Piecework, musculoskeletal pain and the impact of workplace psychosocial factors

Aim To investigate the impact of piecework on musculoskeletalpain and general health, and the influence of perceived workplacepsychosocial factors on any such associations, in a generalUK population. Methods A questionnaire was mailed to an age-stratified randomsample of 10 000 adults aged 18–75 in North Staffordshire,UK. Respondents reporting a current main job were asked if thisjob was paid by a piecework system. Health measures were (i)number of pain areas according to a body manikin and (ii) generalhealth (SF-12v2). Other measures included questions on occupationalhistory and psychosocial aspects of the work environment. Results The adjusted response was 54%. A total of 1193 respondentsreported a current main job, of whom 201 (17%) reported piecework.Pieceworkers were more likely to be older (P < 0.05), male(P < 0.001) and in lower socioeconomic groups (P < 0.001)than non-pieceworkers. Piecework was associated with perceptionsof a poor psychosocial working environment, more pain areas(P < 0.05), more elbow (P < 0.01), forearm (P < 0.001)and hand pain (P < 0.05), and a lower physical health score(SF-12v2; P < 0.01), but no difference in mental health score(P = 0.60), compared with non-pieceworkers. After controllingfor psychosocial factors, and socioeconomic group, the associationsbetween piecework and pain areas, or physical health, were nolonger statistically significant. Conclusions These results show that piecework was associatedwith poorer self-reported general physical health and more areasof pain, which may be attributed to low socioeconomic group,and workplace perceptions of little job control, high physicaldemand and little supervisor support.     

Memorandum health 2000: intersectoral planning for health in the Netherlands

Publishing a major policy document on public health every decadehas become a worthy tradition in the Netherlands. In accordancewith this tradition, the Memorandum health 2000 was publishedlast year.¹ This article describes and analyses the health policy, withthe emphasis on health education, prevention and facet policy.Facet policy refers to strategies applying to all areas thatare outside the scope of public health policy but have a healthcomponent or dimension. The model presented in the policy documentincorporates all relevant factors in health care: physical environment,social environment, lifestyle, state of health, health caresystem and current resources. The factors affecting health care have been described before,but the Memorandum health 2000 goes further than this. The documentpresents these factors in a single integrated model, which highlightsthe relative importance of each individual factor. This is anunprecedented achievement in Dutch government policy.     

ETHANOL WITHDRAWAL HYPEREXCITABILITY IN VIVO AND IN ISOLATED MOUSE HIPPOCAMPAL SLICES

Withdrawal hyperexcitability was seen in isolated mouse hippocampalslices, prepared after chronic treatment with ethanol, by inhalationfor 2 weeks. The pattern of hyperexcitability differed fromthose seen previously when a different method of ethanol administrationand a different strain of mice were used. Thresholds for fieldpotentials were decreased, but the transient increase in pairedpulse potentiation, reported earlier, was not evident. Chronicadministration of the calcium channel antagonist, isradipine(PN-200–110) during ethanol treatment significantly decreasedthe withdrawal syndrome, both in vivo and in vitro. Brain concentrationsof isradipine during the test period were found to be sufficientto produce acute effects on the withdrawal hyperexcitability.No changes were seen in the field potentials when slices wereprepared after treatment with isradipine alone. A small, butsignificant, increase in excitability was seen in vivo afterthe treatment with isradipine alone. Previous studies snowedthat isradipine did not protect against the hyperexcitabilitydue to gamma-aminobutyric acid (GABA)_A antagonism, so the resultssuggest that neuronal calcium channels may be involved in ethanolwithdrawal hyperexcitability, but decreases in GABA_A inhibitionmay not be important.     

Psychological, musculoskeletal, and respiratory problems and sickness absence before and after involvement in a disaster: a longitudinal study among rescue workers

Aims: To examine the longitudinal course of psychological, musculoskeletal, and respiratory problems and sickness absence among rescue workers involved.

Methods: The study population was composed of 1036 rescue workers. Data on health and sickness absence both before and after the disaster were collected from the electronic database of the rescue workers' occupational physicians. Health problems were coded according to an adapted version of the ICD-10.

Results: After the disaster a long term increase was found in psychological, musculoskeletal, and respiratory problems. Compared to six months before the disaster, the average length of sickness absence in the first half year after the disaster increased from 6.6 to 11.6 days, and decreased slowly in the following six month periods.

Conclusions: Rescue workers involved in a disaster may experience subsequent impairment in occupational functioning.

     

The Attitudes of British Methodist Ministers Towards Alcoholism

"The Alcoholism Questionnaire" was sent to 100 Methodist ministersby post. On the basis of the 67 replies received, it is concludedthat the respondents hold healthy and positive attitudes towardsalcoholism at a cognitive level, although it is not known howthey feel or behave in relation to alcoholism. Their views aregenerally in agreement with the experts on alcoholism, but theydiffer on two factors from the views of the general public.Ministers who were abstainers did not have attitudes which wereless healthy than those who were social drinkers. It is suggestedthat ministers who hold such positive attitudes may be instrumentalin altering public opinion about alcoholism.     

Pleural Plaques, Respiratory Symptoms and Respiratory Function in Shipyard Workers Exposed to Man-made Mineral Fibres

In a cross-sectional study the frequencies of respiratory symptoms,pleural plaques and ventilatory function in shipyard workerswith (n=938) and without (n=744) MMMF exposure were compared.In men with at least 10 years of exposure to MMMF coughing withphlegm was found to be somewhat more common (rate ratio=1.3;P<0.01). No difference in ventilatory function measured byFEV₁ and FVC was found. Men with MMMF exposure had pleural plaquesslightly more often (rate ratio 1.4; 95 per cent confidenceinterval 1.1–1.8). The influence of possible unadjustedconfounding factors such as asbestos exposure is discussed. Requests for reprints should be addressed to: Bengt Järvholm, Department of Occupational Medicine, S.t Sigfridsgatan 85, S-412 66 Göteborg, Sweden.     

PREDICTORS FOR HIDDEN PROBLEM DRINKERS IN GENERAL PRACTICE

In The Netherlands general practice attenders are not usuallyquestioned about their drinking habits. The objective of thisstudy was to determine to what extent easily available data(e.g. age, gender) can be used to identify categories of patientswho are at risk of problem drinking as a preliminary to moreintensive screening. Sixteen practices with a total populationof 32,000 patients were involved in the study. All problem drinkersknown by their GPs and a random sample of one in ten patientsnot thought to be problem drinkers were admitted to the studyat their first surgery visit during a 1-year period. A screeningquestionnaire was used to find hidden problem drinkers amongstthe individuals thought to be non-problem drinkers. The overallresponse rate was 91% (n=1405). Problem drinking was detectedin 6% (n=82) of the group regarded by the GPs as non-problemdrinkers (n=1283). Male gender, smoking, life events and chronicsocial problems were the strongest non-alcohol-related predictorsof hidden problem drinking. We conclude that a pre-selectionof patients with a greater risk of problem drinking can be madewithout information related directly to alcohol. Case-findingin this category is much more effective and probably much moreacceptable both to the GP and the patients, than the screeningof all patients.     

Ca2+-activated K+ channels involved in duodenal dismotility induced by ethanol

The purpose of this study was to investigate the role of K⁺channels in duodenal dismotility induced by ethanol in vitro.The amplitude of spontaneous contractions was reduced by ethanolin longitudinal and circular muscle, while frequency did notchange. Charybdotoxin antagonized ethanol-induced inhibitionof the amplitude of spontaneous contractions. Ethanol decreasedACh-induced contractions and this effect was cancelled out bycharybdotoxin. Ca²⁺-activated K⁺ channels may be involved induodenal dismotility induced by ethanol.     

A factor analysis of the important people inventory

Aims:For well over a decade, the Important People Inventory(IP, Clifford and Longabaugh, 1991; Clifford et al., 1992) hasbeen used to collect a wide range of valuable information regardingnetwork support for alcohol use. However, because of psychometriclimitations and varied adaptations of the IP, the followingstudy performed factor analyses to develop a more structurallyconsistent model of the scaleas compared to the existing model.MethodsA first principal components analysis (Varimax rotation) wasrun on the indices of the IP using data from a national investigationof residents within a recovery community (N = 897).Next, a second principal components analysis was run using datacollected from participants recruited from inpatient treatmentsettings (N = 150).Results Results indicated a nine-index,three-factor model, which explained about two thirds of thecommon variance. These three factors included: Support for Drinkingfrom Network Members (3 items), Drinking Behaviours of NetworkMembers (3 items), and General Social Support (3 items).ConclusionsResultsof both studies suggest that the IP fits a multi-component structure.It is recommended that Drinking Behaviours of Network Membersbe examined for predictive validity and that General SocialSupport be removed from the scale or have additional items added.     

Degree of exposure and peritraumatic dissociation as determinants of PTSD symptoms in the aftermath of the Ghislenghien gas explosion

Background

This paper investigates risk factors for the development of posttraumatic stress symptoms in the different survivor groups involved in a technological disaster in Ghislenghien (Belgium). A gas explosion instantly killed five firefighters, one police officer and 18 other people. Moreover, 132 people were wounded among which many suffered severe burn injuries.

Methods

In the framework of a large health survey of people potentially involved in the disaster, data were collected from 3,448 households, of which 7,148 persons aged 15 years and older, at 5 months (T1) and at 14 months (T2) after the explosion. Hierarchical regression was used to determine the significant predictors and to assess their proportion in variance accounted for.

Results

The degree of exposure to the disaster was a predictor of the severity of posttraumatic stress symptoms. Peritraumatic dissociation appeared to be the most important predictor of the development of posttraumatic stress symptoms at T1. But at T2, posttraumatic stress symptoms at T1 had become the most important predictor. Dissatisfaction with social support was positively linked to development of posttraumatic stress symptoms at T1 and to the maintenance of these symptoms at T2. Survivors who received psychological help reported significant benefits.

Conclusions

In harmony with the findings from studies on technological disasters, at T1 6,0% of the respondents showed sufficient symptoms to meet all criteria for a full PTSD. At T2, 6,6% still suffered from posttraumatic stress symptoms. The symptoms of the different victim categories clearly indicated the influence of the degree of exposure on the development of posttraumatic stress symptoms. Problems inherent to retrospective scientific research after a disaster are discussed.     

兰州市三甲医院临床护士灾害认知及灾害护理能力调查

目的 了解临床护士灾害认知及灾害护理能力现状,为临床护士灾害护理继续教育提供参考依据.方法 用便利抽样法,以网络问卷的形式对兰州市4所三甲医院临床护士的灾害认知及灾害护理能力现状进行调查,并对灾害护理能力的影响因素进行分析.结果 共收到合格问卷285份.临床护士对灾害认知量表6个条目的认知水平差异有统计学意义(P＜ 0...     

D2 DOPAMINE RECEPTOR TaqI ALLELES IN MEDICALLY ILL ALCOHOLIC AND NONALCOHOLIC PATIENTS

The prevalence of TaqI A alleles of the D₂ dopamine receptor(DRD2) gene was examined in two subgroups of medically ill nonalcoholics(more prevalent and less prevalent substance users, MPSU andLPSU, respectively) and in two subgroups of medically ill alcoholics(more severe and less severe alcoholics, MSA and LSA, respectively).The prevalence of the Al allele in the 80 nonalcoholic and 73alcoholic patients was 30.0% and 52.1%, respectively (P = 0.009).In the four subgroups of these patients, the prevalence of thisallele was: LPSU = 18.2%, MPSU = 34.5%, LSA = 44.4% and MSA= 58.3%. Linear trend analysis showed that as the use of substancesand severity of alcoholism increase, so does Al prevalence (P= 0.001). Specific, subgroup comparisons showed Al prevalencein MSA to be about 3-fold (P = 0.007) and 1.5-fold (P = 0.04)higher than in LPSU and MPSU subgroups, respectively. Similarly,in a combined analysis of independent studies, Al prevalencein MSA was higher when compared to LSA (P < 5 x 10^–3),MPSU (P < l0^–4 and LPSU (P < l0^–8) subgroups.There was virtually no difference in the prevalence of the Alallele between LSA and MPSU subgroups. None of the specificmedical or neuropsychiatric complications of alcoholism wasassociated with the Al allele. In conclusion, the severity ofalcohol dependence in alcoholics and of substance use behaviorsin controls are important variables in DRD2 allelic association.The present report and converging lines of evidence suggestthat the DRD2 locus could represent a prominent gene risk factorfor susceptibility to severe alcoholism. However, other genesand environmental factors, when combined, still play the largerrole.     

EFFECTS OF BRAIN MEMBRANES ON 1H NUCLEAR MAGNETIC RESONANCE SIGNAL INTENSITY OF ETHANOL IN VITRO

In vivo proton nuclear magnetic resonance (¹H NMR) studies ofethanol in animal and human brains have shown that only a fractionof ethanol in brain is visible by NMR. The goals of these invitro ¹H NMR experiments were to determine: (I) whether theinteraction of ethanol with brain membranes in vitro diminishesethanol visibility; and (2) if a magnetization transfer (MT)effect can be observed for the interaction of ethanol with brainmembranes in vitro. Furthermore, pilot studies were performedto determine if the brain membranes from rats chronically exposedto ethanol had a different effect on ethanol NMR visibilityand spin-spin relaxation time (T2) than brain membranes obtainedfrom control rats. Results show that the NMR visibility of ethanolis lower in rat brain membrane suspensions in vitro as comparedto ethanol in saline solutions. The factors decreasing ethanolNMR visibility are T2 relaxation, water presaturation time,and off-resonance saturation by a frequency-dependent MT pulse.One-pulse NMR measurements without water presaruration showedthat ethanol visibility was significantly increased by 15% inbrain membrane suspensions of ethanol-fed rats, suggestive ofdecreased ethanol partitioning compared to controls. Furthermoreethanol in brain membrane suspensions from ethanol-fed ratsshowed smaller MT effects than from control rats. These resultsprovide a mechanism for decreased NMR visibility of ethanolin brain, and suggest that chronic exposure to ethanol producesmembrane changes which result in increased NMR visibility.     

Editorial: Unfortunate, but Timely

When I proposed "Epidemiologic Approaches to Disasters" as thetheme for the 2005 issue of Epidemiologic Reviews, Jon Samet,Chair of the Department of Epidemiology at the Johns HopkinsBloomberg School of Public Health, remarked that the topic isunfortunate, but timely. We had reviewed most of the submittedand invited papers for the issue and had begun to assemble thosethat had passed peer review when, on December 26, 2004, theworld learned of a disaster of monumental proportions. I rememberedJon's comment: disasters are always unfortunate, but devotingan issue to this topic is indeed     

开原市龙卷风灾民疏散行为调查及其创伤的影响因素分析

目的 分析某次龙卷风灾害事件中人群疏散的行为特征与防灾减灾认知情况,探索影响灾民创伤发生的潜在因素,为城市应急管理和应急医学救援提供依据。方法 随机选取2019年7月3日开原市龙卷风灾害事件中146名灾民为研究对象,对其疏散行为、受灾情况、防灾减灾认知情况等进行问卷调查,采用logistic回归模型分析灾民创伤发生的影响因素。结果 开原市龙卷风为EF-3级。146名受访灾民中,86.30%的灾民是初中及以下学历。有71名（占48.6%）受访者在此次龙卷风中受伤。灾害发生时近7成灾民第一反应是采取一定措施保护自己或家人的人身安全,占73.3%的灾民能够在龙卷风灾害发生时自主进行疏散行动,78人（占53.4%）在5 min内到达躲避点,超过80%的灾民意识到了此次龙卷风的危险性。logistic回归分析结果显示：分别相比年龄<40岁、男性灾民,年龄>60岁、女性灾民更不易在龙卷风中受伤（OR=0.26、0.60,P <0.05）;相比非常或比较关注气象知识的灾民,不太关注、不关注的灾民更容易在龙卷风中受伤（OR=8.22、13.47,P <0.05）;相比对防御知识...     

Increases in body mass index and waist circumference as outcomes of working overtime

This epidemiologic study was undertaken to determine whetherworking overtime is associated with anthropometric indices andserum lipids, risk factors for obesity, in white-collar workers.Non-management white-collar male workers were eligible. Bodyweight and height, waist circumference, skinfold thickness,serum total cholesterol and triglycerides were measured. Weight,height and waist circumference data obtained 3 years previouslywere also used. Lifestyle information was obtained by meansof a self-administered questionnaire. Overtime hours correlatedsignificantly with the 3-year change in body mass index (r=0.206,p<0.0017) and waist circumference (r=0.218, p=0.0091), butnot with either the most recent anthropometric indices or serumlipids. Overtime hours were also intercorrelated (r=0.436, p<0.0001)with dinner time. The present study suggested that working overtimeis associated with the increases in BMI and waist circumferenceover a 3-year period although the associations were weak. Additionally,eating habits of those with working overtime might reflect anintervening effect on the anthropometric changes.     

Epidemiology in the Design of Long Term Studies

Many problems in occupational health practice are related tothe establishment of dose-response relationships and the measurementof risk. The time when one man's clinical impression would sufficeis long since past. An association between two variables may-ormay not-imply a causative link between them or they may bothbe linked to other as yet unrecognized factors. Some knowledgeof the methods, and particularly of the pitfalls, of epidemiologyis now an essential part of an occupational health physician'sstock-in-trade. The problems involved in seeking for long-termrelationships between dose and response are discussed. An erroror omission in the design of a study may not reveal itself untilthe results are analysed when months or years of work proveto have been fruitless. Requests for reprints should be addressed to: Dr P. J. Taylor, CMD/ONS, Post Office CHQ, 23 Howland Street. London, WIP 6HQ.     

Is Smoking Intervention in General Practice More Successful Among Pregnant Than Non-pregnant Women?

The objective of this study was to evaluate the effect of asimple smoking intervention programme, carried out by a largenumber of general practitioners (GPs) among pregnant and non-pregnantwomen. Four groups of women were defined by the dichotomiespregnant versus non-pregnant and intervention versus control.The intervention was semistructured, using a flip-over and abooklet, and it was implemented in an ordinary sequence of consultations.The study involved 187 GPs in western Norway. The subjects were350 daily smoking pregnant women and 274 daily smoking non-pregnantwomen, 18–34 years of age. The point prevalence abstinencerate at 18 months was 15 and 20% for pregnant and non-pregnantwomen, respectively, in the intervention groups, and 7% in thecontrol groups (P_pregnant = 0.06, P_non-pregnant = 0.006) Twenty-fiveper cent of the pregnant women and 34% of the non-pregnant womenreported that they had reduced their cigarette consumption,but had not stopped smoking entirely. If we include all drop-outsas smokers, the continuous abstinence rate during 15 monthswas 6%/0% among pregnant women (intervention/control) and 5%/1%among non-pregnant women. Stopping smoking was associated withhaving a non-smoking partnér {P = 0.001), and being encouragedto do so by their partner (P = 0.004). The prevalence of bothpregnant and non-pregnant women who stopped smoking was higherin the intervention than in the control groups. Pregnant womenstopped smoking as frequently as non-pregnant individuals. However,concerning mean daily cigarette consumption, a positive effectof the intervention was only observed for the non-pregnant women.There is a potential for more women to become non-smokers duringthe periods of pregnancy and child infancy. GPs should receivemore training in this specific health promotion effort. Moreeffective, low cost smoking intervention programmes, designedfor pregnant women should be explored.