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Background: In this paper, we present the protocol for a cluster-randomised trial to evaluate the implementation and effectiveness of a workplace mental health intervention in the state-wide police department of the south-eastern Australian state of Victoria. n. The primary aims of the intervention are to improve psychosocial working conditions and mental health literacy, and secondarily to improve mental health and organisational outcomes. Methods/design: The intervention was designed collaboratively with Victoria Police based on a mixed methods pilot study, and combines multi-session leadership coaching for the senior officers within stations (e.g., Sergeants, Senior Sergeants) with tailored mental health literacy training for lower and upper ranks. Intervention effectiveness will be evaluated using a two-arm cluster-randomised trial design, with 12 police stations randomly assigned to the intervention and 12 to the non-intervention/usual care control condition. Data will be collected from all police members in each station (estimated at >20 per station). Psychosocial working conditions (e.g., supervisory support, job control, job demands), mental health literacy (e.g., knowledge, confidence in assisting someone who may have a mental health problem), and mental health will be assessed using validated measures. Organisational outcomes will include organisational depression disclosure norms, organisational cynicism, and station-level sickness absence rates. The trial will be conducted following CONSORT guidelines. Identifying data will not be collected in order to protect participant privacy and to optimise participation, hence changes in primary and secondary outcomes will be assessed using a two-sample t-test comparing summary measures by arm, with weighting by cluster size. Discussion: This intervention is novel in its integration of stressor-reduction and mental health literacy-enhancing strategies. Effectiveness will be rigorously evaluated, and if positive results are observed, the intervention will be adapted across Victoria Police (total employees ~16,500) as well as possibly in other policing contexts, both nationally and internationally. Trial registration: Current Controlled Trials: ISRCTN82041334. Registered 24th July, 2014.

We conducted a cluster randomized trial of a workplace mental health intervention in an Australian police department. The intervention was co-designed and co-implemented with the police department. Intervention elements included tailored mental health literacy training for all members of participating police stations, and a leadership development and coaching program for station leaders. This study presents the results of a mixed-methods implementation evaluation of the trial.Descriptive quantitative analyses characterized the extent of participation in intervention activities, complemented by a qualitative descriptive analysis of transcripts of 60 semistructured interviews with 53 persons and research team field notes.Participation rates in the multicomponent leadership development activities were highly variable, ranging from10% to approximately 60% across stations. Approximately 50% of leaders and50% of troops completed the mental health literacy training component of the intervention. Barriers to implementation included rostering challenges, high staff turnover and changes, competing work commitments, staff shortages, limited internal personnel resources to deliver the mental health literacy training, organizational cynicism, confidentiality concerns, and limited communication about the intervention by station command or station champions. Facilitators of participation were also identified, including perceived need for and benefits of the intervention, engagement at various levels, the research team's ability to create buy-in and manage stakeholder relationships, and the use of external, credible leadership development coaches.Implementation fell far short of expectations. The identified barriers and facilitators should be considered in the design and implementation of similar workplace mental health interventions.

Background Many workplaces have implemented sit-stand workstations (SSW), which enable a worker to transition between sitting and standing as they perform their work activities. The factors which determine the initial adoption, sustainability or cessation of use for a SSW, remain largely unexamined. This study investigates the experiences of workers who had previously used or were currently using a SSW. Methods The study setting was within an Australian university. Participants who were current or past SSW users, as well as workplace key informants, were interviewed for the study. All interviews were recorded, transcribed and analysed. Transcripts were coded by two researchers for concepts and themes regarding uptake and sustainability of SSW. Discussion and validation of themes was undertaken by the team of three researchers. Results A total of 24 interviews were conducted. Twenty-two interviews were with ceased and current users (16 current and six ceased users) and two interviews were with workplace key informants. Analysis of the interviews with current and ceased users identified three main themes: Personal considerations for use/sustainability; Posture; and Usability. Analysis of the interviews with key informants identified two themes: Considerations and concerns and Policies and procedures. Little information was provided to workers when first using a SSW. Workers who were able to adopt their working style to the new workstations were able to sustain ongoing use of a SSW. Key informants were concerned that employees believed using a SSW would provide a health benefit in its own right without an understanding of the possible risks that might be associated with use. Conclusions Sustainable usage of this type of SSW is achievable, however, it requires some element of adaptation at the individual worker level. Participants spoke about how the use of the SSW in a standing position was typically associated with the time of day, specific task selection and musculoskeletal comfort or fatigue factors. The provision of education to new SSW users with relevant supporting information by a subject matter expert should enable the worker to obtain a more holistic understanding of the safety and health risks and benefits embedded in the use of a SSW. Electronic supplementary material The online version of this article (10.1186/s12889-018-6296-6) contains supplementary material, which is available to authorized users.

Long-term survival (LTS) following abdominal aortic aneurysm (AAA) surgery is an outcome that can compare open surgical repair (OSR) and endovascular AAA repair (EVAR) methods. We examined the LTS of persons following successful AAA repair using administrative health data covering the Australian Pharmaceutical Benefits and Medicare Benefits Schemes from 1993 to 2014.Participants undergoing AAA surgery were identified using procedure codes and the last service provision date used as a proxy mortality marker. LTS and relative survival with control populations in those who survived the initial post-operative period were used to compare OSR and EVAR and estimates between the first and second halves of the study.A total of 2060 persons who had undergone AAA repair were identified. Overall median LTS (95% CI) following elective, ruptured OSR and EVAR were 10.4 (9.1-11.0), 8.5 (6.7-10.3) and 9.7 (8.1-11.3) years, respectively. Relative survival rates at 5 and 10 years were 0.89 and 0.7 for OSR and 0.87 and 0.66 for EVAR. LTS rates were similar for OSR and EVAR in age groups 65-84 years (EVAR/OSR range 0.96-1.16); however, EVAR was superior to OSR in persons aged85 years at 5 years (EVAR/OSR 1.32, log-rank P 0.05). Relative survival following all techniques of AAA repair showed no significant change over the duration of the study.LTS following AAA repair was heterogeneous in comparison with control populations and varied with age and procedure. The 5-year LTS following EVAR in persons aged85 years is superior to OSR. Administrative data can define long-term outcomes following aortic aneurysm surgery and may complement data already collected by surgeons.

BACKGROUND Administrative data may have utility in the impartial assessment of surgical outcomes and rare events. We have used a publicly available sample of the Australian pharmaceutical and health service provision (medical benefits scheme) databases to assess outcomes following parathyroidectomy for primary hyperparathyroidism (PHP). METHODS A cohort study using linked pharmaceutical and medical benefits schemes data was performed covering the period 1993-2014. Procedure codes identified participants undergoing parathyroidectomy for PHP and subsequent cervical re-exploration surgery (CRX), and the last service date used as a proxy for survival. Time to CRX and survival were modelled using Kaplan-Meier analysis. Demographic data and the era of parathyroid surgery were managed as covariates for Cox regression survival analyses. RESULTS A total of 2165 persons undergoing parathyroidectomy for PHP were identified. Median follow-up was 5.3 years (range 0.2-22). The annual number of parathyroidectomies for PHP increased gradually; 72 individuals underwent CRX (3.3%). The median time to CRX was 152 days (confidence interval 0-396) in 2000-2004 reducing to 47 days (confidence interval 15-78) for the period 2010-2014 (log-rank P = 0.027). The proportion of persons requiring CRX reduced over time from 6.1% in 1997 to 2.1% in 2012 (r2 = 0.5817, P = 0.023). Overall median survival (24.6 years) was poorer when compared with age matched controls (log-rank P = 0.025) but was not associated with CRX or gender. CONCLUSION Administrative data can be used for the assessment of surgical outcomes and may be useful for comparisons of surgical performance, and the appraisal of infrequent events. CRX rates following parathyroidectomy for PHP are improving in Australia.

IntroductionEstimating the mortality risk of persons with diabetes can be challenging. Associated conditions such as cardiovascular disease can become the primary cause of mortality and the underlying contribution of diabetes not recorded. Alternative methods to assess mortality risk in people with diabetes would be useful. ObjectiveTo evaluate an Australian pharmaceutical database to identify multi-morbidity cohorts associated with diabetes and determine mortality rates in these groups using prescription exchange cessation as a proxy event for death. MethodsAustralian Pharmaceutical Benefits Scheme data covering the period 2003–14 were used. Persons with diabetes, cardiovascular diseases and dyslipidemia were identified using Anatomic Therapeutic Chemical codes allocated to their recorded dispensed treatments. People with combinations of these conditions were followed and the last recorded prescription exchange used as a proxy event for mortality. Age and gender specific mortality rates and mortality rate ratios for the multi-morbidity cohorts were then calculated from the number of deaths occurring within 10 years. Results346,201 individuals were identified as taking treatments for diabetes, dyslipidemia and cardiovascular conditions in 2004, 86,165 deaths occurred within 10 years of follow up. Overall crude mortality was 26.2/1,000 person years. Age specific mortality rates and rate ratios were calculated for various multi-morbidity groupings. Statin treatments improved the mortality rates associated with diabetes and cardiovascular disease in persons age >54 (Log–Rank

IntroductionThe incidence and prevalence of diabetes within a population are important public health metrics. Pharmaceutical administrative data may offer a resource that can contribute to quantifying these measures using the recorded signals derived from the drugs used to treat people with diabetes. ObjectiveTo estimate the longitudinal incidence and prevalence of drug treated (DT) diabetes in Australia utilising an Australian Pharmaceutical Benefits Scheme (PBS) dataset and compare estimates with community survey data for all diabetes reported in the Australian National Health Survey (NHS). MethodsPersons with DT diabetes were identified within the PBS dataset using assigned Anatomic Therapeutic Chemical codes for `Drugs used in diabetes'. Prevalent persons with DT diabetes were determined by a single annual treatment, and incident cases from the earliest treatment with diabetes medications. Counts were aggregated by age group and utilised Australian national census data as a denominator to calculate diabetes disease frequencies for the period 2004--14. Comparison of PBS prevalence data was made with NHS surveys over equivalent years. ResultsThe age adjusted incidence of DT diabetes was 3.4/1000 in 2006 and increased to 3.8/1000 in 2011 and 5.1/1000 in 2014. Age adjusted prevalence of DT diabetes in Australia also rose from 26.7/1000 in 2006 to 32.1/1000 in 2011 and 42.1/1000 in 2014. DT diabetes prevalence estimates correlated with NHS estimates of self-reported diabetes prevalence across age groups and in 2014 was r = 0.987. However, PBS estimates of DT diabetes prevalence generally underestimated NHS values of self-reported diabetes in older age groups with mean percentage differences of -22% to -3%. In contrast, PBS data captured more younger persons with diabetes in comparison to NHS data. These differences were then used to adjust DT diabetes incidence rates to provide age specific estimates that could potentially reflect diabetes incidence estimates acquired by community survey. ConclusionsPBS data representing dispensed medications prescribed to persons with diabetes offers a perspective for the assessment of diabetes incidence and prevalence. PBS derived DT diabetes prevalence estimates correlate well with community survey estimates of self-reported diabetes, but underestimate NHS data in older age groups. Calibrated DT incidence estimates may potentially reflect community survey derived diabetes incidence estimates and may offer a method for longitudinal monitoring.

© The Author(s). Aim and objective: Primary hyperparathyroidism (PHPT) is associated with multiple comorbidities and diverse symptomology that often require management with prescribed medications. Parathyroidectomy is an established treatment for PHPT but may also reduce the need for medications required to treat the associated conditions. We examined the changes in dispensed drugs given to a cohort of older adults with PHPT before and following parathyroidectomy. Materials and methods: A publicly available administrative Pharmaceutical and Medical Benefits Scheme database was used for this study. Participants aged >45 years undergoing parathyroidectomy for PHPT were identified by procedure codes for the period 2008 to 2014. Anatomic Therapeutic Chemical codes (ATC) assigned to drugs prescribed to individual participants, pre-and postoperatively, were used to define therapeutic groups and calculate cohort prevalences. Changes in dispensed medications following parathyroidectomy were assessed by the modulation of ATC class prevalence estimates of drugs prescribed using the Autoregressive Integrated Moving Averages (ARIMA) time-series methodology. Results: Six hundred and ten persons aged >45 years (M 72.1, SD 7.0) undergoing parathyroidectomy for PHPT were recruited. Preoperative dispensed treatment prevalences were highest for agents acting on the renin–angiotensin system (48%), dyslipidemia (45%), acid disorders (37%), antibiotics (31%), and analgesics (20%). Treatment prevalences for all ATC defined medications remained either unchanged or increased 3 years postoperatively. Polypharmacy following surgery also increased from an average 5.9 (SD = 4.0, range 0–23) prescribed medications for chronic conditions preoperatively to 7.0 (SD = 4.0) at 2 years (p < 0.001). Conclusion: The prevalence of ATC classified drugs prescribed and dispensed for chronic conditions in older adults with PHPT changed minimally following parathyroidectomy and polypharmacy of dispensed medications increased. Clinical significance: Parathyroidectomy performed in older persons for PHPT has a limited impact on the prevalence of dispensed drugs used to treat many of the associated chronic conditions. Mesh: Big data; Chronic conditions; Drug utilization; Hyperparathyroidism; Polypharmacy; Primary; Surgery.

Introduction: Chronic disease (CD) is a leading cause of population mortality, illness and disability. Identification of CD using administrative data is increasingly used and may have utility in monitoring population health. Pharmaceutical administrative data using World Health Organization Anatomic Therapeutic Chemical Codification (ATC) assigned to prescribed medicines may offer an improved method to define persons with certain CD and enable the calculation of population prevalence. Objective: To assess the feasibility of Australian Pharmaceutical Benefits Scheme (PBS) dispensing data to provide realistic measures of chronic disease prevalence using ATC codification and compare values with international data using similar ATC methodology and Australian community surveys. Methods: Twenty-two chronic diseases were identified using World Health Organization (WHO) formulated ATC codes assigned to treatments received and recorded in a PBS database. Distinct treatment episodes prescribed to individuals were counted annually for prevalence estimates. Comparisons were then made with estimates from international studies using pharmaceutical data and published Australian community surveys. Results: PBS prevalence estimates for a range of chronic diseases listed in European studies and Australian community surveys demonstrated good correlation (r > .83, p < .001). PBS estimates of the prevalence of diabetes, cardiovascular disease and hypertension, dyslipidemia, and respiratory disease with comparable Australian National Health Survey data by age groupings (>45 years) showed correlations of between (r = 0.82 - 0.99, p < .001) and a range of percentage difference of -15% to 77%. However, other conditions such as psychological disease and migraine showed greater disparity and correlated less well. Conclusions: Although not without limitations, Australian administrative pharmaceutical dispensing data may provide an alternative perspective on population health and a useful resource to estimate the prevalence of a number of chronic diseases within the Australian population.

Introduction A large body of evidence demonstrates substantial effects of work-related psychosocial hazards on risks of both musculoskeletal and mental health disorders (MSDs and MHDs), which are two of the most costly occupational health problems in many countries. This study investigated current workplace risk management practices in two industry sectors with high risk of both MSDs and MHDs and evaluated the extent to which risk from psychosocial hazards is being effectively managed. Method Nineteen, mostly large, Australian organisations were each asked to provide documentation of their relevant policies and procedures, and semi-structured interviews were conducted with 67 staff who had OHS or management roles within these organisations. Information about current workplace practices was derived from analyses of both the documentation and interview transcripts. Results Risk management practices addressing musculoskeletal and mental health risks in these workplaces focused predominately on changing individual behaviours through workplace training, provision of information, individual counselling, and sometimes healthy lifestyle programs. There were formal procedures to control sources of risk for workplace biomechanical hazards affecting musculoskeletal risk, but no corresponding procedures to control risk from work-related psychosocial hazards. Very few risk control actions addressed risk from psychosocial hazards at their workplace sources. Practical applications To reduce the risk of both musculoskeletal and mental health disorders, existing practices need considerable expansion to address risk from all potential psychosocial hazards. Risk controls for both biomechanical and psychosocial hazards need to focus more on eliminating or reducing risk at source, in accord with the general risk management hierarchy.

Background Pharmaceutical data can be used to identify the presence of drug-treated chronic diseases (CD) in individuals using assigned World Health Organization Anatomic Therapeutic Chemical (ATC) classifications of medicines prescribed. ATC codes define treatment domains and provides a method to case define CD that has previously been used to estimate CD prevalence within populations. Main Aim We determined selected CD incidence from an administrative pharmaceutical dataset, and compared them with published CD incidence results. Approach An Australian Pharmaceutical Benefits Scheme (PBS) database covering the period 2003-14 was used for this study. The earliest prescriptions exchanged by individuals for an ATC defined CD were identified and the annual count recorded. These values were combined with Australian population census data to calculate the annual incidence of ATC defined CD. Australian PBS derived incidence estimates (PDI) were compared with published Australian and world incidence data. Results The PDI of 16 chronic diseases were compared with incidence estimates using self-report surveys from the literature. Mean percentage differences between PDI estimates varied greatly when compared to survey data (mean 33% (SD ±79%). Diabetes (-29%), gout (4%), glaucoma (69%) and tuberculosis (14%) showed closer associations. In contrast, PDI estimates (n/1000/year) showed particularly high incidence levels as compared with self-report data for dyspepsia (16.9 v 4.5), dyslipidaemia (11.6 v 5.6) and respiratory illness (17.6 v 2.6). Conclusion Incidence estimates of drug treated chronic disease can be obtained using pharmaceutical data and may be a useful source for a number of conditions. Some PDI differ considerably from survey data. The interpretation of PDI requires context on how a particular CD presents. Accuracy and relevance are likely to depend upon how drug treatments relate to the initial management of the chronic disease.

BackgroundAntidepressant management with Selective Serotonin Reuptake Inhibitors (SSRI) during pregnancy is associated with risks of congenital malformations and adverse pregnancy outcomes. Main AimWe examined the incidence of SSRI use during pregnancy using Australian administrative pharmaceutical data linked to medical service data detailing antenatal consultations to assess pregnancy risk at current levels of treatment. MethodA published data source from the Australian Pharmaceutical and Medical Benefit Schemes was used to identify pregnant women starting new onset treatments with SSRI medications during the provision of antenatal services. A longitudinal profile of SSRI incidence in the pre, peri and post pregnancy periods were constructed to define incident SSRI use. The potential increased burden from adverse pregnancy outcomes was calculated using estimates of risks from the literature. ResultsFrom 2005-2011, 40,778 women were identified to have started de novo SSRI treatments within 10 years of pregnancy (n=172,951). The prenatal monthly incidence of SSRI prescriptions was 25 per 1000 women in 2005 and 7.5/1000 in 2011. During pregnancy, this incidence fell to 7.5 and 4/1000 women in years, and rose above perinatal levels to between 13 and 33/1000 women one year postnatally (X2 p

BackgroundQuantifying the mortality risk for people with diabetes is challenging because of associated comorbidities. The recording of cause specific mortality from accompanying cardiovascular disease in death certificate notifications has been considered to underestimate the overall mortality risk in persons with diabetes. Main AimDevelop a technique to quantify mortality risk from pharmaceutical administrative data and apply it to persons diagnosed with diabetes, and associated cardiovascular disease and dyslipidaemia before death. MethodsPersons with diabetes, cardiovascular disease and dyslipidaemia were identified in a publicly available Australian Pharmaceutical data set using World Health Organization anatomic therapeutic codes assigned to medications received. Diabetes associated multi-morbidity cohorts were constructed and a proxy mortality (PM) event determined from medication and service discontinuation. Estimates of mortality rates were calculated from 2004 for 10 years and compared persons with diabetes alone and associated cardiovascular disease and dyslipidemia. ResultsThis study identified 346,201 individuals within the 2004 calendar year as having received treatments for diabetes (n=51,422), dyslipidaemia (n=169,323) and cardiovascular disease including hypertension (n=280,105). Follow up was 3.3 x 106 person-years. Overall crude PM was 26.1 per 1000 person-years. PM rates were highest in persons with cardiovascular disease and diabetes in combination (47.5 per 100 person years). Statin treatments significantly improved the mortality rates in all persons with diabetes and cardiovascular disease alone and in combination over age groups >44 years (p

BackgroundEstimates of age-specific mortality rates and relative mortality risks are useful for a variety of health, actuarial and life insurance purposes. Mortality risk may also be associated with individual health service utilisation. Main AimWe aimed to identify mortality events using pharmaceutical administrative data and quantify mortality rates and their relationship to levels of pharmaceutical health utilisation. ApproachA publicly available Australian Pharmaceutical Benefits Scheme (PBS) database was employed for this study. For all individuals listed in the dataset the last recorded prescription exchange was used to define a proxy mortality event and health utilisation was quantified by the average number of prescriptions exchanged per year (ppy). Age-specific mortality rates were calculated from PBS data for a range of heath utilisation levels and used with Australian Bureau of Statistics (ABS) death rate data to estimate relative mortality risk. ResultsThe age-specific population profile of 256 190 persons utilising PBS services closely correlated with Australian census data (r=0.97). Age specific PBS mortality rates calculated using proxy mortality events correlated well with ABS death rates for persons aged >45 years but correlated poorly in younger age groups. In these younger age cohorts PBS utilisation was associated with a high relative mortality risk, whereas for older persons aged mortality rates approached equivalence with ABS data. Mortality rates were associated with use of the PBS. High PBS use (>20 ppy) was associated with poorer mortality rates whereas moderate PBS use (5-19 ppy) was associated with improved mortality as compared to persons using PBS minimally (

A systematic analysis of the literature was undertaken to determine which characteristics of workplace interventions are most effective in assisting people with persistent musculoskeletal pain (PMP) to remain productively employed. Databases of Medline, PsychINFO, CINAHL and Embase were searched using MeSH and other relevant terms. Studies that reported on interventions at, or involving, the workplace were included. Interventions were considered as either focused on the individual or multilevel. Outcome measures assessed included: job loss, productivity, sick leave, pain and cost benefit. A quality assessment was undertaken using GRADE criteria with development of impact statements to synthesise the results. Eighteen relevant articles (14 studies) were identified for inclusion in the review. No high-level evidence for workplace interventions to assist people with PMP were identified. Low numbers of participants and limited studies resulted in downgrading of evidence. However, individually focused interventions will probably reduce job loss and sick leave, but are unlikely to reduce pain. Multilevel focused interventions will probably result in decreased sick leave and provide some cost benefit. The evidence on productivity was limited and of poor quality. Further research is required because sustainable employment for individuals with PMP is important and understanding what works is necessary to ensure effective workplace interventions are developed.

BACKGROUND: The use of antiseptic hand rubs (AHRs), rather than washing with soap and water, is considered to be the gold standard for reducing the frequency of nosocomial infections, as well as being less damaging to the hands than washing with soap and water, but little is known at a population level about usage patterns for AHRs. OBJECTIVES: To describe AHR use patterns among workers in the health and community services industry in Australia. METHODS: Using data from a population-based survey of Australian workers, we focused on health and community services workers' exposure to chemicals at work, including the use of AHRs. Data regarding the frequency of hand-washing were also collected. RESULTS: Nine hundred and fifty-six health and community service workers participated in the Australian National Hazard Exposure Worker Surveillance survey. Of these, 11% reported using AHRs, and 31% reported hand-washing >20 times per shift. According to an adjusted logistic regression model, professional workers [adjusted odds ratio (aOR) 2.29, 95% confidence interval (CI): 1.40-3.72] and frequent hand washers (aOR 3.08, 95%CI: 1.92-4.93) were more likely to use AHRs. CONCLUSIONS: AHR use by health and community service workers was generally lower than expected. AHR use was most likely to be reported by professionals and frequent hand washers, suggesting that AHRs are used as an adjunct to conventional hand-washing.

Purpose Workstyle can be defined as an individual pattern of cognitions, behaviours and physiological reactivity that can occur while performing job tasks. Workstyle has been associated with the development of musculoskeletal disorders (MSDs) amongst office workers in developed countries. However, little is known about the contribution of workstyle on MSDs in developing countries such as Malaysia. The objective of this cross-sectional study was to examine the relationship between workstyle and musculoskeletal discomfort in a sample of office workers in Malaysia. Methods Office workers (N = 417; response rate 65.5 %) from four organisations completed a survey measuring physical and psychosocial hazards, job satisfaction, work-life balance, workstyle, and MSD discomfort levels. Hierarchical regression analyses were undertaken to examine predictors associated with self-reported musculoskeletal discomfort, and more specifically the relationship between workstyle and MSD discomfort. Results Musculoskeletal discomfort was significantly associated with working through pain, mental health, physical demands, gender and work-life balance (R2 = 50.2, adjusted R2 = 0.48; F (13, 324) = 25.09, p = 0.001). Working through pain is the strongest risk factor associated with MSD discomfort (s = 0.49, p = 0.001) compared to other potential risk factors. Conclusions Working through pain is influenced by work, social culture and religious beliefs. Workplace MSDs interventions that focus on the impact of physical and psychosocial hazards with emphasis on addressing adverse workstyles should take into account aspects related to work and social culture of the target population. Changes are recommended at both employee and management levels such as better communications and understanding concerning workplace problems with regards to minimizing MSDs at work.

Purpose Work absence can result in substantial losses to the economy and workers. As a result, identifying modifiable factors associated with return-to-work (RTW) following an injury or illness is the focus of many empirical investigations. Self-efficacy, the belief about one's ability to undertake behaviours to achieve desired goals, has been identified as an important factor in RTW for injured workers. This paper systematically reviewed the literature on the association between self-efficacy and RTW outcomes for workers with an upper-body musculoskeletal injury or psychological injury. Methods A systematic search was conducted across five databases using two main search concepts- 'self-efficacy' and 'RTW'. After removing duplicates, our search strategy identified 836 studies, which were screened for relevance using titles and abstracts. Results A two stage screening process reduced the study pool to six studies using psychological injury cohorts and three using upper-body musculoskeletal (UB-MSK) cohorts. Eight cohorts from seven prospective cohort studies and one sample from a randomised control trial (RCT) were subjected to a risk of bias assessment. Higher levels of self-efficacy appeared to have a consistent and positive association with RTW across return-to-work status and work absence outcomes, injury type and follow-up periods. Effect ratios ranged from 1.00 to 5.26 indicating a potentially large impact of self-efficacy on RTW outcomes. The relationship between self-efficacy and RTW strengthened as the domain of self-efficacy became more specific to RTW and job behaviours. Studies assessing workers with psychological injuries were of a lower quality compared to those assessing workers with UB-MSK injuries. Conclusions Higher self-efficacy had consistent positive associations with RTW outcomes. Further empirical research should identify the determinants of self-efficacy, and explore the processes by which higher self-efficacy improves RTW outcomes.

We developed and implemented an integrated workplace mental health promotion intervention combining job stress reduction with a workplace mental health literacy program. The intervention was evaluated using an uncontrolled design, with organizationorganisation-wide census employee surveys of working conditions and mental health literacy pre-intervention, followed by a 1-year action planning and intervention period, then a post-intervention survey. All employees were invited to be surveyed, and all respondents were included in analysis, independent of participation in intervention activities or employment status (44% response rate at baseline, 37% at final). No significant changes were observed in the targeted psychosocial working conditions – job control, job demands, and social support at work. In contrast, significant improvements in some aspects of mental health literacy were observed, particularly in helping behaviours. Acknowledging the limitations of this being an uncontrolled pilot study, our resul...

BackgroundOccupational contact dermatitis is one of the most common occupational diseases, but there is a lack of reliable information on incidence. Despite acknowledged limitations, workers’ compensation statistics may provide insights into contact dermatitis patterns.ObjectiveThe objective of the study was to characterise historical patterns of workers’ compensation claims for occupational contact dermatitis.MethodsThis was a retrospective analysis of workers’ compensation claims for occupational contact dermatitis from 1996–2015 (n=3,348) accepted by WorkSafe Victoria in Victoria, Australia. Accepted claims per 1 00 000 person-years stratified by sex, age and industry were calculated. Denominators for the population at risk were obtained from the Australian Bureau of Statistics using Victorian Labour Force Survey data.ResultsThe compensation claims rate of occupational contact dermatitis was 6.72 per 1 00 000 person-years for the overall twenty-year period. There was a significant reduction in claims from 11.84 in 1996 to 1.78 in 2015. Males had a higher overall claims rate of 7.97 compared to the rate for females of 5.18. Over the twenty-year period the rate for males decreased from 14.46 to 1.7 compared to a reduction from 8.4 to 1.8 for females. This decrease was still observed when the data were standardised for underlying changes in the age structure of the population. There was an overall decline across all high-risk occupational groupsConclusionsThere was a fivefold decrease in accepted claims for occupational contact dermatitis for the twenty-year period from January 1996 to December 2015 for the state of Victoria in Australia. These results need to be regarded with caution as the declining rate of accepted occupational contact dermatitis claims may indicate changes in workplace dermal exposures or improvements in workplace skin protection practices over time, or they may be driven by underlying changes to the workers’ compensation system or changes to claims behaviour amongst workers.

BackgroundOccupational end users of pesticides may experience bodily absorption of the pesticide products they use, risking possible health effects. The purpose of this paper is to provide a guide for researchers, practitioners, and policy makers working in the field of agricultural health or other areas where occupational end use of pesticides and exposure issues are of interest.MethodsThis paper characterizes the health effects of pesticide exposure, jobs associated with pesticide use, pesticide-related tasks, absorption of pesticides through the skin, and the use of personal protective equipment (PPE) for reducing exposure.ConclusionsAlthough international and national efforts to reduce pesticide exposure through regulatory means should continue, it is difficult in the agricultural sector to implement engineering or system controls. It is clear that use of PPE does reduce dermal pesticide exposure but compliance among the majority of occupationally exposed pesticide end users appears to be poor. More research is needed on higher-order controls to reduce pesticide exposure and to understand the reasons for poor compliance with PPE and identify effective training methods.

Objectives: The aim of this study was to investigate the association between high ambient temperature and acute work-related injury, expanding on previous research in this area. Specifically we examined the relationship between both daytime and overnight temperatures and injury risk and disentangled physically demanding occupational exposures from exposure to outdoor working conditions. Methods: A time-stratified case-crossover study design was used to examine the association between ambient temperatures and acute work-related injuries in Melbourne, Australia, 2002–2012, using workers’ compensation claims to identify work-related injuries. The relationship was assessed for both daily maximum and daily minimum temperatures using conditional logistic regression. Results: Significant positive associations between temperature and acute work-related injury were seen for younger workers (

This systematic review updates the current state of evidence on the effectiveness of softer flooring and cushioned shoe insoles on reducing musculoskeletal discomfort amongst workers who are required to stand for prolonged periods to work and the impact of factors such as age and gender on the outcomes. A systematic search identified 10 unique studies that met the eligibility criteria. The heterogeneity of study designs impacted on the strength of evidence. A moderate level of evidence was found in support of using cushioned materials in reducing discomfort/fatigue among standing workers. A limited level of evidence exists in favour of using insoles over anti-fatigue mats. Insufficient information exists for the impact of gender or age. Larger, good quality prospective intervention trials based in real workplaces that consider the impact of psychosocial and organisational factors on musculoskeletal discomfort whilst standing at work are required to inform industry recommendations.

Background Although there is convincing epidemiological evidence that physical activity is associated with a reduced risk of colon cancer, it is unclear whether physical activity is differentially associated with the risks of proximal colon and distal colon cancers. We conducted a systematic review and meta-analysis to investigate this issue. Methods MEDLINE and EMBASE were searched for English-language cohort and case-control studies that examined associations between physical activity and the risks of proximal colon and distal colon cancers. A random-effects meta-analysis was conducted to estimate the summary relative risks (RRs) for the associations between physical activity and the risks of the two cancers. All statistical tests were two-sided.ResultsA total of 21 studies met the inclusion criteria. The summary relative risk of the main results from these studies indicated that the risk of proximal colon cancer was 27% lower among the most physically active people compared with the least active people (RR = 0.73, 95% confidence interval [CI] = 0.66 to 0.81). An almost identical result was found for distal colon cancer (RR = 0.74, 95% CI = 0.68 to 0.80). Conclusion The results of this systematic review and meta-analysis suggest that physical activity is associated with a reduced risk of both proximal colon and distal colon cancers, and that the magnitude of the association does not differ by subsite. Given this finding, future research on physical activity and colon cancer should focus on other aspects of the association that remain unclear, such as whether sedentary behavior and nonaerobic physical activity are associated with the risk of colon cancer. Refereed/Peer-reviewed

Background. The Australian National Hazard Exposure Worker Surveillance (NHEWS) Survey 2008 was a cross-sectional survey undertaken by Safe Work Australia to inform the development of exposure prevention initiatives for occupational disease. This is a descriptive study of workplace exposures. Objectives. To assess the occupational and demographic characteristics of workers reporting exposure to wet work. Methods. Computer-assisted telephone interviews were conducted with 4500 workers. Two wet work exposure outcomes (frequent washing of hands and duration of time spent at work with the hands immersed in liquids) were analysed. Results. The response rate for the study was 42.3%. For hand-washing, 9.8% [95% confidence interval (CI) 8.9–10.7] reported washing their hands more than 20 times per day. For immersion of hands in liquids, 4.5% (95% CI 3.9–5.1) reported immersion for more than 2 hr per day. Females were more likely to report exposure to frequent hand-washing than males [odds ratio (OR) 1.97, 95% CI 1.49–2.61]. Workers in the lowest occupational skill level jobs were more likely to report increased exposure to hands immersed in liquids than those in the highest (OR 6.41, 95% CI 3.78–10.88). Workers reporting skin exposure to chemicals were more likely to report exposure to hand-washing (OR 3.68, 95% CI 2.91–4.66) and immersion of the hands in liquids (OR 4.09, 95% CI 2.92–5.74). Conclusions. Specific groups of workers reported high levels of exposure to wet work. There were differences between the profiles of workers reporting frequent hand-washing and workers reporting increased duration of exposure to hands immersed in liquids. We also found a high correlation between wet work and chemical exposure.

There is growing recognition of the important role of mental health in the workforce and in the workplace. At the same time, there has been a rapid growth of studies linking job stress and other psychosocial working conditions to common mental disorders, and a corresponding increase in public concern media attention to job stress and its impact upon worker health and well-being. This article provides a summary of the relevant scientific and medical literature on this topic for practitioners and policy-makers. It presents a primer on job stress concepts, an overview of the evidence linking job stress and common mental disorders, a summary of the intervention research on ways to prevent and control job stress, and a discussion of the strengths and weakness of the evidence base. We conclude that there is strong evidence linking job stress and common mental disorders, and that it is a substantial problem on the population level. On a positive note, however, the job stress intervention evidence also shows that the problem is preventable and can be effectively addressed by a combination of work- and worker-directed intervention.

Musculoskeletal disorders (MSDs) are considered to be a major occupational health problem contributing significantly to absenteeism, disability and loss of productivity. The majority of studies related to MSDs have been conducted in developed countries such as Australia, and it is proposed that contributing factors linked with MSD development might operate differently in developing countries like Malaysia, as a result of sociocultural differences. A key issue in the development of MSDs is the contribution of psychosocial factors; however, this is not reflected in current management practices which tend to focus predominately on physical factors. Malaysia and Australia have very different societal structures, which influence the way work is organised and the expectations of employees at their workplaces. Therefore, it is plausible that the contribution of workplace factors to MSD development might differ. This chapter will explore a range of issues in relation to the development of MSDs and use a population of office workers in Australia and Malaysia to explore different explanatory models. A survey tool was used to assess a range of workplace and personal factors, including: work–life balance, job satisfaction, physical hazards, coping strategies, and psychosocial hazards. Analysis was undertaken to assess relevant predictors for each population and then a comparison undertaken to identify key differences between the populations. The chapter will also discuss the results from a qualitative study of female Malaysian office workers who were asked about their coping strategies for persistent musculoskeletal pain. Despite similarities in the prevalence of musculoskeletal discomfort in both the Australian and Malaysian populations, differences were identified in the relative contribution of factors. The findings from this study provide insights into future policy development of management of MSDs. Malaysia is at a formative stage in term of risk management for MSDs and as such a different focus is needed to adequately address relevant workplace factors.

Objectives: This study assesses both the success of medical practitioners in accessing hazardous substances’ information from product manufacturers and the accuracy and clinical usefulness of Material Safety Data Sheets (MSDS) presented by workers with suspected occupational contact dermatitis (OCD). Patients/Methods: 100 consecutively presented MSDS were collected from 42 workers attending an occupational dermatology clinic. Product manufacturers were contacted to verify ingredients. MSDS were evaluated for compliance with the Australian criteria for listing of OCD relevant information (sensitizers present at a concentration ≥1%, irritants present at a concentration ≥20%), and for clinical usefulness. All sensitizers were checked for clinical relevance to the worker’s dermatitis. Results: Manufacturers supplied product constituents for 77/100 MSDS. 58 MSDS satisfied the Australian standard. 57/58 MSDS were deemed clinically useful. Irritants were listed for 19/23 MSDS and sensitizers were listed for 30/68 MSDS (P = 0.001). 3 MSDS contained sensitizers, which were clinically relevant to the presenting worker’s dermatitis, 1 appropriately listed, 1 present at ≥1% but not listed, and 1 present at

Issue addressed: Job stress has been linked to a wide range of adverse effects on mental, physical, and organisational health. Despite the evidence that systems approaches are most effective in reducing the adverse impact of job stress, prevalent practice is dominated by worker- or individual-focused strategies in the absence of commensurate intervention on working conditions. Methods: A literature review and cross-disciplinary conceptual synthesis were combined in the articulation of a systems approach to job stress. Results: An outline of the job stress process is followed by explanation of how a systems approach addresses the various steps in the stress process. Systems approaches to job stress emphasise primary prevention or focusing on stressors as the upstream determinants of job stress. Additionally, systems approaches integrate primary with worker-directed secondary and illness-directed tertiary intervention, include the meaningful participation of groups targeted by intervention, and are context- sensitive. Systems approach intervention principles are illustrated by concrete examples of intervention strategies and activities. Conclusions: Further efforts are needed to promote, disseminate, implement, and evaluate systems approaches to job stress and to improve cross-disciplinary cooperation in this effort. (author abtract)

Prevalence and predictors associated with musculoskeletal disorders (MSDs) vary considerably between countries. It is plausible that socio-cultural contexts may contribute to these differences. We conducted a cross-sectional survey with 1184 Malaysian and Australian office workers with the aim to examine predictors associated with MSD discomfort. The 6-month period prevalence of self-reported MSD discomfort for Malaysian office workers was 92.8% and 71.2% among Australian workers. In Malaysia, a model regressing level of musculoskeletal discomfort against possible risk factors was significant overall (F [6, 370] = 17.35; p

Occupational contact dermatitis (OCD) regularly causes high levels of worker morbidity; however, this is often not reflected in available statistics. This study aimed to collect and verify OCD reports/referrals and generate disease estimates for a defined geographical area in Melbourne, Australia. Two methods of data collection were used. In the first method, 30 general practitioners (GPs), 2 dermatologists and 1 dermatology outpatient clinic within a defined area reported each worker with suspected OCD seen as part of routine practice. With the second method, workers living in the area who were referred to a tertiary referral OCD clinic were included in the study. An occupational dermatologist used a gold standard process that included diagnostic patch testing to verify suspected cases. The incidence rate for confirmed cases was 20.5 per 100,000 workers [95% confidence interval (CI): 13-32.1]. The 1-year-period prevalence rate was 34.5 per 100,000 (95% CI: 24.4-48.7). The positive predictive value (PPV) was highest for the occupational dermatology clinic referrals [63% (95% CI: 49-76%)] compared with reports from the dermatologists/dermatology outpatient clinic [55% (95% CI: 36-74%)] and from GPs [43% (95% CI: 29-59%)]. This study utilizes reports from GPs and dermatologists to provide OCD disease estimates and validation data for an OCD disease register.

The prognosis of occupational contact dermatitis (OCD) takes into account the extent of healing, effect on quality of life and employment, and financial costs for both the individual and the wider community. We reviewed 15 studies published between 1958 and 2002, reporting the complete clearance of dermatitis (range of 18-72%). 9 of the 15 studies reported a clearance rate of between 18 and 40%. Improvement was reported as an outcome in 3 studies between 1991 and 2002 (range of 70-84%). A number of common variables were identified as of possible influence. These include age, sex, atopy, patient knowledge, disease aetiology, duration of symptoms and job change; clinical, financial and social issues are also described. All of these factors need to be considered when managing a patient with OCD. Improved patient knowledge and early diagnosis may be associated with improved prognosis, whereas job change does not make a significant difference. Some patients will develop persistent post-occupational dermatitis, which has important implications for prognosis and workers' compensation. Only a small proportion of eligible patients receive workers' compensation, even though financially supported healing time soon after diagnosis may result in an improved prognosis.

The reported prevalence of allergic contact dermatitis from topical corticosteroids in clinical populations, in the period 1993-2002, varied from 0.55 to 5.98%. This study is a retrospective analysis of 1153 individuals undergoing routine patch testing in an Occupational Dermatology Clinic in Melbourne, Australia. We report a rate of 0.52% for positive patch test reactions to 5 corticosteroids. Corticosteroids tested were betamethasone-17-valerate, budesonide, Diprosone cream (betamethasone diproprionate 0.05%) (Essex-Pharma, a division of Schering-Plough Pty Ltd, Sydney, Australia), tixocortol-21-pivalate and triamcinolone acetonide. Population characteristics were described using the MOAHL (M = percentage of males tested; O = occupational; A = atopics; H = patients with hand eczema; L = patients with leg ulcers or stasis eczema) index. Prescribing patterns, rate of referral and rate of relevant positive patch test reactions were characterized for the region. These results were compared to the rates of corticosteroid allergy and patch testing methodologies from published international studies. It was noted that many high-sensitization potential corticosteroids were not available in our region. Although a low percentage of leg ulcers and stasis dermatitis may be associated with a lower rate of corticosteroid allergy, this association may be confounded by regional factors such as prescribing habits and the local availability of corticosteroids. We conclude that the low rate of topical corticosteroid contact allergy reported by our clinic is associated with regional availability and prescribing practices and the scarcity of stasis dermatitis and leg ulcers in our clinic population.

Musculoskeletal disorders (MSDs) are a major occupational health issue for workers in developed and developing countries, including Malaysia. Most research related to MSDs has been undertaken in developed countries; given the different regulatory and cultural practices it is plausible that contributions of hazard and risk factors may be different. A population of Malaysian public service office workers were surveyed (N = 417, 65.5% response rate) to determine prevalence and associated predictors of MSD discomfort. The 6-month period prevalence of MSD discomfort was 92.8% (95%CI = 90.2-95.2%). Akaike's Information Criterion (AIC) analyses was used to compare a range of models and determine a model of best fit. Contributions associated with MSD discomfort in the final model consisted of physical demands (61%), workload (14%), gender (13%), work-home balance (9%) and psychosocial factors (3%). Factors associated with MSD discomfort were similar in developed and developing countries but the relative contribution of factors was different, providing insight into future development of risk management strategies.

OBJECTIVE:: To examine the relationship between shiftwork and work injury among men and women, taking into account the presence of dependent children. METHODS:: An analysis of respondents to the 2009-2010 Multipurpose Household Survey (n = 6927 women and 7340 men). Logistic regression models examined the work injury risk, adjusting for various covariates. RESULTS:: The risk of work injury associated with shiftwork was higher for women than for men. Nevertheless, gender differences were present only among respondents with dependent children. Shiftworking women with children also had a greater risk of work injury than shiftworking women without children. CONCLUSIONS:: This previously noted elevated risk of injury associated with shiftwork among women compared with that in men may be a product of increased household responsibilities or other factors particular to female shiftworkers with dependent children. Language: en

Objective To examine if the factors associated with days of absence following a work-related injury are similar for mental health versus musculoskeletal (MSK) conditions. Methods A secondary analysis of wage replacement workers’ compensation claims in the state of Victoria, Australia. We examined the relationship between individual, injury, occupational and workplace variables with days of wage replacement over the 2-year period following first day of absence from work separately for mental health claims and MSK claims using negative binomial regression models. Results Mental health conditions were associated with a greater number of days of absence over the 2 years following first incapacity compared to MSK conditions. Differences were observed in employment, injury and industry variables on absence from work for mental claims compared to MSK claims. Working in the agriculture, forestry, fishing and mining industries and employment with a small organisation were more strongly associated with the number of days of wage-replacement among MSK compared to mental health claims, and working in the public administration and safety, or education and training industries or being employed in a position with high time pressure were associated with greater days of wage-replacement among mental health compared to MSK claims. Conclusions Predictors of days away from work in the 2 years following an injury differ for mental health versus MSK claims. Given the increasing number of mental health claims in Australia more research is required to understand differences in return-to-work for this group of claimants compared to those with physical injuries.

Objective: To analyze the occupational and demographic characteristics for workers participating in the Australian National Hazard Exposure Worker Surveillance (NHEWS) Survey, who reported the provision of various types of workplace control measures for exposure of the hands to wet-working conditions, and to identify the barriers for the provision of controls. Methods: Computer-assisted telephone interviews were conducted with 4500 workers in 2008. Workers were asked about the types of control measures provided to them in the workplace for exposure of the hands to liquids. Results: Workplace size was the strongest predictor for the provision of control measures. Compared to workplaces with fewer than five employees, workers in workplaces with 200 or more employees were more likely to report provision of gloves, barrier creams and moisturizers, labeling and warning, and ongoing training and education about skin care. Conclusion: Smaller workplaces have poorer access to control measures to mitigate exposure to wet work.

Background. Hairdressers are one of the largest occupational groups attending our Occupational Dermatology Clinic. However, few seek workers' compensation for their occupational dermatitis. Objectives. To retrospectively analyse and compare workers' compensation claims data and diagnosed disease data for occupational contact dermatitis in hairdressers from 1993 to 2009, for the state of Victoria, Australia. Patients/materials/methods. Data from the Occupational Dermatology Clinic database, the Compensation Research Database and the Australian Bureau of Statistics were used in this study. Results. The clinic database identified 157 hairdressers and apprentices with a confirmed diagnosis of occupational contact dermatitis assessed between 1993 and 2009. Forty-six unique claims for occupational contact dermatitis from 46 individuals were identified from the Compensation Research Database over the same time period. Hairdressers in the 15–24-year age group were significantly over-represented in the claims data relative to the diagnosed disease data (p < 0.01). The median cost per claim was AU$1421, and the median time off work per claim was 20 days. Conclusion. Increased efforts are needed to reduce the incidence of occupational contact dermatitis in hairdressers in Australia, and to ensure that hairdressers with occupational contact dermatitis are aware of their compensation entitlements. Reliance on workers' compensation data for disease surveillance may lead occupational health and safety regulators to underestimate the magnitude of the problem of occupational contact dermatitis in the hairdressing profession.

We present a comparative analysis of patterns of exposure to job stressors and stress-related workers’ compensation (WC) claims to provide an evaluation of the adequacy of claims-driven policy and practice. We assessed job strain prevalence in a 2003 population-based survey of Victorian [Australia] workers and compared these results with stress-related WC statistics for the same year. Job strain prevalence was higher among females than males, and elevated among lower vs. higher occupational skill levels. In comparison, claims were higher among females than males, but primarily among higher skill-level workers. There was some congruence between exposure and WC claims patterns. Highly exposed groups in lower socio-economic positions were underrepresented in claims statistics, suggesting that the WC insurance perspective substantially underestimates the job stress problems for these groups. Thus to provide a sufficient evidence base for equitable policy and practice responses to this growing public health problem, exposure or health outcome data are needed as an essential complement to claims statistics.

Background: The occupational contact dermatitis disease severity index (ODDI) was designed to assess the severity and importantly the functional disability caused by occupational contact dermatitis (OCD) of the hands in patients attending our occupational dermatology clinic. Objectives: To investigate the accuracy of the ODDI. Patients/Methods: Of 205 patients, 95 were assessed as having OCD of the hands. Content validity was assessed by content mapping and expert opinion. Construct validity was examined through comparing the ODDI against global clinical dermatology severity assessment (GCDSA). Intraobserver reliability, interobserver reliability, internal consistency, acceptability and convenience were also assessed. Results: The ODDI was found to have content validity by the experts and was moderately correlated with GCDSA, supporting construct validity (Pearson’s r = 0.54; P ≤ 0.01). The ODDI was shown to be reliable with substantial agreement for both intraobserver reliability [intraclass correlation coefficient (ICC) = 0.62] and interobserver reliability (ICC = 0.75). Internal consistency within the ODDI was almost perfect (ICC = 0.94–0.99) and user survey showed the ODDI to be acceptable, easy and quick to use. Conclusions: The ODDI is a valid and reliable instrument to assess the severity and functional limitations caused by OCD, in patients who have had treatment or modified work duties, associated with some improvement of their dermatitis.

Background The broad aim of this study was to assess the contribution of job strain to mental health inequalities by (a) estimating the proportion of depression attributable to job strain (low control and high demand jobs), (b) assessing variation in attributable risk by occupational skill level, and (c) comparing numbers of job strain–attributable depression cases to numbers of compensated 'mental stress' claims. Methods Standard population attributable risk (PAR) methods were used to estimate the proportion of depression attributable to job strain. An adjusted Odds Ratio (OR) of 1.82 for job strain in relation to depression was obtained from a recently published meta-analysis and combined with exposure prevalence data from the Australian state of Victoria. Job strain exposure prevalence was determined from a 2003 population-based telephone survey of working Victorians (n = 1101, 66% response rate) using validated measures of job control (9 items, Cronbach's alpha = 0.80) and psychological demands (3 items, Cronbach's alpha = 0.66). Estimates of absolute numbers of prevalent cases of depression and successful stress-related workers' compensation claims were obtained from publicly available Australian government sources. Results Overall job strain-population attributable risk (PAR) for depression was 13.2% for males [95% CI 1.1, 28.1] and 17.2% [95% CI 1.5, 34.9] for females. There was a clear gradient of increasing PAR with decreasing occupational skill level. Estimation of job strain–attributable cases (21,437) versus "mental stress" compensation claims (696) suggest that claims statistics underestimate job strain–attributable depression by roughly 30-fold. Conclusion Job strain and associated depression risks represent a substantial, preventable, and inequitably distributed public health problem. The social patterning of job strain-attributable depression parallels the social patterning of mental illness, suggesting that job strain is an important contributor to mental health inequalities. The numbers of compensated 'mental stress' claims compared to job strain-attributable depression cases suggest that there is substantial under-recognition and under-compensation of job strain-attributable depression. Primary, secondary, and tertiary intervention efforts should be substantially expanded, with intervention priorities based on hazard and associated health outcome data as an essential complement to claims statistics.

The aims of this study were to compare treatment and referral practices between general practitioners (GPs) and dermatologists and to evaluate predictors for occupational contact dermatitis (OCD) disease severity measured in terms of worker impairment. Data were collected from 181 patients recruited for a larger study of OCD. Information about treatment recommendations and usual referral practices are reported for 123 patients. Data from patients, diagnosed with work-related skin disease, were modelled for severity of worker impairment. GPs were more likely to treat a patient independently, referring if the patient did not improve, whereas dermatologists were more likely to refer for patch testing on initial presentation. Dermatologists were more likely to recommend gloves and GPs were more likely to recommend soap avoidance/substitution. 2 GPs and no dermatologists reported recommending the best practice combination of moisturizers, topical corticosteroids and soap substitutes. When adjusted for all variables including age, sex, duration and diagnostic subgroup, workers with atopy as a cofactor had the most severe impairment. This study suggests that in Australia, patients with suspected OCD are initially managed within general practice, few clinicians recommend best practice treatments for OCD, and that atopy is associated with severity. These findings have implications for health resource allocation, clinician education, and the pre-employment counselling of atopic patients.

A survey of patients attending an occupational dermatology clinic with suspected occupational contact dermatitis affecting the hands was undertaken to determine if optimal skin care treatment had been instituted prior to referral for patch testing. Appropriate treatment for contact dermatitis of the hands was defined as concurrent use of a soap substitute, use of a lipid-rich moisturizer, and if appropriate, use of a topical corticosteroid in an ointment vehicle. Patients were asked about the use of a particular soap substitute, the name and type of any moisturizer used and the name and type of topical corticosteroids currently used. The products were examined where possible. Only one-third of all patients were using the complete package at the time of their clinic appointment. Nearly all of these patients had seen a dermatologist prior to this appointment. Of the group of patients with work-related diseases who reported having seen a dermatologist prior to the clinic appointment, only 38% were using the complete skin care routine.

Between January 1993 and February 2002, 40 of 1354 (3%) workers who attended a tertiary referral occupational dermatology clinic were diagnosed with allergic contact dermatitis (ACD) from epoxy resin systems (ER). 20 of these patients were followed up at least 2 years post-diagnosis to establish prognosis. Characteristics collected at diagnosis, including age, atopic status and severity, were compared between the follow-up and not followed-up groups. No significant differences were observed. A clinician contacted patients and administered a telephone questionnaire based on variables identified from the literature, which were considered of importance for prognosis. All patients reported improvement of their skin condition since diagnosis. 12 of the 20 {60%[95% confidence interval (CI) 56-94%]} patients had applied for workers' compensation; all of these claims were successful. 16 had ceased working with ER. Of these, 9 [56% (95% CI 29-80%)] reported complete healing and 7 [44% (95% CI 19-70%)] reported ongoing dermatitis. Although no conclusions could be drawn because of the small sample size, factors that may be associated with a poor prognosis were age, atopy, duration of symptoms and severity at diagnosis. The prognosis of ACD from ER is not always favourable, even if a worker ceases exposure.

Wall and Gebauer (Contact Dermatitis 1991: 24: 241-243) first described persistent post-occupational dermatitis (PPOD) as ongoing dermatitis for which there is no obvious present cause, precipitated by prior occupational contact dermatitis (OCD). We propose that individuals exhibiting PPOD lose the capacity for resolution of their condition upon removal from exposure to causative agents and subsequently develop persistent dermatitis, which can be continual or intermittent. Accordingly, we suggest modification of criterion 6 of the OCD criteria developed by Mathias (J Am Acad Dermatol 1989: 20: 842-848): 'Removal from exposure initially leads to improvement of dermatitis, however, over time there may be incomplete or no improvement, despite removal from exposures at work'. To satisfy the definition of PPOD, individuals must meet at least 4 of the 7 criteria, including the altered criterion 6. We present 6 cases of PPOD exemplifying these scenarios, which met the altered Mathias criteria. In some cases, subsequent failure to recognize the initial work relatedness of their skin conditions resulted in the termination of workers' compensation benefits. This situation is particularly relevant in the Australian context. The diagnosis of PPOD needs to be considered in all individuals with work-initiated dermatitis who present with ongoing endogenous-like eczema.

Objectives: The Surveillance by General Practitioners of Occupational Contact Dermatitis Project (Spot) has been designed to provide disease estimates for occupational contact dermatitis within a defined geographic area in Melbourne, Australia. Method: Spot collected reports of occupational contact dermatitis from four separate sources: general practitioners, dermatologists, a Dermatology Outpatient clinic, and an Occupational Dermatology Clinic. Case definition was stratified into two levels, suspected and confirmed. All cases of suspected occupational contact dermatitis reported to Spot were assessed and required to undergo diagnostic confirmation, including appropriate patch testing by an occupational dermatologist. The rates generated by Spot were compared to the rates generated by Victorian workers’ compensation data (Victorian Work Cover Authority) for “Contact dermatitis and other and unspecified dermatitis.” Results: To date, a total of 125 suspected cases have been reported to Spot. 56 cases of occupational contact dermatitis have been confirmed with an incidence rate of 12.5 per 100,000 full-time workers and a prevalence rate of 28 per 100,000. This can be compared to the rate from Victorian WorkCover Authority of 4 per 100,000 (with information not available for incidence or prevalence). Conclusions: Although limited by resources, clinician and worker participation rates, Spot provides a better estimate for occupational contact dermatitis in an Australian urban setting than that currently available through workers’ compensation statistics. The information generated by Spot will provide an important contribution towards the characterisation of occupational contact dermatitis in Australia.