An evaluation of stress education in the Royal Navy

Background Psychoeducational programmes aim to reduce the morbidityassociated with exposure to stressful events. Although theyare widely used, there are conflicting views as to how or whythey might be effective. Aim To examine exposure to ‘stress’ education withinthe Royal Navy (RN) and ascertain any links between stress educationand mental health status. Methods In all, 1559 RN personnel were surveyed using a studyquestionnaire which asked about exposure to and quality of anystress education provided during service. Participants alsocompleted two measures of psychological health, the GeneralHealth Questionnaire (GHQ)-12 item and the Post-Traumatic StressDisorder Checklist. Odds ratios (ORs) were calculated and 95%confidence intervals were computed using multivariable logisticregression adjusting for socio-demographic variables. Results The response rate was 70%; 47% of the sample reportedhaving received a stress brief during service. Those who reportedhaving received a brief had better general mental health (measuredby the GHQ) than those who had not [adjusted, OR = 0.76 (0.59–0.98)].When brief quality was taken into account, only those who receiveda brief and considered it ‘useful’ were significantlyless distressed [adjusted, OR = 0.65 (0.49–0.86)]. Poor-qualitybriefs were no better than having had no brief at all [adjusted,OR = 1.04 (0.74–1.47)]. Conclusions Our data indicate that only educational stress briefswhich are relevant for the target audience may be beneficial.Simply providing stress briefings, without thought to theirquality, may constitute a waste of resources.     

Doctors, their mental health and capacity for work

Background Information about doctors’ mental ill-healthis limited. This study looks at doctors’ careers followingmental illness and the strategies that helped them return towork. Aim To examine the effect of mental ill-health on doctors’careers. Methods Questionnaire survey of members of the Doctors SupportNetwork (DSN). The DSN is a peer support group for doctors whohave experienced, or are experiencing, mental ill-health. Results One hundred and sixteen doctors (35% response rate)returned completed questionnaires (n = 116, 63% female, 37%male). Prior to their ill-health, 80% worked full time, 15%part-time, 2% were not working and 3% were medical students.Following illness, 33% worked full time (P < 0.05), 36% part-time(P < 0.05) and 29% were not working (P < 0.01). Flexibleworking practices were the most helpful reported strategy forenabling a doctor to return to work. Conclusions Following mental ill-health, a doctor’s capacityto work full time is reduced. Most doctors return to full-timeor part-time work. With improved support, more doctors may beable to return to work.     

Burnout and patient care in junior doctors in Mexico City

Background Burnout is known to occur in public service workersleading to a reduction in effectiveness at work. Aim To estimate the prevalence of burnout in junior doctorsand its impact on patient care. Methods A cross-sectional study of junior doctors at three hospitalsin Mexico City was conducted. Measures used included the MaslachBurnout Inventory (MBI), measuring depersonalization (DP), emotionalexhaustion (EE) and personal achievement (PA), a questionnaireabout patient care practices and attitudes and one on sociodemographiccharacteristics. Logistic regression analysis was used to assessthe association between burnout and suspected risk factors. Results A total of 312 junior doctors participated (responserate 65%). In total, 57% were male and the average age was 28.Average scores in MBI subscales were EE: 18.2, DP: 6.9 and PA:37.6. Burnout prevalence was 40% (126). Junior doctors withburnout were more likely to report suboptimal patient care practicesoccurring monthly (OR 5.5; 95% CI 2.7–11.2) and weekly(OR 5.2; 95% CI 1.6–16.3). The logistic regression modelfor burnout included shifts lasting >12 h, current depression,former major depression, first- or second-year junior doctors,male gender and single status. Conclusions Burnout was most strongly associated with shifts>12 h and with both current and previous depression. Reportedsuboptimal patient care was also associated with working shiftsof 12 h. Burnout may be adversely affecting junior doctors’health and their patients’ care.     

Overtime work and stress response in a group of Japanese workers

Background Working long overtime hours is considered a causeof mental health problems among workers but such a relationshiphas yet to be empirically confirmed. Aim To clarify the influence of overtime work on response tostress and to assess the role of other stress-related factorson this relationship. Methods The study was conducted among 24 685 employees of acompany in Japan. Stress response, job stressors and socialsupports were assessed by the Brief Job Stress Questionnaire.Participants were divided into five categories of overtime (0–19,20–39, 40–59, 60 h of overtime per month and exemptedemployees). Results The nonadjusted odds ratios for stress response for40–59 and 60 overtime hours per month in reference to0–19 overtime hours were 1.11 [95% confidence interval(CI) 1.03–1.19] and 1.62 (95% CI 1.50–1.76), respectively.After adjustment for self-assessed amount of work, mental workloadand sleeping time, the association between overtime work andstress response disappeared. Conclusions This large cross-sectional study shows that overtimework appears to influence stress response indirectly throughother stress factors such as self-assessed amount of work, mentalworkload and sleeping time.     

Exposures to blood and body fluids in Brazilian primary health care

Background Primary health care workers (HCWs) represent a growingoccupational group worldwide. They are at risk of infectionwith blood-borne pathogens because of occupational exposuresto blood and body fluids (BBF). Aim To investigate BBF exposure and its associated factors amongprimary HCWs. Methods Cross-sectional study among workers from municipal primaryhealth care centres in Florianópolis, Southern Brazil.Workers who belonged to occupational categories that involvedBBF exposures during the preceding 12 months were interviewedand included in the data analysis. Results A total of 1077 workers participated. The mean incidencerate of occupational BBF exposures was 11.9 per 100 full-timeequivalent worker-years (95% confidence interval: 8.4–15.3).The cumulative prevalence was 7% during the 12 months precedingthe interview. University-level education, employment as a nurseassistant, dental assistant or dentist, higher workload score,inadequate working conditions, having sustained a previous occupationalaccident and current smoking were associated with BBF exposures(P 0.05). Conclusions Primary Health Care Centres are working environmentsin which workers are at risk of BBF exposures. Exposure surveillancesystems should be created to monitor their occurrence and toguide the implementation of preventive strategies.     

Attitudes to job turnover among Finnish anaesthetists

Background Structural changes have led to higher workload andmore frequent conflicts among hospital staff, which in turnhas been shown to be associated with increased employee turnover. Aims To study the willingness of anaesthetists to change theiremployment and factors associated with it. Work-related, individualand family-related factors were investigated as potential influenceson such willingness. Method A postal questionnaire was sent to all working Finnishanaesthetists (N = 550). Results The response rate was 60%; 175 (53% of responders) weremen. Of the respondents, 31% were willing to consider changingto another physician's job and 43% to a profession other thanmedicine. The most important correlates for these views wereconflicts with superiors (odds ratio 6.1; 95% confidence interval2.1–17.7) and co-workers (4.2; 1.4–12.2), low jobcontrol (2.6; 1.4–4.9), a sense of organizational injustice(2.4; 1.3–4.6), stress (6.5; 2.6–16.3) and job dissatisfaction(4.6; 2.4–8.8). Conclusions The establishment of respect, trust and genuinedialogue between co-workers and superiors is needed to minimizethe risk of loss of members of this occupational group.     

Relationship between job, lifestyle, age and occupational injuries

Background Physical job demands (PJD), age, disability and lifestylemay influence the risk of occupational injury. Aim To assess the relationships between PJD, lifestyle and injuryin workers of various ages. Methods A total of 2888 randomly selected workers from northeasternFrance, aged 15, completed a postal questionnaire. The PJD scorewas defined as the total number of the following reported jobdemands: using pneumatic tools, other vibrating hand tools,hammers, machine tools or vibrating platforms and exposure tomanual handling tasks, awkward postures, high pace of work,high physical workload, work at heights, work in adverse climatesor exposure to noise, cold or heat. Data were analysed usinglogistic regression. Results Nine per cent of subjects reported an injury duringthe previous 2 years. The PJD score was related to the injuryrate for workers aged 45: crude odds ratio (OR) 3.5 (95% confidenceinterval = 1.5–8.0) for PJD = 1, 5.0 (2.2–11.3)for PJD = 2–3 and 14.5 (6.5–32.2) for PJD 4, versusPJD = 0. Lower ORs were found for those aged <30 (1.4, 4.2and 9.9, respectively) and 30–44 (1.5, 4.4 and 6.5, respectively).The differences between age groups remained when controllingfor all factors studied. Obesity, smoking and musculoskeletaldisorders were associated with injury risk in workers aged 45(adjusted ORs 1.7–2.6). Smoking was also an injury riskfactor for workers aged <30. Conclusions PJD and lifestyle have a higher impact on injuryrates among older workers than among younger ones. Injury preventionshould address reducing PJD and improving relevant lifestylefactors, especially for older workers.     

The burden of psychological symptoms in UK Armed Forces

OBJECTIVE: To assess the prevalence of psychological symptoms during periods of relatively low deployment activity and the factors associated with each psychological health outcome. METHODS: A survey of 4500 randomly selected UK service personnel was carried out in 2002. The questionnaire included the General Health Questionnaire (GHQ-12), the post-traumatic stress disorder checklist (PCL), 15 symptoms and an assessment of alcohol intake. RESULTS: A total of 20% were above cut-offs for GHQ-12, 15% for symptoms, 12% for alcohol intake and 2% for PCL. Gender, age, excessive drinking and smoking were independently associated with most outcomes of interest. Number of deployments was independently associated with multiple symptoms and excessive drinking. High post-traumatic stress disorder score was more frequent in the Army and in lower ranks. CONCLUSIONS: Psychological symptoms are highly prevalent in UK Armed Forces. Many risk factors are associated with measures of psychological ill-health.     

Piecework, musculoskeletal pain and the impact of workplace psychosocial factors

Aim To investigate the impact of piecework on musculoskeletalpain and general health, and the influence of perceived workplacepsychosocial factors on any such associations, in a generalUK population. Methods A questionnaire was mailed to an age-stratified randomsample of 10 000 adults aged 18–75 in North Staffordshire,UK. Respondents reporting a current main job were asked if thisjob was paid by a piecework system. Health measures were (i)number of pain areas according to a body manikin and (ii) generalhealth (SF-12v2). Other measures included questions on occupationalhistory and psychosocial aspects of the work environment. Results The adjusted response was 54%. A total of 1193 respondentsreported a current main job, of whom 201 (17%) reported piecework.Pieceworkers were more likely to be older (P < 0.05), male(P < 0.001) and in lower socioeconomic groups (P < 0.001)than non-pieceworkers. Piecework was associated with perceptionsof a poor psychosocial working environment, more pain areas(P < 0.05), more elbow (P < 0.01), forearm (P < 0.001)and hand pain (P < 0.05), and a lower physical health score(SF-12v2; P < 0.01), but no difference in mental health score(P = 0.60), compared with non-pieceworkers. After controllingfor psychosocial factors, and socioeconomic group, the associationsbetween piecework and pain areas, or physical health, were nolonger statistically significant. Conclusions These results show that piecework was associatedwith poorer self-reported general physical health and more areasof pain, which may be attributed to low socioeconomic group,and workplace perceptions of little job control, high physicaldemand and little supervisor support.     

Silica exposure, smoking, silicosis and lung cancer--complex interactions

Background Establishing a clear relationship between workplaceexposures and cancer is often difficult. The latent period forcancer development can make it difficult to establish a definitecause–effect relationship. The picture is further complicatedby variable job histories, concomitant exposure to other carcinogensand other factors such as genetic susceptibility and poor nutrition.The lack of accurate and detailed record keeping may potentiallymask informative differences among group of workers. Removingor reducing exposures to probable and known carcinogens, however,can prevent workplace cancer. Aim This paper gives an overview of the literature reportinginvestigations of the relationship between exposure to silicaand development of lung cancer with a focus on the controversyconcerning the roles of silicosis and smoking in the developmentof cancer. Method A literature search was conducted to identify epidemiologicpapers on silica, silicosis and lung cancer using electronicdatabases (MEDLINE, PubMed, Web of Science) from 1996 onwardsand paper bibliographies. Results If silicosis were the necessary step leading to lungcancer, enforcing the current silica standards would protectworkers against lung cancer risk as well. Alternatively, a directsilica–lung cancer association that has been suggestedimplies that regulatory standards should be revised accordingly. Conclusion Further research is needed in order to understandthe complex pattern of interactions leading to lung cancer amongsilica-exposed workers (and cancers and workplace exposuresin general) and to understand whether and to what extent otherworkplace lung carcinogens, total respirable dust and totalsurface size and age of silica particles affect the carcinogenicpotential of silica. In addition, the apparent paradox of alower lung cancer risk in some workplaces with high-level silicaexposure needs further investigation.     

Musculoskeletal Problems in the Tomato Growing Industry: 'Tomato Trainer's Shoulder'?

Tomato training entails highly repetitive shoulder muscle contractions,static contractions and work at shoulder level, factors linkedin other working groups with neck and shoulder complaints. Thefrequency of musculoskeletal complaints was compared using theNordic Questionnaire in 56 tomato trainers and 52 other matchedglasshouse workers whose job did not include these work taskfactors. A higher 12- month (odds ratio (OR) = 5.9; [95% confidenceinterval (Cl) = 2.4–16.7] and 7- day (OR = 3.6, Cl = 1.2–11.1)period prevalence of shoulder complaint was recorded in trainersthan in pickers and deleafers. Other upper limb and upper trunkcomplaints were also more common in tomato trainers, highlightingan area of ergonomic concern.     

Peer support in an occupational setting preventing LBP-related sick leave

Background Low back pain (LBP) is among the most frequent causesof sickness absence in Norway, and it is thought that it couldbe reduced by 30–50% if present day knowledge was implementedin the workplace. Evidence-based interventions in occupationalsettings to prevent sickness absence are still lacking. Aim To evaluate whether peer support would be able to modifygeneral beliefs about LBP, pain experiences, health care utilizationand sickness absence due to back pain. Methods In addition to a media campaign in two Norwegian countiesin 2002–05, aiming at improving beliefs about LBP in thegeneral public, the ‘Active Back’ project traineda peer adviser in six participating workplaces. The task ofthis peer adviser was to provide information aimed at reducingfear of the pain, supportive advice and arrange for modificationsof workloads, etc., for a limited period of time. Results The prevalence of back pain remained constant throughoutthe study period, but self-reported intensity of LBP decreasedat the end. There was a small decline in use of health careprofessionals and significant improvements in beliefs, in linewith the messages of the campaign. Total sickness absence decreasedby 27% and the LBP-related sickness absence by 49%. Conclusion The combination of peer support and modified workloadseemed to have additional effects to the general media campaign,and resulted in decline in sickness absence and improvementsin beliefs about back pain.     

Occupational dental erosion from exposure to acids: a review

Objective Dental erosion is characterized as a disorder witha multifactorial aetiology including environmental acid exposure.The purpose of this article was to summarize and discuss theavailable information concerning occupational dental erosion. Methods Information from original scientific papers, case reportsand reviews with additional case reports listed in PubMed, Medlineor EMBASE [search term: (dental OR enamel OR dentin) AND (erosionOR tooth wear) AND (occupational OR worker)] were included inthe review. References from the identified publications weremanually searched to identify additional relevant articles. Results The systematic search resulted in 59 papers, of which42 were suitable for the present review. Seventeen papers demonstratedevidence that battery, galvanizing and associated workers exposedto sulphuric or hydrochloric acid were at higher risk of dentalerosion. For other industrial workers, wine tasters and competitiveswimmers, only a few clinical studies exist and these do notallow the drawing of definitive conclusions. Conclusion Occupational acid exposure might increase the riskof dental erosion. Evidence for occupational dental erosionis limited to battery and galvanizing workers, while data forother occupational groups need to be confirmed by further studies.     

Evaluation of a workshop on evidence-based medicine for social insurance physicians

Background Evidence-based medicine (EBM), a comprehensive methodto support clinical decision making by using evidence, has beeninstrumental in clinical specialties but not yet in insurancemedicine. Aims We developed and evaluated a workshop on EBM for Dutchsocial insurance physicians who perform disability evaluations. Methods Sixty-six social insurance physicians followed a 1-dayintroductory workshop that focused on teaching two EBM coreskills: to ask answerable questions and to search for the bestevidence. All outcomes were measured before, immediately afterand 3 months after the workshop by means of self-assessment.The primary outcomes were knowledge, skills, attitude and intentionto apply EBM in practice. The secondary outcomes were socialinfluence, self-efficacy and behaviour. Results Immediately after the workshop, a marked and significantimprovement was seen in self-assessed skills (mean difference4.2, 95% CI 3.7–4.6) and in self-efficacy to apply EBM(mean difference 0.7, 95% CI 0.6–0.8). For attitude, knowledgeand intention, the improvements were small. Three months afterthe workshop, the improvements in skills (mean difference 2.3,95% CI 1.8–2.9) and self-efficacy (mean difference 0.5,95% CI 0.3–0.6) remained significant. Conclusions The workshop improved self-assessed EBM skills andself-efficacy both in the short and long term. The workshopalso resulted in limited short-term improvements in self-assessedknowledge and in the intention to apply EBM in practice. TheEBM approach can be successfully taught to social insurancephysicians working in the field of disability evaluation.     

Salivary acetylcholinesterase as a biomarker for organophosphate exposure

Background Workers exposed to organophosphate (OP) pesticidesare required to undergo periodic statutory medical surveillancein several countries. Aim To study the relationship between serum, erythrocyte andsaliva acetylcholinesterase (AChE) levels and to explore theuse of salivary AChE as potential biomarker for OP exposure. Methods A cross-sectional study was conducted on 19 healthyadult male lead-exposed workers who were undergoing six monthlystatutory medical examination. Passive drool saliva sampleswere collected from each worker. Each blood sample was testedfor serum and erythrocyte AChE, and each saliva sample was testedfor AChE. Results Among the 19 subjects, the mean (±standard deviation)of salivary, erythrocyte and serum AChE/cholinesterase were22.7 (±17.4), 17171 (±1467), 8861 (±1876)U/l, respectively. There was a moderate correlation betweensalivary and erythrocyte AChE (r = 0.42, P = 0.071), but notsalivary and serum AChE (r = –0.17, P = 0.48). The levelof AChE in saliva was 1820 times lower than AChE in erythrocytes. Conclusion It is probably not feasible to use saliva as a replacementfor blood for the measurement of AChE levels. This is becauseof the much lower levels of AChE in saliva relative to erythrocytes,the weak correlation between the two measurements and the previouslyreported high intra-individual variation of salivary AChE.     

Accidental blood and body fluid exposure among doctors

Aim To study the epidemiology and time trends of blood and bodyfluids (BBF) exposures among hospital doctors. Methods A 3-year study was carried out using data from the ExposurePrevention Information Network of four teaching hospitals inthe UK. Results One hundred and seventy-five cases of BBF exposuresin doctors were reported over the 3-year study period. Eighty-one(46%) occurred in senior doctors and 94 (54%) in junior doctors.Junior doctors had a higher rate of BBF exposures compared tosenior doctors: 13 versus 4 incidents per 100 person-years,respectively (relative risk 3, 95% confidence interval 2–4).The most frequent setting for BBF exposures among senior doctorswas the operating theatre/recovery (59%). Among junior doctors,it was the patient room (48%). The commonest original reasonfor use of sharps by junior doctors was the taking of bloodsamples (42%). Among senior doctors, it was suturing (41%). Conclusion While ongoing training efforts need to be directedtowards both junior and senior doctors, our data suggest thatjunior doctors are at higher risk of BBF exposures and may needparticular attention in prevention strategies. An improvementin the safety culture in teaching hospitals can be expectedto reduce the number of BBF exposures.     

Carpal tunnel syndrome in the Turkish steel industry

Aim Certain occupations are reported to be associated with ahigh risk for carpal tunnel syndrome (CTS). In this study, weinvestigated the development of CTS in iron–steel industryworkers. Methods Subjects were recruited from a factory of 650 workersand assessed by means of history, physical examination and electrophysiologicaltesting. Results Seventy-nine subjects from the factory and 53 healthycontrols with occupations unrelated to heavy physical work wereassessed. None of the worker group had electrophysiologicalevidence of CTS. One subject in the control group has electrophysiologicalevidence of CTS. In the worker group, all sensory nerve conductionvelocities and ulnar nerve action potential amplitudes in bothhands and distal motor latencies were statistically different. Conclusions In our study, among a group of heavy labourers,no cases of CTS were detected. However, all electrophysiologicparameters of workers were different from controls. Our resultspoint to a diffuse, but subclinical injury of peripheral nervesunder heavy physical work conditions, instead of a local effectsuch as CTS.     

Health care workers' exposure to blood-borne pathogens in Lebanon

Background Accidental exposure to blood-borne pathogens (BBPs)is a risk for health care workers (HCWs). Aim To study the pattern of occupational exposure to blood andbody fluids (BBFs) at a tertiary care hospital. Methods This study reports a 17-year experience (1985–2001)of ongoing surveillance of HCW exposure to BBFs at a 420-bedacademic tertiary care hospital. Results A total of 1590 BBF exposure-related accidents werereported to the Infection Control Office. The trend showed adecrease in these exposures over the years with an average ±standard error of 96 ± 8.6 incidents per year. In thelast 6 years, the average rate of BBF exposures was 0.57 per100 admissions per year (average of needlestick injuries alonewas 0.46 per 100 admissions). For 2001, the rates of exposurewere found to be 13% for house officers, 9% for medical student,8% for attending physicians, 5% for nurses, 4% for housekeeping,4% for technicians and 2% for auxiliary services employees.The reason for the incident, when stated, was attributed toa procedural intervention (29%), improper disposal of sharps(18%), to recapping (11%) and to other causes (5%). Conclusions The current study in Lebanon showed that exposureof HCWs to BBPs remains a problem. This can be projected toother hospitals in the country and raises the need to implementinfection control standards more efficiently. Similar studiesshould be done prospectively on a yearly basis to study ratesand identify high-risk groups.     

Acute respiratory symptoms among sisal workers in Tanzania

Background Few studies have focused on respiratory health effectsamong sisal workers. Aim To report on the prevalence of acute respiratory symptomsamong sisal processors. Methods We interviewed 163 dust-exposed brushing and decorticationworkers and 31 low-exposed security workers from six sisal estatesin Tanzania using a modified symptom score questionnaire todetermine the prevalence of acute respiratory symptoms duringwork. Groups were compared using chi-square tests, Fisher'sexact tests, t-tests and logistic regression, adjusting forconfounding factors. Results After the first working day of the week, 73% of thebrushing workers reported dry cough, 66% sneezing, 65% productivecough, 63% running nose and 34% stuffy nose. Brushing workershad a significantly higher prevalence of these symptoms thandecortication workers. Brushing and decortication workers hadsignificantly more dry cough and sneezing than the control groupof security workers, when adjusting for age, smoking, past respiratorydiseases and residence. Conclusion Processors of sisal fibre have a high prevalenceof acute respiratory symptoms. More detailed studies on workand health in sisal estates are needed, including exposure studies.