Occupational Medicine - current issue

In this issue of Occupational Medicine

Power to the people--open access publishing and knowledge translation

JMW Turner, Keelmen Heaving in Coals by Moonlight 1835

Consistency of secondary colour vision tests in transport industries BackgroundOccupational colour vision testing is a requirement in a number of transport industries, and there are a number of tests that are considered acceptable by the various industry regulatory bodies.AimsTo review the occupational colour vision tests currently in use nationally and internationally and determine whether they give consistent results.MethodsA systematic review of the evidence was carried out according to standard methods. The Ovid Medline database was searched from 1946 to March 2013 using a broad and inclusive strategy.ResultsA total of 8951 citations were identified, from which 20 papers were selected for data analysis. Of these papers, 13 of 20 assessed test sensitivity and specificity, and 11 papers measured the number, type and severity of colour vision deficiency of subjects passing the tests. Three studies also measured test repeatability. The quality of studies included was generally good. Sensitivity and specificity ranged from 64% to 100% and 88% to 100%, respectively. The studies evaluating the newer screen-based tests reported the highest sensitivity and specificity. The marked variability reported between tests and within tests can be attributed to many factors including test protocol, sample selection, test distance and time for dark adaptation.ConclusionsThere was low consistency between the colour vision tests examined. Lantern tests cannot be used to identify type or severity of colour vision deficit and, when used as a screening test for ‘colour safe’ status, give variable results. These results highlight the need for standardization across the transport industries.

Location, vocation, procreation: how choice influences life expectancy in doctors BackgroundStress and mortality are negatively correlated and it is generally accepted that certain professions are more stressful than others. Medical graduates begin as a relatively homogenous population who then choose vastly different career options making doctors an ideal population in which to try to assess whether job stress is likely to be causal to increased mortality.AimsTo establish the influence of various modifiable risk factors on the life expectancy of UK doctors.MethodsWe analysed a decade of obituaries from the British Medical Journal published between January 2003 and December 2012. Data included age at death (AAD), specialty, region (deanery), marriage status and children.ResultsA total of 3068 obituaries were eligible for inclusion. Mean AAD was 78.5 years. Male sex was associated with a significantly increased AAD by an additional 3.8 years (95% CI 2.4–5.2 years, P < 0.001). Public health, obstetrics and gynaecology and laboratory medicine specialties were all associated with significantly increased AAD (P < 0.05). London and Northern Ireland deaneries were both associated with significantly increased AAD (P < 0.05). Each additional child was associated with a relative increase in AAD of +1.1 years (95% CI 0.7–1.4 years, P < 0.001).ConclusionsOur results show that location and career choices may affect life expectancy. While this does not necessarily reflect quality of life, the additional years of life gained from having extra children have a positive effect on your quantity of life.

Sun safety knowledge and practice in UK postal delivery workers BackgroundPostal delivery workers spend a large proportion of their work time outdoors, placing them at increased risk of skin cancer. To date, no studies have examined occupational sun safety knowledge and practice within this group in the UK.AimsTo describe the occupational sun safety knowledge and practice of UK postal delivery workers and to investigate the association of demographic, personal and occupational factors with knowledge and practice in order to identify potential strategies for improving sun safety in this occupational group.MethodsPostal delivery workers completed a questionnaire that collected data on occupational sun safety knowledge and practice in addition to demographic, personal and workplace characteristics. One-way analysis of variances were applied to assess differences in knowledge and practice by these characteristics.ResultsA total of 1153 postal delivery workers completed the questionnaire, a 60% response rate. Thirty-three per cent reported receiving sun safety training within the previous 12 months. The majority of respondents reported correct knowledge on three of the six domains and good practice on four of the six behavioural domains. However, only one-fifth of respondents reported wearing sunglasses and ensuring a plentiful intake of water. Knowledge and practice differed significantly according to demographic, personal and workplace characteristics.ConclusionsThere is a need to raise the profile of occupational skin cancer in this occupational group and to increase the priority given to occupational sun safety policies alongside targeted and tailored interventions, the effect of which can be evaluated.

The relationship between clinical and standardized tests for hand-arm vibration syndrome BackgroundStandardized laboratory tests are undertaken to assist the diagnosis and staging of hand–arm vibration syndrome (HAVS), but the strength of the relationship between the tests and clinical stages of HAVS is unknown.AimsTo assess the relationship between the results of thermal aesthesiometry (TA), vibrotactile (VT) thresholds and cold provocation (CP) tests with the modified Stockholm scales for HAVS and to determine whether the relationship is affected by finger skin temperature.MethodsConsecutive records of workers referred to a Tier 5 HAVS assessment centre from 2006 to 2015 were identified. The diagnosis and staging of cases was undertaken from the clinical information contained in the records. Cases with alternative or mixed diagnoses were excluded and staging performed according to the modified Stockholm scale without knowledge of the results of the standardized laboratory tests.ResultsA total of 279 cases of HAVS were analysed. Although there was a significant trend for sensorineural (SN) and vascular scores to increase with clinical stage (P < 0.01), there was no significant difference in scores between 2SN early and 2SN late or between 2SN late and 3SN. There was moderate correlation between the TA and VT scores and the clinical SN stages (r = 0.6). This correlation did not change when subjects were divided into those with a finger skin temperature <30 and >30°C. CP scores distributed bimodally and correlated poorly with clinical staging (r = 0.2).ConclusionsStandardized SN tests distinguish between the lower Stockholm stages, but not above 2SN early. This has implications for health surveillance and UK policy.

Its not all hot air

Factors affecting finger and hand pain in workers with HAVS BackgroundPain and its management are important aspects of hand–arm vibration syndrome (HAVS).AimsTo determine the factors associated with finger and hand pain in workers with HAVS and, specifically, to assess the impact of several neurological variables as well as the vascular component of HAVS, grip strength and age.MethodsWe assessed men with HAVS at a hospital occupational medicine clinic over 2 years. Subjects scored finger and hand pain separately using the Borg Scale (0–10). The possible predictors we evaluated included the Stockholm Neurological Scale (SNS) and Stockholm Vascular Scale (SVS) stages, current perception threshold (CPT), carpal tunnel syndrome (CTS), ulnar neuropathy, grip strength and age. We carried out nerve conduction testing to confirm the presence of CTS and ulnar neuropathy and measured CPT in the fingers at 2000 Hz, 250 Hz and 5 Hz corresponding to A-beta (large myelinated), A-delta (small myelinated) and C (unmyelinated) fibres, respectively. We calculated Spearman rank correlations to examine the relation between finger and hand pain and possible predictor variables.ResultsAmong the 134 subjects, the median (25th–75th percentile) pain scores were 6 (4–8) for the fingers and 5 (1–7) for the hands. We found statistically significant correlations with finger pain for the SVS stage (r = 0.239; P < 0.01) and CTS (r = 0.184; P < 0.05). The only statistically significant correlation identified for hand pain was a negative correlation with grip strength (r = –0.185; P < 0.05).ConclusionsManagement of finger and hand pain in HAVS should focus on the correlates we have identified.

Fit for work? Evaluation of a workshop for rheumatology teams BackgroundPeople with rheumatoid arthritis (RA) may rapidly cease work prematurely due to ill-health. A recent survey noted that a quarter of respondents with RA experienced job loss within a year of diagnosis and 50% stopped work within 6 years.AimsTo develop and pilot workshops to increase the knowledge, skills and confidence of rheumatology team members to support work-related issues in outpatient clinics.MethodsA 3-h interactive workshop, informed by rheumatology experts and the Royal College of General Practitioners (RCGP) National Education Programme (NEP) about work and health, was developed to address both knowledge and skills in the management of health and work consultations in an outpatient setting. Questionnaires were developed for use pre- and immediately post-workshop, with questions that focused on the confidence of delegates in managing these discussions and the importance they placed upon them.ResultsNinety-nine participants attended five workshops throughout the UK between 2013 and 2104. Seventy-three per cent (72) completed the post-workshop questionnaire. Eighty-nine per cent found the workshop useful or very useful, 88% found it relevant or very relevant and 79% responded that it had an impact or a considerable impact on their practice. Wilcoxon matched pairs signed rank tests were carried out that showed an overall increase in confidence after training.ConclusionsThe results suggest that the workshop was both relevant and useful to participants and had an impact on their practice. This was true for all specialities. The workshops also highlighted participants’ desire to understand how to use the ‘fit note’ to enhance their patient management.