Assessing the profile and utility of diplomates in occupational medicine.

BACKGROUND: The utility of the occupational medicine diploma in the UK is yet to be explored. The NHS 'Growing Occupational Health (OH) and Wellbeing' programme provides opportunities for diplomates to increase their OH work. AIMS: To assess what proportion of diplomates carry out OH work, the type of work being undertaken, to identify obstacles impeding OH work, to capture their interest in future work opportunities and what additional support they require. METHODS: A link to an online questionnaire was sent to diplomates via several professional bodies; we estimate that 2428 diplomates received this. The survey was open from 24 March to 31 May 2022. RESULTS: Replies were received from 310/2428 (13%) diplomates. Fifty-two per cent of respondents were males and 35% were female. Respondents were diverse in terms of age and geographical region. Main employment settings: 13% primary care, 43% secondary care, 31% private sector, 24% public sector and 20% self-employed. Seventy-two per cent of diplomates had undertaken OH clinical work since completion of their diploma, and 90% of those were undertaking OH clinical work at the time of the survey. Specific obstacles to accessing OH work highlighted included existing workload constraints, lack of employment opportunities with OH providers and lack of time. CONCLUSIONS: Many (126/310; 41%) respondents had considered increasing their OH work in the previous 12 months. Increasing mentorship from senior OH clinicians to diplomates was suggested by 4% of respondents to enhance the utility of diplomates.

Variations in self-reported health by occupational grade in the British Post Office: the Q-health project.

Between 1995 and 1998 a national sample of 58,501 (42,885 males, 15,616 females) Post Office employees (29%) completed and returned a postal questionnaire survey providing information on demographic characteristics, physical and psychological health, health and lifestyles and health screening behaviour. Response rates by occupational grade were as follows: manual (male 69.3%, females 43.6%); clerical (male = 11.8%, female, 42.3%); middle management (males 15.5%, females 10.7%) and senior management (males 3.4%, females 3.3%). A number of differences in health status occurred with occupational grade. Angina, high blood pressure, obesity, smoking, arthritis, disability, GP consultations and abnormal smears were all more prevalent in lower occupational grades. Height, job satisfaction, seat belt use and breast self-examination were also lower in lower status jobs. Some findings were unexpected: GHQ scores indicated better mental health in lower grades, whilst knowledge and frequency of testicular self-examination and attendance for mammograms were higher in lower grades. Self-reports for asthma, diabetes and family history of bowel cancer were also greater in higher grades. These findings are considered in terms of response bias, health selection, the psychosocial work environment, occupational health interventions and the nature, meaning and organization of social position within the Post Office.

Reviewing car fleet performance after advanced driver training.

Following a review of car fleet performance information, the high cost of accidents in a small fleet was highlighted. Measures were introduced, including advanced driver training and fleet performance followed-up. Significant improvements in accident rates, with reduced costs were recorded. The savings achieved outweighed the expenditure on the measures introduced.

Mathematical theory of group selection: Structure of group selection in founder populations determined from convexity of the extinction operator.

Genetic analysis for group selection is developed for the case of a biallelic locus (A, a) undergoing group selection of founder populations only. By contrast to R. Levins"E = E(x) models, extinction now depends on genetics at the propagule stage but acts uniformly on larger populations. Biological evidence supports this hypothesis, which also allows mathematical treatment at once simpler and biologically more general than the Fokker-Planck partial differential equation formalism adopted by Levins. It is presently possible to handle cytogenetics of both diploid and haplodiploid type. The model is set up as a quasideterministic recursion in the 5-simplex Sigma(5), collapsing both drift and mendelian selection effects into a single parameter u, which is a Fisher-Kimura-Ohta fixation probability. In the analysis, it is shown that the stability of the fixed points is determined by the convexity of the extinction operator acting on propagules, assumed to be of size 2.THUS, [FORMULA: see text] in which E(1) and E(3) are extinction probabilities for phenotypically uniform founder populations and E(2) is the corresponding probability for founder populations of mixed phenotype. Further parameter regions are defined where fixation of the group-selected gene is globally stable, and this is still possible even when extinction pressure acting on carrying capacity populations becomes weak relative to a fixed mendelian selection strength.

Island models for takeover by a social trait facing a frequency-dependent selection barrier in a Mendelian population.

A population genetic model is presented for selection of a Mendelian trait controlling for cooperative behavior between unrelated conspecifics. Under simple and robust assumptions, such a trait will be selected on a frequency-dependent basis, with a critical threshold frequency (beta(2) (crit)) of the social trait which must be exceeded before favorable selection of this trait can occur. Existence of this threshold gives rise to a basic evolutionary problem as to how evolution from an asocial state (beta congruent with 0) to a social state (beta congruent with 1) can take place. A formal model of this evolution is proposed which rests on obstacles to random mixing (population viscosity). The key fact is the possibility that an initial local concentration of the social trait may be able to spread out under the joint effects of selection and migration and eventually take over a much larger species population. It is argued that this model is the first formal model to capture the ideas of Wright concerning group selection of an altruist trait in an island-structured population.

A frequency-dependent natural selection model for the evolution of social cooperation networks.

A model is presented for the evolution of several aspects of sociality based on reciprocal ties of social cooperation, modeling especially cooperative hunting behavior in carnivores. This model captures the possibility of a critical threshold in gene frequency, which, if reached, will lead to an explosion toward fixation of the "social" trait. This threshold phenomenon might be restated as follows: the precondition for evolution favorable to the specific form of social behavior considered is hard to satisfy, but-once this condition is satisfied-the tendency toward sociality is effectively irreversible. The simple model proposed appears to be highly robust, with most realistic changes additionally favoring the social gene.

Group selection on the boundary of a stable population.

A model of group selection is constructed for the case of differential extinction acting on small boundary populations of a large, fixed population. Consideration is restricted to extinction operators acting at or near to carrying capacity. Under the assumption that the extinction rate is large relative to individual genetic parameters affecting gene frequencies in boundary populations, we discuss the conditions under which differential extinction is most likely to produce a significant effect. In particular, a condition for bimodality in the distribution of gene frequencies in boundary populations (population polymorphism) is that there be some critical allele frequency at which the extinction rate jumps from high to low. An extinction operator linear in allele frequency produces no qualitative effect of this kind. In consequence, we are able to make precise rather limited circumstances under which group selection is likely to have a significant effect.