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Trainee Travel Survey – The Impact of Commuting within the Large Geographical Region of the South West Peninsula on the Perceived Level of Function of Specialty Training Doctors.

Author: Thake, J

Year: 2020

Specialty trainees are required to regularly rotate placements, with concomitant long commutes if multiple house moves are to be avoided. No studies have yet explored whether these commutes to work are contributing to the reported low mood and morale within the UK junior doctor population.

• Explore the commuting requirements of Specialty Training Registrars within the South West (Peninsula) Region and investigate how this commute impacts on their function. Function is defined within five domains of work, home, social, leisure and interpersonal relationships, using the pre-validated Work and Social Adjustment Scale (WSAS) [1].
• Explore the modifying effect of other fixed baseline variables (age, gender, sex, specialty, home circumstances) on their perceived function.

An electronic survey of 779 eligible trainees.

296 trainees (38%) completed the survey, with all specialties and training years represented. The longest commute was 180 miles, with a mean longest commute of 53 miles. The mean current commute was 27.8 miles.

73% of trainees reported some element of functional impairment relating to their current travel time, with 52% reporting this impairment as moderately severe to severe. A positive correlation between commuting distance and impairment of function (r=0.0672, p=<0.001) was demonstrated (regression coefficient = 0.302).

Many trainees highlighted the negative impact of long travel times on personal relationships, health and finances. They also perceived that personal circumstances were not considered for future placements and that insufficient warning was given of pending rotations.

This study confirms that an increase in travel time correlates with a reduction in junior doctor function and therefore supports the recent GMC recommendations that a there is a need to review how trainees are allocated to organisations. It is also suggested that trainees would benefit from greater input into their rotational allocations in order to improve function, morale and wellbeing.

Dr. Jane Claire Thake, 2020


Aviation Associated Neck Pain and the Helmet Mounted Display: The Royal Air Force Experience

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Author: Wilkinson, C

Year: 2019

Helmet Mounted Displays (HMDs) enable aerial warfare advancement but heavy or poorly balanced HMDs, under dynamic flight, may contribute to neck pain. The Royal Air Force’s (RAF) HMD, ‘Helmet Equipment Assembly (HEA)’, is used in Typhoon. The potential for neck injury is of concern to the RAF, however, prevalence and strategies used to manage loads remain unclear.

To calculate prevalence and predictors of neck pain, understand strategies for managing +Gz and determine whether HEA results in more frequent or more severe neck pain than MK10R helmets.
Methodology A cross-sectional survey amongst Typhoon pilots(n=156) collected information on potential predictors with univariate analysis. Positional strategies and Aircrew Conditioning Programme (ACP) participation was included with trend analysis.

Of 95 respondents, self-reported neck pain prevalence was 72%(MK10R) and 77%(HEA). HEA use >50 hours was associated with increased neck pain reporting (OR 2.69, p<0.03). Merge manoeuvres were most likely associated with neck pain and gave rise to most severe pain. 85% pilots reported moving their head routinely under +Gz; 61% stated HEA’s weight/balance impaired targeting. Pain severity was higher in HEA than MK10R (median 3[MK10R],4[HEA],p<0.001). 81% of pilots undertook ACP in training but only 11% continue on frontline.

Findings show high prevalence of neck pain and positive association with HEA use, fitting with international literature. Merge phase of flight, not unexpectedly, was associated with the most likely and most severe neck pain with HEA pain severity worse than MK10R. The high proportion reporting targeting impairment secondary to HEA weight/balance was unexpected given HEA’s operational requirements.
We recommend multi-disciplinary stakeholder participation, with injury profiling, from helmet design inception. Additionally, prioritising the development of novel ways to optimise helmet weight/balance or its burden on pilots (e.g. ACP training) in order to protect this valuable cadre, whilst retaining the operational superiority HEA provides.


Stigma in the workplace: The effect of Mental Health First Aiders

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Author: Bentley, T

Year: 2019

In a landscape of increasing publicity regarding mental health, there is a perception that initiatives which raise awareness will in turn decrease stigma. One such initiative which is increasing in popularity in the workplace is Mental Health First Aid (MHFA). There is an increasing pool of evidence which indicates Mental Health First Aiders (MHFAs) have increased mental health literacy, increased confidence in helping someone with a mental health problem and decreased stigmatising attitudes towards those suffering with mental health. The evidence is less clear whether this decrease in stigmatising attitudes is spread to the work colleagues of those who have undertaken the MHFA training.

The aim of this study is to determine the effect of Mental Health First Aiders on their work colleagues’ stigmatising attitudes towards mental health in a male dominated, UK based, manufacturing company.

A random sample of employees from a population of predominantly male employees, at a UK based manufacturing company were sent a questionnaire which combined two validated scales; the Social Distance Scale and the Depression Stigma Scale. The questionnaire was sent to 60 employees at a site with MHFAs present and 60 questionnaires to a control site where they do not have MHFAs present. The questionnaire scores were collated and the difference in the mean of the overall scores was calculated, along with 95% confidence intervals and p-values. A Pearson Chi-squared analysis, was used to calculate sub scale measures, including social distance, personal stigma and perceived stigma.

A total of 94 completed questionnaires were returned; 48 from the intervention group and 46 from the control group. There was no statistical difference between the total stigma scores, nor in the questionnaire sub-section scores for social distance, personal stigma and perceived stigma.


A Cross-Sectional Survey of the Factors that influence Employment in individuals with Inflammatory Bowel Disease (IBD)

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Author: Nunes, P

Year: 2019

Background: Inflammatory bowel disease (IBD) affects the working age population. The disease is known to have a considerable impact on patients living with the disease, yet few studies have examined how IBD affects work and work productivity in the United Kingdom.

Aims: To examine the factors that influence employment, work productivity and return to work in patients with IBD. Illness perception has been shown to have an impact on labour participation, therefore the study also investigated the relationship between illness perception and employment status. Advice from health professionals, employers and occupational health professional about work and health was assessed.

Design and methods: A cross sectional study was done over a 4 month period in a large hospital Trust in the North West of England. Patients attending gastroenterology outpatient clinics completed a self-administered questionnaire.

Results: 226 patients were recruited, of which 54% had Crohn’s Disease and 46% Ulcerative Colitis. Employment rates obtained were comparable to the background population. Most (89.4%) valued work but 38.4% felt that they had to be‘100% fit and well’ to work. Levels of reported ‘presenteeism,’ that is reduced productivity (77.3%) was higher that reported in the literature (50-60%) and 27.5% of patients reported long-term sickness in the previous 12 months. Advice from occupational health practitioners (OHP) (15.9%), employers/managers (23%), GPs (21.4%) and specialists (40.7%) were low. The main barriers to returning to work were travelling to work, side effects of treatment and waiting on a specialist appointment. Unemployed patients were significantly more likely to have negative illness perceptions

Conclusion: Despite good employment rates, there are high levels of presenteeism reported in patients with IBD. Low levels of advice from OHP may reflect inadequate OH provision or insufficient referrals to OHP by managers for these employees.


Smoking and its effects on Diver Lung Function: A Retrospective Cohort Study

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Author: Jeffrey, G

Year: 2019

Background: Diving is recognised as a hazardous occupation which can expose divers to many different physiological challenges. These challenges have been shown to have an effect on the lung function of divers with the spirometry results of divers differing from the results of non-divers. Amongst the changes identified are those suggestive of small airways, which is a finding found in smokers susceptible to its effects. There is, however, limited research which considers the impact of smoking on the lung function of divers.

Aim: The aim of this study was to explore the impact of smoking upon the lung function over divers.

Design and Methods: The study involved the retrospective analysis of the spirometry results of divers who underwent diving medicals. The analysis employed a cohort study design and followed up divers who smoked and divers who did not smoke over a 5-year period. The study compared their spirometry results at the start of the follow-up period and again at 5-years at the end of the follow-up period.

Results: The results were analysed by comparing the differences in the spirometry results over time in both groups. To assist in this analysis Pearson’s correlations, Fisher’s Z-Test and a repeated measures analysis using mixed modelling were used. The results demonstrated no statistically significant difference between the lung function of divers who smoked and divers who did not smoke at baseline and at the end of the follow-up period.

Conclusion: The study demonstrated a decline in the lung function over a 5-year timeframe in both groups of divers; divers who smoked and divers who did not smoke, with the exception on PEFR which increased in divers who did not smoke. The study identified that, although lung function deteriorated, there was no statistical significance between the spirometry results between the groups at 5-years follow-up. The impact of smoking on the lung function of divers remains unclear and further research is required.


A Study of Dehydration in Royal Navy Student Pilots

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Author: Wrigley, A

Year: 2017

Dehydration of 2% body mass or greater is associated with deleterious physical and mental effects that, in aviation, could potentially impact negatively upon flight safety. The aim of this study was to ascertain if flying unpressurised light aircraft in British meteorological conditions, as undertaken on the Royal Navy Pilot Flying Grading Course (AIR 503), leads to measurable fluid loss, and whether the magnitude of that loss is physiologically significant (i.e. ≥2% body mass).

A prospective, observational study was undertaken. Student pilots undertaking AIR 503 were weighed and underwent bioelectrical impedance measurement of body water, shortly before and after they undertook a sortie of spinning and aerobatics in a Grob 115E Tutor aircraft. No consumption or voluntary loss of fluids occurred between measurements. Contemporaneous meteorological data was recorded. Ethical approval was granted by MoDREC.

16 volunteers (median body mass 77.18kg, IQR 70.60kg, 82.28kg) participated in the study. Median body mass loss/hour was 0.17%, IQR 0.26%, 0.13% (z=3.522, p<0.001). Median total body water gain/hour (as measured by bioelectrical impedance) was 0.35% of body mass, IQR 0.3%, 0.57% (z=-2.458, p<0.05). Airfield dry bulb temperature correlated with body mass loss/hour (⍴=0.64, p<0.01).

Mass loss during the sortie was not physiologically significant, but the fact that a change was observable means the technique has wide application in occupational studies. The observed increase in impedance-derived median total body water, despite loss of body mass over the same period, calls the use of this method in such studies into question. The positive correlation between ground air temperature and mass loss can inform future occupational recommendations: in conditions of high airfield dry bulb temperatures, pilots should take care to minimise dehydration by consuming adequate food and fluids before and after sorties, and minimising time spent on the ground, in and around the aircraft.
[Word count: 299 words]

Flight safety, Student aircrew, Dehydration



Reasons for the non – acceptance of the Influenza vaccination, by NHS workers and students in a London NHS Trust

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Author: Deinde, O

Year: 2019

This research investigates the reasons for non-acceptance of the influenza vaccination in frontline healthcare workers (FHCWs) and others within the context of an acute healthcare setting.

The national influenza vaccination uptake rate amongst healthcare workers (HCWs) in England has been historically low and variable over the years. It remains of importance to immunise staff to minimise the risk of transmission of influenza from healthcare workers (HCWs) to patients and vice versa. The key to improving uptake and achieving the Public Health England (PHE) target annually may lie in understanding the barriers to vaccine acceptance and it makes this research fitting and timely.

This research was based on a literature review and a retrospective cross-sectional analysis of the data collected during the 2016/17 influenza campaign in a National Health Service (NHS) Trust in London.

These showed that reasons for non-acceptance of the vaccine related to perception of vaccine safety (21%), ‘multiple’ reasons (17%), perceptions of vaccine efficacy (16%) and vaccine side effects (16%). Demographic factors pertaining to the individual such as job role, gender, age and ethnicity were associated with non-acceptance of the vaccine. In addition to the existing knowledge base, the FHCWs employer and specific work place settings was also associated with declination of the influenza vaccine.

The results suggest the need to focus on dispelling myths about vaccine safety and efficacy and exploring beliefs in HCWs who identified with an ethnic minority group. The reasons for declining vaccination are multiple and complex and in addition to this, demographic factors (organisational and individual) also influenced vaccination behaviour.

Future research should focus on qualitative work data to further explore personal derived motivations for declining. Further studies would benefit from exploration of demographic factors with multiple regression, with consideration of a cost effectiveness analysis.

Keywords: influenza vaccination, influenza, Occupational Health, human, organisational, prevention.


The effects of shift work on the mental health of NHS Trust employees attending an Occupational Health Department: A cross sectional study

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Author: Nwobodo, A

Year: 2019

This study investigated the effects of shift work on the mental health of employees of an NHS Trust attending the Occupational Health Department within a 5-week period.

Eighty Trust employees were invited to participate, of whom 41 fully completed questionnaires on socio-demography, sleep quantity and quality, health and wellbeing, quality of life (QoL-5) and the General Health Questionnaire (GHQ12). Nineteen of these personnel were non-shift workers and twenty-two were shift workers. Questionnaires were analysed with SPSS using descriptive and inferential statistics.

The main finding was that there was no statistically significant difference in subjective complaints of mental health distress reaching the threshold for caseness between the two groups (shift and non-shift workers) based on GHQ12 score (p = 0.326).

Total Quality of Life scores, as percentage, were analysed for the two groups. There was no statistically significant difference in the overall quality of life with mean scores of 57.7% (SD = 16.6) and 61.6% (SD = 15.6) for shift workers and non-shift workers respectively (p = 0.443). However, participants that met the GHQ12 threshold for mental health caseness did report poorer Quality of Life (p = 0.001).

The shift workers reported shorter sleep duration (p = 0.018) and more use of substances to help initiate sleep (p = 0.025), which reflects possible circadian rhythm disturbance. The respondents who met the GHQ12 threshold for mental health caseness reported more use of substances to help initiate sleep (p = 0.026). In addition, there was a positive correlation between the GHQ12 Likert scores and the use of substances to help initiate sleep (rs = 0.439, p = 0.004) which suggests that participants with less pronounced mental health symptoms below the threshold for caseness, also made more use of substances to help initiate sleep


NHS managers’ view on the implementation of a phased return to work for staff returning from long-term sickness absence

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Author: Tan. K

Year: 2019

Long-term sickness absence places a substantial financial pressure across organisations. A phased return to work plan is one of the methods to facilitate an early return to work following a period of sickness absence. Managers are expected to implement a phased return to work based on the advice from the GP fit note or the Occupational Health (OH) report. Little is known about managers’ views on the implementation of a phased return to work, in particular, their confidence level in planning one, the sources of information used and their views of the most important factors to consider. This study explored the manager’s view by conducting a cross sectional survey.

This study was a descriptive and exploratory study using a web-based questionnaire. All NHS staff with managerial responsibility were identified using a local database of staff and invitations to participate were sent by email.

The content of the OH report and the findings of a discussion with employees are commonly used by managers in implementing a phased return to work. Managers felt previous knowledge of the employee was the most important factor to consider. Subgroup analyses show GP fit note information is not commonly used by managers with a clinical degree but having this qualification does not improve their confidence in managing the return to work. Managers without such degree were four times more likely to be guided by the GP fit note.

By understanding the sources of information used and factors that influence managers’ decision regarding the implementation of a phased return to work, a focus on ensuring they have good quality information can be made. Further research to explore the reasons for not using the information from the GP fit note should be considered.


Systematic review of literature on occupational work related musculoskeletal disorders in ultrasonographers

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Author: Sharma, D

Year: 2019

Work related musculoskeletal disorders (WRMSDs) in ultrasonographers were first reported by Craig in 1985. There appears to be possible association between occupational factors and WRMSDs globally. WRMSDs in ultrasonographers affect working life, reduce work productivity, increase absence due to ill health and can result in disability and deterioration in quality of life and service.


This systematic review addresses growing incidence of WRMSDs among ultrasonographers. The review analysed the evidence of association between occupational factors, applied ergonomics and WRMSDs’ risk in ultrasonographers.

Published articles exploring WRMSDs in ultrasonographers were searched using several databases from 1985 when such conditions started to be recognised, until November 2018. Two independent resources, NHS library and BMA were used for literature searches, retrieving and identification of relevant articles. Studies were excluded if they were using non validated questionnaires or were not in English. Critical Appraisal Skills Programme (CASP) was used for quality appraisal.

This review identified 21 studies from 10 countries reporting WRMSDs in ultrasonographers. The majority of these studies showed increased risk of WRMSDs in ultrasonographers with prevalence rate of 79.96% (95%CI: 77.82%-82.10%). Associations were found between WRMSDs and patients’ body mass index (BMI), ultrasonographers’ gender, working hours, use of ergonomics principles at work and psychosocial factors.

This systematic review shows moderately high prevalence rate of WRMSDs in ultrasonographers with multifactorial causes which are individual, organisational and occupational. This review also identified the role of education and application of ergonomics principles in reducing the risk of WRMSDs in ultrasonographers. Application of ergonomics principles would not eliminate WRMSDs, but is likely to improve the health and wellbeing of ultrasonographers. Further research is necessary to explore how control of multiple factors reduces the risk of WRMSDs in ultrasonographers in the long term. The significant impact of WRMSDs on ultrasonographers, radiology departments and the wider economy supports the need for prospective large scale study.