In this issue of Occupational Medicine
Honorary Editor
The diagnosis and staging of hand–arm vibration syndrome (HAVS) remains reliant on the clinical history despite the amount of time and effort that has been expended searching for a gold standard objective test. Youakim adopted a novel method of further assessing Raynaud's phenomenon in Canadian workers seeking compensation for HAVS (1). Following medical assessment, 36 applicants with reported symptoms of blanching were given disposable cameras with instructions to photograph their blanching. Of the 30 who returned the cameras, just over half (57%) were found to have photographic evidence of Raynaud's phenomenon with very good agreement amongst the four blinded raters. Of the remaining 17 applicants without photographic evidence of Raynaud's, four had not experienced blanching during the follow-up period. The author concludes that the presenting history of Raynaud's phenomenon among workers seeking compensation for HAVS may not be accurate in about half of cases and even a careful clinical history obtained in a specialty clinic may be inaccurate one-third of the time. It is suggested that self-photography can provide a useful, simple and accurate means of establishing blanching in HAVS.
Psychosocial factors are recognized to have a significant influence on work-related health and yet there is often considerable variability in the findings of studies which examine the link between such factors and sickness absence for instance. It has been postulated that the strength of the association might depend on how psychosocial factors are assessed. Roelen and colleagues decided to investigate the link between sickness absence and psychosocial work factors through a multi-level study (2). They conducted their study on 395 insurance company employees and found that when job demands and control according to Karasek's model were self-assessed, they were not significantly related to sickness absence. However, when psychosocial work factors were assessed at the workplace level by an occupational psychologist carrying out interviews, employees had higher rates of short- and long-term absence in the department in which demands were high and control over work was low. The authors conclude that the differing results of assessing psychosocial work conditions at the individual and the workplace level might explain the inconsistent findings in the literature on the relationship of these conditions with sickness absence and feel that this warrants more multi-level studies.
Up to half of all doctors in the UK report their intention to retire before normal retirement age and this is a common pattern in many western countries. Doctors represent a valuable resource and one that is expensive to train. Despite increased recruitment rates there are still manpower gaps in certain sectors of the health service and allied to the increasing demands on occupational pension schemes, the desire to retire may not fit comfortably with national objectives. Heponiemi and colleagues investigated the retirement intentions of Finnish physicians and whether this was influenced by organizational factors and self-reported health status (3). A total of 2800 physicians aged between 45 and 65 responded, representing about a fifth of all Finnish physicians. Just under a third reported strong intentions to retire with a third reporting no intention to retire. Self-reports of poor health, low work ability, taking sickness absence, low job control, and organizational injustice all independently increased the likelihood of retirement intentions. The authors conclude that low job control and organizational injustice may intensify the effect of poor health on retirement intentions and that promoting control and organizational justice might help to decrease early retirement among physicians.
In this issue our international perspective series continues with a look at occupational medicine in Canada and our art series continues with Epstein's chilling Torso in Metal from Rock Drill. Finally in this issue, our new fillers reflecting on life, the workplace, medicine and everything begin. We received a great response to our request for entertaining writers and we will therefore be including contributions from a number of different authors in forthcoming issues. In this issue, look out for thoughts on lawnmower blades by Anthony Seaton.
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 Top References |
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- Youakim S. The validity of Raynaud's phenomenon symptoms in HAVS cases. Occup Med (Lond) (2008) 58:431–435.
- Roelen CAM, Weites SH, Koopmans PC, et al. Sickness absence and psychosocial work conditions: a multilevel study. Occup Med (Lond) (2008) 58:425–430.
- Heponiemi T, Kouvonen A, Vänskä J, et al. Health, psychosocial factors and retirement intentions among Finnish physicians. Occup Med (Lond) (2008) 58:406–412.
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