Occupational health research round-up: September 2018

Amputation and return to work

The extent to which amputees integrate into normal living after losing a limb affects their return-to-work prognosis, according to this study of 147 people with lower extremity amputations. Almost 70% of the people in the study, who were all employed at the time of their limb loss, returned to work, although trans-femoral (above the knee) amputees were less likely to go back than others with lower extremity amputations. Another important factor affecting return-to-work was the number of years since the amputation, the study finds. However, the study concludes that the reason for amputation, that is, whether it was the result of a traumatic work-related event or a non-work-related incident, is not associated with return-to-work prognosis.

Journeay W S et al. “Return to work after occupational and non-occupational lower extremity amputation.” Occupational Medicine, published online 27 June 2018.

Return to work after common mental disorders

Workplace interventions designed to help those with mental ill health back to work are crucial to most organisational wellbeing policies and practices. This systematic review of 42 publications and meta-analysis of 32 studies reveals strong evidence that maintaining contact with employees off sick due to a common mental disorder is an effective approach, as are multicomponent interventions. The results of the research also suggest that interventions targeting stress rather than other mental ill health, such as personality disorders, are amongst the most successful in supporting return-to-work.

Mikkelsen M B and Rosholm M. “Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorder, somatoform disorders and personality disorders.“ Occupational & Environmental Medicine, published online 28 June 2018.

Work-related outcomes in self-employed cancer survivors

Self-employed people with a cancer diagnosis are less likely to take time off work as a result compared with salaried survivors, according to this multi-country study. Amongst those working at the time of the research, self-employed people had reduced their working hours to a greater degree (compared to their pre-diagnosis hours) than salaried workers, but still worked more hours per week than employed survivors. Self-employed people with cancers received less financial support when absent from work compared with salaried employees, and more of the former reported a negative financial impact as a result of the diagnosis. The authors conclude that, “self-employed survivors more often continued working during treatment and had, in general, worse financial outcomes than salaried cancer survivors.”

Torp S et al. “Work-related outcomes in self-employed cancer survivors: a European multi-country study.” Journal of Occupational Rehabilitation, published online 26 June 2018.

9/11 rescuers at higher risk of drug-related mortality

Some rescue and recovery workers at the World Trade Center on 9/11 have a significantly elevated risk of dying from drug or alcohol-related causes, according to this analysis of data from the World Trade Center Health Registry for 2004 to 2012. In total, 5.5% of deaths amongst people on the register were related to substance abuse, but male rescue workers with 9/11-related post-traumatic stress disorder, particularly those who also sustained a physical injury, were at greatest risk of mortality due to drugs and/or alcohol.

Welch A E et al. “Alcohol and drug-related mortality among enrollees in the World Trade Center Health Registry (WTCHR), 2004-12.” Journal of Occupational and Environmental Medicine, published online 13 June 2018.

OCD limits work participation

People with obsessive compulsive disorder (OCD) experience marked difficulties participating in the labour market, according to this Swedish study of 16,267 individuals with the condition and 157,176 controls. People with OCD were more likely to be in receipt of a disability pension, be absent from work long-term or long-term unemployed. The authors conclude that their findings emphasise the need for cooperation between policy makers, workplace rehabilitation specialists and mental health specialists to design and implement strategies to improve the participation of people with OCD in the labour market.

Pérez-Vigil A et al. “Labour market marginalisation in obsessive compulsive disorder: a nationwide register-based sibling control study.” Psychological Medicine, published online 28 June 2018.

Going back to work early eases back pain

An early return-to-work after an absence due to acute low back pain improves the condition and functional recovery, according to this longitudinal study of 557 individuals. Pain and function improved more rapidly for workers with an immediate return (30.7% improvement), or a return within seven working days (36.8%). The benefits of an early return were still partially observed even after controlling for a range of workplace, demographic and health variables.

Shaw W S et al. “Early return to work has benefits for relief of back pain and functional recovery after controlling for multiple confounds.” Journal of Occupational and Environmental Medicine, published online 21 June 2018.

Chronic illness and workplace adjustments

Chronically ill people, particularly as they age, often need adaptations to enable them to remain in work. This study explores how often such workplace modifications are made following a diagnosis of chronic disease, comparing the experiences of self-employed and employed older people. It finds that improvements to working conditions after a diagnosis of chronic illness, for example, giving people greater autonomy and control at work and lowering working hours, were restricted to self-employed people. The authors conclude that “this could suggest that workplace adjustments are necessary after diagnosis of chronic disease, but that the self-employed are more likely to realise these”.

Fleischmann M et al. “Changes in autonomy, job demands and working hours after diagnosis of chronic disease: a comparison of employed and self-employed older persons using the English Longitudinal Study of Ageing (ELSA).” Journal of Epidemiology & Community Health, published online 23 June 2018.

Job strain cuts healthy life expectancy

Poor psychosocial working conditions increase the likelihood of various types of morbidity and may reduce healthy or chronic disease-free life expectancy, this multi-country study suggests. Job strain was consistently related to shorter self-reported healthy life expectancy (1.7 years difference). The association was more pronounced among men and those in lower occupational positions, for example, a difference of 2.5 years was observed among low-grade men compared with 1.7 years among high-grade men. Job strain was also associated with shorter disease-free life expectancy, although this association was weaker and inconsistent, the authors conclude.

Magnusson Hanson LL et al. “Job strain and loss of healthy life years between ages 50 and 75 by sex and occupational position: analyses of 64,934 individuals from four prospective cohort studies.” Occupational & Environmental Medicine 2018, volume 75, pp486-493.

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