Under-reporting of work-related disorders in the workplace: a case study and review of the literature

Addressing OSH challenges in non-standardized work practices in small-scale FMCG units by introducing context-specific ergonomic pouch/sachet cutting apparatus

BACKGROUND

The FMCG manufacturing industry in industrially developing countries operates in a manual or semi-automatic setup, employing a vast labor force. Several non-standardized work activities prevail on the FMCG shop floor and remain prone to safety-related risks involving repetitive motions, forceful exertions, and awkward postures. Among those, the rework of defective pouches/sachets is an unsafe activity of prime concern. It is prone to minor nicks, cuts, and injuries due to inadequate tools being used. It involves sharp cutters/blades and extensive forceful manual hand squeezing, which leads to drudgery and safety concerns. There lies the lack of standardized tools/apparatus for rework activity, and efforts towards its mitigation are required.

OBJECTIVE

Current research aims to address occupational safety-related issues in non-standardized rework activity in small-scale FMCG units through an innovative product design approach.

METHODS

An ergo-audit was conducted in eight small-scale FMCG units to identify the prevailing ergonomic stressors and safety concerns. The most critical area of concern, i.e., rework activity, was chosen through card-sorting sessions and discussions held with the stakeholders. An appropriate context-specific apparatus was designed/developed to ensure better safety and occupational health utilizing a systematic product design method involving three phases: initial field survey, design and development, and field trials.

RESULTS

The apparatus, which was developed and factory-trialed, was evaluated for productivity improvement and ensuring user compatibility from various human factors' perspectives.

CONCLUSION

In field trials, the developed apparatus was found effective in mitigating safety concerns and various ergonomic stressors associated with FMCG rework.

Prevalence of musculoskeletal pain and dysfunction in electrical utility workers: Practical considerations for prevention and rehabilitation in the workplace

INTRODUCTION

This study assessed the prevalence and associations of musculoskeletal pain and dysfunction in electrical utility workers, with the aim of applying the findings to better prevent and rehabilitate workplace musculoskeletal disorders.

METHODS

Employees completed an online survey recording their musculoskeletal symptoms across nine anatomical locations for the preceding 12 months. A total of 565 employees, working across eight different electrical utility organisational work units, completed the survey.

CONSUMER AND COMMUNITY INVOLVEMENT

The study was collaborative and conducted in Australia's largest, wholly government owned electricity company. The study originated from the participating organisation wanting to better understand their musculoskeletal disorder (MSD) risks.

RESULTS

Employees who experienced high job stress were 4.06 times (95% confidence interval [CI] = 1.78-9.29) more likely to report musculoskeletal symptoms in the shoulder compared with employees with lower reported job stress. Employees that perceived their work to have high physical demands report lower back musculoskeletal symptoms at 2.64 times the rate of those perceiving their job to be of low physical demand (95% CI = 1.44-4.84). There were significant differences in the lower back musculoskeletal symptoms according to work unit membership.

CONCLUSIONS

Understanding the prevalence of MSDs is critical to implementing practical prevention and rehabilitation strategies in the workplace. This anonymous survey highlighted that a large proportion of electrical utility workers reported that musculoskeletal symptoms had impacted their ability to perform their job, housework and/or hobbies in the preceding 12 months. Early access to rehabilitation services is essential. However, many workers report barriers to disclosing MSDs; therefore, workplace rehabilitation services may need to be broadened to account for these barriers.

Occupational Injuries Among Construction Workers by Age and Related Economic Loss: Findings From Ohio Workers' Compensation, USA: 2007-2017

Background

This study examined age-group differences in the rate, severity, and cost of injuries among construction workers to support evidence-based worker safety and health interventions in the construction industry.

Methods

Ohio workers' compensation claims for construction workers were used to estimate claim rates and costs by age group. We analyzed claims data auto-coded into five event/exposure categories: transportation incidents; slips, trips, and falls (STFs); exposure to harmful substances and environments; contact with objects and equipment (COB); overexertion and bodily reaction. American Community Survey data were used to determine the percentage of workers in each age group.

Results

From 2007-2017, among 72,416 accepted injury claims for ∼166,000 construction full-time equivalent (FTE) per year, nearly half were caused by COB, followed by STFs (20%) and overexertion (20%). Claim rates related to COB and exposure to harmful substances and environments were highest among those 18-24 years old, with claim rates of 313.5 and 25.9 per 10,000 FTE, respectively. STFs increased with age, with the highest claim rates for those 55-64 years old (94.2 claims per 10,000 FTE). Overexertion claim rates increased and then declined with age, with the highest claim rate for those 35-44 years old (87.3 per 10,000 FTE). While younger workers had higher injury rates, older workers had higher proportions of lost-time claims and higher costs per claim. The total cost per FTE was highest for those 45-54 years old ($1,122 per FTE).

Conclusion

The variation in rates of injury types by age suggests that age-specific prevention strategies may be useful.

Underreporting of work-related low back pain among registered nurses: A mixed method study

BACKGROUND

Identifying and addressing work-related health problems early is crucial, but workers often perceive barriers in reporting these to management. This study aimed to investigate the factors associated with nurses' reporting of work-related low back pain to their managers and explored the reasons why nurses with patient handling injuries did not report them.

METHODS

This study is a concurrent mixed-method analysis of data from two statewide cross-sectional surveys of California registered nurses conducted in 2013 and 2016. The reporting of work-related low back pain to management (n = 288) was examined for associations with individual, occupational, and organizational factors. For qualitative analysis, the reasons for not reporting patient handling injuries were explored using open-ended responses (n = 42).

RESULTS

Reporting was associated with BIPOC (Black, Indigenous, and People of Color) men (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) compared to non-Hispanic White women; being a non-US educated nurse (AOR: 0.90, 95% CI: 0.80-1.01); experiencing greater low back pain (AOR: 1.07, 95% CI: 1.02-1.12); missing work (AOR: 1.38, 95% CI: 1.21-2.62); perceiving high physical workload (AOR: 0.89, 95% CI: 0.81-0.98); perceiving high people-oriented culture (AOR: 1.14, 95% CI: 1.04-1.25); and perceiving high ergonomic practices (AOR: 0.89, 95% CI: 0.81-0.98). Identified themes on the reasons for not reporting injuries included organizational-culture attitudes toward work-related injuries and injury characteristics of musculoskeletal disorders.

CONCLUSIONS

The findings indicate a need for management to remove structural barriers and improve organizational practices, and for a culture that promotes trust and open communication between workers and management.

Workplace violence against healthcare workers using nationally representative estimates of emergency department data, 2015-2017

INTRODUCTION

Workers in the healthcare industry are at increased risk for workplace violence. The goal of this analysis is to determine the rate of injuries healthcare workers incurred as a result of intentional violence by patients in the workplace.

METHODS

Injuries linked to workplace violence that were treated in US emergency departments from 2015 to 2017 were identified using data from the National Electronic Injury Surveillance System-Occupational Supplement (NEISS-Work). All estimates and 95% confidence intervals were calculated using SAS® 9.4 Proc Survey to incorporate the stratified sample design of NEISS-Work.

RESULTS

Approximately 1.14 million injuries to workers in the healthcare industry were treated in US hospital emergency departments between 2015 and 2017. Intentional injuries by another person accounted for 15% of these healthcare-related injuries. The results also showed that male healthcare workers' rate of injuries was 2.3 times higher than their female counterparts despite composing a smaller proportion of the workforce. Injury rates were highest among the less-than-25 age group, and decreased as healthcare workers' age increased.

CONCLUSIONS

Workplace violence is a serious problem in today's healthcare settings that affects both employees and patient care. Although violence in the healthcare industry has been researched for decades, there has been an increase in violent incidents in this industrial sector. The disparity in injury rates by sex and age are areas of concern. Further research in these areas is necessary to understand the root causes of these incidents and inform violence prevention strategies.

Underreporting of workers' injuries or illnesses and contributing factors: a systematic review

BACKGROUND

Accurate identification of work-related health problems is important to understand workplace safety issues and develop appropriate interventions. Although workers' reporting of work-related injuries or illnesses is the very first step of the reporting process, many workers may encounter challenges in reporting them to their management or workers' compensation (WC) programs. This systematic review aimed to identify the level of workers' underreporting of work-related injuries and illnesses and the contributing factors and reasons for underreporting among US workers.

METHODS

This study searched PubMed (Medline), PsycINFO (ProQuest), CINAHL (EBSCOhost), EMBASE (Embase.com), and Social Science Citation Index (Web of Science) using search terms related to underreporting of work-related injury or illness.

RESULTS

Twenty studies (17 quantitative and three mixed methods studies) were identified. The studies investigated reporting to management (n = 12), WC programs (n = 6), multiple organizations (n = 1), and not specified (n = 1). The timeframe used to measure reporting prevalence varied from three months to entire careers of workers, with the most common timeframe of 12 months. This review indicated that 20-91% of workers did not report their injuries or illnesses to management or WC programs. From quantitative studies, contributing factors for injury or illness underreporting were categorized as follows: injury type and severity, sociodemographic factors (e.g., age, gender, education, and race/ethnicity), general health and functioning, worker's knowledge on reporting, job and employment characteristics (e.g., work hour, job tenure, work shift, type of occupation, and physical demand), psychosocial work environment (e.g., supervisor support, coworker support, and safety climate), and health care provider factors. From the review of qualitative studies, the reasons for underreporting included the following: fear or concern, cumbersome time and effort in the reporting process, lack of knowledge regarding reporting, perceptions of injuries as not severe or part of the job, and distrust of reporting consequences.

CONCLUSIONS

The review findings indicated that low wage earners, racial/ethnic minority workers, and workers who perceive a poor psychosocial work environment encounter more barriers to reporting a work-related injury or illness. This review also identified variations in the measurement of work-related injury reporting across studies and a lack of standardized measurement.

TRIAL REGISTRATION

The review was registered in the PROSPERO, an international database of prospectively registered systematic reviews in health and social care (CRD42021284685).

Filing a Workers' Compensation Claim for Low Back Pain and Associated Factors: Analysis of 2015 National Health Interview Survey

OBJECTIVE

The aim of this study was to examine the degree of reporting work-related low back pain (LBP) by workers' compensation (WC) claim filing and associated factors among US workers.

METHODS

We conducted multivariable logistic regression using the 2015 National Health Interview Survey data.

RESULTS

Among 1203 US workers with self-reported work-related LBP diagnosis, only 19.6% filed for WC. Compared with non-Hispanic White workers, Black, Asian, and Hispanic workers were less likely to file for WC. Workers' compensation filing was less frequent among workers in independent work arrangement and who stopped working, changed jobs, or made a change in work and more frequent among workers 45 to 64 years of age and having high LBP frequency.

CONCLUSIONS

Our study findings suggest underreporting of work-related LBP to the WC system is common. Barriers to WC filing should be addressed especially for racial/ethnic minorities and independent workers.

Surveillance of acute nonfatal occupational inhalation injuries treated in US hospital emergency departments, 2014-2017

BACKGROUND

Acute nonfatal occupational inhalation injuries are caused by exposures to airborne toxicants and contaminants in the workplace. A 1990s study found that US emergency department (ED)-based inhalation injury rates were higher than those seen in the United Kingdom and Canada. This study examines 4 years of hospital ED data to estimate current rates of occupational inhalation injuries.

METHODS

Data from the National Electronic Injury Surveillance System Occupational Supplement were used to identify nonfatal occupational inhalation injuries treated in US hospital EDs from 2014 to 2017. A workplace inhalation injury was defined as any worker treated in an ED as a result of inhaling a harmful substance at work.

RESULTS

From 2014 to 2017, there were an estimated 2.2 occupational inhalation injuries per 10,000 full-time equivalents (FTE) (95% confidence interval [CI]: 1.6-2.8) treated in EDs, a rate nearly four times that found in Bureau of Labor Statistics data. Although men incurred 60% (95% CI: 56%-64%) of the injuries, the overall injury rates for men and women were similar at 2.3 (95% CI: 1.7-2.9) and 2.1 (95% CI: 1.4-2.7) per 10,000 FTE, respectively. By age group, workers less than 25 years of age were at greater risk of injury at 4.1 injuries per 10,000 FTE (95% CI: 2.8-5.3).

CONCLUSIONS

These results illustrate the burden of nonfatal occupational inhalation injuries, providing an understanding of how injuries are distributed based on demographics. While inhalation injury rates have declined over the last two decades, additional research is needed to determine whether interventions have reduced risk, or if the availability of alternate sources of medical treatment is a factor.

An introduction to "discrete choice experiments" for behavior analysts

In this paper, we introduce discrete choice experiments (DCEs) and provide foundational knowledge on the topic. DCEs are one of the most popular methods within econometrics to study the distribution of choices within a population. DCEs are particularly useful when studying the effects of categorical variables on choice. Procedurally, a DCE involves recruiting a large sample of individuals exposed to a set of choice arrays. The factors that are suspected to affect choice are varied systematically across the choice arrays. Most commonly, DCE data are analyzed with a multinomial logit statistical model with a goal of determining the relative utility of each relevant factor. We also discuss DCEs in comparison with behavioral choice models, such as those based on the matching law, and we show an example of a DCE to illustrate how a DCE can be used to understand choice with behavioral, social, and organizational factors.

Pain Among Latvian Workers: General Prevalence vs. Registered Occupational Diseases

The problem of painful and disabling work-related musculoskeletal disorders (MSDs) is increasing in many employment sectors of Latvia. Official statistics may underestimate the proportion of affected employees, causing delays in preventive interventions, ineffective rehabilitation, and a reduction of the workforce. This study investigated the prevalence of painful health conditions among Latvian workers by analyzing survey data and comparing these to official statistics on registered occupational diseases (ODs). A total of 2,446 workers participated in the state-level “Work conditions and risks in Latvia, 2017–2018” survey that included questions about pain lasting longer than 3 days during the previous year. The frequency of subjective reports on the presence, severity, and location of pain and related behaviors was assessed in relation to sex, age, education, and job position. Descriptive statistics and cross tabulation with the chi-squared test as well as multinomial logistic regression were applied to the data. Overall, 27.7% of respondents (n = 678) reported experiencing pain, predominantly in the lower back (14.3%) and mostly moderate (47.1%) or severe (45.1%). Only one-fifth of respondents (20.5%) took sick leave from work and one-third (29.0%) did not take action to alleviate their pain. Participants aged 55–74 years had a significantly higher odds ratio (OR) for pain in at least one body region—including hands and legs—than those aged 18–24 years. Women had significantly higher odds of headache (OR = 2.55) and neck pain (OR = 1.85) than men. Respondents with a primary or elementary education level had higher odds of pain in at least one body region (OR = 1.60) and in the lower back (OR = 1.86), while those with secondary education had higher odds of pain in hands (OR = 1.51) than employees with higher education. Unskilled workers had significantly higher odds of pain in hands (OR = 2.42) and legs (OR = 2.12) than directors. Official data revealed a dramatic increase in the proportion of MSDs and related disabilities in the last decade, reaching 75.5% of all first registered ODs in 2019. These results demonstrate a high prevalence of painful conditions among Latvian employees; urgent attention to diagnostics, treatment, and prevention is needed to ensure the musculoskeletal health and productivity of this population.

Understanding occupational safety and health surveillance: expert consensus on components, attributes and example measures for an evaluation framework

Background

Occupational safety and health (OSH) surveillance systems track work-related fatalities, injuries and illnesses as well as the presence of workplace hazards and exposures to inform prevention efforts. Periodic evaluation is critical to the improvement of these systems to meet the demand for more timely, complete, accurate and efficient data processing and analysis. Despite the existence of general guidance for public health surveillance evaluation, no tailored guidance exists for evaluating OSH surveillance systems to date. This study utilized the Delphi technique to collect consensus among experts in the United States on surveillance elements (components, attributes and measures) to inform the development of a tailored evaluation framework.

Methods

A Delphi study approach with three survey rounds invited an expert panel to rate and comment on potential OSH surveillance evaluation framework elements, resulting in an optimal list of elements through the panel’s consensus. Additionally, experts completed a review of OSH surveillance systems they worked with and answered questions regarding the development of an evaluation framework. Descriptive statistics of the ratings were compiled for the Delphi process. Major themes from experts’ comments were further identified using content analysis to inform contextual information underlying their choices.

Results

Fifty-four potential experts across the United States were contacted to participate in the Delphi study. Ten experts began the first survey round with eight then seven experts continuing in the subsequent rounds, respectively. A total of 64 surveillance components, 31 attributes, and 116 example measures were selected into the final list through panel consensus, with 134 (63.5%) reaching high consensus. Major themes regarding current OSH surveillance focused on resources and feasibility, data collection, flexibility, and the inter-relatedness among elements.

Conclusions

A Delphi process identified tailored OSH surveillance elements and major themes regarding OSH surveillance. The identified elements can serve as a preliminary guide for evaluating OSH surveillance systems. A more detailed evaluation framework is under development to incorporate these elements into a standard yet flexible approach to OSH surveillance evaluation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12895-6.

Why Workers Hesitate to Report Their Work-Related Musculoskeletal Symptoms: A Survey at a Korean Semiconductor Company

Underreporting work-related musculoskeletal disorders (WRMSD) has been an issue in South Korea. The purpose of this survey was to figure out how many employees of a semiconductor and liquid crystal display company in South Korea experience WRMSDs and what the possible obstacles in reporting to the company are. A survey was developed with demographic questions, perceived WRMSD symptoms, and reasons for reporting or not reporting WRMSD. The survey was distributed via the company's intranet to all employees (24,380) whose employee identification number ended with an odd number. A total of 2862 employees completed the survey and the response rate was 11.7%. A total of 55.2% of respondents had felt at least one musculoskeletal symptom during the past year. More than 40% of workers who had experienced pain or discomfort during the past year thought their symptoms were more than 50%. work-related. More than one-fourth of respondents answered that they did not report their symptoms to the company more than once. The open-ended answers for not reporting WRMSD were categorized into seven common reasons. The reasons for not reporting WRMSD in previous studies show a combination of personal, organizational, socioeconomical, and cultural factors. To encourage and manage WRMSD effectively, seven recommendations of authors are described.

How Just Culture and Personal Goals Moderate the Positive Relation between Commercial Pilots’ Safety Citizenship Behavior and Voluntary Incident Reporting

Flight safety is consistently influenced by pilots’ self-inflicted incidents in routine flight operations. For airlines, pilots’ reports on these incidents are essential input to learn from incidents (LFI) and for various safety management processes. This paper aims to explain the voluntary reporting behavior of pilots’ self-inflicted incidents from an occupational safety perspective. We investigate how the relation between pilots’ safety citizenship behavior (SCB) and reporting behavior is moderated by pilots’ fear, shame, goals, and goal-striving when reporting, as well as the influence of a just culture on the decision to report incidents. In total, 202 German commercial pilots participated in an online survey. The results showed that reporting behavior can be considered a specific form of self-intentional SCB, but should be differentiated into subtypes depending on a pilot’s unsafe acts (errors or violations) that caused the incident. Reporting behavior-specific motivational factors influenced different subtypes of reporting behavior: Just culture moderated a positive relation between SCB and reported incidents caused by violations. Moreover, depending on the subtype of reporting behavior, the relation was moderated by different types of goals in relation to the pilots. No moderating effects of fear or shame could be demonstrated. Our findings highlight the value of a just culture for encouraging goal-oriented reporting behavior in the context of LFI and safety management.

How Does Selective Reporting Distort Understanding of Workplace Injuries?

This study introduces and applies a new method for studying under-reporting of injuries. This method, “one-to-one injury matching”, involves locating and comparing individual incidents within company and insurer recording systems. Using this method gives a detailed measure of the difference in injuries recognised as “work-related” by the insurer, and injuries classified as “recordable” by the company. This includes differences in the volume of injuries, as well as in the nature of the injuries. Applying this method to an energy company shows that only 19% of injuries recognised by the insurer were recognised by the company as recordable incidents. The method also demonstrates where claiming behaviour and claims management have created systematic biases in the disposition of incidents. Such biases result in an inaccurate picture of the severity and nature of incidents, over-estimating strike injuries such as to the hand, and underestimating chronic and exertion injuries such as to the back.

A Survey of Injuries That Occurred in Veterinary Teaching Hospitals during 2017

Knowing the frequency, extent or severity of injuries that occur to students and staff within veterinary teaching hospitals (VTHs) is necessary for proactive management of their safety. This study surveyed contemporaneously-captured incident reports likely to cause or causing injury to students and staff of veterinary teaching hospitals in Europe, the United States of America (USA), Canada, Australia, and New Zealand, recorded in 2017. Four different severities of incident were evaluated within four different cohorts of people, precipitated by five categories for cause. Within each cause-category, further subdivision was based on the nature of the incident. All colleges of veterinary medicine accredited by the American Veterinary Medical Association (AVMA) Council on Education (COE) or the Australasian Veterinary Boards Council were surveyed. Responses were received from (7/7, 100%) schools in Australia and New Zealand, 12/30 (40%) the United States of America, 1/4 (25%) Canada, 1/1 (100%) Mexico, and 1/3 (33%) United Kingdom, and no responses were received from the AVMA-COE accredited schools in the European Union. The mean incidence of incidents caused by horses was (0.4/1,000 cases), followed by food animals (0.1/1,000 cases), other animals (0.1/1,000 cases), and small animals (0.074/1,000 cases). Within veterinary teaching hospitals at many institutions, veterinary students and veterinarians are particularly at risk of injuries caused by hand-held instruments, such as scalpels and needles. Non-veterinary staff are more at risk than students or veterinarians from injuries caused by small animals. Recording and reporting of incidents is not uniform and may be lacking in detail. Some institutions' systems for record management preclude easy evaluation, and therefore may be insufficient for proactive management of health and safety as required by accreditation bodies.

Masculine Gender Norms and Adverse Workplace Safety Outcomes: The Role of Sexual Orientation and Risky Safety Behaviors

The current study tested the proposition that higher conformity to masculine gender norms (CMGN) is associated with increased safety risk-taking behaviors, which in turn are related to more accidents, injuries, and higher levels of accident underreporting. Additionally, we proposed that sexual minority status would exacerbate the relationship between conformity to masculine gender norms and safety risk-taking behaviors. Using two-wave lagged survey data obtained from N = 403 working adults, findings supported the proposed moderated-mediation model. High conformity to masculine gender norms was associated with increased safety risk-taking behaviors, accidents, injuries, and accident underreporting. Moreover, the relationship between CMGN and safety-risk-taking behaviors was stronger among homosexual men compared to their heterosexual counterparts. Additionally, safety risk-taking behaviors mediated the relationship between CMGN and safety outcomes. Finally, this indirect effect was stronger among homosexual men. Combined, these findings suggest that CMGN adversely impacts employee safety outcomes via safety-related risk-taking. We discuss these implications as well as the need for interventions designed to decrease risk taking behaviors in light of CMGN, particularly among sexual minorities.

Application of data linkage techniques to Pacific Northwest commercial fishing injury and fatality data

Background

Commercial fishing consistently has among the highest workforce injury and fatality rates in the United States. Data related to commercial fishing incidents are routinely collected by multiple organizations which do not currently coordinate or automatically link data. Each data set has the potential to generate a more complete picture to inform prevention efforts. Our objective was to examine the utility of using statistical data linkage methods to link commercial fishing incident data when personally identifiable information is not available.

Methods

In this feasibility study, we identified true matches and discrepancies between de-identified data sets using the Python Record Linkage Toolkit. Four commercial fishing data sets from Oregon and Washington were linked: the Commercial Fishing Incident Database, the Vessel Casualty Database, the Nonfatal Injuries Database, and the Oregon Trauma Registry. The data sets each covered different date ranges within 2000–2017, containing 458, 524, 184, and 11 cases respectively. Several data linkage classifiers were evaluated.

Results

The Naïve-Bayes classifier returned the highest number of true matches between these small data sets. A total of 41 true matches and 8 close matches were identified, of which 29 were determined to be duplicates. In addition, linkage highlighted 4 records that were not commercial fishing cases from Oregon and Washington. The optimum match parameters were the date, state, vessel official number, and number of people on board.

Conclusions

Statistical data linkage enables accurate, routine matching for small de-identified injury and fatality data sets such as those in commercial fishing. It provides information needed to improve the accuracy of existing data records. It also enables expanding and sharpening details of individual incidents in support of occupational safety research.

Gender differences in experience and reporting of acute symptoms among cleaning staff

BACKGROUND

Cleaning tasks pose risks of hazardous chemical exposure and adverse health effects for cleaning workers. We examined gender differences among cleaning staff in the experience of chemical-related symptoms and in reporting to supervisors.

METHODS

We analyzed cross-sectional reports from 171 university hospital or campus cleaning staff on chemical exposures to cleaning products, experience of acute symptoms, reporting of symptoms to supervisors, as well as demographic and psychosocial factors (risk perception, job demand/control, supervisor/co-worker support, and safety climate). Results were analized using multivariable logistic regression, adjusting for demographic, job, and psychosocial factors. Interactions of gender and psychosocial variables were also examined.

RESULTS

Men and women reported different frequencies for exposure-related tasks. Acute symptoms of chemical exposure were more prevalent in women compared with men (46.0% vs. 25.4%; adjusted odds ratio [OR] = 2.63; 95% confidence interval [CI] 1.27-5.46). Women were more concerned about exposure to cleaning chemicals (p = 0.029) but reported symptoms to their supervisor less often than men (18.5% vs. 40.6%, adjusted OR = 0.28; 95% CI 0.09-0.93). More supervisor support was significantly associated with less frequent symptom experience among women (OR = 0.83; 95% CI 0.70-0.99). Asian workers and less educated workers were less likely than others to report symptoms to supervisors. Gender differences in symptom reporting to supervisors were not explained by psychosocial factors.

CONCLUSIONS

Women may have increased susceptibility or perception of symptoms from cleaning compared to men, but this may be mitigated by supervisor support. Female Asian workers with lower education may perceive more significant barriers in reporting work-related symptoms to supervisors. Further research is needed to explore factors related to underreporting.

Worker Injuries in Southern California's Warehousing Industry: How to Better Protect Workers in This Burgeoning Industry?

Dangerous conditions and worker injuries in the rapidly growing warehousing industry have gained attention in recent years, with accounts typically drawing on worker reports and investigative journalism. We analyzed workers' compensation injury claims and California Division of Occupational Safety and Health (Cal/OSHA) citations in Southern California's large warehousing sector. Claims increased from 2014 to 2018, with a majority of injuries caused by repetitive motion, lifting and other ergonomic risk factors. Cal/OSHA cited employers for violating standards to protect workers from unsafe vehicle operations, dangerous machinery and equipment, and falls; and for failing to implement injury prevention programs. These citations address the causes of some worker injuries; however, no Cal/OSHA citations were issued for violating the state's Repetitive Motion Injuries prevention standard. Nor do enforcement activities address the underlying causes highlighted by workers-high production quotas and a relentless work pace-that characterize the industry. We discuss the value and limitations of our approach and the implications of our results.

Cost, Severity and Prevalence of Agricultural-Related Injury Workers' Compensation Claims in Farming Operations from 14 U.S. States

(1) Background: There is no national surveillance of agricultural injuries, despite agricultural occupations being among the most hazardous in the U.S. This effort uses workers' compensation (WC) data to estimate the burden of agricultural injuries and the likelihood of experiencing an injury by body part involved, cause, and nature in farming operations. (2) Methods: WC data from 2010 to 2016 provided by a large insurance company covering small to medium-sized farm operations from 14 U.S. states was used. We investigated the associations between injury characteristics and WC costs and the risk of having a more severe versus a less severe claim. The proportion of costs attributable to specific claim types was calculated. (3) Results: Of a total 1000 claims, 67% were medical only. The total cost incurred by WC payable claims (n = 866) was USD 21.5 million. Of this, 96% was attributable to more severe claims resulting in disabilities or death. The most common body part injured was the distal upper extremity. Falling or flying objects and collisions were the most expensive and common causes of injury. (4) Conclusions: Characterizing the cost and severity of agricultural injury by key injury characteristics may be useful when prioritizing prevention efforts in partnership with insurance companies and agricultural operations.

Air pollution and hospital outpatient visits for conjunctivitis: a time-series analysis in Tai'an, China

Conjunctivitis is one of the most common eye-related health problems and significantly influences patients' quality of life. Whether air pollution increased the risks of conjunctivitis is still unclear. Daily counts of outpatient visits for conjunctivitis, air pollution, and meteorological data during January 1, 2015-December 31, 2019 were collected from Tai'an, China. Generalized additive model with Poisson distribution was used to estimate the relationship between air pollution and visits for conjunctivitis, after controlling for the long-term and seasonal trends, weather variables, and day of the week. The effect of air pollution on visits for conjunctivitis was generally acute and significant at the current day and disappeared after 2 days. The relative risk of conjunctivitis visits associated with per 10 μg/m³ increases in PM_2.5, PM₁₀, SO₂, and NO₂ at lag 0-2 days was 1.006 (95% CI: 1.001-1.011), 1.003 (95% CI: 1.000-1.0107), 1.023 (95% CI: 1.009-1.037), and 1.025 (95% CI: 1.010-1.040), respectively. The impact of air pollution on visits for conjunctivitis varied greatly by individual characteristics. The impact of NO₂ was higher in males than in females, with the opposite trend for SO₂ and PM_2.5. Effect estimates of air pollutants were higher among return visits for conjunctivitis, the elderly, and white-collar workers. Our study highlights that the vulnerable subpopulations should pay more attention to protect themselves from air pollution.

Are All Endoscopy-Related Musculoskeletal Injuries Created Equal? Results of a National Gender-Based Survey

INTRODUCTION

Endoscopy-related injury (ERI) is common in gastroenterologists (GI). The study aim was to assess the prevalence of self-reported ERI, patterns of injury, and endoscopist knowledge of preventative strategies in a nationally representative sample.

METHODS

A 38-item electronic survey was sent to 15,868 American College of Gastroenterology physician members. The survey was completed by 1,698 members and was included in analyses. Descriptive, univariate, and multivariate analyses were conducted to evaluate the likelihood of ERI based on workload parameters and gender.

RESULTS

ERI was reported by 75% of respondents. ERI was most common in the thumb (63.3%), neck (59%), hand/finger (56.5%), lower back (52.6%), shoulder (47%), and wrist (45%). There was no significant difference in the prevalence of ERI between men and women GI. However, women GI were significantly more likely to report upper extremity ERI while men were more likely to report lower-back pain-related ERI. Significant gender differences were noted in the reported mechanisms attributed to ERI. Most respondents did not discuss ergonomic strategies in their current practice (63%). ERI was less likely to be reported in GI who took breaks during endoscopy (P = 0.002).

DISCUSSION

ERI is highly prevalent in GI physicians. Significant gender differences regarding specific sites affected by ERI and the contributing mechanisms were observed. Results strongly support institution of training in ergonomics for all GI as a strategy to prevent its impact on providers of endoscopy.

Two discrete choice experiments on laboratory safety decisions and practices

INTRODUCTION

The path toward enhancing laboratory safety requires a thorough understanding of the factors that influence the safety-related decision making of laboratory personnel.

METHOD

We developed and administered a web-based survey to assess safety-related decision making of laboratory personnel of a government research organization. The survey included two brief discrete choice experiments (DCEs) that allowed for quantitative analysis of specific factors that potentially influence safety-related decisions and practices associated with two different hypothetical laboratory safety scenarios. One scenario related to reporting a laboratory spill, and the other scenario involved changing protective gloves between laboratory rooms. The survey also included several brief self-report measures of attitude, perception, and behavior related to safety practices.

RESULTS

Risk perception was the most influential factor in safety-related decision making in both scenarios. Potential negative consequences and effort associated with reporting an incident and the likelihood an incident was detected by others also affected reporting likelihood. Wearing gloves was also affected somewhat by perceived exposure risk, but not by other social or work-related factors included in the scenarios.

CONCLUSIONS

The study demonstrated the promise of DCEs in quantifying the relative impact of several factors on safety-related choices of laboratory workers in two hypothetical but realistic scenarios. Participants were faced with hypothetical choice scenarios with realistic features instead of traditional scaling techniques that ask about attitudes and perceptions. The methods are suitable for addressing many occupational safety concerns in which workers face tradeoffs in their safety-related decisions and behavior. Practical Application: Safety-related decisions regarding laboratory practices such as incident reporting and use of PPE were influenced primarily by workers' perceptions of risk of exposure and severity of risks to health and safety. This finding suggests the importance of providing laboratory workers with adequate and effective education and training on the hazards and risks associated with their work. DCEs are a promising research method for better understanding the relative influences of various personal, social, and organizational factors that shape laboratory safety decisions and practices. The information gained from DCEs may lead to more targeted training materials and interventions.

Ergonomic endoscopy: An oxymoron or realistic goal?

The current endoscope design is not ergonomic. There is a high prevalence of endoscopy-related injury reported in the literature, and studies have demonstrated high-risk biomechanical exposures during the performance of routine colonoscopy. Endoscopy ergonomics focuses on understanding the endoscopist's interaction with the endoscope and the endoscopy unit and re-designing these tasks to minimize the risk of endoscopy-related injury. The discussion to date has focused on what the endoscopist can do to minimize his or her risk of injury. It is imperative that we re-frame that discussion because the implication that physicians are responsible for implementing personal or workplace interventions places an undue burden on physicians and will be the least effective exposure control method. Endoscope companies need to consider the endoscopist in their design process. As a profession, we need to collectively advocate for endoscopist safety. We offer a perspective on how ergonomic endoscopy can become a realistic and achievable goal.

Transfer of the health care burden of occupational injuries and diseases from labor insurance to national health insurance in Taiwan

BACKGROUND

Occupational injury and diseases result in substantial national health care burden. However, medical costs are often transferred to injured workers or the health insurance system. This study aims to examine the health care service utilization patterns of injured workers under the National Health Insurance (NHI) program in Taiwan and the barriers to medical benefit claims from labor insurance workers' compensation.

METHODS

The total amount spent on medical benefits and national health expenditure from 1980 to 2014 was obtained. Workers who have experienced occupational injuries or diseases were identified in four waves of national surveys, and the types of medical care use were compared. In-depth interviews were conducted with 52 workers who had experienced occupational injuries and diseases.

RESULTS

Since the implementation of the NHI program in 1995, medical benefits from workers' compensation have dropped substantially. In total, 75% of the workers who experienced occupational injuries or diseases had their medical costs covered through NHI. The time and effort costs caused by barriers against claiming medical benefits from workers' compensation decreased the incentive for workers from certain socioeconomic groups to make workers' compensation claims.

CONCLUSION

Medical costs attributable to occupational injuries or diseases were mainly paid through NHI instead of through labor insurance. The economic burden was partially shifted from employers to workers, taxpayers, and the government.

Knowledge of work-related injury reporting and perceived barriers among janitors

INTRODUCTION

The goal of this study was to evaluate and improve janitors' knowledge of workers' rights and responsibilities for assessing and reporting work-related injuries, and to determine the barriers for reporting occupational injuries.

METHODS

Questionnaires, designed to collect data retrospectively for two, sequential six-month periods, were disseminated to 1200 full-time unionized janitors in the Twin Cities. Immediately following the baseline questionnaire administration, a randomly selected sub-group of janitors (~600) received information on workers' rights and responsibilities for reporting injuries; six-months later a questionnaire comparable to the baseline questionnaire was disseminated to the 1200 janitors. Analyses included basic descriptive analyses and identification of potential differences in proportions of job-specific reporting barriers pre-post-intervention.

RESULTS

Among the participating janitors (n = 390), approximately half (53%) were initially unsure of what an OSHA 300 Log was; 56% reported not knowing what workers' compensation was. At baseline, in both intervention and non-intervention groups, approximately 25% reported having a perceived barrier to reporting an injury to their employer. Reported barriers included "fear," "reporting takes too long," "being unsure of the reporting process," and an "understanding that injuries are a part of the job." At follow-up, among the intervention group, there was an important reduction (24%-12%) in having a perceived barrier for reporting a work-related injury.

CONCLUSIONS

A majority of janitors lacked knowledge and awareness of OSHA injury reporting and Workers' Compensation. In order to improve reporting, it is essential to educate employees on OSHA and Workers' Compensation and inform janitors of the injury reporting process through training. Practical applications: Future intervention efforts must focus on the specific barriers for reporting occupational injuries and be tailored specifically to the janitor population. To reduce underreporting of injuries, they must be encouraged to report their occupational injuries. Barriers to reporting these injuries must be eliminated.

Coverage Gaps and Cost-Shifting for Work-Related Injury and Illness: Who Bears the Financial Burden?

The heavy economic burden of work-related injury/illness falls not only on employers and workers' compensation systems, but increasingly on health care systems, health and disability insurance, social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers' compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.

Physicians' opinions about the causes of underreporting of occupational diseases

Occupational diseases cause an important burden on health and economy; however, they are substantially underestimated. We aimed to investigate the opinions of physicians about causes of underreporting of occupational diseases. We collected data with a questionnaire, listing 30 possible causes for underreporting of occupational diseases. 478 physicians participated in the study. The first 3 most frequent causes perceived as "very important" are; employers' perception of occupational safety and health services as a loss of revenue (64.9%), prevalent employment without a legal contract (64.6%), and prevalent employment as subcontracted (59.4%). 52.1% of the physicians worked or currently working as an occupational physician. With the increase of working year as an occupational physician, there was a statistically significant decrease in the strength of importance for 17 of the 30 statements. This finding may be one of the important causes of underreporting of occupational diseases.

Psycho-socio-cultural factors and global occupational safety: Integrating micro- and macro-systems

Occupational health and safety varies greatly around the world. However, there is a dearth of information on contributing factors to global occupational safety at both micro- and macro-level. The aim of this study was to examine which psycho-socio-cultural factors including economic contexts are associated with occupational fatality rates in 51 countries from six continents (Study 1), as well as fatality rates and serious occupational injury rates in 31 European countries (Study 2). Multiple regression analysis showed that universal healthcare and individualism were significantly associated with lower occupational fatality rates in Study 1. To expand Study 1, additional variables regarding healthcare systems and occupational safety were utilized in Study 2 and it was shown that greater overall quality of healthcare system, greater quality of healthcare systems' prevention effort, and higher individualism were meaningfully linked with lower occupational fatality rates. Meanwhile, greater overall quality of healthcare and greater quality of healthcare systems' prevention efforts were meaningfully linked with higher serious occupational injury rates. To prevent workplace fatalities more effectively and to promote workplace safety and health at the global level, socioeconomic and cultural factors at micro- and macro-level need to be appropriately considered. Specifically, safety policies, regulations, procedures, and practices in countries with healthcare systems of greater quality can be benchmarked for other countries. Also, functional aspects of safety communication and participation in cultures with high individualism can be referenced by other countries.

Voices carry: Effects of verbal and physical aggression on injuries and accident reporting

Recent years have witnessed a staggeringly high number of workplace aggressive behaviors as well as employee accidents and injuries. Exposure to workplace aggression is associated with a host of negative psychological, emotional, and physiological outcomes, yet research relating workplace aggression to employee safety outcomes is lacking. This study aims to examine the association between exposure to workplace physical and verbal aggression with workplace injuries and underreporting of accidents and near misses. Furthermore, deriving from social exchange theory, we attempt to reveal an underlying mechanism in the association between workplace aggression and underreporting of accidents and near misses. Finally, borrowing from aggression research on intimate relationships, we compare the relative importance of exposure to physical and verbal aggression on workplace injuries and underreporting. Using survey data from 364 public transportation personnel, we found that both verbal and physical aggression significantly predict workplace injuries as well as underreporting. Moreover, mediation analyses found that the relationship between verbal and physical aggression and underreporting was largely explained by an increase in negative reporting attitudes (rather than decreases in safety knowledge or motivation). Compared to exposure to physical aggression, exposure to verbal aggression best predicted employee underreporting of accidents and near misses. However, physical aggression was a better predictor of injuries than verbal aggression. Given these findings, organizational leaders should strive to foster a safe working environment by minimizing interpersonal mistreatment and increasing employee attitudes for reporting accidents.

Enhancing the detection of injuries and near-misses among patient care staff in a large pediatric hospital

Objectives Compared to other industries, healthcare has one of the highest rates of non-fatal occupational injury/illness. Evidence indicates these rates are underestimated, highlighting the need for improved injury surveillance. This study aims to demonstrate the feasibility of integrating active data collection in a passive injury surveillance system to improve detection of injuries in a healthcare establishment. Methods Using digital voice recorders (DVR), pediatric healthcare providers prospectively recorded events throughout their shift for two weeks. This sample-based active injury surveillance was then integrated into an institutional surveillance system (ISS) centered on passive data collection initiated by employee reports. Results Injuries reported using DVR during two-week intervals from February 2014 to July 2015 were 40.7 times more frequent than what would be expected on the basis of the usual ISS reports. Psychological injuries (eg, stress, conflict) and near-misses were captured at a rate of 16.1 per 1000 days [95% confidence interval (CI) 14.1-18.3] and 35.6 per 1000 days (95% CI 32.7-38.8), respectively. Finally, 68% (95% CI 65-72%) of participants preferred using DVR either as an alternative or complement to the existing ISS. Conclusions This study showed that it is feasible to improve injury surveillance in a healthcare establishment by integrating active data collection based on voice recording within a passive injury surveillance system. Enhanced surveillance provides richer information that can guide the development of effective injury prevention strategies.

The anti-therapeutic effects of workers' compensation in China: The case of seafarers

Workplace injuries are a serious public health problem, potentially leading to loss of earnings, medical expenses, disability and even death for working people. Maritime transport workers - seafarers - are exposed to higher risks of workplace injuries than is the general land-based workforce. China has the world's largest population of international seafarers. Under Chinese law, as elsewhere, losses from workplace accidents are compensated in the form of financial entitlements. However, Chinese seafarers face tremendous challenges in the workers' compensation claim process. This paper investigates the experiences of Chinese seafarers in claiming this compensation, in order to assess the protective capacity of Chinese workers' compensation, known as the Work-Related Injury Insurance System. Drawing on therapeutic jurisprudence, it explores the anti-therapeutic effects that Chinese seafarers confront in the claims process. Based on an analysis of regulatory documents and interview data with the informants - including seafarers, their family members and managerial professionals in the shipping industry - the findings suggest that current work-related injury insurance is unable to provide sufficient assistance for Chinese seafarers. Instead of obtaining effective therapeutic remedies following accidental trauma, Chinese seafarers (and their families) are indeed likely to suffer additional harm in the process of claiming compensation. The paper suggests that further measures should be adopted to improve work-related injury insurance coverage among seafarers, and that efficient sanctions should be strengthened against infringements of seafarers' rights.

Workers' compensation and the working poor: Occupational health experience among low wage workers in federally qualified health centers

BACKGROUND

The working poor are at highest risk of work-related injuries and have limited access to occupational health care.

OBJECTIVES

To explore community health centers (CHCs) as a venue for accessing at risk workers; and to examine the experience, knowledge, and perceptions of workers' compensation (WC) among the working poor.

METHODS

Key informant interviews were conducted among patients in waiting rooms of rural and urban CHCs.

RESULT

Fifty-one interviews of minority workers across sectors identified 23 prior work-related injuries and mixed experiences with the WC system. Barriers to reporting and ways to overcome these barriers were elucidated.

CONCLUSIONS

Patients in CHCs work in jobs that put them at risk for work-related injuries. CHCs are a good site for accessing at-risk workers. Improving occupational healthcare and appropriate billing of WC insurance should be explored, as should best practices for employers to communicate WC laws to low wage workers.

Selection of employee personal protective equipment based on aggressive behavior in pediatric neuropsychiatry

PURPOSE

Hospitalized patients with a developmental or intellectual disability and a psychiatric disorder (dual-diagnosis) often pose a risk to themselves or others leading to high injury rates for their providers. Therefore, evidence-based strategies to reduce employee injuries resulting from interactions are necessary.

METHODS

To reduce injuries resulting from interactions with dual-diagnosis patients, the Initial Behavioural Assessment (IBA) and Protective Equipment Decision Key (PEDK) were used in inpatient neuropsychiatry. The IBA-PEDK identify patients' aggressive behaviors to provide employees with personal protective equipment (PPE). Inter-rater reliability, validity, and adherence were examined.

RESULTS

Injuries significantly decreased after implementing the IBA-PEDK. The average kappa coefficient was 0.64 with a 90.6% agreement. Ninety-three percent of respondents reported wearing PPE at the time of injury.

CONCLUSIONS

A quick, user-friendly tool that provides a standardized method for determining PPE based on patient-specific behavior can significantly reduce aggression-related injuries.

The role of managers in addressing employees with musculoskeletal pain: a mixed methods study

Purpose

This study investigates management awareness of employee musculoskeletal pain and conditions that shape managers’ handling of employees with pain.

Methods

We used a mixed methods design including data from a questionnaire survey and focus group sessions. All employees and managers from seven nursing homes were invited to participate in the questionnaire survey and 327 employees (81%) and 31 managers (82%) responded. Employees were asked about their worst pain intensity the past month and managers were asked to estimate the percentage of their employees who had experienced pain. Thirty-eight managers (93%) participated in focus group sessions addressing the culture for handling pain at the workplace. A multiple case study approach allowed for an integrated interpretation of the empirical findings.

Results

Results indicate limited manager awareness of employee pain. We identified four conditions that shape managers’ handling of employees with pain: (1) Employee handling of—and communication about—pain, (2) the collegial culture for handling pain, (3) managers’ perception of their role towards employees with pain and (4) procedures and informal approaches for handling employees with pain. Across these conditions various degrees of openness characterized the nursing homes.

Conclusions

The degree of openness towards communicating about—and handling pain—in the organization (individual, collegial and managerial levels) influences how managers handle employees with pain. Awareness about employee health is a prerequisite for management to initiate relevant action towards supporting employees. Future workplace initiatives are likely to benefit from addressing openness in the organization to increase awareness and support employees with pain.

Nurses' Inclination to Report Work-Related Injuries: Organizational, Work-Group, and Individual Factors Associated with Reporting

Work-related injuries such as back strain are common among health care workers. Work-related injury data are a primary data source with which managers can assess workplace safety, yet many work-related injuries go unreported. This study examined organizational, work-group, and individual factors, and nurses' inclination to report a work-related injury. Using a cross-sectional mailed survey, a probability sample of currently employed nurses (N = 1,163) indicated their inclination to report a workplace injury. Inclination to report injuries was higher in organizations with onsite health programs and when health and safety committees included non-management nurses and occupational health representatives. Reporting was reduced when nurses felt a lack of concern for staff welfare from supervisors and a climate of blame for worker injuries were present Nurses were also less inclined to report work-related injuries when working in jobs with non-standard work arrangements. Improvements in the reporting climate may influence the completeness and, thus, the value of injury data for identifying hazards in the workplace. These data could provide valuable information for targeting preventive initiatives.

The nature and burden of occupational injury among first responder occupations: A retrospective cohort study in Australian workers

INTRODUCTION

Workers in first responder (FR) occupations are at heightened risk for workplace injury given their exposure to physical/psychological hazards. This study sought to (1) characterise the occupational risk of injury; (2) determine factors associated with injury; and (3) characterise the burden of injury-related disability in police, ambulance officers, fire/emergency workers, compared with other occupations.

METHODS

A retrospective cohort of 2,439,624 claims occurring between July 2003 and June 2012 was extracted from the Australian National Dataset for Compensation-Based Statistics. Cases aged 16-75 years working 1-100 pre-injury hours per week were included. Regression models estimated risk of making a workers' compensation (WC) claim by age, gender, occupation and injury type. Injury burden was calculated using count and time loss, and statistically compared between groups.

RESULTS

The risk of making a WC claim among FR occupations was more than 3 times higher than other occupations. Risk of claiming was highest among female FRs and those aged 35-44 years. Ambulance officers had the greatest risk of upper-body MSK injuries and fire and emergency workers the greatest risk of lower-body MSK injuries. The risk of mental health conditions was elevated for all FR occupations but highest among police officers. The total burden of injury (expressed as working weeks lost per 1000 workers) differed significantly between groups and was highest amongst police.

DISCUSSION AND CONCLUSIONS

First responders record significantly higher rates of occupational injury claims than other occupations. Using a national population based dataset, this study demonstrates that not only are first responders exposed to significantly higher rates of occupational injury than all other occupations combined, but they experience differential injury patterns depending on their occupation. This suggests that among FR occupations injury prevention efforts should reflect these differences and be targeted to occupation-specific patterns of injury.

Worksite Walkthrough Intervention: Data-driven Prevention of Workplace Violence on Hospital Units

OBJECTIVE

The aim of this study was to describe the implementation of a data-driven, unit-based walkthrough intervention shown to be effective in reducing the risk of workplace violence in hospitals.

METHODS

A structured worksite walkthrough was conducted on 21 hospital units. Unit-level workplace violence data were reviewed and a checklist of possible prevention strategies and an Action Plan form guided development of unit-specific intervention. Unit supervisor perceptions of the walkthrough and implemented prevention strategies were reported via questionnaires. Prevention strategies were categorized as environmental, behavioral, or administrative.

RESULTS

A majority of units implemented strategies within 12 months' postintervention. Participants found the walkthrough useful, practical, and worthy of continued use.

CONCLUSIONS

Structured worksite walkthroughs provide a feasible method for workplace violence reduction in hospitals. Core elements are standardized yet flexible, promoting fidelity and transferability of this intervention.

Occupational Health and the Performing Arts: An Introduction

OBJECTIVE

Workplace hazards in the performing arts cause injuries, disabilities, and deaths every year. Occupational health professionals are familiar with most of these hazards and are particularly qualified to contribute to efforts to reduce them. This article reviews current health issues in the performing arts and highlights opportunities for occupational health contributions.

METHODS

Recognized experts in performing arts medicine were consulted and articles illustrating performing arts health issues were reviewed. Literature sources included medical databases, unindexed art-health publications, and popular press articles.

RESULTS

Resources discussing hazards and health issues in theater, dance, voice, and instrumental musicians were located and reviewed.

CONCLUSIONS

Treatment providers have a history of involvement with segments of the performing arts. The occupational health approach to workplace health issues can effectively complement these efforts. Sources of further information on performing arts health concerns are available.

Evaluation of a state based syndromic surveillance system for the classification and capture of non-fatal occupational injuries and illnesses in New Jersey

BACKGROUND

This preliminary study evaluates a real-time syndromic surveillance system to track occupationally-related emergency room visits throughout New Jersey.

METHODS

Emergency Department (ED) chief complaint fields were evaluated from 79 of 80 hospitals in NJ in 2014, using work-related keywords and ICD-9 E-codes, to determine its ability to capture non-fatal work-related injuries. Sensitivity analysis and descriptive statistics, were used to evaluate and summarize the occupational injuries identified.

RESULTS

Overall, 11 919 (0.3%) possible work-related ED visits were identified from all ED visits. Events with the greatest number of ED visits were slips, trips, and falls (1679, 14%). Nature of injury included cuts, lacerations (1041, 9%). The part of the body most affected was the back (1414, 12%). This work-related classifier achieved a sensitivity of 5.4%, a specificity of 99.8%, and a PPV of 2.8%.

CONCLUSIONS

This evaluation demonstrated that the syndromic surveillance reporting system can yield real-time knowledge of work-related injuries.

Linking Incidents in Long-Term Care Facilities to Worker Activities

This article reports on a study examining staff activities being performed when incidents were reported to have occurred. The risk for injury among health care providers who engage in patient handling activities is widely acknowledged. For those working in long-term care, the risk of occupational injury is particularly high. Although injuries and injury prevention have been widely studied, the work has generally focused on incident rates and the impact of specific assistive devices on worker safety. The purpose of this study was to examine reported staff incidents in relation to staff activities. A multicenter cross-sectional exploratory study used retrospective data from reported staff incidents (2010, 2011, and 2012) and prospective data from 360 hours of staff observations in five long-term care facilities during 2013. Descriptive statistics were used to analyze data. A total of 898 staff incidents were reviewed from the facilities. Incidents were most likely to occur in resident rooms. Resident aides were more likely to be engaged in high-risk activities than other care providers. Times when staff incidents were reported to have occurred were not associated with periods of high staff-to-resident contact. Safe handling during low and moderate risk activities should be promoted. Education on what constitutes a reportable incident and strategies to ensure compliance with reporting policies and procedures may be needed to ensure accuracy and completeness of incident data.

Trouble in transit: Organizational barriers to workers' health

BACKGROUND

Valuable insights on the health and behavior of transit workers can be obtained from qualitative research that considers the social environment, which affects job performance and determines levels of perceived stress.

METHODS

Using a grounded theory approach, semi-structured interviews were conducted with American transit workers (n = 32). Recorded interviews were transcribed and analyzed using a constant comparative method.

RESULTS

Participants described categories related to entrenched organizational practices, particularly managements' leadership style, which created an atmosphere of distrust. High demanding work schedules, as a result of technological advances, were discussed in relation to diminished breaks, fatigue, and unhealthy diets. Transit workers also attributed increased work demands and irregular working hours to compromised time with family and friends.

CONCLUSIONS

The described barriers to positive health behaviors and social support underscore the need for interventions that ensure adequate breaks and recovery between shifts and increase safety for transit passengers. Am. J. Ind. Med. 60:350-367, 2017. © 2017 Wiley Periodicals, Inc.

The impact of the introduction of new recognition criteria for overwork-related cardiovascular and cerebrovascular diseases: a cross-country comparison

Cardiovascular and cerebrovascular diseases (CVDs) related to overwork are common in Asia, as is death from overwork, known as karoshi. Japan was the first country in the world to introduce criteria for recognizing overwork-related CVDs in 1961. Taiwan followed Japan in putting in place new policies and then updating these in 2010. We aimed to investigate the effect of introducing the new criteria for recognizing overwork-related CVDs in both countries. We defined the baseline period as the 5 years before launch of the new criteria, then collected data to 5 years after the new criteria. We applied a Poisson regression model to analyze the longitudinal change in rates of overwork-related CVDs before and after, adjusting for indicators of working conditions. Implementation of the new criteria was associated with a 2.58-fold increase in the rate of overwork-related CVDs (p-value < 0.05). However, the examined policy framework in Taiwan still appears to miss a substantial number of cases compared to that are captured by a similar policy framework used to capture overwork-related CVD rates in Japan by a factor of 0.42 (p-value < 0.05). Accordingly, we make a case for enhancements of Taiwan’s system for reporting and recognizing overwork-related diseases and deaths.

Underreporting of Musculoskeletal Injuries in the US Army: Findings From an Infantry Brigade Combat Team Survey Study

Background:

Musculoskeletal injury is a significant threat to readiness in the US Army. Current injury surveillance methods are constrained by accurate injury reporting. Input into electronic medical records or databases therefore may not accurately reflect injury incidence. The purpose of this study was to evaluate injury reporting among active-duty US Army soldiers to explore potential limitations of surveillance approaches.

Hypothesis:

A significant number of injuries go unreported to medical personnel.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 4.

Methods:

Surveys were completed by soldiers assigned to an Army Infantry Brigade Combat Team. Survey questions inquired about injuries sustained in the previous 12 months, injury onset, and whether injuries were reported to a medical provider. Participants were asked to rank reasons for accurately reporting, underreporting, and/or exaggerating injuries. Chi-square analyses were used to compare differences among underreported injuries in terms of injury onset (gradual vs acute) and sex.

Results:

A total of 1388 soldiers reported 3202 injuries that had occurred in the previous 12-month period, including 1636 (51%) that were reported and 1566 (49%) that were identified as not reported to medical personnel. More than 49% of reported injuries were described as acute and 51% were described as chronic. Injury exaggeration was reported by 6% of soldiers. The most common reasons for not reporting injuries were fear that an injury might affect future career opportunities and avoidance of military “profiles” (mandated physical restrictions).

Conclusion:

Approximately half of musculoskeletal injuries in a Brigade Combat Team were not reported.

Clinical Relevance:

Unreported and untreated injuries can lead to reinjury, chronic pain, performance decrements, and increased costs associated with disability benefits. Additionally, unreported injuries can undermine injury surveillance efforts aimed at reducing the musculoskeletal injury problem in the military.

Low back pain characterized by muscle resistance and occupational factors associated with nursing

Objective

to identify the occupational factors associated with low back pain using a surveillance tool and to characterize the low back pain by the resistance of the extensor muscles of the vertebral column among nursing professionals at an Intensive Care Unit.

Methods

Cross-sectional study. The workers answered a questionnaire about occupational factors and participated in a resistance test of the extensor muscles of the vertebral column. Associations were established through Student's T-test or Mann-Whitney's U-test and correlations using Pearson's test.

Results

Out of 48 participants, 32 (67%) suffered from low pain. For the resistance test, the subjects suffering from low back pain endured less time in comparison with asymptomatic subjects, but without significant differences (p=0.147). The duration of the pain episode showed a significant negative correlation (p=0.016) with the results of the resistance test though. The main factors identified as causes of low back pain were biomechanical and postural elements, conditions of the muscle structure and physical and organizational conditions.

Conclusions

the main occupational factors associated with the low back pain were the posture and the characteristics of the physical and organizational conditions. In addition, the extensor muscles of the column showed a trend towards lesser resistance for workers in pain. This evidence is important when considering prevention and treatment strategies.

Get Safety Problems to the Surface

This study examines the relationship that employee perceptions of rewards, training, and selection have with reported and unreported employee injuries requiring doctor's attention, first aid cases, and near misses. Additionally, this study examines the relationship of selection and training with injury reporting beyond that of rewards, because reporting relationships have not previously been examined in either of these areas. Study results indicate that employee perception of training is associated with a decrease in the number of unreported injuries including doctor's attention, first aid cases, and near misses, and employee perceptions of selection are associated with a decrease in the number of unreported first aid cases. Both training and selection were related to the number of unreported injuries above and beyond the effect of rewards for safety. Implications of these findings are discussed.