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Biomedical subjects

David Coggon

Publications and source records attributed to David Coggon.

At least 19 recordsLinked to original sources
PubMed2006

Influenza immunisation: attitudes and beliefs of UK healthcare workers.

AIM: To explore attitudes to influenza immunisation and rates of uptake among staff working in acute hospitals in the UK. METHOD: A cross-sectional survey of 11,670 healthcare workers in six UK hospitals was carried out using a postal questionnaire. RESULTS: Among 6302 responders (54% of those mailed), 19% had taken up influenza immunisation during winter 2002/3. Vaccination was well tolerated, with a low prevalence of side effects (13%) and associated time off work (2%). The majority of subjects who accepted vaccination (66%) were most strongly influenced by the personal benefits of protection against influenza. Prevention of sickness absence and protection of patients were the prime motivation for only 10% and 7% of subjects, respectively. Among 3967 who declined vaccination, the most common primary demotivators were concern about safety (31%) and efficacy (29%). 22% were most strongly deterred by lack of time to attend for vaccination. Free text answers indicated that 37% declined because of a perceived low ratio of personal benefits to adverse effects. Subjects said they would be persuaded to take up vaccination in future by easier access (36%), more information about personal benefit and risk (34%) and more information about effects on staff absence (24%). CONCLUSIONS: These findings indicate that the uptake of influenza immunisation among UK healthcare workers remains low. There is some scope for increasing uptake by improving accessibility and encouragement from professional peers. However, the results suggest that perception of small personal benefit in relation to risk mitigates, importantly, against higher uptake of routine annual influenza vaccination. Thus, resource might better be allocated to ensuring efficient management in epidemic years. The effect of publicity about pandemic influenza on risk perception and vaccine uptake among healthcare workers during winter 2005/6 warrants further study.

Absenteeism↗
PubMed2006

Pain tolerance in patients presenting to primary care and physiotherapy services with upper limb disorders.

BACKGROUND: Arm pain is a common cause of incapacity for work and is often attributed to occupational activities, but in many cases the pathogenesis is unclear. OBJECTIVE: To investigate whether arm pain in the absence of identifiable underlying pathology is associated with reduced tolerance of painful sensory stimuli. METHODS: 133 incident cases of arm pain, recruited from primary care and physiotherapy services, were classified according to a validated diagnostic algorithm. Pain tolerance was measured at three sites in each arm in response to electrocutaneous stimulation. Associations with pain tolerance (the geometric mean of the six measurements at 5 Hz) were assessed by linear regression, and findings were summarised as proportional changes in pain tolerance. RESULTS: Pain tolerance was generally lower than in an earlier community survey. Women had a lower tolerance than men. After allowance for sex, age, use of analgesics and anatomical extent of pain, there was no indication of reduced tolerance in patients with non-specific pain relative to those with specific local pathology. CONCLUSIONS: Pain tolerance may be generally reduced in patients presenting to medical services with arm pain, but those with non-specific pain do not seem to have lower tolerance than those with identifiable local pathology.

Adult↗
PubMed2006

Compensating occupationally related tenosynovitis and epicondylitis: a literature review.

OBJECTIVES: To assess occupational associations with tenosynovitis and epicondylitis, we conducted a systematic literature review. We focused particularly on evidence that might support compensation of these disorders 'on the balance of probabilities'. METHODS: We searched the MEDLINE and EMBASE electronic biomedical databases to 1 January 2005 using combinations of keyword and medical subject headings, and also the references cited in two state-of-the-art reviews from the 1990s. Primary research reports were retrieved and checked for further relevant citations. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect. RESULTS: We found and summarized 18 papers. In the main, these based analysis on job titles rather than on directly assessed physical activities. Few occupations were studied more than once, however, and there was little consistent evidence of jobs or work activities that carried more than a doubling of risk for either disorder. CONCLUSION: Compensation of occupational illness can be problematic for disorders that are not specific to work and for which there are no distinctive clinical features in occupationally related cases. Attribution can, however, be made on the balance of probabilities if there is convincing evidence that risk is at least doubled in an occupational group. Our review highlights the relative lack of data to support such attribution for tenosynovitis and epicondylitis, and discusses the difficulty of compensating upper limb disorders.

Humans↗
PubMed2006

Neuropsychiatric symptoms in past users of sheep dip and other pesticides.

OBJECTIVES: To explore the prevalence and pattern of neuropsychiatric symptoms in past users of sheep dip and other pesticides. METHODS: From a postal survey of men born between 1933 and 1977 and resident in three rural areas of England and Wales (response rate 31%), data were obtained on lifetime history of work with pesticides, neurological symptoms in the past month, current mental health and tendency to be troubled by non-neurological somatic symptoms (summarised as a somatising tendency score). Risk factors for current neuropsychiatric symptoms were assessed by modified Cox regression. RESULTS: Data were available for 9844 men, including 1913 who had worked with sheep dip, 832 with other insecticides but not sheep dip and 990 with other pesticides but never with sheep dip or insecticides. Neurological symptoms were consistently 20-60% more common in past users of sheep dip than in men who had never worked with pesticides, but their prevalence was also higher in men who had worked only with pesticides other than sheep dip or insecticides. They clustered strongly within individuals, but this clustering was not specific to men who had worked with sheep dip. Reporting of three or more neurological symptoms was associated with somatising tendency (prevalence ratio (PR) 15.0, 95% CI 11.4 to 19.5, for the highest vs the lowest category of somatisation) and was more common in users of sheep dip (PR 1.3, 95% CI 1.0 to 1.6), other insecticides (PR 1.4, 95% CI 1.0 to 1.8) and other pesticides (PR 1.3, 95% CI 1.0 to 1.7) than in non-users. Among users of sheep dip, prevalence was higher in men who had dipped most often, but not in those who had worked with sheep dip concentrate. Past use of pesticides was not associated with current anxiety or depression. CONCLUSION: Neurological symptoms are more common in men who have worked with sheep dip, but the association is not specific to sheep dip or insecticides. A toxic cause for the excess cannot be ruled out, but several features of our observations suggest that psychological mechanisms have a role.

Adult↗
PubMed2006

Health-related job loss: findings from a community-based survey.

AIMS: To explore the frequency, nature, determinants and outcome of health-related job loss (HRJL) in men sampled from the general population of three rural areas. METHODS: Data on lifetime occupational history, including any HRJL, were obtained as part of a postal survey of men aged 24-70 years in three rural areas of England and Wales. Incidence rates were calculated for first health-related loss of a job that had been held for >or=1 year. Associations with risk factors were examined by Poisson regression, and by application of conditional logistic regression in a nested case-control study. RESULTS: HRJL was reported by 1408 (13%) of the 10 559 men who had held long-term jobs. The incidence rose steeply with age for cardiorespiratory and neurological disorders, but for accidents and poisoning the trend was, if anything, in the reverse direction. An increase in incidence over time was most marked for musculoskeletal disorders and mental illness, and much less prominent for cardiorespiratory and neurological disease. In comparison with other occupations, the risk was lower in agricultural workers (odds ratio (OR) 0.6, 95% CI 0.5 to 0.8), and higher in policemen (OR 2.4, 95% CI 1.6 to 3.7) and teachers (OR 2.0, 95% CI 1.5 to 2.7), this differential being even greater for HRJL caused by mental illness. Risk was also increased in employees relative to the self-employed (OR 2.0, 95% CI 1.7 to 2.3). Shift work was associated with a higher incidence of job loss caused by mental illness (OR 1.5, 95%CI 1.1-2.2), and heavy lifting with HRJL caused by musculoskeletal disorders (OR 2.6, 95% CI 2.0 to 3.5). After HRJL, 61% of subjects had subsequently obtained further long-term employment, usually within 1 year. CONCLUSIONS: In the population studied, HRJL has become increasingly common, especially in relation to musculoskeletal disorders and mental illness. In addition to being associated with ergonomic stresses in the workplace, it may be importantly influenced by cultural and economic factors. Future research should focus on the minority of workers who leave a job for health reasons and do not rapidly return to further work.

Adult↗
PubMed2006

Risk of prematurity, low birthweight and pre-eclampsia in relation to working hours and physical activities: a systematic review.

BACKGROUND: Occupational activities are suspected of having an adverse impact on outcomes of pregnancy. AIM: To assess the evidence relating three major adverse outcomes (preterm delivery, low birthweight (LBW) and pre-eclampsia/gestational hypertension) to five common occupational exposures (prolonged working hours, shift work, lifting, standing and heavy physical workload). METHODS: A systematic search of Medline and Embase (1966-December 2005) using combinations of keywords and medical subject heading terms was conducted. For each relevant paper, standard details were abstracted that were then used to summarise the design features of studies, to rate their methodological quality (completeness of reporting and potential for important bias or confounding) and to provide estimates of effect. For studies with similar definitions of exposure and outcome, pooled estimates of relative risk (RR) in meta-analysis were calculated. RESULTS: 53 reports were identified-35 on preterm delivery, 34 on birth weight and 9 on pre-eclampsia or gestational hypertension. These included 21 cohort investigations. For pre-term delivery, extensive evidence relating to each of the exposures of interest was found. Findings were generally consistent and tended to rule out a more than moderate effect size (RR >1.4). The larger and most complete studies were less positive, and pooled estimates of risk pointed to only modest or null effects. For small-for-gestational age, the position was similar, but the evidence base was more limited. For pre-eclampsia and gestational hypertension, it was too small to allow firm conclusions. CONCLUSIONS: The balance of evidence is not sufficiently compelling to justify mandatory restrictions on any of the activities considered in this review. However, given some uncertainties in the evidence base and the apparent absence of important beneficial effects, it may be prudent to advise against long working hours, prolonged standing and heavy physical work, particularly late in pregnancy. Our review identifies several priorities for future investigation.

Exercise↗
PubMed2006

Carpal tunnel syndrome and its relation to occupation: a systematic literature review.

OBJECTIVES: To assess occupational risk factors for carpal tunnel syndrome (CTS), we conducted a systematic literature review. METHODS: We identified relevant primary research from two major reviews in the 1990s and supplemented this material by a systematic search of the MEDLINE and EMBASE biomedical databases from the start of the electronic record to 1 January 2005. Reports were obtained and their bibliographies checked for other relevant publications. From each paper, we abstracted a standardized set of information on study populations, exposure contrasts and estimates of effect. RESULTS: Altogether, we summarized 38 primary reports, with analyses based either on a comparison of job titles (22) or of physical activities in the job (13) or both (3). We found reasonable evidence that regular and prolonged use of hand-held vibratory tools increases the risk of CTS >2-fold and found substantial evidence for similar or even higher risks from prolonged and highly repetitious flexion and extension of the wrist, especially when allied with a forceful grip. The balance of evidence on keyboard and computer work did not indicate an important association with CTS. Discussion Although the papers that we considered had limitations, a substantial and coherent body of evidence supports preventive policies aimed at avoiding highly repetitive wrist-hand work. There is a case for extending social security compensation for CTS in the United Kingdom to cover work of this kind.

Carpal Tunnel Syndrome↗
PubMed2006

Non-fatal occupational injuries in British agriculture.

OBJECTIVES: To investigate the incidence, nature and determinants of non-fatal occupational injuries in British agriculture. METHODS: As part of a postal survey, data on lifetime histories of work in agriculture and occupational accidents were obtained from men born between 1933 and 1977 and residing in three rural areas of England and Wales. Incidence rates for different categories of accident were compared with those derived from statutory reporting. Associations with risk factors were explored by Poisson regression, and summarised by incidence rate ratios (IRRs). RESULTS: Of the 10 765 responders (response rate = 31%), 3238 (30%) reported at least one occupational accident at the ages of 14-64 years, leading to absence from work for >or=3 days, including 1492 accidents that could be linked to a specific job listed in the history of agricultural work. The reported incidence of injuries in agriculture was markedly higher than that derived from statutory reporting, particularly for self-employed farmers. During 1996-2003, the highest rates of agricultural accidents were from handling, lifting or carrying (4.9/1000 person-years), falls from a height (4.6/1000 person-years) and injury by animals (3.4/1000 person-years). After adjustment for calendar period and age, the risk of accidents was elevated in men who had only recently entered agricultural work (IRR 3.7, 95% CI 2.7 to 5.1 for men who had worked in agriculture for up to 1 year relative to those who had entered the industry >25 years earlier), and in those who carried out forestry (IRR 1.7, 95% CI 1.5 to 1.9). CONCLUSION: Our findings confirm the substantial underascertainment of serious accidental injuries in agriculture through statutory reporting, particularly for the self-employed. The risk of accidents is highest in new recruits to the industry and in those undertaking forestry, and these groups should be a target for further preventive action.

Accidents, Occupational↗
PubMed2006

Risk factors for specific upper limb disorders as compared with non-specific upper limb pain: assessing the utility of a structured examination schedule.

BACKGROUND: Few community-based epidemiological investigations of upper limb disorders (ULDs) have classified cases by validated procedures involving a structured clinical examination. AIM: To compare risk factor profiles for different diagnostic categories of ULD using one such examination scheme. METHODS: A questionnaire about upper limb pain and demographic, occupational and psychosocial risk factors was mailed to 10,264 adults from two English general practices, followed by standardized physical examination in those with arm or neck pain. Logistic regression was used to compare those with specific ULDs and non-specific arm pain with those who had no neck or arm symptoms. RESULTS: There was a 59% response rate. A total of 1,197 subjects with arm or neck pain underwent standardized physical examination and were classified as having one or more of 11 specific ULDs or non-specific regional pain. Among these, 250 subjects with specific ULDs and 176 with only non-specific arm pain were compared with 2,248 subjects who had no neck or arm symptoms. Certain physical risk factors were more strongly associated with specific disorders than with non-specific pain. In comparison with pain-free subjects, the odds ratios (ORs) in keyboard users (>or=1 h versus <1 h/day) were 3.1 (95% CI 1.3, 7.8) for hand-wrist tendonitis but 1.3 (0.8, 2.1) for non-specific hand-wrist pain. Other differential associations were found with age, sex, manual versus non-manual employment and smoking. Unexpectedly, low vitality was similarly associated with both specific disorders and non-specific pain. CONCLUSION: These findings suggest that the schedule may usefully distinguish disorders that differ in their association with physical risk factors.

Adult↗
PubMed2006

A case-control study of risk factors for arm pain presenting to primary care services.

OBJECTIVES: To investigate the association of occupational activities, mental health and comorbidity with care seeking for arm pain, and to test the hypothesis that specific disorders arise from physical risk factors and non-specific pain from psychological ones. METHODS: Patients with a new episode of arm pain and matched controls were recruited from eight general practices. A questionnaire about risk factors was completed and cases were classified using a validated examination schedule. Questions were asked about occupational activities and psychosocial stressors. Mental health was assessed using the Hospital Anxiety Depression Scale, elements of the Brief Symptom Inventory (somatizing tendency) and the Whiteley Index (health anxiety); comorbidity from chronic fatigue syndrome (CFS) and chronic widespread pain (CWP) was ascertained using standard definitions. Associations were explored using logistic regression and summarized as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: Altogether, 132 cases and 127 controls were studied. Consulting with arm pain was strongly associated with all of the mental health variables and with CFS and CWP, irrespective of the site of arm pain or diagnosis. The OR in those with >3 versus <3 distressing somatic symptoms was 3.9 (95% CI 1.7-9.0). There were several significant associations with physical activity, but none with occupational psychosocial stressors. Repeated wrist/finger movements and carrying weights were more strongly associated with specific diagnoses than with non-specific pain. CONCLUSIONS: Somatizing tendency, health anxiety, low mood, CFS and CWP are more common in arm pain consulters. Certain mechanical activities are also overrepresented, particularly in those with specific pathology.

Adolescent↗
PubMed2006

Determination of 238u/235u, 236u/238u and uranium concentration in urine using sf-icp-ms and mc-icp-ms: an interlaboratory comparison.

Accidental exposure to depleted or enriched uranium may occur in a variety of circumstances. There is a need to quantify such exposure, with the possibility that the testing may post-date exposure by months or years. Therefore, it is important to develop a very sensitive test to measure precisely the isotopic composition of uranium in urine at low levels of concentration. The results of an interlaboratory comparison using sector field (SF)-inductively coupled plasma-mass spectrometry (ICP-MS) and multiple collector (MC)-ICP-MS for the measurement of uranium concentration and U/U and U/U isotopic ratios of human urine samples are presented. Three urine samples were verified to contain uranium at 1-5 ng L and shown to have natural uranium isotopic composition. Portions of these urine batches were doped with depleted uranium (DU) containing small quantities of U, and the solutions were split into 100 mL and 400 mL aliquots that were subsequently measured blind by three laboratories. All methods investigated were able to measure accurately U/U with precisions of approximately 0.5% to approximately 4%, but only selected MC-ICP-MS methods were capable of consistently analyzing U/U to reasonable precision at the approximately 20 fg L level of U abundance. Isotope dilution using a U tracer demonstrates the ability to measure concentrations to better than +/-4% with the MC-ICP-MS method, though sample heterogeneity in urine samples was shown to be problematic in some cases. MC-ICP-MS outperformed SF-ICP-MS methods, as was expected. The MC-ICP-MS methodology described is capable of measuring to approximately 1% precision the U/U of any sample of human urine over the entire range of uranium abundance down to <1 ng L, and detecting very small amounts of DU contained therein.

Humans↗
PubMed2005

Disabling musculoskeletal pain and its relation to somatization: a community-based postal survey.

BACKGROUND: Somatization (a tendency to report distress from somatic symptoms) is a little studied, but potentially important, confounder and effect modifier in occupational studies of musculoskeletal disease. AIMS: To assess the role of somatization as a risk factor for disabling regional pain. METHODS: A questionnaire was mailed to 4998 subjects of working age. Questions were asked about chronic and disabling pain in the past 12 months affecting the arm, low back, knee or combinations of these sites. Distress from physical symptoms was assessed using elements of the Brief Symptom Inventory and mental well-being was assessed using the short-form 36 (SF-36). Associations were examined by modified Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CI). RESULTS: Among 2632 responders, 24% reported chronic pain and 25% disabling pain at one or several sites. Risk of chronic or disabling pain increased strongly according to the number of somatic symptoms reported as bothersome. For example, the HR for chronic upper limb pain in those distressed by > or =2 somatic symptoms in the past 7 days versus none was 3.9 (95% CI 2.9-5.3), and that of disabling upper limb pain was 5.8 (95% CI 4.1-8.3). Similar patterns were found for the low back and knee, and there was a gradient of increasing risk according to the number of sites with disabling pain. In comparison, associations with SF-36 mental well-being score were weaker. CONCLUSION: Somatizing tendency should be evaluated as a possible confounder or effect modifier in studies of occupational risk factors for musculoskeletal pain.

Adult↗
PubMed2005

Assessing case definitions in the absence of a diagnostic gold standard.

Optimal case definition is important in epidemiological research, but can be problematic when no satisfactory gold standard is available. In particular, difficulties arise where the pathology underlying a disorder is unknown or cannot be reliably diagnosed. This problem can be overcome if diagnoses are viewed not necessarily as labels for disease processes, but more generally as a useful method for classifying people for the purpose of preventing or managing illness. With this perspective, the value of a case definition lies in its practical utility in distinguishing groups of people whose illnesses share the same causes or determinants of outcome (including response to treatment). A corollary is that the best-case definition for a disorder may vary according to the purpose for which it is being applied.

Diagnosis↗
PubMed2005

Utility of restricted neck movement as a diagnostic criterion in case definition for neck disorders.

OBJECTIVES: This study explored the utility of restricted neck movement in epidemiologic case definition for neck disorders. METHODS: Data on neck pain, sensory symptoms in the arm, psychosocial and physical risk factors for neck disorders, and the range of active neck movements were obtained through a self-administered questionnaire, interview, and physical examination for a community-based sample of 2145 adults aged 25-64 years. The prevalence of neck pain and sensory symptoms was examined according to the extent of neck movements. Logistic regression was used to assess the relation of risk factors to neck disorders, defined by various combinations of pain and restricted movement, and the associations were compared. RESULTS: The ranges of different categories of neck movement were correlated within persons, and their sum ("total neck movement") was unimodally distributed across persons. The prevalence of neck pain and sensory symptoms was elevated when total neck movement was below the 30th centile, and particularly below the 10th centile. Associations between neck pain and low vitality and poor support at work were stronger when there was also restricted neck movement, but the extent of neck movement did not materially modify the relation of neck pain to physical risk factors. CONCLUSIONS: The restriction of total neck movement may serve as a marker of severity in community-based studies of neck disorders, but no indication was found that it distinguishes a subset of cases with a distinct etiology.

Adult↗
PubMed2005

Epidemiological differences between back pain of sudden and gradual onset.

OBJECTIVE: To explore possible differences in risk factors for low back pain according to its speed of onset. METHODS: We analyzed longitudinal data from 1366 hospital nurses in England who initially had been free from low back pain for at least one month. Risk factors were ascertained from a self-administered baseline questionnaire, and outcomes from serial followup questionnaires. Hazard ratios (HR) for developing a first new episode of low back pain during followup were derived by Cox regression. RESULTS: Low back pain with gradual onset was significantly associated with psychological symptoms measured at baseline [HR 1.7 (95% CI 1.2, 2.4) and higher], but no such association was seen for sudden pain. Low back pain with sudden onset while at work was associated with exposure to specific patient-handling tasks [HR 1.8 (95% CI 1.1, 3.0) to 2.8 (95% CI 1.4, 5.5)]. However, symptoms that came on suddenly elsewhere were not related to occupational activity, and low back pain of gradual onset showed little relation to patient-handling. CONCLUSION: These findings suggest that a useful distinction can be made according to the speed and circumstances of onset of low back pain. If confirmed, they have important implications for the evaluation of ergonomic interventions aimed at reducing back pain.

Acute Disease↗