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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.

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.

Objective: To assess depression literacy, help-seeking and help-offering to others in members of the police force in the state of Victoria, Australia. Methods: All staff in police stations involved in a cluster randomised controlled trial of an integrated workplace mental health intervention were invited to participate. Survey questions covered sociodemographic and employment information, recognition of depression in a vignette, stigma, treatment beliefs, willingness to assist co-workers with mental health problems, help-giving and help-seeking behaviours, and intentions to seek help. Using the baseline dataset associated with the trial, the paper presents a descriptive analysis of mental health literacy and helping behaviours, comparing police station leaders and lower ranks. Results: Respondents were 806 staff, comprising 618 lower-ranked staff and 188 leaders. Almost 84% of respondents were able to correctly label the problem described in the vignette. Among those who had helped someone with a mental health problem, both lower ranks and leaders most commonly reported ‘talking to the person’ although leaders were more likely to facilitate professional help. Leaders’ willingness to assist the person and confidence in doing so was very high, and over 80% of leaders appropriately rated police psychologists, general practitioners, psychologists, talking to a peer and contacting welfare as helpful. However, among both leaders and lower ranks with mental health problems, the proportion of those unlikely to seek professional help was greater than those who were likely to seek it. Conclusion: Knowledge about evidence-based interventions for depression was lower in this police sample than surveys in the general population, pointing to the need for education and training to improve mental health literacy. Such education should also aim to overcome barriers to professional help-seeking. Interventions that aim to improve mental health literacy and help-seeking behaviour appear to be suitable targets for better protecting police member mental health.

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.

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

Much research on precarious employment compares permanent workers with one or two other broadly-defined employment categories. We developed a more refined method of examining precariousness by defining current employment arrangements in terms of job characteristics. These employment arrangement categories were then compared in terms of socio-demographics and self-reported job insecurity. This investigation was based on a cross-sectional population-based survey of a random sample of 1,101 working Australians. Eight mutually exclusive employment categories were identified: Permanent Full-time (46.4%), Permanent Part-time (18.3%), Casual Full-time (2.7%), Casual Part-time (9.3%), Fixed Term Contract (2.1%), Labour Hire (3.6%), Own Account Self-employed (7.4%), and Other Self-employed (9.5%). These showed significant and coherent differences in job characteristics, socio-demographics and perceived job insecurity. These empirically-supported categories may provide a conceptual guide for government agencies, policy makers and researchers in areas including occupational health and safety, taxation, labour market regulations, the working poor, child poverty, benefit programs, industrial relations, and skills development., Au cours des trente dernières années, les économies des pays développés ont adopté des aménagements du travail plus flexibles, habituellement libellés sous le titre d’emploi précaire ou atypique. Par exemple, en Australie, ceux qui occupaient un emploi temporaire ou intermittent ou ceux qui n’étaient pas employés (sous-traitants, travailleurs autonomes) constituaient 28 % de la main-d’oeuvre en 1982, 31 % en 1988 et 40 % en 1999.Un nombre croissant de travaux de recherche à l’échelle internationale a déjà analysé l’impact de ce glissement sur la densité syndicale, les salaires, les heures de travail, la sécurité au travail et la santé occupationnelle et, aussi, sur d’autres conditions de travail. Dans l’ensemble, les recherches démontrent que les aménagements du travail du type précaire ou atypique sont liés à des conditions de travail inférieures à celles qui prévalent chez les permanents accomplissant le même travail. La plupart de ces travaux comparent seulement les travailleurs permanents à une ou deux autres catégories de travailleurs largement définies.La présente étude se veut une tentative de développer une méthode plus raffinée de traduire la précarité en définissant les aménagements du travail actuels, cela en reprenant les caractéristiques d’un emploi et en les comparant avec des données démographiques et des données relatives à l’insécurité d’emploi, telle que vécue par les sujets eux-mêmes. En utilisant une coupe transversale d’une population d’un échantillon pris au hasard, comprenant 1 101 Australiens actifs de la province de Victoria, nous avons répertorié huit catégories d’emploi mutuellement exclusives, notamment, l’emploi de permanents à temps plein (46,4 % des travailleurs de notre échantillon); de permanents à temps partiel (18,3 %); d’occasionnels à temps plein (2,7 %), d’occasionnels à temps partiel (9,3 %); de contractuels à durée déterminée (2,1 %); de travailleurs des agences de travail (3,6 %); de travailleurs à leur propre compte (7,4 %); et d’autres travailleurs autonomes (9,5 %). Ces catégories présentaient des différences cohérentes et significatives au plan des caractéristiques d’emploi, du profil démographique et de l’insécurité d’emploi telle que vécue par les personnes impliquées.Le recours antérieur à des mesures dichotomiques de la précarité d’emploi et des aménagements du travail a conduit à un amalgame des deux. Alors que ces deux concepts se chevauchent dans une large mesure, le fait d’analyser les modèles d’indicateurs variés de la précarité (tels que l’emploi multiple, la durée d’emploi de moins de deux années, et les périodes de chômage involontaire au cours des cinq dernières années), en tenant compte des aménagements du travail, nous informe sur la manière dont les concepts peuvent être distingués. D’une certaine façon, nos conclusions viennent corroborer plusieurs notions connues de la précarité mais, en même temps, elles nous révèlent des éléments nouveaux plus complexes.Comme on pouvait s’y attendre, les travailleurs détenant des emplois occasionnels (à temps plein ou à temps partiel) étaient moins susceptibles d’être membres d’un syndicat que les permanents à temps plein ou à temps partiel. Cette différence était moins prononcée chez les travailleurs des agences de travail et on n’a pas dénoté de différence au plan de la syndicalisation entre les contractuels et les permanents. Nous avons observé un modèle semblable concernant la taille de l’établissement : les permanents, les contractuels et les travailleurs des agences de travail se retrouvaient en plus grand nombre dans des établissements de plus grande taille que les occasionnels.Nous avons aussi constaté que certains groupes traditionnellement considérés comme précaires (les occasionnels à temps plein et à temps partiel, les contractuels et les travailleurs des agences) se situaient aux niveaux les plus élevés de plus d’indicateurs de précarité (occupation actuelle depuis moins de deux années, emplois multiples et insécurité d’emploi) que les travailleurs à leur compte (la plupart étaient engagés depuis plus de deux années). Tout cela indique que le fait de définir la précarité en retenant comme base plusieurs indicateurs de précarité nous permet de distinguer la précarité de d’autres aménagements du travail.De façon particulière, nos observations indiquent que l’emploi multiple, un phénomène qui n’est pas détecté par une évaluation des aménagements du travail, se trouve en grande partie dans les aménagements d’emploi les plus précaires de notre échantillon. Plus du quart des travailleurs occasionnels à temps plein (26,7 %) de notre échantillon détenait deux emplois ou plus, contre seulement 6,5 % des travailleurs permanents à temps plein. Le fait de détenir des emplois multiples était aussi plus accentué chez les travailleurs occasionnels à temps partiel (19 %), chez les contractuels à durée déterminée (21,7 %) et chez les travailleurs des agences de travail ou d’emploi temporaire (17 %). Fait intéressant à noter, 19,8 % des travailleurs permanents à temps partiel occupaient deux emplois ou plus, une observation qui peut indiquer que certains travailleurs permanents n’optent pas volontairement pour du travail à temps partiel. Notre étude vient confirmer aussi notre impression que la détention de postes multiples s’est rapidement répandue au cours de la dernière décennie. Au total, 13 % des travailleurs compris dans l’échantillon détenaient deux emplois ou plus, une donnée qui représente presque le double (7,3 %) de celle de l’étude précédente menée par le bureau australien de la statistique seulement trois ans avant la nôtre (et qui elle-même révélait une hausse importante de l’emploi multiple depuis l’enquête précédente). L’augmentation, l’envergure et la diffusion du phénomène de l’emploi multiple soulèvent des éléments importants de politique et appellent un effort plus poussé de recherche.Une autre conclusion de notre étude est à l’effet que les personnes de la catégorie des emplois permanents à temps plein, qu’on désigne habituellement comme catégorie de référence dans la recherche de nature épidémiologique et autre, étaient plus exposées que d’autres groupes de notre échantillon à l’insécurité d’emploi. La catégorie des autres travailleurs autonomes était la moins exposée, ce qui fait ressortir l’importance d’inclure le plein éventail des types d’aménagements de travail lorsqu’on considère les implications en termes de politiques publiques.Les catégories d’emploi que nous avons identifiées sur une base empirique présentent une plus grande capacité de discrimination que les classifications utilisées antérieurement. Des études à venir devraient pousser plus loin les différences dans les sous-catégories de travailleurs temporaires, des regroupements selon la permanence de courte ou de longue durée, de l’emploi autonome occasionnel et de types différents. Nous avons répertorié des catégories de statut d’emploi mutuellement exclusives, qui présentent des différences cohérentes et significatives au plan des caractéristiques d’emploi, en lien avec des données sociodémographiques et avec la sécurité d’emploi telle que vécue par les travailleurs. Ces catégories, obtenues de façon empirique, reflètent l’état actuel du marché du travail en Australie et nous croyons qu’elles peuvent être utiles aux agences gouvernementales, aux législateurs et aux chercheurs. Notre étude fournit aussi un guide pour des études parallèles dans d’autres pays pouvant ainsi contribuer à une meilleure compréhension de l’emploi précaire., La mayoría de investigaciones sobre el empleo precario comparan los trabajadores permanentes con uno o dos otras categorías principales de empleo. Nosotros hemos desarrollado un método mas refinado para examinar la precariedad basándonos en la definición de los actuales contratos de empleo segsn las características del trabajo. Esas categorías de contratos fueron luego comparadas en términos sociodemograficos y de inseguridad de empleo declarada. Esta investigación se apoya en una encuesta transversal basada en una muestra aleatoria de 1101 trabajadores australianos. Ocho categorías de empleo mutualmente exclusivas fueron identificadas : permanente a tiempo completo (46,4%), permanente a tiempo parcial (18,3%), ocasional a tiempo completo (2,7%), ocasional a tiempo parcial (9,3%), contrato a plazo fijo (2,1%), trabajo a contrato (3,6%), empleo autónomo a su propia cuenta (7,4%) y otro tipe de empleo autónomo (9,5%). Estas categorías muestran diferencias significativas y coherentes en cuanto a las características sociodemograficas y la inseguridad laboral percibida. Estas categorías sustentadas empíricamente pueden servir de guía conceptual para las agencias gubernamentales, los decidores políticos y los investigadores en los campos de la salud e higiene ocupacional, los impuestos, la regulación del mercado laboral, el trabajo precario, la pobreza infantil, los programas sociales, las relaciones industriales y el «desarrolo» de calificaciones.

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.

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.To describe AHR use patterns among workers in the health and community services industry in Australia.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.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-washing20 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.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.