Microsoft word - 2013 june-july
Research Plus June/July 2013
A systematic review of the effectiveness and potential harm of psychological, pharmacological and
emerging interventions to prevent post-traumatic stress disorder (PTSD) in adults found a general
lack of robust evidence. Only interventions designed to work in the first three months after the
traumatic exposure were included (19 included studies, 37 omitted owing to high risk of bias).
Evidence was either lacking or insufficient to draw conclusions for most interventions or outcomes
of interest. Collaborative care – a stepped combination of case management, motivational
interviewing, psychopharmacology and cognitive behavioural therapy (CBT) – appears effective for
victims of injuries requiring surgery; for those with acute stress disorder, brief trauma-focused CBT
is more effective than supportive counselling in reducing PTSD severity; and psychological
interventions are equally effective in men and women. Debriefing is ineffective in reducing PTSD
incidence or severity.
Agency for Healthcare Research and Quality, 2013. Comparative Effectiveness Review no.109.
A systematic review of interventions used to treat adults diagnosed with PTSD, which included 101
papers reporting 92 studies, found that evidence quality was often limited. Psychological therapies
are effective, but only exposure therapy is supported by high strength evidence. There is moderate
quality evidence that cognitive processing therapy, cognitive therapy, CBT-mixed therapies, eye
movement desensitisation and reprocessing, and narrative exposure therapy are effective for
improving symptoms and/or achieving loss of PTSD diagnosis. There is moderate strength
evidence that pharmacological treatments are effective (fluoxetine, paroxetine, sertraline,
topiramate and venlafaxine). There is insufficient evidence to support the often-held view that
psychological treatments should be used before drugs are prescribed.
Agency for Healthcare Research and Quality, 2013. Comparative Effectiveness Review no.92.
Asthma risk rises with cumulative exposure to latex
Each year of cumulative occupational exposure to latex is associated with a 5% increase in the risk
of developing new-onset asthma, this population-based cohort study reveals. A total of 792 people,
asthma free at age 13, were assessed at age 44 for asthma. Occupational exposures were derived
from work histories and an asthma-specific job exposure matrix. A total of 419 participants had
been occupationally exposed to one or more of 18 high-risk agents. New-onset asthma was
associated with exposure to high molecular weight latex and cleaning and disinfecting products in
the unadjusted analysis, but these associations were not significant after adjusting for sex and
smoking. However, cumulative exposure to latex was significantly associated with raised risk,
independent of sex and smoking: 1.6-fold greater risk after six to 15 years’ cumulative exposure
and 2.7-fold greater risk after 16 or more years.
Journal of Occupational and Environmental Medicine 2013; 55(3): 235–239.
Research Plus June/July 2013
Occupational exposure link to adult-onset asthma
Men exposed to epoxy compounds, diisocyanates and acrylates are at increased risk of adult-
onset asthma, with hazard ratios particularly high among non-atopic individuals, according to this
North European population study. More than 16,000 people completed asthma-symptoms and job-
history questionnaires in 1999–2001, having participated in baseline screening in 1989–1992.
Significant raised risks for men were from exposure to: plant-associated antigens (hazard ratio
(HR) = 3.6; 95% confidence interval (CI) 1.4–9.0); epoxy compounds (HR = 2.4; CI 1.3–4.5);
diisocyanates (HR = 2.1; CI 1.2–3.7); and accidental peak exposures to irritants (HR = 2.4; CI 1.3–
4.7). The increase in risk was generally more pronounced in non-atopic men: acrylates (HR = 3.3;
95% CI 1.4–7.5); epoxy (HR = 3.6; CI 1.6–7.9); diisocyanates (HR = 1.5; CI 1.3–6.0); and
accidental peak exposures to irritants (HR = 3.0; CI 1.2–7.2). Both men (HR = 2.6; CI 1.1–6.1) and
women (HR = 2.0; CI 1.2–3.0) exposed to cleaning agents had an increased asthma risk, with the
risks raised further among non-atopic individuals – (male HR = 4.1; CI 1.4–12.1; female HR = 2.5;
CI 1.4–5.0). The population-attributable risk for occupational asthma was around 14% for men and
7% for women.
Annals of Occupational Hygiene, 2013; 57(4); 482–492.
Sickness absence from respiratory symptoms
Exposure to occupational vapour, gas, dust, or fume (VGDF) doubles the risk of respiratory-related
sickness absence (RRSA) in those reporting respiratory symptoms or asthma, according to this
pan-European population-based study. A total of 6,988 participants who were in work at the time of
the study were classified according to their respiratory symptoms or diagnosis. One in 15 (6.9%) of
those with physician-diagnosed asthma, self-reported rhinitis, or wheeze/breathlessness reported
RRSA in the previous year. Exposure to VGDF was associated with significant raised risk of RRSA
in each group: asthma group, odds ratio (OR) = 2.0 (95% confidence interval (CI) 1.1–3.6);
wheeze/breathlessness group, OR = 2.2 (95% CI 1.01–4.8); rhinitis group, OR = 1.9 (95% CI
1.02–3.4). These raised risks remained after controlling for confounders.
American Journal of Industrial Medicine 2013; 56(5): 541–549.
Melatonin levels in nightworkers
Female nightshift healthcare workers experience lower levels of melatonin compared with their
dayshift colleagues, but melatonin disruption – which has been suggested as increasing the risk of
breast cancer in shift workers – is significantly less pronounced in Asian compared with white
workers, this US study finds (n = 276; 225 white and 51 Asian; aged 20–49). Nightshift workers
worked at least 20 hours per week exclusively at night – at least eight hours per shift, finishing no
earlier than 6am – and slept at night during their non-work days. Both white and Asian
nightworkers had lower melatonin levels during daytime sleep relative to dayshift workers during
normal night-time sleep (p < 0.0001). However, during non-work days white nightshift workers had
a 47% reduction in melatonin levels during night-time sleep compared with day workers, whereas
Asian nightworkers experienced only an 18% reduction (p = 0.01 for difference between Asian and
white workers). Asian workers may be protected from the negative effects of shiftwork, conclude
American Journal of Epidemiology 2013; online first: doi: 10.1093/aje/kws278.
Research Plus June/July 2013
Greater flu risk at lower humidity
Maintaining relative humidity (RH) above 40% reduces the infectivity of airborne influenza virus in
medical examination rooms, according to this laboratory simulation study. Live N1N1 flu virus was
nebulised and pumped (to mimic a patient coughing) from a laboratory manikin in a sealed
simulated examination room. A breathing simulator was attached to a second manikin, which acted
as a surrogate healthcare worker. Air samplers were attached to and around the second manikin’s
mouth, and elsewhere in the room. RH was adjusted from 7% to 73%. The total amount of virus
collected at 15-minute intervals up to one hour was approximately the same, regardless of RH;
however, it retained 71%–77% infectivity at RH ≤23% but only 15%–22% infectivity at RH ≥43%,
with most of the infectivity lost during the first 15 minutes. Maintaining higher RH can reduce
infection risk, and this should be considered when designing and building healthcare facilities.
PLoS One 2013; 8(2): e57485.
A randomised controlled trial of an experimental health and wellbeing programme for older workers
at two teaching hospitals in the Netherlands found the intervention to be neither cost effective nor
cost saving. In total, 730 workers aged over 45 years were randomised either to the ‘Vital@Work’
programme (designed to improve physical activity, nutrition and relaxation) or a control group – all
workers received written information about healthy lifestyle. Vitality and need for recovery (NFR)
from work-induced effort were assessed using two standardised questionnaires. Costs were
assessed for the interventions, healthcare utilisation, absence and presenteeism. There were no
statistically significant different vitality and NFR scores between the intervention and control groups
and no significant cost savings in the outcome measures. The intervention cost on average €149
per employee and the return on investment was calculated at €2.21 lost for every €1 invested.
Journal of Occupational and Environmental Medicine 2013; 55(3): 337–346.
Patient lifting device impact assessment
Near-complete use of patient lifting devices is required before the incidence of low back pain (LBP)
and injury claims is noticeably reduced, according to this health impact assessment. The
assessment was based on a ‘Markov chain’ decision-analysis model using information from nine
quantitative studies on the association between manual patient lifting and LBP, and eight studies
on the impact of lifting devices on LBP occurrence. It simulated a 10-year follow up of two
hypothetical cohorts: nurses entering the profession without a history of LBP, and those already
employed. If manual patient handling were completely eliminated – the best-case scenario – the
model predicts that LBP prevalence could be reduced from 42% to 31%, with the impact levelling
off after six years.
Occupational and Environmental Medicine 2013; online first: 10.1136/oemed-2012-101210
Research Plus June/July 2013
Work participation with arthritis
Seven key concepts are important to the work participation of patients with inflammatory arthritis,
this systematic review of qualitative evidence finds (10 included studies; low to high
methodological quality). The seven themes are: disease symptoms (eg fatigue, pain, physical
limitations); management of the disease (eg access to treatment, coping); socioeconomic issues
(such as job insecurity, financial concerns, social support); work conditions and adaptations (eg
help from employer, psychological support, work flexibility); emotional challenges (self confidence,
managing fear etc); interpersonal issues affecting work and family life (including support from
colleagues, supervisors, families, lack of communication, work–life balance); and meaning of work
(eg motivation, importance of work/identity, work as rehabilitation). Different challenges affect
individual patients and put a strain on their ability to cope with work. Patients need ways of
managing these challenges, including early professional involvement and advice.
Rheumatology 2013; online first: doi: 10.1093/rheumatology/ket111
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