Research Plus: June/July 2010

Retirement options

Latest findings from the Whitehall II study of British civil servants suggest that voluntary or statutory (age 60) retirement is associated with slight improvements in physical and mental health compared with remaining in the workforce. However, retirement on health grounds is associated with poorer physical and mental health (though not with an accelerated decline) – a phenomenon attributed to selection rather than causation. People who retire early may ‘enjoy a head start’ in the previously reported improvement in mental health that occurs after mid life.

Epidemiology 2010; 21(3): 284–290.

Overtime raises CHD risk

A study of more than 6,000 UK civil servants (aged 39–61 years, 71% male) finds that overtime work is related to increased risk of coronary heart disease (CHD) independently of other risk factors. Just under half the participants worked overtime: 21% worked one hour, 15% two, and 10% three or four extra hours per day. There were 369 new CHD events in the 11-year follow-up (5.46 events per 1,000 person-years). Three to four hours’ overtime per day resulted in a 1.56-times increased risk of CHD, after adjusting for known risk factors.

European Heart Journal 2010; online first: doi: 10.1093/eurheartj/ehq124.

Double gloving reduces needlestick risks

Single-layer nitrile gloves give better protection than single-layer latex gloves, but ‘double-gloving’ with latex gloves provides better protection than single-layer gloves of either material. Needlestick simulations were carried out using a computer-controlled machine that jabbed a suture needle dipped in anticoagulated horse blood through glove material ‘stretched to represent the skin-tight fit to the user’s hand’ into a cell of a microbiological test plate half-filled with 0.05 ml saline. The median blood cell count, measured using a haemocytometer, was 229.5 for the single latex layer; 33.5 for the single nitrile layer; and 3 for the double latex glove (p < 0.001 for all comparisons).

Occupational Medicine 2010; 60: 205–210.

Mental-health absence

A longitudinal study of nearly 10,000 Dutch telecommunications and postal workers finds that workers with a previous episode of sickness absence with a common mental health disorder (CMHD) are at increased risk of recurrent CMHD sickness absence. The cohort comprised all workers who had taken medically certified absence due to CMHDs during a seven-year follow-up (7.2% of the dynamic working population). A quarter (23%–25%) of the total absence at the telecommunications company, and 9%–13% in the postal company, was attributed to long-term sickness from CMHDs. Median absence duration was 62 days per episode. One-fifth (19%) of the cohort had a recurrent CMHD absence, and 90% of repeat absences occurred within three years.

International Archives of Occupational and Environmental Health 2010; online first: doi: 10.1007/s00420-010-0540-4.

Shouldering the burden

Work that is highly repetitive or involves forceful exertion, awkward postures and high psychosocial job demands is significantly associated with the common shoulder disorder subacromial impingement syndrome (SIS), according to a systematic review (17 papers, seven of high quality). Workers in fish processing and slaughterhouses have the highest risk of SIS. One low-quality study found an association between SIS and computer-based work.

Scandinavian Journal of Work, Environment and Health 2010; 36(3): 189–201.
www.sjweh.fi/show_abstract.php?abstract_id=2895

Ergonomic interventions

A systematic review finds little evidence to support the use of ergonomic interventions to reduce low-back or neck pain among workers not currently on sick leave. Randomised controlled trials were included if they studied ergonomic interventions aimed at changing biomechanical exposure at the workplace (nine papers) or changing work organisation (one paper). Eight papers covered office workers, one was on garment workers and one on kitchen staff. Interventions were no more effective than controls in preventing low back or neck pain in either the short or long term (low to moderate evidence); a meta-analysis also found no significant benefits.

Occupational and Environmental Medicine 2010; 67: 277–285.

Healthy lifestyles reduce mortality

‘Modest, but sustained, improvements to diet and lifestyle could have significant public health benefits’, finds a study of 4,886 UK adults. Adults randomly selected in 1984–85 were assigned a score according to four unhealthy behaviours at baseline – one point each for: smoking; eating fruit/vegetables fewer than three times a day; less than two hours’ physical activity per week; and weekly alcohol consumption above recommended limits. A total of 1,080 participants died within the follow-up period (mean 20 years) – 431 from cardiovascular diseases, 318 from cancer and 331 from other causes. Adjusted hazard ratios were significantly raised for scores of one, two, three or four points – a score of four was equivalent to being 12 years older in health terms.

Archives of Internal Medicine 2010; 170(8): 711–718.
http://archinte.ama-assn.org/cgi/content/abstract/170/8/711

IHD risk due to work pressure

A Danish cohort study finds increased ischaemic heart disease (IHD) risk due to work pressure. A total of 12,116 nurses aged at least 45 years (median age 51) were followed up for 15 years. Working conditions, occupational status, health and lifestyle were assessed by questionnaire. Those reporting excessive work pressure had a 35% higher risk of IHD after adjusting for age and other known risk factors. Adjusting for shiftwork or physical activity at work had little effect on the risk estimates.

Occupational and Environmental Medicine 2010; 67: 318–322.

Depression and work disability

A systematic review finds strong evidence of an association between long duration of depression and work disability; however, there remain many gaps in the evidence. There was moderate evidence for an association between work disability and more severe types of depressive disorders, presence of co-morbid mental or physical disorders, older age and a history of previous sick leave. There was moderate evidence that more severe depressive symptoms were associated with more work limitations, and that clinical improvement was associated with improved productivity.

Journal of Occupational Rehabilitation 2010: online first: doi 10.1007/s10926-009-9224-x.

Anxiety RCT

A multimodal, flexible intervention for common anxiety disorders significantly improves anxiety symptoms and functional disability. The Coordinated Anxiety Learning and Management (CALM) programme allows patients to choose their intervention – medication, cognitive behavioural therapy or both – with additional treatment provided when needed. A total of 1,004 adult patients with anxiety disorders were randomised into CALM or ‘usual care’ groups. CALM resulted in significantly lower symptom scores at six, 12 and 18 months.

Journal of the American Medical Association 2010; 303(19): 1921–1928