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Long-haul crew experience regular misalignment of the circadian rhythm causing several jet lag symptoms. However, it is unclear whether melatonin acrophase shifts post-trip relate to perceived jet lag. In addition, the role of psycho-behavioural variables on the relationship between subjective and objectively measured jet lag and fatigue are largely ignored. Further, recent research indicates that the timing of meals may help reduce jet lag symptoms on days off. The overall aim of the thesis was to give a comprehensive account of jet lag in long-haul cabin crew in terms of the relationship between bio measures and symptom perception. Four studies were undertaken. In Study 1 (longitudinal), 35 long-haul crew completed measures of circadian preference, coping, stress arousal, objective sleep parameters and subjective jet lag. The results found that i) symptoms of jet lag were worse on the day crew returned home and ii) perceived lower appetite than normal and restless sleep (objective) predicted subjective jet lag. In Study 2 (longitudinal, N = 28), circadian phase [melatonin acrophase (peak time)] was also measured. The results found a discrepancy between subjective jet lag change scores and circadian phase change post-flight predicted by perceived lower appetite than normal. In Study 3 (cross-sectional), 95 crew completed measures of illness cognitions, coping, social support, pre-work strategies, subjective jet lag and fatigue. Timeline predicted subjective jet lag, consequences predicted subjective fatigue whereas a reduction in multidimensional jet lag was predicted by increased social support. In Study 4 (randomized controlled trial, N = 60), half the participants formed an implementation intention to eat regular meals on days off (intervention) and half did not (control). Pre-intervention measurements were taken at baseline and post-intervention measures on the second recovery day. Formation of an implementation intention to eat regularly resulted in a reduction of jet lag (unidimensional) but not multidimensional jet lag and objective alertness (PVT). These findings demonstrate that jet lag is in part a psycho-social construct, not just a biological one, which is influenced by sense making and can be moderated through diet. The results have important practical and theoretical implications.

This thesis provides a critical evaluation of a real world project involving the researcher as leader of a review and subsequent development of a new Code of Conduct for the world’s largest health and safety body, the Institution of Occupational Safety Health (IOSH, 2011). The health and safety profession in the UK has seen many changes over the last 10-years, in particular a stronger focus on degree education, continual professional development (CPD) and Chartered Practitioner status. In addition to these progressive changes the profession has also seen a rise in the negative media coverage regarding reported risk aversion in decision-making processes. In response to the negative media and at the request of the conservative party, then in opposition, Lord Young led a complete review of health and safety in Great Britain(Young, 2010). More recently, the Government requested a further independent review into health and safety legislation (Löfstedt, 2011). Since the publication of these reports there have been calls for more rigorous competence standards for consultants and a move towards more industry led self-regulation. This has seen IOSH placed in a strong influencing position, albeit with added scrutiny of its own regulation of members. The researcher led a critical review of the existing Code as part of an IOSH standing Committee, the Profession Committee (PC) that has the responsibility among other things for examining allegations of misconduct. The project was conducted as action research and was divided into 4 cycles or stages. Stage 1 involved the critical review and benchmarking of the existing Code against other Codes using an adaptation of the PARN criteria. Stage 2 involved the consultation process for the development of a new Code. This included the researcher’s role as leader of the project and an evaluation of misconduct cases reviewed by the PC. Stage 3 involved semi-structured interviews of practitioners to explore experiential accounts of ethical issues from practice to inform the guidance on the Code. Finally, Stage 4 involved the concluding consultation and consolidation of all the stages for presentation of the revised Code to IOSH Council for approval. The project reinforced the benefits of applying a systematic approach for the development of professional body documentation. It also revealed the value of applying a flexible iterative methodology in the real world environment to prevent the project from diverging from its real world objectives. The outcome of the project has been positively received by IOSH. A new Code was produced with guidance and a revised disciplinary procedure that is fit for purpose and adaptable to change through the use of robust development and broad consultation processes. It is anticipated that these changes will make a significant contribution to the wider profession and practice. An ethical decision making model was developed from the findings and includes a dissemination strategy for the profession.

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Background and Aims: The Sohar Industrial Zone (SIZ), Oman, which started to operate in 2006, contains many industries that possibly affect the health of the local population. This study was carried out to evaluate the health effects in a population living near SIZ. Methods: Retrospective health care visits for acute respiratory diseases (ARD), asthma, conjunctivitis and dermatitis were collected between 2006 and 2010 for 2 large provinces with geographic proximity to SIZ. Exposure of the surrounding villages was classified using proximity to SIZ. Three exposure zones were defined according to the distances from the SIZ: ≤5, >5-10, ≥20 km representing high, intermediate and control exposure zones respectively. Age and gender-adjusted monthly counts of visits for the selected diseases were modelled using generalised additive models controlling for time trends. The high and intermediate exposure zones were later merged together due to similarity of effects. Exposure effect modification by age, gender and socioeconomic status (SES) was also tested. Results: Living within 10 km from SIZ showed greater association for ARD (RR: 2.5; 95% CI: 2.3-2.7), asthma (RR: 3.7; 95% CI: 3.1-4.5), conjunctivitis (RR: 3.1; 95% CI: 2.9-3.5) and dermatitis (RR: 2.7; 95% CI: 2.5-3.0) when compared to the control zone, for the population of <20 years. For the population of ≥20 years, these risks were: (RR: 2.0; 95% CI: 1.9-2.2), (RR: 3.6; 95% CI: 3.0-4.4), (RR: 2.8; 95% CI: 2.5-3.2) and (RR: 2.1; 95% CI: 1.9-2.4), respectively. Greater exposure effects were observed amongst ages ≥50 years and lower SES groups in the ≥20 years group. Models showed no differences between the gender groups. Conclusion: This is the first study conducted in Oman examining the adverse health effects on the population living near SIZ. We hope that these findings will contribute to building up an evidence-based environmental and public health policy in Oman.

Regular physical activity is associated with improved physiological and psychological wellbeing, by reducing the risk of chronic illnesses such as cardiovascular disease, cancer, obesity, diabetes, osteoporosis and depression. There is a common perception that physical activity levels in the population are declining, and one of the biggest changes affecting this is occupational based activity. Since adults spend on average over 50% of their waking hours at work, work sites have the potential to be an important setting for health promotion initiatives. Cognitions and behaviours are key causal factors behind many of today s most widespread health problems and illnesses. The stage of change model has been highlighted as having intuitive appeal because it considers the dynamic nature of attitudes and behaviour change. This thesis is concerned with the application of the stage of change model to an occupational health intervention promoting physical activity. Several research studies were undertaken to explore the experiences of employees with workplace health initiatives and investigate the strategies and practices used by occupational health to promote healthy behaviours. These research studies highlighted the barriers and facilitators to successful health interventions and contributed towards the design, development and implementation of an activity promotion intervention. Additional research was also conducted to develop information materials based on the stage of change model. The stage approach was simplified and intervention materials were classified based on whether employees were thinking about making a change or not thinking about making a change to their activity levels. In order to test the materials, a twelve month intervention was implemented in ten work sites across the UK that were allocated to one of three groups. Two groups received information materials and one group received no information during the intervention period (control group). The difference between the two groups who received information was that one group received standard activity promotion information (standard group) and the second group received tailored information based on their stage of change construct (staged group). Participants in the staged intervention group demonstrated significant decreases in body mass index, fat percentage, waist circumference, blood pressure and resting heart rate following the twelve month intervention. In contrast, reductions were identified for the standard intervention group for waist circumference and diastolic blood pressure. Finally, there were no long-term significant improvements identified for the control group. However, group comparisons revealed there were no significant differences between the intervention conditions. The intervention also recorded self-reported psychological outcomes, which demonstrated variations throughout the intervention period for all groups. The potential reasons for these inconsistent outcomes are discussed. A process evaluation following the intervention demonstrated employees valued the health screenings and identified issues relating to knowledge, behaviour change and health implications that were important outputs of the intervention. Based on these findings, the research concludes there is scope to make physical activity interventions in the workplace more effective by applying the stage of change approach. Using the process of simplifying the stages and focusing on whether employees want to change their behaviours or not allows occupational health to deliver information that could be more meaningful and have a significant impact on behaviour change. By understanding employees readiness to change their activity behaviours and targeting information based on their beliefs, attitudes and intentions to change may produce significant improvements in health outcome measures compared to standard information. The results also suggest there is potential for this type of tailored intervention to be extended to other occupational health issues.

Adverse work environments, occupational sickness and accidents are common problems for many ‘Small and Medium Scale Enterprises’ (SMEs) in different parts of the world. Seeking better ways to improve health and safety in SMEs is a key target for national authorities and international agencies. This study aims to apply and evaluate the effectiveness of an occupational health training method called ‘Participatory Action Oriented Training’ (PAOT); claims have been made that PAOT is an effective technique for improving health and safety at SMEs in developing countries. An intervention study was performed with the assistance of 20 volunteer SMEs from five major industries in Can Tho City, Vietnam, between May 2007 and May 2008, to evaluate the effectiveness of the PAOT programme. The programme was applied in 10 factories and the traditional local health and safety methods were applied to the 10 ‘control’ factories. The research was conducted in two phases (pre-intervention and post-intervention) and consisted of matched cross-sectional studies using managers’ questionnaires (n=69), environmental measurements (personal dust (n=360), static dust (n=360), toxic gases (n=72), noise (n=540), lighting (n=900), air temperature (n=720), air humidity (n=720), air velocity (n=720)). Data were also collected quarterly follow-up visits to record the number of improvements that had been made, and to obtain monthly factory reports on productivity, workers’ income, accidents, sickness absence, health visits, and health costs. There were significant improvements among intervention factories after one year in terms of environment measurements, numbers of improvements, numbers of cases of sickness and accidents, health costs, productivity and workers’ incomes. The findings of the intervention study support the idea that a PAOT programme produces better outcomes in SMEs than a local traditional occupational health programme. The current study was limited, however, in a number of ways, and a fuller examination of PAOT will require a larger study with more environmental measurements taken over a much longer period of time, together with data on sickness absence and accidents that have been independently validated.

The increase in certified sickness absence recorded in most European countries during the last decade is of increasing concern to public health agencies. While sickness absence can promote rest and recovery from illness, it may also have negative consequences, including increased risks of inactivity and isolation, poorer quality of life and increased uptake of health services. In the Republic of Ireland (ROI) sickness certification is part of General Practitioners’ (GPs’) contractual service to the Department of Social Protection (DSP). Sickness certificates are also issued to patients as evidence of illness for employment purposes. There is limited research exploring GPs certifying practices in the Republic of Ireland. The aim of the thesis was to explore perspectives on sickness certification in general practice in Ireland. The data collection consisted of three stages. Study 1 consisted of in depth individual interviews with 14 GPs across 11 primary care practices in Ireland. Study 2 was based on an on-line questionnaire survey using a number of vignettes with 62 GPs working in primary healthcare. Finally, study 3 consisted of a focus group conducted with eight GPs in a large urban practice in Ireland. Qualitative analysis was conducted in vivo using content and simple thematic analysis techniques. Quantitative data was analysed by descriptive and inferential statistics using PASW version 18 statistical software. Combined results indicate that GPs can find their role as certifiers’ problematic and a source of conflict during the consultation process with patients. GPs concerns are with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances and they felt a need for better communication between themselves, employers and relevant government departments. Willingness to issue a sickness cert may be influenced by the nature of the patient’s presenting problem. A psychological problem generated greater belief that patients were unfit for work, and GPs were more sympathetic and showed greater satisfaction with the decision they had made to certify these patient in comparison to patients with a physical problem. Average sickness certification periods were longer in cases of psychological nature (1-2 weeks) in comparison to the physical complaint (4-7days). Overall GPs displayed a negative feeling towards prescribing sickness leave and there was a perception that sickness certificates were being used by employers as a management tool in controlling absenteeism. GPs also mentioned cultural factors in work place absenteeism and lack of rehabilitative pathway as impacting on sickness certification practices in Ireland. Issuing a sickness certificate appears influenced by medical and non-medical factors. Potential exists for improving the system, but requires significant engagement with other stakeholders such as employers and social benefit agencies. Focus should be placed on referral and rehabilitative pathways for patients to ensure appropriate certification and early return to work.

Exposure to dust and latex allergens has been well established as a cause of health problems but there have been few studies that have examined the extent of problems in latex glove manufactures, especially in Thailand. Therefore, the overall aim of the study was to determine whether exposure to dust and latex allergens was associated with health problems in Thai latex glove manufacturing workers.The study was conducted in 3 latex glove factories in southern Thailand that employed 1,481 workers (931 Thai and 550 foreign workers). Full shift personal air sampling of workers in 10 different departments was carried out using the IOM Multidust™ sampling Head equipped with 25 mm 1.0 mm Polytetrafluoroethyene filters at a flow rate of 2 L/min. A commercial ELISA kit was employed to quantify levels of the Hev b 6.02 latex allergen in air sample extracts. Information on demographics and, occupational history, exposures and health related problems attributed to work was collected by questionnaires completed by Thai workers. Lung function testing using a spirometer was also conducted among Thai workers. Univariate linear mixed-model analysis was used to determine differences in the dust and specific latex allergen concentrations between factories, departments, shifts and days. Multivariate linear mixed model analysis was used to determine exposure determinants to estimate exposure concentrations of inhalable dust and specific latex allergen. Logistic regression analysis was used to determine association between exposure to inhalable dust and specific latex allergens.292 air samples were collected. The geometric mean (GM) and a range of inhalable dust was 0.88 (0.01 – 12.34) mg/m3. The highest dust levels were found in the Stripping 3.01, (0.73 – 12.34) mg/m3 and lowest in the Office 0.11, (0.06 – 0.92 mg/m3) departments. Hev b 6.02 levels were 9.35 (4.08 – 345.53) ng/m3 and the highest and lowest levels were also found in the Stripping [19.76, (4.72 – 192.90) ng/m3] and Office [5.60, (4.37 – 14.64) ng/m3] departments. Factory and Department were important determinants of both inhalable dust and Hev b 6.02levels. 660 (157 men, 503 women) out of 931 workers completed a self-reported questionnaire. The prevalence of health problems attributed to work was highest for skin problems (25.0%) followed by Rhinitis (23.9%), conjunctivitis (22.5%) and cough (16.2%). Cumulative exposure to dust was associated with conjunctivitis attributed to work (OR and 95%CI = 1.02, [1.00 - 1.03]) after adjusted for confounders. A negative association was found between rhinitis and exposure to average dust level (OR and 95%CI =0.69 [0.48 - 0.99]). No other associations were found between either exposure to dust and self-reported ill-health. There were also no association between exposure to Hev b 6.02 and ill-health although skin problems were associated with the highest Hev b 6.02 level (OR and 95% CI = 1.72 [1.02 - 2.91]). Lung function testing was conducted in 474 Thai workers; 41 had airway restriction, 3 airway obstruction and 1 with a combined problem. Cumulative exposure to dust was associated with airway restriction after adjustment for confounders (OR and 95% CI = 1.02 (1.00 - 1.04).