RESEARCH PLUS an Online Resource Signposting the Latest Research in Occupational Health
Research Plus December/January 2014
Occupational lifting during pregnancy
Occupational lifting during pregnancy is associated with a small increased risk of pre-term birth – particularly lifting loads greater than 20kg, more than 10 times a day – a Danish study of nearly 63,000 pregnant women finds. Participants were asked if and how frequently they had to lift more than 20kg (approximately ‘a crate of beer’) or 11kg–20kg (‘less than a crate of beer and more than a bucket of water’). One-quarter (26.4%) of participants reported lifting heavy loads at work; 2.9% lifted more than 1,000 kg a day. After adjusting for confounding factors, such as maternal age and smoking during pregnancy, there remained a dose–response association between daily lifting and pre-term birth (p < 0.001 for trend). The association was strongest for those lifting more than 1,000 kg/day (odds ratio (OR) = 1.50; 95% confidence interval (CI) 1.03–2.19).
Occupational and Environmental Medicine 2013; 70: 782–788
Sleep quality
High job demands and low job control are significant predictors of poor sleep quality, according to this systematic review (20 included papers). Poor sleep quality is defined as having at least one of the following symptoms at least three times a week: difficulty initiating sleep; problem maintaining sleep; waking up too early; or non-restorative sleep. Analysis of 16 longitudinal studies – three of high quality – found sleep quality to be negatively associated with job demands and positively associated with job control, with small to moderate effect sizes (significant ORs ranged from 1.24 to 2.05). There was just one high-quality intervention study, where hospital employees implemented solutions to various problems with job demand, job control, social support and effort–reward imbalance. Work characteristics improved, but there was no change in sleep quality.
Scandinavian Journal of Work, Environment and Health 2013; online first: doi: 10.5271/sjweh.3376
Cost of occupational hand eczema
The annual costs to society of poorly managed occupational hand eczema is €8,800 per person, with most costs attributable to lost productivity, according to this German study of 151 workers admitted to an eczema clinic. Current patient status, sickness absence and estimated resource use (physician visits, diagnostic and therapeutic procedures) in the 12 months before entering the clinic were obtained from participants’ medical histories and from structured interviews. Ninety-three of the patients had moderate to severe eczema. Most had visited a dermatologist, 63% had taken at least a day’s sickness absence in the previous year, and 34% were off sick at enrolment. Mean absence among those who had taken sick leave was 76 days; one in nine took at least six months off. Sickness absence accounted for 70% of total costs, followed by inpatient rehabilitation (13%) and outpatient services (8%). The estimates exclude costs of early retirement, work disability and retraining. The authors acknowledge that their findings relate to workers who had been referred for special treatment, and costs may differ in other situations.
Contact Dermatitis 2013; online first: doi:10.1111/cod.12038
Less power to elbow evidence
Updated treatment guidelines from the American College of Occupational and Environmental Medicine include 270 recommendations and 13 diagnoses for elbow disorders, but most are based on expert consensus rather than quality evidence. Nineteen high- and 89 moderate-quality trials were included in the systematic review – 90% addressed lateral epicondylitis (LE – ‘tennis elbow’). Consensus recommendations are used where direct evidence is lacking. For example, for treating LE there is moderate evidence to support the use of topical non-steroidal anti-inflammatory drugs and limited evidence for using ultrasound or glucocorticosteroid injections. However, while the following are recommended, there is inconclusive supporting evidence: restricting work tasks; tennis elbow bands, straps and braces; home exercises; physiotherapy; acupuncture; and self application of heat or cold. Neither manipulation nor mobilisation are recommended (limited evidence). Various ergonomic interventions and return-to-work programmes are recommended, but supporting evidence is insufficient.
Journal of Occupational and Environmental Medicine 2013; online first: doi: 10.1097/JOM.0b013e3182a0d7ec
Upper limb injuries
There is no evidence from randomised controlled trials that vocational rehabilitation either does or does not promote return to work in individuals with acute upper limb injuries, according to this Cochrane systematic review. Vocational rehabilitation is widely practised, covers a range of interventions designed to help individuals cope better at work, and includes workplace adjustments and physical exercises. The reviewers identified 15 potentially relevant studies, from 322 citations, but none met inclusion criteria. Studies involving workers with chronic upper-limb conditions and those with cumulative trauma disorders or repetitive strain injuries, such as tendonitis or tenosynovitis, epicondylitis, and carpal tunnel syndrome, were excluded. Quality research is needed to verify current OH practice.
Cochrane Database of Systematic Reviews 2013; 10: CD010002
Problem solving reduces recurrent mental health absence
A problem-solving intervention successfully reduced both the incidence of recurrent sickness absence, and time to recurrent sickness absence in workers with common mental health disorders (CMDs), according to this cluster-randomised controlled trial. Eighty workers took part in the ‘Stimulating healthy participation and relapse prevention at work’ (SHARP) programme, based on a mental health management guideline developed by the Netherlands Society of Occupational Medicine. SHARP is a five-step problem-solving process, applied in the first two weeks of the return to work and delivered by an occupational physician. Seventy-eight workers were given ‘care as usual’ by occupational physicians. The incidence of recurrent CMD sickness absence during the 12-month follow-up was significantly lower in the SHARP group than in the control group (OR = 0.40; CI 0.20–0.81); time to recurrent sickness absence was also lower (hazard ratio (HR) = 0.53; CI 0.33–0.86).
Occupational and Environmental Medicine 2013; online first: doi: 10.1136/oemed-2013-101412
Cost-effective intervention
A worksite intervention to improve the health of construction workers proved cost-effective in terms of reducing sickness absence even though it had no impact on measured health outcomes. A total of 293 workers took part in a cluster randomised controlled trial involving 15 departments across six Dutch construction companies – eight departments randomised to the intervention and seven to the control. The six-month intervention consisted of individual training sessions with a physiotherapist to reduce physical workload, an instrument to raise awareness of the importance of rest breaks, and two ‘empowerment’ group training sessions, delivered alongside standard heath and safety ‘toolbox’ training. The control groups received only the health and safety training. At 12 months, there were no significant improvements in work ability, health or mental health, or musculoskeletal symptoms. However, the mean employer cost associated with sickness absence was significantly lower in the intervention group than in the control group (-€760; CI: -€1,497 to -€156). Employer costs remained significantly lower after including the cost of the intervention; saving €6.4 for every €1 invested.
American Journal of Industrial Medicine 2013; online first: doi: 10.1002/ajim.22267
Long working hours
Long working hours are significantly associated with depression, anxiety, sleep, and coronary heart disease, even after removing the influence of shiftwork, this systematic review finds. Evidence for the impact of long working hours on diabetes mellitus, metabolic syndrome, mental and behavioural disorders, cognitive function, and heath-related behaviours (eg alcohol use, smoking and physical behaviour) was insufficient. Long working hours were defined as working time over 40 hours a week or more than eight hours a day, and included time spent on work brought home.
Scandinavian Journal of Work, Environment and Health 2013; online first: doi: 10.5271/sjweh.3388
National return-to-work programme
A randomised controlled trial involving more than 3,000 participants in three Danish municipalities suggests that a multi-component government-funded return-to-work (RTW) programme can be effective in getting people back to work and off sickness benefits but success or failure depends on socio-demographic and administrative factors. The Danish RTW programme is delivered by trained RTW teams and provides coordinated, tailored and multidisciplinary interventions to people sick-listed for any reason, and regardless of employment status (employed, self-employed, temporary or unemployed). The trial participants were all working-age adults in receipt of long-term (greater than eight weeks) sickness benefits. RTW was significantly improved in one of the municipalities (HR = 1.51; CI 1.31–1.74) but there were no significant improvements in the other two. There was a significant intervention effect between the three regions (p < 0.00005), which the authors put down to ‘profound’ differences between the municipalities, including socio-demographic factors and the way the administrations interpret and manage benefits legislation.
Scandinavian Journal of Work, Environment and Health 2013; online first: doi: 10.5271/sjweh.3383
Successful weight-loss programme has no impact on absence
A one-year workplace intervention previously reported as effective in reducing bodyweight among overweight female healthcare workers failed to improve absence or presenteeism, according to this cluster randomised controlled trial1. The intervention comprised a calorie-limited diet, physical exercise and weekly cognitive behavioural training sessions during working hours (54 participants). The 44 control group participants were offered lectures on nutrition during working hours. Randomisation was by work team. As previously reported2, the intervention significantly reduced body weight (mean – 6kg), and reduced body fat percentage. However, there was no impact on sickness absence, productivity, or work ability after three months or one year.
1 Journal of Occupational and Environmental Medicine 2013; 55(10): 1186–1190
2 BMC Public Health. 2012; 12: 625
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December/January 2013/14