Occupational Medicine-Oxford最新文献

Background: Hand-arm vibration syndrome (HAVS) is an occupational disease associated with long-term exposure to power tools leading to hand-transmitted vibration exposure. Prior research has focussed on physical manifestations with little known about the psychological impacts of HAVS.

Aims: To examine if HAVS severity and/or functional impairment is associated with psychological outcomes.

Methods: We conducted a cross-sectional study collecting data through a survey and retrospective chart review of workers being assessed for HAVS at an occupational medicine clinic. We collected information on demographics, work conditions, disease characteristics and physical and psychological outcomes as measured through validated instruments (SF-12, QuickDASH, GAD-2, PHQ-2). Descriptive statistics and bivariate analyses were followed by multivariable models to explore associations between mental health outcomes and predictor variables.

Results: Participants (N = 94; 56% response rate) were male with a mean age of 48.2 years. The majority (62%) worked in the mining sector, and 27% of participants reported feeling depressed and 35% reported showing little interest in or pleasure in doing things, while 28% reported clinically significant anxiety symptoms. In multivariable models, the QuickDASH, a measure of upper-extremity function and disability, was the only significant predictor of psychological outcomes.

Conclusions: Workers with HAVS have poorer mental health and physical functioning outcomes in comparison to the general population. Employers should consider tailored policies and interventions to address the mental health of workers with HAVS.

Background: Many studies have documented exposure to psychosocial factors in healthcare workers (HCWs) during the coronavirus disease 2019 (COVID-19) pandemic. Few have done it prospectively with open-ended questions.

Aims: To describe the evolution of stress factors reported by HCWs during the pandemic.

Methods: A prospective cohort of 4964 HCWs (physicians, nurses, healthcare aides and personal support workers), from four Canadian provinces, received four online questionnaires between the spring 2020 and 2022. Responses to an open-ended question on stressful events were coded into 25 stressors. Multilevel logistic regressions assessed trends in stressors, and the effect of gender, occupation and age.

Results: In 2020, 91% of participants reported at least one stressor compared to 51% in spring 2022. Overall, eight stressors were reported 1000 times or more among 16 786 questionnaires. Five stressors decreased over time: fear of COVID-19, problems with personal protective equipment, changing guidelines, management of difficult cases and changes to work routine. Conversely, an increasing trend was noted for volume of work, and poor behaviour from the public or colleagues. Difficulties managing patients' deaths remained steady. Changes in stressors over time were similar by gender, professional role and age group, although the reporting of some stressors varied within subgroups.

Conclusions: Reporting of most stressors decreased over the pandemic, except for stressors arising from the changing demands on staff and patients as the pandemic progressed. Such changes in workplace psychosocial factors need to be addressed by prevention programmes to ensure an appropriate support response to the needs of HCWs.

Background: Systemic sclerosis (SSc) is the connective tissue disease with the highest individual mortality. Crystalline silica is known to be an occupational risk factor for SSc. To assess past crystalline silica exposure, we aimed to study the validity of a job exposure matrix (JEM) to assess occupational exposure to crystalline silica compared to specific occupational interviews in two populations of SSc patients.

Aims: To demonstrate the reliability of JEM for the assessment of occupational exposure to hazards such as silica, in severe rare disorders like SSc.

Methods: Patients from two university hospital centres underwent standardized assessment of occupational silica exposure and collected job histories through face-to-face interviews. A JEM from the French program Matgéné was used to assess silica exposure and compared to the standardized interview results. Standard metrics were computed for evaluate the accuracy of JEM.

Results: 67 participants from Rennes, and 119 from Tours were included, with respectively 10.5% and 18.0% of patients with silica exposure based on the results of the interview. The JEM with 50% probability cut-off had a good performance when compared with the classic assessment method. A cumulative exposure index from JEM over 250 had an area under the curve between 0.76 and 0.79 and also a very high positive likelihood ratio (17.14 and 10.29).

Conclusions: Despite limitations inherent to JEMs and associated validation methods, the JEM used in this setting provided accurate results to assess occupational exposure to crystalline silica for clinical purposes such as in SSc patients, especially to detect positive cases.

Background: There is growing interest in understanding neurodevelopmental disorders such as Attention-deficit/hyperactivity disorder (ADHD) among doctors. However, the current understanding of ADHD and its association with mental well-being in doctors is limited.

Aims: This study investigated the significance of ADHD among doctors with mental health difficulties accessing a national mental health service for doctors in England.

Methods: Electronic records from 2877 doctors seeking mental health care through the National Health Service Practitioner Health service were analysed. Demographic data, psychopathology scales (PHQ-9 for depression, GAD-7 for anxiety, Core-10 for psychological well-being) and ADHD screening using ADHD Self-Report Scale (ASRS) were examined. Analyses were conducted to explore associations between ADHD screening, demographic variables and co-existing mental health disorders.

Results: The study revealed that over one-third (35%) of doctors in this study sample screened positive for ADHD using the ASRS questionnaire. The male-to-female ratio for screened positive was 1.1:1. The number of doctors screening positive for ADHD reduced with age. A substantial portion of doctors who screened positive for ADHD also exhibited symptoms of co-existing mental health disorders such as anxiety and depression.

Conclusions: This study highlights that assessments for ADHD among doctors presenting with mental health difficulties can be important and relevant. Validated screening tools can be used in this process. The high rate of psychopathology among those who screened positive for ADHD in this study sample indicates the need for detailed assessments to understand the complex dynamic of ADHD symptoms and psychiatric disorders. Recognizing ADHD is important as treatments are different to other psychiatric disorders.

Background: Poor mental health is highly prevalent among schoolteachers. Different occupational, contextual and personal factors have been identified as sources of their psychological distress.

Aims: To explore the association of classroom-level variables with teachers' mental health over the course of an academic year.

Methods: This study included 80 primary schoolteachers and 2075 pupils from the STARS trial conducted in England, which explored the impact of the Incredible Years Teacher Classroom Management programme. Linear regression models examined the relationships between classroom-level predictor variables and teachers' psychological distress, as measured by the Everyday Feeling Questionnaire, at 1 and 9 months into the school year. Predictor variables included classroom size and demographic composition, amount of teaching assistant support, and pupils' mental health, as measured by the Strengths and Difficulties Questionnaire and the Pupil Behaviour Questionnaire. Analyses were adjusted for teacher length of service and trial arm status.

Results: One month into the school year, fully adjusted analyses showed that having a classroom with a higher proportion of male pupils was associated with worse teacher mental health. None of the classroom-level stressors were associated with teacher mental health at 9 months.

Conclusions: Classroom gender balance was associated with teacher's mental health at the beginning but not at the end of the academic year. It is important to consider classroom-level variables when developing interventions and policies for teacher mental health.

Background: There are currently 2.5 million people economically inactive in the UK due to sickness. The government is considering a range of new initiatives to bring them back into the workforce; however, a lack of occupational health (OH) professionals, who play an important part in the recovery of physical and mental conditions that would otherwise inhibit employees from working, is hindering these efforts.

Aims: To identify factors that make OH attractive as a source of employment with the aim of assisting those undertaking recruitment to the specialism.

Methods: We conducted a qualitative study comparing the views of 13 OH nurses and doctors ('insiders') and 45 students and professionals from other medical and nursing fields ('outsiders') across the UK. Both groups provided their perceptions about what makes OH an attractive career. Data collection involved a mix of interviews and focus groups conducted from March to July 2023. Transcripts were thematically analysed using NVivo 14 to manage the data.

Results: Both groups highly valued the work-life balance offered by OH work, which represents a positive point of attraction to employment. In addition, people working in OH talked extensively about more intrinsic rewards-the opportunity to be impactful, to enjoy job variety and to practise preventative approaches.

Conclusions: The intrinsic rewards that OH work brings need to be advertised more widely to attract potential recruits who are 'a good fit' to OH and will be committed to the field.

Background: Understanding of hazardous alcohol drinking and insomnia among Australian ambulance personnel is limited. Australian ambulance organizations have strengthened their organizational human resource management (HRM) to promote their employees' healthy lifestyles, health and well-being.

Aims: To describe the prevalence of hazardous alcohol consumption and insomnia among Australian ambulance personnel and to explore their associations with the organizational HRM strength.

Methods: This cross-sectional study was conducted on 492 ambulance personnel randomly selected from three Australian states. The Alcohol Use Disorders tool, The Insomnia Severity Index and the Perceived HRM System Strength instrument measured alcohol consumption, insomnia and HRM strength. Descriptive analyses, bivariate association analyses and general linear models were used for data analysis.

Results: Twenty per cent of Australian ambulance personnel consumed alcohol at a hazardous level and 68% experienced clinically significant insomnia. There was no significant association between organizational HRM strength and ambulance personnel's hazardous alcohol consumption. There was a significant association between organizational HRM strength (consensus) and ambulance personnel's insomnia experience.

Conclusions: Hazardous alcohol consumption and insomnia were concerns among Australian ambulance personnel. Even though strengthening the HRM system might reduce their experience of insomnia, simply strengthening the HRM system could not reduce their hazardous alcohol consumption.

Background: Sleep of inadequate quality, duration or regularity has potential negative physical and mental health outcomes. The impacts of poor sleep within the paramedic occupation are not well understood.

Aims: This review aimed to determine the prevalence of insomnia, excessive daytime sleepiness and poor sleep quality amongst paramedics, and to identify any relationships between insomnia, excessive daytime sleepiness, poor sleep quality and other health-related outcomes.

Methods: A systematic search identified studies that measured excessive sleepiness, insomnia or poor sleep quality using validated measures. The population was limited to paramedics in Australia, New Zealand or the UK owing to the similar nature of the workload, education standards, shift patterns and scope of practice.

Results: Four studies were included. All used the Pittsburgh Sleep Quality Index, two used the Epworth Sleepiness Scale and one used the Insomnia Severity Index. Sample sizes ranged between 60 and 342. The weighted mean prevalence of excessive daytime sleepiness was 30 %, and poor sleep quality reported as 71%. Only one study measured the association between sleep and other health-related outcomes; this study reported an association between sleep quality and multiple measures of mental health.

Conclusions: The findings of this review suggest that paramedics experience both poor-quality sleep and excessive daytime sleepiness, and further suggest that there may be an association between poor sleep quality and mental health. Given sleep impacts a variety of health outcomes, as well as impacts work performance, research on the specific components of sleep is important.