Archive for July, 2010

The proportion of cancer survivors who return to work after cancer treatment has increased due to improved treatment of the disease (Taskila et al., 2007). Based on studies conducted since 2000, Taskila and colleagues estimated that 41 to 84% of cancer survivors are employed. Although most cancer survivors are able to return to work, some cancer survivors (21 to 31%) experience health impairments as a result of their disease which leads to a decrease in their ability to work or even disability. Past research suggests a supportive work environment facilitates return to work (RTW) of cancer survivors (Spelten et al., 2002).

The mechanism behind the effects of organizational social support on successful return to work of cancer survivors can be explored in light of Social Cognitive Theory (SCT). According to the SCT, the foundation of human motivation and action lies in an individual’s perceived self-efficacy (Bandura, 2004). Self-efficacy (SE) is defined as the confidence a person feels about performing a particular activity, including confidence in overcoming barriers to performing that behavior. Without a strong perception of SE, individuals have little incentive to act or to persevere in the face of difficulties.

Thus, a supportive organizational environment should increase the likelihood of successful return to work among cancer survivors through an increase in SE towards return to work. Although Social Cognitive Theory has not been applied to this field, qualitative research suggests that the work ability of cancer survivors (successful return to work) is associated with self-esteem. Results of one qualitative study showed that two-thirds of cancer survivors reported fatigue, cognitive difficulties, and loss of confidence affected their work ability (Amir, Neary & Luker, 2008). To date, only one intervention study designed to enhance RTW of cancer survivors has been published (Nieuwenhuijsen et al., 2006) and mostly unstandardized, study-specific instruments have been used to assess successful RTW (Spelten et al 2002). It would be interesting to see interventions that applied social cognitive theory as a theoretical framework to assess the relationship between perceived organizational support and successful return to work of cancer survivors, since improvements in cancer treatment are likely to increase the number of survivors who successfully return to the workforce.

Amir Z, Neary D, Luker K. (2008). Cancer survivors’ views of work 3 years post diagnosis: A

UK perspective. European Journal of Oncology Nursing. 12(3):190-197.

Bandura A. (2004). Health promotion by social cognitive means. Health Educ Behav.31(2):143

164. Available from: http://search.ebscohost.com.www5.sph.uth.tmc.edu:2048/login.aspx?direct=true&db=cmedm&AN=15090118&site=ehost-live.

Nieuwenhuijsen K, Bos-Ransdorp B, Uitterhoeve LLJ, Sprangers MAG, Verbeek JHAM.

(2006). Enhanced provider communication and patient education regarding return to work in cancer survivors following curative treatment: A pilot study. J Occup Rehabil.16(4):647-657.

Spelten ER, Sprangers MAG. (2002). Factors reported to influence the return to work of cancer

survivors: A literature review. Psychooncology.11(2):124-131. Available from: http://search.ebscohost.com.www5.sph.uth.tmc.edu:2048/login.aspx?direct=true&db=a9h&AN=11819381&site=ehost-live.

Taskila T, Martikainen R, Hietanen P, Lindbohm ML. (2007). Comparative study of work ability

between cancer survivors and their referents. Eur J Cancer.43(5):914-920.


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Dispersants are being used in the Gulf of Mexico in response to the BP oil well tragedy earlier this year.  According to the CDC, dispersants are applied to remove surface level oil by breaking it up into small droplets.  The droplets are then mixed with the water and diluted.  The two dispersants used contain a non-hazardous detergent and propylene glycol in addition to petroleum distillates.  2-butoxyethanol or butyl cellosolve, another component, has been shown  to irritate the skin and cause respiratory irritation.1

NIOSH  has recommendations for procedures to follow and equipment to use to minimize exposure to 2-butoxyethanol and similar agents1; however, not all workers are being informed of the hazards.  They are also not being supplied the necessary PPE.  Also from late April to mid-July, the federal government has reported a total of 571 illnesses and 757 injuries related to the containment of the oil spill and related cleanup work.  Some of the problems include symptoms associated with 2-butoxyethanol exposure.2

Are BP and its affiliated companies taking the necessary steps to protect all workers associated with the oil spill clean up? 


1. CDC – Oil Spill Response Resources – Reducing Occupational Exposures while Working with Dispersants – NIOSH Workplace Safety and Health Topic [Internet] [cited 2010 7/27/2010]. Available from: http://www.cdc.gov.www5.sph.uth.tmc.edu:2048/niosh/topics/oilspillresponse/dispersants.html.

2. ‘People Are Getting Sick,’ Cleanup Worker Says – New Orleans News Story – WDSU New Orleans [Internet] [cited 2010 7/27/2010]. Available from: http://www.wdsu.com/news/24341576/detail.html.

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Some employers assume that stressful working conditions are a necessary evil-that companies must turn up the pressure on workers and set aside health concerns to remain productive and profitable in today’s economy. But research findings challenge this belief. Studies show that stressful working conditions are actually associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs-all of which have a negative effect on the bottom line.

Recent studies of so-called healthy organizations suggest that policies benefiting worker health also benefit the bottom line. A healthy organization is defined as one that has low rates of illness, injury, and disability in its workforce and is also competitive in the marketplace. NIOSH research has identified organizational characteristics associated with both healthy, low-stress work and high levels of productivity. Examples of these characteristics include the following:

  • Recognition of employees for good work performance
  • Opportunities for career development
  • An organizational culture that values the individual worker
  • Management actions that are consistent with organizational values

According to NIOSH:

  • 40% of workers reported their job was very or extremely stressful;
  • 25% view their jobs as the number one stressor in their lives;
  • Three fourths of employees believe that workers have more on-the-job stress than a generation ago;
  • 29% of workers felt quite a bit or extremely stressed at work;
  • 26 percent of workers said they were “often or very often burned out or stressed by their work”;
  • Job stress is more strongly associated with health complaints than financial or family problems.
  • My conclusion: I don’t want to die of a heart attack at work as my dad, I want a better life.

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    I recently received an email from an OSHA news release: Whistleblowers.gov

    “The Web page will provide information about worker rights and provisions under each of the whistleblower statutes and regulations that OSHA enforces.  Additionally, program fact sheets and information are available that discuss how one can file a retaliation complaint with OSHA. This Web page will continue to be accessible through OSHA’s Web site, www.osha.gov, by clicking on the “Whistleblower Protection” link.”

    The question is, of course, will workers use this website? Language barriers? What do you think?

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    I have been thinking about the blog name “Working to death” and I realized that even though some of us are not exposed to chemical work hazards, we are under a huge occupational stress and that hazards is hard to measure and quantify.

    The human body has a natural chemical response to a threat or demand, commonly known as the “flight or fight” reaction, which includes the release of adrenalin. Once the threat or demand is over the body can return to its natural state. A STRESSOR is an event or set of conditions that causes a stress response. STRESS is the body’s physiological response to the stressor, and STRAIN is the body’s longer-term reaction to chronic stress.

    Occupational stress can affect your health when the stressors of the workplace exceed the employee’s ability to have some control over their situation or to cope in other ways. For example:


    ⇒efforts: the workload is the STRESSOR Workers are overburdened with workloads that remain high regardless of their⇒their workloads: that is STRESS

    Employees feel anxious and their heart rate speeds up because they can not control

    Increased blood pressure, insomnia, or chronic headaches: that is STRAIN

    So what are u doing to get over work stress and live a better life.

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    Overtime Kills

    An article in the European Heart Journal from May 25, 2010 explores the long-term effects of overtime on the incidence of Coronary Heart Disease in a cohort of civil servants in the UK (Overtime work and incident coronary heart
    disease: the Whitehall II prospective cohort study).

    The Whitehall II cohort comprised over 10,000 government office workers recruited from London between late 1985 and early 1988, and followed up 8 times through 2009.

    Average daily working hours were assessed by self-report on the follow-up questionnaire. The reported hours were tallied up and categorized into several groups: normal work day (7-8 hours/day), 1 hour of overtime (9 hours/day), 2 hours overtime (10 hours/day), and 3-4 hours of overtime (11-12 hours/day). The outcome of CHD was defined as the time to incident definite angina, incident non-fatal myocardial infarction (MI), or CHD-related death. National Health Service medical records were used for case ascertainment.

    Forty-six percent of the cohort usually worked overtime; roughly a fifth worked one hour of overtime, fifteen percent worked two hours overtime, and the other ten percent worked three or four extra hours per day. The authors built a series of nested Cox proportional hazard models, adjusting for a variety of psycho-social and medical variables. In all models there was a non-significant dose-response relationship between overtime hours worked and risk of CHD as compared to the no-overtime group. In the 3-4 hour/day overtime group there was a statistically significant increase in CHD of between 1.60 and 1.67 depending on the model used.

    The authors also fit models to a secondary CHD outcome variable, using only death from CHD or incident MI as the outcome events. This model showed the same pattern as the first set: the lower over-time groups had a statistically insignificant increase in risk, while the highest overtime group had a significant increase in risk.  However, this time the point estimates on the hazard ratios were higher. For the 3-4 hour group the hazard ratios were between 1.67 and 1.98.

    This study’s obvious weakness is the self-report nature of the exposure, overtime worked. Nevertheless, the results of this study are in line with what one would expect: people who work 55+ hours per week are at increased risk of CHD. Whether this is due to stress or the impact of such a schedule on overall lifestyle is debatable. What is clear is that if you want to live longer it may not be such a bad idea to punch the clock.

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    There are roughly 5,000 antimicrobial pesticide products registered with the U.S. Environmental Protection Agency, and about 60% of these are targeted to control infections organisms in the health care setting.1 I guess we can’t expect Purell really “make it a touchable world”. I mean with MRSA, XRSA, and VRE becoming more rampant in hospitals it’s important that health care professionals eliminate the risk of nosocomial infections. Unfortunately, it seems that aside from my already increased risk of obtaining numerous of diseases just by being a future physician I am also at an increased risk for obtaining antimicrobial pesticide related illnesses because of these very sanitary products used to prevent disease. The irony.

    The CDC analyzed data from pesticide poisoning surveillance programs in California, Louisiana, Michigan, and Texas (the only four states that regularly collect data on antimicrobial pesticide-related illness) for the period 2002—2007 in health care facilities. Most cases occurred among females (82% – phew!) and persons aged 25–54 years (73% – dang). The most frequent occupations reported were janitors/housekeepers (24%) and nursing/medical assistants (16%). The reported mechanism of injury usually was splashes/spills (51%). The eyes were the most common organ/system affected (55%); only 15% of the 265 persons who had exposures while handling antimicrobial pesticides reported using eye protection.2

    The chemicals responsible for most health-care facility cases were QACs, glutaraldehyde, and sodium hypochlorite (bleach). QACs are widely used to disinfect environmental surfaces or medical equipment designed for skin contact (i.e. blood pressure cuffs). Glutaraldehyde is used as an immersion chemical in disinfecting heat-sensitive medical equipment (i.e. endoscopes). Sodium hypochlorite is used in environmental sanitization and decontaminating blood spills.3 These chemicals can cause irritant symptoms involving the eyes, skin, and respiratory tract; QACs and glutaraldehyde are known sensitizers.4 While using these chemicals, eye and skin protection is required to prevent irritant health effects and splash hazards but who really uses these? Time constraints often cause healthcare workers to quickly clean up between patients in order to see the largest number of them available. In doing so, they get to help more people and the hospital gets more money – A win-win situation (when it’s really lose-lose).

    Hazardous exposure to antimicrobial pesticides and subsequent illnesses can be minimized through safe work practices and effective communication. Health-care facilities should be reminded to choose less hazardous antimicrobial pesticide products, inform employees of the health hazards of antimicrobials used in their facilities, and provide training on the safe handling of antimicrobial pesticides in accordance with label instructions. Although our first concern in the hospital is always the risk of contracting disease or getting shot in the OR by an angered patient (in case you watch Grey’s Anatomy), the last thing we think about is how chemicals used to reduce our possibility of getting us ill actually make us ill.


    1. US Environmental Protection Agency. What are antimicrobial pesticides? Available at http://www.epa.gov/oppad001/ad_info.htm
    2. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a2.htm
    3. CDC. Guideline for disinfection and sterilization in health-care facilities, 2008. Available at http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/disinfection_nov_2008.pdf
    4. Pechter E, Davis LK, Tumpowsky C, et al. Work-related asthma among health care workers: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993-1997. Am J Ind Med 2005;47:265–75.

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