Smoking and injury in Royal Marines' training

BACKGROUND: Training for the Royal Marines (RMs) is considered to be one of the most arduous military training regimes in the world. Approximately 16% of the annual intake of recruits suffer an injury. Smoking has been found to be a predisposition to injury. OBJECTIVE: To examine the relationship between recruits' smoking status on entry to training and subsequent incidence of injury. METHOD: Retrospective, longitudinal analysis of 1 year's intake of RM recruits at Commando Training Centre Royal Marines. RESULTS: A significantly greater proportion of RM recruits who were smokers on entry to training experienced a physical injury during the course than their non-smoking counterparts (chi-square = 8.15, P < 0.01). A recruit who smoked on entry to training was almost twice as likely to acquire an injury during training [relative risk = 1.7 (95% CI = 1.2-2.8)]. CONCLUSION: Smoking status of RM recruits in training was significantly associated with injury.     

Generic task-related occupational requirements for Royal Naval personnel

Physical tests and selection criteria have historically been used by many military organizations. However, the standards associated with them have come under increasing scrutiny in recent years. This paper describes a series of experiments that were conducted to establish task-related occupational tests and standards (TBTs) for Royal Naval (RN) personnel. A total of 172 (106 male and 66 female) RN personnel volunteered for these experiments, which were designed to: identify the anthropometric requirements for operating various safety hatches and doors on board a RN Frigate (TBT1); quantify the metabolic demands of shipboard firefighting tasks and establish an aerobic fitness standard (TBT2); and identify a battery of tests to predict performance of shipboard casualty-carrying tasks (TBT3). Whilst all subjects completed the criterion tasks during TBT1, performance of the bulkhead door (BD) escape task was related to height (r = 0.50- 0.62, P < 0.05) and vertical reach (r = 0.42-0.54, P < 0.05), with shorter subjects struggling to perform the task. During TBT2, the mean metabolic demand of representative firefighting tasks was 38 ml/min/kg, which must be sustained for 20-30 min. Finally, a battery of tests incorporating measures of lean body mass, fat mass, standing broad jump, 20 m sprint, press-ups, sit-ups and grip strength produced a high correlation (r = 0.89, P < 0.01) with casualty-carrying task performance. From the results of these experiments, it is recommended that RN personnel perform the BD simulation task at the recruitment stage (TBT1), to prove that they possess the anthropometric characteristics commensurate with survival at sea. Secondly, personnel should be frequently screened to ascertain whether they have the maximal aerobic power (41 ml/min/kg) commensurate with shipboard firefighting for 20-30 min (TBT2). Finally, they should perform the battery of proposed tests and score at least 34 points, in order to establish whether they have the anaerobic and strength capacity commensurate with shipboard casualty-carrying tasks (TBT3).     

Does military service damage females? An analysis of medical discharge data in the British armed forces

There is anecdotal and some scientific evidence that females in military service experience an excess of work-related injuries, compared with males. To investigate this more fully, we analysed data collected routinely by the Defence Analytical Services Agency on medical discharges in male and female personnel in the British armed forces. We found that for all disease and injury categories of medical discharge there is a statistically significant excess in females; this disparity is particularly marked for discharges on account of injury [relative risk (RR) = 1.65, 95% confidence interval (95% CI) = 1.30-2.10] and musculoskeletal disease (RR = 3.34, 95% CI = 2.75-4.06). Royal Navy females are eight times more likely (RR = 7.92, 95% CI = 3.03-20.66) and Army females seven times more likely (RR = 6.53, 95% CI = 2.60-16.42) than Royal Air Force females to be medically discharged on account of injury. Over the period 1993-1996, there was a statistically significant increase in the rate of medical discharge for both musculoskeletal disease and injury in female personnel in the British armed forces. During the period 1996-2000, a marked gender differential was maintained, but the rate of increase in females reached a plateau. We concur with previous investigators that mixed-sex training imposes particular ergonomic stresses on females and that it is a major risk factor for overuse injury. We discuss other possible explanations for the marked gender differential in medical discharge rates in the military. Some changes to training programmes are now being introduced to correct this health inequality, but further interventions are needed. Modifications to training programmes must be audited systematically and candidate interventions tested through randomized controlled trials.     

Stress in police officers: a study of the origins,prevalence and severity of stress-related symptoms within a county police force

BACKGROUND: High levels of stress-related illness are causing concern across industry. Against a background of impending legislative moves to try to improve this situation, there is a need to identify key work-related stressors. Police work tends to be regarded as inherently stressful because of the personal risk of exposure to confrontation and violence and the day-to-day involvement in a variety of traumatic incidents. As a result, high levels of stress-related symptoms might be expected in this population. OBJECTIVE: To examine the sources of stress-related symptoms within police officers and measure the prevalence of significant associated mental ill-health. METHOD: A cross-sectional questionnaire survey of a population of 1206 police officers was performed to assess levels of strain associated with a series of potential home and work related stressors. Participants were then split into low and high scoring groups on the basis of a General Health Questionnaire (GHQ) threshold score in order to identify those stressors most associated with mental ill-health effects. RESULTS: Occupational stressors ranking most highly within the population were not specific to policing, but to organizational issues such as the demands of work impinging upon home life, lack of consultation and communication, lack of control over workload, inadequate support and excess workload in general. The high scoring group constituted 41% of the population and differed significantly from those with low scores in perception of all stressors, ranking both personal and occupational stressors more highly, and from personality constraints appeared significantly more 'stress-prone'. A significant association between gender and mental ill-health was found, with females more likely to score more highly on the GHQ than males. CONCLUSION: This study confirms previous findings of organizational culture and workload as the key issues in officer stress. Given that the degree of symptomatology appears to be worsening, management action is required. Further research is indicated within the police population into a possible increased susceptibility in female officers.     

A pre-joining fitness test improves pass rates of Royal Navy recruits

BACKGROUND: Military training represents a significant physical challenge. Low fitness levels are strongly associated with an increased risk of injury and training attrition. To increase pass rates for Royal Navy (RN) Phase I training, a pre-joining fitness test (PJFT) was introduced (2.4 km treadmill best effort run). The PJFT was designed to identify candidates with poor levels of aerobic fitness who may be prone to leave training prematurely. AIM: To examine the impact of the PJFT on training length and outcomes. METHODS: Time taken to run 2.4 km and training outcomes were measured before and after the introduction of the PJFT. Information was collected from RN Phase I training establishments and the network of careers offices between 2002 and 2005. Recruits were placed into quartile groups based on 2.4 km overground running performance. The no PJFT and PJFT groups and the 2.4-km run performance quartiles were compared for training outcomes and time spent in training. RESULTS: Training measures were available for 4818 recruits who entered training before the PJFT's introduction (no PJFT) and 3305 after its introduction (PJFT). The pass rate increased from 78 to 88% following the introduction of the PJFT (P < 0.01). The number of recruits applying for voluntary release decreased from 15% (no PJFT group) to 6% (PJFT group) (P < 0.05). CONCLUSION: The PJFT positively impacted on RN Phase 1 training pass rates. A greater number of recruits successfully completed training, fewer applied for voluntary release and the number and length of training extensions were reduced.     

Injury in Australian veterinarians

BACKGROUND: There are a number of risk factors for traumatic injury in veterinary practice but there is little information on the prevalence of injuries or the factors associated with injury in this profession. AIMS: To identify the prevalence of injuries sustained by veterinarians and the groups most at risk for different types of injury. METHODS: Cross-sectional survey of Australian veterinarians. Subjects were asked whether they had ever had a significant work-related injury, a less serious acute work injury in the last 12 months, a work-related chronic musculoskeletal problem or dog or cat bites. The prevalence of injuries by gender, practice type and decade of graduation were reported and multivariate logistic regression was used to examine the risk of each type of injury. RESULTS: Of 2800 veterinarians, over half (51%) reported a significant work-related injury during their career while 26% of practitioners reported having at least one injury in the previous 12 months. Chronic work-related musculoskeletal problems were reported by 49% of respondents. Dog and cat bites were also very common. After adjusting for graduation year and university, males were more likely than females to have experienced cat or dog bites or have a chronic or significant injury, and large animal veterinarians were most likely to have chronic or significant injuries. CONCLUSIONS: A high injury prevalence was found among Australian veterinarians with large animal practitioners at highest risk. This is the largest study of Australian veterinarians to have been reported and has shown that injuries are common and serious in the profession.     

Low back pain among Iranian industrial workers

BACKGROUND: Most epidemiological data concerning low back pain (LBP) are from high-income countries and there is very little information about LBP in the working population in developing countries. OBJECTIVES: To determine the prevalence of LBP in Iranian industrial workers. To explore associations between LBP and physical and psychosocial factors at work, as well as lifestyle factors. METHODS: Cross-sectional study of the largest car-manufacturing group in Iran. The prevalence of LBP, work exposures and lifestyle factors were recorded using the standardized Nordic questionnaire for analysis of musculoskeletal symptoms. Demographic data and lifestyle factors (age, sex, education, weight, work experience, smoking and fitness training) were also collected. RESULTS: Of the 18,031 employees, 78% participated. The majority of subjects in this study population were young males (<30 years) and a small proportion was female (4%). The 1-year prevalence of self-reported LBP in this Iranian industrial population was 21% (20% males and 27% females). The prevalence rate of absence due to LBP was 5% per annum. The multiple logistic regression models indicated that the following remained risk indicators for LBP in the previous 12 months: increasing age, no regular exercise, heavy lifting, repetitive work and monotonous work. CONCLUSION: LPB is a common problem in the working population even in a developing country. Age and gender as well as certain work-related physical and psychosocial factors influenced the prevalence of LBP but the differences between different categories of workers were small.     

An evaluation of stress education in the Royal Navy

Background Psychoeducational programmes aim to reduce the morbidityassociated with exposure to stressful events. Although theyare widely used, there are conflicting views as to how or whythey might be effective. Aim To examine exposure to ‘stress’ education withinthe Royal Navy (RN) and ascertain any links between stress educationand mental health status. Methods In all, 1559 RN personnel were surveyed using a studyquestionnaire which asked about exposure to and quality of anystress education provided during service. Participants alsocompleted two measures of psychological health, the GeneralHealth Questionnaire (GHQ)-12 item and the Post-Traumatic StressDisorder Checklist. Odds ratios (ORs) were calculated and 95%confidence intervals were computed using multivariable logisticregression adjusting for socio-demographic variables. Results The response rate was 70%; 47% of the sample reportedhaving received a stress brief during service. Those who reportedhaving received a brief had better general mental health (measuredby the GHQ) than those who had not [adjusted, OR = 0.76 (0.59–0.98)].When brief quality was taken into account, only those who receiveda brief and considered it ‘useful’ were significantlyless distressed [adjusted, OR = 0.65 (0.49–0.86)]. Poor-qualitybriefs were no better than having had no brief at all [adjusted,OR = 1.04 (0.74–1.47)]. Conclusions Our data indicate that only educational stress briefswhich are relevant for the target audience may be beneficial.Simply providing stress briefings, without thought to theirquality, may constitute a waste of resources.     

Cancer incidence and cancer mortality in a cohort of UK semiconductor workers, 1970-2002

OBJECTIVE: To examine cancer risks in a cohort of workers employed in the manufacture of semiconductors. METHODS: The mortality (1970-2002) and cancer morbidity (1971-2001) experienced by a cohort of 1807 male and female workforce employees from a semiconductor factory in the West Midlands (UK) have been investigated. Standardized mortality ratios (SMRs) and standardized registration ratios (SRRs) were used to assess mortality and morbidity, respectively. RESULTS: Overall mortality was close to expectation in males [SMR 99, 95% (confidence interval) CI 79-122] and significantly below expectation in females (SMR 74, 95% CI 65-85). Incidence of all sites of cancer was somewhat elevated in males (SRR 130, 95% CI 95-173) but close to expectation in females (SRR 94, 95% CI 82-109). There were significant deficits of deaths from cancer of the oesophagus in males and females combined and from cancer of the breast in females. Significantly elevated SRRs were found in males for cancer of the rectum [Observed (Obs) 6, SRR 284, 95% CI 104-619], in females for cancer of the pancreas (Obs 10, SRR 226, 95% CI 108-415) and malignant melanoma (Obs 11, SRR 221, 95% CI 110-396) and in males and females combined for cancer of the rectum (Obs 19, SRR 199, 95% CI 120-310) and malignant melanoma (Obs 12, SRR 217, 95% CI 112-379). Detailed work history data were unavailable for analysis. The finding of excess morbidity was not mirrored in the corresponding mortality findings. CONCLUSIONS: The study found elevated morbidity for a number of cancer sites that may be unconnected with occupation. Elimination of all possible occupational causes will, however, require more detailed analyses of cancer risks in relation to exposure histories.     

Prevalence and causes of self-reported work-related stress in head teachers

BACKGROUND: Work-related stress (WRS) is the leading cause of occupational ill-health in the education sector in the UK. Headship is believed to be a stressful role although there is little current research into stress in head teachers. Changes in the education sector since the late 1980s have meant that the findings of many existing studies are outdated. AIM: To investigate prevalence and causes of self-reported, WRS in head teachers in West Sussex, UK. METHODS: A cross-sectional study using postal questionnaire in a population of 290 head teachers and principals. The measuring instrument was a short stress evaluation tool (ASSET) plus additional questions derived from previous studies. Stress cases were defined as respondents who felt their work was 'very or extremely stressful'. RESULTS: Prevalence of self-reported, WRS was 43%. Using ASSET scoring, work overload and work-life imbalance were the key stressors. Females were significantly more stressed than males for a number of stressors including overload and control. Although there was some evidence that primary head teachers fared worse than their secondary counterparts, once the confounding effects of gender were included, there were few significant differences. CONCLUSIONS: The prevalence of self-reported stress in head teachers in West Sussex is significantly increased compared to recent studies of workers in the UK. The recurring theme in existing studies of workload as a main stressor is confirmed in the findings of this study. Gender and type of school does affect outcome and female head teachers have more reported stressors than their male colleagues.     

Simian virus 40 and mesothelioma in Great Britain

BACKGROUND: Simian virus 40 (SV40) is a DNA virus that has been shown capable of infecting and transforming cells in various species. Laboratory studies have suggested that inoculation with SV40 is associated with various types of cancer, including mesothelioma. AIMS: To test the hypothesis, via an ecological analysis, that exposure to SV40 via contaminated polio vaccines is a risk factor for mesothelioma in humans. METHODS: Mesothelioma mortality rates in Great Britain for two birth cohorts likely to have been exposed to SV40 via poliovirus vaccination were compared with a birth cohort likely to be largely unexposed. RESULTS: There was some evidence for both males (P < 0.05) and females (P < 0.05) that the mesothelioma mortality rates were higher in the first exposed cohort: rate ratio (RR) = 2.4 [95% CI (confidence interval) 1.2-5.0] and RR = 3.7 (95% CI 1.0-14). However, in the second exposed cohort, mortality rates were elevated in females only, and the evidence was slightly less convincing (P = 0.055). CONCLUSION: Although the results for females show a reduction in the mesothelioma mortality rate coinciding with the introduction of the SV40-free Sabin polio vaccine, the absence of a similar result in males and of a priori biological evidence of a sex-specific SV40 effect, makes chance the most plausible interpretation of these findings.     

Fragrance as an occupational allergen

Sensitization to fragrance is believed to occur mainly outside the workplace. This study addresses the frequency of fragrance allergy in patch test patients of differing occupations during a 15 year period. The occupation most strongly associated with fragrance allergy in both sexes was health care work (positive tests in 11.7% of males and 10.4% of females). Retired individuals also had high rates of fragrance allergy (11.6% of males and 14.5% of females), and the prevalence of sensitization increased with advancing age. Health care workers and metal workers had statistically significantly higher rates of allergy to eugenol than did workers in other occupations. Food handlers had significantly higher rates of allergy to cinnamal and cinnamic alcohol. These findings suggest that sensitization to fragrance occurs more frequently in an occupational setting than is generally understood and could have implications for preventive measures.     

Low prevalence of clinical latex allergy in UK health care workers: a cross-sectional study.

The prevalence of natural rubber latex allergy amongst health care workers has been reported to vary between 1 and 40%. This is because different diagnostic criteria have been used on heterogeneous groups of subjects. We have undertaken a cross-sectional study of all 5600 employees in two National Health Service trusts served by one department of occupational health and one department of clinical immunology. The period prevalence (1999-2000) for Type I clinical latex allergy in the clinical health care workers was found to be 17/3500 (0.5%). Difficulties in diagnosis and factors which may have contributed to this low prevalence rate are discussed. No cases were forced to leave health care work as a consequence of their allergy.     

The burden of psychological symptoms in UK Armed Forces

OBJECTIVE: To assess the prevalence of psychological symptoms during periods of relatively low deployment activity and the factors associated with each psychological health outcome. METHODS: A survey of 4500 randomly selected UK service personnel was carried out in 2002. The questionnaire included the General Health Questionnaire (GHQ-12), the post-traumatic stress disorder checklist (PCL), 15 symptoms and an assessment of alcohol intake. RESULTS: A total of 20% were above cut-offs for GHQ-12, 15% for symptoms, 12% for alcohol intake and 2% for PCL. Gender, age, excessive drinking and smoking were independently associated with most outcomes of interest. Number of deployments was independently associated with multiple symptoms and excessive drinking. High post-traumatic stress disorder score was more frequent in the Army and in lower ranks. CONCLUSIONS: Psychological symptoms are highly prevalent in UK Armed Forces. Many risk factors are associated with measures of psychological ill-health.     

A cohort mortality and cancer incidence survey of recent entrants (1982-91) to the UK rubber industry: findings for 1983-2004

AIM: To monitor the occurrence of cancer in a recently defined cohort of UK rubber workers. METHODS: A cohort of 8651 male and female workers from 41 UK rubber factories has been enumerated. All employees had a minimum of 12 months employment and were first employed at one of the participating factories in the period 1982-91. Mortality and cancer incidence data for the period 1983-2004 were compared with expected values based on appropriate national rates. RESULTS: Mortality from lung cancer was close to expectation for males [observed 22, standardized mortality ratio (SMR) 93] and females (observed 2, SMR 70). Mortality from stomach cancer was also unexceptional in males (observed 4, SMR 86) and females (observed 0, SMR 0). Although based on small numbers, significantly elevated mortality was shown for multiple myeloma in males (observed 5, SMR 385) and females (observed 2, SMR 952). All seven of these latter deaths occurred in workers from the general rubber goods (GRG) sector. CONCLUSIONS: The findings should be treated with caution as they relate to a relatively early period of follow-up. Nevertheless, they hold out the prospect that the elevated SMRs for stomach and lung cancers reported for historical cohorts of UK rubber workers will not be present in more recent cohorts. The elevated occurrence of multiple myeloma may represent no more than a chance finding. Alternatively, these findings may reflect the presence of an unrecognized occupational cancer hazard in parts of the GRG sector of the UK rubber industry.     

Absence attributed to incapacity and occupational disease/accidents among female and male workers in the fish-processing industry

Sick-leave between 1984 and 1989 was higher among both female(n=515) and male (n=304) fish-processing workers [observed/expected(O/E) 2.24 and 1.69, respectively] than among non-exposed groups(0.62 and 0.89). Diagnoses in the musculoskeletal system dominated(i.e., neck/upper limbs; females, exposed vs. non-exposed workers:30 vs. 12%: males: 11 vs. 5.8%). In subjects who left employment,the O/E-ratio decreased (females: 3.02 vs. 1.55; males: 2.40vs. 1.55). Among those women hired before the start of the observationperiod, exposed subjects had higher frequencies of sick-leavethan non-exposed, for both total illness and musculoskeletaldiagnoses. In the men, there were corresponding differences,though not fully statistically significant. Reported occupationaldiseases [O/E: females: 4.5; (95% confidence interval) Cl=3.2–6.1;males: 2.3; Cl=1.3–3.9] and accidents (females: 4.3; Cl=3.0–5.9;males: 1.8; Cl=1.2=2.7) were also higher in female than in malefish-processing workers, and much higher than in non-exposedworkers. In conclusion, work in the fish-processing industrywas associated with increased frequencies of sick-leave, especiallybecause of diagnoses of the musculoskeletal system, and occupationaldisorders and accidents, in particular among female workers.     

Variations in self-reported health by occupational grade in the British Post Office: the Q-health project

Between 1995 and 1998 a national sample of 58,501 (42,885 males, 15,616 females) Post Office employees (29%) completed and returned a postal questionnaire survey providing information on demographic characteristics, physical and psychological health, health and lifestyles and health screening behaviour. Response rates by occupational grade were as follows: manual (male 69.3%, females 43.6%); clerical (male = 11.8%, female, 42.3%); middle management (males 15.5%, females 10.7%) and senior management (males 3.4%, females 3.3%). A number of differences in health status occurred with occupational grade. Angina, high blood pressure, obesity, smoking, arthritis, disability, GP consultations and abnormal smears were all more prevalent in lower occupational grades. Height, job satisfaction, seat belt use and breast self-examination were also lower in lower status jobs. Some findings were unexpected: GHQ scores indicated better mental health in lower grades, whilst knowledge and frequency of testicular self-examination and attendance for mammograms were higher in lower grades. Self-reports for asthma, diabetes and family history of bowel cancer were also greater in higher grades. These findings are considered in terms of response bias, health selection, the psychosocial work environment, occupational health interventions and the nature, meaning and organization of social position within the Post Office.     

Musculoskeletal disorders and visual strain in intensive data processing workers

BACKGROUND: This study was conducted for a UK Trade Union in response to increasing numbers of health complaints among intensive computer workers in a data processing environment. AIM: To estimate prevalence of musculoskeletal pain/discomfort and visual strain symptoms among data processing workers and to explore associations with work factors. METHODS: A self-report questionnaire was distributed to data processors (n = 175) and a control group (n = 129) in the same organization. RESULTS: Eighty-six per cent of data processors reported musculoskeletal pain/discomfort in the previous year, with the highest prevalence rate found for the neck (58%). The 12 month reported prevalence for visual strain symptoms was 47%, tired eyes (41%) was the most commonly reported symptom. In the last week, 56% reported pain/discomfort and 25% visual strain symptoms. Data processors reporting pain in the previous year were more likely to be dissatisfied with their jobs (P < 0.01), to report a lack of choice in deciding what they did at work (P < 0.02), to have insufficient time to complete work (P < 0.05) or to receive help from others when time was limited (P < 0.03). CONCLUSION: The prevalence of self-reported musculoskeletal pain/discomfort and visual strain symptoms was high among data processors. A systematic approach to risk reduction addressing organizational, psychosocial and physical work factors is required. This study has implications for reorganization of this and other intensive computer work, given the increasing requirement for intensive computing work in many industrial sectors. More research is needed to investigate interactions between job demands and support systems for these workers.     

Violence exposure and burn-out among Turkish nursing home staff

AIM: The aim of this study was to describe the frequency of violence against personnel from residents and to identify the prevalence of burn-out among staff working in nursing homes. METHODS: The study was performed in two cities in the west of Turkey. A semi-structured questionnaire on violence and Pines' Burnout scale were distributed among all the staff working in six nursing homes, and 214 of them responded. RESULTS: Of the total number of respondents, 56% stated that they had been exposed to violence during the preceding year. More than 20% stated that they had reported violence to their supervisor. Less than 10% had received medical or psychological support following the event. Violent incidents were reported significantly more frequently among staff who reported problems working with elderly residents. There was no relationship between violence towards staff and burn-out. CONCLUSIONS: Violence is commonly experienced by care workers in nursing homes for the elderly. Strategies to improve occupational conditions in nursing homes are required.