Prevalence, management and impact of urinary incontinence in the workplace

BACKGROUND: The few prior studies of urinary symptoms in the workplace have been small investigations of women in specific occupations (e.g. nursing) or industries (e.g. pottery manufacture). In this study, the aims were to describe the prevalence, management and impact of urinary incontinence for a large cross-section of employed women in the USA. METHODS: Five-page questionnaires were mailed to 5130 American households selected from the National Family Opinion survey panel during the spring of 2004. Usable questionnaires were returned by 3364 women in the target age range of 18-60 years. RESULTS: About 37% of the 2326 employed respondents reported urine loss during the last 30 days. The most common strategies for managing incontinence at work included frequent bathroom breaks and wearing pads. The use of urine control methods increased with the severity of urine loss. The effect of incontinence on workplace activities also increased with the severity of urine loss: 88% of employed women with the most severe symptoms reported at least some negative impact on concentration, performance of physical activities, self-confidence or the ability to complete tasks without interruption. CONCLUSION: Urinary incontinence is prevalent among employed women. Those who experience severe symptoms report that it has a negative effect on aspects of work. Programs on the prevalence and impact of urinary incontinence would help educate both employers and employees, and may lead to the development of better management techniques in the workplace.     

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.     

Smoking as a predictor of long-term work disability in physically active and inactive people

Data from a Norwegian 4-year prospective questionnaire studywere used to test our hypothesis that smoking is a weaker predictorof long-term work disability in physically active than inactivepersons. Of 1,788 respondents who were working and not olderthan 62 years in 1990, 1,426 (80%) also returned a questionnairein 1994. For respondents who were taking physical exercise lessthan once a week, smoking predicted long-term work disabilityfour years later [odds ratio (OR)=2.24; 95% confidence interval(Cl)=1.30–3.87; p<0.01], when adjusting for age, sex,workhours per week, heavy lifting at work, emotional symptomsand musculoskeletal pain at time 0. In respondents who wereexercising at least once a week, there was no association betweensmoking and long-term work disability.     

Minor injuries, cognitive failures and accidents at work: incidence and associated features

BACKGROUND: There is a dearth of information examining minor injuries and cognitive failures in the workplace. AIMS: This study aims to describe the incidence of, and characteristics associated with, minor injuries, cognitive failures and accidents in the workplace. METHODS: The study was a community based postal questionnaire survey of people selected at random from the Electoral Registers of Cardiff and Merthyr Tydfil; 7980 questionnaires were returned. RESULTS: Frequent/very frequent minor injuries were reported by 9.8% of the workers and frequent/very frequent cognitive failures (e.g. problems of memory, attention or action) by 10.5%. Work accidents requiring treatment were reported by 5.6% of the workers. Minor injuries, cognitive failures and accidents were associated with a number of demographic and health factors. In addition, minor injuries, cognitive failures and accidents were found to be related to each other. CONCLUSIONS: A large number of workers experience accidents and minor injuries at work. Minor injuries are not recorded by official sources but could have implications in productivity and worker health. Factors identified in this study, as associated with injuries or accidents, could be addressed by specific workplace policies or by raising individual awareness of the risks.     

Treating physicians' perceptions of barriers to return to work of their patients in Southern Ontario

AIMS: The aim of this paper is to understand the treating physician's perspective with respect to the barriers that their patients face returning to work from injury and illness. METHODS: The methodology used was focus groups conducted in Southern Ontario with treating physicians. RESULTS: The main barrier identified by the treating physicians in the return to work process was the lack of accommodated work. The main areas identified for the use of additional resources was facilitated investigations, assessments and treatments for their patients and education and training for treating physicians. With respect to communication, physicians indicated that they wanted to know more about the work to which their patients were returning. CONCLUSIONS: Treating physicians believe that the most significant barriers for the timely return to work for their patients exist in the workplace, specifically related to lack of knowledge about appropriate modified work. The treating physicians' role in the return to work process is demanding due to insufficient time to deal with return to work issues, lack of training, not enough of the appropriate information and the treating physicians' role ambiguity.     

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.     

Low back pain interventions at the workplace: a systematic literature review

OBJECTIVE: To assess the effect of controlled workplace interventions on low back pain (LBP) through a review of controlled studies. The rising costs of employees with LBP have resulted in an abundance of offers to society and organizations of interventions to prevent and/or treat the problem. Little is known of the effect of the different interventions. METHODS: A systematic literature search based on the inclusion criteria: controlled trial, work setting and assessment of at least one of the four main outcome measures: sick leave; costs; new episodes of LBP; and pain. Effect of the interventions was reported for the four main outcome measures. RESULTS: Thirty-one publications from 28 interventions were found to comply with the inclusion criteria. Exercise interventions to prevent LBP among employees and interventions to treat employees with LBP have documented an effect on sick leave, costs and new episodes of LBP. Multidisciplinary interventions have documented an effect on the level of pain. CONCLUSIONS: The results show that there is good reason to be careful when considering interventions aiming to prevent LBP among employees. Of all the workplace interventions only exercise and the comprehensive multidisciplinary and treatment interventions have a documented effect on LBP. There is a need for studies employing good methodology.     

Fitness for work: the need for conducting a job analysis

Ensuring that employees are both physically fit for work by matching their capabilities with the physical requirements of their job, and physically fit for life by promoting health-related physical activities, are important and under-utilized tools in a company's arsenal for reducing absence and ill-health retirement (IHR). Both the Health and Safety at Work Act (1974) and the Disability Discrimination Act (1995) require evidence-based approaches to setting physical and medical employment standards. Proven fitness-related strategies include redesigning the most demanding tasks, selecting and training personnel who possess the necessary physical attributes, and assessing and redeploying personnel to jobs within their capability. An essential precursor to pursuing these strategies is to conduct a job analysis to quantify the physical demands of the job.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

Searching bibliographic databases for literature on chronic disease and work participation

BACKGROUND: The work participation of people with chronic diseases is a growing concern within the field of occupational medicine. Information on this topic is dispersed across a variety of data sources, making it difficult for health professionals to find relevant studies for literature reviews and guidelines. AIM: The goal of this project was to identify bibliographic databases and search terms that could be most useful for retrieving relevant studies on this topic. METHODS: Five broad questions regarding work participation and chronic disease were formulated, focusing on angina pectoris, depression, diabetes mellitus, hearing impairment and rheumatoid arthritis. A search strategy for retrieving information on these questions was developed and run in five bibliographic databases: Medline, EMBASE, PsycINFO, Cinahl and OSHROM. Relevant publications were selected from the search results. The utility of the selected databases and search terms was evaluated by analysing the number of relevant publications that were retrieved. RESULTS: The number of relevant publications retrieved from each database varied. Most (84%) of the relevant publications that were retrieved from each database were unique to that source. For each database, specific search terms for the concept of 'work' were useful for retrieving relevant publications. CONCLUSION: Medline, EMBASE and PsycINFO are useful databases for quick searches. Useful search terms for the concept of 'work' are work capacity, work disability, vocational rehabilitation, occupational health, sick leave, absenteeism, return to work, retirement, employment status and work status. For comprehensive searches, we recommend additional searches in Cinahl and OSHROM, adapting the search terms to specific databases.     

An investigation of the relationship between psychological health and workload among managers

BACKGROUND: Anecdotally, many workers complain of stress at work. However, the relationship between work and stress needs clarification to allow risk assessment and risk management of this hazard in the workplace. OBJECTIVES: To examine relationships between working hours, perceived work stressors, and psychological health in a group of managers. METHODS: Managers at two factories were invited to participate in an anonymous cross-sectional survey. All were asked to complete a work diary for a period of 1 week and a questionnaire comprising the 30-item General Health Questionnaire, an anxiety and depression scale, and questions identifying perceived workplace stressors. RESULTS: Over 60% of managers were above the threshold of caseness on at least one measure of psychological health. No statistically significant relationship was demonstrated between actual hours of work and psychological health. A relationship was demonstrated between some perceived workplace stressors and actual hours worked, and between some perceived workplace stressors and psychological health. CONCLUSIONS: A large proportion of managers in a typical production environment appeared at risk of developing psychological illness. Hours of work were not directly related to psychological health, but were significantly associated with individual perception of some work stressors which, in turn, were associated with measures of psychological health. Perceived workload appeared more important in determining psychological health than actual workload.     

Work activity analysis of Finnish occupational health professionals

BACKGROUND: Some Finnish studies have dealt with how occupational health nurses divide their working hours but other occupational health professionals have not been evaluated. AIMS: This study describes how occupational health professionals allocate their working hours between main tasks. METHODS: Questionnaires were sent to 250 occupational health professionals, of whom 176 (70%) returned the completed forms. The data were analysed by using frequencies, means and one-way analysis of variance test. RESULTS: Employee-oriented tasks accounted for roughly 50% of working hours from all occupational health professionals. The remaining working hours were shared between workplace visits, co-operation with partners, other occupational health care responsibilities and tasks in other health care fields, especially in the health care centres. These working hours varied greatly between the different occupational health professional groups. All units employed full-time occupational health nurses, but the services of physicians, physiotherapists and psychologists were usually provided part-time or even restricted to a few hours each week because these services were difficult to obtain. Occupational health nurses working in the municipal health care centres spent more time on workplace visits than other nurses. Employee-oriented tasks were emphasized more in physicians', physiotherapists' and psychologists' work, especially in private medical health care units and in the jointly owned health care units. CONCLUSIONS: The amount of time occupational health professionals are able to spend on workplace activities appears to be determined by the type of their employer.     

Upper limb disorders among coopers in the Scotch whisky industry

BACKGROUND: Coopering is a physically demanding trade which has existed for >500 years. Anecdotal clinical evidence suggested increased prevalence of upper limb disorders in the population of coopers in one organization. AIMS: To investigate the prevalence of upper limb disorders in coopers and non-coopers. To identify differences in prevalence, and any relationship between the findings and the work practices. METHOD: Cross-sectional study of 108 coopers and 110 non-coopers. The Standardized Nordic questionnaire for the analysis of musculoskeletal symptoms was administered to all participants, who also underwent a clinical assessment for upper limb disorders. RESULTS: Coopers were more likely to report elbow pain in the past 12 months (OR 3.4; 95% CI: 1.8-6.2) and pain in the last 7 days (OR 4.7; 95% CI: 2.0-8.9) and this was likely to lead to prevention of activity in the past 12 months associated with the elbow (P < 0.05). Clinical evaluation highlighted a higher prevalence of upper limb disorders in coopers (OR 9.8; 95% CI: 3.9-24.3) with epicondylitis predominating (OR 8.4; 95% CI: 2.8-25.0). There was also a higher prevalence of problems in the wrist and hand among coopers (OR 8.15; 95% CI: 1.04-64; P = 0.03). Logistic regression analysis confirmed the risk of upper limb disorder in coopers (P < 0.03) accounting for age (P < 0.05) and years of service (P > 0.25). CONCLUSIONS: Coopers appear to be at an increased risk of upper limb disorders. Work practices have been reviewed and a number of changes have been implemented to reduce this risk. Further study of this group is merited in future to determine the effect of changes in work practice on the risk of upper limb disorders.     

Physicians' beliefs in the assessment of work attribution when reporting musculoskeletal disorders

BACKGROUND: There is considerable uncertainty about work-relatedness and musculoskeletal disorders in general, and it is also not clear how physicians decide whether work has caused a disorder in an individual patient. AIMS: To investigate physicians' beliefs about assessment of occupational attribution for work-related musculoskeletal disorders. METHODS: A questionnaire survey was sent to 526 occupational physicians and 248 rheumatologists on: characteristics of cases seen, assessment of work attribution, definition of work-relatedness and threshold for case reporting. Continuous variables were analysed by mean, standard deviation, an independent two-sample t-test and the Mann-Whitney test. Mean and median values were calculated and Spearman's rank test was applied to ranked data. RESULTS: Questionnaires were completed by 68% occupational physicians and 64% rheumatologists. Both groups of physicians believed that 'history of onset in relation to workplace changes' and 'symptoms consistent with work exposure' were the most important factors suggesting work attribution. They considered that the most important objective of a reporting scheme was detection of trends in disease incidence and that the most suitable criteria for defining work-relatedness was the probability that exposure at work 'more likely than not' caused the condition (mean 0.73; SD=0.17), in a perceived likelihood scale (0-1). CONCLUSION: There was a strong agreement between occupational physicians and rheumatologists on questions about work-relatedness and musculoskeletal disorders. The level of probability for concluding work-relatedness has been quantified.     

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.     

Prevalence of musculoskeletal symptoms among aluminium workers

The aim of this study was to determine the prevalence of musculoskeletal symptoms (MSS) in workers in the aluminium industry, and to test the relationship with work by using the duration of employment as a measure of exposure. A total of 5654 workers (92%) answered a questionnaire. Operators, who were more exposed to physically demanding work, showed a greater incidence of MSS than did office workers. Among operators, the duration of employment was significantly correlated with MSS in nine out of ten areas of the body, when adjusted by multiple regression analyses for age, gender, height, weight, smoking and physical activity. Among office workers this relationship was weaker and was significant only for neck and lower back areas. The higher prevalence of MSS among operators and the association between their duration of employment and MSS suggests that a higher risk of MSS is related to the working environment.     

The Bristol Stress and Health Study: accidents, minor injuries and cognitive failures at work

BACKGROUND: Accidents and injuries at work account for several million working days lost each year. Cognitive failures (problems of memory, attention or action) can lead to accidents and injuries in certain contexts. AIM: This work describes the prevalence and associations of workplace accidents, minor injuries and cognitive failures reported by respondents to a follow-up postal questionnaire as part of the community-based Bristol Stress and Health Study. METHODS: Postal questionnaires were sent to 4673 people who participated in the first phase of the study (in which questionnaires were sent to individuals selected at random from the electoral roll). RESULTS: Four per cent of workers reported an accident at work, 8% reported quite or very frequent minor injuries and 13% reported quite or very frequent cognitive failures. Accidents at work were associated with being male, smoking and higher negative job characteristics. Respondents reported workplace accidents at a level similar to the overall UK rate. Accidents and minor injuries, and minor injuries and cognitive failures, shared common associations and all three outcomes were associated with each other. CONCLUSION: Information about cognitive failures is important in the study of accidents and injuries at work. In addition, negative job characteristics represent part of the context in which human error is translated into injury.     

Evaluation of a multidisciplinary treatment for patients with chronic non-specific upper-limb musculoskeletal disorders: a pilot study

BACKGROUND: Upper-limb musculoskeletal disorders (ULMSDs) are considered a major health and socio-economic problem. However, knowledge about the effect of treatment programmes is scarce. Objective To evaluate the effect of a multidisciplinary treatment programme on well-being, disability and return to work in patients with chronic non-specific upper-limb disorders. METHODS: A longitudinal and uncontrolled design with pre-post measurements was used. Forty-one patients on long-term sick leave attended for multidisciplinary treatment aimed at training in personal coping strategies and improving activities of daily living. Outcome measures were generic well-being (SF-36), disability (DASH) and return to work (working hours). RESULTS: General well-being improved significantly between pre-treatment and post-treatment. Level of disability declined significantly between pre-treatment and post-treatment. In 63% of the patients, return to own work was complete at follow up, 4 months post-treatment. CONCLUSION: The results of this uncontrolled intervention study suggest that multidisciplinary treatment programmes improve general well-being, reduce disability and facilitate return to work in patients with chronic non-specific ULMSDs.     

Sick leave analysis among self-employed Dutch farmers

BACKGROUND: Agriculture is one of the most physically demanding and risky industries. Aim The objective of this study was to provide baseline data on the diagnoses, occurrence and duration of sick leave of self-employed Dutch farmers. METHOD: A database of 22 807 sick leave claims of 12 627 farmers during the period 1994-2001 was analysed. RESULTS: Most of the claims (61%) were for musculo-skeletal injuries and disorders. The mean cumulative incidence (CI) was 10.2 claims per year per 100 farmers and did not change over time. However, it varied per agricultural sector and per age category, being lowest in arable farming and in the youngest age category and highest in mushroom farming and in the oldest age category. The duration of sick leave depended both on diagnosis and age category: the slowest recovery from sick leave was seen in farmers with respiratory diseases and farmers in the oldest age category. CONCLUSION: The results make it easier to identify groups of farmers to be targeted to prevent sick leave. To reduce the occurrence of sick leave in agriculture, the strategy should be to prevent musculo-skeletal injuries and disorders. Furthermore, a sector-specific approach is recommended, so that preventive actions can be focused on working conditions-specifically on workload and work safety. Efforts to shorten the duration of sick leave will also be valuable to obtain a reduction of sick leave.     

Falls and fractures in women at work

BACKGROUND: Older women have been observed to have more serious injury particularly fractures after slips, trips or falls at the workplace. It is unclear whether this excess reflects a greater likelihood of falling or a greater proportion presenting with fractures once the fall has occurred. METHODS: Two studies were carried out: Study A, of 130 women who fell at work and matched referents, and Study B, of 120 women who fell at work and sustained a major fracture and 314 matched referents who fell but for whom no fracture was recorded. In Study A, the workplace of the case and referent was observed, questionnaires completed and objective health measures carried out. Study B relied on information obtained from the subject by postal questionnaire. RESULTS: Women who fell were older than referents matched on workplace and occupation, but age did not continue to be a significant factor after allowing for bodyweight and use of spectacles. Fractures were more common in older women who fell, particularly post-menopausal women with low body mass. The risk of fracture increased steadily with age without an obvious discontinuity around the likely age of menopause. CONCLUSIONS: The observed excess of fractures in older women falling at work appeared to be explained by the greater risk of fracture among those who fell.