Surgeons report a high prevalence of musculoskeletal pain and home, work conflict

IntroductionMany surgeons in public health systems were deployed away from elective surgery during the COVID-19 pandemic and are now working under high pressure to reduce long waiting-lists including for people with malignancy.MethodsUsing validated methodology, a questionnaire was circulated to surgeons via societies and social media. Anonymized data from voluntary respondents were collected via a centralized database.Results242 Surgeons responded amongst whom 170 (70.3%) were male. 14% were aged 25 to 34, 28% 35 to 44 years, 35% 45 to 54 years, 17% 55 to 64 and 5.8 % were aged 65 and over. 65.7% were urologists, 13.6% orthopaedics and trauma – others came from a range of surgical specialties. 46.3% suffered lower back pain in the prior month, 47.3% stated that this adversely affected work and recreational activities, 57.1% stated this had occurred > 5x in the previous year. Hip, neck and shoulder pain ranged from 6.2–43.8 % with up to 33.9% stating MSK symptoms had interfered with their work and (with the exception of shoulder pain (48.5%)) in each case >50% described symptoms > 5x pa. Only 8.7% reported receiving any ergonomic support to ensure comfort at work and 26.5% had ever received training in ergonomics. Surgeons reported 26% of the time they were often or always at work when required at home, with 48.8% reporting regular impact on private life. Many surgeons (84.4%) also report conflicting demands at work.ConclusionsPost-pandemic, surgeons report a high prevalence of musculoskeletal pain and work/life conflict. Surgeons could themselves take measures to mitigate these effects but planning and development of rotas and operating theatres could also be optimized. Maintaining the health of surgical staff is fundamental to patient safety and to retain highly-trained professionals within their discipline.

Predictors and Consequences of Not Seeking Healthcare during the COVID-19 Pandemic: Findings from the HEAF Cohort.

The COVID-19 pandemic resulted in a dramatic reduction of routine healthcare availability in many European countries. Among a cohort of English middle-aged adults, we explored pre-pandemic and pandemic factors associated with not seeking healthcare during lockdown, and their effect on subsequent self-reported health measures. Longitudinal data from the Health and Employment After Fifty (HEAF) cohort were used. Pre-pandemic data came from the 5th annual follow-up (2019), when participants were aged 56-71 years, and pandemic data were collected by e-survey in February 2021 and November 2021. Response rates of the two e-surveys were 53% and 79%, respectively. Pre-pandemic predictors of not seeking healthcare were: female gender, higher BMI, higher comorbidity, poorer self-rated health and depression; non-care seekers were also more likely to report that family or friends were affected by COVID-19 and to have been advised to shield. Not seeking healthcare during lockdown was associated with a higher risk of reporting worsening of physical, but not mental, health during the later phase of the pandemic. In this cohort, those with generally poorer health were disproportionately more likely to not seek healthcare during lockdown, which may potentially exacerbate pre-existing inequalities and lead to longer-term health consequences.

Occupational characteristics associated with SARS-CoV-2 infection in the UK Biobank during August-November 2020: a cohort study.

BACKGROUND: Occupational exposures may play a key role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk. We used a job-exposure matrix linked to the UK Biobank to measure occupational characteristics and estimate associations with a positive SARS-CoV-2 test. METHODS: People reporting job titles at their baseline interview in England who were < 65 years of age in 2020 were included. Healthcare workers were excluded because of differential access to testing. Jobs were linked to the US Occupational Information Network (O*NET) job exposure matrix. O*NET-based scores were examined for occupational physical proximity, exposure to diseases/infection, working outdoors exposed to weather, and working outdoors under cover (score range = 1-5). Jobs were classified as remote work using two algorithms. SARS-CoV-2 test results were evaluated between August 5th-November 10th, 2020, when the UK was released from lockdown. Cox regression was used to calculate adjusted hazard ratios (aHRs), accounting for age, sex, race, education, neighborhood deprivation, assessment center, household size, and income. RESULTS: We included 115,451 people with job titles, of whom 1746 tested positive for SARS-CoV-2. A one-point increase in physical proximity score was associated with 1.14 times higher risk of SARS-CoV-2 (95%CI = 1.05-1.24). A one-point increase in the exposure to diseases/infections score was associated with 1.09 times higher risk of SARS-CoV-2 (95%CI = 1.02-1.16). People reporting jobs that could not be done remotely had higher risk of SARS-CoV-2 regardless of the classification algorithm used (aHRs = 1.17 and 1.20). Outdoors work showed an association with SARS-CoV-2 (exposed to weather aHR = 1.06, 95%CI = 1.01-1.11; under cover aHR = 1.08, 95%CI = 1.00-1.17), but these associations were not significant after accounting for whether work could be done remotely. CONCLUSION: People in occupations that were not amenable to remote work, required closer physical proximity, and required more general exposure to diseases/infection had higher risk of a positive SARS-CoV-2 test. These findings provide additional evidence that coronavirus disease 2019 (COVID-19) is an occupational disease, even outside of the healthcare setting, and indicate that strategies for mitigating transmission in in-person work settings will remain important.

Pre-pandemic socio-economic status and changes in employment during the first lockdown (2020) on the health of middle-aged people in England: a longitudinal study.

BACKGROUND: The COVID-19 pandemic markedly disrupted people's lives. It caused higher mortality and morbidity amongst individuals from poorer socio-economic position (SEP). It is well-recognised that job loss has a negative impact on health. We hypothesised that health effects of the pandemic on middle-aged people might be different depending on SEP and changes in employment. METHODS: Data are from the Health and Employment After Fifty (HEAF), a cohort recruited 2013-2014 when aged 50-64 through 24 English general practices. At baseline and annually since, participants completed a questionnaire reporting about demographics, employment, health, lifestyle, and finances. In 2021 we sent an e-survey to all contactable HEAF participants, asking about effects of the first lockdown (March-July 2020). Outcomes were participants' perception of worsening of mental, physical health, and self-rated health (SRH) since lockdown. Associations between SEP, COVID-19 related employment changes and health were explored with Poisson regression with robust standard error, with adjustment for age, sex, and pre-pandemic SRH. RESULTS: In total, 2,469 (53%) returned a usable questionnaire, amongst whom 2,344 provided complete information for these analyses (44% men, mean age 65.7 years). Worsening of mental, physical or SRH since lockdown was reported by 21%, 27% and 17% respectively. Mutually adjusted models showed that reporting struggling financially pre-pandemic (versus living comfortably) was associated with an increased risk of deterioration in: mental (RR = 2.0, 95%CI 1.7-2.5), physical health (RR = 2.0, 95%CI 1.6-2.3), and SRH (RR = 1.6, 95%CI 1.2-2.1). Participants working from home during lockdown and those who lost their job (as opposed to those with unchanged employment) were at increased risk of reporting deterioration in mental health and SRH. CONCLUSION: In a cohort of older workers, working from home, job loss and poorer pre-pandemic SEP were all associated with worsening of mental health and SRH since lockdown.

Physical Activity and Diet in a Global Pandemic: An Investigation of the Impact of COVID-19 on Factors Relevant for Musculoskeletal Health at Two Different Stages of the Lifecourse.

Background: Physical activity, nutrition and other lifestyle factors play important roles in maintaining musculoskeletal health. The coronavirus disease (COVID-19) originated in late 2019, spread globally to be declared a pandemic by the World Health Organisation in March 2020, and led to widespread behaviour change. The aim of this study was to use two existing cohorts, the Hertfordshire Cohort Study (HCS) and Health and Employment After Fifty Study (HEAF), to understand how wave one of the COVID-19 pandemic impacted lifestyle factors associated with musculoskeletal health in the UK. Methods: 125 eligible participants, 65 males and 60 females (drawn from the HCS study, median (IQR) age 84.3 (82.4-86.6) years, all Caucasian, and community dwelling) were contacted by telephone and asked to complete a questionnaire administered by a trained researcher. Data collection occurred over the period July 2020 to February 2021. 2469 participants, 1086 men and 1383 women (drawn from the HEAF study, median age 65.7 (62.0-69.3) years, mostly Caucasian and community dwelling) completed an online questionnaire in March 2021. Results: In HCS, 47% respondents reported being less physically active than before the pandemic (and only 5% more so), 27% said they consumed less alcohol compared to pre-pandemic times (and only 3% more so), and 18% reported eating less than before, although quality of diet was generally unchanged over this timeframe surveyed. In HEAF, 44% participants said they were less active than before the pandemic, while 17% reported being more active. The majority of participants reported no changes in alcohol consumption and diet; however, 19% said they drank more than before (32% of which was above recommended levels), 16% said their diet was less healthy, and 19% reported eating more than before. Conclusion: We have reported the experience of the first wave of the COVID-19 pandemic among participants of two Caucasian community dwelling UK cohorts, highlighting the impact of the pandemic on lifestyle factors associated with musculoskeletal health. Changed physical activity levels were reported in a high proportion of respondents in both studies; an investigation of reversibility of these changes is required.

Enabling work participation for people with musculoskeletal conditions: lessons from work changes imposed by COVID-19: a mixed-method study.

OBJECTIVES: To understand what we can learn from the impact of the COVID-19 pandemic and lockdown about what enables work participation for people with inflammatory arthritis and chronic pain conditions. DESIGN: Qualitative interviews embedded within an observational questionnaire study of individuals with musculoskeletal (MSK) conditions. SETTING: UK primary care (general practices), and secondary care-based rheumatology services. PARTICIPANTS: Individuals with axial spondyloarthritis, psoriatic arthritis and MSK pain from three established cohorts completed an online/paper-based questionnaire (July-December 2020). A subset of respondents were selected for semistructured interviews. PRIMARY AND SECONDARY OUTCOME MEASURES: The survey quantified the effects of lockdown on work circumstances. Qualitative interviews explored the impacts of these changes and the advantages and disadvantages of changes in work circumstances. RESULTS: 491 people (52% female, median age 49 years) who were employed at the time of lockdown responded to the questionnaire. The qualitative analysis included 157 free-text comments on work from the questionnaire and data collected within 18 interviews.Participants reported impacts on mental and physical health, and significant financial anxieties. The impact of work changes varied depending on individual and home circumstances. Some felt forced to ignore advice to shield and continue working. The flexibility offered by home working and changes in commuting enabled greater physical activity for some, while others missed the exercise normally undertaken as part of their commute. Others reported a constant need to be 'present' online, which heightened anxiety and worsened MSK symptoms. CONCLUSION: Lockdown showed that flexible working arrangements, which consider the positive and negative aspects of commuting, posture, movement, and work environment matter for work participation, and can have wider benefits in terms of health and well-being for those with long-term MSK conditions. Incorporating these into new models of work will help make the workplace more equitable and inclusive for people with long-term MSK conditions.

Impact of the COVID-19 pandemic on key workers in England: findings from the Health and Employment After Fifty (HEAF) Study

IntroductionIn the UK, workers who were essential to maintain communications, travel, food and healthcare were deemed ‘key workers’. There is scarce evidence about the effect that the pandemic had on this group of workers as compared with people who were home working, furloughed or retired.ObjectivesTo compare measures of health and lifestyle amongst older key workers as opposed to other older adults working or not working during the pandemic.MethodsIn February 2021 participants in the Health and Employment After Fifty (HEAF) study (aged 55–73) were sent an online survey, enquiring about changes to their mental/physical health and lifestyle during the first UK lockdown (starting late March 2020). Logistic regression was used to explore the association between being a keyworker (healthcare/not healthcare) and adverse outcomes, with adjustment for age and sex. Participants in work but not identifying themselves as key workers were used as the reference category.ResultsA total of 2,040 (46%) returned a usable questionnaire and completed the question about key worker status. 281 were in work but not as key workers;50 were key workers in healthcare;298 were key workers not in healthcare;1,411 were retired. Key workers were predominantly women. Key workers not in healthcare were more likely to see a worsening of mental health (OR=1.6;95%CI 1.0 to 2.4) physical health (OR=1.5;95%CI 1.0 to 2.3), to report that their diet was less healthy (OR=1.8;95% CI 1.2 to 2.8) and to report eating more than pre-lockdown (OR=1.6;95%CI 1.1 to 2.4) compared with participants in work but not as key workers. Associations were similar among key workers in healthcare, however they did not reach statistical significance.ConclusionBeing a key worker during the pandemic (especially not in healthcare) was associated with a deterioration of health and lifestyle choices.

Occupational characteristics associated with SARS-CoV-2 infection in the UK Biobank during August-November 2020

ObjectiveOccupational exposures may play a key role in SARS-CoV-2 infection risk. We used a job-exposure matrix (JEM) linked to the UK Biobank to measure occupational characteristics and estimate associations with a positive SARS-CoV-2 test.MethodsPeople reporting job titles at their baseline interview at assessment centers in England were included. We excluded healthcare workers and people ≥65 years old by March 2020. Jobs were linked to a JEM based on the US O*NET database. For each job, O*NET-based scores (range=1–5) were assigned for characteristics relevant for SARS-CoV-2 infection: physical proximity, exposure to diseases/infection, outdoors-exposed to weather, and outdoors-under cover. O*NET variables were used to determine whether jobs could be done remotely based on two algorithms. We evaluated SARS-CoV-2 tests occurring between August 5th and November 10th, 2020 (time when UK was not shutdown with a 5-day lag added). Cox regression was used to calculate adjusted hazard ratios (aHRs) as estimates of associations with a positive SARS-CoV-2 test accounting for age, sex, race, education, deprivation, assessment center, household size, and income.ResultsOur inclusion/exclusion criteria identified 115,581 people, including 1746 with a positive SARS-CoV-2 test. A one-point increase in physical proximity score was associated with 1.12 times higher risk of a positive SARS-CoV-2 test (95%CI=1.03–1.22). A one-point increase in exposure to disease/infections score was associated with 1.08 times higher risk of a positive SARS-CoV-2 test (95%CI=1.01–1.15). There were borderline associations between outdoors work and a positive SARS-CoV-2 test (outdoors-exposed to weather aHR=1.05, 95%CI=1.00–1.10;outdoors-under cover aHR=1.08, 95%CI=1.00–1.17). People reporting jobs that could not be done remotely had higher risk of a positive SARS-CoV-2 test regardless of the algorithm used to classify jobs (aHRs=1.16 and 1.18).ConclusionNumerous occupational characteristics were associated with increased risk of a positive SARS-CoV-2 test even after accounting for demographic and socioeconomic differences between workers.

COVID-19 lockdown disrupts support networks integral to maintaining foot health: a mixed-methods study.

BACKGROUND: In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals' engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living. METHODS: A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation. RESULTS: Two hundred fifty-five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X2 = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. 'cope or crumble' scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity. CONCLUSIONS: Pain was the most frequently reported foot problem during COVID-19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people's ability to remain physically active. Complaints previously considered relatively 'minor' such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.