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1.  Evaluation of a case management service to reduce sickness absence 
Background
It is unclear whether and to what extent intensive case management is more effective than standard occupational health services in reducing sickness absence in the healthcare sector.
Aims
To evaluate a new return to work service at an English hospital trust.
Methods
The new service entailed intensive case management for staff who had been absent sick for longer than four weeks, aiming to restore function through a goal-directed and enabling approach based on a bio-psycho-social model. Assessment of the intervention was by controlled before and after comparison with a neighbouring hospital trust at which there were no major changes in the management of sickness absence. Data on outcome measures were abstracted from electronic databases held by the two trusts.
Results
At the intervention trust, the proportion of 4-week absences which continued beyond 8 weeks fell from 51.7% in 2008 to 49.1% in 2009 and 45.9% in 2010. The reduction from 2008 to 2010 contrasted with an increase at the control trust from 51.2% to 56.1% – a difference in change of 10.7% (95%CI 1.5% to 20.0%). There was also a differential improvement in mean days of absence beyond four weeks, but this was not statistically significant (1.6 days per absence, 95%CI −7.2 to 10.3 days).
Conclusion
Our findings suggest that the intervention was effective, and calculations based on an annual running cost of £57,000 suggest that it was also cost-effective. A similar intervention should now be evaluated at a larger number of hospital trusts.
doi:10.1093/occmed/kqs223
PMCID: PMC3633198  PMID: 23365116
Sickness absence; case management; intervention; evaluation; cost-effectiveness; healthcare
2.  Musculoskeletal pain in four occupational populations in Sri Lanka 
Background Factors influencing work-related musculoskeletal disorders might differ in developing and developed countries.
Aims To assess the prevalence and determinants of musculoskeletal pain in four occupational populations in Sri Lanka.
Methods As part of the international Cultural and Psychosocial Influences on Disability study, samples of postal workers, sewing machinists, nurses and computer operators were interviewed about pain at each of six anatomical sites in the past month, and about possible physical and psychosocial risk factors. Associations with prevalent pain were assessed by binomial regression.
Results Analysis was based on 852 participants (86% response rate). Overall, the lower back was the most common site of pain, with 1-month prevalence ranging from 12% in computer operators to 30% in nurses. Postal workers had the highest prevalence of shoulder pain (23%), but pain in the wrist/hand was relatively uncommon in all four occupational groups (prevalence rates ranged from 8% to 9%). Low mood and tendency to somatize were consistently associated with pain at all six sites. After adjustment for psychosocial risk factors, there was a higher rate of low back pain in nurses and postal workers than in computer operators, a higher rate of shoulder pain in postal workers than in the other occupational populations, and a relatively low rate of knee pain in computer operators.
Conclusions Rates of regional pain, especially at the wrist/hand, were lower than have been reported in Western countries. As elsewhere, pain was strongly associated with low mood and somatizing tendency. Differences in patterns of pain by occupation may reflect differences in physical activities.
doi:10.1093/occmed/kqs057
PMCID: PMC3428920  PMID: 22661663
Elbow; knee; low back; low mood; neck; psychosocial; risk factor; shoulder; somatizing tendency; wrist; Elbow
3.  [No title available] 
PMCID: PMC3639542  PMID: 22764269
4.  Mortality from Asbestosis and Mesothelioma in Britain by Birth Cohort 
Background
Analysis of occupational mortality in England and Wales during 1991-2000 showed no decline in work-attributable deaths from asbestosis.
Aims
To explore why there was no decline in mortality from asbestosis despite stricter controls on asbestos exposure over recent decades.
Methods
Using data from registers of all deaths in Great Britain with mention of mesothelioma or asbestosis on the death certificate, we plotted death rates by five-year age group within five-year birth cohorts for a) mesothelioma and b) asbestosis without mention of mesothelioma.
Results
Analysis was based on a total of 33,751 deaths from mesothelioma and 5,396 deaths from asbestosis. For both diseases, mortality showed a clear cohort effect; and within birth cohorts, death rates increased progressively with age through to 85 years and older. However, highest mortality from mesothelioma was in men born during 1939-43, whereas mortality from asbestosis peaked in men born during 1924-38.
Conclusion
Our findings suggest that in Britain, mortality from asbestosis has been determined mainly by cumulative exposure to asbestos before 45 years of age, and that the effect of such exposure continues through to old age. That mortality from asbestosis peaked in earlier birth cohorts than mortality from mesothelioma may reflect a difference in exposure-response relationships for the two diseases. The discrepancy could be explained if risk of asbestosis increased more steeply than that of mesothelioma at higher levels of exposure to asbestos, and if the highest prevalence of heavy exposure occurred in earlier birth cohorts than the highest prevalence of less intense exposures.
doi:10.1093/occmed/kqs119
PMCID: PMC3471357  PMID: 23034792
Asbestos; asbestosis; mesothelioma; trends; cohort effect
5.  MUSCULOSKELETAL PAIN IN FOUR OCCUPATIONAL POPULATIONS IN SRILANKA 
Background
Factors influencing work-related musculoskeletal disorders might differ in developing and developed countries.
Aims
To assess the prevalence and determinants of musculoskeletal pain in four occupational populations in Sri Lanka
Methods
As part of the international CUPID study, samples of postal workers, sewing machinists, nurses and computer operators were interviewed about pain in the past month at each of six anatomical sites, and about possible physical and psychosocial risk factors. Associations with prevalent pain were assessed by binomial regression.
Results
Analysis was based on 852 participants (response rate 86%). Overall, the lower back was the most common site of pain, with one-month prevalence ranging from 12% in computer operators to 30% in nurses. Postal workers had the highest prevalence of shoulder pain (23%), but pain in the wrist/hand was relatively uncommon in all four occupational groups (prevalence rates from 8% to 9%). Low mood and tendency to somatise were each consistently associated with pain at all six sites. After adjustment for psychosocial risk factors, there was a higher rate of low back pain in nurses and postal workers than computer operators, a higher rate of shoulder pain in postal workers relative to other occupations, and a relatively low rate of knee pain in computer operators.
Conclusion
Rates of regional pain, especially at the wrist/hand, were lower than have been reported in western countries. As elsewhere, pain was strongly associated with low mood and somatising tendency. Differences in patterns of pain by occupation may reflect differences in physical activities.
doi:10.1093/occmed/kqs057
PMCID: PMC3428920  PMID: 22661663
Low back; neck; shoulder; elbow; wrist; knee; risk factor; psychosocial; low mood; somatising tendency
6.  MUSCULOSKELETAL PAIN IN ELITE PROFESSIONAL MUSICIANS FROM BRITISH SYMPHONY ORCHESTRAS 
Background
Professional musicians may have high rates of musculoskeletal pain, but few studies have analysed risks by work activities or the psychosocial work environment.
Aims
To assess the prevalence and impact of musculoskeletal pain, and its relation to playing conditions, mental health and performance anxiety, in musicians from leading British symphony orchestras.
Methods
Musicians from six professional orchestras completed a questionnaire concerning their orchestral duties and physical activities at work; mental health (somatising tendency, mood, demand, support and control at work, performance anxiety); and regional pain in the past four weeks and past 12 months. Prevalence rates were estimated by anatomical site, and associations with risk factors assessed by logistic regression.
Results
Responses were received from 243 musicians (51% of those approached), among whom 210 (86%) reported regional pain in the past 12 months, mainly affecting the neck, low-back, and shoulders. Risks tended to be higher in women, in those with low mood, and especially in those with high somatising scores. Only weak associations were found with psychosocial work stressors and performance anxiety. However, risks differed markedly by instrument category. Relative to string players, the odds of wrist/hand pain were raised 2.9-fold in wind players, but 60% lower in brass players, while the odds of elbow pain were 50% lower among wind and brass players.
Conclusions
Musculoskeletal pain is common in elite professional musicians. A major personal risk factor is somatising tendency, but performance anxiety has less impact. Risks differ substantially by instrument played, offering pointers towards prevention.
doi:10.1093/occmed/kqr129
PMCID: PMC3428866  PMID: 22003061
7.  THE BURDEN OF SICKNESS ABSENCE FROM MUSCULOSKELETAL CAUSES IN GREAT BRITAIN 
Background
National initiatives to prevent and/or manage sickness absence require a database from which trends can be monitored.
Aims
To evaluate the information provided by surveillance schemes and publicly available datasets on sickness absence nationally from musculoskeletal disorders (MSDs).
Methods
A grey literature search was undertaken using the search engine Google, supplemented by leads from consultees from academia, industry, employers, lay interest groups and government. We abstracted data on the outcomes and populations covered, and made quantitative estimates of MSD-related sickness absence, overall and, where distinguishable, by sub-diagnosis. The coverage and limitations of each source were evaluated.
Results
Sources included the Labour Force Survey (LFS) and its Self-reported Work-related Illness survey module; the THOR-GP surveillance scheme; surveys by national and local government; surveys by employers’ organisations; and a database of benefit statistics. Each highlighted MSDs as a leading cause of sickness absence. Data limitations varied by source, but typically included lack of diagnostic detail and restriction of focus to selected subgroups (e.g. work-ascribed or benefit-awarded cases, specific employment sectors). Additionally, some surveys had very low response rates, were completed only by proxy respondents, or ranked only the perceived importance of MSD-related sickness absence, rather than measuring it.
Conclusions
National statistics on MSD-related sickness absence are piecemeal and incomplete. This limits capacity to plan and monitor national policies in an important area of public health. Simple low-cost additions to the LFS would improve the situation.
doi:10.1093/occmed/kqr061
PMCID: PMC3355371  PMID: 21652574
8.  OCCUPATIONAL HEALTH NEEDS OF COMMERCIAL FISHERMEN IN SOUTH-WEST ENGLAND 
Background
Work in commercial fishing is physically demanding and hazardous, but unlike merchant seamen, fishermen are not required to hold a certificate of medical fitness.
Aims
To investigate the case for regulatory medical standards for commercial fishermen, and to identify priorities for the prevention and management of occupational injuries at sea.
Methods
We surveyed a convenience sample of fishermen at three major fishing ports in South-west England, using a standardised, interview-administered questionnaire.
Results
Interviews were completed by 210 (68%) of 307 fishermen approached. Over their careers, 56 subjects (27%) had been returned to shore as an emergency for medical reasons, a rate of 14.6 (95% CI 11.5-18.2) per 1000 man-years. Most emergency evacuations were for acute injuries, and only five were for illness. A few participants suffered from chronic disease that would call into question their fitness to go to sea. Fifty five fishermen had suffered injuries in the past 12 months, including 12 that had caused loss of more than three days from work. Subjects had self-stitched four of 15 reported hand lacerations, while others had been bound with “Gaffer” tape.
Conclusion
Prevention of hand lacerations should be a high priority, with first aid training and equipment for fishing crews to improve their care when prevention fails. No firm conclusions can be drawn about the value of regular medical screening for commercial fishermen, but such screening should be considered a lower priority than accident prevention.
doi:10.1093/occmed/kqp137
PMCID: PMC3245849  PMID: 19770214
Fishermen; evacuation; health screening; injury; laceration
9.  Responding to change: the 1990s 
doi:10.1093/occmed/kqq091
PMCID: PMC3242042  PMID: 20871018
10.  OCCUPATION AND MORTALITY RELATED TO ALCOHOL DRUGS AND SEXUAL HABITS 
AIms
To identify opportunities for targeted prevention, we explored differences in occupational mortality from diseases and injuries related to alcohol consumption, sexual habits and drug abuse.
Methods
Using data on all deaths among men and women aged 16-74 years in England and Wales during 1991-2000, we derived age- and social class-standardised proportional mortality ratios (PMRs) by occupation for cause of death categories defined a priori as potentially related to alcohol consumption, sexual habits or drug abuse.
Results
The highest mortality from alcohol-related diseases and injuries was observed in publicans and bar staff (both sexes), and in male caterers, cooks and kitchen porters, and seafarers. Male seafarers had significantly elevated PMRs for cirrhosis (179), “other alcohol-related diseases” (275), cancers of the liver (155), oral cavity (275) and pharynx (267), and injury by fall on the stairs (187). PMRs for HIV/AIDS were particularly high in tailors and dressmakers (918, 95%CI 369-1890, in men; 804, 95%CI 219-2060, in women) and male hairdressers (918, 95%CI 717-1160). Most jobs with high mortality from HIV/AIDS also had more deaths than expected from viral hepatitis. Of seven jobs with significantly high PMRs for both drug dependence and accidental poisoning by drugs, four were in the construction industry (male painters and decorators, bricklayers and masons, plasterers, and roofers and glaziers).
Conclusions
Our findings highlight major differences between occupations in mortality from diseases and injuries caused by alcohol, sexual habits and drug abuse. Priorities for preventive action include alcohol-related disorders in male seafarers and drug abuse in construction workers.
doi:10.1093/occmed/kqq040
PMCID: PMC3242044  PMID: 20407041
Occupation; alcohol; drug abuse; HIV; AIDS
11.  SKIN DISEASE IN SHEEP FARMERS 
Background
An unusual inflammation of the pinna has been reported to occur in some sheep farmers at the time of lambing.
Aims
To explore the prevalence of this disorder and its possible causal associations.
Methods
While on attachment to sheep farms during lambing, veterinary students used a standardised questionnaire to interview a sample of farmers about their work, and about symptoms of skin inflammation in their hands, face and ears.
Results
Interviews were completed by 76 (67%) of the farmers approached. Among 74 farmers who had carried out lambing, three (4%, 95% CI 1% to 11%) had experienced temporally related ear symptoms, all on multiple occasions. No farmers with ear symptoms had ever been involved in calving or farrowing, and no ear symptoms were reported in relation to shearing or dipping sheep. There was also an excess of hand symptoms related to lambing outdoors (24% of those who had done such work) and indoors (also 24%), compared with other farming activities.
Conclusions
Our findings suggest that temporally related ear inflammation occurs in at least 1% of farmers who carry out lambing, but not in association with the other farming activities investigated. Lambing appears to be associated also with hand inflammation, but the pathology may differ from that in the pinna.
doi:10.1093/occmed/kqr066
PMCID: PMC3232444  PMID: 21652573
Farming; sheep; lambing; ear; hand; skin; inflammation
12.  REGIONAL TRENDS IN AWARDS OF INCAPACITY BENEFIT BY CAUSE 
Background
Since the early 1990s, rates of incapacity benefit (IB) in Britain for musculoskeletal complaints have declined, and they have been overtaken by mental and behavioural disorders as the main reason for award of IB.
Aims
To explore reasons for this change.
Methods
Using data supplied by the Department for Work and Pensions, we analysed trends in the ratio of new IB awards for mental and behavioural disorders to those for musculoskeletal disorders during 1997-2007 by Government region.
Results
In Great Britain overall, the above ratio more than doubled over the study period, as a consequence of falling numbers of new awards for musculoskeletal disorders. The extent to which the ratio increased was smallest in London (50%) and South-East England (56%), and was progressively larger in more northerly regions (>150% in North-East England and Scotland).
Conclusions
The differences in trends between regions seem too large to be explained by differential changes in working conditions, patterns of employment, or the rigour with which claims were assessed. An alternative explanation could be that the main driver for the trends has been culturally determined changes in health beliefs and expectations, and that these cultural changes began in London and the South-East, only later spreading to other parts of Britain.
doi:10.1093/occmed/kqr008
PMCID: PMC3119467  PMID: 21482620
social security; incapacity; mental; musculoskeletal; trends; health beliefs
13.  ACUTE SYMPTOMS FOLLOWING WORK WITH PESTICIDES 
Objectives
To explore the frequency, nature and determinants of acute symptoms following work with pesticides.
Methods
As part of a postal survey of men born during 1933-77 and resident in three rural areas of England and Wales, data were obtained on demographic variables; occupational use of five categories of pesticide; whether any of 12 specified symptoms had ever occurred within 48 hours of using such pesticides; and tendency to somatise (graded to four levels). Associations of pesticide-related symptoms with risk factors were assessed by modified Cox regression, and the timing of first recalled symptoms in relation to calendar period and years of work with pesticides by Poisson regression.
Results
Of 10,765 responders (response rate = 31%), 4,108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29% and 32% of users), but in the third area, sheep dip was less often associated with symptoms (13% of users) than other insecticides (15% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and there was no evidence that flu-like symptoms clustered unusually among users of sheep dip, as has previously been postulated. Multiple pesticide-related symptoms and symptoms in relation to multiple categories of pesticide were both much more common than would have been expected if individual symptoms were statistically independent. Risk of acute pesticide-related symptoms increased with somatising tendency (prevalence ratio for highest v lowest category 2.4, 95%CI 2.0-3.0), and was higher in men who had used pesticides most often, and who had handled concentrate. First onset of symptoms was more common in the first year of pesticide use (incidence rate ratio 4.5, 95%CI 3.5-6.8 in comparison with first use >15 years earlier), and peaked in the late 1980s. However, this peak of incidence disappeared when men who had worked with sheep dip were excluded from the analysis.
Conclusion
Our findings indicate that acute symptoms are common following work with pesticides, but suggest that in many cases the illness may arise through psychological rather than toxic mechanisms.
doi:10.1093/occmed/kqm066
PMCID: PMC3088901  PMID: 17652342
Pesticides; acute toxicity; psychogenic; somatisation; dippers’ flu
14.  Sickness absence for upper limb disorders in a French company 
doi:10.1093/occmed/kqn084
PMCID: PMC2741592  PMID: 18587147
Adult; Female; France; epidemiology; Humans; Male; Middle Aged; Musculoskeletal Diseases; epidemiology; Occupational Diseases; epidemiology; Shoulder Impingement Syndrome; epidemiology; Sick Leave; statistics & numerical data; Socioeconomic Factors; Upper Extremity; Young Adult

Results 1-14 (14)