Kaveh A Sanati

Employment status and health: understanding the health of the economically inactive population in Scotland

BackgroundAlthough the association between health and unemployment has been well examined, less attention has been paid to the health of the economically inactive (EI) population. Scotland has one of the worst health records compared to any Western European country and the EI population account for 23% of the working age population. The aim of this study is to investigate and compare the health outcomes and behaviours of the employed, unemployed and the EI populations (further subdivided into the permanently sick, looking after home and family [LAHF] and others) in Scotland.MethodsUsing data from the 2003 Scottish Health Survey, the differences in health and health behaviours among the employed, unemployed and the subgroups of the EI population were examined.ResultsBoth low educational attainment and residence in a deprived community were more likely in the permanently sick group. The LAHF and the unemployed showed worse self-reported health and limiting longstanding illness compared to the employed but no significant differences were observed between these groups. The permanently sick group had significantly poorer health outcomes than all the other economic groups. Similar to the unemployed and LAHF they are more likely to smoke than the employed but less likely (along with LAHF and ‘others’) to exhibit heavy alcohol consumption. Interestingly, the LAHF showed better mental health than the rest of the EI group, but a similar mental health status to the unemployed. On the physical health element of lung function, the LAHF were no worse than the employed.ConclusionWhile on-going health promotion and vocational rehabilitation efforts need to be directed towards all, our data suggests that the EI group is at higher risk and policies and strategies directed at this group may need particular attention.

Occupational health services now and in the future: the need for a paradigm shift.

Objective: Occupational health services (OHS) evolved in response to the needs of hazardous industries and on the premise that work was harmful. In the developed world, most of these industries have disappeared, and classical occupational diseases are uncommon. Evidence: The evidence now is that most work is safe and safe work is good for health. Access to OHS is inconsistent, and there is no continuity of care for workers who move to another employer or leave work because of ill health. Consensus Process: OHS therefore care for survivor populations and generally those in large enterprises who need OHS the least. From a societal viewpoint, OHS are not fit for purpose. They have not adapted to the evolving small business and more informal work sector. The health impact of long-term worklessness is large and the workless need access to the competencies of OHS. Conclusion: In the future, OHS should develop to meet the needs of the working-age population and to maximize the functional capacity.

A novel approach to early sickness absence management: The EASY (Early Access to Support for You) way

BACKGROUND: Sickness absence (SA) is multi-causal and remains a significant problem for employees, employers and society. This makes it necessary to concurrently manage a particular disabling condition and consider the working environment and employee-employer relationship. OBJECTIVE: To describe and examine the components of a novel SA management service Early Access to Support for You (EASY) and discuss their potential influence on the intervention. METHODS: A new sickness absence model, starting from day one of absence, was created called EASY. EASY is planned to support both employees and managers and comprises elements already found to be associated with reduction of SA, such as maintaining regular contact; early biopsychosocial case-management; physiotherapy; mental-health counselling; work modification; phased return-to-work; and health promotion activities. RESULTS: During the EASY implementation period, the SA rate at a health board reversed its trend of being one of the highest rates in the Scottish National Health Service (NHS) and EASY was considered helpful by both managers and employees. CONCLUSIONS: This paper describes an innovative occupational health intervention to sickness absence management based on the bio-psychosocial model to provide early intervention, and discusses the pros and cons of applying cognitive behavioural principles at an early stage in sickness-absence events, in order to improve return-to-work outcomes.

European Working Time Directive and doctors’ health: a systematic review of the available epidemiological evidence

Objective To summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians. Design A systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria. Setting Physicians of any medical, surgical or community specialty, working in any possible setting (hospitals, primary healthcare, etc), as well as trainees, residents, junior house officers or postgraduate interns, were included. Participants The total number of participants was 14 338. Primary and secondary outcome measures Health effects classified under the International Classification of Diseases (ICD-10). Results Over 3000 citations and 110 full articles were reviewed. From these, 11 studies of high or intermediate quality carried out in North America, Europe and Japan met the inclusion criteria. Six studies included medical residents, junior doctors or house officers and the five others included medical specialists or consultants, medical, dental, and general practitioners and hospital physicians. Evidence of an association was found between percutaneous injuries and road traffic accidents with extended long working hours (LWH)/days or very LWH/weeks. The evidence was insufficient for mood disorders and general health. No studies on other health outcomes were identified. Conclusions LWH could increase the risk of percutaneous injuries and road traffic accidents, and possibly other incidents at work through the same pathway. While associations are clear, the existing evidence does not allow for an established causal or ‘dose–response’ relationship between LWH and incidents at work, or for a threshold number of extended hours above which there is a significantly higher risk and the hours physicians could work and remain safe and healthy. Policymakers should consider safety issues when working on relaxing EWTD for doctors.

Work-health needs of high-altitude mountain guides (Sherpas) in Nepal - a pilot study.

Much of the research in high-altitude medicine has been concerned with non-indigenous travellers; no study has examined the work-related health issues of high altitude mountain guides (Sherpas) in Nepal. This pilot study was performed to investigate the work-related health issues of people working as Sherpas by evaluating their perceptions of their general health and its relation to work. An occupational and general health questionnaire was tailored for the Sherpas following a focus group with five Sherpa workers. 131 Sherpas participated in this study. Respiratory (60%) and musculoskeletal symptoms (55%) were reported significantly more frequently than other health problems (p < .05). 33 Sherpas reported work accident experiences (25%) and 27 (21%) reported eye conditions. This pilot study identified respiratory and musculoskeletal problems as well as accidents as the main work-related health issues of high altitude climbing Sherpas. Another important finding was the high prevalence of reported eye conditions (21%). Better occupational health and safety arrangements including routine recording of accidents or work-related health problems would give better insight into the health needs of Sherpas.

OP63 Very early workplace sickness absence interventions: A systematic review and meta-analysis of their effectiveness

Background Sickness absence (SA) remains a significant problem globally, notably in developed countries. Early intervention to enhance return to work has been identified as a key priority in disability and SA management and these interventions implemented in the early stages of SA episodes indicate that ‘early’ and ‘very early’ intervention may result in a quicker return to work and be cost-effective. The objective of this systematic review is to investigate the effectiveness of ‘very early’ (under 15 days) SA workplace interventions to enhance return to work. Methods A systematic literature search was conducted in Pubmed, HMIC, Cochrane library database, CINAHL, PsychInfo and Embase. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria. Randomised controlled trials, controlled trials, cluster-randomised trials, cross-over designs, before and after studies and interrupted time-series published in English until September 2014 were included if they assessed the effectiveness of workplace interventions to reduce SA in workers who were on sick leave no longer than 15 days. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. The Cochrane Collaboration tool was used to assess the risk of bias. Results We found limited available evidence on the benefits of ‘very early’ workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomised controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction on the duration and recurrence of SA, and increased self-perception of health and quality of life. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders and less for workers with mental health problems. Conclusion Our review identified a lack of substantive evidence from the literature at this time point to support ‘very early’ intervention compared to usual care. Consensus is required on the definition of ‘early’ and ‘very early’ interventions and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.

Is it better to be poor and unemployed or rich and work in a hazardous environment

Largent discusses the occupational hazards faced by Sherpas on Everest, and the ethics of hiring people from poor communities to do dangerous work.1 Sherpas are one ethnic group among many who undertake high altitude mountain guiding in Nepal and elsewhere. They usually start their climbing career by working as porters who are lowly paid, are poorly equipped, and carry loads …