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Occupational Medicine - current issue



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In this issue of Occupational Medicine

2016-09-07T08:14:12-07:00










Common mental disorders related to incidents and behaviour in physicians

2016-09-07T08:14:12-07:00

Background

Common mental disorders (CMD—burnout, stress, depression and anxiety disorders) are prevalent in physicians.

Aims

To investigate the relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians.

Methods

PubMed was searched for all articles published between 2003 and 2013 that study a relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians. The strength of evidence was assessed through five levels of evidence.

Results

We included 15 studies. We found strong evidence for a significant association between burnout and the occurrence of medical incidents, based on two longitudinal and seven cross-sectional studies with a positive association [odds ratio (OR) 1.07–5.5]; one longitudinal study found a non-significant association (strong evidence). For the association between depression and medical incidents, four longitudinal studies and three cross-sectional studies found a significant positive association (strong evidence; OR 2.21–3.29). For the association between fatigue and medical incidents, one longitudinal study and one cross-sectional study showed a significant positive association, but one cross-sectional study showed a non-significant association (strong evidence; OR 1.37). For the association between sleepiness and medical incidents, one longitudinal study and two cross-sectional studies showed a significant positive association (strong evidence; OR 1.10–1.37). No significant association was found between burnout and unprofessional behaviour (inconsistent evidence). Nor was any evidence found for the association between unprofessional behaviour and depression, fatigue or sleepiness.

Conclusions

CMD in hospital physicians were associated with the occurrence of self-reported medical incidents, but there was inconsistent evidence for unprofessional behaviour.




Systematic review: effect of psychiatric symptoms on return to work after occupational injury

2016-09-07T08:14:12-07:00

Background

Although post-traumatic stress disorder (PTSD) and depression are commonly observed following injury, few studies have focused on the effect of psychiatric symptoms on return to work (RTW) following occupational injury.

Aims

To determine the impact of psychiatric symptoms on RTW after occupational injury.

Methods

PubMed (1980–2014), MEDLINE (1980–2014) and PsycINFO (1980–2014) databases were examined with linked fields of research in February 2015. Reference lists of eligible articles were also searched. Cohort, case–control, cross-sectional studies and intervention studies were selected according to predefined criteria. Evidence was synthesized qualitatively according to the Downs and Black and Crombie checklist. The standard checklist was used to assess the methodological quality of each study by two reviewers.

Results

Five of the 56 records met the inclusion and exclusion criteria. After occupational injury, the rates of RTW after the injuries varied widely, ranging from 31 to 63%. PTSD symptoms and depressive symptoms appeared to be negatively associated with RTW.

Conclusions

Currently, the evidence is insufficient to draw conclusions about the effects of psychiatric symptoms on RTW after occupational injury and more studies are needed. Future studies with large sample sizes are warranted to determine the prevalence of RTW and to detect the psychiatric factors.




Customer-perpetrated work-related violence: prevalence and trends in Britain

2016-09-07T08:14:12-07:00

Background

Incidents of work-related violence (WRV) have increased over the years. These can be damaging to both individual psychological well-being and organizational performance.

Aims

To examine the prevalence and causes of customer-perpetrated WRV in Britain over a 12 year period. Demographic, work and perpetrator’s personality characteristics were examined as predictors of WRV.

Methods

Data from the Crime Survey of England and Wales (CSEW) across 2001–13 were filtered specifically to explore responses from victims of customer-perpetrated crime within the working population.

Results

On average, 22% of all violent crimes committed by customers occurred in the workplace. Further analysis showed that differences in gender, age as well as managerial/supervisory duties, working hours, employment status, organizational size and occupation were significantly related to incidents of WRV. Perpetrators’ personality characteristics were also perceived as predictors of WRV.

Conclusions

This paper provides an alternative approach for reporting customer-perpetrated WRV. Violence at work is considered a widespread problem within the organizational studies literature, which can lead to a variety of stress-related symptoms in affected workers. Based on the current study’s findings, a theoretical model is proposed to help combat customer-perpetrated WRV, and as a basis for future research.







Post-traumatic stress among rescue workers after terror attacks in Norway

2016-09-07T08:14:12-07:00

Background

On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims.

Aims

To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS).

Methods

A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist – specific (PCL-S) assessed PTSS.

Results

There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35–49) was 2% and possible PTSD (PCL ≥ 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (β = 1.7), witnessing injured/dead (β = 2.0), perceived threat (β = 1.1), perceived obstruction in rescue work (β = 1.6), lower degree of previous training (β = –0. 9) and being unaffiliated volunteers (β = 8.3) were significantly associated with PTSS.

Conclusions

In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.




Mortality and cancer incidence at a fire training college

2016-09-07T08:14:12-07:00

Background

An investigation into concerns about possible health effects of fire training practices at an Australian training facility recommended a study to investigate the risk of cancer and mortality of those with risk of chronic occupational exposure to several chemicals.

Aims

To investigate mortality and cancer incidence in firefighters at the Country Fire Authority (CFA) Fiskville training facility, Victoria, Australia, between 1971 and 1999.

Methods

CFA supplied human resources records, supplemented by self-reported information for a retrospective cohort, and allocated firefighters to low, medium or high groups based on probability of exposure. We linked the cohort to state and national cancer and mortality data. We calculated standardized mortality ratios and standardized cancer incidence ratios (SIRs).

Results

The high group (n = 95) had a clearly increased risk of overall cancers SIR = 1.85 (95% CI 1.20–2.73), testicular cancer SIR = 11.9 (1.44–42.9) and melanoma SIR = 4.59 (1.68–9.99) relative to the population of Victoria. Brain cancer was significantly increased for the medium group (n = 256): SIR = 5.74 (1.56–14.7). Mortality was significantly reduced for all groups.

Conclusions

Dealing with supplied records can be problematic but despite the small numbers, we identified an increased risk of cancer for the high group. The mortality data suggested that there was under-ascertainment for the medium and low groups which underestimated risk and a possible reporting bias for brain cancer. Small cohorts can still provide statistically significant findings when investigating locations for cancer risk.




The Boehringer Ingelheim employee study (Part 2): 10-year cardiovascular diseases risk estimation

2016-09-07T08:14:12-07:00

Background

Cardiovascular disease (CVD) may cause an economic burden to companies, but CVD risk estimations specific to working populations are lacking.

Aims

To estimate the 10-year CVD risk in the Boehringer Ingelheim (BI) employee cohort and analyse the potential effect of hypothetical risk reduction interventions.

Methods

We estimated CVD risk using the Framingham (FRS), PROCAM (PRS) and Reynolds (RRS) risk scores, using cross-sectional baseline data on BI Pharma employees collected from 2005 to 2011. Results were compared using Fisher’s exact and Wilcoxon tests. The predictive ability of the score estimates was assessed using receiver-operating characteristics analyses.

Results

Among the 4005 study subjects, we estimated 10-year CVD risks of 35% (FRS), 9% (PRS) and 6% (RRS) for men and 10% (FRS), 4% (PRS) and 1% (RRS) for women. One hundred and thirty-four (6%) men and 111 (6%) women employees had current CVD. The best predictors of prevalent CVD were the FRS and the RRS for men [area-under-the-curve 0.62 (0.57–0.67) for both]. A hypothetical intervention that would improve systolic blood pressure, HbA1c (for diabetes), C-reactive protein, triglycerides and total and high-density lipoprotein cholesterol by 10% each would potentially reduce expected CVD cases by 36–41% in men and 30–45% in women, and if smoking cessation is incorporated, by 39–45% and 30–55%, respectively, depending on the pre-intervention risk score.

Conclusions

There was a substantial risk of developing CVD in this working cohort. Occupational health programmes with lifestyle interventions for high-risk individuals may be an effective risk reduction measure.




Fitness, obesity and risk of asthma among Army trainees

2016-09-07T08:14:12-07:00

Background

Epidemiological data suggest an association between overweight/obesity and asthma. However, less is known about the relationship between physical fitness and asthma.

Aims

To enumerate new-onset asthma diagnoses in Army recruits during the first 2 years of service and determine associations with fitness and excess body fat (EBF) at military entrance.

Methods

New asthma diagnoses over 2 years in Army recruits at six entrance stations were obtained from military health and personnel records. Poisson regression models were used to determine associations of asthma diagnosis with pre-accession fitness testing, EBF and other potential factors.

Results

In 9979 weight-qualified and 1117 EBF entrants with no prior history of asthma, 256 new cases of asthma were diagnosed within 2 years of military entry. Low level of fitness, defined by a step test and EBF, was significantly associated with new asthma diagnosis [adjusted incidence rate ratio (IRR), 1.47; 95% confidence interval (CI) 1.11–1.96 and adjusted IRR, 1.53; 95% CI 1.06–2.20, respectively].

Conclusions

Individuals with low fitness levels, EBF or both are at higher risk of asthma diagnosis in the first 2 years of military service.




Association between temporomandibular disorders and music performance anxiety in violinists

2016-09-07T08:14:12-07:00

Background

Professional violin playing has been associated with a predisposition to develop temporomandibular disorder (TMD). There are a number of risk factors, including physical trauma from the playing posture and the presence of parafunctional habits. Music performance anxiety (MPA) may also be a factor, as it has been associated with playing-related musculoskeletal disorders (PRMD).

Aims

To evaluate a possible association between the presence of TMD and the level of MPA in violin players.

Methods

An observational study using a written questionnaire that retrieved data related to TMD symptoms (Fonseca Anamnestic Questionnaire), MPA level (Kenny Music Performance Anxiety Inventory, K-MPAI), instrument practice time, chinrest type, sex and age. Descriptive, bivariate and logistic regression analyses were conducted.

Results

Ninety-three professional or semi-professional violinists performing in and around Lisbon, Portugal, completed the questionnaire (73% response rate). TMD was present in 50 violinists (58%). There was a statistically significant association between the presence of TMD and high MPA levels (P < 0.001) and the most anxious violinists were six times (95% confidence interval 2.51–15.33; P < 0.001) more likely to report TMD symptoms when compared with the least anxious players.

Conclusions

Violin players had a high prevalence of reported TMD symptoms, which was significantly associated with high MPA levels. It may therefore be necessary to address psychological and physical factors simultaneously in musicians who do not improve with physical therapy alone.




Work stress, poor recovery and burnout in teachers

2016-09-07T08:14:12-07:00

Background

Both work stress and poor recovery have been shown to contribute to the development of burnout. However, the role of recovery as a mediating mechanism that links work stress to burnout has not been sufficiently addressed in research.

Aims

To examine recovery as a mediator in the relationship between work stress and burnout among teachers.

Methods

A cross-sectional study of Finnish primary school teachers, in whom burnout was measured with the Maslach Burnout Inventory-General Survey and work stress was conceptualized using the effort–reward imbalance (ERI) model. Recovery was measured with the Recovery Experience Questionnaire and the Jenkins Sleep Problems Scale. Multiple linear regression analyses and bootstrap mediation analyses adjusted for age, gender and total working hours were performed.

Results

Among the 76 study subjects, high ERI was associated with burnout and its dimensions of exhaustion, cynicism and reduced professional efficacy. Poor recovery experiences, in terms of low relaxation during leisure time, partially mediated the relationship between ERI and reduced professional efficacy. Sleep problems, in the form of non-restorative sleep, partially mediated the relationship between ERI and both burnout and exhaustion.

Conclusions

Supporting a balance between effort and reward at work may enhance leisure time recovery and improve sleep quality, as well as help to reduce burnout rates.




Occupational Medicine Calendar

2016-09-07T08:14:12-07:00




Sickness absence of LU train drivers after track incidents

2016-09-07T08:14:12-07:00

Background

Track incidents including near misses and those causing injury or death are a psychological hazard for train operators. No study has directly investigated how train operators are affected depending on track incident outcome and few studies have investigated the impact of near misses.

Aims

To compare sickness absence (SA) of London Underground train operators following track incidents categorized by outcome, including near misses.

Methods

This was an observational study using historical data of track incidents from April 2008 to October 2013. Track incidents were divided into four categories according to outcome (near miss on platform, near miss on track, significant injury and fatality). Additional information on age, gender and previous relevant history was collected.

Results

A total of 685 track incidents were analysed. There was a significant difference in SA taken after near misses (‘no injury’) incidents compared with significant injury and fatality (‘injury’) incidents (P < 0.001). There was also a significant difference in SA in train operators involved in a fatality incident compared with significant injury incidents (P < 0.05).

Conclusions

SA in train operators following a track incident increases in line with the severity of the incident in terms of outcome. Fatal track incidents caused the highest level of SA followed by significant injury incidents. Near misses also caused substantial levels of SA.




The influence of anthropometrics on physical employment standard performance

2016-09-07T08:14:12-07:00

Background

The Canadian Armed Forces (CAF) recently implemented the Fitness for Operational Requirements of CAF Employment (FORCE), a new physical employment standard (PES). Data collection throughout development included anthropometric profiles of the CAF.

Aims

To determine if anthropometric measurements and demographic information would predict the performance outcomes of the FORCE and/or Common Military Task Fitness Evaluation (CMTFE).

Methods

We conducted a secondary analysis of data from FORCE research. We obtained bioelectrical impedance and segmental analysis. Statistical analysis included correlation and linear regression analyses.

Results

Among the 668 study subjects, as predicted, any task requiring lifting, pulling or moving of an object was significantly and positively correlated (r > 0.67) to lean body mass (LBM) measurements. LBM correlated with stretcher carry (r = 0.78) and with lifting actions such as sand bag drag (r = 0.77), vehicle extrication (r = 0.71), sand bag fortification (r = 0.68) and sand bag lift time (r = –0.67). The difference between the correlation of dead mass (DM) with task performance compared with LBM was not statistically significant.

Conclusions

DM and LBM can be used in a PES to predict success on military tasks such as casualty evacuation and manual material handling. However, there is no minimum LBM required to perform these tasks successfully. These data direct future research on how we should diversify research participants by anthropometrics, in addition to the traditional demographic variables of gender and age, to highlight potential important adverse impact with PES design. In addition, the results can be used to develop better training regimens to facilitate passing a PES.




Workplace violence against medical staff in healthcare facilities in Barbados

2016-09-07T08:14:12-07:00

Background

Anecdotal evidence suggests increasing workplace violence against healthcare workers in the Caribbean, but the prevalence is largely undocumented.

Aims

To determine the prevalence of workplace violence reported by medical staff at primary care clinics in Barbados.

Methods

A study utilizing a modified version of the standard World Health Organization Workplace Violence Questionnaire, designed to assess the incidence, types and features of workplace violence. All nursing and physician staff on duty at the island’s eight primary care clinics during the study period were invited to participate.

Results

Of the 102 respondents (72% response rate), 63% of nursing and physician staff at the polyclinics in Barbados reported at least one episode of violence in the past year. The majority reported being exposed to verbal abuse (60%) and 19% reported being exposed to bullying. Seven percent of the staff reported incidents of sexual harassment, 3% physical violence and another 3% reported racial harassment. Patients emerged as the main perpetrators of violence (64%). Logistic regression showed statistically significant associations between gender and workplace violence. Females and nurses were more predisposed to experience violent incidents than males and physicians.

Conclusions

Over a half of medical staff surveyed reported experiencing some type of violence in the past year, female gender being a significant predictor of abuse. Adequate documentation and implementing clear policies and violence prevention programmes in health institutions are crucial steps towards addressing this issue.




Anaphylactic reaction in a hairdresser due to sensitization to persulphates

2016-09-07T08:14:12-07:00

Severe occupational systemic reactions to persulphates have rarely been described and if so mainly after skin contact with bleaching products. We report the first case of a hairdresser with an allergy to persulphates obtained during professional work, who developed anaphylaxis caused by persulphates present in dental cement during dental treatment. This case documents that sensitization to occupational allergens can induce severe systemic reactions outside the workplace. Additionally, it also recommends the need for greater awareness of medical professionals, including dentists, of the possibility of anaphylaxis in patients with occupational allergy.










Hamilton and Hardys Industrial Toxicology

2016-09-07T08:14:12-07:00




OH Law Online website

2016-09-07T08:14:12-07:00