Health
The International Journal of Occupational and Environmental Medicine | 15 August 2016

Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway

Precarious employment is a major social determinant of health and health inequalities with effects beyond the health of workers. The objective of this study was to investigate the association between precarious employment and sickness absence in four Nordic countries, Denmark, Finland, Norway, and Sweden.

The prevalence of sickness absence was lowest in Sweden (18%), and highest in Finland (28%). Three precarious employment indicators were positively associated with sickness absence; the pattern being largely similar in the total sample. In the sex-disaggregated sample, five precarious employment indicators increased the likelihood of sickness absence; the pattern was heterogeneous, with women generally having significantly higher odds of sickness absence than men. “Low household income” and “sickness presenteeism” were strong predictors of sickness absence among both sexes in most of the four studied countries. Sickness absence varied between the Nordic countries in the sex-disaggregated analyses.

Precarious employment indicators predicted sickness absence in the Nordic countries. Findings emphasize the need to prioritize informed and monitored collective bargaining for all workers, increase working time flexibility, and improving work conditions.

International Journal of Occupational Medicine and Environmental Health | 15 August 2016

Lost-Time Illness, Injury, and Disability and Its Relationship With Obesity in the Workplace: A Comprehensive Literature Review

The objective of this study was to conduct a literature review examining predictors of lost-time injury, illness, and disability (IID) in the workplace, with a focus on obesity as a predictor, and to evaluate the relationship between obesity and lost-time IID. The study objective was also to analyze workplace disability prevention and interventions aimed at encouraging a healthy lifestyle among employees and reducing obesity and IID, as well as to identify research gaps.

The search was conducted in several major online databases. Articles included in the review were published in English in peer-reviewed journals between January 2003 and December 2014 and were found to be of good quality and of relevance to the topic. Each article was critically reviewed for inclusion in this study. Studies that focused on lost-time IID in the workplace were reviewed and summarized. Workers in overweight and obese categories are shown to be at a higher risk of workplace IID, are more likely to suffer from lost-time IID, and experience a slower recovery compared to workers with a healthy body mass index.

Lost-time IID is costly to an employer and an employee; therefore, weight reduction may financially benefit both workers and companies. It was found that some companies have focused on developing interventions that aid reduction of weight and the practice of active lifestyle among their employees.

Occupational & Environmental Medicine | 15 August 2016

Biomechanical and Psychosocial Exposures are Independent Risk Factors for Carpal Tunnel Syndrome: Assessment of Confounding Using Causal Diagrams

Between 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure–response relationships. This analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS.

Although attenuation of the relationships between CTS and some biomechanical and work psychosocial exposures was observed after adjusting for confounding, the magnitudes were small and confirmed biomechanical and work psychosocial exposures as independent risk factors for incident CTS.

Occupational Safety and Health Administration | 15 August 2016

NIOSH’s Engineering Controls Database Can Help Employers Reduce Risk of Workplace Illnesses and Injuries

The National Institute for Occupational Safety and Health’s (NIOSH’s) new Engineering Controls Database provides information on effective engineering controls that can protect workers by eliminating or reducing hazardous conditions. It is based on a hierarchy of controls ranked in order of effectiveness. Well-designed engineering controls can be highly effective in protecting workers and frequently lower operating costs over the longer term. The database can be searched by occupation or work process to find a solution that may work to control the exposure in your workplace.

Read more about the database here.

JPT | 5 August 2017

How the Petroleum Industry Can Learn From the Ebola Crisis of 2014

The Ebola crisis of 2014 was one of the worst infectious disease outbreaks in recent history. It also occurred in a region with endemic medical risks and poor medical infrastructure. These two factors make it an important learning exercise for the global petroleum community. This paper reviews the Ebola outbreak from the viewpoint of an onshore and offshore petroleum operator, providing insight into the real threats the outbreak presented by looking past the media hype and diving into the real organizational effects of the outbreak.

Introduction
West Africa experienced the most severe Ebola virus disease (EVD) outbreak ever recorded. The most-affected countries are Liberia (10,672 cases as of 16 ­August 2015), Sierra Leone (13,494 cases), and Guinea (3,786 cases). Other affected countries include Mali, Nigeria, and Senegal in Africa; and Italy, Spain, the United Kingdom, and the United States, although to a much lower level. Pictorial representation of the number of cases and deaths in affected countries as of 5 July 2015 is shown in Fig. 1.

Number of deaths and people affected by Ebola.

The World Health Organization on 6 August 2014 declared this Ebola outbreak in West Africa to be a public health emergency of international concern.

Lessons Learned
The West Africa Ebola outbreak has been the largest, longest, and most complex since the virus was discovered in 1976. It has had the highest number of cases and deaths ever reported for Ebola.

A functional health system is a prerequisite for any coordinated preparedness for and response to any possible outbreak. The 2005 revision to the International Health Regulations (IHR) is a legally binding agreement whose purpose is “to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.” None of the most-affected countries were compliant with the IHR regulations, and this surely delayed the timely identification of the disease, the setting up of contact tracing and adequate surveillance measures, and the early implementation of infectious control measures in healthcare settings.

This epidemic served as a reminder of the possible negative consequences of globalization (i.e., rapid spread of infection across continents and oceans, putting the entire world at risk). The West Africa Ebola outbreak also reconfirmed that infectious diseases cannot be easily cordoned off to one country or continent. Rather, an outbreak will have an immediate and critical global effect if immediate prevention and control measures are not put in place.

In addition, countries with weak health systems and poor health infrastructure cannot withstand the effect of such rapidly spreading epidemics. In such situations, the country’s health systems will collapse, leading to more and more deaths because many patients with other diseases (e.g., malaria and HIV/AIDS) would not approach the clinics for fear of being exposed to the epidemic. This could lead to economic shutdown of the affected countries, leading to humanitarian crises. Thus, there is a significant need to strengthen and restructure basic public health systems in these countries, including primary healthcare facilities, laboratories, surveillance systems, and critical care facilities.

Another important lesson learned is the importance of collaboration with media in order to provide correct information. This is essential to avoid or control the spread of panic among the community. The additional threat to the population’s faith in government and international agencies can be fatal for both sides.

Lessons Learned for Companies Operating in Tropical Hot Spots at Risk of Zoonotic Infections
Companies operating in tropical hot spots—typically at high risk of zoonotic infections—that are interested in business continuity need vigilantly to understand the health and political context in which they operate in order to keep their employees safe and protected.

From a preparedness perspective, companies should undertake a thorough review of the capability of the country’s national health and veterinary system at the beginning of the project itself, supplemented by periodic reviews. A detailed health-impact assessment of the project should be conducted before the start of the project and for each major project expansion. This assessment should include a review of zoonotic infections and not be exclusively based on the epidemiology of the diseases already present in the country. Companies should develop flexible response plans informed by the characteristics of the disease or an outbreak and not merely based on fixed triggering factors. The response to the Ebola epidemic, in fact, could not rely on trigger matrices developed for other possible outbreaks because one single case would require a substantial and immediate response plan.

When coming up with a strategy to protect the premises and its employees, the company should keep in mind that the regular health, safety, and environment (HSE) emergency-response-plan (ERP) triggers will not always be appropriate in such infectious-disease outbreaks. This was one of the biggest stumbling blocks encountered in this Ebola outbreak (i.e., to get health, safety, and environment managers to understand that the response to this infectious disease epidemic is very different from that to any other threat that uses the normal HSE ERP and traditional triggers).

Risks Involved for Oil and Gas Companies: Offshore Suspected Cases
First Scenario. The biggest risk involved for oil and gas companies operating in affected countries is to have a symptomatic Ebola case offshore. It is very likely for a person who is completely asymptomatic, and who travels from an affected country after unprotected exposure, to become symptomatic while offshore. This would cause fear and panic among the rest of the team and expose the medical personnel available offshore until the diagnosis is confirmed either way. In such a scenario, the best prevention and control measure would be to isolate the suspected case. The medical staff members should protect themselves with the correct personal protective equipment but should still minimize physical contact with bodily fluids of the suspected case until help arrives from a specialist team.

The company should ensure that there are dedicated and trained teams available at the project sites that will be able to respond to such offshore emergencies almost immediately. This specialist team should be ready to move the suspected case, most likely by boat (helicopter providers will be reluctant to respond in such cases), and immediate directions should be given to clean and disinfect the offshore facilities as soon as possible.

Second Scenario. The company is operating in a nonaffected country, and people from affected countries are working offshore and there is a suspected case on the rig. The chances are that there will be no systems in place to deal with such a patient. There may be no laboratory facilities available, so even excluding EVD will be complex.

First, preventing this situation from happening should be the main objective. This can be achieved through training of all the workers who travel to and from affected countries. They should understand how to mitigate the risk and why it is so important to inform the employer about any potential contact with an ­Ebola-risk case. They should then be allowed to stay at home for 21 days and monitor their health, before going offshore.

A second important consideration is that no symptomatic individual from an affected country should be allowed to go offshore. Consideration should be given whether the company will allow people from affected countries to go offshore unless they have gone through a 21-day window period (in the case of EVD) outside of the affected country. The situation may turn out to be complex and controversial, but it depends on the rank of the individual or workforce and the level of understanding about the disease.

Conclusion
Although, at the time this paper was written, the current outbreak was still not completely over, systems are now in place in affected countries to ensure that the same uncontrolled spread of EVD among humans seen in 2014 will most likely never happen again. The lessons learned from this outbreak have definitely sensitized the world to the fact that the spread of EVD among humans becomes almost immediately a global threat and cannot remain confined to a country or a continent. The key is to respond rapidly and effectively at the early stages of the spread. This early-response system was already tested in Nigeria and Mali, where medical infrastructure is more or less the same as in the three heavily affected countries. But, because of the rapid response of the Nigerian and Malian governments, supported by the international community and nongovernmental organizations, the ongoing spread among humans was stopped very effectively, with only a few cases reported.

This was the biggest Ebola outbreak ever, with many lives lost, including healthcare workers in the line of duty. How­ever, the long-term benefit from this outbreak is the development of vaccines that will save many more lives in the future. Such an unprecedented and uncontrolled outbreak is highly unlikely to occur again. These vaccines are still going through various test trials but thus far have demonstrated very positive ­results.


PubMed | 27 July 2016

Association Between Unconventional Natural Gas Development in the Marcellus Shale and Asthma Exacerbations

Asthma is common and can be exacerbated by air pollution and stress. Unconventional natural gas development (UNGD) has community and environmental impacts. In Pennsylvania, UNGD began in 2005, and, by 2012, 6,253 wells had been drilled. There are no prior studies of UNGD and objective respiratory outcomes.

A nested case-control study compared patients with asthma with and without exacerbations from 2005 through 2012 treated at the Geisinger Clinic, which provides primary care services to more than 400,000 patients in Pennsylvania. Patients with asthma aged 5 to 90 years (n = 35,508) were identified in electronic health records; those with exacerbations were frequency matched on age, sex, and year of event to those without.

The study identified 20,749 mild, 1,870 moderate, and 4,782 severe asthma exacerbations and frequency matched these to 18,693, 9,350, and 14 ,104 control index dates, respectively.

Residential UNGD activity metrics were statistically associated with increased risk of mild, moderate, and severe asthma exacerbations. Whether these associations are causal awaits further investigation, including more detailed exposure assessment.

National Center for Biotechnology Information, US National Library of Medicine | 12 July 2016

Occupational Health: Meeting the Challenges of the Next 20 Years

The industrial revolution that took place in the UK between 1760 and 1830 led to profound social change. Occupational medicine was concerned with the diagnosis, treatment, and prevention of occupational diseases, that is, diseases directly caused by exposure to workplace hazards. A similar pattern of development has occurred globally.

The international conceptualization and development of occupational health occurred during the 20th century. A new paradigm for occupational health has emerged that extends the classical focus on what might be termed “health risk management,” that is, the focus on workplace hazards and risk to health to include the medical aspects of sickness absence and rehabilitation, the support and management of chronic noncommunicable diseases, and workplace health promotion.

The future strategic direction for occupational health will be informed by a needs analysis and a consideration of where it should be positioned within future healthcare provision. What are the occupational health workforce implications of the vision for occupational health provision? New challenges and new ways of working will necessitate a review of the competence and capacity of the occupational health workforce, with implications for future workforce planning.

This paper examines the evolution that has taken place in occupational medicine and occupational health (OH) from the second half of the 20th century and discusses the paradigm shift in practice that is now faced by OH practitioners. New challenges and new ways of working will necessitate a review of the competence and capacity of the OH workforce, with implications for future workforce planning.

Rigzone | 5 July 2016

Mental Health Awareness Increasing Within Oil, Gas Industry

Mindfulness-based stress management is growing in popularity across the oil and gas industry as the sector responds to a rise in mental health awareness, said Steve Smith, Robert Gordon University senior lecturer in mental health and wellbeing.

“Approaches involving mindfulness meditation are attracting increased attention as the benefits of this skills-based technique are becoming recognized,” he said.

The fall in oil price and its effect on the economic state of the industry, resulting in thousands of redundancies, has meant that stress-related conditions such as anxiety and depression have become important issues within the sector, Smith said.

“The economic uncertainty has resulted in a rise in stress-related problems, causing issues for organizations as they come to realize that the mental health of their workforce is a major asset to be protected,” he said.

“We already know that stress related illness is one of the major causes of sickness related absence in industry. Work related stress accounted for almost half (43 percent) of all days lost to the British economy in 2014/15, with 440,000 workers affected and a total of 9.9 million days lost…While every employer is aware of the need to protect employees from the effects of harmful and toxic work environments, some are coming to see the benefits of proactively protecting the mental wellbeing of their workforce too,” Smith added.

Smith is currently working with North Sea oil and gas companies as they seek new ways to proactively protect their workforce from the harmful effects of work-related stress. Mindfulness-based approaches are one of the more accessible mental health solutions used by organizations of all sizes and across all sectors, encouraging participants to focus on what is happening now as opposed to becoming engaged in thoughts of future or past events.

PubMed | 22 June 2016

Control of Occupational Exposure to Phenol in Industrial Wastewater Treatment Plant of a Petroleum Refinery in Alexandria, Egypt: An Intervention Application Case Study

Phenol exposure is one of the hazards in the industrial wastewater treatment basin of any refinery. It additively interacts with hydrogen sulfide emitted from the wastewater basin. Consequently, its concentration should be greatly lower than its threshold limit value.

The present study aimed at controlling occupational exposure to phenol in the work environment of wastewater treatment plant in a refinery by reducing phenolic compounds in the industrial wastewater basin. This study was conducted on both laboratory and refinery scales.

The first was completed by dividing each wastewater sample from the outlets of different refinery units into three portions; the first was analyzed for phenolic compounds, the second and third were for laboratory scale charcoal and bacterial treatments. The two methods were compared regarding their simplicity, design, and removal efficiency. Accordingly, bacterial treatment by continuous flow of sewage water containing Pseudomonas aeruginosa was used for refinery-scale treatment.

Laboratory scale treatment of phenolic compounds revealed higher removal efficiency of charcoal [100.0 (0.0) %] than of bacteria [99.9 (0.013) %]. The refinery-scale bacterial treatment was [99.8 (0.013) %] efficient. Consequently, level of phenol in the work environment after refinery scale treatment [0.069 (0.802) mg/m3] was much lower than that before [5.700 (26.050) mg/m3], with removal efficiency of [99.125 (2.335) %].

From the present study, we can conclude that bacterial treatment of phenolic compounds in industrial wastewater of the wastewater treatment plant using continuous flow of sewage water containing Pseudomonas aeruginosa reduces the workers’ exposure to phenol.

PubMed | 22 June 2016

Altered Executive Function in Welders: A Functional Magnetic Resonance Imaging Study

Chronic exposure to manganese (Mn) can lead to impairments in motor and cognitive functions. Several recent studies reported Mn-induced executive dysfunction.

The present study compared the neural correlates of ongoing executive function of welders and healthy controls. Fifty-three welders and 44 healthy controls were enrolled. Participants were given functional magnetic resonance imaging (fMRI) scans and performed two modified versions of the Wisconsin Card Sorting Task (WCST) that differed in cognitive demand, and a task that established a high-level baseline (HLB) condition. Card-sorting tests and word-color tests were also used to assess executive performance.

Neural activation of the bilateral superior-frontal cortex, right-inferior parietal cortex, and bilateral insula cortex were greater in healthy controls than in welders when contrasting the difficult version of the WCST with the HLB. There were also correlations between executive functions by the card-sorting test and word-color test and brain activation in the insula cortex using the WCST.

Results indicated that welders had altered neural processing related to executive function in the prefrontal cortex under conditions of high cognitive demand. Welders also had less activation of the insula cortex, a part of a larger network comprising the lateral prefrontal cortex and parietal cortex.

Coloradoan | 15 June 2016

Colorado To Assess Human Health Risks of Hydraulic Fracturing

The results of a 3-year Colorado State University (CSU) study on air emissions from natural gas extraction will fuel a state assessment of the human health risks posed by hydraulic fracturing.

Former CSU student Bradley Wells collects air samples downwind of a well pad as part of a CSU study on emissions from natural gas extraction. Photo courtesy of CSU.

A team of CSU researchers carried out the USD 1.7 million study in Garfield County in northwest Colorado, a major hub for oil and gas activity.

The team’s goal was to collect and quantify emissions of volatile organic compounds, a major player in smog development, and methane, a potent greenhouse gas that traps more heat than carbon dioxide. As explained in a CSU press release, the team examined emissions from three natural gas extraction activities: drilling, hydraulic fracturing, and flowback.

National Institute for Occupational Safety and Health | 26 May 2016

Can the Workplace Be a Social Health Network?

With recent changes to health care and the introduction of the Affordable Care Act, many companies are implementing workplace health programs and initiatives. Although this is a positive step toward facilitating a healthy workforce, it remains to be seen whether simply having programs will result in better health.

In order to measure the success or progress toward achieving total worker health (TWH), organizations need to do more than just tally up the number of worker safety, health, and well-being programs they have in place. Equally important is workers’ perspective of the climate for health that exists within the organization. Social climate has an impact on the decisions (including health decisions) that individuals make as well as the resources that are available to make those decisions. To maximize the impact of workplace health and safety programs, support for initiatives needs to come from three levels: the organization, the supervisors, and fellow workers.

A new tool has been developed for organizations to identify possible shortcomings in any one of these three facets of health climate, the Multifaceted Organizational Heath Climate Assessment (MOHCA) scale. Research findings have shown that strength in all three facets of health climate are associated with improvements in health and well-being outcomes.