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Research Plus: October/November 2009

Battling respiratory viruses

Physical hygiene measures are highly effective in preventing the spread of severe acute respiratory syndrome (SARS), according to a meta-analysis of six case–control studies. However, an updated systematic review judged most of the randomised and cluster-randomised controlled trials to be of poor quality. The following physical methods are effective: handwashing more than 10 times a day; wearing masks, gloves and gowns; and isolation of potentially infected patients. There is only limited evidence that expensive [US/NIOSH standard] N95 masks are more effective than simple surgical masks – though they may be useful in high-risk situations. There is inconclusive evidence on the benefit of adding virucidals/antiseptics to normal handwashing. The greatest benefit is achieved through hygiene measures aimed at young children and household members of index cases.

RTW after knee and hip replacement

While knee and hip arthroplasties are more common among older people, occupational relevance is likely to increase as the working population ages. A systematic review identified only three papers that examined factors preventing or promoting return to work (RTW) following such surgery, although 25 papers included information on working status. Two-incision surgery promotes faster RTW than the mini-posterior incision technique, while restricting patient movement in the six weeks after surgery prolongs it. Patient discharge guidelines have no effect on RTW times.

Back pain recovery

Large national differences in sustainable return to work (RTW) after chronic low back pain (LBP) are largely explained by the different use of work interventions and job characteristics, according to a multinational cohort of 2,825 sickness benefit/compensation claimants off work for three to four months. Flexible eligibility criteria for long-term disability benefits are more effective than stricter policies in promoting RTW. Just over 41% of claimants from six countries had a sustainable RTW two years after sick leave onset, but this varied significantly, from 22% in Germany to 62% in the Netherlands. Different approaches to work interventions explained more of the between-nation variance than did differences in medical intervention. Use of ‘therapeutic work resumption’ (60%) and adjusted working hours (49%) were highest in the Netherlands, while job redesign was more common in Israel (44%). Germany scored the lowest for all work interventions.

Pesticide link to Parkinsonism

A large case–control study identified a significant raised risk of Parkinson’s disease with occupational use of pesticides, but there was no association with work in healthcare, education or welding, contrasting previous evidence. Risk of the condition increased with pesticide use in general and specifically with use of 2,4-dichlorophenoxyacetic acid. Forty-nine of the cases (8.5%) had exposure to pesticide use, compared with 27 (5.3%) of the controls.

Predictors of mental health absence

For workers who take sickness absence due to minor mental health problems, factors predictive of not returning to work are long duration (more than three months) of health problems before the sick leave, at least three weeks’ absence before seeking help, severity of symptoms (somatisation, anxiety and depression) and the individual’s own prediction of return. Thirty-eight per cent of individuals had returned to work after three months and 61% after six months. Interventions should be targeted at those with long-standing health problems before the onset of absence.

Gender bias in sickness absence rates

Women are generally perceived to have higher absence rates than men – although this is not actually the case in all age groups and professions and is restricted to short-term absence. This literature review used the Multi-Facet Gender and Health Model to classify various biological, psychological and socio-cultural factors that influence health-related sex differences. The reasons for higher rates of female absence, where these exist, are complex. They include: health problems related to pregnancy and menstruation (rather than general morbidity); perceived inequity at work; the nature of work, such as high work demands and little decision latitude; lack of support or opportunities for social support; and comparatively low thresholds for taking sick leave owing to organisational culture. Dual work and childcare responsibilities do not explain higher absence rates in women (the evidence is scarce and mixed) although there may be a healthy worker effect (ie those unable to cope may withdraw from work).

Cadmium exposure

A review of research on possible links between occupational exposure to cadmium and genito-urinary cancers found only weak evidence of associations with bladder, renal and prostrate cancer. Some studies were poorly carried out and did not control for the effects of smoking. The Industrial Injuries Advisory Council does not recommend that genito-urinary cancers be prescribed for cadmium-exposed workers.

Trauma treatment

A systematic review of symptoms, diagnosis, timing and effectiveness of treatment for psychotrauma and post-traumatic stress disorder (PTSD) focused on soldiers and peacekeepers. Psychological treatments can have both short- and long-term benefits, though small sample numbers and different methodologies make published results difficult to compare. There was inconclusive evidence on the effect of debriefing and it remains controversial as a treatment for PTSD. Barriers to treatment are common and include fear of stigmatisation and job loss.

Post-injury depression

Co-morbid depression following physical injury is a significant predictor of poor return to pre-injury function and activity. This prospective cohort study followed 248 people treated for a minor injury at a hospital emergency unit. Physical function and mental health status was determined by validated diagnostic interview at three, six and 12 months. Subjects with depression (18% of the total) were significantly less likely to have returned to their pre-injury activities of daily living and social interaction at each time point. Of those in work at the time of their injury, those with depression were 2.4-times more likely not to have returned to their pre-injury work status after one year.

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