[Review] Physician wellness: a missing quality indicator

[Review] Physician wellness: a missing quality indicator: "When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation."

Major Lipids, Apolipoproteins, and Risk of Vascular Disease [Original Contribution]

Major Lipids, Apolipoproteins, and Risk of Vascular Disease [Original Contribution]: "

Context Associations of major lipids and apolipoproteins with the risk of vascular disease have not been reliably quantified.

Objective To assess major lipids and apolipoproteins in vascular risk.

Design, Setting, and Participants Individual records were supplied on 302 430 people without initial vascular disease from 68 long-term prospective studies, mostly in Europe and North America. During 2.79 million person-years of follow-up, there were 8857 nonfatal myocardial infarctions, 3928 coronary heart disease [CHD] deaths, 2534 ischemic strokes, 513 hemorrhagic strokes, and 2536 unclassified strokes.

Main Outcome Measures Hazard ratios (HRs), adjusted for several conventional factors, were calculated for 1-SD higher values: 0.52 log_e triglyceride, 15 mg/dL high-density lipoprotein cholesterol (HDL-C), 43 mg/dL non–HDL-C, 29 mg/dL apolipoprotein AI, 29 mg/dL apolipoprotein B, and 33 mg/dL directly measured low-density lipoprotein cholesterol (LDL-C). Within-study regression analyses were adjusted for within-person variation and combined using meta-analysis.

Results The rates of CHD per 1000 person-years in the bottom and top thirds of baseline lipid distributions, respectively, were 2.6 and 6.2 with triglyceride, 6.4 and 2.4 with HDL-C, and 2.3 and 6.7 with non–HDL-C. Adjusted HRs for CHD were 0.99 (95% CI, 0.94-1.05) with triglyceride, 0.78 (95% CI, 0.74-0.82) with HDL-C, and 1.50 (95% CI, 1.39-1.61) with non–HDL-C. Hazard ratios were at least as strong in participants who did not fast as in those who did. The HR for CHD was 0.35 (95% CI, 0.30-0.42) with a combination of 80 mg/dL lower non–HDL-C and 15 mg/dL higher HDL-C. For the subset with apolipoproteins or directly measured LDL-C, HRs were 1.50 (95% CI, 1.38-1.62) with the ratio non–HDL-C/HDL-C, 1.49 (95% CI, 1.39-1.60) with the ratio apo B/apo AI, 1.42 (95% CI, 1.06-1.91) with non–HDL-C, and 1.38 (95% CI, 1.09-1.73) with directly measured LDL-C. Hazard ratios for ischemic stroke were 1.02 (95% CI, 0.94-1.11) with triglyceride, 0.93 (95% CI, 0.84-1.02) with HDL-C, and 1.12 (95% CI, 1.04-1.20) with non–HDL-C.

Conclusion Lipid assessment in vascular disease can be simplified by measurement of either total and HDL cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride.

"

Employers told to tackle work related stress to reduce sickness bill

Employers told to tackle work related stress to reduce sickness bill Oona Mashta

The guidance, Promoting Mental Wellbeing through Productive and Healthy Working Conditions: Guidance for Employers, can be seen at www.nice.org.uk/PH22

Published 9 November 2009, doi:10.1136/bmj.b4607

Cite this as: BMJ 2009;339:b4607

The NHS in England, along with other employers, needs to promote mental wellbeing among its staff in a bid to cut the multimillion pound cost of days off resulting from work related stress, says new guidance from the National Institute for Health and Clinical Excellence (NICE).

The cost of work related stress, depression, and anxiety among NHS staff in the United Kingdom results in an estimated loss of about 4.1 million working days a year at a cost of £700m (780m; $1.2bn), estimates NICE.

But the problem was not just about staff taking time off, it said. "Presenteeism" (where staff feel obliged to go to work but are not in a fit state to be there, resulting in reduced productivity) was also a problem. NICE estimates that about 6.2 million working days are lost in the NHS in the UK throughpresenteeism at a cost of £1bn.

The guidelines on promoting wellbeing at work, which are mandatory for the NHS, the largest single employer in the UK with 1.5 million staff, call for improved line management to boost mental health among staff.

The guidance proposes simple steps, such as positive feedback to staff, including praise as well as criticism, making them feel valued, and rewarding them with small perks such as the odd afternoon off and time to attend seminars. Launching the guidance, a panel of NHS advisers said it was important that staff could see that things were done in a just and fair way.....................

What are some of the essential elements physicians should consider when in the role of expert witness?

What are some of the essential elements physicians should consider when in the role of expert witness?: "The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Inquiries and contributions to the Forum should be forwarded to Joseph J. Schwerha, MD, MPH by e-mail at schwer@pitt.edu.
(C)2009The American College of Occupational and Environmental Medicine"

1,3-Butadiene, Styrene and Lung Cancer Among Synthetic Rubber Industry Workers

1,3-Butadiene, Styrene and Lung Cancer Among Synthetic Rubber Industry Workers: "Objective: To evaluate the association between cumulative exposure to 1,3-butadiene (BD) or styrene (STY) and lung cancer among synthetic rubber industry workers.
Methods: Internal Cox regression analyses were performed both with and without natural logarithm transformation of exposure variables and both with and without the inclusion of those unexposed to monomers.
Results: Among women, analyses using untransformed BD exposure showed no trend. Analyses using natural logarithm-transformed BD exposure indicated a positive trend when the unexposed were included (P < 0.05) and an inverse trend when the unexposed were excluded (P < 0.05). No exposure-response trends were seen for BD among men or for STY among women or men.
Conclusions: These results suggest that the association between BD and lung cancer, seen in some analyses of female employees, is not causal. STY did not appear to be associated with lung cancer.
(C)2009The American College of Occupational and Environmental Medicine"

Reproductive History and Adverse Pregnancy Outcomes in Commercial Flight Crew and Air Traffic Control Officers in the United Kingdom

Reproductive History and Adverse Pregnancy Outcomes in Commercial Flight Crew and Air Traffic Control Officers in the United Kingdom: "Objective: To examine reproductive outcomes among flight crew.
Methods: Ten thousand two hundred five flight crew members and a control group of 2118 air traffic control officers completed a questionnaire in 2001 to 2004, United Kingdom.
Results: Similar proportions of flight crew and air traffic control officers reported having ever had difficulties in conceiving a baby. Risks of miscarriages and congenital malformations among pregnancies fathered by men who did not differ by occupation, but stillbirth risk was higher among flight crew (odds ratio = 2.85; 95% CI = 1.30-6.23). Among pregnancies reported by women, risks of miscarriage and stillbirth did not differ by occupation but risk of congenital malformations was higher among flight crew (odds ratio = 2.37; 95% CI = 0.43-13.06).
Conclusions: Flight crew-related exposures were not associated with adverse reproductive outcomes except for possible links, based on small numbers, between paternal exposure and stillbirths and maternal exposure and congenital malformations.
(C)2009The American College of Occupational and Environmental Medicine"

Long-Term Exposure and Health-Related Quality of Life Among Patients With Occupational Rhinitis

Long-Term Exposure and Health-Related Quality of Life Among Patients With Occupational Rhinitis: "Objective: This article evaluates health-related quality of life (HRQoL) among patients with occupational rhinitis (OR), with an average of 10 years after diagnosis.
Methods: A cross-sectional questionnaire with general (RAND-36) and disease-specific (Rhinasthma) HRQoL questions was completed by 119 OR patients and 173 controls of the same age and locality. In addition, the patients compared their estimation of current occupational exposure level with that at the time of OR diagnosis.
Results: HRQoL was impaired among patients with continuing occupational allergen exposure in all Rhinasthma and several RAND-36 scores. The HRQoL among patients no longer exposed was mainly similar to that of the healthy controls.
Conclusions: Among OR patients, continuous occupational exposure decreases QoL years after the diagnosis. To restore the well being of patients with OR, medication only is not sufficient; reduction or cessation of exposure is necessary.
(C)2009The American College of Occupational and Environmental Medicine"

Epidemiologic Studies of Styrene and Cancer: A Review of the Literature

Epidemiologic Studies of Styrene and Cancer: A Review of the Literature: "Objective: To review the epidemiologic literature on styrene and cancer.
Methods: We reviewed studies of workers exposed to styrene in manufacturing and polymerization, in the reinforced plastics industry, and in styrene-butadiene rubber production. We also reviewed studies of workers monitored for styrene exposure, studies of environmental exposure, community-based case-control studies of lymphoma and leukemia, and studies of DNA adducts. Studies of workers in the reinforced plastics industry were considered more informative because of higher worker exposure and less confounding by other carcinogens.
Results: We found no consistent increased risk of any cancer among workers exposed to styrene. A study of reinforced plastic workers reported an association between average estimated styrene exposure and non-Hodgkin lymphoma (NHL, P = 0.05) but no trend with increasing duration of exposure. Other studies of styrene exposure and NHL found no increased risk. In two US studies of reinforced plastic workers, esophageal cancer mortality was increased, but these findings were generated in a background of multiple comparisons. Results for other cancers were unremarkable.
Conclusions: The available epidemiologic evidence does not support a causal relationship between styrene exposure and any type of human cancer.
(C)2009The American College of Occupational and Environmental Medicine"

Exposure Risk Assessment in an Aluminium Salvage Plant

Exposure Risk Assessment in an Aluminium Salvage Plant: "Introduction: A cross-sectional study was conducted to evaluate possible nervous or respiratory system effects from occupational aluminium exposure.
Methodology: Exposed workers in Al salvage plant were compared with controls. The investigation involved a standardized occupational and medical history and assessments of Al levels in ambiance, serum, and urine. This was combined with an evaluation of respiratory complaints, lung, and cognitive functions.
Results: Thirty workers exposed to Al were matched to 60 individuals without exposure to Al. Significantly higher internal doses of Al in urine were found in exposed workers (11.59 [mu]g/L), when compared with the controls (4.37 [mu]g/L). Few high Al atmospheric levels were obtained (0.12-10.86 mg/m3). No significant differences concerning respiratory or neurological symptoms prevalence between the two groups were reported.
Discussion: Chronic exposure to Al dust, at the levels documented in this study over the German limit values, does not induce measurable cognitive decline.
(C)2009The American College of Occupational and Environmental Medicine"

Monday sickness may say more about your job than your health

Monday sickness may say more about your job than your health: "More than a third of sick leave is taken on Mondays, and January is the most common month for absenteeism, research suggests."

The Association Between Beliefs About Low Back Pain and Work Presenteeism

The Association Between Beliefs About Low Back Pain and Work Presenteeism: "Objective: To examine the influence of beliefs about low back pain (LBP) on reduced productivity at work ('presenteeism') caused by LBP.
Methods: Two thousand five hundred seven individuals completed the Back Beliefs Questionnaire, the Fear Avoidance Beliefs questionnaire (FABQ), and questions about LBP-related work-absence, reduced work-productivity, pain, comorbidity, and demographics.
Results: Six hundred seventy (25%) individuals were of working age, employed and reported current LBP. Univariate models showed beliefs were more 'negative' in individuals with work-absence and reduced productivity (P = 0.0001). In multivariable analysis, controlling for confounders, 'FABQwork' was a unique predictor of both absenteeism and presenteeism (each, P = 0.0001), though with small effect sizes.
Conclusions: Negative beliefs about LBP are associated with both work absence and reduced work-productivity. Further investigations should examine their potential as a target for educational interventions when considering initiatives to reduce the socioeconomic costs of LBP.
(C)2009The American College of Occupational and Environmental Medicine"

A New Health Promotion Model for Lone Workers: Results of the Safety & Health Involvement For Truckers (SHIFT) Pilot Study

A New Health Promotion Model for Lone Workers: Results of the Safety & Health Involvement For Truckers (SHIFT) Pilot Study: "Objective: This study was designed to evaluate the effectiveness of a new health promotion model for lone workers.
Methods: A single group pre- or posttest design was used to evaluate intervention effectiveness for reducing body weight and increasing healthful and safe behaviors. Truck drivers (n = 29) from four companies participated in a 6-month intervention involving a weight loss and safe driving competition, computer-based training, and motivational interviewing.
Results: Objectively measured body weight reduced by 7.8 lbs ([DELTA]SD = 11.5, [DELTA]d = 0.68, P = 0.005), and survey measures showed significant reductions in dietary fat and sugar consumption. An objective measure of safe driving also showed significant improvement, and increases in exercise motivational stage and walking fitness approached significance.
Conclusions: Results suggest that the new intervention model is substantially more engaging and effective with truck drivers than previous education-based tactics.
(C)2009The American College of Occupational and Environmental Medicine

Of Interest due to the techniques used, specifically -

Weight Loss Competitions.
Team weight loss competitions reliably produce two or three times the amount of weight loss observed in the Holmes et al 22 study of truck drivers (as mentioned above), produce very low levels of attrition and are especially effective with male workers. Although the Holmes et al nutrition education intervention produced a mean weight loss of about 4 lbs, team weight loss competitions commonly produce average weight loss ranging from 10 to 18 lbs (see Refs. 24–26). The social and financial incentives in team competitions also produce low study attrition, which is a powerful consideration given high voluntary turnover in trucking and excessive attrition (58%) observed in a previous study of truck drivers.23 For example, attrition averaged only 2.6% (range, 0%–13%) across 10 different weight loss competitions reported Stunkard et al (study 2).26 Team competitions are also especially effective with male workers (see Ref. 25), and 95% of truck drivers are men.27 This enhanced effectiveness may be due in part to increased competitive and aggressive tendencies in men28 and/or to higher historical male participation rates in competitive team sports.29
Behavioral Computer-Based Training.
Behavioral computer-based training is twice as effective as passive training in booklets.30,31 Passive training formats in a previous intervention for truck drivers produced no significant improvements in health knowledge.23 A recent meta-analysis supports replacing passive educational booklets with more engaging training tactics. Burke et al 32reviewed the effectiveness of training tactics that were, by their classification, more or less engaging. Passive methods such as lectures, booklets, and videos were classified as less engaging; computer-based training or programmed instruction were classified as moderately engaging; and behavioral modeling and role playing were considered most engaging. In the studies reviewed, engaging methods were nearly three times more effective than less engaging methods. Although truck drivers cannot easily participate in the most engaging face-to-face training formats, moderately engaging computer-based training is a next-best alternative.
Behavioral Self-Monitoring (BSM).
BSM techniques, where individuals repeatedly observe, evaluate, and record aspects of their own behavior, are widely applied by physicians and psychologists to enhance motivation for change.33–35 BSM is increasingly applied in workplace interventions to enhance worker productivity and safety.33 Evidence suggests that BSM is particularly effective in combination with common intervention tactics such as goal setting, training, and feedback. For example, Olson and Winchester 33 reviewed 24 studies of workplace interventions that included self-monitoring and found that the standardized effect size for 66 intervention phases was large by Cohen's 36 standards (mean weighted d = 2.2; 95% CI = 1.7, 2.7; Cohen's standards are small d = 0.20, medium d = 0.50, and large d = .80), as was the mean effect size for interventions targeting driving and other safety behaviors (d = 1.8). Self-monitoring techniques can be easily administered at the individual level and are therefore well suited for involving isolated workers like truck drivers in health promotion programs.
MI.
MI has emerged as an alternative and more effective approach to health coaching than traditional office-based counseling, which lacks proven effectiveness for promoting exercise and healthy eating.37–39 Originally developed to reduce problem drinking and self-harming behaviors,40,41 MI is described as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence.”42 MI techniques have been operationally defined,43 and examples of techniques include reflective listening, asking open-ended questions, and encouraging change talk. The guiding principles are to express empathy, develop discrepancy, avoid argumentation, roll with resistance, and support self-efficacy.41,42 Burke et al 44 conducted a meta-analysis of 31 controlled clinical trials of MI treatments. Standardized differences between treatment and control group means ranged from d = 0.25 to d = 0.56, with effects on exercise and diet averaging d = 0.53 (95% CI = 0.32, 0.74). MI is a good fit for truck drivers because it can be delivered anywhere a worker can receive cell phone service.

"

Spinal fusion surgery over-servicing

Spinal fusion surgery over-servicing: "http://www3.interscience.wiley.com/journal/122678682/abstract?CRETRY=1&SRETRY=0

A disproportionate increase in spinal fusion surgery in private practice in recent years may reflect overservicing by surgeons, Australian researchers say"

N-95 Respirators and Surgical Masks

N-95 Respirators and Surgical Masks: "http://www.cdc.gov/niosh/blog/nsb101409_respirator.html October 10, 2009, by Lisa Brosseau, Ph.D., and Roland Berry Ann. The emergence of H1N1 has created considerable interest about the use of surgical masks and respirators as infection control measures. Given the recent issuance of revised CDC infection control guidance for healthcare personnel that include recommendations for use of N-95 respirators, NIOSH has posted a new blog that examines the scientific principles behind the design and performance of these devices. Read more and comment on the NIOSH Science Blog."

Safety and Health for Tattooists and Piercers

Safety and Health for Tattooists and Piercers: "http://www.cdc.gov/niosh/topics/bbp/bodyart/"

Novel H1N1 Influenza and Respiratory Protection for Health Care Workers

Novel H1N1 Influenza and Respiratory Protection for Health Care Workers: "

Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have ...

Also:

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm"

Mandatory Vaccination of Health Care Workers

http://content.nejm.org/cgi/content/short/NEJMp0910151v1?rss=1&query=current

Lesions missed without whole body exams

Lesions missed without whole body exams: "The importance of performing a whole body skin examination on patients presenting with skin lesion has been underlined by a new study showing that most patients have additional asymptomatic lesions that would otherwise be missed."

Spinal X-ray curbs

Spinal X-ray curbs: "Health minister Nicola Roxon says health budget savings will be made by creating three new 'therapeutic groups' under the PBS and by encouraging doctors to request region-specific spinal X-rays for particular clinical indications."

Tackle work stress, bosses told

Tackle work stress, bosses told: "Employers need to pay more attention to the levels of stress and anxiety in the workplace, key NHS advisers say."

Obese 'struggle to earn living'

Obese 'struggle to earn living': "Obese people in the UK are struggling to earn above the national average income, according to a survey.

Just under half (46%) earn more than £20,000 a year, which is the national average, while the majority earn between £10,000 and £15,000.

The survey conducted by YouGov also indicates that only 5% of people feel their weight has held them back..............."