A cross-sectional study of self-reported work conditions and psychiatric health in native Swedes and immigrants

Several studies have demonstrated that immigrants in Scandinaviancountries are more affected by psychosocial disabilities thanthe native-born population. The aim of the study was to evaluatethe possible impact of work-related stressors on psychiatrichealth in immigrants compared to native Swedes. The study includeda cluster selected cohort of 1,040 men born in 1944 (participationratio=79.9%), living in Gothenburg, Sweden. Of these, 182 (18.0%)were immigrants, defined as being born outside Sweden. Informationon work conditions and psychiatric health were obtained by self-administeredquestionnaires. Employment in native Swedes showed inverse associationsto frequent use of anxiolytics [relative risk (RR)=0.2; 95%confidence interval (Cl)=0.067ndash;0.4], frequent use of hypnotics(RR=0.1; Cl=0.02–0.2) and use of antidepressants (RR=0.3;Cl=0.2–0.5). None of the employed immigrants used anxiolyticsor hypnotics frequently. Swedes seemed to display a number ofpsychiatric ill-health factors related to working conditions.These factors included frequent use of hypnotics, frequent insomnia,use of antidepressants, a high degree of melancholy, and wererelated to shift work, dissatisfaction with current work andmanagement and a low degree of influence on work situation,often related to a high degree of stress at work and a frequentdesire to change type of work. These associations were not seenin immigrants, apart from the risk of frequent insomnia (RR=4.7;Cl=1.2–18.3) and dissatisfaction with colleagues (RR=10.4;Cl=2.27ndash;48.8) when working in shift. With a few exceptions,non-optimal working environment was associated with a low degreeof life satisfaction in both groups. It was hypothesized thatoptimal working conditions are important for maintaining psychiatrichealth, and that immigrants, when employed, seem less affectedby impaired working conditions than native Swedes.     

Abdominal symptoms among sewage workers

The objective of this cross-sectional study was to investigatethe prevalence of abdominal symptoms and the abdominal medicalhistory among sewage workers. 142 male sewage workers and 137male referents in 11 Swedish municipalities were addressed witha questionnaire about abdominal symptoms, medical history, occupationalhistory and life style factors. The sewage workers sufferedless from nausea [adjusted odds ratio (adjOR)=0.18, 95% confidenceinterval (Cl)=0.04–0.84] than the referents. There wasno significant difference in the three months prevalence ofdiarrhoea (adjOR=1.7, 95% Cl=0.79–3.4), dyspepsia (adjOR=0.85,95% Cl=0.49–1.5) or irritable bowel syndrome (adjOR=1.4,95% Cl=0.53–3.5). The sewage workers were affected moreoften by peptic ulcers during their present jobs than the referents,although the increased risk was not significant (adjOR=1.4,95% Cl=0.31–6.1). The odds ratios were adjusted for age,use of tobacco products and alcohol consumption. The conclusionof this study was that sewage workers are less affected by nauseathan comparable referents.     

A five-year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff: Part I: Incidences of retirements

The objective of this study was to compare morbidity betweenambulance staff and other groups of health service workers,to facilitate planning of occupational health (OH) services.A retrospective study of employees of The Eastern Health andSocial Services Board, Northern Ireland was conducted. Subjectswere 181 men and 353 women assessed at OH between 1988–92and found eligible (on the basis of permanent incapacity) toapply for early retirement on medical grounds (EROMG). Ambulancepersonnel showed a high rate of EROMG (55.9/1,000 per annum)both compared with previous ambulance studies (5.7–22.5/1,000),and with other groups in the present study (manual 24.8/1,000,nursing 5.9/1,000 and non-manual 2.6/1,000). Indirect standardizationwas used to correct for age-sex differences between groups,by deriving standardized early retirement ratios (SERR). Ambulanceand manual staff showed high SERRs (636, Cl=558–714 and164, Cl=149–179), whereas nursing and non-manual staffshowed low SERRs (91, Cl=75–107 and 38, Cl=25–52),(all results except that for nursing staff being significantat <0.001). There is evidence that ambulance staff are agroup with high morbidity, and thus deserving of particularattention in terms of preventative and health promotional activities.Other issues requiring consideration in relation to ambulancestaff are redeployment and lowering of the retirement age.     

Smoking as a predictor of long-term work disability in physically active and inactive people

Data from a Norwegian 4-year prospective questionnaire studywere used to test our hypothesis that smoking is a weaker predictorof long-term work disability in physically active than inactivepersons. Of 1,788 respondents who were working and not olderthan 62 years in 1990, 1,426 (80%) also returned a questionnairein 1994. For respondents who were taking physical exercise lessthan once a week, smoking predicted long-term work disabilityfour years later [odds ratio (OR)=2.24; 95% confidence interval(Cl)=1.30–3.87; p<0.01], when adjusting for age, sex,workhours per week, heavy lifting at work, emotional symptomsand musculoskeletal pain at time 0. In respondents who wereexercising at least once a week, there was no association betweensmoking and long-term work disability.     

Communication between an occupational physician and other medical practitioners--an audit

Four hundred and seventy-two consecutive referral episodes relatingto 386 patients attending the Occupational Health Departmentof a general teaching hospital were analyzed to evaluate thefrequency, content and effect on management of communicationsbetween the occupational physician and other doctors. In all,250 episodes (53%) were associated with such a communication.The likelihood of a communication was strongly influenced byreason for referral, particularly in respect of long or shortterm sickness absence; univariate odds ratios (OR)=10.58, 95%Cl=8.13–27.08) and 2.65, 95% Cl=1.55–4.60) respectively;a medical diagnosis of psychiatric illness (OR=3.17, 95% Cl=1.69–5.97));and by number of consultations. Communication was also morelikely when the occupational outcome was ill health retirement,rehabilitation in work or modified work. Ninety-eight per centof specific requests for information or an opinion eliciteda reply. Information received from other doctors influencedthe occupational health physician's management in 52 referralepisodes (20%). Specific action by GPs as a result of communicationwas documented in 54 and by specialists in 37 episodes. Theimportance of communication between occupational health physicianand other doctors in the occupational health process is confirmed.     

Absence attributed to incapacity and occupational disease/accidents among female and male workers in the fish-processing industry

Sick-leave between 1984 and 1989 was higher among both female(n=515) and male (n=304) fish-processing workers [observed/expected(O/E) 2.24 and 1.69, respectively] than among non-exposed groups(0.62 and 0.89). Diagnoses in the musculoskeletal system dominated(i.e., neck/upper limbs; females, exposed vs. non-exposed workers:30 vs. 12%: males: 11 vs. 5.8%). In subjects who left employment,the O/E-ratio decreased (females: 3.02 vs. 1.55; males: 2.40vs. 1.55). Among those women hired before the start of the observationperiod, exposed subjects had higher frequencies of sick-leavethan non-exposed, for both total illness and musculoskeletaldiagnoses. In the men, there were corresponding differences,though not fully statistically significant. Reported occupationaldiseases [O/E: females: 4.5; (95% confidence interval) Cl=3.2–6.1;males: 2.3; Cl=1.3–3.9] and accidents (females: 4.3; Cl=3.0–5.9;males: 1.8; Cl=1.2=2.7) were also higher in female than in malefish-processing workers, and much higher than in non-exposedworkers. In conclusion, work in the fish-processing industrywas associated with increased frequencies of sick-leave, especiallybecause of diagnoses of the musculoskeletal system, and occupationaldisorders and accidents, in particular among female workers.     

Cohort mortality study of rubber and plastics product makers in Italy

A retrospective cohort mortality study was carried Out in 20industrial factories in the Local Health Unit Bologna Sud (EmiliaRomagna, Italy), where different rubber and plastics productswere manufactured. The cohort consisted of 925 subjects (578males and 347 females) employed for at least six months continuously;follow-up was between the beginning of operation of each factory,ranging between mid fifties and mid seventies, and 31 December1989. For those exposed more than one year cause specific StandardizedMortality Ratios (SMRs) were computed using regional rates forcomparison, 90% confidence intervals (Cl) were calculated assumingthe Poisson distribution. Among the 748 subjects employed formore than one year (457 males and 291 females) there were nolost to follow-up, 54 individuals were dead (41 males and 13females) and for three subjects the cause of death was unknown.The results showed that all causes mortality was above expectancyin the total cohort (SMR=123; 54 Obs; 90% Cl=97–154),among males (SMR=117; 41 Obs; 90% Cl=89–152) and females(SMR=143; 13 Obs; 90% Cl=85–228). Increased mortalityfor all malignant tumours was observed in the total cohort (SMR=150;25 Obs; 90% Cl=104–209) and for both genders. All ninelung cancer cases were observed among males, the SMR was equalto 218 and was statistically significant; seven cases occurredat duration of exposure less than 10 years and six at latencyup to 20 years. The interpretation in terms of causality ofthe present investigation is limited by the small number ofobservations and by exposure definition solely in terms of employmentin the study factories; nonetheless the results are indicatingthe existence, in this group of rubber and plastics productmakers, of an adverse health effect which deserve further investigation.     

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.     

The influence of social surroundings on consultation of private care, emergency department, hospital out-patient departments, and primary health care 1384 Consultations made by a defined population in a residential area

The influence of social surroundings on the clients' consultationof four different caregivers (primary health care centre, emergencydepartment, hospital out-patient departments, and private care)was studied prospectively. The study had the advantage of beingpopulation-based, focusing on different social surroundingsin the same residential area, and taking into considerationfour different caregivers. This was a new approach to the studyof health care utilization. We chose a single residential area,whose borders coincided with the catchment area of the localprimary health care centre. This population (n=5085) made 1384consultations to the above-mentioned four caregivers duringseven weeks In the autumn of 1988. The residential area wascomposed of sub-areas with different social surroundings withrespect to the form of tenure. People living In socially disadvantagedmultioccupancy blocks consulted the emergency department moreoften than expected (age- and sex-standardized Relative Risk(RR)= 1.50, 95% confidence interval (Cl) = 1.02–2.21).The population in the socioeconomically most disadvantaged multioccupancyblock made few consultations to private care (RR=0.53, 95% Cl=0.30–0.91)but more to primary health care (RR=4.45, 95% Cl=3.11–6.36).The conclusion was that the population living in socially disadvantagedsurroundings in multioccupancy blocks had an increased riskof consulting the emergency department and primary health care.They had less risk of consulting hospital out-patient departmentsand private care. This result is of importance as it might providehealth planners with information about the influence of socialsurroundings on care utilization. The family physician and thedistrict nurse might play a central role in the meeting of theincreasing demands of care utilization in socially disadvantagedresidential areas.     

Mortality among Finnish Sea Pilots 1956 85: A Retrospective Cohort Study

The National Board of Navigation in Finland employed 942 seapilots in 1956–85, during which time 262 of them died(SMR = 77, 95% Cl = 68–86). The male population in southwestFinland served as control. The causes of deaths were collectedfrom death certificates. The mortality rate for all cardiovasculardiseases and lung cancer was lower among sea pilots than inthe comparison population (SMR = 83, 95% = Cl 69–97 andSMR = 67, 95% Cl 37–97) while for ischaemic heart diseases,it was similar to that of the population as a whole (SMR = 96,95% Cl = 77–115). Health selection due to ischaemic heartdisease was seen in the lower mortality rates among young pilotswho started work in 1956–85. Otherwise, the slightly higherrates may indicate a possibility of adverse health effects ofsea piloting.     

Reasons for Rejection: Why People Fail to Qualify as Firefighters

In the decade beginning 1 January 1985, 916 individuals (includingfive females) were medically examined with a view to joiningthe full-time service of Strathclyde Fire Brigade (SFB). Onehundred and nine (11.9%), including two females, were rejected.The five main causes of failure were: ocular (n = 46, 42.2%);lack of stamina (n = 21, 19.2%); ‘others’ (n = 12,11.0%); cardiovascular (n = 9, 8.3%) and orthopaedic (n = 6,5.5%). Thirty-two had chest X-rays. One abnormality was found— an azygous lobe — but it played no part in thedecision to decline the applicant. There was little life- orhealth-threatening pathology found. The most serious cases weremurmurs consistent with mitral stenosis and regurgitation (oneeach), one case of ocular melanoma, four cases of hypertensionand two cases of haematuria/ proteinuria (++). This study showsthat potentially serious findings can occasionally be detectedin a population of 18–30 year olds who might be expectedto be of better than average fitness, and that routine chestX-rays are not helpful in the selection process.     

Mixed-mode survey of female veterinarians yields high response rate

In a recent study of female veterinarians, a subgroup of healthprofessionals growing rapidly in number, the authors employeda mixed-mode survey design in targeting the cohort of womengraduating from all US veterinary colleges during the 11-yearperiod 1970–80 (n = 2,997). The questionnaire elicitedinformation on a variety of health and occupational factorsand required 35 minutes on average to complete. In the firststage, a modified version of Dillman's Total Design Method formailed, self-administered questionnaires was employed, yieldinga response rate of 82.9%. In the second stage, a telephone interviewof all mail non-respondents was attempted, yielding a responserate here of only 30.1%, but increasing the overall responserate among those contacted to 90.2%. Non-respondents differedlittle from mail (early) or telephone (late) respondents withrespect to year of graduation and geographic region of veterinarycollege attendance. Gentle probing of telephone non-respondentssuggested the personal nature of some questions and the amountof time required to answer all questions were the main reasonsthey chose not to participate. It therefore appears that conventionalsurvey techniques may be successfully employed in health studiesof health professionals, particularly if issues of great concernto the target population are addressed.     

A Study of the Impact of Occupational and Domestic Factors on Insomnia among Industrial Workers of a Manufacturing Company in Japan

Insomnia is one of the most common health problems and has recentlybeen re-termed ‘Disorders of Initiating and MaintainingSleep’, or DIMS. The main purpose of the present studywas to investigate the relationship between daily psychosocialstressors, to which workers are exposed in occupational and/orprivate life, and insomnia among male industrial workers ina medium-sized company located in Nagasaki City, Japan. Allof the workers in the company (n=368, male=319) were asked toanswer six sleep related questions and 24 questions about workingand private conditions. Two hundred and seventy-one (85.0%)of them completed the questionnaire (average age was 40.9 yearsold). Twenty seven point seven per cent of the subjects complainedof insomnia in the last month prior to the survey and the prevalencewas in general accord with previous surveys. On the other hand,the proportion of hypnotic use (1.1%), especially in insomniacgroup (2.7%) was lower than previous reports. The results ofmultiple logis regression analysis demonstrated that four psychosocialfactors were significantly associated with insomnia: i.e. VDTwork overload (odds ratio [OR] 5.058; 95% confidence intervals[95% Cl] 2.381–10.745), limited space of bedroom (OR 2.612;95% Cl 1.283–5.683), over-involvement in job (OR 2.78;95% Cl 1.188–6.540), frequent alcohol beverages consumption(OR 2.595; 95% Cl 1.177–5.719).     

Erythrocyte cholinesterase activity levels in desert farm workers

In this study we have examined 532 migrant farm workers engagedmainly in the cultivation of vegetable crops, in both greenhousesand openfarms, and an equal number of controls. Erythrocyteacetylcholinesterase activity (AChE) was measured to determinethe degree of toxicity due to exposure to organophosphate andcarbamate pesticides in the farm workers employed either asforemen (41.5%) or farmers (58.5%). The mean ages of the farmworkers and controls were 35.2±7.4 (mean±SD) yearsand 34.6±7.1 years. AChE activity of the farm workersand controls was 3.89±0.64 Ul/ml (mean±SD) and4.15±0.29 Ul/ml. The haemoglobin adjusted erythrocytecholinesterase activity (HAChE) was 29.96±4.14(mean±SD)for farm workers and 32.10±2.26 for controls. AChE activitywas very highly significantly lower for the foremen (3.76±0.69)compared to farmers (3.98±0.59) (Student's t-test=4.13,p=0.0001). HAChE was also very highly significantly lower forforemen (29.24±4.37) compared to farmers (30.46±3.88)(Student's t-test=3.64, p=0.0001). The poorly controlled useof pesticides in the farms appeared to have caused sub-clinicalintoxication in the farm workers and indicated the need fortraining and implementation of hygiene practices.     

Ventilatory function of factory workers exposed to tea dust

A cross-sectional study was conducted in order to determinethe prevalence of respiratory symptoms and the effect on ventilatorycapacity in workers exposed to tea dust for at least five yearsduring the sifting process of tea manufacture compared to acontrol group of field workers who were not exposed to tea dustpreviously. Fifty-three subjects each in the study and controlgroups were matched for age, sex, ethnic group and height. Prevalenceof chronic respiratory symptoms was obtained by questionnaire.Spirometric measurements included forced vital capacity (FVC),forced expiratory volume in the first second (FEV_1.0) and forcedmid-expiratory flow rate (FEF_25–75%). The study grouphad a chest radiograph. The odds ratio for any chronic respiratorysymptom was 11.6 (95% confidence interval [Cl] = 3.7–39.4)in the study group. Mean values for the spirometric tests werelower in the study group; the differences in FEV_1.0 and FEF_25–75%were significant. Tuberculosis was not found in the study group,while one subject (2.4%) had radiological evidence of bronchiectasis.It may therefore be concluded that chronic tea dust exposurecauses increased prevalence of respiratory symptoms and a significantdegree of small airways obstruction.     

Respiratory ill-health in Dental Laboratory Technicians: A Comparative Study of GP Consultation Rates

Eighteen Royal Air Force dental laboratory technicians (DLTs)and 69 Service controls matched for age, sex and smoking statuswere compared by means of incidence rates of GP consultationfor respiratory, and all other, illness. By retrospectively calculating for each individual the timeserved (man-years at risk) at the RAF Station concerned, togetherwith the number of consultations that fell into each of thestudy categories, it was possible to produce an incidence rate,per man-year at risk, of consultations for both study and controlgroups. By calculating a relative risk (RR) it was observedthat DLTs were nearly three times (RR=2·95. Cl 1·69–5·13),more likely to attend their GP with respiratory problems thanmembers of the control group, and 1·7 times (RR=1·71.Cl 0·98–3·01) more likely to attend theirGP with other problems. Comparison of the numbers of individuals continuing to use bronchodilatortherapy in each of the two groups suggested that DLTs have ahigher prevalence of conditions that require this form of therapyas treatment. Requests for reprints should be addressed to: Squadron Leader R. Guest, Senior Medical Officer, Royal Air Force Kinloss, Forres, Moray IV36 0UJ, Scotland     

Evaluation of occupational health service in the wood processing industry--determination of employee satisfaction

In order to define priorities for improvement of the occupationalhealth service (OHS) in one primary health care unit, employees'satisfaction was evaluated with a postal questionnaire. Thequestionnaire covered items on service reservation, personalhealth education received, quality of the OHS, and use of theOHS within six months by the employees. This evaluation wasone step of the quality system that was planned in accordancewith the ISO 9004-2 standard for continuous quality improvementof OHS. The study population was all of 1,050 employees workingfor five employers; 546 (52%) employees responded to the inquiry.However, only 377 of them had made use of the OHS within thelast six months before the inquiry. The mean age of the responderswas 42 years (SD=9 years) and 76%of the respondents were men.The percentages of employees with a high degree of satisfactionwith the quality of the OHS and personal health education inthe OHS were 76% and 69%, respectively. However, concerningthe quality of the OHS, the proportion of highly satisfied employeeswas 27% higher (95% Cl=19–35%) among those who had usedOHS within six months compared to the others. Furthermore, whenthe oldest (>48 years) and the youngest (<35 years) agegroups were compared, the difference between the proportionsof highly satisfied employees was 21% (95% Cl=11–31%).In conclusion, the high differences suggest a close linkagebetween the employee's satisfaction with the OHS, the use ofthe OHS and ageing.     

Immunity to Hepatitis A in Paediatric and Nursery Nurses

A cross-sectional epidemiological survey of immunity to thehepatitis A virus (HAV) was undertaken in paediatric and nurserynurses to ascertain whether these occupational groups were atan increased risk of infection with the virus. Seropositivityto HAV was measured in 33 surgical (control), 36 paediatric,55 nursery and 29 specialist paediatric nurses in a districtgeneral hospital, community clinics and a children's hospitalin the West Midlands. IgG antibodies to HAV were found in 27%of surgical (control), 31% of paediatric (relative risk [RR]= 1.19, 95% confidence interval [CI] = 0.56–2.51), 26%of nursery nurses (RR = 0.99, CI = 0.48–2.04) and 10%of specialist paediatric nurses (RR = 0.40, CI = 0.12–1.35).These data are comparable to immunity to HAV for this age groupin the general population of this country and do not supportroutine immunization of paediatric or nursery nurses againstHAV.     

Musculoskeletal complaints in lock assemblers, testers and inspectors

The objectives of this study were to determine the prevalenceof musculoskeletal complaints in a population of lock assemblersin the West Midlands; to follow one group over 12 months andto explore the relationship between survey data, sickness absenceinformation and claims experience. An adapted Nordic MusculoskeletalQuestionnaire was used to determine annual and weekly prevalenceand annual disability rates for musculoskeletal complaints.There was no statistically significant difference in complaintsbetween the six companies, apart from an increased reportingof neck (p < 0.001), upper back (p < 0.001) and hip (p< 0.05) symptoms at one company (Site 4) during the weekprior to the study. When the study was repeated at Site 4 oneyear later, new employees had significantly fewer complaintsof neck and elbow discomfort over the previous year and week,but no difference in wrist complaints was reported. This surveyof lock assemblers has highlighted high levels of self-reportedupper limb complaints when compared to other referent groupsof workers.     

Effect of work with visual display units on musculo-skeletal disorders in the office environment

Background The increase in computer and mouse use has been associatedwith an increased prevalence of disorders in the neck and upperextremities. Furthermore, poor workstation design has been associatedwith an increased risk of developing these symptoms. Aim The aims of this study were (i) to estimate the prevalenceof musculo-skeletal disorders among full-time visual displayunit (VDU) users; (ii) to examine how the prevalence variesby work environment; and (iii) to explore the association withwork factors. Method A survey was carried out on the effect of work with VDUson musculo-skeletal disorders in workers in the office environmentof 56 workplaces. Office workers (n = 298), customer serviceworkers (n = 238) and designers (n = 247) were studied. Results For all the occupations combined, the 12 month prevalencesof musculo-skeletal symptoms in the neck, shoulders, elbows,lower arms and wrists, and fingers were 63, 24, 18, 35 and 16%,respectively. The study indicated that musculo-skeletal painis common among computer workers in offices. There was no strongassociation between the duration of computer work and pain orbetween the duration of mouse use and pain, but workers' perceptionof their workstation as being poor ergonomically was stronglyassociated with an increased prevalence of pain. Conclusions Musculo-skeletal symptoms are common, but the durationof daily keyboard and mouse use had no connection with musculo-skeletalsymptoms. Instead, more consideration should be paid to theergonomics of workstations, the placing of the mouse, the posturesof the upper extremities and the handling of the mouse.