• 제목/요약/키워드: Occupational physicians

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Toxic Encephalopathy

  • Kim, Yangho;Kim, Jae Woo
    • Safety and Health at Work
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    • 제3권4호
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    • pp.243-256
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    • 2012
  • This article schematically reviews the clinical features, diagnostic approaches to, and toxicological implications of toxic encephalopathy. The review will focus on the most significant occupational causes of toxic encephalopathy. Chronic toxic encephalopathy, cerebellar syndrome, parkinsonism, and vascular encephalopathy are commonly encountered clinical syndromes of toxic encephalopathy. Few neurotoxins cause patients to present with pathognomonic neurological syndromes. The symptoms and signs of toxic encephalopathy may be mimicked by many psychiatric, metabolic, inflammatory, neoplastic, and degenerative diseases of the nervous system. Thus, the importance of good history-taking that considers exposure and a comprehensive neurological examination cannot be overemphasized in the diagnosis of toxic encephalopathy. Neuropsychological testing and neuroimaging typically play ancillary roles. The recognition of toxic encephalopathy is important because the correct diagnosis of occupational disease can prevent others (e.g., workers at the same worksite) from further harm by reducing their exposure to the toxin, and also often provides some indication of prognosis. Physicians must therefore be aware of the typical signs and symptoms of toxic encephalopathy, and close collaborations between neurologists and occupational physicians are needed to determine whether neurological disorders are related to occupational neurotoxin exposure.

미국 노인층 관절염 환자들의 성생활: 면담을 위한 질문서 개발 (Sexuality of Older Adults With Arthritis : The Development of an Interview Schedule)

  • 강대혁;로우랜드 오로라;밀러 패트리시아
    • 한국전문물리치료학회지
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    • 제7권4호
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    • pp.16-38
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    • 2000
  • 일상생활동작(activities of daily living)을 주요 목적이자 치료 수단으로 사용하고 있는 작업치료사들이 그 활동 중의 하나인 성적 욕구의 표현(sexual expression)에 대해 체계적인 접근이 미진하다는 지적을 극복 하고자 본 연구가 계획되었다. 특히 만성 장애가 있는 65세 이상 연령층의 성생활에 대해 기술적으로 접근하는 방법을 고안하는 것은 상당한 임상적 의미를 부여 할 수 있다. 본 연구의 주된 목적은 관절염이 65세 이상의 미국인의 성생활에 미치는 영향과 대책에 대한 논의를 작업치료사의 입장에서 자연스럽게 유도하기 위한 질문내용을 고안하는데 있다. 본 연구자들은 광범위한 문헌연구를 바탕으로 7개항의 질문을 작성하여 10명의 노인학 전공 작업치료사들에게 비평을 의뢰하였다. 7명의 작업치료사들이 전문가로서의 세밀한 답변을 해주었고 그들은 공통적으로 일상생활 중의 하나인 성생활이 삶의 질을 향상시키는데 매우 중요한 역할을 함을 강조하였다. 이들 전문가들의 조언을 바탕으로 새로운 질문서가 완성되었다.

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사전동의에 대한 의사, 간호사 및 환자의 인식과 경험 (Comparison of Perception and Experience of Informed Consent among Physicians, Nurses and Patients)

  • 안명숙;민혜숙
    • 임상간호연구
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    • 제14권2호
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    • pp.59-70
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    • 2008
  • Purpose: Purposes of this study were to promote understanding on mutually informed consent by comparing and analyzing the perception and experience of informed consent among physicians, nurses, and patients. Method: Participants in the study were 145 physicians, 300 nurses, and 178 patients from eight hospitals in Busan. To examine their understanding and experience with informed consent, all participants responded to a questionnaire. The collected data were analyzed using SPSS/PC 12.0 program. Results: On the necessity of informed consent, the affirmative percentages were 95.9% for physicians, 99.0% for nurses and 84.8% for patients. As to the most important reason for informed consent 47.6% of the physicians and 64.3% of the nurses answered 'because it is an occupational and ethical duty', while 46.6% of the patients answered 'because it is protection for physicians'. Regarding the legal decision maker for informed consent, 33.1% of the physicians, 27% of the nurses, and 42.1% of the patients answered that the legal decision-making right belonged to the 'patient'. The agreement rate on the necessity of providing a comprehensive explanation about informed consent was 89.0% for physicians, 98.3% for nurses, and 96.1% for patients. Conclusion: Most physicians, nurses, and even patients have inaccurate perceptions and inappropriate experience with informed consent.

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Impact of Coping and Communication Skills Program on Physician Burnout, Quality of Life, and Emotional Flooding

  • Penberthy, Jennifer K.;Chhabra, Dinesh;Ducar, Dallas M.;Avitabile, Nina;Lynch, Morgan;Khanna, Surbhi;Xu, Yiqin;Ait-Daoud, Nassima;Schorling, John
    • Safety and Health at Work
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    • 제9권4호
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    • pp.381-387
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    • 2018
  • Background: Physician behaviors that undermine a culture of safety have gained increasing attention as health-care organizations strive to create a culture of safety and reduce medical errors. We developed, implemented, and assessed a course to teach physicians skills regarding effective coping and interpersonal communication skills and present our results regarding outcomes. Methods: We examined a professional development program specifically designed to address unprofessional or distressed behaviors of physicians, and we evaluated the impact on burnout, quality of life, and emotional flooding scores of the physicians. Assessments of burnout, quality of life, and emotional flooding were assessed preintervention and postintervention. Results: Results demonstrated statistically significant reductions over time in physicians' emotional flooding and emotional exhaustion (EE). Specifically, using a Wilcoxon Signed-Rank test, results revealed that flooding scores at follow-up were statistically significantly lower than at baseline, V = 590, p < 0.05, and EE and personal accomplishment distributions were found to significantly deviate from normal as indicated by Shapiroe-Wilks tests (p < 0.05). A Wilcoxon signed-rank test indicated that EE scores were significantly higher at baseline compared to follow-up 1, V = 285, p < 0.05. Conclusion: We conclude that the physician participants who enrolled in the educational skills training program improved scores on emotional flooding and EE and that this may be indicative of improved skills related to their experiences and learning in the program. These improved skills in physicians may have a positive impact on the overall culture of safety in the health system setting.

Facilitators and Barriers in the Use of a Checklist by Insurance Physicians during Work Ability Assessments in Depressive Disorder

  • Blok, Sebastiaan;Gouttebarge, Vincent;Slebus, Frans G.;Sluiter, Judith K.;Frings-Dresen, Monique H.W.
    • Safety and Health at Work
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    • 제2권4호
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    • pp.328-335
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    • 2011
  • Objectives: Depressive disorder (DD) is a complex disease, and the assessment of work ability in patients with DD is also complicated. The checklist depression (CDp) has recently been developed to support such work ability assessments and has been recommended for implementation in insurance medicine, starting with an analysis of the organisational and social contexts. The aim of this study was to identify the potential facilitators and barriers in the use of the CDp by insurance physicians (IPs) during work ability assessments of employees on sick leave due to DD. Methods: A qualitative research was conducted based on semi-structured interviews. The participants were IPs with at least one year of work experience in performing work ability assessments. The interviews were audiotaped, transcribed and analysed qualitatively. Results: Ten IPs (7 males, 3 females; mean 53 years) were interviewed. Important facilitators, which emerged for use of the CDp, were an oral introduction for colleagues and staff, support from management, valuing the increased transparency in work ability assessments with using the CDp, having adequate time for assessments as well as modification of the appearance (colour, plasticised form) and content (clarifying aspects of the examples) of the assessment tool. The fear of the loss of autonomy, lack of added value of the CDp, high workload, inadequate instructions and lack of time were mentioned as barriers. Conclusion: Adequate introduction to the use of CDp and the fear of the loss of autonomy of IPs need special attention in planning its implementation.

직업성 피부질환에 대한 현황 파악 및 관리 대책 수립을 위한 연구 (A Study on the Establishment of Management Methods about Occupational Dermatoses)

  • 임현술;정해관;최병순;김지용;성열오;김양호
    • Journal of Preventive Medicine and Public Health
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    • 제29권3호
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    • pp.617-637
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    • 1996
  • Occupational dermatosis is one of the most prevalent occupational disorders. However, the extent of the occupational dermatoses including incidences and prevalencies of each disease entity, and etiologic materials are not yet welt stated in Korea. Authors reviewed the literatures on the statistic data and reports on the occupational dermatoses, and surveyed on the occupational dermatoses in two factories, and surveyed the physicians responsible to the occupational dermatoses with formed questionnaire. The results are as follows; 1. Among medical journals published since 1964, there were 31 articles on the occupational dermatoses. Of 31 articles, 18 were case reports and all others were review articles. Of 18 case reports, 9 were epidemiologic survey. The Workers' Periodic Health Examinations revealed that prevalence of the occupational dermatoses was highest(4.36 per 10,000 workers) in 1974, but number of the cases reported were decreased sharply since 1978 with some tendency to increase since 1981. There were 2,240 reported cases of occupational dermatoses between 1966 and 1992, which is 1.90% of all the reported occupational diseases. Skin infection and injuries due to chemicals were most frequent and there were 6 cases of skin cancer. 2. In an epidemiological survey on the dermatoses among 995 workers in a metal product manufacturing factory and 225 workers in a coal chemical factory, there were 794 with dermatomycosis, 296 workers with acne, 130 workers with scar, 123 workers with deformity of toe nails. Scars, photosensitivity dermatitis, deformity of finger and toe nails, and acne were more prevalent in the metal product manufacturing factory(p<0.05). In the metal prouct manufacturing factory, workers treating organic solvents and oils had more dermatoses than those without treating the materials(p<0.05). On the skin patch performed on 16 workers in the metal product manufacturing factory, there were 8 cases of irritation dermatitis and 5 cases of contact dermatitis. Prevalence of contact dermatitis in the metal product manufacturing factory was 1.3%. 3. On the questionnaire survey, 34 dermatologists, 29 doctors of preventive medicine, and 22 family physician replied. The proportion of occupational etiology among all dermatoses assumed by the physicians were below 9%, and the most important occupational dermatosis in Korea was contact dermatitis. Main etiologic materials related to the occupational dermatosis were organic solvent, acid and alkali, and metals. The reason for the scarcity of report of occupational dermatoses were difficulty in diagnosis and physician's ignorance of the occupational etiology. They replied that to prevent the occupational dermatoses in the workplace, the use of protective devices was most important, and development of diagnostic criteria on the occupational dermatoses is urgent. Above results shows us that there is many workers with occupational dermatoses, but they are mostly unreported. Measures to prevent and manage the occupational dermatoses are not satisfactory at present. Hence, authors suggest measures for the precise diagnosis, report and prevention of the occupational dermatoses. a. Dermatologist, preventive physician, and industrial hygienist should work as a team to examine the high risk group and establish the preventive measures. b. Disease entities, diagnostic criteria of occupational dermatoses should be listed, criteria for the compensation and job fitting at recruitment should be established, and manual for the proper treatment and effective prevention of each occupational dermatosis should be developed. c. Patch test antigens against each occupational category should be developed and it should be available to any physicians responsible. d. To facilitate the diagnosis of occupational dermatoses by the doctors responsible for the Workersr Periodic Health Examination, development of standardized questionnaire, education on the techniques of the patch test, and cooperation with the dermatologist in diagnosis of occupational dermatoses is essential.

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Occupational Exposure to Potentially Infectious Biological Material Among Physicians, Dentists, and Nurses at a University

  • Reis, Leonardo Amaral;La-Rotta, Ehidee Isabel Gomez;Diniz, Priscilla Barbosa;Aoki, Francisco Hideo;Jorge, Jacks
    • Safety and Health at Work
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    • 제10권4호
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    • pp.445-451
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    • 2019
  • Objective: The objective of this study was to evaluate the prevalence and incidence of accidents with biological material, the level of knowledge, and compliance to standard precautions (SPs) among dentists, physicians, nurses, and dental and medical students. Methods: A closed cohort study with a prospective and retrospective component was conducted between August 2014 and September 2015. The participants were contacted in two moments during the follow-up period, during which a structured questionnaire divided into six sections was used; the interviews were conducted during the follow-up period (Month 6) and at the end of the observation period (Month 12). Results: The global prevalence of accidents in the previous 12 months was 10.2%, with a difference between professionals and students (13.0% vs. 5.1%, respectively; p < 0.003). The incidence rate was 6.49 per 100 person/year, with difference between the groups (6.09 per 100 person/year in professionals and 7.26 per 100 person/year in students), type of specialization (hazard ratio, 3.27), and hours worked per week (hazard ratio, 2.27). The mean of compliance to SP was 31.99 (±3.85) points, with a median of 33 (30, 35) points against the expected 27.75 points. Adherence to SP was associated with the accident report (p < 0.020). Conclusion: We conclude that the proportion/incidence rate of accidents with biological material was high in relation to that in the literature, being higher in professionals and especially among physicians. The levels of knowledge and adherence to SP were good, with the best found in dentists and dental students.

Association Between Burnout and Intention to Emigrate in Peruvian health-care Workers

  • Anduaga-Beramendi, Alexander;Beas, Renato;Maticorena-Quevedo, Jesus;Mayta-Tristan, Percy
    • Safety and Health at Work
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    • 제10권1호
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    • pp.80-86
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    • 2019
  • Background: Emigration of health-care workers is a problem within global health systems which affects many countries, including Peru. Several factors have caused health-care workers to emigrate, including burnout syndrome (BS). This study aims to identify the association between BS and its dimensions with the intention of physicians and nurses to emigrate from Peru in 2014. Methods: A cross-sectional study, based on a secondary analysis of the National Survey of Health Users (ENSUSALUD - 2014) was conducted. Sampling was probabilistic, considering the 24 departments of Peru. We include the questionnaire for physicians and nurses, accounting for 5062 workers. BS was measured by the Maslach Burnout Inventory-Human Services Survey. Adjusted odds ratio (OR) was calculated using multiple logistic regression. Results: Of the study population, 44.1% were physicians, 37.7% males, and 23.1% were working in Lima. It was found that 2.8% [95% confidence interval (CI): 2.19-3.45] of health-care workers had BS. The overall prevalence of intention to emigrate among health-care workers was 7.4% (95% CI: 6.36-8.40). Association was found between BS and intention to emigrate in Peruvian health-care workers (OR = 2.15; 95% CI: 1.05-4.40). Emotional exhaustion was the BS dimension most associated with intention to emigrate (OR = 1.80; 95% CI: 1.16-2.78). Conclusion: Physicians and nurses from Peru who suffered from BS were more likely to have intention to emigrate. Policies should be established to reduce BS as a strategy to control "brain drain" from health-care workers of Peru.