736 research outputs found
International trends in education and training in occupational hygiene
In many countries occupational hygiene has become an indispensable discipline in managing long-term risks to the health of workers. The international collaboration on education and training started with a workshop in Luxembourg in 1986 (sponsored by the EC and WHO). This meeting provided useful groundwork in defining the scope and function of training and education in occupational hygiene. Subsequent meetings in Geneva in 1989 and 1991 progressed many of the matters raised at the Luxembourg meeting. There is a fair agreement on the educational prerequisites for the professional occupational hygienist. Academic qualifications are regarded as essential since problem-solving, in contrast to rule-following, is best trained at academic level. For this reason a mandatory research project should be included in the curriculum. The general outline of an educational programme includes basic knowledge of physics, mathematics and chemistry, basic knowledge of supportive disciplines such as toxicology, epidemiology and biostatistics, risk analysis and engineering principles, and core and specialized topics in occupational hygiene such as measurement strategies, design techniques, health risk evaluation, principles of control inclusive ventilation, management and laws and legal requirements. Discussions pertains to the preferable educational routes, on the balance between methodology and professional practice, and the focus on prevention and engineering rather than exposure assessment. Currently, the International Occupational Hygiene Association has launched a programme for interchangeability and harmonization of the different certification schemes for professional occupational hygienists. International cooperation among educational resource centres should be strongly encouraged by exchange of students and faculty, as well as educational materials and information
Werken aan volksgezondheid: van woorden naar daden
Rede,
In verkorte vorm uitgesproken
ter gelegenheid van het aanvaarden
van het ambt van gewoon hoogleraar
met als leeropdracht Determinanten van de
Volksgezondheid aan het Erasmus MC, faculteit
van de Erasmus Universiteit Rotterdam
op 24 september 201
Effects of measurement strategy and statistical analysis on dose-response relations between physical workload and low back pain
BACKGROUND: In epidemiological studies on physical workloads and back
complaints, among the important features in modelling dose-response
relations are the measurement strategy of the exposure and the nature of
the dose-response relation that is assumed. AIM: To evaluate the effect of
these two features on the strength of the dose-response relation between
physical load and severe low back pain. METHODS: The study population
consisted of 769 workers in nursing homes and homes for the elderly.
Observations at the workplace were made of 212 subjects. These
observations were analysed to determine exposure to physical load
according to two measurement strategies: the individual approach and the
group approach. The nature of the dose-response relation was evaluated
with nested logistic regression models. RESULTS: The group approach
resulted in higher odds ratios for the associations between physical load
and low back pain than the individual approach. Spline logistic regression
models appeared to describe the dose-response relation between physical
load and low back pain best. The corresponding curve showed small changes
in risk for small changes in exposure, whereas the categorical model only
showed sudden large changes in risk at predefined exposure values.
CONCLUSION: The choice for a particular measurement strategy of physical
load influences the strength of the associations between physical load and
severe low back pain. Spline models allow changes in risk over the whole
exposure range and are therefore a promising approach to identify
quantitative dose-response patterns between physical load and low back
pain
Objective voice parameters in Colombian school workers with healthy voices
Objectives: To characterize the objective voice parameters among school workers, and to identify associated factors of three object
Occupational characteristics of cases with asbestos-related diseases in The Netherlands
OBJECTIVE: To describe the occupational background of cases with an
asbestos-related disease and to present overall mesothelioma risks across
industries with historical exposure to asbestos. METHODS: For the period
1990-2000, cases were collected from records held by two law firms.
Information on jobs held, previous employers, activities performed and
specific products used were obtained from patients themselves or next of
kin. Branches of industry and occupations were coded and the likelihood of
asbestos exposure was assessed. For each branch of industry, the overall
risk of mesothelioma was calculated from the ratio of the observed number
of mesothelioma cases and the cumulative population-at-risk in the period
1947-1960. In order to compare mesothelioma risks across different
industries, risk ratios were calculated for the primary asbestos industry
and asbestos user industries relative to all other branches of industry.
RESULTS: In total, 710 mesotheliomas and 86 asbestosis cases were
available. The average latency period was approximately 40 yr and the
average duration of exposure was 22 yr. Ship building and maintenance
contributed the largest number of cases (27%), followed by the
construction industry (14%), the insulation industry (12%), and the navy
and army, primarily related to ship building and maintenance (5%). In the
insulation industry, the overall risk of mesothelioma was 5 out of 100
workers, and in the ship building industry, 1 out of 100 workers. The
construction industry had an overall risk comparable with many other
asbestos-using industries (7 per 10,000 workers), but due to its size
claimed many mesothelioma cases. CONCLUSION: The majority of cases with
asbestos-related diseases had experienced their first asbestos exposure
prior to 1960. For cases with first asbestos exposure after 1960, a shift
was observed from the primary asbestos industry towards asbestos-using
industries, such as construction, petroleum refining, and train building
and maintenance. Due to the long latency period, asbestos exposure from
1960 to 1980 will cause a considerable number of mesothelioma cases in the
next two decades
Prognostic factors for musculoskeletal sickness absence and return to work among welders and metal workers
OBJECTIVES: To analyse factors that determine the occurrence of sickness
absence due to musculoskeletal problems and the time it takes to return to
work. METHODS: A longitudinal study with two year follow up was conducted
among 283 male welders and metal workers. The survey started with a
standardised interview on the occurrence of musculoskeletal complaints. 61
(22%) workers were lost to follow up. Data on sickness absence among 222
workers during the follow up were collected from absence records and self
reports. Regression analysis based on proportional hazards models was
applied to identify risk factors for the occurrence and duration of
sickness absence due to various musculoskeletal complaints. RESULTS:
During the follow up 51% of the workers attributed at least one period of
sickness absence to musculoskeletal complaints which accounted for 44% of
all work days lost. A history of back pain was not associated with
sickness absence for back pain, partly because subjects with back pain
were more likely to be lost to follow up. Neck or shoulder pain and pain
of the upper extremities contributed significantly to neck or shoulder
absence (relative risk (RR) 3.35; 95% confidence interval (95% CI) 1.73 to
6.47) and to upper extremities absence (RR 2.29; 95% CI 1.17 to 4.46),
respectively. Company and job title were also significant predictors for
sickness absence due to these musculoskeletal complaints. Absence with
musculoskeletal complaints was not associated with age, height, body mass
index, smoking, and duration of employment. Return to work after neck or
shoulder absence was worse among metal workers than welders (RR 2.12; 95%
CI 1.08 to 4.17). Return to work after lower extremities absence was
strongly influenced by visiting a physician (RR 11.31; 95% CI 2.94 to
43.46) and by musculoskeletal comorbidity (RR 2.81; 95% CI 1.18 to 6.73).
CONCLUSIONS: Complaints of the neck or shoulder and upper extremities in
the 12 months before the study were associated with sickness absence for
these complaints during the follow up. Workers with absence due to pain
from back, neck or shoulder, upper extremities, or lower extremities were
at higher risk of subsequent sickness absence in the next year
Influence of an Interdisciplinary Re-employment Programme Among Unemployed Persons with Mental Health Problems on Health, Social Participation and Paid Employment
Purpose
To evaluate the influence of an interdisciplinary re-employment programme on labour force participation and perceived health among unemployed persons with common mental health problems. In addition, the influence of entering paid employment on self-rated physical health and mental health was investigated.
Methods
In this quasi-experimental study with 2 years follow up, 869 persons were enrolled after referral to an interdisciplinary re-employment programme (n = 380) or regular re-employment programme (n = 489). The propensity score technique was used to account for observed differences between the intervention and control group. The intervention programme was provided by an interdisciplinary team, consisting of mental health care professionals as well as employment specialists. Mental health problems were addressed through cognitive counselling and individual tailored job-search support was provided by an employment professional. Primary outcome measures were paid employment and voluntary work. Secondary outcome measures were self-rated mental and physical health, measured by the Short Form 12 Health Survey, and anxiety and depressive symptoms, measured by the Kessler Psychological Distress Scale. Changes in labour force participation and health were examined with repeated-measures logistic regression analyses by the generalized estimating equations method.
Results
The interdisciplinary re-employment programme did not have a positive influence on entering employment or physical or mental health among unemployed persons with mental health problems. After 2 years, 10% of the participants of the intervention programme worked fulltime, compared to 4% of the participants of the usual programmes (adjusted OR 1.65). The observed differences in labour force participation were not statistically significant. However, among persons who entered paid employment, physical health improved (+16%) and anxiety and depressive symptoms decreased (β15%), whereas health remained unchanged among persons who continued to be unemployed.
Conclusions
Policies to improve population health should take into account that promoting paid employment may be an effective intervention to improve health. It is recommended to invest in interdisciplinary re-employment programmes with a first place and train approach
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