Health Care Value Chain Producer Purchaser And Provider

Aim The literature review was carried out to identify and summarize the evidence-base for conservative clinical management of upper limb disorders (ULDs) including specific disorders and non-specific ULDs.

Method Keywords were identified through a scoping study and guidance from the project sponsor. A number of databases were searched including Web of Knowledge, Pub Med, Medline, Ergonomics Online, the Cochrane Library and BMJ Clinical Evidence for the years 1993–2004. Abstracts were obtained for papers identified in the search and full papers were obtained for literature, which included diagnostic methods, conservative treatments, new data or results or systematic reviews.

Results The review identified that there is evidence for the efficacy of conservative treatments for the management of carpal tunnel syndrome, epicondylitis, rotator cuff tendonitis and bicipital tendonitis and tension neck syndrome. There was no evidence found to support or refute conservative treatment of tenosynovitis, tendonitis, de Quervain's disease or diffuse non-specific ULDs.

Conclusion The evidence reviewed was not always of good quality and data gaps including methodological design issues need to be addressed by future research.

Background Previous research has suggested higher work stress among minority ethnic workers.

Aims To determine levels of work stress in three ethnic groups, consider the contribution of racial discrimination to the groups' profiles of occupational and demographic associations with stress, and assess the association between work stress and well-being.

Methods A household quota sample design was used, and 204 black African–Caribbean, 206 Bangladeshi and 216 white (UK born) working people took part in structured interviews.

Results More black African–Caribbean respondents reported high work stress than either Bangladeshi or white respondents. Reported racial discrimination among black African–Caribbean female respondents was strongly associated with perceived work stress. Among the black African–Caribbean respondents, women who reported experiencing racial discrimination at work had higher levels of psychological distress.

Conclusions Perceived work stress may be underpinned by exposure to racial discrimination at work among black African–Caribbean women, and this may affect their psychological well-being.

Background Hand–arm vibration syndrome (HAVS) is associated with the use of hand-held vibrating tools. Affected workers may experience symptoms of tingling, numbness, loss of grip strength and pain. Loss of dexterity may impair everyday activities, and potentially increase the risk of occupational accidents. Although high vibration levels (up to 31 m/s²) have been measured in association with rock drills, HAVS has not been scientifically evaluated in the South African mining industry.

Aims The aim of this study was to determine the prevalence and severity of HAVS in South African gold miners, and to identify the tools responsible.

Methods A cross-sectional study was conducted in a single South African gold-mine. Participants were randomly selected from mineworkers returning from annual leave, comprising 156 subjects with occupational exposure to vibration, and 140 workers with no exposure. Miners who consented to participate underwent a clinical HAVS assessment following the UK Health and Safety Laboratory protocol.

Results The prevalence of HAVS in vibration-exposed gold miners was 15%, with a mean latent period of 5.6 years. Among the non-exposed comparison group, 5% had signs and symptoms indistinguishable from HAVS. This difference was statistically significant (P < 0.05). All the cases of HAVS gave a history of exposure to rock drills.

Conclusions The study has diagnosed the first cases of HAVS in the South African mining industry. The prevalence of HAVS was lower than expected, and possible explanations for this may include a survivor population, and lack of vascular symptom reporting due to warm-ambient temperatures.

Background The Health & Safety Executive estimate that between 1500–3000 UK workers develop asthma through potentially avoidable workplace exposures each year.

Aims To assess the perception of health, safety and the work environment by workers with symptoms suggestive of occupational asthma.

Methods A total of 97 workers referred to hospital specialists with symptoms suggestive of occupational asthma were studied in order to investigate their attitudes to the workplace, safety and health. A qualitative study design using semi-structured telephone interviews at 2 months and 12 months following enrolment was used at 6 national UK centres with a special interest in occupational asthma.

Results Many workers in the study felt let down by the workplace and management and perceived that a lack of health and safety measures had contributed to the development of their asthma symptoms. Many workers felt that their employers were ‘uncaring’ and were pursuing or considering medico-legal cases against them.

Conclusions Workers' perception of risk influences their behaviour in the workplace, and their own health beliefs potentially create barriers to changing this. It is essential to consider workers' perceptions when developing strategies to effect change within the workplace.

Background Although guidelines for the management of low back pain have been promoted, few studies have assessed their effectiveness. One previous study did not include patients with workers' compensation claims.

Aim To assess the efficacy of evidence-based care for acute low back pain in patients eligible for workers' compensation.

Methods In a prospective audit, workers in a health service who presented with acute low back pain were offered the option of usual care from their general practitioner or care provided by a staff specialist who practiced according to evidence-based guidelines. Outcomes were measured in terms of return to normal duties, time off work, recurrence of pain or persistence of pain.

Results Evidence-based care was accepted by 65% of injured workers. Compared with those who elected usual care, these workers had less time off work, spent less time on modified duties and had fewer recurrences. A significantly greater proportion (70%) resumed normal duties immediately, and fewer developed chronic pain, than those managed under usual care. Three types of patients were identified: those who complied readily with evidence-based care, those who initially expressed firm beliefs about how they should be managed and those with occupational psychosocial factors.

Conclusions Evidence-based care can be successful in retaining patients at work, reducing time off work or on modified duties and reducing recurrences and chronicity. The gains are achieved by conscientiously talking to the patients, and not by any particular or special passive interventions.

— Next Page »