Extracts from the public and OH literature

Need for research on link between ill health and occupational injury

Palmer KT, Harris EC and Coggon D (2008). “Chronic health problems and risk of accidental injury in the workplace: A systematic literature review”. Occupational and Environmental Medicine published Online First on 16 April 2008. DOI:10.1136/oem.2007.037440.

The authors investigated whether common important health conditions and their treatments increase risks of occupational injury. A systematic search was conducted of Medline, Embase and PsycINFO databases from inception to November 2006, employing terms for occupational injury, medications and a broad range of diseases and impairments. Most commonly investigated were problems of hearing (15 studies), mental health (11 studies) and vision (10 studies). For impaired hearing, neurotic illness, diabetes, epilepsy and use of sedating medication there were moderate positive associations with occupational injury, but there were major gaps in the evidence base. Studies on vision did not present risks by category of eye disease no evidence was found on psychotic illness for diabetes, epilepsy and cardiovascular disease there were very few papers and exposures and outcomes were mostly ascertained by self-report. Improved research is needed to define the risks of occupational injury arising from common health complaints and treatments. Such research should delineate exposures and outcomes in more detail, and ensure by design that the former precede the latter.

Weight gain in sedentary occupations

Boyce RW, Boone EL, Cioci BW et al (2008). “Physical activity, weight gain and occupational health among call centre employees”. Occupational Medicine 58(4), 238-244. Published by Oxford University Press for the Society of Occupational Medicine1.

A need exists to address weight-gain and obesity risks in sedentary occupations. This study sought to determine relationships between body mass index (BMI), weight gain and ergonomic and exercise variables in sedentary workers. An anonymous questionnaire was administered regarding body weight, height, weight gained since employment, body-part discomfort, shift fatigue, time to achieve job adaptation, physical activity, fitness centre membership, previous employment type and previous injury. Subjects were 393 volunteers (mean age 34 years, 71% female) employed in a call centre. Participants reported substantial weight gain over a period of eight months. In contrast to walking and moderate exercise, only vigorous exercise was significantly associated with non-weight gain. Three risk factors were identified for weight gain: obese when hired, history of previous injury and lack of vigorous exercise.

Obesity and job disability among firefighters

Soteriades ES, Hauser R, Kawachi I et al (2008). “Obesity and risk of job disability in male firefighters”. Occupational Medicine 58(4), 245-250. Published by Oxford University Press for the Society of Occupational Medicine1.

This study examined the association between obesity and risk of job disability among firefighters. A prospective cohort study design was employed in following 358 Massachusetts firefighters enrolled in a state‑wide medical surveillance programme. The authors found that every one unit increase in body mass index (BMI) was associated with a 5% increased risk of job disability. Compared to firefighters in the lowest tertile of BMI, those in the highest tertile had a significantly increased risk of an adverse employment event. The highest categories of BMI had a 60%-90% increased risk of job disability compared to the lowest or normal-weight categories, respectively. Obesity is associated with higher risk of job disability in firefighters, but additional research is needed to further explore the findings. This study may have economic and public health implications in other occupational settings.

Link between physical fitness and sickness absence in male soldiers

Kyröläinen H, Häkkinen K, Kautiainen H et al (2008). “Physical fitness, BMI and sickness absence in male military personnel”. Occupational Medicine 58(4), 251-256. Published by Oxford University Press for the Society of Occupational Medicine1.

The aim of this study was to measure physical fitness and body mass index (BMI) and to assess their association with sickness absence in male soldiers. Data regarding BMI and physical fitness (aerobic endurance and muscle fitness) were collected for male Finnish military personnel and combined with sickness absence data collected in the year 2004. A total of 7,179 male military personnel participated. The group with the longest sickness absences exhibited lower muscle fitness in three of four tests and shorter running distance compared to the groups with shorter sickness absence. In addition, high BMI, poor muscle fitness and poor aerobic endurance were associated with increased sickness absence. The results showed that poor muscle fitness and endurance, as well as high BMI, are risk factors for productivity loss causing additional costs for the employer. Therefore, workers at a greater risk should be offered more multifaceted information about potential health risks, as well as motivational support to improve their lifestyle.

Low recovery expectations in low back pain sufferers

Iles RA, Davidson M and Taylor NF (2008). “A systematic review of psychosocial predictors of failure to return to work in non‑chronic non-specific low back pain”. Occupational and Environmental Medicine published Online First on 16 April 2008. DOI:10.1136/oem.2007.036046.

This study sought to identify psychosocial predictors of failure to return to work in non-chronic (lasting less than three months) non-specific low back pain (NSLBP). A systematic review of prognostic studies identified 24 studies showing strong evidence that recovery expectation is predictive of work outcome and that depression, job satisfaction and stress/psychological strain are not predictive of work outcome. There is moderate evidence that fear-avoidance beliefs are predictive of work outcome and that anxiety is not predictive of work outcome. There is insufficient evidence to determine whether compensation or locus of control are predictive of work outcome. The authors concluded that in order to predict work outcome in non-chronic NSLBP, psychosocial assessment should focus on recovery expectation and fear-avoidance. More research is needed to determine the best method of measuring these constructs and to determine how to intervene when a worker has low recovery expectations.

Hospital managers’ attitude to low back pain among staff

Cunningham C, Doody C and Blake C (2008). “Managing low back pain: knowledge and attitudes of hospital managers”. Occupational Medicine 58(4), 282-288. Published by Oxford University Press for the Society of Occupational Medicine1.

The authors sought to identify hospital line managers’ knowledge, attitudes and beliefs regarding low back pain (LBP) and its management the difficulties encountered in managing the worker with LBP and the organisational needs in relation to managing LBP at work. A cross-sectional survey was conducted of line managers at an Irish university hospital using a self-administered questionnaire. Against current advice, 54% of respondent managers reported that a staff member needs to be pain-free prior to return to work (RTW). Managers reported difficulties in dealing with colleagues of workers with LBP and in knowing the work capacity of the worker with LBP. Managers demonstrated poor awareness of the importance of the manager-worker relationship in influencing RTW. They believed better information, improved staff resources and easier access to health and ergonomic services would facilitate their management of workers with LBP. It was concluded that hospital line managers’ knowledge of their role in LBP management needed to be improved.

No improvements in work-related skin and respiratory disease levels

McNamee R, Carder M, Chen Y et al (2008). “Measurement of trends in incidence of work-related skin and respiratory diseases, UK 1996-2005”. Occupational and Environmental Medicine published Online First on 16 April 2008. DOI:10.1136/oem.2007.036731.

This study investigated UK trends (during 1996-2005) in work-related skin and respiratory diseases, including non-malignant pleural disease, asthma, mesothelioma and pneumoconiosis, and the potential for bias when using surveillance systems for this purpose. The volunteer reporters in three surveillance schemes were specialist physicians for skin diseases, respiratory diseases and occupational physicians respectively, who provided monthly reports. There was little evidence of change in incidences of non-malignant pleural disease, mesothelioma, skin neoplasia and urticaria, but falls were seen for contact dermatitis and pneumoconiosis. Although the direction of changes were similar across reporter groups, the magnitude of annual change in incidence was often not consistent. Some estimated changes in incidence based on volunteer reporting may be biased by reporting fatigue. Differences in the population bases of the surveillance schemes and UK health service capacity constraints may also explain differences in trends found here.

Assessing physicians’ awareness of occupational health and smoking stigma

Verger P, Arnaud S, Ferrer S et al (2008). “Inequities in reporting asbestos-related lung cancer: influence of smoking stigma and physician’s specialty, workload and role perception”. Occupational and Environmental Medicine 65(6), 392-397. Published by BMJ Publishing Group2.

This study investigated physician barriers to workers’ compensation claims for asbestos-related cancers, focusing on smokers’ stigma and physicians’ specialty and role-perception. In a cross-sectional telephone study of 486 randomly selected general practitioners and pulmonologists in France, standardised questionnaires explored their behaviour, attitudes and practices in the field of occupational health and their responses to a case vignette of a lung cancer patient with long-term occupational asbestos exposure. Recommending the filing of an occupational disease claim was significantly associated with specialty, patient’s smoking status, physician’s workload and role perception. To make physicians, and especially GPs, more aware of occupational health and smoking stigma, officials and educators must give these topics higher priority during initial training and continuing medical education. Tools and equipment that take time constraints into account should be developed and disseminated to help physicians manage occupational diseases.

No evidence of harm from maternal exposure to disinfection by-products

Luben TJ, Nuckols JR, Mosley BS et al (2008). “Maternal exposure to water disinfection by-products during gestation and risk of hypospadias”. Occupational and Environmental Medicine 65(6), 420-429. Published by BMJ Publishing Group2.

The use of chlorine for water disinfection results in the formation of numerous contaminants called disinfection by-products (DBPs), which may be associated with birth defects, including urinary tract defects. The authors used Arkansas birth records (1998-2002) to conduct a population-based case-control study investigating the relationship between hypospadias and two classes of DBPs, trihalomethanes (THM) and haloacetic acids (HAA). No increase in risk was found when women in the highest tertiles of exposure were compared to those in the lowest for any DBP. The results provide little evidence for a positive relationship between DBP exposure during gestation and an increased risk of hypospadias but the necessity is emphasised of including individual-level data when assessing exposure to DBPs.

Maternal occupational exposures in female veterinarians

Shirangi A, Fritschi L and Holman C (2008). “Maternal occupational exposures and risk of spontaneous abortion in veterinary practice”. Occupational Environmental and Medicine published Online First on 16 April 2008. DOI:10.1136/oem.2007.035246.

This study examined the relationship between occupational exposures and spontaneous abortion in 940 female veterinarians in Australia. Self‑reported occupational exposures to anaesthetic gases, x-rays, pesticides and long working hours in relation to spontaneous abortion were examined. There was found to be more than two-fold significant increase in the risk of spontaneous abortion in women exposed to unscavenged anaesthetic gases for one or more hours per week. Veterinarians who reported performing more than five radiographic examinations per week had a statistically significant elevated risk of spontaneous abortion compared to those who performed less than five. There was also about a two-fold significant increased risk of spontaneous abortion in women who used pesticides at work. Female veterinarians, particularly those of childbearing age, should be fully informed of the possible reproductive effects of these risks and reduce their exposure by use of protective devices during pregnancy and the time when they are planning to become pregnant.

Occupational exposures and male infertility

Cherry N, Moore H, McNamee R et al (2008). “Occupation and male infertility: glycol ethers and other exposures”. Occupational and Environmental Medicine published Online First on 16 April 2008. DOI:10.1136/oem.2007.035824.

The authors investigated the relation between male infertility and occupational exposures, particularly glycol ethers. A case-referent study was designed in which men attending 14 fertility clinics in 11 centres across the UK in 1999-2002 were recruited, following 12 months of unprotected intercourse and without a previous semen analysis. Cases were those with low motile sperm concentration (MSC) relative to the time since their last ejaculation. Referents were other men attending these clinics and meeting the inclusion criteria. Of 2,118 men in employment at the time of the interview, 874 were cases. Glycol ether exposure was found to be related to low motile sperm count in men attending fertility clinics. This suggests that, at the time of the study, glycol ethers continued to be a hazard for male fertility.

Coping with job stressors in dentistry

Ayers KMS, Thomson WM, Newton JT et al (2008). “Job stressors of New Zealand dentists and their coping strategies”. Occupational Medicine 58(4), 275-281. Published by Oxford University Press for the Society of Occupational Medicine1.

This study investigated job stressors and coping strategies among New Zealand dentists, through a nationwide postal survey of a representative sample of 700 dentists. The most commonly reported stressors were treating difficult children, constant time pressure and maintaining high levels of concentration. The strategies most utilised for managing work-related stress included interactions with people, sports and forgetting about work. There were differences in the strategies used by male and female practitioners to manage stress. There is considerable variation in the number of stressors experienced by dentists. Overseas-qualified dentists appear to be under more stress than New Zealand-trained dentists and may need greater professional support. Dentists should be encouraged to make greater use of active coping strategies.

Workplace violence among medical students

Acik Y, Deveci SE, Gunes G et al (2008). “Experience of workplace violence during medical speciality training in Turkey”. Occupational Medicine Advance Access published on 7 May 2008, DOI:10.1093/occmed/kqn045.

The objective of this study was to determine the type, extent and effects of workplace violence among students during postgraduate speciality training in various departments of medical schools in Turkey. A cross-sectional survey was conducted in seven medical schools representing all geographical regions of Turkey. In all, 68% of 1,712 respondents indicated they had experienced some form of workplace violence, 67% had experienced verbal violence, 16% had experienced physical violence and 3% had experienced sexual violence. The victims’ most prevalent reactions to violence included being deeply disturbed but coping with it for the sake of their career being distressed but discounting such events as common in all occupations and being confused and unsure how to respond. The most frequently named perpetrators of verbal violence were relatives/friends of patients and academic staff, followed by other residents/senior residents, patients, heads of department and non-medical hospital staff. Physicians in speciality training in medical schools in Turkey are subject to significant verbal, physical or sexual violence and precautions to prevent such exposure are urgently needed.

Social deprivation and sickness absence

Wynn P and Low A (2008). “The effect of social deprivation on local authority sickness absence rates”. Occupational Medicine 58(4), 263-267. Published by Oxford University Press for the Society of Occupational Medicine1.

The purpose of this study was to establish if a relationship exists between standard measures of deprivation, used by the UK central government to determine regional health and social welfare funding, and sickness absence and ill-health early retirement rates in English local government employers. The authors found that a significant proportion of variation in sickness absence and ill-health retirement rates in local government in England are associated with local measures of deprivation. Recognition of the impact of deprivation on sickness absence has implications for a number of different areas of work. These include target-setting for local government best value performance indicators, history-taking in sickness absence consultations and the role of deprivation as a confounding factor in sickness absence intervention studies.

Psychosocial factors at work and risk of depression

Bonde JPE (2008). “Psychosocial factors at work and risk of depression: a systematic review of the epidemiological evidence”. Occupational and Environmental Medicine published Online First on 16 April 2008. DOI:10.1136/oem.2007.038430.

This paper reviewed follow-up studies addressing the risk of major depression and depressive symptoms relative to psychosocial stressors in the working environment and evaluated the evidence of causality. Follow-up studies were identified by a systematic Medline search combining search terms for the outcome and measures of job-related psychosocial factors. Sixteen company or population-based studies including some 63,000 employees were identified. Major depression was defined by clinical criteria in seven studies and by symptom scales in another seven. The prevalence of depressive disorder varied substantially, which points to a high degree of study heterogeneity. This review provides rather consistent findings indicating that perception of adverse psychosocial factors at the workplace is related to an elevated risk of subsequent onset of depressive symptoms or a major depressive episode, but several methodological limitations preclude causal inference. Studies that implement objective measures of job stressors or independent outcome ascertainment are warranted.


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