workers, because it has been shown that is capable of leading to occupational asthma and other allergic diseases. Objective: The main objective of this study is the epidemiological characterization of occupational allergic diseases in swine and poultry Portuguese farms. Methods: About 37 (46.3%) workers from 7 swine and 43 (53.7%) from 7 poultry farms participated in this study. The data was collected through a questionnaire the European Community Respiratory Health Survey under the form of interview. Results: The prevalence of asthma was 10%. About 50.0% of the asthmatics had occupational asthma and 37.5% had work-aggravated asthma. Among non-asthmatic workers, it was reported wheezing associated with dyspnea (5.6%), dyspnea after strenuous activity (11.1%) and persistent cough (23.6%). The prevalence of allergic rhinitis was 20%, of which 56.2% of the cases had the 1st crisis after the beginning of work on farms. Among workers without medical diagnosis of rhinitis, 21.9% reported the presence of sneezing, rhinorrhea or nasal congestion without being constipated. There were skin allergies in 31.2% of the farmers, of which 72% were work-related symptoms. Conclusions: Findings of this study suggest that these farms develop activities that promote contact with harmful agents with influence on workers' health and their workers completely devalue the disease symptoms they present.

Introduction. Noise is one of the most common worldwide environmental pollutants, especially in occupational fields. As a stressor, it affects not only the ear but also the entire body. Its physiological and psychological impacts have been well established in many conditions such as cardiovascular diseases. However, there is a dearth of evidence regarding diabetes risk related to noises. Aim. To evaluate the relationship between occupational exposure to noise and the risk of developing diabetes. Methods. This is a cross-sectional analytical study enrolling two groups of 151 workers each. The first group (noise exposed group: EG) included the employees of a Tunisian power plant, who worked during the day shift and had a permanent position. The second group (unexposed to noise group: NEG) included workers assigned to two academic institutions, who were randomly selected in the Occupational Medicine Department of the Farhat Hached University Hospital in Sousse, during periodical fitness to work visits. Both populations (exposed and unexposed) were matched by age and gender. Data collection was based on a preestablished questionnaire, a physical examination, a biological assessment, and a sonometric study. Results. The mean equivalent continuous sound level was 89 dB for the EG and 44.6 dB for the NEG. Diabetes was diagnosed in 24 workers from EG (15.9%) and 14 workers from NEG (9.3%), with no statistically significant difference ( p = 0.08 ). After multiple binary logistic regression, including variables of interest, noise did not appear to be associated with diabetes. Conclusion. Our results did not reveal a higher risk of developing diabetes in workers exposed to noise. Further studies assessing both level and duration of noise exposure are needed before any definitive conclusion.