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Occupational Medicine - current issue



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In This Issue of Occupational Medicine

2016-10-21T06:39:32-07:00







Why I became an occupational physician....

2016-10-21T06:39:32-07:00










Pregnancy outcome in partners of male professional divers in Norway

2016-10-21T06:39:32-07:00

Background

Diving is associated with both acute and long-term effects in several organ systems. Reduced semen quality after extreme diving and a reduced proportion of males in the offspring of divers have previously been reported.

Aims

To study pregnancy outcomes in partners of professional male divers.

Methods

The cohort of divers registered with the Norwegian Inshore Diving Registry was linked to the Medical Birth Registry of Norway (MBRN).

Results

In total, 6186 male divers had 10395 children registered in the MBRN during the study period. Of these, 52% were boys, compared to 51% in the general population. The partners of a subgroup of divers who were most likely to be occupationally exposed at the time of conception reported that early miscarriage was more frequent (27%) than in the general population (21%; relative risk 1.21, 95% confidence interval 1.05–1.39). Otherwise, there was a lower risk of adverse pregnancy outcomes such as preterm birth, stillbirth, low birthweight, small for gestational age and low Apgar score compared to the general population. Birthweight above 4000g was more frequent.

Conclusions

We observed no reduced sex ratio in the offspring of occupational divers. Except for an increase in self-reported early miscarriage in the partners of exposed divers, we observed no excess risk of any of the adverse perinatal pregnancy outcomes studied.




Lifetime impact of injury on education, employment and income for Australians of labour force participation age

2016-10-21T06:39:32-07:00

Background

Research shows that employment rates are low post injury.

Aims

To quantify the economic impact of a long-term injury and identify whether having a tertiary level of education attainment would offset this impact.

Methods

Cross-sectional analysis of the 2012 Survey of Disability, Aging and Carers, which is nationally representative of the Australian population.

Results

Males with any long-term injury had incomes 41% less than males with no chronic health condition (95% confidence interval [CI] –49.3%, –31.6%). For males with a long-term injury, there was no significant difference in the likelihood of being not in the labour force between those with and without a tertiary qualification (odds ratio [OR] 0.83, 95% CI 0.45–1.52). There was no significant difference in the incomes of females with any long-term injury compared with those with no chronic health conditions. For females with a long-term injury, there was a significant difference in the likelihood of being not in the labour force between those with and without a tertiary qualification (OR 0.37, 95% CI 0.17–0.80). If men with a long-term injury had the same probability of participating in the workforce as women, the percentage of men not in the labour force would reduce from 37 to 18%.

Conclusions

Having a long-term injury was a significant personal cost in terms of labour force absence and lower income for males regardless of higher education attainment. For females, sustaining a long-term injury did not appear to significantly affect income.




Systematic review: risk factors for musculoskeletal disorders in musicians

2016-10-21T06:39:32-07:00

Background

Although many musicians suffer from musculoskeletal disorders, aetiological factors are unclear.

Aims

To systematically search for and synthesize the best available evidence on risk factors for musculoskeletal disorders in musicians.

Methods

A database search was performed in PubMed, EMBASE, CINAHL, Pedro, OTseeker and Psychinfo. A manual search was conducted in the journals Medical Problems of Performing Artists and Psychology of Music. Studies with an objective to investigate determinants associated with playing-related musculoskeletal disorders were included. Papers were selected based on adequacy of statistical methods for the purpose of the study. Search, first screening and selection were performed by one author. Two reviewers independently performed the final selection using full-text reports. Methodological quality assessment was performed by two reviewers independently.

Results

One case–control and 14 cross-sectional studies were included. Methodological quality was in general low. Large heterogeneity existed in study design, population, measurement of determinant and outcome and analysis techniques. Data were presented descriptively. Consistent results were found indicating that previous musculoskeletal injury, music performance anxiety, high levels of stress and being a female playing a stringed instrument seemed to be associated with more musculoskeletal disorders. Influence over or support at work, orchestra category/status, exercise behaviour and cigarette smoking seemed to be unrelated with musculoskeletal disorders. No conclusions could be made on causality, as the current data only represent cross-sectional associations.

Conclusions

Because of lack of prospective studies, no causal relations could be identified in the aetiology of (playing-related) musculoskeletal disorders in instrumental musicians.




Effectiveness of educational materials to prevent occupational low back pain

2016-10-21T06:39:32-07:00

Background

Low back pain (LBP) in association with occupation is well documented. A subpopulation of workers can be defined as ‘non-heavy’ manual workers with either light or sedentary roles who may be at risk of LBP due to insufficient physical activity. Educational materials are a potential intervention, which are cost-effective and easily targeted at this population.

Aims

To investigate the evidence for using information material among ‘non-heavy’ manual workers and the effect on their sickness absence.

Methods

A search investigating the effect of educational material on LBP in non-heavy manual workers. Electronic databases were searched and selected references were reviewed. Specific key terms were used including: ‘worker’, ‘non-heavy manual’, ‘booklet’, ‘leaflet’, ‘advice’, ‘sickness’, ‘absenteeism’, ‘prevention’ and ‘low back pain’. Methodological quality was assessed by predefined criteria.

Results

Four studies were identified: one guideline review, one prospective study and two randomized controlled trials. Methodological quality was deemed moderate to high. There was insufficient evidence to show written education altered sickness absence. There was evidence that information given to workers can help change attitudes and beliefs about LBP.

Conclusions

Educational materials alone do not appear to reduce sickness absence for LBP in the ‘non-heavy’ manual working population. However, they can facilitate behavioural change and modify health beliefs and attitudes. Educational materials may be a useful medium to engage workers, provide information regarding practical modifications to their work environment and activities and potentially reduce psychological distress regarding ill-health at work.




Mindfulness-based stress reduction for managers: a randomized controlled study

2016-10-21T06:39:32-07:00

Background

Mindfulness-based stress reduction (MBSR), which was initially used in clinical settings, has also proved to be an effective tool for managing work-related stress in occupational groups inherently exposed to certain psychosocial risks.

Aims

To examine the potential for work-related stress management using MBSR for middle-level managers who are considered to be particularly affected by the negative effects of stress related to organizational restructuring.

Methods

Middle-level managers participated in a randomized controlled study which implemented a 2 (experimental versus control group) x 2 (baseline, post-treatment) study design, yielding a between-group comparison. The participants were randomly assigned to an 8-week intervention group or to a wait-list control group.

Results

The results showed that, relative to the control group, the MBSR intervention had significant effects on several outcomes in the 144 subjects, including: decreases in perceived work-related stress (F(1,140) = 20.4, P < 0.001, d diff = 0.72), negative affect (F(1,140) = 45.3, P < 0.001, d diff = 0.93), intensity of somatic complaints (F(1,140) = 20.7, P < 0.001, d diff = 0.69), and sickness absence (F(1,140) = 67.3, P < 0.001, d diff = 0.69), and increase in self-esteem (F(1,140) = 44.1, P < 0.001, d diff = 1.25), and positive affect (F(1,140) = 6.73, P < 0.01, d diff = 0.43). No effects were found on frequency of somatic complaints.

Conclusions

These results suggest that MBSR is an effective method for managing work-related stress and bolstering psychological resilience in the workplace, particularly in the face of psychosocial risks of a global, economic nature.




Occupational physicians perceptions and experience of appraisals for revalidation

2016-10-21T06:39:32-07:00

Background

Formal, structured annual appraisals are now a regulatory requirement for all doctors and must meet the standards stipulated by the General Medical Council (GMC), including connection with a designated body.

Aims

To investigate occupational physicians’ opinions and experience of the first year of appraisals for revalidation.

Methods

Members of the Society of Occupational Medicine (SOM) were surveyed electronically regarding the appraisal process and its software. A quiz tested knowledge of the requirements and underlying principles and regulations of appraisal for revalidation.

Results

In total, 163 responses were received, with 57 free-text comments. Respondents spent a mean of 31h on the appraisal process (range 0–200h). Less than half of respondents said they had a clear understanding of the appraisal process. Most respondents (88 and 92%) reported difficulties with the appraisal process and the appraisal software. Only 22% felt the time taken for the appraisal process was proportionate to the value gained. Overall, there was support for appraisal and in particular for SOM appraisers, but only half of the respondents found it useful. The average quiz score was 11 out of 15 (74%) with only one respondent scoring full marks. About 25% of respondents were not aware that the responsible officer is obliged to act on any concerns raised. The free-text comments suggested that some physicians found the process costly and stressful.

Conclusions

The findings suggest that the time requirements and process of appraisal for occupational physicians could be improved, and clearer, comprehensive and more accessible guidance should be developed.




Patient and physician views of accompanied consultations in occupational health

2016-10-21T06:39:32-07:00

Background

Accompanied (triadic) consultations, or consultations where a third person is present, are poorly researched and little research has been carried out in an occupational health (OH) setting.

Aims

To elicit the views of patients and OH physicians about accompanied consultations.

Methods

OH receptionists gave a self-administered questionnaire to patients after they attended OH consultations with a companion. We interviewed participating OH physicians to ascertain their views on accompanied consultations.

Results

Twenty-six patient questionnaires were completed (response rate 52%). Seventy-three per cent (19) of responders were accompanied by a spouse and 12% (3) by non-family members. Patients reported their companion was helpful with recall of information (100%), supportive (100%), provided extra information to the physician (81%) and enabled them to discuss the outcome afterwards (92%). In two consultations, the companion attended to provide support on procedural matters. Patients were not concerned that the consultation might involve sensitive discussion or physical examination. OH physicians reported concerns that the companion would make the consultation more difficult or influence its outcome. They felt that written information, guidelines and training in how to manage accompanied consultations would be useful.

Conclusions

Patients who attended OH consultations with a companion felt the companion was beneficial to the consultation and did not have concerns about personal issues. OH physicians felt that further guidance and training on accompanied consultations would be useful. Written information could usefully be provided to patients attending an OH consultation with a companion.




Core competencies for UK occupational health nurses: a Delphi study

2016-10-21T06:39:32-07:00

Background

Occupational health nurses (OHNs) play a pivotal role in the delivery of occupational health (OH) services. Specific competency guidance has been developed in a number of countries, including the UK. While it is acknowledged that UK OHN practice has evolved in recent years, there has been no formal research to capture these developments to ensure that training and curricula remain up-to-date and reflect current practice.

Aims

To identify current priorities among UK OHNs of the competencies required for OH practice.

Methods

A modified Delphi study undertaken among representative OHN networks in the UK. This formed part of a larger study including UK and international occupational physicians. The study was conducted in two rounds using a questionnaire based on available guidance on training competencies for OH practice, the published literature, expert panel reviews and conference discussions.

Results

Consensus among OHNs was high with 7 out of the 12 domains scoring 100% in rating. ‘Good clinical care’ was the principal domain ranked most important, followed by ‘general principles of assessment & management of occupational hazards to health’. ‘Research methods’ and ‘teaching & educational supervision’ were considered least important.

Conclusions

This study has established UK OHNs’ current priorities on the competencies required for OH practice. The timing of this paper is opportune with the formal launch of the Faculty of Occupational Health Nursing planned in 2018 and should inform the development of competency requirements as part of the Faculty’s goals for standard setting in OHN education and training.




Supervised learning events: direct observation of procedural skills pilot

2016-10-21T06:39:32-07:00

Background

Workplace-based assessment (WBA) is the assessment of specialist competence based on what a trainee doctor actually does in the workplace. Between January 2014 and January 2015, all UK occupational medicine (OM) trainees were invited to test a suite of direct observation of procedural skills (DOPS) tools designed in a supervised learning event (SLE) format. The Faculty of Occupational Medicine (FOM) Workplace-Based Assessment Advisory Group (WBAAG) studied feedback on the new format.

Aims

To assess the utility of the redesigned tools, including their acceptability, feasibility, usability and key aspects of their reliability and validity.

Methods

The face and content validity of the new forms were assessed by a comprehension trial (CT), inter-rater reliability by a video scoring exercise and usability and acceptability by an electronic survey of trainees and trainers.

Results

The CT of trainees and trainers indicated that the face and content validity of the revised tools were acceptable. Inter-rater reliability video assessments indicated there was consistency of grading among trainers. Sixty-eight per cent of trainees and 95% of trainers agreed that the redesigned tools were an improvement on the current WBA DOPS tools and 83% of trainees indicated the new tools encouraged them to reflect on their performance.

Conclusions

The results from this pilot study provided evidence to support a request to the General Medical Council (GMC) for the new SLE-DOPS forms to be used for WBA in OM. These changes were accepted by the GMC in January 2016 for implementation in April 2016.




Reporting and prediction of work-related sickness absence by general practitioners

2016-10-21T06:39:32-07:00

Background

Information on sickness absence (SA) duration in general practice is difficult to record. The duration of absence certified by general practitioners (GPs) can be viewed as a prognosis for return to work. The Health and Occupation Research network in General Practice (THOR-GP) collects SA information from GPs associated with cases of work-related ill-health. A sample of these cases is followed up 1 year retrospectively to gather information on the duration of absence.

Aims

To examine the extent of the underestimation of SA in routinely reported data and to investigate how well GPs predict patients’ return to work.

Methods

THOR-GPs submit case and SA information using a web-based form. GPs who submitted selected cases were asked about the total number of days of SA and whether the patient had returned to work.

Results

THOR-GPs’ routine SA data collection underestimated absence duration by 61%. According to the retrospective data, a much larger proportion of periods of absence due to work-related mental ill-health developed into long-term SA (60%) than episodes attributed to musculoskeletal disorders (32%). In over half the reported cases, the return to work was longer than the GP initially predicted.

Conclusions

THOR-GP prospectively reported SA data underestimated the total length of absence; however, these data can examine the episodic rates of absence within different groups. More accurate longitudinal data can be collected retrospectively. GPs’ ability to predict the length of time a patient will be away from work is important to enable treatment and rehabilitation planning in order to decrease the likelihood of a patient falling into long-term SA.




Poor sleep after military deployment: associations with mental health difficulties

2016-10-21T06:39:32-07:00

Background

Sleep difficulties, alcohol use and mental illness are often related; military studies suggest that post-deployment is a high-risk period for sleep problems.

Aims

To examine the prevalence of post-deployment sleep difficulties in UK Armed Forces (UKAF) personnel and associations with alcohol use disorders (AUD) and any mental disorder (AMD) symptoms.

Methods

A prospective, self-report, observational study of UKAF members returning from Afghanistan, questionnaire data were collected immediately following and 6 months post-deployment.

Results

A total of 1636 participants provided study data at both time points. Twenty-three per cent of personnel reported sleep difficulties at follow-up; 11% reported sleep-related interference with daily functioning. Sleep problems were significantly associated with AUD and AMD. Initial post-deployment sleep problems were predictive of AMD but not AUD at follow-up.

Conclusions

The disclosure of alcohol misuse and mental ill-health in UKAF personnel is often inhibited by stigmatizing beliefs; detection could be enhanced by inquiring about sleep problems which may be less stigmatizing than direct enquiries about alcohol misuse and psychological well-being.




Transformed occupational prospects for HIV-associated brain syndromes

2016-10-21T06:39:32-07:00

Abstract We report a case of a full-time worker with late undiagnosed HIV disease presenting as encephalopathy with motor features and a manic-like picture. HIV encephalopathy was a terminal condition before the advent of combination highly active anti-retroviral therapy (HAART). Treatment with HAART, with follow-up in a neuropsychiatric service and rehabilitation involving the occupational health department of his employer, produced a successful return to work. This case demonstrates a remarkable transformation in occupational and other outcomes of HIV-related brain disease in the era of HAART.




Job stress and needlestick injuries: which targets for organizational interventions?

2016-10-21T06:39:32-07:00

Background

Needlestick injuries (NSIs) represent a major concern for the safety of health care workers involved in clinical care. The percentage of health workers reporting these injuries varies between 9 and 38% and the occurrence of NSI is most frequent among employees having close clinical contact with patients or patient specimens. These injuries appear to occur most frequently where organizational factors contribute to the risk.

Aims

To investigate the interactions between organizational level interventions focused on work-related stress (WRS) and the occurrence of NSIs among nurses employed in hospital departments, and to determine the impact of such interventions on the safety budget.

Methods

Comparison of NSI occurrence among nurses employed in hospital health care departments in two 3-year periods, before and after interventions aimed at minimizing WRS. The economic cost of NSIs occurrence was calculated.

Results

The study group consisted of 765 nurses. The cumulative 3-year incidence of NSIs after the implementation of management stress interventions was significantly lower than the cumulative 3-year incidence observed before implementation (OR 0.60; 95% CI 0.43–0.83). A cost saving from managing fewer NSIs than during the first study period was found.

Conclusions

This study found a reduction in NSI occurrence and associated costs following an intervention to bring about proactive, integrated and comprehensive management of stress in the workplace.




Job insecurity, financial difficulties and mental health in Europe

2016-10-21T06:39:32-07:00

Background

The recession has increased job insecurity in the European Union (EU) which may result in higher levels of psychological distress, burnout and anxiety.

Aims

To investigate the association of job insecurity and financial difficulties with mental health in 27 member states of the EU and to explore the moderating effect of having financial difficulties on the relationship between job insecurity and mental health.

Methods

The sample consisted of employed people from 27 European countries where the Eurobarometer survey (73.2 wave, 2010) was administered by the European Commission. Mental well-being and psychological distress were measured using the Vitality and Mental Health Index (MHI-5) subscales from the Short-Form 36-item health survey (SF-36v2). Linear regression including an interaction term was used to test the underlying factors in this study.

Results

Among the 12594 respondents, experiencing job insecurity was associated with lower Vitality [β = –3.82, 95% confidence interval (CI) –5.29 to –2.36] and MHI-5 (β = –3.48, 95% CI –4.91 to –2.04). Similarly, having financial difficulties was significantly correlated with lower Vitality (β = –8.65, 95% CI –12.07 to –5.24) and MHI-5 (β = –11.51, 95% CI –15.08 to –7.94). However, having financial difficulties did not moderate the relationship between job insecurity and both mental health scales.

Conclusions

This study highlights the negative effect of job insecurity and financial difficulties on mental health in the EU. Support to employees facing job security issues should be a priority regardless of the financial circumstances.




Occupational Medicine Calendar

2016-10-21T06:39:32-07:00