Circulating total 25(OH)D and calculated free 25(OH)D in professional academy footballers at a northerly latitude in the UK.

There is limited data on the vitamin D status of UK-based professional academy footballers. Therefore, the objective of this study was to report total 25(OH)D, free 25(OH)D and free 1, 25(OH)2D at the end of the winter (March) and summer periods (October) in a cohort (n = 27) of professional academy footballers in northern England. Blood samples were collected to measure total 25(OH)D, parathyroid hormone, vitamin D binding protein, albumin and calcium. Free 25(OH)D and 1, 25(OH)2D were calculated. Dietary vitamin D intake and retrospective summer sunlight exposure were also collected. At the end of winter, 2/27 (7.4%) players were vitamin D deficient (25(OH)D < 30 nmol/l) and 11/27 (40.7%) were insufficient (25(OH)D > 30 nmol/l < 50 nmol/l). By the end of summer, none were deficient but 3/14 (21.4%) were still insufficient. Median total 25(OH)D (82.2 nmol/l [IQR: 50.3-90.2] vs. 54.2 nmol/l [IQR: 36.8-71.9]; P = .02), free 25(OH)D (25.8 pmol/l [IQR: 15.1-33.1] vs. 13.2 pmol/l [IQR: 9.0-14.9]; P = .005) and free 1, 25(OH)2D (389 fmol/l [IQR: 209-594] vs. 212 fmol/l [IQR: 108-278]; P = .034) were significantly higher at the end of summer than the end of winter. At the end of winter, free 25(OH)D was lower (P = .003) in those vitamin D insufficient (8.8 pmol/l [IQR: 5.5-11.8]) vs. sufficient (13.7 pmol/l [IQR: 12.0-17.0]). There was a high prevalence of vitamin D insufficiency at the end of the winter. Free 25(OH)D was also lower at the winter timepoint and in players that were insufficient vs. sufficient.

Surveillance and return to work of healthcare workers following SARS-CoV-2 Omicron variant infection, Sheffield, England, 17 January to 7 February 2022.

The SARS-CoV-2 Omicron variant has challenged demands to minimise workplace transmission in healthcare settings while maintaining adequate staffing. Policymakers have shortened COVID-19 isolation periods, although little real-world data have evaluated the utility. Our findings from surveillance of 240 healthcare workers from Sheffield Teaching Hospitals, England, show that 55% of affected staff could return before day 10 of isolation with over 25% eligible on day 6, pending two successive negative antigen tests. This outcome is favourable for continuity of healthcare services.

Vocational Outcomes After Traumatic Brain Injury; Prevalence and Risk Factors After 1 Year in a Multivariable Model.

OBJECTIVE: To determine the prevalence of employment status (ES) or full-time study after traumatic brain injury (TBI) in a representative population and its predictive factors. DESIGN: Prospective cohort study. SETTING: Regional Major Trauma Centre. Participants: In total, 1734 consecutive individuals of working age, admitted with TBI to a Regional Trauma Centre, were recruited and followed up at 8 weeks and 1 year with face-to-face interview. Median age was 37.2 years (17.5-58.2); 51% had mild TBI, and 36.8% had a normal computed tomographic (CT) scan. MAIN OUTCOME MEASURE: Complete or partial/modified return to employment or study as an ordinal variable. RESULTS: At 1 year, only 44.9% returned to full-time work/study status, 28.7% had a partial or modified return, and 26.4% had no return at all. In comparison with status at 6 weeks, 9.9% had lower or reduced work status. Lower ES was associated with greater injury severity, more CT scan abnormality, older age, mechanism of assault, and presence of depression, alcohol intoxication, or a psychiatric history. The multivariable model was highly significant (P < .001) and had a Nagelkerke R2 of 0.353 (35.3%). CONCLUSIONS: Employment at 1 year is poor and changes in work status are frequent, occurring in both directions. While associations with certain features may allow targeting of vulnerable individuals in future, the majority of model variance remains unexplained and requires further investigation.

Surveillance for COVID-19 in the English Football League 2019-2020.

Medical surveillance and risk mitigation protocols to reduce viral transmission have underpinned the return of elite football during the COVID-19 pandemic. This article describes the evidence-informed approach and surveillance findings from the English Football League across a 9-week period at the end of the 2019-20 season. Protocols were devised by the lead EFL Medical Advisor with specialist occupational medicine input. Isolation requirements for cases and contacts were in-line with UK Government regulations, with external contact tracing conducted by local public health authorities. Quantitative PCR testing was conducted twice weekly and within 72 hours of fixtures. Forty-three individuals, including 18 players returned positive tests. No positive results were returned after week 5 (round 10). Our findings support those from other leagues that with appropriate compliance, elite football can continue safely during this pandemic. We recommend that protocols and compliance should be revised as necessary according to community prevalence and changes in viral transmission dynamics.

A longitudinal assessment of occupational stress in Emergency Department Nursing Staff.

AIMS: To examine perceptions of occupational stress in Emergency Department (ED) nurses and measure the impact of interventions to address them. BACKGROUND: Cross-sectional studies internationally have established that Emergency Department (ED) nursing staff experience high levels of occupational stress. Few however have examined changes in perceptions of stress over time or the impact of interventions to address them. EVALUATION: A structured questionnaire completed by volunteer nursing staff in one United Kingdom ED assessing perceptions of occupational stress and job satisfaction. Questionnaire rounds were administered in 2014 (T1), 2015 (T2) and 2017 (T3) at 18-month intervals. Statistical analyses were conducted using multivariate regression, t-tests and Mann-Whitney U tests. KEY ISSUE: Statistically significant improvements in effort-reward balance, relational justice and job satisfaction were seen between T2 and T3 for nurses completing questionnaires at all three time points, but not for other stressors. CONCLUSION: This study suggests that organisational interventions, supported by robust research data and consistent departmental leadership can positively influence perceptions of organisational stress in ED nurses. Our approach is generic, internationally applicable and can be adopted in all EDs. IMPLICATIONS OF NURSING MANAGEMENT: These occupational stressors are common to all EDs. Nurse managers should know their distribution amongst their staff. Such data can inform interventions to achieve maximal benefits for staff wellbeing and may be of value when targeting resources in times of financial pressure.

Occupational stress in the ED: a systematic literature review.

INTRODUCTION: Occupational stress is a major modern health and safety challenges. While the ED is known to be a high-pressure environment, the specific organisational stressors which affect ED staff have not been established. METHODS: We conducted a systematic review of literature examining the sources of organisational stress in the ED, their link to adverse health outcomes and interventions designed to address them. A narrative review of contextual factors that may contribute to occupational stress was also performed. All articles written in English, French or Spanish were eligible for conclusion. Study quality was graded using a modified version of the Newcastle-Ottawa Scale. RESULTS: Twenty-five full-text articles were eligible for inclusion in our systematic review. Most were of moderate quality, with two low-quality and two high-quality studies, respectively. While high demand and low job control were commonly featured, other studies demonstrated the role of insufficient support at work, effort-reward imbalance and organisational injustice in the development of adverse health and occupational outcomes. We found only one intervention in a peer-reviewed journal evaluating a stress reduction programme in ED staff. CONCLUSIONS: Our review provides a guide to developing interventions that target the origins of stress in the ED. It suggests that those which reduce demand and increase workers' control over their job, improve managerial support, establish better working relationships and make workers' feel more valued for their efforts could be beneficial. We have detailed examples of successful interventions from other fields which may be applicable to this setting.

A model for teaching occupational medicine.

BACKGROUND: Despite its relevance to medical practice, occupational medicine has been poorly represented in undergraduate training. This article describes a model for the teaching of occupational medicine to student doctors. METHODS: The model comprises two didactic lectures, a student-selected component (SSC) of five interactive two-hour sessions and one occupational medicine objective structured clinical examination (OSCE) station in the final MB ChB clinical exam. Interested final-year students are invited to join the SSC. In session 1, students discuss the scope of occupational medicine practice, which includes a job title-occupational illness quiz, the use of environmental measurements and audiovisual recordings of selected workplaces. Sessions 2-4 involve visits to workplaces such as a laundry, a foundry and a bakery, during which students are asked to record relevant hazards to health, their controls, health effects and how occupational causality might be determined. The final session allows students to present their findings and gain feedback from the occupational physicians and their peers. Occupational medicine has been poorly represented in undergraduate training RESULTS: Twenty-seven student doctors chose to undertake the SSC in three cycles. Students appreciated the relevance of the specialty and the opportunity to systematically evaluate workplaces. Eighty per cent of all final-year medical students (n = 250) passed the occupational medicine station in the OSCE in 2014. CONCLUSIONS: This model for the teaching of occupational medicine links work and medical practice at three stages of undergraduate training and could be adopted by all medical schools. The SSC gave students skills for undertaking illness prevention, workplace evaluation and risk assessment that they had not previously encountered.

Developing a multidisciplinary approach within the ED towards domestic violence presentations.

AIM: To improve the detection and quality of care of patients who attend the emergency department (ED) with confirmed or suspected domestic abuse (DA). DESIGN: A quality improvement report on the design, implementation and evaluation of a specialised service and structured training programme to detect and manage DA presentations within an emergency medicine department. SETTING: The study was set in the ED at the Northern General Hospital, Sheffield, UK. KEY MEASURES FOR IMPROVEMENT: Key measures for improvement included introducing a service within the ED to help staff manage DA and coordinate responses; improve staff confidence in detecting DA; develop a structured and consistent process by which to manage DA presentations. STRATEGIES FOR CHANGE: An Independent Domestic Violence Advocate service was introduced into the department in July 2011 through a multiagency agreement. A structured training and education programme was delivered to ED staff. A 'communications form' was developed for DA risk assessment and case management. The process was reviewed quarterly. RESULTS: One hundred and seventy-two referrals were made to the service (121 distinct clients) over a 12-month period. Staff reported greater confidence in detecting DA, and community partners highlighted the role the service had in improving DA detection and care quality within the city. CONCLUSIONS: Strong leadership and prioritising the issue within the department has facilitated the development of the process and contributed substantially to its success. Support from community partners has been invaluable in tailoring the service and education programme to the needs of staff and patients within the department.

Management of occupational hazards in healthcare: exposure to diphencyprone.

Diphencyprone is a chemical agent used most commonly in the treatment of alopecia areata. Its mechanism of action is through the sensitisation (type IV immune reaction) of affected areas to stimulate hair follicle growth. The consequences of accidental occupational exposure, however, have not been widely recognised. This report describes the clinical presentation and management of two pharmacy technicians that presented to Sheffield Occupational Health Service (SOHS) centre in 2012. Exposure sources were identified through a workplace visit arranged between the SOHS centre and the hospital's pharmacy; a chemical analysis revealed concentrations of the chemical sufficient to induce sensitisation at several points during the manufacturing process. The case highlights the role of close liaison between specialist services (dermatology and occupational medicine) in managing individual patient cases and mitigating risk within relevant occupational groups.

Competence in the musculoskeletal system: assessing the progression of knowledge through an undergraduate medical course.

BACKGROUND: Professional bodies have expressed concerns that medical students lack appropriate knowledge in musculoskeletal medicine despite its high prevalence of use within the community. Changes in curriculum and teaching strategies may be contributing factors to this. There is little evidence to evaluate the degree to which these concerns are justified. OBJECTIVES: To design and evaluate an assessment procedure that tests the progress of medical students in achieving a core level of knowledge in musculoskeletal medicine during the course. PARTICIPANTS AND SETTING: A stratified sample of 136 volunteer students from all 5 years of the medical course at Sheffield University. METHODS: The progress test concept was adapted to provide a cross-sectional view of student knowledge gain during each year of the course. A test was devised which aimed to provide an assessment of competence set at the standard required of the newly qualified doctor in understanding basic and clinical sciences relevant to musculoskeletal medicine. The test was blueprinted against internal and external guidelines. It comprised 40 multiple-choice and extended matching questions administered by computer. Six musculoskeletal practitioners set the standard using a modified Angoff procedure. RESULTS: Test reliability was 0.6 (Cronbach's alpha). Mean scores of students increased from 41% in Year 1 to 84% by the final year. Data suggest that, from a baseline score in Year 1, there is a disparate experience of learning in Year 2 that evens out in Year 3, with knowledge progression becoming more consistent thereafter. All final year participants scored above the standard predicted by the Angoff procedure. CONCLUSIONS: This short computer-based test was a feasible method of estimating student knowledge acquisition in musculoskeletal medicine across the undergraduate curriculum. Tested students appear to have acquired a satisfactory knowledge base by the end of the course. Knowledge gain seemed relatively independent of specialty-specific clinical training. Proposals from specialty bodies to include long periods of disciplinary teaching may be unnecessary.