There is no quantified published evidence about vibration exposures amongst orthopaedic surgeons using handheld power tools in their practice. This group of healthcare professionals are not subject to the legal provisions of vibration control regulations in the United Kingdom.
To measure the vibration induced by a handheld oscillating saw used in a specific type of primary total knee arthroplasty by determining Health and Safety Executive’s (HSE) Ready-Reckoner exposure points.
To use the acquired information for developing further studies to determine whether orthopaedic surgeons should be covered by the control of vibration regulations.
HSE exposure points were calculated by a specialised dosimeter (HAVSense) for two operators during application of an oscillating saw in primary total knee arthroplasty on six artificial joints. Additionally, another dosimeter system (HVM100) was applied for calculating the total value of vibration and exposure time for each operator.
The exposure point scores for each hand of each operator per each trial were well below the Exposure Action Value (EAV) of 100 points with reference to the HSE’s Ready Reckoner tool. however, depending on the number of trials, the sum of the points could exceed EAV. The data from the HMV100 were possibly subject to certain confounding factors.
This study is the first of its kind. Due to small number of the trials, the results if this study from statistical point of view, do not lead to a conclusion that the orthopaedic knee surgeons using the same total knee arthroplasty system are or are not subject to considerable amount of vibration necessitating implementation of the HSE’s control of vibration regulations. However, the obtained information can establish a platform for the expanding the methodology of this study for conducting further laboratory or in vivo-based projects, in order to determine whether the orthopaedic surgeons are required to be covered by the control of vibration regulations.
A comparision of reporting practices for work-related musculoskeletal disorders between occupational physicians and general practitiioners from 2006 – 2013 and rheumatologists from 2005 – 2009 utilising the health and occupational research network surveillance scheme from 2006 – 2013
The Health and Occupation Reporting Network (THOR) is a network of physician-led voluntary surviellance schemes to monitor the incidence and determinants of occupational disease and work-related ill-health. Data on work-related musculoskeletal disorders (WRMSDs) are collected; GPs (reporting to THOR-GP), occupational physicians (reporting to Occupational Physicians reporting Activity – OPRA) and rheumatologists )reporting to MOSS).
The current study aims primarily to compare the reporting practices between GPs, OPs and rheumatoogists as regards tasks and associated movements. The null hypothesis for the study is that there is no significant difference between the reporting practices for Work-related Musculoskeletal Disorders (WRMSDs) between OPs, GPs from 2006 – 2013 and Rheumatologisits from 2005 – 2009.
A retrospective cross sectonal analysis on the data available from the THOR GP and OPRA schemes was undertaken to compare the incidence of Work-related Musculoskeletal Disorders (WRMSDs) by specialists OPs and to relate it to General Practitioner-reported WRMSDs from 2006 – 2013. A comparison of the rheumatology group (MOSS) reports was also undertaken from 2005 – 2009.
A comparison of the reporting practices for WRMSDs between the three schemes revealed that there were statistically significant differences by task, movement, industry and disorder.
The THOR GP scheme included a greater proportion of cases involving forceful upper limb/grip, materials handling, and postural movements. Findings from the OPRA scheme showed a greater proportion of cases involving tasks and movements requried for heavy/light lifting carrying; the current study showed that an almost equal proportion of cases invoving keyboard work were found across the three schemes. Case reports from rheumatologists showed a statistically significant number of cases involving fine hand movement than the other two schemes.
The study fundings do not support the null hypothesis. Reports from THOR provide data on current practice, which are useful for monitoring trends and to guide planning. These findings could serve as a guide to choosing priority areas to focus upon when providing Work Related Musculoskeletal Disord (WRMSD) oprevention education to workers.
What are the learning points for good occupational health practice from a review of the case law pertaining to personal injury claims for psychiatric injury attributed to work related stress
The primary aim of the this study was to review the evidence base for the identification and management of work-related stress and identify what lessons can be learnt from analysing the case law of personal injury claims for psychiatric injury attributed to work-related stress.
Personal injury claims in which an employee alleged they substained a psychiatric injury attributable to work-related stress were idenitfied from the Bailii website. The search was limited to cases appearing before the English and Welsh Courts. Cases were excluded if they involved criminal acts, exposure to combat trauma pr physical assault/injury. The resulting cases were identified and analysed according to a set of objectives.
Forty-three relevant cases were identified between 1994 and 2016. The majority of claimants were public sector employees with the most common causes of stress being overwork, lack of support and perceived buyying/harrassment/victimisation. The most common injury sustained was depression. The key factor in most successful claims was the failure of an employer to act once the signs impending harm to the health of an employee were clear. Guidance points from the case law useful to occupationla health professionals were extracted with supporting evidence.
Work-related stress is an important cause of ill-health and absence with signifcant implications for employers, employees and the national economy. The subjectibe nature of the problem makes identifying effective management strategies difficult and more research is needed.
Development and use of a methodology for audit of explanatory reports issued to accompany the medical certificate following pension assessments for the Local Government Pension Scheme in Scotland.
Dissertation submitted for purpose of Certificate of Eligibility for Specialist Registration (CESR) Application
The aim of this project was to develop and use a methodology for audit to enable improvement of the supporting evidence in the form of explanatory reports issued to accompany a medical certificate issued by an Independent Registered Medical Practitioner (IRMP) in relation to the Local Government Pension scheme in Scotland.
All physicians strive for ongoing quality improvement. Audit is a means of evaluating quality by observing practice and comparing it against a standard. Ill Health Retirement (IHR) has high impact upon the individual, society, the employer and national finances. The consequence of such opinions is demonstrated making it a valid subject for their scrutiny and for ours.
As no benchmark for standards relating to IHR reports was found, this project consisted of two parts. The initial review was a retrospective observational combined quantitative and qualitative analysis of existing data, to inform development and consultation on standards. The second part followed standard audit methodology auditing against those standards and following the audit cycle.
A standard was developed for reports which included the following criteria:
A statement that the IRMP has suitable qualifications
A statement of the IRMP’s independence
A statement in full of the outcome
A statement of the job role
A list of evidence sources
A clear explanation of the reasoning leading to the outcome
Absence of factual errors
A statistically significant improvement in quality with an improvement in clarity of reports from 78% (subjectively poor) to 94% (subjectively very good) was found after adopting an auditable standard.
The methodology has potential for application to reporting in other pension schemes and in other occupational health service providers.
This study showed that developing and undertaking a system of audit of ill health retirement reports is a valid quality assurance aim.
An assessment of hearing in Royal Marine Band-service personnel by instrument played and by deployment history, across a 10-year Health Surveillance strategy.
Royal Marine (RM) musicians have a different noise induced hearing loss (NIHL) risk profile to civilian musicians. Not only do they play instruments on parade and ensemble but they are also exposed to operational noise from weapons, equipment and aviation.
To assess hearing loss in Royal Marine musicians by instrument played and deployment history over the period 2001-2011.
Volunteers were RM musicians with one or more health surveillance pure tone audiograms (PTA), conducted in Portsmouth, between 2001-2011. Volunteer musicians completed a structured questionnaire with consent to review health surveillance data back to 2001. PTA data was compared with ISO7029 (age/gender matched controls). All PTAs were corrected for age and gender (with TDH-39P headset artefact removed). Results were presented as differences by ear and frequency with PTA notch prevalence given as an index of NIHL. Discriminant Function Analysis (DFA) was used to model covariates by instrument and deployment history.
88 volunteers constituted a 91.6% response rate generating 199 Health Surveillance PTAs. Brass players were the largest instrument group (41%) followed by Woodwind (36%) then Percussionists (21%). Mean PTA yield, per person, was 2.34 over a 10-year period. Within the 2010 cohort (n=50), 28.2% had deployed in the last 5 years. Asymmetry of acuity was noted with the left ear worse than the right – most notably in brass players at 500Hz (p<0.05). The prevalence of bilateral audiometric notch in men was 28.1% [95% CI: 16.4% to 39.7%] versus 10.7% [95% CI: -0.7 to 22.2%] in female musicians. DFA gave a 4-parameter model comprising 500Hz [left]; duration of Service; 4kHz [right] and 2kHz [left] as significant variables. These accounted for 57.7% of the variance between brass players and percussionists. DFA gave a model of those deployed vs. not deployed (p<0.05); with 2 & 3kHz in the left ear and 6kHz in the right ear resolving to predict 35.2% of the variance between the two groups.
Data censoring led to an underpowered study. The fact that hearing acuity was generally better than controls is believed to reflect a healthy worker effect. Notch prevalence, across a 10-year timeframe, was given to inform the employers’ risk assessment. DFA demonstrates two models associated with brass playing and deployment. To be validated, this exploratory analysis needs a larger dataset. With 2.34 PTA yield, over a 10-year period, health surveillance yield may be considered insufficient for an employer to discharge their duty of care in a group known to be ‘at-risk’.
Investment in personnel and training; with well maintained/calibrated equipment in order to ensure data accuracy and consistency, is critical. MOD policy should reflect the need for competence in all those involved in PTA data collection, as health surveillance remains an important strategy to prevent hearing loss before employability is impacted. The tracking of all Service personnel, after leaving Service, together with the use of accurate health surveillance data gathered at Service entry, will help redress the observed health worker effect.
Physical fitness, body composition, estimated energy intake and expenditure, nutritional knowledge and choices of Royal Navy Submariners
The Surgeon General’s Armed Forces Feeding Programme consists of a series of studies to inform the Ministry of Defence of the optimum nutrition to be provided in order to maximise operational capability. This report provides details of the first phase of the submariners subsection of the study. Submarines are a unique occupational environment and the constraints upon the provision of food and opportunities for exercise are consi0derable.
An initial cohort of 57 deployable submariners was recruited from a submarine that remained alongside (in port) for a 3 month maintenance period. This replicated the typical period of a deployment. Data were obtained at the start and end of this period. Anthropometric measures (height, weight, and skin fold thicknesses) were recorded. The Multi-Stage Fitness Test (MSFT) was used to measure VO2max. The number of sit-ups and press ups that could be performed in 120 seconds was recorded. Grip strength and static lift strength were obtained using dynamometers. Volunteers completed questionnaires relating to smoking habits, nutritional supplement usage and ill-health episodes during the trial.
Due to operational requirements only 34 men were able to continue to the end of the study period. End point data of this observational study revealed an average increase in body mass of 2 kg per man (P=0.43, d=0.19). Aerobic fitness, as measured by the MSFT, fell (P=0.78). The numbers of sit-ups and press-ups performed rose slightly (P=0.23, P=0.56 respectively) as did grip strength for both dominant and non-dominant arms (P=0.11, P=0.10). Static lift strength rose by an average of 23.73 kg (P<0.01). Smokers comprised 23.5% of the cohort who completed the study, which is greater than the UK national average of 18.5%. Supplement usage and ill health were no different from other parts of the Armed Forces.
It is recommended that submariners are provided with greater opportunities for aerobic exercise and that targeted smoking cessation interventions are undertaken.
Sources of information used by air traffic controllers to decide if defined medications can be used while undertaking safety critical work
Air Traffic Controllers (ATCOs) carry out highly complex cognitive tasks in their safety critical role. This research question arose from telephone calls to NATS Occupational Health Services regarding the use of medications while controlling. There is a paucity of ATCO specific research concerning medication use, knowledge and information-seeking behaviour.
This study aimed to identify the state of knowledge amongst NATS Air Traffic Controllers concerning paracetamol, sedating antihistamines, codeine and antidepressants. The latter three were identified in toxicological studies of accident pilots with undeclared medication use. ATCOs stated information sources they consulted when deciding whether it is safe to take medication while controlling aircraft. Factors influencing choice of information source were considered.
This cross-sectional descriptive study was carried out by self-administered electronic questionnaire over a 5 week period in 2013. A novel survey tool was designed and piloted in a non-operational ATCO group.
There was a 41.6% response rate from an eligible population of 1547 operational controllers. 66.9% had taken medications within the past month. ATCOs demonstrated good understanding of all four medications regarding sedation side effects and use while controlling. NATS internal resources were the most common sources of information consulted except for paracetamol. ATCOs rated ‘speaking to a doctor face-to-face’ and ‘aviation-specific advice’ as most important factors.
This study demonstrated that NATS ATCOs are highly motivated to seek advice from appropriate aviation-specific sources. The study population benefits from an in-house medical service, hence may not be representative of other aviation professionals. As safety-critical workers, it is incumbent on aviation health professionals to educate ATCOs and pilots regarding medication use.
Factors influencing employment outcome for Bank employees with Bipolar Disorder following referral to Occupational Health
Bipolar disorder is a chronic, enduring mental health condition which affects many people of working age and is recognised to have an adverse effect on functional domains, including employment.
The study objectives were to ascertain the employment outcome at the point of case closure for employees of a major UK bank with bipolar disorder who were referred to Occupational Health and to identify differences in the demographic, employment, referral and disease factors between the referral episodes which resulted in job loss and those which did not.
The study was carried out by a review of Occupational Health records of employees of the bank who were recorded as having a diagnosis of bipolar disorder.
32.43% of Occupational Health referral episodes in this study resulted in job loss. Factors statistically associated with job loss were increasing age at referral (p=0.035), being absent from work at the time of referral (p=0.05), ever hospital admission, ever recorded suicidal ideation, ever psychosis, ever electroconvulsive therapy (p values 0.008, 0.018, 0.002, 0.02 respectively). Older age of diagnosis of bipolar disorder was close to being a statistically significant association with job loss (p=0.051).
Job grade, business area, job tasks, contracted hours of work, shift work, being involved in disciplinary action did not appear to impact on job retention or job loss.
Recorded comorbid conditions and recorded substance misuse showed no significant association with job loss, nor was one found with the number of medications, ever having psychological therapy or reporting stress related symptoms.
A relatively high proportion of referral episodes for employees who have bipolar disorder resulted in job loss at the point of case closure. Although markers of more severe disease are most strongly associated with job loss, increasing awareness of Occupational Health clinicians in the nature and impact of bipolar disorder as well as training and education of line managers could support the retention of employees at work.
Predictors of attitude to an occupational medicine career in a cohort of final year medical students in the UK
Since 2004, the Faculty of Occupational Medicine (FOM) has been involved in promoting occupational medicine in UK medical schools. Over the past 30 years, it has long been recognized that there has been a distinct lack of commitment on the part of UK medical schools to the teaching of occupational medicine (1). In conjunction with the Department for Work and Pensions (DWP), the FOM has endeavoured to promote awareness of work and health within medical schools in order to better equip medical students for their future careers, irrespective of their specialty choice and also to encourage medical students to consider occupational medicine as a career. Despite the above, the numbers of doctors trained in occupational medicine remains small (1).
To evaluate the attitudes and awareness of final year medical students in the UK to occupational medicine and to determine predictors of attitude to a career in occupational medicine.
A cross sectional survey was conducted by distributing a paper based questionnaire amongst the study population (n = 348). The data was analyzed using SPSS version 20. Statistical analysis included binary logistic regression analysis.
The response rate was 36% (n=126). The results indicate that amongst this study population, reports of exposure to occupational medicine teaching varied from little exposure to no exposure. Only 18% of the responders recalled having received teaching in occupational medicine. 72% of the responders reported that from the overall teaching they had received during their undergraduate curriculum, they were unable to recognize work related conditions. In spite of this, the majority of responders (82%) reported that knowledge of occupational medicine may be relevant to their future practice.
Predictors of attitude to a career in occupational medicine were not determined as the results from this study were not statistically significant due to the small sample size. However, a trend was observed with older responders more likely to consider occupational medicine as a current career option whilst those responders who reported having a parent as a doctor were less likely to do so. Of note, 77% of the study population had already decided on a career choice preference.
Encouragingly, 7% (9/126) of the study population reported a current interest in a career in occupational medicine and 59% of the responders who were not currently considering a career in occupational medicine had not completely discounted it as a future career choice. The reasons given for not currently considering occupational medicine as a career option were that they did not have enough knowledge of occupational medicine as a specialty.
The results suggest that amongst this study population, there has been insufficient exposure to occupational medicine teaching. Career choice preferences had developed prior to qualifying. Therefore improving the knowledge base of medical students to occupational 7
medicine prior to their final undergraduate year will not only enable them to understand the links between health and work, whichever branch of medicine they pursue but hopefully also encourage them to pursue a career in occupational medicine.
(1) Wynn PA, Aw TC, Williams NR, Harrington M: Teaching of occupational medicine to undergraduates in UK schools of medicine. Occupational Medicine 2003;53:349-353