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Health promotion in the workplace Steve Boorman and Ian Banks Print Publication Year: 2013 Published Online: Apr 2013 ISBN: 9780199643240 eISBN: 9780191755668 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199643240.003.0031

This chapter aims to provide a summary of the development of modern approaches to health promotion in the workplace, illustrated by a number of case studies from UK businesses active in this area. The workplace is an effective forum for health promoting activities and the examples highlight that careful planning and targeting may increase the likelihood of success. Many employers expect such programmes to have high cost, or be difficult to organiseize, but the increasing resources available from third -sector and public health programmes may be accessed by partnership approaches to deliver high- quality programmes, with minimal cost. Comprehensive occupational health should encompass prevention and health promotion, within the continuum ranging from pro-active health support to more reactive intervention to address injury or illness.

Heart valve disease (mitral valve disease): mitral stenosis Bogdan A. Popescu, Shantanu P. Sengupta, Niloufar Samiei, and Anca D. Mateescu Print Publication Year: 2016 Published Online: Dec 2016 ISBN: 9780198726012 eISBN: 9780191792991 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780198726012.003.0035

The most common cause of mitral stenosis (MS) is rheumatic fever followed by degenerative MS. Echocardiography is the key method to diagnose and evaluate MS. Echocardiographic findings are closely related to aetiology. In rheumatic disease echocardiography shows thickening of leaflet tips with restricted opening caused by commissural fusion resulting in ‘doming’ of the mitral valve in diastole. Quantitation of MS severity includes measuring mitral valve area (MVA) by planimetry (anatomical area, by two-/three-dimensional echo), or by the pressure half-time (PHT) method (functional area, by Doppler), and the mean pressure gradient. Planimetry is considered the reference method to determine MVA as it is relatively load independent. The PHT method is widely used due to its simplicity, but different factors influence the relationship between PHT and MVA. Other indices of MS severity are rarely used in clinical practice. Echocardiography also helps in the assessment of consequences of MS, and of associated valvular lesions. Exercise Doppler is recommended when there is discrepancy between the resting echocardiography findings and the clinical picture. Echocardiography is crucial in determining the timing Page 1 of 6 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 18 January 2017

and type of intervention in patients with MS. When considering percutaneous mitral commissurotomy (PMC) valve morphology should be comprehensively evaluated for mobility, thickness, calcifications, and subvalvular apparatus. The echo findings may determine the suitability for PMC, guide the procedure, and assess its results.

Human immunodeficiency virus Paul Grime and Christopher Conlon Print Publication Year: 2013 Published Online: Apr 2013 ISBN: 9780199643240 eISBN: 9780191755668 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199643240.003.0023

Despite significant advances in the treatment of HIV infection and dramatic increases in disease-free survival, there has not been a corresponding increase in employment for those infected with HIV. It is likely that drug side effects, psychological barriers, and continuing (but lessening) prejudice among employers contribute. Occupational physicians working in healthcare require specialist knowledge of guidelines governing the management of HIVinfected healthcare workers. In nearly all other industries HIV-infected individuals can be managed in the same way as any other worker with a chronic, immunosuppressive disease. If the development of novel drugs outstrips viral resistance, and the disabling side effects of effective treatment reduce, the employment prospects for HIV-infected individuals, at least in developed countries, should continue to improve.

Diabetes mellitus and other endocrine disorders Eugene R. Waclawski and Geoff Gill Print Publication Year: 2013 Published Online: Apr 2013 ISBN: 9780199643240 eISBN: 9780191755668 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199643240.003.0015

A few studies of employment and diabetes in the UK indicate some increase in sickness absence. Recent research on the impact of hypoglycaemia at work indicated that severe hypoglycaemia was uncommon. Serious morbidity including accidents or injuries associated with hypoglycaemia at work was very uncommon. Information is still needed on the impact of particular work activities on diabetic control, especially shift work and vocational driving. Because of the paucity of definitive information, the advice given to diabetic workers is often arbitrary and employment decisions are taken with little supporting evidence. Physicians should take care to inform employers and potential employers factually about diabetes and to dispel any prejudice that might exist. The introduction of self-testing and modern systems of treatment have enabled those with diabetes to cope more easily with irregular work patterns. Careers officers and teachers need to know more about diabetes, so that they can give school-leavers accurate advice and enable them to make sensible career plans. A sustained effort is required to educate employers and persuade them to take a more objective view of diabetic workers. It is essential that each individual case be assessed on its own merits with full consultation between all medical advisers. Diabetes per se should not limit employment prospects, for the majority with diabetes Page 2 of 6 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 18 January 2017

have few, if any, problems arising from the condition and make perfectly satisfactory employees in a wide variety of occupations. Other endocrine diseases are less common than diabetes, and have less potential impact on employment. Decisions on this should be made on an individual basis. Once the specific endocrine disorder is either cured, or is stable on treatment, there are not usually any work-related issues. If the condition has caused an impairment it will be considered a disability even if treatment cures or stabilizes the condition. Where a cure occurs surgically, this may be considered a past disability, time limited from the start of impairment to the curative surgery. This chapter focuses on hyperthyroidism, hypothyroidism, thyroid eye disease, and pituitary disease.

Spinal disorders Keith T. Palmer and C. G. Greenough Print Publication Year: 2013 Published Online: Apr 2013 ISBN: 9780199643240 eISBN: 9780191755668 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199643240.003.0011

Non-specific low-back pain (LBP) is one of the commonest conditions afflicting adults of working age. It represents a leading cause of disability and a major cause of sickness absence. The problem posed in assessing fitness for work in back pain sufferers is one that all occupational physicians frequently face. Neck pain and its associated disability are scarcely less common. Collectively, therefore, axial pains affecting the spine pose a major challenge to the decision-maker. Commonly, a number of placement and fitness questions arise. In assessing the absent worker with a current episode of pain: When will symptoms improve or resolve? Is this a short- or a long-term problem? Are any further investigations required to exclude serious pathology? Who (among the many with pain) should be referred for such an assessment? At what point should the occupational physician intervene to hasten rehabilitation? And how? Has work contributed to symptom onset? Might it worsen or prolong symptoms? Is it appropriate to return the worker to the same job or does the work need to be modified? When is chronic spinal pain serious enough to declare a person permanently unfit for work? Could more be done to avoid or control the demands of work before that point is reached? Following spinal surgery, when will the patient be fit for work? Should special restrictions be considered and if so when? At the pre-employment stage the issues are no less difficult: Are there any specific inquiries (questions, examination findings, and investigations) predictive of future spinal pain leading to serious disability or sickness absence? How should these be utilized in assessing fitness for work? In particular, how should a past history of spinal pain be regarded? Are any characteristics sufficiently predictive to warrant restrictions? And more generally: What steps can be taken to promote fitness for work and to prevent spinal pain? What obligations exist under health and safety legislation and the Equality Act 2010? Do current policies on back pain promote well-being and avoid needless work restrictions? In attempting to answer these questions it is helpful to appreciate the frequency and natural history of spinal pain, the markers of serious pathology, and the evidence on fitness assessment and preventing disability. It is also important, for simple mechanical LBP, to be aware of evidence-based advances in management and rehabilitation. Adoption of consensus guidelines has led to better coping and faster recovery. Specific guidelines have also been developed for the Page 3 of 6 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 18 January 2017

management of workers and these address, in part, some of the questions posed above. In this chapter we review these initiatives and the problem of assessing fitness for work in those with spinal pain. Emphasis is given to simple non-specific axial spinal pain as this is the commonest presentation. Only rarely does the clinician make a more specific diagnosis; but occasionally serious pathology underlies symptoms and different responses are needed. Some account is provided of more specific spinal pathologies including prolapsed intervertebral disc, spinal stenosis, fusion surgery, ankylosing spondylitis, Scheuermann’s disease, fractures, and spinal cord injury.

Hearing and vestibular disorders Linda M. Luxon and Finlay Dick Print Publication Year: 2013 Published Online: Apr 2013 ISBN: 9780199643240 eISBN: 9780191755668 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199643240.003.0010

Hearing and balance disorders are common in those of working age and become commoner with increasing age. Hearing impairment can adversely affect an individual’s education and employment prospects and there is limited evidence that it may compromise their safety. Similarly, vestibular disorders are common, can affect fitness for work, workplace performance, sickness absence, and fitness for safety critical work. While individuals with deafness or severe hearing impairment may be unable to work in safety critical roles, they are able to undertake many jobs subject to reasonable workplace adjustments being made (as required under the Equality Act 2010). Sadly, many people with hearing or balance impairment either do not seek, or do not receive, appropriate workplace adjustments and as a consequence continue to experience significant disadvantage in the employment market.

Three-dimensional echocardiography Luigi P. Badano, Roberto M. Lang, and Alexandra Goncalves Print Publication Year: 2016 Published Online: Dec 2016 ISBN: 9780198726012 eISBN: 9780191792991 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780198726012.003.0007

The advent of fully-sampled matrix array transthoracic transducers has enabled advanced digital processing and improved image formation algorithms and brought three-dimensional echocardiography (3DE) technology into clinical practice. Currently, 3DE is recognized as an important echocardiographic technique, demonstrated to be superior to two-dimensional echocardiography in various clinical scenarios. This chapter focuses on the technology of 3DE matrix transducers, physics of 3D imaging, data set acquisition (multiplane, realtime, full-volume, zoom, and colour), and display (volume rendering, surface rendering and multislice) modalities. The chapter also addresses the issues of training in 3DE, and main clinical indications and reporting of transthoracic and transoesophageal 3DE.

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Respiratory disorders Keith T. Palmer and Paul Cullinan Print Publication Year: 2013 Published Online: Apr 2013 ISBN: 9780199643240 eISBN: 9780191755668 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199643240.003.0018

Respiratory illnesses commonly cause sickness absence, unemployment, medical attendance, illness, and handicap.1 Collectively these disorders cause 19 million days/year of certified sickness absence in men and 9 million days/year in women (with substantial additional lost time from self-certified illness) and, among adults of working age, a general practitioner consultation rate of 48.5 per 100/year with more than 240 000 hospital admissions/year. Prescriptions for bronchodilator inhalers run at some 24 million/year, and mortality from respiratory disease causes an estimated loss of 164 000 working years by age 64 and an estimated annual production loss of £1.6 billion (at prices in 2000). Respiratory disease may be caused, and pre-existing disease may be exacerbated, by the occupational environment. More commonly, respiratory disease limits work capacity and the ability to undertake particular duties. Finally, individual respiratory fitness in ‘safety critical’ jobs can have implications for work colleagues and the public. Within this broad picture, different clinical illnesses pose different problems. For example, acute respiratory illness commonly causes short-term sickness absence, whereas chronic respiratory disease has a greater impact on long-term absence and work limitation; and the fitness implications of respiratory sensitization at work are very different from non-specific asthma aggravated by workplace irritants. Occupational causes of respiratory disease represent a small proportion of the burden, except in some specialized work settings where particular exposures give rise to particular disease excesses. The corollary is that the common fitness decisions on placement, return to work, and rehabilitation more often involve non-occupational illnesses than occupational ones. By contrast, statutory programmes of health surveillance focus on specific occupational risks (e.g. baking) and specific occupational health outcomes (e.g. occupational asthma). In assessing the individual it is important to remember that respiratory problems are often aggravated by other illnesses, particularly disorders of the cardiovascular and musculoskeletal systems.

Diets for Modern Living Lionel H. Opie Print Publication Year: 2011 Published Online: Nov 2013 Publisher: Oxford University Press ISBN: 9780198525677 eISBN: 9780191770746 DOI: 10.1093/med/9780198525677.003.0004 Item type: chapter

Chapter 4 covers the complex issues of how to control body weight and how to find the ideal diet, which can lead to fewer cholesterol problems, offsetting incipient diabetes or hypertension, and which will achieve better protection of the heart and brain.

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Rheumatological disorders Steve Ryder and Karen Walker-Bone Print Publication Year: 2013 Published Online: Apr 2013 ISBN: 9780199643240 eISBN: 9780191755668 Item type: chapter

Publisher: Oxford University Press DOI: 10.1093/med/9780199643240.003.0013

Musculoskeletal pain affects up to 50 per cent of the population at any one time. Consequently, low back pain, neck pain, and upper limb disorders are important causes of sickness absence. Spinal disorders, including back pain, are covered in detail in Chapter 11, and will not be discussed further here. Instead this chapter will focus on the other common rheumatological disorders, including upper limb disorders (specific and non-specific), osteoarthritis (OA), inflammatory arthritis, connective tissue disorders, and widespread pain syndromes. Many rheumatological conditions are chronic and potentially disabling but there have been recent developments in medical therapies, especially in the inflammatory rheumatic conditions, which offer the prospect of controlling disease activity, reducing disability, improving quality of life, and enabling work.

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