The management of occupational health by NHS Trusts in the north of England.
(17/967)
This paper reports the findings of an audit of the management of occupational health arrangements in 36 NHS Trusts in the Northern and Yorkshire region of England. A questionnaire was designed based on a national NHS occupational health standard to obtain data on eight categories of occupational health activity: health and safety; pre-employment assessments; Infection Control; health surveillance; sickness absence; ill-health retirement; health promotion and record storage. The management arrangements for occupational health were varied. Assessments of workplace hazards, prevention of HIV-positive workers from performing exposure-prone invasive procedures and the assessment of pregnant workers were identified as issues for further consideration. Provision of competent and effective occupational health services will assist in the management of sickness absence and in the protection and promotion of health of staff. It will also contribute to the health and safety of patients. (+info)
Health surveys in the workplace: comparison of postal, email and World Wide Web methods.
(18/967)
Health surveys in the workplace are an important part of epidemiology, needs assessment and health promotion. Since the workplace is changing rapidly with the use of computer networks, we examined the feasibility, validity and cost of health surveys using e-mail and the World Wide Web (WWW). Five hundred systematically sampled university staff in a convenience sample of 10 English universities were surveyed using either e-mail alone, e-mail plus a WWW form or postal questionnaire. Response rates, speed of response, validity and costs were examined. The postal survey obtained the best response rate: 72% as compared with 34% for e-mail alone and 19% for the WWW, but it was also the most expensive at 92p per reply, with 35p for e-mail, and 41p for the WWW. Most of the electronic responses were made within five days. In 1997, the increased response rate justified the higher cost of postal questionnaires. e-mail and WWW surveys are easy, quick and inexpensive to administer, and despite low response rates may be useful for pilot studies. The rapid changes in the spread and use of information technology means we have to keep reassessing the methods we use for health surveys in the workplace. (+info)
Provision and staffing of NHS occupational health services in England and Wales.
(19/967)
OBJECTIVES: To establish the extent of Occupational Health (OH) service provision in the National Health Service (NHS). METHODS: Two postal questionnaires were used to obtain information from purchasers and providers in the NHS in England and Wales. RESULTS: 99.6% of trust and health authority employers claim to provide some form of OH service to their employees indicating widespread recognition of need, but virtually no service is provided to other staff such as general practitioners (GPs), general dental practitioners (GDPs), and their staff. There is a wide variability in the range and quality of OH services, suggested by the enormous differences in medical staffing levels, and the contractual restrictions where the OH service is provided by another NHS employer. Only about a third (highest estimate) to a quarter (lowest estimate) of NHS staff have access to a specialist occupational physician. CONCLUSIONS: Substantial inequality of access to OH services exists for the NHS workforce, despite previous guidance. There is no real evidence to suggest why the extent of provision of OH services varies so greatly between institutions. (+info)
Morbidity and health care utilisation among elderly people in Mmankgodi village, Botswana.
(20/967)
OBJECTIVE: To evaluate the health status among the elderly in a village in Botswana and their pattern of health care utilisation. DESIGN: A descriptive study where all persons 60 years and older were invited to participate, including a medical examination, laboratory testing and a questionnaire aiming at gathering sociodemographic data. SETTING: Mmankgodi village of Botswana. SUBJECTS: 419 persons were identified as elderly in the village, out of which 337 were included. MAIN OUTCOME MEASURES: The general medical examination also included eye status, vision and hearing tests, nutritional status, blood pressure and registering of physical disabilities. Laboratory tests included haemoglobin, blood glucose, HIV antibodies and serum lipids. The questionnaire contained questions regarding family and civil status, self assessed general health, health problems experienced during the previous month, and health care utilisation. Questions also pertained to smoking, taking snuff, and alcohol consumption. RESULTS: A majority (75%) of the elderly experienced good or only somewhat reduced health, while one quarter suffered more serious health problems. The most frequent health problems were related to the musculoskeletal system. Eye diseases, including cataract and blindness, were also common. The concentration of serum lipids is lower than the one found in the elderly population of Norway. Nutritional status indicated a relatively high prevalence (7%) of malnutrition. The majority of men were still married (87%), while most women were widowed (71%). Women reported more health problems than men, and they also reported more worries regarding their own life situation. There is a tendency for the elderly to seek assistance from the established clinics and other health facilities for their health problems. Worries are either kept to themselves or advice is sought from relatives. Traditional healers were not often consulted for health problems or worries. CONCLUSIONS: Major health problems were identified among the elderly in this geographical area of Botswana. There is presently no health programme in Botswana aimed at the elderly. Some of the diseases and conditions found in this study could easily be identified and treated in the present health system through a health care programme. (+info)
Ignorance is bliss? HIV and moral duties and legal duties to forewarn.
(21/967)
In 1997, a court in Cyprus jailed Pavlos Georgiou for fifteen months for knowingly infecting a British woman, Janet Pink, with HIV-1 through unprotected sexual intercourse. Pink met Georgiou in January 1994 whilst on holiday. She discovered that she had contracted the virus from him in October 1994 but continued the relationship until July 1996 when she developed AIDS. She returned to the UK for treatment and reported Georgiou to the Cypriot authorities. There have been a number of legal cases involving deliberate transmission of HIV, but most have involved forced exposure to infected bodily fluids for example, rape or biting, and have been dealt with using the existing legislation for rape or assault. While it is often difficult to prove responsibility for transmission in cases of forced exposure to HIV, it is even more contentious in cases like those of Janet Pink where an individual has consented to sex but claims that he/she was not forewarned of his/her partner's HIV-positive status. At present there is no specific criminal offence of having unprotected sexual intercourse without disclosing one's HIV-positive status but a prosecution could possibly be brought under any one of a number of existing offences. Perhaps a change of policy needs to be considered. The Home Office has issued a consultation document which outlines a proposal that will allow the criminalization of intentional transmission of diseases, like HIV, that are likely to cause serious harm. This revised legislation would cover all other potentially fatal diseases (including salmonella and legionnaire's disease, for instance) but seems primarily to be targeted at HIV transmission. Should transmission of HIV through consensual sex, without the HIV-positive status of the individual being disclosed, be an offence? This question, and that of whether there is a moral obligation to disclose a positive HIV status prior to having a sexual relationship is the subject of this paper. (+info)
Individual and occupational determinants of low back pain according to various definitions of low back pain.
(22/967)
OBJECTIVES: To test associations between non-specific low back pain and several risk factors when definitions of low back pain vary. DESIGN/SETTING/PARTICIPANTS: A cross sectional study was set up in 1991, 725 workers from four occupational sectors answered a self administrated questionnaire including the Nordic questionnaire and questions about intensity of pain and individual and occupational factors. MAIN RESULTS: Prevalence of low back pain varied from 8% to 45% according to the definition used. Psychosomatic problems, bending or carrying loads were often associated to low back pain, whereas other risk factors were related to some specific dimensions of the disorder. CONCLUSIONS: Risk factors of low back pain vary with the definition. This could explain inconsistencies found in literature reviews. To be able to compare data, it seems important to be precise what definition is used and to use comparable questionnaires. (+info)
Validity of self reported occupational exposures to hand transmitted and whole body vibration.
(23/967)
OBJECTIVES: To assess the accuracy with which workers report their exposure to occupational sources of hand transmitted (HTV) and whole body vibration (WBV). METHODS: 179 Workers from various jobs involving exposure to HTV or WBV completed a self administered questionnaire about sources of occupational exposure to vibration in the past week. They were then observed at work over 1 hour, after which they completed a second questionnaire concerning their exposures during this observation period. The feasibility of reported sources of exposure during the past week was examined by questioning managers and by inspection of tools and machines in the workplace. The accuracy of reported sources and durations of exposure in the 1 hour period were assessed relative to what had been observed. RESULTS: The feasibility of exposure in the previous week was confirmed for 97% of subjects who reported exposure to HTV, and for 93% of subjects who reported exposure to WBV. The individual sources of exposure reported were generally plausible, but occupational use of cars was substantially overreported, possibly because of confusion with their use in travel to and from work. The accuracy of exposures reported during the observation period was generally high, but some sources of HTV were confused-for example, nailing and stapling guns reported as riveting hammers, and hammer drills not distinguished from other sorts of drill. Workers overestimated their duration of exposure to HTV by a median factor of 2.5 (interquartile range (IQR) 1.6-5.9), but estimated durations of exposure were more accurate when the exposure was relatively continuous rather than for intermittent short periods. Reported durations of exposure to WBV were generally accurate (median ratio of reported to observed time 1.1, IQR 1.0-1.2). CONCLUSIONS: Sources of recent occupational exposure to vibration seem to be reported with reasonable accuracy, but durations of exposure to HTV are systematically overestimated, particularly when the exposure is intermittent and for short periods. This raises the possibility that dose-response relations may have been biased in some of the studies on which exposure standards might be based, and that the levels in currently proposed standards may be too high. Future studies should pay attention to this source of error during data collection. (+info)
Epidemiology of participation: an Australian community study.
(24/967)
STUDY OBJECTIVE: To determine the levels of participation in social and civic community life in a metropolitan region, and to assess differential levels of participation according to demographic, socioeconomic and health status. To contribute to policy debates on community participation, social capital and health using these empirical data. DESIGN: Cross sectional, postal, self completed survey on health and participation. SETTING: Random sample of the population from the western suburbs of Adelaide, the capital city of South Australia, a population of approximately 210 000. PARTICIPANTS: 2542 respondents from a sample of 4000 people aged 18 years and over who were registered on the electoral roll. MAIN RESULTS: The response rate to the survey was 63.6% (n=2542). Six indices of participation, on range of social and civic activities, with a number of items in each, were created. Levels of participation were highest in the informal social activities index (46.7-83.7% for individual items), and lowest in the index of civic activities of a collective nature (2.4-5.9% for individual items). Low levels of involvement in social and civic activities were reported more frequently by people of low income and low education levels. CONCLUSIONS: Levels of participation in social and civic community life in an urban setting are significantly influenced by individual socioeconomic status, health and other demographic characteristics. An understanding of the pattern of participation is important to inform social and health policy making. Increasing levels of participation will reduce social exclusion and is likely to improve the overall quality of community life. (+info)