A systematic review describing the prognosis of chronic fatigue syndrome

AIM: To perform a systematic review of studies describing the prognosis of chronic fatigue (CF) and chronic fatigue syndrome (CFS) and to identify occupational outcomes from such studies. METHOD: A literature search was used to identify all studies describing the clinical follow-up of patients following a diagnosis of CF or CFS. The prognosis is described in terms of the proportion of individuals improved during the period of follow-up. Return to work, other medical illnesses and death as outcomes are also considered, as are variables which may influence prognosis. RESULTS: Twenty-eight articles met the inclusion criteria and, for the 14 studies of subjects meeting operational criteria for CFS, the median full recovery rate was 5% (range 0-31%) and the median proportion of patients who improved during follow-up was 39.5% (range 8-63%). Less fatigue severity at baseline, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a good outcome. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome. CONCLUSIONS: Full recovery from untreated CFS is rare. The prognosis for an improvement in symptoms is less gloomy. This review looks at the course of CF/CFS without systematic intervention. However, there is increasing evidence for the effectiveness of cognitive behavioural and graded exercise therapies. Medical retirement should be postponed until a trial of such treatment has been given.     

Epidemiology of chronic fatigue syndrome

BACKGROUND: Chronic fatigue syndrome (CFS) is a controversial disorder with different case definitions, aetiological models and proposed treatments. An epidemiological approach is likely to bring some clarity to the field. AIM: The aim of this article is to review the literature on the epidemiology of fatigue, chronic fatigue and CFS. METHOD: A literature search was conducted using the databases Medline and Pubmed as well as the reference lists of recent reviews to identify the relevant studies. The aim was not to do a systematic review but to review the key studies in the area to highlight the methodological issues. RESULTS: The review is organized according to the following areas: the prevalence of fatigue and chronic fatigue, the prevalence and incidence of CFS, epidemiological associations such as gender, social class and psychiatric co-morbidity and CFS in special groups such as those recovering from a viral infection, specific occupational groups and Gulf War veterans. CONCLUSION: While fatigue as a symptom is very common, CFS is relatively rare. Many of the epidemiological associations seen in specialist clinics are not found in community samples. It is unlikely that one specific causal factor can explain CFS. Future studies should go beyond estimating the prevalence to testing more complex aetiological models.     

Occupational health issues affecting the pharmaceutical sales force

BACKGROUND: The sales force forms a significant sub-population in the pharmaceutical industry workforce. Role and organizational characteristics, such as isolation, peripatetic working and car travel and the psychosocial and ergonomic hazards related to work tasks, present particular occupational health risks. AIM: To review the occupational risks associated with peripatetic sales force work and evidence for the effectiveness of preventive interventions. METHODS: We carried out a review of the available literature between 1990 and 2003. RESULTS: The following hazards were identified as significant and worthy of further investigation for this occupational group: driving on company business; violence in the workplace; stress; ergonomic issues; and mobile phone use. CONCLUSION: To ensure effective prevention and management of employee health problems, specific health management strategies and interventions must be developed to meet the occupational health needs of this group.     

Occupational health guidelines for the management of low back pain at work: evidence review

There is increasing demand for evidence-based health care. Back pain is one of the most common and difficult occupational health problems, but there has been no readily available evidence base or guidance on management. There are well-established clinical guidelines for the management of low back pain, but these provide limited guidance on the occupational aspects. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000. These are the first national occupational health guidelines in the UK and, as far as we are aware, the first truly evidence-linked occupational health guidelines for back pain in the world. They were based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes. The full evidence review is on the Faculty web site (www.facoccmed.ac.uk), but an abridged version is presented here to aid its dissemination.     

As others see us.

If it is to be fully effective, functional activity in business needs to see itself as an integral part of management and not as some specialist, separate adjunct. The so-called professions often find this difficult to contemplate, let alone achieve. In Unilever's UK operations, occupational health activity and staff are effectively integrated into general management and, as a direct consequence, the business benefits and the participants reach higher levels of job satisfaction.     

Occupational groups at risk of voice disorders: a review of the literature

BACKGROUND: Occupational voice health is becoming more important as more people rely on their voices for their work. A number of studies have identified certain occupational groups at increased risk of developing occupational voice disorders, namely teachers, singers and aerobics instructors. Aim The paper aims to review the literature on occupational groups at risk of voice disorders and identify areas for future research. METHOD: A literature review of key databases using key words such as 'occupational', 'voice health', 'voice loss', 'dysphonia' and 'work related' was undertaken. RESULTS: The review identified case reports, studies of attendees at hospital voice clinics and a few cross-sectional studies of occupational groups in the workplace. There were no longitudinal studies found or intervention studies looking at reduction of risk. CONCLUSION: Further research on occupational voice disorders needs to be based in the workplace, and to look at the risk factors for the development of voice problems and for the efficacy of controls.     

Occupational stress management programmes: a practical overview of published effect studies

There are many occupational stress management programmes availablewhich are designed to prevent and cure the negative aspectsof job-stress. The focus of the programmes can be directed towardsthe individual worker, the working group, the organization ofthe work or the organization as a whole. Moreover, programmesshow a considerable variation with respect to the type of interventionsthey promote and their underlying assumptions, as well as theirduration and costs. In this paper, effect studies of occupationalstress programmes published between 1987 and 1994 are reviewed.The aim is to give a practical overview of the variety in occupationalstress programmes, their scope, applicability and the evidenceof their effectiveness. The paper updates the review by DeFrankand Cooper published in 1989.     

Occupational health services in the UK--challenges and opportunities

BACKGROUND: A small minority of the UK workforce currently has access to an occupational physician. Reduction in the size of enterprises, the emergence of atypical work patterns and problems recruiting and training occupational health specialists risk making this minority even smaller. AIM: This paper considers the challenges currently facing occupational medicine and how we can improve access to occupational health services (OHS). It aims to highlight some of the diverse internal and external factors that restrict the UK's ability to provide all workers access to OHS. METHOD: A literature review was carried out and combined with awareness of current trends in business and new legislation together with provision of occupational medicine in other countries. RESULTS: Potentially controversial solutions that might help to make OHS more widely accessible were identified and are discussed. It is hoped that these will provoke further debate. CONCLUSION: Individually and organizationally, we must examine and improve capabilities if we are to improve worker access to OHS and deliver targets to reduce occupational ill-health. It is suggested that this requires a strategic shift to apply resources differently. There is need to explore delegation of tasks traditionally performed by doctors to nurses and other staff together with the outsourcing of non-core work. The increased use of telemedicine and the enhanced use of information technology for training, risk assessments, wellness programmes and questionnaire-based health assessments are other developments that should be explored.     

Occupational health and safety curricula: the factors that decide -an Australian experience

Societal, economic and other changes in recent years have resulted in both an increased level and diversity of education and training in occupational health and safety in Australia. Consideration has been given to the key skills and knowledge required by those who take tertiary level courses and who practise as specialists and generalists in the field of occupational health and safety. The curricula and mode of implementation of these courses are determined by the needs of employers, increased emphasis on quality management systems, the prevailing work climate including information technology, communication and legislative requirements all in the context of a rapidly changing tertiary education system.     

Compensating occupationally related tenosynovitis and epicondylitis: a literature review

OBJECTIVES: To assess occupational associations with tenosynovitis and epicondylitis, we conducted a systematic literature review. We focused particularly on evidence that might support compensation of these disorders 'on the balance of probabilities'. METHODS: We searched the MEDLINE and EMBASE electronic biomedical databases to 1 January 2005 using combinations of keyword and medical subject headings, and also the references cited in two state-of-the-art reviews from the 1990s. Primary research reports were retrieved and checked for further relevant citations. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect. RESULTS: We found and summarized 18 papers. In the main, these based analysis on job titles rather than on directly assessed physical activities. Few occupations were studied more than once, however, and there was little consistent evidence of jobs or work activities that carried more than a doubling of risk for either disorder. CONCLUSION: Compensation of occupational illness can be problematic for disorders that are not specific to work and for which there are no distinctive clinical features in occupationally related cases. Attribution can, however, be made on the balance of probabilities if there is convincing evidence that risk is at least doubled in an occupational group. Our review highlights the relative lack of data to support such attribution for tenosynovitis and epicondylitis, and discusses the difficulty of compensating upper limb disorders.     

Exploring the need for an occupational health service for those working in primary care

A research nurse interviewed 55 practice staff in 11 generalpractices to ascertain their views about their needs for occupationalhealth care. In a second parallel study, a specialist in occupationalmedicine undertook an in-depth audit of occupational healthprovision in five other general practices with respect to theorganization, the health and safety process, the services andthe working environment. In the first study, the majority ofpractice staff reported the need for various aspects of occupationalhealth care, particularly stress at work. In the second study,general practitioners and practice managers possessed a basicawareness of occupational health matters such as Health andSafety legislation, but their limited knowledge was not translatedinto effective management. General practice staff did not knowwhere to obtain occupational health advice; most practices hadno policies or procedures in place to manage health and safety.Both studies illustrate the need for expert occupational healthadvice in primary care.     

CPD for GPs using the THOR-GP website

BACKGROUND: An estimated 3200 UK general practitioners (GPs) practise occupational medicine on a sessional basis. AIM: To assess the educational needs of GPs practising occupational medicine and participating in The Health and Occupational Reporting (THOR) network. METHODS: A questionnaire survey of GPs participating in a national reporting scheme, recording occupational ill-health from general practice (THOR-GP). The questionnaire used scales derived from the syllabus for the Diploma of the Faculty of Occupational Medicine to assess the use of the THOR-GP website for continuing professional development (CPD). Questions were also asked concerning the attitudes and experience of these doctors to CPD in occupational medicine. RESULTS: The response rate was 73% (213/291). Only 22% of responders used the THOR-GP website for CPD. Lack of time was the most frequently cited reason for not using the site. The topics provided on the website which were rated least interesting also appeared as requests for further information in questionnaire returns. CONCLUSION: Online learning has the potential to fulfil the needs of GPs practising occupational medicine. The designers of material for online learning should actively manage and modify the material available in response to educational needs. Further research is required into the clinical and business outcomes of online learning for these doctors.     

Improving mental well-being in the workplace

Occupational physicians, who are in a key position to influencecompany policy on mental health, have limited access to educationon mental health. This paper discusses the results of a postalsurvey of occupational physicians that was designed to identifythe mental health information needs of occupational physicians,determine the way in which this information should be disseminatedand measure the extent to which occupational physicians encountermental health problems in the workplace.     

Quality management of occupational health services: The necessity of a powerful medical profession

Over the past few years there has been a growing interest inquality management in occupational health services. In thisarticle the central role of the medical profession in this areais highlighted from a personal point of view. It is argued thata powerful and active profession is needed as a countervailingpower in the field of tension between employees and the company,and for balancing the interests of these two main clients. Therefore,the medical profession should develop a policy on quality andapply quality management on national and local levels to reacha high professional level. In this way the profession can maintainthe clinical autonomy that is necessary to be a countervailingpower. Elements of such quality management are national guidelines,local peer review and intercolleagual visitation. These activitiesmust be incorporated in the quality management of the occupationalhealth services unit.     

Occupational health management: an audit tool

BACKGROUND: Organizations must manage occupational health risks in the workplace and the UK Health & Safety Executive (HSE) has published guidance on successful health and safety management. AIMS: This paper describes a method of using the published guidance to audit the management of occupational health and safety, first at an organizational level and, secondly, to audit an occupational health service provider's role in the management of health risks. The paper outlines the legal framework in the UK for health risk management and describes the development and use of a tool for qualitative auditing of the efficiency, effectiveness and reliability of occupational health service provision within an organization. The audit tool is presented as a question set and the paper concludes with discussion of the strengths and weaknesses of using this tool, and recommendations on its use.     

Sexual health and HIV in travellers and expatriates

Travellers engaging in sexual contact with a new partner abroad may be at high risk of acquiring a sexually transmitted infection. This review examines the impact of travel on sexual health and provides prevention, management and treatment recommendations to practising occupational health physicians.     

Sensory neural processing in work-related upper limb disorders

Pain in the upper limb is a common complaint in adults, and is often attributed to or exacerbated by occupational activities. In many patients there is no demonstrable pathology in the neck or arm to account for the symptom, and this has prompted the hypothesis that such cases might arise through abnormal neural processing of sensory information with a lowering of pain thresholds. In this paper we review the evidence in support of this theory and suggest directions for future research.     

Case studies of occupational health management in the engineering construction industry

Construction workers are exposed to considerable hazards carryinga health risk, e.g., dusts, fumes, noise and manual handling,yet there is often poor occupational health service provisionparticularly for subcontracted labourers. This paper presentsseven case studies from large. engineering construction organizations.concerning current practice in occupational health management.The results supported the fact that data and records regardinghealth-related absence were limited and inconsistent, and thatlittle existed in terms of medicals and health surveillance,particularly in the case of subcontracted workers. The maindifficulties envisaged were reported to be the sizeable costsinvolved; the temporary and mobile work force; demonstratingcost-benefits to top management and a lack of interest amongstworkers, perhaps exacerbated by the threat of lost livelihood.Managers also admitted limited health expertise and knowledgeof the wider role health professionals could play in healthmanagement. Training and further research in this area are indicated.     

A review of the healthy worker effect in occupational epidemiology.

This review article aims to anatomize sources of the healthy worker effect (HWE) and to summarize advantages and limitations of several approaches frequently proposed to eliminate the HWE. Although the HWE is frequently addressed in the context of selection bias, our review suggests that the selection of occupational cohorts with advantageous health status would preferably be addressed as a source of confounding biases. The authors also conclude that the exclusion of unhealthy workers at employment and the study of active workers are the two main sources of HWE, and that the use of the general population as a comparison group in occupational epidemiology should be avoided if possible. The authors encourage investigators to make distinctions between the underlying factors related to the use of the general population as the comparison group in occupational epidemiology.     

Interventions: what works, what doesn't?

This review examines the evidence for the effectiveness of occupational stress interventions. Three types of interventions are considered: psychotherapy and counselling services, stress management training, and organizational level interventions. The review concludes that there is good evidence that, for specific mental health problems, formal psychotherapy is effective in terms of reducing individual symptoms. Other forms of intervention have been less well evaluated. The evidence that exists indicates that counselling services and stress management training have modest but short-term effects on individual well-being. Organizational interventions have insignificant effects on individual well-being and on organizational outcomes.