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Research Plus:
An online resource signposting the latest research in occupational health

Research Plus highlights original research and systematic reviews from a wide range of current publications. Only peer-reviewed papers meeting evidence quality criteria are included. Research Plus is a joint project with NHS Plus. The current issue is shown below – past issues are also available.

CURRENT ISSUE:

Research Plus: August/September 2010

Economic evaluations are methodologically poor

A systematic review of economic evaluations of OH interventions concludes that, with very few exceptions, their methodological quality is poor. Shortcomings include poor description of the study populations, poor measurement of outcomes and costs, lack of a well-defined research question, lack of declaration of researchers’ independence and conclusions not following the data presented. Using poorly conducted economic evaluation to advise employers on how to allocate resources ‘may result in inappropriate decisions,’ say the authors.

Pregnancy outcomes among childcare workers

Childcare nurses and nursery school teachers may be exposed to a variety of reproductive health hazards, including infections, stress, manual handling and physically demanding postures. This population-based Finnish study found no evidence that childcare work is associated with pre-term birth, perinatal death, congenital malformations or smallness for gestational age. However, it remains important to protect individual workers from potential hazards to reproductive health.

Psychosocial work environment

A systematic review examines the contribution that the psychosocial work environment makes to the incidence of stress-related disorders. There is strong evidence that stress-related disorders are predicted by: high job demands; low job control; low co-worker support; low supervisor support; low procedural justice; low relational justice; and high effort–reward imbalance. There is some evidence (from one study) for a link between emotional demands and stress-related disorders in men, but not in women, some evidence (one study) that job insecurity is a risk factor in men but not in women, and some evidence (one study) that repetitive work is not a risk factor for developing stress-related disorders.

Patient handling

A systematic literature review fails to find evidence to support an independent causal link between workplace manual handling or assisting patients and low back pain (LBP); however, it remains possible that some patient-assisting tasks (such as ambulating) may contribute to it. The review identified 32 relevant studies (published up to 2008) covering a range of occupations (24 studies included nurses). Rather than showing a causal link, there is strong evidence for no association between the studied activities and LBP.

Multiple site musculoskeletal pain

Multi-site musculoskeletal pain is an important risk factor for reduced work ability, according to this population-based Finnish study. A third of subjects reported pain at a single site during the preceding month; 20% at two sites; 9% at three; and 4% at four sites. Multi-site pain increases the risk of poor self-perceived work ability compared with those with no pain or pain at a single site. Multiple pain sufferers predict their work ability will deteriorate and more commonly consider retiring.

Preventing musculoskeletal injuries in healthcare

A systematic review and best-evidence synthesis finds that physical exercise or multi-component patient-handling interventions are beneficial in protecting musculoskeletal health in healthcare settings. There is moderate evidence that a broad range of interventions reduce musculoskeletal injuries and their consequences. Neither patient handling training nor cognitive behaviour training alone improve musculoskeletal health. There is insufficient evidence on the effectiveness in healthcare settings of back schools, participatory ergonomics and intensive off-site injury-prevention programmes.

Neck pain guidelines

This evidence review and practice guideline is based on an evidence synthesis completed by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain. It covers the range of possible treatments for different severities and types of neck pain, and includes a new model that integrates the cause of neck pain with its management. Key messages include that: neck pain may persist and fluctuate; there may be multiple causes including overall physical and mental health, work and daily activities; most neck pain is not the result of serious injury; there is no ‘best treatment’ that suits everyone; and a variety or combination of interventions may be needed.

Shiftworking linked to errors

Higher shift frequency and reduced between-shift recovery time may increase the risk of clinical errors, a study at five hospitals finds. Nearly 1,500 nurses completed anonymous questionnaires on working conditions, job stress and sleepiness. A follow-up assessed self-perceived clinical errors resulting in harm to a patient over the previous six months. After adjusting for confounding factors, nurses doing a three-shift (eight-hour) rotation recorded 40% more errors over the six months compared with those working a two-shift (12-hour) system (p <0.001). Nurses in both systems did similar amounts of night work.

Caffeine use in shiftworkers

Caffeine may help improve the performance of shiftworkers but there is no evidence either way that it can reduce injuries. This Cochrane review found 13 trials studying the effects of caffeine on error and cognitive performance; however, none looked at its effect on workplace injuries. There is weak evidence that caffeine reduces errors in shiftworkers, and some evidence that it improves cognitive performance, but methodological weaknesses limit confidence in the findings. There is insufficient evidence to ascertain how caffeine compares with other interventions, such as naps, bright light and the analeptic drug modafinil.

Supporting healthcare workers

A Cochrane review finds some evidence that stress management training for healthcare workers can be effective in the short term, but no conclusions can be drawn on whether the benefits are sustainable. There is no evidence to support the use of brief stress management training, low quality evidence for the benefits of more substantial training (at least six hours’ contact delivered over a month or longer) but no evidence for sustainability in the absence of refresher training. There is strong evidence that intensive long-term training is effective in reducing work-related stress and burnout, and limited evidence that a management intervention can improve job satisfaction (but no evidence that it improves sickness absence).

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