Snapshot of latest OH research

Fifteen-year trends in occupational asthma

Diar-Bakerly N, Moore VC, Vellore AD et al (2008). “Fifteen-year trends in occupational asthma: data from the Shield surveillance scheme”. Occupational Medicine Advance Access published on 27 February 2008, DOI:10.1093/occmed/kqn007.

The authors assessed trends in occupational asthma (OA) in an industrialised part of the UK over a 15-year period. A total of 1,461 cases were reported to the scheme. Sixty-eight per cent were males with a mean age of 44. The annual incidence of OA was 42 per million of the working population. Occupational asthma was most frequently reported in welders and healthcare-related professions, while fewer than 1% of cases were reported in farmers. Isocyanates were the commonest offending agents, responsible for 21% of reports, followed by metal working fluids (MWFs), adhesives, chrome, latex and glutaraldehyde. Flour was suspected in 5% of cases while laboratory animals in just 1%. The data confirm a high annual incidence of OA in the West Midlands. Incidence remained at a fairly stable background level with many small and a few large epidemics superimposed. Schemes like Midland Thoracic Society’s Rare Respiratory Disease Registry Surveillance Scheme of Occupational Asthma could help in identifying outbreaks by linking cases at the workplace.

Depression and diabetes risk

Cosgrove MP, Sargeant LA and Griffin SJ (2008). “Does depression increase the risk of developing type 2 diabetes?” Occupational Medicine 58(1), 7-14. Published by Oxford University Press for the Society of Occupational Medicine, 6 St Andrew’s Place, London NW1 4LB, tel: 020 7486 2641, fax: 020 7486 0028, email: SOM@sococcmed.demon.co.uk, web: occmed.oupjournals.org.

The authors sought to quantify the association between depression and subsequent development of type 2 diabetes, in order to determine whether an individual in a pension scheme that awards injury pensions, who develops type 2 diabetes, should be awarded an injury pension, if the development of the diabetes followed a work-related depressive episode. The presence of depression or depressive symptoms was associated with increased risk of subsequently developing type 2 diabetes. However, depression was no more frequent among those with and without prevalent, but previously undiagnosed, type 2 diabetes. Further research is needed to determine possible causal mechanisms for the association and to ascertain whether depression and diabetes may have a common aetiology.

Causes of reactive airways dysfunction syndrome

Shakeri MS, Dick FD and Ayres JG (2008). “Which agents cause reactive airways dysfunction syndrome (RADS)?” Occupational Medicine Advance Access published on 27 February 2008, DOI:10.1093/occmed/kqn013.

The purpose of this study was to identify those agents reported as being associated with reactive airways dysfunction syndrome (RADS). Significant information gaps were identified for all types of exposure covered by the abstracts reviewed. In some articles, even the causative agent was not reported. The most commonly reported agents were chlorine, toluene di-isocyanate (TDI) and oxides of nitrogen. Most exposures occurred in the workplace and affected men. Dyspnoea and cough were the commonest symptoms. Although the most commonly reported agent associated with RADS was chlorine, the main finding of a general lack of adequate information on exposure, investigation and outcome suggests that to better explore RADS a more structured approach to gathering information is required. A minimum data set for reporting RADS cases is proposed.

Effect of socioeconomic status and occupation on asthma risk

Li X, Sundquist J and Sundquist K (2008). “Socioeconomic and occupational groups and risk of asthma in Sweden”. Occupational Medicine Advance Access published on 22 February 2008, DOI:10.1093/occmed/kqn009.

The authors investigated possible associations between hospitalisation for asthma and socioeconomic status and occupation. A total of 13,202 male and 11,876 female hospitalisations for asthma were retrieved at ages over 30 years. The socioeconomic groups with less than nine years of education were associated with a significantly increased risk of hospitalisation for asthma. Among male occupations, in two censuses, increased risks were noted for farmers, mechanics and iron and metal workers, welders, bricklayers, workers in food manufacture, packers, loaders and warehouse workers, waiters and chimney sweeps with prolonged exposures. For female occupations, increased risks were observed among assistant nurses religious, juridical and other social science-related workers drivers mechanics and iron and metalware workers and wood workers. The present study suggests that socioeconomic status (low educational level) and occupation have an effect on the population’s risk of hospitalisation for asthma.

Return-to-work policies in occupational health services

Kivistö S, Verbeek JH, Hirvonen Maria et al (2008). “Return‑to‑work policies in Finnish occupational health services”. Occupational Medicine 58(2), 88-93. Published by Oxford University Press for the Society of Occupational Medicine, 6 St Andrew’s Place, London NW1 4LB, tel: 020 7486 2641, fax: 020 7486 0028, email: SOM@sococcmed.demon.co.uk, web: occmed.oupjournals.org.

This study aimed to describe return-to-work services for employees on sick leave offered by Finnish occupational health services (OHS). Of the total sample of 969 occupational health units, 95% responded to the survey. Forty-one per cent reported offering services for facilitating return to work after sick leave. The service usually consisted of occupational physician examination of employees on sick leave for six weeks. This was followed by a joint discussion between employee, physician and supervisor, which could result in work accommodation or a work trial period. Return-to-work policies were more frequently found in the OHS that served only a few employers, provided more group activities and collaborated more with employers and research institutes. Less than half of Finnish OHS offer return‑to‑work services of which the contents show wide variation that is not in line with current scientific evidence. A guideline project for return-to-work practices is needed to fill the gap. More research is needed to best define monitoring and screening practices for workers on sick leave.

Welding and respiratory symptoms

Lillienberg L, Zock J-P, Kromhout H et al (2008). “A population-based study on welding exposures at work and respiratory symptoms”. Annals of Occupational Hygiene 52(2), 107-115. Published by Oxford University Press for the British Occupational Hygiene Society. Web: annhyg.oxfordjournals.org.

In the first European Community Respiratory Health Survey (ECRHS I), an excess asthma risk was associated with high exposure to gases and fumes, mineral and biological dusts. In a nine-year follow-up study (ECRHS II), the aim was to study if welding at work increases the risk of asthma symptoms, wheeze and chronic bronchitis symptoms. The study also aimed to identify specific welding risk factors. Welding was a common task in many occupations and only 7% of the individuals actually called themselves welders and flame cutters, while the largest groups doing welding worked in construction or were motor, agricultural and industrial mechanics and fitters. Welding at work was not associated with an increased prevalence of asthma symptoms or wheeze, but there was an association with chronic bronchitis symptoms. Chronic bronchitis symptoms were significantly higher in those frequently welding in galvanized steel or iron and in those frequently manual welding stainless steel. There was also an increase in the prevalence of wheeze in individuals welding painted metal. The results support that welding in coated material is a respiratory hazard underscoring the importance of preventive actions.

Cancer risk after cessation of asbestos exposure

Magnani C, Ferrante D, Barone-Adesi F et al (2008). “Cancer risk after cessation of asbestos exposure: a cohort study of Italian asbestos cement workers”. Occupational and Environmental Medicine 65(3), 164-170. Published by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web: oem.bmjjournals.com/.

The authors aimed to study mortality for asbestos-related diseases and the incidence of mesothelioma in a cohort of Italian asbestos cement workers after cessation of asbestos exposure. The Eternit factory operated from 1907 to 1986. The cohort included 3,434 subjects active in 1950 or hired in 1950-86, ascertained from company records, without selections. Mortality was increased in both sexes for all causes. In women, ovarian and uterine malignancies were also in excess. No statistically significant increase was found for laryngeal cancer. This study of a cohort of asbestos-exposed workers, with very long follow-up, confirmed the reduction in risk of death from lung cancer after the end of exposure. It also suggested a reduction in risk for pleural mesothelioma with more than 40 years of latency, while risk for peritoneal mesothelioma showed a continuing increase.

Link between income and mental disorders among workers

Virtanen M, Koskinen S, Kivimäki M et al (2008). “Contribution of non-work and work-related risk factors to the association between income and mental disorders in a working population: the Health 2000 Study”. Occupational and Environmental Medicine 65(3), 171-178. Published by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web: oem.bmjjournals.com.

This study examined the contribution of non-work and work factors to the association between income and DSM-IV depressive and anxiety disorders in a working population. The risk of having a depressive or anxiety disorder was found to be 2.8 times higher in the low-income group than in the high-income group among men and two times higher among women. For men, non-work and work factors explained 20% and 31% of this association, respectively. For women, the corresponding figures were 65% and 23%. Low income is associated with frequent mental disorders among a working population. In particular, work factors among men and non-work factors among women contribute to the income differences in mental health.

Nasal and sinus disorders among wood workers

Pesch B, Pierl CB, Gebel M et al (2008). “Occupational risks for adenocarcinoma of the nasal cavity and paranasal sinuses in the German wood industry”. Occupational and Environmental Medicine 65(3), 191-196. Published by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web: oem.bmjjournals.com.

This study examined the risk of wood dust and chemical exposures for adenocarcinoma of the nasal cavity and paranasal sinuses (ADCN) among German wood workers. ADCN occurred relatively more frequently among wood workers that had ever worked as cabinet makers or joiners than as saw millers. Average exposure to inhalable wood dust 5mg/m3 was associated with a high risk, compared to levels below 3.5mg/m3. Assuming 40 years of exposure under these concentrations, the corresponding OR was 4.20. Exposure between 3.5mg/m3 and 5mg/m3 was also found to pose a risk. Exposure to pigment stains before 1970 was associated with an increased risk. No significant associations were estimated for wood preservatives, varnishes and formaldehyde.

Blood disorders in ‘bioprotein’ production workers

Sikkeland LIB, Skogstad M, Øvstebø R et al (2008). “Circulating lipopolysaccharides in the blood from ‘bioprotein’ production workers”. Occupational and Environmental Medicine 65(3), 211-214. Published by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web: oem.bmjjournals.com.

Workers producing bacterial single-cell protein (BSCP), ‘bioprotein’, are exposed to organic dust containing high levels of endoxins (lipopolysaccharides, LPS). Workers in this industry have complained of episodes of fever, fatigue, chest tightness, skin dryness and rubor. The aim of the present study was to quantify LPS and inflammatory mediators in plasma among the workers and non-exposed control subjects. In this study, the authors detected LPS in plasma of individuals exposed to high levels of LPS at their workplace. This finding is supported by elevated levels of several inflammatory cytokines among the workers, significantly exceeding that of the non-exposed control group. To the best of the authors’ knowledge, this is the first time that plasma LPS, together with increased inflammatory markers in plasma, has been detected in an occupational setting.

Effect of chronic pain rehabilitation on sickness absence

Suoyrjö H, Hinkka K, Oksanen T et al (2008). “Effects of multidisciplinary in-patient rehabilitation for chronic back or neck pain: a register-linkage study of sickness absences and analgesic purchases in an occupational cohort”. Occupational and Environmental Medicine 65(3), 179-184. Published by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web: oem.bmjjournals.com.

In a prospective observational study of 10 towns in Finland, the authors sought to determine the effects of multidisciplinary in-patient rehabilitation for chronic back or neck pain on sickness absences and analgesic purchases. The rate of very long sickness absence among the chronic back pain rehabilitees was 3.03-fold, compared to the non‑rehabilitees in the year before rehabilitation. This ratio declined three years after rehabilitation. No further decline in the rate of very long sickness absence was observed in the subsequent years. For chronic neck pain rehabilitees, no evidence of the effectiveness of rehabilitation on sickness absence was found. In relation to consumption of analgesics, the mean rate of defined daily doses declined among the back and neck pain rehabilitees after rehabilitation compared to the non-rehabilitees. Multidisciplinary in-patient rehabilitation for chronic back pain may decrease the risk of very long sickness absence for three years. In relation to rehabilitation for chronic neck pain, no changes in sickness absences were found.

Predicting future health improvement among employees

Kivimäki M, Ferrie JE, Shipley MJ et al (2008). “Low medically certified sickness absence among employees with poor health status predicts future health improvement: the Whitehall II study”. Occupational and Environmental Medicine 65(3), 208-210. Published by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web: oem.bmjjournals.com.

High sickness absence is associated with poor health status, but it is not known whether low levels of sickness absence among people with poor health predict future health improvement. The authors examined the association between medically certified sickness absence and subsequent change in health among initially unhealthy employees. After adjustment for age and sex, there was a strong contemporaneous association between lower sickness absence and better health status. Among participants reporting poor health, low absence was associated with subsequent improvement in health status. This association was only partially explained by known existing morbidity, socioeconomic position and risk factors. Further research is needed to examine whether lower sickness absence also marks a more favourable prognosis for specific diseases.

Evaluating outcomes of workers with self-reported symptoms

Descatha A, Chastang JF, Cyr D et al (2008). “Do workers with self-reported symptoms have an elevated risk of developing upper extremity musculoskeletal disorders three years later?” Occupational and Environmental Medicine 65(3), 205-207. Published by BMJ Publishing Group, BMA House, Tavistock Square, London WC1H 9JR, tel: 020 7387 4499, fax: 020 7383 6661, web: oem.bmjjournals.com.

The objective was to study the three-year outcomes of workers with self-reported symptoms of upper extremity musculoskeletal disorders (UEMSD), with or without a positive physical examination. The three‑year incidence rate was 44.1% one-third of these incident cases had self-reported symptoms in 1993-94. Workers with a positive questionnaire had a significantly higher risk of UEMSD at physical examination three years later. Moreover, workers with positive questionnaires but without UEMSD diagnosed in 1993-94 also had a significantly higher risk of UEMSD at physical examination three years later. Results were similar when gender and age were taken into account. Workers highly exposed to repetitive movements have a high risk of developing UEMSD and should be followed closely in surveillance programmes.

Assessing disability claims for tribunals

Williams AN (2008). “Are tribunals given appropriate and sufficient evidence for disability claims?” Occupational Medicine 58(1), 35-40. Published by Oxford University Press for the Society of Occupational Medicine, 6 St Andrew’s Place, London NW1 4LB, tel: 020 7486 2641, fax: 020 7486 0028, email: SOM@sococcmed.demon.co.uk, web: occmed.oupjournals.org.

This study assessed employment tribunal judgments on disability discrimination in order to determine whether the evidence placed before the tribunal was appropriate and sufficient. Of a total of 2,497 cases, 2,271 were withdrawn or settled before going to tribunal. Of the remaining 226 cases, 38 were default judgments. In total, 188 cases were actually heard and only 65 judgments were recorded. Of these, 50 were full hearings. In 18 full hearings, there was input from an occupational physician, and the tribunal view was that there was discrimination in six cases, four where the advice had been ignored. Only four cases had input from a consultant occupational physician in three cases, the finding was that discrimination had not taken place and in the fourth, the advice from the consultant was ignored by the management.

Psychopathological effects of workplace bullying

Brousse G, Fontana L, Ouchchane L et al (2008). “Psychopathological features of a patient population of targets of workplace bullying”. Occupational Medicine 58(2), 122-128. Published by Oxford University Press for the Society of Occupational Medicine, 6 St Andrew’s Place, London NW1 4LB, tel: 020 7486 2641, fax: 020 7486 0028, email: SOM@sococcmed.demon.co.uk, web: occmed.oupjournals.org.

This study evaluated levels of stress and anxiety-depression disorder developed by targets of workplace bullying, together with outcome at 12 months and to characterise this population in terms of psychopathology and sociodemographic features. At first consultation, 81% of patients showed high levels of perceived stress at work, and 83% and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively [significsntly?] capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD [Define?] scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.

Predicting job loss in those off sick

Wilford J, McMahon AD, Peters J et al (2008). “Predicting job loss in those off sick”. Occupational Medicine 58(2), 99-106. Published by Oxford University Press for the Society of Occupational Medicine, 6 St Andrew’s Place, London NW1 4LB, tel: 020 7486 2641, fax: 020 7486 0028, email: SOM@sococcmed.demon.co.uk, web: occmed.oupjournals.org.

The authors aimed to develop a screening tool to select those at risk of job loss, defined as failure to return to work among those off sick. The screening tool was for use in the job retention and rehabilitation pilot of the Department for Work and Pensions. Five questions holding the greatest predictive power were subjected to multivariate analysis and in the final model had a high C-index of 0.90. They formed the screening tool. The questions cover self-assessment of ability to return to work after current sick leave, of ability to do current job in six months’ time, sick leave in past year, current age and whether awaiting a consultation or treatment. A screening tool identifying those most at risk of job loss has been produced.

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