None listed
Conditions
Brief summary
Impaired health can increase the risk of workplace accidents and injuries, and impair quality of life. For those who do not receive regular medical check-ups, which is often difficult in industries such as transportation due to long and irregular work hours, medical conditions can remain unrecognised. Conditions with a prolonged lead time from the development of the condition to the time of diagnosis are potential targets for screening programs, aiming at early identification and management resulting in improved symptoms and reduced risk of complications including workplace accidents. Over 60% of fatalities in the Victorian transport industry are caused by traumatic injuries and another 30% are caused by cardiovascular disease (CVD). High rates of sleep disorders are also reported in transport workers, and have been associated with an increased risk of accidents. Furthermore, short sleep for even one night has been associated with an increase in crash risk. Given that accidents, CVD and sleep are key and inter-related concerns for transportation workers, the current project assessed the impact of introducing a health screening program in the transport industry. This program was designed to educate and screen for CVD risk factors and sleep disorders, and identify and refer high risk workers for medical intervention via referrals and follow-up advice. It was hypothesised the health screening program would reveal a high prevalence of CVD risk factors and sleep disorders in transportation workers, similar to that demonstrated in previous research in this industry. Furthermore, it was anticipated we would achieve a high level of participation in the screening program and compliance with medical follow-up of abnormal results. Finally, we hypothesised the education and screening program would be associated with a reduced rate of workplace injuries. Educational programs were conducted at participating transport companies and all drivers at these companies were invited to participate in the health screening which consisted of the following measures: the Epworth Sleepiness Scale; the Multivariable Apnea Prediction index; frequency of sleepiness and falling asleep whilst driving; sleep duration; occupational factors (driving and work hours, driving distance, shift type); motor vehicle accident (MVA) history; CVD risk factors (gender, smoking, family history, blood pressure, blood glucose); body mass index; and alcohol intake. Participants received personalised feedback and advice dependent on the results of the screening. The primary outcomes of the project focused on determining the relationship between sleepiness (hypersomnolence) and sleep duration on MVA risk, and the relationship between occupational demands and cardiovascular health. The success of the screening program was also investigated by examining transportation workers’ compliance with medical follow-up recommendations and changes in workplace injury rates.
Interventions
Phase 1: Sleep disorders and cardiovascular health education and screening program
Educational programs were conducted at participating commercial road transport companies and all drivers at these companies were invited to participate in the health screening program.
Education program: Educational material about the causes and risks associated with sleepiness (hypersomnolence), sleep disorders, cardiovascular disease and associated risk factors was presented to transport workers through the di
Phase 1: Sleep disorders and cardiovascular health education and screening program Educational programs were conducted at participating commercial road transport companies and all drivers at these companies were invited to participate in the health screening program. Education program: Educational material about the causes and risks associated with sleepiness (hypersomnolence), sleep disorders, cardiovascular disease and associated risk factors was presented to transport workers through the distribution of posters, health information sheets, and a video about sleep disorders. In addition, trained medical and nursing staff attended workplaces and transport industry functions to deliver presentations to groups of workers on sleep disorders and cardiovascular health. Health screening: Trained nurses visited workplaces to give face-to-face presentations to workers and provide confidential screening for sleep disorders, cardiovascular risk factors, smoking and alcohol use. The screening procedure consisted of the following measures: Self-reported general information: • Gender • Age • Amount of days and hours worked • Hours of sleep during work and rest days • Motor vehicle accident history (accidents where either the police were called, someone was injured, or a vehicle was damaged and required repair) Measured health information: • Height • Weight • Blood pressure • Diabetes risk (blood glucose levels) Self-reported health information: • Current smoking status and amount of cigarettes smoked • Amount of alcoholic drinks on work and rest days • Frequency of falling asleep while driving • Frequency of fearing falling asleep while driving • Daytime sleepiness (Epworth Sleepiness Scale (Johns 1991)) • Obstructive Sleep Apnea risk (Multivariable Apnea Prediction Index (Maislin, Pack et al. 1995)) • Family history of diabetes, hypertension The health education and screening program was conducted at workplaces in the Victorian transport industry (Victoria, Australia) over a three-year period. A total of 134 companies were approached to participate in the health education and screening program and 87% (95% CI 81.31-92.69) of these participated. In total, 3873 of the 11992 transport industry workers at the participating companies undertook individual health screening. Duration and timing of health education and screening: The health educational program performed at workplaces to groups of transport workers usually lasted around 30 minutes, and this was normally followed by health screening sessions. The health screening session lasted around 15 minutes per participant. The health educational program was administered at the workplace. The health screening was also conducted at the workplace, and within the same week of the program. Program materials: The health program support materials provided to participants were developed specifically for the program. The support materials outlining risk factors and symptoms for obstructive sleep apnoea, type 2 diabetes, heart disease and cholesterol were consistent with evidence based guidelines (Australasian Sleep Association, 2018, Obstructive Sleep Apnoea, Retrieved: from https://www.sleep.org.au/documents/item/78; Sleep Health Foundation, 2011, Obstructive Sleep Apnea (OSA) Fact Sheet, Retrieved from: https://www.sleephealthfoundation.org.au/files/pdfs/Obstructive%20Sleep%20Apnoea.pdf; Diabetes Australia, 2015, Type 2 Diabetes, Retrieved from: https://www.diabetesaustralia.com.au/type-2-diabetes; The Heart Foundation, 2018, What is coronary heart disease? Retrieved from: https://www.heartfoundation.org.au/your-heart/heart-conditions/what-is-coronary-heart-disease; The Heart Foundation, 2018, What is cholesterol?, Retrieved from: https://www.heartfoundation.org.au/images/uploads/main/For_professionals/Cholesterol_brochure_2018.pdf). Where appropriate, these support materials also included information and contact details for organisations to help with specific conditions. This was in addition to medical follow-up (outlined below). This included links for the following problems: Alcohol abuse - Direct Line, counselling service Smoking cessation - Quit Help line and the Smoking Cessation Unit, Austin Hospital Diabetes - Diabetes Association, information, education and counselling service Obesity - Gut busters, weight loss program Heart Disease - National Heart Foundation, information and support services Chronic lung disease - Australian Lung Foundation, information and support services Sleep Disorders - Institute for Breathing & Sleep, Australasian Sleep Association Mens’ Line – depression, suicide, relationship problems Phase 2: Program evaluation - medical follow-up The results for each measure collected during the health screening (see above) were entered into a database and categorised as normal, abnormal or severely abnormal for each health outcome. Participants with severely abnormal results were recommended for urgent medical follow-up, whilst those with other abnormal results were recommended for non-urgent medical follow-up. Written feedback and results from the health screening were provided directly to the participant, along with recommendations for (urgent or non-urgent) medical follow-up with their medical practitioner for specialist medical evaluation if required (i.e., abnormal or severely abnormal results). In addition to recommendations for medical follow-up, the feedback provided to participants included specific advice about lifestyle modifications, for example the likely causes of sleepiness and specific advice about minimising sleepiness based on this information. To evaluate the number of participants attending for medical follow-up, general practitioner doctors were asked to sign and return a reply-paid postcard indicating the conditions that were followed-up. In addition, a random telephone survey was undertaken of those participants referred for follow-up but whose card was not returned. Participants medical follow-up was monitored for the duration of the health education and screening program (i.e., a three-year period). Phase 3: Program evaluation – Injury and accident follow-up Company workplace injury data was collected for a 12-month period prior to and following completion of the heath education and screening program using data from a group of companies involved in the first year of the program. This included participants new lost time injuries and days lost due to new lost time injuries calculated for before and after the program. This information was used to further evaluate the impact of the health education and screening program on workplace injuries and accidents.
Sponsors
Dr Mark Howard
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Victorian (Victoria, Australia) transport industry workers employed at one of the companies participating in the educational and screening program. Individual drivers and independent contractors were also included.
Exclusion criteria
None
Outcome results
None listed