-
Salud Colectiva Apr 2014This article reproduces a document from the Instituto de Medicina del Trabajo [Institute of Occupational Medicine], created on July 16, 1973 in the Faculty of Medicine...
This article reproduces a document from the Instituto de Medicina del Trabajo [Institute of Occupational Medicine], created on July 16, 1973 in the Faculty of Medicine of the Universidad de Buenos Aires. The document is a transcription of the interventions of Mario Testa, Alberto Ozores Soler and Ricardo Saiegh in the roundtable discussion "Health in factories" carried out on August 1 of the same year. The preceding lines, written by Mario Testa, puts into context that particular historical moment and the significance of the project, which sought to reconsider the relationship between the universities and research, between the teaching of medicine and the role of physicians in society, issues still relevant today. This document was recovered from the Mario Testa fund, in the Center for Documentation and Research Pensar en Salud (CEDOPS) of the Institute of Collective Health in the Universidad Nacional de Lanús.
Topics: Argentina; Government; History, 20th Century; Humans; Occupational Medicine
PubMed: 24823611
DOI: 10.1590/S1851-82652014000100011 -
Journal of Graduate Medical Education Oct 2017Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable...
BACKGROUND
Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine.
OBJECTIVE
We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine.
METHODS
Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field.
RESULTS
Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field.
CONCLUSIONS
Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.
Topics: Career Choice; Certification; Clinical Competence; Competency-Based Education; Education, Medical, Graduate; Humans; Internship and Residency; Mentors; Occupational Medicine; Program Development; Program Evaluation; United States
PubMed: 29075386
DOI: 10.4300/JGME-D-16-00689.1 -
Journal of UOEH 2020
Topics: Bibliographies as Topic; Environmental Health; Humans; Leadership; Occupational Medicine; Periodicals as Topic
PubMed: 32879186
DOI: 10.7888/juoeh.42.229 -
Annals of the Academy of Medicine,... Jul 2005We describe how the curriculum of community, occupational and family medicine (COFM) has evolved in response to social and educational forces and local health needs....
INTRODUCTION
We describe how the curriculum of community, occupational and family medicine (COFM) has evolved in response to social and educational forces and local health needs. Challenges in the teaching of the curriculum are also discussed.
CURRICULUM
The COFM Department aims to produce medical undergraduates and graduates with the skills to critically appraise evidence, prevent and manage diseases, and promote health in the community and primary healthcare setting. Its teaching programmes consist of the medical undergraduate programme and the Master of Medicine programmes in Occupational Medicine, Public Health and Family Medicine. The undergraduate modules consist of evidence-based medicine, public health in the community, disease prevention and control, occupational medicine practice, health promotion and behaviour, and communication with patients. The university's first completely online module on SARS was jointly implemented by the Department and the Centre for Instructional Technology for the entire student population last year. The COFM curriculum has shifted from giving students factual information through lectures to developing students' critical thinking and problem-solving skills through small group teaching, case studies and community health projects. Innovative assessment methods such as open-book examinations; objective structured communication stations with simulated patients; and evaluation of students' participation in group work are used to assess students' skills in problem-solving, communication and teamwork respectively.
CONCLUSION
While the Department has made significant progress in developing a relevant and updated curriculum based on appropriate learning and assessment approaches, it will strive to do more to develop students' critical thinking skills by using newer approaches.
Topics: Community Medicine; Education, Medical; Family Practice; History, 20th Century; History, 21st Century; Humans; Occupational Medicine; Public Health; Schools, Medical; Singapore
PubMed: 16010387
DOI: No ID Found -
Scandinavian Journal of Work,... Jan 2010This systematic review aimed to identify published observational methods assessing biomechanical exposures in occupational settings and evaluate them with reference to... (Review)
Review
OBJECTIVES
This systematic review aimed to identify published observational methods assessing biomechanical exposures in occupational settings and evaluate them with reference to the needs of different users.
METHODS
We searched scientific databases and the internet for material from 1965 to September 2008. Methods were included if they were primarily based on the systematic observation of work, the observation target was the human body, and the method was clearly described in the literature. A systematic evaluation procedure was developed to assess concurrent and predictive validity, repeatability, and aspects related to utility. At least two evaluators independently carried out this evaluation.
RESULTS
We identified 30 eligible observational methods. Of these, 19 had been compared with some other method(s), varying from expert evaluation to data obtained from video recordings or through the use of technical instruments. Generally, the observations showed moderate to good agreement with the corresponding assessments made from video recordings; agreement was the best for large-scale body postures and work actions. Postures of wrist and hand as well as trunk rotation seemed to be more difficult to observe correctly. Intra- and inter-observer repeatability were reported for 7 and 17 methods, respectively, and were judged mostly to be good or moderate.
CONCLUSIONS
With training, observers can reach consistent results on clearly visible body postures and work activities. Many observational tools exist, but none evaluated in this study appeared to be generally superior. When selecting a method, users should define their needs and assess how results will influence decision-making.
Topics: Biomechanical Phenomena; Humans; Observation; Occupational Medicine; Posture; Risk Assessment; Task Performance and Analysis; Upper Extremity; Workload
PubMed: 19953213
DOI: 10.5271/sjweh.2876 -
Annals of Global Health Oct 2018The institution of specific Occupational Health and Safety (OHS) training programs open to international trainees from developing countries in some European, American... (Review)
Review
The institution of specific Occupational Health and Safety (OHS) training programs open to international trainees from developing countries in some European, American and Asian universities is now a well-established reality. Courses and seminars that focus particularly on this subject, widely varying in approach and duration, have been held for years at these universities; these academic institutions have combined their potential to attract students from developing countries with the scheduling of interesting lectures and training activities, depending on the availability of funds sufficient to cover travel and lodging costs. Interdisciplinarity is the key to the entire program and is its main strength, as the trainees have the opportunity to condense the technical notions and methodological aspects of different disciplines (occupational health, industrial hygiene, safety management, ergonomics) in one course. We firmly believe that these programs are a precious instrument for the training of occupational health professionals from low-income countries, as they are able to address their choices correctly, hopefully achieving the goal of reducing the human costs of development.
Topics: Developing Countries; Environmental Health; Humans; Occupational Health; Occupational Medicine; Sustainable Development; Training Support
PubMed: 30835376
DOI: 10.29024/aogh.2309 -
Journal of Occupational and... Dec 2013New rapid growth economies, urbanization, health systems crises, and "big data" are causing fundamental changes in social structures and systems, including health. These... (Review)
Review
New rapid growth economies, urbanization, health systems crises, and "big data" are causing fundamental changes in social structures and systems, including health. These forces for change have significant consequences for occupational and environmental medicine and will challenge the specialty to think beyond workers and workplaces as the principal locus of innovation for health and performance. These trends are placing great emphasis on upstream strategies for addressing the complex systems dynamics of the social determinants of health. The need to engage systems in communities for healthier workforces is a shift in orientation from worker and workplace centric to citizen and community centric. This change for occupational and environmental medicine requires extending systems approaches in the workplace to communities that are systems of systems and that require different skills, data, tools, and partnerships.
Topics: Community Participation; Databases, Factual; Delivery of Health Care; Economic Development; Environmental Medicine; Humans; Occupational Health; Occupational Medicine; Public-Private Sector Partnerships; Urbanization
PubMed: 24284749
DOI: 10.1097/JOM.0000000000000033 -
Environmental Health : a Global Access... Sep 2020Climate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and... (Review)
Review
BACKGROUND
Climate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and wellbeing. Therefore, identifying effective, affordable, feasible and sustainable solutions to mitigate the negative effects on worker health and productivity, is an increasingly urgent need.
OBJECTIVES
To systematically identify and evaluate methods that mitigate occupational heat strain in order to provide scientific-based guidance for practitioners.
METHODS
An umbrella review was conducted in biomedical databases employing the following eligibility criteria: 1) ambient temperatures > 28 °C or hypohydrated participants, 2) healthy adults, 3) reported psychophysiological (thermal comfort, heart rate or core temperature) and/or performance (physical or cognitive) outcomes, 4) written in English, and 5) published before November 6, 2019. A second search for original research articles was performed to identify interventions of relevance but lacking systematic reviews. All identified interventions were independently evaluated by all co-authors on four point scales for effectiveness, cost, feasibility and environmental impact.
RESULTS
Following screening, 36 systematic reviews fulfilled the inclusion criteria. The most effective solutions at mitigating occupational heat strain were wearing specialized cooling garments, (physiological) heat acclimation, improving aerobic fitness, cold water immersion, and applying ventilation. Although air-conditioning and cooling garments in ideal settings provide best scores for effectiveness, the limited applicability in certain industrial settings, high economic cost and high environmental impact are drawbacks for these solutions. However, (physiological) acclimatization, planned breaks, shading and optimized clothing properties are attractive alternative solutions when economic and ecological sustainability aspects are included in the overall evaluation.
DISCUSSION
Choosing the most effective solution or combinations of methods to mitigate occupational heat strain will be scenario-specific. However, this paper provides a framework for integrating effectiveness, cost, feasibility (indoors and outdoor) and ecologic sustainability to provide occupational health and safety professionals with evidence-based guidelines.
Topics: Climate Change; Global Health; Heat Stress Disorders; Humans; Occupational Health; Occupational Medicine; Stress, Physiological
PubMed: 32887627
DOI: 10.1186/s12940-020-00641-7 -
Occupational and Environmental Medicine May 2007The main findings from reports published in scientific journals on the criteria and methods used to assess fitness for work were reviewed. Systematic searches were made... (Review)
Review
The main findings from reports published in scientific journals on the criteria and methods used to assess fitness for work were reviewed. Systematic searches were made using internet engine searches (1966-2005) with related keywords. 39 reports were identified, mostly from the US and western Europe. Assessment of fitness for work is defined by most as the evaluation of a worker's capacity to work without risk to their own or others' health and safety. It is mainly assessed at recruitment (pre-offer or post-offer), and when changes of work or health conditions occur. Five main criteria used by occupational doctors to evaluate fitness for work were identified: the determination of worker's capacity and worker's risk in relation to his or her workplace, as well as ethical, economic and legal criteria. Most authors agreed that assessment tools used need to be specific and cost-effective, and probably none gives unequivocal answers. Outcomes from fitness for work assessments range from "fit" to "unfit", with other possible intermediate categories such as "fit subject to work modifications", "fit with restrictions" or "conditionally fit (temporarily, permanently)". Workplace modifications to improve or adjust working conditions must always be considered. There is confusion about the decision-making process to be used to judge about fitness for work. There is very scarce scientific evidence based on empirical data, probably because there are no standard or valid methodologies for all professions and circumstances.
Topics: Health Status; Humans; Occupational Diseases; Occupational Medicine; Work Capacity Evaluation; Work Schedule Tolerance
PubMed: 17095547
DOI: 10.1136/oem.2006.029397 -
Pain Physician 2008Appropriately developed practice guidelines present statements of best practice based on a thorough evaluation of the evidence from published studies on the outcomes of... (Review)
Review
BACKGROUND
Appropriately developed practice guidelines present statements of best practice based on a thorough evaluation of the evidence from published studies on the outcomes of treatments, which include the application of multiple methods for collecting and evaluating evidence for a wide range of clinical interventions and disciplines. However, the guidelines are neither infallible, nor a substitute for clinical judgment. While the guideline development process is a complex phenomenon, conflict of interest in guideline development and inappropriate methodologies must be avoided. It has been alleged that the guidelines by the American College of Occupational and Environmental Medicine (ACOEM) prevent injured workers from receiving the majority of medically necessary and appropriate interventional pain management services. An independent critical appraisal of both chapters of the ACOEM guidelines showed startling findings with a conclusion that these guidelines may not be applied in patient care as they scored below 30% in the majority of evaluations utilizing multiple standardized criteria.
OBJECTIVE
To reassess the evidence synthesis for the ACOEM guidelines for the low back pain and chronic pain chapters utilizing an expanded methodology, which includes the criteria included in the ACOEM guidelines with the addition of omitted literature and application of appropriate criteria.
METHODS
For reassessment, randomized trials were utilized as it was in the preparation of the guidelines. In this process, quality of evidence was assessed and recommendations were made based on grading recommendations of Guyatt et al. The level of evidence was determined utilizing the quality of evidence criteria developed by the U.S. Preventive Services Task Force (USPSTF), as well as the outdated quality of evidence criteria utilized by ACOEM in the guideline preparation. Methodologic quality of each individual article was assessed utilizing the Agency for Healthcare Research and Quality (AHRQ) methodologic assessment criteria for diagnostic interventions and Cochrane methodologic quality assessment criteria for therapeutic interventions.
RESULTS
The results of reassessment are vastly different from the conclusions derived by the ACOEM guidelines. The differences in strength of rating for the diagnosis of discogenic pain by provocation discography and facet joint pain by diagnostic facet joint nerve blocks is established with strong evidence. Therapeutic cervical and lumbar medial branch blocks and radiofrequency neurolysis, therapeutic thoracic medial branch blocks, cervical interlaminar epidural steroid injections, caudal epidural steroid injections, lumbar transforaminal epidural injections, percutaneous and endoscopic adhesiolysis, and spinal cord stimulation qualified for moderate to strong evidence. Additional insight is also provided for evidence rating for intradiscal electrothermal therapy (IDET), automated percutaneous disc decompression, and intrathecal implantables.
CONCLUSION
The reassessment and reevaluation of the low back and chronic pain chapters of the ACOEM guidelines present results that are vastly different from the published and proposed guidelines. Contrary to ACOEM's conclusions of insufficient evidence for most interventional techniques, the results illustrate moderate to strong evidence for most diagnostic and therapeutic interventional techniques.
Topics: Evidence-Based Medicine; Humans; Occupational Medicine; Pain Management; Practice Guidelines as Topic; Quality Assurance, Health Care
PubMed: 18690276
DOI: No ID Found