Occupational and Environmental Medicine

IntroductionOccupations vary with respect to workplace factors that influence exposure to COVID-19, such as ventilation, social contacts and protective equipment. Variations between women and men may arise because they have different occupational roles or behavioural responses. We estimate occupational differences in COVID-19 hospital admission and mortality risks by sex. MethodsWe combined individual-level data from 2011 Census with (i) health records and (ii) household-level information from residential identifiers. We used data for a cohort of 1.7 million Scottish adults aged 40-64 years between 1 March 2020 and 31 January 2021. We estimated age-standardised COVID-19 hospital admission and mortality rates, stratified by sex and occupation. Using Cox proportional hazards models, we estimated COVID-19 hospital admission and death risks, adjusting for relevant factors. ResultsGenerally, women had lower age-standardised COVID-19 hospital admission and mortality rates compared to men. Among women, adjusted death risks were lower for health professionals, and those in associate professional and technical occupations (paramedics and medical technicians). Among men, elevated adjusted admission and death risks were observed for large vehicle and taxi drivers. Additionally, admission risks remained high among men working in caring personal services, including home and care workers, while elevated risks were observed among women working in customer service occupations (call centre operators) and as process, plant and machine operatives (assemblers/sorters). ConclusionOccupational differences in COVID-19 hospital admission and mortality risks between women and men highlight the need to account for sex differences when developing interventions to reduce infections among vulnerable occupational groups.

ObjectivesTo assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection. DesignWe analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from December 1st 2020 to 11th May 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups. Setting ResultsEstimated rates of triple-vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%), and retail (85%). High rates were observed for individuals working in health (95% for office-based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios reduced from 1.38 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups. Conversely, estimated relative risk for some occupational groups, such as people working in education, remained high despite high vaccine coverage. ConclusionsVariation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence.

IntroductionNeedle-stick injuries (NSIs) are defined as the sharp point of a needle puncturing human skin. This article examines the risk and illustrates the burden of NSIs for workers in the healthcare, veterinary and research industries, and includes a sample survey population of workers in workplaces using needles. MethodsFor the review component of this article, PubMed and Google Scholar were queried within the date range of 1998-2022, retrieving 1,437 results. A publicly available sample population dataset was and analyzed from British Columbia (n=30) on workplace needlestick injuries. The OSHA, WHO, and NIEHS guidelines were reviewed, and the WorkSafe BC injury database was searched using FIPPA requests. DiscussionRecapping remains a common practice despite decades of guidelines recommending against recapping. NSI research is underpowered and underrepresented in non-healthcare settings. NSIs lead to heightened anxiety, depression, and PTSD in workers and exposure to pathogens, toxic chemicals and permanent tissue damage. NSI annual reporting is likely an underestimate due to chronic underreporting, and the financial impact including work-loss and healthcare costs continues to rise. Current NSI prevention devices have limited uptake and thus, more affordable, versatile and efficient NSI-prevention devices are needed. RelevanceDue to COVID-19, healthcare workers are at a higher risk of receiving NSIs. Emphasis on safe needle handling practices is necessary to maintain workers physical and psychological safety, to protect workers using COVID-19 PPE on long shifts, and to deliver the high volume of vaccinations required to inoculate the global population. ConclusionNSIs are detrimental to healthcare workers wellbeing, chronically underreported, and poorly surveyed. Areas of future research include determining more effective solutions to reduce NSIs, assessing the validity of NSI reporting systems, and integrating solutions with COVID-19 prevention and vaccination protocols.

ObjectivesMost earlier studies on occupational risk of Covid-19 covering the entire workforce are based on relatively rare outcomes such as hospital admission and mortality. This study examines the incidence of SARS-CoV-2 infection by occupational group based upon real-time polymerase chain reaction tests (RT-PCR). MethodsThe cohort includes 2.4 million Danish employees, 20-69 years of age. All data were retrieved from public registries. The sex-specific incidence rate ratios (IRR) of first-occurring positive RT-PCR test from week 8 of 2020 through week 50 of 2021 were computed by Poisson regression for each 4-digit DISCO-08 job code with more than 100 employees (337 in men; 297 in women). Occupational groups with low risk of workplace infection according to a job exposure matrix constituted the reference group. Risk estimates were adjusted by demographic, social and health characteristics including household size, completed Covid-19 vaccination, pandemic wave and occupation-specific frequency of testing. ResultsIRRs of SARS-CoV-2 infection were elevated in 34 occupations comprising 12 % of male employees and 45 occupations comprising 41 % of female employees. All IRR estimates were below 2.0. Decreased IRRs were observed in 85 occupations in men but none in women. DiscussionWe observed a modestly increased risk of SARS-CoV-2 infection among employees in numerous occupations indicating a large potential for preventive actions, especially in the female workforce. Cautious interpretation of observed risk in specific occupations is needed because of methodological issues inherent in analyses of RT-PCR-test results and because of multiple statistical tests. WHAT IS ALREADY KNOW ABOUT THIS TOPIC?O_LIEpidemiological studies suggest that the workplace contribute to the Covid-19 pandemic C_LIO_LIResults are mostly based upon studies of less frequent outcomes as Covid-19 morbidity or mortality which limits inference about risk in specific occupations C_LI WHAT THIS STUDY ADDSO_LIThe risk of Covid-19 infection was increased in 34 of 337 occupations in men and in 45 of 297 occupations in women C_LIO_LISome 12% of the Danish male workforce and 41% of the female workforce are at increased risk of Covid-19 infection C_LI HOW THIS RESEARCH MIGHT AFFECT RESEARCH, PRACTICE OR POLICY?O_LIPreventive actions targeting the workplace may contribute substantially to alleviate disease occurrence in the ongoing Covid-19 and similar future pandemics. C_LI

BackgroundAccidental blood exposures (AEB) are a major occupational hazard for healthcare workers (HCWs), with risk of bloodborne pathogen transmission. While organisational factors are known to influence safety, the specific causal pathways linking management quality to AEB risk remain poorly characterised. ObjectivesTo investigate the causal pathways linking organisational factors, particularly supervisor support, to AEB risk among HCWs through stress and fatigue mediators using Directed Acyclic Graph (DAG) analysis. MethodsSecondary analysis of the STRIPPS cohort study including 32 wards across four Paris university hospitals (n=730 HCWs). A DAG was constructed based on a literature review and previously published multivariate analyses to model causal relationships between organisational factors, psychological mediators, and AEB outcomes. ResultsAEB incidence was 4.1 per 100 visits overall, highest in intensive care units (7.1/100). DAG analysis showed that low supervisor support increased AEB risk through both direct and indirect pathways. Literature evidence indicated a protective effect of supervisor support on both stress and fatigue, while these psychological factors are strongly associated with increased AEB risk. Additional organisational factors including irregular work schedules, rotating shifts, and use of external personnel contributed to elevated AEB risk. Individual factors such as work overcommitment and presenteeism further amplified stress and fatigue pathways. The analysis explored multiple converging pathways from organisational and individual factors through psychological mediators to AEB risk. ConclusionsLow supervisor support drives AEB risk through multiple interconnected pathways affecting stress and fatigue. Interventions targeting organisational support and psychological wellbeing could substantially reduce occupational injury risk among HCWs. HighlightsO_LIWhat is already known about this subject? O_LIAccidental blood exposures (AEB) are a major occupational hazard for healthcare workers (HCWs), with significant risks of bloodborne pathogen transmission and psychological distress. C_LIO_LIOrganisational factors, including leadership and safety culture, are known to influence workplace safety, but their specific causal pathways to AEB remain poorly understood. C_LIO_LIStress and fatigue are recognised as mediators between work conditions and safety outcomes, but their roles in AEB have not been systematically modelled using causal methods. C_LI C_LIO_LIWhat are the new findings? O_LIUsing a Directed Acyclic Graph (DAG) approach, we identified that low supervisor support increases AEB risk through both direct and indirect pathways mediated by stress and fatigue. C_LIO_LIFatigue showed a stronger association with AEB (OR 2.94-4.25) than stress (OR 1.12-1.53), highlighting its critical role in occupational safety. C_LIO_LISickness presenteeism and work overcommitment were identified as key individual-level amplifiers of stress and fatigue, further increasing AEB risk. C_LIO_LIIrregular work schedules and use of interim staff were organisational factors with substantial effects on AEB risk (RR > 3.0). C_LI C_LIO_LIHow might this impact on policy or clinical practice in the foreseeable future? O_LIHealthcare organisations should prioritise supervisor training to improve supportiveness, which could reduce both psychological strain and AEB incidents. C_LIO_LIFatigue risk management systems and scheduling optimisations should be implemented to mitigate the strong effects of irregular shifts and long hours. C_LIO_LIPolicies discouraging presenteeism and promoting mental health support could break the cycle of fatigue and injury among HCWs. C_LI C_LI

Structured SummaryO_ST_ABSObjectivesC_ST_ABSTo examine the prevalence and types of work-related injuries in companion animal practices, explore the context of their occurrence, and the behaviours of injured persons. MethodsA mixed-methods analysis of a cross-sectional online survey of UK employees of a consolidated group of veterinary practices. ResultsOf 647 respondents, 77.6% experienced a work-related injury during their career. In the previous year, 60.2% of veterinary nurses and 58.3% of veterinarians were injured, most frequently in consultation rooms, prep areas, kennels, and reception. Animal-related injuries were the most prevalent injury type. Injuries frequently occurred during cat restraint, anaesthetic recovery, and clinical examinations. Needlestick injuries made up 15.8% of veterinary injuries. 16.3% of injured nurses and 19.4% of injured vets attended hospital. 34.3% of nurses, and 25.1% of vets, needed more than a week to recover from their injuries. Fewer than 10% took time off work, often due to a sense of duty, the ability to manage a reduced workload, or simply wanting to "get on with it." Most injuries to vets went unreported, due to perceived time pressures or the belief that the injury was minor. Around half adjusted their behaviour post-injury, becoming more cautious or changing handling techniques. Clinical significanceThis study reveals a high rate of work-related injuries in companion animal practices. A culture of presenteeism and blame often downplays these risks, hindering safety. To reduce injuries, a shift towards shared responsibility and reflective learning is needed, driven by strong leadership and open communication.

BackgroundWorkers differ in their risk of SARS-CoV-2 infection according to their occupation, but the direct contribution of occupation to this relationship is unclear. This study aimed to investigate how infection risk differed across occupational groups in England and Wales up to April 2022, after adjustment for potential confounding and stratification by pandemic phase. MethodsData from 15,190 employed/self-employed participants in the Virus Watch prospective cohort study were used to generate risk ratios for virologically- or serologically-confirmed SARS-CoV-2 infection using robust Poisson regression, adjusting for socio-demographic and health-related factors and non-work public activities. We calculated attributable fractions (AF) amongst the exposed for belonging to each occupational group based on adjusted risk ratios (aRR). FindingsIncreased risk was seen in nurses (aRR=1.44, 1.25-1.65; AF=30%, 20-39%), doctors (aRR=1.33, 1.08-1.65; AF=25%, 7-39%), carers (1.45, 1.19-1.76; AF=31%, 16-43%), primary school teachers (aRR=1.67, 1.42-1.96; AF=40%, 30-49%), secondary school teachers (aRR=1.48, 1.26-1.72; AF=32%, 21-42%), and teaching support occupations (aRR=1.42, 1.23-1.64; AF=29%, 18-39%) compared to office-based professional occupations. Differential risk was apparent in the earlier phases (Feb 2020 - May 2021) and attenuated later (June - October 2021) for most groups, although teachers and teaching support workers demonstrated persistently elevated risk across waves. InterpretationOccupational differentials in SARS-CoV-2 infection risk vary over time and are robust to adjustment for socio-demographic, health-related, and non-workplace activity-related potential confounders. Direct investigation into workplace factors underlying elevated risk and how these change over time is needed to inform occupational health interventions.

PurposeThe GIG-OSH cohort was established to investigate the impact of digital platform work on occupational safety and health (OSH), working and employment conditions, and health in seven countries in Europe. ParticipantsThe cohort comprises 3,945 digital platform workers from seven European countries. The sample includes both web-based workers (e.g., micro-tasking, freelance design) and on-location workers (e.g., delivery, transport). Participants were recruited using non-probabilistic sampling strategies tailored to national contexts, including social media advertising, recruitment through micro-task platforms, and on-site field outreach. Multidimensional data have been collected through online surveys (implemented via REDCap) covering sociodemographic characteristics, working and employment conditions, psychosocial risks, algorithmic management, and physical and mental health indicators. Findings to dateParticipants had a mean age of 32.6 years at baseline (SD 10.4), and the majority are male (58.8%), with a higher concentration of migrants in on-location tasks (62.2%) compared to web-based tasks (48.8%). Regarding educational attainment, 55.4% of the total cohort holds a tertiary degree, reaching 64.4% among web-based workers. Platform work intensity varies significantly: on-location workers averaged 85.4 hours of work in the last month, while web-based workers averaged 47.0 hours. Mean income from platform work as a percentage of the national median was 20.6% (SD 22.2). The mean WHO-5 Well-Being Index score was 58.7 (SD 20.3), which is notably lower than the European general population average (69.4), indicating poorer mental health outcomes among cohort members. Future plansThe GIG-OSH cohort represents the first large-scale, longitudinal study examining occupational safety and health among digital platform workers across multiple European countries. Future waves will prioritize developing precise tools to measure hourly earnings and unpaid waiting time. Future research should aim to include underrepresented subgroups, such as medical and domestic care workers, and explore potential linkage with administrative records to evaluate long-term health trajectories and the impact of new EU labour regulations. Strengths and limitations of this studyO_LIThis is the first large-scale longitudinal cohort to examine occupational safety and health among platform workers across multiple European countries, addressing an important evidence gap. C_LIO_LIThe inclusion of both web-based and on-location workers enables comparative analyses across diverse task types, employment conditions, and national contexts. C_LIO_LIRecruitment strategies tailored to national contexts enhanced feasibility but limited the representativeness of samples and precluded national-level weighting or benchmarking. C_LIO_LIHigh attrition between waves and the absence of harmonized classifications (e.g., education levels) across countries may constrain the generalizability and longitudinal consistency of findings. C_LIO_LIDespite relying on self-reported data, the study used stakeholder-informed instruments and captured a wide range of occupational hazards--such as psychosocial and algorithmic risks--not typically addressed in conventional labour surveys. C_LI

ObjectivesTo establish whether prevalence and severity of long-COVID symptoms vary by industry and occupation. MethodsWe utilised ONS Coronavirus Infection Survey (CIS) data (February 2021-April 2022) of working-age participants (16-65 years). Exposures were industrial sector, occupation and major Standard Occupational Classification (SOC) group. Outcomes were self-reported: (1) long-COVID symptoms; and (2) reduced function due to long-COVID. Binary (outcome 1) and ordered (outcome 2) logistic regression were used to estimate odds ratios (OR) and prevalence (marginal means) for all exposures. ResultsPublic facing industries, including teaching and education, social care, healthcare, civil service, retail and transport industries and occupations had highest odds ratios for long-COVID. By major SOC group, those in caring, leisure and other services (OR 1.44, CIs: 1.38-1.52) had substantially elevated odds than average. For almost all exposures, the pattern of odds ratios for long-COVID symptoms followed that for SARS-CoV-2 infections, except for professional occupations (OR<1 for infection; OR>1 for long-COVID). The probability of reporting long-COVID for industry ranged from 7.7% (financial services) to 11.6% (teaching and education); whereas the prevalence of reduced function by a lot ranged from 17.1% (arts, entertainment and recreation) to 22-23% (teaching and education and armed forces) and to 27% (those not working). ConclusionsThe risk and prevalence of long-COVID differs across industries and occupations. Generally, it appears that likelihood of developing long-COVID symptoms follows likelihood of SARS-CoV-2 infection, except for professional occupations. These findings highlight sectors and occupations where further research is needed to understand the occupational factors resulting in long-COVID. Key messages What is already known on this topicO_LISARS-CoV-2 infection and COVID-19 mortality in the UK varied by occupational group; yet it is not known if any occupational groups are more susceptible to long-COVID than others. C_LI What this study addsO_LIThis is the first study to examine how prevalence of long-COVID and its impacts on functional capacity differ by industrial sector and occupational groups. C_LIO_LIPrevalence of self-reported long-COVID increased with time across all exposure groups and mostly followed SARS-CoV-2 infection trends; with the exception of Professional occupations that demonstrated notable differences in the direction of odds of long-covid when compared to odds of SARS-CoV-2 infection. C_LIO_LIThose working in Teaching and education, and social care industries showed the highest likelihood of having long-COVID symptoms. The exact same pattern was observed when analysis was performed using occupational groups. When we used SOC groups the likelihood was higher in Caring, leisure and other services. C_LI How this study might affect research, practice or policyO_LIThe findings contribute to the evidence base that long-COVID differences occur across industries and occupations, provides insights for employees, employers, occupational and healthcare for the industries and occupations that may need additional support for return- to-work policies and highlights sectors and occupations where further research is needed to understand the mechanisms resulting in long-COVID and how occupational factors influence the risk of developing long-COVID or interact with long-COVID to increase the impact on activities. C_LI

IntroductionThe PROTECT National Core Study was funded by the UK Health and Safety Executive (HSE) to investigate routes of transmission for SARS-CoV-2 and variation between settings. MethodsA workshop was organised in Oct 2022.We brought together evidence from five published epidemiological studies that compared risks of SARS-CoV-2 infection or COVID-19 mortality by occupation or sector funded by PROTECT relating to three non-overlapping data sets, plus additional unpublished analyses relating to the Omicron period. We extracted descriptive study level data and model results. We investigated risk across four pandemic waves using forest plots for key occupational groups by time-period. ResultsResults were largely consistent across different studies with different expected biases. Healthcare and social care sectors saw elevated risks of SARS-CoV-2 infection and COVID-19 mortality early in the pandemic, but thereafter this declined and varied by specific occupational subgroup. The education sector saw sustained elevated risks of infection after the initial lockdown period with little evidence of elevated mortality. ConclusionsIncreased in risk of infection and mortality were consistently observed for occupations in high risk sectors particularly during the early stage of the pandemic. The education sector showed a different pattern compared to the other high risk sectors, as relative risk of infections remained high in the later phased of the pandemic, although no increased in COVID-19 mortality (compared to low-risk occupations) was observed in this sector in any point during the pandemic.

BackgroundTrade union presence within a workplace could potentially affect employees working conditions and in turn health. We assessed the relationship between union (presence and membership) at the individual level and mental health in the context of COVID-19 employment disruptions. MethodsWe analysed panel data from Understanding Society collected before and during the COVID-19 pandemic (49,915 observations across 5,988 respondents) to assess the relationship between union presence and membership and a validated epidemiological measure of common mental disorders (CMD), the 12-Item General Health Questionnaire with a score of >/4 indicating probable anxiety/depression, referred to as caseness. A mixed-effect log-linear model assessed effect heterogeneity across time and industries, with average marginal effects (AME) indicating effect differences between groups. FindingsIn our sample, 49.1% worked in a unionised workplace, among which 53.8% were union members. Caseness prevalence was higher during the pandemic (25.4%) compared to pre-pandemic (18.4%). Working in a workplace with a trade union was associated with modest protection against CMD risk; (AMEpre-pandemic:0.010, 95%CI:-0.007; 0.027), (AME- pandemic:-0.002, 95%CI:-0.019; 0.016)]. Similarly, for union membership [(AMEpre- pandemic:0.016, 95%CI:-0.007; 0.039), (AMEpandemic:-0.010, 95%CI:-0.023; 0.020)]. Industry level heterogeneity exists in the relationship between union presence and membership and mental health. InterpretationTrade union presence may have a protective effect on workers mental health in periods of crisis, such as during a pandemic. Within unionised workplaces, trade union membership further mitigated the negative effects of the pandemic on mental health. Collective negotiation within workplaces may be protective in periods of uncertainty, benefiting all workers and not only those unionised. FundingMedical Research Council, Chief Scientist Office, European Research Council, Belgian National Scientific Fund (FNRS).

BackgroundOccupational short-latency respiratory disease (SLRD; predominantly asthma, rhinitis, hypersensitivity pneumonitis, and occupational infections) prevalence is difficult to determine but certain occupations may be associated with increased susceptibility. AimsThis study aimed to examine which occupations and industries are currently at high risk for SLRD and determine their respective suspected causal agents based on cases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) scheme in the UK. MethodsSLRD cases reported to the SWORD scheme between 1999 and 2019 were analysed to determine directly standardised rate ratios (SRR) by occupation against the average rate for all other occupations combined. ResultsBakers and flour confectioners showed significantly raised SRR for occupational rhinitis (234.4 [95% CI, 200.5 - 274.0]) and asthma (59.9 [95% CI, 51.6 - 69.5]). Chemical and related process operatives also presented raised SRR values for these two conditions, with SRR of 29.5 [95% CI, 24.3 - 35.7] and 21.0 [95% CI, 16.9 - 26.1] for rhinitis and asthma, respectively. SRR were also significantly raised for vehicle spray painters when considering occupational asthma (63.5 [95% CI, 51.5 - 78.3]) alone, and laboratory technicians were also amongst the top three increased SRR for rhinitis (18.7 [95% CI, 15.1 - 23.1]). The suspected agents most frequently associated with these occupations and conditions were flour, isocyanates, and laboratory animals and insects. Metal machining setters and setter-operators showed increased SRR for occupational hypersensitivity pneumonitis (42.0 [95% CI, 29.3 - 60.3]), largely due to cutting/soluble oils. The occupation mostly affected by infectious disease was welding trades (12.9 [95% CI, 5.7 - 29.3]) and the suspected causal agent predominantly reported for this condition was pathogens and microorganisms, with a predominance of Mycobacterium tuberculosis. ConclusionsThis study identified the occupational groups at increased risk of developing a SLRD based on data recorded over a recent two-decade period in the UK. Asthma and rhinitis were identified as the prevailing conditions and hypersensitivity pneumonitis as a potentially rising respiratory problem in the metalworking industry.

ImportanceNurses work-related stress and sickness absence are high. The consequences of sickness absence are severe for health systems efficiency and productivity. ObjectiveTo measure the association between nurse staffing configurations and sickness absence in hospital ward nursing teams. DesignRetrospective case-control study using hospital routinely collected data SettingFour general acute care hospitals in England Participants3,583,586 shifts worked or missed due to sickness absence by 18,674 registered nurses (RN) and nursing assistant (NA) staff working in 116 hospital units. ExposureNursing team skill-mix; temporary staffing hours; understaffing; proportion of long shifts (12+ hours) worked; full-time/part-time work status in the previous 7 days. Main outcomeEpisodes of sickness absence, defined as a sequence of sickness days with no intervening days of work. ResultsThere were 43,097 sickness episodes. In our reduced parsimonious model, being exposed to a skill mix that was richer in RNs was associated with lower RN sickness absence (OR= 0.98; 95% CI = 0.96-0.99). For each 10% increase in proportion of hours worked as long shifts worked in the previous 7 days odds of sickness were increased by 2% (OR = 1.02; 95% CI = 1.02- 1.03) for RNs. Part-time work for RNs was associated with higher sickness absence (OR = 1.09; 95% CI = 1.04 - 1. 15). When RN staffing over the previous week was below average, the odds of sickness absence for NAs increased by 2% for every 10% increase in understaffing across the period (OR = 1.02; 95% CI = 1.01 - 1.03). For RNs there was a significant interaction between part-time work and RN understaffing, whereby short staffing in the previous week increased sickness absence for full time staff but not among those working part time. NA understaffing was not associated with sickness absence for any staffing group. Conclusions and RelevanceWorking long shifts and working on understaffed wards increases the risk of sickness absence in nursing teams. Adverse working conditions for nurses, already known to pose a risk to patient safety, may also create risks for nurses and the possibility of further exacerbating staff shortages. Key pointsO_ST_ABSQuestionC_ST_ABSWhat is the association between variation in nurse staffing configurations and nurses sickness absence? FindingsRegistered Nurse (RN) understaffing in the preceding 7 days was associated with sickness absence for Nursing Support (NS) staff, but for RNs the association was only seen when working full time. Exposure to shifts with a skill-mix richer in RNs, to higher bank hours and working lower proportions of 12+ h shifts in the preceding 7 days was a protective factor of RN sickness absence. MeaningTo support nurses health and health systems productivity and efficiency, investing in avoiding RN understaffing may be warranted.

ObjectiveTo use a model of occupational stress to quantify and explain the impact of working in critical care during the Covid-19 pandemic on critical care nurses and organisational outcomes. ParticipantsCritical care nurses (CCNs) who worked in the UK NHS between January to November 2021 (n=461). MethodsA self-reported survey measured the components of the Job-Demand Reward model of occupational stress. Job-demands, job-resources, health impairment (mental health (GHQ-12), burnout (MBI), PTSD symptoms (PCL-5)), work engagement and six organisational outcomes (commitment, job satisfaction, changing jobs, certainty about the future, quality of care, patient safety) were measured. Data were compared to baseline data (n=557) collected between April to October 2018. Regression analyses identified predictors of health impairment, work engagement and organisational outcomes. FindingsCompared to 2018, CCNs were at elevated risk of probable psychological distress (GHQ-12, OR 6.03 [95% C.I. 4.75 to 7.95]; burnout emotional exhaustion, OR 4.02 [3.07 to 5.26]; burnout depersonalisation, OR 3.18 [1.99 to 5.07]; burnout accomplishment, OR 1.53 [1.18 to 1.97]). A third of CCNs reported probable PTSD. Job demands predicted psychological distress and job demands increased during the pandemic. Resources reduced the negative impact of job demands on psychological distress, but this moderating effect of resources was not observed at higher levels of demand. CCNs were less engaged in their work. Job and personal resources predicted work engagement and were reduced during the pandemic. All six organisational outcomes were impaired. Lack of resources, especially reduced learning opportunities, lack of focus on staff wellbeing, and reduced focus on quality predicted worse organisational outcomes. ConclusionsThe NHS needs to prioritise the welfare of CCNs, implement workplace change/planning, and support them to recover from the pandemic. The NHS is struggling to retain CCNs and, unless staff welfare is improved, quality of care and patient safety will likely decline.

ObjectivesThe main objectives of this article are (i) to explore the potential relationship between precarious employment and the production of steroid hormones (both adrenal and gonadal) and (ii) to evaluate the psychosocial risk factors at work (i.e. demands, control, and support) and work-life conflicts in this relationship. MethodsCross-sectional data were derived from a sample of workers from Barcelona (n=255 --125 men, 130 women). A set of 23 markers were determined from hair samples to evaluate the chronic production of both adrenal and gonadal steroids. Linear regression models were used to estimate the association between precarious employment and the production of adrenal and gonadal steroids, and decomposition analyses were applied to estimate the indirect effect of psychosocial risk factors and work-life conflict on this relationship. ResultsGender differences in the association with PE-steroid production were found. Among men, gonadal axis steroids were associated with precarious employment (specifically, androstenedione and testosterone), while among women, adrenal axis steroids, primarily cortisol and markers derived from its metabolism, were associated with precarious employment. Psychosocial risk factors and work-life conflicts had significant positive indirect effects only among women. ConclusionsGender differences were found in respect of the indirect effects of psychosocial risk factors and work-life conflicts on the association between precarious employment and the production of adrenal and gonadal steroids, which suggests that, beyond the biochemical differences, the physiological effect of PE could be mediated by the social construction of gender identities, positions and roles in society and family. KEY MESSAGES What is already known about this subject?Previous studies suggest that precarious employment is associated with workers health; however, most studies are based on self-rated health indicators and do not explore the causal mechanisms behind this association. What are the new findings?Precarious employment was associated with the production of some adrenal and gonadal steroids, and the psychosocial work environment had an indirect effect on this association, although with significant gender differences. How might this impact on policy or clinical practice in the foreseeable future?An occupational health policy aimed at improving the quality of employment and, at the same time, the psychosocial work environment can reduce the production of hormones that are associated with stress.

BackgroundSince the emergence of SARS-CoV-2, health care workers (HCWs) have been on the front line in caring for COVID-19 patients. Better knowledge of risk factors for SARS-CoV-2 infection is crucial for the prevention of disease among this population. MethodsWe conducted a seroprevalence survey among HCWs in a French university hospital after the first wave (May-June 2020), based on a validated lateral flow immuno-assay test (LFIAT) for SARS-CoV-2. Demographic characteristics as well as data on the working characteristics of COVID-19 and non-COVID-19 wards and 23 care activities were systematically recorded. The effectiveness of protective equipment was also estimated, based on self-declaration of mask use. SARS-CoV-2 IgG status was modelled by multiple imputations approach, accounting for the performance of the test and data on serum validation ELISA immunoassay. FindingsAmong the 3,234 enrolled HCWs, the prevalence of SARS-CoV-2 IgG was 3.8%. Contact with relatives or HCWs who developed COVID-19 were risk factors for SARS-CoV-2 infection, but not contact with COVID-19 patients. In multivariate analyses, suboptimal use of protective equipment during naso-pharyngeal sampling, patient mobilisation, clinical and eye examination was associated with SARS-CoV-2 infection. In addition, patients washing and dressing and aerosol-generating procedures were risk factors for SARS-CoV-2 infection with or without self-declared appropriate use of protective equipment. InterpretationMain routes of transmission of SARS-CoV-2 IgG among HCWs were i) contact with relatives or HCWs with COVID-19, ii) close or prolonged contact with patients, iii) aerosol-generating procedures.

BackgroundWorking while sick (presenteeism) with an infectious disease contributes to the spread of infections and is detrimental to productivity. Respiratory illnesses are a common cause of sickness in the working population and understanding the prevalence of presenteeism linked to respiratory illness is therefore important. MethodsWinter Covid Infection Study (WCIS) panel members in work aged 18-64 were surveyed in February - March 2024 and asked about presenteeism in the previous 28 days. Multilevel regression and poststratification was used to estimate the prevalence and length of presenteeism and its effect on productivity in the English workforce, as approximated using the WCIS survey sample calibrated to census proportions. Differences by demographic groups and work sector were also analysed. ResultsAround one in six working adults in England worked while sick with a respiratory infection during the study period, and one in ten attended a non-home workplace. Overall, around one day per adult was spent working while sick with a respiratory infection, approximately half of which was non-home working. Respondents felt they were able to work at around three-quarters of their usual capacity while sick. Presenteeism was more common among respondents who were younger, White, worked in a hybrid pattern, lived in larger households, had Long COVID-19, or worked in teaching and education. ConclusionWorking while sick with a respiratory infection is relatively common, including among those who primarily work away from the home. Key messagesAround one in six working-age adults in employment worked while sick with a respiratory infection during the study period (Feb-Mar 2024). - The likelihood of working while sick with a respiratory infection varied by demographic group and work sector. - On average, survey respondents said they could work at around three quarters their normal effectiveness while sick with a respiratory infection.

ObjectivesRespiratory illnesses like Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome and the current SARS-CoV-2 virus pandemic are transmitted by respiratory droplets. Certain dental procedures generate aerosols, one of the highest sources of transmission of droplet infections. During the current pandemic, dentists in the UK were initially restricted in their work and now have guidance from NHS England and the Chief Dental Officer for the full resumption of safe and effective routine dental care to patients. Lack of work, impact on income and working in the continual pandemic situation are likely to cause significant mental stress in dentists. Occupational health (OH) can have a vital role to help such dentists remain in work by advising strategies to cope with stress and offering timely evidence-based interventions and adjustments. The aim was to assess if the dentists in the UK had access to OH and whether access to the OH services helped. MethodsA survey link was sent to 200 dentists in the UK after the peak of the current pandemic. Results124 dentists responded to the survey. The response rate was 62%. 59% of the dentists in the survey did not have access to OH services in their workplace. Only 15% of dentists working in the independent sector had access to OH services compared to 78% working in the NHS or having NHS contracts. None of the dentists in the survey accessed OH services. ConclusionsAccess to OH services for the dentists needs improvement, particularly in the Independent sector in the UK. Article SummaryStrengths and limitations of the study: O_LISample representative of the population studied. C_LIO_LINo observer subjectivity C_LIO_LIPrecise results C_LIO_LIInflexible design, no control group and lack of random sampling C_LI

ObjectivesIdentify workplace risk factors for SARS-Cov-2 infection, using data collected by a United Kingdom electricity-generating company. MethodsUsing a test-negative design case-control study we estimated the odds ratios (OR) of infection by job category, site, test reason, sex, vaccination status, vulnerability, site outage, and site COVID-19 weekly risk rating, adjusting for age, test date and test type. ResultsFrom an original 80,077 COVID-19 tests, there were 70,646 included in the final analysis. Most exclusions were due to being visitor tests (5,030) or tests after an individual first tested positive (2,968). Women were less likely to test positive than men (OR=0.71; 95% confidence interval=0.58-0.86). Test reason was strongly associated with positivity and although not a cause of infection itself, due to differing test regimes by area it was a strong confounder for other variables. Compared to routine tests, tests due to symptoms were highest risk (94.99; 78.29-115.24), followed by close contact (16.73; 13.80-20.29) and broader-defined work contact 2.66 (1.99-3.56). After adjustment, we found little difference in risk by job category, but some differences by site with three sites showing substantially lower risks, and one site showing higher risks in the final model. ConclusionsIn general, infection risk was not associated with job category. Vulnerable individuals were at slightly lower risk, tests during outages were higher risk, vaccination showed no evidence of an effect on testing positive, and site COVID-19 risk rating did not show an ordered trend in positivity rates. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIIn the United Kingdom, there is now a considerable body of evidence showing occupational differences in Covid-19 infection and severity, but with understandable focus on high-risk industries like healthcare. C_LIO_LILess is known about differences in risk of COVID-19 infection in other industries that do not involve directly working with the general public, in particular, there is relatively little evidence on the risks of transmission in the electricity-generating industry. C_LI What this study addsO_LIAt this company, infection risk was not associated with job category after adjusting for test reason; however women were less likely to test positive than men and the risk was higher when there was a power outage, requiring more staff to visit the site in person. C_LI How this study might affect research, practice or policyO_LIThe site risk rating showed a consistent (but modest) dose-response with infection risk, indicating that such risk rating may be useful for identifying "high risk" sites. C_LIO_LIThis analysis demonstrates the importance of adjusting for both date of and reason for test, when prevalence and testing protocols differ over time. C_LI

Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study which included people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes and comorbid depression and cardiometabolic disease. 105 predictors were assessed at baseline and participants were linked to a national disability pension register. During a mean follow-up of 8.6 years, 6836 (7.7%) participants got a disability pension, the incidence varying between 9.9% among participants with migraine and 27.7% in those with comorbid depression and cardiometabolic disease. C-statistics for an 8-item risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, was 0.80 (95%CI: 0.80-0.81) for musculoskeletal disorders (N=33,601), 0.83 (0.82-0.84) for migraine (N=22,065), 0.82 (0.81-0.83) for respiratory disease (N=15,372) and exceeded 0.72 for other disease groups. With 30% estimated risk as a threshold, a positive test detection rate and false positive rate ranged from 42.2% and 18.8% (cancer) to 79.8% and 45.2% (comorbid depression and cardiometabolic disease). Predictive performance was not improved in models with a new set of predictors or re-estimated coefficients. In conclusion, the 8-item work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability.