Preview: Occupational Medicine - current issue
Occupational Medicine Current Issue
Published: Tue, 03 Jan 2017 00:00:00 GMT
Last Build Date: Sun, 15 Jan 2017 01:45:55 GMT
Occupational health issues in the USA
The occupational health and safety issues facing employers, workers, medical practitioners and researchers in the USA are numerous. Many occupational safety and health issues affecting workers in the USA cut across several industry sectors, while others are specific to a particular sector. The US National Occupational Research Agenda (NORA) is a public–private partnership hosted by the US National Institute for Occupational Safety and Health (NIOSH) to stimulate innovative occupational safety and health research and practices. Unveiled in 1996, NORA has become a research framework for the USA. The list of NORA research priorities is long. What follows is a few of the many issues that the NORA industry sectors in the USA have identified as needing the attention of occupational safety and health researchers and practitioners.
In This Issue of Occupational Medicine
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. In England and Wales, it is estimated that there are currently 900000 diagnosed cases, and an estimated 2 million people are thought to have the disease but remain undiagnosed. The primary cause is cigarette smoking, accounting for 80% of the disease burden but other environmental risk factors have been identified including coal, cadmium, silica and biomass. Occupational Medicine has previously published evidence-based guidance for the management of workers with COPD . In this issue, Reynolds et al. studied Welsh slate miners using data from the 1975 cross-sectional survey carried out by the Medical Research Council (Pneumoconiosis Unit) . They found that those who worked in slate mining had reduced lung function which could not be wholly explained by smoking or pneumoconiosis. In never-smokers, there were significant reductions in lung function in miners but no statistically significant increase in COPD. The authors recommend that occupational health providers to slate mines should seek to minimize slate dust exposure and consider workplace surveillance measures for COPD. They note that slate miners are exposed to slate dust containing respirable crystalline silica (RCS). The Health & Safety Executive (HSE) have recently issued renewed guidelines on health surveillance for those exposed to RCS and this now includes a requirement for periodic chest x-rays . However, the workplace exposure level remains unchanged at 0.1 mg·m3 whilst other countries are reducing their exposure levels. The USA have reduced their exposure level to 0.05 mg·m3 which if implemented is more likely to prevent silicosis than health surveillance alone.
Ready, Fire, Aim!
Early on in my career as an occupational physician, I spent a number of years working for a French multinational company. Once established, I was sent to France for 3 months of company immersion. There were 47 of us, half newly recruited from the grand écoles, the elite of the French educational system. The remainder were experienced managers either from France or foreigners like myself from throughout Europe and America. We were now cadre, the professional elite in an egalitarian republic. All male, we were engineers and production managers, accountants and computer programmers, personnel managers and designers, cartographers and chemists and a doctor.
The Nurses Work Functioning Questionnaire (NWFQ)
Stress, anxiety and depression are common mental health disorders in many working populations, including in health care workers such as nurses and allied health professionals (AHPs). These symptoms can adversely affect work productivity , patient safety and the quality of care [2,3].
Occupational Medicine Calendar
2017DateEventContact AddressVenueFebruary 8–11Indian Association of Occupational Health 67th Annual Conference 2017http://occucon.com/New Delhi, IndiaApril 23–26Annual American Occupational Health Conference (102nd AOHC)http://www.acoem.org/educational_conferences.aspxDenver. ColoradoApril 29 – May 4American Aerospace Medical Association Annual Meetinghttps://www.asma.org/scientific-meetings/asma-annual-scientific-meeting/future-annual-meetingsDenver, ColoradoJune 26–28SOM/FOM Conference 2017http://occupationalhealthconferences.comLeedsAugust 19–23The Australian & New Zealand Society of Occupational Medicine Annual Scientific meetinghttp://www.anzsom.org.au/Fremantle, Western AustraliaAugust 28–312017 EPICOH meetinghttps://epicoh2017.orgEdinburghNovember 1–410th European Public Health Conference 2017. Sustaining resilient and healthy communitieshttp://www.ephconferences.euStockholm, Sweden
Improving the assessment of occupational diseases by occupational physicians
BackgroundThe prevention of occupational diseases is limited by a lack of insight into occupational exposure to risk. We developed a six-step approach to improve the diagnosis and reporting of occupational diseases and the selection of subsequent preventive actions by occupational physicians (OPs).
AimsTo evaluate the effect of the six-step approach on the transparency and quality of assessing occupational diseases and the usability of the six-step approach according to OPs and their satisfaction with it.
MethodsA randomized controlled trial. OPs in the control group used the standard information available. OPs in the intervention group used the six-step approach and accompanying educational materials. The actions and decisions of OPs in both groups were analysed using 17 performance indicators. To address the second issue, OPs used the six-step approach over 6 weeks and rated its usability and their satisfaction in relation to several aspects.
ResultsThe average score of the OPs in the intervention group (n = 110) was statistically significantly higher (11/17 performance indicators, 62% of the maximum score) than that of the OPs in the control group (n = 120, 5/17 performance indicators, 30% of the maximum score, P < 0.001). The usability aspects of the six-step approach had mean scores of 7 and 8. Mean satisfaction with the six-step approach was 8.
ConclusionsThe six-step approach resulted in better evidence-based and transparent decision-making about occupational diseases by OPs. Usability and satisfaction were rated as satisfactory by the OPs.
Deprivation, occupational hazards and perinatal outcomes in pregnant workers
BackgroundRecent global economic difficulties have widened social inequalities, but their impact on pregnant workers is not known.
AimsTo investigate the association between deprivation, exposure to occupational hazards and adverse perinatal outcomes in pregnant workers.
MethodsA cross-sectional study performed in 2014 in French occupational health services. Eligible workers were women who had worked during their pregnancy and had a medical visit by occupational health physicians (OHPs) after delivery and at the time of returning to work. Deprivation was measured using the EPICES scale (Evaluation of Precariousness and Inequalities in Health Examination Centres). Information on birth outcomes was self-reported. Occupational risks for pregnancy were assessed by OHPs. Jobs were coded by the occupational health team using standardized French nomenclature. The groups (deprivation/no deprivation) were compared using univariate (chi-squared test) and multivariate Poisson regression analyses.
ResultsOf 1402 pregnant workers, 293 (21%) were classed as deprived. This group more frequently encountered occupational hazards, particularly for physical exposures (P < 0.001), and had a higher risk of cumulated occupational hazards of three or more for pregnancy [adjusted relative risk (RRa) = 4.2; 95% confidence interval (CI) 2.2–7.9]. Our findings suggest that deprivation and exposure to three or more occupational hazards during pregnancy cumulatively increased the risk of pre-term birth (RRa = 3.9; 95% CI 1.2–12.4).
ConclusionsOur data suggest that deprived pregnant workers are an occupationally vulnerable group.
Predicting absenteeism: screening for work ability or burnout
BackgroundIn determining the predictors of occupational health problems, two factors can be distinguished: personal (work ability) factors and work-related factors (burnout, job characteristics). However, these risk factors are hardly ever combined and it is not clear whether burnout or work ability best predicts absenteeism.
AimsTo relate measures of work ability, burnout and job characteristics to absenteeism as the indicators of occupational health problems.
MethodsSurvey data on work ability, burnout and job characteristics from a Dutch university were related to the absenteeism data from the university’s occupational health and safety database in the year following the survey study. The survey contained the Work Ability Index (WAI), Utrecht Burnout Scale (UBOS) and seven job characteristics from the Questionnaire on Experience and Evaluation of Work (QEEW).
ResultsThere were 242 employees in the study group. Logistic regression analyses revealed that job characteristics did not predict absenteeism. Exceptional absenteeism was most consistently predicted by the WAI dimensions ‘employees’ own prognosis of work ability in two years from now’ and ‘mental resources/vitality’ and the burnout dimension ‘emotional exhaustion’. Other significant predictors of exceptional absenteeism frequency included estimated work impairment due to diseases (WAI) and feelings of depersonalization or emotional distance from the work (burnout).
ConclusionsAbsenteeism among university personnel was best predicted by a combination of work ability and burnout. As a result, measures to prevent absenteeism and health problems may best be aimed at improving an individual’s work ability and/or preventing the occurrence of burnout.
Checklist for psychosocial risk evaluation: a prospective evaluation study
BackgroundAlthough psychosocial risk evaluation (PRE) is legally required, implementation is often suboptimal. Occupational health specialists face various challenges in implementing a systematic PRE process.
AimsTo evaluate if a checklist strengthens the competencies of occupational physicians in PRE design and implementation.
MethodsA prospective pilot survey with a baseline and follow-up assessment at 12 months was conducted with occupational physicians who applied the checklist. Three outcome criteria were assessed: (i) physicians’ general competence in PRE, (ii) physicians’ self-reported skills in PRE and (iii) feasibility of the checklist.
ResultsTwenty-four occupational physicians participated. Checklist users reported increased competence in PRE at follow-up, increasing in competence twice as much as physicians who did not use the checklist during the study period although this was not statistically significant. With regard to specific skills over time, checklist users reported increased knowledge of the PRE procedure (P < 0.05), as well as increased strategic planning for PRE (P < 0.01). All feasibility criteria were rated positively.
ConclusionsOur checklist may help occupational health clinicians to overcome the barriers that are responsible for the gap between official recommendations and occupational health and safety practice in PRE. However, our results are based on a preliminary study with a limited sample size.
Chronic obstructive pulmonary disease in Welsh slate miners
BackgroundExposure to respirable crystalline silica (RCS) causes emphysema, airflow limitation and chronic obstructive pulmonary disease (COPD). Slate miners are exposed to slate dust containing RCS but their COPD risk has not previously been studied.
AimsTo study the cumulative effect of mining on lung function and risk of COPD in a cohort of Welsh slate miners and whether these were independent of smoking and pneumoconiosis.
MethodsThe study was based on a secondary analysis of Medical Research Council (MRC) survey data. COPD was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio <0.7. We created multivariable models to assess the association between mining and lung function after adjusting for age and smoking status. We used linear regression models for FEV1 and FVC and logistic regression for COPD.
ResultsIn the original MRC study, 1255 men participated (726 slate miners, 529 unexposed non-miners). COPD was significantly more common in miners (n = 213, 33%) than non-miners (n = 120, 26%), P < 0.05. There was no statistically significant difference in risk of COPD between miners and non-miners when analysis was limited to non-smokers or those without radiographic evidence of pneumoconiosis. After adjustment for smoking, slate mining was associated with a reduction in %predicted FEV1 [β coefficient = −3.97, 95% confidence interval (CI) −6.65, −1.29] and FVC (β coefficient = −2.32, 95% CI −4.31, −0.33) and increased risk of COPD (odds ratio: 1.38, 95% CI 1.06, 1.81).
ConclusionsSlate mining may reduce lung function and increase the incidence of COPD independently of smoking and pneumoconiosis.
Health-related behaviours and mental health in Hong Kong employees
BackgroundPoor physical and mental health in employees can result in a serious loss of productivity. Early detection and management of unhealthy behaviours and mental health symptoms can prevent productivity loss and foster healthy workplaces.
AimsTo examine health-related behaviours, mental health status and help-seeking patterns in employees, across different industries in Hong Kong.
MethodsParticipants were telephone-interviewed and assessed using the Case-finding and Help Assessment Tool (CHAT) with employee lifestyle risk factors, mental health issues and help-seeking intentions screened across eight industries. Subsequent data analysis involved descriptive statistics and chi-square tests.
ResultsThere were 1031 participants. Key stressors were work (30%), family (19%), money (14%) and interpersonal issues (5%). Approximately 18, 9 and 9% of participants were smokers, drinkers and gamblers, respectively, and only 51% exercised regularly. Depressive and anxiety symptoms were reported by 24 and 31% of employees, respectively. Issues for which they wanted immediate help were interpersonal abuse (16%), anxiety (15%), anger control (14%) and depression (14%). Employees with higher educational attainment were less likely to smoke, drink and gamble than those with lower attainment. Lifestyle and mental health status were not associated with income. Employees in construction and hotel industries smoked more and those in manufacturing drank more than those in other industries.
ConclusionsPhysical and mental health of Hong Kong employees are concerning. Although employee assistance programmes are common among large companies, initiation of proactive engagement approaches, reaching out to those employees in need and unlikely to seek help for mental health issues, may be useful.
Illness behaviour of general practitioners—a cross-sectional survey
BackgroundInternational guidelines recommend that physicians should be registered with a general practitioner (GP) and should avoid self-treatment. Adherence to these recommendations is mixed.
AimsTo describe illness behaviour and chronic medical conditions of GPs in Germany.
MethodsCross-sectional, observational questionnaire study. We contacted 1000 GPs by mail in April 2014. We asked about registration with a GP, chronic conditions and self-treatment. We undertook descriptive statistical analysis and analysed associations using t-tests and chi-square test.
ResultsTwo hundred and eighty-five responses (29%) were eligible for analysis. Nineteen per cent of GPs were registered as patients of a GP, 58% reported at least one chronic condition, 68% disclosed self-diagnosis and 60% self-treatment. Self-therapy for chronic conditions was inversely correlated with subjective severity of the disease (r = −0.159; P < 0.05).
ConclusionsThe high rates of self-treatment and the low rate of registration with a GP of German GPs are in contrast to international guideline recommendations. Further research is needed to analyse specific reasons.
Cardiorespiratory fitness testing and cardiovascular disease risk in male steelworkers
BackgroundThe workplace has been advocated as a setting to perform cardiovascular disease (CVD) risk assessments. These risk assessments usually focus on traditional risk factors rather than cardiorespiratory fitness (CRF) despite established associations between CRF and CVD. The lack of guidance on interpreting health-related CRF values has been suggested as a barrier to utilizing CRF in practice.
AimsTo assess the merits of CRF testing in the workplace and explore whether a CRF value identified male individuals above the recommended threshold for further clinical investigation.
MethodsCross-sectional analysis of male steelworkers from Carmarthenshire, South Wales, UK who completed a workplace-based CVD risk assessment with an added CRF protocol based on heart rate responses (Chester Step Test). Receiver operating characteristic (ROC) analysis was undertaken to explore the possibility of a CRF value to identify individuals at an increased 10-year risk of CVD (QRISK2 ≥ 10%).
ResultsThere were 81 participants. ROC analysis revealed that a CRF level of 34.5ml/kg/min identified those individuals above the ≥10% QRISK2 threshold with the best sensitivity (0.800) and specificity (0.687) to discriminate against true- and false-positive rates. Further analysis revealed that individuals with either ‘Average’ or ‘Below Average’ CRF would be five times more likely to have a 10-year CVD risk above the ≥10% QRISK2 threshold than individuals with an ‘Excellent’ or ‘Good’ level of fitness [OR 5.10 (95% CI 1.60–16.3)].
ConclusionsThis study suggests CRF assessments are a useful addition to a workplace CVD assessment and could identify male individuals at increased predicted risk of the condition.
Incidence of tuberculosis among nurses and healthcare assistants in France
BackgroundHealth care workers (HCWs) are considered to be at higher risk of tuberculosis (TB) than the general population. However, a decreasing incidence in the general population as well as improvement in preventive measures in hospitals has reduced the risk for HCWs.
AimsTo quantify the actual incidence of TB in nurses and health care assistants in a low-incidence country.
MethodsWe performed a retrospective study of 80 hospitals throughout France, employing 233389 health care staff (physicians excluded). We calculated the number of pulmonary TB cases over 3 years (700166 person-years) and the total number of staff members in each job category (nurses, health care assistants, administrative staff) in each hospital, to calculate the incidence.
ResultsOverall, the incidence rate varied between 1.27 and 6/100000 for administrative staff and nurses, respectively (non-significant difference). The incidence varied according to the geographical area. However, the incidence in nurses and health care assistants was not different from the general population (7.5/100000).
ConclusionsIn a low-incidence country, such as France, the implementation of measures to prevent occupational TB among HCWs has been effective. These preventive measures should be maintained but medical follow-up could be revised.
Obesity prevalence and accuracy of BMI-defined obesity in Russian firefighters
BackgroundNo data exist on obesity or the accuracy of body mass index (BMI) in Russian Federation firefighters.
AimsTo determine the prevalence of obesity and rates of misclassification of BMI-based obesity status.
MethodsCareer firefighters in the Moscow region completed anthropometric assessments including height, weight, BMI, body fat per cent (BF%) and waist circumference (WC). Using these three methods, we defined obesity as BMI ≥30, BF% >25 and WC >102, respectively.
ResultsThe study group consisted of 167 male firefighters. Obesity prevalence was 22% for BMI [95% confidence interval (CI) 16.9–28.5], 60% for BF% (95% CI 52.5–67.3) and 28% for WC (95% CI 21.3–34.9). False positive rates for BMI-based obesity status were low, with 3% (95% CI −1.1 to 7.1) and 6% (95% CI 1.6–9.9) of non-obese participants defined by BF% and WC standards misidentified as obese using BMI. However, 65% (95% CI 55.7–77.4) of BF%-defined obese participants and 36% (95% CI 22.5–49.9) of WC-defined obese participants were misclassified as non-obese using BMI (i.e. false negatives).
ConclusionsRates of BMI-based obesity in Russian male firefighters were similar to that of males in the general Russian adult male population. Compared with BF% or WC standards, BMI-based obesity classi- fication produced low rates of false positives but demonstrated high rates of false negatives.
Challenging cognitive cases among physician populations: case vignettes and recommendations
BackgroundPhysicians are not immune to cognitive impairment. Because of the risks created by practising doctors with these issues, some have suggested developing objective, population-specific measures of evaluation and screening guidelines to assess dysfunction. However, there is very little published information from which to construct such resources.
AimsTo highlight the presentation characteristics and provide evaluation recommendations specific to the needs of physicians with actual or presumed cognitive impairment.
MethodsA retrospective database and chart review of cognitively impaired doctors who presented to a physician health programme (PHP). Complex cases were highlighted using simple descriptives and clinical vignettes.
ResultsA total of 124 cases were included. Clients presented with a variety of issues other than cognitive concerns. We identified four principal domains of impairment: (i) diseases of (or in) the brain (48%); (ii) mood/ anxiety disorders or treatment side effects (28%); (iii) substance use (9%) and (iv) traumatic brain injury (7%). Age was not a good predictor of impairment and brief screening using the Montreal Cognitive Assessment demonstrated a ceiling effect with this cohort. Although many clients underwent some type of professional or personal transition, impairment did not necessarily indicate worse functioning after care.
ConclusionsPhysician cognitive evaluations should consider a variety of secondary sources of information, particularly vocational performance reports. It may take time before cognitive impairment can be diagnosed or ruled-out in this population. Prior assumptions, especially for non-cognitive referrals, can lead to inaccurate diagnosis and referrals. PHPs must manage cognitive cases carefully, not only in their clinical complexity but also in their psychosocial aspects.
Shift work, mental distress and job satisfaction among Palestinian nurses
BackgroundAssociations between shift work (SW) schedules, mental distress and job satisfaction have never been completely described.
AimsTo examine gender-specific associations of SW with mental distress and job satisfaction in nurses in Hebron District, Palestine, in 2012.
MethodsDetailed information on work schedules (day versus shift), socio-demographic status, mental distress (General Health Questionnaire, GHQ-30) and job satisfaction (Generic Job Satisfaction Scale) in nurses employed in Hebron District, Palestine, was obtained through a questionnaire survey. Associations of SW and outcomes were examined by linear regression analysis.
ResultsOf 372 nurses eligible for the study, 309 and 338 completed surveys regarding mental distress and job satisfaction, respectively. The sample comprised 62% women and 38% men. After adjusting for covariates, women working shifts reported significantly higher levels of mean mental distress [β coefficient 3.6; 95% confidence interval (CI) 0.3–7.0] compared with women working regular day shifts. Men working shifts reported significantly lower levels of job satisfaction (–3.3; 95% CI –6.2 to –0.5) than men working regular day shifts. Women reported higher levels of mental distress than men, but this was unrelated to work schedule.
ConclusionsIn this study, nurses working shifts reported higher levels of mental distress and lower levels of job satisfaction, although these associations were weaker when adjusted for potential covariates. There was no evidence of a gender differential in the association between SW and mental distress and job satisfaction.
Squatting-induced bilateral peroneal nerve palsy in a sewer pipe worker
AbstractCompression neuropathy of the common peroneal nerve (CPN) at the fibula head is a common condition, but it has not attracted attention in working environments. Here, we report a 38-year-old sewer pipe worker who presented with bilateral CPN palsy following 6h working with a squatting posture in a narrow sewer pipe. During the work, he could not stretch his legs sufficiently because of the confined space. His symptoms deteriorated with repetition of the same work for 1 week. Motor nerve conduction study showed conduction block at the fibula head of bilateral CPNs, compatible with compression neuropathy at this lesion. Three months after cessation of work requiring the causative posture, his symptoms and neurophysiological abnormalities had resolved completely. Almost all seven of his co-workers presented transiently with similar and milder symptoms, although one showed CPN palsy for 6 months. Prolonged squatting posture in a confined space causes acute compression neuropathy at the fibula head in the CPN. More attention should be paid to ‘confined space worker’s compression neuropathy’.
Micro and nanoparticles as possible pathogenetic co-factors in mixed cryoglobulinemia
BackgroundMixed cryoglobulinemia (MC) is a rare multisystem disease whose aetiopathogenesis is not completely understood. Hepatitis C virus (HCV) infection may have a causative role, and genetic and/or environmental factors may also contribute.
AimsTo investigate the presence and possible role of environmental agents in MC.
MethodsWe recruited 30 HCV-infected MC patients with different clinical manifestations and a control group of 30 healthy, sex-/age-matched volunteers. We collected serum samples from each patient and incubated at 4°C for 7 days to obtain cryoprecipitate samples. We used environmental scanning electron microscopy (ESEM) and energy dispersive X-ray spectroscopy microanalysis to verify the presence of microparticles (MPs) and nanoparticles (NPs) in serum and cryoprecipitate samples. We evaluated environmental exposure using a medical and occupational history questionnaire for each subject.
ResultsMC patients had a significantly higher risk of occupational exposure (OR 5.6; 95% CI 1.84–17.50) than controls. ESEM evaluation revealed a significantly higher concentration, expressed as number of positive spots (NS), of serum inorganic particles in MC patients compared with controls (mean NS 18, SD = 16 versus NS 5.4, SD = 5.1; P < 0.05). Cryoprecipitate samples of MC patients showed high concentrations of inorganic particles (mean NS 49, SD = 19). We found a strong correlation between NS and cryocrit (i.e. percentage of cryoprecipitate/total serum after centrifugation at 4°C) levels (P < 0.001).
ConclusionsIn addition to HCV infection, MPs and NPs might play an important role in the aetiopathogenesis of MC.