Research Plus: February/March 2008

Shiftwork has RTW consequences

Working non-standard work schedules, for example evening and night work, significantly affects return-to-work outcomes following a workplace injury and should be taken into account by OH professionals and case managers. Compared with injured workers in conventional schedules, working a non-standard schedule significantly increases the risk of being dismissed, resigning or being unable to work full time following an injury at work. Schedules involving overtime and long working hours generally had a greater impact on vocational consequences following a workplace injury.

Journal of Occupational Rehabilitation 2007; 17(4): 641–651.

Coronary risk profile

Patients who discuss their coronary risk profiles with their physicians respond better to treatment for cholesterol disorders. The study followed 3,053 patients – from 230 physicians – undergoing treatment for dyslipidaemia. Half were randomly assigned to receive their coronary risk profile at the beginning of the study and at three, six, nine and 12 months; half received ‘usual care’ (88% remained in the study at 12-months). After adjustment for baseline lipid values, small but significant mean reductions in LDL cholesterol levels and the ratio of total to HDL cholesterol were observed in patients receiving the profiles. These patients were also more likely to reach lipid targets. The impact was stronger in those with worse profiles.

Archives of Internal Medicine 2007; 167(21): 2296–2303.

Osteoarthritis – the occupational risks

A systematic literature review found a significantly increased risk of developing hip osteoarthritis (OA) with heavy physical lifting at work in 12 of 14 published studies. There was also a significant risk associated with farming (found in 13 of 14 studies) and a lesser but nevertheless significant risk in construction work (four of six studies). There was ‘moderate to strong’ evidence of a causal relationship for both heavy lifting and for farming. Three out of five studies found significant associations of hip OA and frequent occupational exposure to climbing stairs or ladders, but evidence for a causal relationship was weak. .

Occupational and Environmental Medicine 2008; 65(1); 6–19.

RTW case management competencies

A literature search identified 40 papers on the impact of return-to-work (RTW) coordinators in preventing workplace disability (RTW coordinator covered a range of job titles, including case manager and disability prevention specialist). Most studies focused on musculoskeletal conditions or work injuries. Six preliminary competency domains were identified: ergonomic and workplace assessment; clinical interviewing; social problem solving; workplace mediation; knowledge of business and legal aspects; and knowledge of medical conditions. Successful RTW coordination depended more on competencies in ergonomic job accommodation, communication, and conflict resolution than on medical training.

Journal of Occupational Rehabilitation 2007; online first: DOI: 10.1007/s10926-007-9115-y.

Cancer risks

A preliminary report of the WHO International Agency for Research on Cancer (IARC) concludes that occupational exposure to painting is carcinogenic (IARC classification group 1); shiftwork involving circadian disruption is ‘probably’ carcinogenic (group 2A); and occupational exposure as a fire-fighter is ‘possibly carcinogenic’ (group 2B). The first finding is based on epidemiological studies that show small but significant increases in the risk of lung and bladder cancer in painters. The shiftwork finding derives mainly from research on breast cancer risk in nurses and flight attendants as well as from laboratory animal studies. Relative risks were consistently increased among firefighters for three types of cancer: testicular, prostate and non-Hodgkin lymphoma.

Lancet Oncology 2007; 8(12): 1065–1066.

Occupational carcinogen exposure

A review of data on occupational carcinogens – including IARC classifications, European Carcinogen Exposure database, HSE National Exposure Database, Central Index of Dose Information on ionising radiation and published literature – estimates that around 7 million people are exposed in Britain. It identified 64 carcinogenic agents/circumstances but found that the top 30 account for 99.5% of the estimated exposed population. The review (completed before the recent workplace smoking ban) identifies involuntary tobacco smoke exposure, solar radiation, crystalline silica, diesel engine exhaust, wood dust and benzene among the leading sources.

Annals of Occupational Hygiene 2007; 51: 653–664..

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 and Environmental Medicine 2007; 64; 642–650.

Chronic pain and depression increase absence risk

Individuals suffering chronic pain alongside depression have a three-fold increased risk of sickness absence, research from the Canadian Community Health Survey reveals. Significant associations with absence were observed for fibromyalgia, back problems and migraine. Individuals with chronic pain who also reported a major depressive episode in the previous 12 months were 2.9-times more likely to be absent than their non-depressed counterparts. Female gender did not increase the risk despite the fact that more women than men experience co-morbid chronic pain and depression.

Journal of Occupational and Environmental Medicine 2007; 49(11): 1206–1211.

Pandemic flu prevention

Physical barriers, including regular hand washing and the wearing of masks, gloves and gowns may be more effective than antiviral drugs in preventing a pandemic influenza epidemic or the spread of severe acute respiratory syndrome (SARS), a systematic literature concludes. Meta-analysis of six case-control studies suggests that physical measures are highly effective in preventing the spread of SARS. The effect of adding virucidals or antiseptics to normal hand-washing solutions remains unclear.

British Medical Journal 2007; online first: doi: 10.1136/bmj.39393.510347.BE.

Computer-work risk review

A literature review of papers published between 1980 and 2007 confirms that workers operating in a computerised work environment are at increased risk of work-related musculoskeletal symptoms if, in response to workload, deadline and performance-monitoring pressures, they perform long hours of computer-based work with high mental demands, work at a hectic work pace resulting in heightened muscle tension and forces, and have inadequate work breaks.

Journal of Occupational Rehabilitation 2007; 17(4): 743–765.

Needlestick avoidance training

Greater surgical experience was found to reduce the rate of needlestick injuries among residential surgeons at a hospital in Wisconsin, US. A retrospective review of OH records and operative case logs demonstrated a lower exposure rate among senior and chief residents compared with junior residents (p < 0.0001). However, enhanced training based on a video outlining surgical risks and specific countermeasures made no significant difference to the recorded injury rate.

Journal of Surgical Education 2007; 64(6): 395–398