Preview: Occupational Medicine - current issue
Occupational Medicine Current Issue
Published: Thu, 30 Mar 2017 00:00:00 GMT
Last Build Date: Thu, 30 Mar 2017 11:46:53 GMT
Developing the evidence base for a new health and work strategy for Great Britain
In its refreshed strategy, Helping Great Britain Work Well , the Health and Safety Executive (HSE) signalled intent to ‘put the health back into health and safety’. This was not just an attempt to separate the elements of what is often perceived as a compound noun, but more im portantly a reflection that we should be aiming to deliver real and substantial improvements in this area. The statistics for the UK are now well known: around 13000 deaths each year from work-related lung disease and cancer are estimated to have been caused by past exposures at work; and an estimated 1.2 million people who worked in 2014/15 were suffering from an illness they believed was caused or made worse by work, of which, 516000 were new cases which started in the year.
In this Issue of Occupational Medicine
It is 30 years since the Stockholm workshop on ‘Symptomatology and Diagnostic Methods in Hand-Arm Vibration Syndrome’ proposed the introduction of a new clinical scoring system for hand arm vibration syndrome (HAVS) to replace the Taylor-Pelmear scale. In the October 2016 issue of Occupational Medicine, Lawson  published an editorial questioning whether the Stockholm Workshop Scale (SWS) was still fit for purpose. It had quickly been recognized that terms like ‘frequent’ and ‘occasional’ were too vague and that the gap between stage 1 sensorineural (intermittent numbness) and stage 3 sensorineural (reduced tactile discrimination and/or manipulative dexterity) was too large. In 2003, Lawson himself proposed a revised scale defining terms like ‘frequent’ and ‘occasional’ and splitting stage 2 sensorineural into early and late.
Edward Hopper, New York Movie 1939
A solid end-wall with an ornate leafy column separates the star of the show (an usherette) from the show of the stars (the movie). Two horizontal brass hand-rails complete the critical division between the subdued but luxuriant glow of fantasy land and the harsh glare of the real world. On the left, three glass lanterns suspended in echelon from the lofty ceiling cast a soft light over plush red velvet seats, where a solitary man and woman ambiguously occupy separate rows in a dark, empty, cavernous auditorium. They stare featureless at the large black and white cinema screen. She wears a floppy wide-brimmed hat and a fur-collared coat, while he is bare-headed but neatly trimmed and suited, his white shirt collar conspicuous in the gloom. On the right the unforgiving lumens from a triple candlestick wall-light (complete with pink shades) capture the pensive form of a tall, beautifully coiffured young woman, stylishly tailored in a military-styled uniform. The smart royal-blue suit has brass buttons, epaulettes, red stripes down wide bottom trousers and complementary red flashes on the cuffs and collar. A pair of black, strappy, high-heel sandals completes the ensemble. Her face is clouded, her eyes closed; she seems deep in thought, her chin resting on her right hand, supported by her left, which clutches a torch (flashlight). She rests her back resignedly against the dado rail of the half-panelled wall behind her. In front, tied-back burnt-orange curtains reveal grey-blue carpeted stairs, which lead up and out of the cinema into the threatening world beyond. The grisaille vignette on the cinema screen displays snowy Himalayan peaks from Frank Capra’s 1937 blockbuster movie Lost Horizon , a story about Shangri-la—a lost sanctuary of peace and safety . Yet the usherette chooses not to watch the film. It provides her with no escape from the theatrum mundi.
Why I became an occupational physician
I didn’t actually set out to become an ‘occupational physician’. In 1970, I answered an advertisement for a doctor with the National Coal Board (NCB) in South Wales; but I had no concept of a specialist dealing with the ‘world of work’ in general. I was a general practitioner in an urban area; we had full lists and there was no deputizing service. Busy nights and weekends on call were followed by full surgeries and lists of home visits the next day. There was little time or energy left for social activities and I knew my job impinged adversely on my family. I was also dissatisfied and uneasy because I was aware that there were holes in my medical knowledge; I felt that as a family doctor, I should have a working knowledge of the whole of medicine, something I felt unable to achieve.
The Oswestry Disability Index
Originally published in 1980, The Oswestry Disability Index (ODI)  is a validated, 10-point patient-reported outcome questionnaire. It is considered the ‘gold standard’  for measuring disability and quality of life (QoL) impairment for adults with low back pain (LBP). Back pain is of particular interest to occupational medicine practitioners, as it has a significant impact on the workplace, with almost 3 million working days being lost each year in the UK .
Occupational Medicine Calendar
2017DateEventContact AddressVenueJune 19–216th International Conference on Whole Body Vibrationhttp://medicine.gu.se/WBV2017Gothenburg, SwedenJune 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 28–31EPICOH 2017 Conference - Eliminating Occupational Risk: Translating Research into Actionhttps://epicoh2017.orgEdinburghAugust 29– September 16th International Congress of the ICOH Scientific Committee on Work Organization and Psychosocial Factorshttp://condor.zaragoza.unam.mx/wops/Mexico City, MexicoSeptember 3–6XXI World Congress on Safety and Health at Work 2017http://www.safety2017singapore.com/SingaporeSeptember 13–1545th International MEDICHEM Congress 2017http://medichem2017.euVienna, AustriaOctober 1–410th International Symposium on Biological Monitoring in Occupational and Environmental healthhttp://www.centercongressi.com/isbm10Naples. ItalyNovember 1–410th European Public Health Conference 2017. Sustaining resilient and healthy communitieshttp://www.ephconferences.euStockholm, SwedenDecember 28–3010th International Joint Conference on Occupational Health for Healthcare Workers: Health & wellbeing in the health care sector; addressing current threats to workerswww.ohhcw2017.orgKhon Kaen, Thailand2018April 29 – May 2Annual American Occupational Health Conference (103rd AOHC)http://www.acoem.org/educational_conferences.aspxNew Orleans. LAApril 29 – May 432nd International Congress on Occupational Health. ICOHhttp://www.icoh2018.orgDublin, IrelandMay 6–10American Aerospace Medical Association Annual Meetinghttps://www.asma.org/scientific-meetings/asma-annual-scientific-meeting/future-annual-meetingsDallas, Texas2019April 28 – May 1Annual American Occupational Health Conference (104th AOHC)http://www.acoem.org/educational_conferences.aspxAnaheim, CAMay 5–9American Aerospace Medical Association Annual Meetinghttps://www.asma.org/scientific-meetings/ asma-annual-scientific-meeting/ future-annual-meetingsLas Vegas, Navada
Subclinical chronic left ventricular systolic dysfunction resulting from phosphine poisoning
AbstractWe present a case of a 32-year-old male crew member of a cargo ship, accidentally exposed to phosphine, a fumigating substance. He and other crew members developed increasing fatigue and digestive disorders 24 h later; two died from acute pulmonary oedema. The patient was admitted to hospital, where bilateral pneumonia, acute nephritis, hepatopathy, electrolyte imbalance and leucopenia were diagnosed. He was discharged from hospital 3 weeks later. He was examined 4 months later for possible chronic consequences of acute phosphine poisoning, which included echocardiography showing normal heart size and cardiac function. However, on advanced quantitative analysis, using two-dimensional speckle tracking echocardiography, depressed global longitudinal strain was found. Our report extends previously published findings of phosphine-induced left ventricular (LV) dysfunction by demonstrating that subclinical myocardial dysfunction resulting from acute phosphine exposure may persist several months after the exposure in an otherwise asymptomatic patient, and potentially may not be entirely reversible. The persistence of subclinical abnormalities of LV longitudinal function can be diagnosed using the advanced quantitative echocardiographic analysis we describe.
Prediction of long-term and frequent sickness absence using company data
BackgroundMore insight into predictive factors is needed to identify employees at risk for future sickness absence. Companies register potentially relevant information regarding sickness absence in their human resources and work schedule administration.
AimsTo investigate which combination of administrative company data best predicts long-term and frequent sickness absence in airline employees.
MethodsSocio-demographic and work-related variables between 2005 and 2008 were retrieved from the administrative data of an airline company. Logistic regression analyses were used to build prediction models for long-term (>42 consecutive days) and frequent (more than three episodes) sickness absence in 2009. Both models were internally validated.
ResultsData on 7652 employees were available for analysis. Long-term sickness absence was predicted by a combination of higher age, recent pregnancy, having a parking permit, having ‘aggravated working conditions’ and previous sickness absence. Recent marriage appeared to reduce the risk. Frequent sickness absence was predicted by being single, not having children of 16 years and older, not having a company parking permit, no shift work, having a job with special operational requirements and previous sickness absence. The long-term and frequent sickness absence models had a discriminative ability of 0.72 and 0.73, and an explained variance of 10.9 and 14.2%, respectively.
ConclusionsThe results show that it is possible to compose prediction models for employees at risk of sickness absence using only administrative company data. However, as the explained variance was low, additional factors should be identified to predict risk of future sickness absence.
Not Tb-proof: latent tuberculosis in Kuala Lumpur Hospital health care workers
BackgroundHealth care workers are commonly exposed to tuberculosis (TB) in the workplace, especially in low- and middle-income countries. They are susceptible to latent TB infection (LTBI) which may progress to active infection.
AimsTo determine the prevalence and factors associated with LTBI in health care workers in a hospital in Kuala Lumpur, Malaysia.
MethodsA cross-sectional study was carried out among health care workers in Kuala Lumpur Hospital, Malaysia’s largest tertiary public hospital. A two-step sampling procedure was used to obtain a proportionate sample of workers from each hospital department. Those selected underwent a self-administered questionnaire on possible occupational risk factors and a standardized tuberculin sensitivity test (TST). TST induration of ≥15 mm was considered positive for LTBI. Logistic regression analysis was used to assess the association of possible work factors with LTBI.
ResultsIn the 399 study subjects, the overall rate of LTBI was 46%. The odds of contracting LTBI were higher for staff working in jobs other than management positions, staff in clinical areas as opposed to non-clinical areas, staff working for ≥5 years compared with those working for shorter periods and staff with diagnosed diabetes mellitus or other chronic diseases compared with those without.
ConclusionsLTBI point prevalence was nearly 50% in health care workers at Malaysia’s major tertiary hospital. Our results suggest that there may be additional LTBI risk factors for health care workers and these at-risk populations should have regular screening.
Long-term epidemiological observation of asbestos-related diseases in Poland, 1970–2015
BackgroundOccupational exposure to asbestos constitutes a major public health concern. Despite this in many countries, data and registration systems for occupational asbestos-related diseases are non-existent or poorly developed.
AimsTo analyse the incidence of occupational asbestos-related diseases in Poland between the years 1970 and 2015, with particular emphasis on the periods after introduction of a ban on asbestos and following introduction of a surveillance programme.
MethodsAnalysis based on all medically recognized cases, certified as occupational diseases and reported obligatorily from all over the country to the Central Register of Occupational Diseases.
ResultsDuring the period 1970–2015, 4983 cases were reported as asbestos-related diseases. The most prevalent were asbestosis, lung cancer, diseases of pleura or pericardium and mesothelioma. A considerable increase in the number of such cases from the beginning of their registration until 2004 occurred after introduction of the Amiantus programme, a nationwide programme of periodic medical examinations for former asbestos workers.
ConclusionsIntroduction of a medical surveillance programme improved case recognition and allowed a more reliable estimate of the number of reported asbestos-related diseases.
Systematic review: chronic obstructive pulmonary disease and construction workers
BackgroundBetween 15 and 20% of prevalent cases of chronic obstructive pulmonary disease (COPD) have been attributed to occupational exposures to vapours, gases, dusts and fumes. Dust at construction sites is still a challenge, but no overview exists of COPD among construction workers.
AimsTo assess the occurrence of COPD among construction workers.
MethodsWe performed a systematic search in PubMed and Embase between 1 January 1990 and 31 August 2016 in order to identify epidemiological studies with a risk estimate for either COPD morbidity/mortality or a spirometry-based definition of airway obstruction among workers in the construction industry. The authors independently assessed studies to determine their eligibility and performed a quality assessment of the included papers.
ResultsTwelve studies were included. Nine studies found a statistically significant association between COPD and work in the construction industry, although only among never-smokers in one study and only for the period after 2000 in another study. One study found that the annual decline in forced expiratory volume in 1 s was significantly higher among construction workers compared with bus drivers.
ConclusionsThis review suggests that COPD occurs more often among construction workers than among workers who are not exposed to construction dust. It is not possible to draw any conclusions on specific subgroups as most studies analysed construction workers as one united group. In addition, no potential exposure–effect relationship could be identified.
Smoking status and physical fitness during initial military training
BackgroundHabitual smoking is prevalent in military populations, but whether smoking status influences physical fitness development during training is not clear.
AimsTo investigate the effect of smoking status on physical fitness parameters during initial British Army infantry training.
MethodsRoutine measures of physical fitness (2.4-km run time and maximum number of press ups and sit ups in 2 min) were obtained in male recruits at weeks 1, 14 and 24 of initial military training. A linear mixed model was used to identify differences in performance between smokers and non-smokers over time.
ResultsAmong 1182 study subjects (mean ± SD: age 20 ± 3, body mass 70.6 ± 9.8 kg, height 1.77 ± 0.07 m; 58% smokers), non-smokers performed significantly better than smokers in all performance tests (P < 0.01), but rates of improvement during training were similar (P > 0.05). Run performance improved by 7% in non-smokers (estimated marginal means 612–567 s) and 8% in smokers (622–571 s). Press up performance improved by 18% in non-smokers (48.3–57.0) and 23% in smokers (44.1–54.5) and sit up performance by 15% in non-smokers (57.3–66.0) and 18% in smokers (53.8–63.3).
ConclusionsSmokers exhibited lower muscular and cardiorespiratory endurance performance than non-smokers. Unexpectedly, however, no significant differences in improvement in performance indices were demonstrated between smokers and non-smokers during military training.
The need for social work services in occupational medicine
BackgroundSince 1998, Maccabi Healthcare Services (MHS) has employed a part-time social worker (SW) in its occupational medicine clinics (OMCs) to help patients deal with the psychosocial aspects of change in their work ability, earning capability loss and rehabilitation issues. The need, expectation and impact of this social work services (SWSs) as part of the independent occupational health service (OHS) have not yet been studied.
AimsTo explore patients’ expectations and satisfaction with the SWS.
MethodsA cross-sectional questionnaire study was administered to MHS members who visited OMCs between September 2011 and July 2012 for fitness-for-work evaluation and were later referred to a SW.
ResultsA total of 203 forms were collected and included in the study. Most of the patients (85%) were interested in receiving information on social work benefits; 70% were interested in receiving help coping with emotional stress and 68% were interested in receiving help about future occupation. A very high percentage (97%) were satisfied with the SW session, its length and the care given. A correlation was found between the patients’ expectations and their satisfaction with the amount of information received (P < 0.01).
ConclusionsThis study supports the need for SW services and their usefulness in OHS. The study shows the positive impact of the SW service within the public health system of the Israeli OHS with a high patient satisfaction level with the SW service in addressing patient questions.
Sedentary behaviour in NHS staff: implications for organizations
BackgroundProlonged sitting is associated with an increased risk of chronic ill-health. Although high levels of sedentary behaviour are documented in desk-based workers, there are few data examining this in organizations with greater job diversity such as the National Health Service (NHS).
AimsTo assess the association of occupational and non-occupational sedentary behaviours with key demographic and occupational characteristics of NHS workers to help inform policy development.
MethodsA cross-sectional survey conducted in a large NHS teaching hospital in the north of England. Volunteer members of staff were asked to complete a web- or paper-based version of the Workforce Sitting Questionnaire. Demographic and occupational data collected included age, gender, ethnicity, educational attainment, occupational group; full- or part-time status and whether the participant reported their job as desk-based. Descriptive statistics and 95% confidence intervals were calculated to compare sedentary behaviour across demographic and job characteristics.
ResultsClerical and desk-based NHS workers were more sedentary at work than other colleagues. New findings identified that NHS workers aged under 30 and those without educational qualifications had high levels of sedentary behaviour outside work. After adjusting for working hours, part-time employees were significantly more likely to be sedentary.
ConclusionsOur results have implications for those developing strategies to reduce sedentary behaviour in the NHS workforce. Whilst standing desks have received much interest, alternative approaches may be attractive to NHS employers in reducing workplace and non-occupational sitting time. These may also be relevant to other organizations.
Measuring the preparedness of military medical personnel for short-notice operations
BackgroundThis service evaluation explored personnel’s preparedness for deploying on the UK’s military response to the Ebola crisis in West Africa.
AimsTo capture the views of medical and support personnel in relation to the pre-deployment training they received for that mission.
MethodsTwo separate groups nominated to attend pre-deployment training completed a survey on the first and last day of their course. Participants were asked to subjectively rate the quality of training and identity aspects of their preparation they found particularly positive, those that generated concerns and to suggest future improvements.
ResultsSubjective ratings of preparedness for all aspects of the mission significantly improved by the last day of training among both groups of trainees (P < 0.001). Thematic analysis of qualitative data established that unit support and practical aspects of training were positively received. For group 1, a prevalent concern on the first and last day of training was a fear of the unknown. Group 2 respondents were concerned about the quality of information and its transmission and the time available to prepare. Respondents in both groups reported the need for consistent and timely information and for the training to be refined for those undertaking a non-clinical role.
ConclusionsThe collective training package was highly effective in preparing personnel to feel more confident and competent to undertake the medical mission in West Africa.
Return to work after occupational injury and upper limb amputation
BackgroundUpper limb injury can result in loss of function, and time away from work. However, the particular occupational consequences of upper limb amputation (ULA) are not well characterized.
AimsTo describe the characteristics of workers experiencing occupational ULA and their work outcomes.
MethodsIn January 2015, we reviewed the Workers’ Rehabilitation Centre records of adults with ULAs in New Brunswick, Canada, going back to 1993.
ResultsWe examined 49 records. Overall, 82% of patients made an eventual return to work, returning after a median of 172 days (range 20–1645 days). Younger patients were more likely to return to work and did so sooner. Patients returning to work did not seem to change job type, as coded through the Canadian National Occupational Classification.
ConclusionsThe majority (82%) of workers in our sample returned to work and to similar job types. In addition, age was a protective factor for return to work. Patients and occupational health clinicians should be reassured with regard to this aspect of their rehabilitation.
Does perceived work ability improve after a cognitive behavioral intervention program?
BackgroundLong-term sickness absence and early retirement are problems in the municipal employment sector. Ways to support work ability and coping at work are therefore required and it is important that timely actions are aimed at employees at risk to improve their health, promote work ability and prevent long-term sickness absence and early retirement.
AimsTo evaluate the effects of cognitive behavioural therapy (CBT) in an early rehabilitation programme to improve employees’ work ability.
MethodsA 9-month investigation was done to estimate the causal impact of the CBT intervention in the study group, compared with a control group that was not offered this intervention. The work ability of each group was measured using the Work Ability Index (WAI), with data obtained by self-reporting at baseline and at follow-up at 9 months. Differences were analysed within each group and between groups.
ResultsParticipants in the intervention group showed a significant increase in several WAI areas, resulting in an overall increase in total WAI score (P < 0.001). There was a significant decrease in WAI in the control group (P < 0.05).
ConclusionsThe results suggest that a CBT-based early rehabilitation programme is effective in increasing employees’ work ability, as measured by the WAI.
Occupational metal exposures, smoking and risk of diabetes and prediabetes
BackgroundMetal exposure and tobacco smoking have been independently associated with diabetes, but no study has been conducted to investigate the interaction between them on the risk of diabetes.
AimsTo investigate the effect of occupational exposure to metals, and potential effect modification by smoking, on the risk of diabetes and prediabetes in a cohort of Chinese male workers.
MethodsWe assessed metal exposure and tobacco smoking at baseline in the Jinchang Cohort of male workers. We used Poisson regression analyses to estimate the interaction between smoking and metal exposures based on occupations, which we grouped according to the measured urinary metal levels.
ResultsAmong the 26008 study subjects, compared with non-smokers, the adjusted prevalence ratio (PR) for diabetes was 1.8 [95% confidence interval (CI) 1.3–2.4] for smokers of >40 pack-years. The adjusted PRs were 1.2 (95% CI 1.1–1.4) among mining/production workers and 2.7 (95% CI 2.4–3.0) among smelting/refining workers, both compared with office workers. There was significant effect modification under the additive model between smoking and metal exposure on the prevalence of diabetes (Pinteraction = 0.001), with an adjusted PR of 3.6 (95% CI 2.4–5.4) for those with >40 pack-years of smoking who had the highest metal exposures, whereas no significant interaction was observed for prediabetes.
ConclusionsBoth exposure to metals and heavy smoking were associated with an increased prevalence of diabetes in this large cohort of male workers. There was also strong interaction between these two exposures in affecting diabetes risk that should be confirmed in future studies.