UK GP's failing to recognize occupational asthma

A new report published this month in the scientific journal, Occupational Medicine, finds that many people who develop work related asthma are not correctly diagnosed by GPs at least in the UK. Work related factors cause one in ten cases of asthma in adults but an audit of patient records suggests that GPs do not recognize this in three quarters of patients.

Every year up to 3000 people in the develop asthma because they are exposed to materials at work. Early diagnosis of occupational asthma and avoidance of further exposure can lead to complete recovery. However, failures to diagnose the condition and delays in accessing specialist advice mean that two thirds of sufferers never make a full recovery.

Researchers at the Institute of Occupational and Environmental Medicine, University of Birmingham conducted an audit of the electronic patient records of working age asthmatics. Occupation was only recorded in 14% of the cases and in nearly all cases (98%) GPs failed to record if they had asked simple screening questions about whether their asthma symptoms improved at weekends and on holiday.

Dr Gareth Walters, the lead author, said “Most workers with new asthma symptoms present to their GPs first, so it is important for health care professionals working in primary care to recognize when these symptoms might be caused by or related to work. Currently occupational asthma is very costly to the NHS and to society - and an early diagnosis can prevent on-going debilitating symptoms, time off work and financial loss for the worker.”

The Society of Occupational Medicine who published the study urged GPs to always question patients who present with respiratory problems about their job, the materials they work with and whether their symptoms improve when they are away from work. They should also be aware of those trades that carry particular risks such as vehicle paint sprayers, bakers, laboratory workers and workers in the chemical industry. The commonest causative agents are isocyanates, flour, cutting oils, laboratory animals and insects, enzymes and wood dusts.

“Highlighting the prevalence of occupational asthma is absolutely key, as too often work-related factors are overlooked,” said Dr Richard Heron, President of the Society of Occupational Medicine. “About 70% of the UK workforce does not have access to occupational health care. This makes it vital that general practitioners are assessing asthma patients for potential work-related causes and referring to specialists where appropriate. More importantly, employers need to be aware of those substances that may cause asthma and where possible remove them or minimize exposure.”

Decline in incidence of heart attacks appears associated with smoke-free workplace laws

A decline in the incidence of heart attacks in one Minnesota county appears to be associated with the implementation of smoke-free workplace laws, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

Exposure to secondhand smoke (SHS) is associated with coronary heart disease (CHD) in nonsmokers, and research suggests that the cardiovascular effects of SHS are nearly as large as those with active smoking, according to the study background. Elimination of smoking in public places, such as by smoke-free laws and policies, has the potential for reducing smoking and perhaps cardiovascular events.

Richard D. Hurt, M.D., and colleagues at the Mayo Clinic, Rochester, Minn., evaluated the incidence of MI and sudden cardiac death (SCD) in Olmsted County, Minn., during the 18-month period before and after implementation of smoke-free ordinances. In 2002, a smoke-free restaurant ordinance was implemented and, in 2007, all workplaces, including bars, became smoke free.

"We report a substantial decline in the incidence of MI from 18 months before the smoke-free restaurant law was implemented to 18 months after the comprehensive smoke-free workplace law was implemented five years later," the authors comment.

When comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI declined by 33 percent from about 150.8 to 100.7 per 100,000 population, and the incidence of SCD declined by 17 percent from 109.1 to 92 per 100,000 population.

"All people should avoid SHS exposure as much as possible, and those with CHD should have no exposure to SHS," the authors conclude.

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Asbestos fears prompt power meter work ban in Australia

Source: ABC 

The Electrical Trades Union (ETU) in New South Wales, Australia is advising its members not to work on electricity meter boards in older houses because of the risk of asbestos.

It is estimated about two million properties built before 1983 have asbestos dust around the meters, with the union concerned about the dust being disturbed during the installation of new electricity meters.

Last week Endeavour Energy issued a 'hazard alert' to its staff, warning them to wear masks.
But the union says that advice was inadequate and announced the work ban on meters.

ETU Secretary Steve Butler says the union has now advised all its members to avoid meter boxes.

 Mr Butler says the State Government now needs to take action.

"We believe the first step the government now has to take is to establish what condition these state meter boxes are in," he said.

The union is also calling for an audit of meter boards that have recently been modified and the removal of all asbestos meter boxes from all NSW Government-owned buildings.

Levels of presenteeism, stress and mental health problems in the workplace rise

The average level of employee absence has fallen compared with last year from 7.7 days to 6.8 per employee per year, according to this year’s Chartered Institute of Personnel and Development (CIPD)/Simplyhealth Absence Management survey.

However, the fall in absence levels coincides with almost a third of employers reporting an increase in the number of people going into work ill. The threat of redundancies and concerns over job security are shown to contribute to such ‘presenteeism’, with organisations that are expecting to make redundancies in the next six months more likely to report an increase in employees going into work when unwell, than employers that are not expecting to cut jobs.

Stress-related absence also appears to be on the increase, with two-fifths of employers (40%) reporting a rise over the past year and only one in ten (10%) reporting that the problem had decreased. Stress continues to feature as the most common cause of long-term absence, for the second year running. The level of reported mental health problems, such as anxiety and depression, among employees is also on the increase. More than twice the number of employers reported an increase in mental health problems in 2012 than did in 2009 (2012: 44%; 2011: 39%; 2010: 38%; 2009: 21%).  
According to the survey, organisations who have noted an increase in presenteeism over the past year are more likely to report an increase in stress-related absence over the same period (52% compared with 38% of those who did not report an increase in people coming in to work ill). Similarly, they are more likely to report an increase in mental health problems, such as anxiety and depression (62% compared with 35% of those who did not report an increase in people coming into work ill). The suggested link between presenteeism and both stress and mental health problems underlines the need for organisations to take pre-emptive action to address employees’ concerns in times of challenge, uncertainty and change.

Commenting on the survey findings, Dr Jill Miller, Research Adviser at CIPD says: “On the face of it, the findings from this year’s survey present some positive news. But we must air caution before celebrating lower absence levels because they may be masking deeper problems in the workplace. This year sees a continued increase in presenteeism which can have a damaging effect on organisations’ productivity. Not only can illnesses be passed on to other colleagues, but ill employees are likely to work less effectively than usual, may be more prone to making costly mistakes and take longer to recover from their illnesses.

“Continuing economic uncertainty and fears over job security appears to be taking its toll on employees. We are seeing employees struggling into work to demonstrate their commitment, suggesting presenteeism can be a sign of anxiety. Failing to address employees’ concerns is likely to confound the issue, impact on morale and commitment and may cause or exacerbate stress or mental health problems.

“We urge employers to examine whether lower absence levels within their own organisations are as a result of more effective absence management or if they reflect the negative impact of presenteeism. Overall a proactive approach to supporting employee wellbeing and managing absence, which includes training managers in how to manage people effectively and early access to occupational health services, remains critical for success.”

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