Work stress, smoking status and smoking intensity: an observational study of 46 190 employees

Study objective: To examine the relationship between work stress, as indicated by the job strain model and the effort-reward imbalance model, and smoking. Setting: Ten municipalities and 21 hospitals in Finland. Design and Participants: Binary logistic regression models for the prevalence of smoking were related to survey responses of 37 309 female and 8881 male Finnish public sector employees aged 17-65. Separate multinomial logistic regression models were calculated for smoking intensity for 8130 smokers. In addition, binary logistic regression models for ex-smoking were fitted among 16 277 former and current smokers. In all analyses, adjustments were made for age, basic education, occupational status, type of employment and marital status. Main results: Respondents with high effort-reward imbalance or lower rewards were more likely to be smokers. Among smokers, an increased likelihood of higher intensity of smoking was associated with higher job strain and higher effort-reward imbalance and their components such as low job control and low rewards. Smoking intensity was also higher in active jobs in women, in passive jobs and among employees with low effort expenditure. Among former and current smokers, high job strain, high effort-reward imbalance and high job demands were associated with a higher likelihood of being a current smoker. Lower effort was associated with a higher likelihood of ex-smoking. Conclusions: This evidence suggests an association between work stress and smoking and implies that smoking cessation programs may benefit from the taking into account the modification of stressful features of work environment. Key words: effort-reward imbalance; job strain; smoking. Abbreviations: OR, odds ratio; CI, confidence interval; SES, socioeconomic status

Should eye protection be worn during dermatological surgery: prospective observational study

Background There is a potential risk of infection with blood-borne viruses if a doctor receives a blood splash to a mucous membrane. The quantification of facial contamination with blood has never been documented in the context of dermatological surgery. Objectives (i) To identify the number of facial blood splashes that occur during skin surgery and to identify the procedures that present higher risks for the operator and assistant. (ii) To assess the provision of eye protection and attitudes to its use in dermatological surgery in the U.K. Methods (i) Prospective, observational study in the skin surgery suite of a U.K. teaching hospital assessing 100 consecutive dermatological surgery procedures, plus 100 consecutive operations in which an assistant was present. Primary outcome: number of face-mask visors with at least one blood splash. Secondary outcomes: to identify if any of the following variables influenced the occurrence of a blood splash: grade of operator, site and type of procedure, and the use of electrocautery. (ii) A postal survey of all U.K.-based members of the British Society of Dermatological Surgery (BSDS) was conducted assessing facilities available and the attitudes of U.K.-based clinicians to the use of face masks during surgery. Results (i) In 33% of all surgical procedures there was at least one facial splash to the operator (range 1–75) and in 15% of procedures the assistant received at least one splash (range 1–11). Use of monopolar electrocautery was significantly less likely to result in splashes to the mask compared with bipolar electrocautery [odds ratio (OR) 0Æ04; 95% confidence interval (CI) 0Æ01–0Æ19]. Compared with the head/neck, operations on the body were significantly more likely to result in splashes to the mask (OR 6Æ52) (95% CI 1Æ7–25Æ07). The type of procedure and the status of the operator did not have a bearing on the likelihood of receiving a splash to the mask. (ii) From the survey, 33 of 159 (20Æ8%) of BSDS members had no face masks available and 54 of 159 (34Æ0%) did not wear any facial protection while operating. The majority (53Æ5%) thought they received a splash in £ 1% of procedures. Conclusions There is a substantial risk of a splash of blood coming into contact with the face during dermatological surgery for both the operator and assistant, regardless of the procedure. The risk of receiving a blood splash to the face may be substantially underestimated by U.K.-based dermatologists. The use of protective eyewear is advisable at all times, but particularly when using bipolar electrocautery, or when operating on high-risk individuals.