Research Plus: October/November 2007

Occupational exposure to HIV and use of PEP

A literature review of occupational exposure to HIV reveals a general lack of direct evidence on the use of post-exposure prophylaxis (PEP) drugs following exposure. There have been no randomised controlled trials and the only published evidence is a small-scale retrospective study from the US. There is supportive evidence from animal studies – albeit with a different virus – the use of antivirals to prevent mother-to-baby transmission and PEP following sexual exposure. Animal studies (limited evidence) support early administration of PEP and 28-day regimens. Many healthcare workers remain ignorant about the correct use of PEP.

Occupational Medicine 2007; 57: 329–336.

Preventing nurses’ back pain

A systematic review of evidence published up to November 2004 on interventions to prevent back injury in nurses identified just 16 studies (eight randomised controlled trials) meeting inclusion criteria. Experimental design was generally poor, with just one high quality paper. There is no strong evidence on the efficacy of any intervention; however, there is moderate evidence that manual handling training alone is ineffective and that multidimensional strategies are required. There is ‘conflicting evidence’ on the efficacy of exercise interventions and the provision of manual handling equipment, and no supporting evidence for stress-management programmes in preventing back pain.

Occupational and Environmental Medicine 2007; 64: 642–650.

Back pain risk factors in nursing

The process of transferring patients has been identified as one of the main risk factors for developing back symptoms in nursing staff. However, a computer-based technique for continuously measuring and recording body posture and musculoskeletal loads finds that patient transfer takes up only a small proportion of the average shift and that nurses adopt many awkward postures throughout their working day. Postures that are both awkward and frequent – and therefore higher-risk – are associated with several common procedures, including bed making, basic care and clearing up.

Annals of Occupational Hygiene 2007 51(4): 385–395.

PTSD evidence reviews

The consequences of exposure to traumatic stress at work, prevention strategies, early identification and screening are reviewed. Emerging evidence includes the role of pre-trauma risk factors (such as previous exposures, ‘catastrophic thinking’ and physical injury), the nature and frequency of the exposure, and post-event factors, such as social support, which can modify the trauma reaction. There is little published evidence on assessing or managing occupational PTSD reactions – including the use of evidence-based therapies in work settings – and recommendations tend to be derived from civilian and military studies.

Occupational Medicine 2007; 57: 404–410.

Pre-eclampsia risks at work

Pre-eclampsia is an important cause of maternal and infant illness and death. A population-based case-control study followed a random sample of women with singleton births over a three-year period. The following physical work factors during pregnancy were significant for pre-eclampsia: prolonged standing without walking; frequent climbing of stairs; and working longer than five consecutive days without a day off. Pushing or pulling objects or persons more than five times a day was significantly associated with gestational hypertension but not pre-eclampsia. A literature review reports generally low-quality evidence in previous studies.

Scandinavian Journal of Work Environment and Health 2007; 33(4): 304–317.

OM competencies

A literature review on competencies in occupational medicine found 20 peer-reviewed papers meeting evidence-quality criteria. Published standards of competence tend to be derived from peer review, or Delphic, methods and there is no ‘valid research-derived evidence base to support the setting of standards of competence required for accreditation as a specialist in occupational medicine’. There is no current international consensus either on what occupational physicians do or on their educational requirements. The authors call for an EU working group to agree competencies.

Occupational Medicine 2007; 57: 342–348.

Wrist disorders

A study of more than 3,100 workers in Denmark in 19 industrial settings – ranging from pig slaughtering and textiles manufacture, to supermarket and bank work – analyses the contribution of risk factors to the onset of hand–wrist disorders. Force was the main ergonomic risk factor for hand disorders in monotonous industrial work, but high levels of repetition may also play a role. Threshold levels were not established. Working with the hands out of neutral position was not identified as a risk factor.

Occupational and Environmental Medicine 2007; 64; 527–533.

CFS link to stomach virus

Most chronic fatigue syndrome (CFS) sufferers report persistent or intermittent gastrointestinal symptoms. The majority (82%) of stomach biopsies from CFS patients tested positive for enteroviral particles compared with only 20% from healthy controls. The presence of enteroviral protein, RNA and the growth of non-cytopathic viruses in the stomach tissue of CFS patients years after initial infection suggest an association between enteroviral persistence or infection and CFS. It is not yet possible to say if there is a causal relationship, but the finding may be important in diagnosis and may support the use of antiviral drug therapy in some patients.

Journal of Clinical Pathology 2007; online first: DOI 10.1136/jcp.2007.050054.

Improved work outcomes for employees with depression

A randomised controlled trial evaluated workplace and clinical outcomes of a telephone-based outreach and care management programme designed to identify depression and promote better treatment – the first study of its kind to be carried out exclusively on employed people. Depression severity and work performance were measured using validated questionnaires. The outreach group recorded significantly lower depression severity compared with controls at six and 12 months, 2.6 extra hours worked per week – equivalent to two weeks a year – and increased job retention.

Journal of the American Medical Association 2007; 298: 1401–1411.

Presenteeism: a systematic review

A total of 113 papers were found to meet evidence criteria on so-called presenteeism – decreased on-the-job performance due to health problems. Various standardised scales exist, but the Work Limitations Questionnaire and Health and Work Performance Questionnaire are the most useful for general populations. There is moderate-to-high quality evidence on the impact of allergies, arthritis, gastro-intestinal and mental health conditions; a lack of relevant studies on chronic pain; low-quality studies on obesity; and weak evidence on diabetes. There was only one presenteeism study (moderate quality) investigating musculoskeletal conditions. In general, the more health risks an individual has the greater the impact on productivity.

Journal of Occupational Rehabilitation 2007; online first: DOI 10.1007/s10926-007-9096-x.

Genetic biomarkers of chemical exposure

Research at the University of Illinois, Chicago, suggests that the expression of specific genes in human peripheral blood mononuclear cells and the production of cytokines can be used to identify exposure to hazardous chemicals. The research team demonstrated a unique profile of gene expression and cytokines production after exposure to benzene and benzene metabolites1, and, in a second paper, to hexavalent chromium2. The findings have potential application for identifying toxic exposure and, it is claimed, in providing scientific evidence in civil claims of industrial injury following exposure to hazardous substances.