Exploring safety culture research in the construction industry

BACKGROUND

Despite numerous regulatory initiatives to improve health and safety in the construction industry, it still ranks as one of the most accident-prone industries worldwide. A dedicated focus on safety culture has been suggested as a complement to laws, regulations and management systems.

OBJECTIVE

This article explores safety culture research conducted in the construction industry, with the aim to provide insight into the specific themes that tend to be in focus as well as what theoretical and methodological approaches that tend to be favored.

METHODS

Searches in scientific databases were conducted twice. In a first attempt, searches resulted in 54 hits but only two articles fit the scope of the study. A revision of the search phrase resulted in 124 hits. Ultimately, 17 articles fit the scope of the study and were included. The content of the articles was analyzed and sorted thematically.

RESULTS

The results show that four themes are prevalent in the existing literature: 1) unique challenges entail a need for situated applications, 2) models developed to operationalize safety culture, 3) measuring safety culture, and 4) safety management and leadership as key factors.

CONCLUSION

Although research focusing on the construction industry has come to favor certain study designs and definitions of safety culture, further research may be enriched by broadening the theoretical and methodological perspectives. Specifically, researchers should conduct more in-depth qualitative studies that take the complexity of the industry into account, including the interpersonal relations between the actors involved.

The effects of psychological risk factors at work on cognitive failures through the accident proneness

BACKGROUND

Various agents such as psychosocial items and accident proneness can affect cognitive failures through different paths. The probable paths are the direct effects of workplace psychosocial items on cognitive failures and their indirect effects on cognitive failures through the mediator variable of accident proneness, which has not yet been studied by others. Thus, the present study aimed to investigate these paths.

METHODS

This cross-sectional study was conducted on 164 male employees of Karoon Sugar Company in 2018. The participants were asked to complete a background and demographic questionnaire, Broadbent cognitive failures scale, accident proneness questionnaire, and Copenhagen psychosocial questionnaire. Obtained data were analyzed and modeled using the statistical descriptive method, ANOVA, independent t-test, Pearson correlation test, and path analysis in the SPSS and AMOS software.

RESULTS

The results of the path analysis showed that, not only, some psychosocial risk items had a significant direct effect on cognitive failures, but also, they could affect cognitive failures through the accident proneness, indirectly. Work-family conflict and social support from supervisors by coefficients of 0.188 and - 0.187 had the highest direct effects, respectively. The highest indirect effects belonged to justice and respect, and work-family conflict by coefficients of - 0.220 and 0.199, respectively. The highest total effects were also related to the work-family conflict and justice and respect by coefficients of 0.387 and - 0.381, respectively.

CONCLUSIONS

In total, our results showed that some psychological items could, directly and indirectly, increase cognitive failure through accident proneness.

Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning From Prison to Community in Later Life

OBJECTIVE

The number of individuals transitioning from correctional facilities to community in later life (age ≥50 ) is increasing. We sought to determine if later-life prison release is a risk factor for suicidal behavior and death by accidental injury, including drug overdose.

DESIGN

Retrospective cohort study.

SETTING

U.S. Department of Veterans Affairs and Medicare healthcare systems, 2012-2014.

PARTICIPANTS

Veterans age ≥50 released from correctional facilities (N = 7,671 re-entry veterans) and those never incarcerated (N = 7,671).

METHODS

Dates of suicide attempt and cause-specific mortality defined using the National Suicide Prevention Applications Network and the National Suicide Data Repository, respectively.

RESULTS

Later-life prison release was associated with increased risk of suicide attempt (599.7 versus 134.7 per 100,000 per year; adjusted hazard ratio [HR] 3.45; 95% confidence interval [CI] 2.24-5.32; p < 0.001, Wald χ² = 31.58, degrees of freedom [df] = 1), death by drug overdose (121.7 versus 43.5; adjusted HR 3.45; 95% CI 1.37-8.73; p = 0.009, Wald χ² = 6.86, df = 1), and other accidental injury (126.0 versus 39.1; adjusted HR 3.13; 95% CI 1.28-7.69; p = 0.013, Wald χ² = 6.25, df = 1), adjusting for homelessness, traumatic brain injury, medical and psychiatric conditions, and accounting for competing risk of other deaths. Suicide mortality rates were observed as nonsignificant between re-entry veterans and those never incarcerated (30.4 versus 17.4, respectively; adjusted HR 2.40; 95% CI 0.51-11.24; p = 0.266, Wald χ² = 1.23, df = 1).

CONCLUSION

Older re-entry veterans are at considerable risk of attempting suicide and dying by drug overdose or other accidental injury. This study highlights importance of prevention and intervention efforts targeting later-life prison-to-community care transitions.

Accident Proneness and Illness Proneness: A Review

Accident proneness may be an episodic or a lifelong disability. It is suggested that many of the chronically accident prone individuals are the same as those prone to recurrent organic illnesses, that is they suffer from a congenital ‘diathesis’.

[Incidence of accident proneness and its influencing factors in rural children]

OBJECTIVE

To investigate the incidence of accident proneness and its influencing factors in rural children.

METHODS

By random cluster sampling, 1 560 children were enrolled from one rural area in Hunan Province, China, and were surveyed with self-designed general and injury questionnaires. Unconditional multivariate logistic regression analysis was used to explore the major risk factors for accident-prone children.

RESULTS

One hundred and forty-seven accident-prone children were screened out and the incidence of accident proneness was 9.42%. Univariate analysis showed that gender (P<0.01), academic record (P<0.01), left-behind status (P<0.05), family type (P<0.05), family economic status (P<0.01), guardian's gender (P<0.05), guardian's marital status (P<0.05), guardian's occupation (P<0.05), and family educational mode (P<0.05) were influencing factors for accident proneness in rural children. Multivariate logistic regression analysis further revealed that low grade (OR=3.683, 95%CI: 1.028-4.283) and very low grade (OR=2.099, 95% CI: 1.587-8.546) in academic record, poverty in family economic status (OR=2.353, 95% CI: 1.222-4.533), and indulgence or indifference (OR=1.914, 95% CI: 1.029-3.559) and fickleness (OR=4.153, 95% CI: 1.847-9.338) in guardian's educational mode were risk factors for accident proneness in rural children, while female gender (OR=0.539, 95% CI: 0.369-0.788) was a protective factor.

CONCLUSIONS

Low academic record, poor family economy, and incorrect family education mode (indulgence or indifference and fickleness) would increase the incidence of accident proneness in rural children, but girls have less accident proneness than boys.

[Sleep disorders and work: guidelines for health surveillance, risk management and prevention]

Sleep disorders and related diseases are becoming increasingly relevant for the health and wellbeing of the general and working populations. Sleep disorders affect all aspects of health, showing a bi-directionality with health conditions and comorbidity with several diseases. Consequently, sleep disorders may have severe negative consequences both for the individual and the enterprise, as well as for society on the whole, in terms of health, productivity and social costs. When considering the disturbances of the sleep/wake cycle, it is important to distinguish between those connected with endogenous biological factors from those related to socio-environmental conditions, including work, and those associated with mental and physical diseases, that are often associated and interact with each other. Many sleep disorders are still underestimated and under-valued in clinical practice and, to a much greater extent, in workers' health surveillance. The present paper is aimed at drawing the attention of the occupational health physician to some key issues, particularly regarding excessive daytime sleepiness, obstructive sleep apnea syndrome and shift and night work, as well as their implications in terms of health and occupational consequences. Information on the main aspects of clinical diagnosis and health surveillance, as well as risk management and prevention at the workplace, are provided.

Accident proneness revisited: the role of psychological stress and cognitive failure

Understanding why accidents occur in the work place has a long and convoluted history. This paper adds to this corpus of research by investigating the relationship between an individual's level of cognitive failure, psychological stress, and work place accident occurrence. Retrospective analysis of accident-case individuals vs. control-match individuals on the General Health Questionnaire (GHQ) and Cognitive Failures Questionnaire (CFQ) was undertaken from amalgamated data of two Royal Navy databases. Individuals in the accident-case sub-sample had higher GHQ and CFQ scores when compared to matched-controls. Mediated regression analysis revealed high GHQ score predicted accidents but was transmitted through high CFQ scores. Individuals who are stressed are more likely to have an accident in the workplace because of a propensity for cognitive failures. A specific recommendation to reduce accident risk in the work-place is discussed.

Mental health measures in predicting outcomes for the selection and training of navy divers

INTRODUCTION

Two models have previously been enlisted to predict success in training using psychological markers. Both the Mental Health Model and Trait Anxiety Model have shown some success in predicting behaviours associated with arousal among student divers. This study investigated the potential of these two models to predict outcome in naval diving selection and training.

METHODS

Navy diving candidates (n = 137) completed the Brunel Mood Scale and the State-Trait Personality Inventory (trait-anxiety scale) prior to selection. The mean scores of the candidates accepted for training were compared to those who were not accepted. The mean scores of the candidates who passed training were then compared to those who failed. A number of trainees withdrew from training due to injury, and their scores were also compared to those who completed the training.

RESULTS

Candidates who were not accepted were more depressed, fatigued and confused than those who were accepted for training, and reported higher trait anxiety. There were no significant differences between the candidates who passed training and those who did not. However, injured trainees were tenser, more fatigued and reported higher trait anxiety than the rest. Age, gender, home language, geographical region of origin and race had no significant interaction with outcome results.

CONCLUSIONS

While the models could partially discriminate between the mean scores of different outcome groups, none of them contributed meaningfully to predicting individual outcome in diving training. Both models may have potential in identifying proneness to injury, and this requires further study.

Pilot age and geographic region of commuter and air taxi crashes: a case-control study

BACKGROUND

Previous studies of major airline and general aviation crashes have identified a host of risk factors. We examined risk factors related to crashes involving commuter air carrier and air taxi flights.

METHODS

A matched case-control design was applied to assess the association of pilot age, total flight time, and geographic region with commuter air carrier and air taxi crashes (14 CFR Part 135) from 1983-2002 in the United States. A total of 2033 commuter air carrier or air taxi crashes from the National Transportation Safety Board aviation crash database were identified as eligible cases. Controls were randomly selected incidents from the Federal Aviation Administration's (FAA) aviation incident database coded under Part 135 operation.

RESULTS

Relative to controls, commuter air carrier and air taxi crashes were less likely to occur in pilots under 30 yr of age (adjusted odds ratio 0.68, 95% confidence interval 0.54-0.88) after adjusting for geographic region and total flight time. With adjustment for pilot age and total flight time, the commuter air carrier and air taxi crashes with pilot error were nearly 13 times as likely to be in Alaska as their matched controls (adjusted odds ratio 12.84, 95% confidence interval 5.24-31.45).

CONCLUSIONS

These results suggest that pilot age may be associated with risk of crash involvement in Part 135 operations. The excess crash risk in Alaska with or without pilot error underscores the importance of environmental hazards in flight safety.

Early identification of children at risk of unintentional injury: a sensation seeking scale for children 2-5 years of age

OBJECTIVE

Sensation seeking is a personality attribute associated with injury in school-age children, adolescents, and adults. This study aimed to develop and evaluate the psychometric properties of a questionnaire measure of sensation seeking for young children 2-5 years of age.

METHODS

Items tapping aspects of sensation seeking (Novelty Seeking, Behavioral Intensity, Thrill Seeking) were developed, content validation was completed by child development experts, and 72 parents then completed the Sensation Seeking Scale for Young Children (SSSYC) twice (3 months intervening) to establish internal and test-retest reliabilities. To assess criterion validity, scores were related to children's preferences for high versus low sensation seeking activities, their free play behavior in an indoor playroom, and to children's history of unintentional injuries.

RESULTS

Indices of internal reliability and test-retest reliability were good and questionnaire scores positively correlated with sensation seeking behaviors during free play, preferences for high versus low sensation seeking activities, and injury measures, providing support for criterion validity.

CONCLUSION

This initial evaluation of the SSSYC suggests that it is a psychometrically sound measure of sensation seeking. This scale may be useful for identifying high sensation seekers at young ages, providing the opportunity for early intervention to prevent unintentional injuries.

Differentiating fall-prone and healthy adults using local dynamic stability

Variability in kinematic and spatio-temporal gait parameters has long been equated with stability and used to differentiate fallers from non-fallers. Recently, a mathematically rigorous measure of local dynamic stability has been proposed based on the non-linear dynamics theory to differentiate fallers from non-fallers. This study investigated whether the assessment of local dynamic stability can identify fall-prone elderly individuals who were unable to successfully avoid slip-induced falls. Five healthy young, four healthy elderly and four fall-prone elderly individuals participated in a walking experiment. Local dynamic stability was quantified by the maximum Lyapunov exponent. The fall-prone elderly were found to exhibit significantly lower local dynamic stability (i.e. greater sensitivity to local perturbations), as compared to their healthy counterparts. In addition to providing evidence that the increased falls of the elderly may be due to the inability to attenuate/control stride-to-stride disturbances during locomotion, the current study proposed the opportunity of using local dynamic stability as a potential indicator of risk of falling. Early identification of individuals with a higher risk of falling is important for effective fall prevention. The findings from this study suggest that local dynamic stability may be used as a potential fall predictor to differentiate fall-prone adults.

Application of the Life Change Unit model for the prevention of accident proneness among small to medium sized industries in Korea

Behavior models have provided an accident proneness concept based on life change unit (LCU) factors. This paper describes the development of a Korean Life Change Unit (KLCU) model for workers and managers in fatal accident areas, as well as an evaluation of its application. Results suggest that death of parents is the highest stress-giving factor for employees of small and medium sized industries a rational finding the viewpoint of Korean culture. The next stress-giving factors were shown to be the death of a spouse or loved ones, followed by the death of close family members, the death of close friends, changes of family members' health, unemployment, and jail terms. It turned out that these factors have a serious effect on industrial accidents and work-related diseases. The death of parents and close friends are ranked higher in the KLCU model than that of Western society. Crucial information for industrial accident prevention in real fields will be provided and the provided information will be useful for safety management programs related to accident prevention.

The syndrome of accident proneness (Unfallneigung): why psychiatrists did not adopt and medicalize it

In the World War I period, psychologists in Britain and Germany independently and simultaneously originated the idea of accident proneness (Unfallneigung). This distinctive syndrome of suffering a series of accidents was logically attractive for psychiatrists and psychoanalysts, especially as a pattern of unconsciously motivated deviant and self-destructive behaviour. Yet except for some mid-twentieth-century interest by psychosomatics specialists, psychiatrists did not systematically embrace the syndrome except occasionally as a symptom of other psychiatric conditions, thus showing that there were limits to the extent to which twentieth-century psychiatrists would medicalize patterns of behaviour.

Accident proneness (Unfallneigung): a classic case of simultaneous discovery/construction in psychology

Using a striking example from the history of applied psychology, the concept of accident proneness, this paper suggests that historians of science may still find viable the idea of simultaneous discovery or construction of a scientific idea. Accident proneness (Unfallneigung) was discovered independently in Germany and in Britain during the period of World War I. Later on, in 1926, the idea was independently formulated and named in both countries. The evidence shows not only striking simultaneity but true novelty and commensurateness of the two formulations that crystallized at the same time in parallel, but distinctly separate, settings.

Dynamic stability differences in fall-prone and healthy adults

Typical stability assessments characterize performance in standing balance despite the fact that most falls occur during dynamic activities such as walking. The objective of this study was to identify dynamic stability differences between fall-prone elderly individuals, healthy age-matched adults, and young adults. Three-dimensional video-motion analysis kinematic data were recorded for 35 contiguous steps while subjects walked on a treadmill at three speeds. From this data, we estimated the vector from the center-of-mass to the center of pressure at each foot-strike. Dynamic stability of walking was computed by methods of Poincare analyses of these vectors. Results revealed that the fall-prone group demonstrated poorer dynamic stability than the healthy elderly and young adult groups. Stability was not influenced by walking velocity, indicating that group differences in walking speed could not fully explain the differences in stability. This pilot study supports the need for future investigations using larger population samples to study fall-prone individuals using nonlinear dynamic analyses of movement kinematics.

Traumatic dental injuries and attention-deficit/hyperactivity disorder: is there a link?

Traumatic dental injuries (TDIs) constitute a major cause of morbidity among children worldwide. Both TDIs and attention-deficit/hyperactivity disorder (ADHD) are prevalent conditions with similar male-to-female predominance and similar age of presentation. While the commonest causes of TDIs have been identified as playground or sports accidents, a well-known feature of ADHD is accident proneness. Violence, another significant risk factor for TDIs, is more likely to be observed in conduct disorder, a common comorbidity of ADHD. Also, both TDIs and ADHD have been found to be associated with left-handedness. The presence of multiple dental trauma episodes (MDTE), as well as increased risk for non-dental injuries in children with TDIs indicates an underlying persistent condition, which resembles ADHD. Higher point prevalence of mental distress at age 30, found to be associated with increased lifetime prevalence of TDIs, may also be taken as an evidence of a background developmental disorder persisting into adulthood with various comorbidities. In conclusion, this review combines the results of several studies and explains the significance of ADHD as an underlying and predisposing factor for TDIs. Increased awareness and close collaboration between different disciplines involved are essential.

Laterality and accident proneness: A study of locomotive drivers

This study attempted to find the association between four measures of laterality (handedness, footedness, eyedness, and earedness) and accident proneness in locomotive drivers. The Sidedness Bias Schedule was administered to a sample of 80 locomotive drivers to ascertain their preferential bias. Their accident records were also available. Positive correlations were mostly found between the measures of hand, foot, ear, and eye dominance. Analyses suggested that there was a higher accident rate among left-handers and left-footers, with multiple regression unable to determine whether handedness or footedness was related more strongly to accident proneness. However, it was clear that accident rate was primarily associated with direction of lateralisation, and not with degree of lateralisation. Drivers with left-handedness were more likely to be involved in accidents, and it is possible that that may be related to the design of the locomotive cabs.

Falls in a rehabilitation setting: functional independence and fall risk

AIM

With this study we wanted to determine the incidence, characteristics and consequences of falls in our rehabilitation setting.

METHODS

An observational study was carried out in a rehabilitation setting for postacute orthopedic and neurological inpatients. Three-hundred and twenty patients were enrolled. Falls risk factors (Downton index [DI] and other known parameters), disability (functional independence measure [FIM]) and balance (Berg balance scale [BBS]) were assessed at admission. Falls that occurred during the rehabilitation stay were prospectively classified (St. Louis Older Adult Service and Information System [OASIS] system) and analyzed.

RESULTS

Forty patients experienced a fall (12.5%). The faller group was characterized by a major clinical complexity; 70% of fallers were neurological patients and 30% presented cognitive impairment (mini mental state examination [MMSE] <24). They presented a statistically significant worse score on FIM (motor and cognitive), BBS and DI at admission, with 74% predictability of falls as measured by total FIM score and age. Falls recorded with the OASIS classification showed a prevalence (52.5%) for not bipedal (wheelchair transfer) and self-generated falls; 35% were intrinsic falls (caused by subject-specific factors) and 12.5% extrinsic falls (caused by environmental factors). Falls resulted in only minor clinical consequences, except for one rib fracture, but led to a significant increase in length of stay.

CONCLUSIONS

In a rehabilitation centre, for good management of resources and safe prescriptions of a patient's independence in activities of daily living, fall risk is better evaluated with appropriate scales.

Association between severity of musculoskeletal injury and risk of subsequent injury in children and adolescents on the basis of parental recall

OBJECTIVES

To describe the frequency of subsequent injuries in children who were seen at an emergency department (ED) for a musculoskeletal injury and to explore factors associated with sustaining a subsequent injury within a year.

DESIGN

This was a prospective cohort study of children aged 1 through 17 years who sought care at an ED for an injury. Subsequent injuries were assessed through telephone interviews.

SETTING

Subjects were recruited from a national database of childhood injury after they presented to a hospital ED at 1 of the 2 pediatric trauma centers in Montreal, Quebec. PATIENTS/ PARTICIPANTS: A consecutive sample of 7640 children aged 1 through 17 years who sought care for a fracture or a soft-tissue injury to an arm or a leg; 6182 completed both telephone interviews (80.9% response rate). Main Exposure Having a more severe injury was defined in 2 ways: (1) fracture of a limb or (2) injury that required follow-up or admission. Main Outcome Measure Having a subsequent injury during 12-month follow-up.

RESULTS

Subjects with an index fracture were at lower risk of subsequent injury than were those with a soft-tissue injury (13.5% compared with 17.7%; adjusted odds ratio, 0.74; 95% confidence interval, 0.63-0.87). Subjects whose injury needed a follow-up were also at lower risk of subsequent injury than those whose injury was treated only in the ED (17.7% compared with 14.3%; adjusted odds ratio, 0.79; 95% confidence interval, 0.67-0.93) as were those who were admitted (17.7% compared with 8.7%; adjusted odds ratio, 0.51; 95% confidence interval, 0.26-0.99).

CONCLUSIONS

Having had a severe musculoskeletal injury may be associated with a decreased risk of subsequent injury in children and adolescents. A possible explanation could be reduced exposure to risk.

A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults

OBJECTIVES

To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions.

DESIGN

A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group.

SETTING

Urban community-living older people.

PARTICIPANTS

Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living.

INTERVENTION

Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem-solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training.

MEASUREMENTS

Outcome measures included self-rated functional difficulties with ambulation, instrumental activities of daily living, activities of daily living, fear of falling, confidence performing daily tasks, and use of adaptive strategies. Observations of home hazards were also conducted.

RESULTS

At 6 months, intervention participants had less difficulty than controls with instrumental activities of daily living (P=.04, 95% confidence interval (CI)=-0.28-0.00) and activities of daily living (P=.03, 95% CI=-0.24 to -0.01), with largest reductions in bathing (P=.02, 95% CI=-0.52 to -0.06) and toileting (P=.049, 95% CI=-0.35-0.00). They also had greater self-efficacy (P=.03, 95% CI=0.02-0.27), less fear of falling (P=.001, 95% CI=0.26-0.96), fewer home hazards (P=.05, 95% CI=-3.06-0.00), and greater use of adaptive strategies (P=.009, 95% CI=0.03-0.22). Benefits were sustained at 12 months for most outcomes.

CONCLUSION

A multicomponent intervention targeting modifiable environmental and behavioral factors results in life quality improvements in community-dwelling older people who had functional difficulties, with most benefits retained over a year.

Adolescents with attention deficit and hyperactivity disorder/learning disability and their proneness to accidents

OBJECTIVE

The aim of the study was to determine if attention deficit and hyperactivity disorder (ADHD)/ learning disability (LD) adolescents are more prone to accidents and to investigate the parental mode of coping with that risk.

METHODS

One hundred and eight high school pupils diagnosed with ADHD/LD and studying in an institute of "special education" were examined and interviewed on the subject of accidents. Eighty-seven pupils, studying in a nearby academic high school, served as a control group.

RESULTS

The results showed that pupils in the study group had been involved in 0.57 +/- 1.6 accidents (until the present study) in comparison to 0.23 +/- 0.4 accidents in the control group (p=0.001). The accidents in the ADHD/LD study group had occurred at the mean age of 11.1 +/- 3.4 yr. Eight decimal three percent of these pupils had been involved in recurrent accidents. Circumstances and locations where the accidents occurred were: falls while running or participating in sports activities (38.5%), home environment (23%), school environment (19.2%) and road accidents (11.5%).

CONCLUSION

The study shows that there is a real risk for ADHD/LD adolescents to be involved in all kinds of accidents. Parents should be counting on the help of professional advisors to decrease that risk. Physicians should caution these adolescents and their parents about that risk and advise them on ways and means of accident prevention.

Determinants of accident proneness: a case-control study in railway workers

BACKGROUND

Accident proneness or workers who have more frequent occupational injuries is common but the role of occupational and individual factors has rarely been studied.

AIM

To assess the relationships of certain occupational and individual characteristics with frequency of occupational injuries.

METHOD

This case-control study included 1305 male workers with occupational injuries during 1999-2000 and 1305 controls from a railway company. A standardized questionnaire was completed by the occupational physician in the presence of the subject. The data were analysed using logistic regression.

RESULTS

Having more than one injury was associated with short service in the present job, younger age, sleep disorders, smoking, requesting a job change, physical disability and lack of physical activity. Safety training was negatively related to injury frequency. Short service in the present job was the only significant factor for single injuries.

CONCLUSION

This study identified a number of work and individual factors that predicted occupational injury frequency and may be useful in designing preventative measures. Occupational physicians could assist workers to be more aware of the risks and to find remedial measures.

[Methodic approaches to determining the level of occupational fitness in jobs prone to trauma]

The article deals with main methods to evaluate functional state of various body systems and with the methods-based criteria of occupational fitness for miscellaneous activities. Examination of 11 types of jobs prone to trauma helped to specify integral parameter for occupational selection.

How mothers parent their children with behavior disorders: implications for unintentional injury risk

INTRODUCTION

This study was designed to test the role of parental supervision in explaining why children with behavior disorders have increased risk of unintentional injury.

METHOD

Children referred to a pediatric behavior disorders clinic and their mothers were unknowingly observed in a "hazard room" environment that housed several items that appeared dangerous but actually were altered to be safe.

RESULTS

Mother and child behavior in the hazard room was correlated to parent-, teacher-, and observational-reports of children's externalizing behavior patterns, children's injury history, and mother's parenting styles. Maternal ignoring of children's dangerous behavior in the hazard room was the strongest correlate to children's injury history.

CONCLUSIONS

Poor parental supervision might serve as a mechanism to explain why children with behavior disorders, and those with oppositional behavior patterns in particular, have increased risk of unintentional injury.

Sleep disturbance and injury risk in young children

The objective of this study was to investigate the relationship between sleep disturbance and both injury rates and injury-prone behaviors in preschool-age and early school-age children, using cross-sectional surveys of sleep disturbance (Children's Sleep Habits Questionnaire) and injury-related behaviors (Injury Behavior Checklist), and chart review of injuries. Participants were 71 patients enrolled in a pediatric clinic in a children's teaching hospital, ages 3 through 7 years, coming either for well-child care in a pediatric primary care clinic or for pediatric emergency room treatment of minor injuries. Results suggest that children with more frequent injuries had significantly more sleep problems overall, particularly anxiety around sleep, than did children with low injury rates. Children with more parent-reported injury-prone behaviors also had significantly more sleep disturbance. Daytime sleepiness-related items did not differ between injury history or injury behavior groups. Results of this study support an increased prevalence of sleep disturbances in young children with higher injury rates and more injury-prone behavior. Sleep disturbance may be a potential risk factor for increased injuries in this age group.

Trauma recidivism in a large urban canadian population

BACKGROUND

Prevention of trauma might be achieved by risk factor modification. Identification of such risk factors can be pursued by various means. Trauma recidivists may possess and highlight risk factors. Accordingly, trauma recidivists were analyzed as a method to elucidate trauma risk factors.

METHODS

A retrospective analysis of 13,057 trauma patients in Toronto was conducted. Forty-two recidivists were identified, and their first admission was compared with a control group of 84 non-recidivists.

RESULTS

The rate of trauma recidivism was 0.38% overall. Trauma recidivists were more likely to be from the inner city, male, homeless, suffering from chronic medical conditions. In addition, psychiatric conditions, an alcoholism history or any alcohol at the time of injury, intentionally injured, or engaged in criminal activity were also significantly more common in recidivists (p <0.05).

CONCLUSION

Risk factors for major trauma can be identified by analyzing recidivists in a large urban Canadian population.

Relationships between injuries at work and during leisure time

The aim of this study is to explore the relationships between injuries at work and during leisure time. Three independent but similar data sets based on the National Work and Health Survey were analyzed. A total of 2156 subjects participated this study in 1997, 2053 subjects in 2000, and 2335 subjects in 2003. In the interview the subjects reported their accidents at work, which had caused at least minor injury during the past 12 months. Workers involved in work injuries were significantly more often involved in leisure-time injuries (p<0.05). Less than 1% of the subjects were involved in both injuries at work and during leisure time during the past 12 months. We can conclude that involving in work injuries could increase the risk of leisure-time injuries.

Road traffic accident among motor vehicle drivers in selected high ways

To assess the knowledge of the motor vehicle driver about the causes of road traffic accidents. This cross sectional study was conducted among the 107 motor vehicle drivers of selected Bus & Truck terminal & taxi stands of Dhaka city. The study was carried out during April to June 2002 at the Department of Health Promotion & Health Education of NIPSOM. The study showed about 55.1% learned driving from a friend. Out of 107 respondent 20.6% showed very high speed is one of the reason for road traffic accident.39.3% claimed for poor maintenance of roads. Regarding engine/vehicle defect 46.7% said head light defect. Increased earning is one of the reasons of very fast driving 35.5% respondent opined. These may be the reason of accident proneness of the society along with factor like family pressure, job dissatisfaction etc. Majority of the driver who took part in this study used light vehicle 54.2% and the rest 30.8% were heavy and 15% like medium light vehicle. Most of the respondent 67.3% was working as professional over for 3-6 years. 41.1% for 3 and 26.2% for 6 years. There were significant relationship (p < 0.002) between very fast driving and defective road and also engine defect were highly significant association (p < 0.005) with road traffic accident It is revealed that formal education, driving license through Bangladesh road traffic authority without unnecessary botheration, proper implementation of traffic law, training of drivers and increase level of public awareness through mass communication could reduce the road traffic accident

Current helmet and protective equipment usage among previously injured ATV and motorcycle riders

Injury recidivism among trauma patients may be related to an individual pattern of high risk behaviors. The extent to which an injury episode modifies this behavior pattern is unknown. A self report, voluntary, anonymous, cross sectional survey was administered to motorcycle and all-terrain vehicle (ATV) riders at a popular recreation site. Data included demographics, injury history, and current usage of helmet and protective gear. Two hundred eighty surveys were completed. History of ATV/motorcycle related minor and major injury were reported by 21% and 9%, respectively. Persons with a history of minor ATV/motorcycle injury only were less likely to use a helmet or protective equipment (78% v 74%, p = 0.58 and 49% v 41%, p = 0.29). Persons with a history of any major ATV/motorcycle injury were also less likely to use a helmet or protective equipment (77% v 56%, p = 0.03 and 48% v 40%, p = 0.53). These findings suggest a pattern of persistent high risk behavior among previously injured persons.

The fast and the fatal: street racing fatal crashes in the United States

The objective of this study was to determine the annual incidence of fatal motor vehicle crashes involving street racing and to describe the characteristics of these crashes compared to other fatal crashes in the United States. The National Highway Traffic Safety Administration Fatality Analysis Reporting System data for 1998-2001 were used for the analyses. There were 149 568 fatal crashes and 315 (0.21%) involved street racing and 399 fatalities occurred in these crashes. In contrast to other fatal crashes, street racing fatal crashes were more likely to occur on urban roadways and were nearly six times more likely to occur at travel speeds> or = 65 mph. Compared with other drivers involved in fatal crashes, street racers were more likely to be teenagers, male, and have previous crashes and driving violations. Street racing involves risky driving behaviors and warrants further attention.

Mortality Risk in a Birth Cohort of Commuter Air Carrier and Air Taxi Pilots

Commuter and air taxi pilots have higher work-related death rates than most other occupational groups. In this longitudinal study, the authors examined the mortality in a cohort of 3263 commuter and air taxi pilots. With adjustment for age, proportional hazards modeling revealed that termination or downgrading of medical certificates during the 11-year follow-up was associated with a significantly increased risk of overall mortality (relative risk, 2.32; 95% confidence interval [CI] = 1.43-3.77). Relative to the general population with similar demographic characteristics, commuter air carrier and air taxi pilots had significantly lower overall mortality (standard mortality ratio [SMR], 0.36; 95% CI = 0.32-0.41) and mortality from cardiovascular diseases (SMR, 0.18, 95% CI = 0.15-0.22), but considerably higher mortality from aviation crashes (SMR, 128.88; 95% CI = 6.35-2624.36). The results indicate that the current medical certification system is effective in maintaining a healthy pilot workforce.

Age, flight experience, and risk of crash involvement in a cohort of professional pilots

Federal aviation regulations prohibit airline pilots from flying beyond the age of 60 years. However, the relation between pilot age and flight safety has not been rigorously assessed using empirical data. From 1987 to 1997, the authors followed a cohort of 3,306 commuter air carrier and air taxi pilots who were aged 45-54 years in 1987. During the follow-up period, the pilots accumulated a total of 12.9 million flight hours and 66 aviation crashes, yielding a rate of 5.1 crashes per million pilot flight hours. Crash risk remained fairly stable as the pilots aged from their late forties to their late fifties. Flight experience, as measured by total flight time at baseline, showed a significant protective effect against the risk of crash involvement. With adjustment for age, pilots who had 5,000-9,999 hours of total flight time at baseline had a 57% lower risk of a crash than their less experienced counterparts (relative risk = 0.43, 95% confidence interval: 0.21, 0.87). The protective effect of flight experience leveled off after total flight time reached 10,000 hours. The lack of an association between pilot age and crash risk may reflect a strong "healthy worker effect" stemming from the rigorous medical standards and periodic physical examinations required for professional pilots.

Individual characteristics in occupational accidents due to imbalance: a case-control study of the employees of a railway company

BACKGROUND

Falls are frequent occupational accidents, and are responsible for a significant amount of lost working time and, more importantly, for a high mortality. The factors involved in falling mechanisms can be of external or individual origin, the latter being less well identified.

AIMS

To assess the relations between certain individual characteristics and occupational accidents due to imbalance.

METHODS

A total of 427 male employees, who had been victims of at least one occupational accident with sick leave due to imbalance (cases) and 427 controls were recruited among the employees of a large French railway company. A standardised questionnaire on life conditions and professional factors, and a description of the accidents was filled in by an occupational physician for each subject.

RESULTS

Some job categories were more affected by a specific release mechanism of work related falls. Certain individual characteristics such as smoking, alcohol consumption, inactivity, sleep disorders, and request for a job change were correlated with the occurrence of occupational accidents. Sick leaves of eight days or over were more frequent in older and overweight injured workers. Some lesions were linked with the specific fall released mechanisms.

CONCLUSIONS

Individual characteristics can increase the risk of occupational accidents, especially falling. This study identified subjects most at risk on whom prevention related to working conditions and falls could be focused.

The paradox of driving speed: two adverse effects on highway accident rate

Whereas speeding is known to be a substantial risk factor in driving, there is no unequivocal evidence that accident rate on limited-access motor highways is considerably affected by average speed or by speed limits meant to regulate it. It is suggested here that the seeming puzzle actually may have a straightforward explanation: accident-prone interactions (APIs) between cars occur when they pass each other--mostly moving in the same directions or in opposite ones. Such interactions are shown here to happen more frequently, the lower average speed is. To the extent that high speed limits contribute to increase in average speed, they serve to reduce the number of such interactions, thereby to moderate at least part of the negative effect of speed on the driver's ability to avoid an impending accident.

Interpersonal violations, speeding violations and their relation to accident involvement in Finland

The aim of the present study was to replicate the distinction between errors, lapses and violations, and to identify aggressive violations from normal or highway code violations. Furthermore, the relationship of these behaviours with road traffic accidents was examined. A total number of 1126 Finnish drivers completed a questionnaire containing the Driver Behaviour Questionnaire (DBQ) with extended violations scale, and questions regarding background information, such as age, gender and mileage. Also, questions about previous accidents and fines were asked. Factor analysis showed that a four-factor structure seemed more appropriate than the earlier established three-factor structure. The four factors were errors, lapses, speeding violations and interpersonal violations. The two types of violations result from different motives, and seem to be associated with different kinds of affect. Both interpersonal and speeding violations were reported most by young males, which was consistent with earlier findings. Logistic regression analyses indicated that errors predicted active accident involvement after partialling out the effects of demographic variables, whereas interpersonal violations were positively related to involvement in passive accidents. This was presumably due to different reporting tendencies of respondents. Speeding tickets were predicted by speeding and interpersonal violations and lapses and penalties for speeding by both kinds of violations and errors. Penalties for speeding, parking and other offences were predicted by interpersonal violations. The implications of these results are discussed.

Is head injury a risk factor for schizophrenia?

BACKGROUND

The few studies that have examined whether head injury is a risk factor for later schizophrenia have had important methodological problems.

METHOD

We examined the rates of head injury among 8288 persons in the 15 years up to their first admission with schizophrenia and compared them with 82880 age- and gender-matched controls. We used hospitalization for concussion or severe head injury as a definition of head injury. We controlled for any generally altered accident proneness prior to schizophrenia by also comparing the groups with respect to exposition to fractures not involving the skull or spine.

RESULTS

Males with schizophrenia had significantly reduced exposure to concussion (OR = 0.864, p = 0.024), whereas females had significantly increased exposure (OR = 1.322, p = 0.025). No differences were found as regards severe head injury. Males had significantly reduced risk of other fractures (OR = 0.616, p < 0.0001), whereas the risk in females did not differ from controls (OR = 1.154, p = 0.189). After adjusting head injury with the risk for other fractures, both concussion and severe head injury were significantly increased in males (OR = 1.501, p < 0.001 and OR = 1.516. p < 0.001, respectively) but not in females (OR = 1.15, p = 0.413 and OR = 0.819, p = 0.442, respectively).

CONCLUSION

Our results do not exclude that for males, head injury may contribute to the risk for schizophrenia in a limited number of cases. This relation may also exist for females, but it is paralleled by an increased liability to traumas in general. Premorbid general accident proneness requires consideration when studying this association.

Brain function and effects of shift work: implications for clinical neuropharmacology

Night or shift work is to a relevant extent unavoidable, suits a growing preference for flexibility and is predicted to spread. However, a significant percentage of shift workers report discomfort or health problems and they often (15-20% of cases) move to different occupations. Apart from social implications, the issue has medical and scientific relevance, with evidence suggesting that the circadian rhythm phases are neither equivalent nor interchangeable with respect to function and performance. Shift work may affect the gastrointestinal and cardiovascular functions, alter the hormonal and sleepiness cycles, favor sleep disturbances of medical relevance, interfere with behavior and social life and increase the risk of accidents (e.g. road accidents). The implications for clinical (neuro)pharmacology are relevant and, in several instances, critical. Shift work can interfere with mechanisms regulating drug kinetics in peripheral compartments and action at selective brain sites, either directly or through effects on the gastrointestinal/hormonal cycles. In this paper, the relevant literature is reviewed and original data on the effects of shift work are reported. Basic and clinical research should take into account the possible effects on drug action of an active life and working schedule in inappropriate phases of the circadian cycles and the risk of inadequate drug dosing or unexpected abnormal action in subjects under long-term or chronic treatment. A scientific approach, action by the scientific community involved in pharmacological research and monitoring by the regulating agencies are advisable. Regulation may help reduce the medical and social impact and improve quality of life.

Human factors in the causation of road traffic crashes

Road traffic crashes (RTCs) are responsible for a substantial fraction of morbidity and mortality and are responsible for more years of life lost than most of human diseases. In this review, we have tried to delineate behavioral factors that collectively represent the principal cause of three out of five RTCs and contribute to the causation of most of the remaining. Although sharp distinctions are not always possible, a classification of behavioral factors is both necessary and feasible. Thus, behavioral factors can be distinguished as (i) those that reduce capability on a long-term basis (inexperience, aging, disease and disability, alcoholism, drug abuse), (ii) those that reduce capability on a short-term basis (drowsiness, fatigue, acute alcohol intoxication, short term drug effects, binge eating, acute psychological stress, temporary distraction), (iii) those that promote risk taking behavior with long-term impact (overestimation of capabilities, macho attitude, habitual speeding, habitual disregard of traffic regulations, indecent driving behavior, non-use of seat belt or helmet, inappropriate sitting while driving, accident proneness) and (iv) those that promote risk taking behavior with short-term impact (moderate ethanol intake, psychotropic drugs, motor vehicle crime, suicidal behavior, compulsive acts). The classification aims to assist in the conceptualization of the problem that may also contribute to behavior modification-based efforts.

Injury proneness and personality

The aim of this research was to investigate some personality factors among groups of 43 physically injured inpatients and 43 non-injured hospital-based controls. The participants completed the Eysenck Personality Questionnaire (EPQ) and the Coping Styles Questionnaire (CSQ). Logistic regression was used to compare the two groups on six psychological risk factors. The univariate regression models suggested three possible risk factors: extraversion, sensitization, and avoidance coping style. The multivariate regression model supported only extraversion and sensitization of emotion. Next, patients in the experimental group were questioned about whether they had considered preventive measures before the accident and whether they felt responsible for their injuries. Correlation analysis showed that introverted subjects felt more responsible for the sustained injuries than their extraverted counterparts. Sensitizers and subjects who scored high on psychoticism, neuroticism, and emotional coping had not considered preventive measures as often as others. Finally, the principal component analysis of risk factors was used to extract two correlates of injury-prone behaviour: extraversion and sensitized avoidance. It was concluded that psychological factors play an important role in predicting injury that is significant enough to require inpatient treatment. Two potential mechanisms of psychological impact have been suggested, notably distraction in extraverted subjects and overestimation in sensitizing avoiders.

Left-handedness as a risk factor for head injuries

OBJECTIVE

To study prevalence of left-handedness among traumatic patients with head injuries.

DESIGN

A case-control study.

SETTING

Queen Elizabeth Central Hospital, Blantyre, Malawi.

SUBJECTS

One hundred and sixty three traumatic patients newly admitted to a surgical ward at Queen Elizabeth Central Hospital, Blantyre during one month period with exception of patients with arm injury, severe injury and confused patients.

MAIN OUTCOME MEASURES

Maximal grip strength of both hands, questionnaire on hand preferred for eight habitual activities.

RESULTS

The overall prevalence of left-handers determined on the basis of bilateral asymmetry in maximal grip strength was non-significantly higher in traumatic than in the control group. Relative to the control group, lefties were over-represented among victims of head injury, while prevalence of left-handers among patients with leg and trunk injuries and among controls was similar. Left-handed patients were more likely to sustain head traumas during fighting, road transport accidents and sport activities. Possible reasons for increased level of traumatisation among sinistrals are discussed.

CONCLUSION

Left-handedness is a risk factor for head injuries obtained during confrontational activities. Therefore, left handers should avoid such type of behaviour in order to reduce traumatisation rate.

Distribution of accidents, injuries, and illnesses by family type. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

OBJECTIVE

To investigate whether family type and psychosocial risks indexed by family type were systematically associated with differences in health outcomes in children.

DESIGN AND SUBJECTS

The study is based on a longitudinal, prospective study of a large (n = approximately 10 000) community sample of families, the Avon Longitudinal Study of Pregnancy and Childhood.

MAIN OUTCOME MEASURES

Frequency of accidents, illnesses, and medical interventions.

RESULTS

At 2 years of age, children in single-parent and stepfamilies were disproportionately likely to experience accidents and receive medical treatment for physical illnesses. In addition, children in single-parent families and stepfamilies were more likely to be hospitalized or receive attention from a hospital doctor for an injury or illness. Exposure to psychosocial risks also were elevated in single-parent families and stepfamilies, compared with intact or nonstepfamilies, and these factors primarily accounted for the connection between family type and children's physical health.

CONCLUSIONS

The consequences of family transitions on children's health extend beyond traditional mental health and behavioral outcomes and include accident proneness, illness, and receipt of medical attention. The mediating processes are not entirely attributable to social class differences connected to family type and may instead be associated with a range of psychosocial risks that are more frequently found in single-parent families and stepfamilies, compared with intact or nonstepfamilies. Prevention and intervention efforts directed toward children at risk for poor behavioral and mental health adjustment secondary to family disruption should consider children's physical health and health-related behaviors.

[A comprehensive evaluation on psychological quality among automobile drivers]

OBJECTIVE

To study the comprehensive evaluation on the indexes of psychological quality on automobile drivers.

METHODS

A index system, consisted of seven psychological indexes (including relevant physiological indexes), was developed through Delphi method and mathematical statistics. Basic data of the seven psychological and physiological indexes including mean, standard deviation and percentile, were taken from more than 8,000 occupational licensed automobile drivers and more than 6,000 trainees who were randomly sampled from 5 cities across China. The weight coefficients of indexes were determined by analytical hierarchy process (AHP).

RESULTS

Comprehensive evaluation equations of the occupational automobile drivers and the trainees were established respectively. The critical values of evaluation were divided into grades by the percentiles of evaluated values. Verified results showed that there was significant difference of the values under evaluation between drivers who had accidents and who did not (t = 14.68, P < 0.01; H = 73.61, P < 0.001). The test of consistence showed that the consistence was quite good (rate of consistence = 92.99%; kappa = 0.85).

CONCLUSION

Results showed that the comprehensive equations for evaluation were reasonable and feasible for detecting the potential accident-proneness drivers.