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Preview: Occupational Medicine - current issue

Occupational Medicine Current Issue





Published: Wed, 11 Oct 2017 00:00:00 GMT

Last Build Date: Wed, 11 Oct 2017 03:50:03 GMT

 



Social Marketing and Public Health; Theory and Practice

2017-10-11

Edited by FrenchJeff. Published by Oxford University Press, 2nd edition, 2017. ISBN: 978-0-19-871769-0. Price: £29.99. 243 pp.



Critical Appraisal of Epidemiological Studies and Clinical Trials

2017-10-11

ElwoodMark. Published by Oxford University Press, New York, 4th edition, 2017. ISBN: 978-0-19-968289-8. Price: £47.99.



The Hygiene, Diseases and Mortality of Occupations

2017-10-11

ArlidgeJ. T.. Published by Percival, London, 1892. 568 pp.



Cochrane Work—championing facts since 2003

2017-10-11

The 2013–15 Ebola virus disease epidemic put health care workers at high risk of a disease with a very high fatality rate in the epidemic areas [1]. Not only were nurses and doctors at risk, but also staff engaged in transportation, cleaning and burial of patients. At that time, it was unclear how best to minimize health care workers’ risk of infection. To cover part of those needs, Cochrane Work conducted a systematic review on personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in health care staff [1]. Now that the frenzy of the epidemic has passed, the World Health Organization (WHO) has set up a task force to use the experiences and the available scientific evidence to be better prepared for a new epidemic. The Cochrane review will be part of the evidence underpinning new guidelines that should increase protection of health care workers against either new epidemics of these same diseases or epidemics of new diseases.



Occupational medicine: paradise lost

2017-10-11

This year marks the 350th anniversary of Milton’s Paradise Lost first being published. It includes the concept of felix culpa (fortunate fall), the philosophy that the good which evolves from the fall leaves us in a better place, with opportunity for greater good than would otherwise have been possible. Occupational medicine in the UK has fallen, captured by the title of an editorial ‘Occupational medicine is in demise’ [1]. It is important to acknowledge that the specialty faces an existential crisis, since transformational change only occurs after creating a sense of urgency, whereas the leading cause of failed transformations is to allow excessive complacency [2]. The fall was anticipated in papers published in this journal between 2001 and 2004 [3–5]. Readers were reminded that the consumer is boss, one who expects value for money and more for their money [3]. Claiming that traditional definitions of occupational medicine did not explain what was on offer, a consumer-focused definition was proposed to explain the unique contributions and added value [3]. It was noted that better marketing was needed for the business case for occupational health services (OHS) [4]. Readers were warned that ‘while the shape of business has changed, the shape of OHS largely has not’ which ‘together with growing manpower shortages, could widen the gap between the need for and the provision of OHS unless radical measures are taken’ [5].



In this issue of Occupational Medicine

2017-10-11

Evidence-based practice is a theme running through this issue of Occupational Medicine. In ‘Occupational medicine: paradise lost’, Paul Nicholson [1] discusses the crisis which occupational medicine finds itself in. He suggests the need for a better focus on the internal and external issues and recommends a clear strategy to address these, underpinned by primary research to improve the knowledge and evidence base for practice. An important resource producing high-quality reviews of evidence in occupational health is Cochrane Work [2]. This resource can assist practitioners in identifying what we should implement from the evidence for what works, and where the evidence shows we should change practice.









Pegasus at Wanlockhead

2017-10-11

With Pegasus upon a day,Apollo, weary flying,Through frosty hills the journey lay,On foot the way was plying.Poor slipshod giddy PegasusWas but a sorry walker;To Vulcan then Apollo goes,To get a frosty caulker.Obliging Vulcan fell to wark,Threw by his coat and bonnet,And did Sols business in a crack;Sol paid him with a sonnet.Ye Vulcan’s sons of Wanlockhead,Pity my sad disaster;My Pegasus is poorly shod,I’ll pay you like my master.



David William Gentleman, Cross for Eleanor 1979

2017-10-11

At London’s Charing Cross underground station there is a most surprising sight. Spread along the curved wall of the Northern Line platform is a full-length (100 yards), black and white mural depicting the design, preparation and assembly of Edward I’s memorial cross to Queen Eleanor, his beloved wife of 36 years who died at Harby 6 miles west of Lincoln 28 November 1290 [1]. She had been in poor health for some time and was taken ill with a ‘slow fever’ while accompanying Edward on a tour of the north. Her embalmed body was escorted by the king in ‘great state’ to Westminster Abbey from Lincoln, where her heart and other organs had already been removed. Edward gave orders that memorial crosses should be erected at each overnight stop on the 172-mile journey south.






Occupational Medicine Calendar

2017-10-11

2018DateEventContact AddressVenueApril 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



Earning CPD points

2017-10-10

The Academy of Royal College’s Principles for Continuing Professional Development confirms that doctors have a responsibility for their own learning and for recording continuing professional development (CPD) that has educational value [1]. While the responsibility for identifying and prioritizing professional development requirements rests with the learner, the editorial team of Occupational Medicine have responded to requests to support this requirement by introducing regular multi-choice questions to key articles in each new edition of the journal.



Perceived effect of deployment on families of UK military personnel

2017-09-15

Abstract
Background
In the UK, little is known about the perceived effects of deployment, on military families, from military personnel in theatre.
Aims
To investigate military personnel’s perceptions of the impact of deployment on intimate relationships and children.
Methods
Deployed service personnel who were in a relationship, and who had children, completed a survey while deployed on combat operations. Data were taken from four mental health surveys carried out in Iraq in 2009 and Afghanistan in 2010, 2011 and 2014.
Results
Among 4265 participants, after adjusting for military and social-demographic covariates, perceiving that deployment had a negative impact on intimate relationships and children was associated with psychological distress, and traumatic stress symptoms. Military personnel who reported being in danger of being injured or killed during deployment, were more likely to report a perceived negative effect of deployment on their intimate relationships. Reservists were less likely to report a perceived negative impact of deployment on their children compared with regulars. Military personnel who themselves planned to separate from their partner were more likely to report psychological distress, and stressors at home. Perceived insufficient support from the Ministry of Defence was associated with poor mental health, and holding a junior rank.
Conclusions
Deployed UK military personnel with symptoms of psychological distress, who experienced stressors at home, were especially likely to perceive that their family were inadequately supported by the military. Those planning to separate from their partner were at increased risk of suffering with mental health problems while deployed.



Sleep problems among Chinese clinical nurses working in general hospitals

2017-09-09

Abstract
Background
Epidemiological data evaluating sleep problems in clinical nurses in mainland China are scarce and an association between sleep problems and occupational stress has not been investigated.
Aims
To assess the prevalence of sleep problems and associated factors and determine their association with occupational stress among clinical nurses in general hospitals.
Methods
Nurses were selected through random cluster sampling. They answered a self-administered questionnaire, which included sociodemographic and occupational variables, the Pittsburgh Sleep Quality Index (PSQI) scoring system and the Job Content Questionnaire for evaluating occupational stress. Logistic regression analysis was used to evaluate factors associated with sleep problems.
Results
There were 5012 participants. Mean PSQI score of 4951 subjects included in the final analysis was 7.32 ± 3.24, with 2713 subjects having PSQI ≥8, accounting for 55% of participants. Female subjects in the intensive care unit and emergency departments were at higher risk of sleep problems. The following factors also presented a risk for sleep problems: multiple years of service, high monthly night shift frequency, primary and intermediate professional status, temporary employment status and high occupational stressors (including high psychological job demands, low job control and low workplace’s social support).
Conclusions
The overall prevalence rate of sleep problems among clinical nurses in general hospitals in mainland China was high. Many factors could affect the sleep quality of nurses, although occupational stress facilitates development of sleep problems. Various risk factors associated with sleep problems among nurses should be studied extensively and measures for relieving occupational stress should be undertaken.



Burnout in Belgian physicians and nurses

2017-09-06

Abstract
Background
Burnout in healthcare is a worldwide problem. However, most studies focus narrowly on work-related factors and outcomes in one health profession or speciality.
Aims
To investigate the prevalence of burnout and its association with job demands, job resources, individual well-being, work-related attitudes and behaviour in physicians and nurses across different specialties.
Methods
Multi-centre cross-sectional study of physicians and nurses working in Belgian hospitals. An electronic questionnaire was used to assess job demands (e.g. workload), job resources (e.g. autonomy) and indicators of well-being, work-related attitudes and behaviours. Structural equation modelling was used to examine interrelationships between explanatory variables and outcomes.
Results
1169 physicians and 4531 nurses participated; response rate 26%. High scores (>75th percentile in reference group of Dutch health care workers) were seen in 6% of the sample on three burnout dimensions (i.e. emotional exhaustion, depersonalization and personal competence) and in 13% for at least two dimensions. In contrast to the other dimensions, emotional exhaustion strongly related to almost all variables examined in the model. Positive associations were seen with workload, role conflicts, emotional burden and work–home interference and negative associations with learning and development opportunities and co-worker support. Emotional exhaustion correlated negatively with well-being, turnover intention, being prepared and able to work until retirement age, medication use, absenteeism and presenteeism.
Conclusions
Work-related factors were critical correlates of emotional exhaustion, which strongly related to poor health and turnover intention. Randomized controlled trials are suggested to underpin the effectiveness of interventions tackling job stressors and promoting job resources.



Sensitization to cow’s milk protein in a dairy worker

2017-09-02

Abstract
Background
Repeated skin exposure and inhalation of milk proteins may lead to IgE-mediated sensitization, normally manifested at the site of contact. Although this is a phenomenon predominantly found in children, it has also been observed in adults.
Aims
To describe a case of a worker who, after being exposed to milk proteins for many years, eventually experienced episodes of anaphylaxis.
Case report
A 62-year-old worker experienced severe episodes of anaphylaxis following the intake of dairy products. He had worked in the dairy industry for 17 years, where he was exposed to dried milk every day.
Conclusions
This case report illustrates how continued exposure to milk proteins, either by skin contact or inhalation, may lead to sensitization which could result in severe manifestations of anaphylaxis.



Recruit Fitness as a Predictor of Police Academy Graduation

2017-09-02

Abstract
Background
Suboptimal recruit fitness may be a risk factor for poor performance, injury, illness, and lost time during police academy training.
Aims
To assess the probability of successful completion and graduation from a police academy as a function of recruits’ baseline fitness levels at the time of academy entry.
Methods
Retrospective study where all available records from recruit training courses held (2006–2012) at all Massachusetts municipal police academies were reviewed and analysed. Entry fitness levels were quantified from the following measures, as recorded at the start of each training class: body composition, push-ups, sit-ups, sit-and-reach, and 1.5-mile run-time. The primary outcome of interest was the odds of not successfully graduating from an academy. We used generalized linear mixed models in order to fit logistic regression models with random intercepts for assessing the probability of not graduating, based on entry-level fitness. The primary analyses were restricted to recruits with complete entry-level fitness data.
Results
The fitness measures most strongly associated with academy failure were lesser number of push-ups completed (odds ratio [OR] = 5.2, 95% confidence interval [CI] 2.3–11.7, for 20 versus 41–60 push-ups) and slower run times (OR = 3.8, 95% CI 1.8–7.8, [1.5 mile run time of ≥15′20″] versus [12′33″ to 10′37″]).
Conclusions
Baseline pushups and 1.5-mile run-time showed the best ability to predict successful academy graduation, especially when considered together. Future research should include prospective validation of entry-level fitness as a predictor of subsequent police academy success.



The effect of age on fitness among female firefighters

2017-09-01

Abstract
Background
The physical demands of firefighting require both cardiovascular and muscular fitness, which both decline with age. While much has been published on age-related changes among male firefighters (FFs), data on female FFs are lacking.
Aims
To describe cardiorespiratory fitness (CRF) and muscular fitness in a sample of female career FFs ranging in age from 25 to 60 years and determine whether ageing affects their achievement of the current recommended professional CRF standards of 12 metabolic equivalents (METs).
Methods
Data were collected on female FFs over an 11-year period. A cross-sectional analysis using one-way analysis of variance with Bonferroni post hoc comparisons was used to compare age groups.
Results
There were 96 study participants. Maximum METs was significantly higher (P < 0.01) in the 25- to 34-year age group (14.6 ± 2.1) compared with the 35–44 age group (12.9 ± 2.0 METs) and the 45–54 age group (12.2 ± 1.8 METs, P < 0.001). While the mean values of all measured age groups met or exceeded the 12-MET profession standard, as many as one-third of FFs <45 years of age and 43% of FFs >45 years of age fell below the benchmark of 12 METs. Muscular fitness as measured by maximum number of push-ups, sit-ups and back endurance was not significantly different between age groups.
Conclusions
Fire departments should recognize and take steps to ensure all female FFs maintain CRF and muscular fitness throughout their careers.



Poor working conditions and work stress among Canadian sex workers

2017-08-23

Abstract
Background
While sex work is often considered the world’s oldest profession, there remains a dearth of research on work stress among sex workers (SWs) in occupational health epidemiological literature. A better understanding of the drivers of work stress among SWs is needed to inform sex work policy, workplace models and standards.
Aims
To examine the factors that influence work stress among SWs in Metro Vancouver.
Methods
Analyses drew from a longitudinal cohort of SWs, known as An Evaluation of Sex Workers’ Health Access (AESHA) (2010–14). A modified standardized ‘work stress’ scale, multivariable linear regression with generalized estimating equations was used to longitudinally examine the factors associated with work stress.
Results
In multivariable analysis, poor working conditions were associated with increased work stress and included workplace physical/sexual violence (β = 0.18; 95% confidence interval (CI) 0.06, 0.29), displacement due to police (β = 0.26; 95% CI 0.14, 0.38), working in public spaces (β = 0.73; 95% CI 0.61, 0.84). Older (β = −0.02; 95% CI −0.03, −0.01) and Indigenous SWs experienced lower work stress (β = −0.25; 95% CI −0.43, −0.08), whereas non-injection (β = 0.32; 95% CI 0.14, 0.49) and injection drug users (β = 0.17; 95% CI 0.03, 0.31) had higher work stress.
Conclusions
Vancouver-based SWs’ work stress was largely shaped by poor work conditions, such as violence, policing, lack of safe workspaces. There is a need to move away from criminalized approaches which shape unsafe work conditions and increase work stress for SWs. Policies that promote SWs’ access to the same occupational health, safety and human rights standards as workers in other labour sectors are also needed.



Emotion-regulation ability, role stress and teachers’ mental health

2017-08-21

Abstract
Background
Work-related stressors, including role ambiguity and role conflict, are related to psychological maladjustment and mental ill-health. However, to date, the role of personal resources such as emotion-regulation ability (ERA) in the prediction of mental health indicators has not been addressed.
Aims
To examine whether ERA would contribute to explaining teachers’ depression, anxiety and stress symptoms beyond role ambiguity and role conflict.
Methods
We carried out a cross-sectional questionnaire survey. We used a correlation matrix and hierarchical regression models to analyse the data.
Results
Three hundred and thirty-six Spanish teachers (185 female) from several grade levels completed the surveys (40% response rate). Role ambiguity and role conflict were positively related to depression, anxiety and stress symptoms. ERA was negatively related to teachers’ scores on depressive, anxious and stress symptoms, with predictive power above the main effects of role ambiguity and role conflict. An interaction between role ambiguity and ERA was also significant in predicting depression.
Conclusions
Our study provides preliminary evidence suggesting the development of integrative models considering work-related stressors along with personal resources such as ERA aiming to prevent teachers’ mental ill-health. Future studies should examine the influence of ERA on psychological symptoms using longitudinal designs.



Workers’ health surveillance: implementation of the Directive 89/391/EEC in Europe

2017-08-19

Abstract
Background
European Union (EU) Directive 89/391 addressed occupational health surveillance, which recommends to provide workers with ‘access to health surveillance at regular intervals’, aiming to prevent work-related and occupational diseases.
Aims
To investigate how EU countries adopted this Directive.
Methods
We invited one selected representative per member state to complete a questionnaire.
Results
All 28 EU countries implemented the Directive in some form. Workers’ health surveillance (WHS) is available to all workers in 15 countries, while in 12, only specific subgroups have access. In 21 countries, workers’ participation is mandatory, and in 22, the employer covers the cost. In 13 countries, access to WHS is not available to all workers but depends on exposure to specific risk factors, size of the enterprise or belonging to vulnerable groups. In 26 countries, the employer appoints and revokes the physician in charge of WHS. Twelve countries have no recent figures, reports or cost-benefit analyses of their WHS programmes. In 15 countries where reports exist, they are often in the native language.
Conclusions
Coverage and quality of occupational health surveillance should be evaluated to facilitate learning from good practice and from scientific studies. We propose a serious debate in the EU with the aim of protecting workers more effectively, including the use of evidence-based WHS programmes.



Ultraviolet radiation and skin cancer risk in offshore workers

2017-08-08

Abstract
Background
Excess skin cancer mortality and incidence have been reported among both land-based and offshore petroleum workers. The association between skin cancer and ultraviolet radiation (UVR) exposure has not been examined in these workers, although they have long off-duty periods and high average income that may allow travelling to sunny destinations. In addition, they have access to solariums free of charge on many accommodation platforms.
Aims
To prospectively examine risk of incident cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC), according to sun-tanning habits with adjustment for aromatic hydrocarbon exposure.
Methods
A cohort of men employed offshore from 1965 to 1999 was linked through the Cancer Registry of Norway 1999–2012. Cox regression adapted to a stratified case-cohort design was used to estimate hazard ratios with 95% confidence intervals.
Results
The cohort included 24917 men. During 13.5 years of follow-up, 112 CMs and 70 NMSCs occurred. A positive dose–response relationship was seen between sunburn frequency and risk of CM (Ptrend < 0.05) and NMSC (Ptrend < 0.01). Solarium use both before and after age 20 was related to increased risk of NMSC. Sunscreen use was associated with increased risk of NMSC (Ptrend < 0.001).
Conclusions
UVR exposure seems to be a significant contributor to the elevated risk of skin cancer observed in North Sea offshore workers. The positive association between solarium use and NMSC risk adds to the growing body of literature on artificial UV devices as carcinogenic.



Differential reporting of work-related mental ill-health in doctors

2017-08-04

Abstract
Background
Evidence suggests that the medical profession is reluctant to report mental ill-health despite its high prevalence.
Aims
To compare differential reporting patterns in the incidence of work-related mental ill-health (WRMIH) affecting doctors with selected comparison occupational groups, as determined by surveillance by general practitioners (GPs), specialist psychiatrists and occupational physicians (OPs).
Methods
New cases of medically reported WRMIH were reported prospectively between 2006 and 2009 by GPs, psychiatrists and OPs as part of The Health and Occupation Research (THOR) network. For GP and psychiatry reporting schemes, incidence rates (IRs) for doctors, nurses, teachers, corporate managers and protective service workers were calculated using information from the Labour Force Survey as the denominator. In OP surveys, participating reporters provided denominator information to calculate IRs for doctors, nurses and teachers.
Results
Average annual IRs expressed per 100000 person/years employed as reported by GPs, psychiatrists and OPs, respectively, were: doctors (309, 971, 430), nurses (891, 208, 670), teachers (1040, 136, 210) and for GPs and psychiatrists, respectively, were: protective service workers (1432, 721) and corporate managers (428, 90). Psychiatrists reported a higher incidence of WRMIH in doctors, whereas GPs reported higher incidences of WRMIH in other occupations (chi-squared test, P < 0.001).
Conclusions
The distribution of the incidence of new cases reported across different schemes suggests a differential reporting pattern of WRMIH in doctors. The higher IR for doctors in psychiatrist-reported WRMIH could be due to factors such as disease severity and bypassing formal referral channels.