Breast cancer and work outcomes in health care workers.

BACKGROUND: Cancer survivors are at a higher risk of leaving the labour market prematurely than healthy individuals or those with other chronic conditions. They continue to report difficulty in re-entering the workplace after diagnosis and treatment. AIMS: To investigate return to work in health care staff with a diagnosis of breast cancer and the adjustments required to assist them. METHODS: We identified health care workers with a diagnosis of breast cancer, seen by occupational physicians in a National Health Service occupational health (OH) service, between 2000 and 2012. Review of OH records was conducted and information relating to return to work and sick leave was recorded. RESULTS: One hundred and seventeen staff members were identified, and 111 (95%) returned to work. Almost all (109) required workplace adjustments to do so: 97 had temporary adjustments and 12 permanent changes. The majority of those who returned to work (98) did so within 1 year. CONCLUSIONS: This study showed a higher return to work rate in the first year, following treatment for breast cancer, than described previously. Workplace adjustments, recommended by an occupational physician, were provided for the majority.

Back pain in pre-registration house officers.

Back pain is a major burden on the working population. It is a particular problem amongst hospital staff, especially nurses. It has been poorly studied amongst doctors. Pre-registration house officers (PRHOs) starting their careers are exposed to a number of risk factors for back problems, both physical and psychological. This questionnaire-based study investigated the prevalence of back pain and its impact on the work of new graduates from two UK medical schools. Around half of the newly qualified PRHOs had significant back pain, one-quarter at least once a week. The frequency of back pain doubled once they started work, although the overall prevalence remained static. One in 10 of them had been unable to perform their normal work activities at some stage because of back pain. One in eight had sought professional help for back problems in the previous 5 years. Fewer than 50% of newly qualified doctors could recall any formal training in lifting and handling.

Colorectal cancer prevention. An approach to increasing compliance in a faecal occult blood test screening programme.

STUDY OBJECTIVE: The assessment of the uptake of colorectal cancer screening offered in a workplace setting. DESIGN: Employees were offered a free faecal occult blood test (Haemoccult). A repeat letter was sent two months later to non-responders. Those with positive tests were invited for colonoscopy. Compliance was measured according to age, sex, and occupational group and the effects of reinviting non-compliers investigated. SETTING: Leicester General Hospital, a large university teaching hospital. PARTICIPANTS: 990 employees aged 41 to 65 years. MAIN RESULTS: Total compliance was 46% with women participating more than men (49% v 34%, chi 2 = 12.2, p < 0.001). The difference was mostly because of women aged 41 to 50 years complying more than their male counterparts (48% v 24%, chi 2 = 15.5, p < 0.0001). Participation was highest in clinical support staff (56%), nurses (52%), and clerical workers (46%). Uptake by doctors (26%) and managers (26%) was significantly lower than by clinical support staff and nurses (chi 2 > 5.5, p < 0.02). Remailing raised compliance slightly from 43.6% to 46.3%. Four employees (1%) had positive faecal occult blood tests but three were negative on repeat testing with dietary restrictions. CONCLUSIONS: The government favours the development of health promotion programmes as stated in its document "Health at work in the NHS". The response in this study, showed methods to increase compliance must be developed if such programmes are to be successful. As uptake was similar to that in several community based programmes in general practice, workplace based programmes could offer a complementary method of delivering screening.

Communication between an occupational physician and other medical practitioners--an audit.

Four hundred and seventy-two consecutive referral episodes relating to 386 patients attending the Occupational Health Department of a general teaching hospital were analyzed to evaluate the frequency, content and effect on management of communications between the occupational physician and other doctors. In all, 250 episodes (53%) were associated with such a communication. The likelihood of a communication was strongly influenced by reason for referral, particularly in respect of long or short term sickness absence; univariate odds ratios (OR) = 10.58, 95% CI = 8.13-27.08) and 2.65, 95% CI = 1.55-4.60) respectively; a medical diagnosis of psychiatric illness (OR = 3.17, 95% CI = 1.69-5.97)); and by number of consultations. Communication was also more likely when the occupational outcome was ill health retirement, rehabilitation in work or modified work. Ninety-eight per cent of specific requests for information or an opinion elicited a reply. Information received from other doctors influenced the occupational health physician's management in 52 referral episodes (20%). Specific action by GPs as a result of communication was documented in 54 and by specialists in 37 episodes. The importance of communication between occupational health physician and other doctors in the occupational health process is confirmed.

The pattern of presentation of carcinoma of the uterine cervix in East Anglia 1960 to 1975.

Changes in the pattern of presentation of carcinoma of the uterine cervix between 1960 and 1975 were studied using the records of 3193 patients registered with the East Anglian Cancer Registration Bureau. Between 1963 and 1968, an increased registration rate for invasive tumours was largely attributable to increased registrations of Stage I and II lesions in the 35 to 49 age group. After 1970 the registration rate for lesions of all stages in this age group declined. Over the same period the 50 to 64 age group showed a tendency for an increased proportion of registrations to be of Stage I or II lesions. There was little change in pattern in the over-65 age group. The possible relation of these changes to the introduction of a cervical cytology screening programme and the implications for future screening policies are discussed.

Carcinoma of the breast in East Anglia 1960-1975: a changing pattern of presentation?

A study was made of the clinical stage at presentation in 10 081 cases of carcinoma of the breast registered with the East Anglian Cancer Registration Bureau between 1960 and 1975. Information about the length of clinical history was obtained in 8862 cases. There has been a gradual increase in the population-adjusted incidence of breast carcinoma in the region during the period studied. Since 1968, there has been a consistent increase in Stage I and II registrations, but a fall in Stage III registrations. Stage IV registrations have remained constant. A greater proportion of women with Stage I or II lesions present with a short clinical history, and this pattern has not changed during the course of the study. We suggest that increased interest in, and opportunities for, the early diagnosis of breast disease are leading to a change in the pattern of presentation.