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Occupational diseases

Mental health Perspective 25 May 2026 Open Access

Psychosocial Hazards for Healthcare Workers: Supporting the Second Victim Also Helps the Primary Victims

The psychosocial hazards of healthcare are well-recognized and are now subject to new legislation in Australia. Missing from this discussion has been the recognition of the second victim phenomenon—the distress experienced by healthcare workers involved in an adverse event, medical error or unexpected patient outcome—which appears to meet criteria for a psychosocial hazard. Organizations should ensure support for second victims by building a restorative and just culture, including ensuring all staff are educated on the second victim phenomenon and can support their colleagues, implementing a staff peer-support programme and ensuring that specialist mental health supports, such as an employee assistance programme, are geared towards supporting the second victim.

Sarah Michael

Occupational diseases Editor's choice 5 August 2024 Free

Addressing the burdens of non‐communicable and occupational diseases: now is always the time

This issue of the MJA presents a broad mix of content. All of the articles warrant in‐depth discussion, both in the pages of the Journal and in other forums. Three articles in particular highlight the ongoing need, and means by which, to address non‐communicable diseases. Schutte and colleagues (https://doi.org/10.5694/mja2.52373) describe a roadmap to achieve 70% blood pressure control in Australia by 2030, under the auspices of the National Hypertension Taskforce of Australia (https://www.hypertension.org.au/the‐national‐hypertension‐taskforce/). Blood pressure is one of the leading causes of morbidity and premature mortality in Australia. Currently, blood pressure is effectively controlled (blood pressure<140/90mmHg) in only 32% of people with hypertension in Australia, an underwhelming figure compared with those of other countries with a high income economy. In response, the Taskforce has set a goal of achieving a world‐best 70% blood pressure control by 2030. They propose to achieve this through a model whereby 90% of cases are diagnosed, 90% of those diagnosed receive treatment, and 90% of those treated meet blood pressure targets; actioned through three pillars focusing on prevention, screening and detection, and effective treatment. The target and timeline are ambitious, but unbridled ambition is not unwarranted when dealing with one of Australia's greatest current health challenges. A key risk factor for hypertension is obesity; however, the health implications of obesity extend beyond the individual. There is growing awareness that maternal obesity is not only associated with higher risk of complications of pregnancy, including diabetes of pregnancy and preeclampsia, but also potentially of longer term cardiometabolic health consequences for the offspring. Within this context, the findings of Baker and colleagues (https://doi.org/10.5694/mja2.52387) reported in this issue become more concerning. They sought to map the changing prevalence of maternal obesity in Victoria over the decade from 2010 to 2019 and found that the proportion of births to women with obesity increased, while the proportion of births to women with a healthy weight decreased. These patterns were present in metropolitan areas, but were most pronounced in regional areas. This is consistent with the increase in population prevalence of obesity over the same time period and is concerning for the broader implications for the health of women and children. Combating the increasing rates of obesity within the Australian population, including maternal obesity, is a key goal of the National Obesity Strategy 2022–2032 (https://www.health.gov.au/resources/publications/national‐obesity‐strategy‐2022‐2032). As with the hypertension roadmap, success in achieving meaningful reductions to the burden of this disease will be difficult but are of the highest priority. The prevention of hypertension and obesity are both complicated by their complex multifactorial aetiologies. While addressing diseases caused by a single causal agent should be more straightforward, the history of industrial lung diseases indicates that they too are complicated. In a lessons from practice article, Thiruvarudchelvan and colleagues (https://doi.org/10.5694/mja2.52371) document a case of asbestosis in an Australian brake mechanic. In Australia, asbestosis and mesothelioma are best known within the context of workplace exposure, particularly within the mining and construction industries. Asbestos‐lined brake pads were phased out, with the final units being installed in 2003, as part of a broad prohibition of importation and sale of all asbestos‐containing products. As the authors note, asbestosis is rare in brake mechanics, owing in part to the physical nature of the asbestos used. Indeed, they believe this may be the first documented case in Australia and note that the latency between exposure and clinical presentation is consistent with a large epidemiological study from Denmark (https://doi.org/10.1136/thoraxjnl‐2020‐215041). This serves as a reminder that continued vigilance is also required in the ongoing battle against environmental exposures, including those in the workplace, which have a nasty habit of re‐emerging. Case in point being the recent evidence of silicosis in people working with engineered stone (https://doi.org/10.5694/mja16.00257), and the subsequent banning of such products in Australia, which came into effect in July 2024. While this is timely, it nonetheless comes almost a century after landmark industrial law reforms were enacted in the United States after 500–1000 workers died of silicosis in the worst industrial disaster in their nation's history (https://www.assp.org/docs/default‐source/psj‐articles/vpspencer_0223.pdf). Currently, over 20 years after asbestos was banned in Australia, approximately 4000 people per year still die from asbestos‐related diseases; the legacy of the extensive use of asbestos in the 20th century. A legacy that continues to evolve, with latent disease from rarer forms of exposure, such as that described in this issue, and in new and perhaps unforeseen ways, such as the recent widespread community concerns of asbestos‐contaminated mulch in parklands and beyond. These burdens of disease are largely beyond an individual's control. As such they warrant, and rely on, the ongoing action of government and leadership from health care authorities to seek to address their impact. The health of our population remains dependent upon it.

Michael Skilton

Environmental health Research 11 December 2023 Open Access

The burden of occupational injury attributable to high temperatures in Australia, 2014–19: a retrospective observational study

Adaptive measures and industry-based policies are needed to safeguard workplace health and safety, particularly in heat-exposed industries

Blesson M Varghese · Alana Hansen · Nick Mann · Jingwen Liu · Ying Zhang · Tim R Driscoll · Geoffrey G Morgan · Keith Dear · Anthony Capon · Michelle Gourley · Vanessa Prescott · Vergil Dolar · Peng Bi

Mja2 52171
Respiratory disease Perspectives 31 May 2021 Free

Dust diseases in modern Australia: a discussion of the new TSANZ position statement on respiratory surveillance

New measures are designed to improve health outcomes for workers in the coal mining, artificial stone and other dust‐generating industries In Australia, there has recently been a worrying resurgence of dust‐related lung diseases (pneumoconioses) previously assumed to be obsolete. Pneumoconioses are chronic fibrotic lung diseases produced by inhaling mineral dust or dusts (pneumon = lung; konis = dust [Greek]). Conditions include coal workers’ pneumoconiosis (black lung disease) and silicosis.1,2,3,4 Many cases of these diseases have been described in Australia for the first time in over 40 years, including a new type of accelerated silicosis caused by cutting and polishing engineered (artificial) stone seen in kitchen and bathroom benchtop workers.5,6 The latter has occurred in men, often at the height of their working lives, producing much disability and distress and resulting in completely preventable deaths. Artificial stone silicosis differs from other types of silicosis in that it progresses more rapidly and is also associated with a higher rate of development of autoimmunity than classical silicosis. Pneumoconiosis has recurred primarily due to a widespread failure of regulatory controls in a situation where the medical evidence for efficacy of surveillance and prevention is very well established.7,8,9 This has included deficiencies in dust monitoring and control, even in industries where lung health is notoriously at risk (eg, mining), as well as potential changes in dust exposure due to increases in length of shifts and changes in mining technologies.9,10,11 New technologies may have altered the types and characteristics of respirable dust particles as well as the total dust levels.4,12 In some industries, new products like artificial stone have been introduced without adequate awareness of likely hazards, alongside lack of labelling, inadequate respiratory protection, and widespread complacency about dust control measures.13 Dry cutting of stone is notoriously dangerous,7,8 yet was occurring frequently and is still not banned throughout Australia. Many employers (often in small businesses without access to any occupational medical advice) did not appreciate the potential hazards of products they were using, and were not warned by the regulators. Thus, they failed to assess the type or levels of respirable dusts, implement any health surveillance, or use even basic dust control measures.7,8 Because symptoms occur only very late in these diseases, workers were often unaware of any adverse effects. Many workplaces were non‐unionised and workers came from non‐English speaking backgrounds, and did not have access to information about dust hazards and ways to find help. Workers were reluctant to be identified because of job insecurity and financial concerns. Even after a respiratory abnormality had been identified, there was sometimes a failure to identify the disease as occupational in origin.10,11 It was only after cases of severe disease were described by the medical profession, and after several cases had been referred for lung transplantation, that the resurgence of pneumoconiosis was identified.3,4,5 These events are a stark reminder that occupational lung diseases are still a real issue in Australia and that we as health professionals need to maintain vigilance to prevent them in the future. As health professionals, we also need to be aware of the full range of health effects resulting from dust exposures. Inhaled dusts have been shown to cause a broader range of disorders than was originally understood.7,8,14 Pneumoconiosis is only one of several lung disorders which can arise from dust inhalation. In general, high dust levels are needed to produce lung fibrosis; however, other diseases have different, often lower, dose–response profiles. There is now convincing evidence that coal and silica/silicate dust inhalation also produces chronic bronchitis, emphysema and diffuse dust‐related pulmonary fibrosis,7,8,14 and that these effects are additive and not only attributable to tobacco smoking. It is also underappreciated that lung cancer and tuberculosis risk rises in a dose‐related manner after silica exposure, and particularly with silicosis itself.7,14,15 Dust exposure is a factor related to several systemic connective tissue diseases,16,17 including Sjögren’s syndrome, rheumatoid arthritis and mixed connective tissue disorder,18 and renal dysfunction has also been described.7,8 Positive auto‐antibodies are particularly common after artificial stone exposure.16 Clinicians must therefore be aware that inhaled dust produces a broader spectrum of disease than just pneumoconiosis. The primary management of pneumoconiosis has always been to reduce or stop dust exposure. This slows the rate of progression of disease and increases time from exposure to development of symptoms (or disease latency).7,8,19 This has been the rationale for respiratory surveillance programs, which involve regular assessment of a worker’s respiratory health in the workplace every few years, and usually include a questionnaire, spirometry and chest x‐ray, with reduction or removal from exposure once a threshold for early disease diagnosis has been reached. These programs have been the cornerstone of the reductions in incidence of pneumoconiosis worldwide19,20 and are compulsory for workers exposed to several dusts in most Australian states and territories. General practitioners often become involved in these programs either as examining doctors or after an abnormal result has been detected, and are key players in ensuring disease recognition, implementing appropriate work plans, and referring for support. It was because of serious concerns about disease resurgence that members of the Thoracic Society of Australia and New Zealand (TSANZ), Australia’s primary organisation representing respiratory health, developed recommendations in June 2016 aimed at controlling coal mine lung dust diseases.3 The TSANZ suggested standardisation of coal mine dust exposure limits throughout Australia, and alignment to international standards (which were generally lower levels than those in Australia). It also suggested a standardised national surveillance program for at‐risk workers and highlighted the need for better education regarding occupational hazards.3 Following media interest and political support, the federal government established a National Dust Disease Taskforce21 to establish a national approach to the prevention, early identification, control and management of occupational dust diseases. It supported establishing a National Dust Disease Register and provided some funds for new research.21 To assist with the forthcoming recommendations of this Taskforce, the TSANZ has reviewed the evidence and developed a position statement22 in light of advances in knowledge and new techniques available for diagnosing respiratory disease. Respiratory surveillance programs for pneumoconioses22 have been mainly based on the World Health Organization recommendations from the late 1970s,19 but respiratory medicine has advanced since those times, enabling detection of much earlier disease. Modern computed tomography scans provide excellent visualisation of lung anatomy at much lower radiation doses than before, and global initiatives have standardised lung function measurement and reporting.23 The gathering, storage and analysis of data have been revolutionised. In its position statement, the TSANZ recommends enhanced methods for respiratory surveillance of dust‐exposed workers using contemporary methods22 (Box 1). Despite legislated reductions in exposure limits,24,25,26,27 dust levels may not always achieve these limits, and workplace exposure data need to be collected and made available in a central repository to enable improved assessment of a worker’s likelihood of developing disease. This would also significantly improve existing understanding of dose–response relationships, especially with artificial stone. Periodic assessments of respiratory health need to involve a standardised format and high quality, standardised imaging and full lung function assessments. Workers with early abnormalities need to be optimally clinically assessed, treated where possible, and protected by suitable legislation from loss or downgrading of employment.22 Implementing such recommendations will inevitably involve detection of other lung disorders, including those which are non‐occupational in origin, and workers will be referred back to their GP for advice. It is therefore important that GPs understand the possible spectrum of diseases induced by dusts and other toxins, and obtain adequate and ongoing training in occupational lung disorders, including local support systems and when to refer for specialist advice (Box 2). The Royal Australian College of General Practitioners has a training resource for GPs which is a useful tool.28 Ultimately, such a system should prove beneficial to the health of both the individual and the community. However, it will require support and careful implementation in its initial stages. Early disease is difficult to distinguish in clinical practice from other lung pathologies, but difficulties in diagnosis can be overcome using modern techniques. International standards for diagnosis are available and new treatments are under evaluation. Multidisciplinary team meetings in hospitals have been established for respiratory disease diagnosis for many years and are now embedded nationally, and a similar system for occupational lung diseases would be a valuable addition to improving the diagnostic process. An occupational multidisciplinary team in each jurisdiction would bring together a wide range of specialties (primary care, occupational and respiratory medicine, occupational hygiene, radiology, pathology and allied health) and could assist hugely in improving diagnostic standards, improving expertise and disseminating information. This would be best advanced using new virtual technologies, which would also enhance involvement by community and rural physicians. The TSANZ recommendations represent best practice on the basis of existing information and need to evolve with new evidence. The TSANZ has also recommended careful evaluation of the efficacy of new measures using prospective studies, and updating in the light of new research. Changing the system would inevitably require increased resources. However, long term costs are likely to eventually decrease for health services and the economy, given the chronic debilitating nature of these preventable diseases. The TSANZ recommendations are a start in the process of re‐engaging industry and regulator, workers, doctors and politicians; hopefully, they will lead Australia towards a future where preventable death and disablement from occupational lung diseases does not occur. [Corrections added on 22 June 2021 after first online publication: the article title was amended and a footnote was added to Box 1.] Box 1 – Thoracic Society of Australia and New Zealand (TSANZ) proposed improvements to periodic health surveillance in the coal mining and artificial stone industries22 Regular training of staff in accordance with international standards of respiratory surveillance (including quality control and assurance). Plain chest radiographs to be performed using International Labour Organization recommended techniques, technically acceptable, with classification only by qualified thoracic radiologists, and compared with previous images. Individual spirometry to be performed according to American Thoracic Society/European Respiratory Society standards; results to be interpreted using reference values of the Global Lung Initiative. Serial data to be compared with longitudinal predicted values using the lower limit of normal to define lung function abnormality, and spirometry longitudinal data analysis software (SPIROLA). Dust monitoring to be performed under typical working conditions (≥ 75% capacity) and recorded using an accredited facility, with individualised data available for periodic surveillance. Extending surveillance methods for artificial stone exposure to potentially include low dose CT. Careful evaluation of the role of ultra low dose CT for coal miners and artificial stone workers in longitudinal prospective studies. Extending surveillance methods for all workers to include lung diffusing capacity (DLCO) at intervals of 3years or less; careful evaluation of such surveillance within longitudinal prospective studies. A flexible, individualised approach to the timing of surveillance of coal mine dust workers, including annual spirometry and DLCO if results are abnormal but do not yet fulfil diagnostic criteria for disease. Active case finding for artificial stone workers previously exposed to high respirable crystalline silica levels using conventional high resolution CT/spirometry/DLCO performed at accredited respiratory laboratories and radiological facilities using recommended protocols; follow‐up by expert treating specialists/teams, preferably at occupational respiratory disorder multidisciplinary team meetings. For artificial stone workers, pre‐employment plain chest radiographs to exclude major abnormalities. For artificial stone workers undergoing active case finding without abnormal chest x‐ray or high resolution CT, annual spirometry/DLCO and imaging 3‐yearly or more often depending on individual factors and test results. Chest x‐ray imaging to be complemented with high resolution CT scans in high risk groups (eg, borderline fibrosis found on plain chest radiographs and/or discrepancy with lung function findings). Improving existing medical databases to allow capacity to compare serial lung function data, occupational exposure history, imaging findings and dust measurements over time. Early evaluation of the diagnostic utility of best available tests (low dose CT, ultra low dose CT and DLCO) using data collected prospectively with consent from workers, ideally in a research setting. CT = computed tomography; DLCO = diffusing capacity of the lung for carbon monoxide. Adapted from: Perret et al. Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: a position statement from the Thoracic Society of Australia and New Zealand. https://doi.org/10.1111/resp.13952. Licence at http://creativecommons.org/licenses/by/4.0. Box 2 – How to manage a case of possible pneumoconiosis in primary care: first steps Be aware that many dusts, fumes and vapours can cause lung diseases. The time between exposure and disease occurrence (latency period) can be very long, usually years. Take time to go through a patient’s full occupational history in detail, from leaving school to retirement. A chronological table of jobs may help (www.atsdr.cdc.gov/csem/exphistory/docs/CSEMExposHist-26-29.pdf). If the patient uses technical descriptions of a particular job, make sure you know exactly what they mean. Ask them to describe exactly what was done. Ask about conditions in the job, including dust controls like ventilation, use of personal protective equipment, dust measurements and any workplace respiratory health surveillance. Ask about shifts, including length of time worked and any improvements in symptoms when away from work (especially on holidays). Ask whether any other workers were affected. Ask if the patient has access to any safety data sheets. These are information sheets which are meant to be made available from the employer if a worker is exposed to a potentially hazardous exposure (www.safeworkaustralia.gov.au/sds). If unavailable, search the internet for the suspected agent of concern, or contact the Australasian Faculty of Occupational and Environmental Medicine to find a suitable occupational physician and obtain advice (www.racp.edu.au/about/college-structure/australasian-faculty-of-occupational-and-environmental-medicine). Make contact with an occupational health practitioner if possible (an occupational physician and/or occupational health nurse and/or occupational hygienist). Small employers may not employ such specialists, but a local occupational health practitioner may be a local GP. Be careful not to contact a patient’s employer without obtaining permission first! Your local WorkSafe or similar government agency may be helpful in identifying a potential hazard and can often provide anonymous advice (ACT: www.worksafe.act.gov.au; New South Wales: www.icare.nsw.gov.au; Northern Territory: worksafe.nt.gov.au; Queensland: www.business.qld.gov.au/industries/mining-energy-water/resources/safety-health/mining; South Australia: www.safework.sa.gov.au; Tasmania: worksafe.tas.gov.au; Victoria: www.worksafe.vic.gov.au; Western Australia: www.workcover.wa.gov.au). Keep careful records of all the above. Negative information is also useful. Ensure that a complete history of the patient’s other risk factors (eg, tobacco use, other inhaled substance usage) is recorded. Obtain relevant investigations performed to recommended standards (spirometry, chest x‐ray, computed tomography scan if indicated). If there is reasonable suspicion of an occupational disease, refer to an occupational physician and/or a respiratory physician with occupational lung expertise (www.racp.edu.au/about/college-structure/australasian-faculty-of-occupational-and-environmental-medicine; www.thoracic.org.au). Costs of care may be covered by WorkCover if a link with employment is established, but this may take time to confirm. Standards for accepting an occupational disease vary in different jurisdictions and do not always accord with medical diagnoses. Other support is available to workers via their local SafeWork or similar government agency.

Deborah H Yates · Jennifer L Perret · Margaret Davidson · Susan E Miles · AW Musk

Mja2 51097
Infectious diseases Letters 3 August 2020 Free

Employee presenteeism and occupational acquisition of COVID‐19

To the Editor: The coronavirus disease 2019 (COVID‐19) pandemic has focused whole‐of‐government efforts on protecting Australia's health. Border closures, case quarantine, public health interventions and social distancing have controlled COVID‐19 case numbers, limiting community acquisition. Workplaces at particular risk of occupational exposure to COVID‐19 — hospitals, aged care facilities and, interestingly, abattoirs — require effective infection control. Presenteeism in this context refers to the occupational transmission risk that employees infected with severe acute respiratory syndrome coronavirus 2 pose by continuing to work despite being symptomatic. Such presenteeism may be an issue common to a number of industries.1 Occupational infection has occurred among Australian hospital staff, notably in North West Tasmania.2 Delayed recognition of COVID‐19 cases leading to infection control breaches, presenteeism with infected health care staff working for up to 7 days with respiratory symptoms, along with other factors all contributed to this hospital outbreak.2 In total, 73 of the 114 outbreak cases were hospital staff.2 Meat processing facility workers have been a notable at‐risk group in the United States, with over 4000 COVID‐19 cases reported, representing up to 3% of affected facility workforces and resulting in 20 COVID‐19 related deaths.3 In Australia, a COVID‐19 cluster was reported among abattoir workers in Melbourne.4 There are meat processing industry work practices that enhance COVID‐19 acquisition risks.4 Commonly, the layout of meat processing facilities challenges implementation of appropriate distancing between workers, who may be spaced as little as 30 cm from colleagues during routine operations. Compliance with wearing face masks is difficult given the pace and physical demands of work. Financial imperatives appear to motivate food processing employees to work even if unwell.3 Australian aged care workers and airline baggage handlers have also experienced COVID‐19 outbreaks. Despite concerns expressed by teachers and early childhood educators, as of 16 June 2020, no major outbreaks had occurred in schools and only one cluster had been reported in a NSW childcare centre.5 A NSW investigation of possible transmission in schools showed only two secondary cases in students.6 Some schools have been closed for deep cleaning after detection of community acquired cases of COVID‐19. Design and implementation of effective, industry specific, infection prevention policies are crucial for employer compliance with the Australian Work Health and Safety Strategy principle that “all workers, regardless of their occupation or how they are engaged, have the right to a healthy and safe working environment”.7 This requires strong, industry group, leadership. Recognition of workplace specific infection risks, provision of reliable personal protective equipment, redesign of work practices, discouragement of presenteeism, and improved access to sick leave must all be attended to for the sake of Australia's workforce.

Damon Eisen

Mja2 50688
General medicine Guideline summary 15 July 2019 Free

Diagnosing and managing work‐related mental health conditions in general practice: new Australian clinical practice guidelines

New Australian clinical practice guideline recommendations to assist GPs with the diagnosis and management of work-related mental health conditions

Danielle Mazza · Samantha P Chakraborty · Bianca Brijnath · Heather Nowak · Cate Howell · Trevor Brott · Michelle Atchison · David Gras · Justin Kenardy · Richard Buchanan · Seyram Tawia

Mja2 50240
Anaesthetics Letters 17 July 2017 Free

Wastewater analysis shows a large decrease in oxycodone use in Adelaide

To the Editor: In Adelaide, which comprises 78% of the population of South Australia, municipal wastewater has been subject to bimonthly analysis since 2009 to measure trends in substance use. Beginning in October 2015, there was a precipitous decrease in the detection of oxycodone residues in wastewater samples (Box). This decrease was counter to the long term trend of increasing amounts of this opioid in previous samples. Prescribing data show a continuing increase in the use of prescription opioid analgesics (POAs), including oxycodone, nationally and in SA, during the period between 1992 and 2011.1 There is a strong relationship between the amount of POAs used in a community and the amount of harm from opioid dependence and overdose.1 The cause of this regional trend change in oxycodone use has not been established. On 1 July 2015, there were some significant changes in the regulation of work injuries in SA which led to a decrease in the number of complex long term claimants, and there was also a similar change in South Australian motor vehicle injury regulation in July 2013. Complex injury claims are strongly correlated with POA use;2 however, the role of these factors is highly speculative and there may be many other factors that contributed to the results. The methods used for the bimonthly wastewater analysis in Adelaide have been published before,3 and another group used this process to report changes in population methamphetamine use in Queensland.4 From October 2015, there was a change in the established temporal trend for oxycodone residues detected in Adelaide wastewater (Box). However, over the same period, there is no such trend change for national Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS data for the number of oxycodone prescriptions dispensed (not total doses),5 or for Adelaide wastewater residues of methadone, which is predominantly dispensed for treatment of severe opioid use disorders via a specific program. A limitation of our investigations was that no regional oxycodone prescription or wastewater data from other jurisdictions were available for comparison. Nonetheless, our findings suggest that wastewater analysis could potentially be used to rapidly monitor changes in substance use on a regional basis. Box – Oxycodone and methadone residue in Adelaide wastewater compared with national data for the total number of oxycodone prescriptions supplied, December 2011 – February 20175 PBS = Pharmaceutical Benefits Scheme. RPBS = Repatriation Pharmaceutical Benefits Scheme.

Philip Crowley · Jason M White · Benjamin J Tscharke · Cobus Gerber

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