Ergonomic and socioeconomic risk factors for hospital workers' compensation injury claims

Influence of Intraoperative Active and Passive Breaks in Simulated Minimally Invasive Procedures on Surgeons' Perceived Discomfort, Performance, and Workload

Laparoscopic surgeons are at high risk of experiencing musculoskeletal discomfort, which is considered the result of long-lasting static and awkward body postures. We primarily aimed to evaluate whether passive and active work breaks can reduce ratings of perceived discomfort among laparoscopic surgeons compared with no work breaks. We secondarily aimed to examine potential differences in performance and workload across work break conditions and requested the surgeons evaluate working with passive or active work breaks. Following a balanced, randomized cross-over design, laparoscopic surgeons performed three 90 min laparoscopic simulations without and with 2.5 min passive or active work breaks after 30 min work blocks on separate days. The simulation included the following tasks: a hot wire, peg transfer, pick-and-place, pick-and-tighten, pick-and-thread, and pull-and-stick tasks. Ratings of perceived discomfort (CR10 Borg Scale), performance per subtask, and perceived workload (NASA-TLX) were recorded, and the break interventions were evaluated (self-developed questionnaire). Statistical analyses were performed on the rating of perceived discomfort and a selection of the performance outcomes. Twenty-one participants (9F) were included, with a mean age of 36.6 years (SD 9.7) and an average experience in laparoscopies of 8.5 years (SD 5.6). Ratings of perceived musculoskeletal discomfort slightly increased over time from a mean level of 0.1 to 0.9 but did not statistically significantly differ between conditions (p = 0.439). Performance outcomes of the hot wire and peg transfer tasks did not statistically significantly differ between conditions. The overall evaluation by the participants was slightly in favor regarding the duration and content of active breaks and showed a 65% likelihood of implementing them on their own initiative in ≥90 min-lasting laparoscopic surgeries, compared with passive breaks. Both passive and active breaks did not statistically significantly influence ratings of perceived discomfort or perceived workload in a 90 min simulation of laparoscopic surgery, with an overall low mean level of perceived discomfort of 0.9 (SD 1.4). As work breaks do not lead to performance losses, rest breaks should be tested in real-life situations across a complete working shift, where perceived discomfort may differ from this laboratory situation. However, in this respect, it is crucial to investigate the acceptance and practicality of intraoperative work breaks in feasibility studies in advance of assessing their effectiveness in follow-up longitudinal trials.

Biomechanical Exposure to Upper Extremity Musculoskeletal Disorder Risk Factors in Hospital Laboratories

Exposure to ergonomic risk factors has been reported for laboratory workers over decades. However, these exposures are not well characterized with respect to the type of laboratory or work organization. This study compared biomechanical exposure to upper extremity (UE) postures and hand activity levels (HALs) in general hospital laboratories by job, work, and laboratory type. The study used observational data gathered using a revised version of the Posture, Activity, Tools, and Handling (PATH) method, generating frequencies of categorized exposures. Eighteen workers were observed in 11 job titles (seven laboratories) in a single hospital by two investigators over a 7 month period. A taxonomy was constructed to categorize the extent to which the laboratory operations were automated. Overall, there were markedly high exposures to postural strain for the distal UE, especially wrist/forearm deviation (73% of observations), gross grasp (71%), and pinch grip (49%). For the HAL categories, 61% of the observations were in the moderate range (3.3–<6.7). Shoulders and elbows tended to remain in the neutral postural range. Posture frequencies were similar among the job categories studied and laboratory types. HAL was higher when the hand was in a pinch grip. Manual operations represented a higher proportion of work time than semi-automated or automated operations. Biomechanical exposure can be documented more extensively and diversely when using the revised PATH approach along with the taxonomy, with respect to exposure variables, such as the type of job, work, or organization in the industry including the hospital laboratories.

A kinematic posture analysis of neurological assistants in their daily working practice-a pilot study

Background

The aim of this pilot study was to analyze postures during the work of neurologists with respect to their occupational activities.

Methods

A total data material of 64.8 h (3885.74 min) of nine (three m/six f) neurologists (assistant physicians) was collected. Kinematic data were collected using the CUELA system (electro-goniometry). In addition, the occupational tasks performed on-site were subject to a detailed objective activity analysis. All activities were assigned to the categories “Office activities” (I), “Measures on patients” (II) and “Other activities” (III). The angle values of each body region (evaluation parameters) were evaluated according to ergonomic ISO standards.

Results

Only 3.4% of the working hours were spent with (II), while 50.8% of time was spent with (I) and 45.8% with (III). All tasks of category (II) revealed an increased ergonomic risk to the head, neck, trunk and back areas. During category (I) especially neck and back movements in the sagittal plane showed higher ergonomic risk levels.

Conclusion

Despite frequently performed awkward body positions in (II), the ergonomic risk is considered as rather low, since the percentage time share totaled only 3.4%. As a result, “Office activities” have been detected as high predictor to cause stress load on the musculoskeletal system in the daily work of neurologists.

Effectiveness of safety training interventions for supervisors: A systematic review and narrative synthesis

A wealth of research demonstrates that work unit supervisors serve a critical function in protecting the safety and health of workers. A systematic review examined the effectiveness of workplace safety training interventions intended for various supervisor populations published from 2000 to 2019. A search of seven electronic databases was supplemented with hand searches from the reference lists of identified publications, relevant scientific journals, and the gray literature. This review included an assessment of the methodological quality using a modified version of the Quality Assessment Tool for Quantitative Studies. A total of 22 peer-reviewed studies met a set of inclusion criteria and were subsequently assessed for methodological quality. Training interventions were grouped into five topical domains: ergonomics, leadership, supervisor-worker interaction, injury, and disability management, and general safety education. Consistent evidence was found for the effectiveness of supervisory training interventions across several outcome measures. To our knowledge, this is the first study to synthesize the literature on supervisory training interventions in the area of occupational safety. While the results are encouraging, they must be viewed with caution due to the fact that the methodological rigor of the reviewed studies was low.

Safety and Health through Integrated, Facilitated Teams (SHIFT): stepped-wedge protocol for prospective, mixed-methods evaluation of the Healthy Workplace Participatory Program

BACKGROUND

Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing.

METHODS

Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame).

DISCUSSION

This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.

Cross-national comparison of two general population job exposure matrices for physical work exposures

OBJECTIVES

Job exposure matrices (JEMs) are increasingly used to estimate physical workplace exposures. We conducted a cross-national comparison of exposure estimates from two general population JEMs to aid the interpretation of exposure-outcome associations across countries and to explore the feasibility of cross-national application of JEMs to provide workplace physical exposure estimates.

METHODS

We compared physical exposure estimates from two general population JEMs created from the FrenchCohorte des consultants des Centres d'examens de santé study (27 exposure variables) and the American Occupational Information Network database (21 exposure variables). These exposure variables were related to physical demands or ergonomic risk factors for musculoskeletal disorders. We used a crosswalk to match French Profession et Catégorie Sociale job codes with American Standard Occupational Classification job codes and calculated Spearman's correlations and Cohen's kappa values for exposure variable pairs between these French and American JEMs. We defined a priori 50 matched French and American JEM variable pairs that measured similar exposures.

RESULTS

All variable pairs measuring similar physical exposures demonstrated positive correlations. Among the 50 matched pairs, 33 showed high correlation (ρ≥0.70) and 46 showed at least moderate agreement (κ≥0.41). Exposures expected to be mutually exclusive (manual work vs office work) showed strongly negative correlations.

CONCLUSIONS

French and American general population physical exposure JEMs were related, sharing moderate to high association and moderate to substantial agreement between the majority of variable pairs measuring similar exposures. These findings will inform cross-national comparisons of study results and support some uses of general population JEMs outside their countries of origin.

A systematic review of socioeconomic status measurement in 13 years of U.S. injury research

OBJECTIVE

The purpose of this review was to assess the impact of socioeconomic status (SES) on injury and to evaluate how U.S. injury researchers have measured SES over the past 13years in observational research studies.

DESIGN & METHODS

This systematic review included 119 US injury studies indexed in PubMed between January 1, 2002 and August 31, 2015 that used one or more individual and/or area-level measures of SES as independent variables. Study findings were compared to the results of a previous review published in 2002.

RESULTS

Findings indicate SES remains an important predictor of injury. SES was inversely related to injury in 78 (66%) of the studies; inverse relationships were more consistently found in studies of fatal injury (77.4%) than in studies of non-fatal injury (58%). Approximately two-thirds of the studies (n=73, 61%) measured SES along a gradient and 59% used more than one measure of SES (n=70). Studies that used a gradient measure of SES and/or more than one measure of SES identified significant relationships more often. These findings were essentially equivalent to those of a similar 2002 review (Cubbin & Smith, 2002).

CONCLUSIONS

There remains a need to improve measurement of SES in injury research. Public health training programs should include best practices for measurement of SES, which include: measuring SES along a gradient, selecting SES indicators based on the injury mechanism, using the smallest geographic region possible for area-level measures, using multiple indicators when possible, and using both individual and area-level measures as both contribute independently to injury risk. Area-level indicators of SES are not accurate estimates of individual-level SES.

PRACTICAL APPLICATIONS

Injury researchers should measure SES along a gradient and incorporate individual and area-level SES measures that are appropriate to the injury outcome under study.

WORKER INJURIES IN NURSING HOMES: IS SAFE PATIENT HANDLING LEGISLATION THE SOLUTION?

In 2012, nursing homes were considered the most dangerous workplaces in the United States. While other industries have guidelines that limit manual lifting of stable objects to ≤50 pounds, the same is not so in the nursing home industry where residents requiring physical assistance may weigh over 250 pounds and where the prevalence of obesity among residents is increasing. Safe patient handling legislation in nursing homes has been enacted in nine of the United States since 2005 (Hawaii, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, and Texas). This paper reviews the problem of worker injuries in nursing homes, describes the legislation passed to address the problem, and reviews the data available on the effectiveness of the legislation. No national studies evaluating the effectiveness of safe patient handling state policies on nursing home injuries exists, although the National Institute on Occupational Safety and Health has recently funded a national evaluation.

Musculoskeletal Injury Prevention for New Nurses

Nurses continue to sustain musculoskeletal injuries even with increased emphasis on safe patient handling and mobility (SPHM) and organizational cultures of safety to protect health care workers. Analysis of data from 2011-2014 registered nurse graduates explored hospital safety culture, SPHM education/training, and incidence of new-nurse musculoskeletal injury. Results indicated hospitals provided some type of SPHM education and training, but 46% of study participants were not informed or aware of national SPHM standards or guidelines. Merely 13.9% of participants stated a written “no manual lifting policy” had been implemented; only 32.9% indicated staffing was adequate for SPHM tasks; and only 39.4% stated the hospital had all of the equipment needed to perform SPHM safely. Thirty-nine percent of participants had already sustained a musculoskeletal injury with an additional 35% sustaining but not reporting an injury. More actions are needed to ensure a decrease in musculoskeletal injuries for new nurses.

Explaining occupational injury rates between migrant and native workers in Taiwan, 1998–2011

This study explains trends in occupational injury rates among migrant and native workers in Taiwan and evaluates the results of related regulatory protection policies for migrants between 1998 and 2011. Results indicate that the relative occupational injury rate between migrant and native workers dropped from 2.1 times to 1.1 times during the whole period; on average, the injury rates for migrant workers were 1.45 times higher compared with non-migrants. Although policies protecting migrants’ rights may have resulted in lower injury rates, the minimum wage policy has otherwise given rise to an increase in injury rates. We argue that governmental regulations regarding the monitoring and management of migrant workers’ safety have been only loosely enforced under the guest-worker policy.

Industry-Related Injuries in the United States From 1998 to 2011: Characteristics, Trends, and Associated Health Care Costs

OBJECTIVE

To describe the trends, correlates, and healthcare costs associated with industry-related injuries across the United States between 1998 and 2011.

METHODS

A retrospective, cross-sectional analysis of hospital discharges was conducted using the National Inpatient Sample. We used the International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify accidents occurring in industrial settings. Joinpoint regression modeling was used to analyze trends.

RESULTS

Most of the 357,716 inpatient hospitalizations were admissions from the emergency department (55%). Fractures were the most prevalent injuries (48.1%), whereas the lower and upper extremities were the most common injury sites (51.7%). The mean per admission cost of direct medical care was $12,849, with an overall downward trend in injuries during the study period.

CONCLUSIONS

A comprehensive trend analysis of industry-related injuries is valuable to policymakers in formulating targeted strategies and allocating resources to address disparities at various levels.

General population job exposure matrix applied to a pooled study of prevalent carpal tunnel syndrome

A job exposure matrix may be useful for the study of biomechanical workplace risk factors when individual-level exposure data are unavailable. We used job title-based exposure data from a public data source to construct a job exposure matrix and test exposure-response relationships with prevalent carpal tunnel syndrome (CTS). Exposures of repetitive motion and force from the Occupational Information Network were assigned to 3,452 active workers from several industries, enrolled between 2001 and 2008 from 6 studies. Repetitive motion and force exposures were combined into high/high, high/low, and low/low exposure groupings in each of 4 multivariable logistic regression models, adjusted for personal factors. Although force measures alone were not independent predictors of CTS in these data, strong associations between combined physical exposures of force and repetition and CTS were observed in all models. Consistent with previous literature, this report shows that workers with high force/high repetition jobs had the highest prevalence of CTS (odds ratio = 2.14-2.95) followed by intermediate values (odds ratio = 1.09-2.27) in mixed exposed jobs relative to the lowest exposed workers. This study supports the use of a general population job exposure matrix to estimate workplace physical exposures in epidemiologic studies of musculoskeletal disorders when measures of individual exposures are unavailable.

Obesity as a Possible Risk Factor for Lost-time Injury in Registered Nurses: A Literature Review

Time-loss injuries are still a major occurrence in Canada, injuring thousands of Canadian workers each year. With obesity rates on the rise across the country, as well as around the world, it is important that the possible effects of obesity in the workplace be fully understood, especially those effects linked to lost-time injuries. The aim of this paper was to evaluate predictors of workplace lost-time injuries and how they may be related to obesity or high body mass index by examining factors associated with lost-time injuries in the health care sector, a well-studied industry with the highest number of reported time loss injuries in Canada. A literature review focusing on lost-time injuries in Registered Nurses (RNs) was conducted using the keywords and terms: lost time injury, workers' compensation, occupational injury, workplace injury, injury, injuries, work, workplace, occupational, nurse, registered nurse, RN, health care, predictors, risk factors, risk, risks, cause, causes, obese, obesity, and body mass index. Data on predictors or factors associated with lost-time injuries in RNs were gathered and organized using Loisel's Work Disability Prevention Management Model and extrapolated upon using existing literature surrounding obesity in the Canadian workplace.

Using O*NET to estimate the association between work exposures and chronic diseases

BACKGROUND

A standardized process using data from the Occupational Information Network (O*NET) is applied to estimate the association between long-term aggregated occupational exposure and the risk of contracting chronic diseases later in life. We demonstrate this process by analyzing relationships between O*NET physical work demand ratings and arthritis onset over a 32-year period.

METHODS

The National Longitudinal Survey of Youth provided job histories and chronic disease data. Five O*NET job descriptors were used as surrogate measures of physical work demands. Logistic regression measured the association between those demands and arthritis occurrence.

RESULTS

The risk of arthritis was significantly associated with handling and moving objects, kneeling, crouching, and crawling, bending and twisting, working in a cramped or awkward posture, and performing general physical activities.

CONCLUSION

This study demonstrates the utility of using O*NET job descriptors to estimate the aggregated long-term risks for osteoarthritis and other chronic diseases when no actual exposure data is available.

Promoting integrated approaches to reducing health inequities among low-income workers: applying a social ecological framework

BACKGROUND

Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity.

METHODS

We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations.

RESULTS

Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers.

CONCLUSIONS

Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.

Does the threshold for reporting musculoskeletal pain or the probability of attributing work-relatedness vary by socioeconomic position or sex?

OBJECTIVE

To examine the effect of sex and socioeconomic position (SEP) on individuals' perceptions of pain and its work-relatedness.

METHODS

We compared self-reported pain in neck-shoulder or arm with clinical diagnoses and workers' judgments of work-relatedness with physicians' assessments based on specific criteria, between sexes and high- and low-SEP participants in the Oslo Health Study (n = 217).

RESULTS

Clinical diagnoses were more frequent in low-SEP subjects than high-SEP subjects with pain and generally higher in women than in men. Pain attributed to work was more frequently assessed as work-related by the physicians in low-SEP subjects than high-SEP subjects and in men than in women of low SEP.

CONCLUSIONS

The threshold for reporting pain seemed higher in low-SEP subjects and among women. Physicians were more likely to agree with low-SEP workers about work-relatedness.

Using job-title-based physical exposures from O*NET in an epidemiological study of carpal tunnel syndrome

OBJECTIVE

We studied associations between job-title-based measures of force and repetition and incident carpal tunnel syndrome (CTS).

BACKGROUND

Job exposure matrices (JEMs) are not commonly used in studies of work-related upper-extremity disorders.

METHOD

We enrolled newly hired workers in a prospective cohort study. We assigned a Standard Occupational Classification (SOC) code to each job held and extracted physical work exposure variables from the Occupational Information Network (O*NET). CTS case definition required both characteristic symptoms and abnormal median nerve conduction.

RESULTS

Of 1,107 workers, 751 (67.8%) completed follow-up evaluations. A total of 31 respondents (4.4%) developed CTS during an average of 3.3 years of follow-up. Repetitive motion, static strength, and dynamic strength from the most recent job held were all significant predictors of CTS when included individually as physical exposures in models adjusting for age, gender, and BMI. Similar results were found using time-weighted exposure across all jobs held during the study. Repetitive motion, static strength, and dynamic strength were correlated, precluding meaningful analysis of their independent effects.

CONCLUSION

This study found strong relationships between workplace physical exposures assessed via a JEM and CTS, after adjusting for age, gender, and BMI. Though job-title-based exposures are likely to result in significant exposure misclassification, they can be useful for large population studies where more precise exposure data are not available.

APPLICATION

JEMs can be used as a measure of workplace physical exposures for some studies of musculoskeletal disorders.

The impact of workplace factors on filing of workers' compensation claims among nursing home workers

Background

Injuries reported to workers’ compensation (WC) system are often used to estimate incidence of health outcomes and evaluate interventions in musculoskeletal epidemiology studies. However, WC claims represent a relatively small subset of all musculoskeletal disorders among employed individuals, and perhaps not a representative subset. This study determined the influence of workplace and individual factors on filing of workers’ compensation claims by nursing home employees with back pain.

Methods

Surveys were conducted in 18 skilled nursing facilities in four U.S. states. Self-administered questionnaires obtained information on demographic characteristics, working environment, and health behaviors/status. Employees who reported low back pain at least once in four questionnaire surveys were included. WC claims from the same facilities were obtained from the employer’s workers compensation insurer and matched by employee name. The dichotomous dependent variable was filing of back-related worker’s compensation claim. Association with predictors of interest, including pain severity, physical job demand, job strain, social support, schedule control, and safety climate, was assessed using multivariate regression modeling. Individual characteristics were tested as potential confounders.

Results

Pain severity level was significantly associated with filing low-back related claims (odds ratio (OR) = 1.49, 95% CI = 1.18 – 1.87). Higher physical demands at work (OR = 1.07, 95% CI = 1.01 – 1.14) also increased the likelihood of claim filing. Higher job strain (OR = 0.83, 95% CI = 0.73 – 0.94), social support at work (OR = 0.90, 95% CI = 0.82 – 0.99), and education (OR = 0.79, 95% CI = 0.71 – 0.89) decreased the likelihood of claim filing.

Conclusions

The results suggest that the WC system captured the most severe occupational injuries. Workplace factors had additional influence on workers’ decision to file claims, after adjusting for low back pain severity. Education was correlated with worker’s socioeconomic status; its influence on claim filing is difficult to interpret because of the possible mixed effects of working conditions, self-efficacy, and content knowledge.

Workplace engagement and workers' compensation claims as predictors for patient safety culture

OBJECTIVE

Demonstrate the relationship between employee engagement and workplace safety for predicting patient safety culture.

INTRODUCTION

Patient safety is an issue for the U.S. health-care system, and health care has some of the highest rates of nonfatal workplace injuries. Understanding the types of injuries sustained by health-care employees, the type of safety environment employees of health-care organizations work in, and how employee engagement affects patient safety is vital to improving the safety of both employees and patients.

METHODS

The Gallup Q survey and an approved, abbreviated, and validated subset of questions from the Hospital Survey on Patient Safety Culture were administered to staff at a large tertiary academic medical center in 2007 and 2009. After controlling for demographic variables, researchers conducted a longitudinal, hierarchical linear regression analysis to study the unique contributions of employee engagement, changes in employee engagement, and employee safety in predicting patient safety culture.

RESULTS

Teams with higher baseline engagement, more positive change in engagement, fewer workers' compensation claims, and fewer part-time associates in previous years had stronger patient safety cultures in 2009. Baseline engagement and change in engagement were the strongest independent predictors of patient safety culture in 2009. Engagement and compensation claims were additive and complimentary predictors, independent of other variables in the analysis, including the demographic composition of the workgroups in the study.

CONCLUSIONS

A synergistic effect exists between employee engagement and decreased levels of workers' compensation claims for improving patient safety culture. Organizations can improve engagement and implement safety policies, procedures, and devices for employees with an ultimate effect of improving patient safety culture.

On the recurrence of occupational injuries and workers' compensation claims

This paper represents the first study to estimate counts of individual occupational injuries and claims over long spells of working life (up to 13 years) in the USA. It explores data from the National Longitudinal Survey of Youth 1979. I found that 37% of all surveyed workers who had experienced one on-the-job accident reported at least one additional injury, but only 56% of all occupational injuries and illnesses resulted in workers' compensation claims. I estimated different count models to assess the effect of different individual worker and job characteristics on individual injury counts and workers' compensation claims counts. Lower educational levels, less tenure, work in dangerous industries and unskilled occupations, and job demands are found to be important determinants of multiple on-the-job injuries. The most interesting results, however, refer to the role played by individuals' pre-injury characteristics: early exposure to dangerous jobs is among the main determinants of higher counts of occupational injuries later in life. Early health limitations are also significant predictors of recurrent workers' compensation claims. These results provide new evidence about the important role played by both the health and the socioeconomic status of young people as determinants of their future occupational injuries.

Description and analysis of hand forces in medicine cart pushing tasks

The primary objectives of this study were to describe and analyze the hand force exertion patterns of experienced nursing home nurses and nursing students during dynamic medicine cart pushing tasks in Initial, Sustained, Turning, and Stopping motion phases. A 2 × 2 × 2 factorial experiment was conducted with 22 participants to estimate the effects of lane congestion, precision cart control, and floor surface on horizontal hand forces. Root mean squared (RMS) lane deviation patterns were also described to provide an indicator of cart handling difficulty across the different study conditions. Descriptive statistics revealed that nurses exerted greater mean hand force (10%) and made more (12%) lane deviation than students and that the highest two-hand forces of 147N were measured in the Turning phase on carpet. Strong correlations between work experience group, body mass, and BMI required that force data for nurses and students be collapsed in analytical models where no group differences existed. Predicted pushing forces on carpeted floor surface were significantly greater than on tile in Initial (14N), Sustained (14N) and Turning (18N), except in stopping where pulling forces were 37N lower. High lane congestion predicted significant peak force increases of 4N and 7N in Sustained and Turning, respectively, but decreased by 20N in Initial. High precision control led to significant decreases in two-hand forces that ranged from 4 to 20N across motion phases. Complex interactions among the experimental factors suggest that work environment (lane congestion and floor surface) and work demands (precision control) should be included in the evaluation of pushing tasks and considered prior to making renovations to nursing home environments.

Health disparities among occupations in Taiwan: a population study

OBJECTIVES

The first large-scale population survey was conducted in Taiwan to examine if and to what extent health disparities of four major chronic physical conditions exist among occupations.

METHODS

Face-to-face interviews about two risk behaviors (i.e., cigarette and alcohol use) and four major chronic physical conditions (i.e., cardiovascular disease, diabetes, liver disease and asthma) were conducted with 13,741 workers from nine major categories of occupations.

RESULTS

Health disparities among occupations were found based on a series of hierarchical logistic regression analyses after controlling for age, sex and two risk behaviors. In general, prevalence rates of cardiovascular disease among elementary occupations and skilled agricultural and fishery workers were approximately two to four times higher than those among other occupations. The above two occupations and plant and machine operators also had higher prevalence rates in diabetes and liver disease.

CONCLUSIONS

The results concerning health disparities among occupations provide policymakers and researchers with invaluable benchmarks of chronic physical conditions among occupations. The findings also suggest the importance of investigating causal relationship between these diseases and exposures at work, identifying and reducing unique risk factors and hazard exposures experienced by workers and conducting targeted surveillance and health promotion programs for at-risk occupations.

Occupational injuries among nurses and aides in a hospital setting

BACKGROUND

Patient care workers in acute care hospitals are at high risk of injury. Recent studies have quantified risks and demonstrated a higher risk for aides than for nurses. However, no detailed studies to date have used OSHA injury definitions to allow for better comparability across studies.

METHODS

We linked records from human resources and occupational health services databases at two large academic hospitals for nurses (n = 5,991) and aides (n = 1,543) in patient care units. Crude rates, rate ratios, and confidence intervals were calculated for injuries involving no days away and those involving at least 1 day away from work.

RESULTS

Aides have substantially higher injury rates per 100 full-time equivalent workers (FTEs) than nurses for both injuries involving days away from work (11.3 vs. 7.2) and those involving no days away (9.9 vs. 5.7). Back injuries were the most common days away (DA) injuries, while sharps injuries were the most common no days away (NDA) injuries. Pediatric/neonatal units and non-inpatient units had the lowest injury rates. Operating rooms and the float pool had high DA injury rates for both occupations, and stepdown units had high rates for nurses. NDA injuries were highest in the operating room for both nurses and aides.

CONCLUSIONS

This study supports the importance of a continuing emphasis on preventing back and sharps injuries and reducing risks faced by aides in the hospital setting. Uniform injury definitions and work time measures can help benchmark safety performance and focus prevention efforts.

Association of self-rated physical health and incident hypertension with O*NET factors: validation using a representative national survey

OBJECTIVE

To examine the predictive validity of Occupational Information Network (O*NET)-based constructs with health outcomes.

METHODS

Data from the National Survey of Midlife in the United States (MIDUS) surveys were used to examine associations of self-rated health and incident hypertension with work characteristics. Job control and substantive complexity (SC) scores derived from the O*NET were imputed to occupation in the MIDUS surveys. Validity was assessed through variance partitioning and regression models contrasting O*NET and survey-based constructs.

RESULTS

Congruence between control scores derived from O*NET and from self-rated scores from MIDUS was good. Shared variance between SC scores and survey-based control was less. All constructs were modest predictors of self-rated health. Substantive complexity was a stronger predictor of incident hypertension (Adjusted Odds Ratio = 1.87).

CONCLUSIONS

Occupational characteristics derived from O*NET variables performed as well as or better than survey-based job control in describing associations with self-rated health and incident hypertension.

The estimated national burden of physical ergonomic hazards among US workers

PURPOSE

To estimate the national burden of physical ergonomic hazards among working adults in the US.

METHODS

We estimated the population prevalence of and the total number of workers who are exposed to physical ergonomic hazards, such as vibration, working in cramped space, kneeling, body bending or twisting, climbing, and repetitive motions using Occupational Information Network (O*NET) data and the Occupational Employment Statistics (OES) from the U.S. Bureau of Labor Statistics (BLS) stratified by occupation title.

RESULTS

Repetitive motion was the most prevalent of all ergonomic hazards (27% of US workers are estimated to be exposed continually). Bending or twisting of the body more than half their time at work was also common, involving over 32 million US workers (25% of US workforce). Kneeling, crouching, stooping, or crawling was another ergonomic hazard that 14 million US workers perform more than half their time at work. Almost 4 million workers climb ladders, scaffolds, poles, etc. for more than half their time at work. We estimate that over 13 million workers (10% of US workforce) were exposed to cramped workspace that requires getting into awkward positions every day. Finally, about 3.5 million workers (2.7% of US workforce) were estimated to be exposed to whole body vibration every day.

CONCLUSION

A large portion of the US work force is exposed to ergonomic hazards known to be associated with musculoskeletal disorders (MSDs). The occupations with the highest prevalence of each ergonomic hazard may be deserving of prompt efforts toward prevention of MSDs.

Statement on national worklife priorities

The National Institute for Occupational Safety and Health (NIOSH) WorkLife Initiative (WLI) [http://www.cdc.gov/niosh/worklife] seeks to promote workplace programs, policies, and practices that result in healthier, more productive employees through a focus simultaneously on disease prevention, health promotion, and accommodations to age, family, and life stage. The Initiative incorporates the Institute's foundational commitment to workplaces free of recognized hazards into broader consideration of the factors that affect worker health and wellbeing. Workplace hazards, such as physical demands, chemical exposures, and work organization, often interact with non-work factors such as family demands and health behaviors to increase health and safety risks. New workplace interventions being tested by the first three NIOSH WLI Centers of WorkLife Excellence are exploring innovative models for employee health programs to reduce the human, social, and economic costs of compromised health and quality of life. Many parties in industry, labor, and government share the goals of improving employee health while controlling health care costs. NIOSH convened a workshop in 2008 with representatives of the three Centers of Excellence to develop a comprehensive, long-range strategy for advancing the WorkLife Initiative. The recommendations below fall into three areas: practice, research, and policy. Responding to these recommendations would permit the WorkLife Center system to establish a new infrastructure for workplace prevention programs by compiling and disseminating the innovative practices being developed and tested at the Centers, and elsewhere. The WLI would also extend the customary scope of NIOSH by engaging with multiple NIH Institutes that are already generating research-to-practice programs involving the working-age population, in areas such as chronic disease prevention and management. Research to Practice (r2p) is a concept focused on the translation of research findings, technologies, and information into evidence-based prevention practices and products that are adopted in the workplace or other "real-world" settings. NIOSH's goal is to overcome the translational issues that now prevent state-of-the-art occupational health, health promotion, and chronic disease research findings from benefiting working age populations immediately, regardless of workplace size, work sector, or region of the country.

Use of O*NET as a job exposure matrix: A literature review

BACKGROUND

O*NET is a publicly available online database that describes occupational features across US job titles and that has been used to estimate workplace physical and psychosocial exposures and organizational characteristics. The aim of this review is to describe and evaluate the use of O*NET as a job exposure matrix.

METHODS

A review of the peer-reviewed published and gray literature was conducted. Twenty-eight studies were found that used O*NET to estimate work exposures related to health or safety outcomes. Each was systematically evaluated across eight main features.

RESULTS

Many health outcomes have been studied with O*NET estimates of job exposures. Some studies did not use conceptual definitions of exposure; few studies estimated convergent validity, most used predictive validity. Multilevel analysis was underutilized.

CONCLUSION

O*NET is worthy of exploration by the occupational health community, although its scientific value is still undetermined. More studies could eventually provide evidence of convergent validity. O*NET has the potential to allow examination of occupational risks that might have otherwise been ignored due to missing data or resource constraints on field data collection of job exposure information.

Factors associated with safe patient handling behaviors among critical care nurses

BACKGROUND

Patient handling is a major risk factor for musculoskeletal (MS) injury among nurses. The aims of the study were to describe nurses' work behaviors related to safe patient handling and identify factors influencing their safe work behaviors, including the use of lifting equipment.

METHODS

A cross-sectional study using a mailed questionnaire with a nationwide random sample of 361 critical care nurses. Nurses reported on the physical, psychosocial, and organizational characteristics of their jobs and on their MS symptoms, risk perception, work behaviors, and demographics. Hierarchical multiple linear regression analyses were used to identify significant factors.

RESULTS

More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort-reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior.

CONCLUSIONS

Safe work behaviors are best understood as socio-cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury.

Functional recovery following musculoskeletal injury in hospital workers

BACKGROUND

Hospital workers are at high risk of work-related musculoskeletal disorders (WRMSDs), but outcomes following such injuries have not been well studied longitudinally.

AIMS

To ascertain functional recovery in hospital workers following incident WRMSDs and identify predictors of functional status.

METHODS

Cases (incident WRMSD) and matched referents from two hospitals were studied at baseline and at 2 year follow-up for health status [SF-12 physical component summary (PCS)], lost workdays, self-rated work effectiveness and work status change (job change or work cessation). Predictors included WRMSD and baseline demographics, socio-economic status (SES), job-related strain and effort-reward imbalance. Logistic regression analysis tested longitudinal predictors of adverse functional status.

RESULTS

The WRMSD-associated risk of poor (lowest quartile) PCS was attenuated from a baseline odds ratio (OR) of 5.2 [95% confidence interval (CI) 3.5-7.5] to a follow-up OR of 1.5 (95% CI 1.0-2.3) and was reduced further in multivariate modelling (OR = 1.4; 95% CI 0.9-2.2). At follow-up, WRMSD status did not predict significantly increased likelihood of lost workdays, decreased effectiveness or work status change. In multivariate modelling, lowest quintile SES predicted poor PCS (OR = 2.0; 95% CI 1.0-4.0) and work status change (OR = 2.5; 95% CI 1.1-5.8). High combined baseline job strain/effort-reward imbalance predicted poor PCS (OR = 1.7; 95% CI 1.1-2.7) and reduced work effectiveness (OR = 2.6; 95% CI 1.6-4.2) at follow-up.

CONCLUSIONS

Baseline functional deficits associated with incident WRMSDs were largely resolved by 2 year follow-up. Nonetheless, lower SES and higher combined job strain/effort-reward imbalance predicted adverse outcomes, controlling for WRMSDs.

Risks and causes of musculoskeletal injuries among health care workers

BACKGROUND

Musculoskeletal injuries (MSIs) persist as the leading category of occupational injury in health care. Limited evidence exists regarding MSIs for occupations other than direct patient care providers. An evaluation of the risks, causes and activities associated with MSIs that includes non-patient care health care occupations is warranted.

AIMS

To examine the risks and causes of time-loss MSIs for all occupations in health care.

METHODS

Workers employed by a health region in British Columbia were followed from April 2007 to March 2008 using payroll data; injuries were followed using an incidence surveillance database. Frequency and rates were calculated for all occupational injuries and MSIs and relative risks (RRs) were computed using Poisson regression. Causes and occupational activities leading to MSIs were tabulated for direct care occupations and non-patient care occupations.

RESULTS

A total of 944 injuries resulting in time-loss from work were reported by 23 742 workers. Overall, 83% injuries were musculoskeletal. The two occupations showing highest RR of MSIs relative to registered nurses were facility support service workers [RR = 3.16 (2.38-4.18), respectively] and care aides [RR=3.76 (3.09-4.59)]. For direct patient care occupations, the leading causes of MSIs were awkward posture (25%) and force (23%); for non-patient care occupations were force (25%) and slip/fall (24%). Patient handling activities accounted for 60% of all MSIs for direct care occupations. For non-patient care occupations, 55% of MSIs were due to material/equipment handling activities.

CONCLUSIONS

Prevention efforts for MSIs should be directed to non-patient care occupations as well and consider their occupation-specific causes and activities.

Surveillance of occupational health disparities: challenges and opportunities

Increasingly, the occupational health community is turning its attention to the effects of work on previously underserved populations, and researchers have identified many examples of disparities in occupational health outcomes. However, the occupational health status of some underserved worker populations is not described due to limitations in existing surveillance systems. As such, the occupational health community has identified the need to enhance and improve occupational health surveillance to describe the nature and extent of disparities in occupational illnesses and injuries (including fatalities), identify priorities for research and intervention, and evaluate trends. This report summarizes the data sources and methods discussed at an April 2008 workshop organized by NIOSH on the topic of improving surveillance for occupational health disparities. We discuss the capability of existing occupational health surveillance systems to document occupational health disparities and to provide surveillance data on minority and other underserved communities. Use of administrative data, secondary data analysis, and the development of targeted surveillance systems for occupational health surveillance are also discussed. Identifying and reducing occupational health disparities is one of NIOSH's priority areas under the National Occupational Research Agenda (NORA).