The use of NHS accident and emergency services by commercial sea fishermen in the North East of Scotland

BACKGROUND: Commercial sea fishing is known to be a hazardous occupation, but little quantitative research has been conducted in the UK. OBJECTIVE: To describe the demography of commercial fishermen accessing NHS accident and emergency (A&E) services and profile the reasons for attendance. METHODS: Eight NHS A&E departments in North East Scotland participated in the audit. A structured data collection form was completed by the attending nurse or doctor during a 6 month period (March-August). All commercial sea fishermen attending during this time were included whether or not the reason for attendance was work-related. RESULTS: There were 164 cases of which 133 (81%) presented with injuries and 19 (12%) with illnesses (12 unknown). Twenty-seven (16%) cases had required emergency evacuation from commercial vessels. The most frequent category of injury was 'hand', 'wrist' or 'finger' followed by 'head', 'face' and 'throat'. CONCLUSION: Commercial sea fishing is a dangerous occupation with many injuries requiring NHS A&E treatment. The relatively high level of injuries compared to illness indicates that there are still safety issues to be addressed and current risk assessment requirements need to be reviewed.     

Surveillance of occupational and work-related diseases between 1993 and 1996 in an engineering company

There are established reporting schemes for some occupational and work-related illnesses but these schemes may underestimate the true incidence of such diseases. Not all cases may be referred to a participating physician and access to adequate diagnostic facilities are not always available. Collecting data directly from occupational health departments may overcome some problems related to under-reporting as they have good access to the entire working population within their company. The aim of this paper is to report the results from such a reporting scheme operated by a large multi-national engineering company during the period 1993-96. All UK sites of Lucas Industries (later LucasVarity) participated. A report form was completed by the occupational health department of each participating site each month. The report form gave abbreviated details of each case of occupational and work-related disease occurring at that site during the previous month. Forms were posted to a central office where the data was collated and analyzed. The incidence of respiratory diseases was broadly similar or slightly higher to that reported from other schemes. Musculoskeletal diseases were by far the most common category of disease reported. During a four year period of reporting the incidence of occupational and work-related diseases decreased overall by approximately 75%. As the reported incidence of respiratory disease was comparable with or slightly higher than that from other schemes, it appears that reporting schemes such as this can provide useful and accurate data. Musculoskeletal diseases are the most common type of disease attributed to work and should probably receive greater attention. The decrease in incidence seen in LucasVarity over time may reflect increased emphasis given to health and safety issues within the company during the reporting period.     

Self-reported work-related health problems from the Oslo Health Study

BACKGROUND: Lack of knowledge about the occurrence of work-related health problems in the general population makes it difficult to estimate the potential for their prevention in the workplace. AIMS: To examine the prevalence of self-reported work-related health problems among adult citizens of Oslo, Norway. METHODS: The study was part of the Oslo Health Study 2000-2001, in which all individuals in certain age cohorts were invited to a comprehensive health screening. All 30-, 40- and 45-year old subjects who attended the screening were asked if they had experienced any of 11 common health problems in the past month, and whether they considered these to be work-related. Of the 26,074 invitees in these age cohorts, 8,594 (33%) answered the questionnaire. RESULTS: Nearly 60% of subjects reported one or more work-related health problems, most commonly reported were pain in the neck/shoulders (38%) and low back pain (23%). Neck/shoulder pain was most frequently attributed to working conditions, by 74% of subjects with this problem; followed by arm pain (72%), fatigue (51%) and low back pain (50%). Work-related fractions for eczema and asthma symptoms were 23 and 18%, respectively. There were marked gender differences, but small age differences. CONCLUSIONS: A substantial proportion of common health problems in the Oslo population were attributed to working conditions. This implies a large preventive potential and call for increased preventive efforts targeted at known risk factors in the workplace.     

Inequity in occupational health services for government hospital workers in South Africa

South Africa's inequitable public health system is mainly delivered by provincial health departments, and exemplifies the potential and problems of occupational health services in middle-income countries. The occupational health services for 153 265 employees in all of South Africa's 370 provincial hospitals were described and compared. Information was obtained from 303 (82%) hospitals, using a self-completed questionnaire and telephone interviews. Thirty-two per cent of hospitals had an occupational health clinic, but 61% of employees worked in hospitals with a clinic. Occupational health clinics were more likely to be present in larger hospitals, and were strongly associated with provision of primary care and chronic disease services to workers. Thirty-nine per cent of hospitals had a safety officer, 41% had access to an industrial hygienist or environmental health officer, and 80% had health and safety committees, as required by law. While occupational health services were more likely in larger hospitals, workforce size did not explain the marked differences between provinces. The study shows that substantial occupational health services exist, but that important gaps persist, even in wealthier provinces and especially in provinces without coherent occupational health policies.     

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.     

Mixed-mode survey of female veterinarians yields high response rate

In a recent study of female veterinarians, a subgroup of healthprofessionals growing rapidly in number, the authors employeda mixed-mode survey design in targeting the cohort of womengraduating from all US veterinary colleges during the 11-yearperiod 1970–80 (n = 2,997). The questionnaire elicitedinformation on a variety of health and occupational factorsand required 35 minutes on average to complete. In the firststage, a modified version of Dillman's Total Design Method formailed, self-administered questionnaires was employed, yieldinga response rate of 82.9%. In the second stage, a telephone interviewof all mail non-respondents was attempted, yielding a responserate here of only 30.1%, but increasing the overall responserate among those contacted to 90.2%. Non-respondents differedlittle from mail (early) or telephone (late) respondents withrespect to year of graduation and geographic region of veterinarycollege attendance. Gentle probing of telephone non-respondentssuggested the personal nature of some questions and the amountof time required to answer all questions were the main reasonsthey chose not to participate. It therefore appears that conventionalsurvey techniques may be successfully employed in health studiesof health professionals, particularly if issues of great concernto the target population are addressed.     

Health and safety in the catering industry

There is evidence that the catering industry has high levels of work-related injury and disease. This study examined the incidence, nature and causes of work-related injury and disease among 315 catering students, at a large school of catering in the west of Ireland, over a 10 month academic year. A high incidence of accidents that caused injury was found. Cuts and lacerations, arising from accidents with knives, were the most common injuries seen, followed by burns and scalds from handling hot liquids. A significant level of work-related dermatitis was also recorded. Trainee chefs were identified as an occupational group with a high risk of occupational injury and disease. This group would benefit from vaccination against tetanus. Work-related injuries and disease generated a significant workload for the student health unit, which in itself is a good reason for catering establishments to make use of occupational health services. Health and safety procedures need to be audited and constantly reviewed at a local level. Further research is necessary to more accurately determine the incidence, nature and leading causes of work-related injury and disease in the catering industry in Ireland. This would help in the planning and implementation of an effective health and safety management system.     

Time to return to work and surgeons' recommendations after carpal tunnel release

BACKGROUND: Time to return to work after carpal tunnel release is extremely variable suggesting that only a small proportion of total sick-leave is for medical reasons. AIMS: To determine factors predicting a delayed return to work. METHODS: Fifty consecutive employed patients undergoing carpal tunnel surgery were tested pre-operatively, and then at 1 month post-operatively using both questionnaires and objective testing. Further follow-up by telephone was carried out every 2 weeks up until 90 days. RESULTS: Forty-nine of the 50 workers had returned to work by 3 months. Time to return to work was extremely variable ranging from 1 to 88 days in those who returned to work. Post-operative recommendations by the surgeon also varied widely from 1 to 36 days. The surgeons' recommendations were the strongest predictors of delayed return to work [odds ratio 30.5; 95% confidence interval (CI), 3.2-288], with physical work (odds ratio 27.7; 95% CI, 1.5-507) and lack of self-rated health (odds ratio 5.0; 95% CI, 1.11-100) adding significantly to the logistic regression model, which was highly predictive (area under the receiver-operator curve of 88%). Patient symptoms and objective findings of disability did not add significantly to a logistic regression model either predicting return to work or the surgeon's recommendations. CONCLUSIONS: Our study suggests that workers will return to work in less than 3 weeks if recommended by the surgeon. A randomized controlled trial is warranted to determine if a higher proportion of workers returning in less than 3 weeks can be obtained by standardizing surgeons' recommendations.     

Ergonomic methods for assessing exposure to risk factors for work-related musculoskeletal disorders

BACKGROUND: This review provides an overview of the range of methods that have been developed for the assessment of exposure to risk factors for work-related musculoskeletal disorders. METHODS: Relevant publications and material on exposure assessment techniques have been gathered for inclusion in this review. RESULTS: The methods have been categorized under three main headings: (1) self-reports from workers can be used to collect data on workplace exposure to both physical and psychosocial factors by using methods that include worker diaries, interviews and questionnaires; (2) observational methods that may be further subdivided between (a) simpler techniques developed for systematically recording workplace exposure that enable an observer to assess and record data on a number of factors using specifically designed pro-forma sheets for establishing priorities for workplace intervention; and (b) advanced techniques developed for the assessment of postural variation for highly dynamic activities that record data either on videotape or are computer analysed using dedicated software; (3) direct measurements using monitoring instruments that rely on sensors attached directly to the subject for the measurement of exposure variables at work. CONCLUSIONS: The choice between the methods available will depend upon the application concerned and the objectives of the study. General, observation-based assessments appear to provide the levels of costs, capacity, versatility, generality and exactness best matched to the needs of occupational safety and health practitioners (or those from related professions) who have limited time and resources at their disposal and need a basis for establishing priorities for intervention.     

The relationship between occupational psychological stress and female fertility

OBJECTIVE: To investigate the association between occupational psychological stress and female fertility. METHODS: This was a case-control study including consecutive working female patients attending fertility and in vitro fertilization clinics in the Soroka University Medical Center. We compared occupational stress between 64 working patients who had attended the clinics due to female infertility (case group) and 106 working patients who had attended the clinics due to their partner's reproductive impairment (control group). RESULTS: Patients from the female infertility group were older (31.9 +/- 6.2 versus 30.2 +/- 4.6, P = 0.047) and tended to participate more in sporting activity [23.4 versus 10.4%, odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.05-6.73, P = 0.022] as compared with patients from the male infertility group. Patients from the case group tended to work more weekly hours as compared with the controls (33.6 +/- 16.8 versus 26.9 +/- 17.4, P = 0.028). High reliability was found, as demonstrated by Cronbach's alpha of 0.81-0.90 for the four burnout parameters. Patients from the female infertility group had significantly lower listlessness scores as compared with the control group, using the Mann-Whitney test (2.6 +/- 1.1 versus 3.1 +/- 1.2, P = 0.013). CONCLUSIONS: Patients admitted due to female infertility tended to have lower listlessness scores as compared with patients admitted due to their partner's infertility problem. No significant association was found between other burnout, job strain and job satisfaction scores and women's fertility status.     

Factors associated with self-assessed work ability

BACKGROUND: Symptoms and health problems caused or aggravated by work are common. In order to study perceived work ability and associated factors, including those related to work, a closer analysis was undertaken in an occupational health setting. AIMS: This study aimed to analyse self-assessed work ability and its determinants in employees seeking medical advice, with special emphasis on work-related factors. METHODS: During 723 illness-related visits to occupational physicians, questionnaires covering personal data, main health problems, their work relatedness, duration and effect on work ability were completed by the employee and physician. Factors associated with self-assessed work ability were studied in a multinomial logistic regression model. RESULTS: The majority of employees considered themselves as being able or partially able to work despite the health problem. Independent predictors of impaired work ability were mental or musculoskeletal disorders, self-assessed work relatedness of the disease, older age, blue-collar work and short duration of the symptoms. If the patient was convinced about the benefits of work-related interventions, the risk for disability was significantly reduced. CONCLUSIONS: Special attention should be paid to the recognition and modification of potential work-related causes of disability. In addition, patients with partial work ability should be encouraged to stay at work instead of taking sick leave. For effective disability management, accommodated work and other evidence-based interventions are needed at the workplace.     

The self-reported well-being of employees facing organizational change: effects of an intervention

The objective of this study was to investigate the self-reported well-being of employees facing organizational change, and the effect of an intervention. It was a controlled intervention study. Subjects were allocated to study and control groups, and brief individual counselling was offered to the subjects in the study groups. Questionnaire measures were administered before and after counselling (a 3-month interval), and non-counselled subjects also completed questionnaires at the same times. The setting was 15 estate offices in an urban local authority Housing Department. Subjects comprised the total workforce of the Housing Management division: 193 employees, male and female, aged 22-62 years, facing compulsory competitive tendering between 1994-97. Main outcome measures were baseline and comparative measures of psychological morbidity, including the General Health Questionnaire (GHQ) and the Occupational Stress Indicator (OSI). Questionnaire response rates were 72% and 47% on first and second occasions respectively. The uptake of counselling was 37%. In comparison with (1) the UK norms for the OSI and (2) the norms for a similar occupational group, this group of workers were under more work-related pressure and their self-reported health was markedly poorer. They were not however at a disadvantage in terms of coping strategies. Those accepting the offer of counselling were subject to greater levels of work stress, had poorer self-reported health and markedly lower levels of job satisfaction than those who did not. Questionnaire scores were not significantly different before and after counselling, giving no evidence of treatment effects on symptomatology. However, almost all subjects rated counselling as having been extremely helpful. This study suggests that adverse effects on staff facing organizational change may be ameliorated by improved management practice.     

Influence of work environment on emotional health in a health care setting

BACKGROUND: Radical changes are taking place in health care services and might be expected to cause job dissatisfaction, absenteeism, somatic complaints and mental health problems. Research in this area is limited and focused primarily on nurses. AIM: To understand the impact of the work environment on the emotional health of doctors and nurses in a general hospital setting. METHODS: Cross-sectional study using self-reported questionnaires including the General Health Questionnaire, the Posttraumatic Stress Disorder (PTSD) Checklist for Civilians, the Trauma Experiences and Work Environment Scale. RESULTS: The response rates for the study were 28% (60) for doctors and 54% (431) for nurses. Whilst the prevalences of psychiatric disorder, anxiety, depression and PTSD were higher for doctors compared with nurses, this was not statistically significant. Both groups reported witnessing someone badly injured or killed as their most distressing experience (doctors 46% versus nurses 41%). Using multiple logistic regression, significant predictors of emotional health was task orientation for doctors (OR = 1.96, 95% CI = 1.1-3.6), and PTSD (OR = 17.2, 95% CI = 6.0-49.6), work pressure (OR = 1.2, 95% CI = 1.01-1.4) and innovation (OR = 0.81, 95% CI = 0.70-0.94) for nurses. CONCLUSION: The prevalence of psychiatric disorder among the doctors and nurses was similar to that in Britain. Elements of the work environment did impact on the emotional health of health care workers. Organizational development initiatives should include employee mental health issues in order to create a more positive work environment.     

Incidence of occupational skin conditions in a food manufacturing company: results of a health surveillance programme

BACKGROUND: The food industry has been associated with a high risk of work-related skin problems. Aim To examine the incidence of work-related skin conditions and the likely causative agents in a single large food company. METHOD: Analysis of a health surveillance programme, conducted over a 7 year period, in a food company with 21 000 employees working in diverse manufacturing processes. RESULTS: The mean incidence of skin conditions, taking all of the different food manufacturing operations together, was 1310 per million employees per annum. The mean incidence was greatest in the manufacturing sector whose operations involved chilled or frozen product (3180 per million employees per annum). Most of the cases reported (184/192 = 96%) were due to primary irritant dermatitis. The two commonest suspected causes of the dermatitis were contact with ingredients and hand washing. Taken together, these factors accounted for 58% of all cases. Although the wearing of gloves is often considered necessary to prevent dermatitis from exposure to ingredients and to lessen the need for hand washing, this factor itself was responsible for 9% of all cases. CONCLUSION: Analysis of a company health surveillance scheme showed the average incidence of work-related skin problems to be lower than previously reported in the food industry.     

Respiratory symptoms and sensitization in bread and cake bakers

This purpose of this study was to examine the relationship betweenexposure to wheat flour, soya flour and fungal amylase and thedevelopment of work-related symptoms and sensitization in breadand cake bakery employees who have regular exposure to thesesubstances. The study populations consisted of 394 bread bakeryworkers and 77 cake bakery workers whose normal jobs involvedthe sieving, weighing and mixing of ingredients. The groupswere interviewed with the aim of identifying the prevalence,nature and pattern of any work-related respiratory symptoms.They were also skin-prick tested against the common bakery sensitizingagents, i.e., wheat flour, soya flour, rice flour and fungalamylase. The results of personal sampling for sieving, weighingand mixing operations at the bakeries from which the study groupswere taken were collated in order to determine typical exposuresto total inhalable dust from the ingredients, expressed as 8hour time-weighted average exposures. Data from the health surveillanceand collated dust measurements were compared with the aim ofestablishing an exposure-response relationship for sensitization.The prevalence of work-related symptoms in bread bakery andcake bakery ingredient handlers was 20.4% and 10.4% respectively.However, in a large proportion of those reporting symptoms inconnection with work, the symptoms were intermittent and ofshort duration. It is considered that the aetiology of suchsymptoms is likely to be due to a non-specific irritant effectof high total dust levels, rather than allergy. None of thecake bakers and only 3.1% of the bread bakers had symptoms whichwere thought to be due to allergy to baking ingredients. Usingskin-prick testing as a marker of sensitization, the prevalenceof positive tests to wheat flour was 6% for the bread bakersand 3% for the cake bakers. Comparable prevalences for soyaflour were 7% and 1 % respectively. However, the prevalenceof positive skin-prick tests to fungal amylase was 16% amongstthe bread baking group with only a single employee (1 %) inthe cake baking group having a positive test. Furthermore, thisemployee had previously worked in a bread bakery. The differencein rates of sensitization to wheat flour between the bread andcake bakers is not statistically significant, whereas the differencefor soya flour is at the borderline of statistical significance(p=0.045). In contrast, the difference in fungal amylase sensitizationis significant at the 0.1% level. For both bread and cake bakers,the 8 hour time-weighted average exposures for each of the activitiesshowed a wide variation with mixing having the lowest averageexposure and sieving the highest. Out of the allergens studiedin this investigation, fungal amylase is the principal sensitizerin large scale bread bakeries, with the main source of exposurebeing the handling of bread improvers. In contrast, the riskof sensitization to wheat flour is low in both bread and cakebakeries. The absence of positive skin-prick tests in the subgroupof cake bakery employees who regularly handle fungal-amylase-containingflour suggests that their levels of exposure are below the thresholdfor sensitization to amylase.     

Workplace exposures and employment patterns in adult onset asthmatics and diabetics

BACKGROUND: Little is known about the impact of working conditions on employment decisions after the onset of chronic diseases in adult life. AIMS: To determine the effects of job characteristics on employment in patients attending asthma and diabetes clinics. METHODS: Patients aged 16-60 years were interviewed when attending outpatient clinics or undergoing day case surgery. The asthmatics (n=165) and diabetics (n=283) were taking regular prescribed medication for their condition, and were in paid employment at the time of diagnosis. Job titles at diagnosis were rated for exposures with the potential to cause or aggravate asthma or diabetes, and median ratings were used to assess the impact of exposures on the probability of changing the job held at diagnosis. RESULTS: Exposure to irritants or sensitizers at the time of diagnosis was more likely in asthmatics than in the comparison group (odds ratio = 7.09; 95% CI 3.12-16.17); physical activity was unrelated to diagnosis. At interview, on average 8.5 years after diagnosis, more asthmatics were unemployed (44%; mean age 47 years) than diabetics (31%; mean age 49 years) with ill-health being the most common reason given. No relation was found between exposure in the job held at diagnosis and subsequent job change. CONCLUSIONS: No evidence was found that changing jobs was used as a strategy to find more tolerable working conditions. The high proportion of unemployment due to ill-health among adult onset asthmatics deserves further investigation.     

Characteristics of health counselling in the workplace via e-mail.

This study was conducted to examine how health counselling via electronic mail (e-mail health counselling) was used in the workplace. The definition of health counselling employed in this study was 'any assistance to an individual seeking to solve any health problem'. A total of 2119 health counsellings conducted at a Japanese company's head office (700 employees) in 1997 and 1998 was used for the analysis, which compared four health counselling methods: e-mail, face-to-face, telephone and ordinary mail. This study distinguished four main characteristics of e-mail health counselling. First, the most and second most frequently used counselling methods were face-to-face and telephone counselling, at 70 and 15%, respectively, with e-mail health counselling ranked third at 13%. e-mail counselling was the second most frequently used method for employees in their 20s and 30s, while it ranked third among those over 40. Only 6% of employees in their 50s used e-mail counselling. Secondly, the proportion of mental health issues treated via e-mail counselling was significantly higher, at 26%, than for other counselling methods, which was at or below 10% for each of the other methods. Thirty-two per cent of all mental health counselling was conducted via e-mail. Thirdly, compared with face-to-face counselling, e-mail counselling dealt with more health issues related to primary prevention than with those related to secondary or tertiary prevention. Fourthly, compared with face-to-face counselling, e-mail counselling dealt more with health issues of third parties. These results suggest that e-mail health counselling may be useful in reaching people other than those targeted by the remaining counselling methods.