Lawrence D. Budnick

Sleep and alertness in a 12-hour rotating shift work environment.

Industrial workers on rotating shifts were evaluated for the effects of rotating shift work. Twenty-five (86%) of 29 workers in the study area who work 12-hour shifts in a scheduled 16-day rotation participated. The mean number of hours of sleep at home after working day shifts (5.6 hours) was less than after the first three night shifts (6.0, 6.4, and 6.6 hours, respectively). At work, the mean number of hours at reported peak alertness was greater during the night shift (6.1 hours) than the day shift (4.9 hours), but the perceived alertness levels were relatively lower on the night shift. Increased perceived difficulty working and decreased perceived productivity and safety were reported on the first night of the night shift. We demonstrate that workers on rotating shift work exhibit low alertness-related outcomes on both shifts. These workers have early shift work starting times that appear to disrupt sleep patterns on both day and night shifts. At this work site, a number of interventions to lessen the effects of rotating shift work are being evaluated.

Guidance for Occupational Health Services in Medical Centers.

INTRODUCTION Guidance for Occupational Health Services in Medical Centers is dedicated to the memory of Dr. Geoff Kelafant who was tragically killed in a diving accident in March 2004. Geoff was the original author of a set of guidelines for the practice of occupational health in medical centers; his work established a format and content upon which we continue to expand with the current guidance document. Geoff’s enduring legacy is the profound impact he made upon medical center occupational health care in the United States and Canada.

Human factors in occupational medicine

Physicians should be knowledgeable of human factors (ergonomics) to address the workplace needs of their patients. Human factors is the discovery and application of principles concerning human capacities and capabilities to the design, evaluation, operation, and maintenance of the work system for the safe, effective, and satisfying use by people. Human factors encompasses a wide range of subjects that relate to the mutual interaction between the worker and the work system, which includes the following: the organization, the environment, and the workplace; the job and the tasks the worker performs; and the equipment and the tools used. The majority of work-related injuries and loss incidents have some contributory cause related to the interaction between the worker and the work system. The goal of human factors activities is to assess abnormal or excessive human stressors and minimize or eliminate the stress to improve performance and reliability and minimize error. Human factors is becoming an integral part of occupational medicine because it is increasingly important in the workplace. This overview of human factors emphasizes the current knowledge of prevention and intervention measures to enhance the functional quality of the workplace.

Protecting health care workers from tuberculosis

The resurgence in cases of active pulmonary tuberculosis (TB) and the emergence of drug-resistant strains of TB have increased the risk that health care workers (HCWs) may acquire serious TB infections which may not respond to usual therapy. Multiple steps are needed to reduce this risk. These include updated periodic training of HCWs to maintain awareness of potential risks of TB; optimizing the design, ventilation, and patient flow in clinical spaces; periodic TB surveillance testing of HCWs; appropriate use of effective respiratory protection; active infection control procedures; and periodic updating of written TB control plans.

Blood assay for tuberculosis: initial findings in a preplacement surveillance program.

To the Editor: The article by Philip Harber, MD, MPH, and Allen Ducaman, MD, MSc, “Training Pathways for Occupational Medicine,” in the April 2006 issue of the Journal, highlights what has been a concern of minefor some time. I have asked three former presidents of the American College of Occupational & Environmental Medicine about the issue of “Where are the new occupational medicine providers coming from?” I received thoughtful responses from all of them but never an answer to the question. They are all astute men but they are also astute politicians. As I go to my local and regional meetings of occupational medicine providers, I frequently see the “usual suspects.” The same faces—the same older, aging faces. As I am planning to attend my 25th reunion of my medical school classmates this August, I have to count myself as one of them. It is time for my colleagues to face the reality that we have made educational pathways perhaps too difficult for physicians interested in occupational medicine as a midcareer change to become board-certified. Too many purported practitioners of “occupational medicine” are really family practitioners or generalists who practice urgency care and learn through experience how to treat occupational injuries and develop their knowledge of the workers’ compensation system in the state they are operating in. This is clearly inadequate. Additionally, it appears, for the majority of us who do occupational medicine on a daily basis, the focus of occupational medicine residencies seems to be far too academic and focusing on the very rare occupational disorders that an experienced occupational medicine provider in a secondary or tertiary referral center will only see a few times in his or her career. More training in psychosocial issues that affect the workplace and a strong basis of understanding musculoskeletal medicine appear to be more appropriate fields of study and practical experience than some of the more esoteric pneumoconioses. Also quite remiss is our engagement and involvement with medical students early in their clinical training and having regular seminars for second-year and third-year medical students to expose them to occupational medicine to generate interest in the discipline as a career choice. I am grateful to Drs Harber and Ducaman for highlighting this issue in the journal; however, as I consider my potential successor at a busy, successful, and pure occupational medicine practice, I worry that I will not be able to find an occupational medicine practitioner board-certified in the field who is possessing the right skill set. My fervent hope is this article will focus the discussion within our specialty and we will act on easing the training required for physicians in other disciplines to transition to occupational medicine and raising interest in medical students to consider occupational medicine as a primary career path. Otherwise, we may find our field with a handful of academic practitioners and too many undertrained providers who learn occupational medicine by “trial and error” without having a firm grounding in occupational medicine’s history and the extensive wealth of knowledge occupational medicine practitioners benefit from. Drs Harber and Ducaman outline the issues, but are we really willing to act?

Influenza immunization among resident physicians in an urban teaching hospital

We surveyed resident physicians (RPs) at an academic medical center to determine the rate of influenza vaccination and reasons for nonvaccination. The overall self-reported immunization rate of RPs in 2013-2014 was 76.7%, and the most common reason for not being vaccinated was lack of time to get immunized (38.6%). Making flu vaccination available in training hospitals and at convenient locations and times that take into account varying work schedules may increase compliance.