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Return to Research Plus past issues

Research Plus: December/January 2007/2008

Future work fitness evidence review

The assessment of future fitness for work (or ‘work ability’) involves assessing risk for multiple causes of illness and disability. An evidence review analysed prognostic factors for return to work for three conditions: myocardial infarction (MI), chronic low back pain (cLBP) and major depressive disorder (MDD). Just six papers from a trawl of 961 abstracts were found to meet inclusion criteria, with none on MDD. A number of common (such as young age) and different prognostic factors for work ability were identified for both MI and cLBP.

No quick fix for obesity

A meta-analysis of trials for the pharmacological treatment of obesity finds that three drugs recommended for long-term use achieve only modest weight reductions. Thirty placebo-controlled trials lasting between one and four years met inclusion criteria (mean weight of cases in trials was about 100 kg, mean Body Mass Index was 35–36). The BMJ paper, which summarises a Cochrane collaboration systematic review, found that orlistat, sibutramine and rimonabant, reduced weight by less than 5kg, equivalent to a total body weight reduction of less than 5%. Although some health benefits were observed, adverse effects were recorded. Rimonabant, for example, increased the risk of mood disorders such as depression or anxiety.

Behavioural interventions for obesity

A systematic review of behavioural and psychotherapeutic approaches to obesity management concludes that there is generally poor quality evidence on the impact of such interventions. Studies that are available suggest that relaxation therapy and hypnotherapy are ineffective. And while there is some evidence that weight-loss programmes using behaviour therapy and lifestyle modification can help short-term weight-loss, these are not sustained in the longer term. There is evidence to suggest that long-term maintenance programmes may help to support lasting behavioural changes and to prevent weight regain .

Audiometric solutions

Research investigated possible auditory processing disorder and hearing difficulties in factory workers exposed to organic solvents – toluene, xylene, methyl ethyl ketone. Controls were non-solvent-exposed workers, matched for age, gender and education level. Both groups recorded mean normal hearing thresholds; however, significant threshold differences were found at some frequencies. Exposed workers scored worse than controls for speech discrimination, temporal resolution, temporal ordering and dichotic stimulation, and reported significantly more hearing complaints in daily life listening situations. The results and accompanying literature review suggest that pure-tone audiometry alone is insufficient to assess hearing in solvent-exposed populations.

Alzheimer’s disease from occupational exposure

A meta-analysis of possible occupational exposures linked to the risk of developing Alzheimer’s disease identified 22 research papers meeting inclusion criteria. A ‘global quality index’ (GQI) was calculated for each paper, based, for example, on definitions and cohort follow-up, selection bias, control of confounding variables and exposure measurement. All but one of the case-control studies had GQIs below 50%; five scored below 25%. Common problems include miscalculation of exposure, misclassification of disease and selection bias. There was evidence for an association of occupational exposure to pesticides with the risk of developing Alzheimer’s disease; inconsistent evidence for associations with electromagnetic fields and solvents; and no evidence for lead and aluminium.

Glomerulonephritis – new evidence on solvent risk

Solvent exposure has been associated with the progression of primary glomerulonephritis to end-stage renal disease (ESRD). A retrospective cohort study followed 269 patients with non-end-stage primary glomerulonephritis confirmed by biopsy. Occupational exposure and other factors were established using a validated interview questionnaire. Aromatic hydrocarbons (toluene and xylene), mixtures of aromatic and aliphatic hydrocarbons, ketones and possibly methylene chloride were associated with the highest risks. Inks, cleaning or degreasing agents and petroleum products were implicated. Interventions to promote screening for proteinuria in solvent-exposed workers and discontinuation of exposure in those with early stage glomerulonephritis may prevent or slow the progression to ESRD.

Nurses’ back pain prevention

A systematic review to assess the interventions to prevent back pain and back injury in nurses identified eight randomised controlled trials and eight non-randomised controlled trials meeting inclusion criteria – only one of high quality. There is moderate evidence from multiple trials that manual-handling training in isolation is ineffective but that multidimensional interventions can be effective. A single trial of lumbar supports provides limited evidence of effectiveness, while a single study of a stress management programme was ineffective. There is conflicting evidence regarding exercise interventions and the provision of manual handling equipment and training. .

Occupational risks for pancreatic cancer

Around 216,000 new cases of pancreatic cancer occur annually around the world. Tobacco smoking and type II diabetes mellitus are established risk factors, but evidence of occupational exposure risks has been inconsistent. A meta-analysis of 261 papers used job titles as the basis for an analysis of risk and found excess cancer risk in laundry and dry cleaning workers, metal-plating workers, printers and pressmen, and fibreboard and plywood workers. Exposure to chlorinated hydrocarbons was a significant risk factor (meta-relative risk = 2.21; 95% credible interval 1.31–3.68). .

Injustice at work

Despite a plethora of theoretical models, there is little prospective empirical evidence of the impact of psychosocial factors at work on sickness absence. Research undertaken as part of the Whitehall II study of British civil servants assessed the impact of relational justice and effort–reward imbalance – measured using standard questionnaires – on sickness absence. After adjustment for age, employment grade, and baseline health, men and women with low relational justice had significant increased risks of long absence spells. High effort–reward imbalance also increased the risk of long spells. Both measures also predicted short absence spells.

Prick testing alone is not enough

The omission of patch testing from the investigation of allergic skin disease, even when contact urticaria is the sole suspected diagnosis, would result in frequent missed diagnosis of contact allergy. Clinical records of 1,060 patients attending for patch testing were analysed; 27% referred from occupational health. Of 262 patients with negative prick tests, 121 had positive patch tests, 92 (35.1%) of which were of current relevance. Nine out of 106 health workers referred to exclude latex contact urticaria had positive prick tests to latex, while 50 had delayed-type hypersensitivity to common allergens including nickel, cobalt, rubber and its additives.

Sewn up for MSDs

A prospective study at 13 US garment manufacturing sites involving 520 sewing machine operators confirms that upper body musculoskeletal pain risk is associated with workplace and personal factors. Female gender, having a physician-diagnosed musculoskeletal disorder, working more than 10 years as a sewing machine operator, higher work–rest ratios, high physical exertion, high job demand and low job satisfaction were among factors significantly associated with reported pain.

Evidence-based OH practice

One hundred and six OH physicians took part in a study of training in evidence-based medicine (EBM); 48 were selected randomly for a short course in EBM followed by case-method learning sessions in peer groups. Participants submitted case files. An expert panel assessed the quality of advice. Physicians in the EBM group advised better return-to-work interventions compared with controls after two months (88% versus 67%, p = 0.01), but the difference was smaller and not significant after four months. There were no differences in the quality of the return-to-work prognoses.

Non-work activities reduce stress

The contribution of ‘active and fulfilling’ non-work time to recovery from work-related stress is underestimated. In total, 314 working healthy adults (72% women, mean age 40.5 years) completed the Occupational Fatigue Exhaustion Recovery Scale and the Pittsburgh Sleep Quality Inventory as well as a custom-built scale for non-work activity (exercise, hobbies and social activity). The pattern of non-work time was significant in determining sleep quality, recovery from acute work-related stress and reduced chronic fatigue. Potential skewing owing to the method of study recruitment (online) is acknowledged.

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