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Occupational Medicine Current Issue





Published: Wed, 27 Dec 2017 00:00:00 GMT

Last Build Date: Sat, 30 Dec 2017 03:49:20 GMT

 



Substance and Behavioral Addictions: Concepts, Causes and Cures

Wed, 27 Dec 2017 00:00:00 GMT

Edited by SussmanSteve. Published by Cambridge University Press, Cambridge, UK, February 2017. ISBN: 978 1 107 49591-3. Price: £24.96 (Kindle edition), £35.99 (Paperback), £96.00 (Hardcover). 404 pp.



The Travel and Tropical Medicine Manual

Wed, 27 Dec 2017 00:00:00 GMT

Edited by SanfordChristopherPottingerPaul and JongElaine. Published by Elsevier, London, 5th edition, 2017. ISBN: 978-0-323-37506-1. Price: £51.99 (paperback—includes access to eBook). 646 pp.



Doctors and mental health

Wed, 27 Dec 2017 00:00:00 GMT

Staff working in the National Health Service (NHS) experience significant work-related mental health distress, as discussed in a major report by the Royal College of Physicians on health and work in the NHS 2013 [1]. This is being played out through high levels of bullying, complaints, sickness absence, rates of burnout, early retirement and emigration. The reasons for the distress are complex and multifactorial and most easily thought of as a combination of the doctors’ vulnerabilities (including their own past traumas and recent life events) interacting with occupational factors (long hours, unpredictable shifts) and/or wider socio-environmental issues (such as increasing culture of litigation, lack of resources and so on) [2]. It might appear, given the explosion of resilience training courses and creeping mandatory training in this area that the problem with the increase in distress among younger doctors is due to some general lack of resilience, that somehow, they lack the ‘right moral fibre’ to survive a lifetime in health care. The General Medical Council (GMC) publication, Be Prepared: Are New Doctors Safe to Practise (2014) [3], contained reports of concerns from postgraduate deans about the resilience of new doctors, their preparedness to work in busy areas and generalized anxiety they have about working with acutely ill patients. However, health professionals past and present are some of the most resilient human beings in our society, necessary if they are to survive a lifetime exposed to disease, distress and disability. Of course, individuals bring their own predisposing experiences (early losses, dysfunctional parenting and personality problems) and precipitating factors (divorce, moving home, illness, bereavements). But while there might be some changes across the generations, moving home more often nowadays for training purposes, for example, these are not sufficient to be causal factors for the rise in mental illness to individual adversity or vulnerabilities. Far more likely is that the levels of distress are linked to larger societal and geo-political changes, as well as the more parochial such as workload, working conditions and rotas.



Hydrogen cyanide—an update

Wed, 27 Dec 2017 00:00:00 GMT

The UK Health and Safety Executive (HSE) has recently released a publication giving revised guidelines for the first aid treatment of cyanide poisoning [1]. This valuable short document gives authoritative advice to all those involved in any potential exposure to this highly toxic chemical.



In this issue of Occupational Medicine

Wed, 27 Dec 2017 00:00:00 GMT

In this issue, there is a particular focus on the health and well-being of clinicians. There is a growing awareness of the importance of practitioner health not just within the profession but also within the specialist colleges and the General Medical Council (GMC). Increased workloads, long hours, fewer resources and rising patient expectations can impact on a doctor’s mental health, and yet there is an apparent reluctance to admit to illness, partly due to a working environment where coping with the daily requirements of the job and patient care are given higher priority than the health of the doctor themselves. There is a perceived stigma associated with mental health problems and doctors often self manage, self prescribe and delay seeking support. In an important editorial, Dr Clare Gerada of the Practitioner Health Programme shares her experiences of treating and supporting doctors with mental health and addiction problems [1]. Encouragingly overall the prognosis appears to be good for those in treatment but failure to address some of the root causes remains a concern.



Thomas Allom, Lymington Iron Works, on the Tyne c. 1835

Wed, 27 Dec 2017 00:00:00 GMT

This small (9.7 × 15.5 cm) drawing by Thomas Allom (1804–72) engraved in steel by James Sands (1811–41) depicts foundrymen at the iron works of Messrs Bulmer and Company in Lymington (now Lemington) in the west end of Newcastle-upon-Tyne [1]. In 1832, Allom toured the English northern counties making sketches commissioned by Henry Fisher, Son and Co. to provide drawings for a publication, Westmoreland, Cumberland, Durham and Northumberland Illustrated to be published in monthly instalments at 1s (5p) each between 1832 and 1835 [2].



I never knew

Wed, 27 Dec 2017 00:00:00 GMT

I’d worked with her for over 20 years and yet I never knew. When she announced her retirement it felt like the end of an era. During one of our last dinners as working colleagues she told me she had recently been to Stockholm during Nobel Prize presentation week. As a child she remembered going to the Nobel Prize dinner and sitting on a table with other small children, one of whom was now the King of Sweden. To relive memories of attending the awards ceremony all those years before she had gone to the Nobel Museum, which displays the details of all the Nobel Prize winners since 1901. ‘That’s my father,’ she said, showing me a photograph of a display in the museum ‘and that’s my grandfather,’ showing me another. I had to ask her to repeat this a few times. She had never mentioned this in all the years I had known her. ‘I wanted people to accept me for who I was rather than someone from a family with two Nobel Prize winners. The only time it became known was when my father died. I had been visiting him repeatedly in Cambridge and when his obituary was published someone put two and two together because of my surname. Fortunately I persuaded them to keep the information to themselves.’



What clinicians should look for in health and lifestyle apps

Wed, 27 Dec 2017 00:00:00 GMT

Smartphones, tablet computers and websites are widely used by clinicians to support patient care and are used by patients to inform, help themselves and challenge their caregivers. Key to the use of this new technology are ‘apps’.



List of Reviewers

Wed, 27 Dec 2017 00:00:00 GMT

Occupational Medicine relies on the efforts of its peer reviewers to help ensure that submitted work is of an acceptable standard. Our reviewers also provide considerable guidance and wisdom, both to authors and to the editorial team. I am indebted once again to the invaluable work carried out by all our reviewers, who give their time willingly and without material reward. Thank you to those who reviewed papers during 2017.



Occupational Medicine Calendar

Wed, 27 Dec 2017 00:00:00 GMT

2018DateEventContact AddressVenueMarch 12–13ICOHS 2018: 20th International Conference on Occupational Health and Safetyhttps://www.waset.org/conference/2018/03/miami/ICOHSMiami, FLApril 16–19BOHS Annual Occupational Hygiene Conferencehttp://www.oh-2018.com/Stratford-upon-Avon, UKApril 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 (ICOH)http://www.icoh2018.orgDublin, IrelandMay 6–10American Aerospace Medical Association Annual Meetinghttps://www.asma.org/scientific-meetings/asma-annual-scientific-meeting/future-annual-meetingsDallas, TXSeptember 23–25OEMAC 36th Annual Scientific Conferencehttp://oemac.org/annual-conference/2018-calgary/Calgary, Alberta



Serum dehydroepiandrosterone sulphate, psychosocial factors and musculoskeletal pain in workers

Thu, 21 Dec 2017 00:00:00 GMT

Abstract
Background
The serum level of dehydroepiandrosterone sulphate (DHEA-S) has been suggested as a biological marker of stress.
Aims
To assess the association between serum DHEA-S, psychosocial factors and musculoskeletal (MS) pain in university workers.
Methods
The study population included voluntary workers at the scientific departments of the University of Trieste (Italy) who underwent periodical health surveillance from January 2011 to June 2012. DHEA-S level was analysed in serum. The assessment tools included the General Health Questionnaire (GHQ) and a modified Nordic musculoskeletal symptoms questionnaire. The relation between DHEA-S, individual characteristics, pain perception and psychological factors was assessed by means of multivariable linear regression analysis.
Results
There were 189 study participants. The study population was characterized by high reward and low effort. Pain perception in the neck, shoulder, upper limbs, upper back and lower back was reported by 42, 32, 19, 29 and 43% of people, respectively. In multivariable regression analysis, gender, age and pain perception in the shoulder and upper limbs were significantly related to serum DHEA-S. Effort and overcommitment were related to shoulder and neck pain but not to DHEA-S. The GHQ score was associated with pain perception in different body sites and inversely to DHEA-S but significance was lost in multivariable regression analysis.
Conclusions
DHEA-S was associated with age, gender and perception of MS pain, while effort–reward imbalance dimensions and GHQ score failed to reach the statistical significance in multivariable regression analysis.



Cost-effectiveness of yoga for managing musculoskeletal conditions in the workplace

Thu, 30 Nov 2017 00:00:00 GMT

Abstract
Background
Back pain and musculoskeletal conditions negatively affect the health-related quality of life (HRQL) of employees and generate substantial costs to employers.
Aims
To assess the cost-effectiveness of yoga for managing musculoskeletal conditions.
Methods
A randomized controlled trial evaluated an 8-week yoga programme, with a 6-month follow-up, for National Health Service (NHS) employees. Effectiveness in managing musculoskeletal conditions was assessed using repeated-measures generalized linear modelling for the Roland-Morris Disability Questionnaire (RDQ) and the Keele STarT Back Screening Tool. Cost-effectiveness was determined using area-under-the-curve linear regression for assessing HRQL from healthcare and societal perspectives. The incremental cost per quality-adjusted life year (QALY) was also calculated. Sickness absence was measured using electronic staff records at 6 months.
Results
There were 151 participants. At 6 months, mean differences between groups favouring yoga were observed for RDQ [−0.63 (95% CI, −1.78, 0.48)], Keele STarT [−0.28 (95% CI, −0.97, 0.07)] and HRQL (0.016 QALY gain). From a healthcare perspective, yoga yielded an incremental cost-effectiveness ratio of £2103 per QALY. Given a willingness to pay for an additional QALY of £20 000, the probability of yoga being cost-effective was 95%. From a societal perspective, yoga was the dominant treatment compared with usual care. At 6 months, electronic staff records showed that yoga participants missed a total of 2 working days due to musculoskeletal conditions compared with 43 days for usual care participants.
Conclusions
Yoga for NHS employees may enhance HRQL, reduce disability associated with back pain, lower sickness absence due to musculoskeletal conditions and is likely to be cost-effective.



Associations between perceived leadership and presenteeism in an industrial population

Sun, 19 Nov 2017 00:00:00 GMT

Abstract
Background
Presenteeism has received increasing attention in occupational health research but the evidence for its association with perceived leadership is scant.
Aims
To assess the association of perceived leadership and presenteeism among industrial workers.
Methods
Survey responses from employees on perceived leadership were linked to the personnel register of a food industry company. The Presenteeism Scale method was used to determine the presenteeism percentage. Perceived leadership was measured as a composite variable of six individual items on motivating and participating leadership. Generalized linear models were used to determine the association of perceived leadership with presenteeism.
Results
There were 847 participants. The majority of office workers of both genders reported better perceived leadership than factory workers. We found that perceived poor leadership was associated with a higher likelihood of presenteeism (rate ratio (RR) 1.64, 95% confidence intervals (CIs) 1.51–1.78). However, there was variation amongst and within occupational groups and genders, with a higher risk of presenteeism amongst male factory workers (RR 2.28, 95% CI 2.02–2.52) than female office workers.
Conclusions
Leadership was found to be significantly associated with presenteeism, with a greater risk of presenteeism in those reporting poor perceived leadership. The association between levels of perceived leadership and presenteeism was stronger in men than women. Organizations should focus on motivating leadership practices to reduce the risk of presenteeism, especially among men.



Effects of cognitive loading and force on upper trapezius fatigue

Sun, 19 Nov 2017 00:00:00 GMT

Abstract
Background
Musculoskeletal disorders (MSDs) are particularly common in the shoulder/neck region for some tasks that involve low force exertions, for example computer work. It has been demonstrated that muscle activity may be stimulated by cognitively demanding tasks. There is a lack of studies on the relationship between qualitative levels of cognitive loading, level of muscle activity, and muscle fatigue.
Aims
To investigate the effects of quantitative levels of cognitive loading on conduction velocity changes and isometric endurance times for the upper trapezius.
Methods
Participants performed a combination of three levels of a cognitively demanding computer task (0, 1.59 and 3 Bits) while simultaneously performing either of two isometric endurance tests (20 and 40% MVC) for the upper trapezius.
Results
Information load had a significant effect (P < 0.05) on normalized conduction velocity slopes for the 40% but not for the 20% maximum voluntary contraction conditions. Information load had a highly significant effect on endurance times for both exertion levels (P < 0.01).
Conclusions
This study found that performing a high-difficulty cognitive task while simultaneously performing increasingly higher levels of static isometric shoulder abduction exertions, fatigued the trapezius muscle quicker than performing an equivalent exertion with low cognitive load. This is particularly relevant to workplaces with increasing levels of automation that require high levels of decision making and computer use.



Work ability, effort–reward imbalance and disability pension claims

Sun, 19 Nov 2017 00:00:00 GMT

Abstract
Background
Effort–reward imbalance (ERI) and self-rated work ability are known independent correlates and predictors of intended disability pension claims. However, little research has focused on the interrelationship between the three and whether self-rated work ability mediates the relationship between ERI and intended disability pension claims.
Aims
To investigate whether self-rated work ability mediates the association between ERI and intended disability pension claims.
Methods
Baseline data from participants of the Third German Sociomedical Panel of Employees, a 5-year cohort study that investigates determinants of work ability, rehabilitation utilization and disability pensions in employees who have previously received sickness benefits, were analysed. We tested direct associations between ERI with intended disability pension claims (Model 1) and self-rated work ability (Model 2). Additionally, we tested whether work ability mediates the association between ERI and intended disability pension claims (Model 3).
Results
There were 2585 participants. Model 1 indicated a significant association between ERI and intended disability pension claims. Model 2 showed a significant association between ERI and self-rated work ability. The mediation in Model 3 revealed a significant indirect association between ERI and intended disability pension claims via self-rated work ability. There was no significant direct association between ERI and intended disability pension claims.
Conclusions
Our results support the adverse health-related impact of ERI on self-rated work ability and intended disability pension claims.



Occupational medicine specialist referral triggers: Mixed-methods analysis of teleconsult cases

Thu, 16 Nov 2017 00:00:00 GMT

Abstract
Background
Qualitative analyses can yield critical lessons for learning organizations in healthcare. Few studies have applied these techniques in the field of occupational and environmental medicine (OEM).
Aims
To describe the characteristics of complex cases referred for OEM subspecialty evaluation and variation by referring provider’s training.
Methods
Using a mixed methods approach, we conducted a content analysis of clinical cases submitted to a national OEM teleconsult service. Consecutive cases entered between April 2014 and July 2015 were screened, coded and analysed.
Results
108 cases were available for analysis. Local Veterans Health Administration (VHA) non-specialist providers entered a primary medical diagnosis in 96% of cases at the time of intake. OEM speciality physicians coded significant medical conditions based on free text comments. Coder inter-rater reliability was 84%. The most frequent medical diagnosis types associated with tertiary OEM referral by non-specialists were endocrine (19%), cardiovascular (18%) and mental health (16%). Concern for usage of controlled and/or sedating medications was cited in 1% of cases. Compared to referring non-specialists, OEM physicians were more likely to attribute case complexity to musculoskeletal (OR: 2.3, 1.68–3.14) or neurological (OR: 1.69, 1.28–2.24) conditions. Medication usage (OR: 2.2, 1.49–2.26) was more likely to be a source of clinical concern among referring providers.
Conclusions
The findings highlight the range of triggers for OEM physician subspecialty referral in clinical practice with employee patients. The results of this study can be used to inform development of provider education, standardized clinical practice pathways, and quality review activities for occupational medicine practitioners.



Predictors of fatigue and work ability in cancer survivors

Thu, 16 Nov 2017 00:00:00 GMT

Abstract
Background
Workers diagnosed with cancer are at risk for job loss or work disability.
Aims
To determine predictors of fatigue and work ability at 36 months after diagnosis in a population of cancer survivors.
Methods
Individuals diagnosed with cancer and who applied for work disability benefit at 24 months of sick leave were surveyed at the time of application and again 12 months later. Fatigue was measured using the Functional Assessment of Chronic Illness-Fatigue scale questionnaire and work ability was measured using the work ability index. Linear regression analyses were applied to identify predictors.
Results
There were 336 participants. Participants who were divorced or widowed had more physical limitations, more depressive symptoms and were more fatigued at baseline, and who worked in health care demonstrated higher levels of fatigue. Lower fatigue was predicted by having received chemotherapy. A higher level of work ability was predicted by having received chemotherapy, better global health and better work ability at baseline. Lower work ability was predicted by being principal wage earner, insecurity about being free of disease, having more physical limitations and having greater wage loss.
Conclusions
Socio-demographic, health- and work-related factors were associated with fatigue and work ability in cancer survivors on long-term sick leave. As fatigue and poor work ability are important risk factors for work disability, addressing the identified predictive factors may assist in mitigation of work disability in cancer survivors.



Hand–arm vibration in orthopaedic surgery: a neglected risk

Mon, 06 Nov 2017 00:00:00 GMT

Abstract
Background
Hand–arm vibration syndrome is an occupational disease caused by exposure to hand–arm transmitted vibration. The Health and Safety Executive has set limits for vibration exposure, including an exposure action value (EAV), where steps should be taken to reduce exposure, and an exposure limit value (ELV), beyond which vibrating equipment must not be used for the rest of the working day.
Aims
To measure hand–arm transmitted vibration among orthopaedic surgeons, who routinely use hand-operated saws.
Methods
We undertook a cadaveric study measuring vibration associated with a tibial cut using battery-operated saws. Three surgeons undertook three tibial cuts each on cadaveric tibiae. Measurements were taken using a frequency-weighted root mean square acceleration, with the vibration total value calculated as the root of the sums squared in each of the three axes.
Results
A mean (SD) vibration magnitude of 1 (0.2) m/s2 in the X-axis, 10.3 (1.9) m/s2 in the Y-axis and 4.2 (1.3) m/s2 in the Z-axis was observed. The weighted root mean squared magnitude of vibration was 11.3 (1.7) m/s2. These results suggest an EAV of 23 min and ELV of 1 h 33 min using this equipment.
Conclusions
Our results demonstrate that use of a battery-operated sagittal saw can transmit levels of hand–arm vibration approaching the EAV or ELV through prolonged use. Further study is necessary to quantify this risk and establish whether surveillance is necessary for orthopaedic surgeons.



The psychological health of remote area medics in Iraq

Tue, 17 Oct 2017 00:00:00 GMT

Abstract
Background
Remote area medics (RAMs) may be at increased risk of mental health difficulties.
Aims
To explore the occupational experiences of RAMs to identify stressors and the mental health impact.
Methods
Semi-structured interviews were conducted with six RAMs working in Iraq to gather data, which was explored using interpretative phenomenological analysis.
Results
Three key themes emerged from the data (i) the experience of being remote, (ii) cultural shock and (iii) social support. A number of key stressors were identified, including loneliness and boredom, associated with being remote, and the loss of professional identity due to the occupational role. Three out of the six participants reported substantial depressive symptoms. A number of positive coping strategies were identified, particularly relationships with other RAMs, via instant messaging forums.
Conclusions
RAMs experience a number of particular stressors that could put them at risk of depression. Adaptive coping strategies were identified; in particular, virtual social support. These findings should be of interest to companies which employ RAMs.



Occupational asthma caused by an epoxy amine hardener

Thu, 12 Oct 2017 00:00:00 GMT

Abstract
We describe a 43-year-old epoxy floor layer who developed work-related asthma while exposed to an epoxy hardener based on isophorone diamine (IPDA). Challenge exposures to the curing of the epoxy resin system and subsequently to the polyfunctional amine hardener containing IPDA both elicited delayed asthmatic reactions. This report further indicates that exposure to epoxy hardeners containing polyfunctional amines should be considered as a potential cause of occupational asthma. Appropriate work hygiene measures should be implemented to minimize airborne exposure to these volatile compounds.



Factors associated with smoking behaviour change in UK military personnel

Tue, 10 Oct 2017 00:00:00 GMT

Abstract
Background
Research in the UK civilian population suggests that poor mental health outcomes are associated with smoking behaviour. In the UK military population, smoking cessation is associated with deployment in the reserve forces. However, little is known about the links between mental health outcomes and smoking initiation and cessation in the UK military.
Aims
The aim of this longitudinal study was to examine change in mental health and military factors associated with smoking initiation and cessation in a representative sample of UK military personnel.
Methods
Data were collected between 2003 and 2009; 5138 regular and reserve military personnel were included in the analyses.
Results
The results showed that smoking initiation was associated with symptoms of psychological distress, symptoms of probable post-traumatic stress disorder (PTSD), relationship breakdown and deployment.
Conclusions
These findings are consistent with existing research in civilian populations showing links between poor mental health and smoking behaviour. Furthermore, our finding that deployment is associated with smoking initiation is also in line with research from the US military and UK reserves.