Body mass index and occupational accidents among health care workers in a large university hospital

INTRODUCTION

Obesity is associated with a number of chronic diseases such as cardiovascular diseases and cancers. The association of obesity with occupational accidents has been suggested although the evidence is less convincing. The objective of the study is to analyse the relationship between BMI values and ergonomic accidents in a large University Hospital.

METHODS

The relationship between body mass index (BMI) and the incidence of ergonomic occupational accidents over a period of 8 years was investigated in a cohort of employees of a large University Hospital, covering almost 27,000 person-years of observation. This relationship was stratified according to the variables age, gender, functional status within the organization and work schedule (part-time or full time). Height and weight were objectively measured, demographic data were obtained from the human resource department and the registration of ergonomic accidents was carried out by the safety and prevention department of the hospital.

RESULTS

The number of ergonomic accidents, expressed as number/1000 person-years was higher for female employees compared to male employees, increased with age and markedly increased from functional class A (leading or expert function and higher educational level) to D (executive function in patient care and technical department). However, the incidence of ergonomic accidents accompanied by loss of working time was not significantly associated with BMI, independently of age and gender. In addition, the type of accident and the severity of the accidents expressed as the number of days absent from work were unrelated to BMI.

CONCLUSION

No independent relationship between BMI and the incidence of ergonomic accidents could be identified in our cohort. Tailoring working conditions to individual BMI levels is not recommended.

The long-term effect of job mobility on workers' mental health: a propensity score analysis

OBJECTIVES

The main purpose of this longitudinal study was to elucidate the impact of external job mobility, due to a change of employer, on mental health.

METHODS

A cohort of Belgian employees from the IDEWE occupational medicine registry was followed-up for twenty-seven years, from 1993 to 2019. The use of drugs for neuropsychological diseases was considered as an objective indicator of mental health. The covariates were related to demographic, physical, behavioural characteristics, occupational and work-related risks. Propensity scores were calculated with a Cox regression model with time-varying covariates. The PS matching was used to eliminate the systematic differences in subjects' characteristics and to balance the covariates' distribution at every time point.

RESULTS

The unmatched sample included 11,246 subjects, with 368 (3.3%) that changed their job during the baseline year and 922 (8.2%) workers that left their employer during the follow-up. More than half of the matched sample were males, were aged less than 38 years old, did not smoke, were physically active, and normal weighted, were not exposed to shift-work, noise, job strain or physical load. A strong association between job mobility and neuropsychological treatment was found in the matched analysis (HR = 2.065, 95%CI = 1.397-3.052, P-value < 0.001) and confirmed in the sensitivity analysis (HR of 2.012, 95%CI = 1.359-2.979, P-value < 0.001). Furthermore, it was found a protective role of physical activity and a harmful role of job strain on neuropsychological treatment.

CONCLUSIONS

Our study found that workers with external job mobility have a doubled risk of treatment with neuropsychological medication, compared to workers without job mobility.

Development and validation of an occupational health triage tool

BACKGROUND

As work and health are closely interlinked, it is important to carefully monitor employees. However, limited resources restrict in-depth follow-up.

AIMS

This study was aimed to develop a low-cost screening instrument for employees' overall health status, that can be used across industries and that allows triaging workers to in-depth health surveillance in case of indications of health or functioning problems.

METHODS

We developed a new questionnaire-based algorithm built on multiple predictors to assess the need for further follow-up. We used a systematic review, Delphi panel (n = 9) and focus group (n = 5) to determine the predictors, tested for language pitfalls in a pilot study and evaluated the questionnaire's validity in two separate studies. Study 1 (n = 60) analysed the discriminatory power of the instrument by comparing it to the assessment of an occupational physician in a sample of employees from diverse occupational settings. Study 2 (n = 869) appraised the factor structure and internal consistency of the screening tool in a sample of employees from the hospital sector.

RESULTS

Risk factors, current physical and mental health, functioning, absenteeism, job satisfaction and lifestyle were identified as the most relevant predictors. Study 1 showed the survey had good criterion validity (area under the curve = 0.72). Study 2 (N = 869, 28% response) demonstrated the internal consistency (Cronbach's α = 0.94), and a factor analysis confirmed a second-order factor structure with adequate model fit (comparative fit index = 0.96, root mean square error of approximation = 0.04 and standardized root mean square residual = 0.07).

CONCLUSIONS

This questionnaire can be used to triage workers for occupational health follow-up and can, additionally, be useful to describe the epidemiology of work-related illness.

The Impact of a Change in Employment on Three Work-Related Diseases: A Retrospective Longitudinal Study of 10,530 Belgian Employees

BACKGROUND

The literature that has investigated to what extent a change in employment contributes to good health is contradictory or shows inconsistent results. The aim of this study was to investigate whether an association exists between a change in employment and cardiovascular, musculoskeletal and neuropsychological diseases in a sample of 10,530 Belgian workers in a seven-year follow-up study period.

METHODS

The following factors were analysed: Demographic variables, a change in employment and the work-related risks. Individuals being on medication for cardiovascular, musculoskeletal, and neuropsychological diseases were used as proxies for the three health issues. Logistic regression models for autocorrelated data with repeated measures were used to examine each medication type.

RESULTS

A change in employment and psychosocial load can have an important effect on the health of cardiovascular employees. Demographic variables, such as BMI and age, are risk factors for all three medications. Repetitive, manual tasks, handling static, exposure to noise levels of 87 dB, mechanical and/or manual handling with loads, and shift work were found to be positively associated with medications taken for musculoskeletal diseases. Exposure to noise 80 dB(A), managing physical loads and night work were found to be associated with being on medication for neuropsychological diseases. Physical activity and skill levels were considered to be protective factors for being on medication for neuropsychological diseases.

CONCLUSIONS

Change in employment and psychosocial load were found as two important risk factors for being on medication for cardiovascular (CVD). Dealing with loads, doing shift work and being daily exposed to the noise of 87 dB correlated with being on medication for musculoskeletal (MSD). Dealing with physical loads, doing night work and being exposed to the noise of 80 dB were risk factors for being on medication for neuropsychological (NPD). While doing physical activity and reporting higher skill levels were found to be protective factors for NPD.

A scoping review to identify strategies that work to prevent four important occupational diseases

BACKGROUND

Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts.

METHODS

To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants.

RESULTS

We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity.

CONCLUSIONS

This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.

Prevalence of high cardiovascular risk by economic sector

Purpose

The aim of this study was to assess the prevalence of high cardiovascular risk and the trend of cardiovascular risk factors in a large sample of Belgian workers.

Methods

A cross-sectional study was performed on the data of workers under medical surveillance by the non-profit occupational health service IDEWE in 2018. The prevalence of poor health for smoking, physical activity, body mass index (BMI), and blood pressure according to the American Heart Association (AHA) definition was investigated. The presence of three or more poor cardiovascular health metrics was considered high cardiovascular risk. A log-binomial regression model was used to compare the prevalence of high cardiovascular risk between economic sectors taking into account age and gender and to calculate predicted probabilities of high cardiovascular risk.

Results

Data about 212,792 workers were available. In 2018, overall, 7% of workers had high cardiovascular risk. Transport and construction had the highest prevalence of high cardiovascular risk, 14% and 12%, respectively. The lowest prevalence, 3%, was observed in education. Differences between sectors remained statistically significant after adjustment for age and gender. In men, workers in transport and storage and in construction had the highest predicted probability of high cardiovascular risk that increased with age. In women, highest predicted probability was observed in transport and storage.

Conclusions

When implementing health promotion initiatives, priority should be given to sectors and professions where risk factors are most prevalent or are increasing rapidly. Measures should be tailored to the special needs of the occupational groups at high risk.

Electronic supplementary material

The online version of this article (10.1007/s00420-019-01458-9) contains supplementary material, which is available to authorized users.

Opinion paper: the role of work in the management of medically unexplained physical symptoms

OBJECTIVES

Patients with medically unexplained physical symptoms suffer from chronic fatigue and/or pain in combination with a variety of other symptoms. A flexible, biopsychosocial approach is needed for diagnostic screening and global management. It is crucial to involve the direct patient environment, including family, friends, colleagues as well as health providers, evaluation, and reintegration sector. The aim of this paper is to review the importance of work in the management of medically unexplained physical symptoms.

METHODS

In this paper, different actors involved explain their views and handling concerning work in the management of MUPS.

RESULTS

Symptom severity and lack of understanding from the environment can negatively impact on earning an independent income from labor for years. Work, whether or not paid, is however, an important life domain with positive effects on physical, psychological, and social well-being. Therefore, health actors are pivotal in starting the professional reintegration process as soon as possible and should discuss this item from the early stage onward. Support services can be consulted in mutual interaction as required. A case manager, acting as a central intermediator within this multidisciplinary approach, may promote effective communication and coordination between the patients and their surrounding actors.

CONCLUSION

The professional reintegration process should start as soon as possible within the management of medically unexplained physical symptoms. As such, the care sector, the evaluation sector, and the professional integration sector should collaborate and effectively communicate with each other.

Observational Surveillance Approach to Detect Novel Work-Related Diseases and Hazards: An Application to a Belgian Occupational Health and Safety Database

OBJECTIVES

Rapid changes in working conditions give rise to new occupational health risks. We applied the Spectrosome approach, a network-based analysis, to investigate associations between disease and multiple occupational exposures.

METHODS

We investigated work and health's associations in a specific sector: the agricultural sector and for a specific and frequent health complaint: sore throat; using PRECUBE dataset of the Belgian Occupational Health and Safety, containing 381.615 occupational health observations. We compared the results of the spectrosome with classic frequency analyses.

RESULTS

Spectrosome approach reports more significant signals of multiple associations of agents compare to the frequency analysis.

CONCLUSION

This difference justifies the usefulness of taking into account the multiplicity of causes leading to a health event, which is a clear asset of the Spectrosome method.

Incidence of ill-health related job loss and related social and occupational factors. The "unfit for the job" study: a one-year follow-up study of 51,132 workers

Objective

The analysis of ill-health related job loss may be a relevant indicator for the prioritization of actions in the workplace or in the field of public health, as well as a target for health promotion. The aim of this study was to analyze the medical causes, the incidence, and the characteristics of employees medically unfit to do their job.

Methods

This one-year prospective study included all workers followed by occupational physicians in an occupational health service in the south of France. The incidence of unfitness for work have been grouped according to the main medical causes and analyzed. We performed a multivariate analysis in order to adjust the observed risk of job loss based on the age groups, sex, occupation and the activity sectors.

Results

A total of 17 occupational physicians followed up 51,132 workers. The all-cause incidence of being unfit to return to one’s job was 7.8‰ (n = 398). The two main causes of being unfit for one’s job were musculoskeletal disorders (47.2%, n = 188) and mental ill-health (38.4%, n = 153). Being over 50 years old (Odds ratio (OR) 2.63, confidence interval 95% CI [2.13–3.25]) and being a woman (OR 1.52, 95% CI [1.21–1.91]) were associated with the all-cause unfitness, independent of occupation and activity sector.

Conclusions

Identification of occupational and demographic determinants independently associated with ill-health related job loss may provide significant and cost-effective arguments for health promotion and job loss prevention.

Associations between common diseases and work ability and sick leave among health care workers

PURPOSE

This study investigates whether common diseases, i.e., musculoskeletal diseases (MSD), cardiovascular diseases (CVD), mental disorders (MD), and respiratory diseases (RD), influence work ability and sick leave and whether lifestyle-related factors, and psychosocial and physical work-related factors are associated with low work ability and sick leave.

METHODS

In a cross-sectional study among 8364 Dutch health care employees, self-reported information was acquired concerning common diseases, lifestyle-related factors, psychosocial and physical work-related factors, work ability, and sick leave. Logistic regression analyses were performed to describe the associations between common diseases with low work ability and sick leave, and to evaluate differences in associations between lifestyle-related and work-related factors with low work ability and sick leave among healthy employees and employees with common diseases.

RESULTS

Employees with MD (OR 6.35), CVD (OR 2.63), MSD (OR 2.62), and RD (OR 2.11) had a higher risk of low work ability compared to healthy employees. Workers with common diseases also reported more often sick leave (ORs > 1.60), in particular long-term sick leave (>25 days). Multimorbidity increased both the occurrence of low work ability and sick leave. Unfavourable psychosocial work-related factors were associated with low work ability and sick leave regardless of health status. Physical work-related factors and lifestyle factors were less consistently associated with low work ability and sick leave.

CONCLUSIONS

Common diseases, and foremost mental disorders, were related to both low work ability and sick leave. To maintain or improve work ability and prevent sick leave, interventions that promote a healthy psychosocial work environment are needed.