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Occupational Medicine - recent issues



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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




In this issue of Occupational Medicine

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










Common mental disorders related to incidents and behaviour in physicians

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




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

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




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

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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







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

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




Mortality and cancer incidence at a fire training college

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




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

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




Fitness, obesity and risk of asthma among Army trainees

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




Association between temporomandibular disorders and music performance anxiety in violinists

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




Work stress, poor recovery and burnout in teachers

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




Occupational Medicine Calendar

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




Sickness absence of LU train drivers after track incidents

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




The influence of anthropometrics on physical employment standard performance

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




Workplace violence against medical staff in healthcare facilities in Barbados

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

Background

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

Aims

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

Methods

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

Results

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

Conclusions

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




Anaphylactic reaction in a hairdresser due to sensitization to persulphates

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

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










Hamilton and Hardys Industrial Toxicology

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




OH Law Online website

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




In this issue of Occupational Medicine

2016-08-03T05:44:47-07:00










Systematic review: complementary therapies and employee well-being

2016-08-03T05:44:47-07:00

Background

A variety of workplace-based interventions exist to reduce stress and increase productivity. However, the efficacy of these interventions is sometimes unclear.

Aims

To determine whether complementary therapies offered in the workplace improve employee well-being.

Methods

We performed a systematic literature review which involved an electronic search of articles published between January 2000 and July 2015 from the databases Cochrane Central Register of Controlled Trials, PsycINFO, MEDLINE, AMED, CINAHL Plus, EMBASE and PubMed. We also undertook a manual search of all applicable article reference lists to ensure that no relevant studies were missed. We only selected published, full-length, English-language, peer-reviewed journal articles. Articles had to address the research objective using valid and reliable measures. We excluded articles concerning return to work or whose populations had been adversely affected by work resulting in the development of health issues.

Results

We included 10 articles in the review from 131 identified. Mindfulness and meditation-based interventions were most effective in improving workplace health and work performance; the latter demonstrating some evidence of maintaining gains up to 3 months later. The evidence for relaxation interventions was inconclusive.

Conclusions

Mindfulness and meditation interventions may be helpful in improving both psychosocial workplace health and work performance, but long-term efficacy has yet to be fully determined.




Tuberculin and QuantiFERON-TB-Gold tests for latent tuberculosis: a meta-analysis

2016-08-03T05:44:47-07:00

Background

Up to now, there has been no universal consensus on the agreement between the tuberculin skin test (TST) and the QuantiFERON-TB-Gold test (QFT) in the detection of latent tuberculosis infection (LTBI) among high-risk populations.

Aims

To estimate the agreement between TST and QFT among health care workers (HCWs).

Methods

A meta-analysis in which all major electronic databases, including Medline, Scopus, Web of Sciences and Ovid, were searched until June 2014. All cross-sectional and cohort studies addressing the agreement between TST and the QFT were included. The extracted data were analysed and the results were reported using random effect models.

Results

The overall kappa statistic between TST and the QFT was 0.27 [95% confidence interval (CI) 0.22, 0.32] and the adjusted kappa statistic for prevalence and bias was 0.41 (95% CI 0.32, 0.50). The kappa for subjects with and without bacillus Calmette–Guérin (BCG) vaccination was 0.27 (95% CI 0.18, 0.36) and 0.31 (95% CI 0.15, 0.46) respectively. The figures were 0.30 (95% CI 0.16, 0.43) and 0.82 (95% CI 0.74, 0.90) for prevalence-adjusted and bias-adjusted kappa, respectively.

Conclusions

The overall agreement between TST and QFT in the detection of LTBI among HCWs was poor. After adjusting for the prevalence and bias indices, kappa statistics reached fair agreement. The utility of each of these two tests is dependent on the prevalence and burden of tuberculosis as well as the BCG vaccination status.




Work ability among Finnish workers with type 1 diabetes

2016-08-03T05:44:47-07:00

Background

Work ability represents the balance between individual resources, health status and job demands. As far as we are aware, these issues have not been examined in working people with type 1 diabetes (T1D).

Aims

To examine how work-related and diabetes-related factors are associated with work ability among male and female workers.

Methods

Questionnaires were mailed to a random sample of 2500 people with T1D from the Medication Reimbursement Register of The Social Insurance Institution of Finland. The associations of the predictors of poor work ability were examined in a logistic regression analysis.

Results

The final sample comprised 767 working people aged 18–64 with T1D; overall response rate 49%. One in every three working men and women with T1D had poor work ability. High job demands and low job control were associated with poor work ability in both genders. Physical work and low worktime control were significantly associated with poor work ability in men but not in women with T1D. A self-reported high value of glycosylated haemoglobin was the only diabetes-related variable associated with poor work ability in both men and women.

Conclusions

Work-related factors and poor glycaemic control were associated with poor work ability in individuals with T1D. Thus, job control and worktime control should be taken into account in supporting the work ability of workers with T1D.




Work-related discussions between French rheumatologists and their rheumatoid arthritis patients

2016-08-03T05:44:47-07:00

Background

Rheumatoid arthritis (RA) causes significant impairment of physical function, and thus adversely affects patients’ ability to work.

Aims

To document how often work limitations are discussed by rheumatologists and RA patients during consultations.

Methods

We conducted an observational study in a sample of French rheumatologists and in a parallel sample of patients recruited by pharmacists. We asked all rheumatologists in France practising in private practice or mixed practice (private practice and hospital) to participate in a telephone survey about their most recent consultation with an RA patient. Randomly selected pharmacists recruited RA patients to complete a questionnaire about their most recent consultation with their rheumatologist. We included patients aged 20–59, with a paid job or unemployed. We calculated the proportion of consultations including work-related discussions in both samples.

Results

Of the 1737 rheumatologists contacted, 153 (9%) described consultations with eligible patients. Of the 1200 pharmacists contacted, 39 (3%) recruited 81 RA patients. The proportion of consultations including work-related discussions was 50% [95% confidence interval (CI) 42–58%] in the rheumatologist sample and 52% (95% CI 41–63%) in the patient sample. The most frequent subject of discussion (88%) was physical problems related to work in both samples.

Conclusions

This is the first study to document the proportion of consultations where rheumatologists and their RA patients discuss work. Both specialists and patients reported that work was discussed in one in every two consultations.




A study of workaholism in Irish academics

2016-08-03T05:44:47-07:00

Background

Workaholism is recognized as a health risk for academics given the open-ended nature of academic work; however, current prevalence rates of workaholism in the academic setting are unknown.

Aims

To assess the prevalence of workaholism within academics and determine the impact of workaholism on psychological well-being, work–life conflict, work–life fit, job satisfaction and perceived work effort.

Methods

Academics in three Irish universities completed a survey including measures of workaholism, psychological well-being, work–life conflict and job satisfaction. Analysis of variance tests were used to compare workaholism types on the outcome measures.

Results

A total of 410 academics completed the survey and were categorized by workaholism type: workaholics (27%), enthusiastic workaholics (23%), relaxed workers (27%) and uninvolved workers (23%). Workaholics reported poorer functioning across all the outcome measures in comparison to the other three groups.

Conclusions

This study demonstrates the high levels of workaholism within academia and highlights the negative impact of workaholism on work-related outcomes and psychological well-being. These findings are significant given the highly intensive nature of academic work today and reducing resources within this sector.




The occupational risk of tuberculosis in a low-prevalence population

2016-08-03T05:44:47-07:00

Background

The incidence of tuberculosis (TB) infection in low-prevalence countries has been declining. Estimates of the risk of occupational TB in these countries are contradictory.

Aims

To evaluate the risk of occupational TB in a low-prevalence population using a comprehensive database.

Methods

All compensation claims in British Columbia (BC), Canada, reporting workplace TB exposure for the years 1999–2008 were reviewed. Cases with TB infection were identified for all occupational groups with five or more claims in the decade and analysis provided estimates of incidence rates of active TB and relative risks of latent TB (LTB) infections.

Results

There were 70 occupational groups making 639 claims including 100 with LTB and eight with active TB. Only 18 occupations had five or more claims. Four occupational groups had a significantly increased relative risk of infection compared with all other occupational groups. These were employment counsellors, registered nurses, x-ray technicians and home support workers. Active TB infections were relatively rare compared with the general population (1–4 compared with 7–10/100000 person-years, respectively).

Conclusions

Few occupational groups were at risk of TB exposure at work on a regular basis. Only a handful had an apparent increased risk of contracting TB and these should be the focus of prevention efforts. Work-related active TB infections are rare hence the burden of occupational TB disease is low in BC.




Snap-fits and upper limb functional limitations in German automotive workers

2016-08-03T05:44:47-07:00

Background

The use of snap-fit fasteners in automotive assembly has increased in the last 10 years. Their impact on musculoskeletal function of the upper limbs in assembly workers is not well described.

Aims

To investigate the association between snap-fit assembly and upper limb functional limitations (ULFLs) in workers after a large-scale expansion of snap-fit assembly by a German automotive company.

Methods

Cross-sectional data on blue-collar production workers’ exposure to snap-fit assembly and ULFLs were collected from medical check-ups and company registers. The association between duration of snap-fit assembly and ULFLs, and the dose–response relationship between the two were analysed using logistic regression, adjusted for body mass index, gender and employment duration before snap-fit exposure.

Results

The study group included 10722 workers. Within the company, 8.4, 6.9 and 10.3% were exposed to snap-fit 1–12, 13–24 and ≥25 months, respectively. After adjusting for confounders, snap-fit exposure for 1–12 months [odds ratio (OR) = 1.59, 95% confidence interval (CI) 0.88–2.88] and 13–24 months (OR = 1.48, 95% CI 0.76–2.88) was not statistically significantly associated with ULFLs compared with an unexposed group. However, exposure to ≥25 months of snap-fit assembly was statistically significant associated with ULFLs showing >2-fold risk (OR = 2.44, 95% CI 1.52–3.92). No clear dose–response relationship was found.

Conclusions

Our study suggests a negative long-term impact from snap-fit assembly on workers’ upper limb function. Company physicians should be vigilant for signs of upper limb musculoskeletal disorders among workers exposed to snap-fit assembly.




Does response propensity bias stress audits?

2016-08-03T05:44:47-07:00

Background

Non-response bias in surveys occurs when non-respondents differ from respondents. Methods of dealing with this include measuring ‘response propensity’. We propose that response propensity has a trait-like component, measurable within the survey. Covariance of this component with survey items could indicate non-response bias.

Aims

To measure and validate trait-like response propensity, to test whether it co-varied with survey items during a routine stress audit and to test whether a prior staff attitude survey may have been biased.

Methods

Stress survey sent to government employees during a routine audit. We designed two new items to measure trait-like response propensity and completion of a prior staff survey. We calculated an odds ratio, correlations and Mann–Whitney U-tests to assess relationships between trait response propensity, completion of the prior staff survey and current stress survey scores.

Results

There were 71 respondents; response rate 68%. The trait response propensity item predicted completion of a prior staff survey (odds ratio 8.75, 95% confidence interval 2.32–33.08). Trait response propensity significantly correlated with two of the 40 survey items and did not significantly correlate with any of the eight ‘stressor’ sub-scales. Non-respondents to the prior staff survey had a significantly lower risk of stress on two of the eight stressor scales.

Conclusions

Trait response propensity seems to be a valid construct. The weight of evidence does not provide an indication of non-response bias (yet neither does it assure freedom from non-response bias). The prior staff survey may have been affected by non-response bias.




Active commuting and cardiovascular risk among health care workers

2016-08-03T05:44:47-07:00

Background

Although the benefit of physical activity on cardiovascular health has been well demonstrated, being physically active can be difficult for health care workers. Active commuting such as walking or cycling may be a good way to promote physical activity.

Aims

To investigate the relationship between active commuting and cardiovascular disease risk factors in health care workers.

Methods

A cross-sectional study of health care workers conducted in Chiang Mai University Hospital, Thailand. Information on demographics and lifestyle, including active commuting, was obtained from questionnaires. Results were analysed with multiple logistic regression, adjusting for other physical activity and possible confounders.

Results

Among 3204 participants, fewer than half engaged in active commuting. After adjustment for poss ible confounders, low active commuting was associated with increased risk of hypertension [adjusted odds ratio (aOR) 1.3, 95% confidence interval (CI) 1.1–1.7]. High active commuting was associated with central obesity (aOR 1.4, 95% CI 1.0–1.8). Compared with non-active commuters, younger active commuters (aged under 40) had reduced prevalence of hypertension (aOR 0.4, 95% CI 0.2–1.0), while older active commuters (aged 40 or over) demonstrated increased hypertension (aOR 1.6, 95% CI 1.1–2.3) and central obesity (aOR 1.5, 95% CI 1.1–2.1).

Conclusions

We found conflicting evidence on the relationship between active commuting and cardiovascular risk factors. Reverse causation may explain the association between active commuting and hypertension and central obesity and should be investigated further.




More hot air

2016-08-03T05:44:47-07:00




Occupational stress, coping and mental health in Jamaican police officers

2016-08-03T05:44:47-07:00

Background

Police are exposed to a wide range of stressors and this is especially true in developing countries such as Jamaica. Exposure to psychosocial stressors and use of maladaptive coping styles can result in mental ill-health.

Aims

To examine the relationship between work characteristics, coping and mental health in Jamaican police officers and to test whether work characteristics are indirectly associated with mental health outcomes through perceived job stress and job satisfaction.

Methods

Police officers from the Jamaican police force completed a questionnaire using a cross-sectional design. We analysed the data using hierarchical regression.

Results

The study group consisted of 134 police officers; the response rate was 94%. Negative work characteristics, lower levels of positive work factors and work support and emotion-focused coping styles were associated with increased levels of depression (F(8, 125) = 7.465, P < 0.001). Subjective feelings of anxiety were positively associated with negative work characteristics and emotion-focused coping (F(8, 125) = 7.586, P < 0.001). The relationship between work characteristics and mental health outcomes was mediated by perceived stress. Job satisfaction mediated the relationship between positive work characteristics and depression.

Conclusions

Stress management and intervention programmes should address modifiable work conditions, monitor stress levels and reduce maladaptive coping.




Alveolar proteinosis associated with aluminium dust inhalation

2016-08-03T05:44:47-07:00

Abstract Secondary alveolar proteinosis is a rare lung disease which may be triggered by a variety of inhaled particles. The diagnosis is made by detection of anti-granulocyte-macrophage colony-stimulating factor antibodies in bronchoalveolar lavage fluid, which appears milky white and contains lamellar bodies. Aluminium has been suggested as a possible cause, but there is little evidence in the literature to support this assertion. We report the case of a 46-year-old former boilermaker and boat builder who developed secondary alveolar proteinosis following sustained heavy aluminium exposure. The presence of aluminium was confirmed both by histological examination and metallurgical analysis of a mediastinal lymph node. Despite cessation of exposure to aluminium and treatment with whole-lung lavage which normally results in improvements in both symptoms and lung function, the outcome was poor and novel therapies are now being used for this patient. It may be that the natural history in aluminium-related alveolar proteinosis is different, with the metal playing a mediating role in the disease process. Our case further supports the link between aluminium and secondary alveolar proteinosis and highlights the need for measures to prevent excessive aluminium inhalation in relevant industries.




BrowZine

2016-08-03T05:44:47-07:00




Brief Pain Inventory review

2016-08-03T05:44:47-07:00




Occupational Medicine Calendar

2016-08-03T05:44:47-07:00







Response to letter from Dr Dzhambow

2016-08-03T05:44:47-07:00