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Preview: Occupational Medicine - current issue

Occupational Medicine Current Issue





Published: Sat, 15 Jul 2017 00:00:00 GMT

Last Build Date: Sat, 15 Jul 2017 15:48:55 GMT

 



Parkes’ Occupational Lung Disorders

2017-07-15

Edited by Newman TaylorAnthonyCullinanPaulBlancPaulPickeringAnthony. Published by CRC Press, Taylor and Francis Group, Florida, 4th edition, 2017. ISBN: 13:978-1-4822-4070-2. Price: £127 (hardback), £110 (softback). 533 pp.



True Tales of Organisational Life

2017-07-15

WrenBarbara-Anne. Published by Karnac Books Ltd, London, 2016. ISBN: 978-1-78220-189-2. Price: £14.99 (paperback). 107 pp.



The new why when designing mandatory medical examinations

2017-07-15

The basic medical training of physicians is almost completely carried out in hospitals using a traditional medical model and this may be less relevant for future preventive work in public or occupational medicine. This is especially the case when performing mandatory medical examinations on workers where the traditional approach hampers good practice. The ‘why’, when thinking about mandatory medical examinations in workers, could be described as to periodically verify, given some specific and special working conditions, whether an employee can perform his or her job safely without an increased health risk [1]. National laws, regulations and professional practice guidelines are responsible for differences between countries in how occupational medicine professionals deal with the content (‘the what’) and procedures (‘the how’) around mandatory medical examinations of workers. The different terminology that is used seems to be the least of the problems: pre-placement health assessments, pre-employment medicals, on-employment medical examinations, fit-to-work medical assessments, etc., because they all speak more or less for themselves. Sectoral differences are obvious because for jobs in some sectors the boundaries between countries are less-existent and therefore applying the same criteria seems logical when a worker crosses countries on a daily basis (i.e. seafarers, train drivers, pilots, professional divers or jobs in the off-shore industry). For these jobs, international consensus guidelines among medical professionals on the content of mandatory examinations have been around for decades. Unfortunately, the classical clinical way of thinking (looking for symptoms, signs and diseases) was predominantly used when designing ‘the what’ in these medical examinations: long lists of diseases had to be checked off by the physician and questions about health history were normal. Today, it is more difficult to update and improve the content of these medical examinations when the old medical protocols continue to be taken as a starting point when updates are discussed, resulting in only small amendments and without questioning their basis. A new basis is needed, the ‘new why’, when designing and performing mandatory medical examinations on workers.



Occupational skin cancer: sweeping the path to prevention

2017-07-15

The skin, the largest body organ, is not only the most common cancer site in Caucasian populations [1], but also the site in which cancer is most easily preventable through education, exposure reduction, early detection and treatment. Solar ultraviolet radiation (UVR), the main risk factor for development of skin cancer, is classified as a group 1 carcinogen by the International Agency for Research on Cancer and World Health Organization [2,3]. A recent meta-analysis reported that occupationally UVR-exposed workers have almost double the risk of developing cutaneous squamous cell carcinoma (cSCC) [4], and at least a 43% higher risk of developing basal cell carcinoma (BCC) compared with non-exposed workers [5].



Global occupational health

2017-07-15

Globally, an estimated 2.3 million workers die every year from occupational accidents and work-related diseases; this equates to 6300 deaths daily [1]. In addition, over 300 million workers have non-fatal occupational accidents resulting in disability and time off work; 2.3 million work-related deaths per year outnumber deaths due to tuberculosis (TB), AIDS and road accidents. The burden is particularly heavy in low- and middle-income countries, where manufacturing is mostly concentrated and health and safety law and its application is often not so well implemented [1].



In This Issue of Occupational Medicine

2017-07-15

This issue of Occupational Medicine also has links to a ‘virtual issue’ which explores a number of occupational safety and health issues from around the globe. The virtual issue collects together a number of previously published research papers collated by the deputy editor Dipti Patel. In the virtual issue editorial, also published in this paper issue, Will Ponsonby explains the estimated global burden of work-related disease, emphasizing that the burden is particularly heavy in low- and middle-income countries, where the health and safety law and its application are not as well implemented, and reminds the reader that the vast majority of workplace accidents and diseases are preventable [1]. The virtual issue papers examine the health and safety implications of recruitment payments in migrant workers in the construction industry in the Middle East [2]; acute respiratory symptoms among sisal workers in Tanzania [3]; the cancer incidence and mortality burden in China from occupational and environmental sources [4]; silicosis in platinum mine workers in South Africa [5]; the effect of childhood labour on final adult height in Brazil [6]; the occupational health of small-scale fishermen in Turkey [7]; the effect of job stressors on smoking cessation in Malaysian males [8]; the prevalence of bovine tuberculosis in certain occupational groups in Pakistan [9]; fatal occupational injuries in northwest Russia [10]; gambling problems in casino employees in South Korea [11] and finally an international comparison of women’s occupational health issues in six countries in Asia and North America [12]. As pointed out by Ponsonby, the virtual issue highlights the diversity of issues internationally in occupational health, indicating that there remains a huge amount of work globally to research the causes of work-related ill-health and that, although many of the problems are the same as the developed world, industry and governments in the developing world should work together to improve occupational health outcomes. The collected research in the virtual issue also emphasizes the international nature of Occupational Medicine and the research we receive from almost every country in the world.



Pieter Bruegel the Elder. The Beekeepers and the Birdnester c.1568

2017-07-15

In this enigmatic disquieting scene, three hooded men wearing long sleeved, full-length smocks made from a heavy duty canvas-like material tied round the waist are collecting hives in the field. The cuffs of the sleeves are open and the hands are unprotected. They wear stockings on their legs and simple tie-up shoes. The face masks are made from basket-weave bottoms. The men’s stances suggest tension or an illicit activity; one of them is trying to open a hive, another is carrying the hive in his arms looking sideways, while a third man is walking towards him. On the right side, there’s a young man perched on the branch of a tree, he could either be a birdnester or one of the thieving beekeepers as the title suggests. In the background, there is a mill on the left and a hive under an awning on the right. It’s possible to distinguish a church tower on the right behind a thatched house or barn and a watermill in the mid-distance, which indicates the proximity of a settlement. The decapitated cone-shaped hives seem to be made of wicker with a lid in the lower and wider part. The hive under the awning is standing on a wooden base, keeping it clear of the ground. At the front, on the right side, there is a hive lying on the floor.



Preparing for retirement

2017-07-15

Retirement for some doctors is defined by their terms of employment and normal retirement age for pension benefit. However, many occupational medical services are now provided by independent doctors often with a portfolio of customers. This situation provides a degree of choice in retirement date with the option of reducing practice commitments as a prelude to full retirement. However, in the final year before retirement, the doctor will need to make important decisions about managing their professional arrangements. In all likelihood there will not be alignment between the different dates for renewals of subscriptions, licensing and revalidation.



The Borg Rating of Perceived Exertion (RPE) scale

2017-07-15

The study of human performance and perceived exertion during physical activity has been an area of considerable scientific interest and research over the last 50 years. The symptom of exertion is unique to an individual and can be used as a subjective estimate of the work intensity undertaken across a variety of populations. The intensity of work is important because of the risks of musculoskeletal injuries and disorders arising from a mismatch between the worker’s capability and the physical demands of their job.



Occupational Medicine Calendar

2017-07-15

2017DateEventContact AddressVenueSeptember 20How to Manage Back Pain at Work – a New Approach, organised by The At Work Partnership Ltdinfo@atworkpartnership.co.ukLondon, UKSeptember 27–29 (part 1) and November 14–15 (part 2)Certificate in OH Law, organised by The At Work Partnership Ltdinfo@atworkpartnership.co.ukLondon, UKOctober 1–410th International Symposium on Biological Monitoring in Occupational and Environmental healthhttp://www.centercongressi.com/isbm10Naples. ItalyOctober 3–6WOS 9th International Conference on the prevention of accidents at workhttp://www.wos2017.net/Prague, Czech RepublicOctober 10–11Workplace Health 2017, organised by The At Work Partnership Ltdinfo@atworkpartnership.co.ukWarwickshire, UKOctober 19Trent Occupational Medicine Symposium 2017http://trentoccupationalmedicine.org.uk/programme/Belfry, NottinghamNovember 1–410th European Public Health Conference 2017. Sustaining resilient and healthy communitieshttp://www.ephconferences.euStockholm, SwedenNovember 15-17ALAMA Autumn Conference 2017http://www.alamaconferences.co.uk/alamawinchester/programme.htmlWinchester, UKDecember 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



Farmer suicides: a qualitative study from Australia

2017-06-14

Abstract
Background
Farmers in Australia, in general, have poorer health outcomes, including higher rates of suicide.
Aims
To investigate risk and protective factors and attitudes towards suicide and help-seeking among farmers living and working in New South Wales and Queensland in Australia.
Methods
A qualitative study in which three farming sites were selected in each state to represent an area with a suicide rate equal to, below and above the state average. Focus groups were conducted with men and women separately.
Results
Focus groups involved 30 men and 33 women. Inductive thematic analysis showed three broad themes characterized responses: environment and society; community and relationships; and individual factors. There was considerable overlap and dynamic interaction between themes. A combination of individual factors, as well as social and environmental stressors, was described as most likely to increase risk of suicide death and reduce help-seeking. The vast majority of known farmer suicides described involved men and many of the issues discussed pertained specifically to male farmers. Participants found suicide as an act complex, intertwined with many factors, and hard to fathom. A common belief was that an individual must feel a complete lack of hope and perceive their situation vastly differently from others to contemplate suicide.
Conclusions
Future suicide prevention efforts for farmers should take a biopsycho-ecological approach. Physical, psychological and cultural isolation could be addressed with education and training programmes and public campaigns. These could also improve people’s ability to recognize possible suicidality.



Systematic review: hand activity and ultrasound of the median nerve

2017-06-03

Abstract
Background
Ultrasound is an established method of viewing the median nerve in the carpal tunnel syndrome (CTS). There is some evidence to suggest that immediate changes may occur in the median nerve before and after hand activity. The evidence for the validity and reliability of ultrasound for testing acute changes in the median nerve has not been systematically reviewed to date.
Aims
To evaluate the evidence for visible change in ultrasound appearance of the median nerve after hand activity.
Methods
A literature search was designed, and three reviewers independently selected published research for inclusion. Two reviewers independently appraised papers using the Evidence Based Library and Information Practice (EBLIP) appraisal checklist, while the third reviewer resolved discrepancies between appraisals.
Results
Ten studies were appraised and the results showed an increase in median nerve cross-sectional area following activity, with a return to normal size within 1 h following activity. Both healthy individuals and those diagnosed with CTS participated, all were small convenience samples. Ultrasonographic measurements of the median nerve were reliable in the four studies reporting this, and the studies demonstrated high quality.
Conclusions
Good-quality evidence as identified by the EBLIP appraisal checklist suggests that following hand activity, the median nerve changes in size in the carpal tunnel. The results may not be generalizable to all people and activities due to the use of small convenience sampling and narrow range of activities studied, in all of the studies appraised.



Impact of working hours on sleep and mental health

2017-06-01

Abstract
Background
The number of hours people are required to work has a pervasive influence on both physical and mental health. Excessive working hours can also negatively affect sleep quality. The impact at work of mental health problems can have serious consequences for individuals’ as well as for organizations’ productivity.
Aims
To evaluate differences in sleep quality and anxiety and depression symptoms between longer working hours group (LWHG) and regular working hours group (RWHG). To examine factors influencing weekly working hours, sleep quality and anxiety and depressive symptoms.
Methods
Participants were divided into two groups, RWHG and LWHG, based on working hours, with a cut-off of 48 h per week. We used the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression symptoms and the Pittsburgh Sleep Quality Index (PSQI) to measure the quality and patterns of sleep.
Results
The response rate was 23%. Among the 429 study participants, those in the LWHG group (n = 256, 53%) had significantly more depressive and anxiety symptoms and worse sleep quality than those in RWHG (n = 223, 47%). Working time was significantly positively correlated with higher corporate position and HADS scores. Moreover, HADS scores were positively correlated with PSQI scores and negatively correlated with age.
Conclusions
This study suggests that longer working hours are associated with poorer mental health status and increasing levels of anxiety and depression symptoms. There was a positive correlation between these symptoms and sleep disturbances.



Job characteristics and mental health for older workers

2017-06-01

Abstract
Background
Adverse job characteristics have been linked with increased incidence of depression and anxiety in working populations. However, the association between job characteristics and mental health, in an older working population while controlling for personality traits, is less well known.
Aims
To examine the association between job characteristics (job demands and job control) and mental health (depression and anxiety) for older workers while controlling for personality traits.
Methods
A sample of workers aged 50–69 years were recruited from a primary health care clinic in Southern Ireland. Job characteristics were measured using the Copenhagen Psychosocial Questionnaire; demands (quantitative and cognitive) and control (influence at work and possibilities for development). Personality traits were measured using the Ten-Item Personality Inventory, depression was measured using the Center for Epidemiological Studies—Depression Scale and anxiety was measured using the Hospital Anxiety and Depression Scale. Descriptive analysis, simple and multiple linear regression analyses were conducted.
Results
The final sample size was 1025 with an initial 67% response rate. Multiple linear regression analysis showed job characteristics (in particular, job demands) to be significant positive predictors of symptoms of depression and anxiety. The inverse was true for job control variables and symptoms of depression. Neither possibilities for development nor influence at work were associated with symptoms of anxiety.
Conclusions
Our findings indicate that despite potential confounders, higher demands at work can impact the worker’s mental health negatively. Reducing job demands and encouraging role development may benefit the mental health of older workers.



Diving and long-term cardiovascular health

2017-05-19

Abstract
Background
Short-term cardiovascular effects from ambient pressure exposure are known. However, long-term cardiovascular effects from diving in humans have been less studied.
Aims
To examine possible long-term cardiovascular health effects from occupational diving.
Methods
We compared the prevalence of cardiovascular disease in former divers to non-divers. We obtained data on male former divers with a certificate valid for professional diving after 1980, from the Norwegian Diver 2011 project, and matched data on the general male population from the HUNT3 Survey. We also compared former divers with high and low grades of diving exposure.
Results
Data were available on 768 former divers. The prevalence of self-reported high blood pressure in former divers who often omitted a dive-free day after 3 days of strenuous diving was 28% compared with 18% in those who rarely violated these regulations [relative risk (RR) 1.47, confidence interval (CI) 1.01–2.15]. Also, the prevalence of myocardial infarction/angina pectoris was 11% in divers with >150 professional dives/year compared with 4% in divers with ≤50 professional dives/year [RR adj. 2.91 (CI 1.23–6.87)] and 16% in divers with >2000 air dives in total relative to 3% in divers with ≤2000 dives [RR adj. 3.05 (CI 1.47–6.34)].
Conclusions
The prevalence of some cardiovascular symptoms and diseases may be higher in male former divers than in the general population. Diving might have adverse long-term cardiovascular effects. Whether this is associated with diving per se or strenuous physical activity requires further studies.



EELAB: an innovative educational resource in occupational medicine

2017-05-17

Abstract
Background
Postgraduate education, training and clinical governance in occupational medicine (OM) require easily accessible yet rigorous, research and evidence-based tools based on actual clinical practice.
Aims
To develop and evaluate an online resource helping physicians develop their OM skills using their own cases of work-related ill-health (WRIH).
Methods
WRIH data reported by general practitioners (GPs) to The Health and Occupation Research (THOR) network were used to identify common OM clinical problems, their reported causes and management. Searches were undertaken for corresponding evidence-based and audit guidelines. A web portal entitled Electronic, Experiential, Learning, Audit and Benchmarking (EELAB) was designed to enable access to interactive resources preferably by entering data about actual cases. EELAB offered disease-specific online learning and self-assessment, self-audit of clinical management against external standards and benchmarking against their peers’ practices as recorded in the research database. The resource was made available to 250 GPs and 224 occupational physicians in UK as well as postgraduate OM students for evaluation.
Results
Feedback was generally very favourable with physicians reporting their EELAB use for case-based assignments. Comments such as those suggesting a wider range of clinical conditions have guided further improvement. External peer-reviewed evaluation resulted in accreditation by the Royal College of GPs and by the Faculties of OM (FOM) of London and of Ireland.
Conclusions
This innovative resource has been shown to achieve education, self-audit and benchmarking objectives, based on the participants’ clinical practice and an extensive research database.



Physician burnout, work engagement and the quality of patient care

2017-05-16

Abstract
Background
Research suggests that burnout in physicians is associated with poorer patient care, but evidence is inconclusive. More recently, the concept of work engagement has emerged (i.e. the beneficial counterpart of burnout) and has been associated with better care. Evidence remains markedly sparse however.
Aims
To examine the associations of burnout and work engagement with physicians’ self-perceived quality of care.
Methods
We drew on cross-sectional data from physicians in Germany. We used a six-item version of the Maslach Burnout Inventory measuring exhaustion and depersonalization. We employed the nine-item Utrecht Work Engagement Scale to assess work engagement and its subcomponents: vigour, dedication and absorption. We measured physicians’ own perceptions of their quality of care by a six-item instrument covering practices and attitudes. We used continuous and categorized dependent and independent variables in linear and logistic regression analyses.
Results
There were 416 participants. In multivariable linear regression analyses, increasing burnout total scores were associated with poorer perceived quality of care [unstandardized regression coefficient (b) = 0.45, 95% confidence interval (CI) 0.37, 0.54]. This association was stronger for depersonalization (b = 0.37, 95% CI 0.29, 0.44) than for exhaustion (b = 0.26, 95% CI 0.18, 0.33). Increasing work engagement was associated with higher perceived quality care (b for the total score = −0.20, 95% CI −0.28, −0.11). This was confirmed for each subcomponent with stronger associations for vigour (b = −0.21, 95% CI −0.29, −0.13) and dedication (b = −0.16, 95% CI −0.24, −0.09) than for absorption (b = −0.12, 95% CI −0.20, −0.04). Logistic regression analyses yielded comparable results.
Conclusions
Physician burnout was associated with self-perceived poorer patient care, while work engagement related to self-reported better care. Studies are needed to corroborate these findings, particularly for work engagement.



Rhabdomyolysis with acute tubular necrosis following occupational inhalation of thinners

2017-05-09

Abstract
Thinners are mixtures of organic solvents commonly containing toluene, xylene, acetone, hexane, benzene and methyl isobutyl ketone. This report describes a case of rhabdomyolysis with acute tubular necrosis and renal failure, most likely attributable to toluene, following occupational exposure to thinners while cleaning a steel water tank. These adverse health effects have previously been reported following acute poisoning or intentional inhalation by drug abusers, but rarely in the occupational setting. Poor working conditions, lack of health and safety training and delayed treatment contributed to the onset and severity of the patient’s complications. This case emphasizes the need for strict control measures, including adequate ventilation, training on working in confined spaces, appropriate personal protective equipment and emergency rescue procedures in such settings. In addition, rhabdomyolysis, acute tubular necrosis and renal failure should be added to safety data material as possible complications of excessive inhalation of thinners.



Suicide in Scottish military veterans: a 30-year retrospective cohort study

2017-05-09

Abstract
Background
Although reassuring data on suicide risk in UK veterans of the 1982 Falklands conflict and 1991 Gulf conflict have been published, there have been few studies on long-term overall suicide risk in UK veterans.
Aims
To examine the risk of suicide in a broad population-based cohort of veterans in Scotland, irrespect ive of length of service or exposure to conflict, in comparison with people having no record of military service.
Methods
A retrospective 30-year cohort study of 56205 veterans born 1945–85 and 172741 matched non-veterans, using Cox proportional hazard models to compare the risk of suicide and fatal self-harm overall, by sex, birth cohort, length of service and year of recruitment.
Results
There were 267 (0.48%) suicides in the veterans compared with 918 (0.53%) in non-veterans. The difference was not statistically significant overall [adjusted hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.86–1.13]. The incidence was lower in younger veterans and higher in veterans aged over 40. Early service leavers were at non-significantly increased risk (adjusted HR 1.13; 95% CI 0.91–1.40) but only in the older age groups. Women veterans had a significantly higher risk of suicide than non-veteran women (adjusted HR 2.44; 95% CI 1.32–4.51, P < 0.01) and comparable risk to veteran men. Methods of suicide did not differ significantly between veterans and non-veterans, for either sex.
Conclusions
The Scottish Veterans Health Study adds to the emerging body of evidence that there is no overall difference in long-term risk of suicide between veterans and non-veterans in the UK. However, female veterans merit further study.



The influence of zero-hours contracts on care worker well-being

2017-05-07

Abstract
Background
Care workers have an important social role which is set to expand with the increasing age of the UK population. However, the majority of care workers are employed on zero-hours contracts.
Aims
Firstly, to investigate the relationship between working conditions and employee outcomes such as engagement and general mental well-being in a sample of UK care workers and management. Secondly, to assess whether the use of zero-hours contracts affects employee well-being.
Methods
A cross-sectional survey of domiciliary care and care home employees, undertaken using the Management Standards Indicator Tool (MSIT), Utrecht Work Engagement Scale (UWES) and General Health Questionnaire (GHQ). T-tests and multivariate linear regression evaluated the differences in scoring between those with differing contractual conditions and job roles, and associations of MSIT scores with UWES and GHQ factors.
Results
Employee understanding of their role and job control were found to be priority areas for improvement in the sample. Similarly, care workers reported greater occupational demands and lower levels of control than management. However, while zero-hours contracts did not significantly influence employee well-being, these employees had greater levels of engagement in their jobs. Despite this, a greater proportion of individuals with zero-hours contracts had scores above accepted mental health cut-offs.
Conclusions
Individual understanding of their role as care workers appears to play an important part in determining engagement and general mental well-being. However, more research is needed on the influence of zero-hours contracts on well-being, particularly in groups with increased likelihood of developing mental health disorders.



Evidence-based review on temporomandibular disorders among musicians

2017-05-03

Abstract
Background
Playing a musical instrument that loads the masticatory system has frequently been linked to temporomandibular disorders (TMDs). Previous literature reviews on this topic do not conform to the current standards of evidence-based medicine.
Aims
To investigate the effects of playing a musical instrument (i.e. violin/viola and wind instruments) or singing on the presence of TMDs, based on evidence derived from observational studies.
Methods
Databases of Medline, Web of Science and Google Scholar were searched using MeSH and other relevant terms. For each study, a quality assessment was undertaken using a modified version of the Newcastle-Ottawa Scale (NOS).
Results
Fifteen relevant papers were identified for inclusion in this review. Of the seven possible points that could be scored with the NOS, the majority of these studies scored under half. Based on the available evidence, the purported relationship between the playing of specific musical instruments and TMDs was not as evident as reported in previous literature reviews.
Conclusions
There is limited evidence to conclude that playing a wind instrument is a hazard to the temporomandibular system. Furthermore, there is no available evidence to suggest that vocalists experience more TMDs than controls. The studies that investigated the presence of TMDs among violists and violinists yielded ambiguous outcomes; some studies reported no association between the playing of these instruments and the presence of signs and symptoms of TMDs, whereas in studies where a clinical examination was performed (though of lower methodological quality), an association was found.