Preview: Occupational Medicine - current issue
Occupational Medicine Current Issue
Published: Fri, 17 Feb 2017 00:00:00 GMT
Last Build Date: Fri, 17 Feb 2017 03:46:22 GMT
The Sage Handbook of Risk Communication
Edited by ChoHyunyi, ReimerTorsten, McComasKatherine A.. Published by Sage Publications, London, 2015. ISBN: 978-1-4522-5868-3. Price: £99. 368 pp. (hardback)
What factors influenced trainees to choose occupational medicine?
BackgroundOccupational medicine (OM) is a varied speciality which ranges from clinical to preventive medicine and therefore offers a wide range of opportunities. However, OM recruitment rates have been variable, suggesting that trainees applying for speciality training may not be considering it as a career.
AimsTo examine the potential factors that influenced current trainees and recently accredited specialists to choose OM as a career.
MethodsAn anonymous online survey distributed via the OM trainees Google group between 9 and 30 September 2016.
ResultsA total of 34 trainees (41% of the total membership of the group) participated in the survey. Twenty-two trainees (65%) were aged between 36 and 45 and 20 (59%) were females. Trainees came from a wide range of backgrounds including general practice (13, 38%), medical specialities (8, 21%) and surgical specialities (6, 18%). Factors such as regular working hours (24, 73%) and dissatisfaction with other specialities (18, 55%) positively influenced trainees to choose OM. Influences from other occupational physicians (OPs; 15, 44%) also played a role in attracting trainees. Negative influences included lack of exposure to OM both at medical school (31, 92%) and at postgraduate level (26, 76%), lack of publicity about OM (25, 74%) as well as a reduction in salary (25, 74%).
ConclusionsMany factors influence the choice of a career in OM. Increasing awareness of OM in both undergraduate and postgraduate training, including involving OPs in such training, could influence more prospective trainees to consider OM as a lifelong career.
Occupational health and safety in Oceania—current state and future priorities
Oceania describes the countries of the Eastern Pacific Ocean, mainly small island nations of Melanesia, Micronesia and Polynesia, the largest of which are Fiji and the Solomon Islands, but also includes the more populous countries of Australia, Papua New Guinea and New Zealand. The distribution of industry varies considerably across the Oceania region. The distribution ranges from largely agriculture-based, rural workforces in many of the smaller nations, to service and industry-based workforces in the developed economies of New Zealand and Australia, although most of the rural-based countries are slowly transitioning to a more industrial and service-based workforce and this trend is likely to continue. Some of the key occupational health and safety (OHS) issues and priorities are common across Oceania, whilst others arise from the geography, climate and industry of the individual countries. Unfortunately, there is not a lot of published information on OHS for the countries of Oceania, apart from Australia and New Zealand.
China’s occupational health challenges
China is a rapidly developing country that has experienced marked socio-economic changes during the last 30 years. However, this has led to a high prevalence of occupational disease (OD). Until 2013, there were only 603 Chinese institutions that could professionally diagnose OD , which corresponds to one institution per 40000 at-risk workers. Furthermore, these institutions were concentrated in economically developed areas and large cities, with few institutions in the less developed central and western areas, which created an imbalance between supply and demand and increased workers’ challenges in accessing OD medical services. In addition, controlling these ODs remains challenging. The Law on Prevention and Control of Occupational Disease (LPCOD) was amended in 2011, which increased the convenience of diagnosing and treating ODs and served as an important remedial measure to protect against an OD epidemic. The applicable LPCOD legislation addresses occupational health (OH) services and OD compensation enforcement based on the OH regulations and provides a legal basis to prevent ODs.
In this issue of Occupational Medicine
Where resources are limited (they always are), it is important to use them efficiently for maximum effect. This is especially true for the delivery of occupational health services. Evidence for the effectiveness of many occupational health activities is lacking. But even where evidence of little or no benefit exists, we often seem constrained to continue with out-dated practices at the expense of truly value-adding activities. Occupational Medicine aims to present robust research evidence to support the effective and efficient delivery of modern occupational health services.
Carl Larsson Harvesting Ice 1905
The late afternoon sun turns the clouds a delicate pink as the pale blue wintry sky fades away into night. Out on frozen Lake Toftan, three men and Brunte, the horse, are hard at work in sub-zero temperatures. The man on the left, Johan is using a large vertical saw to cut blocks of ice which his two colleagues drag with ice-hooks over the horse’s shafts so that Brunte can pull them onto the frozen snow. A row of ice blocks marks the day’s work. In the right foreground, a timber mooring ‘dolphin’ frames the composition and draws the eye past two half-buried horizontal timber posts, which mark the edge of the lake. Sled tracks between the posts show the route taken by the horse as it headed north towards the ice. The men have planted branches around the excavation hole as hazard warning signs. Beyond the lake, low rolling hills lead to a thicket of conifers and a clump of bare deciduous trees, which shroud a small church and its spiky-spired bell tower. The artist’s monogram, a circled CL, can be seen at the base of the ‘dolphin’s’ middle post.
The Mood Disorder Questionnaire
The Mood Disorder Questionnaire (MDQ) was developed by a group of psychiatrists, researchers and patient advocates. It is simple and involves reporting against 15 items. It is a screening instrument for the detection of bipolar disorder (BPD).
Sickness absence among peer-supported drivers after occupational trauma
BackgroundPsychological first aid is a common approach for providing support after potentially traumatic events (PTEs). In Germany, a peer support model is recommended by the German Statutory Accident Insurance (DGUV) to reduce sickness absence after occupational accidents, especially in public transportation. However, data on the effectiveness of peer support are very sparse.
AimsTo analyse whether peer support has an impact on sickness absence after work-related traumatic events in public transportation.
MethodsAn analysis was conducted in two German public transportation corporations. Due to ethical requirements, we used a historical cohort study comparing peer support by colleagues (VAG-1), peer support at supervisor level (VGF) and a non-intervention group (VAG-0). The study period was from March 2003 to December 2012. We used a negative binominal regression model to estimate the relative risk associated with the interventions and potential confounders.
ResultsA total of 259 incident PTEs in employees were observed. A regression analysis identified the severity of PTE (severe and fatal events), VGF and age as significant factors in predicting duration of post-event sickness absence. In a stratified analysis, the mode of peer support (VGF) and age predicted sickness absence for less severe PTEs but this was not significant for severe PTEs.
ConclusionsSevere and fatal PTEs had the strongest impact on sickness absence after PTEs. For less severe PTE, peer support provided by colleagues may be superior to supervisor support.
Subjective health complaints, work-related stress and self-efficacy in Norwegian aircrew
BackgroundThe European civilian aviation industry has undergone major changes in the last decade. Despite this, there is little knowledge about work-related stress and subjective health complaints (SHCs) affecting Norwegian aircrew.
AimsTo investigate the relationships between work-related stress, self-efficacy and SHCs in commercial aircrew in Norway and to explore differences between cockpit and cabin crew.
MethodsAircrew members from the three major airlines operating from Norway completed an electronically distributed questionnaire. Linear regression analyses were used to investigate the association between work-related stress, self-efficacy and SHCs.
ResultsThere was a 21% response rate. Among the 843 study subjects, tiredness, sleep problems, bloating, low back pain, headaches and neck pain were the most prevalent SHCs. Cabin crew reported significantly higher numbers, prevalences and mean values for all SHCs compared with cockpit crew (P < 0.05). In total, 20% reported high stress levels. High levels of work-related stress were significantly associated with all SHC factors in both groups. Self-efficacy partly moderated the relationship between stress and psychological complaints in both cockpit and cabin crew, and for musculoskeletal complaints in cockpit crew. The model explained 23 and 32% of the variance in psychological complaints for cockpit and cabin crew, respectively.
ConclusionsCommercial aircrew in Norway reported high numbers of SHCs, and high levels of work-related stress were associated with high numbers of SHC. More knowledge is needed on the physical, organizational and psychosocial stressors affecting cockpit and cabin crew in order to create a healthier work environment for these groups.
Health check documentation of psychosocial factors using the WAI
BackgroundHealth checks in occupational health (OH) care should prevent deterioration of work ability and promote well-being at work. Documentation of health checks should reflect and support continuity of prevention and practice.
AimsTo analyse how OH nurses (OHNs) undertaking health checks document psychosocial factors at work and use the Work Ability Index (WAI).
MethodsAnalysis of two consecutive OHN health check records and WAI scores with statistical analyses and annotations of 13 psychosocial factors based on a publicly available standard on psychosocial risk management: British Standards Institution specification PAS 1010, part of European Council Directive 89/391/EEC, with a special focus on work-related stress and workplace violence.
ResultsWe analysed health check records for 196 employees. The most frequently documented psychosocial risk factors were home–work interface, work environment and equipment, job content, workload and work pace and work schedule. The correlations between the number of documented risk and non-risk factors and WAI scores were significant: OHNs documented more risk factors in employees with lower WAI scores. However, documented psychosocial risk factors were not followed up, and the OHNs’ most common response to detected psychosocial risks was an appointment with a physician.
ConclusionsThe number of psychosocial risk factors documented by OHNs correlated with subjects’ WAI scores. However, the documentation was not systematic and the interventions were not always relevant. OHNs need a structure to document psychosocial factors and more guidance in how to use the documentation as a tool in their decision making in health checks.
Effects of an employee exercise programme on mental health
BackgroundPrior research indicates that workplace wellness programmes (WWPs) are generally associated with lowered healthcare costs and improved employee health. Despite the importance of mental well-being in workplace productivity and attendance, few WWP studies have focused on improvements in psychological well-being.
AimsTo examine the effects of the Bruin Health Improvement Program (BHIP), a 3-month exercise and nutrition WWP, on seven domains of health: physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life.
MethodsUsing data from BHIP completers, we conducted multiple one-way multivariate analyses of variance and follow-up univariate t-tests to examine changes in physical and mental health, stress, energy level, social satisfaction, self-efficacy and quality of life. Effect sizes were also calculated post hoc to determine the magnitude of each effect.
ResultsResults for the 281 participants reveal significant improvements across all seven domains (P < 0.001). Effect sizes ranged from 0.19 to 0.67.
ConclusionsThis study is unique in revealing the effects of a WWP on multiple domains of psychological well-being. Given rising healthcare costs associated with mental health, targeting mental health through WWP may be an effective strategy for reducing indirect healthcare costs associated with absenteeism and presenteeism.
Hair cortisol in relation to job stress and depressive symptoms
BackgroundMeasurement of hair cortisol concentration (HCC) may be used as a biomarker for chronic stress. However, the association between stress and HCC has rarely been investigated in a working population.
AimsTo explore associations between (i) HCC and various stress measures and (ii) HCC and symptoms of depression in Belgian workers.
MethodsHair samples were collected from workers in two production companies and cortisol content was determined by liquid chromatography tandem mass spectrometry. Participants completed a questionnaire including socio-demographics, health behaviours and standardized measures for assessing stress.
ResultsAfter excluding those workers suffering from a psychiatric or neuroendocrine disease and those treated with glucocorticoids, there were a total of 102 workers with both questionnaire, cortisol results and anthropometric measures. Median HCC was 5.73 pg/mg hair (interquartile range = 4.52–9.06). No significant associations were found between cortisol and the standardized measures related to several work psychosocial risk factors. A significantly lower mean HCC was found in shift workers compared with dayworkers, adjusted for age. Additionally, a significant higher mean HCC was found in workers with symptoms of depression compared with those without symptoms of depression, after adjustment for age.
ConclusionsHCC showed a limited applicability as a biomarker for job stress in this sample, although the results suggest this method may be a suitable marker for detecting early symptoms of depression. Further research is needed to investigate the applicability of HCC in the working environment and within job stress research.
Energy expenditure of deskwork when sitting, standing or alternating positions
BackgroundRecent guidelines recommend accruing 2–4h of standing or light activity during the working day. Use of sit–stand desks could achieve this goal, but whether standing can meaningfully increase energy expenditure (EE) is unclear.
AimsTo study EE, heart rate, feelings and productivity during deskwork while sitting, standing or alternating positions.
MethodsWe measured EE by indirect calorimetry in working adults over three randomly ordered 60-min conditions while performing deskwork: continuous sitting (SIT), 30min of each standing and sitting (STAND–SIT) and continuous standing (STAND). We also assessed heart rate, productivity and self-reported energy, fatigue and pain. Linear mixed models compared minute-by-minute EE and heart rate across conditions. Non-parametric tests compared remaining outcomes across conditions.
ResultsThe study group comprised 18 working adults. Compared with SIT, STAND–SIT engendered an additional 5.5±12.4 kcal/h (7.8% increase) and STAND engendered an additional 8.2±15.9 kcal/h (11.5% increase) (both P < 0.001). Alternating positions to achieve the recommended 4h/day of standing could result in an additional 56.9 kcal/day for an 88.9kg man and 48.3 kcal/day for a 75.5kg woman. STAND–SIT and STAND also increased heart rate over SIT by 7.5±6.8 and 13.7±8.8 bpm, respectively (both P < 0.001). We observed no meaningful differences in feelings or productivity.
ConclusionsDesk-based workers could increase EE without added discomfort by using a sit–stand desk. These findings inform future research on sit–stand desks as a part of workplace interventions to increase EE and potentially improve health.
Trajectory analyses of sickness absence among industrial and municipal employees
BackgroundCompared with the public sector, the private sector is more susceptible to changes in the economic environment and associated threats of downsizing, outsourcing and transfers of production. This might be assumed to be associated with more restrictive sickness absence practices.
AimsTo investigate whether this difference is reflected in higher sickness absence rates in the public sector and to explore the potential of trajectory analysis in researching such absences.
MethodsThe sample consisted of industrial and municipal employees. Latent groups of differential sickness absence during a 6-year study period were searched with a two-response trajectory analysis that jointly captured the spells and the days. Multinomial logistic regressions were used to assess associations of the labour market sector with the set of trajectories obtained.
ResultsThere were 2207 industrial and 3477 municipal employees in the study group. The analysis assigned the employees to three trajectory groups, the ‘low-level’, ‘middle-range’ and ‘high-range’ groups. The relative risk ratios for the middle-range and the high-range trajectories of public sector employees were not higher after controlling for age, gender and occupational.
ConclusionsIn this study, the labour market sector was not a major independent determinant of sickness absence practices. Trajectory analysis can be recommended as a way to determine differential absence practices. The trajectory approach might help occupational health services to identify more accurately the employees who need support to maintain their work ability.
The effect of multimorbidity on sickness absence by specific diagnoses
BackgroundAs the world’s population ages, the prevalence of multiple chronic and non-chronic health-related conditions is increasing. Research on multimorbidity, the co-occurrence of two or more health-related conditions, has mainly involved patient and older populations. Its effect in working populations, presumably younger and healthier, is not well known but could conceivably affect sickness absence (SA) and ability to return to work.
AimsTo examine the effect of multimorbidity on the incidence and duration of SA episodes by frequent diagnostic groups.
MethodsA prospective study (in 2006–2008) of workers in Spain. Information on health-related conditions was gathered with a standardized questionnaire and used to construct a sex-specific multidimensional multimorbidity score (MDMS). In order to estimate the effect of MDMS on incidence and duration of SA episodes due to cardiovascular diseases (CVD), musculoskeletal disorders (MSD) and mental health disorders (MHD), we fitted Cox models adjusted by age, occupational social class and number of prior SA episodes for both sexes.
ResultsThe study population was 372370. Men with high MDMS showed a trend towards higher incidence risk for SA due to CVD and MSD [adjusted hazard ratio (aHR) = 2.03; 95% confidence interval (CI) 1.48–2.78 and aHR = 1.20; 95% CI 1.01–1.43, respectively]. Women showed a similar trend for MSD, but MHD had the strongest association (aHR = 4.78; 95% CI 1.97–11.62) for high MDMS. In both sexes, the effect of MDMS was strongest among those without a prior SA. No consistent associations with SA duration were observed.
ConclusionsMultimorbidity increased the risk of incident musculoskeletal, mental and cardiovascular SA episodes but not their duration.
Medical surveillance for occupational asthma—how are cases detected?
BackgroundIn Finland, medical surveillance, including spirometry, is periodically performed for workers who are exposed to agents capable of causing occupational asthma (OA). Although it has been shown that surveillance can detect OA at an early stage, few studies have assessed its benefits or the role of surveillance spirometry.
AimsTo assess the role of surveillance and spirometry in detecting OA and to evaluate the quality of spirometry.
MethodsWe retrospectively reviewed the medical files of patients in health surveillance programmes who were diagnosed with sensitizer-induced OA at the Finnish Institute of Occupational Health in 2012‒14. We collected information on work exposure, respiratory symptoms, healthcare visits that initiated the diagnostic process, first spirometry and other diagnostic tests.
ResultsSixty files were reviewed. Medical surveillance detected 11 cases (18%) and 49 cases (82%) were detected at doctors’ appointments that were not related to surveillance. The median delay from the onset of asthma symptoms to diagnosis was 2.2 years. Delay did not differ between these groups. No cases were detected on the basis of abnormal spirometry without respiratory symptoms. However, five patients (8%) initially reported solely work-related rhinitis symptoms. Spirometry was normal in half of the cases and quality criteria were fulfilled in 86% of the tests.
ConclusionsFewer than one in five OA cases were detected through medical surveillance. Investigations were initiated by respiratory symptoms. No asymptomatic worker was referred because of abnormal spirometry. Our results highlight the importance of work-related nasal symptoms in detecting OA.
Screening instruments for predicting return to work in long-term sickness absence
BackgroundMultiple somatic symptoms are common and may cause prolonged sickness absence (SA) and unsuccessful return to work (RTW).
AimsTo compare three instruments and their predictive and discriminative abilities regarding RTW.
MethodsA longitudinal cohort study of participants recruited from two municipal job centres, with at least 8 weeks of SA. The instruments used were the Symptom Check List of somatic distress (SCL-SOM) (score 0–48 points), the Bodily Distress Syndrome Questionnaire (BDSQ) (0–120 points) and the one-item self-rated health (SRH) (1–5 points). The instruments’ predictive value was explored in a time-to-event analysis. Different cut-points were analysed to find the highest number of correctly classified RTW cases, identified in a register on public transfer payments.
ResultsThe study involved 305 subjects. The adjusted relative risk regarding prediction of RTW was 0.89 [95% confidence interval (CI) 0.83–0.95], 0.89 (95% CI 0.83–0.95) and 0.78 (95% CI 0.70–0.86) per 5-, 10- and 1-point increase in the SCL-SOM, BDSQ and SRH, respectively. After mutual adjustment for the three instruments, only the prediction of RTW from SRH remained statistically significant 0.81 (95% CI 0.72–0.92). The highest sensitivity (86%) was found by SRH at the cut-point ≤5, at which 62% were correctly classified.
ConclusionsAll three instruments predicted RTW, but only SRH remained a significant predictor after adjustment for the SCL-SOM and BDSQ. The SRH provides an efficient alternative to more time-consuming instruments such as SCL-SOM or BDSQ for estimating the chances of RTW among sickness absentees.