Differential patterns of MSK and mental injury exist among healthcare occupational groups in Victoria, Australia. Given the significant findings, especially the high risks among ambulance personnel, future research should focus on the circumstances of injury to improve understanding and inform prevention programmes.

Occupational activities such as lifting loads, working in constrained spaces, and training increase the risk of pain-related musculoskeletal disorders (MSDs) in military veterans. Few studies have investigated MSD and psychological disorder in veterans, and previous studies had limitations. This cross-sectional study compared pain-related MSD and psychological comorbidity and well-being between 1381 male Australian 1990-1991 Gulf War veterans (veterans) and a military comparison group (n=1377, of whom 39.6% were serving and 32.7% had previously deployed). At a medical assessment, 2000-2002, reported doctor-diagnosed arthritis or rheumatism, back or neck problems, joint problems, and soft tissue disorders were rated by medical practitioners as nonmedical, unlikely, possible, or probable diagnoses. Only probable MSDs were analysed. Psychological disorders in the past 12 months were measured using the Composite International Diagnostic Interview. The Short-Form Health Survey (SF-12) assessed 4-week physical and mental well-being. Almost one-quarter of veterans (24.5%) and the comparison group (22.4%) reported an MSD. Having any or specific MSD was associated with depression and posttraumatic stress disorder (PTSD), but not alcohol disorders. Physical and mental well-being was poorer in those with an MSD compared to those without, in both study groups (eg, veterans with any MSD, difference in SF-12 physical component summary scale medians = -10.49: 95% confidence interval -12.40, -8.57), and in those with MSD and psychological comorbidity compared with MSD alone. Comorbidity of any MSD and psychological disorder was more common in veterans, but MSDs were associated with depression, PTSD, and poorer well-being in both groups. Psychological comorbidity needs consideration in MSD management. Longitudinal studies are needed to assess directionality and causality.

IntroductionCoal miners in Queensland Australia have a pre-employment medical and then medical every five years. In 2015, cases of coal workers’ pneumoconiosis (CWP) were identified among miners/ex-miners, outside the medical scheme.MethodsWe reviewed the respiratory component of the medical scheme and evaluated its design and implementation. We reviewed 91 completed medical forms, 257 chest x-rays (CXRs) and 260 spirograms and surveyed the spirometry equipment and training of providers. We interviewed employer and trades union representatives.ResultsMedicals had become focussed on fitness for work rather than surveillance. Some forms were poorly completed and the questions were inadequate to evaluate respiratory health.The criteria to trigger a CXR were unclear. Only 25% of the CXRs ‘good’ under the ILO classification scheme. 18 of the CXRs showed Category 1 simple pneumoconiosis, only two were identified in the original radiology reports.40% of the spirograms had not been performed to ATS/ERS standards and were uninterpretable. We identified 30 abnormal spirograms of which only 1 had been identified in the medical report. The survey of spirometry providers identified poor knowledge of the equipment, poor quality control processes and inadequate training.DiscussionAn effective scheme needed to more clearly articulated its surveillance purpose and to be reviewed on a regular basis.We recommended that a smaller number of experienced doctors trained and approved to undertake these assessments. The scheme needed better spirometry testing and interpretation, a better CXR referral process, improved CXR interpretation and reporting using the ILO criteria. Clinical guidelines were needed to inform diagnosis and management of CMDLD. Medical screening and surveillance is not a substitute for effective dust control, which is the primary protection against CWP. This is particularly important because it can progress even after dust exposure has ceased. These findings have implications for medical screening in other industries.