Health
Scandinavian Journal of Work, Environment, and Health

Mortality of Shift Workers

Is shift work associated with higher mortality risk? That question has been the subject of much discussion for decades. Mortality risk includes concerns that reflect not only incidence but also case fatality, treatment, information of death certificates, and competing causes of death—especially in advanced age. Although related, mortality and incidence are not the same; the former is broader.

Taylor and Pocock performed the first study using modern epidemiological methods. The cohort included 8,603 male manual workers followed for 12 years. The analysis presented results on indirect standardization [i.e., the standardized mortality ratio (SMR) among day, shift, and ex-shift workers, using the general population as a reference]. The results showed SMR of 97.3, 101.5, and 118.9 for the three groups, respectively. The authors concluded that “the evidence we have obtained … leads to the conclusion that shift work appears to have no adverse effect upon mortality.” In the following years, that study has often been cited as evidence against increased mortality among shift workers. However, a reanalysis of the data casts doubt on the interpretation of the results, arguing that internal comparison between the three groups might indicate that shift work actually increases mortality risk.

Read the full story here.

BMJ Journals | 23 February 2017

Organizational Characteristics Associated With Shift Work Practices and Potential Opportunities for Intervention

Shift work is a common working arrangement with wide-ranging implications for worker health. Organizational determinants of shift work practices are not well characterized; such information could be used to guide evidence-based research and best practices to mitigate shift work’s negative effects. This exploratory study aimed to describe and assess organizational-level determinants of shift work practices thought to affect health across a range of industry sectors.

This study points to organizational determinants of shift work practices that could be useful for targeting research and workplace interventions. Results should be interpreted as preliminary in an emerging body of literature on shift work and health.

Read the full story here.

Long Work Hours Linked to Higher Cardiovascular Disease Risk

Working long hours—particularly 46 hours per week or more—may increase the long-term risk of cardiovascular disease (CVD) events such as heart attack, reports a study in the March Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine.

“In general, we found that the risk of CVD increased as the average weekly working hours increased,” write Sadie H. Conway of The University of Texas Health Sciences Center, Houston, and colleagues. They note that, among full-time workers, CVD risk appears lowest between 40 and 45 hours per week.

The researchers analyzed the relationship between work hours and CVD using data on more than 1,900 participants from a long-term follow-up study of work and health. All participants had been employed for at least 10 years. During the study, a physician-diagnosed CVD event—angina, coronary heart disease, or heart failure, heart attack, high blood pressure, or stroke—occurred in about 43% of participants.

Risk of CVD events increased by one percent for each additional hour worked per week over at least 10 years, after adjustment for age, sex, racial/ethnic group, and pay status. The difference was significant only for full-time workers, not part-timers. Among those who worked more than 30 hours per week, risk increased as weekly hours approached 40 but then decreased again between 40 and 45 hours per week.

Read the full story here.

Journal of Occupational and Environmental Medicine | 23 February 2017

The Positive Effect of Resilience on Stress and Business Outcomes in Difficult Work Environments

Employers are adopting resilience training for their employees at a rate faster than any other intervention in the United States. Resilience—the ability to use positive mental skills to remain psychologically steady and focused when faced with challenges or adversity—contributes substantially to how workers deal with stress and perform at work. Employers are developing resilience to achieve a competitive advantage, similar to how the military trains active-duty soldiers and their family members to withstand challenges.

Interest in the psychological construct of resilience has grown significantly over the past decade, from fewer than 30 peer-reviewed studies per year before 2000 to more than 650 in 2014. In the past, resilience has been defined as “the ability of an individual to recover from a traumatic event or to remain psychologically robust when faced with an adverse event” and “the process of negotiation, management, and adaptation to significant sources of stress or trauma.” In other words, it reflects an individual’s ability to respond well and experience fewer harmful consequences when under duress. More recently, however, studies have examined how resilience influences responses to more common life challenges such as health events and work stress.

Broadly defined as the ability to “bounce back” from adversity, there is evidence attributes of resilience—such as emotion regulation, impulse control, causal analysis, self-efficacy, and realistic optimism—can be learned and developed. In this framework, resilience extends beyond one’s inherent predisposition toward life events and includes a set of acquired skills that mitigate the experience of stress and speed productive responses when setbacks occur.

As interest in employee resilience increases, employers may question whether individual resilience simply reflects the settings and environments in which employees work. It is plausible that employees feeling appreciated and supported at work report higher resilience, while those feeling unsupported in demanding jobs report lower resilience. Further, employers may question whether resilience can counteract the negative effects of a difficult or stressful work environment.

These are important questions because stressful work environments are a known health risk, with documented negative physical and mental health consequences. Job strain—combinations of high job demands, low decision latitude, and low social support—have been linked to stress, cardiovascular disease, and diabetes, as well as rates of absence, disability, and turnover. Beyond producing general mental distress, there is also evidence suggesting that stressful work environments increase the likelihood of developing depression or anxiety for the first time. Further, recent findings point to difficult work environments as a contributing factor in the premature death of workers.

There is some evidence that resilience has a moderating effect on the negative relationship between job strain and job satisfaction. This suggests that workers’ learned ability to be resilient could have protective effects in demanding work settings. More broadly, employers require a better understanding of how resilience scores relate to important health and work outcomes, such as perceived stress, depression, job satisfaction, intent to quit, absenteeism, and self-reported job performance. It is also important to differentiate individual resilience from elements of the work environment, such as social support, job demands, and individual discretion. This cross-sectional study examines the question of whether having greater levels of resilience mitigates the negative effects of stressful work environments.

Read the full story here.

National Center for Biotechnology Information | 10 February 2017

Noise and Neurotoxic Chemical Exposure Relationship to Workplace Traumatic Injuries

More than 5,000 fatalities and 8 million injuries occurred in the workplace in 2007 at a cost of UDD 6 billion and USD 186 billion, respectively. Neurotoxic chemicals are known to affect central nervous system functions among workers, which include balance and hearing disorders. However, it is not known if there is an association between exposure to noise and solvents and acute injuries.

A thorough review was conducted of the literature on the relationship between noise or solvent exposures and hearing loss with various health outcomes.

The search resulted in 41 studies. Health outcomes included hearing loss, workplace injuries, absence from work because of sickness, fatalities, hospital admissions because of workplace accidents, traffic accidents, hypertension, balance, slip, trips, falls, cognitive measures, or disability retirement. Important covariates in these studies were age of employee, type of industry or occupation, or length of employment.

Most authors who evaluated noise exposure concluded that higher exposure to noise resulted in more of the chosen health effect, but the relationship is not well understood. Studies that evaluated hearing loss found that hearing loss was related to occupational injury, disability retirement, or traffic accidents. Studies that assessed both noise exposure and hearing loss as risk factors for occupational injuries reported that hearing loss was related to occupational injuries as much or more than noise exposure. Evidence suggests that solvent exposure is likely to be related to accidents or other health consequences such balance disorders.

Many authors reported that noise exposures and hearing loss, respectively, are likely to be related to occupational accidents.

Find the full paper here.

Underwriters Laboratories | 10 February 2017

How To Maximize Your Occupational Health Investment

What is occupational medicine? According to Wikipedia, occupational medicine specialists work to ensure that the highest standards of occupational health and safety can be achieved and maintained. While it may involve a wide number of disciplines, it centers on the preventive medicine and management of illness, injury, or disability that is related to the workplace.

The interesting part of this definition is the last part: “related to the workplace.” What does that mean? The obvious meanings include injuries or illnesses that occur at the workplace (e.g., slipping on the shop floor, injury caused by malfunctioning work equipment, or a contagious disease acquired at a hospital). Some meanings might even include injuries that happen outside of work but affect the worker (e.g., an arm broken at a sporting event that prevents normal job duties). Ask most people about occupational medicine, and you are likely to get an answer that somehow reflects back on these sorts of circumstances.

Increasingly, however, companies that manage workers are substantially broadening their definition of occupational medicine. These employers are providing employee benefits that carry a high and rapidly increasing cost, and those benefits plans cover impactful health conditions that result from factors well beyond the traditional scope of work-specific medicine. Furthermore, research shows that an employee’s overall health actually has a significant effect on the quality of their work productivity. Given the large investment companies are making in employee health and the causal link between overall health and quality of work, doesn’t it make sense for companies to maximize the effect of their investment?

Many companies are concluding that the answer to that last question is an emphatic “Yes!” and many are re-evaluating how they choose occupational medicine providers. The goal of this paper is to explore some of the dynamics that have led to this change and to provide some perspective for companies considering new service partners to help with their employee health initiatives.

Read the full white paper here (PDF).

The Herald | 27 January 2017

Mental Health Problems “Biggest Risk” Facing Oil and Gas Sector

A failure to deal with mental health problems is the “biggest risk” still facing the oil and gas industry, an expert has warned amid a new drive to raise awareness of the stresses faced by offshore workers.

Steve Smith

Steve Smith said the high-pressure environment of oil rigs and the anxiety of being cut off from loved ones while at sea were among the triggers for potentially “catastrophic” stress and breakdowns.

Smith, a senior lecturer in mental health and wellbeing at Robert Gordon University, has backed a new campaign by the oil and gas recruitment firm Petroplan to encourage the industry to think more about the mental health of its workers rather than choosing to focus physical risks faced by employees.

He said, “We have eradicated or controlled for almost all the risk factors in the highly dangerous environment of oil and gas exploration and retrieval. The biggest risk factor we have left is our own refusal to respond to issues of mental health and wellbeing across the industry.”

Smith, who has previously advised the offshore sector on mental health, said workers were particularly vulnerable to feelings of isolation while working at sea. He added that there were also dangers from high-pressure working environments with no downtime, working in risky territories, the pressures of a macho environment with stigma around “feeling low,” and the difficulties of transitioning back to normal life.

West Virginia University | 18 January 2017

Noise Pollution From Oil and Gas Development May Harm Human Health

Modern oil and gas development techniques such as directional drilling and hydraulic fracturing produce noise at levels that may increase the risk of adverse effects on human health, including sleep disturbance, cardiovascular disease, and other conditions that are negatively affeted by stress, according to a study by authors at the nonprofit science and policy research institute, PSE Healthy Energy and West Virginia University. It is the first peer-reviewed study to analyze the potential public health effects of ambient noise related to hydraulic fracturing operations.

A hydraulic fracturing site in Dawson Creek, Canada, uses heavy equipment such as drills, pumps, and compressors to extract liquefied gas from ground sources like shale and tight sands. Noise from that equipment may increase health risks for adjacent communities, a new study found. Credit: West Virginia University.

A hydraulic fracturing site in Dawson Creek, Canada, uses heavy equipment such as drills, pumps, and compressors to extract liquefied gas from ground sources like shale and tight sands. Noise from that equipment may increase health risks for adjacent communities, a new study found. Credit: West Virginia University.

“People living near oil and gas development may bring up concerns like air pollution, traffic, and groundwater safety, but many also complain about noise,” said Jake Hays, director of the Environmental Health Program at PSE Healthy Energy and lead author of the paper, which was published 9 December in Science of the Total Environment. “But, until now, most of the research relevant to public health has focused on the impacts of air and water pollution,” he said.

Hydraulic fracturing technologies have unlocked oil and gas deposits from formations such as shale and tight sands that previously were not considered economically viable. But the environmental and public health effects of such operations are still emerging. To understand whether noise from hydraulic fracturing might affect the health of surrounding communities, PSE Healthy Energy researchers gathered all available data and measurements of noise levels at oil and gas operations and compared the information to established health-based standards from the World Health Organization and other groups.

They found that noise from hydraulic fracturing operations may contribute to adverse health outcomes in three categories:

  • Annoyance: Sustained noise may produce a host of negative responses such as feelings of anger, anxiety, helplessness, distraction, and exhaustion and may predict future psychological distress.
  • Sleep disturbance: Awakening and changes in sleep state have aftereffects that include drowsiness, cognitive impairment, and long-term chronic sleep disturbance.
  • Cardiovascular health: Studies have found positive correlations between chronic noise exposure and elevated blood pressure, hypertension, and heart disease.

NIOSH | 4 January 2017

NIOSH Releases Guidance for Implementing Total Worker Health in the Workplace

The National Institute for Occupational Safety and Health (NIOSH) and its Total Worker Health (TWH) program released a workbook in December that provides a practical starting point for employers, workers, and other professionals to implement workplace safety and health programs and identify initial steps to improve worker well-being. The workbook can help organizations identify and address job-related factors that may be contributing to health problems, such as hours of work, workload and stress levels, interactions with coworkers, and unhealthful work environments.

NIOSH defines Total Worker Health as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being.

The workbook, Fundamentals of Total Worker Health Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-Being, prioritizes a hazard-free work environment for all workers and applies a modern prevention approach—consistent with traditional occupational safety and health prevention principles—that recognizes that job-related factors can have an important effect on the well-being of workers, their families, and their communities.

“Integrated interventions that collectively address worker safety, health, and well-being help to align with the recognition that work influences overall health,” said NIOSH Director John Howard. “The Total Worker Health philosophy advocates for the integration of occupational safety and health protection in the workplace, advancing overall worker health and well-being through the elimination or control of workplace hazards.”

The workbook introduces five defining elements of TWH:

  • Demonstrate leadership commitment to worker safety and health at all levels of the organization
  • Design work to eliminate or reduce safety and health hazards and promote worker well-being
  • Promote and support worker engagement throughout program design and implementation
  • Ensure confidentiality and privacy of workers
  • Integrate relevant systems to advance worker well-being

In addition to providing examples of TWH approaches, a self-assessment tool, and resources to develop an action plan and measure progress specific to the organization, the workbook features a new conceptual model, the Hierarchy of Controls Applied to NIOSH Total Worker Health. A hierarchy of controls is a system that lists how to minimize or eliminate exposure to hazards in the workplace, from what is most effective to what is least effective. This expanded new model serves to illustrate how Total Worker Health approaches emphasize organizational-level interventions to protect workers’ safety, health, and well-being.

In 2017, NIOSH intends to gather feedback from organizations, practitioners, and others who pilot this workbook.

Find the workbook here.

 

Offshore Energy Today | 15 December 2016

Iqarus Opens Offshore Medics Training Center in Aberdeen

Healthcare and medical solutions company Iqarus has launched a new training center for offshore medics, emergency response teams, and people who work in remote and challenging environments.

Iqarus' training centre in Hereford, UK.

Iqarus’ training centre in Hereford, UK.

Iqarus said on 15 December that more than USD 1.25 million was invested in the design and construction of the center.

The company added that the center would also host offshore medic training currently provided by Iqarus from its Montrose facility, making the Aberdeen-based site “one of the most advanced training facilities anywhere in Europe.”

The Aberdeen site, located next to the fire training center, has more than 4,000 square feet of clinical training rooms, classrooms, and instructor offices. Iqarus’ team of eight full-time trainers will deliver medical and hostile environment training programs for remote and offshore medics, first responders, media, international travelers, and executives.

PubMed | 14 December 2016

Behavioral Interventions To Promote Workers’ Use of Respiratory Protective Equipment

Respiratory hazards are common in the workplace. Depending on the hazard and exposure, the health consequences may include mild to life-threatening illnesses from infectious agents, acute effects ranging from respiratory irritation to chronic lung conditions, or even cancer from exposure to chemicals or toxins. Use of respiratory protective equipment (RPE) is an important preventive measure in many occupational settings. RPE only offers protection when worn properly, when removed safely, and when it is either replaced or maintained regularly. The effectiveness of behavioral interventions either directed at employers or organizations or directed at individual workers to promote RPE use in workers remains an important unanswered question.

The paper’s authors included 14 studies that evaluated the effect of training and education on RPE use, which involved 2,052 participants. The included studies had been conducted with farm, healthcare, production line, office, and coke oven workers as well as nursing students and people with mixed occupations. All included studies reported the effects of interventions as use of RPE, as correct use of RPE, or as indirect measures of RPE use. The authors did not find any studies where the intervention was delivered and assessed at the whole organization level or in which the main focus was on positive or negative incentives. The quality of the evidence for all comparisons was rated as low to very low.

The authors conclude that there is very low quality evidence that behavioral interventions, namely education and training, do not have a considerable effect on the frequency or correctness of RPE use in workers.