An Evaluation of the Keeping Well at Home Booklet

Background

In the first wave of COVID-19, the UK Government relied heavily on digital channels to provide information to the public. This disproportionately excluded older people - one of the groups with least access to (or experience of) using the internet. Approximately 11.5 million people in the UK lack digital skills and 4.8 million people never go online, with around half (51%) of these being aged over 65. The Greater Manchester (GM) response was to work collaboratively with a number of key Ageing groups to develop Keeping Well at Home, a booklet providing evidence based health and wellbeing information and advice for older people during COVID-19 restrictions.

Methods

An evaluation of the booklet was undertaken during summer 2020 by the Healthy Ageing team at the Applied Research Collaboration GM. As national restrictions on movement remained in place at the time, a postal questionnaire was distributed to a sample of older adults in GM.

Results

Nearly 500 questionnaires were returned. The response was overwhelmingly positive; 92% found the information helpful; 90% agreed the booklet would help older people stay healthy during lockdown; 74% had used the home exercises section; 78% found the tips for keeping their mind well helpful. Around 50% of respondents did not have internet access. Paper based resources was the preferred choice for 92% of respondents with only 6% opting for digital versions.

Conclusions

The evidence from the evaluation challenges the growing trend towards communicating just through digital channels, and emphasises the need for tailored paper-based materials for older adults. The Keeping Well at Home booklet also shows the value of working with older adults to ensure the content and design are inviting to readers. Information, support and services must be made available in an offline equivalent and proactively disseminated to reach those who otherwise would not have access to it.

Key messages

Print-based communications are preferred over digital for some groups; ensuring inclusivity is critical as the ‘digital by default’ approach excludes large numbers of our population.

Including target group representatives as co-editors to advise on content and stylistic design is key to ensure content is relevant and useful.

Sentinel approach to detect emerging causes of work-related respiratory diseases

BACKGROUND

The world of work is continually changing, and this could result in new and emerging risks being introduced, including those that may cause work-related respiratory diseases (WRRD).

AIMS

To describe recently emerging and new cases of WRRD and the relevant methodology using data in a national occupational respiratory disease surveillance scheme in the UK.

METHODS

Incident cases of respiratory diseases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) between January 2015 and December 2017 were included. Potentially emerging respiratory hazards manifesting in SWORD data were identified with the following hierarchical approach: (i) new respiratory disease not previously associated with work, (ii) specific exposure/agent not previously associated with WRRD and (iii) industry and/or occupation not previously associated with WRRD.

RESULTS

A total of 1215 cases of WRRD were reported to SWORD between January 2015 and December 2017. No new WRRD were identified. Thirteen potentially emerging causes of occupational asthma were identified, including exposures to agents such as ninhydrin. Four potential new causes were identified for interstitial pneumonia, which included wood and brass dust. Two potentially emerging causes of WRRD were identified for inhalational accidents (green coffee and nitrocellulose), hypersensitivity pneumonitis (diphenylmethane diisocyanate and salami mould), rhinitis (morphine and Amaranthus quitensis) and sarcoidosis (prions and horses).

CONCLUSIONS

Continuous monitoring and reporting of any new work-related disease is a critical function of any occupational disease reporting scheme. Potential emerging causes of work-related health risks have been identified by using a simple and systematic way of detecting emerging causes of WRRDs.

Work-related ill-health in radiographers

Background

In the UK in 2015/16, 1.3 million workers self-reported a work-related illness (WRI) of which an estimated 41% were due to musculoskeletal disorders (incidence rate 550 cases per 100000 people) and 37% were related to stress, anxiety and depression. Little is known about the incidence of WRIs in radiographers.

Aims

To analyse the medically reported incidence of WRIs among radiographers in the UK between 1989 and 2015.

Methods

Incident cases reported by physicians to The Health and Occupation Research (THOR) network through its specialist schemes from 1989 to 2015 were analysed, using the Labour Force Survey as denominator where appropriate.

Results

In total, 218 cases (966 estimated cases) were reported. Of these 190 were in women. The mean age was 40.2 (20-91 years) SD ± 11.8 years. Most cases were reported to the Occupational Physicians Reporting Activity (OPRA) scheme (n = 92). A skin diagnosis was the most frequently reported (n = 77), followed by musculoskeletal (n = 60). Within the EPIDERM scheme, radiographers had the highest incidence rate when compared to all other occupations.

Conclusions

Radiographers had a higher incidence of WRI compared to all other occupations. The most frequently reported WRI was skin conditions. The observed increase in incidence is likely to be due to the increase in the number of radiographers over that time period, although there was no evidence that WRI within radiographers are declining.

Has the fit note reduced general practice sickness certification rates?

BACKGROUND

In 2010, the fit note replaced the sick note to help focus on what people are capable of doing, rather than signing patients 'off sick'.

AIMS

To compare proportions of work-related ill-health issued with sickness certification pre- and post-fit note introduction and assess sickness absence trends.

METHODS

General practitioners (GPs) report data on work-related ill-health and sickness absence via The Health and Occupation Research network in General Practice. The proportion of cases issued with sickness certification 4 years before and 3 years after the fit note introduction were compared. Changes in certification incidence rate ratios were measured over time.

RESULTS

Participating GPs reported 5517 cases of work-related ill-health. Pre-fit note introduction 50% of cases were certified sick. There was no change in the proportion of cases certified sick in the first year post-fit note, despite 13% of cases classified as 'maybe fit'. However, in the second year, the proportion of cases certified sick had reduced significantly (41%) and a larger proportion (19%) was advised on workplace adjustments. In the third year post-introduction, there was a slight rise in the proportion of cases certified sick; therefore, although there was a fall of 2% per annum in certification rates, this was not significant.

CONCLUSIONS

In the first year post-fit note introduction, modifications to work were recommended for people who would previously have been declared fit. Trends analyses showed a slight decrease in the certification rate, possibly indicating GPs will become more practised in advising on workplace adjustments.

Cases of occupational dermatitis and asthma in beauticians that were reported to The Health and Occupation Research (THOR) network from 1996 to 2011

BACKGROUND

Beauticians are exposed to many potential allergens in their occupation.

AIM

To identify the sources of occupational skin and respiratory disease reported in beauticians, with an emphasis on acrylate chemicals, and to investigate the trends over time.

METHODS

We used the Health and Occupation Research (THOR) database to identify occupational disease in beauticians between 1996 and 2011. Trend analysis was carried out to look for any change in the allergens reported over this period.

RESULTS

In total, 257 cases of contact dermatitis (CD) in beauticians were identified, which were associated with 502 suspected agents. The most frequently cited source of allergic CD was acrylate chemicals. The trend analysis showed a small average annual percentage increase in work-related CD in beauticians for all agents (1.1%; 95% CI -2.5 to 4.9). There was a small decrease in cases in which acrylates were not cited (-1.7%; 95% CI -5.9 to 2.7), and a statistically significant increase when acrylates were cited (7.4%; 95% CI 0.9 to 14.4). There were 11 cases of occupational asthma.

CONCLUSION

We found an increase in cases of occupational dermatitis associated with acrylates in beauticians over a 15-year period, and describe other causes of occupational dermatitis.

Work-related ill-health: Republic of Ireland, Northern Ireland, Great Britain 2005-2012

BACKGROUND

Data on work-related ill-health (WRIH) in the Republic of Ireland is inconsistent.

AIMS

To compare the incidence of WRIH in the Republic of Ireland (ROI), Northern Ireland (NI) and Great Britain (GB) reported by clinical specialists in skin and respiratory medicine and by specialist occupational physicians (OPs).

METHODS

Analysis of data reported to three surveillance schemes in The Health and Occupation Research (THOR) network in ROI and corresponding UK schemes.

RESULTS

Contact dermatitis was the most frequently reported skin disease in the three areas. Asthma was the most frequently-reported respiratory disease in the ROI, while asbestos-related cases predominate in GB and NI. Mental health disorders, followed by musculoskeletal disorders were reported most frequently by OPs. Annual average incidence rates for skin disease were 2 per 100000 employed (95% confidence interval [CI] 1.9-2.8) in the ROI and 7 per 100000 for GB (95% CI 4.8-9.4). Unadjusted incidence rates for respiratory disease were 1 (95% CI 0.3-1) and 8 (95% CI 6.1-10.7) per 100000 in the ROI and GB, respectively; adjusted for reporter non-response, these figures increased to 15 (95% CI 11.3-19.6) and 32 (95% CI 28.4-35.6) per 100000 respectively.

CONCLUSIONS

This is the first paper to include THOR data on WRIH from the ROI, NI and GB. Consistent and dedicated data collection in the ROI via the THOR schemes is viable and important in the light of a deficit of occupational ill-health data. Sustained efforts to improve participation are underway.

Comparison of work-related ill-health data from different GB sources

BACKGROUND

A number of data sources help inform policy decisions regarding the risk of work-related ill-health.

AIMS

To compare self-reported and medically reported data from multiple sources and discuss their benefits and limitations in providing estimates of work-related ill-health incidence in Great Britain.

METHODS

Sources included The Health & Occupation Reporting network (THOR & THOR-GP (THOR in General Practice)) and the survey of Self-reported Work-related Illness (SWI). Results from SWI and THOR from GPs, rheumatologists, psychiatrists, dermatologists and respiratory physicians (2006-2009) were compared. THOR-GP data also included patient referrals information.

RESULTS

Overall incidence rates were highest when calculated from self-reported data, and lowest from clinical specialists. SWI rates were higher than GP rates for mental ill-health (SWI 790, GP 500 per 100 000 persons employed) and 'other' diagnoses (SWI 368, GP 41), whereas incidence rates for musculoskeletal (SWI 670, GP 684) and skin diagnoses (SWI 38, GP 152) were higher from GPs. Very few cases of musculoskeletal and mental ill-health were referred to clinical specialists (<1%). Skin (15%) and respiratory (26%) cases were referred more frequently. Case mix varied by data source.

CONCLUSIONS

SWI is more inclusive than THOR-GP; however, reports are unsubstantiated by medical opinion. Clinical specialist reports are subject to biases such as severity and referral patterns. GP data benefit from their inclusion of less severe cases than reports from secondary care and may give a better reflection of the incidence of diseases with a work-related aetiology unrecognized by self-reporting individuals.

HOXA9 methylation by PRMT5 is essential for endothelial cell expression of leukocyte adhesion molecules

The induction of proinflammatory proteins in stimulated endothelial cells (EC) requires activation of multiple transcription programs. The homeobox transcription factor HOXA9 has an important regulatory role in cytokine induction of the EC-leukocyte adhesion molecules (ELAM) E-selectin and vascular cell adhesion molecule 1 (VCAM-1). However, the mechanism underlying stimulus-dependent activation of HOXA9 is completely unknown. Here, we elucidate the molecular mechanism of HOXA9 activation by tumor necrosis factor alpha (TNF-α) and show an unexpected requirement for arginine methylation by protein arginine methyltransferase 5 (PRMT5). PRMT5 was identified as a TNF-α-dependent binding partner of HOXA9 by mass spectrometry. Small interfering RNA (siRNA)-mediated depletion of PRMT5 abrogated stimulus-dependent HOXA9 methylation with concomitant loss in E-selectin or VCAM-1 induction. Chromatin immunoprecipitation analysis revealed that PRMT5 is recruited to the E-selectin promoter following transient HOXA9 binding to its cognate recognition sequence. PRMT5 induces symmetric dimethylation of Arg140 on HOXA9, an event essential for E-selectin induction. In summary, PRMT5 is a critical coactivator component in a newly defined, HOXA9-containing transcription complex. Moreover, stimulus-dependent methylation of HOXA9 is essential for ELAM expression during the EC inflammatory response.

Surveillance for work-related audiological disease in the UK: 1998-2006

BACKGROUND

Noise-induced hearing loss (NIHL) from prolonged occupational exposure to noise continues to rank among the top worldwide work-related ill-health problems.

AIMS

To provide an overview of incident cases based on work-related audiological ill-health data collected over a 9-year period from occupational physicians (OPs), audiological physicians (APs), general practitioners and otorhinolaryngologists.

METHODS

Analysis of numerator data reported by physicians to surveillance schemes within The Health and Occupation Reporting network (THOR). The actual cases were multiplied by the sampling ratio to provide estimated numerator numbers, followed by calculation of incidence rates using denominator data derived from the Labour Force Survey and from surveys of participating OPs.

RESULTS

Two thousand five hundred and eighty-two estimated cases (2584 estimated diagnoses) were received from OPs (Occupational Physicians Reporting Activity [OPRA]), and 2192 estimated cases (3208 estimated diagnoses) of work-related audiological ill-health were received from consultant APs [Occupational Surveillance Scheme for Audiological physicians (OSSA)] from 1998 to 2006. Cases where the causal agent was noise exposure (NIHL and tinnitus) made up of 95 and 97% of all cases reported to OPRA and OSSA, respectively. The annual average incidence rate for noise-induced audiological disorders was 7.9 [95% confidence interval (CI) 4.6-11.1] per 100 000 persons employed (OPRA) and 0.8 (95% CI 0.7-1.0) per 100 000 persons employed (OSSA). Workers with the highest incidence were older males employed in public administration and defence and the manufacture of metals.

CONCLUSIONS

THOR data show that diagnoses related to work-related noise exposure (NIHL/tinnitus), as reported to THOR, remain important health problems, despite preventive measures being in place.

Improving estimates of specialist-diagnosed, work-related respiratory and skin disease

BACKGROUND

Work-related skin and respiratory disease still constitute an important part of the work-related ill-health (WRIH) burden of Great Britain (GB). It is therefore important to be able to accurately quantify the true incidence of these two groups of disease.

AIMS

To improve the accuracy of the methodology to estimate clinical specialist incidence rates, with a focus on skin and respiratory disease. Specifically, we sought to estimate the number of additional cases not captured by voluntary surveillance through The Health and Occupation Reporting (THOR) network and provide a better estimation of the true incidence of work-related skin and respiratory disease in GB.

METHODS

Cases not captured by THOR in 2005-2007 due to non-participation of eligible clinical specialists and due to <100% response rates by THOR participants were estimated, and the numerator adjusted accordingly. Adjusted incidence rates were calculated using Labour Force Survey data as the denominator.

RESULTS

During 2005-2007, 62% of skin cases and 60% of GB respiratory cases were likely to have been captured by THOR. After adjustment, dermatologist-derived incidence rates for skin disease were raised from 9 to 14 per 100,000 employed, while those for respiratory disease were raised from 10 to 17 per 100,000 employed.

CONCLUSIONS

We have provided a significant improvement in the surveillance-based methodology used to estimate the number of cases of WRIH captured by THOR and hence enabled more accurate estimations of GB incidence rates for clinical specialist-reported WRIH.