Association between Body Mass Index and Acute Traumatic Workplace Injury in Hourly Manufacturing Employees

Increased all-cause mortality following occupational injury: a comparison of two states

OBJECTIVES

To measure the impact of lost-time occupational injuries on all-cause mortality in Washington State and, using the same data elements and study design, to determine whether the estimated impact was similar to previous estimates for New Mexico.

METHODS

We linked injuries in the Washington workers' compensation system with Social Security Administration data on earnings and mortality. We estimated Cox survival models of mortality for women and men with lost-time compared with medical-only injuries, adjusting for age, pre-injury earnings and industry. We used quantitative bias analysis to account for confounding by pre-injury smoking and obesity.

RESULTS

The estimated mortality HR was 1.24 for women (95% CI 1.21 to 1.28) and 1.22 for men (95% CI 1.20 to 1.24). After adjusting for unmeasured pre-injury smoking and obesity, the estimated HR for women was 1.10, 95% simulation interval (SI) 1.00 to 1.21; for men, it was 1.15, 95% SI 1.04 to 1.27.

CONCLUSIONS

All-cause mortality for Washington workers with lost-time injuries was higher than for those with medical-only injuries. Estimated HRs for Washington were consistent with those previously estimated for New Mexico, a less populous state with lower median wages and a different workers' compensation insurance mechanism. This suggests that the relationship between workplace injury and long-term mortality may be generalisable to other US states. These findings support greater efforts to enhance safety and to investigate factors that improve postinjury employment opportunities and long-term health. This association should be examined in additional locations, with different study conditions, or using additional data on pre-injury risk factors.

Association of overtime work and obesity with needle stick and sharp injuries in medical practice

BACKGROUND

Needle stick and sharps injuries (NSIs) may cause infections among medical personnel. Obesity and overtime work among medical personnel increase the incidence of work injuries.

AIM

To investigate whether overtime work and obesity increase the risk of NSIs.

METHODS

This cross-sectional study used the data of 847 hospital personnel, including 104 doctors, 613 nurses, 67 medical laboratory scientists, 54 specialist technicians, and nine surgical assistants. Of them, 29 participants notified the hospital of having at least one NSI in 2017. The data collected included age, overtime work, body mass index, medical specialty such as doctor or nurse, and professional grade such as attending physician or resident. The χ 2 and Fisher's exact tests were used to compare categorical variables. Multiple logistic regression analysis and the Sobel test were used to assess the risk of NSIs.

RESULTS

Overtime work, body weight, and medical specialty were significantly associated with NSIs (P < 0.05). After adjustment for risk factors, heavy overtime work was an independent risk factor for NSIs, and healthy body weight and nursing specialty were independent protective factors against NSIs. After adjustment for risk factors, medical personnel with healthy body weight has half as many NSIs as those with unhealthy body weight; the proportion of NSIs in doctors with healthy body weight was 0.2 times that in doctors with unhealthy body weight; the proportion of injuries among residents was 17.3 times higher than that among attending physicians; the proportion of injuries among junior nurses was 3.9 times higher than that among experienced nurses; the proportion of injuries among nurses with heavy overtime work was 6.6 times higher than that among nurses with mild overtime work; and the proportion of injuries among residents was 19.5 times higher than that among junior nurses. Heavy overtime work mediated the association of medical specialty with NSIs.

CONCLUSION

In addition to promoting the use of safety needles and providing infection control education, managers should review overtime schedules, and medical personnel should be encouraged to maintain a healthy weight.

Mortality following workplace injury: Quantitative bias analysis

PURPOSE

Recent studies have shown increased all-cause mortality among workers following disabling workplace injury. These studies did not account for 2 potentially important confounders, smoking and obesity. We estimated injury-related mortality accounting for these factors.

METHODS

We followed workers receiving New Mexico workers' compensation benefits (1994-2000) through 2013. Using data from the Panel Study of Income Dynamics, we derived the joint distribution of smoking status and obesity for workers with and without lost-time injuries. We conducted a quantitative bias analysis (QBA) to determine the adjusted relationship of injury and mortality.

RESULTS

We observed hazard ratios after adjusting for smoking and obesity of 1.13 for women (95% simulation interval (SI) 0.97 to 1.31) and 1.12 for men (95% SI 1.00 to 1.27). The estimated fully adjusted excess hazard was about half the estimates not adjusted for these factors.

CONCLUSIONS

Using QBA to adjust for smoking and obesity reduced the estimated mortality hazard from lost-time injuries and widened the simulation interval. The adjusted estimate still showed more than a 10 percent increase for both women and men. The change in estimates reveals the importance of accounting for these confounders. Of course, the results depend on the methods and assumptions used.

Obesity and Work-Related Injuries Among Farmers in Kentucky, Tennessee, and West Virginia

BACKGROUND

Obesity is a recognized risk factor for work-related injuries (WRI). Despite the inherent safety hazards associated with farm work, research on obesity among farmers is limited giving little guidance to occupational health providers on obesity as a risk factor in farm WRI. This study evaluated the association between obesity and farm WRI.

METHODS

Cross-sectional data were collected from farmers (n = 100) in Kentucky, Tennessee, and West Virginia. Data included a survey (demographic data, farm factors, health indicators, occurrences of work-related injuries consistent with the definition of Occupational Safety and Health Administration [OSHA] recordable injuries) and direct anthropometric measures (height, weight, and waist circumference). Logistic regression was used to model any work-related injury, injuries consistent with the definition of OSHA recordables (herein called OSHA-recordable injuries), and recurrent injuries occurring during farm work performance on body mass index (BMI) and waist circumference.

FINDINGS

Twenty-five percent of the participants reported any injuries, and 18% reported OSHA-recordable injuries. Farmers with a BMI ≥30 kg/m² had 3 times the risk for OSHA-recordable injuries and 5 times the risk for recurrent injuries. No significant relationship was identified between waist circumference and farm WRI.

CONCLUSION

This study provides evidence that increased BMI is a safety risk for farmers. Prospective studies with a larger sample are needed. Occupational health nurses and providers should educate farmers on the potential safety risk of obesity and implement weight management programs addressing obesity in farmers.

Curse or Blessing? Obesity and Income-Related Inequality in the Chinese Labor Force

China owns a huge labor force of around half billion workers in 2018. However, little is known about the prevalence of obesity and the association between obesity and economic status in this special population. By employing the concentration index (CI) and decomposition analysis, this paper addresses this knowledge gap by using the most recent nationally representative dataset. In specific, this study examines the prevalence of obesity and the socioeconomic gradient in the probability of obesity among Chinese workers between 16 and 65. Our results show that the prevalence of obesity is completely different by using a different measure: the overall prevalence of being general obesity (measured by body mass index, BMI ≥ 28) varies by gender and residency from a minimum of 5.88% to a maximum of 9.46%, whereas abdominal obesity (measured by waist circumference, WCmale ≥ 85 cm & WCfemale ≥ 80 cm) prevalence presents a socking level from 64.53% to 67.69%. Moreover, the results show a pro-rich distribution of obesity (general and abdominal) among male workers (CI_BMI = 0.112; CI_WC = 0.057) and a pro-poor distribution among female workers (CI_BMI = −0.141; CI_WC = −0.166). We also find that the direction of the contribution of socioeconomic factors to income-related inequalities in obesity differs by gender. These results have substantial implications for the measurement of socioeconomic inequality in adiposity and for improving health-related policies targeting the Chinese labor force.

Obesity impairs performing and learning a timing perception task regardless of the body position

Obesity has been associated with poorer sensorimotor performance. However, it remains unclear whether these obesity-related impairments can be mitigated by practice. In the present study, we sought to investigate the effects of practice on performing and learning a temporal estimation task, in women with and without obesity. The experimental task consisted of synchronizing the arrival of two rectangles at a target point. Limited to the pressing of a switch, the task was intended to minimize possible muscular fatigue, self-generated perturbations to balance and the need to accelerate/decelerate body segments. Participants were allowed to choose the displacement velocity of the rectangle they controlled and were informed that they would not be offered any choice over it during a test to come. To control for the effect of different body positions on sensorimotor performance and learning, the 19 women with obesity (BMI = 40.0 + 7.33, age = 44.2 + 6.6) and 20 without obesity (BMI = 22.3 + 1.95, age = 43 + 6.9) were assigned into 4 groups, according to their BMI and body position assumed during practice (standing upright with feet together or sitting). As no significant differences concerning body position were found, the data were reanalysed disregarding this factor. Results revealed that while both groups reduced errors during the Acquisition, participants with obesity showed poorer performance (Acquisition) and sensorimotor learning (Transfer). Given the experimental task and adopted procedures, our results tend to support the hypothesis that hindered perception and/or integration of sensory information is associated with obesity.

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual's general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.

Occupational medicine clinical practice data reveal increased injury rates among Hispanic workers

Background

Minnesota has an ethnically diverse labor force, with the largest number of refugees per capita in the United States. In recent years, Minnesota has been and continues to be a major site for immigrant and refugee resettlement in the United States, with a large population of both immigrant and native born Hmong, Hispanic, and East Africans. This study seeks to evaluate the injury risk among the evolving minority workforce in the Minnesota Twin Cities region.

Methods

A retrospective cohort study identifying work‐related injuries following pre‐employment examinations was performed using electronic health records from a large multi‐clinic occupational medicine practice. Preplacement examinations and subsequent work‐related injuries were pulled from the electronic health record using representative ICD‐10 codes for surveillance examinations and injuries. This study included patient records collected over a 2‐year period from January 1, 2015, through December, 2016. The patients in this cohort worked in a wide‐array of occupations including production, assembly, construction, law enforcement, among others.

Results

Hispanic minority workers were twice as likely to be injured at work compared with White workers. Hispanics were 2.89 times more likely to develop back injuries compared with non‐Hispanic workers, and 1.86 times more likely to develop upper extremity injuries involving the hand, wrist, or elbow.

Conclusion

Clinical practice data shows that Hispanic workers are at increased risk for work‐related injuries in Minnesota. They were especially susceptible to back and upper extremity injuries. Lower injury rates in non‐Hispanic minority workers, may be the result of injury underreporting and require further investigation.

Use of various obesity measurement and classification methods in occupational safety and health research: a systematic review of the literature

BACKGROUND

This study systematically examined obesity research in occupational safety and health regarding the use of various obesity measurement and classification methods.

METHODS

A systematic search of the PubMed database on English language publications from 2000 to 2015 using related keywords and search of citations resulted in selection of 126 studies. They were categorized into two groups based on their main research question: 1) general physical or mental work-related functioning; and 2) task or body part specific functioning.

RESULTS

Regardless of the study group, body mass index (BMI) was the most frequently used measure. Over 63% of the studies relied solely on BMI to define obesity. In only 22% of the studies, body fat was directly measured by methods such as dual energy x-ray absorptiometry. Abdominal obesity was defined using waist circumference in recent years, and waist-hip ratio in earlier years. Inconsistent cut-offs have also been used across studies investigating similar topics.

CONCLUSIONS

Few authors acknowledged the limitations of using indirect obesity measures. This is in part due to the limited understanding of some occupational safety and health researchers regarding the complex issues surrounding obesity classification and also the mixed recommendations over the past 2-3 decades and across populations. Efforts need to be made to promote appropriate obesity measurement and reporting in this field.

A Bayesian Approach to Sport Injuries Likelihood: Does Player's Self-Efficacy and Environmental Factors Plays the Main Role?

The psychological factors of sports injuries constitute a growing field of study, even from the point of view of the prediction of their occurrence. Most of them, however, do not take into account the likelihood of the injuries' occurrence and the weight and role of the psychological variables on it. We conducted a study building up a Bayesian Network on a big sample of athletes, trying to assess these probabilistic links among several relevant psychological variables and the injuries' occurrence. The sample was constituted by 297 athletes (239 males, 58 females) from a wide range of sports: track and field; judo; fencing; karate; boxing; swimming; kayaking; artistic rollerskating, and team sports as football, basketball, and handball (Mean age: 25.10 ±-3.87; range: 21-38 years). Several psychological variables, such as anxiety, social support, and self-efficacy were studied. Also, we recorded the history of injuries as well the body mass index and personal epidemiological data. The overall picture of the generated graph and Bayesian Network and its analysis - including the use of hypothetical data by means of several instantiations - includes the nuclear role of the Self-Efficacy regarding the injuries' occurrence likelihood; the decreasing impact of the competitive anxiety previous to the injury; the probabilistic independence of the players' risk behaviors, and the relevance of the environmental clues such the use of coping strategies and social support in order to build up a good level of Self-Efficacy after the occurrence of an injury. All these data are relevant when designing both preventive and recovery interventions from the multidisciplinary as well as from the psychological point of view.

Is Obesity Associated With Adverse Workers' Compensation Claims Outcomes?

BACKGROUND

A pilot study indicated that obesity was associated with an increased time lost from work and higher costs among workers' compensation claimants sustaining severe, but not minor injuries.

OBJECTIVE

The aim of this study was to further test the hypotheses by increasing sample size and controlling for additional confounding factors.

METHOD

Cost and lost time outcomes were assessed for 2301 lost time workers' compensation claims filed in 2011 and 2012 followed to the end of the first quarter of the third postinjury year.

RESULT

Adjusting for gender, age, marital status, attorney involvement, and spinal procedures, the odds ratios of incurring a claim expense at least $100,000 after a severe injury for an overweight or obese versus normal weight claimant was 2.11 [95% confidence interval (95% CI): 1.04 to 4.29] and 2.23 (95% CI:1.12-4.46), respectively.

CONCLUSION

Obesity was associated with increased costs among workers' compensation claimants sustaining severe, but not minor injuries.

Occupational noise exposure and risk of hypertension in an industrial workforce

BACKGROUND

Community noise exposure has been shown to increase the risk of hypertension; however, the relationship between occupational noise exposure and hypertension is less clear.

METHODS

Using an inception cohort of workers in a specialty metals manufacturing company, we retrospectively assessed occupational noise exposure, hearing acuity, and incident hypertension diagnoses using administrative datasets. Time-weighted average noise exposure levels were assigned to employees based on their job histories. Cox proportional hazards models were performed to determine the association of noise exposure with risk of incident hypertension.

RESULTS

The adjusted hazard ratio (HR) of incident hypertension did not significantly differ between groups by cumulative continuous or categorized noise exposure metric.

CONCLUSION

We found no increased risk of incident hypertension with exposure to occupational noise among workers. Further assessment examining workers' use of hearing protection devices is warranted.

Correlation of diabetes mellitus and body weight of adults above the age of 30 years in a medical facility in Ghana

BACKGROUND

Diabetes mellitus (DM) is a metabolic disorder characterized by insufficient insulin production or ineffective pancreatic secretions. In Ghana, the prevalence of DM was estimated to be 6.3% amongst men and women older than 30 years living in the Greater Accra region. The disease can be determined by various means including the use of the multistix that assesses the presence of glucose in urine.

MATERIALS AND METHODS

In this study, 100 subjects were sampled made up of 65% males and 35% females whose urine samples were verified using multistix.

RESULTS

Most (63%) of the subjects diagnosed with the disease fell within the age ranges of 60-69 years and 70-79 years, thus establishing the fact that the incidence of the disease increases with increasing age and increasing body mass index (BMI) over above 25kg/m². Some (44%) had a family history of diabetes. Other factors such as the socioeconomic status (SES) categories, physical activity levels and eating habits of the respondents played different roles in the occurrence of the disease.

CONCLUSION

The sex of the individual, however, did not have a major impact on the occurrence of the disease. This study confirmed that overweight body (BMI≥25kg/m²) especially of older ages above 50 years of have very strong link with the prevalence of diabetes mellitus.

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004-2012

INTRODUCTION

Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers.

METHODS

Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004-2012. Participants were categorized as normal weight (BMI: 18.5-24.9kg/m(2)), overweight (BMI: 25.0-29.9), obese I (BMI: 30.0-34.9), and obese II (BMI: 35+). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software.

RESULTS

During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000±1.2), fingers (11.5±1.3), and knees (7.1±0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR=1.25 (95% CI=1.04-1.52); obese I: 1.41 (1.14-1.74); obese II: 1.68 (1.32-2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR=1.48, (95% CI=1.03-2.13); obese I: 1.70 (1.13-2.55); obese II: 2.91 (1.91-4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR=1.73 (95% CI=1.29-2.31); obese I: PR=2.24 (1.64-3.06); obese II: PR=2.95 (2.04-4.26)].

CONCLUSIONS

Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers.

PRACTICAL APPLICATIONS

Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.

Identifying and mitigating risks for agricultural injury associated with obesity

In some occupational contexts overweight and obesity have been identified as risk factors for injury. The purpose of this study was to examine this hypothesis within farm work environments and then to identify specific opportunities for environmental modification as a preventive strategy. Data on farm-related injuries, height and weight used to calculate body mass index (BMI), and demographic characteristics were from the Phase 2 baseline survey of the Saskatchewan Farm Injury Cohort; a large cross-sectional mail-based survey conducted in Saskatchewan, Canada from January through May 2013. Multivariable logistic regression was used to examine associations between BMI and injury. Injury narratives were explored qualitatively. Findings were inconsistent and differed according to gender. Among women (n = 927), having overweight (adjusted OR: 2.94; 95% CI: 1.29 to 6.70) but not obesity (1.10; 95% CI: 0.35 to 3.43) was associated with an increased odds of incurring a farm-related injury. No strong or statistically significant effects were observed for men (n = 1406) with overweight or obesity. While injury-related challenges associated with obesity have been addressed in other occupational settings via modification of the worksite, such strategies are challenging to implement in farm settings because of the diversity of work tasks and associated hazards. We conclude that the acute effects of overweight in terms of injury do require consideration in agricultural populations, but these should also be viewed with a differentiation based on gender.

•

Obesity can increase risk for injury through biological and physical mechanisms.

•

Associations between BMI status and agricultural injury were examined.

•

Findings were inconsistent and differed according to gender.

•

Overweight is a potential risk factor for injury, specifically in farm women.

•

We suggest ergonomic modifications that are potentially effective for farm settings.

Prevalence of Injury in Occupation and Industry: Role of Obesity in the National Health Interview Survey 2004 to 2013

OBJECTIVES

The aim of this study was to estimate prevalence of injury by occupation and industry and obesity's role.

METHODS

Self-reported injuries were collected annually for US workers during 2004 to 2013. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were obtained from fitted logistic regression models.

RESULTS

Overall weighted injury prevalence during the previous three months was 77 per 10,000 workers. Age-adjusted injury prevalence was greatest for Construction and Extraction workers (169.7/10,000) followed by Production (160.6) among occupations, while workers in the Construction industry sector (147.9) had the highest injury prevalence followed by the Agriculture/Forestry/Fishing/Mining/Utilities sector (122.1). Overweight and obese workers were 26% to 45% more likely to experience injuries than normal-weight workers.

CONCLUSION

The prevalence of injury, highest for Construction workers, gradually increased as body mass index levels increased in most occupational and industry groups.

Two industrial cohorts: baseline characteristics and factors associated with obesity

OBJECTIVE

To describe demographic and health characteristics, and factors associated with obesity among production workers.

METHODS

This cross-sectional study analyzed baseline data from two occupational cohorts. Regression modeling was used to assess associations between worker characteristics and obesity.

RESULTS

A total of 1974 subjects were included in these analyses. The mean body mass index was 29.5 kg/m (SD = 6.5). Having smoked in the past and currently smoking decreased the odds of being obese in the WISTAH Distal Upper Extremity cohort, whereas those feeling depressed had increased odds of being obese. Being a Pacific Islander/Native Hawaiian and married increased the odds of obesity in the BackWorks Low Back Pain cohort.

CONCLUSIONS

Factors associated with obesity differed substantially between the two cohorts. Recognizing factors associated with obesity in specific work settings may provide opportunities for optimizing preventive workplace interventions.

Injury Risk and Noise Exposure in Firefighter Training Operations

INTRODUCTION

Firefighters have high rate of injuries and illnesses, as well as exposures to high levels of noise. This study explored the relationship between noise exposure and injury among firefighters.

METHODS

We recruited firefighters undergoing vehicle extrication and structural collapse emergency response training at a highly realistic training facility. Demographics, health status, body mass index (BMI), and history of serious injuries (i.e. injuries requiring first aid treatment, treatment in a medical clinic or office, or treatment at a hospital) were assessed at baseline, and daily activities, injury events, and near misses were assessed daily via surveys. Participants' noise exposures were monitored for one 24-h period using noise dosimeters. We used a mixed-effects logistic regression model to estimate the odds of injury events and near misses associated with noise exposure as an independent variable.

RESULTS

Of 56 subjects, 20 (36%) reported that they had ever suffered a serious injury during firefighting activities, and 9 (16%) reported a serious injury within the past year. We estimated rates of 6.6 lifetime serious injuries per 100 FTE 16.1 serious injuries per 100 FTE within the past year. Our models indicated a significant increase in injury events and near misses among those with higher BMI, and as well as a dose-response relationship between near misses/injuries and increasing noise levels. Noise levels >90 dBA in the 30 min prior to time of injury or near miss were associated with substantially increased odds ratios for injury or near miss. Our models further indicated that perceived job demands were significantly associated with increased risk of injury or near miss.

CONCLUSION

Our results suggest that noise exposures may need to be incorporated into injury prevention programs for firefighters to reduce injuries among this high-risk occupational group.

Expert ratings of job demand and job control as predictors of injury and musculoskeletal disorder risk in a manufacturing cohort

Objective

To examine associations between workplace injury and musculoskeletal disorder (MSD) risk and expert ratings of job-level psychosocial demand and job control, adjusting for job-level physical demand.

Methods

Among a cohort of 9260 aluminium manufacturing workers in jobs for which expert ratings of job-level physical and psychological demand and control were obtained during the 2 years following rating obtainment, multivariate mixed effects models were used to estimate relative risk (RR) of minor injury and minor MSD, serious injury and MSD, minor MSD only and serious MSD only by tertile of demand and control, adjusting for physical demand as well as other recognised risk factors.

Results

Compared with workers in jobs rated as having low psychological demand, workers in jobs with high psychological demand had 49% greater risk of serious injury and serious MSD requiring medical treatment, work restrictions or lost work time (RR=1.49; 95% CI 1.10 to 2.01). Workers in jobs rated as having low control displayed increased risk for minor injury and minor MSD (RR=1.45; 95% CI 1.12 to 1.87) compared with those in jobs rated as having high control.

Conclusions

Using expert ratings of job-level exposures, this study provides evidence that psychological job demand and job control contribute independently to injury and MSD risk in a blue-collar manufacturing cohort, and emphasises the importance of monitoring psychosocial workplace exposures in addition to physical workplace exposures to promote worker health and safety.

Predictors Associated With Changes of Weight and Total Cholesterol Among Two Occupational Cohorts Over 10 Years

OBJECTIVE

To ascertain worker health characteristics and psychosocial factors associated with changes in body weight and total cholesterol (TC) among two production operation populations.

METHODS

We performed descriptive and predictive analysis of questionnaire data and biomedical measurements from two prospective cohort studies. Our key outcomes were changes in weight, and TC over 5 to 10 years between baseline and exit assessments.

RESULTS

A total of 146 subjects were analyzed. Increases in weight were associated with belief in being overweight and baseline overweight and obesity. Increases in TC levels were associated with female sex, belief that TC levels were "not good," and feeling depressed.

CONCLUSIONS

Most of the reported associations with increases in weight and TC levels are amenable to interventions and may be a target for workplace intervention programs.

The effects of obesity, age, and relative workload levels on handgrip endurance

The purpose of the study was to examine obesity and age effects on handgrip endurance across a range of relative workload levels. Forty-five non-obese and obese younger and older females performed fatiguing handgrip exercises at 20, 40, 60, and 80% of relative handgrip strength. The younger obese group demonstrated ∼7% greater strength, 32% shorter endurance times, and ∼34% faster rate of strength loss, accompanied by heightened perception of effort, than the younger non-obese group. However, these obesity-related differences were not observed in the older age group. Moreover, there were no interactions between relative workload levels, obesity, and age on any of the fatigue measures. Findings obtained here suggest that work-rest schedules computed from existing force endurance prediction models may not be protective of the younger obese working population.

Occupational injury risk by sex in a manufacturing cohort

OBJECTIVES

This study expands previous research comparing injury risk for women and men in a cohort of 24,000 US aluminium manufacturing workers in 15 facilities from 2001 to 2010.

METHODS

We compared injury rates (all injury, first aid, medical treatment, restricted work and lost work time) by sex and by job and sex. Using a mixed effect modelling approach, we calculated ORs and 95% CIs adjusting for age, job tenure, ethnicity and year as fixed effects and person, job and plant as random effects. Additionally, we modelled the data stratified by plant type to examine potential differences in injury risk between smelter (generally recognised as more hazardous) and fabrication production environments.

RESULTS

Risk of injury was higher for women in four out of the five injury outcomes: all injuries combined (OR: 1.58, CI 1.48 to 1.67), injuries requiring first aid (OR: 1.61, CI 1.54 to 1.70), injuries requiring medical treatment (OR: 1.18, CI 1.03 to 1.36) and injuries requiring restricted work (OR: 1.65, CI 1.46 to 1.87). No difference in the risk of lost time injury by sex was found in this cohort. Analyses stratified by plant type showed similarly elevated injury risk for women, although the risk estimates were higher in smelters than fabrication plants.

CONCLUSIONS

To our knowledge, this is the largest single-firm study examining injury risk by sex with sufficient data to appropriately adjust for job. We show a consistently higher injury risk for women compared with men in the smelting and fabrication environments.

Prevalence of obesity by occupation among US workers: the National Health Interview Survey 2004-2011

OBJECTIVE

To estimate the prevalence of obesity and the change of prevalence of obesity between 2004-2007 and 2008-20011 by occupation among US workers in the National Health Interview Survey.

METHODS

Self-reported weight and height were collected and used to assess obesity (body mass index ≥ 30 kg/m). Gender-, race/ethnicity-, and occupation-specific prevalence of obesity were calculated.

RESULTS

Prevalence of obesity steadily increased from 2004 through 2008 across gender and race/ethnicity but leveled off from 2008 through 2011. Non-Hispanic black female workers in health care support (49.2%) and transportation/material moving (46.6%) had the highest prevalence of obesity. Prevalence of obesity in relatively low-obesity (white-collar) occupations significantly increased between 2004-2007 and 2008-2011, whereas it did not change significantly in high-obesity (blue-collar) occupations.

CONCLUSIONS

Workers in all occupational categories are appropriate targets for health promotion and intervention programs to reduce obesity.

Work organization, job insecurity, and occupational health disparities

BACKGROUND

Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status.

METHODS

A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards.

RESULTS

There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective.

CONCLUSIONS

Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

Prevalence of work-related musculoskeletal symptoms among US large-herd dairy parlor workers

BACKGROUND

Dairy production in the US is moving towards large-herd milking operations resulting in an increase in task specialization and work demands.

METHODS

A modified version of the Standardized Nordic Questionnaire was administered to assess MSS prevalence among 452 US large-herd parlor workers. Worker demographics and MSS prevalences were assessed, and differences based on parlor configuration (i.e., herringbone, parallel, rotary) were computed.

RESULTS

Three-fourths (76.4%) of parlor workers reported work-related MSS in at least one body part. Highest prevalences were reported in the upper extremity (55%). Herringbone workers reported a higher prevalence of MSS in the wrist/hand, and rotary workers reported higher prevalences of MSS in the neck, upper back, and shoulders.

CONCLUSIONS

Our findings draw attention to higher work-related MSS in the upper extremity among dairy parlor workers. As the trend toward larger herd sizes on US dairy farms continues, the need for further health and safety research will increase.

Associations between employee and manager gender: impacts on gender-specific risk of acute occupational injury in metal manufacturing

Background

Prior research has shown increased risk of injury for female employees compared to male employees after controlling for job and tasks, but have not explored whether this increased risk might be moderated by manager gender. The gender of one’s manager could in theory affect injury rates among male and female employees through their managers’ response to an employee’s psychosocial stress or through how employees differentially report injuries. Other explanations for the gender disparity in injury experience, such as ergonomic factors or differential training, are unlikely to be impacted by supervisor gender. This study seeks to explore whether an employee’s manager’s gender modifies the effect of employee gender with regards to risk of acute injury.

Methods

A cohort of employees and managers were identified using human resources and injury management data between January 1, 2002 and December 31, 2007 for six facilities of a large US aluminum manufacturing company. Cox proportional hazards models were employed to examine the interaction between employee gender and whether the employee had female only manager(s), male only manager(s), or both male and female managers on injury risk. Manager gender category was included as a time varying covariate and reassessed for each employee at the midpoint of each year.

Results

The percentage of departments with both female and male managers increased dramatically during the study period due to corporate efforts to increase female representation in management. After adjustment for fixed effects at the facility level and shared frailty by department, manager gender category does not appear to moderate the effect of employee gender (p = 0.717). Manager category was not a significant predictor (p = 0.093) of time to first acute injury. Similarly, having at least one female manager did not modify the hazard of injury for female employees compared to males (p = 0.899) and was not a significant predictor of time to first acute injury (p = 0.601).

Conclusions

Prior findings suggest that female manufacturing employees are at higher risk for acute injury compared to males; this analysis suggests that this relationship is not affected by the gender of the employee’s manager(s).

The Relationship between Waist Circumference and Work-related Injury in Reference to the Fourth Korea National Health and Nutrition Examination Survey

Objective

This study aims to investigate the relationship between waist circumference and work-related injury in reference to the fourth Korea National Health and Nutrition Examination Survey.

Methods

By analyzing data from the fourth Korea National Health and Nutrition Examination Survey conducted from 2007 to 2009, we estimated the rate of injury experience according to socioeconomic status, including occupational property, of 8,261 subjects. We performed logistic regression analysis with work-related injury experience rate as dependent variable and waist circumference as an independent variable, Odds ratios (OR) were calculated, which reflect the likelihood of work-related injury experience rate, and 95% confidence interval (95% CI) while controlling for relevant covariates with stratifying by sex, age, nature of injury, site of injury and occupational group.

Results

Among 797 persons who had injury experience over the past 1 year, 293 persons (36.8%) had work-related injury experience. After adjusting the confounding variables, the work-related injury was related to abnormal waist circumference (OR = 1.35; 95% CI: 1.02 ~ 1.78). In subgroups, ORs were higher in men (OR = 1.42; 95% CI: 1.02 ~ 1.98), professional, manager, and administrator (OR = 2.41; 95% CI: 1.10 ~ 5.28). Higher rate of injuries were noted in back and waist (OR = 2.92; 95% CI: 1.49 ~ 5.73), and transport accident had increased risk (OR = 1.60; 95% CI: 1.13 ~ 2.28).

Conclusions

Work-related injury rate differed depending on the waist circumference. The abdominal obesity was associated with higher risk of work-related injury. This study would be useful in selecting appropriate priorities for work-related injury management in Korea.

Obesity and occupational injury: a prospective cohort study of 69,515 public sector employees

Background

Obesity and overweight are suggested to increase the risk of occupational injury but longitudinal evidence to confirm this is rare. We sought to evaluate obesity and overweight as risk factors for occupational injuries.

Methodology/Principal Findings

A total of 69,515 public sector employees (80% women) responded to a survey in 2000–2002, 2004 or 2008. Body mass index (kg/m²) was derived from self-reported height and weight and was linked to records of subsequent occupational injuries obtained from national registers. Different injury types, locations and events or exposures (the manner in which the injury was produced or inflicted) were analyzed by body mass index category adjusting for baseline socio-demographic characteristics, work characteristics, health-risk behaviors, physical and mental health, insomnia symptoms, and sleep duration. During the mean follow-up of 7.8 years (SD = 3.2), 18% of the employees (N = 12,204) recorded at least one occupational injury. Obesity was associated with a higher overall risk of occupational injury; multivariable adjusted hazard ratio (HR) 1.21 (95% CI 1.14–1.27). A relationship was observed for bone fractures (HR = 1.37; 95% CI: 1.10–1.70), dislocations, sprains and strains (HR = 1.36; 95% CI: 1.25–1.49), concussions and internal injuries (HR = 1.26; 95% CI: 1.11–1.44), injuries to lower extremities (HR = 1.62; 95%: 1.46–1.79) and injuries to whole body or multiple sites (HR = 1.37; 95%: 1.10–1.70). Furthermore, obesity was associated with a higher risk of injuries caused by slipping, tripping, stumbling and falling (HR = 1.55; 95% CI: 1.40–1.73), sudden body movement with or without physical stress (HR = 1.24; 95% CI: 1.10–1.41) and shock, fright, violence, aggression, threat or unexpected presence (HR = 1.33; 95% CI: 1.03–1.72). The magnitude of the associations between overweight and injuries was smaller, but the associations were generally in the same direction as those of obesity.

Conclusions/Significance

Obese employees record more occupational injuries than those with recommended healthy weight.

Piecewise exponential models to assess the influence of job-specific experience on the hazard of acute injury for hourly factory workers

Background

An inverse relationship between experience and risk of injury has been observed in many occupations. Due to statistical challenges, however, it has been difficult to characterize the role of experience on the hazard of injury. In particular, because the time observed up to injury is equivalent to the amount of experience accumulated, the baseline hazard of injury becomes the main parameter of interest, excluding Cox proportional hazards models as applicable methods for consideration.

Methods

Using a data set of 81,301 hourly production workers of a global aluminum company at 207 US facilities, we compared competing parametric models for the baseline hazard to assess whether experience affected the hazard of injury at hire and after later job changes. Specific models considered included the exponential, Weibull, and two (a hypothesis-driven and a data-driven) two-piece exponential models to formally test the null hypothesis that experience does not impact the hazard of injury.

Results

We highlighted the advantages of our comparative approach and the interpretability of our selected model: a two-piece exponential model that allowed the baseline hazard of injury to change with experience. Our findings suggested a 30% increase in the hazard in the first year after job initiation and/or change.

Conclusions

Piecewise exponential models may be particularly useful in modeling risk of injury as a function of experience and have the additional benefit of interpretability over other similarly flexible models.

Obesity-related differences in muscular capacity during sustained isometric exertions

Over one-third of the world adult population is overweight or obese, and the prevalence continues to increase. Obesity is a risk factor for injury, and the growing prevalence may be associated with increases in the future incidence and cost of injuries. In this study, we examined obesity-related differences in muscular capacity during sustained isometric exertions involving hand grip, shoulder flexion, and trunk extension. Thirty-six young individuals who were obese or not obese (aged 18-29) completed these exertions at fixed levels of absolute loads involving low-moderate levels of effort. Individuals who were obese had an overall ∼20% higher absolute strength, but ∼20% lower relative strength. These differences were most evident in the hand grip and shoulder exertions. Parameters of fitted exponential relationships between endurance time and task demands (as a percentage of strength) were similar in both groups. Perceptual and performance responses were also consistent between groups. Accordingly, we conclude that obesity may not substantially influence muscular capacity for these tasks.

Body mass index as a predictor of firefighter injury and workers' compensation claims

OBJECTIVE

To determine the relationship between lifestyle variables including body mass index and filing a workers' compensation claim due to firefighter injury.

METHODS

A cross-sectional evaluation of firefighter injury related to workers" compensation claims occurring 5 years after the original Promoting Healthy Lifestyles: Alternative Models' Effects study intervention.

RESULTS

A logistic regression analysis for variables predicting filing a workers' compensation claim due to an injury was performed with a total of 433 participants. The odds of filing a compensation claim were almost 3 times higher for firefighters with a body mass index of more than 30 kg/m than firefighters with a normal body mass index (odds ratio, 2.89; P < 0.05).

CONCLUSIONS

This study addresses a high-priority area of reducing firefighter injuries and workers' compensation claims. Maintaining a healthy body weight is important to reduce injury and workers' compensation claims among firefighters.

A structural equation modeling approach to fatigue-related risk factors for occupational injury

Occupational injury is associated with numerous individual and work-related risk factors, including long working hours and short sleep duration; however, the complex mechanisms causing such injuries are not yet fully understood. The authors used structural equation modeling (SEM) as a novel approach to examine fatigue-related direct and indirect potential risk factors for occupational injury. The study sample contained 89,366 employed workers from the National Health Interview Survey (pooled across 6 years, 2004-2009), an annual survey of a representative cross-sectional sample of the US population. Direct and indirect effects of weekly hours worked and usual sleep duration on occupational injuries were modeled using SEM procedures for dichotomous outcomes and a complex sampling design. Confounding and mediating effects of gender, age, race/ethnicity, occupation, industry, type of pay, body mass index (BMI), and psychological distress were simultaneously examined. Long working hours and short sleep duration independently increased the risk of injury. Additional direct risk factors were gender, occupation, type of pay, and BMI. At the same time, sleep duration mediated the adverse relations of long working hours, high psychological distress, and high BMI with injury. These findings indicate that SEM is a useful approach with which to examine dichotomous outcomes and indirect effects in complex samples, and it offers a comprehensive new model of injury prediction.

Impact of obesity on orthopaedics

The prevalence of obesity among children and adults is increasing worldwide. There are substantial health risks and financial costs associated with the obesity epidemic that impact the practice of orthopaedic surgery. Patients with increased body mass index are more prone to sustaining distal extremity injuries than are those with a normal body mass index. Obese individuals are more likely than nonobese individuals to seek treatment for osteoarthritis of the knee.

Cardiovascular fitness levels among American workers

OBJECTIVE

To explore cardiovascular fitness in 40 occupations using a nationally representative sample of the US population.

METHODS

Respondents aged 18 to 49 years (N = 3354) from the 1999 to 2004 National Health and Nutrition Examination Survey were evaluated for cardiovascular fitness and classified into low, moderate, and high levels. Comparisons were made among occupations.

RESULTS

Of all the US workers, 16% had low, 36% moderate, and 48% high cardiovascular fitness. Administrators, health occupations, wait staff, personal services, and agricultural occupations had a lesser percentage of workers with low cardiovascular fitness compared with all others. Sales workers, administrative support, and food preparers had a higher percentage of workers with low cardiovascular fitness compared with all others.

CONCLUSIONS

Cardiovascular fitness varies significantly across occupations, and those with limited physical activity have higher percentages of low cardiovascular fitness. Workplace strategies are needed to promote cardiovascular fitness among high-risk occupations.

Obesity and injury-related absenteeism in a population-based firefighter cohort

A consistent relationship has been demonstrated between obesity and absenteeism in the workplace. However, most studies have focused on primarily sedentary occupational groups. Firefighting is a physically demanding profession that involves significant potential for exposure to dangerous situations and strenuous work. No studies to date have evaluated the impact of obesity on risk for absenteeism among firefighters. We examined the cross-sectional association between BMI and obesity and injury-related absenteeism. BMI, body fat percentage (BF%), waist circumference (WC), injury, and injury-related absenteeism were assessed in 478 career male firefighters. One hundred and fifteen firefighters reported an injury in the previous year and the number of days absent from work due to their injury. BMI was an independent predictor of absenteeism due to injury even after adjustment for confounding variables. Firefighters meeting the definition of class II and III obesity had nearly five times (odds ratio (OR) = 4.89; 95% confidence interval (CI) = 3.63-6.58) the number missed work days due to injury when compared to their normal weight counterparts and their elevated risk was greater than firefighters with class I obesity (OR = 2.71; 95% CI = 2.01-3.65) or those who were overweight (OR = 2.55; 95% CI = 1.90-3.41). The attributable per capita costs of class II and III obesity-related absenteeism over the last year were $1,682.90 per firefighter, $254.00 per firefighter for class I obesity, and $74.41 per firefighter for overweight. Our findings suggest that class II and III obesity were associated with substantial attributable costs to employers and our cost estimates probably underestimate the actual financial burden.

The association of nutritional status and gender with cross-sectional area of the multifidus muscle in establishing normative data

Despite recognized evidence for the importance of the multifidus muscle in stabilizing the lumbar spine, identifying subjects at risk for injury and subsequent loss of intrinsic spinal stabilization remains difficult. Previous research has failed to associate multifidus muscle size and height, weight, or body mass index (BMI). The purpose of this study was to begin to establish normative data for the multifidus muscle cross-sectional area (CSA) at the L5 level and to identify factors associated with size. Twenty-five participants (17 female), with a mean age of 32.5 (SD 11.6) years without history of LBP were considered for inclusion. Participants' height and weight were recorded and BMI calculated. Ultrasound imaging was used to obtain a CSA in cm(2) of the subjects' multifidus muscles at the L5 level bilaterally; testing was done by two trained testers. Prior to testing, intra- and inter-tester reliability were determined. Percent body fat was determined using a three-site skinfold caliper measurement, also using two trained testers. Mean BMI was 24.18 and mean body fat (%) was 22.88 for all participants. As expected, age and BMI were moderately correlated. Left and right multifidus muscle CSA were highly correlated (r = 0.92, p < 0.001). The mixed model ANOVA indicated a significant main effect for gender as males exhibited larger CSA than females. Participants without history of low back pain present with symmetrical multifidus muscle CSA at the L5 level. Clear gender differences in CSA show that males tend to have larger multifidus muscles at the L5 level, indicating a need to establish gender-specific norms for clinicians examining the L5 multifidus muscle.

Obesity and its relationship with occupational injury in the canadian workforce

Objectives. To examine associations between obesity and occupational injury. Methods. Participants consisted of a representative sample of 7,678 adult Canadian workers. Participants were placed into normal weight, overweight, and obese categories based on their body mass index. Different injury types, location, and external causes were measured. Logistic regression was used to estimate relationships. Results. By comparison to normal weight workers, obese workers were more likely to report any occupational injuries (odds ratio (OR) 1.40, 95% confidence interval (CI): 0.98-1.99) and serious occupational injuries (1.49, 0.99-2.26). These relationships were more pronounced for sprains and strains (1.80, 1.04-3.11), injuries to the lower limbs (2.14, 1.12-4.11) or torso (2.36, 1.13-4.93), and injuries due to falls (2.10, 0.86-5.10) or overexertion (2.08, 0.96-4.50). Female workers, workers ≥40 years, and workers employed in sedentary occupations were particularly vulnerable. Increased risks were not identified for overweight workers. Conclusions. Obese workers experienced 40-49% higher risks for occupational injury.

Work and its role in shaping the social gradient in health

Adults with better jobs enjoy better health: job title was, in fact, the social gradient metric first used to study the relationship between social class and chronic disease etiology, a core finding now replicated in most developed countries. What has been less well proved is whether this correlation is causal, and if so, through what mechanisms. During the past decade, much research has been directed at these issues. Best evidence in 2009 suggests that occupation does affect health. Most recent research on the relationship has been directed at disentangling the pathways through which lower-status work leads to adverse health outcomes. This review focuses on six areas of recent progress: (1) the role of status in a hierarchical occupational system; (2) the roles of psychosocial job stressors; (3) effects of workplace physical and chemical hazard exposures; (4) evidence that work organization matters as a contextual factor; (5) implications for the gradient of new forms of nonstandard or "precarious" employment such as contract and shift work; and (6) emerging evidence that women may be impacted differently by adverse working conditions, and possibly more strongly, than men.

Effects of externally rated job demand and control on depression diagnosis claims in an industrial cohort

This study examined whether externally rated job demand and control were associated with depression diagnosis claims in a heavy industrial cohort. The retrospective cohort sample consisted of 7,566 hourly workers aged 18-64 years who were actively employed at 11 US plants between January 1, 1996, and December 31, 2003, and free of depression diagnosis claims during an initial 2-year run-in period. Logistic regression analysis was used to model the effect of tertiles of demand and control exposure on depression diagnosis claims. Demand had a significant positive association with depression diagnosis claims in bivariate models and models adjusted for demographic (age, gender, race, education, job grade, tenure) and lifestyle (smoking status, body mass index, cholesterol level) variables (high demand odds ratio = 1.39, 95% confidence interval: 1.04, 1.86). Control was associated with greater risk of depression diagnosis at moderate levels in unadjusted models only (odds ratio = 1.47, 95% confidence interval: 1.12, 1.93), while low control, contrary to expectation, was not associated with depression. The effects of the externally rated demand exposure were lost with adjustment for location. This may reflect differences in measurement or classification of exposure, differences in depression diagnosis by location, or other location-specific factors.

Injuries to air force personnel associated with lifting, handling, and carrying objects

BACKGROUND

The U.S. Air Force (USAF) active duty and civilian populations experience a substantial number of lost-workday injuries while lifting, handling, and carrying objects. Back injuries are most frequently reported.

PURPOSE

The purpose of this study is to describe the hazard scenarios of lift-handle-carry injuries to better identify effective countermeasures.

METHODS

The data were derived from safety reports obtained from the USAF Ground Safety Automated System. Lift-handle-carry injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study. A total of 4085 lost-workday injuries resulting in 24,940 lost workdays for USAF military and civilian members met the criteria for inclusion. Objects associated with these injuries were identified and aggregated to determine the most common causes of lift-handle-carry injuries.

RESULTS

Twelve distinct objects or type of objects were identified as the most common source of lift-handle-carry injuries. Among the most common sources of injury were lifting aircraft components, boxes, and furniture. Most importantly, lifting one group of objects, aircraft components, was associated with 33% of all lift-handle-carry injuries.

CONCLUSIONS

Safety report data can be used to identify the most common object or object types causing lift-handle-carry injuries. The information included in this report suggests countermeasures that should be considered for implementation and evaluation studies. Countermeasures to address the most common lift-handle-carry injuries, such as lifting aircraft components among aircraft maintenance workers, are warranted.

Common injuries in athletes with obesity and diabetes

Musculoskeletal injuries and diseases are common in persons with obesity and diabetes mellitus. High body mass index is associated with an increased risk for musculoskeletal injuries, diseases, and disability. There is a significant positive correlation between the level of obesity and musculoskeletal injuries, and disability and health-related costs. The prevalence of obesity and diabetes is inversely proportional to health-related quality of life.